Education of nurses

[PCU_RN9]

Now I know this may upset some but...

I think that all nurses should be BSN prepared at minimum, and all LPN, ASN, and diploma programs should be eradicated.

My reasoning for this? How many other fields can say they are "professionals" with less than an associate degree? Education is never a bad thing and the more education one has, the better. I believe nurses would be seen as more professional, and there would be less people trying to get into the field as a "fast and easy way to make decent money" as many nursing programs advertise. Perhaps then, nurses would see better wages and easier opportunites to find employment.

I would love to hear what others think on this topic. I turly hope this goes into effect in the near future!

[jelly221,RN]

I can understand where you are coming from but unfortunately I think you missed the point of a BSN. What I think most nurses miss is that nursing education is divided into two very distinct areas of study; clinical education and professional development.

I agree with this post, except that I'm not sure that it's the BSN that makes the difference. It seems that personal characteristics would determine a person's conduct and professionalism in the workplace as significantly as taking a few extra courses in college. Sure, maybe those "professionally-minded" people gravitate towards BSN programs due to a probable respect for and love of education & learning.

That's just one of my personal theories based on my limited experience. Background: I graduated from an ADN program 6/11, have been working on a cardiac DOU for 7 mos, am in an MSN program at a well-known school in LA, am moving to CVICU this summer, and have a BS in music from before my ADN. I LOVE education and am all for it. I encourage all of my co-workers and nursing friends to further their education as soon as possible.

The BSN level of education goes beyond the clinical education and introduces concepts such as statistics, economics, leadership, research, and the like. These "fluff" classes help to develop you professionally, they allow you to view nursing in a more global manner. If you received a quality education you should have walked away from the program with some concept of leadership, organizational structure, professional duty, maybe some nursing history, the ability to read a study and understand the statistical significance, and the ability to understand why education is important.

I feel that I (and many of my classmates, several of whom I now work with) walked away from our ADN program with these concepts and more. Perhaps that has more to do with our personal characteristics, though, and how much we put into our program and expected to get out of it.

You might not think that higher educational improves a nurse's performance but the studies prove that it actually does make a difference.

I'm not sure about ALL of the studies, but one of the first studies on BSN v. ADN actually has some serious design flaws. I'll look for the reference tomorrow when I'm not fried afte work. =)

[jelly221,RN]

I don't think an ADN says anything about a person. Afterall, I just finished my ADN, however I also hold a BS in biology/animal science. I have had statistics and probably more science than any BSN prepared student. I have performed my own research, and have used all of my previous education towards my ADN. With that being said, I am going straight to a MSN program so I will have an easier time finding jobs later down the road, not because it will increase my clinical abilities and critical thinking skills. My ADN program kicked our butts, and we are better nurses for it.

You can also go the route of letting students graduate these programs that shouldn't. Many BSN's that work at our hospital only have one patient thier whole entire clinical. I cannot tell you how many I have seen DANGEROUSLY let off of orientation and had no idea (literally no clue) about normal urine or lab levels. Every program lets people graduate that shouldn't in my opinion, whether they are ADN or BSN. What about the age of people graduating and thier maturity factor?? Like another poster said, actually I'll go even further, I'd rather let my 3 year old care for my life than some nurses I've encountered. I honestly think it depends more on the person and their desire to learn and take their responsibilities seriously than where they've graduated from with what degree.

Ha we kinda said the same thing, but if I'd read your post before I wrote mine, I would've just said EXACTLY!!!!

[Asystole RN]

I agree with this post, except that I'm not sure that it's the BSN that makes the difference. It seems that personal characteristics would determine a person's conduct and professionalism in the workplace as significantly as taking a few extra courses in college. Sure, maybe those "professionally-minded" people gravitate towards BSN programs due to a probable respect for and love of education & learning.

That's just one of my personal theories based on my limited experience. Background: I graduated from an ADN program 6/11, have been working on a cardiac DOU for 7 mos, am in an MSN program at a well-known school in LA, am moving to CVICU this summer, and have a BS in music from before my ADN. I LOVE education and am all for it. I encourage all of my co-workers and nursing friends to further their education as soon as possible.

I feel that I (and many of my classmates, several of whom I now work with) walked away from our ADN program with these concepts and more. Perhaps that has more to do with our personal characteristics, though, and how much we put into our program and expected to get out of it.

I'm not sure about ALL of the studies, but one of the first studies on BSN v. ADN actually has some serious design flaws. I'll look for the reference tomorrow when I'm not fried afte work. =)

When I use the term professional I do not refer to the personal attribute or attitude of professionalism but rather of the development of certain skill sets attributed to the professional world. Vocational training mainly focuses on educational training to perform a specific job. Professional training is a more gross education that is focused on assisting the student to learn skills that will help in a wide range of areas, to give the big picture.

You state that you and your colleagues felt as though they already had a sense of skills that I mentioned. Did you take a statistics or economics prior to your BSN class? If not, I find it hard to believe you understood what r=0.34 really meant or how marginal cost and marginal revenue related to each other. If you did, you are much more intelligent than I am. You should have learned something from the classes you took in your BSN courses, I simply highlight statistics and economics because they tend to be the most foreign and easily contrasted.

[nursel56]

==ignore=

[educalcu]

I know for sure that some states are seriously considering this. Current ADN/Diploma would be grandfathered in. This is a sensitive subject. Although studies have shown for many many years that BSN prepared constantly provide better and safer outcomes. Hospitals are recognizing this and our prioritizing BSN's, however changes in health care can be slow.

[nursel56]

No? How many diploma programs are there anymore? What is happening to the masters level NP programs?

What happened to the BSN in 10 law in North Dakota?

You must admit that the education you received in the 80's is not adequate for what registered nursing has become today.

A BSN earned in the 80s isn't adequate either.

Instead of making a hard deadline the powers that be are increasing funding and grants to BSN level programs to help them recruit and develop larger nursing programs. The idea is to make a slow transition using market incentives such as Magnet to increase the demand for BSN nurses and slowly build up the BSN programs to cope. If the plan works well no one will even see the transition, just one day they will looking around and not see any ASN nurses.

They aren't making a hard deadline because they discovered that repeatedly failing to reach those goals made them look silly. Don't see how you can get much slower than 50 years of relentlessly pounding away at the issue and 60% of working nurses are ADN prepared. Do you have any idea what the problem there might be?

I can understand where you are coming from but unfortunately I think you missed the point of a BSN. What I think most nurses miss is that nursing education is divided into two very distinct areas of study; clinical education and professional development.

Professional Development is a term traditionally used to describe what happens after you graduate until you driop dead or get kicked to the curb by a craven healthcare corporation.

The BSN level of education goes beyond the clinical education and introduces concepts such as statistics, economics, leadership, research, and the like. These "fluff" classes help to develop you professionally, they allow you to view nursing in a more global manner.

Not sure what you're saying with the "more global manner". Sounds like some more opaque edu-speak

and the ability to understand why education is important.

It's this crap that will do us in. Yeah, that's an insult to the intelligence you don't seem to feel we have. Your replies border on patronizing when members state what their education included, and further fracture our already really badly fractured profession.

I do quite a bit of reading on this subject matter and I have to say your description of a distinct and completely separate approach to nursing education is not mentioned. Your definition of an ADN nurse as minimally functional is not the acceptable definition in the world at large. It's the AACN description liberally laced with the contempt they hold their fellow RNs in. Maybe listening to that is the reason you don't think that comment was an insult.

You might not think that higher educational improves a nurse's performance but the studies prove that it actually does make a difference.

In what? Patient outcomes?

[Asystole RN]

Holy wall of quotes!

I am glad you brought up North Dakota, their law illustrates that there is indeed a movement to create the BSN the entry level of registered nursing. The law was repealed due to testimony that stated that the current amount of BSN programs were inadequate to fulfill the demand of nurses, especially with the (at that time) looming nursing shortage. This is something that I have talked about, you cannot currently make the BSN the standard of education because there still is not a sufficient infrastructure to educate enough nurses to meet demand.

Some states like New Jersey and New York have, and are, attempting to make hard deadlines, I disagree with this strategy. Most of the current movement is spurred on by a US Department of Health recommendation in 2001 to have 2/3 of the nurses have a BSN level education by 2011. A few years ago ANA officially came out and made a similar recommendation to make the BSN the standard level of education. Yes this was a rumor for many years, now it is becoming official recommendations and facility policy.

I apologize, I lack the vocabulary and grammar to adequately express my ideas sometimes. What I was attempting to say was the BSN program adds courses that may not directly be applicable to clinical nursing but will assist with professional work. An ADN may prepare you to be a clinical nurse but a BSN level of education may give you some extra tools to assist you away from the bedside. Classes like nursing leadership , statistics, and economics are just some of the classes that may provide a nurse assistance in pursuing jobs away from the bedside.

My use of minimally competent was in reflection that many programs are designed with the terminal goal of the student to pass NCLEX, that is the point is it not? This is the reason why NCLEX pass rates are so important in determining the quality of a nursing program, is it not? The NCLEX was not designed to determine if the applicant is a great or even a good nurse, NCLEX only ensures that the applicant is minimally competent. I am not inventing this concept, this has been written about many times, just look in JAN or any number of nursing journals.

And yes, higher levels of education have been shown to improve patient outcomes and decrease patient mortality. There are many studies that reflect this on an individual basis and is even confirmed through meta-analysis.

[kids]

Like I have said before, BSN programs are not goal orientated to improve CLINICAL performance, they are designed to improve PROFESSIONAL performance.

I apologize that your BSN program did not provide you with any useful skills, it must have been boring for you.

When considering expense I would strongly advise you to look at the statistics educational program length, how long it actually takes a student to finish the program. Traditional ADN programs are anywhere from 16 to 24 months long, plus an additional 1 to 2 years of prerequisite courses. In my area of the country the average time it takes to complete an ADN is 4-5 years when prerequisites are included. A traditional BSN program take 4-5 years to complete in comparison.

One of the things I've struggled to grasp (and my instructors were no help) is how improving my "professional performance" make me more professional than my ADN counterparts? Our job descriptions and assignments; assessment and clinical skills are exactly the same, how my additional year of education make me the 'better' nurse?

How does my extra year of education make me better at the backbone and very essence of nursing: patient care?

Don't apologize for my BSN program, I throughly enjoyed it even if it didn't do much more than reinforce what I already knew and was applying. More importantly, it provided me with the three little letters hiring managers have decided they want.

I have compared the length and costs of ADN vs. BSN programs in my area.

The BSN requites 90 prerequisite credits vs. 60 for an ADN.

Carrying comparable credit loads each quarter and attending year round (as the BSN programs require) the ADN takes a full year less than a BSN.

The costs for the nursing programs alone is THREE times the cost of the ADN, in a State with what I consider very affordable tuition costs. Even if the prerequisites for a BSN are done at a community college you're still looking at as much as $48,000 vs. $10,000 in just tuition. That alone puts acquiring a BSN as a first degree out of the hands of most anyone not fortunate financially or willing to go into tens of thousands of dollars in debt.

http://www.nursing.uw.edu/sites/default/files/files/BSN-Grid.pdf

http://www.clark.edu/admissions_fin_aid/admissions/tuition.php

http://www.ohsu.edu/xd/education/schools/school-of-nursing/admissions/tuition-fees/upload/Tuition-Sheet-2012_2013.pdf

http://www.pcc.edu/resources/tuition-fees/

If we keep upping the bar for entry into the profession and elevating ourselves away from the bedside who exactly will be actually caring for our patients.

[nursel56]

asystole --holy blizzard of posts with so many things to respond to! :)

i am glad you brought up north dakota, their law illustrates that there is indeed a movement to create the bsn the entry level of registered nursing.

well, i think we can all agree on that point. the ana published their first position paper on this in 1965. i've been searching for the actual text of the paper as it was written then, but to no avail. here's an article that references it, anyway.

revisiting the american nurses association first position paper on nursing education

the law was repealed due to testimony that stated that the current amount of bsn programs were inadequate to fulfill the demand of nurses, especially with the (at that time) looming nursing shortage. this is something that i have talked about, you cannot currently make the bsn the standard of education because there still is not a sufficient infrastructure to educate enough nurses to meet demand.

and that's part of the problem. i see lots of recommendations, but i guess their active involvement ends at that point. you mentioned "the powers that be" are funding expanded curriculums (curriculi?) and giving grants to people in need. who are these powers that be? i just don't see that or our government as supportive of continued education as they are in canada. ,

which leads me to this point. a pure form of looking at how much value is placed on something is the willingness to pay for it. not only are tuition reimbursements paltry these days, you probably won't get much of a raise for all your hard work if you do go back and get your bsn.

my use of minimally competent was in reflection that many programs are designed with the terminal goal of the student to pass nclex, that is the point is it not? this is the reason why nclex pass rates are so important in determining the quality of a nursing program, is it not?

the context you made that statement in was a comparison of the adn and the bsn, that hinted ,that the adn would never be more than that, but a bsn emerging from taking that same test has a bunch of attributes we must assume, as there is no second test given to test the things the extra time in your bsn courses give you, even if everyone can agree on what those things are.

perhaps you didn't intend it that way, but it sounded like you were describing someone with a cognitive deficit and that is more politically correct way of saying what i was thinking.

i'm not against higher education, but the ana and aacn have a track record of using the adn rn as a foil. it's unfair and demeaning to do that. just today i saw an advertisement for one of linda aiken's books with the banner connecting bsn education to "saving lives". they refer to associate nurses as "uneducated". i think we can figure out what she's actually saying there. yes, your adn may kill you. i don't respect that at all.. if there is a statistical association in her studies, it doesn't mean that.

[Nurselexii]

the person who said this is really incompetent. IF you've talked to anyone who has completed a ADN program they will tell you its just as difficult and competitive and rigorous as an BSN programme. if you look at the RN-BSN schools alot of them are just handing out that BSN basing the fact that the student received the basis of their education in the ASN program. the ADN and the BSN students take the same examination ive never heard that ADN have a higher fail rate with the nclex to BSN studies may stay that BSN prepared nurses are safer for patients. but really you would have to look at what factors were being used to make this judgment.

also your reasoning is because how many other proffesions can call them self professional with less than a asscoiate? i would say alot,

professional artists, dancers, massage therapists, chefs...

you cant compare a 2 year ADN degree to a 4 year degree in liberal arts one is more demanding and in demand than the other

[lindarn]

None of these, less than a Bachelors Degees, professionals, are licensed health care professionals, that are responsible for peoples' lives.

Recreational Therapists, have a four year entry into practice, college degree. But nurses, who are are the forefront of patient care and safety, do not?

There are many non nursing courses that can be added to BSN programs, that I call, "quality of life", classes.

Employment Law, Administrative Law, Insurance Law, Business Law, classes on how to start a business, (yes, PTs, OTs, take these classes).

To name a few. There is barely enough time in an Associates Degree program for the required classes, let alone enough time to ad classes that would help nurses immeasurably, when they hit the workforce.

Alot of the pain that nurses endure, would be lessened if we truly know how to handle ourselves against management, administration, big shot hospital law firms. Wouldn't you like to look your manager in the eye, and state, with certainly, that doing what they ask, violated Federal Law? And be able to quote it? The look on the face would be priceless. I know, because I have been there.

If we knew the law, as it pertained to us, etc, it would go along way in ending the management abuses that we endure. And we could hold our heads high, look them in the eye, and walk away.

Until recently, nurses have been held hostage, by having pretty much only one avenue for employment after graduation-hospitals, or doctors' ofices. Their employment choices being limited by the fact that we had no college degree to show for our two or three years at Diploma nursing programs. We were stuck. And employers knew it.

Now, there are many outpatient areas open for employment, but the pay is usually less that the hospital. So, if a nurse was dependant on the higher hospital salary, then he/she, was stuck in the hospital.

Other professions have moved out of being employees, and grouped together to form "practice groups". This then allows the former employees, to sell their skills back to the hospital, at a higher wage, better benefit options, and the ability to receive the tax write-offs, for the same services that our former employers have gained, enjoyed, and benefited from.

Self employment is freedom from the bondage of being an employee.

Look at how other professions have gained from this. PTs, OTs, Pharmacists, etc. All have opened busineses, earn a lot of money, have freedom and independance. There is not reason that we can't. Many hospitals are now allowing nurses to self scedue. There is no reason that we could not do that as Independant Contractors. Self schedule the ICU, CCU, ER, dialysis, etc.

Dialysis nurses missed a perfect opportunity to gain a favorable foothold if they had self employment in their thing thanks. Instead, doctors, and hospitals, grabbed onto it and a cash cow. Guaranteed payment from the Federal Government, in terms of Medicare and Medicaid?

The Fitness industry, is another area nurses could have gotten a foot hold in. Now individualls with degrees in Physical Education, Physiology, have gotten into providing the preemployment physicals, for the Police Department, Fire Department, etc.

Other companies, are now running the Flu shot clinics in the Fall, and providing Health Fairs to Employers, with BP testing, cholesterol testing, weight mangement, etc. There are ALL areas that nursing could have started/taken over, when the trend started in the 1980's etc, But nurses were/are, not socialized to think like that, and we missed a golden opportunity to get into this at the ground floor.

Think out side the box, for a change. It will open up doors.

These are NOT knew concepts to nursing. I heared these same comments/sentiments, and suggestions, when I was in my BSN program 20+ years ago. Yes, I was originally a Diploma grad from NYC.

It did not take me long after graduation to see that nurses were treated with disdain, and worse than any other department in the hospital. All other departments, who at the time, "only", had a Bachelors degree as entry into practice. These health care professionals ALL increased their entry into practice when DRGs, etc, hit the scene.

They realized that they had to step up to the plate and make sure that they got their piece of the health care dollars pie and made sure that they looked important, or go the way of high button shoes.

They would be left out in the cold, if they could not find ways to increase their marketability, and validate their place in healthcare. They all increase their educational requirements, and now out earn us significantly, and enjoy far more respect than nurses do. Again, think outside the box.

They have also taken over many nursing procedures, that were primarily in nursings' scope of practice. They are leaving us in their dust. Lets make sure that WE get the last laugh! Make the necessary changes to our profession before they make us obsolete! AS it stands now, they are succeeding without even firing a shot.

JMHO and my NY $ 00.02

Lindarn, RN, BSN, CCRN (ret)

Somewhere in the PACNW

[lindarn]

None of these, less than a Bachelors Degees, professionals, are licensed health care professionals, that are responsible for peoples' lives.

Recreational Therapists, have a four year entry into practice, college degree. But nurses, who are are the forefront of patient care and safety, do not?

There are many non nursing courses that can be added to BSN programs, that I call, "quality of life", classes.

Employment Law, Administrative Law, Insurance Law, Business Law, classes on how to start a business, (yes, PTs, OTs, take these classes).

To name a few. There is barely enough time in an Associates Degree program for the required classes, let alone enough time to add classes that would help nurses immeasurably, when they hit the workforce.

Alot of the pain that nurses endure, would be lessened if we truly know how to handle ourselves against management, administration, big shot hospital law firms. Wouldn't you like to look your manager in the eye, and state, with certainly, that doing what they ask, violated Federal Law? And be able to quote it? The look on the face would be priceless. I know, because I have been there.

And we would have a contract to protect us from being fired at will. What is wrong with that?? And protect us from having our pay cut, like it just was in Orlando Regional Medical Center in Florida, a recent thread outline what they just went through.

The public equates worth with education. Yes, the public loves us. But I forsee a future, where the hospitals go on a public campaign, blaming nurses for the high cost of health care, always wanting higher salaries, more nurses for better staffing, etc. And they will go on how many hospitals have closed in California with the staffing ratios, all because of the greed of the nursing profession.

We need to get the public on our side, have public rallies with posters, that state how much the CEO, and cronies, make, their benefits, (free health club memberships, that health care dollars are paying for, instead of better staffing). The public needs to know how this stuff affects them! Nurses also need classes in Public Relations, and Marketing, to learn about this stuff. There is no time in Diploma programs, and Associates Degree programs. And yes, it will benefit us and our patients. These are NOT fluff classes.

If we knew the law, as it pertained to us, etc, it would go along way in ending the management abuses that we endure. And we could hold our heads high, look them in the eye, and walk away.

Until recently, nurses have been held hostage, by having pretty much only one avenue for employment after graduation-hospitals, or doctors' ofices. Their employment choices being limited by the fact that we had no college degree to show for our two or three years at Diploma nursing programs. We were stuck. And employers knew it.

Now, there are many outpatient areas open for employment, but the pay is still usually less that the hospital. So, if a nurse was dependant on the higher hospital salary, then he/she, was stuck in the hospital.

Other professions (besides doctors), have moved out of being employees, and grouped together to form "practice groups". This then allows the former employees, to sell their skills back to the hospital, at a higher wage, better benefit options, and the ability to receive the tax write-offs, for the same services that our former employers have gained, enjoyed, and benefited from.

Self employment is freedom from the bondage of being an employee.

Look at how other professions have gained from this. PTs, OTs, Pharmacists, etc. All have opened busineses, earn a lot of money, have freedom and independance. There is no reason that we can't. Many hospitals are now allowing nurses to self scedule. There is no reason that we could not do that as Independant Contractors. Self schedule the ICU, CCU, ER, dialysis, etc.

Dialysis nurses missed a perfect opportunity to gain a favorable foothold in becoming dialysis providers, if they had self employment in their think thanks. Instead, doctors, and hospitals, grabbed onto it and made it a cash cow. Guaranteed payment from the Federal Government, in terms of Medicare and Medicaid?

The Fitness industry, is another area nurses could have gotten a foot hold in. Now individuals with degrees in Physical Education, and Exercise Physiology, have gotten into providing the pre-employment, and yearly, physicals, for the Police Department, Fire Department, etc.

Other companies, are now running the Flu Shot Clinics in the Fall, and providing Health Fairs to Employers, with BP testing, cholesterol testing, weight mangement, etc. These are ALL areas that nursing could have started/taken over, when the trend started in the 1980's etc, But nurses were/are, not socialized/encouraged, to think like that, and we missed a golden opportunity to get into this stuff, at the ground floor.

Think out side the box, for a change. It will open up doors.

These are NOT knew concepts to nursing. I heared these same comments/sentiments, and suggestions, when I was in my BSN program 20+ years ago. Yes, I was originally a Diploma grad from NYC.

It did not take me long after graduation to see that nurses were treated with disdain, and worse than any other department in the hospital. All other departments, who at the time, "only", had a Bachelors degree as entry into practice. These health care professionals ALL increased their entry into practice when DRGs, etc, hit the scene.

They realized that they had to step up to the plate and make sure that they got their piece of the health care dollars pie and made sure that they looked important, or go the way of high button shoes.

They would be left out in the cold, if they could not find ways to increase their marketability, and validate their place in healthcare. They all increased their educational requirements, and now out earn us significantly, and enjoy far more respect than nurses do. Again, think outside the box.

They have also taken over many nursing procedures, that were primarily in nursings' scope of practice. They are leaving us in their dust. Lets make sure that WE get the last laugh! Make the necessary changes to our profession before they make us obsolete! As it stands now, they are succeeding without even firing a shot.

JMHO and my NY $ 00.02

Lindarn, RN, BSN, CCRN (ret)

Somewhere in the PACNW