BSN and Associate Nurses Are Neck and Neck. Will This Change?

[allnurses]

AACN published The Impact of Education on Nursing Practice in 2015 which discussed multiple studies about ADN and BSN education. One of the more important statements is about Magnet status. Hospitals that have attained Magnet status, are recognized for nursing excellence and superior patient outcomes, have moved to require all nurse managers and nurse leaders to hold a baccalaureate or graduate degree. Hospitals in the process of applying for Magnet status must show plans to achieve the goal of having an 80% baccalaureate prepared RN workforce by 2020.

Then there are the studies that show that hospitals staffed with more BSN prepared nurses have better patient outcomes. This has been a hotly debated topic on AN. Here is one references:

In an article published in the March 2013 issue of Health Affairs, nurse researcher Ann Kutney-Lee and colleagues found that a 10-point increase in the percentage of nurses holding a BSN within a hospital was associated with an average reduction of 2.12 deaths for every 1,000 patients-and for a subset of patients with complications, an average reduction of 7.47 deaths per 1,000 patients. The study is titled "An Increase in the Number of Nurses with Baccalaureate Degrees is Linked to Lower Rates of Post-surgery Mortality."

One of the more prolific threads on AN was titled the difference between ADN and BSN nurses that was started in December 2014.

Many individual healthcare facilities have created policies that will affect the increasing number of nurses earning a BSN. Due to internal policies, the management at many hospitals across the US have been requiring currently employed LPNs and RNs with diplomas and ADNs to earn BSN degrees within a specified time frame. Many non-BSN nurses are being given an ultimatum. Is this right?

It is still being debated

So...what's your opinion? Is getting a BSN on your agenda?

How is the comparison between the number of ADN and BSN RNs at your place of work?

[OHNBJL]

I graduated in 1976 with my ADN. The push for BSN was on the agenda then and remains in the forefront now more than ever. I obtained my BSN in 1994 as my certification for Occ Health Specialist ' strongly recommended' it. I got my degree by 'snail mail' through St. Josephs in ME. As far as the statistics go on deaths,and errors from BSN to ADN, I feel statistics can be skewed. Nursing skills and competency are taught by great clinical instructors, practice, and attention to detail. New computerized medication systems and charting do decrease errors rather they are used by BSNs or ADNs. Patients in hospitals are more critically ill and require much more care. Adequate staffing and reasonable shifts are the answer to less errors. I feel that Twelve hour shifts for ICU and other speciality units only lead to more errors. Facilities favor these long shifts because less staff means less payment of benefits and kess staffing . They argue that one less shift decreased errors because of less communication breakdown between shifts. I do not agree. A tired nurse is not in top of her game and will make errors. Nurses complain of being on 'auto pilot' by the end of their 12 hr shifts. The first 2 yrs if most BSN programs include general electives for BS degrees and courses on historical and political history of nursing and science classes. ADN students must take the needed science classes. What is needed is more clinical time and rotations. Sims labs are great for practice but real patient care is the answer. Preceptorships are also the answer. As predicted by statistics the nursing shirtsge is only going to worsen. To mandate BSN is compounding the problem. Facilities should have competency testing annually to assure nurses are maintaining there skills. At my facility we used to have 'competency days' but they were replaced by computer based testing because of complaints from nurses that they had to complete this testing. Answering test question on a computer is no way the same as participating in scenarios. I taught at competency days and feel that they did help to refresh skills, thereby reducing the chance of errors

[Nitfree]

I agree. I have been an RN for 6 years. I didn't want a BSN until recently,because I am 63 and felt like enough was enough. However, I've been in a BSN program for 2 months now and can honestly say I have learned a lot that I didn't know. My genetics class and care of the older adult made my critical thinking skills sharper. I went back because I wanted to learn more and be the best I could be. In Florida few hospitals are requiring a BSN. It's preferred but ASN's are still clinical leaders in the hospitals here.

[ronsrn]

I wish i could get paid to do these studies. Maybe ill marry a doctor one day that will allow me to do this.

[BostonFNP, APRN]

ronsrn said:

I wish i could get paid to do these studies. Maybe ill marry a doctor one day that will allow me to do this.

There is lots of funding available to conduct these types of studies. Have you ever tried? All it takes is a little effort and writing a proposal.

[kbrn2002, ADN, RN]

There are too many variables involved for me to agree that BSN prepared nurses lower patient mortality all on their own. Hospitals that are able to require BSN or above nurses are more likely to be in urban areas with a correlating much greater pool of available applicants. These facilities are able to be more selective in their hiring. They also most likely generate more profit and receive more funding. As a result they can offer better pay, have better equipment and hopefully have better nurse to patient ratios which all in my opinion have more to do with better outcomes than the degree the nursing staff holds.

The only way I would be convinced that BSN prepared nurses are the deciding factor in better outcomes is if there were some magical study done that could compare two or preferably more absolutely identical hospitals in all ways except for the degree the nurses hold. As I am pretty confident that these absolutely identical hospitals don't exist in the real world I don't think that study will ever be done.

[BostonFNP, APRN]

kbrn2002 said:

The only way I would be convinced that BSN prepared nurses are the deciding factor in better outcomes is if there were some magical study done that could compare two or preferably more absolutely identical hospitals in all ways except for the degree the nurses hold. As I am pretty confident that these absolutely identical hospitals don't exist in the real world I don't think that study will ever be done.

So then how should the profession, or employers, make widespread policy decisions?

That's why we have science. It takes the opinion out of the equation.

[Bob Loblaw]

Who here actually believes that all the ADN schools are simply going to close their doors? I believe more and more ADN schools are opening all the time. I did a BSN but in retrospect believe the most cost effective way is ADN, start working, and have employer pay for the online courses you need for BSN. There are umpteen different schools that offer online courses and grant BSN's.

There is most certainly an RN shortage. There is a shortage of RN's that will work for $18 an hour; however, there is no shortage of RN's that will work for $38 an hour. It's all about perspective.

[OHNBJL]

I totally agree with you!! ADNs are forced to get their BSN in any way possible. On line classes are not only expensive but do not do anything for clinical experience. I just spoke with one nurse who is getting his BSN on line. He is taking all the gen Ed courses: history , world religions, statistics, etc. The clinical component has him going to Wisconsin taking care of three patients : one pedi, one medical, and one surgical. He also had to insert am IV and do meds on these patients. That's all he does for a clinical challenge. But he has been told by his facility. No BSN by a certain date : no job.

[BostonFNP, APRN]

OHNBJL said:

I totally agree with you!! ADNs are forced to get their BSN in any way possible. On line classes are not only expensive but do not do anything for clinical experience. I just spoke with one nurse who is getting his BSN on line. He is taking all the gen Ed courses: history , world religions, statistics, etc. The clinical component has him going to Wisconsin taking care of three patients : one pedi, one medical, and one surgical. He also had to insert am IV and do meds on these patients. That's all he does for a clinical challenge. But he has been told by his facility. No BSN by a certain date : no job.

Just because there is minimal direct clinical work doesn't mean there is no clinical benefit.

[Tommy5677]

I just find it so hard to believe the better outcomes with a BSN thing. I could understand it if there were actually more educational qualities pertaining to the clinical area but there really aren't. The one thing you have to remember is that both are prepared to take the NCLEX. The only things BSNs have that ADNs don't are research and community health. How do those 2 things translate to better outcomes in a clinical area? I'm for a single entry into practice but it has to be done in such a way that is inclusive and please don't relegate ADN's to a nursing home bedside job. It's demeaning and it does nothing for nursing itself. The fact is that community colleges are still churning out ADNs and they should be put to good use. If you go on Indeed.com nearly all the nursing jobs state BSN preferred or required. In my opinion the diploma programs produced the best clinicians and now they're gone. I think a good working solution for prospective nurses is to get your ADN at the community college level, take the NCLEX, get a job, and then go for the BSN online. It makes for a far less expensive education and it's a win win for everyone.

[rzyzzy]

BostonFNP said:

So then how should the profession, or employers, make widespread policy decisions?

That's why we have science. It takes the opinion out of the equation.

here's your problem - the ANA leadership doesn't really "represent" nurses - they tossed LPN's under the bus years ago & they're in the process of tossing ADN's under the bus right now. The ANA is out front & claiming to represent the "profession" while actively dropping a Duker on the "bottom" 50% of nurses.

I can certainly understand why someone with a Master's degree would hope to be called a "professional", but bedside nursing is a trade, not a profession. That's not a put-down, it's simply stating a fact & nurses benefit from that - tradespeople & other blue collar workers are eligible for overtime & "professionals" aren't. Tradespeople wear out their knees, hips & hands doing real physical labor for hourly pay & come home from work with dirty shoes. A "professional" should be able to set their own schedule, manage their workflow, take a day off without any penalty & never come home with a work-related physical injury - besides perhaps a paper-cut or eyestrain. That's not bedside nursing.

"Step two", to use the parlance of the Underpants Gnomes from South Park - is what your employer is planning next - once they've got you calling yourself a "professional", is to take away your hourly pay & overtime. Since you're sooooo smart & sexy, you ought to be able to manage the workflow & any extra time required at work is simply a defect in your character & "time management" skills. Perhaps you should just "try harder" or take a class in time management if you find yourself working too many hours. That's why employers want you to be a "professional" nurse, and not a tradesperson.

[macawake, MSN]

Tommy5677 said:

The only things BSNs have that ADNs don't are research and community health. How do those 2 things translate to better outcomes in a clinical area?

I'm not going to get into the whole ADN vs BSN debate. I'm from another country where the Associates' Degree doesn't exist and I'm not knowledgeable enough on what exactly is included and excluded in the ADN curriculum to offer an opinion. Normally I also stay out of these threads for another reason. They often turn acrimonious and I find that rather depressing. Nurses arguing with other nurses, rather than standing united

However I do wish to comment on the following: I don't understand why you can't see how being research litterate will influence clinical outcomes. In order to provide quality care a nurse has to combine his or her personal clinical expertise with the most current available evidence-based practice. Surely the best way of finding the best, most current research is by having the ability and know-how to identify the relevant clinical question that needs to be asked, knowing how to search for and collect the relevant evidence, having the ability to critically appraise the evidence, integrating the evidence into your daily practice and finally having the ability to evaluate the outcome.

The evidence that we base our practice on should be applicable, valid and clinically significant.

Also, being educated on the scientific method means that you can design and implement (after getting the required ethical approval) your own study. There are countless of areas within nursing where there is a need for more research. Research that will help create real benefits for our patients and better quality care/improve outcomes.

Community health, primary healthcare and primary prevention are all very important areas impacting the general health of a population and will surely affect clinical outcomes. I think that they're important areas to study.