Ok this may be a rant but....

suga_junkie, BSN, RN · Oct 4, 2012

This debate will contine Ad infinitum while there is a two tiered entry levels.

I'm Australian and I find it interesting that there are 2 different RN entry level degrees that result in the same responsibilities and pay (is that right?). Here we only have a (BSN) RN degree undertaken at university for 3 years or an Enrolled Nurse (like LPN) diploma which takes 18 months.

Can anyone tell me the history behind having 2 RN pathways? I'd be interested to know :)

OB-nurse2013, BSN, RN · Oct 4, 2012

I think you saw my post in the other thread.
If the idea is that a nurse is someone who assesses patients, communicates with doctors and administers medications from the bedside (along with all the other necessary and wonderful things bedside nurses do), then yes, you're right, these classes are superfluous.
But if the idea is that a nurse is someone involved in the care of the whole person, family, population and community, including their responses to treatment, stress, their environment and all the many things that effect their health and health behaviors in every place where they find themselves, then a broader classroom preparation becomes necessary.
Where this gets muddy is when assumptions get made, that, for example a two year degree nurse can't do all these things, or, on the other hand, that BSN prepared nurses are clinically inadequate. Neither is true. Clearly, ADNs get a grounding in holistic and collaborative care, and clearly BSNs get the same amount of clinical preparation as ADNs.
Frankly, I am for a broadening of the profession. I would like every nurse to be as well prepared as he or she can possibly be. If doctors go to school as long as they do, why should the people carrying out their orders not be at the very least baccalaureates?
I am for independent nursing as well, for the practice of nursing as a separate discipline, a profession where it's practitioners are prepared as highly as they can be, who can work autonomously.
I would encourage everyone to go and get their bachelors if they have not, and to go on to graduate degrees if they have and are so inclined. It only improves the profession itself and it's perception. It means better opportunities for a greater number of people. It means elevating the profession.
I am really sorry if this sounds snooty. It isn't my intention.
Is a bachelors degree better than an associates degree? Does the question even need to be asked? Of course it is.
Is a BSN prepared nurse a better nurse than an ADN prepared nurse? Does the question even need to be asked? Of course not.
But it remains that the former is better prepared upon graduation to embrace nursing as a complete profession in every environment.
You're welcome to disagree.

I could not have written a better post. Love this!

allnurses Guide · Oct 4, 2012

The causation vs correlation debate is one of study design. There is no possible or ethical way for a randomized placebo-controlled study to be conducted so a correlation is the best insight we will ever get. Aiken did control for other parameters which showed significant associations; perhaps an argument could be made for the uncontrolled parameters, in aggregate, created a confounding parameter which is the downfall of the study design. I don't notice any blatant confounders.
And I was referring to the statement following the quoted text that (paraphrasing from memory) that nurses lacking liberal arts education struggle with the application of knowledge.

I'm sure we could continue to scrutinize and discuss the meaning of everything in the article for an indefinite period of time. I still wouldn't change anything in my reply to blue-eyed guy.

Esme12, ASN, BSN, RN · Oct 5, 2012

I'm Australian and I find it interesting that there are 2 different RN entry level degrees that result in the same responsibilities and pay (is that right?). Here we only have a (BSN) RN degree undertaken at university for 3 years or an Enrolled Nurse (like LPN) diploma which takes 18 months.
Can anyone tell me the history behind having 2 RN pathways? I'd be interested to know :)

Bulletin....we are interrupting your regularly scheduled discussion for this important update..........

Sigh.......confusing isn't it?

At one time the only way to be a nurse was through a hospital "diploma" setting that required the nurses to live at the hospital....kind of like becoming a nun. This process was a bout 3 years long. During WWII the demand for nurses was at an all time high and to supply the need a 2 year program was developed (History: School of Nursing: Adelphi University) off of the hospital campus. The BSN at the time was considered the advanced degree and being a RN before entry was required.

n 1942, Dr. Montag was asked by Adelphi College, under a grant from the U.S. Public Health Service, to determine if local hospitals would cooperate in establishing a school of nursing at Adelphi College. The United States' entry into World War II resulted in an urgent need for nurses. In January 1943, Dr. Montag was named director of the School of Nursing, the first program for nursing on Long Island. The first 25 students were admitted under the Nurse Training Act of 1943, also known as the Bolton Act. After completing the program, most of the students joined the U.S. Cadet Nurse Corps.

In 1965....for whatever reason the ANA (American Nurses association) voted to allow the two tiered entry into nursing in 1965....which began the intense debate. The hospitals (the diploma grad), on the other hand, refused to "give up" their free qualified help (still requiring the nurses to live at he hospital....which they don't do anymore) so the ANA adopted the three tiered entry level that continues to exist today. Hence, the battle began. Even the nursing theorists can not agree as to when the ADN program began. Some talk about Dr. Montag as the pioneer in 1942 and others refer to 1952 as the beginning of the ADN program. One was considered "military" nursing core and the other definitely civilian.

The first Associate’s degree in Nursing (ADN) program was started in 1952 at Fairleigh Dickinson University. An ADN is defined by many nursing entities as “an entry-level tertiary education nursing degree.” In the U.S. this type of degree is usually awarded by community colleges or similar nursing schools. Enrollment in associate’s degree programs increased until the early 1990s, by which time the ADN had started to evolve into more of a stepping stone on the path to a BSN and a career in professional nursing; and the BSN degree took over as the fastest growing option. Today RNs are seeking the BSN degree in increasing numbers. In 1980, 22% of RNs held a bachelor’s degree while 18% had an associate’s degree. By 2004, the number of bachelor’s prepared nurses reached 34.2% while only 33.7 % had an associate’s degree. This indicates that the baccalaureate programs are taking the lead in the production of new nurses.

In 1995 the diploma grad actually had the best "Board" passing grades followed by the Associates degree and lastly the BSN.

The success of this radically new approach to educating registered nurses was phenomenal. The number of ADN programs increased from seven in 1958 to 868 in 1994 (National League for Nursing, 1996). The reasonable cost and proximity of ADN programs to the community provided greater access for diverse populations including adult learners, males, married students, and minority populations.
ADN programs prepared the largest number of new graduates for RN licensure. In 1995, 58,749 (61%) nursing graduates out of a total of 97,052 were from ADN programs (National League for Nursing, 1996). Furthermore, graduates of ADN programs had a high rate of success on the first attempt to pass the NCLEX-RN.
National pass rates for the three types of nursing programs for 1996 to 97 are indicated below (National Council of State Boards of Nursing, 1996–1997):
ADN 88%
Diploma 90%
Baccalaureate 85%
Of the 2.5 million RNs in 1996, over 66% were ADN graduates (NLN, 1996). According to a National League for Nursing (NLN) Report, 1994 ADN graduates functioned in a variety of settings with 22% working outside the hospital (NLN, 1996). ADN graduates possess many of the competencies needed by registered professional nurses.History: School of Nursing: Adelphi University

The ANA, which is a powerful entity to be sure, is not the opnly nursing organization the makes recommendations. Nor do a majority of nurses belong to this organization. But they do have a powerful voice in the practice with nursing with the government and have the reputation as being "The Voice" of nursing practice.....the think tank so to speak. They have decided that the studies they have sponsored have "proven" that the BSN is the superior graduate causing a noticeable rift in the ranks amongst nurses.

Historically...the ADN was an accelerated intense program that out the three years of the hospital programs and condensed it into 2 years. These nurses were clinically proficient with college credits/degree. They held, and still hold, the majority if nursing positions as the hospitals programs closed across the country with the intent to phase the diploma out......some facilities continue to hold onto these programs and the free help they provide...it works for them.

The ANA has since decided that the BSN is the "superior" education for entry level and have sponsored many studies that patients have a better chance of survival when cared for by a "BSN nurse" than an ADN nurse.........of course these studies are conducted by the ANA or some other nursing entity that are heavily tied to the academic institutions which also happen to have the state of the art facilities/cutting edge procedures that also improve patient survival....but that was not included in the statistical data when comparing the two degrees of nurses caring for the patients and the survival rates.

Nursing is not a "regulated" educational requirement other than the national licensing exam that is required to practice......in the interest of free enterprise of course. Therefore not all schools are created equal.......... in the present market, the presence of schools for profit are ever present and the quality of these schools are not (for the most part) regulated nor are the "accredited" by the "governing bodies" .....ANCC American Association of Colleges of Nursing

NLNAC National League for Nursing Accrediting Commission

Once licensed......Each individual state has the "right" to accept and deny licensure in that individual state based on it's own requirements which greed for profits have caused a dumming down, in some cases, of the programs for the almighty dollar.....clear as mud right?

There has been the addition of several levels of nursing practice with Advanced Practice nurses who can, in most states, practice independently of a physician and can bill accordingly. Now that same group of nurses, the ANA, have decided that they have been wrong all along......that the BSN is the best nursing education to have and have developed a marketing tool "Magnet" status that requires a majority of BSN nurses to be the better hospital....and when we are sick we all want the best .....right? Hospitals pay these nurses to come and "accredit" their facility as "Magnet" status therefore making that hospital the "preferred" facility.

The teaching institutions cannot afford to eliminate the ADN programs (still a majority, and cheaper, for educating nurses)for that would closed certain colleges, well at least seriously damage the profit margin, and the colleges protest this......so they remain open. Now, with this economy, and no nursing shortage (supply and demand) hospitals can afford to be choosy and are choosing the BSN as the "better graduate" so now the ADN grads are jobless although they all take the same licensing exam and still have the better passing rate (for the most part).....have no jobs.

All levels of entry have to pass the same exam making them equal. In the best spirit of human behavior....my degree is better than your degree ensues.....making the ADN degree "lower " than the BSN....when we all know that it's bedside experience that counts. ADN grads that are present at the bedside for years are just as qualified as anyone else. Any change in the licensure requirement will require the "grandfathering" of all presently licensed nurses and the "BSN or higher" don't like that...... and the colleges and school protest the loss of their programs and income. So we keep all three.

Shrew....I'm out of breath...........Aren't you glad you asked? :roflmao:

......we will now return you to our regularly scheduled programming........