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?

[Maevish, ASN, RN]

I feel that the title of the post isn't misleading at all. I've been able to work as a traveler in one hospital (a big teaching hospital in Sacramento) as an ASN, but would need my BSN if I were to work there on staff. It IS necessary to be competitive in general, but thankfully not all hospitals are going with those standards because that would take out a huge portion of the nurses working today.

I do want my BSN, but I can't go back to school while I'm still paying for the loans I have now. If, god forbid, one of my parents bites it early, I would have the money to pay back my current loans and pay to go back to school. I don't wish that to happen and it probably won't, so I'm going to have to do it when I can (providing I don't win the LOTTO any time soon).

People do tend to look down on ASNs as a whole, though usually unnecessarily. The BSN won't advance my personal practice much as a beside nurse and I could get the same information from similar classes (and get CEs for them!), I'd just be doing it so that I could work in more places. It will take me longer than just the length of the program to complete because I need the algebras before I can even take statistics and my math skills are severely lacking. I might not even pass the classes needed to take a class I won't use after the program is finished!

I couldn't give two hoots about getting it for any other reason than increasing job availability, meanwhile I have a friend who just got accepted as a doctoral candidate.

Let the ones who WANT the higher learning do it and leave those of us who don't, to just do our thing.

[Maevish, ASN, 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.

While I would agree that there's a nursing shortage, I will also say that there's no REAL nursing shortage. What I mean by that is that hospitals, recruiters, and schools tell you that there's a shortage, but yet there are thousands of us trying to get the jobs that are there on paper, at places where there's no BSN requirement. No one told me in nursing school how hard it can be to get a job. Until they start hiring nurses who want to fill all those empty spots (causing the OT and extra shifts for their existing staff), we won't know when the real shortage occurs.

xo

[BostonFNP, APRN]

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.

The major studies, including the landmark Aiken 2003 study, do control for experience.

[BostonFNP, APRN]

I am always surprised to see that there are a significant number of nurses that consider the increase in the overall education level of the profession rising as a bad thing. After the 1954 white paper from the ANA there was never sufficient momentum for nursing, as a profession, to transition to a bachelor-entry. The result is half a decade later there is a surplus of nurses allowing the market to begin to dictate the educational levels, and to not only selective hire bachelor-prepared nurses but also push out experienced nurses at the higher end of the pay scale. This has fostered a ADN vs BSN fight that is now made even worse by outcomes data, used to pit one against the other.

The truth is that what these studies show is that nurses as lifetime learners make better nurses. If you are a great nurse with a diploma and you continue your education you should be a better nurse with a bachelors or a masters; it doens't mean you are inherently a worse nurse than every other nurse with a higher degree than you.

And on top of all this, we now have these ripoff programs that are simply taking more to stamp a bachelors diploma so nurses can keep their jobs rather than truly educating; that's not going to maintain the same outcome data.

[nutella, MSN, RN]

I want to re-phrase the whole issue somewhat and put it into the context of needs.

Nowadays with the more complex healthcare systems, bedside and front line nurses are needed who have the skills to make critical decisions and employ critical thinking at the point of care. Granted, nursing is mostly task oriented and the bigger picture often forgotten. The question is really : Are nurses nowadays sufficiently prepared to function in today's healthcare systems and provide high quality care (value-based care) in a patient centered model.

When it comes to just performing tasks and "working down the list" it is my experience that all nurses are good at that once they have experience - the ones who can't usually do not make it in bedside nursing for long. When it comes to overall critical thinking and seeing the bigger picture, it is my opinion that this also varies with years of experience and personality. An experienced diploma nurse may be actually able to see the bigger picture and pick up on relevant problems while a new BSN nurse is so focused on completing the tasks that she may not be able to see the bigger picture.

In the end, the market decides a lot about what route nurses will go. If the local has already shifted towards BSN , nurses will be more likely to consider that or go the cheaper route and enroll into a bridge course. I know nurses who are ADN but cannot find a new job because my area asks for BSN or will tell them to get their BSN within so many years of starting. They are stuck or if they lose their job won't be able to find something they desire.

If a nurse wants to pursue leadership, higher education, become NP - of course they will consider a BSN as well.

It is really not true that overall a BSN nurse is better prepared than a ADN or diploma nurse to do their job - it is more complicated.

[nutella, MSN, RN]

BostonFNP said:

I am always surprised to see that there are a significant number of nurses that consider the increase in the overall education level of the profession rising as a bad thing. After the 1954 white paper from the ANA there was never sufficient momentum for nursing, as a profession, to transition to a bachelor-entry. The result is half a decade later there is a surplus of nurses allowing the market to begin to dictate the educational levels, and to not only selective hire bachelor-prepared nurses but also push out experienced nurses at the higher end of the pay scale. This has fostered a ADN vs BSN fight that is now made even worse by outcomes data, used to pit one against the other.

The truth is that what these studies show is that nurses as lifetime learners make better nurses. If you are a great nurse with a diploma and you continue your education you should be a better nurse with a bachelors or a masters; it doens't mean you are inherently a worse nurse than every other nurse with a higher degree than you.

And on top of all this, we now have these ripoff programs that are simply taking more to stamp a bachelors diploma so nurses can keep their jobs rather than truly educating; that's not going to maintain the same outcome data.

I agree with you.

[BostonFNP, APRN]

I also think that nursing is different now than it was 10-20-30 years ago. Things are more acute and the timeline shorter, there are far more meds, far more complex patients, far more dependence on nursing intervention. Experienced nurses have assimilated with time and the but new nurses need a broader range of skills and knowledge at the start.

[AJJKRN]

BostonFNP said:

The major studies, including the landmark Aiken 2003 study, do control for experience.

While I absolutely agree with most of your responses on nurses becoming better as we continue our educations as a whole, if I remember correctly while in my RN to BSN classes where almost every textbook stressed how much better BSN's were as a whole, the Aiken's study (and many others I looked at) did not account for how many of the BSN's that were studied either may or may have not been previously educated with other nursing degrees and thus previous nursing experience prior to obtaining their BSN's.

And as Dogen so expertly eluded to, they did not study the individual facilities access to resources, or lack of, in the variables (but that is another discussion in itself).

As a nurse that started with an ASN, went immediately back and did my BSN, and is soon to start a MSN...well it is just damn frustrating that at least a hat tip off wasn't even given.

As Rodney Dangerfield used to say "I get NO Respect!"

If none of what I just typed did not make any sense, I blame my nightshift brain!

[emtb2rn, BSN, RN, EMT-B]

Diploma rn here, went through rn-bsn program. Also have bs in another field.

My question (which has been brought up by others recently and is also your question) remains: do any of these studies delineate diploma/asn to bsn nurses vs initial degree bsn nurses?

[BostonFNP, APRN]

AJJKRN said:

the Aiken's study (and many others I looked at) did not account for how many of the BSN's that were studied either may or may have not been previously educated with other nursing degrees and thus previous nursing experience prior to obtaining their BSN's.

I've posted my thoughts on this before, but I feel that is a strength of the study; it shows that no matter what the experience of the nurse that more education yielded better results.

The only reason that it is an issue that they didn't track educational paths is that the study is being used to argue BSN entry which is not the real strength of the study. If someone was interested we could try and use the national data on nursing education paths (what percent of ADNs went on to further degrees) to attempt to extrapolate that information, though I would have to think about how to do that statistically.

In your case the study showed that you did the best thing you could do: you gained education and experience.

[BostonFNP, APRN]

emtb2rn said:

My question (which has been brought up by others recently and is also your question) remains: do any of these studies delineate diploma/asn to bsn nurses vs initial degree bsn nurses?

My question is why is that important?

[LadyFree28, BSN, LPN, RN]

BostonFNP said:

I've posted my thoughts on this before, but I feel that is a strength of the study; it shows that no matter what the experience of the nurse that more education yielded better results.

The only reason that it is an issue that they didn't track educational paths is that the study is being used to argue BSN entry which is not the real strength of the study. If someone was interested we could try and use the national data on nursing education paths (what percent of ADNs went on to further degrees) to attempt to extrapolate that information, though I would have to think about how to do that statistically.

In your case the study showed that you did the best thing you could do: you gained education and experience.

I am interested.