West Coast University:
Dean's Corner | February 2009

The Differences Between Associate Degree Nurses and the Baccalaureate Degree Nurses

by Dianne S. Moore, PhD, RN, CNM, MN, MPH
Vice President of Nursing Academics
West Coast University

I have heard the statement "Why should I get a baccalaureate degree in nursing (BSN) when I can get an associate degree in nursing (ADN) and still sit for the same NCLEX and get my RN license?"  This is a very good question and one that every nursing student should ask. The short answer is that a nurse with a BSN has more opportunities to work in a variety of health care settings that offer an extensive array of opportunities for professional growth. Baccalaureate-prepared nurses can be bedside nurses, educators, case managers, discharge planners, administrators, and work in public health, home health, and community clinics. The armed forces require an officer in the nurse corps to have a BSN and joining the military is an excellent opportunity to serve your country, pay for your education, and receive all the wonderful benefits that go beyond the immediate financial rewards. The associate degree nurse is limited to providing direct, hands-on patient care in a more restricted type of health care setting such as hospitals, skilled nursing and long term care facilities, clinics, and physicians' offices.

There are distinct differences between the 72 ADN credits and 125 BSN credits required in each of the nursing programs' curriculum.  The baccalaureate curriculum has a different focus, emphasizing evidenced-based clinical practice and leadership. Additional courses are offered in the baccalaureate curriculum, such as research, statistics, critical thinking, and public health/community health.  In addition, the additional units prepare the baccalaureate nurse to pursue graduate study, leading to an advanced degree in nursing.                                                                                  

On the other hand, students entering associate degree nursing programs are focused on learning the technical aspects of nursing appropriate to providing direct care to patients and families, mostly in acute care settings. The associate degree nursing students learn the knowledge and skills required to care for individuals and families during illness and restoration after medical treatment, and usually practice a more restricted level of nursing care.  The knowledge and nursing competencies are limited to direct hands-on patient care in the hospitals and community health facilities. The associate degree nursing programs have fewer units and teach only the basics of leadership needed for RN supervision of other health providers.  The associate degree nursing programs do not prepare the nurses for graduate study.

One might think, "Well I want to be a bedside nurse and not a manager." The BSN nurse can and does provide excellent direct patient care. In fact research shows they use evidenced-based practice for better patient outcome, another difference in the ADN vs. BSN level of education. At some point in a nurse's career, she/he may decide s/he wants a change of pace. The BSN offers that possibility in a shorter, more flexible path than using the educational superhighway and getting on and off at every exit. For some, the shorter intervals and the opportunities to enter and exit (i.e., LVN, then LVN to ADN-RN, then RN-BSN,) are what they need for a variety of reasons. It is wonderful we have those options today, but if you can get directly admitted to a BSN program you have a more direct and shorter route to your overall goal. The BSN offers more flexibility to pursue various types of nursing care in a variety of settings within health care. 

Today, many hospitals are applying for the ANA Magnet status and prefer to employ BSN graduates. They encourage their own staff to go back to school for their BSN degree or they give preference in hiring to new BSN graduates. Many hospitals will pay the BSN graduate more, either to start, or through more frequent increases in his/her salary.

Numerous research studies have demonstrated that the ADN and BSN nurses are not different in skill competency when they graduate, but within a year, the BSN nurses show greater critical thinking skills, better problem solving, and the development of clinical judgment; three skills of increasing importance for the increase in acuity of patients in hospitals and other health care settings.

All nurses are professional and receive the same opportunities in nursing school to demonstrate professional behaviors through membership in a student pre-professional organization and by acquiring the knowledge and skill of serving as an officer, Board of Directors, chairperson or member of their local chapter of the California Nursing Students Association (CNSA).  Being professional means learning more about the profession of nursing and how it interacts with other interdisciplinary professions to achieve the goals of providing quality health care for individuals and families, and advancing the science of health care for our society.  Professionalism is having the knowledge to understand how our society operates and the nurse's role within it and the obligation nurses have to insure the nation's health is achieved and maintained. Professionalism means being involved with politics and legislation affecting health care, nursing education, and practice. Being a professional nurse means participating in research to increase the body of nursing knowledge and using our experience with patients and families as research tools to design best practices in health care and to demonstrate evidence-based practice. Most importantly, being a professional nurse is maintaining a lifetime membership in professional organizations, especially the American Nurses Association (ANA) and a specialty nursing association. 

In conclusion, the answer to the question, "What is the difference between an ADN and BSN nurse?" is to first answer the question, "What do you want to do as a nurse, not just upon graduation or in two years but five and ten years from now?" Think of a long term goal, your age, your interests and other personal facts.  Do your home work about which nursing education program is best for you before you embark on your educational path.  It is also important to keep an open mind about private vs. state schools, an opportunity unique to California. California is fortunate in the number of fine state nursing programs it has.  Keep in mind, however, that even though private schools may cost more in the short run they may be able to offer better financial aid packages to qualified students and they often provide more flexibility in admission and scheduling than the state schools, allowing you more educational opportunities. You may be admitted sooner and complete the program sooner, preparing you to enter the workforce making  on average in the Los Angeles area, according to the Bureau of Labor Statistics, about $70-80,000 per year as a nurse* before the state school nurses have completed their program. Graduating sooner means you can pay back your student loans while you are gaining experience, and, potentially putting you ahead of your state counterparts. 

Nursing is a wonderful and rewarding profession. Choose it for the right reason, which is because you love the art and science of caring for people. Get the best education you can and you will have a life time of doing what you love to do. When you do what you love each day, it never really feels like work. Enjoy!

* U.S. Department of Labor, Bureau of Labor Statistics, Occupational Employment Statistics Survey, 2006.