Requiring a BSN degree for an ADN scope of practice

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I recently attended an interview which BSN nurses were preferred (essentially required but they couldn't say so) but the duties were not upgraded. The position was at an ADN level of knowledge, skill, and ability. A BSN would be very hard pressed to use their advanced skill set in the position. Even with places that do require a BSN degree, the position doesn't require BSN knowledge. With the all shortage of positions and changes in nursing policy I'm sure this a common practice. I am a firm believer in education but this trend makes me uncomfortable. It's a waste of talent and doesn't increase the professionalism of nursing.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
What I don't understand is why there is a minority that wants to impose a BSN mandate on current ADN RN's. As others have noted no other specialty that increased education requirements forced their older members to go back to school to get a higher degree. Instead they were grandfathered in and their experience was valued. Why is that not the case with nurses and this from fellow nurses? Is it jealousy that some of us are working with less education or less student loan debt?

I think you nailed it. Not long ago a superb young nurse I work with expressed it to me this way. Sitting around on a slow night shift the subject came up. She said that in high school she knew she needed good grades and extracurricular activities to get into a good college. She lamented all the fun times she had missed out on in high school while she was busy studying extra hard and taking part in the debate team and other activities to bolster her college application. She did get into a top rated private college. While is college she was very much in the same situtation as she was in high school. In a demanding nursing program that didn't allow her to spend at much time enjoying the college experience as some of her friends in less demanding programs. She graduated at the top of her class with a $500/month student loan payment. She was dismayed and a little resentful to find herself being precepted by a nurse who was in her high school class but who had gone to the local technical college and got her ADN. He prerceptor had already been an RN in the SICU for 2 years, had her CCRN, was about to finish her BSN and was nearly ready to apply to CRNA school. She also didn't have any student loan debt.

I think that kind of resentment plays a roll.

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Specializes in Adult Internal Medicine.
Nothing you say will change my mind on this.

Nursing has been and should always be based in the scientific process; I do hope one day you will be less close-minded, but that is your own choice.

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Most of the hospitals in my area DO hire ADN new grads. We just hired new grads for our ICU, as a matter of fact, and not one of them has a BSN. I am fully aware that there are hospitals that require a BSN, but apparently that is the minority, not the majority, of hospitals. If you read the posts on this site, you would think no ADN could ever possibly get a job, and that is NOT TRUE!

This is the situation in my area too (large prestigious medical centers, teaching hospitals, large hospitals/medical groups).

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Specializes in Adult Internal Medicine.

In all honesty I really don't care about all the diploma and ADN nurses on there practicing now; if it were up to me I would grandfather in all practicing nurses. I would also give credit from speciality certs toward degrees.

I would change for the future to BSN entry given the extant literature on the topic, the job market, and the future of the profession.

I would also change the continuing education process for all nurses (from diploma to DNP) but that is a different debate.

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Ok, now it's my time to stick up for Boston :)

It is ALWAYS beneficial for nurses to further their education. I do NOT think it wise to sit back and have science, technology, academia pass us by simply because we CAN.

I am an ADN-prepared nurse, and I am hoping to soon continue my educational path for a BSN. At the time I graduated, an ADN was all that any employer in my region ever wanted. And I was not only a good nurse, but one from a management background, which made me desirable for a number of reasons.

Now, some years later, I see the benefit to having BSN behind my name. Do I think it will make me a better nurse? Once upon a time, I'd have said "of course not". Now, I'm just not so sure. I think that anytime anyone reaches beyond what they already know and seeks to learn something MORE, that "more" DOES make them a better...something.

Will I be a better clinical nurse? Maybe, maybe not....pretty impossible to say, since I don't have a measure of comparison! At this point, since it seems my employer will be able to offer me the opportunity, I will continue on with my college education, beyond what I already know.

And then I'd be in a better position to report back on whether it was 'worth it' or not.

One thing I know, down to the bottom of my soul: nurses who demand respect as professionals need to remain on the professional edge. I mean, how can we say we are cutting-edge healthcare professionals without the credentials?

We ALL know (from countless anecdotal stories) the "LPN who can work circles around the RN". Or the "ADN who can work circles around the BSN". Ok, fine. But are we really suggesting that this is the norm? Or are we, as professional nurses, willing to say "I think the real goal of our profession is to have members who are educated to the highest degrees available"?

I may never be an MSN. I may never be an NP. I might! I don't know. But I *DO* know that sticking our heads in the sand and saying "I don't need no stinkin' edukashun" isn't the answer.

I, for one, hope to retire in a better educational position than I started.

I'm also feeling a bit more emboldened by a glass of Opera Prima '10 than I ordinarily might, on this topic :D

Still, I stand by everything I've said.....and will continue to say...when I see nurses who claim that they are 'good just the way they are'. Humans improve with brain fodder, I say ;)

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
In all honesty I really don't care about all the diploma and ADN nurses on there practicing now; if it were up to me I would grandfather in all practicing nurses. I would also give credit from speciality certs toward degrees.

I would change for the future to BSN entry given the extant literature on the topic, the job market, and the future of the profession.

In my opinion if everybody felt the way you did it would have been a done deal already. I think the single biggest obstructions to an all BSN nursing work force is (a) the insistance on a two tiered licensure approch (as described in the ANA White Paper), and (b) the instance that exsisting ADN and diploma RN go back for their BSN.

This is exactly why I am so suspect of the motivations of most advocates of requiring a BSN. If that was their REAL goal why not do as you suggest? The fact that granfathering doesn't seem acceptable to so many send a huge red flag up for me.

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How much student loan debt are you in and how long will it take you to pay it off? I work with many new BSN's in six figure student loan debt that will take decades to pay off!

Going to a private college with exorbitant tuition to get a degree that won't pay it off? Well without a generous scholarship, that wasn't the best idea. I went to a state school to get my BSN and have far from 6 figures in student loan debt.

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Perhaps the problem is not that nurses skip to the end and successfully pass the quiz without reading the material, perhaps the REAL problem is the material is not providing any new education to the reader?

^^THIS! I believe this what many who are opposed to BSN requirements for experienced associate-prepared nurses take greatest issue with; while a BSN may equate to improved patient outcomes (which would therefore support the argument for why a BSN is necessary), requiring ADN nurses with years of invaluable experience to attend classes without regard to prior experience and knowledge just to obtain a degree is counterproductive. For me personally having to attend a class in which the information being presented is information that I already have a firm grasp upon is beyond frustrating and not very conducive to learning in general.

I think that if more RN-to-BSN programs utilized competency-based curriculums that provide opportunities to essentially "test out" or objectively prove competency in each class like that of Western Governors University, there would be less resistance put forth by nurses being forced into obtaining their BSN.

And for what it's worth, I absolutely believe that a BSN degree earned after years of clinical experience is inherently more valuable than a BSN alone as learned information is only valuable when it can be appreciated and applied in context to real life. As is such, there really ought to be more opportunities for more streamlined means of obtaining a BSN in which existing competence and knowledge in a particular subject can be measured to fulfill credit hours. With years of ED nursing experience under my belt, I could do a full body assessment with my eyes closed. While dramatic, what I mean is having to attend an entire semester long health assessment class because it's required in a RN-to-BSN program seems to be rather redundant and a waste of time, money, and energy.

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The point in harping about the BSN is that there are a dozen major studies that demonstrate improved outcomes. People can "debate" the studies but I have yet to have anyone show me a study that refutes them.

From your post on another current thread:

"Studies do not prove causality, we know that. There is truth in the fact these results have shown close associations that have been repeated both national and internationally."

The word "demonstrate" means to show to be true. What are the close associations that show improved outcomes to be true in the studies?

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
While dramatic, what I mean is having to attend an entire semester long health assessment class because it's required in a RN-to-BSN program seems to be rather redundant and a waste of time, money, and energy

Not to mention that a health assessment class isn't even part of many BSN programs. So you either have experienced nurses like you sitting through redundant information, or it's not even included in the program. What is the point?

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Specializes in Nurse Scientist-Research.
In all honesty I really don't care about all the diploma and ADN nurses on there practicing now; if it were up to me I would grandfather in all practicing nurses.

In my opinion if everybody felt the way you did it would have been a done deal already.

And I truly believe the ANA would be thrilled with that compromise, because the profession would overall be way ahead of the curve (educationally at least) within just a few years. Unfortunately, there is no way to guarantee action from all 50 State boards; and it would take coordinated effort from all of them to ensure effectiveness of such an action. I believe the problem is with the political & financial clout held by the hundreds of ADN Schools of Nursing. They know there is no way all of them are going to qualify to change their programs to BSN, and that means they are going out of business.

I believe hospitals don't care that deeply about the differences between ADN vs. BSN and if at the moment they can hire BSNs for the same pay, why not be behind BSNs as the standard? They are not likely to provide pressure on State BONs one way or the other. They would likely support high school as entry level for nursing in the event of another nursing shortage, but there isn't one now and when have we ever known hospitals to make staffing plans that extend more than 24hrs into the future? If I give them more credit, perhaps they are tired of waiting for all 50 BONs to come to consensus and they are going to effect change where they can, which is in the hiring process.

And hey, I know there are pockets of the country where new grad ADNs breeze into specialty critical care positions. I have a hard time believing this is all that common; i.e., if the number of positions this affects is more than 10-20% of available nursing positions. I believe for the most part, few new grad RNs are getting hired anywhere but LTC & LTACH; and don't get me wrong, those are extremely respectable and important jobs. But don't even try to convince me those are the jobs the majority of those new grads were envisioning when they were working their tails off in school.

I cannot believe that having a work force that is more formally educated (as a whole and not sporadically as it is now) will not help nurses work towards better compensation with more respect from hospitals and the rest of the healthcare community.

What does this mean? Not sure, I think it means for any change to happen, there will need to be policy change (as in political, not facility). That's going to be a huge job and until then, we're stuck in this same quagmire of multiple levels for entry to practice. We'll continue to witness varying practices throughout the country and from urban to rural. There will continue to be grand disappointment from new graduate RNs when they discover that just because ADNs in rural Michigan can hire into the ICU doesn't mean anything to him as a new graduate in a cool happening city on the West Coast.

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Specializes in Pediatrics, Emergency, Trauma.
And I truly believe the ANA would be thrilled with that compromise, because the profession would overall be way ahead of the curve (educationally at least) within just a few years. Unfortunately, there is no way to guarantee action from all 50 State boards; and it would take coordinated effort from all of them to ensure effectiveness of such an action. I believe the problem is with the political & financial clout held by the hundreds of ADN Schools of Nursing. They know there is no way all of them are going to qualify to change their programs to BSN, and that means they are going out of business.

I believe hospitals don't care that deeply about the differences between ADN vs. BSN and if at the moment they can hire BSNs for the same pay, why not be behind BSNs as the standard? They are not likely to provide pressure on State BONs one way or the other. They would likely support high school as entry level for nursing in the event of another nursing shortage, but there isn't one now and when have we ever known hospitals to make staffing plans that extend more than 24hrs into the future? If I give them more credit, perhaps they are tired of waiting for all 50 BONs to come to consensus and they are going to effect change where they can, which is in the hiring process.

And hey, I know there are pockets of the country where new grad ADNs breeze into specialty critical care positions. I have a hard time believing this is all that common; i.e., if the number of positions this affects is more than 10-20% of available nursing positions. I believe for the most part, few new grad RNs are getting hired anywhere but LTC & LTACH; and don't get me wrong, those are extremely respectable and important jobs. But don't even try to convince me those are the jobs the majority of those new grads were envisioning when they were working their tails off in school.

I cannot believe that having a work force that is more formally educated (as a whole and not sporadically as it is now) will not help nurses work towards better compensation with more respect from hospitals and the rest of the healthcare community.

What does this mean? Not sure, I think it means for any change to happen, there will need to be policy change (as in political, not facility). That's going to be a huge job and until then, we're stuck in this same quagmire of multiple levels for entry to practice. We'll continue to witness varying practices throughout the country and from urban to rural. There will continue to be grand disappointment from new graduate RNs when they discover that just because ADNs in rural Michigan can hire into the ICU doesn't mean anything to him as a new graduate in a cool happening city on the West Coast.

Well said. :yes:

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