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

[Jurse, LPN]

KalipsoRed21 said:

"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.

I'm an LPN who works in the step-down unit. I had no prior experience. So far, there has been no issue. They said that "the unit rarely hired an inexperienced nurse." I started in the med-surg unit and was transferred to the step-down unit. 

[MaxAttack, BSN, RN]

toomuchbaloney said:

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.

[FiremedicMike, BSN, RN, EMT-P]

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

But your post really has nothing to do with the issue at hand, which is BSN vs ADN.  There is a world of difference between LPN and RN education, and MA isn't even in the same ballpark.  There are phenomenal LPNs and MAs, but it's still not the point.

I am literally working on my RN to BSN and it is literally nothing more than busywork, discussion board posts and papers about meaningless topics that are more strictly graded for their adherence to APA formatting than the substance of the paper - and frankly there's no reason to actually create a meaningful paper because it's not going anywhere beyond the grade book for a meaningless hurdle in our lives.

TL:Dr - RN to BSN had added absolutely nothing to my clinical practice.

[Hoosier_RN, MSN]

FiremedicMike said:

But your post really has nothing to do with the issue at hand, which is BSN vs ADN.  There is a world of difference between LPN and RN education, and MA isn't even in the same ballpark.  There are phenomenal LPNs and MAs, but it's still not the point

Then you totally focused on my post and not the post that it was replying to, claiming that BSNs are much better nurses than ADNs. My post simply pointed out that level of education does not necessarily mean better care, I just used lower levels of education in the healthcare chain, just to broaden the point 

I did my RN to BSN bridge in 2005, it was busy work then, I'm sure not much has changed. Going to my MSN was even more busy work...

My point has been, it doesn't add much to practice, not sure how you didn't get that from my posts 

[FiremedicMike, BSN, RN, EMT-P]

Hoosier_RN said:

Then you totally focused on my post and not the post that it was replying to, claiming that BSNs are much better nurses than ADNs. My post simply pointed out that level of education does not necessarily mean better care, I just used lower levels of education in the healthcare chain, just to broaden the point 

To be fair - I was responding in general.  There are several posts on the thread comparing LPN to RN and MA to RN, I wasn't calling you out directly.

[subee, MSN, CRNA]

FiremedicMike said:

But your post really has nothing to do with the issue at hand, which is BSN vs ADN.  There is a world of difference between LPN and RN education, and MA isn't even in the same ballpark.  There are phenomenal LPNs and MAs, but it's still not the point.

I am literally working on my RN to BSN and it is literally nothing more than busywork, discussion board posts and papers about meaningless topics that are more strictly graded for their adherence to APA formatting than the substance of the paper - and frankly there's no reason to actually create a meaningful paper because it's not going anywhere beyond the grade book for a meaningless hurdle in our lives.

TL:Dr - RN to BSN had added absolutely nothing to my clinical practice.

And that is the failure of our own trade- profession to regulate the quality of our education.  We've just started a cottage industry of passing BSN's out to a lot of folks who aren't getting what they paid for.  I only had one class in my generic BSN program that I thought was a real waste - nursing theory.  I'm glad that I added to my Spanish knowledge and that had a liberal arts education.  We want to be called a profession but we are really white collar trade workers and the degree standards for the add-on BSN are so low, we should probably just give up on the BSN except for folks who want to expand their practice and just let people keep the money in their pockets that they put out for their degree.  

 

[Jurse, LPN]

londonflo said:

An ADN program is very expensive to run. In my state, we are limited to 10 students to a clinical instructor. What those 10 students pay in tuition for the clinical credit (3 hours of clinical equals 1 credit) does not pay the salary of the instructor. 

They talk out of their anal cavities a lot. 

[Rionoir, ADN, RN]

subee said:

And that is the failure of our own trade- profession to regulate the quality of our education.  We've just started a cottage industry of passing BSN's out to a lot of folks who aren't getting what they paid for.  I only had one class in my generic BSN program that I thought was a real waste - nursing theory.  I'm glad that I added to my Spanish knowledge and that had a liberal arts education.  We want to be called a profession but we are really white collar trade workers and the degree standards for the add-on BSN are so low, we should probably just give up on the BSN except for folks who want to expand their practice and just let people keep the money in their pockets that they put out for their degree.  

 

Magnet hospitals say you need to have one within X period of time if you are a new grad, but as long as you change jobs within the first couple years of being a nurse - then once you pass that two year threshold you aren't required to get a BSN any longer. Kind of a silly loophole actually - they should just do away with it as you say.

[toomuchbaloney]

Rionoir said:

Magnet hospitals say you need to have one within X period of time if you are a new grad, but as long as you change jobs within the first couple years of being a nurse - then once you pass that two year threshold you aren't required to get a BSN any longer. Kind of a silly loophole actually - they should just do away with it as you say.

https://www.medpagetoday.com/nursing/nursing/68525

Quote

Last month, a study of a single hospital found that nurses who worked there 2 years after it lost its Magnet designation reported significantly lower work engagementopens in a new tab or window than those who worked there under Magnet status. Similarly, a 6-year-old study found that Magnet hospitals provide better work environments and a more highly educated nursing workforceopens in a new tab or window than non-Magnet hospitals.

A 2010 study, however, found no significant differenceopens in a new tab or window in working conditions between Magnet and non-Magnet hospitals.

The clinical outcomes literature is similarly equivocal: one study from 2013 found that Magnet hospitals have 14% lower mortalityopens in a new tab or window and 12% lower failure-to-rescue rates than non-Magnet hospitals. But a 2011 study showed that non-Magnet hospitals generally had better patient outcomesopens in a new tab or window than Magnet hospitals.

Regardless of whether they work at a Magnet hospital or not, nurses are likely to face continued pressure as hospital administrators focus on keeping costs down, Summers said.

But Nitzky still channeled the blame on Magnet: "What we really need is a massive sit-down strike of all physicians and nurses who work under these oppressive conditions to band together and say, enough. This is not healthcare. This is a profit-generating scheme that preys on direct caregivers and the uninformed public."

Question everything.  

[KalipsoRed21, BSN, RN]

subee said:

And that is the failure of our own trade- profession to regulate the quality of our education.  We've just started a cottage industry of passing BSN's out to a lot of folks who aren't getting what they paid for.  I only had one class in my generic BSN program that I thought was a real waste - nursing theory.  I'm glad that I added to my Spanish knowledge and that had a liberal arts education.  We want to be called a profession but we are really white collar trade workers and the degree standards for the add-on BSN are so low, we should probably just give up on the BSN except for folks who want to expand their practice and just let people keep the money in their pockets that they put out for their degree.  

 

Now there is a real thought. I think it would be more beneficial to have an RN who has certification in the areas s/he is working in rather than a BSN. I still hold that I feel highly critical areas of nursing should have a BSN as well. To be honest I didn't find school to be overly helpful in learning techniques, skills, or time management. I did not learn to be a nurse at school, most definitely. I learned to be a nurse working the floor. However, the step by step process of thinking through a problem, identifying solid literature from 'Google' fluff articles. Those were valuable lessons from school and still help me in my practice today.

[subee, MSN, CRNA]

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. 

I don't know why one needs more than an ADN.  Their jobs hardly require anything from the sciences we take in nursing schools.  I've always thought that they should have their own degree.  It would be awesome to have an ORN graduate on a Friday and.be ready to be up and running on Monday knowing the full range of services in the OR.  We have OR techs with Associate degrees much more knowledgeable and capable.  

 

[FiremedicMike, BSN, RN, EMT-P]

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. 

Prove it.  And don't cite studies that say "hospitals with more BSN's have lower mortality rates" because that ignores a myriad of other confounding variables.

Frankly, it's academically dishonest to say otherwise.  There is literally no possible way to prove that a BSN is the variable that makes one nurse better than another.  The BSN simply cannot ever be isolated as an independent variable in any real meaningful way.  Work experience, life experience, unit staffing, unit management support, even whether or not they had a healthy breakfast that morning or were able to pee in the last hour can affect it.  And lets not forget, no two patients, no two patient outcomes, no two cardiac arrests are EVER the same.

I do want to be clear on one thing, I do enjoy education.  I have a bachelors in another field, now an ADN, currently working on a dual enrollment BSN/MSN program, so I enjoy learning, but I'm not going to sit around the campfire and try to convince everyone that a nurse becomes a better nurse just because they earned a BSN.