AAS vs. BSN

Fun2, BSN, RN · Oct 29, 2005

I'd be curious to see how the study was performed and if they controlled for physicians and management. There's so many aspects contributing to mortality that I can not imagine that ASN degrees are the biggest one...or even one at all....

Same here. I don't want to turn this into another useless ADN vs BSN battle, but ADN's have more clinical experience than a BSN. A diploma nurse has more clincal experience than an ADN or BSN. So, in all reality, how can this be true?

I guess I can see it being true if they *just happened* to chose to investigate deaths that *just happened* to be involving ADN's, but how can a true control occur? Deaths happen, it's inevitable. I don't think most deaths happen or won't happen because the nurse is a diploma, ADN, BSN, MSN or PhD.

It's the same as you can be a 4.0 student and be a crappy nurse, as well as a C student and be a great nurse. I don't think anyone should pay much attention to these things. All it does is create a bad taste between coworkers. (As far as that goes, I have never seen a difference in any of the nurses I've had to be able to "pinpoint" who is diploma, ADN, or BSN!)

With all this said, I am going for my ADN first, but I am only 4 classes away from my future RN-BSN. So I am impartial, I think. I will be getting my ADN and then my BSN. I think they both good.

:nurse:

jenrninmi, MSN, RN · Oct 29, 2005

i read an article recently that stated that hospitals employing a larger number of asn degreed nurses had higher mortality rates. unfortunately, i dont remember who/what organization performed the study......

This is not a new study just so you know. This was something I've been told since before I even got into my BSN program. Whether it's true or not, I don't know.

jenrninmi, MSN, RN · Oct 29, 2005

Same here. I don't want to turn this into another useless ADN vs BSN battle, but ADN's have more clinical experience than a BSN. A diploma nurse has more clincal experience than an ADN or BSN. So, in all reality, how can this be true?

This may be true with some programs, but I graduated with my BSN last April and had many more hours than a lot of the ADN students on this board. So, please don't stereotype BSN programs as having a lesser amount of clinical hours. Thank you.

KatieBell · Oct 29, 2005

I'm in agreement, with Jen. It is very difficult to characterize all programs into a nice nutshell. In addition, programs are always changing and evolving based on nclex scores, new faculty etc.

Fun2, BSN, RN · Oct 29, 2005

This may be true with some programs, but I graduated with my BSN last April and had many more hours than a lot of the ADN students on this board. So, please don't stereotype BSN programs as having a lesser amount of clinical hours. Thank you.

Of course there are programs that do not fall into the norms. Some BSN programs are terrible, some ADN programs are terrible, and I'm sure there are diploma programs out there that are terrible too.

Obviously there are some BSN programs that go above and beyond, and some ADN programs that don't quite cut the mustard. That goes without saying, so as I stated before I don't want to turn this into another useless ADN vs BSN battle as I am only 4 classes away from my RN-BSN. I think both an ADN and a BSN are good!

The comment was obviously to keep useless battles between ADN vs BSN out of the workplace. We all are/will be RN's, we all have to get along, and we all have one goal, to be a nurse in order to care for patients.

If I thought less of BSN's I surely wouldn't be on my way to get my own BSN. This was not to be offensive, so I am sorry if you took it that way.

carveronica · Oct 30, 2005

Everyone gave some good valuable advice. I currently attend a University in california and I'm not as young as any of you. I have a very big family and I have been divorced for many years now. I have wanted to be a nurse my whole life. I have been going to school one class at a time and have got very burnt out. I want so bad to become a nurse. I thought maybe I should just go for my ASN. I don't currently have a job and never had a permanent job for more then one year. It's been hard and stressful. I was accepted into my local University this quarter and want to keep pushing forward to make my dream a reality. This Friday I had an appointment with an advisior who had advised me to get a least two minors. She said that my nursing classes will not be enough units to get any fiancial aid. She suggested that I minor in Sociology or Psychology to fill the gaps. She also said that I can double major. I don't know what to do!!! I can i get any advice out there. I'm getting very tried of school and I want to get started with some career. i don't have very many years to work. :confused:

VickyRN, MSN, DNP, RN · Oct 30, 2005

the article was just a one or two paragraph blurb in 'nursing 2005' magazine. i'll keep you in mind should i run accross the article again.

You are referring to the infamous Aiken study, a prime example of why one needs to critically appraise all research studies and not just accept carte blanche the results as "gospel truth."

Study: Nurses' Education Affects Death Rates

Researcher: Nurses With More Education Better At Critical Thinking

University of Pennsylvania researchers studied data on more than 230,000 patients from 168 Pennsylvania hospitals. They also surveyed more than 10,000 nurses throughout the state.
The researchers found that death rates were nearly twice as high when the percentage of nurses with bachelor's degrees was low. They said care could improve a lot if hospitals recruit nurses with bachelor's degrees rather than two- or three- year programs. The percentages of more highly educated nurses ranged from zero to 77 percent at the Pennsylvania hospitals studied.

This report is a bone of contention among ADN educators. It is so fatally flawed that it has absolutely no redemptive value other than showing it is wise to have surgery in hospitals in which there are board-certified surgeons! Unfortunately, this one unreplicated research report has been promulgated as gospel (by those with radically pro-BSN agendas), and has been a very damaging piece of propaganda indeed.

Here is an analysis I did of this study for my nursing research class:

Probably one of the most controversial research reports of all times in the great BSN versus ADN entry level debate among nursing academia has been the Aiken study. This one research study was the major catalyst for the Institute of Medicine (IOM) calling for a ratio of 60% BSN and 40% ADN/ diploma in the North Carolina nursing workforce.

Objective: To examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications).

Conclusion: In hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.

"Our findings indicate that surgical patients cared for in hospitals in which higher proportions of direct-care RNs held bachelor's degrees experienced a substantial survival advantage over those treated in hospitals in which fewer staff nurses had BSN or higher degrees. Similarly, surgical patients experiencing serious complications during hospitalization were significantly more likely to survive in hospitals with a higher proportion of nurses with baccalaureate education."

"Nursing education policy reports published in the past decade concluded that the United States has an imbalance in the educational preparation of its nurse workforce with too few RNs with BSN and higher degrees. Our findings provide sobering evidence that this imbalance may be harming patients."

Possible confounding variables and biases:

Selection bias: BSN, MSN, and nurses with doctorates all grouped together; ADN's and diploma nurses grouped together (Pennsylvania has one of the highest populations of diploma nurses in the US).

This factor alone seriously compromises the study's generalizability to a target population of just ADNs and BSNs and produces flawed study conclusions.

Aiken noted the study found nursing experience was not associated with lower mortality rates of patients. "It's the educational level that's important and experience alone cannot achieve the same level of benefit for the patient as education plus experience," she said.

In reference to this quotation, the researchers need to do a better job of factoring out the experience variable.

It was not known how many nurses in the sample were originally ADN nurses who went back to get their BSN's (the BSN sample likely had nurses with more education and experience than the ADN's). This is flawed sampling methodology, also, because many BSN nurses were originally ADN nurses who went back to get their BSN's. The opposite is not true- BSN's don't go back to get their ADN.

For an accurate comparison, the researcher needs to compare strictly new ADN graduates with BSN graduates and patient outcomes.

Another possible confounding variable:

Patients admitted to a high tech and/or teaching hospital by virtue of the type of hospital have a better chance of survival. These hospitals often employ higher percentages of BSN and higher degree nurses than smaller outlying hospitals.

Nurse patient ratios:

BSN/ MSN nurses tended to work in the high tech/ teaching hospitals and to have lower ratios of nurse to patient 4:1 as compared with the ADN at 8:1.

Are the researchers adequately controlling for patient acuity level?

The article noted control of acuity level, but no explanation was given for how this was done.

Other points of concern:

Mortality rates increases with age. The study states that the average patient age in the hospitals with more ADNs is 61.9 years, while the average patient age in the hospitals with more BSNs is 57.3 years.

The researchers admit, but do not speak to the control of, that the ratio of Board Certified surgeons in a given hospital has a much greater impact on mortality than does the education level of the nurse.

My comment: The example of the Aiken report highlights the danger of institutions making practice recommendations on the basis of the findings of one, unreplicated study, especially if the study involved has serious biases and flaws in methodology.

Unfortunately, much damage has already been done by the Aiken Report--the average person does not see these flaws and takes the findings to heart as being unquestionably true.

Reference

AACN: (2003, October). Media/ News Watch. Retrieved October 21, 2004, from http://www.aacn.nche.edu/Media/NewsWatch/Oct03.htm

Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., & Silber, J.H. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association (JAMA), 12, 1617-1623.

Bernier, S. (2003). N-OADN update: JAMA Article "Educational Levels of Hospital Nurses and Surgical Patient Mortality."

North Carolina Institute of Medicine (IOM). (2004, March). Executive summary: Final report of the Task Force on the North Carolina Nursing Workforce.

jezabel1961 · Oct 30, 2005

fantastic information! thank you for sharing and providing a better picture of the study. its too bad that a magazine that is supposed to be 'for' nurses didnt do the same.

KatieBell · Oct 30, 2005

Thanks Vicky

As I mentioned before, i didn't think that the study could be valid (in a scientific sense)...I knew there would have to be too many biases etc...

Caveronica- I feel your pain: but you can go ahead and have a second major that you think will be interesting to you. Mine was Biology. I had a blast- took all sorts of cool stuff: Immunology, Cell Bio, Virology...all helpful in my career.

You could pick something like Sociology- if it interests you, I'd pick a second major or minor that is interesting for you...

Fun2, BSN, RN · Oct 30, 2005

Yes, thanks VickyRN, that was quite interesting!

I don't have any doubt that I am doing the right thing....getting my ADN, and and doing the RN-BSN route.

carveronica: I'm not sure what nationality you are, or what language(s) you speak fluently, but could taking language classes be a possibility? If I had to major in another area besides nursing, it would be Spanish. Good luck! Don't give up!! :)

mickimom3 · Dec 14, 2006

hi, i am new has anyone ever heard of just taking the final bsn tests,instead of going on line for a year of more,(the info is fresh in our long term memory)

Clarise · Dec 14, 2006

hi, i am new has anyone ever heard of just taking the final bsn tests,instead of going on line for a year of more,(the info is fresh in our long term memory)

I am graduating in May of 2007 with my ASN. I will be applying for the MSN program at my local state college for the fall of 2007. Because I have a master's degree already (not in nursing) I can go from the ASN to the MSN without the BSN. I will, however, have to sit and take the NLN Comprehensive Baccalaureate Achievement Test prior to admission into the MSN program. My plan is to take the NCLEX in June and then within a week take the achievement test.

Is this the test you were talking about?