Maria chose to go to a two-year nursing program because she was raising her daughter alone and needed the income, while Jason decided he wanted a BSN and chose to stick it out for four years. Both work side by side and both are Registered Nurses. They assess, monitor, give medications, hang IVs and perform the same procedures. Is a BSN really necessary for nurses, the hospital and the patient?
In 1860 Florence Nightingale set up the first nursing curriculum to meet the needs of the hospital. This made it possible for individuals who were outside of religious organizations and the military to become nurses. Soon after, in the late 1800s, visiting nursing was taught and the American Nurses Association began regulating nursing. In 1923, Yale University established nursing programs based on educational needs, rather than the needs of hospitals, setting the stage for future nursing education. Nursing has since grown with specialization and many diverse opportunities. Pressing new demands are on the horizon with healthcare reform and the growing shift in providing care as it moves from the hospital setting to home and community.
More is required of nursing across the entire continuum of healthcare patients with complex needs requiring critical decisions, the integration of technology and the analysis of data. As nurses are required to coordinate care among practitioners, institutions and community agencies — pressure increases to prevent readmission — the BSN preparation, as the standard for entry-level practice, would better prepare nurses for these roles.
Nursing is one of the few professions with such a diverse path to its practice. Until the 1980s Diploma schools produced half of all the nurses. Diploma programs focused on preparing staff to meet the needs of hospitals. With most of these Diploma schools now closed, community colleges produce 60 percent of all nurses and provide a shorter path to becoming a nurse with two-year programs. These two-year programs were born from the need to turn out nurses quickly due to a shortage after WWII.
Currently, regardless of the educational preparation, nurses who pass their state licensing exams become a Registered Nurse. This licensing exam defines entry-level practice with a primary focus in acute care within the hospital setting. What about standards for continued practice, professional development and the expanded roles of nurses today?
In the 40-year debate over the standard for nursing education, there has been no conclusive evidence in the relationship between patient outcomes and nursing education and this has been a major argument against setting a standard for nursing education.
There are other, more pressing reasons today to establish the BSN as the nursing educational standard in light of what is ahead with the changing demands in healthcare. In a study done by Kovner and group (2010), the BSN preparation was found to provide higher levels of preparation in evidence-based practice, research and the area of teamwork and collaboration. There are many studies including the Carnegie Foundation (2009), Macy Foundation (2010) and two Institute of Medicine (IOM) reports (2003, 2009) calling for changes in nursing education to include lifelong learning and competencies that will improve collaboration between physicians and nurses.
The educational diversity of nursing can be a barrier to the expanded roles and competencies required in nursing today. BSN preparation exposes nurses to the needed competencies in leadership, systems thinking, healthcare financing and policy.
In a groundbreaking report Initiative on the Future of Nursing, produced as a collaborative effort between the Institute of Medicine and the Robert Woods Johnson foundation, the performance of the nursing workforce was examined in the context of new demands due to healthcare reform and the continued expansion of healthcare information technology. With more emphasis on public health and policy, community health, disease management, prevention and health promotion, nurses need competencies in these areas already built into the BSN program. Never before has there been a more pressing need to reform nursing education and establish the BSN as the educational standard for nursing.
Establishing a more uniform standard for nursing education provides the foundation to meet these growing demands. Healthcare will continue to change along with the needs of institutions, community, public policy and patients themselves, and nursing needs to be in a position to meet these challenges.