The statistics are ominous: 1 million new or replacement nurses are needed by 2016, an increase of 30% in the number of nurse graduates annually over the current numbers is needed to meet the nation’s health care needs, and 55% of current nurses are planning to retire between 2011 and 2020 (American Association of Colleges of Nursing, 2008b). One approach to the nursing shortage rapidly gaining in popularity is the accelerated baccalaureate nursing (BSN) program, which prepares nurses for the workforce more quickly than traditional nursing programs. According to the American Association of Colleges of Nursing (2008a), there are 197 accelerated BSN programs nationwide, with another 37 such programs in the planning stages.
To increase the supply of baccalaureate-prepared nurses in our region, our school of nursing admitted its first cohort of accelerated or BA/BS-to-BSN nursing students in summer 2006. The curriculum plan is designed to allow students with non-nursing baccalaureate degrees to complete the program in 18 months of full-time study instead of the 3 years required for traditional students. To date, students who have enrolled in this option have a variety of undergraduate degrees including business, chiropractic, social work, and psychology. This variety of backgrounds has brought a rich and diverse perspective to the classroom.
At the same time that there is an increased interest in the accelerated approach to baccalaureate nursing education, much remains to be learned about the students who choose this educational route. One area that has not been investigated or addressed thoroughly in the literature is the attrition rate of these accelerated-degree students. This descriptive study examined the reasons why students leave an accelerated program in one mid-western school of nursing.
There is a growing body of literature on the types of students who choose to enroll in an accelerated-degree program, their experiences, and NCLEX-RN® success rates compared to traditional BSN students (Hamner & Bentley, 2007; Rosenberg, Perraud, & Willis, 2007; Walker, Tilley, Lockwood, & Walker, 2008). However, little definitive information has been reported in the literature about the retention and attrition rates of these students. Identifying the reasons these students leave the program is central to developing effective interventions for retention.
Seldomridge and DiBartolo (2005) reported an average attrition rate of 10%, but an unexpected finding was a 25% no-show rate for fully admitted, registered, accelerated-degree students, which was six times the rate for traditional BSN students. Although no show typically may not be associated with attrition, it does have a similar fiscal and enrollment impact and needs to be considered when assessing factors associated with attrition. Follow-up contact with the no-show students indicated financial considerations were the biggest reason for not attending. Reasons students gave for leaving the program included the pace and intensity, nursing was not what they had thought it would be, and personal issues.
In a subsequent study, Seldomridge and DiBartolo (2007) reported rising attrition rates (23%) among accelerated-degree students and a change in the reasons for leaving. Although pace and intensity remained the major reason for leaving, nonacademic reasons included the need to work, long commute times, child and family responsibilities, and English as a second language.
In a study comparing traditional and accelerated nursing students, Bentley (2006) reported an 88% retention rate (22% attrition rate), whereas Rosenberg et al. (2007) reported attrition rates ranged from 10% to 15%. These references are examples of an unacceptable number of students failing to complete the accelerated program. Rosenberg et al. (2007, p. 414) noted that “despite the inclusion of valid cognitive measures in admissions decisions, attrition remains an issue.”
According to Suplee and Glasgow (2008), overall attrition rates are higher among accelerated-degree students than their traditional counterparts. Clearly, factors related to attrition vary from school to school. Because there is little information about attrition among accelerated-degree students, it became important to our faculty to determine why these students leave to develop effective intervention strategies for increasing retention in this group.
Setting and Sample
The BA/BS-to-BSN accelerated-degree option at our school of nursing is an 18-month full-time course of study. The size of the sample for this study included two cohorts of BA/BS-to-BSN students (n = 39).
In summer 2006, the first cohort of 17 students was admitted, with 12 students graduating on schedule, for a 71% graduation rate. The second cohort of 22 students, who were admitted in summer 2007, had 11 students graduate on time, for a 50% graduation rate. This translates into attrition rates of 29% and 50%, respectively, much higher than for our traditional BSN students. Such attrition rates not only have a negative fiscal impact on the school and its enrollment management but also negate the intent of the accelerated program to supply nurses more quickly to the workforce. In the third cohort (n = 16), students are currently progressing satisfactorily.
After securing approval from the university’s committee for the protection of human subjects, archival data were reviewed including demographic, academic, and admission records on the first two cohorts of accelerated-degree students. In addition, a second source of data that was analyzed consisted of transcripts from informal focus groups with both cohorts of students. Finally, exit interviews with students who left the program or otherwise did not graduate with their cohort were reviewed.
For the first two cohorts of accelerated students (n = 39), 65% were Caucasian and the remaining 35% were African American, Asian, and Hispanic. Thirty-four percent of the students were older than age 30. Of particular note, compared with the approximate 5% to 6% of men in traditional nursing programs nationwide, 35% of the students in our accelerated program were men. This high percentage of male students, which is not typical in accelerated-degree programs, ultimately may prove to be the source for increasing this underrepresented population in the profession of nursing.
In cohorts one and two, the reasons students did not graduate on time (n = 16) varied. The variables for this study included the reasons for attrition, which were the health of either students or their family members (5%), academic dismissal (5%), change of major (2%), undisclosed personal reasons (2%), or electing to continue on a part-time basis (2%). The rest of the students (58%) remained in the program.
The following are examples of quotes from exit surveys and focus groups in both student cohorts that more fully describe the reasons for attrition:
- My mother was in the hospital a total of 87 days from April to October (she is still getting home health care), and there were times where I thought I was going to lose her. During the summer session, I received all As and Bs while staying with her every night in the hospital getting a total of 1 to 2 hours of sleep per night.
- Having clinicals 4 days a week, 6 hours a day plus lecture was a little exhausting.
- Finally, I would like to say that many people in the second-degree program also hold jobs. They are older, and many have children and need to work in order to scrape by.
The focus group data was qualitative in manner; it was a review of the verbatim comments made by the students who had left the program. As this study is one to initiate the body of research related to attrition rates in this population, additional studies at the qualitative and quantitative level are important. The researchers are expecting emerging themes related to attrition as more cohorts complete the program.
Findings related to attrition of the BA/BS-to-BSN students in our school are consistent with previous research (Seldomridge & DiBartolo, 2005, 2007; Rosenberg et al., 2007). These students meet rigorous admission criteria. Despite this rigor, the attrition rates remain unacceptably high. With the development of effective interventions, schools of nursing will be able to decrease these attrition rates. This decrease then will alleviate the negative fiscal impact on universities when students leave.
Toward this end, the faculty at our university identified a number of potentially effective interventions to decrease the attrition among our accelerated-degree students. These interventions include:
- Providing a thorough orientation that emphasizes the pace and intensity of the program.
- Having graduates of the program provide firsthand testimony on how to handle the demands of such a fast-paced program.
- Offering students assistance in preparing a personal budget and identifying additional sources of financial support.
- Providing students with information on opportunities for counseling and stress relief.
For example, as a majority of our current students continue to work 20 to 40 hours per week during the program to support themselves and their family, preparing a personal budget and finding opportunities for additional funding becomes an intervention that will empower students to succeed. In addition, one-on-one faculty mentorships have been established, and scheduled focus groups are readily available as essential aspects of the retention efforts. Such activities will allow faculty to provide support and assess progress. As Meyer, Hoover, and Maposa (2006, p. 327) stated, “Helping prospective students understand that such programs are accelerated, not abbreviated, is crucial.”
Limitations and Recommendations
One limitation of this study is that it focused on only two cohorts of students from one school. However, the findings may be helpful for other schools of nursing offering an accelerated-degree program. More studies need to be conducted on this student population to identify reasons for leaving and to develop effective interventions for decreasing attrition.
Seldomridge and DiBartolo (2005) found accelerated-degree graduates are as successful if not more successful than graduates of traditional baccalaureate nursing programs. Korvick, Wisener, Loftis, and Williamson (2008) reported similar findings when comparing the success of accelerated-degree students to students in the traditional program. On every measure of success, the accelerated students outperformed their traditional counterparts. If effective interventions are found to decrease the attrition rates of these students in the accelerated program, the nursing shortage will be impacted positively.
Because there is currently little evidence in the literature specifically about attrition among accelerated-degree students, areas of additional study include the development of ongoing research to build a database of factors contributing to attrition rates among these students. In addition, alternative sources of funding for these students need to be identified to ease the financial burden they face. Seldomridge and DiBartolo (2005) found these students face financial burden as they pursue a second degree and recommended new sources of funding for this population. One such source of funding is the Robert Wood Johnson Foundation New Careers in Nursing grant. This competitive grant for schools of nursing provides for scholarships in the form of stipends for accelerated-degree students, specifically to those populations underrepresented in nursing.
Hopefully, this type of funding will provide the impetus for recognition of the financial barriers faced by accelerated students. Siler, DeBasio, and Roberts (2008, p. 341) discussed the “availability of grants and loans which could be paid back with a service commitment in a clinical role.” To implement that type of financial support, nurse educators need to work on government policy at both the state and federal levels.
Another recommendation is to survey schools of nursing that have a BA-BSN degree option. This survey should be conducted to examine attrition rates and reasons for those attrition rates among schools of nursing. Rosenberg et al. (2007) described attrition averages that range from 10% to 44%. Because the attrition rate has “important fiscal and moral implications for the students and faculty of any college” (Rosenberg et al., 2007, p. 413), examining these rates and the subsequent data related to attrition is paramount.
Although this is a preliminary study, our school of nursing will continue to collect data as the cohorts progress to track trends related to reasons for attrition of the accelerated-degree students. The current expansion of accelerated BSN programs allows nurses to enter the workforce at a more rapid rate, thereby positively impacting the nurse shortage.
As the body of nursing knowledge accumulates about the accelerated-degree student, implementing and assessing the effectiveness of interventions that support the retention of these students is vital to addressing the nurse shortage. Implementation of the interventions discussed may assist programs in retaining a higher percentage of their accelerated-degree students and ultimately increase the numbers of nurses during this period of critical nurse shortage. This study provides a starting point in developing a body of knowledge about the factors predicting attrition in accelerated-degree students, as current research on this subject is limited.
- American Association of Colleges of Nursing. (2008a). Fact sheet: Accelerated baccalaureate and master’s degrees in nursing. Retrieved from http://www.aacn.nche.edu/Media/FactSheets/AcceleratedProg.htm
- American Association of Colleges of Nursing. (2008b). Fact sheet: Nursing shortage. Retrieved from http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm
- Bentley, R. (2006). Comparison of traditional and accelerated baccalaureate nursing graduates. Nurse Educator, 31, 79–83. doi:10.1097/00006223-200603000-00010 [CrossRef]
- Hamner, J.B. & Bentley, R. (2007). Lessons learned from 12 years of teaching second-degree BSN students. Nurse Educator, 32, 126–129. doi:10.1097/01.NNE.0000270223.30919.4c [CrossRef]
- Korvick, L.M., Wisener, L.K., Loftis, L.A. & Williamson, M.L. (2008). Comparing the academic performance of students in traditional and second-degree baccalaureate programs. Journal of Nursing Education, 47, 139–141. doi:10.3928/01484834-20080301-10 [CrossRef]
- Meyer, G.A., Hoover, K.G. & Maposa, S. (2006). A profile of accelerated BSN graduates, 2004. Journal of Nursing Education, 45, 324–327.
- Rosenberg, L., Perraud, S. & Willis, L. (2007). The value of admission interviews in selecting accelerated second-degree baccalaureate nursing students. Journal of Nursing Education, 46, 413–416.
- Seldomridge, L.A. & DiBartolo, M.C. (2005). A profile of accelerated second bachelor’s degree nursing students. Nurse Educator, 30, 65–68. doi:10.1097/00006223-200503000-00007 [CrossRef]
- Seldomridge, L.A. & DiBartolo, M.C. (2007). The changing face of accelerated second bachelor’s degree students. Nurse Educator, 32, 240–245. doi:10.1097/01.NNE.0000299479.46883.4e [CrossRef]
- Siler, B., DeBasio, N. & Roberts, K. (2008). Profile of non-nurse college graduates enrolled in accelerated baccalaureate curricula: Results of a national survey. Nursing Education Perspectives, 29, 336–341.
- Suplee, P.D. & Glasgow, M.E. (2008). Curriculum innovation in an accelerated BSN program: The ACE model. International Journal of Nursing Education Scholarship, 5(1), Article 1. doi:10.2202/1548-923X.1447 [CrossRef]
- Walker, C., Tilley, D.S., Lockwood, S. & Walker, M.B. (2008). An innovative approach to accelerated baccalaureate education. Nursing Education Perspectives, 29, 347–352.