In this article, you get a picture of the disagreement brewing in the profession. This situation is as old as nursing, I think. Nurses themselves have disagreements daily on the ability of one nurse to do the work of another nurse. But is it based on licensure or is it really about experience?
While I feel pretty neutral on this subject, I will say that there are questions arising daily in nursing practice on the floors, but we all sit for the exact same NCLEX exam and we all get the exact same license issued. So where is the difference and why all the big deal?
I understand the attempt to make a standard and I also understand the need to have nursing considered as a professional occupation by the general population. But, again, what really is the big deal?
It’s no secret that there are three points of entry into practice as a registered nurse: a four-year baccalaureate program, a two- to three-year community or junior college program, or a diploma program that typically lasts three years. Regardless of the length of study and amount of money spent, candidates from all three programs sit for the same licensure exam.
Even so, Bills S4051/A2079B in New York and S620 (nee S2529)/A3768 in New Jersey are seeking to ensure that the baccalaureate of science in nursing becomes the standard for continued RN licensure in those states. The bills would require all RNs to obtain their BSNs within 10 years of initial licensure. Essentially, if you want to remain an RN in either of those states and are a graduate of an associate degree or diploma program, you would have to go back to school.
What Does It All Mean?
According to 2007 National League for Nursing statistics, there are still far more AD programs than BSN and diploma programs in the U.S. New York has 65 AD programs, 55 BSN programs and just one diploma program. According to the New Jersey Hospital Association, New Jersey is home to 18 schools that offer an AD in nursing, and 19 offering the BSN. It does, however, have 11 hospital-based diploma programs — the largest number of such programs in the U.S. after Pennsylvania.
Passage of the legislation in either state could have serious implications for AD and diploma programs, both positive and negative. For example, enrollment in two- and three-year programs could suffer, as potential candidates opt for the four-year program that would ultimately be required to continue to practice. On the other hand, if they become law, the bills would ensure the BSN becomes the minimal standard for RN licensure within 10 years of practice, a step that already has been implemented in other countries.
Some schools of nursing have begun to prepare for those implications, noting the requirement would benefit nursing as a whole. “We have been very proactive in this regard and well-positioned for the BSN in 10 proposition,” says Mary Lebreck Kelley, RN, MSN, MEd, CNE, dean of the Trinitas School of Nursing and director of education at Trinitas Regional Medical Center. The Elizabeth, N.J., school offers a diploma program in nursing that gives students the option of going on for an AD from Union County College in Cranford.
“In 2004, we formed a partnership with the College of Saint Elizabeth to bring a BSN program on-site to our Elizabeth campus, and in 2007, CSE brought their MSN program on-site, also,” Kelley says.
Kelley believes that the legislation, should it pass, would be more benefit than hazard to Trinitas’ program.
“The BSN in 10 proposition will serve to encourage graduates from our program to take advantage of what we already have in place for them on-site,” she says. “I see it as a win-win situation.”
Other schools have taken a similar position.
“I believe that the impact overall will be very positive,” says Joanna Scalabrini RN, MS, MA, dean of the Hopfer School of Nursing at Sound Shore Health System and professor Emeritus at Westchester Community College.
Scalabrini doesn’t think the legislation would have any impact at all on New York’s lone diploma program, and believes the bills will only serve to make the AD more valuable, as it can be seen as a steppingstone. “This path will allow the candidate to obtain a solid nursing education with emphasis on direct patient care, prior to their BSN completion program,” she says. “This 2-plus-2 plan can save a candidate thousands of dollars in education loans.”
Hopfer’s faculty is in full support of the proposal, notes Scalabrini, as are most of the students who attend. “I ask our incoming students at their orientation to present a written argument for or against the BSN in 10,” she says. “I have been doing this since the Board of Nursing first unveiled the idea. No less than 80% of each and every class fully supports this plan.”
Jennifer A. Ort, RNC, MS, chairwoman of the department of nursing at Monroe College in The Bronx (N.Y) also sees the proposal as a chance for nursing to step up its game and be viewed as other healthcare professions are, while not undervaluing AD or diploma programs. “Master’s degrees and even doctorates are entry-level educational expectations for many other healthcare professions,” she says. “BSN in 10 is a wonderful way to allow those who want to be nurses to continue at the associate or diploma level before continuing for their BS.”
Ort says she is most concerned about what the legislation would mean for practical nurses. “… Our nursing program is a one-plus-one LPN-to-RN program,” she says. “What will happen to LPN education when BSN in 10 passes?”
Although some believe the proposals would provide instant credibility to nursing in New York and New Jersey, others, such as Susan Neville, RN, PhD, chairwoman of the department of nursing at the New York Institute of Technology in Westbury, N.Y., and Maria Elena Pina-Fonti, RN, MA, associate professor at York College in Queens and adjunct professor at Molloy College in Rockville Centre, N.Y., believe it’s not that simple. If the proposals pass, they say, more work would be necessary.
“The issues are complex and will require a collective effort by all levels of nursing education to prepare for and sustain this requirement,” Neville says. “For example, seamless educational level articulation models, strategic faculty system/regional assignments, academic and service partnerships, clinical education models and the increased use of technology in educational pedagogy.”
Taking the notion one step further, Pina Fonti believes eliminating AD and diploma programs altogether will help nursing get the same respect as other healthcare professions that required a baccalaureate degree as a minimal requirement.
“The myopic view of subdividing our professional educational process into three distinct levels (two-, three- and four-year programs) catapults us to underpin our fundamental structure and compromises our educational product (the nursing graduate) and our nursing profession in the societal realm,” she says.
“I believe that the structural reframing that is necessary must be implemented in a partnership or consortium approach in which initially the AD program is partnered with an existing baccalaureate program to aid in the transition of the student and with a central focus of phasing out the AD program,” she says.
Although the complex process would be fraught with “growing pains,” Pina-Fonti believes the resulting educational infrastructure would define a new era in the history of nursing. “Ultimately, the partnership created would provide opportunities for growth [both for the student and faculty body] that would far outnumber the challenges created in the implementation of the new program.”
Neville agrees the proposals are imperative to nursing. “These initiatives become pivotal to the profession, as nurses move forward in preparing to meet the increasingly complex, multicultural care needs of patients in a fast-paced technological society.”
Neville and Pina-Fonti are not alone in their line of thinking. In its description of nurse training and qualifications, the Bureau of Labor Statistics offers the following advice: “Individuals considering a career in nursing should carefully weigh the advantages and disadvantages of enrolling in each type of education program. Advancement opportunities may be more limited for ADN and diploma holders compared to RNs who obtain a BSN or higher.”
Baccalaureate degree programs offer more clinical experiences in non-hospital settings as well, notes the BLS, and with the complexity of today’s patients, that benefit could make the task of initially choosing a BSN over an AD or diploma program much easier and the passing of the proposals more appealing.
Tracey Boyd is a regional reporter. Send letters to the editor to editorNY@nursingspectrum.com or comment below.
Here’s the link to the original article.