Nursing Education and Competency
The purpose of this paper is to explore the different paths of education to become a registered nurse. Specially, to examine the educational tracks of the Associate Degree nurse and the Baccalaureate Degree nurse. The question at hand is how do these educational paths differ in the level of competency? First, I will show the difference in educational structure and then examine how these relate to the competency of the nurse following completion of each program. The Associate Degree in nursing came about during the 1950s in an effort to combat a nursing shortage in the Unites States following World War II. An Associate Degree nursing program is a two-year program that is typically affordable and offered at a junior or community college. The focus of this program is “on the basic sciences and theoretical and clinical courses related to the practice of nursing” (Potter & Perry, 2005, p. 16). It prepares the student for “competent technical bedside” nursing in “secondary care settings” (Cresia & Friberg, 2011, p. 33). Following completion of the two-year program, the student is eligible to take the NCLEX-RN (National Council Licensure Examination) and can achieve a license as a registered nurse.
The first Baccalaureate Degree in nursing was “established in the United States at the University of Minnesota in 1909” (Cresia & Friberg, 2011, p. 25). It consists of a four-year program on a university or college campus with a larger financial attachment. There are typically two years of general education requirements followed by two years of upper-level nursing education courses. In addition to the basic science, theory and clinical education the program “include courses in community and public health, beginning research, management and leadership (Cherry & Jacob, 2005, p. 81). It prepares the student to become a “professional nurse generalists for acute care settings, community-based practice, and beginning leadership/management positions” (Cresia & Friberg, 2011, p. 33). Following the completion of the program, the student is also eligible to take the NCLEX-RN to receive licensure. Do these two years of additional education make a more competent nurse? “Over the past several years, policy makers, researchers, and practice leaders have identified that education does make a difference in how nurses practice” (Johnston, 2009).
The University of Pennsylvania in an issue of Medical Care released one such study that supports this in October, 2012 (American Association of Colleges of Nursing, 2012). It states that: surgical patients in Magnet hospitals had 14% lower odds of inpatient death within 30 days and 12% lower odds of failure-to-rescue compared with patients cared for in non-Magnet hospitals. The study authors conclude that these better outcomes were attributed in large part to investments in highly qualified and educated nurses, including a higher proportion of baccalaureate prepared nurses. (American Association of Colleges of Nursing, 2012) The current healthcare environment is changing through federal policy, technological advancements, and a growing global multicultural population. These additional years of education are believed to “enhance the students professional development, prepares the new nurse for a broader scope of practice, and provides the nurse with a better understanding of the cultural, political, economic, and social issues that affect patients and influence” (American Association of Colleges of Nursing, 2012). The four-year baccalaureate program offers more education to develop these skills giving the nurse the ability to adapt and contribute to these continual changes.
Let us now use the following patient care situation of a newly diagnosed patient with Diabetes Mellitus Type II to explore the differences of an Associate Degree nurse (ADN) and Baccalaureate Degree nurse (BNS). A newly diagnosed diabetic needs teaching, the focus of this example will be on how the AND verses a BSN would approach teaching. As stated previously the ADN is prepared at a more technical level, although they share the same basic science and theory as a BSN. After explaining the basics of disease process to the patient, the ADN primary focus may be on the methods of testing blood glucose levels, the correct techniques for drawing up insulin and administration. This is due to the fact that the bulk of their educational training encompassed technical nursing. They would consider proper aseptic techniques for finger stick testing while teaching. Interrupting the results and applying it to a sliding scale of insulin related to food intake and activity. Then teaching the method of drawing up insulin, administration, and sharps disposal. A BSN nurse would teach the basics of the disease process taking the patient’s learning modality into consideration before starting.
What is the patient’s ability to learn? Is the patient ready to learn? What is the best method for teaching (audio, visual, written material, or discussion)? What is the family dynamic and should the family be involved in the teaching? Are there any cultural considerations? The BSN nurse might be inclined to research the topic of teaching new diabetics and find some current evidence based literature to assist in providing the best possible care for this patient. All of these items would have to be taken into consideration before moving onto the task of blood glucose testing, interpreting results and administering insulin. The example above is just a brief look into the thought process that comes with the different tracks of nursing education.
A BNS nurse has a larger knowledge base to work from applying critical thinking, evidence based research and cultural consideration into their daily practice. They also possess some of the qualifications to move toward nursing positions in leadership and management. Research is leaning toward the idea that a nurse that has received a Baccalaureate Degree makes for a more competent nurse. National nursing associations support this thought. Policy makers are privy to this information as well. What seems to be a topic of debate now could soon become a reality and change how we educate future nurses.
American Association of Colleges of Nursing (2012, October 24). The impact of education on nursing practice. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/impact-of-education. Cherry, B., & Jacob, S. R. (2005). Contemporary Nursing: Issues, Trends, and Management (3 rd ed.). St. Louis, Missouri: Elsevier, Inc. Cresia, J. L., & Friberg, E. (2011). Conceptual Foundations: The Bridge to Professional Nursing Practice, (5 th ed.). http://dx.doi.org/. Johnston, K. A. (2009). The Importance of Baccalaureate Degree in Nursing Education. Retrieved October 2, 2013, from http://www.peoriamagazines.com/ibi/2009/apr/importance-baccalaureate-degree-nursing-education Potter, P. A., & Perry, A. G. (2005). Fundementals of Nursing (6 th ed.). St. Louis, Missouri: Mosby, Inc.