I want to talk informally about the exploitative (read scammy) nature of many ADN/RN to BSN programs and their curriculums as they currently exist. In many cases, profit-driven thinking (and not student (nurse) centered thinking) has caused us to charge RNs to relearn a lot of content they learned during their prelicensure ADN and/or in practice as an RN. I believe wholeheartedly that this has also impacted the motivation of many experienced RNs in carrying the heaviest part burden (in many cases) to return to school for a degree they can't find a high degree of value in or a good return on investment. All of this is for a degree that doesn't alter the scope of practice and is steadily becoming less favored when compared with graduate degrees for things like leadership positions and non-direct care roles. Some reports from AACN indicate decreased enrollment in RN to BSN programs in recent years. The reasons are likely multifactorial, but I wonder what role the current curricula might play in this phenomenon.

As my friend Ryan, who ironically is not a nurse but an experienced educator, likes to say, “It seems the difference between the ADN and the BSN are mostly synthetic are more about what people have DECIDED to identify as completely different.” That might be shocking and hard to hear for some advocates for minimum BSN-entry advocates, but it is an assessment that I find to be mostly true as a nursing faculty myself.

NOTE: Let me say this now before all the naysayers yell, “You are anti-education!” (which is ironic, as I started with an ADN and am in the latter part of my PhD in Nursing program and currently hold a Master of Science in Nursing, with a focus in nursing education…): I am not saying that expanding education for nurses is a bad thing. However, we need some honest conversation and new approaches to how we go about it.

The academic/degree inflation in nursing is another conversation we could have, but ill stick to my point for now. Feel free to look here for a Harvard News room article for some information ways academic/degree inflation can be an issue. Currently, large portions of these degree completion program curricula for people who are already licensed and practicing registered nurses include content that is highly repetitive or duplicative, particularly for those who have gone to an associate or diploma program that kept their curriculum updated and modernized. See my nursing education master post for more explanation of this degree program. In my estimation, I feel that anywhere from 60-80%of the content in most RN to BSN programs is already covered, to some degree (may vary slightly according to where and when you went to get your ADN), in the ADN curriculum.

If we break down the current curriculum that most schools use for RN to BSN, I think that content is only enough to cover about 4-6 months of schooling. In my opinion, the difference in the curricula of RN to BSN and pre-licensure ADN programs is not substantial enough to require more than one full-time semester's worth of nursing-specific content. As a young ADN-prepared RN who went through the RN to BSN and then MSN process, I've felt this personally. While I think my school (WGU) did a great job (far better than most, in my opinion) to streamline and reduce repetitiveness for the BSN portion (the MSN portion was phenomenal), there’s still a need for systemic change.

There’s also a lot of variety in the curriculum for RN to BSN programs across the country despite schools being accredited by the same bodies. I’ve always been super interested in the discordance between the standards, such as the BSN essentials, and the makeup/content of our RN to BSN curriculum, which looks so different between schools.  Also, these curricula often look very different than the courses required for traditional or pre-licensure BSN students, to the point where you sometimes wonder how they (the post-licensure & pre-licensure) are the same. Though there have been efforts, we’ve not done a good job, overall assessing and regulating RN to BSN programs.

Let’s take a look at the variety of RN to BSN programs and their plans of study

Note: Consider how some of the curricula pictured above have things like health assessment (which is taught as a core part of ADN-RN program curricula) as a core requirement, and others don’t. Why is there this variation? To be clear, I think it’s insulting and a waste to require licensed RNs to take a second undergraduate-level health assessment course. Many of these nurses are completing comprehensive health and physical assessments in their daily work of caring for patients and their communities.

I’m not convinced that RN to BSN and pre-licensure or traditional BSN programs must look the same. Considering RN to BSN programs as a group, however, we know there can be A LOT of variety in the content and how BSN programs look according to whether you got your initial nursing education in a BSN or your initial nursing education from another program. But, it is time for us to start asking meaningful and honest questions about the assumptions we make about BSN-prepared nurses as a group. We need to consider the assumptions we make when we know there’s a lot of variety in the content and execution of BSN programs, depending on whether you got your initial nursing education in a BSN program or if you got your pre-licensure education in another type of program, like the ADN. Some have already asked this question in our peer-reviewed literature, and the consensus is not clear, even as recently as one 2016 article and this 2019 write-up in the Midwest Nursing Research Society publication.

So why don’t we use RN to BSN programs to do something different and get creative?

We have an excellent opportunity to make the RN to BSN curriculum something that allows our licensed and practice nurses to customize their careers and education to meet their desired goals. Below is a short list of some ideas I’ve had and that colleagues, such as Irnise Williams (known as the Nurse Lawyer), have offered.

• RN to BSN programs could offer advanced coursework for specialty focus (i.e., Home Health, Perioperative Nursing, Critical Care, entrepreneurship, etc..)

• Could we have RN to BSN programs that allow experienced RNs to get more structured supplemental education/experience in a new specialty area?

• Could we have an RN-to-BSN program that provides independent study options, letting nurses build a course and elective curriculum that suits their needs?

There’s a lot of potential in how we could make RN-to-BSN programs more meaningful and useful to potential students and current nurses. I am aware that we would need to navigate a lot of logistics, accreditation questions, and red tape, but for now, I’m choosing to exist in an imaginative and speculative space, for the moment, so that we can begin to understand the potential and start moving towards actions to make things different.

Remember, considering where we are in society and the ongoing barriers and disparities in educational access and progression, I believe we still need multiple educational entry and progression paths in nursing. I choose to view the multiple entry paths as a strength and admirable unique quality of nursing.