Journal of Nursing Education

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A Comparison of RN Students in Two Types of Baccalaureate Completion Programs

Frances W Thurber, PhD, RN

Abstract

ABSTRACT

The purpose of this study was to compare perceptions of nursing programs and attitudes toward professional nursing behaviors in entering and exiting registered nurse students enrolled in generic and second step baccalaureate degree completion programs. The convenience sample of 233 registered nurse students was drawn from eight baccalaureate nursing programs in a metropolitan area. Data included a student profile, perceptions of program in which enrolled, a professional attitude scale, and demographics. Data were factor analyzed to cluster items into distinct empirical groups and then examined by analysis of variance using program type and entry/exit status as covariates.

Factor analysis of program perception data delineated six principal factors. On two of the factors, overall nursing role attainment and communication ability, entering second step students held significantly higher expectations. However, responses of exiting students as to how well expectations had been met were similar between the two program types. Similar analysis of the professional attitude scale differentiated five factors. Results showed that among students entering both program types, second step entrants had significantly more professional attitudes (p < .01). Differences between the exiting groups were not significant. This study suggests that professional attitude formation is not dependent upon type of baccalaureate completion program in which enrolled but may relate to type of prior nursing education.

Abstract

ABSTRACT

The purpose of this study was to compare perceptions of nursing programs and attitudes toward professional nursing behaviors in entering and exiting registered nurse students enrolled in generic and second step baccalaureate degree completion programs. The convenience sample of 233 registered nurse students was drawn from eight baccalaureate nursing programs in a metropolitan area. Data included a student profile, perceptions of program in which enrolled, a professional attitude scale, and demographics. Data were factor analyzed to cluster items into distinct empirical groups and then examined by analysis of variance using program type and entry/exit status as covariates.

Factor analysis of program perception data delineated six principal factors. On two of the factors, overall nursing role attainment and communication ability, entering second step students held significantly higher expectations. However, responses of exiting students as to how well expectations had been met were similar between the two program types. Similar analysis of the professional attitude scale differentiated five factors. Results showed that among students entering both program types, second step entrants had significantly more professional attitudes (p < .01). Differences between the exiting groups were not significant. This study suggests that professional attitude formation is not dependent upon type of baccalaureate completion program in which enrolled but may relate to type of prior nursing education.

Introduction

Despite intense efforts to attract students to baccalaureate programs, the largest proportion (78%) of American nurses are prepared at either the diploma or the associate degree levels (American Nurses' Association, 1979). Increasingly, however, nonbaccalaureate prepared registered nurses, motivated by a variety of professional and personal reasons, are enrolling in baccalaureate degree completion programs.

As a result of these events, many program options have proliferated. Some nurse educators have maintained that the bachelor of science degree should only be obtained through education in a traditional four-year program, which allows time for the necessary professional socialization to occur (Woolley, 1978). Others maintain that programs must be flexible and in tune with the needs and expectations of nonbaccalaureate-prepared RNs who desire to upgrade their academic status (Muzio & Ohashi, 1979). It is this second philosophy which has stimulated the development of many of the 146 "second step" or two-year baccalaureate degree completion programs (Galliford, 1980).

Colleges and universities are currently suffering the effects of budgetary constraints, declining enrollments, and the need to develop new sources of revenue. Thus, nursing's increased commitment to higher educational preparation is indeed timely. Diploma and associate degree prepared registered nurse students can be very desirable additions to enrollment statistics. Not only do these students appear to be more mature, more experienced, and more goal directed, but they are potentially less expensive to educate and generate needed tuition income.

Given such a situation, the following question should certainly be addressed. If, as at least one author has suggested, programs are being developed or drastically altered in order to attract this population of students, is the ultimate quality of baccalaureate nursing education in jeopardy? These programs may, in fact, lose sight of the traditional goals of baccalaureate education and "simply exist to grant a union card" (Kramer, 1981, p. 228).

It is widely held that professionalism, career orientation, autonomy, intellectual ability, and to some extent selfactualization, are among the desired outcomes of baccalaureate education for nurses. These ends are considered attainable in a generic bachelor of science in nursing programs. It has been implied that second step programs also work toward achievement of these goals and may have some impact, especially in the area of professional attitude formation. What we do not know is the degree to which these programs do conform to this overall mission; nor do we know how student outcomes compare with those of the generic-based BSN completion programs. The purpose of this study was to compare students who chose the different program types. The following specific questions were asked:

1. Do the student profiles of the RN students differ according to the type of program selected?

2. Are the programmatic expectations of the two student populations different?

3. Do student perceptions of how well their chosen program has met their expectations over the period of enrollment differ according to type of program selected?

4. Are professional attitude outcomes of RN students in the two types of programs different?

Literature Review

Many authors over the past half century have addressed the issue of professionalism (Bixler & Bixler, 1945; Flexner, 1915; Merton, 1960). Others have specifically addressed professionalism as a developmental and educational process with specific outcome measures that indicate synthesis and integration of theoretical information into specific decision-making skills (Chater, 1970; Mauksch, 1969). Professionalism is the accepted and expected outcome of baccalaureate education, and professional socialization is the complex process by which a person acquires the knowledge, skills, and sense of occupational identity that are characteristic of a member of that profession. Such socialization is a part of, and a responsibility of, the formal educational process (Cohen, 1981; Jacox, 1973).

By and large, studies related to professional socialization in nursing have focused on comparisons among the three basic types of prelicensure programs - diploma, associate degree, and generic baccalaureate degree. Several investigations have compared the competencies of graduates (Beverly & Junker, 1977; Bullough & Sparks, 1975; Gray, Murray, & Sawyer, 1977; Moore, 1967). Repeatedly, baccalaureate-prepared graduates were found to demonstrate a higher level of ability in leadership, judgment, and responsibility areas. Similarly, they were more oriented toward care than cure and could initiate independent and nonprescribed nursing actions more frequently.

A substantial amount of research on socialization of nurses has centered on examining the values and attitudes of graduating students in the three types of nursing schools, or on measuring these values and attitudes in a sample of nurses practicing their first professional roles (Conway, 1983). This focus reflects a general consensus in the literature that attitudes toward practice are viewed as a reflection of the socialization process which occurs in education.

Watson (1983), for example, in assessing the degree of influence an educational program could have on professional socialization, measured attitudes of professionalism and problem identification skills in graduates of all other types of schools. Watson concluded that baccalaureate graduates held more professional attitudes than diploma or associate degree graduates, even though they did not differ in problem identification skills.

Although some efforts have been made by researchers to look at professional development within the context of BSN programs, the focus has generally been on the development of these characteristics in traditional generic four-year BSN students. Little is known about this process within the RN baccalaureate student population, although it is widely assumed to be taking place. Woolley (1978) describes the changes to be wrought in this group of students. She states that "the change we are encouraging our RN students to make is not simply in the amount of knowledge or credits they can gain; instead, it is a whole behavioral change in their attitudes, roles, and functions" (p. 103).

Collectively, these data have prompted nurse educators to look closely at alternative programmatic offerings intended to move RN students toward BSN completion ("second step" programs). As a result, many program options now exist. In 1977, only nine second step programs were accredited by the National League for Nursing; by 1980, some 106 such programs had achieved accreditation. Church (1980) maintains that over 150 postlicensure programs now exist, granting approximately one third of the baccalaureate degrees in nursing each year. Many of these programs have sought to provide greater flexibility geared to the specific needs of this body of students (MacLean, Kenney, & Knoll, 1985; Williams, 1983).

Research directed specifically toward this growing population of students has generally explored differences between RN students and nonstudent RNs (Luddington, 1980). Attitude formation studies have compared RN students to generic BSN students (Kielinen, 1979), and similar RN students upon entry to and exit from a BSN completion program (Mannetti, 1980). Their findings indicate that changes in professional attitudes can be expected to occur in RN students between entry and exit from a baccalaureate completion program.

Curriculum developers have sought to define content areas which will assist RN students in gaining the professional status to which they aspire. As a result of their work, professionalism has been relatively well defined. However, the student outcomes produced by the various program types which attempt to move students toward professionalism are less well understood. A specific aim of this study was to investigate the quality of such programs by comparing the student outcomes.

Methodology

SAMPLE- The sample for the study (N=233) was composed of 42% diploma school graduates and 58% associate degree graduates drawn from RN students enrolled in accredited baccalaureate degree programs in an eastern metropolitan area. Using a cross-sectional design, data were collected from students entering and exiting from five generic-based programs and three second step programs (see Table 1 for distribution of study sample by program type and enrollment status). All participating schools were from the private sector, as they are predominant in the study area and because a combination of public and private institutional types might introduce an additional institutional effect and confound the findings of the study.

Table

TABLE 1DISTRIBUTION OF STUDY SAMPLE BY PROGRAM TYPE AND ENROLLMENT STATUS

TABLE 1

DISTRIBUTION OF STUDY SAMPLE BY PROGRAM TYPE AND ENROLLMENT STATUS

PROCEDURES - Arrangements for data collection were made with individual faculty members designated by the cooperating institutions. Entry data were collected during September or early October of the first academic year. Exit data were collected either in December or April, and in one case August, but always within one month of graduation. The project was explained to the students at either the beginning or end of their class period by the researcher. Informed consent was obtained, and those who were willing to be included in the study then completed the appropriate questionnaire. Of the total of 251 subjects, 93% (N=233) chose to participate in the study.

INSTRUMENTS-The two instruments developed for data collection were four-part entry and exit questionnaires. The first section of both addressed factors motivating the student's return to an academic environment. These items were analyzed to determine their relationship to the type of program chosen by students.

The second section contained items related to student perceptions of their BSN programs. Entering students indicated their initial perceptions of the program in which they had enrolled, and exiting students described their perceptions of their program at time of graduation. Questions used in this section were adapted from a questionnaire already in use for this purpose. The questionnaire, entitled "Survey of BSN Graduates," was developed at a Pennsylvania university in 1979, and has well-established content validity.

The third part of each questionnaire specifically addressed the issue of program outcomes. The process of professional socialization or resocialization requires role change and is evidenced by adoption of new attitudes. Therefore, it was assumed that the educational outcomes for RN students should include the acquisition of more professional attitudes toward nursing behaviors. A Likerttype scale developed by Shortridge (1977) was used to determine attitudes toward professional nursing behaviors. Respondents were asked to indicate levels of agreement or disagreement with various professional nursing behaviors. Established split-half reliability of the scale was 0.63 for freshmen, 0.67 for seniors, and 0.87 for the total population. Test-retest reliability values were 0.66 for freshmen, 0.61 for seniors, and 0.75 for the total population. The fourth and final section of each questionnaire contained specific demographic questions related to age, sex, socioeconomic status, and prior educational experience.

Results

STUDENT PROFILE- Taking the sample as a whole (N=233), 41.8% of the subjects were graduates of associate degree programs, and 58.2% came from diploma or hospital-based programs. Of the associate degree graduates, 6.5% were enrolled in a generic-based BSN completion program while 35.3% were enrolled in second step programs. Both program types seemed to draw fairly equally from graduates of diploma schools, with 31.9% enrolled in generic programs and 26.3% in second step programs.

Analysis of variance indicated significant differences between type of program on three student profile variables: year graduates from basic program, age, and religion. Male students, as well as younger, single, Catholic women with fewer children, were enrolled in second step programs: older, married women with greater family responsibilities and a slightly greater degree of spousal support were more likely to enroll in generic programs.

Of the options offered as potential motivating factors for returning to school, several appeared to be important to all RNs who returned to school to complete a baccalaureate degree. Enjoyment of learning and career advancement were judged to be somewhat important or extremely important by 87.6% and 88.0% of the students respectively. Skills improvement ranked next (85.8%), and a desire to attend graduate school strongly motivated 66.4% of the respondents. Financial security was placed in the important categories by 57.1% of the students.

Nearly two thirds of the nurses in the sample (N= 153) indicated that they saw a need to improve their job performance and subcategorized the following areas in which they felt additional knowledge was needed. Some 69.3% of the respondents felt they needed additional nursing knowledge or an advanced nursing degree to improve their job performance, which seemed to be a strong motivator for them to return to school. Not only did the desire to attend graduate school enter into the decisionmaking process of a great many of the students, but they also had very well-defined goals with respect to how far they wished to progress.

Table

TABLE 2JOB STATUS BEFORE AND AFTER BACCALAUREATE DEGREE

TABLE 2

JOB STATUS BEFORE AND AFTER BACCALAUREATE DEGREE

Table

TABLE 3PROGRAM PERCEPTION FACTORS

TABLE 3

PROGRAM PERCEPTION FACTORS

In regard to position desired after BSN completion, many indicated they desired staff nurse positions. There was a definite preference for higher level positions, however, than those held at the time of entry into the academic setting, while a small increase was seen in those aspiring to administrative and management posts (see Table 2 for job status held before and desired after the baccalaureate degree).

Program Choice Results. In this study, 38.2% of the returning students entered generic-based RN studies programs and 61.8% enrolled in second step programs. This imbalance may indicate that in this geographic region, more students are attracted to the second step option than to the generic BSN completion option.

All respondents were given a selection of nine options which might have affected their choice of program. These options included such items as convenience, recommendations of friends and associates, advertising and recruiting, family members as alumni, the presence of noted faculty members, school reputation, availability of scholarships or financial aid, ability to meet financial requirements, and other self-identified motivators which might affect the choice.

All program choice responses and perception of program responses were submitted to factor analysis using an eightfactor model. Factor loadings from principal axis analysis indicated that Factor 1 accounted for 44.8% of the total variance, and Factor 2 accounted for 13.7% of the total. Orthogonal rotation of the data confirmed the existence of six differentiated factors (see Table 3 for program perception factors).

The first factor is a composite factor which includes six items related to the performance of the professional nursing role (see Table 4 for factor loadings of program perception data). Factor scores were added to the data set and examined by one-way and two-way ANOVAs. The findings for Factor 1 reflect a difference between the two entering groups which did not occur between the exiting groups (F = 7.02, p < .01). The data clearly indicated that second step RN students had higher expectations of their programs upon entry than did generic students, but this difference no longer existed by time of exit from the programs.

Table

TABLE 4FACTOR LOADINGS OF PROGRAM PERCEPTION DATA

TABLE 4

FACTOR LOADINGS OF PROGRAM PERCEPTION DATA

Table

TABLE 5SIGNIFICANT COMPARISONS USING FACTOR SCORE DATA

TABLE 5

SIGNIFICANT COMPARISONS USING FACTOR SCORE DATA

Factor 2, interpreted as the independence factor, also demonstrates an overall difference by program type (F = 6.19, p < .01). Although the entering comparison here was not statistically significant, the findings generally support the ability of the programs to provide additional requisite knowledge for the implementation of certain professional characteristics.

The factor analysis findings for program perception data thus revealed that there are differences in expectations according to program type, the more significant differences occurring between the entering student groups (see Table 5 for significant comparisons using factor score data). Two items which did not load on the factors but which proved to be of interest because of their potential influence on future program development were convenience of the program, and "other influences." Entering generic RN students reported that the convenience of the school influenced their choices more often than did second step students (F = 7.45, p < .01). This finding implies that second step students were more willing to travel farther for their education, perhaps because of their stronger initial expectations of that program.

Table

TABLE 6TRANSFER CREDIT AND ADVANCED STANDING

TABLE 6

TRANSFER CREDIT AND ADVANCED STANDING

Table

TABLE 7SUMMARY OF PROFESSIONAL ATTITUDE FACTORS

TABLE 7

SUMMARY OF PROFESSIONAL ATTITUDE FACTORS

The item categorically known as "other influences," did emerge as being very important to students in all groups, even though it did not prove to be statistically significant between the groups. This category of responses demonstrated a higher set of means than did all other measures (X = 3.95, -X= 4.57). Within this category, students were asked to define miscellaneous factors that affected their program choices. The most important factors to students in all programs and at all levels was their ultimate acceptability by the school, and the school's willingness to offer credit for previous education and experience (see Table 6 for transfer credit and advanced standing data).

Items were then again analyzed. Factor scores were computed and added to the data set, and analyzed using one-way and two-way ANOVAs (see Table 7 for summary of professional attitude factors). The results of the analysis support the conclusion that there are significant differences by program type, with the discrepancy between the entering groups having the major impact.

The differences can be better demonstrated by looking more closely at the individual factors. Factor A appears to be a composite factor encompassing many attitudes related to the diversity of the professional nursing role. This factor alone accounted for 53.7% of the variance, and demonstrated statistically significant comparisons by type of program and between the two entering groups. Factor B (the teaching-managerial role) and Factor C (bedside care orientation) combined with Factor A to comprise 86.7% of the variance. It would be of interest to know if Factors B and C correlate strongly with Factor A; however, since an orthogonal rotation was utilized, a factor correlation matrix was not generated.

Discussion and Summary

The profiles of the two student subpopulations proved to be more similar than divergent. On the whole, all subjects appeared to be highly motivated academic achievers seeking career advancement and access to higher educational opportunities through the completion of a baccalaureate degree. The demographic differences between the two groups were few and were not sufficient to indicate that the subsamples are discretely different.

The programmatic expectations of the two student populations were significantly different in many respects. However, the differences were just the opposite of what was expected, with entry expectations being more divergent while exit perceptions were more alike between the programs. In addition, second step students rather than generic students demonstrated the higher expectation level. The judgment of this group of students would then indicate that the second step programs were achieving the terminal outcomes of baccalaureate education at a high level.

The results show that students entering both program types are not initially homogeneous in their professional attitudes. Initially, there were significant differences, indicating that entering second step students were more professional than generic RN students. Students exiting both program types demonstrated some progression toward the higher attainment of professional attitudes, theoretically due to the advanced educational process. As this educational process continues, both groups gradually adopt similar professional attitudes which by time of graduation from their program are not significantly different.

The socialization process seems to occur to a greater extent in generic program types, in that students come in with lower professional attitudes and progress to the same level as second step students. Because of this length of time of exposure to the school, environment may play a role in socialization as originally anticipated. However, the fact that the two exiting populations are not statistically different in their professional attitudes indicates that the programs may facilitate change appropriate to their specific students, and that the terminal outcomes of both types of programs are similar. In essence, instead of moving students toward outcomes that are clearly different, the programs seem to move the students toward more homogeneous outcomes, where the differences according to program blur and become instead a composite picture of similar professionalism.

Limitations of the study include the use of a convenience sample which limits the ability to generalize beyond highly similar groups. Replication with a larger sample statewide or nationwide should be done to validate the conclusions. An additional limitation of the study was the use of a crosssectional design. A longitudinal study which surveyed the same students as they entered and exited from their program may provide a more accurate picture of actual change over time.

Nursing education probably benefits most from studies such as this. For many years, educators have sought to provide the perfect curriculum that would ensure the best educational outcomes for all students. Unfortunately, baccalaureate education has often sought to remediate the basic preparation of RN students rather than accept certain intrinsic values and build upon them. More recent efforts to adjust and adapt programs on adult learning models to suit previously educated persons have been decried as providing an inferior education.

If, indeed, several types of programs are accomplishing the stated goals of baccalaureate education for nurses, albeit in different ways, then energies would be better spent if directed toward more accurate assessments of what RN students bring to the educational process and consistent efforts to adapt course work to the individualized learning needs of the students, instead of trying to make them fit into the existing mode. It would clearly seem that those programs which attempt to be more flexible and adapt to the needs of this student population will be the ones that survive to produce our future nursing leaders.

Finally, if second step programs are producing good quality student outcomes, generic programs should look to what they can provide that would be different and even greater benefit to these students. One suggestion, as many generic programs are a part of schools of nursing which also offer graduate study, would be to offer articulated baccalaureate-master's degree programs. This would expedite completion of advanced degrees for the many returning RNs who desire this, making the wisest use of valuable student time, as well as efficient use of faculty across levels and ultimately, providing greater student satisfaction.

References

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TABLE 1

DISTRIBUTION OF STUDY SAMPLE BY PROGRAM TYPE AND ENROLLMENT STATUS

TABLE 2

JOB STATUS BEFORE AND AFTER BACCALAUREATE DEGREE

TABLE 3

PROGRAM PERCEPTION FACTORS

TABLE 4

FACTOR LOADINGS OF PROGRAM PERCEPTION DATA

TABLE 5

SIGNIFICANT COMPARISONS USING FACTOR SCORE DATA

TABLE 6

TRANSFER CREDIT AND ADVANCED STANDING

TABLE 7

SUMMARY OF PROFESSIONAL ATTITUDE FACTORS

10.3928/0148-4834-19880601-07

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