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
   

[KalipsoRed21, BSN, RN]

Frankly I think that the current atmosphere in nursing just solidifies my opinion that we should be considered a trade and unionize like brick masons and carpenters do. That management should require a BSN and at whatever point the nurse is no longer doing direct patient care, the field turns into a professional sort of career. Trades people are not necessarily people you need to be overly book educated, but their experience is gold. Who do you want to build your brick house? And apprentice brick mason or a journey man? My money would be on the journey man or higher. Yes the more experienced they are the more it costs, but that is why you get a really nice looking sturdy house.

[Jedrnurse, BSN, RN]

17 hours ago, cynical-RN said:

And the intensity of NCLEX needs to be elevated beyond a minimum competency test. 

I'm not sure how that would work as a graduating nursing student probably couldn't be expected to be beyond minimally competent. Expertise and increased competence would come with actual nursing experience.

What would you propose?

[Guest856929]

19 minutes ago, Jedrnurse said:

I'm not sure how that would work as a graduating nursing student probably couldn't be expected to be beyond minimally competent. Expertise and increased competence would come with actual nursing experience.

What would you propose?

After much thought, I have to agree with nursing being primarily a trade and perhaps the NCLEX should remain as is I.e a minimum competency test. All of which reinforce the notion that nursing, for the most part is an overrated profession, especially academically. 

[Jedrnurse, BSN, RN]

1 minute ago, cynical-RN said:

After much thought, I have to agree with nursing being primarily a trade and perhaps the NCLEX should remain as is I.e a minimum competency test. All of which reinforce the notion that nursing, for the most part is an overrated profession, especially academically. 

If I could redesign the system, I'd bring back the diploma programs with options to continue on to complete a bachelor's degree in a convenient/seamless way. Diploma-trained nurses were some of the most competent people I ever got the chance to work with.

[Guest856929]

22 minutes ago, Jedrnurse said:

If I could redesign the system, I'd bring back the diploma programs with options to continue on to complete a bachelor's degree in a convenient/seamless way. Diploma-trained nurses were some of the most competent people I ever got the chance to work with.

And most of them were hospital-based institutions or at least in my region, which allowed the focus to be more clinical —the most relevant part of nursing. 

[MunoRN, RN]

On 11/19/2020 at 7:52 AM, RN-to- BSN said:

Mandating certification can be done too. I did not have to write a million papers, not even close, btw.

A "million" papers would obviously be an exaggeration, but if not mainly writing papers and research projects, what did your program include?

[MunoRN, RN]

On 11/24/2020 at 4:17 PM, cynical-RN said:

Perhaps you should question the institution that you attended if you received subpar education. I do agree with you however regarding bedside nursing being a trade/vocation rather than a profession. Are you claiming that you’re helping NPs diagnose and design treatment plans for patients or just helping with interventions? Perhaps it’s the setting/environment that you’re currently functioning at that is attracting mediocre providers. If you’re doing all the work, either these providers are inept or you have an inflated imagination of your capacity. Hard to tell. A wise man once said that if you’re the smartest person in the room then you’re in the wrong room. 

Debating whether nursing is a trade or profession seems to be a semi-annual tradition on AN, but I don't think it's all that debatable.

Nursing oversees it's own licensure process and ongoing accountability to that license, the knowledge base required to initially enter the profession is more than minimal and that knowledge base and proficiency grows significantly after initial entry into the profession.  I would agree that there are some nurses that may go their whole career seeing the job as nothing more than a set of tasks to be completed, although the lowest possible level of practice isn't what defines something as profession or not.

[Guest856929]

4 hours ago, MunoRN said:

Debating whether nursing is a trade or profession seems to be a semi-annual tradition on AN, but I don't think it's all that debatable.

Nursing oversees it's own licensure process and ongoing accountability to that license, the knowledge base required to initially enter the profession is more than minimal and that knowledge base and proficiency grows significantly after initial entry into the profession.  I would agree that there are some nurses that may go their whole career seeing the job as nothing more than a set of tasks to be completed, although the lowest possible level of practice isn't what defines something as profession or not.

I can make the same argument you made for barbers and hairstylists. 

[MunoRN, RN]

23 minutes ago, cynical-RN said:

I can make the same argument you made for barbers and hairstylists. 

And both are often classified as professions, so that would make sense.  

What is it about nursing that you feel makes it a non-profession?

[Guest856929]

8 hours ago, MunoRN said:

And both are often classified as professions, so that would make sense.  

What is it about nursing that you feel makes it a non-profession?

Depends on your understanding of the denotative distinction between vocation and profession. Some words are used loosely in America, especially connotatively. 

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

17 hours ago, MunoRN said:

A "million" papers would obviously be an exaggeration, but if not mainly writing papers and research projects, what did your program include?

 Obviously an exaggeration, I was aware of that.  It included video assignments, such as videotaped assessment, making PowerPoint presentations and presenting, discussions and multistage quality improvement projects. Research papers and looking for scholarly sources took only about 1/4 of the entire program. 

[Hoosier_RN, MSN]

2 hours ago, RN-to- BSN said:

 Obviously an exaggeration, I was aware of that.  It included video assignments, such as videotaped assessment, making PowerPoint presentations and presenting, discussions and multistage quality improvement projects. Research papers and looking for scholarly sources took only about 1/4 of the entire program. 

Those are the things that are considered in the million papers. Pretty much standard for all RN-BSN bridge programs. Only exception, my bridge program, assessment was live. We went to a community clinic. Patients had signed a waiver to be seen by a student overseen by an instructor and a NP/MD.  This was in 2005