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.

---

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

[toomuchbaloney]

I think that my educational pursuits, beyond my initial AD in nursing, made me a better nurse only indirectly. The letters satisfied employers but I don't feel that they necessarily made me a better practioner. All honing of intellectual skills benefit us, in the long run. 

[londonflo]

Hoosier_RN said:

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 

Okay, I know I will get a lot of negative replies to my post here:

A BSN graduate has a graduation gown with open sleeves. This means that they have learned how to learn and have established knowledge of their field.

An MSN graduation gown has closed sleeves -- meaning you have learned a mastery of your subject.

The highest level programs today, that were established in 1500 and further like the University of Oxford still confer titles at graduation to mean what I cited above.  

What you do with your degree is up to you. You have cited accomplishments that require a Masters.....evaluate packets that are useful for staff.  Discriminating useful information to include, not including out dated or non useful information.  

You have shown that you have excellent writing skills -- Where did that come from? May be you were blessed with it or may be,  may be, with building on your high school education, BSN  academic studies and ultimately  MSN coursework you learned how to write excellent papers. 

[Hoosier_RN, MSN]

londonflo said:

May be you were blessed with it or may be,  may be, with building on your high school education, BSN  academic studies and ultimately  MSN coursework you learned how to write excellent papers. 

Maybe I was blessed, or maybe it's Maybelline.

Sorry, I'm in a joking mood this morning, and those of us who know, know ?

[subee, MSN, CRNA]

Googlenurse said:

I would advise anyone in the urban Northeast to get that BSN. 
 

Abzolutely.  A BSN will get you a job ?

[Tommy5677]

subee said:

Abzolutely.  A BSN will get you a job ?

Did you see where post COVID nurse salaries are plummeting? That's how much hospitals and admins think of you. As Boomers continue to age, we are heading for a serious crisis, as if we don't already have one. 

[chare]

Tommy5677 said:

Did you see where post COVID nurse salaries are plummeting? That's how much hospitals and admins think of you. As Boomers continue to age, we are heading for a serious crisis, as if we don't already have one. 

I know that travel nurse salaries are dropping and am somewhat surprised this didn't start sooner.  As for staff salaries, this hasn't been my experience.  The facility I just left gave market increases across the board this past February and is planning on merit increases based on upcoming performance reviews.  Regarding my current facility I am unaware of their plans for market/merit increases but my salary, adjusted for cost of living is comparable to where I left.

[Hoosier_RN, MSN]

chare said:

I know that travel nurse salaries are dropping and am somewhat surprised this didn't start sooner.  As for staff salaries, this hasn't been my experience.  The facility I just left gave market increases across the board this past February and is planning on merit increases based on upcoming performance reviews.  Regarding my current facility I am unaware of their plans for market/merit increases but my salary, adjusted for cost of living is comparable to where I left.

I read an article that it is slowly happening, has even happened at a couple of hospitals in my state. Dialysis clinics never raised our pay, so I guess I'm not gonna worry too much at this point. But you don't think that admins want to give up their fluffy bonuses and perks, do you?

Sadly, many nurses are just being regarded and portrayed as greedy. The public is buying it

[Tweety, BSN, RN]

chare said:

I know that travel nurse salaries are dropping and am somewhat surprised this didn't start sooner.  As for staff salaries, this hasn't been my experience.  The facility I just left gave market increases across the board this past February and is planning on merit increases based on upcoming performance reviews.  Regarding my current facility I am unaware of their plans for market/merit increases but my salary, adjusted for cost of living is comparable to where I left.

Same here.  I've never seen salaries drop, only rise over time.  What has dropped is the bonuses for picking up extra shifts.  During covid we would make as much as $1000 a shift for working extra, now it's $500, but hourly rates have remained the same and raises handed out.   

Every now and then there's a market adjustment upward here as well.  There's competition from another large hospital just a few miles from mine.  They just built a new tower and we've built a new free standing ER so the competition for nurses remains high, so salaries remain steady.  

[londonflo]

Hobe said:

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.

As a  Community school nurse, wouldn't you benefit by learning something about the community (children) you serve?  A BSN degree focuses on Community Health. You would look at things like looking at how poverty, poor parenting, poor hygiene, and a poor community effect the student? If you are in a area with higher income families... identify with the students how  (poverty, poor parenting, poor hygiene, and low income) do not effect your school but make them sensitive that these exist..  You could create health programs,  future occupational programs, Heck, you could create a whole program on how Covid effected the US and the world!

Wanta compete with everyone  else in your building who has a baccalaureate degree or higher for pay, respect or what ever your complaint is....Get those degrees that are holding you back!

[Ann Fosque]

Very good advice...a serious MVA prevented me from finishing my online education to RN

 

[subee, MSN, CRNA]

londonflo said:

As a  Community school nurse, wouldn't you benefit by learning something about the community (children) you serve?  A BSN degree focuses on Community Health. You would look at things like looking at how poverty, poor parenting, poor hygiene, and a poor community effect the student? If you are in a area with higher income families... identify with the students how  (poverty, poor parenting, poor hygiene, and low income) do not effect your school but make them sensitive that these exist..  You could create health programs,  future occupational programs, Heck, you could create a whole program on how Covid effected the US and the world!

Wanta compete with everyone  else in your building who has a baccalaureate degree or higher for pay, respect or what ever your complaint is....Get those degrees that are holding you back!

I think the lack of a full semester community health course with clinicals is a real shortcoming.  Until you see how patients live in their own quarters, it's difficult to appreciate where to go with patient teaching.  My semester was spent in a tough neighborhood (if it was a school holiday, clinicals were cancelled) and that has stuck with me decades later what it means to live in that environment...it's so stressful and that affects behaviors.

 

[Ann Fosque]

Point well taken...Thanks for sharing