The Evolution of Nursing: Use of Evidence-based Practice and Critical Thinking

The Evolution of Nursing Practice

Throughout time, nursing has always been a career for those with a passion for caring for others. However, nursing existed before it became a "career." Back in the day, women were primarily the caretakers for families, responsible for cooking, cleaning, and tending to their family members when they became ill. Women were expected to live this lifestyle and care for others without any formal training or education other than what they had learned from motherly figures.

To this day, women are still seen primarily as the caretakers of the family. However, nursing has evolved and opened many opportunities for males as well. Along with breaking the stereotype of gender norms, nursing care now relies mainly on education rather than on the duty of helping others because you were meant to do so.

When it comes to nursing, there are many different routes one can take. These range from Nursing Assistant to Licensed Practical Nurse, from Registered Nurse to Nurse Practitioner. All these career paths fall under the category of nursing. However, they are differentiated by the degrees and education one receives. In the following paragraph, I would like to focus on the differences between an associate and baccalaureate education in nursing.

When it comes to a nurse having an associate's degree versus a baccalaureate degree, one might think the only difference lies in the degrees themselves. However, that is not the case. An article from nursinglicensure.org states, "The level of licensing is the same, and roles do overlap, but nursing leaders are adamant: ADN and BSN roles are not the same." By obtaining an ADN, individuals have the opportunity to break into the nursing world. This degree can be achieved in a relatively short time at a local community college. Consequently, it can be completed more quickly and at a lower cost.

When continuing their education to complete a BSN, nurses focus more on the research and informatics portion of nursing. Because there are always new ways of caring for and practicing with patients being explored, a BSN's focus on critical thinking and leadership skills not only allows nurses to continuously advance in their care but also provides the opportunity to take on a wider scope of practice in the future. "For a nurse who sees herself eventually moving into a supervisory or administrative role, an extra year or two to earn a BSN degree could be a valuable investment in your future," (Turley, 2020).

"Most hospitals and healthcare organizations will soon be transitioning to hire only nurses who have obtained their BSN. "This aggressive goal was set due to academic research that found that patients receive better care in hospitals where nurses have a Bachelor's Degree," (Turley, 2020). According to the American Association of Colleges of Nursing, patients cared for by nurses who have received their BSN have better outcomes. This is due to the nurse being more proficient in employing critical thinking skills. "Higher education makes a difference in the quality of clinical practice," (nursejournal.org, 2020). Due to the high demand for BSN-prepared nurses, some healthcare organizations are even offering to pay for schooling for those who want to transition from an ADN to a BSN.

When it comes to handling patient care, do ADN and BSN prepared nurses differ in the way they make decisions or handle situations? A specific example comes to mind when I think about this topic. I currently work on a stroke and brain specialty unit. Along with the floor nurses, a Clinical Nurse Coordinator (CNC) is staffed every shift. The point of difference between the CNC and the other nurses is that, in order to obtain the position, a nurse must have a BSN degree or higher. I mention this to support my example of a patient care situation in which this BSN-prepared nurse assessed and reacted differently than the ADN nurse. On one of my shifts, a coworker was responsible for a patient who kept requesting pain medication for his unaccountable foot pain. The patient stated that the Tylenol he was currently taking wasn't managing his pain because he was experiencing symptoms of diabetic neuropathy. However, he consistently denied this diagnosis. As a result, the ADN nurse was either dispensing his scheduled Tylenol as it became available or informing him that he would have to wait until it was available. During this situation, the CNC stepped into the patient’s room to see if she could help. Rather than shutting down the patient and informing him that his prescribed medication would become available soon, this BSN-prepared nurse sat down next to the patient’s bed and delved deeper into the situation. She educated the patient about diabetic neuropathy and recommended he consult with a diabetes educator to better understand his diagnosis and why certain pain medications would not alleviate his symptoms. The patient responded positively to the nurse’s approach and agreed to consult with a diabetes educator. I think this is an excellent example of how a BSN nurse employed her critical thinking skills to analyze and react to a situation. Instead of merely administering medication, she utilized her role to find an alternative solution.

The academic preparation of the BSN nurse teaches nurses to use their knowledge of research and evidence-based practice in the workplace. "Students who participate in research while pursuing an online RN to BSN degree are better patient advocates and can support their recommendations with research," (University of West Florida, 2020). With the use of critical thinking and evidence-based practice, nurses can see a patient's situation as a whole, rather than just taking what they see in front of them and coming to a conclusion. The aforementioned patient situation greatly underscores this point. According to an article from PatientEngagementHIT.com, patients who had access to health information were able to make more improvements to their health.

Even with the use of evidence-based practice and critical thinking, positive patient outcomes would not be as prevalent without the connection between the nurse and other care teams. By collaborating with interdisciplinary teams, the nurse is able to tie in the knowledge and experience of others to support overall patient care. The nurse is the primary caregiver of the patient and shares knowledge with interdisciplinary teams to advance patient care. When everyone is on the same page, the patient is able to receive the care needed to safely improve their health. "Healthcare teams have a common purpose: to provide safe, optimal patient care with successful outcomes through communication and collaboration" (Eastern Illinois University, 2020).

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