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Why requiring nurses to have a bachelor's degree can improve patient safety

Nurses who earned a BA reported being significantly better prepared than nurses with associate degrees in several areas of clinical care.

Jeff Lagasse, Associate Editor

Nurses with bachelor's degrees report being very prepared in more quality and safety measures than do their peers with associate degrees, finds a new study by researchers at NYU Rory Meyers College of Nursing.

The findings, published in the Joint Commission Journal on Quality and Patient Safety, both demonstrate a growing gap in preparedness between new nurses with associate and bachelor's degrees and support ongoing efforts to increase educational attainment among new nurses.

THE IMPACT

The report comes amid an increase in healthcare jobs. The state of New York alone surged up to 1.2 million healthcare jobs for 2017.

An article earlier this year in the Journal of the American Medical Association, meanwhile, suggested that so much hiring around the country could potentially lead to hospitals hiring haphazardly rather than bringing in top talent.

That means it's more important than ever for hiring managers to make sure they identify strong candidates for nursing.

NYU researchers examined quality and safety preparedness in two cohorts of new nurses who graduated with either associate or bachelor's degrees in 2007-2008 and 2014-2015.

They surveyed more than a thousand new nurses (324 graduating 2007-2008 and 803 graduating 2014-2015) from 13 states and the District of Columbia, asking how prepared they felt about different quality improvement and safety topics. They then analyzed the differences in responses between nurses with associate and bachelor's degrees.

The researchers found significant improvements across key quality and safety competencies for new nurses from 2007 to 2015, but the number of preparedness gaps between bachelor's and associate degree nurse graduates more than doubled during this timeframe.

In the 2007-2008 cohort, nurses with bachelor's degrees reported being significantly better prepared than nurses with associate degrees in five of 16 topics: evidence-based practice, data analysis, use of quality improvement data analysis and project monitoring tools, measuring resulting changes from implemented improvements, and repeating four quality improvement steps until the desired outcome is achieved.

For those graduating in 2014-2015, nurses with bachelor's degrees reported being significantly better prepared than associate degree nurses in 12 of 16 topics: the same five topics as the earlier cohort as well as data collection, flowcharting, project implementation, measuring current performance, assessing gaps in current practice, applying tools and methods to improve performance, and monitoring sustainability of changes.

THE BIGGER TREND

The researchers note that laws and organizational policies encouraging or requiring bachelor's degrees for all nurses could close quality and safety education gaps. For example, New York State recently passed a law -- the first in the country -- requiring future new nurses to obtain their bachelor's degree within 10 years of initial licensure.

Employers can also effect change by preferentially hiring nurses with bachelor's degrees, requiring a percentage of the nurse workforce to have a bachelor's degree, or requiring nurses with associate degrees to obtain a bachelor's within a certain timeframe as a condition of keeping their employment. 

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