Introduction
Recent studies have shown the importance of quality of nursing education in dealing with modern requirements in healthcare systems. Studies have shown a correlation between nursing outcomes in healthcare systems and the level of education in the nursing workforce. According to the Institute of Medicine, the future of nursing depends on the quality of education and ability to deal with the 21st-century healthcare challenges that are characterized by an aging population and the need to offer services in a more culturally diverse population (2010). Currently, there are three ways in which nurses get licenses to serve as registered nurses: a three-year diploma program, a three-year associate degree offered at community colleges and a four-year baccalaureate degree offered in universities (American Association of Colleges of Nursing, 2016). Modern nurses should have skills in critical thinking, leadership, case management and health promotion, in addition to the academic skills. Although all the graduates in the three programs sit for the same final exam, there is a significant difference in the course work taught in the baccalaureate degree programs and associate degree level programs that impacts their ability to practice in the current dynamic environment in the healthcare system.

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Differences between associate degree and baccalaureate degree programs
There are various differences between associate nursing degree programs and baccalaureate degree programs. Graduates in associate-degree level programs undergo a 2-3 year program that is mainly based on providing the technical expertise. These skills are meant to ensure minimum competency in practice. On the other hand, graduates from the baccalaureate degree program undergo all the course work taught in associate degree and diploma programs, plus additional course work on professional development. The professional developments courses include physical and social sciences, nursing research, public and community health, nursing management, and the humanities (American Association of Colleges of Nursing, 2016). The additional courses by the graduates in baccalaureate nursing programs form the basis for their differences in ability to practice in a dynamic healthcare environment. The Baccalaureate graduates are prepared for a broader scope of practice that includes a better understanding of the cultural, political, economic and social issues that influence the delivery of healthcare services and health outcomes.

Unique competencies among baccalaureate graduates
Policymakers have recognized the differences between associated degree and diploma programs and the baccalaureate degree programs in preparing registered nurses for practice. Currently, nurses prepared for practice through baccalaureate degree programs are highly valued by federal agencies, military, nursing executives, and healthcare foundations among other agencies for their professional skills to adapt their practice to suit various needs. There is overwhelming evidence showing a relationship between healthcare outcomes and the number of baccalaureate graduates in a healthcare facility. A study in 2014 found that a 10% increase in the number of baccalaureate nurse workforce in hospital units in the United States lowered the mortality rate by 10.9% (American Association of Colleges of Nursing, 2015). The studies in the US on the impact of baccalaureate nursing graduates on healthcare outcomes are replicated in other countries where nurses are now encouraged to have professional skills in addition to technical knowledge. Each of the additional courses in the baccalaureate nursing program can be associated with an important factor on healthcare outcome. The courses on physical and social sciences enable baccalaureate graduates to effectively serve in a team alongside other professionals in the healthcare system including doctors, pharmacists, and nutritionists. Courses on nursing research and nursing management enable the nursing workforce to apply evidence-based practice and continuously improve their skills through research. Courses in community health and humanities enable nurses to respect diversity, observe ethical requirements and provide patient-centered care.
A patient care situation whose effective decision making may depend on educational preparedness.

An example of a patient care situation is providing care a member of a minority group who refuses to take a certain medication because of their cultural beliefs. An associate nursing graduate is trained to provide care based on the technical skills in evaluating the health condition without considering socio-cultural issues that impact healthcare outcomes. A baccalaureate nursing degree graduate will be able to evaluate factors that may create barriers to the access of healthcare services among members of certain cultural backgrounds. In this case, a baccalaureate graduate would adjust the general procedure to provide patient-centered care that takes into consideration the beliefs and preferences of the individual. A baccalaureate nursing graduate is supposed to consider a wide range of factors that impact the delivery of care and make the necessary adjustments. In this case, the nurse uses additional skills in social sciences and humanities to provide patient-centered care that respects cultural preferences.

Conclusion
The differences between the associate nurse programs and baccalaureate degree programs show that even though all registered nurses pass through the same licensing exam, they are not equally prepared for modern requirements in practice. The NCLEX exam used for licensing is meant to evaluate minimum technical competency for entry into basic nursing practice (American Association of Colleges of Nursing, 2015). The nursing graduates under the baccalaureate degree program undergo additional courses on professional competency that enable them to develop their career and practice in different environments. The available evidence shows that baccalaureate graduates in the nursing workforce are associated with better healthcare outcomes. These nurses are able to recognize barriers to healthcare provision and apply evidence-based practices in dealing with new requirements and applying current research findings. The baccalaureate degree program also enables the nurses to develop their career through research and practice alongside other professionals in providing specialized care. Policy makers now recommend all nursing training programs to include the additional courses offered in baccalaureate degree programs in order to realize the set goals on healthcare.

    References
  • American Association of Colleges of Nursing. (2015). Fact Sheet: Creating a More Highly Qualified Nursing Workforce. Retrieved 22 January 2016 from http://www.aacn.nche.edu/media-relations/NursingWorkforce.pdf
  • American Association of Colleges of Nursing. (2016). The Impact of Education on Nursing Practice. Retrieved 22 January 2016 from http://www.aacn.nche.edu/media-relations/fact-sheets/impact-of-education
  • Institute of Medicine. (2010). The Future of Nursing: Focus on Education. Retrieved 22 January 2016 from https://iom.nationalacademies.org/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Nursing%20Education%202010%20Brief.pdf