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Thoughts on entry to practice

Monday February 10, 2014
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As an ADN-prepared nurse returning to school I have been confronted with the formidable gap between the current reality of professional nursing and the push to elevate the level and scope of practice in the face of a projected nursing shortage. I have no doubt that higher levels of education, certification and experience have the potential to create better nurses and in turn safer environments for our patients, but I do have to question whether the infrastructure necessary to support these changes is in place.

Aside from the most obvious and pressing issue of the projected shortage is the hard truth that the ADN programs have been hugely successful, to the point that the difference in practice between ADN and BSN nurses is negligible, according to a 2002 study in the Journal of Nursing Education and a 2011 study in the Community College Journal.

There have been some rather sensational studies linking mortality and failure to rescue rates to educational background (for example, in 2003 in the Journal of the American Medical Association and in 2011 in the Journal of Nursing Scholarship), but even the authors of the JAMA report admitted there are other factors that might possess more weight.

In a 2012 study in the Journal of Nursing Regulation, researchers sought to determine what differences in practice might exist and ultimately concluded that BSN nurses tended to work in more desirable environments and that the environment might be more influential than the educational characteristics of the nursing staff. Admittedly, the authors went on to hypothesize that BSN nurses might be more likely to create more positive and collaborative work environments.

I would argue that until there is some measurable difference between nurses of differing backgrounds, that as a profession we need to evaluate what the real motivation for elevating the entry level to practice is and whether the current BSN and RN-to-BSN programs actually achieve something greater. The changes in practice that await are as vast and complex as the science and technology that direct them, and our educational programs need to match those demands.

In the meantime the question stands: Is there substantial benefit and incentive from a program that costs $28,080 compared to one costing $6,120 (according to data in the Community College Journal study)?

My own experience would lean toward no. I have sought the highest level of practice and expertise in my specialty and have worked hard to do so. Over the past two years I have successfully pursued certification as a cardiac device specialist and as an electrophysiology specialist and am on schedule to finish my RN-to-BSN program this summer.

What lies on the other side? Nothing beyond personal satisfaction and my employer’s ability to add my achievements to their application for Magnet. As a young professional I am not sure that nursing offers enough career potential for the amount of responsibility, skill, and knowledge required.

If nursing is to grow into the profession that it should be, it must attract and retain the best prospects. To do that, there must be investment and change brought to the current system. BSN programs must demonstrate a measurable and defined elevation of practice. Nurses must be compensated competitively, and the incentives must continue throughout the various levels of practice.

Until our education programs demonstrate a legitimate, measurable benefit to practice and our profession is able to attract and retain the commitment of the next generation of professionals, is it prudent to eliminate the pathway that, according to the Community College Journal study, has brought in 45.4% of our current labor force?

Eric Deane, RN
Charlottesville, Va.


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