NY Considers Controversial BSN Law

November 3rd, 2011

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By , BSN, RN

New York State is considering legislation requiring all registered nurses to earn a bachelors degree in order to practice. This is a bandwagon that's been causing controversy nationwide since 1923—and it's no different today.

"New York is really a linchpin here in terms of what will happen in the rest of the country, and I believe if we can pass it there will be a cascading effect of other states following," said Barbara Zittel, former executive secretary to New York's Board of Nursing.

New York licenses about 8,000 new RNs each year, and 5,000 of them are prepared at the associate-degree level. On average, about 20 percent of associate-degree nurses go on to earn a bachelor's, Zittel said. In New York, more than half of RNs have bachelor's degrees, slightly higher than the national average of 45 percent.

Research Driven

Last year, the Institute of Medicine (IOM) published a report on the future of nursing that set a goal of increasing the number of baccalaureate nurses to 80 percent by 2020. It is research that is driving this push for more, higher degreed nurses. And, while some of the research is new and fresh, this is not a new research topic or conclusion.

In 1920 the Rockefeller Foundation funded the Committee for the Study of Nursing Education, which included Annie W. Goodrich, M. Adelaide Nutting, and Lillian Wald, to study nursing education in the United States. Known as the Goldmark Report, the nursing leaders found the practice of professional nursing needed a substantial knowledge base and should take place at the collegiate or university level. Goodrich, Nutting and Wald proposed that nurses would be more effective in their roles if they were able to draw from foundational knowledge in the behavioral and biological sciences. As a result of the report, the Rockefeller Foundation funded an experiment in nursing education which became the Yale School of Nursing.

In 2003, a landmark study by Linda Aiken, PhD, RN, FAAN, FRCN, and her colleagues at the University of Pennsylvania School of Nursing found that a 10% increase in the proportion of nurses with a bachelor’s degree was associated with a 5% decrease in both the likelihood of surgical patients dying within 30 days of admission and the rate of failure to rescue. In 2008 their next study reaffirmed that link.

In December 2009, Dr. Patricia Benner and her team at the Carnegie Foundation for the Advancement of Teaching released a study which recommended preparing all entry-level registered nurses at the baccalaureate level and requiring all RNs to earn a master’s degree within 10 years of initial licensure. The authors found that many of today’s new nurses are “undereducated” to meet practice demands across settings.

These studies are producing reactions around the country.

  • "BSN-in-10” proposals in New York and New Jersey have been introduced by state nursing associations to require the baccalaureate degree for all registered nurses within 10 years of graduation from an entry-level RN program. Other states are considering this as well.
  • The U.S. Army, U.S. Navy, and U.S. Air Force all require the baccalaureate degree to practice as an active duty registered nurse. Commissioned officers within the U.S. Public Health Service must also be baccalaureate-prepared.
  • The Veteran’s Administration (VA), the nation’s largest employer of registered nurses, has established the baccalaureate degree as the minimum preparation its nurses must have for promotion beyond entry-level positions. The VA has also committed $50 million over a five-year period to help VA nurses obtain baccalaureate or higher nursing degrees.

New York may be in the news right now with this drive for the BSN prepared nurse however, they are not the first state to pursue such a goal.

From 1987 to 2003 North Dakota required a bachelor's degree for nursing licensure. This law was revoked in 2003, once again allowing nurses with diplomas or associate degrees to practice. While the state's percentage of baccalaureate prepared nurses grew to 54%, many nurses left to practice in other states, nursing associations did not support the legislation and some groups sought to have it repealed saying it worsened the nursing shortage in the state.

More recently, HB7416 came before the legislature of Rhode Island, requiring nurse applicants graduating with an associate's degree or diploma from a nursing program to obtain a baccalaureate degree within ten years of their initial licensure. While not completely rejected, the bill has been held for further study.

Not The First Time

Similar legislation was introduced in New York in 2005. That bill required new nurses to earn a bachelor's degree within 10 years of receiving their nursing license. It did allow for nurses without the degree to continue working while earning their BSN and there were provisions for grandfathering in other already working RNs. The Legislature never voted on that bill.

The current version of the bill now has the backing of community college leaders, who initially resisted it. Unions still oppose the change, citing concerns that grandfathered nurses will demand financial assistance for a bachelor's education even though they are allowed to practice without one.

So, research evidence says patients do better when cared for by nurses with baccalaureate or even more advanced degrees. Many hospital's are willing to help their current nursing staffs move from associate degree to bachelors degree through education incentive programs, hosting classes right on the hospital property and making staffing accommodations for members to attend class. Going back to school has gotten easier with the advent of online learning and it is somewhat less expensive.

On the other hand, more than half the nurses in this country have diploma and associate degree training and are providing fine care. They may not have time to go back to school, may not have the money, may not have the support necessary to tackle hitting the books again while working and maintaining a family. What happens to them? This controversy is not new and it won't go away anytime soon, even with more states pushing for higher education requirements.

8 Responses to “NY Considers Controversial BSN Law”

  1. Kevin Says:

    I agree that this is a very controversial subject. As a Bachelor’s prepared RN, I do not see myself as “smarter” or “better” than an associate’s prepared RN (just want to clear the air).

    I also agree that we as nurses do need to have some type of standardized (minimum) requirement for our education. This isn’t about an “us against them” situation. It’s about becoming one united voice, and creating a better foundation for nurses to springboard into that next level of our education, our careers, and elevate our position to better help our patients.

    I just posted a video response about this.

    http://www.youtube.com/watch?v=btKlpZcbq5M&feature=player_detailpage

  2. admin Says:

    I too am a BSN and I know I am not “smarter” or “better” than the ADNs I work alongside, in fact most of them know more than I ever will about nursing. It is about finding that standard. And that standard holds true for having one nursing license, not 50 plus the District of Columbia and having standard numbers for CEUs nationwide.

  3. Ginnie Says:

    I have a Bachelor of Nursing degree from an Australian university, but because of the different system of education in Australia, all baccalaureate degrees are completed in 3 years, not 4 – we do not have the general education requirement that the US does. I find myself stuck in limbo land, however, because the Commission of Graduates of Foreign Nursing Schools refuses to rubber stamp my degree as anything other than a diploma, despite diploma preparation of nurses in the US being a very different, mainly hospital based system of training, not a university. The CGFNS will not include any extra general education credits I have completed here (because they were not gained outside the country), and will not tell me what they think is missing from my curriculum for me to be able to make it equivalent in their eyes. Because of this, I am shut out of many graduate schools, and even finding an RN to BSN program is somewhat problematic being a foreign degree holder. I live here because I am married to a US Citizen, so going home to Australia is not an option.

    Australian nurses have an excellent standard of care with three year university degree preparation, BUT all of the content in those 3 years is nursing or science related. It’s not all about the time spent studying – it’s about the content.

    In my case, I have given up trying to work with the US education system, and opted to pursue a Masters degree via distance education via an Australian university.

  4. Linden Says:

    I read with interest the comment by Ginnie. I fear that I may end up in the same dilemma. I am an Australian Nurse who is trying to get a license to practise in the US. I did not do a Baccalaureeate degree. I have completed a 3 year Bachelor of Nursing with a 1 year Post Graduate certificate in Critical Care Nursing – majoring in Emergency. What has been the problem with the CGFNS and Australian university nursing curriculum? Where are our deficits?

  5. Din Says:

    This is a plan by the powers at hand to unnecessarily hand out even more student loan debt, while having absolutely zero positive effect on the quality of nursing care. NY State legislators have a well-known and long history of being tied to special interests. It would be terrible if this passes, and will create a nurse shortage.

  6. David Hammond Says:

    Every time I read an article about BSN standardization, it always mentions the Aiken (2003) study. Go on Google Scholar and search for a free .pdf of that study, and read it. It’s really not a significant finding, and that’s the only research article that has been done on ADN vs BSN nurses. Let’s be realistic, do you think we really need a BSN to do our job? The answer is no. I have an ADN and have been a nurse for 4 years, and I tell you there is no difference between ADN and BSN as a floor nurse. I am actually in the process of doing my research paper right now and I’ll have my BSN. I can tell you that doing my RN-BSN program, it hasn’t made me a better nurse, or have I acquired any new skill that will make me more effective on the floor. Instead, I have acquired new debt that doesn’t seem worth the degree. The problem with nurses in the profession itself, no one respects it. It doesn’t matter if you have an ADN or BSN, we are all treated the same without bias. In my own opinion, it is the nursing program itself that needs an entire overhaul, and what is taught. I understand the concept that if everyone had a BSN then there is some illusionary idea that nursing will be looked upon better as a profession. It just simply isn’t true.

  7. helen Says:

    I started my nursing career in a concurrent program received my associate degree in May and BSN the following summer. I am currently completing my MSN in the leadership program. I can now consider myself an RN in the profession of nursing…

    Why are we debating whether or not we should continue, the answer should be yes, yes, yes!!

    We as nurses have the duty to provide the best care to our patients. The profession in nursing has changed, it’s a lifelong learning process. If you disagree that nursing isn’t changing and you must continue with your education, you missed the point. Maybe, you went into nursing for the wrong reason in the first place….

    I on the other hand, will applaud all nurses who continue on with their education….

    Someone mentioned that no one looks at the profession differently, well don’t you think it’s because we haven’t changed 100%, in order for them to see change we must change…
    We must continue to educate so that we too can be considered a profession by all…

  8. Liz Says:

    I graduated from an ADN program in 1981. I would have had to drive at least 2 hours for a BSN program. I had two small children and was in the middle of a nasty divorce. I worked on my BSN at a university with a weekend BSN program after I was promised I could take several years to complete it due to working, children… The program changed and I had to speed up my classses before the new requirements were in place. Didn’t do it… I’m 56 now and I don’t see how I could ever justify the cost at this point. I do wish that the entry level was a BSN. I would love to have a Batchelors degree and would have if it was required. I think it would only help the nurse, patient and nursing’s professionalism.

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