80% BSN by 2020: Where Are We Now?

[J.Adderton]

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:

• The AACN Drafts Proposal for BSN as the Entry Level for RNs, Gets Pushback
• U.S. Nursing Schools Call for Collaborative Action to Raise the Education Level of the Nursing Workforce
• Driving Factors Behind the 80% BSN by 2020 Initiative
   

[Wuzzie]

8 minutes ago, Undercat said:

The writing was on the wall in 1972 when I started BSN program so it's not like you didn't have enough notice to pick your degree up until now.  IF a mandatory BSN would limit our numbers making us more valuable employees, we would all be better off.  ADN for LPN's might not be a bad idea either if it gave them more access to some of acute care jobs in less intensive settings.

Kinda harsh don't you think considering here we are 48 years later and it hasn't happened! Also, you've been around long enough to know that limiting our numbers has never made us more valuable. Nothing will really make us more valuable. Well maybe if we could bill for services. But insurance companies will not allow that. Hospitals pretty much find other ways to fill the holes by creating UAPs with glorified titles to do much of what we do. Heck, like I stated on another post we are still billed as part of the room charge. Having a BSN won't change that either. If so it would have happened by now. Don't get me wrong, I believe in BSN as entry to practice is probably the way to go simply so we have a leg to stand on. But, frankly, this ongoing debate Diploma vs ADN vs BSN is making me tired. 

[RNperdiem, RN]

The writing on the wall was a regional issue, I suspect. In job markets needing nurses, employers were just fine with ADN nurses, in some places this is probably still true.

Most of my classmates were career changers or had student debt and community college was the affordable option. The majority of us already had college educations.

[Soloist, LPN]

maybe slightly off topic but it seems like its getting harder to transition from LPN to RN... the colleges hardly take any LPN's and that leaves the sketchy online options generally... RN to BSN however... I could have gone virtually anywhere and lots of those options didn't even have a nursing program. 

[Guest856929]

I think BSN should be the minimum entry level for all nurses, especially in the acute care setting. Pharmacists, PTs, dieticians, SWs, STs etc. have all shifted from to be careers that are primarily professional rather than vocational. Along the way, they have garnered more respect. 

[Hoosier_RN, MSN]

1 hour ago, cynical-RN said:

I think BSN should be the minimum entry level for all nurses, especially in the acute care setting. Pharmacists, PTs, dieticians, SWs, STs etc. have all shifted from to be careers that are primarily professional rather than vocational. Along the way, they have garnered more respect. 

in some respects I agree.  But until hospital administration starts the ball rolling on respecting nurses instead of looking at nurses as patsies to throw under the bus when there are issues (that are created by said administrators), we won't have respect.  Currently, patients know and management can treat nursing staff like garbage and get away with it, because no one will have our backs

[Guest856929]

4 minutes ago, Hoosier_RN said:

in some respects I agree.  But until hospital administration starts the ball rolling on respecting nurses instead of looking at nurses as patsies to throw under the bus when there are issues (that are created by said administrators), we won't have respect.  Currently, patients know and management can treat nursing staff like garbage and get away with it, because no one will have our backs

Indeed. How can we remedy that? It is especially disappointing because some of the executives are in fact nurses. I guess the bottom line -money, matters more than camaraderie among nurses. Dog-eat-dog profession. Nurses are so replaceable and/or disposable, one would be mistaken to think that there is a shortage of RNs currently.  

[Hoosier_RN, MSN]

2 hours ago, cynical-RN said:

Indeed. How can we remedy that? It is especially disappointing because some of the executives are in fact nurses. I guess the bottom line -money, matters more than camaraderie among nurses. Dog-eat-dog profession. Nurses are so replaceable and/or disposable, one would be mistaken to think that there is a shortage of RNs currently.  

Just a shortage of experienced willing to put up with the nonsense!

[Subee2, BSN, MSN, CRNA]

9 hours ago, Wuzzie said:

Kinda harsh don't you think considering here we are 48 years later and it hasn't happened! Also, you've been around long enough to know that limiting our numbers has never made us more valuable. Nothing will really make us more valuable. Well maybe if we could bill for services. But insurance companies will not allow that. Hospitals pretty much find other ways to fill the holes by creating UAPs with glorified titles to do much of what we do. Heck, like I stated on another post we are still billed as part of the room charge. Having a BSN won't change that either. If so it would have happened by now. Don't get me wrong, I believe in BSN as entry to practice is probably the way to go simply so we have a leg to stand on. But, frankly, this ongoing debate Diploma vs ADN vs BSN is making me tired. 

I'm not adding to the ADN vs. BSN debate here but just saying that if you want to even have a job, one is more marketable with bachelor's.  Even back in the 70's, socialized medicine was on the horizon which meant that the better the piece of paper you had, the better prepared you were for the future.  I wouldn't even have gotten a job (where I wanted a job) in 1972 without the degree. 

[MunoRN, RN]

17 hours ago, JKL33 said:

Interesting comments, Muno.

 

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.

I should add that the main hurdle to trying implement any changes was that there is no evidence to support what the specific factors are of a BSN degree that produce better outcomes.  It was ironic that one of the proposed benefits of a BSN was a better understanding of applied statistics, yet this initiative wasn't based on any evidence that makes it actionable, in other words, a pretty pathetic comprehension of applied statistics that come from not just BSN prepared researchers but doctoral level.  I admit it's a bit embarrassing as a nurse.  

Since the research didn't attempt to isolate the factors of a BSN education that produce better outcomes, we were left to guess.  Was it that BSN prepared nurses were more likely to have lived in dorms?  Was it that they paid more for their education?   Did more debt held by the nursing staff improve patient outcomes?  Our best guess was that if anything actually made a difference, maybe it was the curriculum.

It was hard to pinpoint exactly what part of a BSN curriculum ADN programs were lacking.  ADN programs were less likely to have a separate statistics course but were not less likely to integrate statistics and evidence based practice into their overall curriculum. 

I will admit that I held some unfair views on community college prepared nurses.  We initially assumed that having less University level general requirements may have played some role, but we were surprised to learn that ADN programs were far more likely to have students who had a previous bachelor's degree, with a couple of programs that had even made that a requirement.  So if more education is better it sort of makes you wonder why we allow 'only' BSNs to practice when ADN's often have more college level education.  

As to the content of RN to BSN programs, our representative from an in-state BSN program willingly admitted that their program is just a year of "busy work", but was also somewhat offensively open about that fact that her job was to bring in revenue, not do what's best for the profession of nursing.  

[Wuzzie]

Muno, I think I love you!

[Txdude254]

Thank you for this great article, explanation and breakdown with the nursing shortage not to mention the pandemic all nurses are needed more than ever. 

In my opinion I believe BSN curriculum's are geared more towards management while ADN curriculums are geared towards bedside nursing. I believe that's why some ADN nursing programs have more clinical experience and Hands-On training than BSN programs

 

 

[BSN-to-MSN, ADN, BSN, RN]

I am getting a BSN right now, will be done in August. I think it is worth it. I did see lots of BSN praising in the program: BSN is better prepared to do this, BSN is better prepared to do that. The program seemed to look down on ADNs. Whatever.

I think employers mandating BSN in 5 years upon hire is fair, together with tuition reimbursement it promotes further learning.