Entry Level of Preparation for Registered Nurses

 Nationally, there is no single standard for the level of education required to be prepared for entry into professional nursing practice  Currently graduates of Diploma programs, Associate degrees (ADN), & Bachelor degrees (BSN), despite significantly different learning experiences, are eligible to take the same licensing exam (NCLEX) and are considered ‘equal’ in the nursing field

 This issue has been debated in nursing circles for nearly 100 years  A host of societal and educational circumstances has contributed to a long history of “straddling the fence between expedient educational programs and those that create professionalism” (Joel, 2002)

 Nurses are the least educated of all the healthcare professionals with whom we collaborate - Most require a baccalaureate- level education, at least, and many require a Master’s or higher  The problem is complicated as the US faces an ‘increase in demand for nursing services, an aging nursing workforce, and a shortage of nurses’ (MLC, p.85, 2007)

 Nursing is the largest health care profession  Nurses are often considered undereducated when compared to other health care professionals  3 avenues of training are recognized to become a Registered Nurse  Nurses in the workforce in 2007:  58.4% Associate Degree Level  38.4% Baccalaureate Degree Level  3.1% Diploma Program

 Nursing shortage vs. the economic recession  Quicker access to a nursing degree is not the answer  The cost of a baccalaureate degree compared to an associate degree

 Scrutiny of the nursing profession  Retention of nurses  Patient protection  Making a decision, everyone from all levels of educational pathways must be on board

 1965 ANA position statement  No significant changed has taken place since their first proposal over 40 years ago  Veterans Administration System requirements  Association of California Nurse Leaders  BSN in 2010

 What should be the educational requirement for entry level nurses to ensure the necessary supply of entry level nurses are prepared for the nursing shortage, while ensuring that the newly graduated nurses are well prepared for professional practice in nursing with a high level of competence?

 Nurses  Hospitals  Educational programs  State boards of nursing  Educational programs  Patients  Employers of nurses  Various professional organizations.

 Establishing policies nationwide that are consistent, so that high-quality nursing care is given to all recipients.  Ensuring that through policy change, an adequate number of nurses will be introduced into the work field to fill the nursing shortage.

 Requiring nurses to have a higher level of education, giving nurses more of credibility in the medical field, and allowing them to be policy makers themselves.  Through public education and recruitment, explain the differences in the types of nursing education programs available and explain the importance of the baccalaureate degree and its necessity to further nursing education.

 Do Nothing Option: Continue to allow registered nurses to receive their nursing degree and practice after completing a diploma program, an associate’s degree or a baccalaureate degree.  Incremental Change Option: Continue to allow diploma and associate nursing degree education programs to graduate students. Require these graduates complete their baccalaureate degree within a set time period.

 Major Change Option: Implement a nationwide policy requiring nursing education programs to transition to all baccalaureate degree programs within a set time period, to ensure all nurses have at the minimum a bachelor’s degree in nursing.

OPTION 1: DO NOTHING OPTION Pro: NCLEX-RN is passed by all education levels Con: Patient outcomes are improved through higher education OPTION 2: INCREMENTAL CHANGE OPTION Pro: Baccalaureate earned by all leads to improved consistent outcomes Con: Associate and Diploma still in practice

Option 3: Major change option Pro: Only one education level practicing as registered nurses, improved quality shown with baccalaureate programs Con: Education level does not ensure consistence

OPTION 1: DO NOTHING OPTION Pro: All levels continue to add to nursing new grads, all levels continue to add to practicing RNs Con: Baccalaureate programs admit at highest rate, other factors to consider such as age OPTION 2: INCREMENTAL CHANGE OPTION Pro: Diploma has highest NCLEX pass rates (92%), doesn’t rid nursing of highest pass rates Con: Less people likely to go into nursing due to increased time and money

Option 3: Major change option Pro: Questionable, some may go into nursing with higher education goals Con: Over half new grads in 2008 were associate prepared, Cost of developing education for new nurses is astronomical

OPTION 1: NO CHANGE OPTION Pro: Strength in numbers Con: Out lobbied by AMA, Low education leads to low political credibility OPTION 2: INCREMENTAL CHANGE OPTION Pro: Higher education leads to more credibility, Improving patient outcomes will allow for increased credibility Con: Associate and Diploma nurses will still be practicing (no distinctions made)

Option 3: Major change option Pro: Higher education leads to higher credibility, drastic change will show commitment to credibility Con: Credibility of NCLEX-RN will be questioned

OPTION 1: DO NOTHING OPTION Pro: Feasible with no change needed Con: No change will not allow for conformity in public view OPTION 2: INCREMENTAL CHANGE OPTION Pro: Shows public that level baccalaureate level is the best by requiring it Con: Further confuses the public on how nurses become nurses, leads to more educational avenues

Option 3: Major change option Pro: Public will understand single avenue to become a registered nurse Con: May be a costly change in the beginning stages

Alternative Policies Option 1:‘Do Nothing’ Diploma, ADN, & BSN graduates can all earn RN license Option 2: Diploma & ADN can earn RN license, but must earn BSN within set time of entering practice Option 3: BSN is minimum required education to earn RN and enter into practice Evaluation Criteria Capacity to ensure national consistency in quality of nursing care (-)(+)(++) Ability to meet national nursing needs (++) (+) Likelihood of giving the nursing profession more credibility (-)(+)(++) Feasibility of conforming public opinion on education requirements to a single, streamlined view (-)(+)(++) Score 1(-)5(+)7(+)

 Nursing, as a profession, must adopt a single, national standard  The BSN should be the level of education recognized as the minimum level of education required to be prepared for entry into registered nursing practice

 American Association of Colleges of Nursing, Position Statement (2000). The Baccalaureate Degree in Nursing as the Minimal Preparation for Professional Practice. Retrieved from  Barter, M. and McFarland, P. (2001). BSN by 2010: A California initiative. The Journal of Nursing Administration, 31,  Donley, R. and Flaherty, M.J. (May 2, 2002). Revisiting the American nurses association’s first position on education for nurses. The Online Journal of Issues in Nursing, 7. Retrieved from TableofContents/Volume72002/No2May2002/RevisingPostiononEducation.aspx TableofContents/Volume72002/No2May2002/RevisingPostiononEducation.aspx  George, S., & Young, W. (1990). Baccalaureate entry into practice: an example of political innovation and diffusion. Journal of Nursing Education, 29(8),  Joel, L. (May 31, 2002). Education for entry into nursing practice: revisited for the 21 st century. The Online Journal of Issues in Nursing, 2. Retrieved from N/TableofContents/vol72002/No2May2002/EntryintoNursingPractice.aspx N/TableofContents/vol72002/No2May2002/EntryintoNursingPractice.aspx  Kaufman, K. (2008). Executive summary from the nursing data review academic year , baccalaureate, associate degree and diploma programs. Nursing Education Perspectives, 29(3),  Long, K., Bernier, S., & Aiken, L. (2004). RN education: a matter of degrees. Nursing, 34(3),  Mason, D.J., Leavitt, J.K., & Chaffee, M. W. (Eds.) (2007). Policy & politics in nursing and health care (5 th ed.). St. Louis, MO: Saunders Elsevier.  National Council of State Board of Nursing, (2010). Retrieved from

 Nursing Shortage. (September, 2009). American association of colleges of nursing. Retrieved from  Raines, C.F., & Taglaireni, M.E., (September 30, 2008) Career pathways in nursing: entry points and academic progression. The Online Journal of Issues in Nursing, 3. Retrieved from JIN/TableofContents/vol132008/No3Sept08/CareerEntryPoints.aspx JIN/TableofContents/vol132008/No3Sept08/CareerEntryPoints.aspx  Smith, J.E. (2002). Analysis of differences in entry-level RN practice by educational preparation. Journal of Nursing Education, 41,  Smith, T. (Januray 1, 2010). A policy perspective on the entry into practice issue. The Online Journal of Issues in Nursing, 1. Retrieved from IN/TableofContents/Vol152010/No1Jan2010/Articles-Previous-Topic/Policy-and-Entry- into-Practice.aspx IN/TableofContents/Vol152010/No1Jan2010/Articles-Previous-Topic/Policy-and-Entry- into-Practice.aspx  Spencer, J. (2008). Increasing RN-BSN enrollments: facilitating articulation through curriculum reform. The Journal of Continuing Education in Nursing, 39(7),  Taylor, D.L. (2008). Should the entry into nursing practice be the baccalaureate degree? Association of PeriOperative Registered Nurses, 87,  Thompson, P. (2005). Tomorrow's nurse. We all have a stake in the redefinition of nursing's role and education requirements. Hospitals & Health Networks / AHA, 79(6), 106.

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