BSN as Entry-Level Requirement
To those of you who earned an ADN several decades ago and believe you can nurse circles around today's new grads (and I don't doubt that's true), let me say, before you write a letter, that I understand you are a good and valuable nurses. I don't question your skills, especially at the bedside, and I don't think you should have to go back to school to earn a degree if you have years of experience. That said, I believe the entry level education for nursing should be at least a bachelor's. Healthcare is not what it was 20 years ago and nurses need to change along with it.
To me, it's simple: research supports there are better outcomes when nurses have a BSN. Among the many resources to support this is "Charting Nursing's Future" from the Robert Wood Johnson Foundation. As an industry that supports evidence-based practice, nursing should follow the evidence in regard to education levels.
One of the benefits of the ADN is that is makes entry into nursing affordable. Paying for a two-year degree makes the field accessible to many more people who are qualified academically. Currently, as noted in this issue's cover story, community colleges and four-year universities are partnering in what is now RN-to-BSN programs. A similar model could be developed, but the requirement to take the licensing exam would be a bachelor's degree.
One of the things nursing is doing right is differentiating nurses who practice at advanced levels. Advanced practice nurses (NP, CNS, CRNA, CNM) are recognized by healthcare systems, physicians and increasingly by the public, as having knowledge and skills beyond the staff RN. The acknowledgement is well earned and necessary, especially for nurse practitioners and clinical nurse specialists, who are taking on more leadership roles within health systems (and independent practice in the case of the NP) in conjunction with their clinical expertise.
Nurses have to be part of the health system leadership team. In a recent online article, "Non-Nurse Nursing Directors?" we heard loud and clear that many believe only a nurse can lead nurses. But there are additional skills needed for most leadership positions and education is the way to acquire that knowledge and it begins with a bachelor's degree, which could lead to an MSN or doctoral degree.
Johns Hopkins School of Nursing recognizes the need for higher education for nurse leaders and has taken a unique approach. Just announced is the "Master's Entry Into Nursing" program designed for students with a bachelor's degree not in nursing. Students will graduate with a master's degree and be eligible to take NCLEX.
"The future of healthcare demands that nurses have a solid foundation in evidence-based practice, strong leadership skills, and a commitment to lifelong learning," noted Johns Hopkins School of Nursing Dean Patricia M. Davidson, PhD, MEd, RN, FAAN.
Time for Change
Other healthcare disciplines have successfully changed their entry level requirements. Physical therapy is a good example. It moved from certificate to a bachelor's degree in the ‘50s, to master's in the ‘80s. And now, the vision of the national association (APTA) is "By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy." The changes did not result in a devastating shortage, but instead elevated the field academically, professionally and clinically. It's time for nursing to catch up with other healthcare professions and require a bachelor's degree as entry to the field.