The pressure is on: Why you should get your BSN

Author(s):Catherine Spader, RN

Have you been thinking about going back to school to get your bachelor of science in nursing (BSN)? The good news is that nurses with BSNs or higher degrees are in greater demand than ever, and their opportunities will continue to expand. In addition, pressure is mounting to earn a BSN. If you’re still on the fence, consider this:

  • In 2010, the Institute of Medicine (IOM) released a report (“The future of nursing: Leading change, advancing health”) calling for at least 80% of RNs to have a BSN by 2020.
  • Hospitals wanting to qualify for American Nurses Credentialing Center Magnet Recognition® must provide proof of plans to increase their BSN workforce to 80% by 2020.
  • Many healthcare systems across the country require nurses to earn a BSN, usually within 5 years of hire.
  • New York has passed BSN in Ten legislation that requires nurses licensed after December 19, 2017, to obtain a BSN within 10 years.

“Nurses need to jump on the BSN bandwagon if they haven’t already,” says Joan Shinkus Clark, DNP, RN, NEA-BC, CENP, FACHE, FAONL, FAAN, executive vice president and system chief nurse executive at Texas Health Resources in Arlington. “Not only is it good for them to engage in lifelong learning, but it’s becoming more compelling to get a BSN for employment.” Clark also is past president of the American Organization for Nursing Leadership.

Providing better outcomes

The evidence-based IOM recommendation recognizes that patient needs have become more complicated, and that nurses must attain the requisite competencies to deliver high-quality care, says Ann H. Cary, PhD, MPH, RN, FNAP, FAAN, chair of the board of directors at the American Association of Colleges of Nursing (AACN). She’s also dean and professor at the University of Missouri Kansas City School of Nursing and Health Studies. “Quality patient care hinges on having a well-educated nursing workforce,” she says. “With patient care growing more complex, ensuring a sufficient RN workforce is not merely a matter of how many nurses are needed, but rather an issue of preparing an adequate number of nurses with the right education to meet healthcare demands.”

Research shows that lower mortality rates, fewer medication errors, and positive outcomes are all linked to nurses prepared at the baccalaureate and graduate degree levels. The AACN position paper, “Academic progression in nursing: Moving together toward a highly educated nursing workforce,” cites multiple studies that found BSN-prepared nurses have a positive impact on lowering patient mortality rates. For example, a classic study by Aiken and colleagues, published in 2003 in the Journal of the American Medical Association, found that a 10% increase in the proportion of nurses holding BSN degrees decreased the risk of surgical patient death and failure to rescue by 5%.

“Think about how nursing stacks up with other healthcare disciplines, such as pharmacy, physical therapy, and social work, in which the entry level is a master’s or a doctorate,” Clark says. “A minimum bachelor’s education for nurses is important to create a well-educated interprofessional team that works well together to provide safe and reliable care.”

Staying competitive in the marketplace

BSN nurses are prized by employers for their critical thinking, leadership, case management, and health promotion skills, and for their ability to practice across a variety of inpatient and outpatient settings. “Employers are looking for highly skilled nurses able to translate the latest scientific evidence into practice,” Cary says. “They’re showing a strong preference for BSN- prepared nurses, particularly among new hires. AACN’s most recent data show that 46% of employers now require a BSN, and 88% are expressing a strong preference for nurses with a baccalaureate degree.”

Michele Snider, BSN, RN, CHCR, president of the National Association of Healthcare Recruitment, agrees. “BSN-prepared nurses are the top-tier candidates of choice of RN recruiters for bedside positions, especially for new graduate nurses.”

Because of this trend, it’s likely that nurses with less than a BSN will not have the same future career opportunities and mobility as those with a BSN. In addition, more education generally means higher salaries and more autonomy over nursing practice. “Nurses who have been on the frontlines for a few years are finding that they’re limited in their career paths because they don’t have a BSN,” Clark says. “It opens up opportunities to advance toward becoming a manager, educator, researcher, and advanced practice nurse.”

Metro vs rural settings: What’s the employment forecast for BSN nurses?

Workforce experts believe that the demand for BSN nurses will continue to increase in both metropolitan and rural settings as health systems across the country align themselves with the IOM’s goal of an 80% BSN-prepared nursing workforce by 2020. According to Clark, Texas Health Resources has required all RNs hired in the system since 2015 to have a BSN within 2 years of employment. The large system includes more than 350 points of access in urban, suburban, and rural settings.

Many health systems are following suit. For example, most health systems in Indiana require a BSN, usually within 5 years of hire, according to Snider. Eskenazi Health is on the Magnet journey, and since 2012 has required new nurses to complete their BSNs within 5 years of their hire date. The system includes a 350-bed level-one trauma center and 12 federally qualified healthcare centers and mental health centers. “Because of the nursing shortage, we still hire associate degree–prepared [ADN] nurses, but we offer a robust reimbursement program to support them in getting their required BSNs,” says Snider, who also is an RN-talent acquisition consultant at Eskenazi Health.

Some large metropolitan hospital systems in Colorado also have a BSN requirement for hiring nurses. Others require ADN-prepared nurses to be enrolled in a BSN program within a year of hire with an end-date to completion, according to Audrey Snyder, PhD, RN, ACNP-BC, FAANP, FAEN, FAAN, AGACNP, program coordinator of the adult gerontology acute care nurse practitioner program at the University of Northern Colorado in Greeley. “In the future, ADN-prepared nurses in metropolitan areas may find most of their initial opportunities in long-term, transitional, and rehabilitation care,” Snyder says.

Expanded educational expectations aren’t limited to metropolitan organizations. Rural facilities are increasingly looking for BSN-prepared nurses. Although rural settings have traditionally relied on local ADN community college programs to supply nurses, they have had the same call to action to achieve the 80% BSN rate as their metropolitan cohorts.

“Nurses with a BSN or higher will find an abundance of opportunity in rural organizations because of the lack of local nursing schools that offer BSN education,” says Snyder, who also is president of the Rural Nurses Association. “Rural hospitals need to fill positions, so they will hire associate-degree nurses, but employers see a great amount of value added when a nurse has a BSN.”

Staff nurses in rural hospitals frequently have to work in multiple roles and specialties, and a BSN can better prepare them in the key skills they need, including accessing resources, self-educating, critical-thinking, improvising, and communicating and collaborating with healthcare professionals across the board. A huge demand exists for nurse practitioners, especially those who are acute-care and family certified to care for patients across the lifespan, Snyder says.

To address the need for more BSN-prepared nurses, some rural areas are developing innovative programs to increase accessibility to BSN programs. For example, Florida has a program in which community colleges can offer BSN degree programs. Several counties in Texas, which has a large rural footprint, are currently testing a similar idea, according to Clark. In 2018, Colorado passed legislation that allows community colleges offering ADN programs to develop BSN programs. Concurrent enrollment in an ADN and BSN program may be an option for rural nurses. For example, the University of Northern Colorado has relationships with some community colleges so that students can enroll concurrently in the ADN and BSN programs.

Feel the nursing pride

Nurses who complete their BSNs find many benefits beyond simply getting a job. Clark says that she’s seen the pride of the nurses in the Texas Health Resources system who’ve completed their BSNs. “Getting your BSN reactivates the student in you,” she says. “It also creates a desire to continue learning because you’re engaged and realize that you might want to do other things that require additional education. It helps nurses on the journey toward advancing their careers. Yes, there are nurses who are only getting their BSNs to maintain their jobs, but I see the pride in them when they achieve recognition for completing their degree. In the end, they’re glad they did it for many reasons.”

Catherine Spader is an author and healthcare writer/editor based in Littleton, Colorado.

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