There has been much debate over the years about the differences in competencies between Associates Degree nurses (ADN) versus Baccalaureate Degree (BSN) nurses. In this paper I will discuss my findings and also give a patient care situation in which I describe how nursing care or approaches to decision-making may differ based upon the educationalpreparation of the nurse BSN versus a diploma or ADN degree. Besides the difference in time,credits and money studies are showing a significant difference in ADN nursing versus BSN.
“Research has shown that lower mortality rates, fewer medication errors, and positive outcomesare all linked to nurses prepared at the baccalaureate and graduate degree levels.” (AACN, 2013)
An ADN program is a two-year program in which students learn the basics of nursing such as care plans and performing every day nursing skills, they offer courses that are more affordable and accessible which in this day and age can be a blessing and in the end they produce competent bedside nurses who can sit for the NCLEX.
We can thank Mildred Montag for founding the ADN program back in 1956 due to a major nurse shortage after the war (Friberg, 2011, p. 87-88). But some downfalls are “when combined with practical nurses, the total number of technical nurse types being produced is excessive given current and future market demands (Benner et al, 2000). As for jobs they are limited to hospitals, skilled nursing, long-term care facilities, clinics and physicians offices.
A Bachelor of Science in Nursing (BSN) degree is a four-year degree that is focused on theory and research.
The American Association of Colleges of Nursing (AACN) states that education “enhances both clinical competency and care delivery.” (Rosseter, 2013) Due to more formal education the BSN nurse is more of a critical thinker advancing in daily nursing tasks and avoiding deadly errors. They tend to look farther into the disease process and critical thinking behind it rather then just being a task oriented ADN.
“Programs provide a solid liberal education and substantive upper division nursing major. Both components are combined in ways that prepare a nurse generalist who is able to provide professional nursing services in beginning leadership positions in a variety of settings” (Friberg, 2011, p. 87-88). Obtaining a BSN can open up more job opportunities for a person and in most cases makes you more desirable to employers. Many nurses get burnt out from being floor nurses so if you have your BSN you have the option to move into management or many other areas like insurance companies, pharmaceutical companies, research jobs or even a clinical instructor. “Research shows they use evidence based practice for better patient outcomes.” (Moore, n.d.) “ As also stated in the same article “numerous research studies have demonstrated that the ADN and BSN nurses are not different in skill competency when they graduate, but within a year, the BSN nurses show greater critical thinking skills better problem solving, and the development of clinical judgment; three skills of increasing importance for the increase in acuity of patients in hospitals and other health care settings.” (Moore, n.d.)
In the February 2013 issue of the Journal of Nursing Administration, Mary Blegen and colleagues published findings from a cross-sectional study of 21 University Healthsystem Consortium hospitals which found that hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay. By having the added knowledge from school, it shows in studies that BSN’s have better outcomes with less patient complications, which is good for everyone.
A patient care scenario that comes to mind for me would be a patient in Labor and Delivery that has had slightly elevated blood pressures prior to the pregnancy, but with diet and exercise was able to avoid medication. But on admission an order for a blood pressure medication was ordered as a PRN in case it was needed. As the patient progresses into labor, her pressures start to rise slightly. The ADN nurse comes in see’s the reading looks at her orders and dispenses the medication, because that is what she is trained to do. Whereas the BSN nurse comes in to the patient’s room and see’s the same reading, notices the patient seems more uncomfortable and is a little upset. So as the BSN nurse I would ask if she was having increased pain and if she was offer her something for pain relief because that may help decrease the blood pressure. I would also ask her if something else was bothering her because she seemed agitated and the patient stated that her and her boyfriend had just had a huge argument and she was upset over that. So with some pain relief and quiet environment the BSN nurse was able to avoid giving the patient an extra medication for her blood pressure.