Retention of students enrolled in nursing programs has become a high priority in recent years. As a result of the nursing shortage, the pressure has been on nursing programs to increase the number of registered nurses for their communities. Attaining this goal has focused efforts on increasing both enrollment and the rate of retention. Valencia Community College (VCC) in Orlando, Florida, has used a grant-funded part-time faculty position for the past eight years to increase retention. This effort has been effective and well received by students and faculty.
Prior to the decrease in availability of qualified applicants in the early 1980s, VCC always had full classes and a long waiting list. Enrollment figures in 1982 showed a continuing decline despite concentrated efforts to contact potential students and retain those who enrolled.
In 1983, a study was conducted which showed that the retention rate continued to be unacceptably low, especially for minority and other high-risk students who were academically, economically, and/or socially disadvantaged. These students, however, showed a high degree of interest in becoming professional nurses. They were well motivated to study and to work, but frequently did not have the educational background or problem-solving skills necessary to master the nursing curriculum. Many were older students in their 30s or 40s who had complex personal obligations that detracted from time for and concentration on academic pursuits. The nursing faculty did not have the additional time needed to tutor these disadvantaged students. It became evident that additional faculty would be necessary to provide support services to help these students successfully complete the nursing program.
Faced with a continuing influx of highrisk students, faculty of the VCC nursing program developed the position of educational specialist. This faculty member would help students having difficulty in nursing theory, clinical skills, pharmacology, and dosage calculations. Unfortunately, money for a new faculty position was unavailable. To fund this new position, the chairman of Health and Public Services wrote a grant proposal for Federal Vocational Funds, Vocational Division, Category II, Disadvantaged Persons. The grant was approved allowing an educational specialist to be hired in November 1983. Renewed annually, the grant has provided valuable hours of individual instruction, support, and encouragement to minority and other highrisk students over the years. Many of these students have successfully completed the associate degree nursing program, passed the state board license examination, and are now providing nursing care in the community. VCC graduates continue to have an excellent record with a pass rate of 90% or better on state boards.
Availability and Services
All students are informed of the availability of the educational specialist many times throughout the nursing program. When students first inquire about admission to the program, they are told of the services provided by the educational specialist as well as other VCC support services. This information is repeated during the orientation program. In the first class of every nursing course a few suggestions are given to improve study habits and to decrease stress. At that time, the educational specialist is introduced, the role explained, and office location and hours are given. Students are advised to seek assistance as soon as they perceive they have a problem rather than waiting until they are so far behind it is impossible to catch up. They are also told that they may be referred to the educational specialist if their clinical instructor feels they need help.
The students are reassured that there is no stigma attached to recognizing the need for additional help in mastering a particular concept or skill. And, because the educational specialist is not assigned a clinical group or lecture responsibilities, it is possible for students to view this faculty member as a nonthreatening source of assistance. Students are informed that all VCC faculty are committed to helping them achieve their goal to become professional nurses, and are encouraged to share their problems or concerns with their clinical instructor. In this way, students at high risk for failure can be identified for early referral.
All nursing faculty help in the initial identification of students undergoing high stress. Early in Nursing I, students are given the Holmes & Rahe Social Readjustment Rating Scale test to assess current stress levels. Results are shared with the educational specialist to provide a basis for initiating contact with the student. When students who have been referred to the educational specialist do not make an appointment for evaluation and remediation, the educational specialist initiates the contact by inviting the student to group or individual study sessions.
Initially, the educational specialist encounters mostly instructor-referred students. However, once students use the services, they frequently return on their own for help in other nursing courses. Some students just stop for a minute to chat, to give an update on their progress, or to discuss a specific concern or family problem that may hinder their progress. The educational specialists office maintains the reputation of being a "safe" and friendly place to vent pent-up feelings or get a little encouragement.
Variety of Problems Seen
Students who use the educational specialist's office time are a cross-section of the total nursing enrollment. The student population in the nursing program is very diverse: some students are single parents of young children; some are working 30 or more hours a week while carrying a 17hour class schedule; a few are new to this country and culture; some are seeking a second career; many have prior experience in the health care field as LPNs, EMTs, or medics from the armed services; and a few have never been in a hospital before. The average student age is 33 and approximately 14% are men. This diversity brings a wide variety of problems to the attention of the educational specialist.
Problems most often seen, ranked according to prevalence, are as follows:
* test anxiety,
* poor or forgotten math skills,
* poor study habits or not knowing what to study,
* working too many hours for class loads,
* single parents struggling with financial and family problems,
* difficult personal problems that need referral,
* need to vent frustrations and fears,
* English as a second language, and
* learning disabilities.
Most disadvantaged students have several of these problems. To address the needs of the students, the educational specialist works with them individually or in small groups, listens to and assesses their problems, helps sort out alternatives, gives suggestions for ways to improve study habits and to decrease test anxiety, tutors in math and nursing theory, bolsters failing spirits, and encourages positive attitudes. For problems needing additional attention, many referrals are made to other departments in the college such as the math and reading laboratories, financial aid, and counseling.
Nursing faculty have frequently experienced the frustration of insufficient time to devote to helping a slow but promising student succeed in the clinical area. With an acutely ill patient population and with 10 to 12 students to supervise and instruct, the faculty's clinical time is stretched to the limit. The result has been some students lost from the program and from the nursing profession who might otherwise have succeeded had additional help been available to them.
Working with students in the clinical area is an essential part of the educational specialist's job. For students having difficulty putting theory into practice, individual clinical instruction and reinforcement are provided as the need is perceived by instructors and/or students. During clinical time, students are asked questions pertinent to the concepts currently being studied.
If a student is slow in learning how to organize patient care or needs some additional assistance in learning required nursing skills, the educational specialist is available for the two clinical days weekly to give one-on-one instruction to that student in the hospital setting. Group instruction with two or three students is sometimes used to decrease anxiety in some individuals.
Because students know the educational specialist will help them, in any way possible, to complete the course, they often are able to relax and to ventilate the perceived problems causing or resulting from thenpoor performance in the clinical setting. The educational specialist counsels the student as to what steps are necessary to correct the observed problems. With the student's agreement, a time is set for révaluation. All student encounters are documented to maintain continuity of information of the student's progress.
When an instructor observes a student having difficulties in the clinical area that have not been corrected after counseling and after a reasonable amount of time, the instructor may ask the educational specialist to evaluate the student's performance. This gives the instructor an unbiased assessment of the student's strengths and weaknesses before the student is given a midterm or final evaluation or is advised that failure in the clinical rotation is imminent. This also provides the student with an evaluation from a person with whom a history of criticism, failure, or anxiety has not been established.
Records have been developed to follow the progress of high-risk students through their nursing education, graduation, success on state board examinations, and job placement. Despite this, it is difficult to document exactly how much improvement has been made in the retention rate of these students as a direct result of the availability of the educational specialist.
A number of changes have been made in the nursing program over the past eight years, all of which have contributed to increasing student retention in the Nursing I course, from 68% in the 1985-1986 school year, to 85% in 1988-1989. However, it is apparent that both students and faculty have used the services of the educational specialist more every year. In the 1984-1985 school year, approximately 50 students interacted with the educational specialist during office time. By the 19881989 school year, this number increased to 326 individuals with more than 900 office contact hours logged.
Students have been very open in their appreciation of the availability of the educational specialist. They often stop by the office to tell, with great enthusiasm, of passing a difficult unit test or the required math exam. A heartfelt "thanks for all your help* is frequently heard. In this time of constantly increasing demands for registered nurses, the part-time faculty position of educational specialist plays an important role in helping disadvantaged and minority students successfully attain their goals. These are highly motivated students who might otherwise be lost from the nursing profession.