Ethical and Legal aspects of Nursing practice DQ 1

Please answer the following Discussion Question. Please be certain to answer the three questions on this week DQ and to provide a well-developed and complete answer to receive credit. Also, please ensure to have read the assigned chapters for the current week.
DQ 1: Case Study, Chapter 1, Entry Into Practice: The Debate Rages On

The entry-into-practice debate in the United States continues to be one of the oldest and hottest professional issues nurses face as we enter the second decade of the 21st century. It appears that little progress has been made since 1965 in creating a consensus to raise the entry level into professional nursing practice, although experts do not agree even on that issue. Your neighbors ask you for information about considerations for selection of an appropriate nursing education program for their child.

1. Your neighbor is confused because both ADN and BSN schools preparing graduates for RN licensure meet similar criteria for state board approval and have roughly the same number of nursing coursework units. How would you summarize the arguments for changing or not changing the nursing entry level?

2. There is current evidence-based research that explores the impact of registered nurse educational level on patient outcomes. What does the current evidence-based research conclude about the impact of RN educational level on patient outcomes?

3. Achieving the BSN as the entry degree for professional nursing practice will take the best thinking of our nursing leaders. What will it require in order to successfully achieve the BSN as the entry degree for professional nursing practice?

Chapter 1 Entry Into Practice: The Debate Rages On

Entry-to-Practice Debate

1940s

Esther Lucille Brown’s Nursing for the Future

1965

ANA Position Paper

Orderly transition from hospital-based diploma programs to education in colleges/universities

ANA Position Paper #1

Premises

Education in institution of higher education

BSN as minimum for professional nurse; associate’s degree as minimum for technical practice

Short, intensive preservice programs in vocational educational institutions for assistants in health care occupations

ANA Position Paper #2

Two levels of preparation

Technical

Junior or community college 2-year programs

Associate’s degree (ADN); beginning, technical practitioner to provide care in acute-care settings, under supervision of professional nurse

ANA Position Paper #3

Two levels of preparation

Professional

College or university 4-year program

Bachelor’s degree (BSN)

ANA Position Paper #4

Reaffirmed in 1978 by ANA House of Delegates with BSN as entry to practice by 1985

Resolution in 2008

BSN within 10 years of licensure for diploma- and associate-degree-educated nurses.

Individual states for mandating and implementing

Issue still not settled

Proliferation of ADN Education #1

1960s

Primarily diploma schools of nursing education

Baccalaureate enrollment increasing

Associate’s degree programs just beginning

Proliferation of ADN Education #2

2000s

Diploma programs virtually gone

ADN as primary model for initial nursing education

BSN education on the rise with 15 consecutive years of enrollment growth

55% of current RN workforce holding a baccalaureate or graduate degree

Question #1

Is the following statement true or false?

During the 1960s, most nursing education was provided at the baccalaureate level.

Answer to Question #1

False

Diploma nursing programs were the most common type of nursing educational program in the 1960s.

Licensure and Entry Into Practice

NCLEX passing rates—no significant differences

Similar competencies across educational spectrum

Minimum technical competencies versus performance measurement over time or test of all knowledge, skills

Similar criteria for state board approval

Demographic differences of BSN, ADN grads

Employers’ lack of role differentiation, incentives

Shorter time for ADN; cost- or time-prohibitive for BSN

Educational Levels and Patient Outcomes #1

Arguments against raising entry level

Educational degree unrelated to providing high-quality care

BSN too theoretically oriented; deficiency in basic skills mastery

Educational Levels and Patient Outcomes #2

Research findings associated with BSN

Higher educational levels  better patient outcomes

Better care environments, best nurse staffing levels, and most highly educated nurse  lowest surgical mortality rates

Clarke (2017) raises some doubts about concluding that these outcomes are related to BSN nurses providing a higher quality of care vs. practicing in the hospital environment, where more BSN nurses are employed

Employers’ Views and Preferences #1

Usually no distinction in scope of practice or incentives for BSN education

Possible increasing awareness of differences between BSN and ADN grads

Preference for clinical placements by some employers based on higher degree programs

Nursing manager and administrator positions now requiring or preferring at least BSN

Employers’ Views and Preferences #2

A 2014 survey by the American Association of Colleges of Nursing found that 45.1% of hospitals across the country require new hires to have a bachelor’s degree

Magnet hospital programs require nurse managers and leaders to have a bachelor’s degree and also require a higher percentage of nurses at BSN level

Veterans Administration requires BSN as minimum for new hires as well as all non-entry-level nurses

Shifting Health Care Delivery Sites and Required Competencies #1

Hospitals  community and integrated health care settings; need for more highly educated, autonomous nurses

Affordable Care Act: RNs must be skilled in population health, case management, and quality metrics emphasized in baccalaureate nursing curriculum

Tri-Council for Nursing: education advancement to enhance quality and safety across health care settings

Shifting Health Care Delivery Sites and Required Competencies #2

IOM 2010 report

Increase from 50% to 80% of BSN nurses in workforce over the next 10 years

Double population of nurses with doctorate degrees

Shifting Health Care Delivery Sites and Required Competencies #3

Educating Nurses: A Call for Radical Transformation

BSN as entry level

Master’s degree within 10 years of initial licensure

NACNEP: 2/3 of RNs with BSN or higher by 2010

Council on Physician and Nurse Supply (2007): shift in federal funding for more BSN-level programs

Entry Level and Professional Status

Most other professions require graduate degree for entry

Growing educational gap between nursing and other health professions

View by some: BSN for entry is elitist

Failure of educational parity contributing to view of nurses as “second-class citizens” in health care arena

Nursing as the only health care profession not requiring at least a bachelor’s or higher degree for entry into practice

Question #2

Is the following statement true or false?

An employer will most likely pay a nurse with a BSN a larger salary than a nurse with an ADN.

Answer to Question #2

False

Employers commonly provide no incentives for BSN education in terms of pay, recognition, or career mobility.

Two-Year ADN Program?

Argument: 2-year ADN program a myth

Minimum of 12 to 24 months of prerequisites + 2 full years of nursing education

60 semester units or 90 quarter units of coursework (or more)

BSN programs: approximately 120 semester units

Increased ADN time: need to prepare ADNs for more diverse environments, positions needing management skills

ADN content versus BSN content

Shortages and Entry-Level Requirements

Short-term threat of raising entry level: exacerbation of existing nursing shortage

Long-term effects

Elevation of nursing’s public image with increased recruitment

Increase in recruitment-profession with greater academic prestige

Increased retention rates—possible stabilization of workforce due to increased job satisfaction

Persistence of chronic nursing shortage negates argument as excuse for postponing action to raise educational standards

Professional Organizations, Unions, and Advisory Bodies Speak Out #1

NOADN: Reaffirmation of role, value of associate’s degree nursing education, practice

NLN: Multiple entry points for nursing; focus on lifelong learning, progression

Nurse Alliance of the Service Employees International Union (SEIU): Rejection of BSN as necessary for entry into or maintenance of practice

More resources to support nursing education at all levels

Professional Organizations, Unions, and Advisory Bodies Speak Out #2

Specialty professional organizations (AACN, NANN, ANNA, AORN,…

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Ethical and Legal aspects of Nursing practice DQ 1

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