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]

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.

*** The residency has saved the hospital a ton of money in recruiting and nurse turn over costs. The grads are in big demand with other area hospitals and we have seen several cases where another hospital happily bought out the contract the residents signed to be able to hire them.

The only fly in the ointment were BSN prepared SICU residents taking the training but heading off for CRNA school before completing the two year contract they signed to get into the residency. As a result of that only ADN prepared grads are hired into the residency for the SICU. BSN and ADNs are both hired for the residency for other units. With the exception of one resident who was killed in a car crash, and another who dropped out of nursing to be a stay at home mom, the ADNs have a 100% contract completion rate so far.

I agree it should be standard. I also declare anyone not advocating for residency training rather than BSN as entry to practice as anti education.

[BostonFNP, APRN]

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.

I asked this originally and it went unanswered, so I will challenge you again with it: where are the published studies refuting any of the half-dozen major studies that all point in the same direction? If there is clearly bias in the published outcomes studies, shouldn't it be easy for the studies to be refuted? To use your example:if Chevy was publishing data regarding its miles-per-gallon superiority over Ford, do you think Ford would publish its own data showing that their miles-per-gallon are the same or better? Or do you think they would just stand in the corner and say that "well Chevy is biased thats why their cars have better gas milage"?

There is a significant amount of data out there that has been provided. You don't like the results so you choose to exclude them and claim that there is no "unbiased" data.

The ability to think critically in clinical situations comes from experience alone.

What study does that come from?

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.

This is, by far, the worst of the arguments for not requiring a higher base level of education. It makes me cringe. We are talking about patient outcomes, their lives, and your argument (and I have heard it many times from others) is that it's simply not convenient to individual nurses to work toward improving outcomes. Many nurses have sacrificed time and money? Who are the nurses that haven't sacrificed time and money? If any haven't its the ones with less education right?

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.

Are you suggesting that undergrad nursing classes are the same material as graduate nursing classes?

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.

What proof? Link please.

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.

I agree wholeheartedly; it is largely based on the individual. Education makes an individual better. Nurse A with a ADN is better than Nurse B with a BSN? Sure, it happens all the time, especially when you add experience in. The question is Nurse A with a BSN better than Nurse A with an ADN. This is that the data suggests, not the comparison between A and B.

[BostonFNP, APRN]

I agree it should be standard. I also declare anyone not advocating for residency training rather than BSN as entry to practice as anti education.

I love the idea of tertiary care residency programs, and the literature clearly supports their effectiveness (though most of that research was done by hospital-affiliated researchers, so maybe it shouldn't be counted because it is biased?).

Do you think that residency programs would have the same effect on all of nursing, remembering that only about half of RNs work in tertiary care settings? It is an interesting notion.

[avengingspirit1]

In response to BostonFNP:

You say there is a significant amount of data out there to prove that hospital staffed with more BSN nurses provide better patient care. I also challenged you time and time again to show me data from sources other than studies backed by organizations such as the AACN, ANCC, IOM, ANA and four year schools which all stand to benefit by having nurses run back to school. You have yet to provide any such source.

Even the authors of the 2003 Landmark study "More BSNs equal better patient outcomes" admitted their data was manipulated but were very quick to say it produced no bias. In the Health section of the Sun. July 14 edition of the Philadelphia Inquirer, hospital patient satisfaction scores were published. The hospital scoring the lowest just went to BSN only hiring in the last year and a half. This is one of the hospitals that is forcing its most experienced nurses to obtain BSNs under the threat of termination. As you can see it did wonders for their satisfaction score. Another local hospital that went to BSN only hiring within the last year, didn't even make the middle of the list. The top two scoring hospitals do not have a BSN only hiring mandate. What does that tell you.

Have you talked to real working nurses and their patients? Do you read the postings from real working nurses instead of studies done by people who many sit in university ivory towers and haven't touched a patient in ten years or more?

What makes me cringe is that many in academia need a study with evidence based research that costs thousands of dollars to tell them if one goes out in the rain without an umbrella, they'll get wet. Talk to real working nurses and patients then get back to me. In the meantime I'll wait for that unbiased data you claim is out there; just like I'll wait for the second coming.

I'll have more respect for those in academia if they would admit the BSN push is purely money driven. I'll use it against them in one my newspaper editorials, but I'll respect them for telling the truth.

[SleeepyRN]

I don't think my BSN degree will make me a better nurse. I think having the intelligence, perseverance, dedication, integrity, and drive to gain the most education I can makes me a better nurse.

I do have some questions? I am a RN with an ASN degree and 18 credits into a RN-BSN program. Why are we labeling ourselves? I am not a ADN, ASN, future BSN. I am (name) a Registered Nurse.

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. Why can't we all just be Nurses?

My diploma does read ADN.

[SleeepyRN]

I don't understand why ADNs get so upset because they think that BSN grads belittle them but in the same breathe belittle the BSN by stating that BSN grads are ill prepared and don't have clinical experience. Aren't you doing the same thing that you don't want done to you? There are studies that prove that BSN students are better prepared which is why most hospitals are transitioning to BSN only. But does it really matter who is better prepared? We all pass the same boards, right? Get over it![/quote']

I think one of the problems is grouping all ADNs as having the same opinion and grouping ALL BSNs as having the same opinions. I don't get "so upset" when a BSN looks down on my education. I get slightly annoyed at that one individual's ignorance. On the other side of things, I have heard SOME other ADNs say that the quality of clinicals of BSNs is inferior to that of ADNs. Not all of us believe so. I certainly don't.

I've said it before, the quality of BSN programs vary among themselves, as do the quality of ADN programs among themselves. When speaking of clinicals, each student's experience can vary greatly among the students who are in the same clinical group, let alone comparing one student's education in an ADN clinical and one student's experience in a BSN clinical. I know just in my program alone, students with one clinical instructor at one facility, had a greatly different experience than those students with a different clinical instructor at a different facility.

My point is, let's keep in mind the great variety that exists among these schools. I'm sure there are some ADN programs that are superior to some BSN programs, and vice versa. Let's also keep in mind that the student's educations vary greatly as well. Many ADN grads have other bachelor's or even master's degrees that they bring to the table, making their education greatly superior to a BSN who only has a BSN. And yes, I know, vice versa exists as well.

Why can't we all just respect one another? We all have special talents/knowledge/experience that we bring to the table. Acknowledge that fact and learn to be more open minded and respectful toward one another. We all need to learn to support each other more and stop all this divisiveness. A BSN grad has the right to be proud of their degree, and so do ADNs. But please, let's start being respectful of one another.

[SleeepyRN]

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.

Actually studies HAVE been done showing that new grads excell more so if they go through a residency program. Unfortunately, I cannot recall the name of the study. I believe an article in Nursing2012 or Nursing2013 covered it. These residency programs seem so much more beneficial than extra time in leadership and community health that is required in a BSN program. I'd take THAT nurse over any other new grad (ADN or BSN) with minimal training ANY day. I wish these residency programs were more prevalent. There is only one hospital system in my area that does this, and of course, due to limited spots, it is extremely competitive. You can have a top notch GPA and letters of recommendation along with years of hospital tech experience and not get in. It's a shame, but that's our economy.

[SleeepyRN]

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.

I have no studies to back this up, but I believe hospitals are hiring BSNs so that they can become/maintain Magnet Status, not because they believe patient outcomes will be better, but because they want to attract patients with insurance or money, making it all about the money. They want to look more "upscale" to attract MONEY. I worked for a hospital before, during and after the process of becoming Magnet. No one will convince me that the ADN nurses who got "let go" during this process, was a coincidence in timing. They cleaned house and now have many new grads. Mostly PCTs who worked there and then graduated right when the hospital became magnet.

[PMFB-RN, RN]

Do you think that residency programs would have the same effect on all of nursing, remembering that only about half of RNs work in tertiary care settings? It is an interesting notion.

*** I can see how learning superb assessment and critical thinking skills and gaining experience dealing with a large variety of patient conditions, and the confidence that comes with it, would benefit any nurse.

Just my opinion but I don't see any reason why RN case managers, or school nurses, or whatever kind of nurse couldn't have their own residency tailored words the area of nursing they will work in. After all we don't send orthopedic surgeons to the same residency an internal medicine physicians. Different fields, different residencies.

[PMFB-RN, RN]

I asked this originally and it went unanswered, so I will challenge you again with it: where are the published studies refuting any of the half-dozen major studies that all point in the same direction? If there is clearly bias in the published outcomes studies, shouldn't it be easy for the studies to be refuted? To use your example:if Chevy was publishing data regarding its miles-per-gallon superiority over Ford, do you think Ford would publish its own data showing that their miles-per-gallon are the same or better? Or do you think they would just stand in the corner and say that "well Chevy is biased thats why their cars have better gas milage"?

*** Of course Ford would have a vested financial interest in refuting Chevy's claim. There is nobody to make money from a study to refute the biased studies.

[BostonFNP, APRN]

*** Of course Ford would have a vested financial interest in refuting Chevy's claim. There is nobody to make money from a study to refute the biased studies.

Not the AACN or N-OADN? Or the hospitals like yours that only hire ADNs? Not current ADN nurses?

[BostonFNP, APRN]

In response to BostonFNP:

You say there is a significant amount of data out there to prove that hospital staffed with more BSN nurses provide better patient care. I also challenged you time and time again to show me data from sources other than studies backed by organizations such as the AACN, ANCC, IOM, ANA and four year schools which all stand to benefit by having nurses run back to school. You have yet to provide any such source.

Even the authors of the 2003 Landmark study "More BSNs equal better patient outcomes" admitted their data was manipulated but were very quick to say it produced no bias. In the Health section of the Sun. July 14 edition of the Philadelphia Inquirer, hospital patient satisfaction scores were published. The hospital scoring the lowest just went to BSN only hiring in the last year and a half. This is one of the hospitals that is forcing its most experienced nurses to obtain BSNs under the threat of termination. As you can see it did wonders for their satisfaction score. Another local hospital that went to BSN only hiring within the last year, didn't even make the middle of the list. The top two scoring hospitals do not have a BSN only hiring mandate. What does that tell you.

Have you talked to real working nurses and their patients? Do you read the postings from real working nurses instead of studies done by people who many sit in university ivory towers and haven't touched a patient in ten years or more?

What makes me cringe is that many in academia need a study with evidence based research that costs thousands of dollars to tell them if one goes out in the rain without an umbrella, they'll get wet. Talk to real working nurses and patients then get back to me. In the meantime I'll wait for that unbiased data you claim is out there; just like I'll wait for the second coming.

I'll have more respect for those in academia if they would admit the BSN push is purely money driven. I'll use it against them in one my newspaper editorials, but I'll respect them for telling the truth.

First off, these studies do not "prove" anything. They do show a correlation that suggests that outcomes vary by education level. Understanding this comes from a basic research class and highlights why those classes are important.

So you are looking for a study in which the author(s) are not affiliated with a four year college or a major professional organization? Tell me, what percentage of published research do you think fits this criteria? I would venture less than 5%.

How about this study:

The impact of hospital nursing characteristics on 30-day mortality.

Authors

Estabrooks CA, Midodzi WK, Cummings GG, Ricker KL, Giovannetti P.

Journal

Nurs Res. 2005 Mar-Apr;54(2):74-84.

All data is "manipulated" as part of statistical analysis, this is not bias. In fact it is an important part of ensuring that studies are not confounded or biased. Again this is basic research knowledge highlighting the need for nurses to understand how to read and interpret research.

As far as your "article" in the local newspaper, that is a great example of how raw (non-manipulated in your terms) data may not tell the whole story. What was the staffing ratio in that hospital? What was the acuity level of the patient? Was this a nursing-specific patient scarification survey?

How long have you been a RN, talking to "real nurses"? Lets compare your years of experience in direct patient care to those "ivory tower" nurses you are so fond of insulting. Maybe you should have the slightest bit of respect for those "fake" nurses who have put in years of service in the trenches and then have moved on to teach a new generation of nurses for careers at the bedside or have worked to improve nursing working conditions for their colleagues.

If you wish to sit there and parrot the same old hypocritical arguments you googled on the Internet, that's your prerogative. It doesn't make it true. You talk about how the BSN push is "all about the money" but you have admitted your problem with it is the money and time the added degree costs. So the anti-BSN push is also "all about the money". Ironically, the evil Mag hospitals pay for their ADNs to complete their BSN.