Is the RN--->BSN push a clever way to get older nurses out of the way

jadelpn, LPN, EMT-B · Apr 19, 2014

Is there a recent study or data that supports this? It's not my area of expertise, but it flies in the face of everything that I recall from education and practice. In fact, I try my hardest to keep my patients out of the hospital, and when they are admitted, I do my best to get them out of the hospital as quickly as safely possible.
I do agree the increasing the education level of the nursing workforce plays an important role in this paradigm shift in in-patient length of stay.
I have always considered this study one of the landmark studies on the topic:
Kaboli, P. J., Go, J. T., Hockenberry, J., Glasgow, J. M., Johnson, S. R., Rosenthal, G. E., ... & Vaughan-Sarrazin, M. (2012). Associations between reduced hospital length of stay and 30-day readmission rate and mortality: 14-year experience in 129 Veterans Affairs hospitals. Annals of internal medicine,157(12), 837-845.

"For all medical diagnoses combined, risk-adjusted mean hospital LOS decreased by 1.46 days from 5.44 to 3.98 days, or 2% annually (P

Coming straight outta acute care, I will tell you that there are a number of days associated with different diagnosis. Period. That is supported by whatever insurance they have or have not.

So if your patient is not at the fuctional level they could be, please be sure that they can get up and walk to the bathroom and/or out the door, otherwise, you HAVE to plan an alternate level of care by that last day.

Or the facility doesn't get paid.

Now a more seasoned nurse would say that perhaps the patient needs a bit more PT to be able to go home and live as opposed to exist in a recliner or their bed. That in order to take control of their diabetes, they really need to see the dietician again. B

ut they were admitted s/p pneumonia, therefore, in 2 days they are so outta here!

A seasoned nurse would say "hey, wait a minute, pneumonia is secondary to the fact that our patient is eating and drinking lying in bed, they will not get out of the bed, they have a fear of falling, and they have little control of their blood sugar".

A manager with no bedside experience would state "not our problem, stick to the original diagnosis" and a less seasoned nurse would be "you got it" and document to "patient has had 3 doses of IV abx, labs WNL, will discuss with MD discharge" or some other checkbox thing.

Where a more classic bedside nurse would say to MD "can I get a PT/OT and dietary consult? And perhaps social work, as patient is not getting out of bed at home".

A classic bedside nurse would say "waittttt a minute, we have other issues here" and a non-classic bedside nurse would say "we are to deal with the diagnosis, and that's it".

Insurance companies do not pay facilities for nurses to elaborate. If you elaborate, it makes the DON and manager not so happy.

So we all need to apparently stop making stuff up.

nurseprnRN, BSN, RN · Apr 19, 2014

You forgot "and I walked 20 miles to school, in the snow, uphill, both ways".

Nah, I hitchhiked to classes from my apartment in the next town. :) But I did have to walk about 3/4 of a mile from the approved parking area under the freeway to one of my clinical placements. In winter. In snow and ice. :)

nurseprnRN, BSN, RN · Apr 19, 2014

In our area all the ADN programs require one semester of chem, two semesters of combined A&P with lab, one semester of micro with lab, one semester each for English, sociology, and psychology.
So YOUR program required all those classes (you don't say they are required but I am assuming). Other program do not. A BSN behind a nurse's name doesn't give you much of an indication whether they took all those classes or not. I also haven't seen any data that shows patient outcomes are or would be better depending on whether those classes were taken or not.
Apparently, from the data I have seen, it is only the letters "BSN" that seem to matter.

To a point, I agree with you; I think it behooves anyone to look behind the letters and see what it took to get them. I have had occasion to recommend that an attorney client look very carefully at an opposing "nursing expert" whose many-decades-old diploma was followed by degrees in management and a "doctorate" granted in 9 months by a "school" that was shut down for fraud a few months after that "degree" was paid for, ahem, awarded. He was shocked to hear that such academic dishonesty was possible (and that "PhD" and the honorific "Doctor Soandso" is still on that person's website and marketing materials)-- oh yes, it is, and you need go no further than the "academic research" section on AN to see many examples.

So I'll see your deficient BSN and I'll raise you the "MSN" that you can get sitting online with a "capstone" of a SurveyMonkey. Like many of us, I did a real MN with daily live classes and face-to-face contact with colleagues, researchers, clinicians, and other experts, and a real thesis using real live people in real critical care beds as subjects, critiqued (hard) by real nationally-ranked experts in nursing and physiology. Like most of us, I have always resented the hell out of the assumption that a nurse is a nurse is a nurse, and now I resent the hell out of the assumption that an MSN is an MSN is an MSN, too. This is why I want to know what real education stands behind those programs, and why I recommend that people realize that you don't always "get what you pay for" in "education," since many bad programs cost a bundle of money but the degree may well not be worth the paper it's printed on.

nurseprnRN, BSN, RN · Apr 19, 2014

But when it comes down to it, it would appear it's not the better outcomes they're really focused on, it is more about what you call it, it's degree snobbery at it's most basic.

Precisely wrong; it is precisely the outcomes these studies focus on. Show us where you think they don't do that.

allnurses Guide · Apr 19, 2014

Coming straight outta acute care, I will tell you that there are a number of days associated with different diagnosis. Period. That is supported by whatever insurance they have or have not.
So if your patient is not at the fuctional level they could be, please be sure that they can get up and walk to the bathroom and/or out the door, otherwise, you HAVE to plan an alternate level of care by that last day.
Or the facility doesn't get paid.
Now a more seasoned nurse would say that perhaps the patient needs a bit more PT to be able to go home and live as opposed to exist in a recliner or their bed. That in order to take control of their diabetes, they really need to see the dietician again. B
ut they were admitted s/p pneumonia, therefore, in 2 days they are so outta here!
A seasoned nurse would say "hey, wait a minute, pneumonia is secondary to the fact that our patient is eating and drinking lying in bed, they will not get out of the bed, they have a fear of falling, and they have little control of their blood sugar".
A manager with no bedside experience would state "not our problem, stick to the original diagnosis" and a less seasoned nurse would be "you got it" and document to "patient has had 3 doses of IV abx, labs WNL, will discuss with MD discharge" or some other checkbox thing.
Where a more classic bedside nurse would say to MD "can I get a PT/OT and dietary consult? And perhaps social work, as patient is not getting out of bed at home".
A classic bedside nurse would say "waittttt a minute, we have other issues here" and a non-classic bedside nurse would say "we are to deal with the diagnosis, and that's it".
Insurance companies do not pay facilities for nurses to elaborate. If you elaborate, it makes the DON and manager not so happy.
So we all need to apparently stop making stuff up.

I disagree on a number of points from an in-patient provider perspective but it's far to off topic to debate here as this is a healthcare systems issue not a nursing education issue.

Your contention is that nursing shouldn't move toward increased education because BSN nurses are more likely than ADN nurses to push patients out of the hospital faster which results in worse outcomes and re-admissions? I don't think there is any data to support this at all...

Much of your argument seemed to be based on experienced vs inexperienced rather than education level. Actually I would make the opposite point that you did: education can help experienced nurses learn to function in a modern healthcare system. Or become more involved in research or policy to make changes and help sculpt the modern healthcare system.

MunoRN, RN · Apr 19, 2014

Precisely wrong; it is precisely the outcomes these studies focus on. Show us where you think they don't do that.

By "they" in that statement I wasn't referring to the studies.

The studies suggest better outcomes in patients cared for by BSN graduates. Of course, that doesn't mean that just calling a nurse "BSN" will produce better outcomes, it means that there are characteristics of BSN education that have the potential to result in better outcomes.

So if your goal is to produce better outcomes, what we need is to provide the program characteristics that produce better outcomes to all nurses, it makes no difference what you call them. If it's not better outcomes that you're looking for, but rather a status symbol, then you're clearly more interested in that than patient outcomes.

jadelpn, LPN, EMT-B · Apr 20, 2014

I disagree on a number of points from an in-patient provider perspective but it's far to off topic to debate here as this is a healthcare systems issue not a nursing education issue.
Your contention is that nursing shouldn't move toward increased education because BSN nurses are more likely than ADN nurses to push patients out of the hospital faster which results in worse outcomes and re-admissions? I don't think there is any data to support this at all...
Much of your argument seemed to be based on experienced vs inexperienced rather than education level. Actually I would make the opposite point that you did: education can help experienced nurses learn to function in a modern healthcare system. Or become more involved in research or policy to make changes and help sculpt the modern healthcare system.

My point is that in most current BSN programs, an RN who is an ADN or a diploma nurse gets said BSN with a LOT of elaborate paper writing. A fresh BSN can then go onto a masters, and have little bedside experience other than clinicals. In a education based degree as opposed to a clinically based degree, nurses at bedside will follow the protocols of the facility due to sheer inexperience. Add a master's prepared manager and it is all about the business as opposed to all about the patient.

BSN's Masters...they all have their place. But in the most current climate of money, money, money and little on a patient's well being we are being led by more and more people who have very little experience.

If we woke up tomorrow and unless we could "cure" a patient of all their ills or else lose our jobs to NP only models, or every patient could be billed a million dollars for a multi-disciplinary approach to nursing, the entire culture would change, and the managers would be clamoring for nurses who actually had a ton of experience taking care of patients, instead of taking care of business.

I think that if I wanted to go into marketing, public relations, or acting I would have. I would like to think that there's at least one nurse who goes into nursing to, well, be a nurse.

PMFB-RN, RN · Apr 20, 2014

So I'll see your deficient BSN and I'll raise you the "MSN" that you can get sitting online with a "capstone" of a SurveyMonkey. Like many of us, I did a real MN with daily live classes and face-to-face contact with colleagues, researchers, clinicians, and other experts, and a real thesis using real live people in real critical care beds as subjects, critiqued (hard) by real nationally-ranked experts in nursing and physiology. Like most of us, I have always resented the hell out of the assumption that a nurse is a nurse is a nurse, and now I resent the hell out of the assumption that an MSN is an MSN is an MSN, too.

Think about what a good deal those SurveyMonkey MSN programs are for the people who take them. They get the same credential you, and others who attended rigorous programs do, and the assumption the education is similar.

As new grad RN my first job was in a 9 month critical care nurse residency for new grads going into specialty areas. It was rigorous and high stakes. Quite a few didn't have what it takes and were invited to work in lower acuity areas.

Mostly it went by body systems. An APN or PA or physician would come and lecture about the A&P and patho of the body system. We would then head to the library and do related literature reviews and present them to the class. Then physicians would come and lecture about the types of patients and procedures we would see. Usually we would then go the OR and observe surgeries and procedures. Then for a couple weeks we would be detailed to a preceptor who was not only highly experienced, but who had volunteered to precept and had received preceptor training. They got paid premium pay to precept. Every day we would take those patients with our preceptor. After that there would be a test and failure was failure. Your test scores where considered with the comments and rating of your preceptor before we were allowed to continue on in the residency.

At the same time we took turn carrying the code, trauma and RRT pagers as residents. We also spent time on med-surg learning time management and prioritization, and in the ER and other units. We spend several nigh shifts shadowing the hospitalist. By the time the residency was over all of us had taken part in 4-8 codes, many more trauma activations and RRTs.

For those who managed to graduate from the residency and be offered jobs in SICU, MICU, PICU, ER, PACU, NICU or L&D we were assigned a mentor and scheduled to work the same shift as our mentor for the first year after the residency before we were considered competent, independent nurses on our units. After that we were required to cross train to another unit or two.

Despite going though such a program I have been told simply because I didn't wish to go on for my BSN (I have since) I didn't care about furthering my nursing education. In my view those who have not completed a similar program are the ones who are lacking in nursing education.

martymoose, BSN, RN · Apr 20, 2014

ok going back to the discussion about ap physics, chemistry, anthropology, etc. I failed to realize that these were taken in HIGH SCHOOL. As part of a regular curriculum, not specific to nursing.

Do you want to know why I didn't make that connection? Because I took those classes over 30 years ago!!

So, most people who are ADN,Diploma, etc. are being told they need BSN for "better pt outcomes".

Hmm, what age group does that put most of us in who are ADNS, etc. Yep, the older adult group.

Of course the BSN thing is a great push for getting older adults out. I imagine the hospitals are banking on it. I'm sure ( anecdotally so, no study that I'm aware of done) that a certain percentage of older/second career ADNs will be out of jobs because 1) no return on the investment , and 2) who wants to go back to school AGAIN after age 40 or so.

Ageism- bank on it.

allnurses Guide · Apr 20, 2014

ok going back to the discussion about ap physics, chemistry, anthropology, etc. I failed to realize that these were taken in HIGH SCHOOL. As part of a regular curriculum, not specific to nursing.
Do you want to know why I didn't make that connection? Because I took those classes over 30 years ago!!
So, most people who are ADN,Diploma, etc. are being told they need BSN for "better pt outcomes".
Hmm, what age group does that put most of us in who are ADNS, etc. Yep, the older adult group.
Of course the BSN thing is a great push for getting older adults out. I imagine the hospitals are banking on it. I'm sure ( anecdotally so, no study that I'm aware of done) that a certain percentage of older/second career ADNs will be out of jobs because 1) no return on the investment , and 2) who wants to go back to school AGAIN after age 40 or so.
Ageism- bank on it.

Do you think it's more about ageism or more about bringing in lower tier pay nurses to replace the nurses maxed out at the top?

And the last data I saw showed a pretty similar median ages between BSNs and ADNs.

martymoose, BSN, RN · Apr 20, 2014

Do you think it's more about ageism or more about bringing in lower tier pay nurses to replace the nurses maxed out at the top?
And the last data I saw showed a pretty similar median ages between BSNs and ADNs.

Anecdotal, but the BSN's with 2 years experience make the same as someone with 10 years experience where I am, so I am not so much on board with it being about pay.

Funny, none of the new nurses are particularly unattractive or gray haired. Even the guys. I still think it's for public perception.( not the ONLY reason, but a reason)

cinlou, BSN, MSN, RN · Apr 20, 2014

"Of course the BSN thing is a great push for getting older adults out. I imagine the hospitals are banking on it. I'm sure ( anecdotally so, no study that I'm aware of done) that a certain percentage of older/second career ADNs will be out of jobs because 1) no return on the investment , and 2) who wants to go back to school AGAIN after age 40 or so."

I went back for my BSN and MSN Ed after 33 years, I may die before I pay off my loans. But I knew staying at the bedside was getting to be physically difficult. I knew I would not be able to retire early, with my husbands health. So I thought education was the way to go so I could offer what I have learned over the years to new nurses. I want to graduate those I would want to care for me when I need it. Did I learn new technical skills? No. I learned teaching skills. And I fuse my years of experience into those. I have to keep up to date with all the changes in health care to be sure the students are getting up to date material. But I also know the longer I am in education that my other skills I have honed over the years will get weak if I don't use them.