ADN's being pushed out

allnurses Guide · Mar 25, 2013

Do you think that the difference between an ADN and a BSN are just "management" classes?
No, I do not. I asked the question because I wanted to hear an answer in regards to actual benefit the patient achieves from a Bsn degree nurse.
The hospitals I was a patient at only had RN and first name on the badges, so there is no way for me to grade the nurses based on their degree.
At this time, I want to pursue a career change as a nurse. I am moving to a new state and will not pay out of state tuition for an undergraduate degree. So, I have plenty of time for research on entry options and goals.

I think in today's employment market you are better off getting your BSN regardless of those issues, because we are in a seller's market and most likely will be for some time to come.

If wishes were horses..
The articles in JAMA do NOT always reflect the AMA views: it is a peer-reviewed journal. You seem to not understand what that means.
I suspect that you would have some sort of wild conspiracy theory for any study that disproved your vehement argument.
Yet again, a challenge: kindly enlighten us on the flaws and bias in the said publication.

I posted a bunch of links on the previous page. It's significant to me that among others saying the same thing, the 2010 IOM report recommends setting a goal of 80% BSN-educated nurses by 2020 but added “The causal relationship between the academic degree obtained by RNs and patient outcomes is not conclusive in the research literature”.

avengingspirit1 · Mar 25, 2013

You don't seem to understand common sense logic. What I'm saying is that just because a bunch of like-minded people gave a thumbs-up to another's research who has the funding and backing of organizations with similar views and has enough clout to have it published in JAMA, does not mean it is to be taken as Gospel.

Are you going to next tell me that one needs a doctorate with evidence-based research to conclude that standing in the rain will get you wet? You're only proving the point that the longer one spends in the fantasy work of academia, the more out of touch with reality they become. They better hope admissions into four year BSN programs increase and that federal budget cuts don't result in the downsizing of their departments, because they don't stand a chance in the real working world. You see, outside of academia, companies expect quantifiable results, not theories and propaganda which has so far all we've been given by these academic elitists.

allnurses Guide · Mar 25, 2013

I posted a bunch of links on the previous page. It's significant to me that among others saying the same thing, the 2010 IOM report recommends setting a goal of 80% BSN-educated nurses by 2020 but added “The causal relationship between the academic degree obtained by RNs and patient outcomes is not conclusive in the research literature”.

The only way to "prove" causation would be a randomized controlled trial. This would be a very difficult study to design and run.

Statistically significant correlation controlled for confounders is likely the closest we will get. Unless someone has an idea of how to realistically run a RCT on the topic.

allnurses Guide · Mar 25, 2013

You don't seem to understand common sense logic. What I'm saying is that just because a bunch of like-minded people gave a thumbs-up to another's research who has the funding and backing of organizations with similar views and has enough clout to have it published in JAMA, does not mean it is to be taken as Gospel.
Are you going to next tell me that one needs a doctorate with evidence-based research to conclude that standing in the rain will get you wet? You're only proving the point that the longer one spends in the fantasy work of academia, the more out of touch with reality they become. They better hope admissions into four year BSN programs increase and that federal budget cuts don't result in the downsizing of their departments, because they don't stand a chance in the real working world. You see, outside of academia, companies expect quantifiable results, not theories and propaganda which has so far all we've been given by these academic elitists.

I understand that common sense logic is something that is subjective. You don't seem to understand that your subjective opinion doesn't trump objective research. You obviously have no research experience and have a very poor understanding of how peer-reviewed published literature works. You can continue to have your opinions, everyone is entitled to theirs, but don't pretend that it can refute published research.

As far as quantifiable results, how do you think hospitals are paid? How do you think peer reviewed publications get published. Oh, on their quantifiable results.

dt70 · Mar 25, 2013

I think in today's employment market you are better off getting your BSN regardless of those issues, because we are in a seller's market and most likely will be for some time to come.
I posted a bunch of links on the previous page. It's significant to me that among others saying the same thing, the 2010 IOM report recommends setting a goal of 80% BSN-educated nurses by 2020 but added “The causal relationship between the academic degree obtained by RNs and patient outcomes is not conclusive in the research literature”.

I am not in nursing yet and do not possess the knowledge to determine what a bsn degree directly benefits a patient, which led to my initial question.

With everyone so busy their hardly at the bedside except to perform a specific task with some exceptions, at least that's my experience as the patient. I do not see the whole picture.

I agree bsn is needed for anyone entering field now. All paths to bsn has pros and cons.

If the goal is to have 80% bsn educated nurses by 2020 and RN to BSN takes 2 years, why is there an issue now for hiring ADN's?

Keeping unemployment up can be good for business by keeping salaries down or stagnant.

Such as requiring file clerks to obtain bachelors degrees. I can see in ten years you'll need a ba degree to work at wawa's

In my field of work there is no end to studying. Increased knowledge does provide you with better solutions to complete tasks.

DNPpat · Mar 25, 2013

You are asking some very reasonable questions, and your humility is refreshing. Your final sentences here are so important, but let's return to that in a moment.

The original poster spoke about experienced and (in the poster's opinion) highly qualified AD nurses losing their employment, presumably to allow the employer to hire BSN graduates to replace them. If true, that is inexcusable and in no one's best interest. These experienced nurses represent a huge 'brain trust' for us all. If employees have been discriminated against they sometimes have recourse through their state labor board or union representation, and I would encourage them to pursue that.

That aside, there is a very good reason for the powerful professional shift in favor of more advanced education for nurses. This push comes from within nursing, not from outside pressure. Although there has been a recognition of the need for many years, market forces have largely impaired progress. The increasing complexity of health care has definitely made it more clear recently. I won't take space here with details, but if you (or others) are interested a good place to start is with the Carnegie Foundation report in 2009 titled Educating nurses: A call for radical transformation. The IOM report mentioned earlier provided a further review of the evidence and also concluded with a powerful call for a more highly educated nursing workforce. Virtually all of the major national nursing organizations support this change, including the American Nurses' Association, the National League for Nursing, the American Organization of Nurse Executives and I can assure you they did not take these positions without careful and thoughtful review of the evidence and implications.

This is never meant to be disrespectful of the enormous contribution made every day by associate degree nurses. The ASN and ADN programs have a proven track record of providing high quality education for entry-level nurses,and this is a very important pathway into the profession. Some of the most important support for academic progression in nursing, however, comes with the endorsement of the national organizations responsible for providing ADN programs. The American Association of Community Colleges and the National Organization for Associate Degree Nursing, among others, have noted the need for an associate degree entry point *and* progression on to higher degrees. See American Association of Colleges of Nursing | Joint Statement on Academic Progression for Nursing Students and Graduates.

To your specific question, there are a couple of reasons for hospitals to trend toward hiring of BSNs now, even if the stated goal is 80% by 2020. Here is the easy one: If a hospital has 50% AD nurses, and they want to move to a higher percentage (without the totally unethical behavior of firing folks who don't deserve it) they can only change the numbers in two ways - encourage their current nurses to go back to school, or preferential hiring. Since many of their existing employees may choose not to get an advanced degree, they change their hiring practices.

The more subtle reason is that changes in health care will likely favor the facilities with more highly educated nurses. Nurses with a BSN or higher are more likely (not exclusively) positioned to evaluate health outcomes in view of the current research, evaluate population health within a community, minimize acute care episodes, and a variety of other things that will become increasingly valuable to patients and providers alike.

So.... back to your last sentences. Even after my lengthy diatribe here, I can't think of a better way to say why this issue is important. Increased knowledge puts more tools in the tool chest, and we all benefit from that.

HeatherMax · Mar 25, 2013

Do you think patient care technicians/care partners/CNA's will end up filling the void from the lack of LPN/ADN's at magnet hospitals? How can there be a good patient to nurse ratio if all nurses in a magnet hospital are have their BSN? How can the hospital afford them all?

allnurses Guide · Mar 25, 2013

The only way to "prove" causation would be a randomized controlled trial. This would be a very difficult study to design and run.
Statistically significant correlation controlled for confounders is likely the closest we will get. Unless someone has an idea of how to realistically run a RCT on the topic.

You repeatedly asked avenging spirit to cite sources for specific flaws in Linda Aiken's studies and seemed to scoff at the replies you received. That is why I posted those particular links.

If one states that proving causation is difficult to do, we shouldn't arbitrarily decide among those who don't which one we think is closest to proving it and publicly state that it does, which is something that happens all the time, and very often the zeal those proponents have for their point of view leads them to say things that present ADN educated nurses as a risk to patient's lives, with varying degrees of alarm.

avengingspirit1 · Mar 25, 2013

What we have here is anything but unbiased published scholarly research. What we have is a biased piece of propaganda specifically designed to boost the revenues of four year schools and hospital management while doing nothing for nurses (except adding to their debt) and the patients they care for. Sell the sales pitch to misinformed students while you can. The truth about these higher degree pushes is coming out shortly. And I'm happy to be a part of it.

The ironic part of it is that most these denizens of academia crying for the BSN push all know they're doing it for their own selfish benefit. I say most because I really believe that some have lived in a university bubble for so long, and have lost touch with reality and actually may believe this display of apocryphal writing. But the others are plain phonies trying to project an image with false altruism.

allnurses Guide · Mar 25, 2013

You repeatedly asked avenging spirit to cite sources for specific flaws in Linda Aiken's studies and seemed to scoff at the replies you received. That is why I posted those particular links.
If one states that proving causation is difficult to do, we shouldn't arbitrarily decide among those who don't which one we think is closest to proving it and publicly state that it does, which is something that happens all the time, and very often the zeal those proponents have for their point of view leads them to say things that present ADN educated nurses as a risk to patient's lives, with varying degrees of alarm.

Actually I asked or his/her own critique of the paper and to discuss the flaws/bias that were being mentioned.

I would like to address two things in your response though:

1. Nothing is 100% in research or science. We rely on statistical significance. It's been awhile since I read Aiken's article but I am fairly sure that it was a relationship between education and outcome. It don't recall it being called proof. That wouldn't be acceptable in published research.

2. I would never argue that present ADN nurses are a risk to patient's lives. This study in question provides some basis for promoting both a BSN ETP for the future and continuing education for current nurses (at all levels).

allnurses Guide · Mar 25, 2013

I am not in nursing yet and do not possess the knowledge to determine what a bsn degree directly benefits a patient, which led to my initial question.
With everyone so busy their hardly at the bedside except to perform a specific task with some exceptions, at least that's my experience as the patient. I do not see the whole picture.

In a way this entire discussion is taking place because there is no one answer to that specific question. We are talking about an aspect of one of the many "moving target" reasons given for why this should be mandatory, namely that a BSN-educated nurse has superior bedside nursing skills and presumably would notice his or her patient going downhill and intervene before the ADN nurse would. Some unlucky souls would be alive today if their nurse held a BSN degree, regardless of years of experience, regardless of whether they became a BSN through a bridge program or traditional 4 year brick and mortar program.

All of that is somewhat ironic, because you will hear at least as often that where the ADN nurse really excels is at the bedside, but maybe they don't include accurate assessment of changes in a patient's condition that could lead to their death a bedside nursing skill.

For the best encapsulation of the rationale behind this effort, which began with an ANA position paper published in 1965, (representing a faction of nurses - not the entire field of nursing) the 2010 IOM Report: Future of Nursing - Focus on Education is really the best. When you break it down, it amounts to what we often hear in talking points - jargon laden prose that boils down to - you need a BSN to understand complex technology, electronic medical records, participate in meetings with other department heads, determine what sort of healthcare insurance a patient has, and a few others. They do emphasize community health, statistics, leadership as well, but connecting the dots between those and better patient outcomes looks near impossible at this point.

They also make the point that a much higher percentage of patients will be dealing with chronic illnesses, the very thing they usually say the less-educated nurses are better suited to do. I wish that wasn't as clear as mud, but that's what we are in the midst of now. All of it has been simmering for years, but the end of the nursing shortage changed the playing field considerably.

I've never heard any nurse say that increased education is a bad thing. So much as changed in nursing and in education in the last 47 years. There are a lot of people who reject the argument that education = a traditional BSN program.

allnurses Guide · Mar 26, 2013

. . .I would like to address two things in your response though:
1. Nothing is 100% in research or science. We rely on statistical significance. It's been awhile since I read Aiken's article but I am fairly sure that it was a relationship between education and outcome. It don't recall it being called proof. That wouldn't be acceptable in published research.
2. I would never argue that present ADN nurses are a risk to patient's lives. This study in question provides some basis for promoting both a BSN ETP for the future and continuing education for current nurses (at all levels).

No, Dr. Aiken didn't claim proof at all, she acknowledged some of the limitations of her original work, and Dr Peter Buerhaus, who is certainly like-minded agreed with that.

The issue has been distorted somewhat by the troops in the field who often imply that better patient outcome is directly connected to the nurse's degree, and that is what bothers me, having observed nurses of all educational backgrounds for so long.

If the notion is accepted as truth, I really hope they delve into what it was exactly that accounted for the differences in mortality and failure to rescue. I've heard it thrown out there that it is "surveillance" the BSN nurse excels at but if they can narrow down those characteristics it would really help hone course objectives.