A nurse is an R.N. when she/he takes state boards. I am an ADN with certification in OR nursing. I have worked with good and bad nurses, but found no difference when it came to the initials behind one's name. I am in middle management. One thing you can never do is become complacent with your knowledge. Strive to learn and never stop. I have had physicians state they prefer ADNs as we have more hands on experience. You can read a book to tell you how to do a procedure, but if you've never done it, taking the book to the patient's bedside is tacky! If you are young,I recommend getting a BSN after a few years of experience, as this will afford you more opportunity for clinical advancement in the future. I am a rare example with my degree, but have worked with the same institution for 30 years, 20 in the OR, and no my title is not "honorary". I have worked hard and continue to expand my knowledge every day. Peg Team Coordinator