This article presents the emergence and maturation of career ladders in nursing education and practice over a period of forty years. It advocates for research to determine the amount, type, and measurement of clinical experience that is essential for progression along academic and clinical career ladders.

Career ladders developed in the United States (US) as a seminal response to “the war on poverty,” a social and political movement of the 1960s. The War on Poverty was launched in the US by President Johnson in 1964 as a showcase program of the Great Society Era. It expressed the cherished American dream, namely, that education could help people rise from poverty. President Johnson spoke of the war on poverty as giving underprivileged young Americans “the opportunity to develop skills, continue education, and find useful work” (Halsall, 1998, p. 1). Reissman and Popper (1968), sociologists of this period, described how ordinary people could combine education and job progression to achieve their economic and professional aspirations. Because of the opportunities presented by career ladders, there would be “no dead end” careers, or as Ramphal (1968) expressed it, no “stunted professional nurses” (p. 1236). It was expected that these career ladders would offer, to those nurses whose early educational choices made it difficult to use education as a mode of career advancement, new opportunities to build on their past learning and experience. This possibility re-awakened the “rags to riches” myth and appealed to diverse publics: politicians, industrial leaders, employers, and the general public. In these discussions, career ladders were envisioned as planned, coordinated, and well-articulated academic programs designed to help people move up the academic hierarchy in a step-like manner. The metaphor of a ladder emphasized that each step would provide new, not repetitive, knowledge and skills. Although the career ladder concept could have been applied initially at any level of the academic hierarchy, it found a first and welcoming home in community colleges.

Politicians and leaders in state and local governments saw community colleges’ emphasis on career ladder programs as attractive academic opportunities for many disciplines. Politicians and leaders in state and local governments saw community colleges’ emphasis on career ladder programs as attractive academic opportunities for many disciplines. Closer to home and less expensive than four year schools, community colleges educated students, created jobs, and contributed to the ambience of local communities. Public officials promoted policy change, educational planning, and curriculum reform to enable students to begin their studies in community colleges and complete them in four year schools.

The majority of community colleges offered diverse, occupationally oriented, or pre-professional programs. This approach provided companies with interns; gave employers opportunities to evaluate future employees; and, in many fields, lessened the need for on-the-job training and long periods of orientation. Students and their families saw that community colleges provided opportunities for relatively inexpensive education and quicker access to job markets. Open enrollment, opportunities for remedial assistance, and the availability of government loans made community colleges very attractive to students, guidance counselors, and parents.

In this article the authors will present three phases in the evolution of career ladders in nursing education and practice and will discuss their development, maturation, and institutionalization over a span of forty years. In phase one, academic career ladders were spiral staircases, complex, confusing, and poorly articulated entry and exit pathways. Phase two saw the maturation of career ladders across all levels of nursing education and practice. In phase three, academic and clinical career ladders built upon theoretical perspectives have enriched academic programs and clinical practice and are increasingly being integrated into the curriculum, clinical advancement programs, and the magnet hospital movement. The authors will conclude by discussing questions, such as the amount of clinical experience needed in an educational program and the amount of clinical practice needed before seeking an advanced degree. They will highlight the need for more research and dialogue about the amount, type, and measurement of clinical work and argue that these studies are needed to better inform decisions about professional legislation, accreditation, certification, education, healthcare outcomes, and future-oriented career ladders.

Phase One: The Spiral Staircase in Nursing Education

...the first phase of career ladders in nursing were spiral staircases rather than ladders. Nursing and allied health programs became particularly popular academic offerings in community colleges. The elaborate educational entry and exit path to professional nursing was recognized by early leaders in the community college movement as a prototype of Reissman’s and Popper’s (1968) career ladder. Community college administrators found nursing’s multi-level educational approach to professional practice to be a career ladder designed in heaven. Students could become licensed practical nurses, work while they completed associate degree programs, and achieve eligibility to write the National Council Licensure Examination for Registered Nurses (NCLEX-RN). As registered nurses (RNs), associate degree nurses (ADNs) were eligible for good jobs in the nation’s healthcare industry. Because few hospitals differentiated among the educational preparation of nurses, ADNs successfully competed for the same positions and salaries as baccalaureate and diploma graduates.

However, nursing’s early career ladders were easier to describe than to achieve because the first phase of career ladders in nursing were spiral staircases rather than ladders. In the 1960s, registered nurses who sought Bachelor of Science in Nursing (BSN) degrees embarked on a program involving an additional two to three years of study in a baccalaureate program. It was easier for ADNs than for hospital school graduates to articulate career ladders because ADNs had earned lower division college credit in their community college programs. With advance placement examinations and liberal policies for transfer of credit, it was possible for some ADN graduates to enter four year nursing schools as full-time, junior-year students and graduate with their class. However there were no assurances that the curriculum in community colleges resembled programs of study in four-year colleges and university schools. Diploma graduates learned that while their hospital-based programs emphasized clinical competence, their transcripts did not show academically recognized courses in basic and social sciences and the liberal arts. RNs who moved frequently or changed schools also faced special challenges on first-generation career ladders. Many of these nurses learned that some of their credits were not transferable. It was not uncommon for some registered nurses to literally start over again because it was so difficult to articulate their programs of study with the nursing curriculums in four-year colleges and universities.

In addition to the complexity of articulating nursing curriculums across schools, there were policy disagreements among nursing leaders, including different interpretations of policy documents; ambiguity about the nature of career ladders and modes of entry and exit; and disagreements about whether there should be separate programs for diploma/ADN (RN) and generic students or a unified curriculum for all undergraduate nursing students. Illustrative of this dissonance, Ramphal, in a provocative article in the American Journal of Nursing (AJN), challenged the logic and lack of empirically derived data to support the statements about career ladders made by professional organizations and nursing’s influentials (Ramphal, 1968). To highlight her thesis, Ramphal cited a memo written in 1967 to the National League for Nursing's (NLN) Department of Baccalaureate and Higher Degree Programs (DBHDP) (Ramphal, 1968). Drawing from the text of the memo, Ramphal cited Schlotfeldt’s identification of three possible interpretations of a career ladder: a single career ladder in the health professions; a career ladder designed to allow mobility within one profession; and a blended or hybrid professional and health-professional career ladder which facilitated interdisciplinary education for students of all health professions (Ramphal, 1968). Ramphal (1968) also identified barriers in educating nurses in career ladder programs, saying that the NLN, the only accreditor of nursing programs at that time, was denying accreditation to RN to BSN programs. Her article stimulated a series of responses which reflected philosophical and interpretive differences in understanding career ladder programs; these responses appeared in the Letters section of the September, 1968 American Journal of Nursing. Mary Dineen (1968), then chair of the NLN’s Department of Baccalaureate and Higher Degree Programs, responded to the Ramphal article by refuting the claim that the NLN had a policy that supported the denial of accreditation to RN to BSN programs. Restating the accreditation policy and philosophy of the NLN, she discussed its application to baccalaureate programs specifically designed for RNs. Schlotfeldt (1968a) in her response took issue with Dineen’s interpretation and supported Ramphal’s thesis. Schlotfeldt (1968b) cited the acceptance of a 1964 Statement of Beliefs and Recommendations Regarding Baccalaureate Nursing Programs Admitting Registered Nurse Students by NLN’s Department of Baccalaureate and Higher Degree Programs (DBHDP). According to Schlotfeldt’s interpretation, the DBHDP’s 1964 statement recommended that all BSN students (RN and generic) be admitted to one nursing program (Schlotfeldt, 1968a). In her opinion, the 1964 recommendation said that while generic and RN students could register for different courses, they should not be enrolled in different degree programs. (Schlotfeldt, 1968a). Schlotfeldt (1968a) presented evidence to support her reading of the 1964 document. After the promulgation of the 1964 NLN statement, many BSN programs designed especially for RN students closed.

Phase Two: A Career Ladder in Nursing

Social forces encouraged the development of achievable academic career ladders. These forces included the 1965 American Nurses Association’s (ANA's) first position statement on the education of nurses; work place policies requiring BSN degrees for advancement; early support from nursing associations, notably the National League for Nursing (NLN) and the National Student Nurses Association; growth in associate degree programs; closure of many diploma schools; and enhanced financial aid for all levels of nursing education. Later, the success of the nurse practitioner movement, acceptance of certification for advanced practice nurses, and improved employee benefits which provided tuition assistance and a growing professionalization in the nursing community encouraged more nurses to return to school. Contemporary career ladders do not resemble the cumbersome, spiral staircases or reflect the convoluted academic requirements and progression policies of the past. Evidence for the acceptance and institutionalization of career ladder programs is found in the following set of statistics: approximately 55.4 percent of the RNs who graduated within the past five years earned associate degrees, and 34.3 percent of practicing RNs have associate degrees (Department of Health and Human Services [DHHS], 2006). The American Association of Colleges of Nursing (AACN) (2008b) noted that more schools have RN to BSN programs (601) than traditional BSN programs (569). Earlier, the AACN (1998) had promulgated its statement supporting educational mobility for ADN graduates. In 2006, AACN updated its Fact Sheet describing three types of articulation agreements: school to school (18 states); state-mandated (8 states); and state-wide (24 states and the District Columbia) (AACN, 2006). Another sign that career ladders had come of age is reflected in an interview with the current NLN President, Elaine Tagliareni, “I am thrilled to be president because of NLN’s value placed on all levels of entry….multiple entry points to the profession allows for greater diversity in background and value” (Walker, 2008, p. 2). Prophetically, thirty years earlier, Farley’s (1978) evaluative study of an open curriculum/career ladder at Long Beach City College in California had demonstrated that high risk students could be highly successful with proper curriculum plans, and that career ladders in nursing education were economically sound and could decrease attrition in community colleges. However, Yordy (2006) provided a public perspective on nursing’s academic labyrinth by tracing traditional and emerging educational pathways and plotting time lines for program completion. His research did demonstrate that even in neutral climates, articulated educational programs that allow nurses to earn higher degrees in nursing still do take time to complete.

These more mature career ladder programs focused attention away from particular courses and progression policies toward the end point, the achievement of the desired terminal degree as quickly as possible. The second phase in nursing’s career ladder trajectory expanded and extended academic articulation  beyond entry-level programs, blurring the boundaries which separated the levels in nursing’s academic hierarchy. Once nursing overcame hurdles to success on career ladder programs by developing accessible, feasible, academic-articulation patterns, it spawned an amazing number of curricular ladders and lattices. These included: BSN programs for college graduates (accelerated programs); first professional degree programs at the master’s level; nurse doctorate programs (ND); ADN to Master’s of Science in Nursing (MSN) programs; BSN to clinical nurse leader (CNL) programs; BSN to MSN and BSN to PhD programs; BSN to the Doctor of Nursing Practice (DNP); MSN to PhD; and MSN to DNP programs. These more mature career ladder programs focused attention away from particular courses and progression policies toward the end point, the achievement of the desired terminal degree as quickly as possible.

One very interesting and innovative program in nursing’s effort to build career ladders is the accelerated-degree programs for college graduates from other disciplines. Begun in 1970 at St. Louis University, accelerated-degree programs developed slowly. Twenty-two years after the first program began, only fifteen accelerated-BSN programs were in existence (Rodgers, Burson & Kirschling, 2004). Today young college graduates have discovered second degree programs in nursing, a phenomenon which Rodgers, Burson and Kirschling called “an explosion” (p. 18). Illustrative of this interest, the AACN, in the fall of 2007, updated its 2002 study and reported that 205 nursing schools offered accelerated-BSN programs for non-nurses (AACN, 2002). Rodgers, Burson and Kirschling named three factors which stimulated academic interest in accelerated programs: decline in traditional baccalaureate nursing program enrollments; the nursing shortage; and the faculty’s enthusiastic appraisal of accelerated students who sit in front of classrooms, engage in discussions, write well, successfully complete their programs of study, and pass NCLEX examinations. Other researchers, however, have found that second-degree students were not that different from traditional students who express similar reasons and motives for electing careers in nursing (Toth, Dobratz & Boni, 1998). To the above list could be added student factors: a desire to pursue service careers post September11; employment possibilities; the length of programs; and upward mobility (AACN, 2008b; Wu, & Connelly, 1992).

Phase Three: Professional Advancement in Nursing

The third phase of the career ladder continuum links academic progression to the development and demonstration of clinical and professional competence and to advancement in the workplace. The third phase of the career ladder continuum links academic progression to the development and demonstration of clinical and professional competence and to advancement in the workplace. Hospital clinical ladders, which proliferated in the eighties, were oriented to assuring clinical competence, recognizing performance rather than longevity, addressing recruitment and retention, and encouraging and rewarding bedside nurses who elected to stay at the bedside rather than pursue administrative careers (ANA Cabinet on Nursing Service, 1984). This third phase of the career ladder continuum is characterized by variety and diversity in the number and type of clinical and educational advancement pathways. Diversity is reflected in established clinical pathways in both acute and longterm healthcare environments. These advancement opportunities range from linkages to Magnet-recognition programs to the development of ladders to assure the educational and occupational development of nursing assistants. There are also innovative academic/clinical ladders to prepare clinical nurse leaders (CNL) at the master's level and entry level PhD or DNP nursing programs. Recently, attention has been given to clinical/academic career pathways for clinicians, as more clinicians are engaged by schools of nursing to teach clinical courses.

A number of trends characterize this third phase of career ladders in nursing. Contemporary opportunities for professional advancement articulate with emerging efforts by healthcare systems to adapt to changing reimbursement schema, to respond to nurse shortages, and to manage changes in technology and the delivery of care. Most advancement programs integrate education, certification, increased responsibility and authority over practice, and increased salary. Clinical ladders are now integral components of Human Resources programs in healthcare settings. Contemporary language, used to describes career mobility and advancement, reflects Magnet recognition programs and magnet concepts, but also strives to integrate professional practice models, theories, and evidence-based practices into care delivery systems (ANCC, 2004). Today, career advancement is not limited to acute care hospitals. Extended care facilities, interested in the retention of nursing assistants, have developed career progression programs for nursing assistants. These programs include formal courses, promotions, increased responsibilities, and salary enhancements as employees move along progressive levels of the ladder (How we developed, 2000). Another trend which has emerged during the third stage of development is the career progression of clinical faculty, once defined by Freund (1990) as a group of clinicians, usually employed in local health systems, who are recruited by schools of nursing to supplement full- and part-time faculty and engage in clinical teaching. Yet in an interesting article discussing the hiring of clinical faculty and the implementation of clinical faculty tracks in Korean universities, Lee, Kim, Roh, Shin and Kim (2007) commented that over the past two decades this new group of teachers has increased in number, but still lacks job security, tenure-track appointments, mentoring, or any defined developmental pathway to improve or recognize their teaching performance.

Changes in governmental, academic, and accrediting organizations’ emphasis on outcomes and evidence-based practice have also influenced the third phase of career ladders and professional advancement. Shifts in the orientation of accreditation processes, begun in the 1990s, strengthened academic efforts to support career ladders and to craft articulation agreements that endorsed them. Nurse educators, who led the curriculum revolution of the 1980s (Valiga & Ironside, 2007), and competency-based education of the 1990s (Lenburg, 1999a; Lenburg, 1999b; Redman, Lenburg & Hinton Walker, 1999) were prepared conceptually and philosophically to reshape and evaluate academic and clinical ladders around professional competencies and desired outcomes. The transition to competency-based curricula changed the structure of advancement ladders in academia and practice. In competency frameworks, such as Lenburg’s Competency, Outcomes, and Performance Assessment (COPA) model, progress is measured by the achievement of competencies, i.e., a set of specific, critical, nursing concepts and behaviors (Lenburg, 1999a). Academically speaking, measuring competencies and outcomes encourages programs to prepare graduates able to achieve program outcomes in a more efficient and economic manner.

The traditional application of Donabedian’s (1966) evaluatory model to education and care delivery addressed structure and process elements more than outcomes. Academic accreditors and evaluators examined structures and processes, such as faculty preparation; the curriculum; academic governance, transfer and progression policies, and student preparation and success within the program. They also examined admission and progression policies, processes related to academic planning and scheduling, grading structures, student and faculty selection policies, and graduation requirements. Health system accreditors also looked at clinical structures and processes, measuring progress in these indicators and basing accreditation decisions more on structures and processes than outcomes. The assumption that there is one way or one “best” way to get from here to there has guided academic and clinical thinking for many years. In contrast, the current emphasis on outcomes envisions the desired “product,” for example the competency and readiness for practice; capacity in the use of evidence and findings from research; or the ability of health systems to consistently achieve their goals of health improvement and safe, quality care. Curriculum or system planners, reflecting on the desired end states, can now move beyond a lock-step approach to nursing education and create multiple pathways to achieve the desired goals. While it is still possible to mock nursing’s complex entry- and exit-articulated curriculum models, contemporary students can achieve their academic and professional goals more efficiently today than they could in the past, without the challenges of built-in redundancy and delay.

Issues in the Articulation of Nursing Education and Practice

Although hundreds of articles have been written over the past forty years about nursing’s career ladders, issues which transcend academic/professional borders remain. One issue is the value which nursing bestows on the achievement of clinical experience in educational programs. Nursing leaders have failed to reach agreement or consensus about the amount, type, and measurement of the clinical experience necessary for academic or clinical advancement. Additionally, divergent opinions exist among nursing’s leaders, faculty, and nurses at the point-of-service regarding the clinical experience needed before seeking additional academic preparation. There are also differences of opinion about the amount, type, and measurement of clinical experience necessary to meet licensing, accreditation, and certification standards. These issues will be discussed below.

Nursing’s Belief in the Value of Clinical Experience or Practice in Nursing Education Programs

Commonly held opinions suggest that a specified number of clock hours/clinical practice credits are essential for students in pre-professional and specialty programs....These opinions...have been accepted...but never tested.The provision for adequate and supervised clinical experience is embedded in nursing’s academic tradition. Anderson (2002) comments that accelerated or entry-level MSN programs that recruit students with degrees in other disciplines must address and overcome lack of clinical experience. Rodgers and Healey (2002), reflecting on their twelve years of experience with second-degree, entry-level master’s programs, commented that faculty and nurse preceptors hold different opinions about the wisdom and feasibility of accepting students into programs or clinical practica without nursing backgrounds or experience. These beliefs shape admission requirements and curriculum development, especially in advanced practice programs, in entry-level master’s or doctoral programs and in BSN to PhD or DNP offerings. The authors are personally familiar with the issues raised by Rodgers and Healey and also Anderson because beliefs about the amount, type, and measurement of clinical experience became barriers to be overcome in their innovative curriculum initiative to prepare advanced practice nurses to work with underserved individuals and families in urban settings. In the effort to blend a clinical specialization in community public health nursing with family nurse practitioner preparation, faculty and students had to demonstrate that they achieved the clinical requirements of both programs of study.

Commonly held opinions suggest that a specified number of clock hours/clinical practice credits are essential for students in pre-professional and specialty programs. A new initiative by nurse practitioner groups, the American Nurse Credentialing Center (ANCC) and the National Council of State Boards links the title advanced practice nurse to a new set of definitions, one of which prescribes the number of clinical hours spent in direct care of individuals during educational programs and prior to applying for re-certification (ANA, 2008; ANCC, 2008; ANCC, 2007). Specifically, the American Nurses Association (2008) recently published a white paper which uses licensing, accreditation, certification, and education (LACE) themes to promote a regulatory model which identifies characteristics of advanced practice and the use of the title APRN. This model states that applications for certification and licensure must provide evidence that a specified number of clinical hours has been achieved. These opinions, arising from nursing’s roots in apprenticeship education and concerns with process elements in the curriculum, have been accepted, codified by practice acts and accrediting bodies, but never tested. Second-wave, career ladder programs, especially accelerated programs, and first professional degree programs challenge this unexamined belief.

Practice as a Pre-Requisite for Higher Education in Nursing

Some faculty and nursing staff think that registered nurses should have “experience,” and sometimes experience in a particular role or with a particular patient population, before returning to school.  These assumptions remain untested Some faculty and nursing staff think that registered nurses should have “experience,” and sometimes experience in a particular role or with a particular patient population, before returning to school.  Although these assumptions remain untested, they often guide admission decisions and clinical placement. A minimum of one year of experience is an entrance requirement for admission to advanced practice programs, especially practitioner programs, in many schools of nursing.

While a study, work, study, work pattern can be justified, it may partially explain the under-education of the nursing workforce and concerns related to the age of nurses who complete advanced degrees. Consider a nurse desiring to obtain a PhD degree. If the average age of associate degree new graduates is 32 years (DHHS, 2006), and if, immediately after graduation, a new graduate pursued a full-time program in one school which has an articulated program leading to a PhD degree, the nurse would be about 40 years of age when receiving the PhD degree. If, however, the nurse follows the typical nursing pattern of study, work, study, work, still commonly seen in schools of nursing, the nurse will be closer to 50 years of age when receiving the PhD degree. This pattern allows, on average, about 15 years for the nurse to use knowledge gleamed in the PhD program to discover and develop important, in-depth nursing knowledge in a specific area.

The Search for Modalities to Assess Initial and Ongoing Competency

Studying the effect of clinical experience on success in academic study and professional nursing practice will advance the career ladder movement and ultimately lead to better patient outcomes.No one doubts the importance of competency for practicing in our very fast-paced, unstructured, technologically driven, and under-resourced healthcare systems. However, approaches for assessing and measuring this needed competency remain elusive. In the 1980s, Benner noted the limitations of commonly used methods of validating competency. These methods included, for example, expert consensus using the nursing process as a framework, descriptions of “typical” nursing behaviors, industrially oriented job analysis, and analysis of behavioral events (Benner, 1982). Although nursing science has developed since the 1980s, there remain a limited number of nurse-sensitive outcomes that are grounded in science and able to document competency. Ill- structured clinical environments also make it difficult to assure or predict competency beyond a few situations where there is clarity around desired patient outcomes and a limited number of variables to control.

Until research supports better answers about the amount, type, and measurement of clinical experience or practice, nurses in academia, practice, and regulatory bodies will continue to act out of their beliefs and accept their traditions. In a more desirable world, decisions about academic and clinical progression would be supported by evidence. Studying the effect of clinical experience on success in academic study and professional nursing practice will advance the career ladder movement and ultimately lead to better patient outcomes.

Conclusion

Although nursing science has developed since the 1980s, there remain a limited number of nurse-sensitive outcomes that are grounded in science and able to document competency. This article has described three phrases of the development of career ladders in the US over the past 40 years. The need for evidence-based answers regarding the amount of clinical experience needed in an educational program and the amount of clinical practice needed before seeking an advanced degree has been identified. The authors have also highlighted the need for more research and dialogue regarding the amount, type, and measurement of clinical work needed for safe and effective patient care. Although the various stages of career ladders have indeed advanced the nursing profession, we need to continue seeking evidence to support the most promising career pathways in nursing.

Authors

Sister Rosemary Donley, PhD, ANP-BC, FAAN
E-mail: donley@cua.edu

Sister Rosemary Donley is an Ordinary Professor of Nursing and Director of the federally funded Community/Public Health Nursing Advanced Practice Programs at The Catholic University of America, Washington, D.C., and First Councilor of the Sisters of Charity of Seton Hill. Sr. Rosemary Donley received a diploma from the Pittsburgh Hospital School of Nursing, and holds a B.S.N. degree from St. Louis University and M.N.Ed. and Ph.D degrees from the University of Pittsburgh. She is a certified adult nurse practitioner. Her clinical and research interests include health policy, clinical decision making and healthcare literacy.

Sr. Rosemary has served as Executive Vice President (1986-97) and Dean of Nursing (1979-86) at The Catholic University of America. She is past President of the National League for Nursing and Sigma Theta Tau International Honor Society of Nursing, and past Senior Editor of Image: The Journal of Nursing Scholarship. She has also served as a member of the Secretary of Health and Human Service’s Commission on Nursing, and as a consultant to the U.S. Army and Navy Medical Commands. Sr. Rosemary is currently co-chair of the NLN think tank on Expanding Racial, Ethnic and Gender Diversity in Nursing Education and a member of the Institute of Medicine. Sr. Rosemary has numerous publications and is a frequent presenter throughout the United States and abroad. In 2006, she was named a living legend by the Academy of Nursing.

Sister Mary Jean Flaherty, SC, PhD, RN, FAAN
E-mail: Flaherty@cua.edu

Sister Mary Jean Flaherty is an Ordinary Professor of Nursing at The Catholic University of America (CUA), Washington, D.C. She received a diploma from the Pittsburgh Hospital School of Nursing and holds a B.S.N. degree from Duquesne University and a M.S.N. degree along with a PhD in Curriculum and Supervision from the University of Pittsburgh. She is a maternal-child clinical nurse specialist. Her research interests are grandmothers, post-partum care, breast-feeding, and mentorship. Her work has been funded by the Department of Health and Human Services, The Catholic University of America, and Sigma Theta Tau International.

Sister Mary Jean has served as Dean of Nursing (1992-2000), Director of the Doctoral Program (1988-1990), and Chair of the Graduate Program in Nursing of the Developing Family at the CUA, where she also served as Associate Director of Education, National Center for Family Studies. Sister Mary Jean has also been a World Health Organization nurse consultant, and an educational consultant and a program evaluator for the National League for Nursing (NLN). Additional roles include being a member, Vice Chair, and Chair of the Board of Review, Baccalaureate and Higher Degree Programs for the NLN. Sister Mary Jean has been a member of several college and health system boards, the National Commission on Nursing Implementation Project, the Committee of Graduate Nursing Education for the China Medical Board, and an evaluator for the Middle States and Southern Regional Colleges and Universities.

Reissman, F., & Popper, H. (1968). Up from poverty: New career ladders for non-professionals. New York: Harper & Row.