Should Nurses Have to Have a B.A.?

Political Analysis of Establishing the Baccalaureate Degree as Minimum Requirement for Nursing

Establishing the baccalaureate degree as minimum requirement for nursing

Identifying and analyzing the problem

The challenges of the modern healthcare environment have grown increasingly complex and diversified. The skills required for a competent nurse have grown and expanded with changes in technology; also, cost-cutting by many major healthcare institutions have shifted duties once solely confined to physicians onto the shoulders of nurses. Given the additional roles and responsibilities assumed by nurses, there have been increasing demands that nurses have at least a baccalaureate degree as minimum requirement for entering the nursing profession. At present 39% of all nurses have degrees from four-year colleges (Perez-Pena 2012:2).

Outlining and analyzing proposed solutions

Despite the nursing shortage, many hospitals have begun to demand that nurses now have a B.A., causing many seasoned nurses to have to return to school. "That shift has contributed to a surge in enrollment in nursing courses at four-year colleges, particularly at the more than 600 schools that have opened 'R.N. To B.S.N.' programs, for people who are already registered nurses to earn bachelor's degrees. Fueled by the growth in online courses, enrollment in such programs is almost 90,000, up from fewer than 30,000 a decade ago, according to the American Association of Colleges of Nursing" (Perez-Pena 2012:1). This number is likely to increase as "professional groups and employers continue to push for more education, citing studies linking better-educated nurses to better patient care. Where traditional nursing education focuses on practical skills, students in four-year programs learn more about theory, public health and research" (Perez-Pena 2012:1).

And an "added incentive for hospitals is the coveted 'magnet' designation, awarded by the American Nurses Association to about 400 hospitals and sometimes featured in their advertising. Among the association's criteria for magnet status is the nursing staff's level of education" (Perez-Pena 2012:1). However, considerable challenges remain for nurses wishing to return to improve their education as well as undergraduates wishing to obtain a B.A. In nursing, namely the lack of qualified instructors, which forces these programs to turn away applicants because of a shortage of available places: some community colleges have begun to offer B.A.s to meet the demand (Perez-Pena 2012:2).

Understanding the background of the issue

Medical errors are a significant problem in the U.S. It has been estimated that as many as 98,000 patients die every year, solely due to preventable medical errors (Orsolini-Hain 2008). The increased interest in data-driven analysis has revealed that nurses with a B.A. seem statistically less likely to commit medical errors. Three separate studies that "linked an increased proportion of R.N.s with baccalaureate degrees in acute care hospitals with significantly decreased patient mortality rates (Aiken, Clarke, Cheung, Sloane & Sliber, 2003; Estabrooks, Midodzi, Cummings, Ricker & Giovanetti, 2005; Tourangeau, et al., 2006). Combined, these studies examined almost 300 hospitals, about 300,000 patients and almost 23,000 nurses" (Orsolini-Hain 2008). This suggests from an institutional perspective that requiring B.A.s for nurses improves care, decreases mortality, and also decreases the likelihood of malpractice allegations.

The shift to managed care and the calls for cost-cutting have also increased demands for better nursing education as nurses are called upon to perform diagnostic procedures and treatments they were not in the past, given that nurses are less expensive to employ than physicians. Nurses are also called upon to perform more managerial roles which benefit from the additional reflection and experience conveyed by a B.A. Finally, the increased emphasis on preventative care also has placed greater demands upon and opened up opportunities for nurses, as a patient-centric focus has traditionally been at the heart of the nursing profession.

Locating the political setting and structures involved

Hospitals have an increasing need to demonstrate that they can provide cost-effective care which is still of high quality: increasing the educational levels of staff is one way to do so. Nursing associations likewise have an interest in boosting the image of the profession. That is yet another reason why the ANA (American Nursing Association) developed the Magnet Recognition Program "to promote quality and excellence in patient care delivery in hospitals by nurses in professional practice" and one of the contingent requirements of this accreditation is to have a certain percentage of B.A.-accredited nurses (Orsolini-Hain 2008).

Evaluating the stakeholders

Nurses themselves increasingly wish to return to school, aware of the fact that they can make more money and that more institutions are requiring nurses to have B.A.s. Many also report that they perceive a difference in the care they are able to provide for their patients in a positive fashion. "Nurses also reported that they changed the way they practiced nursing and felt more like a nurse than ever before because of how differently they were thinking after earning a baccalaureate degree" (Orsolini-Hain 2008). However, many nurses complain that returning to school when they have the competing demands of work and family obligations can be challenging and the majority of nurses still do not hold B.A.s "As of 2004, only 21% of associate degree graduates returned to school to pursue a B.S.N." (Orsolini-Hain 2008).

Part of this is also due to the challenges of finding an appropriate nursing program to attend, given the nursing faculty shortage. Nursing schools thus also have a critical interest in improving and expanding the program slots for nurses but have difficulty attracting faculty members with appropriate qualifications. "Universities and community colleges have a hard time competing with hospitals, corporations and the military, who can all offer nurses with advanced degrees much higher salaries" (Ingeno 2013). Some schools have adopted 'creative' responses to this: "addressing the shortage of nursing educators through the use of part-time faculty working in clinical teaching environments. Full-time faculty can then concentrate on curriculum-based instruction and skill-building capacities" (Maitland 2012).

Conducting a values assessment

The nursing profession is increasingly demanding respect on parity with physicians and the value of enhancing the professional qualifications as well as improving patient care must be weighed against the difficulty of address the nursing shortage. At present, "there is no single standard for education required for entry into professional (registered) nursing practice (Smith 2009).