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

[BeatsPerMinute, BSN, RN]

I'm going to be honest: I didn't read everything posted here. I don't need someone to try and tell me that a BSN > ADN. The concept is absolutely ridiculous. BSN vs ADN, in my opinion, has very little impact / difference in actual patient care. And the push to make everyone BSN, MSN, PhD, with XYZ certs, (whatever alphabetic soup they are demanding) is just stupid. 

[Tommy5677]

BeatsPerMinute said:

I'm going to be honest: I didn't read everything posted here. I don't need someone to try and tell me that a BSN > ADN. The concept is absolutely ridiculous. BSN vs ADN, in my opinion, has very little impact / difference in actual patient care. And the push to make everyone BSN, MSN, PhD, with XYZ certs, (whatever alphabetic soup they are demanding) is just stupid. 

I'm in total agreement. Many with a BSN who got their ADN first will tell you it's nothing but fluff (community health and research, neither of which is on the NCLEX) There are also many BSNs, including one here, that will tell you stats show BSNs nurses are better. The research was done by a University with, are you ready, a BSN program. It's laughable. The nursing profession is it's own worst enemy, afraid to stand up for itself (if we wanted to we could put hospitals in their place, groveling at our feet). 

[Bug Out, BSN]

Tommy5677 said:

I'm in total agreement. Many with a BSN who got their ADN first will tell you it's nothing but fluff (community health and research, neither of which is on the NCLEX) There are also many BSNs, including one here, that will tell you stats show BSNs nurses are better. The research was done by a University with, are you ready, a BSN program. It's laughable. The nursing profession is it's own worst enemy, afraid to stand up for itself (if we wanted to we could put hospitals in their place, groveling at our feet). 

While I am in agreement that ADN nurses are essential I would disagree with the overall (not necessarily your sentiment) that BSNs are not useful. 

For a basic floor nurse I personally think an ADN is enough.

For those in any kind of leadership (including charge) and education I personally would vote for the BSN to be the minimal educational requirement. While not all programs are created equal the focus on research and some of the other "fluff" in my personal opinion helps people to value and understand research, standards, guidelines, etc. 

I do not work a bedside role, my role is better described as more of a consultant role. From my experience I have found a general difference when I speak to ADN, BSN, MSN, and DNP nurses when it comes to certain types of topics and research. 

[toomuchbaloney]

ADN nurses are fully prepared to provide competent bedside care in a variety of settings. 

BSN programs are not fluff.  

[subee, MSN, CRNA]

Bug Out said:

While I am in agreement that ADN nurses are essential I would disagree with the overall (not necessarily your sentiment) that BSNs are not useful. 

For a basic floor nurse I personally think an ADN is enough.

For those in any kind of leadership (including charge) and education I personally would vote for the BSN to be the minimal educational requirement. While not all programs are created equal the focus on research and some of the other "fluff" in my personal opinion helps people to value and understand research, standards, guidelines, etc. 

I do not work a bedside role, my role is better described as more of a consultant role. From my experience I have found a general difference when I speak to ADN, BSN, MSN, and DNP nurses when it comes to certain types of topics and research. 

Maybe it's time to have two tiered board exams to put this topic at rest.

[toomuchbaloney]

subee said:

Maybe it's time to have two tiered board exams to put this topic at rest.

It's just manufactured to create disagreement among nurses.  That disagreement makes it easier for facilities to overwork and underpay bedside nurses.  

[Bug Out, BSN]

subee said:

Maybe it's time to have two tiered board exams to put this topic at rest.

I agree. In true nursing fashion I think the profession attempts to be everything to everyone all at the same time. I personally would support a further subdivision of bedside nurses from a leadership sort of class of nurses. Personally I think about it like the military, you have the basic enlisted and then the college prepared officers. 

[subee, MSN, CRNA]

Bug Out said:

I agree. In true nursing fashion I think the profession attempts to be everything to everyone all at the same time. I personally would support a further subdivision of bedside nurses from a leadership sort of class of nurses. Personally I think about it like the military, you have the basic enlisted and then the college prepared officers. 

I didn't consider anything outside of getting a BSN but never saw it as a stepping stone to leadership.  I thought I was interested in psych or public health nursing (ended up doing neither:) but just wanted an advantage in a NYC market.  I worked in a teaching unit where all of the staff understood that they were working on an RN orientation unit and had chosen to be there.  We had 2 such units in the hospital where ALL new grad hires started their orientation before they moved on to their assigned specialty units.  Our units had people from all educational backgrounds.  A BSN gave me a modest salary boost but that was about all.  It did, however, give me entry into a variety of positions and eventually CRNA school at age 36.

[Jurse, LPN]

I don't know how they get rid of the ADN when they can't even staff the units adequately.

[FiremedicMike, BSN, RN, EMT-P]

Just popped in to say that I'm wrapping up my first class of my RN to BSN.

Last weeks homework assignment was a discussion board post about our opinions of technology and a 5 question quiz on mobile apps for nursing.

Damn, I'm a better nurse already…….

[subee, MSN, CRNA]

FiremedicMike said:

Just popped in to say that I'm wrapping up my first class of my RN to BSN.

Last weeks homework assignment was a discussion board post about our opinions of technology and a 5 question quiz on mobile apps for nursing.

Damn, I'm a better nurse already…….

Complain to the school.  Not to us:)  We are fully aware of the crappy RN-to-BSN programs that make student cynical about education.  You aren't getting what you paid for.

[subee, MSN, CRNA]

Tommy5677 said:

I'm in total agreement. Many with a BSN who got their ADN first will tell you it's nothing but fluff (community health and research, neither of which is on the NCLEX) There are also many BSNs, including one here, that will tell you stats show BSNs nurses are better. The research was done by a University with, are you ready, a BSN program. It's laughable. The nursing profession is it's own worst enemy, afraid to stand up for itself (if we wanted to we could put hospitals in their place, groveling at our feet). 

A six credit public health course is not fluff.