These days, the minimal educational requirement in order to enter the practice for a Registered Nurse is a diploma or an associate degree. Unlike hospital-based nursing schools that prepare the nurses with diplomas and community colleges that require 2 years of studying, BSN programs span over 4 years either at a college or a university. A range of professional groups including the American Nurses Association (ANA), the Institute of Medicine (IOM), and the Tri-Council for Nursing assert that the minimal requirement should be a Bachelor of Science in Nursing (aka BSN) degree, because it is believed to bring about better patient outcomes (Haskins & Pierson, 2016). Yet, the opposition to this view is still strong as the empirical research has produced insufficient findings to clarify whether this practice will be the best for the profession. The purpose of this paper is to synthesize the available evidence on how the BSN degree impacts the outcomes of patient care in comparison with the associate degree, and examine how preparation in a certain kind of a nursing program is likely to impact the patient outcomes in one practical case.
Hospitals’ use of medical services provided by BSN educated nurses leads to an increase in positive patient outcomes. Specifically, a recent meta-analysis of empirical studies on the relation between the nurse education level and the rates of 30-day mortality and failure-to-rescue cases allowed Haskins & Pierson (2016) to claim that in comparison with lower degrees in nursing, namely the associate degree and diploma, the BSN degree leads to improved patient outcomes. By the results of Haskins & Pierson’s study, only a 10% increase in BSN-educated nurses can lead to the reduced odds of 30-day mortality by up to 9%. Failure-to-rescue odds can go down up to 8%. Based on the evidence they got from the analyzed studies, Haskins & Pierson (2016) made a prediction that if all U.S. hospitals moved to a workforce which would contain 80% of nurses with a bachelor’s degree, 2,100 lives could be saved for a period of just one year (for instance, back in 2006, it could be 60% of observed deaths under given conditions).
Apart from improved 30-day mortality and failure-to-rescue outcomes, baccalaureate in nursing was found to lead to a higher level and a broader range of nursing competencies. In particular, Goode et al. (2001) found that BSN-educated nurses have stronger leadership and critical thinking skills. Goode et al.’s (2001) research stemmed from earlier research, in particular from the evidence provided by Johnson’s (1988) study that found nurses with bachelor’s degrees had better professional competencies with regard to problem-solving, communication ability, knowledge, teaching, and professional role. Goode et al. (2001) also relied on the earlier research that documented better critical thinking skills and clinical decision making scores in BSN-educated nursing professionals. Their own results showed that nurses who had been enrolled in baccalaureate programs outperformed AD-educated nurses in leadership and critical thinking. Moreover, they were more satisfied with their job outcomes than AD or diploma nurses. In addition, BSN nurses have lower levels of medication errors and fewer procedural violations.
Also, nurses who graduate with the bachelor’s degree in nursing are better prepared for leadership and management roles. They have better capabilities to anticipate, react as well as respond to complexities, uncertainties, and changes; they can effectively lead changes themselves; and they are more ready to start using technical innovations in the nursing practice (Daly et al., 2003).
As for critical thinking, while some may argue that critical thinking incorporates one’s inherent abilities which only sharpen and facilitate over time, in reality BSN nursing curriculum also fosters critical thinking in these medical professionals. Specifically, scholars point out that the development of a critically alert as well questioning cast of mind is integrated in the courses taught across the curriculum. Many agree that case studies, debates, comparison and other writing activities, solving ethical dilemmas, planning care, and writing analyses for publication develop the critical thinking skills in BSN nurses (DeSimone, 2006). Interestingly, the evidence of better critical thinking skills among BSN nurses in comparison with AD nurses is provided by the two groups of nursing professionals themselves. In particular, scholars report that newly licensed nursing specialists with bachelor’s degrees admit to feeling better prepared than did their peers with AD education in the areas of evidenced-based practice in critical care, concerning the use of quality improvement data analysis, applying in a systematic manner methods and tools to improve their performance, and assessing the gaps in professional activity such as practice, teamwork, and collaboration (McIntosh et al., 2016).
In addition, nurses who graduate with a bachelor’s degree have better cultural competence than nurses with a lower level of education. According to Aponte (2012), BSN-educated nurses develop the ability to appropriately care for the populations that are diverse due to training in cultural sensitivity and due to a higher level of cultural knowledge. In particular, BSN-educated nurse is aware of and trained to apply such interdependent constructs as, for example, cultural awareness, cultural skill, cultural knowledge, cultural encounters, and cultural desire (Aponte, 2012). Now, if to take a specific situation which requires a high level of cultural competency, a BSN educated nurses may act more effectively than a nurse with AD education due to the embedded framework of how to deal with diverse patients in her professional worldview. In case with the minority patients, especially those who represent a lower socio-economic class and do not speak English, these nurses may act more professionally. In a specific situation with a disadvantaged Spanish-speaking minority patient, the BSN-related nurse, guided by the standards of performance and her knowledge, may activate her cultural awareness, i.e. she is likely to engage in deliberate self-examination of her biases towards the non-English-speaking poor minority patient, avoid imposing her own cultural beliefs, practices, values, or patterns of behavior upon the client as well as think of the client’s worldview as worthy and equal. Moreover, this nurse will probably try to apply the cultural knowledge that she got when taking courses about culturally diverse groups. This will help him/her rightfully consider the input from the client regarding his health condition and see how the client interprets his illness and how he/she perceives it. Next, the BSN-educated nurse is likely to apply her cultural skill in this case as he/she will be able to conduct a relevant assessment after collecting cultural data from the client in a sensitive manner. Further, he/she will more readily engage in face-to-face cultural encounters with the client and look for ways to make these encounters more and more productive. Finally, the BSN-educated nurse is likely to demonstrate her cultural desire, i.e. her genuine interest in the client and desire to learn from him and respond to his differences in a positive way. By contrast, a nurse with the lower education level is highly unlikely to engage in this complex process of cultural encounters, is likely to see her treatment driven by stereotypes and lack of understanding, fail to interact with the client regarding the illness, and, as a result, deliver the nursing care of much lower quality.
In conclusion, there are significant differences in the professional competencies and patient outcomes between the nurses with a bachelor’s and associate degrees. In all respects, BSN nurses fit better the changing modern healthcare environment and the demands of the new healthcare strategies including those within the Affordable Care Act. Using the example of the minority non-English-speaking and disadvantaged patient the author has shown how a nurse with the BSN training can act more effectively owing to her better education.
- Aponte, J. (2012). Cultural competency in baccalaureate U.S. nursing education: Hybrid course.
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- DeSimone, B. (2006). Curriculum design to promote critical thinking of accelerated bachelor’s
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nurses. JONA: The Journal of Nursing Administration, 31 (2), 55-59. - McIntosh, C., Thomas, S., Siela, D. (2016). Non-bachelor of science in nursing Registered Nurse to bachelor of science in nursing Registered Nurse: A change in critical thinking. Dimensions of Critical Care Nursing, 35 (6), 303-308.
- Haskins, S. & Pierson, K. (2016). The impact of the bachelor of science in nursing (BSN) degree on patient outcomes: A systematic review. Journal of Nursing Practice Applications & Reviews of Research, 6 (1), 40-49.
