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Competency Differences Between RNs Prepared at ADN Versus BSN Level

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Competency Differences Between RNs Prepared at ADN Versus BSN Level Nursing education in the United States offers many levels of competency falling under the licensed title of registered nurse (RN). These levels offered in a continuum, begin with nursing as a vocation in the form of licensed practical/vocational nurse (LPN/LVN) followed by an associate degree (ADN), baccalaureate of science degree (BSN), masters of science degree (MSN) and doctorate. All have curriculums that build upon the previous designation in hopes of creating a highly sophisticated nursing profession geared toward handling an evolving healthcare system of diverse populations, technical advances and outcomes. This paper will focus on comparing the competencies between the ADN versus BSN education in order to highlight the need to pursue a BSN level of education.

Research conducted by Poster et al. (2005) notes differing curriculum for each type of nursing program produces a difference in entry-level postgraduate competencies within clinical behavior, judgments and knowledge base. These differences according to the American Association of Colleges of Nursing (2005) are largely in the “research, theory, public and community health, management, and humanities (AACN, 2005). The associate degree education was a response to nursing shortages and provided an affordable, rapid educational choice to motivated individuals who wanted to enter the medical field. The education is provided at a community college covering the sciences, pharmacology and clinical skills. The two-year nature of the program doesn’t provide the time or development for critical thinking skills in addition to research, theory, public health, management and leadership that are offered in a baccalaureate education. The BSN education is offered over a period of 4 years in a college setting providing a more holistic approach to an individual’s nursing experience. This “incorporates the roles of assessing, critical thinking, communicating, providing care, teaching and leading” (Grand Canyon University, para. 7). I also believe that an individual’s maturity over a four-year period has time to evolve with the concepts of critical thinking and decision making the BSN framework offers.

The difference in cost and time from ADN to BSN programs is a deciding factor in many educational decisions. The economy and decrease in job opportunities has driven many into the nursing profession that may not have initially considered it a career option. Sadly, I believe that has contributed to the lack of interest in pursing an advanced education. The professional choice wasn’t driven out of a motivation to help humanity or a sense of altruism; it was merely an employment opportunity. The differences in critical thinking skills can be applied to a clinical setting to compare the differences between an ADN, diploma and BSN education. One of the clinical setting scenarios that illustrate the differences in decision-making based on educational preparation is in the case of discharge planning. The clinical picture is that of an eighty-year old female being discharged after a fall that created a significant wound requiring complex wound care and a wound vacuum. Her spouse requires a walker and help with his activity of daily living (ADLs).

They live together and up until this point the female drove for both of them. It is up to the RN to begin the process of discharge planning and coordination with the interdisciplinary team to provide a safe plan for this patient. Beginning with the ADN, I believe she would be successful at contacting a home health agency to provide wound care and visits for dressing changes. She would be able to arrange for transportation home and be of assistance in helping the patient to schedule a physician office visit. I’m not sure due to a lack of education in public health awareness that the ADN would be capable of a broader assessment that would take the spouse, the home environment, other caregivers, or other options for care outside the home. I believe the Diploma RN would have taken a broader approach to the assessment to include the spouse, home, caregivers and alternative care options, but I think the diploma RN would be limited by her lack of theory and knowledge of research outcomes to be able to extrapolate that into more advanced thinking regarding the best alternatives for wound management and care of a wound vacuum within the home of two elderly people, one of which is dependent on the other for ADL’s.

The BSN having an appreciation for evidenced-based outcomes has recently read a study advocating that wound healing is impacted by dressing changes, wound vacuum care and observations performed by specially trained wound RN’s. The BSN, knowing this, either advocates for a skilled care center or home health agency that offers wound RN consultations, thus assuring that her patient has a better chance of healing without complications. The BSN’s critical thinking skills produce a proactive, preventive approach that is individualized to the patient’s condition, environment and social history. In conclusion, the difference in competency between an ADN and BSN education has many implications, one of which is patient mortality. In one study “a 10% increase in the proportion of nurses holding a bachelor’s degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue” (Aiken, Clarke, Cheung, Sloane, & Silber, 2003, p. 1617). This type of outcome especially in patient mortality demand that more attention is placed on helping nurses to advance their educational levels in pursuit of professional excellence and most importantly public safety.


Aiken LH, Clarke SP, Cheung RB, Sloane DM, Silber JH. Educational Levels of Hospital

Nurses and Surgical Patient Mortality. JAMA. 2003;290(12):1617-1623.


American Association of Colleges of Nursing. (2005) The Impact of Education on Nursing Practice. Retrieved from http://www.aacn.nche.edu/media-relations/EdImpact.pdf Grand Canyon University College of Nursing Philosophy [ para 7]. Retrieved from http://www.gcu.edu/College-of-Nursing-and-Health-Care-Professions/Philosophy.php

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