The document discusses the impact of requiring a Bachelor of Science in Nursing (BSN) as the entry-level degree for nursing. It notes that while other healthcare professions require specific degrees, nurses can enter with an associate's, diploma, or BSN. However, as healthcare becomes more complex, a BSN better prepares nurses with enhanced critical thinking skills linked to improved patient outcomes. By 2020, 80% of nurses are recommended to hold a BSN to meet future demands of an aging population requiring highly skilled nurses. While challenging to implement due to education and cost barriers, requiring a BSN entry-level would result in a better trained nursing workforce able to meet diverse patient needs through leadership roles and quality, patient-centered

1. Running Head: BSN: ENTRY LEVEL NURSING 1
The Impact of Bachelor’s of Science in Nursing as Entry Level Requirement
Michael R. Dunbar
Introduction to Nursing
Lone Star College – CyFair
20 March 2014

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Nursing in America is comprised of approximately 3 million licensed and
practicing professionals; while the concept of healthcare has grown and evolved
over the course of time and has become a more complex and integrated system, the
profession of nursing has maintained the same quality of education standards
required to enter into the health care workforce and has not advanced to coincide
with the changing tides of health care needs. The majority of professions in America
require certain education prerequisites that culminate in a degree; this path is often
singular in nature and relatively straightforward. When contrasting and comparing
this education-to-professional career model with nursing, the approach is
drastically different and more complex. Nurses, unlike all other health care
professionals, can enter practice via 3 different degrees: a hospital diploma, a
community college associate’s degree in nursing (ADN), or a Bachelor of Science in
Nursing (BSN). Graduates of all programs take the same licensing examination to
practice nursing (Scott & Brinson, 2011). While this method has worked to a point
to meet the demands of health care, there is a drastic shift looming on the horizon
that requires an immediate refocus on current practices. Nursing has been labeled
by society as a most trustworthy profession, however, with the growing population
of aging Americans, this trust is waning as adequacy of nurses and their competency
comes into question. Because nursing is failing to meet the standards of
professionalism in respect to education, a baccalaureate education must be the new
gold standard for newly licensed nurses as they enter the work force. While many
fear this shift will have a negative impact on the nursing profession and health care
in general, studies have shown that nurses who obtain a baccalaureate education

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enhances knowledge and critical thinking skills, which impact patient outcomes
(Lane & Kohlenberg, 2010). Since America is in the midst of a broad health care
overhaul combined with the growing aging population, it is an ideal time to similarly
revamp nursing in order to supplement these increasingly difficult changes. The
way in which nurses earn an education during the 20th century have become
antiquated and are no longer suitable to meet the current or future demands the
health care systems present, as patient needs and medical venues grow more
complex, nurses must have the proper educational toolset to provide quality health
care.
Regardless of reforming nursing education and the notion that a Bachelor of
Science in Nursing (BSN) is recommended as the essential new starting point for
future nurses; the nursing profession has always been deemed a unique field
because it has prided itself as being a lifelong learning profession. Historically this
idea is true as medical cases and care practices change rapidly as science and
research continue to make new discoveries and advances in life saving techniques;
however, what has stagnated is the drive to further the education beyond what is
necessary to maintain proficiency in the job market. While an ADN program
provides an affordable education experience… they are our greatest source for an
ethnically diverse nursing workforce… achievement of the ADN must become, for a
large number of nurses, only the starting point (Scott & Brinson, 2011). In order to
institute change in the nursing profession and have a positive impact on future
health care practices, the current recommendation by the Institute of Medicine
(IOM) is that by 2020, 80% of nurses in the United States should hold a bachelors

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degree, without doing so could effectively handicap nursing resources as the patient
demand exceeds the nursing supply.
The initial vision was for technically trained nurses to assist BSN-level nurses
in practice, much in the same way that physical therapy assistants work with
physical therapists. Instead, nurses with a 2-year ADN gained equal licensure status
and soon became the larges pool of US nurses (Scott & Brinson, 2011). This 20th
century approach to managing health care has essentially been utilized far beyond
its intended shelf life and must be replaced with a more forward-thinking education
approach for future nurses before the negative impact has a detrimental effect on
providing the patient with quality care. Since the 65 and older American population
will exceed 20 percent before 2030, the need for highly skilled and properly trained
nurses must take precedence. While nursing has multiple education paths, the
consequence is that too few pursue further education which in turn has a
detrimental effect and causes a long term shortage in advance-practice registered
nurses (APRNs), certified registered nurse anesthetists (CRNAs), and especially
Masters of Science in Nursing (MSN) which are the basis of nursing-school faculty.
Currently, of the approximately 72,000 nurses graduating from associate’s degree
nursing programs, only about 4000 are likely to ever obtain a master’s or higher
degree – a yield that cannot produce enough faculty to replenish a workforce of
more than 3 million nurses (Aiken, 2011). While there are various obstacles to
overcome, mostly based on legislature and financial burdens; the detrimental effect
should the BSN not be sought by all nurses will be exponentially greater as the
health care demands on the existing nursing model cause a systemic collapse due to

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excessive strain. And while the focus is to promote continued education and for
nurses to obtain a BSN, there is no goal to phase out or discredit associate degree or
diploma programs, but to recognize the enhanced preparation of baccalaureate
education that is not present in associate degree programs and thus to meet the
demands of today’s health-care system (Lane & Kohlenberg, 2010). However, due to
the similar time and cost requirements between ADN and BSN programs; the benefit
of better trained critical thinkers with future roles as leaders in health care and
decision makers in the growingly complex medical field will outweigh the difficult
shift that is required in order to require entry-level nursing to be at a baccalaureate
level.
While implementation strategies are still being developed, there are several
facilitators bringing the BSN as the entry-level degree to fruition in order to meet
the future demands in nursing. For example, if organizations require a BSN or
higher degree for leadership positions, and if they reward direct care nurses who
invest in educational advancement, then RNs will make the choice to return to
school (Scott & Brinson, 2011). However, this does not come without it’s own sets
of drawbacks considering the current education system is not standardized from
state to state or institution to institution; therefore most if not all ADN students
attempting to return to school to obtain their BSN must take additional prerequisite
courses. Since there is a lack of a central or standardized system combined with the
additional fees, it creates its own obstacle and creates friction for a full-time nurse
attempting to further their education in order to meet the new entry-level
requirements needed to satisfy future nursing demands. In order to guarantee

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success, support must be in place before mandating the BSN as the new gold
standard for entry-level nursing positions. Nursing leaders, policy makers, even
legislature must be enacted with a simplified education system that promotes the
necessary increase required to meet growing demands. Students will not pass up an
opportunity to obtain a bachelor’s degree for the same cost required for an
associates degree, and nursing schools, including community colleges, will respond
to financial incentives that reward them for granting a bachelor’s degree as the end
point of basic nursing education (Aiken, 2011). The end result will produce a better
suited nursing field that will be adequately prepared to meet diverse patient’s
needs, have the ability fulfill leadership roles in a variety of health care venues,
administer quality patient-centered care, and supplement the expanding roles
nurses are now being sought in specialty areas once only staffed by doctors.
Because of the ever-changing health care system and the growing demands it
creates, the education system necessary for training nurses must equally transform
in order to have nurses succeed. Enacting the BSN as the starting point for future
nurses will provide a stable foundation that will result in improved patient
outcomes; in essence, preventative health care measures that will result in a
positive impact on future patient-centered are.

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References:
Aiken, L. H. (2011). Nurses for the future. New England Journal of Medicine,
364(3), 196-198.
Lane, S. H., & Kohlenberg, E. (2010). The future of baccalaureate degrees for nurses
Nursing Forum, 45(4), 218-227. doi:10.1111/j.1744-6198.2010.00194.x
Scott, E. S., & Brinson, H. (2011). Escalating the pathway from the associate’s
degree in nursing to the bachelor of science in nursing and/or the master
of science in nursing. NC Med J, 72(4), 300-303.