Phasing Out ADN?

[Candi Williams]

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.

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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

[Hoosier_RN, MSN]

Tommy5677 said:

43 Years ago I received my ASN from a private university. We started with 66 and graduated 32 so yes, there is a weeding out process. Also, when I did the ASN I did the entire thing in 2 years, including 2 semesters in the summers, which is kind of not a thing anymore.

I started in a class of 60, 24 graduated, some failed out, some dropped out, some had to hang back due to pregnancy, etc. We did summers as well

[Tommy5677]

londonflo said:

I was a faculty member at a diploma school. We had a few drop or fail for dosage and calculation (when it was desired desired over hand) .  

Wow. I just learned how to do a simple algebra calculation for that one

[Lust4life, BSN]

londonflo said:

I was a faculty member at a diploma school. We had a few drop or fail for dosage and calculation (when it was desired desired over hand) .  

That part was really rough! Do you know if they are still testing on dosage calculations? I never had to use any of the math I learned at work. I was good at it in school, but now I'm rusty. 

[SuzanneRNLA]

One of the first things we had to do was pass a math test with 100% to stay in the ADN program. And, yes, as a Pediatric RN, I did use the math a lot at work, especially on dosages.

[Lust4life, BSN]

SuzanneRNLA said:

One of the first things we had to do was pass a math test with 100% to stay in the ADN program. And, yes, as a Pediatric RN, I did use the math a lot at work, especially on dosages.

Ahhh yes, in pediatrics. Yikes ?

[Googlenurse, ASN, BSN, RN]

I don't know why some nurses say common sense is  all a nurse needs. 
 

How can a nurse use common sense without a good knowledge base? 

Common sense without a good knowledge base is extremely useless. 
 

If all it takes is common sense to be a nurse, then what's the point of going to school?

 

[Tweety, BSN, RN]

Googlenurse said:

I don't know why some nurses say common sense is  all a nurse needs. 
 

How can a nurse use common sense without a good knowledge base? 

Common sense without a good knowledge base is extremely useless. 
 

If all it takes is common sense to be a nurse, then what's the point of going to school?

 

Agree.  You have to have both.  A knowledge base and common sense that can then lead to good critical thinking skills.  The question I suppose is that is the knowledge base of the ADN adequate for bedside hospital nurses?  I think the answer is yes because I did it for over 15 years until I got my BSN.  

Hoosier_RN said:

I started in a class of 60, 24 graduated, some failed out, some dropped out, some had to hang back due to pregnancy, etc. We did summers as well

I graduated over 30 years ago from an NLN Accredited ADN program.  To date, it was the the most difficult thing I've accomplished other than staying at the beds for over 30 years.  We started with 60 and ended with 60.  No one was weeded out, although one barely scraped by and I heard the failed the NCLEX.   

[Hoosier_RN, MSN]

Tweety said:

No one was weeded out, although one barely scraped by and I heard the failed the NCLEX.   

I don't know that anyone was purposely weeded out, but like you, that ASN was the roughest education that I ever attained. I just think some folks weed themselves out of situations when it's tougher than what they want to deal with. Be it nursing, marriage, or whatever anyone chooses to apply. Those in your class chose to tough it out. Many in mine weren't going to do CNA work (1st semester clinicals at a local LTC), and get their hands dirty. A few thought that they should be handed a degree because they applied to school...

[Tweety, BSN, RN]

Hoosier_RN said:

I don't know that anyone was purposely weeded out, but like you, that ASN was the roughest education that I ever attained. I just think some folks weed themselves out of situations when it's tougher than what they want to deal with. Be it nursing, marriage, or whatever anyone chooses to apply. Those in your class chose to tough it out. Many in mine weren't going to do CNA work (1st semester clinicals at a local LTC), and get their hands dirty. A few thought that they should be handed a degree because they applied to school...

I think a lot of people going into the program don't understand how tough it is and how many hours you have to put in.  Others also don't understand that yes, you have to sometimes deal with poop and other unpleasant things even if you are the RN and not the CNA.  Many have a wake up call.  My class I think was the only one for a few years before and after (my sister followed me two years later and had some drop outs) that had all of us make it through.  The ADN certainly isn't the easier softer way to become an RN.

[Hoosier_RN, MSN]

Tweety said:

I think a lot of people going into the program don't understand how tough it is and how many hours you have to put in.

The ADN certainly isn't the easier softer way to become an RN.

I think this is even more true today

[QualityRN]

Are you kidding? Nurses are disgusted and leaving the profession. Hospitals and Boards of Nursing will be lucky to have any nurses at all if they keep play around. 

[Tenebrae, BSN, RN]

Hannahbanana said:

I despise the fluff you describe. It cheapens the idea of professional education. 


So much of what I learned in my BSN has not been remotely useful in my 12 years of nursing. 

My year 3 cultural safety paper was taught by one of the most culturally unsafe nurses I have ever met. Thats not to say that cultural safety is not essential in nursing but for goodness sakes have it taught by someone who can do the role a service