BSN as entry into practice; why we decided against it. - page 13

by MunoRN

24,859 Views | 240 Comments

While hopefully avoiding stoking the ADN - BSN debate unnecessarily, I thought I'd share my experience with my state's consideration of BSN as entry into practice, as well as the BSN-in-10 initiative. About 3 years ago I sat... Read More


  1. 0
    Quote from Ntheboat2
    This "debate" is not a new one. As I mentioned, nurses required zero education at one point in time. Then, there were diploma programs.
    I'm sure when the topic of "phasing out" diploma programs came up, people had these same exact opinions and said, "NEVER!" How many diploma nurses do you see now?

    Then, there's the lovely debate about LPN's being phased out. Of course, every LPN will say that's not true, and it might not be true in other parts of the world, but it is true where I live and in many parts of the US. The hospitals here no longer hires LPNs and the few who are left are working on their RN. They didn't tell LPNs that they had to go and get a higher education....they just quit hiring them.

    What's really the difference between raising the entry level requirement and not hiring those who have a certain degree? Either way, they aren't working, and if they are then they are only working in certain facilities like doctor's offices or LTC.

    The standards for CRNA's are higher, and I'm sure there was a debate about that too and people who said it'll never happen. Now, Nurse Practitioners are next on the list.

    Who knows when it'll happen, but it's only a matter of time.
    This is actually a good point. And I agree for the most part. Question though, and I'm not being a smart-butt (I wanted to say "Smart-something else, but don't want to get banned for TOS.), I'm asking-Isn't the Scope of Practice lesser for LPN's than RN's? If so then the hospitals may just prefer to have RN's vice LPN's. But the key is that there is a discernible difference between the two, whereas to my knowledge, there is no discernible difference between a BSN RN and an ADN RN. When the Scope of Practice changes between the two, then I'm right behind you on the BSN requirement-assuming the BSN programs actually teach useful information for an entry level nurse, and not just some "filler" classes that many BSN's have today. You know, info that encompasses the new Entry level Scope of Practice for nurses.
  2. 0
    Quote from Ntheboat2
    Actually, the source that I personally read does say *significantly* instead of somewhat.

    "Data show that health care facilities with higher percentages of BSN nurses enjoy better patient outcomes and significantly lower mortality rates. Magnet hospitals are model patient care facilities that typically employ a higher proportion of baccalaureate prepared nurses, 59% BSN as compared to 34% BSN at other hospitals. In several research studies, Marlene Kramer, Linda Aiken and others have found a strong relationship between organizational characteristics and patient outcomes."

    Just a couple more interesting tid-bits from that source:


    "Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 – one by the state of New York and one by the state of Texas – clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level. These findings are consistent with findings published in the July/August 2002 issue of Nurse Educator magazine that references studies conducted in Arizona, Colorado, Louisiana, Ohio and Tennessee that also found that nurses prepared at the associate degree and diploma levels make the majority of practice-related violations."

    "Chief nurse officers (CNO) in university hospitals prefer to hire nurses who have baccalaureate degrees, and nurse administrators recognize distinct differences in competencies based on education. In a 2001 survey published in the Journal of Nursing Administration, 72% of these directors identified differences in practice between BSN-prepared nurses and those who have an associate degree or hospital diploma, citing stronger critical thinking and leadership skills."

    Once again, this is an age old debate. All I know is that history tends to repeat itself. When it comes down to it, I couldn't care less what the guy beside me does with his education or career. I just think people are fooling themselves by thinking there is no difference between the two or that the standards are not going to be raised. Whether it's next year or 20 years from now, that's the direction it's going. Personally, I think it will be sooner than later considering that NP's and CRNA's are already making the move. Something else people said would never happen.
    You see, Ntheboat2, THIS I can work with. I probably won't be able to respond until tomorrow as I want to read this wonderful lit your at chore that you have provided (I know how to spell "Literature", damn it! I'm just joking a little ) Let me read it, do some more research. Who knows, maybe you got me....
  3. 0
    Quote from PRICHARILLAisMISSED
    This is actually a good point. And I agree for the most part. Question though, and I'm not being a smart-butt (I wanted to say "Smart-something else, but don't want to get banned for TOS.), I'm asking-Isn't the Scope of Practice lesser for LPN's than RN's? If so then the hospitals may just prefer to have RN's vice LPN's. But the key is that there is a discernible difference between the two, whereas to my knowledge, there is no discernible difference between a BSN RN and an ADN RN. When the Scope of Practice changes between the two, then I'm right behind you on the BSN requirement-assuming the BSN programs actually teach useful information for an entry level nurse, and not just some "filler" classes that many BSN's have today. You know, info that encompasses the new Entry level Scope of Practice for nurses.
    Yes, there is a different scope of practice for an LPN vs. RN.

    There was not a difference in scope of practice for a diploma RN or ADN or BSN for that matter, but that still hasn't stopped diploma nurses from being phased out.

    CRNA's scope hasn't changed, but educational requirements have. Same thing with NP's. Nothing is going to change with their practice, but if they want to practice then they will have to get a doctorate even though MSN has been the standard forever.
  4. 0
    Quote from PRICHARILLAisMISSED
    You see, Ntheboat2, THIS I can work with. I probably won't be able to respond until tomorrow as I want to read this wonderful lit your at chore that you have provided (I know how to spell "Literature", damn it! I'm just joking a little ) Let me read it, do some more research. Who knows, maybe you got me....
    haha...
  5. 0
    Quote from Ntheboat2
    Yes, there is a different scope of practice for an LPN vs. RN.

    There was not a difference in scope of practice for a diploma RN or ADN or BSN for that matter, but that still hasn't stopped diploma nurses from being phased out.

    CRNA's scope hasn't changed, but educational requirements have. Same thing with NP's. Nothing is going to change with their practice, but if they want to practice then they will have to get a doctorate even though MSN has been the standard forever.
    But you know what though, If CRNA's and NP's were already providing great service, I just think that it's CRAZY to ask them to get a higher degree just for the sake of a higher degree. I mean, if this higher degree actually opened up their scope of practice and what they could charge then "Yes" why not? But to force them to get a higher degree just cause it looks or sounds better is ridiculous to me.

    Now, whether it's gonna happen or not is another matter entirely. But that still doesn't make it right....
  6. 0
    Quote from Ntheboat2
    haha...
    Don't be too premature on that "HAHA..." Gotta do my research.
    Remember, there is still the matter of the BSN not adding to the scope of Practice.........
  7. 0
    Quote from PRICHARILLAisMISSED
    Don't be too premature on that "HAHA..." Gotta do my research.
    Remember, there is still the matter of the BSN not adding to the scope of Practice.........
    It wasn't a "neener, neener haha," but a "that's funny haha."

    You can't even hear the way I type!

    I'm not debating that there's no difference in the scope. I'm just telling you what has happened and what is currently happening....and the education requirements are rising while scope stays the same.

    (insert shrugging my shoulders smiley here)
  8. 0
    On another note... (I was just reading about the NP requirements)

    "For decades, a bachelor’s degree was all that was required to become a pharmacist. That changed in 2004 when a doctorate replaced the bachelor’s degree as the minimum needed to practice. Physical therapists once needed only bachelor’s degrees, too, but the profession will require doctorates of all students by 2015 — the same year that nursing leaders intend to require doctorates of all those becoming nurse practitioners." http://www.nytimes.com/2011/10/02/he...pagewanted=all

    This is particularly interesting to me since I've only toyed with the idea of getting my MSN to be a mental health NP.
    I figured I would work for awhile, stack up a little money, and then enter a program when I was comfortable in my role.
    Now, I'm having to rethink that plan. If they require a doctorate by 2015 in order to be a NP then I will need to be FINISHED with my NP program and be licensed by 2015 which means I have to start this upcoming year, no exceptions. From what I understand, if you're already licensed by 2015 then you'll be "grandfathered in," but if you're not, then you have to get a doctorate. People say that this isn't going to happen, but read what I quoted above. It happened to pharmacists. Furthermore, my school is only offering the MSN online now through RODP. They were well known for their MSN program so for them to do away with it says something. They now have a new program in anticipation of this change that only admits BSN students and after a 3 year program you are a DNP.

    I imagine that even if the entry level for RN's does change then it will work the same way. So, it wouldn't affect anyone who already has an ADN, and schools will likely stop offering the program before the change would affect any current students. I guess that's another reason I don't see why ADN nurses are so adamant that the standards not be changed...because it's not going to require that they go back to school anyway. Granted, it might be harder to switch jobs or get hired in after the change. I doubt it though because I never heard pharmacists having a hard time getting jobs when they were licensed with bachelor's degrees.
  9. 0
    I'll ask again; let's say you're in charge (Ntheboat2) of restructuring our Educational system, what would you do? How would you accommodate the additional students in a BSN program? Would you just change the name of ADN programs to "BSN" programs and add the additional 45 general credits? How would you bring the ideal and the reality together?
  10. 3
    On Aiken, her frequently cited study on ADN vs BSN Nurses deserves a closer look. This sort of sums up a concern with her data "Hospitals with higher proportions of baccalaureate-and master’s-prepared nurses also had slightly less experienced nurses on average and significantly lower mean workloads." We know (from Aiken's previous work) that higher patient ratios=greater mortality risk, greater risk of errors, etc), so the concern is if she adequately accounted for this. Her method did not actually correct for this in the individual populations she was studying, rather she used a hospital wide HPPD, an inaccurate method for comparing staffing in hospitals with very different service lines. She was careful in her conclusions to actually not correct for staffing ratios at all; "Our results imply that had the proportion of nurses with BSN or higher degrees been 60% and had the patient-to-nurse ratio been 4:1, possibly 3810 of these patients (725 fewer) might have died, and had the proportion of baccalaureate nurses been 20% and had staffing uniformly been at 8:1 patient-to-nurse ratios, 5530 (995 more) might have died." Sort of like if I were to claim I could get Angelina Jolie to marry with me if I just wear a different cologne, and if I'm Brad Pitt. It's pretty likely that one of those factors has more to do with it than the other.

    I had a statistics teacher that referred to a test of accuracy in controlling factors as a "center measurement test". If you're trying to find the middle of a board, you measure the board then divide that by two, measure that far from one end and that's your "center". Of course it may not really be the center, that's just the center that you've determined by controlling for half the supposed length. To check that, measure the same distance from the other side, if it doesn't match, your method was wrong. The same can be done with these studies. We know that predominately BSN hospitals benefit from better patient ratios for similar patients, we also know that better patient ratios produce lower mortality rates. So if Aiken successfully removed all influence of staffing ratios, then we should see the same results if we apply the same methodologies to patient outcomes when predominately BSN facilities (Magnet facilities) have worse staffing ratios, which isn't the case; "Non-Magnet hospitals had better patient outcomes than Magnet hospitals. Magnet hospitals had slightly better outcomes for pressure ulcers, but infections, postoperative sepsis, and postoperative metabolic derangement outcomes were worse in Magnet hospitals. Magnet hospitals also had lower staffing numbers." Similar methodologies, but obviously didn't completely remove the staffing ratio element from the equation.

    Most importantly, in order to apply this information we can't just change the letters on someone's diploma and expect noticeable changes, we need to know what specific attributes caused these changes. The majority of ADN programs have already moved to BSN affiliations and have adopted their curriculum and model, so what's missing?
    redhead_NURSE98!, tewdles, and PMFB-RN like this.


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