The Importance of Higher Education in Nursing Kristy Snyder
Grand Canyon University: NRS 430V
July 6, 2014

Nursing, like many professions, requires formal training and education, but it is the level of education in the nursing profession that sets on exceptional nurse apart from others. Safer patient outcomes and reduction in patient mortality and secondary insults of illness has decreased with an increase of staffing Baccalaureate Degree in Nursing (BSN) nurses over a staff consisting mainly of Associate’s Degree in Nursing (ADN) nurses. This paper focuses on the educational differences and competencies between nurses with an ADN and BSN respectively and the experience and skill sets that form the clinical decisions made by these nurses and how their decisions affect patient care and outcome.
Mildred Montage was a nurse educator in the 1950’s and was the leading advocate and creator of the ADN in reaction to the stark shortage of nurses in the years preceding World War II (Creasia & Friberg, 2011, p.14-15). This degree was designed to decrease the shortage of nurses and the adequate level of clinical nursing skills and successful pass rate of graduates on the National Council Licensure Examination (NCLEX) were all taken into accountability for measuring the success of the ADN programs. An associate degree nurse is defined as a nurse attending a community college, up to three years but no less than two years, with training in clinical skills. A nurse graduating from a community college nursing program gains an ADN and is then qualified to sit for the NCLEX to obtain licensure as a Registered Nurse (RN) (ANA, 2014)
A baccalaureate degree nurse is defined as a nurse attending a university or state college for a up to five years but no less than four years, with the same courses and training as an ADN program, in addition the BSN program trains on the physical and social sciences, nursing research, public and community health, nursing management, and humanities (ANA, 2014). The graduates of the BSN program also sit and take the NCLEX. Just as the ADN, BSN programs were created due to the nursing shortage in the years preceding the First World War (Creasia & Friberg, 2011, p. 14-15). The GI Bill of Rights was passed in 1946 by Congress allowing veterans to obtain either a college education or vocational training. There were many veterans who worked as nurses in the military, and this bill provided them with the opportunity to attend the new nursing programs and gain their degree in nursing education and administration (Creasia & Friberg, 2011, p. 14). As time proceeded, there was an increase interesting in the nursing programs and nursing as a profession which perpetuated the direction of nursing education as we know it today and where it is going in the near future (Creasia & Friberg, 2011, p. 14-15).
Even though both the BSN and ADN programs encompassed the same courses and skill training, it was the courses of physical and social sciences, nursing management, and humanities that create the difference between the two different graduates and the overall expectation for patient care outcomes. The additional courses not only expand professional growth but also equipped the student for a broader scope of practice. The theory of the courses and skills obtained while in school enabled a better understanding of care in relation to social, cultural, and religious concerns and how to better relate to the patient. Having this understanding further leads to an improved awareness of the political, economic, and socio-cultural apprehensions that could have an influence over the emotional state of the patient which could ultimately impair or worsen the patients overall health. The differences in the competences of an ADN and a BSN nurse have been proven with many studies that all show a decrease in patient mortality rates and secondary insults of illness with an increased staffing of nurses with a BSN. A study conducted by the South Carolina Colleagues in Caring Project, Columbia (1999) stated “BSN-prepared nurses advance more quickly in the clinical setting, generally are more motivated and self-directed, and are more assertive after six months of practice” (Bellack & Loquist, 1999). The same study also concluded that panelists of the study were able to “articulate differences in preparation of nurses by level of education” (Bellack & Loquist, 1999).
Patient case studies enable students and nurses alike to assist in the discovery of evidence-based practices. In a case study, by Linda Aiken,PhD, RN, FAAN (2008), of 232,342 patients ages 20 to 85 years old who underwent general surgical, orthopedic, or vascular procedures within 168 different hospitals in the state of Pennsylvania (Aiken, Cheney, Clarke, Lake, & Sloane, 2008). This specific study was narrowed to patients with common surgical procedures because most hospitals execute these procedures, and risk modification for surgical results is better established than that for medical conditions (Aiken et al., 2008). The different patient outcomes and characteristic that were monitored and data established were for death of the patient within thirty days of hospital admission and deaths within thirty days of admission midst those with complications otherwise called “failure to rescue” (Aiken et al., 2008). From the result of this study, it was found that “Surgical mortality rates were more than 60% higher in poorly staffed hospitals with the poorest patient care environments than in hospitals with the better care environment in the sample; the best nursing staffing levels, and the most highly educated nurses” (Aiken et al., 2008). A more recent study by Dr. Blegen with the University of California, San Francisco (2013) and colleagues discovered that hospitals with a higher percentage of RN’s with BSN’s had a decrease of in-patient and thirty-day mortality, lower failure to rescue, and lower cardiac deaths as well as postoperative deep vein thrombosis (DVT)/pulmonary embolism (PE), hospital acquired pressure ulcer’s (HAPUs), and overall decrease length of stays (LOS) (Blegen, Goode, Park, Spetz, & Vaughn, 2013).
In conclusion, the shortage of nurses stemming from the First World War was ultimately resolved by both ADN nurses and BSN nurses and together compose a vital role in the healthcare industry. Encouraging continued education, for every nurse at every level, will not only enhance the profession of nursing but also the care of the patients across the spectrum of healthcare. Patient safety is and should always be the most important aspect and outcome of providing healthcare to the population and it is the constant collaboration within the system that contributes to that safety. Many patients believe, a nurse is a nurse, and it is the care, provided by that nurse, that the patient will always remember years after being discharge, not that nurses qualifications. It is those qualifications however that does ultimately separate the BSN and ADN nurse when it comes to those critical thinking skills, socio-cultural differences amongst the patient, and the overall management of the patients care. The additional curriculum and training provided with the higher level education has proven to be an exceptional benefit for the continued growth of the nursing profession.
References
Aiken, L., Clarke, S., Sloane, D., Lake, E., & Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing Administration, 38(5), 223-229.
Bellack, J., & Loquist, R. (1999). Employer responses to differentiated nursing education. Journal of Nursing Administration, 29(9), 4-8,32.
Blegen, M., Goode, C., Park, S., Vaughn, T., Spetz, J. (2013). Baccalaureate Education in Nursing and Patient Outcomes. Journal of Nursing Administration, 43(2), 89-94.
Creasia, Joan L., Elizabeth Friberg. Conceptual Foundations: The Bridge to Professional Nursing Practice, 5th Edition. Mosby, 2011. VitalBook file.