Ok this may be a rant but.... - pg.4 | allnurses

Ok this may be a rant but.... - page 4

Why does it seem that most people believe that ADN programs are not as good as BSN programs?! Do we not all take NCLEX? Do we not all have the same goals...to be good caring nurses? Why is there... Read More

  1. Visit  Skips profile page
    0
    My husband holds an ADN. I am currently in school for a BSN. The main difference I have noted is generally the theory surrounding nursing. In my program, we spend a heck of a lot more time learning theory, research, and cultural viewpoints. In his program, they hit the ground running, beginning clinicals 6 weeks after the very first day of nursing school. They were required to care for their own patients. I did not begin clinicals until level 2. The first clinical was shadowing a nurse for the day. After that, we have a partner to take care of one patient for the day for 2 weeks. After that, we are on our own with a patient. It's just different. I'd say the pace is a lot different. He learned the same nursing care that I am learning now, though. Also, there is community health thrown into the mix for me. He did not do any of that in his ADN program. Just different stuff you have to learn on top of clinical skills. (:
  2. Visit  BlueEyedGuy profile page
    3
    Much of this thread has been about bluster, ego, and feelings of adequacy. How about some evidenced based practice?

    I'm a proponent of BSN as entry to practice. Why? They have shown through research that they provide safer patient outcomes. Here's a few quotes pulled from different studies of the subject:


    • "... there were 4.9 fewer deaths per 1,000 patients on intensive care units staffed with a higher percentage of nurses with bachelor's degrees" (AACN, 2012)
    • "The noted nurse researchers found that every 10% increase in the proportion of BSN nurses on the hospital staff was associated with a 4% decrease in the risk of death" (AACN, 2012).
    • "The findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients" (AACN, 2012)

    These are just a few examples from studies that are listed on the AACN website. Those "extra" gen-ed classes, nursing electives, Nursing Leadership, Community Health, Nursing Theory, and Research have a measurable effect on patient outcomes.

    Reference
    American Association of Colleges of Nursing (AACN). (2012). Creating a More Highly Qualified Nursing Workforce. Retrieved from http://www.aacn.nche.edu/media-relat...sing-workforce


    Luckyyou, zoe92, and OB-nurse2013 like this.
  3. Visit  JBudd profile page
    3
    The gen ed prep classes are not the same for both, in many programs. The widely varying reqs are a concern to BONs, in my state there is a mandate to start making the curriula and prereqs start being consistent with each other. I have looked up prereqs for different ASN schools, one accepts a B in high school biology as sufficient. One requires a basic math class, with simple algebra only.

    Now, I've read many posts, and know that some ADN students have a much deeper and better prep than that, many already have a bachelors in another area. But the fact remains, many ADN programs have much weaker prereqs. Some have leadership classes, others don't.

    BSNs do spend more time in school, both in prereqs and nursing classes. I am proud of my ASN students and grads! But I also know how much more I studied for my BSN; from 3 semesters of psych vs 1, to a lot of chemistry and biology, stats and algebra, history, languages, social studies, etc. In the BSN part, theory, leadership and mgmt, an entire semester of community health instead of a shorter rotation....

    No, I am not being "snooty", I am relating my experience. My ASN students are well educated in nursing, and are competent and able RNs. I work with a fair number of my former students, and gladly. The BSN nurse has a broader education in many areas, and education is always a good thing for any person. Any professional benefits from being widely educated.
    nursel56, zoe92, and OB-nurse2013 like this.
  4. Visit  nursel56 profile page
    1
    Quote from BlueEyedGuy
    Much of this thread has been about bluster, ego, and feelings of adequacy. How about some evidenced based practice?
    It would be more convincing if you didn't get all your studies from a list provided by a group who has an interest solely on one side of the argument.

    I found this excellent article in following my personal interest in the subject matter from what many people would agree is the inception of the argument, the 1965 ANA position statement about education for entry into practice and the difference between a professional nurse and a technical nurse. The authors are generally in agreement with the principles set forth there, but state:

    Quality care is easy to describe but difficult to measure. Because technical and professional nurses write the same licensing examination, hospitals, as the major employers, do not differentiate among the educational levels of staff nurses in patient care responsibilities or salary. Given the educational mix of registered nurses in the care environments, the number of health professionals involved in hospital-based practice and the complexity of care, it is difficult to identify any factor, such as the educational level of the nurse, in studies of health care outcomes. Consequently, the measured impact of professional nursing on patient care is ambiguous and unproven.

    Revisiting the American Nurses Association’s First Position on Education for Nurses

    It's long, but well worth the read.
    Last edit by nursel56 on Oct 2, '12 : Reason: wonky fonts
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  5. Visit  BostonFNP profile page
    1
    I am not quite sure if your post about revisiting the 1965 ANA statement is intended to solidify the argument for BSN or refute it?

    It is true the 1965 statement sparked the debate after which the ANA has supported the BSN. The 2002 revisit you linked concludes that nurses are the least educated in the medical field and a new position that reflects changes is warranted. This was prior to the Aiken et al 2003 landmark study that showed significantly decreased mortality with a larger workforce of BSN nurses, findings that were repeatedly demonstrated in the following years spanning hundreds of thousands of patient outcomes.
    Last edit by BostonFNP on Oct 2, '12
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  6. Visit  nursel56 profile page
    1
    Quote from de2013
    I am not quite sure if your post about revisiting the 1965 ANA statement is intended to solidify the argument for BSN or refute it?

    It is true the 1965 statement sparked the debate after which the ANA has supported the BSN. The 2002 revisit you linked concludes that nurses are the least educated in the medical field and a new position that reflects changes is warranted. This was prior to the Aiken et al 2003 landmark study that showed significantly decreased mortality with a larger workforce of BSN nurses, findings that were repeatedly demonstrated in the following years spanning hundreds of thousands of patient outcomes.
    I posted the link for several reasons. I thought it was interesting and contains a timeline of references throughout the decades since the paper was first published all in one place. If someone was interested in pursuing the topic further, there are a wealth of "leads" in it to serve that purpose.

    I also posted it because it appeared to not be one of the many drum-beating lists of resources intended to prove a point the person or persons tailors to suit that pre-decided agenda. A good example of that would be the way the AACN cherry-picks studies and predictions made by people like Peter Buerhaus.(that is usually done to buttress their claim that we are still in the midst of a nursing shortage though)

    As far as I know every factor mentioned in the excerpted paragraph from 2002 was still true a year later. It's easier to say "correlation does not equal causation". Believing that nurses are undereducated compared to other professions doesn't change the rules on what constitutes "proof". I found the article to be informative and fair. Others may agree.
    Last edit by nursel56 on Oct 2, '12 : Reason: clarify
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  7. Visit  BostonFNP profile page
    0
    Quote from nursel56

    I posted the link for several reasons. I thought it was interesting and contains a timeline of references throughout the decades since the paper was first published all in one place. If someone was interested in pursuing the topic further, there are a wealth of "leads" in it to serve that purpose.

    I also posted it because it appeared to not be one of the many drum-beating lists of resources intended to prove a point the person or persons tailors to suit that pre-decided agenda. A good example of that would be the way the AACN cherry-picks studies and predictions made by people like Peter Buerhaus.(that is usually done to buttress their claim that we are still in the midst of a nursing shortage though)

    As far as I know every factor mentioned in the excerpted paragraph from 2002 was still true a year later. It's easier to say "correlation does not equal causation". Believing that nurses are undereducated compared to other professions doesn't change the rules on what constitutes "proof". I found the article to be informative and fair. Others may agree.
    What is your interpretation of the line directly preceding the cited text and directly following the cited text?
  8. Visit  nursel56 profile page
    0
    Quote from de2013
    What is your interpretation of the line directly preceding the cited text and directly following the cited text?
    It's unclear to me what you're asking for. By "the line" do you mean the sentence in the preceding paragraph that refers to registered nurses as "undereducated members of the health care team when compared with physicians, etc"?

    I would say it's probably true. The benefits of higher education span across the totality of everything a nurse (or anyone for that matter) does.

    However that is not to say that there is a proven causal relationship between better patient outcomes and what type of education a registered nurse has had. Linda Aiken's first study is not universally accepted as proving that where there are better patient outcomes, every other factor that could possibly account for the improved outcome has been ruled out, or that within the category of "BSN" and "ADN" prior experience or prior nursing education was taken into consideration.

    I don't see how you're arriving at the idea that if one is true the other can't be, and apparently neither did the authors of the article. If you think the article is outdated the 2010 IOM Report on the Future of Nursing: Focus on Education contains most of the points made within this article in terms of the overall need for and benefits of a more educated workforce, it also states: "The causal relationship between the academic degree obtained by RNs and patient outcomes is not conclusive in the research literature."
    Last edit by nursel56 on Oct 4, '12
  9. Visit  BostonFNP profile page
    0
    The causation vs correlation debate is one of study design. There is no possible or ethical way for a randomized placebo-controlled study to be conducted so a correlation is the best insight we will ever get. Aiken did control for other parameters which showed significant associations; perhaps an argument could be made for the uncontrolled parameters, in aggregate, created a confounding parameter which is the downfall of the study design. I don't notice any blatant confounders.

    And I was referring to the statement following the quoted text that (paraphrasing from memory) that nurses lacking liberal arts education struggle with the application of knowledge.
    Last edit by BostonFNP on Oct 4, '12
  10. Visit  suga_junkie profile page
    1
    Quote from Esme12
    This debate will contine Ad infinitum while there is a two tiered entry levels.
    I'm Australian and I find it interesting that there are 2 different RN entry level degrees that result in the same responsibilities and pay (is that right?). Here we only have a (BSN) RN degree undertaken at university for 3 years or an Enrolled Nurse (like LPN) diploma which takes 18 months.
    Can anyone tell me the history behind having 2 RN pathways? I'd be interested to know
    Esme12 likes this.
  11. Visit  OB-nurse2013 profile page
    0
    Quote from Anoetos
    I think you saw my post in the other thread.

    If the idea is that a nurse is someone who assesses patients, communicates with doctors and administers medications from the bedside (along with all the other necessary and wonderful things bedside nurses do), then yes, you're right, these classes are superfluous.

    But if the idea is that a nurse is someone involved in the care of the whole person, family, population and community, including their responses to treatment, stress, their environment and all the many things that effect their health and health behaviors in every place where they find themselves, then a broader classroom preparation becomes necessary.

    Where this gets muddy is when assumptions get made, that, for example a two year degree nurse can't do all these things, or, on the other hand, that BSN prepared nurses are clinically inadequate. Neither is true. Clearly, ADNs get a grounding in holistic and collaborative care, and clearly BSNs get the same amount of clinical preparation as ADNs.

    Frankly, I am for a broadening of the profession. I would like every nurse to be as well prepared as he or she can possibly be. If doctors go to school as long as they do, why should the people carrying out their orders not be at the very least baccalaureates?

    I am for independent nursing as well, for the practice of nursing as a separate discipline, a profession where it's practitioners are prepared as highly as they can be, who can work autonomously.

    I would encourage everyone to go and get their bachelors if they have not, and to go on to graduate degrees if they have and are so inclined. It only improves the profession itself and it's perception. It means better opportunities for a greater number of people. It means elevating the profession.

    I am really sorry if this sounds snooty. It isn't my intention.

    Is a bachelors degree better than an associates degree? Does the question even need to be asked? Of course it is.

    Is a BSN prepared nurse a better nurse than an ADN prepared nurse? Does the question even need to be asked? Of course not.

    But it remains that the former is better prepared upon graduation to embrace nursing as a complete profession in every environment.

    You're welcome to disagree.
    I could not have written a better post. Love this!
  12. Visit  nursel56 profile page
    0
    Quote from de2013
    The causation vs correlation debate is one of study design. There is no possible or ethical way for a randomized placebo-controlled study to be conducted so a correlation is the best insight we will ever get. Aiken did control for other parameters which showed significant associations; perhaps an argument could be made for the uncontrolled parameters, in aggregate, created a confounding parameter which is the downfall of the study design. I don't notice any blatant confounders.

    And I was referring to the statement following the quoted text that (paraphrasing from memory) that nurses lacking liberal arts education struggle with the application of knowledge.
    I'm sure we could continue to scrutinize and discuss the meaning of everything in the article for an indefinite period of time. I still wouldn't change anything in my reply to blue-eyed guy.
  13. Visit  Esme12 profile page
    2
    Quote from suga_junkie
    I'm Australian and I find it interesting that there are 2 different RN entry level degrees that result in the same responsibilities and pay (is that right?). Here we only have a (BSN) RN degree undertaken at university for 3 years or an Enrolled Nurse (like LPN) diploma which takes 18 months.
    Can anyone tell me the history behind having 2 RN pathways? I'd be interested to know
    Bulletin....we are interrupting your regularly scheduled discussion for this important update..........

    Sigh.......confusing isn't it?

    At one time the only way to be a nurse was through a hospital "diploma" setting that required the nurses to live at the hospital....kind of like becoming a nun. This process was a bout 3 years long. During WWII the demand for nurses was at an all time high and to supply the need a 2 year program was developed (History: School of Nursing: Adelphi University) off of the hospital campus. The BSN at the time was considered the advanced degree and being a RN before entry was required.
    n 1942, Dr. Montag was asked by Adelphi College, under a grant from the U.S. Public Health Service, to determine if local hospitals would cooperate in establishing a school of nursing at Adelphi College. The United States' entry into World War II resulted in an urgent need for nurses. In January 1943, Dr. Montag was named director of the School of Nursing, the first program for nursing on Long Island. The first 25 students were admitted under the Nurse Training Act of 1943, also known as the Bolton Act. After completing the program, most of the students joined the U.S. Cadet Nurse Corps.
    In 1965....for whatever reason the ANA (American Nurses association) voted to allow the two tiered entry into nursing in 1965....which began the intense debate. The hospitals (the diploma grad), on the other hand, refused to "give up" their free qualified help (still requiring the nurses to live at he hospital....which they don't do anymore) so the ANA adopted the three tiered entry level that continues to exist today. Hence, the battle began. Even the nursing theorists can not agree as to when the ADN program began. Some talk about Dr. Montag as the pioneer in 1942 and others refer to 1952 as the beginning of the ADN program. One was considered "military" nursing core and the other definitely civilian.
    The first Associate’s degree in Nursing (ADN) program was started in 1952 at Fairleigh Dickinson University. An ADN is defined by many nursing entities as “an entry-level tertiary education nursing degree.” In the U.S. this type of degree is usually awarded by community colleges or similar nursing schools. Enrollment in associate’s degree programs increased until the early 1990s, by which time the ADN had started to evolve into more of a stepping stone on the path to a BSN and a career in professional nursing; and the BSN degree took over as the fastest growing option. Today RNs are seeking the BSN degree in increasing numbers. In 1980, 22% of RNs held a bachelor’s degree while 18% had an associate’s degree. By 2004, the number of bachelor’s prepared nurses reached 34.2% while only 33.7 % had an associate’s degree. This indicates that the baccalaureate programs are taking the lead in the production of new nurses.
    In 1995 the diploma grad actually had the best "Board" passing grades followed by the Associates degree and lastly the BSN.
    The success of this radically new approach to educating registered nurses was phenomenal. The number of ADN programs increased from seven in 1958 to 868 in 1994 (National League for Nursing, 1996). The reasonable cost and proximity of ADN programs to the community provided greater access for diverse populations including adult learners, males, married students, and minority populations.

    ADN programs prepared the largest number of new graduates for RN licensure. In 1995, 58,749 (61%) nursing graduates out of a total of 97,052 were from ADN programs (National League for Nursing, 1996). Furthermore, graduates of ADN programs had a high rate of success on the first attempt to pass the NCLEX-RN.

    National pass rates for the three types of nursing programs for 1996 to 97 are indicated below (National Council of State Boards of Nursing, 1996–1997):
    • ADN 88%
    • Diploma 90%
    • Baccalaureate 85%

    Of the 2.5 million RNs in 1996, over 66% were ADN graduates (NLN, 1996). According to a National League for Nursing (NLN) Report, 1994 ADN graduates functioned in a variety of settings with 22% working outside the hospital (NLN, 1996). ADN graduates possess many of the competencies needed by registered professional nurses.History: School of Nursing: Adelphi University
    The ANA, which is a powerful entity to be sure, is not the opnly nursing organization the makes recommendations. Nor do a majority of nurses belong to this organization. But they do have a powerful voice in the practice with nursing with the government and have the reputation as being "The Voice" of nursing practice.....the think tank so to speak. They have decided that the studies they have sponsored have "proven" that the BSN is the superior graduate causing a noticeable rift in the ranks amongst nurses.

    Historically...the ADN was an accelerated intense program that out the three years of the hospital programs and condensed it into 2 years. These nurses were clinically proficient with college credits/degree. They held, and still hold, the majority if nursing positions as the hospitals programs closed across the country with the intent to phase the diploma out......some facilities continue to hold onto these programs and the free help they provide...it works for them.

    The ANA has since decided that the BSN is the "superior" education for entry level and have sponsored many studies that patients have a better chance of survival when cared for by a "BSN nurse" than an ADN nurse.........of course these studies are conducted by the ANA or some other nursing entity that are heavily tied to the academic institutions which also happen to have the state of the art facilities/cutting edge procedures that also improve patient survival....but that was not included in the statistical data when comparing the two degrees of nurses caring for the patients and the survival rates.

    Nursing is not a "regulated" educational requirement other than the national licensing exam that is required to practice......in the interest of free enterprise of course. Therefore not all schools are created equal.......... in the present market, the presence of schools for profit are ever present and the quality of these schools are not (for the most part) regulated nor are the "accredited" by the "governing bodies" .....ANCC American Association of Colleges of Nursing
    NLNAC National League for Nursing Accrediting Commission

    Once licensed......Each individual state has the "right" to accept and deny licensure in that individual state based on it's own requirements which greed for profits have caused a dumming down, in some cases, of the programs for the almighty dollar.....clear as mud right?

    There has been the addition of several levels of nursing practice with Advanced Practice nurses who can, in most states, practice independently of a physician and can bill accordingly. Now that same group of nurses, the ANA, have decided that they have been wrong all along......that the BSN is the best nursing education to have and have developed a marketing tool "Magnet" status that requires a majority of BSN nurses to be the better hospital....and when we are sick we all want the best .....right? Hospitals pay these nurses to come and "accredit" their facility as "Magnet" status therefore making that hospital the "preferred" facility.

    The teaching institutions cannot afford to eliminate the ADN programs (still a majority, and cheaper, for educating nurses)for that would closed certain colleges, well at least seriously damage the profit margin, and the colleges protest this......so they remain open. Now, with this economy, and no nursing shortage (supply and demand) hospitals can afford to be choosy and are choosing the BSN as the "better graduate" so now the ADN grads are jobless although they all take the same licensing exam and still have the better passing rate (for the most part).....have no jobs.

    All levels of entry have to pass the same exam making them equal. In the best spirit of human behavior....my degree is better than your degree ensues.....making the ADN degree "lower " than the BSN....when we all know that it's bedside experience that counts. ADN grads that are present at the bedside for years are just as qualified as anyone else. Any change in the licensure requirement will require the "grandfathering" of all presently licensed nurses and the "BSN or higher" don't like that...... and the colleges and school protest the loss of their programs and income. So we keep all three.

    Shrew....I'm out of breath...........Aren't you glad you asked?

    ......we will now return you to our regularly scheduled programming........
    Last edit by Esme12 on Oct 5, '12
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