Nurse Education Today
Volume 30, Issue 2 , Pages 105-106, February 2010

Employers prefer BSN nurses: But where’s the financial compensation?

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Accepted 29 September 2009. published online 02 November 2009.

Article Outline

 

Studies in the USA have shown nurses who have a Baccalaureate of Nursing Science (BSN) deliver more competent care than nurses with an associate degree (ADN) (Barter and McFarland, 2001). However, despite the American Nurses Association (ANA) recommendation for a BSN as entry level to practice many nurses do not continue their education. Financial compensation may be the reason.

Due to the rapidly changing healthcare environment and the increasing complexity in healthcare, nursing leaders generally agree that higher levels of education are needed (Lillibridge and Fox, 2005, Megginson, 2007). Our society is aging, acuity levels in hospitals are rising, and technological advances continue to increase life expectancy. However, even with the push for a BSN, approximately 70% of practicing RNs in the US are educated at the ADN level (Megginson, 2007).

The difference between an ADN and a BSN is related to training (Lords, 1999). Associate degrees prepare RNs to function in a hospital setting (Barter and McFarland, 2001) and focus on skills that are needed for basic nursing tasks (Kubsch et al., 2008). These programs produced 60% of licensed RNs in the 1990s (Dervarics, 2002). Baccalaureate programs add the component of a liberal education that is based on humanities, arts, philosophical, and theoretical approaches (Kubsch et al., 2008). According to Robert Skotheim, President of Occidental College, “A liberal arts education drives a student towards a degree of intellectual and emotional self-confidence so that you think that it’s okay to want to change society—or even change yourself. It aims to produce leaders of change” (Plate, 2008, p. 13). BSN programs incorporate concepts such as adaptation, leadership, critical thinking, and communication (Anderson and Tredway, 2009).

As workplace issues become more complex, the expansion of nursing practice’s scope and the growth of autonomy results in the need for expanded education, critical thinking, and problem solving skills which comes (Anderson and Tredway, 2009). The National League for Nursing incorporated aspects of critical thinking into the baccalaureate programs in 1987 (Miller and Malcolm, 1990). Critical thinking can be defined as the ability to “question, examine, and reflect on ideas and values” (Staib, 2003, p. 449). It is essential to have a broad knowledge base to make critical decisions in healthcare. The minimum level of education for an RN has been an ongoing dilemma and has not been resolved since 1965 when The Committee on Nursing Education recommended a professional nurse should be educated at the baccalaureate level (Donley and Flaherty, 2002).

However, in today’s economy, ADN nurses have to consider the cost of obtaining a BSN. Lois Lowry, DNSc, conducted a study using a net present value (NPV) methodology to examine the cost of education and derived benefits of a BSN education. Lowry found that nurses who have a BSN do not gain any additional monetary rewards when compared to ADN and diploma nurses. The issues that impact financial returns for BSN nurses are wage compensation and inconsistent practices of paying differentials for BSN nurses (Lowry, 1992). A later study found that the average wage increase for an ADN who acquired a BSN in 1996 was $2543 (p<0.00) and in 2000 was $2178 (p<0.00) (Graf, 2006). Moreover, this does not “identify the value of the premium in comparison to the expense incurred in obtaining the degree” (Graf, 2006, p. 138). When considering opportunity costs such as time investment, loss of income (working overtime or a second job), and self-funded tuition, nurses may not perceive a BSN is worth it. Even though these studies were done years apart, the issue of BSN compensation continues to exist today.

Educated employees help create high performing organizations and investing in human resources help organizations remain competitive in today’s global economy. Organizational incentives for nurses to obtain a BSN need to be put into place, because a BSN increases the nurse’s value to the organization. The late Peter Drucker, professor and entrepreneur, believed highly skilled people are an organization’s most valuable resource (Sharad, 2008). The problem of attracting more RNs to continue their education may depend on how much the organization values nursing education in terms of compensation.

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References 

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PII: S0260-6917(09)00189-0

doi:10.1016/j.nedt.2009.09.015

Nurse Education Today
Volume 30, Issue 2 , Pages 105-106, February 2010

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