Professional Documents
Culture Documents
ADN v BSN
Nursing is at war with itself; the conflict is between associates degree nurses
against their siblings with a bachelors degree. The battles are being fought in many
arenas, from the med-surg floors of local hospitals, to the corridors of power in
Washington DC. “What should the entry level be for practice as a registered professional
in the United States?’ “Do BS prepared nurses provide safer care than their ADN
counterparts?”, “Should ADN programs be phased out all together?” These are just a few
of the questions facing nursing today, questions that pit nurse against nurse, and ADN
nurses against the most influential organization representing nursing in the United States,
the American Nurses Association (ANA). The issues in this quarrel have been tearing at
nursing for over forty years, and there is no easy end in sight.
In 1962 the ANA published a position paper that stated that the minimum
educational level for practice into nursing should be the bachelors degree. The ANA’s
position grew out of a need to give nurses a more professional science based education
making it less the apprenticeship based vocation it had mostly been to that point. At the
time of the publication of the position paper 78% of new nursing graduates received their
education from a hospital based diploma program. This schooling lasted three years and
at the end the student received a diploma. Due in large part to the efforts of the ANA by
2000 the number of diploma graduate nurses had been reduced to 29.6% (Nelson,
2002,”Looking Backward” Para 2), by 2010 only 4% of nursing graduates sitting for their
state licensure examination were educated in vocational diploma awarding programs. The
ANA’s glass though was only half full, filling the vacuum left by the vanishing hospital
based programs were schools of nursing based in community and junior colleges that
Columbia University. In her dissertation Dr. Montague made a proposal for a new kind of
nurse to help ease the severe nursing shortage that existed to this time. This nurse was to
be dubbed a “nursing technician” their education was to last two years, and their role was
programs were to “alleviate the critical nursing shortage, to provide a sound educational
base for nursing instruction by placing these programs in junior or community colleges
The programs that Dr Montag and her team were responsible for creating have become
today’s ADN programs. (Haase, 1990, p. 26-27) The first associates degree program in
nursing was started at New Jersey’s Farleigh Dickinson University in 1952 (Ironically,
this program was phased out in 1970, being replaced by a BSN program) This program
and four more pilot programs like it were wildly successful and were quickly copied. 25
years after their introduction there were over 700 schools of nursing in the United States
offering the associates degree, today there are more than 800. These programs graduated
60% of the new nurses sitting for their state’s licensure exam in 2010. As in 1952 these
include males, older students and minorities. (Haase, 1990, p.38) Dr Montag reported that
the graduates of her pilot programs were able to pass the state boards and function as staff
Controversy notwithstanding a patient who receives care from a BSN nurse has
better outcomes and is safer than those treated by ADN nurses. It should be inconceivable
that there is such controversy surrounding this issue; BSN equals better, cheaper, safer
care Nursing, nurses the health care community and society as a whole should be
advocating for the BS to be the minimum degree required for entry into practice as a
registered nurse. There are however several factors which have kept this from happening.
In 2010, 60% of nurses graduating from nursing school in the United States received
1,016,900 by 2020 (US: Supply versus Demand Projections for FTE Registered Nurses,
Source: Data from the Bureau of Health Professions. (2004)) The current output from all
nursing schools BS, ADN and diploma now in existence would have to be increased 90%
in order to meet this projected shortfall. In addition to the nursing shortage there is
currently no political will to change the Nurse Practice act to make the bachelors degree
the minimum degree required for entry into practice. North Dakota was the only state in
the union to have this requirement, but this was subsequently overturned in 2003 when a
group which included nurses, long term care facilities and community colleges
successfully lobbied to have this requirement repealed. These factors plus the shortage of
nursing faculty, the lack of funding for associates nurses to return to school etc make the
quest to raise the educational requirement difficult for the foreseeable future.
There are currently 18 states that have legislation pending that would require
nurses who currently hold associates degrees to return to school and obtain their BSN
within 10 years of graduating from nursing school. In New York this requirement would
be incumbent on nurses who graduate from nursing school after 2012. The same powerful
forces that aligned against the legislation in North Dakota are coming out again to lobby
for this bills defeat. This time though there are equally important forces united in an
attempt to see these bills through to passage, and they have some powerful