Education Conspiracy

[Avid reader]

Does anyone see a huge difference between an ADN and a BSN prepared nurse, nursing skills wise? Very little of my BSN coursework have been utilized on the floor and to be honest, experienced Diploma nurses frequently possessed better skills. Sure, there was management and leadership skills, but unless that is your intent, I cannot see the point.

Personally, the nurse with desire and curiousity for her craft have always appeared to me better, at not only practical skills but also interpersonal. I acquired more debt but little else.

Is there collusion between the AACN and learning institutions pushing this agenda? Why is it so few nursing international bodies have adopted very little of this trend?

[compassionresearcher]

I guess we could go back and forth all day finding articles to support our own opinions. The bottom line is people are successful with and without degrees. It all depends what you do with what you have.

Many of my former classmates from elementary school who didn't like or do well in class went on

to learn trades, now they're successful businessmen who own their own company.

One has to do what they believe is right and what matches their skill set. For some, that is extended education and for others, it's blooming where they're planted. My Bachelor's is not in nursing, but I was able to get into a Master's program with an ASN and non-nursing BA. I wouldn't necessarily advise an ASN with a BA in non-nursing to go back for the BSN as an end point unless your hospital required it and you loved and wanted to keep your job. But if a high school student was trying to choose a program, I would suggest going for the 4-year degree.

The study below affirms Aikens results.

http://www.aahs.org/aamcnursing/wp-content/uploads/Baccalaureate-Education-in-Nursing-and-Patient-Outcomes.pdf

OBJECTIVES: The aim of this study was to examine the effects of registered nurse (RN) education by determining whether nurse-sensitive patient outcomes were better in hospitals with a higher proportion of RNs with baccalaureate degrees. BACKGROUND: The Future of Nursing report recommends increasing the percentage of RNs with baccalaureate degrees from 50% to 80% by 2020. Research has linked RN education levels to hospital mortality rates but not with other nurse-sensitive outcomes. METHODS: This was a cross-sectional study that, with the use of data from 21 University HealthSystem Consortium hospitals,analyzedtheassociationbetweenRN education and patient outcomes (risk-adjusted patient safety and quality of care indicators), controlling for nurse staffing and hospital characteristics. RESULTS: Hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay. CONCLUSION: The recommendation of the Future of Nursing report to increase RN education levels is supported by these findings.

[llg, PhD, RN]

Another angle on this issue: A lot of ADN programs pad their curriculum with extra courses to make money and to try to show that their graduates are just as capable as BSN's. Instead of taking 4 full time semesters (as the original, standard Associate's Degree programs were conceived to take), they take 5 or even 6 full time semesters. Usually, it is structured as 2 semesters of pre-reqs followed by 4 semesters of nursing classes.

The people who should be angry about such programs are the graduates of such programs. Those people took extra classes, paid extra money, spent extra time, etc. spending 3 years to get a 2-year degree. They take 3/4 of a BSN program, but their diploma/degree is the same (ADN) as other people who spent only 18 months. They should be angry about that. But instead, they defend their school by focusing on how much they learned in those classes and how prepared it made them at graduation. They fail to see that they have been ripped off -- paying for that extra education, but getting a degree reflective of a lower level of education.

I had a friend who taught in an LPN program. She was bragging about how she taught her students a lot of stuff that was beyond the scope of LPN practice -- so her students knew almost as much as an RN. I told her to stop that as it only made for unhappy LPN employees. They would be frustrated that they were not able to use what they learned and would not be credited with having that knowledge. That lack of recognition would frustrate them.

I believe ADN faculty have often tried to similarly blur the line between ADN and BSN -- to the detriment of our profession. The 2 levels should be clearly distinguishable, with clear differences between the 2 curricula. It would then be clear what type of education would be right for certain types of jobs. A person could then choose the career path (and educational requirements) that best fit their needs.

[Ruby Vee, BSN]

I tend to agree. However, I think the goal of many BSN programs (their stated goals- which may not translate to reality in all cases) is to attempt to instill critical thinking, et cetera. I know some ADN nurses that are fantastic. However, I also know some ADN nurses that suck tremendously (recent grads) because they don't care and only wanted a quick route to become a nurse. That sort has a very different mindset than the majority of recent BSN nurses I know. At the risk of sounding classist, it tends to be more of a class issue, I think.

Whoa . . . judge much. Class issue?

[Ruby Vee, BSN]

You do sound classist; are you really saying BSN nurses come from a "higher class"? You really don't mean that do you? If so, you are not "risking sounding classist", you ARE and it's very unbecoming a professional of any sort to be.

ADN programs DO instill critical thinking and it is NOT a "quick route" to becoming an RN, if you consider it takes minimum 3 years with all the pre-req's to finish.

I have met many new BSNs out the gate who sucked, too. Some really DID think they were "Better" than the ADN counterparts, because their professors told them so, in some cases. But their performance and critical thinking skills were no better stacked against the ADN with the same (lack) of experience fresh out of school.

Your post smacks of arrogance.

I am very pro-education, and working on advancing mine but again, you won't catch me putting down others simply based on the letters behind (or not behind) their names.

"Classist" is probably a better term than the one I used: "Judgemental". Arrogant is probably also accurate.

The ADN graduates I've precepted show just as much critical thinking as the BSN graduates, and perhaps more. Some of the BSNs have their BSNs because Mommy and Daddy insisted upon a "college degree" and paid the way. Most of the ADNs in my experience decided what they wanted to do with their lives and obtained the degree with minimal help. That made them better employees than those BSNs, many of whom had never held a job before. Interestingly, the ADNs who worked their way through school, were better critical thinkers and better employees than the BSNs who looked down on them for their "lesser degree."

The classist, judgemental way of thinking particularly frosts me because I was one of those "lower class" kids who grew up without plumbing or electricity -- got my BSN by age 22 and a graduate degree in my 30s. No one would call me lower class now, with my solid middle class income -- but I certainly was.

[SmilingBluEyes]

You are right; we COULD go back and forth ad infinitum. The study was shown flawed by MANY others and resources/other studies and articles since. I believe it to be flawed. I also believe having a BSN IS a great thing for a career, knowledge and advancement. Never will you see me say advancing education is anything but a wise and smart thing to do. My goal is an MSN, and I am now getting "Back into it, full force" to make it happen.

I don't denigrate others' education to make my point. No one should.

I hate seeing a study whose methodology was flawed from jump, used to back up that statement (paraphrased) "BSN-prepared nurses deliver safer care than their diploma or ADN counterparts". All other things being equal, in terms of staffing ratios, experience, skills mixes, and acuity, just to mention a few, that is simply NOT TRUE.

I guess we could go back and forth all day finding articles to support our own opinions. The bottom line is people are successful with and without degrees. It all depends what you do with what you have.

Many of my former classmates from elementary school who didn't like or do well in class went on

to learn trades, now they're successful businessmen who own their own company.

One has to do what they believe is right and what matches their skill set. For some, that is extended education and for others, it's blooming where they're planted. My Bachelor's is not in nursing, but I was able to get into a Master's program with an ASN and non-nursing BA. I wouldn't necessarily advise an ASN with a BA in non-nursing to go back for the BSN as an end point unless your hospital required it and you loved and wanted to keep your job. But if a high school student was trying to choose a program, I would suggest going for the 4-year degree.

The study below affirms Aikens results.

http://www.aahs.org/aamcnursing/wp-content/uploads/Baccalaureate-Education-in-Nursing-and-Patient-Outcomes.pdf

OBJECTIVES: The aim of this study was to examine the effects of registered nurse (RN) education by determining whether nurse-sensitive patient outcomes were better in hospitals with a higher proportion of RNs with baccalaureate degrees. BACKGROUND: The Future of Nursing report recommends increasing the percentage of RNs with baccalaureate degrees from 50% to 80% by 2020. Research has linked RN education levels to hospital mortality rates but not with other nurse-sensitive outcomes. METHODS: This was a cross-sectional study that, with the use of data from 21 University HealthSystem Consortium hospitals,analyzedtheassociationbetweenRN education and patient outcomes (risk-adjusted patient safety and quality of care indicators), controlling for nurse staffing and hospital characteristics. RESULTS: Hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay. CONCLUSION: The recommendation of the Future of Nursing report to increase RN education levels is supported by these findings.

[RobbiRN, RN]

I had a four-year bachelors degree in another field and sat on boards responsible for multi-million dollar budgets prior to completing my 5th and 6th years of college level education to obtain my ADN. I've maintained my CEN with 100 hours of continuing ed in my field of expertise every four years. The one size fits all mentality, that an ADN is an ADN, and all BSNs are better educated ignores multiple other areas of education and experience any given nurse might bring to the job.

[NotYourMamasRN]

If bedside skills were the only thing required of nurses, than sure a diploma or AS would be great. There is more to nursing than bedside skills. A lot of the nurses who have been nurses for 20, 30, 40 years are great at the bedside. But they are not always great with computer competency, EMR competency, drafting policies, understanding legislation, understanding best management practices for the different demographics and generations they surely lead on the floor, making a dashboard in Excel, understanding how diversity affects the workplace, using a database to acquire scholarly research for bedside practice, or writing a proper professional email not in all caps. All things they would be fully competent in if they got a BS.

[SmilingBluEyes]

Not necessarily. These competencies are offered in continuing education and often required anyway by many workplaces. Seeking certification and belonging to Specialty Organizations also affords such competencies. A BSN by itself does NOT afford all of these things or else all BSN nurses would be competent in all these areas--- and they are not. I have seen many have to learn the above, especially those with BSNs older than 10 years. It's about continuing education and keeping current and relevant.

If bedside skills were the only thing required of nurses, than sure a diploma or AS would be great. There is more to nursing than bedside skills. A lot of the nurses who have been nurses for 20, 30, 40 years are great at the bedside. But they are not always great with computer competency, EMR competency, drafting policies, understanding legislation, understanding best management practices for the different demographics and generations they surely lead on the floor, making a dashboard in Excel, understanding how diversity affects the workplace, using a database to acquire scholarly research for bedside practice, or writing a proper professional email not in all caps. All things they would be fully competent in if they got a BS.

[HotChicken]

This post is rubbing me the wrong way for some reason. Full disclosure, I'm a new nursing student. I have zero clinical experience and have dealt with neither ADN or BSN bedside nurses, so I have no way to compare the two.

I am, however, pursuing my BSN because the hospital that I eventually want to begin my career with will only accept BSNs for their nurse residency program. I am 34. Mommy and Daddy are not paying for my education, I am. I am not arrogant and I firmly believe that a new grad ADN and BSN are on level playing fields after they pass the NCLEX.

I don't know why I felt the need to chime in. I'm just getting a real "us vs. them" vibe.

[elkpark]

If bedside skills were the only thing required of nurses, than sure a diploma or AS would be great. There is more to nursing than bedside skills. A lot of the nurses who have been nurses for 20, 30, 40 years are great at the bedside. But they are not always great with computer competency, EMR competency, drafting policies, understanding legislation, understanding best management practices for the different demographics and generations they surely lead on the floor, making a dashboard in Excel, understanding how diversity affects the workplace, using a database to acquire scholarly research for bedside practice, or writing a proper professional email not in all caps. All things they would be fully competent in if they got a BS.

Nonsense :) -- I know plenty of BSN prepared RNs, including people who went through traditional, four-year BSN programs "from scratch" as well as people who returned to school with a diploma or ASN, who can't do any of those things (let alone be "fully competent" at them).

[cjcsoon2bnp, MSN, RN, NP]

I feel like this is a debate that has been going on the AllNurses forum for years, probably over a decade at this point. I started off in a local ADN program but transferred to a BSN program before I started clinicals because the wait list for the ADN program was over 1 1/2 years. The semester that I transferred to the BSN program I received a phone call from the ADN program that said I was formally accepted and could start clinicals in the next semester (too little, too late). I have worked side-by-side with great nurses (some were ADN-prepared and some were BSN-prepared) but I have also worked alongside some poorly-prepared practitioners (again some individuals had an ADN and others had a BSN). Just to address a few points that always come up in this debate...

"ADN nurses are better prepared clinically" or "ADN students have more clinical hours"

This is something that many ADN programs and their graduates love to profess and use it as the primary reason for why students should choose an ADN program. The number of clinical hours in a program depends on multiple factors including if the governing board of nursing has language in the state nurse practice act that mandates a minimum number of clinical hours for nursing education programs (surprisingly many states don't have this). Other factors include the number of credits required to complete the degree, the format of a program, how courses are structured and if students complete an independent clinical practicum (versus all clinical experiences being completed in groups).

I also believe that how clinically prepared students and newly graduated nurses are is highly dependent on the individual program. What nursing programs emphasize in their foundation courses (assessment skills, skills labs/stations, simulation activites etc.) and how programs are perceived by healthcare institutions in the surrounding community helps to shape this. One of the BSN programs in my state is a part of a well respected university with a high-cost pricetag and it is a widely held belief that the graduates of this program are not well prepared to function in the RN role. On the flipside, one of the nearby ADN programs has held a great reputation for producing excellent nurses for decades but public records from the department of health have shown consistantly falling first-time NCLEX pass rates from this institution over the past 5 years.

As a manager I've hired both ADN and BSN nurses and found that how clinically competent a nurse is has more to do with their personal commitment to lifelong education and professional practice than where they went to school or the degree they hold.

"BSN programs teach critical thinking and prepare nurses for leadership/management/administrative roles"

Critical thinking (CT) skills are a core competency for all RNs regardless of their degree and CT development is expected to be integrated into the curriculum of all nursing programs. I'm not convinenced that graduating from a BSN program suddenly turns someone into a critical thinker.

In terms of preparing nurses for leadership roles, I will say that nurses functioning in a leadership or management role should possess at least a BSN but regardless of the degree earned the newly minted RN does not have the knowledge or expertice necesary to start in a administrative position. The fact is that a BSN includes foundational coursework in humanities and nursing coursework is likely to cover more content in legislation and public policy, healthcare systems, and the analysis/utilization of nursing research which is important for working professionals.

To be honest, the real problem I have with our current system is that there are so many different degree options you can have to become an RN and yet we all take the same NCLEX. I believe the educational requirements should be standardized with a single entry level degree option and there would be less fighting over degrees (that is not to say that the current BSN system doesn't need some work to remove some of the fluff). I also don't like how many students in ADN programs are told they can be an RN in just two years but the reality is that most ADN programs take three years to complete and then they are encouraged by their employers to promptly enter RN-BSN programs. Depending on where you live in the country, your job prospects for an entry-level RN position can be limited because of the ADN degree (especially at larger healthcare systems or in metropolitan areas) even though you took the same NCLEX as your BSN colleagues and I think that is inherently unfair.

We could discuss this topic ad nauseam but I think that we shouldn't be discouraging people from furthering their education and at the same time we need to acknowledge that their are other noteworthy forms education then what is taught at a university and awarded with a degree.

!Chris

[cocoa_puff]

Avid Reader, I'm sorry but I have no idea what you just said.