ADN or BSN: What's the Big Deal?

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    The results of the 2017 allnurses Salary Survey will be released soon. You will be able to use interactive graphs and data from more than 18,000 respondents to do a customized search based on your needs. In the 2015 survey, the numbers of BSN and ADN nurses were tied. Read more to see if that has changed.

    ADN or BSN: What's the Big Deal?

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

    Villanova University - Hospitals Require Nurses to Have a BSN Degree

    2015 allnurses Salary Survey Results

    NurseJournal - BSN Degree vs RN Differences
    Last edit by tnbutterfly on Apr 23
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    56 Comments

  3. by   BostonFNP
    This should be an interesting discussion

    If we are speculating on the shift mine is that this represents a blend of employer preference in a low-demand market, gentrification, and the exponential increase in APN programs.

    The article mentions Magnet and IOM recommendations but steers away from the growing body of research on patient outcomes, whether it factors into this or not, it not clear.
  4. by   traumaRUs
    As CMS and other governmental bodies impose on nursing regulation, we are going to see more standardization (hopefully) in education, licensure and certification (for APRNs). The Consensus Model is also paving the way....
  5. by   AntonioErvin
    Let me just say that I have seen great ADN nurses, and horrible BSN nurses, and vice versa. IOM 2020 initiative is what is directing the BSN movement. In order to be a "MAGNET" Hospital you must have a nursing staff that has @ least 80% BSN. I personally think all nurses should have @least a BSN, because it shows that all nurses have the same schooling.
  6. by   Watermaster
    Always a horse race, ADN v BSN...
    I have a very impressive academic pedigree; however, I was called to care sometime after earning my BS and MS in the 'hard sciences'. Certainly the hierarchy in nursing positions and salaries follow higher academic accomplishments; that is inarguable and perhaps appropriate in many situations. My (insignificant) opinion is that only the insecure argue about which individual academic accomplishment is superior to others.
    Every one of us can learn something from the person next to us regardless of their academic pedigree. I too have a lot to learn in this profession and appreciate the sharing of knowledge when appropriate. Timing being an issue for me the ADN path was the best choice to enter the profession of caring for those who are unable to care for themselves. I am quite content, but will likely pursue still higher academic accomplishments as I would in any profession while on life's path.
  7. by   Maerzie
    I was fortunate in graduating before all the foolishness occurred. I had my education in a hospital-based Nursing School, and received my nurse diploma, becoming a Registered Professional Nurse AFTER I passed my state boards, which are very high requirements in Wisconsin and California. My nursing school actually staffed the hospital, in those days, and, because of all the varieties of hands on, supervised experience, turned out the very best of nurses. I did, later, go on to get my BSN, where more technical knowledge is learned (and got an enormous 10 cent an hour raise, LOL!), but hands-on, supervised, multi-disciplined practice and learning STILL turns out the best nurses, right out of the gate.

    My very FIRST job was Charge Nurse, on a 52 bed surgical floor. Nowadays, new nurses don't have the knowledge OR the experience to want to be, or accept, any role of being "in charge". At one position, I frequently had several new RN's, fresh out of school and with their new registration, and one, with her BSN, had never even inserted an N/G tube, NOR a Foley catheter, while another, a graduate of an ADN program, did not know the DIFFERENCE between an N/G tube or a Foley catheter! This ignorance should NEVER be put out onto the market, as an R.N.! That is VERY POOR schooling and a shame to their teachers, that they allow such neglect, causing so much fear and insecurity in a new nurse, who trusted that her school prepared her/him well! Practice and experience, including experience of being in charge of a department, is ESSENTIAL to instill the confidence needed by every single nurse. If a nurse feels ignorant and inexperienced, he/she is much more vulnerable to error, which, in nursing, could cause a fatality! No RN wants to have to go to a superior o learn all these things she SHOULD have gotten competence in, as a student, but, these days, there are THOUSANDS (or more?) of these "nurses" out in the market, making nearly the same salaries as the competent, experienced nurses.

    There is ZERO excuse for the inferior schooling, allowed to claim certification by the NLN, to exist anywhere. It is not the letters, RN, ADN, or BSN, which make the difference. Certification of nursing programs is being handed out too easily, obviously. It's the quality of the school and the amount of supervised experienced skills included in the program. Far too many include only a token amount of hands-on, supervised experience, not NEARLY enough to put anyone's LIFE into those hands. This is NOT the fault of the graduates. It is the fault of the inferior "pancake schools" that are usually sloppily "certified?", and are in a hurry to turn out huge numbers of graduates, without the essential experience. After all, we DO need the nurses, and there is a LOT of MONEY involved! The more corners that are cut, the more inferior the education of the graduate nurses will be. This is,sadly, symptomatic of the current growing disease in our country: GREED! Money before quality!
    Last edit by Maerzie on Apr 22
  8. by   RRTNurse
    The BSN argument of "better care" was predicated on flawed studies of patient outcomes without taking into consideration confounders. It was adopted quickly by Administrators of the "Magnet Hospital" in showing hospitals that were encouraging their RN's to reach higher academic goals and thereby were showing themselves to be "employers of choice" amongst RN's and thereby improving outcomes and patient experience. Medicare and Medicaid then seized upon it and tied Magnet (and therefore academic achievement among RN's) to reimbursement.

    BSN is about the money. In more ways than one. Some see through the facade of business. #Patientsbeforeprofits
  9. by   CanadianRN2017
    IMHO, it really does not matter ADN/BSN unless you plan on going into management or research. The BSN program where I live does not even require the students in the program to take a pharmacology course... they will learn as they go I was told by one of the instructors. Really? Just looking at the "hands on" clinical experiences, the ADN students appear to have more patient/bedside time than the BSN students... BSN students are too busy doing research and other things. Not that research is a problem... please don't get me wrong, someone has to be willing to do it... I think each has a role to play, and the letters after RN should not make any difference in excellent patient care.
    Let's just try and support each other to do the best job we can.
  10. by   umbdude
    It's becoming quite easy for ADN nurses to get BSN these days (many ADN programs in my area are partnering with schools for RN-to-BSN), and maybe that partly explains the decrease of ADN% as more ADN nurses go back to get a BSN. I don't see any difference between ADN and BSN in delivering patient care. It always depends on the individual, not the type of program.
  11. by   MunoRN
    I think maybe the author misunderstood the Villanova article, Magnet does not actually require 50% or more of staff nurses to have a BSN, it only requirement is for management staff.

    I think it's important when discussing this to understand evidence on outcomes, what steps have been taken since these studies, and the rationale behind the IOM recommendations, all of which are commonly misunderstood.

    The studies that show differing outcomes between Associate and Bachelor level graduates looked at nurses who graduated from these programs in the 70's, 80's, and 90's, and as a result of these studies there has been a shift in Associates programs to adopting BSN curriculum, since that is the presumed source of the differing outcomes. There have been no studies to evaluate the effect of this change, so we can't really say if current ADN grads are likely to produce poorer outcomes in their patients. Assuming the same variations in outcomes still exists despite these changes would be like if you found a patient was hypertensive, so you gave an antihypertensive, then without rechecking the BP just assumed they were still hypertensive.

    The IOM didn't recommend that we no longer utilize ADN programs, and given the negative effect that would have on nursing education that would be counterproductive if our goal is to improve nursing education. They suggested moving towards a more standardized curriculum with ADN programs adopting BSN curriculum, a process which is already well underway. They also suggesting achieving these BSN goals by simply renaming ADN programs as BSN programs (the would also require ADN students fulfill their remaining general credit requirements that their pre-requisites don't cover), in theory this could be done by simply making current ADN programs satellite programs of current BSN granting universities. As it turns out, it's relatively easy make ADN program satellite BSN programs in terms of curriculum, but convincing BSN granting institutions to change from the current RN-to-BSN programs they offer isn't all that easy since this would typically result in a loss of income. But since the differences in outcomes these studies found were likely not due to the three letters that describe someone's education, but rather the substance of the education itself, there hasn't been a significant push to force that issue.
  12. by   BostonFNP
    Quote from CanadianRN2017
    and the letters after RN should not make any difference in excellent patient care.
    But what if they did? Would it change your impression?

    Quote from umbdude
    I don't see any difference between ADN and BSN in delivering patient care. It always depends on the individual, not the type of program.
    In small sample sizes the variance within individuals is clearly greater than between degrees, this is was large studies are built for.
  13. by   Kyburgoo
    This topic just makes my blood boil. The letters after your name mean absolutely nothing if you can't handle what's put in front of you. For those that have a burning desire to get into management or further their nursing, go for it! There aren't enough good bedside nurses anymore, regardless of whether they have an ADN or BSN. Instead of looking at who has what initial after their name, how about looking at nurse to patient ratios and how much is being put on nurses these days. No nurse can do good bedside nursing with the ratios that are out there. Does that make them a "bad " nurse? Not necessarily. Some people have a ton of book smarts and not a lick of common sense.
  14. by   Secretperson
    When a senior in high school begins the process of choosing a career or at least exploring what they want to be when they grow up, they now look at the average income for said career.

    This was me recently:

    "When you look into the average income of a nurse the powers that be group ADN degrees with MSN degrees and pop out a pretty good number....our new generations are smart enough to realize that there is a low earning group of nurses and a high earning group of nurses, so the people who are looking to support themselves or be head of household get into nursing now days with the immediate goal of a masters degree......Which just about any other terminal career already requires!!!"

    This is me now:

    "This whole argument is so old, I am personally super happy that we have a faltering ADN and BSN group, because it is pushing creativity at the top of nursing. Nursing is so top heavy with education right now that the powers who wanted this are crapping their pants.

    See what we have found with this whole education push is that no matter how much you educate someone in nursing you cant force a mindset that demands a higher wage, get better frontline nurse managers, or develop a nursing administration who understands the organizational side enough to facilitate better day to day operations...

    Kudos nursing...it is so fun to think that we will soon all be PHDs earning the same as the ADN, guess that fifteen thousandth dissertation on patient safety r/t fall scores was worth it "

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