ADN or BSN: What's the Big Deal?

[allnurses]

I was talking about this topic with one of my younger nurse friends. She shared the following comments with me.

Quote

Funny to me that 20 years ago when I graduated with my BSN, I was told that ADN/ LPN programs were being phased out and that minimum entry level nursing positions would soon be BSN. Fast forward 20 years and it appears ADN and LPN programs are going strong.

I want to start by saying that quality bedside nursing care can be provided no matter the advanced degree or not. As a new graduate, I survived and so did my patients thanks to the care and support and knowledge of many many LPN's and ADN's. There are also plenty of not so great nurses out there with various degrees. That being said, there has been much discussion, surveys and studies done regarding the differences in the career of a BSN prepared nurse, LPN, and an ADN prepared nurse. The results of the 2015 allnurses salary survey presented that 39% of respondents held an ADN and 39% held a BSN. As we are about to release the comprehensive 2017 allnurses nursing salary results, we will see where the trends have gone.

So what's the big deal...as long as you are an RN? The title of RN whether earned through a Degree or Diploma program will allow you to provide the same level of basic nursing care as we see in hospitals, clinics and doctors offices. The BSN prepared nurse, however, has many more options that require higher responsibilities, therefore higher pay. This is due to the more in-depth coursework in physical and social sciences including public health, nursing research and nursing management. An RN with a BSN can choose a career in nursing education, public health, or clinically focus in specific diseases or adult, pediatric, geriatric care. A BSN is required to be considered for many positions or to further one's education to focus on speciality care.

In 2010, the Institute of Medicine introduced new demands on the nursing field when it set a target goal for 80% of all nurses to hold bachelor's degrees by 2020. This goal was derived from academic research indicating that patients receive better care in hospitals when the majority of nurses hold a BSN or higher. The American Nurses Credentialing Center (ANCC) devised the Magnet Recognition Program to draw attention to top healthcare facilities. This recognition means that 100% of the organization's nurse managers have a BSN or graduate degree. "Achieving Magnet status also means that there are generally a higher number of nurses holding a BSN degree for jobs in direct patient care. Approximately 50% of all nurses associated with direct patient care in a Magnet-recognized hospital currently have a BSN."

The 2017 allnurses survey results have shown some slight shifts. In 2017 the percentage of BSN prepared nurses has remained steady at 39% while ADN's have dropped by 2 percentage points. The number of MSN's have increased by 1%. Why might this be? Is there a greater demand for advanced practice nurses? Are employers encouraging and/ or supporting advancing degrees? Is retirement a factor in the decrease in ADN's? As our final results are revealed, new light might be shed on factors influencing the slight shift from last year to this year. Will the trend continue? Are you thinking of furthering your education? We want to hear from you!

We as nurses should support each other in furthering education, as well as respecting those who have years of bedside experience but might not have higher education degrees. As the field of nursing continues to grow our knowledge base will be required to change to keep up with the technology and level of care.

The 2017 allnurses salary survey results will be released soon. It will be interesting to see if the interactive survey results show pay differences based on degree as well as location, speciality and gender.

2015 allnurses Salary Survey Results

[SmilingBluEyes]

BlackbirdRN said:

I graduated with my BSN in 1981 and was also told that ADN programs would be phased out.

The bottom line is there is a difference between ADN nurse and BSN ones and it is not about research and it is not about management. It is about thinking bigger & broader with theory based decision making. The ADN new nurse will always out perform in clinical skills the BSN nurse in the first 6-9 months but after that, EVERYONE has figured out how to start IVs, put in foleys and NGs, do dressing changes, change beds with patients still in them.

It is after that when your patient is febrile but their white count is stable, they are SOB but their lungs are clear and their urine specific gravity is unchanging though they are putting out tons of urine. That is where theory based learning of pathophysiology comes in to help you decide not only to call the doctor but what to tell him. What else did you think to check on the patient before calling?

BSN nurses may or may not make better managers because they don't really teach that in a BSN program but what they do teach is communication analysis, psychology and sociology prerequisites help you figure out why people verbally respond differently. What motivates people.

So stop with the comparisons. They are different. ADN nurses make excellent direct care providers while BSN nurses have a year of extra theory and many prerequisite classes to further their ability to problem solve and analyze situations to develop a path to solve problems.

You got your BSN in 1981, some 35 years ago. Education in both AD and BSN programs has changed. In my ADN program in the late 1990s, believe me, a lot of critical thinking, problem-solving and information on managing and supervising others was covered. In every clinical situation we were forced to use "critical thinking" to problem-solve with patient care (and limited resources and supplies, where thinking outside the box was demanded of us)----- and also in discussion in post-clinical conferences. We went well beyond the "whats" but also the "hows, whys and what-ifs", too. For example: It was not enough to know what a drug was but also to understand the pathophysiology along with it and how it may affect many other drugs/systems and WHY that particular drug was chosen for that individual patient, not to mention drug interactions etc and their complications. We were asked to look at patients holistically and as individuals.

We also were required to (when feasible and possible) communicate with charge nurses, physicians and other care providers on our assigned patients when concerns came up. It taught us how to interact professionally with other health care team members.

Your "bottom-line" generalizations are too many for me to touch on individually. But it's just that; generalizations. It's not true that BSNs can't be good bedside nurses out of school or that AD nurses can't critically think and understand the nuances of health care. Both the AD and BSN nurse needs EXPERIENCE beyond whatever education he or she has. There ARE differences in education preparation, that I know. I will never disrespect BSN/MSN programs (working on one now). Education never is wasted.

But It's also incumbent on the individual to get the most out of his or her own program, AND advance their education--- ( both in college and other ways)----to stay relevant and current.

[Wuzzie]

SmilingBluEyes said:

You got your BSN in 1981, some 35 years ago. Education in both AD and BSN programs has changed. In my ADN program in the 1990s, believe me, a lot of critical thinking, problem-solving and information on managing and supervising others was covered.

Your "bottom-line" generalizations are too many for me to touch on individually. But it's just that; generalizations. It's not true that BSNs can't be good bedside nurses out of school or that AD nurses can't critically think and understand the nuances of health care. We did and do; right out of school, no one can do all that anyhow. That takes EXPERIENCE beyond whatever education a nurse has. There ARE differences in education preparation, that I know. I will never disrespect BSN/MSN programs (working on one now). Education never is wasted.

But It's also incumbent on the individual to get the most out of his or her own program, AND advance their education--- ( both in college and other ways)----to stay relevant and current.

This. ^^^. Hell, that stuff was covered in my DIPLOMA program over 30 years ago. And just to be clear on something, this DIPLOMA RN practiced in a extremely advanced nursing career, is published and has taught nationally on critical care nursing not advanced bed-making. Education is what each individual makes of it. I've done quite well thank you.

[BlackbirdRN]

I clearly differ from you. I applied to both ADN and BSN programs. I reviewed the curriculum for both. I have tutored ADN nurses. You my friend need to get over yourself. You are clueless when it comes to what a BSN program teaches.

[BlackbirdRN]

You may be right that programs have changed. I graduated in 1981. Unfortunately, my son was recently ill and in the hospital for one week and I figured by this time the ADN nurses might be closer to the BSN ones. Instead I had to instruct a young ADN nurse how to call the doctor and ask whether she should be giving NSAIDS to my son who was going for a procedure due to possible risk of bleeding. She responded, "It isn't my job to decide what meds to give, the doctor would have changed the order if he was concerned."

With my anger restrained, I told her it was exactly her job to question whether a med was safe for a patient that the doctor may have not thought about holding it. As a young nurse, I might have been nervous to call the doctor but I would NEVER have said, "It wasn't my job ..."

So I hope you are right. That ADN nurses have enough pathophys to question doctors orders because nurses are infact the last check to make sure patient are kept safe.

[Wuzzie]

BlackbirdRN said:

I clearly differ from you. I applied to both ADN and BSN programs. I reviewed the curriculum for both. I have tutored ADN nurses. You my friend need to get over yourself. You are clueless when it comes to what a BSN program teaches.

I'm not your friend. I choose to hang with people who don't make patently false, self-aggrandizing generalizations that insult large groups of highly-educated, critically-thinking, EBP-practicing, excellent nurses. Why do you bother tutoring ADN students? According to you they are hopeless. You should just tell them to quit since they are going to kill somebody with their inability to think and problem-solve. Clueless? You have no idea what I do and do not know and the arrogance of that statement is all I need to know. I've said it before and I'll say it again. An excellent nurse is largely a product of the individual's aptitude, initiative and willingness to continue educating themselves regardless of their foundational education. Most of what you described as making a BSN "better" than an ADN is innate in the individual not learned in a nursing theory class. But if feeling superior because you have a BSN gets you through the day then have at it. I'm sure your ADN colleagues, students and friends appreciate your point of view.

[Wuzzie]

BlackbirdRN said:

You may be right that programs have changed. I graduated in 1981. Unfortunately, my son was recently ill and in the hospital for one week and I figured by this time the ADN nurses might be closer to the BSN ones. Instead I had to instruct a young ADN nurse how to call the doctor and ask whether she should be giving NSAIDS to my son who was going for a procedure due to possible risk of bleeding. She responded, "It isn't my job to decide what meds to give, the doctor would have changed the order if he was concerned."

With my anger restrained, I told her it was exactly her job to question whether a med was safe for a patient that the doctor may have not thought about holding it. As a young nurse, I might have been nervous to call the doctor but I would NEVER have said, "It wasn't my job ..."

So I hope you are right. That ADN nurses have enough pathophys to question doctors orders because nurses are infact the last check to make sure patient are kept safe.

Careful, your confirmation bias is showing. I'm curious to know if the fact that your son's nurse was an ADN was on her badge or did you ask? I have never once been questioned about my education (nor had it required to be indicated on my badge) and I have taken care of physicians, nurses, VIPs and a handful of famous people. If you did, and she was as young as you described, I can only imagine how rattled she got. Regardless, given your opinion about the inferior status of her education it must have been difficult to conceal your disdain. You should have demanded a BSN educated nurse immediately so you could have avoided the unpleasantness of dealing with her inexperience and inability to think and your son would have had a superior nurse. Do I think her answer was appropriate, of course not, but we are only hearing one side of the story. As it stands you got your pound of flesh and I'm quite sure that young nurse has learned her lesson and had a terrible shift so...bonus.

Here's the thing, you cannot,with a straight face, tell us that you have never worked with a BSN who couldn't critically think herself out of a paper bag or a stellar diploma/ADN nurse that ran circles around her peers. Again, it's the individual, their innate abilities and what they do with their education not the education alone that separates a mediocre nurse from an excellent one.

I hope everything worked out for your son and truly wish him the best as he recovers from his recent illness and surgery.

[Here.I.Stand, BSN, RN]

BlackbirdRN said:

So I hope you are right. That ADN nurses have enough pathophys to question doctors orders because nurses are infact the last check to make sure patient are kept safe.[/Quote]

Actually there was a significant difference in the pathophysiology class I had in my ADN program and the one in my BSN program. Do you want to know what that difference was? Proctored exams. The BSN online patho class had no proctored exams!

I'm sure you will be happy to hear, my ADN instructors drilled it into us like an oil rig that we are to question EVERYTHING. That it's OUR license on the line, and "just following orders" will never be a viable excuse.

What you experienced with your son was not ADN nursing -- it was laziness and carelessness.

[Here.I.Stand, BSN, RN]

Here.I.Stand said:

What you experienced with your son was not ADN nursing -- it was laziness and carelessness.

Either that or at her limit of grilling.

[Not_A_Hat_Person, RN]

michaelg510 said:

Has anyone had issues getting a job as a result of not having a bsn?

I have. I graduated with an ADN in 2008, just before the economy crashed. No one was hiring new grad ADNs. Many of my classmates spent more than 6 months looking for their first job. Some moved. I finally found a job in an ALF after a 10-month job search and a 250-mile move.

Hospitals in my area don't hire nurses with less than a BSN. I've been turned down for multiple jobs because I don't have a BSN.

[guest517]

Since I'm not a RN yet, I know I can't really base my opinion off of experience but, I feel like the degree path depends on the individual. 4 year BSN Programs are not cheap at all and some of us don't wanna rack up thousands of dollars in student loans so the alternative choice of attending a community college and earning an ADN seems much more appealing to me. Even though BSN graduates have more opportunities to advance in their careers, they likely have more student loan debt to pay off so I guess it really levels off at the salary stand point for both programs. I will be attending school for nursing in January for the ADN track and I'm nervous and excited for this new career path. I feel like students who want to do a nursing program should 100% go the ADN route first, its so much cheaper and there are countless RN to BSN programs available after you graduate.

[MunoRN, RN]

BostonFNP said:

It's much more helpful to consider this trend on a national level rather than an individual level which seems to get very personal for posters. What's behind the national trend what the AN survey showed?

Actually what I think was interesting was the lack of a trend. The portion of BSN nurses has not changed, but the portion with an advanced degree has increased and ASN has decreased (although there's a missing chunk of 2% in the 2017 survey so there seems to be some margin of error).

Some portion of that increase in advanced degree nurses comes from the previous BSN group, which has then been replaced by formerly ASN nurses, but it would be interesting to see how many of those with advanced degrees started out as an ASN, since one of the IOM's arguments for the BSN is to increase the number of nurses who continue on to get an advanced degree. With almost 200 Associates RN to MSN programs out there, it would seem unlikely that starting with ASN is a major roadblock to eventually getting an advanced degree, but it would be interesting to see the actual numbers.

[Pianoplaya94]

I've actually never heard of an ADN before coming to these forums. In Canada, associate degrees in nursing do not exist and in order to become an RN you MUST have a BSN/BN.