Should RNs Be Required to Earn Their Bachelor’s Degree?

A bill before the New York State legislature threatens to change nursing licensing rules, requiring all registered nurses (RNs) to earn a Bachelor’s of Science in Nursing (BSN) within 10 years of becoming an RN. Supporters argue that the increased education translates to better outcomes for patients; however, opponents say such a requirement may only further exacerbate the projected nursing shortage.

Photo by Walt Stoneburner on flickr.com

No state currently requires RNs to have earned their bachelor’s degree to practice, but similar bills have appeared in a total of 18 states. Many countries, including Canada, Sweden, Greece, Portugal and South Korea require a four-year degree for licensure as an RN. As of 2008, however, around two-thirds of RNs only possessed associate’s degrees, with the remainder holding BSNs or advanced nursing degrees, like an Master of Science in Nursing or Ph.D. North Dakota formerly required RNs to have a bachelor’s degree, but that law was repealed in 1987 when the state faced a nursing shortage.

Support for strengthening nursing education requirements has been building for some time after a number of studies demonstrated the positive effects of a four-year degree. A 2003 study completed by University of Pennsylvania professor Linda Aiken, RN, is a major instigator of calls for this legislation. Aiken’s study reported that the death rates of surgical patients in hospitals where over 70 percent of RNs had bachelor’s degrees were nearly half the rate in hospitals where only 10 percent of RNs held four-year degrees.

Other studies support Aiken’s findings and provide further evidence of the benefits of additional nursing education. Rochester General Hospital in Rochester, NY, offered incentives to its RNs to complete their bachelor’s degrees, providing tuition assistance and partnering with schools in the area. From 2002 to 2007, the percentage of RNs holding BSN degrees jumped from 33 to 47. In that same time period, medication error rates dropped from 1.66 to 0.82 per 10,000 doses, and length of stay declined from 5.6 to 4.6 days. Meanwhile, nurses were happier with their jobs and vacancy rates dropped from 22 percent to 3 percent.

Still, since such a large proportion of RNs enter the workforce after earning only an associate’s degree, opponents of the bill are concerned that many of these prospective nurses would become ineligible or be deterred from starting a career. Despite a shrinking of the nursing shortage in recent years, experts predict the United States will be 260,000 registered nurses short of its needs by 2025. Requiring all RNs to earn four-year degrees may only increase that number, which is especially troubling as the Baby Boomer generation ages and health care needs nationwide grow.

Legislation or not, hospitals are beginning to enact similar requirements on their own. Some hospitals boast that more than 90 percent of their RNs hold bachelor’s or higher degrees, simply due to hiring preferences, but others are turning preferences into requirements. The North Shore-LIJ Health System, which runs 14 hospitals in the New York City area, says they will require all RNs to enroll in a BSN program within two years of starting and to finish the degree within five years.

An increasingly complex health care system and evidence of better patient outcomes when nurses have more education are strong motivators to make a BSN a requirement for registered nurses. With the nursing shortage on the decline as people have flocked to nursing during the economic downturn of the past few years, and hospitals showing strong preference for BSNs, the market may make this legislation unnecessary. If it does pass, however, and the nursing shortage grows, opponents will be shaking their heads and muttering, “Told you so.”