Letter to the Editor by Stull on "Entry Into Practice: Is It Relevant Today?"

Entry Into Practice: Is It Relevant Today?

March 24, 2004
in response to topic Entry Into Practice: Is It Relevant Today?  (May 31, 2002)

Dear Editor:

I am writing in response to the much debated Entry into Practice issue. I am a nurse prepared at the Associate Degree (AD) Registered Nurse to the Bachelor of Science in Nursing (BSN) to the Master of Science in Nursing levels, living and practicing in North Dakota, the only state in the union to have mandated the baccalaureate degree as the requirement for entry into practice as a registered nurse. Unfortunately, in April of 2003, the North Dakota legislature, in a landmark decision, was successful in removing from statute this only professional-entry-into-practice edict that arose from the American Nurses' Association (1965) position on education requirements for professional, technical, and vocational nursing practice. Those who supported this 2003 legislative action argued forcefully and convincingly that the patient care community in North Dakota would benefit economically from this action through increased nursing educational "opportunities" for those wishing to attain an AD and subsequent license to practice as an RN in North Dakota.

It is well known that nursing is the only health profession which allows someone to practice as a professional without a baccalaureate degree. This reversal of the requirement for nurses to have a baccalaureate degree is unfortunate and in spite of the most recent research reported in the Journal of the American Medical Association (JAMA) asserting there is " a statistically significant relationship between the proportion of nurses in a hospital with bachelor's and master's degrees and the risks of both mortality and failure to rescue...Each 10% increase in the proportion of nurses with higher degrees reduced the risk of mortality and of failure to rescue by a factor of 0.95%, or by 5%, after controlling for patient and hospital characteristics" (Aiken, Clarke, Cheung, Sloane, & Silber, 2003, p. 1620).

Until the state of North Dakota recognizes what is vitally important to the health of our communities, we can do no less than provide what has been mandated by law - increased educational opportunities for those wishing to practice nursing. But in so doing, we (educators, employers, and nurses) must clearly delineate the difference between AD and BSN practice to ensure all nurses are providing the safest care possible within their scope of educational preparation. Additionally, for the future of the profession of nursing, the nation's entire nursing community must advocate for differing levels of education having different licensing exams and practice roles depending on whether a nurse has an AD or the BSN degree in order to once and for all put this issue of Entry into Practice behind us.

Alison Stull, RN, MSN
Assistant Professor, Department of Nursing
Dickinson State University
Dickinson, ND


Aiken, L., Clarke, S., Cheung, R., Sloane, D., & Silber, J. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290, 1617-1623.

American Nurses Association. (1965). A position paper. New York: Author.