The U.S. health care delivery system has gone through enormous and transformational changes in the past two decades. The traditional hospital-centered health care delivery is no longer able to support the expanded demands of health care services, especially outside hospitals. In the same token, the traditional role of a nurse as bedside direct caregiver is insufficient to meet the accelerating needs of nurses in other areas, such as health promotion and disease prevention, case management, leadership and research.
As a result of that, preparation of the entry-level of professional nurses requires a broader competencies so that nurses are educationally prepared to function with more independence in delivering diversified care. The American Association of Colleges of Nursing (AACN) recognized the Bachelor of Science degree in nursing as the minimum educational requirement for professional nursing practice (AACN, 2000).
There are significant differences between associate degree nursing programs and baccalaureate degree nursing programs. The baccalaureate program not only include all of curriculum in the associate degree programs, but also provides in-depth study in physical and social sciences, nursing research, leadership and management, community and public health nursing, patient education, and the humanities (Johnston, 2009). The broader and more in-depth education enhance professional development and critical thinking. The baccalaureate graduate is prepared to better understand many issues in culture, society, economy and politics. Such skills are essential for today’s nursing professionals.
In clinical practice, associate degree nurses provide bedside care in less complex situation while baccalaureate degree nurses design and manage a comprehensive plan of care. They understand more in patient’s signs and symptoms, supervise other nursing personnel, support staff, and guide patients through the complicated health care resources in a community, and educate patients on health care options and advanced directives .
Over the past several years, researchers and policymakers have identified that educational preparation does make a huge difference in how nurses practice. Johnson’s (1988) meta-analysis indicated that there were significant differences between professional (baccalaureate degree) and technical (associate degree and diploma) nurses on measures of nurse performance. Measures included communication skills, knowledge, problem-solving, and professional role. Pardue (1987) investigated the differences in critical thinking ability and decision-making skills among 121 associate degree, diploma, baccalaureate, and master’s prepared nurses. Results indicated that nurses with master’s and baccalaureate degrees had the highest scores in critical thinking ability.
In my hospital the ICU nurses are BSN’s, and they are responsible for patient education in addition to providing bedside care. An example of a patient care situation that was positively affected by having a BSN nurse available, recently occurred at the department where I work. A 37 year-old lady who is a post-liver transplant patient was admitted to the ICU for organ rejection and severe anemia. The medication compliance issue was brought up by the resident doctors. The ICU nurse provided medication reconciliation and discovered that patient often missed Prednisone. The nurse therefore spent more time on educating post-transplant immunosuppressant medications and reinforcing the importance to be compliant with medication regimen.
The patient finally confessed that Prednisone made her gain lots of weight, which was the main reason why she did not take this medication. The nurse researched clinical evidence based on patient’s primary diagnosis and corresponded medical treatment options. She realized that patient has a diagnosis of recurrent autoimmune hepatitis and Prednisone is one of medications that treat autoimmune disease.
The ICU nurse called out a meeting with the multidisciplinary team included the transplant social worker, pharmacist, nutritionist, nurse practitioners and surgeons. Patient and her care giver husband were also invited to the discussion of the plan for her care. Because of the shared decision making, the transplant team agreed to lower her Prednisone dose to the minimum and add a small dose of diuretic to avoid water retention caused by Prednisone. Through social worker’s help, patient agreed to take Prednisone every day and her husband promised to remind her to take the medication. Nutritionist provided consultation in fluid and salt restriction.
This example demonstrated that the baccalaureate degree nurse was well prepared to understand the pathophysiology and disease process. She conducted research study and obtained the best available evidence in reference to patient’s care. Finally she used her coordination and collaboration skills and gathered a meeting of the multidisciplinary team and patient’s family. She also demonstrated a strong leadership skill in case management.
She placed patient at the center of the care and approached to a shared decision-making. Without any doubt, her performance is a result of the educational preparation she received from the baccalaureate nursing program. If this case was handled by an associated degree nurse, her educational skill sets might not have prepare her to fulfill the task.
American Association of College of Nursing (2000). The baccalaureate degree in nursing as minimal preparation for professional practice. Retrieved from http://www.aacn.nche.edu/publications/position/bacc-degree-prep ————————————————-
Johnson, J. H. (1988). Differences in the performance of baccalaureate, associate degree, and diploma nurses: A meta-analysis. Research in Nursing & Health, 11, 183 – 197. DOI: 10.1002/nur.4770110307 ————————————————-
Johnston, K. A. (2009). The importance of the baccalaureate degree in nursing education. Retrieved from http://www.peoriamagazines.com/ibi/2009/apr/importance-baccalaureate-degree-nursing-education ————————————————-
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, 354-61.