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

[FiremedicMike, BSN, RN, EMT-P]

subee said:

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.

I go to a respected nursing college that has been around for 120 years, this isn't a fly by night program. 
 

I'm getting exactly what I paid for and exactly what I wanted - the least painless way to get that magic piece of paper that turns my associates degree into a bachelors.

[subee, MSN, CRNA]

FiremedicMike said:

I go to a respected nursing college that has been around for 120 years, this isn't a fly by night program. 
 

I'm getting exactly what I paid for and exactly what I wanted - the least painless way to get that magic piece of paper that turns my associates degree into a bachelors.

I got it now.  The least painless is the best.

[FiremedicMike, BSN, RN, EMT-P]

subee said:

I got it now.  The least painless is the best.

Why are you so smug?  You fly into these education threads and insist that nursing education isn't an inconsistent mess, crapping on everyone who questions their rigor and insisting they chose a bad program.

You do all of this while ignoring the fact that this is actually what the majority of the programs look like. 

[subee, MSN, CRNA]

FiremedicMike said:

Why are you so smug?  You fly into these education threads and insist that nursing education isn't an inconsistent mess, crapping on everyone who questions their rigor and insisting they chose a bad program.

You do all of this while ignoring the fact that this is actually what the majority of the programs look like. 

Doesn't mean we have room for improvement.  So many people on disparage the RN-to-BSN programs on this forum, that I think something is terribly wrong when people spend so much money for their extra credits and seem to be getting so little.  I worked with a nurse who's public health rotation consisted of going into a barbership and passing out information on hypertension.  That was it!  If we can't present students with something better, perhaps we should't REQUIRE people to do that as part of their employment.  If it doesn't add anything to the ADN, let's drop it.  It's another not very good cottage industry if so many students think it is useless.  And just because the majority of the programs suck, isn't any reason to think that's OK.  Personally I think an ADN is better enhanced with certifications than a BSN from a mill.

[FiremedicMike, BSN, RN, EMT-P]

subee said:

Doesn't mean we have room for improvement.  So many people on disparage the RN to BSN programs on this forum, that I think something is terribly wrong when people spend so much money for their extra credits and seem to be getting so little.  I worked with a nurse who's public health rotation consisted of going into a barbership and passing out information on hypertension.  That was it!  If we can't present students with something better, perhaps we should't REQUIRE people to do that as part of their employment.  If it doesn't add anything to the ADN, let's drop it.  It's another not very good cottage industry if so many students think it is useless.  And just because the majority of the programs suck, isn't any reason to think that's OK.  Personally I think an ADN is better enhanced with certifications than a BSN from a mill.

I think at the end of the day, you and I completely agree.  Folks who went to high quality BSN programs out of the gate may be better prepared as new grads, but in my experience, the majority of folks these days are doing ADN, starting practice, and then attending any one of the numerous RN-to-BSN programs.  These programs are widely reported to be mostly fluff, and with that fact being well known, categorically stating BSN = better or BSN = required is silly at best.

 

[Wuzzie]

subee said:

Personally I think an ADN is better enhanced with certifications than a BSN from a mill.

I've been saying this all along. It's become a big business and it seems it doesn't matter if it's a university or an on-line course. Certifications in specialties would seem to be a better option for nurses and their patients. 

[Tommy5677]

toomuchbaloney said:

BSN programs are not fluff.  

It's an opinion

[toomuchbaloney]

Tommy5677 said:

It's an opinion

It's an opinion that nursing offers nothing beyond the ADN that isn't fluff. The evidence contradicts that opinion.

[Asystole RN]

There is a real debate here as to the value of general education for a specific profession such as bedside patient care. 

For most professions a high school diploma or GED is required as the base level of general education. Is this even necessary? The arguments against a BSN hold true for high school diploma.

Should nursing be pure vocational training with a standardized test with no base general education requirement?

[subee, MSN, CRNA]

Tommy5677 said:

It's an opinion

Doesn't that depend on the quality of the program?  Do you want to be a profession or a trade?  My Spanish courses made things easiler for me when working.  I had the time in a four year program to do that.  But, in reality, we need to introduce methods to increase our numbers of graduates without lowering our standards.  The ADN now is already close to a 3 year program and they do receive general course requirements.  I, on the other hand, wanted a BSN and did what I had to do to get it.  But I don't think that it should be a requirement.  It did give me more opportunity but other people don't want to get it and they shouldn't be required.

[Asystole RN]

subee said:

Doesn't that depend on the quality of the program?  Do you want to be a profession or a trade?  My Spanish courses made things easiler for me when working.  I had the time in a four year program to do that.  But, in reality, we need to introduce methods to increase our numbers of graduates without lowering our standards.  The ADN now is already close to a 3 year program and they do receive general course requirements.  I, on the other hand, wanted a BSN and did what I had to do to get it.  But I don't think that it should be a requirement.  It did give me more opportunity but other people don't want to get it and they shouldn't be required.

I am someone who really wants nursing to be viewed as a profession. I do not think nursing is just bedside care, as many here do. 

The problem with nursing though (in true nursing fashion) is it is trying to be everything to everyone all at once. 

When we compare your job to my job to a bedside nurse to a school nurse to a psych nurse to a vascular access nurse to an informatics nurse to an infection preventionist nurse to an OR nurse there are generally very few practical similarities other than the similarities shared by all healthcare professions/trades. 

Nursing had started to fracture to represent some of these differences by creating CNAs, LPNs/LVNs, etc. Recently there has been a reversion to attempt to homogenize the profession. 

Personally I think the profession and our patients are better suited by fracturing the profession so that people can specialize. I see no reason where there cannot be ADN or even diploma nurses who are specifically trained to be at the bedside and only at the bedside. Have BSNs and MSNs be their own thing. DNPs/NPs,APRNs are already mostly their own thing. 

I think the problem is that everyone wants to be called a nurse/registered nurse and we are attempting to fit dozens of healthcare professions under a single title. Of course someone who is happy working bedside is going to disagree with a CRNA, DNP, APRN, etc... 

I personally think we should consider a restructuring of titles rather than shoehorning every specialty under the same profession. 

[toomuchbaloney]

The problem is the suggestion that the BSN should be the entry level for registered nurses.  That is wrong.  There is no reason to crowd out or diminish the very competent, even excellent nursing practiced by ADNs in a variety of bedside environments from outpatient clinics to ICU care.