Why there is a debate re: ADN/BSN

[Berkeley]

The government (military and VA) differentiate between nurses with an ADN and those with a BSN. The ANA differentiates between them, but the civilian industry does not. If the civilian hospitals ever decided that there isn't a nursing shortage and only show interest in hiring those with BSNs, all the junior colleges will dry up overnight.

I personally knew a captain in the Air Force a while back (I think it was a previous life :) ) who only had an ADN. But at that time the military really needed nurses, so they commissoned ADNs not on their eductaion but on their professional liscense of RN.

It all depends on how bad they need nurses. End the nursing shortage with a bad economy and you'll end the ADN as an entry-level degree to professional nursing.

Do you think this is true?

[MICU RN]

I have a different take on this issue:

1.I believe ASNs will become more popular in the future.

2. I have read that at least 60% of the nursing programs in the country are currently ASN type programs.

3. A direct correlation with the current work conditions and status of nursing as a profession to why it will be dominated by ASNs instead of BSNs.

I have only been a RN for 5 1/2 years, but have met many new graduates over that time because I work in a big public teaching hospital. ANd I have talked to many about job satisifaction and wanting to stay at the bedside for a career. Overwhelmingly, most BSNs I spoke to are not as satisfied with bedside nursing as much as the ASNs. There may be many reasons and some exceptions, since this observation is based on my perspective and not scientific at all. However, I have noticed some trends, such as BSNs students usually compare their job role and compensation to other four years university prepared professions, which means usually they see their friends making more money and subjecting themselves to less stress and crappy work conditions . Therefore, they start to get dissatisfied quicker. As opposed to most ASNs who are more likely to compare their job to other associate degree prepared roles or in some cases other blue collar jobs and therefore see working at the bedside , not such a bad job. I mean you make twenty something a hour and you get benefits and job security. So, I think much of has to do with the perspective of the nurse. Also, I think with the push in all professions for more education, the options to move up in management with a ASN are getting less ,therefore, you may not be able to move past the bedside with a ASN like you could in the past. So most I know tend to make the best of it. As I said, theses are just some of my views and I don't mean to insult either side or take a side in the argument who is better prepared. I started with a ASN and then went back and got my BSN so I would have more options. I think the ASNs grads come out just as prpared to do bedside nursing, but that does not mean there education is the equivalent in regards to university standards.For example, when I went back I had to take many more classes and write many more papers than in my ASN program, which better prepared me for the next level in academics, graduate school. But as I said clinical wise I felt very prepared a ASN graduate.

[Spidey's mom, ADN, BSN, RN]

I've been a RN for 5 years now and I'm wondering about the idea that if the nursing shortage were over, BSN's would be the choice of hospitals. Correct me if I'm wrong but haven't nurses always had a couple of ways to get their RN degree and hasn't there been waxing and waning of nurses for years? Nursing shortages have come and gone for years and we still have Diploma Nurses, ADN's and BSN's. So, I'm wondering about the supposition that when this particular nursing shortage is over, BSN will be the way to go?

MICU RN . .I think you make some great points.

The truth for me is I live in a rural area with a community college 70 miles away and a University over 3 hours away. In order to get my RN as a married adult with children, I chose the ADN route. Of course, the right way to do it would be to go for your degree right after graduating from high school before you get married and have children.

I completely understand that nurses have a unique way to be educated and you can make the argument that if I wanted to become a physical therapist, I'd have to move somewhere where I could get a degree and that wouldn't be at the community college level. So, why make an exception for nurses?

I'm not sure how to go back and change how RN's get their RN. Seems a quagmire to me.

My former college experience when I was not married and did not have children was as a Social Work major at a University. I am all for further education.

steph

[MishlB]

Originally posted by Susy K

I hate flame wars, but if there's going to be one, at least start it on something that's accurate and NOT misleading. [/b]

OK, Suzy...apparently I read it wrong, and took it to mean an ADN is "good enough" in this time of shortages. I wasn't referring to your posts being edited, but someone elses. I am sick of these debates, guess I will go to my corner.

[cwazycwissyRN, RN]

Do to the fact the role of the LPN keep raising to include most of the RNs duties.........of which the LPN gets paid much less+++++++the BSN who has more time invested in school but gets paid no more than the RN............

Makes a person have to question whether the LPN and RN role will not be combined into task oriented professional health care providers................and the Nurse the be entry level BSN. This would mean 60% savings to facilities with 60% being RNs who would no longer be nurses. The now LPNs and RNs would be task oriented health care providers.........under the supervision of the nurse (BSN) pay the BSN who feels like they deserve more than the RN. Pay the LPN who feels they should be paid what the RN make (they already nearly do our duties)....

Now I am dizzy .......it would save facilities money and that is always the bottom line. BSN one per shift to manage the profesional health care providers..........yup ......food for thought , doubt it will happen, but food for thought.

[rstewart]

Actually Cwazy, I don't think your scenerio would not be too far off the mark if the BSN was mandated as the minimum educational preparation for professional nursing practice. Advocates for the BSN as entry level do not envision the elimination of otherwise prepared nurses, but rather they see a differentiated practice model with different roles for each preparation level.

Indeed, many advocates for the proposed BSN minimum will argue that nursing wages will rise if adopted (or that multiple entry routes are in some way responsible for holding wages down); I would disagree. I suspect that wages for most nurses would remain unchanged or perhaps even decline.

How could that be? Well, the majority of the "work" of nursing is at the bedside in our hospitals and nursing homes. I'm not making a value judgment here, just pointing out the reality that the 24 hour a day, seven day a week nature of these institutions is where the need is. Not coincidentally, that is also where the so-called nursing shortage can be found----at the bedside and particularly on off-shifts, weekends, holidays etc.

Now one can mandate entry educational levels to the PhD., but that is not going to effect either total reimbursement received by the providers (in fact, reimbursement is declining) nor does it change the reality that the patients need their meds, treatments, monitoring etc. 24/7. So when the providers figure their care hours and skill mixes, the vast majority of the employment slots would be allocated to the less educated licensed nurses; the fact is nurses educated at those levels have for decades demonstrated safe and effective nursing care (Aiken's recent idiotic study notwithstanding). Since those slots will be, in effect paraprofessional, employers will feel justified in paying less than professional wages. The employer's ability to do this will be tempered, of course by the law of supply and demand.

But there will be far fewer BSN slots than BSNs. So until a BSN slot opens, their choice will be unemployment or take the lower level (and lower paid) paraprofessional job at the bedside. And many will take those jobs to pay the huge school debts they have incurred.

They will no longer be able to complain that they should be getting more money than ADNs because they will, in fact, be doing the job that the academics defined as ADN roles. So they will complain to anyone who will listen that there should be more BSN slots---but nobody will listen......not the legislators who need to keep medicare/medicaid spending under control....not big healthcare who wants to keep the profits for high CEO salaries and their shareholders.

After a while the "word" will be out; everyone will know a friend, former roommate, relative, neighbor etc. etc. who went to a 4 year school but has been languishing for years in a so-called paraprofessional job because the professional BSN jobs are scarce.....sooooooo.....applicants for BSN programs will actually decline and even greater reliance will be placed on otherwise prepared nurses (and UAPs) to perform bedside nursing functions.

Now the one way this scenerio could be altered would be if it could be demonstrated that BSNs offer greater value to the employer at the bedside (more BSNs = fewer complications, fewer lawsuits, greater measurable productivity etc.) I suspect that is why the nursing establishment was so eager to talk up the results of Aiken's study, no matter how poorly designed. They have to come up with an answer to the question, "If we can alleviate the nursing shortage faster and cheaper with AD prepared nurses, why should we allocate our limited resourses to BSN programs?"

[MrsWampthang, BSN, RN]

There is no difference between ASN and BSN as far as bedside nursing goes, no difference in skills. I am an ASN and I do my job as well, if not better than some of the BSNs I work with, and frankly I would resent it if a new BSN grad came in and tried to supervise me or one that had never worked in the ER before. Just because you have a BSN, doesn't make you a better, more efficient nurse skill wise.

JMHO,

Pam

[CougRN]

I'm sure this has been posted before but this is just a thought. If we ever go to a BSN as a minimum requirement for nursing then I would suspect that all ADN/ASN nurses would be grandfathered in. This would mean that anyone with less than a BSN would still be RN's and continue to practice as they always have. The only change would be any new nurses to join the ranks would have to have a BSN. Thus not taking away from anyone with a diploma or ASN/ADN. Just a thought.

[Q.]

Originally posted by CougRN

I'm sure this has been posted before but this is just a thought. If we ever go to a BSN as a minimum requirement for nursing then I would suspect that all ADN/ASN nurses would be grandfathered in. This would mean that anyone with less than a BSN would still be RN's and continue to practice as they always have. The only change would be any new nurses to join the ranks would have to have a BSN. Thus not taking away from anyone with a diploma or ASN/ADN. Just a thought.

Actually, this has been posted several times before (not necessarily in this particular thread). It has always been the premise that all existing RNs would be grandfathered in and this new minimum requirement would only apply to new students. But for some reason, it doesn't seem to really get addressed or factored into people's opinion.

[Sekar]

rstewart brought up a very valid point. I don't see BSN RNs running in droves to fill up those less desirable nursing jobs currently held by LPNs and Diploma RNs / ASN RNs. LTCs, small rural hospitals, off shifs, holidays, all those areas that require skilled bedside nursing but not a BSN will be very vacant. If you think there is a nursing shortage now, just try making the BSN entry level for our profession.

Those of you who argue for the BSN entry level like to point at Physical Therapy, Occupational Therapy, etc.... as similar fields and justification as to why we need to have BSN as entry. Those jobs are not nursing. They don't work the off shifts, they don't get the worst of the patients and physicans like nurses. Changing our entry level is NOT going to improve our pay nor make us look one iota more professional in the eyes of the medical community. Clean up our ranks first by removing the dud nurses we all know are out there, start acting like the professionals we profess to be, raise our young nurses properly, be technically proficient, stand up for ourselves, and the problems that everyone complains about will begin to fade away. It's a much harder answer than simply stating "we need to make BSN the entry level for nursing" but it will be far more effective. Perhaps that is why so many favor the BSN fix, it's an easier concept to grasp.

[RN Rotten Nurse]

I would think that if our economy was in good shape and there was an abundance of nurses, facilities would want to hire nurses that had the most years of experience regardless of being ADN or BSN. They would want to hire the RN that could take care of the most patients efficiently and adequately so that they wouldn't have to hire as many nurses. In fact, that's the way our facilities should be run now. If I owned a private hospital and I wanted to make a profit, I would check out a nurses credit rating, references from previous employers(how many times she called in sick, late, etc) and how efficient she was. I am an ADN nurse and a clinical supervisor(but we try to keep that quiet) because many of our nurses that I supervise are BSN's. Fact is, the ones in my area can't handle my job. I don't see the point in a BSN.

[Pretzlgl]

Originally posted by Sekar

Changing our entry level is NOT going to improve our pay nor make us look one iota more professional in the eyes of the medical community. Clean up our ranks first by removing the dud nurses we all know are out there, start acting like the professionals we profess to be, raise our young nurses properly, be technically proficient, stand up for ourselves, and the problems that everyone complains about will begin to fade away. It's a much harder answer than simply stating "we need to make BSN the entry level for nursing" but it will be far more effective. Perhaps that is why so many favor the BSN fix, it's an easier concept to grasp.

Excellent, excellent points you have made here. And you did so very eloquently. This is exactly how I feel and you have expressed it so well. Thank you.

[Sekar]

Originally posted by Pretzlgl

Excellent, excellent points you have made here. And you did so very eloquently. This is exactly how I feel and you have expressed it so well. Thank you.

Pretzlgl, you are quite welcome. And thank you for some positive feedback.