Healthcare is shifting focus from hospital-centered, individualized inpatient care to more primary and preventive care throughout the community. Experts recognize that more highly educated nurses are needed to ensure that patients have access to skilled, patient-centered care across the care continuum. This requires nurses who can practice in a variety of settings and environments, and function with more independence in clinical decision making.
Care within the hospital setting continues to grow increasingly more complex, and nurses must make critical decisions in providing care for their patients. Due to a tighter job market, rapidly expanding clinical knowledge and mounting complexities in healthcare, many nurses are returning to school to earn their RN-BSN degree.
This article takes a look at industry recommendations, employer preferences and improved patient care with a BSN-prepared nursing staff, as well as the increased salary that BSN graduates can expect.
Preparing nurses at the bachelor’s level has become a national priority. The Pew Health Professions Commission was created to help policy-makers and educators produce healthcare professionals able to meet the changing needs of the U.S. healthcare system. In 1998, they called for a more concentrated production of baccalaureate and higher degree nurses.
Other agencies followed suit. The National Advisory Council on Nurse Education and Practice (NACNEP) calls for at least two-thirds of the nurse workforce to hold baccalaureate or higher degrees in nursing. In 2010, the Institute of Medicine (IOM) called for 80% of the nursing workforce to hold at least a bachelor’s degree by 2020.
This increase in BSN-educated nurses is viewed as necessary to move the workforce to an expanded set of competencies, especially in the domains of community and public health, leadership, systems improvement and change, research, and health policy.
It is essential for nurses to be prepared to meet the diverse needs of patients, function as leaders, and advance science to benefits patients. Consequently, the American Association of Colleges of Nursing (AACN) recognizes the BSN as the minimum educational requirement for professional nursing practice. A BSN education introduces students to a wider range of competencies than other educational pathways.
The BSN curriculum includes the clinical, scientific, decision-making, and humanistic skills necessary to navigate today’s healthcare environment. Franciscan Missionaries of Our Lady University's (FranU) online RN-BSN program offers courses in Evidence-Based Nursing, Leadership Principles in Nursing, Community Health Nursing, Healthcare Policy, and Professional Nursing Concepts, among others.
The IOM supports nurses achieving higher levels of education and training through an improved education system that provides opportunity for a seamless transition to higher degree programs. An RN to BSN degree from FranU can position you for further educational advancement, such as a Master’s of Science in Nursing (MSN).
Employer Preference for BSN-level Nurses
Earning your BSN will make you more desirable to employers. A 2017 online survey conducted by the American Association of Colleges of Nursing (AACN) asked U.S. nursing schools offering baccalaureate and graduate programs if employers in their region were requiring or indicating a preference for hiring new nurses with a BSN.
Responses showed 49% of hospitals and other healthcare settings require new hires to have a BSN, while 86.3% of employers expressed a strong preference for BSN-prepared nurses. A number of national agencies are seeking BSN-level nurses to fill positions within their agencies.
The Veterans Administration (VA) is the country’s largest employer of registered nurses. It has set the baccalaureate degree as the minimum preparation nurses must have for promotion beyond entry-level in VA facilities. The military seeks nurse corps officers who can provide the best patient care and leadership.
In order to practice as an active duty nurse in the Army, Navy, or Air Force, you must possess a BSN. The U.S. Public Health Service also requires commissioned officers to be baccalaureate-prepared.
The ANCC developed the Magnet Recognition Program to recognize organizations that value nursing talent and provide nursing excellence. Nurses strive to work at Magnet hospitals. These facilities outperform non-Magnet hospitals in patient outcomes (lower occurrence of falls, pressure ulcers, mortality, and failure-to-rescue, and higher patient satisfaction), nursing workforce measures (higher RN retention rates, nurse staffing ratios, and proportion of nurses with specialty certifications) and other areas such as lower occupational injury rates.
Nurses understand Magnet Recognition means they will receive education and development through every career stage. As of January 1, 2013, to qualify for Magnet status, 100% of nurse managers in the organization must hold a BSN or graduate degree in nursing.
Although the ANCC doesn't specifically mandate a bachelor’s degree for direct care nurses, in a typical Magnet facility, 48.4% of direct care nurses hold a BSN.
Improved Patient Care
A growing body of research supports an association between higher proportions of BSN-prepared nurses on staff and better patient outcomes. A landmark study conducted by L. Aiken found that patients in hospitals in Pennsylvania had “a substantial survival advantage” if they were treated in hospitals with higher proportions of BSN-prepared nurses. A 10% increase in the proportion of BSN-prepared nurses was associated with a 5% decline in mortality following common surgical procedures.
These results were confirmed in a later study by C. Estabrooks and colleagues. In a study titled “An Increase in the Number of Nurses with Baccalaureate Degrees is Linked to Lower Rates of Post-surgery Mortality,” nurse researcher A.
Kutney-Lee and colleagues found that a 10-point increase in the percentage of BSN-prepared nurses within a hospital was associated with an average reduction of 2.12 deaths for every 1,000 patients. For a subset of patients with complications, an average reduction of 7.47 deaths per 1,000 patients was found.
In an article published in Health Services Research, C. Friese and colleagues conclude that “moving to a nurse workforce in which a higher proportion of staff nurses have at least a baccalaureate-level education would result in substantially fewer adverse outcomes for patients.”
Their research on the effect of nursing practice environments on outcomes of hospitalized cancer patients undergoing surgery, found that BSN-prepared nurses were significantly associated with lower mortality and failure-to-rescue rates. The study “Baccalaureate Education in Nursing and Patient Outcomes” examined the association between RN education and patient outcomes.
The researchers discovered that hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower failure to rescue, congestive heart failure mortality, decubitus ulcers, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay.
Even with specialty certification, ADN-prepared nurses are unable to close the gap on providing better patient care. In the Journal of Nursing Scholarship, Drs. Deborah Kendall-Gallagher, Linda Aiken, and colleagues released the findings of an extensive study of the impact nurse specialty certification has on lowering patient mortality and failure to rescue rates in hospital settings.
Researchers found that certification was associated with better patient outcomes, but only when care was provided by nurses with BSN-level education. Evidence shows that patient safety is impacted by nursing education level. As cited in the Milbank Memorial Fund report When Care Becomes a Burden, two separate studies conducted in 1996 showed significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree (ADN) and diploma levels as compared with the baccalaureate level.
These findings are consistent with findings published in the July/August 2002 issue of Nurse Educator magazine that referenced other studies finding that nurses prepared at the ADN and diploma levels make the majority of practice-related violations.
More Job Options and Increased Responsibility
The more education you have, the more opportunity and options you’ll have for furthering your career. A growing body of research suggests that a bachelor’s degree or higher prepares nurses for greater professional responsibility and more complex practice.
Unlike associate degree programs, BSN curriculum provides courses on navigating evidence-based practice, health policy and finance, interprofessional communication and collaboration, systems leadership, disease prevention and population management. These topics are of vital importance for nurses tasked with managing a challenging and increasingly diverse healthcare environment.
ADN-prepared nurses largely function at the bedside in less complex patient care situations. The nurse with a baccalaureate degree is prepared to make life-and-death decisions; design and manage a comprehensive plan of nursing care; understand a patient's treatment, symptoms, and danger signs; supervise other nursing personnel and support staff; master advanced technology; guide patients through the maze of health care resources in a community; and educate patients on health care options and how to adopt healthy lifestyles.
Many BSN-prepared nurses do provide direct patient care. They serve in leadership positions in case management, care management, and health education. These positions typically require nurses to have completed a bachelor’s degree or higher.
Nurse leaders set the tone for professionalism and the value of continued education on their units. A study titled “Understanding Clinical Expertise: Nurse Education, Experience, and the Hospital Context” discovered that the composition of the hospital staff, particularly the proportion of nurses with at least a BSN, was associated with significantly greater odds of a nurse reporting a more advanced clinical expertise level.
Although a nurse's education level and years of experience influence his or her level of expertise, gains in the probability of an individual nurse being an expert can also be achieved through having a nursing staff that is more educated. If the IOM goal of having an 80% BSN prepared workforce by 2020, strong role modeling by those in leadership roles is vital.
BSN graduates can expect a financial return on their investment. According to Payscale.com, the average annual salary for BSN-prepared nurses is $78,000, as compared to $67,000 for ADN-prepared nurses.
Nurses with a bachelor’s degree are also prepared to fill management positions that are more highly compensated. They are also positioned to advance their education and earn a graduate degree which may lead to a larger salary.
Get started on the path to career advanced today. FranU’s 100% online RN-BSN program is an excellent option for busy nurses looking to learn the skills needed to succeed in today’s complex healthcare environment. Contact us today to find out more about the program.
For more information please see Why Nurses Over 50 Flock to Online BSN and MSN Programs and 5 Easy Steps to Become a Tech Savvy Nurse.
American Association of Colleges of Nursing (2017). Employment of new nurse graduates and employer preferences for baccalaureate-prepared nurses. Retrieved from the AACN website.
American Association of Colleges of Nursing (2000, December 12). The baccalaureate degree in nursing as minimal preparation for professional practice [Position Statement]. Retrieved from the AACN website.
American Nurses Credentialing Center (n.d.). AANC Magnet Recognition Program. Retrieved on September 23, 2018 from the ANCC website.
Hawkins, J. E., and Shell, A. (2012, March). Magnet hospitals are attracted to the BSN but what’s in it for nurses? Nursing2018, 42(3), 50-52.
Institute of Medicine (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
McHugh, M. D., and Lake, E. T. (2010). Understanding clinical expertise: Nurse education, experience, and the hospital context. Research in Nursing & Health, 33(4), 276–287.
PayScale (n.d.). Associate degree nursing (ADN) degree. Retrieved on September 23, 2018 from the PayScale website.
PayScale (n.d.). Bachelor of science in nursing (BSN) degree. Retrieved on September 23, 2018 from the PayScale website.
Robert Wood Johnson Foundation (2013). Charting nursing’s future: Reports on policies that can transform patient care. Washington, DC: The George Washington University.
Sherman, R. O. (2013, January 17). Why nurse managers need a BSN. Retrieved from the Emerging RN Leader website.