This paper will outline the differences in competencies between Associate Degree in Nursing (ADN), and Bachelor in Science of Nursing (BSN) prepared nurses. Then identify a patient care situation describing how nursing care or approaches to decision making may differ based upon the educational preparation of the nurse. The Free online Dictionary (2013) depicts competency as “The quality of being competent or capable of performing an allotted function.” Here is a comparison of two different pathways to becoming a Registered Nurse: Associate Degree in Nursing (ADN), and Bachelor in Science of Nursing (BSN) programs. Born out of the nursing shortage in 1952, the Associate Degree nurse came in to fruition thanks to Mildred Montag. The Associate Degree program for Registered Nurses is two-three years length. This program does hold academic credit based on clinical and general studies preparing these students to be able to function as “technical” bedside nurses. At the end of the ADN program students are eligible to take the NCLEX-RN (Creasia & Reid, 2011).
The Bachelors of Science program is four years in length and actually regarded by the American Nurse association as the original entry level requirement to becoming a Registered Nurse (Smith, 2009). This program originated in 1909. The BSN program is based on evidence based practice, Community nursing, and prepares these nurses for leadership roles whereas the ADN programs do not function to prepare nurses in leadership roles (Creasia & Reid, 2011). This is due to the program providing education, described by Creasia & Reid, 2011, also on “Information management, health care policy and finance, communication/collaboration, clinical Prevention/population health and professional values.” (p. 25). At the end of the program these Nurses are eligible to take the NCLEX-RN.
With differences in the level of education among RN’s this brings up the controversial topic of: Do the difference in educational levels of BSN prepared nurse and ADN nurse make the more educated BSN more prepared for the challenges of nursing today? There is much more research needed on this topic. Online Journals such as Policy Politics Nursing Practice Ellenbecker, 2011 state, “Today’s environment of expanding knowledge, the call for interdisciplinary healthcare delivery teams, and evidence of the relationship between nurse education and improved patient outcomes strongly indicate the need for nurses prepared at the baccalaureate level.” (115-125). Studies such as Aiken (2003) depict negative outcomes such as failure to rescue and mortality were nineteen percent lower in hospitals post-surgical patients where sixty percent of the nurses had baccalaureate degrees. The American Association of Colleges of Nursing 2003 provide an entire fact sheet depicting how BSN nurses may be more prepared than diploma or ADN to meet the demands of nursing today.
They state this is due to the broader span of course work provided in the BSN program. The BSN nurse learns what the diploma and ADN nurse learn but receive a more “in depth” experience thus allowing them enhanced “professional development, a greater understating of cultural, political, economic and social issues affecting patients and influencing health care delivery.” (AACN 2003). Nurses holding a BSN education could indeed be more able to provide the approach of looking at the patient as a whole, as well as enhanced critical thinking skills. (AACN 2003). One clinical example that depicts the difference in patient care situation describing how nursing care or approaches to decision-making may differ based upon the educational preparation of the nurse BSN versus a diploma or ADN degree.
The issue of “may” provide different approaches to decision making is appropriate. There are studies that support that BSN prepared nurses are better prepared and studies that suggest that there is no significant difference in care delivered by BSN compared to the care delivered ADN and Diploma nurses. When faced with the evidence that BSN prepared nurses are taught a higher level of education and to utilize evidence based practice (AACN 2003) (Creasia & Reid, 2011). The BSN prepared nurse may be better prepared to think more critically and research why they do a task and not just do the task blindly. For instance evidence-based practice provides hospitals with ways to decrease CAUTI from occurring (AJIC 2011). This is “Catheter-associated urinary tract infections (CAUTI). According to AJIC 2011, “CAUTI are “common, morbid, and costly”. “Nearly 25% of hospitalized patients are catheterized yearly, and 10% develop urinary tract infections.
Evidence based guidelines exist for indwelling urinary catheter management but are not consistently followed.” (pp. 1-6). Being educated enough to look up what the evidence based practice guidelines on catheters are can significantly increase positive patient outcomes. Furthermore, AJIC 2011 states also that when nurses where “re-educated” on a “basic skill” and” infusing best evidence into current practice were important to raise awareness of simple interventions that positively impacted patient outcomes and infusing best evidence into current practice were important to raise awareness of simple interventions that positively impacted patient outcomes.” (pp. 1-6).
Nurses who are more educated on reasons behind evidence based practice understand the importance of implementing it into current nursing practice. So it could be said that a BSN prepared nurse is more likely to utilize the practice guidelines that are evidence based. This provides an example how a BSN nurse could be more likely to make a different judgment call than a diploma or and nurse and take initiative to ask the MD for an order to support an evidence-based decision. To summarize there three pathways to becoming a Registered Nurse: Diploma, ADN, and BSN programs. Each has unique qualities. The program that offers a more “in-depth” education is the BSN program. All programs lead to the same end point of allowing the student to the NCLEX-RN. There are varying viewpoints on whether or not a BSN versus ADN nurse is better educationally prepared for the nursing workforce today.
American Association of Colleges of Nursing. (2013). The impact of education on nursing practice. Retrieved on January 18, 2013 from: http://www.aacn.nche.edu/media-relations/fact-sheets/impact-of-education Aiken, L. H. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290 , 1617–1623. Retrieved on January 19, 2013 from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3077115/ Creasia, J. L., & Reid, PHD, RN, K. B. (2011). Conceptual foundations the bridge to professional nursing practice. (5th ed.). Ch. 2, pp.1-39. St. Louis, Missouri: Elsevier Mosby. Retrieved on January 19, 2013 from: http://pageburstls.elsevier.com/books/978-0-323-06869-7 Ellenbecker PhD, RN, C. (2010, 08 30). Policy politics and nursing practice preparing the Nursing Workforce of the Future. vol. 11 no. 2 115-125. Retrieved from on January 19, 2013: http://ppn.sagepub.com/content/11/2/115.abstract Farlex, Inc. (2013). The free dictionary. Retrieved on January 19, 2013 from: http://www.thefreedictionary.com/competencies
Oman, K. S., & Flynn Makic, M. B. (2011). Nurse-directed interventions to reduce catheter associated urinary tract infections. American Journal of Infection Control, 1-6. Retrieved on January 19, 2013 from: http://www.ucdenver.edu/academics/colleges/medicalschool/departments/medicine/hcpr/cauti/documents/TeamPublications/Nurse-Directed Interventions to Reduce Catheter-Associated Urinary Tract Infections.pdf