AACN - Your Nursing Education: A Look at the Facts

Nursing is the nation's largest health care profession with more than 2.9 million registered nurses practicing nationwide. Despite its large size, many more nurses are needed into the foreseeable future to meet the growing demand for nursing care. As you plan or consider a career as a registered nurse, you should know these facts:

The Bachelor of Science degree in nursing is the critical first step for a career in professional nursing. The American Association of Colleges of Nursing (AACN), American Organization of Nurse Executives (AONE), American Nurses Association (ANA) and other leading nursing organizations recognize the BSN degree as the minimum educational requirement for professional nursing practice. While graduates can begin practice as an RN with an associate degree or hospital diploma, the BSN degree is essential for nurses seeking to move up the career ladder and provide a higher level of quality care..

The BSN nurse is prepared for a broader role. The BSN nurse is the only basic nursing graduate preferred to practice in all health care settings -- critical care, ambulatory care, public health, and mental health -- and thus has the greatest employment flexibility of any entry-level RN. The BSN curriculum includes a broad spectrum of scientific, critical-thinking, humanistic, communication, and leadership skills, including specific courses on community health nursing not typically included in diploma or associate-degree tracks. These abilities are essential for today's professional nurse who must be a skilled provider, designer, manager, and coordinator of care. Nurses must make quick, sometimes life-and-death decisions; understand a patient's treatment, symptoms, and danger signs; supervise other nursing personnel; coordinate care with other health providers; master advanced technology; guide patients through the maze of health resources in a community; and teach patients how to comply with treatment and adopt a healthy lifestyle.

In particular, a report by the National Advisory Council on Nurse Education and Practice, an advisory panel to the federal Division of Nursing, noted that baccalaureate nursing programs are far more likely than other entry-level tracks to provide students with on-site clinical training in non-institutional settings outside the hospital. As a result, the BSN graduate is well-prepared for practice in such sites as home health agencies, outpatient centers, and neighborhood clinics where opportunities are fast expanding as hospitals focus more on acute care and health services move beyond the hospital to more primary and preventive care throughout the community.

The BSN nurse is preferred. More nurse executives are indicating their desire for the majority of their hospital staff nurses to be prepared at the baccalaureate level to meet the more complex demands of today's patient care. In fact, the words "BSN preferred" are appearing more frequently in classified ads for registered nurses nationwide.

Aware of the expanding opportunities, RNs are seeking the BSN degree in increasing numbers. In 1980, almost 55 percent of registered nurses held a hospital diploma as their highest educational credential, 22 percent held the bachelor's degree, and 18 percent an associate degree, according to figures from the federal Division of Nursing. By 2004, a diploma was the highest educational credential for only 17.5 percent of RNs, while the number with bachelor's degrees had climbed to 34.2 percent, with 33.7 percent holding an associate degree. In addition, 13 percent of the current nursing workforce hold master's or doctoral degrees. According to a report released by the Health Resources and Services Administration in July 2002, associate degree in nursing graduates are declining at a somewhat faster rate than baccalaureate graduates, with the net result that baccalaureate graduates now comprise an increasingly greater share of total graduates. These numbers indicate the high premium that nurses place on advanced education in today's growing market, and the demand by employers for RNs who are baccalaureate-prepared.

Federal figures project that if current trends continue, the shortage of RNs will continue to grow throughout the next 20 years. By 2020, more than 800,000 RN positions are expected to go unfilled nationwide, according to the National Center for Workforce Analysis, an agency of the U.S. Department of Health and Human Services. But already, in an expanding number of markets, hospitals and other employers are struggling to meet the rising demand for RN care and have stepped up recruitment.

As nursing and health care delivery expand, opportunities abound outside the hospital. Between 1996-2004, the number of registered nurses in community health settings, including home health care rose to 14.9 percent. An estimated 11.5 percent of RNs were practicing in outpatient settings in 2004, including health maintenance organizations and physician- and nurse-based practices, and 6.3 percent of RNs work in long-term care facilities.

The average annual earnings of registered nurses employed in nursing was $57,784 in 2004, according to the federal Division of Nursing. Clinical Nurses Specialists, Nurse Practitioners, and other nurses prepared in graduate degree programs command much higher salaries.

With patient care growing more complex, ensuring a sufficient RN workforce isn't merely a matter of how many nurses are needed, but rather an issue of preparing an adequate number of nurses with the right educational mix to meet health care demands. The National Advisory Council on Nurse Education and Practice has urged that at least two-thirds of the basic nurse workforce hold baccalaureate or higher degrees in nursing by 2010. Currently, only 47.2 percent do.

Moreover, a 1995 report by the Pew Health Professions Commission called for a more concentrated production of nurses from bachelor's- and graduate-degree programs. Today's rising need for registered nurses does not appear to be a repeat of the widespread nursing shortage of a decade ago, when employers hired qualified entry-level RNs virtually regardless of their nursing degree preparation.

Job commitments for new graduates show the climbing demand for RNs with advanced clinical skills. While nursing schools estimate that an average of 77 percent of entry-level BSN graduates had jobs waiting upon graduation between August 1997 and July 1998, that number was 93 percent for master's-degree nursing graduates and 82 percent for graduates of master's-level nurse practitioner programs.

However, in the same period, graduates of RN-to-BSN tracks saw the largest pool of placements, a sign of employers' especially acute demand for experienced RNs. Nearly all -- an estimated 98.6 percent -- of RN-to-BSN graduates between August 1997 and July 1998 had jobs waiting, according to nursing schools responding to an AACN annual survey.

Flexibility is the key. All projections forecast accelerating demand for nursing care and for nurses with expanded education and skills. Still, the accelerating demand for RNs varies by region and market. As a result, flexibility will be key both for entering and moving within the profession. Some graduates may need to pursue employment in different parts of their home states, in another state, or even in another region where hiring in certain clinical settings or specialties may be more plentiful.

The health system's increasing demand for front-line primary care, and the accelerating drive toward managed care, prevention, and cost-efficiency, are driving the nation's need for nurse practitioners, clinical nurse specialists, certified nurse-midwives, and other RNs with advanced practice skills.

Prepared typically in graduate programs, advanced practice nurses (APNs) include the following four categories of clinicians:

Mounting studies show that the quality of APN care is equal to, and at times better than, comparable services by physicians, and often at lower cost. For example,

Even after acknowledging flaws in some of the studies it reviewed in 1986, the congressional Office of Technology Assessment (OTA) concluded that nurse practitioners can deliver as much as 80 percent of the health services, and up to 90 percent of the pediatric care, provided by primary care physicians, at equal or better quality and at less cost. In the 12 studies reviewed, OTA found that the quality of care by nurse practitioners -- including communication with patients, preventive actions, and reductions in the number of patient symptoms -- was higher than comparable care by physicians.

At the University of Rochester, researchers reported that intensive-care babies cared for by neonatal nurse practitioners averaged 2.4 fewer hospital days and more than $3,400 less in charges than those cared for by medical residents, despite the fact that the NPs' infants were younger and had significantly lower birthweight. Unlike residents, nurse practitioners don't rotate, are "more consistent caregivers" who can follow infants through their entire stay, and need to rely less on support services to stay apprised of a patient's progress, the authors suggest in the 1994 study.

Last Updated: September 5, 2006

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