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
   

[JKL33]

25 minutes ago, MunoRN said:

It's not only allowed, but required as a function of our professional license that we have autonomy to refuse to follow a Physicians instructions when we deem it appropriate.  

I don't get even half the number of nasty-grams that the Physicians I work with get telling them they can't do this or that, most of which notable come from nurses, and if they don't abide by that 'authority' then there are punitive consequences.  Is Medicine not a profession then?

Hourly vs Salary doesn't define a profession, although if it did, most of the Physicians in my hospital are paid hourly, they don't bill for individual services.  So again, they aren't "professionals".  The fact that nurses are typically paid hourly is because we're more savvy than those who agree to paid by salary, I went into nursing in large part to get away from salaried work.

I'm sorry, Muno, but some of this is nothing more than example of how (other) professions also make bad choices. Some of them have a few more things going for them than we do, though.

But, by the way, the fact that many physicians are employees still doesn't mean they necessarily punch a clock as if they can't be expected to show up on time or put in an honest day's work. Every physician I work with is employed by the hour and they do not punch a clock at all. They do have to account for their time if there is an irregularity, but are allowed to do it in a dignified manner.

Our clock-punching is, rather, an additional way we are disrespected, assumed to be unprofessional and not professionals and completely treated as if we aren't. It is also another way we are dicked around. At "one place I know" the allowed punch in time is barely enough time to walk from the clock to the rah-rah huddle area. I mean, at some point just please don't try to defend such BS.

I will admit some ignorance about this. What other professionals clamor around an area so that they can all quickly punch in and race out to a designated area to begin their work day?

[Guest856929]

28 minutes ago, MunoRN said:

It's not only allowed, but required as a function of our professional license that we have autonomy to refuse to follow a Physicians instructions when we deem it appropriate.  

I don't get even half the number of nasty-grams that the Physicians I work with get telling them they can't do this or that, most of which notable come from nurses, and if they don't abide by that 'authority' then there are punitive consequences.  Is Medicine not a profession then?

Hourly vs Salary doesn't define a profession, although if it did, most of the Physicians in my hospital are paid hourly, they don't bill for individual services.  So again, they aren't "professionals".  The fact that nurses are typically paid hourly is because we're more savvy than those who agree to paid by salary, I went into nursing in large part to get away from salaried work.

I will provide you with an example that will distinguish between authority and autonomy. An ICU bedside nurse has the autonomy to titrate medications given certain parameters, or the nurse can select a particular treatment from an order set; however, the nurse cannot order a different medication. Therefore the nurse is following the instructions of the provider whose authority guides the treatment plan. Just because you can choose to do an axillary or temporal temperature, it does not grant you the authority to treat anything. You are there to perform limited skills based on the treatment plan initiated by whoever is your authoritative figure. 

I will not debate the anecdotes you provided. Physicians indubitably function in a profession, bedside nurses do not. 

[KalipsoRed21, BSN, RN]

6 hours ago, MunoRN said:

It's not only allowed, but required as a function of our professional license that we have autonomy to refuse to follow a Physicians instructions when we deem it appropriate. 

Most often I agree with you MunoRN, but in this aspect I vehemently disagree. It maybe that we should have autonomy to refuse unsafe orders and ratios, but that is simply not the truth of our trade. I have been put in this very position very early in my career. The doctor ordered a patient he had not reconciled medications on and who had just had his first hemodialysis session (no subsequent sessions had yet been set up by case management and it was the weekend) to be discharged. I refused. My CNO was contacted by the MD and she then proceeded to call me, threaten to report me for insubordination, that I would be fired come Monday, etc. I needed my job, I was only months into my first RN job, I lived in a small town and there was only one hospital. I backed off and ended up telling the patient that I think he should refuse discharge. He did and ended up coding 4 hours later. Luckily he was at the hospital and able to have emergent pacemaker implanted and so he lived. 
Next week I came to work and nothing was said about any of it. I later received a safety award for “great care” of this patient. The MD didn’t get into trouble. No one said they were sorry for threatening my license or my livelihood. And I learned a valuable lesson. If I do ‘right’ by my patient I can be professionally ruined; if I do ‘wrong’ by my patient at the direction of those I am subordinate to, I have no doubt I will be the scapegoat for whatever damage is done and I will be professionally ruined. Your assertion that because our trade requires us to protect the patient with our knowledge it is a profession is hogwash. We have little to no power as individuals no matter what our oath says. Our patients aren’t safe in the current industry that is healthcare....and we all know it and ignore it due to needing an income and having no support for change. Mention Union in any facility outside of California and watch your hours become non existent. Get angry because you are working through every lunch and start to buck the system by clocking out ‘no lunch’; then start getting written up because “it is your responsibility to make time for your lunch.” So no, nursing isn’t a noble ethical profession. It is a bunch of caring people being used and abused by slave masters for a livable hourly wage. 
 

I am right with you as far as nurses shouldn’t be directing doctors. We shouldn’t be bullying them into ‘doing what we say or we will make their life hard.’ I never wanted to any other responsibility as a nurse other than to follow orders and be able to collaborate when I have a concern. But doctors can and have instructed nurses to do the wrong thing  ( to me it is HIGHLY debatable IF a nurse should ‘know’ to disregard an MD order) and some of those nurses follow through with those orders but then get their licenses suspended and the livelihoods taken away “because they should have known better.” That is just the industry’s way of making sure that the highly expensive doctor falls last. We are a dime a dozen and the scapegoat for everything. We get paid well because we are the scapegoats....not because learning to care for people is hard, or requires intense book learning...it just requires experience and repetition.
 

8 hours ago, JKL33 said:

No it isn't. The material for a bachelor's degree in nursing simply isn't truly challenging. However, nursing school itself is a complete mind-[blank] rigamarole because of ?....

Nurses with self-esteem problems.

JKL33, I couldn’t agree with you more. Nursing school is just away to drive out those who refuse to be beaten down and abused. It is hard because those who are running the institutions are horrific abusers themselves. Nursing is the most hatefully abusive career I have ever had. But I keep it because the abuse pays better than most. And I really don’t wish to go back into school for further debt in any other career out of fear I will be trapped like I already am in this one.

[Subee2, BSN, MSN, CRNA]

On 11/28/2020 at 2:57 PM, cynical-RN said:

If you have to clock-in and out to track your hours at the plantation so that you can perform skills and interventions that are guided by an authoritative figure, you're in a vocation, not profession. Bedside nursing is a trade irrespective of codes, ethics, and oaths. Bedside nurses have zero authority, maybe autonomy to choose interventions in a given rectangle, but if they think and act outside that box, there are punitive consequences, even if they did the right thing. 

So bitter.  If you find nursing so demeaning, just do something else.  If this is the vitriol you bring to work every day, you must be tortured.  Unless you work for yourself, there are always compromises to complete autonomy. 

[Guest856929]

8 minutes ago, Undercat said:

So bitter.  If you find nursing so demeaning, just do something else.  If this is the vitriol you bring to work every day, you must be tortured.  Unless you work for yourself, there are always compromises to complete autonomy. 

Ad hominem attacks detract from the subject at hand. Yearn to be more rational than emotional. Everything I stated is reality on the ground which you’re perhaps detached from if you oppose it without valid evidence to the contrary! 

[JKL33]

1 hour ago, Undercat said:

So bitter.  If you find nursing so demeaning, just do something else. 

Instead of this kind of talk, why don't you write about what you disagree with? (Caveat: I will admit that I wouldn't have used plantation verbiage but other than that I generally agree with the spirit of what the poster wrote.)

Sincere question: Is your belief that people who work in nursing shouldn't be here if they have considerably "negative" viewpoints about what is going on in nursing? That they should find something else to do instead of speaking negatively about nursing? Do you believe that if a nurse sees some inadequacies in nursing or some things they consider to be highly inappropriate or wrong or abusive, that must automatically mean that they, individually, are bitter and should find something else to do?

My perspective is that I have spent a respectable amount of time working as a registered nurse now, and I am allowed, as a member of this profession or non-profession, to raise and/or participate in a nursing-related dialog that represents my experiences and observations within this profession or non-profession.

It is not legitimate to disingenuously imply that if people want something better for nursing then they must be bitter and should leave.

You accuse this poster of being bitter, but my perspective would be that people who try to inaccurately portray our profession in the other direction are actively participating in harming this profession at least as much as anyone else is. None of us are actually required to dutifully act all demure for the sake of nursing when we disagree with certain portrayals of nursing or certain directions that nursing is taking. Just as you have felt free to drop in and post your pot-shot disagreement with this poster, this poster had a right to speak as well and has a right to remain in nursing and state these things. If they decide that everything about nursing makes them completely unhappy or ethically conflicted, I'm sure they will find ways to help make changes (including participating in discussions just like this one) or maybe they will choose to leave. But they don't need your direction either way.

I believe that we have ginormous problems in nursing and still believe that nursing itself is useful work that betters humanity. I am capable of holding  both of these beliefs and still feel a desire to try to continue to participate in nursing, doing the work as best I can according to the way I believe it is meant to be done.

Only un-thinkers try to put people into the simplistic boxes you are suggesting.

And I will stay here and report what I see and say what I feel until I either help turn the tide or else give up trying.

[MunoRN, RN]

On 11/29/2020 at 10:22 PM, KalipsoRed21 said:

Most often I agree with you MunoRN, but in this aspect I vehemently disagree. It maybe that we should have autonomy to refuse unsafe orders and ratios, but that is simply not the truth of our trade. I have been put in this very position very early in my career. The doctor ordered a patient he had not reconciled medications on and who had just had his first hemodialysis session (no subsequent sessions had yet been set up by case management and it was the weekend) to be discharged. I refused. My CNO was contacted by the MD and she then proceeded to call me, threaten to report me for insubordination, that I would be fired come Monday, etc. I needed my job, I was only months into my first RN job, I lived in a small town and there was only one hospital. I backed off and ended up telling the patient that I think he should refuse discharge. He did and ended up coding 4 hours later. Luckily he was at the hospital and able to have emergent pacemaker implanted and so he lived. 
Next week I came to work and nothing was said about any of it. I later received a safety award for “great care” of this patient. The MD didn’t get into trouble. No one said they were sorry for threatening my license or my livelihood. And I learned a valuable lesson. If I do ‘right’ by my patient I can be professionally ruined; if I do ‘wrong’ by my patient at the direction of those I am subordinate to, I have no doubt I will be the scapegoat for whatever damage is done and I will be professionally ruined. Your assertion that because our trade requires us to protect the patient with our knowledge it is a profession is hogwash. We have little to no power as individuals no matter what our oath says. Our patients aren’t safe in the current industry that is healthcare....and we all know it and ignore it due to needing an income and having no support for change. Mention Union in any facility outside of California and watch your hours become non existent. Get angry because you are working through every lunch and start to buck the system by clocking out ‘no lunch’; then start getting written up because “it is your responsibility to make time for your lunch.” So no, nursing isn’t a noble ethical profession. It is a bunch of caring people being used and abused by slave masters for a livable hourly wage. 
 

I am right with you as far as nurses shouldn’t be directing doctors. We shouldn’t be bullying them into ‘doing what we say or we will make their life hard.’ I never wanted to any other responsibility as a nurse other than to follow orders and be able to collaborate when I have a concern. But doctors can and have instructed nurses to do the wrong thing  ( to me it is HIGHLY debatable IF a nurse should ‘know’ to disregard an MD order) and some of those nurses follow through with those orders but then get their licenses suspended and the livelihoods taken away “because they should have known better.” That is just the industry’s way of making sure that the highly expensive doctor falls last. We are a dime a dozen and the scapegoat for everything. We get paid well because we are the scapegoats....not because learning to care for people is hard, or requires intense book learning...it just requires experience and repetition.
 

JKL33, I couldn’t agree with you more. Nursing school is just away to drive out those who refuse to be beaten down and abused. It is hard because those who are running the institutions are horrific abusers themselves. Nursing is the most hatefully abusive career I have ever had. But I keep it because the abuse pays better than most. And I really don’t wish to go back into school for further debt in any other career out of fear I will be trapped like I already am in this one.

I think you're conflating employer expectations with professional expectations, in a profession those are two different things and you made need to go against your employer to abide by your professional requirements.  

I think you've stumbled upon a better criteria for evaluating whether something is a profession than much of what is commonly used.  In a non-professional vocation your legal liability is mainly based on the directives you receive from your employer.  In a profession your legal liability is mainly based on your professional standards and requirements, regardless of your employers directives.  You might lose your job from following your professional standards instead of your employer, but you could lose your license for going against your professional requirements in order to abide by your employers, that's what a profession is.

[The0Walrus, BSN, RN]

If you take out the N out of BSN you'll know how I feel about the BSN.

I got my BSN with my RN. I didn't get it because I felt like it would help me at all. More so, now with my BSN I don't feel I'm any smarter or know more than an RN.

The classes I took for my BSN had maybe 20% with patient care. Consider classes like statistics, sociology of the family, history of nursing, contemporary nursing -which for the most part was about learning about nursing theorists.. none of these classes matters when it comes to nursing care.

I paid 18,000 for my BSN and got paid 0.80 cents an hour for the BSN. Financially, it doesn't make sense. When it comes to knowledge it still doesn't make sense. I don't feel it would have helped me all that much in the grand scheme of things. The only thing the BSN was good for really was it gave me the ability to go for my DNP. That's it.

Even with my BSN, when I worked at the nursing home when I first came out of school the LPNs knew more than me so I wasn't even any better than the LPNs.

[Subee2, BSN, MSN, CRNA]

12 hours ago, The0Walrus said:

If you take out the N out of BSN you'll know how I feel about the BSN.

I got my BSN with my RN. I didn't get it because I felt like it would help me at all. More so, now with my BSN I don't feel I'm any smarter or know more than an RN.

The classes I took for my BSN had maybe 20% with patient care. Consider classes like statistics, sociology of the family, history of nursing, contemporary nursing -which for the most part was about learning about nursing theorists.. none of these classes matters when it comes to nursing care.

I paid 18,000 for my BSN and got paid 0.80 cents an hour for the BSN. Financially, it doesn't make sense. When it comes to knowledge it still doesn't make sense. I don't feel it would have helped me all that much in the grand scheme of things. The only thing the BSN was good for really was it gave me the ability to go for my DNP. That's it.

Even with my BSN, when I worked at the nursing home when I first came out of school the LPNs knew more than me so I wasn't even any better than the LPNs.

I'm sorry you went to a lousy program.  However, a college education is about the liberal arts.  If you think sociology and statistics are irrelevant to nursing (or to a college degree) there's not much anyone can say here.  A closed mind doesn't do you any favors in the long run.  What if you decide to leave a bedside job.  You want to be competitive in the market.

[JKL33]

21 hours ago, MunoRN said:

I think you've stumbled upon a better criteria for evaluating whether something is a profession than much of what is commonly used.  In a non-professional vocation your legal liability is mainly based on the directives you receive from your employer.  In a profession your legal liability is mainly based on your professional standards and requirements, regardless of your employers directives.  You might lose your job from following your professional standards instead of your employer, but you could lose your license for going against your professional requirements in order to abide by your employers, that's what a profession is.

I agree with this.

I guess the question is, given the extreme power imbalances and the types of entities who are in bed together, what good is any of this when there's (relatively) no support for our professional standards? Sure, plenty of "nursing" entities pay lip service to what we (supposedly) are and the values by which we (supposedly) operate, but in doing so they have the benefit of knowing that the system is set up to pick off individuals who don't toe the line and to fill as many roles as possible with novice/beginner nurses who don't yet have their bearings and have been purposely scared into thinking that if they don't do what their employer says they will lose their license.

Nursing has basically made a mockery of even these things!! We teach people in school that they will face "ethical dilemmas" and imply that those are puny things like having to question a physician's order.

[rzyzzy]

On 12/1/2020 at 12:58 PM, MunoRN said:

I think you're conflating employer expectations with professional expectations, in a profession those are two different things and you made need to go against your employer to abide by your professional requirements.  

I think you've stumbled upon a better criteria for evaluating whether something is a profession than much of what is commonly used.  In a non-professional vocation your legal liability is mainly based on the directives you receive from your employer.  In a profession your legal liability is mainly based on your professional standards and requirements, regardless of your employers directives.  You might lose your job from following your professional standards instead of your employer, but you could lose your license for going against your professional requirements in order to abide by your employers, that's what a profession is.

The legal jeopardy attached to nursing isn’t a feature that makes anyone safer.  In nursing, going against your employer’s wishes will result in termination in nearly every case.  Unsafe staffing ratios being the pinnacle of this “professional” double speak.  
 

the bottom line that the “professional” camp refuses to see is that the various departments of labor have clearly defined what a “professional” is, and it’s based solely on autonomy and economic power.  The ability to say “no” without being walked out of the building and blacklisted.  The ability to decide for yourself what gets prioritized, and what doesn’t happen, based on your “professional” judgement..

 

the vast majority of RN’s only have the autonomy to do the impossible list in whatever order they choose, they don’t have the authority to revise the list based on their “professional” judgement.  
 

and this parroting of the “professional” line endangers even the ability to get paid by the hour to complete your impossible mission.  “Professionals” , according to the department of labor - are exempt from overtime.  Take away the overtime and see how much awesome talent you can attract.  

[anewsns]

Well , it’s good that bachelors degree nurses bring such a good boost to patient care , but the nurses reality also matters. We have lives and families and hobbies , so getting a bachelors degree really needs to be worth it on a personal level. It seems like there’s really not much other incentive to get a bachelors degree other than not getting fired (and I don’t think most places will fire you .) Also , people with bachelors degrees can find more opportunities away from bedside so once they pay their dues , they will often leave. I think ASN programs hold nurses by the bedside longer (as there is nowhere else to go .) I think if hospitals want nurses with bachelors degrees to stay, they are going to have to start treating nurses better and giving a big pay raise to bachelors prepared nurses.