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No ADN’s by 2020? Institute of Medicine Report on Nursing’s Future


“Working on the front lines of patient care, nurses can play a vital role in helping realize the objectives set forth in the 2010 Affordable Care Act, legislation that represents the broadest health care overhaul since the 1965 creation of the Medicare and Medicaid programs. A number of barriers prevent nurses from being able to respond effectively to rapidly changing health care settings and an evolving health care system. These barriers need to be overcome to ensure that nurses are well-positioned to lead change and advance health.”
80% BSN Nurses by 2020?

One of the most ambitious recommendations in the report is the section on advancement of nursing education. It proposes the goal of transitioning the average 50% of the nursing workforce at the BSN level today to that of 80% of the workforce in the next 10 years. While this is a worthwhile goal, without the funding to pay for the ADN nurses to advance to the BSN level and the increase in pay that such an advance might ordinarily offer in another field, there is little hope of achieving this goal.

It makes no sense to shut down the existing pipeline of ADN nursing programs and requiring BSN as the minimum standard of education for registered nurse (RN). With the predicted nursing shortage, these ADN programs will be the only way we can meet the needs of the aging population and declining nursing workforce. Unless there is a major influx of scholarship funding from public and private sources to encourage nurses to go back to school in droves and provide them the financial incentive to do so, it is unlikely that the 80% goal will be reached by 2020.
Practice Within Full Scope of Nurse Training

One part of the process that met with approval from all of the panelists was the focus on expanding the scope and inclusion of advanced practice nurses nationwide. With health care costs continuing to skyrocket and a lack of needed primary care resources, offering a full provider status to nurse practitioners nationwide is one of the most effective ways to approach the broad primary care gap that exists. When physicians purport that they should be the only primary prescribers and decision makers for all patients, the IOM reports suggests that these objections be treated as anti-competitive practices and price fixing in the health care marketplace.

If you are a nurse, what do you think about shifting the educational percentages to 80% BSN? In some organizations, there is even a push for higher percentages of MSN degrees. What are you seeing where you work?


As an ADN nurse I don't believe that a nurse has to have a BSN to be effective in the field of nursing. There is a big difference in book learning and practice. There is nothing wrong with learning theory in a classroom, but are you able to "practice" nursing. Bedside nursing is not about 'writing' standards or policies. Bedside nursing is about seeing to patients' needs in the most effective manner according to standards. Yes I said patients, not clients. There is a push to also require all managers to have a MSN to practice. I know managers with BSN's that are top notch because that is what they love doing and they are excellent managers! The kind of letters you have behind your name might look impressive to some, but it does not impress a sick or dying patient. This should not be the case in nursing!
Posted @ Thursday, May 10, 2012 11:13 AM by P Peeples
I really think that letters do not make a diffence whether you are a good nurse or not, but I do believe in order to stay competitive with the growing health care field nursing must increase the basic standard. In some states PT assistants salaries are much higher new RN graduates and that I believe is because PT students will end with a terminal degree. I personally believe depending on what degree, nurses are not getting enough leadership skills in their professional training and need more leadership and planning to incorporate policy changes and standards in nursing. Every nurse regardless of education level should be an avocate for all nurses.
Posted @ Tuesday, May 15, 2012 12:36 PM by tee RN
As an Associate degree RN nursing student who plans to continue my education to BSN and, hopefully, beyond, I think an RN is a RN! Continuing to learn is part of "The Nursing Process".
Posted @ Wednesday, May 16, 2012 9:45 AM by Arthur Johnson 3rd
An RN is an RN! as long as you have those credentials behind your name there is no difference what degree you have because the work is no different and neither is the salary!
Posted @ Tuesday, June 12, 2012 1:16 PM by Nursenina
I truly believe that our patients deserve to be cared for by the most educated nurses possible. I started my career with an ADN, but soon went back to school to increase my education. I continued on to recieve my MSN, not because I was told to, but because education is life long learning. I also support certification for nurses to demonstrate knowledge, NCLEX only demonstrates basic competency. If you are ill and need a physician would you not choose one that is board certified? I would
Posted @ Tuesday, June 12, 2012 1:42 PM by Heidi
The shift to BSN requirements is going to leave many of us ADN students without the ability to even afford the education. The reason I started with an ADN is because I cannot get federal grants and cannot routinely rely on school grants to pay for school and still support my family. If I had to fork over 24K a year for a BSN, I would never have started back to school. Once employed as an RN I can complete a BSN. (I'm dually enrolled for the BSN now) An ADN is far more affordable and in my opinion the more rigorous of the two tracks. Our ADN program is in some instances, more highly regarded than the local BSN programs simply because we have a better success rate for graduation and passing the NCLEX-RN.
Posted @ Tuesday, June 12, 2012 2:42 PM by Heather
Truth of the matter is this shift has already begun in the major city where I live. Many facilities will not even consider an ADN graduate for hire! Sadly, many new grads are discouraged at the lack of prospective employers and feel their educational efforts were in vain. Many of my classmates work full-time, are parents and now they are faced with struggling even more to even be competitive in a market that screams SHORTAGE but refuses to acknowledge our education. It is frustrating to see the proverbial goal-post moved. As a class, we are now faced with the realization that a BSN must be achieved quickly or we face little to no choice in employment.  
I have nothing against going back to the obtain my BSN. My goal all long has been to become a NP-Educator but without an employer to allow me to practice it will make a daunting path even more perilous. I do wholeheartedly believe phasing out ADN programs will significant cripple the prospective RN population. However, the other aspect of this arguement that must be exposed is that many facilities are already phasing ADN's out by refusing to employ them.
Posted @ Tuesday, June 12, 2012 2:56 PM by Paula
I have intentionally keep my head in the sand regarding this topic and now find myself playing catch up.  
I have been an ADN for 26 years. And plan to have another 15 years ahead of me.  
Explain to me about 2020. Will they just require new grads to have BSN to take the test? Will ADNs still be RN's? Or is it that facilities will just hire BSN? How is that possible with the shortages? Will it be possible to just stay an ADN? Or is this a salary advantage?
Posted @ Thursday, July 12, 2012 1:06 PM by Kellee
I have been an ADN for almost 20 years, I have a sister who has her BSN, if you are a bedside RN it makes no difference in fact I believe ADNs are better prepared clinically than BSN nurses. Unless you plan on going forth with administration or teaching position, I see no need to spend the money on obtaining a BSN, especially if you are an older nurse, you will never recoup the costs to obtain the degree
Posted @ Sunday, October 28, 2012 10:49 PM by Paula Buydos
Here we go again! In the 60's and 70"s it was all about closing of the Hospital Based training schools to promote the BSN. Instead we developed the AD programs. Now we are trying to do away with the AD programs which are a postiive and productive pathway to a career. Yes, as an AD graduate with an MSN and a career in Reserach and Administration, I welcomed AD grads, encouraged and supported their advancement to BSN, MSN and NP careers. Our Profession keeps going around in circles from staff shortages to overflowing. Rather we need to develop a comprehensive policy for selection,educating,and enhancing skills across the career years.
Posted @ Tuesday, January 29, 2013 1:07 PM by Susan
What about outsourcing of Nurse jobs to other countries? Our Nursing industry is having hard time to survive.
Posted @ Thursday, March 14, 2013 4:26 AM by crestor online
Much of nursing education revolves around acute care rather than community settings that include aspects of primary care, public health, and long-term care. Nursing education frequently does not incorporate the intricacies of care coordination and transitions. Nor does it promote the skills needed to negotiate with the health care team, navigate the regulatory and access stipulations that determine patients’ eligibility for enrollment in health and social service programs, or understand how these programs and health policies affect patients and health outcomes. Nursing curricula need to be reexamined, updated, and adaptive enough to change with patients’ changing needs and improvements in science and technology
Posted @ Tuesday, May 14, 2013 12:48 AM by james
I just found your article while doing research for a MSN class. I am an RN with an ADN, and I also hold a BA in history. While I was in nursing school, I noticed that many BSN students were watching what I was doing in clinicals and mistaking me for a nurse with at least a year of experience based on what I was allowed to do as a student. I received much more hands on education and practice than my BSN counterparts did at the same points in our respective programs. Given the nursing shortage (that I believe to be manufactured by policy makers and hospital administrators), I feel that ADN prepared RNs will be instrumental in continuing to provide care to the patient population. I do not feel that BSN nurses will be able to meet all the needs of patients without the help of those RNs educated at technical colleges.
Posted @ Saturday, September 28, 2013 8:23 PM by Jennifer Pendergrast
The National League for Nursing reports in the 2008- 2009 academic year ... on the Future of Nursing at the Institute of Medicine made the following point, and I ... the proportion of nurses with a baccalaureate degree to 80% by 2020. ... ADN programs graduate the largest number of minorities, except in the Asian population. 
Posted @ Thursday, October 03, 2013 12:37 AM by marry
Medicine (IOM) Report on the Future of Nursing are reflected in our ongoing work to ... Competency Institute (CCI) are currently conducting a job analysis to explore ..... the ADN graduates to the BSN level within 10 years of licensure. Future ... IOM Recommendation 5: Double the number of nurses with a doctorate by 2020.
Posted @ Thursday, October 03, 2013 12:43 AM by sofia
Truth of the matter is this shift has already begun in the major city where I live. Many facilities will not even consider an ADN graduate for hire!
Posted @ Friday, October 11, 2013 7:09 AM by cipro buy online
I personally think that this issue is going one sided because like we all know, nursing should not just be about degree, because there is high shortage of nurses, there is not topic on compensating nurses for burnout, no topic about increasing nurses pay rate. Clinically speaking, what percentage of BSN holders can handle burnout in nursing? We must not forget that classroom nursing is completely different from real life nursing.
Posted @ Saturday, November 16, 2013 7:27 PM by Onyii
It makes sense that an employer would want the most educated individual correct? This goes for just about anything.  
The ADN programs are turning out new grad after new grad that cannot find jobs. Many have student loans or have built up debt during school, now what? Look around the web boards, there is such dispair. It is really sad. To further worsen the situation new grads are advised to take whatever job they can get in order to gain experience and then leave for a better job. This is wasted training money and nurses who aren't really into what they are doing. How would you like to have a nurse who only took the job because it was what all she could get? 
I think its irresponsible at this point to keep the ADN programs with such a dismal outlook for employment. Instead, turn them into a successful transfer student to get into a BSN program.  
On another note I'm sure we have all read the studies about death rates among ADN and BSN prepared nurses.... Just curious about people's thoughts on that....
Posted @ Wednesday, December 18, 2013 5:29 PM by Reg Nurs
I haven't seen too many bsn and master degree nurses doing bedside nursing in the hospital,other facilities or homes. The ones I worked with were managers or in critical care units. 
Most patients need basic bedside care nursing. I have heard Bsn and master degree nurses say, "I didn't go to school to pass bedpans and bathe patients." I know for a fact that healthcare is team work. It takes various levels of providers to be sucessful. I worked in the nursing field as a LPN for 8 years before going back to be an AD RN. I worked a total of 30 years in patient care nursing and loved it. Otherwise I would not have wanted to be a nurse. I think we will continue to need ADN level nurses. They should have the choice to advance if they want or need to. 
They should not be denied employment because they cannot afford or do not want to go back to school. If they get through ADN school they have given and sacrificed a lot. It is not easy for everybody. Maybe,the majority can continue their education. After all they are the majority. The majority rules? I think that nursing at all levels are needed and appreciated. I retired almost 11 years ago. Thanks to the field of nursing! Thanks to the nurses that continue to provide care at all levels!!
Posted @ Monday, May 05, 2014 8:30 AM by Concerned and Curious
I'd like to just say this..Bedside nurses are basically treated like dirt. Patients and families rarely say thanks for the good care provided. The majority feedback u will get is what wasn't done right not and look for ways the sue you. Most BSN and MSN nurses won't put up with this bull after having so much education. There is no need to take the ADN away from bedside. I do however agree that higher degree nurses seeking admin level positions should have a BSN or MSN.
Posted @ Friday, March 06, 2015 10:01 AM by Nurse David
I do agree that shifting the educational percentage to 80% BSN in the workforce makes sense, but this may not be feasible economically. As some of you have expressed in your post that a nurse is a nurse; I used to believe that when I was an ADN nurse. When I went on to further my education and graduated with my MSN it changed my perspective. I had no clue how to perform research as a nurse to improve outcomes for my patients. You see bedside nursing is not the only way to care for patients. It is finding new ways to do better at what we do. and not just to continue to perform task and duties the way we did "back in the day" because it worked. With new technologies and the emergence of new diseases and an aging population with people living longer with more chronic diseases; we as nurses must keep up with the technology and the best practices for improved patient outcomes. Nurses have to become critical thinkers and not just follow orders from others to provide for patient center care. How do we become critical thinker? through developing our minds and furthering our education. I am grateful for the opportunity to go back to school and receive my MSN. Now I teach at a local college to train and inspire our future nurses. I feel competent and confident that I am able to provide students with the tools they need to provide the best care possible for their clients using evidenced based practices and patient centered care.
Posted @ Monday, April 13, 2015 4:30 PM by Theresa Watson
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