ADN vs. BSN – a nurse’s thoughts on the New York bill requiring a BSN in 10
In December 2017, New York State signed a bill that requires all newly licensed nurses with their Associates Degree in Nursing (ADN) to obtain their Bachelors of Science in Nursing (BSN) within 10 years of their initial licensure. (Here is a link to an article explaining this in more detail.)
When this news hit, the nursing community had a pretty polarizing response across social media. While some were excited for the education advancement, others were pretty upset. As an experienced nurse, I’d like to explain a little of the background and offer my thoughts.
Why (some) people are happy about it
Many feel that requiring the BSN degree continues to legitimize and increase the professionalism of nursing.
When you look at the health care team, nurses have the lowest educational requirement for an entry-level position next to respiratory therapy.
See below for the entry-level requirements for the other health care team members:
- Physician – medical degree
- Advanced practice provider (NP/PA) – graduate degree
- Pharmacist – doctorate degree
- Physical therapist – doctorate degree
- Occupational therapist – master’s degree
- Speech therapist – master’s degree
- Chaplain – bachelor’s degree for entry-level, but to work in a hospital most have a Master’s of Divinity with additional certifications in crisis support
- Social work – bachelor’s, many with master’s
- Case management – bachelor’s (in some instances, an ADN-prepared RN)
- Respiratory therapy – associate’s degree (with bachelor’s option)
- Registered nurse – associate’s degree (with bachelor’s option)
Many feel that if the nurse is the leader of the health care team, that there should be only one option for entry-level practice. And given the complexity of nursing care today, many also feel the minimum requirement should be a bachelor’s degree.
Without getting into the research of why a BSN should be required, the legislation in New York noted several reasons. Supporting literature noted that because of increasing complexity of the American healthcare system, and rapidly expanding technology, the educational preparation of the RN must be expanded. – Jennifer Mensik, PhD RN FAAN
There is also research to suggest that hospitals with more BSN-prepared nurses have better outcomes as well.
Why (some) people are really not happy about it
Many individuals feel that the ADN who is fresh out of school is not more clinically-prepared than the BSN-prepared nurse. Many health care facilities also do not pay nurses more for having a BSN. Rather, they offer a clinical ladder option which enables the nurse to be paid more for achieving certain professional development goals, and this typically includes a BSN.
Therefore, the argument is: why should anyone spend more money and more time to get a degree in which it doesn’t appear to put them ahead of the curve clinically, nor does it offer more money?
Many bedside nurses also work elbow-to-elbow with incredibly intelligent and amazing nurses who have their ADN. It can also feel pretty insulting to someone who has been an awesome nurse for the last 20 years with an ADN only to be told they have to go back to school on their own dime… when a fresh newbie nurse with a BSN who doesn’t know the basics yet is just fine.
And finally, the main difference between the ADN degree and the BSN degree has to do with the additional credit hours. These additional courses tend to be more research-based or increased requirements in pre-requisite (IE not nursing) courses. Again, why pay thousands of dollars for a research course, community health course, and some pre-req’s that have nothing to do with nursing?
Oh, and did I mention the whole nursing shortage thing? We’re already struggling for nurses, and now we’re going to up the requirement to become one? Humm…
Also, the inflation of higher education, and how it is substantially higher than the increase in personal incomes and the general inflation rate. It is becoming more and more expensive to have a bachelor’s degree, and for many – they simply cannot afford to take on additional debt… especially when it will not necessarily increase their pay.
How I feel about it
First, I want to give you some background on myself… I’m a BSN-prepared nurse working on my MSN, who has worked at the bedside in both critical care and floor nursing with ADN, BSN, and even MSN-prepared nurses at the bedside. I never started with an ADN.
When I think about this ideally
I think it makes sense for the minimum requirement of a bedside nurse to at least be a bachelor’s degree. With the amount of information I need to know to be successful at the bedside, as well as the fact that technology and research will continue to advance as patients become more complex… a 4-semester / 70 credit hour degree isn’t going to cut it. Especially when I think 10 years down the line.
When I think forward, to 2030… 2040… 2050, do I believe should we make some progress towards more education for entry-level for into our continually evolving profession?
I also can’t deny the research that has come out over the years, nor the efforts of organizations to have this come to fruition.
I think it makes sense… ideally.
When I think about this practically
Now, when I sit down and think about the fact that we’re in the midst of a nursing shortage… that college is becoming more and more expensive each year, while income and inflation don’t hold a candle do it… and that we don’t have enough nurses as it is today… how can we start to get picky now?
I think about the nurse with 3 kids, a mortgage, a car payment, and student loans from the associate’s degree… the nurse who works overtime, is the head of committees, the best damn nurse on the unit, who has saved countless lives and works himself to the bone just to make ends meet. Should he have to take on more debt, and spend less time with his kids, all to just have 3 different letters behind his name and not make a dime more?
That doesn’t seem fair to me.
While I think we need to progress in our educational requirements, I don’t know how we can do so while we’re barely holding our heads above water. I feel like some facilities are struggling so much for nurses that by upping the entry-level requirement to BSN, we’re handing them a 20 lb weight. And they’re just going to start sinking.
Practically, I don’t know how this change will occur in the midst of a shortage.
However, the longer we wait, the more difficult it will be.
A solution offered to me by another experienced nurse was to simply grandfather everyone in now and give all prospective nurses a decade-long heads up that the requirement will change in 10 years.
What I think the BSN should look like
If an individual knows they want to become a nurse, I believe the core curriculum should change.
As I mentioned before, a typical ADN program is approximately 4 full-time semesters or 70 credit hours. A typical BSN program is approximately around 120 credit hours. The difference in the courses is usually a few nursing courses (like a research course and maybe community health) but also more requirements for pre-requisites.
Now, that seems just silly to me. More pre-req’s? Some of my pre-req’s were… well, completely unnecessary to my career as a nurse. I took a music theory course, film appreciation, and some computer courses.
I personally don’t believe that the first two years of a BSN should look like another major. While the core prerequisites (microbiology, anatomy and physiology, chemistry, nutrition, sociology, psychology, developmental psychology, and so forth) should remain, I think there should be different courses required for the nurse seeking a BSN.
I also believe the BSN courses should be less NCLEX-focused and more centered on practical-preparedness.
I would love to see courses like:
- Health care policy and law – because it is constantly changing
- Evidence-based practice – one course on what it is, another on how to evaluate and implement it
- An entire course on lab values
- An entire course on just anatomy and electrophysiology of the heart and cardiac medications
- An entire course on the respiratory system
- Equipment management
- Time management / delegation / prioritization
Theoretically, if a nursing school had 6 full-time semesters to prepare a someone to become a registered nurse (and let’s just say 2 semesters of those science-pre-req’s) they wouldn’t be so pressed for time to ensure the graduate passes the NCLEX and would be able to spend more time preparing the student for actual practice.
I feel that nursing education has strayed from truly preparing students for practice and focused more on NCLEX pass rates. I get it – the school must be able to demonstrate that graduates of their school can pass boards… and while that is an admirable focus, it’s not all there is.
Hospitals now have residency programs to facilitate the transition to practice for a graduate nurse because the learning curve is so steep… but why is that the case? Why is the nurse who has graduated from an accredited nursing school, with thousands and thousands of dollars in debt, not practically prepared? I believe in residency programs, but I also believe in more of a partnership between nursing schools and health care facilities to make this transition smoother.
I believe that requiring a BSN as an entry-level degree for the profession of nursing is a good thing, provided that there are improvements to the existing BSN educational requirements that would enable the graduate to not only pass the NCLEX but also feel confident providing patient care after graduation.
Better for our patients and our profession?
In my opinion – absolutely.
What are your thoughts about this new legislation?
Where Have All the Nurses Gone? The Impact of the Nursing Shortage on American HealthcareHow The Lack Of Higher Education Faculty Contributes To America’s Nursing Shortage, Part I – Scholar’s Choice EditionGoing Broke by Degree: Why College Costs Too Much