A Different Approach to the ADN vs. BSN Debate

Nursing Students ADN/BSN

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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

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I think it's really important to refrain from stereotyping when we debate the BSN/ADN and diploma routes of entry to professional nursing. Thanks.

Specializes in Home Health Care.
I agree. I precept the BSN students in the program here weekly. (They do a preceptor thingie rather than the group thing with the instructor present.) I am very familiar with their program. They get the same number of clinical hours as the ADN students, and their program is geared towards producing beginning bedside nurses and passing NCLEX (they had the highest pass rate in the state year before last) not producing managers. They take one course in Leadership/Management.

Off topic.....I'm in an ADN program...We also have preceptorship (96 hours ), and we have to take the Nursing Seminar class (Leadership and management).

Probably d/t the NCLEX changes i suspect.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Off topic.....I'm in an ADN program...We also have preceptorship (96 hours ), and we have to take the Nursing Seminar class (Leadership and management).

Probably d/t the NCLEX changes i suspect.

Interesting. It was built into our ADN but not a separate course or very detailed. Again, ADN programs are moving more towards a BSN type ciriculum and not awarding the degree.

I'm sorry, but I think you've misunderstood something: there is no "State board" exam; the NCLEX-RN is a national licensing exam. That means that the exact same testing material (randomly chosen from the databank) is used in every State.

There is no such thing as a "Missouri board", so it's not possible that this non-existent board changed anything for the NCLEX in your particular State. While there IS a Missouri State Board of Nursing (as there is for every State), they have no control over the content of the questions given for the NCLEX in your State. The one I take in NY is the same testing material that is used in WI, MO, etc.

If there was a change in the passage rates of any particular school, it had to do with how they were addressing their curriculum compared to the material being tested on the NCLEX.

In response to the above post:

Your right I am sorry. I meant to say the NCLEX, however for some reason put the State Board. I do realize it is the NCLEX, thanks for the clarification. I am not sure the hint of sarcasm was necessary, knowledge is greatly appreciated. My point was that mandating a BSN may not occur anytime soon, but steps are being made to create ADN programs to incorporate BSN material or to alleviate ADN students from passing the NCLEX. I have been gettin all my information ready for the Missouri State Boards in order to be able to take the NC-CLEX Unless you took the boards two years in a row you may not realize that. This is something we discussed in out Med Surg II class and again are discussing this in our newly added Nursing Issues as a direct reflection of this change. Our instructor doesn't believe that a BSN mandate is possible right now with the current shortage, but she stated there are other ways to accomplish this BSN requirement. For example the NCLEX change. I am new to this site. I hope not everyone carries the same derogatory response as you did. Must say it makes me hesitant to respond. I gain so much from everyone’s opinion so I shared what little experience I have in regard to the subject!

I think you're falling into a stereotype here, and one that seems to be categorically wrong. It's been shown time and again that while there may be a school exception here or there that has clinical requirements far above the norm, in reality, ADN and BSN students get about the same amount of actual clinical time. Now and then you'll see someone post about how their ADN or their BSN program had TONS more clinical time than the other guy but for the most part, the programs both feature about the same requirements to sit for the same NCLEX-RN.

:idea: I am only speaking from what I have been exposed to. I did use traditional in referring to ADN programs which may have been a trigger for that response. I will graduate in May and comparing the clinical hours I have not done, but curriculum related to ADN and BSN there are several classes that are related to management. These classes may not have management in their title; however they are geared toward enhancing management skills within the nursing profession. Our school does a lot of observations and many times I have been there with a BSN student. We have discussed their program and they shared that their first two years are prerequisites and then their final two years are clinical. They do a lot of observations with management and get various types of clinical experience. The clinical that we have are bed side clinical. The observation's I have are related to different specialties. This nursing issues class is the first class where we actually have a practicum and we set up our own clinical, which consists of management positions. I do not mean to stereotype, I am really just sharing what I have been exposed to. I will pay closer attention to how I word my response. My posting is only to share. I can't even say I am green yet, I am just starting. One thing's for sure rather a RN has a BSN or ADN degree the person in the position truly makes the difference.

My understanding is that each state has their own requirements in regard to the number of clinical/class hour requirements? Is that correct? Each school can go above but not below those requirements. For example my school added this Nursing Issues class, which is not required by the state, but in order to help students pass the NCLEX they added it. In the BSN program I applied for the entire program is online and I set up my own clinical's. The tests are taken at the University and that is the only time I am required to actually appear on campus. Has anyone obtained their BSN online and if so what did you think?

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
:idea: I am only speaking from what I have been exposed to. I did use traditional in referring to ADN programs which may have been a trigger for that response. I will graduate in May and comparing the clinical hours I have not done, but curriculum related to ADN and BSN there are several classes that are related to management. These classes may not have management in their title; however they are geared toward enhancing management skills within the nursing profession. Our school does a lot of observations and many times I have been there with a BSN student. We have discussed their program and they shared that their first two years are prerequisites and then their final two years are clinical. They do a lot of observations with management and get various types of clinical experience. The clinical that we have are bed side clinical. The observation's I have are related to different specialties. This nursing issues class is the first class where we actually have a practicum and we set up our own clinical, which consists of management positions. I do not mean to stereotype, I am really just sharing what I have been exposed to. I will pay closer attention to how I word my response. My posting is only to share. I can't even say I am green yet, I am just starting. One thing's for sure rather a RN has a BSN or ADN degree the person in the position truly makes the difference.

Your post was fine, if that's what it is like there.

People, other than yourself. tend look at the surface and make a judgement about BSN programs. Yes, the BSN programs have courses in ethics, management, research, etc. But they still have fundamentals, med-surg, pysch., and ob and have clinicals in all these areas. Yes, they have clinicals in public health, management, doctors offices, but they also have many hours in the hospital learning the basics - how to pass meds, start IVs, etc. The nurse I precepted Wednesday had a clinical with me in med-surg and the next day had to give a presentation in a clinic. People tend to block out the many hours of med-surg and say "see, BSNs get no real clinical experience and not geared towards the bedside." Which is not true, which is why some of us were quick to get defensive and I apologize for that.

(I'm also just as quick to defend those who stereotype ADN programs as just a two year program that doesn't stack up next to a BSN's. My opinion, for what is matters, is they both prepared nurses equally as entry level bedside nurses. ADN is not a two-year program, but the difference between an ADN and a BSN isn't just a few courses in management.)

I realize it's different in different areas. I feel sorry for the BSNs in your area, because no one is going to hire them into management without bedside experience and it sounds like they aren't getting that training.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
My understanding is that each state has their own requirements in regard to the number of clinical/class hour requirements? Is that correct? Each school can go above but not below those requirements. For example my school added this Nursing Issues class, which is not required by the state, but in order to help students pass the NCLEX they added it. In the BSN program I applied for the entire program is online and I set up my own clinical's. The tests are taken at the University and that is the only time I am required to actually appear on campus. Has anyone obtained their BSN online and if so what did you think?

That's correct. Also many accrediting agencies such as the NLN have clinical hour requirements as well, both for ADNs, BSNs, and ADN to BSN.

Your post was fine, if that's what it is like there.

People, other than yourself. tend look at the surface and make a judgement about BSN programs. Yes, the BSN programs have courses in ethics, management, research, etc. But they still have fundamentals, med-surg, pysch., and ob and have clinicals in all these areas. Yes, they have clinicals in public health, management, doctors offices, but they also have many hours in the hospital learning the basics - how to pass meds, start IVs, etc. The nurse I precepted Wednesday had a clinical with me in med-surg and the next day had to give a presentation in a clinic. People tend to block out the many hours of med-surg and say "see, BSNs get no real clinical experience and not geared towards the bedside." Which is not true, which is why some of us were quick to get defensive and I apologize for that.

(I'm also just as quick to defend those who stereotype ADN programs as just a two year program that doesn't stack up next to a BSN's. My opinion, for what is matters, is they both prepared nurses equally as entry level bedside nurses. ADN is not a two-year program, but the difference between an ADN and a BSN isn't just a few courses in management.)

I realize it's different in different areas. I feel sorry for the BSNs in your area, because no one is going to hire them into management without bedside experience and it sounds like they aren't getting that training.

Thanks for the information. Every time I read these postings I begin to understand more about why this is such a heated topic. At the school I attend you do hear a lot about BSN students not knowing anything when it comes to floor nursing and vice versa for my BSN friends about ADN students, referring to ADN students as less qualified than they are because of the Community College quality of education. I am a pretty gray area person. From what I have been exposed to the BSN's do get bedside experience but they also get other experience on top of that. I was able to observe at a Cancer Clinic. While I was there a BSN nursing student was working there. When I say working there I mean she was doing her clinical experience but very much so by herself. I didn't realize she was a student until we all went to lunch. I thought she was a staff nurse and she still had one year until she graduated. When I think about "leadership skills" I think about being able to do tasks independently and using critical thinking skills to get goals accomplished. In my ADN experience we did our care independently but we had an instructor available to us all the time. In order to give out medications we had to discuss them with our instructor and all IV meds required the instructor to be present. Yes this is a good practice and it allows me to feel safe about providing safe care for my patients, but it also has negative impacts. The BSN students I have been exposed to did have that same instructor experience but then they also get a lot of independent time to perform tasks. I feel like that gives them an edge in reference to gaining critical thinking skills. The same nurse at the cancer clinic shared that she also takes care of several patients at a time. My clinical experience consisted of one to two patients and we had two days when we acted as a team leader with four patients along with another student. My ADN degree was definitely more than a two year degree and very challenging.

I am excited to gain more knowledge to be able to provide better care to my patients. My goal is to work towards Nurse Practitioner, which is also offered online. I must say that the model I observed at this rural hospital had a great appreciation of educational levels and experience. The BSN nurse had several roles they could step into as did the ADN and diploma nurse prepared. However the PCC role required at least a BSN degree. The D.O.N expressed that BSN prepared nurses fit this role based on the skills the acquired via school in reference to managing patient care and the ability to educate their patients. At first I was sort of offended but what she was saying did have value. She went on to share that BSN prepared nurses get education beyond ADN students in areas that enhance critical thinking skills and communication skills. The PCC role literally follows the patient from admission to whatever unit until they are discharged. The PCC manages the care throughout the entire stay and plans care accordingly. The PCC I followed met with the doctor and did rounds with him and then suggested ways to care for the patient, made outside contacts related to patient care and communicated with the staff RN about plan of care. The staff RN's are ADN nurses, BSN nurses, and diploma. This model was a great experience. The idea behind this model of nursing relies on education and experience for each defined role. The BSN nurse could step into most RN positions, however RN's that did not have at least a BSN had some limitations. The PCC role was interesting and striked an area of interest for me. They were internal case managers. The PCC nurse shared that she felt that her extra education was appreciated here and at other hospitals she did not always feel like her education was appreciated. What is your take on this model?

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 :twocents: worth.

this to me sounds like the current UK degree over diploma as the only entry for registration

if you choose the diploma program u can advance to the degree after it just a case of making up the extra modules

I don't agree with the point that if BSN is required for entry to practice, many people won't choose nursing. I think there is another pool of people who want to choose nursing if BSN is the minimum entry level to practice - people right out of high school.

I got a bachelor's degree in another area before nursing, and the reason for not choosing nursing right out of high school even though I was very interested in becoming a nurse was that one can become a nurse only with 2-3 years of education. Some just simply won't consider nursing if people without a bachelor's degree are also allowed to do the exact same work.

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