Should nurses have a baccalaureate degree for a entry level position?

In the journal article “the future of baccalaureate degree for nurse” contends that with the advances in medical technology and increasing complexities of patient care a baccalaureate preparation for nurses is necessary for better patient outcomes, patient satisfaction and patient safety. The article sites research conducted by Dr. Akin that demonstrated mortality rates of patients in acute care setting was improved in proportion to the amount of baccalaureate nurses on staff (Lane & Kohlenberg, 2010, p.221). The research takes into consideration multiple factors  that may affect the health outcomes of patients to  include: staff skills, nurse physician relationship, nursing’s experience levels, and staffing levels but, with all those factors taken into consideration 36.9% of the variance of mortality was accounted for by nurses education.

The article also states research has concluded in hospitals that have nurses with higher educational preparation, had greater levels of patient satisfaction.  This is a significant finding in an era were hospital reimbursements will be biased on satisfied customers. The authors of this article contend that it is difficult to determine the value of education on patient’s outcomes entirely but, advance education increases critical thinking skills, confidence, maturity, and open mindedness and requiring the baccalaureate degree as an entry level position would change the characteristics of the working nurse force for the better. The authors of this article also contend that for nursing to survive as a profession it must be based on scientific research and investigation; this can only be accomplished through advanced education requirements at the foundation of the practice. Only in this way will nurses rebuild its “image of professionalism by meeting the characteristics that professions embody” (Lane & Kohlenberg, 2010, p.221). “ The role of the nurse is changing with the transformation of health care, but unfortunately, the level of education typically remains the same, as evidence by the small percentage of nurses who pursue higher levels of education” ” (Lane & Kohlenberg, 2010, p.220).

“The journal article RN education: A matter of degrees” Kathleen Long, brings to light the debate that the associate level nursing degree allows an entry level position into the field that contends with the current nursing shortage. That the push toward advance degrees is due to the decreasing rates of enrollment in post secondary nursing education programs. Much of what is covered in the baccalaureate program is redundant and unnecessary to practice at the bedside.  That the foundation level of education provides enough competence to begin practice and the remaining education takes place through experience. Advanced education is only needed in roles such as teaching, leadership and advanced practice. The lack of financial compensation and time commitment for nurses obtaining advanced degrees further complicates matters and would lead to a greater nursing shortage. Requiring advance education for entry level nursing would only compound this already looming problem. Long asserts the research done by Dr. Aiken is flawed because it fails to take in to account technological resources and patient workloads. Long states “one would expect hospitals with fewer resources to incur higher mortality rates, regardless of staffing characteristics” (Long, 2004, p.2). “In the end Dr. Aiken’s data shows an increase in mortality as and staffing levels –and patient age increases” (Long, 2004, p.2). If the age data are adjusted for general mortality rates, however, the age- adjusted mortality rate actually goes down as average ages – and staffing – go up”(Long,2004,p.2). Long infers the difference in mortality was not a result of education levels of nurses but, rather the nurse to patient ratios (Long, 2004). Long stated that much of her findings are a result of her experience as a advanced practice nurse for the last fifteen years; she has no scientific evaluation to support her opinion.

In the article written by Denis Ryan “Third-level nurse education learning from the Irish experience” contends that for the profession of nursing to continue to grow, it is necessary to combine elements of traditions of nursing and academia. It is important for the future of profession, that nurse promotes themselves as centers of research excellence (Ryan, 2008). To successfully accomplish this task qualified staff and researchers must be developed. Other professions have gained recognition as a profession due to contributions to society through science and research. The profession of nursing is failing in this area due to lack of advanced education and training of its members. The traditions of nursing have a longstanding significant place in the profession but, should not become sacred cows that hold the nursing profession from evolving. A combination of tradition and education is necessary to meet the challenges in health care today. Tradition is the roots and academia is the braches that not only insure nursing remains a profession but, grows to meet the needs of the patients they serve (Ryan, 2008).

Although the research findings have data support and refute the significance of education on entry level positions for registered nurses. One common thread is apparent without the promotion of advanced education and a scientific evidenced based nursing care, the foundation of nursing is in jeopardy of crumbling and losing its professional status. The traditions that are unique and define the nursing professions are also important to maintain because, they define the uniqueness of the profession. As a nurse that has twenty years into the profession. I also can see some truth in what Long asserts, that showing minimal competence to perform nursing is a good entry point into the profession; much of the learning of nursing is in practice. One unique fact I would like to point out about Long is if she did not have an advanced education would have she been able to successfully evaluate Aiken data? I know before I began my bachelor’s degree; I did not have the ability to analyze scientific literature and apply it to practice. So in some ways by author Long disproving Aiken, she only confirmed her findings, that the profession needs more nurses with advanced degrees, to increase the knowledge base of the profession and critically evaluate nursing research.  All research is valid in my opinion, despite reliability because, it generates questions and the pursuit of understanding.

    My reaction to the research has not changed my opinion on the importance of advanced education. I also may be a little biased in my opinion because; I pursued this degree knowing I would take a financial loss. I have always felt that nursing should have an entry level of a Bachelors degree, because I began as a Licensed Practical nurse and I felt I did not possess the knowledge to have others peoples live in my hands. The nursing profession as a whole has the duty to build a stronger more competent work force. The mentoring and guidance, I have received in college has changed the very person I am and my professional practice. In the beginning of my nursing practice, I did things because that was the way I was taught or it was a doctor’s order. Now I do things because they are scientifically proven evidenced biased practice that combines a knowledge bias from multiple disciplines and it is right for the patient. When I began nursing I was focused on the task, now I am concerned with the why? I am in agreement with Ryan the combination of academia and tradition will build and maintain the profession. “The true purpose of education is to cherish and unfold the seed of immortality already sown within us; to develop, to their fullest extent, the capabilities of every kind  with which God made us, has endowed us” Ann Jameson.

References

Lane,S.,& Kohlenberg (2010). The future of baccalaureate degrees for
     nurses. Nursing forum, 45(4), 218-227.

Long,K. (2004). Rn education : A matter of degrees. Issuess in nursing, 34(3), 1-5.

     Retrieved    from http://proquest.umi.com.ezp roxy.liberty.edu:2048/pqdlink

Ryan,D. (2008). Third-level nurse education: learning from the Irish

     experience. British journal of nursing, 17(22), 14021407.