diploma programs are similar to apprenticeship programs for physicians in the 1800s before the widespread development of medical schools (Gebbie, 2009). As nursing gained a stronger theoretical foundation and other types of nursing programs increased in number, the number of diploma programs declined remarkably throughout the 20th century except in a few states, such as New Jersey, Ohio, and Pennsylvania. One advantage of the diploma program is that there are guaranteed clinical spaces for those accepted into the program, something ADN and BSN programs cannot offer. The number of all working nurses who began their nursing education in diploma schools fell from 63.7 percent in 1980 to 20.4 percent in 2008; the number of new diploma graduates dropped to 3.1 percent of all graduates in the 2005–2008 graduation cohort (HRSA, 2010).

At present, the most common way to become an RN is to pursue an ADN at a community college. The proportion of nurses in the United States whose initial education was an ADN increased from 42.9 percent in 2004 to 45.4 percent in 2008 (HRSA, 2010). ADN programs in nursing were launched in the mid–20th century in response to the nursing shortage that followed World War II (Lynaugh, 2008; Lynaugh and Brush, 1996). Generally speaking, the ADN remains less