ADN Nurses Being Forced to go Back to School?

[tnbutterfly - Mary]

New Rules Send Upstate Nurses (in S.C.) Back to School

Hospitals across the country are now mandating that nurses with associate degrees obtain a Bachelor of Science degree.The change went into effect July 1 for nursing staff at Greenville Health System. The organization anticipates 300 nurses will be required to sign a Memorandum of Understanding stating that they will return to school for a BSN degree within four years.

The change in education requirements for nursing staff is based on a recommendation from the Institute of Medicine. The non-profit advisory group wants 80 percent of all nurses to have a four-year degree by 2020.

"We hope for the patient, it will provide enhanced care," according to Judith Thompson, CEO of the South Carolina Nurses Association.

One rationale behind this is that since the role of the nurse in the hospital is changing and becoming more complex, more education is needed to keep up.

What do you think about making nurses with years of experience under their belts to go back to school or risk their jobs?

[brandy1017, ASN, RN]

The educational requirements are increasing in just about every other professional field and bachelor degrees are becoming the norm. Heck, many companies even expect that their admin assistants and receptionists to possess a 4 year degree. I do not see why we should not expect the same of nursing, or be uninterested in elevating the status of RN's. I have two bachelor degrees, am finishing up my master's in Public Health, and will start my BSN in January. I anticipate that my education will make me more aware of issues facing entire healthcare systems of delivery rather than just my world of nursing. It will put me in a position to be a stronger advocate for my patients, my fellow RN's, and provide a better opportunity for my input to be valued as healthcare is restructured.

While not everyone has the same ambitions I have, I feel strongly that RN's should welcome higher levels of education if for no other reason than to have "you only have an associates" no longer be a source of disrespect or derision from physicians and administration.

So how are you paying for all these degrees? Are you independently wealthy or are you planning on paying back student loans for the rest of your life? Why would you get a MA public health first and then a BSN, seems backwards to me and very expensive! I have no intention of giving the greedy college/university system any of my hard earned money if I can help it. They have taken enough already!

[brandy1017, ASN, RN]

The educational requirements are increasing in just about every other professional field and bachelor degrees are becoming the norm. Heck, many companies even expect that their admin assistants and receptionists to possess a 4 year degree. I do not see why we should not expect the same of nursing, or be uninterested in elevating the status of RN's. I have two bachelor degrees, am finishing up my master's in Public Health, and will start my BSN in January. I anticipate that my education will make me more aware of issues facing entire healthcare systems of delivery rather than just my world of nursing. It will put me in a position to be a stronger advocate for my patients, my fellow RN's, and provide a better opportunity for my input to be valued as healthcare is restructured.

While not everyone has the same ambitions I have, I feel strongly that RN's should welcome higher levels of education if for no other reason than to have "you only have an associates" no longer be a source of disrespect or derision from physicians and administration.

I've never had a patient, supervisor or doctor ask me about my degree. Also never heard anything disparaging from any of them either about ADN RN's. I feel proud of myself and perfectly fine with my ADN and if I wanted a bachelors degree I could easily get one. I was one semester short of a liberal arts degree when I realized it wouldn't do me any good in the job market and I didn't want to be one of the many people working with a bachelors degree in a low paid secretarial job. Ironic that I make more money with my ADN than many friends I know that have a BA degree!

[BrandonLPN, LPN]

But hospitals are all about control and they love telling their employees what to do like forcing vaccinations on everyone! Too bad for the ones that get GB from it!

I don't think its about control, in the case of the article of the OP, I think its about taking advantage of a weak economy and bullying employees who don't have a lot of options in said economy. (And FWIW I respectfully disagree with your views on vaccination)

I can understand a hospital implementing a policy where all new RN hires are required to have a BSN. I can buy that they are implementing such a policy out of a sincere belief that it is in the best interest of their facility and their patients.

What I do NOT buy is the claim that forcing current employees to go back to school or be fired is driven by anything other than opportunism and greed.

They KNOW many of these older nurses are not in a position to go back to school. They KNOW many (if not most) will not upgrade by the deadline. They KNOW most of the nurses this policy targets are nurses with high senority and, thus, at the top of the pay scale. That's kind of the point. What a great way to eliminate a segment of your staff that recieves high compensation.

Do any of the BSN nurses on this board who are currently working at the bedside really think that the ADN/diploma RNs who work beside them are a danger to their patients? To the point where they ought to go back to school or get FIRED? I've never heard any BSN nurse I've worked with anywhere, ever, say they feel unsafe or concerned working with an associates prepared nurse. And I work with some crusty old broads who are not afraid to speak their mind about anything.

The only place I have been exposed to nurses saying they feel ADNs are unsafe, or that ADN degrees are a source of "disrespect" from MDs is here, on allnurses.com.

[newohiorn, BSN, RN, EMT-P]

You can "believe" what you want, but the research does not support your hypothesis.

I did not state a hypothesis, which would imply that I am conducting a study on this topic. I stated what I believe, my opinion.

As to what the research shows, Aiken appears to be the primary researcher in this area and even she is quoted as stating there is an association between better outcomes and higher numbers of BSN nurses. It does not show a causative relationship. It is certainly reasonable to suppose that a hospital that hires more BSN nurses may also have better management in place, better physicians or many other reasons that their patients may have better outcomes that may or may not have to do with BSN nurses. A hospital may decide to hire more BSN nurses while simultaneously starting a program to reduce infection, etc. There are a lot of factors in play besides BSN nurses.

I do not discount the idea that BSN prepared nurses may very well be the reason there are better patient outcomes but this has not been proven to be the cause. If that is the case and that is why the hospitals, the schools and the AACN are pushing for more education I would have no problem with it, but I still believe there are other factors at play, mainly money. Just my opinion.

From Robert Wood Johnson Foundation website (the underlines are mine):

Building the Case for More Highly Educated Nurses - Robert Wood Johnson Foundation

Nursing is the only health profession with multiple pathways to entry-level practice. Three leading health scientists affiliated with the Robert Wood Johnson Foundation (RWJF) are among those who have shown that pathways that lead to the bachelor's degree in nursing (BSN) and higher may improve patient outcomes.

Hospitals that employ larger numbers of BSN-prepared nurses have lower patient mortality rates, according to Linda Aiken, PhD, RN, FAAN, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. A 10-percent increase in the proportion of nurses with BSNs was associated with a 7-percent decrease in patient deaths, she found in a study published in February in the Lancet.

"Is there any reason to believe that the proportion of nurses with bachelor's degrees is associated with better outcomes? The answer is 'Yes,'" Aiken said in an interview.

And she has more than a decade of research to prove it. In 2003, Aiken found that patients in hospitals in Pennsylvania had "a substantial survival advantage" if they were treated in hospitals with higher proportions of BSN-prepared nurses. That groundbreaking study, published in the Journal of the American Medical Association, found that a 10-percent increase in the number BSN-prepared nurses reduced the likelihood of patient death by 5 percent.

The link between nurse education and patient outcomes was confirmed in 2011, when Aiken published a study in Medical Care that found that a 10 percent increase in the proportion of BSN-prepared nurses reduced the risk of death by 5 percent. In 2013, Aiken co-authored a study in Health Affairs that found that hospitals that hired more BSN-prepared nurses between 1999 and 2006 experienced greater declines in mortality than hospitals that did not add more BSN-prepared nurses. "We've established this association over and over again," she said. "If hospitals really want to improve care, they should hire more nurses with bachelor's degrees.

[roser13, ASN, RN]

The educational requirements are increasing in just about every other professional field and bachelor degrees are becoming the norm. Heck, many companies even expect that their admin assistants and receptionists to possess a 4 year degree. I do not see why we should not expect the same of nursing, or be uninterested in elevating the status of RN's. I have two bachelor degrees, am finishing up my master's in Public Health, and will start my BSN in January. I anticipate that my education will make me more aware of issues facing entire healthcare systems of delivery rather than just my world of nursing. It will put me in a position to be a stronger advocate for my patients, my fellow RN's, and provide a better opportunity for my input to be valued as healthcare is restructured.

While not everyone has the same ambitions I have, I feel strongly that RN's should welcome higher levels of education if for no other reason than to have "you only have an associates" no longer be a source of disrespect or derision from physicians and administration.

Well, I must surely have been living and working on another planet all my life if all of your education and research has proven that here on Earth, physicians give-any-kind-of-damn about how an RN obtains his or her license. Not once has a physician asked about my education. Not once have I or any of my peers (yes, I asked) seen or heard of an MD taking the time to show "disrespect or derision" toward a nurse due to his or her education. And somehow I have managed to obtain a management position in a hugely successful medical practice after only 15 years of practice and only an ASN.

On the other hand, maybe that's what the docs do when they socialize with each other. Yeah, I bet that's where it comes from - at DOCTOR parties, they sit around and derisively discuss the education of the nursing staff at the local hospital!

[VivaLaVespaGirl, BSN, MSN]

Well, I must surely have been living and working on another planet all my life if all of your education and research has proven that here on Earth, physicians give-any-kind-of-damn about how an RN obtains his or her license. Not once has a physician asked about my education. Not once have I or any of my peers (yes, I asked) seen or heard of an MD taking the time to show "disrespect or derision" toward a nurse due to his or her education. And somehow I have managed to obtain a management position in a hugely successful medical practice after only 15 years of practice and only an ASN.

On the other hand, maybe that's what the docs do when they socialize with each other. Yeah, I bet that's where it comes from - at DOCTOR parties, they sit around and derisively discuss the education of the nursing staff at the local hospital!

Roser, I am not attacking you nor am I attacking ADN nurses; I am advocating for the nursing profession. As I stated earlier, my opinion is based on my husband's experience as a hospital executive, the experiences of my ADN nurse friends, as well as my own interviews of a Director of Nursing and a few physicians for grad school project. The fact that you have not experienced a lack of respect from doctors makes me very happy. However, you also have years of experience. Newer nurses coming in don't have that and thus may have a different perspective. I also live in an area where ADN nurses are rarely being hired for hospital positions and are being forced to get their BSN or lost their jobs. My ADN friends are certainly feeling the lack of respect - especially from administration.

Never once did I say or imply that ADN nurses are somehow incapable of development and management. You read into that on your own. Putting "words into my post" does not help make your point - it makes you sound defensive and diminishes what you are communicating to me. What I can say, however, is that it is difficult for me to understand how, in one breath, nurses complain about doctors lack of respect for them, but in the next claim it doesn't happen in order to validate maintaining the two-year degree. It either happens or it doesn't. Pick one - or explain to me the difference. I start my BSN program in January, so I truly want and appreciate the education as it can only benefit me.

I have immense respect for all nurses regardless of their educational background. That being said, I do believe that nursing should be a 4 year degree going forward. I believe very strongly in education and I think it will do a lot to advance the nursing profession. The more educated a workforce is - the more powerful it is.

[brandy1017, ASN, RN]

Never once did I say or imply that ADN nurses are somehow incapable of development and management. You read into that on your own. Putting "words into my post" does not help make your point - it makes you sound defensive and diminishes what you are communicating to me. What I can say, however, is that it is difficult for me to understand how, in one breath, nurses complain about doctors lack of respect for them, but in the next claim it doesn't happen in order to validate maintaining the two-year degree. It either happens or it doesn't. Pick one - or explain to me the difference. I start my BSN program in January, so I truly want and appreciate the education as it can only benefit me. ... The more educated a workforce is - the more powerful it is.)

Personally I have rarely been disrespected by a doctor, most are appreciative and thank you for calling about a problem. There is an occasional bad apple that can act like a jerk, but that has to do with the doctor and not the level of education of the nurse!

If anything some doctors, though certainly not all, are more concerned about NP/PA replacing them as primary care doctors, but that is another story.

I'm sorry I don't believe education makes a person more powerful. Education may make you more knowledgeable, sometimes about esoteric things that are only relevant to jeopardy and it will certainly leave you more in debt! Our educated workforce is finding itself with stagnant incomes and worse benefits and many are underemployed.

Education equals power is a myth. Look at the poor primary care doctors, who are underpaid, drowning in student loans, being replaced by NP/PA with lesser education for the same job. Most can no longer remain independent and find themselves forced to work for a hospital or insurance company. Instead of their education being valued, the govt, insurance and hospitals prefer to hire lesser educated people for less money! Also the working conditions for primary care are insane assembly line conditions. Unions were what brought power, good pay and good benefits to the masses and these are virtually non-existent now.

Back to the BSN, they have no more power over their work environment than an ADN! Most aren't even paid more for their BSN. They have no say over staff ratios. It was the NLN in CA that got safe patent ratios mandated. It will take unions to do this for the rest of the country, because the govt is sold out and it goes against the financial interests of the hospitals.

[roser13, ASN, RN]

" What I can say, however, is that it is difficult for me to understand how, in one breath, nurses complain about doctors lack of respect for them, but in the next claim it doesn't happen in order to validate maintaining the two-year degree. It either happens or it doesn't. Pick one - or explain to me the difference." VivaLaVespaGirl

You are confusing two issues. I did not say that I had never experienced a physician showing disrespect for a nurse. I said that neither I nor any of my peers has ever experienced physicians belittling or disrespecting specific RN's due to their lack of BSN preparation. As I read your post, that is what your research has shown and as I said, it is vastly different from my experience.

[Karou]

Wow, what a heated topic!

For what it's worth, I have never heard a physician ask a nurse if she had an ASN or BSN. I have never heard of it happening either. However, I am a newer nurse with only two years of RN experience, so obviously that doesn't mean a lot.

Once we had a nurse explaining the difference to a physician, and the physicians response was, "you mean there are different levels of nurses? I didn't know that". Interesting. I think nurses care more about degrees than anyone else in the health care field.

I am an ADN employed at a magnet hospital, and as part of the hiring process was required to sign a contract promising that I will get my BSN in three years. I already intended on doing that so it wasn't a problem for me. All new nurses have to sign this contract and I think it is absolutely fair. We knew it when being hired into the position. There are several seasoned nurses on my unit currently enrolled in ADN to BSN programs. There are also several (seasoned) ADN's I work with who have no intention of ever going back to school.

I really don't have a strong opinion on this. I do not feel that a BSN is automatically a better nurse than an ASN (assuming equal experience). It depends on the nurse him/herself. Your education is what you make of it. If you payed little attention in school or didn't participate completely in clinicals then you are less prepared than someone who did. An ASN might have worked three times harder in school than a BSN and be a better nurse because of it.

I do feel that as professionals everyone can benefit from further education. To say that isn't true is blind. I believe that if an ASN is an amazing nurse, he/she will only become even better by obtaining a BSN. Is it necessary? Maybe not. But improvement is always a good thing. I hate the idea of a hospital ever forcing someone to get a higher degree, especially seasoned nurses. If you have been out of school for 15 years and are an excellent ADN, why should you HAVE to go back? Seems unfair to me and I would be upset on behalf of my coworkers if they were forced to go back to school after working for our company for 15 years. Encouragement is fine, but not as a requirement.

I am sorry if I repeat others... I didn't read all of the comments. I also worked 19:00 to 07:00 so please ignore me if I don't make sense! I am about to crash asleep. Anyway, that's just my opinion, for whatever it is worth.

[Esme12, ASN, BSN, RN]

Frankly I am so done with this...it isn't fair to subject senior nurses who have extensive expertise at the bedside back to school and tell them they are no longer worthy employees after busting their behind for 30 years.

I think as nursing goes forward the BSN is the single entry of choice. Will it EVER happen? Not for a while for all of the ADN programs will not let go of the cash cow.

Should SEASONED nurses (20+ years), close to the end of their career, be forced back to school. ABSOLUTELY NOT!

[VivaLaVespaGirl, BSN, MSN]

Frankly I am so done with this...it isn't fair to subject senior nurses who have extensive expertise at the bedside back to school and tell them they are no longer worthy employees after busting their behind for 30 years.

I think as nursing goes forward the BSN is the single entry of choice. Will it EVER happen? Not for a while for all of the ADN programs will not let go of the cash cow.

Should SEASONED nurses (20+ years), close to the end of their career, be forced back to school. ABSOLUTELY NOT!

I absolutely agree with you.

[CT Pixie, BSN, RN]

My facility requires all new hires who are not BSNs to enroll in a RN to BSN program within 1 year of hire and completion of the BSN program by the 6th year of hire. That all started last year when they obtained magnet status . I'm not sure if nurses hired prior to the implementation of this policy have to obtain their BSN or not.