The RN to BSN Transition: A Qualitative Systematic Review

Monday, 9 November 2015: 2:25 PM

Allison B. Anbari, RN
Sinclair School of Nursing, University of Missouri-Columbia, Columbia, MO, USA

Background and Significance

Despite ongoing recommendations from leading healthcare and nursing organizations that propose entry to nursing practice should be at the bachelor’s degree level, approximately 60 percent of newly licensed registered nurses still enter practice with an associate’s degree or diploma in nursing. Due to current recommendations, there has been a rapid growth in the number of associate’s degree to bachelor’s in nursing programs (RN to BSN programs). There are now more than 600 RN to BSN programs in the United States. Concurrently, much is written about the need for a seamless transition of associate degree and diploma nurses (ADNs) to bachelor’s prepared nurses (BSNs).

The purpose of this qualitative systematic review (QSR) was to understand more about what occurs when an ADN returns to school for a BSN and to develop a model of what a seamless transition of ADN to BSN might look like. To date, a model describing the phenomenon of ADNs returning to school for a BSN degree does not exist. The questions that guided the QSR were: What must happen for a nurse to return to school for a BSN degree? What occurs while attending a RN to BSN program? What outcomes of the additional education, if any, to nurses identify? If outcomes are identified, what are contributing factors?


This QSR was guided by approaches suggested by Finfgeld-Connett, a leading nurse researcher and pioneer of the QSR method. By definition, QSRs concentrate on generating results that are generalizable and transferable to nursing practice and policy.

Articles and unpublished dissertations using qualitative or mixed methods that were conducted in the United States and met the inclusion criteria were reviewed. The findings of six dissertations and 13 articles were included in this QSR which translates to approximately 445 practicing nurses’ perspectives on the ADN to BSN transition. Using content analysis and reflective memoing, the findings of these 19 studies were synthesized into a model of the phenomenon of an ADN returning to school and transitioning to a BSN.


Motivation, time, the chosen program, and finances must be coordinated and aligned before an ADN considers enrolling in an RN to BSN program. ADNs are faced with ongoing challenges that follow them as they make the decision to return to school, as well as during progression through the program. Throughout the decision making process and during coursework, ADNs require support. RN to BSN students work to achieve balance as they navigate through school. Institutions of higher learning and the nurses’ workplaces provide inconsistent support and often present challenges. Despite adversity, ADNs still make a noticeable transition. RN to BSN students and graduates identify the benefit of online instruction and key courses, which motivate them and make the value of a BSN more relevant. Positive outcomes of obtaining a BSN include benefits to the nurses’ personal and professional lives as well as to their nursing practice. A visual representation of the RN to BSN transition was generated.


A seamless transition of the ADN to a bachelor’s prepared nurse does not exist at this time. The results of this QSR and corresponding model are useful to nurses, academicians, and healthcare organizations as they move to meet current recommendations.