I'm just curious...

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Oct 26, 2010

When I started nursing school, I was told that by 1990 a BSN would be the minimum for entry to practice, and that existing nurses would be "grandfathered in." Considering the pressures of the nursing shortage as it waxes and wanes, financial pressures from hospitals, LTC facilities, doctors offices, etc, and the fact that healthcare is increasingly greed driven in this country (IMHO), I'd say nothings going to change in our lifetimes. Of course, your mileage may vary, and objects in the mirror are larger than they appear.

roser13, ASN, RN · Oct 26, 2010

While I am an ADN myself and do not believe in the movement toward a BSN minimum preparation, I think that I can help you understand some of the ramifications of this potential.

If and when any BSN minimum educational preparation is enacted in this country, there will likely be little to no impact on the status or license of any current nurse. You can believe that:

*No current LPN or ADN/RN will have their license revoked or be instantaneiously dumped by their employer.

*Any mandatory educational requirement will be phased in over time.

For example, take the current Nurse Practioner move toward PhD preparation. An entire generation of NP's will not suddenly be jobless and licenseless. They will be grandfathered in, perhaps with more stringent CEU's or other stipulations. But they will still be working.

Personally, I see this "movement" as an ivory tower speculation, not workable in real life. Plus, it's been around forever; it never quite goes anywhere. Even if it does happen in my lifetime, I will not worry. Look at it this way: with the Baby Boomers beginning to enter late middle/old-age and the attendant healthcare implications of that large group of Americans, the nursing profession simply cannot abandon its current LPN/ADN nursing workforce in favor of a crop of BSN new grads. For one thing, there wouldn't be enough nurses, and for another, the overall quality of nursing would plummet without any experienced nurses around. Trust me.....it will be OK.

MissJulie · Oct 26, 2010

Let me preface this by saying that I am currently working as a CNA and attending an ADN program to evetually attain my RN. As far as going on for a BSN, that is yet undecided at this point, it really depends on what happens these next two years while I complete the ADN program. However, I do feel as someone getting their "foot in the door" into the world of nursing, I do, and should, have a voice in this discussion. Now, onto the answers...

1. What exactly are you proposing we do about the millions of LPN's in this country, as well as the thousands currently going through LPN programs right now? Do you strip us of our licensure? Demote us to being CNA's or techs?

I believe that anyone that is currently working as an LPN or is becoming and LPN should be allowed to work in this field and that the colleges, if decided to change the BSN as "entry level" should gradually phase out the other programs. Now, as far as stripping of the license, that would be insane! Why take something that someone worked so hard for and just throw it away? That's just crazy to me! Demoting someone with specialized training to someone that is "assistive personel" is just as crazy as taking away the licensure. Personally, I believe that some sort of tuition assistance should be provided, if the institution has decided to only employ BSN nurses.

2. Same question, applied to the ADN's-what do you propose be done with them?

As someone who will hopefully have her ADN in about a year and a half, see the above. If facilities want to BSNs, then tuition assistance should be provided, at least to those that are already employed. Firing someone because they have already been working for you with a valid degree and liscence because you've decided to go up a level would be crazy, especially if you're in an area with less BSNs then ADNs (such as my area)!

3. What do you percieve are the potential ramifications of making a BSN the entry point in terms of bedside nursing. Have there been any studies done to determine how many BSN students would be content working at the bedside for their whole career? And what about in the nursing homes and LTC, which is where the projected need will be the greatest? I'm just curious, because I've read so many posts from RN's (ADN's and BSN's alike) who are bemoaning the fact that they have to "settle" for nursing home work in this economy, and have no desire to make that their career. If we phase out LPN's, and especially if we make BSN the standard point of entry, is it really realistic to think that there will be enough bedside nurses in LTC to care for our aging population?

For years, BSNs have been seen as a higher level, because they are. They have recieved more training, but a lot of it (so I'm told by instructors) is paper work and theory, not extra skills and techniques. Also, in the contact I have had with BSNs, the general consensus is to continue on to the MSN or NP, depending on the person and situation, so believing that a BSN would be happy at the bed side would depend on the person, not necessarily the degree.

4. How is this push towards a higher educational standard going to effect the role of nursing? Because we all know that facilities will not be able to afford to hire all of these BSN's without "outsourcing" many tasks that have traditionally been part of the nurses role to UAP's. If we have UAP's providing bedside care, doing things like med administration, trach suctioning, etc. (which is already happening of course) then what, exactly, is a nurse? Are we just the "managers" who oversee care?

So many things have been delegated away over the years! If BSNs are the new level of nurses, then what are nurses? If nurses are people that give medications, change and hang IVs, care for patients, and the like, then anyone can be a nurses! But, if nurses are people that give a damn, then it takes more then a degree, it takes a heart!

In my opinion this change probably won't happen in my lifetime, at least I hope not :) The phasing out will have to take years, if not decades. There is a place for everyone at the big table that is nursing, if you've got the heart for it!

Just my opinion. And, yes, I know that opinions are like *******s, and everyone has one!

MattiesMama · Oct 27, 2010

Great responses so far guys, thanks! I happen to live in a state (CT) that seems to be especially proactive in pushing this agenda, so while I would like to think it's not going to actually happen, in a lot of ways it already is. The LPN scope of practice has been SO restricted we have all been barred from any area of practice besides LTC, and even they are going towards hiring only RN's, or at least making it clear that they are strongly preferred. That coupled with the fact that our LPN programs are some of the longest in the U.S. (18 months) and there are VERY few bridge programs, it feels like TPTB around here are really going out of their way to make this "ivory tower" thing a reality. At least that's how it feels from this end...

himilayaneyes · Oct 27, 2010

Fast fact: I am a RN, BSN

1. What exactly are you proposing we do about the millions of LPN's in this country, as well as the thousands currently going through LPN programs right now? Do you strip us of our licensure? Demote us to being CNA's or techs? Well, I definitely don't think that the LPNs who are licensed now should have their hard work taken away by stripping them of their licenses. And I seriously doubt that you'll be demoted...although the hospitals are cheap. I'd hope that they wouldn't do that. CNAs have certificates while LPNs have licenses. Many places won't allow you to work below your license. Eventually the plan is to phase out the LPN programs...but they have to set an official date (year) to do that...the same way they're doing for the NP programs. Those practicing and those in school now (as long as they finish by a certain date) should be allowed to become LPNs and practice.

2. Same question, applied to the ADN's-what do you propose be done with them? Some hospitals, particularly magnet hospitals, require that a certain amount of their nurses have BSN. I know of a hospital in FL that requires 50% of it's nurses to have BSNs, but they may still hire you as a ADN nurse and pay for you to get your BSN for a work agreement. ADN programs would eventually be phased out the same way that the LPN programs would be, but those ADNs practicing now and those in school should be allowed to work. Once again they have to set an official date for the RN, BSN only standard.

3. What do you percieve are the potential ramifications of making a BSN the entry point in terms of bedside nursing. Have there been any studies done to determine how many BSN students would be content working at the bedside for their whole career? And what about in the nursing homes and LTC, which is where the projected need will be the greatest? I'm just curious, because I've read so many posts from RN's (ADN's and BSN's alike) who are bemoaning the fact that they have to "settle" for nursing home work in this economy, and have no desire to make that their career. If we phase out LPN's, and especially if we make BSN the standard point of entry, is it really realistic to think that there will be enough bedside nurses in LTC to care for our aging population? A lot of RNS don't want to work LTC (I'm one of them)...I prefer acute care; everyone has their preferance. So as far as our baby boomers who will need to be in SNFs..it won't be pretty. However, with the economy the way it is...a lot of RNs, especially new grads, are having to "settle" for LTC. As far as making BSN the entry point, it'll make competition for nursing positions more fierce than it already is, particularly for those wanting to advance into managerial positions. BSNs will no longer have an edge, it'll be all experience (which is important)...but new grads won't stand a chance...it's already bad as it is. And I'm no expert...however, I can only foresee the nursing shortage becoming even more severe.

4. How is this push towards a higher educational standard going to effect the role of nursing? Because we all know that facilities will not be able to afford to hire all of these BSN's without "outsourcing" many tasks that have traditionally been part of the nurses role to UAP's. If we have UAP's providing bedside care, doing things like med administration, trach suctioning, etc. (which is already happening of course) then what, exactly, is a nurse? Are we just the "managers" who oversee care? I'm not sure what LTC will do...but I doubt that hospitals will take away any tasks just b/c you're a BSN...in the hospital the BSN is wiping up code browns the same as the ADN and the diploma nurse...and more than likely not being paid any more. We don't have med aides like LTC does...so as far as acute care...I think the nurses' role would pretty much be the same.And as a nurse you are considered a part of the interdiscplinary team caring for the patient...and are pretty much the liason between all of those components and the patient. I doubt that role will change. If anything, to save money the hospital will make the nurses do even more for less pay.

Is this ok with you? And if not, what exactly do you propose we do about it? Is a compromise even on the table anymore? My sister is a LPN. So I definitely don't think that we should just get rid of a large group of nurses. However, I can understand their point of making the BSN standard so that we can be viewed as a profession. Notice that when you apply to facilities as a nurse you are not listed under the professional section along with the pharmacist, the dietician, the MD, etc. Some people even think we're part of allied health care. If I'm not mistaken, I believe in Canada...nurses are required to have a 4 year degree. As far as the States are concerned, I suppose it'll advance the profession...but backfire on the patients if we get rid of a large group of workers unless those already working are "grandfathered" in while the LPN and ADN programs are phased out...that's the only way I could see that working. Then of course, you'll have people who would've been nurses not wanting to do 4 yr programs and choosing a different profession..but what can you do.

catshowlady · Oct 27, 2010

Sorry, too tired to answer all points. BUT, regarding #1, one hospital in my area DID demote all LPN's to tech/UC role. I think they were able to keep their pay grade, at least. My hospital is phasing out the LPN role. All LPN's will be required to retire or obtain their RN, can't remember over what time frame.

:paw:

GHGoonette, BSN, RN · Oct 27, 2010

I can't go into all the technicalities mentioned, but in my country there has been a move to phase out Enrolled Nurse (LPN eq) training; now they are putting an end to bridging training as well. The effect this will have on patient care makes my hair stand on end.

We have already seen the negative effects on patient care of making students college or university based as opposed to hospital based. Now they are proposing to remove the mainstays of bedside care as well, totally ignoring the fact that about 90% of nursing care is basic care, requiring intermediate skills levels. Sometimes I think that nursing in my country is destroying itself from within.

allnurses Guide · Oct 27, 2010

I want to commend you for thinking through this issue and posing such practical questions, MattiesMom! I hadn't really considered some of the scenarios you proposed, such as an all BSN workforce in every one of those job areas that are seen as less desirable, such as a SNF. I will look forward to the responses from the contributors who are actively involved in advancing the agenda on a regular basis "from the inside" , and are usually the ones who will state that "studies show better outcomes for patients with all-BSN" level care.

They've been quite successful in New York, but it's taken a long time. I'm going to guess they will talk about phase-ins, tuition reimbursements and time limits. They will probably talk about using techs or aides to do the things they choose not to do and say that even in a Skilled Nursing Facility their presence will make working there so much better they won't see it as "undesirable" anymore. A bit circular but there you are!

WoosahRN, MSN, RN · Oct 27, 2010

(Currently ADN RN but working on MSN now.)

I should probably get my facts before I respond but I think it is New York that has the most active plan (currently) for requiring BSN. I believe they are giving all LPN/ADNs 10 years to obtain a BSN. I can't remember when the deadline is. Also the umbrella of hospitals I work for is phasing out LPNs. I do know they haven't been hiring any for a while but they are still being employed, although not in the acute areas. I believe I saw a recent newsletter about a timeline. I think that they had 3 or 5 years to get their RN. Forgive me that I'm not looking up the actual info.

To respond to another point, I don't believe that for the most part they can eradicate the ADN programs. I do think that LPNs will have a much tougher time finding work but I can't imagine the entire license not existing. But who knows. There are a lot of education options that make moving to the next step "easier". Rather more accessible I guess.

My mom graduated nursing school in 1978 with her RN and she's been hearing about the ADN/BSN argument for 30 years now. So needless to say I'm not too terribly worried that there will be thousands of unemployed nurses on the streets in the very near future while a few BSN nurses take care of all our healthcare needs.

Let's all remember that they (hospitals, employers) need us more than we need them. They can't admit patients and run their places of business without nurses. So as much as they might want a certain title behind our name their hands are tied due to this need. I imagine they would have more success if they provide the educational and financial incentive to all their employees. I personally don't have a strong opinion about ADN v. BSN. I am advancing my degree for ME and no one else. I plan on remaining at bedside but want the education under my belt in case I am ready to move to another point in my career (considering NP but enjoying bedside right now).

MattiesMama · Oct 27, 2010

Really interesting to read the responses here...

I always like to look at what other countries are doing...I think Canada, for example, has a pretty good approach. Their LPN's now have 2 years of education and graduate with an associated degree. To become an RN you need to go for 2 more years of college, and graduate with a BSN. So while all of their RN's have 4 year degrees, it's not the "entry point" per se. I would love to hear from someone who nurses in Canada to get a perspective on how that is working.

I think something like that, along with reforming nursing education just might work...

MattiesMama · Oct 27, 2010

I want to commend you for thinking through this issue and posing such practical questions, MattiesMom! I hadn't really considered some of the scenarios you proposed, such as an all BSN workforce in every one of those job areas that are seen as less desirable, such as a SNF. I will look forward to the responses from the contributors who are actively involved in advancing the agenda on a regular basis "from the inside" , and are usually the ones who will state that "studies show better outcomes for patients with all-BSN" level care.
They've been quite successful in New York, but it's taken a long time. I'm going to guess they will talk about phase-ins, tuition reimbursements and time limits. They will probably talk about using techs or aides to do the things they choose not to do and say that even in a Skilled Nursing Facility their presence will make working there so much better they won't see it as "undesirable" anymore. A bit circular but there you are!

Thanks, and this is exactly why I'm asking these questions. I've sat on the sidelines on a lot of these debates. I get frustrated...I don't really care about "patient studies". Anyone who's taken statistics knows that you can twist them to suit any argument you want to make. What I do know for sure is that while this squabbling is going on, the very facets of our profession are being sliced, diced, and auctioned off to the highest bidder. It makes me sad to think that 20 years ago (maybe less?) you didn't have "med aides" and "dietary technicians". I've also seen people argue that these tech's make life "easier" for the nurse...and I just have to shake my head. It only makes things "easier" because you have an unsafe patient load, and it takes some of the burden off of your shoulders to delegate a task to someone else. And you only have an unsafe patient load because your employer realized it was more cost-effective to hire 1 nurse and 10 techs than it would be to hire 5 nurses. They aren't doing you a favor :uhoh3:

And I think deep down, the aversion towards working in SNF has less to do with unsafe patient loads than it does with the fact that many nurses simply don't want to work with the elderly. Because it's depressing, maybe a little boring, and a constant daily reminder of your own mortality. Whatever the reasons are, it's just not all that popular. There is simply no way that we will recruit enough BSN's to work in that setting to meet the needs of the aging population, period.