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Reaching for the stars

RN to BSN

Gaisser, D'Arcy DNP, RN, ANP-BC; Ciurzynski, Susan M. PhD, RN-BC, PNP

doi: 10.1097/01.NURSE.0000475494.39278.5d
Department: LEARNING CURVE
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Benefits of earning a BSN

D'Arcy Gaisser is an assistant professor of clinical nursing at The College at Brockport, in Brockport, N.Y. Susan Ciurzynski is an associate professor of clinical nursing at the University of Rochester and a senior APRN at Golisano Children's Hospital in Rochester, N.Y.

The authors have disclosed that they have no financial relationships related to this article.

ARE YOU a diploma or associate degree-prepared nurse with a wealth of knowledge and expertise in the clinical setting? Ever wonder what all the BSN fuss is about? This article describes the benefits, challenges, and some possible solutions for nurses who are contemplating pursuing a bachelor's of science in nursing (BSN) degree, including the innovative RN STARS program designed to help nurses overcome common barriers.

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Why higher education?

In today's complex healthcare systems, higher level nursing education improves our ability to provide quality patient-centered care. As the healthcare industry becomes more complicated, RNs need to possess competencies in leadership, systems change and delivery, and health policy.1,2 BSN curricula can provide RNs with these essential skills.1-4

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A wealth of research in the last decade supports the need for RNs to attain BSN degrees.2,5-7 Empirical evidence reveals that a highly educated nursing workforce correlates with better patient outcomes and less mortality.5-8 Specifically, Aiken and colleagues (2014) reported better patient outcomes in hospitals with more BSN-prepared nurses; for every 10% increase in the number of BSN-prepared nurses, they found a corresponding 7% decrease in patient mortality. Length of stay and number of adverse events were also found to be inversely correlated with higher levels of nurse education.7,9,10

Despite this evidence, 46% to 51% of working RNs don't have a BSN degree. Many nurses practice their entire career with a diploma or associate's degree and don't engage in educational advancement and degree completion.1,2,11 Minimal educational requirements for entry into professional nursing practice have been debated by national organizations for decades, and remain hotly contested.1,2

The demand for BSN-prepared nurses creates many challenges for RNs, the first of which is successful entry into a BSN program. Many RNs have difficulty returning to school because they graduated many years ago and may not have the technology skills required by most programs. Additionally, fear of failure, inadequate writing skills, and a lack of familiarity with contemporary approaches to teaching and learning deter some nurses from even applying to a BSN program.12-14

The Institute of Medicine's report The Future of Nursing urges educators to provide a seamless academic progression to higher levels of education for nurses.2 The literature supports orientation back into the classroom to boost writing and computer skills, although the best method and timing for such an intervention hasn't clearly been established.13-21

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Reach for RN STARS to overcome barriers

In an attempt to explore the feasibility of delivering a continuing-education workshop for associate and diploma-prepared nurses in a workplace setting, a pilot program was launched in late 2013 as part of a doctorate in nursing practice (DNP) capstone project. A live and simulated educational intervention, Registered Nurse Scholarship Training for Academic Re-entry Success (RN STARS), launched with the goal to prepare nurses holding a diploma or associate degree for successful academic reentry into a BSN program.

The RN STARS workshop was conducted in a computer classroom that was easily accessible for nurses working at a large academic medical center in western New York State. The educational content relied heavily on live computer demonstration and student practice opportunities, so a computer classroom with individual computer workstations was an important feature. Although three hours were allotted for classroom activities, the actual time needed for training was collected as a process measure.

The project was approved by the academic institution's research subjects review board. Nurses were invited to participate if their highest educational attainment was an associate's degree or diploma in nursing and they could communicate in English. Participants weren't eligible if they had applied for, been accepted into, or had completed a BSN program.

The program included a range of activities designed to prepare RNs for academic reentry (see Workshop content and activities). These activities allowed RNs to practice their writing and computer skills and create a refined personal statement to use if they chose to apply to a BSN program.

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Encouraging results

Workshop feasibility and satisfaction were assessed based on data collected from workshop participants and staff using a Likert-type scale and open-ended questions that allowed participants to share comments and suggestions for improvement (see RN STARS staff feasibility survey).

Nurse (n = 10) and staff (n = 3) satisfaction with the RN STARS initiative was favorable. Satisfaction was high for the workshop: 100% of the 10 participating RNs strongly agreed that they were satisfied with the workshop content, delivery, and location, and stated that they'd recommend the workshop to other RNs. The evaluations revealed that the program could possibly be offered in 90-minute windows with classes of five or fewer students for more efficient learning and better turnover.

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Aiming high

The results of this pilot project provide preliminary support for developing and implementing an assistive bridging workshop to prepare associate and diploma-prepared RNs for a BSN program. The promising results and empiric support from the literature indicate that future research should formally examine the effectiveness of implementing a prematriculation educational workshop for nurses who might be considering academic reentry.

The need for higher educational attainment is clear; however, nurses may require some assistance before reentering academia. This ongoing challenge must be addressed soon; associate-prepared RNs continue to outnumber BSN-prepared nurses as first-time NCLEX test takers.11 Innovative strategies like the RN STARS initiative are needed to help RNs make a seamless transition to degree attainment.1,12,15-17,19,22

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RN STARS staff feasibility survey

This short survey was administered to the staff after program completion in order to improve future iterations of RN STARS.

  1. Describe what went well with the RN STARS workshop.
  2. Is staffing the RN STARS workshop worth continuing as part of your workload?
  3. Did you feel like you contributed?
  4. List any part(s) of the RN STARS workshop you would omit.
  5. What would you add to the RN STARS workshop?
  6. Is the workload reasonable?
  7. Would you be willing to work at the RN STARS workshop in the future?
  8. Do you feel the RN STARS workshop is valuable to the students?
  9. What other staff would you suggest attend and contribute to the RN STARS workshop?
  10. Was there any part of the RN STARS workshop that was frustrating?
  11. Please add thoughtful suggestions for improvement (feel free to continue answers on the back).
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REFERENCES

1. American Association of Colleges of Nursing. Nursing Education Programs: increase the proportion of nurses with a baccalaureate degree to 80% by 2020. 2012. www.aacn.nche.edu/education-resources/nursing-education-programs.
2. Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine. The future of nursing: leading change, advancing health. 2010. http://iom.nationalacademies.org/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx.
3. Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine. To err is human: building a safer health system. 1999. www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx.
    4. Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine. Crossing the quality chasm: a new health system for the 21st century. 2001. www.iom.edu/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx.
    5. Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003;290(12):1617–1623.
    6. Aiken LH, Clarke SP, Sloane DM, Lake ET, Cheney T. Effects of hospital care environment on patient mortality and nurse outcomes. J Nurs Adm. 2008;38(5):223–229.
    7. Aiken LH, Sloane DM, Bruyneel L, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet. 2014;383(9931):1824–1830.
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