Different pay and responsibility for 2 year RN's VS 4 year RN's

SmilingBluEyes · Feb 10, 2003

I never said experience was MORE important. But ANYone coming here saying formal BSN education equals skill in nursing, is wrong in my book. That was the only disagreement I expressed w/anyone on the board.And I stand by it. I would NEVER argue that additional education is anything but invaluable,however. That to me is a given, and yes very important.

l.rae · Feb 11, 2003

Originally posted by P_RN
Watch the personal attacks please.

P

l tried to be a saint:saint:.....found l just caint:chair:.....and a poet l aint........

gpip · Feb 11, 2003

I will finish my bsn completion program in april. I think it has made me personally a better nurse, Not because of the nursing classes but brcause of some of the others. organic and biochemistry,and micro have helped me understand why I am doing things better and some of the other classes have helped me understand where the patient population is coming from sometimes these have made me better at the bedside. This does not make me better than any one. My wife went straight into a BSN program and functioned very well at the bedside. It is not the degree that makes the nurse. It is the person that makes the nurse as well as the experiance.

EmeraldNYL, BSN, RN · Feb 11, 2003

Originally posted by gpip
I think it has made me personally a better nurse, Not because of the nursing classes but brcause of some of the others. organic and biochemistry,and micro have helped me understand why I am doing things better and some of the other classes have helped me understand where the patient population is coming from sometimes these have made me better at the bedside.

I agree, gpip--this is an excellent point. This is what I meant when I stated that BSN prepared nurses have more "skills". I did not just mean technical skills or ability. And lets not forget that nursing is a big wide world, and encompasses so much more than just bedside nursing. I was referring to the bigger picture, including administration, case management, etc... It upsets me when I hear people say that liberal arts classes or prereqs are "junk" or pointless. Perhaps these classes won't help you to drop an NG tube better or insert an IV, but they will make you a more well-rounded person. As an example, I had to take a foreign language-- someday I may get to use my language skills at the bedside if I have a patient that speaks a different language. More importantly, I think that requiring a BSN for minimal entry would give nurses greater professional status and enable us to lobby for greater salary and benefits. I think the general public is often confused because there are so many ways one can enter nursing-- sometimes people do not realize all the training and education it takes to become a nurse. I remember a previous thread where someone said she was shocked because she had a patient who didn't think that nurses had to have any college education. Basically, I am just a huge proponent of education in general, because I think that it can only be beneficial.

EmeraldNYL, BSN, RN · Feb 11, 2003

Here's an interesting article I found on CINAHL....

BSN by 2010: A California Initiative

[Articles]

Barter, Marjorie EdD, RN; McFarland, Patricia Lenihan MSN, RN

Marjorie Barter, EdD, RN, [email protected], Associate Professor and Chair, Graduate Department, School of Nursing, University of San Francisco, San Francisco, California, and member, Association of California Nurse Leaders Professional Practice Committee,

Patricia Lenihan McFarland, MSN, RN, [email protected], Executive Director, Association of California Nurse Leaders, Sacramento, California.

The Association of California Nurse Leaders (ACNL) is the state nursing leadership organization strategically positioned to design and influence health policy and innovative approaches to creating healthy communities. The membership of ACNL includes 900 nursing administrators, managers, educators, and consultants. Members of ACNL, many with executive responsibilities for patient care in large systems, formulate policy for nurse recruitment and utilization at the majority of hospitals and healthcare delivery systems in California.

ACNL members recognize that the nursing shortage is growing more acute, and that workforce planning is critical to the future of nursing.1-4 After months of discussion about the appropriate educational credentials for nursing practice in the interdisciplinary environment prevalent in healthcare systems, ACNL members recognized the need for a system-wide change in nursing education. ACNL members have agreed that the nursing workforce of the future must have a minimum of a bachelor of science in nursing (BSN). Acute-care hospitals, traditionally seen as the foremost employer for Associate Degree in Nursing (ADN) graduates, identified a need to recruit more BSN graduates because of the complexity of care and the need for nurses with clinical leadership skills. In 1999, the ACNL board of directors reaffirmed the organization's position on nursing education and developed a strategic plan to upgrade the educational preparation of RNs in California. This plan is known as the BSN by 2010 Initiative.

The BSN by 2010 Initiative calls for changes in nursing education and is grounded in three principles:

* the BSN will be the entry level degree for all new nurses to sit for the NCLEX in California beginning in 2010;

* all nurses who are licensed as RNs as of 2010 will be grand-fathered (no change in RN licensure status will occur); and

* an articulated system of nursing education will be developed so that students who start at a community college can earn a BSN in 4 years.

With this initiative, ACNL is positioned to lead the profession of nursing into a future of exciting new possibilities.

Why the BSN for Entry Into Practice?

Nursing roles have evolved from a technical perspective to that of patient care manager with highly developed clinical and technical skills. Managed care requires rapid assessment, treatment, and movement of patients through the system. Today's professional nurse is expected to coordinate and facilitate the interdisciplinary team through the use of appropriate and timely resource allocation and management. RNs must have the flexibility to safely practice across a range of settings from hospital to community.5 The scientific knowledge explosion, combined with sophisticated technology, requires nurses to have broad preparation, including genetics, biotechnology, informatics, and skills in chronic care management. A 4-year nursing degree provides the minimum foundation for this future. Australia, Great Britain, and Canada now require the BSN for new nursing graduates to be licensed.

RNs continue to be educated in community colleges, along with pharmacy technicians and occupational and physical therapy assistants. The associate degree is generally used to prepare assistive and technical personnel in medical records, radiology, and clinical laboratories, while professionals in these disciplines are educated at the baccalaureate or graduate degree level. If registered nurses are to maintain an equal role with other healthcare professionals, they must attain educational credentials appropriate to the professional role.

Education of Allied Health Professions

The nursing profession must enter the 21st century as a full partner with other disciplines in the health-care arena. When nursing is compared to other healthcare professions, it is obvious that RN educational requirements for professional practice are less demanding. In the 1950s, both occupational therapists (OTs) and physical therapists (PTs) could be certified without a college degree. Both professions have now upgraded the entry-level educational requirements to a master's degree. The Occupational Therapy Education Accreditation Council has notified all OT programs that effective January 1, 2007, only postbaccalaureate OT degree programs will be eligible to receive or maintain accreditation status.6 The accrediting organizations for physical therapy programs will only accredit master's programs beginning in 2002.7 Nationwide, all new pharmacy students in fall 2002 will enroll in a doctorate in pharmacy (PharmD) program.8 Social workers and speech therapists in most states have long been educated at the graduate level.

Registered and licensed professionals, such as OTs, PTs, and pharmacists, who were graduated from approved programs prior these changes, will continue to be licensed under the grandfathering mechanism commonly used when increasing educational requirements. Grandfathering means that whenever educational requirements for entry into practice are changed, all those practitioners who are presently licensed in a profession remain licensed, with all rights and privileges granted that licensure. They do not have to go back to school to earn the extra credentials because they are already licensed. The change in educational requirements pertains only to those who graduate after the effective date of the change.

Other Professional Groups

Two other professional groups, engineers and teachers, have had chronic shortages of "trained" personnel, yet retain firm educational requirements and continue to advance those requirements. Engineers have had the BS as an educational requirement for many years. Engineering organizations are now identifying a need for increased education and are proposing a master's degree for engineers. It is likely that a graduate degree will be required as basic preparation for an engineer in the future. Teacher preparation in most states requires a BA/BS degree and 1 additional year in a credentialing program. Although a national shortage of teachers exists, no one is suggesting less than a 4-year college degree for teachers. Should the profession of nursing continue to expect less for RNs who have life-saving responsibilities?

The ADN and Myths of Nursing Shortage and Diversity

The common wisdom that ADN programs are necessary to prevent or alleviate nursing shortages should be reexamined. The model for the ADN program was developed in 1949 by Dr. Mildred Montag, and has been widely used since the 1950s. The associate degree program was designed to prepare a nurse technician who would operate under the supervision of the professional registered nurse, but at a higher skill and knowledge level than the licensed vocational nurse. The need for an associate degree nurse technician was justified by the continued shortage of registered nurses.9 The chronic shortage of nursing personnel continues to this day in spite of the proliferation of ADN programs nationwide. Can nursing, as a profession, continue to support the myth that ADN programs are necessary to prevent nursing shortages?

Another prominent myth about the multiple entry educational requirements is the need to support diversity in nursing. A recent survey of minority student completion of the associate degree (AA) and the baccalaureate degree (BS/BA) degree compared to white students showed minimal differences. The survey did reveal that the AA degree provides educational entry for more white women than for women of color.10 African-Americans have made great strides in advancing up the educational ladder in many fields; however, nursing schools have not seen significant overall gains in enrollment from African-Americans and other minorities.11

Women now earn significant numbers of the advanced degrees in fields such as dentistry (38%), law (43%), medicine (41%), pharmacy (66%), optometry (54%) and veterinary (66%).10 These figures indicate that while women are able to spend considerable time and money earning advanced professional degrees, nursing has not been able to attract similar numbers of men. Could it be that the educational bar is set too low for many high-achieving men and women to be interested in nursing?

An analysis of RN workforce data by Bednash 12 identified several issues of concern for employers. The current RN workforce contains less than one third BSN-prepared nurses and only 10% with master's or doctoral degrees. Hospitals and other employers continue to express a preference for BSN prepared nurses, but the demand exceeds the current supply. In addition, the variety of educational options leading to RN licensure is confusing to the public and leads to the perception that nursing is not a profession, decreasing the number of potential number of applicants to baccalaureate or higher degree nursing programs.

National Trends in Nurse Recruitment

The Veteran's Administration (VA) system has changed the qualifications needed for RNs to be appointed, promoted, or reassigned. The revised Nurse Qualification Standard 13 was designed to ensure that RNs are educationally prepared to provide care in all clinical practice roles and settings, including outpatient, home, and community settings. The BSN, or BS/BA in a health-related field, is now required for newly hired nurses to be appointed or promoted beyond the staff nurse 1 level. VA employed nurses who did not have a BSN when the new regulations became active were given until 2005 to secure a degree, after which time promotions to staff nurse 2-5 levels will require a baccalaureate degree. The armed forces have long required the BSN for nurses and require graduate degrees for many nursing roles.

The Pew Health Professions Commission 14 called for several changes in the nursing profession to strengthen it for the 21st century. Among the recommendations were to reduce the size and number of nursing education programs by reducing the ADN and diploma programs by 10-20%. In addition, the PEW commissioners cited an ongoing concern about the difference between the 2-year, 3-year, 4-year, and master's degree prepared nurse. Because of this concern, the PEW commission recommended that nursing title(s) be clarified and simplified.

Trends in California

A recent and alarming trend in California has been noted. Dropout and failure rates are increasing at community college nursing programs. Attrition of nursing students is approaching 48% at certain ADN programs, due to the open-access lottery system currently used in California for community college admission. In the new system, students with high grade point averages have the same chance for admission as those with the lowest academic scores.15 This policy has resulted in the admission of students who are not prepared for the academic rigor of the nursing curriculum. The high attrition rate creates subsequent higher costs to taxpayers and deepens the nursing shortage. BSN programs are not affected by this change because they can be selective and choose those students with higher academic achievements for admission.

There is considerable variability in program length and curricula for California ADN programs. Less than 40% of ADN programs in California are accredited by the National League for Nursing (NLN),16 and the total semester units for the ADN vary by more than 30 units between programs, ranging from 62 to 90+ units. This would indicate that students graduating from ADN programs might have very different educational experiences, culminating in different levels of competency at graduation. Curricula in BSN programs are more standardized, given the fact that all are accredited by NLN and/or the American Association of Colleges of Nursing (AACN).

Why are nursing majors treated differently from other majors in community colleges? Nursing students in many ADN programs are spending more than 2, and sometimes more than 3 years, to be awarded a 2-year degree. This discriminates against nursing students if students in other majors are not required to spend more than 2 years for an associate degree. Many ADN graduates in California spend 3 (or more) years at the community college and 2 years at the university level for the BSN. Two years at a community college and 2 years at a college or university should result in a 4-year degree, the BSN. It would be more cost effective for taxpayers to pay for 2 years of pre-nursing at the community college, and two years of BSN education at the college or university level, culminating in a 4-year education.

The ACNL Action Plan

ACNL 17 has developed a 10-year action plan to effect this important change in the entry-level educational requirements for California nurses. The plan identifies five constituent groups: RNs and RN organizations, business and service, education, regulatory/legislative, and the public (consumers). Timelines have been developed to divide activities into three phases over the next 10 years. Phase 1 consists of education of all constituent groups and development of alliances. During phase 2, ACNL will actively build coalitions, seek changes in funding for education, and work with the California Board of Registered Nursing and educators to develop curricula. Finally, in phase 3, ACNL will seek changes in state regulations to require the BSN for practice as an RN. Because a large number of ADN-prepared RNs will be grandfathered, ACNL will continue to support the concept of competency based differentiated practice.

By informing and educating nurses, other health professionals, and consumers, ACNL will build a strong coalition to advance with the BSN 2010 Initiative. Despite the nursing shortage, many ACNL members are now listing the BSN as the preferred degree for all RN positions and the required degree for some RN positions in their organizations. The ratio of positions that require a BSN is expected to increase as we reach 2010.18 ACNL will provide speakers to other nursing groups, high school and community college career counselors, and the media to explain the need for the BSN for all future nurses.

The ACNL BSN by 2010 Initiative is a plan to prepare for the future education of nurses. Nursing can no longer support a rationale for associate degree or diploma entry to the RN license, given the complexity of nursing roles and the educational requirements of other health professions. Because of the grandfathering mechanism, all registered nurses will continue to practice under the license that they have earned prior to 2010. Since the majority of nurses in California have been educated at the associate degree level, ACNL will continue to support efforts to promote differentiated competency-based practice and will facilitate educational opportunities for all nurses who wish to further their education.

It is critical that we honor our past. The nursing profession has earned the trust of the public because of the clinical expertise of nurses from all types of educational backgrounds. We must recognize the accomplishments of all nurses and incorporate them into the new paradigm for nursing education and practice. The BSN by 2010 Initiative will position nursing to maintain its status as a profession in the 21st century.

tiger · Feb 11, 2003

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Feb 11, 2003

BSN by 2010: A California Initiative

[Articles]

Barter, Marjorie EdD, RN; McFarland, Patricia Lenihan MSN, RN

The reason why I am so interested in this thread, is that I ran across it during a state board meeting in which I am an officer, Staff Nurse. They asked my opinion about the whole 2-4 year thing. The people that perpetuated the supporting arguements in that circle did not have an AD and had not worked floor nursing in many years.

The same thing that probably can be said about this article and the ACNL. They probably don't have an AD or have worked on the floor in many, many years. They are in management positions where they come up with position statements for staff nurses without having the information to back it up.

MHO.

l.rae · Feb 11, 2003

Nikki....it doesn't work like that in real life....which is why this model fails time and time again.....these ppl have no clue about real life at the bed side.....and as stated time and time again...adn and bsn take the SAME NCLEX.....obviously, if BSN offered anything different to the clinical aspect of nursing, their NCLEX would have to reflect that.....it doesn't. If the Clueless Ones want to make BSN the entry level and grandfather ADN's in for the face lift they so desire....so be it........But those who want to perpetuate the ingorance and insult that BSN is superior clinically than ADN will have a very rude awakening when reality slaps them in the face....and it will.....which is why in the face of these rude and insulting insuations from those with no real experience, I can still sit back and :)...........l have to wonder about those who basicly have little or no background on which to base their oppinions that have been denounced time and time again by the seasoned veterens absolutely scare me to death....they show lack of wisdom and judgement and respect....l would not want such a nurse taking care of me or my family regardless of the initials behind his/her name.....l'd like to be a fly on the wall when the clue bus rolls by them.......LR

New CCU RN · Feb 11, 2003

Originally posted by kasey14546
[ I'm surprised at how many of you commented that experience was more important than education. I agree that experience is very important and that education has little value without the experience to back it up. However, to become nurses we needed specialized training in this field. That training is the back bone of our experience. If you feel that education is that meaningless you back up the claim that techs can replace us if they are trained.
I couldn't agree with you more there! You pretty much have summed up exactly why it is important that nursing take the step that so many other professions have done in order to "raise the bar". No one is saying that an ADN or a Diploma nurse is not a good nurse.
The point is that by requiring a BSN or moving towards a BSN will in turn help the nursing profession. PT did this....they went from Bachelor's entry to Master's and now there is talk of PhD entry, Pharmacists did this...the majority of the programs are MS only now, and the list goes on.
We all complain that nurses don't get the respect and pay they deserve. Well certain things will do this. Upping the education requirements is one of these.

l.rae · Feb 11, 2003

Originally posted by EmeraldNYL
Kasey, I agree with you 100%. Usually a BSN is required for management positions in my area, but new staff nurses make the same regardless if they have an ADN or BSN. I don't think this is right considering the BSN has more education, and therefore more skills. The profession of physical therapy has become a mroe well-respected, higher-paying profession because they all agreed to now requiring the phD. If nurses could all agree to make the BSN the minimal required entry level, this may help advance our profession as well. BTW, welcome to the board!

newccurn.....yes, they DID say it...see above.....what you state in your post is worlds apart from what the above post implies....but l do disagree with you somewhat......NO ONE here disputes education and advancing the professional image of nursing, but BSN brings nothing else to bedside nursing and in MANY instances offers little in the way of compensation save for more opportunity to advance away from the bedside.....and this helps the nursing shortage ...HOW?....and then when the cost of education is driven up and up because further education is required to do the same job we do now......not good.... new RN's and mngt RN's with very limited experience and foresight purport this increased entry level because they are clueless as to bedside nursing. When l complete my BSN...l REFUSE to stay at bedside nursing.....it would be sensless to obtain a higher degree and continue at bedside where l will bring no further skills than l already have and with little or no compensation.....and therefore....bye bye to 22+ experience in nursing.......and this helps the nursing shortage....HOW?....if all nurses are BSN and the hospital admin already knows that nurses actually don't require the further education to perform the skills....do you really think the pay will increase?....No.....they are very greedy when it comes to paying nurses....Nurses already have what it takes to demand to be treated like professionals.....their jobs are absolutely indespensable in health care....health care CANNOT survive without nurses.....if we can't take this vital fact and demand better treatment, a few more initials will not do the job....Reminds me of an old Andy Griffith show....Barny is out of town and Jerry VanDyke plays the clumsy no-confidence dufus family friend. Aunt Bea talks Andy into hiring Jerry to do a few odd jobs around the jail while Barny is gone......What Jerry really wants is a uniform and a badge....this would really make him proud...he really wants that badge. Andy says ok to uniform...but NO BADGE!....while Andy is out on errands...Jerry takes the Badge, pins it on the uniform and off he goes........sees a couple of men fighting and tries to break it up. Needless to say they shove him out of the way and continue their fight while Jerry jumps up and down on the side lines yelling...."hey..l've got a badge...stop it..l've got a badge....guys, look, l've got a badge!".....ya know, this is how l see this whole nursing degree situation....yes a badge is good...but if you don't have what it takes to back it up...it is useless...........l just see a whole lot of inexperienced delusional nurses jumping up and down yelling at administration...."hey...l've got a degree!"...don't get me wrong, the degree and further education is great.....but it won't help our cause till we use the power we already have to advance our profession.......cutting arrogent remarks such as the one quoted above will always serve to deter this goal.........LR

Tweety, BSN, RN · Feb 11, 2003

Originally posted by ocankhe
Yes expirience is the best teacher. However it is a generally accepted principle that the more education you have the more you appreciate and can do with the expirience you gain.

I'm going to respectfully disagree with that statement. A degree on the wall IMHO has nothing to do with how one reacts, learns and grows from experience.

Also, you said "Also one should remember that hospital nursing/ direct patient care nursing is just barely half the employment opportunities for RNs. Many of those non hospital opportunities require the non clinical type courses in ones education background in order to be successful."

I definately would agree with this statement.

Tweety, BSN, RN · Feb 11, 2003

Originally posted by gpip
I will finish my bsn completion program in april. I think it has made me personally a better nurse, Not because of the nursing classes but brcause of some of the others. organic and biochemistry,and micro have helped me understand why I am doing things better and some of the other classes have helped me understand where the patient population is coming from sometimes these have made me better at the bedside. This does not make me better than any one. My wife went straight into a BSN program and functioned very well at the bedside. It is not the degree that makes the nurse. It is the person that makes the nurse as well as the experiance.

It's a myth that ADN nurses don't understand the "why's". Our pathophysiolgy in our program (I can only speak for the one I went to) explained the "whys" quite well.

I was in report once and a BSN nurse said, "an ADN knows how to hang an IV with Potassium, but it takes a BSN to know why"....sigh....

That said, I'm not against making the standard for RN to be a BSN. I'm not flaming BSN's at all mind you. But it's my honest opinion that for bedside (not teaching, or management, or those other things) the ADN program I went was quite sufficient book knowledge.