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BSN:
Entry Level Position
Audra K. Medley
Nursing 208
March 24, 2009
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In the past, novice nurses started their careers in hospitals on medical-surgical
(med-surg) units. Years were spent on the med-surg floor in order to obtain confidence,
skill competencies, experience and sound clinical judgment. As the novice nurse matured
into an experienced nurse, leaving the task oriented med-surg floor for more complex
units, Intensive Care Units (ICU), Critical Care Units, (CCU), Intermediate Care Units
(IMCU), telemetry units was expected. With the onset of the nursing shortage, novice
nurses are finding themselves in these advanced care units with minimal nursing skills,
judgment and experience. “Competent practice as a critical care nurse requires
knowledge, skills, and experience that far surpass those required for entry level nurses to
gain licensure as a registered nurse” (Alspach, 2003). Nurses with BSN degrees have
more critical thinking skills and better clinical judgment that improves patient outcomes.
Does the education level of nurses have a positive correlation with patient outcomes and
mortality?
The extent to which educational preparation impacts patient outcomes and
mortality is paramount to many. The nurse is the first line of defense for patient
outcomes in that the nurse is at the bed side and is monitoring for changes in the patient
status. It is the constant monitoring of patient status that alarms the nurse to a negative
change in patient status or a deteriorating condition. The study conducted by Aiken,
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Clarke, Cheung, Sloane and Silber “tested whether hospitals with higher proportions of
direct-care RNs educated at the baccalaureate level or above have lower risk-adjusted
mortality rates and lower rates of failure to rescue (deaths in patients with serious
complications)” (2003).
Nurses that are able to recognize the signs of deteriorating
patient conditions have been vital at the bedside. It has been supposed that these nurses
are disproportionately higher educated, baccalaureate and masters prepared. According
to JAMA, “raising the percentage of RN’s with bachelor’s degrees from 20 percent to
60 percent would save four lives for every 1,000 patient undergoing common surgical
procedures”(JAMA, 2003).
“The patients admitted to hospitals today manifest greater complexity, comorbidity, illness severity, and age than those of past generations” (Alspach, 2003).
This onslaught of sicker, older and more obese patients has added new responsibilities to
the already overworked and understaffed nursing staff. This new generation of patient
has brought with it the inability to manage symptoms as independent occurrences. The
increase in co-morbidities has made every vital sign, laboratory work-up and chief
complaint equally important.
This makes it harder to differentiate between “normal” for this patient and a vital
change that could be an early sign for patient deterioration. “Undoubtedly, developing
competence and confidence with patient care was identified as the most challenging
endeavor, especially with newly encountered situations. While these nurses discussed
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learning about crisis scenarios in school, they lacked the confidence when actually faced
with serious patient conditions in the practice setting” (Hodges, Keeley, and Troyan,
2008).
In an attempt to quantify higher education of nurses as an important variable for
patient outcomes and mortality, Ridley explains
that a 10% increase in the proportion of BSN nurses was associated with a 5%
decrease in likelihood of death (30-day mortality. Estabrooks et al. (2005)
concurred with the latter findings by suggesting that hospitals with a higher
proportion of BSN nurses were associated with lower rates of 30-day patient
mortality (95% confidence interval). (2008).
This evidence supports the idea that advanced education of nurses is a direct correlation
of positive patient outcomes, decrease in patient mortality and an increase in survival
rates.
Advanced education has it benefits. For the nurse with higher education it
facilitates upward mobility and endless career paths. For the institution that employs that
individual, it increases the number of nurses with BSNs or higher and thereby getting
them closer to the much coveted magnet status. For the patient that that nurse is giving
care, it increases that patient rate of survival and decreases patient risk for mortality.
According to Kathleen Long, “a workforce that’s better educated overall will help ensure
patient safety and goal outcomes” (2004), is a statement that is not only shared by many
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but should be the code by which all healthcare professionals practice. Providing better
quality and safer care is a priority. The evidence is clear, RNs with BSN degrees or
higher decrease patient mortality and increase survival rates.
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References
Aiken, L., Clarke, S., Cheung, R., Sloane, D., & Siber, J. (2003, September). Educational
Levels of hospital nurses and nurses and surgical patient mortality. JAMA:
Journal of the American Medical Association, 290 (12), 1617-1623. Retrieved
March 24, 2009, form CINAHL database.
Alspach, G.(2003). The value of certification as a critical care nurse: An un solicited
opinion. Critical Care Nurse, 23, 8-9.
Clarke, S., & Connolly, C. (2004, February). Nurse education and patient outcomes: A
commentary. Policy, Politics, & Nursing Practice, 5 (1), 12-20. Retrieved March
24, 2009, form CINAHL database.
Hodges, H. Keeley, A., & Troyan, P. (2008, March). Professional resilience in
baccalaureate-prepared acute care nurses: first steps. Nursing Education
Perspectives, 29(2), 80-89. Retrieved March 24, 2009, form CINAHL database.
Ridley, R. (2008, April). The relationship between nurse education level and patient
safety: an integrative review. Journal of Nursing Education, 47(4), 149-156.
Retrieved March 24, 2009, form CINAHL database.
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JAMA article links level of nurse education and patient mortality: ANA says latest
findings reinforce need to invest in nursing at national, state and institutional
levels. (2003, December). Alabama Nurse, Retrieved March 24, 2009, form
CINAHL database.