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.

[nurseyblues, BSN, RN]

llg said:

I would limit the ADN role to the entry level roles -- not including charge functions, precepting, unit-level leadership, staff development, etc. Those types of things would be BSN level functions.

Specialty certification exams would be offered at 3 levels -- the ADN, BSN, and graduate levels. That way, all nurses would have a way to show that they had specialized knowledge in their focus area -- appropriate for their level of education.

Thank you for your comments, and I completely agree with this. ADNs would be your entry-level, bedside nurses. I think ADNs who had returned after gaining 1 full year of experience to earn a certificate could be considered for charge roles and as preceptors for new grads, but I too feel that BSNs should be your Staff Development and other non-clinical, lower leadership roles.

The reason I feel that some RN experience prior to BSN enrollment is important is based solely on my own experience with some of what I saw in my own BSN program, as well as what I've seen graduate from BSN programs: nurses without absolutely minimal actual nurse experience strutting around waving their BSN and calling themselves "advanced" nurses when they cannot perform the bare basics of patient care. I think that does a disservice not only to the patients and the other nurses who work with these people, but a our profession as a whole as it sometimes hurts our credibility. I've met a lot of BSNs that I would not want anywhere near me if I was hospitalized, and just as many seasoned RNs without that extra degree that I would trust with my life.

Thanks again for your input; I enjoyed reading your post. ?

[HurtRN]

What school did you attend?

[nurseyblues, BSN, RN]

Natalie513 said:

oh also, most of us trying to get our BSN only want to be bedside nurses working 3 12s or 4 8s. But around here you have to have a BSN for those jobs.

Thank you for your comments. I think that's another problem we're running into in our profession: the lack of consistency. In my area, only bedside RNs work 3-12s or 4-10s. If you advance or take on any "higher" role, they're almost all Monday-Friday, 8-4 or 9-5. That was the biggest grumble our nurses had after they were basically forced to get their BSN; if they stayed at the bedside there was no more money, but if they left the bedside they had to work more days--and then still only made a little more (or less, since many lost shift differential/holiday pay/overtime since almost all the non-clinical positions are also salaried and not hourly.)

[nurseyblues, BSN, RN]

Caroline123 said:

I think that some of these online programs are nothing more than a "racket". The amount of money charged is a rip off! Designed to make money knowing that many facilities are moving to hire BSN only

Yes, ma'am. I agree, speaking as one who is still paying for mine with not a penny more in salary. This issue is actually making national news right now, how profit schools are price-gouging because they know that employers are demanding higher and higher levels of education from their employees.

[subee, MSN, CRNA]

nurseyblues said:

I completely agree with Mom of 4 that we as a profession need consistency in our education and how we enter various points of the market. I respectfully disagree that the BSN should be the minimal starting point for all bedside nurses. I feel that requiring a 4-year degree just to get started may discourage some who are in need of stable employment now, and in my experience the BSN curriculum offers a lot of leadership and academic content that is more beneficial to roles away from direct patient care. Requiring the BSN just to get started would also devalue all the degree above the BSN. As another poster stated, the BSN is becoming the new MSN—which means that the MSN is the new BSN, and the PhD becomes the new MSN. Every higher degree becomes a step down from what it was. In that situation, when a PhD becomes equivalent to a Master's degree, where do you go from there? There is no higher degree to pursue, and pay will not keep pace with the education since the job itself is not changing—only the credentials are.

If I could set up my idea of consistent and practical nurse education, it would be structured something like this:

ADN: Entry point for bedside nursing.

These nurses are the bulk of the nursing workforce should come into the market as skilled clinicians ready to provide care to actual human beings. ADN programs would consist of the necessary basics like college math, A&P, and ethics, then the remainder of the curriculum would focus on intensive clinical training and practical exams. Making ADN the entry point ensures that every nurse has the credibility that comes with having an actual degree from an accredited school, and prevents the market from having to wait 4 years for new talent to enter the field.

Specialty Certificates:

I would like to see ADN schools also offer specialty certification programs for ADNs with at least 1 year of work experience. These programs would be short, clinical intensives in areas such as wound care, diabetes, telemetry, etc. and would require that the student pass a standardized certification exam. This would give new nurses a chance to advance their bedside practice, earn a bit more than the new ADN grads coming into the field, and act as mentors in the clinical setting. There would also be significant benefits to the patients and facilities as a result of having highly skilled, specially trained clinicians working on the patient care units.

BSN: Entry level administrative/non-clinical positions. These would be the nurse unit managers, case workers, clinical coordinators, etc. BSN programs already focus on leadership and business, with minimal additional clinical training, so this degree is a good starting point for those wanting to branch away from the bedside. I would like to see BSN programs require 3 years of ADN experience prior to enrollment, with at least 1 full year being in an acute/inpatient setting.

MSN: The doorway to middle/upper management and administrative roles.

These would be the DON's, the nursing instructors for all the ADN/BSN programs, the nurse consultants, those who perform work in clinical trials/research, etc. This degree would require 3 years of actual nurse experience, with at least 2 in an inpatient setting. I believe that to lead others, a nurse needs to be at least as proficient, and preferably more, than those being led.

DNP: The standard for Advanced Practice Nursing.

Nurses working as Nurse Practitioners, Nurse Anesthetists, Nurse Midwives, and Clinical Nurse Specialists would hold this degree. DNP programs would again consist of intensive clinicals as well as the leadership and business curriculum that independent practitioners need to work safely and legally. These specialties function similarly to doctors, and should therefore also hold a doctorate degree for consistency, credibility, and national marketability. A minimum of 5 years actual nursing experience would be required, with at least 2 in the area of specialization (for instance, midwife students would spend at least 1 year in Labor & Delivery, etc.).

PhD: The upper echelon of nurse academics and leadership.

These would be the Chief Nurse Executives, Legal Nurses, Nursing Professors for MSN/DNP programs, and senior nurse researchers. These are the nurse theorists and scholars who write the textbooks, and the nurses who lobby for the profession in political arenas. An MSN with a strong GPA and solid work history would be required for enrollment in this highest-level program.

A structure like this would not only ensure consistency and lend credibility to each role, it would also justify a pay scale that reflects the amount of education and clinical experience for each tier. It would be easier to demand higher pay as a BSN, MSN, etc. if you were actually doing a different job that required different education and experience.

Why are you assuming that more education reflects a desire to move in management?

There are plenty of other positions in nursing that require the perspective the BSN requires. The problem is that there are so many proprietary programs offering such a lousy education to RN's going onto BSN. The degree becomes increasingly cheap and meaningless in the case if these "add on" BSN programs. I can't believe the previous post from someone claiming to be a WORST nurse because of continuing education. Please explain how that happens.

[Libby1987]

nurseyblues said:

Thank you for your comments, and I completely agree with this. ADNs would be your entry-level, bedside nurses. I think ADNs who had returned after gaining 1 full year of experience to earn a certificate could be considered for charge roles and as preceptors for new grads, but I too feel that BSNs should be your Staff Development and other non-clinical, lower leadership roles.

The reason I feel that some RN experience prior to BSN enrollment is important is based solely on my own experience with some of what I saw in my own BSN program, as well as what I've seen graduate from BSN programs: nurses without absolutely minimal actual nurse experience strutting around waving their BSN and calling themselves "advanced" nurses when they cannot perform the bare basics of patient care. I think that does a disservice not only to the patients and the other nurses who work with these people, but a our profession as a whole as it sometimes hurts our credibility. I've met a lot of BSNs that I would not want anywhere near me if I was hospitalized, and just as many seasoned RNs without that extra degree that I would trust with my life.

Thanks again for your input; I enjoyed reading your post. ?

Ouch. I was a BSN prepared nurse straight from HS and out of a brick and mortar State U. I was certainly able to perform the bare basics.

[moldyoldyrn]

I think that the benefit to the BSN in part is dictated by the system you work in. If you are in a University hospital, Federal Service, Military Nursing, Oh YES it helps. While most nurses in those settings decide to go on to clinical specialization, a Masters, become a Practitioner, or go into some special field such as GI Procedures, Cath lab, the BSN is sort of recognized as the starting point. I have worked with RNs of all stripes and there are ADN grads much better prepared than some BSNs it really does not matter however when they come up against a pay scale that dictates that the BSN grad gets the higher salary. I had a college degree and when I wanted to attend Nursing School I was told to only consider BSN program and that advice came from a well known and respected Diploma program. Yes it was many years ago but the fact that some programs are linking with local colleges to train nurses with the aim of them getting the BSN says to me that there is a new wave coming. I do understand that because of limited funds some folks have to start at ADN and work their way up. There is no shame in that. It is a starting point. Maybe we should all look at every level as a starting point to the next level. I still believe that a good BSN program gives one the full gamut of what the nurse should strive for. There are some programs that may not be as good as others but then that can be said about many different scholastic programs. I was never sorry I got my BSN and while I was treated badly initially by a select few diploma grads, I got my act together, realized that despite my BSN the key to every aspect of nursing is reading the latest literature, studies and putting yourself out there to learn and keep learning about procedures, technique, communication, evidence, standards of practice, etc., etc., etc.. Sometimes admitting I did not know how to do something came in real handy. I always had a book in my hand and a copy of AJN and I have been that way even after I retired. I did not stop, I got a masters but realized quickly that I wanted to be in direct care because 1-that is why I went into nursing 2- I was really good at it. I was a clinical instructor for a long time and loved it but again, I was with the patient and doing direct care. There were many snobby RNs who thought because they were in management they were better than those of us who worked with patients. I felt sorry for them because I always had that affirmation from the patient and/or family that said I'd helped them. I always felt the best giving a bath or shower(med cart be damned)to someone who had not had one in awhile or who was terminal and had the simple need to feel clean. It is the best part of the profession. When we look down the road as to where the greatest need will be it will not be in the office, it will be at the bedside. The job does not have to be boring or lackluster, it can be the most exciting thing you have ever done, that is up to the individual. It is what you make it. I have told many new nurses to work in every specialty until you can decide where you fit and what you want to do. Do Medicine, Surgery, Peds, L&D, Clinics, Public Health, Cardiac, Renal, Neuro, Trauma, do ICU level of care, step down, basic. All of that experience will round you out nicely and it will certainly never be wasted. No one has ever complained to me about that advice. To me Nursing as a profession was the trip of a life time and a train I never wanted to get off. I started in the early 1970s, surely it is more enticing and exciting now irrespective of one's level of education. There is place for all of us.

[nurseyblues, BSN, RN]

Libby1987 said:

With the level of responsibility required to perform well, I respectively 100% disagree that entry level degree should remotely be decided on providing stable employment to those needing it now.

Thank you for your comment. I suppose I should clarify: some of the best nurses I've ever worked with were those with less than a bachelor's degree. They were skilled, talented clinicians who worked hard and learned fast from their hands-on experience. I'm not suggesting that we "dumb down" entry-level nursing so that people who need to find a job fast can just enter nursing. Not at all--I'm actually suggesting that we require more: an actual 2-year degree from a nationally accredited, clinically intense program. That way we have skilled nurses entering the workforce every two years, and don't miss out on people who would be outstanding nurses but just can't commit to four years of school right now because they have financial needs. It's much easier to pay your way through BSN school on working RN salary than on a waitress salary. That's all I'm saying. Let those talented people earn their ADN and get to work, then proceed to higher education if they choose after they have some real-world experience to draw from.

[johsonmichelle]

I think it depends on the job market, I'm a new nurse with an ADN and most places prefer a bsn. The places that are more desirable are more strict on nurses having a bsn.

[Caroline123]

Yes, one school I went to I'm not saying who but it starts with a C charges 750$ per class yup no typo here!!!

whats even worse are those schools on television charging people 45k to 60k to become a LVN. It should be against the law!!!

Another example of the way the people with the least are insured of remaining that way??

i guess that's what is called free enterprise! It's really shameful

[Caroline123]

Oh and by the way, they don't even give those poor folks pre requisites to become RN's

[nurseyblues, BSN, RN]

Libby1987 said:

Ouch. I was a BSN prepared nurse straight from HS and out of a brick and mortar State U. I was certainly able to perform the bare basics.

Please don't take offense. Mind you that I said "some of what I've seen." To a degree, education is what you make of it, and you get out what you put in. I am not implying by any means that anyone who gets their BSN first is a bad nurse or can't perform patient care. Again, my article and my comments here refer mostly to working RNs returning to school, and also refers mostly to the online programs that are available now for working RNs.

Naturally, if you went BSN straight out of HS, then your program was also your RN program and would include all the required RN clinical portions. I am referring to those who are already nurses--diploma or ADN--who go back for a BSN right away through an online program or other RN-BSN program. I am not referring to HS to BSN, only RN to BSN. These programs, because they are for those who already have an RN, do not offer additional clinical experiences, which means that if an RN with minimal clinical skill goes in, a BSN with minimal clinical skill comes out.

There are inevitable problems when that nurse then tries to assume a role of leadership over nurses with strong clinical backgrounds and years of experience.

Again, I should have been very clear that my article and subsequent remarks are referring to RN-BSN education. I am talking about working bedside nurses who return to school to obtain only the BSN portion of their degree, which is almost always non-clinical since the student is already a practicing nurse.