Do Bachelor's Degrees Save Lives? - The Facts about Earning a BSN
In most lines of work, there’s one clear path to getting your foot in the door. But nursing is unique in that it offers multiple paths to entry-level positions. Whether you’ve earned a diploma, an associate degree or a bachelor’s degree, you know there is more than one way to become an RN.
Some assert that there are some pretty distinct differences in the capabilities, responsibilities and patient outcomes that come with each educational milestone. It's no secret that more voices in the field are citing those differences as a driving force behind the push to convince more RNs to pursue BSN degrees. But are the benefits as clear-cut as they've been made out to be?
Here's what we found from doing some research on what has been written.
The push for more BSNs
Initiatives like "80 by '20" and "BSN in 10" have become hot topics in the nursing world, but they're often misunderstood. Here's a quick breakdown of the differences:
80 by '20 is a call-to-action that requires 80 percent of nurses to hold bachelor's degrees by 2020. This initiative has been put in place by the Institute of Medicine in tandem with the Robert Wood Johnson Foundation.
BSN in 10 is a proposed policy that would require new nurses to obtain their BSN within 10 years of entering the field if they wish to continue practicing. The initiative originated with the New York State Nurses Association and has received support from the House of Delegates of the American Nurses Association.
The motivation for initiatives like these is threefold. Proponents hope to see improvements in patient care; increased prospects and longevity in nursing careers; and efficiencies in the ability of healthcare facilities to manage increasing patient loads.
It hasn't taken long for other healthcare organizations to align with these commitments. Many hospitals may be drawn by the motivation to uphold high standards of patient care and professional development in order to achieve magnet status, while others can't seem to ignore the question, "Do bachelor's degrees really save more lives?"
The link between education & mortality rates
Healthcare organizations and hospital leadership continually recognize the contributions made by nurses of all educational levels. But many have acknowledged reports that suggest qualifications impact mortality rates.
What does the data say?
Studies suggest a correlation between patient mortality rates and the level of education achieved by their nurses. A 2014 study supported by the National Institutes of Health reported a 7 percent decline in patient mortality for each 10 percent increase in the number of nurses who hold bachelor's degrees. Put simply, nurses with more education appear to have better patient outcomes.
The study brought the conversation a step further by comparing patient outcomes with nursing workload. Hospitals in which 60 percent of nurses hold bachelor's degrees and care for six or fewer patients saw a 33 percent decrease in patient mortality when compared to hospitals in which only a third of nurses hold a bachelor's degree and care for up to eight patients.
This suggests a significant decrease in the number of patient deaths for nurses who have more education and also care for fewer patients. The data suggests that healthcare organizations recognize the need to not only increase RN qualifications, but also increase the number of nurses available to care for patients.
The added benefits of earning a BSN
Because many healthcare facilities are prioritizing a bachelor's level education for RN candidates, the number job prospects for nurses with bachelor's degrees has seen a huge surge in recent years.
In fact, Burning-Glass was used to identify more than a million RN job postings from the past year and found that candidates holding a bachelor's degree qualified for 78 percent of them, while diploma and associate degree holders qualified for just 53 percent.1
The prospects are also greatly increased for RNs hoping to progress into advanced nursing positions later in their careers. For example, we examined nearly 100,000 nurse manager job postings from the last 12 months. The data revealed that candidates with bachelor's degrees qualified for 70 percent of the jobs available, while associate degree holders qualified for just 25 percent of them.2
But the job vacancies don't tell the only story here. There is also increased earning potential for bachelor's degree holders. Nurse manager candidates with bachelor's degrees can expect a $7,000 increase in mean annual salary.3
Are BSNs worth more than the hype?
The initiatives in place to encourage more RNs to earn bachelor's degrees are hard to ignore, but there are two sides to every coin. Some professionals are pushing back despite support from leading healthcare organizations. It's a debate that continues to rage throughout the comment streams of nursing blogs across the Internet.
So what do you think? Are there tangible benefits to a nursing workforce with a higher percentage of bachelor's degrees? Is the jump from RN-BSN worth it? Share your thoughts in the comments below!
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Rose_Queen said:
I don't like the whole push to force nurses back into school to complete a BSN later in life. In fact, many in my facility have decided that they will retire early rather than return to school if the facility indeed follows through with the no BSN = no job on 1/1/2020.
If the push for the BSN continues, then the US needs to do it similar to Canada: grandfather in those already licensed or in school, but as of a certain date, the BSN program is the only option
Heck, that is the AMERICAN way. That is exactly how every other health profession did with when they got degree inflation-itis.
PT didn't make its therapists with masters degrees go back and get doctorates in order to stay employed. Neither did pharmacy.
Nursing is alone in wanting experienced nurses to return to school to continue their employment.
The only rational I can think of for this is that those who spent lots of money and time getting a BSN initially are very annoyed that anyone would have the gall to practice with anything less than a BSN, much less find ADN and diploma RNs in management and other leadership positions, so they need to be punished.
I think we can easily rule out any propaganda about better patient outcomes. If patients REALLY had better outcomes with more BSN RNs at the bedside then nursing would have done exactly what PT and pharmacy did and set a date after which a BSN would be required, and grandfathered in all the other RNs. Such a strategy would have resulted in almost no opposition from practicing nurses and would be relatively easy to implement, and we could well have BSN and entry to practice years ago.
Instead they have chosen a strategy to punish working RNs calculated to create the most possible enemies and opponents.
I think we can easily rule out any propaganda about better patient outcomes. If patients REALLY had better outcomes with more BSN RNs at the bedside then nursing would have done exactly what PT and pharmacy did and set a date after which a BSN would be required, and grandfathered in all the other RNs. Such a strategy would have resulted in almost no opposition from practicing nurses and would be relatively easy to implement, and we could well have BSN and entry to practice years ago.
Instead they have chosen a strategy to punish working RNs calculated to create the most possible enemies and opponents.
There are plenty of PTB in nursing who would love to do that, but, you forget, they CAN'T. Nursing organizations and even the BONs can't just change the requirements for licensure; they have to go through the state legislatures and convince the state leges that this is necessary. They have been unsuccessful in doing this so far. The ADN programs and state community colleges have a lot of support in the state legislatures, and the vast majority of the general public doesn't have any idea how nursing licensure works anyway, so the legislators in the various state houses don't see any compelling reason to change how it works in their state. The only state that was ever successful in getting the entry level changed was ND, and they changed it back a number of years later.
None of that has anything to do with whether or not there is evidence supporting the value of BSN-prepared nurses at the bedside vs. nurses with other levels of preparation -- it's all politics and money.
And there is no BON that has "chosen a strategy to punish working RNs" by pushing them to return to school for a BSN -- that is all coming from employers.
The whole "Magnet Hospital" and requiring a RN to get a BSN is ridiculous. RN's who hold an ADN are not less safe than those who hold a BSN. In fact, I work with enough of both that from personal experience I can tell you the stand out nurses are normally the ones who hold an ADN. BSN classes are writing papers on leadership and management, nothing in it promotes better or safer patient care. But kudos hospitals for pushing RN's into more student debt to keep them tied down to a contract longer.
The trend in the US, and probably the whole world, is to push as much work for as little pay down the management ladder as possible. Someone mentioned that tasks are beginning to be timed. That may be an outlier right now, but it or something similar will become routine. In management, if you can measure it you can manage it, and if you can manage it you can get more money and power, whether or not it helps the healthcare staff, the clients or the population. Other industries are no different or even further down the path of squeezing the people who actually do the work. Yeah, good management is really great and necessary for the organizations, but someone has to do the dirty work with their hands that cannot be swept under a pile of paper or electrons or other BS. And, that is where the art and the humanity is. Someone is going to have to pay for good work, and if left up to the people with money and in power, the people without money and power will be/are paying with their blood, sweat, and tears (yes, there was a band many years ago with that name and they played some great music, but that is not my point.)
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
elkpark said:
There are plenty of PTB in nursing who would love to do that, but, you forget, they CAN'T. Nursing organizations and even the BONs can't just change the requirements for licensure; they have to go through the state legislatures and convince the state leges that this is necessary. They have been unsuccessful in doing this so far. The ADN programs and state community colleges have a lot of support in the state legislatures, and the vast majority of the general public doesn't have any idea how nursing licensure works anyway, so the legislators in the various state houses don't see any compelling reason to change how it works in their state. The only state that was ever successful in getting the entry level changed was ND, and they changed it back a number of years later.
None of that has anything to do with whether or not there is evidence supporting the value of BSN-prepared nurses at the bedside vs. nurses with other levels of preparation -- it's all politics and money.
And there is no BON that has "chosen a strategy to punish working RNs" by pushing them to return to school for a BSN -- that is all coming from employers.
I understand what you have said. But I would point you to the ANA's official position on this. How are state boards of nursing going to go against what the ANA advocates? As you said there are other factors that will come into play, but NURSING isn't even advocating for grandfathering, at least not officially.
Step one, I would think, would be for nursing organizations, primarily the ANA, to adopt a position that state BONs can get behind and use when determining entry to practice requirements.
The ANA has chosen to adopt a policy calculated to create as many enemies to BSN as entry to practice as possible. If having a BSN prepared RN work force was actually their priority, they would have chosen to grandfather. The fact that they didn't demonstrates to me that having a BSN prepared RN as entry to practice is NOT the goal they actually wish to achieve.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I have seen the resentment of ADN RN's by BSN and direct entry MSN nurses. This is the story that really gets to them
Amy works hard in high school, misses out on lots of fun things in order to get great grades and accepted into a good university. While in college she studies nursing, a very challenging field that leaves her little time to party. She works hard and takes out $40-$80K in student loan debt. After four years of hard studying she is a newly minted RN with a BSN and ready to start the nurse residency program for ICU.
She meets her preceptor Bob who was in her high school class. In high school Bob had a lot of fun. After graduating he enrolled in one of Wisconsin's technical college nursing programs. The total cost is about $7K After two years of challenging study Bob graduates with his ADN and enters the nurse residency program for ICU. For the next two years Bob makes about $60k a year, has health insurance, got an online BSN from WGU in a year for a cost of $7K, paid for by the hospital. Bob did well in the residency program and is now a competent critical care nurse. Four years after graduating high school Bob has two years of solid ICU experience, CCRN, a BSN, made $120K, and has no student debt.
Amy is just starting her career, with a $500/month student loan payment. Debt free Bob is considering applying to CRNA school, or applying for an assistant nurse manager position in the hospital.
I have seen this exact scenario played out numerous times. The Amy's of the nursing world are angry and it shows in the policy position adopted by the ANA and AACN.
I understand what you have said. But I would point you to the ANA's official position on this. How are state boards of nursing going to go against what the ANA advocates? As you said there are other factors that will come into play, but NURSING isn't even advocating for grandfathering, at least not officially.
Step one, I would think, would be for nursing organizations, primarily the ANA, to adopt a position that state BONs can get behind and use when determining entry to practice requirements.
Regardless of anything the ANA may or may not say, the BONs do not determine entry to practice. They can only write and implement rules based on the standards established by the state legislatures. In order for anything to change regarding nurse licensure, a state legislature would have to be convinced that the change was necessary and pass legislation making changes to the state Nurse Practice Act, a practice that is referred to colloquially as "opening up the Nurse Practice Act."
State BONs and nursing advocates are extremely reluctant to do this because, once you "open up" the Nurse Practice Act, anyone can weigh in and lobby for changes that they want. The state hospital association, the state physicians association and the AMA, consumer advocate groups, individual citizens -- it's not like the legislature just passes what the BON wants and that's that. The same legislative process applies to this as to any other legislative proposal; there is a period of public comment, there are public hearings, anyone who has any interest in the topic is able to comment and advocate and lobby. Most state nursing associations and BONs have had bad experiences in the past with "opening up the Nurse Practice Act" to get something changed that they want, only to find themselves worse off than they were to begin with at the end of the process, and the Act changed to include something that is the exact opposite of what they were trying to get included. Believe me (I have been directly involved at the state level in the past with making decisions about whether it's worth trying to get something changed), when this process is started, the physicians and hospital associations and every other group associated with or interested in healthcare don't just sit back and let the nurses have what the nurses want; they all have agenda that they want to pursue in relation to nursing and healthcare, and most of them are more experienced, powerful and better funded lobbyists than the nursing groups.
For better or worse, there is v. little support outside of nursing for mandating a BSN for licensure, with or without grandfathering in nurses. Regardless of what they may believe in their heart of hearts, and regardless of what the ANA may pronounce, no BON is (currently) willing to take the risk of opening up their Nurse Practice Act for an issue that the public and legislators understand and care about so little. The nursing community in each state has little to gain, and quite a bit more to lose, in that process.
Specializes in Oncology; medical specialty website.
PMFB-RN said:
I have seen the resentment of ADN RN's by BSN and direct entry MSN nurses. This is the story that really gets to them
Amy works hard in high school, misses out on lots of fun things in order to get great grades and accepted into a good university. While in college she studies nursing, a very challenging field that leaves her little time to party. She works hard and takes out $40-$80K in student loan debt. After four years of hard studying she is a newly minted RN with a BSN and ready to start the nurse residency program for ICU.
She meets her preceptor Bob who was in her high school class. In high school Bob had a lot of fun. After graduating he enrolled in one of Wisconsin's technical college nursing programs. The total cost is about $7K After two years of challenging study Bob graduates with his ADN and enters the nurse residency program for ICU. For the next two years Bob makes about $60k a year, has health insurance, got an online BSN from WGU in a year for a cost of $7K, paid for by the hospital. Bob did well in the residency program and is now a competent critical care nurse. Four years after graduating high school Bob has two years of solid ICU experience, CCRN, a BSN, made $120K, and has no student debt.
Amy is just starting her career, with a $500/month student loan payment. Debt free Bob is considering applying to CRNA school, or applying for an assistant nurse manager position in the hospital.
I have seen this exact scenario played out numerous times. The Amy's of the nursing world are angry and it shows in the policy position adopted by the ANA and AACN.
Oh, please. You can't paint all RNs who didn't get a BSN as slackers, anymore than new BSN grads can call be painted as incompetent when compared with their new grad ADN peers.
When I went to nursing school, there were no BSN programs in my area. I did well in HS, but not enough to get competitive scholarships and I didn't come from a family that had the money for a 4 year college program. So I took advantage of the option available to me 30+ years ago: I went to a hospital based diploma program.
Do I wish I had a BSN? Yes, but I wouldn't change the education I got from my nursing school. It was a very competitive school to get into, and even harder to be able to graduate. I don't think for one minute I was a slacker for going to St. ******* Hospital School of Nursing. My fellow graduates would laugh in your face for your ridiculous assertion.
My state nursing association is embracing "80 by 20", where 80% of RNs will have a BSN by 2020. Forget the aging workforce, the shrinking population, and the hospital that laid off RNs last month.Did I mention the fact that our public colleges are some of the most expensive in the nation?
PMFB-RN, RN
5,351 Posts
Heck, that is the AMERICAN way. That is exactly how every other health profession did with when they got degree inflation-itis.
PT didn't make its therapists with masters degrees go back and get doctorates in order to stay employed. Neither did pharmacy.
Nursing is alone in wanting experienced nurses to return to school to continue their employment.
The only rational I can think of for this is that those who spent lots of money and time getting a BSN initially are very annoyed that anyone would have the gall to practice with anything less than a BSN, much less find ADN and diploma RNs in management and other leadership positions, so they need to be punished.
I think we can easily rule out any propaganda about better patient outcomes. If patients REALLY had better outcomes with more BSN RNs at the bedside then nursing would have done exactly what PT and pharmacy did and set a date after which a BSN would be required, and grandfathered in all the other RNs. Such a strategy would have resulted in almost no opposition from practicing nurses and would be relatively easy to implement, and we could well have BSN and entry to practice years ago.
Instead they have chosen a strategy to punish working RNs calculated to create the most possible enemies and opponents.