NEW YORK NURSE: April 2007
by Nancy Webber
It felt like an historic occasion.
More than 100 registered nurses gathered at NYSNA headquarters in March for a Summit on the Educational Advancement of the Nursing Profession. They came from many corners of the nursing community to discuss what has been called “a fresh approach to an old issue.”
The fresh approach is state legislation that would require registered professional nurses to earn bachelor’s degrees in nursing (BSN) within 10 years of their initial licensure. The legislation, which was first introduced last year, exempts already-licensed RNs and students enrolled in nursing schools at the time the law is enacted.
The old issue was a movement to require a bachelor’s degree for entry into nursing practice. In 1974, the NYSNA Voting Body passed a resolution calling for this requirement to be in place by 1985. The resolution stated that allowing multiple kinds of basic nursing education was creating “immeasurable” public and professional confusion.
But the “1985 Proposal” was met with passionate opposition. “The issue was perceived as demeaning and downgrading nurses with associate degrees or diplomas,” wrote NYSNA member David Keepnews in the February 2006 issue of Policy, Politics & Nursing Practice. “That perception – accurate or not – has long stymied productive discussion of entry into practice.”
Although a bill requiring BSN preparation for entry-level RNs was introduced in the State Legislature for 10 consecutive years, it was never enacted. The current proposal is seen as a compromise that may be more palatable to both RNs and to schools that offer associate degrees or diplomas in nursing.
The RNs attending the summit included nurse educators from both BSN and AD programs, nurse administrators, nurse researchers, nurses who work for hospital associations, representatives of state agencies, staff nurses, and nurse union leaders. Invited by NYSNA and the New York Organization of Nurse Executives (NYONE), they all had an opportunity to express their opinions about the proposal.
Fittingly, the summit was opened by Margaret McClure, the nurse administrator and educator who championed the “1985 Proposal.” Since the failure of that effort, she has devoted her career to helping establish the Magnet Hospital Recognition Program.
“Education matters,” McClure told the group. “Additional education is needed to accompany the additional experience of RNs who practice in complex healthcare environments.” According to the State Education Department, only 17% of RNs with associate degrees now go on to earn their BSNs.
Other nurse educators agreed with McClure’s reasoning.
Patient acuity is higher and nurses have greater responsibility, explained Harriet Feldman, dean of the Lienhard School of Nursing in Valhalla. Nurses must use clinical judgment in a wide range of healthcare settings. “The BS graduate applies critical thinking to solve problems in complex situations and interprets research evidence that can be applied to practice,” she said. “The AD graduate uses critical thinking to plan, prioritize, and evaluate care.”
This opinion was shared by Marianne Markowitz, director of the associate degree nursing program at St. Joseph’s Hospital School of Nursing in Syracuse. She admitted, however, that the current proposal at first was not well-received by AD programs when it was made public in 2003.
“We expressed our concerns to the State Board for Nursing, and came to the conclusion that this proposal does not denigrate the AD or diploma graduate,” Markowitz said. “This is where the state has to go.” The New York State Associate Degree Nursing Council has voted in favor of the plan.
Markowitz stressed the need for a statewide “articulation” plan for AD graduates who go on to earn BSN degrees. Ideally, the number of credits to be carried over and the required coursework would be accepted as a standard by all nursing programs in the state.
There are now 44 programs offering “RN completion” degrees – BSN degrees for students who already are registered nurses. Some predict that if the legislation is approved, more online and workplace-centered programs will emerge.
Several speakers were concerned that nursing is being lapped by other professions, in terms of educational requirements.
Fifty years ago, physical therapists and occupational therapists could be certified without college degrees. Now, master’s degrees are required for them to enter practice. Physician assistants and athletic trainers must have bachelor’s degrees. Physicians, dentists, podiatrists, psychologists, and pharmacists must have doctorates.
Only registered nurses can enter professional practice with associate degrees. The growing educational gap can be a problem when nurses seek to be equal partners in healthcare decision-making and protect their scope of practice.
Karen Ballard, former director of the NYSNA Practice & Governmental Affairs Program, cited two research studies that correlated better patient outcomes with a higher proportion of RNs with bachelor’s degrees. A study by Linda Aiken at the University of Pennsylvania found 90 deaths per 1,000 patients at facilities where 20% of the nurses had bachelor’s degrees. There were 76 deaths per 1,000 patients when 60% of the RNs were baccalaureate-prepared.
“The advancement of nursing education is the challenge for our generation of nurses,” Ballard said. “We can do it by working together and by focusing on nursing practice that meets the needs of our patients.”
Anne Bové, president of the NYSNA Delegate Assembly, agreed that as nursing practice expands, education should expand as well. “In BSN programs, students are prepared to practice in all settings, including community health,” she said. “AD programs provide clinical preparation for practice in acute care and long term care settings.”
Bové also stressed that staff nurses would need assurances that advanced education would be accessible and affordable before they would support the proposal.
“Employers must be willing to give nurses educational leave,” she said. “There also must be money available, either through tuition reimbursement from employers or funding from the state, to help nurses meet this new requirement.” Her concerns were echoed by summit attendees from the Public Employees Federation and 1199SEIU Nurse Alliance.
In general, nurses’ unions have not embraced the proposed legislation. The presidents of community colleges have loudly voiced their opposition, despite the support from most AD nursing programs. Hospital associations have argued that requiring bachelor’s degrees for future nurses will make the nursing shortage worse.
Margaret McClure argues that the proposal actually will increase the nurse workforce by enlarging the pool of nurses prepared to earn advanced degrees and teach nursing.
“We are turning away qualified applicants because of a lack of faculty,” McClure said. “In the past, nearly all nurses who earned advanced degrees became teachers. Now, they can become nurse practitioners, clinical nurse specialists, or administrators. We need more bachelor’s-prepared nurses in the pipeline to meet all these needs.”
The “advancement of the nursing profession” legislation has been introduced in both houses of the State Legislature (A2480/S294). It will be one of the four priority bills promoted by nurses and nursing students attending the NYSNA Lobby Day on April 17 in Albany.