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Nursing education update
Navigating today's degree options
By Lisette Hilton
Nursing education is evolving as healthcare becomes more complex. That’s because nursing is at the frontlines of changes to education designed to meet the needs of not only today’s patients, but also systems of care. asked Martha M. Scheckel, PhD, RN, dean and professor of nursing, health and human behavior,
Viterbo University, La Crosse, Wis.
, to update readers on education trends in nursing.
Describe today’s degree options.
Today’s degree options include practical nursing, the associate degree, baccalaureate degree, diploma, master’s degree and doctoral degree.
The diploma has been phased out over a number a years, but some diploma programs still exist.
Practical nurses work under the supervision of registered nurses. Their scope of practice can include assessing a patient’s needs, to performing particular skills, to providing patient education.
The registered nurse is prepared with an associate degree, a baccalaureate degree or a diploma. In nursing you can take the state board exam after any of those degrees.
The scope of practice for a registered nurse is to care for patients across the lifespan, bringing to that care a high level of knowledge and skills in areas, such as providing high-quality bedside nursing; bringing clinical reasoning and judgement, and critical thinking to patient situations; ensuring quality and safety of all patient populations; and acting as leaders in nursing.
Today’s registered nurses use evidence-based practice to provide care. I often give new nursing students an example of why evidence-based practice is so important. Say, for example, the nurse is working in the emergency room and has a patient with a heart condition who comes in frequently due to ongoing cardiac symptoms.

That nurse needs to be able to read, understand and use evidence-based practice in order to help keep that patient out of the emergency room and at home.
Now the master’s degree [is] undergoing a transformation to where the future will have more doctor of nursing practice, or DNP nurses, and fewer master’s-prepared nurses. This transformation is due to complex healthcare environments, which are requiring more and more nurses with advanced preparation in nursing practice.
Nurses can also obtain a PhD, which prepares them to generate research for use in the discipline of nursing and other closely related disciplines.
A comprehensive description of nursing education across time is in the new second edition of
Trends in Nursing Practice Policy and Leadership
, by Gayle Roux and Judith A. Halstead.
What’s happening with the associate degree in nursing? Is it transitioning to the BSN?
No. I think in the U.S., we will continue to see associate degree programs in full force. I do think that we will continue to see momentum to meet the goal in the
Institute of Medicine's 2010 report
of having 80% BSN-prepared nurses by 2020.
Nowadays, what we’re seeing, because of the IOM report, is that institutions are mandating that an associate degree-prepared nurse acquire the bachelor’s degree in a specified amount of time—perhaps five years or six years. In essence, nurses who go to a community or technical college graduate with the associate degree and pass their state boards, can continue to work and earn income while getting their bachelor’s in nursing degree. The other thing that has happened over the last few years since that IOM report is seamless academic progression programming from a community or technical college into a university. We’re seeing partnerships forming between community colleges and universities so a student can still get that associate degree and move right into baccalaureate completion. There have been lots of initiatives around the country and funding for creating these academic progression programs.
What is most important for nurses to understand about higher education, in your mind?
It’s imperative for developing the knowledge, skills and attitudes to be part of the healthcare team — to ensure quality and safety in patient care and excellent patient outcomes. It is so important. I was initially an associate degree prepared nurse, and I knew there were things that I was missing. I had enough to function as a safe, excellent nurse, but I knew there was course work that I didn’t get.

Public health was one area. In my program, pathophysiology was another area. I felt that I was an effective nurse, but I felt I was a more effective nurse with that additional education.
What are basic differences among doctorate nursing degrees?
AACN has a great document about the differences among the doctoral degrees. According to the AACN document, the DNP prepares “nurse leaders at the highest level of nursing practice to improve patient outcomes and translate research into practice.” AACN states that the objectives of the PhD and DNS are to: “Prepare nurses at the highest level of nursing science to conduct research to advance the science of nursing.”
Having both the DNP and PhD is really a beautiful combination. I’m a PhD nurse, prepared in research. But the DNP prepared nurses are really good at taking that research and knowing how to synthesize it and translate it at the bedside.
We’re seeing partnerships forming between community colleges and universities, so a student can still get that associate degree and move right into baccalaureate completion
- Martha Scheckel, RN

How does higher education open doors in nurses’ careers?
Advancing one’s education prepares nurses for leadership whether it be at the bedside where it is critical or whether it is for policymaking to improve healthcare. In addition, the utilization of PhD prepared nurses has come a long way. It used to be that you wouldn’t see a PhD-prepared nurse in an acute care facility. Now it’s commonplace. A hospital in my community has nurse scientist on staff, coordinating research projects.
DNPs, of course, are in many settings. We can expect to see the doctor of nursing practice being very widespread and in a lot of settings. I see that as a positive. But there is a significant concern that there won’t be enough doctorate-prepared nurses with a research focus. The AACN is calling for more PhD-prepared nurses because the generation of nursing science is so critical. We really have to strike a better balance.
You mentioned that healthcare complexity is resulting in a greater emphasis on higher education. What about the increasing emphasis on quality improvement in healthcare? Is that putting more pressure on the profession to become more highly educated, as well?
Absolutely. According to
AACN'S The Essentials of Baccalaureate Education
even at the level of preparing the baccalaureate nurse, there’s huge emphasis on teaching nurses systems’ level thinking, which does encompass helping them understand QI initiatives.
Finally, where is the nursing workforce in terms of its pursuit of higher education?
I think we’re getting closer to full doctor of nursing practice, with less emphasis on master’s-prepared nurses. The baccalaureate degree remains a force in the profession, especially since the IOM report cited research by Linda Aiken and others that demonstrated the more baccalaureate-prepared nurses at an institution, the better the patient outcomes and lower the mortality rate. That, I think ultimately, moved nursing ahead.

We started to see policy changes in hospitals, where they said the associate degree is fine but we want you to have your bachelor’s degree in x-amount of time. Associate degree nurses continue to play a huge role, however. In rural America, for example, where there are community and technical colleges, associate degree nurses are absolutely critical for supplying nurses to rural hospitals.
According to the
Campaign for Action
, the number of nurses receiving DNPs from accredited nursing programs increased by about 16% between 2015 and 2016, while the number of people receiving PhDs increased by 8%.

In an
AACN press release
, Susan B. Hassmiller, PhD, RN, Senior Adviser for Nursing with the Robert Wood Johnson Foundation, said: “Strengthening the pipeline of nurses entering both research- and practice-focused doctoral programs is critical to meeting the nation’s growing demand for nurse scientists, faculty, expert clinicians, leaders and innovators.”
Lisette Hilton is a freelance writer.
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