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The groundswell of support for increasing the education level of practicing nurses comes from several different sources, including studies on improved patient outcomes, studies showing increased skills in better educated nurses, support from professional associations and employer demands. Taken together, their message is clear: nurses with an associate degree (ADN) who want to be ready for the future of their profession should plan on pursuing a Bachelor of Science in Nursing (BSN).

Patient Outcomes

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The first study to gain widespread recognition for the connecting BSN-prepared nurses to improved patient outcomes was published in the September 24, 2003 issue of The Journal of the American Medical Association (JAMA). Lead author Linda Aiken and her colleagues from the University of Pennsylvania’s School of Nursing found that a 10% increase in the proportion of baccalaureate prepared nurses resulted in a 5% decrease of patient deaths and complications. The study also showed that death rates among surgical patients at hospitals where fewer than 10% of the nurses held bachelor’s degrees were almost double the rates at hospitals where more than 70% had the higher level of education. Even before Aiken’s study, however, Claire Fagin’s book When Care Becomes a Burden cited a New York State Education Department survey which found that nurses with ADNs were nine times more likely to be charged with procedural violations, including medication errors.

Research continues to show that increased educational requirements improve a range of healthcare issues, including fewer patient falls, better surgical outcomes and a decrease in the failure to rescue rate.

Increased Skills

As far back as 1988, a study published in Research in Nursing and Health (.PDF) showed that nurses with BSNs had stronger communication and problem solving skills. A 1990 study published in the Journal of Advanced Nursing found that those with BSNs had higher proficiency in making diagnoses and evaluating interventions. In 2002, a study published in the Journal of Nursing Education (.DOC) that looked at RN-to-BSN graduates from 1995-1998 concluded that the extra education resulted in higher competency in nursing practice, communication and leadership.

A more educated nursing workforce will also be better equipped to meet the demands of more complex care, coordinate that care among clinicians and community agencies and use new technologies to make care more effective.

Professional Associations

Propelled by this research, many nursing associations are now pushing for new BSN mandates. The Institute of Medicine and the Robert Wood Johnson Foundation’s The Future of Nursing report recommends that 80% of RNs obtain at least a BSN by 2020. The Carnegie Foundation’s Educating Nurses: A Call for Radical Transformation insists that the bachelor’s degree should be the minimum requirement for entry into the nursing profession. At an American Nurses Association meeting last year, 85% of the 501 nurse leaders from all over the country voted for the “BSN in Ten” resolution, which would require nurses graduating with their associate’s degree to earn their BSN within a ten-year timeframe.

State Legislation

Several states are considering enacting legislation requiring RNs to obtain a BSN. New York, New Jersey and Rhode Island have submitted bills that would require all newly licensed RNs to obtain a BSN within 10 years of initial licensure.

Employer Demands

With or without state legislation, hospitals clearly state their preference for BSN-educated nurses. Aiken and her colleagues completed a 2003 study of 168 Pennsylvania hospitals and found that death rates for surgical patients were nearly twice as high in hospitals where less than 10% of nurses had bachelor’s degrees as they were at hospitals where over 70% did. Teaching and children’s hospital and those seeking Magnet-level accreditation also favor the BSN for employment.

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