Appropriate health and patient care requires significant training. Some researchers speculate that nurses who go on to receive their BSN often provide superior care. On the other hand, some suggest that nurses with associate degrees are not as prepared when entering the workforce. Because associate degrees are inexpensive, many capable nursing students choose this route. While there is not significant research that dictates the differences in competency levels, hospitals and researchers seem to believe that baccalaureate-degree level nurses are better equipped for critical thinking than their associate-degree level colleagues.
While nurses follow different educational paths, they have to graduate from an accredited program and pass their licensure exam. The most popular programs are associate degree programs (ADN) and baccalaureate programs (BSN). The ADN program is usually a two-year program at a community college. In addition, nursing students have to fulfill liberal art course prerequisites. On the other hand, the BSN program is typically based in a four-year university, and students decide on a specialty, so their programs prepare them for working with patients and community care.
However, four-year universities have more resources, so their students will gain more experience. Aiken et al. (2003) has noted “baccalaureate-prepared nurses are more likely to demonstrate professional behaviors important to patient safety such as problem solving” (Introduction, para. 4). This suggests that many resources enhance nursing students’ education. In addition, as Aiken et al. (2003) has found: “Hospitals with higher percentages of nurses with BSN or master’s degrees…have postgraduate medical training programs, as well as high-technology facilities” (Results, para. 1). In order to effectively learn, students must have a variety of tools at their disposal such as clinical simulations. However, BSNs are significantly more expensive, so universities are able to afford high tech training.
In essence, nursing students have to consider their financial resources before they decide between BSN versus ADN degree. As NurseVillage.com (n.d.) has reported “Many students can’t afford a four-year degree, so they choose to go the route of the two-year associate degree” (para. 7). Nursing students either pay for their educations out of pocket or rely on financial aid. In addition, many nursing students who end up going for their BSN are often already working. Perhaps their salaries allow them to further their education, while nursing students in the community colleges are only starting out. In fact, Fulcher and Mullin noted (2011) that “RNs graduating in 2005 or later, 56.6%...received their initial nursing degrees from ADN programs, while 33.6%...received nursing degrees initially in BSN programs” (p. 6), so it is likely that most intend to go on to BSN programs. On the other hand, nurses with ADNs gain as much experience as nurses with BSNs because they are working with patients. Research suggests nurses with BSNs are more competent, but it seems that their results do not rely on work experience.
Regardless of the course of study in the 2-year versus 4-year university, often times programs do not provide the essential experience in order to create competent critical thinkers. Albutt G et al. (2013) has suggested that “clinical placement experience is gained in the traditional hospital setting” (p. 41-2). Nursing students have more to learn after they graduate. As they move on to the clinical environment, chances are they do not have experience because experience increases with time. With that in mind, there is not a competence level based on education, but a difference in experience. As new nurses finish their accredited programs, they must continue to learn through socialization. Socialization occurs when nurses have direct experience and they use their experience to build upon their schooling.
Direct experience allows nurses to practice their skills in areas such as prompt treatment and health promotion. As care providers, nurses’ number one goal is to care for their patients. While education does not predict the amount of commitment, BSN nurses may have had additional studies that they can draw from when treating patients.
For example, consider a patient care situation that involves caring for a patient who has been in a work accident. At his construction site, the patient suffered a severe fall and appears to have an open fracture on his right leg. In addition, the patient is unable to speak English. The physician diagnoses that the patient has a fractured Tibia and Fibula and uses a translator to tell the patient he will have to undergo surgery. The patient is suffering from severe pain, but he also suffers with anxiety. While nurses have to alleviate the patient’s pain, they will have to help the patient control his anxiety. In order to provide the patient physical and mental comfort, nurses have to utilize their critical thinking skills.
Because nurses with BSNs often specialize in one aspect of nursing care, they have significant education that provides them with the foundation of building their critical thinking skills. Benner et al. (n.d.) has asserted “Skillful practitioners can think critically…[and] One’s ability to think critically can be affected by age, length of education (e.g., an associate vs. a baccalaureate degree in nursing)” (p. 6). While nurses’ initial reactions may be to help the patient with his pain, they also have to realize that the patient has anxiety because he may not understand what is going to happen. English speaking patients can communicate with nurses, so when they are anxious, they have the ability to ask for help. On the other hand, the non-English speaking patient does not. Ultimately, nurses must rely on their critical thinking skills to understand that the patient also suffers with anxiety.
In sum, critical thinking often develops with practice, but it needs a solid foundation in order to grow. Because BSNs offer more resources and education to develop that foundation, it seems that these particular nurses would have an easier time providing and caring for patients’ needs. While nurses with ADNs or BSNs may be equally competent when it comes to physical care, the BSN education provides the vital tools in order to build competent critical thinking skills.
Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational Levels of Hospital Nurses and Surgical Patient Mortality. JAMA: The Journal of the American Medical Association, 290(12), 1617-1623. doi: 10.1001/jama.290.12.1617
Albutt, G., Ali, P., & Watson, R. (2013). Preparing nurses to work in primary care: Educators’ perspectives. Nursing Standard, 27(36), 41-46. Retrieved from http://www.nursing-standard.co.uk/
Are all RNs created equal? The associate’s vs. bachelor’s degree. (n.d.). NurseVillage.com. Retrieved from http://www.nursevillage.com/nv/content/careerresources/student_nursing/created_equal.jsp
Benner, P., Hughes, R. G., & Sutphen, M. (n.d.). Clinical reasoning, decision making, and action: Thinking critically and clinically. Patient safety and quality: An evidence-based handbook for nurses (pp. 1-23). Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/BennerP_CRDA.pdf
Fulcher, R., & Mullin, C. M. (2011). A data-driven examination of the impact of associate and bachelor’s degree programs on the nation’s nursing workforce. Retrieved from http://www.eric.ed.gov/PDFS/ED522919.pdf