Evolution of Nursing Practice Over Time
The roles and expectations of nurses have evolved to require real medical knowledge and clinical experience. Nursing practice evolved from a four-step process (APIE) to a five-step model: Assess, Diagnose, Plan, Implement, and Evaluate (ADPIE). Initially, nurses could not diagnose patients, but today they do. This development had massive implications on how nurses started to think, reason, learn, and teach nursing care situations (D’Antonio, 2015). At the same time, nurses were used to limited hospitals and battlefields as their surroundings. However, the situation has changed because today, they are everywhere: in patients’ homes, military bases, schools, doctors’ offices, on the road (in ambulances), facilities, and even offering help through telehealth services. Their scope has been expounded extensively, which explains why they are in high demand in the US and overseas.
Nursing career has also evolved from being general nurses to depicting different specialized opportunities such as nurse midwives, oncological nurses, orthopedic nurses, clinical nurse specialists, nurse educators, and pain management nurses, among others (D’Antonio, 2015). Their treatment approach also follows the same script: nurses are no longer constrained to looking after patients but also carrying out other important patient care services such as midwifery, counseling services, patient empowerment, prescription, and many more. The levels of technological incorporation have also changed because nurses today are more tech-savvy and rely heavily on technology than in the past centuries.
Comparison between ADN and BSN
The Bachelor of Science in Nursing (BSN) program is an advancement of an Associate Degree in Nursing (AND) program. A registered nurse (RN) is an individual who has completed an AND or a BSN degree program, but in most cases, people refer to an AND as an RN. RNs are responsible for simple nursing care, such as recording patients’ medical history and symptoms, taking their vitals, educating patients on diseases, using simple medical equipment, and working closely with doctors to serve patients. On the other hand, a BSN-prepared nurse is qualified to undertake more complex procedures under the supervision of a doctor and can also manage other nurses. Besides educating patients and handling simple medical equipment, BSN nurses also perform nursing research, conflict management, disease prevention, and leadership responsibilities.
It is important to note that the primary difference between ADN and BSN nurses is the perks that come with advanced education. In other words, the scope of practice changes from an ADN to a BSN because advanced nursing education is associated with leadership responsibilities, higher pay, more specialized responsibilities/opportunities, and advanced quality of care. Registered nurses with BSN degrees do not just go to school longer but also gain a more in-depth education that leads to better patient outcomes and quality of care than nurses with ADN degrees. A study conducted by Lasater and colleagues (2021) to determine the changes associated with BSN and their impact on patient outcomes revealed that having BSN nurses in a healthcare center leads to fewer medical errors, lower patient mortality, and better relationships through effective communication. Therefore, the two are different, and it is the reason I am pursuing a BSN to make a difference in the healthcare field.
Client Care Situations for an ADN Nurse and a BSN Nurse
For example, a patient visits a facility and goes through a patient assessment, and a clinical decision is required. The nature of the assessment undertaken by an ADN nurse will differ from that undertaken by a BSN nurse. The ADN nurse will likely follow the necessary procedure of taking patient vitals, recording their medical history, and involving a doctor for diagnosis and treatment. On the other hand, a BSN nurse with more advanced education will likely convert information needed into answerable clinical questions, track down evidence based on the answers provided, critically appraise the responses and evidence for validity, impact, and applicability, and incorporate scientific evidence into clinical decision-making. In other words, the BSN nurse will incorporate evidence-based practice in the assessment process, diagnose the patient, and initiate the treatment process, which can be done by working closely with a doctor. The different levels of education between the two make the difference.
Significance of Applying Evidence-Based Practice
Evidence-based practice is the application of scientifically proven approaches to patient care and treatment processes. Evidence-based practices often lead to better patient, institutional, and provider outcomes, such as reduced costs and consistent care (Balakas & Smith, 2016). It leads to the prioritization of patient needs by medical practitioners, which translates to better patient outcomes. This is because EBP is a combination of clinical expertise, the best research evidence, and patient values and preferences. Nurses benefit from EBP by keeping practices current and relevant, contributing to the science of the profession, and increasing nurses’ decision-making skills and confidence (Li, Cao, & Zhu, 2019). The academic preparation of the RN-BSN nurse supports the application of EBP because it leads to better patient outcomes. A nurse who applies EBP is always confident during decision-making because they have scientific evidence to support their decision.
Nurses’ Communication and Collaboration
Healthcare and the provision of healthcare services are very complex as they contain numerous disciplines and professions that contribute to a patient’s overall care. More than five medical practitioners can see a single patient in a hospital unit during their stay in the facility. For example, during an operation, a single patient is surrounded by up to 10 or even more medical practitioners to ensure success in the procedure. For this reason, multidisciplinary or interdisciplinary client care is required, which is often facilitated by high levels of collaboration and seamless communication. A study conducted by Gausvik and colleagues (2015) to determine the effect of structured nursing communication on interdisciplinary teams showed that accurate, efficient, and timely communication among multidisciplinary teams improves perceptions of safety, understanding of care plan, the efficiency of operation, teamwork, and leads to job satisfaction. Therefore, it is important for interdisciplinary teams to communicate effectively and collaborate for better results and the safety of patients.
References
Lasater, K. B., Sloane, D. M., McHugh, M. D., Porat-Dahlerbruch, J., & Aiken, L. H. (2021). Changes in the proportion of bachelor’s nurses associated with improvements in patient outcomes. Research in nursing & health, 44(5), 787–795. https://doi.org/10.1002/nur.22163
Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses-systematic review. Medicine (Baltimore);98(39): e17209. Doi: 10.1097/MD.0000000000017209. PMID: 31574830; PMCID: PMC6775415.
Gausvik, C., Lautar, A., Miller, L., Pallerla, H., & Schlaudecker, J. (2015). Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork, as well as job satisfaction. J Multidiscip Healthc. 2015 Jan 14;8:33-7. Doi: 10.2147/JMDH.S72623. PMID: 25609978; PMCID: PMC4298312.
D’Antonio P. (2015). Nursing history review. Volume 24: Official Journal of the American Association for the History of Nursing (24th ed.). Springer Publishing Company.
Balakas, K., & Smith, J. R. (2016). Evidence-Based Practice and Quality Improvement in Nursing Education. The Journal of perinatal & neonatal nursing, 30(3), 191–194. https://doi.org/10.1097/JPN.0000000000000197
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