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Looking for history behind how RN's and LPNs developed

ADN/BSN   (29,139 Views 34 Comments)
by LPN-n-2005 LPN-n-2005 (New Member) New Member

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cnmbfa has 40 years experience and specializes in OB/women's Health, Pharm.

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Lindarn: You hit the nail smack on the head. We will never move ahead if we stay the least educatied group of HC professionals out there. I also strongly agree that no other group would consider letting folks with degrees in other fields into their professions after gving them the briefest possible ducation in the basics, not matter how intense the course may be. Don't you wonder how much is retained if you cram all of clinical nursing into 16 months?

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cnmbfa has 40 years experience and specializes in OB/women's Health, Pharm.

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jpRN84: The closure of most diploma programs is related to finances, and to the problems their grads may have in getting credit for their education if they do want to get a BSN or go to grad school. They were and are not closed as a "slap in the face" to anyone.

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red2003xlt has 5 years experience as a LPN and specializes in Addiction / Pain Management.

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In Florida LPN's and RN's take the exact same pre-req's to get into either program. Many RN's programs allow for their student to sit for the NCLEX-PN after one year of school.

Counting the year of pre-req's plus one year of nursing specific courses blows the One Year Post High School argument completely out of the water.

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2,642 Posts; 14,867 Profile Views

With the exception of 1 year RN accelerated programs for those who already have a Bachelors or Masters degree, the core RN curriculum should not take more than 2 years of full time study. A BSN should not be a minimum requirement for entry level practice because it only has the required 2 years worth of nursing courses, plus the remaining liberal arts and science requirements found in any Bachelors program in any major. If there is a push for Bachelors prepared nurses, the office weenies at the ANA need to simply state that a Bachelors degree, any major in that degree, plus the requisite nursing courses qualifies as a BSN (if you start fresh in a BSN program), or BSN equivalent, if you bring to a nursing program a Bachelors or higher degree. This is a turf battle perpetuated by bean counters who would like to see every non-BSN RN forced to go into hock to get a BSN, or face being phased out as a licensed professional RN.:rolleyes:

A BSN program has upper level nursing classes as well as liberal arts and sciences requirements. A bachelors degree in accounting, or biology or whatever else major does not have these classes....which is why a bachelors degree in another major is not equivalent to a BSN.

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2,801 Posts; 13,301 Profile Views

A BSN program has upper level nursing classes as well as liberal arts and sciences requirements. A bachelors degree in accounting, or biology or whatever else major does not have these classes....which is why a bachelors degree in another major is not equivalent to a BSN.

My experience of the bachelor's portion of my BSN was more about the "rounding out" of the education - the delving into related/big picture issues that intentionally are *not* unique to (but very integral to) the practice and profession of nursing such as qualitative and quantitative research methods, psychology of aging, sociology of professions, and such.

My BSN program was a junior-entry program. Of course, all pre-reqs & gen ed coursework had to be finished (eg A&P, micro, chem, nutrition, anthro, English). We also had research methods, statistics, epidemiology, and upper division electives (such as psychology of aging). Outside of a public /commuity health nursing rotation, I can't clearly identify what *nursing* coursework was 'above and beyond' that for any standard RN program. Our nursing theory, nursing research, and legal/ethical issues courses were just one course each.

In short, I don't see that our BSN program could've covered that much more *nursing* content than any standard RN program. Accelerated 2nd bach programs manage to cram the entirety of the nursing-program-specifc coursework into just 12-16 months.

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2,642 Posts; 14,867 Profile Views

My experience of the bachelor's portion of my BSN was more about the "rounding out" of the education - the delving into related/big picture issues that intentionally are *not* unique to (but very integral to) the practice and profession of nursing such as qualitative and quantitative research methods, psychology of aging, sociology of professions, and such.

My BSN program was a junior-entry program. Of course, all pre-reqs & gen ed coursework had to be finished (eg A&P, micro, chem, nutrition, anthro, English). We also had research methods, statistics, epidemiology, and upper division electives (such as psychology of aging). Outside of a public /commuity health nursing rotation, I can't clearly identify what *nursing* coursework was 'above and beyond' that for any standard RN program. Our nursing theory, nursing research, and legal/ethical issues courses were just one course each.

In short, I don't see that our BSN program could've covered that much more *nursing* content than any standard RN program. Accelerated 2nd bach programs manage to cram the entirety of the nursing-program-specifc coursework into just 12-16 months.

For a BSN program to be accredited, there's certain content it has to provide, above and beyond the requirements of an ADN program. Your state BON should list the criteria required for BSN's as opposed to ADN programs in your state.

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1,061 Posts; 14,612 Profile Views

jpRN84: The closure of most diploma programs is related to finances, and to the problems their grads may have in getting credit for their education if they do want to get a BSN or go to grad school. They were and are not closed as a "slap in the face" to anyone.

In some cases students who recently graduated from a diploma school which had a new agreement with a college to allow their diploma graduates to continue did not.

The agreement between the diploma school and college was for our diploma grads to continue and not have to repeat a number of courses.

When the students presented their completed diploma school records , the college basically advised that they would need to take all courses .

This was even with grades above what the agreement required.

The college acknowledged the agreement, but more that

diploma nurses from our school would be favored for entrance to their program.

Any attempt for the diploma school administrators to advocate for reduced courses was met with resistance. The college was well aware the diploma school would be closing soon.

If the administrators had known, they would have selected another college who would have kept the agreement honored for an appropriate way to finish.

jpRN84 is on the right track. In some cases politics (and egos) of some college nursing school administration have played a role in the rocky transition of diploma school students who were caught in the middle of the transition.

Cliff notes version-What was promised by this college nursing school

administration was not honored,and the selfish decision they made to do this prior to the diploma school closing did not allow time for another college program agreement.

In the end, in many cases it is not about nursing education as much as it is about the money (for the colleges).

And yes, it was a slap in the face for our diploma school administration

and instructors who had worked hard to get an avenue for students to

continue. All of our instructors had MS Nursing degrees and we were

disappointed how poorly and with disrespect they were treated by

their university colleagues. If the college above did not want the agreement,

they should have said so, not put the agreement in writing and then

not honor it.

Edited by jahra

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2,801 Posts; 13,301 Profile Views

For a BSN program to be accredited, there's certain content it has to provide, above and beyond the requirements of an ADN program. Your state BON should list the criteria required for BSN's as opposed to ADN programs in your state.

I tried to find the criteria on the BON website, without any luck. I know that a public health nursing section is a BSN, but not an ASN, requirement in my state (or at least used to be).

Whatever the differing requirements are on paper, my thinking was more in regard to those people who ask how much difference there is between having an ADN and a bachelor's in another field as opposed to a BSN. Not much, it seems to me, if the bachelor's is in a nursing-complementary field such as psychology or nutrition.

The BSN as I see it offers more chance to delve further into more academic issues such as nursing research, nursing as a profession, but it doesn't necessarily offer a whole lot in regard to further development of clinical nursing practice. I think the physical assessment course we took was more comprehensive than that required by ASN programs, but for complete newbies with no experience to build on or draw on, a 20 hour assessment course versus a 30 hour assessment course does not necessarily make a big difference in practice.

I forgot, though, that this thread was started on the development of RNs and LPNs. Discussion of BSN programs does fit in in regard to the on-going development of nursing education and licensure, but I suppose it's a discussion for another thread. Interesting as always!!

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I am wondering where the difference in RN and LPN first orginated from. How were these catergories first developed from the start of nursing? Anyone know any background information?

Under the Nightingale system, nursing education and governance was moved into hospitals who over saw not only the training, but much of the regulation as well. Upon graduation a student nurse was awarded a diploma and became a "trained" nurse, to distinguish her/him from the various charwomen and other sorts calling themselves "nurses".

While this system worked well for hospitals, it produced a maddening inconsistency among nurses. Many hospitals educated nurses to suit their particular mission, often education in areas not felt to be required or offended certain religious or moral values was omitted. You had Catholic programs not wishing to use then modern sciences (such as A&P), programs for male nurses omitting OB/GYN and Peds because there was nil chance a "male nurse" would ever be employed on those wards. And so the story goes..

While for much of recorded history, outside of religious orders nursing had been a "job" for (low) women, Florence Nightingale saw the need for a formalised system of education for nurses. For one thing moving everything into a hospital and awarding some sort of diploma lent respectability to what had previously been seen as work for harlots. If not for this respectable families would not have allowed their daughters to attend nursing schools, nor would it have been seen as a fit vocation for decent women.

Hospitals ran nursing programs for several reasons. First it provided them with a very inexpensive supply of labour. Until the laws were changed student nurses under the apprentice system did much of the patient care on the wards in addition to their classroom studies. Sometimes the former would be greater than the later. Programs varied as hospitals were often inclined to produce nurses that suited their needs, rather than any sort of benefit to the profession. Nursing schools also provided a low cost way for hospitals to make money as student nurses were often sent out on private duty cases within the community.

The other obvious reason for running a nursing program was to produce a steady supply of (graduate) nurses. Nursing being a primarily female occupation, and often restricted to young unmarried girls,(many programs had age restrictions for entry, did not take married or in some cases even widowed women, also did not admit divorced women), then as now many left the profession

Forget the exact number, but at one time there ten of thousands of hospital based diploma nursing programs in the United States, in short most every hospital in the country at one time or another had a school of nursing.

Finally state or federal governments decided to bring nursing education, qualifications, all that went with it under their control. Hence graduate/trained nurses became "registered nurses" as they acquired a formal license issued by a government office. One reason for doing this was a matter of public safety. It settled once and for all just whom was entitled by law to hold themselves out as a nurse, and established a central database if you will of credentials that could be checked by anyone seeking to employ (a nurse).

The other reason for setting up state/government nurse practice acts was to bring some sort of consistency to qualifications for entry into the profession. If one examines practice acts from the fifty United States, they are remarkably similar in many aspects including the "moral" clauses.

Prior to government nurse practice acts a nurses registry was simply a list complied by a hospital or private agency of nurses available on their books. These nurses "registered" with such places to find work, and one assumed (or hoped) the place did due diligence in making sure the nurse in question had proper credentials and was competent, but that didn't always happen. Indeed today many nursing agencies are still referred to as "registries", but also are various state data banks of licensed nursing personnel (RNs, LPNs, LVNs, nursing assistants).

Regarding the decline of hospital nursing programs.

While the apprentice method of producing nurses was great, nursing arts began to move away from simply practical education to the "theory and rationale" thinking method. Many programs adapted and continued to produce great nurses, but this all cost money. Once it was shown that associate college degree nurses could perform just as well as diploma grads (albeit with a little post graduate seasoning called orientation), there became less and less reason to justify the cost of keeping a nursing program. Once insurance and federal programs stopped paying hospitals to provide nursing education, things became dire still.

Many hospital programs to survive partnered with colleges or universities to provide at least some access to college courses but still awarded a diploma. Others did so in order to award an associates or even in some cases a BSN. One often encountered stumbling block was whom would be issuing the degree. Under one system hospital nursing students would spend a year or two at a college/university taking courses, then spend their final year or so at the nursing school. The former began to chafe about giving a degree where much of the education took place outside of their control, and often backed out.

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cpilny has 25 years experience and specializes in Cardiology, Nurse Educator and Homecare.

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It's not sad, it's progress. Medicine is progressing, and the knowledge base that an RN needs to practice today is far more complicated that 25 or 30 years ago. When I started nursing 25+ years ago, an ADN was sufficient to practice on many if now all units in a hospital. I worked for many years as a Cardiac and ICU nurse at the Cleveland Clinic with an ADN. With the advances in practice and the increased responsibility and technology today, my education would not have been sufficient.

My regret, and I never regretted the decision to become a nurse, is that I never pursued the NP degree. I did get an MSN in Nursing Education, but the NP is more recent.

I guess it's like a commercial I recently saw on TV....what if we had settled for the first thing? We'd still be using 3 pound cell phones, phonograph records and "really slow" computers instead of smart phones, iPods and iPads, etc., etc. :D

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