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The Future of Nursing: Leading Change, Advancing Health
expensive than a BSN because of the cost structure of the community college system and the shorter program duration. Once conceived as a 2-year program, the ADN is seen as taking less time than a BSN, but this situation has changed over the years (Orsolini-Hain, 2008). In most non–health care disciplines, the associate’s degree takes 2 years to complete. In nursing, however, surveys have found that it takes students 3–4 years to complete an ADN program because of the need to fulfill prerequisites and the lack of adequate faculty, which lead to long waiting lists for many programs and classes (Orsolini-Hain, 2008). The ADN curriculum often combines intense science and clinical coursework into a condensed time frame, posing additional challenges to completing the program in 2 years.
BACHELOR’S OF SCIENCE IN NURSING
The BSN is a 4-year degree, typically offered at a university; the first university-based schools of nursing were founded in the early 20th century (Lynaugh, 2008; Lynaugh and Brush, 1996). BSN programs emphasize liberal arts, advanced sciences, and nursing coursework across a wide range of settings, along with leadership development and exposure to community and public health competencies. As of 2008, 34.2 percent of RNs throughout the United States had started with a BSN, up from 31.5 percent in 2004 (HRSA, 2010). Beginning in the latter part of the 20th century, an accelerated option for a BSN or MSN became available to applicants who had already completed a bachelor’s degree in a different field. Also known as fast-track or second-degree programs, these programs have added substantially to the growing number of baccalaureate graduates (AACN, 2010).
Most BSN students complete their degrees in 4 years. Accelerated programs that offer the BSN to students who have already completed a bachelor’s degree are typically completed in 11–18 months, with intense coursework and professional formation accelerated based on previous collegiate and life experience (AACN, 2010).
For much of the 20th century, following the release of a significant 1965 position paper of the American Nurses Association, nursing leaders and educators tried to standardize nursing education and make the BSN the minimum entry-level requirement for nursing practice. Four states were targeted for early implementation (Smith, 2010). Only one of them—North Dakota—fully followed through on that recommendation by establishing the BSN as the minimum degree in nursing in 1987 (Smith, 2010). In 2003, however, the state legislature, at the urging of hospitals and long-term-care stakeholders, passed a law that allowed nurses with an ADN to practice (Boldt, 2003). Nationwide, market forces and the needs of individual employers generally determine whether a BSN is required for entry into practice.