Approximately 40% of the nation’s three million registered nurses (RNs) completed their nursing education through 2-year associate’s degree programs. Even before the release of the 2010 Institute of Medicine’s report on The Future of Nursing that set goals for 80% of RNs to attain a baccalaureate degree by 2020, some hospitals were beginning to exhibit a preference for hiring RNs with baccalaureate degree. Research has shown that inpatient mortality rates were reduced in hospitals with higher employment of BSNs (Aiken, Clarke, Cheung, Sloane, and Silber 2003), and magnet accreditation status requirements for 75% of nurse managers to have a BSN began influencing the hiring rates for BSN nurses.

With these forces in mind, David I. Auerbach, Peter I. Buerhaus, and Douglas O. Staiger set out to understand if a preference for BSN-prepared RNs is occurring across the country; and if this preference was reflected in real differences in what RNs with different educational backgrounds were earning and where they were working.

Data from the American Community Survey (2003-2013) were analyzed to evaluate trends among Associate-Degree Nurses (ADNs) and their employment settings, earnings and employment rates relative to BSN prepared RNs.

The data revealed that ADN-prepared RNs had higher unemployment rates than BSN-prepared RNs beginning around 2009, and were increasingly less likely to work in a hospital setting than BSN prepared nurses. The percentage of ADN-prepared RNs working in hospitals fell from 65% to 60% over the years studied, and conversely, the percentage of BSN prepared nurses working in hospital settings increased from 67% to 72%. An increasing percentage of ADN-prepared nurses worked in long-term care settings over the period.

On the other hand, the earnings gap between BSN prepared nurses and ADN prepared nurses remained constant throughout the period studied, at roughly $10,000 per year. This was true for all RNs and for those working in hospitals only.

Reasons for an observed shift in employment setting of ADN-prepared RNs are unclear – they may be gravitating toward non-hospital settings as a second choice, though it is also possible that their educational preparation is a better fit for those settings. There are also numerous programs available for ADN-prepared RNs to obtain a BSN if desired.

With regard to hospitals’ preference for BSNs, it could be that the new information about higher proportions of BSN hospital staffing being associated with lower mortality, combined with the use of financial incentives to reward hospitals for improving quality, increased the value of BSNs relative to ADNs in hospital settings.

There will be increasing demands on nurses in all settings to monitor and improve quality, to navigate increasingly complex technology and health IT, to practice efficiently, to help coordinate care for patients, and to seek to improve the health of populations in addition to caring for individuals. RNs who are able to obtain the necessary skills and experience via coursework or though on the job programs will be better positioned to succeed in the future.

For the full study published in the January/February issue of Nursing Economic$click here


Auerbach D, Buerhaus P, and Staiger D. Do Associate Degree Registered Nurses Fare Differently in the Nurse Labor Market Compared to Baccalaureate-Prepared RNs? NURSING ECONOMIC$. January-February 2015. Vol. 33 No. 1.