Nursing is complex, and within the profession there are many spectrums of career possibilities. Nursing is based on a foundation of caring and what draws many to the profession is a commitment of service. The knowledge and education sought to prepare nurses however differs between the two “entry” level paths of associate degreed nurses and baccalaureate degree nurses and thus forms a difference in the way they perform their professional practice.
Associate Degreed Nurses
Associate degree nursing programs were developed in the early 1950’s as a response to postwar shortages (Creasia, Friberg. 2011) they were intended to be two years in duration and designed to prepare the graduate for bedside care in the secondary setting. These program quickly became successful and programs spread across the United States at a record pace. The associate degree program were found to be clinically sound and offered heavily hands on approach, they traditionally graduate nurses that are task oriented and perform well. Associate graduates are tested via the NCLEX after program completion to obtain licensure. The associate degreed path remains the major point of entry into the profession today.
The educational prerequisite of the associate degree nursing program are not as robust in sciences often eliminating the need for organic chemistry and advanced mathematics. The associate degree nursing path also is remedial as compared to the BSN in the liberal arts, often leaving the graduate with subpar communication skills when compared to the BSN counterpart. Baccalaureate Degreed Nurses
Baccalaureate degree programs are traditionally structured as four year programs with the nursing clinical focus at the latter two years. Programs differ from Associate programs in that there are courses required which focus on the professional development of the student, and thus the growth of the profession. Baccalaureate programs prepare the graduate for scopes beyond bedside care. Leadership and research roles favor the bachelors prepared graduate. The advanced professional focus allows the graduate to view the practice beyond the task orientation of the associate degreed nurse.
A comparison study (Ginger, N. & Davidhizar, R., 1990) found that baccalaureate nurses were more concerned with research methodology, teaching of the individual and the group, and community assessments. The study concluded that the baccalaureate nurse was more process driven than the task oriented associate degreed nurses. Healthcare today is composed of a multiple disciplinary team of practitioners with varied levels of education, preparing nurses at the minimum of the baccalaureate level has been a push of many professional organizations.
Recent research (Aiken, 2008) has confirmed a strong link in the educational level of nurses and improvement in patient mortality. The study found when the institution increased the percentage of baccalaureate prepared nurses by 10% that the corresponding mortality decreased by 4%. Practical Comparison
One of the situational comparisons that I feel would demonstrate the practice focus differences of the two educational preparations is in dealing with imminent death and dying. Throughout the career of any healthcare provider we will be faced with this challenge, and while there are many task associated with the algorithm of advanced life support or complexity of the hospice patient, there are multiple psych social aspects to consider.
The baccalaureate nurses educational preparation allows her to focus on the causes of the underlying pathophysiology, understand the chemistry of the multiple medications involved and problem solve for alternative treatments is initially unsuccessful. The baccalaureate nurse is able to communicate effectively with the healthcare team and reassuringly guide the family thru this difficult process. In my years of practice I feel that clinical experience and confidence can elevate the associate degreed nurse to a comparable level in this situation as well but I have seen that the baccalaureate graduate achieves this standard well before the counterpart.
Patient presentation has become more complex and the array of treatments available seems almost endless. Our patients and their families deserve the best outcomes from the best prepared team.