Wednesday, January 14, 2015

Yeah. . . .no. I'm having some thoughts about BSNs.

I'm an ADN-prepared nurse. Those of you who've been here for a while know that I often refer to those two years (three, actually, counting prerequisites) as the Hardest Work I Ever Put In For An Extended Period of Time. It was like drinking from a firehose, like trying to cross a raging river while wearing combat boots, like riding a bull with no previous experience. And the instructors I had hammered one thing home over and over: that we, as front-line nurses, had the right and the responsibility to consider ourselves colleagues of our BSN or MD or PA coworkers, not as helpers or assistants.

Of course, that was in the days of The Nursing Shortage. ADNs like me were being fought over by multiple hospitals. Nobody in my class started work at a nursing home; we all got acute-care or better jobs right off the bat.

Now my facility is going for Magnet status, which means BSNs are the basic standard of nursing education. And I have some problems with that.

First, I've seen a massive drop-off in terms of the diversity of our nursing staff. Used to be, Manglement would hire people with ADNs, provided they had either a bachelor's degree in something--anything--or equivalent experience not related to nursing. As a result, I got hired with a man who'd worked as a hospital chaplain for ten years, a woman who'd been in the Navy for a decade, three people from three different African countries, and a guy who'd been a medic in the first Gulf War (1990's) and had worked as a mechanical engineer afterwards.

Now they hire BSNs. And since they hire only people with BSNs from colleges here in the US, we have a crop of new hires who are all white, middle-class, and in their twenties. All of them are native-born, all of them are young, and for all of them, this is their first job outside of, say, Sonic. They're also all female.

This is a problem. This utterly fails to reflect our patient population. Not that that's a necessity, but for Heaven's sake: you ought to have at least some employees who can connect on some level with the people they're caring for.

Second, the BSN programs in Texas seem to focus mainly on management and leadership. Which is all well and good, but you're getting folks who, at the end of their senior year, have absorbed a ton of nursing theory and still have no time-management skills. As a result, we've lengthened the preceptor period for new grads to sixteen weeks. The preceptor period for ADNs was twelve weeks. Why? Because, at the end of our last semester, we were providing care for five patients. The BSN-prepared nurses provide care for two.

And they don't catch up. I'm seeing BSNs who, after two years on the floor, are still having time-management issues severe enough to attract Manglement's attention. They're schooled in critical thinking, they're schooled in history, but they simply don't have the chops to handle more than two post-op admissions in a shift. (Oh, Lord, how I wish I were exaggerating.)

Third and finally, I'm working with a lot of new grads who don't have a good fund of general knowledge (to use the MD's term). I'mma be a snob here and suggest that a working knowledge of, say, how to Google effectively, or American history, or politics, might all be good things to have on a day-to-day basis while you're living your life and doing your job. I'm not getting that from the new grads I work with. I have the reputation of knowing everything there is to know about everything simply because I know how to look shit up. I can assess sources, decide which ones are bunk and which ones are decent, and move on from there in a winnowing process. The new nurses I work with (and by "new" I mean "anybody who's graduated in the last three years") do not have that ability. I don't know if it's a liberal arts education or maturity or what, but unless it comes to them from a textbook, they do not know how to analyze information.

Maybe it's a lack of curiosity. When I get a patient from Backobeyondistan, I try to find out everything I can about their culture and belief systems. I'm the only one who does that. *sigh*

ANYWAY. There is a place for BSNs, no doubt. I'm planning to start mine this year, so's I can continue to work somewhere other than assisted-living facilities. Some BSN degrees (though not the ones here, from what I can tell) give graduates an excellent foundation in pathophysiology, assessment, and basic sciences. (Ours tend to require two semesters of state history and a couple of classes on theory.) Some actually prepare students to be nurses, not just research-bots or management candidates.

Overall, though? I'd rather see more diversity in the graduates we get. I want to see middle-aged, fat women like myself who are on their second or third career. I'd like to get into a conversation about Buxtehude with a dude who got his BA in organ music, then went back to school when his carpal tunnel got too bad. I'd like to see the occasional Indian nurse, or Filipino/a nurse, who took the exact same courses for her or his degree but has been denied a job because his/her  diploma didn't have "US" on it.

I'd be interested to hear what you guys have to say.


Anonymous said...

Here in minnesota most of the hospitals are either changing to require BSN's or you have to be enrolled in a program with a date expected to complete in X amount of time. To address the change in the times, our community colleges are changing up what they offer. You now can start your nursing program, and bow out after 4 semesters with your associate degree, and take the boards, or go on for another 3 and finish your BSN. If you take the boards at the AD level, you still have ability to rejoing for a specific amount of time and pick back up and finish. They are hoping that they can get most of their graduatates through with the BSN at less cost, address the needs of the "non-traditional student" and have a more practice based education.

LibertarianRN said...

I started with my CNA, then got my BSN. I felt very poorly trained by my program. It was much more focused on politics, policy, and theory than on actual patient care. The program has only gone downhill since I graduated two years ago - now they have halved the clinical hours for the final preceptorship and replaced those hours with sim lab - same for clinicals throughout the program. They are being chopped for sim lab - which is only good for teaching you how to parrot back what the instructor expects to hear, and has no relation to true patient care. Fewer and fewer bedside nurses are willing to precept the program's students, since the paperwork requirements for the preceptors are so heavy, and senseless.

I usually recommend that someone interested in nursing start with their CNA to learn if they can do the work, get their ADN to start learning how to be a nurse, then get their BSN to make their boss happy.

Dawn said...

I started nursing school at 31 as a second career nurse. Graduated at 33. I did my 2 year, got hired and worked for a bit because I needed to make money since I got out of work to focus on nursing school. I will now be done with my BSN in May. So far, I think the BSN coursework is tedious and just like busy work. I don't feel at all the info I am learning is helping me to be a better nurse, but I am doing it since eventually I will not have a choice.

bobbie said...

I never 'bothered' with a BSN degree because I never thought that public health nursing or statistics would do me any good when my ICU patient was crashing...
And I don't feel like I missed out on anything at all.

cowango said...

Well first let me say I'm surprised you're an ADN because you have the skills of a BSN trained back in the day. I got my BSN back in the dark ages from a very well respected program in the Midwest, and back then there wasn't emphasis on management or leadership. However, they did stress group dynamics. Even then there was howling from experienced nurses that the BSN program didn't provide enough clinical, and compared to the hospital-based programs we were surely lacking. If you didn't do work on the side as an aide, woe unto you after graduation.

I do believe the hype that we finally are moving toward a BSN as entry to practice. It's up to the programs to recruit diverse individuals, and obviously some do a better job than others. I work with a lot of ADNs and don't find them as well prepared in terms of looking at the whole patient. I think the experienced nurses have gained the skills, but new grads are more technically driven.

With healthcare becoming more and more complex we need people who have a very broad and indepth education to tackle the complexities seen in our patients and the care that is needed. It may require that nursing schools require an internship, much like doctors. I've heard some talk of doing just that. In the meantime, I think hospitals should think at least twice before hiring new grads (whatever their schooling) directly into critical care areas. They are not ready for that level of care that requires a multitude of skills, such as multitasking, expertise in emergency situations, and prioritization. Not to mention being able to identify someone who is crashing with your eyes practically closed.

So, again, you can blame Manglement for putting these poor sods in a place where they have no business and where they have way too steep a learning curve. My sympathies.

Jenn said...

I was a diploma grad in 2007. I have since gone back and earned my BSN in order to qualify for my current position.

That being said, everything you wrote is true. The nurses with diplomas and ADNs consistently are the best with patient care. I am not the only one who things so, either. I started out in a large metropolis with multiple world-class hospitals, and every single unit I interviewed for gave me an offer - BECAUSE I came from a diploma program.

Oh, yeah, I started out in a medical intensive care unit...

Leslee said...

I am a new grad ADN prepping to take the NCLEX in February, and I am having a hell of a time even getting an interview. I have a BS in biology and it's not helpful either.

KTRN said...

Where I come from in small town Iowa, all a BSN seems to prove is that you had the money and the gumption to jump through the graduation hoops. Hopefully us ADNs with 20 or more years of experience can grandfather in. The thought of going back gives me the cold shakes.

Anonymous said...

Hi there! I've been following your blog for a year or two now, love your insight on the day-to-day.

I graduated from an ADN program this past spring. I've had the hardest time finding a job, until the last month or so, in which time I've had some offers from many types of facilities/units - med/surg at a teaching facility in a small city, urgent care, child psych, and OB at a rural hospital in the middle of nowhere.

While I'm thankful for the opportunities (and definitely NOT trying to be picky or snobby), they're not units/areas that I'm passionate about. I'm finding it VERY difficult to start in the area(s) I'd like. Meanwhile, I see BSN nurses walking right into their unit of choice with no issue. Why is there such a disconnect?

This isn't my first career. I've worked since I was 16. I earned a Bachelors in another field. I've had a career for several years. I wanted to become a nurse to work with sick children, something I was genuinely interested in. Yet, I can't even get an interview in peds. My prior education, work experience, diverse background and matured age mean nothing. It's as if I was born yesterday.

I chose an ADN program for several reasons. It was more affordable for me, the campus was close to where I live, and the program would allow me to start work sooner, gain experience.

I have to say that my ADN program did not prepare me as well as it should have. We never took 5 patients at any point during school. A lot of that came from the nurses though. They didn't WANT us to do much, and would usually restrict the important stuff, saying that "it'll take too long to really show you so I'll just do it so I don't get behind. You can watch me do it."

My ADN program was very disorganized. I came away from it wondering if it was worth it. Sure, I learned a TON. I passed my boards. But the hands-on, time-management of it all - we didn't get to do much of that.

I've been on numerous interviews TRYING to find my first job. Some interviews were very intense panel interviews that ultimately left me feeling worthless. And other interviews were so disorganized that I asked myself why I wasted my time.

I had one recently in which the manager forgot that I was coming in. She had nothing prepared and asked me things like, "What would you do if you saw the tech not doing their job?" and then next, "How would you handle a situation where another nurse wasn't pulling their weight?" SAME QUESTION. But what it told me is that she seems to have a problem with accountability. I left feeling like I would've been a snitch just by doing my job.

My dream of being a pediatric nurse is just that, a dream. Those ADN letters on my resume are really hurting me. The pediatric hospitals (at least in my area) are Magnet facilities that won't even consider me. Everyone tells me "get some med-surg experience and the doors will open" - but I'm going to have to uproot my entire life to get THAT experience.

I'm going to move soon and take that med-surg job. I'm excited to start and learn. And, I'll have my BSN by the end of the year. So hopefully some doors will open that lead to my goal. But, it's not what I was expecting when I began this journey a few years ago. My large hometown metroplexconglomerate boasts numerous hospitals and positions, and I can't get one. Many of my classmates can't get one.

Anyway, enjoy reading your posts. I just think that, right now at least, ADN was a mistake for my long-term goal.

Anonymous said...

I worked as an ADN for about 5 years, then went back and just finished my BSN in August. I actually found a lot of diversity at the moment in RN-BSN courses, because of all the ADN nurses going back to school, from a variety of jobs/backgrounds.

The coursework was very disappointing, lots of fluff and busywork. I would have loved some A&P courses, heck I'd even re-take the ones from my ADN, just to see how much I missed. The courses I enjoyed most were the liberal arts electives. You get mixed with other students from dozens of majors (and non-nursing instructors), and the different perspectives was nice.

I guess the one thing I came away with was the sense of empowerment and capability nurses have. Of course, when you then walk into the job and things are dictated to the nth degree by management, the disconnect is quite a letdown.

Anonymous said...

When I graduated as an ADN I thought I was the shit. I picked up quickly and could handle a full load after only a short orientation. Later as I felt bored I returned for the BSN then MSN and recently finished my DNP.

The theory in nursing is total bullshit and should be abolished as it serves zero purpose. I do believe expanding nurses understanding of research and EBP should be the cornerstone of advancing education. Also important is the understanding of the financial and community impact of the ever evolving healthcare system. We need to educate our people on ways we can effect change and stop settling for whatever we are given and start making demands that protect our patients and out career.

caffeine and xanax said...

Texas is so weird with that state history coursework. Last time I had state history in English was in fourth grade! Anyway, it's up to the program, ADN or BSN to make sure practical experience is adequate as well as theory. Here they have really amped up senior year BSN programs as far as clinicals. I'm a preceptor and my students work with me two 12 hour shifts per week four months long. At the end of the semester they take my full ICU assignment, in a level one regional center, university hoslital and top research facility. They have ALL gone on to be MICU nurses, some in this state and some in other states. My externs (junior BSN nursing students) have gone on go receive internships in top programs in ICUs around the country. Again, it's the BSN programs that are responsible for providing preceptorships and practicum hours. And it's your management that needs to make sure they are hiring new grads or new hires who can handle your workload.

Elysa said...

I hear you. What you're saying is valid, especially if your area doesn't have a lot of diversity to begin with.

I'm on the other end of this. I had a career for 10 years, and to switch, since I already had a BA, did a MSN-entry program.
I hated it, and the entire time I begged to be let out into the BSN or better yet community college associate program. My thought was just as you said: I already have a BA and experience, and all I needed was the associate to become a NURSE. Which is all I wanted to be.

As I watch hiring, transferring (jumping ship, I should say) and firing at two different hospitals here on the East Coast, the BSN doesn't affect diversity mostly because where I live IS diverse. But the flat-out disdain I hear expressed for having "only an associate" is really ticking me off. Those are the nurses I learn most from! And EVERYONE's experience counts. I hated that our LPNs were demoted to patient care associates and not called Nurses anymore. And yeah, nearly all of the nurses affected by that decision were minority or second-career or veterans of military service.

Funny enough, I was going to come to you to ask for advice on nurses moving to Texas- I'm planning on coming back to take care of family members in transition. I'm already doing the application searches. Sounds like I'll be ok in the education department, but maybe my diversity factors will hurt?

At any rate... it sounds like Texas is gonna have to go through another nursing shortage in order to get it together and start hiring different types of people. I hope not.

Unknown said...

As a white, 20-something, middle class woman who got her BSN and then went straight into acute care, I have to say I agree with you on all of your points! I was not prepared for orientation when I finished school, and definitely not prepared for work when I finished orientation; and time management was a huge roadblock for me to get over in the first year or so.
I felt like I got better experience for being an acute care nurse working as a CNA than the actual clinicals. I have worked at two MAGNET facilities (my current facility is in the middle of being re-certified) and the vast majority of the people I work with are young, white, and female.
I used to be a preceptor for students/new grads and I really had to work hard to get them focused on time management.
Since facilities, especially large trauma centers, are becoming more focused on MAGNET status (which includes wanting more BSNs) do you think MAGNET requirements should include certifications other than BSN (including ADN, certifications from other countries, etc.)? Do you think this is a problem with the American education system (sending mostly young, white, middle class students to BSN programs)?

This was a really interesting and thought provoking post - thanks for that!

Laura said...

I think it's a reflection of a problem that's taking over the US in general, in that a bachelor's is becoming/has become the new entry level degree. It doesn't matter if the industry actually *needs* that degree, you just have to have one to get the job in the first place. I'm sure that used to be because getting a bachelor's (supposedly) showed that you had critical thinking skills, could work towards an extended goal, etc, but now? I have my doubts. As a consequence, you can't find a job unless you are specifically qualified for that job via education, regardless of what you can do. I don't think medicine's focus on BSNs is going to change until society as a whole remembers that people without bachelors degrees can, in fact, do a wide range of jobs.

Aviana said...

I am a retired diploma RN. When the BSN programs started years ago, I was working in ICU. The instructor came by all excited because she heard a patient with pulmonary edema had been admitted. She wanted to bring all her students by to witness the chest tubes being installed. One of the doctors ordered her to leave. You can't run a hospital when the nurses don't know how to do nursing. When my daughter went to nursing school, I had to work as a CNA at my hospital when she was on vacations. I talked with the staff on her floor and she got lots of "experience" in everything useful. She's retired now too.

Lace said...

I actually do have my BSN, I'm in my 20's, American (born and raised, and white as a sheet), and female. With that being said I 100% agree with the difference between ADN vs BSN. Don't get me wrong, I went to a WONDERFUL college but I did take a lot of management/theory classess. SO WHAT? I have to handle 5 patients now, at once, teach me something about that. I'm glad I stumbled upon this blog, I'm a "new" nurse. I graduted May 2013.

Anonymous said...

I am an "old" nurse who ran the gauntlet of aid, LPN, now ADN and counting the months till retirement. My observations on the young white BSN prepared is that their goal is to get away from patient care asap. They have their eyes on a management position, away from weekends, holidays and the dirty work. Us old nurses have always known the BSN's come to the floor not even knowing how to place a foley. The 16 week orientation has taken care of some of they get 4 months of orientation and then stick around for a few more months, then they are gone. some of them don't even make it through orientation, they figure they didn't get a 4 yr degree so they could clean up poo.

Renee in CO said...

I have a BSN, and am a middle-aged second career nurse. In general, I'm in favor of the BSN because I think we need to raise the standard overall and establish a reputation of professionalism for nurses. As for my time management skills, I'm guessing that varies a lot by program, and I thought my program did a nice job with the poor material (me) they got handed. I've had to learn a lot in the last 4 years, though.

I think your argument for diversity is the best one I've seen so far, and in the academic hospital I work at, it's an issue. We get some older new grads, but the ethnic diversity is completely lacking. My first few months there, I was overwhelmed by the sheer volume of 20-something girls with blonde ponytails and hipster glasses. This is not what our patient population looks like, of course.

I'd like to see a way to improve the overall education level of nurses and at the same time improve that diversity. Maybe I'm just dreaming.

Barb said...

I'm a BSN-prepared nurse and graduated about a million years ago. My program in a small Midwestern liberal arts college was pretty exceptional as we were team leading with 5-7 patients under our wings during the latter part of our clinicals. Time management skills--you betcha, leadership--even more so, technical stuff like lines, EKGs--not so much but it was easily picked up. Not all BSN programs are alike.

Anonymous said...

I recently graduated with my BSN from an accelerated program and we were taught time management (we had to handle 5 patients by the end of school), how to evaluate research, evidence based practice, how to find information, leadership skills, critical thinking and the whole sha-bang. Not all BSN programs are only rooted in theory. I feel that I got a great "hands on" education. I got over 1300 clinical hours in the period of 22 months and had the benefit of wonderful clinical instructors who accepted nothing but the best from us. I also worked as a CNA before and after school in a hospital and many of my class mates did as well. I do agree with you that the transition to BSN has somewhat affected the diversity in nursing (although I, myself, am a minority, most people in my program were middle class, Caucasian, women in their 20's. Nothing wrong with that... just stating the facts.)I don't agree that BSN nurses are any less prepared to be bedside nurses than ADN prepared nurses.

buffalo gal said...

it seems to me that the nursing profession is requiring BSN and Magnate status as a way to justify what nurses do - which is keeping the ship afloat despite the best efforts of management and profit driven boards. I am that middle aged person who could converse about a range of subjects from Buxtehude to Bauhaus, and have the ability to interface with a diverse patient population because of a rich life experience. Eager to join the profession and already possessing a bachelors degree in another field, I got my ADN and passed my boards only to find the job market impossible to enter due to no prior experience. I went for my BSN and left in disgust after one semester of tedious, inane coursework that insulted my intelligence. Nursing theory and management skills have absolutely nothing to do with the critical thinking and time management skills that are essential to sound nursing practice. As the profession changes to BSN only hiring practices, two year programs would be better utilized as a cost effective way to begin the journey, but should not result in the ability to take state boards until academic requirements are met. Luckily I still have work in my previous career and can fulfill my desire to care for others by volunteer work. I salute all of the nurses out there and wish I could have been one of you.

New RN (with a BS in Nursing) said...

I have to agree with some of the other commenters, that not all BSN/BS in Nursing programs are the same; just like any schools, some are good. I chose to go to a well-known school in the region. I was surprised to find myself in a class with a good majority of the class holding a previous bachelor's in another field (including myself), and some students who had master's degrees... and associated with that finding, the class included a variety of people of different ages/backgrounds/ethnicities, too. All brought experience from a variety of professions, both medical/healthcare and otherwise. Many had kids, some young, and some adult children, too. I absolutely LOVED the different perspectives I gained from working with my classmates, as well as the perspectives brought by the instructors.

Nursing school was harder than anything I had ever done; more difficult than my previous degree, and more than my previous experience managing people/information/schedules entailed. In nursing school, I am proud to say that I was taught (not listed in any particular order) to think critically, research well, ask questions, refine my leadership skills, and was exposed to a good variety of community nursing roles. Sidenote: I DO think it's important to have experience in a variety of nursing fields--despite our crazy (read: inefficient, reimbursement-driven) healthcare system, there is power in preventive healthcare, and, like many others, I see the future of the nursing profession expanding more to the community setting (public health nursing FTW!).

And, I feel I was well-prepared... I graduated last June after spending TWO terms (2x longer than the ADN programs) in my final year working my preceptor's schedule (500+ hrs on the floor). I quickly picked up time management skills needed to take care of a full patient load on the unit I was at (though not without a ton of sweat and hard work... AND a bit of anxiety and a few tears, of course, as I was pushed past my comfort zone DAILY by a great preceptor more often than not!). I was hired back to that same unit, and was in good shape to be on my own after a few weeks of orientation (it took a little time getting back into the groove of things, both because of changes to the unit, and after having spent weeks with my head in books, studying for the NCLEX...).

P.S. Locally, I see the frustration of ADN nurses being pushed to get their bachelor's and the way some of them see it as busywork and/or a burden. I wish these nurses didn't feel pushed by management (and Magnet status) to do something they don't value, because I think it's just creating bitterness and a divide. I'm *not* trying to say I don't appreciate ADN nurses--I absolutely love the experience brought by some of the nurses on my unit, who have decades of nursing experience... sometimes working as a nurse longer than I've been alive. I just wish it were easier for ADNs to go back to school, and to good programs that they could value as worth their time (and, in many cases, money).

Anonymous said...

Back in the day, I needed to work. Got my paramedic, and worked full time while going to my ADN program... I spent 8 years in ICU, 4 in the OR, and moved on to management in LTC of all places. None of the places I worked required a BSN, and I never missed having one. My hospital system decided against the whole magnet blah blah blah because it's brutal enough to get NURSES in my rural state, much less requiring them to have BSNs. Certification, however, is a big deal. They pay for two. Both paying for the test itself, and a nice bump in hourly rate for each cert. IMHO, that's a smart move. Studying for both my certs (CCRN and CNOR) was extremely verified that, yes, I do know my stuff. But, I also learned an enormous amount of NEW stuff, especially things that I don't use very often. I don't miss, nor do I care about ever having a BSN, and I'm thrilled that I won't have the stress of my employer requiring that hanging over my head.

Anonymous said...

I want to first start out by making a observation that continues to make me go hmmm. I live in the state of Idaho. There are a few state ran community colleges in the state but the majority of nurses are coming out of three of the main universities with BSNs, yet many of the hospitals don't care what type of degree you have (except for our two MAGNET status facilities). Now that being said our two neighboring states, Washington and Oregon are saturated with community colleges, there ADN programs have waiting lists that last for a year or more, and many of them are in areas like Seattle and Portland. What I find so interesting is that both these states are starting to only hire BSNs in many of their hospitals. This makes no sense to me what so ever???
Another point I want to thrown out there is the image of nursing to the outside world, or high school students exploring potential careers. I don't think they are getting the realistic picture of what nursing is. This includes prior to nursing school and during. I think the image includes great pay, three days a week, and a thrilling work environment. We were discussing nurse burnout and that something like 50% of new grads leave the profession after a year. I think it's in part to the misunderstandings of what your job entails as a nurse and that yeah maybe you make a nice living, but every single cent of that is earned. I also think the lack of prioritization, communication, critical thinking, etc., is somewhat generational. I'm 30, I'm not saying I'm a pro at these, nor am I saying ALL 21-25 yo nurses are lacking these skills. So I don't think it's necessarily the type of degree you obtain, but may relate more to an individual/generational issue
I don't think one is better than another. I had two options, the BSN and ADN programs that were available are 10 minutes apart from each other. I was a non traditional student, had 5 years of college already and was one class away from a bachelors in general studies. It made sense for me, it was 3.5 years for the BSN and 3 for the ADN. It's about what works for you. And when assessing the quality of nurses produced from each, there are many variables that need to be evaluated. I hope the reality of job prospects are being relayed to potential students who are looking at ADN programs (and LPN too). I think each degree brings a different perspective to the table.
One last thing, the cost of Idaho universities is some what low, so while we are all white (because we are in Idaho a state with minimal diversity), there are many of us from all points in our lives and from different financial backgrounds. So if your looking for a lower cost BSN program, or bridge program Idaho is not the worst place.

Anonymous said...

Snerk...I got my BS in organ performance before nursing school. Had to be BS because I doubled with general science. Been in healthcare 10 years now between CNA/school/RN/BSN, finished BSN last spring. Though we're not actively pursuing Magnet due to our terrible survey scores (whups), our managers tend to hire the BSNs over ADNs. A recent discussion with my manager about how we're training a huge influx of new grads this spring (had someone up there decide to take away the float RN diff and pretty much everyone in float pool quit) revealed our local BSN program is under way too much regulatory pressure to be able to produce effective GNs. I'm not sure what any stats may be, but they are also having trouble meeting clinical hours and are allowed to use simulations. So they are. Some GNs we get are great! Some SNs we have in clinical are great! Most have problems, to the point of not even listening to their preceptor. I do know things, even if I'm not your instructor. In fact, some of these instructors are so caught up in their power trip and push for 'professional nurse' that they refuse to allow their students to go see other stuff outside of their assignments. I am a bit pissed off.

Unknown said...

I am conflicted on this one.

I argue (frequently, loudly, belligerently) that nursing is about the brain as much as the heart. It is an academically, intellectually, scientifically rigorous discipline. Nursing must hold itself up as a profession based on evidence, informed by theory, and rooted in ongoing formal and informal education. Setting a bachelor's degree as the entry point would support that.

With that being said, I don't see that the additional schooling prepares BSN students for the floor any better than ADN students. The management training is worse than useless, and the BSN students' leadership training is more than offset by the life- and work experience brought to the table by the majority of the ADN students I've worked with.(I believe this is supported by the literature, but I haven't looked it up since the last time I got wadded up about this half a decade ago.)

The point about diversity is also well-taken. There was a tremendous difference between my nursing class and the classes that came through my town's private-school nursing consortium. It's gotten better now that a public school has opened a campus here, but it's still not ideal, and (from the outside, at least) I don't see as rich a mix of non-traditional and older students.

Equally important is the diversity of opportunity. Without the ADN option at my community college, I would be out bar backing for minimum wage. Making a four-year BSN the only entry point to registered nursing is going to slam the door on a lot people who would otherwise be amazing nurses. Developing the kind of transitional programs described in an earlier post will help, but that will require a massive amount of program restructuring and, I expect, would still raise hurdles and navigation issues. My opinion (based on my own experience and that of my classmates) is that it will put too much squeeze on struggling people who can scrape it together for two years until they get a steady paycheck, but won't be able to do much more than that.

In short, I recognize the validity of wanting to make a four-year degree the minimum requirement, but it chafes me to think of how many people that might shut out.

As an aside: Tragically, if my Facebook feed is any indication, there is no difference at all between ADN nurses and BSN nurses when it comes to recognizing the difference between the CDC and So much for all those evidence-based practice classes.

Anonymous said...

I'm in Texas, in a town with 3 universities that all have BSN programs. I graduated in 2012 and started off on the Neuro unit. Let me say that I hear ya. I get it. I am a 20 something BSN grad who came into a Critical Care unit with no previous nursing experience. I, on the other hand, worked throughout high school and college because I wanted to, unlike most of my fellow students. Now, my schooling was paid for me by my parents, but I still worked. I've actually found that most of my fellow BSN students problem is that they don't have any previous experience working FOR someone. Not for a boss, but for a paying customer; or patient, in our field. They don't know how to interact. I think that they are plenty smart, plenty capable, but just not good at working, having never done it before.

On the other hand, I have coworkers who are ADN prepared working along side me who have plenty of skill-based knowledge who do weird things sometimes because it's been 20 years since school and they don't really understand their patho to know WHY they are doing something or why they WOULDN'T want to do something else. I see both sides really. I also have ADN's who are amazing and wonderfully competent nurses!

I also only got 7 weeks orientation where as the last male, ADN, and nursing as a second career, middle aged person I coached got 16 weeks. I was begging to have him transferred to a new floor, but management wanted more "diversity". Soooo now he struggles along on nights when I think he would be better suited for somewhere else, just because it LOOKS better to have him here.

I truly see so many sides to this that I don't think it's a one-blame game. So many things go into making a good nurse. Skills, personality, time management, knowledge (even if its just when to ask for help), and having the right staff to work with! It's hard!

Suzie said...

I agree that getting a BSN should not be the only entry point into nursing. ADN nurses are and can be just as good if not better at their job than BSN nurses. Although some bring up a fine point that academics and education are important factors when it comes to nursing success, there are quite a few "filler" courses within the BSN curriculum that don't actually adequately prepare you. The point regarding diversity, though true, doesn't bother me quite as much as I believe in hiring the best person for the job, regardless of their circumstances. If they happen to be white, middle-class, and female, then so be it. But if they're getting the job over someone who is more qualified and effectively show better promise, then that's when we have a problem.

Oldfoolrn said...

The foundation of an ADN or diploma nurse's education is patient care. BSN's are educated depending on the academic philosophy of their school. In my experience most are navel gazers that typically like office-sitting-not patient care

Susan said...

I started nursing twenty-nine years ago after finishing a year of general education requirements and a nursing program.
Four years into it the rumor was "Oh, you better get your BSN" That was 1990. I only did it when our hospital set up a sweet deal with UCF so licensed nurses took one three hour class a week on stuff like research, leadership, and a practicum at the end. It was just a hoop I chose to jump through because they made it so easy.
We get students all the time from private programs, two and four year programs. Most enter their last semester never having started an IV, inserted a foley, or dropped an NG tube.
Education should be pulled as part of magnet status. The focus should be all on patient care, not the letters behind our names.

Aesop said...

ADN grad.
Still, after 20+ years, >15 in the E.D.

IIRC, CA has something like 16 BSN programs, and 40 ADN programs (anal BSN advocates, feel free to correct me with the current actual stats.)

So ADN courses will prepare twice as many nurses twice as fast, meaning that for CA, for example, to go for statewide magnet status, we'd have steal every BSN from the next twelve most populous states, and pay $50/hr.

Which latter is about the only thing that would make jumping through the BSN hoop worth my time or trouble at this point.

My personal guesstimate is that 75% of the theory is a self-greasing axle for nursing educators/schools of nursing, and an irrational amount of hubris from the "I Am Professional, hear me roar!" crowd. (Calm down, crazies: professional is an attitude and work ethic, not a sheepskin. Write that on your hands, lest ye forget.) The other 25% is of some use in management, research, and advanced practice, all of which should and generally does require far more than even a BSN.

Using it as a weedout is going to be its own reward when someone scratches their head and wonders "Gee, now that we got rid of all those ADNs, how come stuff isn't getting done anymore, and everything is falling apart, and we're so criminally short-staffed 24/7/365?"

But until manglement (great word, I'm sooooo stealing it) breaks suction and pulls their collective heads out, that light will never dawn.