Baccalaureate In Nursing Education Introduction
The trajectory of baccalaureate nursing education is marked by persistent struggles, milestones, and significant transformations. From its early conceptualization to its current state, the path to establishing baccalaureate nursing education as a standard has been fraught with challenges. This article explores the historical struggles, key milestones, and contemporary developments in baccalaureate nursing education, highlighting pivotal moments and the ongoing efforts to advance the field.
Struggling to Develop Baccalaureate Nursing Education
Early Attempts and Progressive Models
The early 20th century saw several attempts to integrate baccalaureate education into nursing. One of the pioneering efforts was initiated at Teachers College, Columbia University, in 1917. This program was notable for its innovative approach, offering students a blend of university-level science education, clinical training at Presbyterian Hospital in New York, and specialization in areas such as public health or education (Bullough & Bullough, 1978). This model represented a significant departure from the traditional diploma-based education, laying the groundwork for the development of more comprehensive nursing curricula.
By the 1930s, the popularity of these “collegiate curricula” had increased, with the number of students completing such programs doubling. However, these programs were often disorganized and resembled modern graduate education more than undergraduate nursing education. They emphasized specialization in areas like public health, teaching, administration, and clinical specialties (Stewart, 1943). The lack of a cohesive structure and standardization in these early baccalaureate programs highlighted the difficulties in establishing a unified and effective model for nursing education.
Brown Report and Struggle
The struggle to define and develop baccalaureate nursing education continued into the 1940s, with significant contributions from the Brown Report. Published in 1948, this report made bold statements regarding the future of nursing education. It asserted that nursing education should be situated within institutions of higher education and advocated for an integrated curriculum that combined liberal and technical training for professional practice (Brown, 1948).
The Brown Report proposed that the degree granted should be the Bachelor of Science in Nursing (BSN) and emphasized the need for nurses to be prepared for complex clinical situations requiring high levels of education and skill. This report was instrumental in shaping the discourse around baccalaureate nursing education and laid the foundation for further development in the 1960s. By this time, baccalaureate programs began to take shape, with a focus on liberal education, intellectual skills, and content areas such as leadership, management, community health, and teaching. This differentiation from diploma or associate degree education marked a significant milestone in the evolution of nursing education (Kelly & Joel, 2002).
Baccalaureate Nursing Education and the Role of ANA
The Role of the American Nurses Association (ANA)
The American Nurses Association (ANA) played a crucial role in advocating for baccalaureate nursing education. In 1965, the ANA published a position paper that called for the baccalaureate degree to be established as the entry-level requirement for professional nursing practice. This position paper was a significant endorsement of the baccalaureate model and strengthened the argument for advancing nursing education to higher academic standards.
However, the push for baccalaureate education faced resistance from other groups. For instance, the Surgeon General’s Consultant Group’s document “Toward Quality in Nursing” (US Public Health Service, 1963) and the National Commission for the Study of Nursing and Nursing Education (1970) were cautious in their recommendations. While these groups acknowledged the need for improved nursing education, they stopped short of mandating baccalaureate preparation for all licensed nurses. They advocated for additional research to better understand the skills and responsibilities required for high-quality patient care.
Despite these calls for further research, comprehensive studies on the relationship between educational preparation and nursing practice did not emerge until several decades later. The ongoing debate about the value of baccalaureate education highlighted the need for empirical evidence to support the claims made by advocacy groups and professional organizations.
Contemporary Understanding of Baccalaureate Nursing Education
Since the 1960s, the number of baccalaureate nursing programs has grown significantly. As of recent reports, there are approximately 674 baccalaureate programs (Amos, 2005). This growth reflects the increasing recognition of the importance of advanced education in nursing. Despite a decline in enrollments during the 1990s, there has been a notable increase in baccalaureate nursing graduates since 2001, with an 18 percent rise in graduates (AACN, 2006b).
Recent studies have provided valuable insights into the relationship between educational preparation and patient care outcomes. Earlier research suggested that registered nurses performed similarly in practice regardless of their academic preparation. However, a series of recent studies has challenged this view, showing that hospitals with a higher percentage of baccalaureate-prepared nurses experience lower patient mortality rates (Aiken, Clarke, Cheung, Sloane, & Silber, 2003; Estabrooks, Midodzi, Cummings, Ricker, & Giovannetti, 2005; Tourangeau, 2007). These findings underscore the value of baccalaureate education in improving patient outcomes and have contributed to the growing momentum for making the baccalaureate degree the standard for entry-level nursing practice.
Support for baccalaureate nursing education does not imply a rejection of other forms of nursing education, such as associate or diploma programs. Instead, it emphasizes the importance of encouraging nurses to pursue advanced degrees, making baccalaureate education more accessible and affordable, and fostering collaboration among nurses with varying educational backgrounds.
Start of Baccalaureate Education in the State of New York
Legislative Efforts and Proposed Changes
In 2007, the New York State Nurses Association introduced a bill (A2480/S294) aimed at advancing nursing education within the state. This bill proposed requiring registered professional nurses to obtain a baccalaureate degree in nursing within ten years of their initial licensure. The proposal was modeled after a similar requirement for public school teachers in New York, who must obtain a master’s degree within five years of their initial certification.
The bill represented a significant step towards promoting baccalaureate education for nurses and addressing the broader goal of improving the quality of nursing care. If enacted, this legislation could serve as a model for other states, potentially increasing the number of baccalaureate-prepared nurses nationwide. A coalition called the Coalition for Advancement of Nursing Education (CANE) was formed to support the bill and generate momentum for its passage (http://www.rneducationadvanceny.org).
As of February 2008, Bill A2480/S294 had been referred to the higher education committees of the New York State Assembly and State Senate. The status of the bill can be tracked on the New York State Nurses Association website (Retrieved 4/10/08 from http://www.nysna.org/advocacy/acti). The outcome of this legislative effort could have far-reaching implications for the future of baccalaureate nursing education and the overall quality of nursing practice.
Conclusion
The journey towards establishing baccalaureate nursing education as a standard has been marked by numerous struggles, milestones, and evolving perspectives. From the early attempts to integrate baccalaureate education into nursing to the pivotal contributions of the Brown Report and the role of the American Nurses Association, the development of baccalaureate nursing education has been a dynamic and ongoing process.
Contemporary understanding of the value of baccalaureate education, supported by recent research showing improved patient outcomes, has strengthened the case for advancing educational standards in nursing. Legislative efforts, such as the proposed bill in New York, highlight the continued commitment to promoting higher education for nurses and improving the quality of care.
As nursing education continues to evolve, it is essential to support and enhance baccalaureate programs, address barriers to further education, and adapt to the changing demands of the healthcare system. By understanding the historical context and current developments, we can appreciate the progress made and work towards advancing the nursing profession for the benefit of patients and communities.