¶ … nursing profession is undergoing fundamental change as it relates to both internal and external regulation. Externally, new legislation such as the Affordable care act has created nearly 30 million newly insured Americas. This new demand for services, although lowering overall health care costs, presents challenges as it relates to the nursing profession. Nurses will now need expertise beyond prior requirements in order to serve this newly insured population. As such, it is my contention that new requirements eliminating the two-year nursing program will be a welcomed addition. In 2011, 60% of all RN candidates in the U.S. were non-bachelor prepared. Over the next 10 to 15 years, 33% of these individuals will be retirement eligible (The U.S. nursing workforce, 2013). The future now presents an interesting opportunity to uplift the standard of care for society, while also helping improve the overall health care system. A baccalaureate degree requirement will be a step in the correct direction. By elevating the entire standard of the procession, society and practitioners themselves will ultimately benefit. To begin, the traditional notion of nursing has now been altered forever. What once was simply a role of care giving has now been adapted to reflect the current realities of the health care system in America. The health care system now demands expanded delivery of outpatient and primary care throughout the community. It also requires a greater numbers of clinical specialists to treat an array of acute and chronic illnesses, in underserved populations. As stated in the introduction, due to the Affordable Care Act, a vast array of individuals are now insured. These individuals have a wide variety of needs and demands as it relates to care. The changing dynamic of the industry therefore demands nursing personnel who can function in a more independence manner. This is particularly true as it relates to clinical decision-making, management, and educating patients. The nurses of the future must also possess a broad health care competency as a provider, manager, and coordinator of care. This can be accomplished in part, through heighted educational standards.

Growth in outpatient centers and neighborhood clinics is rising rapidly. Patients now prefer the convenience made possible by improved clinical technologies. Minimally invasive and interventional procedures have decreased the need for lengthy hospital stays as well. Technology through rapid innovation can now be seamlessly moved out of hospital corridors and into easier-access locations, providing still further value for outpatients. Unlike graduates of diploma or associate-degree nursing programs, the nurses with baccalaureate degrees are much better prepared to practice with the high growth areas of the industry. Integration and convenience are continuing to erode the traditional healthcare system. The BSN nurse is well-qualified to deliver care in private homes, outpatient centers, and neighborhood clinics where demand is fast expanding

Today's professional has a myriad of responsibilities that require a heightened level of education. A nurse must now make quick, sometimes life-and-death decisions; design and manage a comprehensive plan of nursing care, understand a patient's treatment, supervise other nursing personnel, master advanced technology and much, much more.

Even professions and leaders within the hospitals themselves recognize the large gaps in value between ADN and BSN nursing professionals. Many nurse executives have indicated their desire for the majority of hospital staff nurses to be prepared at the baccalaureate level. This is due to the fact that many high ranking executives recognize the need for nurses to meet the more sophisticated demands of today's patient care (National Advisory Council on Nurse Education and Practice, 1996) For example, chief nurse officers at university health systems reported that they prefer an average of 70% of their staff nurses to be BSN-prepared, according to a recent survey by the University Health System Consortium. This again, is a testament to the overall value proposition that nurses educated with a BSN provide over those with an ASM. More than 70% of the CNOs surveyed stated that they perceive a difference in the practice of baccalaureate and associate-degree-prepared nurse. Many of these CNO's indicated that RN's with a baccalaureate degree possessed better critical thinking skills and leadership abilities among baccalaureate nurses

Not surprisingly, the requirement and value that BSN's provides relative to others is striking. The overall

Teamwork, leadership, collaboration, innovation are now all needed in a changing health care system. BSN's through their training can offer this value at a very high level. Many hospitals have now established "BSN-preferred" policies for new hires. For example, the Veteran's Administration, the nation's largest employer of registered nurses, has established the baccalaureate degree as the minimum preparation its nurses must have for promotion beyond entry-level beginning in 2005. The institution has already committed $50 million over the next five years to help VA nurses obtain baccalaureate or higher nursing degrees (University Health System Consortium, 1999).
The opposition to the BSN requirement believes that no new value is added through increased education to employers. They often site that licensing and various other examinations can be conducted and passed with the additional education. This argument, although on the surface is true, completely missing the value proposition the BSN's provide to their employers and society overall. The evidence presented above proves as much. Employers, particularly in regions characterized with a high degree of competition, need differentiation. Patients, now have a wide array of needs and choices to satisfy those needs. Nurses that can add value to the overall organization are therefore in demand. Employers prefer candidates who have other skills that can complement a nurses overall medical knowledge (American Association of Colleges of Nursing, 1988). Aspects mentioned in detail above such as critical thinking, leadership, and communication skills, are now heavily demand. The nurses, according to employers themselves, who possess a BSN have these skills in larger capacity than those who do not.

In fact nurses themselves now see the value in obtaining further education as it relates to their careers. RNs are returning to school in increasing numbers to earn the BSN degree. Between 1975-1999, the number of RNs (with associate degrees or hospital diplomas) graduating from BSN programs rose from approximately 3,700 a year to more than 12,000 annually (American Association of Colleges of Nursing, 2000). From 2006 to

2007 alone, enrollments in RN to baccalaureate programs increased by 11.5% or 5,188 students, which makes this the fifth consecutive year of enrollment increases in these degree completion programs

Another argument against the new educational requirement is that rising tuition costs will create a burden on nurses attempting to obtain credentials. This too, is a very real problem as tuition costs have indeed raised substantially. However, as noted above, employers are so in need for highly qualified candidates that offer the skills that patients demand, many of the costs of education are subsidized. As mentioned above, the VA has committed nearly $50 million for nurses to obtain their BSN. Many organizations are doing the same in an effort to not attract, but retain competent talent within their organization. In addition, BSN graduates are paid more due to the scarcity of potential candidates, and the overall value they provide relative to their ADN counterparts. Community Colleges are also embracing the overall demand for nursing professions by instituting their own courses that are both cost effective and efficient. Currently, community colleges are working to provide more baccalaureate nurses into the profession and meeting community demands. Sixteen states have changed regulations to allow community colleges to offer baccalaureate programs, BSN graduates, on average, make over $65,000 per year and have job security, which helps to pay for many of the unexpected expense incurred obtaining the degree.

Understandable, proponents against such regulation indicate the massive shortages currently prevailing in the health care industry. These shortages are only exacerbated by the growing need for specialized services. The opposition also states that requiring more education will only hinder care in the short run. This argument does have merit. The time required for BSN candidates to study and fulfill their duties is indeed taken away from other job duties and responsibilities. This occurrence however is short-term in nature. In many instances candidates have a multitude of options as it relates to their educational choices. Many can elect to perform classes on weekends, nights, or online. These benefits allow candidates to obtain their designations at a pace that beneficial for their lifestyle.

There is currently a shortage of nurses within the profession overall. Even more alarming, there is shortage of nurses with the relevant skills needed for the coming change in the health care profession. According to the Online Journal of Issues in Nursing, applications to nursing programs are up across the entire United States. The journal also indicates that competition for limited enrollment slots is intensifying. In addition to strong interest among new high school graduates, nursing has also become an attractive option for career changers looking to transition into the healthcare workforce. In fact 587,000 new nursing positions will be created in 2016, making the nursing the nation's leading growth profession (Raines, 2008).

In conclusion, the adoption…