BSN vs Bachelor's + RN School

[jjjoy]

Just a thought here... if you disagree, please be respectful...

There is a strong push from some for BSN to be the entry to practice for RNs.

What about instead of requiring a BSN, to require those applying for RN school to have a bachelor's degree? The bachelor's could be in any field, though there would also be certain pre-reqs that if not covered in the bachelor's program would still need to be taken to apply for RN school. RN school would be revamped to include whatever BSN content is currently lacking, though some of it would already be covered by the previous bachelor's and pre-requisite classes.

This is how medical school works. And in my state, to qualify for a teaching credential program you also have to have a bachelor's degree. It might force more consistency between nursing programs in regard to pre-requisites, as currently they vary a lot from school to school. This plan also doesn't force nursing programs to include collegiate course or offer college degrees. RN school would be strictly about training nurses. Students would be entering the programs already possessing critical thinking skills that they honed while earning their bachelor's degrees.

Universities could even offer a bachelor's degree in "Nursing studies" or "Health care sciences" that would include standard RN school pre-reqs as well as cover topics relevant to nursing and health care.

Let's discuss the merits of BSN versus bachelor's + (revamped) RN school and not whether or not BSN should be the entry for practice.

[jjjoy, LPN]

What are all of these *extra* classes that ADN programs have in addition to the basics? Nutrition? Psychology? Llg, you comment that students should be angered that they have to take 3 yrs worth of classes to earn a "2-yr" degree, but is it really even possible to train up RNs (foundational courses such as micro and A&P as well as core nursing courses) AND include the gen ed requirements for an associate's degree in just two years?

[llg, PhD, RN]

What are all of these *extra* classes that ADN programs have in addition to the basics? Nutrition? Psychology? Llg, you comment that students should be angered that they have to take 3 yrs worth of classes to earn a "2-yr" degree, but is it really even possible to train up RNs (foundational courses such as micro and A&P as well as core nursing courses) AND include the gen ed requirements for an associate's degree in just two years?

You are assuming that the "end product" graduate of the program would be expected to function in the nursing role the same as a BSN grad. But that isn't what the ADN degree was originally meant to be. ADN grads were not originally intended to assume as much responsibility as many now assume. 4 semesters of study was considered enough because they were not expected to perform at a level equal to a BSN.

Also, there are ADN programs now that take only 4 semesters post high school -- and those grads get the same degree and take the same jobs that graduates of longer programs do. In fact, one local program where I live takes people just out of high school and gives them and ADN after 15 months of full time study -- with no college-level prereq's.

[jjjoy, LPN]

You are assuming that the "end product" graduate of the program would be expected to function in the nursing role the same as a BSN grad. But that isn't what the ADN degree was originally meant to be. ADN grads were not originally intended to assume as much responsibility as many now assume. 4 semesters of study was considered enough because they were not expected to perform at a level equal to a BSN.

You say that ADN grads were not originally meant to assume as much responsibility as they do. Presumably you are speaking of bedside nursing? Could you be more specific? Not caring for such complex patients as they do now? Not having to coordinate so many different services for patients? What was supposed to be the differentiation in roles between ADN-RNs and BSN-RNs at the bedside and how was the BSN education supposed to support that? And as many argue, if there are to be such different roles between ADN-RNs and BSN-RNs why do they have the same licensing exam? And who was defining these different levels of practice? ANA? Was it a vision for the future (that never came to be) or a reflection of current nursing needs (that has since changed)?

Also, there are ADN programs now that take only 4 semesters post high school -- and those grads get the same degree and take the same jobs that graduates of longer programs do. In fact, one local program where I live takes people just out of high school and gives them and ADN after 15 months of full time study -- with no college-level prereq's.

VERY interesting! Are these students who took specific pre-nursing coursework while still in high school, such as micro and A&P and chem? Those usually are intro level courses and could easily be taught at the high school level to motivated students. If that's not the case, then I'd be very curious to hear more about those programs!

[justme1972]

To say that an ADN plus BS in another field = BSN is like saying that a Associate's Degree in Physics plus a BSN is the same thing as a BS in Phyics. "It just ain't so."

It's simply bad logic. I have a PhD in Nursing. Had I gotten an Associate's Degree in Physics, my PhD in Nursing would not make me qualified to take the place of someone with a PhD in Physics.

My sister has a degree in Sociology and is currently enrolled in an ADN program in another state. The hospitals in her area told her that they recommended that she get her BSN as soon as possible (mainly because she too, wants advance practice nursing), but because her prior BS is in a Human Relations field, that she could apply and most likely get hired for, BSN-preferred positions.

I agree with you to an extent. But I think what you have that other degree in matters. Something like Fine Art, Broadcasting, etc...those aren't even going to come close to being the same. However, let's say you had a BS in Psychology, and were employed as a psychiatric nurse with an ADN...you have had WAY more Psychology with that degree, than anyone else with a BSN.

[dzadzey, MSN, RN]

From what I can see in the clinical setting, there's really not much practical advantage to having BSN over ADN. After even a few months of work experience, any RN is worth a newly minted BSN.

The bachelors, and higher degrees, really only come into play in management, nursing education and advanced practice. And even then, management doesn't require a Bachelor's degree. My institution is now requiring management positions be staffed by BSN's, which is cutting a huge number of people with a great amount of experience and institutional memory out of the running for those positions. A sheepskin doesn't automatically grant the knowledge and wisdom needed to be a successful manager. Believe me, our unit manager is a perfect example...She has a Master's degree and and is a terrible manager.

[Tweety, BSN, RN]

You say that ADN grads were not originally meant to assume as much responsibility as they do. Presumably you are speaking of bedside nursing? Could you be more specific? Not caring for such complex patients as they do now? Not having to coordinate so many different services for patients? What was supposed to be the differentiation in roles between ADN-RNs and BSN-RNs at the bedside and how was the BSN education supposed to support that? And as many argue, if there are to be such different roles between ADN-RNs and BSN-RNs why do they have the same licensing exam? And who was defining these different levels of practice? ANA? Was it a vision for the future (that never came to be) or a reflection of current nursing needs (that has since changed)?

VERY interesting! Are these students who took specific pre-nursing coursework while still in high school, such as micro and A&P and chem? Those usually are intro level courses and could easily be taught at the high school level to motivated students. If that's not the case, then I'd be very curious to hear more about those programs!

ADNs have stepped into many roles away from the bedside to include managers and other things. People in my RN to BSN programs had an amazing variety of non-bedside jobs. The intent of the ADN was bedside nursing and that's it.

The only pre-reqs those students probably needed was like my program: high school chemistry and algerbra. A&P, Micro. etc are not pre-req courses to nursing, but co-reqs that can be taken alongside nursing. As I noted above, ADN programs have switched to 3-year status and made those courses pre-reqs in many programs. But the original intent, as is the intent of most associate degree programs, was for it to take 2 years, or four semesters. Most people don't complain because it's too hard to take all of those courses at once, there's waiting lists, and many are older with children and/or jobs, and other responsiblities, aren't 18 year olds fresh out of high school that can devote many hours to school/study.

In some ways ADNs have been given the advantage that they can move into "BSN preferred" positions based on experience (and often who they know) and get good jobs, responsiblity and money.

On the other hand we are asked to take co-req courses, and other courses that fall just short of getting an actual BSN and that's a rip off in some schools in my opinion.

[llg, PhD, RN]

You say that ADN grads were not originally meant to assume as much responsibility as they do. Presumably you are speaking of bedside nursing? Could you be more specific? Not caring for such complex patients as they do now? Not having to coordinate so many different services for patients? What was supposed to be the differentiation in roles between ADN-RNs and BSN-RNs at the bedside and how was the BSN education supposed to support that? And as many argue, if there are to be such different roles between ADN-RNs and BSN-RNs why do they have the same licensing exam? And who was defining these different levels of practice? ANA? Was it a vision for the future (that never came to be) or a reflection of current nursing needs (that has since changed)?

VERY interesting! Are these students who took specific pre-nursing coursework while still in high school, such as micro and A&P and chem? Those usually are intro level courses and could easily be taught at the high school level to motivated students. If that's not the case, then I'd be very curious to hear more about those programs!

See Tweety's post above. It says a lot of what I would say on the topic of what I meant by the fact that ADN grads have been given more responsibility than they were originally intended to be prepared for. The original idea was to prepare nurses for the bedside only -- where they would be following orders and/or following policies that were developed by nurses with higher levels of education. That's why the original programs did not include topics such as research. They were also not supposed to be doing much education or management. Nor were they supposed to be working with the type of independence typically found in community health roles. The idea was that there would be other people (e.g. nurses with BSN's and MSN's, etc.) who would be in the work setting who would be developing the policies and providing the leadership -- and the ADN grads would be working within the guidelines established by those other nurses.

However, ADN's with experience have been promoted into positions of leaderships over the years. I'm not saying they were not good people -- but one of the consequences of that fact is that people began to think of the ADN as being "the same as a BSN minus the general education courses" as opposed to being fundamentally different in it's intended scope of practice. Also, ADN programs wanted to help their graduates be more qualified for those more advanced positions and began adding course requirements to their programs -- which was popular with the ADN school administrations because it brought in more money for the school. Thus developed the mess we currently live with in which some schools are requiring almost as much for and ADN as other people take for a BSN.

As for schools that only require 4 semesters post high school or less -- there are lots of them. A few require a couple of pre-reqs, but it's nothing like the 3-year programs that you write of.

[jjjoy, LPN]

I appreciate everyone's input and perspectives!

Hmmm... ADN training as intended only for bedside care... if that's the case, things really haven't followed as planned, have they?

I've questioned the idea before of having more distinctive nurse licensing - such as "Acute care nurses" and "non-acute care nurses." Here, I can see all nurses first learning about chronic disease, geriatric issues, health promotion, human development, and basic skills (injections, dressings). With this training, they'd be qualified to work in LTC and other non-acute settings. From there, nurses could continue on to learn about acute conditions to qualify for "Adult acute care nurse." Finally, nurses could specialize in critical care, L&D, pediatrics - areas you can't easily transfer general acute care experience to. Or nurses could choose to follow a different non-acute track, taking further studies in "community nursing" - school nurses, public health, occupational health.

Any of these nurses could also choose to earn a bachelor's degree with a focus on nursing. These bachelor's programs would cover research and management perhaps. But in this scenario, would bachelor's nurses have to be qualified as acute care nurses? Or would non-acute training be enough?

I think that's a good question all on it's own. Currenly, BSN programs include all that ADN programs do. That is, they train up nurses for bedside care. AND they also train them in public health and the basics of research. But do BSNs *need* that much training in acute care? If BSNs aren't necessarily going to work bedside, why so much emphasis on it? Why not have acute care be just one of several different tracks BSN students can choose? Instead of training them all in so many different areas, why not have BSN-acute care, BSN-community health, BSN-chronic care, BSN-management... or something like that?

I hope I'm not coming across negatively. I find this stuff very interesting and enjoy tossing ideas around. I'd love to find a local nursing conference on nursing education to attend, but haven't yet found one. :cheers:

[llg, PhD, RN]

I hope I'm not coming across negatively. I find this stuff very interesting and enjoy tossing ideas around. I'd love to find a local nursing conference on nursing education to attend, but haven't yet found one. :cheers:

To me, you're not coming across as being negative at all -- just that you haven't been aware of the history of the nursing profession and of the rationale behind decisions that have been made over the years -- and that you are seeking to understand why we have the mess we have now.

As I suspect you feel, it would be nice to start over from scratch. But that's unlikely to happen. There are too many people with too many vested interests who will fight to the death to keep their particular program open and functioning in the way that it has always functioned.

If it were up to me, I would shorten the long ADN programs -- making it very clear to everyone that the graduates had not received the same nursing education as the BSN grads. Then each person could decide which program best suited their needs with a clear understanding of what types of jobs would be available to them after graduation. I would also make it a violation of the nurse practice act to hire nurses for jobs for which they did not have the right level of education. That would clarify things and give us a system everyone would understand. It might not be perfect, but with a clear set of guidelines and levels, everyone would know where he/she stood.

One disagreement I have with your suggestions in your above post jjjoy is that you seem to assume that specialties such as peds and maternity are build upon and adult med/surg foundation. As a long-time NICU nurse and teacher of NICU nursing, I disagree with that. A person does not need adult acute care experience to do all of the other specialties. But I agree with you that it might be preferable to allow undergraduate students to specialize in various specialties and get over this hang up on "generalists" that suggests that "a nurse .. is a nurse .. is a nurse" mentality. After a general introduction to basic principles, students could choose to be "certified" in one of many tracks -- and then would need to return to school to take an educational module to certify them in other tracks if they wanted to change specialties. A lot of people wouldn't like that, but I think we would be better off in the long run.

[nicole83]

As it is, many schools are now offering "accelerated" BSN programs for those who already possess a bachelor's degree that in theory squeeze two years worth of RN training plus any special BSN coursework into 1 year.

We all know that "2-year" RN programs are really require at least 3-years of study because of pre-reqs like microbio and A&P. Yet BSN programs usually are 4 years of coursework from start to finish. So with just 1 year of difference in coursework, the BSN provides a bachelor's degree and includes *all* those extra BSN courses.

Something doesn't add up.

People have mentioned that things don't "add up." While doing my bachelors degree in another subject then nursing, I decided I wanted to do be an NP. I took the prereqs while working on my undergrad degree, graduated right on time with a social sciences undergrad degree and went on to the "grad" program. To clarify, my nursing program is 3 years total. In about 18 months I completed my RN portion (during this time I also took grad classes and them for 18 more months I just focus on the NP portion. When I graduate, I will not have a bachelors degree in nursing (because my school says I didn't really earn one becasue I only took nursing classes) but I will have a masters degree in nursing, even though I won't have one in nursing. SO add it all up and I will have spent 7 years in school and earned 1 bachelors degree (not in nursing), the ability to sit for the NCLEX and a masters degree= basically the same as double majoring and then going to grad school. So it is possible to get a bachelors in something else and become a RN in about 5 and 1/2 years.... it adds up in a psycho way and you have to learn fast... obviously there are certain people who dont learn well this way and shouldnt do the program....

Someone questioned the value of a bachelors in something not nursing- it gives you a different perspective on things. Many of the accelerated programs are difficult to get into and result in students that can usually handle this rigorous type of program. This program might not be right for everyone but works for some. I dont have the citation at the moment but studies have been done that have found NPs who do these accelerated programs without an undergrad degree in nursing do ok the first couple of years out of school and then actually surpass in performance nurses who go about the degree the "traditional" way... Yale has one of these programs too. I'm not sure about how well people who do the RN programs in 12 or 18 months due but I'd imagine they could also possibly out perform traditional RN program nurses if these programs are highly selective or there could be no difference. I think it depends on the student and on the quality of the program.... because I know several bachelors level RNs that I would not want taking care of me and an excellent diploma nurse who could care for me anytime... :)

[jjjoy, LPN]

One disagreement I have with your suggestions in your above post jjjoy is that you seem to assume that specialties such as peds and maternity are build upon and adult med/surg foundation. As a long-time NICU nurse and teacher of NICU nursing, I disagree with that. A person does not need adult acute care experience to do all of the other specialties.

I'm not in disagreement on this. After tossing out all other traditional thoughts on education, I just didn't toss out this one. There is very a strong emphasis on adult acute care in RN training as well as the persistent idea that all nurses should put in their time in adult med-surg before branching out. I don't necessarily agree. It is an interesting question, though, what would be considered absolutely necessary in any kind of nursing education if RN programs weren't dominated by acute care/bedside training.

But I agree with you that it might be preferable to allow undergraduate students to specialize in various specialties and get over this hang up on "generalists" that suggests that "a nurse .. is a nurse .. is a nurse" mentality. After a general introduction to basic principles, students could choose to be "certified" in one of many tracks -- and then would need to return to school to take an educational module to certify them in other tracks if they wanted to change specialties. A lot of people wouldn't like that, but I think we would be better off in the long run.

I can definitely see some merit in this idea and I can also see where the opposition to such a plan would come from as well.

[HealthyRN]

But I agree with you that it might be preferable to allow undergraduate students to specialize in various specialties and get over this hang up on "generalists" that suggests that "a nurse .. is a nurse .. is a nurse" mentality. After a general introduction to basic principles, students could choose to be "certified" in one of many tracks -- and then would need to return to school to take an educational module to certify them in other tracks if they wanted to change specialties. A lot of people wouldn't like that, but I think we would be better off in the long run.

This is a very interesting idea and I can certainly see that it would have some benefits. However, I believe that the vast majority of nurses would disagree because nurses would lose their ability to switch specialities so quickly and easily. That is one aspect of nursing that is appealing to many.