“Moving to a nurse workforce in which a higher proportion of staff nurses have at least a baccalaureate-level education would result in substantially fewer adverse outcomes for patients” (Friese, Lake, Aiken, Silber & Sochalski, 2008). Of the three most popular ways to become a registered nurse, a Bachelor of Science in Nursing (BSN) degree has been recognized as the best training for nurses in the current complex healthcare system.
A baccalaureate prepared nurse possesses additional skills in critical thinking, leadership, case management, health promotion and can function extremely well across all healthcare settings. A BSN is a four year degree covering all clinical areas of nursing as well as professional nursing, areas not covered by the Associate Degree in Nursing and the hospital administered diploma curriculums. Critical thinking skills are an integral part of nursing care as they allow the nurse to analyze and interpret data that directly affects a patient’s care.
Nurses are at the front lines of patient care and have a view of all aspects relating to the patient and these skills help the nurse put it all together. The baccalaureate education places a generous amount of focus on critical thinking skills compared to the closely related Associated Degree in Nursing (ADN) that focuses on the technical bedside skills. The level of emphasis placed on critical thinking at the baccalaureate level gives the nurse stronger communication and problem solving skills.
Research has shown that 72% of hospital directors identified differences in practice between a BSN and an ADN nurse, citing stronger critical thinking skills (Journal of Nursing Administration, 2001) Leadership in nursing involves the ability to appropriately recognize actions that can be delegated and make assignments that fit each member of the nursing care team. Leadership is an essential part of the BSN curriculum, but it is not included in the ADN curriculum, giving the baccalaureate prepared nurse the ability to create an effective flow in the care of the patient that incorporates both the medical and comfort needs of the patient.
Delegation of duties alleviates stress and exhaustion ultimately decreasing the occurrence of errors in the nursing practice. Two separate studies performed by the state of New York and the state of Texas show significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels. These studies stress the importance of a nurse prepared at the baccalaureate level in the delivery of safe patient care.
Health promotion is increasingly becoming an important aspect of patient care in the inpatient and outpatient settings as well as in long-term care and rehabilitation facilities. The prevention of disease, alleviation of symptoms and deterring the recurrence of disease is the goal of care for health care providers everywhere. BSN prepared nurses are in a great position to achieve this goal, because of the diversified curriculum covered on the baccalaureate level instilling independent thinking.
This training is discernibly lacking in the ADN curriculum as the purpose of the curriculum is to prepare competent technical bedside nurses for secondary facilities of healthcare such as nursing homes. An 84 year old female patient is admitted to a critical care unit of a large hospital in respiratory distress and symptoms indicative of septic shock, under the care of a BSN trained nurse. The patient is sedated, intubated and treated with intravenous fluids and medications. The treatment is aggressive and a slow improvement is seen.
The nurse creates a plan of care that includes palliative care knowing that a palliative physician is well equipped to speak to the family members regarding the goals of care based on the prognosis and gain a clear understanding of the family’s wishes for their loved one. The nurse adjusts the plan of care as needed by anticipating that this patient’s recovery includes rehabilitative treatment such as physical therapy and utilizes hospital resources to get the necessary treatments in place.
The plan of care also includes education for the patient and family regarding current treatment, future prevention of infection and early recognition of symptoms. While an ADN trained nurse would focus on executing the physician orders, the BSN trained nurse is well suited to care for this patient providing exceptional care that incorporates the patient, family and community. Studies support that care provided by nurses with baccalaureate level education was associated with better patient outcomes.
ADN nurses who possess only technical bedside skills for care at secondary settings may encounter difficulties providing care in the current complex healthcare situations as it requires skills in case management, critical thinking and health promotion. In the absence of a baccalaureate level education patients are denied a wholesome look at all facets of their care. Effective nursing practice calls for more attention than the delivery of basic bedside skills and a baccalaureate prepared nurse is well placed to be the perfect advocate for his or her patients.