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

Entry Into Practice: Is It Relevant Today?

February 14, 2012

Response by Shweta Singh to the topic “Entry Into Practice: Is It Relevant Today?” (May 31, 2002).

Dear Editor:

I write in response to the topic, “Entry Into Practice: Is It Relevant Today?” (May 31, 2002).

Nurses are the largest component of the healthcare workforce, yet we are amongst the least educated.  Pharmacists and physical therapists have acknowledged the gravity of their own vital roles, and consequently require their ranks to be uniformly prepared with a minimum of a doctoral and master’s degrees, respectively.  Why haven’t nurses tackled this issue?

BSN entry into practice has been a passionately debated issue for over 46 years.  In all the time that we’ve spent arguing amongst ourselves, tragic consequences have occurred. Unlike the debates of the past, we now have research showing that death can be prevented by staffing more BSN-prepared nurses (Aiken, Clarke, Cheung, Sloane, & Silber, 2003). Because of this research, many of the nation’s top hospitals, where patients go to get the best care possible, now only hire BSN- prepared nurses (Boyd, 2010).  This trend is also being seen in stronger forms beyond our borders. Great Britain, Canada and Australia require all nursing students to obtain a BSN in order to be licensed as an RN (Barter & McFarland, 2001). This is no longer a debate about the status-quo convenience or anecdotal stories of competent ADN colleagues.  Patient care and safety has always been and must remain paramount to the decision we make about our professional education.

The cyclical nursing shortage is often cited in support of maintaining associate degree entry into practice.  However, due to interminable wait-lists and prerequisite requirements, ADN programs are ironically inefficient.  It can take over 2-3 years to get into an ADN program, let alone complete it.

By allowing the majority of new graduates to enter the profession with a diploma or an associate degree, we set ourselves up for a faculty shortage. One study found that less than 6% of 72,000 ADN-prepared nurses may go on to obtain a master’s degree (Aiken, Cheung, & Olds, 2009). Even if we made the untenable assumption that each of those master’s prepared nurses would go on to teach, we would still be left with a tremendous shortage. If we had reversed the proportions of ADN and BSN graduates between 1974 and 1994, we could have potentially had up to 50,000 more potential faculty members today (Aiken, Cheung, & Olds, 2009). We are now able to see the effects of how varying nursing education levels have not only caused a serious faculty shortage, projected to get worse within the next 10 years, but have caused thousands of qualified nursing applicants to be wait-listed and/or rejected annually. Even unbiased, highly respected organizations such as the Institute of Medicine (IOM, 2010) have crunched the numbers, thoroughly assessed all factors and concluded that there is a dire need for more BSN-prepared nurses. Considering the barriers to nursing education reform, this challenge must be addressed creatively and collectively. This may require evolving the curriculum of current ADN programs to be able to provide a bachelor’s degree in nursing. Though this is far from ideal, it is a potential compromise solution our profession would be unwise to discard.

Education engenders respect and empowers nurses. Now more than ever, nurses need to have an educated, unified stance to be able to sit at the table with important decision makers and advocate for the advancement of the nursing profession.

While the debate will inevitably persist, I’ll continue to do all that I personally can to help address some of the abovementioned pressing problems. I may have more loans than my ADN colleagues, but I’m emboldened to know that my degree translates far beyond different letters after my name. While I actively continue to work with acutely ill, increasingly complex patients at the Hospital of the University of Pennsylvania, I know that my education is helping decrease the odds of complication and death.  And as I round out my graduate education, I am committed to teaching future BSN nurses, who will care for and save patients long after I’m gone.

Shweta Singh, BSN, RN, OCN
E-mail: shwetas@nursing.upenn.edu


Aiken, L.H., Cheung, R.B, & Olds, D.M. (2009). Education policy initiatives to address the nurse shortage in the United States. Health Affairs, 28(4), 646-656.

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

Barter, M., & McFarland, P.L. (2001). BSN by 2010: A California Initiative. JONA: The Journal of Nursing Administration, 31(3), 141-144.

Boyd, T. (2010). Hospitals begin to require BSNs, Aren’t waiting on BSN in 10 Legislation.  Nurse.com. Retrieved from http://news.nurse.com/apps/pbcs.dll/article?AID=2010310180001

Institute of Medicine. (2010).  Future of nursing: Focus on education. Retrieved from www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Nursing%20Education%202010%20Brief.pdf