Why, would any RN oppose requiring a BSN for all future nurses?

[Roland]

Okay, I could see certain philisophical objections, such as if you are a libertarian, or strict conservative that opposes most governmental regulations (after all standards for education are a form of governmental regulation). However, any such provisions would almost certainly have provisions that "grand-fathered" in all current RN's who had diploma or ADN/ASN degrees (and would probably include those students currently enrolled in ADN programs).

The bottom line is that pay, and to a lesser extent respect for ANY profession, is primarily determined by supply and demand for that profession. Now as nurses, there is little that we can do to address demand ( save perhaps for buying stock in fast food restaurents since that will surely generate more business in terms of cardiovascular disease). However, we can address supply. In so much as getting a BSN requires more time and effort than a ADN it will TEND to diminish the supply of nurses. Virturally every profession in the United States has recognized this simple principal from accountents, to physicians and pharmacists. Over the years they have successfully lobbied their various state and federal representatives to steadily raise the requirements in order to obtain a license to practice their profession. Consider Pharmacists for instance. At one time all one had to do was "work behind the counter" under the instruction of an experienced pharmacist for several years to acquire a pharmacy license. Then they required an examination. Gradually, the requirements were increased to a two, then a four year degree. Now it requires SIX years of difficult schooling plus a challenging examination to practice pharmacy. The net result is that the pay of pharmacists has dramatically increased, and they are now in a true "buyers market" for their services.

It's the way the "profession game" is played in the United States. I'm not saying that it is without it's moral implications. As someone who is largely libertarian, I am usually opposed to most governmental intrusion in the private sector. However, I'm also a realist, and as someone who plans on spending the rest of my life in this profession, I realize that this is the sort of thing that will help to raise the compensation, and benefit level of my chosen profession.

[caroladybelle, BSN, RN]

Roland, there are so many holes in your theory, it is unreal.

There is teacher shortage, and many teachers have advanced degrees, yet they are still poorly paid. In addition, their jobs require extensive continuing education but they still get paid poorly. And many of them have wretchedly poor working condition.

Many of the most creative and successful minds have little formal education. Bill Gates dropped out of his University,yet he is incredibly wealthy, successful, charitable and creative. Einstein was incredibly poor at school, yet incredibly intelligent.

I was a student, places into "gifted"education classes in early grade school. The vast majority of these students were estimated at an IQ over 135 or higher. Yet, these same students frequently dropped out of school, failed out of school, or left school at graduation at the same rates or higher than those of "average" intelligence.

I have seen very few jobs that test IQs for acceptance, but I have seen plenty of college grads, even with Masters degrees working at Starbuck's to make ends meet.

What we get paid is based on how much society values our services. And society does not see nurses as having much value. They obviously value the Trumps and the superbowl football players and Michael Jackson more.

[Roland]

for RN's is being driven down by the over supply created by the current situation (not mandating a BSN for all NEW nurses). This is of course exascerated by practices such as bringing in nurses from oversea's. As to the problem with high nurse to patient ratios my approach to this problem is multifaceted:

1. Agressively, support attorneys and even encourage them to bring liability/ malpractice lawsuits when patients experience negative outcomes in high nurse to patient ratio situations. Thus, I would seek to make it ECONOMICALLY painful for health care providers to maintain HIGH ratios.

2. Support and publicize scientific studies that show a correlation between high nurse to patient ratios and negative outcomes for patients (this would also make the jobs of attorneys above easier).

3. After enough of these studies had sufficiently mobilized alarm within the general public I would heavily lobby states, and then federal legislatures to enact MINIMUM, MANDATORY RN to patient ratios (say around ten to one). I would also lobby for legislation that would require health care facilities to publicly display these ratios on all advetisments, and at all entrances to their facilities.

Only after the above provisions were in place would I seek to make the BSN mandatory (again I would exempt all current RN's who had ADN's and diploma degrees as well as all student nurses who had started taking prerequisites to enter a nursing program). I would also provide exemptions for certain rural areas that did not have enough nursing facilities, and also seek to implement the programs outlined above to allow existing ADN programs to more easily convert to a BSN format. It would take time, but within a decade or so RN salaries would begin to climb at rates significantly higher than inflation bringing them closer to parity with equivatlent professions (in terms of skill, and value).

Again I reference IQ only to illustrate that no matter how high you raise average education (or even intelligence) that there will still always be competition for scarce resources. Stated simply if you made the AVERAGE level of intelligence and education impossibly high, you would still have those that worked in fast food by default. Perhaps, that is why ALMOST all professions (with RN's being in my opinion an exception) are constantly working on increasing the BARRIERS TO ENTRY to their respective professions. The only way that "NURSING" actively does this is by the time honored method of "eating their young". This is not the most effective method to create such barriers, I would argue.

[fab4fan]

A minimum ratio of 10:1? Gee, thanks. I can see you have boatloads of experience as a nurse. Just because you mandate minimum ratios, BTW, does not mean nurses magically appear. There is a cancer in our profession (to paraphrase John Dean), and it's going to take a lot more than minimum standards and a mandatory entry level to fix it.

And please, spare me the "nurses eating their young" rant. There are plenty of new nurses out there with sharp teeth, too.

I applaud your enthusiasm, even though I think it is a bit naive.

[Marie_LPN, RN, LPN, RN]

A minimum ratio of 10:1?

Tell ya what, Roland, I'LL do the 10:1 ratio only AFTER you test-drive that arrangement for 3 months.

(Forgot to add, let's make about 6 of those pts. alert, non-oriented, wants to wander in the halls, C-diff and MRSA+, incontinent all around, unsteady on their feet, loud, etc.)

[rstewart]

Originally posted by Roland

seem to keep bringing up the BSN verses ASN debate as to what degree is better? Can't you see that's not my point? My only concern here is maximizing RN salaries. Point out why that is a horrible idea all day long if you want, but don't keep going back to this bickering over ASN verses BSN.

There is no evidence that requiring a BSN in order to practice professional nursing will maximize RN salaries. Your basic mistake is repeatedly misusing the supply and demand relationship as it applies to nursing services.

There is indeed a demand in the marketplace for individuals to provide high quality direct care nursing services in various settings; this demand is particularly acute in settings where services must be available 24 hrs/day and 7 days/week.

Regardless of the final title the associate prepared providers would retain (should they lose the RN designation), the fact is that they would retain a decades long history of providing high quality nursing services at the bedside and elsewhere----even in the most high tech/high stress areas. That fact would not be lost by the nation's hospitals, LTC facilities etc., nor by the government, private insurers, and large employers. These stakeholders all have an interest in keeping the cost of healthcare labor at the status quo, or lower.

So requiring a BSN might well reduce the supply of so-called professional registered nurses as envisioned by the academic elite. However, that does not necessarily mean that the market will reward those individuals with even a modest premium over those with associate degrees who are capable of performing nursing services. Today's wage structure confirms that possibility. Rarely do BSN staff nurses make more than AD staff nurses. And when the additional cost of financing those extra hours are factored in along with 2 years of lost RN income spent in school, the pure monetary return on investment is often lost for years if not permanently.

In order for the BSN requirement to have a material effect either it must be demonstrated to stakeholders that they are incrementally more productive than AD prepared nurses or they must by statute reduce the AD nurse's scope of practice.

Unfortunately, the "bickering" to which you refer is intrinsic to the topic and always will be. AD prepared nurses must be characterized as less safe and/or less productive in order to achieve change. If a worker can be adequately educated to perform the work faster and at less cost, in times of a shortage especially, the burden is on the opposition to demonstrate the reason for an alternative approach.

The infamous so-called study which purports to demonstrate decreased mortality for surgical patients in hospitals with more BSNs is in direct response to this reality. In essense, BSN academia says yes, we need more nurses, but don't turn to AD programs to make up the void. Simply ignore the fact that despite past assurances in decades past, BSN programs have failed to provide sufficient graduates to meet our nation's health care needs.

[fab4fan]

One of the few times we agree, Marie!

[Marie_LPN, RN, LPN, RN]

Originally posted by fab4fan

One of the few times we agree, Marie!

Thanks, i think.

[fab4fan]

:chuckle

I meant it as a compliment!

[Roland]

"most professions and trades seek to create barriers to entry in order to limit supply and artificially inflate their compensaton, but nursing in large part does not." Would you agree with that thesis? Again, I have been arguing three points that emanate from this perspective:

1. Seek to require RN's by legislative statute for as many medical procedure as is possible (consider the pharmacy analogy, no pharmacist license, no drugs dispensed).

2. In order to acquire an RN license you must have a BSN (or be in an exempted catagory such as a current ADN/diploma nurse).

3. This will tend to reduce supply, while at the same time "artifically" maintaining demand. Therefore, health care providers will be faced with the choice of paying a salary sufficient to attract the RN's (via the BSN route) that they need or not offer their health care services.

As to my suggestions about a specific RN to patient ratio for legislation it could be lower or higher. The idea of legislation is usually to establish minimum rather than ideal standards. I suggested ten to one in reply to criticism that my proposal would result in thirty to one ratios.

Also, I am not BLIND to the opposition by other interested parties (HMO's, Insurance companies, physician groups ect) that this proposal would engender. I realize that it would be a long, hard fight. However, it is one which has NO chance of being successful if it cannot even garner the support of those who would benefit most directly from it's passage!

[caroladybelle, BSN, RN]

The problem Roland is that quite frankly many of us don't care to have the highest pay imaginable.

And you are so focused on money that YOU JUST DON'T GET IT.

What we care about is having enough well prepared nurses to staff hospitals and MD offices across this country. And your plan does nothing to focus on that.

We care about having reasonable conditions in our workplace, adequate well trained support staff and enough supplies to do our jobs. And there is nothing in your plan to address that.

We care about our patients receiving excellent care. And I have yet to see where your proposal offers anything to help pt care (Don't get on the idiotic BSN vs ADN bandwagon again).

Your plan offers us nothing but a vague ideal of possible raised wages for having a much higher patient load. Thanks, but NO THANKS!!!!!!

If you want the big bucks because you THINK that it takes that to care for your family, fine for you. But some of us manage on public school, one phone line and clothing from Target and be happy to do so, if the hospital is good, the pay adequate and the conditions wonderful.

The very title of this thread is dismissive to those of us that do not believe the way that you do.

Keep repeating your refrain but don't be rude if the rest of us have other priorities that are different but just as valid as yours.

[Roland]

but my primary concern here is nursing pay and benefits. I believe that good ratio's, adequate supplies, and adequate facilities are important, but they are not my primary responsibility. Indeed, I would argue that "patients" have a large responsibility in determining the quality of these assets. In my perfect libertarian world, people would pay for their own health care costs out of pocket (with the exception of major medical, and those who truly could not afford to pay for services). I believe that employer, and governmentally paid health care has created a rift between the consumer and the product being offered (in this case health care). I believe that most people put more research into the hotels they stay at on vacations, and the restauants they eat at on birthdays than they do their healthcare facilities. You might counter that there is no way people could possibly afford to pay these costs themselves. I would counter that this is in large part DUE to excessive govermental, and privately paid health insureance that has contributed to double digit increases in health care costs for decades.

Obviously, we come from vastly different perspectives. I have problems with Bush because in my opinion he is far too left wing, and hasn't gone nearly far enough in his foreign interventions (I would advocate war with Syria, Iran, and Saudi Arabia if they didn't abandon their support of terror). I wouldn't trade with China because they utilize slave labor. Nor, would I expand Medicare to pay for prescription drugs for the middle class (I would provide a benefit for those who truly needed it by expanding Medicaid as appropriate. I would also allow the importation of cheaper equivalent medications from oversea's and curtail the exclusive patant period that US drug makers enjoy.) I wouldn't allow illegal immigrants to receive the same benefits as those who have legally come to this country. I WOULD use the military to back up the borderpatrol to slow the influx of illegals ( I would also however expand by several fold the number of LEGAL immigrants that we allowed to enter). Michael Moore once made the comment that Clinton was the greatest REPUBLICAN President of all time (because of his support of NAFTA, and welfare reform). I would say that Bush should be considered one of the best Democratic Presidents.

My point is that although our perspectives are vastly different I think that we might be able to agree that nurses are largely underpaid and over worked. The methods that I advocate are not extreme. Indeed, I think that you would find that the VAST majority of trades and professions employ these methods to maximize their economic positions. These are time honored approaches that have been utilized since the MIDDLE AGES (consider for instance that the word Master Piece referred to the culminating work of journeyman artisans who wished for a "license" to sell on their own after years of apprenticeship).

[caroladybelle, BSN, RN]

Originally posted by Roland

but my primary concern here is nursing pay and benefits.

My point is that although our perspectives are vastly different I think that we might be able to agree that nurses are largely underpaid and over worked. The methods that I advocate are not extreme.

ARE YOU COMPLETELY UNABLE TO SEE ANY OTHER OPINIONS OTHER THAN YOUR OWN?

We ( obviously many of the other posters here, as well as myself ) do not agree. I have never accepted a job as nurse where I felt underpaid. If you have, well then YOU need to find another one. Pay is NOT an issue for many of us. And a restricted supply is not going to correct us being overworked.

I regret that you are unable to comprehend that idea. But we are not going to agree that nurses are underpaid....if we do not believe we are underpaid.

It does not require having the same "perspective". It does not require one to be Republican, Democrat, liberal, conservative or any other trite label. It does not require posters to post long, unnecessary diatribes on one's own politics, etc. It does require that you be accepting that some of us do not feel underpaid for what we do, and that limiting the supply is not going to help with the overwork situation.

If you feel so grossly underpaid, there are plenty of good paying positions to be had. Perhaps you might sharpen your negotiating skills.

But it is hard if not impossible to "sell" something to us if we don't want/need it and it will be more likely to harm us in the long run.