In its 2010 The Future of Nursing report, the Institute of Medicine called for increasing the percentage of BSN-prepared nurses to 80% by 2020. Since then, a number of hospitals have implemented BSN-or-above hiring practices for new nurses, and some have required current nursing staff to return to school and earn a BSN in order to keep their jobs.
Unfortunately, there’s no magic wand to make the transition to a mostly BSN-holding nursing workforce a smooth one. Look behind the rising percentage of BSN-prepared nurses, and you will find considerable amounts of money, energy, and time spent—not to mention some feelings bruised on the subject of professional worth.
What’s an employer to do? Here are some disadvantages and advantages of requiring nurses to earn a BSN.
Earning a BSN requires significant out-of-work time. Degrees are awarded, not given, in return for a student’s putting in the time and effort to master curriculum content. Even in the case of online RN-to-BSN programs or classes offered on-site at bigger hospitals, requiring a nurse to earn a BSN is, in essence, requiring a valued staff member to take personal time away from family, friends, and other off-the-job pursuits.
Earning a BSN is financially costly. The cost of completing an RN-to-BSN generally runs between $12,000 and $26,000, plus additional costs for books and other fees each semester, according to a recent article on nursetogether.com. Even if the financial burden is eased through an employer’s tuition assistance program, the price of a BSN is significant—especially so, if a nurse needs to cut back on work hours to complete the required degree.
Mandating the BSN can seem like a dismissal of on-the-job experience. “I have been a nurse for 27 years,” writes one nurse with an associate’s degree in nursing. “I feel that when employers see ADN instead of BSN, they ignore the value of experience. I find it rather offensive, as I have done 4 different specialties in that time, and feel that hands-on experience is much more valuable than 2 more years of nursing school.”
Her view isn’t unique. Ask veteran ADN-prepared nurses what they think of a mandate to earn a BSN, and you will undoubtedly hear similar, deeply-felt sentiments.
A BSN prepares nurses for new professional demands. Healthcare has undergone massive changes in recent years. Today’s nurse is increasingly responsible for a wider slate of duties, including participation in initiatives to improve a hospital’s quality, safety, and efficiency performance. “Nurses are also in the forefront of care coordination and prevention now that more care is being delivered in the home, the community, and remotely,” observes the Robert Wood Johnson Foundation. “Baccalaureate degrees, with their inclusion of public and community health content, help equip nurses to meet these challenges."
Shifting to a mostly BSN nursing staff aligns your facility with the profession. The Institute of Medicine isn’t alone in its BSN-preference. The powerful Tri-Council for Nursing—an alliance of the American Association of Colleges of Nursing, the American Nurses Association, the American Organization of Nurse Executives and the National League for Nursing—came out in support of a more highly educated nursing workforce months [G1] before the IOM report was released, and the American Nurses Credentialing Center now requires Magnet applicants to document their progress in increasing BSN-staffing.
Recent studies suggest more BSNs on staff leads to better care. Within the past couple of years, studies have linked BSN-staffing to declines in patient mortality, readmission rates, and average lengths of stay. The Robert Wood Johnson Foundation also reports that BSN-staffing has been associated with improved outcomes, including lower incidence of pressure ulcers, post-operative deep vein thrombosis, hospital-acquired infections, and post-surgical mortality.
A 2012 article in the New York Times documented one emergency department nurse’s journey to earn a BSN as required by her employer. The mandate impacted her family, household, and even her employment schedule (she shifted to part-time to complete coursework). The article concludes with this:
Yet she endorses the bachelor’s requirement, pointing to the high stakes of her job, working in the emergency room. On a recent day that she described as slow, she had treated, among others, a middle-aged man who fainted in the heat and needed a cardiac work-up, a young woman in withdrawal from an opiate addiction, a pregnant woman with abdominal pain who spoke no English, an elderly woman with a badly infected thumbnail, an elderly man with gastrointestinal bleeding who had an adverse reaction to a plasma transfusion, and a young man whose tingling hands, head pain and elevated blood pressure persuaded a doctor to order a CT scan.
“It blows me away how much influence nurses have on serious treatment decisions,” Ms. Matton said. “After going back to school, I think more critically about what we’re doing, and I have a better understanding of why we’re doing it.”