Editorial
An alternative proposal: The single entry level The AORN House of Delegates has taken a bold step. It voted to support a single academic entry level for future registered nurses. That entry level would be the baccalaureatedegree in nursing. Despite some vocal opposition in the Forum discussions, the delegates gave the single entry level statement enthusiastic support in their voting on March 8. AORN’s statement is going to be controversial, and it is going to raise some questions. In the nursing world of the future, AORN envisions only registered nurses prepared at the baccalaureate level. The single entry level is an alternativeto the American Nurses’ Association (ANA) position that calls for two categories of nurses. The professional registered nurse would be prepared at the baccalaureate level; the second category, as yet untitled, would be prepared at the associate degree level. AORN has taken a stand in oppositionto this concept of two categories, or two levels, which have sometimes been called professional and technical. AORN believes that two categories will perpetuate the confusion about nursing practice. Especially in the operating room, AORN believes that “an artificial distinction between technical and professional nurses could fragment nursing practice.” For these reasons, AORN has proposed a single entry level of the baccalaureate degree for registered nurses, eliminatingthe associate degree
B
and diploma degree nurse programs. But the statement does not speak explicitly to the problemof whether there will be supporting personnel, and if so, who they will be. Those who read the statement, especially in its short form, may have some questions about the statement’s intent in this regard. The “second category” has been a thorny issue for nursing. There has been reluctance to even label this group. At the ANA Convention, delegates carefully avoided such terms as “two levels” or “professional” and “technical.” The 1965 ANA position paper states that this category would include the associate degree and diploma prepared nurses. It also recommends upgrading licensed practicalivocational nurses (LPNNs) to the associatedegree level. The New York State 1985 proposal reflects this position. But each of these groups that would be lumped in the second category are represented by strong interest groups. Those associated with diploma and associatedegree programs see that nursing practice downgraded. The LP/VNs feel strongly about their identity. Through their organization, The National Federation of Licensed Practical Nurses, they have stated that they want entry into nursing practice to be the LPiVN level and want to retain “the LP/VN title and profession.” The AORN statement assumes that LP/VNs would continue regulating their practice as they do now. This may be an issuethat AORN will have to clarify in the future. But one fact is clear. AORN delegates support the baccalaureate degree as the entry level for future nurses. In supporting this, operating room nurses have shown their farsightedness and their commitment to professionalism. Considering that only 15% are now
AORN Journal, May 1979,Vol29, No 6
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preparedat the baccalaureatedegree and that 65% are diploma graduates and 13% are associate degree graduates, operating room nurses demonstrated their ability to put aside individual self-interest and look objectively at the future. The AORN statement calls for implementation of the single entry level by disseminationof the statement to other nursing organizations. It also calls for advocating appropriate restructuring of the nursing education system to facilitate increased accessibility to baccalaureate programs for current as well as future nurses. The ad hoc Committee on Entry into Practice will continue to implement the position. Nursing has not yet rallied strongly around the ANA position. It is perhaps partly due to the nature of organizations. Since they meet annually, they only make important decisions once a year. Many state nurses associations are working toward the ANA goals. At the same time that AORN was deliberating, the California Nurses Association voted to support the ANA resolutions. The National League for Nursing, not unexpectedly, has come out firmly for the status quo-four levels of entry
for nursing practice. Only a few specialty nursing organizations have gone on record as endorsing the ANA position. The Emergency Department Nurses Association and the American Association of Occupational Health Nurses are two. Some are adopting a waitand-see attitude. AORN’s statement may be an alternative that other groups can support. Members can help give it impetus by discussing it with other nurses in their hospital and community. Nursing needs the baccalaureatedegree as the basis of its profession. AORN’s statement strongly supports this. Although there may be some questions and disagreements regarding the intent of the statement as it relates to supporting personnel, it clearly backs the baccalaureate degree for registered nurses. AORN now joins those nurses and organizations who are working toward implementing this goal. Nursing needs to be together to reach it.
Elinor S Schrader Editor
How others see the AORN statement To see how others perceived AORN’s statement on a single entry level, we talked with several nursing leaders after Congress. Barbara Nichols, ANA President, who attended the AORN Congress for a few days, said she “was pleased to know that AORN had joined with ANA in supporting the baccalaureate education as the entry level for professional nursing practice.” “I do not see it as in conflict with ANA’s position,” she added. “I am ecstatic about it. It symbolizes the commitment-the need for professionalism. If OR nurses can identify that their practice is professional, that is consistent with ANA’s goals.” Looking at whether “we have one level or two levels,” Nichols said that “over time, with more deliberation and definitive study, we may get to a single entry level. At some time in the future,
1022
nursing may arrive at that point. Two levels may be a bridge.” Nichols sees that AORN and ANA are in agreement that baccalaureate education is necessary for professional practice. She perceives the question of one or two levels as a separate issue. “If we can get agreement in nursing on the BSN,” she stressed, “then we can go on to fabricating mechanisms to move that forward.” Also commending AORN for its resolution was Anne Zimmerman, immediate past-president of ANA, who presided over last June’s ANA convention. However, she believes it is a “half position.” She questioned what AORN’s stance was in regard to the second category of nursing. “There is another shoe to drop.” She suggested that AORN will wait until the categories are titled and defiged, then take a position.
AORN Journal, May 1979,V o l 2 9 , No 6
An alternative proposal: The single entry level The AORN House of Delegates has taken a bold step. It voted to support a single academic entry level for future registered nurses. That entry level would be the baccalaureatedegree in nursing. Despite some vocal opposition in the Forum discussions, the delegates gave the single entry level statement enthusiastic support in their voting on March 8. AORN’s statement is going to be controversial, and it is going to raise some questions. In the nursing world of the future, AORN envisions only registered nurses prepared at the baccalaureate level. The single entry level is an alternativeto the American Nurses’ Association (ANA) position that calls for two categories of nurses. The professional registered nurse would be prepared at the baccalaureate level; the second category, as yet untitled, would be prepared at the associate degree level. AORN has taken a stand in oppositionto this concept of two categories, or two levels, which have sometimes been called professional and technical. AORN believes that two categories will perpetuate the confusion about nursing practice. Especially in the operating room, AORN believes that “an artificial distinction between technical and professional nurses could fragment nursing practice.” For these reasons, AORN has proposed a single entry level of the baccalaureate degree for registered nurses, eliminatingthe associate degree
B
and diploma degree nurse programs. But the statement does not speak explicitly to the problemof whether there will be supporting personnel, and if so, who they will be. Those who read the statement, especially in its short form, may have some questions about the statement’s intent in this regard. The “second category” has been a thorny issue for nursing. There has been reluctance to even label this group. At the ANA Convention, delegates carefully avoided such terms as “two levels” or “professional” and “technical.” The 1965 ANA position paper states that this category would include the associate degree and diploma prepared nurses. It also recommends upgrading licensed practicalivocational nurses (LPNNs) to the associatedegree level. The New York State 1985 proposal reflects this position. But each of these groups that would be lumped in the second category are represented by strong interest groups. Those associated with diploma and associatedegree programs see that nursing practice downgraded. The LP/VNs feel strongly about their identity. Through their organization, The National Federation of Licensed Practical Nurses, they have stated that they want entry into nursing practice to be the LPiVN level and want to retain “the LP/VN title and profession.” The AORN statement assumes that LP/VNs would continue regulating their practice as they do now. This may be an issuethat AORN will have to clarify in the future. But one fact is clear. AORN delegates support the baccalaureate degree as the entry level for future nurses. In supporting this, operating room nurses have shown their farsightedness and their commitment to professionalism. Considering that only 15% are now
AORN Journal, May 1979,Vol29, No 6
1021
preparedat the baccalaureatedegree and that 65% are diploma graduates and 13% are associate degree graduates, operating room nurses demonstrated their ability to put aside individual self-interest and look objectively at the future. The AORN statement calls for implementation of the single entry level by disseminationof the statement to other nursing organizations. It also calls for advocating appropriate restructuring of the nursing education system to facilitate increased accessibility to baccalaureate programs for current as well as future nurses. The ad hoc Committee on Entry into Practice will continue to implement the position. Nursing has not yet rallied strongly around the ANA position. It is perhaps partly due to the nature of organizations. Since they meet annually, they only make important decisions once a year. Many state nurses associations are working toward the ANA goals. At the same time that AORN was deliberating, the California Nurses Association voted to support the ANA resolutions. The National League for Nursing, not unexpectedly, has come out firmly for the status quo-four levels of entry
for nursing practice. Only a few specialty nursing organizations have gone on record as endorsing the ANA position. The Emergency Department Nurses Association and the American Association of Occupational Health Nurses are two. Some are adopting a waitand-see attitude. AORN’s statement may be an alternative that other groups can support. Members can help give it impetus by discussing it with other nurses in their hospital and community. Nursing needs the baccalaureatedegree as the basis of its profession. AORN’s statement strongly supports this. Although there may be some questions and disagreements regarding the intent of the statement as it relates to supporting personnel, it clearly backs the baccalaureate degree for registered nurses. AORN now joins those nurses and organizations who are working toward implementing this goal. Nursing needs to be together to reach it.
Elinor S Schrader Editor
How others see the AORN statement To see how others perceived AORN’s statement on a single entry level, we talked with several nursing leaders after Congress. Barbara Nichols, ANA President, who attended the AORN Congress for a few days, said she “was pleased to know that AORN had joined with ANA in supporting the baccalaureate education as the entry level for professional nursing practice.” “I do not see it as in conflict with ANA’s position,” she added. “I am ecstatic about it. It symbolizes the commitment-the need for professionalism. If OR nurses can identify that their practice is professional, that is consistent with ANA’s goals.” Looking at whether “we have one level or two levels,” Nichols said that “over time, with more deliberation and definitive study, we may get to a single entry level. At some time in the future,
1022
nursing may arrive at that point. Two levels may be a bridge.” Nichols sees that AORN and ANA are in agreement that baccalaureate education is necessary for professional practice. She perceives the question of one or two levels as a separate issue. “If we can get agreement in nursing on the BSN,” she stressed, “then we can go on to fabricating mechanisms to move that forward.” Also commending AORN for its resolution was Anne Zimmerman, immediate past-president of ANA, who presided over last June’s ANA convention. However, she believes it is a “half position.” She questioned what AORN’s stance was in regard to the second category of nursing. “There is another shoe to drop.” She suggested that AORN will wait until the categories are titled and defiged, then take a position.
AORN Journal, May 1979,V o l 2 9 , No 6
