Published
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.
Originally posted by fergus51When did a holier than thou BSN student say that ADN and diploma nurses are lowly? I have never heard such a thing.
fergus: There have been numerous threads/posts that state this.
BSNurse: Perhaps that was your experience. I know that I would be burned at the stake if I posted that in my experience, BSN's were clueless in the clinical setting. That may be my experience, but I wouldn't say it...it's insulting (and before anyone jumps on me, I'm using this statement as an example only).
I will say this: My diploma education has served me well; I've worked in numerous specialties, and am currently in a mgmt. position (hospice director) . When I'm hiring a nurse, I care more about his/her competence than what letters follow his/her name.
There are a lot of ways to gain knowledge; a college degree is but one pathway.
BSNurse: Perhaps that was your experience. I know that I would be burned at the stake if I posted that in my experience, BSN's were clueless in the clinical setting. That may be my experience, but I wouldn't say it...it's insulting (and before anyone jumps on me, I'm using this statement as an example only).
Why do you act like people are attacking you personally. Why is it insulting to you? We all have to draw from our experiences. Really, re-read my post. You clearly didn't get the jest of the whole post. Do you really believe that all BSN's are clueless? (I know you stated it was just an example). No where in my post did I say ADN's are clueless. In fact, I believe I took up for all nurses, no matter what degree they had. I was taught how to use critical thinking in my program. Where did it state in my post, that you weren't taught how to think critical? As an LVN, I was treated like I didn't know my head from my butt by some ADN's but that doesn't make me believe all ADN's are like that. Why do you attack all BSN's simply because of their degree status? I don't believe I gave you any reason to be hostile to me in my first post (the second one was a little smart *ss) hehe. That's just me. Can't we all just get along?
It is personal to me, and I don't need to justify that to anyone. As I said before, the diploma program I went to taught me well, and there have been plenty of times over the many years that docs have said, "You graduated from "X Nursing School"? That's a tough program!"
And no, I don't think all BSN's are clueless, I used that as an example, just as you said in your experience diploma and ADN nurses were lacking in critical thinking.
Whatever. I'm glad you are happy with your level of education. And I wasn't attacking all BSN's...just those who feel complelled to remind us non-BSN's that we are lacking in one way or another.
Originally posted by BSNurseHello everyone,
Coming from an LVN (LPN) to BSN background, let me give you my perspective. I've precepted for ADN's and BSN when I worked as an LVN. When any new nurse come's on the floor they will need guidance no matter what your degree is. If you have more experience on the floor than someone with a higher degree does then it makes sense that you are going to know how to do more, as far as clinical application. I was shocked when I had to show ALL these RN's how to put foley's in and start IV's. It's not always about not knowing how to do something. It's about being out of school, starting a new career and finding out how things are done in that hospital. I decided to go the BSN route (after 12 years as an LVN) because I wanted more opportunity to go into management. As I went through the BSN program they stressed critical thinking. I kept thinking to myself, you know, I haven't learned a thing more (medically) than I learned in LVN school (this is an exaggeration). I did, however, learn how to think more critically for my patient's and in different situations. I learned to look at the whole picture. In my experience, LVN's have more clinical experience than ADN's, ADN's have more experience clinically than BSN's, and BSN's have the least clinical experience but more knowlegde based education than the others. My point is...within 6 months, the BSN nurse will catch up, clinically, with the LVN and the RN but she still has the advantage of the critical thinking skills taught in the BSN program. This is not to belittle anyone and of course this doesn't apply to everyone. I know several very sharp ADN's. I also know some very sharp LVN's. I know some BSN's that I can't believe graduated. We are all in this together and there are plenty of jobs for everyone. I would hope that everyone would want to better themselves educationally. Not everyone has the time, money or will to go the BSN route. I think it is all up to the person and what they want in life. There are advantages to going the LVN route as well as the ADN and BSN. We should all support each other and not knock each other down.
I think that if the BSN education stresses critical thinking more than the ADN, (I can't dispute this statement, because I don't know), that it doesn't take long for the ADN RN to catch up with the BSN in the critical thinking department. (Same as you say the BSN catches in clinical time.)
The whole nursing process that ADN's and BSN's learn alike, the assessment, evaluation, diagnosis, etc. is part of clinical thinking. While I agree with your statement that more education is best, I'm going to disagree that the ADNs aren't taught critical thinking skills. Maybe the reason some of us come out not being 100% proficient in some skills as foley insertion, and IV starts is that we are spending so much time on that blasted nursing process and learning critical thinking skills. :)
Again, let me clarify that I'm in no way against RNs being required to have a BSN in the future, if it's for the benefit of nursing as a "profession". Do with me as you will, call me what you want. Even when the inevitable change happens as you say it will, there will still be a place for me, and I don't care what you call me.
My main concerns isn't that we are viewed as a profession like Pharmacy is viewed as a profression. But that I have safe staffing and resources to provide the best care possible. Sorry if I'm so short-sited and selfish, but my immediate needs need to be taken care of right now. :)
Originally posted by BSNurseI did, however, learn how to think more critically for my patient's and in different situations. I learned to look at the whole picture. In my experience, LVN's have more clinical experience than ADN's, ADN's have more experience clinically than BSN's, and BSN's have the least clinical experience but more knowlegde based education than the others. My point is...within 6 months, the BSN nurse will catch up, clinically, with the LVN and the RN but she still has the advantage of the critical thinking skills taught in the BSN program.
Once again--my own critical thinking skills I attribute not to my AA program in nursing, not to clinical experience as an operating room nurse, IV nurse educator or diabetic nurse educator; not to my nursing continuing education or to my experience and years of doing OR trauma----
I attribute my critical thinking skills to my years as a Vietnam era hospital corpsman working ER, OR, L&D, newborn nursery, med-surg, mental health, sick call, ambulance duty--wherever I was told to go----years spent here, not in Vietnam. I attribute, really, most of my CLINICAL skills to what I learned during those years--from corpsmen who WERE just newly back from the hell of Vietnam--of course, I am continually trying to learn more and improve upon them.
I bring this up because now there is a brand new generation of corpsmen --actually, two--who served during wartime ( Iran or Iraq)and are now contemplating becoming nurses.
These people, without a doubt, have superb critical thinking skills--as well as clinical skills. They will also have attained superb teaching skills, should anyone care to take advantage of their considerable experience, as we did with the corpsmen newly returning from Vietnam. Just imagine what both seasoned and brand-new nurses could learn from them!
Who loses out if you deny them the chance to practice "entry level nursing" if they choose not to get a BSN?
If enough of you are "passionate" enough to lobby for "BSN as the minimum entry level for nursing, " these talented folks are going to say, as my already working as a med surg nurse neighbor did when a BSN was demanded of her to be able to work in mother-baby, the h**l with it, and take their considerable critical thinking and clinical skills where they can be appreciated and utilized. Once again, it is obvious who will suffer.
i guess the issue i have with allowing people with "past experience" to bypass certain educational requirements in nursing, is that NOBODY ELSE DOES IT. as an RN you can't get credit for your "years of experience" and walk into med school in the 2nd or 3rd year. if i worked as a legal aid (but did not take classes toward an actual law degree as set out by a university) i won't be able to bypass schooling just because i may have a great wealth of knowledge. The world just doesn't work that way in most cases anymore we need to keep up with the times. I just don't have the view that nursing should have all of these different means of entry. This is strictly my opinion and i respect that others view it differently. I think that a person who has a great wealth of knowledge as a corpsman or army medic should still have to go through the same classes as everyone else. Now this person will probably find them easier and excel in them and the education will only enhance and build on the solid foundation that was already there but i still feel the formal education is needed. Not necesarily because BSNs make "better" nurses, I have already stated many times i have no idea and make no judgement about that, but i feel it is needed to keep pace with others and improve nursings image. Some people may not find these things important but there must be something to it if all other allied health professionals are upping there educational preparation. Nursing shouldn't get left behind. if we want to be viewed as well- educated professionals then we should value education in our chosen field.
Originally posted by smkoepkei guess the issue i have with allowing people with "past experience" to bypass certain educational requirements in nursing, is that NOBODY ELSE DOES IT.
Well--I don't know that "nobody else does it" as I have not researched the issue--I only know that I feel that, if you have skills and can prove that you have them by challenging exams and/or demonstrating your clinical competency, why not?
So, you don't believe in challenging exams or being awarded advanced nursing placement into a nursing program based on your skills and experience--I guess this is where we will "agree to disagree." :kiss
Gee, smkoepke, I am glad you were not among the board members who allowed me advanced placement into nursing school--I might have been denied if you had used your influence and arguments--I don't know where I would be today--dead serious! I know I would have been discouraged enough to have given up on nursing school, and might never have followed up later.
I had initially had a goal in mind of med school--so I also took pre-med courses during nursing school--but decided I loved nursing enough to stay put.
Had I not been admitted in the first place, though, I would probably stiil be working at Taco Bell or somewhere, as some young corpsmen who got out of the military at that time and found that the considerable skills they had attained didn't translate to a civilian job ended up doing -- they had to eat.
I hope that the talented corpsmen coming back from Iraq aren't faced with this dilemma.
Originally posted by snrubel
This is my first post to the board after lurking for some time... As a person with a graduate degree in another field I note the nature of this debate is part of the problem.
The bottom line is this: Until nursing recognizes the BSN as the entry-level education for practice then nursing will not be as respected as it should be by other health professionals.
Sorry, but that's the truth. Education = respect in the medical field as someone else has already pointed out. Associate's degree recipients are never going to be given autonomy and be considered peers by those with Master and Doctoral preparation.
I have an Associates. I have plenty of autonomy--I am my own boss. I have the respect of the people that matter when I work in my clinical specialty--docs, techs, fellow nurses who are also "in the trenches," and my patients .
Do I really care what my fellow RNs who have Masters' and Doctoral preparation think of me? Not particularly.
Do I pine away, stressing because they do not consider me their "peer?" Not at all.
They have their places in nursing--management and the ivory tower, if they are adept enough at scratching past their "peers" (other MSNs and PhD candidates) on the way up the ladder and haven't had their eyes scratched out. Frankly, I want no part of that scene. I, too, have my own place in nursing--consulting and patient care.
"I got plenty of respect;" thank you very much!
I guess I don't understand the whole "critical thinking" concept either..maybe it is because I am an ADN and never learned it LOL.
To me critical thinking = experience+ general knowledge of illness+ common sense. Critical thinking is asking the questions.."why" am I treating this pt with this med or this fluid. "Why" are these diagnostics being ordered and "What" could these results mean? or "What" are the sx that this person is complianing of , "What" could be going on, "How" can we find out what is going on, "How" should we treat this and "What" has my experience been with pts having similar symptoms.
Example: Young man brought into the ED by mom
c/o "not feeling well, pale , tachy pulse, several minor lacs on the face arms...was rock climbing approx 6 hours before and fell 3-4 feet..mild tenderness on left side, no real significant bruising anywhere.. as a triage nurse, using my "critical thinking" skills even though I apparently was never taught any. I got him right back to a bed..nothing was horribly horribly wrong with him at this point but knowing that he had a blunt trauma, he was tachy and pale and he had pain on the left side...there was a possibility of internal bleeding. He went for a CT and then to surgery to remove his lacerated spleen....
Example: Mom brings in an 8 yr old c/o abdominal pain. After asking all of the "critical thinking" questions I find out he has frequent abdominal pain and has for several months..this primarily occurs after eating, he vomits occasionally and has lost 5 pounds since his last peds exam. Vitals are normal but the little boy is pale and diaphoretic..I have seen this before but not often. I get a urine on him...glucose is off the charts..he ends up being dxd with diabetes. I learned the sx for diabetes in school and through my ENPC class learned that in children a hallmark sign is abd pain.
Example: 50+ yr old man brought in by EMS..cardiac arrest, was coded enroute, codes again in the ED. The nurse speaks with the wife after looking at the EMS paperwork and asks some hx questions to find out "Why" this could be happening. "Why" is your husband on lasix? CHF.. "What" is the dose..I am not sure. "What" has been going on lately with is CHF? Well his legs swelled up so his PCP tripled the dose for the last 3 days. "What" about K+ did the PCP put him on that? No..I called his cardiologist to come in..after everything was said and done (and he was dead) the cardiologist walked up to me and said, Do you know WHY this happened? I said..low K+? He threw the chart down and said Look...K+ was 1.8
My point here is that being taught to ask the "W" questions happens in every program and as a licensed nurse every one of us had better be asking them.
Maybe in a BSN program they place more emphasis on this BUT there is no program long enough to teach a student all of the possibilities. We learn each pathology one at a time...as a nurse there will be very few of your pts that actually only have one diagnosis..again, there is not enough time in a program to teach you how to care for a CVA pt that has HTN, COPD and Diabetes as co morbids..the nurse has to take all that she/he has learned about all of the illnesses and incorporate it into what questions need to be asked and what to look for.
I do value education and if the day comes where the BSN is the entry level so be it but I don't think it is going to change anyone's perception of nurses. The general public is oblivious to the caste system and I have not noticed any of the Docs having more respect for the BSN vs the ADN. Docs respect nurses that know their speciality and most of that knowledge is gained through continuing ed and experience.
I guess I don't understand the whole "critical thinking" concept either..maybe it is because I am an ADN and never learned it LOL.
To me critical thinking = experience+ general knowledge of illness+ common sense. Critical thinking is asking the questions.."why" am I treating this pt with this med or this fluid. "Why" are these diagnostics being ordered and "What" could these results mean? or "What" are the sx that this person is complianing of , "What" could be going on, "How" can we find out what is going on, "How" should we treat this and "What" has my experience been with pts having similar symptoms.
Example: Young man brought into the ED by mom
c/o "not feeling well, pale , tachy pulse, several minor lacs on the face arms...was rock climbing approx 6 hours before and fell 3-4 feet..mild tenderness on left side, no real significant bruising anywhere.. as a triage nurse, using my "critical thinking" skills even though I apparently was never taught any. I got him right back to a bed..nothing was horribly horribly wrong with him at this point but knowing that he had a blunt trauma, he was tachy and pale and he had pain on the left side...there was a possibility of internal bleeding. He went for a CT and then to surgery to remove his lacerated spleen....
Example: Mom brings in an 8 yr old c/o abdominal pain. After asking all of the "critical thinking" questions I find out he has frequent abdominal pain and has for several months..this primarily occurs after eating, he vomits occasionally and has lost 5 pounds since his last peds exam. Vitals are normal but the little boy is pale and diaphoretic..I have seen this before but not often. I get a urine on him...glucose is off the charts..he ends up being dxd with diabetes. I learned the sx for diabetes in school and through my ENPC class learned that in children a hallmark sign is abd pain.
Example: 50+ yr old man brought in by EMS..cardiac arrest, was coded enroute, codes again in the ED. The nurse speaks with the wife after looking at the EMS paperwork and asks some hx questions to find out "Why" this could be happening. "Why" is your husband on lasix? CHF.. "What" is the dose..I am not sure. "What" has been going on lately with is CHF? Well his legs swelled up so his PCP tripled the dose for the last 3 days. "What" about K+ did the PCP put him on that? No..I called his cardiologist to come in..after everything was said and done (and he was dead) the cardiologist walked up to me and said, Do you know WHY this happened? I said..low K+? He threw the chart down and said Look...K+ was 1.8
My point here is that being taught to ask the "W" questions happens in every program and as a licensed nurse every one of us had better be asking them.
Maybe in a BSN program they place more emphasis on this BUT there is no program long enough to teach a student all of the possibilities. We learn each pathology one at a time...as a nurse there will be very few of your pts that actually only have one diagnosis..again, there is not enough time in a program to teach you how to care for a CVA pt that has HTN, COPD and Diabetes as co morbids..the nurse has to take all that she/he has learned about all of the illnesses and incorporate it into what questions need to be asked and what to look for.
I do value education and if the day comes where the BSN is the entry level so be it but I don't think it is going to change anyone's perception of nurses. The general public is oblivious to the caste system and I have not noticed any of the Docs having more respect for the BSN vs the ADN. Docs respect nurses that know their speciality and most of that knowledge is gained through continuing ed and experience.
BSNurse
4 Posts
Fab4, Did you read my post? Your not helping your case for stating you were taught critical thinking in your program. Re-read my post. I'm not going to argue about who is better. I believe in my post I stated "In my experience..." I think that means it's mine, not yours. It is always better to seek more knowledge. Can you argue that point?