The value of RN-to-BSN programs

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Elizabeth Newman
Elizabeth Newman

More than a decade ago, I debated whether or not I should go to graduate school. At one point I narrowed it down to master's' degree programs in public health, at which point both my father and my boyfriend said to me, “What will you do with that degree?”

“Write about healthcare,” I said. “Hopefully for a magazine or a newspaper.”

“I think you can do that without spending tens of thousands of dollars and moving to Michigan or Boston.”

It would have been a different story if, like my father had wanted, I earned a master's degree in education so I could teach, or pursued an MBA to take a different path in journalism. But specific to the programs I investigated, the cost-benefit ratio didn't work out related to potential earnings versus the cost. Not to mention — spoiler alert — I still managed to wrangle my way into writing about healthcare for a national magazine.

But the story is different if you're a nurse, specifically one with an RN degree.

That's because of a push over the past seven years to prod nurses to achieve higher-level degrees, heralded in a 2010 report from the National Institutes of Health and the Robert Wood Johnson Foundation.

“It really ties patient outcomes to BSN nursing,” said Heidi Sanborn, RN, BSN, Clinical Assistant Professor and Interim Director of the RN-BSN and Concurrent Enrollment Program in the College of Nursing and Health Innovation at Arizona State University, in an interview Monday. “There's a call to get 80% of all practicing nurses educated to BSN level or higher by 2020.”

The common refrain to this goal is that it's unfair to long-term care to push higher education. One commenter last year said that if this trend continues, we will “have nurses who want to be ‘suits' and we will continue to have a nursing shortage. Nursing needs to get back to its roots of bedside nursing and caring for a patient. It need a grassroots holistic approach that doesn't try to deny the more basic skills of nursing.”

But Sanborn is quick to point out that no one is saying education makes someone a better nurse, related to direct patient care. Instead, research has found those with a bachelor's degree in nursing had a better ability to develop critical thinking skills and be more proactive in seeing which patients or residents were “headed in the wrong direction,” she said.

In long-term care, that can be tied specifically to whether staff can better predict who is at risk for rehospitalizations. For all the technology and data-gathering in the world, we know that good staff can often be the difference related to rehospitalizations or catching problems with residents before they become emergencies.

That's why the idea of a BSN program should be a draw to long-term care RNs, Sanborn says.

"There's not a nurse in this world, with very few exceptions, who goes into the profession for any reason but wanting to help people,” she said. She stressed that RNs can be excellent nurses, but that BSN training focuses on the bigger picture.

“It's about looking at trends and acting in a way to help the patient before he or she gets into trouble,” she says.

Plus, there are market realities, which if you're a director of nursing you should be sharing with your staff. Even with an anticipated nursing shortage, some hospitals are shrinking, requiring nurses to look for other jobs.

“In terms of long-term marketability in terms of your career, nurses may have been hired as an associate-degree nurse with years and years of experience,” Sanborn says. “But because the market is shifting, they become stuck at the job they are in. That could mean management within their own facility, as well as moving to other organizations.”

There's also been a push for academic institutions to come to nurses rather than wait for them to arrive. Most nurses have families and busy lives, Sanborn said, which means these institutions have had to change, instituting online programs or other flexible options. That's also an incentive for long-term care administrators to promote these programs.

“When you look at RN to BSN programs, we are all doing a better job of bringing it to them,” she said. “There's little to no downtime when administrators are looking at staff going back to school: It doesn't take away their ability to go to work. They are designed to be flexible based on what is going on in their own lives.”

For administrators and executives, the focus on professional development can be multifaceted. Certainly tuition reimbursement, as noted in the report, matters, and can be tied to requiring a nurse to work at the institution for a certain amount of time. But higher-level nurses also can be a marketing tool for consumers, appealing to prospective residents who want to know they are in good hands. Institutions also can show support in other ways: Sanborn noted that where she used to work “BSN” was plastered on her name tag, indicating that the company was supportive of the higher-level degree.

Of course, all of this isn't to imply that additional education is easy. Any professional development, even if it is a certification course or weekend workshop, requires a certain amount of time, dedication and money. Finishing a bachelor's degree should be something earned, with pride. But it also shouldn't be impossible, and as an industry we should support efforts to make it accessible for more of our registered nurses.

Follow Senior Editor Elizabeth Newman @TigerELN.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.