ADN's being pushed out

allnurses Guide · Jun 30, 2013

*** As I have mentioned I haven't not seen any such reliable studies. Speaking as a rapid response nurse, whose job it is to respond to changed in patient condition, I have totally unable to detect and greater or lesser degree of critical thinking prioritization or assessment skills bases on the staff nurses degree. I spend large parts of his shift explaining and teaching things, not just the how, but the why to nurses who hold ADNs, BSNs and MSNs. Shouldn't there be some detectable difference between them?

I have heard the ADN vs BSN outcomes studies be criticized for validity but I haven't seen a solid argument for reliability: there are now several major studies which produce the same results. How valid they are is perhaps debatable given some of the methodologies, but they seem to be fairly reliable in terms of results, unless I am missing some major refuting papers.

As far as personal experience, yours is in a very high expertise speciality setting. Do you feel it is representative of "typical" bedside nursing? I wonder if you worked on a med-surg unit at a community hospital if your experience would be the same? I haven't worked as a bedside nurse for a number of years so I am likely not the best person to judge by personal experience either, hence why I place some trust in the published literature on the subject.

allnurses Guide · Jun 30, 2013

Four year college grads would be RN's and ADN grads can be *whatever" title can be thought up that won't cause offence (much).

This issue of title is alone an extremely complex issue.

First, you need to change the title moving from a set point forward, you can't go back and revoke a title that has already been granted.

Second, you would need to have separate licensing exams.

Third, don't we already have this exact system? The NCLEX-PN and NCLEX-RN with a one-two year versus four year degree and separate scopes of practice and separate titles?

PMFB-RN, RN · Jun 30, 2013

I have heard the ADN vs BSN outcomes studies be criticized for validity but I haven't seen a solid argument for reliability: there are now several major studies which produce the same results. How valid they are is perhaps debatable given some of the methodologies, but they seem to be fairly reliable in terms of results, unless I am missing some major refuting papers.

*** That is the price I pay for writing posts after working 12 hours and being awake for 30 hours. My usually bad grammar gets worse. I also intended to use the word "unbiased" rather than reliable.

As far as personal experience, yours is in a very high expertise speciality setting. Do you feel it is representative of "typical" bedside nursing?

*** My position is high expertise. The settings I practice in are rehab, med-surg, peds, ER and ICU. The nurses I deal with are just regular staff RNs, some fantastic and some not.

I wonder if you worked on a med-surg unit at a community hospital if your experience would be the same?

*** Med-surg is where I respond to a majority of rapid response calls. I practice in a small (250 bed) community (wonderful, high paying, good benifits, union, non-Magnet) hospital, at least for my main job as RRT RN. I also work part time in a much larger Magnet hospital doing critical care transport (ground, hate helicopters), teaching in the critical care nurse residency program, and occasionaly precepting nurse residents in a variety of ICUs including burn ICU, CVICU, PICU, MICU, ER and the trauma life support unit. I am also on the RRT team for that hospital but it is not a full time position. All positions obtained as an ADN RN.

I have never worked as a staff RN in med-surg.

PMFB-RN, RN · Jun 30, 2013

Second, you would need to have separate licensing exams.

*** Good point. The exam for the BSN grads would have to be much more comprehensive in scope than the current NCLEX RN is. This would mean a vast change would have to occure in BSN education since current programs teach to pass the same exam as the ADN programs.

MunoRN, RN · Jun 30, 2013

Leaving aside your excellent post there is another fly in the "BSN" ointment. Not all students either just out of high school or returning can cope with four year college studies.
BSN degrees do not function in a vacuum, and those students must meet the same entry, retention and graduation standards as everyone else on campus going for a four year degree.
General and organic chemistry, finite math, statistics, 300 and even 400 level English, and so forth just aren't up everyone's street academically. But it makes no difference if one obtains all A's in nursing major courses, if you cannot cope with gen ed/core you aren't going to graduate.
If you really want to deal with the real look to Canada and create two levels of professional nurse. Four year college grads would be RN's and ADN grads can be *whatever" title can be thought up that won't cause offence (much).
Nursing must adapt to serve the needs on the ground of the local area. For instance here in NYS yes, the large "destination" hospitals like NYP and Mount Sinai maybe able to justify hiring only BSN grads for whatever reasons. But there are plenty of hospitals elsewhere in the state that manage fine with ADN grads.

That's an understandable but nonetheless very inaccurate view of 2-year college curriculum and standards. The pre-Nursing program classes at a 2-year college are exactly the same as the classes one would take at a 4-year school. This is a requirement of all credit transfer agreements. The only difference is the location of the class. I remember going to school for my first (and ultimately unused) bachelors degree, a biology degree, I took my first quarter of the Organic chem series during the spring. I figured the second quarter of it would be hard if I waited a whole summer between the first and second quarter of the series so I should take the second quarter at the local community college, plus, I assumed it would be easier since it was at a community college. As it turned out, I was just one of many University students who falsely assumed a community college class would be easier, it was the hardest quarter of the series for me. The Universities largely dictate the standards that community colleges must follow since offering transferable credits is the majority of their business, and I don't know of any state that allows community colleges to teach to, or expect, a lower standard than their 4-year big brothers require. So, in general, if a student can't cut it at a 4-year school, then they can't cut it at a 2-year school either, and vice-versa.

Despite my O-chem experience, I still had a bit of a slanted view of ADN programs, until I started with my local ADN programs. I graduated from one of the top 5 BSN programs in the country, yet the lowest GPA admitted to my local ADN program last quarter was 3.86, while my top 5 alma mater typically runs GPA lower limit around 3.00, in the same classes.

I don't know of any Nursing programs that require 400 level English, although if you consider having previously taken 300 and 400 level classes to be an indicator of students who are more likely to "cut it" then it's actually ADN students who win that comparison; far more ADN applicants have previous bachelor's degrees than BSN applicants.

DoGoodThenGo · Jun 30, 2013

That's an understandable but nonetheless very inaccurate view of 2-year college curriculum and standards. The pre-Nursing program classes at a 2-year college are exactly the same as the classes one would take at a 4-year school. This is a requirement of all credit transfer agreements. The only difference is the location of the class. I remember going to school for my first (and ultimately unused) bachelors degree, a biology degree, I took my first quarter of the Organic chem series during the spring. I figured the second quarter of it would be hard if I waited a whole summer between the first and second quarter of the series so I should take the second quarter at the local community college, plus, I assumed it would be easier since it was at a community college. As it turned out, I was just one of many University students who falsely assumed a community college class would be easier, it was the hardest quarter of the series for me. The Universities largely dictate the standards that community colleges must follow since offering transferable credits is the majority of their business, and I don't know of any state that allows community colleges to teach to, or expect, a lower standard than their 4-year big brothers require. So, in general, if a student can't cut it at a 4-year school, then they can't cut it at a 2-year school either, and vice-versa.
Despite my O-chem experience, I still had a bit of a slanted view of ADN programs, until I started with my local ADN programs. I graduated from one of the top 5 BSN programs in the country, yet the lowest GPA admitted to my local ADN program last quarter was 3.86, while my top 5 alma mater typically runs GPA lower limit around 3.00, in the same classes.
I don't know of any Nursing programs that require 400 level English, although if you consider having previously taken 300 and 400 level classes to be an indicator of students who are more likely to "cut it" then it's actually ADN students who win that comparison; far more ADN applicants have previous bachelor's degrees than BSN applicants.

Cannot speak for where your community (two year) and four year college/university are but at least here in NYC for the City University there is a huge difference and it begins with admission requirements. Testing FAQs - Testing - CUNY

Under NYC statues any student who graduates from a NYC high school is automatically promised a spot in CUNY. Where one goes, that is to a four year or community college depends upon the above. Back in my day the senior colleges (four year schools) only basically required one graduate with a high school average of 80% or better. That wasn't working out and thus again see the above.

How classes and such are taught does vary in the CUNY system by which type of school one attends. For instance at Hunter-Bellevue IIRC the chemistry classes are not just pre-nursing and student nurses but (were) made up of all Hunter students studying health sciences. This included the "Pre-Health) majors such as pre-med, dentist and right down to physician assistant. On the ground this translated to chemistry courses taught at not always the 'chemistry for weeines" level some nursing students would like. This of course is natural for a four year college, but not all what some expect.

Pre-nursing sequence for the ADN programs at each of the CUNY two year programs are basically the same with perhaps slight variations: Nursing

To my knowledge not one of the ADN programs requires full organic chemistry, some may have a fundamentals of general and organic however. While NYS mandates organic chemistry for most if not all BofS candidates. Here is the recently revised Hunter-Bellevue School of Nursing curriculum: NEW GENERIC PATHWAY PROGRAM â€" Hunter College

PMFB-RN, RN · Jun 30, 2013

To my knowledge not one of the ADN programs requires full organic chemistry, some may have a fundamentals of general and organic however. While NYS mandates organic chemistry for most if not all BofS candidates. Here is the recently revised Hunter-Bellevue School of Nursing curriculum: NEW GENERIC PATHWAY PROGRAM â€” Hunter College

*** Some BSN programs in your state, and maybe some others require O chem, however a BSN, or MSN for that matter is NO indication that a nurse has taken O chem. Many BSN programs do not require it at all (nor should they IMO). The BSN programs here at the UW schools do not require organic chem.

MunoRN, RN · Jun 30, 2013

Cannot speak for where your community (two year) and four year college/university are but at least here in NYC for the City University there is a huge difference and it begins with admission requirements. Testing FAQs - Testing - CUNY
Under NYC statues any student who graduates from a NYC high school is automatically promised a spot in CUNY. Where one goes, that is to a four year or community college depends upon the above. Back in my day the senior colleges (four year schools) only basically required one graduate with a high school average of 80% or better. That wasn't working out and thus again see the above.
How classes and such are taught does vary in the CUNY system by which type of school one attends. For instance at Hunter-Bellevue IIRC the chemistry classes are not just pre-nursing and student nurses but (were) made up of all Hunter students studying health sciences. This included the "Pre-Health) majors such as pre-med, dentist and right down to physician assistant. On the ground this translated to chemistry courses taught at not always the 'chemistry for weeines" level some nursing students would like. This of course is natural for a four year college, but not all what some expect.
Pre-nursing sequence for the ADN programs at each of the CUNY two year programs are basically the same with perhaps slight variations: Nursing
To my knowledge not one of the ADN programs requires full organic chemistry, some may have a fundamentals of general and organic however. While NYS mandates organic chemistry for most if not all BofS candidates. Here is the recently revised Hunter-Bellevue School of Nursing curriculum: NEW GENERIC PATHWAY PROGRAM â€” Hunter College

Typically the remedial classes CC colleges offer are open to everyone, however not everyone is guaranteed the ability to take college level classes and progress to an associates degree, this appears to be no different in the case of CUNY.

I picked a random NY ADN program; Borough of Manhattan Community College (BMCC), and it turns out they do require the same chem classes as the Hunter Bellevue BSN program, they just list them differently. The Hunter-Bellevue pre-reqs lists O-chem specifically, while the BMCC lists BIO 425 and 426, but you'll notice the same O-chem series that is listed in the Hunter Bellevue pre-reqs is a pre-req for the BIO 425 and 426 classes that BMC requires. The only difference appears to be that Hunter-Bellevue adds a requirement of 1 course of US history.

DoGoodThenGo · Jun 30, 2013

Typically the remedial classes CC colleges offer are open to everyone, however not everyone is guaranteed the ability to take college level classes and progress to an associates degree, this appears to be no different in the case of CUNY.
I picked a random NY ADN program; Borough of Manhattan Community College (BMCC), and it turns out they do require the same chem classes as the Hunter Bellevue BSN program, they just list them differently. The Hunter-Bellevue pre-reqs lists O-chem specifically, while the BMCC lists BIO 425 and 426, but you'll notice the same O-chem series that is listed in the Hunter Bellevue pre-reqs is a pre-req for the BIO 425 and 426 classes that BMC requires. The only difference appears to be that Hunter-Bellevue adds a requirement of 1 course of US history.

Yes, in theory remedial classes are open to any CUNY student the goal is for at least recent high school graduates to arrive either a two or four year college ready to work on that level. There has been much noise of late regarding the numbers of NYC high school grads arriving at CUNY requiring remedial classes, some quite extensive. CUNY’s Remediation Needs Remediation | EdVox

Rise in remedial enrollment noted at CUNY, SUNY | Baruch Ticker - Baruch Connect

Things got so bad that the head of CUNY basically took the NYC Department of Education to task essentially telling them to pull up their socks and stop graduating students that were not prepared.

Should also note that as of 2001 CUNY senior/four year colleges no longer offer remediation classes. If one cannot pass and or otherwise demonstrate competence in Math or English (see above) you can either take an immersion class or remedial classes at a community college or part of an associate degree program elsewhere, then transfer.

CUNY Trustees Approve Resolution To End Remediation in Senior Colleges

Regarding chemistry, at least for CUNY community colleges things are varied. While BMCC does require organic, neither College of SI, Queensborough, nor Meger Evers. The last three have various general chemistry or physics classes however.

The debate about how much science a nurse should know is one that has been going on for years so doubt you and I will solve it, *LOL*. Some in the profession seem to feel all professional nurses prepared on at least the BSN level should have strong exposure to sciences.

http://www.aacn.nche.edu/education-resources/baccessentials08.pdf

Esme12, ASN, BSN, RN · Jul 1, 2013

The studies have shown better patient outcomes in those patients cared for by BSN. Aiken has done plenty if these studies herself. One cannot convince non-BSN that BSN is preferred. We need to look to better our profession then fight about it among ourselves.

Right.....the person performing the study has a vested interest...for me that is a conflict of interest and the study to me looses it's objectivity of truthfulness and accuracy.

I do believe the best thing is going to be on level entry if only so we can stop beating this dead horse........and I also believe that in this horrible job market that there are some markets that are being selective to the BSN.

Having been a nurse my self for 34 years......I was ADN entry. MY BSN added nothing to my experience but how to better navigate the internet and take online courses. To me it added NOTHING to make me a better nurse....but that was before all this push for BSN entry and the dumbing down of the bedside nurses role saying that physical assessment is an "advanced skill" and suddenly without mounds of debt you could no longer be a clinical Spec or manager.

I think that we had better leadership when those at the top had already put in their time and had been a bedside nurse....and was promoted because of their experience and exemplar reputation as a nurse first that learned how to be a boss.....than someone who couldn't stand bedside nursing so they went back to school to become the boss and tell everyone what evidence based practice is even though they have never practiced the evidence.

PMFB-RN, RN · Jul 1, 2013

Right.....the person performing the study has a vested interest...for me that is a conflict of interest and the study to me looses it's objectivity of truthfulness and accuracy.

*** Not just you.

I was ADN entry. MY BSN added nothing to my experience but how to better navigate the internet and take online courses. To me it added NOTHING to make me a better nurse....

*** Mine was even worse. I am pretty sure I got dumber while "earning" my BSN. I certainly missed out of some real world experience and applicable training while I was writing a paper about what it was like to walk around with a golf ball in my hand and a sock over it.

but that was before all this push for BSN entry and the dumbing down of the bedside nurses role saying that physical assessment is an "advanced skill" and suddenly without mounds of debt you could no longer be a clinical Spec or manager.

*** Ah, not just me who feels the staff nurse's roll has been dumbed down.

I think that we had better leadership when those at the top had already put in their time and had been a bedside nurse....and was promoted because of their experience and exemplar reputation as a nurse first that learned how to be a boss.....than someone who couldn't stand bedside nursing so they went back to school to become the boss and tell everyone what evidence based practice is even though they have never practiced the evidence.

*** Tell it sister!

PinkNBlue, BSN, RN · Jul 1, 2013

Love the last post above mine (darn phone didn't let me quote it). So so true.