Journal of Nursing Education

Evaluation of Graduates of an Associate Degree Nursing Program

Salva Failla, RN, DNS; Mary Ann Maher, RN, MA, MN; Charles A Duffy, PhD

Abstract

ABSTRACT

Approximately 58% of the RN nursing programs in the United States are associate degree programe (ADN). The curricula of these programs are designed to prepare graduates to competently provide direct patient care. The purpose of this descriptive comparative study -was to evaluate the nursing performance of ADN graduates as perceived by graduates, faculty, and employers. In the first phase of the study, graduates and faculty completed the Six-Dimension Scale of Nursing Performance (6DSNP) at the time of graduation. Six months later, the graduates again were asked to complete the same questionnaire along with their employers. Findings indicated a significant difference in the planning and evaluation performance of graduates at graduation and 6 months later as perceived by the graduates. Graduates rated themselves significantly higher in all areas of performance when compared to faculty and employers. There was no significant difference in the perception of graduate performance between faculty and employers. This outcome assessment provides needed data on perceptions of ADN programs.

Abstract

ABSTRACT

Approximately 58% of the RN nursing programs in the United States are associate degree programe (ADN). The curricula of these programs are designed to prepare graduates to competently provide direct patient care. The purpose of this descriptive comparative study -was to evaluate the nursing performance of ADN graduates as perceived by graduates, faculty, and employers. In the first phase of the study, graduates and faculty completed the Six-Dimension Scale of Nursing Performance (6DSNP) at the time of graduation. Six months later, the graduates again were asked to complete the same questionnaire along with their employers. Findings indicated a significant difference in the planning and evaluation performance of graduates at graduation and 6 months later as perceived by the graduates. Graduates rated themselves significantly higher in all areas of performance when compared to faculty and employers. There was no significant difference in the perception of graduate performance between faculty and employers. This outcome assessment provides needed data on perceptions of ADN programs.

In 1994, there were 1,501 nursing programs that prepared graduates to take the licensing examination for registered nursing. Of this number, 58% (868) were associate degree nursing (ADN) programs in which 50% (135,895) of the total number of students were enrolled (National League for Nursing [NLN], 1995).

The curricula of all nursing programs assist graduates to develop the abilities needed te competently perform in the clinical area. Successful completion of the NCLEXRN* is an indicator of program effectiveness, but as an outcome criteria, the evaluation of nursing performance in the clinical area is critical.

Outcome assessment has become a key issue within all areas of society (Lenburg, 1991), including nursing education. The assessment of educational outcomes allows for the review of competencies expected of all graduates of nursing schools. Revised competencies of ADN graduates were specified by the NLN Council of Associate Degree Program (CADP) in 1990. According to Deering-Flory and Neighbors (1991):

These educational outcomes encompass competencies that should be demonstrated by the graduate following 6 months of practice as a registered nurse (p. 74).

The purpose of this research was to evaluate the nursing performance of graduates of an ADN program. Evaluation of performance as perceived by graduates, faculty, and employers of graduates can assist in determining the effectiveness of the educational program. By examining input provided by all of these groups, a more complete picture of curriculum effectiveness can be obtained.

Table

TABLE 1Slx-Dlmenglon Scale of Nursing Performance Scores for Graduates, Faculty, and Employers Means Standard Deviations)

TABLE 1

Slx-Dlmenglon Scale of Nursing Performance Scores for Graduates, Faculty, and Employers Means Standard Deviations)

LITERATURE REVIEW

Several studies have focused on employer evaluations of graduate competencies (Burch, Joyce-Nagata, & Reeb, 1991; Deering-Flory & Neighbors, 1991; Neighbors, Eldred, & Sullivan, 1991; Ryan & Hodaon, 1992). Burch et al. (1991) addressed competencies of ADN graduates as perceived by nurse administrators of health agencies. Employers agreed with all of the competencies proposed by nurse educators. Findings indicated administrators expect graduates to perform competently in the technical areas of nursing care. Administrators indicated a weakness among ADN graduates in their efforts to promote nursing as a profession.

In another study by Deering-Flory and Neighbors (1991), administrators agreed that ADN competencies as described by the NLN CADP were realistic, and the competencies could be accomplished by 6 months after graduation. Neighbors et al. (1991) also addressed competencies of ADN graduates in the workplace. Results identified discrepancies between what staff nurses and administrators expected as required skills versus the skills being taught in nursing schools.

In a study by Ryan and Hodson (1992), employer perceptions of graduates of a baccalaureate program over a 5-year period were addressed. Findings revealed general agreement among employers that graduates performed satisfactorily; however, deficits in clinical skills and charge nurse abilities were indicated. The need for collaboration between education and service was emphasized. In addition, use of employer feedback regarding graduate performance was considered a valuable tool in the evaluation of educational program outcomes.

In one of the few studies addressing educator and service administrator views of student expectations (Grabbe, 1988), the greatest consensus between the two groups involved caregiver and role expectations. The strongest discrepancy identified was the capacity to function as a manager or team member and a communicator. Administrators tended to expect more behaviors characteristic of the role of manager and team member, as well as the role of communicator.

Students' nursing performance and nursing programs have been addressed in several studies (Brooks & Shepherd, 1990; Marquis & Worth, 1992; Sanford, Genrich, & Nowotny, 1992; Swanson, 1987; Vanetzian & Hoggins, 1990; Ziv, Ehrenfeld, & Hadani, 1990). Swanson (1987) studied three types of senior baccalaureate students:

* Students who began their nursing education in a baccalaureate program (generic).

* Registered nurses prepared in ADN or diploma programs who were admitted with advance placement into baccalaureate programs (generic-completion).

* Students who began a program specifically designed for RNs (completion).

The different program types were not significantly different in their ability to predict nursing performance. Total role commitment and the time and effort expended by the students were significant predictors of performance.

A study of graduate self-appraisal and employer appraisal of the graduates' nursing performance was conducted by Vanetzian and Higgins (1990). Educational preparation of the graduates and evaluators included diploma, ADN, and BSN students, though a majority of the sample was BSN prepared. The 6-DSNP (Schwirian, 1978) was used, and the responses of the graduates and employers at 6 months and 1 year were compared. Nursing performance was rated at least satisfactorily at both times for both groups. At the 6-month data collection period, graduates appraised their own performance in leadership, planning, evaluation, teaching and collaboration, interpersonal relations, and professional development significantly higher than their employers' appraisals. At 1 year, employers scored the graduates significantly higher in their critical care abilities when compared to the graduates' scores. Employer appraisals were significantly higher for all performance areas at 1 year when compared to their 6-month scores of the graduates. However, graduates rated themselves significantly higher only on the planning and evaluation subscale at 1 year.

Using a multivariate approach, Marquis and Worth (1992) conducted a study focusing on internal and external outcome variables as perceived by students, faculty, and supervisors. Graduate competency rating scores correlated significantly with the faculty clinical evaluations only. In addition, there was a significant relationship between graduate and supervisor competency ratings.

Nickel et al. (1995) addressed community competency levels of baccalaureate students as perceived by students, educators, and health department supervisors. Results indicated a higher student perception of competence when compared to educators and administrators. Educators reported higher student functioning levels than administrators.

Sanford et al. (1992) found no significant differences in the clinical judgment of baccalaureate and nonbaccalaureate graduates. These results were not consistent with a 1990 study by Brooks and Shepherd. In the latter study, critical thinking and decision-making abilities were addressed in four types of nursing programs. The comparative critical thinking scores of generic baccalaureate and RN completion students were significantly higher than diploma and ADN students. There were no significant differences among the generic baccalaureate, ADN, or diploma students regarding then* clinical decisionmaking abilities. However, RN completion students did score higher than the other student types in this area. Findings also indicated a significant, though weak, relationship between critical thinking and decision-making skills among the four program types.

Table

TABLE 2Differences In the Mean Scoree of the Six-Dimension Scale of Nursing Performance Between Faculty and Graduates (on graduation)

TABLE 2

Differences In the Mean Scoree of the Six-Dimension Scale of Nursing Performance Between Faculty and Graduates (on graduation)

The literature reflects research that focuses primarily on student and employer evaluation of student and graduate competencies. Educational preparation of students included all program types. There is limited research that focuses primarily on ADN competencies as viewed by students, educators, and employers.

THEORETICAL FRAMEWORK

The theoretical framework of this study was System's theory. According to Rezler and Stevens (1978):

The System's model IB an all-encompassing one, adaptable to various educational programs and levels within programs (p. 70).

Nursing education is a system composed of related and interdependent parts, and the process by which a system functions is analogous to the process by which a curriculum operates. Both students and faculty bring varied experiences and knowledge to the educational process (input). Throughout the students' nursing education, a curriculum plan is followed (throughput). The intended end result of this process are individuals who have the ability to perform competently in the health care system (output). One measure of curriculum evaluation can be reflected via student, faculty, and employer evaluations of the students' performance in the clinical area.

Research Questions

This descriptive comparative design tested the following research questions:

* Is there a difference between the graduates' and faculty members' perceptions of the graduates' nureing performance?

Table

TABLE 3Differences in the Six-Dimension Scale of Nursing Performance Between Graduates on Graduation and 6 Months Later Means (Standard Déviations)

TABLE 3

Differences in the Six-Dimension Scale of Nursing Performance Between Graduates on Graduation and 6 Months Later Means (Standard Déviations)

* Is there a difference between the graduates' perceptions of their nursing performance on graduation and 6 months after graduation?

* Is there a difference between the graduates' perceptions of their nursing performance 6 months after graduation and their employers' perceptions?

* Is there a difference between the faculty members' perceptions of the graduates' nursing performance and the employers' perceptions?

METHOD

Sample

The first phase of the study consisted of 77 graduates and 18 faculty members. The second phase of the study included 33 graduates and 7 employers. The graduates ranged in age from 21 to 59 (mean = 31, SD = 7.7). The majority of the graduates were female (79.2%) and White (89.6%), either single or divorced (54.8%), had no children (58.4%), and did not have previous health care experience (70.1%). Most of the graduates had an income of less than $20,000 (54.6%) and had no educational preparation other than the earned ADN (92.2%). A majority of the faculty were female (94.4%). All were prepared at the master's level and had been nurse educators from 4 to 28 years (mean = 12.3, So = 6.47). The employers had been in the supervisor role from 1 to 15 years (mean = 7.78, SD = 6.04). Of the 7 participants, 42.9 % were educated at the baccalaureate level; the remaining 57.1% were prepared at the diploma (28.6%) and associate degree (28.6%) levels. Graduates and faculty participants were obtained from a southeastern community college nursing program. Employers were solicited from the hospitals in the com* munity.

Instrument

Nursing performance was measured by a slightly modified version of the 6-DSNP which is a 51-item scale containing six subscales (Schwirian, 1978):

* Interpersonal relations and communication (12 items).

* Teaching and collaboration (10 items).

* Professional development (10 items).

* Planning and evaluation (7 items).

* Critical care (7 items).

* Leadership (5 items).

The original version was 52 items with 11 items devoted to the teaching and collaboration subscale. Based on a 4-point rating scale of performance, an average score is obtained for each subscale. The professional development subscale which reflects the frequency professional behaviors are displayed uses the ratings of 1 = seldom or never, 2 = occasionally, 3 = frequently, 4 = consistently. The other scales, which rate performance of specific activities, use 1 = not very well, 2 = satisfactorily, 3 = well, 4 = very well. The instrument can be completed in 10 to 15 minutes.

Content and construct validity has been established (Schwirian, 1978). Reliability for the scales as based on employer appraisals and graduate self-appraisals are as follows: interpersonal relations and communication (graduate, .96; employer, .90), teaching and collaboration (graduate, .93; employer, .90), professional development (graduate, .98; employer, .89), planning and evaluation (graduate, .94; employer, .90), critical care (graduate, .92; employer, .86), and leadership (graduate, .90; employer, .84) (Schwirian, 1978). For this study, internal consistency was determined by Cronbach's alpha. For the graduates, reliability for all scales ranged from .64 (leadership) to .90 (communication). For faculty, reliability scores ranged from .74 (planning) to .90 (communication and professional development). For the employers, reliability of eubscales ranged from .79 (leadership) to .96 (teaching).

Table

TABLE 4Differences In the Mean Scores of the Six-Dimension Scale of Nursing Performance Between Employers and Graduates (6 months after graduation)

TABLE 4

Differences In the Mean Scores of the Six-Dimension Scale of Nursing Performance Between Employers and Graduates (6 months after graduation)

Table

TABLE 5Différences In the Mean Scores ol the Six-Dimension Scale of Nursing Performance Between Faculty and Employers

TABLE 5

Différences In the Mean Scores ol the Six-Dimension Scale of Nursing Performance Between Faculty and Employers

Procedure

After approval was granted from an institutional review board, participants were asked to complete a consent form with assurances that anonymity and confidentiality would be maintained. In the first phaae of the study, graduates and faculty were asked to complete a participant information form and a slightly modified version of the 6-DSNP questionnaire, which focused on various dimensions of nursing performance. Graduates completed the form as it pertained to them, and faculty completed the 6-DSNP as it applied to the graduates as a collective group, reflecting the class in general. Faculty had clinical contact with these graduates during their first or second year of the curriculum. The second phase occurred 6 months after graduation. Graduates who participated in the first phase were asked to complete the 6-DSNP again. At this time, the graduates were asked to provide the names of their supervisors, so they could evaluate the graduates individually. With this information, the supervisors were sent an introductory letter regarding the study, a consent form, a demographic sheet, and the questionnaire. The second phase of the study was conducted through the mail with a follow-up reminder letter for those forms that were not returned.

RESUITS

Analysis of data was performed through the use of descriptive statistics and t tests for independent and related samples (p < .05). Because only seven graduates were evaluated by then- employers, caution must be exercised when considering the statistical significance of the results for employers. However, a review of ratings among employers revealed a consistent scoring of competence among graduates. Though limited in number, these findings indicate employers perceived these graduates ta be competent health care providers.

Graduates rated their performance higher than faculty and employers. Graduates perceived themselves as performing well at graduation and 6 months after graduation. Faculty and employers perceived graduates as performing satisfactorily to well on graduation. All groups reported graduates as engaging in professional behavior on a frequent to consistent basis. The means and standard deviations of subscale scores of the 6-DSNP are reflected in Table 1 for all groups.

Research Question 1

Is there a difference between the graduates' and faculty members' perceptions of the graduates' nursing performance? There was a significant difference between graduate and faculty perceptions of graduate performance on graduation. Faculty scored graduate performance significantly lower than the graduates on all subscales (Table 2).

Research Question 2

Is there a difference between the graduates' perceptions of their nursing performance on graduation and 6 months after graduation? There was a significant difference between the graduates' perceptions of their nursing performance on graduation and 6 months after graduation in regard to planning and evaluation. The graduates scored their performance higher on graduation. Though not significant, the graduates also indicated higher scores at graduation for the subscalea of professional development and critical care (Table 3).

Research Question 3

Is there a difference between the graduates' perceptions of their nursing performance 6 months after graduation and their employers' perceptions? There was a significant difference between graduates' perceptions of their performance 6 months after graduation and employers' perceptions. Employers' scores were significantly lower on all subscales in comparison to the graduates (Table 4).

Research Question 4

Is there a difference between the faculty members' perceptions of the graduates' nursing performance and the employers' perceptions? There was no significant difference between faculty's and employers' perceptions of graduate performance. However, faculty scored graduates lower on all subscales in comparison to the employers (Table 5).

DISCUSSION

The intended outcome of ADN programs is to prepare graduates who can competently provide patient care. In accordance with the framework of the study, System's the* ory, the findings recognize the elements of input (i.e., graduate, faculty, employer evaluations of performance) that can be used to evaluate the effectiveness of the curriculum (i.e., throughput), so the nursing performance of graduates (i.e., output) can be viewed as competent and contributory to health care delivery.

This study reveals several differences in the perceptions of performance by ADN graduates, faculty, and employers. Overall, the research reflects a positive perception of nursing performance of ADN graduates by all groups. Consistent with another study of ADN graduates (Kroll, 1994), graduates perceive themselves as competent in their ability to perform nursing care. After 6 months of experience, graduates perceived themselves aa performing well in all subscales, though a significantly lower score on the planning and evaluation subscale was reported. It is not surprising that graduates rated themselves so well on graduation because their experience is limited to a learning environment that is, understandably, more controlled. As a result, perceptions of their performance may not be as realistic at graduation as they are after practicing as a RN for 6 months. This study's graduates continued to excel in their performance after graduation; thus, a sense of competency was felt by graduates at graduation and 6 months later.

Although this study revealed no significant differences between faculty's and employers' perceptions of graduate performance, graduates scored themselves significantly higher than faculty and employers. This is consistent with what has been reported in the literature. Orchard (1994) emphasizes educators' responsibility to establish clear, reasonable, and consistent clinical expectations for all students. Communication of performance objectives and feedback regarding performance throughout the clinical experience is essential to the teachinglearning process of nursing. By collaborating, educators and employers may identify differences in performance expectations that need to be addressed in the curriculum or clinical orientation after graduation. As Maynard (1996) states:

the education procees must provide the skills and knowledge.. .and service the opportunity and time for development (p. 17).

Though generalization of these findings is limited because of the convenience sample and its size, the study provides much needed data on perceptions of ADN educational preparation. Recognizing the small sample of employers, further research would allow for a more comprehensive study of employers' perceptions. As Kroll (1994) states:

nursing programs have consistently needed to prove their effectiveness to obtain the power and prestige in institutions that would guarantee adequate funding (p. 5).

Because of the distinctions in educational preparation among ADN, baccalaureate, and diploma education, continued research is needed on assessment of outcome criteria for all programs. Longitudinal studies of students and graduates, faculty, and employers for all programs are needed. The collection of qualitative data also would contribute an important dimension not captured by quantitative instruments alone.

REFERENCES

  • Brooks, KL., & Shepherd, J.M. (1990). The relationship between clinical decision-making skills in nursing and general critical thinking abilities of senior nursing students in four types of nursing programs. Journal of Nursing Education, 29. 391-399.
  • Bureh, S., Jcyce-Nagata, B., & Reeb, R, (1991), A comparison of evidenced and expected ADN competencies. Advancing Clinical Care, 6, 33-36.
  • Deering-Flory, R-, & Neighbors, M. (1991). NLN competencies for the associate degree nurse. Nursing and Health Care, 12, 474479.
  • Grabbe, L.L. (1988). A comparison of clinical evaluation toóla in hospitals and baccalaureate nursing programs. Journal of Nursing Education, 27, 394-398.
  • Kroll, C. (1994). Outcomes among graduates from Washington state community college associate degree nursing programs. Nurse Educator, 19(3), 5.
  • Lenburg, C.B. (1991). Assessing the goals of nursing education: Issues and approaches to evaluation outcomes. In M. Garbín (Ed.), Assessing educational outcomes (pp. 25-52). New York: National League for Nursing.
  • Marquis, B., & Worth, C. (1992). The relationship among multiple assessments of nursing education outcomes. Journal of Nursing Education, 31, 33-38.
  • Maynard, C. (1996). Relationship of critical thinking ability to professional nursing competence. Journal of Nursing Education, 35. 12-18.
  • National League for Nursing. (1990). Educational outcomes of associate degree nursing programs: Roles and competencies (NLN Publication No. 23-2348). New York: Author.
  • National League for Nursing. (1995). Nursing data source 1991 (NLN Publication No. 19-2429). New York: Author.
  • Neighbors, M., Eldred, E., & Sullivan, M. (1991). Nursing skills necessary for competency in the high-tech health care system. Nursing and Health Care, 12, 92-97.
  • Nickel, J.T., Pituch, MJ., Holton, J., Didum, J., Perzynski, K_, Wise, J-, & McVey, B. (1995). Factors associated with perceived competency levels of graduating seniors in a baccalaureate nursing program. Journal of Nursing Education, 12, 3-8.
  • Orchard, C. (1994). The nurse educator and the nursing student: A review of the issue of clinical evaluation procedures. Journal of Nursing Education, 33, 245-251.
  • Rezler, A.G., & Stevens, B.J. (1978). The nurse evaluaior in education and service. New York: Mc-Graw-Hul.
  • Ryan, M. E., & Hudson, K.E. (1992). Employer evaluations of nurse graduates: A critical program assessment element. Journal of Nursing Education, 31, 198-202.
  • Sanford, M-, Genrich, S., & Nowotny, M. (1992). A study to determine the difference in clinical judgment abilities between BSN and non-BSN graduates. Journal of Nursing Education, 31, 70-74.
  • Schwirian, P.M. (1978). Evaluating the performance of nurses: A multidimensional approach. Nursing Research, 27, 347351.
  • Swanson, M. J. (1987). Baccalaureate nursing education: Students, perceptions of roles, effort, and performance. Journal of Nursing Education, 26, 380-383.
  • Vanetzian, E.V., & Higgins, M.G. (1990). A comparison of new graduate and evaluator appraisals of nursing performance. Journal of Nursing Education, 29, 269-275.
  • Ziv, L., Ehrenfeld, M., & Hadani, RE. (1990). Student evaluation of the school program. Journal of Nursing Education, 29, 6065.

TABLE 1

Slx-Dlmenglon Scale of Nursing Performance Scores for Graduates, Faculty, and Employers Means Standard Deviations)

TABLE 2

Differences In the Mean Scoree of the Six-Dimension Scale of Nursing Performance Between Faculty and Graduates (on graduation)

TABLE 3

Differences in the Six-Dimension Scale of Nursing Performance Between Graduates on Graduation and 6 Months Later Means (Standard Déviations)

TABLE 4

Differences In the Mean Scores of the Six-Dimension Scale of Nursing Performance Between Employers and Graduates (6 months after graduation)

TABLE 5

Différences In the Mean Scores ol the Six-Dimension Scale of Nursing Performance Between Faculty and Employers

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