Myra Magallanes
NRS-430V
April 21, 2016
Chris Bartholomew

Educational Preparation
As early as the 1950’s, the ongoing debate regarding nursing education in the United States has been whether a minimal entry-level requirement is needed. If graduates from an associates and baccalaureate program are similarly compatible in theoretical knowledge and clinical practice, what then are the differences? Multiple studies have been conducted on the topic of nursing education, and organizations such as the National League for Nursing (NLN) and the American Nurses Association (ANA) stand firm on the need for higher educational standards for nurses in all practice settings, and emphasize the baccalaureate degree as the minimal entry level for ‘professional’ nursing practice (Giger & Davidhizar, 1990). The following essay will discuss the differences in knowledge base and competencies between the associate-degree and the baccalaureate-degree nurse clinician.
Historically there have been three routes of entry into the field of nursing. For the purposes of this paper, we will focus on the associates program traditionally offered at community colleges, and the baccalaureate program taught at the university level. Graduates from both of these programs sit for the same (NCLEX-RN) National Council Licensure Examination (AACN, 2015). Course study in an associate’s degree program usually includes nursing fundamentals and clinical care across the lifespan, but their main educational focus revolves around clinical skills, health assessment, and medication administration. Baccalaureate programs, on the other hand, encompass the entire curriculum taught at the associate’s level with a more detailed study of the physical and social sciences, nursing research, public and community health, nursing management, and the humanities. This added educational preparation gives the new nurse a more comprehensive look at nursing practice and provides the nurse with an improved perspective of the issues that affect patients and influence healthcare delivery (AACN, 2015). As in education, clinical practice also substantiates the differences between degrees and the influence on patient care and outcomes.
In a study by Pardue (1987), one of the specific problems addressed was the degree of decision-making skills and critical thinking ability amongst associate degree nurses. The study found that associate degree nurses used measurement of body function as an assessment strategy and were more concerned with process driven nursing tasks (Pardue, 1987). From personal observation and clinical experience, the associates prepared nurse is more tasks oriented and more frequently will seek out validation of decisions made regarding patient care. In emergent situations the nurse tends to perform basic patient assessment before calling upon senior staff for guidance. When calls are placed to physicians that lack of information provides an inadequate clinical picture, and consequently, may alter appropriate patient interventions. This is not to say that with time and experience the nurses skills will not improve, but the immediate lack of analytical questioning is one of many differences between the associates and bachelors prepared nurse.
In a similar study, Giger and Davidhizar found that “baccalaureate degree nurses are knowledgeable in the areas of nursing diagnosis, concept analysis and theoretical identification, and implementation of the nursing process than their counterparts, the associate nurse” (1990, p1014). In 2012 the CNO of St. Jude Medical Center presented nursing and management with the following proposal: all nursing in a managerial roles needed to complete their baccalaureate degree by the end of 2015, and all others were strongly encourage to obtain the degree by 2020. Since that time all but 4 nurses (clinical coordinators) and a large number of bedside clinicians have met the goal of bachelor’s preparedness. The increase in the number of baccalaureate nurses in the clinical setting and involved in direct patient care is evident in the decrease in patient readmissions, the increase in HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, and the decrease in hospital acquired infections (HAI). There is more effective communication with physicians and ancillary disciplines, more critical thinking in the analysis of patient data, more patient teaching, and ongoing implementation of practice standards. Nurses within this organization are becoming true professionals and leaders in their nursing practice. Even though associates programs were initially established to meet a nursing shortage by providing technical training along with basic nursing fundamentals, healthcare is demanding more of nursing practice. The differences in education between baccalaureate and associate degree nurses is significant enough that a radical transformation in entry level education needs to reflect the views of many leading nursing organizations. Nurses of today work as part of an interdisciplinary team (physicians, pharmacists, speech pathologist, physical and occupational therapist, etc.) that are educated at the master’s level or higher…nurses should not be the least educated member of the healthcare team.

References
Giger, J.N., & Davidhizar, R.E. (1990). Conceptual and Theoretical approaches to patient care: associate versus baccalaureate degree prepared nurses. Journal of Advanced Nursing, 15, 1009-1015.
Pardue, S.F. (1987). Decision-Making Skills and Critical Thinking Ability Among Associate Degree, Diploma, Baccalaureate, and Master’s-Prepared Nurses. Journal of Nursing Education, 26 (9), 354-361.
The Impact of Education on Nursing Practice. (May 19, 2015). Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheet/impact-of-education.