Making the case for differentiation of registered nurse practice: Historical perspectives meet contemporary efforts

Abstract

In recent years, the nursing profession in the United States (U.S.) has made new efforts to advance the education of registered nurses (RNs) who provide direct patient care to the baccalaureate degree in nursing (BSN). This renewed focus is partially due to current research noting that an RN's education is positively correlated with improved patient outcomes. In spite of the research and efforts, multiple educational pathways for entry into RN practice continue to thrive throughout the U.S. and around the globe. The purposes of this paper are to present three historical cases describing the original intent of the graduates' differentiated practice role for entry-level RN educational pathways in America and evaluate the current efforts to advance the education of RNs within the U.S. for practice differentiation by education. Lack of practice differentiation among differently prepared RNs has persisted in America for more than a century and until recently hospitals often disregarded the RN's education when hiring direct care nurses. Lack of practice differentiation by education has affected the quality of nursing care as shown by the recent research. The current efforts to advance the education of the RN do not differentiate the practice of the differently prepared RNs. The present context provides the nursing profession an opportunity to differentiate RN practice based on education. Thus, the clinical ladder program is proposed as a model to initiate differentiated RN practice at the institutional level. Clinical ladder programs can be revised to meet the needs of the individual regions around the globe.

Differentiated nursing practice as a catalyst for transformations in nursing: A multiphase qualitative interview study

“…There are a few limitations to the present study that should be considered when interpreting the results. First, the findings are only applicable to nursing practice in Dutch hospitals, although similar findings on differentiated nursing practice in the United States were described by Matthias ( 2015 ). Despite this, the present findings may help to predict trends in nursing practice transitions in other countries.…”

“…States were described by Matthias (2015). Despite this, the present findings may help to predict trends in nursing practice transitions in other countries.…”

Exploring Nurses’ Knowledge of the Glasgow Coma Scale in Intensive Care and Emergency Departments at a Tertiary Hospital in Riyadh City, Saudi Arabia

“…Conversely, the present study results do not confirm previous studies and showed no statistically significant association between educational attainment and knowledge of the GCS (Al-Quraan & AbuRuz, 2016; Jadduoa, Mohammed & Abbas, 2013). According to Matthias (2015), nurses with postgraduate degrees are not shown to be more accurate in assessment compared with registered nurses who possess either a diploma or a bachelor's degree. This research gap regarding the complexity of nurses' educational attainment warrants further exploration.…”

Countering Structural Racism through Alternative Approaches to Baccalaureate Nursing Education

“…Diploma Programs, established in the 1870s, were the first pathway to nursing (Matthias, 2015). Diploma programs were typically either affiliated with hospitals or were independent in an apprenticeship model to provide education and career options for women (Anderson, 1981;Petges & Sabio, 2020).…”