According to the United States Department of Labor, the registered nurse workforce is expected to rise by 15% from 2016 to 2026 (White, 2017). The employment gap for registered nurses is estimated to rise based on the number of registered nurses who are expected to retire in the next decade. The projected need for replacements and growth in the nursing industry is expected to reach 1.10 million by 2024 (White, 2017). According to research, the United States is currently experiencing lower mortality rates, positive patient outcomes, and less medication errors, which has been linked to the preparation of physicians at the baccalaureate and higher degree levels (Fawaz et al., 2018). In addition, the needs of health care in the United States is continuously shifting to a population-based focus and community-based approach to care. Therefore, the healthcare system in the United States requires RNs who can practice in multifaceted settings to fulfil the dynamic needs of the population (Fawaz et al., 2018). The ANA (American Nurses Association) was the first healthcare body to recognize that the educational preparation of nurses a direct connotation to better patient outcomes. This paper advocates for the bachelor of nursing degree to be set as the minimum requirement for registered nurses as it is directly associated with improved patient outcomes, decreases healthcare costs, and leads to enhanced patient care.
Literature Review
The IOM (Institute of Medicine) commends that eighty percent of nurses must have a BSN by 2020 (Fawaz et al., 2018). This need has been fueled by increased research detailing that healthcare institutions with a higher percentage of BSN-prepared nurses have improved patient-outcomes. Besides, there is also a need for professional nursing educators to analyze issues and trends in order to analyze the need for both organizations and individuals (Salmond & Echevarria, 2017) . The nursing profession contains multiple paths for entry, an option that is currently being challenged by the directive issued out by the IOM (Fawaz et al., 2018). According to research, only six percent of registered nurses who received an associate degree between 1970 and 1994 went on to pursue a master's degree or a doctorate. Therefore, the directive by IOM is to increase the required skills and knowledge of current and future nurses so that they can effectively work in multidisciplinary teams to meet the multifaceted needs of patients. The AACN (American Association of Colleges of Nursing) supports the notion that the BSN should be the minimum required for registered nurses citing the complexities in the 21 st -century healthcare environments and care of patients that are needed for nurses who can adapt, direct, and promote change into practice (Salmond & Echevarria, 2017) . The AACN is also in support of practicing nurses to go back to school and seek a BSN that develops both clinical proficiency and patient care.
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According to a study that was conducted by the RWJF (Robert Wood Johnson Foundation), registered nurses with BSN's were found to have lower incidences of hospital-acquired contaminations, pressure ulcers, and post-surgical deaths. In other studies, institutions with a high number of BSN nurses have been found to correlate with the delivery of superior healthcare and better patient outcomes that is vital to successful hospital management (Salmond & Echevarria, 2017) . Djukic et al. (2019) found out that healthcare institutions that employed nurses with a BSN experienced reduced mortality rates from less postoperative deep vein thrombosis, congestive heart failure, and a decline in the number of patients suffering from pulmonary emboli. In a study that was conducted by Salmond and Echevarria (2017), increased patient outcomes were linked with the achievement of higher education in nursing in nine European countries. According to the study, for every 15% rise in nurses with a BSN degree, there was an 8% decrease in the likelihood of patient deaths. In institutions that more than 65% of registered nurses with a BSN, they experienced a decline in the number of patients that died after surgery was 1/3 lower than institutions that had fewer than 60%. Other studies show that for every 20% rise in BSN prepared nurses, there was a 7% decrease in the probability of patients dying within 30 days of admission (Tartavoulle et al., 2018).
Due to an increase in patient outcomes, there is an increase in the demand for BSN prepared nurses. To achieve higher levels of competency and patient outcomes, hospitals must retain a workforce that is BSN prepared (Potera, 2015) . Therefore, advancing nurses' education will help ensure that registered nurses are highly-qualified and equipped to meet the evolving expectations of the healthcare industry.
Discussion
The nursing profession is critical to the safe, humane provision of healthcare and health services to populations not just in the United States but across the world. Today, nurses experience several challenges (Potera, 2015) . The primary challenge that relates to nursing enlightenment lies in the preparation of nurses for undergraduate studies. In the past, nursing education prepared students to exercise for the day, but it did not prepare them for future practice. However, this does not mean that nursing education is irrelevant. Today, nurses are responsible for providing competent, safe, adequate patient care, but yesterday’s nursing practices are not able to meet the requirements of today’s patient population (Parolisi, 2020) . Today, the patient populace is elderly and has become progressively complex, and the proficiencies that are required in today’s health care settings surpass hands-on practical skills. The education that nurses received in the 20 th century is inadequate in combating the healthcare realities of today (Parolisi, 2020) . This means that healthcare institutions in the United States and globally not to take into consideration the number of nurses that they have attending to patients but also their educational preparation.
Today, the world has rapidly changed from nations with defined borders, economies, and cultures to a world with porous borders where people, practices, cultures, and economies have merged (Parolisi, 2020) . Today, nursing care is under threat of being eroded. Care is described as a role, an ethic, an attribute, and an act. As human life and rights become increasingly under threat from multiple dimensions, nurses will be challenged in their resolve and care to human life irrespective of circumstances (White, 2017) . Irrespective of their social and economic capabilities of target populations, nurses must protect and advocate for their right to access and obtain quality health and care. Although there is an increased national emphasis on baccalaureate-prepared nurses, an understanding of the barriers and motivators for nurses to return to school is essential for success (White, 2017) . The complex requirements of today’s healthcare command exemplary nursing leadership and the use of evidence in driving practice.
Healthcare institutions comprehend that higher thinking and education results in improved patient outcomes and a productive nursing workforce. The promise of job security in the future is an influential motivator for RNs to return to school and acquire a BSN. However, there are barriers to returning to school. According to Parolisi (2020), the most common barriers are financial constraints, lack of adequate academic support, the complexities in the qualification requirements for BSN programs, competing priorities, and lack of time. To eliminate these barriers, specific motivators such as personal fulfillment, career development, and the nurse’s internal motivation to expand their knowledge should be considered. According to a study conducted by White (2017), the most anticipated external benefits by nurses returning to school were flexible work hours, the length of the program, increased job opportunities, and tuition reimbursement. Therefore, healthcare institutions must have a greater understanding of how these challenges affect diploma and associate degree registered nurses and the implications that they have on healthcare organizations that are in pursuit of meeting the 80% BSN completion rate by 2020 (Parolisi, 2020) .
Although the 80% requirement by IOM of registered nurses having acquired a BSN will not be met by the end of 2020, considerable progress pertaining to this objective has been achieved (Parolisi, 2020) . The nursing fraternity is experiencing an increased number of registered nurses’ graduation from BSN programs has tripled, and entry-level students are moving towards BSN and entry-level master’s programs (Parolisi, 2020) . Healthcare institutions, on the other hand, are continuously rewarding registered nurses for attaining additional education. Healthcare consumers will be the primary beneficiaries of this initiative, as they will receive care from competent nurses who have been prepared to address the complex needs of healthcare in collaborative teams.
Conclusion
A BSN degree is beneficial to both registered nurses and their patients. To meet the 80% national threshold, higher education administrators, employers, nurse educators and legislators must combine resources and provide opportunities that will enable all nurses to commit to the future of their educational development. Therefore, nursing education must also evolve to keep pace with the changing healthcare needs of the population, with an emphasis on population health and health equity as well as initiatives that increase diversity and inclusiveness in the nursing workforce. There is a greater need to understand the challenges encountered by practicing registered nurses in pursuing advanced education, which is vital for healthcare institutions in developing initiatives that will help in increasing the number of nurses with BSN degrees. Also, there should be joint collaborations between healthcare organizations and educational institutions to promote an educated workforce that will ultimately result in improved patient outcomes.
References
Djukic, M., Stimpfel, A., & Kovner, C. (2019). Bachelor's Degree Nurse Graduates Report Better Quality and Safety Educational Preparedness than Associate Degree Graduates. The Joint Commission Journal on Quality and Patient Safety , 45 (3), 180-186. https://doi.org/10.1016/j.jcjq.2018.08.008
Fawaz, M., Hamdan-Mansour, A., & Tassi, A. (2018). Challenges facing nursing education in the advanced healthcare environment. International Journal of Africa Nursing Sciences , 9 , 105-110. https://doi.org/10.1016/j.ijans.2018.10.005
Parolisi, T. (2020). Experiences of graduates in Massachusetts of the United States from a RN-to-BSN program. International Journal of Nursing Sciences , 7 (2), 206-213. https://doi.org/10.1016/j.ijnss.2020.02.001
Potera, C. (2015). Bachelor’s Degrees Not Only Save Lives, They Save Hospitals Money. AJN, American Journal sof Nursing , 115 (2), 14. https://doi.org/10.1097/01.naj.0000460668.95532.82
Salmond, S., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopaedic Nursing , 36 (1), 12-25. https://doi.org/10.1097/nor.0000000000000308
Tartavoulle, T., Adorno, M., Garbee, D., Kensler, P., Manning, J., & Pierce, S. (2018). Predictors of Success in BSN Students. International Journal of Nursing Education Scholarship , 15 (1). https://doi.org/10.1515/ijnes-2017-0028
White, E. (2017). A Comparison of Nursing Education and Workforce Planning Initiatives in the United States and England. Policy, Politics, & Nursing Practice , 18 (4), 173-185. https://doi.org/10.1177/1527154418759666