Differences between the Associate Degree in Nursing and the Baccalaureate Degree in Nursing
In order to compare the competencies between nurses prepared at the associate-degree level versus the baccalaureate-degree level, one must first compare the requirements to obtain these degrees. The Associates Degree in Nursing, abbreviated ADN, is a two-year degree usually earned through a community college. It requires 60 credit hours to complete and upon completion the graduate can apply for licensure through the state in which they will practice. The Bachelors of Science in Nursing, also called BSN, is a four-year degree obtained at a university. It includes the same areas of study and has the same license upon completion of the NCLEX as the ADN nurse, but delves further into nursing theory as well as pathophysiology and technical skills. Many employers require the bachelors degree for higher positions in nursing such as clinical managers and nurse specialists.
Differences in competencies between nurses prepared at the associate-degree level versus the baccalaureate-degree level
As explained above the bachelors degree in nursing requires two more years of education and a much deeper study of nursing theory and pathophysiology than the associates degree. The question is does this extra education and focus on nursing theory make a BSN nurse more competent than an ADN nurse. Research suggests there is a significant effect of nurse experience and a significant effect of the percentage of BSN nurses in each hospital (Kendall-Gallagher, Aiken, Sloane &Cimiotti, 2011) in regards to better patient outcomes. To understand the difference one must look at the basic nursing process and how knowledge of nursing theory and pathophysiology affects it.
The basic process taught in nursing school in providing patient care is assessment, plan, intervention and evaluation. Assessment is one the first things a nursing student learns. The associate-level and bachelor-level nurse will both have learned this skill in the very first days of nursing school. Both nurses will also be competent with the last step, evaluation of the interventions. The advantage a BSN nurse will have lies in the middle two steps- plan and intervention. The plan and interventions a nurse provides is affected by their decision-making skills and this is based on their education.
Plan and Intervention
To determine a patients plan of care, one looks at the abnormal assessments and then uses their knowledge of pathophysiology to determine the plan of care. While the BSN nurse will not necessarily have more clinical hours in assessing the patient, they will have taken more classes in pathophysiology than the ADN nurse and therefore may notice a disease process more readily than the ADN nurse. This is where the interventions will occur. Interventions are determined by the nurse based on their decision-making skills.
Nursing is a field in which one is given a great amount of autonomy. Therefore much of a patients care is affected by a nurses decision-making skills. Ones ability to make decisions is affected by many things including past experiences, environment and education. The focus here is education and how the additional study for the BSN affects nurses decision-making skills. The BSN nurse will have studied pathophysiology and nursing theory in greater depth than the ADN nurse. This extra knowledge is then applied to the decisions a nurse makes for their patient. These decisions have a great impact on patient outcomes and recent studies have indicated that there is decreased morbidity, mortality, and failure-to-rescue rates in hospitals that employ larger percentages of baccalaureate prepared nurses (Altman, 2011).
Effect of baccalaureate-degree level nurses on patient outcomes
In the acute situation the BSN nurse can use their knowledge of pathophysiology in addition to their decision-making skills to decrease morbidity and mortality. Taking into account the greater picture, a more holistic approach based on the BSN nurses familiarity with nursing theory, will improve patient outcomes. For example lets look at a hospital admission for a congestive heart failure exacerbation. Both the ADN and BSN nurse will assess the patient and notice classic signs like shortness of breath and edema. Both nurses will plan on diuresis and paying close attention to respiratory status. The difference will come with the holistic approach that a BSN nurse is more likely to take. The emphasis on the nursing theories that a BSN nurse has studied will allow them to look at the patient as a whole, rather than dealing with only stabilization of symptoms. The knowledge of nursing theory the BSN nurse has will allow them to delve further into why this patient admitted and what they can do to prevent a readmission.
The BSN nurse asks questions as to what caused the exacerbation. It may be that the patient needs more teaching on diet and medication compliance. They will ask the patient about their home situation. Its possible the patient is having financial burdens that have kept them from filling their prescriptions. The BSN nurse is more likely to look at the home situation. The patient may have depression with the diagnosis and need some resources for social support. In regards to Kings theory, nursings central goal is to help individuals maintain their health so that they can function in their roles (Creasia, 180). By helping the patient function in their role, the nurse empowers the patient to lead a healthier life. The patient is sent home educated with the resources needed to lead a healthy life and therefore reduces unnecessary hospital admissions. This in turn allows the space available for hospital admissions that are necessary and leads to a healthier community.
Altmann, Tanya K. (2011). Registered nurses returning to school for a
bachelors degree in nursing: Issues emerging from a meta-analysis of the research. Contemporary Nurse: A Journal for the Australian Nursing Profession, 39, (2): 256-72. Creasia, J; Friberg, E. (2011). Conceptual Foundations: The Bridge to Professional Nursing Practice. (5th Edition). St. Louis, Missouri: Mosby, Inc., an affiliate of Elsevier Inc. Kendall-Gallagher, Deborah; Aiken, Linda H.; Sloane, Douglas M.; Cimiotti, Jeannie P. (2011). Nurse Specialty Certification, Inpatient Mortality, and Failure to Rescue. Journal of Nursing Scholarship, 43, 188-94.