A Most Interesting Development

By James X. Stobinski, Ph.D., RN, CNOR, CSSM(E), CNAMB(E)

I entered nursing with a diploma of nursing, and I was the last male graduate of Toledo Hospital School of Nursing in 1985. The school closed two years after my graduation after providing decades of pre-licensure education. At the end of World War II, diploma programs were the most common pre-licensure education programs; the schools were closely linked to the hospitals which administered the programs. At its peak, Toledo Ohio had eight diploma schools and each was affiliated with a hospital in the city. These programs placed an emphasis on developing clinical skills and much of the coursework was delivered on the hospital campus. 

The rapid proliferation of associate degree programs after World War II and the transition to baccalaureate degrees led to a rapid decline in diploma programs. There are a handful of diploma programs still in existence. In 2024, there were 2,422 diploma graduates that took the NCLEX examination; a little over 1% of all test takers in that year.¹ The recently released 2024 National Nursing Survey informs us that about 9% of all current RNs entered the profession with a diploma of nursing.² I have grown accustomed in recent years to being the only diploma graduate at nursing professional meetings and often must explain how these programs are still relevant today. With all of this in the background, a recent article by Paige Twenter caught my attention. Her article describes the start up of a new diploma school in West Virgina, a most interesting development.³

The WVU Medicine Center for Nursing Education is starting a diploma of nursing program with a cohort of 24 students to begin classes in August. The program will be 21 months in length and the graduates will be eligible to take the National Council Licensure Examination. This is the first diploma program startup in recent memory. These students will receive, “… a full tuition waiver and free books and resources in exchange for a three-year work commitment.”⁴ The school was flooded with hundreds of applications from 20 states and six foreign countries when application opened in August 2024.⁴

This is a significant investment, and the return on investment (ROI) is far from certain for West Virginia, but desperate times necessitate innovation. West Virginia, despite having an array of nursing schools, continues to have difficulty staffing all of its facilities. Prolonged staffing shortages and the high cost of temporary staff combine to make the resource intensive startup of a hospital-based school a reasonable risk. If one considers the total cost of nursing turnover, hiring bonuses and orientation costs the startup costs seem more affordable. Starting a diploma of nursing school acknowledges the long history of nursing education and the strengths of a hospital-centered education process. The senior leadership at the school, Dr. Tanya Rogers and Dr. Melanie Heuston, as quoted in the Twenter article, maintain that the program is both feasible and scalable for other healthcare systems.³

The 2024 National Nursing Survey highlights the post-pandemic American nursing workforce where we are informed that 73% of American nurses now have a BSN or higher degree.² This report also tells us that, “… about 40% of nurses report they plan to leave nursing or retire over the next 5 years.”² Short of some dramatic shifts, staffing shortfalls in West Virginia and elsewhere in the country will not spontaneously resolve. A diploma school could facilitate entry into the profession followed by professional development such as certifications and additional academic degrees. The few remaining diploma of nursing graduates will likely track the career progression of this small group in West Virginia to see if a proud legacy of past years has a new future. 

James X. Stobinski, Ph.D., RN, CNOR, CSSM(E), CNAMB(E), is a member of the Central Michigan University faculty and serves as director of clinical education alliances at the National Institute of First Assisting (NIFA).

References 

1. NCSBN. (2024). The pathway to practice. https://www.ncsbn.org/public-files/NCLEX_Stats_2024_Q4_Passrates.pdf
2. Smiley, R.A., Kaminski-Ozturk, N. R., Burwell, M., Oliveira, P, Shobo, C. M., Allgeyer, Y., Zhong, R.L., O’Hara, E., Volk, C., Martin, B.A. (2025). The 2024 National Nursing Workforce Survey. Journal of Nursing Regulation, (16)1, S1 – S88.
3. Twenter, P. (March 31, 2025). ‘The cavalry is coming’ — Inside WVU Medicine’s $14M nursing diploma program. Becker’s Clinical Leadership.  https://www.beckershospitalreview.com/nursing/the-cavalry-is-coming-inside-wvu-medicines-14m-nursing-diploma-program/?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=1460A2907323E9V
4. WVU Medicine. (2025, April 30). Center for Nursing Education | WVU Medicine Information. https://wvumedicine.org/info/center-for-nursing-education/