Nursing in the United States is a mixture of credentials, education, and practice. The profession is confusing even to those in healthcare. Many in the healthcare field and the patients they care for are unable to identify the different types of nurses and their level of practice. The purpose of this paper is to describe the current state of nursing in the United States, specifically that of Registered Nurses (RN).
The largest population of licensed nurses in the United States are Registered Nurses. In 2019, the National Council of State Boards of Nursing (NCSBN) reported there were over 4.7 million licensed registered nurses. To become a registered nurse, the candidate must complete an educational program approved by individual state boards of nursing or the state education regulatory agency. The educational program prepares licensure candidates as entry level generalists. Following completion of the educational program, candidates must successfully complete the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and meet the licensure requirements for their primary state of residence.
Entry to practice is the terminology for the educational program that qualifies a candidate to sit for the NCLEX-RN examination. In 2019, prospective nurses could complete six types of educational programs that qualified as entry to practice programs. Diploma programs are generally three-year programs based at an institution, such as a hospital-based educational program. Associate degree programs are 18 months to two-year programs, often at community colleges, junior colleges, or hospital-based schools of nursing. Baccalaureate entry to practice programs are generally at colleges or universities offering a Bachelor of Science in Nursing (BSN) degree. The generic BSN degree requires four years to complete. Time to degree completion could be less if a student has a previous baccalaureate degree in a different discipline. A limited number of programs, historically viewed as graduate education, now offer entry to practice graduate degrees. These include the Master of Science in Nursing (MS in Nursing or MSN), Doctor of Nursing Practice (DNP), or Philosophy Doctorate (PhD).
Prior to 2010, the majority of nurses entered practice with an associate degree in nursing. However, in 2010, the Institute of Medicine (IOM) made the recommendation to the United States to increase the proportion of nurses with a baccalaureate degree to 80% by 2020 (Institute of Medicine, 2010, p. 281). The Institute of Medicine's recommendation changed the face of nursing education. In 2010, only 39% of US educated graduates qualified to take the NCLEX-RN examination for the first time by earning a BSN (NCSBN, 2011). By 2018, the last year in which data is available, 50% of those who tested for the first time qualified with a baccalaureate degree (NCSBN, 2019).
To achieve the goal of 80% BSN nurses, the IOM (2011) recommended "defined academic pathways, beyond articulation agreements, that promote seamless access for nurses to higher levels of education" (p. 3). Following the release of the IOM recommendation, the number of programs advancing nurses from associate to baccalaureate degree increased, as did the number of baccalaureate...