Associate’s Degrees in Nursing: The Road Ahead
By Jennifer Bender, RN, MSN, FNP-C
The History of Entry-Level Nursing Education
Registered nurses and those wanting to enter the nursing profession can choose from a wide variety of degree options. Those options reflect the even wider variety of job positions and work settings you can pursue. This makes being a registered nurse a bit unique.
Nursing, along with its reputation and educational requirements, has been built and transformed over the centuries. What we represent today began when a few amazing people in history saw a need to provide care to others; and they built a profession around that need.
The history of nursing began as far back as the 17th century, in 1633, when the Sisters of Charity, Servants of the Sick Poor, would nurse the poor in their homes. It wouldn’t be until 200 years later, in 1873, that the New England Hospital for Women and Children Training School for Nurses would graduate America’s first trained nurse. In those days, nurses were trained primarily in hospital-based diploma programs. Diploma nursing programs combined classroom and clinical instruction, usually over three years, and were intense programs that prepared nurses for the technical application of the nursing process but did not focus on teaching nursing theory or evidence-based nursing practice. Diploma programs are diminishing steadily and in 2006 only comprised about 4% of all basic RN education programs.
In 1909, in an attempt to move training programs out of the hospitals and integrate them into the university setting, the University of Minnesota became the first university to offer the Bachelor’s degree of Science in Nursing (BSN). This set a new standard for the training of nurses. By 1922, Sigma Theta Tau, nursing’s honor society, was founded with the expectation that the baccalaureate degree was to be required for entry into professional practice. Again in the 1940s, the Committee on the Study of Nursing Education and the Committee on the Grading of Nursing Schools issued reports urging that only college graduates be regarded as professional nurses. During the World War II era, though, the U.S. saw a decline in registered nurses. To address the shortage, nursing schools began developing another degree option that would prepare registered nurses through a two-year program.
The first Associate’s degree in Nursing (ADN) program was started in 1952 at Fairleigh Dickinson University. An ADN is defined by many nursing entities as “an entry-level tertiary education nursing degree.” In the U.S. this type of degree is usually awarded by community colleges or similar nursing schools. Enrollment in associate’s degree programs increased until the early 1990s, by which time the ADN had started to evolve into more of a stepping stone on the path to a BSN and a career in professional nursing; and the BSN degree took over as the fastest growing option. Today RNs are seeking the BSN degree in increasing numbers. In 1980, 22% of RNs held a bachelor’s degree while 18% had an associate’s degree. By 2004, the number of bachelor’s prepared nurses reached 34.2% while only 33.7 % had an associate’s degree. This indicates that the baccalaureate programs are taking the lead in the production of new nurses.
The BSN Option
After decades of debating and advocacy by all sides, the BSN degree is starting to come into its own as the primary path to entry level nursing. Although, it will never completely replace the Associate’s degree. The Associate’s degree program can still prepare students well for the practice of nursing, and with its shorter duration and more manageable cost, is the most viable option for many people to begin their careers as nurses. However, a number of factors are putting the BSN degree into the spotlight. The American Association of Colleges of Nursing (AACN), American Organization of Nurse Executives (AONE), and the American Nurses Association (ANA) all recognize the BSN degree as the minimum educational requirement for professional nursing practice.
In 2004, Kyungrim Shin, EdD; Duk Yoo Jung, MSN; Sujin Shin, PhD; and Myoung Soo Kim, PhD, RN conducted a study that investigated the critical thinking styles and skills of senior nursing students and found significant differences in critical thinking dispositions and skills among the students in ADN, BSN, and RN-to-BSN programs. An Associate’s prepared nurse acquires a broad body of nursing knowledge, but the application of this knowledge tends to be limited to structured care settings where policies and procedures are well established. Most ADN programs do not include training in performing, interpreting, or putting into practice clinical research.
The study, published in 2006 in the Journal of Nursing Education, revealed that nurses who had completed either a BSN program or an RN-to-BSN program had received more emphasis on developing the independent clinical judgment skills needed in an ever increasing complex work environment. We are seeing patients who require a higher level of nursing care than ever before. Consequently, there is a growing focus on evidence-based nursing practice, and nurses can benefit more than ever from a formal educational preparation in interpreting research and integrating findings into safe practice.
While graduates can begin practice as an RN with an Associate’s degree, the BSN degree is essential for nurses seeking to move up the career ladder and eventually away from the bedside. As our older nurses begin to retire, there will be many vacancies in experienced nursing leadership and teaching roles that will need to be filled in order to support the continued growth of our profession. These positions all require the BSN or a higher degree.
Finally, whether or not it seems fair or right, a BSN can make a real difference in how a nurse is perceived by other healthcare professionals. Interestingly, most ancillary healthcare professionals such as, nutritionists, registered dietitians, social workers, physical therapists, radiology and ultrasound technicians, pharmacists and other laboratory specialists require a bachelor’s degree or higher as entry level educational preparation.
Today’s Nurses
Registered nursing is the largest health care occupation, with 2.5 million jobs in 2006. It is projected that by the year 2016 we will need half a million new nurses to fill vacancies brought on by the fact that our aging population’s need for nurses continues to increase, while many experienced nurses are retiring. This will create the second largest number of new jobs among all occupations, and represents a 23% overall increase in the number of registered nurses needed in the workforce.
The National Advisory Council on Nurse Education and Practice has urged that at least two-thirds of the basic nurse workforce hold baccalaureate or higher degrees in nursing by 2010. As of 2006, only 47.2% do. Hospitals are focused on this gap as well, and many are encouraging or even requiring ADN nurses to go back to school for their BSN degree. The National Sample Survey of 2004 noted that 20.7% of those initially educated in associate degree programs had continued their education to obtain post-RN degrees.
The Associate’s Degree in Nursing is a great first step on the path to lifelong learning, and for many people, is the best way to get started in the nursing profession. Encouraging those Associate degree nurses to go on and earn their BSN will help the nursing profession to practice effectively in a health care environment that includes growing older populations with multiple chronic conditions, increasing patient acuities, shrinking hospital stays, rapid and continuous technological advances, and improvements and advancements in medical therapies.
Increasing the number of BSN prepared nurses will also help nursing join the ranks of many other old and honorable professions that developed from an apprentice-ship model into a science-based baccalaureate program of study. It will be another step toward our profession getting the respect it so richly deserves.
Reference List
American Association of Colleges of Nursing (2002). Hallmarks of the Professional Nursing Practice Environment. [On-line]. Available: http://www.aacn.nche.edu/publications/positions/hallmarks.htm. Accessed September 22, 2008.
American Nurses Association (2008). The Nursing Process: A Common Thread Amongst All Nurses. [On-line]. Available: http://www.nursingworld.org/especiallyforyou/studentnurses/thenursingprocess.htm. Accessed September 22, 2008.
Hasse, P.T. (1990). The origins and rise of associate degree nursing education. Durham, NC: Duke University Press.
McEnroe Ayers, D.M., Coeling, H. (2005). Incorporating Research into Associate Degree Nursing Curricula. Journal of Nursing Education, 44(11), 515-518.
Shin K., Jung D.Y., Shin S., Kim M.S. (2006) Critical Thinking Dispositions and Skills of Senior Nursing Students in Associate, Baccalaureate, and RN-to-BSN Programs. Journal of Nursing Education, 45(6), 233-237.
Standard curriculum for schools of nursing. (1917, 1927, 1937). New York: National League for Nursing.
Tanner, C. (2002). Clinical education, circa 2010. Journal of Nursing Education, 41, 51-52.
About The Author
Jennifer Bender is a Registered Nurse with a Master’s Degree in Nursing and a certification as a Family Nurse Practitioner. She currently works with MinuteClinic, Inc. in Baltimore, Maryland and lives in Annapolis, Maryland with her husband.
Jennifer received her BSN in 1995 from the University of Pittsburgh and her MSN in 2003 from the University of Maryland. She has worked in many settings and held many titles including Navy Nurse Corps Nurse, Pre-admission Testing Nurse, Middle School Nurse, Adolescent Health Clinic Nurse, Camp Nurse, Undergraduate Nursing Program Clinical Instructor, Clinical Educator, Medical/Surgical Staff Nurse, Cardiac Catheterization Nurse Practitioner, Chest Pain Center Nurse Practitioner, and Retail Health Clinic Nurse Practitioner. Her passion lies in educating her patients about health and wellness and mentoring and teaching her colleagues, nursing students and prospective nursing students about nursing practice.
