Is the BSN for Everybody? Things to Consider when Considering School

[nurseyblues]

How important is schedule to you?

If you're the kind of nurse who loves working three 12s and having the rest of your week off, you might find that options are limited away from the bedside. Many non-clinical positions are Monday-Friday, daytime operations that only offer 8 hour shifts. Some may offer 4-10s or rotating shifts, but 3-day work weeks are hard to come by outside of direct patient care.

What part of nursing do you enjoy?

If you really love taking care of patients, and really loathe sitting in meetings and doing paperwork, that's something to consider when thinking about your BSN. Leadership and education positions tend to involve a lot of writing and speaking; if figuring out schedules, sending emails, and giving presentations is not your thing, most administrative BSN roles won't be a good fit.

On the other hand, if the clinical aspect of nursing is your passion and you intend to eventually pursue an advanced practice role as a nurse practitioner or nurse anesthetist, you will absolutely need your BSN first. CRNA programs also require at least a year of recent critical care experience, so you won't want to stray far from the bedside once you have your BSN.

Is your goal to get a raise?

If you're thinking of getting a BSN just to earn more and become more marketable, it helps to have the facts. In many hospitals, there is no wage increase for earning your BSN. Most facilities determine pay based on the job description, more so than the credentials. For instance, the administration looks at market values and determines that RNs at the bedside should make X dollars an hour. Some may add a bit to the hourly wage for a BSN, but many do not; a bedside nurse is a bedside nurse and they are paid as such even with a BSN.

This is certainly something many would like to change, but before that can happen there will need to be a fundamental change in BSN education. Currently, a nurse can earn a BSN in a matter of months online without a single live lecture or any hands-on learning. Few, if any, BSN programs require a clinical component or practicum. There are no advanced clinical skills, no new knowledge significant enough to affect performance at the bedside, and therefore no real justification for an increase in pay. An overhaul to existing BSN programs, including advanced clinicals, might help to change that and make BSNs more marketable.

If you do intend to transition into a higher-paying leadership role with your BSN, go for it; just bear in mind that most management and education roles are salaried, not hourly, so figure that into your calculations. If you're someone who relies on occasional overtime or likes to pick up holidays for the premium pay, these differentials usually don't apply to salaried (aka "exempt") positions.

Are you hoping for a competitive edge in the job market?

If you're trying to get ahead, continuing education and impressive credentials will certainly help. Bear in mind, though, that the BSN is becoming very commonplace now among bedside nurses. Many hospitals strongly encourage, and even require, nurses to obtain a BSN within a certain number of years after hire or in order to apply for transfers within the organization. In the recent past, BSN nurses were in leadership roles as nurse managers, directors of nursing in long-term care, and nursing instructors in diploma and ADN schools. Now that the average bedside nurse has, or is expected to earn their BSN, leadership and advanced roles are requiring even higher levels of education. You should absolutely pursue the degree if you want to advance, but many nurses now are also seeking additional certifications in various specialties like diabetes, oncology, or wound care, in order to stay competitive.

Is money no object?

One more thing any nurse should consider before returning to school is the matter of finances. Some may qualify for federal grants or full scholarships, but most working nurses will end up paying at least part of their tuition and fees out of pocket. If you're lucky enough to get a free ride, take full advantage of it. If you're like most nurses and have to rely on student loans and/or tuition reimbursement, take all the factors into account before you decide. For instance:

What is your current financial situation? Even with student loans and tuition reimbursement, many nurses often have out of pocket expenses for every semester. If your nursing job lands you a certain income bracket, you may only receive partial student loans and have to pay the remainder of tuition yourself. That's something to consider if money is already tight. Also remember that currently, getting your BSN does not guarantee an increase in monthly income. All too often BSNs find themselves in the same job making the same money, but now with a student loan payment to contend with every month.

How close are you to retirement? The repayment period for most student loans is 10 years, so it may not be worth it if you plan to retire in 6. However, if your finances are such that you could pay extra or pay the loan off early, you might want to go ahead.

Are you planning to relocate or change employers after graduation? Employer tuition reimbursement usually exchanges financial aid for months or years of continued service post-graduation. If you leave your employment before the debt is worked off, the benefit has to be paid back to the facility. Read the tuition assistance policies carefully to determine how long you'll need to stay on after graduation and what your payback amount would be should you choose to leave early.

Is your projected BSN salary enough to balance out the student loan debt? Most BSNs end up paying around $240 per month for their student loan after graduation, so bear in mind that you'll need to make at least that much more per month just to break even. The sad truth is that as it stands now, many BSNs find themselves struggling to make that monthly payment when there is no wage increase for earning the extra degree. Leadership roles will usually pay you a bit more, but remember to think about the schedule requirements and exempt/non-exempt status of those positions.

What's the bottom line?

Generally speaking, you almost can't go wrong with more education. The more letters behind your name, the better your resume looks, and there is also a sense of personal achievement. Still, when considering a BSN program, it's important to examine all the pieces: your goals, your finances, your lifestyle and family situations, as well as your likes and dislikes when it comes to work. Do you need to be home with your kids more? Do you rely on overtime or shift differential to make ends meet? Do you love patients but hate paperwork? These are all things to consider.

We all eagerly look forward to the day when the BSN translates to tangible benefits for the average nurse. Sadly, as it stands right now, for many there is no life-changing advantage and the BSN serves only as a stepping stone to an even higher degree or advanced clinical practice. The information here is not meant to discourage anyone from pursuing higher education, only to help put the undergraduate degree and its pros and cons into perspective.

If your facility requires the BSN for bedside nurses, then your choice is simple. However, if you just really love taking care of patients and have no desire to enter leadership or administration, you may fare better with a specialty certification in an area that interests you. The cost is far less, and the BSN does not focus on clinical skills. If you do want to qualify for entry-level leadership and education roles, then the BSN is the way to go. In future we hope to see the BSN carry more weight and offer more leverage, but to do so it must also provide increased skills and greater knowledge. Changes in education are likely the only thing that will translate into changes in benefits. Still, the great thing about nursing is that we have a wide-open, versatile field where there is something for everybody. Hopefully the information included here can help you decide which of those somethings is right for you in your own nursing practice.

[AutumnApple]

I'm not making the correlation between more expensive education and better working conditions. Can you expand?

From what I've seen, the only people who benefit from higher education costs is the schools giving said education. Healthcare facilities don't look at our tuition bill and say "Oh, look at that, better improve the nurse to patient ratios!".

In fact, quite the opposite tends to go on. Conditions are getting worse while BSN for bedside care continues to be pushed. I guess they (healthcare facilities) don't see the connection either.[/quote

When we start cranking out less nurses, we become more valuable to the employer. Like what the physical therapists have done. With community colleges cranking graduates out, employers have little incentive to keep their staff satisfied. California has achieved a stable work force in their hospitals. Very low staff turnover. That's good for everyone..

.except new grad.

Ah, Ok. You're looking at it from a......desaturating the field point of view. I guess it could work out that way.

Me, not sure what I think about that just yet. I can say this: I worked during a period where facilities were desperate for nurses. If you applied somewhere, you were usually called for an interview within two days. Then you'd be interviewed and hired the same week. I was interviewed and hired same day.

The facilities, while desperate for help, did not do very well in retaining people still. They just did the same things, but moaned about it more when people left. In fact, most of the time, when people moved on, they blamed us, the nurses.

Hmph, it's a topic worth more thought.

[me_again]

I'm a 64 year-old, second-career ADN nurse. I've been a nurse for seven years now, and am getting my BSN online. Even though I do not live in Texas, I chose to go through a university in Texas, because that is where I got my ADN.

Every course I requested to be transferred WAS accepted by the online program, in part because I already had the pesty poli-sci and history classes required for Texas. The cost of the program will come in very close to the cost advertised by the university, less than $10,000.

My reason for getting the higher degree is simple: I don't want ANY door I might want to walk through to close on me for lack of a BSN!

[AutumnApple]

(Gasp) "Close to 60% of our GN hires are moving on after their first year is done. You nurses need to get your act together and treat them well enough that they stay."

"They are leaving because (hospital 15 min. down the road) charges half as much for parking and every shift has an admissions nurse."

"No, it's not that, I addressed that in an email already."

"Your email said parking prices were going up and there was no room in the budget for admissions nurses."

"Yes, like I said, I addressed it. So, obviously the problem is that the nurses are not doing what they can to make new hires feel welcome."

I wish I was kidding about this conversation. That was the head of HR gracing our Quality Improvement committee with their presence. She was obviously peacocking what she was told to say. The administrator who was supposed to attend the "emergency meeting" was too busy to attend.

You reap what you sow.

[smartnurse1982]

Libby1987 said:

No, I'm in Home Health. I was an RN case mgr in home health not case mgmt, which is a different field. Home Health of course not the same as Private Duty Nursing shift work. I wish posters would use the accurate industry titles as the two fields are as you eluded, very different.

I would never group the degree of difficulty nor the full scope of responsibilities of a home health nurse below that of an acute care nurse. If anything, I would say the BSN should be prioritized for home health versus inpatient bedside for all of the team mgmt required.

You think Rn's should have a Bsn to work repetitive,task focused Private duty Nursing,at a time when our hourly wages are being cut?

Most Private Duty Nurses are actually Lpn's. Out of 8 cases I work,I am the only field Rn for 7 of those cases.

[smartnurse1982]

I agree with you,and as to the underlined,I believe the ADN is sufficient for non-acute care only.

I say this as an ADN nurse.

I really do not know why so many ADN's have a difficult time believing that they are not wanted in acute care. You are not wanted,i know it is harsh. We have to go where we are wanted,and that is non-acute care.

[PearsonBSN]

It is a sad truth, but you are correct. ADNs won't go away, just as LVNs/LPNs didn't go away, but they are scarce in Acute care facilities. The accreditation agencies are raising the bar for entry level for RNs. When it doesn't cost any more to hire a BSN than it does an ADN, then the answer is simple. Physicians have a minimum of 8 years of school, pharmacists have about 6 years, physical therapists have 6-8 years, and none of them spend as much time with patients as nurses do. It would make sense that nurses have a minimum of 4 years to work in a hospital setting.

It it was a great ride. My 2 year degree served me very well. I would estimate that over my 20 year career, I have earned around $1.5million, before taxes. I couldn't believe how good I had it. Times are changing, so I had to change. The nursing profession is like being a shark. If we don't keep learning (swimming) we will drown and get left behind. If we want to maintain our jobs, we must meet THEIR requirements. Most hospitals offer some form of tuition support which is more than fair. It isn't their responsibility to pay for our education needed to keep our job. Physicians cannot practice without their degrees and hospitals don't pay back the doctor's student loans.

It is what it is, either get on board or get left behind.

[Libby1987]

smartnurse1982 said:

You think Rn's should have a Bsn to work repetitive,task focused Private duty Nursing,at a time when our hourly wages are being cut?

Most Private Duty Nurses are actually Lpn's. Out of 8 cases I work,I am the only field Rn for 7 of those cases.

Nope. I was referring to Home Health whereas you are referring to Private Duty.

I recently met with the medical director of a local hospitalists' group, he wants to know when we'll start treating early acute CHF with Lasix IVP in the home. There's very little repetitive task oriented about Home Health anymore, in fact the tasks need to be performed second nature while our primary role is assessing, problem solving and treating acute and acute on chronic patients. In addition to being directly responsible for regulatory compliance, reimbursement and directing care.

[AutumnApple]

I find it is the healthcare facilities and "accrediting agencies" who are flip flopping on the issue, not the nurses.

They send mixed messages, the policies are loosely enforced regarding what positions require and everything is done via word of mouth (through the grape vine).

"Why do they do it this way?" you might ask. It is, as you put it, simple: They want to have their cake and eat it too.

As you said, "When it doesn't cost any more to hire a BSN than it does an ADN............". And they want to keep it that way. You go on to mention how much schooling physicians, pharmacists and physical therapy are required to complete. What you leave out is, the jobs they go into afterwards compensates for all of that.

The gain justifies the strain. With them that is, not so much with us.

Not the case with nursing. Wages, benefits and working conditions are all dropping. Yet they want the bar to raise on what we show up at the door with for the same position. And you see the results of that: The ADN isn't going away.

If I can spend "X" amt getting my degree and receive "Y" benefits........or........spend double "X" amount on schooling but still only receive "Y" benefits..........well, as you said, the choice is simple.

There is a physician shortage right now. Can you imagine if they used the same approach with them as they are us? Pay and treat them the same way they did in the 70's, yet raise the requirements on them. There'd be a new, historically large shortage of physicians if they did. I can assure you the same goes for pharmacists and physical therapists.

So ask yourself this: What makes them believe it's a perfectly fine way of doing things with nurses?

They are looking for Florence Nightingale. They want nothing but altruistically motivated nurses who have no need of a paycheck. I don't think there are enough of them to go around to fill the need for nurses.

[LanaEl]

"There are no advanced clinical skills, no new knowledge significant enough to affect performance at the bedside, and therefore no real justification for an increase in pay."

Really?

There is plenty of empirical evidence showing that BSN nurses provide a higher quality of care, safer care, and even decrease mortality rates. This is the major reason why virtually every hospital in the United States is pushing so hard for BSN nurses on their staff. Not just for ***** and giggles.

[CKPM2RN, ASN, EMT-P]

Oh my god you nailed it! If only we could have a structure that made this much sense.

[GadgetRN71, ASN, RN]

Regarding the clinical component...Nurses in these programs(RN to BSN) are working nurses. That is their clinical.

Now, for those in NP programs etc, obviously they need clinicals and hands on learning other than what they get at their jobs. Even the online NP programs I have seen have clinical aspects of their programs.

I am doing my online RN to BSN at a well regarded state university that also has a long standing brick and mortar program. I am not paying through the nose, and my program is more than "a few months". Actually, I thought this little dig at online education made the article less credible in my eyes. Just because the author went to a for profit school and paid handsomely for it( I know, because I was considering the same one) doesn't mean that the rest of us are in the same boat.

To be honest, I thought this article lacks awareness of the realities that nurses are facing. The BSN is becoming required at most hospitals and in most areas. That's the cold hard fact, and all the pontificating in the world won't change that. Sure, my employer doesn't require the BSN yet, but that could change tomorrow, and what if I want a better paying job? There are plenty of great places to work in Boston that pay very well. Most require the BSN.

I refuse to spend the rest of my career feeling stuck and indebted to my employer. The only people that don't need the BSN in my eyes are those close to retirement. Anyone else is taking a risk not stepping up their game. It's just too competitive out there.

[Ddestiny, BSN, RN]

LanaEl said:

"There are no advanced clinical skills, no new knowledge significant enough to affect performance at the bedside, and therefore no real justification for an increase in pay."

Really?

There is plenty of empirical evidence showing that BSN nurses provide a higher quality of care, safer care, and even decrease mortality rates. This is the major reason why virtually every hospital in the United States is pushing so hard for BSN nurses on their staff. Not just for ***** and giggles.

I've had this statistic sited multiple times as I am earning my BSN (graduating this December) but I still don't understand what makes the difference. Correlation, causation?

I ask because I *don't* see where the advanced knowledge that is actually helping patients, is actually being learned. In my bridge program I have not taken any patho classes, no advanced med/surg, no pharmacology, nothing about actually caring for patients. I've learned about leadership, administration and how to perform research. I guess I can see that being able to digest research is helpful, but again, it requires that someone actually seek it out in practice for it to be helpful. I took a Bioethics class but it was actually a Gen Ed (closest to nursing related I could find to fulfill the requirement).

I think that anyone that is invested in themselves and their career is probably more likely to be a better nurse. If you just want to show up and get a paycheck (and we all know people that are that way) then you aren't going to be proactive in your treatment. I'm getting my BSN because I want to later on go to grad school for my NP. But as I said earlier, if I did not want to go to grad school, I would have dropped out of my program after the first semester because I am not interested in the administrative side of nursing and that is what I'm being taught.

I have no problem with education, even just for education's sake. But I do resent education that is not applicable. I wish that there were separate BSN programs for those that want to work in administration and those that want to continue working with patients.