BSN as entry into practice; why we decided against it. - page 3
While hopefully avoiding stoking the ADN - BSN debate unnecessarily, I thought I'd share my experience with my state's consideration of BSN as entry into practice, as well as the BSN-in-10... Read More
Nov 17, '12To put it another way VICEDRN, if we were to take an ADN program that is essentially identical to an BSN program except for 8 credits of community health and leadership, and simply change the name on the degree from "ADN" to "BSN", could we expect to see in improvement in patient outcomes? Most likely there are other factors than what we call the degree, so what are they?
Nov 17, '12Quote from somedaypedsAny chance your new employer is affiliated with a BSN granting university?The hospital I just signed on with requires a bachelors in 5 years. At their tuition reimbursement rate per year, it may take me 5 years to complete the one year program. After paying for my LPN and LPN to ADN programs out of pocket, I am very interested in having the rest of my education sponsored.
Nov 17, '12I actually researched and wrote a paper about this controversy in school. The issue is complex and multifaceted, with several competing interests at play. Surprisingly, whether BSN nurses are better prepared than ADN nurses is not the main point. The biggest issue are the community colleges. They are the biggest players in nursing education and have considerable political cloud. Nursing degrees are their premier "crown jewel" academic program, almost often their most sought after degree. A nursing program grants community colleges huge prestige and access to all kings local, state and federal funding. It is source of pride for them and they WILL NOT let go of that bone! As such, any realistic BSN requirement debate has to include them. Simply requiring a BSN for entry level and thus removing them out of the game is a non-starter. Thus the BSN in 10 idea, which allows the community colleges to keep their nursing degree programs. Any future discussion has to include the community colleges interests in mind. I heard that some of them are offering BSN degrees. I think that only when the community colleges get on board - by offering BSN degrees for instace - will we see BSN requirement adopted by state legislators and board of nursing.
Nov 17, '12Entry to practice in Canada is the BSN. Period. The last province to eliminate diploma programs was Alberta at the end of 2010. Some universities do a very good job in preparing graduates for the "real world" of nursing and others don't. The basic curricula are virtually identical; major differences are seen in the way courses are delivered. The "problem-based" or "context-based" learning model used by some schools has been decried by students and employers alike as being ineffective at preparing nurses for the degree of responsibility they face on the job. (And who wants to pay the big bucks for an education then discover that much of it will be self-taught?) The ultimate determinant of the quality of nursing care provided, in my opinion, relates to personal factors and not where or how a person was educated. Some people are just naturally better at some things than other people are. I work in an area that hires many new graduates from our local universities. Over the years I've seen many of them start their careers; some have flourished from Day One and others have floundered. To credit or blame the source of their basic nursing education is simplistic and unsupportable. Of note, on my high-acuity critical care unit, it's virtually impossible to distinguish the diploma nurses from the BSN nurses after the first year or so.
About 12 years ago I compiled a head-to-head comparison of the diploma education at a community college with the BSN education at a university in the same city. In terms of hours of didactic preparation it was a dead heat. In terms of clinical practice, the community college came out ahead. The major differences were how long it took to complete the programs, liberal arts content, the number of formal papers and tuition. There was no difference in the pass/fail ratio on the Canadian Registered Nurse Exam. When published, my analysis met with a great deal of consternation and criticism from those nurses whose credentials contained more letters than their names; they were however unable to dispute my conclusions.
The critical thinking argument is an interesting one. When I applied to a highly-regarded hospital-based diploma program in 1991, I was initially rejected because I was a mature student out of the formal education system for 15 years. The reason I was given was that without upgrading my basic education I wasn't likely to meet the acid test of critical thinking required to be successful in the program. I was able to demonstrate to them that in my case, experience was the best teacher and that critical thinking was part of my day-to-day life. And here we are. I still don't have a degree of any stripe, nor am I interested in one. I prefer focused continuing education in my specialty. That model has served me well for nearly 20 years.
Nov 17, '12Just sayin' but there is a 10/30/12 article on Medscape describing lower mortality rates for surgical patients in Magnet hospitals. What other "profession" whines about the cost of schooling as much as we do? Just because we're married with kids and have OTHER OBLIGATIONS, we should put our education on the back burner? There is a reply several posts up in which the poster argues for the adequacy of ADN education witherrors that make me embarrassed for us. As long as the CC's keep cranking the grads out, nurse's salaries will lag behind other "professions" with similar responsibilities and staff satisfaction will be poor. I don't understand why your kid's piano teacher must have a degree in music but the nurse that cares for your intubated newborn can come from an RN with a CC education. I wish that the CC's could provide the pre-nursing courses while we did something more akin to a diploma program for the last two years to keep tuition costs down while the students provided labor for the hospital.
Nov 17, '12Quote from trueblue2000That's the problem right there. At this point, a BSN degree doesn't provide a significant wage increase over an ASN, therefore making it an unattractive option for nurses. I am an ASN prepared nurse and the reason I'm currently working on a BSN (at one of those substandard online programs ) is that it will provide me more money down the road. There has to be a tangible benefit to spending more time and money on essentially the same degree, as evidenced by the fact that we take the same boards.The biggest advantage of a BSN requirement in my opinion would be higher wages and a higher degree of respect for nurses as professionals. Nurses are the least educated of the health care workers if you think about it. I think this a big reason why we are treated like crap by physicians, administration and patients. A two-year junior college degree will never command the wages, recognition and respect we deserve.
I think you make a brilliant point about community colleges' role in all of this. Why would they want to give up the money and prestige associated with nursing programs?Last edit by Aurora77 on Nov 17, '12
Nov 17, '12Quote from PureLifeRNUh, because no one said that? The woman said exactly what she meant, which was that she'd rather have a nurse that knew what they were doing. She never at any time specified which degree the person who "knew what they were doing" had. It's really simply stated: she doesn't care what degree her nurses have as long as they know what they're doing.I cant stand this type of argument. Why is it always assumed that BSN's DONT know what they are doing?!?
Nov 17, '12I think it is fruitless to argue the I'm better than you stand. Nursing needs to start think(critically thiking that is) about practicality and reality- gived the nurse a job before you demand she make a "sofie's choices" decision which will impact her/his family's wellbeing. Isn't that the business nursing is supposed to be in Health and Well being"/
Nov 17, '12Quote from merleeafter years of nursing, and with the yearly hourly wage increase, then things start to look better... meaning after 5 to 7 years in nursing, you should be i would hope making at least 60 grand a year. in nursing, the money takes time to come in... but after years of experience, it usually pays offI have always been concerned about who stays at the bedside. Why would someone pay 40 - 60 - 80 thousand dollars for a BSN to stay at the bedside working shifts, weekends, holidays? How many people are staying in 24/7 positions 10 years out?
Salaries have not kept pace with the cost of a quality education, and some nurses are finding their salaries are topped out at less than what they paid for their education. In other words, they may not ever make a yearly base salary of 60 grand even though they paid that or more for their education.
Nov 17, '12I have my BSN. I think it varies across state boards and accreditation requirements but where I live all one needs is college level A&P courses (just 8 hours) and a good ACT score before entry into an ADN program. I personally feel like these schools focus more on building nursing skills while BSN programs focus more on the WHY we use these skills and evidence-based practices. The level of critical thinking is different. Both extremely difficult and both produce great nurses. The people in my class all passed NCLEX the first time, but a test has nothing to do with what kind of nurse a person will be. Honestly I would have gotten my ADN first if I would have decided on nursing as a career straight out of high school, but a higher degree is a personal choice. My facility pays just a dollar more per hour for a BSN..that's not much comparing the cost of education. Anyone can go back to school through online programs (my school offers a RN TO MSN PROGRAM no Bachelor's required) and can work while learning. Earning my BSN was expensive. I lived on student loans and a pt on campus job that was more stress than what it was worth. It would have been nice to have a good paying PRN job that actually enhanced my nursing education. There's nothing wrong with either program as entry level. One is not better than the other. They're different paths to the same end. The sky is the limit in this field for anyone starting out. I personally don't feel either superior or inferior to an ADN nurse.Last edit by sosweetrn on Nov 17, '12
Nov 17, '12All the following refer to populations, not individuals:
The problem isn't that ADN programs aren't good enough. They are good enough on the own! Here is the problem:
- The pool of applicants to nursing schools vastly exceeds slots.
- There are more nursing students than there are acute care clinical placements.
- There is no nursing shortage of new nurses.
- Every time a new grad job is posted, recruiters get 100+ qualified resumes per open slot.
- Job searches are frequently taking over a year with many NGRNs becoming "stale grads"
From an employer standpoint, it eases HR duties and gain more educated providers without increasing cost.
This is ethical from the patient care standpoint if there is no loss in quality of care. There is a benefit if patient care improves which studies suggest despite the OP's "new math."
This is ethical from the labor standpoint as it provides less numerical opportunities due to the barrier, far fewer who invest time and money will find themselves unemployable "stale grads."
It isn't that the ASN programs aren't good enough, it is that the market wants BSNs and the BSN programs and grads are out-competing the ASN programs in many markets. That may not be "fair" in idyllic world, but we live in the REAL WORLD.
aQuote from PureLifeRNSo it is around here. My BSN program provided 800-1200 clinical hours depending on the student's choice of electives. I ended up getting significantly over 1200 clinical hours.I cant stand this type of argument. Why is it always assumed that BSN's DONT know what they are doing?!? All these posts from ADN's stating "My ADN school had more clinical hours", "My community college school is sooooo much better than the university." "ADN's know more than BSN's"
Well how about this? MY BSN school has more clinical hours, better NCLEX pass rate and prepares students to be better nurses than the local community college.....but no, that would be an inflammatory remark.
The ASN programs do the state minimum of 750 hours, do not rotate to the specialty pediatric hospital, usually have shorter OB rotations, and many have to use LTC for med surg and more because there aren't sufficient acute care placements.
Nov 17, '12Let's bring this back a few steps. Local CC is NOT going to accept preceptors w/o BSN. Even if they've been an RN for 25 years. Who would you rather learn from? A new BSN, or someone who has experience?
Nov 17, '12Quote from subeeIn the medical fields, there is but one other field besides nursing that hasn't realized the improved patient care and higher salary comes with higher education, understanding deeply the why, the research, and broadening scope and field.What other "profession" whines about the cost of schooling as much as we do? Just because we're married with kids and have OTHER OBLIGATIONS, we should put our education on the back burner? There is a reply several posts up in which the poster argues for the adequacy of ADN education witherrors that make me embarrassed for us. As long as the CC's keep cranking the grads out, nurse's salaries will lag behind other "professions" with similar responsibilities and staff satisfaction will be poor. I don't understand why your kid's piano teacher must have a degree in music but the nurse that cares for your intubated newborn can come from an RN with a CC education. I wish that the CC's could provide the pre-nursing courses while we did something more akin to a diploma program for the last two years to keep tuition costs down while the students provided labor for the hospital.
Look at PT, OT, speech, social work, RT, Radiology, Pharmacy etc... all of those used to be vocational education, associates, or bachelors that have progressed to bachelors, masters, or doctorate level for entry.
The only field that hasn't besides nursing is EMS. If you look on the EMS forums, you'll see threads like this arguing that a GED and 600 hours of voc-ed certificate is good enough for a paramedic who incubates, does 12 leads, ACLS, etc, too heck with those hoity-toity associates degrees. The next thread will be decrying why paramedics only make $14/hr.