Transitioning from ADN to BSN: Nursing Education Pathways

Introduction: The Case for BSN Education

Over the years, the promotion of higher education for nurses has been a recurring focus of national reports. One important reason is the growing body of evidence linking improved nursing performance with continued education. Another factor is that nurses who pursue Master's programs often concentrate on education, which helps ensure an adequate supply of nurse educators as well as clinical nurse specialists and midwives (Scott & Brinson, 2011).

Education. Researchers and policymakers continue to emphasize that education is a key determinant of nurses' performance in medical facilities. Bachelor's degree programs provide more content than diploma programs and tend to be more thorough. Notably, institutions with a higher proportion of baccalaureate-prepared registered nurses have reported fewer patient fatalities. This inverse relationship demonstrates that education level is a critical determinant of performance and competency (Johnston, 2009).

Disasters, Violence, and Terrorism. Natural disasters demand increased nursing attention, particularly given the complexities introduced by the high populations of modern urban areas. Nurses must be adequately trained to handle disasters of significant scale and magnitude. Cases of domestic violence — primarily against children and women — also require nurses' professional attention (Jacob & Vanderhoef, n.d.).

IOM Recommendations and the Need for Higher Education

In 2010, the Institute of Medicine (IOM) issued a landmark report titled The Future of Nursing: Leading Change, Advancing Health. The report examined in depth the roles nurses should play in reforming the healthcare system. Three important messages emerged for the nursing profession. First, the IOM recommended transforming nursing practice. Second, it identified that the future of the profession depends on nurses' continued training and education, along with the creation of systems to ensure smooth academic progression (Garner, 2011).

One notable characteristic of nursing is that several educational pathways can lead to a registered nurse (RN) license at the entry level, including the associate degree in nursing (ADN), the baccalaureate degree (BSN), and hospital-based diploma programs. Academics continue to debate what minimum educational requirements should be stipulated for nurses (Garner, 2011).

It is nonetheless clear that higher education levels are required for nurses to adequately meet current workplace demands and perform at peak levels. The IOM offered the following reasons why higher education should be considered a necessity:

In 2003, the IOM published Health Professions Education: A Bridge to Quality. This document made several recommendations aimed at improving professional healthcare education with respect to competency, safety, and quality (Bertch, 2012).

Rationale for recommendation: Improving quality requires identifying errors and hazards in care, understanding them comprehensively, and instituting measures to mitigate them.

Barrier: A fundamental mindset shift is needed in the continuing education of practicing registered nurses. Many nurses are unaware of the full extent of quality and safety problems and lack adequate training to address them systematically (Bertch, 2012).

Learning Theories in Nursing Education

Learning theories guide the educational systems through which nurses are trained. An understanding of these principles enables effective knowledge transfer and promotes efficiency and effectiveness. The theories extend beyond the classroom and can be applied to problem-solving, constructive communication, behavior development, and habit change (Aliakbari, Parvin, Heidari & Haghani, 2015).

Nursing curricula are typically grounded in adult learning concepts, since adults form the primary audience. Constructivism is particularly popular in such settings. The foundation of constructivism is the construction and deconstruction of knowledge — drawing connections between new material and the learner's existing experiences or prior awareness. Internalization and reconstruction of these concepts allow meaningful learning to take place (Josephsen, 2014).

Advantages. Constructivism allows students to build new understandings and construct knowledge through reflection and introspection. Learners seek meaning based on their own knowledge and experiences, which promotes deep thinking and independent investigation (What is unique about Constructivism, n.d.). Additionally, constructivism reflects changing student and teacher roles: the teacher becomes a guide, mentor, or coach, and learners function as cognitive apprentices. Knowledge development is advanced as the teacher engages learners at the edge of their capabilities (What is unique about Constructivism, n.d.).

Disadvantages. Constructivism lacks the structured framework that other methods provide. Students who thrive in highly structured environments are at a disadvantage, and because learning is often personalized, uniformity in achievement levels is difficult to ensure (Constructivist Learning Theory: Pros & Cons, n.d.). Since students tend to evaluate their own progress, traditional grading systems are devalued, and some students may copy peers rather than constructing their own knowledge. Furthermore, students who cannot form abstractions or connections between existing and new knowledge may become frustrated and confused — a limitation that can be addressed by combining constructivism with other learning approaches (Constructivist Learning Theory: Pros & Cons, n.d.).

Creating interactive learning environments has always been a challenge for nurse educators. To achieve this, educators must encourage active participation, design creative cognitive strategies that appeal to learners' preferences, and remain flexible in their approach (Amerson, 2006).

Howard Gardner's theory of multiple intelligences (MI) provides a conceptual framework to guide the design of classroom activities that promote interactive, participative learning and energize lectures. In his 1983 publication Frames of Mind, Gardner identified the components of MI learning and argued that determining an individual's intellectual profile and using that information to enhance learning is both possible and beneficial. In a 1999 publication, Gardner defined intelligence as a "biophysical potential to process information that can be activated in a cultural setting to solve problems or create products that are of value in a culture" (Amerson, 2006).

Gardner identified eight categories of learning intelligence, all of which have been found relevant to classroom settings. The application of MI in teaching has been shown to reduce teacher directedness, increase the authenticity of learning experiences, and increase student initiative and control (Amerson, 2006).

Advantages. The premise that all students are gifted in their own unique ways encourages educators to approach teaching with nuance, recognizing that learners are not uniform and may possess different talents and skills. An environment responsive to these differences is more conducive to learning for all students.

Disadvantages. Scholars from testing and psychometric communities have critiqued MI theory. One critic argues that the intelligence-testing literature does not support the notion of eight independent intelligences, but instead supports a single overarching intelligence. Another notes that the evidence base for Gardner's work lacks strength and that no extensive research exists to confirm its practical effectiveness in educational settings (Armstrong, 2009). In practice, relying exclusively on any single method will inevitably advantage some students and disadvantage others (Amerson, 2006).

Conclusion

Having the RN-to-BSN curriculum revised so that it is more useful to the practice of registered nurses will surely encourage nurses to return to class. However, for many RNs, the motivation to go back is due to changing roles or because only an MSN can meet the demands of a job. Programs that allow smooth advancement from ADN to MSN through advanced credit or other mechanisms will be particularly effective in encouraging nurses to continue their education (Sportsman, n.d.).

The unique needs of ADN and diploma holders must also be addressed. These nurses return to school at the competent or expert stage of professional development, yet research reveals that exposure to new academic material often moves them back temporarily to the level of advanced beginner or novice (Sportsman, n.d.).

Increasing the proportion of nurses who hold BSN or higher qualifications will be a significant undertaking for the nation's nurse educators, but one with clear benefits for patient outcomes and the health system as a whole.