ADULT NURSING STUDENTS PERSISTING TOWARD DEGREE

COMPLETION: A CASE STUDY OF AN RN TO BSN

ACCELERATED COMPLETION PROGRAM

Margaret C. Delaney Ed.D, APRN, CNP-BC

Learner Objectives

Evaluate the experiences of students who overcame challenges commonly found in the adult student population, yet were still able to complete the adult RN to BSN accelerated nursing completion program.

Recognize the faculty-driven indicators which play a role in supporting the adult RN to BSN student population.

Understand the role Institutional Support Systems and a High-Touch Environment play on nursing student retention.

Identify the role critical bonds play in fostering an RN to BSN students ability to reach completion.

Inquiry Spark

Standards of Accreditation (AACN exceptions): Family obligations Relocation Financial barriers Decision to change major

Literature exists on why students depart….

What makes them stay?

Statement of the Problem

The nursing profession is projected to need an additional one million nurses by 2020. In reaction to the

anticipated shortage, nursing programs are feeling a burden to

grow their programs rapidly, admit as many qualified applicants as

possible, streamline curricula, and ultimately graduate as many nurses

as possible (AACN, 2015)

The Literature

Significant evidence affirms the barriers which commonly prevent adult students from finishing their degrees

family responsibilities career or job demands lack of financial support loss of social support community commitments poor previous academic performance foreign education (ESL) adverse educational experiences loss of tuition reimbursement financial aid issues poor institutional fit poor health or ill family member

(Boylston & Jackson, 2008; Commission on Collegiate Nursing Education [CCNE], 2013; Duffy et al., 2014; Robertson, Canary, Orr, Herberg, & Rutledge, 2010)

Less research exclusively identifies the particular characteristics of a successful RN to BSN adult student and how they

overcome barriers

(Jeffreys, 2012, 2015, Kern, 2014)

Purpose Statement

The purpose of this qualitative case study was to investigate the experiences of students who overcame challenges, commonly found in the adult student population, yet were still able to complete a registered nurse (RN) to Bachelor of Nursing in Science (BSN) completion program at a Midwestern private, faith-based institution.

Research Questions

What makes the students successfully complete an accelerated RN to BSN program at a Midwestern, faith-

based, private institution?

What are these students’ personal characteristic that can attribute, if at all, to their ability to successfully complete an accelerated RN to BSN program? How do these students meet the challenges, if any, on the way toward their degree

completion? What are the facets of an accelerated RN to BSN program that can contribute, if at all,

to the students’ ability to reach completion? What support do the department and institution provide for the students in order for

them to succeed academically?

Gap in Literature

The RN to BSN student population has been understudied

Scarce research exists specifically addressing factors that solely lead to understanding what constitutes successful completion in this particular student subpopulation

Vast majority of the retention studies, discussed in the literature, exclusively quantitative

(Jeffreys, 2015; Kern, 2014,)

Literature Review Take Away:Factors that Support or Restrict RN to BSN Persistence through a Program

Support Persistence

Motivators for the returning adult RN to BSN students: desire for personal achievement personal satisfaction ability to balance individual

responsibilities (mostly time and money).

recognition and job securityBahn (2007), Delaney & Piscopo (2004) and Robbins & Hoke (2013) ; Dowswell et al., Duffy et al., (2014)

Restrict Persistence

The RN to BSN student’s decision to remain in a course, and persistence may occur during, and at the end of each nursing course.

(Jeffreys, 2012, 2015)

Methodology: Theoretical Positioning of the Study

Positioned within the interpretive paradigm of inquiry or “Social Constructivism”

“Assumes the social world is constantly being constructed through group interactions, and thus, social reality can be understood via the perspectives of

social actors enmeshed in meaning-making activities”

(Hesse-Biber & Leavy, 2011, p. 5).

Theories that Align with Social Constructivism

Knowles’ (1990) basic assumptions of andragogy

Adult learning theory

Tinto’s (1975,1987,1993) retention model Institutional fit

Shelton’s model of Nursing Student Retention Student characteristics & role they play in student success; self-efficacy, environment

Jeffreys’ (2004, 2012) model of nontraditional Nursing Undergraduate Retention and Success (NURS);

Jeffreys’ (2012) HOLISTIC COMPETENCE acronym

Student profile characteristics; values & beliefs (motivations); academic factors; environment factors; professional integration & socialization; outside surrounding factorsFaculty helpfulness

Data Collection

Multiple sources of data in-depth semi-structured

interviews purposeful sample

institutional documents researcher field notes

Data Analysis Strategies

First cycle• Outline• Built Researcher

Database

Second cycle• Nvivo 11• Collapse

Third Cycle• Collapsed categories'

Line-by-line extraction• Finalized Researcher

Database

Final Categories and Codes:Total Indicators=1,592Total Codes=104Total Categories=39

Validation Strategies: Establishing Trustworthiness

Thick Description

Member Checking

My involvement in the case

Reflexivity

Triangulation Looked for themes from

institutional documents to echo themes from the interviews

Analysis of Institutional Documents

Systematic Evaluation Plan (SEP) Assess program effectiveness Driven by mission, goals, and expected student outcomes Three year cycle

Alumni Exit Survey Documents Years: 2012-13; 2013-14; 2014-15.

Triangulation of Themes Identified from Exit Survey Examined survey questions for comparisons to interview generated

themes

Thematic Analysis

Six major and forty-one subthemes: • Institutional and Program Fit• Role of Current Professional Climate and Decision to Pursue BSN• Institutional Support Systems and the Role of Critical Bonds• Critical Bonds Formed among Peers• Family Support and the Role of the Critical Insider• Personal Characteristics that Contribute to the Students Ability to Complete.

Major Finding #1

Institutional Fit:

•Program Delivery Model•Inclusive Environment•Benedictine Values

“You get that classroom interaction I was looking for, so that was my driving force. Plus, there were different locations.” (Deb)

“Liked that it was a cohort program….I needed the small intimate classroom, built around your work schedule. It was nice to have the close knit, small, welcoming environment. The instructors made it a really comfortable environment. I think an environment where you are comfortable it is a lot easier to learn and grow. (Sam)

“First, was the cohort format. Next was the style of the program, on ground and you were able to be with the people you started with. That helps with rapport.” (Ron)

Benedictine has a 3+ one…It was a seamless transition…I think location has a lot to do with it. You have the option to attend wherever it was most convenient. (Fay)

I could not find another program where you could have dedicated, consistent classroom time. Where you can complete it in essentially in 11 months” (Jill)

The program successfully infused Benedictine values in their students,(Ron)

Sometimes, if you are able to talk about your issues you can work through it, and I think that’s what was hugely different at Benedictine. You have people you could go to when things fall apart.” (Sam)

Major Finding #2

Role of Professional Climate

• Magnet status, career stability, & more opportunity

• Employer Support

• “I was working at wonderful institutions, but it was under the terms I needed to obtain a higher degree. When you want to work for the best of the best…” (Sam)

• “When I was applying for another job, everybody kept saying, “you don’t have to go back and get your bachelors now, but eventually you will, if you are offered the job.” (Fay).

• “Was thinking more about obtaining my Masters, so I needed the BSN first to fulfill that goal.” (Maeve) • “Earning a BSN puts you on the path to continuing your education. Continue education, so that I can

eventually teach down the road” (Ann)• “I wanted more career options.” (Ron)• “I had wanted to do it when I was in nursing school and I couldn’t, knew I had to get right to work after

my husband died. I got this job and they paid 100% tuition reimbursement, and, they also told me, I had three years to get it because I was the last nurse hired with the ADN.” (Kate)

• “As part of my job security, if something unforeseen happened and I had to leave my current position, who accepted me as an ADN, I was concerned that not having a bachelor in nursing would be limiting for me” (Jill)

Major Finding #3

Institutional Support Systems & Role of

Critical Bonds

• Critical bonds formed with faculty to foster student success• Faculty uphold a high touch environment• Faculty embrace adult learning principles• Nursing administration uphold a high touch environment• Academic advisors uphold a high touch environment• Resources utilized to foster success

“Several of the professors were very motivating. They were supportive. I felt they definitely wanted us to succeed. Very professional at all times, and I think seeing that open my eyes.” (Deb)

“Faculty was very knowledgeable and very helpful. They answered everything that you could throw at them. They are certainly very well versed in their field.” (Jill)

“When faculty exudes passion, you get excited to go to class.” (Sam)

“Overall (faculty) did a wonderful job making us feel like we were going to be successful…There is just so much support! There is so much support surrounded around finishing.” (Ann)

“Teachers would often interject, for those of you who are moving on to graduate school, or this or that…just mentioning it helps you visualize, you know. I think it made us hope,” (Maeve).

Having that kind of encouragement, I think is really empowering.” (Ron)

“The availability of the instructors to answer questions even on off-hours, like, if you email an instructor, you will get a response quickly.” (Deb)

“I could simply bring a question at any hour. I could email or text, and that is something you don’t get it every institution.” (Sam)

“A lot of instructors, made it really easy for you to come and talk to them, everyone was extremelyapproachable. Having access to the instructors helps keep your stress-in-check too…answer questions” (Mel)

“If you had a question or you needed clarification, you know, I think they made it very conducive to our learning.” (Erin)

“My concerns were taken seriously. It was clear to me administration wanted to see us succeed too. To see that the issue was addressed so quickly, and on the weekend no less, on her own personal time, really made me feel she cared about me and my issue.” (Deb)

“There were a lot of resources, people to turn to. These people were always available, and I have to mention her name without a doubt, number one was Dr. X. she gave me a lot of guidance throughout the program. She was actually my first teacher in the program, at Benedictine.”(Maeve)

“Always very proactive in obtaining feedback” (Ron)

“It was a Sunday afternoon and (Dr. X) just did all that she could do to help me…That is something I will never forget.” (Kate)

Example: Institutional Support Systems and Critical Bonds

“Leaving was probably the hardest thing that I had to do, but coming back was a very smooth transition, and everybody made that easy for me. Looking back on it now, it was such a smooth and effortless transition to return. . . . In fact, you actually made a follow-up call to me a few months after I stepped out. You asked me how I was doing. You asked me “Are you ready to began, how are you?” Then Dr. X had done that too. You didn’t even know how much it meant; it meant a lot to me. You just encouragedme. I remember that being really nice and comforting to hear. I remember Academic Advisor C. saying the school was not going to make me pay for the whole class over. So, it was really just the understanding; the experience had humanity to it. It wasn’t like you were a number. It was a difficult time for me. I was drowning in student loan debt, and I’m thinking about how I hadn’t saved the proper amount of money. At the time, I think I was 24. Who would have thought I would break my back, be out-of-work and school for nine months without an income?” (Sam)

Major Finding #4

Critical Bonds Formed with Peers

• Collaboration and teamwork• Peers promote a nonjudgmental

inclusive environment to overcome obstacles

• Diversity in nursing practice: years of experience, age, and demography

“There were times when she wanted to give up… and I said…nooooo (laugh), absolutely not! I need you, we need each other” (Deb)

“We did a lot of peer groups, and peer studying and that really helps in the real world. It helps because teamwork is a huge thing in our profession.” (Sam)

“I preferred it when the students had to kind of teach (group projects)…you come to class much better prepared, and just because of that you learn more.” (Mel)

“People had different connections, so you got to not only meet them, but also some of their colleagues. It opened up several doors for you.” (Erin)

“It’s a big mix of different types of students” (Mel)

“We were really diverse, we were very open with each other” (Ann)

Major Finding #5

Family Support & Role of the Critical

Insider

• Role of sister in the absence of parental support• Role of mother• Role of spouse/partner• Role of children• Role of family and significant other in

overcoming a challenge

Subtheme: Role of the Older Sister, Mother, Spouse/Partner & Children:

“It (college) was definitely not an expectation (laugh). However, marriage is an expectation! I suppose even more than education is an expectation…My sisterwas more supportive than anything” (Deb)

“My mom was very, very strict. We always had to have good grades, preferably straight A’s. So, just very strict, but I’m glad she was. I know because of her I finished what I have always set out to do.”(Fay)

My husband was instrumental in helping me with this. (Mel)

“My son (14yrs old), was a big support. He knew when I had to study, and he LOVES his sister, so he would watch her, play with her. I didn’t have to feel guilty focusing on my studies because I knew she was being taken care of. He would say, “I’ll do it, I’ve got it mom” . (Fay)

Subtheme: Role of Family in Overcoming a Challenge

“My youngest son, 16 years old, became very ill and was diagnosed with cardiomyopathy. And…he needed a heart transplant. That was a life-changing experience…Ummm, we were down at (the children hospital) for four months. We live down there while he was placed in a drug-induced coma, as we waited for a heart transplant and his recovery from the transplant surgery. It was a blur. It was (pause) I can’t even explain, it was surreal. I was going to drop out, I was just a basket case. But my husband… My whole family… they all said to me, “why”? My husband said, “Why? There is nothing you can do for him by dropping out, other than sitting by his bedside crying.” Which I did a lot. He said: “at least sit by his bedside and study.” You know Margaret, and I did! I did! My son was on a ventilator, he was on life support, and I did, I sat there, and I read. I think it really helped my mind; it really helped me.” (Maeve)

Major Finding #6

Personal Characteristics that Contribute to the

Student’s ability to Complete

• High expectations for self• Determined to complete a goal• Resiliency (overcome a challenge)• Healthy coping strategies'• Factors of the program that caused stress and strategies used to

combat it.• Ability to make connections to EBP to transform practice

“I was very accountable for my own actions, my own hard work, and I think that set me up for success.” (Sam)

“I pushed myself to get it done because my mom (pause) lived her life with regret. I am not always motivated, but I am ambitious, and just plain being stubborn I think that had a role; to want to get it done.” (Deb)

“Confidence, have the confidence in yourself, that you know you can complete the program.” (Mel)

“I’m driven, motivated…umm… When I set out to do something “I have to get done”…have to finish it.” (Fay)

“I don’t start things that I don’t finish.” (Kate)

“If I set my mind, and focus on a goal, then that’s it, that’s done. That is how I’ve always been. I’ve always just been that person. (Erin)

Lessons Learned

Retention is multifactorial

Finding suggest student attrition may bea faculty-indicator rather than upper administration problem

Fostering critical bonds is essential Faculty, administration, advising and

peer

Students experience stress when faced with the unexpected

Faculty availability is fundamental to a students ability to reach completion

Recommendations to the Program/Institution

Consider revising faculty/tenure evaluations to more accurately measure our role in fostering student success

Consider data collection strategies that emphasize student success.

Assess potential missed opportunities

Create a culture of transparency in regards to retention and attrition Create a culture of transparency in regards to retention and attrition

Collect data that measures the ever changing needs of all stakeholders Potential students Professional environment Community College Partners

Q & A

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