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

[Googlenurse, ASN, BSN, RN]

Tommy5677 said:

I guess I should clarify. It's only a bad thing when you have been relegated to it. ADN nurses can rarely find positions anywhere else, including case management. Definitely not school nursing and even then it wouldn't matter if I had 20 years ER experience.

I was able to case manage and become a sub school nurse with just an ADN. The only thing I couldn't do was get hired into a med surg  acute care unit with just an ADN.

Imagine that! I always used to find that so strange. So I was good enough to be a school nurse and case manage but not work in med surg? 
 

 

[Tommy5677]

Googlenurse said:

I was able to case manage and become a sub school nurse with just an ADN. The only thing I couldn't do was get hired into a med surg  acute care unit with just an ADN.

Imagine that! I always used to find that so strange. So I was good enough to be a school nurse and case manage but not work in med surg? 

I never did CM but I was a Medicare health coach for BCBS for 11 years with an ADN in the early 2000s. No one ever questioned it. When I moved to the East Coast in '15 Anthem BCBS had an ad for the exact position I was doing in Oregon. With 11 years experience they would not even give me the time of day. Honestly, I don't much care anymore as I'm on the verge of retirement working for a Psych NP and she never questioned my credential. I'm the director of her holistic practice and certified in Low Energy Neurofeedback and Alpha-Stim.com. It's one of the best nursing gigs I've ever had. Planning on full retirement in '25.

[kbrn2002, ADN, RN]

Tommy5677 said:

I guess I should clarify. It's only a bad thing when you have been relegated to it. ADN nurses can rarely find positions anywhere else, including case management. Definitely not school nursing and even then it wouldn't matter if I had 20 years ER experience.

Not having a BSN is no issue for school nursing around here. Again, it's all market based. Our district hires RN's at ADN degree or BSN and also LPN's. There's no difference in pay so a BSN won't get you any higher wages. 

 

 

[cgw5364, ADN]

Snatchedwig said:

No. Same thing that LPN's getting "phased out". With the pandemic, I've seen no difference in hiring practices of LPN's or ADNs.

 

And while we are on the topic. Clinically I learned absolutely nothing in the BSN program. It's a silly pointless research degree.

Hospital in my area only hires BSN and LPN. I am an ADN nurse with over 30 years' experience and a certified Mother-Baby nurse. Thankfully I did not have to find a job when I moved because my remote non-bedside nursing job came with me! 

[cgw5364, ADN]

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.  

One of the best nurses I ever worked with was an LPN. She taught me, a new ADN nurse working Oncology how to function as a nurse. 

[kbrn2002, ADN, RN]

cgw5364 said:

Hospital in my area only hires BSN and LPN. I am an ADN nurse with over 30 years' experience and a certified Mother-Baby nurse. Thankfully I did not have to find a job when I moved because my remote non-bedside nursing job came with me! 

Yep, the necessity of getting that BSN is market based. I've never seen any corroborating evidence but I assume it at least partially has to do the availability of BSN degree programs in the area. 

A local hospital attempted to go BSN only a few years back and it failed miserably. They changed their policy back to hiring ADN after less than a  year. Totally because they simply couldn't hire enough BSN nurses to staff the place.  Our region has only one BSN program in about a 150 mile radius that graduates one class a year  while there are four ADN programs in the same region, two that I know have two graduating classes a year. There's simply way more ADN prepared nurses than BSN prepared nurses in the area.

[Tommy5677]

Tommy5677 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. 

This is one of the ways BSN prepared nurses attempt to belittle ADNs. I did all the above you cite here with an ADN. Yeah, it's called home health care, or HHC which I did for the same company for 7 years. The things you list here are basic nursing concepts so please don't tell me I'm incapable of any of it because I don't have a BSN and community health nursing. Besides, community health is way more than just about discharge planning for home health care. Apparently I know that better than you. Such a feeble attempt.

I think it's time I opt out of notifications for this thread as I will no longer entertain any of this nonsense.

[Googlenurse, ASN, BSN, RN]

kbrn2002 said:

Yep, the necessity of getting that BSN is market based. I've never seen any corroborating evidence but I assume it at least partially has to do the availability of BSN degree programs in the area. 

A local hospital attempted to go BSN only a few years back and it failed miserably. They changed their policy back to hiring ADN after less than a  year. Totally because they simply couldn't hire enough BSN nurses to staff the place.  Our region has only one BSN program in about a 150 mile radius that graduates one class a year  while there are four ADN programs in the same region, two that I know have two graduating classes a year. There's simply way more ADN prepared nurses than BSN prepared nurses in the area.

This is  what I don't understand. Why do hospitals want to hire Lpn's and not hire ADN RN's? 

I always maintained there is no nursing shortage. If everything improved with staffing ratios, pay, etc and hospitals accepted ADN nurses, this nursing shortage will evaporate overnight.

The hospitals always claim there aren't enough RN's but then they skip over ADN nurses. 

[Wuzzie]

Googlenurse said:

I always maintained there is no nursing shortage. If everything improved with staffing ratios, pay, etc and hospitals accepted ADN nurses, this nursing shortage will evaporate overnight.

There is no nursing shortage. There is, however, a shortage of nurses willing to bend over and take it in the rear anymore.

[kp2016]

Wuzzie said:

There is no nursing shortage. There is, however, a shortage of nurses willing to bend over and take it in the rear anymore.

I just coughed my coffee out my nose. 100% agree. Many years ago I enrolled to start my Masters at a well know school in my city. My hospital would pay about 25% of the fee after you passed each semester with no increase in wages after completion but a required work commitment of several years. One of the LPN's who had at that point been an LPN for more years than I'd been alive told me "silly girl, don't waste your money, you should buy yourself a nice dress and enjoy being young". 

Some what sexist and dated advise but they weren't wrong. I cancelled my enrollment and spent the money on myself. I don't have a Masters and do not regret it. The whole ADN vs BSN argument is the same in my mind. If you don't need to spend the time and money, don't. If you have too due to the job market in your area, take the cheapest opinion you can find. 

[catdevil27]

ADN is here for the long haul. I'm an ADN in California, I have spent a good deal of my career supervising BSN'S in multiple settings. A specific degree doesn't make one nurse "better" than another. Some people are just innately more geared toward nursing and an institution or a piece of paper don't provide

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[Tommy5677]

catdevil27 said:

ADN is here for the long haul. I'm an ADN in California, I have spent a good deal of my career supervising BSN'S in multiple settings. A specific degree doesn't make one nurse "better" than another. Some people are just innately more geared toward nursing and an institution or a piece of paper don't provide

At least one nurse here would beg to differ. She believes the research showing better patient outcomes with a BSN where the university providing the research has a BSN program, is valid. Mmm hmm. In an ideal world we would have all BSN's but this is not an ideal world. As I said before, if you want to validate BSN required then give them a test that includes the community health and research components the ADNs don't have. Don't tell ADNs they are less than while making them take the same test.