ADN's being pushed out

LadyFree28, BSN, LPN, RN · Aug 9, 2013

****There is nobody to make money from a study to refute the biased studies.

I'm inclined to go with Boston FNP's response above to this quote.

The issue should be HOW people are using the data interpreted.

In my research proposal, I used the Aiken study and subsequent studies that didn't use the model; they used it as a source in their proposal; not their data. None of the data states that BSN prepared nurses we superior over ADNs; rather, the more education, coupled with more experience, had better outcomes of mortality...a correlation. If anything, the research correlates with Benner's Novice to Expert Theory.

There have been plenty of written texts that have been misinterpreted in our human history...just because one has "suggestions" they at just that; unfortunately, some vested interests have used it as a means to further the profession without taking into account a palatable solution. That does not mean he researched is flawed in itself; it's the persons who are interpreting the research without regard to the realities of the climate of the profession and the accessibility of shaping all nursing professionals from novices to experts successfully is the REAL issue and the focus on providing REAL solutions. :yes:

avengingspirit1 · Aug 9, 2013

In response to BostonFNP:

The study you mentioned was undertaken by the following: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

I am harsh with academic elitists in ivory towers not because they no longer do patient care, but because they want to push their ideals all nurses. I am honest and will say right out that I don't have the years of experience they do. But what I do have is the ability to see through the haze of academia and apply common sense and logic to every day situations. I truly believe that the more time one spends in academia, the more out of touch with reality they become. Some of these people even seem to have a sense of infallibility.

The truth is that colleges and universities these days are less about providing a quality education and more about raising revenue through ominous tuition increases and providing students with a social and lifestyle experience. You can archive recent articles in publications such as Newsweek and Time about this topic.

I'll repeat myself again: I think it's great if a nurse chooses to further their education. But it should always be a choice. As baby boomers have aged, enrollments have decreased at many four year colleges. At least 200 colleges and universities have closed over the last ten years due to decreasing enrollments. The best way to counteract this is to make it so that those over 40 must return to school. Hence we saw the push for higher degrees in fields such as PT and Pharmacy. Here in PA, entries to those fields were raised to requiring Doctorate Degrees. I spoke to professionals in those fields with and without Doctorate Degrees and they all have told me it was nothing more than a money-making scheme initiated by leaders in those professions who were all affiliated with institutions that benefited monetarily by raising the bar.

Nurses, being the intelligent professionals that we are have, have seen right through this. That is why there hasn't been a groundswell of support for this movement and the BSN push has come to a stalemate. And there are more of us than all other healthcare professionals so that politicians fear losing votes by supporting something that most of the rank and file don't want.

All I've done is to relay the truth I learned by speaking to those in healthcare administration who will admit it to a 50 year old contemporary.

Also the hospitals in my area pay for only a small portion of an RN-BSN program. It may be different where you are; and that's a good thing.

You're educated and very intelligent but we will probably always agree to disagree on this subject. I have yet to hear any doctor or patient say they can see a difference in the level of care provided by ADNs and BSNs. As a matter of fact, I have been accepted into two RN-BSN programs but I can't justify the cost with return on investment. To me, the purpose of education is to teach me something I can use. When I can find proof that a BSN will make me a better nurse, they will have me at hello. Until then, reviewing skills, pathology and patient evaluation techniques will be a priority. Now I wish that was what an RN-BSN program was about.

Good luck with your baby. That should be the priority in your life. But I know you're intelligent enough to know that. Believe or not, I do respect you.

PD, aka avengingspirit, PA

PMFB-RN, RN · Aug 9, 2013

Not the AACN or N-OADN?

*** Certainly NOT the AACN! To judge from their actions and statements they despise nurses. I don't know who the N-OADN is.

Or the hospitals like yours that only hire ADNs?

N

*** My hospital hires all 4 kinds of new grads. Only the SICU doesn't hire new grad BSNs for the residency program. Experienced ICU nurses with BSN are hired into the SICU.

ot current ADN nurses?

*** Maybe but they are no more organized than the rest of nursing. We (nurses) can't even agree that we should make more money or have safe nurse to patient ratios.

PMFB-RN, RN · Aug 9, 2013

I'm inclined to go with Boston FNP's response above to this quote.
The issue should be HOW people are using the data interpreted

*** What I would LOVE to see is a large study compairing patient ourcomes when cared for by nurses who have specialy certifcation and nurses who do not. I have see one such study that was done by an MSN student but the sample size was very small. The results where pretty clear that specialy certification resulted in better patient outcomes. I believe, but don't have evidence to show, that the same result would be obtained with a much larger sample size.

If the results of a large study shows similar data then we would all be irresponsible for even talking about BSN as entry to practice until after all elligable nurses obtained certification.

As an aside, my hospital pays a large certification differential (in large part as a result of the study I mentioned), and no differential at all for BSN or MSN or doctorate.

LadyFree28, BSN, LPN, RN · Aug 10, 2013

PMFB-RN, I believe that there will be a study in the near future. :yes:

I have been fortunate to be in a program that was measuring traditional student and non-traditional/second degree/healthcare experienced students and their success in nursing school for my BSN. I was a part of year 2 of a 5 year study. I still stay in contact with my research teacher. There are plenty of nurses who want to shape our "expertise" in the best way; and that really is the best focus for our profession.

LadyFree28, BSN, LPN, RN · Aug 10, 2013

Good luck with your baby.

Boston is a HE not a SHE....

Just wanted to put it out there. :whistling:

SleeepyRN · Aug 10, 2013

How about the fact that a patient's outcome stems from multiple nurses with varying levels of education? One nurse might be an ADN, then report off to a BSN to care for that patient. And back and forth throughout the length of stay.

I think there are way too many variables to lend any credence to these studies. Go ahead and highly disagree. I'm typically a very open minded person who loves healthy debate, but I don't see my mind changing on this. I'm getting my RN to BSN because it's required. I'll do it, get it over with and move on. But I understand it's not that simple for others.

avengingspirit1 · Aug 11, 2013

All the intellectual jargon posted by those with higher degrees have not and can not refute that which is irrefutable: All the so-called experts trying to drive the BSN push with their pseudo-science studies are backed by organizations such as the AACN, IOM and the ANA which are all committed to the BSN entry.

With the government funding cuts that are due to come to fruition this Fall, it is estimated that hospitals may have to reduce their workforces by at least 5%. I would be leery of any hospital that promises continued employment as well as any tuition reimbursement to nurses who pursue a BSN or higher degree. Get it in writing and have it reviewed by an attorney. If they're not willing to put it in writing, assume it's not true. Short of that, this is probably the worst time in history for a nurse to take on more student loan debt.

The websites below contain an excellent critique of the Aiken study as well as how many nurses feel about the BSN push. The reality is that the BSN push has stalled. Most nurses don't want it and realize just who is driving the BSN push. If it had any real merit, it would have been endorsed by the majority of nurses years ago. Anyone who will tell you the BSN push is not money driven is either very naive or outright lying.

https://allnurses.com/general-nursing-discussion/critique-study-more-157387.html

http://news.nurse.com/article/20130307/NATIONAL02/103180008

https://allnurses.com/registered-nurses-diploma/adn-vs-bsn-127175-page2.html

https://allnurses.com/general-nursing-discussion/critique-study-more-157387-page5.html

allnurses Guide · Aug 11, 2013

In response to BostonFNP:
The study you mentioned was undertaken by the following: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Believe or not, I do respect you.

Likely we will never agree about this issue; I do want to respond to two things:

First is the issue of research studies. You quite astutely pointed out that the study I most recently cited was authored by academic faculty, while this is true, Canada is BSN-entry. Why would they publish biased work when there is no incentive? There are several other large Canadian studies which mirror the US studies. It's a large multinational conspiracy. You can continue to say that you are just waiting for data to change your mind, but be honest about the fact there will be an excuse for any data that would change your mind.

I respect all nurse, no matter their background or their Ed level. I just honestly believe for nursing to offer the best patient outcomes and remain a respected and well-paid profession, there is an important role for education.

All of these arguments are quite moot as, ultimately, the market will dictate the minimum entry long before registration or legislation will.

allnurses Guide · Aug 11, 2013

How about the fact that a patient's outcome stems from multiple nurses with varying levels of education? One nurse might be an ADN then report off to a BSN to care for that patient. And back and forth throughout the length of stay.[/quote']
This is very true, but that doesn't preclude research, though it could slightly confound it. The percentage of time a given patient spends with a ADN vs a BSN nurse "should" be estimated by the percentage of those types of nurses employed by the hospital.
Scenario:
Patient A and Patient B have the same history and have the same operation done by the same surgeon.
Patient A has a ADN nurse for 80% of his care (let's say four out of five shifts) and is discharged without complication.
Patient B has a BSN nurse for 60% of his care (let's say three out of five shifts) and ends up with a major complication that delays his discharge.
What factors account for the variance?

MunoRN, RN · Aug 11, 2013

The polarization that occurs in these arguments tends to just produce two drastically diverging false interpretations, and worse, just moves us farther away from being able to plan our route forward. One side overstates the evidence, the other discounts it all in response. Really, these studies certainly suggest a difference in outcomes based on education, although stating or inferring that they prove this relationship would have to ignore everything we know about what various types and circumstances of research are actually able to state about their results.

Having sat on a committee who's initial intention was to make a roadmap for transitioning to either BSN as entry to practice, or BSN in 10, I can tell you that these studies don't offer a whole lot of guidance on how to move forward. As best as we can tell, the curriculum of BSN programs is what separates patient outcomes, and as a result of this and other factors, the transition in ADN programs to adopting BSN curriculums is well under way. So the question is, what else needs to be done?

Despite being around for about 50 years, the push to BSN as entry to practice has yet to result in any legislative action except for one failed attempt, a trend that is unlikely to change in the near future. Despite our initial intention to make this switch, we found this was not attainable, and this is where the polarized pro-BSN crowd tends to diverge from reality. The first problem is that we can't expand BSN programs that significantly without severely harming clinical experience. The second is cost. States can't afford to make that sort of change in financial obligations, and despite claims that the "market" wants BSN's, the market has not been willing to pay more for BSN's. This is another misconception; that the market wants BSN's mainly because of better outcomes. I had the opportunity to hear a VP of Nursing at a major medical center make the case for BSN's, which I assumed would include numerous references to Aiken and other studies. Her comment was that they were in a unique position of both selling and buying the same product, thus their preference for BSN's. Her example was that if you worked at a factory that made Coke, you wouldn't expect to find Pepsi in the vending machines. In reality, the market's typically offer more for what it finds to be more valuable, and that higher monetary value hasn't materialized in BSN's.

In reality, employer preferences for bachelor's degrees aren't really much different in Nursing than in any other profession; it's a filtering criteria. There's an ADN program in my area that requires a previous Bachelor's degree for admission, it doesn't matter in what. A degree in art history probably won't be of significant help in Nursing school, but it's a way of filtering out previous educational performance, just like the huge number of jobs that require a bachelor's degree, in anything, not because the degree itself is that helpful, but because it infers some level of previous performance.

In the end, our committee that had intended to make a bachelor's a requirement at either entry or in 10 years, came to the conclusion that the only realistic option was to simply rename an ADN program as a BSN program, which would mean that it's just the term "BSN" that makes for better outcomes, which I don't think anyone thinks is the root cause of different outcomes. The best option seemed to be to take BSN curriculum and spread it out geographically to allow for adequate clinical opportunities, which is a process that is already well underway. The question that seems to get ignored, is what else should be done differently.

SleeepyRN · Aug 12, 2013

What factors account for the variance?

Multiple variables can account for this. Its not as easy to simply sum it up as "well, more ADN nurses cared for patient B so the lower patient outcome must stem from that." New nurse versus experienced nurse. Competence of the physician....

Also remember that just because you have 2 similar cases (patient case studies) doesn't mean their outcome will be the same even if it was 1 nurse who took care of them. Everyone's bodies react differently to the same illness and same treatment. I'm still all for higher education if one can do it. But I would like it to be more about case studies, how to work with high patient ratios, most common errors and how to correct them. Not leadership and management. I only think public health should be an option. We get just enough of that in ADN programs to perform in a non community health job. I don't want to get rid of the RN to BSN. I want to revamp the program so we can use it very clearly in our daily lives.