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.

Specializes in O.R., ED, M/S.

You know the thing that really irritates me the most is when people start to talk about "entry-level" to make us more of a profession. Just what is a "professiona"? Atheletes who take a pay-check each month is considered a "professional". Electricians, plumbers, carpenters, etc.... are considered "professionals" in their chosen field. None of them have a degree in their field, maybe some certification from their association but usually not a degree from a college, I know you can go to trade schools and some JCs for this but you won't be seeing some guy graduate from Baylor with a degree in "household appliance repair". I think everyone has their own opinion of what constitutes a professional and in my opinion it doesn't necessariy have a bunch of letters behind their name. We are all "professionals" and me not having a BSN or MSN doesn't make me any less of a nurse. I will challenge anyone on this subject! Also to say that having a BSN should be the minimum credential to practice nursing is still ridiculous. I will, as well as most of you out there will be long gone before this happens. This is an issue that has been going on for as long as I can remember, over 27 years, and still has not been resolved. As far as I can remember it has not been an issue in any nursing organization in the country. I am sure it has been brought up by the few that are still upset that they went through all those years of nursing and still make the same as a person who went through half the time! They are just **ssed off! I am sorry for sounding so negative and too tell you the truth, I think this has to be the longest post I have made. I am sure there will be someone out there that will prove me wrong on some of the comments I made, but what the heck its only my opinion. I think it is healthy to talk about this stuff and with what is going on in nursing today we really need to support one another and put aside our petty differences to make our "profession" strong as a whole. Mike

Sorry for the long post!

As far as I am concerned, both ADN's and BSN's pass the same state boards, so therefore have comparable skill and knowledge levels. I don't believe that length of education neccessarily determines what type of nurse you will be. I think it is time we all see each other as fellow nurses and not as titles. Obviously this study did not take into cosideration a lot of other factors that affect patient care.:o

i guess i feel that we need to have a clear and distinguished difference between RN education and other healthcare workers. there are cma's that have associate degrees in their programs and while we all know the difference in their education, and others (techs pct, cnas etc) vs the educaton of an RN, they still are gaining more and more practice rights which in the long run will spell TROUBLE for nursing. If nurses don't show that they value education and not just "skills", management and administration won't value a nurses education either. If an Rn has a "2" year degree and a CMA has a 2 year degree and can perform many of the skills of the RN (and gaining more every year) what is managements incentive to hire more RN's? i also feel that other occupations that nurses work with would have less of an elitist attitude and show more respect if the education level is on par. I am not makeing a judgement about who is better i'm just trying to think of the future and some of the issues that could improve nursings image.

just clarifying a few things, i don't want anyone to think that i am saying any nurse with less than a BSN just has "skills", of course all nurses are well educated. what i am saying is that advancing our educational requirements the same as all other health occupations can bring respectability to our work. and as i said before i think all existing RNS should be grandfathered in and community colleges shouls form partnership agreements with the state universities, I heard that they have already initiated this in parts of Canada and i think we should do the same.

There are three Canardian provinces that have done this, and it is VERY controversial at times. I think it will eventually have to be done if only to get rid of the arguments over which is better.

Originally posted by smkoepke

i guess i feel that we need to have a clear and distinguished difference between RN education and other healthcare workers. there are cma's that have associate degrees in their programs and while we all know the difference in their education, and others (techs pct, cnas etc) vs the educaton of an RN, they still are gaining more and more practice rights which in the long run will spell TROUBLE for nursing. If nurses don't show that they value education and not just "skills", management and administration won't value a nurses education either. that could improve nursings image.

Using this rationale, only "NURSING" education counts, right? Therefore, the minimum requirement should be a BSN? Not just a bachelor's degree, and definitely not an AA?

So--somebody with an AA--or even a bachelors-- in mechanical engineering, or chemistry, or math, or physics, or psychology --or even art or English for heaven's sakes--who is brilliant in one of these fields but has grown tired of it and seeks a mid-life career change--must go back to get a BSN--not just an AA in nursing--because all his or her education to date is not "Valuable--" because it isn't "NURSING" related? I don't buy it. I also think life experience is invaluable, too.

Also, using this rationale--what about the foreign doctors who have plenty of medical education--but are here working as medical assistants. lab techs, anesthesia techs etc. until they can take boards-- given that their education is more advanced than a BSN nurse, should that BSN nurse feel threatened because this individual just might know more than she does?

Or should she feel that his level of education is not "valuable" and not a threat to her career or knowledge base, because, after all, it is not a BSN? Education and knowledge are only "valuable" if they were attained as part of a NURSING education curriculum? Again, I don't buy it.

And what about the med school dropouts who are brilliant, but decided that medicine wasn't a good fit for them, and instead decided they would be better at the direct patient care opportunities offered in nursing? Do we discount all their education as "not valuable" because, again, it wasn't NURSING education? Despite their knowledge and skills, you would demand that they obtain a BSN to enter practice as a nurse? Again, I don't buy it.

Also, I have known some very educated--brilliant, really--EMTs, respiratory therapists, anesthesia techs, operating room techs, ultrasound techs--many with far more education than I have.

They are not out to try to "steal" my job as a Registered Nurse providing patient care from me--they love what they do. They are excellent at it. Am I to feel "threatened" by the fact that they have advanced degrees, and I don't? Or am I to discount their extensive knowledge and skills as "not valuable" because it is not NURSING related?

Too many nurses try to reinvent the wheel and create problems where there are none.

Too many nurses are just so intense that they must worry over non-issues that they see as issues, or at least potential issues.

I see too many of those personality traits among these posts.

Stop stressing. There are plenty of nursing jobs to go around--plenty at which no one cares what degree you hold. If they do, it is the type of place that will guarantee a miserable working environment, anyway. Their priorites are skewed.

Why even bother to get a BSN if there is no monetary incentive to do so? If someone tells you you need a BSN to get hired or continue in a position, go elsewhere.

It's not like there is a huge influx of BSN nurses out there waiting to beat down hospital doors to take jobs away from anyone, just as there is no secret conspiracy of patient care technicians or other ancillary personnel scheming to take away nursing jobs.

I'll say it again: AA, BSN, MSN--who cares. Not me. Not any doctors I have ever worked with--I don't think I have EVER been asked what degree I hold.

To the people that matter--in my clinical nursing specialty, that would be surgeons, anesthesia providers, operating room technicians, most of my fellow RNs--or at least the ones who don't buy into the "BSN is better" theory--and, of course, my patients----IT SIMPLY DOES NOT MATTER.

Do you think I care one way or another that a nurse manager might form an opinion of me based on what degree I hold? No, and I really would not expect her to care one way or another what my opinion was of her, regardless of her titles or degrees. We both have roles to fill, and my role, and my confidence in how well I carry out my role, does not require me to have a BSN, nor does it require her approval of me.

One last point: If advanced degrees in nursing are so important,why aren't AA and BSN nurses held to different standards of care--if some of the messages I have been reading here are on target, BSN nurses, due to their advanced degrees and more "valuable" nursing education, should be held accountable to the delivery of a higher standard of nursing care than those of us with AAs and thus less "valuable" nursing education are. The fact that they are not speaks volumes. Think about it.

As a diploma RN I too feel hurt when someone insinuates I am somehow less than a BSN...they show their own insecurities when they feel they must do this. Most of us who have been working awhile know the truth. I work with some awesome LVN's in my ICU who I would trust over some of the RN's...so it's more than the title that makes the nurse.

My support for BSN as entry has nothing to do with who makes a 'better' nurse...I'm looking at our future as RNs and feel it will be essential for us to go this route...if nothing else to unite us.

If I am mandated to get my BSN, I will probably just retire...enough is enough and I can't see the point of paying the outlandish prices now to repeat almost all those courses (which are too old to accept, colleges tell me)Just another slap in the face to those of us who have been actively practicing for so many years.:rolleyes: I won't play their money game which is why I stopped pursuing the BSN.

Specializes in ER - trauma/cardiac/burns. IV start spec.

What a crock. Around here people refer to the adns and asns as real nurses and bsns are b**s**t nurses.

Just like graduating with all As or all Cs. ADNs and BSNs take the same test and we do the same work UNLESS you want to be management.:p

For those of us who work in the trenches it makes no difference which degree you have. It certainly doesn't to the patients.

Well, good to know it's unacceptable to demean ASNs, but ok to do so for BSNs. I hope you don't participate in that bull s*** nurse stuff. I have always found good and bad among all levels.

I have to agree w/ fergus' posting. There's good and bad at all levels. I happen to have both degrees and I am glad for it. Anytime you have an opportunity to go for more education, DO IT!

You never know when you may be glad you did. I think, in most cases, the degrees are pretty equal as far as what you bring to the bedside fresh out of school.

My ADN program prepared me well to assume the role of brand new grad back in 1987. I worked beside another ADN grad and 2 BSN's (1 from Georgetown and 1 from Boston College). We were all pretty equal. I am gonna sound a little prouder than I'd like to here, so forgive me. We got scores on our boards and mine was the best, in fact I got a letter of commendation from the stae of MD for my score. That's because our school focused on preparing you to do the basics of bedside care and pass those darn boards and they did a great job. Whatever is your basic educational level, IMHO, your program needs to stress the basics.

One day you may be a nursing leader (a dubious honour these days), but you need to be able to prioritize and be skilled at tasks like physical assessment, giving meds, etc. It's a crime when you have a new grad who spent his/her or their parents good money at a school that taught leadership/management and delegation courses, but did not teach them how to give an IM injection or tell whether or not an IV is infiltrated. I've have seen both ADN and BSN grads having a really tough time w/ basic skills. Techs I work w/ who attend a local ADN program tell me that they are taught how to delgate to different levels of practioner (LPN, CNA, etc.). Well that's marvelous, but you've got to know how to do it yourself before you pass it off to someone else while still, in some cases, retaining responsibility for it being done. It is too bad the BSN cannot be earned by ADN's and diploma nurses who have been at the bedside for a length of time and attend a lot of continuing ed courses related to their area of practice.

One thing, I did learn in my BSN program was that a researcher can manipulate the #'s to reflect the point he/she wants to make in some cases. Is this an example of this? Was everything equal in terms of level of experience, etc? Were some of the BSN's in the study ADN's or diploma RN's (who had returned to school for the BSN) who had more experience than the ADN's in the study or were they all generic grads? Honestly it seems a little fishy to me.

good lord stevierae i never stated or implied that other education in fields other than nursing is not "valuable" please don't put words in my mouth. What i am saying is that there needs to be a clear cut and defined educational preparation for an RN. The same way that there is a clear cut preparation for most other professions. you don't see doctors, pts, lawyers, engineers, architects etc... (in this country) that skipped 1 or more years of schooling and still some out as MD's or PT's etc.. they have a standard degree that all must earn in order to practice or sit for licensing exams. I believe i already said 3TIMES that existing rns should be grandfathered in so it would NOT affect them. I am just looking for ways to promote more respectablility and job protection in the future and i think this is a logical advancement that needs to be made. You used to be able to get into medical school without a bachelors degree (provided you had the prereqs) you used to be able to be a pharmacist with only a bachelors now its PHD level and on and on and so forth. Why shouldn't nursing advance as well. If we want to be looked and respected more by our colleagues i think a standard educational level at bachelors should be mandated. FOR THE 4th time I AM NOT MAKING ANY JUDGEMENT ON WHO IS A BETTER NURSE. I am just trying to think of ways to advance the profession in the same ways that other healtcare fields have. All of these other professions have seen their salaries rise with educational level as well so that is something to think about as too. again PLease people don't take this post as a "slamming" your educational level type of post, it is not meant for that, I am just noticing what seems to be working for other professions and thinking it could apply well to my chosen future profession.

Regardless of if I am a ASN or a BSN I have the ability to care for my patients just the same. I also have the same compasion and care for each and every client just the same. I am continuing on to recieve my BSN but I don't think that I should be outcasted for a ASN behind my name. My mother has been a ASN nurse for 12 years and she makes more than any other BSN and has been in supervisory positions before they were offered to a BSN..

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