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Old 04-26-2012, 12:35 AM
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Default MSN vs. BSN as entry-level nursing PART 3

(part 3)

On March 23, 2010, the U.S. president signed the healthcare reform bill into law. With the healthcare system changing, nurses are also changing in their career path as well. Because part of the healthcare reform was designed to help those 47 millions of American who don’t have insurance. Karen Haller, RN, PhD, FAAN, vice president of nursing at Johns Hopkins Hospital said, "We don't have the primary care providers to care for those people, so I think the demand for nurse practitioners will grow astronomically.” She also said "Quality and safety improvements are by and large led by nurses who have a master's-prepared nurse’s degree". Holy Cross Hospital Executive Director of Nursing Services Taren Ruggiero, MSN, RN explained that “We will need to find nurses who have critical thinking and are getting away from being task oriented.” These evidence supported the need of MSN in the near future.

The changes in healthcare and our society with 78 million aging baby boomers means nurses trained in gerontology, family practice, hospice and palliative care, faith community, home health and holistic practices especially should be needed. To ensure that primary care nurse practitioners have the skills to care for these patients, a program called Adult-Gerontology Primary Care Nurse Practitioner Competencies is developed as a hybrid curriculum, merging the knowledge, skills, attitudes and competencies of NPs providing primary, acute and geriatric care. It is evident that a more skilled professional is needed to meet these needs. As the physician shortage continues to increase, highly skilled nurses are becoming more depended upon. Growing gaps in qualified medical staff in the U.S. can be filled with Advanced Practice Registered Nurses with MSNs. While access to proper medical care is decreasing in rural areas, costs are rapidly increasing making adequate care unavailable to those that need it the most. An MSN degree would make a nurse qualified to treat much of the population that is currently being underserved due to the physician shortage and rising costs. These “mid-level” positions are essential to an economy that is face with a shortage of physicians. Physicians are increasingly becoming more dependent on Nurse Practitioners as the shortage increases. It is expected that the shortage will cause even more problems as the Health Care Reform creates access to healthcare for 32 million more people by 2014.

What can the Nurse Practitioner do? The article Doctors Turning to Assistants for Primary Care by Amanda Cuda defines the nurse practitioners role in health care. “ NP’s practice all the same functions as a RN but they are also able to diagnose many common conditions or illnesses, prescribe certain medications and perform some minor procedures or surgeries. “ (Cuda, 2012) NP’s have the ability to hold their own practices working independent of a doctor but often times, physicians choose to hire NP’s into their practice over other physicians to save on costs. NP’s are preferred because of the high level of patient centered care they provide. NP’s are “trained” in the art of nursing presence. “In a 2009 survey by the Connecticut State Medical Society of 498 physicians statewide, 25 percent of those polled said they employed a physician assistant and 46 percent employed an adult nurse practitioner.” (Cuda, 2010)

"There's increasing recognition that if we're going to meet the primary care needs of our country we're not going to meet them just by training more physicians. It's time to start talking about how we work together" (Cuda, 2012). Need continues to grow. In 2010 the nationwide physician shortage had reached 13,700. According to the Association of American Medical Colleges. The affordable care act will continue to widen the gap. AAMC estimates that by 2015 the shortage will be nearly 62,900, and by 2020 an alarming 91,500! The affordable care act strives to provide more Americans with health insurance. This means more Americans will be seeking healthcare than ever before. This concerns physicians and other professionals in the healthcare community.

Dr. Frank Scifo, director of Primary Care Development at St. Vincent’s Medical Center in Bridgeport says: "The cadre of primary care physicians is definitely shrinking," he said. "We want to make sure we have a succession plan in place to serve the needs of the community. We're going to have to tap into these pools of midlevel clinicians more. It's an essential part of meeting health care needs in the coming years." (Cuda, 2012) Nurses and doctors are aging. The American Medical Association suggests that the largest portion of current healthcare professionals are in their 50’s and are expected be retiring in the next 15-20 years also contributing to this gap. (Cuda, 2012) Some of the trends for today’s health care are a nurse practitioner seeing a client at a family clinic instead of a physician, a certified nurse anesthetist administering the anesthetic instead of an anesthesiologist, and nurses doing follow up after discharge instead of physicians. All of the nurses in these positions have a graduate-level degree or a Master’s of science in nursing. This serves as a proof that the demand for MSN, a doctoral degree, clinical specialties, teaching, and research will double in the nursing field. Another study estimated that the U.S. could save as much as $8.75 billion annually if APN were used appropriately in the place of physicians. The need for advanced practice nurses is apparent.
MSN is a master's of science in nursing, when comparing to BSN (bachelor’s science in nursing), it has two more years of advance education in nursing skills within a specialized area. The master's degree builds on the baccalaureate degree to enable the student to develop expertise in one area. That specialty can range from running a hospital to providing care for prematurely born babies, to researching the effectiveness of alternative therapies to tackling social and economic causes of health problems. Master's-level study incorporates theories and concepts of nursing science and their applications, along with the management of health care, as well as develops the knowledge, leadership skills, and interpersonal skills that will enable them to improve the health-care system.

A master’s degree is the future trends of nursing. The trends that future MSN will need to look are: the changing demographics and increasing diversity, technological explosion, globalization of the world’s economy and society, shift to population-based care and increase complexity of patient care. The cost of healthcare and the challenge of managed care, the education of consumers about alternative therapies and palliative care, health policy and regulation, growing need for interdisciplinary education for collaborative practice, nursing shortage, and significant advances in nursing science and research. All of these elements play an important role of our healthcare today and the future.
According to research and statistics, registered nurses are among the most trusted professionals for the 11th year in a row, (Jones, 2010). Nursing has also become one of the most sought out after careers. The nursing shortage has also brought more interest to the profession, including those new to nursing, as well as people simply looking for a change. Not only are salaries increasing and opportunities expanding, but it is important to acknowledge that nursing will always be in demand (Raines & Taglaireni, 2008). People are always going to need healthcare and are going to seek nursing care and advice.

According to Raines & Taglaireni (2008), the past decade has focused on new and innovative pathways to prepare nurses for an increasingly complex and uncertain healthcare environment. For example, the three traditional entry points in nursing include: diploma programs, associate degree programs, and baccalaureate programs. It is important to recognize the “phasing out” of licensed practical nurses in the acute care settings and also the push for continuing nursing education at more advanced levels. At the present time, baccalaureate degree nurses are more likely to pursue a graduate degree. In addition, there are programs to help nursing students further their education by pursuing a master’s degree in nursing (MSN). Not only are there more direct paths for RNs to take, but many schools are offering entry-level master’s degree programs. These programs are mainly geared towards people wanting a career change and who wish to enter nursing at an advanced level (Raines & Taglaireni, 2008). Many folks are beginning to take full advantage of this opportunity because of the nursing shortage. If there is an increased demand for nurses, people have job security – especially in rough economic times.

Entry-level master's degree programs prepare nurses for advanced generalist roles, including the Clinical Nurse Leader (CNL). In addition, master’s prepared nurses focus entirely on evidence-based practice, which integrates research and clinical knowledge to achieve patient-centered care. By focusing on quality improvement measures and evidence-based practice, the nursing profession will be able to achieve positive patient outcomes in care delivery.
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