There are nearly 4.2 million registered nurses in the United States. That’s three times the amount of physicians nationwide! It’s no surprise that nurses are the largest component of the healthcare workforce and also the primary providers of hospital patient care. Nurses take on tremendous responsibility in any healthcare setting–and that’s part of the reason there’s been a concerted effort to increase the number of bachelor’s prepared nurses.
The history of the push for BSN nurses
About 56% of RNs hold a Bachelor of Science in Nursing or higher degree, and it’s estimated that roughly 42% of nurses pursue a baccalaureate when seeking licensure to enter the profession.3 The push for nurses to earn their bachelor’s really got going in 2008 when The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) began an initiative to transform nursing which lead to the 2010 publication of The Future of Nursing: Leading Change, Advancing Health by the IOM.4 The “action-oriented blueprint for the future of nursing” included suggestions for how to improve processes and prepare nurses for their position at the center of the ever evolving healthcare system along with encouragement to remove regulatory and institutional obstacles that get in the way of nurses using their training, skills and knowledge to their full potential. It also, most notably, called for an increase in the percentage of nurses with a bachelor’s degree, with a goal of 80% of the workforce attaining BSNs by 2020. While that mark has yet to be reached, the number of BSN nurses has been climbing since 2010.2
Why is there so much emphasis on nurses earning BSNs?
While earning an Associate Degree in Nursing (ADN) is generally the fastest way to become a licensed nurse, nursing bachelor’s are considered to provide more in-depth treatment of the physical and social sciences, nursing research, public and community health, nursing management, and the humanities.2 In the September-October 2014 issue of Nurse Educator, a University of Kansas research team published findings from a statewide study, which showed that only 42 of 109 baccalaureate outcomes were reported met in ADN programs. The 67 outcomes that were not met were in the categories of liberal education, organizational and systems leadership, evidence-based practice, healthcare policy, finance and regulatory environments, interprofessional collaboration, and population health.2 These additional topics are believed to equip students for a broader scope of practice, begin shaping their careers for professional development and to have increased knowledge of the healthcare field in order to understand the social, economic, political and cultural issues that shape the industry and affect the lives of their patients.
Crucially, the call for further education isn’t just coming from one place. Industry organizations, politicians, researchers and hospital systems alike see the evidence and are doing their part to motivate RNs to earn their bachelor’s. For example, the Tri-Council for Nursing (a group made up of the American Association of Critical Care Nurses, American Nurses Association, American Organization for Nursing Leadership and National League for Nursing) issued a statement detailing findings that a more highly educated nursing workforce is critical to meeting the nation’s care needs and delivering safe, effective patient care. In the policy statement, the Tri-Council states that “without a more educated nursing workforce, the nation's health will be further at risk.”2 Additionally, in 2017 Governor Andrew Cuomo signed legislation that required RNs graduating from associate or diploma nursing programs to earn a bachelor’s in nursing within ten years of initial licensure. New York legislatures supported the measure given, “the increasing complexity of the American healthcare system and rapidly expanding technology, the educational preparation of the registered professional nurse must be expanded.”2
Obviously a robust education and continued professional development and training efforts are important for any medical professional to stay current within their field, but why is there such an intense effort particularly for nurses to earn their bachelor’s? It all comes down to outcomes.
BSN nurses lead to better patient outcomes
Studies consistently find that nurses with BSNs have better outcomes individually and when working within a unit of multiple BSN holders. Studies that have examined the differences between Magnet and non-Magnet hospitals (which require nurse leadership positions to have bachelor’s and, for some roles, master’s degrees in nursing) have found similar results that point to a more highly-educated staff resulting in better outcomes. The AACN has aggregated research in this vein and provides the following evidence:
- In the March 2019 issue of The Joint Commission Journal of Quality and Patient Safety, a New York University study found that baccalaureate-prepared RNs reported being significantly better prepared than associate degree nurses on 12 out of 16 areas related to quality and safety, including evidence-based practice, data analysis, and project implementation.2
- Dr. Linda Aiken and colleagues published a paper in the Journal of the American Medical Association that showed that in 1999, for every 10 percent increase in the proportion of a hospital’s bedside nurse workforce with BSN qualification there was an associated 5 percent decline in mortality following common surgical procedures.5
- In the October 2014 issue of Medical Care, researchers from the University of Michigan reported that a 10% increase in the proportion of baccalaureate-prepared nurses on hospital units was associated with lowering the odds of patient mortality by 10.9%. It was also found that increasing the amount of care provided by BSNs to 80% would result in significantly lower readmission rates and shorter lengths of stay.
- In an article published in the March 2013 issue of Health Affairs, nurse researcher Ann Kutney-Lee and colleagues found that a 10-point increase in the percentage of nurses holding a BSN within a hospital was associated with an average reduction of 2.12 deaths for every 1,000 patients—and for a subset of patients with complications, an average reduction of 7.47 deaths per 1,000 patients.
How can a BSN change your career?
Earning your BSN doesn’t only forecast better outcomes for your patients, it also means good things for your career. First of all, the national average salary for BSN graduates is $89,000 annually, a $10,000 increase from the average salary for a nurse who only has an RN. Earning a BSN also makes you more hirable. The AACN found that 40.6% of hospitals and other healthcare settings are requiring new hires to have a bachelor’s degree in nursing, while 77.4% of employers are expressing a strong preference for BSN program graduates.
Additionally, you’ll be better prepared for professional development and shaping your nursing career. BSNs are able to specialize in different areas like pediatrics, obstetrics and gynecology, surgery and more. Hospitals that have achieved require nurse leaders and nurse managers to have a baccalaureate degree, so if you want to work your way up at a nationally lauded organization, a BSN is a must.
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