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Dominican College

2013

Lisa-Marie S. ©
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Higher Degrees in Nursing


Higher Education in Nursing and its Impact on Healthcare


Nyack College


Abstract


Over the last decade, there has been recent expansion of clinical knowledge and increase in health care complexities. This has determined that registered nurses should continue with academic progression in order to complete the various responsibilities that are required of them.

Therefore, the Associate’s nursing degree has been considered the bare minimum requirement for nursing practice and the Institute of Medicine has suggested nurses to pursue higher education in order to benefit their patients, employers and communities.


Higher Nursing Education in the Past

In the 1970’s, although there were individuals who believed that higher education in nursing would further enhance the profession by training educators and raising leaders, many saw higher education in nursing to be unnecessary. They believed that academic learning was not what made a competent nurse, but it was practical training that bred strong caregivers (Ring, N. 2002).

This belief was strongly correlated with the fact that nurses were primarily women during this period of time. Nurses struggled with combining their household and work duties, which included marriage and bringing up children. Society expected a woman’s career aspirations to come second, therefore, viewing higher education as useless (Ring, N. 2002).

According to the U.S Department of Health and Human Services, in 1980 a hospital diploma was primarily held by 55 percent of registered nurses. Merely 22 percent held a Bachelor of Science in Nursing degree and 18 percent of professional nurses had an associates degree as their highest educational credential (United States Dept. of Health & Human Services, 2010).

The number of registered nursing obtaining their Bachelor of Science in Nursing soon escalated in 1995, when a call for higher degree nurses was mandated (United States Dept. of Health & Human Services, 2010). Many hospitals started requiring BSN degree holders for new hires due to the constant changes in the health care system as well.

The Current Need for Academic Progression

Associate degrees are still considered a vital first step in the nursing profession. This degree can be obtained to teach the basic necessities for the well being of patients. But the Institute of Medicine has now suggested nurses to continue further education in order to achieve two goals: prepare more baccalaureate nurses for the profession and a increase of nurses obtaining their doctorates by the year 2020.

Pathways into Higher Nursing Education

  1. Bachelor of Science in Nursing (BSN):This degree is awarded from a four-year university or as a ‘Second degree’ for those who have a bachelors in another discipline. Basic science, liberal arts, and nursing courses are to be complete along with clinical experience in order to obtain this degree.

  2. Master's of Science in Nursing (MSN) Degree: This degree is awarded in order to become a Nurse Pracititoner, who have more clinical authority and autonomy. Most MSN programs allow nursing studets to have a special "track" for their chosen medical specialty (ex: Pediatrics, Family, Geriatrics, Anesthesia, Midwifery)

  3. Doctor of Nursing Practice (DNP) or Doctor of Philosophy (PhD): These are the highest degrees one can earn in nursing. Students must first have a bachelor's and then a master's degree before obtaining a doctorate degree. The DNP degree focuses on the clinical aspects of nursing, whereas the PhD degree is the more common choice for those who wish to pursue education and a strong foundation for nursing research.

Healthcare is Changing

The Institute of Medicine has made it clear in their 2010 report, that the current nursing curriculum does not prepare future nurses properly in todays fast-paces and ever-changing health care system. Entry-level nurses possess fundamental knowledge of patient needs, but now it is required of nurses to improve the safety, quality and efficiency of their patient’s care.

This is due to the decline of inpatient visits and an increase in outpatient settings such as home services, health maintenance organization and community clinics. The health care system now also puts emphasis on technology, data access and management. Registered nursed with baccalaureate, masters or doctorate degrees are better equipped to meet the standards of these changes (Bleich, M. R. 2011).

On March 23,2010, President Barack Obama signed the Affordable Care Act or otherwise known as “Obamacare” that improves and lowers health care costs and allows more individuals the access to health care. From this law, millions of Americans gain insurance, which worsened the current shortage of primary care physicians.

Nurse Practitioners with either a masters or doctorate degree and nurse midwives will be able to fill this gap. Nurses have always played a pivotal role in health care and with coordinated effort and significant academic progression can ease or even eliminate this primary care physician shortage.

How Patients Will Benefit

Not only does the Affordable Care Act increase the quality and affordability of health care, but its main goal is to offer more primary, preventive and health coordination services from primary health care providers. As a result, this will not only improve patient outcomes, but also reduce the length of hospital stays.

With these changes, nurses with graduate education are needed for not only advanced clinical roles, but licensed independent practice in order to deliver appropriate primary and acute care to patients of all ages (Kovner CT,2010).

How Hospitals and Other Employers Will Benefit

Nurses with their baccalaureate, master’s or doctorate degrees obtain up to three times more clinical training in various outpatient environments than do their associate degree counterparts. Previous educational training as a result benefits employers, especially hospitals.

More health care organizations prefer nurses with their BSN or higher degrees and encourage those who are already employees to continue higher education. Tuition assistance, employee time off for education reasons and salary differentials based on education are frequently being seen in hospital settings.

In terms of patient outcome, hospitals with higher degree nurses tend to have lower occurrence of falls, mortality, employee injury rates, and impressive patient care. Higher educated nurses can also be used as faculty that precept the next generation of nurses (Pittman P 2012).

Barriers in Obtaining Higher Degrees

In 2004, the American Association of Colleges of Nursing strongly endorsed the level for advanced nursing practice to be moved from a master’s degree to the doctorate degree by the year 2015. Nurses graduating from Doctor of Nursing Practice program will be nursing educators.

This will be implemented by the creation of various transition programs (BSN to DNP, MSN to DNP, etc), higher salaries and tuition reimbursement by healthcare facilities (American Association of Colleges of Nursing 2004).

Many practicing nursing may not want to add on to their debt and return to school because unfortunately, not all employers reimburse tuition.

In spite of the fact that the demand for competent nurses is growing every day, many qualified candidates are not admitted into graduate programs because of limited seats available. Nursing schools have also increased their grade point average requirement, prerequisite courses and patient care experience hours, making graduate programs highly selective.

With these barriers in mind, it is crucial for health care employers, academic institutions and even the government to create promising strategies for nurses to transition seamlessly into higher education.

In the 1970-1980’s, higher degrees were deemed as useless and irrelevant to the profession. Work training and experience were seen as the reasonable method to develop as competent patient caregivers, not education. Currently with our fast paced and ever changing healthcare system, an associate’s degree is merely a stepping-stone to providing appropriate patient care; BSN, MSN and/or DNP degree holders are needed now more than ever.

It is important to realize that receiving further academic progression does not only benefit the individual, but it impacts his or her co-workers, employers, patients and the entire system as a whole. Nurses with higher degrees are essential and will enhance leadership, educational benefits and positive change amidst the drastic healthcare reform we face today.

Bleich, M. R. (2011). IOM report, The future of nursing: Leading change, advancing health:

Milestones and challenges in expanding nursing science. Research in Nursing & Health, 34(3), 169-170.

Gerard, S. O., Kazer, M. W., Babington, L., & Quell, T. T. (2014). Past, Present and Future Trends Of Master's Education In Nursing. Journal of Professional Nursing, 30, 326-332. Retrieved October 10, 2014, from the Ebsco Host database.

Kovner CT, Brewer CS, Yingrengreung S, Fairchild S. New Nurses’ Views of Quality Improvement Education. Joint Commission Journal on Quality and Patient Safety. 2010;36(1):29-35. Retrieved October 09, 2014, from the Ebsco Host database.

Position Statement. (n.d.). American Association of Colleges of Nursing. Retrieved October 20, 2014, from

Ring, N. (2002). A personal and historical investigation of the career trends of UK graduate nurses qualifying between 1970 and 1989. Journal of Advanced Nursing, 40(2), 199-209. Retrieved October 10, 2014, from the Ebsco Host database.

The registered nurse population initial findings from the 2008 National Sample Survey of Registered Nurses (pp. 39-60). (2010). 1980-2008. Rockville, MD: United States Dept. of Health & Human Services, Health Resources and Services Administration.



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