BSN as entry into practice; why we decided against it. - page 14

by MunoRN

23,603 Visits | 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
    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." With More Doctorates in Health Care, a Fight Over a Title - NYTimes.com

    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.
    *** Not only won’t a doctorate be required in 2015 for NPs, it can't be required by then. I am not saying a DNP won’t ever be required but as of now there is nothing more than a suggestion by the AACN that DNP be the entry for advanced practice by 2015. The AACN isn’t in charge of deciding what the requirements for advanced practice are. Plenty of colleges of nursing have no intention of going to DNP for their NP programs. There is no need for you, or anyone else to make sure you are licensed by 2015 in order to be grandfathered in.
    I am quite surprised at the position you take on this, trying to slide under the (non existent) wire with a lower education standard. I would think that, given your comments thus far in the discussion, you would be all in favor of obtaining that DNP to practice an an NP.
  2. 0
    Quote from MunoRN
    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?
    I know all about reliabilty, validity, limitations and every other factor involving research.

    I just find it funny that you're so skeptical of any study that doesn't defend your stance. Of course, there MUST be something wrong with the study! If it goes along with your theory, no need to question it! I haven't done a lot of in-depth research or determined what factors may have impacted any study regarding this topic whether it's in favor or against. Why? It's time consuming so it has to be something that's not already obvious in order to dedicate any time to it. There's an abundance of evidence on the surface that all points to change. Besides, anyone with a brain can find flaws in every single study...even the author him/herself. Especially the author, in fact.

    It doesn't matter at this point. This is a sinking ship and the sea is already filled with pharmacists, physical therapists, CRNA's, NP's, and sooner or later...RN's.

    There's always a few passionate souls that would rather go down with the ship no matter what.
  3. 0
    Quote from PMFB-RN
    *** Not only won’t a doctorate be required in 2015 for NPs, it can't be required by then. I am not saying a DNP won’t ever be required but as of now there is nothing more than a suggestion by the AACN that DNP be the entry for advanced practice by 2015. The AACN isn’t in charge of deciding what the requirements for advanced practice are. Plenty of colleges of nursing have no intention of going to DNP for their NP programs. There is no need for you, or anyone else to make sure you are licensed by 2015 in order to be grandfathered in.
    I am quite surprised at the position you take on this, trying to slide under the (non existent) wire with a lower education standard. I would think that, given your comments thus far in the discussion, you would be all in favor of obtaining that DNP to practice an an NP.
    When did I argue that a DNP shouldn't be required? It's a natural progression too. The only way you should be "surprised" about me trying to "slide under the wire" is if I were advocating that not only the BSN be the minimum requirement, but that ADN's who have been licensed/practicing before the change have to go back and obtain a BSN. I've never said that nor implied that. In fact, you conveniently (again) left out the part of my post where I addressed the fact that anyone licensed already wouldn't have to go back to school.
  4. 1
    When did I argue that a DNP shouldn't be required?

    *** (shrug) I dunno. I didn't claim you had. Why asking me?

    ( It's a natural progression too. The only way you should be "surprised" about me trying to "slide under the wire" is if I were advocating that not only the BSN be the minimum requirement, but that ADN's who have been licensed/practicing before the change have to go back and obtain a BSN.


    *** Not the case at all In addition to the one I mentioned there are several others way I should be suprised. Your position is inconsistant. You activily argue aginist what you call a lower education standard for RNs and yet tell us you wish to seek a lower education standard for yourself for NP.

    I've never said that nor implied that

    *** Who are you arguing with? I didn't say you did.

    In fact, you conveniently (again) left out the part of my post where I addressed the fact that anyone licensed already wouldn't have to go back to school.

    *** Not conveniently, intentionaly. Should BSN ever become the sole entry point for RN, that dipiloma and ADNs would be grandfathered in can be taken for granted. Everybody knows this as there is vast precedent for it. It's why we have CRNAs without any degree at all, NPs practicing without a masters, pharmacistis working with bachelors , etc, etc. There is not, and can be no, debate about it. There is no need for YOU to "address" it.

    I am interested in hearing your answers to the questions MunroRN has asked you. The questions you have ignored so far.
    One question for you. How is it that you know so little about your own field as to believe a doctorate would be required by 2015?
    redhead_NURSE98! likes this.
  5. 2
    Quote from MunoRN
    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?
    *** I can think of at least one easy solution. Many countries that require a BSN have a 3 year BSN program for nurses that looks very similar to many ADN programs here. I have worked as an RN in New Zealand and that is the case there. Why not simply change ADN to BSN on the degrees and keep everything the same as it is now? Then everyone would be happy. The pro BSN people would get their wish of the BSN being the single entry point for nursing. The rest of us could be satisfied that the local community college programs will continue.
    nursel56 and Esme12 like this.
  6. 2
    I would like to throw in another twist to this saga. My school has just removed it's basic health assessment course for RN to BSN completion and replaced it with an Advanced practice physical assesment course. If you finish your BSN by 2015 your ok, but if not, then you take the advanced practice assessment course to complete your BSN. Where does we think this is all leading?? My guess, how about the only entry level into practice will be MSN/APN( generalist). No way on gods green earth am I going to get an APN/MSN to answer call bells, push pills, bow down to administration, and be harassed, disrespected and intimidated by the nursing assistants and any other person off the street, including the MBA's.
    Esme12 and redhead_NURSE98! like this.
  7. 1
    Quote from Ntheboat2
    I know all about reliabilty, validity, limitations and every other factor involving research.

    I just find it funny that you're so skeptical of any study that doesn't defend your stance. Of course, there MUST be something wrong with the study! If it goes along with your theory, no need to question it! I haven't done a lot of in-depth research or determined what factors may have impacted any study regarding this topic whether it's in favor or against. Why? It's time consuming so it has to be something that's not already obvious in order to dedicate any time to it.
    Then I don't think you should be presenting as facts their conclusions, questioning the diligence of, the personal biases of, or opining here with the people who did take the time to look below the surface chatter, because you are speaking two different languages. "Obvious to Ntheboat2" not obviously a widely accepted standard. :-)
    redhead_NURSE98! likes this.
  8. 0
    Quote from PMFB-RN
    When did I argue that a DNP shouldn't be required?*** (shrug) I dunno. I didn't claim you had. Why asking me?( It's a natural progression too. The only way you should be "surprised" about me trying to "slide under the wire" is if I were advocating that not only the BSN be the minimum requirement, but that ADN's who have been licensed/practicing before the change have to go back and obtain a BSN.*** Not the case at all In addition to the one I mentioned there are several others way I should be suprised. Your position is inconsistant. You activily argue aginist what you call a lower education standard for RNs and yet tell us you wish to seek a lower education standard for yourself for NP.I've never said that nor implied that*** Who are you arguing with? I didn't say you did.In fact, you conveniently (again) left out the part of my post where I addressed the fact that anyone licensed already wouldn't have to go back to school.*** Not conveniently, intentionaly. Should BSN ever become the sole entry point for RN, that dipiloma and ADNs would be grandfathered in can be taken for granted. Everybody knows this as there is vast precedent for it. It's why we have CRNAs without any degree at all, NPs practicing without a masters, pharmacistis working with bachelors , etc, etc. There is not, and can be no, debate about it. There is no need for YOU to "address" it. I am interested in hearing your answers to the questions MunroRN has asked you. The questions you have ignored so far. One question for you. How is it that you know so little about your own field as to believe a doctorate would be required by 2015?
    Okay...my entire post was based on an article (which I quoted n gave the source to) which I was reading for personal knowledge. It plainly talks about nursing leaders intending to require doctorates by 2015. So, how my sharing an article (which I never claimed was even peer reviewed by the way) and elaborating on that specific article as well as what I've seen personally happening at the local university makes me "clueless about the field" or whatever you said. Furthermore, it's not my problem to revamp how businesses operate. If a BSN is required then the schools can offer BSN programs or not. It's not as though we don't have an abundance of nurses! In fact, it might be exactly the answer to this problem of so many schools "pumping out new grads." every school is not obligated to provide a nursing program. Finally, your obsession is weird. Just saying. Now, pick away, out of context...as usual.
  9. 0
    Quote from nursel56
    Then I don't think you should be presenting as facts their conclusions, questioning the diligence of, the personal biases of, or opining here with the people who did take the time to look below the surface chatter, because you are speaking two different languages. "Obvious to Ntheboat2" not obviously a widely accepted standard. :-)
    I'm pretty sure that your definition of "in depth" when it comes to research studies and my definition of "in depth" are nowhere near the same. Many studies don't even publish all of the variables involved in the study, but the ones that do can take a great deal of time to analyze. Your implication that everyone must do an in depth analysis on the subject (both sides of it) in order to make a reference is very ridiculous. There's a huge difference in reading a study and researching it. "peer reviewed" wasn't a phrase made up just for fun.
  10. 2
    Quote from Ntheboat2
    I know all about reliabilty, validity, limitations and every other factor involving research.

    I just find it funny that you're so skeptical of any study that doesn't defend your stance. Of course, there MUST be something wrong with the study! If it goes along with your theory, no need to question it! I haven't done a lot of in-depth research or determined what factors may have impacted any study regarding this topic whether it's in favor or against. Why? It's time consuming so it has to be something that's not already obvious in order to dedicate any time to it. There's an abundance of evidence on the surface that all points to change. Besides, anyone with a brain can find flaws in every single study...even the author him/herself. Especially the author, in fact.

    It doesn't matter at this point. This is a sinking ship and the sea is already filled with pharmacists, physical therapists, CRNA's, NP's, and sooner or later...RN's.

    There's always a few passionate souls that would rather go down with the ship no matter what.
    "If it goes along with your theory, no need to question it!" - I'm not sure if you're referring to your views or mine.

    To clarify my stance, I would love to know that the money I spent on a BSN was well worth it and that the difference in what I spent was to get a completely different education than an ADN, but as it turns out I shared some of the misconceptions of ADN programs that many BSN's appeared to have. At this point I prefer reliable information over blind reliance on something that says what I hoped it would say, even if it doesn't make sense beyond an overgeneralized "that feels right" sort of level.

    Even if we assume the studies are undeniable, without understanding the specific mechanism by which BSN programs produce better students we aren't going to get anywhere. It's unlikely that just calling a program "BSN" is the source of the differences. Coreg produces better outcomes in heart failure, it's white and round. Does that mean other pills we be just as effective so long as the are white and round?
    Esme12 and redhead_NURSE98! like this.


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