The current preparation of an associate degree nurse usually begins in a community college, although some programs are based in senior colleges or universities. The associate degree program is 18 to 21 school calendar months in length. The NLN recommends that associate degree nursing programs consist of 60 to 72 semester credits (90 to 108 quarter credits) and that there be a balanced distribution of no more than 60% of the total number of credits allocated to nursing courses (NLN, 2001). In some programs, the student must complete the general education and science course requirements before beginning the nursing courses. At the end of the program, the student receives an associate’s degree in nursing.

Associate degree nursing education has helped to bring about a change in the type of student who enrolls in nursing programs. Prior to the emergence of associate degree nursing programs, nursing students were traditionally single, white females younger than 19 years of age who came from middle-class families (Kaiser, 1975). Associate degree programs attract a more diverse student population that includes older individuals, minorities, men, and married women from a variety of educational and economic backgrounds. Many of these individuals have baccalaureate and higher degrees in other fields of study and are seeking a second career. Along with their maturity, these students bring life experiences that are applicable to nursing. The students tend to be more goal-oriented and have a more realistic perspective of the work setting. The community college curriculum is conducive to students who want to attend school on a part-time basis.

Standards and competencies for associate degree programs are developed and maintained by the NLN Council of Associate Degree Programs. At the NLN 1998 Education Summit, the associate’s degree in nursing (ADN) competencies were revised to include multiculturalism, long-term care, systems management, and interdisciplinary collaboration. Graduates of associate degree programs are eligible to take the NCLEX-RN examination for licensure.

Dr. Montag’s original proposal for the associate degree program to be a terminal degree is no longer applicable. In 1978, the American Nurses Association proposed a resolution regarding associate degree programs that recommended they be viewed as part of the career upward-mobility plan rather than as terminal programs. The associate degree program has provided students with the motivation to further their education and the opportunity for career mobility. Although many nursing students end their education with an associate’s degree, many others enter the associate degree program with every intention of continuing their nursing education to the baccalaureate level or even further.

In the 1960s, baccalaureate programs made it very difficult for the RN to return to school to earn a baccalaureate in nursing. Most of the time, these nurses found themselves receiving no credit for their past education or experience. A resolution was passed in 1978 by the American Nurses Association (ANA) that helped to change this philosophy. This resolution urged the creation of quality career-mobility programs with flexibility to assist individuals desiring academic degrees in nursing. Several basic patterns are available for achieving upward mobility in nursing; within these basic patterns are many variations. Career ladder programs or bridge programs, BSN-completion programs, external degree programs, accelerated programs, and online universities are the basic patterns that will be addressed in this section. In assessing the available educational options, one source of information is the All Nursing Schools website (www.allnursingschools.com/find/). Potential students should also contact individual schools for information regarding their particular programs.

The career ladder or bridge concept focuses on the articulation of educational programs to permit advanced placement without loss of credit or repetition. There are many variations on this type of program. Multiple-exit programs provide opportunities for students to exit and reenter the educational system at various designated times, having gained specific education and skills. An example is a program that ranges from practical nurse to RN at the associate’s, baccalaureate, master’s, and doctoral levels. A student in such a program may decide to leave the educational system at the completion of a specific level and be eligible to take the licensure examination applicable to that educational level. On termination, the student may choose to work for a while and later return for more education at the next level without having to repeat courses on previously acquired knowledge or skills.

A growing number of basic nursing education programs within the community college setting are beginning to offer career ladder programs, affiliating themselves with upper-division colleges in the area. A student can enter the community college to spend 1 year studying to become a practical or vocational nurse. After a year, the student can decide to stop and take the practical nurse licensure examination or continue and complete the associate’s degree in nursing. At the end of the second year, the student is eligible to take the RN licensure examination and may choose either to exit with an associate’s degree or to attend an affiliated upper-division college to obtain a bachelor’s degree (Figure 7-2).

A BSN-completion program is a baccalaureate program designed for students who already possess either a diploma or an associate’s degree in nursing and hold a current license to practice as an RN. Depending on the part of the country, these programs may also be known as RN baccalaureate (RNB) programs, RN/BSN programs, baccalaureate RN (BRN) programs, two-plus-two programs, or capstone programs. There are more than 620 BSN-completion programs In addition to the BSN-completion programs, 161 RN-to-master’s degree program options are available and there are 27 additional nursing schools planning to implement a BSN/MSN completion program in the near future (AACN, March 2010b). In most of these programs, nurses receive transfer credit in basic education courses taken at other institutions plus either some transfer credit for their previous nursing courses or the opportunity to receive nursing credit by passing a nursing challenge examination.

The usual length of such programs is 1 to 2 years, depending on the number of course requirements completed at the time of admission to the program. To meet the needs of the returning student, many BSN-completion programs offer flexible class scheduling, which allows the student to continue working while going to school. Another innovation being implemented to address the needs of individuals seeking baccalaureate degrees in outlying geographic areas is telecommunication-assisted studies and Internet courses. More than 400 programs have part of their curriculum online while there are an increasing number of programs available completely online (AACN, March 2010b).

MSN programs are particularly attractive to the growing number of college graduates who decide later in their lives to enter nursing. Generally, the program is 24 to 36 months in length. On graduation these students are expected to demonstrate the same entry-level competencies in nursing as baccalaureate graduates. MSN graduates from these programs are then eligible to take the NCLEX-RN. Currently, there are 65entry-level master’s programs in the United States (AACN, 2010c).

The last, and the least common, path leading to the RN licensure examination is the doctoral degree, where the graduate has a nonnursing baccalaureate degree. This program began in 1979 at Case Western Reserve University in Cleveland, Ohio. Rush University in Chicago initiated a similar program in 1988, and the University of Colorado began one in 1990 (Forni, 1989). These programs, such as the one at the University of Texas at Austin, provide basic nursing courses, along with advanced nursing courses. On completion, the graduate is eligible to take the NCLEX-RN examination.

Graduate nursing education, like other graduate programs, is responding to changes in social values, priorities in the public sector, and student demographics, in addition to technological advances, knowledge development, and maturity of the profession (McCloskey & Grace, 2001). According to the National Sample Survey of Registered Nurses (2008), 32% of RNs with a baccalaureate or higher degree listed their initial RN education as diploma or associate’s degree, indicating that RNs in the workforce are recognizing the need to further their education and are returning to college to further their education either in nursing or nursing-related fields such as public health and health care administration.

Graduate education programs are available on either a part-time or a full-time basis. Graduate programs require a good grade-point average at the undergraduate level. Prerequisites for most graduate programs are satisfactory scores on the Graduate Record Examination (GRE) or the Miller Analogies Test (MAT). Although an increasing number of graduate programs are waiving the entrance examination requirements, it is strongly recommended that all students, whether they plan to pursue graduate studies or not, take the GRE after completing their undergraduate studies. Taking another test may be the last thing you want to do, but it is much easier to do it now, while the information is current in your mind, than later, when you decide that you want to continue your education.