Change in BSN requirements

DoGoodThenGo · Aug 30, 2010

For at least 20 yrs before the advent of ADN programs, leaders such as Dr. Brown advocated a jump to college level prep. The BSN programs didn't 'take off' on this model because it was very difficult to encourage workers to get a bach degree for what at the time amounted to a minimum wage job. It's not that there was anything 'wrong' with being a BSN, but that there wasn't enough interest in the programs because it was widely considered overkill. The result is that these programs only appealed to educators, and not bedside nurses.
There needed to be an intermediate to move to college level prep.
You are wrong to say that ADN programs took off because the hospitals stopped offering diploma programs. Hospitals began to have huge problems recruiting for their programs. Post WWII women either turned to nuclear families, or had learned because of the war that their options weren't limited. And diploma programs were basically 'chaperone' programs for adult women until marriage. Why commit to 3 yrs of not seeking a husband for a job that I really don't need when I can work anywhere? It's not that the hospitals stopped offering diploma programs (they worked GREAT for hospitals and hospitals resented the move away from their cheap labor pool). No, it's that those programs weren't able to sufficiently recruit in changing times.
And so the ADN program 'took off' because it was a great compromise between two extremes. It rode the post WWII GI bill wave of community colleges and it seated nursing education in a more favorable environment, where science became more important than anecdotal legacies.
Hospitals saw the advantages, in both superior education (not knocking today's diploma programs, they have adapted to the same superior level), and in the ability to recruit nurses. THAT is why diploma programs failed - because the ADN was a better alternative.
And the reason WHY BSN programs 'took off' in the wake of ADN programs is because the college model was validated. At the same time that ADN programs grew from 0 to 60% of programs, BSN programs grew from 5% to 35% of programs. The ADN program might have been a model that supplanted diploma programs, but it was also a model that validated BSN programs.
It's just not true to say that ADN programs 'dumb down' or 'hold back' nursing. ADN programs were the critical link to move nursing education to the college arena. BSN programs could not have done that alone because the jump from untrained apprenticeship to bacclaureate degree was too large for the stakes being offered. ADN programs provided the bridge between the two. They 'took off' because they work, and they work well. As a direct result, the stakes have equalized to the prep required and there is a real incentive for a student to go to a BSN program to be a bedside nurse.
I think we should examine how to move forward. But the key to doing that is two-fold: 1. We don't ignore the legacies that brought us to this point, and 2. we involve all stake-holders. There is a rational argument for BSN entry moving EVERYBODY along. Putting down the ADN programs that got us this far isn't it.
And, I never said that because there is a greater relative need for nurses, that 'dumbing down' the requirements was justified. I said that that drives the debate much more than a concept of 'shortage'. I disagreed that a 'shortage' holds back this issue; rather, for our employers, the relative greater need for nurses generally holds back this concept, shortage or not. And THAT is why our employers will never agree to BSN and will always outlobby for those requirements to be tabled or modified.
If your goal is to strong-arm BSN entry requirements by making them law, you are outgunned and not by ADN students but by employers with better lobbyists that don't want to give away the very pay and respect you think such a requirement would bring.
You are mistaken if you think that 'magnet' programs will offer this bridge to BSN-entry. Their goal is not improving nursing as a model, but improving the retaining of nurses. They may advocate for BSN entry, but they do all still hire ADNs with experience and most important, they still do not provide a real differential in salary that would move the standard to BSN. The goal isn't to create a new an improved BSN nurse: the goal is to offer non-monetary incentives for nurses to move to BSN at ADN prices. Think hard about that before you invest your hope in these programs for BSN. They might want BSN, but they want it WITHOUT the pay and respect that would come along with it. For employers, this is the magic pill: how to get a better trained nurse without having to pay for it in precisely the terms that you adocate such a move should create. For nursing's entire history, being 'called' was used as a rationale to pay nursing less. For magnet programs, they have simply substituted a measure of repect for BSN and some minor improvements that should have been standard fare in any case as a rationale to pay you less.
I think we CAN move to a BSN entry model. But it will take a consensus of all of us. And THAT is why I think that denigrating ADNs hold back this debate. So long as it is fundamentally polarized, it goes nowhere. 40 yrs of history should adequately prove that.
Where we go from here is either to continue to go nowhere, or to respect each other in whatever transition we all decide is best.
~faith,
Timothy.

Am going to put these comments in one post, though they refer to several.

One, associate degree nursing programs were not in any way a "jumping off" point or had nothing to do with women returning to the domestic sphere or any other reason post WWII.

Two year college nursing programs were proposed for several reasons, mainly to produce nurses in numbers fast enough to meet demand, especially for the war. The standard hospital based nursing program at the time was three years, an associate was two to two and one half. In theory one year or six months less is not *that* huge a difference, but since many community colleges could crank out grads twice a year, versus yearly for most diploma schools, it quickly added up.

For the record most hospitals were not thrilled with the idea of associate degree nurses,and wished to keep their own nursing programs for various reasons. One, it meant a ready trained (notice I said "trained" not educated) group of graduate nurses that knew their clinical setting backwards and forwards. Thanks to the apprentice method of learning as practiced by many hospital programs, student nurses not only learned how to practice nursing, but to do so the way the hospital wished. Hospital based student nurses rotated through every area the nursing service covered. Hence the only major difference post graduation is one changed caps and swapped out the student nurse's uniform for starched whites.

Hospital program nurses required little orientation due to the above. Indeed until labour laws were changed, student nurses provided much of the care on the wards (for no pay), and that also made a huge difference in the bottom line of running a hospital.

As the nursing profession changed, and therefore how nurses needed to be educated had to change, hospitals began to see the benefit of two year grads. In some cases they did exceed hospital grads,but only with long orientations (again something diploma grads normally did not require). Hosptials had to weigh the benefits of providing graduate nurses (as they were called then), from associated programs with long enough orientations to bring them up to speed,versus the cost. This was the unwritten trade-off, which by the way seems have been broken today by many hospitals refusing to hire new grads, or only taking on small numbers.

Running a nursing program is expensive, and as the nature of the health care "business" changed, many hospitals decided running a school of nursing was an expense they no longer could afford. Especially as noted above when they could hire college educated nurses that with a bit of seasoning would function as well as diploma grads.

Yes, as you say many hospital based diploma programs had to adapt. Most became ADN or AAS programs by joining up with a local community college. Others simply ceased to exist (New York has only one diploma program in the entire state).

The opportunities you speak of in employment and other areas for women, did not really occur after the end of WWII, but in the 1972 when Congress passed Title IX, and the various other laws and court ruling that have followed. It was this that opened the floodgates for women to leave "pink collar" ghetto jobs, and if one may say, nursing has never really recovered.

Right up through the 1960's a woman had few if any real career choices. Basically it was the nunnery, teaching, or nursing. Oh you can add service and office work as well.

It didnt' matter whether one got a BA from Barnard or managed a BS from Ole Miss, the only decent career for a nice girl was to marry and have children. College was seen as going for one's "Mrs. Degree", as it was hoped by going where the boys were, or at least a male college's "sister" school for girls, one could nab a Yale man or some such.

Girls who wanted to become doctors were most always steered into nursing at the high school level. Even if she stood firm, the required classes in advanced math and science were often refused her, without these there wasn't a chance to get into a decent pre-med program. Even if she did manage to get the high school bit over with many colleges didn't let women take the required pre-med science/math courses either, hence the push for Title IX.

A few more points:

Some posts claim associate degree students have more clinical experiences than those in a BSN program. That *may* have been true years ago, but many of the later have more clinical time than the former these days for several reasons.

For one thing the increased body of knowledge required for all nursing students because they all take the same board exam, means ADN/AAS programs have had to make some changes. BSN students are in school for four years, which gives a program plenty of time to spread required courses out, leaving room for expanded or simply just more clinical time. Some BSN programs are starting clinical experience in the second year, so in essence students are doing three years of nursing, not the two many associate with four year degrees.

Assoicate in Applied Science and Associate Degree (Nursing) are two different sorts of programs. Though both are "technical" degrees, the later is supposed to contain content that enables one to move onto a BS program easily. AAS degrees are probably closer to the hospital programs of old in that by being allowed to forsake some of the general education requirements, students are allowed to focus more on their major.

What often gets lost in this debate is that ADN/AAS nurses were never intended to replace BSN nurses, nor were the later designed to work at bedside. However as all sit for the same boards, and now that all 50 states have consented to the national NCLEX, there isn't anyway to change "a nurse is a nurse, is a nurse" mentality.

You have three types of nurses (diploma, ADN,BSN) whose education by nature should be different (ever hear of a two year college student doing the same course work as a four?), now having to adapt themselves to pass one exam and being left to the whim of the market place (hosptials and other clinical settings), to sort out what should have been settled within the precincts of the nursing profession ages ago.

On our first day of Nursing 101 (Med/SurgI) our professor told us how great nursing was for a young girl because it was a profession that could be put down and taken up again easily. By this she meant the lot of makes a woman's life. In time we all (hopefully) would marry, leave nursing to take care of husband, home/household and babies. Should (god forbid), things didn't work out, or hubby wasn't bringing home enough money, we could dust off those caps and return to the bedside to make money.

The woman was dead earnest, and it still rings true today, which IMHO, is one of the reasons this debate over mandatory BSN has gone on for over fifty years and counting. For every nurse who wants to raise up the PROFESSION, others need a quick way to make money. Am not saying these are all nor even the main reasons, but ...

In any event, whilst nurses have been busy doing what they do best on this matter, the world at large is moving on. More and more hospitals or healthcare systems are going to "BSN preferred", or at least making movements in that direction.

Yes, this may have been tried before, but several factors work in favour of these schemes this time. Not the least is the rapid increase of second degree BSN programs coupled with quite allot of unemployed four year college grads in need of a job.

Streamline2010 · Sep 13, 2010

Hey. :-) Thanks for the history lesson, DoGoodThenGo and ZASHAGALKA.

GQGomer · Oct 24, 2010

Have to chime in. It seems sometimes educational standards are being raised without any REAL necessity to change anything. If the AAS/ADN nurse is as just good as the BSN nurse, then the only people who benefit are those who are making $$$$$$$$$$ by trying to force everyone to get a BSN (ie the SCHOOLS are laughing all the way to the bank). Not seeing much merit in a BSN - an associate's degree seems quite sufficient. Just more hoops through which to jump with not much benefit re: being a better nurse. My understanding is most of the additional work for the BSN is busy work (research, theory, etc). WHY do people want to pay more than necessary for their educations? If a BSN becomes standard for ALL, NO ONE will have an edge over anyone else re employment anyway. Someone mentioned teachers and social workers. I cannot fathom why a social worker would need anything beyond a bachelor's degree for that kind of work - not exactly rocket science. Likewise, with teaching. I honestly can't fathom why anyone would need beyond even an associate's degree to teach. It's a blatant fluff field. (Have several teachers in the family, so I know what their education consists of - it's absolutely nuts to make people go one angstrom beyond an associate's degree to teach - why pile on the busy work? Coursework in lesson planning, classroom control, ESL? Ridiculous. The 3 R's have been pushed aside to make room for rubbish. No one wonder Johnny STILL can't read at age 18!) Now, people are doing the same thing with nursing and the degree holder will get no benefit once (if) it becomes standard for everyone. Logically, the whole concept is artificial and it serves mainly to clean out student wallets; not to mention the additional time required. With current options of LPN, ADN/RN, and RN/BSN/MSN,etc people are currently able to tailor their education to their (& the employer's) needs with the option to continue. That's a nice, flexible way to do things for most people. With a BSN nurse not generally being better qualified for the actual job, why force everyone into a BSN? In my case, I already have 2 BS degrees, so unless a 3rd bachelor's degree (BSN) is going to make some significant difference in quality of nurse or amount of pay, it seems like pointless BUSY WORK.

Come to think of it, people did the same thing with medicine. First it was just medical school (think 50 yrs ago). Then along came the residencies. Now, it's almost unheard of to practice in a niche area (ie subspecialize) without doing one or more (often lengthy - as in 2 or 3 yrs) fellowships (after a 3-5 yr residency in addition to 4 yrs college & 4 yrs of medical school) TOO. Not sensing the MD's are really gaining much out of it - especially since their pay has been substantially whittled away over the past 30 years. (An ironic aside: much of the public thinks MD's are overpaid. Seems they're WAY underpaid given all that education/training.) In a nutshell, they're forced to get much MORE education for much LESS pay these days. Not quite the paradigm it was supposed to be. There's a lesson for all of us in there! (Look to the long term, folks.)

Think of it this way, WHAT benefit are YOU going to get from a BSN if everyone else has a BSN too? If you think you're going to be paid more, you're dreaming. You'll only get stuck paying more for something that is of no real benefit to you, the patient, or the employer. The schools, however...well...CHA-CHING sums it up nicely!

lifelearningrn, BSN, RN · Oct 24, 2010

Someone mentioned teachers and social workers. I cannot fathom why a social worker would need anything beyond a bachelor's degree for that kind of work - not exactly rocket science. Likewise, with teaching. I honestly can't fathom why anyone would need beyond even an associate's degree to teach. It's a blatant fluff field. (Have several teachers in the family, so I know what their education consists of - it's absolutely nuts to make people go one angstrom beyond an associate's degree to teach - why pile on the busy work? Coursework in lesson planning, classroom control, ESL? Ridiculous. The 3 R's have been pushed aside to make room for rubbish. No one wonder Johnny STILL can't read at age 18!)

Have you worked in social work? Rocket science it may not be, but it definitely takes an educated person to understand the various dimensions of different groups of people, the effects of socioeconomic status on a certain case file, how to handle abused children, elderly, and special needs individuals. This isn't necessarily something that can be taught with an undergrad degree in sociology. In some cases maybe.. but I think graduate work (certs) is probably a good idea for certain types of case workers. [i must say I've seen a lack of respect for social workers more than once on this message board]

I do think the requirement and hoops teachers need to go through to get certified to teach is absolutely ridiculous.. but an associate's degree? Being an associate degree holder myself, I think it take a little more education than that to educate our children. The three Rs are important, but our kids need to be learning a hell of a lot more than that.

You seem to have a general lack of respect for education as a whole. I disagree..

NightNurse876 · Oct 25, 2010

Oh Ratchett,

My sister is a teacher with an MSN. I am very glad she has one. She helps those students who have trouble reading, she is able to put together programs for schools to properly aid and prepare the students that fall in that category. She is able to identify their needs and formulate a way to meet then...she learned that getting her masters. My mother is also a teacher who specializes in culinary. She teaches her students how to prepare food, about portion size and nutrition, something most of them do not get at home, thank good for her as well. My mom couldn't do my sister's job and vice versa. You truely have no respect for education..."just do the minimun and get out there, everyone is doing the same job' seems to be ur thing....reality check time friend; our society needs specialized professionals to meet all our needs.

Also no need for a BSN...do you have one or plan on getting on? Who is to do the research to help further this profession. And anyone who is a nurse and thinks this isn't a profession needs to LEAVE, you are dragging us down. A BSN prepares you to go into many areas of nursing and gives a good glimpse into each. Did I like my research class? No. Did a swear I would never do research? Yes. But I see that there are many things/areas I would like to se improve in nursing and research is now a passion of main that I plan to fully commit to in a few years. The nurse is not just a bucket of skills the nurse has the chance to make the most changes in a patients life. We are with them the most and have the pleasure of treating physical ailments but also mental and spiritual ailments as well, or at least identifying them.

I notice that after a while some r just in it for the steady paycheck and the ability to pick up/put down the profession and its hard to change that but that's why we have options you can start with a diploma and move up to a PhD and thats great. The people who want to grow and excel will naturally do so but if we want to be taken seriously as a profession who is truely resposible for patient care more that any other group that walks the hospital halls we have to set the bar...and BSN is a great place to start.

GQGomer · Oct 28, 2010

Re comments about lack of respect for the fluff fields, that's just the way it is. Pragmatically, some of the less demanding degrees are full of busy work with little merit. Regarding the teaching "profession" (if one can actually call it a profession), it's a joke. Those people are glorified babysitters. Most can't even muster the brain power to do something as simple as college alegebra. Re courses such as social studies and similar areas that students are required to take: those courses seem a lot more like liberal propaganda and indoctrination of young minds. The liberals pretty well run the educational system in the US. The 3 R's are lost in the process. Those 3 R's are highly significant in attaining and doing well in future employment as an adult. Let's just put it this way, most nurses could do a much better job of teaching children what they really need to know including some of the hard core math and sciences. It's a travesty that people are required to spend 4 years on mostly pure rubbish coursework in order to teach. To reiterate, the leftist slant has no business in the world of impressionable young children. Teachers, in general, are paid far too much based on the level of difficulty (ie. ease) of their degrees and also based on the number of days they actually work compared to most people. They are basically fluff-educated government leeches sucking off the tax payer. Quite frankly, it's not fair to the children in this country either.

NightNurse876 · Oct 28, 2010

Re comments about lack of respect for the fluff fields, that's just the way it is. Pragmatically, some of the less demanding degrees are full of busy work with little merit. Regarding the teaching "profession" (if one can actually call it a profession), it's a joke. Those people are glorified babysitters. Most can't even muster the brain power to do something as simple as college alegebra. Re courses such as social studies and similar areas that students are required to take: those courses seem a lot more like liberal propaganda and indoctrination of young minds. The liberals pretty well run the educational system in the US. The 3 R's are lost in the process. Those 3 R's are highly significant in attaining and doing well in future employment as an adult. Let's just put it this way, most nurses could do a much better job of teaching children what they really need to know including some of the hard core math and sciences. It's a travesty that people are required to spend 4 years on mostly pure rubbish coursework in order to teach. To reiterate, the leftist slant has no business in the world of impressionable young children. Teachers, in general, are paid far too much based on the level of difficulty (ie. ease) of their degrees and also based on the number of days they actually work compared to most people. They are basically fluff-educated government leeches sucking off the tax payer. Quite frankly, it's not fair to the children in this country either.

In every profession are people that shouldn't be there but to say the things you have said is ridiculous...That's just the way it is you say...regarding your lack of respect for the "fluff fields", so what is a real field to you? You are absolutely wrong in your statements, but the facelessness of the internet allows people to act this way... the end! :down: :down: :down:

And the liberals don't run the education system, you'd be surprised how close of a friend of your kind run the educational system. Its not the teacher's fault that (in Florida) they have to teach FCAT most of the time instead giving students core knowledge needed in the real world. Teachers dont make the curriculum, it is given to them. They don't choose the books, they are given to them. They are tasked with making their students learn, finding where they are weak and creating ways to strengthen them. I have had great teachers, not all of them were but some really helped me to learn and what you say is an insult to all of them.

GQGomer · Oct 30, 2010

WHY am I so amused? Guessing someone is a teacher or former teacher. Seems I hit the nail on the head and a little too close to home for comfort. Advice: get a REAL degree and get the hell out of the tax payers' pockets. Repeat after me class: "Middle class welfare queen!" People like you are dragging this country down. You're always wanting something for free at someone ELSE's expense. Get some pride and get a REAL work ethic!! We are NOT your parents nor do we owe you a darned thing. Fend for YOURSELF...you're an adult, correct?! Or...perhaps you'd prefer to move to Europe and LEACH off the system like all the bums there do...we don't need more bums here! (May I suggest Greece?!!!) No wonder people like you never get ahead and no wonder you're always so full of class envy. If people like you spent nearly as much time on a real education and developing a REAL work ethic as you do scheming to steal from the tax payers while mired in envy, you might actually get somewhere in life. Geezus. Sighhhhhhhhhhhhhhhhhh (Betting this one hates the "rich" too...chuckle). Whatever happened to this country's spirit of independence and pride in doing for oneself? Where is the integrity? Let me give you a little hint: all those CEO's and other "rich" so many love to hate actually worked a LOT harder than most people have ever worked to get where they are in life. Perhaps you'd do better to emulate them rather than to hate them. There is much to be learned from others' successes. The US used to be such a great country. Hopefully, one day, she will be restored to her former glory...

BTW, in case it's not clear, you are not, I repeat NOT, "entitled" to OTHER people's hard-earned money. STOP thief!!!!!!!!!!!!!!!!!!!!!

Silverdragon102, BSN · Nov 1, 2010

Closed for staff review