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

[SuzanneRNLA]

SuzanneRNLA said:

I graduated with an ADN in 1977, and that was the message back then. And yet here we are, still hearing the same message. I have never had a problem getting a job I wanted. I've been a floor nurse, supervisor, manager, director, case manager, and Information systems RN. I've taught in MSN, BSN, ADN and LPN schools. I do have a BA and MS in other fields, though.

 

[Tommy5677]

SuzanneRNLA said:

graduated with an ADN in 1977, and that was the message back then. And yet here we are, still hearing the same message. I have never had a problem getting a job I wanted. I've been a floor nurse, supervisor, manager, director, case manager, and Information systems RN

I'm not far behind you and graduated in '80. I too could have most any position I wanted until about 10 years ago. Now all the ads are either BSN preferred or required.

I remember the days (I'm on the verge of retirement so that gives you a clue) when you could have a direct appt with the DON who oftentimes would hire you on the spot (a sign of desperation to be sure). Then HR took over. Now you need 2 interviews with HR before you even get to see the DON and then at least 2 interviews with the DON. All while competing with 200 other RN's for the same job. If you're not the greatest interviewee on the planet...

I worked as a Health Coach on the west coast with an insurance company for 11 years, moved east, saw an ad for exactly the same job I was doing all those 11 years. They didn't even give me the time of day and I'm sure it was because of degree status. Oh and both were BCBS companies.

[FiremedicMike, RN, EMT-P]

Tommy5677 said:

I'm not far behind you and graduated in '80. I too could have most any position I wanted until about 10 years ago. Now all the ads are either BSN preferred or required.

I remember the days (I'm on the verge of retirement so that gives you a clue) when you could have a direct appt with the DON who oftentimes would hire you on the spot (a sign of desperation to be sure). Then HR took over. Now you need 2 interviews with HR before you even get to see the DON and then at least 2 interviews with the DON. All while competing with 200 other RN's for the same job. If you're not the greatest interviewee on the planet...

I worked as a Health Coach on the west coast with an insurance company for 11 years, moved east, saw an ad for exactly the same job I was doing all those 11 years. They didn't even give me the time of day and I'm sure it was because of degree status. Oh and both were BCBS companies.

Last year, 3 months from graduation, I emailed the recruiter at 7pm for an ED position.  She responded 5 mins later to setup a phone interview for the next day, a 5 minute discussion to schedule a unit interview the following Monday, and I had a job offer 3 hours after the unit interview.  
 

Im not sure what highly competitive environment you're in but we're not seeing that in this area.

[Hoosier_RN, MSN]

SuzanneRNLA said:

 

Same in '93. I did go get my BSN in 05, as I knew eventually I wanted to promote. I got my MSN a few years ago just for my own satisfaction. I'm back at the chairside as a charge nurse, not sure I want to do direct management again

[londonflo]

FiremedicMike said:

Im not sure what highly competitive environment you're in but we're not seeing that in this area.

I wonder if it is 'age ism'. I worked for many self-insured health care companies. I developed a chronic illness that had an elusive diagnosis. Calling in sick was met with anger and disbelief. And as I was always hospitalized, I got a visit from my boss. ( when she was hospitalized. there was a sign on her door -- no visitors). One time I was not even paid for my sick day because "I might need the $$ later" for another sick day, per my boss. Thank God I left for a better job.

At my next job,  I was on the insurance committee (another self-insured). When deciding the rates for the enrollees we were shown the top 5 bills the insurance company had to pay (no names). This was the justification for the insurance rates increasing --- nothing said about how much $$ had been collected to pay the bills. Just a knee-jerk reaction to raise the rates. 

[FiremedicMike, RN, EMT-P]

Just popping in..

I'm now well into my RN to BSN and I still feel exactly the same, perhaps a bit more cantankerous.  For frame of reference, I go to a respected program that has been around a long time and run in a brick and mortar school.

My take thus far?  Every single class is about "how to write a paper" and each class acts like it's the first time we've been taught to write a paper.  They truthfully don't care what we write about "we're just really making sure you understand the process of researching and writing a paper".

My opinion on anything I'm writing is truly irrelevant, so long as I can APA cite it.  Spending a year of my life learning to correctly APA cite papers that I don't care about is not going to help my nursing practice at all (FiremedicMike, 2023). 

 

[Hoosier_RN, MSN]

FiremedicMike said:

Just popping in..

I'm now well into my RN to BSN and I still feel exactly the same, perhaps a bit more cantankerous.  For frame of reference, I go to a respected program that has been around a long time and run in a brick and mortar school.

My take thus far?  Every single class is about "how to write a paper" and each class acts like it's the first time we've been taught to write a paper.  They truthfully don't care what we write about "we're just really making sure you understand the process of researching and writing a paper".

My opinion on anything I'm writing is truly irrelevant, so long as I can APA cite it.  Spending a year of my life learning to correctly APA cite papers that I don't care about is not going to help my nursing practice at all (FiremedicMike, 2023). 

 

Amen! 

[Red Shirt 6, CNA]

One time I asked a manager at a hospital about hiring LPN, ADNand I was told that they do not like to hire LPN or ADN because many hires will go for their BSN, MSN, or NP . Then the nurses would have to be paid more or the nurses end up leaveing because the hospital does not have open positions. And management would have to interview and hire again. So it is easier for them to make all positions RN BSN. I am not sure about other types of employers think about hiring with BSN as required or preferred. 

[toomuchbaloney]

Red Shirt 6 said:

One time I asked a manager at a hospital about hiring LPN, ADNand I was told that they do not like to hire LPN or ADN because many hires will go for their BSN, MSN, or NP . Then the nurses would have to be paid more or the nurses end up leaveing because the hospital does not have open positions. And management would have to interview and hire again. So it is easier for them to make all positions RN BSN. I am not sure about other types of employers think about hiring with BSN as required or preferred. 

What a pathetic excuse to keep staffing low.  

[Rionoir, ADN, RN]

Tell me you live in California without telling me you live in California... 

[floydnightingale]

CD2 BSN here: I could never tell the difference between an ADN and a BSN nurse and they'll have to seriously ramp up BSN programs to satisfy their wants and needs. In my experience the most knowledgeable and capable RNs came from hospital diploma programs but as far as I know that ended long ago.

[Don Gloves]

I have a BS in another subject, then earned an ADN (with honors) in 2007 while my children were young. The community college was much closer than the university that offered a second degree BSN. I check the box for a four-year degree- but alas, no BSN. Paying > $10,000 for an RN to BSN while saving for my kids' college didn't happen. Over the course of my career, I've worked with many a mediocre BSN nurse. IMHO, it's about the individual nurse, their experience and integrity, versus their credentials.