The debate on whether nurses with an Associate Degree in Nursing (ADN) or a Baccalaureate Degree in Nursing (BSN) provide different levels of care and impact patient outcomes has been ongoing for many years. Current statistics show that there are significantly more institutions offering ADN programs (1,048) compared to BSN programs (696) in the United States (Cherry & Jacob, 2017). Linda Aiken, PhD, RN, a prominent figure associated with the Robert Wood Johnson Foundation (RWJF), argues that hospitals with higher proportions of BSN-prepared nurses have better patient outcomes and lower mortality rates (RWJF, 2014). Aiken’s research in 2003 found a 5% decrease in patient deaths at hospitals that increased their proportion of BSN-prepared nurses by 10% (RWJF, 2014). However, critics of Aiken’s work question the causal relationship between nurse education and patient outcomes, suggesting that there may be other contributing factors that need to be considered (Sentinel Watch, 2014).
Aiken’s research raises important questions about the potential impact of nurse education on patient safety. However, it is crucial to recognize that patient outcomes are influenced by a multitude of factors, and attributing improvements solely to the educational level of nurses may be oversimplifying the complex nature of healthcare delivery. Deaths and adverse outcomes cannot be solely attributed to ADNs’ care, or lack thereof. Poor staffing, long shifts, poor communication, fatigue, and documentation errors are just a few examples of system-level factors that impact patient care, regardless of nurses’ educational background.
In defense of Aiken’s perspective, it is important to note that no one is labeling ADN nurses as “bad nurses” (Sentinel Watch, 2014). Rather, Aiken emphasizes the need for evidence-based practice and leadership skills that are often more emphasized in BSN programs. By promoting these aspects, Aiken suggests that BSN-prepared nurses are better equipped to identify and address system problems, leading to improved patient outcomes. However, it is important to critically examine the evidence supporting Aiken’s claims and consider alternative explanations for the observed associations between nurse education and patient outcomes.
One limitation of Aiken’s research is the potential for confounding variables. For example, hospitals with higher proportions of BSN-prepared nurses may also invest in other resources and implement evidence-based protocols that contribute to improved patient outcomes. In these cases, it is difficult to isolate the effect of nurse education alone. Additionally, Aiken’s research primarily focuses on mortality rates as an outcome measure. While mortality is undoubtedly a critical indicator of patient safety, it does not capture the full range of patient outcomes, such as quality of life, satisfaction, or functional status.
Furthermore, the availability and accessibility of ADN programs make them a viable option for many individuals who may otherwise be unable to pursue a BSN due to financial constraints or personal circumstances. Limiting access to ADN programs could potentially exacerbate the shortage of nursing workforce, particularly in underserved areas. It is crucial to consider the potential unintended consequences of shifting the emphasis solely towards BSN education and ensure that individuals with ADN degrees are not unjustly stigmatized or discriminated against.
While expanding nurses’ knowledge through obtaining a BSN degree can undoubtedly benefit their practice, it is important to recognize that deaths and adverse outcomes are multifactorial and cannot be solely attributed to nurses’ educational background. Instead of focusing solely on the educational level of nurses, it is vital to address broader system-level issues such as staffing, workload, communication, and patient safety protocols. Future research should aim to explore the complex interactions between nurse education, workforce factors, and patient outcomes to inform evidence-based policies and improve the overall quality of nursing care.