80% BSN by 2020: Why Aren’t We There Yet?

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BSN by 2020 (Pixabay)

Guest Author: I’m pleased to welcome Jeff Oescher as a guest author to the Nursing Education Expert blog. Jeff is a medical writer for Vohra Wound Physicians, a national wound care physician group. For more on Jeff, scroll to the bottom of the post.

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**This document contains some affiliate links. See the end of the post for more information.

IOM Recommendation: 80% BSN by 2020

Nursing is the only healthcare profession where there are two pathways, an associate’s degree of nursing (ADN) and a bachelor’s degree in nursing (BSN), to entry-level positions. Sparked by research showing that BSNs provide patients with a higher level of care than ADNs and a growing need for more nurse leadership in healthcare, healthcare leaders have made recommendations that are changing the nursing field and nursing education (Kutney-Lee et al., 2013). Perhaps the most well-known recommendation came from the Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health (2011). The recommendation was to “increase the proportion of nurses with a baccalaureate degree from 50% to 80% by 2020.”

Great strides have been made in attempts to reach the recommendation, but nursing isn’t there yet (Boivin, 2017; Lynch, 2015). Many believe that 2025 is a more reasonable goal (Boivin, 2017; Pinto, 2019; Spetz, 2018). Others believe that it’s non-achievable because there are too many hurdles. The important questions are: why was such a lofty recommendation made? How close did we get to it? What are the roadblocks that caused us not to get there?

Why was “2020” the Recommended Date?

The 80% by 2020 was certainly a lofty recommendation; some might even call a pipe dream. But to understand why it was made, one has to consider the sub recommendations found on pages 3 and 4 of the report.

A quick read over shows that the sub recommendations, while well-intentioned, could never occur in just 10-years. Such drastic changes to educational structures, funding, and hospital policies take time and can only be achieved by hospitals and academic institutions with enough money and resources (Boivin, 2017; Pinto, 2019; Spetz, 2018).

But still, while 2020 proved to be too soon to expect the 30% increase, there were drastic improvements and, perhaps more importantly, the identification of roadblocks that could get in the way of achieving the recommendation in the future (Boivin, 2017; Pinto, 2019; Spetz, 2018).

Steps Moving Us Forward

Magnet Status. Some hospitals have been able to get close to or reach 80% BSN recommendations (Lynch, 2015). Usually, these are hospitals that seek Magnet Status, an award given by the American Nurses’ Credentialing Center (ANCC) to hospitals that satisfy a set of criteria designed to measure the strength and quality of their nursing.

New York ‘BSN in 10’ Bill. In 2018, a bill was passed in New York that requires ADNs entering the profession to get a BSN within 10 years or their license will be suspended Nelson, 2017). Nurses who are already licensed are grandfathered in regardless of their degree level and don’t have to go back to school. As older nurses retire, they are being replaced with BSNs or ADNs pursuing their BSN and the proportion of nurses with a bachelor’s degree will steadily increase.

Standardization of Prerequisites. The Campaign for Action, a group focused on reaching the recommendations in the 2010 report, has helped 25 states standardize prerequisites and general education requirements across the nation in all nursing programs (National Academies, 2016). This is a giant step in removing one of the common barriers that prevent ADNs from entering a BSN program and obtaining a degree.

Individual Hospital Measures. Regardless of Magnet Status, some hospitals chose to hire only BSNs or help ADNs get their BSN. Many hospitals have a nursing school affiliate and offer free tuition to current employees. They also offer tuition reimbursement to nurses who earn their BSN at their affiliate and then work at the hospital. In some cases, a differential is even paid to nurses with a BSN.

Online courses. There’s been a steady increase in the number of ADN to BSN online courses, which makes it much easier for working nurses because they can complete courses on their own time (Tate, 2017).

Community colleges and universities working together. More community college ADN programs and universities are working together to combine their programs and offer community college students an opportunity to earn a BSN (Boivin, 2017; Lynch, 2015; Nelson, 2017).

Why Aren’t We There Yet?

Lack of Time and Money. First and foremost, many recent ADN graduates—especially those who already have families—don’t have the time or money to go back to school to get their BSN. The pressures of starting a new and stressful nursing job while having to pay student loans, bills, payments, etc. are enough to handle. Going back to school seems to be more realistic a few years down the line when one’s career is more stable. No matter where they are in their careers and lives, time and money complications will always be there for ADN graduates.

Lack of Hospital Funding and Resources. The number of patients seen at hospitals is steadily increasing as the baby boomer generation gets older (Geriatricnursing.org, n.d.). Many hospitals are understaffed and can’t afford to make having a BSN a hiring requirement. They also can’t afford to offer a differential to BSNs, which means there are no incentives for ADNs to go back to school.

Lack of Legislation. The New York ‘BSN in 10’ bill was the first of its kind… and it took 14 years to pass. It’s expected that other states will pass bills, but the time frame is unknown. It’s also unclear if New York’s bill will have negative consequences (i.e. nurses do not want to go to school for four years and chose another career path.)

Where Do We Go from Here?

Having an ADN pathway into entry-level nursing certainly complicates the effort to get 80% of nurses to be BSNs. It may be possible to reach the number, but not without drastic changes to nursing education. Now that roadblocks have been identified, finding ways around them will help. Legislation like the bill passed in New York may also be an answer, but it’s impossible to tell right now. Regardless of how or when the goal is met, it’s important to always keep in mind that providing the best nursing care possible to patients is most important.

How to Cite this Blog Post in 7th ed. APA: Oescher, J. (2020, April 7). 80% BSN by 2020: Why aren’t we there yet? [Blog post]. Nursing Education Expert. https://nursingeducationexpert.com/bsn-by-2020 

This post was proofread by Grammarly.** 

References and Sources (7th ed. APA)*

*Hanging indent doesn’t work on my blog posts, so just know that you need to use a hanging indent for your reference page citations when using APA format.

Boivin, J. (2017, July 31). Can nursing meet the 80/2020 goal? American Nurse Today, 12(7), 33-34. https://www.myamericannurse.com/can-nursing-meet-802020-goal/

Geriatricnursing.org. (n.d.). Baby boomers and their effect on healthcare. https://geriatricnursing.org/baby-boomers-and-their-effect-on-healthcare/

Institute of Medicine (IOM). (2011). The future of nursing: Leading change, advancing health. The National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK209885/

Kutney-Lee, A., Sloane, D. M., Aiken, L. H. (2013). An increase in the number of nurses with baccalaureate degrees is linked to lower rates of postsurgery mortality. Health Affairs, 32, 579–586. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711087/

Lynch, J. P. (2015, December 10). IOM releases progress report on the future of nursing 2020 goals. https://www.nurse.com/blog/2015/12/10/iom-releases-progress-report-on-future-of-nursing-2020-goals/

National Academies of Sciences, Engineering, and Medicine. (2016, February 22). Achieving higher levels of education. In S. H. Altman, A. S. Butler, & L. Shern (Eds.), Assessing progress on the Institute of Medicine Report The Future of Nursing (pp. 57-107). National Academies Press. https://www-ncbi-nlm-nih-gov.libproxy.uccs.edu/books/NBK350166/pdf/Bookshelf_NBK350166.pdf 

Nelson, L. (2017, December 30). New York’s BSN in 10 Law and the Push For 80% of Nurses to Hold BSN by 2020. https://nurse.org/articles/BSN-initiative-80-2020/

Pinto, B. (2019, October 28). 80% BSN by 2020 initiative: What now? https://www.thechicagoschool.edu/insight/health-care/80-percent-bsn-by-2020-what-now/

Spetz, J. (2018). Projections of progress toward the 80% bachelor of science in nursing recommendation and strategies to accelerate change. Nursing Outlook, 66(4), 394-400. https://doi.org/10.1016/j.outlook.2018.04.012

Tate, E. (2017, April 26). Addressing the nursing shortage. Inside Higher Ed. https://www.insidehighered.com/digital-learning/article/2017/04/26/online-programs-offer-academic-progression-nurses

Wolters Kluwer. (2017, February 17). IOM: 80% of registered nurses have BSN degree by 2020. http://nursingeducation.lww.com/blog.entry.html/2017/02/19/iom_80_of_register-0Z2N.html

ABOUT THE AUTHOR: Jeff Oescher worked for over 6 years as an orthopedic clinical associate and case technician. He now works as a medical writer for Vohra Wound Physicians, a national wound care physician group.

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