According to the American Association of Colleges of Nursing (AACN), education has a critical impact on the competency of a nurse clinician and other healthcare providers. The education gained in school provides nurses with critical thinking skills and competencies necessary to excel in delivering quality patient care. The Associate of nursing degree provides the essentials necessary to provide nurses with the basic skills requirements needed to provide competent nurse care. The AACN (2014a) suggests that registered nurses comprise the largest portion of the US workforce and are the highest paid, with just under 60 percent of RNs working in general medical and surgical hospitals. Healthcare services are largely provided by nurses, with many also working in settings that include private practice, health maintenance organizations, public health agencies, home healthcare and related agencies (AACN, 2014a). A nurses education may impact her ability to work in various settings, with increased education opening doors to more advance practice. The primary pathway to professional nursing compared to technical practice is the BSN; a technical practice is more associated with the associate level degree (AACN, 2014a).

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The Bachelor of Science Nursing Degree (BSN) prepares nurses to meet the demands of contemporary society. Nurses with a BSN are able to work in multiple settings, including working as leading nurses in healthcare foundations, magnet hospitals, and federal agencies and as nurse executives (AACN, 2014). The BSN program incorporates the work included in the Associate and Diploma programs along with additional coursework in professional development and greater understanding of issues that affect nursing from a political or healthcare perspective (AACN, 2014).

According to the American Organization f Nurse Executives (AONE), as per the AACN (2014), registered nurses should be prepared by a BSN to be prepared as clinicians in challenging and complex roles. At present statistics demonstrate that only 55 percent of nurses hold a degree equivalent to a BSN or higher, according to a report published in The US Nursing Workforce: Trends in Supply and Education (AACN, 2014). Other statistics suggest that having a BSN may reduce the number of errors, including an average reduction in deaths by 2.12 by every 1,000 patients as a result of greater training and education (AACN, 2014).
Patient Care Situating How Nursing Care or Approaches to Decision Making May Differ Based n BSN vs. Diploma or AND

According to McHugh & Lake (2010), clinical expertise leads to quality patient care. Factors contributing to expertise include individual nurse education and experience on clinical nursing expertise. Further, contextual factors that impact care include the educational and experience levels of a nurses coworkers along with the nurse (McHugh & Lake, 2010). Their studies demonstrate the mean nurse experience level at the hospital level does not significantly impact mortality; a higher number of nurses with more than five years of experience does result in fewer medication errors and fewer patient fall rates (McHugh & Lake, 2010). Lower experience, or nurses at the associate level, are more likely to experience more near-miss needle stick misses, and more likely to experience burnout than inexperienced nurses. Educational influences also suggest that nurses at the associate level have less of a foundation for judgment necessary to make solid decisions as those gained from experience. Theory and principles gained during experience from a BSN allow nurses with a BSN to ask more targeted questions related to patient problems; these nurses may provide safer patient care, and make sounder clinical decisions (McHugh & Lake, 2010).

McHugh & Lake (2010) also suggest that BSN prepared nurses may be associated with lower surgical patient mortality and failure to rescue. This may be associated with experience, and better skills in delivering decisions in urgent care settings. However the total years of experience working in a hospital is not associated with total overall better outcomes, and did not change the relationship between education and outcomes. Thus, a BSN prepared nurse more likely possesses better critical thinking skills than an associate-prepared nurse, and may possess better clinical judgment skills than those nurses prepared with less education.

There are many levels of expertise however, even within the associate and bachelor level. These include the beginner nurse, competent nurse, proficient and expert nurse. Nurses at the beginning stage are typically still learning and taking part in internships or learning. Those with competency or proficient are more likely to possess a degree and have advanced problem-solving and critical thinking skills.

  • AACN. (2014a). Fact Sheet. Retrieved from:
  • AACN. (2014). The Impact of Education on Nursing Practice. Retrieved from:
  • McHugh, M.D. & Lake, E.T. (2010). Understanding Clinical Expertise: Nurse Education, Experience and the Hospital Context. Res Nurse Health, 33(4): 276-287.