Clinical Question of the Week #4

With the recent publication of her most recent book on nursing education, Patricia Benner emphasizes the need for the nursing profession to move to requiring a BSN degree for nurse’s basic entry into practice.  And eventually, to a clinical master’s or doctorate degree, as pharmacists and physical therapists have done.  What do you think, will requiring a BSN or a MSN degree improve direct care nursing or will this move us further from the bedside?



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15 responses to “Clinical Question of the Week #4

  1. As a Diploma grad, I don’t feel that having a BSN is essential to make a good nurse. In my years of experience at all levels of care, what makes a good nurseis compassion & empathy. It seems to me that the higher the degree a person has the further away from the patients bedside she/he is. And then she/he doesn’t have a clue what those of us at the bedside really have to do.

  2. Linn Crutcher

    I graduated from Kellogg Community College in Battle Creek in 1976. I only went on to obtain my BSN at Nazareth College in 1982 because I had had 3 years of college in Ohio and didn’t want those years to not count for something. I hired in on the night shift on a unit that had renal patients, kidney transplant patients, urology surgery and some gyne patients. I learned more in my 3 years on that floor than all the nursing degrees put together!

    While BSN classes were somewhat helpful, most were not – chemistry, physics, etc. Old fashioned experience and like Cheryl C. mentioned, compassion and empathy are worth more than all the PhD’s in the world.

    Of course, if you don’t want to be at the bedside, then advanced college degrees are necessary for teaching or administration. Three cheers for all the nurse practitioner students, too!!!

  3. Maria

    I am a ADN nurse. I advanced in my field by getting Certified in Infusion Therapy. (CRNI)
    I am now getting my BSN. I do not think it has changed my bedside nursing skills. But it has changed the way I look at evidence based practise and nursing research. I feel I can use research more in my practice now. I guess time will tell.

  4. faith allen

    i don’t think a bsn will help on the caring, compassion level. i graduated from an adon program in 1977 at 21….i did work always on the floor. in a nursing home for 9 years and in the hospital for 21 yrs…either you have it or not. can’t be taught, its something you feel….

  5. Jill Morang

    While I’m not sure that a Bachelor’s degree makes for better bedside care, I do believe that requiring a BSN as entry level moves the profession forward. I think that this move is required for nursing to be seen as a profession and nurses as professionals. I’m not saying that nurses today are not professionals, but the view of other professions is that nursing is not on the same playing field. Physical therapy and pharmacy is already requiring advanced degrees for practice. It is time for nursing to move forward and to embrace the changes that will only enhance nursing

  6. carol butler

    I believe that entry-level nurses should have a bachelors degree.we are the only profession that allows a 2 year degree – which makes us not professional but technical – can you think of any profession that allows this – not teachers – engineers – physical therapists etc.maybe they should all go to 2 year programs and everyone would save money!!! why don’t teachers demand a shorter course of study – they actually need a masters within 5 years of being out – would you mind if your child was taught by a teacher with a 2 year degree – you probably would… there are very good ADN nurses and there are very poor BSN nurses – that is not the point -the point is that professional jobs require a university degree – having a well-rounded education is important to us all.

    • Lorraine Goward

      I have never seen an associates degree in nursing earned in two years. That’s a misnomer. Show me a program that actually gets you through in two years!
      I believe nurses in general are getting farther and farther away from the bedside, with the increased use of non-licensed assistive personnel. We have a nursing shortage. I would like to see a license require a baccalaureate, but we will only have a greater shortage until we can increase the number of educators available to produce these advanced degree RNs. Personnally, I do not see any difference in the care provided by ADNs as compared to BSNs. It comes from the heart.

    • Bryan Jones, RN

      I can see your point. I need those extra history and art classes to make me a better nurse. You seem to be very stuck on titles and appearance. As to “professional” versus “technical”, it is people with your mindset who keep us behind as a “profession” and divide us against each other. The well rounded education is something perpetuated by higher education to keep itself in business. Most of us constantly update our skills and learn whole new sets as we change areas of practice. We are licensed with a basic skill set. If you need (or want) other skills besides that, it is up to you to get them. Try not to confuse degrees with skill or competency.

  7. Annemarie

    Nurses are and need to be intelligent and compassionate caring individuals. Many patients state that it is the nurses who spend the most time and effort for hospitalized patients. Entry into practice should be BSN. That being said how do we get there? Why not have proficiency evaluation to grandfather whose that meet the criteria of a professional nurse? Why not continue to educate new LPNs and RNs with associate degrees have them get experience? Why not build programs that address what knowledge and skill set is actually needed as they grow and learn. Make these programs accessible and affordable. Then make having these skills reward-able in terms of remuneration. This remuneration should be tied to achieving outcomes: Patient without hospital acquired complications (phlebitis, UTI, skin breakdown and pneumonia), patient and family satisfaction with knowledge of the patient’s plan being know and carried out, comprehensive treatment of the whole person, understanding of the past medical history, all medications, patient’s understanding of the plan, comprehensive plan for launch back to home without readmission. Team knowledge of end of life decision making with good palliabtive care
    Yes, these are the outcomes. We recognize a great nurse by achievement of all these things and timely care provided. Let’s keep our standards high.
    As far as the MSN issue, arguement heard. First one step then another

  8. I was a diploma graduate, then finished my BSN 32 years later (better late than never). I was always taking classes intermittantly….since I believed I should have a degree.
    To level the playing field with other healthcare professionals, we need degrees. Research has shown that the more nurses with BSNs on a nursing unit, thus at the bedside, the “better” the care (the same is said of experienced nurses). Nursing needs a broad educational experience to see the “big” picture of the system and the patients, their communities, and how all of it fits together. We need writing, and speaking skills. We need to understand how public policy affects healthcare, our work environment, and the lives of our patients, as well as us. This is too much to put in a two-three year ADN program, plus all the nursing skills and clinical practice.
    To be at the table with other professionals, we need to be recognized as professionals and education is one of the ways the world recognizes professions. Can’t be helped, it is just the way things are.
    I wouldn’t trade what I learned in a three year diploma program, but hospitals, healthcare, and nursing was very different back then.

  9. Brenda

    For 34 years, at least that is how long I have been aware of nursing issues, we have talked about this very subject. I originally wanted to go to a 3 year school so I would be a “better bedside” nurse. In MN there was only 1 diploma program at the time. They accepted me and then told me they felt I should go to a BSN program right away. What a wonderful gift they gave me. I too have worked with many nurses–it doesn’t matter which degree you have when it comes to empathy and caring. Yes, I have learned the most while working nights in a small hospital but I have also seen what having the BSN background for following through and working out procedures has done. I agree it is time to require the BSN as a beginning. My aunts all gave me the best advice though–even though I was in school they advised I begin working in the nsg. environment as I took my schooling to know that I wanted to be there. After 30 years, I know I am in the right place!

  10. Diane Benson

    I graduated from a Diploma program in 1974, finished my Bachelor’s degree in Health Studies in 1977. I have found that my Bachelor’s degree may have given me a leg up on some jobs I’ve applied for in the past but otherwise has not done much for me as a professional. What is missing from this discussion is this. I have taught in a ADN program in the past & have known recent students who have graduated from an ADN. The programs are not 2 years in length but are 3-3 1/2 years depending on the course load taken of prerequisites. Unfortunately many BSN programs are no longer 4 years but may be closer to 5 years(not necessarily more nursing classes). But a pediatric rotation for a BSN is no longer than for a ADN program, so who is the better prepared nurse? I have also found that BSN trained nurses are more likely to move into other fields in which pay, hours are better (working as a drug rep, medical equipment sales). It will not solve the nursing shortage to require advanced degrees. Most hospitals may have 1 or 2 Pharmacists working the night shift but many RNs. You rarely find drug stores open past 9pm. I don’t know any Physical Therapists who work in the middle of the night & most don’t work weekends. Comparing the logistics related to the above fields are like comparing apples & oranges.

  11. Bonnie N.

    I began with an Associate Degree in Nursing (2yr.) and then 10 years later completed my BSN degree. I was fortunate to have my schooling paid for by my employer, although my nursing union, Michigan Nurses Association, fought for this language in my CBA . I sought my BSN simply because I was considering a location change and knew that having a BSN would make me more competative on my resume’. The question you ask, however, is whether or not having the advanced degree improves direct patient care? In my opinion, no. The technical skills, emotional skills and psychosocial skills needed for direct patient care can be acquired during the 2 year nursing program. The BSN gave me the skills to further delegate, research, and “manage” nursing practice but did not necessarily give me the skills to further my patient care practice. I do believe that we, as nurses, have come a long way in being considered professionals by society at large, but unfortunately we still have a considerable way to go. Having a BSN degree is necessary to be categorized as a professional as with other fields of study. I did not seek my BSN because I thought it would make me a better RN; just more competative in the job market. I personally recommend seeking the four year degree, and the MSN or PhD if the desire is to teach or become managerial our profession. My answer may sound like a contradiction in philosophies, but I am certain of this: I am glad to have my BSN but it doesn’t make me any better, kinder, or harder working than my co-worker with the ADN or AASN degree.

  12. Camie

    The main difference I see between the ADN and BSN is about 5 classes. Second, the ADN nurses in my area are better prepared for the bedside clinical nature of nursing. The BSN nurses are better prepared for management type roles. Even clinicals are different. One university only has students ‘watching’ the care not ‘doing’ the care. I am an ADN grad with a BA in another field. Having the ‘well-rounded’ education doesn’t mean anything to anyone unless there is a BSN behind my name. I am currently going for my MSN, but because I want to teach. Being aware of EBP, comes from within, not from a bachelors degree. The nurses that bring the EBP to the bedside are all ADNs on my unit. There are many reasons to get the BSN, staying at the bedside is not one of them. It WILL pull nurses from the bedside if we mandate bachelors for entry level of practice.

  13. Carolyn Warren

    I agree that having a BSN does not make you a better bedside nurse. When I recieved my degree (ADN) I went to work in a hospital. One of the nurses I worked with was a new grad with a BSN. She had never done a sterile dressing change, put in an indwelling catheter, or started an IV. When I asked her about it she just said she knew how to do it because she had all the “theory” behind the treatments. I’m sorry, but theory and doing are often very different.
    As far as pharmacists needing the higher degrees, that is great, but why are the 2year pharmacy tech programs so full? Because they need people that will actually do the work?
    I considered getting my BSN at one point, but I love the work I do (public health) and while new hires are now required to have a BSN, there are no incentives for me to get mine ( unless I might want to become a supervisor — NOT).
    Entry level BSN required? I really do not see the benifit for patients.

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