ADN's being pushed out

SleeepyRN · Mar 26, 2013

You are obviously working very hard to continue your eduction: education must carry considerable merit with you. What is the merit of education?

To continuously grow as nurses, learning as much as we can so we can better ourselves and be able to be the best we can in our specialty of choice. Any time I have argued that a BSN nurse isn't a better nurse than an ADN prepared nurse, what I've meant by that is this: while in my ADN program, we did cover subjects such as community health, (I'll use this as my example) most BSN programs probably covered it more extensively. I have been working in pediatrics for 6 months. If I had graduated from a BSN program, I don't see how I'd be better at my job in that specialty just because I had a little more community health experience.

In the grand scheme of things, however, I think that if you can continue your education, it can only help. Some education will be forgotten and unused, but the education you put into practice every day will be well worth it.

SleeepyRN · Mar 26, 2013

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.

So you think that a new grad BSN is superior to a new grad ADN RN at the bedside. I completely agree that most BSN programs offer more education in areas such as community health and SOME more leadership focus. But you are referring to assessment skills gained in both programs. ADN programs contain the same learning content (and standards) in assessment in med-surg and critical care as BSN programs. So why would a BSN nurse have better assessment skills than an ADN nurse?

I'm all for furthering your education if you can, but not because I believe BSNs have better assessment skills. I think assessment skills have more to do with the individual than their degree. For example, I rocked A&P and patho. I studied A&P extensively. I didn't study for the test, but for the knowledge. When I took my A&P exams, they were a breeze because I held higher standards for myself than what was expected of me from my teachers. Because I had a great base of knowledge in A&P, nursing school was much easier for me than many of my classmates because I didn't have to go back and restudy A&P to understand patho. I know that as an ADN nurse, I have a much greater understanding of the disease process than many BSNs because of the effort I put into it. So no, just because one has a BSN does not mean their knowledge of the disease process is more expansive, nor does it mean their assessment skills are better than that of an ADN. Med-surg is Med-surg is Med-surg, no matter where you take it. Same content, same learning outcome expectations.

allnurses Guide · Mar 26, 2013

I would suggest that the question is not so much "more education" but rather what the education is in. If the education is in management and nursing theory, and the rest of the education was equivalent to that of an ADN from a quality program, would that additional education have made any difference? Does having a more in-depth education in psychology make you better able to assess that patient who can't breathe because their lungs are full fluid from pulmonary edema?

My contention would be...

I would argue that, yes, additional education could help the nurse make that assessment. There is much more to assessment than noticing someone is acutely retracting or tachypneic, that's a very important part, but there is far more that may affect outcomes.

Education doesn't necessarily make one person better than the other, it allows an individual to increase their own potential.

allnurses Guide · Mar 26, 2013

There are of course multiple factors that go into making a great nurse that have nothing to do with education level (personality, availability...). I was simply pointing out 1 preference of mine.

I agree the variation between individuals is likely greater than the variation between degrees.

allnurses Guide · Mar 26, 2013

So you think that a new grad BSN is superior to a new grad ADN RN at the bedside. I completely agree that most BSN programs offer more education in areas such as community health and SOME more leadership focus. But you are referring to assessment skills gained in both programs. ADN programs contain the same learning content (and standards) in assessment in med-surg and critical care as BSN programs. So why would a BSN nurse have better assessment skills than an ADN nurse?
.

I agree, as above, that variation between individuals is likely greater than that between degrees.

You mention assessment not being different, then gone on to say how BSNs are more trained in community health. Is there no assessment in community health? Is there no application of a community health assessment in tertiary care?

allnurses Guide · Mar 26, 2013

So you think that a new grad BSN is superior to a new grad ADN RN at the bedside. I completely agree that most BSN programs offer more education in areas such as community health and SOME more leadership focus. But you are referring to assessment skills gained in both programs. ADN programs contain the same learning content (and standards) in assessment in med-surg and critical care as BSN programs. So why would a BSN nurse have better assessment skills than an ADN nurse?

I 'm sorry if my writing wasn't clear, but I didn't say I believed that. I was replying to what I thought was dt70's question about what specifically is the benefit of being taken care of by a nurse with a BSN as opposed to an ADN. I was trying to point out that there is inconsistency among advocates for mandatory BSN for entry to practice when they are asked that question. Sometimes they bring out the better patient outcomes argument, which surveyed nurses in direct care roles, aka bedside nursing.

Other times they (BSN advocates, not me) will make the argument that the ADN role is adequate for basic bedside care, due to their more task-oriented education. but without a BSN they will have a limited ability to grasp abstract theory concepts, see the big picture, think critically, read and understand academic research or become well-rounded. I'm with you. I believe these things are much more a matter of individual differences, including prior degrees and personal life history.

soxgirl2008 · Mar 26, 2013

What also gets lost in the discussions between ADN/BSN is that, ultimately, they both are 2 year programs. The ADN program I currently attend has identical, if not slightly higher (statistically insignificant though) pass rates on the NCLEX than the BSN program at the local university, and their pass rate is quite high as it is.

Good point. The ADN program here does 2 years of nursing courses and 1-1.5 years of pre reqs. The BSN program also does 2 years of nursing courses but with 2 years of pre reqs. My friend goes to the BSN school, and his nursing curriculum is identical to ours at the ADN program, the main difference in our two programs is the pre-reqs taken. They require organic chem, nutrition, history courses, art courses, foreign language, etc.

Not saying at all that those classes aren't important and help someone to be more well rounded, because they definitely do. However, I think many people assume that the difference between ADN and BSN programs is the nursing courses, and in some cases it's not.

I plan on going back for my BSN right away, and I am an advocate of higher education, however, holding a BSN/MSN/DNP does not automatically mean that your assessment and critical thinking skills are going to be superior to that of an ADN nurse. Your personality, life experiences, the way you think, etc play just as much of a role as your education. Will I be a better nurse with an MSN than I will be as an ADN? I think so, because I will have more knowledge which is always good. What I don't like is the way of thinking some people have that holding only an ADN puts you in this "box" as far as assessment and critical thinking skills go, and that my critical thinking skills are always going to be lesser than that of someone with higher education. Will having more education improve my critical thinking and assessment? Yes, but not having more education doesn't mean I'm automatically the "worst" at critical thinking if I'm the only ADN on a floor full of BSN nurses.

I guess my point is people should strive for higher education to be a better nurse than they were before and to be the best nurse They can be. To improve themselves. Not so they can say "well I have this degree so I'm a better nurse than that nurse over there"

allnurses Guide · Mar 27, 2013

Exactly. The variation between individuals may be greater than the variation due to their degrees, I don't think many would argue that. Higher education helps individuals reach their potentials.

In aggregate sufficient sample size should account for individual variations in each group, so on a population level it can be possible for the variation between degrees to show some significant difference.

As far as arguing, on average, ADN assessment skills are better than MSN skills, is a tad of a stretch.

SleeepyRN · Mar 27, 2013

I agree, as above, that variation between individuals is likely greater than that between degrees.
You mention assessment not being different, then gone on to say how BSNs are more trained in community health. Is there no assessment in community health? Is there no application of a community health assessment in tertiary care?

The poster was referring to assessment at the bedside. So that's what I was responding to. If I as an ADN-RN were to take a community health position, I would like more education in that field, yes.

SleeepyRN · Mar 27, 2013

Good point. The ADN program here does 2 years of nursing courses and 1-1.5 years of pre reqs. The BSN program also does 2 years of nursing courses but with 2 years of pre reqs. My friend goes to the BSN school, and his nursing curriculum is identical to ours at the ADN program, the main difference in our two programs is the pre-reqs taken. They require organic chem, nutrition, history courses, art courses, foreign language, etc.
Not saying at all that those classes aren't important and help someone to be more well rounded, because they definitely do. However, I think many people assume that the difference between ADN and BSN programs is the nursing courses, and in some cases it's not.
I plan on going back for my BSN right away, and I am an advocate of higher education, however, holding a BSN/MSN/DNP does not automatically mean that your assessment and critical thinking skills are going to be superior to that of an ADN nurse. Your personality, life experiences, the way you think, etc play just as much of a role as your education. Will I be a better nurse with an MSN than I will be as an ADN? I think so, because I will have more knowledge which is always good. What I don't like is the way of thinking some people have that holding only an ADN puts you in this "box" as far as assessment and critical thinking skills go, and that my critical thinking skills are always going to be lesser than that of someone with higher education. Will having more education improve my critical thinking and assessment? Yes, but not having more education doesn't mean I'm automatically the "worst" at critical thinking if I'm the only ADN on a floor full of BSN nurses.
I guess my point is people should strive for higher education to be a better nurse than they were before and to be the best nurse They can be. To improve themselves. Not so they can say "well I have this degree so I'm a better nurse than that nurse over there"

I feel like I wrote this post, lol. I've pointed out many times that ADNs are actually 4 year degrees as well. Our prerequisites just aren't included in our core nursing curriculum. Besides the science classes, our program required humanities classes as well. Admittedly not as much as a BSN of course. And of course we had to take English I & 2. Some could, and many do, do it in about 3 years. Since I have all my classes from my biology double major, I luckily had all those classes finished already, thank God. Minus nutrition and lifespan.

My humanities and interdisciplinary classes, while interesting and even enjoyable, in my opinion doesn't make me a better nurse. A more well rounded individual, sure. I very well could be wrong. I just don't see it. I'm open to hearing why BSNs believe so, although I can't guarantee that my opinion would be swayed.

What's kind of ironic is that I've always believed that core nursing courses should be expanded by 1 year. (3 years instead of 2) I never admitted this to anyone but my family because the other nursing students would think I'm crazy lol. I think 2 extra semesters of learning more in depth patho and doing clinicals would be extremely beneficial. In that last year, everything is finally coming together, the bigger picture being seen. 2 more semesters of more clinical and tons of case studies...I would have loved that. Yes, yes, I know. I know you get this once you start working. Its just my opinion. I'm ready for the tomatoes to be thrown at me, lol.

SleeepyRN · Mar 27, 2013

Other times they (BSN advocates, not me) will make the argument that the ADN role is adequate for basic bedside care, due to their more task-oriented education. but without a BSN they will have a limited ability to grasp abstract theory concepts, see the big picture, think critically, read and understand academic research or become well-rounded. I'm with you. I believe these things are much more a matter of individual differences, including prior degrees and personal life history.

I respect your opinion (and appreciate your healthy manner of debate as others can be condescending) but I still disagree. One's ability to read and understand academic research, in my opinion, comes from an individual's level of intelligence. Student A can enter a BSN program with average or even slightly lower than average reading and comprehention skills and struggle with the research that is required. Student B can enter an ADN program with above average skills and perform well with research assignments, which in my ADN program were numerous throughout the entire program, not just one research class. (Strict grading and very high expectations btw)

SO, my point. By your logic, student A who had difficulty with research, yet got by and obtained his/her BSN, will be better prepared than the ADN graduate who excelled at research. I'm not seeing the logic.

I also think that there is a limit to how much critical thinking can be taught in an academic setting. I believe that critical thinking comes with individual intelligence and more experience. So taking out other possible factors, an ADN nurse with say 5 years experience has better critical thinking skills than a new grad BSN. I'll add to that. Assuming all variables are the same, I believe a new grad BSN and a new grad ADN have the same critical thinking skills. Why do you believe they do not? Since tone is difficult to ascertain in some writing, I want to let you know that question is not to be snotty, but an honest question. Say a BSN and ADN are standing at the bedside of the same patient. What specific educational content can the BSN draw from that an ADN cannot? Is it from a research paper the BSN read? ADNs did/do research too. Is it a professional issues in nursing class the BSN took? I took 2 profesional issues in nursing classes (and compared the course descriptions of the ones I took and the ones I have yet to take for my RN-BSN....and they're the same topics.) Is it from an informatics class the BSN took? I don't see how that's relative to the topic. According to Aurora University's BSN program, there are only 3 nursing classing that I did not take in my ADN program: informatics, community outreach, and research. Public health and research were incorporated into our entire program. I agree and admit public health is probably focused on more in the BSN program. Not academic research though, that was abundant in our program.

So back to the 2 grads at the bedside with the patient. Which of those 3 classes makes the BSN more qualified? It's not from any Med-surg class or corresponding clinical. If that were the case, extra Med-surg would be incorporated into an RN to BSN program.

allnurses Guide · Mar 27, 2013

I respect your opinion (and appreciate your healthy manner of debate as others can be condescending) but I still disagree.

Thank you for that feedback, because it doesn't come naturally. In fact I think that somehow my attempt to sound fair has led you to believe I lean toward agreement with those who put forth what I will call a "BSN exclusive" point of view. In reality I'm a critic of that point of view. I try to tone it down out of respect for other members here who don't agree with us, because they often interpret criticism of their tactics as criticism of education itself, which is wrong

One's ability to read and understand academic research, in my opinion, comes from an individual's level of intelligence. Student A can enter a BSN program with average or even slightly lower than average reading and comprehention skills and struggle with the research that is required. Student B can enter an ADN program with above average skills and perform well with research assignments, which in my ADN program were numerous throughout the entire program, not just one research class. (Strict grading and very high expectations btw)

I agree with that, and would add that the amount and velocity of information available to us now compared to even 15 years ago makes the potential for one with that level of intelligence to constantly grow and learn more about their chosen field anytime they choose to without spending much or getting anyone's permission almost limitless.

SO, my point. By your logic, student A who had difficulty with research, yet got by and obtained his/her BSN, will be better prepared than the ADN graduate who excelled at research. I'm not seeing the logic.

Neither am I.

I also think that there is a limit to how much critical thinking can be taught in an academic setting. I believe that critical thinking comes with individual intelligence and more experience. So taking out other possible factors, an ADN nurse with say 5 years experience has better critical thinking skills than a new grad BSN. I'll add to that. Assuming all variables are the same, I believe a new grad BSN and a new grad ADN have the same critical thinking skills. Why do you believe they do not?

I don't believe they do not. I think the BSN advocates have co-opted a term and claimed they are the only purveyors of that term, in this case "critical thinking" or deductive reasoning. They can argue that a more comprehensive knowledge base improves the accuracy of your reasoning, but they can't teach reasoning itself, or more importantly prevent others from using it because they have deemed your job description as "task-oriented" or merely for purposes of "data-collection".

One of the things that drives me crazy is the invention of euphemistic, non-specific language to promote a point of view that has no real basis in fact. This is rampant in the ongoing campaign by the AACN, the ANA, and a few other groups who are all affiliated with each other.

You should question it! I do. I'll say that we should soon know how serious the problem of a less than 80% BSN workforce is taken by those who are sworn to uphold the public good, members of legislatures in all 50 states who thus far have rejected (except North Dakota who passed but later repealed their law) the lobbying pressure form the ANA and others. They have a golden opportunity to show by their actions what they truly believe.