The initial question
If you want to become a registered nurse, is it better to enter a two-year associate degree program (ADN) or a four-year bachelor degree program (BSN)? Graduates of either one are eligible to become registered nurses. So most students who want to become registered nurses ask the same question – why would I go to school four years when I can get the same registered nursing license in two? It’s a fair question, and the answer depends upon your career goals and financial resources.
First let’s look a basic nursing education ladder.
Nursing Education Ladder
|Name of Nursing Degree||Details about Credential|
|Diploma in Nursing||• 12-18 months to complete.
• May trained in a hospital.
• Less common today.
• Gradually being phased out.
|Associate Degree in Nursing (ADN)||• 18-24 months to complete.
• Offered in community colleges and career/trade schools.
• Sometimes there is a waiting list to get in.
|Bachelor of Science in Nursing (BSN)||• 4 years to complete.
• 18-24 months to complete if applicant has an associate degree in nursing.
• Offered in colleges, universities and some career schools.
• Some lecture classes may be offered online.
|Doctorate in Nursing||• Depending upon type of doctorate, can take 3-6 years to complete.
• Can be completed on ground or online.
• Offered at universities.
• Three possible credentials:
• Doctor of Nursing (ND)
• Doctor of Nursing Science (DNSc)
• Doctor of Nursing Philosophy (PhD)
As you can see, if you embark upon a nursing career, you can start at a diploma level and gradually advance to the next nursing credential. But there are limitations on what you can do with each one. Each successive degree takes longer to complete and requires a greater financial investment. However, the more education you have, the better your income and career opportunities.
Beyond the BSN there is the MSN (master’s of science in nursing) and doctorate degrees as well as specialized nursing certifications. The minimum of a BSN is required to pursue many of them.
In November 2017, a survey was facilitated by Nurse.Org. Results revealed the current top ten nursing specialties. The pie chart below shows you those, many of which require at least a BSN plus an additional certification to get started. The information on the chart may assist you in determining whether to start your education at an associate degree level or if it’s better to enroll in a BSN program right away.
What advantages are there to being a BSN-prepared nurse?
It’s important to understand that regardless of your initial degree (AND or BSN), once you pass the National Council Licensure Exam for Registered Nurses (NCLEX-RN) you will be a registered nurse. You can learn more about the license through the National Council of State Boards of Nursing.
With an ADN you’ll provide basic patient care and may work under the supervision of an RN who possesses a BSN. While there may be some advancement, options are limited. But a BSN opens more doors, and opens them more quickly.
A typical registered nurse position includes some or all of the following tasks:
- Conducts more complex procedures than an ADN-trained RN.
- Consults closely with doctors.
- Educates patients.
- Provides basic nursing care.
- Records patient symptoms and medical history.
- Supervises staff.
- Supports the family of the patient.
- Uses simple medical equipment.
With a BSN you’ll often be seen as a leader and may be promoted faster. If you choose, you can go into nursing fields outside hospitals. You could become a nurse educator or public health nurse. You can more easily step into one of the nursing specialties, which enables you to earn higher salaries. With a BSN you’re also only a step away from a master’s in nursing (MSN), which makes you eligible for additional nursing certifications.
The following charts provide a quick view of the primary advantages of both degrees. If you strictly compare the number of advantages between the two, the BSN is the optimal choice. But numbers cannot make all decisions. How an additional two years of education versus four years of education impacts your life and your financial resources is an intangible you have to consider in your decision.
The main advantages for obtaining a BSN
|BSN Advantage||Explanation of BSN Advantage|
|Some nursing careers are open only to BSNs.||• A BSN is necessary if you want to go to graduate school (MSN).
• Advancing into one of four of the highest paying nursing jobs requires a BSN. (These are: nurse anesthetist, clinical nurse specialist, nurse midwife, and nurse practitioner.)
• A BSN is required to move beyond providing basic clinical care.
• Only BSNs can move into administration and supervision.
|BSN curriculum goes beyond teaching of clinical skills.||• BSN curriculum includes communication, critical thinking and leadership skills – all required for higher paying nurse employment.
• The American Association of the Colleges of Nursing (AACN) considers a BSN as the minimum requirement for a professional nurse.
|BSN holders provide better patient care.||• Research by the AACN as well as the Health and Medicine Division (HDM), appears to validate a BSN nursing education translates into better patient care, including lower mortality rates.
• AACN research indicates BSNs have better proficiency in making good diagnoses.
|BSN may be a future requirement.||• The HDM recommends that the number of nurses holding BSN degrees be increased from 50% to 80% by 2020.
• The HDM strongly encourages nurses to get their BSN within five years of earning an ADN.
• The AACN is following the HDM’s recommendations.
• Many healthcare providers will only hire BSNs.
|BSNs are eligible for a wider range of professional advancement.||• With a BSN, you can enter specific nursing specialties such as surgery, gynecology or oncology.|
The main advantages for obtaining an ADN
|ADN Advantage||Explanation of ADN Advantage|
|Obtaining an ADN gets you into nursing practice quicker.||• An ADN only takes 18-24 months to obtain.
• An ADN enters the field of nursing practice quicker.
• Less time is spent in theory and more time is spent in practical application while in school.
• Less time in school means you enter the job market sooner.
|Because an ADN program is shorter, tuition costs are lower.||• Less time in school means less tuition to repay.|
|ADNs who pass the NCLEX-RN are still registered nurses licensed to practice nursing.||• Although an ADN takes less time, you still acquire the skills you need to be a registered nurse and to pass the NCLEX-RN.|
Why do hospitals prefer BSN-trained nurses?
Because healthcare is such pervasive topic in the United States, all providers strive to meet the highest clinical practice guidelines possible. The less arbitrary the practice, the more consistent medical care becomes. As a result, the Institute of Medicine (IOM), now known as the Health and Medicine Division (HDM), a part of the National Academies of Sciences, Engineering and Medicine adopted, and published eight care standards. Now hospitals and other allied health providers conduct self-evaluations to ensure they meet those criteria. One of the guidelines is to hire only BSN-trained nurses. You may wonder about this distinction if the registered nursing licenses are the same.
Ongoing research appears to validate that BSN-prepared nurses administer a higher quality of care to patients. As a result they achieve better patient outcomes. The two additional years of education students in BSN programs experience provides greater rigor, depth, and scope of training and clinical experiences. This creates positive differences when starting to work with patients on a nursing floor.
The following video gives you more information on the HDM (formerly IOM) standards and their development.
Is a BSN mandatory?
You may have heard discussions that registered nurses who don’t have a BSN will have to get one. The HDM is applying much pressure on the healthcare industry to make a BSN the minimum requirement for nurses. Their recommendation is for 80 percent of all nurses to hold a BSN by the year 2020. Although no formal requirement is yet in place, it seems likely that this qualification will become standard. As a result, many employers, especially hospitals, are voluntarily making the BSN a minimum requirement for their nursing staff.
The following video from The Robert Wood Foundation provides additional information, and insight, on this discussion.
What are the educational differences between an ADN and a BSN?
The education in an ADN program and the one offered in a BSN program is vastly different. There are two immediate distinctions.
- Length of time – An ADN can be completed in 12-18 months. Most BSN programs take 48 months. So, entering the nursing field is quicker for ADN-credentialed nurses.
- Financial investment – The longer a program takes, the more expensive it is for a student. Additionally, the longer a person is in school, the longer it takes to enter the field and start earning a salary.
According to American Association of the Colleges of Nursing (AACN), traditional ADN and BSN programs both teach the competencies of nursing. Both also require nursing clinical experiences, which provide direct patient-care learning and application in healthcare settings.
But BSN programs also give students more gives students a more comprehensive vision of patients and patient care. Clinical experiences are more extensive, and include the practical application of leadership and supervisory skills
BSN programs provide:
- Advanced classes – Advanced classes provide higher and more in-depth detail about the complex issues affecting patients and the overall healthcare environment.
- Leadership training – Specific training on leadership, management, public health, social sciences, and critical thinking helps nurses gain employment as administrators, researchers or educators.
- Nursing informatics – Advanced courses teach new technologies present in the workplace.
- Nursing theory – Nursing theory teaches nurses how to see a broader picture of healthcare and how they fit into that picture.
Because healthcare must be viewed in light of cultural, economic and social issues, a BSN curriculum also incorporates how those factors impact medicine and healthcare delivery systems. These additional courses contribute to why better patient outcomes and higher standards of care are attributed to BSN-prepared nurses.
However, not everyone is in a position to start out in a four-year program. So earning an associate degree in nursing and then passing the NCLEX-RN is an excellent place to start. Then, with time and experience, practicing nurses can go back to school and obtain their BSN.
What are bridge programs?
Current ADN registered nurses who want to earn the BSN credential in less time can complete something called an RN to BSN bridge program. A bridge program is exactly that – an educational “bridge” that moves RNs from an associate degree to a bachelor’s in 12 to 18 months. The number of courses an applicant has satisfactorily completed in their associate degree program that can also transfer into the bridge program determines its length.
Individuals seeking a second career as a nurse may also find a BSN bridge program helpful. It can assist in adapting someone’s acquired skills to the skills needed for entry into a formal nursing program.
Committing to two or four years of school is a big decision. So sitting down with trusted friends and family and reviewing your options may be helpful. Creating a support system to help you with transportation, homework, and other life obligations can create the time and environment you need to take on the demands of professional nurse training. Whether you start out with an ADN or a BSN, you will find this kind of preparation makes a positive impact toward achieving your goal.
Take time with your decision, and then make the one that best suits your needs.
Would you like to get started on a path to nursing right away? No problem. The Apprentice Doctor offers two different kits that can help you take your very first step.
The Apprentice Doctor® Suturing Course and Kit is a resource that teaches you How to Suture Wounds in a short period of time. As a nurse, you’ll use this skill, so why not get started now? The kit contains everything you need you need to get started. Take a look at the following video for a closer view of kit items.
The Apprentice Doctor® Phlebotomy Course and Kit is another handy resource at your fingertips. This kit teaches you how to confidently perform phlebotomy procedures. Drawing blood is another skill nurses need – and they have to be very good at it to minimize any discomfort to the patient. If you want to start your education in nursing, why not begin phlebotomy training right away? Take a quick look at the following video to see all the items contained in the kit.
The Apprentice Doctor offers more articles on nursing. You may be interested in the following:
For an podcast interview with a surgical nurse, click here.