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

[subee, MSN, CRNA]

Asystole RN said:

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. 

I have posted before about it's time for 2 levels of board exams.  But the fact is now that our shortage has become dire and we need to make a lot more bedside nurses without lowering standards and also provide means for students to earn some income working on the floors to help pay for their education.  

[Asystole RN]

subee said:

I have posted before about it's time for 2 levels of board exams.  But the fact is now that our shortage has become dire and we need to make a lot more bedside nurses without lowering standards and also provide means for students to earn some income working on the floors to help pay for their education.  

I agree with you that there should be different board exams. 

I disagree about the shortage however. I think there is a potential shortage in the future but I have not seen great evidence for an existing shortage. 

Proponents of the shortage cite an aging population and aging nursing workforce, while true, this does not seem to have panned out in current hospital admission rates. Excluding the x-factor event of COVID, hospital admission rates up to 2019 have largely been rising at low single digits, largely only equaling admissions in the early 80's. 

It is true that we should expect higher rates of admissions in the future we should also keep in mind healthcare has greatly improved with an increase in preventative care and an incredible increase in ancillary and tertiary care. The variety of care and the use of technology has greatly influenced healthcare. I am not certain, at least I have not read great rationales, as to why there is/will be a shortage. 

While hospitals are struggling with filling positions salaries have largely been stagnant over the past 1-2 decades and working conditions if anything have decreased, all the while organizational profits have increased. I have recruiters calling me hiring for positions that pay LESS than what I was paid as a new grad over a decade ago. 

There is a strong desire for hospital, medical, and yes even nursing associations (largely run by corporate nursing leaders) to scream there is a shortage. If they can significantly increase the supply of nurses they can reduce compensation. Adequate supply means they have to keep up with inflation at least or else nurses will look for alternatives to the hospital bedside for inflation standard compensation. 

My biggest source of evidence that there is no shortage is that if there was we would see a significant increase in compensation and benefits for nurses as the demand remains the same or increases as patients increase. I am not aware of anywhere in the country where bedside nurses are reporting significant compensation increases, let alone keeping up with inflation. 

[FiremedicMike, BSN, RN, EMT-P]

Asystole RN said:

I agree with you that there should be different board exams. 

I disagree about the shortage however. I think there is a potential shortage in the future but I have not seen great evidence for an existing shortage. 

Proponents of the shortage cite an aging population and aging nursing workforce, while true, this does not seem to have panned out in current hospital admission rates. Excluding the x-factor event of COVID, hospital admission rates up to 2019 have largely been rising at low single digits, largely only equaling admissions in the early 80's. 

It is true that we should expect higher rates of admissions in the future we should also keep in mind healthcare has greatly improved with an increase in preventative care and an incredible increase in ancillary and tertiary care. The variety of care and the use of technology has greatly influenced healthcare. I am not certain, at least I have not read great rationales, as to why there is/will be a shortage. 

While hospitals are struggling with filling positions salaries have largely been stagnant over the past 1-2 decades and working conditions if anything have decreased, all the while organizational profits have increased. I have recruiters calling me hiring for positions that pay LESS than what I was paid as a new grad over a decade ago. 

There is a strong desire for hospital, medical, and yes even nursing associations (largely run by corporate nursing leaders) to scream there is a shortage. If they can significantly increase the supply of nurses they can reduce compensation. Adequate supply means they have to keep up with inflation at least or else nurses will look for alternatives to the hospital bedside for inflation standard compensation. 

My biggest source of evidence that there is no shortage is that if there was we would see a significant increase in compensation and benefits for nurses as the demand remains the same or increases as patients increase. I am not aware of anywhere in the country where bedside nurses are reporting significant compensation increases, let alone keeping up with inflation. 

I had my first job lined up 2 months before graduating in May of 22 and was offered the standard new grad rate.  Between job offer and my actual license in hand start date in June of 22, our system did 2-3 market adjustments and my first paycheck was nearly $10/hour higher than what I was originally offered, which was a 37% increase.  I'm told we have another market adjustment coming within the next 2 months.

I'm in a populated Midwest city with 6 RN programs in the area..

[toomuchbaloney]

Asystole RN said:

I agree with you that there should be different board exams. 

I disagree about the shortage however. I think there is a potential shortage in the future but I have not seen great evidence for an existing shortage. 

Proponents of the shortage cite an aging population and aging nursing workforce, while true, this does not seem to have panned out in current hospital admission rates. Excluding the x-factor event of COVID, hospital admission rates up to 2019 have largely been rising at low single digits, largely only equaling admissions in the early 80's. 

It is true that we should expect higher rates of admissions in the future we should also keep in mind healthcare has greatly improved with an increase in preventative care and an incredible increase in ancillary and tertiary care. The variety of care and the use of technology has greatly influenced healthcare. I am not certain, at least I have not read great rationales, as to why there is/will be a shortage. 

While hospitals are struggling with filling positions salaries have largely been stagnant over the past 1-2 decades and working conditions if anything have decreased, all the while organizational profits have increased. I have recruiters calling me hiring for positions that pay LESS than what I was paid as a new grad over a decade ago. 

There is a strong desire for hospital, medical, and yes even nursing associations (largely run by corporate nursing leaders) to scream there is a shortage. If they can significantly increase the supply of nurses they can reduce compensation. Adequate supply means they have to keep up with inflation at least or else nurses will look for alternatives to the hospital bedside for inflation standard compensation. 

My biggest source of evidence that there is no shortage is that if there was we would see a significant increase in compensation and benefits for nurses as the demand remains the same or increases as patients increase. I am not aware of anywhere in the country where bedside nurses are reporting significant compensation increases, let alone keeping up with inflation. 

https://www.usnews.com/news/health-news/articles/2022-11-01/the-state-of-the-nations-nursing-shortage

Quote

Even before the COVID-19 pandemic began to unfold at the start of 2020, a gap existed between the supply of registered nurses as reflected by federal data and demand through 2030 as projected by a pre-pandemic study from the U.S. Department of Health and Human Services. Once the COVID crisis hit, health care positions were not isolated from sudden job losses, which helped widen the gap between projected demand and the actual number of registered nurses in the U.S

https://www.aha.org/news/headline/2023-04-13-study-projects-nursing-shortage-crisis-will-continue-without-concerted-action

https://www.pbs.org/newshour/show/pandemic-burnout-worsens-nursing-shortages-in-hospitals-across-u-s

https://www.freep.com/story/news/health/2023/04/06/michigan-nurse-shortage-study-workplace-conditions/70077961007/

Maybe your metrics are flawed. 

[Asystole RN]

FiremedicMike said:

I had my first job lined up 2 months before graduating in May of 22 and was offered the standard new grad rate.  Between job offer and my actual license in hand start date in June of 22, our system did 2-3 market adjustments and my first paycheck was nearly $10/hour higher than what I was originally offered, which was a 37% increase.  I'm told we have another market adjustment coming within the next 2 months.

I'm in a populated Midwest city with 6 RN programs in the area..

Thats good! I would bet money though that your compensation is probably still not where it should be. When I was in nursing school I was given a 1-year paid externship and offered a sign-on bonus. In my market though the pay is still the same as it was over a decade ago but without the sign-on bonus and worse benefits. 

[Asystole RN]

toomuchbaloney said:

https://www.usnews.com/news/health-news/articles/2022-11-01/the-state-of-the-nations-nursing-shortage

https://www.aha.org/news/headline/2023-04-13-study-projects-nursing-shortage-crisis-will-continue-without-concerted-action

https://www.pbs.org/newshour/show/pandemic-burnout-worsens-nursing-shortages-in-hospitals-across-u-s

https://www.freep.com/story/news/health/2023/04/06/michigan-nurse-shortage-study-workplace-conditions/70077961007/

Maybe your metrics are flawed. 

My metrics are not based upon opinions, case studies, and patient interviews. My logic is very simple. A core fundamental principle of economics is that where there is scarcity, price increases. If there is a scarcity of nurses where are all of the retention bonuses? Where are the raises that simply keep up with inflation? Where are all of the hiring bonuses? 

When there was true scarcity, during the x-factor of COVID, we did see historically high wages with travelers but that has not translated to increased wages post COVID. 

Where are all of the nurses with amazing bonuses and raises? 

[toomuchbaloney]

Asystole RN said:

My metrics are not based upon opinions, case studies, and patient interviews. My logic is very simple. A core fundamental principle of economics is that where there is scarcity, price increases. If there is a scarcity of nurses where are all of the retention bonuses? Where are the raises that simply keep up with inflation? Where are all of the hiring bonuses? 

When there was true scarcity, during the x-factor of COVID, we did see historically high wages with travelers but that has not translated to increased wages post COVID. 

Where are all of the nurses with amazing bonuses and raises? 

You are seeing a reflection of the American Healthcare system and the functioning business model that has not valued nurses since the 1980s, and that dating is being generous.  Nurses have largely been considered an expensive necessity by health business for many years.  The money people always look at nursing services for cost savings because they say we don't make them money.  

I would suggest that without nurses to staff the inpatient units, hospitals largely become outpatient surgical centers and outpatient treatment centers. The profit focused health system benefits from the lack of a unified nursing union or bargaining group and infighting over degrees. 

[Asystole RN]

toomuchbaloney said:

You are seeing a reflection of the American Healthcare system and the functioning business model that has not valued nurses since the 1980s, and that dating is being generous.  Nurses have largely been considered an expensive necessity by health business for many years.  The money people always look at nursing services for cost savings because they say we don't make them money.  

I would suggest that without nurses to staff the inpatient units, hospitals largely become outpatient surgical centers and outpatient treatment centers. The profit focused health system benefits from the lack of a unified nursing union or bargaining group and infighting over degrees. 

You are kind of making the argument from both sides and have now flip flopped. 

If there is a nursing shortage that means there is a lack of nurses for the demand. If nurses are not valued then there is a lack of demand, hence no shortage. 

Unions and healthcare organizational motivations aside, there is either too much demand or too little demand. A shortage would mean demand exceeds supply. Hospitals devaluing nurses means supply exceeds demand. 

Tell me, in your experience and in your opinion...do you think nurses are valued or not not valued? If they are not valued then supply exceeds, or at least meets, demand. If you feel they are valued, compensated exceedingly well, raises are common and exceed inflation then there might be a shortage. 

The same profit driven organization you demonize is the very organization that has sold you on the idea that there is a scarcity of nurses so that supply is increased. 

[Asystole RN]

@toomuchbaloney

Think about this thought exercise/economics exercise. Why are physicians paid more than nurses? You might think it is because physicians have more education. If education was the driving factor then why is the national average salary for those with a PhD in Microbiology, history, etc either very close to the national average of nursing or sometimes even less? 

What drives salary, outside of regulatory factors, is demand. Physicians are scarce so they are paid more. Nurses, microbiologists, and historians either meet or exceed demand, hence no scarcity which means suppressed compensation. 

When things are scarce prices increase. Hurricane wipes out the oranges in Florida and then we all are paying a premium for orange juice. Nurses go on strike (decreasing supply increasing scarcity) the hospital has to pay higher wages to either the scabs or the striking nurses. 

Why is the nursing shortage a common issue touted by AHA and other organizations? For the very reason you mentioned. Nursing is a great place to cut costs. The more nurses that are graduated means supply will exceed demand allowing hospitals to suppress compensation and increase staffing ratios.  

 

[toomuchbaloney]

Asystole RN said:

You are kind of making the argument from both sides and have now flip flopped. 

If there is a nursing shortage that means there is a lack of nurses for the demand. If nurses are not valued then there is a lack of demand, hence no shortage. 

Unions and healthcare organizational motivations aside, there is either too much demand or too little demand. A shortage would mean demand exceeds supply. Hospitals devaluing nurses means supply exceeds demand. 

Tell me, in your experience and in your opinion...do you think nurses are valued or not not valued? If they are not valued then supply exceeds, or at least meets, demand. If you feel they are valued, compensated exceedingly well, raises are common and exceed inflation then there might be a shortage. 

The same profit driven organization you demonize is the very organization that has sold you on the idea that there is a scarcity of nurses so that supply is increased. 

I'm telling you that in the healthcare world, they have been over working and underpaying nurses for decades.  Short staffing is a business model and our declining health measurements reflect the consequences of allowing payment and money to fracture our system in to profit centers. The public has been gas lighted into believing that we have the best health system in the world and that simply is not true and this is part of the reason. 

Nurses are only paid more when it's a crisis for the hospitals. The pandemic reflected that.  As a profession, we are divided and willing to accept what they give us. 

[toomuchbaloney]

Asystole RN said:

@toomuchbaloney

Think about this thought exercise/economics exercise. Why are physicians paid more than nurses? You might think it is because physicians have more education. If education was the driving factor then why is the national average salary for those with a PhD in Microbiology, history, etc either very close to the national average of nursing or sometimes even less? 

What drives salary, outside of regulatory factors, is demand. Physicians are scarce so they are paid more. Nurses, microbiologists, and historians either meet or exceed demand, hence no scarcity which means suppressed compensation. 

When things are scarce prices increase. Hurricane wipes out the oranges in Florida and then we all are paying a premium for orange juice. Nurses go on strike (decreasing supply increasing scarcity) the hospital has to pay higher wages to either the scabs or the striking nurses. 

Why is the nursing shortage a common issue touted by AHA and other organizations? For the very reason you mentioned. Nursing is a great place to cut costs. The more nurses that are graduated means supply will exceed demand allowing hospitals to suppress compensation and increase staffing ratios.  

 

MDs seized professional power and nurses did not.  MDs are largely esteemed by hospitals based upon profit generated and reputation within the community.  

The supply has almost always exceeded the demand because the demand has, for very many years, been below what the data says it should be.  That's the chronic understaffing.  What was normal pre-pandemic was nurses accepting unsafe staffing levels because (fill in current budget or admin concern). Now post pandemic, there's some expectation that you will work harder than you worked in 2019 but it's not as bad as 2000 so you should be good.  

Until nurses organize themselves AND we step away from this failing profit focused health system the trends won't change in favor of nurses. 

[Asystole RN]

toomuchbaloney said:

I'm telling you that in the healthcare world, they have been over working and underpaying nurses for decades.  Short staffing is a business model and our declining health measurements reflect the consequences of allowing payment and money to fracture our system in to profit centers. The public has been gas lighted into believing that we have the best health system in the world and that simply is not true and this is part of the reason. 

Nurses are only paid more when it's a crisis for the hospitals. The pandemic reflected that.  As a profession, we are divided and willing to accept what they give us. 

I 100% agree with you that they have been underpaying nurses for decades and overworking them. This is a reflection of a supply of nurses that meets or exceeds demand. 

As someone who travels the world assessing healthcare professionally I would partially disagree about the quality of healthcare. Too complex of an issue to cite a "best" but we are the best in many factors (by default) but worse in many other factors. I can speak for ages about quality of healthcare between different countries but your point is taken. 

I love that you say nurses were only paid more when it is a crisis! Its true! Scarcity of resources in action! Evidence that there is no shortage of nurses. 

We are a divided profession and unfortunately we are victims of a sustained propaganda campaign by those wishing to profit off an excess of nurses (schools, hospitals, healthcare organizations, etc).