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Reflection on Wrongness: Should AND Nurses Pursue BSN?

One of the most memorable quotes from all the books that I have recently read is Kathryn Schulz’s “If you really want to be right (or at least improve the odds of being right) you have to start by acknowledging your fallibility (…)” (Shulz, 2010). The greatest oncologist of our time, a brilliant journalist, and an intriguing book author in the sphere of the so-called popular science, Schulz offers a new look at how to treat errors. In contrast to people’s tendency to deny error and perceive it as a personal failure, the error should be understood as a way to truth and improvement of the world around us, Schulz believes.  And doubt, which is likely to undermine our certainty and cause us to question our belief, is nothing but a tool of exposing the truth. Doubt, Schulz believes, is a skill and even a cognitive luxury, since through doubt new knowledge emerges and old beliefs get disproved.


It is this concept of belief as something that should inevitably be subject to doubt that allows questioning many accepted truths in our society. In nursing, for example, doubt can be a good tool of examination of the belief that Associate degree nurses should necessarily strive to obtain the Bachelor’s degree.  Using Schulz's ideas on belief, evidence, certainty, and doubt and relying on her concept of error as a positive and rewarding experience, I would like to argue that contrary to the popular belief that Associate degree nurses should all have a BSN, it may not be so. It is up to the nurses to opt for their further education prospects, but  BSN should not be a requirement and is not a viable alternative to getting the Associate degree training.         

Not only is Schulz’s work beneficial in terms of helping people realize the potential of reflecting on their errors, but it also helps conduct analysis or some sort of deconstruction of the beliefs that have haunted the U.S. healthcare system and healthcare education for years. The necessity of a Bachelor’s degree for all U.S. nurses is one of them. While the National Advisory Council on Nurse Education and Practice acknowledge the advantages of BSN-prepared nurses for the healthcare system in America, this popular view may get challenged if to apply at least one of Schultz’s premises.  

Schultz argues that belief is a too shaky thing to depend on while making decisions. Evidence is what matters. Yet, it is a great challenge to pluck up the courage and take advantage of evidence, especially if it contradicts the belief. Having looked for information that is contradictory to what our beliefs are, we avoid the so-called inductive bias and have a chance to obtain truth (Schulz, 2010). This information and changed beliefs will also help us avoid a variety of errors in our everyday activities.

If to apply this premise to nursing education, the belief that all BSN nurses will be advantageous for our healthcare system needs to be questioned. The fact that this belief is exercised by numerous healthcare practitioners evidence that it is held with certainty. According to Schulz, “we take our certainty as an indication of accuracy” (Schulz, 2010, p. 74), so to look for an alternative vision, one needs to provide truly compelling evidence that will serve against the widely accepted belief. This will apparently result in a new vision of the problem.   

If to implement this very idea to the context of the belief that all nurses should obtain the Bachelor’s degree by some precise deadline, one needs to prove the opposite. For this, one needs to provide at least some evidence that this idea will not be successful in the U.S. context. Here it is! From available sources, it becomes clear that the cost of BSN education for nurses does not get compensated by their increased salaries in the years to come (Graf, 2006, p.135). Even though nursing was announced to be a profession for which BSN would be obligatory, two-thirds of all graduates of nursing have been ADNS in recent years. Indeed, the cost of baccalaureate appears so high that many nurses, in particular those who are older and have families and children, opt for the Associate's degree. At the same time, there are serious faculty shortages that do not allow so many applicants to get enrolled in BSN programs today (Connolly et al, 2008).

While the health care industry continues growing, the shortage of nurses (if only those with BSN are accepted for work) will lead to the system’s dysfunction or collapse. On the other hand, not all medical problems require the advanced skills of BSN nurses, who among other things receive training in critical thinking, communication, and leadership skills. ADNs, who spend up to three years practicing in classrooms and medical settings, possess the overwhelming majority of the skills required from the BSN nurse. They get trained in both geriatric and pediatric nursing, study microbiology, and are allowed to administer direct care in a range of medical settings (Donley & Flaherty, 2008).  Thus, the belief that ADNs should grow to get a Bachelor’s degree is based rather on someone’s subjective certainty than on the objective evidence and real situation in our country when not all ADNs may afford to get their BSNs.  

In summary, Schulz’s ideas on being wrong are highly applicable to the nursing context. This paper has demonstrated how using doubt, important data could be obtained that will further undermine the certainty about a widely discussed issue in nursing education.  As a result of deconstructing the popular idea of advantages of BSN nurses and the necessity of obtaining the Bachelor’s degree for every nurse, it appeared that ADN is a more rational and better-justified choice. This view is based on a range of facts provided, in particular, in three peer-reviewed sources used to write the paper.

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