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

[Lust4life, BSN]

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?

 

I totally agree. When I started nursing school I had to be educated and trained to think "like a nurse". Until then, it would be very hard to pass the tests given in nursing school.

I went into the program with common sense and "common" knowledge of some medical issues. (Which I learned isn't that common...some ppl [women] didn't know what a hysterectomy was, etc). I couldn't understand why I kept missing test questions....the answers seemed like common sense to me. 

Once the light came on and I understood the rationales and how to think critically, like a nurse, things made more sense. 

The ability to think that way, isn't common. 

[Skotts]

I've been an LPN for 16 years and when I hear RN I yawn. I've worked in so many facilities and if books are the criteria for an RN label they really need to re-evaluate, books cannot teach experience. I have and continue to run circles around RNs with years of experience and I'm also making over six figures a year! Why should I go take an algebra class to get a label that will not do anything but give me a headache like I get now from an inexperienced RN who has no clue how check VS correctly. You want things to work correctly, give me 5 seasoned LPNs with 10+ experience because these new trained RNs are lost and the ones who sit on their butts are equally clueless.

[heron, ASN, RN]

I graduated nursing school in 1972 and have heard this same caveat ever since then. They might have better success in promoting the BSN if tuition was affordable without crippling loans.

[Hoosier_RN, MSN]

heron said:

I graduated nursing school in 1972 and have heard this same caveat ever since then. They might have better success in promoting the BSN if tuition was affordable without crippling loans.

And actually added something more than fluff classes. I went to a state U, brick and mortar (there was no online back then) and had a community health component. Everything else was just research and writing papers. It added 0 to my practice, just some more letters behind my name

[Tweety, BSN, RN]

We have a very good ADN school here that is a community college, so their ADN to RN bridge is pretty cheap, especially if you work somewhere with tuition reimbursement, a widely available benefit.  Almost 100% of the new grads that work with me are in the RN to BSN bridge, so a lot of people getting the BSN isn't organizational driven but self-driven because they want something more.  For a good deal of them it's advanced practice like CRNA or APRN.  

I certainly don't think getting my BSN added anything to my practice, but I wanted some options should something happen that I age out, or injure out of bedside nursing.  I did take a BSN required management job but hated that and am back at the bedside.  I could say my BSN is only letters behind my name, but I'm proud of that accomplishment anyway and did learn a thing or two.

[autumnal]

LPNs are nurses, too... I'm an LPN and briefly worked at a hospital that brought back LPNs in the past few years. 

[RosesrReder, BSN, MSN, RN]

After the pandemic, I have noticed a huge trend in both states I practice in.  PRN nurses now make less that FT/PT.  All the remote or hybrid jobs are advertises as LVN or RN as well as homehealth and the similar.  The pay is usually very insulting.  For example, I interviewed for a position recently with the state and they offered $22/hr.  They said that is competitive for the area and it could be filled by LVN or RN.  

My colleagues are experiencing a backshift in situations.  The BSN+ nurses are being pushed out and everyone is hiring new grads and giving preference.  We have a local nurse transparency pay page where nurses compare wages and being loyal to the company and the more years of experience under the belt is not wise.

They claim a shortage but there is not one in my area.  When you interview they let you know there are many fish in the sea so either take it or leave it.  The newer nurses with ADN degrees are getting all the remote/hybrid jobs because they are the only ones willing to accept the horrible pay.  One newer nurse accepted an $18 hour job just to not take bedside.  

Additionally, now some employers who require a BSN/MSN now only give you years of experience credit commencing when you got the degree.  For example, I was an ADN for the majority of my nursing career then went back for BSN and MSN.  A BSN with no ADN can potentially come in higher as a newer nurse because they aren't counting my ADN.  The gaslighting is real LOL.

The pandemic has really brought out a lot of transparency and the ugly from employers.

Lastly, my BSN and MSN have not added any value to my practice.  I would still do it again and get my ADN and potentially have stayed that way and not incurred so much additional debt if there had not been a terrible push and fearmongering.  I refuse to let anyone help me pay for my degrees because it is not worth turning into an indentured servant and owe them anything much less my loyalty if they are underserving.

[londonflo]

Hoosier_RN said:

I went to a state U, brick and mortar (there was no online back then) and had a community health component. Everything else was just research and writing papers.

A baccalaureate degree is representative of a well rounded, educated person. This includes identifying an idea to study, investigating resources, identifying the research question, and presenting your findings with your thoughts for others to use for future work (which includes citations that include the necessary information for others to Spring board from there).  You contribute to the future of the nursing profession.

If we truly want to be called a profession...we need to show we are lifelong learners who seek to learn  along the same path that other professions use to call themselves professionals. That means learning the theory and ability to communicate ideas to fellow nurses, other disciplines and the public. 

 

[Hoosier_RN, MSN]

londonflo said:

A baccalaureate degree is representative of a well rounded, educated person. This includes identifying an idea to study, investigating resources, identifying the research question, and presenting your findings with your thoughts for others to use for future work (which includes citations that include the necessary information for others to Spring board from there).  You contribute to the future of the nursing profession.

If we truly want to be called a profession...we need to show we are lifelong learners who seek to learn  along the same path that other professions use to call themselves professionals. That means learning the theory and ability to communicate ideas to fellow nurses, other disciplines and the public. 

 

I had my BS in another profession. Perhaps this is why I was already a well rounded critical thinker prior to nursing, with the ability to clearly communicate. For some, it may add to their practice. For me, it was 7 classes on how to research,  which I had learned in my other field 

[DoubleblessedRN, ADN, RN, EMT-B, EMT-P]

I just don't see it happening, at least while I'm still working as an RN.  They've talked about it for many years and it hasn't happened, and when COVID first surfaced I think the severely critical shortage was much more realized.  They've also talked about phasing out LPNs/LVNs for years as well, and that hasn't happened either.  As a matter of fact there are more job opportunities now than there was before as well as some newer LPN programs less than ten years old.

I have an ADN, and I'm not interested in pursuing a BSN, unless I changed my mind and decided I would like to pursue NP.  There's certainly nothing wrong with being more educated.  But what would be the point of spending thousands of dollars obtaining a BSN if I wasn't interested in a management, research or other position that would require a BSN?  Especially when working as a staff nurse on a unit where there is no difference in pay between an ADN and a BSN.  I felt that when I applied for nursing school that an ADN was the best choice for me due to my life circumstances:  I just began taking prerequisites right after my children were born.  I wanted to work as a nurse as soon as possible so that we could afford a bigger, better home with better schools for our children.  However, my son just finished his first year of college at a university.  Initially he was interested in a different health profession, but a couple months ago he decided to pursue nursing.  And I told him that he should just continue to attend his current school and obtain the BSN.

[londonflo]

Hoosier_RN said:

I had my BS in another profession. Perhaps this is why I was already a well rounded critical thinker prior to nursing, with the ability to clearly communicate. For some, it may add to their practice. For me, it was 7 classes on how to research,  which I had learned in my other field

Hoosier,

I always enjoy your clear communications, rational comments,  and most of all thoughtful comments with a description of how you came to your conclusion. 

It is readily apparent that you have honed your skills in a  baccalaureate school. (? and masters?)

[Hoosier_RN, MSN]

londonflo said:

Hoosier,

I always enjoy your clear communications, rational comments,  and most of all thoughtful comments with a description of how you came to your conclusion. 

It is readily apparent that you have honed your skills in a  baccalaureate school. (? and masters?)

Yes I have my MSN, still not sure that improved my practice, other than I get to put together education packets for staff, as they tell me that I write excellent papers