BSN and Associate Nurses Are Neck and Neck. Will This Change?

[allnurses]

AACN published The Impact of Education on Nursing Practice in 2015 which discussed multiple studies about ADN and BSN education. One of the more important statements is about Magnet status. Hospitals that have attained Magnet status, are recognized for nursing excellence and superior patient outcomes, have moved to require all nurse managers and nurse leaders to hold a baccalaureate or graduate degree. Hospitals in the process of applying for Magnet status must show plans to achieve the goal of having an 80% baccalaureate prepared RN workforce by 2020.

Then there are the studies that show that hospitals staffed with more BSN prepared nurses have better patient outcomes. This has been a hotly debated topic on AN. Here is one references:

In an article published in the March 2013 issue of Health Affairs, nurse researcher Ann Kutney-Lee and colleagues found that a 10-point increase in the percentage of nurses holding a BSN within a hospital was associated with an average reduction of 2.12 deaths for every 1,000 patients-and for a subset of patients with complications, an average reduction of 7.47 deaths per 1,000 patients. The study is titled "An Increase in the Number of Nurses with Baccalaureate Degrees is Linked to Lower Rates of Post-surgery Mortality."

One of the more prolific threads on AN was titled the difference between ADN and BSN nurses that was started in December 2014.

Many individual healthcare facilities have created policies that will affect the increasing number of nurses earning a BSN. Due to internal policies, the management at many hospitals across the US have been requiring currently employed LPNs and RNs with diplomas and ADNs to earn BSN degrees within a specified time frame. Many non-BSN nurses are being given an ultimatum. Is this right?

It is still being debated

So...what's your opinion? Is getting a BSN on your agenda?

How is the comparison between the number of ADN and BSN RNs at your place of work?

[Zyprexa_Ho]

I've said this in other threads and I'll say it again. What these studies really need to do is control for years of experience in comparing ASN and BSN grads. At least part of the effect of increased benefit from BSN grads has to come from ASNs (plus their years of experience) becoming BSNs. So it may look like BSNs provide better care when part of that reason could be from their experiences earned while or before working on their BSN.

[Boomer MS, RN]

jsfarri said:

I've said this in other threads and I'll say it again. What these studies really need to do is control for years of experience in comparing ASN and BSN grads. At least part of the effect of increased benefit from BSN grads has to come from ASNs (plus their years of experience) becoming BSNs. So it may look like BSNs provide better care when part of that reason could be from their experiences earned while or before working on their BSN.

I suggest you read the published literature on this topic. That's what I was taught to do, and it has served me well. Reading and critiquing studies can be enlightening.

[mmc51264, BSN, MSN, RN]

I work with ADN, BSN and diploma nurses. Can't tell who's who. I did get my BSN and in an MSN program, but that is what I wantm not being made to. My organization reimburses for tuition for BSN and is paying for a portion of my masters

[Boomer MS, RN]

mmc51264 said:

I work with ADN, BSN and diploma nurses. Can't tell who's who. I did get my BSN and in an MSN program, but that is what I wantm not being made to. My organization reimburses for tuition for BSN and is paying for a portion of my masters

Bravo to your organization. Can it be cloned?

[NuGuyNurse2b]

Boomer MS, RN said:

I suggest you read the published literature on this topic. That's what I was taught to do, and it has served me well. Reading and critiquing studies can be enlightening.

Wow, attitude. Well what does the published literature say about jsfarri's comment? Do they refute it? instead of being so holier-than-thou, you can share your alleged expertise.

[FloridaBeagle]

I never got an ADN in the first place. Any literature on accelerated BSN's? I never see us talked about.

[Boomer MS, RN]

NuGuyNurse2b said:

Wow, attitude. Well what does the published literature say about jsfarri's comment? Do they refute it? instead of being so holier-than-thou, you can share your alleged expertise.

I cited a study published by a respected nursing leader that addressed jsfarri's questions. I've already read that article and wanted to share the information. I love learning from the literature and continue to read some journals.l If anyone else is not interested, it's not a problem for me.

[Dogen]

Boomer MS, RN said:

Linda Aiken, PhD, a well known and respected researcher out of the University of Pennsylvania, has published extensively on this subject. Here is one example: Educational Levels of Hospital Nurses and Surgical Patient Mortality And, yes, it is not a true experiment, which would be impossible for this kind of research. The investigators list their inclusion criteria. She also has published on nursing ratios that are far better in CA affect patient care. I find her that most encouraging! Research such as hers can only benefit the practice of nursing and the patients. There may not be a paper published with multiple regression analysis, but that does not diminish her findings. Critiquing a study is good though!

I'm not trying to discredit any particular researcher, but I do find it disingenuous to compare hospitals on the basis of nursing staff education and mortality rates. The methods of Dr. Aiken's paper are thus:

"Descriptive statistics (means, SDs, and percentages) and significance tests (χ2 and F tests) were computed to compare groups of hospitals that varied in terms of their educational composition on hospital characteristics, including nurse experience and nurse staffing, and patient characteristics. Logistic regression models were used to estimate the effects of a 10% increase in the proportion of nurses who had a bachelor's or master's degree on patient mortality and failure to rescue, and to estimate the effects of nurse staffing, nurse experience, and surgeon board certification."

Neither chi-square nor an F-test will tell you what factors predict the outcome. Logistic regression can, but the variables they chose were almost entirely nursing related. They don't compare things like number of cath labs or access to an MRI or 24-hour echocardiography or the number of medical specialties available 24 hours per day. Those are the sorts of things that I think are likely to cluster together with higher numbers of BSNs (because I'm assuming BSNs are more likely to be required in places that have those things and less likely to be required in place that have none of them), and which would be a third variable problem if they vary alongside the percent of BSNs on staff.

Again, I'm not saying that I know this to be true, but I have yet to see a research article that claimed BSNs reduced mortality that actually compared BSN rate to other things that also likely reduce mortality and show that BSNs were independently likely.

[Boomer MS, RN]

Dogen said:

I'm not trying to discredit any particular researcher, but I do find it disingenuous to compare hospitals on the basis of nursing staff education and mortality rates. The methods of Dr. Aiken's paper are thus:

"Descriptive statistics (means, SDs, and percentages) and significance tests (χ2 and F tests) were computed to compare groups of hospitals that varied in terms of their educational composition on hospital characteristics, including nurse experience and nurse staffing, and patient characteristics. Logistic regression models were used to estimate the effects of a 10% increase in the proportion of nurses who had a bachelor's or master's degree on patient mortality and failure to rescue, and to estimate the effects of nurse staffing, nurse experience, and surgeon board certification."

Neither chi-square nor an F-test will tell you what factors predict the outcome. Logistic regression can, but the variables they chose were almost entirely nursing related. They don't compare things like number of cath labs or access to an MRI or 24-hour echocardiography or the number of medical specialties available 24 hours per day. Those are the sorts of things that I think are likely to cluster together with higher numbers of BSNs (because I'm assuming BSNs are more likely to be required in places that have those things and less likely to be required in place that have none of them), and which would be a third variable problem if they vary alongside the percent of BSNs on staff.

Again, I'm not saying that I know this to be true, but I have yet to see a research article that claimed BSNs reduced mortality that actually compared BSN rate to other things that also likely reduce mortality and show that BSNs were independently likely.

I appreciate your comments. However, I am not sure I agree with you about Dr. Aiken's research.; I remain more convinced than you. What I'd love to see is you debating in a class with Dr. Aiken or other professors, and I guarantee you that they would applaud your critique. Someone who is using her critical thinking skills to question the findings! Respectful discussion among colleagues was stimulating in my graduate studies. There is more published out there about this subject, but maybe you are more familiar with the literature than I am. I assume the authors had a statistician to guide them with their statistical analysis, but perhaps there are gaps and also room for criticism regarding the study design. Controversial subject, isn't it?

[meanmaryjean, DNP, RN]

Itsybit56 said:

Nursing boards for an ADN/ASN are exactly the same for a BSN. I am very concerned with nursing care related to shortage. We already have a nurse shortage nation wide. I feel hospitals only wanting BSN nurses is going to increase this shortage. The focus is wrong. We need to utilize all our nurses MSN, BSN, ASn/ADN and LPN to decrease the nursing shortage and that would improve patient outcomes and reduce deaths.

There. Is. NO. Nursing. Shortage.

[Boomer MS, RN]

meanmaryjean said:

There. Is. NO. Nursing. Shortage.

Amen. Amen.

[Aromatic]

this shortage myth is just a term used for hospitals to stay short staffed, thus increasing profit margins. And also for coercing more people to go into nursing, thus increasing profit margins for colleges.

Be wary