Oh The Places You'll Go: The Why, How and What of Higher Education

Throughout my career as a nurse, I have advocated for nurses to seek higher degrees. After I obtained my ADN, I converted my previous BS into a BSN, and then got my MSN. Most recently, I finished my PhD and I just got hired as an assistant professor at the University of South Carolina Upstate (USC-U) in Spartanburg (Woot! Go Spartans)! It has always frustrated me that nurses can still graduate with a 2-year degree for entry into practice, not because an ADN doesn't have the requisite skills for patient care, but because patient safety is improved when nurses with higher degrees care for patients. Nurses with higher degrees have an increased interdisciplinary voice, and an increase in job satisfaction as well.

ADN PROGRAMS ARE IMPORTANT

This article isn't about the debate over what degree is needed for entry into practice. Though the AACN recommends the BSN for entry into practice, that doesn't mean that the ADN nurse isn't well prepared. ADN nurses are needed to address the nursing shortage. The main reason for choosing a BSN is that its focus on general education courses will better prepare a nurse (AACN). Multiple studies have shown improved patient outcomes when BSNs are doing the care. In addition, nurses with higher degrees have a more equitable seat in interdisciplinary settings. When nurses (2 years preparation) are sitting down with Physicians (8 years), Physical Therapists (7 years), Social Workers (4 years), and Pharmacists (8 years) to discuss patient outcomes, there may be a lack of respect from other healthcare practitioners, and the nurse herself may also feel insecurity at the difference in education. Finally, studies have shown that nurses with BSNs make more money, have more career options, and are better situated to earn an advanced degree.1

GET THAT BSN!

More ADNs (81,633) received state licenses than those who received BSNs (72,637) in 2016.2 Despite many nurses wanting a BSN, there are barriers, one of which is geography - many potential nurses don't live near where a traditional BSN is available. Another is finances. Tuition at a four-year university isn't something students can afford. Solutions include many community colleges offering bachelor's degree nursing programs. A BSN can be obtained in the traditional manner which is four years at an accredited university or college, there are accelerated programs for those with degrees in other fields, or you can enroll in a wide variety of conversion degrees such as LPN-BSN, RN-BSN and even dual degrees, which allow you to attend community college for two years, followed by enrollment at a four-year institution. Many of these degree programs are offered online and can be done one class at a time. Often the place you work will reimburse you for your educational expenses as well.

I already had a BS in biology, so I decided to get my ADN, followed by enrollment in an online RN to BSN program. The hospital where I worked as an ADN offered tuition reimbursement, so I didn't pay a penny for my BSN degree.

There are so many things you can do with a BSN, including certification. The list of potential certifications is long and interesting. I was a certified oncology nurse, with chemotherapy certification, now I have certifications in patient safety and holistic nursing. A growing trend is a certification in dialysis nursing, but you can get certified in anything from Med. Surg. to Certified Breast Care Nurse to Wound Ostomy and Continence Nurse (WOCN).3You can also be a legal nurse consultant or get involved in travel nursing to spice things up. If you want to be a nurse researcher, an informatics nurse, a critical care nurse, a nurse advocate, or a public health nurse, you'll need your BSN.

ADVANCED PRACTICE REGISTERED NURSES

Though there is controversy and discussion about which nursing roles are under the APRN umbrella, in actuality, there are only four roles that should be legally designated as APRNs. These roles require regulation above the RN license because they provide care to patients beyond the RN scope of practice. This expansion to the scope of practice includes diagnosing, treating, prescribing, and administering anesthesia. Because this expanded scope can put the public at risk, individuals who have APRN status must meet specific qualifications that include education and certification above and beyond the RN role. Boards of nursing legally recognize APRNs to assure public safety.⁴

An APRN is an RN who has earned a graduate-level degree like a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP). There are four recognized APRN roles: certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), clinical nurse specialist (CNS) and nurse practitioner (NP). In addition, nurses can gain specialized knowledge in one of six populations:

• Family
• Adult-gerontology
• Neonatal
• Pediatrics
• Women's health
• Psychiatric-mental health

I was surprised to discover that though the US clearly defines these roles, in other countries these titles are not protected. In other words, there is no international agreement about the use of titles to distinguish APN roles.

OTHER ADVANCED DEGREES

Healthcare terminology is confusing, and nursing is no exception. You can be a registered nurse with an Advanced Degree without being an Advanced Practice Registered Nurse! An advanced degree simply means anything beyond a bachelor's degree. An MSN is needed for employment as a case manager, nurse educator (job opportunities are predicted to be up by 19% by 2022!), chief nursing officer, nurse administrator, diabetes nurse and health policy nurse. A new role for nurses is the Clinical Nurse Leader. CNLs are master's level nurse graduates with the skills and knowledge to create change within complex systems and improve outcomes while they remain direct care providers. I'm going to write more about the CNL in Part 2.

Becoming a nurse attorney is another option, requiring an RN and a legal degree, which takes three years in addition to an undergraduate degree of some kind. (I wrote an article about nurse attorney Lori Brown. Allnurses has a feature where you can ask nurse attorney Lori Brown any question you like!

And what about that PhD (Doctor of Philosophy)? You have to have a Doctorate (either NP or PhD) to teach in MSN, PhD or NP programs, so nurses who want to go the academic route, typically obtain a PhD (I wrote about the difference between NP and PhD here. Nurse researchers and Chief nursing officers in large, well-respected institutions typically have a terminal degree as well. You can get your PhD online or in a traditional, seated environment from a wide variety of schools.5

WHERE TO GO?

The National League for Nursing does a survey of nursing schools every two years. In 2014, they reported 1,869 basic RN programs, including 1,092 ADN programs, 710 BSN programs and 67 diploma programs in the U.S.6 Where you get your degree does matter. It's important to choose an accredited school - for example, the Veterans Association won't hire graduates from schools that don't have accreditation by ACEN or CCNE.7 Many educational programs offering higher degrees won't accept transfer credits from schools that lack accreditation. In addition, you want to choose a program that fits your lifestyle. Not everyone will want to be in an online program. Consider how often the school admits students - if they only admit every Fall, for example, if you have to drop out for any reason, you'll have to wait a year to rejoin the next class. It's also important to look at NCLEX pass rates. If the school you are considering doesn't have a successful NCLEX pass rate, you have to ask yourself how well they are preparing their students? And schools who fall below NCLEX passing standards for several years can be shut down.

Allnurses has a great resource when you are looking for a school - they have peer reviews of nursing schools. Click here for more info.

Be careful with sites that advertise! Often those organizations will only present those schools who have paid for advertising. Even articles that look benign, like "A Guide to Become a Registered Nurse" which I found on google, can actually be a hidden advertisement for select nursing schools.

It's difficult to find a comprehensive database of nursing schools. One tool I have used is the U.S. News and World Report. They rank colleges each year according to multiple criteria and include tuition, enrollment, and acceptance rates as well as many other details.8To unlock all the features offered by this organization however, you have to pay $40.00

The AACN has a resource page for students to help you find a nursing program. You can search by state or by type: American Association of Colleges of Nursing (AACN) > Students > Find a Nursing Program. They have also included a link to a website that allows you to apply to several nursing schools with one application: American Association of Colleges of Nursing (AACN) > Students

Be sure to tune in to Part 2, where I talk specifically about the role of Clinical Nurse Leader.

REFERENCES

1. Advantages of a BSN
2. The battle over entry-level degree for nursing continues
3. Credentials and Certifications
4. Advanced Practice Registered Nurse
5. 31 best specialty career choices for nurses
6. Number of Basic RN Programs
7. Veterans Administration Healthcare Application
8. Best Colleges in South Carolina

number-of-basic-rn-programs-total-and-by-program-type-2005-to-2014.pdf