ADN vs BSN Nurses' Competency

NurseSpeedy, ADN, LPN, RN · May 7, 2020

On 5/5/2020 at 1:49 AM, StudentNurseMNUS said:
Hello everyone,
Based on your experiences, do you think ADN nurses are just as competent as BSN nurses straight out of nursing school? I'm attending a four year university to attain my BSN degree and have taken various challenging courses, a majority of which I had to successfully pass to even get into the program. However, my friend attended a local community college to get an ADN and often boasts to me of how easy his prerequisite courses were, since he took them online, and how easy nursing school was since the professors he had were not as rigorous as the ones I currently have. He passed his NCLEX and has been working in a telemetry unit for 5 months now. So is a BSN degree just a longer degree because it is filled with humanities courses and "busy work" nursing courses rather than just the essentials? Is a BSN degree over-preparing students or is the ADN degree not demanding enough? Should ADN nurses even have the same scope of practice as BSN nurses?

Both take the same NCLEX RN exam.

Employment will depend greatly on the job market and what you want to do. I have seen the job market fluctuate over the past 20 years. Employer’s hire what they can find. Experience is a major factor right now in some areas that are getting hit hard. Not a place for a new nurse-of ANY level.

How hard/difficult a program is will depend on the specific school and the student.

My LPN clinicals were literally like a nursing boot camp. Our uniforms were graded before we even hit the floor. We took on an assignment. We didn’t leave a minute early.

My RN classes were 15 years later and more laid back. That school now has an online transition program from ADN to BSN. Most additional courses are on management and community health, along with general ed classes.

londonflo · May 7, 2020

In my 40 plus years of providing formal nursing education, I have taught in diploma, associate degree and bachelor's programs. Students in each program were dedicated, caring and smart. Nowhere will an "easy" program continue to survive. Society and our state governments will not allow a substandard program to continue to graduate nursing candidates for licensure. Just look at the list of nursing programs and their NCLEX rates on your BON site. You will see that following a couple of years of pass rates that are below the national average the following label will be added "closed".

I have learned that human nature sometimes creates a need for individuals to feel superior in knowledge gained or feel that they had an "easier" or "more difficult" time. Often those individuals are quick to cite their perceptions and beliefs, sometimes in a belittling manner. Could we build ourselves up instead? After all it is the year of the nurse -- not the year of the LPN, ADN, BSN, MSN, NP, or DNP nurse. I can add this, thank God for all the nurses we have during this pandemic. Your services were well needed and continue to be needed wherever your practice

LovingPeds, MSN, APRN, NP · May 7, 2020

On 5/5/2020 at 12:49 AM, StudentNurseMNUS said:
Hello everyone,
Based on your experiences, do you think ADN nurses are just as competent as BSN nurses straight out of nursing school? I'm attending a four year university to attain my BSN degree and have taken various challenging courses, a majority of which I had to successfully pass to even get into the program. However, my friend attended a local community college to get an ADN and often boasts to me of how easy his prerequisite courses were, since he took them online, and how easy nursing school was since the professors he had were not as rigorous as the ones I currently have. He passed his NCLEX and has been working in a telemetry unit for 5 months now. So is a BSN degree just a longer degree because it is filled with humanities courses and "busy work" nursing courses rather than just the essentials? Is a BSN degree over-preparing students or is the ADN degree not demanding enough? Should ADN nurses even have the same scope of practice as BSN nurses?

I'm actually not surprised to find this statement from a BSN student. And before anyone gets up into arms, let me explain why. I was fortunate enough to take prerequisite courses from both a community college and a university which offered BSN, MSN, and DNP options. Both offered the same quality undergraduate education with these prerequisites. Do not knock community college courses because they are at state level interchangeable with their much more expensive university counterparts and most of them are taught by master's prepared instructors. Many students who have to pay out of pocket are extremely intelligent in taking the cheaper option for the same outcome. Many of the professors at the university for my undergraduate nursing prerequisites (health assessment, nursing ethics, etc.) stressed the superiority of the BSN over the ADN degree - without exception. So I am not surprised by the bias in your statements. It has in many ways been educated into you.

The difference between the ADN degree and the BSN degree as far nursing goes is rather minute. Both degrees undergo two years of the exact same nursing content and clinical standards as defined by the state BON in order to meet the requirements to take the NCLEX. The difference between the degree is mostly in the prerequisite courses they take. ADN students take basic sciences, English, history, and usually an art or music along with a few electives. BSN students take the same classes with a few more sciences, ethics, statistics, and electives. This usually equates to approximately one year's difference in undergraduate training - all of which is in the prerequisites. Most BSN students take two years of prerequisites and then their two years of nursing classes. Most ADN students complete their basics in the year prior to starting their ADN classes, but many can complete the same basics along with their nursing classes which is why it is considered a two year degree. Both degrees are required to be taught by someone with the minimum of a MSN. I know this because I have taught the same class as an adjunct at both the ADN and BSN level. Imagine that! The same instructor teaching both.

The extra courses are not necessarily "busy work" because they do help lay a foundation to a basic education. However, your ability to read a research paper and extrapolate statistical information is a moot point during a patient code. The basic skills that you need to be a safe and effective nurse are there regardless of program. The ability to critically think (which I think you're associating only with a BSN) is taught in both programs. You have to have the ability to critically think as a novice nurse in order to pass the NCLEX.

Personally, I went the option of ADN because I was in school for the fun at the time. I went back to for my BSN. I've never regretted doing that. I felt like I got more personal attention from my ADN instructors than I did with the BSN instructors who taught my BSN nursing prerequisites. My ADN instructors were extremely encouraging while still holding me to the standard that I needed to be held to. If I was in lab working on a skill, I could pull any one of the instructors into the lab to help me if I needed it. I didn't feel like I had that at the university I attended. I'm not saying that it is that way with all programs. That was just my experience with this particular university at the time. Everyone of my ADN instructors had over 20 years of experience in nursing education, an MSN, and two of them (out of six) were doctorate prepared.

As far as which is better prepared, make no mistake, as far as a basic bedside nurse it's about even. This depends heavily on the student and what they put into their education. I've had excellent ADN students who excelled both in theory and clinical and I've had BSN students who made me fear not only for patient safety but for the future of nursing.

Many academics will stress that a BSN should be the minimum requirement for a bedside nurse and will correlate that with professionalism, better standards of care, etc. Some studies have demonstrated that hospitals with more BSN prepared nurses than ADN prepared nurses have reduced failure-to-rescue rates and better patient outcomes; however, how much of this is related to patient ratios, better unit education, better orientation, peer-support, and mentorship? How do you control for that? I have worked in a hospital that hires mostly ADNs and the had hospital management throw me to the wolves as a new grad. I was two months on the unit before getting general hospital orientation. I had a six week orientation to the unit before I was left in charge of the floor with an LPN who, thankfully, was experienced. When I finally transferred to a larger hospital who had more BSN prepared nurses (with the same ADN degree at the time by the way), I had a one week general hospital orientation followed by a one week nursing orientation with patient simulation before ever seeing the floor. When I did see the floor, I had an assigned charge nurse on every shift and I can only count once in my entire time there that I had one patient more than our usual 3 - 5. You are obviously a smart person. Tell me, how much of that plays into those statistics?

The truth is that any nurse who desires the best for their patients will continue to grow, learn, follow standards of care, and improve even after graduation. I've worked with nurses over the years who it would surprise you to find out they had an ADN. From the way they discussed patient cases, pathophysiology, and nursing care, you honestly could have thought they had a MSN at least.

Please don't go into nursing thinking that your BSN, which you should be proud of, makes you better than your peers.

murseman24, MSN, CRNA · May 7, 2020

Where I did my ADN the CVICU nurse manager that was interviewing me said the graduate from our school came out better prepared than the more expensive competing BSN program in the area. I think it's program and area specific, good and bad ADN/BSN schools.

But yes, the curriculum outside of the ADN specific only to the BSN is nothing but fluff any way you slice it. Though the overall quality of the program is PROGRAM specific.

Same with MSN and DNP. You do have a hiring advantage, as some hospitals prefer BSN graduates (Magnet) and the trend is moving toward BSN for entry level and DNP for APRNs.

HappyMonkey, ADN, RN · May 7, 2020

I gave this a lot of thought when I decided to become a nurse. I chose the ADN route due to cost and flexible scheduling as I was working full time and raising 4 kids.

After I began working, I began to look at further education. My previous career had already included IVR and IVC research and I already had experience as a manager.

In the end, after looking at what I would be learning, I chose to get national certifications rather than pursue a BSN. I knew I didn't want to go into research or management. I chose education that would further specifically my bedside practice.

To that end, I accomplished my CEN, CPEN and CCRN, all with intense amounts of study and passing each on the first try.

Had I not gone to travel nursing, where my specialty can change every 3-6 months, I would most certainly have continued to renew these certifications. Fortunately, the education I got when I obtained them, doesn't go away.

I think people should really look into what they want to accomplish in their nursing career/practice, and seek out the additional education best suited to their goals.

In my case, I was thrilled to learn so many intense and important things that truly supported my bedside nursing. I have NO idea which degree any of my coworkers hold and I'm very proud to work with a great group of people who are smart, experienced and support each other and work together!

~Happy

Added: I've been a lurking on AN since I began nursing school in 2001. I post rarely and my user name has changed (as my email has). I've been a nurse now for 15 years and I must say that this community of nurses, with all the amazing perspectives and experience, has been helpful, supportive and just plain interesting and fun. I steer many of my peers and friends here.

KUDOS to all of us nurses and those endeavoring to join our ranks! Happy Nurses' Week/Day/Year!

StudentNurseMNUS · May 7, 2020

16 hours ago, LovingPeds said:
I'm actually not surprised to find this statement from a BSN student. And before anyone gets up into arms, let me explain why. I was fortunate enough to take prerequisite courses from both a community college and a university which offered BSN, MSN, and DNP options. Both offered the same quality undergraduate education with these prerequisites. Do not knock community college courses because they are at state level interchangeable with their much more expensive university counterparts and most of them are taught by master's prepared instructors. Many students who have to pay out of pocket are extremely intelligent in taking the cheaper option for the same outcome. Many of the professors at the university for my undergraduate nursing prerequisites (health assessment, nursing ethics, etc.) stressed the superiority of the BSN over the ADN degree - without exception. So I am not surprised by the bias in your statements. It has in many ways been educated into you.
The difference between the ADN degree and the BSN degree as far nursing goes is rather minute. Both degrees undergo two years of the exact same nursing content and clinical standards as defined by the state BON in order to meet the requirements to take the NCLEX. The difference between the degree is mostly in the prerequisite courses they take. ADN students take basic sciences, English, history, and usually an art or music along with a few electives. BSN students take the same classes with a few more sciences, ethics, statistics, and electives. This usually equates to approximately one year's difference in undergraduate training - all of which is in the prerequisites. Most BSN students take two years of prerequisites and then their two years of nursing classes. Most ADN students complete their basics in the year prior to starting their ADN classes, but many can complete the same basics along with their nursing classes which is why it is considered a two year degree. Both degrees are required to be taught by someone with the minimum of a MSN. I know this because I have taught the same class as an adjunct at both the ADN and BSN level. Imagine that! The same instructor teaching both.
The extra courses are not necessarily "busy work" because they do help lay a foundation to a basic education. However, your ability to read a research paper and extrapolate statistical information is a moot point during a patient code. The basic skills that you need to be a safe and effective nurse are there regardless of program. The ability to critically think (which I think you're associating only with a BSN) is taught in both programs. You have to have the ability to critically think as a novice nurse in order to pass the NCLEX.
Personally, I went the option of ADN because I was in school for the fun at the time. I went back to for my BSN. I've never regretted doing that. I felt like I got more personal attention from my ADN instructors than I did with the BSN instructors who taught my BSN nursing prerequisites. My ADN instructors were extremely encouraging while still holding me to the standard that I needed to be held to. If I was in lab working on a skill, I could pull any one of the instructors into the lab to help me if I needed it. I didn't feel like I had that at the university I attended. I'm not saying that it is that way with all programs. That was just my experience with this particular university at the time. Everyone of my ADN instructors had over 20 years of experience in nursing education, an MSN, and two of them (out of six) were doctorate prepared.
As far as which is better prepared, make no mistake, as far as a basic bedside nurse it's about even. This depends heavily on the student and what they put into their education. I've had excellent ADN students who excelled both in theory and clinical and I've had BSN students who made me fear not only for patient safety but for the future of nursing.
Many academics will stress that a BSN should be the minimum requirement for a bedside nurse and will correlate that with professionalism, better standards of care, etc. Some studies have demonstrated that hospitals with more BSN prepared nurses than ADN prepared nurses have reduced failure-to-rescue rates and better patient outcomes; however, how much of this is related to patient ratios, better unit education, better orientation, peer-support, and mentorship? How do you control for that? I have worked in a hospital that hires mostly ADNs and the had hospital management throw me to the wolves as a new grad. I was two months on the unit before getting general hospital orientation. I had a six week orientation to the unit before I was left in charge of the floor with an LPN who, thankfully, was experienced. When I finally transferred to a larger hospital who had more BSN prepared nurses (with the same ADN degree at the time by the way), I had a one week general hospital orientation followed by a one week nursing orientation with patient simulation before ever seeing the floor. When I did see the floor, I had an assigned charge nurse on every shift and I can only count once in my entire time there that I had one patient more than our usual 3 - 5. You are obviously a smart person. Tell me, how much of that plays into those statistics?
The truth is that any nurse who desires the best for their patients will continue to grow, learn, follow standards of care, and improve even after graduation. I've worked with nurses over the years who it would surprise you to find out they had an ADN. From the way they discussed patient cases, pathophysiology, and nursing care, you honestly could have thought they had a MSN at least.
Please don't go into nursing thinking that your BSN, which you should be proud of, makes you better than your peers.

Thank you so much for your kind and objective reply to me. I realize my comments were condescending and influenced by the fact I am in the process of completing my BSN. You have made some excellent points and I think that while education is a highly important part of what makes an individual a great nurse, it is not the only factor. As you mentioned, my cohort also has some pretty terrible nursing students who obviously do not care about patient safety, just looking good in scrubs and pretending they are in a cool medical show. Conversely, I have also met some highly educated ADN nurses who were very much acclaimed in their units. Again thank you for not chewing me out like plenty of nurses did here, although in retrospect I don't know what I was expecting by posting such a post. Your post has definitely given me more perspective into what it truly means to be a nurse and how I shouldn't have a superiority complex simply because I am getting my BSN rather than my ADN. Sorry everyone! I swear not all BSN students are as snobbish as I was.

I can now see there are plenty of terrific RNs out there with both associates and bachelors degrees. However, there are also terrible incompetent nurses out there who may have either an ADN OR BSN. I just hope to be in the former group, making a positive significant difference in someone's life.

Wuzzie · May 7, 2020

@StudentNurseMNUS A very mature and humble turn around. Your openness to criticism, willingness to listen and more importantly hear other viewpoints while accepting responsibility and your teachability are all hallmarks of someone who will make an excellent nurse and a good human. Well done! ???

southshore2014, APRN · May 7, 2020

Hello,

Previous to nursing school I earned an associates in business administration and a baccalaureate degree in rigorous psychology program summa cum laude. I then went back and completed my ADN at a local community college. One of the most difficult things I have ever done in my life!

My community college's NCLEX pass rate for my graduating year was 98%, which was substantially higher than the local 4-year university's. That being said, after graduating I enrolled in an NCLEX preparatory course hosted by another school's ADN program (for-profit 2-year institution) and was horrified at some of the foundational questions the students were asking. I appreciated the students asking to learn, but was alarmed that their education had not prepared them with this knowledge. Their program was later placed on hold by the state due to their poor preparedness for NCLEX.

I am currently in graduate school and am slated to be finished with my nurse practitioner program in less than a year. I find my ADN program greatly prepared me for the rigor of being an advanced practice student.

With holding a baccalaureate degree, completing a rigorous ADN program and being a graduate student, I am certainly in no way discouraging anyone from pursuing higher levels of academic studies. I may even agree that, to elevate the nurse profession, it could make sense, for all nurses to eventually earn a BSN. I do not, however, believe that ADN programs are inferior or superior. They are much needed programs. At the end, I believe it all comes down to the strength of the program, regardless if it is ADN or BSN degree based.

Guest1033582 · May 7, 2020

On 5/5/2020 at 1:49 AM, StudentNurseMNUS said:
Hello everyone,
Based on your experiences, do you think ADN nurses are just as competent as BSN nurses straight out of nursing school? I'm attending a four year university to attain my BSN degree and have taken various challenging courses, a majority of which I had to successfully pass to even get into the program. However, my friend attended a local community college to get an ADN and often boasts to me of how easy his prerequisite courses were, since he took them online, and how easy nursing school was since the professors he had were not as rigorous as the ones I currently have. He passed his NCLEX and has been working in a telemetry unit for 5 months now. So is a BSN degree just a longer degree because it is filled with humanities courses and "busy work" nursing courses rather than just the essentials? Is a BSN degree over-preparing students or is the ADN degree not demanding enough? Should ADN nurses even have the same scope of practice as BSN nurses?

I will start off by saying, I just finished my very first semester of nursing school so I am not on the field. But I have perspective: my dad has been an ADN nurse for almost 40 years and my aunt has been a BSN nurse for about 15.

The objective viewpoint from people in the field currently:

Both have to pass NCLEX-RN. Both have to complete a similar number of clinical hours. The ADN degree is more bare-bones and clinical focus, whereas the BSN degree combines a clinical focus with some extraneous courses such as Leadership, Research, and Healthcare Policy/Economics. Moreover, (at least in my area) BSN programs offer at least two semesters of pathophysiology and two of pharmacology while the ADN programs seem to focus solely on pharmacology. My dad says his years of experience has made him a good nurse, better than most if not all bachelor's new grads, but he would have been better prepared at the get-go with a BSN. My aunt says when she was first hired, there was a slight knowledge gap between ADN and BSN new grads but with a few months' experience, it virtually went away.

My personal, humble, not-at-all experienced viewpoint:

My parents never even let me entertain the idea of an ADN because they want all of their children to get at least a bachelor's degree. So BSN was always my only option. I took Microbiology transiently at a community college over the Summer to ease up my schedule and let me say--10x easier than my other science prerequisites that I took at my private, 4-year university (#2 nursing program in my state). Do I find it a bit unfair that the people who got an easier education will have similar job prospects as I do? Absolutely. Do I believe ALL RNs should be required to get a BSN eventually? 100%, and my father and aunt agree. But I know that when I graduate, I will have an edge over ADN grads at least in my area for jobs. I want to end up in the ED--hard for a new grad, but a BSN with a 3.5 vs an ADN with a 4.0--the BSN should win because employers know that BSN programs have much higher standards. Many hospitals in my area won't even hire you with an ADN anymore.

TL;Dr:

Based on mine and my family members' observations, I believe an ADN nurse can become as competent as a BSN one. It will take more time and I do believe BSN is the superior degree to begin with, but I have just as much respect for experienced ADN nurses as I do for experienced BSN nurses.

Wuzzie · May 7, 2020

4 minutes ago, emilyjoy19 said:
Based on mine and my family members' observations, I believe an ADN nurse can become as competent as a BSN one. It will take more time and I do believe BSN is the superior degree to begin with, but I have just as much respect for experienced ADN nurses as I do for experienced BSN nurses.

I do believe that you should have read the OP’s reversal of her opinion and not posted this. You don’t appear to understand the definition of “competency” otherwise you would understand that when it comes to competency there is no difference between the two degrees. Why would BONs allow nurses with inferior competency be licensed? Your parents want you to get a BSN because it opens more doors for you in the future not because it is to superior. ADN nurses do not have to catch up to BSN nurses. What an insulting viewpoint and belies your claim of “respect”. Here’s a thought, when you get to clinicals why don’t you ask for an ADN prepared nurse as a preceptor and let her know how superior your education is to hers. See how far that gets you.

Nurse Magnolia, BSN, RN · May 7, 2020

20 minutes ago, emilyjoy19 said:
Based on mine and my family members' observations, I believe an ADN nurse can become as competent as a BSN one. It will take more time and I do believe BSN is the superior degree to begin with, but I have just as much respect for experienced ADN nurses as I do for experienced BSN nurses.

Based on the beginning of your paragraph, it's clear that you don't actually believe the sentence at the end of your paragraph. BSN nurses are NO MORE COMPETENT at graduation than ADN nurses. Hear me again. BSN nurses are NO MORE COMPETENT at graduation than ADN nurses. Just because you took an extra history class or another gen ed does not make you a better nurse. Nor does, in my opinion, taking massively difficult science courses that you will not use as a bedside nurse. I graduated with a diploma first and that diploma program had MANY MORE hours of clinical requirements in 16 months than the local, extremely highly ranked top 10 four year nursing program has in all four years. Tell me then, who would be more prepared to actually walk onto the floor??

Hiring managers in our area clamored to hire us diploma grads and we all had jobs before graduation last year. Unless you were going to write an APA formatted paper on day one, don't think you are so special with your BSN on the floor. I honestly don't even know what degrees the people I work with have. I NOW have a BSN - after having two other bachelor's degrees - and it will help if I'd like to move up and into other areas of nursing, but that's it. I know a little from having other bachelor's degrees that it is not the golden ticket you think it is.

Your entire response was clearly written by someone who hasn't experienced a lot. You haven't been on the floor yet, even in clinical. You likely haven't even taken a real nursing class yet if you just finished your first semester of nursing school for a BSN. Be proud you are getting your BSN - any bachelors degree is an accomplishment - but get the heck out of here with this nonsense that anything less than BSN can BECOME competent if they just try a little harder. Seriously - Not much makes me angry on this site - but this was seriously full of crap.

Guest1033582 · May 7, 2020

1 minute ago, Nurse Magnolia said:
Your entire response was clearly written by someone who hasn't experienced a lot. You haven't been on the floor yet, even in clinical. You likely haven't even taken a real nursing class yet if you just finished your first semester of nursing school for a BSN. Be proud you are getting your BSN - any bachelors degree is an accomplishment - but get the heck out of here with this nonsense that anything less than BSN can BECOME competent if they just try a little harder. Seriously - Not much makes me angry on this site - but this was seriously full of crap.

I HAVE been on the floor, actually. Just finished Fundamentals and clinical. My clinical was in an LTC, LTAC, and hospice. I get a lot of my perspective from my family members who are currently nurses (again, one with an ADN and one with a BSN). I wholeheartedly believe that BSN nurses graduate more competent and ADNs will catch up, but they just aren't there yet for the most part. I am sure there are good and bad nurses on both sides--but I think a BSN should be the entry degree for nursing.

6 minutes ago, Wuzzie said:
I do believe that you should have read the OP’s reversal of her opinion and not posted this. You don’t appear to understand the definition of “competency” otherwise you would understand that when it comes to competency there is no difference between the two degrees. Why would BONs allow nurses with inferior competency be licensed? Your parents want you to get a BSN because it opens more doors for you in the future not because it is to superior. ADN nurses do not have to catch up to BSN nurses. What an insulting viewpoint and belies your claim of “respect”. Here’s a thought, when you get to clinicals why don’t you ask for an ADN prepared nurse as a preceptor and let her know how superior your education is to hers. See how far that gets you.

My school requires us to introduce ourselves as BSN students because they said we should be proud of our further education and competency. And we are only allowed to have BSN prepared preceptors. In my Intro to Professional Nursing class that I took last semester, we had to write a whole paper about ADN vs BSN nurses and there was some interesting research I'd encourage you to peruse about pt outcomes and such. And yes, I have been to clinical (see my above comment).