For several decades, the education standards for entry into nursing practice have generated spirited discussion among nurses and legislators alike. That discussion is sure to heat up once again with BSN in 10 bills on the floor in both the New York and New Jersey state legislatures. The bills would require all newly licensed RNs to obtain a BSN within 10 years of initial licensure.
If signed into law, the proposals will have a lasting impact on the nursing profession. There are a number of concerns about what the passage of the two bills would mean for the schools of nursing in New York and New Jersey, that, like the rest of the country, already are turning potential candidates away because of faculty shortages. Concern over the fate of ADN and diploma programs also is a major issue, as is the potential monetary burden that could be placed upon nurses to fulfill the BSN education requirement.
On the other side, some argue the new requirement would be worth it to ensure nurses in New York and New Jersey are equipped to handle the ever-increasing complexity of patient care. In addition, they say nursing needs to step up its game to remain viable and equally competitive in the healthcare arena by making the baccalaureate degree the minimal requirement to maintain licensure.
All nurses need to know the facts regarding BSN in 10 S620 introduced by [N.J.] Sen. Joseph Vitale (D-19th), the chairman of the Senate Health Committee, says Bonnie Michaels, RN, MA, NEA-BC, vice president and CNO at Mountainside Hospital in Montclair, N.J., and a member of Nursing Spectrums Regional Advisory Board.
New York States Bill S4051/A2079B (The Educational Advancement for the Nursing Profession) and S620 (nee S2529)/A3768 in New Jersey most commonly referred to as the BSN in 10 proposals include the same general points. Both pieces of legislation would require new graduates of associate degree and diploma programs to obtain their baccalaureate degrees in nursing within 10 years of the date of initial licensure. If passed, the New York law would take effect immediately, while New Jerseys would take effect after 90 days.
Exceptions to the Rule
Both states provide a grandfather clause for nurses who already are licensed and those who are enrolled in nursing school before enactment. They both also have an option for nurses who dont complete the degree in the allotted time frame.
There is an option to request an extension from the New Jersey Board of Nursing if [a nurse]cannot complete the requirement within 10 years, Michaels says.
New Yorks senate bill provides a similar option. A nurse who fails to complete his or her BSN within the 10-year time frame may be granted a conditional registration if he or she pays a fee and agrees to meet the requirements within one year. The extension would be good for one year, but may be extended for an additional year with payment of another fee. Any extension is at the discretion of the New York State Education Department.
Sponsored by Sen. Toby Ann Stavisky (D-16th) and Assemblyman Joseph D. Morelle (D-132nd) in New York, and Sens. Vitale and Dana L. Redd (D-5th) in New Jersey, bills in both states give similar reasons for enacting the legislation. New Yorks bill notes that higher patient acuity, advancing technology and procedures, and complex patient care, along with shorter lengths of stay, are creating a greater demand for nurses skills. That bill cites research studies that it says clearly demonstrate the added value of additional education in relation to improved patient outcomes. One study, it notes, demonstrated each 10% increase in the number of baccalaureate prepared nurses results in a 5% decrease in surgical patient deaths.
The language in New Jerseys legislation is similar: Studies comparing patient outcomes with the educational background of nurses demonstrate that in hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.
Raising the Bar
Initiatives to raise the educational level of practice in nursing date back as early as 1965, when the American Nurses Association voted to make the BSN the minimum for entry into practice. A similar initiative was proposed again in 1985. Although the proposal garnered support from some professional organizations, the initiative did not become law.
The BSN in 10 is an offshoot of sorts of those proposals. The bills, as written in both states, do not call for the BSN as the minimal requirement for entry into practice nor do they advocate for the closing of associate degree or diploma programs. Nurses will continue to be able to enter the profession through those means. New Jerseys S620 does state, however, that it is the sponsors intent that currently licensed nurses also seek to advance their education and training.
According to Bill S4051 (New York), Other countries are responding to these changes by requiring the baccalaureate degree as an entry requirement for nursing licensure, while other professions are demanding master and doctoral degrees as their entry point.
Here in the U.S., health professions such as pharmacy already have made the doctoral degree their minimum entry requirement.
Coming Full Circle
While a doctoral student at Teachers College, Columbia University, in the 1950s, Mildred Montag, RN, EdD, founder and former director of the School of Nursing at Adelphi University in Garden City, N.Y., completed her dissertation on the creation of a two-year nursing program to train a technical nurse who would work in conjunction with a baccalaureate-prepared nurse, according to an article on the universitys Web site.
Montags work on this seven-site pilot program was extremely successful, essentially bringing nursing programs to community and junior colleges and allowing for quicker access to the nursing profession.
When Dr. Montag wrote her dissertation at Columbia University, most nursing schools were three-year, hospital-based programs, says Marilyn Klainberg, RN, EdD, associate professor of nursing at Adelphi and author of the article. Not unlike today, there was a nursing shortage. Her notion was intended to decrease this nursing shortage by decreasing the length of the education process from three to two years.
According to the National League for Nursing, as of 2007 there are more ADN programs than BSN programs in New York and New Jersey, and since 1987, the number of ADN programs nationally has steadily risen. In seeming acknowledgement of those statistics, legislators in both states maintain that the entry points to obtaining initial nurse licensure would not change with the passage of the bills. However, the belief is higher educational requirements would attract additional recruits, as nursing might be seen as a more viable professional career option.