Educational Preparation

May 22, 2011

There are different routes in becoming a Registered Nurse. There is the 2-3 year Associate degree level (ADN), which can be obtained at a community college, and there is the four year baccalaureate degree (BSN), which can be obtained at a university. In both routes after finishing the program the candidate needs to take the licensing examination test called NCLEX-RN. When making a decision of what route to take the difference in competencies need to be taken into consideration. Differences include level of knowledge, skill preparation, and clinical judgment. A BSN degree nurse has a more comprehensive knowledge base than those who have an ADN. The bachelor nursing program includes everything taught to an associate degree nurse plus more detailed studies on physical and social sciences, public and community health, humanities, nursing research, and nursing management. Nurses that obtain a baccalaureate degree in nursing have a broader knowledge of disease prevention, health promotion, and risk reduction (Ellis, 2007). Having a BSN degree prepares a nurse to deal with illness and disease management in a more efficient way than an ADN nurse. In addition, those who obtain a BSN degree must be able to make critical decisions about patient care and learn to understand more in depth about the patho-physiology of disease processes (Forster, 2008). The ADN education is more task orientated, putting less emphasis on applying critical thinking when making clinical decisions, sometimes resulting in poor patient outcomes. These differences are what separate BSN form ADN nurses. When looking at the skill preparation between ADN and BSN we can see that while ADN nurses are trained with more technical skills, BSN nurses obtained higher level of education and are taught stronger problem solving and communication skills in comparison. Having stronger problem solving skills gives the BSN the capability of making accurate nursing diagnosis and proficiency in evaluating nursing interventions. Lack of problem solving from the ADN can result in a negative patient outcome. In addition, BSN nurses possess stronger communication skills than ADN nurses which allow them to not only communicate but to listen and interact better with patients, patient’s family, communities, and diverse populations. BSN nurses are able to communicate effectively in a verbal, nonverbal, written, or electronic matter without forgetting to take into consideration culture, level of education, and social environment of the patient and their family (“UMKC “2011). Incorporating problem solving skills and communication skills will help a BSN nurse evaluate patient’s outcome. One of the big differences between BSN and ADN is that BSN is trained to develop more clinical judgment, which is an essential component to a nurse. It is essential for delivery in nursing care. The website UMKC states that “Professional judgment is the outcome of critical thinking in nursing practice. Which incorporates decision-making processes that involves evidence and reason to facilitate the evaluation of outcomes and goals” (2011). Nowadays clinical judgment is referred to as nursing process model of practice. In this model nurses will solve a problem by using assessment and nursing diagnosis, planning and implementing nursing interactions, and concluding with the evaluation of such interactions (Tanner, 2006). Being able to follow the nursing process model of practice shows how a BSN educational preparation will help the nurse function with more independence in obtaining success when making clinical decisions. It becomes hard for the ADN to incorporate clinical judgment in their practice due to the limitation in their educational preparation.
A few months ago I was involved in a patient care situation where I believe the patient’s outcome was negatively affected due to lack of formal education and critical thinking by the ADN nurses. A 22 year old was admitted to the orthopedic unit from the ED with multiple trauma due to a motorcycle accident. He was found to have fractured ankle, fracture ribs, wound to right hip area, and incidentally found to have new onset diabetes. Patient stayed a few days in the hospital since blood sugar levels were out of control requiring insulin sliding scale. Pain management and ambulation with crutches was also a concern due to rib pain and ankle fracture. Planning for discharge the case manager knew patient was returning to his apartment which he shared with two friends his age. Case manager was concerned about setting up home health for diabetic teaching, dressing changes, physical therapy and also to arrange a taxi voucher since patient stated he had nobody to take him home. The primary care nurse’s concern was that since the diabetic nurse educator was off the day of discharge the patient needed to learn how to inject insulin. Before going home the primary nurse documented that patient returned demonstration on how to inject insulin and that diabetic diet information was given. Case manager had arranged for home health RN and PT to follow up. This patient came a few days later to the ER on Ketoacidosis, possible seizures and ended up in the Intensive Care Unit. Looking at the re admission, when the patient was interview in the ICU, he was able to recite the signs and symptoms of hyperglycemia, but did not understand the consequences of having high blood sugars levels and the risk of going into a diabetic coma. He stated the home health nurse saw him 48 hours after discharge, insulin was too expensive, he didn’t have health insurance, and he did not have transportation or help to do grocery shopping so he ended up eating junk food most of the time. Doctor follow up was not done for diabetes management. Looking at the reasons for re admission the ADN nurses, both primary care nurse and case manager, failed to incorporate the roles of critical thinking, assessing, communicating, teaching and leading. In this case the diabetic teaching for this patient was done at the last minute; the diabetic educator should have been consulted ahead of time given the patient’s new diagnosis, age and lack of resources. It appeared that the primary care nurse was more concern about the technical part of the teaching (injections) than making sure her teaching was effective and the patient understood the importance of his symptoms, and consequences of his non compliance. Case manager and nurse should have communicated with each other about how soon and how often the home health nurse was going to visit the patient and both should have discussed with the patient about how he was going to buy his prescriptions, and the food necessary to follow a diabetic diet. Knowledge, clinical judgment, and skill preparation are some of the more important competencies between nurses prepared at the associate degree level and the baccalaureate degree level. These competencies play an important factor in patient safety and quality of care. A BSN prepared nurse is more efficient in assessing, making nursing diagnosis and evaluating nursing interventions.

References
Ellis, S. (2007). Nursing Articles to BSN or not to BSN - That is the nurse's question! In Nursing.Degree.Net. Retrieved May 15, 2011, from http://www.nursingdegree.net/articles/se060326-bsn-nurse.htm

Forster, H. (2008, May 27). ADN vs. BSN. In Nursing Link. Retrieved May 13, 2011, from http://nursinglink.monster.com/education/articles/3842-adn-vs-bsn

RN-BSN Program Outcomes (2011). In UMKC. Retrieved May 14, 2011, from http://nursing.umkc.edu/undergraduate-degrees/rn-bsn-program-outcomes.asp

Tanner, C. A. (2006, June). Thinking Like a Nurse: A Research-Based. Journal of Nursing Education, 45(6), 204-211. Retrieved May 21, 2011, from http://ahn.mnsu.edu/nursing/facultyformsandinfo/thinkinglikeanurse.pdf