ADN vs. BSN in Nursing: Time to ‘Move Forward Together!’

By: Martha Tice MS, RN, ACHPN, Clinical Nursing Editorial Director, Nurse.com
Martha Tice, RN

Martha Tice, RN

Marilyn Tavenner, RN, BSN, MHA, a onetime staff nurse, was confirmed May 15th as the administrator of the Centers for Medicare & Medicaid Services. “I think one of the things that is so critical about how nurses view the world is that you are looking at how do you get everybody involved in the process, whether it’s family, whether it’s staff,” Tavenner said in a February 2012 article on Nurse.com. Tavenner encourages discussion and is open to hearing all sides, but once a decision is made, “we all move forward together.”

Interesting that we can do that for our patients but not for our profession. With Nurses Week behind us, we need to move forward together and address the barriers to implementing a common educational preparation for registered nurses. The ADN/BSN debate has been going on for decades. The conflict negatively affects nurses, the profession and ultimately the people we serve.

There will always be those who excel independent of their educational preparation. That is not the point. Comparing nurses against one another based on educational preparation has not gotten us very far. Patients’ conditions and the healthcare environment are becoming more and more complex so we need to work within the interprofessional team to achieve positive outcomes for our patients. And, the majority of the interprofessional staff has a minimum of a baccalaureate education. Shouldn’t each nurse come to the table with the same credentials? If you believe the nurse is viewed as an equal when the dietitian holds a bachelor’s degree, the social worker a master’s degree, the pharmacist and physical therapist a doctorate degree while the nurse holds an associate degree, you are kidding yourself. Nurses bring a unique blend of psychosocial and physiological knowledge to the mix that no other member of the team possesses. Yet we are often not afforded the same respect as the other disciplines based on educational preparation. Is that fair? Of course not, but fairness has nothing to do with achieving what is best for our patients. And doing the best for our patients is what nurses are about, so we need to act and move past our differences!

The nurse who had the biggest influence on my career was a faculty member of the diploma program I was headed to after high school. I grew up in a rural Kansas family with no college graduates. There were only two baccalaureate programs in the state at the time. One was in the “big city,” the other in a town of 30,000 people — both seemed frightening to a shy girl from a high school class of 60 kids. That instructor talked about the direction nursing was going and encouraged me to take the leap and pursue a BSN. That was over 40 years ago!

Despite my fears, I took her advice and I have been beyond grateful to her for that advice. When I decided I wanted to formalize my clinical leadership role and impact the delivery of care delivered by other nurses, yet not become a manager, the Clinical Nurse Specialist pathway was the ideal way to do that. I didn’t have to worry about finding a way to get a BSN (while starting a family) before applying to graduate school. Her guidance made my professional path so much easier and afforded me so many opportunities that I could not have possibly envisioned at the age of 17.

I know getting an AD can be a financial decision. The fact that the board exam and the license are not different based on educational prep makes it harder for people to consider the baccalaureate path. After all, it was my plan to take the shorter and less scary way to becoming a registered nurse myself. It’s not about individual nurse capabilities, but about bringing the profession up to a common minimum preparation. We help patients and families make difficult decisions daily. Unfortunately, we can’t seem to do that for nursing by phasing out AD programs and making the commitment to one common entry level.

In 2011, 60% of all RN candidates in the U.S. were non-bachelor’s prepared. The course ahead for nursing is going to get more challenging as 1/3 of the nurse work-force is expected to retire over the next 10 to 15 years.* Don’t we want those who remain to be prepared to step into clinical, academic and public policy leadership positions? The path would be much smoother if they enter nursing prepared with a BSN degree.

The Institute of Medicine and Robert Wood Johnson Foundation report on the future of nursing can be found on the IOM website: http://www.iom.edu/reports/2010/the-future-of-nursing-leading-change-advancing-health.aspx.

*The U.S. nursing workforce: trends in supply and education. U.S. Department of Health and Human Services Web site. http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/index.html. Published April 2013. Accessed May 20, 2013.

If you are thinking about advancing your nursing career, check out Georgetown University. Its School of Nursing & Health Studies offers an innovative Master’s in Nursing online. Visit their site and get more information.

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71 Responses to ADN vs. BSN in Nursing: Time to ‘Move Forward Together!’

  1. Robert Hess, RN, PhD, FAAN says:

    And you know, Martha, I’m on board with nurses stepping up and upgrading their credentials to a BSN at the very least.

    • Lynn Walsh-Lopez says:

      I am a RN with a ADN. I would love to go back to school for my BSN but I don’t have the money to go back to school. I am 52 years old and to take out a loan for the next 10 years to pay for school is not practicle for me. I am planning and saving on my retirement years. If there are any companies who would like to pay for me to go back to school that would be great. I work for a non profit hospital who only gives their employees $1000.00 a year for tuition reimbursement. This doesn’t even pay for books. Any thoughts or ideas?

      • Hi Lynn! I am 52 years old also, and it was a tough decision to go back to school, all right. I found a community college that is $100/credit and you take one course at a time. I buy used books and use the online library constantly. I am frightened that the wealthy attorney-politicians will cut my Social Security and I will have to work until I am older than 65, as I am sure you have planned since you were 16 like I was. Who will hire a 65 year old? Maybe at least if I have a BSN, it will be more likely!

    • And I too, would love to upgrade to BSN, to Nurse Practitioner….How I wish that happened 50yrs ago. Yes 50yrs…and still employed, and running . How I love Nursing. I am a diploma school grad. Passed State Boards without any problem, and employed for years….Married and started a family. Uh oh…there went the money. All of a sudden, guess who’s going to College…Yep! those kids……and guess who’s paying…..Yep! my job. Now it should be my turn….who is going to pay? If just a BSN, what difference will it make in the type of employment I would obtain. Is there a fast track to Nurse Practitioner….NO!….It’s a wonderful idea….but, if you, the so called hierarchy of the Profession, who insist on these regulations have no reasonable answers to the financial end, who does?….People who are older, cannot take out loans to continue education. Who is going to lend them the money? I, thank God, am already a wonderful nurse. Power packed with incredible knowledge and skills., and still more energetic and more functional than the new BSN Grads…..who are chomping on the bit to take my job. Show me the money, and I’ll take the course, Nurse Prac….Here I come!!!

    • Jane says:

      It’s not credentialing. RN is your credential. It is $20,000 of research, statistics and paper writing.

  2. Mollie. Gehley says:

    I am a Diploma RN of more than 50 years and I agree that the basic entry for RN needs to be a BSN. All other disciplines in the hospital have Bachelot or Masters degrees and the RN cannot be expected to lead the team if she is not educationally an equal .

    • I am in the same situation but we need it easier or more affordable to get the BSN and more clinical studies. I know BSN’s out of school with no knowledge of how to put a bed pan under a patient.

      • Leslie Sokolow says:

        I agree with you Wendee…..so I am not so sure that having a BSN is the right thing to have right out of school.
        These new RNs need some experience with the “everyday” dealings of a floor nurse(which of course has changed since the 1970s) and to learn the “basics” of caring for another human being.

  3. Cathy Fitz says:

    “” If you believe the nurse is viewed as an equal when the dietitian holds a bachelor’s degree, the social worker a master’s degree, the pharmacist and physical therapist a doctorate degree while the nurse holds an associate degree, you are kidding yourself”” I think that almost borders on offensive. Nurses, no matter what the educational preparation, hold a special place in the hearts and minds of their patients. Not only are they equal, the far surpass other professions when it comes to trust, hard work, patient education, accountability and responsibility.

    • Leslie Sokolow says:

      I like your comment Cathy……nurses hold a great deal of pride whether a diploma, ADN or BSN in a hospital setting
      Actually my feeling is : the BSN does not have as much clinical experience as the diploma or ADN(hospital based program)
      I have an ADN and am very proud of it. But after 37 years in nursing, if I have not gone back by now……I’m not ever.

      • Your right, the need for much more clinical experience for the BSN is needed. I feel that our clients see us as professionals.

      • Jane says:

        I agree 100 percent, Leslie. This movement is a coordinated effort of schools and nursing organizations. I have yet to meet a BSN out of school who can assess, perform tasks or write complex orders better than a diploma nurse.

  4. Balogun Rafiat says:

    Please i want to go for my 2years direct in Nursing. Already had diploma. Please can you tell me those that offer that.thanks

  5. Jennye Cox, MSN, RN, CNOR says:

    Finally, someone who links the pharmacist, physical therapist, etc. with the RN! I have been saying this for 20 years. I graduated as a diploma nurse 43 years ago, then obtained my BSN in 1999 and MSN in 2011. I would still like to be in school for a DNP if I wasn’t so old. This is a step we MUST take. Thankfully many of the big magnet hospitals are requiring their nurses to get a BSN. We need to keep pushing. To me the cost should not be an issue. It is expensive to go to pharmacy and physical therapy school, too. Keep up the good work.

  6. Catherine Sweeney Rn says:

    This is an argument that has been going on since I was is school getting my ADN in 1972. The discussion continues. I reached the point where I could not care for patient ans my agency placed me working in the education department. I then felt that I should further my formal education and received my BSN online about three years ago and am now working on my MSN. I understand all the different ways of thinking. Allowing nurses to get an ADN knowing they must get a BSN in 10 years cans help that problem. I still identify myself as RN and not RSN as this seems a little strange since no other discipline identifies their education level. ADN nurses can work as well as BSN nurses but are not trained in management and research. The ADN nurse can care for patient without that knowledge and can learn it in the BSN school. As you can see I am an older nurse who is taking these courses online and has managed to do so and keep up my GPA, but I am not sure if I could have done it back when I graduated high school. There are so many different ways to look at this, I think we need to make a decision and put it in place. The profession looks weak if we cannot make a decision on somthing that has been around for so many years.

    • What is an RSN? As the original article said, it is not about being able to care for patients; it is about respect for our profession. At the last hospital I worked in the pharmacists were called Pharm D if they had their PhD, and the doctors did seem to have more respect for them, PT, OT, SLP, and social workers who had higher degrees. It doesn’t make them better people, just more highly educated which is a mark of distinction in our society.

    • Jane says:

      Not everyone is interested in research or management. Or, another set of letters that mean nothing to anyone but you. An ADN is perfectly capable of reading research studies and comprehending them. We would maybe rather be doing the interesting clinical work instead of sitting in a tiny office sweating out the correct way to write a footnote and thinking grand thoughts about new ideas for an motivational employee bulletin board with a costco size jug of twix for snackies by our sides.

  7. Deanne says:

    This is coming from a nurse with 40 years of experience, probably doesn’t live paycheck to paycheck……If 1/3 nurses will be retiring in the next 10 to 15 years, lets go ahead and make the nursing shortage even more difficult, let’s make out ADN require a BSN. What about the LPN’s that only go to school for less than a year and can almost do everything an RN does? What’s gonna be done about that? Where is all the money going to come from in order to help ADN’s get a BSN? I surely would like to know that! Let’s make our ADN’s go back to school and spend about another 20 to 30 grand to get a BSN for maybe a $1 more an hour…..really. I love my job as an RN. It’s already hard being a nurse with all the medicare cuts, over time, more and more patient demands and very little say in so much of what we do because it’s all about the bottom dollar and patient satisfaction scores. It’s so easy to say “You need a BSN ‘when you already have one, especially if you are management, you are not the one seeing patients, it is us staff nurses who are. I just hope there is going to be ways for ADN’s to get the financial assistance they need in order to attain an BSN. So while you all are making it the entry level for nursing then I hope you are implementing financial assistance and mandating medical institutions that we work for to allow us time to actually be able to find the time to complete a BSN while we are still trying to pay bills and raise a family and working more than 40 to 50 hours a week. Thank you!

    • Kay says:

      Deanne, I agree 100% with what you posted and the passion you posted it with. Your points are very comprehensive. I have been a diploma RN for 32 years. I don’t even know where to begin to express my thoughts. This debate has been going on for decades. During these decades, a lot of us older nurses have been raising families and contributing to the financial part of our own households. Now all of a sudden during the worst economic times of this country, since the great depression of the 1920′s, the almighty unrealistic nursing powers that be have shut us older diploma and ADN’s out of the only means we have to support our families and mandate that in order to work, we must enter into more debt (student loans) and go back to school. For what? $1.00/hr more so we can have bragging rights with the others we work with. I too am livid. Those who have mandated this do not want for a paycheck. These economic times have left me divorced and in bankruptcy with 2 kids to continue to put through college. I don’t see any Nursing association who are making these demands paying for my continuing education. I have seen myself on the unemployment line for a total of 1 year and 4 months.l That is how I went back and into a BSN completion program!! I went to the unemployment office and talked to the department head I was so mad. This is a vicious cycle of cant get a job without a BSN, but cant get a BSN without the money from a job. All this BS about a nursing shortage and we have nurse collecting unemployment. We have older nurses on unemployment. We have older nurses age 65 yrs old being fired from their long term (30+years) jobs in hospitals- YES this is happening!!! This is a shame on the NURSING profession!! I did as the unemployment advisor advised me to do. I filled out financial aid papers and begged for money to pay for classes. I received a Pell Grant. For those who don’t know what Pell grants are, they are free money for needy students that do not have to be paid back. So what has nursing accomplished? In my case, put more of a tax burden on the citizens of my state. For what? Bragging rights for the pharmacist and doctors and social workers. I still have not completed my BSN at age 57yr. I have no retirement. I used it to live off of when I was out of work for 8 months because a diploma grad couldn’t and still can’t get a job in my state. I put “BSN in progress” on my resume and landed a hospital position, finally after 4 long years of temporary positions. Now what I find since I have been back in the hospital among all these BSN’s is a very concerning lack of basic clinical nursing skills.

      The older diploma grads who have posted objections and concerns to this BSN mandate on this forum are rightfully posting. There is a definite need for diploma programs, greater amounts of instructed clinical time.

      • Sally says:

        Kay, you are so right! I am forty, a single parent, and an ADN with a Bachelor’s in a different field. The state I live in is flush with nurses. Following a divorce I needed to move to be closer to family to help with child care. I have 15 years experience and can not find a nursing job because I don’t have a BSN. I know tons of nurses who can’t find a job. Nursing shortage my a$$.

      • Pete says:

        You’re right. Most those almighty, unrealistic nursing powers pushing for the BSN are affiliated with Colleges and Universities that stand to gain tremendously by forcing nurses to run back to school. More grants and government funding is just the tip of the iceberg. So far, in the four years of researching this subject, I have not come across any evidence from a neutral source that proves BSN prepared nurses are better nurses and provide superior patient care. What I have come across are complaints from patients and experienced nurses that many of the new young BSN nurses are deficient in basic nursing skills. It’s not the degree that makes the nurse, but experience and attitude.

      • Stephanie says:

        I agree. This is an insult to me. For the past 25 years, I have dedicated myself to nursing. Now, I am no longer able to continue my current job because I will not go back to school? Money is not the only issue here. How about my time? I work full time and am raising 2 elementary aged children. How on Earth am I supposed to make this happen? I don’t even get to sleep most of the time. This will destroy my marriage and my family. Where is the compassion? I am being forced out of my position because I will not go back to school? How about grandfathering us ADN’s in and closing out the ADN programs? After all, isn’t this what was done with PT’s and pharmacists? This is a true embarrassment to the Nursing profession. Only nurses would allow this to happen to our field. I am angry. I am too young to retire and too old to go back to school. Kudos to those of you that have a BSN but don’t shaft those of us that don’t. If I have to go back to school, it will be for another career that will take better care of me.

  8. John says:

    I don’t think the degree is important. Nursing care is based on knowledge and experience. BSN level nurses typically has less bedside experience while in school as other programs. Also, there is a compensation issue. Hospitals (especially those who are magnet or want to be magnet) want more higher degree staff for certification; but do not compensate those who have higher degrees. It used to be that the higher degree you held, the more you made. That has pretty much gone away.

    • John, BSN says:

      And by the way, I do hold a BSN and in the 19 years that I have been a nurse I have never gotten more pay than a diploma or ADN prepared nurse.

  9. Sonali Dhir says:

    Liked your points, if other members of the team have more creditials, the nurses need to be educated to at least BSN as well

  10. I agree. I started as a CNA, then LPN, then ASN. I had to wait a long time to get my BSN, then MSN; and it was a financial decision.While I am grateful for the opportunity, I see many new nurses who just view it as a fast way to make a decent wage; and, they have little compassion for people, and no respect for other nurses. Most of those would be filtered out in a four year program.

  11. sue says:

    I do not see why a RN must have a BSN. The only difference between the ADRN and BSN were some management classes. I have a Bachelors in another field but an ADRN. Both have served me well

    • Hi Lynn! I am 52 years old also, and it was a tough decision to go back to school, all right. I found a community college that is $100/credit and you take one course at a time. I buy used books and use the online library constantly. I am frightened that the wealthy attorney-politicians will cut my Social Security and I will have to work until I am older than 65, as I am sure you have planned since you were 16 like I was. Who will hire a 65 year old? Maybe at least if I have a BSN, it will be more likely!

      • Sorry! Wrong place! I was replying to Lynn Walsh-Lopez. But Sue, all I can say is, ‘you don’t know what you don’t know.’ You would be surprised at how your critical thinking skills can flourish the more you learn about the world.

      • It doesn’t take a classroom to learn Critical thinking. I do NOT see it in any new BSN grad. I am not against a College education, at all, it is a must for all, whatever profession you wish to partake. A Nursing program’s Core Curriculum should be Liberal arts, Social studies and Sciences in the first 2 yrs. The last 2yrs, intense Clinical training. Roll up the sleeves Nursing, with Anatomy , Physiology, and Pathophysiology. Critical Thinking comes with time.

  12. Catherine says:

    I find your opinion the ultimate, biased, farce! I say, let the nursing license holders in each state, have a democratic vote. I doubt this would fly. This proposal will not only increase the work load on the nursing staff willing to go back to school, it wouldn’t prove much of a pay off, in the end. How about doing something that would truly elevate the nursing profession by allowing nurses to spend time nursing, like initiating patient care ratios?

  13. susan says:

    I am a diploma grad and have been a nurse for 38 years. I’m back in school pursuing my BSN in hopes of continuing on for my MSN. I never realized how important a degree is. I am learning so much but it has also given me a greater voice at the policy table. I believe this should be a minimum requirement for our profession.

    • Yes, Susan, you are right. All new students going into Nursing, should enter a College BSN Program, but, what about those of us who are ADRNs or Diploma school RNS, who have worked for years, as I, for over 50 yrs. Why not a Grandfather clause. We have a an enormous amount of skills and knowledge to offer, to assist the new BSNs into the clinical area, easing their transition from the classroom. Alice has spoken of the fear of the loss of Social Security. I collect social security, and work per diem to make ends meet. No one can live normally by them self strictly on Social security, and the pension that I receive, is laughable. If social security is taken away from us, and the hospitals let all of us go, we would be in a big mess. This has become a reality, the Hospital where I work, has informed their RN staff, that they must have BSN by 2016, just 3 years from now. The financial burden, is too much for us, and the hospitals are definitely not going to assist. So what is to happen, I predict a Major uprising from the Ranks. A march on Washington…also to the State Capitals, to protest to the States Boards of Nursing….? Do you think that either one cares?

  14. LaReda Robbins says:

    So what about LVN’s? Should we just get rid of them altogether?

    • I was a CNA, and an LPN, but I do believe higher education is important. We should require something equivalent to an LPN’s training for patient care tech or aides or whatever you call them. It would solve a lot of problems for nurses, because you would be able to trust that person to understand why your direction was important. As it is a lot of aides/techs think because they have “been doing this for years” that they know better than the nurse. I have a lot of respect for aides, and I realize they do the bulk of the heavy work, but they do not always understand the rationale for what we do.

  15. dennis B says:

    I Have my ADN. I have not found in 17yrs that my “lack of education” wa hampered me in any way. Now that is not to say I am not or have not been considered for management I haven’t, nor do I wish to be. I and a healer not a bookkeeper. I care for my pt’s, not the hospitals bottom line. When I was in school in Nusring 101 it was clearly stated that “WE, Nusres” ARE NOT TO WORRY ABOUT MONEY as we care for our pts. In todays howpitals that is what management does. most nurses that I know today that are managers they are less in tune with what should be instead of the bottom line. So after that rant, I remember that when I was in school this was the topic also. It is amasing that we are still on the same topic. You want higher minimal requirements but you forget that we are allready short handed and will be even more when my ganeration retires. Then what are you going to do??
    I do not feel going into dept for 100 of thousands of dollars to get that BSN is worth the 40 thousand gross we get. Doctors have thought I was not educated enough when i first met them. By the end of the first month they realized that I had and still do keep myself upm to date. I will never get that BSN but I will always give as good as or better care than any and all the BSN’s out there.
    Sorry disagree!!!!!!!!!
    GOD BLESS YOU ALL

  16. Gwendolyn Bennett says:

    I already possess an undergraduate degree with in education. Degreed professionals in other disciplines such as nursing can obtain a teaching certification in 3 semesters and step into teaching. A BSN is respected to teach with a teaching cert., but a B.S. is not respected in nursing with an ASN to step into clinical, academic and public policy. Really?

  17. Susan says:

    We have been having this argument for so many years – is there a reason nurses have to be so exclusionary. Sorry folks, but there is room for all levels from LPN/LVN to MSN and PhD etc. If you look at the bottom line – it really does not take a BSN to take a blood pressure or temperature etc. On the other hand, having advanced options gives nurses of all degrees, a place to grow and expand.

  18. Luann Yealdhall says:

    I have just finished my BSN program after 21 years as an ADN. Am I more prepared now to go to work everyday? Not really, not as a floor nurse. Am I more prepared to step into a clinical leadership role? Yes. I have learned so much but the course that I learned the most from for leadership was a FEMA class I took as a filler course. I have spent 21 years precepting diploma’s, ADNs, BSNs, and MSN prepared nurses and the ones who come out of school best prepared to step into take care of patients are the diploma and ADNs. I have never lost a new graduate and I keep in touch with all of them. I still keep in touch with my preceptor. If we have all these people with advanced degrees who want to lead may I ask who is going to follow? Who is going to be the bedside nurse? The new graduate? Will you have floors being run by new graduates without a mix of older more experienced nurses? Would you want your family member being taken care of by a floor of new graduates?

  19. Judi Serhal, R.N. ASN says:

    The high cost of college tuition is a definite consideration, and more ADN nurses would pursue the BSN, if not for the financial aspect of it. As a recent ADN grad, I certainly plan on going further, but I’ll admit, the expense will be a burden on my family, for years to come. Until the tuition costs are brought under control, the decision to get a BSN vs ASN will be challenging, at best.

  20. Deb says:

    I also agree the BSN should be the entry level degree.

  21. Margherite Matteis says:

    Definitely. It is very important for optimum patient care.

  22. Susan Felder says:

    Patients who see a nurse walk in their room does not care whether your name tag has BSN or ADN on it. The patients care whether you as a nurse can help. It does not matter whether you have your BSN or ADN. It matter that you care about the individual patients you are taking care of. Some nurses are losing their compassion for the patient because they are entering the nursing profession for the money instead of the compassion to care for the sick. Patients care is not focus on how higher level of education a nurse may have but does the nurse cares for the patient and the outcome of the patient. I have been working in the nursing profession for 21 years. 2 years as a CNA, 7 years as a LPN, and 11 years as a RN with an ADN degree. The classes I took as ADN student were different than a BSN student. The only difference is that the research , leadership, and management classes were not focus on. Nurses need to work together for to better the profession instead of focusing on the level of education a nurse may have. It does not matter how high your level of education is if the nurse does not care for her patient they will receive a level care that is not about the patient but the nurse making it through his or her shift.

  23. Lynn Humphrey says:

    Education level has nothing to do with providing good patient care. I became an LPN at the age of 40 which was 20 years ago. I never was dedicated enough to go back to school. I became a nurse to take care of patients, not paper work or the bottom line. I have seen LPN, ADN and BSN new grads that should not have become nurses because they have no compassion for the patient. The ADN and BSN grads did not have enough clinical hands on training. They come on the floor never having changed a catheter, changed a dressing, cared for a feeding or even personal care to a patient. Nursing is about hands on patient. You can have all the “book knowledge” in the world, but as most nurses will agree with, nursing education does not prepare you for the real world dealing with patients and families. If I or a family member is ever in the hospital, give me a good ole fashioned hands on nurse. I don’t care what his or her title is. The nursing field has problems, most of it brought on by higher degree nurses looking down on those of us who were not able to get a BSN or MSN.

  24. kirsten says:

    I am a diploma grad and don’t have a desire to go back for a BSN. I love being at the bedside and feel my education was rich in hands on experience.

    • You are right. Diploma nurses lived nursing. Some of the best nurses I have ever worked with and learned from were diploma nurses. Those schools have pretty much already been phased out though. Ideally nursing should be an apprentice program, but that’s not going to happen, so the next best thing is more education/ more accountability.

  25. JR says:

    So, I’m reading this…& the consensus seems to be….nurses should enter with their BSN. Now, in another 10,20 or whatever years will they need their MSN to be a beside caregiver? Please tell me how a BSN prepared nurse can deliver the same care I’m giving as a regular little old RN in a better more prepared way?? I find nursing is always trying to be something else. Copying models from industries that do not deal with the human variable 24/7, for example the ‘L E A N’ process. I am personally quite tired of having expectations being shoved down my throat , being snubbed etc. I fully admit that obtaining a bachelors was not on my horizon for varied reasons, and yet, I have all the required classes to maintain my position ACLS,PALS,TNCC,ENPC,MICN,CEN……

    I do believe, and would hope, that once a nurse has gained ‘x’ amount of experience that he/she could fast track the program a little more so than seems available . From what I’m seeing, the further away from school you get, the more you have to do to get back into a program. When perhaps, a BSN for experienced nurses should be somewhat more fitted to filling in the areas that need to be addressed.

    If a highly educated poop scooper pill pushing documenting computer fighting pump managing multitasking problem solving weight lifting do everything just tell the nurse nurse (read/say in one breath) is all thats needed then go ahead….make everyone do the BSN. Not sure how many will want to stay at the bedside….it does seem to infer to many that once you have that education then you MUST move up the ladder, it is the thing to do , then you are stuck with managers who have little to no personal experience or people skills….except on paper…not the REAL world.

    Ps did Florence have a BSN?

    • Again, as stated in the article it is not about giving better care; it is about elevating the profession. How many times will another professional go through the litany of the different levels of caregivers before they believe nurses are passing the proverbial buck? ” Oh he/she is just an LPN, Associate nurse, CNA etc.” If every nurse has an least a BSN, then all BSN nurses couldn’t “move up the ladder” could they? We would have professional, educated people taking care of patients. I also commented earlier aides should have the equivalent of an LPN/LVN education. I too was a CNA, LPN, ASN, BSN and now MSN, and I am eternally grateful for that “ladder”, but I have seen too much over the years not to realize higher education is critical.

      • OH, how I take offense when I hear “elevating the profession….”, as if an RN was something from an elementary school. What have I been all the 52 yrs that I have been practicing Nursing, a mere insignificant piece of “WHAT”? Bottom of the barrel..Just an RN. My career has been so full and satisfying….working in venues, such as OR., Med./Surg./ ICU/CCU, Hemodialysis, Gastroenterology, where I remain this day. I have even been the coordinator of a busy Endoscopy Unit. Yes at this age, I am still capable of giving my all, working per diem at two Endoscopy units; and I have done all this without having a BSN. The education I have received during the time I’ve been practicing, through inservices, on line certificate courses, and my patient contact has been priceless, my knowledge and skills are incredibly diverse, also, having sharp critical thinking skills. I realize, that for a young person interested in Nursing, today, the BSN program is the only way to start, but I still think that the BSN programs are short-changing the college Nursing grads. What is the primary focus of the curriculum…definitely NOT Nursing. The cost of this education is over-whelming and the colleges/universities are graduating these women and men, sending them out into the work force where they are hit with such “reality shock”, that we lose them to Teaching and administration, or even to other industries, and’ as so many of you have said, who will be there to care for the sick when people like me and others are not on duty anymore…..It definitely time to reassess the curriculum….Try more Clinical.

  26. beth says:

    After 14 years as a bedside nurse (ASN with a previous BA in biology) I went back to school for my BSN. There were too many doors of advancement closed to me without the BSN, even with my BA already! But that said, I received no pay difference when I earned my BSN, nor do I feel I am a better bedside nurse with my BSN. I also have 2 national certificates (more “letters” behind my name) which I earned prior to my BSN. I also did not receive any increase in pay with each of those certificates. My name badge is not allowed to have ANY of the certificates nor my advanced degree of BSN on it. It simply has my first name and title of registered nurse. Period. What I did for myself was to have my scrub jackets with my full title on it – degrees and “letters” behind my name, no different than what would be if I had an office with a name plate outside the door.

    To answer the debate here. I think we will be increasing the nursing shortage by mandating all RN’s be BSN trained. But I also agree that we need to bring our credentials to the table with other partners in the healthcare system. Why do we have both ADN and BSN nurses taking the same RN boards? We have CNA, Medicine aides, LPN/LVN. Why not RN/ADN and BSN as two different levels of nursing? Just a thought. – from a nurse with ASN, BSN, ONC, CMSRN

  27. Karen Flatt says:

    Karen Flatt
    I started in the laundry, kitchen, nurse aide, med aid, LPN, RN. I now have my Masters. I am teaching LPN currently. I understand about all of these degrees but I want to see standard of care to improve and I am not convince that More education achieve better care. If the school would focus on bedside care then maybe. Each level is important for the nursing profession. There are some things the some RN will not do because they have an advance degree. I will be 50 in January and I am seeing some real scary nurses from all stages of the nursing profession. The bottom line nursing means taking care of patients and families and that means seeing and touching the patient not just seating at the desk or barking orders or new policies. Nurses must want to go to school and to make a difference in care.

  28. Lisa says:

    Seriously, why are we still arguing over this old saw? Like the person above, I think we should be talking about patient ratios, the future of healthcare, and how we are going to provide for our patients while doing with less and less. I am an ADN with over 20 years experience, and my degree, which the BSN world would have me think of as “less than”, never stopped me from doing anything I wanted in nursing. I’ve been a Director of Nursing in a facility of 200+ beds, I’ve been a CCRN certified open heart ICU nurse, I’ve circulated in the OR, and I’ve case managed for insurance companies. I believe, given the current healthcare climate, and the aging of our population, that requiring RNs to spend 4 years in a program with LESS clinical preparation than an ADN or Diploma program is, frankly, ludicrous. Can we at least argue about something that effects the care of our patients? Like the above reader, I never met a patient who cared what kind of degree I had, only that I was an RN, and there to help.

  29. Maryann Gaul , R.N. says:

    I am a 73 yr old Diploma School Grad. of 52 yrs. ago. I have been listening to this for about 50 yrs. now. My background in Nursing is incredibly diverse: OR, Med/Surg., ICU/CCU, Hemodialysis, and at this time, GI/Endoscopy. My skills are sharp, and my clinical knowledge and critical thinking also sharp. My opinion on this topic: it does not take very many letters trailing after your name to do this job. The College/ University BSN Programs are severely over rated. The graduates have been severely short changed, especially when you consider the cost of this education. They are NOT educated to be functioning nurses. They lack the skills necessary, and the compassion, empathy and the ability to communicate with their patients. There is no ability to critically think. And now, they are wondering why it is nearly impossible to find a job. This is a “No Brainer”…..My opinion on this topic: major change in the BSN program ..first 2 years, Liberal Art, Medical sciences, sociology, and Pschology, etc. Last 2 years intense clinical EXPERIENCE. Let the student get their hands into it. What you need, are some nurses with the experience I own, to guide them into the real world of Nursing. I have two letters trailing after my name, R.N. that is all I want, that is all I need, in order to fulfill the goals that will assist a patient back to his/her optimal level of health. I have nothing against furthering their education but, first get some nursing experience. I still take courses on line, most are certificate courses to improve my knowledge and skills. I cannot afford colledge credit courses, and I refuse to take out student loans at this stage of the game. And guess what, I feel no less a nurse for it.

  30. Thom says:

    I love your comment Maryann, I couldn’t agree with you more!! Education is only one part of the equation, and its not the be all/end all.

  31. Dipti says:

    Hi Martha, thanks for sharing this valuable post. Really very useful information shared regarding nursing courses. Awaiting for more posts like this.

  32. Kay Gremmels says:

    I think the most important piece of this debate, “BSN required”, has been left out of every discussion I have ever read about the BSN requirement; How and Who pays for this continuing education? aka Student loans? Financing the degree? In nursing, we all like to fanaticize we are right up there with the business prototypes by expounding mostly just throwing around a buzz phrase we don’t fully understand, on the bottom line, MONEY but how does a nurse who has a mortgage/rent to pay, light bills, heating bills, grocery bills, kids to support and life in general to budget for and is probably unemployed or under employed, pay for this advanced education? Student loans
    are out of reach for some- those who are over extended with mortgage, bankruptcy to save the roof over theirs and their family’s heads, single parents, divorced parents. Going back to school for a BSN requires cash/money for tuition. Education is not free. Employers have cut the purse strings to this benefit and many offer only a pittance or spit in the bucket to the real cost of a BSN; An amount more like in the real time sum of $1,000/ semester or year if they offer anything.
    This is my pet peeve with the powers that be in nursing. They don’t think in practical terms. They have these ‘pie in the sky’ dreams and make them into mandates that effect a a person’s life and well being. They are flat out unrealistic or at the very best, offer no implementation strategy’s to get their ‘pipe dreams’ off the ground. They have never thought their plan through. They have made a judgment that the patient needs a bedpan, but don’t offer the bed pan. So what good is the plan?? Is this lack of formulating a complete plan of care( the BSN required mandate) an example of how one thinks with an advanced degree? Incomplete thought processes or just leave it for some one else to figure out?
    Change the entire entry way into a workforce employment means to earn a living, and leave it at that. Well Nursing, many of your “patients” ( your nursing membership) have died ( unemployed, working in other areas non nursing- grocery stores retail/Macy’s, Wal-Mart’s, Lowe’s, Home depot…) or are under employed and are thinking of only keeping their heads above water not pursuits in higher education and adding on additional debts( student loans). I have run into many of older nursing colleagues without BSN’s (LPN’s included) working in Home Depots. I have attended community college open houses where there are RN’s and LPN’s looking to get retrained into other fields- catering businesses because they can’t find nursing employment. Then the real 4th of July bang comes when Nursing as a profession cries, writes articles and prances its arrogant self off to Washington proclaiming “Nursing Shortage”. Nursing, you have created this mess yourself. At some point the nursing powers that be in out association and academia leadership needs to begin to look at this aspect of the debate and formulate some real time solutions to the issue. Assess, Plan, Implement and Evaluate- basic Nursing process.

  33. Pingback: Shared governance: For nurses, it began as greater autonomy | Nurse.com Blog

  34. Irene says:

    It is a way for hospitals to get rid of older nurses who are most likely not to have an ADN or Diploma. Also, they can get nurses to wear more “hats” such as case manager and insurance work.

  35. Irene says:

    Nurses who train overseas can pay an additional fee and be orientated in an ICU/OR, etc. They then can claim experience and will get hired over the American BSN who wasn’t allowed to actually do much in a hospital.

  36. aleta says:

    I’m so livid with what’s going on in the nursing profession! I’m another older nurse (60) who CANNOT and WILL NOT throw my retirement money into some stupid requirement that people have decided that ADN/diploma nurses need to do. Your employer first off is not assisting in helping financially to obtain a BSN and, secondly, they are certainly not going to pay you anymore because you have your BSN (1-2 $ more an hr will not help to repay the thousands of dollars you spent obtaining the degree) . And the majority of higher degree nurses I come in contact with cannot spell or speak correctly! If this is what our higher degree nurses are going to be like, heaven help us.

    • Leslie says:

      I am 58 and have 37 + yrs in the Nursing Profession and I have never wanted to further my education or I would have done so when I was younger.
      I totally agree with Aleta…..those BSN nurses have no clinical experience and do not know how to relate to their patients……#1 to me.
      Money is not the driving force here…….it is the stupidity of the hospitals to think they have “professionals” because the nurse has a BSN.
      When I see some of these BSN nurses working on the floor, it makes me so angry at their attitudes that I think BSN = BullShit Nurse !!!!
      I will keep my ADN and continue to work as the professional I am and care for my patients the way they are supposed to be taken care of until I retire.

    • Jane says:

      You said it!!! Thanks! I suspect 80 percent of the people cheering on for BSNs either: will be in debt until the end of time, get a nice 1-3 year endentured servitude with their stipend from the hospital, or Mommy and Daddy kept their bedroom open for them and are shelling out the dough.

  37. Kay Gremmels says:

    I have to agree with Arleta and Leslie- what I see going on up on these nursing units is whole other blog in itself. Our inpatient units are now a disaster. I was away from the inpatient units for 3 years ( 2010-2013) due to a lack of a BSN in spite of having 30 + years of bedside hospital nursing ( including telemetry and cardiac step down)- couldn’t get hired into a full time hospital position, only a perdeim position that ended in 2010 and had to file bankruptcy to save the roof over my daughters and my head. Was forced to work in temp positions for 5 years. These units are full of foreign nurses who do not have the same work ethic we did and young BSN’s who don’t know any better. This is what I am running into. I am getting patients of an ICU with clotted PICC lines, unreported labs from the day shift that I have to call at midnight and get orders for, empty beeping IV and feeding pumps on first rounds with not available bottles to replace them, over flowing trash cans, stage 2′s, being told to restrain broken arms on patients who are climbing out of bed in lieu of putting a patient on a 1:1, told to hurry up the death of a terminal patient on a morphine drip just so the ICU can clean out and take the bed for another patient, walking into bleeding trachs that no one can explain, rooms stinking to high heaven with stool covered dirty linen not removed, dirty filthy old dinner trays left in patient rooms that have sat around for hours, stool all over the bathroom floor, discovering the patient has a surgical incision under an abdominal binder with the old original dressing still on it, pushing IV drugs( Fentanyl) on a med/surg/tele unit that are to only be pushed in ICU environments and doing so simply because they are ordered- never questioning the orders, and not knowing the reversal agents for these drugs much less where to find them. This is pure filth. But these young nurses have their BSN’s and the hospital has their magnet designation. These young BSN nurses are dangerous, fearless, act without thinking and are “Clueless.” This is not just coming from one BSN program, it is coming from many as I live in an area where there are many BSN programs around me. For me, it is exhausting to have to follow behind them as the oncoming nurse. It is too much for one nurse to fix and I am the only senior nurse on my shift. There is no one left to teach these new nurses who to do their jobs, it is a free for all and the hospital’s turn a blind eye to it because they are getting of cheap so they think so the CEO doesn’t have to cut their million dollar salary to pay older experienced nurses. This is why the Medicare people and the government is up in arms- why should our taxes be raised to up Medicare reimbursements for a hospital who hires only cheap labor with no experience? The ANA and the powers that be in nursing don’t get it. They need to get off their butts, out of their offices and put a pair of scrubs on and come to work for a few weeks on these hospital units they have
    helped to create. And another kick in the butt is, a young nurse-no BSN with 2 yrs experienced getting an interview for a case manager position. I, at 58 yr old with 30+ yr experience have taken the loans out and in school for that precious BSN to keep employable until 65 yr old, have applied to several and cant get a interview. I have had
    it to say the least. If I could quit nursing tomorrow and find another way to support myself, I would!!

    • Leslie says:

      You are a better person than I……….yes I want to stay employed but I will not pay 40,000.00 to get a degree which to me is useless
      Shame you ave not been able to get interviews……….our profession SUCKS big time and it is so sad when I remember fondly almost 38 yrs ago when I first started to work and it truly was a Labor of LOVE for my patients and my job that only paid be $6.50 an hour.
      Good luck to you and keep me posted on your success

    • Maryann Gaul, RN says:

      WOW….I have no clue where you are working, but PLEASE leave the name and address of this facility here, and I will be sure to send the State and Federal Gov. HHS, inspectors there to SHUT THE PIG STY DOWN!!!

      • Kay Gremmels says:

        The hospital I refer to is Capital Health, specifically the Neuroscience department- the Neuro ICU and the neuro telemetry units, in Trenton, NJ. The state board of health has come in after we were told by the assistant nurse manager, who is unfit to hold the license of RN, we would not be getting any more help (nursing assists. or RN’s) to watch patients, to do 1 to 1 nursing observations on neurologically impaired impulsive patients who were pulling out their trachs and climbing and falling out of bed. Two patients fell and sustained injuries: one was an 84 yr old who suffered a fractured hip (a sentinel event) and the other was an 48 yr old non english speaking who hit their head so hard on the floor, the patient had suffered a cerebral bleed- confirmed on CT scan (another sentinel event). The Assist Nurse manager demanded we put the 48 yr back in the bed without being seen by a doctor first before moving off the floor for evaluation. The assist nurse manager ( with considerably little nursing experience) insisted the patient was “alright” in-spite of the patient holding the back of their head.. Both of these falls had to be reported to the state DOH and the facility( a magnet designated hospital, to boot) was put on frequent state monitoring with a corrective action plan but it only addressed the falls not the rest of the negligence, lack of clinical competency and incompetent nursing leadership and direction. But they are saving a ton on very inexperienced nursing salaries and lack of ancillary staff- inadequate staffing is the method of the day!! I have had doctors ask me why these falls are occurring and ask me when I call for orders, what the staffing numbers are for that shift.
        I raised my concerns to the assistant nurse manager only to incite her anger and I was watched like a hawk- every word I said was reported back to the ANM. To the point where my phone conversations with physicians asking for orders for patients were recorded on one of the ANM’s closest friends cell phones, which was then converted to text message and sent off to the ANM at home. How do I know this- because the young less experienced nurse who was recording me had the brass nerve to read me the text message verbatim before she sent it. I reported this HIPAA violation to the corporate compliance department (legal/risk management) and the HR director. The act was explained away as an “accident” the nurse forgot to shut her cell phone off. How many 30 yr olds forget to shut their sell phones off? and there is a policy of not using one’s cell phone on duty for personal reasons. I was the one fired.
        I was fired because I am older, a WASP who speaks English, more experienced, know better, know the difference between right and wrong and am therefore a threat to this new order of Nursing culture and lack of experience. They tried to run me out of there with continuous and ongoing disrespect, refusal to help me, giving me the patients no one else wanted. giving me the heaviest assignments; one night I had 3 patients with trachs, tube feedings, nonverbal and incontinent and the other climbing out of bed. I was forbidden to raise questions or objections because if I did, they would call the supervisor; one night I was told by the less experienced charge nurse who could barely speak English, I was “not busy”. When I questioned her “not busy” comment, she called the supervisor and told the supervisor, I was disrespecting her. Working in this place was like working in a communist prison camp. It was night after night abuse and fixing the gross incompetency from the shift before me. It was demoralizing and exhausting.
        The more disturbing fact is the length they will go to get rid of a RN by disregarding the safety of the patients!! They say us older generation nurses bullied our co workers- let me say, nothing like this. This younger group of nurses have us older nurses beat in the bully department by a country mile. At least our generation were competent in our nursing care.

  38. RNjacko55et@aol.com says:

    This whole you need to be a BSN instead of an RN is a bunch of BS. This is all about backroom deals where people who make money off nursing school BOOKS and the Universities that make money off these BSN programs WANT every RN to be a BSN so they can get some more money for their next golf fundraiser. Let’s just keep it real ladies. We all know there is not a flipping thing that a BSN learns that a RN can’t learn from experience. This is such a JOKE. And the pre-requisities they have are absurd! Really? You want the nurses to take Speech, as if they can’t communicate? You want them to take sociology as if they don’t know about social issues? You want them to take psychology 100, as if we’ve never seen a 5150 or dealt with someone suffering from mental illness? Word out: Psychology 100 doesn’t teach you SQUAT about any real life dealings with patients with mental illness. This is a GENERIC psychology class that doesn’t amount to C%$#. This is a total SCAM. I”d like to know WHO is making money off the books that are being promoted for these new “pre-requisites” . WHY wouldn’t a BSN curriculum include things like SPECIAL NEEDS POPULATION? How to handle dementia patients? WHat’s with this candy ass bs about sociology, psychology and speech? Really….SPEECH. Here’s my speech. Read and see what BS all this is.

  39. Sally says:

    After 25 years of nursing, these articles never cease to amaze me. I do agree, to a certain extent, that education (formal) is important. However, anyone who has worked as a nurse knows that nothing compares to experience. I have played a role in numerous studies which have been biased in opinion and statistics, regardless, can always be manipulated. Unfortunately, a BSN does not make a person compassionate or give one an ounce of common sense. A good nursing improvement strategy for ALL of these agencies that want to have a voice in the world, is to ADVOCATE for continued educational unit REQUIREMENTS! I have yet to read about how to keep nurses updated on new medications, new procedures, new interventions/prevention measures for patients. We are actively dietitians, therapists, pharmacists, social workers and eyes and ears for the physicians. However, at least here in Indiana, not one nurse is required to do anything after graduation (except, of course, pay for a renewal). Has anyone really seen the RN to BSN course requirements? Humanities (believe me, World HIstory helped me so much in my nursing career……oh, and don’t forget theater and music, oh yes, very helpful too). The only thing those courses did for me was put me in debt.

    As nurses and all of these agencies, especially the ANA, why are we not advocating for our patients in other ways. I would love to see the study of the nursing home patients care where a nurse has 45 patients! So, all the magnum status in the world’s hospitals will be great until a patient has to transfer to a lower level of care where nobody can even mandate patient/nurse ratios!! How pathetic.

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