Nursing educators are challenged like never before to enrich the nursing curriculum in order to prepare baccalaureate nurses for leadership roles. One of the most complex challenges lies in dealing with KN students who are returning to colleges and universities, seeking bachelor's degrees in nursing. These students with diverse backgrounds, both in preparation and in practice, require that nursing educators critically assess current nursing programs and their relationship to the experienced RN (Green, 1987; DuGas, 1985).
Five years ago, our nursing department began actively to recruit these RNs. Like other colleges and universities, we found that RNs were frustrated with a curriculum designed for full-time, generic nursing students with time to finish a degree in an uninterrupted, four-year program of study (Parlocha & Hiroka, 1982; Hillsmith, 1978). Another frustration these students faced was a feeling that college nursing educators had no consideration for what they had already learned through clinical work experience.
With this concern in mind, the Augustana College Nursing Department worked especially hard to come to grips with the increasing problem of access and flexibility for RNs caught in the dilemma of working while meeting changing professional demands of a career which remains essential to modern society. We perceived a need to guide these mature students to become leaders in their work settings and also to become good students, open to new learning about nursing.
The nursing department looked first to proficiency testing as a way of dealing with an RNk prior learning and providing access. Other nursing programs have used advanced placement through competency examination or self-study as options for advancement to the senior year (Seylor, Morgan, Datillo, & Luke 1984; Borgman & Ostrow, 1981). The difficulty here is that testing is conducted in an artificial testing situation and often in a brief time. Not only is intense testing stressful, but it does not allow for important interaction between faculty and student. Role modeling is a major teaching tool that a professor of nursing uses, and this vital element is missing in competency testing and in some selfstudy techniques. More importantly, neither method adequately tested clinical competency. Testing alone does not adequately assess clinical competency.
Other colleges had utilized assessment of prior learning through a documented portfolio, but not in the comprehensive way our nursing department felt was necessary (Barba, Carrolton, & Yeaw, 1985). So began a curriculum innovation, a pilot project which has restructured Augustana's nursing curriculum to assist RNs. This paper will explain the important transition which took place. A central issue of this transformation involves our commitment to the idea that RNs must be given some recognition for their knowledge and expertise acquired from work experience. After doing a needs assessment and developing a model to make our nursing program accessible to RNs, we restructured the junior year to consist of a bridge course, entitled, Change: A Professional Challenge, and a portfolio of prior learning for 19 credit hours.
Historical Development of the Model Curriculum Plan
The primary goal of the plan was to make Augustana's nursing program more accessible to RNs desiring a baccalaureate degree in nursing. There were two basic assumptions essential to the development of this model:
1. RN students will be expected to attain the same terminal objectives at completion of the major as the generic students do.
2. Flexibility will be sought in recognizing clinical experience and expertise of individual RNs.
With these assumptions in mind, the nursing department began the planning process.
First, data were collected from resource people through interviews of LPNs and RNs in the community. RN students who had completed our degree program and representatives of nursing management from the three hospitals in the community provided important data. The campus representative for CAEL (Council for Adult and Experiential Learning) was also consulted.
Three major concerns surfaced in the data analysis when the project team attempted to match needs of the RNs with the program our college was presently providing:
1. Development of formal means of updating RNs in knowledge and skills - Besides health assessment education, nursing process, communication skills, and assertiveness education, these RNs needed methods for dealing with threats to self-esteem and for providing motivation to learn and change.
2. Recognition for acquired knowledge and expertise - The plan called for a means of measuring clinical knowledge and theory competence at the entry level.
3. Consistent progress in academic classes while working full-time and maintaining other roles - The corresponding need to be met included flexibility in scheduling part-time options and in academic support.
The Model Curriculum
These three concerns led to major changes in the nursing curriculum to accommodate the needs of RNs. The policies which were developed were designed to assist the progression of RNs through the nursing curriculum at Augustana. This did not entail a separate program, but a new model within the existing program. The changes were adopted by the entire faculty as necessary and desirable.
The model curriculum for registered nurse students began with a bridge course entitled Change: A Professional Challenge. This course was designed to address the first major concern about updating knowledge and skills of returning RNs. The course facilitates the transition of the RN student to baccalaureate nursing and provides a structure and direction for the RN to begin portfolio development. The major theme of the course is change, with theory addressing intrapersonal and interpersonal communication, nursing process, health assessment, leadership, and professionalism.
The bridge course emphasized the nursing process, a concept new to some RNs who had attended diploma nursing schools five or more years earlier. Although they were technically quite sophisticated in nursing procedures, they lacked the academic knowledge and the philosophy of the nursing process necessary for the baccalaureate nurse. Accordingly, they now began to focus upon wellness as much as diseases, and more upon the psychosocial needs of the patient and family rather than just upon technical procedures. In short, this bridge course initiated them to new ways of knowing what nursing is today.
During the bridge course, the RN is taught how to write the portfolio of prior learning. This portfolio addresses the second major concern which emerged from the needs assessment, a need to give recognition to the RN for acquired knowledge and expertise. The portfolio follows recommendations from CAEL (Council for Adult and Experiential Learning) in form, in documenting, and articulating learning, not simply experience.
Through this portfolio, the RN describes and documents that she/he has attained the year-end objectives for the junior year in nursing. The central theme of the portfolio is the nursing process, and the RN is required both to describe and to present evidence of this problem-solving process in the same form and with the same substance expected of generic students.
The objective of the portfolio is to assess the nurse's prior learning from the work setting, previous workshops, inservice programs in hospitals or health-care agencies, and memberships and leadership positions in professional organizations. The RN student presents the portfolio to the nursing department and requests credit for her/his knowledge and experience, with each portfolio equivalent to six nursing courses for a total of 19 semester hours.
The portfolio includes separate sections for an autobiography and resume, a statement of the student's philosophy of nursing, process recordings (interaction analysis), complete nursing care plans for a designated number of patients, and documentation of the RNs proficiency from supervisors in the work setting and other methods, such as certificates of workshops attended or a bibliography of articles consulted.
To address the third major concern about consistent academic progress, the nursing department restructured the senior year from an integrated 10-credit hour course and one credit seminar to four separate interrelated nursing courses, which are sequenced for a part-time study option. Thus, part-time study in the senior year has become an option available to RNs that had not been available before. An additional benefit is an option to do a portion of the clinical requirement of the courses in their work setting. For example, an RN staff nurse in a renal dialysis unit is starting a support group of dialysis patients in her work setting, a project for which she will earn 20 hours of clinical credit.
The first three nursing portfolios to be turned into the office of the Academic Dean marked an historic occasion. These RNs, with rich experience and sincere motivation to be leaders in their fields, had successfully completed the junior year in approximately four months. They had taken the bridge course during the summer session and then written their portfolios immediately after that course.
The clearly beneficial results of assessing competency in this way have allowed students to become better learners, stronger nurses, and junior colleagues to their professors. Nursing faculty have seen five definite strengths emerge.
The first is that the RN receives a more solid understanding of the nursing process than she/he had before taking the bridge course and writing a portfolio. In the bridge course, students learn what the nursing process is, its terminology, how it applies to clients, and how to use this information in the portfolio. The point is not that they don't know nursing, but that they learn to know in a new way - a way which focuses upon wellness and the coping of family and patient with health and illness problems, not just upon disease and technical procedure.
The second outcome involves the process RNs must go through to develop their philosophy of nursing, which must be written as part of the portfolio. Thinking and writing about one's career and its values have proven to be enlightening for RNs caught up in day-to-day activities with little time for reflection.
The third outcome is the self-awareness which comes when RNs look at their communication style with clients and analyze its effectiveness. Miller and Wolff (1981) underscore that one important way to strengthen learning for adults is through the process of self-awareness because it forces individuals to examine their value systems and motivations. RNs in our program examine their communication styles both in theory and in practice in the bridge course and through the portfolio.
The fourth outcome is that the portfolio enables them to make role transitions needed for professional nursing and allows nurses to develop the psychological safety necessary for progress to occur (McGrath and Bacon, 1979). Defensive attitudes vanish. Since the nursing department has developed a legitimate method of sending the message that the work and life experiences of RNs are valuable, defensiveness has dissolved. Students no longer feel compelled to challenge the professor.
RNs have become junior colleagues as nursing educators work with them to draw them into the new philosophy of baccalaureate nursing. In the past, when nursing professors challenged their experience or knowledge by not allowing them any credit for it, RNs felt they must respond in kind. The bridge course and the portfolio have eliminated such a compulsion. Now well into its third year, 20 RNs have entered the senior year with more confidence and with valuable time saved.
Through this curriculum innovation, RNs gain reinforcement about the value of their work. For they see clearly and at first hand that nursing is a meaningful profession. The academic setting accepts their work as valuable and critical to society by formally recognizing it, and their new knowledge allows them to discover new merit in what they are doing. Not only is a supervisor in a clinic or hospital evaluating their activities, but they, themselves, and their professors are also measuring their work in a much broader context. Work and study are partners - each reinforcing the other.
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- Borgman, M. F, & Ostrow, CL. (1981). An advanced placement program for registered nurses. Journal of Nursing Education, 2CX5), 2-6.
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- Green, CP. (1987). Multiple role women: The real world of the mature RN learner, Journal of Nursing Education, 26(7), 266-271.
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- Miller, R., & Wolff, C (1981). The helping professions. In A. Chickering (Ed.), The Modern American College (pp. 529-537). San Francisco: Jossey-Bass.
- Parlocha, P., & Hiraki, A (1982). Strategies for faculty: Teaching the RN student in a BSN program. Journal of Nursing Education, 21(5), 22-25.