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!
Thank you for your response. I do have a few questions to ask you regarding the comparison to BSN and ADN nurses. The problem I have with your information is that up until 2 years ago (specifically in my area) ADN nurses were considered gold. To get into the program a person needed at least a 3.80 GPA, and to stay in the program was even harder. The surrounding area had many BSN programs from private schools where most of the nurses graduated with over $50,000 in school loans. I feel as though my program deceived me and my fellow class mates, however all of the past graduates had no problems gaining positions. Of course my goal was to go on to gain the highest degree possible but I wanted to do this while I was working. I feel as though the ADN programs should be shut down if the statistics show that BSN graduates are in fact the best for the job! Why is it that we sit for the same exam and hold the same degree? If there is going to be a biased when hiring a "lower degree" then there needs to be a change with the actual degree system. I feel as though I along with fellow ADN graduates are being unfairly judged when a degree cannot accurately determine who the best R.N. for the position is.
Here is what HE wrote back...
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I completely understand your anger and disappointment here. Most nursing organizations agree that a bachelor's degree should be the minimum requirement for entry into nursing given the research on the outcomes of nursing care based on education level and the complexity of the RN role. Advocates for ADN programs, however, have a great deal of political clout and are very vocal about keeping the ADN option viable for many reasons, including ensuring that hospitals have an adequate supply of nurses. I know of other instances where ADN program have told students that they are equally prepared for practice as BSNs, but that is just not true. In no profession is an associate degree viewed as equivalent to a bachelor's degree. The NCLEX exam assesses "minimum technical competency" and does not test for differences between graduates of different programs. That being said, I encourage you to not lose hope and keep looking for positions in nursing. You were at the top of your class and are licensed for practice, both achievements that will land you a job (maybe not your first or second choice job at the moment). Robert
Specializes in psychiatric, UR analyst, fraud, DME,MedB.
I am sorry , I am getting confused w/ the " technical minimum competency" . Looking at the courses between the adn and the bsn ----- they required the same preparation from the sciences, such as anatomy , micro ,physio, and of course the pre chemistry as pre requisites in some of these sciences. The bsn have what you call the public health courses and some management courses....but clinically -------the training is the same! the measure of a true nurse is what and how you can apply your knowledge clinically and not just a booksmart. Frankly telling some are booksmart w/ their degrees, and but can not easily apply it. Do not get me wrong ...I am for higher educations , but it really annoys me when someone tries to belittle the other just because they do not have the "higher" degree. Trying to make a distinction as to who is better or not is immature and childish. Hospital for that matter should encourage their nurses to get their BSN w/ the hospital offering some help in it ! Be creative and be part of the solution and not the problem ?
Althought BSN and ADN take similar course, BSN focus more on critical thinking and hollistic view of nursing care. I have work with both BSN and ADN, BSN demonstrate in better communication skills, cultural sensitivity, critical thinking, and higher knowledge in both nursing and science in general. ADN is more clinical and skills focused.
NRSKarenRN, BSN, RN
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Entry Into Practice: Diploma programs for registered nursing