Second Opinion

In this forum for discussing “hot button” issues facing the nursing profession today, we welcome your thoughts and opinions. Check this space each issue to see how our readers answer the provocative questions we pose.

Our question this issue:
Are baccalaureate-prepared nurses really needed in the acute care setting? Why or why not?

I believe that nurses working in the acute care setting should be prepared at the baccalaureate level. Nurses in the acute care setting must have excellent critical thinking skills, be able to analyze complex information from multiple sources, and problem solve quickly. In addition, they need a state-of-the-art understanding of cultural norms so that they can effectively serve their clients and families who come from diverse backgrounds. For example, a recent group of nursing students working in their leadership rotation at Johns Hopkins Hospital found that they encountered patients from every corner of the world. Often our students are praised for their excellent analytical skills as well as their knowledge of cultural norms that can influence health outcomes.

Carm Dorsey, MS, RN
Clinical Instructor
Johns Hopkins University School of Nursing

Given that there is no distinction in the registration and licensing process for nurses prepared at the associate, baccalaureate, or master’s level, and the current nurse shortage is forecast to reach 800,000 fewer registered nurses than needed by the year 2020, your question becomes a philosophical debate that has gone on for as long as I have been a nurse. With current registered nurse shortages running as high as 19 percent, acute care facilities have to be flexible and creative in how they deploy the scarce resource that registered nurses represent, if they are to provide quality care to the communities they serve.

There is room on an effective team for registered nurses prepared at all levels. However, different roles require different levels of training and education. The key is to build a professional nursing culture that differentiates between the levels of education and matches educational preparation to level of practice; that rewards nurses through an equitable pay program based on their education and responsibilities; that supports and encourages nurses to continue their education; that has a clinical promotion track as well as an administrative one; and that recognizes and values every nurse on the team.

Julia Gooden Bolton, ’61
Williamstown, MA

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