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Is BSN Better?

Vol. 9 •Issue 5 • Page 17
Is BSN Better?

The question lingers, as a new councilrecommends substantial government funding to expand BSN enrollment

Amid a call for expanded education funding to help alleviate the nursing shortage, a new Council on Physician and Nurse Supply is urging government agencies to shift their focus from ADN to BSN programs.

"A growing body of research supports the relationship between the level of nursing education and both the quality and safety of patient care," states a release issued by the group after its first meeting in late January. "However, nurse education is currently balanced toward associate degree nursing programs, which receive the bulk of federal funding for nurse education, yet few ADN graduates progress to advanced practice and faculty roles, both of which are needed."

A Plan to Stem Shortage

Co-chaired by Linda H. Aiken, PhD, RN, and Richard "Buz" Cooper, MD, the Council on Physician and Nurse Supply is an independent, multidisciplinary group that studies demand for nurses and physicians and proposes ways to align training with needs. Supported by the healthcare staffing firm AMN Healthcare, San Diego, the think tank is based at the University of Pennsylvania, Philadelphia, but includes nurses and physicians from across the country.

The group held its initial meeting in Philadelphia, where it declared that, at current levels of training, nurse and physician shortages would deepen to the point there wouldn't be enough of the clinicians to meet future needs.

"The council is requesting substantial additional federal and state funding of nursing education to expand enrollments at the BSN and higher levels, where the nursing shortage — including the shortage of faculty — is greatest," Aiken, who is nursing professor and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, told ADVANCE. "The council recommends new funding be targeted to expansion of BSN programs in order to create a larger pool from which new faculty and advanced practice nurses can be recruited."

Aiken said the advice to emphasize BSN education is consistent with the positions of every major nursing organization and that she expected the nursing community to be "very positive about the council's recommendations."

Support, With a Caveat

Several nursing experts told ADVANCE they do support the council's suggested BSN emphasis — provided ADN funding does not dwindle away.

"The New York State Nurses Association (NYSNA) supports the council's recommendation for a national effort to substantially expand nursing education with an emphasis at the BSN level. However, not at the exclusion of ADN programs and funding," reads a statement issued by NYSNA's Nursing Advocacy and Information Program.

The NYSNA referenced a 2002 report that showed a third of NPs practicing in New York and as almost a third of nursing faculty or deans in the state actually began their nursing careers with ADNs. "Although a fewer number of associate-prepared nurses progress to advanced practice and faculty roles (10-15 percent less), NYSNA believes that in order to meet the growing demand for qualified and diverse RNs, baccalaureate programs and funding should be accessible to the entry-level student as well as the associate-degree nurses desiring to advance their education," concluded the statement.

While noting that the Pennsylvania State Nurses Association (PSNA) supports efforts for nurses to attain BSNs and higher degrees, PSNA executive administrator Betsy M. Snook, MEd, BSN, RN, said, "An associate degree provides a good basis for a nursing career."

"I agree the emphasis should be in BSN education," said Billy Bevill, MSN, RN, associate director of recruitment and retention at the North Carolina Center for Nursing, Raleigh, "but not to the total exclusion of ADN education."

Bevill predicted increased funding resulting from the council's request would likely go toward increasing capacity at existing BSN programs, not creating new ones. "Having more programs will not improve quality and safety; it is the increased percentage of BSN and higher degree nurses in the workforce which accomplish thatoutcome," he said. "Current research speaks for itself: The higher the mix of BSN/higher degree nurses in the workforce, the lower the morbidity and mortality rates."

Do BSNs Improve Care?

But not everyone is convinced by the research. "Because quality and safety issues are influenced by so many factors, further research is needed to better understand how training and education influence quality outcomes," said Snook. "For example, other factors such as nurse-to-patient ratios, working hours or infection control protocols contribute to the quality of patient care. Quality and safety issues must be viewed in a multi-matrix context."

A 2003 JAMA study, co-authored by Aiken, that suggested a decline in patient mortality when nurses with BSNs or higher degrees were involved in care isn't enough to conclude that BSN nurses deliver safer care than their ADN counterparts, said nurse administrators at Harrisburg Area Community College (HACC), Harrisburg, PA.1 They pointed to an article published last summer in the National Organization for Associate Degree Nursing journal suggesting the study's conclusion lacks support.2

HACC reiterated this position to ADVANCE last week. "Aiken's research attempts to address a difference between the quality of care provided by associate degree nurses and baccalaureate or higher degree nurses. But this as well as other variables were not taken into consideration and therefore call the conclusions into question," reads the joint statement by Rhonda Maneval, DEd, RN, interim assistant dean and director of nursing at the Lancaster and York campuses, Ronald Rebuck, MSN, RN, director of nursing, Harrisburg, and Marilyn Teeter, MSN, RN, director of nursing at the Gettysburg campus. "Sweeping generalizations regarding the associate degree nurse are inappropriate."

The administrators suggested a better plan would be to place additional funds in ADN programs in tandem with BSN completion programs. The model would boost the nursing population in the short-term while increasing the number of eventual BSN nurses, they said, creating a win-win situation for everyone.

The LPN Effect

Regarding LPN education, Aiken commented the council "has made no recommendation on the future of LPNs."

Patty Knecht, MSN, RN, director of practical nursing at the Centers for Arts and Technology's Brandywine Campus, Coatesville, PA, suggested for now the recommendation would likely impact ADN more than LPN education.

"In essence, it would be logical to conclude there would be two levels of practice: LPN and BSN," said Knecht. "The LPN education would most probably then result in an ADN. It would be critical to assure there was a clear career path to BSN and MSN from LPN, especially in light of underrepresented minorities in RN programs."

  • To access references for this article, go to and click on the References tab under Education on the left side of the homepage.

    Jolynn Tumolo is a freelance writer in Morgantown, PA.


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