January 7, 2010, 1:32 pm

Speaking of Degrees…

cutiedollI love this doll!!!!

She’s so cuuuuuute!!!!!!!!

I should buy her. Found her at Ruby Lane, which has a bazillion shops, but if you type “nursing” into the search box you will find a treasure trove of nursing ephemera. Diplomas, pins, yearbooks, prints, journals – I’ve found stuff I didn’t even know existed.

Bought an entire year of the American Journal of Nursing (’58) and it is in my closet, just waiting for me to scan!

I see a resemblance.

Must be the freckles.


interviewLooking to hire nursing staff?

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Are you looking for a new job? They’ve got hundreds of positions listed. I know, I’ve checked it out. Not that I’m looking for a new job, or anything. Just like to keep an eye on what is going on out there.


The discussion regarding the entry level for nursing has been ongoing for decades. I have articles written in the 1940s extolling the virtues of the BSN long before the first ADN program opened in 1952.

Every now and then, someone broaches the topic of making the BSN the entry level and BAM! the flames that ensue make the health care reform debate look like Mr. Roger’s Neighborhood.

Why the rancor?

Well, if one states that the BSN should be the entry level for a registered nurse, then it follows there must be a reason why an ADN should not.

That does not sit well with ADN graduates.

It sure didn’t sit well with me.


Now, 5 months away from graduating with my BSN, I see a difference.

Or, I guess you can say I feel a difference.

I am a different nurse than I was 2 1/2 years ago.

Notice, I didn’t say “better”.


My clinical skills are the same.

If you want to define nursing as the ability to put the right tube in the right orifice using the right technique, the BSN gives no advantage. Clinical skills for the ADN and the BSN are taught in class but honed in practice. While the ADN program may include more clinical hours, it has been my experience that neither program produces nurses ready to “hit the road running”.

My understanding of nursing has broadened.

Some disdain nursing theory and say it has no basis in daily practice, but have they really looked at what theories are out there? All nursing programs are based on one. For me it was Sister Calista Roy’s Adaptation Model. Theories give a framework, a way of approaching assessment and care, a nursing philosophy.  You can argue that it’s useless, but you are using one every day, whether you realize it or not.  Now, it will be a cold day in Hades before I use “Energy Field Disturbance” as a nursing diagnosis but until I studied theory, I had no idea that Rogers’  Science of Unitary Human Beings even existed.  When I saw Jean Watson’s Theory of Human Caring, it was like getting hit by lightening. Watson’s theory, to me, is nursing.

Do my patients know which nursing theory I adopt? No. Do they care? No.

But I know. And I care. My nursing care has more depth, more perspective and a greater meaning to me because of the wider knowledge obtained through an in depth study of nursing theory.

I didn’t get that in my ADN program.

The nursing profession is more diverse than I imagined.

Okay, yeah I knew there was home health and public health was something done “out there” somewhere and some nurses worked 9-5 in a clinic, but like a horse wearing blinders, all I saw is what was right before me. Bedside hospital nursing.  That’s what I was educated to do.  Anything outside of bedside nursing required a BSN, minimum. No way was I going to do that! Blech! I lived nursing full time as it was.

As a result, I was never able to take advantage of opportunities that were there when I was so burnt out at the bedside I left crumbs when I walked.

Case management, nurse practitioner, becoming a nursing professor, home health, nursing research, school nursing and lord almighty, public health!!!!  I had no idea about public health – I thought it was visiting people in homes and running immunization clinics. It’s is that, but it is so much more!

You can advocate for patients, thousands at a time, in so many ways!

I was not exposed to that in my ADN program.


I guess you could say the last 2 1/2 years have been a transforming process for me. The BSN program has enriched my life, my practice and, although they would never know it, my patients.

So, do I think the BSN should be the entry level degree into nursing?

Well, if I said yes, I’d need Secret Service protection!

I would say if you are just entering the profession and it’s at all feasible for you, go the BSN route from the start.

I think it should be required – BUT (hold your fire!) there much to be said for being an ADN grad and then going for the BSN. In fact, I would almost recommend that. I know that I have gotten so much more out of the BSN education with many, many years of clinical practice behind it.

When you are an ADN and you are studying for the BSN, you have perspective, a place to assimilate what you are learning into your current practice. Subjects like nursing theory and research take on a clearer perspective, as opposed to being vague ideas and dull methodologies.

The BSN is worth getting.  I know I have developed both personally and professionally.

(Now, if I can just get through this last semester…)


  • paedsnurse

    January 7, 2010 at 2:04 pm

    I did the BSN program but only after I had completed my first undergrad degree. I feel like the extra couple of years helped me mature and develop my thinking before I even began nursing school. When I think back to when I was in undergrad, was I really ready for the responsibilities of being a nurse?

    Watson and Rogers were the two theories that I understood the most. Watson first and foremost and Rogers second. And I wholeheartedly agree with you: Watson’s theory IS what nursing is about!

  • Bill

    January 7, 2010 at 4:36 pm

    As a librarian, I am happy that you have discovered research, and apparently have enjoyed it. That is what your librarian is here for, to help you become a more well-rounded nurse. Employment website looks good, not going to recommend to friends 😉


  • Nurse K

    January 7, 2010 at 5:56 pm

    Nursing theories are what academians make up to remind themselves of what nursing is since they haven’t done it in so long. Oh, and learning about them = watching grass grow only without all the excitement.

  • RehabRN

    January 7, 2010 at 6:26 pm

    I’m with paedsrn, Kim. To go straight to a BSN program straight out of high school would not have worked for me.

    I learned a whole lot of useful tricks in the business world, especially telephone etiquette and how to be service-oriented. I also learned to work in teams, something that is sorely needed on many units, especially my own. We all have individual licenses, but when we think we’re all “superstars” and shouldn’t help others, we’re making a big mistake.

    BTW Dorothea Orem is my favorite nursing theorist, with Martha Rogers and Sister Callista Roy right behind (did lots of studying of them for my cert exam).

  • NPs Save Lives

    January 7, 2010 at 6:38 pm

    What a cute nurse doll! Yes, she looks a little like you.

  • Nosokomaniac

    January 7, 2010 at 7:01 pm

    “I have never let my schooling interfere with my education” – Mark Twain

    My goal is to become a CNA at the moment and work while chasing my LPN/ADN (depending how the semesters fall). Then work for a bit, then work while chasing BSN. Then work some more, then further as I discover what I truly enjoy.

    Any career, and I’ve had lots, should be worked through at your own pace. But I can’t shake the feeling that easing into nursing, with a liberal dose of real-world experience along the way, seems to turn out more people who know what they want.

    I’m no expert on the argument, but my completely anecdotal opinion (friends, scouring thru blogs/message boards, and chatting with educators) is that working as much as possible in the field along the way, in tandem with studies, helps. So that time between ADN and BSN can’t hurt. Heck, the time between CNA and ADN can’t either. In fact, by most of the opinions I can find, it helps immensely.

  • Kerri.

    January 7, 2010 at 7:25 pm

    Is that doll holding … holding another doll?

  • Kim

    January 7, 2010 at 8:42 pm

    For me it comes down to money. I can afford the ADN now – it costs something like 1/10th as much in tuition – and once I am working in the field I really hope I can find my way to a BSN/MSN. I will understand that when I get there, but right now I just need to get my RN. But this is the best post I’ve seen on the topic – when I started this whole project of deciding my path to nursing, it was stunningly confusing and no one was explaining without being polarizing why I might want to choose one road or the other.

    I’d gladly go to a University and get a BSN, if it didn’t cost so freaking much.

  • ER Nurse_JR

    January 9, 2010 at 5:05 pm


    All through high school, I always wanted to go away (far from home) to college, spend 4 years there and get my bachelors in nursing. I had it all planned out: graduate w/ my BSN at 22 and be working shortly after. My 5-year plan did not go as planned, mainly because I grew homesick (ironic) and came back. I knew I wanted to be a nurse, but getting into another nursing school was tough. My path to nursing school was not easy, but then again nursing is not easy, so it made me greatly appreciate my opportunity to attend school and ensure I did the best work I could do, then and now. I went to a hospital-based nursing school and am an ADN graduate from May 2008. I do feel that an ADN hospital-based program repeatedly exposed me to more basic nursing skills, better preparing me for my first days as a “new” nurse.

    I will not criticize an ADN program, but like you, I now see the benefits of a BSN. I am currently enrolled in an online BSN program. I knew I needed a BSN to further my career and education and only looked at it a stepping stone towards the MSN. As the program has progressed, I am learning more about myself, my profession, and my roles as a registered nurse. I find myself being more pro-active in the care of my patients and in bettering those I work with. I never realized how much the BSN program would change me, but I am happy I choose to pursue a BSN.

  • Jo

    January 12, 2010 at 8:58 pm

    Congrats on going back to university! The world of opportunities will continue to open for you within the nursing profession in adminstrative, management, education, specialist roles.. and also past nursing if you wish (as you have an undergraduate degree). YAY nursing! 🙂

  • Jo

    January 12, 2010 at 9:01 pm

    … and like you I absoulutely adore the ‘upstream approach’ to healthcare that public and community health provides.

  • […] BSN vs ADN-Battle Royale of the Century! Posted January 13, 2010 Filed under: Nursing Profession | Tags: 2 year vs 4 yr nursing degree, ADN vs BSN, associate degree in nursing, bachelors degree in nursing | Kim, at Emergiblog, wrote this post about her feelings in obtaining a BSN degree after working as an ADN for…. […]

  • Pattie, RN

    January 14, 2010 at 8:53 am

    Great post…the facts without mud-flinging! I had a BA in another field before I got my BSN, and was a mother, which really was great prep for Nursing 101. I am a new Nursing Educator and just starting my MSN, and frankly have not worked at the bedside in a hospital since 1994 (I graduated in ’91) SInce then–home health, hospice, public health, occupational health, and now, finally, the teaching I have wanted to do for years. The BSN opens minds and doors. oh—and I am an Orem gal through and through…only do for the patient what they can NOT do for themselves and teach them self-care (and that is the essence, really, of home care…)

  • Quilter Nurse

    January 15, 2010 at 3:42 am

    Kim, love your blog even though I am a critical care nurse and have been for 35 years. You crack me up and have me laughing though the quiet nights in the ICU (like ER those nights are rarer and rarer at our hospital).

    Like you, I was a late comer to the BSN. Did the hosptial diploma program, was ready to go full bang the Monday after graduation and loved it. Changed to ICU in 1975 and truly found my niche.
    Went back for an Associate’s in the early 90’s but chemistry scared me off of completing the BSN then and then there was the need to get my kids through college.
    My hospital united with a University to provide RN-BSN classes with great financial support and I did it! Graduated in 2007 at age 58. Like you found, the BSN provides more seasoning and rounding out. Theories seemed so ephemeral but surprisingly absolulely was basis of what I did daily.
    Would agree that if one can do the BSN first it’s worth it but think that in this economy, ADN is good to start, get some clinical experience then have the funds to complete the BSN with greater meaning.

    Keep up the good work, I look forward to the laughs!

  • […] *This blog post was originally published at Emergiblog* […]

  • Susan

    January 19, 2010 at 6:26 pm

    I am really enjoying all of your thoughts on this topic. I went right through BSN after high school and am so glad. I have thought BSN should be the only way to begin practice, but now I see life’s circumstances certainly show good rationale for AD first. I applaud all of you working your way up there. I started as a CNA also (well, that was before there was certification) and now my daughter is going through CNA classes to get her start in health care. I just finished my MSN 17 years after getting by BSN. We definately need more research comparing BSN vs. AD preparation in a variety of settings. Research starts with us.


    January 31, 2010 at 8:30 am

    Great post Kim. I too am a “late bloomer,” finishing my BSN in 12 months after almost 30 years as an ADN. The BSN has broadened my thinking and knowledge and has made me realize how much I more I have to give. I start working on my MSN in March!

  • […] 9. “Speaking of Degrees…” at Emergiblog […]

  • […] Speaking of Degrees… (emergiblog.com) […]

  • roni

    November 17, 2010 at 5:02 pm

    lvn to rn?

    hi there is a school i am interested in but they require getting my lvn first and working one year then getting the rn. does that make sense? is that a good strategy? help please? i am also interested in psychiatric nursing, i have my masters in counseling and am thinking of becoming a nurse? any suggestions or ideas?
    thanks for all the help in advance!

  • FancyScrubs

    January 30, 2011 at 3:14 am

    Love the nursing doll within a doll!

  • Julie

    May 14, 2011 at 1:30 pm

    I am in my last semester of nursing school going for my BSN and it wasn?t until just recently and after meeting and being in the clinical setting with other students from other schools going for their ADN degree that I realized how fortunate I am to be in a BSN program. I feel like I have a much more well-rounded education. Yes students from both programs will graduate with the same skill set but it is the theory behind the skills that I feel will make me a better and more prepared RN. The program I attend places a lot of emphasis on research, evidence-based practice and theory which is the foundation of quality and safe nursing practice. The BSN program also focuses on leadership, public health and communication which I feel is equally important. I have a much greater understanding and knowledge base because of that. I can honestly say that when I perform a task or a skill, I know the rationale behind why I am performing that task or skill. I feel that this has also contributed to my greater understanding and ability to critically think. ADN grads certainly will be successful RNs but I really do believe that the entry level of preparedness and implications for safe and sound nursing care which are most often clarified by research and nursing theories will not be on the same level. I also feel that the critical thinking skills that I have developed cannot be taught at the bedside and this I believe gives me a long-term advantage. As the BSN program comes to completion and my future career as an RN approaches, I truly feel that I too have more depth when it comes to understanding, perspective, knowledge and meaning and that my BSN will prepare me for the full scope of professional nursing responsibilities.

  • Sherry

    June 1, 2011 at 1:01 pm

    I started out taking classes at a community college and planned on getting my ADN there. I finished all of my basic classes and found that there was a 2 year waiting list. I looked at my options and decided to transfer and get my BSN. I am in my last semester and have had the opportunity to meet several nurses with their ADN and they all told me that they desire to go back and get their BSN. I learned a lot from the ADNs but I did notice that there were things I learned in school that they didn’t know about. My program is based on evidence-based practice, this is one area that I found was not apart of many of the ADN programs. I feel that I have received a more well rounded education in my program. I do look forward to learning more from my ADN coworkers and I hope they can learn from me as well.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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