Position Statement on BSN Requirement for RN Practice
There has been long-standing debate within the nursing profession about the minimum degree required for professional nursing practice. Recently the debate re-ignited in New York with proposed legislation that would mandate the BSN for future RNs to continue practice beyond 10 years. This debate is of critical concern to the more than 17,000 SEIU registered nurses who work in New York State as well as to RNs across the country.
Position
The Nurse Alliance of SEIU Healthcare, an organization of 85,000 registered nurses advocating for quality patient care, firmly rejects any bill that would limit entry into or maintenance of practice to the BSN - a limitation that would restrict the number of RNs available to practice. It strongly supports legislation that would increase the slots in both ADN and BSN programs. It also supports measures that would facilitate the participation in and reduce barriers to educational advancement for registered nurses.
Background
The healthcare industry is undergoing a transformation as advances in technology and an emphasis on continuous quality improvements bring about rapid change. However, the growing shortage of RNs threatens patient outcomes at a time when technology and new treatment modalities show great promise for saving lives and improving the health of the nation. In 2005, there were more than 125,000 nurse vacancies nationally. The looming retirement of many of today's nurses will only make the situation worse. Furthermore, as many as one out of three new nurses are leaving the bedside within one year of entry into practice as the combined stressors of too many patients and poor working conditions (including mandatory overtime) take their toll. Low wages in some parts of the country, especially where there is low union density, also contribute to the shortage in nursing. Nationally close to 500,000 licensed RNs are choosing to work outside the profession. Researchers project a nursing vacancy of up to 800,000 by 2020. We are faced with a double-edged sword: nurses are leaving the profession and not enough new nurses are entering it.
Quality care is impossible when there are too few nurses at the bedside and when working conditions undermine the best intentions of the skilled nurse. Better staffing ratios, increased wages, and better working conditions for nurses are all part of the solution to the nursing crisis. In the context of addressing these issues, there are also education and training initiatives that can support the objective of quality care while enhancing the effectiveness of nursing.
The Nurse Alliance of SEIU is a strong advocate for initiatives and programs that are educating more nurses as well as those that strengthen retention. Recognizing the deep commitment of nurses to their patients and their profession, SEIU respects the knowledge and skill gained through the clinical experience of both the ADN and BSN. The union also supports the upward mobility and continued education of nurses as they seek to provide ever better patient care in an increasingly complex healthcare system.
The effort to recruit new nurses is seriously hampered by problems in the current system of nurse education. In 2005, more than 150,000 qualified students were turned away from nursing schools. The reasons include insufficient public funding for nursing programs, not enough faculty, and not enough clinical sites, nursing labs and classrooms. In addition, schools often do not have the flexibility in scheduling or instructional modalities (i.e. distance learning, cohort learning, etc.) to be accessible to the experienced full time healthcare worker interested in nursing or advancing from ADN to BSN. Legislation must be put in place that will not only improve the working conditions of nurses but also make it possible for more students and incumbent workers to enter and complete nursing school at both the ADN and BSN levels.
Currently there are proposals under consideration in New York and other states that would mandate the BSN as an entry into practice or as a requirement for maintenance of practice after ten years. These proposals, however well intentioned, would only have the affect of lowering the number of nurses at the bedside at a time when nursing faces an unprecedented shortage. Furthermore, these proposals do not recognize the considerable experience gained by nurses through years of on-the-job training and continuing education.
In the journal Nursing Economics, (May-June 2006, Vol. 24, No. 3), Catherine Graf argues that the demand for more BSNs must in part be filled by the advancement of the current ADN pool of nurses. However, she points out that the cost to the ADN, balanced by the return on her investment, is prohibitive. This cost is not only the direct expense of tuition, books, etc., but also the indirect costs to family and work life that make a return to school difficult for many experienced nurses. There are many measures that government, unions, nursing organizations, and employers can support that can make the cost of learning less onerous on the nursing student. These measures would ensure that a larger number of current nurses could advance to the BSN level without lowering the number of nurses at the bedside.
Recommendations
The Nurse Alliance of SEIU Healthcare recommends the following measures that would promote recruitment, retention and the advancement of RNs:
- Credit for experience - a system needs to be developed by degree granting institutions to measure nursing competencies so clinical and academic credit can be granted to experienced nurses who demonstrate advanced knowledge in various scopes of practice.
- Development of systems of flexibility and support in the workplace so nurses can work while obtaining higher education
- Tuition assistance for nurses pursuing the BSN degree through a combination of federal, state, and employer funding
- Academic articulation between ADN and BSN programs to provide maximum transfer of academic credits
- An expansion of places in ADN programs and increased capacity at schools offering these degrees to ensure that there is a steady stream of new nurses moving towards a BSN degree while filling much needed nursing positions.
- Increased capacity at colleges offering the BSN degree to ensure that all qualified nurses have a place in accredited schools
- Satellite classrooms at healthcare institutions to maximize access and participation of the incumbent workforce.
- An increase in faculty nursing salaries to support more nursing faculty
- A provision to prohibit mandatory overtime as one of the barriers nurses face while pursuing their education.
- Support for programs that offer remediation and academic review for nurses who have been out of school for an extended period of time.
- Assistance to RNs not working in nursing to obtain their BSNs and re-enter nursing practice.
- Support for schools to develop on-line and hybrid programs to assist nurses who cannot attend on-site classes due to work and family responsibilities or because of the travel involved (particularly in rural areas).
The Nurse Alliance of SEIU Healthcare is committed to increasing the number of nurses at the bedside. Setting safe nurse-to-patient ratios, supporting an increase of new nurses through increased slots in ADN and BSN programs, and facilitating the advancement of all registered nurses can achieve this goal. Success will require the cooperation of unions, employers, educational institutions, and the community. It will also need an increase of public resources. The measures outlined above will contribute to the solution. Mandatory restrictions on entry to practice or maintenance of practice requiring the BSN are counterproductive in this time of crisis and will face the opposition of the Nurse Alliance of SEIU.
