1. Witt, Catherine L. RNC, MS, NNP-BC

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The question of educational preparation for nursing practice is not new. Forty-five years ago in 1965, the American Nurses Association published a position paper calling for the baccalaureate degree as the minimum requirement for entry into professional nursing practice.1 It is interesting that nearly a half century later, we are no closer to achieving this standard. Many components of the debate have not changed. Healthcare continues to become increasingly complex. The amount of knowledge required to provide safe patient care has increased substantially. Nurses are also required to have an in-depth knowledge of healthcare systems, information technology, and research methodology. An increasing number of studies have shown that there is a connection between baccalaureate nursing education and lower mortality rates.2-4

FIGURE. Catherine L.... - Click to enlarge in new windowFIGURE. Catherine L. Witt

Despite this evidence, in 2004, only 47.2% of RNs currently working have a baccalaureate or graduate degree.5 Fifty-one percent of RNs currently working have an associate degree or a diploma in nursing.5 This is in contrast to other healthcare professionals with whom patients interact. Physical therapists, occupational therapists, pharmacists, social workers, audiologists, and speech therapists have not only a baccalaureate degree but also graduate degrees. This argument has been used to justify requiring nurse practitioners to have a doctoral degree but should illustrate the need for a baccalaureate degree (BSN) as a minimum entry-level educational criterion for nurses.


There are many other arguments for increasing the requirement for entry into practice. Unfortunately, despite 45 years of debate, we have not made much progress as a system. Human nature being what it is, many will put off pursuing this degree until it is required. I would ask you to consider this waiting until someone makes you do something, meaning that you might put it off until it is too late. Some nurse practitioners have learned this to their detriment. While most states have "grandfathered" those practitioners who do not have a master's degree, changing rules requiring certification, prescriptive authority, or other factors have limited the ability of a few to practice. It is possible that future changes in nurse practice acts will limit the practice of those who do not have the necessary education. This applies to nurse practitioners who must consider returning to school to obtain a doctorate of nursing practice and nurses who must consider earning a baccalaureate degree.


There are certainly many practicing nurses who do not have a baccalaureate degree and provide safe, effective care to their patients. They have a wealth of experience that is invaluable. They may reasonably question the value of returning to school in the middle of a satisfying career. One author looked at barriers that prevented nurses from pursuing a BSN degree.6 Incentives included increased options in their career, including improved mobility and opportunities. The possibility of pursuing an advanced degree that would allow for advanced practice nursing, management opportunities, or teaching careers was another incentive. Barriers included not enough time, lack of confidence, and lack of recognition by employers. Previous negative experiences in school were also noted as a barrier.


Employers can do more to encourage their staff to return to school. Tuition reimbursement and student loan forgiveness programs can help. Pay differentials that reward education and requiring a BSN degree for leadership positions can also provide incentives. Changing state or certification requirements have proved to be a big incentive for advanced practice nurses. Schools of nursing can help by recognizing and giving credit for educational and work experiences. Easy transfer of credits from associate degree programs to 4-year schools should be made standard. Increased federal funding of nursing education at the baccalaureate and graduate levels should be a priority.


However, waiting for someone to make you pursue a degree is not very proactive. The desire to increase one's professional credibility and career options should be a driving force. In fact, states, hospitals, and certification boards can change rules and requirements for various positions with little warning, meaning that by the time someone makes you get a degree, you will not have adequate time to make it happen. Also, if you are waiting until you have time, consider that you will likely never have unlimited free time in which to pursue a degree unhindered. You have to make available the time. There are now more options than ever: online programs, accelerated programs, traditional classroom programs, and even on-site work programs in collaboration with hospitals and universities. Don't wait until it is too late. There is no time like the present.




1. Nelson MA. Education for professional nursing practice: looking backward into the future. Online J Issues Nurs. 2002;7:3. Manuscript No. 3. Accessed March 14, 2010. [Context Link]


2. Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003;290:1617-1623. [Context Link]


3. Aiken LH, Clarke SP, Sloane DM, Lake ET, Cheney T. Effects of hospital care environment on patient mortality and nurse outcomes. J Nurs Adm. 2008;38:223-229. [Context Link]


4. Estabrooks CA, Midodzi WK, Cummings CG, Ricker KL, Giovanetti P. The impact of hospital nursing characteristics on 30-day mortality. Nurs Res. 2005;54,72-84. [Context Link]


5. American Association of Colleges of Nursing. Fact Sheet: creating a more highly qualified nursing work force. Accessed March 14, 2010. [Context Link]


6. Megginson LA. RN-BSN education: 21st century barriers and incentives. J Nurs Manag. 2008;16:47-55. [Context Link]