Entry into Nursing

The basic question behind the phrase “Entry Level” is “What are the educational requirements essential in the preparation for professional nursing practice?  The key word, of course, is professional.  The question, “what determines professional nursing” will not be addressed here.  The question which will be addressed is, “Why are we concerned about educational preparation for professional nursing practice?”

Historically, as a primary female vocation, nursing has been affected by all issues which affect women.  One issue has been that of low status in society.  Traditionally, this country has identified higher education in colleges and universities to be one way to gain greater social status.  Nursing has elected to follow this trend.

Prior to the time of Florence Nightingale, nursing went through a period known as “The Dark Ages of Nursing.”  During this time, except for the nursing care provided by religious orders, nursing was carried out by women prisoners and prostitutes.  Nursing had a long way to come to erase the stigma of such a time.  The schools of nursing established by Florence Nightingale were planned carefully to permit women to enter nursing without fear of ostracism by society.

In 1913, Mary Riddle, a nurse leader said, “the general esteem in which a vocation is held increases in direct proportion with the educational standards of that vocation.”  This is still a basic belief today.  In the 1940’s the Brown report emphasized the need for college preparation for nursing. 

In 1960, the American Nurses Association House of Delegates established its plan for increasing the status of nursing through university education.  In 1964, the ANA directed its committee on education to work with all deliberate speed toward this goal.  In 1965 a formal statement was issued as an ANA position paper that the educational preparation for entry into professional nursing should be at the baccalaureate (BSN) level. 

In 1974 the New York State Nurses Association resolved that this BSN preparation should go into effect by 1985.  This is the “85 Resolution.”  In 1978 this resolution was adopted by the ANA, the National Student Nurses Association, the VNA, and SNAV.  This is not a law.  It is a resolution; a statement of intent.  The ANA is one of our professional organizations, yet only 15-20% of the nursing population is members.  Can it be said then that this mandate for higher education is a mandate from the profession?

There is certainly logic to both sides of the entry-level issue.  If that logic were not convincing on both sides then the issue would have been resolved years ago, one way or the other.  To accept the logic of both sides of an issue is to seek a wise agreement rather than being locked into a position which must be defended at all costs.

There is logic in recognizing that nursing knowledge and responsibility has changed mightily in the last two decades and to meet the challenge of that change requires higher education.  There is logic in acknowledging that society recognized college degrees as being desirable and that nursing has a responsibility to work to upgrade its status as a profession in this society.

On the other hand, there is the logic of recognizing that this change in nursing knowledge and responsibility has been recognized by nursing educational programs other than those programs based in colleges and universities and that their response has been a positive one. 

It is logical to realize that graduates of these nursing programs have been and continue to be strong contributors to the nursing profession.  To diminish the status one already has attained creates dissension, and this dissension in the long run has been detrimental to the nursing profession.

If nursing desires the Baccalaureate degree as the educational criterion for professional nursing, it could look at what it has and devise logical mechanisms for the majority to attain this criterion.  When this mechanism is put into action, what already exists would be the required status.  This would be a middle-ground decision which would gain the increased educational requirements without threatening the credibility of many for the advancement of a few.

Whatever method we use to reach a goal, nursing must accept the fact that the public will identify as nurses those persons who are working directly with them.  How the nurse responds and reacts as she provides direct care will determine the image of nursing in so far as the public is concerned.  If nursing is not represented by these persons in a professional manner, then our educational preparation will not change this perspective.

Shirley Odell, MSN, RN

Director, Riverside Hospital of Professional Nursing


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