Reforming nursing education...

[SteffersRN87]

After reading several threads regarding the entry-level MSN programs and which level of nursing education should become the standard, I want to share a classroom discussion I had a while back...

What if a MSN became the solid standard for entry into nursing practice? What if we all practiced in the role of a nurse practitioner? Now, I know that this will surely NEVER happen! But, a six year program leading towards a MSN degree with the outcome of a nurse practitioner may not be such a bad idea. Think about it... We could manager our own patients' care instead of the way a physician thinks it should. We could prescribe pain medication when a patient needs it.

Anyways, as I said it will probably never happen, but it was a very interesting discussion.

SO WHAT DO YOU THINK ABOUT IT???

[Music in My Heart]

We need to as nurses start demanding more respect and establishing nursing as a unique disciplinary with our own research and evidence based practice, journals, etc.

Start?

This stuff is already happening in spades... and has been for quite some time. There are many nursing journals and abundant "nursing" research.

[PMFB-RN, RN]

I agree with lovebug. We need to as nurses start demanding more respect and establishing nursing as a unique disciplinary with our own research and evidence based practice, journals, etc. I think a step in that direction would be to start mandating bachelor's degree minimum.

*** That would be more interesting if the BSN was oriented to evidence based practice rather than old, out dated theorys. Like a great many ADN RNs I already had a BS degree in another field. I was shocked at how far behind other industries and professions nusing education is. In my previous field the university was was leading the industry. Students where learning cutting edge stuff. In nursing it's the other way. The university is busy teaching the old and outdated.

Besides, I think it's already starting to head in that direction nowadays at least where I live (New York) it's becoming pretty difficult for ADNs to pick up jobs because all of the jobs are requiring BSN minimum. Which is only fair.

*** The hospital where I work is no longer hiring new grad BSNs into it's critical care nurse residency. It's not in the policy but they are no longer going to be hired. ADNs only. I know of at least one other intensive care doing the same.

[DoGoodThenGo]

I agree with lovebug. We need to as nurses start demanding more respect and establishing nursing as a unique disciplinary with our own research and evidence based practice, journals, etc. I think a step in that direction would be to start mandating bachelor's degree minimum. Besides, I think it's already starting to head in that direction nowadays at least where I live (New York) it's becoming pretty difficult for ADNs to pick up jobs because all of the jobs are requiring BSN minimum. Which is only fair.

Considering ADN and Diploma (the few that remain) nursing programs out number BSN schools in NYS, and certianly in NYC, find it odd to hear you say it is only "fair" that BSN become the mimimum for entry the profession.

Yes, many of the prestigious teaching hospitals/medical centers, especially those with or seeking Magnet Status, can get away with the all BSN requirement. But that is now when due to hospital closings, reduced turn over, and other reasons there happens to be a good surplus of nurses, especially experienced nurses running around, but what happens after all this is over?

Those same insitutions spend plenty to hire "BSN" graduate nurses from all over the United States, or import them from the Phillipines, and would love to see any data that outcomes were better than hiring a ADN grad.

Currently many GNs, BSNs included are cooling their jets as NYC hospitals aren't hiring for the most part. Ifor one would be plenty ticked off if I came out of four (or more) years of college with the average amount of debt associated, and could not find a nursing job for love nor money.

Finally, at least in NYC, BSN RNs do not make that much more than ADN grads, especially bedside, and they still deal with all the goo, poo, spew and everything else the later has to as well.

[VICEDRN, BSN, RN]

would love to see any data that outcomes were better than hiring a ADN grad.

I am not exactly sure what you mean about "data that outcomes were better than hiring a ADN grad." Were you referring to in-sourcing or to ADN versus BSN.

Here is the link to the JAMA article I referred to. You can read it in its full text.

http://jama.ama-assn.org/cgi/content/abstract/290/12/1617?lookupType=volpage&vol=290&fp=1617&view=short

Also, I found this as well:

"Evidence shows that nursing education level is a factor in patient safety and quality of

care. As cited in the report When Care Becomes a Burden released by the Milbank

Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of

New York and one by the state of Texas - clearly show that significantly higher levels of

medication errors and procedural violations are committed by nurses prepared at the

associate degree and diploma levels as compared with the baccalaureate level. These

findings are consistent with findings published in the July/August 2002 issue of Nurse

Educator magazine that references studies conducted in Arizona, Colorado, Louisiana,

Ohio, and Tennessee that also found that nurses prepared at the associate degree and

diploma levels make the majority of practice-related violations."

http://docs.google.com/viewer?a=v&q=cache:atphFRn2JoIJ:www.sckans.edu/file/27+adn+vs+bsn+entry+level+nursing+JAMA+article&hl=en&gl=us&pid=bl&srcid=ADGEEShBdRuHSQADuE4Ya_IxDzTqB0wliPdx3Uw2UdUMw17ZbzZijAKKdhV4QoInrjgpdkFb79rsty_SljcE9tJCmDD31mZyWW6gWGGpqsjG5_i6uBESTuVMn-x-aRhc47LUB_nKgYWO&sig=AHIEtbTCuBCiTXzPgGMSPvcefmiHIkHbsg

Speaking strictly from the data standpoint, I would say that the issue has certainly been studied from a variety of angles but I am interested in hearing your thoughts on the issue.

[VICEDRN, BSN, RN]

*** The hospital where I work is no longer hiring new grad BSNs into it's critical care nurse residency. It's not in the policy but they are no longer going to be hired. ADNs only. I know of at least one other intensive care doing the same.

Is this not exactly the point? Let me guess: The hospital wishes to have ADN candidates rather than BSN candidates because all of the money they "waste" on training promptly disappears when the BSN goes to graduate school. Am I right? This goes on all over the country and definitely right here in my state as well.

If the Bachelor's was the minimum standard of education, the hospital would actually have to try to retain staff at the RN level by some other means rather than taking advantage of an unfortunate educational disparity that prolongs the amount of time an ADN prepared nurse needs to be prepared for graduate school. (hypothetically) Working conditions might actually improve as a result and BSN/RN level nursing might appeal to more people as a long term career rather than a mid-point between here and grad school.

Thanks for the example! It fits perfectly!

[PMFB-RN, RN]

Is this not exactly the point? Let me guess: The hospital wishes to have ADN candidates rather than BSN candidates because all of the money they "waste" on training promptly disappears when the BSN goes to graduate school. Am I right?

*** Yes, you hit the nail on the head.

If the Bachelor's was the minimum standard of education, the hospital would actually have to try to retain staff at the RN level by some other means rather than taking advantage of an unfortunate educational disparity that prolongs the amount of time an ADN prepared nurse needs to be prepared for graduate school.

*** Well maybe and no. Making the BSN the starting point may well leave the hospital with just as big a problem getting nurses. As I mentioned before RNs get paid OK for a community college degree that takes a couple years but maybe not enough to attract enough people willing to put the time and expense in to make the money we make and work under the conditions we work under.

No because the ADN RN takes much less time to be prepared to go to CRNA school than a BSN grad. BSN = four years of school, and then must complete a minimum of one year in an ICU, more likely two. That's 5 to 6 years. ADN = two years of school then can work in the ICU for two years while getting an RN to BSN. The RN to BSN programs are designed for working nurses. That's 4 years and now has a BSN AND 2 years of solid experience. Not to mention the ADN would have made something like $80-$120K over those two years the BSN didn't, had health insurance fo those two years and very likely paid very little for the ADN from a community college and maybe got the hospital to pay for the BSN. (I live in Wisconsin where an ADN actually takes two years and there are no college level prereqs for the technical college associates programs)

(hypothetically) Working conditions might actually improve as a result and BSN/RN level nursing might appeal to more people as a long term career rather than a mid-point between here and grad school.

*** You may be right. They might, but pay won't. Another thing to consider is the very unique life experience, maturity and skills that typical older and second career ADN nurses bring to nursing. IMO making BSN the entry point would be a huge mistake. If a BSN is required then require ADNs to get their BSN withing a certain amount of time after they get their license through an RN to BSN program. The other hurdel I mentioned before is the outdated and useless fluff nature of BSN education. Make it real, cutting edge, clinicaly useful and base it on an adult learning model and maybe more people would be interested.

[VICEDRN, BSN, RN]

*** Well maybe and no. Making the BSN the starting point may well leave the hospital with just as big a problem getting nurses. As I mentioned before RNs get paid OK for a community college degree that takes a couple years but maybe not enough to attract enough people willing to put the time and expense in to make the money we make and work under the conditions we work under.

...Not to mention the ADN would have made something like $80-$120K over those two years the BSN didn't, had health insurance fo those two years and very likely paid very little for the ADN from a community college and maybe got the hospital to pay for the BSN. (I live in Wisconsin where an ADN actually takes two years and there are no college level prereqs for the technical college associates programs)

...*** They might, but pay won't. Another thing to consider is the very unique life experience, maturity and skills that typical older and second career ADN nurses bring to nursing.

... I edge, clinicaly useful and base it on an adult learning model and maybe more people would be interested.

1. Since there is presently no problem with unfilled openings in nursing, I don't see any reason why we would worry about getting nurses. In the future, if the hospital wants to retain staff, maybe they should work on that rather than in sourcing or pressuring nursing schools to pump out new grads.

2. The pay will go up when the minimum education standard is set due to either increased demand and a shrinking labor pool or because the federal government actually changes its wage structure for RNs. Do you know that under one model of health care reform, (and I do favor reform for the record), the government valued our labor at $8.00/hr? You know why? Because you don't need a Bachelors degree for it.

I don't understand why a second career necessarily means ADN. I find that idea mystifying though I think I have seen that mentioned on here. The BSN and the ADN take the same amount of time if you have a previous bachelors in my state. The accelerated BSN is four semesters, same as the ADN. Most second career types around here are BSN students. The traditional ADN candidates take five years to get their ADN d/t the number of pre-reqs.

Also, as someone else pointed out, if the hospital is seeking magnet status or if the labor market is tight, the hospital may prefer to recruit BSNs only if only for marketing purposes. Thus, the ADN may find themselves "working towards" a transfer from med/surg to ICU.

2. I agree with you about having life-experience but I firmly believe that if you can do the ADN, you can totally complete the BSN.

3. I have a previous Bachelors degree from an elite women's college. The pay an RN makes at either the ADN level or BSN level is actually quite good compared to what new grads with liberal arts degrees make as far as I have seen and experienced. Your comment about the $80-120k kind of illustrates that point. One of my friends made 30k working in IT when we graduated and we were like in awe of her!

4. Could the BSN program be any fluffier? I really think not. I have suffered through ethics, leadership, professionalism. We completely agree on that. :heartbeat

[profstudent4life]

Besides, I think it's already starting to head in that direction nowadays at least where I live (New York) it's becoming pretty difficult for ADNs to pick up jobs because all of the jobs are requiring BSN minimum. Which is only fair.

*** The hospital where I work is no longer hiring new grad BSNs into it's critical care nurse residency. It's not in the policy but they are no longer going to be hired. ADNs only. I know of at least one other intensive care doing the same.

Forgive me if there is an obvious answer to this...but why are they only hiring ADNs? This confuses me, especially at a time when it seems "everyone" (and by everyone, I mean employers) is pushing the BSN.

[VICEDRN, BSN, RN]

Forgive me if there is an obvious answer to this...but why are they only hiring ADNs? This confuses me, especially at a time when it seems "everyone" (and by everyone, I mean employers) is pushing the BSN.

This is why:

*** The hospital where I work is no longer hiring new grad BSNs into it's critical care nurse residency. It's not in the policy but they are no longer going to be hired. ADNs only. I know of at least one other intensive care doing the same.

Is this not exactly the point? Let me guess: The hospital wishes to have ADN candidates rather than BSN candidates because all of the money they "waste" on training promptly disappears when the BSN goes to graduate school. Am I right? This goes on all over the country and definitely right here in my state as well.

[silentRN]

you guys are all joking yourselves if you think you'll get more money for a BSN. Hospitals can't even afford to give raises, and it's been 21 months since I've seen a raise, and I work STICU in a Level One teaching hospital, the only Level One in Southern Arizona, and a hospital that makes the nationwide best hospital list every year; plus it's MAGNET.

Let me ask you, when have you ever used the knowledge you've gained in school in real life work situations? Nursing theory goes out the window. The real learning happens on the job. You learn what you need to know to do your role on that specific unit you're on. Nursing is limited in its scope. We make assessments and document what we see, which no one ever looks at and means nothing to other disciplines, we only document to CYA. We pass medications, but at least in the ICU we can titrate. And, we clean people. There really isn't much more us, as nurses, do. Now you're telling me you think everyone should be mandated to get a bachelor degree for this? A lot of nursing education appears to be so irrelevant to reality, and that JAMA study is a joke. It's funny how when you go back to school for your RN to BSN, you will hear a lot that BSN nurses know how to "critically think." So, I guess that means ADN nurses can't critically think. I was offended by that. All of this, to try to make nursing a profession. Do you really think by obtaining your BSN you become a better nurse?

[VICEDRN, BSN, RN]

you guys are all joking yourselves if you think you'll get more money for a BSN. Hospitals can't even afford to give raises, and it's been 21 months since I've seen a raise, and I work STICU in a Level One teaching hospital, the only Level One in Southern Arizona, and a hospital that makes the nationwide best hospital list every year; plus it's MAGNET.

Let me ask you, when have you ever used the knowledge you've gained in school in real life work situations? Nursing theory goes out the window. The real learning happens on the job. You learn what you need to know to do your role on that specific unit you're on. Nursing is limited in its scope. We make assessments and document what we see, which no one ever looks at and means nothing to other disciplines, we only document to CYA. We pass medications, but at least in the ICU we can titrate. And, we clean people. There really isn't much more us, as nurses, do. Now you're telling me you think everyone should be mandated to get a bachelor degree for this? A lot of nursing education appears to be so irrelevant to reality, and that JAMA study is a joke. It's funny how when you go back to school for your RN to BSN, you will hear a lot that BSN nurses know how to "critically think." So, I guess that means ADN nurses can't critically think. I was offended by that. All of this, to try to make nursing a profession. Do you really think by obtaining your BSN you become a better nurse?

I don't know what to tell you honey. My last bachelors gave me the ability to make photocopies in a suit and listen to a dictated letter, occasionally doing a little minor legal research and file management. Welcome to the world of education inflation. Hence, the increase in masters required occupations.

The hospital only pays a buck an hour more to BSNs around here. Its not a fancy pay difference. The point is is that it is easier to demand better pay when the standard actually requires a degree. (Who said anything about getting it now or in the future?)

The JAMA study is one of several I mentioned and I am sorry if it offends you. I didn't do the study. The fact that it was successfully duplicated suggests that its statistically valid at the least. Do I think it makes me or anyone else a better nurse? I hate questions like these because this is what is coming: I argue facts, you talk about your experience and in the end, we both ignore the role free will and individuality play in every person's story. So why argue?

My understanding (reflected in my original post) is that this would also allow us to expand the scope of practice.

[PMFB-RN, RN]

The hospital only pays a buck an hour more to BSNs around here. Its not a fancy pay difference. The point is is that it is easier to demand better pay when the standard actually requires a degree. (Who said anything about getting it now or in the future?)

*** That may be your opinion but I see absolutely no indication of that being true. The only two things I have ever seen raise nursing wages in the 14+ years I have been a nurse is shortages and unions. Do you have have some evidence that it is easier to demand more money if nurses required a BSN than if not?

The JAMA study is one of several I mentioned and I am sorry if it offends you. I didn't do the study. The fact that it was successfully duplicated suggests that its statistically valid at the least.

*** I saw a study that indicated that the biggest difference in patient out comes related to nursing education where when nurses where clinically certified, CCRN, CEN etc. I am going to try to find that study for you. It is why at my (Magnet) hospital there is zero pay difference for beside nurses whether they have ADN, diploma, BSN, MSN, or PhDs (we have two PhDs working bedside in our medical ICU) but there is a pay kicker for clinical certification.

Speaking of Magnet - I believe it is mearly a fad that will pass like so many others. It's not like as a nurses you can tell the difference working at a Magnet vs non-magnet hospital.