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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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:
QuoteThe 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.
QuoteClinical 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.
QuoteThe 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).
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!
References
Mahaffey, e.H. (2002, may). The relevance of associate degree nursing education: past, present, future. Online journal of issues in nursing. Retrieved July 30, 2009, from: : The Relevance of Associate Degree Nursing Education: Past, Present, Future