Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Registered Nurses Returning to School for a Bachelors Degree in Nursing: Issues Emerging from a Meta-Analysis of the Research

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Registered Nurses Returning to School for a Bachelors Degree in Nursing: Issues Emerging from a Meta-Analysis of the Research

Article excerpt


Healthcare is a fast paced, dynamic environment where providers of care should continually renew, update, and challenge their knowledge. 'The complexity of medical and surgical interventions undertaken in hospitals requires an even bigger and more sophisticated clinical workforce' (Aiken, Clarke, & Sloane, 2002, p. 187). The idea that basic nursing education will prepare a nurse for a lifetime of practice is no longer reasonable given rapid technological and scientific advancements (Bahn, 2007; Gillies & Pettengill, 1993; Gould & Kelly, 2004). The American Nurses Association (2000) actively promotes the acceptance of lifelong learning and continued competency upgrading for nurses and many states mandate continuing education (CE) hours.

Talk began more than four decades ago about making the Bachelor of Science in Nursing (BSN), or equivalent degree, the standard for entry-intopractice. While some countries have adopted this standard, there is still a vast discrepancy in education that includes practicing nurses who graduated with an Associate's degree (ADN) or diploma in nursing. Although this meta-analysis focuses mainly on the U.S. with global research taken into account, the findings are useful internationally.

In some countries nurses still graduate with an ADN or diploma in nursing. In the U.S., only about 20% of ADNs and 30% of diploma educated nurses continue their formal education to the baccalaureate level or beyond (Health Resources and Services Administration, 2006). Both the National Advisory Council on Nurse Education and Practice (1996) and the American Organization of Nurse Executives (2005) encouraged baccalaureate education and suggested that nursing should strive for a workforce comprised of two-thirds baccalaureate prepared nurses by 2010. This has not been achieved. A recent report on The Future of Nursing in the U.S. (Institute of Medicine [IOM], 2011) is recommending increasing the proportion of nurses with BSNs from 50 to 80% by 2020. To move closer to this goal worldwide, nurses educated below the baccalaureate level need to be encouraged to return to school for continued formal education. In fact, The Future of Nursing report (Institute of Medicine [IOM], 2011) also recommends that schools of nursing promote seamless transition for nurses to higher levels of education.

One rational for the push for BSN nurses is because recent studies have indicated that there is decreased morbidity, mortality, and failure-torescue rates in hospitals that employ larger percentages of baccalaureate prepared nurses (Aiken, Clarke, Cheung, Sloane, & Silber, 2003; Aiken, Sochalski, & Lake, 1997; Clarke & Aiken, 2003; Curtin, 2003; Estabrooks, Midodzi, Cummings, Ricker, & Giovannetti, 2005; Friese, Lake, Aiken, Silber, & Sochalski, 2008; Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002; Tourangeau, Giovannetti, Tu, & Wood, 2002). There are continual advancements in healthcare and increases in patient acuities. Even the public is aware of the need for nurses to have a baccalaureate degree. Mattson (2002, p. 72) reported that '76% of the public thinks nurses should have 4 years of education or more past high school to perform the duties of their job'.

There is a current nursing shortage expected to be critical by 2020 (Yordy, 2006). There is also a perception that ADN and diploma programs are shorter in academic semesters. Given this situation, it is unlikely that ADN or diploma programs will vanish any time soon. It also means there are fewer incentives for these nurses to return to school to secure or retain employment (Delaney & Piscopo, 2004).

Another critical factor in the nursing shortage is lack of faculty. In 2008, the U.S. nurse faculty vacancy rate, for all levels of nursing education, was 7.6% (American Association of Colleges of Nursing, 2009). Predictions are that this vacancy rate will increase as the nursing shortage progresses (Yordy, 2006) which means that even the shorter programs will have faculty staffing problems. …

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