The role of a nurse has been recognized for centuries. The educational requirements of a nurse have been debated for about as long. Throughout the centuries, the role of the nurse has changed and at the same time, so have the education requirements for entry into the profession. Nurses have been educated in different scholastic settings throughout the ages and although nurses function in similar roles within the workplace, there are differences in competency based on educational background. This paper will focus on the competency differences in students trained at the associate level versus those trained at the baccalaureate level.
Prior to 1909, prospective nurses were taught in hospital-based schools. These nurses earned their Diploma in Nursing after spending 2-3 years of intense training, living and working in a hospital. In 1909, the first permanent undergraduate university nursing program was established at the University of Minnesota. The time and money that was required for university programs made it difficult for many and enrollment was extremely low compared to the hospital-based diploma programs (Creasia & Friberg, 2011).
In 1924, working with an endowment established by the Rockefeller Foundation, Annie Goodrich started a baccalaureate program, Bachelors of Science in Nursing (BSN), at Yale University. In addition to the core training that nurses received in diploma programs, Goodrich’s program was based on acute illness, psychosocial dimensions of illness and public health principles (Creasia & Friberg). Brought on by a desperate nursing shortage after World War II, nurse educator, Mildred Montag proposed a new program for training nurses.
Montag proposed a two-year associate degree program, through community or junior colleges that would train students to be nurse technicians. These Associate Degree in Nursing (ADN) students were eligible to sit for the state nursing licensure examinations. Upon successfully passing the state nursing licensure exams, these nurses were employed as graduate nurses. After a five year study of these students, the program was deemed acceptable since the students were able to pass the state licensure exams and demonstrate an adequate level of nursing competency (Creasia & Friberg).
In 1951, Mildred Montag’s doctoral thesis, Education of Nursing Technicians (1951), proposed that nurses could be prepared for “intermediate functions requiring skill and some judgment” (as cited in Schank & Stollenwerk, 1988). Montag’s model would prepare nursing technicians to: assist in the planning of care, give general care with supervision and assist in the evaluation of nursing care given. Montag’s model did not have any mention of a management or leadership role for these nurses (as cited in Schank & Stollenwerk).
BSN programs prepare students to provide holistic care to patients, families, populations and communities. These programs provide students with a “broad perspective and understanding of nursing, health and healing, the environment and persons as diverse individuals, families, groups and communities” (Poster et al. , 2002) . Baccalaureate programs integrate liberal arts, leadership/management training, public health, evidence-based research and the use of informatics into their curriculum.
While the core nursing classes are very similar in the ADN and BSN degrees, the BSN programs better prepare students for leadership roles with organizations. Given the increasing use of technology in healthcare, a nurse who is trained at the baccalaureate level will be better prepared to use research skills and evidenced-based practice to provide care to patients and communities. In the case of a patient who presents to the hospital for treatment of pneumonia, the ADN nurse will have the basic skill set to deal with the immediate needs of the patient and provide the nursing care that the patient requires.
The BSN nurse will also provide this same care but will also have the knowledge and skills to look deeper into the cause of the illness. Research and evidence-based practice will allow the BSN nurse to look at contributing factors. Patient education would include the use of community resources and education would expand beyond just the patient and include family and support systems. The use of informatics will allow the BSN nurse to analyze data and look for trends within the community or population.
The day-to-day nursing activities of the ADN and BSN nurse are very similar (Smith, 2002, p. 494). The opinions of nurse executives regarding the leadership/management capabilities of ADN and BSN graduates clearly show that the executives feel that the BSN graduate is more capable of being a charge nurse, head nurse or supervisor (Schank & Stollenwerk, 1988, p. 255).
Experience and time on the job contribute to the care that a nurse provides. Study results describe the more experienced, educated nurse as likely to demonstrate more Conceptualizing, Ego Strength, Independence, Influencing and Coaching” (DeBack & Mentkowski, 1986, p. 284). While the two degrees offer similar core education, the baccalaureate programs offer a deeper understanding of theory, research, evidence based practice, leadership and community based care. Research studies have shown that the better the education level of the nurse, the better patient outcomes (Aiken, Clarke, Cheung, Sloane, & Silber, 2003).