NY State may require nurses to obtain 4-year degrees

[Brian]

But some worry that an already severe shortage will become worse.

New York is mulling over a requirement that would force all RNs to earn a bachelor's degree in order to keep their RN certification-a step that critics worry could serve as a body blow to a profession already facing a severe shortage.

Under the state Board of Nursing proposal, RNs with associate's degrees would have to earn bachelor's degrees within 10 years, or their RN certifications would be downgraded to that of licensed practical nurse. That would make nursing somewhat like teaching in New York state; certified K-12 teachers need master's degrees or must obtain one within three years of starting a job. It would also add years and thousands of dollars to the difficulty of becoming an RN...

Full Article: http://www.rochesterdandc.com/news/0413BA3TIOG_news.shtml

[ZASHAGALKA, RN]

If BSNs weren't such 'technical' nurses, and tried to be more 'professional', like the ADNS are: then we'd be more professional as a group.

Yes, I said that right.

And, if THAT statement annoys you, then you understand the fundamental gulf that this moot debate will always engender.

Because, in essense, this is the EXACT argument that is used, in reverse. And, it's used IN SPITE OF THE FACT that experience is our greatest educator. And it's used in spite of the fact that it is just not true. And yet, this deceitful arrogance is still indoctrinated in some programs.

See, this argument can't take place 'in the trenches' because out there, we are ALL RNs and the fact that experience and overall education rounds each of us means that the mark of 'excellence' and/or 'professionalism' is a sum of education and experience that doesn't quite so neatly fit into this BSN vs. ADN debate. No, this is merely an 'academic' debate. And a moot debate to boot!

It is my considered opinion that the strongest advocates of this position are new BSN grads/students that don't yet have the experience to understand the fallacy of thier indoctrination; and the instructors that teach this indoctrination. It is my considered opinion that this fallacy doesn't translate well out of the academic environment and into the 'real' world.

Someone that would use this argument does so to make themselves feel superior at the expense of the majority of their peers.

Tell me.

How professional is that?

And that, my friends, is why we aren't a profession.

~faith,

Timothy.

[ZASHAGALKA, RN]

Linda Aiken at the University of Pennsylvania has done some research on patient outcomes and the educational preparation of nurses. You can view the abstract of one article at http://jama.ama-assn.org/cgi/content/abstract/290/12/1617

I want to comment some on this study, but first, let's look at the actual STUDY, instead of an abstract: (By the way, this post is SOLELY the work of the poster.)

http://www.tc.umn.edu/~ankel001/education/ED%20RN.pdf#search='Educational%20Levels%20of%20Hospital%20Nurses%20and%20Surgical%20Patient%20Mortality'

(I can't make this link, but if you put in "Educational Levels of Hospital Nurses and Surgical Patient Mortality" in yahoo search, this was, for me, the 4th response. Look for the www .tc.umn.... response.)

This is an 3 yr old study using 7 yr old data that has never been validated. Would you like to know why?

1. Academic Laziness

The original data pool was used for an earlier study about staffing levels and mortality GENERALLY. That data was just copied onto this template for this study. But it wasn't just copied; it was copied with the full assurance of the authors that the results of the first study that used this data could be 'factored out' of this, subsequent study. This fact serves the purpose of compromising BOTH studies.

2. Discrimination Bias (Hospital Selection)

Before analyzing the data, the authors first decided that it would be necessary to 'exclude' hospitals that didn't fit their data set. Some were excluded for valid reasons (they didn't report to the data set. Although, however valid, the exclusion ITSELF taints the data. THIS IS EXPECIALLY TRUE SINCE THIS EXCLUSION INCLUDES ALL VA HOSPITALS - a known source for high BSN recruitment. The very hospitals that might yield some useful data on the subject were ELIMINATED from the study!) - but some were excluded because the data they generated didn't meet the authors' needs. In other words, INCLUSION of said data would disturb the conclusions of the study.

So the authors warrant that exclusion of some data is relevant. Ok, I can concede that point as I understand that large standard deviations can skew data. But, excluding large amounts of data that are quite possibly within the single standard deviation being studied on the basis that such data wasn't available serves the purpose of undermining the whole study. It is a frank admission that the data itself is incomplete, and so, suspect.

This is the compounded error of the academic laziness mentioned above. The data set was copied from another study with the full understanding that it didn't meet the needs of this study, AND COULD NOT MEET THE NEEDS OF THIS STUDY because of its lack of inclusion of hospitals MOST LIKELY to represent a significant sample of this study. Rather than develop data that was 'pertinent' to THIS study, that academic laziness now calls for this lacking, and possibly highly relevant, data to merely be excluded from consideration.

3. Degree Bias

The Authors state in the study, "Conventional wisdom is that nurses' experience is more important than their educational levels." It is this ''conventional wisdom' that the study aims to examine. But how does it do so? By buying into the exact same conventional wisdom!: "Because there is no evidence that the relative proportions of nurses holding diplomas and associate degrees affect the patient outcomes studied, these two categories of nurses were collapsed into a single category"

HOLD ON. In a study about how degrees affect patient outcomes, an essential tenet of the study is to disregard degrees held??? After such manipulation, how can you say with a straight face that a study that disregards the relationship between degrees can make a conclusion REGARDING the relationships between degrees?

4. Lack of Substantiating Data

"It was later verified that this decision did not bias the result."

This statement, or others like it, appear throughout this 'study' without mention of the methods used to 'verify'.

"Previous empirical work demonstrated. . ." - um, exactly WHAT empirical work was that?

In fact, the study makes lots of claims and manipulates the data in lots of ways that it nevertheless insists that you have to trust its 'independent verification' that such didn't bias the results. Of course, that is without being provided access to said independent verification.

You have to love the 'self-affirming' validity of it all.

5. Data Manipulation

A. The data was 'manipulated' to grant varying degrees of credibility depending upon whether it was received by a 'teaching' hospital vs. a 'non'-teaching hospital. So, the study acknowledges that whether the place is full of learning docs MIGHT bias the study. And so, it 'manipulates the data' to account for this possibility.

B. The data was 'manipulated' to grant varying degrees of credibility to hospitals that are more 'technological' (e.g. have transplant services) as opposed to less. So, the study acknowledges that the level of care might bias the study. And so, it 'manipulates the data' to account for this possibility.

C. "An important potential confounding variable to both clinical judgment and education was the mean number of years of experience working as an RN": telling comment, but never fear, the data was 'manipulated' to take this into account.

D. Nursing workloads might affect patient outcomes. (Indeed, THIS was the previous study that this study's data set was copied from.) But, in this case, the data was 'manipulated' to take those workloads into account.

E. "Estimated and controlled for the risk of having a board certified Surgeon instead of a non-board certified Surgeon." The use of 2 'dummy variables' comparing MD licenses to general vs specialty board certification was "a reasonable way for controlling surgeon qualifications in our models."

In fact the authors admit to manipulating the data 133 ways! But all of these 'manipulations' were later 'verified' to have produced no bias.

6. Key Criteria Conjecture

The study's two key criteria: deaths within 30 days of hospital admissions and deaths within 30 days of complications due to 'failure to rescue'. But how were these criteria established?

In the first case, they were established by comparing the data set to vital statistic records (death records). I doubt they accurately compared 235,000 individual patients (data points) against another data set (death records) that was probably multiple times in size, but OK - I'll buy this for the moment.

In the second case, however, 'failure to rescue' was defined - NOT BE EXAMINING ACTUAL CASES OF FAILURE TO RESCUE - but by establishing different ICD-9 secondary codes from admit to discharge. An assumption is made that a different code meant that a 'failure to rescue' had occurred. What?!

RE-READ THAT LAST! By making dubious assumptions on data sets (hospital reporting statistics) - this study conjectures how this translates to 'failure to rescue' and then makes conclusions based on what this 'failure to rescue' might mean! ALL BY ITSELF, THIS NEGATES THE ENTIRE STUDY.

But, it was 'verified' to not bias the study results. How was this part 'verified'? Well, you're gonna love this: "expert consensus as well as empirical evidence to distinguish complications from pre-existing co-morbidities."

In other words, the experts (the study authors) know which data is which by looking at ICD-9 codes and that is sufficient to determine 'failure to rescue' and then extrapolate that data to RNs and their education status.

7. Risk Adjustment.

Still trust this study? Try this one: "Patient outcomes were risk-adjusted by including 133 variables in our models, including age, sex, whether an admission was a transfer from another hospital, whether it was an emergency admission, a series of 48 variables including surgery type, dummy variables including the presence of 28 chronic, pre-existing conditions as classified by ICD-9 codes, and interaction terms chosen on the basis of their ability to predict mortality and failure to rescue in the current data set."

So the data was manipulated 133 ways, excluding some data. But, and this is key: there are SO VERY MANY variables that could effect patient outcomes that you have to adjust for EVERYTHING except for what you're looking to find. Right? This is not only what the authors contend, but they contend that they SUCCESSFULLY adjusted the data, 133 different ways, for just this purpose, and completely without bias. Amazing.

8. Logistics Regression Models

So, after the study took in all this manipulated 'data', it compared hospitals with higher BSN-RNs to those with less, and reached a conclusion. Right? Wrong.

It took the data and ran a 'logistics regression model' as to what might happen in a given hospital "if there were a 10% increase in BSN RNs."

This study doesn't even compare the relative levels of RN education. It conjectures what might happen using a 'logistics regression model' of the data that it manipulated 133 ways!

Now if this isn't a key statement: "The associations of educational compositions, staffing, experience of nurses, and surgeon board certifications with patient outcomes were computed before and after controlling for patient characteristics and hospital characteristics." Indeed.

9. Direct Standardization Models.

Apparently, even after all the above manipulation, there were still 'clusters of data' that had to be 'standardized' using 'robust estimations'. The study does at least have the guts to admit that such 'standardizations' turns the final conclusion into an 'estimation'. Too bad it only makes that admission in the body of the study, and not in the 'abstracts'.

10. Alternative Correlations

The study admits that fewer than 11% of hospitals in Penn in 1999 (the area/year of the study) had 50% or greater BSNs. And then the study cites co-factors that could unduly influence the study under these situations: "Hospitals with higher percentages of BSN or masters prepared nurses tended to be larger and have post-graduate medical training programs, as well as high-tech facilities. These hospitals also had slightly less experienced nurses on average AND SIGNIFICANTLY LOWER MEAN WORKLOADS (emphasis mine). The strong associations between the educational composition of hospitals and other hospital characteristics, including workloads, makes clear the need to control for these latter characteristics in estimating the effects of nurse education on patient mortality."

Wow. Two key things from that statement: a direct acknowledgment that this 'study' is an 'estimation' and an acknowledgment that such an 'estimation' only occurred after 'the need' to highly manipulate the data.

In fact, I think it much more likely to argue that such "co-correlations" makes any 'estimated' conclusions IMPOSSIBLE to verify.

11. Study Conclusions.

This is one of the study's least reported conclusions. See if you agree: "Nurses' years of experience were not found to be a significant predictor of mortality or failure to rescue in the full models." Why is that? Because the above statement is true? Or, is this an indication that the models were so skewed. . . I mean, 'adjusted' as to make them completely unreliable?

The authors admit that their "estimations" can only lead to an "implication" that increased education means better nurses. OK. I'll agree with that. But, because the same study 'factored out' experience, I think it is impossible to estimate how even a fraction of experience affects the conclusions of the study.

Indeed, in order to arrive at its conclusion, the authors must first dismiss the 'conventional wisdom' that experience IS a factor, as they did, in the above statement. Without the above assumption, this whole body of work is worthless. If experience factors in, then the key question cannot be tied simply to education, BUT MUST BE TIED TO BOTH QUALITIES.

And so, the authors find themselves in a conundrum, in which they must first dismiss the importance of experience in order to highlight the importance of education. Amazingly enough, their study reached both conclusions: experience is meaningless to patient outcomes and THEREFORE education level is, by itself, a measurable standard.

The problem with that is once dismissed, the correlation between experience and patient outcomes is NOT part of this study. Neither, for that matter is alternative educational pathways, such as non-BSN bach degrees. Given the broad range of said experiences and educations within nursing, negating those experiences and educational pathways also serves the purpose of negating the validity of the study itself.

Simply put, this flawed and un-reproducible study is worthless. And that's the bottom line.

~faith,

Timothy.

[1brosnst]

Hi my name is Stephen . I hope I have rexieved a nurcing degree under the allnurses account prohram and if this counts towords college nursing credirs to graduate through the school of nursing through your school please PM me.

thanks Stephen

personal email and full name edited out of message. Per Terms of Service, we may not use full names or email addresses, for security reasons. Thank you.

[tookewlandy]

If there already is a nursing shortage why in the world would they think it is smart to make BSN a requirement to practice nursing as an RN. It doesn't seem that many nurses these days want to stay at the bedside with all the programs that take people who have no health care background and make them an MSN or Nurse Practitioner in a year or 2. So cut out the ADN and you really got yourself a nursing shortage worse than any kind of shortage we have today.

Earning a BSN or any kind of Bachelors is a big deal, you should be proud of that you worked hard for it and deserve to hold your head up high. But the same is true for people who earn an Associates whether it be ADN or Associate of Animal technology or whatever.In fact, Anyone who goes to college and earns a degree, diploma,certificate, no matter what it is should be proud and know one should try to tear it down cause maybe it did not take as long as theirs did, or because they don't offer certain classes that another one may make mandatory.

I am going to start an ADN program in the fall. I really don't have a desire to get a BSN and if an ADN can teach me what all the things it takes to become a nurse then why should we have to go back and GET BSN. it makes no sense at all.

[zenman]

If there already is a nursing shortage why in the world would they think it is smart to make BSN a requirement to practice nursing as an RN. It doesn't seem that many nurses these days want to stay at the bedside with all the programs that take people who have no health care background and make them an MSN or Nurse Practitioner in a year or 2. So cut out the ADN and you really got yourself a nursing shortage worse than any kind of shortage we have today.

I am going to start an ADN program in the fall. I really don't have a desire to get a BSN and if an ADN can teach me what all the things it takes to become a nurse then why should we have to go back and GET BSN. it makes no sense at all.

If there is a life threatening shortage of nurses, the appropriate corrective measure is not to shorten the length of training. That is exactly why the ADN nurse was created and it has been one of the worst decisions ever made by the profession, and one nurse in particular. There should not be an "us vs them" type of mentality. If there is a shortage of other professions do you see them cutting their education? No. If there is a teacher shortage, let's shorten their education. I'm sure your kid will still be able to catch up some day...with experience. Requiring one level of entry is, or should be mandatory to place nursing in the same ballpark with other professions. Many of you guys are lacking in those liberal arts courses that make you really "educated and smart" about what's really going on, LOL!

[tookewlandy]

If there is a life threatening shortage of nurses, the appropriate corrective measure is not to shorten the length of training. That is exactly why the ADN nurse was created and it has been one of the worst decisions ever made by the profession, and one nurse in particular. There should not be an "us vs them" type of mentality. If there is a shortage of other professions do you see them cutting their education? No. If there is a teacher shortage, let's shorten their education. I'm sure your kid will still be able to catch up some day...with experience. Requiring one level of entry is, or should be mandatory to place nursing in the same ballpark with other professions. Many of you guys are lacking in those liberal arts courses that make you really "educated and smart" about what's really going on, LOL!

But not everyone cares if nursing is in the same ballpark as every other profession. Nursing is in its own ballpark, and if the ballpark was doing so bad , then why are sooooo many people who already have bachelors and masters going to nursing school. Another thing, liberal arts courses may make you more Educated in a certain area, but its not what makes ANYONE SMART.

[leslie :-D]

even with nsg in the same ballpark as others, it still won't change the harrowing work conditions. this is a serious consideration for those who wish to remain at the bedside.

there are more pertinent issues at hand.

leslie

[SmilingBluEyes]

there are more pertinent issues at hand.

leslie

YOU said it girl!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[zenman]

But not everyone cares if nursing is in the same ballpark as every other profession. Nursing is in its own ballpark, and if the ballpark was doing so bad , then why are sooooo many people who already have bachelors and masters going to nursing school. Another thing, liberal arts courses may make you more Educated in a certain area, but its not what makes ANYONE SMART.

I know a lot of nurses don't care about having the same minimal level of education as other professions. Now you see the results...the outcomes are staring you in the face. We're fighting and saying that we can have less education in spite of the fact we have your life in our hands while the person teaching your kids has to have a BA or even more. Do you see the logic in that?

Liberal art courses provide education in a broad area and liberal arts grads are prized by companies with effective management.

[NephroBSN, BSN, RN]

....................

[SmilingBluEyes]

Asked this in another thread......

In countries where BSN is the one point of entry, how is it, nursing is still not respected as it should be, as a profession overall, and why are so many clamoring to practice here in the USA where ADN is the major point of entry to RN practice?

Have YET to hear anyone respond to this one.

[lindarn]

Asked this in another thread......

In countries where BSN is the one point of entry, how is it, nursing is still not respected as it should be, as a profession overall, and why are so many clamoring to practice here in the USA where ADN is the major point of entry to RN practice?

Have YET to hear anyone respond to this one.

I would say that it has more to do with the culture of the country, and its male dominated heirarchy. In other words, nurses are women and women are not respected as part of their culture, regardless of what they do. Women are less equal than men, when it comes to respect, and the impact and control that they are allowed to have. In other words, women are treated like dirt, regardless of how much or little education they have. Nursing is not respected because it is a female dominated profession. Period. It doesn't matter how much education they have. Women in these countries have no power when they are in female dominated professions, just like here.

But it doesn't have to be like that in this country. It has become like that because nurses have been slow to unionize and take control of their profession. Without a union contract, they are afraid to complain, and bring their concerns to the public. They would be, and are, being fired, in retaliatory discharges. They are made the "example", for everyone to see what happens when you complain.

In this country, it has more to do with our socialization as less worthy than physicians, and the culture that grew up around nursing, as being subservient handmaidens to physicians, who until recently, were mostly men. It is not like that in other professions, and it doesn't have to be like that in nursing.

The women in these countries in female dominated professions are VERY subservient to men and authority in general, and it shows in the way they are so easily intimidated by the hospital administration. That is why hospitals like to being them over here. They are so easily pushed around, and threatened with being sent back to their own country in disgrace if they don't do what they are told.

It doesn't have to be like that here. I cannot believe how naive nurses are. WHO is tellling you that a BSN is not important? Who refuses to recognize and reward nurses with BSNs? Who, in general, treats you like crap? Who lies to you, and continuously works at making your contributions to patient care and outcomes invisible? And now you believe them when they say that "a nurse is a nurse is a nurse" regardless of how much education they have? I have a bridge in Brooklyn I will be happy to sell you, along with the beachfront property in the Arizona desert.

In other words, the ADNs and diploma nurses need to validate their self worth and self importance, and the best way to do that is to believe the administration when they tell them these things. Administration then doesn't have to be the bad guy, and make a big thing out depriving nurses with a higher degree a higher rate of pay. They just tell the ADNs and Diploma nurses, "WELL, those nurses with those BSNs. THEY WANT TO MAKE MORE MONEY THAN YOU BECAUSE THEY HAVE A MEASLY PIECE OF PAPER!!! IMAGINE THAT!!! And the ADNs and Diploma nurses do their dirty work for them in contract negotiations. And they come out smelling like a rose.

And the ADNs and Diploma nurses fall for it hook, line and sinker. And the administration is laughing all the way to their board room meetings.

JMHO.

Lindarn, RN, BSN, CCRN

Spokane, Washington