Premises of the 1965 ANA Position Paper on Entry into Practice
- The education of all those who are licensed to practice nursing should take place in institutions of higher education.
- Minimum preparation for beginning professional nursing practice should be baccalaureate education in nursing.
•Minimum preparation for beginning technical
practice should be associate education in
nursing.
•Education for assistants in the health-care
occupations should be short, intensive
pre-service programs in vocational
education institutions rather than on-
the-job training programs.
Two Levels of Preparation Suggested:
- Technical
* Professional
Technical Degree
- Proposed by Mildred Montag.
- Would result in an associate degree in nursing (ADN).
- Would prepare a “beginning, technical practitioner who would provide direct, safe nursing care under the supervision of the professional nurse in an acute-care setting.”
Professional Degree
- Would result in a bachelor’s of science in nursing (BSN).
- Would encompass coursework taught in ADN programs as well as more in-depth treatment of the physical and social sciences, nursing research, public and community health, nursing management, and the humanities.
Forty years after the 1985 ANA Position Statement, entry into practice at the baccalaureate level has not been accomplished.
Even the strongest supporters of the BSN for entry into practice cannot deny that despite efforts spanning more than 50 years, registered nurse (RN) entry at the baccalaureate level continues to be an elusive goal.
Growth in ADN Programs
- From 1974 to 1994, associate-degree programs witnessed an increase of 103%; more than 56,000 individuals graduate from ADN programs each year.
- By the year 2000, ADN education represented nearly 60% of all graduates.
Many employers state they are unable to differentiate roles for nurses based on education, since
both ADN- and BSN-prepared nurses hold the same license.
In addition, state boards have asserted their inability to develop a different licensure system given the fact that
employers have not developed different roles.
Critics of BSN as entry into practice argue
there is no need to raise entry levels since passing rates for the national nursing licensing examination (NCLEX) show no significant differences between ADN, diploma, and
BSN graduates.
•Most ADN-prepared nurses would argue that
significant differences exist between their practice and that of a licensed vocational/ practical nurse, despite there often being only 12 months difference in educational preparation.
•Yet many ADN-prepared nurses argue that the additional 2 years of education BSN-preparednurses have over their ADN counterparts makes little difference in their practice.
Demographic Differences Between ADN and BSN Graduates
•ADN graduates are approximately 5 years
older than graduates of baccalaureate programs.
•It is also generally believed that ADN graduates represent greater diversity in race, gender, age, and educational experiences than baccalaureate-prepared nurses.
Does a “2-Year” ADN Program Even Exist?
- Almost all ADN programs currently require 3 or more years of education, with a minimum of 12 to 24 months of prerequisites and a full 2 years of nursing education.
- Most associate degrees require approximately 60 semester units or 90 quarter units of coursework.
- Despite the fact that the National League for Nursing Accreditation Commission (NLNAC) (1999) suggests that the maximum number of credits for an ADN program be 108 quarter units or 72 semester units, many ADN schools struggle to meet this criteria.
An increasing number of studies have reported differences between the performance levels of ADN- and BSN-prepared nurses; however, research overwhelmingly supports
better outcomes for patients cared for by BSN-prepared nurses than those with associate degrees.
Employers appear to be increasingly aware of purported differences between BSN and ADN graduates and this may be reflected
in their hiring preferences.
Baccalaureate- and graduate-level skills in
research, leadership, management,
and community health are increasingly needed in nursing as health care extends beyond the acute-care hospital.
Nursing is the only health care “profession” that does not require
at least a bachelor’s degree for entry into practice
Will Raising the Entry Level Impact the Current Nursing Shortage?
- Immediate short-term threat may be to exacerbate the existing shortage.
- However, in the long run, it may increase recruitment to and retention in the field.
- Increasing the proportion of baccalaureate- prepared nurses in the registered nursing population may actually be essential to stabilizing the nursing workforce since nurses prepared at the BSN level were found to have higher levels of job satisfaction, a key to nurse retention.
“Respect for persons is violated when nurses and student nurses denigrate
each other over credentials and over who are the competent nurses. Nurse educators and administrators violate respect for persons when they bicker and dispute each other over educational preparation and hiring practices” (Silva & Ludwick, para 7).
Grandfathering allows individuals
to continue to practice their profession or occupation after new qualifications have been enacted into law (Ellis & Hartley, 2004). Several organizations have actively advocated that all registered nurses should be grandfathered if the entry level is raised.
Transition programs/services for non-baccalaureate- prepared nurses must be designed to
facilitate entry into baccalaureate and advanced education and practice programs. In addition, there must be increased funding for colleges and universities granting baccalaureate and advanced practice nursing education programs.
- The entry-into-practice debate in the United States is one of the oldest and yet hottest professional issues nurses face as we enter the 21st century.
- Experts are divided as to the progress that has actually been made on the issue.
The question comes down to whether the nursing profession wants to spend another 40 years debating the issue or whether it wants to proactively take the steps necessary to make this goal a reality.
