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The Success of Nursing

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Differences in Competencies: The Associate-Degree Level versus the Baccalaureate-Degree Level in Nursing Grand Canyon University: NRS-430V | Nursing History, Theories, and Conceptual Model 06/09/2013

Differences in Competencies: The Associate-Degree Level versus the Baccalaureate-Degree Level in Nursing

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Current trends in healthcare are leading to more complex, advanced patient care and needs. Hospitals and patient services are now in need of highly skilled, trained, and educated professionals to deliver this care. The impact of these trends extend into the profession of nursing, where employers are taking a closer look at the outcomes of patient care delivered by ADN graduates vs.

BSN prepared nurses. Although ADN graduates make up the majority of licensed RN’s, evidence-based research indicates those with BSN or higher are better prepared to adapt to the changes in healthcare. They demonstrate better communication skills, and critical thinking processes. BSN nurses also report higher incidences of job satisfaction than their ADN counterparts, and are directly linked to decreased patient injuries and death in healthcare settings.

The nursing profession must recognize the ongoing transformational health care system, and provide educated and economically responsible care for those they serve. Value of trained nurses was brought to light by Florence Nightingale during the Crimean War. In early November, 1854 Nightingale and 38 trained nurses traveled to Scutari, finding themselves on the frontlines of a sanitary and medical disaster. The hospital barracks were infested with fleas and rats, soldiers were lying in make-shift beds made of straw with dirty linens and bandages festering with disease and infection. Just six months after Nightingale and her team arrived mortality in the hospital dropped from 42.7 percent to 2.2 percent (Coehn, 1985). During the civil war, nurses in the United States reduced morbidity and mortality rates in soldier hospitals, and on battlefields.

The success of nursing in the military provided evidence that the use of trained nurses were a benefit, to society as a whole (Creasia, Friberg 2011). In the early 1900’s nursing education was primarily received at hospitals. Graduates mostly worked as private duty nurses, tending to wounds, bathing and administering medications. Others worked in hospitals where autonomy and leadership were considered insubordinate. During WWII nurses were once again at the bedside of soldiers and responsible for treatment decisions for the first time. This lead to once again, the need for highly trained nurses. The Cadet Nurse Corps program was initiated in 1943 where over 100,000 nurses received formal education and training (Travel Nurses Now, 2013). Nurses however remained in short supply post WWII across the United States. One response to the shortage, was the development of two year Associates Degree programs at community colleges.

The ADN programs were cheaper, faster, thus making nursing a career possibility to a broader more diverse population of students (Creasia, Friberg 2011) In 2008 the National League of Nursing (NLN) conducted a survey of students enrolled in nursing schools across the United States. Fifty three percent of students were enrolled in ADN programs, forty three percent were in BSN, while the remaining four percent were in a Diploma of Nursing program (National League of Nursing Data Review 2010). The rate of completion of the ADN nurse has exceeded that of the BSN, creating a deficit in higher educated nurses preferred by health care facilities. Technological advancements such as computer charting, emphasis on patient education with complex care plans, and community health needs has attributed to the need of nurses who are prepared to go beyond the bedside. Core components of nursing practice are: professional behaviors, communication, assessment, clinical decision making, caring interventions, teaching and learning, collaboration, and managing care (NLN Council of Associate Degree Nursing Competencies Task Force 2000). Both ADN and BSN programs encompass these components into the curriculum, however BSN provides greater emphasis in leadership, communication, and social sciences.

These in-depth courses produce graduates with enhanced professional development preparing them for a broader scope of practice (AACN, 2012). Thus ADN nurses are labeled as “technical” while BSN nurses are referred to as “professional.” Numerous research studies have demonstrated that ADN and BSN nurses are not different in skill competency when they graduate, but within a year, BSN nurses show greater critical thinking skills, better problem solving, and the development of clinical judgment (Moore 2009). For example, consider a patient who is a non-compliant diabetic and has been admitted to the hospital for myocardial infarction. During the course of stay the patient underwent bilateral heart catheterization which resulted in the stenting of a coronary artery. Ready for discharge, the ADN nurse follows hospital protocol, provides the patient with all the required informational handouts, and discharges the patient accordingly. The minimum standards have been met, however it is highly likely the patient will be back within thirty days of discharge given the non-compliant history. At the BSN level consideration for the patients’ current state of health is viewed from all aspects of the nursing metaparadigm: person, environment, health, and nursing (Hoody & Leddy 2006). How long has the patient been a diabetic? Do they have a knowledge deficit or psychological component that is contributing to their non-compliance? Does the patient have an intact support system, means of transportation?

Once issues are identified, a plan of care must be put in place in order to help the patient manage their health and prevent repeat hospitalizations. Although the ADN graduate is be capable of recognizing barriers/needs, the BSN professional is better prepared to actively address the patients’ health issues from multiple view points, creating opportunity for the patient to be involved in their own health.

Regardless of educational merit, nurses are dedicated to improving patient experiences and outcomes. The educated nurse of today has the ability to use evidence-based research for managing situations, educating patients, utilizing prevention focused care. This results in decreased morbidity and mortality rates among patient populations, much like the crusade that Nightingale and her team began, over 150 years ago.

American Association of Colleges of Nursing. (2012). Fact Sheet: The Impact of Education on Nursing Practice. Retrieved from http://www.aacn.nche.edu/media-relations/EdImpact.pdf Coehn, I. Bernard. (1984). Scientific American: Florence Nightingale

Publication No. 250(3):128-137. Retrieved from http://www.smccd.edu/accounts/case/biol675/docs/nightingale.pdf Friberg,
Creasia and. (2011). Conceptual Foundations: The Bridge to Professional Nursing Practice. 5th Edition. Mosby

Hood, L. J., & Leddy, S. K. (2006). Conceptual bases of professional nursing (6th ed.).
Philadelphia: Lippincott Williams & Wilkins.
National League for Nursing. (2000) Council of Associate Degree Nursing Competencies Task Force. Retrieved from http://cms.cerritos.edu/registered-nurse/competencies-expected-of-adn.htm National League for Nursing. (2010). Nursing Data Review Academic year 2007-2008

Baccalaureate, Associate Degree, and Diploma Programs. Retrieved from http://www.nln.org/researchgrants/slides/ndr_0708.pdf
Moore, S. Dianne. (2009). The Differences Between Associate Degree Nurses and the Baccalaureate Degree Nurses. Retrieved from www.westcoastuniversity.net/deanscorner Travel Nurses Now. (2013). The history of Nursing. Retrieved from


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The Success of Nursing. (2016, Nov 19). Retrieved from https://graduateway.com/the-success-of-nursing/

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