ADN/ASN RN vs BSN RN

[libran1984, ASN, RN]

As an LPN working in a suburban ED, I perform complex tasks like IV therapy, blood transfusion, IVP medication administration and of course I utilize my own critical thinking skills. All of this is granted under my state's board of nursing practice act and of course with the hospital's permission. I feel well prepared to cross over into my local community college's LPN to ASN RN program (just waiting on the acceptance letter due in October). I have several concerns that I wish to pose to the general RN community.

With no further shortage of nurses, many hospitals are stepping up the entry point for the RN to be a BSN. I read on these forums quite often how much discontent this idea sews within the community. I wish to ask many of you RNs to honestly reply to this thread with your feelings and experience.

1. Do you find the care an ADN provides to be substandard to a BSN, please explain?

2. What specific skills are learned in a BSN program that wouldn't be learned to a greater extent on the job?

3. Do you prefer to work with an all BSN staff and why?

4. Is the BSN more equipped to deal with the technology found in a hospital setting and if so, please explain?

5. Is it fair to pay a BSN more money than an ASN? Is it fair to pay a BSN more money than an ASN who already posesses a Bachelor's in a non-nursing field?

6. What effects are the ADN/ASN RNs feeling from their current hospital administration to obtain a BSN?

7. Do many ADN/ASN RNs feel their jobs will eventually only reside in LTC and other ECFs, effectively replacing the LPN.

8. Many ASN/ADN RNs still hold a Bachelor's degree in a non-nursing field, should they still pursue a BSN?

9. Is an ASN/ADN more suited to deal with lower ESI acuity level patients, such as level III or lower while a BSN deals more with level II and I.

10. What are community colleges and ADN/ASN RN's actively doing to ensure the 2 year RN remains part of this nation's healthcare system (besides passively complaining online?).

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I pose these questions for fear that not long after I graduate, despite my amazing LPN ER experience and my soon to be even greater RN ER experience, I will be ill-equipped for this ever expanding world of nursing. I believe an LPN and RN should strive for continued education, but do not feel it needs to be expressed by an overly expensive 4 year degree. I feel community colleges adequately prepares a person for the RN experience. I feel even more so that an LPN who becomes an RN is to be more prepared for the RN experience than a new grade BSN or ASN.

I asked my manager why this attitude of BSN>ASN exists during a performance appraisal (which I got a 4% raise - the max possible raise yay). She said the BSN is more prepared because when she was going through her BSN program she was practically required to spend a minimum of eight hours creating care plans, creating drug cards, and using NANDA approved nursing Dx's. She said that thanks to her BSN training she felt a BSN nurse was more capable of predicting patient outcomes and understanding pathophysiology and etiology.

I refrained from saying anything that LPN school, although it was merely 12 months long, detailed everything she just said.

I just want the RNs to stand up for their education level. I want them to fight against this new establishment of BSN only.

I'm just sick of always being on the lower end of the totem pole. Half of the LPNs I work with possess a higher degree than their RN counterparts but have only the LPN license in the field of nursing. Still we are treated as substandard nurses by many RNs.

One friend has an MSN and says she's equally frustrated for now she is contantly egged on to obtain her DNP.

One thing is for sure. A nurse is not a nurse. Its all about classification and I fear one day in the foreseeable future the ASN RN will go the way of the LPN, more scarce and less desireable in the acute care setting.

[NayRN]

First, in my state, LPNs are not allowed to hang blood, do IV pushes, or do an admission physical assessment on a patient. Here, an LPN in the ED is unheard of. Also, where I am, ADN RNs are the majority. I have been working on my BSN, and I also hold another bachelors degree. My nurse manager holds an ADN.

It makes no difference to me what degree my coworkers hold. I have worked with great LPNs and substandard BSN-RNs. To me, being a great clinical nurse has more to do with common sense, intelligence, adaptability, and temperament than anything else.

In my experience, what I gained from my BSN program after I got my ADN was a more in depth study of nursing theory (terribly boring), a more advanced pathophys and physical assessment class, an understanding of evidence-based practice and research, a more thorough understanding of nursing laws and ethics, and an increased aility to network with other organizations due to the process of finding a place to do clinical hours, setting up those clinical hours, and creating/completing a project within that clinical experience. I liked the independence involved in the program. Some of it was boring, but some of it I do use.

The evidence-based practice course in particular helped me to understand some things that I have been able to apply to my job. For example, my hospital uses a fall risk scale that they modified from an evidence-based one. I have been trying my best to convince them that from a practice standpoint and a legal standpoint it is best to use a validated scale to predict a patient's risk for falling, unless they would like to fork out the money to clinically trial and validate their own scale. So far, no luck, but I think that maybe with my gen ed and clinical skill based ADN program, I might not have been willing or able to take on this challenge as confidently.

There was no pressure from anywhere for me to go on with my schooling. I am getting my BSN more as a personal goal than anything else. As far as the pay differnce goes, I really have no comment-I will not get a raise when I do acquire my BSN, and since I hold a higher degree than most of the managers in the hospital, I don't worry that I will be phased out at this time. And I can't imagine why a BSn would be better with technology, unless perhaps more BSNs are earning their degree online and are therefore exposed to it more.

I also do not understand the debate about holding a bachelors degree in another field, and that having anything to do with the decision to get a BSN. It's 2 different worlds. Only my gen ed classes were the same for both of my BS degrees. A business major has absolutely nothing to do with a nursing major, with the exception of some leadership training and a required ethics course. Writing business plans and learning accounting practices vs. having to complete a 90 hour community nursing clinical and ponder health care specific ethics is apples and oranges. So no, if a BSN is required, it will not do to say "but I have this history degree-does that count?" I doubt it.

Does that help?

[sapphire18]

If you're that worried about it, you should do something about it and go for the bachelors degree. I don't see ADNs being pushed out anytime soon, however. Harder to find employment? In some areas, yes. In others, no. The only thing this thread is going to accomplish is starting a debate and stirring up some emotions, unfortunately.

[DatMurse]

While I am only a student I was told that the BIGGER HOSPITALS in Houston are pushing out ADN/ASN RNs. I have also HEARD of this about other MAJOR cities. Now it is only from what I HEARD

[sannikemi]

Dear Libran,

I feel your pain. I was an LPN for thirteen years and worked in the hospital for eleven years. The ill treatment l received during my LPN years was truly heartbroken. I went back for my Bachelors and in my last semester, just two months to my graduation, I was forced to either work as CNA or resign. I begged my manager and my nursing vice president to allow to stay on my job for the remaining two months that l needed to graduate but they refused. I had to use my PTO for educational leave so l can keep my job after graduation. Two months after, I obtained my BSN and when l returned, l was denied orientation into my new role. I was told that l do no need orientation because l have an experience. The worst of

it was my pay was increased by only $4/hr. I believe it is all about magnet status. Personally, l was glad that l was challenged as it was a drive for me to professionally upgrade myself. I am glad I have my BSN because it gives me job security. I will advise you to do the same because, you do the same task and get paid less and your job is threatened. My manager said, the attack was not on me but my position as an LPN. I am now enrolled in my master's program and if God wills, l am taken it to the "gold star". Goodluck in your future plan. It is worth it.

[applewhitern, BSN, RN]

The ADN prepared nurse takes all the courses necessary to pass NCLEX and obtain an RN license, actually the same test the BSN takes. In regards to what your manager said, when I was in the ADN program we also did in-depth care plans, Nanda-approved nursing diagnosis, and drug cards. We also took pathophysiology, microbiology, etc. When I went back for the BSN, there was very, very little difference. I had to take a couple more humanities and research, but nothing significantly different than the ADN. I think the best thing is simply experience. No, I don't think BSN's should be paid more, when they are doing the same job as the ADN. The push for BSN is not everywhere yet. My DON has an ADN; my cousin is also a DON with an ADN. The hospitals here are requiring a "certification" in the area in which you want to work, but are not requiring a BSN. From what I have seen in my 23 years experience as an RN, an ADN is just as prepared to take any acuity patient as a BSN is. As a matter of fact, I learned far more in my ADN school than I did in the BSN, and we did more clinical hours than most BSN classes do. I just get so tired of the ADN vs. BSN debate! I have both and I have to say my ADN education was superior than the few extra fluff classes I took in the BSN program.

[DatMurse]

The ADN prepared nurse takes all the courses necessary to pass NCLEX and obtain an RN license, actually the same test the BSN takes. In regards to what your manager said, when I was in the ADN program we also did in-depth care plans, Nanda-approved nursing diagnosis, and drug cards. We also took pathophysiology, microbiology, etc. When I went back for the BSN, there was very, very little difference. I had to take a couple more humanities and research, but nothing significantly different than the ADN. I think the best thing is simply experience. No, I don't think BSN's should be paid more, when they are doing the same job as the ADN. The push for BSN is not everywhere yet. My DON has an ADN; my cousin is also a DON with an ADN. The hospitals here are requiring a "certification" in the area in which you want to work, but are not requiring a BSN. From what I have seen in my 23 years experience as an RN, an ADN is just as prepared to take any acuity patient as a BSN is. As a matter of fact, I learned far more in my ADN school than I did in the BSN, and we did more clinical hours than most BSN classes do. I just get so tired of the ADN vs. BSN debate! I have both and I have to say my ADN education was superior than the few extra fluff classes I took in the BSN program.

In no disrespect to you, but I do believe that BSNs should be paid more. we do have more schooling in core classes. That is how the rest of the workforce is in the world. People with 2 year degrees do not get paid as much. Even though the knowledge is irrelevant to the situation. I dont see how history and a computer class will make you a better nurse.

I also do agree that nursing knowledge of bsn vs adn is about 5 more classes based on leadership which experience can easily overshadow. At the same time you are comparing a 2 year nursing program to a program which is just merely an upgrade of a degree. So your ADN program(which is probably 16-18 classes) will be teaching you more than your BSN program(which is only a few leadership courses and maybe something else).

In no way am I trying to bash Associates but in the workforce it showed that the person strove for a more advanced degree.

[llg, PhD, RN]

1. Of course there are terrific individual people who will excel in their jobs regardless of their educational level -- and other people who will perform badly in their jobs regardless of their education. That is a given. You can't make policy based on individual who are either significantly above or below average. Similarly, there are particular schools that are either above average or below average. Again, you can't use the existence of those exceptions to justify saying that all education programs are "the same" in that they all prepare nurses with the same capabilities. Policy needs to be based on the bigger picture, the typical course content, the typical level of abilities, etc. And the NCLEX is just a test that shows a bare minimum knowledge level for safe practice. It doesn't measure different levels of practice.

2. I support the nursing profession's efforts to raise the standard of education for our profession. That includes encouraging nurses to pursue higher levels of education and it also includes raising the standards within academic programs. There are a lot of mediocre programs out there churning out graduates that have added letters behind their names, but who have not learned a lot in their programs. If someone says they didn't learn anything in their BSN completion program, either they didn't try very hard or they went to a bad school. Once again, those individual cases should not determine policy.

3. For nurses who have gone to high quality educational programs ... I definitely see a difference in the abilities of the ADN grad and the BSN grad. Most BSN grads are more able to locate and understand the nursing literature, making them more productive as team members in problem-solving. They are more comfortable reading the research literature and interpreting it to apply to practice. I find them better-prepared to serve as leaders -- to help develop and evaluate programs, to plan and evaluate educational programs, to develop policies, etc. I also find that most BSN grads have a better grasp of community health, and can think about "population nursing" in addition to the care needed by one particular patient -- and they are more likely to incorporate public/community health concepts into their care even if not working in a community health setting.

4. The physical skills of nursing and the day-to-day of basic bedside nursing are only a portion of the "practice" of nursing. While I find that ADN-prepared nurses are capable of fulfilling those basic functions, I find that a higher percentage of the BSN grads are better-prepared to go beyond those basic tasks to fulfill a broader role that nurses are capable of having. Sure, some nurses without BSN's are capable of that, too. But you can't make policy on individual cases. You have to consider the facts of what was included (and excluded) in each curriculum and the preparation that most graduates of each type of program received. Most BSN's receive an education preparing them for a broader role and larger responsibilities than is typically provided by most ADN programs -- the increased general education component, the leadership course, the community health, the theory, the research, etc. add up to something worthwhile.

5. Some of my best friends have ADN's and have not yet gone back to school. But most of them are starting to go back as they realize that they lack some of the knowledge that their colleagues have. Many have confided in me that they don't always feel comfortable at group meetings as the other nurses are discussing things they don't fully understand. They don't have confidence in some of their abilities because they haven't taken the research courses, theory courses, community health course, etc. So they defer to others rather than being a full contributer to the group. They are tired of feeling inferior in their knowledge and are going back to school -- not because they are being forced to in order to keep their jobs -- but because they FEEL and SEE that they lack knowledge.