Nursing Education

Introduction

More than four decades ago, nursing entities ignited a movement to make the Bachelor of Science in Nursing (BSN) the standard for entry-into-practice. Primarily driven by the desire for nursing to meet the criteria of a profession this endeavor was and is continually being overshadowed by the widespread shortage of nurses in the U.S and worldwide. Studies have documented that each additional patients added to the workload of staff registered nurse (RNs) increases the risk of patient mortality from even common surgical procedures (Aiken, Clarke, Cheung, Sloane, & Silber, 2003, p. 1617). Because nurse understaffing and its effects on the quality of care and patient safety findings are daunting, nursing has long focused on palliating this issue. Recently however while trying to identify the ideal nurse-to-patient ratio researchers started to actively analyze whether other nurses workforce characteristics are important in achieving excellent patient outcomes.

Staff nurses are at the forefront of patient care. Because they spend more time with patients than any other healthcare providers, they are relied upon for early detection of complications and are in the best position to initiate interventions that minimize negative outcomes. Critical thinking and the exercise of clinical judgment are key elements to prompt and effective assessment and implementations. Findings expose strong correlations between nurse's educational level and appropriate nursing judgment. Basic nursing education is no longer suited for a lifetime career in the current healthcare system given the rapid technological and scientific advancements. Several U.S. studies focused on post-operative patients on general floors examined patient outcome both in terms of mortality and "failure to recues" within 30 days of admission (Aiken et al., 2003, p. 1616). This evidence-based paper will focus on surgical patients recovering from major surgeries such as gastrointestinal, cardiovascular, and orthopedic.

Mortality is defined as patients death that occurs within 30 days of admission and "failure to rescue" as death in patients who developed serious complications within 30 days of admissions (Aiken et al., 2003, p. 1619). Patients at highest risk are those with two or more comorbidities such as hypertension, obesity and diabetes. This US study examined patient outcomes both in terms of mortality - defined as patients who died within 30 days of admission - and "failure to rescue" - death in patients who developed serious complications, again within 30 days of admission. Aiken et al. speculated that BSN educated nursing are better equipped to care for post-operative patients than ADN educated nurses.

Clinical Guideline, Bundle or Best Practice

According to the Health Resources and Services Administration (HRSA) 2010 report, among the 1,388,884 RNs whose initial nursing education culminated in an ADN only 20.8 percent obtained additional degrees after licensure and BSNs were received by 12.1 percent (citation). It takes associate-degree educated nurses and average of 7.5 years to obtain a BSN. Associate-degree prepared nurses outnumber BSN-prepared nurses because the ADN curriculum is not only shorter than the BSN curriculum but school offering the program are more prevalent and affordable. An associate degree in nursing is the minimum education requirement for licensure as a registered nurse. The degree usually takes two years for completion and is typically offered at a community college. A bachelor nursing program is a four year degree offered in colleges and universities. Students admitted to a BNS program take two years of general education courses and two years of nursing courses. Compare to the associate degree program, bachelor's degree programs include more training in the physical and social sciences. They additionally offer communication, leadership and critical thinking course which are becoming increasingly important as nursing practice becomes more complex (U.S Department of Labor, Bureau of Labor Statistic, 2012). The lack of differentiation of practice at the bedside care level provided minimal recognition but today the idea that an RN is and RN regardless of educational preparation is challenged.

Addressing this topic often creates strong disagreement among nurses. Many exhort nursing to continue focusing on closing the shortage gap rather than fueling arguments between the two nursing education channels. In trying to solve this issue the best way is to utilize evidence-based practice (EBP). As stated by Polit and Beck (2012) "a basic feature of EBP as a clinical problem solving strategy is that it de-emphasizes decisions based on custom, authority, or ritual. The emphasis is on identifying the best available research evidence and integrating it with other factors" (p. 25).

Aiken et al. simultaneously carried two independent studies of the same 168 Pennsylvania hospitals over approximately a two-year period. One study focused on patient-to-nurse ratio and patient mortality while the other study focused on the educational level of nurses and patient mortality. The results of the first study mentioned revealed:

The odd of patient mortality increased by 7% for every additional patient in the average nurse workload in the hospital and that the difference from 4 to 6 and from 4 to 8 patients per nurse would be accompanied by 14% and 31% increases in mortality respectively. (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002, p. 1992)

Out of the 232 342 post-surgical patients included in the study 4535 died within 30 days of admission. The authors deducted that if the patient-to-nurse ratio across Pennsylvania was 4:1 4000 patients would have died and if it was 8:1 more than 5000 would have died. The statistics show a preventable of 1000 if staffing was adequate (Aiken et al., 2002)

The second study key findings reveal that a 10 percent increase in the proportion of BSN educated nurses decrease the risk of patient death and failure to rescue by five percent (Aiken et al., 2003, p. 1622). The study further argued if nurses holding a BSN constitute 60 percent of the hospital bedside workforce 19 percent less death would occur than if the bedside workforce is makeup of only 20 percent of the nurses educated at that level. This would be 17.8 fewer deaths per 1000. Aiken et al. (2003) states that if 60 % of hospital bedside nurses have a BSN and the patient-to nurse ratio is 4:1 1,700 deaths could be prevented (1622). A comparison to the two studies disclosed that an extra 700 individuals' live could be save if registered nurses caring for those patients had a bachelor degree in the field .

One of the oldest studies on the educational differences between BSN and ADN, Aiken