Michelle BerryMegan Dirks

Jennifer EllifrittAnna Marshall

Entry Level of Preparation for

Registered Nurses

Problem Identification

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

Problem Identification

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)

Problem Identification

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)

Background: Social

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

Background: Economic

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

Background: Ethical

Scrutiny of the nursing profession Retention of nurses Patient protection Making a decision, everyone from all levels

of educational pathways must be on board

Background: Legal and Political

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

Issue Statement

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?

Stakeholders

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

Policy Objectives

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.

Policy Objectives

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.

Policy Alternatives

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.

Policy Alternatives

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.

Criterion 1:Capacity to ensure national consistency in quality of nursing care

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

Criterion 1:Capacity to ensure national consistency in quality of nursing care

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

Criterion 2:Ability to meet national nursing needs

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

Criterion 2:Ability to meet national nursing needs

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

Criterion 3:Likelyhood of giving the nursing profession more credibility

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)

Criterion 3:Likelyhood of giving the nursing profession more credibility

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

Criterion 4: Feasibility of conforming public opinion on education requirements to a single streamlined viewOPTION 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

Criterion 4: Feasibility of conforming public opinion on education requirements to a single streamlined viewOption 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

Comparison of Policy Alternatives

Alternative PoliciesOption 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(+)

Summary & Recommended Policy

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

References

American Association of Colleges of Nursing, Position Statement (2000). The Baccalaureate Degree in Nursing as the Minimal Preparation for Professional Practice. Retrieved from http://www.aacn.nche.edu/publications/positions/baccmin.htm

Barter, M. and McFarland, P. (2001). BSN by 2010: A California initiative. The Journal of Nursing Administration, 31, 141-144.

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 http://cms.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/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), 341-345.

Joel, L. (May 31, 2002). Education for entry into nursing practice: revisited for the 21st century. The Online Journal of Issues in Nursing, 2. Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol72002/No2May2002/EntryintoNursingPractice.aspx

Kaufman, K. (2008). Executive summary from the nursing data review academic year 2005-2006, baccalaureate, associate degree and diploma programs. Nursing Education Perspectives, 29(3), 182-184.

 Long, K., Bernier, S., & Aiken, L. (2004). RN education: a matter of degrees. Nursing, 34(3), 48-51.

Mason, D.J., Leavitt, J.K., & Chaffee, M. W. (Eds.) (2007). Policy & politics in nursing and health care (5th ed.). St. Louis, MO: Saunders Elsevier.

National Council of State Board of Nursing, (2010). Retrieved from http://www.ncsbn.org/index.htm

References

Nursing Shortage. (September, 2009). American association of colleges of nursing. Retrieved from http://www.aacn.nche.edu/media/factsheets/nursingshortage.htm

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 http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/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, 491-494.

Smith, T. (Januray 1, 2010). A policy perspective on the entry into practice issue. The Online Journal of Issues in Nursing, 1. Retrieved from http://cms.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/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), 307-

313. Taylor, D.L. (2008). Should the entry into nursing practice be the baccalaureate

degree? Association of PeriOperative Registered Nurses, 87, 611-620. 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.

Questions?

THE END