80% BSN by 2020: Where Are We Now?

In 2010, the 80% BSN by 2020 initiative rolled out in an effort to boost nursing’s competency level.  Have we reach the 80% goal?   Read on to find out if we’ve made progress over the past 10 years.

80% BSN by 2020: Where Are We Now?

A decade ago, our healthcare system was growing more complex and patients were sicker than ever.  In response, The Robert Wood Johnson Foundation and the Institute of Medicine (IOM) rolled out a 2-year initiative to determine if the nursing workforce was prepared to face these challenges. Data was gathered, analyzed and in 2010, the IOM released a report of evidence based recommendations to improve the skill and competency of working nurses.

80% BSN by 2020

The report was clear… nurses needed a higher level of education. Therefore, the IOM pushed for more BSN nurses by setting the goal of 80% of RNs earning a BSN by 2020. When the report was released in 2010, only 49% of nurses were educated on a baccalaureate level. 

Distinct Differences

BSN and ADN nurses fill many of the same positions, with both performing similar tasks.  But, there is a growing number of research studies that show BSN graduates bring greater skill to their work than ADN or diploma graduates. The American Association of Colleges of Nursing (AACN)  provides an overview of numerous studies in the fact sheet, The Impact of Education on Nursing Practice. 

According to research, BSN graduates are better prepared to:

  • Use evidence-based practice
  • Analyze data
  • Implement and manage projects
  • Communicate with other disciplines 
  • Promote patient safety
  • Work in leadership positions

Nurses with a bachelor degree have also been linked to:

  • Lower odds of patient deaths
  • Better patient outcomes
  • Leading to lower costs
  • Fewer adverse events
  • Fewer medication errors
  • Stronger use of research
  • Stronger leadership skills

Progress Towards Goal

The nursing profession won’t meet the goal of an 80% BSN workforce by 2020, but progress is being made.  The Future of Nursing’s Campaign for Action works to implement the IOM’s 2010 recommendations.  Here is a quick look at their progress:

  • Starting in 2012, the number of nurses graduating with a BSN, including RN-to-BSN, is higher than those graduating with an associate degree.
  • From 2010 to 2012, the number of RN-to-BSN graduates increased by 180%.
  • In 2018, the percentage of working nurses with a bachelor's degree (or higher) was up from 49% in 2010 to 57% in 2018.
  • Since 2010, the number of nurses with a doctorate degree has doubled.

To reduce the hurdles faced by nurses in obtaining advanced degrees, 30 states are now enrolling nursing students into 1 of 5 promising program models:

  • RN-to-BSN degree from a community college to allow RNs to complete bachelor education at a community college
  • State or regionally shared outcomes-based curriculum
  • Accelerated RN-to-MSN programs
  • Shared statewide or regional curriculum between universities and community colleges.
  • Shared baccalaureate curriculum to shorten the time between obtaining an associate and a bachelor's degree.

Making it Easier to Return to School

ADN graduates share common concerns about returning to school. Online RN-to-BSN programs are designed to address these concerns by:

  • Building on previous education to shorten the time it takes to earn a BSN
  • Providing multiple start dates for RNs to enroll at a time convenient for them
  • Formatting coursework to be completed at a time and place that works best for the student
  • Making online programs more affordable than traditional campus-based programs

Nurses may also qualify for loan forgiveness and loan-for-service programs

BSN Minimal Degree for Entry Level Nurse

The American Association of Colleges of Nursing (AACN) stated in a draft position paper the organization “strongly believes that registered nurses should be minimally prepared with the bachelor of science in nursing or equivalent nursing degree”.

So where does this leave the associate level nurse?  The National League for Nursing (NLN) argues entry points into the nursing profession shouldn’t be limited, as more nurses are needed to ease the nursing shortage.  In addition, the NLN argues 2-year community college programs are “front and center in attracting students of color and those who may be marginalized by economic disadvantage”.

Does The ADN Still Matter?

We are all feeling the strain of the nursing shortage, especially as the pandemic marches on.  What does this mean for ADN graduates?  It’s impossible for baccalaureate programs to graduate enough nurses in a time-frame needed to fill the current (and future) shortage gap.  Both inpatient and outpatient settings need all the nursing “hands on deck” they can get.  So, the answer is a loud “YES”, associate trained nurses are still needed and new grads will have no problem finding a job.

What Do You Think?

Do you agree with requiring a percentage of working nurses to hold BSNs?  Also, is it fair for employers to mandate the nurses they hire to obtain a bachelor degree within a specific time-frame?


References:

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J.Adderton

About J.Adderton, BSN, MSN

(Columnist)

I have been a nurse for over 25 years, specializing in community health, education and project management.  I have now come full circle and am enjoying bedside nursing.

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Thanks for the update on these initiatives. 

In today's world, all nurses are needed to handle the COVID overloads nurses are having to handle.  

All Nurses Matter!

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Specializes in Education, FP, LNC, Forensics, ED, OB.
5 hours ago, tnbutterfly - Mary said:

Thanks for the update on these initiatives. 

In today's world, all nurses are needed to handle the COVID overloads nurses are having to handle.  

All Nurses Matter!

Totally agree, @tnbutterfly - Mary

Thank you, @J.Adderton, for this update.

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Well....

IMO:

The selling point (having supposedly better-educated RNs at the bedside to care for sicker patients) has been shown to be a complete ruse in my mind, as evidenced by:

  • The sheer amount of anti-intellectualism that has accompanied all of this
  • The fact that very painfully little of the difference between ADN programs and BSN programs has anything to do with taking better nursing care of sicker patients (more patho, deeper understanding of treatments/therapies and their indications, etc)
  • The fact that employers are actually quite perfectly satisfied with keeping very few proficient/expert nurses at the bedside, regardless of anyone's level of education.
  • The fact that this wasn't about patients and their safety and well-being (if it were, one would not expect employers to expend any effort to have BSNs only to turn around and utterly cripple those nurses' ability to provide excellent patient care).

The logical conclusion is that this was never about having better-educated nurses to care for sicker patients. Or needing "professionals" at the bedside.

I put this in the category of an attempt at engineering by people who are *clearly* way out of their league.

 

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Having been a ADN nurse for almost 30 years, I don't believe for a minute that a BSN is a better nurse.  Let's face it, we are on the job learner's!  Nursing school at any level does not make us ready for the real world of nursing.  

If anyone believes taking a RN to BSN course online will make us better nurses, that's just crazy.  

In my experience, entry level BSN nurses just think they are smarter, but their practice shows the truth.

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Specializes in ICU.

In my neck of the woods, nurses in the hospitals continue to comment that the local ADN programs offer more clinical hours and better prepare their nurses to enter practice. I’m not sure how true that is but it seems to be a common theme in my area. I came from an ADN program as I had a prior BA in an unrelated field, so the community college is how I was able to afford going back to school to be a nurse. I think I held up great to my fellow new grads with BSN degrees. However, I could certainly see how spending more time studying any subject has the potential to bring more skill.

I like the point about getting nurses prepared from disadvantaged areas through community college education. I do believe we would be leaving behind a lot of smart and dedicated nurses if we didn’t offer that option as the universities are so overpriced, among other financial issues with getting a four year degree.

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Specializes in Critical Care.

I participated in a group initiated by the state a couple of decades ago that had the goal of transitioning to BSN-as-entry-to-practice.  We first thought this would be fairly straightforward, which was followed by realizing it's more complicated, which was followed by realizing it was just a bad idea. 

We concluded that our best guess as to why studies suggested better patient outcomes when cared for by BSN nurses was the curriculum, so our recommendation was that all nursing programs adopt BSN curriculum, which is now a state mandate in the state as well as a number of other states.  So the goal effectively morphed into 80% BSN curriculum by 2020, which we've met.

The first issue we had was that you can't just expand existing BSN programs without harming the quality of the education.  This is because BSN programs already face challenges with clinical availability (they often have a higher ratio of students to clinical placements), so further increasing their program size exponentially without the same increase in clinical opportunities wouldn't be beneficial.

The other issue was that these would significantly reduce the number of second-career nurses and to a lesser degree nurses from diverse backgrounds.  Unlike assembling widgets in a factory, the quality of the profession of nursing relies on the life experience and resulting wisdom of those in the profession, so it was considered detrimental to remove the education pathway many if not most of these nurses take.

The proposed solution was to turn current ADN programs into satellite BSN programs.  Basically, BSN programs would expand their programs into off-campus programs (taught at Community Colleges).  Even though some of these satellite programs already existed, the representatives of BSN programs weren't in agreement this.  They were surprisingly honest in just coming out and saying that they stood to make more money if they took the typically one quarter's worth of credits that separated an ADN program from a BSN program and stretch that out into a year long RN to BSN program.  I was pretty astounded that this came from a public University administrator but they're under nearly the same pressure to bring in revenue that a for-profit school is.

In the end, we decided on the system that generally exists now; encourage or even require programs to adopt BSN program curriculum, and to not require ADN nurses to transition to a BSN degree through an RN-to-BSN program.  Nursing is already challenged by short career spans, and a RN-to-BSN program requirement would only exacerbate that problem with little apparent offsetting benefit.

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Interesting comments, Muno.

On 11/14/2020 at 5:50 PM, MunoRN said:

The first issue we had was that you can't just expand existing BSN programs without harming the quality of the education.  This is because BSN programs already face challenges with clinical availability (they often have a higher ratio of students to clinical placements), so further increasing their program size exponentially without the same increase in clinical opportunities wouldn't be beneficial.

Well that and the fact that portion of curriculum found in BSN programs and "missing" in ADN programs just doesn't have jack to do with (better) assessing patients, making plans for their care, delivering their interventions in an appropriate manner and reevaluating their statuses. It has nothing to do with the nursing process as it applied at the bedside.

I realize this is my experience; my take on the situation. I would love to know if you can comment about whether there were any conversations about this in your experience on the task force/group in which you participated.

I firmly believe that the bridge programs prepare nurses to do "something else" [other than provide direct patient care]. There's nothing wrong with a certain portion of us wanting to do something besides provide direct care to patients. It's just that it all begs the question of why the focus of all of this had to be (or seemed to be) on nurses who love to care for patients--or why, if it was going to be about improving care at the bedside, it didn't result in a curriculum that focused on that.

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Specializes in Med-Surg.

I see nothing has changed much in this discussion of ADN vs. BSN

I'm now at the point I was an ADN for half of my nursing career and I got my BSN in 2007 and have been a BSN for the last half.  For me it has been time and experience that have made me a better clinician and critical thinking, not my degree.  

However, at the end of the day I do support the idea of BSN being the degree for nurses.   

The hospital I work for was recently bought out again and they are encouraging RNs to get the BSN with pay increases and tuition reimbursement at 100%.  

However, telling an ADN that's worked for you 25 years that they must get a BSN will not make that nurse a better nurse and perhaps shouldn't be forced.

As you can tell I'm all over the place and see both sides.  This discussion could have been 30 years ago and I'm betting 30 years from now we'll be talking about it the same way.

Thanks for the update. 

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Specializes in Peds ED.

I think having multiple paths to nursing to increase the accessibility of the career is important. If it’s the curriculum that makes the difference and schools are covering the same curriculum, it’s seems like a win for affordable and accessible higher education.

I’m always dismayed though that in these conversations, the only education that is often considered valuable to the bedside nurse is education that is directly applicable to bedside nursing. My first degree was in Literature and that absolutely has had an impact on my critical thinking skills as a nurse. I definitely don’t recommend folks who want to become nurses spend 4 years getting a liberal arts degree first, because my path was less than ideal in many ways, but I noticed that the folks in my Accelerated BSN program who came from similar liberal arts backgrounds had less of an issue acclimating to the “none of the answers are incorrect but one is more correct than the others” style of questions than my classmates who came from science backgrounds did. Even if you don’t plan to leave bedside care, I think there’s a big difference between the “fluff” of a university stretching curriculum to make more money off bedside nurses and the “fluff” that isn’t directly related to bedside care.

The other thing that is missing from these studies is acknowledgment that while there might be overall trends favoring one degree over another, on a micro level the specific program makes a huge difference. I work in a city that has two amazing, hospital-based diploma programs. Most of my coworkers graduated from one or the other and the programs are highly regarded, and the graduates are sought after by hospitals in the region. Where I lived when I went to nursing school, some of the BSN programs had better clinical placements than most of the ADN programs and most of the local facilities also only hired new grads with BSN degrees. Looking at your local schools and local market (or the schools and job market where you intend to be) is going to be more important for gaining the best preparation on an individual level than simply following a study of nationally conglomerated data.

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Having been an ICU nurse for my entire nursing career spending a little more than half as an ADN, which I truly think should be referred to as an ASN on here as that is what the degree is, just like we call it a BSN, I can provide a little insight.  

My BSN did nothing to add to my outcomes or critical thinking.  That all came with my years of experience.  We hire mainly BSN new grads with a few ASN nurses.  There’s very little difference in them.  They are all the same amount of scary to me.  And most come out with the same I know it all attitude.  

I got my BSN for one reason.  To give me a little more flexibility job wise when I get to the point that I can’t do bedside anymore.  Which is probably coming in the next 5 years or so.

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Specializes in ER, Pre-Op, PACU.

I am doing an RN to BSN program as a requirement of my job. I think it’s silly and useless but I keep telling myself that my employer is paying for a useless degree. It would be different if I had little prior education, but I have a previous master’s degree, bachelor’s degree, and 2 associate degrees. 

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