As a proficient professional, a Registered Nurse (RN) should take responsibility for own personal, educational, and professional growth as a healthcare provider to perform the comprehensive scope of ever-evolving nursing practice for highest patient outcomes. As X. Malcolm (n.d.) stated, “Education is the passport to the future, for tomorrow belongs to those who prepare for it today.” Similarly, the nursing educational growth is fundamental to nurses’ personal and professional growth. There are two pathways to begin as a registered nurse: Associates Degree in Nursing (ADN) and Bachelor of Science in Nursing (BSN). A student can opt for ADN or BSN degree, but his or her title remains same: Registered Nurse. Although both nursing degrees fulfill the basic requirement to become a licensed registered nurse after passing National Council Licensure Examination-RN (NCLEX-RN) examination.  BSN empowers a student nurse with critical thinking, communication, management, leadership skills as well as a better understanding of a variety of aspects of the patient care like physical, psychological, social, political, economic, cultural, public health, wellness, community nursing to face present and future healthcare demands or challenges.

Associate Degree Education

            Associates Degree in Nursing is two years entry-level nursing program that incorporates a balance between courses in natural, social, behavioral sciences, and nursing. Academic associate degrees consist of about 70 credit hours with most of the requirements in nursing courses. It equips the student nurses with the fundamental set of technical and clinical skills necessary to provide an adequate bedside patient care in the secondary healthcare settings like skilled nursing facilities, long-term care facilities, and community hospitals. An ADN graduate performs simple nursing care, recording patient symptoms, and medical history, supporting the family, educating patients on diseases or diagnoses, working in close consultation with doctors, or using and managing simple medical equipment. This program is beneficial for a student who cannot afford the school or residential expenses for an extended period. One can get ADN degree from a community college, spending less money and time to enter the nursing workforce. An ADN nurse can acquire the BSN degree through an RN-to-BSN program like Grand Canyon University, Phoenix, AZ has an RN-to-BSN bridge program.

Bachelor’s Degree Education

BSN is a four years program from the four-year colleges and Universities that incorporates approximately total 120 credit hours from liberal arts and natural, social, and behavioral science courses and nursing courses. BSN graduates are prepared to give and direct care for the patients, families, populations, and communities experiencing complex and volatile health care needs in an organized or unorganized setting.  It is a bigger investment of time and money as compared to ADN, but it opens doors for a wide range of jobs like management positions, insurance carriers, nurse educators, case managers, nursing researchers, and nursing specializations like public health, pediatrics, geriatrics, oncology, etc. It includes all nursing and general education courses that ADN includes, but also include some additional courses with the emphasis on leadership, management, evidence-based practice, nursing research, informatics, quality care and patient safety.  Although both programs provide students with hands-on learning with actual patients in healthcare facilities, BSN enhances decision making, analytical, prioritizing, problem-solving, and critical thinking skills to understand issues affecting the patient care or healthcare setting, and provide better patient care as a confident and a professional nurse. Both programs prepare nurses for adequate patient care and perfume duties such as assessments, formulating nursing diagnoses, treatments, interventions, and completion of procedures, and documentation within the scope of nursing practice. BSN graduates use problem-solving skills, set priorities, and evidence-based practice more effectively, that results in better patient care and patient outcomes.

Research on Competencies

There are multiple studies reflects BSN nurses as more competent, professional, confident, and versatile nurses equipped with better problem solving, decision making, critical thinking skills who can assume a role of innovator, patient advocate, case manager, patient educator, discharge planner, and collaborative leader.

Mbewe and Jones (2015) presented a study “Does Associate Degree Curricula Adequately Prepare Nurses for Leadership Roles?” in the Academy of Medical-Surgical Nurses’ newsletter for January/February 2015. This study included fifty graduates from the New York City ADN programs as survey respondents. The survey questioned on respondent’s characteristics, educational preparation, perceptions of his or her skills, and how ADN program curricula could be improved to prepare him or her to be nurse leader. Results of this study showed eighty-four respondents did not feel comfortable with their leadership skills due to lack of professional identity and preparation for leadership roles. New ADN graduates feel unprepared for leadership and management roles in nursing due to increased nurse-to-patient ratio, patient care complexity and acuity, and shortened clinical rotations (Mbewe & Jones, 2015).  This study recommends improvement in ADN curricula to enhance nurses’ professional identity and readiness for leadership and management roles.

The second study included twenty-one University Health System Consortium hospitals to analyze the relationship between RN education and patient outcomes, controlling nurse staffing and other hospital factors influencing the patient care (Blegen et al., 2013). This study concluded that the hospitals with a higher percentage of BSN or higher educational degree nurses had the shorter hospital stay and lower rates of postoperative deep vein thrombosis or pulmonary embolism, failure to rescue, decubitus ulcers, and congestive heart failure mortality rate (Belgen et al., 2013).

 Another study demonstrated a compelling relationship between RN education level and patient outcomes, based on data that each ten percent increase in the proportion of BSN graduate RN drops the risk of failure to rescue and patient mortality by five percent (Zittel et al., 2016).

Approach to Care

According to Rosseter (2014), BNS provides the nurses with stronger communication, problem-solving skills, and higher proficiency in their ability to make the nursing diagnoses and evaluate nursing interventions. BSN provides nurses a better understanding of evidence-based nursing practice and nursing metaparadigm that changes their approach to care. For example, an Eighty-years-old male patient with unusual abdominal pain on Medical-Surgical unit, get diagnosed with liver cancer. Both ADN and BSN graduate working on that unit does assessments, formulate nursing diagnoses, perform interventions, do evaluations and documentation based on that patient’s symptoms, treatment options, patient’s questions and concerns. Both nurses provide symptomatic care for pain, nausea, vomiting, breathing issues, insomnia, or other physical issues related to cancer and its treatment; patient education and support. This patient’s care needs more than above mentioned basic nursing process. It includes age-appropriate care; guidance for making treatment decisions; support for social, emotional, and spiritual needs; support for caregivers, family, and friends; communication with patient’s doctors, social worker, billing department, and other healthcare providers as needed. To provide holistic care, BSN nurse can confidently assume the role of a case manager, educator, patient advocate, and utilize skills of problem-solving, decision making, evidence-based practice, communication, critical, and analytical thinking.

Conclusion

ADN and BSN are stepping stone to enter healthcare field as a registered nurse. BSN opens door to a broad range of career opportunities and advances nursing programs. As Martin Luther King (n.d.) stated, “The function of education is to teach one to think intensively and to think critically. Intelligence plus character – that is the goal of true education.” Similarly, BSN provides knowledge and tools for nurses to achieve holistic care goals and manage upcoming challenges in the ever-changing and the evolving healthcare system and culturally diverse population with the ever-changing needs. ADN nurses can pursue BSN degree while working and earning as a registered nurse to overcome two major barriers to continuing education and achieving proficient professional identity. 

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