Entry into Practice: Diploma Programs for Registered Nursing

Diploma programs are the oldest and most traditional type of nursing education in the United States. These programs are two to three years in duration and provide nursing education primarily in the hospital setting. Graduates of these programs receive a diploma as opposed to a college degree. Most diploma programs are now affiliated with colleges or universities that grant college credit for certain courses.

Many hospital schools of nursing collaborate with nearby colleges to provide basic humanities and science courses. Graduates receive credits to apply towards an associate or baccalaureate of science degree. In some cases, students earn dual credentials, a hospital diploma and an associate degree. An example is the articulation agreement between Watts School of Nursing and Mount Olive College.

Diploma graduates take the same state licensing examination for registered nursing as graduates of associate degree and baccalaureate programs.

Diploma nursing programs were the earliest nursing programs, starting in the United States in the late 1870s as hospital-based training programs in cities such as New York, Boston, Philadelphia, Chicago, and Hartford. The inspiring force for diploma programs was the Nightingale School of Nursing founded by Florence Nightingale in London in 1860. These first nursing school models then quickly spread across the nation. As the number of hospitals expanded, the need for nurses increased, and hospitals developed their own training programs, which became the main source of nursing staff.

The earliest programs were taught by physicians and were only a few weeks in length. The curriculum was not standardized and there was very little theory or classroom experience. The nursing students provided free labor for the hospitals, as they often worked 12 to 18 hours a day, 6 to 7 days a week. During their training period in the hospital, the students learned nursing skills through copious hands-on experience.

Diploma programs later evolved into courses taught from a nursing perspective by nurse graduates, and gradually increased the amount of time required for completion. By the latter half of the 1900s, most programs were three years in length. Early graduates such as Linda Richard wrote rudimentary nursing textbooks and began offering specialty training to provide nursing staff for hospitals and clinics.

Until the 1960s, diploma programs were the major source of registered nurse graduates. These programs were at their pinnacle in the 1950s and 1960s, with approximately 1300 diploma schools in operation throughout the United States. In recent years, however, the number of diploma programs has dwindled to less than 10 % of all entrance RN education programs, producing only 6 % of RN graduates. Their decline became obvious during the 1970s, as nursing education made the shift from apprentice-type instruction based in the hospitals to instruction at the college and university level. Also, many hospitals could no longer afford to subsidize diploma nursing education. In 2004, there were only 68 diploma programs left in the United States.

Diploma nursing programs currently provide a solid foundation in biology and social science aspects of nursing practice, with a strong emphasis on clinical experiences in direct patient care. They generally provide more hours of clinical instruction than any other type of entry-level program. The curriculum is similar to that of associate degree nursing programs, with the primary difference being the additional clinical hours and hands-on experience. Graduates are adept in clinical skills and find employment in acute care, long-term care, and community health care facilities.

Most remaining diploma schools in the United States are located in the Midwest and East. Many programs still thrive in Pennsylvania and New Jersey. There are two diploma programs left in North Carolina: Watts School of Nursing (the oldest nursing school in the state) and Mercy School of Nursing.

Some of the most outstanding nurses I have had the pleasure of knowing during my career were graduates of diploma programs.

References

Foundations of Nursing: Caring for the Whole Person

Blais, K. K., Hayes, J. S., Kozier, B., & Erb, G. (2006). Professional nursing practice: Concepts and perspectives (5th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

Cherry, B., & Jacob, S. R. (2005). Contemporary nursing: Issues, trends, & management (3rd ed.). St. Louis, MO: Mosby Elsevier.