Debate concerning the education standards necessary to enroll into the nursing practice in the United States has been going on for several decades now among all stakeholders, in particular the nurses and the legislators. The idea of having at least two thirds of the nursing workforce enroll for a baccalaureate degree as proposed by the U.S. Department of Health and Human Sciences has elicited both support and opposition from the concerned parties. The medical administrators argue that there are too few degree holders in the nursing career who can handle the complex health care system. Among the few, a higher percentage prefers to pursue further studies; that is, masters and doctorate programs to enable them enter into more lucrative opportunities such as serving as nurse trainers (Shin, Jung, Shin & Kim, 2006).
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According to the American Nurses Association (ANA), the proposed legislation will not affect the current registered nurses (RNs). The law also seeks to maintain the existing educational system in which students pursue professional qualification through associate degree and diploma programs. The program will only affect new entrants into the career seeking initial licensure in those states where the law has been enacted. The law will allow newly licensed RNs, duration of 10 years following the initial licensure, to attain their Bachelor of Science in Nursing (BSN). Antagonists to the law have raised concerns that it could place a financial burden on the nurses as they strive to fulfill the BSN education requirement. The effect of the law has already been felt in the states of New Jersey and New York where nursing colleges have stopped absorbing students owing to inadequate faculties. There is also the unknown fate of the Associate Degree and diploma programs (Hill, Lawson & Rhodes 2008).
Amendments in the nursing profession education curriculum in the United States have been carried out on several instances with an aim to advance the career. In the 1950s, the government introduced the associate degree programs through which thousands of professional nurses have been trained. This program focused on preparing graduate nurses for the National Council of State Boards of Nursing Licensure Examination for Registered Nurses (NCLEX-RN) which allows them to perform as recognized competent nurses across the United States.
Due to the fast changes in technology, medical procedures, complex treatment techniques and emerging chronic health conditions, it has been deemed paramount that nurses continue learning to be at par with the changes. Furthermore, the field of nursing is going through major transformations with emerging issues of ethics and consumer expectations. Therefore, this calls for a renewed approach to overcome these challenges. The new approach proposed entailed starting a baccalaureate program in the nursing profession. Medical experts believe that the Baccalaureate program provides a platform for additional detail and emphasis on nursing theory, and reliance on research for analysis.The program also exposes students to specialized practice models that were never part of the associate degree program (Wolf & Hoerst, 2007). These specializations enable one to gain more knowledge and skills on particular field segments such as public health, clinical medicine and home care among others. The program creates a strong foundation in analytical skills, liberal arts and critical thinking skills that play an important role in the nursing profession to enable one to offer competent care. Curriculum developers have incorporated into the program, lessons on leadership skills that will equip the nurses with knowledge to monitor and supervise licensed practical nurses and other subordinate personnel.The baccalaureate program is also set to address challenges that have resulted due to errors commonly committed by those who have undergone lower cadre course work. The program will also prepare registered nurses (RNs) to gain up-to-date skills to overcome emerging challenges (Viterito, 2006).
The proposed law would apply to future graduates of both diploma and associate degree programs. The current licensed RNs, as well as current students pursuing diploma and associate degree programs, will not be affected by the enactment of the law; thus, they will not be required to acquire the baccalaureate level of qualification. To cater for those nurses who will be affected by this change of qualification criteria, duration of ten years is given to allow as much time as possible for one to acquire the BSN. On request from the particular states’ nursing regulatory bodies, a maximum of two years extension is allowed. The program will also be available on a distance learning model to increase accessibility, and allow for flexibility for all nurses; in particular, those who have busy working schedules or any other commitments. To ease the entry of more nurses into this program, all colleges offering the BSN program have modified their cut-point entry requirements by accepting both associate degree and diploma level RNs credits without necessarily asking for the requirement for validating exams. Further efforts in ensuring wider accessibility of this program to all nurses who may need it include the on-line mode of teaching and work site models that avail learning materials directly at the nurses’ facilities. All these models have been adopted to ensure a wider choice for different student requirements to enable the initiative succeed without disadvantaging any of the new future graduates (Ouzts, Brown & Swearingen, 2006).
Pros and Cons of BSN in TEN
The course content that has been developed for the BSN program has inculcated all elements necessary to prepare an all round nurse. The main focus of the program is the consumer-patient. From the studies carried out by medical experts over the years, a connection has been found between higher education level and improved patient outcome. It has been identified through statistical evidence that as patient care becomes complex, so should be the nurse’s skills. Furthermore, with the emerging trends in customer expectations, the nursing profession requires matching skills in communication, research and leadership. The program structure has put an emphasis on research and evidence based practice, as well as critical and creative thinking skills as opposed to the current model of associate degree and diploma programs whose focus was task-oriented (Viterito, 2006).
Currently, there is a biting shortage of nurses in about all states. Recruitment of more nurses in future depends on the availability of faculty to serve as tutors and offer leadership. Inadequate faculty has curtailed the training of the required number of nurses to satisfy the overwhelming demand in hospitals. In addition, most faculty members currently are fast approaching retirement age. This means there is an urgent need to replace them in order to ensure continuity. This will only be achievable if the currently available nurses advance their academic standards and acquire relevant skills and experience to serve as faculty members. The BSN program readily offers this opportunity (Viterito, 2006).
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The BSN program raises the bar to achieve higher quality training as has been the trend in other medical care disciplines. This will create a sense of credibility among graduates in all interdisciplinary interactions. The program offers an opportunity for a well structured linear model for one to achieve his or her ultimate level of nursing qualification by eliminating the previously existing gap in the curriculum structure; that is, Licensed Practical Nurse to Associate Degree to Bachelor of Science in Nursing to Masters in Nursing to Doctorate level (LPN-AND-BSN-MS-Doctoral). The model allows for professional collaboration and partnerships between the curriculum providers and industry. This creates a platform for increased professionalism, and offers a chance for one to get scholarships or additional tuition reimbursements. It also enables the acquisition of the mandated continuing education for nurses (CE). The various learning models offered by the BSN program give the working class an unparalleled opportunity to work as they further their education. Those pursuing the course while still working also enjoy support at their workplace through incentives. The research based model of teaching adopted in the BSN program will entice a closer collaboration of institutions with the state in areas of disease diagnosis and treatment research techniques (Ouzts, Brown & Swearingen, 2006).
On the other hand, several issues have been raised by those opposed to the program. Antagonists argue that there is no major difference between the BSN and the Ads’ technical expertise since they all have to pass the NCLEX-RN in order to be allowed to practice. Furthermore, experience has shown that most graduates take time to acclimate; therefore, technically BSN may not really be the ultimate solution. Most hospital administrations have expressed reservations to the proposal since the higher nurse qualifications will translate into higher remuneration demands that will in turn increase running costs. Diploma and Associate Degree holders may feel alienated and looked down upon in working settings where they are mixed with the BSN holders. Small hospitals or those based in remote areas may suffer from understaffing as they may not afford to pay the BSN holders.This could negatively affect their service delivery leading to poor patient outcomes. The law could disadvantage many AD nurses since a significant percentage is quite old, and may not be willing to pursue the BSN program despite the ten year allowance. The open learning model proposed may not be entirely successful since most rural settings have no access to reliable technological facilities. Furthermore, technology has its associated limitations (Wolf & Hoerst, 2007).
The research-based learning mode proposed requires substantial investment which may cause financial strain on nursing institutions and the state. The law has not sufficiently addressed issues of articulation. This is a recipe for misunderstanding among the different stakeholders, especially in the area of standardization. To pursue the BSN program will be more expensive than other levels, and this will put off those who cannot afford. Social experts argue that this is discriminatory and may force many to pursue alternative careers. This could eventually see the nursing sector suffer from further shortages in terms of workforce than currently being experienced. Legislators opposed to the proposal argue that amendments to the Nurse Practice Act may face more hurdles than currently being experienced. These include regulating interstate nursing practices, as well as contradictions between the National Licensure and certifications with the individual state laws (Wolf & Hoerst, 2007).
The ‘BSN in TEN’ proposal has both pros and cons and it is important that all stakeholders reach an agreement on any emerging issues. From the context of the debate, it seems that the proponents understand how the program is to address emerging challenges in the complex medical care delivery system, as well as addressing the faculty shortage problem. To bring everyone on board, it is important that nurses and other interest groups are educated on the importance of the program. Stakeholders also need to advocate for funding of the nurses’ education to eliminate the financial barriers that may hinder some from pursuing the course, or increase financial incentives for those pursuing BSN. Therefore, it is important to address all legislative impediments to the actualization of the program, and enhance collaborating in research and removal of redundancy in course content and means of service delivery.
Hill, A., Lawson, R. & Rhodes, R. (2008). Collaborative co-op as a means to expand BSN enrollment & diversity. ABNF J. Spring, 19(2): 48-50.
Ouzts, K. Brown, J. & Swearingen, D. (2006). Developing public health competence among RN-to-BSN students in a rural community. Whitney School of Nursing. University of Wyoming, Laramie, Wyoming, USA. 23(2): 178-82.
Shin, K., Jung, D.Y., Shin, S., Kim, M.S. (2006) Critical thinking dispositions and skills of senior nursing students in associate, baccalaureate, and RN-to-BSN programs. Nurse Education, 45(6): 233-7.
Viterito, A. (2006).A critique of “Education levels of hospital nurses and surgical patient mortality,” Teaching and Learning in Nursing, 1(1): 2-3.
Wolf, Z.R., & Hoerst, B. (2007). Professional commitment in RN-BSN and basic BSN students: program evaluation. Nurse Education, 32(2): 61-5.