Education Level of NursesIn contrast to many careers, where there is one standard route to a future career, the venture into nursing can begin by taking one of many paths. According to the American Association of Colleges of Nursing’s Robert Rosseter (2015), there are three academic routes to a career in nursing, at the registered nurse level. First, they state that individuals may pursue a diploma through three-year programs that are generally conducted through existing hospitals. Second, they report that associate’s degrees are earned through a three-year program at community colleges. Third, in order to earn a bachelor’s degree in nursing, one must pursue a four-year degree which is typically offered at four-year universities. According to Rosseter (2015), a bachelor’s degree in nursing teaches coursework, and allows the development of higher-level thinking skills which goes above and beyond those learned in other routes to a career in nursing. Specifically, they claim that more emphasis is placed on developing the depth of knowledge in the sciences, nursing research, nursing management, and health at a community level. In terms of the outcomes, an article written by Will Erstad (2015), for Rasmussen College, provides insight into the advantages of a four-year degree in nursing. He states that although all tracks culminate with taking the same licensing exam, the eventual careers may be slightly different. For instance, a nurse with a four-year degree has more options, including the ability to be a nurse educator, or to work in educating communities at a public health level. Overall, Erstad (2015) highlights that earning a four-year nursing degree may allow for better job opportunities throughout one’s career and this can lead to a higher earnings potential. In particular, and as reported by Ricky Persson (2014), those with a bachelor’s degree in nursing can enter programs for advanced nursing specialties, such as nurse practitioner, or nurse anesthetist, without needing additional coursework before matriculating. While there are advantages in terms of future earning potential with a four-year degree in nursing, when examining the costs, and time to completion, a two-to-three year degree can result in substantial savings. For instance, as reported by Janine Kelbach (2015), a two-year degree at Bevill State Community College cost approximately $10,080 at the time, whereas a four-year degree at The University of Alabama cost $100,824. Finally, in terms of public health, a study from The Journal of the American Medical Association, by Aiken and colleagues (2003), it was noted that within a surgical patient sample, there were lower mortality rates in hospitals that had a greater ratio of four-year degree nurses to two-year degree nurses. In sum, there are clearly differences in the time, financial, and educational requirements between the degrees, and although the lead to the same licensing exam, those with a four-year degree can be preferred for more advanced positions.

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Educational Preparedness and Decision-Making
In terms of a clinical situation that differently prepared nurses may handle differently, there are many that come to mind. First, because those nurses with a four-year degree are better trained in evidence-based approaches and research compared to those with two-year degrees, I could see a situation in which a patient issue arises, perhaps behavioral difficulties with a patient, despite being appropriately medicated by the attending physician. The nurse with a four-year degree may consult the literature to find behavior interventions that can be used by staff to manage unwanted behaviors. In contrast, a nurse with a two-year degree may not rely on this information, or know how to appropriately consult the necessary literature. The nurse with the four-year degree could implement these interventions, and possibly train other staff members, and nurses with two-year degrees how to implement these techniques. The nurse with the two-year degree may rely solely on clinical experience without the knowledge of how to consult the literature. This could be an issue if the nurse has limited experience with persistent behavioral difficulties despite appropriate medication management. Furthermore, the difference in patient care can be seen at a systemic level. If this nurse finds that this intervention works so well that less medication is needed, perhaps this nurse can educate others in the community regarding the literature and the intervention strategies that were used. He or she may be able to go to skilled nursing facilities and disseminate this information, whereas, a nurse with only two years of education would be overstepping his or her training if he or she were to do this.

In sum, while the paths to different nursing degrees can vary, the national licensing exams remains the same, suggesting that the basic knowledge-base is acquired by individuals with either degree. However, the eventual career paths can be vastly different, with nurses holding four-year degrees having wider flexibility in terms of careers and duties, and those choosing a two-year degree having less educational debt. Overall, there are clearly benefits and drawbacks to each approach, and it is reasonable to presume that many decisions are made based on lifestyle factors and eventual career goals.

  • Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., & Silber, J.H. (2003). Educational levels of hospital nurses and surgical patient mortality. The Journal of the American Medical Association, 290, 1617-1623. doi:10.1001/jama.290.12.1617
  • Erstad,W. (2015). RN vs. BSN: What you should know. Rasmussen. Retrieved from:
  • Kelbach, J. (2015). AND vs. BSN: The big debate. Nursing Explorer. Retrieved from:
  • Persson, R. (2014). Choosing a two-year or four-year RN program: Does it matter? Gap Medics. Retrieved from
  • Rosseter, R. (2015). The impact of education on nursing practice. American Association of Critical-Care Nurses. Retrieved from: