Differences in Competencies Between Associate Degree and Baccalaureate Degree Nurses Nursing education can be confusing because there are so many ways to become a nurse. However, throughout history, nurse leaders have advocated the importance of higher education for nurses. But as nursing shortages developed, the need for more and more nurses became apparent. To help solve the nursing shortage problem, Mildred Montag developed the associate degree of nursing program (ADN) in 1952. It was designed to be completed in two years and provide a balance of general nursing education along with clinical courses.
The original program designed by Mildred Montag was for associate degree nurses to work under the supervision of professional baccalaureate prepared nurses. Due to confusion, the graduates of the associate degree nursing program were allowed to sit for the National Council Licensure Examination (NCLEX-RN). This NCLEX exam was the same exam given to baccalaureate degree nurses (Creasia & Friberg, 2011). Now, associate degree nurses can be found in almost every setting from hospitals to long term care facilities.
However, even though associate nurses have the skills to provide adequate patient care, the advanced education of the baccalaureate degree nurse provides leadership skills, advanced critical thinking skill and improved patient outcomes (Lane & Kohlenberg, 2010). Therefore, in recent years the difference in competencies between the associate degree nurse and the baccalaureate degree nurse has been examined, resulting in a push for more nurses to obtain a bachelors degree (BSN). Associate degree nursing programs teach the technical aspect of nursing care. An associate prepared nurse can function well at the bedside.
She can monitor the patient’s needs and record the outcomes of treatments. An associate prepared nurse can use critical thinking skills to determine her best course of action in most situations. But the constantly changing field of healthcare is demanding higher educated nurses. It is demanding nurses that are more professional and have an understanding of theory based practice. Nursing and medical organizations across the nation are recommending that all RNs advance their education. An advanced level of education can improve patient safety and quality of care (“Fact Sheet: Creating,” 2013).
This has been evidenced by numerous studies on the correlation between higher educated nurses and patient outcomes. Researchers at the University of Pennsylvania conducted a study that found surgical patients had 14% lower odds of dying as an inpatient within 30 days when being cared for by higher educated nurses. Another study conducted at the University of Toronto found hospitals that increased their pool of baccalaureate prepared nurses by just 10% had a decrease in death of discharged patients (“Fact Sheet: Creating,” 2013).
To fully understand the differences in competencies between an ADN and a BSN, it may be necessary to evaluate how each would perform in a specific patient care situation. For example, a 66 year male is hospitalized with an open wound on his leg. The wound is positive for MRSA and the patient is diabetic. The associate degree nurse dresses the wound properly, and teaches the patient how to take care of the wound. She helps manage the patient’s diabetes and teaches him how to manage it at home. The patient is discharged home with instructions and prescriptions.
He is re-admitted a week later with high blood sugars and a worsening leg wound. The same patient is cared for by a nurse with a BSN. During his stay the nurse dresses his wound properly, and manages his blood sugar levels. During her time with him, the nurse questions the patient about his family and his home. Through casual conversation she discovers the patient lives alone, but his daughter lives close by. She also learns he is unable to clean his home properly, but he is adamant about staying there.
With the patient’s permission, the nurse contacts the patient’s daughter to learn more about the challenges the patient faces in caring for himself. After talking with the daughter, the nurse discovers the patient has not had an eye exam in 5 years and his vision is poor. He does not follow a diabetic diet and prefers to eat out rather than cook at home. Armed with this new information, the nurse talks with the patient. She tactfully points out his vision problems and poor diet choices. The patient admits he needs new glasses, but cannot afford them. He admits to having trouble seeing the numbers on his insulin syringe.
He also states following a diabetic diet is too difficult so he doesn’t bother. The nurse takes this information to the hospital’s case management team and together they get home health care that will help him with his dressings. They also manage to find help to clean his home and funding to get him new glasses. The nurse then makes an appointment for the patient for diabetic teaching provided by the hospital. Prior to discharge the nurse teaches the daughter how to change the wound dressing and how to give insulin injections. She encourages the daughter to go with the patient to diabetic education classes. The BSN nurse did more than just discharge the patient.
She used the metaparadigm of nursing model to treat the patient as a whole. The metaparadigm consists of person, environment, health, nursing and how they all interact with each other. (Gunther, 2011). She recognized the patient was an individual person with individual health needs. She discovered his physical and environmental challenges and learned how they were affecting his health. Utilizing the information she obtained she found the patient the appropriate help for his situation.
The associate degree nurse is certainly capable of taking care of patients in almost any healthcare setting. However, healthcare is changing rapidly with increased acuity and short lengths of stay and nursing must change with it by producing more professional, well-educated nurses. References Creasia, J. L. , & Friberg, E. E. (2011). Pathways of Nursing Education. In M. Iannuzzi, & R. Richman (Eds. ), Conceptual foundations: The bridge to professional nursing practice (5th ed. (pp. 23-26). [PageBurst]. Retrieved from www. elsevier.
com Fact sheet: Creating a more highly qualified nursing workforce. (2013). Retrieved from http://www. aacn. nche. edu/media-relations/fact-sheets/nursing-workforce Gunther, M. (2011). Theories and frameworks for professional nursing practice. In M. Iannuzzi, & R. Richman (Eds. ), Conceptual foundations: The bridge to professional nursing practice (5th ed. (pp. 97-99). [PageBurst]. Retrieved from www. elsevier. com Lane, S. H. , & Kohlenberg, E. (2010). The future of baccalaureate degrees for nurses. Nursing Forum, 45(4), 218-227. doi:10. 1111/j. 1744-6198. 2010. 00194.
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