The Beginnings of Associate Degree Nursing Education in North Carolina
The Beginnings of Associate Degree Nursing Education in North Carolina
Before World War II, 3-year hospital-based nursing schools served as the primary source of nursing education in the United States. While some of these diploma programs offered excellent curricula with varied and appropriate clinical sites, others were haphazard at best. Physicians frequently owned small private hospitals and created nursing schools to ensure a supply of inexpensive labor. The physicians frequently taught the courses, and what they taught largely depended on the type of patients currently being treated in the hospital. Too often, the chief nurse for the hospital was also the director of the nursing school and sometimes its primary nursing instructor. The training period was 3 years. Thirty six months of education were necessary for graduates to sit for state licensing examinations and for diploma programs to receive national accreditation.
World War II was a catalyst for many changes in nursing and nursing education. There were not enough Registered Nurses to serve the needs of the civilian population and to meet the needs of the US military around the world. The US Congress responded to this crisis by unanimously passing the Nurse Training Act of 1943, also known as the Bolton Act. This new law established the Cadet Nurse Corps, a government program to provide grants to schools of nursing to expand enrollment and shorten the training period to increase the number of nurses working in the armed forces, government and civilian hospitals, health agencies and in war related industries (US Cadet Nurse Corps, 2010). In order to place more nurses into service during the War, the Cadet Nurse Corps decreased the time nurses were in training to 30 months. The Cadet Nurse Corps graduates proved themselves to be clinically effective and professional health care providers.
After the War, nursing leaders were struggling to determine the best way to educate the nations nursing workforce. Many wanted to continue the 3 year, hospital based diploma programs that already educated the vast majority of nurses in the US. Others advocated the BSN degree as a necessity for entering the nursing profession. A few were interested in having nursing education take place in an academic setting, but did not feel that 4 years of college were crucial for nurses to be able to provide excellent patient care. Dr. Mildred Montag, a nursing leader from New York was in this last group. Dr. Patricia Haase (1990) wrote:
Dr. Montag sought to alleviate a critical shortage of nurses by decreasing the length of the education process to two years and to provide a sound educational base for nursing instruction by placing the program in community/junior colleges. In 1958, the W.K. Kellogg Foundation funded the implementation of the project at seven pilot sites in four states.
Many changes in education occurred in the 1950s including the creation of community colleges. These new institutions offered technical education and training that was not offered in high schools or 4 year colleges. Typically community college students commuted to their classes rather than reside on campus. Program length varied from a few months to two years in order for students to be eligible for the range of certifications, registrations and degrees offered at the community college. The first seven experimental ADN programs in the US, funded by the Kellogg Foundation, took place in community and junior colleges. Each program had a distinct location (rural, urban) and served a distinct clientele (white, African American, Native American – segregation was still the law in many states). The Kellogg experiment in ADN education was deemed a great success across the board (Haase, 1990).
Excitement about this new way to educate nurses spread rapidly across the country. The number of ADN programs in the US increased from seven in 1958 to 130 in 1965 to 1,000 in 2007 (National League for Nursing, 2009). In the mid 1950s nursing leaders in NC were watching this national development. Because the state had not yet developed the community college system, the NC Board of Nursing and the NC Nurse Association worked with leaders at NC Women’s College (now UNC-Greensboro) to establish the state’s first Associate Degree in Nursing program. It operated for a decade from 1957-1967. UNC-G did not have a school of nursing of any sort at that time. Ms. Mary Mansfield was the first director of the first ADN program in NC and Ms. (later Dr.) Alice Boehret was the first faculty member. They worked hard to create a new curriculum, secure appropriate clinical placements and teach all the courses. In the fall semester of 1957 12 students entered this pioneer program (Toney, 2009). In 1965 UNC-G was authorized to offer the BSN degree so the AND program was phased out and replaced by the BSN program in 1967.
Another short lived Associate Degree Nursing program began at Chowan College in Murfreesboro, NC in the fall of 1964. Chowan College is a small Baptist college in the rural northeastern section of the state. According to Toney (2009) “… conversation begun in 1963, between the College, Roanoke Chowan Hospital and Duke University, culminated in the establishment of an Associate in Arts Degree in Nursing program in 1964 … The program was underwritten by a three year grant from Duke University Medical Center … 7 students comprised the first graduating class in 1967”. Due to budgetary reasons the program was discontinued after the spring semester of 1974. The program graduated a total of 119 nurses.
The third program in the state, and the first to survive and thrive to the present day, was again founded by a small rural Baptist college - Garner Webb Junior College (now University) in Boiling Springs, NC just southeast of Charlotte. In September, 1965, 43 students, including one male, entered this new program and 35 of them became the first graduates to earn an Associates of Arts in Nursing degree from the college. They took 72 semester hours of coursework and used several hospitals in the area as clinical sites. This is oldest continuing program to offer the Associate Degree in Nursing in North Carolina. Gardner Webb University currently (2010) offers five nursing degrees:the Associate Degree in Nursing (ADN), the Bachelor of Science in Nursing (BSN), the Davis Nursing Program (RN to BSN), the Master of Science in Nursing (MSN) and the Doctor of Nursing Practice (DNP) (Toney, 2009).
1963 was a watershed year for associate degree nursing education in North Carolina. In 1963 the NC General Assembly passed the Higher Education Act to establish a network of public community colleges to offer technical, occupational and college parallel curricula. These new colleges would be administered by the Department of Community Colleges under the State Board of Education. College of the Albemarle and Central Piedmont Community College were the first two institutions to officially become state supported “community colleges” in NC. Associate degree nursing programs would become part of this new system. (, 2009).
In 1964 the NC Board of Higher Education, the NC Medical Care Commission and the NC State Board of Education sponsored a survey of nursing and nursing education in the state. They gathered a group of nurses, physicians, hospital administrators and educators together to collect data and make recommendations about meeting the current and preventing any future nursing shortages. Dr. Ray Brown, a health administrator from Duke Hospital was hired to write the final report. The committee advocated the establishment of associate degree nursing programs in the community college system. Brown sited two primary reasons to support this conclusion. First, the number and appropriateness of clinical sites utilized by student nurses would increase. Brown (1964) reported:
“A properly located institution of higher learning can effectively pool the clinical resources of a number of small hospitals in the area … These colleges will be spread across the state and some will be located in areas where there are no hospitals of sufficient size to have a school of nursing”.
Students in diploma programs generally did most of their training at one hospital. Some programs had cooperative arrangements to use the state mental hospitals for mental health nursing rotations and the smaller hospital schools of nursing occasionally larger hospitals for clinical experiences pediatrics and/or obstetrics. Rather than being primarily tied to a single hospital, community college faculty would be able to choose from a variety of hospitals and other health care institutions to provide the best learning opportunities for their students.
Brown also explained that the community college ADN programs would increase the number of nursing students who were unable or ineligible to attend residential diploma programs. He noted that the costs at a community college program would be much less than a diploma or senior college program since students would not be purchasing room and board. Because students would not be expected to live on the campus, married students and parents who had been excluded from consideration as nursing students in residential programs could now study nursing. Finally, potential students who, for any number of reasons, could not leave their families or communities for a three or four year period now would have a path to become Registered Nurses.
In September, 1964 the NC Department of Community Colleges held a meeting for those interested in establishing ADN programs in the state. Many interested parties attended. In 1965, Central Piedmont Community College (CPCC) became the first state supported community college in North Carolina to offer the Associate Degree in Nursing. CPCC was followed the next year (1966) by Rockingham Community College, Sandhills Community College, Southeastern Community College Community College, Western Piedmont Community College (opened September 7, 1966 with 30 students) Clarke (2006), and Wilmington College ( personal communication with Dr. Barbara Knopp, 9-14-2010). In each subsequent year more state supported community college ADN programs were added to this list.
As of September 25, 2010 the NC Board of Nursing lists 54 approved ADN programs on its website, 49 of which are based in state supported community colleges. In 2015, Gardner Webb University and Central Piedmont Community College will be celebrating 50 continuous years of Associate Degree Nursing education in the state.
Brown, R.E. (1964) Report of survey of nursing education in North Carolina.
Clarke, L.R (2006) WPCC: A brief history 1964-2005. Morganton, NC: Pioneer Press.
Haase, Patricia T. (1990). TheOrigins and Rise of Associate Degree Nursing Education. Durham and London: Duke University Press.
Toney, S.P. (2009). Garner-Webb University School of Nursing: History and heritage. Shelby, NC: Westmoreland Printers.