Nursing Education

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Nursing education related legislation includes designating dollars for scholarships and/or loan forgiveness to improve nurse recruitment/retention as well as efforts to measure continued competence.

Entry into the profession results from completion of one of the following four types of education programs and subsequent eligibility to sit for the licensing exam (NCLEX); (1) hospital-based diploma, (2) hospital-based or community college associate degree, (3) bachelor's degree, and (4) master's degree; (#4) is a less common entry point).

State Legislative Approaches

Generally, state legislation establishes funding to either create a new nursing education program, expand capacity of an existing program, or to provide for nursing scholarships and/or loan forgiveness.

Continued Competence

Mandatory Continuing Education – some states have legislated mandatory education for license renewal/re-registration as a means to demonstrating continued competence.

View document listing specific state requirements mandatory continuing education

Nursing Education Advancement - approaches continued competence through formal education/degree granting beyond the entry level. A legislative model exists that would require RNs to attain a baccalaureate degree in nursing within ten years of initial licensure, exempting (grand-parenting) those individuals who are licensed or enrolled as a student in a nursing program at the time the law is enacted.
Since 2005, legislation requiring a BSN within ten years of initial licensure has been introduced in three states (NY, NJ, and RI); none of which passed as yet.

During 2013 Session – two states considered:

  • New Jersey AB 553/SB 1258
  • New York AB 3103/SB 628

Why Legislate?
Practice has continued to evolve with increased specialization, greater demands related to technology, paperwork, and responsibility for coordinating and supervising care provided by other workers. Declining reimbursement rates have had a great influence on staffing patterns. Nurse positions have been eroded with nurse extenders (assistive personnel) filling positions previously designated for nurses; leading to fewer nurses supervising more assistive personnel in provision of care for increasingly complex patients.

This approach continues to recognize all educational entries into the profession while acknowledging the changing healthcare environment and associated competencies necessary to adapt to those changes.

An incremental approach permits those choosing to enter the profession with a diploma or associate degree to pursue additional skill sets while strengthening entry level competencies: moving from novice to expert. Nursing education advancement with work experience can result in greater relevance for the learner. Baccalaureate nursing education is intended to result in a deeper understanding of the cultural, political, economic, and social issues that affect patients and influence health care delivery. Coursework offered at the baccalaureate level include such areas as healthcare economics, health informatics, health policy, leadership, and research.


  • Research has revealed the relationship between advanced education and patient outcomes, such as lower patient mortality.
  • Baccalaureate prepared nurses are more likely to report higher job satisfaction scores in relation to opportunities for growth, and to remain in practice longer than others.
  • Increasingly more complex healthcare needs of a multi-cultural and aging population underscores the need for advanced education.
  • A stronger theoretical base and foundation in nursing research is needed as a result of the shift to evidenced based practice and expansion of more sophisticated technologies, pharmacologic and other treatment modalities.
  • Sound leadership skills are essential for case management, as well as to support the ability to delegate and supervise care provided by dependent practitioners (LPNs) and nurse extenders within the framework of varying care delivery models.
  • There is a shortage of nursing faculty and subsequent limited cadre of nurses from which to draw.
  • Advanced education will better enable nurses to practice as full partners on a multidisciplinary team, given the education advancement of a number of other health professions: Social workers - master's degree; Physical therapists – master's degree in 2002, doctoral required by 2020; Pharmacists – PharmD has replaced the bachelor of pharmacy degree.
  • The military (US Army, Navy and Air Force) require a baccalaureate degree for nurses on active duty. The Veteran's Health Administration requires a baccalaureate degree for nurses wishing to advance beyond entry level appointment. Internationally, the baccalaureate degree in nursing is required upon entry into the profession in the Philippines, Australia, Ireland, and half of Canada's provinces. The Royal College of Nurses voted to support a transition to require a university degree for professional nursing practice.
  • A recommendation that at least 2/3 of the nursing workforce hold a baccalaureate degree or higher by 2010 was presented to Congress by the National Advisory Council on Nursing Education and Practice (a group appointed by the Secretary of Health and Human Services)

Recent References

  • An Increase In The Number Of Nurses With Baccalaureate Degrees Is Linked To Lower Rates Of Post-surgery Mortality
    Ann Kutney-Lee
    , Douglas M. Sloane and Linda H. Aiken Health Affairs, Vol. 32, No. 3: 579-586 (March 2013)
  • Baccalaureate Education in Nursing and Patient Outcomes
    Mary A. Blegen, Colleen Goode, Shin Hye Park, Thomas Vaughn, Joanne Spetz JONA, Vol. 43, No. 2 (February 2013)

Nursing education advancement legislative tool kit: briefing paper, strategic action plan, model bill and talking points. (Available to members only)

Brief History of ANA's Position on Nursing Education
Passage of the Comprehensive Nurse Training Act in 1964 prompted the American Nurses Association (ANA) Committee on Education to study nursing education, practice and scope of responsibilities. At the time, the study recognized the increasing complexity of health care and changes in practice, raising concerns about hospital - based diploma education programs. Subsequently, in 1965, the ANA Board of Directors adopted the Committee on Education's statement, which became ANA's “position paper” and contained the recommendation that the “minimum preparation for beginning professional nursing practice should be baccalaureate degree education in nursing. The position paper noted that the educational programs of the time prepared workers for current practice and structures, not for the future. Also contained within the position paper was the description of three levels of nursing education: baccalaureate education for beginning nursing practice, associate degree education for beginning technical nursing practice, and vocational education for assistants in the health service occupations

The 1965 ANA position paper was later reaffirmed by a 1978 ANA House of Delegates resolution which resulted in the recommendation that by 1985 the minimum preparation for entry into professional practice would be the baccalaureate degree. The designation of two levels of nursing practice, professional and technical, was reaffirmed. What was envisioned to be an orderly transition to an educational system of two levels and subsequent differentiated practice never occurred.

Learn more about federal scholarships and loan forgiveness

Updated 12/2013
Disclaimer: Every effort has been made to include all legislation enacted, but omissions are possible.