Consumers are calling for evidence of the value and credibility of educational programs in all disciplines. At the same time, there is increased emphasis on identifying outcomes in nursing education (Byrd, Garza, & Nieswiadomy, 1999; Cragg, Plotnikoff, Hugo, & Casey, 2001). Health care in the United States has experienced rapid and dramatic changes during the past decade. Factors such as governmental and private insurance reimbursement constraints, the creation of large health care networks through mergers, increased consumer knowledge and demands, and an aging population have affected all levels of care provision, as well as all health care providers. A professional role orientation is needed for graduate nurses to survive within this changing health care arena (Nesler, Hanner, Melburg, & McGowan, 2001), including characteristics such as flexibility, accountability, leadership, autonomy, and lifelong learning (American Association of Colleges of Nursing [AACN], 2001). Professional autonomy has been cited as a mark of professional socialization (Conway, 1988; Keely, 1990; Williams & McGowan, 1995).
Students take several different avenues of educational preparation to become RNs, including 2-year, 3-year, and 4-year programs of study (U.S. Department of Health and Human Services, 2001). In 1965, the American Nurses Association called for the baccalaureate degree to be the entry level into professional practice (Warner, Ross, & Clark, 1988). Although this has not yet come about, the proposal is continually revisited and reaffirmed by nursing leaders (Zerwekh & Claborn, 2003).
The hallmark of baccalaureate nursing (BSN) education has been the education of professional nurses. Indeed, courses designed to develop aspects of professionalism in graduates are a foundational part of the BSN curriculum (Logan & Franzen, 2001). Numerous baccalaureate completion nursing programs that allow returning RNs to enroll in part-time or full-time study to obtain their BSN degree are in place across the United States. Between 1975 and 1999, the number of diploma or associate degree graduates who returned to complete a BSN degree increased from approximately 3,700 per year to more than 12,000 per year (AACN, 2000). This return to school to accommodate evolving and changing nursing roles often necessitates a resocialization to the professional role (Cragg et al., 2001), and whether returning baccalaureate completion nursing students can attain the same degree of professional socialization as that expected from generic BSN graduates is central to that issue. Can a resocialization from the technical role, which is the focus of the 2-year and 3-year programs, to a professional role, the hallmark of BSN education, occur? Lack of adequate socialization has been linked to negative outcomes, such as attrition from the profession and decreased productivity (Nesler et al., 2001).
This study sought to determine whether students who graduate from two-plus-two baccalaureate completion nursing programs have the same professional socialization as students who graduate from generic BSN programs (i.e., basic 4-year programs). As professionals, graduates of BSN programs must be prepared to meet the demands of the current health care arena. This study is significant because of its addition to the body of knowledge surrounding the professional socialization of BSN graduates.
Results of this study have particular significance for faculty and administrators of nursing programs in influencing the instructional design and theoretical framework of curricula in BSN programs, and are also valuable to employers, third-party payers, and the public, all of whom seek to determine the unique contribution of RNs to the health care arena. In addition, the results of this study add vital information to the continuing entry-into-practice debate within the nursing community.
Five research questions guided this study. The first was the main focus of the study: Is there a difference in the level of professional socialization between students who graduate from two-plus-two baccalaureate completion nursing programs and students who graduate from generic BSN programs?
Typically, baccalaureate completion nursing students are older students who are returning to college, whereas generic BSN students have only recently completed high school. Older individuals usually have more experience with life in general and with the health care arena in particular, both of which may influence their professionalism. Therefore, the second research question addressed the relationship between age and the level of professional socialization of graduating students of two-plus-two baccalaureate completion nursing programs and generic BSN programs.
Often, baccalaureate completion nursing students are RNs who have had many work experiences over a period of years. Employment may have encouraged autonomy, a mark of professionalism, or created an attitude different from professionalism, depending on the organizational structure and occupational culture of the employing agency. Therefore, the third research question sought a relationship between the number of years employed as an RN and the level of professional socialization of graduating students of two-plus-two baccalaureate completion nursing students.
In addition to differences in age and employment experience, students often come to baccalaureate completion nursing programs from 3-year hospital diploma programs or 2-year associate degree programs, both of which typically produce technically oriented graduates (National League for Nursing [NLN], 2000). To determine whether the type of basic program makes a difference in the level of resocialization to the professional role, the fourth research question asked whether there is a difference between the level of professional socialization of graduating students of two-plus-two baccalaureate completion nursing programs whose basic nursing program was a diploma program and students whose basic nursing program was an associate degree program.
The ability of organizational structure, in particular decentralized democracies versus centralized bureaucracies, to empower nurses for independent clinical decision making is identified in nursing leadership/management texts (Tappen, Weiss, & Whitehead, 2001; Zerwekh & Claborn, 2003). Areas of nursing outside of hospitals (e.g., community health, school nursing) are usually more decentralized, allowing nurses to use independent decision making and self-management. The final research question of this study addressed this issue: Is there a relationship between area of major nursing experience and the level of professional socialization of graduating students of two-plus-two baccalaureate completion nursing programs?
Socialization is the process by which individuals learn the social roles that will facilitate their participation and performance in the society of which they are a part (Hurley-Wilson, 1988). The general model of socialization and resocialization, as developed by Hinshaw (1977), provided the theoretical basis for this study. Hinshaw’s Socialization Model, adapted from the work of Simpson (1967), consists of three phases. During phase one, perceptions of role shift from preconceived ideas to expectations defined by standard setters. Individuals choose to learn the new role expectations and, therefore, are seen to take an active role in socialization or resocialization.
During phase two, individuals identify and attach themselves to significant others in the new social system. In initial socialization settings, these significant others are often faculty members. In situations of resocialization, these may also be colleagues or supervisors who are chosen as role models. Strong emotions may accompany the identification of incongruencies between what was anticipated and what is presented by the significant others (Hinshaw, 1977).
In the third phase, the values and standards of the new role are internalized. According to Hinshaw (1977), the depth of this internalization varies in one of three ways:
- Compliance, in which the individual acts the part to receive positive feedback.
- Identification, in which certain behaviors, but not values, are selectively chosen.
- Internalization, in which the individual accepts the norms and values of the role because he or she really believes in them.
Professional socialization of members during the educational preparation period is one of the hallmarks of any profession. Benner (1985) noted that faculty’s socialization and display of professional values is important to novice nurses who enter workplaces in which bureaucratic values often conflict with professional values.
The literature records several studies of the professional role socialization of nursing students during the past several decades. Corwin’s (1961) salient study of BSN and diploma students and graduates in the mid-western United States showed no significant difference between role orientation in students of these programs, but a significantly higher professional role orientation in BSN graduates. Whelan (1984) showed progression in professional role orientation from starting to ending in an upper-division program in the northeastern region of the United States, and Lawler and Rose (1987) found baccalaureate completion nursing students to be more professional than either associate degree nurses or generic BSN nurses.
Thurber (1988) found no significant difference between exiting second-step students (i.e., those undertaking BSN-completion education) and generic BSN students in professional behaviors. Keely (1990), studying returning RN students in traditional and nontraditional programs in southern California, found no significant difference in Professional Nurses Autonomy Scale scores. Hillery (1991) compared associate degree, diploma, and baccalaureate completion nurses in Iowa, and found that those with higher professional role scores were more likely to be older graduates who had completed their BSN requirements and were practicing in non-hospital settings.
Eckhardt (1992) studied differences in graduating RN students from generic, RN-track (i.e., program for RNs to complete their BSN degree within a generic BSN program), and second-step baccalaureate programs and found no statistically significant differences in professional role conception. Greenawalt (1996) found no significant differences in the professional characteristics of generic BSN students throughout the various undergraduate levels of a program and compared to practicing nurses who were graduates of the same program. Clearly, a review of the literature has revealed inconsistencies in outcomes.
This non-experimental, descriptive study used the Nursing Activity Scale (NAS) with permission from the author, Schutzenhofer (1987). The scale consists of 30 items that describe situations in which a nurse must display some degree of professional nursing autonomy. The items are weighted such that 1 = low, 2 = medium, and 3 = high levels of autonomy. Items on the scale relate to areas such as professional development, nurse-physician relationships, patient advocacy, use of nursing judgment, and use of research. Respondents answer each item using a 4-point Likert-type scale, ranging from “very unlikely of me” to “very likely of me” to act in this manner.
Doctorally prepared nurse educators, nursing experts, and the current literature were used to show content-related validity and internal consistency of the NAS. Cronbach’s alpha was found to be .91. The literature documents a decade of use of the NAS with various samples and settings (Alexander, 1988; George, 1997; Halcom, 1987; Lemons, 1988; Martin et al., 1991; Pariseau, 1995; Schutzenhofer, 1987; Schutzenhofer & Musser, 1994; Tomey, Thomas, & Thomas, 1993; Williams & McGowan, 1995). Several researchers found higher levels of professional autonomy to be associated with more years of experience, higher levels of education, or age, whereas others found no significant correlation.
Deans or division chairs of two-plus-two baccalaureate completion nursing programs and generic BSN programs for the central states, as well as some Atlantic states, as identified in the official NLN (2000) publication of programs of nursing, were contacted by the researcher and asked whether their program would participate in the research. A letter summarizing the focus of the research was read to them over the telephone, and those who agreed to participate were assigned a number so the questionnaires could be coded according to program type. Only those institutions that offered one or the other of these programs were chosen. The number of questionnaires requested, which depended on the number of graduating students, was mailed to each program in the spring of 2001. Written directions to the dean or designated survey administrator accompanied the questionnaires. The cover letter attached to each questionnaire informed the students that participation was voluntary and completion of the survey implied their informed consent. All students also received a blank envelope and were instructed in the cover letter to place their completed questionnaire in the envelope before returning it to the survey administrator, to ensure anonymity.
The target population with which the study was concerned was graduating students from NLN-accredited BSN programs, both generic and two-plus-two, in a 15-state region of the United States. All of the two-plus-two completion nursing programs (with no generic BSN program) in this area were chosen to obtain a final count of 16 programs. Of the 41 generic BSN programs in this area, 10 were purely generic (with no associate degree or RN-to-BSN programs) and were included in the study. Many of the generic BSN programs were eliminated because they had recently begun baccalaureate completion nursing programs.
The questionnaires were returned by mail between early April and early June 2001. Fourteen of the 16 two-plus-two completion nursing programs and 9 of the 10 generic BSN programs returned questionnaires, for a total program response rate of 88.5%. Two hundred ninety- nine of the 456 questionnaires requested were returned, for a response rate of 65.6%. This return rate includes the three programs that did not respond after initial contact, which had a potential of 55 total possible returns. With these programs eliminated, the actual return rate of questionnaires was 74.6%.
The generic BSN programs were generally larger than the two-plus-two completion nursing programs, so although there were 9 generic programs and 14 two-plus-two programs, 62.9% of the sample were generic BSN students. Women represented 91.3% of the sample, and men were not included in the data analysis due to theorized differing ways of knowing and intellectual and ethical development between the sexes (Baxter Magolda, 1992; Gilligan, 1982). The mean age of the sample was 26.6, with a range of 35 years (i.e., 20 to 55).
The last three demographics related to the two-plus-two baccalaureate completion nursing students only. The mean number of years employed as an RN was 7.7 years, with a range of 33 years. Regarding type of basic RN program completed, graduates of associate degree programs comprised 77.5% of the sample, with 16.2% of the sample from diploma programs. This is consistent with the trend in nursing education and the closing of diploma programs. A large majority of the two-plus-two baccalaureate completion nursing students (68.9%), listed a hospital as their area of major experience. Other areas (i.e., community health, long-term care, school nursing, occupational health, and physician’s office/clinic) had smaller representation, between .97% and 3.9%. All those who indicated a hospital was not their area of major work experience were combined into one group for analysis.
An independent t test was performed to determine whether there was a difference in professional socialization between graduating students of two-plus-two baccalaureate completion nursing programs and of generic BSN programs. No significant difference was found between the groups (t = .076, df = 174.796, p > .05).
The Pearson product-moment correlation coefficient (r) was computed to determine whether there was a relationship between age and the level of professional socialization in graduating students from the two types of programs. A positive, but not significant, relationship was found (r = .100, p = .102). No significant relationship was found between age and the NAS score for individual programs. Analysis of covariance was performed to analyze the three variables of age, program, and NAS score. When program was controlled, age approached significance as a predictor (F = 3.874, p = .050).
The Pearson product-moment correlation coefficient (r) was also computed to determine whether there was a relationship between years employed as an RN and level of professional socialization of graduating students of two-plus-two baccalaureate completion nursing programs. No significant relationship was found (r = .124, p = .237). Linear regression was estimated, following the correlation, to predict scores on the NAS from years of employment. This supported the no-significant-relationship finding. On average, for every year of employment, an additional .313 point was earned.
An independent t test was also computed to address whether there was a difference in the level of professional socialization between graduating students of two-plus-two baccalaureate completion nursing programs whose basic nursing program was a diploma program and students whose basic nursing program was an associate program. Actual difference in mean scores on the NAS was 1.28. No statistical difference was shown (t = –.201, df = 89, p = .841).
Finally, an independent t test was computed to determine whether there was a relationship between the area of major nursing experience and the level of professional socialization of graduating students of two-plus-two baccalaureate completion nursing programs. The sample size did not allow for comparison of multiple groups with analysis of variance, as originally planned. Instead, those in non-hospital settings were combined, and this group was compared to the group whose major nursing experience was in a hospital. Those with major nursing experience from non-hospital settings had the higher mean score. However, there was no significant difference in mean scores on the NAS (t = .568, p = .572).
Graduates of both generic BSN and baccalaureate completion nursing programs in this study had mean scores in the “higher level of professional autonomy.” A major educational outcome for BSN education was met: professional socialization. The generic BSN students displayed a professional orientation, evidencing socialization, and the two-plus-two baccalaureate completion nursing students displayed a professional orientation, showing resocialization into a professional role. It may be concluded that the socialization and resocialization processes at these programs were effective. Hinshaw’s (1977) model of socialization was supported.
Age, years of employment as an RN, and area of major nursing experience did not affect the level of professional socialization. This is inconsistent with some of the previous literature (Hillery, 1991; Martin et al., 1991; Tomey et al., 1993). It does provide more control and increase the internal validity for the major focus of the study, a comparison of the professional socialization of graduating students from generic and two-plus-two baccalaureate completion nursing programs, as these factors are associated with two-plus-two programs.
The study indicated that the type of basic program of baccalaureate completion nursing students, diploma or associate degree, is not an issue; students from both types of basic RN programs were resocialized into a professional role.
This was a descriptive, non-experimental study. No experimental treatments were given, and no control other than gender was attempted. A nonprobability, purposeful sampling technique was used. Therefore, the results should be limited to students from similar programs. Generalizability of the findings is limited to the characteristics of the sample and the operational definition of professional socialization (i.e., autonomy as a mark of professionalism, as measured by the NAS).
The shortage of nurses in the United States is reaching a crisis level. Baccalaureate-prepared nurses in particular are in demand to meet the needs of the changing health care scene. Since the graduates of baccalaureate completion nursing programs were shown to not be significantly different from students of generic BSN programs in relation to professional socialization, the creation and development of baccalaureate completion nursing programs should be encouraged.
Curricular strands in BSN education should continue to focus on professional role development. Teaching methods and learning experiences for professional socialization were found to be effective in these programs. The nursing community should continue its efforts to move the public’s view of nursing from an “emerging” profession to a full-fledged profession.
Age should not be a limiting factor for admission to BSN education. The NAS scores were not significantly related to age. In addition, recruitment efforts should be directed to a variety of employment sites. Nurses from a variety of hospital and non-hospital settings demonstrated high scores on the NAS.
The author recommends that the change in professional socialization from entry to exit in generic BSN and baccalaureate completion nursing programs be measured. Knowing the starting point of these students would be valuable. Change in professional orientation over the course of the programs could be compared. I also recommend that this study be repeated to determine the correlation between professional socialization and the demographic characteristics of race, ethnicity, socioeconomic status, and nursing experience of family members. These characteristics were not the focus of this study but could significantly affect professional socialization.
It is also suggested that the effects of distance education on professional socialization be studied. Distance education programs are proliferating across the United States, and socialization of students has been noted as a concern with distance education. Recent studies have supported the belief that professional socialization is possible through distance education (Cragg et al., 2001; Lia-Hoagberg, Vellenga, Miller, & Li, 1999; Nesler et al., 2001), but continued research in this area is needed.
Finally, research concerning the professional socialization of graduates of innovative “fast-track” and “accelerated” programs is recommended. Growth in the development of such programs is an effort to supply nurses for the current nursing shortage and will test the professional socialization process.
This study holds implications for several groups within the nursing community. To accrediting bodies, the study indicates that both generic BSN and baccalaureate completion nursing programs are producing the professional product they claim to be producing. This should continue to be a desired outcome of BSN education. Implications for faculty include verification that the curricular models in place to promote professional development are effective. Faculty should continue to be purposeful in modeling professional behavior.
An implication for admission policies and recruitment efforts within nursing education is that age and work history should not limit admission to educational programs. Professional socialization can occur throughout a wide range of ages and is possible in students with a variety of backgrounds.
The results of this study imply that career and guidance counselors should continue to present multiple levels of entry into nursing to junior and senior high school students in discussions of vocational choice. For the immediate future, several avenues of entry into nursing will remain, and students should choose the program most appropriate for them. The possibility of returning to complete a BSN degree for those who choose a diploma or associate degree program should be emphasized.
An implication for the profession is that there is inherent worth in both generic BSN and baccalaureate completion nursing programs. Both types of programs have been shown to produce a professional product. Although a challenge for the public to understand, educational diversity in nursing education does not appear to be a problem in this regard. Kramer (1974) noted that inappropriate socialization results in attrition from the profession. This study implies that students from both generic BSN and baccalaureate completion nursing programs have achieved a professional socialization on graduation. With opportunity for development in the workplace, this will contribute to increased retention of nurses within the profession.
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