ADN's being pushed out

allnurses Guide · Mar 26, 2013

namely that a BSN-educated nurse has superior bedside nursing skills and presumably would notice her patient going downhill and intervene before the ADN nurse would. Some unlucky souls would be alive today if their nurse held a BSN degree, regardless of years of experience, regardless of whether they became a BSN through a bridge program or traditional 4 year brick and mortar program.
All of that is somewhat ironic, because you will hear at least as often that where the ADN nurse really excels is at the bedside, but maybe they don't include accurate assessment of changes in a patient's condition that could lead to their death a bedside nursing skill.

IMHO

This really isn't the crux of the issue, at least how many see it.

Patient stays are getting shorter. Medication and treatment regimens are getting more complex. Patient Education, assessments, EBP, traige, home/community nursing is even more important. This requires nurses to practice to their full scope.

Traditional "bedside" and task-oriented nursing is changing.

allnurses Guide · Mar 26, 2013

The issue has been distorted somewhat by the troops in the field who often imply that better patient outcome is directly connected to the nurse's degree, and that is what bothers me, having observed nurses of all educational backgrounds for so long.

That may be true, unfortunately. And it's not right.

That doesn't mean her research is biased and flawed though; interpretation by the masses may be.

dt70 · Mar 26, 2013

Thanks DNPpat for your latest post.

It made sense for the hiring strategies.

I am here because I am interested in switching from IT to Nursing. And the allnurses iPhone app

Is great.

My Bsn questions were composed from a patients perspective . "what's in it for me" .

I'm hoping to attend a 4 year conventional program. I have a low gpa but since it's only an aas degree , just the science pre reqs can raise it significantly.

if your local market still hires adn's and you find a

locally respected school then continue to Bsn it will take longer but in the end you'll have the degree.

In my case, those my age who chose nursing and

graduated with Bsn, graduated 20 years ago,

so whatever path I need to take for Bsn is long gone to catch up to them.

I do have more questions I don't want answered here.

I tried google but no luck. I'll have to think it over or do more research.

allnurses Guide · Mar 26, 2013

IMHO
This really isn't the crux of the issue, at least how many see it.
Patient stays are getting shorter. Medication and treatment regimens are getting more complex. Patient Education, assessments, EBP, traige, home/community nursing is even more important. This requires nurses to practice to their full scope.
Traditional "bedside" and task-oriented nursing is changing.

What I hope for is that nursing leadership ie "academic elitists":-) and large employers focus on ameliorating those things that currently make community college programs more attractive to prospective nurses, listed in mind-numbing detail in the Data Driven analysis link I posted previously. I have no doubt that if the expertise and creative energy of those who advocate for things like 80% by 2020 and BSN in 10 were focused in that direction we'd all be much happier. It's already started to happen in some schools. I'm not completely cynical about their motivations yet.

scrubs101 · Mar 26, 2013

My two cents...I am an ADN nurse. I went to a University, not to a "collage". It took me three years not 2. This was not because I was lazy or taking my time actually it was required. I even went to class in the summer. My last semester I was precepted in a major hospital not a simulation lab as some of you have mentioned. In my research with regards to the difference in ADN and BSN, BSN includes nurses research and more theory. The ADN had more clinical skills and critical thinking focus.

It is too bad that we are being divided by degree. After all we all passed the NCLEX. However I do see the merit of a BSN, merely as it will enable those to have higher management opportunities.

Personally I am disappointed in the lack of knowledge regarding the ADN requirements by BSN nurses. It is somewhat insulting really. It reminds me of some Doctors attitudes and even some patients...that Nurses walk in off the streets.

Sad.

Again this is my opinion.

allnurses Guide · Mar 26, 2013

What I hope for is that nursing leadership ie "academic elitists":-) and large employers focus on ameliorating those things that currently make community college programs more attractive to prospective nurses, listed in mind-numbing detail in the Data Driven analysis link I posted previously. I have no doubt that if the expertise and creative energy of those who advocate for things like 80% by 2020 and BSN in 10 were focused in that direction we'd all be much happier. It's already started to happen in some schools. I'm not completely cynical about their motivations yet.

The collaboration between schools now offing direct bridges gives me hope: it offers an affordable path to entry. I hope this continues as it represents a shift in academia.

scrubs101 · Mar 26, 2013

I also want to mention that as an ADN nurse I never had difficulty in assessing any of my patients in the ER or the CCS where I worked when it came to complex pathologies or declining status. I have however worked with MSN nurses who could not pass ACLS.

allnurses Guide · Mar 26, 2013

I also want to mention that as an ADN nurse I never had difficulty in assessing any of my patients in the ER or the CCS where I worked when it came to complex pathologies or declining status. I have however worked with MSN nurses who could not pass ACLS.

I have no doubt you are the best around in assessing. The question is would you be even better with more education?

akulahawkRN, ADN, RN, EMT-P · Mar 26, 2013

I also want to mention that as an ADN nurse I never had difficulty in assessing any of my patients in the ER or the CCS where I worked when it came to complex pathologies or declining status. I have however worked with MSN nurses who could not pass ACLS.

I have no doubt you are the best around in assessing. The question is would you be even better with more education?

I would suggest that the question is not so much "more education" but rather what the education is in. If the education is in management and nursing theory, and the rest of the education was equivalent to that of an ADN from a quality program, would that additional education have made any difference? Does having a more in-depth education in psychology make you better able to assess that patient who can't breathe because their lungs are full fluid from pulmonary edema?

What also gets lost in the discussions between ADN/BSN is that, ultimately, they both are 2 year programs. The ADN program I currently attend has identical, if not slightly higher (statistically insignificant though) pass rates on the NCLEX than the BSN program at the local university, and their pass rate is quite high as it is.

Is there an educational difference between ADN and BSN? Yes. Clearly there is... but it's probably not very much so, until you start looking at management-level or community/public health education.

Personally, I think there's a greater education difference between ADN/BSN vs MSN (not ELM) than ADN vs BSN.

LadyFree28, BSN, LPN, RN · Mar 26, 2013

You are asking some very reasonable questions, and your humility is refreshing. Your final sentences here are so important, but let's return to that in a moment.
The original poster spoke about experienced and (in the poster's opinion) highly qualified AD nurses losing their employment, presumably to allow the employer to hire BSN graduates to replace them. If true, that is inexcusable and in no one's best interest. These experienced nurses represent a huge 'brain trust' for us all. If employees have been discriminated against they sometimes have recourse through their state labor board or union representation, and I would encourage them to pursue that.
That aside, there is a very good reason for the powerful professional shift in favor of more advanced education for nurses. This push comes from within nursing, not from outside pressure. Although there has been a recognition of the need for many years, market forces have largely impaired progress. The increasing complexity of health care has definitely made it more clear recently. I won't take space here with details, but if you (or others) are interested a good place to start is with the Carnegie Foundation report in 2009 titled Educating nurses: A call for radical transformation. The IOM report mentioned earlier provided a further review of the evidence and also concluded with a powerful call for a more highly educated nursing workforce. Virtually all of the major national nursing organizations support this change, including the American Nurses' Association, the National League for Nursing, the American Organization of Nurse Executives and I can assure you they did not take these positions without careful and thoughtful review of the evidence and implications.
This is never meant to be disrespectful of the enormous contribution made every day by associate degree nurses. The ASN and ADN programs have a proven track record of providing high quality education for entry-level nurses,and this is a very important pathway into the profession. Some of the most important support for academic progression in nursing, however, comes with the endorsement of the national organizations responsible for providing ADN programs. The American Association of Community Colleges and the National Organization for Associate Degree Nursing, among others, have noted the need for an associate degree entry point *and* progression on to higher degrees. See American Association of Colleges of Nursing | Joint Statement on Academic Progression for Nursing Students and Graduates.
To your specific question, there are a couple of reasons for hospitals to trend toward hiring of BSNs now, even if the stated goal is 80% by 2020. Here is the easy one: If a hospital has 50% AD nurses, and they want to move to a higher percentage (without the totally unethical behavior of firing folks who don't deserve it) they can only change the numbers in two ways - encourage their current nurses to go back to school, or preferential hiring. Since many of their existing employees may choose not to get an advanced degree, they change their hiring practices.
The more subtle reason is that changes in health care will likely favor the facilities with more highly educated nurses. Nurses with a BSN or higher are more likely (not exclusively) positioned to evaluate health outcomes in view of the current research, evaluate population health within a community, minimize acute care episodes, and a variety of other things that will become increasingly valuable to patients and providers alike.
So.... back to your last sentences. Even after my lengthy diatribe here, I can't think of a better way to say why this issue is important. Increased knowledge puts more tools in the tool chest, and we all benefit from that.

^Well said! Agree!

LadyFree28, BSN, LPN, RN · Mar 26, 2013

I would suggest that the question is not so much "more education" but rather what the education is in. If the education is in management and nursing theory, and the rest of the education was equivalent to that of an ADN from a quality program, would that additional education have made any difference? Does having a more in-depth education in psychology make you better able to assess that patient who can't breathe because their lungs are full fluid from pulmonary edema?
What also gets lost in the discussions between ADN/BSN is that, ultimately, they both are 2 year programs. The ADN program I currently attend has identical, if not slightly higher (statistically insignificant though) pass rates on the NCLEX than the BSN program at the local university, and their pass rate is quite high as it is.
Is there an educational difference between ADN and BSN? Yes. Clearly there is... but it's probably not very much so, until you start looking at management-level or community/public health education.
Personally, I think there's a greater education difference between ADN/BSN vs MSN (not ELM) than ADN vs BSN.

^Agreed.

I saw the striking similarities, yet, there were additional classes for the BSN that require a framework to understand changing shifts and relativity to education, how to assess and expand it, work with various populations, increased classes in analyzing decision making, including ethical matters, responding and understanding what behaviors, and social mores drive the people we serve and our colleagues, how people interpret communication and learning styles, historical cultural and socioeconomic psychology, is ALL relevant in working in this profession. Yes, you go over these issues in an ADN program, and make take a for course at the "100 level" while Bachelor programs want 200 level courses in all prerequisites.

For me, when I did not succeed in nursing school the first time in an ADN program, I was welcomed back into the program, however, I started doing my own due diligence and examination, at 19...I had no help, no one was a nurse in my immediate family. I looked and, for me, it was logical to go for the BSN. Most of the reason that I didn't go to get my BSN was initially fear; ironically, I got my degree from the University that have me a full scholarship, but at the time was having issues in their nursing program. It was worth the wait, and education as a LPN to get the BSN in 2012...The dots have been connected so much so from already being a bedside nurse as an LPN. The pro-nursing attitude; the inclusion of respect of the University in terms of nurses as a whole from the "elitists" (not my term...) WHO WERE ADNs and STILL work at the bedside, made my education VERY rewarding, and flexible and excited to the upcoming changes in the profession because I AM prepared. Those educators, IMHO, mirror US...there was no snobbery, only the importance in investing and bring successful in this profession.

The role is expanding, and the things I do and the decisions, advocacy, and education I do are more so from the additional education. I will be attending a class on basic X-Ray interpretation at my hospital; they listen to what we feel that could benefit our practice....I am sure that will be incorporated in our practice in the near future.

Regardless of where our level of nursing is headed, we are going to need an educational mentality to get us to that level and has the competency that reflects the vast knowledge we already have; in other words, we are going to continuously need to expand, and if that means the BSN is the entry level to practice, so be it. Bridge programs are becoming more and more accepted, even CC teaming up with Universities, so there is an opportunity to gain the extra "tools" that a well-said PP stated.

That is not a BAD thing; I only see it as positive; and our wages are not going to go down, either, as people fear...they may stay the same, they have a good chance of increasing eventually; if anything, Nursing is not a profession to become a millionaire in...you can make up to 6 figures; however it will no way reach a half mil; but you can still live comfortably if the individual has a good hand on their finances...had to address that, because it seems to be a trend on AN for posters insisting, or stating that our wages are going to be cut because of an increase in education. I don't agree with that.

SleeepyRN · Mar 26, 2013

Apples to oranges in this comparison.
If you had to be cared for by a team of ASN nurses with 15 years of experience or a team of BSN/MSN/DNP nurses with 15 year of experience which would you choose?

I didn't clarify my point well. In my example of being treated as a patient, I would be treated by a BSN nurse. But by a BSN who first was LPN, then ADN-RN, then BSN.

There are of course multiple factors that go into making a great nurse that have nothing to do with education level (personality, availability...). I was simply pointing out 1 preference of mine.