TABLE 1 Entry Into Practice: Nursing Programs, 1950–1990

 

1950

1961

1970

1973

1978

1990

Program

Diploma

1129

875

636

494

367

152

ADN

3

84

437

574

656

829

BSN

61

176

267

305

349

489

 

SOURCE: DeBack (1994) and Murphy (1979).

Committee on the Study of Nursing Education (1923) and the Committee on the Grading of Nursing Schools (1928)—that issued reports on themes that would concern nursing for the remainder of the twentieth century: the standardization of nursing education, restriction of the supply to ensure adequately paid work, and distribution and specialization of the aggregate work force. The 1930s were a period when hospitals expanded and private duty nursing declined, as the sick were unable to pay for home care because of the economic depression.

Two reports in the 1940s were to sound once again the theme of the need for standardized nursing education. The Brown Report (1948), considered to be "the nursing equivalent of the 1910 Flexner Report in medicine" (Friss, 1994, p. 604), urged that only college graduates be regarded as truly professional. That same year, the Committee on the Function of Nursing (1948) recommended upgrading standards for both the licensed practical nurse (LPN) and the registered nurse (RN), the former with an associate degree and the latter with a bachelor's of science in nursing (BSN) degree. In 1951, Montag elaborated on the growing distinction between technical training, which was to be established under the ægis of the community college, and professional education, which belonged at the bachelor's level (Montag, 1951). The first associate degree in nursing (ADN) program was started in 1952 at Fairleigh Dickinson University.

Programs offering ADNs have largely replaced diploma programs in the last four decades (see Table 1), but they became another means of acquiring the RN rather than the LPN (Deloughery, 1977; Murphy, 1979; Fondiller, 1983). Entry into professional nursing practice has been further complicated by the development of generic master's and doctoral programs on the grounds that undergraduate education is foundational to truly professional practice, just as it is for dentistry, law, and medicine (Dolan et al., 1983). For example, the first generic nursing doctorate (ND) was started at Case Western Reserve University in 1979, and there are now three such programs (Watson and Phillips, 1992).

Graduate education for nurses, however, first took the form of additional preparation in the functional areas of education and administration as nurse leaders prepared for academic or supervisory roles. The first master's degree was awarded by Teachers College of Columbia University in the 1920s, and that



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