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To BSN or not to BSN - That is the nurse's question!

The Goldmark Report in 1923 was the first to recommend that the entry level of education for professional practice as a registered nurse should be a Bachelor of Science in Nursing degree (BSN), and heated debate has raged among nurses over the issue ever since.

Diploma and Associate Degree RN’s will clearly tell you that they can run rings around BSN program graduates when it comes to patient care. They’ll explain that they have more actual clinical experience and patient care know how in their little finger than a new BSN grad, and 99% of the time they’re right about that! I’ll be the first to admit that if I get seriously ill I’m hoping that my nurse graduated from a diploma program like the one they used to offer at Cook County Hospital in Chicago. Those nurses had so much training and hands on care experience by the time they graduated that few physicians could hold a candle to them on their best day.

This isn’t about whether BSN nurses are better than ADN or Diploma nurses

Up until a few years ago I would have been just as emotional as the next nurse in arguing against the very idea of making the BSN degree the minimum educational level to practice as a professional nurse. The arguments were many and seemed to make sense – no difference in pay for a BSN versus an ADN or Diploma nurse, we all do the same job etc….

But The Times, They Are a Changing…. And so has my point of view

“Rapidly expanding clinical knowledge and mounting complexities in health care mandate that professional nurses possess educational preparation commensurate with the diversified responsibilities required of them. As health care shifts from hospital-centered, inpatient care to more primary and preventive care throughout the community, the health system requires registered nurses who not only can practice across multiple settings - both within and beyond hospitals - but can function with more independence in clinical decision making, case management, provision of direct bedside care, supervision of unlicensed aides and other support personnel, guiding patients through the maze of health care resources, and educating patients on treatment regimens and adoption of healthy lifestyles. In particular, preparation of the entry-level professional nurse requires a greater orientation to community-based primary health care, and an emphasis on health promotion, maintenance, and cost-effective coordinated care.” (American Association of Colleges of Nursing, Position Statement, Dec. 2000)

Nursing is a dynamic profession and lifelong learning is essential for nurses to stay current with the increased complexity of the healthcare needs of today and into the future. In other words, the needs of our patients are changing, as we must change in order to be prepared to better serve that need.

BSN degree nurses are better prepared to meet patient needs

The main difference in study between an ADN and BSN is the emphasis on additional education in leadership and management, wellness, and community nursing. BSN prepared nurses possess greater knowledge of health promotion, disease prevention, and risk reduction as well as illness and disease management and are prepared to assist individuals, groups, and communities to prevent disease and achieve optimum levels of wellness. As nurses expand their role and move further into providing more community based primary care delivery the need for BSN prepared nurses is apparent.

Having a BSN degree means more career opportunities

The health system's increasing demand for front-line primary care, and the accelerating drive toward managed care, prevention, and cost-efficiency, are driving the nation's need for nurses who are prepared to practice in non-structured setting and interact directly with the public in matters of providing health and prevention services to the community, and that requires a BSN prepared nurse for starters.

Am I saying that every RN should become a BSN?

No, of course not! That’s an individual choice each of you needs to make for yourselves. Don’t do it for money. In many cases there’s no benefit in pay for having a BSN versus an ADN or Diploma- at least initially. The truth however is that increased education leads to increased responsibilities and increased career opportunities which give rise in turn to increased pay.

BSN nurses will have more career options than ADN and Diploma nurses. Diploma nursing programs are all but extinct anymore and I expect the ADN programs will vanish sometime in the future as well, but those of you who are already licensed will continue to be able to practice as an RN. You might find your job opportunities becoming narrower in the near future however. North Dakota has required all new nurse hires to possess a BSN degree since 1987. The New York State Board has similar legislation pending. The Dept. of Veteran’s Affairs began requiring all new hires to possess at least a BSN degree in 2005. Who knows what’s coming next?

Having a BSN degree allows more opportunity for employment, increased responsibility, and career progression. It opens the door for professional certification in specialty areas of nursing practice and leads to an expanded role as a provider, designer, manager, and coordinator of patient care as well as provides the foundation for graduate education.

Today’s working RN’s can attain a BSN degree without sacrificing their present job or income by going through an accredited online program. Programs are available that offer NLN accredited LPN to RN/BSN degrees, RN to BSN degrees, RN/ BSN to Master’s degrees, and even PhD in Nursing. Your employer’s education benefits often cover the expense of advancing your degree and tuition assistance is available for those who need additional help.

Nurses wishing to explore available online nursing degree options can learn more by visiting Medi-Smart.com’s online nursing school directory. Medi-Smart is a nursing resource and education site for nurses by an experienced nurse and you can interact with fellow nurses as well as student nurses in the nursing discussion forums while you’re there.

Healthcare delivery is changing. Nurses need to change along with it to meet the need.


About the Author: Sara Ellis RN, BSN has over 20 years experience in NICU, ICU, and ER nursing. To learn more about Nursing visit Medi-Smart.com, a site that offers nursing career resources, online nursing degrees, and continuing education for nurses.




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