Solution to ADN vs BSN--Revamp Nursing Education?

[UM Review RN, ASN, RN]

let's pretend that we agree to disagree on the adn vs bsn debate and start all over again with nursing education. let's call it a "professional registered nursing degree program."

first, answer the poll question: do you believe that the rn's educational needs--both clinical and theoretical--are fully served by today's adn or bsn education programs?

then, tell us what types of courses today's nurse needs in order to be best prepared to enter the workplace.

[nursemike, ASN, RN]

Okay, I lied. I am participatiing in this thread, because it does seem like a valid question. I graduated in May with an ASN and reasonably good grades--not all A's, but close, and I recently passed NCLEX (yippee!). So, in theory, it seems like I ought to be pretty well prepared to be a nurse. What I'm finding is, I have a pretty good foundation to learn to be a nurse. I can function pretty well independently, as long as nothing goes wrong, but even small deviations from the routine throw me a little, and when something goes seriously wrong, as it did just a few hours ago, at least inwardly I'm on the edge of full fight-or-flight mode.

In my previous job, I had to take a course on precepting new hires, and what I'm going through is exactly what I was told to expect with an orientee. It has been helpful to see that, now that I'm the orientee, but still...

I feel like I went through a pretty good program, but a lot of the emphasis was on passing NCLEX. Which, obviously, is important. Great nurses pass NCLEX. Mediocre nurses pass NCLEX. Even poor nurses pass NCLEX, because if you don't pass, you don't get to be any kind of nurse.

But, yes, I can certainly see value to an education that would let you hit the floor as a fully competent nurse. I just don't know what that would be. I am orienting with some BSN grads, and while I think they're doing great, what they describe is not that different from what I'm experiencing. I wouldn't say any of us were floundering, but it's not easy.

If I had world enough, and time, I think the path I would chart to a nursing career might be CNA-LPN-Diploma RN-BSN. I don't know whether the LPN step would be as necessary to a diploma nurse, but it would certainly have been a helpful step toward an ASN. On the other hand, for me, an ASN was by far the most practical entry into nursing, and I do fully expect to be a competent practitioner--eventually! OJT is certainly an effective way to learn, and given the cards I had, the only thing I would really seriously have changed would be to have done a summer externship, to get more OJT sooner.

So yes, I think each of the entries into nursing prepares us to learn what we need to know, but I'd venture to guess that even diploma nurses have a lot to learn.

[UM Review RN, ASN, RN]

I was thinking along the lines of less Gen. Ed. courses, or maybe mini-courses, and more theory and clinical time, perhaps an internship. Along the same lines as you describe, Mike, but for instance, here you need to get your CNA which for some reason takes a few weeks or months (ridiculous!) before you even enter nursing school, yet that is not counted toward your education. The CNA requirement could definitely be compressed into a couple of weeks for the nursing student.

And we really and truly need a Microbiology course that has to do with nursing. Ours was all over the darn place. I really didn't need to know all that about DNA transcription, I needed to know about drug-resistant TB, for instance.

Just a couple of thoughts off the top of my head.

Who thinks up the requirements for the nursing programs, anyhow? Don't experienced nurses ever have anything to say about their profession from education to retirement?

[oldiebutgoodie, RN]

I think it would be nice to have "Tracks", so that those of us interested in Med Surg, for example, have more opportunity to delve into Med-Surg issues in more depth. I think that waiting until a Master's program to get that depth is too long of a wait.

I would revamp the whole care plan thing--too much time is spent on the wording of the evaluation,etc, when the core issue is "What do we need to do when a patient shows impaired gas exchange?".

My program spent hours and hours and hours on the client-nurse relationship, which is pretty unrealistic when the average nurse doesn't have time to sit for an hour and chat, using therapeutic communication.

I suggest more hard science, less touchy-feely. I am not dismissing the importance of the psychosocial stuff, but we get so much of it, and maybe we could use a little more pharm, for example.

Oldiebutgoodie

[Works2xs]

Good question. But it's difficult to answer effectively without answering a couple of lead in questions and/or setting a framework.

First, what is currently in each type of program?

Second, why does this currently fail to differentiate the degree programs (or if it DOES differentiate, how?).

Third, what is the goal of the education for each of these degrees?

Fourth, is the NCLEX the ruler by which a degree will be measured?

From what I've been able to gather, it appears to break out like this -

Programs:

ADN: core technical and clinical knowledge base for passing NCLEX cert

BSN: core technical and clinical knowledge for passing the NCLEX cert as well as two years of general education.

Differentiate: the two years of general education credits

Goal:

ADN: prepare the student for entry into the nursing profession.

BSN: prepare the student for entry into the nursing profession and provide the groundwork for advanced skills and to facilitate faster career growth

NCLEX the ruler?:

In short, NO. Why? Consider this from http://www.allnursingschools.com site:

The National Council Licensure Examination is a standardized exam that each state board of nursing uses to determine whether or not a candidate is prepared for entry-level nursing practice.

Sounds great, so why do I say no? It represents what amounts to a MINIMUM standard. It ensures that nurses entering the field all have the same basic understanding of craft. It simply doesn't address the other workplace influences, people issues, business practices, etc. that all impact the nursing environment on a daily basis.

The NCLEX note above is where I think people get all in a knot. Instead of looking at the NCLEX as the minimum requirement, it's looked at as the only requirement. The ADN degree meets that, but doesn't go past it. What about the BSN?

I invite you to look at the coursework for any 4 year degree. Is it a solid 4 years of degree-specific information? No. They pretty much all have the usual math, science, humanities, and writing requirements. The nursing programs I've looked at appear to follow the same premise of other fields. Certainly, this isn't a surprise. I guess if you think that's a waste of time, then I'd suggest getting the entire educational process tossed out. Personnally, after two decades in one field and a lifetime of learning, I'd never suggest that those classes were anywhere near "a waste". While I didn't fully understand it at the time, looking back on my experience I know those "soft" courses added a ton to my ability to understand and respond to the "real world" issues in the workplace.

So, for my money, the NCLEX is a test to ensure people meet minimum requirements for the job. The ADN (pretty much like any technical based ed) focuses on the specifics of the craft. The differentiator for the BSN is the addition of education/knowledge that adds to the minimum. It prepares the nurse for career advancement and facilitates integration into the workplace. They both START at the same place, but the latter provides a broader base.

So before the curriculum is tossed for the BSN degree, I think people should consider just what the differences truely are; how the program stacks up with the rest of the world of higher ed; and what that extra means to the nursing profession specifically. Simply filling the syllabus with nurse-specific course work may end up throwing the baby out with the bathwater. I can see some adjustment to that end of the scale, but not a wholesale shift. Just my thoughts. I'm interested to see what folks say.

[UM Review RN, ASN, RN]

So before the curriculum is tossed for the BSN degree, I think people should consider just what the differences truely are; how the program stacks up with the rest of the world of higher ed; and what that extra means to the nursing profession specifically. Simply filling the syllabus with nurse-specific course work may end up throwing the baby out with the bathwater. I can see some adjustment to that end of the scale, but not a wholesale shift. Just my thoughts. I'm interested to see what folks say.

Maybe I need to rephrase the question, because I don't think you understood what I asked. I wasn't asking how to make it easier or water down the BSN.

Let's be a little hypothetical here so I can clarify.

Scenario: there is no ADN or BSN program. Create a universal nursing program that gives nurses the ability to start working as a professional nurse--preferably without a long orientation and preceptorship on the job post-graduate--that is rich in both theory and clinical.

[tntrn, ASN, RN]

The idea to standardize nursing education programs is a good one; but whatever it would be, needs to neither bump up the egos of the BSN idea or deflate the egos of the ADN's and ASN's.

However it's hard to imagine any newly graduated and licensed nurse, of any description, being able to hit the floor running and be without some kind of necessary real world learning. Not too many jobs or professions where that is possible and to expect it of nurses is unreasonable.

School is school and I believe it prepares you for the perfect nursing world: optimum staffing; scheduled breaks; no personality clashes with physicians; you get the picture. The real world isn't like that and I've had new nurses flat out state: "They said it would be like this if (fill in the blank)." Well, it doesn't work that way in the real world. I don't know what can really prepare you for that. You must experience it firsthand to even begin to understand.

[jnette, ASN, EMT-I]

The idea to standardize nursing education programs is a good one; but whatever it would be, needs to neither bump up the egos of the BSN idea or deflate the egos of the ADN's and ASN's.

However it's hard to imagine any newly graduated and licensed nurse, of any description, being able to hit the floor running and be without some kind of necessary real world learning. Not too many jobs or professions where that is possible and to expect it of nurses is unreasonable.

School is school and I believe it prepares you for the perfect nursing world: optimum staffing; scheduled breaks; no personality clashes with physicians; you get the picture. The real world isn't like that and I've had new nurses flat out state: "They said it would be like this if (fill in the blank)." Well, it doesn't work that way in the real world. I don't know what can really prepare you for that. You must experience it firsthand to even begin to understand.

Now we're talking !

[live4today, RN]

Let's pretend that we agree to disagree on the ADN vs BSN debate and start all over again with nursing education. Let's call it a "Professional Registered Nursing Degree Program."

First, answer the poll question: Do you believe that the RN's educational needs--both clinical and theoretical--are fully served by today's ADN or BSN education programs?

Then, tell us what types of courses today's nurse needs in order to be best prepared to enter the workplace.

Good thread Angie! :) I voted "yes"....the RN's educational needs are fully served by today's nurses regardless of whether they are Diploma Grads, Associate Degree Grads, or Bachelor Degree Grads. I view all three of those programs as "entry level". A Masters Degree is where the advanced clinical and theoretical studies begin. So, if I were to create the most ideal career field for nurses, it would be done by unifying the entry level course material giving all nursing students the same training across the board leaving nothing out. Make the program specific to the needs of the patient/doctor/nurse relationship. The Diploma Grads in years past were the ideal nurse that basically ran the hospitals. They are the ones who precepted me 18 years ago, and I was VERY impressed...still am...with working along side of them.

Perhaps we should return to hospitals training nurses with a uniform educational and clinical structure. Once those students graduate the hospital programs (which must be uniform across the board), then they can sit for the NCLEX. Once licensed, the hospitals should continue to educate their nurses to a higher certification level in advanced nursing education and clinical emphasis. Scratch college as we know it today for educating nurses, and come up with a uniform hospital wide educational and clinical program for nurses.

Diploma nursing has the best art of training nurses with the exception of missing many of the necessary sciences and general education courses. Take the Diploma nursing curriculum as a basis for the groundwork and build from their program. To me, certifications are far more important for growth in nurses than how many college courses one can take.

Remove nursing programs from all the colleges and universities...take the training and education of nurses back into the hospitals where they should have never left.

Community Health Nursing should be a certification course study, not part of a degree program. All nurses across the board should be privy to taking this course in the event they want to do CHN.

My motto for nursing unification is to "SIMPLIFY" the training of tomorrow's nurses and stop all the mass confusion about whose choice of learning is the best. Afterall, it's alllllllllllllllllllllllllllllllllllllll about the money colleges and universities rake in which is utter nonsense to me. We're so tied up in that nonsense we can't see through it to "SIMPLIFY" many training programs, courses of study, and certification skills to form one common program that all prospective students can succeed in. Cut out the middle man "the colleges" and take it back to ground zero where it was most effective in the first place, and build on those skills with continuing education certifications in the area of each nurses choice. :)

[nursemike, ASN, RN]

I was thinking along the lines of less Gen. Ed. courses, or maybe mini-courses, and more theory and clinical time, perhaps an internship. Along the same lines as you describe, Mike, but for instance, here you need to get your CNA which for some reason takes a few weeks or months (ridiculous!) before you even enter nursing school, yet that is not counted toward your education. The CNA requirement could definitely be compressed into a couple of weeks for the nursing student.

And we really and truly need a Microbiology course that has to do with nursing. Ours was all over the darn place. I really didn't need to know all that about DNA transcription, I needed to know about drug-resistant TB, for instance.

Just a couple of thoughts off the top of my head.

Who thinks up the requirements for the nursing programs, anyhow? Don't experienced nurses ever have anything to say about their profession from education to retirement?

Sounds reasonable. My program had one semester, total, of A&P. BSNs had a semester of Anatomy and one of Physiology. I think I got all the A&P I truly need. It was an interesting class, and pretty hard, but I don't think more detail would have made me a better nurse. Our Micro class was almost entirely nursing students, and the instructor geared it toward nursing students. For us, the Krebb's cycle was a "black box" in cellular metabolism--we learned what went in and what came out, but didn't spend much time on what happened inside the box.

Even our ASN program had some dubious non-nursing requirements, though. I had to take a course called Race, Class, and Gender. It's only purpose was to show that our university was teaching people to be socially conscious. It was a total waste of time. I loved English, but did we really need Composition and Rhetoric? If I were an MSN doing research, maybe, but one semester of technical writing would have served my needs better. Frankly, I was a competent writer after high school. What I really needed to learn for nursing was APA format, and really, I won't use that outside of school. Spanish would have been more useful than English, even in WV.

I don't think anyone in my class hated careplans more than I did. Oddly, I don't think anyone saw their value as much as I did, either. I fought tooth and nail to get through something that is just checkmarks, at work, but I do think they helped me learn to think more like a nurse. When I do a Braden score or check the mark for Impaired Skin Integrity or Fall Risk, I actually do consider what's going on with this patient and why is this a problem. I don't have a lot of time to dwell on it, and some of it is more intuitive than reasoned, but it's there in the back of my mind, at least.

I do wish we had had more time for basic skills like IV's and suction. I've been oh-so-close on a couple of IV starts, but have yet to have a successful one since school. We do have occassional patients in single digits on the Glasgow Coma Scale, so I've gotten to practice some skills--under a watchful preceptor, of course. But it has been a blessing not to do my first real-life straight cath on a fully conscious patient, for example.

[pricklypear]

I think a "Professional Nursing Degree" would be great. Sort of like Medical schools are within another University campus, but are autonomous, and assign their own degree.

My fantasy College of Nursing: It could either be free standing, or within the campus of a community college or University. You would complete a core of the normal requirements of a AS degree, then go to the College of Nursing and complete _____ more for the PDN (professional degree in nursing). When you're done with that, you are a few steps away from the BSN, if there was even a need for it anymore.

I've been thinking lately, with all this ADN/BSN discussion, that people (outside of nursing) look at the ADN degree as "just another Associates degree". I don't have any associates degrees, so I don't know for sure, but I would be willing to bet that the nursing program is the most rigorous program at most CCs, and doesn't get the respect it deserves since it is lumped in with everything else. If credits were given strictly on hours spent, the nursing students would have many more credits than other students. Am I making any sense?

[Tweety, BSN, RN]

I think the schools are doing a pretty good job. I don't it's a realistic expectation to produce functioning nurses in nursing school. That should come on the job, as the jobs nurses take after they graduate are so varied. (I like the idea of tracks, I feel my time in peds and ob/nursery wasn't helpful to me at all.)

I think too much time is spent on trivial stuff, like how to properly fold the corners when making a bed, and as someone said the wording of those dang care plans.