Pathways to a BSN in Nursing

In 2010, the Institute of Medicine (IOM) and the Robert Wood Johnson (RWJ) Foundation created a report called The Future of Nursing: Leading Change, Advancing Health. A reason for convening this committee was because the Patient Protection and Affordable Care Act (commonly referred to as ACA) was passed in that same year. The passage of this act meant that there would be an increase in demand for primary care services and management of chronic disease as more Americans became insured.

One of the premises of this report was that nursing could and should provide leadership to advance healthcare in the United States. One of the recommendations of this committee was to “Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020”. (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine The Future of Nursing: Leading Change, Advancing Health Copyright 2011)

In 2015, a committee was convened to measure the progress since the first IOM/ RWJ report. In response to the recommendation to increase the proportion of BSN prepared nurses, this second report noted that approximately half of the 3 million nurses in the United States still had an Associate Degree (ADN). The report noted that it will be “extraordinarily difficult” to achieve the goal of 80% BSN degrees by 2020. (National Academies of Sciences, Engineering, and Medicine. 2016. Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington, DC: The National Academies Press.)

However, it is critical that nurses, or students looking at nursing as a career, understand the implications of this recommendation.

What are the Pathways to a BSN Degree?

There are currently three pathways to a Bachelor of Science in Nursing (BSN) degree: Entry-level baccalaureate programs, Accelerated baccalaureate programs, and Baccalaureate completion programs.

Entry-level baccalaureate programs, often referred to as generic baccalaureate programs, are intended for those students who are not already Registered Nurses (RN). This pathway enables an individual without an undergraduate degree to go through the program, earn a BSN degree, and, upon successful completion, take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) exam.

Accelerated baccalaureate programs, often referred to as second degree baccalaureate programs, are nursing licensure programs that enable an individual with a baccalaureate degree in a non-nursing field to complete the BSN in less time than it would take for an entry-level BSN. Typically, the time to complete this program is less because the student has already completed many of the general education requirements for a bachelor’s degree. Upon successful completion of this program, the student is eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) exam.

Baccalaureate completion programs are those programs that allow a current Registered Nurse with an Associate Degree in Nursing (ADN) or diploma in nursing to complete a BSN degree. These programs are often called RN to BSN or ADN to BSN programs. The primary difference in these programs is that the student has already successfully passed the NCLEX-RN exam and is working for the BSN degree while practicing as a Registered Nurse.

Over time, the entry-level and baccalaureate completion programs have shown a steady climb in number of enrollees:

Figure 1: Accessed from Assessing Progress on the Institute of Medicine Report The Future of Nursing, July 2016

In addition, the number of graduates from the programs have shown a steep increase:

Figure 2: Accessed from Assessing Progress on the Institute of Medicine Report The Future of Nursing, July 2016

Why Should I Get a BSN Degree?

There are many good reasons to work toward a BSN degree: better education leading to better patient care, better wages, more responsibility, increased ability to move upward into leadership positions, and increased likelihood of being hired into a position you want. In fact, over the 4 years from 2011 – 2014, the American Association of Colleges of Nursing (AACN) found an increasing desire by employers to hire BSN prepared nurses.

Percentage of Employers Indicating a Requirement of Preference for Baccalaureate-Prepared Nurses, 2011-2014

2011 2012 2013 2014
Require 30.1 39.1 43.7 45.1
Strong preference 76.6 77.4 78.6 79.6

Figure 3: Accessed from Assessing Progress on the Institute of Medicine Report The Future of Nursing, July 2016

Conclusions of the IOM/ RWJ Committee

In reviewing the progress toward the goal of 80% of the RN workforce being BSN prepared by 2020, the committee concluded that:

  • From 2010 to 2014, the percentage of nurses with a BSN increased from 49 to 51 percent;
  • All three pathways to a BSN have increased in number of enrollees and graduates;
  • The BSN graduation has increased faster than the ADN rate;
  • Employers have indicated a strong preference for Baccalaureate prepared nurses;
  • Acute care hospitals are leading the way in the move toward hiring BSN prepared nurses;
  • As the BSN becomes the norm, wages and job opportunities for Associate Degree and Diploma nurses are likely to decrease;
  • ADN and diploma nurses may be shifted into non-hospital and long-term care settings.

What do these conclusions mean for me?

Essentially, as you think about nursing as a career, it is important to understand the trends that are happening in healthcare. If you know you want to be an RN, you need to ask yourself the following questions:

  • Where do I want to work? Does my future employer hire only BSN nurses? Get in touch with the Human Resources department of the facility where you would like to work and ask them about requirements for nurses.
  • Can I get financial help from my current employer to increase my education? If you are already working in healthcare, your employer may be able to provide financial educational incentives that will allow you to continue working and pursue your education at a lower cost to you.
  • How much do I have to spend on my education? If finances are limited, you may want to consider a two- year ADN degree. This will allow you to work as an RN while you save money for a baccalaureate completion program.
  • Will my current non-nursing baccalaureate degree allow me to complete the BSN faster? Contact the admissions department of the educational institution that offers the BSN. They will be able to tell you how many credits will transfer and how long it will take to complete your BSN.

If you want to be a nurse, or if you are already a nurse, your goal should be to aim for the baccalaureate degree in nursing. Of course, the path to that degree will vary, but the signs are very clear that you should be working toward the BSN.