Entry into RN Practice: Associate Degree Nursing (ADN)
There are multiple entry levels into the profession of registered nursing. The various entry points are associate-degree in nursing (ADN), bachelor of science in nursing (BSN), diploma nursing programs, and direct-entry nursing graduate programs. These divergent entry levels can be perplexing to students, members of the allied healthcare team, and the general public. In this blog, we will discuss the associate-degree entry level, the most common pathway to registered nursing in the U.S.
Approximately 60% of newly minted RNs in the us are graduates of associate-degree programs. More than 980 such programs exist across the nation.
The associate-degree educational process prepares students for a safe, beginning level of competent nursing practice. Successful completion of an accredited two-year program qualifies graduates to write the national council licensure exam for RN (NCLEX-RN). The typical ADN course load consists of 70-80 semester hours, spread over 4 to 6 semesters. Some ADN programs only admit new students in the fall; others admit a class of students every fall and Spring.
The curriculum, which consists of nursing theory and a broad assortment of clinical experiences, provides knowledge and skills for patient-centered care in a variety of settings. The curriculum may be fully integrated, interweaving the subject matter throughout the program, or non-integrated, approaching each subject matter separately. Employment opportunities include acute care and sub-acute facilities, nursing homes, clinics, and community agencies.
Associate-degree nursing programs originated in 1952 as the dissertation research of Mildred Montag, a nurse educator with Columbia University. In her research project, Montag introduced two-year associate degree pilot programs, by paring down the time needed to educate nursing students, from the three years required by the diploma programs of the era.
This was done to address the critical post-WW II nursing shortage. Montag hoped that extensive orientation programs for new graduates, furnished by the hiring facilities, would make up for knowledge gaps from the loss of the third year of formal instruction. As a side note to this, we see many hospitals today refusing to hire new grads due to the extravagant costs involved in training.
With the establishment of ADN programs, nursing education reached an important scientific and professional milestone. The base of nursing instruction was transferred out of the hospital setting (apprentice system) to the broader collegiate level in community colleges:
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The curriculum design reflected approximately half general education courses and half nursing courses. The concept of nursing was patient-centered, not disease centered. Nursing courses were based on broader structures, e.G., adult nursing, maternal and child nursing, etc. Fundamental concepts were taught early in the programs, which were later built on, with complex concepts taught in the second year.
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Clinical experiences reflected great differences, too. Community facilities were added to hospital-based experiences. Clinical sites included "day nurseries, nursing homes, specialized hospitals, health clinics, family planning agencies, public schools, physicians' offices, and self-help groups." interestingly, these clinical sites mirror those of many community college programs today, who have developed "new" curricula.
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The student populations in the pilot programs differed from student populations in traditional nursing programs. The programs attracted older students, many of whom were married, widowed, or separated. Traditional hospital-based programs had not allowed older or married students. A higher number of male students were also represented in the pilot associate degree nursing programs. Many of the population dynamics from this period continue to date (Mahaffey, 2002, 12-14).
Advantages of the ADN
Relative low cost.
Less time investment. Excluding prerequisites, ADN programs require two academic years for completion.
Better accessibility.
Better outreach to rural and isolated communities, minority populations, the disadvantaged, and males.
Able to quickly produce nurses during cycles of acute nursing shortage.
Puts local people to work by equipping them with a respectable, marketable career that helps meet the health care needs of the local community.
Associate-degree graduates are vested in their community and tend to work in the local area in which they are educated.
Disadvantages of the ADN
Class size in the typical ADN program is limited, and a considerable number of applications are received each year. Many qualified applicants are turned away or can wait years to get into the program.
In most ADN programs, the co-requisites are treated as prerequisites. This can result in many students spending three to five years to get through the two-year program.
Students often need to retake science and other co-requisites for better standing in the very competitive admission process into the ADN program.
In the end, many nursing graduates invest way beyond the typical 75 hours required for an associate degree. They are not given proper academic recognition for all these extra semester hours and rigorous work. The typical ADN program, in actuality, is somewhere between an associate degree and baccalaureate degree.
Less opportunities for advancement in the nursing field. Many associate-degree nurses, as they age, are unable to keep up the pace in the chaotic clinical environment. Yet, they often are "stuck" in the role of bedside nurse due to lack of educational qualifications for managerial, unit educator, case management and other less physically-demanding roles.
It is a common myth that ADN programs offer more clinical opportunities for students than their BSN counterparts. In North Carolina, for instance, the board of nursing determines the clinical hour requirements and these are the same for both ADN and BSN programs throughout the state.
In my next blog segment, we will discuss the hot topic of the BSN entry level. Stay tuned!
I am entering my last semester in an ADN program and overheard one of the nursing faculty say the other day " the ADN is the only 2 year degree that takes 5 years to get" hahahaha SO TRUE!!!!
It's well worth it though!! I will be done soon and able to work (God willing there's a job for me haha) and I can go on to acheive my BSN while I work... to this very poor college student this was the way to go... I will graduate with NO student loans to pay back!
On the downside... it will have taken me 5 years to complete my 2 year degree LOL =)
Specializes in Gerontological, cardiac, med-surg, peds.
Grace Oz said:
I appreciated being able to read this, Vicky, thank you.
I must confess to sometimes being a bit confused with the various levels in the USA. It somehow seems more complicated than here in Australia. ?
Would you like to elaborate more on the various types/ levels of nursing in Australia, Grace Oz? I have found this bit of information concerning nursing in Australia:
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Nurses are classified into two broad categories:
registered nurses (who usually have a degree), and
enrolled nurses (who usually hold a certificate or advanced diploma).
Registered nurses make up the majority of all nurses.
Although the level of expertise varies within these groups, in general, registered nurses perform more complex medical procedures and hold more responsibility than enrolled nurses. For instance, in most jurisdictions only registered nurses have the authorityotherwise retained by general practicesto administer medications.
There are also other differences between registered and enrolled nurses. In general, registered nurses are more likely to be employed in critical or intensive care and less likely in geriatrics/gerontology; more likely to be employed in acute care hospitals and less likely in nursing homes; less likely to be working part-time; and more likely to work in capital cities, than enrolled nurses.
Specializes in Gerontological, cardiac, med-surg, peds.
rwbglock23 said:
Great post. I can testify to almost all of the disadvantages you have listed! It has taken me about 3 years to get admitted into the ADN program that I start in the Fall. Unfortunately this is how nurses are produced at I believe you said 60% per year which means that the majority of the nurses who went for their ADN, could have likely earned their BSN in the same amount of time. For me, weighing my options in the decision of ADN vs. BSN, the flexibility of taking my prerequisite (which were actually my co-requesite) classes at different times of day and one class per semester so I could work full time was the deciding factor.
Thank you for sharing your experiences, rwbglock23. The convenience and flexibility of the ADN is often the deciding factor in students choosing this entry-level degree over the other options. As a matter of fact, this is why I chose the ADN route back in 1993. My local community college was less than 1 mile from my house (at the time). The campus was very small and the system was so much easier to navigate for someone who had been out of college for aeons.
rwbglock23 said:
I intend to work as an RN and continue my RN to BSN at a university once I pass the NCLEX-RN, as I am sure many ADN nurses intend to. Hopefully I won't get stuck in the rut so to speak of just working as a ADN RN.
Good for you. This is what I did. Immediately upon graduating with my ADN (back in 1996) and after securing my first RN staff nurse job, I set about taking pre-req courses towards my BSN. I finally was able to enter an RN-BSN bridge program in 1998, and graduated with my BSN in 1999. This was all done while I was working full-time as a staff nurse. Getting my BSN proved to be an excellent career move, as it opened many doors for me.
rwbglock23 said:
Maybe you can post something on how we go about choosing a specialty within nursing after graduation? I would be curious to know how one would go about becoming a Trauma or Flight Nurse, for example. Maybe you can describe the top 5 most popular and what needs to be achieved to get into those specialties.
Thank you for this suggestion - an excellent idea for a future blog entry ?
Specializes in Gerontological, cardiac, med-surg, peds.
Kyla.ann said:
I was wondering if you could go more in depth on the limits of an ADN as far as jobs and advancement. I was under the impression that ADN & BSN's had pretty much the same opportunities.
This is often true for bedside nursing positions.
However, most hospitals prefer at least a BSN for management positions. The same holds true for professional nursing leadership roles, such as academic nurse educator, unit educator, case management, public health, research, school nursing, clinical instructor, and many other nursing positions. Some hospitals (such as Magnet affiliates or the VA system) prefer BSN graduates, which can be pivotal to getting hired in today's very competitive nursing job market. Smaller community hospitals will often allow ADN nurses to occupy management and leadership positions, but with the stipulation that the employee go on to get his or her BSN or MSN while working full-time in the new role.
If you wish to continue your nursing education to advance practice after graduation, you may need your BSN first before you can apply. Some advance practice nursing programs do have ADN-MSN bridge programs, such as nurse practitioner or nurse midwifery. But the very competitive CRNA programs do not.
Hope this answers your question. I graduated with an ADN, but went on to get my BSN. This proved to be a very smart career move for me.
Specializes in Gerontological, cardiac, med-surg, peds.
A_Simp said:
Interesting blog! From my own experience, it did take 3 yrs for me to complete my RN - 1 yr for the pre reqs and the other 2 yr for the NSG courses.
I realize there is quite a bit of debate regarding ASN vs BSN but for my particular situation, I all ready have a AS and BS in another field and found the ASN route the most cost effective approach to earning my RN. In my area of the country and hospital there is no $$ difference or distinction unless I am looking to grow into management or education position.
Out of the 30 or so students from my nursing class about 3/4 of us had all ready obtained degrees in other subject areas. One classmate had a MS in guidance, another MS in history and was a teacher. I believe the ASN route is a good option for 2nd or 3rd career changers, who's goal is to getting into bedside NSG. After they are licensed and get their feet wet, they can continue onward with their education, while taking advantage of tuition programs through their employer.
ASN vs BSN is not an accurate comparision because of what I mentioned above about 2nd or 3rd career changers. Most are older, non-traditional students, including myself, offering a diverse skill set and life expierences. In my own case, I was a business consultant for a franshise company and had to develop relationships with franchisees in order to educated them on how to operate all facets of running a sucessful business. In addition, I am a certified, FAA flight instructor and responsible for devolping flight training cirruculm as well as assisting students to develop critical thinking and technical skills in order to obtain their pilot licenses. When you're up in the air flying and there is an emergency or situation, you just can't stop and pull over to work the problem out.
Unfortunately, instead of looking at a person as the "Whole Package" and really seeing all that they have to offer, we are relegated and at times, unfairly judged just by the type of NSG degrees we hold - ASN or BSN.
I taught in both types of programs - ADN and later BSN. I found what you relate to be true. The "typical" student in an ADN program is "non-traditional" - older, with vast life experiences, often with one or more prior degrees, professions, or careers. The "typical" student in BSN programs is much younger, in his or her 20s, of the more "traditional" college mold.
I also was a "non-traditional" student myself when I started taking courses towards my ADN back in 1993. I was 38 years old, married, with two preteen children. I had some college background, but no degree. I also brought with me the seasoned maturity and perspective that only life experiences can bring.
All in all, it took me three years to complete the ADN program - one year to knock out all the co-reqs, and then two years to complete the rest of the program. Since I made very high scores on the entrance exam and all A's in the co-reqs (especially anatomy), I got into the competitive program on the first try. This was a program that rejected 9 out of 10 applicants (about 400 applicants for 36 slots).
For those with baccalaureate degrees in another field, the accelerated BSN or direct-entry MSN programs might be something to consider. At least in these programs, the student receives academic recognition (in that he or she receives a BSN or MSN upon graduation) for all those prior courses or degrees.
Specializes in Gerontological, cardiac, med-surg, peds.
AznMurse said:
considering all the credits, hours, etc. spent on the ADN program which most think should be more than an ADN to which I agree, Maybe they should rename the current ADN programs as accelerated BSN and totally eliminate the 12-15 months accelerated BSN program w/c to me sounds really absurd! How can someone learn all that much and retain it in just 15 months? Granted they pass the NCLEX but that could just very well be test taking skill variable.
I'll discuss the educational differences in BSN or accelerated BSN programs versus ADN in my next blog. There are some real differences in required curriculum. Please stay tuned.
Specializes in Gerontological, cardiac, med-surg, peds.
MedSurg32RN said:
Unfortunately, it is even harder to get into a BSN program. Both BSN and ASN could benefit from more clinical time. With many asking Congress to import foreign educated nurses the ADN is a good solution to nursing shortages.
This depends on your location. In my state (North Carolina), it is often easier to get into state university BSN programs than the typical ADN community college program. This is because the university BSN programs have extremely large class enrollments and admit in both the fall and Spring of every year. However both types of programs are very competitive and many qualfied applicants are turned away. And, with the BSN, the student must put in two full years for the prereqs before applying for the nursing program.
As for required clinical time, this is determined by state boards of nursing and not by individual nursing programs. Many BSN programs, however, offer an optional student extern opportunity over the Summer between the junior and senior years. This is 10 or 11 solid weeks packed full of intense clinical bedside experience.
Specializes in Gerontological, cardiac, med-surg, peds.
multicollinearity said:
I've seen ADN programs exceeding 85 credits. I think it's obscene for the degree-level being earned. I don't know how NLN lets their accredited programs get away with it.
This was the way it was in North Carolina, back in 1993. However, the Board of Nursing put a stop to this practice and ADN programs statewide had to be pared down to ~ 74 semester hours. Before the BON intervened, there were more co-reqs such as Microbiology and programs ran 80+ hours for completion.
Specializes in Gerontological, cardiac, med-surg, peds.
wildchipmunk said:
Thank you for this excellent piece and the considerable effort you put into its creation.
You're very welcome. It's very interesting to me to research the development of all these divergent entry levels, their pros and cons, and to present the information in a non-biased manner.
Specializes in Gerontological, cardiac, med-surg, peds.
nursgirl said:
I am entering my last semester in an ADN program and overheard one of the nursing faculty say the other day " the ADN is the only 2 year degree that takes 5 years to get" hahahaha SO TRUE!!
It's well worth it though!! I will be done soon and able to work (God willing there's a job for me haha) and I can go on to acheive my BSN while I work... to this very poor college student this was the way to go... I will graduate with NO student loans to pay back!
On the downside... it will have taken me 5 years to complete my 2 year degree LOL ?
It will be well worth it in the end. Best wishes to you for a bright future in the wonderful career of nursing ? We may have many paths into our career, but the desire is the same - to provide the best patient care possible.
nursgirl
129 Posts
I am entering my last semester in an ADN program and overheard one of the nursing faculty say the other day " the ADN is the only 2 year degree that takes 5 years to get" hahahaha SO TRUE!!!!
It's well worth it though!! I will be done soon and able to work (God willing there's a job for me haha) and I can go on to acheive my BSN while I work... to this very poor college student this was the way to go... I will graduate with NO student loans to pay back!
On the downside... it will have taken me 5 years to complete my 2 year degree LOL =)