The national voice for academic nursing which is the American Association of Colleges of Nursing (AACN) associates the level of education with a significant impact on the competencies and knowledge of the nurse (Mackey and Bassendowski, 2017). This is because nurses with Bachelor of Science in Nursing (BSN) are well-prepared to tackle the challenges that come with the demands for quality and safe healthcare. They are much better compared to the Associate degree counterparts as they possess better skills in leadership, critical thinking, health promotion, and case management (Mackey and Bassendowski, 2017). Additionally, they boast the ability to comfortably practice and provide healthcare in a wide scope in both outpatient and inpatient setups. As a result, the unique value BSN-prepared nurses is highly recognized by various organizations and institutions which include federal agencies, nurse executives, the military, magnet hospitals, nurse advocacy groups, minority nurse advocacy groups, healthcare foundations and various leading nursing organizations (Mackey and Bassendowski, 2017). Due to this, AACN has taken up the responsibility of encouraging employers to provide practice environments that encourage nurses to advance their education to BSN level or even above it. AACN also calls for BSN graduates to ensure their competencies and level of education is valued by seeking out employers who appreciate their skills.
Impacts of BSN-prepared Nurse
A research study by Aiken et al. (2015) on how nursing degrees/level of education impact patient mortality rates indicates that better educated (BSN) nurses are associated with better patient outcomes. The study shows that after common surgical procedures, BSN-prepared nurses presented with lower patient mortality rates compared to AD nurses. The study goes ahead to show that there was about 30 percent mortality rate in hospitals with 60 percent of their nursing staff having BSN degree compared to hospitals with only 30 percent of their nursing workforce having BSN degrees.
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Similar findings were obtained from an earlier study co-authored by Aiken which was published in 2013 in Health Affairs (Aiken et al., 2015). The study clarifies that the fact that hospitals with BSN nursing staff present better patient outcomes and lower mortality rates do not mean that ADN-prepared nurses harm the patients. What is meant is that process and system problems result in various issues such as medical errors and hospital-acquired infections leading to high mortality rates and poor patient outcomes. Additionally, the aim of this system approach is to show the inevitability of minor human errors which get magnified in the existence of poor systems. Because this approach does not focus on punishment as the remedy to this, it has opted to determine and identify the factors that increase the probability of these errors occurring and then work on minimizing the effects of these errors on patients. This is achieved by acting on the involved systems of care and workflows.
According to Aiken et al. (2015), in order to properly correct the existing systems errors and come up with a long lasting solution, more skilled and highly trained nurses who are capable of implementing the recommended solutions with ease. This is where BSN nurses come in as they are more suited for this as their curriculum puts more emphasis on evidence-based practice and leadership. This is unachievable for the ADN program because it is far much shorter compared to the BSN program.
Aiken et al. (2015) argue that nursing practice will be impacted by the ongoing changes in healthcare provision and that it is a wise idea for those with ADN degree to re-examine their feelings and thoughts about the possibility of furthering their studies in order to acquire BSN degree. Many nurses who had to go back to school in order to fulfill the requirement of the employer can attest that despite initially not buying to the idea that the BSN degree would bring any changes in the way they practiced nursing, it came with a number of unexpected benefits. A study by the National Student Nurses Association (NSNA) found out that these benefits include improved reasoning ability, better nursing and leadership skills, and better nursing practice perspectives. Other benefits are the attainment of goals, transformed personal life, and actualization of dreams through more education.
Research evidence accumulated over decades shows that the quality of nursing care directly impacts patient outcomes with several studies showing a direct positive correlation between patient outcomes and BSN nursing education (Holle et al., 2019). For instance, a study by Journal of Nursing administration in 2013, revealed a lower number of cases of postoperative deep vein thrombosis and pressure ulcers in patients cared for by BSN-prepared nurses (Liu et al., 2019). Another study by which was published in Medical Care in 2014 observed that lower patient mortality with BSN-prepared nurses. When the BSN-prepared workforce was increased by 10% the mortality rate reduced further by 10.9% (Liu et al., 2019). As the general health evolves, patient outcomes will be greatly impacted by the quality of nursing care (Holle et al., 2019). A large percentage of hospitalized patients will want more complex and robust care as Baby Boomers hit retirement age. More robust and complex nursing care may call for the application of advanced techniques and procedures as well as interdisciplinary collaborative working which require a more educated nursing staff provided in BSN-prepared nurses.
BSN-prepared nurses bring more on the table as their contribution goes beyond bedside care (Holle et al., 2019). As per Robert Wood Johnson Foundation, BSN-prepared nurses are more suited with up the leader duties such as filling management and leadership contributing to safer work environments (Liu et al., 2019). They are associated with lower turnover rates as they find more satisfaction in their careers. Through this, there is improved staffing and savings by the healthcare facilities. With on-going increase and growth of evidence that associate higher nursing education with improved patient outcomes, policymakers as well as nurses leaders will work to ensure that programs that aim to expand the number of BSN-prepared nurses are supported and facilitated (Holle et al., 2019).
During the transformation of the nation’s healthcare landscape, a wide range of evidence indicated that there was a need for highly educated nurses (Gerardi et al., 2018). Significant changes within the practice environment and healthcare system call for major changes in nursing education. More educated nurses such as BSN-prepared nurses are required in ensuring that nurses can provide quality, patient-centered, and safe nursing care to patients in public, community and primary health settings (Gerardi et al., 2018). This will allow nurses to reflect the diversity of the populations to they provide care to. As a result, the future of nursing report has a set a goal to ensure that at least 80 percent of registered nurses (RNs) should possess BSN or higher degree. It is argument was based on the fact that several studies have attributed higher nurse education such as BSN nurses with much better and improved patient outcomes.
According to Gerardi et al. (2018), the indicator of a health system capable of delivering safe and quality healthcare is the readiness of the nursing staff to show its safety and quality competencies. A previously conducted research study showed the existence of safety and quality loopholes and gaps between BSN-prepared and AD prepared nurses who had their graduation in 2004 and 2005 (Djukic et al., 2019). The study focused on assessing the required changes in the nursing workforce in an attempt to improve patient outcomes. It indicated that registered BSN-prepared nurses were much better prepared than their AD-prepared registered counterparts in five out of the sixteen study topics. The 2014 to 2015 cohort study showed that BSN-prepared registered nurses indicated a significantly better preparedness than the AD-prepared registered nurses in twelve out of 16 topics studied (Djukic et al., 2019). The study concludes that improvement of organizational policies and accreditation to have BSN education qualifications for all registered practicing nurses may be the answer to minimizing safety and quality gaps in safeguarding the quality of patient care (Djukic et al., 2019).
Another study published by the AACN showed a rapidly increasing number of registered nurses to BSN programs recording a 12% increment between 2013 and 2014 (Schroeder et al., 2016). This was mainly attributed to increased recognition and acceptance among nurses and patients of the role of higher education in the improvement of patient outcomes and safety. It is clear that higher education is the difference in many situations or cases as long as patient safety and outcomes are concerned. Therefore BSN-prepared nursing workforce is essential in medication administrations and treatment, accurate and effective communication of instructions to patients and their families, new technology proficiency, and ability to appropriately relate with patients as they provide nursing care.
A nurse staffing study by National Institute of Health (NIH) showed that patient mortality reduces by 7 percent when the number of BSN-prepared nurses is increased by 10 percent (Schroeder et al., 2016). Generally, the research links RNs with higher education such as BSN-prepared with positive patient outcomes, lower patient mortality rates, and fewer medical errors.
A study by Ann Kutney-Lee and colleagues figured out that an average 2.12 deaths reduction was realized for every 1000 patients when BSN-prepared nurses were increased by 10 percent (Kutney-Lee et al., 2015). In addition, an average reduction of 7.47 deaths for every 1000 patients was observed in a subset of patients with complications.
Mary Blegen and company published the results of a cross-sectional study of twenty-one University Health system Consortium hospitals where they had observed lower congestive heart failure mortality, postoperative deep vein thrombosis, shorter length of stay, failure to rescue, pulmonary embolism and decubitus ulcers in hospitals that had a higher proportion of registered BSN-prepared nurses (Schroeder et al., 2016). The study also indicated an increase (7%) in the likelihood of an inpatient to die in thirty days of admission with a one-patient increase in the nurses’ workload. A decrease in the likelihood by 7 percent was seen in every 10-percent increase of the BSN-prepared RNs.
A study conducted by researchers from the University of Pennsylvania observed that there patient in Magnet hospitals exhibited 12 percent lower odds of failure to rescue as well as 14 percent lower odds of inpatient death within thirty days in comparison to patients in non-magnet hospitals (Long, 2017). According to researchers’ conclusion, this difference in patient outcomes was as a result of investing highly educated and qualified nurses majorly comprising of the BSN-prepared RNs.
In every research conducted, it has been proven that hospitals with more BSN-educated or prepared registered nurses than the diploma or AD-prepared registered nurses are the safest. As a result, there has been a constant urge for nurses to acquire higher education (Long, 2017). It is widely believed that whereas most healthcare facilities are just fine with registered nurses with associate’s degree, the long-term benefits of employing a BSN-prepared registered nurse are far much better.
Conclusion
Despite prove by research and literature that there is a clear link between improved patient outcomes and BSN-prepared nurses, there is an elaborate plan to enable nursing leaders, educators, and other stakeholders to increase the percentage or proportion of registered BSN-prepared nurses (Long, 2017). It is important that a clear plan is drawn as this will help to increase the urgency of addressing the challenge at hand. This will help in advancing nursing practice as well as nursing education (Long, 2017).
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