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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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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VickyRN

About VickyRN, MSN, DNP, RN

VickyRN, PhD, RN, is a certified nurse educator (NLN) and certified gerontology nurse (ANCC). Her research interests include: the special health and social needs of the vulnerable older adult population; registered nurse staffing and resident outcomes in intermediate care nursing facilities; and, innovations in avoiding institutionalization of frail elderly clients by providing long-term care services and supports in the community. She is a Professor in a large baccalaureate nursing program in North Carolina.

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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.

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.

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 the great information.:up:

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Specializes in Med/Surg/Ortho/HH/Radiology-Now Retired.

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. :)

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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.

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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).

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Specializes in Tele.

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.

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Specializes in med-surg, radiology, OR.

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.

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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.

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Specializes in Acute Care Psych, DNP Student.

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.

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Specializes in Triage, MedSurg, MomBaby, Peds, HH.

Thank you for this excellent piece and the considerable effort you put into its creation.

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She mentioned North Carolina as having laws stating that ADN program must have the same clinical hours as BSN

programs. But I find it interesting that she doesn't mention the other states. Is it only like that there? I sense something amiss.

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Thanks for posting this! I look forward to reading your next segment

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