Requiring a BSN degree for an ADN scope of practice

[Gentleman_nurse]

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.

[smartnurse1982]

. There is NO difference in nursing practice and the standards of care between a BSN grad and the ADN grad.

WHat about the paper published by the ANA that states patients have better outcomes when the staff are BSN grads?

[meanmaryjean, DNP, RN]

WHat about the paper published by the ANA that states patients have better outcomes when the staff are BSN grads?

Apples and oranges. The standards are the same. The NCLEX is the same. The outcome may indeed differ, but the practice and standards are, on paper, the same.

[Gentleman_nurse, MSN]

Maybe I'm obtund...I still don't understand. The ADN and the BSN are entry degrees. The BSN allows for more rounded of a general education with NO difference in the clinical and nursing curriculum. Both graduate and new grads without nursing experience.

It is true that many facilities are hiring BSN only grads, pushing the BSN entry agenda, however, they are still bedside nurses. There is NO difference in nursing practice and the standards of care between a BSN grad and the ADN grad.

What is this difference and how should the job descriptions be different?

Perhaps this story might help.

When I graduated from college with my BA many years ago I applied employment position at a Museum. I was offered a position for a slightly higher than minimum wage heavy labor job to move boxes. During the interview it came out they were only interested in hiring college graduates for the position but the job didn't require anything more than a 8th grade education.

I see a similar trend in nursing. Institutions are requiring entry level nurses to possess a bachelors degree yet don't utilize the formal knowledge they bring. Maybe they see something intangible. Maybe over time the duties will grow to incorporate it. It's just a thought. I was wondering others think about this phenomena.

[TheCommuter, BSN, RN]

Perhaps this story might help.

When I graduated from college with my BA many years ago I applied employment position at a Museum. I was offered a position for a slightly higher than minimum wage heavy labor job to move boxes. During the interview it came out they were only interested in hiring college graduates for the position but the job didn't require anything more than a 8th grade education.

Ah. You're referring to credentialism, a.k.a. credential inflation, b.k.a. degree inflation.

[itsmejuli]

Ah. You're referring to credentialism, a.k.a. credential inflation, b.k.a. degree inflation.

Exactly.

I'm looking at changing careers. Often I see that a "bachelors degree in any field" is required. What the heck difference will a "bachelors degree in any field" make when compared to someone with over 30 years work experience and an AA? Would a 22 year old new grad with a BA and no work experience get hired over me with an AA and 30 years work experience?

[brandy1017, ASN, RN]

If you already experienced this for an entry level job in the art field, why are you so surprised this would be an issue in a science field? I agree both ADN & BSN do the same job, but if a hospital can get someone with more education for the same money, does it really surprise you? The magnet status movement has been pushing for more BSN RN's and seem to be winning, also the glut of nursing grads makes this an easy choice as well.

Now more than ever, getting a job is about who you know. ADN's are still being hired and some even work in management but the pressure is on for BSN if not MSN. You must convince them to hire you. Showcase your nursing skills, experience and BA college background. Or you can enroll in a BSN program while you are trying to get a job, that would probably help, but would also cost an arm and a leg. Only you can decide what is the best move for you to make!

I'm sticking it out with an ADN because I need to save my money for security now and in the future. I just don't think the return is worth the risk financially as I'm older and much closer to retirement. If I were younger I would probably get the BSN and go by the cheapest route, probably WGU. Also if I was younger I would seriously consider getting an NP and getting out of the hospital assembly line break your back work environment!

And that is the advice I would give others just starting out! It really doesn't pay to stay a floor nurse and while you may have energy when you're young, you are only one patient away from being injured and in lifelong pain! This risk is all the more now as the obesity crisis has transformed our country and it is common to get even 300-500 pound patients in the hospital and nursing homes! If you aren't dramatically injured, you are still being subjected to the wear and tear on your body over time and most nurses have chronic back pain. It is really not worth it! If you have been doing this for years and don't have chronic back pain count yourself lucky!

[elkpark]

As already noted, there is no "ADN scope of practice." There is RN scope of practice, and there are RNs who chose to pursue licensure via an ADN degree, and those who chose to pursue licensure via a BSN degree (also diploma grads and MSN entry grads). While it is true that there is little to no difference between the two in acute care bedside nursing jobs, there is a lot more to nursing than just acute care bedside nursing. There are many kinds of nursing positions which require a BSN, and having one does open doors to professional opportunities not available to ADN-prepared nurses.

People who don't see value in a baccalaureate degree in nursing are welcome to not get one. However, more and more employers are preferring, if not requiring, them and that trend is not likely to change until there is another real nursing shortage. To focus strictly on the "task" aspects of nursing practice (what things can BSN-prepared RNs do that ADN-prepared RNs can't) is really taking a v. narrow and shortsighted view of nursing practice.

[caliotter3]

I doubt that writing research papers that correctly utilize APA format is needed for most entry level nursing positions. I take the BSN requirement as little more than a way to cull the herd before the first cut. Most people without a BSN will not apply to a position where a BSN is required. Some won't bother where the job listing says "preferred" either. That cuts down on the number of applicants and the work entailed with dealing with more applications. Then there is the perk of bragging rights because your institution has "high" standards.

[mmc51264, BSN, MSN, RN]

Not to make light of the subject too much, we a nurse who came up with "RN" stands for narcotics and refreshments and "BSN" now stands for Bed Side Nursing.

I have a BS in another field and my ADN (one semester away from finishing RN-BSN program), which technically make me a "baccalaureate trained nurse" which is a phrase they throw around. This is not the same as a bachelor degreed nurse. I live to split hairs must to annoy LOL.

I am enjoying the extra learning that I am getting in my BSN program, and I have said before that I think it is a good thing to get your ADN and then go for the BSN later, it has more meaning and context. I know it is not easy to get jobs with an ADN, but I have noticed that many places are advertising jobs, and instead of "preferring" a BSN, they ad the caveat that if you are an ADN, you must sign a contract to obtain BSN within a certain time frame (enrolled within 2; finished within 5 seems to be the norm)

[lub dub]

[llg, PhD, RN]

I am one of those people who would like to see 2 scopes of practice. I think that nursing made a big mistake when they created the ADN degree in not establishing 2 separate levelss. Not having a clear delineation and separate NCLEX's has caused a huge mess that is hard to fix.

I can't speak for every employer, but most that I am familiar with are prefering BSN's not just because it looks good for Magnet -- or some other such reason -- but mainly because they want nurses with the additional education. They want their staff nurses to have the ability to engage fully in evidenced-based practice, research, population care, etc. They want people who have taken the theory classes, research classes, statistics, etc. and who have been socialized into the professional culture that says that these sorts of activities are appropriate for the average staff nurse. And they want their staff nurses to be able to step into first-level leadership roles such as Charge Nurse, Preceptor, Assistant Head Nurse, Unit Educator, etc. positions and functions when necessary. They (we) believe that in most cases, the BSN-prepared nurses are more ready and able to fulfill those types of functions. It's not about the "physical tasks" of nursing -- it's about the leadership/broad perspective issues.

[monkeyhq]

I do not understand exactly how two levels could be established. The scope of practice is exactly the same: RN. The 'nursing skills' education is the same.

How are the hairs split between nurses that graduate from a diploma program (there are still many 2-3 year diploma programs out there) vs. an ASN vs. a BSN? Should a delineated test add more advanced math, physics, psychology, earth sciences, advanced language arts, business administration, advanced statistics, ethics, and other electives? How should those electives be decided so that they apply in a uniform way to all BSN program graduates? Should half of the test be written in a foreign language (as most BSN programs require FL credits)? Should there be an essay component to the NCLEX? How are colleges across the United States going to ensure the exact same theory classes?

I am not asking these questions to be a smarty butt, I am genuinely curious how something like that would work.

I do understand that many hospitals are asking for BSN nurses, but I believe that is more driven by the desire to achieve Magnet status than anything else. I agree that there may be some weight to better outcomes for patients when more BSN prepared nurses are involved. I think this may have more to do with the aptitude of the individual nurse, the hours of clinical experience, the closer association with hospitals for clinical locations 4-year programs tend to enjoy (for-profits around here have a tough time getting in hospitals for clinical sites), the financial status of the hospital and community, and a host of other factors.

I am not devaluing the BSN prepared RN in any way (I am working on my own BSN right now). But I don't believe that the standard between an ADN and BSN is so great that an exam should be used to separate what a RN can and cannot do at each level.

I have 20+ years experience in accounting (associate's level), administration, business management, and government. I could transition that skill set into any of the first-level leadership roles listed without adding 60 hours of coursework. Should someone with 'life experience' such as myself (and many other ADN or degree program nurses) be able to sit for the 'advanced BSN' NCLEX without having the gen-ed coursework if we are certain we are prepared? We already are RN's. Must we pay a university for the privilege of certifying what we already know? If we pass, do we get the same letters (BSN) behind our "RN" on our badges?

Again, please don't take this sarcastically, I would genuinely like to know how this would all work?

*in my state, clinical hours tend to be much higher for BSN programs and community college ADN programs than the clinical hours of for-profit college ADN program. My local community college ADN program is the best nursing program in the area with a NCLEX pass rate of 97% (over 100 students test each quarter) and requires over 900 clinical hours. Their program admissions standards are higher than that of the local 4-year university, and the waiting list to get into the program is years long. The largest university BSN program in my area has a pass rate of 85%, and requires 700 clinical hours. The biggest for profit program has a pass rate of 80%, and requires 600 clinical hours. Regardless of their path, if a student passes the NCLEX, they pass the NCLEX. It is not a stretch to associate a greater number of clinical hours with higher pass rates, and perhaps, some better nurses. But not all. I've met C- ADN's who were the best nurses, and A+ BSN's that could give two hoots about patient care or doing the job of nursing.