BSN vs ADN

Susie2310 · Dec 6, 2012

I believe a lot has to do with when and where (school, location) you trained. I obtained my RN through an ADN program 17 years ago. I did med-surg rotations at 3 local hospitals. My first clinical rotation was split between an oncology unit and ortho/neuro unit. My second semester clinical rotation was on an ICU step down unit, where the patients were on telemetry. I also did a med/surg rotation at another hospital close by, and a fourth med/surg rotation at a third hospital, where I did my rehab rotation. I did my ob/gyn rotation at a local hospital, and my psychiatric rotation at a state hospital on a locked psychiatric unit and in the psychiatric ER. I also did my pediatrics rotation at this same hospital. My geriatrics rotation took place at a local nursing home. In my final semester I did student work-experience and my preceptorship on that same oncology unit.

From the second week of nursing school we were in clinicals two days a week at the hospitals. We had theory and lab on two days at school. The program focused on training us to be competent entry-level bedside nurses. We were trained to provide total care from day one: bathing, toileting, ambulating, meds, treatments, whatever we had been competency checked on we were to do. The majority of the clinical skills we were taught I was able to practice on patients: our program was very good at making sure we practiced as many skills as possible each day we were in clinical. Only in our last semester were we allowed to practice team leading; with a minimum of four patients we were allowed to let the aide bathe our patients for the first time in our training. All our instructors worked in the local hospitals.

When I bridged in to the closest BSN program at a nearby university directly after obtaining my RN, I heard some students in that program say that in their final semesters they had received hardly any clinical training and did not feel confident in giving care. I heard people say that they only had one or two patients, and that their instructor was always there with them when they were giving meds. In the community placements that I shared with these particular students, I did observe that their clinical practice appeared to be less confident and knowledgeable than the group I graduated with from my ADN program. I do know that the generic BSN program was structured quite differently to the ADN program and bridge to BSN that I did.

The above are just my experiences. I do not know anything about how the generic BSN students I mentioned transitioned in to the work-force, although I am aware of one person who is a manager at a local hospital. I have run in to people in my ADN group who are working locally in hospitals, surgery centers etc.

I hope this sheds some light on to your question. From reading allnurses I believe the quality of clinical training for ADN's and BSN's varies considerably between different schools and areas of the country. In some areas the ADN program clinical components are stronger, and the new grads are stronger clinically initially, hence some experienced ADN nurses stating that they experience the BSN grads to be less clinically competent in their early working career.

roser13, ASN, RN · Dec 6, 2012

When I was in my ASN program 15 years ago, the prevailing wisdom was that associate degree RN's were being prepared (via greater clinical exposure) to be the "workhorses" of the nursing profession and were better equipped to hit the ground running after graduation. BSN's were supposedly more prepared to perform management tasks and their clinical hours were (supposedly) lesser. Of course at that time, it also was a given that in 5-10 years, BSN would be the minimum entry level for any nurse :)

From the BSN's that I oriented with, I did find that a majority of them felt less comfortable with some basic nursing tasks simply because their clinical hours had taken place in the years prior to senior year. Senior year consisted mostly of management seminars and public health classes and a whole year had gone by since any of them had set foot on a Med/Surg floor.

Just my experience.

Grizabelle · Dec 7, 2012

Thank you both for your feedback. Very constructive.

Your observations are interesting. It reminds me of the differences between my first (school clinical instructor) and second semester (preceptor). Waiting for the school instructor to show up when they have students on 3 different floors is a nightmare. Having a preceptor was much more liberating because I could do what needed to be done constantly instead of waiting on my instructor to show up.

It almost sounds like that might be the essence of the difference? Do ADNs have more preceptors? In our program everyone has a clinical instructor the first semester then for the second semester and on they supposedly give out preceptors based on how well you did in your prior semester classes (unless you requested a specific hospital / shift that was clinical instructor only).

Susie2310 · Dec 7, 2012

In my ADN program we had clinical instructors throughout. We only had a preceptor at the end of our fourth semester for the preceptorship. The preceptorship was overseen by a clinical instructor.

akulahawkRN, ADN, RN, EMT-P · Dec 7, 2012

Kind of from the outside looking in (from a few years ago): The ADNs seemed to be far more clinically focused than the BSN students that I have run into. That just simply means that the ADNs are more confident at doing many of the task stuff, while the BSNs are more confident in the academic stuff, getting more managerial stuff. I've read that as far as floor nursing goes, the new ADN generally has better patient outcomes for about the first 2 years after graduation where the BSN starts having better outcomes after that because by then the clinical skills are basically equal, but the BSN is able to incorporate EBP more fully/easily on a daily basis because they're able to better understand the research. It's not a failing of either type of RN... it's just that their focus is a bit different.

Of course, there are other considerations as well, such as quality of the program, clinical instructors, and so on, but the above has been my general impression for a while and I've not seen anything that really contradicts that.

Another reality is that I highly doubt that without looking at name badges, after about the first year or so of post grad work, anyone would be really hard-pressed to guess which nurse was the ADN and which one was the BSN just by watching what they do and how they do it.

Personally, I don't care which one I get, I just want a nurse that's clincally competent.

Susie2310 · Dec 7, 2012

That "task stuff" that ADN's are more confident at actually requires clinical assessments and nursing judgement! Which requires thinking, not rote behavior.

Incorporating evidence based practice into clinical practice can be done perfectly well by ADN's. They have brains too, even if they haven't taken statistics or written a research paper. I haven't heard of any studies that demonstrate the superiority of BSN training. This has previously been discussed on allnurses.

Grizabelle · Dec 8, 2012

Yeah, I don't want to get into assumptions that one is better than the other but look at the assumptions that the training is different and figure out why it was considered different other than a few classes that dont have a clinical focus. Yeah, I got a patho class upfront but then care classes that both ADNs and BSNs take seem to be more of the same patho so Im not really buying that as a good rationale for the assumption.

We had a discussion in class about how the ADN degree came to be and were told that originally it was just because there was a serious shortage of nurses so they created the ADN programs to fit the need at the moment. I was just curious if the ADN had morphed into something else more like an apprenticeship type of training (based on all the assertations that ADNs are so much more clinically skillful) or if there was even actually a difference in the training you get outside of the specific extra classes you get with a BSN (aka Do ADN nurses get more time in clinicals? Not from what I have been able to tell).

Im also leaning towards thinking it's about the school. The 2 schools I decided between were a local ADN with a 75% pass rate on the NCLEX or a slightly farther BSN with a 99% pass rate. I don't mean to imply that all BSN schools have a higher pass rate either, Im certain there are BSN schools with dismal NCLEX pass rates... I mean that you have to look at the school not the degree.

Im also just want to know what skills I need to work on to "make up" for the perception that as a BSN nurse I am less qualified than the ADN nurse. I am very conscious of the competition to get a job when school is done.

Guest343211 · Dec 8, 2012

No... I do not want to get into which one is better.
I am in a BSN program, it was the best choice for me for a number of reasons and I am happy with that choice.
I am simply curious why some people say BSN nurses are "lost" on the floor when they get hired so they would rather have ADNs. I have a friend that is in an ADN program and we appear to have the same quantity of hours in clinicals, we do clinicals at mostly the same hospitals, the care plans we do sound pretty similar other than I have to do some additional work for mine. She does her classes in a compact format so instead of taking Psych and Care II each for a whole semester her program split the semester up and she did Psych half time and Care II half the time.... so in the fall semester we did the same classes except that I also had research and Gero. We have both been busy with school so havent had time to compare anything else other than I have the few random classes like Path, Research and leadership that she doesnt get... but taking those shouldn't make me less effective on the floor.
It sounds like its a reference to clinical experience but if the amount of clinical time is the same with the same random luck opportunity to actually do things like trach, ostomy or wound care. Random odds of starting IVs that either one of us may or may not get...
What is the difference and why is the assumption an ADN will have more practical experience?
Is this just an assumption that BSN nurses will be less task oriented?

IDK, I think overall, it depends on the person. Other than that, today, it go either way. One BSN program could have students with better clinical instructors and experiences compared to another ADN program, and vice versa.

I just think nursing education should be standardized to a baseline education of a baccalaureate program of study. Cuts out a lot of nonsense, and it's the only reasonable step in terms of moving forward. Other than that, it comes down to each individual practitioner and how they continue to learn and grow, and continue to do so. And if they are willing to pay the price to be as sharp as they can be in their particular area of practice. Often what I find is that people don't want to pay the price to be the best they could be. That goes for all fields and areas.

Guest343211 · Dec 8, 2012

That "task stuff" that ADN's are more confident at actually requires clinical assessments and nursing judgement! Which requires thinking, not rote behavior.

That is generally true for all of nursing, regardless of baseline degree.

Incorporating evidence based practice into clinical practice can be done perfectly well by ADN's. They have brains too, even if they haven't taken statistics or written a research paper. I haven't heard of any studies that demonstrate the superiority of BSN training. This has previously been discussed on allnurses.

Well, there is Linda Aiken's study from U of Pennsylvania.

I already stated in another thread that two year schools should just focus on preparing nursing students for four year programs, helping them with transferrable GE courses, and giving them mentoring programs, for which they would obtain transferrable credit. This would save on the cost of obtaining the four-year degree, and it would help students get insight into whether or not this is the right field for them--and if it is what they think it is. If they find out it's not, they won't lose the GE credits and may transfer them to another area of study.

But the two year programs just need to stop with the whole ADN deal. It's pretty much a dead that anything other than a basic four-year program of study in nursing is the educational standard for entering practice. It's enough already. Make it such that unless you have that four-year degree in nursing, you can't sit for the NCLEX.

Honestly, I don't see what the big deal is. If nursing is ever going to raise up to a professional standard, it's the only way to go. But I would make the clinical requirements and experiences for those in four-year programs tougher, so to help prepare them better for clinical functioning after graduation.

Overall, however, the 4 yr degree isn't as much about individual practice per se. You develop that after you graduate and practice for a while. You decide what kind of practitioner you will be. It may, however, set the tone for the how you will practice.

It's about moving the profession forward--and in this it has been kicking and dragging its feet for more than 3 or so decades. It's totally lame.

It's ridiculous to me that people can become RNs in two years. Physicians and student physicians frequently jest about this.

Do you know what you are if you have a two-year degree in teaching? A teacher's aide. I'm just saying. . . it's time to get real about the whole thing.

somenurse · Dec 8, 2012

When i got my ASN (was called ASN back then, not ADN)

which was eons ago, it was a 32 month long program, nonstop, all year long,

like, you'd begin the nursing program, in Sept 2013,

through Sept 2014,

through Sept 2015,

and graduate in May of 2016. But you went all year round, no summers off, nope. 32 months of education. not 24 months. And OHhhh was it EVER full full full time!! oh my, it really was!!

Some ASNs had 33 month programs, graduating in June, but mine was only 32 months.

which i always wished the college in the town i was in at that time, had offered a BSN, which was 36 months long, (9 mos per year, spread over 4 years) but, my town's college did not offer a BS in nursing. With 4 more months of schooling,

and time in there somewhere to get a foreign language, (was req'd at the BSN programs in that state) then i'd have had a BSN.

4 MONTHS of difference between my ASN and a BSN.

I'm always surprised, when i hear people refer to a "2 year" ADN, and wonder, have things changed nowadays? Are there really 24 month ADN degrees now? WOW!

EMBARRASSINGLY, i am not entirely certain of the difference, if any, between an ASN and an ADN, i always think it is just symantics.

Susie2310 · Dec 8, 2012

Yeah, I don't want to get into assumptions that one is better than the other but look at the assumptions that the training is different and figure out why it was considered different other than a few classes that dont have a clinical focus. Yeah, I got a patho class upfront but then care classes that both ADNs and BSNs take seem to be more of the same patho so Im not really buying that as a good rationale for the assumption.
We had a discussion in class about how the ADN degree came to be and were told that originally it was just because there was a serious shortage of nurses so they created the ADN programs to fit the need at the moment. I was just curious if the ADN had morphed into something else more like an apprenticeship type of training (based on all the assertations that ADNs are so much more clinically skillful) or if there was even actually a difference in the training you get outside of the specific extra classes you get with a BSN (aka Do ADN nurses get more time in clinicals? Not from what I have been able to tell).
Im also leaning towards thinking it's about the school. The 2 schools I decided between were a local ADN with a 75% pass rate on the NCLEX or a slightly farther BSN with a 99% pass rate. I don't mean to imply that all BSN schools have a higher pass rate either, Im certain there are BSN schools with dismal NCLEX pass rates... I mean that you have to look at the school not the degree.
Im also just want to know what skills I need to work on to "make up" for the perception that as a BSN nurse I am less qualified than the ADN nurse. I am very conscious of the competition to get a job when school is done.

Perhaps you could ask at the facilities where you doing your clinical rotations what they specifically will be looking for in a new employee. Talk to your instructors. It sounds as though you are attending a good program, so hopefully your program has a good record of their graduates finding employment. If your program is well regarded by local employers then maybe graduates of your school are preferred by the hospitals etc. over ADN graduates. There are a lot of variables it seems.

Hopefully some other posters will offer some good suggestions.

Best of luck.