Kari is a retired operating room registered nurse. Although she is retired, the interest never waned. She loves all things OR-related.
What is a Diploma of Nursing?
A diploma of nursing program is a 3 year hospital-based program with a focus on clinical experience. Often you will see a diploma program stating it is a 2 year program. However, once you complete the prerequisites you will have spent 3 years in school. You are eligible to take the National Council Licensure Exam (NCLEX) once you have completed the diploma of nursing program. This is the standardized exam that all the United States use to ensure student nurses are qualified to perform entry level nursing as a registered nurse.
Diploma or Bachelor's?
Why did I pick a diploma program? It was the focus on clinical activities that I wanted. I had never worked in the medical field before. A good friend, who was a nurse, convinced me that I would make a wonderful nurse. At my location, I had my choice of a diploma program or a bachelor's program. The bachelor's students did not start clinicals until their 4th year. I did not want to commit 3 years of my life only to find I did not like my major, therefore it was a diploma for me.
The college courses consisted of developmental psychology, anatomy and physiology, computer science, english, biology among others. Prerequisites included high school chemistry, which I did not have. I was allowed to take chemistry during the first summer vacation.
A Little History
Diploma of nursing programs were the most numerous type of program at one time. In the beginning, these hospital based programs only accepted girls who had graduated from high school. The girls could not be married. They were required to stay in dormitories with the other students. They could only wear the most minimal of makeup (if they could wear it at all). They were locked in at night. And they worked 50-60 hours a week at the hospital they were training in.
Most of our instructors were diploma nurses who had gone on to get their master's or doctorate degrees. They would tell us stories about the days of their training. The one thing that stands out in my mind is the camaraderie they often spoke of. They became "sisters" to the others in their class. They learned to help each other and accept help from each other.
When I went to diploma school I was allowed to live off campus, wear makeup and my home life was my own. At my school we only worked 6-8 hours a day at the hospital. Not every day, some days we attended college classes at a university. Other day we attended nursing lectures at the hospital. And some days we did both. The instructors were the same for both the lectures and the clinicals. All my instructors except one had been diploma school graduates.
We did have to wear a uniform. Our uniform was a navy blue dress with a white apron covering the front. As women we had to wear dresses the first sememster. After that we could by uniforms with slacks. I do think the dresses looked more professional and since that was what I had that was what I continued with. Uniforms cost money after all.
My instructors were smart, no-nonsense and dedicated. They each knew that they had to turn our ragtag group into nurses they would trust with their families. Most of them could be very mean if they needed to be.
We had one very timid girl in our group. One instructor continuously said things that flustered this young girl. The girl was very nice and tried to do her best. I asked the instructor why she was so mean to this nice girl.
"Why are you always so awful to her?", I inquired of the instructor. "She is so nice and tries hard."
"If she can not learn to stand up to me she will never stand up to the doctors. Nurses are patient advocates first and foremost," that instructor informed me.
Patient advocacy is a large part of being a nurse and sometimes you must question the doctor knowing that he/she is going to yell at you. Being awful to certain students was one way they culled our herd. We started with 50 some students and finished with 23.
The first semester I knew less than a nurse's aide. I remember having to do my first bed bath and bed linens change. The woman patient was unresponsive and the family was present. The first thing I did is explain to the family that I and another student were going to bathe and change their loved one. I suggested they go and get coffee while we were busy.
The family left and both my fellow student and I breathed a sigh of relief. Doing things the first time is hard, but it's harder if someone is watching you. I was very unsure about the bathing. Luckily my partner began bathing the patient. I followed along with what she was doing. When we came to the code brown in the diaper, I led the way. I had children so I knew all about changing diapers. Together we got it done. The importance of teamwork cannot be over emphasized.
We started writing care plans during our first semester. I had the hardest time in the beginning. I can no longer understand what the problem was. "Care plan" is pretty self explanatory. It is a plan of care that the nurse completes to help the patient with a specific problem.
The second semester we graduated to passing medication also. We needed a ton of information regarding the medicine. We needed to know what the medicine was used for. Which medicines, if any, the medication would have an adverse reaction with. Also which medicines may make the expected results stronger. We needed to know the 5 rights of medication passing.
- Correct Medicine
- Correct Dose
- Correct Patient
- Correct Path
- Correct Time
We were trained to always know these facts before giving the medicine. We were required to look and verify the correct medicine 3 times. One time when we took it from the drawer; one time when we portioned it out; and one last time when we returned it to the drawer. I still look at medication 3 times before giving or taking it.
The first two semesters we focused on problems caused by immobility. Laying in bed all day is very bad for the body. Patients can develop constipation, blood clots or pneumonia laying abed. (And those are just a few of the problems.) We bathed, turned, ambulated and did deep breathing/spirometer. We taught and supported patients and their families. We did other things also, but these things were what we did most.
Each year of our program was broken up into 2 semesters. The first year we had clinicals on the medical floor and the surgical floor. The second year we participated in OB/GYN and pediatrics. The third year we focused on critical care and outpatient settings.
The class was split into 2 groups, one doing medical while the other did surgical and so forth. You bonded with your clinical group. We could not leave until our care plans were complete, even if that was 10 pm. We helped each other and were helped by each other. The instructor would stay until everyone was done. She was not in the best of moods if she had gotten home after 10 the evening before. It was in all our best interests to complete our care plans within 8 hours.
I Love Nursing
I found out that I loved nursing that first year. My friend had been correct, this was the job for me. It was so much more than just bed pans and bathes. Patient teaching and patient advocacy are entwined with all the physical tasks you are doing. Simple caring and treating others with dignity are so important. I was made to be a nurse.
Our human development professor stated at the beginning of our semester that we should not expect an "A". He said no one gets an "A" in his class. After our final exam he called me into his office. I was so disappointed. I could not understand how I did so badly on the exam he had to discuss it with me in private.
I arrived at his office and he told me to take a seat. He proceeded to tell me I had received an "A" in his class and he thought I was wasting my time being a nurse. He informed me that I was smart enough to be a doctor.
This incident took place during my second year of school. I thought about what he said and I replied, "Doctors can only cure diseases, nurses cure people".
Nurses look at people holistically. We do not make medical diagnosis, we look at the whole person, body, mind and spirit, to determine how we can help people live with what is happening to them.
By this time I was part of a study group. We were 5 altogether. At times we had more, we were never a closed group. Everyone was welcomed, but we were the core. The 5 of us became very close. Like sisters, we had the comradarie the instructors always spoke of. We were all in the same clinical group. We spent most of our time together between course work, clinicals and studying.
I was the note taker because I tend to take word for word notes. While we were in obstetrics I really did not have to take any notes.
"Why aren't you taking notes," asked the note passed to me. "When they say something worth writing down, I will write it," I passed back.
The instructors would spend the day instructing, but nothing they said was ever on the tests. That semester I lived on 4 hours of sleep at night because I needed to do a ton of studying to help my friends and myself to pass.
More Than Only Nursing
We always had some type of fund raiser going at the same time as our classes and clinicals. Our fall back was the bake sale. I participated in so many bake sales those 3 years. We would raise money for local charities and various equipment for the hospital among other things.
We participated in health fairs and blood drives. Volunteering and participating were never ending tasks. But they were rewarding tasks. Whenever you do something for some one else, expecting nothing in return, it feels wonderful.
Not having wanted to be a nurse my whole life, I didn't realize that we would have a "capping ceremony". This was were you received your nurse's cap. You know, the white little hat that nurses in old movies wear, that cap.
We were offered the chance to have a capping ceremony early. All my fellow students were overjoyed. I still did not understand at this point. It was not until our actual capping ceremony that anyone mentioned we would have to wear the caps on all our clinicals. If I had understood that part I would have voted to save the ceremony for later.
"You don't see the medical students wearing little caps," I would complain to my classmates and instructors as I knocked the cap off my head for the thousandth time that day. They just laughed. I do finally understand what the big deal is, but at the time I was clueless.
Spending so much time on the floor we learned all the equipment very well. We could run the beds, IV pumps, the Hoyman lift, almost all of the commonly used equipment. I should say that not many patients had IV pumps back in those days. We were taught to count drops. We did blood pressures using a Sphygmomanometer and stethoscope. (What is called a "manual" blood pressure today.) We actually held patient's wrists to count their pulse rate.
Extra knowledge is never wasted. I have been the only nurse on the floor who could count the drops when we ran out of IV pumps. I can still take a "manual" blood pressure. I will still hold the wrist to see if the pulse is steady or erratic.
By the third year we were almost nurses. The floor nurses would ask to leave when they saw us arrive. The floor nurses knew we would do their job. We passed the medications, assessed the patients, admitted new patients, all the tasks the floor nurse would be doing if we were not there.
Many of the floor nurses had completed our program. They knew their patients were safe with us. These nurses had encouraged us, helped us and trained us for the past 3 years. They knew we were capable.
This was the year we finally made it to the intensive care unit (ICU) where anything can happen at any time. We learned to run the ventilation equipment, how to do pulmonary pressures and several other skills. We did not learn it only in a classroom, lab or on a doll. We learned with real people.
The Pros of a Diploma Program
Diploma programs are hospital based. This means all clinicals are at the same hospital. Students learn how the hospital does thing. Students become familiar with all the equipment the hospital has. Students know where to find different departments and supplies. The charge nurses of the different units know the students. These students have worked at this hospital for 3 years.
Having a job where you are familiar with the routines, equipment, policies and procedures and staff is a giant plus for a new nurse. The main difference between being a student and being a new nurse is that now you have a license you can lose.
Unlike the associate nurse, you have already seen and probably performed all the tasks you may be asked to do. I have known many nurses fresh out of associate degree programs who have never even seen a foley catheter irrigated. Many had never put an IV in an actual person. These technical skills need hands on learning.
You have already worked on almost every floor and in most outpatient settings associated with the hospital. You have met the doctors and know who to approach and how to handle them. You are familiar with with your job those first couple of years as you build your confidence.
You will have a job straight out of school. This hospital wants to hire you. They do not have expend the same effort required to orient staff new to their facility. This saves the hospital tremendous money. You are valuable.
Cons of a Diploma of Nursing Program
One of the main cons of having a diploma in nursing is that regular people do not know what that mean. "Is it a bachelor's or an associate's?" people often ask me. "How long did you go to college?" Questionnaires almost never have diploma when they ask for your education. I'm always torn between "some college" or "associates". I do not feel either answer appropriately describes my training.
Percentage of Students Passing The NCLEX Per Degree Type
|Type of Degree||2017||2015||2013||1994-2003|
Passing the NCLEX
The whole reason to attend any nursing program is to prepare yourself to pass the National Council of Licensure Examination (NCLEX). This is the test you need to pass to become eligible to work as a registered nurse. As you can see in the table above, diploma programs out perform associate degree programs in pass rate. I included the 1994-2003 statistic to show that diploma programs, at one time, out performed even bachelor's degree programs.
The school I attended had a pass rate of 98-100 percent each year. Pass rate is one thing you need to look at before choosing any program. If only 70% of their students are passing the NCLEX you probably should find another school.
I Recommend a Diploma of Nursing Program
I feel that all nurses would benefit from attending a diploma program and going on to get their BSN from that point. The hands-on experience obtained at diploma schools cannot be disregarded or dismissed. Other nurses need to work 3 years on the floor to gain the experience you graduate with.
Nursing Poll: What Type of Degree Do You Have?
Student Poll: What Type of Nursing Degree Will You Pursue?
This is where my diploma school was located.
© 2017 Kari Poulsen
Kari Poulsen (author) from Ohio on March 23, 2019:
Donna Pimentel, I still think all nurses should start as diploma. There is much more clinical exposure. I am also very proud to be a diploma nurse. Thank you for reading and commenting. :)
Donna Pimentel on March 14, 2019:
I am a Diploma nurse. Been a nurse for 34 years. My specialty is ICU nursing. I am proud. And felt well prepared when I finished nursing school. I am proud.
Kari Poulsen (author) from Ohio on September 03, 2018:
I am sorry but I do not know the answer to that question.
MoeTN on September 02, 2018:
thank you very much for all the information you posted here .
and wanna ask you if you don't remind of course :
if a foreigner got 3 years nursing diploma .
is it accepted and qualified by the CGFNS or have to continue one year study in us and become BSN !!!
Kari Poulsen (author) from Ohio on February 05, 2018:
Kathy, it sounds like you come from a very caring family. I do not think they have any diploma schools left in the USA. associate's is good. It will get her in the field sooner and jump start a bachelor's if she ever wants it. Tell her I said good luck. School is very hard, there is so much to learn in such a short time. Best wishes to you, Kathy!
Kathy Burton on February 04, 2018:
Great article. My mom was a RN. Now my daughter-in-law want to get her associate degree in nursing. My niece in an BSN. I love having nurses in family. Very hopeful my DIL will be able to start school next year.
Kari Poulsen (author) from Ohio on November 30, 2017:
Hi Nicole. Good work getting your bachelor's. Congratulations!! Most people do not realize how much it has changed. I remember working in hospitals without respiratory therapy depts. The nurses did all the breathing treatments along with giving meds. :)
Kitty Fields from Summerland on November 30, 2017:
Kari - I too am an RN, associate's prepared. BUT I graduate in a week and a half with my bachelors! It's funny, because for the past few years people ask me, How do you have only your associates and be an RN? Most people don't realize how much the nursing education field has changed over the years. My area where I live is slowly making their way towards requiring RNs to have their bachelors'...so while I've been taking a break to care for my baby son, I've also been working on my bachelor's. Thanks for your support!
Kari Poulsen (author) from Ohio on October 23, 2017:
Thanks, Betty :)
Betty A F from Florida on October 23, 2017:
Way to go Kari!
Kari Poulsen (author) from Ohio on September 28, 2017:
Thank you Bill. I used to tell the docs and hospitals, "You pay me, but I work for the patients".
Bill Holland from Olympia, WA on September 28, 2017:
Great information for anyone considering that "calling." Bless you for being a nurse. I consider nurses the backbone of any hospital, the ones who comfort the sick and bring a touch of love to any patient.