BSN's deliver safer care than ADN's??

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Now, I am all for further education, but I think this study is skewed. I truly don't see how they have come to the conclusion that taking more courses in the humanities and other such non-nursing related courses is going to produce a more competent bedside nurse. The core nursing cirriculum for most ADN and BSN programs is quite similar in my experience. I can see where the BSN nurse may have it over the ADN in managerial type roles, but as a bedside nurse? I think lots more studies need to be done before this quick conclusion is drawn. One factor that may affect nursing in this negative way is the poor economy. Maybe it is that some people are going into nursing just because it will almost guarantee them employment and don't really want to be in nursing and therefore are not as dedicated as nurses? These people may not want to go for the BSN. I don't know...that is just something I am throwing out there because this makes no sense to me. I don't want to start the old BSN vs. ADN war, but this is news and I was wondering, what do you all think?

http://www.upi.com/view.cfm?StoryID=20030923-050052-9024r

WASHINGTON, Sept. 23 (UPI) -- The ongoing nursing shortage in the United States has forced some hospitals to rely on nurses with less than a college education as they scramble to fill vacancies but new research suggests the practice can yield deadly consequences for patients.

The study, the first of its kind, reveals patients undergoing surgeries at hospitals where a greater proportion of nurses have obtained a bachelor's or higher degree experienced a lower rate of death than patients at hospitals where most nurses had only associate degrees.

Such findings have implications not only for patients but also for how nursing schools, hospitals and even the U.S. Congress should address the nursing shortage, Linda Aiken, a nurse and lead investigator of the study, told United Press International.

These institutions have made efforts to address the nursing shortage by facilitating the rapid training of nurses via associate degree programs, but the study indicates in the long-run the strategy might be worse for both patients and hospitals, said Aiken, who is director of the center for health outcomes and policy research at the University of Pennsylvania's School of Nursing in Philadelphia.

It underscores the need to find ways to increase the numbers of nurses graduating from bachelor degree programs, she said, noting some hospitals studied did not employ a single nurse with a bachelor's or higher degree.

In the study, which is published in the Sept. 24 issue of the Journal of the American Medical Association, Aiken's team examined patient data from 168 Pennsylvania hospitals over a 19-month period beginning in 1998. They found, all other factors being equal, hospitals where 60 percent of the nurses held a bachelor's degree or higher had a 19-percent lower rate of surgical patients dying within 30 days of admission or dying from complications than hospitals where only 20 percent of nurses had higher degrees.

The authors estimate if all the hospitals in the study could meet the 60-percent, bachelor's-degree-or-higher threshold, 725 patient deaths could have been prevented over the study period.

The differences in patient mortality rates "are stunning and should make people very concerned," Geraldine Bednash, a registered nurse and executive director of the American Association of Colleges of Nursing, told UPI. "One of the first questions (patients) ought to ask people in a hospital is what is the proportion of their nurses with bachelor's degrees, and if it's not 60 percent or higher, I'd be very concerned about going into that hospital," Bednash said.

The higher rate of patient deaths associated with lower education level is compounded by the fact that "all of the federal government's projections about the nursing shortage over the past decade have not only projected a shortage of nurses but a severe shortage of baccalaureate degreed nurses," Aiken said. At present, less than half of all hospital staff nurses across the nation hold bachelor's degrees or higher.

"Policymakers seem to think we just need to get nurses out fast," but that is not good for hospitals or patients, Bednash said, suggesting legislators should focus on developing ways to produce more nurses with bachelor degrees because "it makes a difference in people's care and whether or not they live or die."

President George W. Bush signed the Nurse Reinvestment Act into law in 2002 in an effort to remedy the nursing shortage and Congress will likely authorize no more than $163 million for fiscal year 2004. But this falls far short of the $250 million the American Association of Colleges of Nursing estimated would be needed to address the problem.

"To date, we've had mostly a symbolic response from Congress," Aiken said, noting the money the legislative body has appropriated is "not a sufficient amount to close the nursing shortage."

Hospitals also have a role to play in addressing the problem, however, Aiken continued. They should "subsidize continued education to the nurses because there is a return to the hospital in terms of greater productivity and better patient outcomes," she said. But many hospitals do not seem to recognize the value of more education in their nurse because many have discontinued tuition reimbursement programs to help their nurses obtain bachelor's or advanced degrees, she said.

Aiken also noted the study found nursing experience was not associated with lower mortality rates of patients. "It's the educational level that's important and experience alone cannot achieve the same level of benefit for the patient as education plus experience," she said.

Joan Hrubetz, dean of the school of nursing at Saint Louis University, said as medical treatments become even more sophisticated, hospitals "will need nurses with advanced education to be able to deal with the kinds of treatments and diagnostics" that likely would be developed in the era of genetics and molecular-based medicine. "I don't think there's any question we need better trained nurses," Hrubetz told UPI.

Nevertheless, hospitals appear to be reluctant to make any changes based on this single study.

"Hospitals are very interested in studies such as this ... but it really needs to have further studies done because this really only represents one state," Rita Turley, president of the American Organization of Nurse Executives -- a subsidiary of the American Hospital Association -- told UPI.

The good news is although enrollment rates in baccalaureate nursing programs had been down over the past decade, they now appear to be on the rise. In addition, many schools are offering rapid training programs, in which holders of bachelor degrees in other fields can obtain a bachelor's degree in nursing in approximately one year, which may help increase the number of people joining the nursing profession.

I just have to say that I don't think that is true at all because there is only a few things that are different in adn vs bsn as far as research material, I'm not knocking the bsn because they also work very hard to earn that degree and I work with a couple of girls that are doing the same programs now and i don't see the difference as far as the level of care, i don't think it has anything to do with the level of schooling I think it has to do with something else entirely but the lower you are on the poll the easier you are to blame i hope this gets figured out because it gives people a bad rap before they even start

first i will qualify my post by stating that i am not a nurse yet so am making no judgements about whos "better' yada yada, i DO think though that to gain respect with other healthcare colleagues the future RN's need to be entry level BSN. I say this because every other profession in healthcare has upped their educational requirements. not to mention that many of these professions were duties that used to be carried out by nursing staff, (respiratory therapists, PTs etc.) now these people are required to have higher degrees thatn nurses. Nurses educational preparation needs to be at the university level to keep up with the advances in other professions. I think all RN's should be grandfathered in and the requirments changed to bsn for new nurses. To accomplish this the community colleges need to enter into partnership agreements for telecourses or distance learning with the state universities so that people who are not close to a 4 yr institution will still have an opportunity to enter nursing as an RN. this will keep the shortage from being affected by new educational requirements and will make nursing a true "professional" degree by community standards and not just our own. Again not saying who is better just saying it may be for the greater good. (especially with all the practice rights CMA'a are now getting that used to be nursing practice!:rolleyes: )

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Originally posted by smkoepke

first i will qualify my post by stating that i am not a nurse yet so am making no judgements about whos "better' yada yada, i DO think though that to gain respect with other healthcare colleagues the future RN's need to be entry level BSN. I say this because every other profession in healthcare has upped their educational requirements. not to mention that many of these professions were duties that used to be carried out by nursing staff, (respiratory therapists, PTs etc.) now these people are required to have higher degrees thatn nurses. Nurses educational preparation needs to be at the university level to keep up with the advances in other professions. I think all RN's should be grandfathered in and the requirments changed to bsn for new nurses. To accomplish this the community colleges need to enter into partnership agreements for telecourses or distance learning with the state universities so that people who are not close to a 4 yr institution will still have an opportunity to enter nursing as an RN. this will keep the shortage from being affected by new educational requirements and will make nursing a true "professional" degree by community standards and not just our own. Again not saying who is better just saying it may be for the greater good. (especially with all the practice rights CMA'a are now getting that used to be nursing practice!:rolleyes: )

Sounds absolutely reasonable to me. I was one of those "rural types" who lived 100 miles from the NEAREST BSN- degree offering 4 year institution. Not in any way do-able with a military husband and family to care for. Now here I am, having to get a BSN after becoming an RN and doing it long-distance. (sigh), class by class, and sheesh, it's expensive.

And, yes, I AGREE, the entry level SHOULD BE BSN only. NO problem in my mind there, but we do need to solve the problem of ACCESS for so many. And it's a bunch---seeing as 60% of us who are RN's hold ADN/ASN degrees! This post makes excellent points and I agree 100%!

I can't believe this old argument is rearing its ugly head again.

BSN, AA, MSN--who cares? I have an AA in nursing--I have never had any desire to be a nurse manager or one of the "important people."

I have over 23 years experience as an operating room RN, taught IV nursing and infusion products, did diabetic nurse and patient education, and, most importantly, I am a successful independent legal nurse consultant.

I even have my own office downtown--don't have to work in a "cubicle" or share cramped office space as some nurse managers do, or take work home, or work overtime, or take call.

If I don't feel like going to the office, I don't have to--I can work from home, or not work at all, if I don't happen to feel like it on any particular day.

I charge attorneys $150 an hour for my knowledge, skills, training, eductation and experience as a nurse; more if I testify.

I don't have to work in a hospital setting anymore unless I happen to feel like it, and I often do, so I take occasional travel assignments both because I really enjoy operating room nursing and because it increases my credibility when I appear as a testifying expert in cases involving the operating room.

My "lack" of a BSN has never hurt me. In fact, when I went back to college, it was with the idea of getting a BS in biochemistry. I lost interest in doing research because of the realities involved with low pay, begging for grants, and the necessity of animal research, which I absolutely will not do.

So, I am a few credits short of a B.S.--if and when I do go back and finish it, it will probably be in English, and will instead be a B.A.--obtained for my own enjoyment and because I now have more time to go back to school, not because I feel any professional need for a "Bachelor's."

In fact, I laugh at all the nurses who feel a need to wear ID badges with their "alphabet soup" of various degrees listed after their RN--yet they can't start an IV or scrub a craniotomy, if they can scrub at all--and God forbid they should ever encounter a trauma situation, without their "policy and procdure manual" in hand to guide them in how to proceed.

I credit most of my technical and medical knowledge, gut instinct and critical thinking and split second decision making skills to my years as a Navy hospital corpsman and emergency room/operating room technician during the Vietnam Era, and can hold my own against any advanced degree nurse anywhere, anytime--as can most ex-military corpsmen. Bring 'em on.

Can't we send this "BSN as the minimum requirement for entry level nursing practice" to the graveyard? "Can't we all just get along?"

Shodobe, come check in and put your 2 cents into this nonsensical argument.

Sorry you are so offended. Stevierae but didn't you just list your 'vegetable soup' credentials? I would certainly hope after 28 years you would have a lot of skills- it shows you continue to learn. But again, this argument is not about the individual but about the profession as a whole which I believe would be in a much better position to represent itself as a profession if everyone had a bachelor's degree. I believe being an RN these days should require a degree. I don't believe you can learn nursing by osmosis or being in the field but it certainly can add to the skill base.

And you are right, there are many nurses who are managers who have lost their psychomotor skills but many have not. Having a degree did not make them less functional.

If this profession required a 4 year degree it would be less likely other paraprofessionals would be encroaching on nursing. In my state paramedics are practicing as nurses (illegally I believe), nurse assistants are referring to themselves as a nurse and rad techs in cath labs want to administer cardiac drugs!!! How do you tell others that you profession is more than just technical skills if you can't convince other nurses of that?

Specializes in Nursing Education.
Originally posted by stevierae

I can't believe this old argument is rearing its ugly head again.

BSN, AA, MSN--who cares?

We need to care about this and I would venture to say that many people are passionate about this issue. Your experience is wonderful and I am sure you are a very talented nurse and CLNC. But the issue is not about experienced nurses, it is about entry level into our profession. If we don't care about it, then who will? I dare say that I do not want Medicine or the Government making decisions about entry level into nursing practice. These are decisions that need to be made by nurses.

As a group of professionals, we need to wake up and realize that this issue is not going to go away and it needs to be addressed and settled once and for all. Some people are even advocating for entry-level at the Master's degree. Look at pharmacists .... several years ago, as a profession, they changed their entry-level from a Bachelor's degree to a Doctorate. The previous poster is correct, read all the literature, all the research and the definition of a profession. Nursing education has fallen behind that of ALL other health care professions, yet, we hold the responsibility and accountabilty for many decisions concerning the patient's life. I am sorry, I think the patient deserves a nurse that has as much education as possible.

Flame away all you want, but I really believe this issue will NEVER end until it is addressed by nurses and a decision is made to improve entry-level.

On a final note, it is very important to understand that the Associates Degree for nursing is mis-titled. Most all of the ADN programs I know about require more than 2 years of education. I know from my experience, it took my 3 years to finish my degree. So perhaps we are closer to BSN entry-level than everyone thinks.

Thanks for hearing me out and if you feel like you need to flame me, go ahead, I am ready for it.:cool:

Specializes in Med-Surg.
Originally posted by RNPATL

Thanks for hearing me out and if you feel like you need to flame me, go ahead, I am ready for it.:cool:

I hate to say, when I got to your last statement, I really laughed out loud. I'm not going to flame you.

It is an old debate. It wouldn't bother me a bit if all RNs had to be BSNs. Have them take another board than the ADNs, or do away with the ADNs altogether. As an ADN graduate, I don't feel bothered by that. I agree in the long run it's for the best if we can make it happen.

But to think that requiring all RNs to have BSNs is going to grant us all this respect and magically make things better for us is naive. Plus it isn't going to help the "shortage" any either. If all of a sudden all RNs were BSNs, we'd still have a lot of problems.

Originally posted by 3rdShiftGuy

But to think that requiring all RNs to have BSNs is going to grant us all this respect and magically make things better for us is naive. Plus it isn't going to help the "shortage" any either. If all of a sudden all RNs were BSNs, we'd still have a lot of problems.

So very true. The BSN is no magic wand...just a move in the right direction for our profession. :cool:

first of all, no one will ever be able to take away the adn nurses or diploma nurses out there. they will always be grandfathered. but if the general public would like to see what a REAL nursing shortage they can have, then they can pass some new law mandating that all RN's have a BSN. Alot of us will be out of a job - including me. But I don't think it would last very long. This country is in to much desperate need for nurses to go that route. And if they do, I will just do something else. No skin off my back.

Specializes in Nursing Education.
Originally posted by 3rdShiftGuy

Have them take another board than the ADNs, or do away with the ADNs altogether.

But to think that requiring all RNs to have BSNs is going to grant us all this respect and magically make things better for us is naive.

Thanks for not flaming me and I am glad that I gave you a giggle tonight. I agree with you that requiring BSN's is not going to magically make nursing better or change the challenges that nurses face, but I do believe it would be a start to developing more credibility as a profession.

I also need to say to the other posters that I think there is a place for all levels of nurses. I certainly would never advocate for the ADN to be done away with. Like you mentioned, the nursing shortage is significant, we need all levels of nurses.

I am also an ADN, but it does not change my position on professional entry into nursing.

Originally posted by efy2178

Sorry you are so offended. Stevierae but didn't you just list your 'vegetable soup' credentials?

LOL, I am not offended, and I did not mean to list any "vegetable soup of credentials--" I do not have any TO list--I was simply trying to show people that for me, NOT having a BSN has not been a handicap--and I have never, ever had an attorney ask what degree, AA or BSN I have, or what certifications I have. It just does not matter--they want what is in my HEAD.

What I meant by people who have a veritable "vegetable soup" of titles are true situations such as this:

I have seen RNs in various hospitals all over the West Coast whose name tags read like this:

Jean Smith, EMT, LVN, RT, RN, CNOR, RNFA, Clinical Nurse Educator, AA, BSN, MSN, PhD Candidate

Trust me, I am not exaggerating. Now, why do you think they display all these titles? Are they REALLY still an actively practicing EMT, LPN or RT, if they have since become an RN, or do they simply pay dues to keep those titles--for specialties in which they are no longer clinically active? And who really cares anyway? Who are they trying to impress? The docs? The patients? The nurses "under" them (that's the most likely reason.) I just don't get it.

Originally posted by RNPATL

On a final note, it is very important to understand that the Associates Degree for nursing is mis-titled. Most all of the ADN programs I know about require more than 2 years of education. I know from my experience, it took my 3 years to finish my degree. So perhaps we are closer to BSN entry-level than everyone thinks.

Exactly right!! When did this term "ADN" come into effect anyway--it is a misnomer, and makes people think that people (like me) who have an AA in nursing did nothing in college (true, community college) but clinical nursing courses, and therefore are not well-rounded and are incapable of seeing the "big picture. " They, in fact, are making a very incorrect assessment.

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