How close are we to an 80% baccalaureate-educated nursing workforce?
With 2019 coming to an end, nurses are asking where we are in meeting the goal set by the landmark 2010 Institute of Medicine (now the National Academy of Medicine) report on the Future of Nursing to have 80% of practicing RNs with a BSN by 2020.
Thanks to the hard work of truly amazing nurses and other healthcare professionals, during the past decade we’ve made important, positive strides.
BSN by 2020 starts after decades of debate
The year 2010 was significant after a long history of efforts aimed at uniform nursing education preparation.
For many decades before the IOM report, there was an ongoing debate within the profession around the question: “Is the BSN the decisive credential for licensure and entry into practice?” Attempts at coming to consensus were unceasing, and there were many starts and stops along the way.
As far back as the 1920s, in an attempt to move nursing into mainstream university education, the historic Goldmark Report called for the BSN to be standard preparation for entry into practice. Later, the advent of the associate degree in nursing in the 1950s reopened talks on the subject, and later still the question was addressed in the well-known 1985 proposal on nursing education.
The debate continued through the following decades and into the new century, and the 2010 IOM report brought nursing together around a host of big professional and educational goals, one being the recommendation that 80% of practicing RNs have a BSN by 2020.
Upon its release, the report indicated approximately 36% of RNs were entering nursing with a baccalaureate degree. But because many came with a diploma or associate degree and later earned a baccalaureate, there were about 50% of practicing nurses nationwide in 2010 with a BSN.
Work done, lessons learned
In November 2010, the Robert Wood Johnson Foundation initiative called The Future of Nursing: Leading Change, Advancing Health took up the baton, established the Campaign for Action, and did a mammoth amount of work, helping to increase the nationwide percentage of baccalaureate-educated nurses from 49% in 2010 to 51% in 2014, moving toward the ultimate goal of 80% BSN by 2020.
Various other professional nursing organizations, such as the Academic Progression in Nursing (APIN), which is funded by RWJF and led by the Tri-Council for Nursing, joined the effort. Other organizations included the American Association of Colleges of Nursing (AACN), the American Nurses Association (ANA), the American Organization of Nurse Executives (AONE) and the National League for Nursing (NLN).
Certain states were selected by APIN from 2012 to 2014 for funding that would be used to advance their work on academic progression. RWJF invested more than $9 million in the program by the end of 2016 and nine states (California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas and Washington) were participating by that year.
Then in 2017, AACN circulated a position statement draft called, “The Baccalaureate Degree as Entry-Level Preparation for Professional Nursing Practice,” to get public opinion on the issue. In part, AACN said it “believed registered nurses should be minimally prepared with a BSN or equivalent nursing degree,” and the position statement mentions how the IOM’s BSN by 2020 goal has “generate momentum” toward that goal.
In an article, Robert Rosseter, chief communications officer for AACN, clarified the draft did not say nurses could not enter the profession with an associate degree. “The focus here is on academic progression — moving nurses on to higher levels of education,” he said in the article.
Many goals achieved
- Progress continues, outcomes remain positive, and nursing continues to move forward in growth of four-year programs, which went from 882 in 2002 to 1,413 in 2012.
- The Campaign for Action is still learning from the states as they work at the national level.
- State action coalitions and implementation programs have been successful, as have strategies to advance academic progression.
- The campaign has provided technical assistance on academic progression to 25 state action coalitions and implementation program grantees, in the belief that “standardizing prerequisites and general education requirements across the nation in all nursing programs is a fundamental step in advancing nursing education and removing barriers that make it difficult for nursing students to move from an associate degree in nursing to a (baccalaureate) program.”
Almost time to celebrate!
According to two leaders during this decade-long process — Susan B. Hassmiller, PhD, RN, FAAN, senior adviser for nursing, Robert Wood Johnson Foundation, and director, Future of Nursing: Campaign for Action, and Susan Reinhard, PhD, RN, FAAN, senior vice president and director, AARP Public Policy Institute and chief strategist, Center to Champion Nursing in America — the new National Academy of Medicine report soon will be released and its findings discussed at a gathering of action coalitions and other leaders in healthcare.
This will give everyone an opportunity to celebrate the work that’s been done and measure how much closer we have gotten to 80% BSN by 2020 and other important recommendations.
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Article is titled how close are we and still never said… very click bait title if I say so myself.
I have been an LPN for over 20 years. I think that 80% of RN’s having 4 year degrees by 2020 is an unrealistic goal. I can understand if an RN wants to get a certification to specialize in a particular area of nursing, then a 4 year degree is necessary. For example, I live in Minnesota, and the pay difference between an ADN RN and an RN with a bachelor’s degree working in a hospital is less than 2 dollars. What incentive is that to achieve your BSN? Why accumulate more student loan debt for $2.00 an hour more? I can understand if an RN wants to be a public health nurse, etc., then getting your bachelor’s degree in nursing is a good idea. Just my opinion…
I have never seen a facility in my area that has any differential for having a BSN. Two dollars an hour would be wonderful! But I, like many other nurses, are feeling the terrible burden of student loans that we took to get that degree with no return on investment. If I had to do it over again I am not sure that I would have gone on to school. I see all the ADNs that I graduated with many years ago, earning the same, and free from debt. They had better lives than I have had because of the time and money I put into a degree that at the time seemed so important.
To join your comment, I have not seen a facility with reduced FTR rates. Look at the news. By pushing the BSN, as entry to practice, you get brand new RNs who trained in SIM labs or who wrote papers, in lieu of actual patient-touching clinical experience. Nursing schools can teach them to pass NCLEX, but patients die due to poor clinical and critical decision making.. Clinical experience is being sacrificed. As a result, new nurses, including BSNs are not practice ready. NCSBN supports this and is changing NCLEX-RN to NextGen to include questions that can gauge a candidate’s critical thinking, clinical judgement and decision making. Nursing education is to blame for this fiasco. You have nurses talking about “bedside” nursing is not for them so they are going straight for NP. What have we done? Hire a well trained nurse even if they are diploma or ADN. Let them work and get experience while earning a BSN. You will have a reduced FTR. (Failure to Rescue).
Deltra I have to join your comment, I have been a nurse for over 40 years. I have seen a decrease in basic bedside nursing. We are spending much time teach toward the NCLEX and trying to develop critical thinking and clinical reasoning. I think every nursing program should mandate the student to take a CNA course and become certified. This way the basic skills of care are taught. When the students take their Fundamentals of Nursing class they have some idea of basic care and can excel in basic nursing skills: NG tube insertion, IV, and Urinary catheter insertions.
In my Fundamentals of Nursing Clinical, I had a student who did not know how to change a resident or do peri-care. We need to make sure the student is competent in the basic skills with clinical, simulation, and skills lab. In some programs that are accelerated the students are not given enough time for practice, clinical sites are limited. Nursing students are focusing on big money with advanced degrees.
I worked for many years as an ADN graduate in the last 15 years received my BSN and MSN. What I learned through my undergraduate and graduate education doing all those papers and research projects that it helps you think differently. It teaches you to think to analyze, synthesize, and evaluate situations that come before me. BSN is needed as an entry-level degree into nursing, so long the Fundmanetal s
of Nursing which is basic nursing is taught with competency and practicality.
Debby, I did the same as you. I became an RN later in life with an ASN, then went back five years later to get my BSN part time. I then did a cohort, full time-2 year MSN program for Nursing Education. All my “nursing skills” were learned in the ASN program. The BSN and MSN were more administrative, analytical, and concept-thinking in nursing. It helped me to think like a researcher, but I already had the core nursing techniques and skills mastered to think on a different level. I have trained a lot of nurses over the years (from younger to older graduates along with two {associates} and four {bachelors} year degrees) and the two year students are able to handle the “tasks” of nursing with more ease or equal to the four year nurses. The push to get nurses to a BSN level has more to do with the respect of the nursing profession than the education. This country equates education with status and respect. The problem is the institutions, ie: the hospitals, have not caught up to the 2020 standards. I make the same money per hour as a ASN nurse as I do a MSN. I did get a small stipend for tuition reimbursement along the way. Nurses are a big part of the budget in most medical institutions and we are not compensated equally to other jobs because of our numbers. An OT or speech pathologist with the same degree as nurses make far more than nurses in most hospitals because there are so few of them and it is billed separately. Nursing billing is lumped under other costs of hospital stays and is not a line item in the billing breakdown. By far, we spend the most time with patients, do the most teaching, and wrap all departments up with instructions throughout their hospital stay and at discharge. Maybe we need to go at the initiative through employers instead. They want more educated nurses, then you get what you pay for. Most nurse that went on to advance their education are carrying a boatload of debt without an increase in pay. This just promotes advancement to other nursing jobs for compensation instead of promoting nurses to stay in their current job for continuity. I’m all for continued education and advancement but the system is not in sync with the education expectations. The amount of education and knowledge nurses required is far beyond the pay grade they receive. I once heard a patient’s family member say they wouldn’t get out of bed to be a garbage collector (I’m not degrading on garbage collectors-we need all jobs to make society run, I’m talking about educational requirements) for less than $10 MORE than what I was making per hour!! I was so deflated at the time. It’s time we change the direction and get the compensation we deserve. Have the educational institutions back us up and target who is paying nurses!! Both need to be on the same page in order for the change to happen for all!!
Speech Pathologists do not “have the same degrees as nurses”. The entry into practice is a graduate degree. The programs generally are from brick and mortar schools, with highly competitive admission standards. The minimum length of programs is 2 full-time years, including the summer for students with an undergraduate degree in communication disorders. For students from other disciplines most programs require 3 full years of study. After completing graduate school and boards, a 9 month full time fellowship is required for licensure.
After receiving a BSN from a reputable university and then practicing for a number of years, I returned to graduate school to pursue speech pathology. The standards are high and the programs are rigorous and demanding.
I have been a nurse for 43 years from a diploma school. Continued my education and accumulated 84 credits. I never finished. In my opinion fundamentals of Nursing was the most important course in preparing you for the profession. You must have complete understanding of technique and patient concerns. I was prepared with all mentioned including GITube placement. Our schooling was 36 months with a 2week vacation 1x/ year. I had Ethics, Sociology, psychology, fundamentals, English and worked in the hospital. Collegiate programs involve the same amount of months and every summer off. I feel I was more prepared. I love my profession and the patients I care for. I have always had managerial positions and perhaps the basic is a personality issue as well. Nurses need to be totally prepared for their daily encounters no matter what road they travel and I think the Collegiate program needs an update.
I am an ADN and proud of it!! Having worked with so called MSN’s. Some of them having no clinical experience what so ever. Clip board nursing at it’s worst. I have worked with LPN’s that have more and better clinical skills! I am now retired and glad I am out of the rat race.
I’ve been hearing this nonsense for years. I have a ADN and am just as informed on patient care as the BSN nurses that I have worked with. In fact most of the BSN nurses want an office job and get it eventually. I have no student loan debt while many of them are paying off theirs. Also there’s nothing I hate worse than some office manager with her BSN dictating to the floor nurses how to care for patients while having done no direct patient care in many years. I’ve been in nursing for over 30 years and can’t wait to retire from this profession because of management in many jobs I’ve had throughout the years. I worked with a nurse recently with a Master’s in nursing that couldn’t even put a catheter in a patient or a rectal tube. Why? Because many of the nurses with advanced degrees don’t want to work in direct patient care and I’ve heard many of them say it. I’ve made a good living with my associates degree, can’t complain. I think it’s a marketing ploy for the universities.
I agree! There should be stronger requirements for advanced practice nursing such as a minimum of 3 years as an RN. I see nursing students on FB saying that they don’t want to work medical-surgical, but go straight for NP. We have created monsters.
What’s the sense of a BSN anyway? I agree with others that ADN is good and adequate in an industry that needs to not worry as much about degrees over patient care. Nursing hasn’t grown as a field in which members are unified on issues. These issues include patient care, staffing ratios, violence to nurses, adequate pay for BSN degree. I have a ADN, MBA in health management and BS in Community Health. I have been an DON and worked in Occ health, wellness. I am serious that if someone can convince me that I will benefit from a BSN, I will apply soon. The part of the BSN piece that frightens me is if the nursing industry begins to move towards not recognizing ADN vs BSN degrees. I understand the movement within nursing as PT and Pharmacy field has moved toward doctorates, but where is the added value for the patient vs. the field? It’s a waste of time and resources at this point.
I work for the VA, and promotion past the first few pay grades requires a BSN or a close equivalent. I’ve looked into BSN programs after taking BADNAP course (10 month ASN course for people with a prior Bachelor’s) and a good many of them require no time in a classroom or a clinic. The courses focus on leadership and research which seem to set you up to sit behind a desk more than they make you a better nurse at the bedside.
We’re still at a huge deficit when it comes to nursing jobs and hospitals know that any advantage to having a BSN on the job is more than mitigated by having empty positions in wards attempting to achieve an arbitrary goal. But as the article states, the number of BSNs grew a whole 2% from 2010-2014. At that rate we’ll hit the magic 80% marker by… 2110.
I’ll consider the getting a BSN if the pay increase offsets the money I’d have to invest; but unless there’s schooling in a specialized field I’m interested in, I doubt my skills will magically increase while typing on a keyboard at home.
With the lack of work ethics,committment, and accountability amongst nurses.Many facilities of a rehabilitation or LTC nature have such a lack that many managers are working a unit
So the BSN may not keep anyone behind a desk with these ongoing issues.
It depends on your personal goals and where and if you want to advance..stay at the bedside and in a hospital at that pay wage is perfectly fine. because we will always need a bedside nurse and we want those to be the very best there is!! Kudos for staying there! Making over $100,000 a year with a choice of working just about anywhere as a Nurse Practitioner…that is where the motivated flock to, where an entrepreneur in nursing wants to be (yes there are actually national organizations specifically for Entrepreneur Nursing.) Where ever you are, whatever your comfort level, whatever economic status you prefer to aspire to, or remain at, whether you are a single woman without family or the breadwinner for a family…all those variables feed into your decision. The issue is not who is better, ADN nurses are priceless. Feel free to stay where you are but realize that there are states that do pay a significant difference and do offer rewards for those with higher education. (Magnet Hospitals for example). I personally never wanted to be restricted by title, never wanted to NOT have the choice to compete in the market, never wanted to NOT have the opportunity to travel and teach and be active on national committees. To be able to do that kind of thing means investing in oneself in a different way. Being happy with where you are is key, but nurses let Administrations walk all over them and do not advocate for better pay or better benefits and too often believe they have no voice. Lots of griping on this topic but little to no action from the trenches where good care hinges on acuity and staffing. Ask yourself every day, what did you do to advance your profession overall? The rest of us with Masters Degrees or DNP will continue to advocate for the advancement and options available to those with higher-level critical thinking skills, different leadership skills, and the ability to choose any field, any time, any place. I guess you could say that those who advance love change and challenges beyond having the same job for more than a few years. I have been in nursing for over 40 years and have loved every single new job and advancement and pursuing life-long educational opportunities. It is the drive and the journey in learning that is the real motivator here…we get bored easily! And the reward for wanting to grow? A great salary range potential and the ability to go anywhere in the US, especially now that NPs are becoming Primary Care Providers in all fields and specialties. Awesome!! With telemedicine, the choices continue to grow! That Nurse Anesthetist putting you to sleep? She was someone who was too constrained at the bedside. Thank God also for those who advance to lead those who like to be led…everyone has a place. Enjoying your place and loving your choice does not heed to be justified to anyone. We need to be supporting all levels and working together to provide the best care, the safest care, and own who we are proudly. But, the goal is still BSN. I hear this so much from my AD students who go on to their Masters…you do not know what you do not know until you gain higher education.It is not for everyone. I have relatives who have never left the tiny town I could not wait to get out of in Ohio in 1971 after graduation. They ae happy as clams! What is the difference between that and being happy in the level of nursing anyone chooses to stay at?
I have a lot to say about this subject. Let me start by saying that I obtained my BSN 36 years ago when student loans were not outrageous. I have always been a bedside nurse and will be until I retire. Over the years, I have had the privilege of working with nurses who had 3 year degrees and numerous LPN’s. These nurses were as qualified and skilled as I was at taking care of our patient population(NICU). I started hearing about the push to have your bachelors several years ago at about the same time people started talking about the coming baby boomer retirement mass exodus. So, several of the 3 year programs around where I live have closed and it’s almost exclusively 4 year bachelor programs. By doing this, the push for BSN nurses, I feel a lot of women who would have become a nurse by getting their 3 year degree, went on to other fields because they did not have the time or money to obtain a BSN, thus reducing the number of women going into the nursing workforce. This, at a time when we are facing a huge reduction in the nursing workforce because of baby boomers retiring.
I also have negative feelings about “Magnet” hospitals requiring a certain percentage of BSN nurses and APN. My negative feelings with Magnet started when a surveyor asked a room full of nurses, what accomplishment they were proud of. Most of the other nurses were bragging about going back to school or other endeavors that didn’t involve direct patient care. My proud moment was being the primary nurse of a baby for a significant amount of time(16months) and teaching the young mom had to be a mom and how to take care oh his complex needs. The surveyor was over the moon about the other stuff that was mentioned but she barely batted an eye at my accomplishment. So right there, I realized that Magnet’s focus wasn’t about direct patient care but how good we can make the nursing profession look by having a large number of BSN and APN nurses.
In the last several years, I’ve noticed that the push is now to not only obtain your BSN, but to go on and obtain your APN degree. It’s just not good enough to stay a bedside nurse; the nursing graduates now are expected to go on and obtain their APN degree. So, at this time, when we are facing a nursing shortage, the nursing profession is shooting themselves in the foot by putting a huge focus on BSN and APN degrees. Don’t get me wrong, there is nothing wrong with an BSN or APN degree but I just wish some more focus is put back on the value of bedside nursing. If all the young nurses go on to become APN’s, who is going to be left taking care of patients at the bedside?
Hi Susan. I did a lot research on the whole Magnet Status concept. It is basically a money-making scheme dreamed up by the ANA where hospitals pay the ANCC for the seal of approval. Then that hospital qualifies to receive large government stipends. Hospitals know in advance when the reviewers are expected. They reduce their patient to nurse ratios, make sure things are spotless and staff nurses with the most initials after their names during the inspection. Once the reviewers leave, the hospital goes back to doing things they way they did before.
If you carefully read the requirements for Magnet Status, you can see they are hardly above the requirements needed to pass a JACHO inspection. Probably the most important is that the check from the hospital to the ANCC clears. I’m sure there are hospitals that really do try to provide superior patient care. But they should be judged on their own merits; not on a paid for seal of approval.
Mr. Lee, I agree 100%!!
I work at a well known magnet hospital. They treat ADN nurses like they don’t count, & I can tell you they do not pay one penny more for a BSN. The tuition reimbursement was minute fraction of the $28K it cost for the online non-nursing classes to go from ADN to BSN.
Agreed! Well said!
Bring back diploma schools where students actually have experience at time of graduation. I went to a diploma school and got my BSN 10 years later but I don’t feel I gained anything for having it other than maybe job security.
So??? How close to 80% are we? Still never got an answer.
This pisses me off. To get my BSN costs so much money with no real benefit. On top of that to say that people with an ASN are not as qualified as a BSN because the biased statistics say that they are better nurses can kiss my …..
Just because a BSN can write good papers has nothing to do with patient care. I can give just as good care.
The fact that these BSNs think people with ASNs are stupid is crap…
Especially since i took the same damn test that they do, passed it my first time around. So if i took the same test as a BSN what is the friggin difference outside of the fact i can not write a good paper.
UGH UGH
If they focused on more patient care so it makes me a better nurse, than maybe but i do not want to be a leader not now not ever. I think it should be based on what we want to do in the future not based on how to write a good paper or learn how to be a leader maybe..
But i do not see the difference between an ASN BSN outside of writing good papers.
As for critical thinking i am very good thank you very much.
I personally also think this is prejudiced….because i am just as good as any BSN
They have been talking about this since I became a nurse in 1981. It hasn’t happened yet. Why have nursing boards not made the BSN as entry into practice? I started out as associate degree nurse then went on for my BSN. After that I went on for a MSN. Why has it taken so long to upgrade the level of nursing education? Each level of nursing offers valuable education and further professionalizes its member. Salary wise the hospitals must offer a salary that commensurates with the additional education and also help nurses to continue their education by providing tuition reimbursement.
I have been in the field since 2002 (CNA) got my LVN in 2003 and learned possible side effects/adverse side effects on medication administration, proper sterile technique with tasks (foley care, IV insertion *without* the fancy gadgets) proper order entry + carry out. I sat as monitor tech, LVN with IV insertion verification on a very busy Telemetry floor I loved. I had real charge nurses that would fight for the safety of our patients and nurses with admitting offices that tried pushing patients in. We (nurses) were able to build quality care with establishing rapport, trust, true bedside manner with the patients we had on hand. With my six year LVN experience I was granted a high intensity 18 month bridge program: LVN to RN-ADN in 2008.
I carry the true ethic and art of nursing with my ADN. The BSN programs teach nurses about business. The BSN nurses I have experienced lack integrity with their patients, are simply task-driven and have no time management, no respect with the art of nursing (Florence N. would be ashamed) and they will discharge patients unsafely, feel entitled that they do not have to answer call lights. They have increased infection rates because they do not do pericare with foleys, they do not clean patients crusty eyes before applying eyedrops, do not teach patients on how an actual suppository works and let the patient run to the toilet once they feel the urge in their rectum when they are suppose to *squeeze the butt muscles* so that the actual product can migrate to the lower intestine. All this increased hospital stay in regards to all the above mentioned. The graduates that went straight into their BSN from high school are giving IV Protonix too fast and sending their patients into tachy-dysrhythmia! They give their meds, sit down on their iPhones and “chart” talk crap about other nurses and get complaints from MD’s about their incompetence on the floor. Do they try to understand their patients? Some. 90% do not. They whine, complain, and move elsewhere because they are inhuman, act like high school kids that just want to gossip. These nurses are are then hired to bully other nurses from their managers. The increased patio rate has had significant losses: deaths, falls, death by falls, increased re-admission rates and therefore a once well known tertiary care facility has lost its phenomenal “crown” of being one of the best Los Angeles Medical Centers in town.
The BSN’s put their hands in the air and say “there is nothing we can do” as they agree to dump patients anywhere there is a bed. The BSN case managers are the worst yet with their business minds. God is watching and hopefully you will have a good nurse and will learn that your business mind in this business is killing your patients and nurse morale. Thank you BSN, not only for engaging in placing these poor and incompetent nurses in debt they will have to pay for the rest of their living life. No wonder they don’t care – they just want the money to pay their debt or Gucci.
They only way I would get my BSN is it was paid for. I am not falling for that gimmick. God is watching – stop pushing nurses to think business when they need to take care of your family members. BSN is true BS when you do not have the experience. Sip on that.
Having a BSN and working with ADN’s and LPN’s, I have been humbled by the excellence that they bring to the field. On the other hand, I have worked with BSN’s who don’t seem to know the 1st thing about patient care. I agree, this title promised much more than the article delivered and I don’t see a reason to ‘celebrate’ from what was said.
All I’m going to say is its amazing to me that once a nurse gets her BSN & gets into Management how she forgets what it’s like to be at the bedside. Just because you have those initials after your name doesn’t make you a good manager. I also agree that the Magnet program is a joke and is run by those who forgot what nursing is all about. It means nothing to a patient or those who work in a non-Magnet approved hospital or even one that is magnet approved Getting a BSN doesn’t make you a better nurse, experience does!!!
after 40+ years in nursing I am now sitting on the sidelines. My entry into nursing was pretty smooth because my education and clinical practice prepared me for hospital floor nursing. When I was a third year student, I worked in the hospital 3 days a week and had classes the other 2 days. When I started my first job, it was on night shift and I learned a lot from a very experienced LPN. Every job I have had, I have grown in my knowledge and experience that no amount of college education would have given me. What I have noticed about the people just entering the profession is their disregard for our (nurses’) history. Our schooling included a history of the profession and respect for our history. We wore caps to show our pride. We were taught to dress professionally with clean uniforms, shoes, neat hair, minimal jewelry (wedding band). Now, nursing students attend classes in shorts and flip-flops. When it comes time for work, they used to dress inappropriately, with nail polish and gaudy jewelry. I swear this is why the hospital where I work adopted a policy of all nurses wearing scrubs that different colors designated your position in the organization. This is the way management could enforce a dress code without singling out any group or preferences. (I once saw a floor nurse who was pregnant with low slung pants and a short top, which left her belly exposed. This was at eye level with a patient in the bed.) Nursing was good to me. I met incredible people, worked in several nursing areas, and I am still in awe of what is being accomplished by nursing and research (the possibility of transplant a liver that had been infected by hepatitis!) I did not consider furthering my textbook education because I learned a lot more from my work than I would ever learn in a classroom. I am proud of my cap and my diploma.
Not one patient or doctor ever asked me or any nurse I know whether they had a diploma, associate’s or BSN. We all take the same licensing exam. How narrow-minded is it when the letters after a nurse’s name becomes more important than experience and specialty certifications that denote high proficiency in certain areas of nursing.
Give me that diploma or associate’s prepared nurse with 20+ yrs experience and specialty certification in critical care any day over a BSN who has spent more of their education writing papers than in clinical training. Experience and competence trumps initials any day.
I got my Associate Degree in 1988 and I’ve always done hospital nursing, mostly the nightshift. I have several certifications and more experience than anyone else on our floor. Most shifts I work I am in charge, even though our policy is that charge nurses have their BSN. There is not substitute for experience and my boss knows it. The young BSNs I work with are more concerned about social media, and getting there NP then they are about our patients. It’s sad and scary. I’m not going back to school. I love what I do and am content with my job and salary. Most of our BSNs don’t want to be here. Who will be here to take care of hospitalized patients? You bet we’ve shot ourselves in the foot.
Hi all! I’m all for more education! I currently hold an ASN degree and work as a clinical mentor in a busy ICU. I’m currently looking into getting my BSN for various reasons as a means to go for a higher degree / more education. No one is telling me I have to- like NY? I’ve come across many different nurses throughout the years. I will say one thing is for certain! There is absolutely no correlation between a “good” nurse and a “bad” nurse based off of their education- when talking about bedside RNs. Nurses that are motivated to learn are good nurses. I entered an ASN program because of many different reasons- accumulation of student loan debt, impacted programs, soaring cost of BSN programs. The whole 2 year degree vs 4 year degree is where I get bugged the most. I went to a university before entering my ASN program and had already accumulated many credits. When I look back at what was required for an ASN nurse who was starting from scratch at this “2 year” program- they were required to take pretty much 4 semesters worth (12 credits / semester) of prereqs. Only then could they apply for the “2 year” nursing program. When I compare that to my local BSN program it’s almost the same format- but they get to call it a “4 year” degree? And yes their 4 year nursing program is only 2 years of nursing classes? Now as I am looking for RN-BSN courses I feel like I’m shopping for a car? Sales reps call me at all hours of the day to try and sell me their program. I try and weed through all of the fine print / extra fees and catches. And someone has determined that I’ve somehow lost out on 30-40 credits by getting my ASN? So RN-BSN nurses have to go back to school on average for 14 months because someone has deemed that they’ve only completed a 2 year degree. I also completed nursing leadership and management classes in my ASN program- somehow there is this pervasive idea that ASN RNs have no comprehension of this? The last thing that bugs me is there are multiple programs that offer a second bachelors to BSN degree in less that 1.5 years? So now it’s not acceptable to go to a 2 year program? But it’s perfectly ok to go to a <1.5 year program? Even if your previous major was art history? I have nothing against artists! Ha ha! The whole thing just feels like a giant money grab. That's probably the single biggest reason I've waited to so long to get through this part of the game. The powers that be who are making up this 80% by 2020 are most likely completely removed from the real nursing process. I guess the main lesson here is life is never fair. Thanks for listening! Last but not least I dislike anything that sews division. I feel that the whole ADN vs BSN debate has sewn a lot of division among nurses. I wish that wasn't the case. Good day to you all!
The whole thing is a giant money grab. Especially with these online RN-BSN programs. And most are just that, BS! The teachers know it’s BS, most nurses know it’s BS. The only ones who may not know are the 20 something HR twerps that got the job because their parents made a call. Think about it; with no classroom overhead such as heating,a/c, the profit margin must be around 400%. The brick and mortar schools have been hurting for at least 10 yrs now and will try to do whatever they can to get more students through their doors. You’ll find that most of those supporting making nurses return for a BSN are in way affiliated with Academia. Those doing the most shouting were nursing professors who taught nursing or ran nursing programs at four year schools.
After reading so many comments I would like to share some more of the “history” that was overlooked in the article. In the 1970’s the issue of BSN as a level of entry for Nursing was a hot topic. Due to the pushback from 3 year program diploma Nurses the ANA backed down from pursuing any measures toward standardizing the profession. Eventually, with the AIDs epidemic a nursing shortage followed and imported Nurses began to join the workforce.
As one of the “mothers of Nursing” told me over breakfast at the ’81 ANA convention, “If we don’t define Nursing, it will be taken away from us, piece by piece.” I have seen this happening over 40 plus years.
Today we have several working titles and credentials that identify us as Nurses. Yet if you ask Nursing students, patients, family, friends and other professionals what Nurses do, what they are responsible for, the answers are appalling ! And the mention of “bedside Nurses” and direct patient care that so many here have referred to seems to overlook the one thing that we, as Nurses bring to the table, namely assessment. As an instructor I stress that we can bring anyone off the street and they can be taught a task such as IV or Foley insertion. That does not mean they can assess or troubleshoot the needs of a patient before, during or after that task or procedure. The complexities of polypharmacology and comorbidities are involved in the care of patients as well as advancing technology. Of course we all need a strong foundation in the basics of anatomy and physiology, assessment, recognizing life threatening and often subtle changes, and hands on physical care – something every Nurse should be competent in. But the elephant in the room has been there for far too long. We need a single level of entry, a standardized, nationally accepted program, and compensation for being professionals. As long as the discrepancies in education and hands – on training persist we will continue as a profession to be critical and mistrusting of each other.
The goal to have BSN credentialing is a worthwhile one. Sadly, without defining the minimum standardized level of entry, we are only churning out continued dissatisfaction within Nursing, fueled by a lack of compensation that recognizes us as professionals.
I believe that a nurse with an ADN has a better practical curriculum than that of a BSN. Why is there such a push to get a BSN. I am in the Chicago area and almost all hospitals require a BSN? Why? Most schools in the area offer ADN programs. You are pushing the ADN to have to work in other settings and you are taking nurses away from the bedside. If someone wants that then they should be able to get it, but making someone with an ADN feel inferior and not able to work in a hospital is just not right. We are shooting ourselves in the foot as a profession by not allowing these nurses to work in the hospital and requiring that they need to get their BSN.
I agree with education. Nursing is an ever changing profession. I don’t believe that we are educating ew nurses as well as we should. We are more concerned with degrees than quality well education. New nurses are getting advanced degrees without experience. How can nursing instructors teach without knowing how to do something. I too went back for my BSN because it was required for my job My instructors talked at us. No experience… just what the book said. Eventually, we will have nurses with a lot of letters after their name but truly won’t know how to work acute care. Nursing is hands on. We are teaching them not to go the bedside but be an administrator… an administrator with no hands on clinical experience. Every nurse should be required to have med Surg experience prior to any degree advancement or teaching
Agree with you Mary. A nurse with 20+ years experience would have had to adapt to all the new technologies during that time. To be able to learn and adapt to new protocols and technologies and teach them to others is far more valuable than having more initials after one’s name. I went to a three yr hospital based diploma program. I had previously earned a Bachelor’s Degree in Business and saw no need for a BSN. Were were required to do many research papers and presentations in our diploma program. But we spent 3 days a week in hospital clinical training, learning, and doing the work of nurses. And let me be very frank; most of these online RN-BSN programs are just that, BS! The teachers know it, so-called nursing leaders know it, and most mature nurses know it also. The only ones who may not know it are the 20 something HR nurse recruiters who got their jobs because their parents made a phone call. But these online programs are money-makers. Thin about it; no classroom overhead, no heating/ac or maintenance. The profit margins must be over 400%. Probably why the Clintons had a vested interest in Laureate Education which is the parent company of Walden University.
Experience is the best teacher! I do not care if you’re a LPN, ADN or BSN! Degrees have no impact on your skills, bedside manner and how well you care for your patients. Most nurses I have worked with in the last10 years have lacked experience, empathy, skills and drive to take excellent care of their patients. I am so glad I can finally retire from this money driven racket in 12 years!!!!!
As a 33 year ADN veteran, I am tired of this debate. While other folks were getting their advanced degrees, we diploma/ADN nurses were at the bedside, taking darned good of you and your family members. I am 61, gave up my travel career as an OR nurse and settled at a Magnet hospital. A BSN enrollment within 6 months was required. So, i am trying to figure out how this will benefit me personally, let alone enhance the nursing care I have so diligently practiced for the past 30 odd years. Oh! Since I am maxed out on the wage scale, where will this help me financially?
I am a “Registered Professional Nurse”. That’s what my license says. Health care is a business and making the care the most expensive in the world with the overly be-lettered, ill educated, inexperienced nurse is a very stupid attempt to make health care inaccessible to the public.
The Diploma trained nurse is still the best, most cost affective provider of care. BSN does not guarantee licensure. ADN does not guarantee it either. Every single one of my classmates in my diploma program passed the boards on the first attempt.
Yes, the Diploma system was very tough, very subjective and extraordinarily strict. It was a dedicated program for the training of a medical professional. It was not a democratic process where the grade point average was negotiable. The BSN and ADN were added to “round out” the provider…read, make it more expensive to care for the sick…”But, they’re more educated”. Yes, in the wrong things. Nursing school did not deal in remedial mathematics. The science and evidence-based practice data collection goes out the window when overtime needs to be paid or some task needs to be done by a knowledgeable provider. This education is being touted as an improvement..the nurses salaries have not reflected a monetary rise in this “improvement” in the quality of the physical care.
In most institutions, the true care is being provided by CNAs, techs, MAs, LPNs who are cheaper.You know, those people who just came in off the street. Those people are the life blood of care these days. They seem to be only ones who can perform a task.
Practice! That’s a word that seems to be foreign to many of our new nurses. They are afraid. Afraid of failure, afraid of a litigious public afraid of caring..afraid to lead…Magnet hospitals, NCI designations and other labels are simply another money grubbing attempt by business factions to syphon off the benefits that might be available in populations where the government/insurance companies might pay. Teaching hospitals are especially bad. Using the labor of other countries to staff the hospitals and not paying those doctors/nurses what they are truly worth.
I was speaking with a nursing student recently who, in the world of COVID, has decided not to continue…”I don’t want to die..especially at that hourly pay”. I never thought that I would ever agree with a nationalization of standards for the professional nurse like they have in other countries, but until we have those standards, we will have to listen to the whining of the hospitals who plead poverty, the lamentations of the colleges who don’t know what to teach and how to do it and the patients who are being deprived of the care that they need at price that they can afford. We will also have to acknowledge that until we improve the quality of the basic nurse, we will never be able to gain the respect of the public who believes that nursing is cheap labor.
I’m a diploma nurse who graduated in 1973. I personally do not see the advantage of a BSN. I do not see any BSN who has better basic nursing knowledge upon graduation or critical thinking skills.
The cost of the education these days is out of this world.
When I graduated I had only 6 months less of education than the comparable BSN of the time.
Nurses today need at least 3-6 months of orientation before they can take the floor competently. It’s a shame!
32 years ago i graduated from a Diploma Nursing program. I was taught all the skills needed for bedside nursing. We had some credits in our program which could go towards a BSN. No one really was interested at the time. We hit the ground running passing the boards (and yes I vividly remember checking the mailbox daily for the “envelope” on pass or fail).
It infuriates me that a nurse with 32 years of experience is only hired now if they commit to getting their BSN within 5 years.
I left my last hospital job after 21 years because they merged with another hospital and changed the requirements. I had 3 kids to put thru school…i just couldn’t justify the money and time for a few cents more an hour.
My daughter is a senior now in a wonderful nursing program that actually focuses on skills needed for bedside nursing (and yes she will also have the coveted BSN when she graduates). So many of the new nursing graduates have no interest in bedside nursing. Is it because they push the management/BSN vs hands on clinical nursing in so many of the schools? It’s really kinda sad. I loved bedside nursing for 32 years. Personally I never wanted any management jobs so I never considered the BSN.
This is a terrible idea and it has been for the 50 years I’ve been a practicing nurse. The closure of diploma programs – initiated by Akers’ flawed “research” for the RWF and loss of comprehensive nursing examinations for licensing increased the number of novice level, inexperienced practitioners while reducing the overall number of nurses at the bedside. Even though the scheme made a LOT of money for the universities and a lot of debt for nurses, prioritizing academics over practice resulted in poorly prepared nurses who are not only unsafe but frustrated and overwhelmed. Years ago most nurses graduated prepared to practice. Now, after a four year degree, they require employer paid residencies because they have no technical proficiency. The critical thinking so valued by the ANA is useless in the context of the highly skilled, iterative processes that make up a nurse’s daily routines. It was called nurse training for a reason and I shudder at the thought of a new BSN critically thinking his way through my code blue – please send me the ADN or (if there are any left) a diploma grad who’s been mentored and supervised through it until it’s second nature and can function without youtube or a “code whisperer”. Give me an experienced LPN over the MSN who’s undergrad was social work or computer science but was licensed as an RN after a crash course in nursing 101 any day. Better yet, pay the knowledgeable LPN for the practical PATIENT CARE skills she has so she can choose to continue her education and move into a more competent role. I am a proud diploma grad with a masters and a doctorate and I’ve seen Benner’s full spectrum of novice to expert in practice. The plan to flood our healthcare facilities with BSNs will not make patient care safer and does an enormous disservice to both our patients and profession. It was a bad idea back then – it is an even worse idea now.
I’ve worked with all levels of nursing. Since teaching facilities have pushed for BSN’s the quality of nursing care has declined. It has been declining at least since the 90’s. Instead of making a nurse better at the bedside it’s adverse effects were unqualified bedside nurses wishing to be administrators. What a disaster! I’ve worked with amazing LPN’s that could’ve run circles around them. I’ve worked with amazing nurses at all levels but its not the years sitting in a classroom that make you a good nurse….it’s compassion, dedication and being at the bedside! The absolute best nurses I ever worked with were hospital trained diploma nurses and that’s just about all gone. I was an ASN for many years, getting my education at a community college with experienced nurse educators. If not for that opportunity I never would’ve been a nurse. The educational system has really ruined nursing. Now it’s very difficult to get into a community college program so the alternative is pay a high price at a private school of sorts….most of them are awful and the nurse has to be trained all over again by the hospital. Get over letters and get back to real teaching with real educators = real nurse graduates. We’re all dying out here.
This is why are progress is so slow, not everyone in nursing is meant for bedside care, we all have our strong points. Yes I believe all nurses should start out on a med/surg floor for at least 2-3 years, and if they want to specialize go for it. We as nurses are always fighting amongst ourselves who’s better LPN, ADN, BSN?. It doesn’t matter. It just seems like we are the only discipline without a standard entry level. We will never get the pay or respect we deserve. I’ve been a staff nurse, head nurse, bed manager and chief nurse and over time because of I ended up doing more administrative and educational duties, of course you’re going to get rusty on some bedside care like inserting an NG tube etc, but I learned when you teach, those skills never goes away, they just stay dormant until you need them. So if you want to blame someone blame the schools who try to compete with each other, ANA, Nursing boards and whoever else sets these standards.
Nursing is a second career for me, I went to nursing school to better the lives of my children, as a newly si gel mon, when they were 1 and 5. I have an associates degree. I have worked in long term care, assisted living, hone and inpatient hospice settings. I have been in leadership roles more than half my career and have supervised MSN RNs. I have thought about going back for my BSN but what is the incentive? I have worked hard for my position and I deserve it and would make no more money if I had a BSN or MSN so why would I sacrifice all that time and money to do it? I know I would need a BSN if I wanted to work in a hospital in my area, so that is the trade off for me and that’s ok because hospice is the field I have been called to.