Ms. Yastik is Assistant Professor, and Dr. Anthony is Associate Professor, McAuley School of Nursing, University of Detroit Mercy, Detroit, Michigan.
Address correspondence to Maureen Anthony, PhD, RN, Associate Professor, McAuley School of Nursing, University of Detroit Mercy, 4001 W. McNichols Road, Detroit, MI 48221-3038; e-mail: firstname.lastname@example.org.
In 2007, the American Association of Colleges of Nursing (AACN) identified the accelerated bachelor of science in nursing (BSN) as an innovative approach to baccalaureate nursing education (AACN, 2008). Second-degree and accelerated nursing programs were designed for students with bachelor’s degrees in other areas who wanted to complete a BSN in less time than traditional baccalaureate programs. Accelerated programs have a two-fold benefit. In addition to addressing the nursing shortage, they have been reported to attract adult learners with diverse backgrounds who bring exciting new perspectives to the profession (Seldomridge & DiBartolo, 2005).
The first program that specifically recruited college graduates for nursing was the Vassar Summer Program. A critical shortage of trained nurses during World War II led to the creation of a summer school at Vassar, where college graduates received intensive education in the sciences to prepare them to enter established schools of nursing throughout the country. Graduates of the summer school then completed the nursing programs in 2 years, rather than 3 years (Kalisch & Kalisch, 2003). The more recent trend of second-degree programs began in 1971 at Saint Louis University. Although the programs have been available for more than 30 years, only recently have the numbers of programs begun to grow rapidly. Currently, there are more than 200 accelerated BSN programs in the United States, ranging from 12 to 18 months in length (AACN, 2008).
Anecdotally, second-degree nursing students have been described as assertive, motivated, and exceptional learners (Miklancie & Davis, 2005), and as being highly sought after by employers following graduation (Howard-Ruben, 2002). However, empirical literature on second-degree nursing education is sparse. A profile of second-degree students by Meyer, Hoover, and Maposa (2006) identified three factors that students in the study perceived as integral to their ultimate success: previous experience in undergraduate degree programs, high achievement motivation, and maturity. Little is known about teaching strategies that match the specific needs of this population of students. The increase in second-degree baccalaureate programs has led faculty to discover teaching methods that meet the unique learning needs of these students.
The University of Detroit Mercy is Michigan’s largest Catholic University. The McAuley School of Nursing is the second largest school, with more than 900 students. The second-degree program began in 1996 as a 22-month program that compressed the traditional curriculum into a shorter time frame. In 2002, it was restructured as a 12-month program with a curricular redesign that facilitated intense immersion through three content domains: evidence-based culturally competent care, research and inquiry, and professional role development. The first cohort consisted of 17 students, followed by increased demand and rapid expansion. Currently, 115 students are enrolled and the demand continues to grow.
The health assessment course in the second-degree option is a 2-credit course that focuses on health assessment of adults and uses interviewing techniques to obtain a basic health history that incorporates spiritual, sociocultural, psychological, and physical dimensions. Issues of privacy, confidentiality, and cultural sensitivity are discussed. Laboratory experience provides students with opportunities to perform specific physical assessment. Originally, health assessment was designed as a 15-week course for traditional baccalaureate nursing students. During the first year of the newly designed, 12-month second-degree program, the length of the course posed a problem for both students and faculty in the clinical area. Second-degree students began their first fundamentals clinical rotation during the third week of the semester; thus, they were unprepared to perform a complete health assessment on their assigned clients in the clinical setting. Clinical faculty voiced frustration that a large portion of the clinical hours were being spent teaching basic health assessment, rather than other fundamental skills. A decision was made to condense the course into an intensive, 2-week format prior to the fundamentals clinical rotation so second-degree students would enter the clinical area with the basic skills needed to assess their clients.
The 15-week health assessment course was restructured using Fink’s (n.d.) principles of good course design. These principles include challenging students to a higher level of learning, using active forms of learning, giving frequent and immediate feedback to the students on the quality of their learning, using a structured sequence of different learning activities, and having a fair system for assessing grading (Fink, n.d.).
The first time all the students met together as a cohort was on the first day of class. A health assessment BINGO game was used as an ice breaker and also to acquaint students with some of the basic elements of health assessment, primarily inspection and health history. As students met their classmates, they wrote the name of a student in a square of the BINGO card who matched either a physical trait such as eye color or a health history fact such as “has had an appendectomy.” Small prizes such as stethoscope name tags and pens were provided as students filled their BINGO cards. The first day continued with a lecture on basic assessment and interview techniques, followed by a laboratory period during which students obtained a health history from a classmate.
Challenge Students and Use a Structured Sequence of Different Learning Activities
Each day, a new body system was covered during a traditional lecture period, followed by a video and hands-on experience in the laboratory. To maintain the rapid pace necessary to complete the course content, it was emphasized that students had to review anatomy and physiology, as well as the assigned chapters in the text each night prior to class. Reading assignments in the text were selected to reduce the amount of reading and to allow students to focus on, and master, essential content. Daily cumulative quizzes were given, each one building on the previous days’ content. For example, on the third day, students were quizzed on material from the first and second day, and on the fourth day, they were quizzed on information discussed on the first 3 days. This format required students to review previous content on a daily basis and allowed faculty to recognize areas of confusion that required clarification. It also allowed faculty to repeat critical content throughout the course to emphasize the important principles of assessment. On the fifth day, a midterm examination was given, followed by the next body system. The second week repeated the previous week’s format until the eighth day.
Use Active Forms of Learning
On the eighth day, students were divided into groups and were rotated through skill stations that were designed to facilitate active learning of content. Each skill station emphasized health assessment of a body system. Case studies were presented that required the students to work in a group to identify terminology, subjective and objective data, and abnormal findings versus expected findings. They were also required to demonstrate selected examination techniques to their classmates at each station and obtain feedback from the classmate. An additional technique used at the stations was to have students provide brief wellness teaching to a classmate to help students differentiate the role of the nurse in wellness, as opposed to in disease treatment.
Use Fair Assessment and Grading Systems and Provide Frequent and Immediate Feedback
All quizzes and examinations were reviewed in class after they were administered, so students could have immediate feedback and ask for clarification. Grades were posted on Blackboard® by the end of the day. On the ninth day, a final written examination that covered content from the first day was given. The midterm and final examination grades and the average of the daily quizzes were each worth 25% of the final grade. Prior to averaging the quiz grades, the lowest score was dropped. This provided students with an opportunity to adjust to the rapid and demanding pace of an accelerated course without affecting their final grade.
On the tenth day, students signed up in pairs to perform a head-to-toe physical assessment on one another. The grade for the head-to-toe assessment was the remaining 25% of the final grade. At the end of the first week, students were given a grading rubric that contained all of the critical elements of the physical examination that they would be expected to demonstrate. They were given open laboratory time to practice and receive individual attention from faculty. The grading rubric contained all elements of a head-to-toe examination that beginning students should be able to perform on a hospitalized client. In addition to providing an opportunity for faculty to evaluate student performance, this format also allowed faculty to correct misconceptions and errors in technique before students entered clinical rotations.
Student feedback was very positive. Although initially skeptical, the students quickly embraced the fast pace. Comments on the course evaluation included:
- I never thought I could master health assessment in two weeks, but I did. I feel very comfortable starting clinical next week.
- Thank you for the daily quizzes. They forced me to read and study in a way I would [not] have otherwise.
There were no negative comments from students. Clinical faculty were similarly satisfied with the outcomes of the course. They were given a copy of the final head-to-toe grading rubric so they would know the expectations for students in clinicals. They reported that the students arrived on the first day of clinical rotation eager to put their new skills to work with real patients. Based on the positive student and faculty feedback, the course will continue to be taught in this intensive format.
Given the remarkable growth in second-degree nursing programs in recent years, it is essential that nurse educators explore innovative methods of content delivery to meet the unique needs of second-degree BSN students. The profession of nursing will be enhanced by the talents and knowledge brought by this new wave of nursing students.
- American Association of Colleges of Nursing. 2008. Fact sheet: Accelerated baccalaureate and master’s degrees in nursing. Retrieved January 7, 2008, from http://www.aacn.nche.edu/Media/FactSheets/AcceleratedProg.htm
- Fink, LD (n.d.). Fink’s five principles of good course design. Retrieved on August 10, 2006, from http://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/finks5.htm
- Howard-Ruben, J. (2002, February11). Second-degree students sprint to nursing careers. Nursing Spectrum. Retrieved February 5, 2007, from http://include.nurse.com/apps/pbcs.dll/article?AID=2002202110325
- Kalisch, PA & Kalisch, BJ2003. American nursing: A history (4th ed) Philadelphia: Lippincott Williams & Wilkins.
- Meyer, GA, Hoover, KG & Maposa, S2006. A profile of accelerated BSN graduates, 2004. Journal of Nursing Education, 45, 324–327.
- Miklancie, M & Davis, T2005. The second-degree accelerated program as an innovative educational strategy: New century, new chapter, new challenge. Nursing Education Perspectives, 26, 291–293.
- Seldomridge, LA & DiBartolo, MC2005. A profile of accelerated second bachelor’s degree nursing students. Nurse Educator, 30, 65–68. doi:10.1097/00006223-200503000-00007 [CrossRef]