The theoretical and practical training

provided to nurses with the purpose to

prepare them for their duties as nursing
care professionals.
Experienced nurses and other medical
professionals are the ones who impart this
education and experience to nursing
students.
The traditional focus of nursing education was
to teach the knowledge and skills that would
enable a nurse to practice in the hospital setting.
However, as nursing responds to new scientific
knowledge and technological, cultural,
political, and socioeconomic changes in society,
nursing education curricula are revised to meet
the needs of nurses working in changing
environment.
Educational programs available for nurses
include practical or vocational, registered
nursing, graduate nursing, continuing education,
and in-service.
unlike the historically untrained or poorly
trained practical nurse, who had unlimited and
unsupervised freedom to practice, the present
practical nurse is often a hybrid. Todays
practical/vocational nursing student is being
taught basic skills during the education programs.
After licensing, the LPN/LVN is permitted to
perform complex nursing, as delegated by the
registered nurse and allowed by the nursing
practice act.
Practical nursing, the most basic level of nursing
practice, began with industrial revolution of the late
1800s.
To meet labor workforce during this time, many
people moved from rural areas to urban areas.
Women needing employment often provided
domestic services, including those associated with
caring for the sick.
To support the skills of this new healthcare provider,
in 1892 the Young Womens Christian Association
located in Brooklyn, NY, offered the first formal
practical nursing course.
they work under the supervision of registered
nurses.
The practical nurse is responsible for stable
patients and patients with common health
problems.
They also are responsible for collecting and
reporting abnormal data, providing bedside care
and health teaching
The practical nursing education programs are often
offered in community colleges. Most programs are
12 to 18 months in length, and graduates of these
programs complete a state practical exam (NCLEX-
PN) prior to being employed.
For some individuals, this short course of study is a
stepping stone to pursuing advance nursing
education.
It also allows them to work as a practical nurse while
obtaining further education.
Diploma nursing (originally known as hospital
nursing) began during the latter part of the 19
th

century with a growth in hospitals.
Knowledge of asepsis partially spurred hospitals
growth and precipitated a demand for more nurses.
Training of hospital nurses at this time was based on
an apprenticeship model where nursing students
provided service (direct patient care) in exchange for
a few educational lectures, room and board and a
monthly allowance.
The apprenticeship model flourished because it
offered women an opportunity for a vocation, it
improved care of the sick and decreased the cost
of nursing service in hospitals while student
nurses provided patient care services for a
minimal allowance.
Despite the benefits of the apprenticeship model,
it underwent criticism from
nursing education leaders.

Goldmark (1923) in particular emphasized that the
training needs of students and the service needs of
hospitals were incongruent.
She wrote that when the needs of the sick must pr
edominate; the needs of education must yield (Go
ldmark, p. 195).
To balance the academic needs of nursing student
s with their need for clinical
experiences, Dr. Richard Olding Beard advocated
for university education for nursing students.
He contended that university education would eli
minate the
incongruence between the hospitals service need
s and the educational needs of students.
In1909 Beard began a nursing program at the Univ
ersity of Minnesota. This program is often heralded
as the first baccalaureate nursing program.
However, it closely resembled diploma education
because
even though nursing students met university
standards for admission and coursework, they were
required
to work 56 hours a week on the hospital ward (Bullo
ugh & Bullough, 1984).
Following Dr. Beards efforts, the National League for
Nursing Education (NLNE) made numerous attempts to
redesign diploma nursing education programs. In 1917, 1919,19
27, and 1937 the NLNE published Standard Curriculum for
Schools of Nursing.
This report encouraged diploma programs to decrease students
time working on the ward and to increase their education by of
fering 3years of course work in the sciences
and clinical experiences caring for diverse
populations (e.g., medical surgical, pediatric, and obstetric patie
nts).


Hospitals that continue to support diploma programs
maintain this educational option because these progra
ms supply the nurses needed in their hospitals,
they provide a geographically accessible program for
some students, they offer a
nursing degree in a short length of time, and they
often offer tuition remission.
To meet the educational needs of diploma students,
many of these programs collaborate with colleges and
universities to offer students options to obtain associat
e and baccalaureate degrees.
Additionally, it is important to note that despite
the reasons for the decline of diploma programs menti
oned earlier, some studies
suggest that diploma nurses are as competent in resear
ch, leadership, and critical thinking as graduates from
other undergraduate nursing programs (Clinton,Murre
lls, & Robinson, 2005).

Thus, for now it seems that diploma programs,
though having experienced a turbulent history, are p
ersisting and will continue to
be a valuable asset to the nursing profession.
Community college/associate degree nursing
programs, which arose in the early 1950s, were the
first and only educational programs for nursing that
were systematically developed from planned
research and controlled experimentation.
Several trends and events influenced the
development of these programs.
The Cadet Nurse Corps
The community college movement
Earlier nursing studies
Dr. Mildred Montags proposal for an associate degree.

The Cadet Nurse Corps of the US was
legislated and financed during the WW II
to provide additional nurses to meet
both military and civilian nursing needs.
The corps proved that qualified nurses
could be educated in less time than the
traditional 3 years.
After the WW II, the number of
community colleges in the US grew
rapidly. The low tuition and open-door
policy of these colleges made higher
education more accessible to all by
offering the first 2 years of a 4year
college program.
EARLIER NURSING STUDIES
Studies of nursing education, such as the
Goldmark report in 1923, the committee on the
grading of schools of nursing in 1934, and the
Brown report in 1948, also had a significant
influence on the development of 2 year
programs. The recommendations in all of these
reports supported independent schools of nursing
in institution of higher learning separate from
hospitals.
In US, associate degree programs were started
after Mildred Montag published her doctoral
dissertation in 1951, the Education of Nursing
Technicians, which proposed a 2 year
education program for RNs in the community
colleges.
Dr. Montag made the suggestion as a solution to
the acute shortage of nurses that came about
because of WW II. She conceptualized a
nursing technician or bedside nurse able to
perform nursing function broader than those of
the practical nurse and smaller in scope than
those of the professional nurse.
The first associate degree in nursing (DN)
program started at Columbia University
Teachers College in 1952 under the
direction of Mildred Montag.
In 1978, the ANA proposed a resolution that
associate degree programs were no loner
to be considered terminal but part of a
career upward-mobility plan.
Today many students enter an associate
degree program with the intention of
continuing their education in nursing to the
baccalaureate or higher level.
The first school of nursing in a university
setting was established at the University of
Minnesota in 1909. this programs
curriculum, however, differ little from a 3
year hospital program.
It was not until 1919 that the University of
Minnesota established its undergraduate
baccalaureate degree in nursing. Most of
the early baccalaureate programs were 5
years length. They consisted of the basic 3
year diploma program in addition to 2 years
of liberal arts.
Today baccalaureate nursing programs are
located in senior colleges and universities and
are generally 4 years in length. The curricula
offer courses in the liberal arts, sciences,
humanities and nursing.
The usual degree awarded is a Bachelor of
Science in Nursing (BSN).
Because of changes in the practice
environment, the nurse who holds a
baccalaureate degree is beginning to
experience greater autonomy, responsibility,
participation in institutional decision making
and career advancement.
Most graduate programs are conducted by
departments within the graduate school of a
university, and the applicant must first meet
requirements established by the graduate school.
The applicant must be a registered nurse license.
The applicant generally must hold a
baccalaureate degree in nursing from an
approved college or university.
The applicant must have letters of
recommendation form supervisors, nursing faculty
or nursing colleagues indication the applicants
ability to do graduate study.
The growth of university nursing programs
encouraged the development of graduate
study in nursing.
In 1953, the newly established National League
for Nursing encouraged educators to develop
programs for masters degrees in nursing. The
major emphasis of the programs was to be
research and specialization for teaching and
administration.
The first clinical masters degree (in
psychiatric nursing) was offered at Rutgers
University in New Jersey in 1954.

Today masters programs generally take
from 1.5 to 2 years to complete. Degrees
granted are the master of arts (MA),
master in nursing (MN), and master of
science in nursing (MSN).
Masters degree programs provide
specialized knowledge and skills that
enable nurses to assume advance roles
in practice, education, administration
and research.

Doctoral programs in nursing, which award
the degrees of doctor of philosophy (PhD),
doctor of nursing science (DNS) or nursing
doctorate (ND), began in the 1960s in the
US.
These programs further prepare the nurse
for advance clinical practice education,
administration and research.
Before 1960, nurses acquired doctoral
degrees in such related fields as
psychology, sociology, physiology and
education.


In 2004, the American association of colleges
of nursing approved a move to prepare
advance practice nurses (nurse practitioners,
nurse anesthetist, nurse midwives and clinical
nurse specialist) at the doctoral level-awarding
a doctor of nursing practice (DNP).
Content and approach vary among doctoral
programs. Some focus on the usual clinical
areas, such as medical-surgical nursing and
others emphasize such nontraditional areas as
transcultural nursing.
Some programs emphasize theory
development but all emphasize research.
Thank you!


As noted previously, in 1943 Isabel Stewart remarked
that efforts to redesign
diploma nursing education included experimenting with
new nursing education models. One model was associat
e degree nursing education.
It began in response to the post-
World War II nursing shortage and it gained momentum
following the Ginzberg Report (1949), which suggested
that in comparisonto a 4year nursing program it would b
e more efficient and economical forcolleges to offer a 2-
year course of study in nursing.
Ginzberg believed that not all nurses needed
baccalaureate education to provide patient care.
Nurses could be prepared to provide safe and
competent patient care in less time than
baccalaureate education, which would provide a
feasible solution to the nursing shortage.
It was at this time that Mildred Montag (1951) descr
ibed how 2year associate degree nursing programs,
housed in community colleges, could prepare reg-
istered nurses (RNs) as semiprofessionals.
This group of RNs would meet the
demand for nurses by acquiring enough nursing skill
and judgment to provide
nursing care, but not the expert skill and judgment
of baccalaureate-prepared nurses.
Further study by Montag (1959) suggested that
nurses prepared with an
associate degree were performing similarly to staff n
urses prepared with baccalaureate degrees.
Moreover, those within the nursing profession
believed that,with the exception of preparation
in leadership and public health, nurses with an
associate degree provided outstanding bedside nursi
ng care (Smith, 1960).
Indeed there were many advantages to associate
degree nursing education and these advantages
remain present in todays associate degree nursing
programs.
Nevertheless, at the height of this programs
success,in 1965, the American Nurses Association (A
NA)published a position paper stating that those
licensedto practice nursing should be prepared in institut
ions of higher education (universities).
It also stated that the minimum
preparation for the professional nurse should be a
baccalaureate degree. In other words, the position pa
per equated
professional nursing with baccalaureate education.
This potentially meant that associate degree
prepared nurses could not practice as registered
nurses unlessthey had licensure requirements that
were different from baccalaureate-pre-pared nurses.
Current research suggests that baccalaureate
prepared nurses are associated with improved
patient outcomes,that hospitals prefer to hire baccala
ureate-prepared nurses, and that magnet
hospitals have a higher percentage of baccalaureate
prepared nurses (Graf, 2006).

This is not to say that associate degree nursing progr
ams (like many diplomaprograms) will disappear.


However, these studies do indicate mobility
programs(discussed later in this chapter),
through which associate degreeprepared nurses
obtain baccalaureate and higher degrees in
nursing, will take on even greater
significance than they have in the past.