ADN or BSN: What's the Big Deal?

[BostonFNP, APRN]

This should be an interesting discussion :)

If we are speculating on the shift mine is that this represents a blend of employer preference in a low-demand market, gentrification, and the exponential increase in APN programs.

The article mentions Magnet and IOM recommendations but steers away from the growing body of research on patient outcomes, whether it factors into this or not, it not clear.

[traumaRUs, MSN, APRN]

As CMS and other governmental bodies impose on nursing regulation, we are going to see more standardization (hopefully) in education, licensure and certification (for APRNs). The Consensus Model is also paving the way....

[AntonioErvin]

Let me just say that I have seen great ADN nurses, and horrible BSN nurses, and vice versa. IOM 2020 initiative is what is directing the BSN movement. In order to be a "MAGNET" Hospital you must have a nursing staff that has @ least 80% BSN. I personally think all nurses should have @least a BSN, because it shows that all nurses have the same schooling.

[Watermaster]

Always a horse race, ADN v BSN...

I have a very impressive academic pedigree; however, I was called to care sometime after earning my BS and MS in the 'hard sciences'. Certainly the hierarchy in nursing positions and salaries follow higher academic accomplishments; that is inarguable and perhaps appropriate in many situations. My (insignificant) opinion is that only the insecure argue about which individual academic accomplishment is superior to others.

Every one of us can learn something from the person next to us regardless of their academic pedigree. I too have a lot to learn in this profession and appreciate the sharing of knowledge when appropriate. Timing being an issue for me the ADN path was the best choice to enter the profession of caring for those who are unable to care for themselves. I am quite content, but will likely pursue still higher academic accomplishments as I would in any profession while on life's path.

[Maerzie]

I was fortunate in graduating before all the foolishness occurred. I had my education in a hospital-based Nursing School, and received my nurse diploma, becoming a Registered Professional Nurse AFTER I passed my state boards, which are very high requirements in Wisconsin and California. My nursing school actually staffed the hospital, in those days, and, because of all the varieties of hands on, supervised experience, turned out the very best of nurses. I did, later, go on to get my BSN, where more technical knowledge is learned (and got an enormous 10 cent an hour raise, LOL!), but hands-on, supervised, multi-disciplined practice and learning STILL turns out the best nurses, right out of the gate.

My very FIRST job was Charge Nurse, on a 52 bed surgical floor. Nowadays, new nurses don't have the knowledge OR the experience to want to be, or accept, any role of being "in charge". At one position, I frequently had several new RN's, fresh out of school and with their new registration, and one, with her BSN, had never even inserted an N/G tube, NOR a Foley catheter, while another, a graduate of an ADN program, did not know the DIFFERENCE between an N/G tube or a Foley catheter! This ignorance should NEVER be put out onto the market, as an R.N.! That is VERY POOR schooling and a shame to their teachers, that they allow such neglect, causing so much fear and insecurity in a new nurse, who trusted that her school prepared her/him well! Practice and experience, including experience of being in charge of a department, is ESSENTIAL to instill the confidence needed by every single nurse. If a nurse feels ignorant and inexperienced, he/she is much more vulnerable to error, which, in nursing, could cause a fatality! No RN wants to have to go to a superior o learn all these things she SHOULD have gotten competence in, as a student, but, these days, there are THOUSANDS (or more?) of these "nurses" out in the market, making nearly the same salaries as the competent, experienced nurses.

There is ZERO excuse for the inferior schooling, allowed to claim certification by the NLN, to exist anywhere. It is not the letters, RN, ADN, or BSN, which make the difference. Certification of nursing programs is being handed out too easily, obviously. It's the quality of the school and the amount of supervised experienced skills included in the program. Far too many include only a token amount of hands-on, supervised experience, not NEARLY enough to put anyone's LIFE into those hands. This is NOT the fault of the graduates. It is the fault of the inferior "pancake schools" that are usually sloppily "certified?", and are in a hurry to turn out huge numbers of graduates, without the essential experience. After all, we DO need the nurses, and there is a LOT of MONEY involved! The more corners that are cut, the more inferior the education of the graduate nurses will be. This is,sadly, symptomatic of the current growing disease in our country: GREED! Money before quality!

[RRTNurse]

The BSN argument of "better care" was predicated on flawed studies of patient outcomes without taking into consideration confounders. It was adopted quickly by Administrators of the "Magnet Hospital" in showing hospitals that were encouraging their RN's to reach higher academic goals and thereby were showing themselves to be "employers of choice" amongst RN's and thereby improving outcomes and patient experience. Medicare and Medicaid then seized upon it and tied Magnet (and therefore academic achievement among RN's) to reimbursement.

BSN is about the money. In more ways than one. Some see through the facade of business. #Patientsbeforeprofits

[CanadianRN2017]

IMHO, it really does not matter ADN/BSN unless you plan on going into management or research. The BSN program where I live does not even require the students in the program to take a pharmacology course... they will learn as they go I was told by one of the instructors. Really? Just looking at the "hands on" clinical experiences, the ADN students appear to have more patient/bedside time than the BSN students... BSN students are too busy doing research and other things. Not that research is a problem... please don't get me wrong, someone has to be willing to do it... I think each has a role to play, and the letters after RN should not make any difference in excellent patient care.

Let's just try and support each other to do the best job we can.

[umbdude, MSN, APRN]

It's becoming quite easy for ADN nurses to get BSN these days (many ADN programs in my area are partnering with schools for RN-to-BSN), and maybe that partly explains the decrease of ADN% as more ADN nurses go back to get a BSN. I don't see any difference between ADN and BSN in delivering patient care. It always depends on the individual, not the type of program.

[MunoRN, RN]

I think maybe the author misunderstood the Villanova article, Magnet does not actually require 50% or more of staff nurses to have a BSN, it only requirement is for management staff.

I think it's important when discussing this to understand evidence on outcomes, what steps have been taken since these studies, and the rationale behind the IOM recommendations, all of which are commonly misunderstood.

The studies that show differing outcomes between Associate and Bachelor level graduates looked at nurses who graduated from these programs in the 70's, 80's, and 90's, and as a result of these studies there has been a shift in Associates programs to adopting BSN curriculum, since that is the presumed source of the differing outcomes. There have been no studies to evaluate the effect of this change, so we can't really say if current ADN grads are likely to produce poorer outcomes in their patients. Assuming the same variations in outcomes still exists despite these changes would be like if you found a patient was hypertensive, so you gave an antihypertensive, then without rechecking the BP just assumed they were still hypertensive.

The IOM didn't recommend that we no longer utilize ADN programs, and given the negative effect that would have on nursing education that would be counterproductive if our goal is to improve nursing education. They suggested moving towards a more standardized curriculum with ADN programs adopting BSN curriculum, a process which is already well underway. They also suggesting achieving these BSN goals by simply renaming ADN programs as BSN programs (the would also require ADN students fulfill their remaining general credit requirements that their pre-requisites don't cover), in theory this could be done by simply making current ADN programs satellite programs of current BSN granting universities. As it turns out, it's relatively easy make ADN program satellite BSN programs in terms of curriculum, but convincing BSN granting institutions to change from the current RN-to-BSN programs they offer isn't all that easy since this would typically result in a loss of income. But since the differences in outcomes these studies found were likely not due to the three letters that describe someone's education, but rather the substance of the education itself, there hasn't been a significant push to force that issue.

[BostonFNP, APRN]

CanadianRN2017 said:

and the letters after RN should not make any difference in excellent patient care.

But what if they did? Would it change your impression?

umbdude said:

I don't see any difference between ADN and BSN in delivering patient care. It always depends on the individual, not the type of program.

In small sample sizes the variance within individuals is clearly greater than between degrees, this is was large studies are built for.

[Kyburgoo]

This topic just makes my blood boil. The letters after your name mean absolutely nothing if you can't handle what's put in front of you. For those that have a burning desire to get into management or further their nursing, go for it! There aren't enough good bedside nurses anymore, regardless of whether they have an ADN or BSN. Instead of looking at who has what initial after their name, how about looking at nurse to patient ratios and how much is being put on nurses these days. No nurse can do good bedside nursing with the ratios that are out there. Does that make them a "bad " nurse? Not necessarily. Some people have a ton of book smarts and not a lick of common sense.