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.
This article that BSN's deliver safer care than ADN's should be an eye opener for ALL nurses.
This article was printed in JAMA and was published in several newspapers nationwide. This is what society thinks of nurses. Many lay people do not see nursing as a profession because you can go to school for 10 months and receive you diploma and say that you are a nurse.
What PROFESSION do you know of that you can go to school for that period of time and be considered a professional? Beauty school? Nail technicians?
Even with an associates degree there are paraprofessionals. physical therapy ASSISTANTS, dental ASSISTANTS. In the world of professionals it takes a Bachelor's degree to achieve that status; and even then it may take a Master's degree. i.e Physical therapists, Social Workers, Attorneys.
I'm sure there are plenty of LPN's and ADN's that are very good in their jobs. The point is, that society feels that we are not professionals because we do not have a minimal requirement for entry level into nursing.
For those of you saying that there is no monetary reward for having your BSN, what have you done to change that?
How many of you out there belong to the ANA? I can tell you that 98% of physicians belong to the AMA. How many of you write to your congress man regarding staffing ratios and othere issues that affect RN's?
When all nurses can pull together to create minimal requirements to become RN, society will continue to see us as non-professionals.
Denise, RN, BSN
member of the FNA/ANA and the AACN
As a student nurse in an LPN program the LPN vs RN vs BSN debate (if this is indeed a debate) does concern me. I have every intention of going all the way with my education as my long term goal is to become a certified nurse midwife or perhaps a nicu specialty nurse. In any case I do understand that many people feel nurses should be required to enter the profession with a bachelors and that doesnt frighten nor does it threaten me. It isnt feasible for many intelligent people who have the desire to become nurses to take the 4+ years of expensive schooling that this might require (like myself) and with fast track programs like ADN to BSN, ADN and LPN many people are able to get a career quickly that can be built upon. I think what some people have a hard time with is that nursing isnt historically an academic feild like say biological research or chemistry. It is historically closer to the working class/technical end of the spectrum. Nurses are increasingly required to understand more of what they do skillwise and to have the discerning eye and the banked knowledge to see problems and solutions thus causing this rift between the traditional clinical skills that a nurse needed to perform his/her job as opposed to the new academic knowledge that greatly enhances his/her abilities in a profession where your responsibilities keep growing.
was that a spill or what...
I just somehow disagree with the idea that doctors will respect nurses more if they are all BSNs, it might be that nurses will have more self respect in a profession that requires a BSN. I will probably gain flack for that statement- its a close to what I mean as I can get into words.
But seriously and this is my opinion and you know what they say about opinions...
If they dismantle all the LPN and ADN programs next year and decide that all nurses must be BSNs, I am quite sure that they will establish programs if not identicle to then at least quite similar to these and come up with a new title and hospitals will likely offer comparable pay for these same jobs and these non nurse healthcare team members will work under the supervision of MDs and BSNs, just a thought... What do you all think? Afterall who will fill these spaces if all the RNs have their BSN and then move up the ladder or spend most of their time doing paperwork?
Liz
The ANA is a toothless lion. I used to belong, and could see no benefit other than a free subscription to AJN, where I could read all about how inferior I was since I went to a lowly diploma program.
When I worked at an agency that was union under the ANA, we got bupkus from our representative. I wasted a lot of time as an officer and staff rep. for management meetings. Grrr!
Maybe people would be less defensive if the BSN's et al would stop whacking them over the head with how inconsequential (oooh, a 5 syllable word from a diploma grad) anything less than a BSN is.
When all nurses can pull together to create minimal requirements to become RN, society will continue to see us as non-professionals.
And please explain to this undereducated nurse what this sentence is supposed to mean. So, all nurses get a BSN and are still seen as non-professionals? Wow, what an incentive.
I don't mean disrespect to anyone.
All I'm saying is that no other career that is considered PROFESSIONAL can be obtained with an AA or a diploma. If diploma nursing was so popular, there would still be diploma nursing programs available. But... there are only a handful left.
SOCIETY (aka lay people) see nursing as non-professional because it can be obtained in 1-3 years. You can not be considered a professional in any other career with just a two year degree. pre-med students may start out in a junior college but they have to go on to a University. pre-Juris Doctorate students start out at a junior college but they have to go on to Law School. shall I go on?
Most people don't see nurses in the same league as accountants, engineers, teachers, etc... because most of us don't have Bachelor's degrees. The only way to change that is to improve our standards, starting with having minimal requirements to become nurses.
I started out with my ADN and immediately after graduating, went to a University for my BSN. Doctors, phycians assistants, nurse practitioners, physical therapists, occupational therapists, and even patient's treat me with more respect because my badge now has RN, BSN.
After graduating from nursing school, we all start out knowing absolutely nothing about critical thinking. It comes with time as a nurse. I work in a level one trauma center. The Medical students graduate knowing absolutely nothing about critical thinking. (I know some people are different and this does not apply to everyone). Their clinical skills come with clinical experience.
Also, just because there is a nursing shortage does not mean that we can't raise our standards.
There is a shortage of physicians in Florida. Does that mean that they will start accepting two year premed students right into their programs? I don't think so.
Will law schools say it does not matter that you don't pass the bar? I don't think so.
Nurses need to stand up to the standards of professionalism and improve ourselves.
Well, that seems pretty superficial to me if all it took was a few more letters behind your name to get respect. Sorry for the bluntness.
Using your theory, then athletes and musicians would not be esteemed by the public, since many of them do not have degrees. We know that this is not true. Athletes and musicians provide something that society values; they do not have the same sentiment when it comes to nurses.
I am not anti-education, but I deeply resent slaps at my education. For the record, I went to one of the toughest programs in my state...when docs found out a nurse was a grad from "X Hospital," they would often comment on how well prepared the nurses were. There is something to that.
A degree does not automatically confer professionalism or proficiency on the recipient. Were that the case, all doctors would be excellent because of their level of education. We all know that this is not the case.
Until the public values what nurses do, all the degrees in the world won't change things.
Originally posted by DeniseRNBSN[b.
After graduating from nursing school, we all start out knowing absolutely nothing about critical thinking. It comes with time as a nurse.
Once again--please do not use the term "we all--" please speak for yourself.
"We all" did not come out of nursing school knowing absolutely nothing about critical thinking--as I mentioned, I credit the bulk of my critical thinking skills to my years as a Vietnam era corpsman, and they got better in nursing school--otherwise I would not have passed my boards.
Please do not devalue what I, and my fellow corpsmen of that era, and my brother and sister corpsmen of subsequent eras brought and continue to bring to the table.
Yes, of course my critical thinking skills got --and continue to get--better as I actually gained clinical experience as an RN, and better with age and LIFE EXPERIENCE, and better as the result of a lifetime committment to continuing ed.
There are going to be nursing students today--I am certain there already are--that were brilliant and wealthy IT professionals when the dotcom bubble burst, and needed to find new careers.
I am honored that they chose nursing, and excited about what a contribution they they can make. Please do not devalue the critical thinking skills that they bring to the table.
Many of the nursing students in my program were women who had had successful business careers for many years, got burnt out, and decided to follow their dreams of nursing school. Their stellar critical thinking skills allowed them to reach the "glass ceiling" in their professions, and their critical thinking skills--and gut instinct, which is equally important, told them when it was time to leave.
Many more of our class were women who, after raising families, suddenly found themselves divorced after years of marriage. Some had fled abusive marriages.
We had a classmate who lived--with her 4 children--in her car.
Not only did these women have excellent critical thinking skills developed during their careers as wives and mothers--managing households and families--but they had strong survival skills--another asset necessary to become, and stay, in nursing.
All these people I mentioned brought their critical thinking skills to our program, shared them with us in the classroom, clincials and post-conferences, and had a profound effect on the rest of us.
Why do we have to keep repeating that we are talking about ENTRY LEVEL NURSING here, anyway?
Originally posted by melrey11If you ADN nurses are so proud of your title, why did you half *** it with a 2 year diploma and settle for less? Sorry, call it like I see it, why butter it up? Nursing is a PROFESSION and deserves to be recognized with a degree.
U know i am not even a nurse yet and i hate how ever one fights over who is better. I mean don't u both take the same NCLEX:confused: , and most place I see sure don't make a diff in pay when it comes to whether u have a BSN or ADN, so i can't even see , how one can say the ADN HALF *** it,:roll, if u ask me they were some smart ***, WHY? they manage to to get what they needed in two years and still make the same money some one with a 4 year degree make;) . I say to each it's own u all are nurse:)
Originally posted by melrey11If you ADN nurses are so proud of your title, why did you half *** it with a 2 year diploma and settle for less? Sorry, call it like I see it, why butter it up? Nursing is a PROFESSION and deserves to be recognized with a degree.
OMG, you have got to be kidding me! If its so half *** to get an ADN and so all fired hard to get a BSN, why the heck do we take the same boards? Guess the 60% or so of the ADN nurses out there didn't realize that by getting their ADN first or "settling" for an ADN they would be so disrespected or devalued by people like you. FYI, I will not be proud of my title, I will be proud that I am a NURSE.
You have the right to say BSN required is the way to go, thats fine, but bashing ADN's like that is just wrong. We are all fighting battles together, and there is just no call for attitudes like that.
I have said it before and I will say it again, there is room for all of us.
DB, ADN 2004
Originally posted by melrey11If you ADN nurses are so proud of your title, why did you half *** it with a 2 year diploma and settle for less? Sorry, call it like I see it, why butter it up? Nursing is a PROFESSION and deserves to be recognized with a degree.
inflammatory and inappropriate post.
wrmbreeze
48 Posts
As said by imagin916
In response to this, I have seen MANY ADN programs have thier classes lined up something like this: Nursing 101-104, with no seperate pharm, or community health, nutrition, ect. Thier med surg classes are usually combined with skills and pharm. This is not ALL schools, but many of them are set up this way. I took all these classes separate, not together in one. I have never heard of an ADN program that takes ALL subjects seperately. Maybe they have some out there, but not around here.
I'm gonna show you my first 2 semesters
semester #1 Semester #2
Fundamentals Adult Nursing
Pharmacology Nursing Assessment
A&P 1 A&P 2
Nutrition 16 hrs
General Psych
17 hrs
All of my classes are seperate and not combined. Every ADn program is different so it is not fair to group them together.
Also As said by imagin916
In addition, I dont believe what the hospitals say all the time either. I have had MANY hospitals at our school job fair say that they prefer BSN grads to ADN grads, and that they can tell the difference between the two. I dont know how you would tell one from the other since all new grads walk in there knowing nothing! Some hospitals in this area dont even allow ADN new grads to go into specialty areas at all. There are even some that wont hire new grad ADN's.
Its fine and dandy to not believe them, but they are our future employers. That said the hospitals around here actually say they prefer the students from our program because they know what we can do being that they helped teach us. I do agree that as new grads we are all on the same playing field. As I stated in an earlier post none the floor nurses here have anything other than RN on their badge so who's to know what type of degree that they have.