In July of this year, a joint position statement between the Organization for Associate Degree Nursing and the American Nurses Association (ANA) was published on "Academic Progression to Meet the Needs of the Registered Nurse, the Health Care Consumer, and the U.S Health Care System" (ANA, 2015). The position statement is supportive of the Institute of Medicine's (IOM's) (2011)Future of Nursing: Leading Change, Advancing Health recommendation that 80% of nurses be educated to the Bachelor of Science in Nursing (BSN) degree by 2020.
We are making amazing progress on reaching this goal. According to figures collected by the ANA (http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/), 55% of the current registered nurse (RN) workforce holds a bachelor's degree or higher. From 2009 to 2013, just 2 years into the challenge, RN to BSN enrollment and graduate rates more than doubled from 19,606 to 40,213, and all BSN graduation numbers increased from 66,727 to 100,198 (http://campaignforaction.org/campaign-progress/number-rn-bsn-program-graduates-a). Of these, 40.1% of all BSN graduates in 2013 were RN to BSN graduates, colleagues who made the investment of time and money to increase their level of education toward achieving the national recommendation. In addition, the ANA also reports that 43.7% of healthcare settings require new hires to have a minimum of a bachelor's degree and 78.6% express a strong preference for BSN graduates.
Our discipline has long been engaged in debate around entry to practice. I must admit that as a new high school graduate making decisions about my future, I did not really understand the implications behind choosing an associate's degree versus a bachelor's degree for entry into nursing practice. My parents did not have college degrees but motivated me throughout my childhood to set my goal on obtaining a university-based education. Fortunately, I love learning and knowledge (though not necessarily the rigors of studying, I will admit) and I made a somewhat naive decision to attend a university (which by default meant I would pursue a baccalaureate degree).
I feel fortunate that I had the means and opportunity to obtain a baccalaureate degree as entry to nursing practice, even though I didn't really understand the implications for my career at that point in my life. I know of many colleagues who chose an associate's degree because of finances, easy access to coursework, shorter time to employment, or admission requirements, among other reasons. Regardless, as practice requirements for knowledge and leadership have accelerated over time, so too has the need for registered nurses to pursue higher levels of education in order to adequately address the needs and expectations of consumers and the discipline. Sacrifices of time, money, and ego are required from all who pursue additional education. So, why the need for additional education beyond entry to practice?
Clearly, as a clinical academician, I value higher education. In my current appointment, I oversee the graduate programs in nursing at my university, which include both master's and doctoral degrees. This role requires me to motivate and inspire new graduate students, counsel those who are struggling or perhaps lack commitment, and celebrate with those who are successful in obtaining their advanced degrees. I am always amazed at the stories my students share of how colleagues are unsupportive or derogatory about their decision to go back for more education. Many share how others will chastise them for pursuing a degree that doesn't necessarily guarantee them more income or a promotion. Some students surprisingly don't anticipate the amount of dedication or commitment required to pursue higher education. Just last week, I had a new doctoral student leave the program after his first semester because he said, "It is too hard." I had to laugh when my administrative assistant asked him if he realized he was applying to a doctoral program! Andrew Carnegie's saying, "Anything in life worth having is worth working for," certainly applies to higher education. Sure, going back to school is hard and the demands will be great, but the outcome of achieving higher education that benefits patients, society, and the nursing profession is worth working for.
Although many would love to obtain advanced education, but are unable to for very legitimate reasons, I know there are others who push back without truly giving consideration to pursuing higher education. So let's consider the "why" of pursuing additional education. First, the demands and expectations of nursing now go beyond basic "nursing process." Individuals sitting for the National Council Licensure Examination for Registered Nurses (NCLEX) (National Council of State Boards of Nursing [NCSBN], 2012) are expected to have knowledge in four main areas of client need: (1) safe and effective care environment; (2) health promotion and maintenance; (3) psychosocial integrity; and (4) physiological integrity. Not so different from what many of us would say our entry-to-practice education prepared us for. But "the devil is in the details."
Specific areas of knowledge expected of today's nursing graduates with associate degree include such subjects as advance directives, case management, interdisciplinary team collaboration, concepts of management, information security and technology, performance improvement, ergonomic principles, hazardous and infectious materials, and error prevention, to name a few (National League for Nursing [NLN], 2012). Additional expectations expected of baccalaureate graduates include knowledge of organizational and systems leadership, evidence-based practice including skills in formulating research questions as well as critiquing and applying published research, information management, healthcare finance, policy, regulatory environments, interprofessional collaboration, and care of not only individuals and families but also groups, communities, and populations across the life span in all healthcare environments (American Association of Colleges of Nursing, 2008; NLN, 2012). Needless to say, many nurses learn some of this content experientially; yet, nothing substitutes for the systematic and directed learning of both didactic and clinical applications of knowledge in a practice discipline such as nursing.
I have students who enter their doctoral program with very prestigious accomplishments in their practice arena. They often admit upon graduation, however, that their initial expectation was that they would just breeze through their coursework because they were accomplished experts and successful clinicians in their nursing roles (and they were). Usually, by the second semester of study, I begin to hear comments that they cannot believe how much they are learning and how they didn't realize what they didn't know. I'm always proud of learners who recognize we never "arrive" at learning.
The expanse of knowledge is overwhelming, and we are hard-pressed to ever get ahead of the new knowledge that is emerging so rapidly. Schilling (2013) asserts that clinical knowledge is doubling every 18 months. He also cites IBM's claim that although human knowledge doubles every 12 months, it will soon double every 12 hours, thanks to the Internet (IBM Global Technology Services, 2006). The explosion of information and knowledge, and our ability to share it, is escalating, but our ability to make sense of that knowledge or apply it usefully is limited by our capability to learn as rapidly as knowledge is developing. I believe, we owe it to our patients to continue to pursue higher education that prepares us to be more effective caregivers, decision makers, leaders, collaborators, and advocates-just a few of the expectations of the current nursing role.
A word of caution: Applicants to higher education programs should recognize that all programs are not created equal. Whether you pursue online or in-the-seat coursework, it is important to choose a college or university where the faculty assemble themselves together regularly to direct the curriculum of study, evaluate student performance, and participate in shared governance. Otherwise, the student risks taking classes that might be interesting or well taught but do not build upon a thoughtful and deliberate curriculum designed to matriculate the student from foundational to advanced educational outcomes. The earned degree then is not respected or meaningful to employers or society, even though the institution does grant a degree.
In considering the IOM (2011) recommendations, our SGNA (Society of Gastroenterology Nurses and Associates) leadership has made efforts to support our members in pursuing advanced education. Our Society provides a competitive "SGNA Advancing Education Scholarship" to a gastroenterology registered nurse pursuing a BSN, MSN, or PhD degree (http://www.sgna.org/Portals/0/About-Us/Doc/Awards-Scholarships/SGNA_RN_Advancing) and, hopefully, regionals are doing the same for local members. Many employers provide tuition reimbursement to help defray the costs of pursuing higher education, and some provide differentiated pay for each level of higher education obtained.
Regardless of tangible benefits, my own experience has been that I fell in love with nursing when I pursued my additional degrees. My advanced educational experience allowed me to immediately build upon the foundational knowledge with which I started as a new graduate to now understand and appreciate the greater breadth and depth of nursing expertise and knowledge that I was not ready to see or experience as a novice. Even as an experienced nurse and expert clinician, I found that my advanced education provided me with new ways of knowing that I would never have achieved outside of my formalized educational experience. Continuing education experiences were often useful and insightful, but they did not provide the systematic, thoughtful learning achieved through formal advanced education.
If you have been thinking of pursuing additional education, I hope my perspectives are encouraging to you and you move forward with a definitive plan to pursue your next level of education. For those of you who are unable to do so, I trust you will encourage those around you who are pursuing higher education or considering another degree. Our patients deserve professionals who are formally and critically educated beyond entry to practice, and our discipline benefits from nurses who are highly educated and articulate about the broad body of knowledge required of healthcare practitioners today.
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