Transitioning from ADN to BSN: A Nursing Education Plan

From ADN to BSN: The Case for Transition

While both the Associate Degree Nursing (ADN) program and the Bachelor of Science in Nursing (BSN) program lead to licensure as a registered nurse (RN), the BSN program provides nursing students with considerably more exposure to the training, knowledge, skills, and experience that prove useful in a real-world nursing environment. The ADN program, by contrast, is more limited and does not fully exploit opportunities for deepening students' knowledge of and appreciation for the nursing concepts required in today's health care industry.

For example, an ADN program does not devote as much time to the importance of evidence-based practice as a BSN program does, nor does it provide as many simulation opportunities for students to strengthen their clinical skills in a controlled environment before entering live clinical settings where decisions can be a matter of life and death. For these reasons, transitioning from an ADN program to a BSN program is the recommended route for nurses today.

Factors, IOM Guidance, and Program Barriers

Two factors that influence the need for a BSN program are social and economic, as Khawaja (2015) has noted. The social factor is the reality that BSN programs provide students with greater choice in how to apply their human capital. An ADN program offers nursing students only a limited range of career options, whereas the BSN program establishes a firm foundation upon which a policy of lifelong learning can be built.

Moreover, nurses who complete a BSN program emerge with greater range and depth of training that prepares them to provide a higher quality of life—both economically and socially—for themselves as they pursue their careers, and a higher level of quality care to a diverse patient population. A BSN program may offer courses in community nursing, pediatrics, psychosocial nursing, and related subjects, all of which give nurses better preparation for addressing the needs of patients and for building a solid base of nursing knowledge that can be used to pursue more advanced careers. Additionally, the more education an RN possesses, the more critical that RN is to a country's health: such nurses are able to offer care across a range of settings (Kirschling, 2017), thereby providing social and economic support to the nation's infrastructure (Well, 2007). Thus, both social and economic factors point to the need for BSN programs.

The Institute of Medicine (IOM) has informed the decision for a BSN program by promoting its "Future of Nursing" initiative, which advocates for increased education for nurses. The IOM (2010) recommends that the percentage of nurses holding a BSN reach 80% by 2020. Another goal is for the number of nurses with a PhD to double by 2020. These targets cannot be achieved without more BSN programs giving student nurses greater opportunities to advance their education.

The IOM (2010) recommends that, in order to integrate quality and safety initiatives in the BSN program, there should be greater focus on evidence-based practice, collaborative practice, teamwork, and the use of technological tools that support an environment of high-quality care. Following these recommendations, nurses are expected to practice to the full extent of their education in serving their communities and to provide safe, quality care to patients.

The IOM (2010) cites high turnover rates among nurses resulting from a lack of transition-to-practice residency programs and insufficient education and training for student nurses. ADN programs do not offer enough opportunities for nurses to prepare for the real-world challenges that await them in today's health care facilities, where patients present with a complex array of health problems. Nurses who obtain a higher level of education are better positioned to help patients with more complex issues. The more education and training a nurse receives in evidence-based practice, collaborative care, teamwork, and technology, the more likely that nurse will be to provide quality, safe care to patients regardless of their condition, and the less likely that nurse will be to commit errors on the job.

One possible barrier to implementing the IOM's recommendations is that establishing an environment with multiple educational opportunities has been made difficult at the federal level. For example, the Federal Trade Commission (FTC) "has long targeted anti-competitive conduct in the health care market, including restrictions on the business practices of health care providers" (IOM, 2010, p. 2). The FTC must eliminate policies that restrict healthy competition in the health care field—policies that limit student nurses' options for obtaining higher levels of education and discourage professionals from pursuing pathways into nursing education. For a BSN program to operate efficiently, it requires access to a sufficient pool of nursing educators. Therefore, it is important for stakeholders at local, regional, state, and federal levels to communicate with nursing educators and nurse professionals to ensure that federal trade rules do not limit student nurses' potential. The more that nurse professionals, nurse educators, and nursing students work together to create the best possible learning environment, the more likely the IOM's recommendations are to be implemented.

Learning Theories and Authentic Learning in the BSN Curriculum

The humanistic theory of learning places the student at the center of the learning process. It is grounded in the work of Carl Rogers and Abraham Maslow. Rogers (1951) stated that the person-centered approach was the most effective because it offered "the best vantage point for understanding behavior is from the internal frame of reference of the individual" (p. 495). Similarly, Maslow's (1943) hierarchy of needs identified key components within a needs paradigm that must be satisfied before an individual can become self-actualizing.

Two advantages of humanistic theory are: (1) it provides a student-centered approach to learning that focuses on the needs of the individual student, and (2) it provides the basis for adequate motivation, relationship-building, communication, and self-efficacy (Halstead, 2007).

Two disadvantages of humanistic theory are: (1) it places too much emphasis on subjective experience, and (2) it assumes an overly positive perspective of human behavior. At some point, students must be required to engage in simulations, pass assessments, and demonstrate critical thinking skills regardless of personal challenges they face (Halstead, 2007). Just as the teacher may adopt a student-centered approach, the student must adopt a subject-centered approach, since self-centeredness is not conducive to learning.

The key components of authentic learning are: (1) the opportunity to engage with real-world problems that allow students to participate in the work actual professionals encounter; (2) the opportunity to engage in critical thinking activities that promote cognitive development through simulation exercises; (3) the opportunity to engage with other learners in a real community; and (4) the opportunity to empower students by supporting the development of their agency through student choice (Rule, 2006). These components can inform the development of the new BSN curriculum by providing a framework for engaging nursing students throughout a four-year program.

One advantage of authentic learning is that it enables teachers to provide students with the real-world experiences they need to be ready to enter the nursing profession. As a result of authentic learning in the BSN program, nursing turnover rates could be reduced and the nursing field could experience greater stability and growth.

One disadvantage of authentic learning in the new BSN program is that every student has a unique learning style, and authentic learning may not appeal to all students (Halstead, 2007). Some students may find the approach to be poorly organized or executed and may benefit from a more traditional method of instruction.

Conclusion and Key Recommendations

The BSN program is necessary for nursing students in today's health care industry because patients present with increasingly complex problems that require a higher level of education than the ADN program provides. Additionally, the IOM (2012) has demonstrated that nurses need more education in today's climate to ensure that safe and quality care is delivered to patients. The BSN program can better prepare nursing students for the realities of professional nursing practice.

Key recommendations essential for consideration are that the BSN program incorporate authentic learning as a primary pedagogical approach and humanistic theory as its foundational basis. Two delivery modalities should be implemented—traditional classroom learning and online learning—as each provides a unique platform capable of meeting the needs of all students. Formative and summative assessments should be employed, and classroom assessment techniques should be conducted regularly, to monitor where students are succeeding and where they need additional support throughout the program. The program should also uphold the civil rights laws and professional code of ethics that constitute national standards in the nursing industry.

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