Healthcare Complexities, Shifts Call for Nurses to Further Education

02/22/16   |  
Hannah Lemon

Drastic shifts in the healthcare system and patient needs have changed education requirements and recommendations for nurses. During the past century, the focus of the nation’s healthcare needs has transitioned from the treatment of acute illness and injuries to chronic conditions and prevention.1

There are three levels of nurses: diploma, associate (ASN) and professional/baccalaureate (BSN). Hospital nurses of the past were trained in clinical-focused diploma programs to quickly fill the nation’s nursing shortage. Today, Nurses are facing new challenges as hospitals require advanced degrees.

Following the passing of the Affordable Care Act, the healthcare system was forced to rethink the roles of healthcare professionals to provide safe, quality, patient-centered, accessible and affordable care.1 In response, the Institute of Medicine (IOM) published "The Future of Nursing: Leading Change, Advancing Health" report, which directly addressed the need for more education for nurses.

The IOM appointed a committee to create action items for the future of nursing. The group recommended that the proportion of nurses with baccalaureate degrees be increased to 80 percent by 2020.1

Francine Thomas quote about baccalaureate education

A BSN degree program introduces registered nurses (RNs) to healthcare policy and financing, community and public health, leadership, quality and health systems improvement, evidence-based practice, technology and informatics, interprofessional education and more.4 As of 2014, there were more than 679 RN-BSN programs available nationwide, including more than 400 programs that were offered at least partially online.2

One such program is at Our Lady of the Lake College (OLOL) in Baton Rouge, Louisiana. Offered 100 percent online since 2008, the program prepares nurses to fill leadership roles in delivering evidence-based care and provides a foundation for continued education and career advancement in a rapidly changing healthcare environment.

“Baccalaureate education has a significant impact on knowledge, not just skills,” said Francine Thomas, Ph.D., RN, director of OLOL’s RN-BSN program. “You need to know the bedside and technical skills, but a baccalaureate degree provides knowledge in many other areas. This broader knowledge helps you take better care of the patient.”

The appeal for higher education for nurses is not new. Until the 1950s, diploma nursing programs were efficient in staffing hospitals with skilled bedside health providers, but in 1965, the American Nurses Association published its first position paper on nursing education, calling for an overhaul.3 The paper reported that those licensed to practice nursing should be prepared in institutions of higher education, and the minimum preparation for the professional nurse should be a baccalaureate degree, marking a new age in nursing education.4

In the years preceding the Affordable Care Act, the evidence-based practice movement reinforced the need for nurses’ higher education and the delivery of effective, safe and efficient care.5 Evidence-based practice equips health practitioners with a qualitative approach to patient care that takes into account one’s clinical expertise, relevant available evidence and patient preference and values.5

The 2000s also brought clarity to the differences between ASN and BSN graduates when studies started showing baccalaureate nurses were associated with improved patient outcomes.4 Thomas pointed out that hospitals with baccalaureate-prepared nurses have lower turnover and report higher job satisfaction as well as better clinical outcomes.

Mounting evidence during the past 20 years highlights the correlation between higher education for nurses and improved patient outcomes.1 The 2014 study, “Economic Evaluation of the 80% Baccalaureate Nurse Workforce Recommendation,” published in Medical Care, revealed that a 10 percent increase in the proportion of baccalaureate nurses on hospital units correlated with an 11 percent decrease inpatient mortality.2

These kinds of findings led the American Nurses Credentialing Center to require hospitals to have 100 percent of nurse managers with a BSN or graduate degree in nursing for a hospital to receive its Magnet designation of distinction. Magnet status is awarded to healthcare organizations for high-quality patient care, nursing excellence and innovations in professional nursing practice.6

The Future of Nursing Committee recommends that healthcare organizations encourage diploma and associate degree nurses to enroll in baccalaureate nursing degree programs within five years of graduation.1

“Our RN-BSN students already know they want to go further in their careers,” Thomas said. “A lot of their jobs mandate them to get their baccalaureate degree within a certain time and will likely encourage them to go on to get their master’s degree, especially when in leadership positions.”

Master’s and doctoral degrees are required for primary care providers, nurse researchers and nursing faculty, all of which are in high demand.1 The Future of Nursing Committee recommends doubling the number of nurses with a doctorate by 2020.1

“One of the emphases of our RN-BSN program is to make leaders out of the graduates and encourage them to go to graduate school,” said Phyllis Pedersen, D.N.P., C.R.N.A., dean of the OLOL School of Nursing. “One of our strengths is that we have dedicated faculty who are true experts in the content that they teach.”

Pedersen, Thomas and their colleagues are currently making curriculum revisions and additions, which Pedersen recommends all RN-BSN programs do at least every 10 years to ensure coursework coincides with what new evidence is showing.

“In the past, there was a huge gap in nursing between research and translating it into better patient outcomes,” Pedersen said. “Completing the RN-BSN allows you to form the ability to understand and translate research into practice. You have to learn how to get into the literature and see what the evidence says. We’re creating, in essence, translators of the knowledge.”


  1. The Institute of Medicine’s “The Future of Nursing” report
  2. Creating a More Highly Qualified Nursing Workforce. American Association of Colleges of Nursing
  3. American Nurses Association’s First Position on Education for Nursing
  4. Nursing Education: Past, Present, Future by Martha Scheckel PhD, RN
  5. The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. OJIN: The Online Journal of Issues in Nursing
  6. Magnet Recognition Program Overview

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