ADN vs. BSN - patient mortality rates

[Katniss88]

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.

[Dakeirus]

Not this again.

[mmc51264, BSN, MSN, RN]

It's not all for ADNers to do OK!!! As nurses, we have to practice at the highest professional level. Please that this from a BSN who worked his way from LPN to ADN, and now BSN.

I am now embarking to my journey to becoming MSN, and I think that it is great to stay current with nursing knowledge. In addition nurses should pride themselves in continuing higher education. I understand that it takes a lot of sacrifices to achieve higher education goals.

Good luck in your endeavors.

I was being somewhat sarcastic. Obviously there are doing more than ok. And the Reuters article doesn't take into consideration that we get some of the sickest pts that can't get any quality of care at a smaller hospital. The hospital that I am at is willing to try and save people that other hospitals can't.

I am an ADN, but I also have a BS in Biology and a Masters in teaching. I am starting my RN-BSN in a few weeks. I value the education. I am a 2nd (well, really 3rd) career with life experience, experience with the geriatric population as a HH aide for 3 years before and during nursing school. I feel that I have every right to be safe in an environment along side a 22yo BSN graduate.

[westieluv]

As an RN who has been practicing for 23 years and has worked until very recently on various acute care inpatient units, my personal experience has been that ADN nurses are every bit as competent as BSN nurses. What I see a lot of in the new, younger BSN nurses is the attitude that they didn't get into nursing to do bedside care, and that their job is just a stepping stone to some kind of desk job or being a future CRNA, NP, etc.

I now do acute, impatient dialysis treatments in local hospitals and I had a 20-something nurse tell me just a few days ago when her patient needed something that, "This is why I got my BSN. I didn't go to school to wipe butts and get heel spurs from being on my feet all day! I'm going into management ASAP."

I'm not saying that all BSN nurses have that attitude, but I have seen it much more than I would like to. Most ADN nurses, OTOH, seem to be fine with bedside care and seem to have more of a clinical background. Having spent the last couple of decades working in healthcare and with nursing staff day in and day out, if I were critically ill, I would have no problem at all having an ADN nurse care for me, but I would not want a nurse who is only caring for me until he/she can "move up in the world" and leave bedside nursing behind.

Just an observation from an older, seasoned nurse.

[HM-8404, BSN, RN]

I'm not sure if the standards are local or national, but in my area the ADN students graduate with many more patient care clinical hours than the BSN students do. In the last semester of nursing school both are doing preceptorships, plus while the BSN students are hanging out with the nurse managers for their management class the ADN students are doing more patient care clinicals.

[Chisca, RN]

As an RN who has been practicing for 23 years and has worked until very recently on various acute care inpatient units, my personal experience has been that ADN nurses are every bit as competent as BSN nurses. What I see a lot of in the new, younger BSN nurses is the attitude that they didn't get into nursing to do bedside care, and that their job is just a stepping stone to some kind of desk job or being a future CRNA, NP, etc.

I now do acute, impatient dialysis treatments in local hospitals and I had a 20-something nurse tell me just a few days ago when her patient needed something that, "This is why I got my BSN. I didn't go to school to wipe butts and get heel spurs from being on my feet all day! I'm going into management ASAP."

I'm not saying that all BSN nurses have that attitude, but I have seen it much more than I would like to. Most ADN nurses, OTOH, seem to be fine with bedside care and seem to have more of a clinical background. Having spent the last couple of decades working in healthcare and with nursing staff day in and day out, if I were critically ill, I would have no problem at all having an ADN nurse care for me, but I would not want a nurse who is only caring for me until he/she can "move up in the world" and leave bedside nursing behind.

Just an observation from an older, seasoned nurse.

Amen, from an ADN who is also a CCRN.

[tokmom, BSN, RN]

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.

Oh heck. I'm not worried the pt will ask for the BSN over myself. They think the housekeeper is a nurse!

[CPT_Charlios]

Not to knock on ADN prepared nurses (I worked with great nurses who are ADN prepared), but I think our profession should have one standard to be a professional nurse like other health care professionals. PT/OTs are mastered prepared and many of their programs are going towards doctorates, albeit they are not as in high demand as nurses. The ADN level of nursing was developed out of a need to produce nurses in response to a shortage during and following World War II which sadly, continues to this day. It was proposed as a temporary solution to a shortage and was not intended to replace the professional level of nursing education.

Numerous chief nurses have indicated their desire for the majority of their hospital staff nurses to be prepared at the BSN level to meet the more "sophisticated demands of today's patient care". In a recent survey by the University Health System chief nurse at various university health systems stated that they prefer an average of 70 percent of their staff nurses to be BSN-prepared and they "perceive a difference in the practice of baccalaureate and associate-degree-prepared RNs, citing better critical thinking skills and leadership abilities among baccalaureate nurses." Multiple studies has back that conclusion. Studies have also found that nurses prepared at the baccalaureate level have stronger communication and problem-solving skills and a higher proficiency in their ability to make nursing diagnoses and evaluate nursing interventions.

This is a catch 22 because of the nursing shortage and the demand of only BSN prepared nurses.

http://www.aacn.nche.edu/publications/position/bacc-degree-prep

[COLOR=#003366]http://www.aacn.nche.edu/media-relat...t-of-education

[tokmom, BSN, RN]

OP, don't get your knickers in a twist about this article. The BSN push has been around for years. I took the NCLEX in 1989 and even back then, there were whispers of phasing the ADN out of nursing. I have managed to hang on all these years just fine. I am currently in a RN-BSN program just to cover my bases, since a lot of hospitals around me are going the BSN route at this time. There are a few areas of work I am interested in that also require a BSN.

Have I learned anything in my coursework? Of course I have. I feel that my practice has improved because of it. I won't be defensive and not give my BSN program any credit at all.

The ADN/BSN debate will be around until robots take our place. The pendulum will swing from hospitals only hiring BSN vs ADN again, just like it does every decade or so.

Embrace who you are, learn what you can and forget the rest.

[clarecrawford]

without a doubt,the more resources available to the staff working toward positive patient outcomes the more success they will have achieving it.Whether that is enough staff ,sleep and time off or just having basic supplies available to them to be able to preform their jobs aND THE ABILITY TO ACCESS WORKING EQUIPMENT makes all the difference

[Katniss88]

Oh heck. I'm not worried the pt will ask for the BSN over myself. They think the housekeeper is a nurse!

For that very reason, sometimes it would seem nice for nurses to wear or have something that signifies someone as a nurse, like in the past when you had to wear all white(I'm not for wearing all white). Some of the hospitals have badges that has RN in big letters and some don't, so you don't know who's a nurse and who isn't.

[BrandonLPN, LPN]

This thread has become just another generic ADN vs BSN argument. Haven't we had enough of those?

The original premise of this thread (look at the title) is the question of the validity of the claim that ADN nurses have a higher mortality rate than BSN nurses. That's a pretty bold claim. As has been pointed out, the slight difference in mortality rates can be attributed more to the types of hospitals that tend to employ a larger percentage of BSNs vs ADNs. Said hospitals tend to be the major metropolitan hospitals. The difference in outcomes clearly has more to do with greater access to cutting edge diagnostics and medical specialists than it does to educational difference among it's RNs.

We can debate whether or not nursing needs a professional upgrade until the cows come home. But why not a healthy debate about the topic of the actual thread, for a change?

[BostonFNP, APRN]

I see a lot of nurses speak very critically about the flaws of the Aiken (2003) study. The most common cited reasons:

1. The hospitals with more BSN nurses have better staffing, more experienced nurses, and board-certified surgeons. Well, the study actually controlled for all these confounders.

2. The study was done by biased reviewers. Well, like most research, the study was done by academically associated nurse researchers (like clinical trials are done by pharmaceutical companies). It was also extensively peer-reviewed by one of the most stringent journals in healthcare. I don't think the JAMA has a vested interest in the nursing agenda.

3. The Akien study is flawed in its design. How come there have been any other studies that have shown different results?

4. The study didn't account for nurses that began as diplomas or ADNs. That is an irrelevant point; the years of experience were consistent in both groups.

I do feel that the study had some flaws, but people rarely mention them, rather they just rehash these urban myths about the study.