This article covers Patient Safety Outcomes between ADN and BSN Nurses.


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Patient Safety Outcomes between ADN and BSN Nurses

One of the major recommendations indicated in the Institute of Medicine (IOM) report titled “The future of Nursing:  Leading change, Advancing health” is to increase the number of nurses with Baccalaureate degree to 80 percent by 2020(IOM, 2010). The recommendation was a culmination of several research studies that investigated the competence of nurses with various levels of education on patients’ outcomes.

To become a registered nurse in United States, an individual can use three main routes.  The first is to pursue a three year diploma course offered in hospitals; the second approach is to undertake a 3 year associate degree (ADN) that is usually taught in community collegesand the final path is to enroll for a four year baccalaureate degree, which is usually offered in advanced senior colleges and universities (American Association of Colleges for Nursing, n.d).   However, nursing graduates from all the aforementioned programs must take similar national exams to be fully licensed to operate in the country.

One of the main objectives on nursing is to provide healthcare services to patients and promote their health. In this regard, the patients’ outcomes are used as the benchmark for assessing the quality of care delivered by the nurses. For this reason, the relationship between patient’s outcomes and nurses level of education has been studied in the past, resulting to recommendations that more nurses should be enrolled for Bachelor of Nursing (BSN) instead of Associate Degree Level (ADN).

Several research studies have associated BSN nurses to better patients outcomes than ADN nurses (Aiken, Clark & Cheung, 2003).   The patients outcomes associated with BSN nurses includes reduced mortality rate and increased satisfaction of both the clients and their families (Phillips, et al, 2002).  A study by Johnson (1988) showed that BSN prepared nurses had better communication and problem solving skills in addition to higher competence in making nursing diagnoses and assessing nursing interventions compared to ADN prepared nurses.

Another study found an improvement of requisite nursing skills among ADN and diploma nurses who completed BSN program (Philips, et al, 2002). Other research studies have found BSN nurses to have enhanced research skills and ability to relate with patients better than ADN (Aiken, Clark & Cheung, 2003).  Nursing professional bodies and significant healthcare institutions prefer BSN nurses to ADN (Lucero, Lake  & Aiken, 2010).  This preference is attributed to the fact BSN program is more rigorous and inclusive of relevant courses suitable for imparting appropriate skills to nurses than ADN, , which empower nurses adequately to undertake clinical and non-clinical related roles in the dynamic healthcare system.

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Patient safety outcomes between adn and bsn nurses
Patient Safety Outcomes between ADN and BSN Nurses

BSN program is more rigorous, taking one additional year than the ADN. Moreover, the program includes both scientific and social subjects, which empowers nurses with additional skills especially communication and interpersonal competences (Aiken, Clark & Cheung, 2003). This enhances the ability of BSN nurses to treat and interact with patients and other clinicians, which ultimately leads to better patient’s outcomes. Moreover, BSN program prepares the nurses to assume leadership positions in the profession and be more adaptable to integrate the emerging technologies in healthcare into practice (American Association of Colleges for Nursing, n.d). This ultimately results to better patients’ outcomes.  

From my experience, I agree with the findings that BSN prepared nurses report better patient’s outcomes compared to their ADN counterparts.  However, it is also important to note that patient’s outcomes are not solely dependent on nurse’s level of education. Other factors, including the resources available in the health institution, the motivation of the nurses and nursing staffing are influential in determining patient’s outcomes (Lucero, Lake & Aiken, 2010).


Aiken L.H, Clark, S., & Cheung, R(2003). Educational levels of hospital nurses and surgical patient mortality. JAMA, 12: 1617-1623.

American Association of Colleges for Nursing.(n.d). The impact of education on nursing   practice. Available from

Institute of Medicine. (2010). The Future of Nursing: Leading Change, Advancing    Health. Washington, DC: National Academies Press.

Johnson, J. (1988). Differences in the performance of baccalaureate, associate degree and  diploma nurses: A meta-analysis. Research in Nursing and Health, 11, 183-197.

Lucero, R, Lake E.T & Aiken, L.H. (2010). Nursing care quality and adverse events in  US hospitals. Journal of Clinical Nursing. 19:2185-2195.

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