Is it true that a BSN will be mandatory soon?

Ruffles 1 · May 9, 2008

I don't think there is anything wrong with getting further education, if the pay can keep up with what nurses have to pay to further their education. There are more opportunities for BSN nurses but you will be taking them away from the bedside because the pay is not worth it to stay in the hospital setting thus a nursing shortage at the bedside.

kcochrane · May 11, 2008

My last paper with my initial nursing class for my bridge to RN is on this subject and this thread has been very useful..thanks everyone.

Susan9608 · May 12, 2008

My thoughts about why a BSN is a good thing for nursing are these. Almost every other medical professional, with the exception of RTs, I believe, require that their professionals have at least a bachelors - if not more, to enter into the profession. This has been discussed time and time again.

I think the important distinction here is that with very few exceptions, nurses can and do carry out most of the services other disciples provide. RTs, for example. In some hospitals, or even in some units within hospitals, there are no RTs. Or perhaps, there are only a few, who come in to set up vents or do treatment planning. The nurse is then the one responsible for carrying out all the treatments, from CPT to nebulizers to suctioning, what have you. The same thing with OT/PT/ST - some hospitals, particularly in smaller communities, don't have these services, and rely on the nurses to carry out these functions. And the same with dietitians - nurses are often the ones helping doctors to figure out a patient's caloric needs and do diet planning or diet education.

A nurse is capable of doing most - not all, but most - of these things that these other disciplines do within the context of inpatient treatment. Yet, our educational requirement is significantly lower and often times our pay is significantly lower as well. I know some nurses here have posted that they make well over $100,000 a year, but I don't think that's the norm. I don't want to have to work over time or swing shift or night shift in order to make decent money. I want to work my 3 12-hour shifts (day shifts) a week and make more than $50,000 a year, after taxes. Currently, after taxes and my insurance benefits, I take home about $45,000.

I know that in my particular hospital, the PTs, OTs, STs, and dietitians make significantly more $$ than I and do a lot less work than I do. And I think it's related to education. They all have a standardized education level, so they can demand a higher pay rate. There isn't this argument, "Well, some of you guys only have a 2 year degree and some of you have a masters, so we're only going to pay for the least common denominator."

That's one factor.

I also think that if nurses could all get behind the idea that a BSN would be a good standardized point of entry nursing education, then the course content could be changed to make it seem more "worthwhile" to pursue in terms of clinical hours or expanded, beyond the bedside knowledge. But when nursing is so divided over the issue of whether or not a BSN should even exist, what motivation is there to even improve the existing content at all?

I don't understand why nurses, who have to fight so many other people for so many things, insist on fighting with each other or why they want to hold each other back. Why would anyone look at more education and see it as a bad thing for any profession? I have not yet seen any argument that doesn't come across as just defensive and petulant and petty. Why not put nursing on par with some of these other professions out there? We all know that nurses can - and DO - run circles around them anyways. Why not finally making others realize it as well?

jjjoy, LPN · May 13, 2008

A nurse is capable of doing most - not all, but most - of these things that these other disciplines do within the context of inpatient treatment. Yet, our educational requirement is significantly lower and often times our pay is significantly lower as well.

Interesting point.

I suspect that many resist the idea of requiring a bachelor's degree because they feel that if that had been required of them, that they might not have become nurses at all. And that it would unnecessarily restrict others like themselves from acheiving the goal of becoming an RN. ADN programs have traditionally been much more *do-able* for non-traditional students. And the stepped approach that many have taken (eg LPN-to-RN), has made it possible for many to become RNs who otherwise may not have been able to garner both the resources and academic confidence and requirements to take on a 4-year university degree from scratch.

No, a student doesn't NEED a 4-year university degree in nursing to become a good nurse. But neither does a lwyer NEED a 4-yr-uni degree + 3 yrs law school to be a good lawyer, nor does a teacher NEED a 4-yr-uni degree + teaching credential to be a good teacher, nor does a P.T. NEED a 4-yr-uni degree + 3 yr doctoral degree to be a good P.T., etc. Heck, no one NEEDS a high school diploma to be able to read, write, think critically, start a business, get a good job, succeed in college. For various reasons we draw a line somewhere.

I'm not convinced that BSN should be the entry level for RNs, but the reasoning that you don't NEED a BSN to be a good nurse isn't a good reason against it in my opinion. I've posted thoughts previously on why I don't see BSN as entry to practice as a very practical plan at this point.

Susan9608 · May 13, 2008

And that it would unnecessarily restrict others like themselves from acheiving the goal of becoming an RN.

I suppose that's true. But I think that if it's made mandatory for all nurses to have a BSN as an entry level, perhaps steps can be taken to ease the burden of obtaining a BSN. For example, (and these are just off the top of my head, so I haven't put a tremendous amount of thought into them, so I'm sure there are a million flaws that people will be only too happy to point out), 4-year-universities could absorb the ADN programs nearest them, taking on the instructors, facilities, etc, as satillite schools or something, so that there would be more room for more students. Also, all the funding and scholarships that go to ADN programs could then be applied towards the same students going to BSN programs.

I also don't really understand how it can be that much bigger a burden when people keep claiming that ADN programs really aren't 2 years long, but closer to 3 or even 4 years long ... at least from a time stand point. Of course, there is still the financial consideration. But if having a standardized entry education of a BSN can raise the pay level of RNs significantly, then perhaps the financial considerations of loans and such wouldn't be such a hinderance.

I'm sure PTs and OTs had the same considerations regarding finances when they decided that their students would have to have masters and such in order to practice - more expense and such. Yet they some how managed. If they can do it, why can't nurses?

jjjoy, LPN · May 13, 2008

I'm sure PTs and OTs had the same considerations regarding finances when they decided that their students would have to have masters and such in order to practice - more expense and such. Yet they some how managed. If they can do it, why can't nurses?

I think the history and development of nursing over time makes a difference. Nursing goes way back to the basics... keeping patients warm, fed, and clean. The most basic of nursing care doesn't require a whole lot of education. And nursing was generally seen as an undertaking for women of limited means who had to support themselves before getting married.

Nursing IS often the catch-all field. Jack of all trades and master of none. Versatile and always useful, but not able to demand the same kind of high wages as a specialist. Nursing care includes a lot of maintenance, prevention of problems and responding to changes in status. Things that are hard to measure and hard to measure the impact of compared to other health services.

Different than nursing, PT and OT have generally been rather specialized fields focusing on rehab. By nature they are more outcomes focused than nursing, which makes it easier for the average person to *see* that they are not just maintaining status quo (as nursing is likely to appear to do), but clearly contributing directly to improvement; and the most basic of rehab strategies would likely *appear* to be more skilled than basic nursing care, which many might too easily assume that any well-intentioned person should be able to figure out pretty quickly.

I wonder how much the fact that many nurses were trained by hospitals may have contributed to the difference in the development of these fields. Student nurses lived at the hospital, actually worked on the floors according to their level in school, and had just one day off a week - for church and/or courting. Nurses were almost considered the *property* of hospitals who had to be paid a minimal salary to cover basic costs, as opposed to skilled workers that had to be remunerated for their valuable time and talents. Heck, today, staff nurse wages are still considered more of an "overhead" cost than a "cost for service."

I'd bet there's much more to learn about the different fields to inform this conversation.

"If they could do it, why can't nursing?" is a valid question. There ARE reasons. Otherwise, it wouldn't be question!

hpcat · May 13, 2008

My thoughts about why a BSN is a good thing for nursing are these. Almost every other medical professional, with the exception of RTs, I believe, require that their professionals have at least a bachelors - if not more, to enter into the profession. This has been discussed time and time again.
I think the important distinction here is that with very few exceptions, nurses can and do carry out most of the services other disciples provide. RTs, for example. In some hospitals, or even in some units within hospitals, there are no RTs. Or perhaps, there are only a few, who come in to set up vents or do treatment planning. The nurse is then the one responsible for carrying out all the treatments, from CPT to nebulizers to suctioning, what have you. The same thing with OT/PT/ST - some hospitals, particularly in smaller communities, don't have these services, and rely on the nurses to carry out these functions. And the same with dietitians - nurses are often the ones helping doctors to figure out a patient's caloric needs and do diet planning or diet education.
A nurse is capable of doing most - not all, but most - of these things that these other disciplines do within the context of inpatient treatment. Yet, our educational requirement is significantly lower and often times our pay is significantly lower as well. I know some nurses here have posted that they make well over $100,000 a year, but I don't think that's the norm. I don't want to have to work over time or swing shift or night shift in order to make decent money. I want to work my 3 12-hour shifts (day shifts) a week and make more than $50,000 a year, after taxes. Currently, after taxes and my insurance benefits, I take home about $45,000.
I know that in my particular hospital, the PTs, OTs, STs, and dietitians make significantly more $$ than I and do a lot less work than I do. And I think it's related to education. They all have a standardized education level, so they can demand a higher pay rate. There isn't this argument, "Well, some of you guys only have a 2 year degree and some of you have a masters, so we're only going to pay for the least common denominator."
That's one factor.
I also think that if nurses could all get behind the idea that a BSN would be a good standardized point of entry nursing education, then the course content could be changed to make it seem more "worthwhile" to pursue in terms of clinical hours or expanded, beyond the bedside knowledge. But when nursing is so divided over the issue of whether or not a BSN should even exist, what motivation is there to even improve the existing content at all?
I don't understand why nurses, who have to fight so many other people for so many things, insist on fighting with each other or why they want to hold each other back. Why would anyone look at more education and see it as a bad thing for any profession? I have not yet seen any argument that doesn't come across as just defensive and petulant and petty. Why not put nursing on par with some of these other professions out there? We all know that nurses can - and DO - run circles around them anyways. Why not finally making others realize it as well?

I doubt any hospital can afford to pay nurses what they pay OTs, PTs and RTs, regardless of what those nurses do. Let's face it, they need a LOT more nurses than these three disciplines combined. As it is, most healthcare agencies will do anything they can to save money on staffing, from shortstaffing to hiring part timers so they don't have to pay benefits to using CNAs and LPNs to fill in where an RN is really more appropriate.

I think if anything is going to start a fight, it's whether a recent BSN or MSN gets paid more in a hospital than an ADN with certification and/or years of experience. Do you discount someone's experience and expertise because they didn't go for 2 more years of school? How do you figure out that pay scale? How about a diploma nurse - are they less valuable?

Once again, I'm always in favor of more education because I'm a brainiac, but education shouldn't be a tool for barring or discriminating qualified people from entering or advancing the field. An ADN at the top of her class can be more capable than a BSN at the bottom of her class. A diploma grad with years of experience makes me feel more confident than an MSN new grad who's never actually worked in the field.

A good way to encourage furthering education is incentives. But is any nursing union going to push for more benefits/pay for BSNs or MSNs? That's my question.

Ruffles 1 · May 13, 2008

I think as nurses we do as much or more than we are required to do, we are always multi-tasking. We have to be a RT, OT, PT etc. I don't think a nurses job description is very defined.

RNGrad2006 · May 13, 2008

"An ADN at the top of her class can be more capable than a BSN at the bottom of her class. A diploma grad with years of experience makes me feel more confident than an MSN new grad who's never actually worked in the field".

This is true and that is why an ADN at the top of their class is paid a LOT more than a BSN at the bottom of their class. But being still a relatively new nurse (2 years in) BSN's and ADN's are paid the same at my hospital unless you go through the process of a career ladder. Only then do you get extra pay. I went through the hard work of the application since taking classes towards a BSN qualifiies as one measure on the career ladder. I am also actively involved on a hospital committee which is another measure amongst a few others but was still declined on my application. So the fact I am getting a BSN sometime next year is not exactly paying off in extra pay but I am getting a lot more for it personally. I am learning a lot through my program and I believe the fact that I am taking the vast majority (12 of 15) classes as nursing classes they are practical and useful and do make me think. I think it will improve the nurse I will become down the road because I am taking the classes and can apply them to my clinical practice. And yes, I agree those of us who are laddering by taking LPN first and then RN and then BSN are taking WAY more classes but I think I have learned different things through each step along the way. I had always intended to end up where I am going at this time but my motivation for the ladder approach was partly due to faster entry into nursing school, less expensive, and allowed me to work along the way gaining valuable experiences I otherwise would not have received. I think it is different for everyone but I do see the value in furthering education. It is not just a bunch of fluff. It is a lot of hard work that I believe should be rewarded and does contribute to professionalism. Does that mean I believe that ADN nurses are unprofessional...absoulutely not... but until you have gone through the process it is very difficult to state there is no value in getting a BSN. In Canada they have made it mandatory as entry level to practice in most provinces by not having any schools available to teach ADN level programs any longer (since 2003 in British Columbia) and it does create its own problems with less spots for students, more severe nursing shortage etc... This is not black and white just as nursing is not black and white. But certainly a hot topic that will ever be completely agreed upon. There is certainly value to be seen in each point of view.

PMHNP10 · May 13, 2008

There will never be an agreement on this topic, so let me try an angle possibly not mentioned:

ADN should be the entry level and that's it (i.e., BSNs don't graduate and start working on the floor

After a given amount of experience, nurses can decide to work towards the BSN program (or not) by entering a 1 year RN-BSN program.

Upon graduation, the BSN can stay at the bedside or venture into other areas if so chosen

this plan obviously makes entry into nursing at 1 level, eliminates the resentment between the 2 current entry levels, and most importantly, ends this neverending debate

hpcat · May 13, 2008

There will never be an agreement on this topic, so let me try an angle possibly not mentioned:
ADN should be the entry level and that's it (i.e., BSNs don't graduate and start working on the floor
After a given amount of experience, nurses can decide to work towards the BSN program (or not) by entering a 1 year RN-BSN program.
Upon graduation, the BSN can stay at the bedside or venture into other areas if so chosen
this plan obviously makes entry into nursing at 1 level, eliminates the resentment between the 2 current entry levels, and most importantly, ends this neverending debate

I like this idea. :yeah:

hpcat · May 13, 2008

"This is true and that is why an ADN at the top of their class is paid a LOT more than a BSN at the bottom of their class."

Unfortunately, not in NY. Everybody gets close to the same pay for the same job regardless of education. Unless you count 50 cents more an hour as better pay. In NY, no, it ain't.