The Importance of the Baccalaureate Degree in Nursing Education

by Kimberly A. Johnston Ed D, RNC, CNE
Methodist College of Nursing

There are three educational pathways one may follow to become a registered nurse. The first is a three-year diploma program; another is an associate degree, most often offered by a community college; the last is a four-year baccalaureate degree offered at four-year colleges and universities. Methodist College of Nursing (MCON) is an example of a baccalaureate degree program. The baccalaureate degree earned is the Bachelor of Science in Nursing (BSN). Presently, the greatest number of nurses graduate from associate-degree programs (59%), followed by baccalaureate programs (37%), and then diploma programs (4%). Graduates of all three programs sit for the same NCLEX-RN licensing examination.

These various entry levels into nursing practice have been the topic of discussion within the nursing profession for many years. In 1965, after a three-year study, the American Nurses Association (ANA) issued “A Position Paper on Education Preparation for Nurse Practitioners and Assistants to Nurses.” The paper stated, in part, that “the education of all those who are licensed to practice nursing should take place in institutions of higher education” and “minimum preparation for beginning professional nursing practice at the present time should be baccalaureate degree education in nursing.” While many groups within and related to nursing support this position, the three educational pathways to registered nursing still exist.

Education Makes a Difference

Over the past several years, policymakers, researchers and practice leaders have identified that education does make a difference in how nurses practice. The baccalaureate nursing program includes all of the content in the diploma and associate-degree programs, plus it provides students with a more in-depth study of the physical and social sciences, nursing research, nursing leadership and management, community and public health nursing, and the humanities. This broader and more in-depth education enhances the student’s professional development and allows the baccalaureate graduate to better understand the many social, cultural, economic and political issues that impact patients and influence healthcare.

Several studies have demonstrated an inverse relationship between the proportion of BSN nurses and mortality of the hospitalized patient. In other words, they found that as the proportion of baccalaureate-degree registered nurses increased in hospitals, patient deaths decreased. These studies demonstrate that lower levels of patient mortality are associated with the nurses’ education levels.

Nursing education is also associated with patient safety and quality of care. In Claire Fagin’s “When Care Becomes a Burden: Diminishing Access to Adequate Nursing,” it was recommended that, in response to the greater acuity of hospital patients, the numbers of nursing schools in community colleges and hospitals be decreased while the capacity in baccalaureate degree and graduate programs be increased.

Many groups such as the federal government, the military, nurse executives, healthcare foundations, nursing organizations and various practice settings advocate for an increase in number of BSN nurses in all clinical settings. The U.S. Army, Navy and Air Force require the baccalaureate degree for active duty as a registered nurse, and the U.S. Public Health Service requires the baccalaureate degree in nursing for a nurse to be a commissioned officer. A nationwide Harris poll conducted in 1999 found that 76 percent of the public believe nurses should have four or more years of post-high-school education to practice. Many countries, like Canada, Sweden, Portugal, Brazil, Iceland, Korea, Greece and the Philippines already require a four-year undergraduate degree to practice nursing.

Economy and Expediency Should Not Influence Education

It is clear that education influences nursing care. The argument is often made that the associate degree costs less and takes less time to complete. However, economy and expediency should not influence nursing education, and ultimately, patient care outcomes. It is more costly and there is more time involved if one first receives the associate degree in nursing and then goes on for the baccalaureate degree. The associate degree takes two to three years and the baccalaureate degree two to three years beyond that. Therefore, the individual will take four to six years for a Bachelor of Science in Nursing degree. In addition, many associate-degree graduates find it difficult to return to school due to work and life constraints, as well as simply being “out too long.” Research supports the importance of baccalaureate education for the registered nurse in relation to positive patient outcomes. The state nursing associations for New York and New Jersey have introduced “BSN-in-10” proposals to require the baccalaureate degree for all registered nurses within 10 years of graduation from an entry level RN program.

While many argue that the associate-degree nursing education produces more registered nurses for our communities in a shorter time period, this should not be the primary focus, nor should cost of education. The baccalaureate-educated nurse brings a more comprehensive and in-depth education to the healthcare arena than the associate-degree or diploma nurse.

Research has begun to show the importance of the baccalaureate education in relation to patient outcomes; however, nurses still remain the least educated of all health professionals. Yet it is the nurse who provides almost all direct patient care in hospitals and many other healthcare settings. We require the teachers who educate our children to have a minimum of a baccalaureate degree. Why then would we settle for less education for the nurses who provide the care to our loved ones during the most vulnerable times of their lives? iBi

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I wholeheartedly agree with the idea that all nurses need to earn a degree before they start their nursing degrees, but the 10 year legislation might prevent some nurses from entering the field. There is already a severe nursing shortage and the lines to nursing schools are already discouragingly long. For the interest of patient care and for the nurse's own career advancement, nursing degrees should remain an educational, profitable, and ultimately rewarding option for registered nurses.

The reason for this shortage is because as soon as you are registered, the opportunity to immediately enter the industry, find a job, and earn a good (or great) salary is sometimes too compelling. Not only that, but only those with a Masters in Nursing can teach and train younger nurses, and the demand/pay for nurses who hold Masters is so high that they frequently avoid teaching positions.

you know the biggest complaint from nurses and other educated persons who hold higher degrees (masters and above) is that the two year degrees are cheap and are not educated as well as a baccalaureate in nursing, now i admit there are some shortfalls but to me this whole uproar for every nurse to be a baccalaureate nurse upon graduation is shortsighted and foolish, 58.4% of nurses in 2007 were associate degrees instead of requiring every nurse to be a baccalaureate upon graduation restrict where they can work and require them to go back to school instead of causing more problems in healthcare or feed the greedy colleges why do you think there is such a push for people to have baccalaureate degrees? money anybody?

As an Army LPN I can tell you that having different levels of nursing actually makes more sense do to the chronic shortages in the profession. Yes, education is important, but you can utilize your "less educated" nurses in lower acuity settings and still allow patients to have excellent health care. The LPN functions as your low-level workhorse in the medical-surgical setting and can typically manage 6-7 patients without any problems freeing up the 2-year RNs so they can deal with the higher acuity patients. BSNs serve best in the charge nurse/ward master/team leader or intensive care setting where they can take advantage of their higher education to coordinate their less-educated counterparts or deal with the highest acuity patients. Take away your LPNs and 2-year RNs and your BSNs are going to have 30-40 patients each - How well is their higher education going to help them with that situation?

Good Point.  It's an excellent idea.  This something that could be proposed to the Nursing Association?

 Could you substantiate using figures; by what percentage did mortality and other health indicators improve by having Degree nurses in acute care settings.


Until nurses have BSNs there will continue to be low self-esteem, constant craving for recognition from others, sub-optimal acknowledgement of peer status in every way. Why can't we get this?

If any successful nurse with years of experience and specialty certifications that demonstrate expertise in their area practice feels they need to write a few more papers in APA format that have nothing to do with enhancing patient care, then all the extra initials in the world won't help.  They should seek psychiatiric counsel as their feelings of low self-esteem are from within.  Any organization that would not want to hire a nurse with that kind of experience is run by narrow-minded, ignorant idiots.

Yeah. Right. Whatever. That's nice. Nursing shortage? I don't care. I've been working at all my prerequisites and I'm getting straight A's... but... Economy and Expediencey? You're joking, right?

After I finish my baselines, I have to wait 1 year until I can even apply for the RN program.

I've heard the waiting list of 1+ years? Excuse me intelligent persons, but if there's a "critical shortage in nurses"... why are you keeping prospective nurses on hold...?

It takes 1-2 years to complete the RN program.

That's 3-4 years and now you want me to add an additional 2 years onto that? To get my Bachelor's? And it might even take me longer cuz who knows, maybe the University I go to doesn't accept my college's credits and they make me take courses over so they can make more money off of me...

Hah, no thank you! :) I'm changing my major to something a little more expedient. If there's a shortage of nurses, I'm sorry but that is entirely your problem - I tried to help. You wouldn't let me. Now go deal with it.

I am just asking this question : Would you rather be in a plane whose plane whose pilot has few months of flight and tons of education or with a very experienced one with decent training? I have a lot of (foreign) education myself but i find that old fashion rn are more knowledgeable than bsn/msn nurses

ADN programs were created during WWII to facilitate more nurses during a shortage. We are still in that shortage of RNs and therefore the rationale for ADN programs is still present.

I find the comments interesting. I have been a nurse for  37 years, and I am a proud diploma grad. To tell you the truth, no one is very impresses with the nurses now coming out of school -especially in the degree program. It seems somewhere along the way, it became far more important to take gym, archeology, art interpretation, and gym then nursing courses. I can document this easily, as my aging mother, 90 years old, and a diploma Rn has spent much time in the hospital in the last 5 years. The care has been horrible - there is no way I can go in to this on line, but I would be ashamed to call myself a nurse with such inability to care for the human being. Yes, they are great at the computer, but where is the love? If you feel we need to have degrees, then let's go back to the nursing school format. Have 1 year in studies unrelated, and then 3 years of nursing instruction. I hear from the nurses who work the floors, and they are burned out from having to train new nurses how to care for patients. Disgusting. I am afraid to get old and be cared for by these people when I am 90.

I graduated with a diploma in 2008 and am so proud to have been part of that 4% of nurses with a nursing diploma.  I had awesome teachers, 3 years of clinical in-hospital hands on experience, and feel that when I first got onto the floor (hospital) I was prepared.  I was able to advance faster than other new grads who have the BSN or MSN degrees, and had been able to take on more responsibility than them as they were still trying to learn how to ex: put in IVs, manage 2-3 patients at a time on a 25 patient med-surg floor, etc.  After 2 months, Charge nurse, and after 6 months on the floor I was precepting BSN/MSN new grads (some who had NEVER put in an IV, changed basic dressings, placed foley catheters, etc. in school!!!)

I believe that having an AWESOME preceptor helped me transition onto the floor.  The hospital did not have a nurse residency program for new grads at the time.  So it was the guidance that I had and being able to learn from experiences that helped me become a better nurse.  I believe that it's up to a nurse residency program or designated preceptor to help "the minimally prepared nurse" to be the best nurse they can be, regardless of the BSN, ADN, or Diploma nurse.

Put BSN/MSN RN new grads on a unit and ADN/Diploma experienced RNs on another unit and let me know who's patients are better taken care of at the end of the shift.  Every educated nurse (regardless of degree) has to pass the NCLEX & have experience.  If the RN is a new grad, give them the opportunity to be in a residency (or give them a knowledgable mentor) until they are observably able to manage as a fully functioning RN. To associate patient mortality rates with whether the RN has an BSN, ADN, or Diploma ALONE is rediculous.


after reading all those comments, I believed that they all have made sense in in their claims, anyway they're all entitled to their own opinion. However i think this issue is more about the individual's will, capacity to learn and ability to deliver the best patient care regardless of the title whether a BSN, an AD or a diploma grad. 

If they're really serious about getting 80% of the nursing workforce to be BSN in 2020, then stop the community colleges and hospitals from offering non-baccalaureate nursing courses effective immediately and just leave the BSN mandatory to the current and/or future nursing students starting hereof.

Taking a nursing course is not cheap and easy.  Economy and expediency would always be a factor of influence that affect the capacity of the individual to complete the course or not. But I got the point that if that individual wanted to pursue a more prestigious career and ultimately a brighter future, then he or she should do everything there is to achieve it.

And it won't be easy for those non-BSN nurses to go back to school and again spend time and money for a baccalaureate degree unless they want to aim for a more prestigious title and ultimately a brighter tomorrow.

fellow citizen think positively.  at least in the US, when you get your degree, you are automatically guaranteed of a promising nursing profession.

In some countries that only mandates BSN degree to be recognized as a nurse, like here in the Philippines, not only that Nursing course cost a fortune... but the academic and clinical requirements are so high and taxing but after graduation, even after passing the state board, there's no guaranteed job available for nurses. So some of these poor fellows ended up in call center jobs, others at warehouses, salesperson in department stores, school office personnel and all other non-patient care type of jobs.

Worst, for them to gain experience after passing the board, they have to pay the hospitals or any medical clinics just to let them work and practice what they have finished, of couse without pay.

Based on HRSA 2008 statistics, almost 49% of the non-U.S. initial nursing education for US RN population came from the Philippines. That was the reason why BSN course became popular in the Philippines, until for some reason, the demands slowed down.  

I hope the same Nursing organizations and associations who push for the BSN degree among the nursing workforce in the U.S. can do something too to accomodate these competent but unfortunate BSNs in the Philippines. There are more opportunity to improve the nursing practice, not only the States but in the global context of patient care as well.

Anyways, Nursing care is supposed to be universal and not bound by any barriers, be it distance ,culture or language, in caring human being.

thank you for reading my letter this far..


Diploma vs BSB

I graduated from a state university with a BS in biophysics with no skills other then how to take a multiple choice exams and am about to graduate from an 18 mo diploma RN program and I am managing/holding down the whole floor with 3 other classmates. To me it looks like a case of big universities seeing that more ppl are looking for real life skills that will get them jobs no offense to all you humanities majors out there. My school opened in the late 1800's. Back in those days nursing students started their day scrubbing floors and changing beds. What's next a BS in welding? Common sense and tons of practice is what makes a good nurse. And trust me, you arent getting much practice sitting in an emphatheater staring at a PowerPoint. 

Perhaps going for a BSN is not necessary but it does help your nursing resume. It could make the difference since your potential employers might choose you over someone without a higher education degree when you'll start looking for a job.

I graduated with a diploma in 1968 and BSN in 1974. The only thing I learned in my BSN program is that most of the faculty had little or no practical experience. Over the last 40 years I have worked with many new grads, mostly AA & BSN, & none are prepared to work in a hospital. Sorry to say, but most nurses think their education ended the day they graduated. The nursing educators run nursing and yet have the least clinical experience in it. They compare themselves with physicians but don't give students te clinical experience that medical students get. The last 2 years of med school is almost all clinical.The leaders in medicine all treat patients the leaders in nursing sit in meetings and have not touched a patient in years, if ever.

Prof. Linda Aiken and her colleagues have examined the impact of nurses' education on patient morbidity and mortality. Her paper titled "Educational Levels of Hospital Nurses and Surgical Patient Mortality" clearly shows that in hospitals with more BScN prepared nurses, patient outcomes were better (yes, they controlled for staffing numbers, size of hospitals, nurses' years of experience, etc.): "After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patient’s surgeon was board certified, a 10% increase in the proportion of nurses holding a bachelor’s degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue (odds ratio, 0.95; 95% confidence interval, 0.91–0.99 in both cases)." The study was published in 2003 in the Journal of the American Medical Association, Volume 290, number 12, pp. 1617-1623.

Did this study determine if the BSN nurses were prior ADN nurses who went back to further their education? If that is the case, then the study is flawed. Anyone with enough drive, experience, and education would improve patient outcomes. I think all these studies about BSN nurses and patient outcomes need to determine the extent of "prior" education and experience of the nurses being studied.

I am an ADN nurse with a PhD in nursing, I still work at the bedside and teach. I get so sick of educators and administrators of hospitals bashing the more experienced ADN nurse. We should be encouraging people to further their education, not discouraging them. We also need to figure out ways to allow the BS student to finish courework towards a BSN "without" repeating courses. The IOM report lays this all out, but noone is paying attention to it...sad.


Nurse, PhD, MSN, FNP, BSN, RN

In Pakistan nurses are very hard worker but sorry to say that about 80% of Pakistani society is unaware from the importance of nursing profession even medical professional are unaware of there importance. Basically I am also male Nurse also master degree holder in nursing but our identification as nurse is very different in society, but I have proud on my profession and I love with my profession, I want to advise to other for gain knowledge about nursing profession give importance to nurses in society and improve quality of life with the help of proper nurses practice.

if you save one life it mean you are hero if you save handred lives it mean you are Nurse

I am a ADN nurse that is in school for my BSN the only reason that I started the program is to get into another program that required the BSN. I have worked for 7 years and was astonished when I worked with BSN nurses that could quote a theory yet had no clinical skills. I know understand why in three semseters I can wright a paper and correctly cite using APA format. No where in this program has the focus been on patient care I am greatful that I have the experience. I am a charge nurse in the ICU where half of the nurses are ADN, three are diploma and the rest BSN the experience is what keeps patients alive not the degree.

I am very interested in the comments made above.  I have been a Nurse educator for almost 35 years and before that a practising nurse midwife starting at certificate level in the 1960"s and moving towards a PhD.  I am interested in what actually takes place in the  programme for BSc nurses that marks them out? The degree in itself means nothing, it is a label attached to a four year programme, it is the content, curriculum and models of education with the development of the skills and competencies  that makes the difference.  In theory, I suspect that with good teaching all levels of nurse can achieve the same outcomes in terms of clinical competence and knowledge. If anyone would like to suggest to me what the key ingredient for the improved outcomes demonstrated by BSc nurses is, not simply more in depth learning and decision making skills, but is there anything else?

What a bunch of mindless robots some people are.  The BSN push was initiated and is being perpetuated by the very people and institutions that stand to benefit monetarily from having waves of nurses running back to school.  The one 2003 study (all other studies spinned off from this one with some even being published by the same people) that nursing academia loves to trumpet as being the Holy Grail of why nurses should spend thousands of dollars for a BSN has been shown to have been flawed in many ways.  Case in point: Doing continuing education in a specialty area or even earning a certificate that demonstrates excellence in a specialty is not good enough.  Only spending thousands of dollars at nursing program that is approved within the confines of the AACN, ANCC as well as other nursing governing bodies is acceptable.  The AACN is spending a lot money pushing its pwerful political agenda.  They want to limit competition in nursing education by discontinuing allowing diploma and associate program graduates from being able to sit for the licensing exam.


Most RN-BSN programs are laden with courses such as Sociology of Nursing, Multiculteral Aspects of Nursing, Theoretical Foundations for Nursing and Current Issues in Nursing.  These courses have no clinical significance what-so-ever and do nothing to hone the critical thinking skills of an RN. 

If a nurse chooses to further their education for future jobs in administration or management, that's fine.  But for academic elitists to try to convince healthcare facilities through propaganda and outright lying that hiring only BSN nurses will result in better patient care is deplorable. 

It's not the degree that makes the nurse, but the nurse that makes the nurse.  That's the way it always was, and will be.


How can you possibly say that current issues in nursing are not applicable to the skills of a nurse when nursing practice itself is based on current evidcened based practice? And when you focus on the "critical thinking" skills of a nurse, if you only have the technical training provided by the ADN programs, you do not have a broad understanding of the why's and how's, you only have the technical requirements needed to perform the functions, which is all well and good if you are the type of nurse that only wants the minimum required knowledge base required to do the job. I hate to tell you, nursing is more than just putting in an IV or performing a standardized assessment. You actually do apply theory and sociology if you know what it is and how to use it.

As far as the nurse making the nurse, how misinformed you actually are. My FNP-BC, PNP-BC and DNP degrees have absolutely molded my mind and enhanced my practice into what it is. I surely didnt do it by myself without the education....

the best way to argue the ADN vs BSN nurses capabilities should be based on how the training is done under the two programs, knowledge is important but without enhanced and rigorous practice the BSN student is no better than the ADN in the field.May the BSN nurses tell us their sincere views when they compare themselves to ADN  nurses


I am a BSN nurse from Malaysia. My country does train diploma nurses and degree nurses. I was one of the furtunate one who obtained local university offered course of Bachelor in Health Sciences (Major in Nursing). Before i was recruited, i personally went to work as a nurse assistant in a private hospital (3 months)  just to get some experience, overview of the roles and routines of a nurse.

In order to get into BSN,  i am  required to complete 2 years of pre-university course (STPM) right after 11 years of basic primary and secondary school program. I was indeed uneasy to pass all subjects. As a degree nursing (4 years course) student, we have practical started only from second year of nursing as we have a thoroughly anatomy & physiology, biochemistry, courses with all the other students of dietic, biomedic, medical radiation, nutiritionist, and sport science students.  My nursing journey started on year 2 to year 4.  Year 4 are mainly practical in all different department and at night we do our nursing research. At the end of our nursing course, we were trained they same in skill as diploma student but we have deeper knowledge requirement and  research skills plus others business/ forensic/sport science skill as to be more diversity equiped nurse.  My classmates and i did face challenges and critics from diploma nurses as they are they one who guided us during practical posting in all ways.  We always make them fuss and treated as we degree nurses always ask " WHy" in every skills and procedures. Doctors finds favors on us because we are more curious to learn and having more guts to question in order to learn.

After graduate, many senior diploma nurses finds us treatening and uneasy to teach as degree nurses are trained to think and analyse everything to the details. It is sometimes uneasy for diploma nurses to understand as they are well trained to respect and follow seniors in all procedures, policy, and culture. As we are called degree nurses, we have higher espectation from those diploma nurses. But diploma nurses just can not understand that degree nurses are trained they same in skills part as diploma nurses. Nurses always assess each other capabilities through skills. (it is unfair, we are trained the same. hence, we need time to catch up on hands on skill too.)

On the other hand, we have more skills and expert besides nursing EXP: COmmunication, computer skills, research skills, lab skills (Culture and swabs), exercise, health teaching, project management, setting up own business.. and etc) which doesnt use or being assessed in the clinical.This skills will be needed when we become a leader in future, and from starting point, we are all ready to excel!)

As per nursing community expectation required, i paid myself to pursue CCN (citical nursing care) right after 3 years of working experience in medical surgical wards, diagnostic room, cath-lab, and chest clinic. It was uneasy to go through with little exposure but i did it with maximun passion and enthusiasm. In malaysia, many diploma nurses waited at least 5 years to be sponsored  to persue post basic courses with contract.

During post basic course, i did better than majority of diploma nurses with ICU experiences (min 3 to 5 years) ( but low census in their Hospital). As i have went through BSN first year studies, all foundation of biochem,anatomy and physiology are easy to catch up and refreshing indeed, while my diploma classmates all struggling with the studies. Indeed, i find in difficult during practical and skills as i don't have much experienc in ICU and almost lost touch in nursing care after working in respiratory clinic. But i went through and excel very fast after being guided by passionate and experienced senior nurses.

I am now working partime as a CCN in icu of one private hospital (high census- full 12 beded). Able to take care 3 ptca patients; 1 ventilator +post ptca patients (or light cases). At the same time i am currently doing Master in Nursing Health Sciences (partime 3 years mixed mode).

My clinical instructors are BSN also with two post basic qualification and 15 years of experience in nursing. I find her very boastful but still i am willing to learn and listen to her advice even she always put me down in all colleagues by saying that i have Master. Comparing myself with those diploma nurses, the first time i work in ICU with zero experience but CCN , i can compare my skills with those who have worked 3 years without CCN. Deep down, I still believe, BSN nurses can excel and go further compare to diploma nurses.  Maybe those who are not taking nursing as a noble job but a job for salary will be different and soon to be looked down by diploma nurses. I strongly believe that as a nurse with altrusim, autonomy and a humble heart  will be a great nurse.  Back to the point:

1. It is experience that makes better nurses.

2. It is qualification that can empowered a well equiped experience nurse.

3. Qualification first or experience first? It is only a time matter. But qualification is indeed needed to serve the more knowledgeable society.


I'm struggling to understand the qualification process in the USA- I'm half way through a 3 year Bsc in adult nursing in the UK. My year is 50% theory (although clinical skills are taught in simulated wards regularly) and 50% on clinical placements lasting 4-6 weeks in a variety of settings e.g. acute medical/surgical, community. From day 1 there is huge focus on patient centred care and evidence based practice. There is controversy here about the benefits of university trained nurses compared with hospital trained nurses. I have found that there is some snobbery towards students being called too posh to wash but that is absolutely untrue in the majority of cases. I have learned so much from experienced staff without a degree and am in awe of their knowledge but....give us time and we will get there- nobody woke up and suddenly had expert skills! Mentorship and exposure will help to put theory into practice. I would agree that a nurse with a degree but no compassion or communication skills is useless and dangerous to the profession however a caring nurse with limited knowledge or ability to understand new technology, research and protocols is not someone who can provide good quality, holistic care. The healthcare needs and treatments are constantly evolving so maybe the scope of nursed today is not as romantic and altruistic as it is expected to be but as a student we are reminded of core nursing beliefs and values which underpin everything we do which I feel are enhanced by higher education.  

The need to standardize the Nursing profession should not be a form of entertainment. I understand individual pride in their various achievements but we must collectively have pride in the nursing profession. When I started the BSN program some years back, I felt a course in understanding movie was redundant. Guess what!  I can direct a movie on healthcare in my little medical room without problem. I present health talk in the school through dramatization. My actors and actresses are my regulars to the medical room.   The baccalaureate program makes it possible for me to understand and address the social, political and cultural needs of my community.  Yes! Nursing involves practice, but how do you give quality health care without understanding the patient’s background?   Remember! The baccalaureate program will give a wider scope to a better quality of care.

I am a ADN-RN who was 45 when I applied to nursing school.  SoI had successfully brought with me my experiences in management trained by one of the top ten management systems in the world in th 1980's, customer service skills, learning the ability to listen and help in customer service the best way possible with the proper training and support available to me.  I chose to go to nursing school due to my extreme interest in medicine and my need at the time that i really wanted to help sick and ailing people, especially the elderly which have a soft spot in my heart. In my mind they of all people deserve only the best care available as they have supported the world the younger generation now lives in and deserve the best care of their lives as they age and their human condition deteriorates . I am humble but have been told that I am extremely intelligent, am extremely inquisitive and ask many questions for validation, clarification of the facts and to extend my own knowledge. This appears to intimidate people. At my age i did not think medical school was a good investment as the ability would be somewhat limited after my education and residency would put me in the senior age group lessening my chances to be gainfully employed. So after having career counseling and talking to peers I decided on the current plan of action.  So I attended Jefferson State Community College in Birmingham, AL and graduated Summa Cum Laude.  While intially working within a hospital setting in ortho surgical recovery and rehab and then later for two years in a Open Heart/Cardiac floor for over two years which I have enjoyed the most in my nursing career.  My family is in Ohio and my mother was ailing and had really no ties to the Birmingham area, I decided to move back to Ohio.  Went through all the required steps to get my RN license in Ohio, that's when things took a turn downward.  There is a plethera of BSN nurses in this rural area and it ended up the only position I could acquire is in long term care. While I thought this maybe a good fit as I cared for elderly and rehab patients, it soon became apparent it was basically about "filling the beds" as stated by administrators I worked with , I tried as best as I could to do what was asked of me but allowed myself to be pushed past my professional and personal tolerances,   it's slowly took its toll on me as i was assigned the care of 28 to 32 patients, one nurse with two aides but if one aide did not show up, it was expected that us that were there to pick up the slack.  My tolerance lasted about 2 years in three different nursing homes but each time i find myself in the same position.  I was tired of apologizing to residents about things that were out of my control. Superiors did not want to admit that guidelines by the Ohio state board of nursing were not being followed stating " Well, we don't do things around here like that"  Being past my personal and professional tolerances working in what appeared to be a "toxic environment", my ability to filter my verbal comments became less and less. I am now being investigated by the Ohio board of Nursing as if I am fit to provide safe bedside care to residents. Upon review with the Board of Nursing it was explained to me that his assessment was employee/employer related and did not relate to ultimate nursing practice. My ultimate and main concern was these elderly and disabled residents were not being given the care they so rightfully deserved.  I have been an RN for 10+ years and honestly feel there is a great chiasm between what is written in words and the physical and emotional care given each day by a truly gifted nurse.   A sheet of paper regardless of the credentials simply resides on a desk or in a file while a truly effective nurse is a physical experience that happens daily and cannot be truly captured in words and is the ultimate in the care they give to the patient.


James G. Hartke, RN    ..... and proud of it 

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