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. Specialties Educators Article

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You are reading page 3 of Entry into RN Practice: Associate Degree Nursing (ADN)

VickyRN, MSN, DNP, RN

49 Articles; 5,349 Posts

Specializes in Gerontological, cardiac, med-surg, peds.
elkpark said:
Thank you once again, Vicky. I was glad to see you commented on the growing reluctance of hospitals to hire new grads, due to the extensive time and expense involved in getting them ready to function effectively. We were starting to see more and more of this in recent years, even before the recent recession (although the situation has certainly gotten worse since the economy tanked).

I have heard that it costs the hiring facility anywhere from $40,000 to $100,000 to orient and train each new nursing grad. This is absolutely mind-boggling. Add to this the turmoil of the clinical practice environment and the fact that many new grads quit during or after their first year of employment to find nursing jobs elsewhere.

elkpark

14,633 Posts

VickyRN said:
I have heard that it costs the hiring facility anywhere from $40,000 to $100,000 to orient and train each new nursing grad. This is absolutely mind-boggling. Add to this the turmoil of the clinical practice environment and the fact that many new grads quit during or after their first year of employment to find nursing jobs elsewhere.

I've heard both of these figures, also (the cost of orienting/training new grads and the fact the turnover is now so high for new grads), as well as the factoid that the attrition rate (leaving nursing for good, not just changing jobs) for new grads is now significantly higher than it's ever been before. I attribute much of this to the fairly dramatic changes in nursing education in recent decades. New grads used to graduate pretty well prepared to function as entry level RNs. Now, facilities find that they have to teach new grads practically everything they need to know to get through a shift, they're sick and tired of having to shoulder the expense and effort of doing that, and they're starting to put their feet down (and I can't say that I blame them).

IMHO, nursing education has really thrown the baby out with the bathwater, and I (again, MHO) think we're getting pretty close to a real breaking point -- as seen by the growing reluctance of so many facilities to hire new grads. I believe a big part of the problem is a serious disconnect between nursing academia and the real world. I know that, in the last BSN program in which I taught (a well-repected program in a state uni), the faculty was made up of the tenured, doctorally prepared professors who had been there a v. long time and had little or no contact with the "real world" of nursing in many years, and we "serfs and peons" -- the MSN-prepared faculty who taught most of the undergrad curriculum (much of the theory and all of the clinical). The "grand poohbahs" all believed that we had a great program, a really strong curriculum, and were doing a great job of teaching our students everything they needed to know about nursing. We "serfs and peons" used to hole up in someone's office and vent a lot about how guilty and conflicted we felt about what a poor job the program was doing of preparing the undergrad, pre-licensure students to be practicing RNs and what we could do about it. I, personally, was shocked by how little the students knew about nursing when they graduated. When we tried (on a number of occasions) to bring these concerns up to the high and mighty professors who ran the program and made all the decisions, they just blew us off. I left that position after one year, and it's v. hard for me to imagine a situation in which I'd be willing to take a teaching position again, although I love teaching -- the crap (IMHO) that goes on in much (most?) of nursing education now is just too much for me to put up with.

(And don't even get me started on the NCLEX, haha! :banghead:)

Specializes in Float Pool, acute care, management/leadership.
VickyRN said:
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.

Vicky, I would love this and I look forward to reading it. I graduated with a B.A. in Ethnic Studies/Public Health in 2008 and I am so torn between doing an ADN, a traditional BSN, an accelerated BSN, or going for a direct-entry MSN program.

I could really use all the advice and insight that anyone has to offer in making the aforementioned decision.

VickyRN, MSN, DNP, RN

49 Articles; 5,349 Posts

Specializes in Gerontological, cardiac, med-surg, peds.
j450n said:
Vicky, I would love this and I look forward to reading it. I graduated with a B.A. in Ethnic Studies/Public Health in 2008 and I am so torn between doing an ADN, a traditional BSN, an accelerated BSN, or going for a direct-entry MSN program.

I could really use all the advice and insight that anyone has to offer in making the aforementioned decision.

Over the next several weeks, I will be posting about the differences. I hope the information will be helpful to you.

GretchenT

21 Posts

I'm just starting my pre-requisites this fall for an associates program at my local community college. Because I have to spread out my credits (financial reasons) and I'll still be working full time, I'm not looking at actually being able to enter nursing school until 2011. I will be a career changer, coming from a teaching background, and I already hold a Bachelor's and 2 master's degrees.

So, this is very timely information for me as well...I look forward to reading your future installments.

MotivatedOne

366 Posts

Specializes in GYN/GON/Med-Surg/Oncology/Tele.

Great post Ms. Vicky...I do disagree with one point though. I work in a hospital that hires ADN nurses with experience as Assistant Unit Managers. The Unit Manager on my floor was the assistant unit manager on the same floor up until the previous UM decided to seek employment elsewhere. My UM was told that if she'd promise to go back to school and get her BSN, they'd give her the UM position. She worked as the UM while getting her BSN degree.

So it is possible for an ADN trained nurse to get a mangerial position if she has an adequate amount of experience.

csab

580 Posts

This was a great informational blog post. Thank you! I am always looking for more information about ASN vs BSN vs accel. BSN, etc. I have a bachelor's field in totally unrelated field (interior design) so in many ways I am starting from scratch (had no science courses before, and have no healthcare experience) and it is scary and confusing. Currently I'm taking pre- and co-reqs for an ASN program at a community college, and will apply in the next month to hopefully start nursing classes in January. However I am also still investigating an accel. BSN program, but it is just so much more expensive and that is what is hard to get past, since I don't want loans and would not be eligible for need-based aid. It seems like it would certainly be more cost-effective to get the ASN and then have the employer pay for a lot of the additional costs of an RN-BSN program. That, however, assumes I could even GET a job as a new grad AND that the hospital would still have their tuition reimbursement programs available 2 yrs from now, considering the economy and the cost cutting that hospitals are doing these days.

MotivatedOne

366 Posts

Specializes in GYN/GON/Med-Surg/Oncology/Tele.
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 think that if they were to turn ADN programs into ABSN programs, there wouldn't be an initiative to apply to a traditional BSN program because you'd basically be getting the exact same degree but at a much lower price...I know I'd opt for the CC ABSN program vs a traditional 4 yr BSN program.

MotivatedOne

366 Posts

Specializes in GYN/GON/Med-Surg/Oncology/Tele.

Ms. Vicky I'm sorry I probably should've read all of posts before posting my previous reply...You've covered my comment.

Specializes in perinatal & family practice.

Vicky-

As you are a nursing instructor & graduate student I thought I'd ask your opinion...I graduated with a BSN in 1980, worked 8 years in neonatal & some peds, received an MSN in perinatal nursing, subspecialty in developmental disabilities, worked at least 4 more years...moved, then didn't work for a while, ...took an RN refresher course that included the theory & skills component.

In the past 2 years I worked in a rural hospital & was unprepared for the pace- & left after 3 months (I was given a choice to leave or chance getting fired). I just left a position as a family practice RN after a year, again, being told I was too slow to keep up with the documentation & non-nursing components- that the patients really liked me & my clinical skills were solid- but, again, I was asked to resign or risk being terminated for breaking a couple policies.

So now I don't know what to do- it really seems a new grad is much more appealing to hire than me-

do I take yet another refresher course in another state? Go through nursing school- diploma program or something? (don't even know if I'd be admitted if I'm already an RN).

I may end up moving back to my home state in a big city- thinking maybe the orientation would be better- review more than just the basics required by the state (safety stuff)-

what do you think would be my options?

angel67

6 Posts

Thanks for your article I can testify to everything you have mentioned. I have been in a Technical college since 2006 taking classes while working full time and finally in August I will be starting the ADN program it's been a long time coming. Unfortunately, I still have what around five semesters of nursing classes to take before finishing school. In the beginning what I thought was only a few years has become much longer. Your article has made me realize my outcome may have some restrictions I didn't plan for.

elkpark

14,633 Posts

MotivatedOne said:
Great post Ms. Vicky...I do disagree with one point though. I work in a hospital that hires ADN nurses with experience as Assistant Unit Managers. The Unit Manager on my floor was the assistant unit manager on the same floor up until the previous UM decided to seek employment elsewhere. My UM was told that if she'd promise to go back to school and get her BSN, they'd give her the UM position. She worked as the UM while getting her BSN degree.

So it is possible for an ADN trained nurse to get a mangerial position if she has an adequate amount of experience.

Certainly it's possible -- but fewer and fewer hospitals are willing to do that as time goes on. With an Associate's degree, you have to hope you're in one of those facilities, or try to find one, if you want to "move up." With a BSN, you have that option/potential anywhere you go.