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Position
Statement: Rapidly expanding clinical knowledge and mounting
complexities in health care mandate that professional nurses
possess educational preparation commensurate with the diversified
responsibilities required of them. As health care shifts from
hospital-centered, inpatient care to more primary and preventive
care throughout the community, the health system requires
registered nurses who not only can practice across multiple
settings - both within and beyond hospitals - but can function
with more independence in clinical decisionmaking, case management,
provision of direct bedside care, supervision of unlicensed
aides and other support personnel, guiding patients through
the maze of health care resources, and educating patients
on treatment regimens and adoption of healthy lifestyles.
In particular, preparation of the entry-level professional
nurse requires a greater orientation to community-based primary
health care, and an emphasis on health promotion, maintenance,
and cost-effective coordinated care.
Accordingly, the American
Association of Colleges of Nursing (AACN) recognizes the
Bachelor of Science degree in nursing as the minimum educational
requirement for professional nursing practice. (See also
our fact sheet on Associate
Degree in Nursing Programs and AACN's Support for Articulation.)
Background
For U.S. health care delivery, the traditional role of the
nurse as bedside caregiver - and of the hospital as traditional
site for health care delivery - no longer can support a health
system that demands expanded delivery of outpatient and primary
care throughout the community, greater numbers of clinical
specialists to treat an array of acute and chronic illnesses,
and wider use of nurse practitioners and other advanced generalists
to provide citizens, especially underserved populations, more
accessible and affordable care.
Nor
will merely producing more direct care providers be sufficient
to meet the accelerating need for nurses in other areas, such
as health promotion and disease prevention, case management,
and managed care settings.
As
health care shifts increasingly away from hospital-centered,
inpatient treatment, other points of delivery - health maintenance
organizations, community health and other outpatient centers,
homes, the workplace, public schools, and nursing-school-operated
nursing centers - have emerged to provide a continuum of health
care services outside the hospital. Many of these facilities
are part of new integrated health networks that provide and
coordinate care among a host of facilities within a community.
These accelerating changes in how and where health care is
delivered have created demand for nursing personnel who can
function with more independence in clinical decisionmaking
and case management, performing the traditional role of clinical
caregiver, and teaching patients how to comply with treatment
regimens and maintain good health. Indeed, today's registered
nurse not only must communicate effectively with patients
and other health care professionals, but also must have broad
competency as a provider, designer, manager, and coordinator
of care. 1
Such
responsibilities include skill at delegation and, increasingly,
will require planning and integrating treatment for patients
as they receive care across multiple settings. As such, registered
nurses at the entry-level of professional practice should
possess, at a minimum, the educational preparation provided
by a four-year Bachelor of Science degree program in nursing
(BSN).
The
BSN Nurse is Prepared for a Broad Role
Unlike
graduates of diploma or associate-degree nursing programs,
the nurse with a baccalaureate degree is prepared to practice
in all health care settings - critical care, outpatient care,
public health, and mental health. Accordingly, the BSN nurse
is well-qualified to deliver care in private homes, outpatient
centers, and neighborhood clinics where demand is fast expanding
as hospitals focus increasingly on acute care and as health
care moves beyond the hospital to more primary and preventive
services throughout the community.
In
addition to the liberal learning and global perspective gained
from a four-year baccalaureate education, the BSN curriculum
includes clinical, scientific, decisionmaking, and humanistic
skills, including preparation in community health, patient
education, and nursing management and leadership. Such skills
are essential for today's professional nurse who must make
quick, sometimes life-and-death decisions; design and manage
a comprehensive plan of nursing care; understand a patient's
treatment, symptoms, and danger signs; supervise other nursing
personnel and support staff; master advanced technology; guide
patients through the maze of health care resources in a community;
and educate patients on health care options and how to adopt
healthy lifestyles.
At
increasing numbers of hospitals nationwide, baccalaureate-prepared
nurses are being utilized in ways that recognize their different
educational preparation and competency from other entry-level
RNs. In these differentiated practice models, BSN nurses not
only provide more complex aspects of daily care and patient
education, but also design and coordinate a comprehensive
plan of nursing care for the entire length of a patient's
stay - from pre-admission to post-discharge - including supervising
nurses aides and other unlicensed assistive personnel, designing
discharge and teaching plans for patients, and collaborating
with patients, physicians, family members, and other hospital
departments and resource personnel. Associate-degree nurses
function primarily at the bedside in less complex patient
care situations, and provide additional aspects of care such
as teaching patients how to cope with their conditions and
to maintain their care upon discharge. 2
The
BSN Nurse is Preferred
In
1980, almost 55 percent of registered nurses held a hospital
diploma as their highest educational credential, 22 percent
held the BSN, and 18 percent an associate degree. By 1996,
a diploma was the highest educational credential for only
24 percent of RNs, while the number with BSN degrees climbed
to 31 percent, with 34 percent holding an associate degree.
3
A
recent report by the National Advisory Council on Nurse Education
and Practice, an advisory body to the federal Division of
Nursing, urged that at least two-thirds of the basic registered
nurse workforce hold baccalaureate or higher degrees in nursing
by 2010. 4 Presently, only
about 40 percent do.
In
addition, a 1995 report by the Pew Health Professions Commission
called for a more concentrated production of bachelor's- and
higher-degree nursing graduates. 5
Indeed,
nurse executives have indicated their desire for the majority
of hospital staff nurses to be prepared at the baccalaureate
level to meet the more sophisticated demands of today's patient
care. 6 For example, chief
nurse officers (CNOs) at university health systems report
they prefer an average of 70 percent of their staff nurses
to be BSN-prepared, according to a recent survey by the University
HealthSystem Consortium. More than 70 percent of the CNOs
stated they perceive a difference in the practice of baccalaureate-
and associate-degree-prepared RNs, citing better critical
thinking skills and leadership abilities among baccalaureate
nurses. 7
Moreover,
with sharp declines in inpatient visits and briefer patient
stays increasingly becoming the norm -- shifting more health
care delivery to outpatient settings -- the skills of the
BSN nurse are essential for practice in other community sites,
such as health maintenance organizations, home health services,
community clinics, and managed care firms.
(With
the continued change and mounting complexity in health care
delivery, calls have increased in some circles of nursing
for the graduate degree to be the entry-level requirement
for professional nurses.)
Many
hospitals not already requiring the Bachelor's of Science
degree in nursing have established "BSN-preferred" policies
for new hires. For example, the Veteran's Administration,
the nation's largest employer of registered nurses, has established
the baccalaureate degree as the minimum preparation its nurses
must have for promotion beyond entry-level beginning in 2005,
and has committed $50 million over the next five years to
help VA nurses obtain baccalaureate or higher nursing degrees.
8
Recognizing
the expanded opportunities, RNs are returning to school in
increasing numbers to earn the BSN degree. Between 1975-1999,
the number of RNs (with associate degrees or hospital diplomas)
graduating from BSN programs rose from approximately 3,700
a year to more than 12,000 annually. 9
#
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(Approved
By Board of Directors, July 20, 1996)
(Updated:
December 12, 2000)
References
1
American Association of Colleges of Nursing. (1998). The
Essentials of Baccalaureate Education for Professional Nursing
Practice, pp. 4-5. Washington, DC: Author.
2
American Association of Colleges of Nursing. (1995). A
Model for Differentiated Nursing Practice, pp. 26-29.
Washington, DC: Author.
3
Division of Nursing. (March 1996). The Registered Nurse
Population: Findings from the National Sample Survey of Registered
Nurses, p. 16. Washington, DC: U.S. Department of Health
and Human Services, 1995.
4
National Advisory Council on Nurse Education and Practice.
(October 1996). Report to the Secretary of the Department
of Health and Human Services on the Basic Registered Nurse
Workforce, p. 9. Washington, DC: Division of Nursing,
Health Resources and Services Administration.
5
PEW Health Professions Commission. (November 1995). Critical
Challenges: Revitalizing the Health Professions for the Twenty-First
Century, p. 51. San Francisco, CA: University of California,
San Francisco Center for the Health Professions.
6
American Hospital Association. (1987). Report of the Hospital
Nursing Personnel Survey, p. 36. Chicago: Author.
7
University HealthSystem Consortium. (October 1999). Survey
on Educational Preparation of Nurses, p. 2, 8. Oak Brook,
Ill: Author.
8
Department of Veterans Affairs. (December 18, 1998). VA
commits $50 million to new national nursing initiative
[news release]. Available at www.va.gov/pressrel/98nni.htm.
Accessibility verified December 12, 2000.
9
American Association of Colleges of Nursing. (2000). 1999-2000
Enrollment and Graduations in Baccalaureate and Graduate Programs
in Nursing, p. 11. Washington, DC: Author.
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