Journal of Nursing Education

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The Leadership/Management Role: A Differentiating Factor for ADN/BSN Programs?

Mary Jane Schank, PhD, RN; Ruth Stollenwerk, DNSc, RN

Abstract

ABSTRACT

The resurgence of the ADN/BSN issue relative to educational preparation and roles and the concomitant development of positions taken by the professional associations and National Commission on Nursing pointed to the need for study of current ADN/BSN curricula and utilization of graduates. Based upon a brief historical literature review and ADN/BSN competency statements, the leadership/ management role was selected for study as a possible differentiating factor between these programs. Findings from a statewide study of ADN and BSN programs and a representative sample of nurse executives indicated that an education and service dilemma exists relative to this role. The majority of ADN program directors noted that a leadership/management component should be part of ADN curricula, whereas BSN program directors did not concur. Nurse executives utilized ADN graduates in leadership/ management positions and stated that length of experience was an influencing factor in selection. Numerous other findings showed a discrepancy in beliefs and practices among educators and nurse executives. This survey demonstrates the need for curriculum changes and role clarification. The leadership/management role may be a viable area for consideration.

Abstract

ABSTRACT

The resurgence of the ADN/BSN issue relative to educational preparation and roles and the concomitant development of positions taken by the professional associations and National Commission on Nursing pointed to the need for study of current ADN/BSN curricula and utilization of graduates. Based upon a brief historical literature review and ADN/BSN competency statements, the leadership/ management role was selected for study as a possible differentiating factor between these programs. Findings from a statewide study of ADN and BSN programs and a representative sample of nurse executives indicated that an education and service dilemma exists relative to this role. The majority of ADN program directors noted that a leadership/management component should be part of ADN curricula, whereas BSN program directors did not concur. Nurse executives utilized ADN graduates in leadership/ management positions and stated that length of experience was an influencing factor in selection. Numerous other findings showed a discrepancy in beliefs and practices among educators and nurse executives. This survey demonstrates the need for curriculum changes and role clarification. The leadership/management role may be a viable area for consideration.

Selective Literature Review

In 1951, Mildred Montag began a trend that changed the pattern of nursing education dramatically. Based on her doctoral thesis, Education of Nursing Technicians (1951), Montag proposed education for a new kind of nurse, a nursing technician. This person would have an education consisting of two years in a community or junior college and would be prepared for "intermediate functions requiring skill and some judgment" (p. 6). She stated that the functions of the nursing technicians would be: "(1) to assist in the planning of nursing care for patients; (2) to give general nursing care with supervision; and (3) to assist in the evaluation of nursing care given" (p. 70). In her suggested curriculum, there was no evidence of a leadership/management component (pp. 99-100).

Today, a disparity exists between Montage original curriculum design and current ADN educational programs. Furthermore, marked differences exist between the intended role of the ADN graduate and utilization of this nurse. Examples of this disparity can be found in the writings of various nurse educators and administrators. Ashkenas (1973) studied graduates of ADN programs during their first six months of employment to identify factors they saw as being aids or deterrents to their care of patients. She found that there was very little differentiation between the role of the professional nurse and the technical nurse in most of the agencies in which associate degree nursing graduates were employed. The ADN graduates noted that although the majority were employed as staff nurses, they were frequently asked to perform activities and assume responsibilities other than those for which they had been prepared. Ashkenas found little evidence of identification of the ADN graduate as a technical nurse.

De Chow (1977) pointed out that "when the ADN programs were conceived, they were not meant to prepare graduates for administrative positions and tasks" (p.6). She noted there was "... a real unwillingness within the educational arm of nursing, in concert with the service arm, to identify explicitly the role and responsibilities of each of the practitioners who is prepared in nursing" (pp. 6,8). The manager role has crept into ADN education over the years according to Larowe (1978). Since 1967, the AD Council has included the expected competency to "supervise other workers in technical aspects of care" (p.17).

Utilization of graduates from ADN and BSN programs is largely determined by the philosophy and needs of the employing agency (McSherry & O'Neill, 1978). In a 1978 NLN publication, discussing the Nursing Service perspective regarding the role of ADN graduates, the Committee of the American Society of Nursing Service Administration noted they saw no difference among beginning practitioners from BSN, ADN, or diploma programs. They stated that licensure was the same for each and that legal responsibility was identical. Additionally, they noted that to formulate staffing patterns and job descriptions that were significantly different for associate degree, diploma, and baccalaureate nurses was not practical or cost effective. The Society stated, "the role confusion in utilizing graduates supposedly prepared differently exists not only among nursing service administrators, but among deans of the various programs and their respective curriculum experts as well" (p. 10). Chamings and Teevon (1979) asked nurse educators in technical and professional programs whether they perceived differences in expected competence among graduates. They found that while there were differences in expectation, differences in competence remained unclear.

This literature review gives some historical perspective to the current situation in which nursing is trying to establish specific educational components, role responsibilities, and titling for the ADN and BSN graduate. The authors believe that one possible means for differentiating both preparation and utilization of ADN and BSN graduates is that of the leadership/management role. The rationale for selection of this component was based upon the original concept of ADN preparation and the literature which seemed to indicate that this area created more confusion than any other component among educational levels and between service and education.

Study Design

The study questions were: (1) what guidelines are used by ADN and BSN programs for curriculum; (2) do ADN and BSN programs include a leadership/management component; (3) do ADN and BSN programs differ relative to a leadership/management component; (4) do nurse executives perceive ADN and BSN graduates to have leadership/management capabilities; and (5) is there a difference in the utilization of ADN and BSN graduates relative to the leadership/management role?

Questionnaires were sent to all 17 ADN and 11 BSN program directors in the state of Wisconsin and to a representative sample of 70 nurse executives. The nurse executive questionnaire was designed to obtain data regarding numbers and preparation of nurses employed in the institution, roles assumed by ADN and BSN nurses, and in-service educational programs, required continuing education courses, or credit courses outside of the organization in leadership/management. Further information obtained included beliefs concerning whether ADN and/or BSN graduates should function in leadership/management positions and how length of experience influences this decision. Other items examined whether ADN programs should prepare graduates to function in leadership/management positions and what content should be offered for this preparation. Executives were also asked if the leadership/management role should be a differentiating factor in ADN and BSN programs. Information was obtained concerning differentiation in salary and opportunities in work and promotion between ADN and BSN nurses. Demographic data were collected describing the nurse executive's basic preparation, highest degree, years as administrator in the current position, years in nursing administration, and size and type of institution.

Questionnaires for ADN and BSN program directors were designed to ascertain if their respective program had a specific course in leadership/management or if leadership/management content was presented as part of another course. They were also asked if the program had a leadership/management practicum. Directors of both programs were queried about their use of the Wisconsin Statewide Study on Nursing Competencies (1982). The program directors were also asked if they used the ANA competencies (Selected Competencies, 1980) or other guidelines for curriculum design. Finally, the directors were asked if there should be a leadership/management component in the ADN curriculum.

Findings

NURSING EDUCATION- Survey findings were analyzed according to the five study questions. The first three questions dealt with data obtained from directors of ADN and BSN programs, and the final two questions were concerned with data gleaned from nurse executives. The analysis of data is based upon the following returns: 12 of 17 (71%) ADN program directors, nine of 11 (82%) BSN program directors, and 46 of 70 (66%) nurse executives.

The initial study question was: what guidelines are used by ADN and BSN programs for curriculum? Data revealed that all ADN programs used competency guidelines: 66% used the Wisconsin Statewide Study on Nursing Competencies, 25% used the ANA Selected Competencies, and 25% indicated use of NLN Council Guidelines. Findings indicated that 33% of BSN programs used the Wisconsin Statewide Study on Nursing Competencies, no program used the ANA Selected Competencies, and 11% used the NLN Council Guidelines.

When program directors were asked about curriculum content dealing with leadership/management, 100% of ADN and BSN respondents indicated they had a specific course or that content was part of another course. An interesting finding was that 92% of ADN respondents had a leadership/management practicum as compared to only 66% of the BSN respondents.

It was the opinion of 92% of ADN directors that a leadership/management component should be part of the ADN curriculum. Only 11% of the BSN directors shared the same opinion. One ADN director stated, it should be included "as long as it is required by the employing agency." A BSN respondent indicated, "only management should be part of the ADN program."

Table

TABLE 1EDUCATION AND TIME IN NURSING ADMINISTRATION OF NURSE EXECUTIVE RESPONDENTS

TABLE 1

EDUCATION AND TIME IN NURSING ADMINISTRATION OF NURSE EXECUTIVE RESPONDENTS

Table

TABLE 2OPINIONS OF NURSE EXECUTIVES REGARDING LEADERSHIP/MANAGEMENT CAPABILITIES OF ADN & BSN GRADUATES

TABLE 2

OPINIONS OF NURSE EXECUTIVES REGARDING LEADERSHIP/MANAGEMENT CAPABILITIES OF ADN & BSN GRADUATES

Guidelines from the Wisconsin Statewide Study, the ANA, and NLN regarding nursing role components attempt to differentiate between the ADN and BSN graduate. However, the inclusion of the same titled role components for both ADN and BSN programs (e.g., manager role), may be a major source of confusion and conflict. The questions that remain to be answered are: can or should a leadership/management role be more specifically differentiated, should ADN graduates be prepared to lead and/or manage (e.g., what), and how can the answers to these questions be translated into curriculum and practice changes?

NURSING ADMINISTRATION- Seventy nursing executives were surveyed relative to the leadership/management capabilities of ADN and BSN graduates and their utilization in practice. Analysis was based upon the returns from 46 (66%) executives.

Demographic data revealed that the basic preparation of the nurse executives ranged from LPN to BSN. The highest degree attained by those responding was the masters degree. About 50% of the masters degrees were in nursing and 50% were in other areas. These areas included counseling and guidance, health services administration, management, and public health. Time in present positions and in nursing administration ranged from less than five years to longer than 15 years. The institutions at which the executives were employed had 40 to 517 beds. Specific demographic data are presented in Table 1.

There were diverse opinions among nurse executives relative to leadership/management capabilities of ADN graduates, but homogeneous opinions regarding capabilities of BSN graduates. These findings are presented in Table 2. Data showed that length of experience of ADN and BSN graduates would influence use in leadership/ management roles by nurse executives. An interesting finding was that the most frequent time frame was identical for both levels of graduates in charge nurse and head nurse positions. Tables 3 and 4 present these findings.

Twenty-six percent of nurse executives stated that ADN programs should prepare graduates to function in leadership/management positions. When asked if the leadership/management role should be a differentiating factor between programs, 76% responded in the affirmative. One respondent stated that "ADN programs should be eliminated" and one noted that "leadership/management is only one of several factors that should be used to differentiate between programs." A large percentage of nurse executives indicated that ADN programs should include leadership/ management content dealing with management of groups of patients (89%) and management of peers and ancillary personnel (74%). Only 22% of the nurse executives indicated that management of a clinical unit should be included as part of the ADN educational program.

When queried about utilization of ADN and BSN graduates, nurse executives identified similar use of these graduates in the roles of staff nurse - bedside, primary nurse and team leader. A high percentage of ADN (84%) and BSN (82%) graduates assumed the role of the bedside staff nurse. Analysis revealed that a higher percentage of BSN graduates were in the roles of charge nurse, head nurse, and supervisor.

Most organizations (83%) did not have a salary difference for ADN and BSN graduates. Over 60% of the organizations differentiated between ADN and BSN graduates in the areas of role/job opportunities and promotion, according to nurse executives.

Fifty-four percent of the executives stated the organization had an in-service education program in leadership/ management. Only 11% of the ADN graduates and 20% of the BSN graduates were required to participate in this program prior to assuming a leadership/management position. Nurse executives (78%) did indicate a need for a clearer distinction in goals between ADN and BSN programs. One executive commented that "the goals are clear, but the use is confused;" another noted that "there needs to be a different license for each program."

Table

TABLE 3OPINIONS OF NURSE EXECUTIVES REGARDING EXPERIENCE INFLUENCING THE USE OF ADN/BSN GRADUATES IN CHARGE NURSE, HEAD NURSE, OR SUPERVISOR POSITIONS

TABLE 3

OPINIONS OF NURSE EXECUTIVES REGARDING EXPERIENCE INFLUENCING THE USE OF ADN/BSN GRADUATES IN CHARGE NURSE, HEAD NURSE, OR SUPERVISOR POSITIONS

Table

TABLE 4OPINIONS OF NURSE EXECUTIVES REGARDING LENGTH OF EXPERIENCE AS A FACTOR IN THE USE OF ADN/BSN GRADUATES IN CHARGE NURSE, HEAD NURSE, OR SUPERVISOR POSITION

TABLE 4

OPINIONS OF NURSE EXECUTIVES REGARDING LENGTH OF EXPERIENCE AS A FACTOR IN THE USE OF ADN/BSN GRADUATES IN CHARGE NURSE, HEAD NURSE, OR SUPERVISOR POSITION

Conclusions and Recommendations

In the 20 years since the ANA position statement, many attempts have been made to clarify and establish criteria for ADN and BSN graduates. Today, nursing is making a concerted effort through its professional organizations and, specifically, the National Commission Project, to resolve the ADN/BSN dilemma. This study of the leadership/ management component as a possible differentiating factor for ADN/BSN programs could be used as a basis for helping to resolve the current dilemma which would be in accord with the original intent of ADN program development.

This study points out that a dilemma still exists in the preparation and utilization of ADN and BSN graduates, specifically, in relation to the leadership/management component. Three major educational findings were: (1) 92% of the ADN program directors indicated that a leadership/ management component should be part of the ADN curriculum as compared to 11% of the BSN program directors, (2) 66% of the BSN respondents noted that a leadership/ management practicum was part of the curriculum as compared to 92% of the ADN respondents, and (3) all ADN respondents utilized competency guidelines as compared to 44% of the BSN respondents.

Nursing service findings revealed: (1) The majority (76%) of nurse executives were of the opinion that leadership/ management should be a differentiating factor between programs. However, they noted that content relative to management of peers and ancillary personnel (74%) and management of groups of patients (89%) should be included in the ADN curriculum. (2) Length of experience would influence utilization of ADN/BSN graduates in leadership/ management positions. It was interesting to note that an identical time frame was identified for ADN/BSN graduates to move into charge nurse and head nurse positions. (3) A majority of nurse executives indicated that BSN graduates should function in charge nurse, head nurse, and supervisor positions rather than ADN graduates. However, 67% of the executives also noted that ADN graduates should function in charge nurse positions and a lesser amount indicated these graduates should function in head nurse (30%) and supervisor (24%) positions (see Table 2).

Based upon the literature, positions of the professional organizations, tasks of the National Commission, and findings of this study, it would appear that leadership/ management should be considered as a viable issue in helping to resolve nursing's ADN/BSN dilemma. It is recommended that: (1) a clear operational definition be developed for the terms, management, leadership, coordination, and collaboration; (2) one set of national guidelines be used for ADN and BSN curricula development (these guidelines should clearly and succinctly differentiate the capabilities of the graduates relative to the leadership/ management component); and (3) a national study of the leadership/management component be conducted.

In order to solve nursing's dilemma and to implement the recommendations, there needs to be a sustained, collaborative relationship between service and education and ADN and BSN program directors. The same is true for nursing's professional organizations.

References

  • Ashkenas, T.L. (1973). Aids and deterrents to the performance of associate degree graduates in nursing. New York: National League for Nursing.
  • Chamings, RA., & Teevon, J. (1979). Comparison of expected competencies of baccalaureate- and associate-degree graduates in nursing. Image, 11,(1) 16-21.
  • De Chow, G. (1977). Characteristics of associate degree education: Competencies of the graduate. In Preparing the associatedegree-graduate. New York: National League for Nursing.
  • Larowe, A. (1978). Identifying the competencies and roles of AD nurse graduates. In AD graduates: Can they fit your system's needs? New York: National League for Nursing.
  • McSherry, M.E., & O'Neill, R.H. (1978). A transition program for new graduates. In The AD graduate: From student to employee. New York: National League for Nursing.
  • Montag, KL. (1951). The education of nursing technicians. New York: G.R Putnam & Sons.
  • Report of statewide task force on nursing competencies. (1982). The Wisconsin Statewide Study of Nursing and Nursing Education. Madison, Wisconsin: Nursing Study Committee.
  • Selected Competencies: ADN Selected Competencies: BSN, (1981). In Summary of Proceedings, American Nurses' Association 52nd Convention, June 8-13, 1980. Kansas City, MO: American Nurses' Association.

TABLE 1

EDUCATION AND TIME IN NURSING ADMINISTRATION OF NURSE EXECUTIVE RESPONDENTS

TABLE 2

OPINIONS OF NURSE EXECUTIVES REGARDING LEADERSHIP/MANAGEMENT CAPABILITIES OF ADN & BSN GRADUATES

TABLE 3

OPINIONS OF NURSE EXECUTIVES REGARDING EXPERIENCE INFLUENCING THE USE OF ADN/BSN GRADUATES IN CHARGE NURSE, HEAD NURSE, OR SUPERVISOR POSITIONS

TABLE 4

OPINIONS OF NURSE EXECUTIVES REGARDING LENGTH OF EXPERIENCE AS A FACTOR IN THE USE OF ADN/BSN GRADUATES IN CHARGE NURSE, HEAD NURSE, OR SUPERVISOR POSITION

10.3928/0148-4834-19880601-05

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