Proposal
The 2008 American Nurses Association House of Delegates RESOLVED, that the American Nurses Association support initiatives to require registered nurses (RNs) to obtain a baccalaureate degree in nursing within ten years after initial licensure, exempting (grand-parenting) those individuals who are licensed or are enrolled as a student in a nursing program at the time legislation is enacted; and be it further
RESOLVED, that the American Nurses Association advocates for and promotes legislative and educational activities that support enhanced nursing education.
Brief History
Passage of the Comprehensive Nurse Training Act in 1964 prompted the American Nurses Association (ANA) Committee on Education to study nursing education, practice and scope of responsibilities. The study recognized the increasing complexity of health care and changes in practice (at that time), raising concerns about hospital - based diploma education programs. The Committee’s recommendations resulted in 1965 “position paper” in which ANA declared the “minimum preparation for beginning
professional nursing practice should be baccalaureate degree education in nursing” and in which three levels of nursing education were described: Baccalaureate education for beginning nursing practice, associate degree education for beginning technical nursing practice, and vocational education for assistants in the health service occupations. The position paper noted that the educational programs of the time prepared workers for current practice and structures, not for the future.
The 1965 ANA position paper was later reaffirmed by a 1978 ANA House of Delegates resolution which resulted in the recommendation that by 1985 the minimum preparation for entry into professional practice would be the baccalaureate degree. The designation of two levels of nursing practice, professional and technical, was reaffirmed. What was envisioned to be an orderly transition to an educational system of two levels never transpired.
In the 1960’s, nursing and especially hospital nursing was largely controlled by hospitals and physicians. And of course it was in hospitals where the majority of nurses practiced. There existed a strong identity and loyalty between nurses and the hospital in which they were trained and eventually became employed. Most of today’s remaining hospital-based programs award an associate degree in nursing upon completion and continue to receive federal graduate medical education funding for clinical hours completed.
Practice has continued to evolve with increased specialization, greater demands related to technology and paperwork and growing responsibility for coordinating and supervising care provided by other workers. Because hospitals have remained the primary site of employment, nurse staffing levels have been directly affected by changes in
reimbursement, especially Medicare. At a time when patient demands increased, nurse staffing was not increased. Rather through nurse attrition, positions have often been replaced with nurse extenders (assistive personnel) resulting in fewer nurses, supervising more assistive personnel in provision of care for increasingly complex patients. In addition to more career choices, it is also believed that during the past two decades, fewer individuals have expressed an interest in nursing, determining it to be too demanding, undervalued and unrewarding.
Rationale for Supporting Nursing Education Advancement
The “RN to BSN in ten years” approach continues to recognize all educational entries into the profession while acknowledging the changing health care environment and associated competencies necessary to adapt to those changes. An incremental approach permits those choosing to enter the profession with a diploma or associate degree to pursue additional skill sets while strengthening entry level competencies: moving from novice to expert. Nursing education advancement with work experience can result in greater relevance for the learner. Baccalaureate nursing education is intended to result in a deeper understanding of the cultural, political, economic, and social issues that affect patients and influence health care delivery. Coursework at the baccalaureate level include such areas as healthcare economics, health informatics, health policy, leadership, and research.
It is also known that….
Research has revealed the relationship between advanced education and patient outcomes, such as lower patient mortality.
Baccalaureate prepared nurses are more likely to report higher job satisfaction scores in relation to opportunities for growth, and to remain in practice longer than others. Increasingly more complex healthcare needs of a multi cultural and aging population underscores the need for advanced education.
A stronger theoretical base and foundation in nursing research is needed as a result of the shift to evidenced based practice and expansion of more sophisticated technologies, pharmacologic and other treatment modalities.
Rationale for Supporting Nursing Education Advancement continued
Sound leadership skills are essential for case management, as well as to support the ability to delegate and supervise care provided by dependent practitioners (LPNs) and nurse extenders within the framework of varying care delivery models.
There is a shortage of nursing faculty and subsequent limited cadre of nurses from which to draw.
Advanced education will better enable nurses to practice as full partners on a
multidisciplinary team, given the education advancement of a number of other health professions: Social workers - master’s degree; Physical therapists – master’s degree in 2002, doctoral required by 2020; Pharmacists – PharmD has replaced the bachelor of pharmacy degree.
The military (US Army, Navy and Air Force) require a baccalaureate degree for nurses on active duty. The Veteran’s Health Administration requires a baccalaureate degree for nurses wishing to advance beyond entry level appointment. Internationally, the
baccalaureate degree in nursing is required upon entry into the profession in the Philippines, Australia, Ireland, and half of Canada’s provinces. The Royal College of Nurses voted to support a transition to require a university degree for professional nursing practice.
A recommendation that at least 2/3 of the nursing workforce hold a baccalaureate degree or higher by 2010 was presented to Congress by the National Advisory Council on Nursing Education and Practice (the group appointed by the Secretary of Health and Human Services)
ADN competencies versus BSN
A comparison of terminal competencies between ADN and BSN education programs is difficult, due in large part to the way they are framed by the accrediting bodies. Depth and breadth of knowledge are what is most distinguishable. Whereas an ADN graduate is expected to “recognize”…., a baccalaureate prepared graduate is expected to “explore” “the impact of economic, political socio-cultural, legal and political forces in the delivery of health care.” Components for each education level follow.
The nine Essentials of Baccalaureate nursing education are:
Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice
A solid base in liberal education provides the cornerstone for the practice and education of nurses.
Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety
Knowledge and skills in leadership, quality improvement, and patient safety are necessary to provide high quality health care.
Essential III: Scholarship for Evidence Based Practice
Professional nursing practice is grounded in the translation of current evidence into one’s practice.
Essential IV: Information Management and Application of Patient Care Technology
Knowledge and skills in information management and patient care technology are critical in the delivery of quality patient care.
Essential V: Health Care Policy, Finance, and Regulatory Environments
Healthcare policies, including financial and regulatory, directly and indirectly influence the nature and functioning of the healthcare system and thereby are important considerations in professional nursing practice.
Essential VI: Inter-professional Communication and Collaboration for Improving Patient Health Outcomes
Communication and collaboration among healthcare professionals are critical to delivering high quality and safe patient care.
Essential VII: Clinical Prevention and Population Health
Health promotion and disease prevention at the individual and population level are necessary to improve population health and are important components of baccalaureate generalist nursing practice.
Essential VIII: Professionalism and Professional Values
Professionalism and the inherent values of altruism, autonomy, human dignity, integrity, and social justice are fundamental to the discipline of nursing.
Essential IX: Baccalaureate Generalist Nursing Practice
The baccalaureate graduate nurse is prepared to practice with patients, including individuals, families, groups, communities, and populations across the lifespan and across the continuum of healthcare environments.
The baccalaureate graduate understands and respects the variations of care, the increased complexity, and the increased use of healthcare resources
inherent in caring for patients. Source: The Essentials of Baccalaureate Education for Professional Nursing Practice (August 18, 2008)
Core Components for ADN education include:
Professional Behaviors Communication Assessment
Clinical Decision Making Caring Interventions Teaching and Learning Collaboration
Managing Care
Source:
Educational Competencies for Graduates of Associate Degree Nursing Programs (2000) National League for Nursing: Jones and Bartlett Publishers.
References:
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