ADN's being pushed out

[MSN Student]

I work for a large Magnet hospital. As nursing becomes more popular, and nurses not in short supply, I have noticed something ominous has being going on lately. Several of our older and very seasoned ADN nurses are being fired. The excuses for firing are ridiculous. I have sadly seen some excellent nurses lose their jobs. I am wondering if they want to get rid of the ADNs so they can look "better" with an all BSN staff. Or perhaps they want rid of older nurses who have been there longer because they are higher on the pay scale. Either way, it is very scarey. I myself am BSN, and i am not ashamed to say that what I know does not hold a candle to these fired nurses. Any thoughts?

[PMFB-RN, RN]

Also why BSN's, why not BDN's? ADN is not my degree, its ASN. I have never met someone with a BDN or ADN on there diploma. Just an observation.

*** There are a variety of associate degrees for nurses. ADN is used to include them all. For example I have an associates in applied science, others have different degrees that lead to taking the NCLEX. Rather than list all the different associates degrees we just say ADN.

There are really only two bachelors degree in nursing. The BSN and the BAN, but the BAN is pretty uncommon outside the upper Midwest.

[Smiley06]

[COLOR=#003366]PMFB-RN

http://www.aacn.nche.edu/media-relations/fact-sheets/impact-of-education here is one of the many studies that suggest this.

You can look up the rest. It is not a biased opinion! And many hospitals are trying to become magnet status which is pushing out ADNs and hiring more BSNs because of the studies that suggest patient care is higher with BSNs. Hince the creation of the original post.

I am not pro ADN or BSN I am just saying why write a post about someone belittling your program ADN or BSN and then in the same post belittle there program. Unless you can state facts.

If everyone passed the same boards why does it matter.

[PMFB-RN, RN]

American Association of Colleges of Nursing | The Impact of Education on Nursing Practice here is one of the many studies that suggest this.

*** I see, first there are studies that "prove", now they "suggest". That is an AACN opinion piece. Why is it that those who do studies that find that BSN nurses are better are those who stand to gain financially from more BSN nurses?

You can look up the rest. It is not a biased opinion! And many hospitals are trying to become magnet status which is pushing out ADNs and hiring more BSNs because of the studies that suggest patient care is higher with BSNs. Hince the creation of the original post.

*** The problem with that is that first, many hospital are dropping Magnet. Magnet is headed towards being a fad of the past. Second nothing about Magnet certification requires a candidate, or certified hospital to hire a certain percentage of BSN prepared staff nurses. There is a requirement for the hospital to have a plan in place to meet the IOM's recommendations. You know the IOM, the organization that is a prime distributor of false "nursing shortage" propaganda.

I am not pro ADN or BSN I am just saying why write a post about someone belittling your program ADN or BSN and then in the same post belittle there program. Unless you can state facts.

If everyone passed the same boards why does it matter.

*** Everybody seems to have their own facts. However when one group is attempting to eliminate the very existence of another, it is normal for those who are to be eliminated to feel defensive and occasionally fight back against their attackers.

[SC APRN, DNP, APRN, NP]

*** There are a variety of associate degrees for nurses. ADN is used to include them all. For example I have an associates in applied science, others have different degrees that lead to taking the NCLEX. Rather than list all the different associates degrees we just say ADN.

There are really only two bachelors degree in nursing. The BSN and the BAN, but the BAN is pretty uncommon outside the upper Midwest.

So why not just say "BDN"?

[PMFB-RN, RN]

So why not just say "BDN"?

*** Because it would be silly. There are only two kinds of bachelors degrees in nursing in the US, but many more associates degrees.

[avengingspirit1]

In response to Boston FNP:

So far, all the so-called data I've seen that tries to lend credence to the notion that hospitals staffed with more BSNs provide better patient care has come from those who stand to benefit financially by having nurses run back to school. It's similar to a Chevy salesman providing data to prove that a Chevy is better than any other brand out there. You have not provided any data from sources other than those who will gain by driving the BSN push. The ability to think critically in clinical situations comes from experience alone. I am not way knocking higher education. If someone wants to spend the rest of their life acquiring more letters after their name and still be paying it off in their 70s, that's their choice. But don't push it on the rest of us. I happen to prefer chocolate ice cream but should I propose that everyone else eat chocolate ice because it is better?

Many nurses have already sacrificed much time and money to become nurses. Maybe now they just want to go to work and spend their off time with family. Maybe they have other interests outside of nursing they want to pursue. Or maybe they just don't want to sit in a classroom or in front of a computer anymore writing papers in APA format to better the bottom line of a university or keep professors employed.

Before I became a nurse, I was teaching and started working on master's in education. The material presented was the same material I learned in undergraduate school but just packaged differently and cost 3X more. The proof that Magnet Hospitals are a scam and that higher degree pushes are all about money have come from nurses who've worked in magnet hospitals and people who have worked in higher education systems. They have spoken to me but will not speak officially for fear of losing their jobs or being blacklisted.

There are many ADN nurses who are better nurses than those with a BSN. And there are many BSN nurses who are better than Associates or ADN nurses. Either way, it all has to do with the individual nurse, not the type of degree they may have.

[CrunchRN, ADN, RN]

Blah, blah, blah..................... LOL! We must have 8 million pages of this debate from the last year alone.

[PMFB-RN, RN]

It has been our (one of the hospitals where I work) experience that nurses who are educated in the hospital's 9 month nurse residency program and then assigned to a on-unit mentor for the next year have fewer medication errors, and their patients are more often within parameters, have fewer unplanned extubations, fewer cases of VAP, central line infections and do better in a host of other quality markers than nurses who were not trained in the residency. Of course being one health system the numbers are small, but due to the very high data collection they have had for many years, measurable. This is true regardless of weather or not the nurse has a diploma, ADN or BSN (but does not hold true for DE MSN grads, but those numbers are very small and I hesitate to draw conclusions).

Nurses in the residency spend a month in general hospital orientation and taking refresher courses in A&P and patho. Then for 4 months they are assigned a trained preceptor on a busy med-surg unit. They work two 12 hour shifts a week on med-surg and have two 8 hour class room days a week. Their clinical progress is measured and tested. The classes are very high quality and consist of basic things like EKGs, ACLS, TNCC as well as many classes on specific patient populations. For example when learning neuro they will have a neuro surgeon and neurologist come and speak about their kind of procedures they do, why they do them, and what the important nursing considerations are for their patients. Then an experienced RN will teach classes about nursing care, A&P and patho for neuro surg and neurology patients. then the residents will me placed with a preceptor and be assigned to care for neuro patients. Then the resident will be tested in both a written test and a hands on skills test (for example operating an ICP monitor or managing a ventricular drain). These tests are high stakes. The processes repeated fro each patient population, CV surg, trauma, renal, etc. They are also sent tp places like same day surgery to practice placing IVs, ER to place NGs and other places to learn hands on skills. Each resident will also spend a day with the wound care nurses, a respiratory therapists and others. They will also get the opportunity to observe surgeries and procedures.

After the 4 months of med-surg clinical and classes they are assigned a trained preceptor in the SICU, or other unit they will be working in (ER, PACU, PICU, NICU, MICU and others). They will work two 12 hours shifts in the units with their preceptors and continue with the two 8 hour class room days for three months. They will also spend a shift of two in other units, like the SICU residents will spend a shift in ER and PICU, ect. The last month will be three 12 hour shifts a week in their assigned unit working closely with their preceptor and one 4 hour day for testing and evaluations. They have both written and hands on skills tests to pass and weekly evaluations between the residency director and their preceptor to monitor progress. Some wash out and don't make it. After residency they are assigned an on-unit mentor and work the same schedule as their mentor for a year. The mentor has agreed to be the "go to" person for that nurse and is an experienced nurse in that unit.

Now I believe that nurses trained in the residency program, or similar will out preform (measurable improved patient outcomes) nurses not so trained. I have a limited amount of data to back up my belief.

I could take the same position as the "BSN as entry to practice" people and say that a residency should be required for RN practice. I would also claim that anyone who doesn't agree is "against education".

Of course no study would ever be done on patient outcomes of residency trained nurses. There isn't any money to made doing so.

[LadyFree28, BSN, LPN, RN]

Blah blah, blah..................... LOL! We must have 8 million pages of this debate from the last year alone.[/quote']

When I joined in 2004, the MOST popular thread was LPN vs RN.

No matter what "versus" it seems as though this issue is more enacted HERE than on the actual floor and field.

There are FAR more things we nurses can do to improve our practice and celebrate our diversity in our field...within reason....I think that is possible without making assumption on how our fellow colleagues desire to enter the profession...it what we DO once we are LICENSED that make a difference in contributing to our profession is what matters.

There is investment in education, there is no doubt about that, and one is free to do so. It's WHAT you CHOOSE to do with it to contribute to the profession...If you feel as though you are contributing to the profession, then keep the contribution coming...keep calm and NURSE on... instead of beating this dead horse...

You can't push ANY group of nurses out of anything...as hard as "some interested parties" seem to be...it just is not going to happen... nursing history has been the greatest indicator and teacher of this; just revisiting particles of this dead horse is only partaking in a more of venting match, IMHO.

NEWSFLASH: Nurses-LPN, ADN, BSN...nurses of every level are here to STAY.

[inshallamiami]

In reply to Boston FNP,

So tell me how taking redundant courses (I say redundant because this material is included in any RN program) such as Theoretical Foundations, Current Issues, Professional Ethics and Leadership will mean the difference in patient outcomes. Those courses came right from the syllabuses of RN-BSN programs I've reviewed. There is not one thing there that will make any difference clinically.

You obviously are coming from the perspective of someone who is affiliated with or working for a college or university and they are probably picking up your tuition tab. Many universities in the Philadelphia area will pick up tuition tabs if you teach either in the classroom or as clinical instructor. That is probably why you can have a baby at home and pay off a new mortgage.

We all know that colleges and universities are a business and their business is to increase revenue. That came from an administrator in one of Philadelphia's healthcare systems.So please stop all the phony altruism about how having nurses run back to school is for the benefit of patients. Many hospitals in the area now have agreements with universities that offer on-site RN-BSN programs. What better way to make sure those seats are full and keep that revenue coming in than for a hospital to require its nurses to obtain a BSN. Talk about a racket!

The only winners in this BSN drive will be the schools. They are guaranteed the tuition money from the federal "guaranteed" student loan programs. The now greatly indebted nurse is not guaranteed to make any more money than they did before they got the BSN and the patients will receive no better care. And as far as BSNs being required for "Magnet Status". That's another racket meant to deceive the uninformed general public into thinking one hospital is better than another. All of the nurses I talked said Magnet Status is a scam and it many cases has made working conditions worse. Hospitals pay the ANA thousands of dollars in order to receive the large government stipends that are awarded for obtaining and maintaining Magnet Status. I have been working to get the message out through the media.

To risk losing our most experienced nurses, who many are in their 40s and 50s, by mandating they put out thousands of dollars for a BSN or risk termination is one of the dumbest things I've ever heard. "Embarrassing to explain to patients why there are so many entry levels into nursing?" I have never had a patient ask me whether I had a diploma or BSN. The only thing they want to know is; are you experienced and can you help me. I'll tell you what will be embarrassing; when I tell people the truth that hospitals are forcing out their most experienced older nurses to hire new BSNs so they can pay them the bottom end of the nursing pay scale. And that is the truth that also came from a health system administrator!

Absolutely correct! It is ALL about the money

[LadyFree28, BSN, LPN, RN]

It has been our (one of the hospitals where I work) experience that nurses who are educated in the hospital's 9 month nurse residency program and then assigned to a on-unit mentor for the next year have fewer medication errors, and their patients are more often within parameters, have fewer unplanned extubations, fewer cases of VAP, central line infections and do better in a host of other quality markers than nurses who were not trained in the residency. Of course being one health system the numbers are small, but due to the very high data collection they have had for many years, measurable. This is true regardless of weather or not the nurse has a diploma, ADN or BSN (but does not hold true for DE MSN grads, but those numbers are very small and I hesitate to draw conclusions).

Nurses in the residency spend a month in general hospital orientation and taking refresher courses in A&P and patho. Then for 4 months they are assigned a trained preceptor on a busy med-surg unit. They work two 12 hour shifts a week on med-surg and have two 8 hour class room days a week. Their clinical progress is measured and tested. The classes are very high quality and consist of basic things like EKGs, ACLS, TNCC as well as many classes on specific patient populations. For example when learning neuro they will have a neuro surgeon and neurologist come and speak about their kind of procedures they do, why they do them, and what the important nursing considerations are for their patients. Then an experienced RN will teach classes about nursing care, A&P and patho for neuro surg and neurology patients. then the residents will me placed with a preceptor and be assigned to care for neuro patients. Then the resident will be tested in both a written test and a hands on skills test (for example operating an ICP monitor or managing a ventricular drain). These tests are high stakes. The processes repeated fro each patient population, CV surg, trauma, renal, etc. They are also sent tp places like same day surgery to practice placing IVs, ER to place NGs and other places to learn hands on skills. Each resident will also spend a day with the wound care nurses, a respiratory therapists and others. They will also get the opportunity to observe surgeries and procedures.

After the 4 months of med-surg clinical and classes they are assigned a trained preceptor in the SICU, or other unit they will be working in (ER, PACU, PICU, NICU, MICU and others). They will work two 12 hours shifts in the units with their preceptors and continue with the two 8 hour class room days for three months. They will also spend a shift of two in other units, like the SICU residents will spend a shift in ER and PICU, ect. The last month will be three 12 hour shifts a week in their assigned unit working closely with their preceptor and one 4 hour day for testing and evaluations. They have both written and hands on skills tests to pass and weekly evaluations between the residency director and their preceptor to monitor progress. Some wash out and don't make it. After residency they are assigned an on-unit mentor and work the same schedule as their mentor for a year. The mentor has agreed to be the "go to" person for that nurse and is an experienced nurse in that unit.

Now I believe that nurses trained in the residency program, or similar will out preform (measurable improved patient outcomes) nurses not so trained. I have a limited amount of data to back up my belief.

I could take the same position as the "BSN as entry to practice" people and say that a residency should be required for RN practice. I would also claim that anyone who doesn't agree is "against education".

Of course no study would ever be done on patient outcomes of residency trained nurses. There isn't any money to made doing so.

On your last line...that was my research proposal in my research course in my BSN program. There are several "transition to practice" research programs going on, the PIs have used Benner's model; some programs are in the Phase II in research in I think two or three states.

I think the push for a comprehensive "transition to practice" as a rule is far more important to focus on...but that is another thread on AN that we have participated in and that is more important in our profession than the entry level of practice. The programs are promising for new and experienced nurses. I hope for a variation of transition to practice and pathways of giving nurses the tools to be an "expert" in each area of nursing...I've been able to do this in the "bedside" and hopeful to continue to do so in every capacity of my practice.

[avengingspirit1]

In response to PMFB-RN:

What you described is the finest example I ever heard of for transitioning a new nurse from a new grad to the role of caregiver. Residencies like the one you described should be required of all nurses regardless of what type of nursing program they graduated from. But hospitals will argue that they don't have the resources to do this. Yet take a look at the salaries of those in a hospital system's top management and you'll see where the resources are going.