Why nurses are feeling more prepared after earning bachelor’s degrees than associate’s degrees
Back in 2010, the Institute of Medicine (now known as the National Academies of Sciences, Engineering, and Medicine) published “The Future of Nursing: Leading Change, Advancing Health.” This report provided recommendations for how nurses can best advance the nation’s health while meeting an increased demand for care.
Among other recommendations, the report called for an increase in the proportion of nurses with bachelor’s degrees to 80 percent by 2020—a recommendation supported by studies showing that nurses with bachelor’s degrees have better patient outcomes, including lower mortality rates.
Now a more recent study led by researchers from the NYU Rory Meyers College of Nursing finds that it works both ways—nurses themselves who hold bachelor’s degrees are reporting that they feel better prepared in areas of quality and safety measures than do their peers with associate’s degrees.
These findings were published in the Joint Commission Journal on Quality and Patient Safety. They demonstrate not only a gap in preparedness between the two groups of professionals, but further evidence for industry leaders to support higher educational standards for aspiring nurses of the future.
Maja Djukic, PhD, RN, is an associate professor at the NYU Rory Meyers College of Nursing. She is a Macy Faculty Scholar and served as the study’s lead author. She’s been interested in finding differences between the educational levels dating back to 2006, when she was part of a group that helped collect data on those who graduated in 2004 and 2005.
Initially, the Robert Wood Johnson Foundation sponsored the research around the Quality, Safety, and Education for Nurses Project. Dr. Djukic was able to collaborate with the Foundation and develop a set of survey items to assess preparedness within the nursing workforce within specific competencies.
For the most recent study, Djukic and her colleagues Christine Kovner, PhD, RN, FAAN, and Amy Witkoski Stimpfel, PhD, RN, examined people who graduated with either bachelor’s or associate’s degrees in 2007–2008 (324 nurses), and a larger group (803 nurses) who graduated in 2014–2015.
They asked these 1,100-plus nurses how prepared they felt after graduation on various quality improvement and safety topics, then analyzed the differences in these responses between those with associate’s degrees and those with bachelor’s degrees.
“In the 2007-08 cohort, baccalaureate-prepared nurses reported being significantly better prepared than those with associate’s degrees in five out of 16 topics in which we surveyed,” said Dr. Djukic. “For the 2014-15 cohort, the baccalaureate-prepared nurses reported being significantly better prepared in 12 of those 16 topics. The increase has more than doubled, which is how we quantify the significance.”
Overall, the group saw the increase over time, but empirically speaking was unsure why that increase was so pronounced. Speculation exists that baccalaureate-level programs have invested greater resources into their teaching of quality and safety competencies, while an even simpler explanation accounts for the difference in time between the two curricula.
“In the baccalaureate curriculum, the added time allows for deeper focus upon issues of quality and safety—four years versus two years,” Dr. Djukic pointed out.
Dr. Djukic, of course, works in New York—the only state to mandate the ‘BSN in 10’ concept by which all newly licensed nurses to obtain a baccalaureate degree within 10 years of licensure. The law was a long time in the making, so there are varying degrees (no pun intended) of uncertainty regarding the likelihood of other states enacting similar laws.
“How do you fix it? Do you require all nurses to receive bachelor’s degrees?” asked Dr. Djukic. “Or as an employer, you can mandate your employees to get a baccalaureate-level education.”
Some have gone as far as to suggest preferential hiring practices for those nurses with bachelor’s level degrees, or at the very least requiring nurses with associate’s degrees to obtain a bachelor’s degree within a certain period of time as a condition of maintaining their employment.
“In New York City, that’s not an issue,” Dr. Djukic explained. “There are plenty of baccalaureate-prepared nurses.”
“But in a rural area or other areas with shortages, employers will tell you, ‘We don’t have a choice—we hire whomever can hire.’”
This is where the transitional program would come into play—the idea of hiring nurses with associate’s degrees with the requirement or the understanding that they will pursue a bachelor’s degree within a designated time frame. “You can fund them for their schooling as an employer,” said Dr. Djukic. “If it’s an issue of supply, that’s fine, but they can still pursue higher education.”
The fundamental issue, it would appear, is whether or not employers see the increased value of the bachelor’s degree within the nursing field. By incentivizing nurses to pursue higher education, employers can have a tangible impact on moving the profession at large in the direction of the bachelor’s degree.
“In my view, that is the most effective strategy,” said Dr. Djukic. “You can require the bachelor’s degree, while strategizing how to incentivize your workforce to pursue higher education.
“Is it money? Is it time off? Is it flexibility around scheduling to give them time to complete the degree? We don’t have those answers, but we can show the value of baccalaureate education. These incentives will likely work more quickly than passing state legislation.”