Different pay and responsibility for 2 year RN's VS 4 year RN's - page 6
I'm completing an RN to BSN program in 2 months. I have learned so much in the BSN program I wish I had taken it sooner. The additional education has taught me skills I never learned in trainings,... Read More
Feb 10, '03Originally posted by Sally_ICURN
True skill only comes with experience in this profession. School can show you how and lay the foundation for becoming a skillful nurse, but until you can apply what you've learned, and learn from your mistakes, and then teach what you have learned over and over and over and over again...successfully, then and only then, does one possess the skills of nursing.
I think there's a huge difference between nursing skills, which is "doing things" and the process that a nurse goes through to determine "what needs to be done." One cannot possibly do the first without having a firm grasp on the later.
Nursing school is to train us to think using nursing's own unique scientific method (nursing process) and each and every nursing program in the country, be it ADN, ASN, BSN has to meet the requirement to teach the nursing process to be accredited by the NLN - the professional association for nurse educators. The extras that are taught in a BSN program are nice but are also unnecessary UNLESS one plans to go into management, OR nursing decides to require a more uniform education among it's members.
One degree does not make a better nurse than the other.
Feb 10, '03The only place I ever hear this topic discussed in online. I never hear it at work, except I love hearing stories from diploma nurses and what it was like "back in the day."
We are ALL taught the nursing process. It's the SAME no matter where one is educated. There may be better instructors in some places than others, but the point is that we are all learning the same stuff in order to practice nursing. The thing is, not everyone possesses the critical thinking skills that are so fundamental to nursing. I mean, not everyone progressses or continues to "get it" deeper and deeper with each experience.
I think it's a uniquely individual thing that is not based on a degree.
Feb 10, '03After 16 years in this profession, I can say that the BSN's we get are least prepared for actual floor nursing. Way back when the diploma grads were still the norm, those girls rocked! A diploma grad had oodles of practical time and had some great skills, not to mention time management.
I have to agree, BSN's for management....yes. Here at the hospital I work at you have to have or get your master's within a 2 year period to be management. But as for more responisiblities...if the BSN"s want to be in charge everyday and have more liberties...go for it! LOL!
IMHO, a nurse is a nurse when it comes down to it. We all do the same thing, follow the same critical pathways and protocols. When you are on the floor, does it really matter what you are?
Feb 10, '03Emerald, this subject has been dragged up and beat on this forum more times than you can count. Simply said... we are TIRED of debating it...and it seems it is some of the new grad or student BSN's on up who want to debate their superiority...so that is why you have recieved a less than stellar response to your statement.
Do a search and read the mountains of comments on the subject if you wish.
For the record, I would welcome BSN as entry level if only to unite our profession, something that is sorely needed. I would insist on being grandfathered in...don't force me to repeat courses I've already taken...that would get me to retire in a heartbeat. And add to the 'shortage'.
But when the 'superiority' angle starts, us old diplomas and ADN's and experienced LPN's tend to get a bit rankled... and for just cause, IMHO.
Feb 10, '03I want to thank all of you for responding to my original posting. I should have said in the original one that I have been an RN since 1988 and most of that time have been in charge of the units I was on.
I still say that I believe that management and leadership positions should start with a BSN education. Although I ran the units well with the ADN, I believe I could have done a better job with the BSN education.
I'm surprised at how many of you commented that experience was more important than education. I agree that experience is very important and that education has little value without the experience to back it up. However, to become nurses we needed specialized training in this field. That training is the back bone of our experience. If you feel that education is that meaningless you back up the claim that techs can replace us if they are trained.
Education is important, and it needs to be combined with experience for a complete nurse. The more education you can add to your foundation of nursing, the higher you can build your level of experience.
Feb 10, '03Sorry P_RN; I guess I am just sick and tired of hearing this, esp. from people that do not have the exp. to back up their claims.
I'll try to temper my replies in the future.
Feb 10, '03I never said experience was MORE important. But ANYone coming here saying formal BSN education equals skill in nursing, is wrong in my book. That was the only disagreement I expressed w/anyone on the board.And I stand by it. I would NEVER argue that additional education is anything but invaluable,however. That to me is a given, and yes very important.
Feb 10, '03Originally posted by P_RN
Watch the personal attacks please.
Feb 10, '03I will finish my bsn completion program in april. I think it has made me personally a better nurse, Not because of the nursing classes but brcause of some of the others. organic and biochemistry,and micro have helped me understand why I am doing things better and some of the other classes have helped me understand where the patient population is coming from sometimes these have made me better at the bedside. This does not make me better than any one. My wife went straight into a BSN program and functioned very well at the bedside. It is not the degree that makes the nurse. It is the person that makes the nurse as well as the experiance.
Feb 11, '03Originally posted by gpip
I think it has made me personally a better nurse, Not because of the nursing classes but brcause of some of the others. organic and biochemistry,and micro have helped me understand why I am doing things better and some of the other classes have helped me understand where the patient population is coming from sometimes these have made me better at the bedside.
Feb 11, '03Here's an interesting article I found on CINAHL....
BSN by 2010: A California Initiative
Barter, Marjorie EdD, RN; McFarland, Patricia Lenihan MSN, RN
Marjorie Barter, EdD, RN, email@example.com, Associate Professor and Chair, Graduate Department, School of Nursing, University of San Francisco, San Francisco, California, and member, Association of California Nurse Leaders Professional Practice Committee,
Patricia Lenihan McFarland, MSN, RN, firstname.lastname@example.org, Executive Director, Association of California Nurse Leaders, Sacramento, California.
The Association of California Nurse Leaders (ACNL) is the state nursing leadership organization strategically positioned to design and influence health policy and innovative approaches to creating healthy communities. The membership of ACNL includes 900 nursing administrators, managers, educators, and consultants. Members of ACNL, many with executive responsibilities for patient care in large systems, formulate policy for nurse recruitment and utilization at the majority of hospitals and healthcare delivery systems in California.
ACNL members recognize that the nursing shortage is growing more acute, and that workforce planning is critical to the future of nursing.1-4 After months of discussion about the appropriate educational credentials for nursing practice in the interdisciplinary environment prevalent in healthcare systems, ACNL members recognized the need for a system-wide change in nursing education. ACNL members have agreed that the nursing workforce of the future must have a minimum of a bachelor of science in nursing (BSN). Acute-care hospitals, traditionally seen as the foremost employer for Associate Degree in Nursing (ADN) graduates, identified a need to recruit more BSN graduates because of the complexity of care and the need for nurses with clinical leadership skills. In 1999, the ACNL board of directors reaffirmed the organization's position on nursing education and developed a strategic plan to upgrade the educational preparation of RNs in California. This plan is known as the BSN by 2010 Initiative.
The BSN by 2010 Initiative calls for changes in nursing education and is grounded in three principles:
* the BSN will be the entry level degree for all new nurses to sit for the NCLEX in California beginning in 2010;
* all nurses who are licensed as RNs as of 2010 will be grand-fathered (no change in RN licensure status will occur); and
* an articulated system of nursing education will be developed so that students who start at a community college can earn a BSN in 4 years.
With this initiative, ACNL is positioned to lead the profession of nursing into a future of exciting new possibilities.
Why the BSN for Entry Into Practice?
Nursing roles have evolved from a technical perspective to that of patient care manager with highly developed clinical and technical skills. Managed care requires rapid assessment, treatment, and movement of patients through the system. Today's professional nurse is expected to coordinate and facilitate the interdisciplinary team through the use of appropriate and timely resource allocation and management. RNs must have the flexibility to safely practice across a range of settings from hospital to community.5 The scientific knowledge explosion, combined with sophisticated technology, requires nurses to have broad preparation, including genetics, biotechnology, informatics, and skills in chronic care management. A 4-year nursing degree provides the minimum foundation for this future. Australia, Great Britain, and Canada now require the BSN for new nursing graduates to be licensed.
RNs continue to be educated in community colleges, along with pharmacy technicians and occupational and physical therapy assistants. The associate degree is generally used to prepare assistive and technical personnel in medical records, radiology, and clinical laboratories, while professionals in these disciplines are educated at the baccalaureate or graduate degree level. If registered nurses are to maintain an equal role with other healthcare professionals, they must attain educational credentials appropriate to the professional role.
Education of Allied Health Professions
The nursing profession must enter the 21st century as a full partner with other disciplines in the health-care arena. When nursing is compared to other healthcare professions, it is obvious that RN educational requirements for professional practice are less demanding. In the 1950s, both occupational therapists (OTs) and physical therapists (PTs) could be certified without a college degree. Both professions have now upgraded the entry-level educational requirements to a master's degree. The Occupational Therapy Education Accreditation Council has notified all OT programs that effective January 1, 2007, only postbaccalaureate OT degree programs will be eligible to receive or maintain accreditation status.6 The accrediting organizations for physical therapy programs will only accredit master's programs beginning in 2002.7 Nationwide, all new pharmacy students in fall 2002 will enroll in a doctorate in pharmacy (PharmD) program.8 Social workers and speech therapists in most states have long been educated at the graduate level.
Registered and licensed professionals, such as OTs, PTs, and pharmacists, who were graduated from approved programs prior these changes, will continue to be licensed under the grandfathering mechanism commonly used when increasing educational requirements. Grandfathering means that whenever educational requirements for entry into practice are changed, all those practitioners who are presently licensed in a profession remain licensed, with all rights and privileges granted that licensure. They do not have to go back to school to earn the extra credentials because they are already licensed. The change in educational requirements pertains only to those who graduate after the effective date of the change.
Other Professional Groups
Two other professional groups, engineers and teachers, have had chronic shortages of "trained" personnel, yet retain firm educational requirements and continue to advance those requirements. Engineers have had the BS as an educational requirement for many years. Engineering organizations are now identifying a need for increased education and are proposing a master's degree for engineers. It is likely that a graduate degree will be required as basic preparation for an engineer in the future. Teacher preparation in most states requires a BA/BS degree and 1 additional year in a credentialing program. Although a national shortage of teachers exists, no one is suggesting less than a 4-year college degree for teachers. Should the profession of nursing continue to expect less for RNs who have life-saving responsibilities?
The ADN and Myths of Nursing Shortage and Diversity
The common wisdom that ADN programs are necessary to prevent or alleviate nursing shortages should be reexamined. The model for the ADN program was developed in 1949 by Dr. Mildred Montag, and has been widely used since the 1950s. The associate degree program was designed to prepare a nurse technician who would operate under the supervision of the professional registered nurse, but at a higher skill and knowledge level than the licensed vocational nurse. The need for an associate degree nurse technician was justified by the continued shortage of registered nurses.9 The chronic shortage of nursing personnel continues to this day in spite of the proliferation of ADN programs nationwide. Can nursing, as a profession, continue to support the myth that ADN programs are necessary to prevent nursing shortages?
Another prominent myth about the multiple entry educational requirements is the need to support diversity in nursing. A recent survey of minority student completion of the associate degree (AA) and the baccalaureate degree (BS/BA) degree compared to white students showed minimal differences. The survey did reveal that the AA degree provides educational entry for more white women than for women of color.10 African-Americans have made great strides in advancing up the educational ladder in many fields; however, nursing schools have not seen significant overall gains in enrollment from African-Americans and other minorities.11
Women now earn significant numbers of the advanced degrees in fields such as dentistry (38%), law (43%), medicine (41%), pharmacy (66%), optometry (54%) and veterinary (66%).10 These figures indicate that while women are able to spend considerable time and money earning advanced professional degrees, nursing has not been able to attract similar numbers of men. Could it be that the educational bar is set too low for many high-achieving men and women to be interested in nursing?
An analysis of RN workforce data by Bednash 12 identified several issues of concern for employers. The current RN workforce contains less than one third BSN-prepared nurses and only 10% with master's or doctoral degrees. Hospitals and other employers continue to express a preference for BSN prepared nurses, but the demand exceeds the current supply. In addition, the variety of educational options leading to RN licensure is confusing to the public and leads to the perception that nursing is not a profession, decreasing the number of potential number of applicants to baccalaureate or higher degree .
National Trends in Nurse Recruitment
The Veteran's Administration (VA) system has changed the qualifications needed for RNs to be appointed, promoted, or reassigned. The revised Nurse Qualification Standard 13 was designed to ensure that RNs are educationally prepared to provide care in all clinical practice roles and settings, including outpatient, home, and community settings. The BSN, or BS/BA in a health-related field, is now required for newly hired nurses to be appointed or promoted beyond the staff nurse 1 level. VA employed nurses who did not have a BSN when the new regulations became active were given until 2005 to secure a degree, after which time promotions to staff nurse 2-5 levels will require a baccalaureate degree. The armed forces have long required the BSN for nurses and require graduate degrees for many nursing roles.
The Pew Health Professions Commission 14 called for several changes in the nursing profession to strengthen it for the 21st century. Among the recommendations were to reduce the size and number of nursing education programs by reducing the ADN and diploma programs by 10-20%. In addition, the PEW commissioners cited an ongoing concern about the difference between the 2-year, 3-year, 4-year, and master's degree prepared nurse. Because of this concern, the PEW commission recommended that nursing title(s) be clarified and simplified.
Trends in California
A recent and alarming trend in California has been noted. Dropout and failure rates are increasing at community college nursing programs. Attrition of nursing students is approaching 48% at certain ADN programs, due to the open-access lottery system currently used in California for community college admission. In the new system, students with high grade point averages have the same chance for admission as those with the lowest academic scores.15 This policy has resulted in the admission of students who are not prepared for the academic rigor of the nursing curriculum. The high attrition rate creates subsequent higher costs to taxpayers and deepens the nursing shortage. BSN programs are not affected by this change because they can be selective and choose those students with higher academic achievements for admission.
There is considerable variability in program length and curricula for California ADN programs. Less than 40% of ADN programs in California are accredited by the National League for Nursing (NLN),16 and the total semester units for the ADN vary by more than 30 units between programs, ranging from 62 to 90+ units. This would indicate that students graduating from ADN programs might have very different educational experiences, culminating in different levels of competency at graduation. Curricula in BSN programs are more standardized, given the fact that all are accredited by NLN and/or the American Association of Colleges of Nursing (AACN).
Why are nursing majors treated differently from other majors in community colleges? Nursing students in many ADN programs are spending more than 2, and sometimes more than 3 years, to be awarded a 2-year degree. This discriminates against nursing students if students in other majors are not required to spend more than 2 years for an associate degree. Many ADN graduates in California spend 3 (or more) years at the community college and 2 years at the university level for the BSN. Two years at a community college and 2 years at a college or university should result in a 4-year degree, the BSN. It would be more cost effective for taxpayers to pay for 2 years of pre-nursing at the community college, and two years of BSN education at the college or university level, culminating in a 4-year education.
The ACNL Action Plan
ACNL 17 has developed a 10-year action plan to effect this important change in the entry-level educational requirements for California nurses. The plan identifies five constituent groups: RNs and RN organizations, business and service, education, regulatory/legislative, and the public (consumers). Timelines have been developed to divide activities into three phases over the next 10 years. Phase 1 consists of education of all constituent groups and development of alliances. During phase 2, ACNL will actively build coalitions, seek changes in funding for education, and work with the California Board of Registered Nursing and educators to develop curricula. Finally, in phase 3, ACNL will seek changes in state regulations to require the BSN for practice as an RN. Because a large number of ADN-prepared RNs will be grandfathered, ACNL will continue to support the concept of competency based differentiated practice.
By informing and educating nurses, other health professionals, and consumers, ACNL will build a strong coalition to advance with the BSN 2010 Initiative. Despite the nursing shortage, many ACNL members are now listing the BSN as the preferred degree for all RN positions and the required degree for some RN positions in their organizations. The ratio of positions that require a BSN is expected to increase as we reach 2010.18 ACNL will provide speakers to other nursing groups, high school and community college career counselors, and the media to explain the need for the BSN for all future nurses.
The ACNL BSN by 2010 Initiative is a plan to prepare for the future education of nurses. Nursing can no longer support a rationale for associate degree or diploma entry to the RN license, given the complexity of nursing roles and the educational requirements of other health professions. Because of the grandfathering mechanism, all registered nurses will continue to practice under the license that they have earned prior to 2010. Since the majority of nurses in California have been educated at the associate degree level, ACNL will continue to support efforts to promote differentiated competency-based practice and will facilitate educational opportunities for all nurses who wish to further their education.
It is critical that we honor our past. The nursing profession has earned the trust of the public because of the clinical expertise of nurses from all types of educational backgrounds. We must recognize the accomplishments of all nurses and incorporate them into the new paradigm for nursing education and practice. The BSN by 2010 Initiative will position nursing to maintain its status as a profession in the 21st century.Last edit by EmeraldNYL on Feb 11, '03