goingCOASTAL

The Houston area is still hiring anyone with a license ... a lot of people who need general hospital experience for other things (grad school, specialty niche, certifications, etc.) will come and do their time and move on. No reason why you couldn't move here for 6mos to a year and move back with that coveted "recent hospital experience."

Family considerations may have me considering a California move in the next 6-12 months. I'm currently in the Houston market, and am wondering which areas more closely resemble the economic climate there (salary, real estate, crime, etc.)

I've been a nurse for 17 years, and all of it has been in the South (mostly urban areas, though). When I started, I was still "in the closet" professionally for the first 3-4 years, and it wasn't until I was in a larger city that I was more open about it. By open - I mean, if someone asked, I would answer their question, but it wasn't (and it still isn't) something I broadcast. Sometimes I feel like I'm being treated as "one of the girls," and sometimes I'm not. It doesn't bother me either way, and during all of my time as a bedside nurse, the only overt bigotry I ever received was actually from patients (one using the F-word before ordering me out of the room, another who didn't know about me said she like our hospital best because we didn't have all those Q-words running the place like a competitor) ... but, in seventeen years of nursing, I can count those instances on one hand. My advice - don't look for instances like that to happen, and if they do: ignore them. These attitudes are dying out and aren't pervasive enough to influence your practice one way or the other. If you find yourself in a really unfriendly environment - find another job. Most hospitals are STARVING for bedside nurses and only care about your enthusiasm and experience.

I am in the process of enrolling at WGU, which, if you read their story, will probably be the leader of the pack of online educators in the next 10-15 years because of their innovation in education technology, and because of their extraordinary value (it's now cheaper than many state-supported universities). While WGU and Aspen share many of the same accreditations, Aspen is not, however ... and I repeat NOT ... regionally accredited, which is the gold standard for academic excellence. You will hear people "rag" on WGU for it's competency units (as opposed to GPA), but it is still regionally accredited. Without that accreditation, you will not be able to transfer any hours to another college, nor will a lower level degree be accepted for admission to another grad school. This is an absolute standard across the board at higher institutes for learning. Aspen makes no mention of this in the website, so who knows if they're even pursuing it or not ... but, without this, your degree is just a piece of paper with ink on it to another university.

I graduated last year, so I'll attempt to answer most of these for you. Pros and Cons of UTA RN-BSN Pros: 1) It's still relatively cheap, although the price does increase every year. If you skip a session, your next class will be at the market rate. In my progress, it stayed the same because I never skipped a term. 2) I could do the clinicals in my workplace. 3) You get the same degree that the campus-based students that UTA students get when they graduate (and you can go graduate with them if you so choose). Cons: 1) There's really no interaction with the online professors. They create the syllabus and the rubric, and record the lectures, but your interaction is with a third-party course instructor (or coach) who is not an employee of UTA. They're all nurses, but they work for Academic Partnerships - and some of them are very nice and accommodating, and some of them treat their sections like tiny fiefdoms. 2) It's not the cheapest anymore. It was when I started, but if I were to start now, WGU would be cheaper. 3) The online resources on the main school website (like MyMav) can be confusing, especially at first. The website has had a couple of do-overs, but it's not very organic, and is very much the product of a heavily bureaucratic traditional university. Other advice ... don't be in a hurry. I started off taking one class at a time, and liked it so much, that's about all I did. I know of one student right now who's doubling up and is having a very difficult time. Taking one class at a time earned me all A's except one B - but it's your choice. If your career track requires emergency action - take two at once, otherwise, don't risk it. And if you do, don't take their stats, college algebra, or research class with anything else (or together). Some of the classes were hard, but I was surprised that many were relatively easy. I am a nurse who had 14 years under my belt at the time of enrollment, and you'd be surprised how much you know because of your experience. If I had it to do over again, I would probably have still chosen UTA back in 2009, but know that I've done the research ... if I had to take it over again today, I would probably go to WGU, which is cheaper and competency based (which means you can go through the material you already know MUCH quicker). I was considering them again for my MSN ... but, I've recently decided to go with WGU for the reasons I've mentioned. I want good value for my dollar, and after carefully researching them, they seem to have that hands down.

Every accreditation and certification known to man has an expiration date. UTA is the largest nursing school (physically, and online) in the state of Texas, and I'm most certain there are people who have the job responsibility of not losing any of their accreditations. They will continue to have that accreditation.

This class was a bit intimidating ... I think it was the second class I took after Professional A&B. The textbook was boring as Hades, so I made sure I focused on understanding the definitions and terms for the different types of research and that I aced all of the assignments. Perhaps the MOST important factor is to be active in the research group they put you in. My group had five students - one of them dropped the first week, and two of them did almost nearly no work at all. It was just me and one other student that did almost all of the work for our group project (that we all got the same grade on). My motto for this class: don't wait, participate! If you decide to ride the backs of your teammates ... you'll get whatever grade they get (and me and my workmate wanted to make sure that WE got A's, even if that meant unfair workloads).

I finished their program a year ago ... yes, there are assignments due EVERY week. It's really only "self-paced" in that you don't have a physical classroom to be in across campus at 2:25pm. Most of my classes had assignments due by the end of the week, but others had discussion questions or other things due as early as Tuesday ... it really depended on who you had for an instructor. I would definitely take the suggestion that vle4 said - take a laptop. If you go two weeks without uploading assignments - you may find yourself dropped from the class, or worse ... having 40% of your grade being a flat zero.

very interesting that you consider $6,000 a year as "expensive." i have my adn and bsn from two state schools, and with tuition hikes by the legislature here in texas, wgu is now cheaper than my tax supported alma maters. additionally, the "competency" remark is also unfounded. wgu is very explicit that their competencies are equivalent to a "b" grade, so someone who has a wgu degree has the equilalent of a 3.0 or higher. a "c" student would pass any undergraduate university in america - they wouldn't pass wgu. whoever wrote this reply also doesn't understand that the "southern association of colleges and **schools** (the replier got that wrong)" doesn't accredit schools in every state ... only schools in most of the south. wgu gets its accreditation from the same regional accrediting body that accredits every university in wgu's home state of utah, the northwest accreditation commission. the poster is also incorrect in calling it a proprietary school. wgu is a non-profit university, not a for-profit corporation. i think this replier is confusing wgu with uop, devry, etc. those other schools are mostly interested in profit ... wgu is interested in innovation in higher education. check it out before blasting it without the facts.

If you seriously want to someday master the art of managing nursing (administration), you first need to learn the art of knowing and understanding and managing the stress your staff will go through for most of their career. The best nursing administrators are those who have served their time - and mastered it - in the trenches. The one's who "put in their year" before escaping to grad school are often the worst at administration, and speaking as someone who put in fifteen years before pursing a grad degree and a management job - if you think your patient load is causing you stress, wait until you're managing 50 or 100 nurses. You will wish you had your bedside job back. Learn your profession before trying to manage those who will probably spend their entire career at the bedside. They'll appreciate your hard-earned knowledge (and the booksmarts that come with your later improved education). If you don't - they won't pay attention to you. And why should they ... if you dont' have the foggiest clue about how to relate it to real-world experiences?

A BSN degree really prepares you to be more of a consumer of nursing research than an ADN degree, which just prepares you to perform professional nursing. You do not get Nursing Research, or a holistic in-depth approach to all of the facets of nursing practice, not only to the whole human in all of their age ranges, but within the community as well. I don't speak about this from a point of arrogance ... I was an ADN nurse for 14 years before I went back to school for my BSN ... and yes, I really learned a lot I didn't know before, and the biggest thing was about learning how to improve my practice through evidenced-based research.

I would go for something more general (RN) that will allow you to get a broad experience initially, then specialize in an area you're comfortable with later. With specialized health degrees, there can be less "wiggle" room when it comes to specialization, and then you're just stuck with a degree that allows you to do one kind of work. You can literally work in ANY arena in health care - be it a bedside nurse or an insurance case manager with a BS in nursing.

I would highly recommend getting your BSN. The nursing "shortage" is turning into a "graduate glut" - a lot of Houston area hospitals are no longer hiring new grads, and when they do, they're focusing on BSN students. I've heard the same thing about UTMB - if the drive is not too far, you could also consider UTHSC in the Medical Center. The choice would be yours, but I wouldn't pay too much attention to "who people would rather work with" - I can tell you that the trend among those that HIRE nurses are 1) experienced first, and lacking that, 2) BSN only (for new grads). There were a LOT of new grads in 2010 - BSN and ADN alike that could NOT find jobs in the Houston market. Some of them had to work in nursing homes until they could find something, and with the NASA layoffs in the next few months, the "trickle down" effect here in Houston could make it even worse. Please, please, please ... ignore the rhetoric about ADN-vs-BSN ... your best opportunity for WORK in the next few years will be with your BSN.

I just finished their program in May, the RN-BSN completion program, and I really learned a lot. The reason I chose that program over places like Phoenix, etc., was because 1) it's from a traditional university, with a REAL nursing school, and 2) I wanted to keep my options open RE:grad school (I always hear bad things about grads from "online universities." The thing that REALLY sold me was the low-low price ... I have not found a program this cheap, but I think it's only this low if you live in TX. Plus, I work in a partnership hospital, so there was even a larger discount. You can do really well IF you follow some common sense rules 1) take only one class at a time if you're doing the 5 week courses. The "general" courses (pre-reqs) used to be 5 wks, but they're mostly 8 and 16 wk courses now. I would probably double those up ... BUT (and it's a big BUT) ... do all of your "generals" first. Reason: some of the nursing classes are only offered once every 7 or 8 sessions, and you can get them ALL done sequentially if you don't take a break with your nursing. If you decide to take a 5 wk break, or take a general class in the middle, you could wind up graduating late because you couldn't take a specific nursing class until next year ... this happened to one of my friends. Overall, I would recommend this if you can get in, if you can afford it, and definitely if you're in a partnership hospital. Several people in my facility are doing this program. With the RN-BSN, the "clinical" is following a manager or director "X" amount of hours during your management class ... MOST of your courses are writing papers, research (a LOT of both). I do have a friend taking the initial licensure BSN class - but, she's still doing general courses, so I don't have any information on that - I would imagine that program is a little more difficult.

Yes, this is a very "emotional" subject. I've been an ADN nurse most of my career and have recently obtained my BSN. I once believed - as most do - that there is no difference, but I saw the writing on the wall, as one has already stated "BSN-only" being the standard for all opportunities outside of bedside nursing. Not that I was trying to educate myself away from a bedpan, but as I enter my middle ages, I've seen more than a few nurses at or past retirement age that were really struggling at bedside nursing - not mentally, but physically. I have absolutely nothing against the noble art of bedside nursing - it is the bedrock of our career - and it will always be an option for me, regardless of where I'm at in life ... but my thing? I didn't want it to be my only option - because it can be hard, grueling work. And ... when I went back to school ... I actually learned a few things! I didn't know all that could be known, and it really enlightened me to all of the wonderful things going on in nursing research, one article in particular that showed lower death rates when hospitals have higher rates of BSNs. So, it's not just an opinion anymore (like I once thought), it is becoming established scientific fact. There are reasons why hospitals are pushing this, and if you need proof, google "Education levels of hospital nurses and surgical patient mortality" that was published in JAMA.

emt made some good points, but a lot of hospitals have stopped hiring new ADNs. Hospitals are also becoming very competitive regarding quality standards, and many of them are ramping up for magnet status - which requires that the bulk of your nursing force (if not all) be BSN prepared. Degrees aren't everything. I know people who've been promoted all the way to ADON with only an Associate's degree, but these people have a heck of a lot of experience, and they're also becoming the exception rather than the rule. In some states, the nurse practice act dictates the level of education required for DONs - I believe in my state, I hospital CNO must be master's prepared, and she (or he) must at least have a BSN (if the MS isn't in nursing). Grad schools - from what I've seen - require a BSN, especially if it's an advanced practice nurse. No way around it, and yes, the trend is going toward doctoral prepared nurses. Some universities offer accelerated BSNs for persons who already have a bachelor's degree - I think a lot of those are 12 or 13 month plans.

There certainly are cheaper venues ... if you're worried about cost, take some more time and consider some other schools you haven't applied to yet. I was able to finish my BSN for less than $7,000. With your desire for an MPH, I take it you have some advancement plans beyond bedside nursing. In many states (not sure about Illinois), at least one of your "real" degrees will need to be a Science degree in Nursing (meaning BSN or MSN). While there are certainly plenty of nurses today in leadership positions with their business bachelor's and an MPH or MHA, these people are mostly grandfathered in ... people aren't advancing into senior leadership without one of those degrees being in nursing, though. Get your BSN, then you can get your Master's in anything else - business, public health, administration, etc. But, if you want a career path - either your bachelor's or master's has to be in nursing.

I've been a nurse for 16 years, and this debate has gone on longer than that. I've been an ADN nurse for most of that time, and have recently completed my BSN. While my experience as a nurse helped making going back to school much easier than it was the first time around, I actually learned a lot. I know I'm a better nurse now because of the BSN ... despite the hype, it was a lot more than just "management" - in fact, of the eight or so nursing courses I had to take, only one of them dealt with leadership. But, that's just anecdotal. The facts are in the research. If you're not aware of this article, please read "Educational Levels of Hospital Nurses and Surgical Patient Mortality" published way back in 2003. When removing all other factors, the study showed that a "10% increase in the proportion of nurses holding a bachelor's degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue" (Aiken, 2003). And then ... consider the facts from real life. Even down here in the South, hospitals faced with a glut of applicants are choosing BSNs over ADN students more than they ever have before. From what I've heard, it's difficult for an ADN nurse in Houston to find a job in the Medical Center. My hospital prefers them as well - and they are fully aware of the science on this matter. My advice to everyone - if you have an ADN, find a low-cost way to degree-up (I completed mine at UT-Arlington online). If you're taking pre-reqs to get into nursing school - take the extra time and get your BSN. Hospital doors are literally locking on ADN applicants. Aiken, L., Clarke, S., Cheung, R., Sloane, D., & Silber., J. Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290 (12), 1617-1623.

Sounds to me like your patient (if he was elderly) was experiencing the "Geriatric cascade" - which is where older adults can succumb to frailty and a downward spiral JUST from laying in bed constantly. Was just learning about it in my RN-BSN classes - and it suggested that ALL older adults, unless clinically contraindicated, MUST be encouraged to get out of bed by the second admission day (up for meals, up to restroom, etc.), or they risk ending up exactly like your patient - either in the nursing home, or the funeral home. I hope to learn more about this phenomenon and use it in my practice.

Nursing isn't the only part of a hospital that requires management. Theoretically, you could follow the Operations track and work to become a Chief Operations Officer, or Chief Financial Officer ... both which are more likely to lead to a hospital CEO position than an MSN. However, a lot of experienced RN administrators not only have an MSN, but an MBA as well, and many more nurse administrators are stepping into CEO roles as years pass (I personally know two CEOs with RNs who did the COO track). To my knowledge, hospital administration is the highest paid "anything" a nurse can get. I'm currently finishing my BSN, have a mid-level management job at my hospital, and am currently exploring ALL of my grad school/career path options.

Congratulations on your upward mobility track! I have no idea about a nursing facility career track (nursing home, LTC facility), but I know if you're wanting to expand your horizons in hospital healthcare administration, there's a few different choices you might want to consider ... particularly considering that during this recession, your potential competition is using their time to upgrade their credentials. What I've seen in my 15 years of hospital nursing is a little bit of everything people have mentioned (managers and directors with Associates degree in nursing, management getting jealous over ambitious staff, etc.), but I have noticed some definite trends in upward mobility, and I've known TONS of management, and work for the largest hospital chain in the States: 1) Yes, "just an ADN" is sufficient to get a job in most hospitals - as a staff nurse, and even this is changing. Nursing is going into a glut, and it's looking worse. In many cities, even BSN grads are having a hard time finding work in hospitals. Yes, there are managers and directors in hospitals with less than BSN, but people being hired into those positions now have higher degrees ... and the "higher the better." 2) The most successful degree plan is one that adds to your current achievement. If you already have a BSN, your best option will be to get your Master's degree in either Nursing (MSN), Business (MBA), or Healthcare Administration (MHA). Certainly, having an additional degree is helpful, but upline managers are mostly interested in your *highest* degree - which will always be your BSN if you go back for this associates. As we both know from experience, education isn't always the difference, but in higher level management (service-line director, nurse executive), they most likely won't even interview you without the higher level degree. Ex: You will never be a chief nursing officer in a large hospital just with a BSN (again, it's your highest degree that counts). If you want the most options, get the higher degree. The additional associate's might make a difference in a competitive situation in your current locale (if the other applicant just has a BSN only), but healthcare is changing, and it's changing everywhere as young and mobile unemployed nurses are going ANYWHERE in the US to find work. If you settle for less ... you'll be left in the dust. About myself: I'm one of those "ADN's" who was promoted into a department managment position after many years of charging. Our hospital has started looking at magnet status, and our whole chain has been on a huge quality improvement push, and I've recently been informed having my BSN will be required to keep my job. In school currently, and almost finished with that. My fellow managers and directors who already have a bachelor's are in master's programs (and I work in a medium sized suburb of a large metro area), so upward mobility for me will now require a Master's degree in something - or I won't get the job. Good luck ... and again, think "up."

BSN-only in hospitals is something the ANA has pushed for for 25-30 years, but why hasn't it happened? Because community colleges were pushing out much-needed RNs by the truck-load ... it absolutely wasn't feasible. Today, with the recession and the economic realignments going on, we're mostly in a glut ... and hospitals and state boards of nursing are able now to hire and legislate what they want about nurses because the market allows for it. It's not some corporate conspiracy ... it's market forces at work, and at the moment, there are more RNs than there are jobs for RNs. Hospitals have a choice, and the states can enact laws they feel will impact healthcare in a positive way without impacting the industry economically. Of course, there is a downside to this. In a lot of places, nurses get paid by licensure ... not degree ... so you have to ask yourself, if a hospital had a choice ADN vs BSN, which would they choose considering they cost the exact same hourly?

I think the debate should change from "who's a better nurse" to "change in job security." I don't care what the ANA says, in a lot of areas in the US, there's no such thing as a "nursing shortage" anymore. There is a glut, and now employers get to choose. Regardless of what any of us think, or regardless of our personal anecdotes, studies are proving that patient mortality improves not only with better nurse-to-patient ratios, but also with nurses with higher education (BSN and higher). With stories coming out of the Northeast about ADNs not only not finding work out of school, but also losing jobs (being replaced by BSNs) ... this isn't "our" fight anymore ... it's about what we all should evaluate when it comes to how we provide for our families. We can be proud and AWESOME nurses who make a difference all we want, but if the corporation that owns your hospital suddenly makes a BSN-only decision ... you're out on the street. Before the tomatos start ... I've been an ADN RN for 15 years, and I'm darn proud of it. Last year, I went back to school, and I'm nearly finished with my BSN, and I've learned two things in the process: 1) I'm a better student now because I have a frame of reference, and 2) I didn't know all I thought I knew (or needed to know) about nursing, patient outcomes, and the healthcare industry. I'm still learning! I think the "fights" we create amongst ourselves over who's the better nurse is foolish and petty, but the REAL concern is how each of us address a changing market place. This is a capitalist society whether you like it or not, and ALL of our jobs are part of that free-market place. In a growing glut (such as the one we have now), we need to evaluate what the best decisions are not only for our patients and career advancement, but also or our continuing ability to provide for our families. It's time to degree up ... and that's some advice I'm giving myself!

The difference is because hospitals have to maintain their own credentialing with the state, CMS (Medicare), and JCAHO. While physician offices often do some of the same stuff, most of the clinicians there actually don't have to be licensed at all - they're practicing under the physician's license. I've actually heard of people being hired off the street to work in doctor's clinics - even giving shots, etc. I wouldn't compare what goes on in a hospital to what goes on in clinics. It makes for great conversation, true, but it really isn't based on the reality of healthcare. There are some physician clinics where there isn't a licensed nurse at all ... and a hospital would lose their credential and accredidation if they tried the same.

It really depends. I've heard the Med Center is mostly BSN only, but Houston is a REALLY large town, and I know a lot of happily employed ADNs ... me being one. Of course, I see the writing on the wall, an am nearly done with my BSN track (and yes, I've learned a lot - even after 15 years of acute care experience), and there is some new research coming out about patient mortality compared to nurse education levels. I would agree that BSN programs need a little more intensity when it comes to clinicals, however, I think it will be really difficult in the next 10-15 years to get a job in ANY hospital without a BSN, and to get promoted (as I've also recently been) without that and/or higher. I'm actually enjoying returning to school, and am looking at opportunities beyond my BSN as well. ADNs are awesome nurses (I like to think I'm one of those), but it is a trap to think you'll learn all you'll ever need to know in those twenty-four months of nursing boot camp. Education will move our career forward, and for each of us individually, it will create job-security for those of us who plan on STILL being nurses in the next 20-30 years.