If we make BSN the entry level degree, we should be paid more

[runningcrazy]

First, I do not want to challenge nurses with several years of clinical experience that are ADN or diploma trained nurses or those nurses that graduated recently with a ADN, and I do not want to challenge anyone by saying that there is a difference between the ADN versus the BSN prepared nurse.

There is a push for all nurses to be BSN prepared or for ADNs to achieve their BSN; however, there is no increase in wages for the majority of those with their BSN or those going from an ADN to a BSN. I find that as a workforce, we do not understand our worth. Why do we need the BSN as it costs more and it has no pay benefits. Students that have an ADN from a community college have less student loans, and they make the same a student that has a BSN; however, the BSN student has increased student debt with no increased monetary income to show for their degree.

I challenge the nursing workforce to acknowledge our value as a profession, and demand an increase in pay if we are to have a BSN. The current yearly income of a nurse is based on the costs of an ADN level of education; however, it does not match the cost of a BSN cost of education. If I am required or it is preferred that I have my BSN, I need to be paid accordingly. I do not practice nursing strictly for the income, but I do appreciate putting a dollar value on the work I do.

Thoughts?

[BostonFNP, APRN]

*** The market isn't correcting it's self. The current glut of nurses was deliberately created using false "nursing shortage" propaganda. Looking at pay for education level is only one small part of the equitation. Nurses are under paid when level of responsibility vs compensation is taken into account.

Citation? Personal opinion?

If we want to not just look at education vs compensation and also evaluate the responsibility vs compensation shouldn't we also include responsibility vs education? Do you think the education of nurses is commiserate with their responsibility?

[DoGoodThenGo]

Actually, it's based on neither -- it's based on what the market will bear. There was a thread here quite a while back about Mass General (I think) offering a new grad ICU training program at a ridiculously low hourly wage (in return for some great education, contacts, and the possibility of a permanent job at MGH when you completed the program). The program had scads of applicants. There is great variety in nursing wages around the country, reflecting the cost of living and the supply/demand ratio of nurses in a particular region, not the cost of a nursing education. If hospitals could get an adequate supply of licensed nurses willing to work for $8/hour, they'd be offering nurses $8/hour.

One of the largest and most prestigious hospitals here in NYC, the NYP/Cornell system has just such a new grad program set up. Posts about it can be read in the NY forum.

New grads who participate are offered vastly lower wages than normal new hires and IIRC are being employed through an agency. Some have turned down the offer, others have taken NYP on it with hopes of offers of FT employment later.

[BostonFNP, APRN]

Where do you think MGH got the idea to start their ICU internship? Think the medical model influenced it at all?

[DoGoodThenGo]

Have we given employers BSN education for free? Or have employers just realized that nursing was one of the best paid fields for education level and we are now seeing the market simply correct itself? The 2013 Georgetown report was fairly compelling with nursing being in the top 5 new graduate jobs in regard to pay at the BA/BS level.

Up until recent events new ADN grad nurses could land NYC hospital positions with starting salary of low to mid $70K per year. There were and still are persons with four year college degrees if not post graduate that do not make that kind of money. Some NYC hospitals are now offering new grads low $80K as a starting wage plus shift differentials.

Until stuff began to hit the fan experienced NYC nurses with that same ADN degree could pull at or near $100K per year by traveling, working a second hospital, OT and so forth.

One had to pick no small number of jaws off the floor after informing them that associate degree nurses could pull that kind of "NYC" money. Comments ranged from "You're kidding"?, to "Nurses????", to "I had no idea they made *that* kind of money".

[Susie2310]

OP makes a very sound argument. BTW, this is the same one that is used by physicians - in order to justify paying NPs less for the same services.

I support BSN entry for acute care. At this time, we don't have sufficient evidence that more BSN staff produce better outcomes in non-acute settings.

Physician training involves, as I understand it, generally tens of thousands of hours of training. Physicians must first obtain an undergraduate degree, usually in a science, followed by four years of medical school, then approximately 3-7 years in internships/residency, followed often by more years of specialty training. Masters level nurse practitioner training, according to one prominent university web site I checked, involves hundreds of clinical hours and requires one to first obtain an RN, a BSN, and then complete three years of schooling in an MSN NP track (usually three years); if one wishes one can then complete a DNP (a couple of years more). Physicians follow the medical model in their training; nurse practitioners follow the nursing model. The higher salaries for physicians reflects their far more extensive medical education and training: Do you dispute that physicians have far more extensive medical education and training than nurse practitioners?

I understand your second paragraph to be saying that we do have sufficient evidence that more BSN staff produce better outcomes in acute care settings. Please would you be good enough to post a link to your evidence, so that we may all be informed and may evaluate this evidence for ourselves.

[DoGoodThenGo]

*** Considering they aren't qualified to do anything that an ADN isn't qualified to do I disagree. Besides the BSN is just giving the hospital money, as you pointed out.

In my view it is perfectly understandable why hospitals would prefer to hire BSN grads. It's all about the money. Recruiting and training nurses is expensive. Providing decent wages and benefits to nurses is also expensive. Hiring BSN grads means less recruiting, salary, benefits, and training costs.

If you examine wages paid to nurses in other countries where the BSN (not always a four year degree) has long been the standard for professional nurses, you'll largely find no vast upwards changes in wages.

What usually happens is slowly practical/vocational nurses are eased out of at least acute care, and you just have "professional nurses" both BSN and what remains of diploma/ADN grads with the latter fading through attrition. Then you are just left with BSN nurses and various aides or techs.

In most of the United States where BSN degree nurses were vastly out numbered by ADN or diploma grads historically most places barely paid more than a few dollars (or less than a dollar) more per hour for the difference. Considering long as both work bedside there was nor is any difference in their duties based upon education level. There is not one state that divides professional nurses by degree; be they ADN, diploma or BSN a nurse is a nurse is a nurse far as state boards are concerned including scope of practice.

With a bumper crop of new grads over the past few years combined with various other factors such as low census and closures/mergers it is happy hunting season for hospitals.

When the major way one could obtain a BSN was a four year undergraduate program large numbers of those seeking to enter the profession chose the ADN route. People needed a fast way to complete their education, get licensed and work. With the plethora of ABSN/second degree programs, plus undergraduate four year schools busting at the seams with students , many hospitals have no shortage of BSN grads. This does not even include experienced diploma/ADN nurses who have enrolled in bridge programs.

Price for any good or service is largely related to two terms we all learned in college economics classes: elastic and inelastic. That is at what price/cost would an employer or person substitute a higher cost good or service for something cheaper. Or, is there no acceptable substitution and therefor market prices/rates must be paid.

Long as a "nurse is a nurse is a nurse" hospitals can play ping pong with the mandatory BSN bit has they have done many times in the past. That is if or when there is a shortage of nurses places can and have dropped their lofty ideals regarding four year nurses and willingly embraced ADN/diploma grads.

[PMFB-RN, RN]

One had to pick no small number of jaws off the floor after informing them that associate degree nurses could pull that kind of "NYC" money. Comments ranged from "You're kidding"?, to "Nurses????", to "I had no idea they made *that* kind of money".

*** I hope you reminded them that those nurses where highly likely to be working every third, or every other weekend at least, that those nurses would likely be working on at least half of the holidays and would be lucky to spend half of their Christmases with their family's, that those nurses had a high chance of being injured at work, and that many of those nurses had to work nights to make that kind of money. Not to mention that many nurses hold patient's lives in their hands and small mistakes can result in bad outcomes for their patients.

Take those things into account and the pay doesn't seem so great.

[BostonFNP, APRN]

*** I hope you reminded them that those nurses where highly likely to be working every third or every other weekend at least, that those nurses would likely be working on at least half of the holidays and would be lucky to spend half of their Christmases with their family's, that those nurses had a high chance of being injured at work, and that many of those nurses had to work nights to make that kind of money. Not to mention that many nurses hold patient's lives in their hands and small mistakes can result in bad outcomes for their patients. Take those things into account and the pay doesn't seem so great.[/quote']

Nurses do have a high level of responsibility. Curiously they don't have a high level of liability but that is another discussion.

Do school bus drivers hold children's lives in their hands daily? Do pilots and air traffic control techs hold hundreds of lives in their hands?

[proud nurse, BSN, RN]

I have my ADN. I agree BSN should be paid more. It's a higher educational level. Most professions compensate for the difference between associate and bachelor...why not nursing? It probably wouldn't be much anyway. I've heard ADN say we hold the same license, take the same boards, and if we're bedside nurses we have the same job responsibilities. Which is true. Then I read here about ADN saying how they can't even get an interview because they're not BSN prepared. ADN can be sitting around a year or two after graduating without a job because the BSN is preferred. The BSN might not be getting paid more than the ADN, but at least he/she is getting paid. I'm also not challenging anyone's skills or education, just giving my opinion :)

[PMFB-RN, RN]

Citation? Personal opinion?

If we want to not just look at education vs compensation and also evaluate the responsibility vs compensation shouldn't we also include responsibility vs education? Do you think the education of nurses is commiserate with their responsibility?

*** The length is more than adequate. The content isn't. However I am assuming you are only referring to formal education.

[PMFB-RN, RN]

I have my ADN. I agree BSN should be paid more. It's a higher educational level. Most professions compensate for the difference between associate and bachelor...why not nursing?

*** With the exception of a few other health professions, like respirator therapy and physician assistant, what other professions receive the same training and do the same job regardless of degree?

[Guest219794]

When you buy gas for your car, do you consider all the variables that went into getting the gas? Do you pay accordingly? I don't. One of my cars needs 87 octane- I find the cheapest 87 octane I can, and buy it. My boat engine is pretty sensitive, and needs high quality fuel without ethanol. The expensive stuff saves me money, so I buy it. I still look for the cheapest stuff that gets the job done.

it is all about supply and demand. Simple stuff. It has nothing to do with difficulty, education levels, etc.

If they can get people who meet the qualifications for $10 an hour, that is what they will pay. If nobody who meets the qualifications will work for under $50 an hour, that is what they will pay.