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?

[avengingspirit1]

Dear BostonFNP:

While I don't agree with you and believe with all my heart believe that all the so-called experts driving the BSN push are backed by the AACN, ANA, ANCC, state nurses associations as well as other organizations that stand to benefit from coercing nursing students to put out thousands of more dollars for courses such as "Sociology of Nursing", Philosophical Aspects of Nursing" that BSN and RN-BSN programs are laden with, I feel I must apologize to you.

I can be a hot-headed, fiery Italian guy at times and am passionate about this topic, just as I am passionate about our current administration lying about "If you like your plan............"; however it is no way for one professional to talk to another. So I apologize for getting testy.

We will always agree to disagree on this matter, but you stick to you guns and I must respect that. No nursing publication will publish anything contrary to the Aiken study as they make too much money selling advertising space to four your nursing schools and those that offer RN-BSN programs. As I told one publication, coming from a business background, I understand why you do what you do.

So you keep doing what you feel you need to do and I will do the same. For the record, I think it's great if a nurse wants to continue their education, but to tell nurses with 20+ years experience along with specialty training and certifications that demonstrate excellence in certain areas of nursing that they must $15,000-$30,000 for something that has no clinical benefit or significance is ludicrous and counter-productive. And every front line nurse I know of has concurred.

Once again, I apologize for getting too testy. Stay well.

[JustMeRN]

No problem with people making their kids their priority. Just own it. See my postings on much exaggeration of the gender pay gap which is likely due to women exiting the work environment to have and raise kids. Fantastic, really (not being sarcastic). There is no higher calling than to raise good kids.

But since you are a mom who obviously (once more, not being sarcastic) cares deeply for her children. What if your school starting mandating hiring of only certified teachers, something that has happened locally. Would you want to hear all the rhetoric about how hard it was for teachers to go back to school and get that certification. How about when the un-certified teachers failed to produce anything but opinion pieces on the effectiveness levels of certified versus non-certified? How about make it ok for the teachers who had really rough circumstances. Would that make it ok? Would you want to have less educated teachers teaching your kids because all the research supporting it was written by academicians and is obviously slanted?

In my mind, it's like so much other anti-science stuff we hear out there (on the great wide web). Can't trust the vaccine research because if it's not directly funded by pharmaceutical companies, then it's funded by people who hang out with pharmaceutical companies, or use pharmaceutical products. Can't trust the research on climate change because those researchers are in bed with the alternative fuel people, or they are in academia and want more people to go to college and learn how to save the earth's resources, or something like that. . . Can't trust whomever is on the wrong side of my opinion basically.

I don't think I said I don't trust the research, or that I don't think nurses should be educated. In fact, the more I read, the more I see that yes, that is the way we should be headed. My real issue with the whole thing is the implimentation of reccomendations that all nurses must hold a BSN by 2020. Like many things in nursing the policy makers are making policies that do not support nurses, but add to their burden. I don't at all understand why the push twords BSN is increasingly a main topic of conversation. Why is the possible 5% reduction in poor outcomes more important than the possible 7-30% reduction predicted with adequate staffing? I suppose that's a rhetorical question, because I think I know the answer. Because by requiring nurses to obtain a BSN the financial burden of improving patient outcomes is placed squarely on the individual nurse. I don't think that is a fair or reasonable solution. IMO it continues the long history of nurses being the doormat in the acute care setting. Hospitals, politicians, administrators refuse to improve patient outcomes with adequate staffing because it hurts their bottom line. But then think it perfectly reasonable to ask a nurse, making a comfortable middle class income (cause nobodies getting rich being a nurse!) to spend tens of thousands of dollars on a degree, and offer no reward or compensation. So how exactly does this help nurses? I don't think it does.

as to your teachers example. If the teachers are licensed (I don't know exacly how that works for teachers) and up to date, experienced, and effective, then no, I would no support sacking that teacher, or requiring him or her to obtain a higher degree to continue doing something they already do well. If the move is to only hire those with advanced degrees as spots open, sure, if research shows those teachers to be more effective then I have no problem supporting a change to new hiring practices. On that same note, I would whole heartedly support tuition assistance for those teachers who wanted to go back to school but found the cost too prohibitive. I never grumble about the education portion of my taxes, and would happily pay more to support teachers and schools. I think it is somewhat unfortunate that most Americans don't understand the big business of hospital care, because the only way it probably will change is if the consumer demands better.

[TiffyRN, BSN, PhD]

I don't think I said I don't trust the research, or that I don't think nurses should be educated. In fact, the more I read, the more I see that yes, that is the way we should be headed.

I'm not in the group that supports running out all the ADNs. I was an ADN nurse for nearly 20 years. I'm a supporter to change the entry-level to BSN starting immediately and in a couple of decades there will be no debate. As it is, we are allowing hospitals to use it as a screening tool to help them sort through their applications. If we should see another nursing shortage (or more exactly, a shortage of nurses willing to work in the current conditions), they will abandon this dedication to BSN so quick it will make your head spin.

Right now, it's convenient for the hospitals to support BSN but I (unlike some) don't believe the science will change. Let's act the way other reasonable professions have; which is to change the standards for incoming professionals and grandfather in the rest.

[mamavik2]

I am an ADRN, with 30+years experience in hospital nursing. Having said that, there were many times over the years I would have loved to go back for my BSN, but family and financial realities made that impossible for me. I also lost a job due to this, mostly since our hospital was bought it by another and there were many new grad BSN nurses willing to work for much less than I was making at the time so we old work horses weren't as valuable even with our experience since with new techniques, more up to date training they felt they were more valuable to them. We did the in house in services offered and some online or other learning courses but still felt there was more to learn.

[JustMeRN]

Again, point out where I said anyone was lazy. You may feel that I indicated you were lazy or selfish because you refuse to put your profession before your personal/family motives but that's not what I said, that is what you seem to feel in response to my post.

I am not judging anyone, everyone has their own priorities, and family is a far more important priority than a job. This discussion isn't about individuals; the discussion is about the profession as a whole. When looking at the macro level those individual priorities and motives are not the primary concern of the profession. The primary concern should be patient outcomes and, secondarily, maintaining good working conditions and fair wages. Please don't take comments personally like they are directed at you because they are not. They are directed as the profession as a whole.

Remember, a surgeon gets the same education as a GP. It's the training (residency/fellowship) that is longer for a surgeon.

Actually, you and I agree here in some respects but there are also two issues that you are putting into one issue.

Absolutely experience is an important factor, that's been proven time and time again. It seems you also believe education is important, and while others in this thread disagree, I think there is enough evidence to conclude that as well. It is my belief, based on the extant data, that increasing the education of nurses can improve patient outcomes independent of experience.

Hospitals firing experienced D/ADN nurses that don't get a BSN has little to do with patient outcomes, I think we all know that. If it did, it would have been done years ago. The majority is based on the hospitals cutting a chunk of their biggest expense. If hospitals were truly interested in the best outcomes they would be paying for their experience D/ADN nurses to complete their BSN (education + experience). The truth is that many of these experienced nurses are at the top of the pay scale and replacing them with lower-paid nurses is a financial improvement. Now because the market is oversaturated, these hospitals can require the less-experienced replacements to have BSNs so they get the best experience + education from their less-experienced replacements.

You can personally attack me if it makes you feel better but it really doesn't contribute much to the topic on hand and actually detracts from meaningful discussion. And again, quote me calling someone lazy or selfish.

I wasn't making that comment directed at your education. I have no idea what program you are in (or even that you were in a program). Again you seem to take every comment I make like it is directed at you personally.

What I was saying is that I agree with a lot of the people here that there are clearly sub-par programs that are exploiting the current job market to make a quick buck and likely will contribute very little to patient outcomes. As a profession we should try to get these programs to go away.

My apologies, I don't mean to come across as personally attacking. I do take this issue more personally because to me it's more than than just discussing the research and its implications. I was pushed out of a job because I couldnt (not only didn't want to, but couldn't) afford the degree I was told I needed. So it's not just theoretical four me. It's not just about what we should take from this research and apply it moving forward. It's loosing a job I have had the majority of my adult life. It hurt. It still hurts. What's being done to nurses in the name of advancing professionalism is so very wrong.

I started reading your posts agreeing with you, then you started loosing me when you made these comments.

Ok we agree that increasing education makes an individual nurse better over time.

We agree that for some individuals there is some selfishness at play.

I think some of my comments bordered on criticism because they were voiced in response to putting the nurses priorities above the patients: those that would go back to school provided it was no sacrifice to them, acknowledging that they would be better nurses for it, but unwilling to invest in it.

I am sorry that people are unwilling to make sacrifices to be the best nurse they can be. It's embarrassing to explain to patients why nursing has so many levels of entry because it basically boils down to two reasons: convenience of the nurse or nursing as a task-based profession. Neither are best for the patient

i get the feeling from these, and other, posts that you just don't understand that going back to school is not always an option. That making a choice not to go back to school because you can't afford to is not being selfish, it is being financially responsible. That not everyone has enough social support to go back to school. Understanding your limits is not selfish, it is reasonable. Labeling anyone who can't go back to school, but knows it is the best practice, as selfish is insane!

[JustMeRN]

I'm not in the group that supports running out all the ADNs. I was an ADN nurse for nearly 20 years. I'm a supporter to change the entry-level to BSN starting immediately and in a couple of decades there will be no debate. As it is, we are allowing hospitals to use it as a screening tool to help them sort through their applications. If we should see another nursing shortage (or more exactly, a shortage of nurses willing to work in the current conditions), they will abandon this dedication to BSN so quick it will make your head spin.

Right now, it's convenient for the hospitals to support BSN but I (unlike some) don't believe the science will change. Let's act the way other reasonable professions have; which is to change the standards for incoming professionals and grandfather in the rest.

I don't disagree that that entry level nursing education should be standardized. I don't know that the entry level should be BSN. ADN nurses still have their place. And in all fairness the studies conducted only adressed hospital outcomes. Adn nurses are not obsolete. Adn nurses in the setting of acute hospital care are likely becoming not enough. Hospitals moving tword hiring only BSN nurses is not an unreasonable step in today's healthcare environment. Firing all the adn nurses currently in hospital positions is just wrong.

Eliminating adn programs all together considerably shrinks the pool of eligible students. Many nurses chose / choose an adn education because it is what they can afford, and unless schools start dropping tuition that isn't likely to change. If you eliminate all adn programs you don't have enough nurses to go around, you have no one to fill the less desirable positions and short staffing issues in LTC, home health etc become severe. You can't call adn nurses LPN' s without changing their scope of practice. Change their scope of practice and now you run into the same staffing issues in those less desirable areas, because there are many things an LPN can not do that are needed in these areas.

Bsn nurses should make more money. That was one thing I always though odd. But, in that line of thinking, hospital nurses in the northeast make roughly 20% more than non hospital positions in my experience. If a BSN is a requirement to work in hospital care then your BSN nurses have higher earning potential as they should.

[lindarn]

You are right, when you state that the entry into practice should be standardized, but you dropped the ball when you go on to state, that ADN should be all that is required to be a nurse.

RECREATIONAL THERAPISTS, have a Bachelors Degree as entry into practice. That is a four year college degree, to lead cruises on ships, etc. And you don't believe that a Registered Nurse, who is responsible for patient's lives, also should have a four year college degree?

I don't know where the idea came from, that the additional two years from ADN to BSN, is only, "fluff, filler classes". I was a Diploma grad originally, and my program had us enrolled in a local college, where we took our hard sciences (A&P, two semesters, Chemistry, psychology, English, etc), and we graduated with 32 college credits).

When I enrolled at CSULB, my program consisted of, Pathobiology, Pathophysiolgy, Inorganic and Organic Chemistry, Statistics, Nursing classes, like Public Health, Nursing classes, for the entire two years, (I don' t remember what they were called), but we had to find our own clinical, and had X amount of clinical hours that had to be attained, with a preceptor, etc. It took me 6 years going part time to finish my BSN, and working full time three 12 hour shifts a week, and going to school part time, to accomplish. They were most definitely not fluff classes. We had end of semester papers to accomplish with each class. For two years. It took me longer to finish because I was working full time 12 hour shifts, and going to school part time. I also concurrently earned a Minor in Physical Education, with my BSN. My PE classes, added, Exercise Physiology, Anatomy and Kinesiology, and a slew of other PE classes to my schedule. Think push ups (boys, not girls), Situps, Bar Dips, and Pull Ups, at the gym,etc.

I am sorry about the experiences that nurses are having to go through. Nurses who already licensed nurses, should be grandfathered in. Only new nurses should have to earn a BSN.

I am not sure who dropped the ball, when it came to, "completer programs", for a BSN. If the only classes that are offered/taken, are the truly fluff classes that are being discussed here, than you are being robbed of an education.

Substandard programs should be close- this is where politicians come in- make complaints to them.

Also, I strongly believe, that if nurses had taken control of our profession from the get go, and demand that the ANA, take the helm to decide on an entry into practice, then hospitals would not be manipulating the educational requirements of nursing. It is nothing less than abusive to require an older, experienced nurse, with family obligations, to drop everything, take a significant finally hit, to go back to school and earn a BSN, with no guarantee of continued employment with a facility. It is the job of an professions, governing group, who should be deciding on the entry into practice, not groups of administrators. Nasty letters should be sent to the ANA, and your State Nursing Associations, as well.

I can see it now, nurses making large sacrifices, to earn BSN, and then the hospital fires them on some trumped up charge- thinning the older nurse herd.

I really don't know what the answer is, besides unionizing with the NNOC, get some legislative action from your Congressperson, to try to fix this mess. A group that has some clout.

It is really not just about having better outcomes, with BSNs. The profession needs to pony up and increase its educational requirements for once and for all. Three entry into practices only serves to continue to keep us divided, and infighting. And the hospitals love it.

LPNs should also go to a two year Associates Degree as entry into practice.

The public equates worth with education. Higher education should be rewarded with higher pay. Period. Regardless of the same job description

I believe that the hospitals, that are requiring a BSN from their present nursing staff, should be made to foot the bill, and have classes on the premises, at convenient hours to the nursing staff, taking into consideration shifts, etc. Pharmacists had classes in the hospitals, when they went to a Doctorate. It was made as convenient as possible, as to not disrupt their personal lives. Why not nurses. Actually, Long Beach Memorial Hospital has joined with CSULB, to offer a BSN program on premises, after work hours. Of course, 20 years after I graduated!

The ball is in you court, nurses. You can continue on the same path, with no end in sight, or you can pony up, come together, and fix the problem.

As usual just my NY $0.02

Lindarn, RN, BSN, CCRN (ret)

Somewhere in the PACNW

[crossfitnurse]

Or we just leave it alone. Don't you guys get tired of going back and forth about this?

[chare]

Three entry into practices only serves to continue to keep us divided, and infighting. And the hospitals love it.

Four actually. Don't forget the MSN entry to practice.

And think of the poop storm this is going to create in a few years.

[ajmclean]

Wow. The battle continues. And I love the "show me a study" "cite your comments", etc. As a nursing student who is planning on a BSN just because I want one, I find this debate interesting and funny. One reason: Coffee. So many studies out there over many years. One study says coffee bad. The next study says coffee good. The next study says coffee bad, etc., etc., etc. Studies say what you want them to say. And as some have said, if a BSN is so important and so much better, where's the money????? Those that are singing the praises of how much better a BSN nurse is are probably genuine in their beliefs. As a former paramedic (before it was an Associate degree college program), we weren't smart enough I guess to know we were not as good as those who had a degree. We just figured out that our experience was what mattered.

[TiffyRN, BSN, PhD]

Also, I strongly believe, that if nurses had taken control of our profession from the get go, and demand that the ANA, take the helm to decide on an entry into practice, then hospitals would not be manipulating the educational requirements of nursing. It is nothing less than abusive to require an older, experienced nurse, with family obligations, to drop everything, take a significant finally hit, to go back to school and earn a BSN, with no guarantee of continued employment with a facility. It is the job of an professions, governing group, who should be deciding on the entry into practice, not groups of administrators. Nasty letters should be sent to the ANA, and your State Nursing Associations, as well.

Preach it sister.

This is the crux of the problem. By not uniting, we are allowing other professions make disparate demands. Nurses are not presently in charge of these decisions.

[BostonFNP, APRN]

My apologies, I don't mean to come across as personally attacking. I do take this issue more personally because to me it's more than than just discussing the research and its implications. I was pushed out of a job because I couldnt (not only didn't want to, but couldn't) afford the degree I was told I needed. So it's not just theoretical four me. It's not just about what we should take from this research and apply it moving forward. It's loosing a job I have had the majority of my adult life. It hurt. It still hurts. What's being done to nurses in the name of advancing professionalism is so very wrong.

First off you don't have to apologize to me, I would much rather just continue a dialogue about the issue. I am pretty thick skinned both as a product of my job and my personality.

I do feel for you. I think it is wrong in many ways for businesses to be doing what they are doing, but I think that's why it is so important to continue this (sometimes gruelling) discussion. If this discussion had been more common 50 years ago when there was first discussion about the issue, we wouldn't have people being forced out of jobs now like you (unfortunately) were. I do think that many people in your position will admit they saw the writing on the wall a long time ago, though.

I also do think we (all nurses and all healthcare facilities) have an obligation to patients to be the best that we can and I think most people would agree additional education for nurses wouldn't hurt patients and would likely help them. I also think that nursing employers have a duty in promoting and investing in that via tuition reimbursement just as nurses have a duty in investing the time and effort in in that.

I started reading your posts agreeing with you, then you started loosing me when you made these comments. I get the feeling from these, and other, posts that you just don't understand that going back to school is not always an option. That making a choice not to go back to school because you can't afford to is not being selfish, it is being financially responsible. That not everyone has enough social support to go back to school. Understanding your limits is not selfish, it is reasonable. Labeling anyone who can't go back to school, but knows it is the best practice, as selfish is insane!

I will say some of my prior posts sound harsher than I intended them, and while I was not calling any one individual selfish I did imply that of everyone and that is more harsh than I need to be.

I have gone back to school, four times. I know what it is like. I did it with almost no money to my name, then with a baby on the way, then with with a toddler. I have loans that I am still paying off. I do understand the cost of it, even more the cost in time away from my family. On the other side, my family life is much better with how happy I am now in my work and I make plenty of money to pay back my loans, most nurses do.

I absolutely agree that family is very important, actually most important. But the two are not always mutually exclusive. I can be done, and if I read right, you are doing it right now?

Selfish sounds like a harsh term but I don't mean it to me. I mean it in the sense that people make choices to put their family first, I don't blame them, but that's not (always) what is best for the profession on a whole. Doctors manage to have families. Lawyers manage to have families. Social workers manage to have families. Teachers manage to have families. All have entry degrees higher than nurses.

So I do apologize for being overly harsh.