For almost 50 years, a Bachelor of Science in Nursing (BSN) has been the preferred entry level designation for the practice of professional nursing (American Nurses Association, 1965). Attainment of the BSN has been promoted by many groups and organizations, including the American Association of Colleges of Nursing (AACN, 2011b), the American Organization of Nurse Executives (2011), the National Advisory Council on Nurse Education and Practice (2003), and leading nursing scholars and nurse educators (Benner, Sutphen, Leonard, & Day, 2010).
The Institute of Medicine’s (IOM) recent publication, The Future of Nursing (2010), renewed attention to the importance of enhancing the educational attainment of nurses. In a seminal move, the IOM recommended that 80% of RNs be baccalaureate prepared by 2020. To meet this objective, the IOM (2010) asserted that graduates from Associate Degree in Nursing (ADN) and diploma programs should be offered “seamless access” (p. 12) to BSN programs and encouraged to progress to the BSN early in their career.
Despite the widespread and repeated calls for the BSN as the entry into practice, most RNs practicing in the United States were educated in ADN or diploma programs, and the ADN remains the most common way to become an RN. The U.S. Department of Health and Human Services, Health Resources and Service Administration’s (2010) most recent survey of RNs reported that 45.4% of currently practicing RNs obtained their initial education in an ADN program and 20.4% obtained their initial education in a diploma program. Thus, only approximately one third of all practicing RNs received their initial education at the BSN level.
The U.S. Department of Health and Human Services, Health Resources and Service Administration report (2010) presented some encouraging relevant findings. Among them was the observation that many diploma or ADN graduates are taking advantage of opportunities to further their education, as almost one third of all BSN-prepared RNs had obtained their degree from a “completion” or “bridge” program. Of note, when diploma-educated nurses continue their education, they do so approximately 10.5 years following their initial RN education. Nurses whose initial RN education was at the ADN level averaged 7.5 years between their ADN and BSN degree. In addition, approximately 3% of RNs were pursuing a BSN at the time of the survey.
According to the AACN (2011b), the number of RN-to-BSN programs is growing rapidly, with more than 600 in operation in the United States. Of these, approximately 400 programs offer courses online. The growth in the number of RN-to-BSN completion programs and more widespread availability of these programs due to the use of online modalities have resulted in a rapid increase in the numbers of students in completion programs. Indeed, between 2009 and 2010, enrollments in these programs increased by 21.6% (AACN, 2011b). This growth in the number of RN-to-BSN programs, as well as increasing support or preference for BSN education, has prompted a need to review programs’ characteristics. This article reports an in-depth survey conducted to assess the current status of the organization, practices, curricula, and future trends of RN-to-BSN programs in the United States.
The nursing literature from the past decade provides little information specific to RN-to-BSN programs. The relatively scarce literature fits into distinct categories, including the rationale for promoting BSN education, motivation and barriers to obtaining a BSN, program and curricular issues, and specific topics regarding RN-to-BSN students or programs.
Rationale for Promoting BSN Education
The literature supporting the need to endorse the BSN as the basic degree for nursing is compelling. It is widely recognized that BSN-educated RNs possess a broader knowledge base, resulting in the enhanced ability to provide holistic care and integrate complex concepts, such as disease prevention, research, outcomes management, risk assessment, and quality improvement, into their practice (IOM, 2010; Spencer, 2008; Tri-Council for Nursing, 2010). Further, there is mounting evidence of improved patient outcomes related to the educational preparation of nurses (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; IOM, 2010; Tri-Council for Nursing, 2010).
In addition, public health departments and the U.S. military and Veterans Administration, as well as many other employers, prefer RNs with BSN preparation. The BSN also provides the foundation for advanced education at the graduate level (Cronenwett, 2010). Finally, hospitals seeking Magnet status designation have accelerated the preference for more BSN-prepared nurses (AACN, 2011a).
Motivation and Barriers for RN-to-BSN Education
Several articles (Delaney & Piscopo, 2004; Kubsch, Hansen, & Huyser-Eatwell, 2008; Megginson, 2008; Wros, Wheeler, & Jones, 2011; Zuzelo, 2001) described the motivation for diploma-educated or ADN-educated RNs to obtain a BSN. The reasons cited include the desire for a college degree, encouragement by employers to obtain a BSN, professional growth, and a desire to seek graduate education.
Wros et al. (2011) explained that nurses generally enter RN-to-BSN programs to advance their careers because the BSN is the gateway to graduate education and subsequently to advanced practice or positions in nursing education or research. Megginson (2008) found that the reasons nurses cited for returning to school included enhanced career options with a BSN, achievement of personal goals, professional improvement, encouragement by colleagues to advance their education, and finding a “user-friendly” RN-to-BSN program.
Numerous barriers were cited in the literature for diploma-educated or ADN-educated RNs to continue their education. The most common barriers were multiple role demands (e.g., managing work, family, and school), tuition costs, and handling course expectations successfully (Spencer, 2008; Zuzelo, 2001). Megginson (2008) summarized that hindrances encountered by students were lack of time, fear of returning to an academic setting, negative recollections of previous educational experiences, fear of technology, and a lack of recognition for differentiation with BSN education.
RN-to-BSN Program and Curricular Issues
Very little was found in the literature specifically describing RN-to-BSN curricula. Indeed, Spencer (2008) acknowledged there has been little research in the area of RN-to-BSN curricula. One article (Delaney & Piscopo, 2007) mentioned curricular or content-specific courses, reporting that the critical content or cornerstone courses of RN-to-BSN programs are research, theory, leadership, and community health; otherwise, basic descriptions of programs of study were absent.
Only one source was located that discussed organizational characteristics of RN-to-BSN programs. Wros et al. (2011) explained that the number of credits required and the length of RN-to-BSN programs vary. This was presumed to be a positive finding, and they recommended that programs provide flexibility to accommodate learners’ family schedules and full-time work.
Specific Attributes of RN-to-BSN Programs and Students
Specific topics or aspects of RN-to-BSN education were described by several authors. For example, some articles described particular courses, such as public health (Ouzts, Brown, & Diaz-Swearingen, 2006) or “bridge courses” (Huston, Shovien, Damazo, & Fox, 2001, p. 250). Other authors reported qualities or characteristics of RN-to-BSN students, including critical thinking ability (Brown, Alverson, & Pepa, 2001; Shin, Ha, Shin, & Davis, 2006; White & Gomez, 2002) and professional socialization (Eckhardt, 2002). Other topical areas were promotion of streamlined articulation plans (Jacobs, 2006; Spencer, 2008), considerations for online instruction (Kozlowski, 2004), and “academic integrity” (cheating) in online programs (Hart & Morgan, 2010, p. 498), which is an important issue, particularly with respect to the rapid growth of online RN-to-BSN programs.
Among the conclusions identified in the recent literature was the importance for RN-to-BSN programs to ensure quality of education and enhance the perceived relevance of both classroom and clinical experiences. Finally, it was reinforced that RN-to-BSN curricula should be flexible and attentive to students’ career goals for the educational experience to be meaningful.
The recent calls among health policy makers and nurse educators to increase emphasis and enhance the number of RN-to-BSN programs led the faculty from our school of nursing to conduct a thorough review of the completion program and evaluate how it compares with other programs. The first step was to review recent relevant published articles. Although the literature discussing RN-to-BSN programs was varied and informative, it was surprisingly scarce. Further, no single source was found that provided a comprehensive examination of programmatic issues, such as admissions requirements, program length, and the format for content delivery. Curricular information detailing courses required, course content, evaluation methods, and clinical requirements was also lacking.
Therefore, the purpose of our study was to obtain a snapshot of current RN-to-BSN education for comparative purposes and to evaluate current practices and anticipate trends. The findings from this study are vital, given the rapid growth of RN-to-BSN programs and the corresponding increase in the number of students.
The questionnaire for this study was developed by a team of faculty with primary responsibility for program development, oversight, and curricular issues for the RN-to-BSN program at a large medical center-based school of nursing. The faculty received input from five colleagues on the initial draft of the questionnaire to determine content validity and ensure readability. Revisions were made, and the survey was adapted for Web-based administration using the Zoomerang® software. The online questionnaire was tested by eight nursing faculty familiar with RN-to-BSN education and revised again before the final survey was deployed.
Survey questions were grouped into four general categories. The first covered basic background information (e.g., program size, number of credit hours, admission criteria, length of time to complete the program, prerequisites). The second category included curricular and instructional information (e.g., courses, clinical requirements, instructional formats). The third category focused on methods of evaluation. The fourth category addressed specific information regarding the content or topics covered in different courses. Most questions were forced choice but allowed an option for the respondent to provide comments. The information related to specific content of the courses (e.g., Research, Leadership and Management, Community and Public Health Nursing) was evaluated using a Likert-type format (findings from these items will be reported at a later time).
The population for the survey included all RN-to-BSN completion programs identified in the United States. The AACN’s (2011c) list of accredited programs was used as a starting point for the invitation to participate and was cross-referenced with the National League for Nursing Accrediting Commission’s (2011) list of accredited programs. A contact person, such as the RN-to-BSN program coordinator or program director, was identified for each program, and an invitation to participate in the survey was e-mailed to that individual. The cover letter explained the purpose of the survey and informed the prospective participant that completion would take approximately 15 minutes. Completion of the survey was considered as tacit consent.
In total, 614 RN-to-BSN program directors in the United States were invited to participate in the survey; 364 visits were recorded to the Web site. Of these, 244 individuals started and 210 completed the survey, for a completion rate of 34.2%.
Survey Population Findings
Respondents were asked several questions about their school to determine generalizability. This information included items relating to location, nursing program setting, enrollment, and number of graduates per year.
Geographic Location and Program Setting. Responses to these items indicated that geographic locations were diverse and highly representative. The largest number and percentage of responses (22%) were from the Midwestern states. Others were distributed as follows: Northeastern states (14%), South-Central states (14%), Mid-America states (14%), Southeastern states (13%), Southwestern states (11%), Mid-Atlantic states and District of Columbia (10%), and Northwestern states (2%).
More than half (52%) of the nursing programs were located in public universities, whereas almost 40% were located in private universities. Much less common were public medical center (2%), private medical center (2%), community college (1%), and other (4%).
Size of Program and Number of Graduates. Almost half (46%) of the programs were small (less than 50 students currently enrolled). In contrast, 14% of programs reported 50 to 74 students, 19% reported 75 to 125 students, and 21% had more than 125 students currently enrolled. Most programs (53%) reported fewer than 25 graduates per year, followed by 25 to 49 graduates (20%), 50 to 74 graduates (14%), and more than 75 graduates (13%).
Findings Related to Program Characteristics
Various program characteristics were assessed. These items focused on the length of the program and average time for completion, grade point average (GPA) standards, and prerequisite requirements.
Length of Program (Credit Hours Required). When asked how many course and credit hours were required for completion, the most common response (28%) was 30 to 40 credit hours; an additional 22% indicated 41 to 60 credit hours, and the remainder noted either < 30 or > 60 credit hours. However, many respondents (25%) answered Other and explained in the comments section that they were either on a quarter-hour system or that hour requirements varied, based on each student’s needs.
More than 25% of the respondents provided narrative comments that helped to interpret the information. Most explained that their program required a total number of credit hours—generally 120 to 130 for the BSN—with a designated number of credit hours (usually around 30) being in nursing courses beyond the ADN. In many cases, the respondents explained that approximately half of the total hours (60 to 65) should be nursing courses (initial ADN, plus additional BSN courses), and the second half of the total (again, 60 to 65 hours) would be general academic education and liberal arts courses. In several cases, the respondents explained a minimum number of hours were required to be taken at the institution granting the degree (typically 25 to 40).
Length of Time for Program Completion. A surprisingly wide range of responses was submitted regarding time to complete the program. The responses ranged from 9 months to 5 years, with an almost equal number of participants indicating 12 to 18 months (44%) and 19 to 24 months (42%) for completion. A few (5%) indicated time to completion as less than 1 year and 9% indicated more than 2 years. Narrative comments suggested the length of time for completion varies depending on whether the students are full time or part time and whether the completion time included the time to finish prerequisites.
GPA Requirements. Only approximately half (49%) of the programs reported having minimum GPA requirements. The most commonly reported GPA requirement was 2.5 (41%). A GPA of 3.0 or greater was required by 10% of the programs.
Prerequisites Requirements. Approximately one fourth (26%) of the respondents indicated that students are required to have all of their general education and liberal arts prerequisites completed prior to admission, implying that 74% are not. Individual comments for this question were enlightening. Some respondents explained that students are required to complete all prerequisite courses (notably all science courses and statistics) prior to starting the program, but students had until graduation to complete the general education courses (e.g., English literature, political science).
Of note, several respondents reported recent changes regarding whether students must complete all non-nursing requirements prior to starting nursing courses. Three respondents noted recent changes that eased the requirement, whereas two others indicated recent changes made the requirements more stringent. Comments included, “We are beginning to prioritize admission to those applicants who have the majority of prerequisites completed” and “We have moved from ‘strongly encouraged’ to ‘requires completion.’”
Findings Related to Instructional Format and Curricula
Several areas regarding the curriculum and instructional formats were assessed. The questions for this section also related to methods for awarding credit, other than completion of course work, and information related to specific courses or content areas, clinical requirements, and evaluation strategies.
Instructional Format. In response to the question regarding how courses in the program were presented to students, the most common response was “online and face-to-face classes” or “hybrid” or “blended” courses. Indeed, approximately two thirds of programs offered courses in a blended-type format. Only 11% reported traditional (face-to-face) classes alone, whereas 24% noted that their programs were exclusively online. Comments for this question suggested a move toward online and hybrid options.
Non-Course Methods for Awarding Credit. More than 70% of the respondents reported that students are allowed to earn credits by means other than completion of courses. This question had the most comments, with almost two thirds of respondents explaining how credits are earned. Comments frequently included notation that credit is awarded for completion of courses in the ADN program. For example, “We offer blanket credit for nursing courses completed in the ADN and diploma programs” and “[students are] given 32 credits for nursing course work that allowed them to sit for the NCLEX®.” The amount of credits awarded for completion of the ADN or diploma program ranged from 25 to 45 credit hours. The higher numbers were rare and likely refer to quarter credits. The most frequent response to this question was 30 to 33 credit hours.
In addition to awarding credit for hours for ADN or diploma program completion, many respondents indicated that they use “credit by examination” options. College-Level Examination Program® testing was specifically mentioned by approximately 20% of respondents. Several wrote that they use a “portfolio” in which students can earn credit by providing evidence they met objectives of courses through prior learning, work experience, or national certification.
Courses and Content. When asked to indicate whether programs have an independent course that covers selected content areas, the findings were unexpectedly variable. The most frequently required courses and content areas are presented in Table 1. Almost all programs required courses in leadership and management, community health nursing, research, and health assessment. In the comments section, several respondents noted that some of the content areas, most commonly Statistics and Anatomy and Physiology, were program prerequisites. Also, some respondents indicated that some of the courses in their programs combined content areas. For example, one individual said “theory and research are combined in one 3-credit hours course.” Others answered, “combined assessment and patho[ology]; research and theory,” “patho[ology] and pharm[acology] are combined into one course,” and “informatics and research are combined into one course.”
Table 1: Specific Courses Required by the Programs Surveyed
Comments also provided information regarding content areas and courses that were not included on the original list. The following numbers in parentheses indicate the total number of respondents who included the topic or content: professionalism (10), transition or bridge course (7), ethics or legal/ethical issues (7), health policy (6), professional issues (6), care of family or family theory (5), and culture and transcultural nursing (4).
Some respondents wrote that students are allowed to choose electives. Courses specifically designated as electives included gerontology, critical care, women’s health, global children’s health, patient education, complementary and alternative health care, health promotion, parish nursing, and rural health. Several courses (e.g., gerontology, critical care, complementary and alternative health care) were mentioned by more than one respondent.
Clinical Requirements. Eighty-four percent of the responding RN-to-BSN program representatives require students to complete at least one clinical course. Table 2 summarizes the most commonly required clinical courses. As this table shows, most programs require clinical experiences for Community and Public Health Nursing and Leadership, Management, and Role Transitions, although the amount of clinical time is strikingly variable. Clinical time for Health Assessment is required by approximately one third of respondents, and less than 10% indicated clinical requirements for other courses. In those instances, Critical Care, Health Promotion, and Gerontology were most commonly mentioned.
Table 2: Clinical Courses and Requisite Hours of Programs Reporting a Clinical Requirement
Evaluation. Responses regarding the processes used for evaluation were enlightening. Nonclinical and didactic courses were evaluated by several methods. Table 3 indicates the most commonly reported methods were individual or group presentations, papers, and projects. Of note, standard multiple choice examinations and mixed-methods examinations were evenly split, with approximately one third using them always or frequently, one third sometimes, and one third rarely or not at all. Standardized, nationally normed examinations were the least frequently used evaluation method.
Table 3: Evaluation Methods for Didactic Courses
Written comments indicated other evaluation methods for didactic courses. Methods mentioned by several respondents were rubrics, case studies, quizzes, discussion boards, reflective journaling, and portfolio validation. Also listed were evaluation strategies, such as community assessment, change project, leadership simulation, and completion of continuing education certification (e.g., Quality and Safety Certification).
Methods frequently used for evaluation of clinical courses are presented in Table 4. The most common evaluation methods are projects and papers, clinical logs, and preceptor input. Of note, instructor observation is relatively uncommon, which is different from the practice for traditional prelicensure students. Written comments added other clinical evaluation strategies, such as case studies, discussion boards, conference attendance, simulation, and service-learning projects.
Table 4: Evaluation Methods for Clinical Courses
One critical finding of the survey was that 73% of respondents noted their university plans to increase enrollment in the upcoming year. Several stated they were planning to enhance or add online courses or add fully online programs. A few respondents mentioned a desire to grow but cited resource limitations—either faculty or financial. For example, one individual said, “[plan to expand] only if we can get the faculty,” and others explained they planned to increase enrollment when funding becomes available. However, one person noted that their program had been forced to reduce admissions due to state budget cuts.
Other respondents commented on recent changes that were made to bolster enrollments. For example, one person stated they “changed the curriculum to be more relevant to RNs” and another stated they “lowered our tuition.” Another person noted that their program was working with a local community college network and had revised the program to allow ADN students to graduate with their BSN one semester after obtaining their associate’s degree.
Neither the National League for Nursing Accrediting Commission nor the Commission on Collegiate Nursing Education have specific criteria or standards for review of RN-to-BSN programs. Rather, these programs are included in accreditation of the basic or host BSN program. Currently, it appears that program length and curricular distinctions are dictated largely by tradition, requirements of the parent university (e.g., number of courses taken in residence and minimum institutional or state’s legislative requirements for obtaining a degree), and the state’s Board of Nursing’s differentiated practice guidelines rather than a standardized or uniform approach. Perhaps it is time that this lack of direct accountability is reviewed, and more constant or specific guidelines should be proposed and considered.
Although programs set their own admission practices and policies, in light of recent significant growth and further expansion plans, they need to be attentive to the possibility of “dumbing down” the RN-to-BSN degree by easing or cutting back minimum requirements. For example, prerequisite courses are intended to provide the foundation on which to build a knowledge base, but only 25% of the programs required all prerequisite courses to be completed prior to admission; this contrasts starkly with admission practices for generic BSN prelicensure programs. Further, only half of the program directors reported requiring a minimum GPA for admission. This, too, contrasts markedly with basic BSN programs and calls into question students’ preparation for a truly rigorous education.
The length of time for completion of the RN-to-BSN degree is difficult to assess as students may attend school part time or full time, but every effort should be made to encourage these students to complete their education as quickly as possible. Program directors, faculty, community partners, and state policy makers should work to make the best use of external support (e.g., tuition assistance), and course offerings, plans of study, and delivery formats should be flexible enough so that students can complete the programs in a timely manner (i.e., less than 2 years). Completing one’s education in a timely manner is particularly important during periods of economic downturn, as sources for financial aid become more limited and fewer employers provide tuition assistance.
Although there is some uniformity among the RN-to-BSN programs in some areas relating to curriculum (e.g., number of hours required), there is notable variation in others, such as courses and content areas and clinical requirements. The most commonly reported courses required in the plan of study were Research and Evidence-Based Practice, Community and Public Health Nursing, Management or Professionalism, and Health Assessment. These courses are consistent with accreditation requirements for BSN programs and differentiated practice parameters. Other important, perhaps essential, areas that should be included in all programs are: Health Information Systems and Informatics, Health Promotion, and Gerontology. If and why these courses are not more prevalent should be examined.
Probably the most critical area that should be addressed from a nationally focused or accreditation perspective, however, relates to clinical requirements. Although 84% of the programs reported requiring at least one clinical course, there was remarkable variation in the number of clinical hours. Furthermore, there is the implication that approximately 16% of the programs have no clinical component. This leads to concerns regarding educational rigor and questions whether the program is indeed comparable to generic or traditional prelicensure BSN education.
Also called into question is whether the lack of clinical requirements (or very minimal clinical requirements) supports the accusation of “diploma mills.” To address these concerns, a minimum of clinical courses and clinical hours needs to be considered. One proposal is that all RN-to-BSN students should be required to complete at least 80 hours of community and public health nursing and at least 80 hours of leadership and management clinical experiences. The manner in which these clinical hours are met should remain flexible and determined by each program’s faculty.
Much of the growth in RN-to-BSN education is in the area of online, hybrid, or blended courses. These types of courses support flexibility and allow programs and courses to be offered nationally. This is both positive and potentially problematic. Although online courses and programs are highly adaptable and allow access to virtually all potential students, efforts must be taken to ensure that the Web-based courses and programs are just as rigorous as their traditional counterparts and are equivalent to prelicensure courses and programs. In addition, the move to more online offerings may negate or limit opportunities for students who have not been in the educational arena for many years, who may not be computer literate, or who simply prefer traditional face-to-face education.
Clearly, there is considerable momentum in nursing education to transit diploma-educated and ADN-educated RNs into baccalaureate education. This is evident as 73% of the programs surveyed reported having plans to increase enrollment, whereas others indicated they would do so if not limited by a lack of faculty or financial resources. Analysis of the survey findings leads to the suggestion that it is time to hold a nationwide dialogue regarding RN-to-BSN educational programs. A national conference, symposium, or forum on RN-to-BSN education would provide an opportunity for nurse educators to discuss issues related to some degree of program standardization. There should be a delineation of RN-to-BSN programs’ goals and outcomes and a review of how they align with expectations of state Boards of Nursing, conform with criteria proposed by accreditation organizations, and meet the needs of potential employers.
One trend worth noting from the survey, as well as from the literature (Benner et al., 2010; IOM, 2010), is that many community colleges and baccalaureate programs are partnering to help students with the RN-to-BSN transition. These models could also be presented at a national conference. Finally, it is hoped that more funding will be made available for these partnerships and program expansion in the near future. Strategies for obtaining financial support of programs could also be discussed.
A major limitation of the study was potential bias relating to willingness to complete the survey. It is feasible that only the directors from more established programs were comfortable providing details about their programs and describing anticipated changes. Therefore, it is possible that programs developed in the past few years are underrepresented. In addition, review of the respondents’ demographics (i.e., geographic location, program setting, number of students and graduates) suggests that the directors of large, nationwide, for-profit, online-only programs may not have completed the survey.
Professional nursing has been encouraging the BSN since 1965. Now is the time to ensure that the educational opportunities and requirements for the RN-to-BSN programs are consistent and the education is sound. Fulfillment of the IOM’s (2010) “80 by 2020” goal will require concentrated, focused efforts on the part of RN-to-BSN educators. However, we must remain vigilant to ensure that increasing the number of programs, adding more students, encouraging flexibility, and enhancing online options and opportunities are accomplished in a manner that maintains academic integrity and graduates BSN-prepared RNs who are equipped to practice in complex environments and community settings and who are ready for graduate study.
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Specific Courses Required by the Programs Surveyed
|Course||Programs Requiring the Course (%)|
|Leadership and Management||91|
|Community Health Nursing||89|
|Anatomy and Physiology||17|
Clinical Courses and Requisite Hours of Programs Reporting a Clinical Requirement
|Clinical Course||Programs Requiring Clinical Experience (%)||Range of Clinical Hours||Average No. of Clinical Hours|
|Community and Public Health Nursing||94||15 to 180||79.5|
|Leadership, Management, and Role Transitions||69||16 to 270||79.8|
|Health Assessment||35||4 to 120||40.8|
|Critical Care||8||40 to 120||60.6|
|Health Promotion||6.5||20 to 180||67.4|
|Gerontology||4.7||20 to 90||51.5|
Evaluation Methods for Didactic Courses
|Evaluation Method||Frequency of Evaluation Method (%)|
|Frequently or Always||Sometimes||Rarely or Not At All|
|Individual projects and papers||83||14||2|
|Group projects and papers||59||32||9|
|Multiple choice examinations||35||35||30|
|Mixed-method examinations (e.g., short answer, essay)||30||31||38|
|Standardized examinations (e.g., HESI™, NLN)||9||9||82|
Evaluation Methods for Clinical Courses
|Evaluation Method||Frequency of Evaluation Method (%)|
|Frequently or Always||Sometimes||Rarely or Not At All|
|Paper or project||81||14||5|
|Self-evaluation and peer evaluation||61||14||25|