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

[Rionoir, ADN, RN]

I've been hearing this for years but it's never going to happen - only academics think that BSNs are more prepared to be nurses. The reality is that RN to BSN is a silly degree that shouldn't be required unless one wants to jump through the hoops to go on to higher levels of education. It absolutely does not make one a better bedside nurse.

[KalipsoRed21, BSN, RN]

Rionoir said:

I've been hearing this for years but it's never going to happen - only academics think that BSNs are more prepared to be nurses. The reality is that RN to BSN is a silly degree that shouldn't be required unless one wants to jump through the hoops to go on to higher levels of education. It absolutely does not make one a better bedside nurse.

You had me until the end. Yes, getting a BSN DOES make you a better nurse. NO, a BSN is not required to be a competent, safe, effective, and great nurse.

In general, more education DOES help fulfill gaps in one's ability to process issues.

I work with a medical assistant who is excellent. She has been one for 15 years. She has proven that she can run the whole clinic by herself...she is very good. She fancies herself "practically a nurse" and I wholeheartedly agree that she is. However, things pop up that she cannot think through to the most appropriate level of care. For instance, I had been letting her do self catheter teaching, I mean she is the one who showed ME the material, but recently found out that she doesn't make sure the patient tries it before they leave. She does realize that different sample types are better for different issues. A coude is best for prostates hard to pass, some catheters just have a rubber 'grippy' that slides up and down the catheter for patients to use to insert sterile. Some have a plastic sleeve encompassing the entire catheter. The second is best for people with manual dexterity issues because it prevents them from touching the catheter at all on accident. My MA has been doing urology for 5 years. I have been doing it for 1. And that would be an example of how education helps you put pieces together BETTER. Is the MA's care bad or incompetent? No. Is my care better? Yes. Is my care REQUIRED to have good outcomes? NO. But the more complex the needs are....YES.

So I would say ADN is not required to be a great nurse, depending on your career goals. And that on certain hospital units, it would be best if hospitals hired more ADNs. Like medical surgical, telemetry, psychiatry, orthopedic units, pre-op, non specialty clinics, and urgent care. But once one decides they want more, like ICU, emergency department, OR, trauma, etc....yeah you need to be aiming to get a BSN. 

[Hoosier_RN, MSN]

KalipsoRed21 said:

You had me until the end. Yes, getting a BSN DOES make you a better nurse. NO, a BSN is not required to be a competent, safe, effective, and great nurse.

In general, more education DOES help fulfill gaps in one's ability to process issues.

I work with a medical assistant who is excellent. She has been one for 15 years. She has proven that she can run the whole clinic by herself...she is very good. She fancies herself "practically a nurse" and I wholeheartedly agree that she is. However, things pop up that she cannot think through to the most appropriate level of care. For instance, I had been letting her do self catheter teaching, I mean she is the one who showed ME the material, but recently found out that she doesn't make sure the patient tries it before they leave. She does realize that different sample types are better for different issues. A coude is best for prostates hard to pass, some catheters just have a rubber 'grippy' that slides up and down the catheter for patients to use to insert sterile. Some have a plastic sleeve encompassing the entire catheter. The second is best for people with manual dexterity issues because it prevents them from touching the catheter at all on accident. My MA has been doing urology for 5 years. I have been doing it for 1. And that would be an example of how education helps you put pieces together BETTER. Is the MA's care bad or incompetent? No. Is my care better? Yes. Is my care REQUIRED to have good outcomes? NO. But the more complex the needs are....YES.

I'm going to respectfully disagree. I've met LPNs of 1 year who can outperform and outthink BSNs of 20+ years. It's more about ability to think critically and carry out the thought path, which a classroom doesn't guarantee. I've seen it often throughout my career

[Rionoir, ADN, RN]

KalipsoRed21 said:

You had me until the end. Yes, getting a BSN DOES make you a better nurse. NO, a BSN is not required to be a competent, safe, effective, and great nurse.

In general, more education DOES help fulfill gaps in one's ability to process issues.

I work with a medical assistant who is excellent. She has been one for 15 years. She has proven that she can run the whole clinic by herself...she is very good. She fancies herself "practically a nurse" and I wholeheartedly agree that she is. However, things pop up that she cannot think through to the most appropriate level of care. For instance, I had been letting her do self catheter teaching, I mean she is the one who showed ME the material, but recently found out that she doesn't make sure the patient tries it before they leave. She does realize that different sample types are better for different issues. A coude is best for prostates hard to pass, some catheters just have a rubber 'grippy' that slides up and down the catheter for patients to use to insert sterile. Some have a plastic sleeve encompassing the entire catheter. The second is best for people with manual dexterity issues because it prevents them from touching the catheter at all on accident. My MA has been doing urology for 5 years. I have been doing it for 1. And that would be an example of how education helps you put pieces together BETTER. Is the MA's care bad or incompetent? No. Is my care better? Yes. Is my care REQUIRED to have good outcomes? NO. But the more complex the needs are....YES.

So I would say ADN is not required to be a great nurse, depending on your career goals. And that on certain hospital units, it would be best if hospitals hired more ADNs. Like medical surgical, telemetry, psychiatry, orthopedic units, pre-op, non specialty clinics, and urgent care. But once one decides they want more, like ICU, emergency department, OR, trauma, etc....yeah you need to be aiming to get a BSN. 

There's definitely a difference between LPN and BSN, but ADN (RN) programs have a huge focus on critical thinking just as a BSN program would. I took all but two courses in a RN to BSN program and it was literally just all writing papers and nursing history. You don't learn anything clinical in a BSN program that you wouldn't also learn in an ADN program. We all have to take the NCLEX at the end of the day, so there really aren't any shortcuts to that.

[subee, MSN, CRNA]

Hoosier_RN said:

I'm going to respectfully disagree. I've met LPNs of 1 year who can outperform and outthink BSNs of 20+ years. It's more about ability to think critically and carry out the thought path, which a classroom doesn't guarantee. I've seen it often throughout my career

But that's not what the poster said.  They said that BSN students are exposed to more processing skills, which believe me, they go through in their non-nursing classes.  They said that nursing education specifically isn't better in a BSN program.  An it doesn't help make any difference if an LPN thinks critically - there are just certain functions that they can't do by regulation but I would never want an LPN that thinks any differently than critically (I just wish they could all become RN's).

[Hoosier_RN, MSN]

subee said:

But that's not what the poster said.  They said that BSN students are exposed to more processing skills, which believe me, they go through in their non-nursing classes.  They said that nursing education specifically isn't better in a BSN program.  An it doesn't help make any difference if an LPN thinks critically - there are just certain functions that they can't do by regulation but I would never want an LPN that thinks any differently than critically (I just wish they could all become RN's).

And I will say again, I know some BSNs that took all the classes that still can't think their way out of a room with multiple exits, while there are LPNs who just "get it". We all know nurses, actually all professions, like that. I think the extra classes may help round that out in some, but others already have it.

I had all of the classes in my computer science bachelors classes, I literally took 2 research classes and a community heath class, over 2 semesters because of how they're offered, to get my BSN through IU many years ago. I can't say that it did much to change how I think as a nurse, as I had multiple data science research classes in my other degreed program, they just couldn't be used as they were not "nursing", although the concepts were the same

[FiremedicMike, BSN, RN, EMT-P]

This issue is being conflated by people trying to compare LPN to RN or even MA to RN and is a completely irrelevant to the discussion.

 

[Hoosier_RN, MSN]

FiremedicMike said:

This issue is being conflated by people trying to compare LPN to RN or even MA to RN and is a completely irrelevant to the discussion.

 

Nope, trying to point out that for some, level of education is sometimes irrelevant in a field. There are educated book smart idiots, and there are people who don't have the formal education that definitely highlight that idiocity by running rings around the "educated" person. Education doesn't always = intelligence or ability to process

[Ann Fosque]

I agree...I have experienced the truth in this statement...

1st hospital...a Level II Trauma Center...worked nights...ER Registrar and Admitting & Bed Control Rep

2nd a Community Hospital... worked as a Clinical Coordinator 

3rd and last a Burn Center and TPLT Center...working as a Clinical Navigator 

Once upon a time...we had Team Nursing 

Hospitals are now hybrid...Corporations and Healthcare Institutions...some Nurses are frustrated and disappointed...others are doing well

[subee, MSN, CRNA]

Hoosier_RN said:

Nope, trying to point out that for some, level of education is sometimes irrelevant in a field. There are educated book smart idiots, and there are people who don't have the formal education that definitely highlight that idiocity by running rings around the "educated" person. Education doesn't always = intelligence or ability to process

I am aware this is an aside:)  but I think where one goes to college makes a huge difference.  In my freshman year, 3 girls were assigned to one room which made it a shock when the 3 of us met in this small room.  But an hour later at the new resident's meeting, we found out that 1 out of the 3 students in the dorm rooms will flunk out.  I think that, under that kind of pressure, students have to learn to negotiate for success in staying in and that involved thinking sharply in all our classes.  That kind of discipline transfers to the next set of challenges that the students have to face.  However, the RN-to-BSN programs are money sinks with online professors who have other jobs, are difficult to speak with, etc.  No, at that point more credits doesn't mean very much.  The ADN program will give any intelligent and motivated person enough education to succeed in a hospital practice.  Most nurses are good autodidacts which is the most important quality.  We would be foolish to think that ADN programs are going away any time soon.

[KalipsoRed21, BSN, RN]

Hoosier_RN said:

Nope, trying to point out that for some, level of education is sometimes irrelevant in a field. There are educated book smart idiots, and there are people who don't have the formal education that definitely highlight that idiocity by running rings around the "educated" person. Education doesn't always = intelligence or ability to process

"Some times" formal education IS irrelevant for SOME people. But establishing average pathways of achievement usually occur because 'on average' the required amount of education achieves the desired outcome. The question is 'Are they going to phase out ADN.’ In general the answer is 'No'. On average I think we can all agree that ADNs are under utilized. But I would maintain that 'on average' the best outcomes for the patient and the employer in highly critical areas (ER, ICU, Stepdown, Transplant, etc) would be a BSN RN who has has at least 2 years of floor experience. Best basic would be Tele Med Surg.

[toomuchbaloney]

We've known and documented through research that increased contact with RNs improves patient outcomes. This is true in both inpatient and outpatient settings.  The forprofit health industry ignores that data, preferring to keep nursing staffed at bare bones minimums.  Our patient outcomes have been in decline for decades because of this. The studies do not place a differentiation on the degrees of the RN as the basic knowledge base of even a hospital trained "diploma" nurse provided this improved patient experience and outcome.  The industry that chronically under pays and understaffs nursing units as a business model is insistent that if the nurses would just get BSNs rather than ADNs, they would be so much more productive and better at doing the work of two disciplines or 2 staff. This fear mongering is part of that control.