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

[londonflo]

Hannahbanana said:

Florence didn't have a uni degree

Her basic education was:  as a nursing student at the Institution of Protestant Deaconesses in Kaiserswerth, Germany, from 1850-1851.Prior to that she was a matron of a health care institution. 

Nightingale used tools such as case studies to teach the practice of nursing. Her nurse training model, which is based on theoretical principles and practical practice for mastery of skills,

Florence was involved with several universities one of which was Oxford:

https://nightingalesociety.com/papers/florence-nightingale-oxford-university-and-balliol-college/

AND her nursing school was focused on education, grounded on it. . 

I spoke at Oxford University in 2010 on Florence Nightingale. I know what I am talking about. 

[SuzanneRNLA]

londonflo said:

I only spoke about the research education. But while you brought up community health nursing, have you considered what a patient needs in the home after an ICU or, for that matter, any discharge home with regards to assistive devices? I thought not. 

Actually, I've worked in Home Health/Community Health for 11 years. And yes, I worked closely with hospital discharge planners and physicians to make sure transition from hospital (or skilled care) is smooth and as seamless as we can get it. Also, you mentioned you learned APA formatting in your BSN program, I learned it in high school--didn't need my Bachelor's Degree for that.

[Snatchedwig, BSN, CNA, LPN, RN]

londonflo said:

I don't see a BSN designation after your name. What do you consider 'advanced' research at the associates level?

I'm working on my masters right now. Also lemme put that after my name because whatever we put on the internet is a fact. 

 

'advanced' research applies to the whole point of the BSN degree. We wrote about Florence (once again), nursing theories and their relevancy (it's not), then we took a trip down to sample sizes and numerals, took a wild trip to writing about what qualities a leader should have, all the way back to somehow writing about evidenced based practice and indwelling foleys . All of that was addressed in the associates level.

[londonflo]

c'est la vie

[toomuchbaloney]

I'm not certain that acute care hospitals ever acknowledged the nursing research that patient outcomes were improved as they spent more time with an RN at the bedside.  Now it seems they want to skip that part and pretend that continued short staffing patient outcome failures will be remedied if the overworked nurse just gets a BSN... to make the same money and benefits.  

[MaxAttack, BSN, RN]

londonflo said:

I only spoke about the research education. But while you brought up community health nursing, have you considered what a patient needs in the home after an ICU or, for that matter, any discharge home with regards to assistive devices? I thought not. 

Maybe that's indicative of your own training but "discharge planning starts at admission" was drilled into my head during my ADN preparation. Even if a patient is intubated and sedated and unable to participate in their own care it helps our families to give them idea of what they can expect when the acute phase is over.

[Tommy5677]

Googlenurse said:

To me it's simple.

Anyone that wants to work in a hospital should get the BSN.

Even now in the midst of a a severe shortage, many hospitals still have "BSN preferred" on their job advertisements. 

An RN that wants to work in non acute care doesn't need a BSN . That may change in the future though, as the local VNA in my area only wants BSN educated nurses. 

The profession of nursing can do whatever it wants or sees fit. I get the BSN thing on several levels but one person referred to getting the RN to BSN as "fluff".  It's not right to continue the ADN programs and then relegate them to nursing homes. It's insulting and a slap in the face and I can no longer in good conscience encourage people to go into the field of nursing. If you think all the fluff is necessary to be a good nurse then BSN's should have a different exam that includes said fluff. Do not tell ADN's they are less than and then make them take the same exam. It's total BS. When it comes to change, we sure have a history of shooting ourselves in the foot.

[Tommy5677]

londonflo said:

I only spoke about the research education. But while you brought up community health nursing, have you considered what a patient needs in the home after an ICU or, for that matter, any discharge home with regards to assistive devices? I thought not. 

When I did Medicare HHC in the 90's I did it with an ADN (I prefer ASN since that's what I have). I was the respiratory lead and traveled all over the city of Las Vegas (outside my territory) because many others were reluctant. When I worked as a Medicare Health Coach for a major insurance company, I assisted with the development of the respiratory program (asthma and COPD). Nobody at either place ever questioned or challenged my credential because I was liked and respected. Currently as I near full retirement I work part time for a psych NP providing holistic services for her patients, probably the best gig I've had as a RN. I think the point is that nurses now with an ADN would have a difficult time getting a position with any of the above, even with all the experience.

[GardenNurse31, LPN]

I am an LPN with AAS and BA in psychology.  I currently work for a major hospital system in NYS. I make more than RN that was already at current location, and make BSN starting salary.  I read that LPN's were being faced out, when I was in LPN school. I was told that I could only get job in LTC or rehab and would need to get BSN within 2 years if I want to make decent pay!  Here I am 7 years later still LPN.  The most negative experience  was with other nurses (RN) that treated me as less than.  Doctors, MA, NA's don't care if I am LPN/ RN/BSN!  I clearly do not work in the ER or Critical care nor do I want to.  It is not easy, even with tuition assistance  and financial  aid, to go back to school.  If they truly want to faced out, then stop accepting students into these programs.  

[Ann Fosque]

Very nice...I'm proud of your accomplishments...as far as phasing LPNs out, I doubt that will happen any time soon.

Best wishes 

[mmc51264, BSN, MSN, RN]

The pendulum has swung. When I was a new grad 11 years ago, with and ADN, I was not considered a candidate for several jobs because of the lack of a BSN. Now, my organization is hiring LPNs right now. Magnet system. 

I was hired where I am now (10+ years) and we have been hiring ADNs since I was hired. One just had to get their BSN within 5 years, I believe. I am not sure how the LPN addition fits in. I worked with LPNs at a rehab facility early in my career and they were fabulous. I am now wondering how the differences in scope are going to affect current bedside practice. 

[mmc51264, BSN, MSN, RN]

nightwingcreations said:

It's like the push to do away with LPNs,

I just posted that in my organization (Magnet) is now hiring LPNs again.