Are New Nurses With Bachelor’s Degrees Better Prepared Than Nurses With Associate Degrees?

A new study from researchers at New York University reveals that nurses with bachelor's degrees report being very prepared in more quality and safety measures than do their peers with associate degrees.

The findings, published in the Joint Commission Journal on Quality and Patient Safety, demonstrate a growing gap in preparedness between new nurses with associate and bachelor's degrees and support ongoing efforts to increase educational attainment among new nurses.

In 2010, the Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine) published "The Future of Nursing: Leading Change, Advancing Health." The milestone report provided recommendations for how nurses can best advance the nation's health and meet the increased demand for care. The report calls for an increase in the proportion of nurses with bachelor's degrees to 80 percent by 2020--a recommendation supported by studies showing that nurses with bachelor's degrees have better patient outcomes, including lower mortality rates.

"The evidence linking better outcomes to a higher percentage of baccalaureate-prepared nurses has been growing. However, our data reveal a potential underlying mechanism--the quality and safety education gap--which might be influencing the relationship between more education and better care," said Maja Djukic, PhD, RN, associate professor at NYU Meyers and the study's lead author.

"Understanding the mechanisms influencing the association between educational level of nurses and patient outcomes is important because it provides an opportunity to intervene through changes in accreditation, licensing, and curriculum."

A nursing workforce that is well-prepared in quality and safety competencies is critical for delivering high-quality and safe patient care. However, a previous study led by NYU Meyers' Christine Kovner, PhD, RN, FAAN, identified gaps in quality and safety education between associate- and baccalaureate-prepared nurses who graduated between 2004 and 2005.

In their new study, the researchers--Djukic, Kovner, and NYU Meyers' Amy Witkoski Stimpfel, PhD, RN--examined quality and safety preparedness in two additional cohorts of new nurses who graduated with either associate or bachelor's degrees in 2007-2008 and 2014-2015. They surveyed more than a thousand new nurses (324 graduating 2007-2008 and 803 graduating 2014-2015) from 13 states and the District of Columbia, asking how prepared they felt about different quality improvement and safety topics. They then analyzed the differences in responses between nurses with associate and bachelor's degrees.

The researchers found significant improvements across key quality and safety competencies for new nurses from 2007 to 2015, but the number of preparedness gaps between bachelor's and associate degree nurse graduates more than doubled during this timeframe.

In the 2007-2008 cohort, nurses with bachelor's degrees reported being significantly better prepared than nurses with associate degrees in five of 16 topics: evidence-based practice, data analysis, use of quality improvement data analysis and project monitoring tools, measuring resulting changes from implemented improvements, and repeating four quality improvement steps until the desired outcome is achieved.

For those graduating in 2014-2015, nurses with bachelor's degrees reported being significantly better prepared than associate degree nurses in 12 of 16 topics: the same five topics as the earlier cohort as well as data collection, flowcharting, project implementation, measuring current performance, assessing gaps in current practice, applying tools and methods to improve performance, and monitoring sustainability of changes.

The researchers note that laws and organizational policies encouraging or requiring bachelor's degrees for all nurses could close quality and safety education gaps. For example, New York State recently passed a law--the first in the country--requiring future new nurses to obtain their bachelor's degree within 10 years of initial licensure. Employers can also effect change by preferentially hiring nurses with bachelor's degrees, requiring a percentage of the nurse workforce to have a bachelor's degree, or requiring nurses with associate degrees to obtain a bachelor's within a certain timeframe as a condition of keeping their employment.

 

So...what do you think? Share your thoughts in the comments below.

 

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Vicki Caraway, MSN, RN, CNE

I was a graduate of a BSN program, at a highly-ranked university in North Carolina. I thought I was very well prepared to come into nursing practice. I thought I was a notch ahead of any AD program. In reality, I am not sure I was as prepared as I thought. I worked with a mixture of ADN and BSN graduates from other programs. We all needed supervision, guidance, and support, until we got more experience under our belts. I believe that there is a culture that prevails in many BSN programs, that leads the students to believe that they… Read more »

Amy G

I have an associates degree in nursing. I do not think that a BSN is better. I also do not think it should be a requirement to get it either. It’s not fair. I can’t afford to go back and get that. Also, I have had to train/ orient several BSN nurses in my career and have had to educate them on medication side effects to look for, brand name/ generic names for medications. I had very “old school” teachers were I trained at and they engrained that stuff in our heads. It’s very important to know that for certain… Read more »

SMS-ADN

Do a study on demographics of ADM vs BSN. In my market, most ADN have previous nursing field experience and get more hands-on experience through school. BSN tend to be younger with less real-world experience and less clinical experience in school.
Stop classifying & judging nurses by the level of degree and start accounting for their individual ability. There are tons of high-degree nurses who don’t know the first thing about actually providing best care for patients but they sure can write papers about it and sit on committees to qualify it.

Jeanne

Simply stated, if a BSN is to be required than it needs to be worth it. I have an ADN and have practiced for 25 years. The caliber of young, wet behind the ears nurses I am meeting with BSN and Masters have no experience clinically. Schools are terrified and have put all there efforts into pumping out “corporate” nurses. AI is here now and it is here to stay. Welcome to the Jetson’s era of healthcare, our jobs will soon be phased out on a very large scale. That is really the heart of the issue.

Eric F Heins, RN

Lets consider what will happen if you increase obstacles to becoming a RN. Increasing the degree qualifications required for entry to nursing as an RN will only INCREASE the nursing shortage. That may lead to higher wages for those in the field, but also harder shifts with heavier patient loads. That will not help patients have better outcomes.

Lela Parker RN

I graduated from a diploma program & agree they are the best. I worked with BSN students that were graduating in 2 weeks. They had never given more than 1-2 injections, had not started IVs, had not inserted a urinary catheter, NG tube etc. I think there have been improvements in the BSN programs. The BSN program doing clinicals @ our hospital was on probation due to poor state board results. The diploma programs consistently had better state board scores & functioned better in a clinical setting. I learned so much in our diploma program & feel sorry for the… Read more »

Dawn Cordova

I agree with this article 100%!! Infact we are only profession whose entry level is ADN …I’m hoping more states and cities will follow suit of California and gravitate towards BSN only!

MARY BOTELHO

FEW NURSES WHO COME OUT OF SCHOOL TODAY ARE PREPARED CLINICALLY. AS A NURING SUPERVISOR I CAN SPEAK FROM EXPERIENCE. MOST NEW NURSES WALK ONTO THE FLOOR LIKE A DEAR IN THE HEADLIGHT, AND BARELY MAKE IT PAST THE FIRST YEAR. THERE A FEW EXCEPTIONS, AND THEY TURN OUT TO BE REALLY GOOD NURSES. SITTING IN A CLASSROOM IS ONE THING, EXECUTION IS QUIT ANOTHER. I HAVE INTERVIEWED NURSES FROM, WHAT ARE CONSIDERED TO BE THE TOP NURSING SCHOOLS, AND I COULD NOT HIRED THEM BECAUSE THEY COULDN’T FORMULATE, OR PRIORITIZE, A BASIC PLAN OF CARE FOR THE SIMPLEST OF… Read more »

Lyudmyla Melnyk

I have ADN. I work and precept many RNs with BSN. What I see that they are faster typing their notes on computer. I never met one who who came with great critical thinking skills in Nursing .I had to walk them trough how to think critically as a Nurse, as I was at some point helping my baby daughter walking. Great nurse come from whitin and experience! I also work with many nurses with Masters degree. None of them are better nurses then nurses with ADN, or BSN. If you don’t like your patients, or bedside nursing in general… Read more »

Curtis Reeves

I’ve read many of the comments and many leave me shaking my head. From many of the comments, there is far too much of “us vs. them” mentality and that will never advance our profession. I was initially schooled in an ADN program 32 years ago and a few years ago completed my BSN. And while my ADN education carried me far and I was part of many exciting experiences, the BSN degree opened even more doors. Best decision I ever made! Many complain that all they did was write papers. And while that is indeed true, they seemed to… Read more »

James Younce

2 1/2 years vs 4 years. 4 years is more exposure. Staff floor experience is where one really learns to be a good nurse!
That said, a truly good nurse comes from within. Not every student nurse is destined to be a good nurse. It’s just not in their make up!

mighteemouse RN

As a diploma prepared RN, I have had a very good career. I think diploma prepared nurses have far more clinical experience as new grads and are much more ready to “tackle” the job of an RN than their ADN or BSN counterparts are right out of school. I did start to work on my BSN later in my career, and I found a lot more “BS” than “N”. The History of Rock and Roll was certainly going to make me a better nurse. Those were the types of classes required for a BSN. Fine and practical arts and a… Read more »

Janet

I received an ADN 14 years ago and have recently started a BSN program in order to obtain a charge nurse position. I find the knowledge I am gaining in the BSN program is a bird’s eye view of nursing and healthcare while the ADN program was mostly about the clinical aspects of nursing. The knowledge obtained in the BSN program is not imperative to performing the duties of a staff nurse in a hospital setting. I was very fortunate to have attended a very arduous ADN program. I do notice that new graduates do seem to lack some basic… Read more »

Ann Marie Wiiliams

Why not do it all- an ADN with an RN and then ARNP? There is no substitute for experience + advanced training. I’d rather have someone treating me with all that in their tool kit!

Cheryl McFaden

The bottom line is this is poor research design which does not measure the dependent variable, since the researchers used student self-report to measure preparation. Self report is notoriously inaccurate and requires insight, knowledge and experience. As a long time nurse educator, I am far more comfortable with a new nurse who questions whether he/she has a true understanding of safety, versus an overconfident graduate who will then make errors. In my experience, new nurses have no idea how they are functioning, and multiple research studies that poll the nurse leaders that hire these graduates support this. If you want… Read more »

Kathleen

As a RN who initially received a diploma in nursing I disagree with the nurse who said that diploma nurses are not taught critical thinking. That was covered in our program as well as EKG interpretation. Later on I got my BSN and it consisted mainly of writing papers, lots of papers. I had more options with a BSN and it was a requirement for a charge nurse position in the health care system for which I worked. With my BSN I was able to be promoted to charge nurse. However, I have worked with many wonderful nurses who have… Read more »

Rosemary Boyd RN IBCLC

I would say we need to look at this study very carefully, first it was completed by a University, therefore there is bias in the project. 2nd they asked the OPINION only of these BSN and ADN new grad nurses on whether or not they FELT prepared in key safety measures. They did not do a knowledge test on them to actually see who was better prepared in safety. 3rd if there really is a discrepancy in patient Safety outcomes in the practice of ADNs vs BSNs then the solution is NOT to require everyone has a BSN (which is… Read more »

M. Bergen

Leave to diploma nurses to talk and think so sub-intelligently about BSN prepared nurses. It takes intelligence and a strong GPA to get into a demanding university nursing program, unlike community colleges that take anyone and everyone and train them to be nurses without further education towards a bachelors degree. BSN nurses have very good critical thinking skills that will develop 6 months into the job because they are too busy getting higer education to be leaders and educators down the road. Yes, I agree that diploma nurses have better clinical skills but only at the start, then after about… Read more »

CM

My DIPLOMA program left me with more clinical hours than most BSN programs in the state and a 60 hour preceptorship on a unit of our choice. I’d rather have the hours of experience on the floor than the extra letters behind my name!

Stella Conklin J.D.

Perhaps part of the question should be why nurses leave the profession in less than 10 years. As a former nurse who practiced for 34 years, I would rather have anyone but a new grad BSN care for me if I were in the hospital. Why would we expect nurses to spend the money and incur significant student loan debt, if the likelihood is that they will not be practicing in 10 years.

Jamie, ADN-RN

Looking at the metrics of the study, it seems to me that they were pretty much looking at non-bedside categories of nursing: flowcharting, data collection analysis, project implementation and monitoring, etc. The study was skewed toward BSNs because that’s what they spend a lot of their school time doing. My patients are not their data nor are they projects! ADNs get a little of that type of education, but we’re mostly at the bedside in the hospital doing total patient care (starting the first term of nursing school) and learning practical stuff about pathophysiology and pharmacology. As soon as I… Read more »

Rhonda Hellner

I have my BSN so that, as a traveling nurse, have more access to areas that I want to go; however, my Diploma nurse training developed who I am as a nurse while the BSN is more in research and paper writing.
The ADN is similar to the diploma but no program now focuses on patient care or continuity of care like the diploma nurse had. When it comes to mentoring a new graduate, I find the ADN to be more willing to listen and perform

Jeff F

BSN programs are overrated and I agree that the newer workforce of nurses ignore the basic skills which with experience make you practice “best nursing.” Inexperienced BSN nurses are encouraged to move through the ranks fast and become Nurse leaders, managers, advanced practice nurses. This foolish and this is what makes nursing look less professional. These studies mention nothing about grinding experience. Learning hands on is the greatest teacher. As far as safety. A focus on personal responsibility needs to be addressed. These new grads rely on Policy and procedure to guide them and this leads to malpractice. Not understanding… Read more »

Karen

After 41 years of practicing with an ADN plus two certifications, I heartily agree that the ADN RN’s are prepared to perform at the bedside much better the the BSN’s. After precepting nurses from all programs, I got to the point that I would no longer precept the nurses from the BSN programs. I found them to be dangerous at the bedside because they had very little hands on experience and only did things because they had read about it with no thought about how or more importantly WHY they were doing it. They had arrogant attitudes and weren’t worth… Read more »

Lisa

This study must have been done by a University. This is total hogwash. Universities churn out thousands a year with useless degrees that can’t obtain employment while the skilled labor jobs go unfillef. Keep pushing that BSN required degree and see how many of those bedside positions are filled.

Vivian

I’ve worked with great 2,3,4 year degree nurses. Personal effort, passion, genuine care and commitment cannot be bottled into a program. Perhaps a bigger question and concern should be the elimination of RN’s from the provider practices. The MA (medical assistant) is not nearly prepared enough for the pt care handled in the office settings. Through no fault of their own….the majority are just not equipped with the knowledge base or critical thinking that is required to avert disaster for many of the patients they serve.

Debbie

I agree. It’s BS. Best practices comes from keeping yourself up to date in the field. Read extensively! Safety comes from adequate staffing, critical thinking skills, and checking your patients, not the alarms and machines. As an ADN nurse with 40 yrs in and 2 national certifications, I have precepted BSN nurses in several fields of practice. Every single one announced (s)he didn’t need to perform any of the skills I offered them. They were all going to be managers! I would walk them through the numbers (1 chief, many, many peons), but they couldn’t be swayed. Each was going… Read more »

MMJ RN CCM

It’s typical for proponents of BSN entry minimum requirement to put forward this type of article. The fact is in 30 years of practice I’ll stand with the diploma and associate degree nurses every time. I don’t need some one who doesn’t want to get their hands dirty or who lives to supervise. There is a nursing shortage. Let’s get real people!

LaVonna Littlefield

It only mentions “new ADN prepared nurses”. What about those of us who have been nurses for 20+ years( myself 27 1/2 years)

Terry Hanson

Diploma nurses best

Karen

I disagree. I have an ADN. We all have to start the same way in a new job, and learn the same way; on the job. You don’t get a head start just because you have a BSN; it’s a level ground.

Sue

I agree that a person has to have a calling to be a good nurse but the change is coming like it or not. I tell people it the hardest yet most rewarding thing I have ever done. I encourage all of my people to continue on for the higher education if they are seeking an ADN as their entry into nursing. Stepping through the process is a great way to learn and become a well rounded nurse. I started with a BSN but worked on a busy floor as an extern while in school as my entry into the… Read more »

Patricia Sadowski RN

I started as a Lpn,then went back fo my RN from a Assiciate Degree program.I worked as a Lpn while I was in school and the clinical skills that I learned during that time were so valuable.I then received my associates degree and did very well on My state boards.I just retired last year after 5 yrs.as a LPN and 42 yrs.as a RN.There were no programs years ago to obtain your BSN like there are now for RN’S.I was raising my children and putting them through college.The programs were also very expensive and I would have never recouped the… Read more »

SANDRA HILDRETH

I agree that Nurse staffing levels are too low. What do you intend to do with all the LPN’s? I guess they’ll become the CNA’s. ADN’s are just as qualified as any BSN and maybe more so because the BSN doesn’t want to get her hands dirty and wants to do paperwork only. Please hire more nurses and don’t be afraid if a nurse hasn’t worked in a hospital for 2 or even 3 years that she’s not up to par. Just think how easy it is to accommodate and familiarize an ADN that has worked for more than 10… Read more »

Linda

I think the most prepared nurses come from the 3 year diploma programs ,which do not exist anymore . These nursing students got more practical experiences and more time spent in each area of nursing. Want to make a difference in the nursing shortage, bring back the diploma programs ! But keep the associates programs also . In this time of shortages , we need all the various schools available for nursing !

Sharon Evans

As and Associate Degree Nurse who has to supervise and train new BSN Nurses I can tell you now. They learn a lot of statistical data information and how to do flow charts, etc. But know little of patient assessment, understanding diseases and affect on the anatomy and physiology that is required when talking to your patients. Knowing this information allows you to ask the appropriate questions to obtain answers to help the Physician since a time crunch is now a part of each patient appointment. Having a Nurse who starts out asking appropriate questions once a patient has voiced… Read more »

Tracy S

Exactly, nurses with ADN degrees know how to nurse. Nurses with BSN degrees know how to write a paper about it. You can’t teach caring and empathy.

Ron Gaunt

“They” can report and “feel” whatever they want…doesn’t mean they are. I came to nursing after completion of a 4-year degree in another field and went to a long ago-gone hospital based program and let me tell you we were prepared to be and function as nurses. The BSN nurses were prepared for the NCLEX – that’s it. They spent much less clinical time in training where you learn the skills to organize your day, manage your patients and function. The old hospital-based programs wanted you ready to go – and not take 2-3 months to “orient” sound like an… Read more »

Thelma

What will happen when all the ADN nurses retire there will be a very large nurseing shortage we do most off the bedside

William Jackson

But none are equip to do patients care on day one as the diploma grad. We charge nurses our senior year.

Jenny Ann Rauch

Who is planning on paying for the advancement in degree?

SMDRN66

It’s BS. Studies have shown that ADN students score the highest on the NCLEX, with Diploma second, and BSN third. Diploma RNs are the best clinically since they get the most hands on experience. ADN nurses are usually older and have more life experience. This study also fails to factor in natural ability. Some people are just better at being nurses, because it’s almost like what they are born to do. I know there is a push to get rid of the diploma and ADN programs, but that is a huge mistake. Having a higher degree doesn’t make better nurses.… Read more »

Brian Barrett, RN

Nurse staffing levels are too low. Hire more nurses. Please.

KN

What do I think? I think nursing has been lagging behind other healthcare disciplines for years in terms of educational requirements. Back in the 1980’s there was a push for the bachelor degree in nursing to be the minimum entry into the field. And where are we? Still having this tired debate. Physical therapy degrees, for instance, require a bachelor degree as a minimum (with a push for many to obtain graduate level work) and their liability and responsibilities are nowhere near the level of those of a registered nurse. I think the associate degree in nursing is outdated and… Read more »