pathway of nursing education

First formal nursing program

Established in 1873 at the Boston Training School for Nurses; based on Florence Nightingale's model from London's St. Thomas' Hospital.

Early nursing education model

Apprenticeship model; students provided hospital labor with little formal education.

Brown Report (1948)

Recommended moving nursing education from hospitals to colleges and universities to standardize training and improve quality.

Three basic pathways to RN

Diploma, Associate Degree (ADN), and Baccalaureate (BSN).

Common factor among nursing pathways

Graduates from all three pathways are eligible to sit for the NCLEX-RN exam.

Diploma programs

Typically 3 years; hospital-based; students provided patient care as part of training; few remain today.

Strengths of diploma programs

Eligible for NCLEX-RN; strong clinical focus.

Weaknesses of diploma programs

Not collegiate-based; credits don't transfer easily; expensive to operate.

Baccalaureate (BSN) programs

College-based; usually 4-5 years; include general education, science, leadership, public health, and research courses.

Strengths of BSN programs

Eligible for NCLEX-RN; access to graduate study and advanced practice roles; greatest career mobility.

Weaknesses of BSN programs

More costly and time-consuming; early criticism for limited clinical exposure.

Accelerated (Second Degree) BSN programs

Designed for students who already hold a bachelor's in another field; shorter duration to graduation.

RN-BSN track

Allows diploma or ADN RNs to earn BSN by awarding credit for prior education and experience.

Associate Degree (ADN) programs

Developed by Mildred Montag in 1952 to address nurse shortages; 2 years; community college-based; most common pathway.

Strengths of ADN programs

Eligible for NCLEX-RN; affordable tuition; accessible; same entry-level RN pay as BSN.

Weaknesses of ADN programs

May take longer than 2 years; limited advancement without BSN; fewer opportunities in leadership or advanced practice.

Selecting a nursing program

Consider cost and quality; check program accreditation and NCLEX-RN pass rates.

Magnet hospitals preference

Many Magnet-status hospitals hire only BSN-prepared nurses or require ADN nurses to complete BSN within a set time.

Vocational education (LPN/LVN)

Developed in 1942; 9-15 months; prepares nurses to work under RNs; eligible for NCLEX-PN.

Limitations of LPN/LVN roles

Restricted scope of practice; limited career advancement; courses often non-transferable.

Unlicensed assistive personnel (UAP)

CNAs, GNAs, PCTs, and CMAs; perform basic patient care under RN supervision.

Certified Nursing Assistant (CNA)

Completes an approved course and exam; works in hospitals, long-term care, or home health.

Certified Medicine Aide (CMA)

CNA/GNA with specialized training; administers oral meds and some injections but no IV medications.

Master's Degree in Nursing (MSN)

Prepares nurses for advanced clinical or specialty roles; typically 18-24 months; requires BSN and certification exam.

Examples of MSN specializations

NP, CRNA, CNM, CNL, CNE, Informatics Specialist.

Doctoral programs in nursing

Include PhD, DNP, DNS/DNSc, DSN, and EdD.

PhD in Nursing

Research-based doctorate preparing nurse scientists and faculty.

Doctor of Nursing Practice (DNP)

Practice-focused doctorate emphasizing advanced clinical leadership; entry-level for NPs since 2015.

Program accreditation

Voluntary process ensuring programs meet quality standards; conducted by CCNE (AACN) or ACEN (formerly NLNAC).

Commission on Collegiate Nursing Education (CCNE)

Accredits BSN and higher programs; affiliated with AACN.

Accreditation Commission for Education in Nursing (ACEN)

Accredits diploma, ADN, and BSN programs; formerly NLNAC.

Certification for nurses

Voluntary credential validating specialized knowledge and clinical competence in over 40 practice areas.

Purpose of certification

Recognizes professional achievement and expertise; enhances credibility and career advancement.

Main certification body

American Nurses Credentialing Center (ANCC) - accrediting arm of the ANA.

Continuing education (CE)

Lifelong learning to maintain competence; formerly called CEUs; now measured in contact hours.

Purpose of continuing education

Ensures current practice knowledge and accountability in a changing healthcare environment.

States requiring CE hours

Some states mandate CE to renew RN licenses; others are voluntary.

In-service education

Employer-provided training for staff on policies, safety, new equipment, or procedures; not eligible for CE credit.

Key difference between CE and in-service

CE maintains licensure and professional development; in-service focuses on facility-specific skills.

ANA 1965 report on education

Recommended BSN as the minimum entry level for professional nursing practice by 1985.

Current issues in nursing education

System remains confusing with multiple pathways; faculty shortage limits expansion.

Trend: Magnet hospital hiring

Preference for BSN-prepared nurses due to evidence of improved patient outcomes.

Emerging trend: DNP for NPs

Requirement for nurse practitioners to hold a doctorate (DNP) after 2015.

Trends shaping the future of nursing

Changing demographics, technological advances, evidence-based practice, interprofessional collaboration, and global healthcare.

Evidence-based practice (EBP)

Integration of research and best available evidence to guide nursing care decisions.