A Different Approach to the ADN vs. BSN Debate

[Sheri257]

Over and over again, we read the same things on these threads. Pay BSN's more at the bedside, and mandate a BSN for all entry level nurses. There is widespread assumption that a BSN mandate would limit the labor supply even further and increase nursing wages.

I'm not sure that would actually happen but, for the sake of argument, let's assume that it would. Ok: so now you're making more money but, since I live in California where we have mandated staffing ratios ... it got me thinking. What's going to happen in the other 49 states where you don't have ratio laws? Isn't it possible that with a more limited labor pool the hospitals would give you even more unreasonable patient loads at the bedside than you have now?

A BSN mandate could very well limit supply and increase wages but it does nothing to improve working conditions. This is where, IMO, a ratio law is a better alternative because it does both. While a ratio law doesn't limit the supply, it does increase the demand and wages by limiting the number of assigned patients to each RN and forcing the hospitals to create more nursing positions.

Plus, it has the added benefit of making your life a hellava lot easier at the bedside which a BSN mandate doesn't do. By limiting supply even further, a BSN mandate could very well thwart attempts to mandate ratios in other states if there aren't enough nurses to staff mandated ratios.

Now ... this may not satisfy BSN nurses who want more consideration for your degrees but, this is where I don't understand you guys. I'm a recent ADN grad and I'll be spending the next two years working on my BSN. You BSN nurses are already way ahead of me.

You definitely qualify for more jobs than I do. There are, at least, some jobs where you can make more money than me at the bedside and, there are other jobs where your BSN counts as additional experience, etc. for promotion. In my area, at least, the BSN career opportunities are tremendous because there aren't that many BSN nurses to begin with. You're also way ahead of me in getting your master's, which increases your job prospects even further.

I see plenty of benefits with the BSN as it is. If I didn't ... I wouldn't bother with the time and expense of furthering my education.

And I wonder if any of the BSN nurses have considered the flip side of all of this? If everyone had a BSN then, everyone would also qualify for those other job opportunities that only you qualify for now. For nurses who don't want to work at the bedside, you already have a huge advantage over the rest of us.

Do you really want every nurse to qualify for the jobs that only you qualify for now? In some ways, this could actually be detrimental to BSN nurses who, IMO, have a huge advantage over the rest of us as it is.

As the old saying goes ... be careful what you wish for.

Just some food for thought.

:typing

[Sheri257]

Why are people so critical ...is it jealously? Or is it that people want to have more for less work, less time, less effort? It really isn't fair overall. We should want to hold bachelor's degree. We all should want to be overachiever's so that we can put our best foot forward and give our patients the best care possible.

Look: I'm going to get my BSN. And if BSN nurses think I'm a lousy nurse because I have an ADN, so be it. They're entitled to their opinion. It really doesn't bother me.

However, I've been reading this board a long time. And most of the time ... it's the BSN's who bring up this argument. Before this particular forum was created .... they'd post the same thing on other threads no matter how off topic it was. They should be paid more money, they are better nurses, they should get this or that because they have a BSN. And maybe they're right.

But I've never seen the ADN's go out of their way to criticize BSN's nearly as much as the BSN's criticize ADN's. If the BSN's think people are being critical .... maybe they need to look in the mirror.

:typing

[lauralassie]

It never fails to amaze me that it seems so many BSN nurses mention "bed side nursing " like it is the lowest of jobs you can have. I've done upper admin, bed side and nursing education CQI. Just let me say, bed side nursing requires more skill than anything I've ever done. If we're talking difficulty of jobs then lets do a complete switch and make us lowley ADN and Diploma nurses do admin and the BSN do the more difficult job of bed side nursing. That is where the real skills are. To use critical thinking while multitasking to improve pt outcome and complete all the tasks for pres-gainy, JACHO etc,,, etc.... that is a skill. Compiling research, putting lectures together, organizing ceu classes and JACHO preperation is a piece of cake compaired to "bed side nursing". Hummmm, maybe we should rethink what a task or skill is.

[Atl_John]

This was posted on another thread but the local CC here has only 42 hours of nursing courses, where as the local university has 63 hours of nursing courses.

I'm not exactally sure what the CC consider's a nursing course but they were counting in A&P's and micro's, the university considers those pre req's and doesnt' count them in "nursing" hours. When I took those out of the counting as they do in the local university's program it was 23 hours with NURS in front of them. The local university has 60 hours with NURS in front of it that are actually related TO nursing. I took out the 3 hours that are a 400 level Physiology course, even though its very useful and needed for what our nursing courses then teach you afterwards. It is an advanced physiology course that is taught just to nursing students, yet it is advanced enough that I am actually a UTA now for the 500 level Mammalian PHysiology Lab that Pharm. and Pre-med students have to take. I'd like to see an ADN program give as good of an education.

[Sheri257]

Perhaps I should have put this more succinctly in my original post but ... the point of this thread isn't to rehash who's better, what's better, etc. There's tons of threads that already talk about this ad nauseum.

The point of this thread is to figure out if any of this is practical and, what the ramifications would be if it actually happened. To wit:

* Where would the money come from to convert all of the ADN programs to BSN's?

* What would happen to ratios if a BSN mandate limited labor supply? Isn't it possible that patient loads would increase? Couldn't this thwart efforts in other states to pass ratio laws not to mention, make bedside nurses' lives more difficult?

* Why would BSN nurses want every nurse to get a BSN when it gives them a huge advantage and allows them to qualify for jobs that other ADN nurses don't qualify for?

:typing

[FullTimeTraveler]

1st, mandatory BSNs would stop the generalization of ADNs and BSNs all as RNs. 2nd, although many have argued that ADNs are just as good as BSNs, no one can argue that they're better degrees, where as God knows how many nurses have argued that BSNs are a superior form of education. I never argued that there aren't extremely intelligent ADNs. But to simply get an ADN when you have the choice of getting a BSN b/c it will essentially get you the same job is just plain lazy. The problem lies in this good enough attitude. We're in the medical field. We should be striving for excellence, not the idea that "I'm just as good as the next person".

[Tweety, BSN, RN]

Lizz, I agree that is definately the ADNs who are less critical and more on the defensive.

I also understand that it's not possible to advocate for mandatory BSNs without stepping on a few ADN's toes. I don't mind having my toes stepped on, I can take it.

1st, mandatory BSNs would stop the generalization of ADNs and BSNs all as RNs. 2nd, although many have argued that ADNs are just as good as BSNs, no one can argue that they're better degrees, where as God knows how many nurses have argued that BSNs are a superior form of education. I never argued that there aren't extremely intelligent ADNs. But to simply get an ADN when you have the choice of getting a BSN b/c it will essentially get you the same job is just plain lazy. The problem lies in this good enough attitude. We're in the medical field. We should be striving for excellence, not the idea that "I'm just as good as the next person".

I don't think everyone who chooses an ADN program when they have the opportunity to get a BSN is lazy. Their goals might be different.

As a 15-year ADN nurse, with a few certifications under my belt, a "Nurse Excellence Award", I feel that I can strive for excellence in my practice without a BSN.

[RNsRWe, ASN, RN]

Perhaps I should have put this more succinctly in my original post but ... the point of this thread isn't to rehash who's better, what's better, etc. There's tons of threads that already talk about this ad nauseum.

The point of this thread is to figure out if any of this is practical and, what the ramifications would be if it actually happened. To wit:

* Where would the money come from to convert all of the ADN programs to BSN's?

* What would happen to ratios if a BSN mandate limited labor supply? Isn't it possible that patient loads would increase? Couldn't this thwart efforts in other states to pass ratio laws not to mention, make bedside nurses' lives more difficult?

* Why would BSN nurses want every nurse to get a BSN when it gives them a huge advantage and allows them to qualify for jobs that other ADN nurses don't qualify for?

:typing

Thanks for clarifying the points to address, lizz. Worthwhile discussion lost on a tangent.

Ok, I'll play :)

Where would the money come from? I fail to see the government stepping up and handing out the grants that would be needed to accomplish this. If it had been a priority for the gov't to address the nursing shortage up until this point, it would have been done. But it isn't. And if the current shortage (without going onto that tangent of "there isn't really a shortage") isn't enough to motivate gov't to fund the programs that exist already, they certainly aren't going to do what it would take to take ALL programs and make them BSN. There have been tens of thousands of qualified, eligible candidates for BSN schooling that have been turned away because of lack of space in schools and clinical sites. Lack of faculty as it stands NOW. So to answer the first point: there isn't any money that will suddenly materialize.

The second point, about ratios, gives me pause to wonder about the quality of healthcare as a whole in America. As it currently stands, I'm already worried about what happens when friends or loved ones need a hospital stay: are they on an adequately staffed unit? Are the ratios not only acceptably safe and adequate, are they GOOD? Can I sleep well knowing they are being well attended, or am I worried that I need to be there, or call there, more often to make sure of it?

I expect that a loss of ADNs during a transition period to all-BSN will naturally occur ("I was going to retire in five years, but I think I'll just get out now" or "I have 25 good years left in me, I think I'll finally make the decision to work in another field"). And I think that ratios during that time will be horrid, as well as the time period following the mandate, in which there simply are not enough BSN-prepared nurses available to fill the slots of those ADNs who have not yet completed the additional schooling, or left entirely. The very goal of the initiative, purportedly to elevate the level of the standard of care, would be undermined by the inability to maintain safe, quality environments.

Why would BSN nurses be pressing this issue so hard when it would eliminate the edge they currently hold for certain positions? I don't really understand it, exactly. On the one hand, I understand the push for an all-BSN entry level, as it legitimizes the choices THEY have made for themselves. Human nature says that we like to have everyone else in agreement with us. What better validation of your own opinion of the superiority of BSN degrees over ADN degrees than a professional mandate? Beyond this natural desire to be "in the right all along", I can't quite explain it. Currently, there are positions to which only BSN nurses may apply. They seek to increase the competition for those positions by virtue of this desire.

If anything, having BSN as the minimum entry for practice absolutely ensures a new debate: whether BSN-prepared nurses are really qualified to hold positions that really should go to MSN nurses. BSN nurses become the "lesser" nurse; they become the "less educated", "non-professional" that they sought to erase. This thinking isn't new; it's been discussed on these boards forever. And yet, the expectation that having BSN as a minimum standard of entry somehow improves the outlook for all nurses erroneously continues. BSNs would suddenly find themselves no longer eligible for the very jobs they currently desire: they'd be outdone by MSNs, NPs. They would be sniffed at as "just" BSNs, who were too lazy to get an advanced practice degree. They would become the lowest common denominator on the food chain, where they currently place ADNs.

Interesting concept.

[MSADN, ADN]

Part of the choice to take an ADN over a BSN many times has to do with opportunity, location, and financial considerations. Besides, there are plenty of RN to BSN (to MSN, even) programs for furthering education. In my case I may have to do 160 hours more of clinical to "upgrade" my ADN RN to a BSN RN. The rest of the hours are writing, writing, writing. All of my ADN courses will be accepted as hours within the BSN program leaving me with 1 year of work to finish the higher degree.

[RNsRWe, ASN, RN]

Lizz, I agree that is definately the ADNs who are less critical and more on the defensive.

I also understand that it's not possible to advocate for mandatory BSNs without stepping on a few ADN's toes. I don't mind having my toes stepped on, I can take it.

I don't think everyone who chooses an ADN program when they have the opportunity to get a BSN is lazy. Their goals might be different.

As a 15-year ADN nurse, with a few certifications under my belt, a "Nurse Excellence Award", I feel that I can strive for excellence in my practice without a BSN.

Woohoo! You lazy thing, you.

I chose nursing late in the career plan, but certainly not "late in life", LOL. Was it POSSIBLE for me to get a bachelor's degree (which, given my family obligations, would likely take about 7 years)? Yes, it was possible. Not practical, not reasonable, and not particularly enticing. I wished to become a staff nurse in a hospital, and I knew that a more "do-able" program existed with an ADN, which in my circumstances would take about 3+ years to complete. Juggling children, household, husband, extended family, volunteerism and special concerns for 3.5 years while I worked on this endeavor hardly placed me in the "lazy" category. It placed me in the "nursing is so important to me personally that I will sacrifice ALOT over the next 3.5 years to achieve this important goal".

Perhaps, as I've frequently stated, I will continue coursework. *IF* I choose to do this, and I just may, it will NOT be because I feel inferior as a nurse now. It is because I might just want to have a bachelor's degree, or I might just want to learn from the additional schooling (some of those courses actually look a tad interesting!! LOL).

Or I might skip the BSN altogether and move straight into an RN-BSN-MSN combo program to get it done quicker. Or would that be too lazy....?

[RGN1]

Letters after your name DO NOT make you a better nurse. The best way to learn to nurse is at the bedside & NO amount of essays & classes are EVER going to prepare you for that!!!

You are either a good nurse or not & whether you're a BSN, MSN, ADN, Diploma, or like me a plain old UK RGN (didn't really have uni education for nursing in my day) it won't make a jot of difference to that.

Personally I think your pay should reflect the job you do NOT what degree you have. Good nurses should be rewarded for the good work they do period!

I also don't see why an ADN or diploma nurse can't go on to do some of those "exclusively" BSN jobs if they have gained the relevant experience over their years of nursing in the real world.

Just my worth.

[RNsRWe, ASN, RN]

We all should want to be overachiever's so that we can put our best foot forward and give our patients the best care possible.

And all this time people thought that with my insane studying, very good grades and multi-tasking to the extreme *I* was an overachiever already!

Remember, too....if you got your wish and BSNs were the bare minimum entry level to nursing, very quickly you'd be hearing that you should not stay an underachiever for having only a BSN....you should want to be an overachiever and give your patients the best care possible, like the MSN nurses. Perspective is everything.

[Tweety, BSN, RN]

And all this time people thought that with my insane studying, very good grades and multi-tasking to the extreme *I* was an overachiever already!

Remember, too....if you got your wish and BSNs were the bare minimum entry level to nursing, very quickly you'd be hearing that you should not stay an underachiever for having only a BSN....you should want to be an overachiever and give your patients the best care possible, like the MSN nurses. Perspective is everything.

That reminds me once a coworker accused me of being an overachiever when I was a charge nurse because I went above and beyond for my nurses and patients, and even helped out administration. Guess until I finish my next two courses and get my BSN I won't be overachiever enough in some people's eyes. Just another lazy ADN nurse I'll be until then.....sigh.