ADN vs. BSN - patient mortality rates

Nursing Students ADN/BSN

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I came across an article that was talking about the importance of a baccalaureate degree in nursing. Here is a quote from their article, "Several studies have demonstrated an inverse relationship between the proportion of BSN nurses and mortality of the hospitalized patient.In other words, they found that as the proportion of baccalaureate-degree registered nurses increased in hospitals, patient deaths decreased."

I have my ADN degree, the college I graduated from is highly regarded and better prepares their students than the BSN program down the road. Also, the ADN program I graduated from does far more clinicals than BSN program down the road, and in my opinion that is better at preparing student nurses for starting their career. I am not speaking for all the other ADN or BSN programs in the country. I just thought this would make an interesting topic and would like to hear everyone's opinion on this subject.

Individual nurses will vary regardless of educational level. Overall, more education is better. I started as an ADN-RN and finished the BSN later. I support BSN for entry to practice.

Fine, but citing flawed studies that "prove" ADNs are less safe in delivering care should not be an argument.

I think it's boderline libelous to paint a picture to the general public that ADN and LPN nurses are a danger to their health. Yet this is what these studies try to do. They're deliberately misleading.

I think there is an argument to be made for making the BSN the entry for RN. Bashing current ADNs should not be a part of that argument.

(not implying that's what you're saying, just sticking with the overall topic of this thread)

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Specializes in SICU.

All I can say is that my ADN-BSN program is a joke, academically speaking. It's the easiest schooling I've ever taken part in. I can't speak for the rest of the programs out there, but $30,000 and a year later I can write an APA paper a little better. That's about it. I'm sure all my patients will be wildly thankful for that.

The system

is.

a.

joke.

Have I gotten my point across?

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Can you link the article? It is difficult to evaluate the evidence without the actual study.

I forgot got to include the link:

The Importance of the Baccalaureate Degree in Nursing Education | peoriamagazines.com

I wish people wouldn't write such articles because the public will start to think ADN nurses are not as competent as the BSN nurses. You can't really tell who has their ADN or BSN unless you ask, but I'm sure some patients will or have started to ask. If the ADN programs did not provide an adequate nursing education then they would have stopped them all together. I don't have a BSN degree, but I spent four years at a community college. The first two years I completed the prerequites and then by the third year I was in their ADN program where I had to complete 5 semesters which was two years. It was a lot of hard work and very emotional at times between the tests and check-off's wondering whether or not you were going to pass. I believe if there was such a huge difference between an ADN graduate and a BSN graduate then we would have taken a different NCLEX-RN.

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I forgot got to include the link:

The Importance of the Baccalaureate Degree in Nursing Education | peoriamagazines.com

I wish people wouldn't write such articles because the public will start to think ADN nurses are not as competent as the BSN nurses. You can't really tell who has their ADN or BSN unless you ask, but I'm sure some patients will or have started to ask. If the ADN programs did not provide an adequate nursing education then they would have stopped them all together. I don't have a BSN degree, but I spent four years at a community college. The first two years I completed the prerequites and then by the third year I was in their ADN program where I had to complete 5 semesters which was two years. It was a lot of hard work and very emotional at times between the tests and check-off's wondering whether or not you were going to pass. I believe if there was such a huge difference between an ADN graduate and a BSN graduate then we would have taken a different NCLEX-RN.

The same anxiety you described is also present for BSNs, LPNs, diplomas--you name it. When you want something, you work hard and sometimes you worry.

The NCLEX-RN is measuring to make sure you're not going to kill anyone before you enter practice, as I understand it. BSN programs aren't teaching you any more or less skills or critical thinking than ADNs. It's a difference mostly between the content learned in nursing theory, which is not typically tested in-depth on the NCLEX.

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Specializes in CRNA, Finally retired.

Can someone just shoot this thread?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I think everyone is entitled to their opinion and remember that allnurses promotes

the idea of lively debate. This means you are free to disagree with anyone on any type of subject matter as long as your criticism is constructive and polite. Additionally, please refrain from name-calling. This is divisive, rude, and derails the thread. Our first priority is to the members that have come here because of the flame-free atmosphere we provide. There is a zero-tolerance policy here against personal attacks. We will not tolerate anyone insulting other's opinion nor name calling.

Our call is to be supportive, not divisive

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Specializes in ER.
There are several studies that link the shared characteristics of Hospitals with a high proportion of BSN's with lower mortality, but none have really directly linked a BSN level education with lower mortality. Proportions of BSN's are higher in larger, research and teaching hospitals which also tend to have lower patient ratios and significantly more patient care support. We know all of these characteristics can decrease patient mortality, so how much of the reduced mortality is due to better patient ratios, for instance, and how much is due to higher average level of education has never been well defined in research. These studies do adjust for these characteristics but there's been a lot of controversy as to whether or not these adjustments fall short.

I'd love to be able to say my patient's are less likely to die because I have a BSN, but at the same time without a study that more closely resembles a randomized and controlled study I don't think we can say that with certainty, there is some data that might suggest that, but it's not something we "know".

You constantly say but of course ignore that no study ever really directly links anything to anything else and in this case, it would be impossible to do so because doing so would be unethical and impossible given the complexities of every single individual patient.

The fact is that over 300,000 patients were involved in the several studies and metanalyses that were done and the proof is definitive. More BSN prepared nurses on a unit mean fewer patient deaths. The studies aren't flawed.

I should have added: The studies even crossed international lines: One study was done in Canada which helps to control for socioeconomic problems in patient populations.

For the OP: There are many lengthy threads on this topic. Also, ADNs have been shown in other studies to be better prepared to "do stufff" their first six months of practice. After that, the BSNs skills catch up and their critical thinking carries them the rest of the way on towards better nursing practice. Am sure you can find those studies as well.

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Specializes in Acute Care Psych, DNP Student.
Can someone just shoot this thread?

No, let's not. Let's keep discussing it until professional nurses realize and admit more education is better for the patients we care for. It may take 20 years - but eventually we will get there and get out of a vocational mindset.

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Specializes in Critical Care.
You constantly say but of course ignore that no study ever really directly links anything to anything else and in this case, it would be impossible to do so because doing so would be unethical and impossible given the complexities of every single individual patient.

The fact is that over 300,000 patients were involved in the several studies and metanalyses that were done and the proof is definitive. More BSN prepared nurses on a unit mean fewer patient deaths. The studies aren't flawed.

I should have added: The studies even crossed international lines: One study was done in Canada which helps to control for socioeconomic problems in patient populations.

For the OP: There are many lengthy threads on this topic. Also, ADNs have been shown in other studies to be better prepared to "do stufff" their first six months of practice. After that, the BSNs skills catch up and their critical thinking carries them the rest of the way on towards better nursing practice. Am sure you can find those studies as well.

I'm actually just repeating the author's declared limitations of their studies, from one of the frequently referred to studies on the topic by Linda Aiken:

Our estimates of numbers of lives that might be saved through improved care environments are meant to be rough estimates and should be interpreted cautiously. This study shares a limitation with many health services research projects based on cross-sectional data. Longitudinal data, as well as the inclusion of other variables related to competing explanations for the findings, would help to establish causal links between better care environments and more favorable patient and nurse outcomes.

These studies are rough guesstimates, and yes there is a difference between this and directly linking something, that's the basic difference in power between a retrospective study and a randomized controlled trial; when a finding could be due to a number of factors, you can't say with certainty that the finding is due to any specific factor unless you tightly control those other factors, which these studies have not yet done. For instance, studies comparing levalbuterol and albuterol narrowed down the effects of s-albuterol to a number of pathways, making it possible to say it could be beta mediated. Then a study was done where beta blockers were added and the effects disappeared, which means we can now say they are beta mediated with some certainty. Those are two very different levels of being able to directly link something to something else. Using the same acuity adjustments these studies use, it would seem obvious that if a Hospital put's the word "University" in their name, then they will have lower mortality rates, yet I hope we don't believe that if every hospital in the US adds "University" to their names that their mortality rates will go down.

It's a little ironic that argument for BSN's seems to so frequently overstate the findings of these studies when supposedly part of what separates BSN's from ADN's is their superior skills in understanding research.

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Specializes in ICU, BURNS, TRAUMA, TRANSPORT, HH.
Individual nurses will vary regardless of educational level. Overall, more education is better. I started as an ADN-RN and finished the BSN later. I support BSN for entry to practice.

I agree, except for that BSN to practice part...there is no evidence to support the notion that to begin practicing as an RN you must have a BSN to be safe, proficient, or even to become expert in the care.

To advance the notion that we must have additional education for entry in nursing, at additional cost, for no good reason smacks of legislating based upon "professional pride" more than "professional practice". For a profession that is supposed to be very evidence based, I wonder how we can justify that?

IMHO.

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I came across an article that was talking about the importance of a baccalaureate degree in nursing. Here is a quote from their article, "Several studies have demonstrated an inverse relationship between the proportion of BSN nurses and mortality of the hospitalized patient.In other words, they found that as the proportion of baccalaureate-degree registered nurses increased in hospitals, patient deaths decreased."

Would this be a reference to the long-ago discredited Aiken study? If so...I don't know how it keeps turning up as current, when it was recognized as fatally flawed quite some time ago.

I seem to recall that one of the reasons for the discrediting was that it didn't account for the number of RNs who had been diploma nurses prior to becoming BSNs, as well as those who had been ADNs prior to becoming BSNs. And those who had gone through BOTH prior to holding BSN degrees. In other words, there was failure to recognize the importance EXPERIENCE played in the lower mortality or higher level of care demonstrated by the "BSN" nurses. Something that strikes me as intensely obvious, but hey, I didn't accept that study for publication ;)

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Unless the studies are performed on the exact same patients, I don't think that it can be proven in one way or the other whether the ADN or BSN nurse is more suited to keep them alive. Now, if the ADN's patient were to expire, and we could turn the clock back and give the BSN a go at it, THEN we would know once and for all who wins ;)

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