BSN patient outcomes

S.G. · Aug 10, 2013

I did a research proposal in my program, so I hope to answer the OP's question, and contribute my point of view in the discussion.
My research proposal was focused on how ADN-BSN nurses and BSN nurses improve their practice, using the Benner Novice to Expert Model.
When looking at previous research, each article I have reviewed, including the studies that are being used to "elevate" the profession-which it is, already...our profession cannot be perceived nor compared to other professional educational formats, IMO, because of the nature of the clinical work that we do, especially of what is expected in our practice.
NONE of the studies PROVED that the entry level should lean towards BSN...it SUGGESTED that with more education, PLUS experience showed a correlation towards better patient outcomes.
If anything, the research supports Benner's novice to expect theory. More educated and experienced nurses have better outcomes. It also suggests that having a better skill mix will help new nurses transition easier from novice to expert, based on my interpretation; which I used in my research proposal.
I also went to a program where they were piloting a 5 year study on traditional nursing students and non-traditional/second degree/healthcare experience nurses in terms of succeeding a BSN program...they are going to correlate data to their RN-BSN program as well. I was in year 2; so when their research is done, I anticipate to see what data they produce.
The REAL issue is ensuring that nurses can successfully transition from novice to expert, not necessarily in entry level to practice per se, but in ensuring how nurses can improve their practice successfully. It also comes down to HOW one interprets data objectively.
If that means the option to get a BSN, getting certified in the area of practice, or ensuring educational credits for a stronger practice, then those options seem pretty logical; as long as the OPTIONS (did not say "requirements") are logical, the benefits to the patient and the Nurses's practice can correlate to better outcomes for all.

Thank you for your response. Very interesting indeed :)

I had actually not been able to think if a practical application for my theories course. It's actually very refreshing to think I may use that information down the road just as you have done. It's good to see theory applied to what I find to be an interesting topic of discussion.

PMFB-RN, RN · Aug 10, 2013

I haven't done the research myself, so please forgive me if this is an ignorant thought.
I have read studies citing that BSN prepared nurses have better patient outcomes than ADN prepared nurses.
I find myself wondering if any studies compare ADNs to BSNs who were not diploma or ADN nurses first. I haven't found a study that doesn't include experienced nurses who have gone back for their BSN (I haven't tried very hard to look but I did search a bit while going back for my own BSN). It seems like it would make sense that more experience and more education would have better outcomes. Is there a difference in patient outcomes for new grad BSN versus RN-BSN students? I would think yes. It's not a fair comparison to say that BSN nurses have better outcomes than ADN nurses if RN-BSN nurses are included in the study. RN- BSN nurses should have better outcomes than ADN nurses if only because they do have more experience.
Just my random thought for today...

*** Since those studies are being used in the BSN as entry to practice discussion I would not consider them valid if they included ADN RNs who have gone back and got their BSN. They _MAY_ be valid in an argument for requiring all nurses to get a BSN, but would not be evidence for a BSN as entry to practice arument.

An unbiased study that compaired patient out comes of RNs who entered practice as BSNs to RNs who entered practice as ADNs (reguarless of later educational achievments) would be useful in the BSN as entry to practice discussion.

Ruby Vee, BSN · Aug 10, 2013

I personally had better outcomes as a patient before I was a BSN. I was younger then, though. Do you think that made a difference?

PMFB-RN, RN · Aug 10, 2013

I personally had better outcomes as a patient before I was a BSN. I was younger then, though. Do you think that made a difference?

*** Any study that wants to compair patient out comes based on degree needs to srot out those nurses who entered practice as BSN from nurses who entere practice as ADN, reguardless of any other educational achivement they have earned. For the purposes of the study the ADN RN needs to be counted as an ADN, even if they have a BSN, masters or doctorate that they earned later. At least if they want to be used as evidence for BSN as entry to practice they do.

Esme12, ASN, BSN, RN · Aug 10, 2013

I did a research proposal in my program, so I hope to answer the OP's question, and contribute my point of view in the discussion.
My research proposal was focused on how ADN-BSN nurses and BSN nurses improve their practice, using the Benner Novice to Expert Model.
When looking at previous research, each article I have reviewed, including the studies that are being used to "elevate" the profession-which it is, already...our profession cannot be perceived nor compared to other professional educational formats, IMO, because of the nature of the clinical work that we do, especially of what is expected in our practice.
NONE of the studies PROVED that the entry level should lean towards BSN...it SUGGESTED that with more education, PLUS experience showed a correlation towards better patient outcomes.
If anything, the research supports Benner's novice to expect theory. More educated and experienced nurses have better outcomes. It also suggests that having a better skill mix will help new nurses transition easier from novice to expert, based on my interpretation; which I used in my research proposal.
I also went to a program where they were piloting a 5 year study on traditional nursing students and non-traditional/second degree/healthcare experience nurses in terms of succeeding a BSN program...they are going to correlate data to their RN-BSN program as well. I was in year 2; so when their research is done, I anticipate to see what data they produce.
The REAL issue is ensuring that nurses can successfully transition from novice to expert, not necessarily in entry level to practice per se, but in ensuring how nurses can improve their practice successfully. It also comes down to HOW one interprets data objectively.
If that means the option to get a BSN, getting certified in the area of practice, or ensuring educational credits for a stronger practice, then those options seem pretty logical; as long as the OPTIONS (did not say "requirements") are logical, the benefits to the patient and the Nurses practice can correlate to better outcomes for all.

Here's the deal.....one can't say that the BSN is superior and directly responsible for better outcomes......when in the studies they include experienced nurses with certifications in their field of expertise.

I believe in education....don't get me wrong....but I believe a nurse with 20 years experience (or, as in my case...35 years) in one field of expertise AND certification (official certification) in their field is NOT necessarily benefited by the BSN with a direct correlation to the improved outcomes of patients...when it is CLEARLY the clinical expertise and experience that the patient is benefiting from.

To make a blanket statement that patients directly benefit from the BSN, when that information is misleading and NOT accurate, isn't practicing evidenced based nursing.

Which has a larger impact....the BSN grad or the ASN/ADN grad with 25 years of critical care experience with their CCRN, CEN, CFRN, CSC and TNCC, ATCN, ENPC RN-BC....prove to me the BSN will improve this nurses practice and patient outcomes and maybe it might convert my thoughts.

To use a lame excuse (inferiority complex) that because we don't have as much education (college debt) as "other professionals"......thereby making us nonprofessionals and inferior doesn't impress me...... for that college educated inexperienced professional can't do my job at the bedside....and that includes nurses with nursing degrees. A BSN did nothing for my patients as I had already has 25 years of bedside experience.

Show me how this 10 month program on line improved my patients outcome and improved my patients outcomes

Now do I believe that at least for now the BSN is the education route of choice? Yes I do as in most parts of the country the plethora of nursing grads has made a competitive market. Will it stay this way......I don't think so for those who turned to nursing because of financial desperation in this poor economy will eventually bail when something better comes along......leaving what will turnout to be, what I believe, a sizable hole....in about 6-10 years.

S.G. · Aug 10, 2013

Here's the deal.....one can't say that the BSN is superior and directly responsible for better outcomes......when in the studies they include experienced nurses with certifications in their field of expertise.
I believe in education....don't get me wrong....but I believe a nurse with 20 years experience (or, as in my case...35 years) in one field of expertise AND certification (official certification) in their field is NOT necessarily benefited by the BSN with a direct correlation to the improved outcomes of patients...when it is CLEARLY the clinical expertise and experience that the patient is benefiting from.

This is the thought process I was following. You were able to voice it much more eloquently. As you've already said, the studies are flawed and can show no evidence that a BSN would improve the patient outcomes from an experienced nurse. I have never heard if someone finding a study that does not include these experienced nurses in its confusions that the BSN is of benefit. I do believe that it would benefit new grads but, again, there is no "real" evidence without a study excluding experienced nurses.

Thank you for your opinions.

sistasoul · Aug 10, 2013

Hi,

I have an associate degree in nursing and I am currently taking classes towards my BSN. I had 10 classes to take to get my bachelors and I have completed six thus far. Of all of the classes I have taken only the health assessment and pathophysiology has helped me at the bedside. Actually the health assessment was an in depth assessment that bedside nurses do not have time for. The other classes have not helped in the least unless you want to get into management. And even then I have another bachelors degree in Finance which would be better suited to a management position. I don't want to say that knowledge is a waste but most of these classes are not going to help you if you plan on staying at the bedside.

Experience will always trump education when it comes to nursing or actually any job for that matter. Just my humble opinion.

LadyFree28, BSN, LPN, RN · Aug 10, 2013

Here's the deal.....one can't say that the BSN is superior and directly responsible for better outcomes......when in the studies they include experienced nurses with certifications in their field of expertise.
I believe in education....don't get me wrong....but I believe a nurse with 20 years experience (or, as in my case...35 years) in one field of expertise AND certification (official certification) in their field is NOT necessarily benefited by the BSN with a direct correlation to the improved outcomes of patients...when it is CLEARLY the clinical expertise and experience that the patient is benefiting from.
To make a blanket statement that patients directly benefit from the BSN, when that information is misleading and NOT accurate, isn't practicing evidenced based nursing.
Which has a larger impact....the BSN grad or the ASN/ADN grad with 25 years of critical care experience with their CCRN, CEN, CFRN, CSC and TNCC, ATCN, ENPC RN-BC....prove to me the BSN will improve this nurses practice and patient outcomes and maybe it might convert my thoughts.
To use a lame excuse (inferiority complex) that because we don't have as much education (college debt) as "other professionals"......thereby making us nonprofessionals and inferior doesn't impress me...... for that college educated inexperienced professional can't do my job at the bedside....and that includes nurses with nursing degrees. A BSN did nothing for my patients as I had already has 25 years of bedside experience.
Show me how this 10 month program on line improved my patients outcome and improved my patients outcomes
Now do I believe that at least for now the BSN is the education route of choice? Yes I do as in most parts of the country the plethora of nursing grads has made a competitive market. Will it stay this way......I don't think so for those who turned to nursing because of financial desperation in this poor economy will eventually bail when something better comes along......leaving what will turnout to be, what I believe, a sizable hole....in about 6-10 years.

Esme. I agree.

My point is to state that with my own 2 eyes, NONE of the research is stating that BSN is superior over ADN...if anything, it's correlating to a Nursing theory, and that skill mix-experienced nursing and new nurses put together-have better patient outcomes, and a TON of other correlations-skill mix can include LPNs too. :yes: -that support that a robust nursing staff that is essential to healthcare... (CONTRARY to what some organizations are trying to do to the profession)

My other point is that I don't think the research in itself is flawed, it's WHO is interpreting the research that could be having flawed thinking...to err is human...

I have a background in healthcare...13 years, with 8 years in nursing, 7 as a LPN. I know I plan on staying in this business. I've invested my time and dues in this business and I love it.

I'm addressing the issue if HOW and WHO-what are the extrinsic and intrinsic factors that involved the person who is interpreting the data...that is where the issue is.

I've been on AN since 2004-when I was a PN student...hot topic: LPN vs. RN :blink:

Unfortunately, there will be people who have an inferiority complex and tons of other personality "traits" that are not necessarily at the bedside, but on our team...and if history in humanity serves me well, there are tons of texts out there that are open to interpretation and open to debate. Research is not immune to the same application.

I think for those who ran to this profession may leave...however, this idea that nursing was a money maker did not happen overnight...I seen it ever since I started working in healthcare...they are far more outnumbered to the ones who are in it as a career-like, you, myself and countless posters on AN, and who I've encountered at school, work, conferences, and in my travels abroad. We are the ones who have the ability to shape change. I have been able to do this as a bedside LPN, so understand what eyes I'm looking at the research with. This is a nurse NOT with an inferiority complex or a complex at all...but a competent, empowered, informed nurse, looking it theoretically, hopefully absent from flawed agendas. :yes:

PMFB-RN, RN · Aug 10, 2013

Hi,
I have an associate degree in nursing and I am currently taking classes towards my BSN. I had 10 classes to take to get my bachelors and I have completed six thus far. Of all of the classes I have taken only the health assessment and pathophysiology has helped me at the bedside. Actually the health assessment was an in depth assessment that bedside nurses do not have time for. The other classes have not helped in the least unless you want to get into management. And even then I have another bachelors degree in Finance which would be better suited to a management position. I don't want to say that knowledge is a waste but most of these classes are not going to help you if you plan on staying at the bedside.
Experience will always trump education when it comes to nursing or actually any job for that matter. Just my humble opinion.

*** It's great you are finding some benifit to at least some of your classes. For me the BSN was only re-hash of things I already understood. For example the health assessment class I took in the BSN program sucked compaired to the one week long, all day intensive health assessment class I had previously takes that was offered by TCHP.

TCHP - Free, high qualiety classes available to any nurse in my hospital. Not only free but usually we can go to a certain number of theses classes on paid time.

http://www.tchpeducation.com/

lindarn · Aug 10, 2013

As I read through the plethora of comments on this thread, I have to wonder, if, when PTs, OTs, Pharmacists, increased their educational requirements, if there was the same complaints?

It seems that, the higher ups in their profession, decided that increasing the entry into practice was better for the common good, and it was established. There are several positive outcomes when increasing the educational requirements for a profession.

First, is the one that I mentioned a couple of days ago- that increasing nursings' entry into practice, differentiates us from lesser educated professions. Namely the practice now, of alowing RRTs to insert PICCS, and other invasive procedures, none of which is part of their ecucational preparation, therefore, not in their scope of practice.

Next, when other professions increased their educational requirements, it cut out alot of individuals, who were looking to earn a degree in as short a time period as possible. THAT is definatelly the case with nursing.

If a higher level of education is required, fewer the individuals will want to enter the profession. In a simple case of, fewer numbers, mean more bargaining power, more control over our profession. That is certainly a plus. Not every, Tom, Dick, and Harry, is cut out to be a nurse. But when it seems so easy to become a nurse, we end up with too many nurses for hospitals to pick from, and it becomes a buyers market for them. More of us, = less power for us, as well.

PTs and OTs did not protest like nurses when the educational levels were increased. Why, then do nurses feel the need to whine about it, ad nauseum. Our lower levels of education make us look like a bunch of blue collar trailer trash, instead of the educated, medical professionals that we are. The increased educational levels benefits all of us. I wished that I had a nickel for every time I was told, "what do you 'girls', expect- you only went to school for two years". And they are right. The public equates worth with education.

When we demand more money for what we do, we can use the higher levels of education as an argument. Teachers need a Masters to teach KINDERGARTEN!! While they are responsible for the safety of the children when they are in classs, they are not responsible for their lives, when they are critically ill.

Why do nurses think that more education is a bad thing? Do teachers really need a Masters Degree to teach Kindergarten kids the alphabet and counting to 10? It is the other things that they learn about childrens developement, and learning styles, that enhance the educational experience for the children, and make learning an enjoyable thing. That is what the increased education is for. The learning that enhances the ability of nurses to better plan and manage the care of their patient. Not, "why do I need a BSN, to give patients a bath or whipe their butts? it is more than that. You don't know, what you don't know, because you don't know. Period.

if nurses had more educational time in their program, they could learn things like, Employment Law, Starting a Business, etc. Maybe these are not courses that will give you addtional knowledge to understand your patient's diagnosis, but they sure would be helpful in a nurses daily life in todays, anti employee climate. Knowing how to handle management abuses, etc, and countering acusations and allegations, designed to get rid of, "troublmakers", would make nursing a more pleasant career.

JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN (ret)

Somewhere in the PACNW

LadyFree28, BSN, LPN, RN · Aug 11, 2013

...agreed lindarn. Excellent points. :yes:

S.G. · Aug 11, 2013

Love your post, lindarn!