New BSN Foundational Courses Will Help Nurses Advance Their Education

    • May 12, 2015
Student nurses receive instruction in a class.

Kandi DeVenere had been a practicing nurse for two decades when she was tapped to take a leadership role at the hospital where she worked in rural Washington state. The good news came with a condition that proved to be far more difficult to meet than she had anticipated.

DeVenere had graduated with an associate’s degree in nursing (ADN) in 1989 and needed to earn a bachelor’s degree in nursing (BSN) so she could serve as manager of the hospital’s emergency department. When she inquired about baccalaureate degree requirements at the University of Washington at Bothell (UW-Bothell), she was told that many of the credits she had earned as an ADN student were not transferrable. “I was so defeated,” she said. “They basically wanted me to re-do my degree.”

DeVenere begrudgingly complied, taking on the difficult and demoralizing task of repeating a number of courses while also working full-time. Just getting to class was a challenge; she either had to drive an hour after work to get to night courses or rearrange her work schedule to attend morning classes. The process took so long, though, that she was not able to get the promotion.

Still, she spent about a year, and some $5,000, re-taking courses in math, English, chemistry, statistics, and microbiology. Adding insult to injury, she said, she had to sit alongside teenage students who aspired to one day hold the very job she already had. “Here I was a 40-year-old woman in class with 18-year-olds,” she said. “It was a humbling experience.”

In the end, though, it was worth it; she completed her degree and was promoted to a different position as clinical manager of the orthopedic and surgical care unit, and she’s now earning her master’s degree.

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Moving from an ADN to a BSN program shouldn't be as hard as it often is, leading nurse educators say. Nurse education policies can “hold students hostage” and prevent them from moving seamlessly from an ADN to a BSN program.

Jean Giddens, PhD, RN, FAAN, dean and professor at the School of Nursing at Virginia Commonwealth University

One key way to ease the transition is through BSN foundational courses—a set of non-nursing course requirements for BSN programs that could be adopted by nursing schools at universities and community colleges. This standard set of requirements would allow students to transfer credits more easily and prevent many from having to repeat courses. That, in turn, would help nurses advance their education more quickly, and at less expense and effort, proponents say.

Such a policy certainly would have helped Stephene Swift, who had practiced as an ADN nurse for 10 years when she decided to get her bachelor’s degree at UW-Bothell. She soon found out, though, that she would have to take four additional courses—two in math and two in Spanish—just to apply to UW-Bothell. The news had a “big impact” on her life, costing her about $4,500 and delaying her plans to advance her education for three years.

Chicago Summit

There is good reason to make it easier for students to get bachelor’s degrees, nurse education experts say. A more highly educated nursing workforce is needed to care for an increasingly complex and diverse population of patients, according to a 2010 report by the Institute of Medicine (IOM). Studies have shown that nurses with bachelor’s degrees are linked to improved patient outcomes and lower mortality rates. More highly educated nurses are also needed to take on faculty and leadership positions and primary care APRN roles, and to conduct scientific research.

Last summer, leading nurse educators met in Chicago to review prerequisite and general education requirements for BSN programs and identify an “ideal set” of courses that would serve as a national standard of foundational courses.

The summit was organized by Academic Progression in Nursing (APIN), an initiative that aims to accelerate implementation of promising practices that will help facilitate academic progression and reach the IOM report’s recommendation that 80 percent of nurses hold BSNs or higher by 2020. Supported by the Robert Wood Johnson Foundation (RWJF), APIN works with nine Action Coalitions organized by the Future of Nursing: Campaign for Action to transform nursing and nurse education.

Summit participants included Campaign staff members and representatives from nurse education and practice. At the meeting, they created a “menu” of foundational courses that included:

  • roughly 24 general education credits in areas such as English and communications, humanities, fine arts, and statistics and logic;
  • roughly 12 basic sciences credits in areas such as chemistry, biology, microbiology, and physics;
  • roughly nine social sciences credits in areas such as psychology and sociology; and
  • roughly 16 human sciences credits in areas such as anatomy & physiology, nutrition, pathophysiology, and pharmacology.

Participants decided to use the term “foundational” to describe the courses because it “helps us to think about these in a broader and more encompassing way,” Giddens said in a webinar designed to gather feedback from the field. The term helps nurse educators “drill down,” she said, to common and essential content areas.

The adoption of a standard set of foundational courses would make it easier for BSN administrators to accept transfer credits and for students to move into BSN programs, added Donna Meyer, MSN, RN, dean of health sciences and project director for the Lewis and Clark Community College Family Health Clinic and president of the National Organization for Associate Degree Nursing. It would also facilitate curriculum development and help standardize preparation for professional nursing practice, she said. “It allows variability or flexibility without having to penalize students if they transfer in from another institution.”

Another way to promote seamless academic progression in nursing is through agreements like the one that Washington state community and technical colleges made with four-year universities last year to create a shorter, smoother path to the BSN. The agreement will help students like DeVenere and Swift earn BSNs, which will, in turn, improve the quality and safety of patient care, proponents say.  

APIN and Campaign for Action leaders, as well as summit participants, plan to ask community college and university administrators across the country to compare their requirements for nursing students with the recommended foundational courses, and to work together across institutions to identify areas of alignment. They also plan to start discussions about foundational courses with state Action Coalitions, state boards of nursing, and accrediting agencies. The changes will take time, Giddens said, adding: “I wish it was easy.”