Implementing BSN as entry to practice

green34 · Jul 2, 2013

In my state, very few BSN programs have significantly more clinical hours. Some even have less. The pass rate is the same for the local BSN programs. I do not see the advantage. The best charge nurse is a diploma nurse with tons of experience.

LadyFree28, BSN, LPN, RN · Jul 2, 2013

No. It wouldn't.
Personally, I have always been in favor or keeping the 2 levels of nursing education (ADN and BSN) -- but making a more concrete and clear differentiation between the two.
An Associate's degree should take no longer than 4 semesters: that was it's original intent and that's how it is in most fields. But ADN requirements have been allowed to "creep" upward over the years so that ADN grads would be better prepared to function at higher levels in today's health care system (without having to get a BSN). (In reality, I think the creep is also due to the school's wanting to require more courses to make more money.)
I say "shorten the ADN programs." Make them shorter, easier, and cheaper. As for the BSN programs, make them more academically rigorous with a solid liberal arts and science foundation followed by a professional nursing education -- upgrade them and enforce high standards. (I think it can be done in 4 years -- 8 semesters of full time study.) My plan would create 2 distinct levels of nursing. The ADN and BSN grads would take separate NCLEX exams and hold different licensures, with their scopes of practice clearly distinct from each other, though with some overlap of content.
Under my plan, the ADN would remain available as an entry into practice for those who can't do a BSN at the start -- or who choose not to for some reason. It would give them a decent job and provide a large workforce adequately trained to do basic care at the bedside for many acute care patients and LTC residents. The BSN's could also provide care at the bedside, but have additional career options based on broader & more indepth education provided by the BSN. The market would then influence (but not totally decide) how many of each an employer (or society in general) would need.
Under my system, everyone would know their role in the system from the start. It's the lack of clarity that is the source of many of the conflicts and tensions that exist. If things got clarified and codified, everyone could then choose what educational path best met their personal needs.
Just my $.02
llg

^What you speak about is basically having the ADN become the LPN standard...The LPN has a shorter program, takes a different NCLEX. If that is the case, are you saying to make ADNs LPNs???

As a former ADN, LPN, and BSN student...successful at completion of a PN and BSN program, I was very prudent about the investment of my education. When I compared ADN and BSN programs, the BSN programs I selected in my area for choice had access to a health clinic in a community, as well as electives to have additional clinical time, so when I hear "BSN programs do not have rounded clinicals, blah blah blah," well, that's just not true, and it's not true for many that have had the opportunity to complete a BSN program in my area. I choose a BSN program over an ADN program because the prereq's were the same; in essence, a completion of a ASN would be 4 years, just like a BSN. For me, it was logical to go for the BSN, so I turned on returning to a ADN program. The BSN program was WAY more flexible to attain: I had two days a week for classroom, every other weekend for clinicals, and had consecutive semesters. It was a part time program. CCs in my area have full-time programs. To me, the BSN programs are more flexible and accessible to working people, accept CC credits, and the end, IF I choose to go further, I can. The portability and flexibility was much more favorable as a working LPN.

I think the climate of our educational system gets so convoluted and confused because each state and each program differs, leading to misinformation about LPNs, as well as the two entries into nursing. In my area, the "BSN in 10" is supported by many hospitals; it's not a requirement, but the push to have nurses evolving to meet the needs of healthcare is not necessarily a bad thing, but most hospitals know the challenges of their nurses, hence the enforcement is not there. It would be impractical to cut workforce, especially when NURSE outcomes are becoming a huge part in keeping reimbursement in fact in such as horrible economic climate.

I am in support of Benner's theory and her concerns about education of nurses and the future of nursing. The focus, to me, is how, in this market, can we support the glut of nurses to transition from novice to expert successfully?

That should be the focus.

llg, PhD, RN · Jul 2, 2013

^What you speak about is basically having the ADN become the LPN standard...The LPN has a shorter program, takes a different NCLEX. If that is the case, are you saying to make ADNs LPNs???

That's not exactly what I was saying -- but close. LPN's have restrictions on their practice that I would not want to impose on the ADN's. My vision of the ADN role would include patient assessments, giving IV push meds, hanging blood, etc. -- things that LPN's can't do in some states.

In my vision, we would have 5 levels of nursing personel:

1. Certified Nursing Assistant (pretty much what we have now)

2. Registered ADN nurse (merge the LPN and ADN levels to include the possibility of bedside acute care skills -- but excluding unit leadership roles, some patient teaching roles, care coordination roles, etc. for which the broader BSN education would be preferred.)

3. Registered BSN Nurse (includes bedside care, unit level leadership roles, community health, health education, etc.)

4. MSN level -- unit level leadership, staff education specialists, program coordinators, clinical instructors, assist with staff education, CNL's, etc.

5. Doctoral --

A. DNP -- advanced practice (not just clinical, but also administrative & educational practice)

B. PhD -- advanced scholarship (research, theory, philosophy)

LadyFree28, BSN, LPN, RN · Jul 2, 2013

That's not exactly what I was saying -- but close. LPN's have restrictions on their practice that I would not want to impose on the ADN's. My vision of the ADN role would include patient assessments, giving IV push meds, hanging blood, etc. -- things that LPN's can't do in some states.
In my vision, we would have 5 levels of nursing personel:
1. Certified Nursing Assistant (pretty much what we have now)
2. Registered ADN nurse (merge the LPN and ADN levels to include the possibility of bedside acute care skills -- but excluding unit leadership roles, some patient teaching roles, care coordination roles, etc. for which the broader BSN education would be preferred.)
3. Registered BSN Nurse (includes bedside care, unit level leadership roles, community health, health education, etc.)
4. MSN level -- unit level leadership, staff education specialists, program coordinators, clinical instructors, assist with staff education, CNL's, etc.
5. Doctoral --A. DNP -- advanced practice (not just clinical, but also administrative & educational practice)
B. PhD -- advanced scholarship (research, theory, philosophy)

And that is where the rub lies...LPNs in some areas can hang blood now...and for years, with technology, LPNs can hang "IV push" meds. As an LPN, I was able to have a very broad scope in my state and in the facilities I worked. One faculty I worked in, I was IV competent (or "certified") where I was cleared to draw labs off if PICC lines and Broviacs, whereas there were RNs that couldn't. So, when you have area that have LPNs working within the same set of policies, I can see the merger of ADN and LPN.

My point is that there is such a blanket black and white theory about how and what certain levels of what education or nursing role one has, producing many myths, confusion, and not a collective picture of what a nurse "knows"...NO ONE KNOWS unless they have had the same opportunities across the board, and that is not going to happen. Unless standards are going to be at the federal level-which it won't...the specifics of access to healthcare are state and region specific, to the needs of their residents-nursing will continue to be ubiquitous. Could it be streamlined? Perhaps, and that can be for the better if done with seats at the table for LPNs, DNs, ADNs, BSNs and helping to shape what the next step can be.

loriangel14, RN · Jul 2, 2013

*** We could alwasy do what some of the other countries that require a BSN have done. Simply pronounce all the ADN programs 3 year BSN programs without changing them. That however would not acomplish the goals they have in mind.

They didn't do this in Canada.We had a 2 year diploma and a 4 year degree option. They just eliminated the 2 year program. Now the PN program is 2 years long and BSN is the minimum for RNs.

PMFB-RN, RN · Jul 2, 2013

They didn't do this in Canada.We had a 2 year diploma and a 4 year degree option. They just eliminated the 2 year program. Now the PN program is 2 years long and BSN is the minimum for RNs.

*** Ya I know. I wasn't talking about Canada.

PMFB-RN, RN · Jul 2, 2013

It's the plan New York is proposing. It actually would allow single moms, laid off factory workers, farmers wives, military vets, etc., more time to have a chance to stay in the game as the market dictates more requirements for BSN.

*** Yes I know they are. Sounds reasonable to me. I have no problem with requiring BSNs. I have a problem with making BSN as entry to practice.

Your kid's piano teacher has more academic requirements than the nurse who cares for your vented child.

*** (Shrug) I am unmoved by such arguments. If the nurse who is taking care of my venter child is fantastic and know their stuff, how they came to know their stuff is of little important to me. Of course I come from the perspective of having obtained an ADN in 9 months and also having cared for many, many children on vents, ECMO, two vents (one for each lung), nitrous oxide vents, and other complex interventions. and I have personally intubated hundreds of children AND run their vents.

However, I know it's more complicated than that because there are many jobs that can be done by ADN

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*** Yes as is proven every day by many tens of thousands of RNs. It the same as any other RN regardless of academic degree they hold.

I'm mystified how you compare BSN with the ability to mix socially with country club types. I completed BSN while getting food stamps- not while polishing jewelry.

*** _I_ don't. Wanting nurses to become white collar workers and to be able to socialize with physicians and administrators is one of the motivating factors behind BSN and ETP. Didn't you know that? Read here post #214:

https://allnurses.com/general-nursing-discussion/what-deal-all-838927-page22.html#post7399072

DoGoodThenGo · Jul 2, 2013

*** Oh no. That would never fly. Those who advocate for BSN as entry to practice would absolutly be aginst anything like BSN in Ten. It simply would not acomplish the goals they have in mind. It would still allow people to recieve their training in low cost community colleges and graduate with no or little debt. It would also continue to attract the undeirable types of students to nursing. Single moms, laid off factory workers, farmers wives, military vets, etc. Hardly the kind of people who will rub elbows with physicians and administrators socialy at the country club and golf courses.[/QUOT
It's the plan New York is proposing. It actually would allow single moms, laid off factory workers, farmers wives, military vets, etc., more time to have a chance to stay in the game as the market dictates more requirements for BSN. Your kid's piano teacher has more academic requirements than the nurse who cares for your vented child. However, I know it's more complicated than that because there are many jobs that can be done by ADN (OR nursing comes to mine) and ADN would allow many to get their foot into the "profession". What I don't know about the New York plan is whether it puts ADN programs out of business or allows them to stay open and then give grads. 10 years to complete BSN. I'm mystified how you compare BSN with the ability to mix socially with country club types. I completed BSN while getting food stamps- not while polishing jewelry.
Think one huge reason NYS's "BSN in Ten" proposal has gone nowhere can be due to lobbying by ADN programs and or those seeking to attend. Don't think the proposal called for outright banning of associate degree programs (NYS has only one diploma school left), but sooner or later there would probably be a huge drop off in enrollment if the BSN is made mandatory. Associate programs would have to enter into articulation agreements with four year colleges to assure seamless transfer for their students.
ADN programs vastly out number BSN schools in NYS, and that means you are looking at potentially putting many persons out of work and or forcing them to step up their game. One can imagine the argument being used that because of a "nursing shortage" now is not the time to start such a scheme.

DoGoodThenGo · Jul 2, 2013

They didn't do this in Canada.We had a 2 year diploma and a 4 year degree option. They just eliminated the 2 year program. Now the PN program is 2 years long and BSN is the minimum for RNs.

In countries such as France, Canada, UK and so forth where education and healthcare policy are controlled often by a central government such decisions are more straight forward. However in the United States you have fifty different BONs all of which guard their powers and authority quite closely. That they consented to the central NCLEX board exam instead of their own was a feat in of itself, and something even today not everyone is totally happy about.

There is also the scope of practice for LPNs/LVNs varies from state to state. At least in NYC hospitals LPNs have long been phased out of acute care for the most part. IIRC the places that do hire (Mount Sinai) use practical nurses in their clinics and so forth.

mmc51264, BSN, MSN, RN · Jul 2, 2013

Saying that an ADN program is "only" a 2 year program is not entirely accurate. Most are so competitive that in order to get into the 4 semesters of nursing classes, most student have completed a general Associate's degree so they end up with 2 associates when they could have had a 4 year degree. I was lucky, I already had a BS in Biology, so I had almost nothing to take so I got in first application. I went through quite a rigorous program. We had over 650 hours of clinical time. I work at a large teaching hospital that is magnet, and surprised at the number of ADN that are working there. More than half. Of those, half are going on (me included) to get BSN. I think it is important. I value education. You cannot tell on the floor who is a diploma (there are a few left), ADN or BSN unless you look at a badge. We have others that have masters in related fields, as well (public health for ex.) I think that if we were to go to the BSN as the entry, we would have to fix the pay and pt ratios. Down here in the south, without unions, not much changes.

I was a school teacher and it is in a similar situation (only worse). There is an abundance of teachers, but the schools are so broke, they need new grads to keep the budgets in line. It is easier to pay 3 new grad 20K a year than a veteran, masters educated teacher 60k.

Personally, I like that I could practice after 2 years and NOW further my education, which will give me more of a context. I like the BSN in 5 better. Especially with all the programs out there now that are really flexible. I am getting mine online from a state university, so it is not going to put me in debt, I can afford the tuition and I have the option of doing it in 3, 4 or 5 semesters. I chose 4 b/c I thought that was what I could handle. I am an older non-traditional student and new grad (well, I guess not anymore, I have been practicing a year now; May 2012 grad) and this works for me.

Another discussion would be those going straight into an MSN program and getting leadership credentials that have never worked the floor. Another day perhaps :sneaky:

PMFB-RN, RN · Jul 2, 2013

Think one huge reason NYS's "BSN in Ten" proposal has gone nowhere can be due to lobbying by ADN programs and or those seeking to attend. Don't think the proposal called for outright banning of associate degree programs (NYS has only one diploma school left), but sooner or later there would probably be a huge drop off in enrollment if the BSN is made mandatory. Associate programs would have to enter into articulation agreements with four year colleges to assure seamless transfer for their students.
ADN programs vastly out number BSN schools in NYS, and that means you are looking at potentially putting many persons out of work and or forcing them to step up their game. One can imagine the argument being used that because of a "nursing shortage" now is not the time to start such a scheme.
*** Maybe. Maybe BSN in ten doesn't have much support. I am not sure who the natural support would be. BSN in ten would continue to attract the undesirable types into nursing, is unlike to result in grads with huge debt (indentured servants), not going to transform nurses into the social equals of the almighty doctor and administrators at the country club. Doesn't sound like anything the BSN as ETP crowd would be interested in.

DoGoodThenGo · Jul 2, 2013

Saying that an ADN program is "only" a 2 year program is not entirely accurate. Most are so competitive that in order to get into the 4 semesters of nursing classes, most student have completed a general Associate's degree so they end up with 2 associates when they could have had a 4 year degree. I was lucky, I already had a BS in Biology, so I had almost nothing to take so I got in first application. I went through quite a rigorous program. We had over 650 hours of clinical time. I work at a large teaching hospital that is magnet, and surprised at the number of ADN that are working there. More than half. Of those, half are going on (me included) to get BSN. I think it is important. I value education. You cannot tell on the floor who is a diploma (there are a few left), ADN or BSN unless you look at a badge. We have others that have masters in related fields, as well (public health for ex.) I think that if we were to go to the BSN as the entry, we would have to fix the pay and pt ratios. Down here in the south, without unions, not much changes.
*snipped only for brevity sake*

Problem is that in many cases demand for entry far outstrips available seats.

Here in NYC the CUNY community college ADN programs have by and large tightened entry requirements (raising the needed GPA to 3.0 from 2.5, adding NLN, TEAS and or SAT tests) and so forth and yet most still have tons of native students with GPAs of 3.5 to 4.0 in the pre nursing sequence and high scores on standardized tests. There are only one hundred seats but >150 well qualified applicants, someone is not going to make the cut.

The problem then becomes what do you do? Because of the way CUNY is structured those who are not admitted in the first round have a choice. Try and apply somewhere else (private program) and get in or wait and apply for the next class. If this keeps up then yes you have students that have completed all non-nursing courses and could have earned an associates degree waiting around cooling their jets.

FWIU CUNY and SUNY BSN programs are often no better. Everything depends upon the strength of the applicant pool and their numbers.