1. DeCelle, Gina MSN, RN

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In today's ever-changing healthcare environment, patient care is becoming even more complex requiring nurses who are adequately prepared to meet the needs of a diverse patient population. A societal need to promote quality patient care and improve outcomes has driven researchers to examine factors that lower morbidity and mortality, decrease medication errors, and decrease failure-to-rescue rates in hospitals and healthcare agencies.1-8 Data suggest a strong correlation between these outcomes and BSN-prepared nurses or those with more advanced degrees.9

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With expansive developments in technology and science, the impression that fundamental nursing education will suffice is no longer prudent.10-12 Healthcare employers readily recognize the impact of advanced degrees and hire nurses who meet these standards.13 Data indicate that greater than 75% of nursing employers mandate or undoubtedly prefer new graduate nurses with a BSN rather than an associate degree (ADN) or diploma.14


The American Nurses Association, the National League for Nursing, and the American Association of Colleges of Nursing support and endorse lifelong learning and continuing education for nurses, and many state boards of nursing require continuing-education hours.15-17 The National Advisory Council on Nurse Education and Practice and the American Organization of Nurse Executives encourage nurses to obtain a BSN degree and suggest that the profession of nursing should strive for a workforce consisting of at least two-thirds of BSN-prepared nurses by 2010.18,19 This level of preparation hasn't yet been achieved.


More recently, the Institute of Medicine released its Future of Nursing report, which challenges the nursing profession to increase the number of BSN-prepared nurses to 80% of the workforce by 2020.20 Three of the four key messages from this report are related to nursing education: (1) nurses should practice to the full extent of their education and training; (2) nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression; and 3) nurses should be full partners, with physicians and other health professionals, in redesigning healthcare in the United States.20


Nurses are uniquely positioned to serve as partners with other care professionals to improve and redesign care delivery across a wide continuum of healthcare settings. In order to provide quality care that's patient-centered, accessible, evidence-based, and sustainable, nurses must demonstrate a willingness to transition to advanced nursing roles through advanced education.


Motivation and barriers

Going back to school can be an intimidating idea for many nurses, especially if they haven't been in the educational setting for a while. Practicing nurses may be ambivalent about pursuing a higher degree-although they feel that going back to school will help advance their careers, getting through nursing school the first time was difficult enough. Now, they have professional obligations and personal factors to consider. Researchers suggest that nurses need to be encouraged to return to school and assisted in their return.9 Understanding their attitudes and perceptions can help determine ways to foster positive feelings about education and returning to school.


A consistent finding from the research is RNs who return to school for a BSN or plan to return are young females who completed an ADN and have been employed as an RN for a limited number of years.9 Several personal motivators have been identified from the research: personal achievement or satisfaction, positive attitude regarding BSN education, improved self-esteem, and future career plans.9 Professional motivators include pressure from employers and the profession of nursing, career advancement, career mobility and options, professional enhancement, increased professional values, recognition and job security, the need for a BSN in the life of their career, improved clinical judgment, and increased knowledge.9


It has been noted that RNs who are less likely to return to school are married and have children.9 Lack of confidence is another reason that RNs cite for not returning to school, whereas others don't realize that advancing their education level is critical for professional development.19 One study found that RNs experienced the greatest numbers of barriers between the ages of 30 and 59.21 The nurses in these age groups acknowledged several barriers to returning to school: age, being single (never married, divorced, or widowed), having dependents (children or other relatives), and working full-time or working in permanent positions that limited their opportunities or reported lack of employer support.21


Personal obstacles included family, time away from family, having multiple roles or other responsibilities, and fear. Having a negative experience during ADN or diploma enrollment and having a negative attitude toward BSN education are other reasons RNs didn't return to school.21 Professional barriers included lack of monetary remuneration, lack of acknowledgment in the workplace, lack of enhancement in clinical skills, lack of financial or emotional incentive, and conflicting work schedules or shift work, which increases fatigue and decreases motivation.22


Additionally, some academic barriers have been alluded to in the research: insufficient credit for prelicensure coursework and experience, unneeded or duplicated classes, travel distance and campus location, inconvenient or inflexible class schedules, enrollment procedures, poor academic advisement, and length of time to complete a program.22


Understanding these issues can help nursing employers and nurse educators overcome the barriers that prevent higher education and lifelong learning, and develop ways to engage RNs in the educational system.


The proverbial ducks in a row

One of the most important things that nurses returning to school can do is review their educational options and decide which program is appropriate for them. There are more than 650 RN-to-BSN nursing programs in the United States. Hundreds of these programs are offered either partially or completely online, making enrollment options more flexible than traditional brick and mortar classroom instruction. This type of nursing program builds on the fundamental skills gained in ADN and diploma programs.


Today, RN-to-MSN programs are growing in popularity, with more than 150 programs in the United States. Baccalaureate and graduate coursework are included in these programs, as well as research components. BSN-to-PhD programs already exist and future programs will include the ability to move from the RN to a doctoral degree.


Nurses who haven't been in school for a while may find today's educational technology daunting. Computer skills are essential for success in traditional, hybrid, and online nursing programs, and in professional practice.23 With the advent of electronic health records, computerized documentation systems, and advanced devices for bedside care, nurses will face a plethora of technologic advances that require them to seek further training. One study suggests that nursing students rate themselves higher on their computer skills than their actual ability to perform these skills.23 This type of information helps nurse educators and practicing nurses who plan to return to school better understand the need to continually inventory and update their computer skills.


Some important skills that nurses can hone before returning to school include word processing, building spreadsheets and databases, and Internet skills, including the ability to use e-mail.23 Nursing students pursuing advanced degrees are often required to write and format papers, use computer or virtual simulation in learning, and use library databases and search engines. Nursing students may be asked to participate in online discussions that are synchronous and asynchronous, use and develop videos, participate in webcast classes, and submit assignments electronically. Because not all nursing students demonstrate the same ability to perform computer skills, researchers suggest that nursing educators assess competencies upon admission to the program and provide educational opportunities to develop necessary skills.23 Taking related computer courses can help nurses improve these essential skills and gain new expertise.


Another essential aspect of a nurse's professional development with advanced degrees is the ability to produce written papers. Many nursing students aren't well versed in the use of the American Psychological Association's (APA) formatting for written assignments. This style is most commonly used to cite sources within the social sciences. These skills are critical in constructing papers with specific margins, pagination, citations, and references. Nurses can improve their ability to create high-level manuscripts by reviewing the APA manual and utilizing online programs that assist in its use, such as The Owl by Purdue University.


Nursing students may be required to utilize other electronic devices such as smart phones or tablets. Smart phones are the most popular form of handheld device in nursing education.23 Smart phones and other mobile devices can function as personal information managers. These devices are also designed to meet the unique needs of healthcare providers, including nurses, by providing drug databases, treatment information, and medical news, as well as images related to specific disease processes. These devices serve as a clinical companion and provide instructional support. They also allow immediate communication with faculty, especially when nursing students aren't under the direct supervision of the faculty member as is the case with nurse practitioner students. Gaining skills in the use of this type of technology expands nurses' knowledge of complex information systems and helps increase the student's marketability after graduation.24


Learning for a lifetime

Lifelong learning will continue to be a critical element in the nursing profession as interprofessional practice unfolds in healthcare and as the role of the nurse changes to meet the needs of the nation in primary care and preventive services. Nurses need to embrace these changes, and the complexity and dynamics of patient care, by becoming engaged in educational pursuits to provide the highest quality care. In this manner, nurses can help revolutionize healthcare.


By understanding the issues and concerns surrounding continuing education, making the commitment to advance nursing knowledge and skills, and by doing their homework, nurses will be able to make well-informed choices about their future endeavors.




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