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

[Ann Fosque]

Wonderful!

[MaxAttack, BSN, RN]

londonflo said:

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. 

I mean you just made the strongest case against BSN being the end all be all. There's much more to someone's nursing practice than their degree. What the ANA is pushing for would see Florence Nightingale herself not being qualified to be a nurse.

[londonflo]

MaxAttack said:

I mean you just made the strongest case against BSN being the end all be all.

I think you misread my comment. 

Nightingale was all in favor of college education. Her father was an extraordinary proponent of teaching Florence the highest quality of education.  

 In turn, Florence was a strong advocate for a college education.  Oxford is a University, Balliol a college as one of the over 30  colleges that make up Oxford.

She created the use of statistics in health care. 

Quote

Project for "social physics" at Oxford: the case for evidence-based social policy

In 1891, Nightingale formed the project of getting a chair or lectureship in "social physics" established at Oxford, the university that trained the most senior politicians and civil servants, the people who most needed to have statistical knowledge at hand. 

 

[Googlenurse, ASN, BSN, RN]

shon31 said:

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.  

How do you know you make more than the RN's at your facility? I'm just curious since most people I know don't share their salaries. 

[Googlenurse, ASN, BSN, RN]

Tommy5677 said:

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.

Do you think of Long term care "as less " than acute care? 
 

I wasn't saying that ADN nurses should prepare to work in non acute care. It just seems that in my area, that is where this is going. 
 

I do think ADN and Lpn programs are not doing a good job telling their students that most will not end up in acute care. They are still drilling that get 6 months of med surg bs that is outdated.  There is nothing wrong with that. I'm speaking as a nurse that hasn't had the chance to work in acute care until after I got my BSN. 
 

This may not sound right, but part of the problem is that many only see acute care as the end all be all and look down on long term care when nurses are needed everywhere. Lots of care takes place outside the hospital in 2023. 
 

 

[londonflo]

MaxAttack said:

There's much more to someone's nursing practice than their degree. What the ANA is pushing for would see Florence Nightingale herself not being qualified to be a nurse.

There were no nursing degrees in Florence Nightingale's time nor did the ANA exist.  Florence Nightingale was better educated than many university graduates, university dons, master's prepared  then and now. Get a Grip on what her self study; family (father's) education; hospital education; experience in mental health; war time organization of providing complicated care to wounded; supervising many inexperienced and experienced nurses;  & expert use of the power of political pressure and the press!  

[MaxAttack, BSN, RN]

londonflo said:

I think you misread my comment. 

Nightingale was all in favor of college education. Her father was an extraordinary proponent of teaching Florence the highest quality of education.  

I think you misread your comment. The ANA wants actual BSN-prepared nurses. I'm in favor of being a millionaire. Does that make me one?

[MaxAttack, BSN, RN]

londonflo said:

There were no nursing degrees in Florence Nightingale's time nor did the ANA exist.  Florence Nightingale was better educated than many university graduates, university dons, master's prepared  then and now. Get a Grip on what her self study; family (father's) education; hospital education; experience in mental health; war time organization of providing complicated care to wounded; supervising many inexperienced and experienced nurses;  & expert use of the power of political pressure and the press!  

Exactly my point. All of those accomplishments and EXPERIENCES were without a university degree. 

You've provided a great example that a nurse should not be judged to be inferior based on the presence or lack thereof of a particular degree.

[Ann Fosque]

Very interesting viewpoints...to me, this is not so simple...only because Hospitals are now corporations...managed care

It would be wonderful to see them employ BSN Nurses for all acute care positions in Hospitals

Not all essential healthcare employees are Nurses

[Googlenurse, ASN, BSN, RN]

I reflected on this with some colleagues.

What we think is happening is that hospitals are trying to phase out ADN RN's in favor of Lpn's. Hospitals don't have to pay Lpn's the same as RN's, so the hospitals save money. 

[CrunchRN, ADN, RN]

That wouldn't surprise me.

 

[londonflo]

MaxAttack said:

Exactly my point. All of those accomplishments and EXPERIENCES were without a university degree. 

How could she have something that did not exist (BSN) at the time?