Dr. Cangelosi is Associate Professor, and Dr. Moss is Assistant Professor, George Mason University, College of Health and Human Services, School of Nursing, Fairfax, Virginia.
This study was funded by a Duke University/Helene Fuld Foundation grant. The authors would like to thank Sandra Laski for her assistance with this study.
Address correspondence to Pamela R. Cangelosi, PhD, RN, CNE, Associate Professor, George Mason University, College of Health and Human Services, School of Nursing, 4400 University Drive, MS 3C4, Fairfax, VA 22030; e-mail: email@example.com.
In an effort to address the severe nursing shortage in the United States, schools of nursing have instituted creative ways to increase student enrollment and capacity. One strategy has been to increase the number of accelerated second-degree baccalaureate nursing programs for individuals who hold a baccalaureate degree or higher in a field other than nursing. In 2007, there were 205 accelerated second-degree baccalaureate programs, with 37 new programs in the planning stages (American Association of Colleges of Nursing, 2008). In 11 to 18 months, depending on the specific program, these individuals can earn a baccalaureate degree in nursing and be eligible to take the National Council Licensure Examination (NCLEX-RN®) to become a professional nurse.
Research investigating the efficacy of these programs is limited and primarily focuses on curricular issues or student experiences. Although recommendations for faculty have emerged from these studies, published research designed to investigate the experiences of faculty teaching these students is rare. In light of the shortage of nurses in both education and practice, examination of faculty experiences is also needed. Enrollment in schools of nursing must continue to be increased to meet the expanding societal need for nursing care; however, to increase educational capacity, more faculty must be recruited and retained. Listening to the voices of accelerated second-degree students is important, but it is also important to listen to the voices of the faculty teaching these students. Through this process, the development and refinement of accelerated second-degree nursing programs can become more efficient, effective, and evidenced based, and the perspectives of faculty can be addressed.
Empirical evidence related to curricular issues primarily questions whether accelerated second-degree programs should or should not closely resemble traditional programs. Sheil and Wassem (1994) queried second-degree students about what they believed constituted a successful accelerated second-degree curriculum. These students believed that the keys to a successful accelerated second-degree program were a program 2 years long, including summers; consideration given to students’ prior life experiences and individual needs; and competent academic advising.
For efficiency, Seldomridge and DiBartolo (2007) suggested that accelerated second-degree and traditional baccalaureate nursing students be combined into large classes. Commonly known as blended classes, this arrangement may provide a richer learning environment by fostering the sharing of different life experiences in the classroom. However, Seldomridge and DiBartolo also noted that this may not be the best curricular design for both groups of students. Although economical, large classes do not promote discussion, hinder individual attention by faculty, and may be intimidating for those returning to school after a long break. Parallel curricula, or separate programs for accelerated students and traditional students, offer the benefits of allowing an easier transition for accelerated students into the traditional program if the student is unable to maintain the accelerated pace, as well as smaller faculty-to-student ratios, which promotes more individualization of student learning needs.
From survey data obtained from 17 graduates of one accelerated program 1 year after graduation, Raines and Sipes (2007) concluded that these students felt well prepared by the second-degree curriculum. Emphasis on nursing knowledge, situations, and professionalism, together with immersion in the actual practice of nursing, were cited as the most positive aspects of the accelerated curriculum.
Suplee and Glasgow (2008) described the successful 11-month accelerated program in which they teach. The concepts of professional socialization, technology infusion, and evidence-based practice were threaded throughout the curriculum. Orientation for faculty teaching in this program and careful restructuring of classes and teaching strategies to promote the acceleration of learning has resulted in the graduation of more than 500 accelerated students, with an average first-time pass rate of 95% to 100% on the NCLEX-RN.
Literature related to accelerated second-degree students often centers on their experiences while enrolled in an accelerated program. Hegge and Larson (2008) surveyed 137 accelerated students from six programs about their perceived stressors and coping strategies. Results indicated that these students experienced higher prolonged stress while in the program than in previous life situations. Discussion of feelings with someone was ranked as one of the most frequently used coping strategies by these students.
Kohn and Truglio-Londrigan (2007) interviewed five second-degree nursing students from a large university in New York with the purpose of understanding “the meaning of the lived experience of being a second-career baccalaureate nursing student” (p. 391). Eight themes emerged from the data, with the emotions of uncertainty, trepidation, anxiety, and frustration permeating all.
Cangelosi (2007) interviewed 19 second-degree graduates from six nursing programs in the mid-Atlantic region of the United States. An overarching pattern from these interviews revealed that these students perceived faculty as essential to their success in the accelerated programs. The removal of pedagogical barriers with the facilitation of accelerated learning by faculty were viewed by the students as the most helpful aspects of their accelerated programs.
Weitzel and McCahon (2007) also surveyed second-degree students regarding their stressors and coping strategies. As Hegge and Larson (2008) discovered, Weitzel and McCahon found these students to experience high levels of stress; however, Cangelosi (2007) noted that these students also viewed faculty as strong sources of support and instrumental in the students’ success in the program.
Implications for faculty are derived from all of these studies, yet research devoted to faculty perceptions of teaching second-degree accelerated students is not evident. In this study, faculty teaching in accelerated second-degree nursing programs described their experiences teaching these students.
Hermeneutics is a term that suggests the concept of bringing to understanding (Leonard, 1994). In hermeneutic phenomenology, the meaning of everyday life experiences is the focus. Heidegger, a leader in the field of phenomenology, believed that we often fail to notice what is common (Cohen, Kahn, & Steeves, 2000). As van Manen (1997) stated, “The purpose of phenomenological reflection is to try to grasp the essential meaning of something” (p. 77). Through the situational perceptiveness, discernment, and depthful understanding that phenomenological research provides, the gaps in understanding that empirical research often creates when applied to nursing may be filled (Plager, 1994; van Manen, 1991, 1997). The hermeneutic phenomenological method was used in this study to understand the meaning of the everyday experiences of faculty teaching accelerated second-degree baccalaureate nursing students and how these experiences helped or hindered their teaching and learning practices with these students.
After approval from the review board of the sponsoring institution was obtained, 14 faculty who were currently teaching accelerated second-degree baccalaureate nursing students in schools along the East Coast of the United States were recruited through the snowball method of sampling. The faculty had to have at least 2 years of experience teaching accelerated second-degree baccalaureate nursing students and at least 2 years experience teaching nursing students in a traditional BSN program of study. Participants were also required to speak English fluently, currently teach full time or part time, and be able to be interviewed and audiotaped in person or via telephone for approximately 1 hour.
All of the participating faculty were Caucasian, and 12 were women and 2 were men. Experience teaching accelerated second-degree baccalaureate nursing students ranged from 2 to 9 years, with an average length of 3 years. Experience teaching traditional baccalaureate nursing students ranged from 2 to 17 years, with an average length of 6 years. The majority of the participants were masters prepared, but two were doctoral candidates and three were doctorally prepared. Eleven participants worked full time and three worked part time. The participants were recruited from eight different schools, seven of which were urban and one was rural. Six of the schools were private and two were public. The length of the second-degree programs ranged from 12 to 18 months, and the annual number of admissions to the second-degree programs ranged from 7 to 150 students, with an average of 65.
After signing an informed consent statement that explained their participation in the study, each participant was given a pseudonym to preserve confidentiality. Only one researcher had the key linking the pseudonyms to the participants. Interviews were unstructured and were conducted by one of the researchers or a research assistant for approximately 1 hour in a private location chosen by the participant. All interviews were conducted in person except for two interviews, which were conducted via the telephone. All interviews were audiotaped, transcribed verbatim, and reviewed for accuracy by the researchers. Data for this study were obtained from the interviews, a demographic inquiry, and journal notes written by the researchers throughout data collection and analysis. Before each interview, participants were asked to think about their experiences as a faculty member teaching accelerated second-degree baccalaureate nursing students and then respond to the question, “Is there an incident that stands out in your mind that reflects the essence of what it means to teach accelerated second-degree baccalaureate nursing students?” Prompts that asked what the participants liked best and least about teaching these students elicited greater details and more in-depth stories. Throughout each interview, the researcher restated and summarized participants’ comments so any assumptions or misunderstandings by the researcher could be addressed. This also permitted verification of the researcher’s interpretation and greater understanding by the participant (Benner, 1994; Dinkins, 2005).
A team of six researchers experienced in hermeneutic phenomenology read the transcripts and analyzed them to identify themes and to come to an understanding regarding the interpretation of the data. The original transcripts were reevaluated by all of the researchers until consensus was reached for significance and themes. Van Manen’s (1997) approach to human science research guided the data analysis for meanings, similarities, distinctions, and dissonance. Journal writings by the interviewers gave background to the data by providing details about the interview environment, the interviewer’s reactions, and the participant’s nonverbal cues.
All of the participants described teaching accelerated second-degree baccalaureate students as “challenging.” Some participants embraced these challenges, whereas others preferred the experience of teaching more traditional undergraduate students. Despite probing questions in the interviews, few participants discussed their approaches to teaching accelerated second-degree baccalaureate students. Many viewed these students as “different,” but few consistently considered different teaching strategies that may be effective with these students. The following two themes emerged from the data analysis, and both reflect the sense of challenge these participants encounter when teaching second-degree students:
- At the Top of My Game.
- Teaching to Think Like a Nurse.
At the Top of My Game
One participant, Candice, stated:
Gosh it’s tough. It’s really tough [teaching second-degree students]. First of all, I’d better be at the top of my game. I better know what I am talking about. I’m very careful to prepare, even though I have taught the course many times before.
The theme, At the Top of My Game exemplifies the feeling of having to be extremely prepared to teach this group. The participants characterized their second-degree students as “bright,” “motivated,” “not afraid to question authority,” and “ready to buck the system.” The prior education and experience of these students was also intimidating to some participants. Second-degree students may have experiences beyond the scope of or vastly different from the participants, causing greater anxiety, and even fear, for some participants. When preparing to teach second-degree students, the participants prepared in detail for classes, gathered up-to-date information, and braced to defend their position on any topic. As Candice noted above, she feels it is “tough” to teach students who once were physicians or attorneys. Candice stated that the second-degree students are “far more questioning” than traditional students, and although she has many years of experience as a clinical nurse and a teacher, she has experienced “lots of questioning of my authority as an expert nurse.” Despite her apprehension about teaching second-degree students, Candice finds it rewarding. She realized, “[Students] want to challenge authority, but by the same token, they want to be challenged.” It is both her desire and the students’ drive to be challenged and to excel that motivates Candice to perform “at the top of my game.”
Tracey, a novice teacher, finds these students “extremely difficult” to teach. As she revealed:
They [the second-degree students] are very nitpicky. They will hound you and are happy to point out if you are wrong. They will have the book out and say “On page 72 it says dadada.” They challenge you on every little point.
She feels the second-degree students are “perfectionists” and “want to be sure they have done everything right.… If they miss one little thing, they’re arguing with you why did they miss it.” Tracey feels more at ease teaching clinical courses to second-degree students because her clinical expertise is where she feels at the top of her game. She admits she is intimidated by these students and openly states that in the classroom, she would prefer to teach more traditional students.
Barbara, another participant, also finds the second-degree students to be “demanding;” however, she embraces this aspect of them:
The greatest joy I get out of teaching is learning, and I am always learning from them, because they come from so many walks of life. We’ve had professional skiers, we’ve had journalists, we’ve had librarians, we’ve had English teachers, and we’ve had every conceivable type of person.… In their own way, their life experience contributes and enriches the lives of me and the other students. On the other hand, they can be very demanding. They know what they want and when they want it, and how they want it, even though it may not be educationally sound.
Barbara has 16 years of experience teaching and finds it “positive” when the second-degree students “question and probe.” She builds on the students’ prior experiences, recognizes the students’ need to “know exactly what they are supposed to do,” and acknowledges their feelings of being “so pressed for time.” Barbara finds the students’ questions to be not only stimulating, but also catalysts to keeping her at the top of her game.
Derek was very open in his description of how he teaches accelerated second-degree students, and he proposed a lingering question for all educators to consider:
I find the second-degree students to be very inquisitive, and I like that. They have experience in the workplace, so they know they are learning how to function in real-life situations. They’re demanding and want to get the most out of their education as long as it can be done in a condensed way! They keep me on my toes, and that is good. I make sure I know my content, am up on the latest research, and know the best practices. Shouldn’t we be that way teaching all students?
Teaching to Think like a Nurse
Throughout the interviews, the participants expressed their intent to help the second-degree students understand what they need to know and do as a nurse. Many expressed concern that the accelerated format did not allow enough time for the students to become socialized as a nurse or learn to think like a nurse. Jessica expressed this concern when she stated:
There’s some sort of roping in that has to happen, and I don’t mean it in a bad way. There’s a culture, an inculcation.… I think the culture of health care for some of the accelerated students is really hard for them to get into and when they’re in an accelerated program…they have to learn all these different terms and a different language.… How extraordinary that is in a year or 16 months.… I think they [the accelerated second-degree students] go through so quickly—how do you give them all those things?
Having been a second-degree student herself, Abby has a unique perspective to share with her second-degree students. She can empathize with their need to be “perfect” and “hyperfocused,” and she notes, “They are already hard on themselves. I didn’t really have to be too hard on them.” Abby struggles to help these students begin to visualize themselves as a nurse and to think like a nurse. She stated:
I was in the nursing program myself, so I was that same kind of student. I can relate to that and I also can try to pull them back every now and then. I can sympathize with how hyperfocused they are on their grades for this or that, but I have had now 11 years of experience after my own second-degree nursing program, and I try to help put it in perspective for them in terms of what they should really be focusing on and not to worry about which multiple-choice questions they got wrong on a test. But instead be thinking about how competent are you as a nurse? And, how are you thinking about these problems? And, whether or not you would have designed the questions the way the instructor did is not what your future life as a nurse is going to be.… I really think their [the students’] focus should be on how they are learning to care for patients, and that’s just probably the oldest story in the book. I am trying to tell them not to worry about grades, but just think about the big picture [but] their life right now is revolving around grades.
Abby feels like her role is “more to figure out what they really were missing,” given that they come to the program with prior school and work experience and “with good skill sets in certain things.” From Abby’s viewpoint, “what they really were missing” is the ability to think like a nurse, and she was determined, despite the accelerated pace, to “give them the tools [and] help them develop the skills” that will help them learn how to think and act like a nurse.
Charles was clear when he stated, “I’ve learned to stop sweating the small stuff.” After teaching accelerated second-degree students for 5 years, Charles has learned to “work with them [second-degree students] better, and that’s been on my part.” Charles reports, “it was an us-against-them kind of perspective” when the second-degree program started 5 years ago; however, he has become “more comfortable” teaching these students. As Charles related:
Some of my colleagues get really focused on skills.… They spend the first hour reading the syllabus to them [second-degree students] the first day of class.… They’re very bright students. They don’t need to spend 4 hours learning how to make a bed.
With these students, Charles saw this as “sweating the small stuff” and found he is more successful helping the students think like a nurse by instilling “lifelong learning skills in my classroom.”
Candice was concerned about how the second-degree students learn to think like a nurse. She succinctly summed up her concern:
I think human beings need time to socialize to certain environments—socialize to a profession, socialize to an environment. And I’m not sure that four semesters is enough time for somebody who’s already an adult, has been through a program, [and] has already got lots of biases and life experiences, suddenly to come into a four-semester compacted program and emerge a nurse.… It takes time to socialize to nursing, I think. This may be a problem with other tracks, it’s just with the traditional program, you’ve got 4 years to socialize and evolve into a nurse, and four semesters, or two, three, whatever the other [second-degree] programs are. [It] doesn’t seem like very much time to do that.
Discussion and Implications for Nursing Education
Faculty participants in this study perceive these students to be “challenging” and even “exhausting” to teach. Faculty think these students are committed to learning at an accelerated pace; therefore, faculty must also be committed to teaching at an accelerated pace. Faculty who described positive interactions with second-degree students openly admitted they had to “work at” their teaching to achieve harmonious relations and rewarding outcomes. However, faculty who were uncomfortable or “have no desire to teach these students” held firm to the belief that accelerated second-degree students are “no different” from traditional BSN students, because “we hold them to the same objectives and outcomes.” Faculty participants noted that accelerated second-degree students boldly “question the status quo,” causing many novice faculty and some experienced faculty who cherish traditional methods to dislike and even avoid teaching this group.
Many accelerated second-degree nursing students are in the unique position of having been experts in their previous fields and are now novices in both a rigorous academic program and a new profession. Faculty who were sensitive to this unique position acknowledged and incorporated into their teaching the prior experiences of these students and created a successful “pedagogical relation” (van Manen, 1991, p. 72) with these students. Faculty with this successful relationship consider second-degree students as “one of the futures for nursing.” With an ever-increasing shortage of nurses and nurse educators, accelerated second-degree students embody the determination, intelligence, and sense of urgency so desperately needed to address these concerns.
Faculty who decided to work at their teaching approach to meet the challenges of these students related several teaching strategies they found to be effective. Direct, constructive, and respectful feedback without any “tiptoeing around certain things” was viewed as essential in teaching second-degree students. Time is of the essence in these programs, and faculty think that students must be able to “catch it on the first pass,” with faculty intercepting and quickly addressing a teachable or “pedagogical moment” (van Manen, 1991, p. 40). In addition, faculty noted that they must have the self-confidence and ego strength to receive the feedback these students often give. Faculty participants thought that these students openly evaluate the education they are purchasing and expect competent, even superior, teaching for their money.
Faculty who felt successful teaching second-degree students stated that acceptance of the varied learning styles and approaches of these students was another positive teaching technique. Appealing to the maturity and intelligence of these students, and addressing the frequent “type A personalities” of this group, faculty stressed the importance of synthesizing what the students were learning into how to function and think like a nurse. Emphasis on testing, the minutiae of basic skills, and grades only increased the pressure these students were experiencing and detracted from the greater goal of becoming a competent and caring nurse. Repeated realignment of goals with “the big picture kept front and center” helped both the faculty and students focus on what must be learned. This technique also assisted the students in more rapidly socializing to the role of a professional nurse. Although “socialization is a social process that happens to an intake of students…as they undergo the process of professional preparation” (Jarvis, 1986, p. 468), Jarvis was quick to note that an understanding of the educational process by all faculty will facilitate socialization by creating a “relevant educational climate” (p. 468) both in the classroom and in the clinical setting. Faculty who accentuated the “big picture” and “the necessity of lifelong learning” understood the educational process these students require and felt successful in establishing an educational atmosphere that encouraged the students to think like a nurse.
The findings from this study also have implications for traditional nursing education. Many students in traditional baccalaureate nursing programs have a degree in another field, and many are older than the traditional college-age student. Teaching strategies that are effective with accelerated second-degree students may also be successful with traditional students. Perhaps our definition of traditional should be revised, as well as our educational strategies for this group of students.
The small number of participants, the lack of participant diversity, and the limited geographic region of this study are limitations that must be considered. Research in which more ethnic and geographically diverse faculty are included is needed to further understand the experiences of faculty teaching accelerated second-degree baccalaureate nursing students.
Accelerated second-degree baccalaureate nursing programs provide one method of addressing the severe shortage of clinical nurses in today’s complex health care environment. These programs are increasing at an unprecedented rate, requiring more faculty who are confident in teaching and addressing the needs of this unique group. Through the understanding of the perceptions and experiences of faculty teaching second-degree students, the recruitment and retention of faculty who feel successful and rewarded teaching these students has the potential to significantly increase. In this study, it was surprising that faculty did not focus on themselves and their needs, but instead focused on the needs of the students. Future research addressing the needs and expectations of faculty teaching accelerated second-degree baccalaureate students is necessary. From research, the appropriate preparation of faculty for teaching these students can be achieved. The future growth and success of these programs depends on a sufficient number of faculty who feel effective teaching these students.
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