Phasing Out ADN?

The national nursing shortage has caused a crucial call for nurses. One solution to the nursing shortage is to hire Associate Degree in Nursing (ADN) graduates, but will the growing trend pushing for all nurses to have a Bachelor of Science in Nursing (BSN) phase out ADN programs?

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Phasing Out ADN?

Should We Hire ADNs? or Phase It Out?

The national nursing shortage has caused a crucial call for nurses. Nurses are a core part of the healthcare industry. They are the largest professional sector within the healthcare workforce and are essential to patient care. One solution to the nursing shortage is to hire Associate Degree in Nursing (ADN) graduates, but will the growing trend pushing for all nurses to have a Bachelor of Science in Nursing (BSN) for hire, phase out ADN programs? Let's bring to light the nursing shortage and the advantages and disadvantages of ADN and BSN degrees.

The growing trend in the healthcare industry pushing for all nurses to have a BSN degree for hire will not phase out ADN nurses anytime soon. The demand for nurses is too high. Approximately 40 percent of new nurse graduates earn their degrees from associate degree programs. An advantage of ADN programs is bringing new nurses into the workforce sooner. ADN programs prepare students to take the NCLEX-RN exam and become Registered Nurses (RN) in two to three years versus four-year BSN programs.

Why ADN?

ADN programs are more appealing to many because of the low cost and shorter time frame it takes to become a Registered Nurse; it grants them the opportunity to start working as a nurse sooner. Being introduced into the nursing workforce sooner affords them income as a nurse and a chance to gain experience while pursuing a BSN degree. In 2010 the Institute of Medicine (IOM), now the National Academy of Medicine, recommended that 80% of registered nurses earn a BSN degree by 2020. As a result, medical institutions prefer to hire nurses with a BSN degree or higher. Some institutions require a BSN degree for hire, and if they hire a nurse with an ADN, a condition of employment is earning a BSN degree within a certain length of time.

Why BSN Degree or Higher?

Better Pay

Nurses with BSN degrees have the possibility to generate higher income compared to those with ADN degrees. They can obtain positions offered to nurses who hold BSN degrees or higher. These positions come with more responsibilities and higher pay—positions such as managers, administrators, and educators.

Improve Patient Care

Research has shown that medical institutions that have a higher percentage of qualified BSN nurses on staff deliver quality patient care. They contribute to decreased medication errors, better patient outcomes, lower hospital-acquired infections, decreased mortality rates, and a decline in failure-to-rescue rates.

Magnet Certification

Healthcare organizations have begun seeking nurses with higher education and aspire to Magnet Certification. A major requirement for earning certification is the educational level of the nurses on staff. The higher the percentage of nursing staff with a BSN or greater, the better their chances are of Magnet certification. Magnet Certification yields outstanding nursing processes with notable quality, safety, and patient satisfaction.

Ramifications of Nursing Shortage

Discussions about concerns over the nursing shortage were taking place prior to the Covid-19 Pandemic. The Bureau of Labor Statistics predicted a shortage of over one million registered nurses by the year 2022. Cutbacks in nursing are attributed to one of the reasons for the shortage. Nurses fall victim to reductions in labor costs because they make up the largest labor force in the healthcare industry. Those reductions are decremental to the safety of patients and nurses. Another cause for the shortage is not enough educators. Nursing programs routinely turn down applicants because they have a limited number of nursing educators to train them. Other causes for the shortage are nurse burnout, an increase in the aging population, and an aging workforce.

Covid-19 escalated the nursing shortage. Covid caused an increase in patient volume, a rise in nurse burnout, early retirement from nurses who were close to retirement, and nurses leaving the profession altogether.

Nursing shortages give rise to medication errors, patient falls, increased morbidity, and increased mortality rates. When organizations lack appropriate staffing levels, the patient-to-nurse ratio is higher. This leads to nurse burnout and discontent. A suitable amount of nursing personnel reduces errors, increases patient safety, improves patient satisfaction, and enhances nurse retention.

Healthcare organizations, nurse leaders, and government officials must devise solutions to the nursing shortage. They must strive to engage and keep nurses. Retention of nurses brings about quality nursing care, improved patient care, and patient satisfaction.

References/Resources

ADN vs BSN Debate: These Are the Real Differences Between ADN and BSN Prepared Nurses: Nightingale College

The Staffing Shortage Pandemic: Journal of Radiology Nursing

Are ADN & ASN Programs Needed to Meet the Nursing Shortages at Hospitals?: Advocate Search Group

Nursing Workforce Challenges in the Postpandemic World: National Library of Medicine

Nursing Fact Sheet: American Association of Colleges of Nursing (AACN)

Nursing educators: Stress the importance of a BSN in nursing, your students will thank you: Wolters Kluwer N.V.

Nursing Shortage: (Stat Pearls) National Library of Medicine

Reaching beyond 80% BSN-prepared nurses-One organization's journey to success: Nursing Management

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Candi Williams

About Candi Williams

Candi Williams RN BSN. I've been an RN for 24 years. Worked in Perioperative Department as a preop/discharge staff nurse for 18 years, Was charge over that department for 8 years and nurse manager for one year.

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Specializes in OR, Nursing Professional Development.

The ANA has been pushing (unsuccessfully) for the BSN as entry to practice for decades. I don't see it ever coming to fruition, unless by some miracle we end up with an obscene nursing surplus who all actually want to work.

In my area, the ADN nurses never went away, except for a very brief period when one hospital essentially shot themselves in the foot. They've been hired at pretty much all facilities. Yes, there was an agreement that the BSN would be completed within a set number of years, but it was not required to apply or be hired.

I strongly believe that if the US does, in the remote chance it actually happens, require the BSN for initial licensure, then they need to follow the process that was set out by Canada when they made the switch: working nurses were grandfathered in. Making something essentially a retroactive requirement is not the right way to do it.

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Specializes in oncology.

The ANA really picks and chooses what RN issues they want to focus on---

1) Where were they during Covid, speaking up for the safety of nurses? Instead they added some CEU programs on their site and wrote some letters.

Why wasn't the organization FRONT and CENTER on the TV news?, explaining what a stressful day was like for the nurse during this time (not just  nurses in the COVID units). Nurses on other units were laid off after  elective surgeries were canceled. 

2) Did the ANA emphasize anywhere where Covid  was impacting the students curriculum for those preparing to enter the work force ? 

3) ANA is AMERICAN NURSES Association - not the BSN AMERICAN NURSES Association 

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The USA is not a monolithic entity.

Some places have the highly educated populations where maybe 80% BSN is a feasible idea. I live in an urban area with many colleges and universities and the area attracts people from outside who want to live here.

But, the USA also has places that run rural, elderly and downscale where there are too few nurses to go around regardless of degree.

I would be in favor of grandfathering in ADNs, but a part of me wonders if this can be used as an excuse to bypass older nurses without being accused of ageism.

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Specializes in Perioperative Nurse. Preop and discharged patients.

I agree, I don't see it coming into fruition either.  In my area, ADN programs more than double the number of BSN programs being offered, yielding more ADN nurse graduates for hire than BSN. Also a BSN degree is not a requirement for hire here so some of my colleagues see no reason to go back for their BSN; especially since the ADN staff nursing pay scale is the same as BSN staff nurses unless you are in management.

It's my opinion that if they ever make BSN a requirement for initial licensure, working nurses with greater than five years' experience should be grandfathered in. That would help with the transition, otherwise there will be an even greater shortage of working nurses.

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Specializes in oncology.
RNperdiem said:

Some places have the highly educated populations where maybe 80% BSN

 Currently an add-on BSN (post ADN) program does not mean highly educated,  Have you ever looked at the current BSN completion programs including their course work,  course requirements and clinicals trying to apply knowledge learned with an actual  population? WGU added an easy to do clinical for their program. So many individuals are wriggling to get out of it or going for another school.

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I will be honest. I was looking at the cheapest and least demanding BSN. I was not looking for any great intellectual fulfillment or demands. I had enough going on in my life (husband with pancreatic cancer, two kids at home during the pandemic, job, elderly mother etc.).  But, I knew in my area that a BSN mattered, and for professional survival, I needed to get one, especially as an older nurse working in a magnet hospital.

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Specializes in oncology.
RNperdiem said:

(husband with pancreatic cancer, two kids at home during the pandemic, job, elderly mother etc

May be that is enough that anyone can manage now .I hate  the phrase "enough on my plate" if that means you have to eat it all. Take good care of your husband, children....and the "Perdiems". 

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Specializes in School Nurse.

Here's the thing, an ADN gives you everything you need to be a good nurse, just because you get a BSN doesn't mean you'll be a better nurse. They did grandfather in ADN in my state but any new nurse getting an ADN needs to get a BSN in 10 years. It's a money grab for colleges and a status symbol for hospitals. I would never, even with employer help, have the extra money to spend on it or the time especially to do clinicals. The return on investment wasn't there. I did go to a college open house $20,000. I see some now advertising online for $11,000 but I am not sure I believe that will be the final cost. Our ADN program had a better NCLEX pass rate than the 4 year BSN schools.

What would make better nurses? Other nurse could mold better nurses by giving better training. Hospitals should be advocating for better training. I get it. It's hard to train when you are overworked. New nurses regardless of the degree are thrown into the trenches of the hospital to sink or swim. I never wanted to be a hospital nurse but nursing schools are all oriented towards hospital nursing. News flash, there are plenty of other types of nursing.  I get more out of CE's, professional development, experience and mentors then I could ever get from additional college courses to give me a BSN after my name. 

62 years young

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Specializes in CEN, Firefighter/Paramedic.

I've always laughed at the verbal judo - "institutions with a higher percentage of BSN nurses deliver better care" (paraphrase).

The words are always crafted in such a way so as allow the reader to infer that the BSN is the difference maker, but without actually coming out and saying it  

It would be more impactful if these "studies" actually compared ADN to BSN within a specific unit/facility to compare med errors, length of stay, patient harm data, or any other metrics that could demonstrate competency.  Lets compare apples to apples, nurses in the same place with the same policies and same patient load - is there a statistically significant difference.

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Specializes in oncology.
Hobe said:

. I never wanted to be a hospital nurse but nursing schools are all oriented towards hospital nursing. News flash, there are plenty of other types of nursing. 

You betcha! A BSN can lead you to all those other types of nursing. Think about home health, out patient health, well baby visits.. and so much more....enrich your job scope, mind and thinking.!

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Specializes in oncology.
Hobe said:

.  I get more out of CE's, professional development, experience and mentors then I could ever get from additional college courses to give me a BSN after my name. 

It doesn't sound like you have a college course to contrast with CE's, professional development, experience and mentors.  How do you know you will not learn something more in a college course???

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