A Different Approach to the ADN vs. BSN Debate

[Sheri257]

Over and over again, we read the same things on these threads. Pay BSN's more at the bedside, and mandate a BSN for all entry level nurses. There is widespread assumption that a BSN mandate would limit the labor supply even further and increase nursing wages.

I'm not sure that would actually happen but, for the sake of argument, let's assume that it would. Ok: so now you're making more money but, since I live in California where we have mandated staffing ratios ... it got me thinking. What's going to happen in the other 49 states where you don't have ratio laws? Isn't it possible that with a more limited labor pool the hospitals would give you even more unreasonable patient loads at the bedside than you have now?

A BSN mandate could very well limit supply and increase wages but it does nothing to improve working conditions. This is where, IMO, a ratio law is a better alternative because it does both. While a ratio law doesn't limit the supply, it does increase the demand and wages by limiting the number of assigned patients to each RN and forcing the hospitals to create more nursing positions.

Plus, it has the added benefit of making your life a hellava lot easier at the bedside which a BSN mandate doesn't do. By limiting supply even further, a BSN mandate could very well thwart attempts to mandate ratios in other states if there aren't enough nurses to staff mandated ratios.

Now ... this may not satisfy BSN nurses who want more consideration for your degrees but, this is where I don't understand you guys. I'm a recent ADN grad and I'll be spending the next two years working on my BSN. You BSN nurses are already way ahead of me.

You definitely qualify for more jobs than I do. There are, at least, some jobs where you can make more money than me at the bedside and, there are other jobs where your BSN counts as additional experience, etc. for promotion. In my area, at least, the BSN career opportunities are tremendous because there aren't that many BSN nurses to begin with. You're also way ahead of me in getting your master's, which increases your job prospects even further.

I see plenty of benefits with the BSN as it is. If I didn't ... I wouldn't bother with the time and expense of furthering my education.

And I wonder if any of the BSN nurses have considered the flip side of all of this? If everyone had a BSN then, everyone would also qualify for those other job opportunities that only you qualify for now. For nurses who don't want to work at the bedside, you already have a huge advantage over the rest of us.

Do you really want every nurse to qualify for the jobs that only you qualify for now? In some ways, this could actually be detrimental to BSN nurses who, IMO, have a huge advantage over the rest of us as it is.

As the old saying goes ... be careful what you wish for.

Just some food for thought.

:typing

[rags]

Personally, I'd like to see nurses of ALL degrees band together and stand up for better working conditions, fair pay and ratios and respect for the work we do. After we can ALL stand up together, then maybe we can talk about the details.

My 2 cents.

:yeahthat:

[hemorn1]

I chose to get my ADN, the difference in classes between ADN and BSN was a chemistry and 12 hours of humanities, and I did not think that would better prepare me to be a nurse. (oh yeah, there was one hour micro lab credit difference too) We all take the same test. Since ADN's are "educated" enough to take the same licensure exam as BSN's, maybe they should make the BSN's exam longer and harder since they are better "educated". Because someone has 12-15 extra credit hours does not mean they are more educated.

I have worked in nephrology for the past 10 years, and have met nurses in this field from ADN's to Masters. All of them said they did not get Nephrology training in college, outside of a snippet about ESRD and basic A & P. You learn the most about your specialty after you get out of school.

I have actually had home health BSN prepared nurses tell my patients to drink more water, sending bananas and oranges to treatment with them as snacks, ect. I also had a resident at the hospital pumping 1000cc of saline/hr into one of my patients. She looked like a balloon, and the resident said she thought she was dehydrated. I think it is a safe bet to to assume that resident had more hours of education than most BSN's. Its not about which degree you have, its about critical thinking skills and IQ.

[jjjoy, LPN]

The following is cut and paste from a few previous posts of mine:

I think it bears repeating that almost no one is saying that ASNs aren't good RNs or even that BSNs are better nurses. The question is about the often arbitrary educational requirements to be qualified to apply for certain jobs.

It's true you learn a lot on the job but you still need some kind of basic foundation and screening out process. The question is how much foundation is enough foundation? What criteria must be met to allow someone to hold the title of "nurse" or "practical nurse" or "registered nurse"? The criteria can and do change over time, sometimes for better, sometimes for worse.

[jjjoy, LPN]

You make some good points EmerNurse. : )

[Tweety, BSN, RN]

I chose to get my ADN, the difference in classes between ADN and BSN was a chemistry and 12 hours of humanities, and I did not think that would better prepare me to be a nurse. (oh yeah, there was one hour micro lab credit difference too) We all take the same test. Since ADN's are "educated" enough to take the same licensure exam as BSN's, maybe they should make the BSN's exam longer and harder since they are better "educated". Because someone has 12-15 extra credit hours does not mean they are more educated.

I wouldn't mind this at all. Give the BSN's a test that is reflected of their extra courses in reasearch, management theory, etc. Then there would be a distinction.

The difference between most ADN and BSNs is not a matter of 12-15 credit hours. If it is again, as I've been saying, ADNs should be outraged. But since it's not true, I'm not outraged. :)

[PANurseRN1]

1st, mandatory BSNs would stop the generalization of ADNs and BSNs all as RNs. 2nd, although many have argued that ADNs are just as good as BSNs, no one can argue that they're better degrees, where as God knows how many nurses have argued that BSNs are a superior form of education. I never argued that there aren't extremely intelligent ADNs. But to simply get an ADN when you have the choice of getting a BSN b/c it will essentially get you the same job is just plain lazy. The problem lies in this good enough attitude. We're in the medical field. We should be striving for excellence, not the idea that "I'm just as good as the next person".

Lazy because someone chose an ADN program? Theses are the kind of statements that add to the divisiveness in the profession and drag it down.

[somethingaboutmary]

I am currently enrolled in an ADN program and will graduate in May. I have already applied for the BSN program. I must say after researching some of this in our Nursing Issues class, that there is a difference in ADN nurses and BSN nurses. The education preparation is different. When I first started school people would comment that ADN prepared students had a higher board passing rate than BSN prepared nursing students. I looked over our board newsletter and that was correct at that time. Now our Missouri board has changed the way the boards are being written. They now focus more on management and prioritizing care than they do diseases process. So prior to this change our ADN School had 98% board pass rates. After this change occurred our board rate decreased. This is when our school integrated managing and other BSN responsibilities in our ADN classes along with adding the Nursing Issue class I am currently in. NO these classes are not going to bring us up to a BSN prepared level, however it does give you some insight into the differences in the two degrees. I will say that nursing school is extremely hard, no matter what degree level it is. For us ADN graduate nurses there does appear to be a difference in the degree areas. ADN prepared nurses traditional do have a lot of bedside skills and BSN seem to get a lot of management tools.

I recently was able to get in some clinical time at a hospital that has a different delivery model than most hospitals I have been exposed to. They allow nurses to be placed in various positions based on education and experience. So an ADN nurse can work on the floor or they can do a role that this hospital has as Clinical Care Coordinator. Then the BSN prepared nurses can do any of these positions and it opens them to nurse managers and Patient Care Coordinators. When I asked the DON to explain this decision to me she stated "The CCC has clinical responsibilities and an ADN nurse is prepared to handle that potion. The PCC is more managing the patients and education, which is a BSN prepared nurse role. The PCC is much like a case manger that follows a patient while they are in the hospital and coordinates care with the doctor and other healthcare staff. Yes, the CCC is higher ranking as far as the hierarchy goes, but the responsibilities are very different".

After she explained this to me it helped me see the difference between these two areas of educational levels. I just thought I would share some information with you about my experience in these areas. I see both sides, but why would we ever want to mandate BSN nurses! I am not sure I understand that. Let's work to make administration recognize these differences and utilize the educational preparation each group has by increasing wages and creating positions that utilize BSN educational background!!! Food for thought!

[RNsRWe, ASN, RN]

I looked over our board newsletter and that was correct at that time. Now our Missouri board has changed the way the boards are being written. They now focus more on management and prioritizing care than they do diseases process. So prior to this change our ADN School had 98% board pass rates. After this change occurred our board rate decreased.

I'm sorry, but I think you've misunderstood something: there is no "State board" exam; the NCLEX-RN is a national licensing exam. That means that the exact same testing material (randomly chosen from the databank) is used in every State.

There is no such thing as a "Missouri board", so it's not possible that this non-existent board changed anything for the NCLEX in your particular State. While there IS a Missouri State Board of Nursing (as there is for every State), they have no control over the content of the questions given for the NCLEX in your State. The one I take in NY is the same testing material that is used in WI, MO, etc.

If there was a change in the passage rates of any particular school, it had to do with how they were addressing their curriculum compared to the material being tested on the NCLEX.

[RNsRWe, ASN, RN]

whoops, double post

[RNsRWe, ASN, RN]

ADN prepared nurses traditional do have a lot of bedside skills and BSN seem to get a lot of management tools.

I think you're falling into a stereotype here, and one that seems to be categorically wrong. It's been shown time and again that while there may be a school exception here or there that has clinical requirements far above the norm, in reality, ADN and BSN students get about the same amount of actual clinical time. Now and then you'll see someone post about how their ADN or their BSN program had TONS more clinical time than the other guy but for the most part, the programs both feature about the same requirements to sit for the same NCLEX-RN.

[Woodenpug, BSN]

"Do you really want every nurse to qualify for the jobs that only you qualify for now?"

Yes! though I have a few months to graduation. One problem with a mixed force is that BSN's are sometimes "cared for" by ADN's who can then remind the supervisor/ manager that a favor is due. Some, few managers never really acquire bedside skills. They are often out of touch with the realities "in the trenches." Of course, mandating BSN entry level will cause more harm than good. And overall ADN and BSN are both adequate preparation for entry level into nursing.

[Tweety, BSN, RN]

I think you're falling into a stereotype here, and one that seems to be categorically wrong. It's been shown time and again that while there may be a school exception here or there that has clinical requirements far above the norm, in reality, ADN and BSN students get about the same amount of actual clinical time. Now and then you'll see someone post about how their ADN or their BSN program had TONS more clinical time than the other guy but for the most part, the programs both feature about the same requirements to sit for the same NCLEX-RN.

I agree. I precept the BSN students in the program here weekly. (They do a preceptor thingie rather than the group thing with the instructor present.) I am very familiar with their program. They get the same number of clinical hours as the ADN students, and their program is geared towards producing beginning bedside nurses and passing NCLEX (they had the highest pass rate in the state year before last) not producing managers. They take one course in Leadership/Management.