The distinction in competencies between an associate-degree nurse (ADN) and a baccalaureate-degree graduate (BSN) is not often clear-cut. The reason for this relates to the similar educational requirements for licensure, which means that the RN license, not the academic pathway, determines practice roles (Matthias, 2015). Nevertheless, fundamental differences exist between ADN and BSN preparation regarding the study duration and credit requirements. While the ADN is a two-year community college diploma in which nurses are prepared for practical and clinical skills, the BSN is a four-year program that further develops the ADN competencies (Matthias, 2015). Therefore, an ADN-prepared nurse is suited for a technical RN role, while a BSN graduate is prepared for professional nursing tasks upon sitting the licensure (NCLEX) exam.
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The BSN practice includes patient assessment, critical thinking, effective communication, care delivery, health teaching, and leadership (Grand Canyon University [GCU], 2016). It was initiated in the 1900s as an entry-level program for public health nursing practitioners (Matthias, 2015). In contrast, the associate degree was designed in the 1950s to develop nurses with technical and clinical skills. In this regard, the philosophical foundation of a BSN program includes tackling contemporary public health issues through health promotion, preventive interventions, compassionate end-of-life care, etc. Thus, baccalaureate nurses are trained on factors affecting health outcomes at the individual, family, and community levels. They learn the legal, ethical practice, and psychosocial issues affecting health care delivery (GCU, 2016). In comparison, associate-degree nurses are primarily prepared for bedside care. They learn skills in routine procedures and clinical decision-making as opposed to broader public health issues. Therefore, the BSN practice is broader in scope than the ADN role.
The outcomes of the quality of care delivered differ between associate-degree and baccalaureate-degree nurses. The elaborate BSN curriculum and educational experiences make baccalaureate-prepared nurses more competent in providing patient care. A retrospective study by Yakusheva, Lindrooth, and Weiss (2014) established that a 10% rise in BSN nurses was correlated with a 10.9% drop in the mortality rate, reduced re-hospitalizations, and shorter LOS. Therefore, baccalaureate preparation exposes students to the broader concepts of patient care and health care delivery to make them effective hands-on RNs.
Career Opportunity Differences
Another distinction relates to career opportunities. Although there is no educational differentiation when it comes to RN practice, differences emerge when making long-term professional choices. Baccalaureate programs incorporate many courses that are lacking in associate-degree curriculums. In particular, BSN-prepared nurses learn management and leadership skills that enable them to take up administrative or faculty roles. They also study nursing theories and informatics to help them research on the complex issues of today’s health care system. In contrast, ADN-prepared nurses are only prepared on bedside care delivery and clinical judgment; thus, they cannot progress to leadership or teaching positions.
The dissimilarities in clinical competencies are not many; however, BSN and ADN nurses differ widely in reflective practice, communication, decision-making, and leadership skills (Yakusheva et al., 2014). Since the baccalaureate graduates have received more in-depth training, they are better prepared to handle complex clinical cases and challenges. The additional educational experiences allow them to question the rationales for standard clinical procedures as opposed to simply using them. However, both BSN and ADN nurses can provide bedside care, administer medication, and monitor patient symptoms as the standard clinical roles.
Patient Care Situation
Critical thinking is an essential skill in making clinical decisions. A program to support and educate first-time mothers on postnatal care at home may involve different decision-making approaches between BSN and ADN nurses. First, their responses to the patient situation will differ, as the baccalaureate-degree graduate will be competent in patient-nurse communication compared to his/her associate-degree counterpart. BSN programs train students in critical thinking, patient assessment, and clinical communication, which empowers them to make evidence-based decisions. As such, a BSN nurse will link the patients to community support programs, e.g., food stamps, and life skills experts to facilitate care continuity.
In case of health complications involving the infant or the mother, the nurse can decide on the specific procedure or intervention required. Although associate-degree and baccalaureate-degree graduates have similar clinical competencies, the BSN nurse is better prepared to deliver safe and quality care compared to the ADN RN. His/her guidance will result in better outcomes for both the mother and the child. The additional training means that he/she is less likely to commit medication errors that may affect the quality of patient care.
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The basis for clinical decision-making is an effective evaluation and understanding of the results to develop a diagnosis. In this case, the mother’s complaints must be assessed in the context of the intervention that would produce optimal outcomes. The BSN nurse is trained to identify and interpret symptoms through effective patient-nurse relationships and make accurate diagnoses promptly. The professional approach to decision-making considers the principles of autonomy, altruistic values, social justice, etc. that are critical to holistic care (GCU, 2016). In contrast, an ADN graduate has only technical/clinical skills; therefore, his/her clinical judgments will be devoid of the spiritual or socio-cultural considerations. Consequently, they will only be partially accurate.
Grand Canyon University [GCU]. (2016). Grand Canyon university college of nursing and health care professions philosophy. Web.
Matthias, A. D. (2015). Making the case for differentiation of registered nurse practice: Historical perspectives meet contemporary efforts. Journal of Nursing Education and Practice, 5(4), 108-115. Web.
Yakusheva, O., Lindrooth, R., & Weiss, M. (2014). Economic evaluation of the 80% baccalaureate nurse workforce recommendation: A patient-level analysis. Medical Care, 52(10), 864-869. Web.