NY State may require nurses to obtain 4-year degrees - page 35
But some worry that an already severe shortage will become worse. New York is mulling over a requirement that would force all RNs to earn a bachelor's degree in order to keep their RN... Read More
May 10, '06Ok...first off, I will apologize for the "shoddy 2 yr" comment. I agree that sciences at a CC can be just as well done as a 4 yr. The comment was aimed really at something else. So lets move on.
Now...How can nurses get unified? Whats the deal with Unions, etc? Why have we no voice? And who is going to take the reins here and bring us all together for better conditions?
And honestly...I dont mean to sound naive but I know this is---Other than abandonment issues...why cant we "walk out" a la the hispanics over the immigration issues? Imagine the fear and change that could inspire? Someone tell me why nursing hasnt done these things please...I want to really know.
May 10, '06Good grief! I can't think of anything that would be worse for the nursing shortage, especially in New York. I have my BSN only because I had to wait to be accepted so I took all classes required for my BSN. I was accepted to an ADN and BSN program at the same time.
I chose the BSN. This could only make the nursing shortage worse!
May 10, '06If NY really wants to export their ADN nurses to other states, let 'em. When healthcare starts to suffer the voters will demand a change.
May 10, '06Quote from earle58Probably some of the respect issues are related to other professions having to have more education than nurses, even though they are not working in life and death situations.how will that respect manifest itself?
do you plan on working as a bedside nurse?
if so, will you get lighter patient loads because of having a bsn?
truly, what kind of respect? i don't understand.
And why do people keep bringing up that the only difference between ADNs and BSNs is the humanities...don't they see the differences? Look at the course descriptions.
May 10, '06I'd love to know what the "shoddy two year degree" comment was really about, then. I also wonder where the heck that puts me; I graduated from a diploma program 21y ago. Yes, I've got 2/3 of the credits for a BSN, but I'm totally turned off by all the politics, so I doubt I'll ever finish it. Truth be told, I'd rather get a degree for fun, like in music or literature.
Another question I have: If ADNs and diploma nurses are so inferior, are you going to refuse to let anyone with less than a BSN be your preceptor if and when you graduate? What will you do if you find out your charge nurse is "only" and ADN/diploma grad?
Have you posed your questions of your professors? Have you paid any attention to what the CNA is doing? (That is, the California Nurses' Assn.)
If you do a search, you'll find that the questions you've posed have been asked many times over the years. Perhaps you can find your answers there.
Normally, I have no problem answering questions from students even though those questions have been asked before and the answers are easily found be doing a search. But I'm disinclined to go out of my way when I see people who aren't even nurses yet denigrating nurses who are out there actually providing care. Part of being a good nurse is being able to play nice with everyone: aides, LPNs, RNs, etc. All the degrees in the world will not help you if you can't do that, and the unity you seem to want so much will never happen if you have such contempt, concealed or not, for your co-workers. Providing good patient care takes a team effort, from the housekeeper up to managers. Learn that lesson early, or you'll find your transition into the real world of nursing harder than it need be.
May 10, '06Quote from NephroBSNMore importantly, why aren't BSN's a force to be reckoned with?Just a thought. Are there more ADN educated nurses than BSN's?
If so why aren't they a force to be reckoned with.
Also, I have no problem with any of them putting ADN after RN on their badge and signing their charts that way. I would never be offended by that.
They aren't, plain and simple.
Maybe if BSN's had so much more power than the rest of us, then maybe us ADN's would buy all of the propoganda about how we'll all be so much more respected and better off if we only would get our BSN.
As ADN's, we are, in fact, a force to be reckoned with.
If hospital administrations and the public had their way, it would be to have all RN's be BSN prepared and yet pay them the same as an ADN and give them the same minimal power they have today as staff nurses.
They want the education and credentials, but are not willing to pay the premium to get it.
If every state decided to only allow BSN's to be licensed as RN's, healthcare and hospitals as we know it today, would crumble.
Look at North Dakota and their "success" in having only BSN RN's.
It doesn't work. For many reasons.
I'd love to see anyone state any account of any hospital who is successfully hiring only BSN RN's to staff their units in their entire hospital and getting buy with anything less than minimal difficulties.
Yes, we are in fact, a force to be reckoned with.
Name one hospital in the entire U.S. that doesn't use ADN or Diploma RN's and instead use only a BSN staff.
May 10, '06Quote from sushiartI believe that "walk outs" would in fact, inspire fear and change.And honestly...I dont mean to sound naive but I know this is---Other than abandonment issues...why cant we "walk out" a la the hispanics over the immigration issues? Imagine the fear and change that could inspire? Someone tell me why nursing hasnt done these things please...I want to really know.
But in reality, it's just not the same as in the Hispanic/illegal alien fight.
Too many nurses are way too comfortable in their jobs and lifestyles, despite the grumbling that goes in this forum.
It seems that most are not quite dissatisfied enough to actually give up their comfortable middle class lifestyles, mortgages in middle class suburbs, and tuition to their children's private schools, to actually walk out on their jobs to create change for the entire profession.
It's much easier to blame nursing's problems on the fact that we have so many under-educated people in our profession calling themselves nurses.
If we got rid of LPN's and ADN RN's, things would really change for the rest of us, right?
The fact of the matter is this:
The day I don't see any more groveling and "yes master" mentality toward physicians and family members of patients, is the day this profession will finally move up.
Blame it on nursing's low educational standards all you want, but every time I see a nurse bowing down to MD, patient, or family member abuse simply because they are afraid to lose their job and/or retirement package, I just want to puke.
Weak nurses who will do anything to feed their kids and pay their mortgages, no matter who disrespects them or why, is the true weakness and problem with our profession.
But go ahead, blame it on the lowly educated non-BSN's.
We still won't demand what we are worth. We'll settle for whatever will pay for us to get by and still let others belittle and abuse us.
A BSN will not change that.
If a BSN requirement would change all of this, then why don't I see BSN's standing up for themselves rather than spending their shifts making sure that they don't upset the doctors, families, or management?
They are just as guilty as the rest of us in keeping our profession weak.Last edit by RN34TX on May 10, '06
May 10, '06sorry if it's offensive to anyone; but I suspect that it has something to do with the overwhelming amount of estrogen in the profession.
May 10, '06Quote from zenmanummmm, just spent three hours looking over course descriptions.... they look the same.
....And why do people keep bringing up that the only difference between ADNs and BSNs is the humanities...don't they see the differences? Look at the course descriptions.
May 11, '06Quote from battposummmm, just spent three hours looking over course descriptions.... they look the same.
Having taught in both programs, I can tell you from experience that they are not the same...do you have that experience to allow you to say that or do you just have an opinion? Look at any school, preferably those that have both programs and look at the difference.
May 11, '06If BSNs weren't such 'technical' nurses, and tried to be more 'professional', like the ADNS are: then we'd be more professional as a group.
Yes, I said that right.
And, if THAT statement annoys you, then you understand the fundamental gulf that this moot debate will always engender.
Because, in essense, this is the EXACT argument that is used, in reverse. And, it's used IN SPITE OF THE FACT that experience is our greatest educator. And it's used in spite of the fact that it is just not true. And yet, this deceitful arrogance is still indoctrinated in some programs.
See, this argument can't take place 'in the trenches' because out there, we are ALL RNs and the fact that experience and overall education rounds each of us means that the mark of 'excellence' and/or 'professionalism' is a sum of education and experience that doesn't quite so neatly fit into this BSN vs. ADN debate. No, this is merely an 'academic' debate. And a moot debate to boot!
It is my considered opinion that the strongest advocates of this position are new BSN grads/students that don't yet have the experience to understand the fallacy of thier indoctrination; and the instructors that teach this indoctrination. It is my considered opinion that this fallacy doesn't translate well out of the academic environment and into the 'real' world.
Someone that would use this argument does so to make themselves feel superior at the expense of the majority of their peers.
How professional is that?
And that, my friends, is why we aren't a profession.
Timothy.Last edit by ZASHAGALKA on May 11, '06
May 11, '06Quote from KatRN,BSNI want to comment some on this study, but first, let's look at the actual STUDY, instead of an abstract: (By the way, this post is SOLELY the work of the poster.)Linda Aiken at the University of Pennsylvania has done some research on patient outcomes and the educational preparation of nurses. You can view the abstract of one article at http://jama.ama-assn.org/cgi/content...ct/290/12/1617
http://www.tc.umn.edu/~ankel001/education/ED%20RN.pdf#search='Educational%20Levels%20of%20Ho spital%20Nurses%20and%20Surgical%20Patient%20Morta lity'
(I can't make this link, but if you put in "Educational Levels of Hospital Nurses and Surgical Patient Mortality" in yahoo search, this was, for me, the 4th response. Look for the www .tc.umn.... response.)
This is an 3 yr old study using 7 yr old data that has never been validated. Would you like to know why?
1. Academic Laziness
The original data pool was used for an earlier study about staffing levels and mortality GENERALLY. That data was just copied onto this template for this study. But it wasn't just copied; it was copied with the full assurance of the authors that the results of the first study that used this data could be 'factored out' of this, subsequent study. This fact serves the purpose of compromising BOTH studies.
2. Discrimination Bias (Hospital Selection)
Before analyzing the data, the authors first decided that it would be necessary to 'exclude' hospitals that didn't fit their data set. Some were excluded for valid reasons (they didn't report to the data set. Although, however valid, the exclusion ITSELF taints the data. THIS IS EXPECIALLY TRUE SINCE THIS EXCLUSION INCLUDES ALL VA HOSPITALS - a known source for high BSN recruitment. The very hospitals that might yield some useful data on the subject were ELIMINATED from the study!) - but some were excluded because the data they generated didn't meet the authors' needs. In other words, INCLUSION of said data would disturb the conclusions of the study.
So the authors warrant that exclusion of some data is relevant. Ok, I can concede that point as I understand that large standard deviations can skew data. But, excluding large amounts of data that are quite possibly within the single standard deviation being studied on the basis that such data wasn't available serves the purpose of undermining the whole study. It is a frank admission that the data itself is incomplete, and so, suspect.
This is the compounded error of the academic laziness mentioned above. The data set was copied from another study with the full understanding that it didn't meet the needs of this study, AND COULD NOT MEET THE NEEDS OF THIS STUDY because of its lack of inclusion of hospitals MOST LIKELY to represent a significant sample of this study. Rather than develop data that was 'pertinent' to THIS study, that academic laziness now calls for this lacking, and possibly highly relevant, data to merely be excluded from consideration.
3. Degree Bias
The Authors state in the study, "Conventional wisdom is that nurses' experience is more important than their educational levels." It is this ''conventional wisdom' that the study aims to examine. But how does it do so? By buying into the exact same conventional wisdom!: "Because there is no evidence that the relative proportions of nurses holding diplomas and associate degrees affect the patient outcomes studied, these two categories of nurses were collapsed into a single category"
HOLD ON. In a study about how degrees affect patient outcomes, an essential tenet of the study is to disregard degrees held??? After such manipulation, how can you say with a straight face that a study that disregards the relationship between degrees can make a conclusion REGARDING the relationships between degrees?
4. Lack of Substantiating Data
"It was later verified that this decision did not bias the result."
This statement, or others like it, appear throughout this 'study' without mention of the methods used to 'verify'.
"Previous empirical work demonstrated. . ." - um, exactly WHAT empirical work was that?
In fact, the study makes lots of claims and manipulates the data in lots of ways that it nevertheless insists that you have to trust its 'independent verification' that such didn't bias the results. Of course, that is without being provided access to said independent verification.
You have to love the 'self-affirming' validity of it all.
5. Data Manipulation
A. The data was 'manipulated' to grant varying degrees of credibility depending upon whether it was received by a 'teaching' hospital vs. a 'non'-teaching hospital. So, the study acknowledges that whether the place is full of learning docs MIGHT bias the study. And so, it 'manipulates the data' to account for this possibility.
B. The data was 'manipulated' to grant varying degrees of credibility to hospitals that are more 'technological' (e.g. have transplant services) as opposed to less. So, the study acknowledges that the level of care might bias the study. And so, it 'manipulates the data' to account for this possibility.
C. "An important potential confounding variable to both clinical judgment and education was the mean number of years of experience working as an RN": telling comment, but never fear, the data was 'manipulated' to take this into account.
D. Nursing workloads might affect patient outcomes. (Indeed, THIS was the previous study that this study's data set was copied from.) But, in this case, the data was 'manipulated' to take those workloads into account.
E. "Estimated and controlled for the risk of having a board certified Surgeon instead of a non-board certified Surgeon." The use of 2 'dummy variables' comparing MD licenses to general vs specialty board certification was "a reasonable way for controlling surgeon qualifications in our models."
In fact the authors admit to manipulating the data 133 ways! But all of these 'manipulations' were later 'verified' to have produced no bias.
6. Key Criteria Conjecture
The study's two key criteria: deaths within 30 days of hospital admissions and deaths within 30 days of complications due to 'failure to rescue'. But how were these criteria established?
In the first case, they were established by comparing the data set to vital statistic records (death records). I doubt they accurately compared 235,000 individual patients (data points) against another data set (death records) that was probably multiple times in size, but OK - I'll buy this for the moment.
In the second case, however, 'failure to rescue' was defined - NOT BE EXAMINING ACTUAL CASES OF FAILURE TO RESCUE - but by establishing different ICD-9 secondary codes from admit to discharge. An assumption is made that a different code meant that a 'failure to rescue' had occurred. What?!
RE-READ THAT LAST! By making dubious assumptions on data sets (hospital reporting statistics) - this study conjectures how this translates to 'failure to rescue' and then makes conclusions based on what this 'failure to rescue' might mean! ALL BY ITSELF, THIS NEGATES THE ENTIRE STUDY.
But, it was 'verified' to not bias the study results. How was this part 'verified'? Well, you're gonna love this: "expert consensus as well as empirical evidence to distinguish complications from pre-existing co-morbidities."
In other words, the experts (the study authors) know which data is which by looking at ICD-9 codes and that is sufficient to determine 'failure to rescue' and then extrapolate that data to RNs and their education status.
7. Risk Adjustment.
Still trust this study? Try this one: "Patient outcomes were risk-adjusted by including 133 variables in our models, including age, sex, whether an admission was a transfer from another hospital, whether it was an emergency admission, a series of 48 variables including surgery type, dummy variables including the presence of 28 chronic, pre-existing conditions as classified by ICD-9 codes, and interaction terms chosen on the basis of their ability to predict mortality and failure to rescue in the current data set."
So the data was manipulated 133 ways, excluding some data. But, and this is key: there are SO VERY MANY variables that could effect patient outcomes that you have to adjust for EVERYTHING except for what you're looking to find. Right? This is not only what the authors contend, but they contend that they SUCCESSFULLY adjusted the data, 133 different ways, for just this purpose, and completely without bias. Amazing.
8. Logistics Regression Models
So, after the study took in all this manipulated 'data', it compared hospitals with higher BSN-RNs to those with less, and reached a conclusion. Right? Wrong.
It took the data and ran a 'logistics regression model' as to what might happen in a given hospital "if there were a 10% increase in BSN RNs."
This study doesn't even compare the relative levels of RN education. It conjectures what might happen using a 'logistics regression model' of the data that it manipulated 133 ways!
Now if this isn't a key statement: "The associations of educational compositions, staffing, experience of nurses, and surgeon board certifications with patient outcomes were computed before and after controlling for patient characteristics and hospital characteristics." Indeed.
9. Direct Standardization Models.
Apparently, even after all the above manipulation, there were still 'clusters of data' that had to be 'standardized' using 'robust estimations'. The study does at least have the guts to admit that such 'standardizations' turns the final conclusion into an 'estimation'. Too bad it only makes that admission in the body of the study, and not in the 'abstracts'.
10. Alternative Correlations
The study admits that fewer than 11% of hospitals in Penn in 1999 (the area/year of the study) had 50% or greater BSNs. And then the study cites co-factors that could unduly influence the study under these situations: "Hospitals with higher percentages of BSN or masters prepared nurses tended to be larger and have post-graduate medical training programs, as well as high-tech facilities. These hospitals also had slightly less experienced nurses on average AND SIGNIFICANTLY LOWER MEAN WORKLOADS (emphasis mine). The strong associations between the educational composition of hospitals and other hospital characteristics, including workloads, makes clear the need to control for these latter characteristics in estimating the effects of nurse education on patient mortality."
Wow. Two key things from that statement: a direct acknowledgment that this 'study' is an 'estimation' and an acknowledgment that such an 'estimation' only occurred after 'the need' to highly manipulate the data.
In fact, I think it much more likely to argue that such "co-correlations" makes any 'estimated' conclusions IMPOSSIBLE to verify.
11. Study Conclusions.
This is one of the study's least reported conclusions. See if you agree: "Nurses' years of experience were not found to be a significant predictor of mortality or failure to rescue in the full models." Why is that? Because the above statement is true? Or, is this an indication that the models were so skewed. . . I mean, 'adjusted' as to make them completely unreliable?
The authors admit that their "estimations" can only lead to an "implication" that increased education means better nurses. OK. I'll agree with that. But, because the same study 'factored out' experience, I think it is impossible to estimate how even a fraction of experience affects the conclusions of the study.
Indeed, in order to arrive at its conclusion, the authors must first dismiss the 'conventional wisdom' that experience IS a factor, as they did, in the above statement. Without the above assumption, this whole body of work is worthless. If experience factors in, then the key question cannot be tied simply to education, BUT MUST BE TIED TO BOTH QUALITIES.
And so, the authors find themselves in a conundrum, in which they must first dismiss the importance of experience in order to highlight the importance of education. Amazingly enough, their study reached both conclusions: experience is meaningless to patient outcomes and THEREFORE education level is, by itself, a measurable standard.
The problem with that is once dismissed, the correlation between experience and patient outcomes is NOT part of this study. Neither, for that matter is alternative educational pathways, such as non-BSN bach degrees. Given the broad range of said experiences and educations within nursing, negating those experiences and educational pathways also serves the purpose of negating the validity of the study itself.
Simply put, this flawed and un-reproducible study is worthless. And that's the bottom line.
Timothy.Last edit by ZASHAGALKA on May 11, '06