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 PlfgBSN nurses seem to have more knowledge in prevention then most ASN nurses. What I mean to say is that they can see a problem coming before it is right in front of them. ASN nurses can act when the problem presents itself, but shouldn't we as healthcare providers look at the whole picture and do what we can to prevent anything unforseen from happening.
I see your viewpoint, but your generalization of variously educated RNs is inaccurate. To say that "BSN nurses are like this, ADN nurses are like that" is a very short-sighted, immature and INACCURATE generalization.
I'm sure that many administrators would smile with smug satisfaction reading thread. They can very secure in their ivory towers, knowing that we are still divided over such stupid, petty issues.
Obviously, by my name, I am a BSN prepared nurse. I saw this thread on the main page as I logged in and could not help but to reply to it. I have not read all of the individual posts but I felt that I had to "put in my two bits" anyway.
Throughout my nursing school career, I have been bombarded from both sides (ADN and BSN) as to the merits and downfalls of each discipline (are they even separate disciplines?) Anyway, from the BSN side, I get the "more school=better nurse" bent and from the ADN side I get the "more clinical hours=better nurse" idea.
I have been up in the air over who is actually right for the past two years of school.
Now that I am actually out in the "real world" and working, I am happy to say that I honestly do not know the educational preparation of over half of the nurses I work with. All I know about most of them is that they have obviously passed their boards and that many of them are fine nurses that I aspire to be like.
Inevitably, there are a few nurses that I would rather not work with. I am unsure of what degree several of them have, I just know that , whatever their degree, they are not good nurses and I do not feel that they would be good nurses even if they had gone to school for 50 years!
Now, this is my opinion and my personal observation. I intend this in no way to applaud or demean either degree. I am just happy that I have finally made my own mind up that the true merit of a nurse is not determined by his/her degree. I am sure that several of the nurses I look up to are ADN prepared nurses and I am also sure that several of them are BSN nurses. Either way, I can only hope that I will have half the skill, heart and character that these nurses have.
Originally posted by ERKevThis is all a bunch of bull, as far as I'm concerned. We don't need the devision within our ranks! This report is, after all, by JAMA!!! Do you see this??? JAMA... They have an inate hatred for RNs to begin with! They have, over the years, attempted to replace us with high school grads under the tutiledge of MDs over and over as their "fix" for our shortage. And Holier-than-thou persons within our ranks back them up with this bickering.
I (WE!!!) don't NEED to justify ourselves to the physician communty (the authors of this rediculous waste of paper).
I agree with you totally! But, I think the point that the article in JAMA makes, is that if nursing, as a professional body, is not going to determine its future, than another professional body will step in and do it for us. It is high time that nursing comes together and makes some decisions as to where we are going on this issue. Take a look at the posts here. Nurses after nurse defending their position and their education level.
We have to remember that we are talking about entry level. Yes, the article addressed functioning RN's with experience. However, we must address the issue of entry-level and make a decision as to what is best for the patient as well as for our profession. I am an ADN, was an LPN and am almost finished with my BSN. I agree with many of the ADN posters and feel that all I am doing is paying my dues as I complete the BSN degree. But, the reality of it is, the advanced degrees do not give nurses better clinical skills, they give nurses a boardened ability to think in more abstract terms. Does this benefit the patient? Perhaps, but it is a part of turning out a well-rounded and complete graduate.
We could debate the ADN to BSN issue until the end of time. Rather than debate this issue, we need to be working with our professional organizations and defining our own future, rather than allowing other professions define for us what we need to do.
Case and point, take a look at all the other health care professionals around us ..... there is not one that considers the Associate Degree as entry level. Each profession has changed its entry-level .... Pharmacy now requires a Doctorate for entry ..... Physical Therapists are at the bachelor degree ..... clinical dietitans are at the bachelor degree .... speech therapists are at the Masters level. The question I would ask many nurses is: Why is it ok for nurses to have the lowest entry-level degree and yet, have the most responsibility and accountability for the patient's clinical recovery? From my perspective, I want to have as much knowledge as possible to provide my patient with the best care possible. If that knowledge will be gained by continuing my education, then that is what I need to do.
As a profession, many nurses are very emotional and passionate about entry-level. I submit that perhaps we need to be more enlightened and begin to recognize that the BSN must be the entry level for our profession before we are ever going to have collaborative relationships with other health care professionals. But really, the final issue here is whether nurses are going to allow Medicine or the government set the course of our profession. WE NEED TO MAKE THE DECISION ON THE FUTURE OF NURSING, NOT GOVERNMENT OR MEDICINE!
Sorry, but I had to put in my 2 cents on this again. Patrick
If we can get past the elitism and look to what is best for RN's in the future, and our professional role and all it does and will encompass, we DO need to move to BSN as entry level, IMHO.
That does not mean I think a BSN is a better nurse than an ADN or Diploma RN, I am looking at the big picture and trying to be proactive for my profession.
In retrospect I wish I had the means and foresight to finish my
BSN when I was younger....I would have had more options. Now all my credits are too old and I would need to repeat most courses. 20 20 hindsite.
I could support a plan allowing current RN's to be grandfathered, and like Canada: mandate a BSN for new nurses after a certain date.
JMHO.
The first word out of my brain when I first read the title of this thread was bullshick!
Seventeen years in nursing, I've worked with Diploma, ADN, and BSN nurses. I'm still more impressed with Diploma Nurses than the other two.........and NO, I am not a Diploma Nurse.
I do believe in education, and promote education as much as I can with my own adult children and grandchildren, so I do NOT knock anyone for obtaining as much education as you deem possible and satisfying for yourself.
There's is nothing wrong in beginning "somewhere" in nursing, and I do promote a continuance in nursing in order for one to reach their goals in the nursing field.
I do NOT think it matters what nursing degree a nurse has when working as a bedside nurse. They are all perfectly capable and knowledgeable to assess and carry out a medical/nursing plan of care for their patients.
Anything more than a bedside nurse.......such as if you want to be a Nurse Manager.......should be with experience (first and foremost) as a bedside nurse and should have a Masters in Nursing.....and nothing less.
DONs should have nothing less than a PhD in Nursing (IMHPO) and also their bedside nursing experience should be top-notched in addition to their PhD in Nursing.
Having a "higher agree" only does NOT and should not qualify one to manage other nurses who have more experience than they do at the bedside.
"Nurse" is what matters to me, i don't give a flying rodent's rear what the degree is.
( this is the thread that never ends, it just goes on and one my friends, we all post it. not knowing what it was, And we'll go on singing it forever just because This is the thread that never ends, It just goes on and on, my friends....... )
I would also like to point out to all the following:
Where else but nursing do you get graded on a different scale in college? At least in the ADN programs I am aware of, less than 80% is failing. In all other programs of higher ed, the norm is less than 70% is failing. And what about the year or two of prerequisite courses in order to start or apply to the nursing program?
Nursing programs are MUCH more demanding than most others. Most ADNs will tell you it took them very nearly 4 years of 3/4 time or better to get their 2 year degree. And, in addition, we had to take some humanities courses, i.e., fine arts, etc...
Now that my anger has subsided, I will agree that a BSN has it's place, but I don't think it's necessary for entry level. Some RNs prefer to stay at the bedside. Stepping up into management should require a minimum of a BSN. But to provide good, competent bedside care, it is rediculous to even consider requiring a BSN in order to practice.
Just because the ADN has a 2 year degree, doesn't mean they didn't work just as hard as the BSN to get it. Maybe a few less "BS" courses, but one heck of a lot of stress, work and study...
I'm stepping back off my soap box now...
This morning a nurse friend called to chat. She was telling me that another friend of hers who is a medical assistant (not certified) was upset because her job titile on her paycheck was changed to that of a non-nurse. She refers to herself as a nurse and has been doing so for 28 years. Also, she never was certified because it was not offered when she became a medical assistant. So she had the physician she works for get her status changed to 'nursing'. I find this to be unethical and misleading to patients. Last I knew, the ANA was trying to get legal protection for the term 'nurse'.
ERKev
34 Posts
Sorry, I have to jump in here. Sorry if this has been touched upon already. This particular post REALLY raised the hair on the back of my neck...
I have an ADN. I have been nursing for 15 years. I am an Emergency Nurse (and a damn good one, I might add). I have worked with ADN nurses, BSN nurses, MSN nurses, MDs, DOs, NPs, PAs, etc... Some scare me to death! Regardless of their educational levels!
Bottom line is this: NURSE! Do you know what you're doing??? Are you in over your head? Deal with it responsibly! Get out if you can't handle it. Press forward if you can!
Nursing tends to make things seem more complicated than it has to be in order to justify their desire for professional recognition. Nursing Care Plans... WHAT A JOKE!!!! I haven't done one since school. My patients LIVE!!! I don't have (nor WANT) a BSN. I'll stand up against any other ADN, BSN, MSN in my dept!!!
This is all a bunch of bull, as far as I'm concerned. We don't need the devision within our ranks! This report is, after all, by JAMA!!! Do you see this??? JAMA... They have an inate hatred for RNs to begin with! They have, over the years, attempted to replace us with high school grads under the tutiledge of MDs over and over as their "fix" for our shortage. And Holier-than-thou persons within our ranks back them up with this bickering.
I (WE!!!) don't NEED to justify ourselves to the physician communty (the authors of this rediculous waste of paper). We do not need to convolute our own practice to look important!!! WE ARE IMPORTANT!!! We don't need to make extra work for ourselves to perform already difficult tasks!!!
If I'd had the money and time, I may well have gotten a BSN. I didn't! But, don't tell me that I (we) am not a good nurse! Don't tell me I (we) am less than a BSN (or MSN!). I've worked with both over the years and I'm here to tell you that those degrees mean NOTHING when it gets down to the bottom line: saving lives....
Maybe my 15 years means nothing to you, but my patients appreciate it. The physicians I work with appreciate it. The PAs I work with appreciate it. The only ones I have trouble with are Residents/Interns, NPs and other advanced practice nurses (who seem to look down thier noses at the lowly "little people").
Smoke THAT....
Sorry for the steam, but you folks REALLY ruffled my feathers tonight!!!
ERKev
ADN and PROUD OF IT!!!!
P.S. I would suggest you and others of your ilk read between the lines. Maybe you won't destroy your own profession!!! Oh! And READ my taglines....