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.