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?

[Lisa.fnp]

rzyzzy said:

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.

You have many issues with the ANA. I will comment on the definitions of Professionals vs. Tradespeople

The definition of Professional;* which in short is; a vocation, is listed as being a recognized profession founded upon specialized educational training....Nursing is listed as being a recognize profession as well as accountants, teachers etc. Autonomy, though a defining characteristic, is not one of the main criteria's. These would include, though not limited to*

1. Education.*

2. Training in the field.*

3. Taking an exam in theories of the field.*

4. Licensors

5. Continuing education.

6. Code of ethics for the professionals as defined by the governing body of the said profession.*

Doesn't the above 6 things sound like the process nurses go through and is the definition of a profession?* You seem to be confused and hurt knee have nothing to do with it. Every profession has individuals that cannot behave according to the standards set by the profession. One things Nursing is not, a tradesperson.

[rzyzzy]

Lisa.fnp said:

You have many issues with the ANA. I will comment on the definitions of Professionals vs. Tradespeople

The definition of Professional;* which in short is; a vocation, is listed as being a recognized profession founded upon specialized educational training....Nursing is listed as being a recognize profession as well as accountants, teachers etc. Autonomy, though a defining characteristic, is not one of the main criteria's. These would include, though not limited to*

1. Education.*

2. Training in the field.*

3. Taking an exam in theories of the field.*

4. Licensors

5. Continuing education.

6. Code of ethics for the professionals as defined by the governing body of the said profession.*

Doesn't the above 6 things sound like the process nurses go through and is the definition of a profession?* You seem to be confused and hurt knee have nothing to do with it. Every profession has individuals that cannot behave according to the standards set by the profession. One things Nursing is not, a tradesperson.

Nope - let's break this down & use an actual definition that's codified in law, shall we?

"Learned professional" - I.E., doctor, lawyer, architect, CPA, etc. they all have advanced degrees, beyond a BSN, function with autonomy & generally at least legally, have the ability to hang a shingle on their porch & start a "practice".

Is a nurse "autonomous"? No, they aren't- at least with a BSN. You can't "practice" any of your skills, or hand out any pills without the orders of a "learned professional". Just like a builder can't decide on his own that a beam is "meh, thick enough" without calling in another "learned professional" (IE., architect) to sign off on it. Just like an accountant or bookkeeper can't over-rule a CPA.

Learned professionals are are explicitly defined in labor law & they don't get overtime. They don't need any protection under the law, because their education & autonomy under the law allow them to go off on their own & do their own thing if the big bad corporations & businesses treat them unfairly. BSN nurses don't have that as an option. You can't hang a shingle on your porch with a BSN.

Professional doesn't have a definition in labor law, unless that "learned" part is included.

What you're trying to do, by calling yourself a professional (without an advanced degree), is steal a bit of that cache that learned professionals earn when they go to school for a decade, without the "work" part. It's silly & unnecessary- nurses are already highly respected. No need to steal any extra valor.

The trap that you're in extreme danger of falling into - is that by calling yourself a professional, when you aren't - at some point the world believes your lie. Then, it's no big deal to strip nurses of hourly pay & overtime protections under the law - "they already *say* they're "professionals"... "professional", "learned professional", etc... same thing, right?

Words mean something.

You know that, or you wouldn't be using the term "professional"..

At some point, you sound just like those people who wanted to call themselves "domestic engineers" - ignorant. Fix the stigma against being a housewife, or against working with your hands, but don't try to twist a word to mean something it doesn't mean.

I wouldn't argue that nursing is a "skilled trade"- if it makes you feel better. I wouldn't argue that advanced-practice nurses aren't "learned professionals", but RN's, nope. not professionals. We work with our hands, have limited autonomy & extensive schooling & hands on training are required - like other skilled trades.

[Boomer MS, RN]

rzyzzy said:

Nope - let's break this down & use an actual definition that's codified in law, shall we?

"Learned professional" - I.E., doctor, lawyer, architect, CPA, etc. they all have advanced degrees, beyond a BSN, function with autonomy & generally at least legally, have the ability to hang a shingle on their porch & start a "practice".

Is a nurse "autonomous"? No, they aren't- at least with a BSN. You can't "practice" any of your skills, or hand out any pills without the orders of a "learned professional". Just like a builder can't decide on his own that a beam is "meh, thick enough" without calling in another "learned professional" (IE., architect) to sign off on it. Just like an accountant or bookkeeper can't over-rule a CPA.

Learned professionals are are explicitly defined in labor law & they don't get overtime. They don't need any protection under the law, because their education & autonomy under the law allow them to go off on their own & do their own thing if the big bad corporations & businesses treat them unfairly. BSN nurses don't have that as an option. You can't hang a shingle on your porch with a BSN.

Professional doesn't have a definition in labor law, unless that "learned" part is included.

What you're trying to do, by calling yourself a professional (without an advanced degree), is steal a bit of that cache that learned professionals earn when they go to school for a decade, without the "work" part. It's silly & unnecessary- nurses are already highly respected. No need to steal any extra valor.

The trap that you're in extreme danger of falling into - is that by calling yourself a professional, when you aren't - at some point the world believes your lie. Then, it's no big deal to strip nurses of hourly pay & overtime protections under the law - "they already *say* they're "professionals"... "professional", "learned professional", etc... same thing, right?

Words mean something.

You know that, or you wouldn't be using the term "professional"..

At some point, you sound just like those people who wanted to call themselves "domestic engineers" - ignorant. Fix the stigma against being a housewife, or against working with your hands, but don't try to twist a word to mean something it doesn't mean.

I wouldn't argue that nursing is a "skilled trade"- if it makes you feel better. I wouldn't argue that advanced-practice nurses aren't "learned professionals", but RN's, nope. not professionals. We work with our hands, have limited autonomy & extensive schooling & hands on training are required - like other skilled trades.

Oh dear, oh dear, oh dear. Sigh. I feel sorry for you that you don't see RNs as professionals. We all are entitled though to our opinions, which are part of who we are. Having graduated in 1970, I acknowledge that there are still major problems with the profession. I respectfully disagree when you say, "Words mean nothing." Although I worked with my hands, I also worked with a lot more, specifically my brain.

[Cowboyardee]

Boomer MS, RN said:

Oh dear, oh dear, oh dear. Sigh. I feel sorry for you that you don't see RNs as professionals. We all are entitled though to our opinions, which are part of who we are. Having graduated in 1970, I acknowledge that there are still major problems with the profession. I respectfully disagree when you say, "Words mean nothing." Although I worked with my hands, I also worked with a lot more, specifically my brain.

I gotta agree with rzyzzy here. Be careful what you wish for. There are legal protections in place for hourly workers that are not typically applied to 'professionals.' Would you strip your coworkers of those protections in exchange for an honorific that brings no actual increase in autonomy on its own?

I pride myself on my clinical skills, judgment, and experience. It has saved lives, pure and simple. I don't need an honorific to take pride in that; I'll take legal protections over an empty honorific any day. Change the law to allow me to practice independently, and then I'll get on board the profession bus.

And frankly, the 'oh dear, oh dear, sigh, i feel sorry for you...' comes off as needlessly patronizing.

[Boomer MS, RN]

Cowboyardee said:

I gotta agree with rzyzzy here. Be careful what you wish for. There are legal protections in place for hourly workers that are not typically applied to 'professionals.' Would you strip your coworkers of those protections in exchange for an honorific that brings no actual increase in autonomy on its own?

I pride myself on my clinical skills, judgment, and experience. It has saved lives, pure and simple. I don't need an honorific to take pride in that; I'll take legal protections over an empty honorific any day. Change the law to allow me to practice independently, and then I'll get on board the profession bus.

And frankly, the 'oh dear, oh dear, sigh, i feel sorry for you...' comes off as needlessly patronizing.

Sorry. Didn't mean to sound patronizing, as that was not my intention. If you want to practice completely independently, then go to graduate school and become an NP. How NPs practice, however, can vary from state to state. I have a hard time with some of your logic. So be it. To each his own!

[Cowboyardee]

Boomer MS, RN said:

Sorry. Didn't mean to sound patronizing, as that was not my intention.

No problem. Just sayin, is all.

Boomer MS, RN said:

If you want to practice completely independently, then go to graduate school and become an NP. How NPs practice, however, can vary from state to state.

In truth, I do not seek to practice independently, and do not really believe that nurses without advanced degrees should be able to (though I'd be willing to hear any interesting argument to the contrary). I was writing of the kind of autonomy that makes being considered a profession by regulatory agencies worthwhile - it was an example rather than a suggestion.

FWIW, if you were to argue that a NP is a professional, I'd more or less agree with you.

Boomer MS, RN said:

I have a hard time with some of your logic. So be it. To each his own!

We've gotten somewhat removed from the initial posts that started up this argument, so it seems that the context is lost. I don't much care to argue the semantics of what it means to be a 'profession.' In truth, if you want to consider bedside nursing a profession, I disagree but I also don't really care. Because you, as a private individual, have little power to affect the conditions of my employment.

Now, if regulatory bodies want to consider bedside nursing a profession, that's a very slippery slope to losing the protections associated with tradeworkers for no obvious benefits in the foreseeable future. Just as worrisome is the specter of self-regulation that typically applies to professions, since the most prominent 'professional' nurses organization (the ANA) has a dismaying record for failing to support bedside nurses (e.g. failure to support mandatory minimum ratios; advocacy of 80% BSN by 2020 with no provision for grandfathering experienced nurses; no real advocacy for protecting experienced nurses whatsoever).

[rzyzzy]

Boomer MS, RN said:

Oh dear, oh dear, oh dear. Sigh. I feel sorry for you that you don't see RNs as professionals. We all are entitled though to our opinions, which are part of who we are. Having graduated in 1970, I acknowledge that there are still major problems with the profession. I respectfully disagree when you say, "Words mean nothing." Although I worked with my hands, I also worked with a lot more, specifically my brain.

I'd never say that RN's don't behave in a professional manner, just that using the term "professional" is reaching & unnecessary & could come back to bite us in the behinds in the future. Further, being a skilled-trade isn't a put-down, unless you create that association in your own mind. If it wasn't for trades like ours & others, the civilized world wouldn't be nearly as civilized.

[BostonFNP, APRN]

Cowboyardee said:

Hold on there - I called studies fatally flawed because of their methodology and flawed assumptions. Be a good 'scientist' yourself - wait to hear my reasoning before making assumptions about my conclusions.

I addressed some parts of your post above (bold, underlined, in the quote), but I'll cite an example here. In truth, I have neither the time nor the inclination to address every single study that has ever been printed on the matter.

I will refer to the 2013 study correlating nursing education levels with patient mortality, for a few reasons. For one, it is one of the easier studies to find in full without access to one database or another.

My assumption that you view the studies as "fatally flawed" because you have a pre-conceived opinion about the topic is derived from the fact you have cleared stated your personal experience on the issue. Further, it seems that you have not read many of the studies and have not read even the full-text of the major studies. I find it hard to reconcile that you could have determined them fatally flawed if you have not read them or have not read the full-text of many of them. It is my assumption, and you can certainly disagree with me or prove me wrong.

Cowboyardee said:

First, a brief summary. The study in question looked at hospitals in Pennsylvania at two different time periods, recording hospital-reported patient mortality for surgical patients and RN-reported educational levels, staffing levels, and years of experience. The study found that an increase in the percentage of BSN educated nurses within a hospital was associated with lower mortality rates. The study attempted to isolate and control for those other variables (staffing levels, years of experience, and 'skill mix' for nurses), though the authors admitted that staffing levels and skill mix did not change enough in most of the hospitals tested for the results to be statistically useful. Fair enough so far?

This is a fundamentally different study from the landmark studies being discussed earlier in this thread. It does not directly compare BSNs to non-BSN nurses rather it compares outcomes in hospitals that increased their percentage of BSNs.

Cowboyardee said:

1) The study authors assumed they had shown that nursing education was a causative factor with respect to patient mortality when in fact they had only shown it to be correlative. This is just bad science. Often, media and various institutions make this mistake when reporting the results of a study, but study authors should know better, and frankly it makes me question the objectivity of their research. What's more, the authors even go on to make some ill-considered statements about the nature of the causative effect of RN education.

Seeing as they had no business assuming they had found a causative relationship in the first place, this is doubly ill-considered.

This was a longitudinal retrospective study not a RCT. They created a regression model and were able to demonstrate statistical significance. This is a well-established method of determining a causal relationship. I am not sure I fully agree with their implications but the statistical analysis is certainly a widely used technique.

Cowboyardee said:

2) They omit discussion (to say nothing of measurement) of any outside factors that might contribute to the correlation they found. This is somewhat more egregious since some of these factors are fairly obvious and also quite measurable. Pages earlier in this thread, Dogen mentioned the likelihood that hospitals increasing their BSN-prepared workforce might also acquire state of the art facilities (cath labs, differentiated specialized ICUs, advanced therapies, more in-house specialists). Most of these things can be measured. All of them can be discussed. The study did neither.

It is not always possible to expound on every possible variable. Major confounders are checked and adjusted for if needed. What would you have liked expanded on? In your example, sure, some hospitals may have more advanced facilities along with more BSNs, but perhaps they also have more acute patients? Moreover, in this study, it's a moot point as the study looked at changes in nursing education compared to changes in mortality not between different hospitals.

Cowboyardee said:

But it's significantly flawed, and the authors' willingness to conflate correlation with causation is unscientific and unprofessional enough that I truly question the motives and objectivity of those who participated.

I'm sorry but I still don't see the "significant flaws" of the study. I think it has some flaws, all do, but I don't see anything that suggests there was a lack of scientific rigor.

[BostonFNP, APRN]

Cowboyardee said:

Change the law to allow me to practice independently, and then I'll get on board the profession bus.

Nurses do practice independently in some manner of speaking as they are individually licensed.

Part of this issue may be the predecessor to nurses being truly independent, billing seperately for their services, and employed independently from hospitals as providers are. Part of winning that battle is becoming a true profession.

[Susie2310]

Unsurprisingly some of the people arguing on this thread for "professional" status for nurses are the same people who have argued strenuously on other threads for nurse practitioner independent practice and BSN for entry into practice. Perpetual enrollment of nurses in ADN-BSN courses, generic BSN programs, accelerated BSN or direct entry masters programs is necessary to achieve this. The goal of some is to achieve a preponderance of nurses enrolled in these programs versus ADN/Diploma programs. If a preponderance could be achieved, this would help accomplish both raising the educational level of nurses entering the profession to be more in line with other professions that bill for their services, and would limit entry to the profession, thereby resulting in increased job security for advanced practice nurses/higher degreed nurses and higher salaries (supply and demand). Community college ADN programs are a wonderful, inexpensive (relatively, compared to a four year university) way to receive good quality clinical training as a nurse and to enter the field of nursing as a licensed nurse. The majority of nurses do not have a BSN or higher. All one needs to do is connect the dots.

How to encourage/persuade/compel people that an ADN/Diploma is insufficient? Well, first there is the need to demonstrate that this is the case.

Some of the above posters on this thread have explained some of the downsides to bedside nurses (the great majority of nurses) receiving "professional" status.

[travelingrn2001, ASN, BSN]

Kind of strange, I just finished my RN to BSN program and not a single hour counted towards my continuing education requirement for my license.

I thought this was an interesting side note.

[Lisa.fnp]

roser13 said:

No need whatsoever to mention your male-ness. Your gender has no bearing on your nursing question.

If he decided to share his gender, why is that a problem for you? What issues do you have? It's wonderful that he shared gender. Male nurses are a great advantage to hospitals and hiring agencies, and different opportunities are presented to Male nurses. Male nurses provide a balance, strength, perspective, additional security, and are more reliable not taking maternity leave every other year (figure of speech). Being a male nurse might give him an advantage especially not being in the trenches for a while.

Having your Masters with your research skills I would think you are well qualified in Management to run a department, or maybe try travel nursing to a small Community hospital to get back in the trenches again.