Differences in Competencies Associate vs Baccalaureate

Since the inception of the Associate Degree in Nursing there has been research and discussion as to whether this degree should continue. This is due to the adversity in the level of competency between the two. Current popular thought is that the entry level into nursing should be the Bachelor of Science in Nursing. I also believe the Associate Degrees’ time is over. The increase in the complexity of medicine should make the baseline in nursing should be the Baccalaureate Degree.

It has been shown that a nurse’s level of education can become a major factor to the safety and quality of care of their patients. There has been an increase in studies over the years that directly examine patient outcomes in similar situations between Associate Degree Nursing (AD) and Baccalaureate Degree Nursing further know as (BSN) (Fagin, 2001)

Fagin, (2001, para. 50) while citing Green stated:

Surveys revealed that nurses who had an ADN as their core education were destined to be charged nine times more often with violations than those with a BSN degree. These findings, significantly, tracked almost exactly those noted by the state of Texas in a similar study.

The state of New York and the State of Texas both conducted separate studies that were conducted in the year 1996. Both of these studies agree on the point that there is a significantly higher degree in levels of medication errors and procedural mistakes made by nurses that are from Associate Degree and Diploma Degree nurses as compared to that of a Bachelor of Science Nurse. These results are equivalent with the results disclosed in the July/August 2002 issue of Nurse Educator magazine (Fagin, 2002).

Research has shown that when you have a shortage of registered nurses at the baccalaureate and higher degree it is endangering the safety of the patient. In a study done at the University of Pennsylvania they found that patients experience a significantly lower death and failure to rescue rates where there are more baccalaureate degree nurses providing direct patient care. The study stated there were a total of at least 1,700 deaths that could have been prevented if the facilities had in their employment a minimum of 60 percent of baccalaureate trained nurses and a nurse patient ratio no higher than one to four (Aiken, 2003).

The studies have shown that nurses that have gone thru the baccalaureate program have a higher degree in articulation and problem deciphering abilities (Johnson, 1988) and are more proficient in their ability with nursing diagnosis and the evaluation of nursing interventions (Giger & Davidhisar, 1990).

Research further shows that those registered nurses that have obtained their degrees at the associate degree and diploma levels have an increase in their level of skills when completing a BSN degree. When comparing RN to BSN graduates from the years 1995 to 1998 it was (Rosseter, 2010, para. 24) shown that these students had a higher competency in nursing process, articulation, management, professional integration and analysis/dissemination (Phillips, C.Y., Palmer, C.V., Zimmerman, B.J. & Mayfield, M. 2002).

All the above studies seem to agree that when a BSN is involved there is a greater chance the patient outcome will be more positive than when the same patient in the same situation is taken care of by an ADN. The reasoning appears to be that with their higher education the BSN has an enhanced degree of assessment skills. This then allows for better critical thinking abilities. Just these two skills alone make the chances of a good patient outcome greater. The BSN learns these skills and others such as health promotion, teaching, theory etc… All of which assist the patient with the chance of the best possible outcome.

The following incident is an example the above research results: Several years ago I was working at a local hospital assisting with endoscopic procedures. I had just taken a patient that had undergone a procedure done under anesthesia to the recovery room. I gave report to the accepting nurse and after the patient’s safety was secure I went to get my next procedural patient. As I was walking through the recovery room I saw one of our BSN nurses assessing a patient that appeared pale and diaphoretic. The nurse that was caring for him was on the phone talking to a friend. She was a graduate of an Associate Degree Nursing program. When she was asked what was going on with her patient by another nurse her response was” he’s ok he’s just asleep”. The BSN said he doesn’t look right and proceeded to take his vital signs. She noticed that the blood pressure results were at an unacceptable level compared to his initial set when he was admitted. She checked his record and found that he was diabetic and had the tech do a finger stick test on the patient. The result was in the low 30’s. The patient usually averaged in the 120’s with his sugars. An order for D5 IVP was obtained and then given to the patient. The patients’ vital signs were checked every 5 minutes until stable. Within a few minutes the patient began to stir, and his color began to return to normal. Other than a complaint of a headache that he had when he was admitted he was back to his normal self.

The above studies along with the above incident show that it is imperative for nurses to continue with their degrees. It is the goal of all national nursing organizations to increase the level of education especially for those with less than a BSN. This is ultimately for the safety and well-being of the patient but it is also for preventive care. For as knowledge increases so does your degree of competency which can increase patient safety, lower hospital stays and increase work satisfaction.

I however would propose more regional based study comparisons along with a comparison of equal levels of experiences and years of service to find if the knowledge gap remains constant, narrows, or widens within these parameters. Then mediate continuing education within these differences to assist with closing any gaps. This is to increase the safety of the patient until the BSN becomes the entry level for nursing, for the ADN nurse will be around for a long time.