Nursing education expert Donna Ruelens-Trinkaus, PhD, MSN, RN, explains what those options are, the pros and cons of each and what students should consider before deciding to pursue an undergraduate nursing degree. Ruelens-Trinkaus is chairwoman of the Accelerated Career Entry BSN program at Drexel University in Philadelphia.
Founded in 1891, Drexel University has been ranked among the nation’s 100 best universities for the past five years, and is one of America’s 15 largest private universities.
Ruelens-Trinkaus: There are three pathways students can select to receive a nursing education.
The first is a diploma program, where the student will receive a diploma as a nurse and some college credits but not a college degree. A diploma helps prepare a student to sit for the NLCEX-RN. Diploma programs range in length from 22 months to two years. These hospital-based degree options have become rare nowadays.
The associates degree in nursing, or ADN, is a program that awards the student an associates degree. This typically takes two years and prepares the student to sit for the NCLEX-RN.
The bachelor of science in nursing program can take up to four years and prepares the student to sit for the NCLEX-RN. In the past 10 years, some schools began to offer accelerated BSN programs for students who already have a bachelor’s degree in another subject area and want to become a nurse. These programs generally take from 11 months to about 18 months to complete. All the nursing education programs vary in clinical experiences.
Ruelens-Trinkaus: Many of the hospitals in the U.S. are attempting to be awarded Magnet status and the BSN is an entry-level requirement at Magnet hospitals. Therefore, the BSN graduate will have an advantage over nurses with an ADN or diploma. Many of the Magnet-designated hospitals will not consider hiring a registered nurse if they do not have a BSN.
One pro for students is associate and diploma programs cost less than BSN programs because diploma programs are hospital-based and ADN degrees are community college-based.
Another potential pro for graduates of ADN or diploma programs who are hired into hospital systems is that many systems then offer tuition reimbursement to pursue the BSN.
Ruelens-Trinkaus: There are several important considerations.
One is a university’s or college’s NCLEX pass rate. Drexel’s is 97% to 100%. Each state has a baseline requirement. For the state of Pennsylvania, for example, 80% is the pass rate required to maintain state board approval.
Make sure the college or university has an accredited program. It can be accredited by the National League of Nursing Commission for Nursing Education Accreditation or the Commission on Collegiate Nursing Education. If a school is not accredited, you may not be able to sit for your licensure.
Ask yourself if the degree you’re thinking about meets your career desires. For example, do you want to become a nurse practitioner or an educator? Make sure it meets what your needs are, and what you are planning for your future. You want to make sure there are options for financial aid, if needed.
This is a big one: specialties. A lot of nursing education programs have started to integrate specialties into the general curriculum. For example, some schools integrate pediatrics into the curriculum, so separate pediatric clinical experiences will diminish and may possibly go away altogether.
The specialties are pediatrics, community or public health, maternity or reproductive health and mental health. If you take away those individual specialties and integrate them into the curriculum, you’re losing out on getting this specialized knowledge and clinical experience. This experience can help you determine whether that is a specialty in which you might want to work in the future.
Consider a school’s location. Do you want to live in a city or in the suburbs? This also will impact the types of clinical experiences you will receive.
Consider how many clinical hours and the types of clinical experiences you will be provided. For example, in Philadelphia, you might have the opportunity to go to an internationally recognized children’s hospital, as well as several nationally ranked hospitals.
Ruelens-Trinkaus: Salary is based on location more than the type of undergraduate degree you completed. In a city, you make more money than in the outlying suburbs and small communities. But the BSN offers more job options than the associates degree or diploma programs.
Ruelens-Trinkaus: Absolutely. A 2010 Institute of Medicine report identified an overall goal for 80% of the nursing workforce to have a BSN by 2020.
The report addresses the way our healthcare has changed. So much of healthcare is now community-based, versus acute care in the hospital. Typically, concentrations in community or public health, leadership, research and health policy is not included in the ADN or diploma programs. They are part of the curriculum for a bachelor’s degree.
Ruelens-Trinkaus: In nursing education, we have identified that one way to address the need to increase the BSN workforce would be for four-year colleges or universities to collaborate with community colleges and develop a bridge program to allow the ADN student to roll into an RN-to-BSN program.
Drexel is working with Delaware County Community College to bridge their ADN students into Drexel’s RN-to-BSN program once they complete their courses at the community college.
Additionally, this may enable the ADN graduate to obtain a job at a Magnet hospital, because they are already a student in an RN-to-BSN program. This would allow them to be eligible for tuition reimbursement from their employer, to help pay for the RN-to-BSN education.
Ruelens-Trinkaus: I truly believe the future of entry-level nursing education is the BSN. However, I have been a nurse for more than 32 years, and it has been more than 40 years that this has been a part of the conversation. We have never been able to accomplish this goal.
I think this is a multifaceted, complex issue. Cost is one issue that many students face when enrolling in a program. Additionally, many people identify later in life that nursing is something that brings them the fulfillment they need in a career.
The accelerated programs are reflective of the student that is changing careers, sometimes because of a life event, such as taking care of a sick loved one, when they discover that nursing is what they are passionate about.
I think the demographic of the nurse has begun to change, and it now encompasses a diverse group of individuals. Therefore, being able to address everyone’s needs into one pathway will be very difficult.
However, with the current healthcare climate, it is imperative to have entry-level nursing education be that of the BSN. We need to have multiple systems in place to try and address getting people on board with this. I don’t think there is only one way to do it.