NY/NJ bills revive debate on education standards for nurses.
Both the New York and New Jersey state legislatures are considering bills that would require all newly licensed RNs to obtain BSN degrees within 10 years of initial licensure. The Bills--S4051/A2079B in New York and S620/A3768 in New Jersey, commonly referred to as the "BSN in 10" proposals--recall initiatives dating to 1965 that attempted to raise the minimum educational level of practice in nursing to BSN. The current proposals neither call for the BSN as the minimal requirement for entry into practice nor do they advocate for the closing of ADN or diploma programs, but they have sparked a heated discussion of the issue once again.
(The NLN's Reflection & Dialogue, "Academic/Professional Progression in Nursing," was developed in response to this proposed legislation and that in other states that has revived the question of educational preparation for nursing practice.There is a growing consensus among nurse educators, legislators, and colleagues in service that our current system of nursing education has not provided enough opportunities and incentives for associate degree and diploma program graduates to pursue baccalaureate and master's education, and for baccalaureate graduates to obtain advanced degrees.)
Concerns have been raised about what passage of the bills would mean for nursing schools in New York and New Jersey that, like the rest of the country, already are turning potential candidates away because of faculty shortages. Other major concerns include the fate of ADN and diploma programs, and the monetary burden that could be placed on nurses to fulfill the BSN requirement.
Proponents of the proposals say that the new requirement would ensure that nurses in New York and New Jersey are equipped to handle the ever-increasing complexity of patient care. Furthermore, some in favor of the bills say that, to remain viable and equally competitive in the health care arena, nursing needs to make the baccalaureate degree the minimal requirement for maintaining licensure.
The measures in both states cover the same general points, requiring new graduates of AD and diploma programs to obtain their BSNs within 10 years of the date of initial licensure, and providing a grandfather clause for nurses who already are licensed and for those who are enrolled in nursing school before enactment. For the nurse who cannot complete the degree requirement in the allotted time frame, the bills also provide options to request an extension and be granted a conditional registration.
Each bill gives similar reasons for enacting the legislation. New York's bill notes that higher patient acuity, advancing technology and procedures, and complex patient care, along with shorter lengths of stay, are creating a greater demand for nurses' skills. It also cites research studies that "clearly demonstrate the added value of additional education in relation to improved patient outcomes." One study, it states, found that "each 10% increase in the number of baccalaureate-prepared nurses results in a 5% decrease in surgical patient deaths." The language in New Jersey's legislation similarly references studies comparing patient outcomes with nurses' educational background.
According to the National League for Nursing's 2007 statistics, New York and New Jersey have more ADN programs than BSN programs, and since 1987, the number of ADN programs nationally has steadily risen. Through legislators in both states have offered assurances that passage of their legislation would not change this situation and that nurses will continue to be able to enter the profession through ADN and diploma programs, the call for higher educational requirements seems implicit. With respect to health care's increasing complexity, New York's bill S4051 states, "Other countries are responding to these changes by requiring the baccalaureate degree as an entry requirement for nursing licensure, while other professions are demanding master and doctoral degrees as their entry point." In addition, New Jersey's S620 states, "it is the sponsor's intent that currently licensed nurses also seek to advance their education and training." If passed, the New York law would take effect immediately; New Jersey's law would take effect after 90 days.