ADN vs. BSN for Entry Level Nursing

JenNJFLCA · Aug 3, 2006

I just graduated from a 4 year BSN program. One thing I keep seeing on this website is how BSN's lack the bedside experience that ADN's have.

I don't know about other programs, but I think we had a lot of time at the bedside.

The first semester we did all the skills in a skills lab and went up on the floor a few times to get our feet wet, no real major bedside time. For 2 semesters, I did clinicals 12 hours a week for 14 weeks (168 hrs/semester). For 1 semester I did 12hrs/week for 14 weeks in Critical Care Units and 6 hours/wk for 14 weeks of Mental Health Nursing clinicals in the hospital. For my final semester, I was required to complete 220 hours with a preceptor for my preceptorship (I did mine on a cardiac tele floor).

Is my program unique or do other BSN programs have over 1,000 hours at the bedside as well?

LovesGreyhounds · Aug 3, 2006

I think it's very nice that there are numerous ways to get an RN and I think it depends on the individual's situation what is best for them. The person who has more time, then the BSN would be good. For the person who has to get out there working as quick as possible, doesn't have the time or funds, then the Associates is the way to go for them. I personally need to take awhile getting through my pre-reqs so my husband & I can save for when I start the actual nursing program so I think I'm going to do the BSN since I have the time to do it.

sayalittleprayer · Aug 3, 2006

I love this site!!! Now that I have that out of the way, I want to chime in on the subject of BSN vs.ADN. One poster was absolutely correct in saying that this is a hot topic for those of us just entering the profession. I weighed both BSN programs and ADN programs heavily. I can't speak to all programs, but in Chicago the main difference in the two were the additional humanities and liberal arts courses required- well that and maybe a few more semesters of Chemistry. I have a BA and will have an MA soon. I will be starting an ADN program in the fall and for me getting a BSN would have made no sense. Most of the additional courses required (with the exception of higher level Chemistry) I would have already had in one of my two programs. One poster suggested that those of us who possess a BA in another subject along with an ADN should not be given the same credit as those with a BSN. I strongly disagree. If I have the necessary science courses/nursing courses and the same humanities/ lib arts courses then I want the same degree of respect and consideration. Keep in mind that those of us who come to the table with degrees in other areas have a very valuable perspective. My BA in Communications has helped me tremendously in dealing with all kinds of people from various backgrounds. My MA in Gerontology has been invaluable in teaching me about hospice, Medicare/Medicaid, care planning, social services and government policies regarding aging. I would strongly challenge anyone who suggests that my other degrees coupled with an ADN would not warrant the same respect and recognition as a BSN.

lvs2nrs3535 · Aug 8, 2006

For the seasoned nurses and longtime posters, a little patience please. Those of us new to nursing and the boards would like to put in our input/opinions. It may be a dead horse to you, but you do always have the option of not reading these posts. I for one am still very interested in the subject. thank you vicki for posting all the relevant sites. that was much more helpful than the harangue I received at one point from someone who did not wish me to waste her time on something that has been gone over and over again. As a new nurse, these debates are still interesting to me. Seriously, the horse may be dead, but in that case, a little more talk isnt going to kill it then, will it? :lol2: Also, as a new nurse with two small children, a house, a husband and not to mention 2 dogs and a cat to take care of, my time is precious, and I dont always have time to hunt down all these previous threads. (Oh for the days of time to surf the net without feeling like I am stealing time away from all of the above, not to mention the continuous learning that goes with the new job!).

Thanks so much for those of you with advice and posing threads that are relevant to our questions.

KristyBRN

ZASHAGALKA, RN · Aug 10, 2006

From AACN's website:

http://www.aacn.nche.edu/Media/pdf/NJSNALetter.pdf

This is not a BSN-entry debate/discussion. The resolution recognizes diverse entry points but supports educational pathways that lead to an ultimate goal: BSN.

So, don't beat the dead horse. You know the one.

Should RNs be required to EVENTUALLY obtain a BSN?

Personally, I have more respect for this angle then I do for minimum-ENTRY. I'm all for education. I have a bach degree. It is NOT a BSN and I got it AFTER I got my RN.

To me, getting a BSN was not conducive nor necessary to MY goals. Would MAKING it part of each of our long term goals improve the autonomy those that argue for BSN entry want WITHOUT diminishing the validity of alternative entries?

(Or course, the AACN spared no opportunity to advance their bogus study by Aiken in 2003 regarding misleading stats on failure to rescue and mortality. But, that's a different thread, if fact, one I've posted lots in: https://allnurses.com/forums/f8/critique-study-more-bsns-equal-better-pt-outcomes-157387.html)

~faith,

Timothy.

ZASHAGALKA, RN · Aug 31, 2006

I posted this in another thread and thought it deserved its own:

A 3-5 dollar an hour differential for BSN will bring ALL RNs along.

See, it's a difference in perspective. The debate is so heated because it's been so polarized for so long when what was needed all along was a consensus.

Today's RN, regardless of entry, is a PROFESSIONAL NURSE, and each of us is entitled, as primary stakeholders, to claim that professionalism.

The question becomes, where do we want to go, AS A GROUP.

For far too long, BSN's have used the issue as a kind of intellectual whipping post: MY DEGREE IS BETTER THEN YOURS.

And ADNs have been rightly 'insulted' and, as a result, reactionary: same pay for same work.

Reality is in the middle. In fact, after years of trying to set up a 'differentiation of practice', there is little evidence that the differences in degrees merits such a differentiation.

AND IN FACT, education DOES matter.

The question is: where do we want to be as a group. If you are a BSN, there is some merit to the argument that a Bach standard for nursing will move us along in pay and respect.

And if you are an ADN, you are limited in salary, just like the BSNs. Most employers 'top out' our salaries at some point in your career.

A BSN differential will give ADNs an alternative avenue to avoid the 'topped out' salary and, later in your career, a case to advance that salary, IF YOU GO BACK AND GET THE DEGREE. But, getting that degree MUST be worth the cost. A salary diffential leads to not only that immediately being the case, as an incentive to move to a BSN, but in the creation of a common point from which to demand greater pay and autonomy: FOR ALL OF US.

Not having a consensus holds us ALL BACK. It limits our pay and autonomy for all. The result is that, for all practical purposes, BSNs do no better at the table then ADNs. While that is indeed a smug 'gotcha' to the 'technical' insult, such limits are limits placed on us all.

We must change our preconceptions and our 'us against them' mentality. That means each polarized position in this debate must concede key points. BSNs MUST concede that the gain of a BSN-standard is NOT about professionalism in the context of 'as opposed to our peers'. And that means understanding the reality that YOU, as a BSN, receive the relative SAME treatment as an ADN. So, WHERE YOU WANT TO BE is not in context of 'as opposed to ADN', but in conjunction WITH ADNs.

For the ADN, the key concession is the acknowledgment that there IS an advantage to BSN. Without disrespecting your point of entry, you must UNDERSTAND that the true credentials from which to argue our case involves a bach degree standard and the monetary differentials that create that standard. Because, while the argument IS valid that there are no significant differences between degrees and current practice, we are ALL being treated by our lowest common educational denomination, and raising that to a higher educational 'standard' will ultimately serve to bring us all along.

Moving towards a BSN will open up an avenue where, eventually, WE ALL BENEFIT.

But, there must be a first step. The VERY FIRST STEP, is to eliminate the polarization of this issue that the ANA created with their insult to ADNs. There must be a blanket acceptance and consensus that we are ALL professionals.

But, then, we have to get past this artificial limitation, which is really imposed on us from the outside: by hospitals and employers that DO NOT WANT TO BREAK THE CAPS ON SALARY - AND LIMITS ON AUTONOMY - THAT ARE COMFORTABLY IN PLACE FOR THEM - AND LIMITING TO US.

That means we must go along with the idea that more education means more money. The result of that will be to create a real incentive to have a 'higher' avenue from which to demand more money and autonomy, for us all. And it will skew the RN title towards BSN. Over a 10-15 yr period, as ever greater percentages of RNs either intially prepare to BSN for an initial salary differential, or take advantage of the monetary incentive to 'upgrade' their degrees, the profession will move along towards BSN. AT THAT POINT, when significant majorities of RNs ARE BSN, as a result of incentives instead of demands, only then can we re-evaluate minimum entries. But, first, lets realize and encourage the situations that begin to promote that view, INSTEAD of an all or nothing polarized debate.

The key concept is this: not a degradation of where we are today, but grasping at where we can be tomorrow. We must get beyond this useless argument over entry points and look forward, to a common point. Forget the polarization of the concept of BSN-entry. But, it IS time we worked to a common point of BSN-standard, that, no matter your point of entry, the point in common rises to BSN, with the goal of a tide that raises all our boats.

If you plan to be in nursing for 20 yrs, in THAT time, we can move to a BSN standard that creates a better working and wage condition for us all. I can say that without denigrating ADNs, of which, I am one. It's not an issue of having 'inferior' training. It's simply not. It IS an issue of creating the means of more bargaining power. Those means involve credibility - and in the BUSINESS WORLD - such credibility is significantly expressed in education. Our employers view this as a business. We should, too.

There is a consensus to be found here. It's just not at either end of the polarization of this debate. THANK you, ANA, for that useless polarization, created by your baseless name-calling and trivial academic elitism for the last 40 yrs.

No, the consensus is how do we get to a place that will suit us ALL better? It's time we had a 'rally point', a place from which we can demand what is ours. BSN is that point. That doesn't mean leaving some of us behind. It DOES mean creating the incentives that brings us ALL UP to the same place.

Right now, our 'default' place IS limited because of divergent entry points. I respect those divergent points of entry: they give us multiple avenues from which to attain the professionalism that is rightly ours. But, the NEXT step, is a common point, a rally point, from which to BE the unstoppable force that we SHOULD be.

BSN is that logical point. If implemented in an 'insult' free manner, it brings us all along, allowing ALL OF US access to a brighter future.

But this will NEVER be offered to us. We must demand it. And that requires a consensus of stakeholders and an acknowledgment that such power is beneficial to us all. In order to REACH that point, we must be united. Because, only as a group, can we demand what is rightfully ours: a true place at the table and a realistic cut of the take.

I'm not afraid of having to go back at some time in my career and add BSN to my title if it means the credibility to claim that place and that cut. But, I also will not tolerate the inference that I hold nursing back. I AM TODAY'S PROFESSIONAL RN, TODAY. But, neither extreme position is on point, and NEITHER serves us well. WE must find common ground.

And we must view this issue through a common lens: not as a point of contention, but as a 'tipping' point that serves the greater good of ALL RNs. We MUST decide, as a group, that we are IN THIS as a group. And, we must fundamentally understand this: this fractious debate does NOT serve ANY of OUR interests.

~faith,

Timothy.

ICRN2008, BSN, RN · Aug 31, 2006

Both the ASCP and NCA offer different certification exams for Medical Technologists/Clinical Laboratory Scientists (BS) and Medical Laboratory Technicians/ Clinical Laboratory Technicians (AS). The scope of practice is also limited for the associates degree-prepared technicians in most settings (for instance, they can not work in the blood bank). Because of this, MTs make about 30% more than MLTs in most settings. I have always wondered why nursing doesn't do something like this as an incentive to earn a bachelor's degree. To be honest, I can understand why nurses with an ADN are not necessarily in a hurry to earn a BSN, because there is pretty much no financial incentive to do so.

gonzo1, ASN, RN · Aug 31, 2006

Timothy, this is so well written and thought out that I am inspired to go for my BSN. This may not be as hard to achieve as one would think either, since I work at a place that will pay my tuition for doing so. I think a lot of nurses remember how hard nursing school was and are fearful of getting into that again, since at this time there is little incentive. After all our house supervisor is an ADN. However, I have to stop and remember that I have earned my RN and that can not be taken away from me. School most likely will never be quite as hard again because that gut wrenching pressure to excell and pass NCLEX will not apply in future education. Unless of course, I would decide to do NP. From this point on after getting my ADN all education is icing on the cake. Thank you for writing such an inspiring and well formulated plan, nudging me to look at the BSN in a whole new light.

ZASHAGALKA, RN · Aug 31, 2006

The original scopes of practice were envisioned to be FAR different for ADN and BSN.

Reality NEVER cooperated. In reality, from the start, ADNs have performed in the professional capacity as an RN.

So, this has served to confuse the issue. If I can do the same job, and have the same scope of practice, WHY bother to go back to school? And the answer is that it isn't about a 'differentiated' practice, but about holding a coin of power.

To the extent we MAKE IT about a differentiation of practice, we simply polarize and deadlock a move that would benefit us all. IF we are ALL basically compensated at the ADN level, and we are, then a move to a BSN standard would raise the compensation package - for all of us.

I HAD an opportunity to get a BSN. I saw no real value in it, so I chose a BA - Biology as my bach degree. My aggie ring, which I could not have gotten w/ a BSN, serves me better for credibility purposes.

But, if we can reach a consensus on a 'rally' point, reaching to that point WOULD have a real value to it.

~faith,

Timothy.

Tweety, BSN, RN · Aug 31, 2006

Good points Timothy.

One challenge will be to get employers to value the BSN and pay the large differentials. Employers don't seem to have a vested interest in moving our profession towards our goals. This is evidenced by the many places that don't require a BSN for advanced positions. I know many managers and directors that are ADNs, little incentive for these nurses to get a BSN if they have achieved their goals.

You do bring up the good point that it is very difficult to move towards these goals without insulting someone and stepping on toes.

Quickbeam, BSN, RN · Aug 31, 2006

I'm in a position where I talk to a lot of people who are considering nursing. I always tell them to pursue a BSN. Why? Well, I'm an example. Clinically, I worked shoulder to shoulder with ADNs who were fabulous. However, Once I became unable to lift and do the physical work of floor nursing, My BSN opened the door to many opportunities that were not there without it.

I think entry level nurses now should look at the long haul....will their education provide options for them once they are no longer able to do hospital/LTC/direct care work?

I'm a career changer and I almost opted for an ADN program over a BSN. I now have a career until I retire thanks to my BSN.

Sheri257 · Aug 31, 2006

IF we are ALL basically compensated at the ADN level, and we are, then a move to a BSN standard would raise the compensation package - for all of us.

If we're talking about wages ... I don't believe that at all. I think it's a hellava more complicated than that. For one thing ... you've already had a labor shortage for many years now which hasn't driven up wages very much.

And, for all practical purposes, you already have more barriers of entry into the labor pool that are very similar to the BSN in that waiting lists are now typically two years to get into an ADN program.

What used to take four years to get through my ADN program (with pre-reqs) now takes six years because of the waiting list. That's actually longer than the BSN program in my area, which only takes one extra year than our ADN program. And, you're not taking into account accelerated BSN programs where people with other degrees can get through nursing school in just one year.

Presumably the point here would be increase barriers of entry into the labor pool and reduce labor supply. But the labor supply has already been short for a very long time now yet ... RN wages have barely kept up with inflation.

There are other factors at play here that are keeping wages low.

:typing