A 2013 report by the Institute of Medicine (IOM) studied the roles, responsibilities, and education of nurses to recommend changes in the evolving and increasingly complex U.S. healthcare system. One key recommendation suggests increasing the proportion of nurses with bachelor of science in nursing (BSN) degrees from 50% to 80% by 2020.
While the number of bachelor’s-level nurses has increased, the IOM report did not reach its goal. According to Campaign for Nursing’s Future, an initiative of the Center to Champion Nursing in America, 49% of registered nurses (RNs) held a baccalaureate degree in nursing in 2010, which has increased to 56%. Efforts continue toward the 80% goal, including requiring BSNs for active-duty military nurses and nurses within the Veteran’s Administration.
This guide outlines how BSN-level nurses earn higher salaries, have greater employment prospects, and produce better patient outcomes than RNs who only hold an associate degree in nursing.
According to the American Association of Colleges of Nursing (AACN), bachelor’s-level nurses gain abilities beyond basic nursing skills, such as case management, critical thinking, health promotion, and leadership. While nurses can earn their RN licenses with ADN or diplomas in the field, BSN programs include ADN coursework, along with community and public health, humanities, and research.
The BSN curriculum creates well-rounded and informed professionals who understand the connections between healthcare and issues within the broader society.
Nursing has decreased its focus on inpatient care in favor of a patient-centered system of primary and preventative care. Rather than a duplicative and fragmented array of doctor visits, hospitalizations, procedures, and tests to treat patients, primary and preventative care focuses on integrative care and collaborative practice models.
BSN-level RNs receive the training to join multidisciplinary teams and educate patients about regular screenings, maintaining healthy lifestyles, and following care plans.
BSN degree-holders have the knowledge and training to practice in several settings, including home-based services, residential facilities, and specialty clinics. Bachelor’s-level nurses find employment in administration, clinical nursing, leadership, management, and nursing education.
ADN and diploma training cover core competencies of nursing, but the BSN curriculum includes nursing informatics, nursing theory, and health policy, along with more extensive clinical experiences. BSN degree-holders become better-prepared RNs for specialized roles in adult-gerontology, neonatal, oncology, pediatric, and psychiatric-mental health specialties.
A 2020 AACN survey found that 94% of BSN graduates secured employment 4-6 months after finishing their programs. In addition, 82.4% of employers strongly prefer BSN-prepared nurses, and 41% of hospitals and healthcare facilities require BSNs.
The AACN cites a 2019 New York University study indicating that RNs with BSNs are significantly more prepared than those with ADNs in 12 out of 16 quality and safety areas, including data analysis, evidence-based practice, and project implementation.
In 2017, New York passed legislation making it the first state to require new nurses to obtain a BSN within 10 years of their initial licensure. Known as “BSN in 10,” the law aims to improve patient outcomes across the board. Studies show that each 10% increase in BSN-prepared nurses leads to a 5% decline in risk-adjusted patient mortality. As more states consider adopting similar laws, current RNs with BSNs will experience career advantages.
The shifting emphasis on primary and preventative care, along with the fact that RNs outnumber physicians by a 3-to-1 ratio, indicate that nurses will continue to function as primary care providers. Graduate nursing education at the master’s and doctoral levels prepare specialty-focused advanced practice registered nurses (APRNs) — the next step for BSN-level RNs.
The advantages to becoming an APRN include significant increases in salary and employment opportunities. Most graduate programs require applicants to hold BSNs.
The AACN cites a 2013 study of 21 University HealthSystem Consortium (UHC) hospitals that analyzed the connection between patient outcomes and RN education levels. The study revealed that hospitals employing a higher percentage of BSN-level RNs saw fewer patients develop decubitus ulcers.
Decubitus ulcers — also called pressure ulcers or bedsores — are painful wounds that result when caregivers fail to change patients’ positions every couple of hours and keep patients’ skin clean and dry.
Deep vein thrombosis (DVT) manifests as blood clots primarily located in patients’ legs. Loose clots that enter the bloodstream can cause serious conditions, such as pulmonary embolism. Post-operative DVT can happen to patients experiencing long recoveries during which they fail to walk around or exercise their legs while in bed.
The UHC study found that hospitals with a higher percentage of RNs with BSNs counted fewer patients with postoperative DVT, due to better movement care and shorter hospital stays.
Research cited by the Robert Wood Foundation supports the association between a higher number of BSN-prepared RNs and fewer patients who acquire infections while in the hospital.
Hospital-acquired infections include bloodstream infections, pneumonia, surgical site infections, and urinary tract infections. Higher levels of training for RNs lead to increased skill in managing tasks like changing catheters, sanitizing ventilators, and changing patients’ dressings — all of which can lead to infection if improperly and unsafely performed.
Several studies cited by the AACN showed links between BSN-educated nurses and better patient outcomes, including reduced post-surgical mortality rates. In 2014, University of Michigan researchers discovered an association between a 10% increase in BSN-prepared nurses in hospitals and an 11% decrease in the odds of patient mortality.
A 2013 article stated that a 10-point increase in the percentage of hospital bachelor’s-level nurses correlated with an average of nearly 7.5 fewer deaths for every 1,000 patients with complications.
BSNs have become the required or preferred degree in many hospitals and medical facilities. BSN degree-holders bring a level of skill and professionalism needed in an increasingly complex and technological healthcare environment. The AACN cited a study of acute care hospitals that found an increase in the percentage of nurses with BSNs and a decrease in those with only ADNs.
With the call for 80% of the nursing workforce to hold BSNs and legislation like the “BSN in 10” potentially taking hold, baccalaureate degrees in nursing offer a glimpse into the future of the profession. High school graduates can earn their BSNs in four years, and licensed RNs can obtain BSNs in 1-2 years through RN-to-BSN bridge programs.
An ADN or nursing diploma qualifies nurses to obtain their RN licenses, but more employers continue to require bachelor’s-level education in their nurses. An ADN may suffice for nurses seeking entry-level nursing positions, but more opportunities await BSN degree-holders — 64% of the nursing workforce has a BSN or higher degree.
BSN program graduates earn higher salaries than ADN-level nurses. PayScale reports an average annual salary of $70,000 for nurses with ADNs and an $85,700 average salary for BSN degree-holders. Education levels correlate with higher pay, and the top 10% of RNs earn a median annual wage of over $111,000.
Elizabeth Clarke (Poon) is a board-certified family nurse practitioner. A native of Boston, MA, Clarke tired of the cold and snowy winters and moved to Coral Gables, FL in order to complete her undergraduate degree in nursing at the University of Miami. After working for several years in the UHealth and Jackson Memorial Medical systems in the cardiac and ER units, Clarke returned to the University of Miami to complete her master of science in nursing. Since completing her MSN degree, Clarke has worked providing primary and urgent care to pediatric populations.
Feature Image: The Good Brigade / DigitalVision / Getty Images
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