Making RNs Obtain a Baccalaureate Degree?

[Chronis]

I was curious what everyone thinks about the debate over the law being proposed in New York which seeks to require all registered professional nurses to attain a baccalaureate degree in nursing within ten years of their initial licensure?

http://www.advisory.com/Daily-Briefing/2012/01/04/BSN-in-10

The New York bill A01977 wouldn't apply to registered professional nurses who are already licensed in the state of New York. Also those currently in school to become registered professional nurses in the state of New York would also be grandfathered in and exempt from the new legislation.

I have looked into research regarding this topic and the research I have seen seems to support the fact that nurses educated at the baccalaureate degree have lower mortality rates for patients. One study indicates that increasing nurse's educational level decreases the risk of patient death and failure to rescue by four percent (Aiken et al., 2008). Also hospitals with a higher proportion of baccalaureate-prepared nurses have a lower mortality rate (Friese et al., 2008). In fact the Institute of Medicine has issued a call for 80% of registered nurses to possess a baccalaureate degree or higher by 2020 (Institute of Medicine, 2011). Other research I found supports the fact that BSN nurses are associated with lower mortality rates. I have included this research below:

Estabrooks, C. A., Midodzi, W. K., Cummings, G. G., Ricker, K. L., & Giovannetti, P. (2005). The impact of hospital nursing characteristics on 30-day mortality. Nursing Research, 54(2), 74-84.

Tourangeau, A. E., Doran, D. M., Hall, L. M., Pallas, L. O. B., Pringle, D., Tu, K. V., et al. (2006). Impact of hospital nursing care on 30-day mortality for acute medical patients. Journal of Advanced Nursing, 57(1), 32-44.

To be fair I tried locating research that would cast doubt on the research above or that would come to a different conclusion. I was however unsuccessful in locating any such research. If anyone has any additional research that would repudiate the fact that nurses prepared at the bachelor's level seem to have a lower rate of mortality for their patients could you please post it? I would love to see such a study and would be very interested in reading it.

References

Aiken, L.H., Clarke, S.P., Sloane, D.M., Lake, E.T. & Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing Administration, 38(5), 223-229.

Friese, C.R, Lake, E.T., Aiken, L.H., Silber, J.H. & Sochalski, J. (2008). Hospital nurse practice environments and outcomes for surgical oncology patients. Health Services Research, 43(4), 1145-1163.

Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press.

[dishes, BSN, RN]

chronis

I'm an Ontario RN, so I'm aware of the role of RPNs/RNs and the studies on staffing education levels and patient outcome. At one point, some Ontario employers used the BSN pt outcomes studies to try and staff with all BScN nurses, but now they use the RN/RPN patient outcome studies to support a mix of staffing. One thing that has been made clear from mandating nursing education as a 4 year BSN and 2 year diploma PN, is that employers are getting a better bang for their buck.

dishes

[nursel56]

Correlation does not prove causation, regardless.

[GitanoRN, BSN, MSN, RN]

haven't we discuss this topic previously?

[nursel56]

Why, yes! Just 2 days ago we had one stagger across the finish line. At least this person provided their links right away . . .

[dishes, BSN, RN]

haven't we discuss this topic previously?

yes and if this topic continues to come up, i think esme may suffer brain damage from banging her head against a brick wall.

[NPluvsalsa]

My commEnt is mistakes and med errors probably have less to do with the education and more to do with the nurse patient ratio... I believe if the floors are equipped with enough nurses people have the time to be diligent...when any person is running overworked expected to do

the job of two people then the patient lives are in danger.... Im all for commonsense solutions... Many people seem to over look the most practical reasonable solutions... Nurse helpers

[NPluvsalsa]

People like CNA, LPN, CAN assist the stress on the bedside nurse... Trying to make everyone have a BSN that's just fine...but I wonder the results of the studies when there are even less nurses to deal with the already shortage and poor staffing ratios... Things that make me say hmmm...

[joanna73, BSN, RN]

At some point, the BSN probably will be the minimum requirement. I see nothing wrong with that. For one thing, this will eliminate the high numbers that continue to enter the profession. In Canada, the BSN has been the requirement for all new RNs since 2005. Many diploma nurses returned to school. We no longer have two year programs.

[RyanCarolinaBoy, ADN, BSN, MSN]

while I am all for education, I believe that an RN is an RN is an RN. I work in an environment that promotes education actively, paying for ADN's to complete their BSN free of charge. And many have done so. I work with Masters prepared nurses at the bedside on a daily basis. Having said that, there is no way for me to distinguish which nurses went to ADN vs BSN without directly asking them. No difference in scope, no difference in our pt outcomes. A professional nurse is simply that. If the powers that be wish to promote the BSN as the entry level of practice, i'm all for that. But all this cattyness in nursing simply needs to stop. The whole "i'm a better nurse b/c i'm a BSN, RN" is absolute 110% rubbish!

For God's sake, do a study on something that actually matters. Like "does this dress make me look fat?"

[That Guy, BSN, RN, EMT-B]

Maybe nursing will be taken seriously for a change if the entry to practice is raised....

[Chronis]

many nurses have adn's but got bsn's online was that accounted for? i doubt it. this research is focusing on the wrong variables if you ask me.

futurernmena,

i am sorry to hear about your boss. in response to your question to the best of my knowledge the current research would count adn nurses who complete their bsns as bsn nurses because that’s what they would be. i don’t see how that would affect any of the data in the studies however.

chronis

i'm an ontario rn, so i'm aware of the role of rpns/rns and the studies on staffing education levels and patient outcome. at one point, some ontario employers used the bsn pt outcomes studies to try and staff with all bscn nurses, but now they use the rn/rpn patient outcome studies to support a mix of staffing. one thing that has been made clear from mandating nursing education as a 4 year bsn and 2 year diploma pn, is that employers are getting a better bang for their buck.

dishes

dishes,

do you know what those studies are called regarding the use of rn/rpn vs. rn? or what journal article they where published in? i would be skeptical to take anything employers said on faith. in my experience at least in america employers are more worried about saving money that protecting patient’s health.

correlation does not prove causation, regardless.

nursel56,

that’s the same argument the tobacco companies used when they where trying to dispute the studies that showed smoking caused cancer. however if you have any ideas on unknown variables that might have effected all the studies i would be glad to hear them.

haven't we discuss this topic previously?

gitanorn,

topics regarding a new york rn-bsn bill have probably been discussed several times throughout the years. that’s because new york has proposed similar bills to a01977 requiring rns to go on and get their bsns for the last 8 years

but all this cattyness in nursing simply needs to stop. the whole "i'm a better nurse b/c i'm a bsn, rn" is absolute 110% rubbish!

ryan,

i certainly agree with you that cattiness in nursing must stop. horizontal violence in nursing is mean spirited and unprofessional. the issue of rn-bsn should not be used to attack individual nurses. however if the current studies do indicate that the training in bsn programs helps reduce patient mortality shouldn’t we take a hard look at implementing such training in our workforce? don’t we have a duty as health care professionals to give the best care possible to the general public?

[nursel56]

nursel56,

That's the same argument the tobacco companies used when they where trying to dispute the studies that showed smoking caused cancer.

What does that have to do with what we're talking about now? Are you saying that a company who uses science in a nefarious way negates the essential truth that an association made with no attempt to isolate the variables is not a valid argument?

However if you have any ideas on unknown variables that might have effected all the studies I would be glad to hear them.

You don't see any of them yourself? The 2003 Aiken chart review alone is loaded with variables. If you have any ideas of instances where we can say with certainty that the presence of a BSN nurse caused a change in outcome I'd be glad to hear that. I don't believe it exists. Until it does, you cannot state "the training in BSN programs helps reduce patient mortality".

Not going to go through the whole list, but this is a pretty comprehensive list of issues with the ANA/AACN described "landmark study" most often cited as proof that you may end up deceased if an ADN nurse takes care of you 24/7 while you're in the hospital, so I would suspect the others follow suit.

http://www.aacc.nche.edu/Resources/aaccprograms/health/Documents/aacc_analysis_aiken.pdf

That same Institute of Medicine you referred to said this in 2010:

"The causal relationship between the academic degree obtained by RNs and patient outcomes is not conclusive in the research literature."