BSN is a joke

Nurses General Nursing

Published

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??!?!?

The data has been consistent across numerous studies and numerous countries.

You haven't answered my question. What is the level of evidence for the studies? Are the studies not qualitative in design? This is a fairly low level of evidence.

Specializes in Adult Internal Medicine.
You haven't answered my question. What is the level of evidence for the studies? Are the studies not qualitative in design? This is a fairly low level of evidence.

Low level of evidence? These were major studies published in some of the most prestigious peer-reviewed (nursing and medical) journals in the world. Do you think that because studies are not RCTs they are not valid? The majority of published research is not RCT (nor could it be) and it is laughable to assert that retrospective cohort studies or observational studies hold no statistical weight.

I have some concerns about how several of these studies were structured but that does not invalidate them.

The truth of the matter here is you just don't want to believe it because of your personal bias, can we at least agree on that? There is nothing wrong with that, but we can drop this nirvana fallacy that because a study isn't perfect its not valid.

Specializes in Adult Internal Medicine.

As of 2009, just over half of ADN students were second career students, often with previous degrees, this comes from research put together for a 2009 committee on making BSN the entry to practice, it says I'm not supposed to "re-publish" any of it, I'll see if that is still the case.

I would be very interested in that data. The last published data I saw on a similar topic was from 2014 and showed that about 40% of ADN students were over the age of 30 compared to only 18% of BSN students.

Second degree ADN nurses were not addressed in any of these studies that I am aware of. There are a few interesting potential consequences to this: 1. second degree ADNs would be assumed to be less likely to benefit from a bridge program, 2. they are falsely increasing the ADN outcomes, 3. they potentially, if separated, may help in teasing out some potential and previously inseparable confounders.

I agree that the research has shown different levels of education in programs a couple of decades ago resulted in differing outcomes. There was no delineation of what exactly these outcomes resulted from, but the best guess seems to be that it was the differing content and curriculum, it could be due to other factors are less obvious but seem unlikely, for instance it could be because BSN students are more likely to live in a dorm, I tend to doubt that having ASN students live in a dorm for a year would necessarily improve the outcomes of their patients down the road.

This is one of my biggest problems with the studies: the authors seem to conclude that having more ADNs bridge to BSN would improve outcomes but I don't see any data to really support that. All we know is that hospitals with larger percentages of BSNs have better outcomes when other factors are controlled for. Scientifically it is as likely to be dorms or learning at a younger age or schooling full time or any random confounder that the authors couldn't control for. You can add all the same exact coursework but that may not change the results, that's the problem for me, we don't know what exactly works.-

The studies that exist indicate BSN nurses get better outcomes. So unless someone can produce a study that indicates that is not true, there is not point in debating this. Nursing is a profession. Professions require an bachelor's degree, at a minimum.

CCs can't offer BSNs because CCs, by definition, are 2 year institutions.

Finally, employers can require whatever training and hiring standards they wish. So suck it up. ADN RNs who don't want a BSN can get jobs where a BSN is not required. Otherwise, just put on your big girl or big boy pants and be a professional. I'm an NP and if the DNP becomes a requirement, I'll suck it up and get a DNP.

These discussions about not wanting a BSN and that BSNs are worthless make me cringe in shame for the nursing profession.

Specializes in HIV.

These discussions about not wanting a BSN and that BSNs are worthless make me cringe in shame for the nursing profession.

Agreed 100 percent. It is literally near painful to read.

If you do not want to be educated, don't be a nurse. Plenty of healthcare options don't require a degree.

The studies that exist indicate BSN nurses get better outcomes. So unless someone can produce a study that indicates that is not true, there is not point in debating this. Nursing is a profession. Professions require an bachelor's degree, at a minimum.

The debate has already taken place. You're late to the party. Do a search on this site and you should find pages of discussion.

Specializes in Adult Internal Medicine.
The debate has already taken place. You're late to the party. Do a search on this site and you should find pages of discussion.

Just like if you do searches on PubMed you'll find pages of studies.

Specializes in Hospice, Palliative Care.

In an actual scientific experiment, one can accurately separate out the components being tested to provide validity to the research. How are the studies that show having a BSN decreases mortality or otherwise improves patient outcomes separating the degree from the nurse just having more experience? We have no way to know if the same person would have decreased mortality or improved outcomes if they didn't get their BSN as opposed to getting their BSN because as they are on the journey to complete their degree, they are gaining even more work experience.

While I'm one of those people who disagree in the quality and accuracy of the studies showing RN's with BSN degrees improve patient outcomes more than those with lesser degrees, I do find the journey on getting a BSN to be beneficial from having a broader and more diverse understanding of the field. I am currently going through the Capella University Flexpath program, and find most of the research I have to do in each class can be connected to my work environment and the community being served by the hospital system where I work.

While it is anecdotal, I can see from my current assessment of learning that gaining a knowledge of complementary and alternative medicine (CAM) and spirituality that I might view assessing my patients for their use of CAM differently, and such an assessment might help our treatment team provide better care. From that perspective, I would disagree with the author of the opening post in that BSN courses are disconnected from bedside nursing.

Specializes in Emergency.
Actually I don't think I am. I agree with you. What I don't agree with is the posters whose position ARE absolutes. FTR I am all for the BSN being the entry point for nursing and I hope it happens sooner than later. But not because I think it's superior. I just think in the court of public opinion it will support nursing as an actual profession rather than a trade. I think we need to do a better job of supporting high quality continuing ed and ecertifications as well.

You may consider this apples and oranges but there are several instances where persons on this board have stated that the Baccalaureate is what designates one as a professional over being a simple tradesman or vocation. I have issue with that and the discussion would go on a lot longer than is practical here but I would say that if that is your belief/attitude, you don't really understand labor, labor law, labor practice and professionalism.

I also think that you sell nursing short. The court of public opinion already places nursing extremely high in trust and professionalism. I tried to link a Gallup poll here but it seems every medical trade has hijacked the Google search engine and has a way to show itself as the highest in public trust. ANA included. At this point I am unwilling to dig deeper because it would be another internet rabbit hole.

Many "trades" require deep education and although the collar may be blue, the education is more intense and longer than a 4-year degree. Would the sentence, "I am a professional fire fighter by trade" make sense to you? I also consider myself a professional nurse since I passed the NCLEX-RN and have been working in the "industry". (I mean face it; at this point it is becoming the medical-industrial complex.)

To note, I do plan to study for BSN, I like education in general and I want to be employable wherever I go. But to designate BSN as the entry point will exclude a lot of good nursing candidates. Community colleges are affordable, local and have classes at all hours. To attend a four-year school while working full-time is just not possible for a lot of good nursing candidates so why not have a good compromise?

1. ADN/ASN is the MINIMUM entry point. 2. It will be standard to enter a BSN program within so many years (months?) of passing NCLEX to maintain license until BSN is obtained. 3. And for dog's sake! Grandfather in those ADN/ASN nurses who have been steadily working for 20 years.

My opinions of course are mine, influenced entirely by my point of view and my life history. I am always open to discussion.

You may consider this apples and oranges but there are several instances where persons on this board have stated that the Baccalaureate is what designates one as a professional over being a simple tradesman or vocation. I have issue with that and the discussion would go on a lot longer than is practical here but I would say that if that is your belief/attitude, you don't really understand labor, labor law, labor practice and professionalism.

I also think that you sell nursing short. The court of public opinion already places nursing extremely high in trust and professionalism. I tried to link a Gallup poll here but it seems every medical trade has hijacked the Google search engine and has a way to show itself as the highest in public trust. ANA included. At this point I am unwilling to dig deeper because it would be another internet rabbit hole.

Many "trades" require deep education and although the collar may be blue, the education is more intense and longer than a 4-year degree. Would the sentence, "I am a professional fire fighter by trade" make sense to you? I also consider myself a professional nurse since I passed the NCLEX-RN and have been working in the "industry". (I mean face it; at this point it is becoming the medical-industrial complex.)

To note, I do plan to study for BSN, I like education in general and I want to be employable wherever I go. But to designate BSN as the entry point will exclude a lot of good nursing candidates. Community colleges are affordable, local and have classes at all hours. To attend a four-year school while working full-time is just not possible for a lot of good nursing candidates so why not have a good compromise?

1. ADN/ASN is the MINIMUM entry point. 2. It will be standard to enter a BSN program within so many years (months?) of passing NCLEX to maintain license until BSN is obtained. 3. And for dog's sake! Grandfather in those ADN/ASN nurses who have been steadily working for 20 years.

My opinions of course are mine, influenced entirely by my point of view and my life history. I am always open to discussion.

I believe most true professions consider nursing semi-professional. A trade, which usually does take skill and significant training, is characteristically defined by its manual labor component.

A profession typically has a more formalized training or educational requirements with a minimum barrier of entry. To be a nurse you might have a diploma, an associates, bachelor's, or even a masters by the time you enter the profession. This level of variability in the educational requirements is unusual in most true professions.

Some see the state regulated licenses as being the minimum barrier of entry but most outside of nursing would see the educational requirements being the standard barrier of entry.

Every physician has a doctorate for example, you cannot be an associates surgeon.

I think most people can agree that nursing is on the cusp.

The NCLEX is the professional licensing exam for RN's. There is no two tiered system; one for BSN prepared graduates and one for ADN/Diploma prepared nurses. State boards of nursing do not make a distinction that BSN prepared nurses are better prepared to practice nursing. The BSN push comes from nursing academia - this has already been discussed on this thread.

From my own experience (I apologize for not being able to provide a study as I number just one individual) during my last semester of my ADN-BSN bridge program, at a respected bricks and mortar state university, I heard generic BSN students in their final semester say that they had received hardly any clinical training and didn't feel prepared to be nurses. This was evident in the practicum that we participated in together. I am not generalizing this to all BSN programs, but I have heard these comments often enough during the 20+ years since I have been licensed that even though there is apparently no study to "demonstrate" that ADN students are better prepared clinically than BSN students, I have to take these comments into account. We don't need a study to tell us everything; contrary to what some people appear to believe, we just need to be intelligent and observant.

We have qualitative studies that purport to show that BSN prepared nurses provide care that yields superior patient outcomes versus ADN prepared nurses. The studies are not without flaws, yet we are urged to accept them without question. Also, qualitiative studies do not provide a level of evidence close to that of Randomized Control Studies. Anyone who disagrees is free to research this for themselves. What outcomes are we talking about? If clinical outcomes, what outcomes precisely? Morbidity and mortality - no. Retrospective patient questionnaires about aspects of the care the patient received from the nurse during their hospitalization?

The OP and other people on this thread commented that their experiences of BSN education after they are already a licensed RN fell short of their expectations, and the topic has been brought up that new graduate nurses need more clinical preparation in nursing school to be able to function at a basic level clinically when entering the workplace. I would like to see these topics addressed by those charged with educating nursing students - a discussion of what needs to change in ADN-BSN programs to provide a better experience for already licensed RN's, and what needs to change in nursing programs to better prepare students to practice at a basic level when they start working.

Specializes in Critical Care.
I would be very interested in that data. The last published data I saw on a similar topic was from 2014 and showed that about 40% of ADN students were over the age of 30 compared to only 18% of BSN students.

Second degree ADN nurses were not addressed in any of these studies that I am aware of. There are a few interesting potential consequences to this: 1. second degree ADNs would be assumed to be less likely to benefit from a bridge program, 2. they are falsely increasing the ADN outcomes, 3. they potentially, if separated, may help in teasing out some potential and previously inseparable confounders.

This is one of my biggest problems with the studies: the authors seem to conclude that having more ADNs bridge to BSN would improve outcomes but I don't see any data to really support that. All we know is that hospitals with larger percentages of BSNs have better outcomes when other factors are controlled for. Scientifically it is as likely to be dorms or learning at a younger age or schooling full time or any random confounder that the authors couldn't control for. You can add all the same exact coursework but that may not change the results, that's the problem for me, we don't know what exactly works.-

I'm not sure that second career ADNs are necessarily falsely increasing the outcome data for ADNs since they are a core part of the ADN group. And I agree that to lose those second career nurses and the other beneficial demographics that ADN programs bring would not benefit nursing.

It would be nice to see a post-hoc study of data from all these studies to isolate the specific factors that produce better outcomes so that we can be sure they are replicated, but currently it seems to be assumed that it is mainly the content and curriculum, which likely isn't too far off.

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