Differences in competencies between nurses prepared at the ADN versus the BSN
The nursing curriculum has been evolving over time to meet the needs and demands of the population which have been changing over time. In a bid to ensure that care delivery meets the optimal goals of recovery, restoration and sustaining a high quality of life, the basic foundation for the nursing profession has been on ensuring that the curriculum adequately prepares the nurses for the tasks ahead (Auerbach, Buerhaus, & Staiger, 2015). A particular response that the profession can refer is the Future of Nursing Report by the Institute of Medicine which required that nurses be allowed to the highest level of their education and knowledge while at the same time opening up the channels for the nurses to pursue their education to higher levels so as to enable them grow into their roles and even venture into the more demanding roles of leadership and management (Institute of Medicine (US), 2011).
The IOM report based its recommendations on the fact that the limited scope of practice for nurses significantly impacted on the ability of the sector to cope with the needs of the population which were predicted to expand beyond the capability of the physicians and doctors currently in practice and those who will ultimately be integrated into the system in future. One of the aspects that emerged from these changes was the differentiation of the Bachelor of Science in Nursing (BSN) and the Associate Degree of Nursing (ADN). The ADN has previously been the hallmark upon which entry-level nurses would be admitted into the roles of the Registered Nurses (RNs) (Rosseter, 2014). However, with the expanded channels for education, the BSN role emerged. Since then, a debate as to the differences in competencies between these two roles; that is the BSN and the ADN have been on the public sphere and even at the workplace.
The BSN-prepared nurses and the ADN-prepared nurses are all expected to pass the NCLEX-RN exams for licensure as the common point. The NCLEX-RN does not in any way test any differences in the preparation of nurses across the BSN and ADN roles. Rather, it seeks to test the competency of the nurses as they prepare to get into basic practice. In essence, on the levels of preparedness to manage patient situations are within the same level which implies that at the level of clinical practice, these two roles will achieve equally optimal results as long as the other factors such as infrastructure, individual patient needs and the collaborative environment are constant across the workplaces (Rosseter, 2014).
The major differences across BSN and ADN programs is that the BSN equally emphasizes on the entire course work covered in the associate degree program but in a more in-depth approach due to the availability of time. Apparently, the ADN program is covered within a period of two to three years while the BSN is covered within four years. The ADN prepares the nurses for the actual clinical roles and it is more specific to the technical areas of nursing. Essentially, the AND has its focus on five key competencies including the nursing process, professionalism, collaboration, communication as well as managing care (Institute of Medicine (US), 2011). These roles technically define the more specific aspects of clinical work and the technical issues that emanate at the site of care. With the BSN program, more focus is given to each of these competencies with additional focus on physical sciences, social sciences, community and public health, nursing research, nursing management, leadership as well as humanities and their influence on the nursing process (Matthias & Kim-Godwin, 2016). The BSN nurse therefore focuses on the competencies offered in the ADN while also emphasizing on the professional development of the nurse. The BSN enables the nurse to adopt and utilize the skills in nursing and apply evidence-based practices in resolving the clinical issues that they may face at the workplace.
Further, the BSN also focuses on the role of modern technologies and therefore preparing the nurses on the applying these technologies in patient care. On the other hand, the BSN enables the nurses to effectively explore the aspects of healthcare finance, regulatory and policy mechanisms as well as quality assessment, quality improvement, patient safety and informal and formal leadership roles (Matthias & Kim-Godwin, 2016). Despite these differences, it is important to recognize that in the actual delivery of care, all nurses are prepared effectively and within similar environments, there would be no difference in the care provided by the ADN-prepared nurse or the BSN-prepared nurse. This is based on the recognition that the nursing process competency is widely emphasized across the two programs thus equipping the nurses with the basic skills of clinical work which can be proven by the administration of a common NCLEX-RN exam which has provided a leverage across these two programs to allow the two groups practice within the same scope (Auerbach, Buerhaus, & Staiger, 2015).
Patient care situation describing how nursing care or approaches to decision-making across BSN versus ADN
A typical situation that I have encountered is in regard to an elderly patient, 67 year-old who presented at the clinic with complaints of headache, dizziness and a chronic wound on his right arm. He was diagnosed with diabetes five years ago and has recently, as early as eight months ago been diagnosed with depression. The death of his wife, two years ago and the death of his two sons and their families in a grisly road accident subjected him to a coma for three days which on recovery he was later diagnosed with the depression. He lost all his businesses when his partners decided to collude with attorneys and he now depends on the good will of his friends and his church to foot his bills. He has been seeking to sell his house and remaining properties and die ‘die peacefully on the streets’. He does not have a social insurance which he has been unable to sustain.
The ADN nurses at our facility recommended that the patient be admitted into the geriatric unit upon which his condition will be monitored and care management made on a review basis. However, within the care team, the two BSN-prepared nurses argued that the patient be attached to a permanent social worker and caregiver who will help the patient their care as well as their properties and help in the recovery of the patient’s social and health life. Ultimately, the decision was settled on having the patient attached to a permanent care giver as this was thought to be the best holistic approach to the management of the patient and aid in the patient’s ability and will to seek independence and a viable quality of life (Auerbach, Buerhaus, & Staiger, 2015).
References
Auerbach, D. I., Buerhaus, P. I., & Staiger, D. O. (2015). Do associate degree registered nurses fare differently in the nurse labor market compared to baccalaureate-prepared RNs?. Nursing Economics, 33(1), 8.
Matthias, A. D., & Kim-Godwin, Y. S. (2016). RN-BSN Students’ Perceptions of the Differences in Practice of the ADN-and BSN-Prepared RN. Nurse educator, 41(4), 208-211.
Rosseter, R. J. (2014). The impact of education on nursing practice. American Association of Colleges of Nursing Fact Sheet.
