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Support for the BSN

By: By Leah Curtin, RN, ScD(h), FAAN

The degree benefits nurses, hospitals, and patients.

The battle over nurses’ education isn’t so much over as that it’s entered a new stage. In 1962, when I began my school of nursing hospital-based diploma, the director of our program informed students in no uncertain terms that we must go on to get a bachelors in nursing (BSN) as soon after graduation as possible—and that was almost 50 years ago. Broad agreement now exists among nurses, hospitals, and physicians that nurses need at least a BSN, which benefits nurses, patients, and hospitals. 

  • In 2011, the Institute of Medicine called for 80% of nurses in the workforce to have a BSN by 2020, and organizations re-evaluated their hiring practices to develop a more highly educated staff. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity reaffirms this aim, stating: “[T]he goal of achieving a nursing workforce in which 80 percent of nurses hold a baccalaureate degree or higher remains relevant, and continuing efforts to increase the number of nurses with a BSN are needed.” 
  • In a 2014 study by the American Association of Colleges of Nursing (AACN), nursing school respondents noted that 79.6% of employers had a strong preference for nurses with a BSN. In addition, 45.1% of hospitals and other healthcare settings required new hires to have a BSN. This is a continuing trend. In AACN’s 2020 report, 82.4% of employers had a strong preference for BSN graduates, and 41.1% of hospitals and other healthcare settings required new hires to have a BSN. 
  • In 2017, New York passed legislation making it the first state to require that new nurses obtain a BSN within 10 years of their initial licensure. Known as “BSN in 10,” the law aims to improve patient outcomes. 
  • A classic study by Aiken and colleagues (2003) found that each 10% increase in BSN-prepared nurses decreased the risk of surgical patient death and failure to rescue by 5%. Other studies have confirmed these findings, including a 2011 study by Aiken and others showing that each 10% increase in BSN reduced risk of patient death and failure to rescue by about 4%. 

The argument over which degree (BSN or associate degree in nursing [ADN]) should be the decisive credential for entry into the nursing profession has been ongoing. However, now is the time to resolve the argument, especially because COVID-19 offers nursing an opportunity to update the public’s understanding of the profession, emphasizing what nurses have achieved in clinical, academic, and leadership roles.  

State boards license graduates with a BSN or an ADN. As a potential nursing shortage looms and more nurses feel the pressure and the desire for a BSN, community colleges are offering RN-to-BSN programs that help nurses fit education into their schedules. These programs are less expensive than a traditional BSN. Given the cost of a college degree these days, this is no small concern.  

According to the Bureau of Labor Statistics, RN employment is projected to grow by 15% from 2016 to 2026—faster than the average for all occupations. We need to take action to influence the political process so state nurse practice acts require nurses to have a BSN. We can’t take another 50 years to act. We have the support now, and we need to use it. 

But what does this say about the profession of nursing and the educational needs of those who enter it? I’m happy to see such support for BSNs. However, given the increase in nurses’ responsibilities and functions, I also think nurses’ need at least a year of practical internship before they practice solo. What do you think? 


leah curtin registered nurse faan

Leah Curtin, RN, ScD(h), FAAN

Executive Editor, Professional Outreach

American Nurse Journal


Aiken LH, Cimiotti JP, Sloane DM, Smith HL, Flynn L, Neff DF. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Med Care. 2011;49(12):1047-53. doi:10.1097/MLR.0b013e3182330b6e

Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational levels of hospital nurses and surgical patient mortality. JAMA. 2003;290(12):1617-23. doi:10.1001/jama.290.12.1617

Bennett CL, James AH, Kelly D. Beyond tropes: Towards a new image of nursing in the wake of COVID-19. J Clin Nurs. 2020.

Daily Nurse. Community colleges seek to fill the need for BSN nurses. June 23, 2016.

Smith AA. Debate continues on nursing degrees. Inside Higher Ed. December 22, 2017.

Thew J. ‘BSN in 10’ becomes law in New York. HealthLeaders. January 2, 2018.

1 Comment. Leave new

  • I read this article and can’t believe what has been written especially since we as a country are just starting to come out of combat with COVID 19. I am a ADN and have been since 2006. I will continue to practice as a ADN as long as I can. I have seen over the years nurses go back to the “shake and bake” programs to obtain their BSN and at the end besides money and time gained no practical objective benefits other than now they can promote to manager.

    Over the past two years I have been taking patients inside the ICU, Emergency room (Triage & holding) due to COVID. In each of these areas I am constantly a resource to other nurses due to my experience as a nurse. Who do you think comes to me? BSN’s! There is a wealth of experience in older nurses that have very desirable skills that we currently in most settings need, but can no longer find employment. Most of those nurses actually enjoy nursing and have no desire to become CRNA’s (which don’t become better nurse’s and usually the motivator is better pay/schedule) or (NP’s which is experiencing a flooding of nurses that barely have two years and bring nothing to the table, other than what they read on their computers. These cupcakes turned into NP’s have no sense of innovation, or able to think “outside the box.”

    I love these articles written by non-clinical nurses that have not practiced in years. Thank you from the nurses that have been practicing with their hearts, souls, and in many cases their bodies. Going forward I would understand, but any nurse with 10 years or more would have no subjective value at the bedside other than promote ability which often times leads out the door for most nurses. Being a GOOD manager has more to do with ability, experience , and love of nursing.


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