Nursevillage.com - Career Resources - Student Nursing - The Associate’s vs. Bachelor’s Degree

A battle rages in the nursing profession and it’s getting ugly — it’s the fight amongst associate degrees and diplomas against BSNs. With the nation already suffering from a major nursing shortage it seems the last thing the nursing profession would need is in fighting. The two sides differ in opinion on the quality of care provided by associate degrees versus BSNs.

Adding fuel to the fire was a recent study published in the Journal of the American Medical Association that links nurses’ education levels with hospital death rates. The findings suggest that recruiting nurses with four-year bachelor degrees instead of just two-year associate degrees or three-year hospital diplomas “may lead to substantial improvement in the quality of care.” The study performed by the University of Pennsylvania’s Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing care.

Let Get Ready to Rrrrrrumble

In a review of data from 168 Pennsylvania hospitals, surgery patients’ death rates were nearly twice as high when the percentage of nurses with bachelor’s degrees was low. The American Association of Colleges of Nursing (AACN) supports and applauds the study’s key finding:

In hospitals, a 10 percent increase in the proportion of nurses holding Bachelor of Science in Nursing (BSN) degrees decreased the risk of patient death and failure to rescue by five percent.
Patient mortality and failure to rescue would be 19 percent lower in hospitals where 60 percent of the nurses had BSNs or higher degrees than in hospitals where only 20 percent of the nurses were educated at that level.
If the proportion of BSN nurses in all hospitals were 60 percent rather than 20 percent, 17.8 fewer deaths per 1,000 surgical patients would be expected.
At least 1,700 deaths could have been prevented in Pennsylvania hospitals alone if BSN prepared nurses had comprised 60 percent of the of the nursing staff and the nurse patient ratios had been set 4 to 1.
Nurses’ years of experience had no impact on mortality or failure to rescue rates.

The National Association for Associate Degree Nursing (NOADN) challenged these results saying the study is flawed because it considered nurses with master’s degrees and other higher degrees with those who obtained only bachelor’s degrees. NOADN says the conclusion of the data appears to only support these key points:

Patients admitted to high-tech and/or teaching hospitals have a better chance of survival. The study’s data clearly indicated that the proportion of BSNs is much higher in high-tech hospitals.
There is a higher mortality rate for older patients. The study says that the average patient age in hospitals with larger numbers of AD nurses is 61.9 years and in hospitals with the highest BSN levels it is 57.3 years.
Higher workloads are a risk factor in patient care. Hospitals with the highest percent of Diploma/AD nurses also have excessively high patient loads. (The author says that they controlled for this but did not say how. In fact, a small percentage of Diploma/AD nurses with excessively high patient loads could greatly skew the outcome.)

Both sides seem to come to very valid conclusions, so who’s right?

Can’t We All Just Get Along?

Professionals from both sides of the argument will agree that nurses from all three education routes take the same RN licensure exam and there is little difference amongst the outcomes of first time test takers. With this said, you have to look at this argument logically.

Would mandating a higher education level with today’s nursing shortage really be the smartest thing to do? According to current demographics approximately 60% of our country’s Registered Nurses come from associate degree programs (National Council of State Board of Nursing 2001). Many students can’t afford a four-year degree, so they choose to go the route of the two-year associate degree or the three-year hospital diploma. To take this option away from individuals looking to enter the nursing industry would be detrimental to the profession.

At the same time, you have to recognize the fact that the healthcare industry is constantly advancing and the nursing industry has to invest in lifelong learning opportunities. Many AD nurses go on to higher levels of nursing education by receiving tuition help from their employers. The RN to BSN career path is not only common but logical. Associate degree nursing education offers a dynamic pathway for entry into the registered nursing (RN) practice. It offers accessible, affordable, quality instruction to a diverse population. Once an AD nurse enters the workforce it would not be unreasonable for healthcare organizations to mandate that within a certain time frame nurses go on to receive their BSN degree. In fact some states are already considering this option. The New York State Board of Nursing is proposing the Initiative to Advance the Profession of Nursing, which will require nurses who are prepared at the associate degree and diploma levels to complete a baccalaureate degree within 10 years of graduation.

Calling a Truce

The nursing profession ultimately has to learn to be respectful of all nursing education channels to help address the nation’s nursing shortage. Lifelong learning to promote continued competence and enhanced knowledge should continue to be emphasized by the entire nursing industry.

All the efforts being made to define the future of nursing need to focus on making the profession stronger as a whole, not one education level stronger than another. The nursing profession should intensify its focus on collaborating with other organizations to create and promote national models for upward education mobility to baccalaureate and master’s programs.

College produces an educated, well-informed nurse who is capable of performing the advanced treatments necessary in today’s healthcare industry. College alone will never make a great nurse. That is because while so much of healthcare does change, patients do not. They will always need compassion and caring qualities that are embedded in a good nurse’s soul. Nursing organizations should work with one another to develop great nurses who through their caring and knowledge will produce a higher level of quality care.