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

[2BS Nurse, BSN]

In my area, the major health care companies require new ADN grads to complete the BSN (within 5 years of employment). They also contribute money toward the program. Honestly, the BSN program was pretty much a repeat of ADN program (I went to an excellent school for the ADN). I didn't get much out of the BSN program, but I do have a bachelor's in science in another field that required some really hard courses. The only reason I completed it was because it allowed me to change jobs easier.

The job market wasn't that great when I graduated - way before Covid. The students who worked as CNAs were hired first, not necessarily the students with BSNs.

[2BS Nurse, BSN]

I agree with Hobe: "What would make better nurses? Other nurse could mold better nurses by giving better training. Hospitals should be advocating for better training". These days, new nurses have to seek out training on their own time.

I'm my more limited experienced, it's the nurse who actually gives a sh*% about providing good care who makes the best nurse. I've worked with many who just don't care, BSN or not.

Moving into the education or supervisor fields don't always = better pay. Once salaried, you're putting in many unpaid hours. In my area, BSN and ADN are paid the same. You're not offered a salary increase upon BSN completion.

[traumaRUs, MSN, APRN]

I did the whole LPN to ADN to BSN to MSN to post-MSN certificates

At least for me, the BSN did NOT make me a better nurse - it made me poorer due to school loans. Having to pass "fluff" classes doesn't equate to better nursing. Add more pathophysiology, pharm and A&P and then I'll buy into it.

 

[nightwingcreations, CNA, LPN]

The whole idea is solely focused on hospital nurses. There is a large area of nursing jobs that do not pay better for a BSN over and ADN. It's like the push to do away with LPNs, who do they think does a majority of the nursing jobs in long term care facilities?  Or for that matter in rural hospitals. It's never going to happen. 

[RN1987]

I got more clinical experience in the ADN program. My BSN program was basically writing nonsense papers.

[Googlenurse, ASN, BSN, RN]

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

[mandm97, RN]

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. They did grandfather in ADN in my state but any new nurse getting an ADN needs to get a BSN in 10 years. It's a money grab for colleges and a status symbol for hospitals. I would never, even with employer help, have the extra money to spend on it or the time especially to do clinicals. The return on investment wasn't there. I did go to a college open house $20,000. I see some now advertising online for $11,000 but I am not sure I believe that will be the final cost. Our ADN program had a better NCLEX pass rate than the 4 year BSN schools.

What would make better nurses? Other nurse could mold better nurses by giving better training. Hospitals should be advocating for better training. I get it. It's hard to train when you are overworked. New nurses regardless of the degree are thrown into the trenches of the hospital to sink or swim. I never wanted to be a hospital nurse but nursing schools are all oriented towards hospital nursing. News flash, there are plenty of other types of nursing.  I get more out of CE's, professional development, experience and mentors then I could ever get from additional college courses to give me a BSN after my name. 

62 years young

 

I could not agree more with Hobe!  

[Tommy5677]

On some levels I get it. Professionalism being one of them. However, I believe the way nursing is going about it is a fools game, just as I believe phasing out diplomas was a huge mistake. I still believe diploma nurses were the best clinicians and most could run circles around BSNs.

However, I want to see the INDEPENDENT research about all those wonderful outcomes with BSN over ADN. I'm not buying it. Are BSN prepared nurses smarter? Does the additional coursework not on the NCLEX make them better clinicians? Really?

Another thing I would like to point out is this. ADN's are typically about 62 semester credits, BSN 120. And then you have the RN to BSN programs touting their nonsense about getting your RN to BSN in 3 semesters. Well, someone tell me how you can get 60 credits in 3 semesters and work. You can't do 20 credits a semester even when you don't work.. You have additional college coursework required and a slew of BSN required coursework, none of which is on the NCLEX. There should be something in place that would allow you to CLEP out of most if not all of it. I think the whole thing is a mess.

ADN programs were created in the 60's because of the shortage and the need to get nurses educated and on the floor, STAT! Has that need changed? Please tell me how. Most of the hospital nursing shortages are created by greedy CEOs who don't want to pay for adequate staffing because it might cut into their own exorbitant salaries.

Nursing  in general needs to get it's own collective act together before making a huge step like this. As far as I'm concerned that accomplishment is already a universe away.

[Hannahbanana, BSN, MSN]

FiremedicMike said:

It would be more impactful if these "studies" actually compared ADN to BSN within a specific unit/facility to compare med errors, length of stay, patient harm data, or any other metrics that could demonstrate competency.  Lets compare apples to apples, nurses in the same place with the same policies and same patient load - is there a statistically significant difference.

Your prayers have been answered. Actually, they were answered years ago. If you were really interested in evidenced-based care, you'd look up some of the great research on this very question done at the University of Penn and their associated hospital(s). 
TL;Dr: fewer infections, complications, readmissions, and shorter length of stay the higher %age of BSNs at bedside.
As to the initial post on this recurring thread, you could copy and paste it substituting "diploma" for "ADN" and it would be identical to what you would read if you time-traveled back to the origins of ADN programs and their proliferation in the 70s-80s, right down to the "I did it because they made me but I didn't learn anything and I'm a great nurse" tropes.

For my money, the economics are the driver here. There's a sheet-ton of press now with hospitals whining about how much money they spent on agency/travel nurses during COVID and now that they have reduced staffing due to burnout. Much pearl-clutching and angst over lost profits and unionizing by those selfish nurses. I keep waiting for the flood of letters to the editor pointing out the obvious: if they put half, no, even a third of that money on improving their regular staffing and pay scales there would be no shortages and a more loyal staff.

What does this have to do c degrees? Look around at other professions. A degreed work force as a whole commands higher salaries and higher respect, whether you like it or not. Nursing leadership, including the ANA, knows this. That's why they keep trying to advocate for strengthening the profession as a whole by increasing its average educational level. When actual bedside nurses finally realize how they have willingly refused to seize the power that a better science, economic, and leadership education they could have given them from the beginning, we'll all be better off, nurses and patients alike.

Yes, I went to BSN right from high school, at a time where only about 5% of nurses had bachelor's degrees. Yes, I had seven semesters of lab science courses over four years (2 semesters of basic chem, one semester of organic; bio, micro, anatomy, physiology, plus pharmacology), three years of 24 hours per week of bedside clinical including full quarters of psych, peds, public health, OB, medical, and surgical, an optional semester in critical care, and semesters of sociology, anthropology, and economics. This all seemed normal to me. College, right?
My first job out of school was in a 17bed PACU in a 700-bed hospital. They hired me, a diploma grad from their own school of nursing, and an ADN grad at the same time; it was astonishing to me how little these two knew about science and how we had to apply it every damn day. I got promoted to relief charge within 6 months, had better performance reviews,  regularly got assigned the sickest pts, and got poached by the ICU head nurse in a year. Because I was better prepared and had a better basis for learning more complex topics. 

The push to make a genuine bachelor's degree in nursing the entry into practice is to demonstrate that nurses are smart, autonomous, and educated professionals. That's economics. 
 

 

[londonflo]

Hannahbanana said:

They hired me, a diploma grad from their own school of nursing, and an ADN grad at the same time; it was astonishing to me how little these two knew about science and how we had to apply it every damn day.

One hand clapping!

I also graduated from a BSN program but didn't think I was more special than others who achieved their RN through other basic nursing programs. 

 

Hannahbanana said:

Nursing leadership, including the ANA, knows this

The ANA is not supportive of nursing, they want $$$$$$$$$$$$. Think about all the hoopla about magnet status....they are making so much money from hospitals who think 'magnet status' is prestigious. 

Then...if they think the BSN is so great why do they recommend   certifications which require more study (conveniently provided by them)  (there by making more $$)  

Quote

Study Plan Approximately 6 months before you plan to take your exam, develop a study plan. This could include self-study, finding a study buddy or group, taking a review course, taking an online narrated review course, reviewing current textbooks and articles, or other methods. The key is to have a study plan and follow through with it.

 

The ANA is so focused on money, they do not really focus on anything BUT money coming into their organization. How do they really represent the average nurse? They sure didn't do it during Covid 19 when the American Association of Nurse Practitioners  sent some whimpering nurses to talk to Trump! Did I read a prominent media rebuttal from the ANA who shared the same concerns? No! the ANA wrote a letter! 

https://www.cnbc.com/2020/05/06/coronavirus-equipment-trump-rebukes-nurse-in-white-house-exchange.html

 

[FiremedicMike, RN, EMT-P]

Hannahbanana said:

Your prayers have been answered. Actually, they were answered years ago. If you were really interested in evidenced-based care, you'd look up some of the great research on this very question done at the University of Penn and their associated hospital(s). 
TL;Dr: fewer infections, complications, readmissions, and shorter length of stay the higher %age of BSNs at bedside.
As to the initial post on this recurring thread, you could copy and paste it substituting "diploma" for "ADN" and it would be identical to what you would read if you time-traveled back to the origins of ADN programs and their proliferation in the 70s-80s, right down to the "I did it because they made me but I didn't learn anything and I'm a great nurse" tropes.

For my money, the economics are the driver here. There's a sheet-ton of press now with hospitals whining about how much money they spent on agency/travel nurses during COVID and now that they have reduced staffing due to burnout. Much pearl-clutching and angst over lost profits and unionizing by those selfish nurses. I keep waiting for the flood of letters to the editor pointing out the obvious: if they put half, no, even a third of that money on improving their regular staffing and pay scales there would be no shortages and a more loyal staff.

What does this have to do c degrees? Look around at other professions. A degreed work force as a whole commands higher salaries and higher respect, whether you like it or not. Nursing leadership, including the ANA, knows this. That's why they keep trying to advocate for strengthening the profession as a whole by increasing its average educational level. When actual bedside nurses finally realize how they have willingly refused to seize the power that a better science, economic, and leadership education they could have given them from the beginning, we'll all be better off, nurses and patients alike.

Yes, I went to BSN right from high school, at a time where only about 5% of nurses had bachelor's degrees. Yes, I had seven semesters of lab science courses over four years (2 semesters of basic chem, one semester of organic; bio, micro, anatomy, physiology, plus pharmacology), three years of 24 hours per week of bedside clinical including full quarters of psych, peds, public health, OB, medical, and surgical, an optional semester in critical care, and semesters of sociology, anthropology, and economics. This all seemed normal to me. College, right?
My first job out of school was in a 17bed PACU in a 700-bed hospital. They hired me, a diploma grad from their own school of nursing, and an ADN grad at the same time; it was astonishing to me how little these two knew about science and how we had to apply it every damn day. I got promoted to relief charge within 6 months, had better performance reviews,  regularly got assigned the sickest pts, and got poached by the ICU head nurse in a year. Because I was better prepared and had a better basis for learning more complex topics. 

The push to make a genuine bachelor's degree in nursing the entry into practice is to demonstrate that nurses are smart, autonomous, and educated professionals. That's economics. 
 

 

Sounds like you went to a quality BSN program that added substance to your ADN.

By in large, RN to BSN programs are pure fluff.  I'll be "attending" the program at a major brick and mortar school with a respected program that has been around for years.  It is 100% online, ZERO clinical component, and consists of nine 5-week courses that consist SOLELY on discussion board posts and papers, I believe I read in one of my earlier emails with their office that there aren't even exams.

This program will add exactly nothing to my clinical practice, but by golly I'll have that illustrious BSN which will magically lower my infection rate and  hospital stay.

 

[SuzanneRNLA]

londonflo said:

You betcha! A BSN can lead you to all those other types of nursing. Think about home health, out patient health, well baby visits.. and so much more....enrich your job scope, mind and thinking.!

I've been an RN for 46 years, and have worked all of the above plus informatics. I've managed and directed Home Health, as well and doing my own home visits. I've been a hospital RN, Clinic Manager, HH, and Informatics RN. All with an ADN. There were NO local BSN programs when I received my ADN. None after, either, unless one went full time. I had a family and had to work, so my degree (obtained part time, before online classes, is in Psychology. I earned my MS 10 years later--not in nursing, either. No problem EVER finding a job in nursing.