BSN nurses

Home Health Columnist / Guide · Jun 8, 2003

Gosnell, D. (May 31, 2002) "The 1965 Entry Into Practice Proposal - Is It Relevant Today?" Online Journal of Issues in Nursing. Vol. #7 No. #2, Overview and Summary. Available: http://www.nursingworld.org/ojin/topic18/tpc18ntr.htm

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Article published May 31, 2002

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OVERVIEW AND SUMMARY: THE 1965 ENTRY INTO PRACTICE PROPOSAL - IS IT RELEVANT TODAY?

Davina J. Gosnell, PhD, RN, FAAN

The topic of "Entry into Practice" is one that has plagued nursing for decades. Throughout this period, position statements have been regularly forthcoming from various professional organizations, no doubt the most remembered being the ANA "First Position on Education for Nursing" of 1965. Each has aroused debate and controversy, more often within the discipline of registered nurses, but also to a lesser extent by other communities of interest including physicians, hospitals, professional and educational organizations and associations, and the general public. The themes of these various documents have been to move formal nursing education out of the service sector and into academic education, to suggest the nature of education needed for the future, and to address nursing's anticipated future. Overall, entry into practice has been one of the most contentious issues in all of nursing.

One might question why OJIN has chosen at this point in time to address the entry into practice issue. Many of the same questions raised with each position document published still remain. Are there now different answers to be found? What the reader will realize in examining the positions of authors Donley & Flaherty, Mahaffey, Nelson, and Joel is that the historical context of nearly half a century suggests varied perspectives in answer to the questions. It is not a matter of finding right and wrong answers but rather in understanding the differences in perspective and context.

Especially interesting to note is that during the period of time examined, there has indeed been considerable change in the actual entry into practice demographics. For example, in the early 60's, 75% of all nurses were educated in diploma schools of nursing, 16% in baccalaureate programs, and associate degree nursing was in its infancy. By the year 2000, diploma education had dramatically declined to just 6%, while BSN doubled to 30%, but ADN has risen to nearly 60% of all new graduates. Indeed, entry into practice has changed! It is also somewhat sobering to note that although the vast majority of today's new nurse graduates are being educated in academic programs, today's nurses are the least educated of all health professionals with two-thirds possessing less than a baccalaureate education. In contrast, most other health professionals (i.e., therapists, speech pathologists, pharmacists) are now requiring entry into practice at the graduate level. Each of the authors provide insightful explanations of the evolutionary factors contributing to the entry into practice issue in nursing. Themes of professional turmoil, health care economics, feminine oppression, external societal controls, political and governmental policy, and lack of valuing of education are found in the perceptive critiques and analyses of these authors.

In "Revisiting the American Nurses' Association First Position on Education for Nurses," Donley and Flaherty provide an insightful comparison and contrast between the education scene of the 1960's and the contemporary educational issues in nursing today. The authors offer not only an in depth review of the 1965 ANA Position Paper but clearly describe the parallel political forces and social issues occurring at the time. Interesting to note is their observation that "circumstances of 1965 are somewhat similar to those of today." Workplace issues, insufficient workforce supply, and lack of professional autonomy are noted to be parallel themes of the two periods.

Mahaffey inThe Relevance of Associate Degree Nursing Education: Past, Present, Future" presents the reader with a comprehensive overview of the remarkable evolution of ADN education. The dramatic impact of ADN education is realized just in sheer numbers from 7 pilot programs in the 50's to more than 800 programs today. Mahaffey, like Donley and Flaherty, notes parallel societal issues of the decade of the 60's and today, including issues of nurse shortage, decreased interest in nursing as a career, and use of creative educational strategies. An important contribution of ADN education is that it has traditionally appealed to the non-traditional student - older, minorities, and males represent nearly twice as many ADN students than those in other type programs. Despite the relevant significant impact ADN education has had on the entry into nursing issue, Mahaffey notes that "decisions were sometimes made without significant representation of all program types." She further pleads an essential need for inclusion of the voice of ADN educators, as well as nurses in practice, in the groups who are designing a vision for nursing.

In "Education for Professional Nursing Practice: Looking Backward into the Future" Nelson provides a retrospective review of educational developments in nursing since 1965. She too, as have the previous authors, identifies the similarities of societal and political pressures felt by nursing, both then and today. In contrast to Mahaffey's compelling argument as to the important contributions of ADN education, Nelson expresses concern that as in the past when, diploma programs served the needs of hospitals, so too today's associate degree nursing program has become primarily a vocational program with a terminal degree and serves as a lucrative offering for technical and community colleges. She then provides a series of compelling arguments in support of rationale for BSN entry into practice, and notes that several organizations have expressed preference for the BSN, including the American Organization of Nurse Executives and the Veterans Administration. She concludes that, "Doors to future educational changes should be kept open, but moving education to the BSN level is the first step."

The last article by Joel entitled "Education for Entry into Nursing Practice: Revisited for the 21st Century" suggests that nursing education has not been in control of its own destiny but rather, "nursing has been dominated by an external loss of control" and has been "swept along by a host of societal and educational circumstances." Joel reiterates for us the true characteristics of a profession - service oriented, learned, and autonomous. Of service, she notes that service orientation must be relevant to the times and carefully orchestrated to meet specific societal needs. To be learned requires not only a unique body of knowledge and skill and considerable educational investment and rigor but also "cognitive artfulness." Autonomy, she reminds us, has two perspectives: the autonomy of the field of work and autonomy of the individual. She concludes that "nursing has resisted the normal course of occupational development" and notes that nurses have traditionally derived their identity from their statutory title, RN, rather than from their academic preparation. The clear differences in clinical competency between the associate degree nurse and the graduate level advanced practice nurse have been unquestionably demonstrated. Joel suggests further pursuit of this differentiation of practice and presents the view that "nursing would always be a work in the process of becoming."

And so, as you, the reader, reflect on the issues of entry into practice not only from the perspectives of these authors, but from your own unique vantage point, I challenge you to share your thoughts, new insights, and reactions to these authors by either writing a letter to the Editor or by submitting a morificecript which will further elucidate the issue of entry into practice. We look forward to hearing from you.

twarlik · Jun 8, 2003

Originally posted by pama
Peaceful2100, Perhap I should have said "National statistics from the NCLEX-RN for the past fifteen plus years for first time candidates has demonstrated the ADN graduate scored better on the exam than the BSN graduate". I did not make the stats up, nor did I mean to ruffle feathers.

No feathers ruffled here!

Just curious...where are you getting your stats from? I was checking out the website for the National Council of State Boards of Nursing and from what I could tell, ADN graduates don't score higher on the NCLEX. I had a hard time navigating their site and they certainly don't make the information easy to get to, so I could be incorrect. I also got info from the National Organization for Associate Degree Nursing website that said for the year 2000 BSN grads scored slightly higher. Think I put this in one of my earlier posts...

Todd

twarlik · Jun 8, 2003

Thanks NRSKarenRN for your post!

As someone who's just entering the field of nursing I think that it's so interesting to read about the history of this issue.

One thing that caught my eye was the statement in one of the articles that Karen posted: "An important contribution of ADN education is that it has traditionally appealed to the non-traditional student - older, minorities, and males represent nearly twice as many ADN students than those in other type programs." I was just thinking about this the other day and was wondering if more "non-traditional" students persued an ADN education. I look around in classes I've taken at the community college and I am surrounded by older students. My classes at the university are predominately 20-something and female. Most are first-time students, fresh out of high school. Wondering if this is something anyone else has observed...?

peaceful2100, BSN, RN · Jun 8, 2003

Originally posted by pama
Peaceful2100, Perhap I should have said "National statistics from the NCLEX-RN for the past fifteen plus years for first time candidates has demonstrated the ADN graduate scored better on the exam than the BSN graduate". I did not make the stats up, nor did I mean to ruffle feathers.

As I said in a previous post, it is time we all start working together. Once the RN is behind the name, we are all professional nurses, regardless of the degree or diploma.

Hopefully you will not complain that you are not being paid more. Afterall you will be doing the same jobs, have the same license, and will be on the same professional level as the ADN and diploma nurse. All beginning Registered Nurses should be paid the same.

I understand now. Thanks for the clarification. I agree that nurses do the same job and take the same test to get their license. I just find it ironic how some people (I am NOT saying you) don't value a nurses education in regard to pay but yet in other professions their education is Valued. People make excuses about doctor's salaries about how they have all those loans to pay back and while a nurse with a BSN most certainly do not have as many loans to pay back as a doctor does they MAY have more than an associate's degree nurse. To say the least and the inital disappointment of not seeing even a slight difference with my BSN however, my starting pay is pretty nice.

Also based on the FACT and only based on the FACT that nurses do the same job and that pay is not where it should be for BOTH ADNs and BSN's I can PERSONALLY agree with the fact that it should be the same for what nurses have to do.

fairyprincess2003 · Jun 13, 2003

I agree with Tonya.

I feel that there should be ADN's, and many are great nurses. BUT it is not fair to try and slight the BSN as the same degree because it's not. I am 33,000 in debt right now(and still going for more) Many people at my university fail the pre-reqs and have to take them at a two year to catch up(and get A's) At least where I am from, the educational level is higher at a 4 year institution. The only way for any profession to move up is with education. I cannot stand it when PT or Resp therapists act like they are above nurses or something, especially when I have the same if not more(in resp case) education. I do feel BSN's should be paid more. Just like people with masters degrees are paid higher in the same field as BS. Just my opinion though. Both ADNs and BSNs should make more money though!

Janel S. BSN

Hellllllo Nurse, BSN, RN · Jun 13, 2003

Originally posted by sbic56
pama

I wanted to reply to that post, but knew it was for you to do so. Thanks. I agree with your post 100%.

Same here.

geekgolightly, BSN, RN · Jun 23, 2003

I want a BSN. Rather, I want a Master's. I do not plan on teaching nor do I wish to go into administrative work. I want to be a floor nurse or I want to start a practice where I would always have direct patient care.

None of this I could do if I had been required to get a BSN first. The ADN has afforded me, by shaving off one year of school and tens of thousands of dollars, a way into this profession.

The difference in the degree seems to be more about cultural courses taken, maybe a chemistry class and statistics, as well as some philosophy or government courses. All core courses both in ADN and BSN are taken in the same length of time. I think it's great that BSN's feel that a well rounded education is important to them, but I have a hard time swallowing that this makes them a better nurse. And with autodidacts being as they are (and I have found that most nurses are also autodidactic) I don't even think that a well rounded education means that one with a higher degree knows more about more aspects of life and society than does one with a lesser degree. A master's or higher is, of course, a different ball game.

All graduates must pass the NCLEX. The pass rate is essentially the same betwen the ADN and the BSN. As an ADN soon to be graduate, I do think it is strange that BSN's might not be offered more pay for their dilligence in completing a degree of one more year of schooling. I think this would ruffle some feathers, but I also think it would promt many to further their education. I realise this is a controversial statement, but I'm all about that.

sbic56, BSN, RN · Jun 23, 2003

All graduates must pass the NCLEX. The pass rate is essentially the same betwen the ADN and the BSN. As an ADN soon to be graduate, I do think it is strange that BSN's might not be offered more pay for their dilligence in completing a degree of one more year of schooling. I think this would ruffle some feathers, but I also think it would promt many to further their education. I realise this is a controversial statement, but I'm all about that.

So why do you think not getting paid more would entice others to further their education beyond ADN?

geekgolightly, BSN, RN · Jun 23, 2003

Originally posted by sbic56
So why do you think not getting paid more would entice others to further their education beyond ADN?

Maybe I worded this weird. I mean to say that I think that a pay increase for the BSN is a good thing; that it would promt those who see "no point" in going to school, to finally do so. I would like for the majority of nurses to want a bachelors degree. Not because I think BSN nurses know more than ADN nurse, but it lends a certain respectibility to the career in general, as well as invigorates the nursing population to reinvest in education.

I do not think that ADN pay should be lowered, rather the BSN pay should be increased. I think it's wonderful that I invested three years of my time for a degree which will afford me not only a career that I love, but it will actually afford a life for me. What other two year degree will start you at 50k a year? (my start pay). I will go on and further my education without the finanacial incentive, but I think it would promote the professionalism of nursing to have a differentiation of pay for the BSN, as so many would go ahead and take the bullet of more education = more money spent in school as there are financial rewards to doing so.

What do you think?

sbic56, BSN, RN · Jun 23, 2003

geekgolightly

First of all, I do think it is going to continue to be that nurses will be required to have more and more education. I was an LPN for years and decided to go on to get my ADN, not because I truly had a burning desire to do so, but because in my state, LPN's were being phased out of the hospital setting and I felt the security of my position was threatened. So, I have job security and a bigger paycheck. Do I feel like more of a professional? No, but maybe that is just me. Actually, I felt some irritation in regards to how some of those in "higher" positions than myself had changed their perception of my worth and ability when I had RN behind my name. After 13 years as a very active LPN, I did not feel like the year of school made much difference in how valuable I was as a nurse.

I don't necessarily think increasing educational requirements is a negative trend at all, especially with ongoing advances in medicine, we will need to keep current. I am still undecided as to whether the education, in and of itself, will improve nursing as a profession any more than it did in the situation I just described with the LPN's upgrading to RN's. True, some "within" saw me as "more professional", as I stated, but does more education improve the face the profession overall?

I don't think nurses in general are disrespected as a profession by the general public, though I do think their perception of us is a bit confused, because the role of nurses is so poorly defined or understood. I see nurses as being perceived as less instrumental in the actual outcome of a patients individual care and moreso being the taskmaster that follows the orders of the doctor. We know that is not the case, but if you ask the average person what a nurse does, they will probably tell you that they "pass pills" or know we take care of patients, but have no idea how crucial our assessments are to the patient's well-being. It is abundantly clear to them that the physician has an important job; what they do not realize is that he knows what he knows because most times a nurse has told him so and he then makes his decisions accordingly based on that info. One can't blame the patient/public for such a skewed vision of what nures are, when in the course of their stay what they see is their nurse emptying waste cans, fetching water and otherwise appearing to be in a subserviant, second rate role. This is not to say that we should not do these things at all. (Though, I do think we do way to much ancillary crap.)I just want to point out that because this is often what the public sees us do, they believe this is our main function.

Phew! So will education alone improve our image? No, but we'll be even smarter than anyone knows! Seriously, I think educating the public is every bit as important as requiring more education. Ya think?

Hellllllo Nurse, BSN, RN · Jun 23, 2003

Some school's are still teaching the "RNs need to be BSNs" thing?

They are not current on what is going on in nursing.

Nursing jobs are now being filled by less qualified candidates. Years ago, it was unheard of for an LPN to be a DON. It's fairly common, now. UAPs are taking many jobs that were formerly offered to nurses only.

I lived in a county in AZ where an ADN RN was head of the county vaccination program, and was sent to a seminar to learn how to write for grant monies. It used to be that this was a strictly MSN thing.

The director of my dialysis unit is an ADN, and so is the ADON. There are no BSNs there at all and it is a large unit. Unlicensed techs are now allowed to do physical assessments and IV meds there. All of the nurses there have strongly objected, to no avail.

Employers want health care workers with less education and expanding scopes of practice and that's what's happening.

RNs can perform procedures that used to be done by docs only, LPNs can give IV meds, which used to be RN only, and so on.

This trend is not desirable or beneficial in my opinion, but it's what IS.

Hellllllo Nurse, BSN, RN · Jun 23, 2003

to sbic56-

I don't agree w/ everything you said in your post, but what a great post it is.