3 Obstacles to Higher Education Levels in Nursing

Evidence shows that patient outcomes improve when nurses have baccalaureate degrees. But most nurses don't have them and increasing the numbers with BSNs is tough. Nurse leaders must get fired up and overcome three things that stand in their way.

23 comments on "3 Obstacles to Higher Education Levels in Nursing"
Beth Freed, CCRN, MSN, FNP-BC (12/30/2012 at 7:09 PM)

In an ideal world, every nurse would strive to gain the highest education possible. Money, time, responsibilities, lack of support, raising families, caring for elderly/sick parents, etc can be blamed for not achieving these goals. It is easy on the outside looking in to downplay 'the whys', and unrealistic to think the only good nurses are BSN trained. I have former coworkers (ICCU) that range from having Associate to BSN education of whom I would trust my life because of their experience, critical thinking skills, caring, and compassion. In that setting, if you are not passionate about what you do, you do not survive. The focus needs to be on CONTINUED education in order to train already talented nurses to remain on top of their profession.
Christy (10/12/2011 at 3:30 PM)

I am currently working on my ASN in California. My sister-in-law has a BSN (also in California). She works with nurses who have graduated from the school I am attending and as far as she can tell, the major difference in education is management type classed required for a BSN. The program here is so impacted that most nursing students (myself included) must take additional classes while waiting to gain admittance to the nursing classes. I am currently taking psychopathology. A class not required, but relevant to my chosen profession. Next semester I will be taking organic chem and nutrition. Again, classes not required, but may aid me later in my studies. I can accept that "better out comes" happen with a BSN. Now find out why and incorporate that into an ASN program. Also, figure out a way to get more nursing students through school. I don't want to do the classes faster, I just don't want to have to wait 2 years to start. There is no perfect solution. If as a country we are worried about a nursing shortage, then we need to do what we can to get more qualified people the education they desire to become nurses.
KATHY MARSHALL (10/6/2011 at 9:23 AM)

Yes, nurses need to be educated at least to a BSN level. But I am not. Why? First, let me say I have over 20 yrs. experience and I have many "certifications" as well as "extra" college credits that don't apply to a BSN program. I have checked into numerous RN to BSN programs and have found the minimum # of credit hours I need to fufill the requirements for a BSN is 42. I work full time so part-time attendance is my only option. If I took 2 classes a semester (6 credits) it would take me 7 semesters (2 1/2 yrs with summer classes) and cost me about $17,000. During those 2 1/2 yrs there would be no time for vacations, etc. I am 54 years old. Although I'd love to get my BSN and work on a Master's, the requirements don't make sense to me, considering my past education and experience.
Paulette Cogle (8/28/2011 at 5:57 PM)

Is it the degree that does the work of improving patient outcome or is it the dedication, work ethics and love for nursing that does the job? As an Associate degree nurse of many years, I have worked with all the degrees, BSN/MSN/NP. The nurses who did the best job in my experience is the nurse who cares and practices Nursing as they were taught. There were BSN/MSN nurses who I was afraid to leave my patients to overnight. They felt that getting that degree meant they were not to touch patients. I have no problem in entry level being a BSN, I am in the process of obtaining one. What I have a problem with is the constant rhetoric of who does a better job. Who are these people making these decisions? I have constantly wondered. I am almost sure these people are no longer at the bedside and has not been for a very, very long time. One advanced Nurse who refused promotion for many years did so while stating,"the further you get from the bedside, the more out of touch you become" I believe it is a group of out of touch nurses who make statements about who gives better care. Nursing is not about politics, nursing is about people. Yes, encourage us to go back to school, Nursing is dynamic. uplift the profession wherever you can. The greatest need however is for Nurses to be supported; emotionally, mentally and financially. Nursing unions are a joke, delegates lobby for political and personal gain while floor nurses eat each other('Nurses eat their young'). The experienced nurse hates the new nurse, the different degreed nurses terrorize and put each other down; caught in between is the patient who needs care. Advanced degree nurses are not at the bedside to advance the career and improve patient outcome. Many of them feel they should no longer be at the bedside to change diapers. I have heard it being said and not so prettily said either. The few MSN Nurses I know who stay at the bedside, stay because they hate the politics of administration and how self serving those Nurses are. There is only one obstacle in Nursing; Nurses. Encourage and pay for Nurses to return to school, it is the right thing to do. Compensate Nurse Educators; my nursing school could not adequately train student nurses during clinical. Stop the 'who is better' it is not good for the profession. Teach us how to do the job as if it is your child/self in that bed. Screen properly for new candidates, why are people coming into this profession? Do they care about health and healing? Show injured nurses that the profession is also concerned about them and not only the patient who is bringing in income for the facility. When we have done all of this then Nurse Leaders wont have a problem. Nurses will know that this caring profession really cares about them and is not really there waiting to punish, point fingers and condemn while pitting one degree against another. A BSN for entry level will not then be an obstacle to overcome.
16787684 (8/28/2011 at 3:02 PM)

Remember back in the 70's when the surgeon general warned about smoking - and most of the doctors quit while many of the nurses kept right on smoking? I feel that nursing's turning their backs on higher education is a lot like that....
Caitanya Min (8/28/2011 at 7:32 AM)

I will make my comment short and to the point: As a second career nursing student, I think it is disappointing and ultimately detrimental that nurses only need to get a certificate to become a nurse. Do we accept that from doctors? How about employing armchair cancer researchers who like to do it as a hobby? Medicine and healthcare has become more complex from the 1950s and 1960s, etc., and nursing "leaders" and those who want to become nurses need to stop making excuses. I am not dismissing all the kind and wonderful LVNs or non-BSN RNs out there. I'm saying that we need to take it up a notch. We're the only English-speaking country that accepts non-BSN RNs.
Lisa Nabholz (8/26/2011 at 9:32 AM)

Just this thread of comments is evidence of why nurses may be the most trusted among patients yet not respected by other healthcare professionals. Comments about the evidence not supporting the higher level education and outcomes reflect lack of reading the research objectively. Some of the best nurses I've worked with who had excellent knowledge and skills were LPNs, however when it came to the complexities of processing a patient report of symptoms with the scientific/social education/knowledge those with less education respond with limited patient teaching. They follow orders but don't stretch their knowledge to investigate or keep up with new trends based on replicated studies. We would shun an M.D. who had minimal education and updates since medical school. To keep falling back on the school of hard knocks and long bedside hours is not necessarily undisputable facts that nurses are better through trial and error. Don't get me wrong,some of the best compassionate nurses were Non-BSNs, yet they were limited in ability to move the profession to a higher level due to lack of basic higher education rounding out. Physics, geometry etc. explain a great deal about some of our treatment protocols i.e. chest tube management, kidney function etc. Please keep an open mind when considering a BSN or higher.
anonymous (8/25/2011 at 12:31 PM)

I don't understand how evidence shows that BSN nurses improve patient outcomes... My first hand experience differs from that "research." I have oriented and worked with nurses from various educational levels. Some of the BSN nurses I worked with lacked the critical thinking necessary for bedside nursing. I am a nurse returning to school 30 years post diploma. Some of my clinical specialties include ICU and ED, and I have several advanced certifications. My BSN classes include: Advanced Math, Language, and 6 nurses classes which I completed in my diploma program. I find this unessary and insulting. How will geometry improve my clinical skills? Excellent nurses possess clinical knowledge, experience, compassion, good work ethics. That is the nurse I want at my bedside. I don't think patients care about initials, but the other qualities are vital. Regardless of edcuational background, all RNs have passed the same nursing boards. Let's grandfather RNs and move on to our MSNs.
Kim McAllister (8/24/2011 at 7:39 PM)

If I waited for "nurse leaders" to come to a consensus on anything, I'd be in a sorry state. The only "obstacle" to a higher education level in nursing is between the ears of each individual nurse. What does "Professional" (capital "P") mean to YOU? If it's an ADN and an RN licence, more power to you - that's what it meant to me for 29 years. Then I decided that FOR ME, it was time to move on and I earned my BSN. Not because "nursing leaders" said it was time, but because I realized it was time. I will tell you this much from my experience. Until you have the education of a BSN (or MSN or PhD or DNP) or WHATEVER behind you, you do not know what you don't have, and you don't know what you don't know! You can't know. It doesn't make you inferior, it doesn't make you a bad nurse! Hell, I was a great nurse, and I still am. But, to me, personally, I am a more accomplished one. Not compared to my ADN colleague, but to my ADN self. It starts one nurse at a time folks, that is how a profession changes, one nurse at a time. You don't know what you are missing. Not
Ken Wolski, RN (8/24/2011 at 4:28 PM)

I take issue with the narrow focus of the mandated degree, the Bachelor of Science in Nursing (BSN). Nursing is an art as well as a science. The overemphasis on one aspect of nursing is to the detriment of the other. Nurses face a multiplicity of roles in the workplace today and a science background is not necessarily the best preparation for all these roles. Indeed, with the BSN, all we are doing is turning out square pegs for an infinite variety of holes. The requirement should be that the RN attain any baccalaureate degree within ten years. There is no shortage of learning experiences that can help RNs to become better people and hence better nurses. Lifelong learning can then be seen as a joy, and not a mandated chore.
Lisa Nabholz RN MSN/ED (8/24/2011 at 2:21 PM)

The rationale for nurses with higher education improves outcomes is good, however the expectation of these nurses generally is that with the higher degrees will be more money and less direct care. It grieves me to hear many new nurses balk at providing basic nursing care to patients because "that's not what I went to school for". There are probably multiple factors that have contributed to this paradigm shift from a hands on to a hands off approach with patients. However, nursing educators and employers must better prepare nurses for "real nursing", and employers must make the necessary adjustments to nurse patient ratios where the balance between physical and mental work is not overwhelming!
DeAnn (8/24/2011 at 2:01 PM)

The editor is entitled to her opinion, but the "evidence" is just not there to support her contention. RNs are the sentinals who provide the ongoing assessments of patients; there must be sufficient ratios or RNs at the bedside to monitor, intervene and implement treatment when subtle signs and symptoms of deterioration occur. RN staffing must be flexed up from baseline minimums based on the acuity/severity of illness/dependency of the patient/and, experience/competency level of the RN. Having a degree is not the equivalent of validated competency. Continuing education is certainly commendable, but unfortunately, there are confounding variables and flawed methodology in the few studies out there to support a generalizable claim that patient outcomes are improved if the entry into practice degree is Diploma, ADN, or BSN. Aiken, et al, (HSR 2010), makes a much stronger and statistically significant claim to support higher RN to patient ratios.
robert berell (8/24/2011 at 1:35 PM)

The article and some of the comments refer to evidence that BSN prepared RNs provide better patient outcomes than ADN or diploma prepared RNs. However there is no such evidence of that. Surely before the profession can get behind evidence based practice we need to look critically at the issue and not just repeat the evidence myth!
chris (8/24/2011 at 1:24 PM)

Yes, the entry level into nursing should be a BSN. We all know it but let's face it. There are regions in our country that an educated nurse is not a valuable asset. Take it from me....just finished my master's (gerontology clinical nurse specialist) and got offered a clinical nurse job in a magnet facility. The education, years of hard work, stellar employment history and evaluations mean nothing.
jsilver (8/24/2011 at 12:24 PM)

I do not support a BSN requirement for entry into nursing practice, and I am an educator. 1) Politically, it will be VERY difficult (as the ANA is well aware) to get any kind of legislation enacted. Community colleges are very well protected politically, and when legislators are petitioned to make the BSN an entry level, they see a removal of this pathway to individual empowerment. They also question the wisdom of this given the nursing shortage. 2) There are simply not enough 4 year universities to make this a reality, particularly given the increasing shortage of qualified nursing faculty. 3) We have more important priorities in our field, including becoming politically empowered. The CNA/NNOC (now the NNU) has conclusively demonstrated that political empowerment is possible without mandating the BSN.
Christy Price Rabetoy (8/24/2011 at 12:14 PM)

As noted, nurses remain the least educated member of the health care team. As such they do not have, nor will they ever have, any significant influence over health care practices. Why would any reasonable person listen to someone who has only a 2 year degree, or worse yet, no college degree? Providing warm, nurturing bedside care is such a small part of the overall role of "good" nurses. Evidence based care is what real professionals strive to provide. Real professionals have a minimum of a 4 year degree! Period - end of discussion.
Kathleen Bartholomew (8/24/2011 at 11:59 AM)

The title should have been "3 Excuses to Higher Education". Demand, Fear, and Ignoring Evidence are the result of poor leadership.If we continue to be reactive, then where will we end up? Already 20 states are allowing medical assistants to give meds in long term care because of demand! As a profession, we must to what is RIGHT. I have the greatest admiration for ALL nurses-ADN & RN but it is time for leaders to build a bridge and cross our own education chasm.
Teri Bycroft, Ed.D, MSN, RN (8/24/2011 at 11:40 AM)

When I first heard about the IOM/RWJ Future of Nursing Report I thought that once again nursing complacency had allowed the disciple of medicine to try and dictate nursing practice. However, after I read the report, I realized how smart this was. This multidiscipline committee, including nurse leaders, has taken the bull by the horns. M.D.s, not nurses, are telling other M.D.s that RNs are able and have to be allowed to practice at their licensed capabilities if indeed we are to provide adequate healthcare coverage to our citizens. ANA has recommended for over 2 decades that a professional nurse should have a BSN within 10 years of becoming an RN. This report steps that timeline up to within 5 years. While ADN graduates are good nurses, evidence has indeed shown the benefit to patients and employers when an RN has a BSN. I teach in an RN to BSN program and the difference in the students' critical thinking skills is significantly [subjectively] changed and improved by the end of the program. There are many RN to BSN programs that are geared toward the working RN. Is nursing not committed to life long learning?
rkthompson1 (8/24/2011 at 11:12 AM)

I, too, am in agreement with the comments submitted so far. The ADN degree has true value, but not as an end in and of itself. As reported, patient outcomes are enhanced via BSN. However, one wonders what that evidence based information encompasses. Do the studies limit subjects to new BSNs or ADNs who have gone on to the BSN? Would be interesting to know???
Sharon Sussman (8/24/2011 at 11:11 AM)

Question: Why are we the only profession that corrolates the shortage with dollars and cents? (Bandaids vs cures)What about job satisfaction in the quest for recruitment and retention? What about the many studies that evidence improved patient outcomes with nurses who are BSN prepared? What about professionalism and self-efficacy? Last I heard, the AMA is predicting a significant shortage in physicians over the next 5-10 years. But what I am not hearing is cutting standards to increase enrollment in medical schools. Any applicant for this field will have to fulfill the academic prerequisets in good standing, take the MCATs, and spend 4 years in medical school and a minimum 4 years in a residency program. It is time we accept that nursing is becoming more complex and the requirements for practice more evidence based. To achieve the goals of the IOM (which should be our initiative!) for the future of nursing a minimum requirement for entry into practice MUST be a BSN. Nursing is not about tasks but about best practice for improved patient outcomes. Doing things the "way we've always done it" is an unacceptable answer to a huge problem; providing excellence in today's healthcare climate. It is in the best interest of all nursing leaders and all healthcare stakeholders to support this initiative.
Ken Nelson III, MSN, RN, NE-BC (8/24/2011 at 10:47 AM)

Nurses need to look at the value that they bring to society and not the supply and demand when deciding whether or not higher education should be endorsed. We are the largest piece of the health care puzzle, yet in most interdisciplinary conferences at the bedside we are the least educated. The patients that we care for deserve the highest level of expertise, and this includes education that is commensurate with responsibility. As an initial ADN graduate, I felt prepared to give safe care to my patients; however, my critical thinking and ways of knowing increased with each progressive degree that I earned. Now in the role of a nursing unit manager, I have used my successes to encourage staff to pursue advanced degrees and certification. Should a nurse "feel bad" if another nurse has more education than he or she does? I think the real question should be, "What are we as nurse leaders going to do about the data that is staring us in the face?"
Jesse (8/24/2011 at 10:25 AM)

Good points. A couple of observations. approximately 2/3 of the RN work force are associate degree or 2 year degree nurses. Part of the reason for this is that many organizations pay for the license not the degree. In many facilities the salary is exactly the same for the 2 year degree nurse as it is for the 4 year or BSN prepared nurse. Until we convince the employers that the value is there and that they should pay more than a token for the BS prepared nurse it will be very difficult to convince an ADN prepared nurse that there is any reward for being a BSN. Other arguements do exist including the leadership preparation and the opportunities to become nurse leaders. But, clinical bedside nurses often want to stay at the bedside. They don't see being a nursing leader as something for them because they desire to remain in a role that allows them to work with patients and not adminstration.
Dave Hanson (8/24/2011 at 10:22 AM)

Bravo! Thanks for the clarity you brought to this highly charged issue. I'm in complete agreement [INVALID] this doesn't have to be an "either / or" situation. We can and should expect both [INVALID] for one another, our profession and patients. The voice of the nurse leader will be essential in helping us achieve both. Together, stronger, bolder!


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