Once nursing education and registration was standardized in the late 1800’s and early 1900’s, a degree in nursing was on the Baccalaureate level. However, following World War II, a need for more nurses became apparent, and large numbers had to be trained quickly in order to fill the shortage. Mildred Montag is credited with the creation of the Associate Degree nursing degree, to help correct this problem. The Associate in nursing degree has remained a controversial topic since then.
Comparison of Degrees
Obviously, half the amount of time spent in training is going to cause one to be less prepared. Since it is the philosophy of nursing to provide the best care possible, this can be seen as a violation of that belief. On the other hand, nursing as a whole needs to have the numbers necessary to provide care for people by and large. These two opposing ideas are the source of this controversy.
The The Grand Canyon University College of Nursing Philosophy (2014) lays out the benefits of a Baccalaureate in nursing by pointing out the key elements of critical thinking and the fact that nursing as a field is theory driven. The idea behind an Associate Degree is to become a “technical” nurse (Grand Canyon University Media, 2016). This is someone who is trained in the actual actions of patient care but not necessarily in the philosophy that drives patient care, or the critical thinking skills required to troubleshoot problems as they arise. That a nurse can be trained to understand the technical aspects of nursing is shown by the fact that nurses of both education levels can do well on the NCLEX which is “minimum technical competency” (American Association of Colleges of Nursing [AACN], 2015).
A number of studies have been done that statistically demonstrate the benefits of having higher numbers of Baccalaureate nurses as compared to associate degree nurses. One study of 21 university hospitals found that higher numbers of nurses with a Baccalaureate degree or higher had lower mortality rates across a variety of different conditions (Blegen et al, 2013). These findings are not bound to any one country as the article by Aiken et al (2014) points out, showing an increase in post surgery survival rates in 300 hospitals across Europe correlated with higher nursing education levels. According to the study, an increase of 10% in the proportion of Baccalaureate nurses to associate degree nurses could lower mortality risk by 7%.
It appears to this author that the increased critical thinking skills and understanding of the philosophy of nursing previously mentioned, would account for this difference in mortality. A nurse with a more advanced degree will have spent more time practicing different scenarios and understanding the methodology behind nursing practice. Someone with an associate's degree may technically know how do accomplish all of the task as someone with a Baccalaureate degree, but they may not understand fully how and when to practically apply them.
As time goes on, the needs for more nurses being trained faster in the wake of World War II diminishes. Higher education levels have become more readily available to people, with many more people earning Baccalaureate degrees now than in the past, and because of this fact and the need for better trained nurses, the future trend seems to be moving more in favor of having a Baccalaureate degree or higher (Institute of Medicine, 2010).
A real example could be in the setting of a mental health hospital. In such a setting, much of the technical aspects of nursing are less useful than the philosophies and problem solving skills. If a patient begins to appear to have trouble breathing and is sweating profusely, a number of conditions may be the cause. Someone with an Associate degree may know to check the patient’s vital signs. When the vitals show the patient has an elevated heart rate but their oxygen level is fine and their blood pressure is still within a safe range, they may find this confusing. Of course, it is possible they will recognize a panic attack. But someone with a higher degree of education and critical thinking is more likely to recognize it sooner.
Furthermore, there are a number of things that can be done in this situation that having advanced understanding of the philosophy of nursing can help with. Philosophy is what drives the policies and procedures of a hospital. Someone with a higher understanding of this philosophy may be aware that it is likely the patient has a standing order from the doctor for an IM of lorazepam in such a case. Or they may know better where in the client’s chart to look for such a thing, or may be aware of some other policy or state regulation that is pertinent. In situations like that where every second matters, just being able to solve a problem faster can make a huge difference on quality of care.
This scenario is one in which there is almost no risk of death. But if it is generalized to other situations such as a heart attack, it can become very apparent why just a few seconds of thinking can mean the difference between life and death, and why, though their technical skills may be the same, someone with a Baccalaureate degree in nursing has an advantage in patient care as compared to someone with an Associate’s degree.
Aiken, L H., Sloane, D M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., … Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine european countries: a retrospective observational study. The Lancet, 383(9931), 1824-1830.
American Association of Colleges of Nursing (2015). Fact sheet: creating a more highly qualified nursing workforce. Retrieved on from http://www.aacn.nche.edu/media-relations/NursingWorkforce.pdf
Blegen, M. A., Goode, C. J., Park, S. H., Vaughn, T., Spetz, J. (2013). Baccalaureate education in nursing and patient outcomes. Journal of Nursing Administration, 43(2), 89-94.
Grand Canyon University (2011). Grand canyon university college of nursing philosophy. Retrieved From NRS430V.v10R.GrandCanyonUniversityCollegeofNursingPhilosophy_Student_3-24-14.docx
Grand Canyon University Media (2016). Nursing timeline of historical events. Retrieved from 2016 from http://lc.gcumedia.com/zwebassets/courseMaterialPages/nrs430V_timeline.php The Institute of Medicine (2010). The future of nursing. Retrieved on from https://iom.nationalacademies.org/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx