Today, a wide variety of students enroll in nursing education programs.
In addition to the traditional high school graduate who enters a nursing program, nontraditional students are enrolling in increasing numbers. Although some literature describes programs for these nontraditional students, only recently have empirical data about these students become available (Diers, 1976; Feldman & Jordet, 1989; LaVerdier, 1973; Seidl & Sauter, 1990; Slavinsky, Diers, Dixon, 1983; Smith, 1989).
This study addressed the similarities and differences between nontraditional students - those entering a basic nursing program with a baccalaureate in another field or discipline - and traditional nursing students. From one graduating class, 17 nontraditional students and 18 traditional students were compared on demographic variables, indicators of academic achievement, the Community Health Orientation Scale (CHOS), the Bern Sex Role Inventory (BSRI), definitions of nursing, and goal statements.
T tests on the CHOS and the BSRI, and content analysis of nursing definitions revealed few differences. However, differences in demographic variables, academic achievement indicators, and professional goals were found. Content analysis of nursing definitions revealed that both groups defined nursing as a caring, holistic, and health-promoting profession. However, traditional students used the word "professional" in définitions while the nontraditional students did not. Both groups identified their goals to include pursuing graduate education. Five-year goals for the nontraditional students were all oriented toward patient care, whereas those of the traditional students included educational and administrative goals in addition to direct patient care. Many nontraditional students cited the need for further clinical experience, while few of the traditional students saw more clinical experience as a desire or need. Faculty teaching within both programs were interviewed regarding similarities and differences between the groups. Challenges and constraints/ adversities were voiced by the faculty.
While further research is important to verify where similarities and differences occur between these groups, these findings suggest implications for program planning in nursing education. As a result of this study and continued investigation, unprecedented change has transpired within the educational programs involved.
Programs especially for returning RN students have existed for some time. However, programs for college-educated students were not widely emphasized in the past, even though nontraditional students are not new in nursing education. In 1977, some 2500 college graduates were admitted to schools and colleges of nursing (Slavinsky, Diers, & Dixon, 1983). By 1985, 86% of nursing schools accepted students holding a previous degree, although only 17% actually targeted this group for recruitment (Redman, Cassells, & Jackson, 1985). Recognizing this group as a market for recruitment has resulted in an increasing number of programs specifically designed for this population (Feldman & Jordet, 1989; LaVerdier, 1973; Plummer & Phelan, 1976; Smith, 1989). The value of these newcomers to nursing lies not only in their contribution to alleviating the nursing shortage, but in the experience and maturity they bring to the profession and their subsequent performance as colleagues within the profession.
In 1987, a Task Force on Nontraditional Programs at the University of Virginia (UVA) School of Nursing was appointed to examine faculty concerns regarding student enrollments and attracting a more diverse student body. The group considered the nursing shortage, the need for reform in undergraduate education, and requests from individuals in other fields for nursing education designed to meet their unique needs. The faculty supported the development of an educational program for individuals with degrees in other fields who wished to pursue a career in nursing. Six beliefs provided the foundation for program development. The program should:
* Meet the high academic standards of the University of Virginia and the School of Nursing;
* Be tailored to the knowledge, experience, and maturity of students without requiring unnecessary validation;
* Provide reasonable substitutions based on the students' abilities and special interests;
* Prepare students for roles and levels of practice that are challenging and ofler advancement;
* Be described completely, accurately, and consistently both verbally and in writing;
* Provide wide flexibility based on the knowledge, experience, and maturity of the student (UVA Committee Report, 1987).
The Second Degree-MSN Program
In 1988, the Second Degree-MSN Program was implemented for students holding a baccalaureate or master's degree in another field. Admission requirements include a previously earned baccalaureate or master's degree from an accredited institution, a minimum grade point average of 2.0 on a 4.0 scale on undergraduate course work, and three letters of recommendation. Students are encouraged to complete the Graduate Record Exam (GRE) prior to admission, but they are required to provide GRE scores by their third semester in the program. Prior to successful completion of the GRE, the student may enroll in a maximum of six hours of graduate credit within the master's curriculum.
Second Degree - MSN Track Courses
Students admitted to the program are given advanced placement credit for the general education courses taken for their initial baccalaureate degree. No other prerequisites or specific courses are required. The adult learning principles of individuality and self-directedness are the principles used for implementing educational experiences. Each student is provided with selections of learning experiences essential for a foundation upon which to build nursing experiences. Students concentrate more on some learning experiences than on others, depending upon their own previous education and experience.
The baccalaureate degree is earned after students complete two years of study. The first year of the Second Degree-MSN Program includes 32 hours of course work (Table 1). This is a year of intense course work that bridges general education courses with nursing. Students take courses in the supporting sciences, study beginning theoretical constructs related to nursing, and have clinical experiences with well individuals of all ages, obstetrical patients, and ill children and adults with basic nursing needs. Since there are no prerequisites to the program, anatomy and physiology content is integrated with client assessment. Other content that traditional students receive in distinct courses is included within the major nursing strategies courses taken by the Second Degree students. This includes content about nutrition, the teaching/learning process, microbiology, and health care systems. The first year of the program is also intended to provide beginning socialization into the world of nursing.
The second year includes the same courses taken by nursing students in the final year of the traditional baccalaureate program (Table 1). A unique feature is the opportunity for students to take selected graduate level courses in lieu of undergraduate courses. For example, students may take their administration or research courses on the graduate level, rather than the undergraduate level. A total of nine hours of graduate credit can be taken prior to the completion of the BSN. One attraction of the program is the ability of the student to take these graduate level courses and to be able to continue into the MSN program. Obtaining the master's degree in nursing within a three-year period is quite an enticement for the goal-directed adult learner.
The third year of the program includes the three core courses for the master's program: theory, research (if not previously taken), and issues of the profession. Students also meet the requirements for the clinical track that they select. Most of the students take at least six graduate credits in their second year. This allows them to progress with lighter course loads during the third year and to work to help supplement their nursing experience as well as limited financial resources from the previous years in the program.
The program is designed around principles of adult learning. Faculty with specific interest in adult learning and working with nontraditional students are selected to teach in the program. Faculty enthusiasm and interest in the program remains high. The challenges and rewards inherent in teaching adult learners continue to attract faculty to the program.
The program has proved to be very attractive to students. Recruitment efforts have been minimal. In the first year of the program 19 students were admitted; thereafter, class size was limited to 30 students. While the numbers of applications to the program have exceeded all projections (the 1991 class had 105 applicants), the faculty has determined that 30 students is currently the optimum number to admit to a class. This number was derived considering the student-faculty ratio necessary to facüitate this group's intense curriculum and faculty obligations for other programs.
Students' first degrees represent a variety of disciplines, including music, art, education, psychology, biology, chemistry, and business. Unusual backgrounds inelude criminal justice, agronomy, and interior design/fashion merchandising. Ages also vary greatly from 22-year-olds having just completed their baccalaureates to others changing their careers in their mid40s. The percentage of men in each class is higher than in the traditional program, with three to five men in each class. The average admission GPA has remained consistent around 3.4 on a 4.0 point scale.
Students entering the Second DegreeMSN Program indicate that they have had a variety of experiences with health care providers. These experiences have included either their own or a family member's health care needs, or personal experience as a health care worker or volunteer. They also provide a variety of reasons for their choice to enter nursing (Table 2). Some students indicate that they have explored and compared careers in both medicine and nursing and have chosen nursing both for its holistic approach to the client and because it is seen as a career demanding less sacrifice of other (personal) life goals. Many students indicate a desire to be a part of a profession seen as caring and humanistic in its approach to people. Students also specifically mention admiration for nurses as a reason for their choice.
Students in the Second Degree-MSN program are adult learners and present the characteristics associated with this group. They are highly motivated and goal-directed. While part-time study is available, most students elect full-time study in order to complete the program as expeditiously as possible. They are ready to learn and, like other adult learners (Seidl & Sauter, 1990), often are vocal about their need to have an experiential and problem-oriented approach to learning experiences. They are not satisfied spending class time on content that they feel is not directly related to nursing. As novices in a field, these students are similar to traditional students in expressing the need for "hands-on" experiences.
Students in this program have been extremely successful. A higher percentage of second degree students than traditional students have cumulative GPAs above 3.5 at graduation. In addition to evidence of achievement in grades, anecdotal reports from clinical nursing faculty and nursing staff working with students in both their student role and as nursing assistants have been complimentary. Reports have been received that nurses on hospital units have repeatedly encouraged students to return as graduates.
Major Themes in Responses to the Question: Why the Decision to Enter Nursing?
Issues in Planning end Implementing the Program
To date, all students have successfully completed the Mosby Assess Test at or above the 95th percentile. From the entering class of 1988, all BSN graduates were successful on the NCLEX and are currently employed aa nurses. Of the 17 students graduating in the first class, half elected to stop at the baccalaureate level and the others either began graduate study or indicated that they would do so after a year's leave of absence. Seventeen of the 24 members of the second class that entered the program in 1989 progressed immediately to the MSN program; five took a leave of absence and only two students did not plan to continue. Procedures are in place that allow students to take a leave of absence for three semesters without having to reapply to the master's program for admission.
Planning and Implementation Issues
During program development and implementation, several key issues were identified (Table 3). General education requirements and methods for giving credit for previous work were two issues requiring resolution. Initial discussion focused extensively on what general education courses were needed as prerequisites. The decision made was to include no prerequisite courses, but to build on a broad base of previous educational experiences and to provide students who had limited science backgrounds with the necessary content within nursing courses. Microbiology content is included in pharmacology; nutrition and teaching/learning theory are included within clinical nursing courses; and anatomy and physiology (A & P) is incorporated into the client assessment course. With the exception of A & P content, this approach has proven sound. However, students consistently identify difficulties mastering the extensive amount of material associated with A & P at the same time they are learning client assessment skills, basic nursing skills, and growth and development. After extensive discussion among both faculty and students, the faculty are proposing that A & P become a prerequisite course.
Provision for transfer credit for courses that might substitute for required nursing courses is also necessary. Students are requested to provide transcripts and course descriptions of courses previously completed that might be equivalent to courses such as growth and development and communication. Within courses, credit for previous learning is given in a variety of ways. For example, basic communication skills, included in the beginning nursing course, is taught using a modular approach. Students with previous experiences and course work in basic communication skills receive recognition for those and can build on rather than repeat previous experiences. Students are provided with a written module including a pretest, multiple learning resources, several study guides, and a posttest. Role playing seminars are held so students can practice techniques. Students select, with the aid of the pretest and instructor guidance as needed, the learning experiences they will use to master basic communication concepts and skills.
Socialization into nursing as well as into the school is an issue for this student group because of their diverse educational backgrounds, their various Ufe experiences, and their learning needs as adults. Students come with specific ideas about nursing and preconceived notions about health care providers, specifically nurses. Experiences in the classroom and the clinical setting sometimes challenge these preconceptions and, as such, prove discomforting. Along with this is the experience of returning to the student role after other successful experiences.
During the first year that the program was offered, all first year courses were provided to this group in classes separate from traditional students. Faculty thought this would facilitate development of a group identity and beginning socialization to nursing. Both students and faculty found problems with this approach. Students indicated that it was difficult to blend with traditional students during the second year of the program and faculty were often teaching the same content separately to each group of students. Currently, pharmacology and growth and development are offered concomitantly to both traditional and nontraditional students. Students report positive benefits from this early interaction and plans are underway to integrate these students in first year clinical courses.
Sequencing of clinical courses was also an important issue when planning the program. Two clinical courses were planned for the first semester of the first year. One course focuses on basic nursing concepts and skills and a second course addresses health promotion and wellness. After providing these courses concurrently during the first year of implementation, faculty decided that acquisition of basic skills and concepts was essential prior to beginning clinical experiences in obstetrics and community settings. Course scheduling now allows these courses to be sequenced consecutively within the first semester.
Facilitating mastery of clinical nursing skills among this nontraditional student group continues to be a challenge for faculty. Lack of confidence in new skills and the need to maintain self-esteem necessitates carefully designed clinical experiences, constructive criticism coupled with confidence building, and help with stress management. Students need to be actively involved with planning their own clinical and classroom experiences. In addition to individual faculty-student planning for clinical experiences, scheduled meetings between all faculty and students take place regularly during the first year. Less group interaction appears to be needed during the second year of the program.
Faculty advisers for the program teach within the program and assume responsibility for ongoing evaluation of program implementation as well as helping students make course selections and plans for progression to the master's program. Written policies related to the program have been developed and are combined in a handbook for students and faculty advisers. These include policies related to course selection, program requirements, and progression to the master's program.
An unanticipated and somewhat startling issue that arose involves faculty frustration over poor evaluations received from this group of students. It appears that the principles of andragogy are easier to preach than they are to practice. Faculty feelings grew out of inexperience with this type of student. It appears that these students come to the program with the idea that they will be treated as peers by faculty; however, collegiality is not awarded to one's protégé until completion of the educational program. The principles of andragogy, even when practiced by faculty, do not always meet the needs of this group. In the area of clinical skills acquisition, the students' need for competency and selfconfidence overrode the principle of selfdirectedness. At times, these students need more "spoon-feeding* than the traditional undergraduate. Recognition of these students' impelling need for self-assurance and competence within the clinical setting led faculty to restructure the clinical skills (psychomotor) portion of the first nursing course to include seven weeks within the laboratory setting prior to entering a health care setting.
One final issue continues to plague the faculty concerning the program. Faculty remain divided as to the ability of these inexperienced novice nurses to attain the role of advanced practitioner - the goal of the master's program- within the threeyear period of the program. Several faculty still support the notion of a minimum of one year of nursing experience prior to entering the master's portion of the program. Specialty master's programs offered at UVA include Home Health Care, Critical Care, Adult Health, Pediatrics, Community Health, and Psychiatric/Mental Health. Clinical experiences are individually set up with the student's experience level in mind. Autonomous practice must be carefully examined with the novice nurse. Faculty in the Critical Care Program still require that students have the clinical experience necessary to attempt advanced practice in a critical care setting. To date, no problems have been encountered in relation to this issue, as the students progressing immediately on to the MSN have proven themselves capable in every way.
For the purpose of ongoing improvement, all courses are evaluated each time they are taught. As previously discussed, student and faculty forums are conducted regularly. In addition, faculty teaching within the program met regularly as the initial implementation began. The BSN Curriculum Committee also sought student input through nontraditional student membership on the committee. Formal summative evaluation of the program by the first graduates, including those who completed only the BS as well as those who have proceeded to the MS, is now underway.
While formal summative evaluation is not complete, there is evidence of success of the program. The achievements of the students during their academic program, the complimentary anecdotal reports of faculty and nursing staff who have worked in the clinical environment with the nontraditional students, the Mosby Assess test and NCLEX results, and the increasing interest in the program evidenced through large numbers of applications for admission indicate the success of the program. The motivation and accomplishments of this group of students during their initial nursing education holds great promise for their potential as contributors to the profession of nursing.
- Diers, D. (1976). A combined basic-graduate program for college graduates. Nursing Outlook, 24, 92-98.
- Feldman, H., & Jordet, C. (1989). On the fast track. Nursing and Health Care, 10, 491493.
- LaVerdier, R. (1973). An accelerated nursing curriculum. Nursing Outlook, 21, 524-526.
- Plummer, E., & Phelan, M. (1976). College graduates in nursing: A retrospective look. Nursing Outlook, 24, 99-103.
- Redman, B., Cassells, J.M., & Jackson, S.S. (1985). Generic baccalaureate nursing programs: Survey of enrollment, administrative structure/funding, faculty teaching/practice roles and selected curriculum trends. Journal of Professional Nursing, 1, 369-380.
- Seidl, A., & Sauter, D. (1990). The new nontraditional student in nursing. Journal of Nursing Education, 29, 13-19.
- Slavinsky, A., Diers, D., & Dixon, J. (1983). College graduates: The hidden nursing population. Nursing and Health Care, 4, 373-378.
- Smith, P. (1989). Nonnurse college graduates in a specialty Master's program. Nursing and Health Care, 10, 495-497.
- UVA Committee Report. (1987). Report on nontraditional programs. University of Virginia Task Force. Charlottesville, VA.
Second Degree - MSN Track Courses
Major Themes in Responses to the Question: Why the Decision to Enter Nursing?
Issues in Planning end Implementing the Program