Entry into Practice: Diploma Programs for Registered Nursing

Diploma programs are the oldest and most traditional type of nursing education in the United States.

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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.

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.

Thank you for your acknowledgement that a Nursing Diploma means something today. I am in persuit of my BSN, because after 30yrs experience as a registered nurse my diploma isn't good enough at some institutions in the Philadelphia area. I think that this a major insult to the nursing profession. Of course it's being supported by the graduate degree nurses with MSN, PhD and 5 years experience whose superior knowledge enables them to make these type of decisions.

If a diploma is no longer a proper education preparation for nursing practice why do diploma schools still exist????? DO I SOUND BITTER ? Acutally, I am insulted.

Wow its so refreshing to hear that there are people who are proud of the diploma programmes in RN. I completed mine in 1996. I have met people different nursing collages, but still have to meet someone with a Diploma like me. I have always known that Diploma Nurses are best trained nurses because they know a lot about taking care of patients, rvs, medications and all aspects of nursing. I have seen BSN nurses who come from college with no clue of what needs to be done in the ward. One thing I know is that even though our diplomas are looked down at, we are full of knowledge. I am proud of my diploma

If you pay close attention, you'll notice that it's mostly students and educators in other (esp. BSN) nursing programs who disparage diploma programs and grads -- I have consistently gotten positive comments in job interviews over the years, even now with a BSN and MSN, when interviewers see that I was originally a diploma grad, and I get lots of comments about how "everyone knows" diploma schools have always turned out the best nurses.

I was just recently accepted into a diploma program in the Northeast, and I couldn't be happier! :D

I thought it seemed like it would be a better program than the ASN at our local community college since it does provide 2x more clinical time. However, you're all making me worried now that I may be at a disadvantage when looking for a job down the road. I do have a non-related B.S. degree in Finance, if that will matter at all. And as a result, I have taken all the generic courses, such as stats, that the ADN graduates are required to take.

Is this something I should be worried about??? Do you think my B.S. degree will help at all when it's time for me to look for positions, particularly at the hospitals that supposedly won't hire diploma grads??

Your finance degree will not help you at all in nursing (unless, eventually, you move into management/administration -- it might be considered a plus at that point -- but not as a new grad). I know this is v. frustrating for people who have education or successful careers in other fields, but turn the question around and think about it -- how much would a nursing degree help you in the finance world??

However, I would not be too concerned about finding employment, esp. if your school has a strong reputation in your area. There are only a limited number of facilities that are hard-line about only hiring BSN-prepared nurses. Most places would give you exactly the same consideration as any other new grad (maybe more, depending, again, on the reputation of your school).

I would encourage you, though, to plan to pursue a BSN (through a BSN completion program for people who are already RNs via an ADN or diploma program -- they're all over the place) before too long, because that will significantly increase your range of career opportunities within nursing over time.

Congratulations (on your acceptance) and best wishes! :balloons:

Thanks for your reply. I didn't think my degree would help except to maybe land a job at a hospital that would perhaps prefer an ASN over a diploma grad. I definitely plan on obtaining a BSN, since I am interested in pursuing a MSN degree. Perhaps the better option for me would be to find a RN to MSN program. I've heard some MSN programs will accept RN's that have a B.S. degree in a related field, but I doubt Finance classifies as a related field. Oh well, one step at a time! :)

Thanks for your reply. I didn't think my degree would help except to maybe land a job at a hospital that would perhaps prefer an ASN over a diploma grad. I definitely plan on obtaining a BSN, since I am interested in pursuing a MSN degree. Perhaps the better option for me would be to find a RN to MSN program. I've heard some MSN programs will accept RN's that have a B.S. degree in a related field, but I doubt Finance classifies as a related field. Oh well, one step at a time! :)

There are some MSN programs that don't require a BSN, but deciding to go that route will significantly limit your range of possible programs. There are tons of "BSN completion" programs out there, many of them inexpensive (although it pays to shop around -- some are outrageously expensive!), all designed for people who are working full-time as RNs, and comparatively painless to complete (compared to your initial nursing school program). I was able to complete a BSN (as a diploma grad with two earlier years of general college) in two semesters, going one day and one evening a week (that was considered a "full-time" student in that program), and it was a state university, so the cost was v. reasonable. Now (I did my program back in the early '90s), many of the programs are entirely on-line, and you can work at your own pace and convenience. If it were me, I would go ahead and do the BSN as soon as convenient after you start working and begin to feel like you know what you're doing as an RN (I would not do it at the same time that you're attempting to survive that first year as an RN -- that's more than enough to deal with by itself :)), and make decisions about graduate school when it's appropriate for you.

Unless your school, specifically, has a really bad reputation, I can't imagine a hospital that has a hiring preference for ADN grads over diploma grads -- the only thing hospitals sometimes care about is BSN vs. ADN/diploma; nobody I've ever heard of cares about ADN vs. diploma.

Best wishes!

Specializes in gerontology.

I loved this post! I graduated in '68 from a diploma program, have had a wonderful nursing career and am proud of my diploma heritage. We saw things in those clinicals that one would never get now! I was 2nd year student during the Belvidere, Il. tornado on a Friday afternoon. Just got back to the dorm when the nun came flying in to gather all of us students to go back to the hospital. We worked triage, cleaned mud and blood from massive wounds, worked all through the weekend, discharging patients and admitting the wounded, tending to their emotional and physical needs, and also taking care of the families of these victims, most of whom were children. That's just one of the finer experiences I've had. Now if you're on a college campus, are you going to get a chance at something like that? We learned early in our training about critical thinking, we just didn't give it a name! Its a real shame the diploma schools are gone. We did staff the hospitals, tha's true, and people got great care. So glad it was available to me.

Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.

I, too, am a diploma graduate. I consider myself to have been blessed with the opportunity to attend a 3yr program in Boston. It afforded me with a myriad of clinical experiences. Our clinical experience started the 1st semester, all while taking college courses. Clinical rotations (consisting of 8 weeks at a clip) were at a variety of hospitals in Boston and the immediate outlying area. I am proud to say I am a diploma graduate!

it is hard to get quality education from schools lately. i think the hands on approach is definitely the way to go for some people

Specializes in neuro/ortho med surge 4.

Hi all,

I graduated in 2008 from an ADN program. I think clinical experiences are lacking in these types of programs. At least I feel it was in mine. When I graduated I had never inserted a foley and had barely hung any IVs never mind IVPB's. I only received 3 weeks of floor training as a new grad with the charge nurse of the day. I was so woefully unprepared. Then throw in calling Docs, admits and discharges and the constant interuptions. I am surprised I have survived. I am so glad I had a t least worked as an aide before becoming a nurse. Being an aide and a nurse are totally different but it taught me invaluable communication skills and hands on care. I had heard about the diploma programs and if one had been available when I attended school I definitely would have went that route.

Im starting nursing school in Aug. Im soo excited..its a degree program at one of the best nursing schools in the state. I keep hearing about how I wont get hired without my BSN yet we come out nowing more. Im still going here first and then Ill get my BSN. Im glad you wrote this article it makes me feel like I made the right choice by doing my degree first even though I got scholarships to BSN programs I feel like the degree is the bestchoice.

Hello everybody,

I've got a question. Maybe you could help me?!

I am a student of medicine from Lithuania. Maybe you know any information about summer nursing courses for students or smth like this in Sweden?!

Thanks a lot!!!!!

Anastasija