Is it true that a BSN will be mandatory soon?

teeituptom, BSN, RN · Aug 23, 2007

I'm not. There was a hospital, in Boston, that hired only B.S.N.'s. They found that they had fewer repeat admissions, fewer medication errors and better patient outcomes. That is, until they merged with another Boston hospital, that didn't require a B.S.N. as part of their hiring policy. The influx of AD nurses into their hospital, bought about more medication errors, less patient education and poorer patient outcomes. Deaconess was one of the hospitals. And I have forgotten the name of the other. But I did read a study that proved the benefi9ts of hiring only B.S.N.'s.
Woody:balloons:

Any study in Boston had to be influenced by beans. :lol2:

Multicollinearity, BSN, RN · Aug 23, 2007

I'm not. There was a hospital, in Boston, that hired only B.S.N.'s. They found that they had fewer repeat admissions, fewer medication errors and better patient outcomes. That is, until they merged with another Boston hospital, that didn't require a B.S.N. as part of their hiring policy. The influx of AD nurses into their hospital, bought about more medication errors, less patient education and poorer patient outcomes. Deaconess was one of the hospitals. And I have forgotten the name of the other. But I did read a study that proved the benefi9ts of hiring only B.S.N.'s.
Woody:balloons:

Even if this story is true, I doubt it was ADN vs. BSN. For example, the other hospital could have had trouble with bad moral and as a result retained sub-optimal employees. I suspect it is too simplistic to say it was an ADN vs. BSN issue.

I would first suspect differences in the administration and culture in each hospital rather than how the RNs got their degrees.

ZASHAGALKA, RN · Aug 23, 2007

To quote myself:

https://allnurses.com/forums/f283/true-bsn-will-mandatory-soon-87404-17.html

Any change would require a consensus of all stakeholders.

In reality, there is a balance between education and experience, or, more to the point, experience is an education all its own.

Any such change would require a 'grandfather' clause. Even NY, which came the closest to passing this before it was tabled last year without a vote had a grandfather clause.

The issue isn't requiring current RNs to go back to school. That would never happen. The issue is how will a new requirement affect current RNs down the road. As more and more percentages of new RNs hold BSNs, how does that affect the respect owed to those that hold the legacy of nursing?

As such, a 'grandfather' is not enough to assuage the concerns of current stakeholders. There must also be a guarantee that those stakeholders do not suffer a diminished respect or role as the new requirements take hold.

Given the rhetoric surrounding BSN entry, that is far from assured. And THAT is why a 'grandfather' is not the assurance to those already in the profession that those that wish for BSN entry would like it to be.

The concept of 'grandfathering' is a 'no-brainer' NOW, when 60% of all RNs do not hold BSN - and you need their support. How about 10 yrs after a BSN-entry, when that number falls to 40%? 15 yrs when that number falls to 30%? 20 yrs when that number falls to 15%?

If you are interested in a consensus, you have to not only address the concept of 'grandfathering' at the initiation of such a change, but the concept going forward, as well. The results of that change will serve to make non-BSN RNs the minority over time. How will this issue be perceived THEN, when those that are being asked to give up their majority role become more and more a minority, with every passing year?

Will there come a point later, when those tried and true RNs will be forced to undergo a role change in order to 'close the deal' of BSN standard? With every passing year after a BSN entry is passed, those stakeholders that do NOT hold a BSN will not just become an ever increasing minority, they will also happen to be nursing's most experienced nurses.

Any change in standard also MUST embrace the total concept of RN, and not the 'differentiations' that exist now, such as the concept that only BSNs should be in management. That is such an arbitrary standard, in any case. True, BSN grads might get more training in that regard, but those that vie for management positions normally have years of experience that more than make up the difference. This is an essential concept to moving forward. IF an ever increasing number of BSNs serves to further 'differentiate' the practice of ADNs and diplomas going forward, then no assurance of 'grandfathering' is enough to convince those practicing now that their roles will not be endangered as time goes by.

It was a mistake for TPTB to advocate a differentiation between RNs. It's a throwback to a time when the ANA advocated two distinct roles for ADN/BSN. Time has not kept up with that - all 3 degree paths now establish the same general designation. Indeed, the concept has moved past that: most that advocate BSN entry no longer envision two distinct roles for RNs, but a move for ALL RNs to a BSN standard. As such, 'inter-differentiation' between RNs is a passe concept. More important, while it is a concept that was essential to a move to two distinct roles, it is a concept that holds back a single RN BSN entry. Why? Because it serves to remind current stakeholders why a 'grandfather' is not an adequate safety net to serve against such a change.

If you want to move to a BSN-standard, you must convince current RNs that this move will not only not affect them at the START of such a change, but that it will not affect them throughout their careers.

~faith,

Timothy.

ZASHAGALKA, RN · Aug 23, 2007

I'm not. There was a hospital, in Boston, that hired only B.S.N.'s. They found that they had fewer repeat admissions, fewer medication errors and better patient outcomes. That is, until they merged with another Boston hospital, that didn't require a B.S.N. as part of their hiring policy. The influx of AD nurses into their hospital, bought about more medication errors, less patient education and poorer patient outcomes. Deaconess was one of the hospitals. And I have forgotten the name of the other. But I did read a study that proved the benefi9ts of hiring only B.S.N.'s.
Woody:balloons:

Cite this study, if you can. I don't believe that it is a factual study. In fact, Dana Beth Weinberg wrote an entire book about that merger - Beth Israel/Deaconess, and I don't believe she mentioned this study.

In fact, that book, Code Green, goes into detail to discuss the myriad of changes after that merger that resulted in putting the bottom line over patient care. It would be impossible to take out one link, education of nurses, and hold it out of context to the institutional changes that occurred during that merger.

http://www.nursingadvocacy.org/media/books/code_green.html

"By Weinberg's account, the mixing of these two cultures was not a success. Though the new BIDMC was ostensibly to adopt the primary nursing model, and Beth Israel nursing executives initially dominated the new nursing service, Weinberg shows how BIDMC nurses across the board came to feel that they were struggling to overcome a lack of institutional support, especially human and other resources. Some of this was inevitable. Many Beth Israel nurses did not respect the Deaconess model, which they felt offered less than what patients needed from nurses. Many Deaconess nurses regarded the Beth Israel approach as a wasteful luxury hospitals could no longer afford, and the Beth Israel nurses themselves as "very Nancy Nurse-y," as one Deaconess nurse memorably put it."

"The restructuring and the new "flex staffing" policy effectively increased the patient loads of individual nurses, and made them responsible for more tasks in the hospital as support positions and resources were cut back. At the same time, the formerly powerful Beth Israel Nursing Department was splintered, greatly reducing the profession's institutional status. Increasingly frantic bedside nurses became alienated from nursing administrators, who reacted defensively to concerns for patient safety, which they characterized as a self-serving resistance to change. Weinberg also shows how nursing practice was disrupted by particular problems flowing from the restructuring in specific units, such as coordination problems in the new combined Emergency Department, and turf battles between surgeons from the two original hospitals in the new cardiothoracic unit that led to a decline in nurse-physician collaboration. "

Sounds like more going on there than differences in degrees, yes?

This was also a key weakness in the Aiken Study: trying to isolate 133 independent variables in order to say that education of nurses - AND ONLY EDUCATION - made the difference. Not to mention, the Aiken study never actually studied different staff compositions.

Why the Aiken Study is flawed:

https://allnurses.com/forums/f8/critique-study-more-bsns-equal-better-pt-outcomes-157387.html

If you are interested, another thread on this topic:

https://allnurses.com/forums/f283/change-bsn-requirements-99033.html

~faith,

Timothy.

gizelda196 · Sep 8, 2007

know what I'd like to see in this thread? someone explaining how a state (pick one, it's up to you) will fund this monumental overhaul of nursing education! It's only been mentioned a couple of times that you need an MSN or PhD to teach beyond the ADN level, and in some states, an MSN is required to teach beyond the LPN level. And guess what those instructors make? Not a heck of a lot- especially considering the other areas they can pursue for more cash. University instructor pay is abysmal- I have several friends who teach at the university level, and until you're either published somewhere or tenured, the pay sucks. Meanwhile, an ADN could take a travel job and make a six-figure income. No wonder the equation isn't working!
Oh, and don't forget how many clinical instructors you need. I believe the law in NC was 1 instructor for every 8 students on the floor. Even if you're grandfathering in all the current ADN and Diploma nurses, you still have a HUGE population of people you'd need to divert into BSN programs. Will the clinical instructors need an MSN as well?
Even if the states find the cash to pay all these extra instructors (and future instructors will need $ to pay for grad school- I doubt hospitals are going to foot the bill if the new MSN/PhD is going to teach full-time instead of work solely for the hospital), they'll have to make BSN programs accessible to those considering nursing school who:
- can't currently afford the BSN tuition (that was me)
- have college credits from other programs that are too old to transfer (that was me as well)
- have another Bachelor's degree but don't have access to a 2nd degree accelerated BSN program
- can't afford to spend 4 years in a job with flexible enough hours to allow for the demands of nursing school- because, quite frankly, most of these jobs (i.e. CNA, EMT, etc.) don't pay well enough to keep a roof over one's head for very long (yep, me again!)
So...the states are going to have some cash flow issues. Will they increase taxes? Charge more for university tuition? Build toll roads? Squeeze the already stretched public school system some more?
Am I missing something here? Or is this the reason states haven't pursued this?

EXACTLY!!!!!!!!!!!

anonymurse · Sep 13, 2007

I'm not. There was a hospital, in Boston, that hired only B.S.N.'s. They found that they had fewer repeat admissions, fewer medication errors and better patient outcomes. That is, until they merged with another Boston hospital, that didn't require a B.S.N. as part of their hiring policy. The influx of AD nurses into their hospital, bought about more medication errors, less patient education and poorer patient outcomes. Deaconess was one of the hospitals. And I have forgotten the name of the other. But I did read a study that proved the benefi9ts of hiring only B.S.N.'s.
Woody:balloons:

Basic flaw in the original study that started all this is that they didn't track how many of the BSNs they studied were prior diploma RNs. Now if you could cough up a study that compared the safety of diploma RNs with non-diploma RNs, then I'd be interested, because a nursing educator told me there's a BSN program here that graduates students who have only had 2 pts at once, whereas a diploma school here requires students to handle 4 minimum, more if possible. Now we're talking a difference of 3.5 vs. 4 years, which doesn't say anything to me, or a difference of competency with 2 or 4 pts, which speaks volumes in terms of safety. Just from a personal standpoint, on this basis, if I were on a high-workload floor, I'd rather have a diploma nurse caring for me. I would say another factor of importance is whether a program is attached to a teaching hospital or not. This is a factor that cuts across the artificial BSN/ASN/diploma divide. Those without hospitals are forced to scrape up what they can in systems not used to working with students.

Jerico, BSN, RN · Sep 13, 2007

Well, yes.

Since most people that DO the hiring are likely BSNs these days and "prefer" BSNs then I'd have to advise you to GET a BSN.

It's only one more year and only harder to get into...but worth every struggle.

You CAN do it. We ALL can do it. We all NEED to do it.

Have been at the helm of the male dominated administration. They think it is "Interesting how all us "ladies" (aka nurses) infight and get jealous and can't get their "****" together as a group". They use it to manipulate nursing as a whole, trust me. They do said they did not fear unionizing because women don't care what they earn.

Truly sad. But it is a direct QUOTE from a administration meeting I was in early in my career as an administrator in the 80s. Yes, I was the ONLY female hospital administrator in the room and I was NOT a nurse at the time.

nurseshrek · Sep 21, 2007

I graduated BSN,took the NCLEX RN in California and passed....So im an RN in California now....what do I need to do to have my BSN accredited? OR is my BSN already accredited by passing the NCLEX RN????

70 percent of all RNs are ADNs.
There are simply not enough BSN programs to meet the demand right now, if a law were ever passed to mandate that all nurses possess the BSN degree.

CityKat, BSN, RN · Sep 21, 2007

My professionalism professor back in NY, is on the committee in NY (can't remember the name, sorry) and she said NY state and NJ state are going to require all nurses to have the BSN and I believe there was some grandfathering in along with that.

leslymill · Sep 21, 2007

They asked this question 30 years ago. :lol2:

So I guess my thinking is false.

Then again....

It should be true.

RNsRWe, ASN, RN · Sep 29, 2007

I graduated BSN,took the NCLEX RN in California and passed....So im an RN in California now....what do I need to do to have my BSN accredited? OR is my BSN already accredited by passing the NCLEX RN????

Not sure what you're talking about here.

Your "BSN" is an academic designation. The designation you got after passing the NCLEX-RN is one of licensure. Two different things, which is why you can have three different paths to get to the exact same NCLEX-RN exam. If you graduated from a Diploma school, you hold a Diploma in nursing. If you graduated from an Associates (2-yr) program, you hold an Associates in nursing (or A.S, whatever). And if you graduated from a Bachelors (4-yr) program, you hold a Bachelor's in nursing, simple as that.

The State BON that issued you an RN license doesn't delineate ADN from BSN from Diploma. Doesn't care. RN=RN.

Where it will matter HOW you got to the RN license is when you seek a position that requires a BSN. And in that instance, you have your degree on paper (just like any other Bachelor's degree in any other field) to back you up.

caroladybelle, BSN, RN · Sep 29, 2007

I'm not. There was a hospital, in Boston, that hired only B.S.N.'s. They found that they had fewer repeat admissions, fewer medication errors and better patient outcomes. That is, until they merged with another Boston hospital, that didn't require a B.S.N. as part of their hiring policy. The influx of AD nurses into their hospital, bought about more medication errors, less patient education and poorer patient outcomes. Deaconess was one of the hospitals. And I have forgotten the name of the other. But I did read a study that proved the benefi9ts of hiring only B.S.N.'s.
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I believe that you might want to get your data straight. As this merger was documented in a book, "Code Green", it is easy to see the myriad issues.

The hospitals were Beth Israel and Deaconess. BI had a greater percentage of BSNs than Deaconess, but did hire nonBSNs.

BI had a long history of supporting innovative nursing. The units that I worked on, fostered "true Primary nursing" by RNs, with very little UAP assist. Deaconess was more set with "Team nursing", diluting the nursing with care by UAPs. Deaconess tended to be more of a 7-3 job, with more nurses getting off work on time, while nurses at BI often stayed late dealing with sudden issues in their patients, or patients that were their Primary that they might not have been assigned to that day. The difference went down to the "do you leave the floor at lunch"...at BI they rarely did, but more often did at Deaconess.

One of the reasons that the nurses were that way, is that nurses were allotted more "power" at BI than at Deaconess. Unfortunately it was alos considered "expensive".

The merger come about as there was need to cut costs from both facilities if they were to survive. Mass Gen had formed partnerships with various facilities, and was dominating the area.

A problem...primary nursing is more expensive in personnel than "team" nursing. Two separate nursing managements are more expensive than one. And MDs and MBAs that are used to "running" nursing get ticked when they have to deal with "nurses that run themselves". Many of the nurse leaders that developed the innovative nursing styles fell to "budget" issues or not having the proper "united" mindset.

Did infection/problem rates rise...yes...but which "hospital nurses" caused this? Well, figure that for me to send my crashing immunosuppressed BMT patient for a CT, with the "combined" resources" that save money, I had to leave my other patients, get on an ambulance to transport my pt and I...two blocks down to the only CT open at night in the combined facilities (the buildings are separated by a couple blocks) and then back....while my coworkers cover my patients for an hour or so. Or when my IL2 patient has a massive MI, I have to accompany him to the "other" building via ambulance. The infection rates went up across the board........can I blame that on the "influx" of BSNs...as it would be as valid?

There were clearly many other more major factors at work.

When a patient is two blocks away from their "primary" nurse, and the oncology staff, it is really difficult to have continuity of care by either Medicine or Nursing. Education starts to fall by the wayside, because of distance issues. It is much easier for nurses to educate other department nurses or patients, when one is handing off booklets or papers rather than faxing stuff. Especially for the mountains of paperwork that accompany high dose IL2 and BMTs.

Are BSNs "more" dedicated because they didn't leave for meals or stayed after frequently (PS I do that and I am not a BSN)....or is that maybe not the healthiest way to care for ourselves and patients. I will say that it is not healthy for me and admit that upfront. Should we not be striving for us to...at least most of the time, to take breaks from work, leave on time and not be considered as "not dedicated" enough?

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As far as BSNs increasing the professionalism, with which nurses are viewed....there is another book, better known than "Code Green" that was written about Beth Israel, long before its' merger with Deaconess. It is read by most interns/med students and sets the bar for trashy nurse behavior. It is called "The House of G-d"....and trust me, does not portray nurses in a very professional manner.

Can I blame the Mediao image of nurses portrayed on the BSN preference of BI? It would be as valid.