BSN is a joke

[nurseguy22]

I am a nurse at a major hospital where I have worked over a year after gaining my ASN. I have returned to get my BSN. What I'm not understanding is why there is such an ENORMOUS disconnect between what I do at work and the class work I need to do. It doesn'y apply at all. I have to take family care classes and informatics with very little practical application. I have to memorize all the rules of APA. My patients don't care if I can wrote a wonderful APA formatted paper. They just don't. It's like there is no appreciation in BSN education for what nursing is really about. At no time will I EVER do a CFIM on my patient or a PEEK readiness assessment. Get real. Where is the disconnect? Everyone I talk to say's the same thing about their BSN program, that it is completely useless. Who decided that nurses needed extensive training in social work and paper formatting?!?! I don't deal with social work. I have a team of social workers for that. At no time will I ever be in a patients home trying to improve the communication between family members ect. There are family counselors ect for that. It isn't my job! Yet here I am getting trained in areas I have no interest in, and will never ever use in my career. And for what? So I can say I have 3 letters behind my name and the school and hospital can make more money? Its a joke. I'm learning nothing of value. I would drop out and find a new school, but everyone I talk to has the same opinion about where ever they went. Basically healthcare has become obsessed with accolades, but forgot that those accolades were supposed to represent a level of expertise.

Why is there such an enormous disconnect between real life nursing and nursing education??!?!?

[Wuzzie]

1. These kind of BSN vs ASN threads pop up on a regular basis and I am always saddened by them. It's funny how I've never seen a thread started by someone with a BSN, MSN or DNP saying how bad diploma or ASN nurses are (simply because I don't think the vast majority of nurses with those degrees hold that view, I know that I don't), but I've seen many where BSN's are disparaged.

These discussions almost always feel very emotionally charged, and not always rational/fact-based.

2. Since I have never thought of any nurse as "less than" based purely on level of academic accomplishment, I am always a bit surprised when a poster feels the need to launch a seemingly unprovoked broad-brush attack on every single BSN-holder (or rather the quality/value of their education). I'm sure that some schools are academically more demanding and others are somewhat lower in quality, but that isn't in my opinion a good enough reason to designate a BSN degree, a "joke".

Mac,

1. I normally agree with you but this time I think you're a bit off the mark. I haven't ever seen a post here specifically targeting BSN nurses just for the sake of disparaging them. I have seen defensive responses from ADN/Diploma nurses who bristle at the idea that somehow they are less of a nurse because they do not have a BSN. Now that I've seen multiple times. Examples would be the poorly constructed, yet often cited, Aiken study that supposedly supported the idea that patients taken care of by BSN's had better outcomes, the oft floated idea of "grandfathering" in diploma nurses as "technical nurses" not professional nurses, the sub-text that somehow diploma/ADN nurses aren't quite smart enough to suceed in a BSN program (or they would have gone that route in the first place), that diploma/ADN nurses are best-suited to work in nursing homes not acute care because they lack the critical thinking skills (supposedly only taught in BSN programs with complete disregard to the fact that critical thinking abilities are mostly innate) to care for acutely ill patients. I think that is where the frustration and emotion comes from and frankly, as a diploma trained nurse, I'm quite tired of hearing/reading that I'm close but not quite good enough.

2. I don't think the OP was referring to the BSN education as a whole as a "joke". He was referring to the RN-BSN programs and, as I understood it, as they relate to seasoned nurses. I do understand where he is coming from although I think he could have been a bit more diplomatic in his approach.

Personally I think the decision to go back to school should be a personal choice one makes based on their financial situation, goals and current situation. Being forced to do it for reasons with little benefit to the person who is doing all the work (by this I mean no increase in pay, meeting institutional goals rather than personal ones) is an overreach.

[imenid37]

" I have to memorize all the rules of APA."

For probably less than $ 50, you can get PERLLA. It will save you the hassle of using the APA manual. My advice is do the BSN now or if it becomes an urgent matter, it will be a real pain.

[shibaowner, MSN, RN, NP]

One of the great things about nursing as a career is that there are many different pathways. I've known many nurses that started out as CNAs, then moved up one step at a time - LVN, RN, BSN, advanced practice, and eventually to a DNP or PhD. This allows someone to complete their education over time and incur minimal debt.

However, it appears to me that many ADNs are defensive and resent it when employers mandate earning a BSN within a certain time period. College is now required for most professions.

I also fail to understand the continued assertions that ADNs have better skills. Where is the evidence? And why would that be? Both BSN and ADN programs teach the same skills.

And I'm sick of the false choices presented, as if all BSN nurses lack experience and all ADNs have loads of experience. There are plenty of BSN nurses who have 20, 30, 40 years of experience. There are also newly minted ADNs with NO experience.

Finally, there is plenty of NEW evidence that is being updated constantly, that BSN nurses have better patient outcomes. This is not based on just one study by one person. Does anyone have evidence to the contrary? If so, let's see it. Here is a recent article:

Building the Case for More Highly Educated Nurses - RWJF

If nurses want to be more respected as a profession, and earn more money, then they need to start acting like professionals, which includes obtaining a BSN and valuing continuing education.

[MunoRN, RN]

One of the great things about nursing as a career is that there are many different pathways. I've known many nurses that started out as CNAs, then moved up one step at a time - LVN, RN, BSN, advanced practice, and eventually to a DNP or PhD. This allows someone to complete their education over time and incur minimal debt.

However, it appears to me that many ADNs are defensive and resent it when employers mandate earning a BSN within a certain time period. College is now required for most professions.

I also fail to understand the continued assertions that ADNs have better skills. Where is the evidence? And why would that be? Both BSN and ADN programs teach the same skills. And I'm sick of the false choices presented, as if all BSN nurses lack experience and all ADNs have loads of experience. There are plenty of BSN nurses who have 20, 30, 40 years of experience. There are also newly minted ADNs with NO experience.

Finally, there is plenty of NEW evidence that is being updated constantly, that BSN nurses have better patient outcomes. This is not based on just one study by one person. Does anyone have evidence to the contrary? If so, let's see it. Here is a recent article:

Building the Case for More Highly Educated Nurses - RWJF

If nurses want to be more respected as a profession, and earn more money, then they need to start acting like professionals, which includes obtaining a BSN and valuing continuing education.

I think you're confusing recently published with recent data. One of the more recent studies, the 2013 Aiken study, looked at ADN grads who on average graduated around 1985. Is the quality of non-BSN graduates in 1985 a reliable indicator of the quality of ADN programs in 2017? It might be if ADN programs haven't really changed any since then, but they've changed significantly during that time.

Assuming the data on 1985 graduates is still an accurate measurement of today's programs is like saying you're patient who had a SBP of 180 ten hours ago, and has since received of a boatload of antihypertensive, is still hypertensive even though you haven't rechecked a BP since ten hours ago.

[BostonFNP, APRN]

I think you're confusing recently published with recent data. One of the more recent studies, the 2013 Aiken study, looked at ADN grads who on average graduated around 1985. Is the quality of non-BSN graduates in 1985 a reliable indicator of the quality of ADN programs in 2017? It might be if ADN programs haven't really changed any since then, but they've changed significantly during that time.

Assuming the data on 1985 graduates is still an accurate measurement of today's programs is like saying you're patient who had a SBP of 180 ten hours ago, and has since received of a boatload of antihypertensive, is still hypertensive even though you haven't rechecked a BP since ten hours ago.

I am not sure I really follow this argument: do you consider all of the extant studies invalid and obsolete because there have been recent changes to curriculum? That would make just about every study on every topic invalid.

Aiken's landmark study in 2003 used data from 1998-1999. Aiken's JAMA study in 2011 used data from 2006-2008 (which is fairly contemporary in research terms). Aiken's Lancet study in 2014 used data from 2009-2010. There are consistent multinational studies using rather contemporary data.

When were these major curriculum changes done?

[shibaowner, MSN, RN, NP]

I think you're confusing recently published with recent data. One of the more recent studies, the 2013 Aiken study, looked at ADN grads who on average graduated around 1985. Is the quality of non-BSN graduates in 1985 a reliable indicator of the quality of ADN programs in 2017? It might be if ADN programs haven't really changed any since then, but they've changed significantly during that time.

Assuming the data on 1985 graduates is still an accurate measurement of today's programs is like saying you're patient who had a SBP of 180 ten hours ago, and has since received of a boatload of antihypertensive, is still hypertensive even though you haven't rechecked a BP since ten hours ago.

Where is your evidence? Do you have any evidence? Can you find any evidence? Apparently not. I have yet to see a single piece of evidence indicating that ADN nurses have better skills upon graduation. And I have yet to see a single piece of evidence that ADN nurses have the same outcomes as BSN nurses.

You just criticize Aiken, but you clearly did not even read the article I provided. Why do people keep saying the Aiken study uses 1985 data? Aiken has continued doing further studies for over a decade.

Aiken - 2014 in The Lancet - data from 2009-2010 in NINE European countries found better outcomes with increased RN education

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62631-8/fulltext

Aiken - 2011 based on data from 2005-2007

The Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments

Aiken - 2016 based on data from 2008 in South Korea

Effects of nurse staffing, work environments, and education on patient mortality: An observational study

Yakusheva, Lindrooth & Weiss (2014) based on 2011 data

Nurse Value-Added and Patient Outcomes in Acute Care

[lonewolfiern]

Sir/Mam,

I am so sorry you took my reply as being snarky. I didn't mean to hurt your feelings at all.

You stated in your sentence how physicians "disparage education". All I was trying to say was that physicians Do hate having to go back in a Simulation situation to be able to practice in their chosen field.

I actually thought by adding "LOL" would make what I was saying seem light hearted. I am sorry that it made you angry instead.

[BostonFNP, APRN]

I would agree that people often take this debate as a personal attack, seeing an implication that because they are an ADN nurse that they want harm to come to their patients or that they want to degrade the nursing profession.

Which I think we all agree isn't the case.

To make BSN the entry to practice would effectively cut the output of nurses in half, which would force nursing to alter it's role in healthcare, it's not clear we would even continue to exist.

Do you have some data on that? Any plan for BSN entry would require a lead in period to allow ADN programs to expand into BSN programs perhaps with a small drop in output. I would worry more about what the implications on diversity would be.

We could fix this problem by doubling the number of students in current BSN programs, which would drastically worsen the quality of education in those programs due to overloaded clinical sites, particularly when the recent progression in nursing education is to better synchronize didactic and clinical experience, which requires more clinical flexibility, not less.

Doubling the number of students in BSN programs won't fix the problem and it may make it worse. There are a lot of other factors at play here, and I think/hope everyone recognizes that (poor quality BSN bridge and BSN programs, post-bac ADNs, increasing education costs, etc).

by far the majority of second career nurses come from ADN programs.

I've never seen that data, and if that's the case it makes an interesting argument. Do you have access to it/can you share it?

I'm all for moving towards what provided a better education and better nurses that provide better nursing care, but a BSN only system clearly isn't how to achieve that.

I am not sure if you agree there is/ws a difference in ADN vs BSN outcomes or not? If you think there is/was, then how have ADN programs changed to address it, and how did they know what to change?

[SCnurselisa]

In a hospital, the skills of a BSN prepared use maybe are not well utilized. You do have a team to do each part. Pharmacy, social work, case manager. I have worked in the hospital setting. I now work in a specialists office. I have used more of my BSN skills in that field. Medications are denied for coverage by insurance companies, being able to write an intelligent letter of appeal to get your patient the medication he needs is integral. You are also a case manager/social work wrapped in one. You have a patient who needs a specialized cancer medication. You enroll the patient, but they have a large deductible or copay they will never be able to afford. You must know what services are available to find these services for your patient. It is all about being a patient advocate and going the extra mile. I use my bachelors education daily in my current position as a nurse in the specialty office setting. This is a rewarding setting, you get follow up on your patients, you know their family, they trust you, you go the extra mile for them. More education is never a waste.

[Jeg91821]

I think the most important part of the BSN is the research. Recognizing and being able to read and understand research will help your patient outcomes. Research shows correlation between having a BSN, over an ASN, and better patient outcomes. We follow research for a reason. Evidenced-based practice is everything. When you get to a point where you think your opinion is better for your patient than the research, it is time for you to find another profession.

[Susie2310]

There have been pages and pages of discussion on this forum of ADN versus BSN, and pages and pages of discussion about the studies that purport to show that BSN educated nurses provide care that yields superior patient outcomes versus care provided by nurses with an ADN. I participated in some of the discussions, along with some of the other posters on this thread. From the formulation of the research question, sampling methods used, study population, methodology, statistical methods, level of evidence, and conclusions drawn, there has been lengthy debate by a number of posters. Remember the push for the BSN and the push towards requiring higher education for nurses by nursing academia and nursing leaders. If anyone is interested, and cares to do so, if you do a search on this forum you should find numerous threads on these topics.

To the above poster re correlation: correlation is not causation. Also, there are many reasons for a relationship.

[BostonFNP, APRN]

To the above poster re correlation: correlation is not causation. Also, there are many reasons for a relationship.

To be clear, numerous studies have demonstrated statistical significance not just "a correlation".