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?
Yes.
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.
via GIPHY
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.
To summarize
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.
Lofty goal?
Probably.
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 Healthcare
How 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
Here’s the other side of this article from an ADN nurse since this perspective is from a BSN nurse. What this fails to mention is that most ADN nurses are ADN nurses bc it’s their second career. Many already have bachelors degrees in other fields of science and there fore have double the amounts of credits the BSN nurse has. For instance, I went to an ADN program with a women who graduated from Yale in biology, had her Masters in something else science related from Tufts, but wanted to be more close and personal with patients. The credit hours this article lists is also not correct. It was more than 4 semesters and 70 hours. In fact my ADN program doubled the clinics hours compared to the 4 year colleges around this area. It probably differs from state to state, but in my opinion it sets a dangerous precedence. Once one state demands something others may follow. And nurses are leaving nursing in droves now. I would want the ADN nurse who chose this career as a second career and is going to stick it out. We also took more science classes than the 4 year degree programs who had to take history and research classes. I am an ADN nurse and people always say I must have a BSN bc I’m a leader in my field… pulmonary nursing which this article specifically targets as a learning curve. When I am precepting I always find ADN students to take clinical more serious than the young BSN students who I can’t get to get off their cell phones or come out of the lounge. In my opinion, it’s individual based. I don’t think anyone can say that a BSN makes you a better nurse, better prepared, etc.
You are correct that I did not outline the ADN nurse who is prepared with a bachelor’s degree in another field. From my understanding, the profession has created the “Accelerated BSN” option to enable these nurses to have a BSN without taking that ADN step. However, this is a relatively new option, quite competitive, and not available everywhere. The science aspect of it may also be redundant, depending on the applicant’s previous education. Truly, those who already have a bachelor’s in another field and have completed an ADN should only need to take a research course if they haven’t already within their other education. That discrepancy has yet to be addressed by the profession as a whole.
I would love to know which ADN schools require substantially more than roughly 70 credit hours to award their degree; all local programs to me past and current (this one, this one, this one, and this one), many of which are high quality, require less than 70 credit hours to graduate with an ADN. All of which outline their suggested timeline of completion of within 4 semesters, with the exception of 1 (5, with only 2 courses in the last semester). When you consider students who have retaken courses, had to take additional courses that may not have satisfied a requirement, that could easily bump it up – but it is not how the program is designed. As far as time goes, if it takes time to get into a program (which for many it may), or if one does not take classes full time, it will take more than 2 years/4 semesters. However, the associates degree is designed for a full time/2-year completion ideally. If it takes an individual longer, that doesn’t change the way it was created to function in the first place. Many individuals take 3-4 years to complete their associates degree, through no fault of their own.
The purpose of this post to look at the future of our profession as a whole and the educational requirements to sustain the continue medical and nursing advancements and ever-mounting nursing responsibilities. What would be ideal? What should we strive for? In my opinion, a BSN degree that has been optimized is the way to go for entry-level into our profession. I am not saying this because I believe ADN nurses as less valuable than their BSN counterparts. Although, I can see how this may be how it feels with all of the BSN talk. Everyone has had their personal experiences at the bedside with nurses who have been prepared with ADN/BSN. I acknowledge the current deficits in the BSN. However, I do not believe the answer for the future of the profession is less education. I am saying it because to learn all there is to care for patients appropriately simply cannot be done within an ADN degree when we’re looking decades down the line.
Physical therapists must have a doctorate degree to care for patients. Most hospital chaplains have a Masters of Divinity. OT/ST both require at minimum a masters. Pharmacists must have a doctorate. Physicians have roughly 15-20K clinical hours with their 11-15 years of college education. However, the nurse – the leader of the health care team – has multiple entry-level points, one of which is only 2 years beyond high school. Truly, outside of RT, we’re the only ones with an associates option. Respiratory therapy now offers a bachelor’s option.
I don’t believe major decisions on the future of the educational requirements of the profession should be based on individual’s opinions and experience. Yes, there are BSN nurses that aren’t great, and amazing ADN nurses. Does that mean that we should scrap the BSN entirely and only require nurses to have the ADN to enter the field because of the experience of others? Or should we optimize the BSN, enable those with another degree to transition smoother, and promote the overall professionalism of our role in the health care team? I believe that the future of the educational requirements of our profession should be based in research, comparing with other members of the health care team, continually evaluating the level of practice required for entry-level nurses that continues to evolve, and noting deficits and addressing those.
Most ADN programs are at minimum 3 years. There is 1-2 years of pre- requisites and 2 years of clinicals. BSN programs are closer to 5 years. Even if you do not have other classes required as pre-requisites to your pre-reqs, you are still looking at 3 years for ADN. I had 102 credit hours when I graduated with my ADN, and enough for 2 degrees. Psych 101, Lifespan and Development, ethics, speech, 2 english classes, 2 math classes, sociology, microbiology, A&P I and II, 12 elective credits, world history, all before ever touching clinical rotations. Then was 2 years of accelerated clinical rotations- fundementals I and II, psych, peds, OB, 3 semesters of med surg. another couple “mini” classes on random crap.
What did I do to complete my BSN? 32 credits of mostly nonsense. paper writing, general social science courses, one interesting class on public health. a statistics course. The entire time dealing with the “talking down” to ADN nurses that rankles me to my core. We take exactly the same nursing courses. The exact same science courses. There is absolutely nothing in the educational process that differs from an ADN and a BSN that will make you a better nurse- to the contrary ADN nurses typically have greater clinical time and are better prepared as new graduates to assume a clinical bedside role.
I agree with your assessment of the need for change in the educational process- I have long thought that and even wrote a paper on it for school. But requiring experienced nurses to fork over tens of thousands of dollars to see a 50 cent per hr raise if they are lucky is just wrong. The only thing that is happening with increasing the education requirements and encouraging nurses to achieve advanced degrees is it will push more and more nurses out of bedside nursing. Nurses are now going for accelerated APRN degrees and never working at the bedside. Most new graduates intend to leave bedside within 1-2 years for APRN degrees. Who will be left to mentor, teach and care for patients if we chase out all the ADN nurses?
Just grandfather the ADNs and Diploma RNs through attrition, just like they did with the Physical therapists and Pharmacists…I have worked with some of the best RNs who are diploma grads and Pharmacists who hold Bachelors ….so as I repeat again….phase out through attrition …don’t force unnecessary hardships upon competent professionals
Well said.
Thank you, Kati, for creating another timely discussion!
I believe we need to set the RN standard at the bacclaureate level for all the reasons you stated above. As far as what that means for ADN’s, perhaps we could create a pathway to the BSN. As Kelly stated above, if an ADN already has a bachelors in another field, that would be worth so many points. Years of practice would count for so many points. Maybe there would be a few mandatory courses like leadership that would be required.
I believe the bachelors route to nursing should require a mandatory course in Holistic Nursing which would include self-care (every nurse would graduate knowing their worth, their responsibility towards self-care and have a toolbox of wellness/care options they knew well so they enter this challenging field prepared). It was also include the core values and such things as motivational interviewing, etc.
As far as other courses nurses should take other than the ones you mentioned are already required, yes, perhaps more health related options would be great. But, I would also encourage business (esp. entrepreneurship) courses for example. I personally liked the option to take non-nursing courses. I feel it made me a more well rounded individual.
Again, thanks for starting the conversation. Looking forward to hearing what others think. And, yes, we need to be thinking of this nursing shortage! Crisis creates opportunity. Time to think out of the box.
Hey Sue!
I agree and think one of the major things that can be addressed is that pathway from ADN to BSN, especially for those with an existing bachelor’s degree. If we can have a direct-entry master’s option, why can’t we remove the redundancy in the ADN to BSN process? I know so many people with an ADN who went into it with a bachelor’s in a science-related field, but have to retake science courses to satisfy the BSN requirements. Especially considering the shortage, that seems completely unnecessary.
Wouldn’t it be amazing to see a BSN completely redesigned? Something designed not only to enable the graduate to pass the NCLEX, but be so well-prepared that they don’t even need a residency program? That would be my goal, however unrealistic it may be!
as a plain old RN, I have to say that I believe that many of us plain old RN’s have had more floor experience than some of these BSN prepared nurses. A few extra classes in philosophy, geography and English does not make them any better. A nurse who learns while she works is someone who can always see what her patients need. Learning while working means learning about all the new drugs that come out, what to look for in patients and what treatments are the newest and best. A lot of this learning comes on the job, a job that at one time was an extra job to help bring in additional money for the family, but now may be the only job in the family. Simply requiring more structured classes is not a way to help anyone out of a nursing shortage. And besides all this, there are now employers who want each nurse to be certified in whatever specialty that they may work in, like the Certified Med/Surg nurse. Having a current license should be a certificate but some places it is not. Stop regulating the nursing profession out of business!
Hi Mary Ann! I do assume you mean “plain old RN” = ADN. Depending on the school, an brand new ADN may have more clinical hours than a brand new BSN, but may not. It all depends on the school and their requirements. As stated from the article, I’m not advocating for English, philosophy or geography classes – rather classes and that would optimize the BSN-prepared nurse to be more equipped at the bedside, which means more clinical experience in school. One of the reasons for the shortage is because hospitals cannot afford to pay for the extended orientation of a new graduate nurse, as it is much more cost-effective to get an experienced nurse hired so they spend less on orientation. If nursing schools prepared nurses appropriately upon graduation to be more practically prepared for patient care, hospitals wouldn’t have to pay to make up this gap. New graduate nurses are having a heck of a time landing jobs out of school right now, despite the shortage. Standardizing and optimizing the entry-level of nursing to coincide with the educational requirements of all other disciplines that is supported by research isn’t unnecessary regulation. It’s necessary progress.
I’m 56 years old. I’ve been certified for over 25 years in oncology. I am now finding roadblocks to all future employment due to this change. Experience should commensurate with a BSN. I don’t want to spend my retirement money to go back to school. There is a great nursing shortage, economical restraints and I don’t plan on doing research or changing policy. I don’t think writing papers or learning more about nursing theory will change anything regarding my expert practice and patient care. I feel that the hospitals have bought all the private practices and making it impossible to feel safely employed. This is demoralizing and many nurses will need to turn to unemployment or other social services after proving they are competent nurses for over 25 years. I have a 4 year degree and never thought I would need to get another baccalaureate degree to keep me employed. This is a slap in the face to all seasoned ADN’s. I have kids and aging parents that need my help and no extra funds or time to go back for another degree………..So Angry!!!!
Would love to gather enough support to take this to a class action suit.
If you agree please say you are in