Entry into Practice: Diploma Programs for Registered Nursing

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    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.


    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.
    Last edit by VickyRN on Sep 12, '09
    jahra, scoochy, forchunet, and 19 others like this.

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  2. About VickyRN

    VickyRN has '16' year(s) of experience and specializes in 'Gerontological, cardiac, med-surg, peds'. From 'Under the shadow of His wings...'; Joined Mar '01; Posts: 12,044; Likes: 6,439.

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    39 Comments so far...

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    A lot of current ASN and BSN programs are seriously dificient in clinical practice, IMHO.
    HazelLPN, MarcyC, scoochy, and 6 others like this.
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    Quote from SuesquatchRN
    A lot of current ASN and BSN programs are seriously dificient in clinical practice, IMHO.
    I like the fact that my BSN program offers an optional extern program during the summer between the junior/senior years. This consists of 10 weeks jam-packed with clinical experiences and 1:1 mentoring by an experienced staff nurse. Externship programs are a throwback to the diploma model, except that the professional standards of a university (evidence-based practice, etc.) are upheld during the mentoring process.
    Kathleenk likes this.
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    Thank you...from a 2006 Diploma program grad xx
    HazelLPN, jahra, blueheaven, and 1 other like this.
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    Elizabeth ,NJ had the first all male nursing Program at a Catholic Hospital, they claimed to be the first Nursing Diploma school in USA
    blueheaven and VickyRN like this.
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    Quote from >30yrsRN
    Elizabeth ,NJ had the first all male nursing Program at a Catholic Hospital, they claimed to be the first Nursing Diploma school in USA
    Lots of schools make lots of different claims, but all the nursing history sources I've ever seen report that the first hospital-based schools of nursing in the US, based on the Nightingale/St. Thomas model, were at Yale-New Haven in New Haven, Bellevue in NYC, and the New England Hospital for Women and Children in Boston. Since all three started up around the same time, it's not clear which one was really the first, and all three are usually mentioned together.

    Thank you, Vicky, for leaving out the usual disparaging comment about diploma schools being "primarily focused on technical skills." Since graduating from my diploma program many years ago, I've completed a BSN and an MSN, and have taught in both ADN and BSN programs. The longer I've been out of school and "out and about" in nursing, the more I appreciate what an excellent nursing education I got in my original diploma program. Not only did we graduate with excellent clinical skills and ready to "hit the floor running," they also did a better job of teaching us critical thinking, professionalism, ethics, leadership, etc., than any of the ADN or BSN programs I've had experience with since then.

    IMHO, we've "thrown the baby out with the bathwater" in many ways in nursing education.
    Last edit by elkpark on Sep 8, '09
    sallyrnrrt, HazelLPN, JacknSweetpea, and 9 others like this.
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    I'm another diploma graduate who feels that today's nursing education has left the nursing out of it. The hospital program I graduated from was the most difficult nursing ed program in the province, known for creating well-rounded, competent, compassionate (it was a Catholic hospital after all) and intelligent nurses. Our clinical experiences were even longer and more in-depth than the other diploma programs in the province and our senior practicum the longest in the country. Our class was the last to graduate from the diploma program before the collaborative program with the university got rolling and the school itself closed in 1995, two years short of a century after it opened.
    sallyrnrrt, KeyMaster, VickyRN, and 2 others like this.
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    Bravo for diploma nurses!! As a GN I was the one on the floor teaching the BSN grad how to start IVs and place foleys. Fast forward 25 years later. There are no more diploma programs in my area. A couple of ADN via CC, but most are BSN programs. I teach a specialty fellowship program which is supposed to acclimate nurses into the periop area by building on the general skills of the med-surg nurse. My current class is 75% GNs/brand new RNs. We spent one of our clinical days LEARNING HOW TO SPIKE IVPBs and PRIME IV TUBING. What DO they teach in nursing school these days???? Who cares if you can quote Martha Roger's theory of nursing if you can't hang an IV safely? Florence Nightingale's environmental nursing theories are wonderful and relevant, but if you don't learn how to change the sheets on your patient's bed the knowledge is of no value.
    And while I am on my personal rant about how wonderful diploma programs are and how clinically prepared graduates are to actually nurse the patient....
    I am currently in an RN to BSN program (kicking and screaming, but I need those three letters) and one of the classes I had to take was "Transition into Professional Nursing". Really. I suppose I have been practicing as an UNPROFESSIONAL nurse for the last 25 years!
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    "professional standards of a university (evidence-based practice, etc.) are upheld during the mentoring process. "

    The diploma program that I went through was a 3 year program at the time I attended. Now, they are affiliated with the university and offer a 2 year AD degree.

    Proud diploma grad of 1978
  11. 9

    Thank you for this article you wrote. It was wonderful thinking that there are still people out there that think that diploma nurses are worth something.
    I graduated this last may from one of the last 3 year diploma schools left on the east coast. My school has been around since the late 1890's.My class had 100% pass rate on the NCLEX but there are still places that look down on us here and it is difficult to find a job.
    So thank you again for writing this article have a great weekend.
    :heartbeatTricia RN:heartbeat class of 2009 diploma grad and proud of it
    sallyrnrrt, JacknSweetpea, MarcyC, and 6 others like this.

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