Don’t Cling to Tradition: A Nursing Student’s Call for Realism, Respect

By Medora McGinnis. Medora is a student at Bon Secours Memorial College of Nursing in Richmond, Virginia, and the 2011-2012 Imprint Editor of the National Student Nurses’ Association (NSNA). This is her first post for this blog. 

There was a time when the majority of all nursing programs were diploma programs, emphasizing practice over theory. They were largely based out of hospitals and proved very well suited for this training. Popular among students, they provided the majority of the nursing workforce well into the 1950s. But these programs began to lose popularity as they were supplanted by other forms of training. At the same time, patient care was shifting and hospital care costs were exploding. By the late 1970s, 40 diploma programs were closing their doors every year.

The year is now 2011, and there are less than 40 diploma programs nationwide. I am a senior nursing student in one of these programs, and have been a part of their transition from the diploma to the four-year BSN. My graduating class will be the last of the diploma graduates, and many of us plan to continue our education and quickly complete an RN-to-BSN program. Why? Certainly to maintain our momentum, and to be competitive in today’s workforce. But the undertone in the nursing community, especially among young and new nurses, is that the BSN is required in order to earn respect.

One very interesting fact regarding diploma programs—one that most  people may not realize—is that there is typically only a 10-credit deficit between the diploma or ADN nurse and the BSN nurse. That’s correct, only 10 credits—or, for example, an average of three humanities courses. Many of these programs also have twice the number of clinical hours as BSN programs, preparing their graduates to walk right into the NCLEX exam (and pass with flying colors), and from there right into the nursing workforce.

But why am I making this point, when clearly there are only a handful of such programs left? Aren’t we talking about a dinosaur here? While many working RNs are graduates of diploma programs—and effective nurses, I might add—we are being encouraged to earn the BSN degree just to get hired in many hospitals, or so that a hospital where we already work can achieve Magnet status. And it’s not just new grads feeling the pressure, but also experienced, seasoned nurses.

However, there’s a practical problem here for many. How can a working RN, especially one with a complex life that often includes a family and other responsibilities, find a way to attend college to complete the RN-to-BSN program? Or how does a BSN nurse find a way to attend a master’s program or beyond? One way is through online RN-to-BSN programs and other “nontraditional” bridge programs that are often only two to three semesters long, partially or totally online, and provide the additional theory and research courses that diploma and ADN programs forgo so that they can offer the additional clinical time.

So again we face the issue of respect: such programs, while more appropriate for a busy, working, multitasking RN, may not earn the same level of academic respect as face-to-face RN-to-BSN programs. Some sources even go so far as to imply that any RN-to-BSN degree is inferior to a “traditional” four-year program. Maybe a little realism is called for. In the world we live in today, “traditional” is less and less visible. And do we all know exactly what we want to study when we’re 18? Or do some of us change careers, find a new calling, or choose a new challenge?

In reality, the initials after my name are what I’m after. I would like to feel proud of my academic accomplishment, and I know that I will—regardless of the institution listed on my BSN degree. As a wife, mom of five, successful full-time nursing student, NSNA editor, and hospital employee, I know that every single accomplishment in our lives should be celebrated. Like the note in our ICU staff restroom, “Remember to be nice. We may never know another person’s battle.”

New grad nurses are entering nursing in a remarkable time—evidence shows that minimum education requirements are reflected in patient outcomes. We are already onboard with this, and can’t wait to move forward. Even so, I can only hope that our nation of nurses will rise up to meet me, along with the coming wave of other RN-to-BSN graduates, and share the respect that we already have for them; we are all shoulder to shoulder, providing safe and competent nursing care.

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2016-11-21T13:12:22+00:00 July 26th, 2011|career, students|21 Comments
Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. Christine Quigley May 14, 2016 at 11:56 am

    After 47 yrs. in nursing, I retired last May 1st. I graduated from a stellar nursing diploma program at Kings County Hospital in Brooklyn, NY. This was a world recognized premier nursing program, as we had many students from around the world. It was a brutal program to get through, only 6 weeks off in a total of 2 1/2 years, very, very acute patients but I had some of the best nursing instructors in the industry.

    I was made to feel inferior to the BSN RN’s by administrators the longer my career progressed, especially the last 5 years or so. I was pressured to go back to school to get my degree, which at age 60, I felt was unnecessary when I was so close to retirement to take on additional financial burden. I’ve had an immensely rewarding and varied career, even plan on going back on a pre diem basis.

    I will say this- my fellow RN’s, however, had immense respect for diploma trained RN’s. Felt that we had much more clinical training, and developed better critical thinking in tense medical situations.

  2. […] Don’t Cling to Tradition: A Nursing Student’s Call for Realism, Respect « Off the Charts […]

  3. Online Registered Nursing Programs January 28, 2012 at 1:03 am

    The decision to go back to school can be both exhilarating and terrifying. Deciding whether to stay at a local college, move to attend a school across town, across the state, or even Cross the county, or opt for a distance learning program can be one of life’s most daunting, and rewarding, choices.

  4. RN to BSN Online Programs January 25, 2012 at 1:51 pm

    I also agree with this great article.
    To add the the confusion and messy degree/certification overlap in the nursing industry is the existence of the LVN nurse.

    Vocational nursing is lumped together invariably with LPN nurses, however LVNs can only practice in California and Texas, and they can only get “tainted” RN certifications.

    They are all too often washed into LPN but vastly different in a lot of respects !

  5. JenniferR August 23, 2011 at 12:29 pm

    I have found it very difficult to be part of a profession with such a spectrum of education. Peers I have had discussions with in other licensed professions find it even more difficult to understand how diploma, associate and bachelors prepared nurses all get to take the same exam and do the same job. We aren’t all on the same page. Thank you for the article.

  6. Ingrid baptiste August 19, 2011 at 10:57 am

    Thank you Ms McGinnis for your balanced view on the ongoing and sometimes contentious forum on nursing education. I agree with comments that the journey may be different but the destination is the same.
    I began my nursing in a diploma program in the UK. On moving to the USA I entered academia and obtained BSN and MSN degrees.I have never experienced any disrespect prior to obtaining these degrees. This could have been due to the competent and confident manner in which I practiced nursing. I have no doubt that the invaluable broad-based experience gained from the diploma program prepared me for the complex layers of nursing practice. Subsequent college degrees honed my critical and analytical
    skills. Mine has been a very rewarding journey.

  7. Deirdre Arvidson, RN, BSN August 18, 2011 at 9:53 am

    After 17 years in nursing and going back for my BSN online I have landed a great job that I love and much responsibility. Unfortunately, there are those who believe that perhaps I don’t deserve to have this position because I don’t have that masters level degree. What I do bring is great enthusiasm, compassion, and a willingness to work hard. I believe all the nursing experience I have had through the years has prepared me for this one job and I am truly grateful to those that hired me and gave me this chance.

  8. […] Don’t Cling to Tradition: A Nursing Student’s Call for Realism, Respect By Medora McGinnis, a student at Bon Secours Memorial College of Nursing in Richmond, Virginia, […]

  9. […] Don’t Cling to Tradition: A Nursing Student’s Call for Realism, Respect « Off the Charts […]

  10. […] Don’t Cling to Tradition: A Nursing Student’s Call for Realism, Respect « Off the Charts […]

  11. Giulia July 29, 2011 at 8:05 pm

    I actually attend school with Medora, and I can tell you first hand that anyone who doesn’t show her proper respect simply has a case of sour grapes! I swaer I want to follow her around for a week just to figure out how she does it all.

  12. Medora S. McGinnis July 29, 2011 at 3:32 pm

    Thank you all! I love to see that there are many others in the nursing profession who also see (and appreciate) the value of nurses who began in a diploma program. Because our nursing heritage comes from these programs, it’s so important to recognize that while the IOM has recommended the BSN as the most appropriate entry level education for Registered Nursing, it has taken some time to make the transition. I’m thrilled to be an incoming diploma nurse, and also thrilled to have the choice to continue onto the BSN and beyond…

    Our National Student Nurses Association would be excited to have your views and comments on our blog as well ~ check out, and for more information. All pre-nursing students, current nursing students in diploma/ADN/BSN programs, and RN to BSN programs can join! We have also launched an initiative to increase SUSTAINING membership, will RNs ~ all practicing nurses and faculty members are invited! This year is NSNA’s Diamond 60th Anniversary.

  13. Jennifer Olin July 28, 2011 at 5:51 pm

    I am a BSN nurse…mostly because I already had bachelors degrees in two other subjects and it was two years for an ADN or two years for a BSN. With that said, singularly my best instructors in nursing school were the ones who started out as Diploma nurses. They had skills and things to teach me that weren’t in books. I had already proved repeatedly I could read and learn, what I needed was vocational training and that’s what those former Diploma nurses had to offer. Ten years later I am a skilled OR nurse who has recently circled back to the first two degrees (Journalism and English) with my own blog. I tell everyone who ever asks, the Diploma nurses had more to teach me than any of my other nursing professors. Good luck to you in this vocation. I came to it later, like you, and I wouldn’t trade my experiences for anything.

  14. John Blankenship July 27, 2011 at 11:08 am

    Thank you Medora for your thoughtful insights into the history and
    practice of Diploma programs and nursing. As someone who
    graduated from a diploma program, and like many of my peers is
    continuing the path to BSN/MSN, I have to say that I am very grateful
    to be a diploma grad, the experience was invaluable. Regardless of
    how or where we received our training, attributes like compassion,
    advocacy, insight and understanding are what make the difference
    with our patients. These are skills that we are introduced to as
    nursing students, to move the concepts from the abstract to the
    concrete requires practice. Cultivating awareness is no different
    than cultivating a garden, it has to be “watered” with experience and
    “tended” by weeding out misperceptions and misrepresentations of
    what and who nurses are, as well as “planted” at the proper depth
    to ensure growth. This is the legacy of diploma programs.

  15. Steve Barrett July 27, 2011 at 3:05 am

    I am a Licensed Vocational Nurse and I work in a nursing home. Yes, I failed the RN program at a community college. But my DON assigned me to the Alzheimer’s unit because of her confidence in my skill at relating to the Alzheimer client and her family. The philosopher Wittgenstein said that theory is useless. “In the beginning was the deed.” How does the old saying go? “The proof is in the pudding.” The initials behind your name and /or the amount of respect you receive don’t necessarily have anything to do with your value.

  16. Medora S. McGinnis July 26, 2011 at 7:06 pm

    Thank you all for your thoughtful replies. I’m so honored to be able to share this voice and perspective with you, and to see your feedback. I love Fran’s quote, “Once bedside is in place, academics can come later.” I also believe that we are strengthening nursing’s role in transforming healthcare, as Barbara states, and that together we can use our collective voice “to move our profession and health care reform forward.”

  17. RehabRN July 26, 2011 at 5:20 pm

    Some folks don’t respect anyone with an RN, regardless of training, and unfortunately, many times, among the multidisciplinary team, nursing is often the least educated overall. No one hears this about PTs, OTs or other allied health care providers, most of whom now require a practice doctorate. What we need is overall compassion and respect, not just for patients, but also for our coworkers.

    Another problem is that many BSNs (who completed an accelerated program like me) are told we aren’t real nurses because we didn’t spend years in school…by other 4-year BSNs ADNs and diploma nurses. I did my required clinical hours in less time, and yes, I was still required to pass NCLEX, just like everyone else. Can I use more experience? Sure. I view every day I work as a learning experience, and I seize whatever learning opportunities I can in my spare time.

    With such a general lack of respect, it’s no wonder why we are where we’re at today.

  18. Barbara Glickstein July 26, 2011 at 4:06 pm

    A thoughtful and important blog post from Ms. McGinnis. The IOM report on The Future of Nursing addresses the BSN as an entry level degree for the future of nursing. Advancing these objectives strengthens nursing’s role in transforming health care. United, we are much stronger, smarter and powerful. Ms. McGinnis’ asks that as RNs we use our a collective voice and act together to move our profession and health care reform forward. Thank you Ms. McGinnis.

  19. Tricia Logan July 26, 2011 at 3:05 pm

    I am one of the many “mid-life” RN’s. I went to nursing school in my mid-thirties and earned an ADN degree. I also have Bachelor’s and Master’s Degrees in Education and many years of teaching (including ten at the community college level). I am now in my fifties and I have run into the “initial” game. Because I do not have MSN after my name, I am not qualified to teaching nursing. I read about a critical shortage of instructors, I would love to teach nursing but I am not going back to school for yet another degree. I love nursing, I am an excellent teacher (background in curriculum development and adult education, no less). So I will stay at the bedside (which I love) until I retire or until my back gives out.

  20. Fran July 26, 2011 at 2:40 pm

    Indeed, as a nurse of many years, I can only say that the only nurses I do not have respect for are the ones who do not respect the people we care for. They can be phD’s or diploma nurses, it does not matter. The “initials” after your name, although good for a ego trip, are only as good as the name that preceedes them.

    The best nurses I ever worked with are “diploma” nurses as they know the value of bedside nursing. They KNOW how to care for a patient. Once “bedside” is in place, academics can come later. In my experience, academics first does not a nurse make. In my world, everyone would go through diploma school first, and then to academia. This progression produces the most caring and compassionate nurses.
    Congratulations on entering nursing, be true to your ideals, and be true to the person in care. peace.

  21. Lois Roelofs July 26, 2011 at 2:08 pm

    Thanks for your thoughtful post. I found, as a diploma grad that went back to school as a mom for bachelor’s, master’s, and doctoral degrees in nursing, that I was never disrespected. I sincerely wish the same degree of respect for you! You’re entering a wonderfully caring and rewarding career. Congratulations!

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