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  1. Loversidge, Jacqueline PhD, RNC-AWHC
  2. Yen, Po-Yin PhD, RN
  3. Chipps, Esther PhD, RN, NEA-BC
  4. Gallagher-Ford, Lynn PhD, RN, DPFNAP, NE-BC
  5. Genter, Lynne MS, RN, CRRN
  6. Buck, Jacalyn PhD, RN, NEA-BC


OBJECTIVE: The aim of this study was to describe differences in associate degree (ADN) and baccalaureate degree-prepared (BSN) nurses' perceptions of top-of-license (TOL) practice.


BACKGROUND: To date, no empirical work has examined whether ADN and BSN nurses approach TOL practice nursing activities differently.


METHODS: We conducted a qualitative pilot study with focus groups to explore the perceptions of a group of ADN- and BSN-prepared nurses concerning nursing activities and their relation to TOL practice.


RESULTS: Subthemes emerged differentiating how ADN and BSN nurses perceived their responsibilities related to critical thinking, communication, and patient education. For professional nursing care, 5 subthemes further emerged: (a) approaches to assessment, (b) chart review, (c) psychosocial patient care, (d) documentation, and (e) handoff.


CONCLUSIONS: The differences identified in approaches to TOL practice activities by educational preparation have implications for staffing patterns that can optimize the contribution of ADN- and BSN-prepared nurses. Further research is indicated.