The education for receiving a diploma or certificate from a hospital school of nursing has a different setup than a university or community college. The course is usually two years long and the time is spent entirely in a hospital setting. Nursing students are allowed to enter the hospital nursing school right after high school graduation as long as certain high school prerequisites are fulfilled. The curriculum is very similar to that of a university or community college providing actual classroom settings within the hospital and basic nursing knowledge. There are usually two levels (one level per year) for students in hospital schools of nursing. At level one, the student is able to have patient interaction and they are able to observe the procedures that take place, but the students cannot perform the procedures. The same is true of level two, except the students are able to collaborate with hospital faculty and classmates to delegate patient care. During the last five months of the course completion, the nursing students spend all of their time in clinicals where they are able to specialize in certain areas of nursing. The amount of clinical hours averages out to be about the same as the university clinical hours (16-18). Once the student graduates from the hospital school of nursing, they are also required to take the NCLEX licensure exam. Students from this pathway also obtain the same RN status as students from universities or community colleges (“Bridgeport Hospital,” 2003).
Advantages and disadvantages. As said before, there are many advantages and disadvantages for becoming an RN in each of the three pathways. These advantages and disadvantages help to determine which schools provide the best nursing education. They also help students decide which pathway is best for them. Since each individual student has their own set of specific needs and circumstances, they each need to decide which nursing education route fits them the best. Among some of the important influential factors associated with the different routes are the educational and clinical requirements, classroom setting, and the cost of the education.
Educational and clinical wise, all three nursing programs are at an advantage. Universities have an advantage over the educational requirements compared to community colleges and hospital schools of nursing. Since universities require two years of general studies, it allows students to learn about more than just nursing. By obligating the students to take two years of general studies, it enables them to become educated in other areas. Their knowledge in other areas can help them to become more culturally diverse, which is always a positive aspect in a hospital. Hospital nursing schools are also at an educational advantage because the students are all trained the same as the employees of the hospital. If the students decide to work at the same hospital that they were taught at, they’ll know how to follow the procedures exactly, where the different units of the hospital are located, and the equipment and medication that is provided at the hospital. They will have a head start over people who transfer to the hospital to work. As far as clinical hours go, universities are tied with hospital nursing schools for the number of clinical hours provided. Community colleges, on the other hand, are lagging behind on clinical hours. By allowing more hours in the clinicals, it helps the students to gain more hands-on experience, which can be a very beneficial tool for learning. The more times a student practices procedures and is involved in medical situations, the more it helps them to learn all the aspects of nursing. It prepares them for when they will be responsible for controlling and handling medical situations on their own.
An advantage of both community colleges and hospital schools of nursing is the classroom setting. Both routes typically have smaller class sizes than universities, which allows for smaller student to teacher ratios. Students are able to learn in small class settings where it is easier for the teacher to focus their attention on the individual needs of the students. The hospital nursing schools also have an advantage over the two other schools because their classroom setting is in a hospital. The students can observe situations first hand. All of the medical equipment and necessary medication can be shown and demonstrated to the students since they are in a hospital setting. They have easier access to viewing items or situations when they are constantly in a hospital setting as opposed to a school setting.
The amount of money spent on school plays a large factor in determining where students wish to attend college. A major advantage of attending a community college is that it helps to save a lot of money. By examining Shoreline’s Nursing Program, assuming the student is a Washington resident over the age of 18, the student will be paying about $3,840 for both years of nursing school (“Shoreline Community College,” 2004). Universities and hospital nursing schools, on the other hand are quite pricey. By examining the University of Washington’s Nursing Program, the cost of tuition for all four years for a Washington resident would add up to $21,140. The amount of money for the hospital school of nursing is very close to the amount that a university charges. According to the Bridgeport Hospital School of Nursing in Connecticut, the estimated tuition for both years of nursing school would be around $21,000 for in-state tuition. Universities and hospital schools of nursing can be quite expensive, especially for a college student. The amount of money needed to pay for community college is substantially less than the amount needed to pay for a university or a hospital nursing school. The educational route that a student uses depends greatly on monetary funding.
Debate Over Nursing Education
There are claims that have been made to hurt certain educational aspects that are untrue. For many years there has been a debate over which educational route is the best for becoming an RN. It has been widely publicized that RN’s obtaining baccalaureate degrees have been held at a higher status than RN’s with associate degrees or diplomas. The claim was even made by Pederson (2003) saying, “A hospital's employment of nurses who have earned an associate's degree in nursing in lieu of a bachelor's degree in nursing will significantly increase that hospital's mortality rate for post-surgical patients” (p.4). This claim showed statistical data, but some upset researches investigated the statistical evidence further and found it to be inaccurate. Pederson had construed the evidence to make an opinionated claim. Statements like these are what give nursing education, other than from a university, a bad name.
Nurses with BSN’s are suppose to be “better” than nurses with AD’s or diplomas because their education is at a higher level and because of the prestige of attending a university as opposed to a community college or hospital school of nursing. The prestige of a school is a personal opinion, but as far as education level goes, it is basically the same curriculum for each nursing school pathway. The classes are each titled differently, but they hold the same educational content. Table 1 shows a chart comparing some of the nursing classes between the University of Washington, Shoreline Community College, and Bridgeport Hospital School of Nursing. Not every university, community college, and hospital nursing school has the exact same curriculum, but other schools are very similar. Harrison (2004) says, “Diploma and degree nursing students attend the same lectures. The only difference is that they are assessed at different levels. Diploma nurses are asked to discuss results, whereas degree students have to critically analyze the results” (p. 12). Learning to become a nurse is the core topic within nursing school so this would cause many curriculums to be similar to one another. True, there are some colleges that have more advanced technology and research, but those are just some bonuses added onto the basics of becoming a nurse. Every nursing school will teach the students the necessary and basic information of nursing (Harrison, 2004, p. 12).
One extremely important observation that should be pointed out is that all RN’s must take and past the NCLEX, which is the same for every nursing student. Nurses educated in universities, community colleges, and hospital diploma programs are all capable of passing the NCLEX and becoming the best RN possible. In the year 2000, 59.8% of the first-time test takers entered the nursing field after taking the NCLEX had associate degrees. Another 36.5% of first-time test takers entered the nursing field had baccalaureates degrees and 3.8% had hospital-based diplomas (Perez, 2003, p. 10). There were less nursing students that passed with baccalaureate degrees than there were students with associate degrees, even though students with baccalaureate degrees are suppose to have a “better” education. This goes to show that students who attend community colleges are quite capable of passing the NCLEX. These students did not need to go to an expensive university to obtain quality education.
One beneficial factor of obtaining a baccalaureates degree is that it allows nursing students to advance more easily. According to Perez (2003), “Bachelor programs create a pathway for nurses by focusing on sociological and psychological skills, emerging medical technology, skills associated with healthcare management and focused fields of medical specialization” (p.11). If a nurse is considering specializing in an area of the nursing field, they should look into a BSN program. Many master programs prefer to enroll students who have obtained a baccalaureates degree, not to say that students with associate degrees or diplomas cannot get in. It is only preferred that a student has a BSN degree (Perez, 2003, p. 11).
Additional Nursing Programs Added
The United States has been experiencing a huge nursing shortage over the past couple of years. Part of the nursing dilemma is due to problems within the nursing education system. Each year more and more students are becoming interested in the nursing field, but are turned away from nursing schools because of the limited numbers of nursing faculty, clinical sites, and classroom space. The American Associates of College of Nursing (AACN) reported that as of Fall 2003, there was an increase of 16.6% of students admitted to nursing programs over the previous year, but still 11,000 qualified students were turned away from nursing programs (“Enrollments Surge,” 2003). 11,000 students who could potentially become nurses is a large amount to reject, especially in our time of need for nurses. The best way to combat the educational problems would be to allow more government funding for the nursing programs. With more funding the nursing schools would be able to pay the nursing faculty higher wages and obtain more clinical sites and classroom space. Since it would cost the government a lot of money to help fix these problems, the government has created new cheaper educational programs that are used to promote nursing growth quickly.
There are options being made possible to help increase the amount of students that are able to enter a nursing program. Sometimes hospitals prefer to hire nurses that have obtained a baccalaureate degree, which is causing some nurses to fall short of a job. To help combat this problem a program was made for RN’s who have an AD or diploma and wish to obtain a BSN. This program is called the BS-RN program. These programs are offered at many colleges and sometimes there are direct transfers between community colleges and universities. Direct transfers allow students with ADs to be automatically accepted into a BSN program. By obtaining a BSN, it helps to improve the nurse’s education and provides the BSN status that some hospitals are looking for. Some nurses may also participate in a BSN program because they wish to pursue their education and learn more about the nursing field by taking additional classes and others just simply want the title of having a BSN degree. Every nurse has his or her own personal motives (Fetzer, 2003, p. 139).
Furthermore, some universities are providing online BS-RN programs. The University of Maryland School of Nursing is one of the many schools to offer a BS-RN program. The assignments are done online while the examinations are done either online or as a proctored session. A program, such as Blackboard, is used to organize the class and to create a database for students to post their work. The nursing program is run much like this English class is. The students are given textbooks to read and do exercises from. The assignment worksheets are posted online and they are written assignments so computers must have word processing. After the students complete the assignment, they post it online allowing the teacher to grade them and make comments. The examinations are slightly different than that of a typical class. They may take place online using randomized tests and time limits or the examinations can be proctored at a testing center with the instructor’s approval. The computer users must also have a digital movie player because short movie clips are shown including surgeries, the human body, and other medical practices. Clinicals are not provided because they are similar to the clinicals they have already experienced from community colleges and hospital nursing programs. Any processes that are unfamiliar to the nurses are done over the digital media player showing all angles of the images (Mills, Fisher, & Stair, 2001, p.235).
There are both advantages and disadvantages to having an online nursing program. One advantage is the convenience of taking an online course. Large amounts of RN’s with associate degrees that are seeking baccalaureate degrees are older and have family, work, and community obligations. They do not always have time to take out of their busy schedules to sit in class for a couple of hours. By having the classes online, the BS-RN students may take the classes at their own pace and do the assignments during a time at which they are not busy. Another advantage is that students who are not close to a BS-RN program may participate in the course from the convenience of their home. The online course breaks down geographical barriers and provides: accessibility, convenience, and the opportunity for self-directed work. Along with the advantages come the disadvantages. One major disadvantage that can be found with any online class are feelings of isolation and frustration with technology. There are always computer and internet problems occurring, which can cause huge problems when the two items are necessary for the class (Mills & Fisher & Stair, 2001, p.235). It is the responsibility of the students to sort out the pros and cons of an online course and to decide what is best for them.
Another nursing program that is offered is designed for students who already have a baccalaureate degree in another field and wish to switch over to the nursing field. These students are provided with an accelerated program that runs straight for 12-18 months as opposed to the typical two to four year nursing programs with summer breaks. The courses are very intense and there are no breaks throughout it. Although the course is fast paced, the positive aspect is that it is over with very quickly. One very big, beneficial aspect of the accelerated program is that it allows people with a four-year degree to change their careers quickly. The graduates with degrees would not need to withstand four more years of college, but rather just one to one and a half more years. The accelerated course covers the same material as regular nursing schools and it also requires the same amount of hours spent in clinicals as traditional programs. Graduates with four-year degrees who come back to college to pursue nursing are looked upon as highly respectable and are sought after. The AACN says, “Graduates of second-degree programs are in high demand by nurse employers since they bring many layers of education and experience to enrich their clinical practice” (“Enrollments Surge,” 2003). For this reason, the AACN believes there should be more federal money used towards accelerated nursing programs so the program will be able to grow.
Although these programs are offered to make it more convenient for people to obtain BSN degrees and to help speed up the process of becoming a nurse and, the quality of the programs must be maintained. The students must be certain that these are the correct programs for them and that they are going to learn everything in an online nursing course or an accelerated nursing course as they would normally learn in a standard nursing program. It is important that the students take the online course seriously and are dedicated to learning more about nursing and do not simply just want to be able to say they have a baccalaureates degree in nursing. The online program is supposed to help the RN’s advance their education and so it is necessary that the students consistently do all of the work. The quality of the accelerated program must be held above trying to get the nursing students through it quickly. By pushing the students through the program too quickly, the soon to be RN’s may make more mistakes with patients, which could potentially lead to more patient deaths. Although it is important to try and obtain the highest number of RN’s possible, the primary concern is to create nurses that know their field extremely well and end with the least amount of patient mistakes and fatalities as possible.
When it comes down to it, there is not one correct answer as to which nursing pathway is the “best.” Every person has their own opinions about each program, but hopefully this paper has helped to shed some light on the truth of the matter. The quality of the education depends greatly on the specific school and not on the type of school. There are always going to be spectacular universities and then there are always going to be mediocre universities. The same goes for community colleges and hospital nursing schools. To classify nurses from community colleges as “bad nurses” would be shameful since the majority of nurses in the world have associate degrees. They are the ones who have been helping people when they are in need of medical attention. Both universities and community colleges have advantages and disadvantages. It is up to the nursing student to decide which route has more advantages and is right for them. Only they hold the power to decide.
Resources
As enrollments surge, thousands turned away from our nation's nursing schools. (2003, December). Us Newswire.
Bridgeport Hospital School of Nursing. (2003). Diploma in nursing courses. Retrieved August 10, 2004, from
Fetzer, S. J. (2003, May-June). Professionalism of associate degree nurses: The role of self-actualization. Nursing Education Perspectives, 24(3), 139-143.
Halter, M., & Polet, J. (2002, January-March). The place of baccalaureate nursing programs in the liberal arts setting. Nursing Forum, 37(1), 21-29.
Harrison, S. (2004, June 9). Degree vs diploma: Can education to degree level really produce more confident nurses and better patient outcomes? Nursing Standard, 18(39), 12.
Hurley, M. L. (1994, June). The push for specialty certification. RN, 57(6), 36-34.
Increase in nursing school enrollments/graduations. (2004, May). AORN Journal, 74(5), 974.
Lippman, H., & Dayer-Berenson, L. (1991 February). How hard will it be to get your BSN. RN, 54(2), 32-37.
Mills, M. E., Fisher, C., & Stair, N. (2001 September). Web-based courses more than curriculum. Nursing and Health Care Perspectives, 22(5), 235.
Pedersen, R. P. (2003, October 13). The bum-rap on community college nursing education. Community College Week, 16(5), 4-5.
Perez, A. (2003, March 31). More, better and faster: Getting students into nursing, stat. Community College Week, 15(17), 10-11.
Shoreline Community College. (2004). Shoreline community college nursing program. Retrieved August 3,2004, from
Short, N. (2000, November). Online learning: ready, set, click. RN, 63(11), 28.
University of Washington. (2004). University of Washington degree programs: BSN curriculum. Retrieved August 3, 2004, from
