Nursing News

‘BSN in 10’ Bills Could Start a Trend

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By Jennifer Larson, contributor

January 27, 2012 - If a bill currently under consideration by the New York state legislature becomes law, nurses in that state will have to obtain a bachelor’s degree within 10 years in order to retain their licenses and keep working.

New York has considered some version of the current bill (A01977 / S02533A) for about eight years now, according to Deborah Elliott, MBA, RN, deputy executive officer for the New York State Nurses Association (NYSNA), which has announced its official support for the legislation.

But the state’s effort to compel nurses to get a bachelor’s degree has existed far longer than eight years; one proposal that was introduced in 1974 and approved in 1985 would have required a bachelor’s degree for entry to practice, but that provision met so much opposition that it stalled. The current bill does not contain an entry-to-practice requirement.

“It does not impact anyone who is currently licensed or in school,” Elliott emphasized, noting that those people would be grandfathered in if the bill becomes law.

The New Jersey legislature is also considering a “BSN in 10” bill this year. The legislature has considered similar bills that date back as far as the 2006-2007 legislative session.

The new bill, A553, was introduced January 10 and is similar to the New York legislation. It would continue to allow new nurses to enter practice with a diploma or associate degree but they would be required to get a baccalaureate degree within 10 years of licensure. The law would not affect nurses who are already licensed by the time the law takes effect, although the bill does encourage nurses who are already licensed to further their education.

Other states have considered similar legislation in the past, but no other states currently have bills pending. For example, Rhode Island has considered legislation in previous years, but so far no new bills have been introduced.

But that could change. Elliott commented, “I would be surprised if there aren’t other states that come forth.”

There seems to be growing support for this type of change in other states, at least. Although a specific bill has yet to be introduced in Pennsylvania, the Pennsylvania Organization of Nurse Leaders has a position statement that supports a BS- in-10 initiative as long as any legislation would also grandfather in any already-licensed nurses.

Indeed, BSN-in-10 initiatives are not new, but they may have gained some additional momentum in the wake of the landmark 2010 report, titled The Future of Nursing, published by the Institute of Medicine and the Robert Wood Johnson Foundation. Among other recommendations, that report called for 80 percent of the nursing workforce to have a bachelor’s degree in nursing by 2020.

“When that report came out, that certainly gave us some fuel,” Elliott said.

Studies have shown that better patient outcomes are linked to higher levels of education in nurses. In fact, the New Jersey bill explicitly discusses that phenomenon.

It states, “The purpose of this bill to encourage newly-licensed RNs to advance their education in order to deliver the best quality care to their patients in an increasingly complex health care environment. Studies comparing patient outcomes with the educational background of nurses demonstrate that in hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.”

Bills like the BSN-in-10 legislation in New York typically earn the approval of the American Nurses Association (ANA) as long as they do not exclude nurses from also entering the profession with an associate degree or diploma, said Adam Sachs, spokesman for the ANA.

“We do support initiatives to earn the BSN in 10 years,” said Sachs. “But we’re not trying to exclude other current avenues for entering the profession.”

A 2010 report funded by the Carnegie Foundation for the Advancement of Teaching, Educating Nurses: A Call for Radical Transformation, also addressed the need for more baccalaureate-prepared nurses, but it went one step further. The authors suggested requiring a BSN for entry to practice. However, the authors noted, “To make this so, the profession needs to agree on how to transform the current diverse pathways into a unified whole” and it called for cooperation to create more articulation agreements and seamless transitions, as well as other resources and support.

According to the American Association of Colleges of Nursing, there are 650 RN-to-BSN programs in the United States, as well as a growing number of state-wide articulation agreements in states such as Florida, Connecticut, Arkansas, Texas, Iowa, Maryland, South Carolina, Idaho, Alabama, and Nevada that pave a smoother path for nurses looking to advance their education.

One question that has been asked when the issue of BSN-in-10 initiatives is brought up: How easy would it be for nurses with an associate degree to obtain a bachelor’s degree? It depends.

The 2010 National Sample Survey of Registered Nurses found that it took nurses with associate degrees about 7.5 years on average to return to school and complete their baccalaureate degrees. So, according to that set of data, it is possible to meet the decade requirement.

But if more nurses will need a baccalaureate degree in the future, they will need support. The prospect of returning to school can be daunting for nurses who have families to support and jobs they can’t afford to leave. Employers may have to offer some flexibility to help their nurses to continue their education, Sachs said.

Additionally, nursing school capacity will have to be expanded, he said. That’s a complex issue, however, because nursing schools often have to turn away qualified applicants because they don’t have enough faculty to teach them. And the faculty shortage is not expected to abate any time soon.

For now, many will be monitoring the situation in New York and New Jersey.

Elliott says the NYSNA is optimistic about the New York bill’s chances of passing. “I think it’s pretty promising,” she said.


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