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

[FiremedicMike, RN, EMT-P]

Tommy5677 said:

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.

 

I do believe those programs are advertising intentionally out of context.  Most of them are 3 semesters of the core BSN classes and they don't include your upper level gen-ED requirements.

[londonflo]

Hannahbanana said:

you'd look up some of the great research on this very question done at the University of Penn and their associated hospital(s). 

When the first studies came out, decades ago, the results were quoted over and over without new studies done. Yes, we in ADN education got the point and added to our curriculums. 

Please cite the new studies (less than 5 years old) .

 

[Hannahbanana, BSN, MSN]

FiremedicMike said:

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

Precisely not my point— it was NOT an ADN-to-BSN program. I went directly from high school to a university college of nursing for a bachelors degree. My point is that I want to see every nurse take a program like that to be  a fully prepared professional for today's needs. ((Fireproofies on))
When you see the gnashing of teeth over lower NCLEX pass rates "because it was so hard!!” — remember that today's nurses need to have a stronger scientific and gen ED background more than we ever needed before, and they ought to test for that. If nursing isn't as easy as people think, well, prove you're ready and prepared for it.

I despise the fluff you describe. It cheapens the idea of professional education. 


 

[Hannahbanana, BSN, MSN]

londonflo said:

When the first studies came out, decades ago, the results were quoted over and over without new studies done. Yes, we in ADN education got the point and added to our curriculums. 

Please cite the new studies (less than 5 years old) .

Here you go, a summary and a link to the paper (you can get Nursing Outlook online). Finding this took me approxiamtely 45 seconds. Google Scholar is a wonderful thing.

 

Hospital Nurses and Patient Outcomes: A Matter of Degree?

Bachelor's-Prepared Nurses Associated with Better Outcomes 

https://ldi.upenn.edu/our-work/research-updates/hospital-nurses-and-patient-outcomes-a-matter-of-degree/

January 13, 2022 By:

Joshua Porat-Dahlerbruch, PhD, RN and Linda H. Aiken, PhD, RN, FAAN, FRCN

Our recently published study of 510 hospitals and 20,268 practicing nurses is the first to answer this important question. We found that hospitals with a larger proportion of nurses with BSN qualifications have significantly lower risk-adjusted mortality for surgical patients, regardless of the specific pathway nurses take to earn a bachelor's degree in nursing. In other words, it does not matter whether nurses obtain their BSN through a traditional 4-year program at a college or university or an RN to baccalaureate completion program; all paths leading to a largely bachelor's qualified hospital nurse workforce contribute to better patient outcomes.  

Specifically, we found that every 10% increase in the proportion of BSN nurses in a hospital resulted in a 5.5% decrease in surgical patient mortality. This means that hospitals with 80% of the nursing staff holding a BSN by any pathway have mortality rates about 25% lower than hospitals with 30% of their nurses with BSN qualifications.

Our study findings also have implications for access to education and diversity of the BSN workforce. Baccalaureate completion programs are often thought to enhance access to BSN education and promote diversity among BSN nurses. Ethnic and racial minority nurses are less likely to obtain a BSN through a 4-year program but are slightly more likely to obtain a BSN or higher at some point in their career via baccalaureate completion pathways. As such, besides contributing to more BSN nurses in the workforce, maintaining multiple pathways to the BSN may also contribute to BSN workforce diversity and potentially to reducing health disparities.

Our study provides the first empirical evidence indicating that the 80% BSN goal and better patient outcomes can be met by increases in BSN nurses educated through both traditional 4-year and baccalaureate completion pathways. These study results are positive news for hospital employers and the nursing profession aiming to transition to a primarily BSN-prepared workforce. While graduations from BSN programs in 4-year colleges and universities are growing slowly, trends suggest that these programs will not be able to expand enough to meet the target of a largely BSN nurse workforce. Our results suggest that alternative pathways to the BSN can and should play an important role in achieving the NAM target of 80% BSN nurses within the next decade. 

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Variations in nursing baccalaureate education and 30-day inpatient surgical mortality, was published in Nursing Outlook on November 8, 2021. Authors include Joshua Porat-Dahlerbruch, Linda H. Aiken, Karen B. Lasater, Douglas M. Sloane, and Matthew D. McHugh.

Published:November 08, 2021DOI:https://doi.org/10.1016/j.outlook.2021.09.009

[londonflo]

 

Would still like to see  citations of current studies on BSN versus ADN differences on benchmarks related to patient safety, infection rates, etc.

[Hannahbanana, BSN, MSN]

I got an email with another post from you, copied here:

You had science credit courses that lasted a semester:

Hannahbanana said:

 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),

with each 4 credits you had 8 courses spread over 8 semesters: equals 32 credits

Hannahbanana said:

three years of 24 hours per week of bedside clinical including full quarters of psych, peds, public health, OB, medical, and surgical,

8 hours of credit (3 to 1 ratio) for clinical per week (using your numbers ) X 6 semesters = 48 credits. 

Hannahbanana said:

semesters of sociology, anthropology, and economics

each 3 credits.  equals 9 credits.

Just following your numbers calculated by the usual credit per semester course.....

32+48+9+ = 89        11.2 credits a semester.

but the link took me to this one. Not sure what you meant by counting credits in this way, because not all colleges count them the same. I just did full semesters of each as noted, and that was all I meant. The lab courses were three 1-hour lectures per week plus one lab for 3 hours, and the non-lab ones were a standard 1-hour class 3x/week. Clinicals were 07-1430, plus an hour of post-conference Tu-W-Th, and my nursing classroom courses were 4 hours on Monday and 3 hours on Friday. Mondays I had classes from 0800 to 2200, because I took one class for 4 hours from 18-22 since the rest of the day was full up with everything else.

Geez, I couldn't do all that now to save my soul.

[Ann Fosque]

Too bad Team Nursing is not an option...Team nursing is a system that distributes the care of a patient amongst a team that is all working together to provide for this person. This team consists of up to 4 to 6 members that has a team leader who gives jobs and instructions to the group...

Perhaps it could be a stop-gap measure used until hospitals recover financially post COVID-19 

[bobbiesal]

When I attended the National Student Nurse's Association conference in 1985, I argued for ADN programs as the entry to practice. My school presented me with an award for this. I argued that bedside nursing doesn't require a BSN & those who wish to do so will continue their education. I practiced in the NICU and PICU for 10 years before receiving my BSN in 1995, as part of a hybrid program at UW-Madison.  Then my MSN in 1997. And my PhD in Nursing from Columbia University in 2011. I teach undergraduate nurses in pediatric clinical and practice full time as an NP in Genetics. I still maintain my original argument - there aren't enough faculty and the cost of a BSN program is astronomical - and AD RNs are every bit as capable to provide patient care as BSNs. My ADN program is comparable to the ABSN program I teach in - and apparently prepared me for rich career in nursing. Honestly - support nursing and all the tracks available to get qualified students to the bedside! Focus on excellence in education and feed that curiosity to lifelong learning - make it easier and more affordable to pursue further education instead of stanching the flow of RNs to practice at the bedside!

[Googlenurse, ASN, BSN, RN]

I don't know that I buy the argument a BSN is so much more unaffordable than Lpn and ADN programs.

I know Lpns that paid $54,000 to go to Lpn school through Lincoln Tech. 

I also know RN to BSN students that paid $25,000 for Chamberlains program. It was even more than that but my job had tuition reimbursement. So after tuition reimbursement it was $25,000.

I chose WGU because it was non profit and cheaper. My job didn't even have tuition reimbursement for WGU, but it still was cheaper than Chamberlain even with tuition reimbursement. Chamberlain is for profit. 

[FiremedicMike, RN, EMT-P]

Ann Fosque said:

Too bad Team Nursing is not an option...Team nursing is a system that distributes the care of a patient amongst a team that is all working together to provide for this person. This team consists of up to 4 to 6 members that has a team leader who gives jobs and instructions to the group...

Perhaps it could be a stop-gap measure used until hospitals recover financially post COVID-19 

Some of the weakest nurses in my ED went through a traditional 4 year BSN program.  They do a poor job of prioritizing the needs of their own patients, there is no possible way they could supervise 4-6 members covering 15-25 patients.
 

Simply making them a supervisor because they have a BSN is pretty ridiculous.

 

[Tommy5677]

Hannahbanana said:

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). 

With regards to better patient outcomes with BSN's, if the University of Penn has a BSN program with associated hospitals, that is not objective, independent research. Please try again.

[Tommy5677]

FiremedicMike said:

I do believe those programs are advertising intentionally out of context.  Most of them are 3 semesters of the core BSN classes and they don't include your upper level gen-ED requirements.

Then it's intentionally misleading.