BSN as entry into practice; why we decided against it. - page 3

by MunoRN 26,799 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. 2
    Two things:

    1. The aiken study is one of three major studies on the topic. Each of which conclusively correlated a BSN prepared staff with better patient outcomes. One of the studies was done in Canada which has a universal coverage system so I don't you can argue payor mix for outcomes.

    2. There is a definitive reason hospital managers don't like to hire BSNs. The fact is that hospitals certainly do not want to pay more money for a better trained staff (after all, what motivates that? Better pt outcomes and they aren't being paid for that) and BSN nurses are just that much closer to being able to go to grad school.

    Our ICU managers actually had to be forced into hiring BSN grads when the hospital considered a magnet status. Too many BSNs were doing their two years and going to grad school.

    As for conversion, its my experience that ADN programs train their students a certain way. Focusing on skills more than critical thinking and as a result, the nurse's practice is corrupt from the get go. Getting some online BSN so they can bypass "difficult" courses like statistics and college algebra doesn't improve their level of practice.

    Sorry but a finding that disavows the findings of several large studies is unfortunate for our patients and the future of nursing.
    SummitRN and subee like this.
  2. 0
    Quote from SummitAP
    Without going on for 1000 words, OP's state is very different than my state on almost every point:
    • Significant prereq differences in BSN favor
    • Large GPA difference in BSN favor as BSN programs are merit based while nearly all ASN programs are minimum->waitlist admission
    • Slightly more to massively more clinical hours in BSN programs
    • Massive hospital BSN preference or requirement, especially for NG RNs
    • Major or exclusive preference for BSN students in clinical placement and internship offerings
    • Accelerated, traditional, and flexible BSN programs for professional and second career students
    • etc etc etc.

    That said, I'd love to see how OP "properly" corrected Aiken's "failed" math and upon what OP based the correction factors?
    My state is similar to this. There are less and less hospital jobs available that are preferring ADN RNs vs BSN RNs. BSN prepared RNs can get a hospital job a lot easier than an ADN RN. However, non-hospital jobs are ready and available for an ADN or BSN RN to take. There are plenty of them, but the hospitals here are pretty picky, since there are about 5 nursing programs in my city alone to choose from (and that doesn't count the city right across the river). Only one of them is an ADN school, the rest are BSN schools. Two of the hospitals won't even hire ADN nurses anymore. I guess it depends on the area.
  3. 0
    I cant stand this type of argument. Why is it always assumed that BSN's DONT know what they are doing?!? All these posts from ADN's stating "My ADN school had more clinical hours", "My community college school is sooooo much better than the university." "ADN's know more than BSN's"
    There was a time that the college / university BSN programs really didn't get much clinical time. My sister graduated with a BSN in 1984 and she said they were woefully ill-prepared for clinical work, and had to learn everything on the job. There still are a few BSN degree programs that look more like a liberal arts degree than a nursing degree. Most have restructured to place more emphasis on clinical experience, probably due to employers were refusing to hire their grads anymore.


    As for conversion, its my experience that ADN programs train their students a certain way. Focusing on skills more than critical thinking and as a result, the nurse's practice is corrupt from the get go. Getting some online BSN so they can bypass "difficult" courses like statistics and college algebra doesn't improve their level of practice.

    This is another problem that mostly been eradicated, at least in the associate degree programs that I looked at. Granted, I never started looking at RN programs until 1Q 2010.

    Western PA still has many diploma schools, quite a few associate degree programs at community colleges and branches of Penn State, and the urban areas have the BSN programs. And all of them have stayed alive by responding to the market. AS RN added critical thinking. BSN upped the clinical instruction hours. And diploma RN requires usually at least 9-10 non-nursing college courses, equivalent to or more than what's needed for associate degrees.

    Diploma RN required nutrition, and algebra or a satisfactory score on their school math exam. Online RN-to-BSN had algebra or some equivalent math as a prereq, and statistics had to be completed beforehand or done concurrently with the BSN courses.

    I don't see what the big deal is with nursing students and math and statistics. Both of them are easier than nursing courses.
    Last edit by Streamline2010 on Nov 17, '12
  4. 7
    The biggest advantage of a BSN requirement in my opinion would be higher wages and a higher degree of respect for nurses as professionals. Nurses are the least educated of the health care workers if you think about it. I think this a big reason why we are treated like crap by physicians, administration and patients. A two-year junior college degree will never command the wages, recognition and respect we deserve.
  5. 0
    Quote from VICEDRN
    Two things:

    1. The aiken study is one of three major studies on the topic. Each of which conclusively correlated a BSN prepared staff with better patient outcomes. One of the studies was done in Canada which has a universal coverage system so I don't you can argue payor mix for outcomes.
    You hit the nail on the head there, Aiken correlated BSN prepared staff with better patient outcomes, she did not show causation. If causation exists then we should be able to what specific factors produce better outcomes, which she has not shown.

    Quote from VICEDRN
    2. There is a definitive reason hospital managers don't like to hire BSNs. The fact is that hospitals certainly do not want to pay more money for a better trained staff (after all, what motivates that? Better pt outcomes and they aren't being paid for that) and BSN nurses are just that much closer to being able to go to grad school.
    Our review was based only in our state, and very well may not translate to other states, but in my state increased pay is not the reason for reluctance to hire BSNs. For the most part, BSNs make the same as ADNs. Some hospitals pay an additional $1 per hour, although that additional dollar can be obtained through other means as well such as specialty certifications.

    The reluctance to hire BSN's is cost related however. New Grad training is extremely costly. Hospitals have experienced a shorter orientation period for ADNs as a higher percentage of ADNs finish school having taken a full load of patients for the majority of their preceptorship. This will likely be different in areas where BSN programs have sufficient access to clinical spots, however in my state our BSN programs are too concentrated to allow for the same amount of clinical experience that the more dispersed ADN programs can provide.

    Quote from VICEDRN
    Our ICU managers actually had to be forced into hiring BSN grads when the hospital considered a magnet status. Too many BSNs were doing their two years and going to grad school.

    As for conversion, its my experience that ADN programs train their students a certain way. Focusing on skills more than critical thinking and as a result, the nurse's practice is corrupt from the get go. Getting some online BSN so they can bypass "difficult" courses like statistics and college algebra doesn't improve their level of practice.
    At one time this was the case, however except for two "old school" ADN programs that were being phased out, we found no difference in critical thinking emphasis. Even the "old school" ADN programs required college level algebra, and they were the only two that did not require statistics. Most of the ADN and BSN programs required pre-calc and statistics (typically psych dept statistics), however there were ADN programs that required calculus and statistics for math majors.

    Quote from VICEDRN
    Sorry but a finding that disavows the findings of several large studies is unfortunate for our patients and the future of nursing.
    I don't think the current situations is as unfortunate as you would suggest. Since the ANA made it's recommendation on BSN education 40 years ago, ADN programs have essentially become BSN programs, just without the name. So clearly everyone agrees that in large part the BSN model is the better model, it's just not as accurate as it was 40 years ago to claim that ADN and BSN programs are significantly different.
  6. 1
    Quote from VICEDRN
    Two things:

    1. The aiken study is one of three major studies on the topic. Each of which conclusively correlated a BSN prepared staff with better patient outcomes. One of the studies was done in Canada which has a universal coverage system so I don't you can argue payor mix for outcomes.

    2. There is a definitive reason hospital managers don't like to hire BSNs. The fact is that hospitals certainly do not want to pay more money for a better trained staff (after all, what motivates that? Better pt outcomes and they aren't being paid for that) and BSN nurses are just that much closer to being able to go to grad school.

    Our ICU managers actually had to be forced into hiring BSN grads when the hospital considered a magnet status. Too many BSNs were doing their two years and going to grad school.

    As for conversion, its my experience that ADN programs train their students a certain way. Focusing on skills more than critical thinking and as a result, the nurse's practice is corrupt from the get go. Getting some online BSN so they can bypass "difficult" courses like statistics and college algebra doesn't improve their level of practice.

    Sorry but a finding that disavows the findings of several large studies is unfortunate for our patients and the future of nursing.
    Oh yes, let's not forget the "My brick and mortar school is better than your online school argument"
    mya612 likes this.
  7. 2
    To put it another way VICEDRN, if we were to take an ADN program that is essentially identical to an BSN program except for 8 credits of community health and leadership, and simply change the name on the degree from "ADN" to "BSN", could we expect to see in improvement in patient outcomes? Most likely there are other factors than what we call the degree, so what are they?
    mya612 and Esme12 like this.
  8. 2
    Quote from somedaypeds
    The hospital I just signed on with requires a bachelors in 5 years. At their tuition reimbursement rate per year, it may take me 5 years to complete the one year program. After paying for my LPN and LPN to ADN programs out of pocket, I am very interested in having the rest of my education sponsored.
    Any chance your new employer is affiliated with a BSN granting university?
    Esme12 and tokmom like this.
  9. 1
    I actually researched and wrote a paper about this controversy in school. The issue is complex and multifaceted, with several competing interests at play. Surprisingly, whether BSN nurses are better prepared than ADN nurses is not the main point. The biggest issue are the community colleges. They are the biggest players in nursing education and have considerable political cloud. Nursing degrees are their premier "crown jewel" academic program, almost often their most sought after degree. A nursing program grants community colleges huge prestige and access to all kings local, state and federal funding. It is source of pride for them and they WILL NOT let go of that bone! As such, any realistic BSN requirement debate has to include them. Simply requiring a BSN for entry level and thus removing them out of the game is a non-starter. Thus the BSN in 10 idea, which allows the community colleges to keep their nursing degree programs. Any future discussion has to include the community colleges interests in mind. I heard that some of them are offering BSN degrees. I think that only when the community colleges get on board - by offering BSN degrees for instace - will we see BSN requirement adopted by state legislators and board of nursing.
    SummitRN likes this.
  10. 1
    Entry to practice in Canada is the BSN. Period. The last province to eliminate diploma programs was Alberta at the end of 2010. Some universities do a very good job in preparing graduates for the "real world" of nursing and others don't. The basic curricula are virtually identical; major differences are seen in the way courses are delivered. The "problem-based" or "context-based" learning model used by some schools has been decried by students and employers alike as being ineffective at preparing nurses for the degree of responsibility they face on the job. (And who wants to pay the big bucks for an education then discover that much of it will be self-taught?) The ultimate determinant of the quality of nursing care provided, in my opinion, relates to personal factors and not where or how a person was educated. Some people are just naturally better at some things than other people are. I work in an area that hires many new graduates from our local universities. Over the years I've seen many of them start their careers; some have flourished from Day One and others have floundered. To credit or blame the source of their basic nursing education is simplistic and unsupportable. Of note, on my high-acuity critical care unit, it's virtually impossible to distinguish the diploma nurses from the BSN nurses after the first year or so.

    About 12 years ago I compiled a head-to-head comparison of the diploma education at a community college with the BSN education at a university in the same city. In terms of hours of didactic preparation it was a dead heat. In terms of clinical practice, the community college came out ahead. The major differences were how long it took to complete the programs, liberal arts content, the number of formal papers and tuition. There was no difference in the pass/fail ratio on the Canadian Registered Nurse Exam. When published, my analysis met with a great deal of consternation and criticism from those nurses whose credentials contained more letters than their names; they were however unable to dispute my conclusions.

    The critical thinking argument is an interesting one. When I applied to a highly-regarded hospital-based diploma program in 1991, I was initially rejected because I was a mature student out of the formal education system for 15 years. The reason I was given was that without upgrading my basic education I wasn't likely to meet the acid test of critical thinking required to be successful in the program. I was able to demonstrate to them that in my case, experience was the best teacher and that critical thinking was part of my day-to-day life. And here we are. I still don't have a degree of any stripe, nor am I interested in one. I prefer focused continuing education in my specialty. That model has served me well for nearly 20 years.
    prmenrs likes this.


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