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ADVANCE Perspective: Nurses

Whither the ADN?

Published March 11, 2013 4:30 PM by Rich Krisher

What’s the ideal level of educational achievement for RNs to enter practice? At issue is the future of ADN nurses. A clinical instructor of ADN students told me recently how they’re being squeezed out of job opportunities at Magnet-designated hospitals. Also, she said, new graduates with ADNs are finding themselves at a disadvantage when competing with those holding BSNs in today’s tough employment climate.

The Institute of Medicine’s 2010 report, “The Future of Nursing: Leading Change, Advancing Health,” devotes considerable space to advocating for an all-BSN workforce. The Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, which issued the report, calls for a rise in the percentage of the nursing workforce holding BSNs from 50% currently to 80% in 2020. That increase “is imperative as the scope of what the public needs from nurses grows, expectations surrounding quality heighten, and the settings where nurses are needed proliferate and become more complex.”

RN bridge programs could be a major part of any such effort. Cheryl Wagner, PhD, MSN/MBA, RN, associate dean of graduate nursing programs at American Sentinel University, which offers such programs, draws a hard, bright line.

“ADN programs prepare nurses for basic bedside clinical care of patients, which is slowly moving into the realm of the nursing assistant or the licensed practice nurse,” she states in a media release for her program. “Registered nurses are required to know more about the overall condition of the patient as well as being able to work independently in the community and make leadership decisions.”

She further states: “Nurses with an ADN are not as well prepared to be contributing members of the profession, which dooms nursing to a role of following doctor’s orders.”

The knowledge, passion and professionalism of nurses at all points of educational achievement cannot be denied. However, as education requirements have been raised in other healthcare professions, nursing has remained stagnant and risks losing influence. That’s not an outcome anyone wants.

Does the return justify the investment required to achieve a more-educated nursing workforce?


I would also like to point out, that if you go to Pearson View and read the fine print, you will find that the study material for the LPN is the same as the RN!

Jennifer Mathews December 21, 2015 10:47 AM

I just came across this article.  Oh my!  Here's what I have to say:  I've been a CNA, LPN, and attended traditional university for my BSN.  My LPN program at Augusta Tech in Thomson, Ga was much more thorough, challenging, and difficult in the areas of assessing, pharmacology, disease processes and nursing skills than my BSN program.  However, I did have 13 years behind me as an LPN in MSU and ICU.  May I add, I did not crack a single book for my BSN program, except for the open book tests for the leading/managing classes? May I also add, that I still get disgruntled when I remember the smug attitude the "KIDS" in my BSN class because they felt they were "superior" because they would have a BSN?  Many of them refused to even bathe their patients during clinical, because that thought it was beneath them.  It is the character, integrity, and nature of the person --not the initials behind the name--that makes a Real Nurse.  When I got my BSN, yes, I was happy for the doors it opened for me!  However, I am the same nurse--I just have new initials.

Jennifer December 21, 2015 10:44 AM
Augusta GA

Dr. Wagner's program is doing their nursing students an injustice.  I went through Georgia Perimeter College to earn my ADN and had outstanding prep for being an RN.  The courses I took focused on individual subjects with the last semester focusing on combined systems and the care of the "overall condition" (Wagner as cited in Krisher, 2013, p. 4) of the patient. If you recognize that their are deficiencies, then you are at an advantage.  You have time to correct those areas.  It is because of ADN programs that aren't teaching on a BSN-level, minus the leadership courses, that give ADN programs a 'bad wrap'.  

As an older learner, the ADN program allowed me to continue working while I went to school.  I immediately upon graduating went into an online BSN program, and I am now in my last class of an online MSN program.  Neither the BSN or MSN programs have taught me anything about nursing.  What I learned, I learned in my ADN program.  During my residency at a local hospital, I scored just as high if not higher on tests than did my BSN counterparts.  

This is a call to revise ADN programs to the level of GPC in Clarkston, Georgia.  If you don't like it; do something about it.

Dausha White, Acute Care/Hospice - Charge RN, Inpatient Unit April 28, 2013 8:49 AM
Decatur GA

Interesting article.  It does not address many of us, however.  The Diploma graduates of years past.  I graduated from a 33 month diploma program which required us to take the same classes required for the BSN.  I graduated with 120 semester hours of credit- algebra, anatomy and physiology, chemistry and chemistry lab, English composition, foreign language, multiple classes in psychology and sociology, anthropology electives and more, in addition to many more hours in a clinical setting than the BSN programs in the same geographical area.  It is appalling to me that ADN graduates are given more credit by some BSN completion programs than what I was offered.  (Yes, I attended a fully accredited diploma program.)  I am currently returning to school to obtain my BSN, as I wish to go on for my master's.  To assert, however, that those of us who have been practicing for many years without the "BSN" are only suited for following  physician orders  is an unfair characterization.  I have practiced for more than 30 years and would pit my skills, education and knowledge base against those of any BSN graduate.  

there are a great many of us "old fossils" who have consistently striven to maintain high quality practice by actively pursuing continuing education, reading nursing research and attending local seminars to be certain that our practice is of the highest level and that we are providing our patients and their families with the same quality of care and compassion that we would like to see provided to ourselves if we were ill.  As nurses, we need to be less divisive and make the transition from one level to another far less difficult.  It has become easier in the last couple of decades, but, we have far to go and attitudes such as the one noted above are poorly grounded  in fact.

Piete, , RN-BC self employed April 26, 2013 4:58 PM
Rockvale TN

I have been were many of the bloggers have been.  I started taking college courses at the local community college due to my husband working in the state got a reduced tuition rate.  I did not have the GPA or finances to go to the four-year degree route.  Thank goodness I was able with alot of work and mom-mom helping pay daycare was able to finish after many years part-time with a Diploma in Nursing.  I was so proud of myself and so was my family especially my mother who was a teen mom and single by the time I was 7years of age.

I went back to get my BSN part-time which you can get no tuition reimbursement or loans for part-time studies and had to stop when the finances dried up.  I fortunitely was hired after 9 years in geriatric nursing to teach at a high school vo-tech teaching the CNA/GNA program to 11 th graders many of who are in my exact situation.  No support and no GPA close to getting into a 4 year BSN program where the GPA requirements and competetive nature shuts them out.  So I encourage them through their CNA/GNA where encouraging to continue their education where they will be sucessful, being it at the community college in their area where they recieve schlorships and support with course work or 4 year universities where they will have a place to live while completing a vigerous schedule while supporting themselves.  It's not easy to encourage our next generation of health care workers when the bar is being set so high.  I feel we will lose this work force to other careers where they have less time in class and can make be working alot sooner which in this economy is crucial for many of our kids who have no one other than their teachers and peers to encourage them and support them while navigating through this maze of healthcare bureaucracy.

Angie April 23, 2013 8:37 AM

Maybe many nurses are not in a position to fork over $25,000 for a BSN.  Maybe many BSN nurses are not in a position to fork over more than that for an MSN.  Maybe many MSNs would rather not take out a second mortgage on their homes for a Doctorate.  

Maybe there are other things in nurses' lives that have to take priority over spending thousands of dollars to write more papers in APA format.  Maybe many nurses have kids in school with tuition to pay.  Maybe there are doctor's bills, mortgages or kids' braces to pay for.  Or maybe nurses just want to enjoy life now instead of having to worry about deadlines for papers assigned by nursing professors at four year schools who figure assigning papers is much easier than actually working as a nurse.

It just boggles my mind at how many of those driving the BSN push think there's a tuition fairy that will leave nurses money under their pillows to pay for these higher degrees.  

All nurses must complete the required CEUs to maintain their licenses.  So by law nurses must keep current with the latest news and research.  

And why do these people still think the only way to further one's self is by taking very expensive courses at four year schools.  To say that nurses can't expand their knowledge other ways is degrading to nurses.  And if it's not all about revenue for four year schools, why aren't there other options for continuing education besides expensive four year colleges and universities?    

Peter Digiuseppe April 11, 2013 4:44 PM
Philadelphia PA

After reading through all of the comments on this article, I feel compelled to add a few comments.

I understand the angst felt by my fellow nurses who have commented here. However, if you have your ADN and have worked at the bedside for many years, how much time have you had to read your nursing journals to keep up with the news and recent research?  From conversations with nurses that I have worked with over the years, my guess your answer would be little to none.

BSN prepared nurses have had education that has emphasized cultural diversity, leadership, and the very important evidence based practices. Hopefully, the cultural diversity will make nurses more aware of the customs of their patients and families. Our patients come from cultures very different from those we had to care for years ago. In order for our patient teaching to be effective, we must be aware of these differences.

With a good understanding of nursing leadership, perhaps we can finally end the "nurses eat their young" culture that most of us have encountered. Along with that aspect, an understanding of leadership will prevent the "cattiness" so prevalent in our workplaces. This is even apparent in many of the responses. I encourage all of you to weigh the effect your words have on those around you.

Higher education in nursing prepares you to understand and appreciate the differences of skills and understanding of nursing as a profession in those around you. I suggest that rather than pointing fingers and acting sullen when something goes against your perception of a person or event, act with professionalism and maturity. Respond by mentoring, encouraging, and most of all by setting an example for others to emulate. Be proud of your profession.

If you do not have your BSN, try to find a way to attain it. You are not in a position to criticize something you have not completed yourself. It will add to your understanding of our profession and how many changes have occurred. We no longer do things "the way the have always been done".  We now complete our tasks of patient care based on scientific "evidence based practice". This includes wound care, removing urine catheters as soon as possible because they are related to increased bacterial infections, and many, many other aspects if patient care.

If you have your BSN, I encourage you to complete your MSN. There may come a time that you are no longer able to work on the floor because of the physical toll nursing takes on your body. You will be glad you did because of the doors it will open for you.

If you have your MSN, go for your Doctorate. You will be able to teach, do further research to raise the competencies of the nursing profession.

All of these steps increase your feeling of personal accomplishment and your ability to further contribute to our advancing body of knowledge. Over the years the field of nursing has developed into a vast number of specialities from med-surg, to forensic nursing, holistic nursing, geriatrics, informatics, and to educating new nurses who are the best we have. However, fresh out of school, they need mentoring until they solidify what they have learned in the books and become comfortable in their workplace. Mentor, do not criticize.

In case you have some pre-conceived notions about who I am and what Ivory Tower I speak from, I work nights as a charge nurse part-time so I can care for my husband, who has end-stage emphysema, during the day. So, yes, I still do hands on bedside nursing. I also serve as an Alumni Mentor for nurses in ADN and BSN programs both nationally and locally. I am in close contact with RNs who could benefit from the very things I have noted above.

God bless you all for your hard work. You make a difference in the lives of so many. Don't let your frustrations allow you to waste your precious time with petty sandbox squabbles in the workplace. They are so far beneath you. Be proud of the professional nurse you are.

Susan, Geriatrics - MSN/Ed, BSN, RN, SNF April 11, 2013 10:26 AM
De Leon Springs FL

I recently read the article concerning ADN's. It is obvious that the person writing the article has no knowledge of what the ADN program provides in educational format.  ADN's are required to take the same board exam as BSN's.  I have been an ADN RN since 2000.  I have worked in hospitals in Kentucky, Ohio, North Carolina, and Texas. As an ADN, I have the knowledge and the ability to look at the overall condition of a patient and the ability to work independently. I find the author biased and short sighted.

Sheryl Day, Cardiac - RN April 6, 2013 10:57 PM

This article is unbelievable.  Cheryl Wagner, in attempting to promote her University programs, makes the most unsubstantiated claims which are insulting and ridiculous.  Does she really believe that ADN programs are turning out nursing assistants (I won't even grace her remarks by cataloging LPN's in the same category)?  Does she really believe that as ADN's we are "doomed to following doctor's orders."?  If one wanted to make a rational, intellectual argument for mandatory BSN nurses, she missed the boat entirely.  I'm very disappointed that she refers to herself as a nurse, and I would guess that she is better suited behind a desk than at the bedside.

This article is tremendous evidence that advanced degrees do not always exhibit a superior intelligence.

Pete Lawrence, Oncology/Hematology - Oncology Nurse Clinician, Wellstar April 3, 2013 8:35 PM
Marietta GA

If any nurse feels they need more initials after their name in order to command respect then they have far deeper problems that all the initials in the world won't help with.  A major reason why nurses may not get the respect they deserve is that doctors and other healthcare staff see the cattiness and school-girl antics that takes place on the floor with nurses.  With the cliques and the who likes who, and who doesn't like who, and who's trying to get who fired, how the heck do you expect other healthcare professionals to respect nurses.  And this goes on with nurses of all educational levels, including DNPs.

Respect is earned, not obtained by spending $25,000 and writing a few more papers in APA format on nursing theory and current nursing issues.  

Peter Digiuseppe, B.A., RN March 29, 2013 11:03 PM
Philadelphia PA

I graduated as an adn in 1981 and the discussion at the time was bsn vs. adn,who was truly the professional nurse. Now 32 years later we are continuing this inane profess the advancement of nursing by requiring bsn as entry level for rns. This is the future,the forward way of thinking to advance our profession as well as increase our standing within the healthcare community you say. Yet two pages beyond your editorial are ads for WHITE UNIFORMS as well as nursing caps!!if you can only be recognized as an RN because you wear a white dress and a hat then you are a lousy nurse. Do you want nurses to excel to grow and to succeed or return to 1980 when we were forced to give up our chairs to doctors?to follow them through the hall carrying charts and even more offensive never discuss or teach our patients. Individuals with archaic ideas are the reason nurses do not get the respect they deserve for being great nurses. As well as the reason we cannot get together and become a phenomenal political force for improvement and change we should be.

Christine Bailey, Micu - Rn, HCA largo fl March 29, 2013 10:05 PM
Largo FL

Let's take a look at Ms. Wagner's quote; “ADN programs prepare nurses for basic bedside clinical care of patients, which is slowly moving into the realm of the nursing assistant or the licensed practice nurse,” she states in a media release for her program."  

The last line says it all, media release for her program.  What we have here is nothing more than a sales pitch coming from another academic elitist in an effort to sell her program.  At least other elitists tried to display phony altruism by stating how having nurses run back to school is to elevate the profession and for the benefit of the patients.  This one's not even intelligent enough to be subtle and flat out states what I've been saying all along; that the BSN push is all about the money.

And nurses, don't be overly impressed or intimidated by the initials after Ms. Wagner's name.  I spoke to a doctor a couple of days ago who corroborated what other professors have told me as far back as 25 yrs ago.  That getting into many of these higher level academic programs such as a PhD program has less to do with academic merit and more to do with having the right connections.  If you are liked by certain people, your application and research gets a thumbs-up.  If not, it's try again some other time, maybe.  

Nurses, I'll repeat myself again.  All those driving the BSN push have something to gain by trying to force nurses to run back to school.  From the hospitals who require that all their nurses get BSNs and then rent space to universities that offer on-site RN-BSN programs; and who pay the ANA thousands of dollars for a contrived seal of approval called Magnet Status in order to get that large government stipend, to the academic elitists who will reap the benefits of increased enrollments in their programs in the form of increased revenue, funding, job security and probably bonuses off the top for themselves (yes I know for fact that there are big bonuses given in non-profit organizations), this is nothing short of a racket.

To all you nurses who are still out there treating patients after 10, 20, even 30 years, I salute you.  You exemplify the nursing profession, not the Cheryl Wagners of the world.  And try to hang on.  As I've said before, I've been talking with the media about a story concerning this degree elevation nonsense.  I will try to do what I can to get the story told.          

Peter Digiuseppe, B.A.,RN March 29, 2013 5:24 PM
Philadelphia PA

As others have already so eloquently commented, this is an insulting article.  I as well have an AD and have been a nurse for over 25 years. On the one hand, LPN's have so many practice limitations, yet she says the bedside care will be moving to their roles along with CNA's.  If bedside care no longer involves assessment, iv medications, blood, etc.  that should work out fine.  I find it interesting that of  everyone who continues to express the need for nurses to get BSN's, and beyond (indeed one article suggested that a Doctorate in Nursing be the entry level degree!!) that none of them are actually bedside nurses.  They are administrators, educators, researchers, public policy makers-all very valid roles but of no use to the man in room4 with an acute mi or the woman in room 16 having a seizure at 4 am on a Saturday night.  They are at home.  The RN's (REAL NURSES-ADN, LPN, BSN whatever the initials) that stand by the bedside and care for patients are the ones that are the real caregivers and care takers of our patients.  I have to wonder with all of those initials behind her name (PhD, MSN/MBA, RN) when was the last time that Ms. Wagner was in the vicinity of a patient and actually providing some nursing care.

Tom P March 28, 2013 11:24 PM

I must say I agree with Kathleen from Walla Walla wholeheartedly! As a proud graduate of a 2 year RN program in 1990 I know I am definitely more qualified than just "following Dr."s orders".  I was SO offended by this comment.  I have spent my career in Geriatrics and have loved every minute of it.  I  sincerely believe the clinical skills I learned for the ENTIRE 2 years of my schooling was instrumental in my having critical thinking skills. And the last time I checked, we all take the NCLEX-RN boards sitting on our respective fannies, BSN or ADN.  I love being a nurse but hate the way nurses seem to belittle each other depending on a bunch of letters after one's name.  Our common goal is excellent patient care with optimum outcomes, right?  I would MUCH rather have a nurse with more BEDSIDE experience taking care of me or any of my loved ones.  I don't need someone's opinion on nursing theory or some other useless subject to prove to me that they are a good nurse.  I need a compassionate smile and a caring attitude.  

MiMi, Wound Care - RN, ADN, CWCC, SNF March 28, 2013 11:55 AM
Long Beach NY

I was disappointed to read the statement made by Cheryl Wagner.  It is sad to read how this individual feels that ADN nurses are not as well prepared to be contributing members of the profession and states that ADN nurses doom nursing to a role of following doctor's orders.  I am an ADN nurse of 25 years,  who is actively participating in a program to obtain my BSN.  I welcome the education and information I am receiving as I complete this endeavor, but I feel I was qualified and prepared to be a member of this profession prior to returning to school.  As far as following a doctor's order, well this is how nurses must  practice in their scope of nursing care at the bedside.  I am not a doctor and therefore I do not write orders.  A person such as Cheryl Wagner who has a  PhD,  MSN/MBA, and RN titles, should be aware that her statement is unjustified and having the audacity  to state something which is undeniably biased shows her lack of education.

Marcia, ICU - RN, Baylor March 27, 2013 3:48 PM
Dallas TX

I am an ADN graduate, class of 1980 who now is enrolled in a BSN program with Thomas Edison State College. I enrolled to fulfill the expectations of a new position I sought. I was nervous about returning to school after 30 years. It requires time away from other important things in life but has given me a new outlook on what it means to be a professional nurse. I do not wish to be away from the bedside. I do not feel nurses without a BSN lack the skills of caring for patients. I know that the idea of being a lifelong learner was never a part of nursing culture for many reasons but now it is an expectation. There is research that proves there to be a link between outcomes and the nurses' education. For the patients' sakes we need to pay attention to the evidence. Politicizing this is not an answer. Recognizing our professional responsibility is.

Cheryl Sauerbier March 24, 2013 11:22 AM

I read all of this with much dismay. Nurses who have worked as Diploma Grads or ADN for many years have a lot of clinical experience that can'tand never will be taught in school. Hands down any day they are the ones I wan't taking care of me or my family. Recently I precepted BSN students in my area that  were ready to graduate. Lacked time management , prioritizing skills. Took an hour break and an hour lunch I barely had time to go to the Bathroom. great on the computer though. So the solution is internships which cost the hospitals a lot of money. Experienced nurses have to pick up all the slack and coach them along. Hospitals are a high stres environment to begin with so the experienced ones pick up all the slack and still may lose their jobs MAKES SENSE TO ME!

catherine, NICU - RNC-NIC, St Joseph's Women's Hospital March 24, 2013 9:43 AM
Tampa FL

I have been an RN for over thirty years.  I hold an ADN. I also hold CCRN certification, and am BCLS and ACLS certified.  Over these many years, I have been in charge of my unit, held management positions, and have mentors many a young nurse, both with ADNs and BSNs.

I am a good nurse.

I began a BSN program here in WV this spring, but withdrew because working five twelve hour shifts in a row, and doing overtime was not conducive to  four discussion questions requiring answers backed up by scholarly articles, grading the discussion board, and writing a paper about it, a nursing theorist powerpoint, a philosophy of nursing paper, a concepts paper, and six tests.  It was midterm and the professor still had not graded any of my papers.  The only grades I had were from my fellow students.  All peer reviewed. The professor's answer when I inquired about the grades?  I'll do it in a few weeks. For that I was paying tuition. And she has a pHD. The ability of a nurse to do the job and do it well, comes from the heart, not the degree. If you Ivory tower people want more BSNs then hospitals need to be flexible with scheduling, and professors need to drop the "weed them out" attitude, and realize we are already Nurses, and make the work appropriate to people who are already skilled and need to build on what they already know. Don't treat us like we are stupid, or are kids just out of high school. If you want to get rid of ADNs, go ahead.  I hope there's a BSN waiting to take care of you all by herself.

Liz Molenda, ICU - Staff Nurse March 21, 2013 3:18 PM

As I prepare to retire after forty years of nursing, I find it intriguing to read this article, as well as the comments that followed. Nothing has changed in nearly half a century. My experience is diverse, and I have practiced in such varied capacities, that I feel more than justified to voice the opinion I hold. My ASN has been uncomfortable at times, because of the attitude displayed here. Granted, now that I am seeking part time, post-retirement employment, I realize that more letters after my name would open a some tightly locked doors for me. However, I feel amply qualified for every posted job I see. Actually, I am probably a better candidate than most applicants, regardless of their degree. How unfortunate that young nurses, just embarking on their careers, will struggle with the stigma for years to come.....all because of a group of people who must find a way to feel superior. This has become the single most identifying mark of recent generations, not only in the work force, but in society in general. Over the years, I have had countless nurses work and train under me. Each has their own strengths and weaknesses, but few of the outstanding qualities that I recall were a product of their education. Each individual contributes and extracts what they want from their chosen path of learning. APRN students are often surprisingly ill prepared, while there are LPNs that I would want by my side in any circumstance, at any time. I very much appreciate Peter from Philly's remarks, and am hopeful that he will continue to articulate his concerns. It is time that higher education is not automatically equated with higher ground.

Deb March 20, 2013 12:51 PM

I am an LPN who went to school for her RN, but due to some health issues had to drop out 3 weeks before graduation,  this was in 1996.  I then went to go back to finish up, and I found out I was pregnant and had complications, and delivered 2 months early.  I was able to sit for my LPN boards, since at the time I completed 2/3rds of my RN education (this has now been Phased out and can no longer be done in NY).  I have been working as a nurse for 15 years.  I have decided I want to return to get my RN, as they are trying to phase out LPN's.  I have become very discouraged in this, as I now have to take every class over again, since it is over 5 years since I received my LPN.  If someone tells me that they are going into nursing, I want to tell them think long and hard before you do.  

It is sad I feel this way.

Kimberly Kivler, LPN March 18, 2013 8:08 PM

I have been a RN since 1988. Graduated with honors from an ADN program. I passed the same state licensure exam as diploma and BSN prepared RNs. I have seen what was done to LPNs as they were phased out, and now we ADNs  are told get a BSN or lose your job in 2018. The degree does not make a person a better nurse. Magnet dictates, hospitals pay big bucks for this designation, and the education system reaps the rewards as nurses spend their retirement to obtain more letters after their name. More educated nurses won't stay at the bedside, working off-shifts/weekends/holidays all their lives. The intentions are good (I still have faith to hope), but the elite dictators of this change are destroying the healthcare system.

Doreen, NICU - RN March 16, 2013 8:33 PM
Harrisburg PA

I have an ADN, earned in 2002.  I am currently working on my BSN - not because I feel it will necessarily make a difference in the job I do every day, but because I feel the need to push myself, to study, to learn more about the field, and therefore myself.  I give the highest level of care, everyday, and have been a charge nurse and team leader on many units.  What I can tell you is this - I have had BSN nurses work for me who were dangerous nurses - I wondered how on earth they ever graduated nursing school.  I have had LPN's work for me who could show the RN's a thing or two. So let's not assume that earning a BSN is going to make the ultimate difference in nursing care. It will do this only if nurses are prepared to take the education and apply it diligently, dutifully and intelligently.

Mary, Pediatrics - RN, educational March 16, 2013 6:05 PM
Binghamton NY

The advancement of nursing as a profession relies heavily on education. However, nursing's main focus is on patient care. By moving nurses into advanced practice roles and leaving direct patient care to CNA's and medical technicians we may end up losing touch with reality.

Joy, RN March 16, 2013 4:58 PM
Rockville MD

1968-LPN's capable of all aspects of "nursing" except, Charge, IV push meds, hanging blood,defibrillator. Secretaries and LPN's transcribed oders,LPN's also took physician telephone orders, RN's signed off on them. Responsible for assessments, planning, implemetation, response. LPN's worked in areas ICU, ED, PEDI, ONCOLOGY,TELEMETRY (monitering & teaching classes), SURGICAL/MEDICAL, OB-GYN, etc.

RN if want to take managerial type postions or teach. Suggested.

Wages, RN's starting pay $1.00 higher than LPN's.

1983-LPN's suddenly unable to document without an RN signing off on work as previously done. Job became more of assistant roll. Yesterday capable of assessement today not. RN pay rises steadily, LPN's does not. Must get an RN if want to stay employed in a hospital setting,AD, DIPLOMA, BSN. BSN necessary if want managerial or teaching positions. RN pay increases based on Degree.

LPN's now in nursing homes and Dr.Offices.

1990-Must get a BSN to be hired by many hospitals. MSN for managerial, teaching positions.

2000- BSN required, MSN preferred.

2013- MSN required, ADN preferred

2014 and beyond..ADN required, DNP preferred.

The ongoing saga of Nursing. We accept what is dictated by colleges & universities that medical institutions follows. Increased work load, more technological equipment use, yet..BSN's are now working as a 1968 LPN. WOW you never stop learning.

Susan, Emergency - RN-AD, Hospital March 16, 2013 3:56 PM
Boston MA

Reading this article really, really upset me.  How dare Mrs Wagner's comments comparing a ADN nurse to an assistant nurse.  I would have to HIGHLY disagree with her statements.  I became a Registered Nurse 10 years ago, proudly from an associate's degree program.  Why did I choose associate's over bachelor's? Well, for one it was during a nursing shortage.  I could get my RN and start working right away, not having to go 4 years time.  Also, ADN vs BSN we ALL take the same board's exam.  We are all REGISTERED NURSES.  We all started out making the same rate AS GNs, so 2-3 years vs 4, I took the 2 years.  Not only that, looking into the programs back then in a BSN program go to school for 3 years and not having any clinical until the 4th year.  Instead in an ADN program I had my clinicals as I was learning the different specialties.  How dare she say that nurses with ADN aren't prepared to be contributing members of the profession.  I have been an ADN for 10 years with multiple experiences including preceptor, charge nurse, sepsis Team Leader etc.  You really couldn't tell me from a BSN nurse, we both do the same JOB on the floor.  In fact ADN graduate nurses are better prepared for the floor than a BSN graduate, I know because I've precepted both.  The ADN graduate has more CLINICAL experience.  Sure, I have looked into RN-BSN programs, but honestly it is just more PAPERS to write, it doesn't change what I do as an RN.  So stop with the negative comments  about ADN nurses.  WE ARE ALL RNS and WE ALL TAKE THE SAME BOARDS EXAM!!!

sarah rullo, medical surgical - registered nurse, hospital March 15, 2013 7:16 PM
camp hill PA

I am a proud graduate of a Diploma program and then later BSN and MSN.  I am a nurse educator at an excellent Baccalaureate Program.  I did once oppose the BSN as a minimum entry but after I stopped resisting it, I found that a BSN education could really further my career and improve my nursing.  We have to quit fighting about this.  It is not personal, it is professional.  We have to advance the profession.  To do so we need to support nurses from all backgrounds and encourage all nurses to continue their education.  In the long run, it is what is best for our patients as well as our profession.

Debra Dickman, Nursing - Assistant Professor, Blessing-Rieman College of Nursing March 14, 2013 11:16 PM
Quincy IL

My ADN was hard won and has served me well for 33 years. Trust me, BS or AD, neither prepares you for what you see, do, have to do. You must commit yourself to lifelong learning and listening to patients, being the go between, empathetic, but with boundaries. Finesse, caring, and organization skills. If you want to learn assessment skills the AD instructors gave us thorough lessons, tying together. We need some nurses now.2 years to workforce.Some may choose to go on. Not all have to. There's enough work for all kinds.They said this 30 yrs ago.

Mary Gerdt, LTC,et al - RN Case Manager, State employee March 14, 2013 9:20 PM
State of VT

I have been a nurse for about 40 years. The convrsation in this article has been going on for that long or longer. I started as a ASN later got my BSN and a MA in Health Administration. I went on to get my BSn because I saw the difference in what a BSn learned and a ADN and it was more criticl thinking and fooward thinking.

I disagree with the comment about LPNs and Nursing Assistants. What I have seen is those are the positions that are being faded out in favor of the ADNs and techs. I have also seen that the role of managers and supervisors are being given exclusively to BSNs and above. Hvaing been both I feel tht I can safely say that there is a difference (not that a ADN can not learn how) in the typ[e of training and the way you approach your profession. it is all in what you wnat  to do and the post school training and opportunities that you recieve.

The bottom line is this the phrae that just causes the hair on my back to rise is "A Nurse is a Nurse no matter the degree" that statement is simply not true but with the infighting that we do that is what we project to the rest of the medical industry.

Do I have a solution no. Do I feel that all RNs should be BSNs no. I feel that there is a place for ADNs and BSNs it depends on what your goals are and accepting your roles.  

William, Long Term Care - VP of Clinical Services March 14, 2013 12:38 PM
Memphis TN

Talk about bias,  Ms. Wagner is an associate dean of a school of nursing.  Just like all others driving the BSN push, she is affiliated with an institution that stands to reap the financial rewards from forcing all nurses to have to run back to school.  The  AANC, ANA, IOM along with other organizations committed to BSN entry into the nursing field staffed with officials and representatives who all in some way affiliated with four year nursing programs.    I expect all those who work with four year nursing programs to support the ANA's position.  What better way to help ensure job security than to force all nurses to have to run back to school and go into debt for thousands of dollars to write a few more papers in APA format on current nursing thought and issues.  

Is it any wonder that at a time when  national attention is being given to the subject of whether four year degrees are worth it and “200 college and university campuses have closed during the last 10 years due to decreasing enrollments as baby boomers aged" (Nursing Spectrum, Jan. 9, 2012) that they want to force nurses to have to run back to school.  

In looking the curriculum of RN-BSN programs, I found they consist of courses such as: Professional Ethics, Leadership in Nursing, Research Methods and Currents Issues in Nursing.  All of these courses are incorporated in some way in every accredited nursing program and to have to pay thousands of dollars to have to take them in a BSN program especially since they have nothing to do with improved patient care is a sham.  Also, there is no extra hands-on or clinical training in most RN-BSN programs.  In written posts and testimonials from working doctors and nurses, not one has said that BSN nurses are providing superior patient care.  In fact, I was told the opposite that ADN and A.S. nurses are providing superior patient care due to their superior clinical education.  Also not one physician has ever said there were able discern whether a nurse was an ADN, A.S. or BSN prepared nurse by observing the way they worked on the floor.

Many of our most experienced nurses are in their 40s and 50s and have over 20 yrs of experience along with specialty certifications that demonstrate proficiency in areas such as trauma and ICU and who also have called upon to mentor new nurses, are being told by their hospitals to earn a BSN (Bachelor’s of Science in Nursing) within 3 years with a veiled threat of termination if they refuse.  Some of these nurses even have Bachelor’s Degrees in other areas.  These are the most experienced nurses that you and I would want to have taking care of us. Many of these nurses have stated that they would leave the profession rather than go into debt at that time in their lives for something that has nothing to do with helping them provide better patient care. Also many of these nurses know that the thousands of dollars it will cost to earn a BSN will not be paid off by the time that nurse is ready to retire.  It is also worthy to mention that many of these hospitals offer on-site RN-BSN programs through a business partnership with four year schools.  What better to ensure those seats are filled and keep that money coming in than for a hospital to require its nurses to earn a BSN.  

As I stated in letters sent to the governors of New York and New Jersey:  If a tragedy such as Hurricane Sandy were to occur again, can we afford to lose our most experienced and skilled nurses just to keep colleges professors and other nursing academic elitists employed and give notoriety to those who postulate flawed and bias propaganda and try to pass it off as scholarly research for their own gain?  And most of these people probably haven't touched a patient since Bill Clinton was in office or shortly after.

And stop with all the phony altruism about how having nurses run back to school is for the benefit of the patients and to elevate the profession.  The only thing these people want to benefit and elevate is the amount of revenue brought into the 4 year schools they work for.

These academic elitists are the most venal, prevaricating bunch of people I've ever known to exist and this degree inflation garbage is the biggest scam going today.  

A major news station I had contacted expressed an interest in this story.   They asked if some nurses would be willing to speak out.  If any nurses in the Phila. area are interested, there should be a way to contact me through Advance.

Peter Digiuseppe March 13, 2013 10:51 PM
Philadelphia PA

I am HIGHLY offended at the comments made in the second to last paragraph in this article.  Does this CHeryl Wagner, with all of the impressive letters after her name, REALLY think that BSN and advanced degrees are where RN's learn their critical thinking skills?? Really??  I and ADRN in my field for almost 11 years, and I will go up against ANY BSN, MSN, etc who challenges my skills!!!  I would rather have a seasoned ADRN taking care of me and my family versus someone who took statistics,  history, or some other elective any day.   BTW, even with my "pingy" AD, I can write a mean research that could whip any BSN into a frenzy.

Mimi Meeder, Tele; m/s;Crit care - RN March 13, 2013 9:52 PM
Aston PA

I wholeheartedly agree with C (above). Shame on anyone for down playing the impact that ADN or diploma nurses have on the profession. Having been an practicing RN for nearly 35 years, a manager for just about as many and a patient myself, may I just add that in most cases, I preferred to work with and supervise the ADN or diploma grad. I just don't think that a BSN grad gets enough clinical experience to be proficient at the bedside. It is really about ability to critically think- to heck with theory if you can't rationalize critical steps to patient assessment and stability!  Learning about English, History and Religion has little to do with whether or not you can assess & carry out processes critical to patient safety and the provision of good care. I wish I had a nickle for every ADN or diploma grad that I had supervise a BSN because he/she was not prepared or exposed to real life clinical situations.

CD, RN March 13, 2013 5:47 PM

I read the comments from Dr Wagner about AD nurses  not being well  prepared  to be part of the nursing profession, and dooms  them as nurses  following Dr's orders. That is an unfair statement to make. Nurses spend more time with the patients than anyone else, and have to make important decisions as when to implement critical interventions.  I believe all nurses are capable of being part of the nursing profession as long as their facility offer continuing eduction, and the nurses become certified in their specialty . Most nurses  regardless of education take about 2-3 years to reach their leadership and work independently. However, I do believe that nursing as a profession should be one page with the BSN as entry level. As time evolves that will happen though attrition,however,to make it happen we need to discontinue Diploma and AD programs along the way. This debate has been in the making for 20-30 years, and it will not go away until those programs are closed. In addition, Many AD or Diploma nurses orient BSN nurses, because of the complexity of care with all the new technology that is being offered and their clinical background At the present time, there is room for all type of nurses,so patients can  receive the best care possible.( WE WANT NURSES WHO ARE NOT AFRAID TO TOUCH THE PATIENT).

Jessie , Educator - RN,MSN, BCC March 13, 2013 4:15 PM
Newtown PA

I went back to school in my40's, received my ADN at the age of 47, 10 years ago. I was not aware, as stated in this article, that bedside nursing was going to become the realm of nursing assistants or LPN's!  I do bedside care on a busy surgical unit.  Most of the BSN RN's I speak to are more interested in the administrative area of nursing.  If everyone has a BSN, who is going to do bedside care?  Up until now, our hospital has hired AD RN's, then required them to get their BSN within a certain amount of time, and reimbursing them for a certain amount of tuition. Why can't hospitals continue with this practice.  Also, BSN's don't seem to have a lot of clinical experience, while AD RN's usually start clinicals the first week of school.  

patricia March 13, 2013 1:31 PM

This question has been asked so many times; as it was when I became a nurse 30 years ago. Though I have BSN behind my name, I can honestly say I learned the most from ADN's, LPN's and CNA's. What is important is who the nurse IS; not the letters behind her/his name.

Stacy, Pediatrics - RN,BSN March 13, 2013 1:25 PM

I have heard this argument since I started nursing school over 30 years ago!!  First it was the LPN that was to be replaced, so now it is the ADN.  I think the nursing profession needs all areas and education levels for the health care community.  I did not take a different exam to to get my RN license than a BSN nurse takes.  Sure they learn more in 4 years, but that doesn't necessarily make them better.  I have taught 4 year nurses things that they should have learned in that 4 years.  I feel I have just as much nursing knowledge as any BSN. I may not know the management area they learn, but not everyone wants to be on the administrative end of nursing.  oI could go on and on but I have made my point

Judy, RN March 13, 2013 1:00 PM
Clarksville TN

I'm an educator teaching in an ADN nursing program in NYC. My education started with an ADN degree in nursing 34 years ago. Since then, I have completed and obtained my BSN and MSN in nursing. I sincerely believe that I am who I am as a professional nurse because of my ADN education. It offorded me the privilege to care for the ill with dignity and respect. I believe in education, hence that is why I am teaching. My advance degrees were for me to enhance what I already knew not to change the essence of what I had learned in my ADN education. We need nurses - focused, caring, intelligent, able and capable. ADN students have these qualities. I do agree that the more eduation you obtain, the better overall you are in your job.But, by discounting the value of an ADN education, we devalue its contribution to our profession and to the people we nurse.

Gricididis , Nursing - Educator, SPSON March 13, 2013 9:57 AM
Staten Island NY

After reading this, I find I'm curious what the credentials of the writer are. I'm unable to find them, despite looking under "about the blog and author". But that's not necessarily relevant. Having been a proud Diploma RN for 31 years, I'll add my 2 cents. The push for making a BSN the minimum entry level into Registered Nursing has been going on since well before I became a nurse. I remember older nurses talking about it when I was in school. Some of us who don't have a BSN find it offensive to be belittled and thought of as second class nurses because we don't have the right initials behind our name. To think that learning stops when one graduates from whichever school of nursing one attends is ridiculous. No patient and few other nurses have ever asked me about my educational background and credentials, except during the hiring process. Even then, as long as I have an RN license, no manager has particularly cared what route I took to get there. I have worked in NICU most of my career and successfully been a charge nurse, even without those precious initials you prize so highly. Some of us only want to do bedside nursing. That doesn't make us any less a Nurse; worthy of respect and inclusion. I could rant on, but I'll finish here. Please get over yourselves, BSNs.  

C, RN March 12, 2013 6:59 PM

I used to share the same beliefs expressed by Kathleen and Robert. However, at the age of 48 and after 25 years of being an RN, ADN, I started taking classes online in an RN to BSN Bridge program.  I have completed the nursing curriculum and have only two more electives (5 credits) to complete which I will do through DANTES.  I do work full time in a very demanding job (not clinical nursing).  I want to share that I cannot believe how much I didn't know until I took the BSN classes.  So, for all of those ADN nurses who believe that they are equally prepared, think again.  Once you start taking classes for your BSN, you will be shocked at how much you still have to learn.  I am not the only ADN nurse who felt this way. In fact, most of the students in every class shared this eye-opening experience.  If you choose to be a bedside nurse on a general med-surg floor throughout your career, then maybe the ADN if fine. However, you should be aware that it is only a matter of time before you are edged out by a BSN prepared nurse.  

For those of you who are just starting your ADN, try to bridge to you BSN as soon as possible.  And for anyone considering nursing, do everything you can to get your BSN.  Many community colleges who have ADN programs are partnering with 4 year universities in order to make an easy pathway to that BSN. If I had to start all over again, I would have kept going for my MSN at the minimum.

Sherril, R.N. March 12, 2013 3:28 PM

Ditto to Kathleen.  I don't have time to fill out all the information required just to post here, but with a comment like that to say 'amen,' to...  

While I'm here, I only have a mere 13 years as an RN, and plenty of time as a patient myself.  On a **practical** level, that has translated into one thing.  The only difference between the vast majority of ADNs and RNs I've worked with is the amount they are paid.  

Please don't forget to work on ways to ensare GNAs and NAs once they have entered the 'system,' too.  Encourage growth at all levels.  Thank you for listening to yet  another point of view on this subject.

Robert Albert, Admin of Geriatric Care - RN March 12, 2013 1:47 PM
Baltimore MD

Thank you for addressing this important issue in nursing education.  I disagree with Dr. Wagner's assertion that, “Nurses with an ADN are not as well prepared to be contributing members of the profession, which dooms nursing to a role of following doctor’s orders.”  One of the goals of an ADN program should be to prepare the ADN nurse for eventual transfer to a 4-year university to earn the BSN degree, however, there are many in our society (especially in rural America) who are not so privileged as to afford a 4-year university education easily.  The ADN nurse is able to work as a RN to earn the additional money that it takes to afford the BSN degree.  As Dr. Wagner well knows, the ADN nurse takes the same licensing exam (NCLEX-RN) as the BSN nurse from a 4- year school, so for her to say that the ADN nurse is prepared to simply to "follow orders" devalues the critical thinking that any nurse does, whether ADN or BSN prepared.  Thank you for listening to another point of view on this subject.

Kathleen Adamski, , Dean, Health Science Education Walla Walla Community College March 12, 2013 11:00 AM
Walla Walla WA

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