Evidence of a Culture of Safety: Role of Bachelors Prepared Nurses in Patient Safety

Does having a bachelor's degree in nursing mean that nurses will be better prepared?


Does a Bachelor's degree make nurses more competent?

There is mounting evidence that clearly and irrefutably shows that nurses who hold BSN degrees bring unique skills to the clinical setting, and ultimately play a critical role in patient safety. The American Association of Colleges of Nursing (AACN), publicly states that education makes a clear and evident difference on the competencies and knowledge base of the nurse clinician ( It's only common sense that this would be true in any profession but with the debate about whether ADNs or BSNs are more effective nurses, competency is not really the question.

The question is: Which of these two degrees most completely prepares nurses for high level, safe patient care in an increasingly complex healthcare system?

Nurses who hold BSN degrees have a strong and focused foundation in the field that prepares them to meet the many demands faced in their field. Bachelor's prepared nurses have well-honed abilities in the areas of critical thinking, case management, leadership, health advocacy, and their ability to practice with competence in a wide variety of health care settings. The addition of coursework that is more intensive and even some that is humanities based can more holistically prepare nurses for the demanding work that they will face on a day to day basis.

An Associate's Degree in Nursing prepares students with the fundamental skills necessary for nursing including development of care plans and the physical hands-on daily tasks of the job. However, a Bachelor's Degree requires nurses to think more inferentially, and teaches them to incorporate research-based practices into nursing care. The knowledge base that includes evidence based practice can automatically carry over into the nurse's practice. This added body of knowledge can help make patients safer. Incorporating evidence into critical thinking may also help to eliminate deadly errors during times of extreme stress.

Bachelor's degree nursing programs include all of the same course work that is taught in associate degree and diploma programs. However, the curriculum encompasses a much more in-depth approach to the treatment of both physical and social sciences, research, leadership, public and community health issues, as well as humanities. The additional coursework better prepares today's nurses with a deeper understanding of cultural issues, political issues, as well as the pragmatic tasks that are required in the daily performance of the job.

The last decade has brought about a distinct awareness from policymakers that a higher education definitely makes a difference in patient care and safety. For example, in October 2010, the Institute of Medicine released a report calling for an increase in numbers of practicing BSNs, to 80% by 2020. The committee who authored this report stated that "the demands of an evolving health care system and meet the changing needs of patients, nurses must achieve higher levels of education."

Another research study published in the March 2013 issue of Health Affairs found a 10 point increase in the percentage of nurses holding a BSN in a hospital was directly correlated with an average reduction of 2.12 deaths per 1,000 patients (An Increase In The Number Of Nurses With Baccalaureate Degrees Is Linked To Lower Rates Of Postsurgery Mortality Ann Kutney-Lee, Douglas M. Sloane, and Linda H. Aiken Health Aff March 2013 32:579-586; doi:10.1377/hlthaff.2012.0504). The study, entitled "An Increase in the Number of Nurses with Baccalaureate Degrees is Linked to Lower Rates of Post-surgery Mortality, goes on to state that the advanced degree equips nurses with a better understanding of patient care.

Most university hospitals actually prefer to employ baccalaureate prepared nurses, recognizing the clear difference in their competencies based solely on their advanced education. Administrators recognize that the difference between a bachelor's degree and an associate degree or diploma is stronger critical thinking and the preparation to take on leadership roles. Many studies also note that nurses who are educated at the bachelor's degree level have stronger communication skills, are better able to problem solve, and are much more proficient at making nursing diagnoses and evaluating the patients.

No one is suggesting that associate degree nurses are less competent or purposefully harming their patients. In fact, because of associate degree nurses and their ability to perform the daily hands-on tasks that are required, they actually facilitate the ability of all nurses to more efficiently perform their jobs. The facts are clear. Issues such as medication errors, hospital acquired infections and other similar problems are due to a variety of causes, but nurses who have stronger critical thinking skills and a greater knowledge base are able to become more active in the profession.

As an attempt to help correct systems errors and emphasize patient safety, the health care field needs nurses who are empowered with the education to implement solutions rather than just carry out orders. The BSN curriculum emphasizes coursework that will sharpen those skills, creating nurse leaders that question, evaluate and evolve readily.

Health care itself is a constantly evolving, fluid field. As the changes continue, nursing practice will inevitably be affected. The way in which nurses are able to practice safely will be affected. Many employers are moving towards requiring associate degree nurses to continue with their education and gain a BSN in order to continue with their employment, a move that many nursing organizations support.

While these educational mandates may present initial reluctance on the part of working nurses, it is important to note that many nurses who do go back and gain their BSN cite clear changes in their ability to practice. They notice subtle differences in their skill sets, their ability to reason and make decisions, and to effectively and more safely provide patient care.

As a part of National Nurses Week 2016, we encourage you to look into expanding your own education, as an effort to help create and expand a Culture of Safety in nursing. We also encourage you to download our Safe Nurses Toolkit, so you can print and distribute our articles on your unit and recognize those nurses who go the extra mile to keep patients safe.

Remember, an educated nurse is the most powerful member of the healthcare team…so expand your nursing education today!

Thank you for all you do, and Happy Nurses Week from all of us at!