The secret of: ADN vs. BSN vs. Diploma

There are multiple entry points for an RN and so there is a lot of confusion and a lot of different opinions about who makes the best nurse. So let’s shed some light on the secrets behind the three main roads to a RN. We have already discussed the PN/VN /LPN to RN route in one of my secrets, and if you have a bachelors the BSN or MN route to RN.

The three main roads are confusing and misunderstood. So the secret to knowing which program is right for you involves understanding these 3 roads. The first road is the diploma RN because literally it was the first road.



The Diploma RN route was at one time the only way to become an RN. It is one of the earliest types of nursing education in the United States. Less than 4% of all RN education comes from this type of program today but 20.4% of all RN’s practicing today fall into this category. These programs are and were administered by hospitals so may also be referred to as hospital-based programs. By the 1950’s these programs had affiliated with nearby colleges and universities; these schools adopted general education requirements and science courses as part of the curriculum. The diploma schools today offer just that, a diploma, no AD (associates degree) or BSN ( bachelor of science in nursing) but, some of them are affiliated with a college or university and allow for some postsecondary credit to be formally awarded.

The diploma schools in operation today have sound educational programs that meet the same accreditation criteria necessary like the other programs. These programs vary from 27 to 36 months long. There is a strong emphasis on client experience and time spent in clinical areas. These programs may be on the rise in the future as hospitals see a need to “grow their own nurses” to help fill gaps in the nurse shortage. You may be working with many of the aging nurse population in the hospital who came from these type of programs, and are great nurses.

Associates Degree RN (ADN)… the majority of nurses educated today come from these programs. This education usually occurs at a community/ junior/ or technical college. Originally RN nursing programs were moved from a 4yr. college or university setting to this new setting because of nursing shortages around WWII time. There was a need to produce more nurses in a faster time. The original thought was to move them back to a 4 yr. after the shortage period….. NOT GOING to happen now!!! With RN’s graduating in increasing percentages from this setting and with the shortage of nurses still being an issue for many years to come, this place of instruction is here to stay! Over 60% of allRN’s graduating last year came from this type of program. This setting produces great nurses, and is usually more assessable to more people. Quality may vary by the program not by the setting. Some will still argue that good nurses cannot be produced by two year programs, usually the criticism comes from the university BSN programs Many ADN or 2 yr. RN’s argue that by the time they finish their pre requisites and RN program they have been in school for 4 yrs. Which may be the truth, if math and English skills were needing to be refreshed or brought up to a college level. Students make the mistake of thinking it will be harder to get into a 4yr.RN program than a 2yr.RN program.

It is assumed that all 4yr RN programs are competitive and this is not always the case as talked about in secret #11. A recent survey showed 42% of ADN programs turned away qualified candidates. This leaves 58% where you can assume they took every qualified candidate. This number drops to 21% in BSN programs, that leaves 79% of all BSN programs took everyone that qualified for admittance with no one being turned down. These figures tell you that for the odds you should go with BSN.

National nurse organizations support the BSN route. There are two states who have tried to pass legislation that requires you to have your BSN within 10 years of graduating with your ADN. Other states are considering this type of legislature as well.

In a tight economy when there is not a nursing shortage due to:
• Nurses postponing retirement
• Part-timers go to full time
• Extra shifts worked
• Retired nurses coming out of retirement
• Elective surgeries postponed hospital census is down

there is more power behind this type of discussion and more people listen to changing entry level RN’s to BSN. As long as a shortage exists with RN’s this will be difficult legislature to get passed.

Some of you may find it is harder to get into your competitive 2yr program at the local community college than the private university sitting in your back door. So consider applying to all options. You will however have to be accepted to the college or university and meet their requirements.

What else can the 4yr.RN program do for you? It may open a few doors not available with a 2yr.RN. For example: supervisory or administrative jobs, public health including school nursing. There are some specialty credentialing organizations that require a baccalaureate degree for initial basic certification for nursing specialty, but not all do. Some hospitals may require it for specialty areas, most do not.

Recently our local hospital is trying to obtain a special status. This status requires that a certain percentage of RN’s be BSN’s. So, for right now they are favoring BSN graduates over ADN graduates for hiring and mentoring programs. In a tight economy where there is NOT a shortage of RN’s, the degree of BSN RN will be favored over the diploma or ADN RN for hire.

The national survey shows 25.2 % of RN’s educated initially in AD or diploma programs obtain baccalaureate degrees. Many times employee money is available for this education. These programs are called RN to BSN programs. They are usually geared to accommodate the schedule of the working nurse and many of them are online or partly online. They are structured totally different than your RN training. Clinical work consists of usually, community oriented nursing for a very limited time. Very little use of exams, you will be writing papers.

Will a BSN pay you more? One of the big questions in your mind is, will you be paid more from one type of school or degree than another? The answer is probably not. If there is a difference, it will be slight. Some hospitals will pay an extra $1-4 an hour for a BSN, others do not. Keep in mind that nursing is a cost for hospitals and they can receive no additional compensation from insurance reimbursement for higher degree nurses, hence no real desire to give more money for nurses who can do the same job effectively.
I am always asked, ” who produces the best RN?” There is a bit of a competitive nature among educators as to who is the best. Generally speaking ADN programs contain more clinical hours with the patient. Some hospitals prefer this. Others feel BSN programs produce better critical thinkers and they can make up for the lack of clinical experience easier than developing the thinking part.
I think the truth is in the program. There are good and bad programs in both ADN and BSN programs. I can only answer what I know about my local area and program. I can boast that our ADN program NCLEX RN pass rates beat all of the 4yr. RN programs in the state. And I can also tell you that the local hospital prefers our ADN RN graduates for hire over the university graduates. Is this the case for all ADN 2yr. programs?…NO. Which leads to the next very important secret… # 31 to tell you what your local hospital prefers.
Go to the state grid list ( I provided for you in the bonus section) and it will tell you which programs exist in your state and what type of programs they offer.

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