Our Nurse Recruitment Team is often asked why we require nurses with a BSN (Bachelor of Science in Nursing) degree to join Shearwater and work in the United States. We have many types of nurses apply including LPNs and experienced Registered Nurses without BSNs, but in almost all cases our minimum requirement is Registered Nurses with a BSN. Let’s make clear that all types of nurses are needed and appreciated, but there are important reasons why we have this requirement.

1. The U.S. Healthcare industry has shifted to a BSN-required nursing workforce.

As far back as the 1960s, United States healthcare organizations like the U.S. Army, U.S. Navy, and U.S. Air Force all required a BSN to practice as an active duty RN. Since then, the U.S. Healthcare system has only become more complex, and the RN is now a critical coordinator of patient care, which requires more critical thinking, coordination of care within a multidisciplinary team, clinical reasoning, and prioritization.

The Veterans’ Administration (V.A.) – the nation’s largest employer of RNs – recently established the BSN as minimum preparation for nurses that want to be promoted beyond entry-level.

The nation’s Magnet Hospitals – recognized for nursing excellence and superior patient outcomes – set a goal to reach 80% BSN nurses by 2020.

And the list goes on of organizations moving towards a BSN-dominated workforce…

  • The American Association of Colleges of Nursing (AACN) and the American Organization of Nurse Executives (AONE) called for all RNs to have a BSN to “adequately prepare clinicians for the challenging, complex roles.”
  • The Carnegie Foundation for Advancement of Teaching called for the entry level to practice to be BSN.
  • Robert Wood Johnson Foundation (RWJF) released a report that cited the Institute of Medicine’s (IOM) call to increase the number of BSN nurses in the workforce to be 80% by 2020 and RWJF linked better patient outcomes to BSN and higher education nurses.


It’s not just the U.S. making this shift. Canada, Sweden, Portugal, Brazil, Iceland, Korea, Greece, and the Philippines all require (or will soon require) a BSN as the entry level to RN practice.

2. Patient Outcomes are improved with BSN-prepared nurses.

As early as 2001, research documented significant positive outcomes of care delivered by BSN-prepared nurses in rates of patient mortality, complications from illness and hospitalization, failure to rescue, hospital length of stay, fewer medication errors, safety, and quality care.

Blegen et al (2013) found that a higher percentage of RNs with BSN meant lower congestive heart rate mortality, decubitus ulcers, failure to rescue, postoperative deep vein thrombosis, and shorter lengths of stay.

Yakusheva et al (2014) found that a 10% increase in proportion of BSN nurses was associated with a lowering of patient mortality by 10.9%.

3. Nurses with a BSN are better prepared to work on a multidisciplinary team.

It’s not just nurses who have advanced their degree level to adapt to a more complex healthcare environment. Pharmacists, physical therapists, and social workers also trend towards higher education than current minimum requirements by setting a goal of Master’s Degree as their entry to practice.

Nurses are part of care team comprised of many skill and education levels. As stated in the AACN article, “Since nurses are responsible for direct patient care and care coordination, these clinicians should not be the least educated member of the healthcare team.”

4. Nurses with a BSN have more opportunity for career advancement.

Dr. Betty Rambur (2003) noted in her research that “nurses prepared at the BSN level were found to have higher levels of job satisfaction… better able to handle the role… which is key to nurse retention.” The Health Resource and Service Administration (HRSA) reports that RNs with BSNs (compared to Associate or Diploma) “experience faster salary growth and higher lifetime earnings over the course of their careers, thanks to the opportunities for promotion and specialization… advancing their education has tangible benefits to the nurse.”

As stated before (and confirmed by what we’ve seen among most of our hospital clients), increasing numbers of U.S. hospitals hire ONLY BSN nurses.

The evidence speaks strongly for BSN nurses. Hospitals, healthcare organizations, education systems, and individual nurses should now be aware of this shift.