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.

I've never hired nurses but in another field I've done my share of hiring as a manager. Though I had nothing against people with a high school degree or an Associates, either they had to show me a lot of verifiable experience and time spent in that particular field or I would lean toward someone with a Bachelor's degree. Mostly it was because it was felt that someone who had stuck it out and made it through the whole Bachelor's program had a bit more commitment and drive to be in that field.

I wouldn't be surprised if hiring managers in nursing departments have similar thought processes. There may not be a difference in professional competence between ADNs and BSN's (especially those who graduated a few years ago when standards were more rigorous and/or those who have lots of experience). However, it may show a different level of drive.

At the same time, not everyone has the money or opportunity to study straight through to BSN right away. This is why hiring managers have to look past the credentials to the person who is applying for that job. If hospitals want more BSN's on staff, they should have programs to encourage their best ADN's to continue onto BSN. As they say, a bird in the hand is worth two in the bush. Bringing in a freshly-minted BSN with zero experience who burns out will cause more grief and disruption to the staff than helping a trusted ADN to continue with their professional development. Another lesson learned from experience. My worst hire was a man who had a Master's in that particular field and looked like a million bucks on paper. My best hire was a young lady with nothing but a high school degree who blossomed in her position, got an MBA during her time working in my department, and eventually took over from me as manager when I stepped down.

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Those threads have nothing to do with "disliking" the BSN degree. It is about being told after 30 years you are no longer good enough and need to get some letters after your name....which in most RN-BSN programs add NOTHING to your nursing practice.

So is it necessary to respond to that with telling those that have a BSN that their extra time in school is worthless and only taught them to write a paper in APA format?

The arguments are always, "But I have experience!!!" Guess what, there are a few people with BSNs that have been a nurse for more than a week. Or, "I have kids/life/whatever, I don't have time/money for more school." Some of us made the sacrifice, and deserve a little credit for that. Or, "I have a degree in something else!" Good for you! If anything was the waste of time, the degree in an unrelated field was, not the degree in what you want to do now.

I'm sooooo tired of walking on eggshells. Can't DARE say my degree is "better" because it will hurt someone's feelings, but get to listen to everyone tell me how worthless the extra time I spent going to school was.

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Specializes in Nurse Leader specializing in Labor & Delivery.
The "push" for Magnet is long over. What we have is the best of the hospitals, many of whom were early adopters (and many more top hospitals who neglected to follow the Magnet fad at all), more and more not even bothering to recertify. This who are still, at this late date, pushing for Magnet are pretty much the dregs of health care and looking to slap a big MAGNET band aid over their shortcomings and mismanagement.

Thank you. Right now in my MSN program, I have to write a paper from the viewpoint of a CNO who wants to bring Magnet to their facility, and has to get buy-in from nursing staff. I'm supposed to talk about how great and beneficial it is. The problem is that I think it's all a crock. I was lamenting to my husband about how am I going to write a convincing paper on something I do not believe. He said "Just pretend you're Sam Seaborn and you're writing the opposition paper." :)

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Thank you. Right now in my MSN program, I have to write a paper from the viewpoint of a CNO who wants to bring Magnet to their facility, and has to get buy-in from nursing staff. I'm supposed to talk about how great and beneficial it is. The problem is that I think it's all a crock. I was lamenting to my husband about how am I going to write a convincing paper on something I do not believe. He said "Just pretend you're Sam Seaborn and you're writing the opposition paper." :)

Wow, tough assingment. I have worked at a number of Magnet hospitals, including two who were on their "Journy to Magnet".

My experience is that the very good hospitals were already good before Magnet. Hospitals that had serious problems didn't fix them by going Magnet.

Maybe describe how much fun it will be for the nurses to be handed 3x5 cards with likely surveyor's questions on them and the hospitals canned answers printed under them. They aren't going to want to miss the fun of the thinly veiled threats to their job if they don't reply to the questions exactly as printed on the card.

One really nice thing about Magnet, on survey day at least their units that are typicaly staffed with 50% travlers, will be staffed at 120% with permanant staff. Some of them on OT.

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Those threads have nothing to do with "disliking" the BSN degree. It is about being told after 30 years you are no longer good enough and need to get some letters after your name....which in most RN-BSN programs add NOTHING to your nursing practice.

We, as a profession, need to stop thinking of this issue as being all about us. This has to do with what is best for our patients, and what is best for the profession as a whole. There is published research that proves that patients cared for by bachelors-prepared nurses have better outcomes than those cared for by nurses with less education. (Abstracts for published research on this topic are available here: An Increase In The Number Of Nurses With Baccalaureate Degrees Is Linked To Lower Rates Of Postsurgery Mortality and here: Baccalaureate Education in Nursing and Patient Outcomes : Journal of Nursing Administration .) This is evidence-based practice. In 1965, Rosemary Donley and Mary Jean Flaherty, both doctorally-prepared RNs, wrote the following:

"Registered nurses are under-educated members of the healthcare team when compared with physicians, social workers, physical therapists and dieticians, to name a few. Under-educated members of the health team rarely sit at policy tables or are invited to participate as members of governing bodies. Consequently there is little opportunity for the majority of practicing nurses to engage in clinical or healthcare policy."

I also want to add that I have never encountered a scenario where a nurse was told that he or she is "no longer good enough" simply because they do not have a bachelors degree. That is another example of bringing this down to a "how does this affect me" scenario. Again, this discussion is about professionalism, and raising the bar in nursing.

To say that getting "letters after your name" adds nothing to your practice is false.

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Specializes in CT, CCU, MICU, Trauma ICUs.

This hornet's nest gets stirred up often and I don't see an end to it soon. I am disturbed by the division it causes within our ranks. I blame poor leadership at the national level. There is no clear plan for the future.

I have been an LPN (for a year), am currently an ADN (for 23 years) finishing my last classes for BSN this fall. Next year I hope to get into a CRNA program. I've done enough bedside and am ready to try something different, but still use my critical care skills. That's the only reason I've finished my BSN. I can honestly tell you that it has not changed my bedside practices in the least. I'm only getting it so I can move on from the bedside.

As an RN I have only worked critical care, with 18 years of that in ICU (CT/Trauma/General). CCRN'd for 15 years. I make note of my experience because I think my field of practice could not be more pertinent to the discussion of BSN vs ADN. I don't list my creds to toot my own horn; I just think I've earned the right to voice my opinion.

It seems those who don't know "what's what" want to make ADN's glorified techs, a new type of LPN, or think that BSN prepared RN's should be the Charge RN's. Besides the fact that all is kinda weird I don't think these people really know what goes on in acute care hospitals, much less ICUs. Techs are the first ones to be downstaffed or just not scheduled. We have always had to be self sufficient, meaning no matter what education you have you will be cleaning pts, doing glucoses, taking pts to tests, emptying bedpans, feeding pts, handing out food trays, etc. This is on day shift! Don't forget titrating that Levophed gtt, shooting cardiac outputs, making sure your ventric is level and getting that admission! I work at a Magnet hospital and my ICU has the Gold Beacon Award from AACN. These are my days. The NPs, MSN, BSN and ADNs make the same money I do. Having your CCRN doesn't get you a raise, either. Getting a bump in your pay require hours putting together a portfolio to achieve a new grade level, which must be kept up with and improved upon yearly. What in all that makes getting an advanced degree more attractive? There is a historically poor chance of getting a promotion at hospitals. They'd rather hire for management from outside.

Based on my experience I am incredibly cynical about this whole debate. If you cite the BSN studies by Aiken why do you not look at the more numerous nurse: patient ratio studies? These are actually more impactful to patient care, recovery, safety and prevention of complications than the BSN vs ADN studies, much less the debate. Here is just one: Hospital Nurse Staffing and Quality of Care | Agency for Healthcare Research & Quality (AHRQ)

So keep arguing about the BSN vs ADN debate. Employers are thankful for checking off the BSN boxes when they are inspected, at little cost to them. They are grateful that we are otherwise occupied with pecking orders, and fear of losing your job, if you don't have your BSN by a certain year, despite your history of best practice and continued excellent care.

It all comes down to money in the end. My manager would love to get rid of the diploma, and ADN, RNs with 25 years of experience and hire new RNs with their BSNs just to check off that box. She pressures everyone to get their BSN while we work short staffed. Some of these people should be saving for retirement, not getting in debt with student loans, because they only have another 10 years to work.

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Specializes in Adult Internal Medicine.

The people that make the argument that more education hasn't changed their practice at all either really impress me or really scare me. Either they are the perfect nurse or they are too self-confident to reflect on/evaluate their practice and make appropriate changes.

I for one change my practice nearly every day with every article I read, conversation I have, research studies I work on, and my doctoral classes.

Practice should be dynamic. If you can take a class and then not apply it to your practice you are likely not getting anything out because you put nothing in.

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If you cite the BSN studies by Aiken why do you not look at the more numerous nurse: patient ratio studies? These are actually more impactful to patient care, recovery, safety and prevention of complications than the BSN vs ADN studies, much less the debate.

Here is the abstract for an article that looks at staffing ratios and nurse education levels and how they relate to patient outcomes (this was written by Aiken as well): Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study : The Lancet .

By the way, here is the abstract for the article Aiken wrote in 2002, published in JAMA, that addresses staffing ratios and their effect on patient mortality: Hospital nurse staffing and patient mortality... [JAMA. 2002 Oct 23-30] - PubMed - NCBI .

I fear for a profession whose members look suspiciously at requiring more education of its members, or who devise reasons why it is not necessary. This is one reason why the medical profession and the nursing profession are miles apart.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
The people that make the argument that more education hasn't changed their practice at all either really impress me or really scare me. Either they are the perfect nurse or they are too self-confident to reflect on/evaluate their practice and make appropriate changes.

I for one change my practice nearly every day with every article I read, conversation I have, research studies I work on, and my doctoral classes.

Practice should be dynamic. If you can take a class and then not apply it to your practice you are likely not getting anything out because you put nothing in.

I agree with when you say "education". Like you I see education as a constant and on going part of my life & practice. My BSN didn't change my practice. The reason why is that is didn't contain any education that was new to me, or for that matter related to nursing. Not just me. The highly experienced critical care & ER nurses who were in my class had a similar experience.

While I view ongoing education as imperative, I also know there are many ways of learning and acquiring it. It seems to me that only one way is honored and valued, the one that leads to a degree. I also see this as being pretty new to nursing.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

I fear for a profession whose members look suspiciously at requiring more education of its members, or who devise reasons why it is not necessary.

Really? That is what you think is happening? That we are suspicious of education? I think you have missed the point entirely.

This is one reason why the medical profession and the nursing profession are miles apart.

I don't think they are as far apart as you think. There are at least 3 different degrees that can result in becoming a physician. Two of the doctorates, and one bachelors. This doesn't seem to bother the medical side at all. I don't see MDs insisting that DOs return to school for MD degrees. I don't see either of them insisting that the BSBM physicians return to school for doctorates.

Same for PAs who, like nursing has multiple entry paths to practice.

I don't think medicine has the self esteem problem that nursing does.

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I don't think they are as far apart as you think. There are at least 3 different degrees that can result in becoming a physician. Two of the doctorates, and one bachelors. This doesn't seem to bother the medical side at all. I don't see MDs insisting that DOs return to school for MD degrees. I don't see either of them insisting that the BSBM physicians return to school for doctorates.

Same for PAs who, like nursing has multiple entry paths to practice.

I don't think medicine has the self esteem problem that nursing does.

What does BSBM stand for? I looked it up, and all I found was bachelors of science in business management, and bible study by mail.

Medical doctors and osteopathic doctors both attend four years of medical school, after which they both must obtain licensure, and then both must spend time in residency. There is no difference in the amount of time they spend in school/training. The focus of the two programs is different. So comparison of MDs & DOs versus ASN & BSN nurses is a case of apples and oranges.

In order to gain entrance into a PA program, you must have a four year degree. So what do you mean by "multiple entry paths"?

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Specializes in Adult Internal Medicine.

The breakdown of accredited PA programs in AS/BS/MS is 2/10/184. If nursing had only grandfathered-in ADN programs accounting for

MD/DO is still a doctorate-level ed.

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