Ms. Rico and Ms. Davies are Clinical Assistant Professors, and Dr. Beal is Robert Wood Johnson Executive Nurse Fellow, Professor and Chair of Nursing, and Associate Dean of the School of Health Sciences, Simmons College, Boston, Massachusetts.
Address correspondence to Janet Sweeney Rico, MBA, FNP-BC, Clinical Assistant Professor, Simmons College, 300 The Fenway, Boston, MA 02115; e-mail: email@example.com.
Accelerated nursing programs for college graduates have been graduating RNs since 1971. According to the American Association of Colleges of Nursing (AACN), 215 accelerated baccalaureate and 57 accelerated master’s programs were available in the United States in 2008 (AACN, 2008a). Although these programs have continued to proliferate at a rapid pace, little research has been conducted on the outcomes of these programs. The question of how best to educate this cohort in the midst of a nursing faculty shortage is a concern and even more of a priority as it has been recognized this cohort has different learning needs. This different but rapidly growing population of nursing students will help fill the need for RNs, and many programs have been established to help second-degree students move more expediently into the profession. Some also would point to the tragic events of September 11, 2001 and the life-altering impact those events had on many individuals who then desired a different purpose in their careers. Finally, there also has been increasing interest from second-degree students in areas of advanced practice nursing, including clinical and teaching tracks.
Although a significant number of articles on these accelerated programs has been published, the majority of articles have been nonresearched based and focused on describing the curriculum plans of these programs, the demographic profile of students, and some of the challenges faced by students. The majority of these programs preparing baccalaureate graduates take between 11 and 18 months to complete. These programs are rigorous and intense, and the majority of students are advised against working during the programs. In addition, the admissions standards are higher then for traditional baccalaureate programs. These programs are able to teach the nursing curriculum in an accelerated format because students are college graduates who have completed science and liberal arts requirements.
Research has slowly begun to show that compared to students in traditional nursing programs, accelerated students tend to be older, married, highly motivated, and more often male (AACN, 2008b). These second-degree students score higher on the NCLEX-RN® and critical thinking measures than traditional students (Meyer, Hoover, & Maposa, 2006; Seldomridge & DiBartolo, 2005). Second-degree students also tend to be highly anxious and frequently lack self-confidence while in school. They are used to excelling and hold high standards for themselves and for the program and faculty. Second-degree students are in nursing programs for clear reasons and they want to succeed (AACN, 2008a; www.aacn.nche.edu; Cangelosi & Whitt, 2005; Meyer et al., 2006; Seldomridge & DiBartolo, 2005). After second-degree students graduate, employers report high levels of satisfaction with their performance as they tend to be strong problem solvers, have a greater maturity with a variety of life experiences, and become lifelong learners (Beal, 2007). Although these reports have been interesting and highly factual, there has been a limited amount of research into what the facilitators and barriers are to the success of these students or what teaching practices work best for this highly motivating and at times challenging cohort of students.
In September 2007, the Journal of Nursing Education published a special issue containing articles on accelerated baccalaureate nursing students and programs. Kohn and Truglio-Londrigan (2007) reported the lived experience of these students revealed themes related to questioning oneself; seeing oneself in a different way; preparing for going back to school; experiencing a bundle of emotions during school; dealing with difficult transitions, faculty control, and life imbalance; and feeling scared as they prepared to graduate and assume their new and challenging role of RN. Kohn & Truglio-Londrigan (2007) reported second-degree accelerated students credit their clinical instructors with their success in the program. Mullen (2007) described self-regulating learning strategies used by second-degree accelerated students and reported the use of these strategies increased as students approached completion of their program. Rosenberg, Perraud, and Willis (2007) found the use of structured admissions interviews was helpful in denying application to students determined to be less likely to succeed, and Teeley (2007) reported on the success of using hybrid Web-based courses for these adult learners. Approaches to enhance socialization (Utley-Smith, Phillips, & Turner, 2007) and service learning for accelerated students (Ward et al., 2007) also were published in this issue. Although these studies were informative, most were based on small samples from one school only and were qualitative in design, and therefore cannot be generalized to all programs. In addition, no research to date has been conducted on the best teaching practices of faculty in these accelerated programs.
Anecdotally, faculty know accelerated students tend to be challenging to teach. Administrators of nursing programs also are aware that some faculty prefer teaching this cohort, whereas other faculty clearly do not. In addition, the faculty who enjoy teaching these students tend to be preferred by these students. Cangelosi (2007) described how important it is for faculty to meet the individual needs of these students in creative and individualistic ways.
In March 2007, Duke University School of Nursing received funding from the Helene Fuld Health Trust to bring 27 competitively chosen schools with their practice partners together to develop a research agenda focused on evaluating outcomes of accelerated students. This agenda included four broad research topics:
- Student recruitment and support.
- Best practices in classroom instruction.
- Best practices in clinical instruction.
- Transition to practice.
We participated in this invitational project and focused on faculty best practices as a topic of concern and interest to us. Specifically, we wondered what faculty teaching strategies and styles are the most effective for this cohort of students. In this study, recent graduates of an accelerated baccalaureate nursing (BSN) program and students who had completed the prelicensure curriculum in a direct-entry master’s (MSN) program described their perceptions of best teaching practices for accelerated nursing students.
A qualitative descriptive design was used (Kearney, 2001) as this design is most helpful in the discovery of previously undescribed phenomenon. In this case, best classroom and clinical teaching strategies for accelerated nursing students were explored. Specifically, content analysis was used with in-depth reading of transcripts to understand situations and events, looking for patterns across narratives and using a construct of description rather than explanation, and identifying common themes to describe experiences (Knafl & Webster, 1988; Sandelowski, 2000).
Setting and Sample
The setting of the study was a department of nursing in a large private college located in New England. The study received approval from the university’s institutional review board. All (N = 54) accelerated BSN and direct-entry MSN students who had completed the 18-month prelicensure curriculum during the past 2 years and who had been working as RNs for at least a year were sent a letter inviting them to participate in the study. A total of 14 students agreed to participate.
All participants signed an informed consent statement that detailed their participation and rights. Confidentiality was assured. Specifically, participants were informed not only in the consent form but also by the interviewer of the following: focus group sessions and interviews were to be transcribed by a professional transcriptionist, all identifying information was to be removed from the transcripts, audiotapes were kept in a locked file in the principal investigator’s office for 1 year and then were destroyed, and consent forms were kept separately from the tapes in the locked file and were not linked to any particular tape.
Mean age of the participants was 27 (SD, ±2). All of the participants were Caucasian women who had completed the prelicensure curriculum in the institution’s accelerated programs. Although there is no research to support the similarities or differences between accelerated BSN and direct-entry MSN students, all of the students in this program were similar in terms of previous degrees, age, admission requirements, profiles, and program outcomes. These students tracked together in the prelicensure curriculum and all but one student passed the NCLEX-RN on the first attempt since the program’s inception in 2000.
Data were collected during focus groups using an open-ended interview guide that focused on best teaching practices in both the clinical and classroom settings. Prior to the interview and during the consent process, participants were asked to reflect on: 1) the best teaching practices during the prelicensure curriculum that they believed were instrumental in their transition to the role of RN, and 2) the qualities of faculty and teaching styles that were perceived as most effective with accelerated prelicensure students. During the focus groups, these two questions were repeated with probes as necessary. Participants also were asked to describe an unforgettable classroom and clinical situation in which faculty applied best teaching practices.
Two focus groups were held, with six students in one group and eight students in the other. The researchers hired and trained two graduate social work students to conduct the focus groups. Each focus group lasted between 60 and 90 minutes and was audiotaped. Audiotapes were transcribed verbatim by a professional transcriptionist.
Content analysis (Knafl & Webster, 1988; Sandelowski, 2000) was used to analyze the data. Each of the three researchers first independently reviewed the audiotapes and transcripts. They then came together and reviewed all transcripts to identify themes and reach 100% consensus. A code book was developed, and transcripts again were reanalyzed for 100% consensus about all themes. Themes were identified when more than 50% of the participants discussed issues that were coded within the theme. Analytical rigor was maintained by the researchers achieving full consensus on the findings, the development of an audit trail, and participant verification of themes. An audit trail was developed whereby quotations were listed under each theme. The researchers then discussed the audit trail to assess for thematic saturation and to reach consensus. On completion of the data analysis, a summary report was e-mailed to all participants for verification and resonance with themes. Again, full consensus was reached.
Six themes were identified by the participants as best faculty practices. These qualities were evident in students’ descriptions of effective faculty and weak or absent in less highly regarded faculty. The six themes were:
- Appreciate accelerated students as adult learners.
- Communicate passion for the profession.
- Challenge and motivate.
- Practice while teaching and share experiences.
- Support accelerated students.
- Use varied teaching styles.
There were no distinct differences in themes noted in questions related to clinical and classroom teaching. Based on the review of participant responses, thematic saturation was greater than half across all themes.
Appreciate Accelerated Students as Adult Learners
Participants clearly articulated they viewed themselves as adult learners and expected faculty to interact with them as adults in a collegial manner. Students believed they had much to offer to the nursing role from their life experiences, and their experience sometimes was not appreciated by faculty. Students had completed their undergraduate programs and chose to pursue a second career only after much thought and sacrifice. Many had left a stable career and living situation to return to school. One participant stated, “We made an active decision to quit our old jobs or give up our old careers to be here.”
Participants identified a need to be able to make their own decisions in respect to how they managed their time. One participant commented, “I’m not a 19 year old who’s here on mom and dad’s dime and on the weekend I’m out partying.” They expressed a desire to be independent in making choices that worked for them to succeed. Participants also made it clear they wanted faculty to acknowledge that they already know how to be successful.
Communicate Passion for the Profession
Another best faculty practice identified by these accelerated program graduates was an ability to show passion and excitement about nursing in the classroom and in the clinical setting. One participant discussed the importance of passionate clinical faculty who impart their love of the profession to their students. These participants considered an exceptional faculty member as “somebody who is there because they genuinely care about improving the nursing profession by teaching students.”
Another participant described faculty enthusiasm that motivated her to excel. Essential faculty behaviors were described by one student as:
the enthusiasm that a lot of the teachers show here definitely; having the expectation that we’re learning from the best, and they expect us to be the best…a great bar to set.
Challenge and Motivate
As is the case in most programs, accelerated students in our program are ambitious and driven, and have high expectations of themselves, faculty, and the program overall. They expect to be challenged and feel comfortable in challenging faculty. One participant shared an example of a clinical faculty member with the ability to challenge students, expecting nothing less than she gives them. This participant noted, “She really challenges us. She gives so much of her time and her energy. At the same time, she expects that back from us.” Students in accelerated programs like to be pushed by faculty.
Another participant described the best faculty as one who effectively could motivate students to achieve. She said:
I think you can push us harder and faster; not so much criticizing but telling you once in awhile you can improve on this, and that will kind of make you want to go further and make you want to do better.
Practice While Teaching and Share Experiences
Faculty practice was highly regarded by the participants. Accelerated students want to be taught by up-to-date faculty who are committed to their own ongoing learning. One participant stated, “They still have their foot in practice, and they weren’t out of touch with what was actually going on. They’re willing to share their stories.”
Participants appreciated faculty who shared their patient experiences. They believed the stories brought learning to life and helped them learn more effectively. One participant stated, “I thought it was helpful to hear professors talk about their own practices. When they weave that into lectures, it was very helpful.”
Support Accelerated Students
Faculty who sincerely believed in students and were openly supportive of the accelerated program were considered faculty in the best practice category. Students spoke of faculty supporting them as they managed lives outside of school. The faculty who knew students and really were on top of their progression were well respected and thought of as exceptional. One participant commented:
The ones that genuinely seem like they care if you’re doing well.… “J” [a faculty member] really had a vested interest in us succeeding, and [she] was happy if we did well and wanted to help us improve if we weren’t doing well.
Participants respected faculty who were empathic and made an effort to understand the accelerated student experience, as well as faculty who were supportive of their lives outside of school. One participant said, “If you’re open in communication about what’s going on in your life, they are actually very receptive to whatever personal issues you might be having at the time.”
Participants really wanted to have a relationship with the faculty. They enjoyed faculty continuity throughout the program. One participant commented:
You have some of these teachers several times. It is nice to get to know them and to feel that in the end they believe in you. They take the time to get to know you and how you learn and try to work with you. They take the time to sit down with you…try to make sure that they do what they can to help you succeed.
Use Varied Teaching Styles
The final theme to emerge as a best teaching practice was faculty integration of various teaching methodologies in the classroom and clinical setting. No one teaching style was preferred by accelerated students; rather, they appreciated a variety of styles. Several participants still identified the traditional PowerPoint® presentation as their chosen method for learning. One stated, “I think PowerPoint is essential. I mean with technology nowadays, it would be a shame not to utilize it.”
Other participants preferred an adjunct role for Power-Point use. One participant commented:
You use PowerPoint slides in conjunction with the reading that you’re required to do and use them both to study. The PowerPoints should be a supplement to the actual teaching.
Accelerated students want faculty to deliver knowledge using many different methodologies. Many of these students consider PowerPoint to be a supplemental aid. Accelerated students need cases, simulation, and real world, and lots of it. These students want hands on, and they want experienced faculty to give them real-world scenarios.
Case studies were reported as being an effective teaching strategy for these students, who found that cases improved their critical thinking skills. One participant noted:
I liked the case studies and the questions…. I like that kind of thought process where I get to actually think it through on my own and really understand what’s going on.
Participants believed the use of case development made them think independently. One participant said:
I liked the case studies and the questions. I like to have that kind of thought process where I get to actually think it through on my own. In the end, they [case studies] were good and I learned a lot.
Faculty members who encouraged and helped students strengthen their verbal presentation skills to peers, faculty, and others on the health care team were considered to be using an effective teaching strategy. One participant stated:
When we would describe our patients for 20 minutes and then each one of us each week would have to present a topic based on women’s health and maternity, I thought that was very helpful.
The “Socratic Method,” which involves students actively within the classroom with expectations of preparation for class and guided questioning, was described as being a helpful teaching strategy for some students. One participant said, “She [the faculty] would present a case and we would have to answer, and she would say, ‘Tell me more.… What do you think?’”
Another participant noted:
I would say “T” is one of those professors who tells you exactly how it is and also gives you how it should be. And it’s nice, especially now that we’re out in the real world, because it really is very different…the two, nursing in the book versus nursing in clinical.
Discussion and Implications
This study supports the literature, albeit sparse, on the best teaching practices for use with the burgeoning cohort of accelerated nursing students. Approaching this issue from the perspective of what students tell us they need, our findings support previous research findings that found accelerated students need more guidance and support, and stronger support systems than traditional nursing students (Guttierrez, 1991). Participants in this study described a need for faculty who supported them and believed in their ability to excel in a rigorous fast-paced program. They also placed faculty who understood students’ need for support in juggling their lives outside of school in the “best practice category.”
Participants indicated they wanted faculty to “get to know them” beyond knowing their names. It would make sense that best practice for accelerated nursing education would necessitate an understanding of each student’s individual learning needs and an understanding of how best to support students in the context of their adult lives. Cangelosi (2007) reported similar findings and described the need for faculty to individualize teaching and to clear the path for students to achieve their goals. These students are moving at a fast trajectory in a culture that is foreign to most of them. Students described a need for a relationship with their faculty, and they wanted that relationship to be collegial. As one of our focus group participants stated:
I feel like they’re colleagues [the faculty] and there’s more of a give and take, and we’re working professionals with the other, rather than a kind of top-down kind of structure.
A theme that occurred throughout our research was one of best teaching emanating from an adult learner perspective. Walker et al. (2007) described similar findings. They found students expected faculty to give them what they need to succeed and to “know them by name.” Their research reinforces our theme of adult learner expectations in the need for these students to have opportunities for self-directed learning. This cohort expects faculty to guide them in self-directed learning, and they describe themselves as highly motivated.
Varied teaching strategies reinforced the adult learner theme, and our research corroborated the findings of Walker et al. (2007). Accelerated students appreciate the case study teaching methodology. Our findings also indicated students learned best from faculty who are able to impart their own patient encounters into the teaching strategy. Accelerated students want real-world application, again supported by Walker et al. (2007), with students stating they trusted faculty to tell them what they needed to know.
Preparation of accelerated nursing students is challenging. As a rapidly growing cohort, they are increasingly seeking nursing school programs both nationally and internationally. As a group, accelerated students have different learning needs and styles. The issue is how best to prepare faculty to teach these students. Accelerated students are unafraid to question the norm, and they bring news ways of viewing the profession and the health care system overall. As nurse educators, we must embrace nontraditional students and capture what works for them most effectively.
This study highlights many themes seen in the few studies previously reported and in anecdotal discussions of what works best in teaching accelerated students. These students want nursing faculty to teach them in a collegial, supportive relationship, challenging them innovatively as adult learners, with faculty sharing their own experiences as clinicians. These students ask us to be innovators and to expect no less than what we expect of ourselves. Accelerated students like self-assured faculty who like to be challenged themselves. Participants in our study described a best practice professor as someone who “really cares about our learning and really challenges us…gives so much of her time and energy and at the same time, expects that back from you.”
An interesting finding in our study was the perspective these students have of themselves in relation to faculty. They realized they can be challenging to teach, and as we found in our study, they described themselves as “tough” and occasionally “brutal.” They also admitted that they grow a lot in a short period, and they certainly recognize that they become more self-aware.
Although this study is limited in its generalizability because of its qualitative approach, it is one of the first studies to report on best teaching practices for accelerated nursing programs. Future research could further qualitatively explore these themes with students from other geographic areas and types of programs. In the future, a survey could be developed based on these themes and sent to graduates of accelerated programs within and outside the United States. Although we found no differences, it would be interesting to further explore differences and similarities between pre-entry MSN students and accelerated BSN students.
Our challenge is to take the feedback from this cohort and incorporate these themes into our own teaching strategies. Administrators hiring faculty to teach this cohort might consider incorporating our findings into the selection process for faculty interested in working with this growing population of nursing students and also for faculty development. We are fortunate to have such interest in the nursing profession from across all disciplines. These graduates can only serve to enrich our profession, broaden its breadth and depth of knowledge, and challenge the system to be the best it can be in coping with the complexity of providing health care in the 21st century.
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- American Association of Colleges of Nursing. (2008b). Accelerated programs: The fast-track to careers in nursing. Retrieved May 27, 2009, from http://www.aacn.nche.edu/Publications/issues/Aug02.htm
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