Implementing BSN as entry to practice

[MunoRN]

We seem to go around and around in this discussion about the premise of BSN as the level for entry to practice, yet the bigger question of whether or not that is even possible seems to get ignored. The ******* contest (quantitative comparison of micturation velocity and accuracy) that these threads seem to devolve to would seem to be a futile exercise since we're discussing a goal that is arguably moot.

For those that think this is a viable option, how do you see this working in practice?

[Isabel-ANP-BC]

I know I'm probably going to annoy some people, but....And before I go too far I want to say that I am an ASN RN originally and that I'm currently working on the DNP--

1) LPNs should continue to be a 1 year full time program. Scope of practice limited things such as passing PO/PR/Otic/Optic/SL/SQ/IM meds, observations, taking histories, confirming allergies, doing dressing changes on pressure ulcers, and other duties along those lines. Still the backbone of LTC and where needed outpatient offices/clinics.

2) RN--2 year full time associates degree. Can do assessments, hang IVs, handle central lines, but not educated for clinical leadership, management, or as a way to transition into advance practice roles. Strictly direct line patient care. AKA Registered Nurse.

3) RPN-4 year full time BSN. Can do all of what an RN can do, plus entry level management, precept, charge nurse. AKA Registered Professional Nurse.

All three of the above take different licensing exams and all three have very distinct scopes of practice, with the higher level building on the previous level(s).

Advanced practice nurses: MSN, PhD, DNP, DNS, etc.

MSN is the entry level to advanced practice nursing. Good for clinical nurse leaders, educators teaching at the LPN, RN, and RPN levels. Also entry level for clinical nurse specialists. PhD or DNP or other equivalent doctorate required to teach MSNs and doctorate level students. Prescriptive advanced practice nurses should be required to have a doctorate.

Nursing wants to be considered a true profession, lets set it up so looks like one.

[mmc51264, BSN, MSN, RN]

Respectfully, that's not going to work. We have ADN nurses on out floor that have been there 10+ years that do charge, precept, pain team, RRT; all of this learned in the course of their career. What you are presenting would have a new grad BSN accepting a higher responsibility with less experience. Many of the things nurses do well are learned through experience. That is why I commented on direct entry MSN with no clinical experience. Not going to get as much respect as someone who has been on the floor.

Besides it is confusing enough to pts. who the players are! We have CNAs, nurses, NP, ANP, PA, interns, residents, attendings. If you add 3 or 4 different types of nurses, the staff is going to be confused. I still can't figure out exact scopes between LPN and RN. The BON guidelines are WAY too vague. They also vary state to state.

Again, I don't believe a 2 year ADN is truly a 2 year degree. I have not known a single person that completed an ADN program from scratch and did the whole program in 4 semesters.

[PMFB-RN, RN]

Respectfully, that's not going to work. We have ADN nurses on out floor that have been there 10+ years that do charge, precept, pain team, RRT; all of this learned in the course of their career. What you are presenting would have a new grad BSN accepting a higher responsibility with less experience. Many of the things nurses do well are learned through experience.

*** Right. Some people don't seem to realize that nursing skills and mostly learned on the job hands on and are not well suited for classroom learning.

That is why I commented on direct entry MSN with no clinical experience. Not going to get as much respect as someone who has been on the floor.

*** DE MSN grads are treated, paid, and trained exactly the same as ADN and BSN grads in my hospital.

Besides it is confusing enough to pts. who the players are! We have CNAs, nurses, NP, ANP, PA, interns, residents, attendings. If you add 3 or 4 different types of nurses, the staff is going to be confused.

*** Good point.

Again, I don't believe a 2 year ADN is truly a 2 year degree. I have not known a single person that completed an ADN program from scratch and did the whole program in 4 semesters.

*** I know dozens, maybe more. In my state ADN programs are set up to be two year programs and do not have college class pre-reqs. Some do have waiting lists but we get lots of people on the waiting lists while still in high school and can enter nursing school immediatly after HS graduation. This results in quite a few 19 and 20 year old RNs showing up for orientation each year.

[green34]

I think that no one should be eligible for a charge position based on their degree. I think it should be through people skills and experience. The best charge nurse was one who worked over 25 years in the ER. He has seen a lot. However, he is a diploma nurse.

[nursel56]

I think the only viable option is for those who prefer strategies that create stratification beyond what we have today, with higher walls between the strata to embrace the whole of nursing themselves, advocate for all the layers as they currently do not and create in reality the "seamless track" and many other concepts put forth in the IOM Report, which I refer to so often because it is the most cogent distillation of the aims of those who currently have the levers of power in their hands and have the ability (money, power, connections) to effect a change in the stalemate and find flexible strategies to blend these.

Part of my thinking is based on MunoRN's previous thread where a state committee studied what the actual differences in content between the ADN and BSN programs in their state, and discovered the gap narrower than previously thought. The IOM report itself acknowledged when it stated:

Many nursing schools have dealt with the rapid growth of health research and knowledge by compressing available information into the curriculum and adding layers of content that require more instruction. .

In other words a way of comprehensively, objectively assessing current ADN program content from samples all over the country vs comparing one ADN program to one BSN program and commencing the argument from that point, which is not really accurate anymore.

The committee recommends that the proportion of nurses with baccalaureate degrees be increased to 80 percent by 2020. While it anticipates that it will take a few years to build the educational capacity needed to achieve this goal . . .

I'm sure they would never state how long something would take without knowing what that something is so why not share it and lift all nursing boats? The rancor over "BSN in 10" might actually decrease.

The AACN is already familiar with the process. They did it when they formed a committee to study Master's degree programs with an eye toward changing the name of some msn programs to DNP programs. Perhaps they have an intrinsic bias towards giving grant money to each other.

[MunoRN, RN]

So the general idea for switching to BSN as entry to practice seems to go something like this: (correct me if I'm wrong)

Keep the BSN as it is but change their role to more of a care manager/coordinator.

Downgrade the ADN to more of an LPN type role, and reduce their educational requirements accordingly, yet they would still need to do everything an RN currently does in terms of assessments and interventions

The shortage of bedside RN's that would be created by only having BSN's be RN's would be fixed by having ADN's still do all they bedside care roles currently done by all RN's, the BSN role would be added to the patient care team.

How far off am I?

[DoGoodThenGo]

For generations head nurses, supervisors and the rest of administration/management were nurses that had worked their way up from the bedside. While some may have gone back for their BSN and then graduate degree as they moved up the ranks, many head nurses and supervisors started and remained diploma or ADN grads until they retired.

[DoGoodThenGo]

Respectfully, that's not going to work. We have ADN nurses on out floor that have been there 10+ years that do charge, precept, pain team, RRT; all of this learned in the course of their career. What you are presenting would have a new grad BSN accepting a higher responsibility with less experience. Many of the things nurses do well are learned through experience. That is why I commented on direct entry MSN with no clinical experience. Not going to get as much respect as someone who has been on the floor.

Besides it is confusing enough to pts. who the players are! We have CNAs, nurses, NP, ANP, PA, interns, residents, attendings. If you add 3 or 4 different types of nurses, the staff is going to be confused. I still can't figure out exact scopes between LPN and RN. The BON guidelines are WAY too vague. They also vary state to state.

Again, I don't believe a 2 year ADN is truly a 2 year degree. I have not known a single person that completed an ADN program from scratch and did the whole program in 4 semesters.

Would say probably as late as the 1980's or even early 1990's it was possible to get through a ADN program in the two and one half years most ran, provided all one's ducks were in a row.

Today however under the working theory that all GNs take the same NCLEX and a "nurse is a nurse, is a nurse" ADN programs have had to step up their game often in terms of adding content which stretches out the length of time it takes to finish. BSN programs OTOH being already four years have some wiggle room.

Case in point Hunter-Bellevue recently revamped their BSN program to start the nursing sequence one year earlier in the sophomore year for the undergraduate/generic path. This gives students three years instead of the previous two. IIRC there are other programs out there as well that follow this model.

It is worth mentioning again that ADN programs were never meant to be the "best" method for educating nurses, but a faster than the traditional three year diploma programs which was where in the majority at the time. Whatever deficiencies in education that resulted from this shortened program could be smoothed over during a newly licensed RN's orientation.

[Z71RN]

bsn only nurses? I am for it 100%, speaking from a financial standpoint only. considering the state that nursing is in with many new grads not finding jobs, hospitals cutting staff, the general public being fooled to believe that there is a shortage and puppy mill like nursing schools are pumping out thousands of new nurses every semester. this is the only way I can see to where we can bring nursing back to a more favorable balance with the supply and demand. grandfather all non-bsn active rn's, inform all the community colleges and on-line programs to close shop! I also believe that you do not need a higher degree to be a effective leader and to think otherwise is silly.

[MunoRN, RN]

Would say probably as late as the 1980's or even early 1990's it was possible to get through a ADN program in the two and one half years most ran, provided all one's ducks were in a row.

Today however under the working theory that all GNs take the same NCLEX and a "nurse is a nurse, is a nurse" ADN programs have had to step up their game often in terms of adding content which stretches out the length of time it takes to finish. BSN programs OTOH being already four years have some wiggle room.

Case in point Hunter-Bellevue recently revamped their BSN program to start the nursing sequence one year earlier in the sophomore year for the undergraduate/generic path. This gives students three years instead of the previous two. IIRC there are other programs out there as well that follow this model.

It is worth mentioning again that ADN programs were never meant to be the "best" method for educating nurses, but a faster than the traditional three year diploma programs which was where in the majority at the time. Whatever deficiencies in education that resulted from this shortened program could be smoothed over during a newly licensed RN's orientation.

Hunter Bellevue didn't revamp their program, they just took a year of pre-reqs and called it the "lower division" of the program, students still don't start taking Nursing classes until Junior year. Some programs say their BSN program is 2 years plus a year of pre-reqs plus a year of electives, and others say they have 3 years of program and 1 year of electives, yet they all have the same structure, it's just a matter of whether or not they call their pre-reqs part of the program or not.

[MunoRN, RN]

bsn only nurses? I am for it 100%, speaking from a financial standpoint only. considering the state that nursing is in with many new grads not finding jobs, hospitals cutting staff, the general public being fooled to believe that there is a shortage and puppy mill like nursing schools are pumping out thousands of new nurses every semester. this is the only way I can see to where we can bring nursing back to a more favorable balance with the supply and demand. grandfather all non-bsn active rn's, inform all the community colleges and on-line programs to close shop! I also believe that you do not need a higher degree to be a effective leader and to think otherwise is silly.

We'd be cutting our supply of Nurses in half, yet even during the biggest surplus of new grad Nurses the vacancy rate was only down to about 5%, a "shortage" occurs when vacancy rates are about 9-10%, 50% would be unworkable yet hospitals would be quite happy with that, that would make it no problem to just replace bedside Nurses with MA's.

Manipulating supply and demand could certainly be to our benefit, but push it too far and it will easily lead to the extinction of the bedside Nurse.

As for the "shortage", there most definitely is a shortage, the problem is we incorrectly define a "shortage" as whether or not it's easy to find a job. The shortage exists in that the patient who 10 years ago were in ICU as a 1:1 or 1:2 ratio are now on med-surg floors with a 1:6 ratio (which isn't working all that well), so the problem isn't that there are now enough Nurses, it's that we aren't using nearly as many as we should be.

[OneDuckyRN]

I'm a new grad from an ADN program and have been practicing for less than 2 months in a large teaching/magnet facility, so I might not be the most qualified to speak on this subject, but I have a few perspectives I'd like to offer.

The CC I graduated from has a 97% first-attempt pass rate on the NCLEX, which is higher than our neighboring BSN colleagues. I've heard all the arguments about how BSN-educated nurses are better at critical thinking and clinical skills than the ADN students. That's all well and good, and makes sense from a theoretical standpoint. More education = a higher skill set, right? I'd buy it, except that I know how to carry out certain procedures (PICC line dressing changes, for example) that my preceptors (who have BSNs) have NEVER done in their professional practice. Where did I learn this? I spent my last two semesters of clinicals at our local LTACH, where I got a lot of practice doing these things. Also, I've been asked what I would do in certain scenarios (not as a test of my thinking skills) by a BSN nurse who has been practicing much longer than I have. I've also spoken to several managers in our hospital who, if not for our Magnet status, would actually prefer to hire ADNs from my school over BSNs from the local university simply because we have much more clinical experience. According to them, the critical thinking comes with time, and even the best BSN grads need time to develop those skills.

All of that said, I do plan to return to school for a BSN within the next year because I enjoy learning, and if I should ever want to take my nursing practice and do something different with it, like public health nursing, I want to be sure that I am competitive. I think that requiring a BSN within a set time frame (5-7 years seems reasonable) is a good idea, but based on my limited experience, I don't see that having one right off the bat would have benefited me or my patients at all.