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Discussion

Entry into RN Practice: Associate Degree Nursing (ADN)

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!

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

National Organization for Associate Degree Nursing (N-OADN)

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    • Featured Replies

    • Experts
    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:)

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    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.

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    • Author
    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.

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    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.

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    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.

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    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.

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    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.

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

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    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?

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    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.

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    • Experts
    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.

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    Great article. I can attest to a lot of what you've written. I have been going to school now for about two and a half years, taking prereqs and coreqs. I will, if all goes OK, be starting in Block 1 of nursing school in the Fall of 2010. This is after a year and a half wait. So for my ADN to become an RN, I will have spent about a total of four and a half years in school. For what is called a "two year degree". If you add in the wait time to get into NS that we have at the community college system I'm in, it's a total of over five years.......

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