Journal of Nursing Education

Research Briefs 

Does Prior RN Clinical Experience Predict Academic Success in Graduate Nurse Practitioner Programs?

Majeda M. El-Banna, PhD, RN; Linda A. Briggs, DNP, ANP-BC, ACNP-BC; Mayri Sagady Leslie, EdD, CNM; Erin K. Athey, DNP, RN, FNP-BC; Arlene Pericak, DA, FNP-BC; Nancy L. Falk, PhD, RN; Jessica Greene, PhD

Abstract

Background:

There is limited evidence on whether prior RN clinical experience is predictive of academic success in graduate nurse practitioner (NP) programs. The purpose of this study was to explore whether the frequently held assumption that more prior clinical experience is associated with better academic success in The George Washington University online NP programs.

Method:

Applications (n = 106) for clinical NP students entering from 2008–2010 were examined along with data on academic performance.

Results:

No relationship was found between years of prior RN clinical experience and three educational outcome variables (cumulative grade point average [GPA], clinical course GPA, and having failed any courses or been put on probation). However, students with the most prior RN clinical experience were less likely to graduate in 4 years, compared with those with the least experience.

Conclusion:

These findings serve as a building block of empirical evidence for admissions committees as they consider entry requirements for NP programs. [J Nurs Educ. 2015;54(5):276–280.]

Dr. El-Banna is Assistant Professor and Director, Nursing Advancement (ADN to BSN/MSN) Program, Dr. Briggs is Assistant Professor, Dr. Leslie is Assistant Professor and Director, MSN Concentration in Nurse-Midwifery, Dr. Athey is Assistant Professor, Dr. Pericak is Assistant Professor, Dr. Falk is Assistant Professor and Director, MSN Clinical Research Administration Program, and Dr. Greene is Professor and Associate Dean for Research, School of Nursing, The George Washington University, Washington, DC.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Majeda M. El-Banna, PhD, RN, Assistant Professor, Director, Nursing Advancement (ADN to BSN/MSN) Program, School of Nursing, The George Washington University, 45085 University Drive, Suite 201, Ashburn, VA 20147; e-mail: melbanna@gwu.edu.

Received: August 15, 2014
Accepted: January 21, 2015

Abstract

Background:

There is limited evidence on whether prior RN clinical experience is predictive of academic success in graduate nurse practitioner (NP) programs. The purpose of this study was to explore whether the frequently held assumption that more prior clinical experience is associated with better academic success in The George Washington University online NP programs.

Method:

Applications (n = 106) for clinical NP students entering from 2008–2010 were examined along with data on academic performance.

Results:

No relationship was found between years of prior RN clinical experience and three educational outcome variables (cumulative grade point average [GPA], clinical course GPA, and having failed any courses or been put on probation). However, students with the most prior RN clinical experience were less likely to graduate in 4 years, compared with those with the least experience.

Conclusion:

These findings serve as a building block of empirical evidence for admissions committees as they consider entry requirements for NP programs. [J Nurs Educ. 2015;54(5):276–280.]

Dr. El-Banna is Assistant Professor and Director, Nursing Advancement (ADN to BSN/MSN) Program, Dr. Briggs is Assistant Professor, Dr. Leslie is Assistant Professor and Director, MSN Concentration in Nurse-Midwifery, Dr. Athey is Assistant Professor, Dr. Pericak is Assistant Professor, Dr. Falk is Assistant Professor and Director, MSN Clinical Research Administration Program, and Dr. Greene is Professor and Associate Dean for Research, School of Nursing, The George Washington University, Washington, DC.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Majeda M. El-Banna, PhD, RN, Assistant Professor, Director, Nursing Advancement (ADN to BSN/MSN) Program, School of Nursing, The George Washington University, 45085 University Drive, Suite 201, Ashburn, VA 20147; e-mail: melbanna@gwu.edu.

Received: August 15, 2014
Accepted: January 21, 2015

No current consensus exists regarding whether clinical nursing experience is essential for success in nurse practitioner (NP) graduate master’s degree programs. Some NP programs require students to have 1 to 2 years of prior nursing experience, and some require no experience. This lack of uniformity exists even in the top graduate nursing programs in the country (Columbia University School of Nursing, 2015; Vanderbilt University School of Nursing, n.d.; Yale School of Nursing, 2015).

Very little empirical evidence examines whether clinical nursing experience is related to better education outcomes among NP students. A study examining nurse anesthetists found that the number of years of critical care experience prior to entry into a nurse anesthetist program was not predictive of success in the program (Burns, 2011). In fact, there was a negative correlation between the number of years of experience and graduate grade point average (GPA). A similar finding was echoed in a nursing student’s master’s thesis on NP students. The years of experience as an RN and graduate GPA consistently demonstrated an inverse relationship in the study (Locke, 2014).

A larger body of literature exists that examines other factors that predict success in NP programs, such as GPA and graduate record examination (GRE) scores (Creech, 2011; Crosby, Dunn, Fallacaro, Jozwiak-Shields, & MacIsaac, 2003; Haritos, Shumway, Austin, & Ellis, 1995; Katz, Chow, Motzer, & Woods, 2009). Undergraduate GPA has been the factor most studied, and several studies have found it to be positively correlated with success in graduate nursing programs (Ortega, Burns, Hussey, Schmidt, & Austin, 2013; Suhayda, Hicks, & Fogg, 2008).

Due to the limited data on this topic and the fact that most admission criteria for NP programs are based largely on expert opinion (Crosby et al., 2003; Rich, Jorden, & Taylor, 2001), faculty from The George Washington University School of Nursing decided to investigate this question empirically. Knowing how important prior clinical experience is for success among graduate nursing students has the potential to make NP admission criteria more evidence based.

Method

This retrospective study examined whether prior RN clinical experience was related to educational outcomes among online master’s of science in nursing (MSN) primary care nurse practitioner students. The George Washington University Institutional Review Board approved the protocol for this study. The study sample consisted of graduate nurse practitioner students admitted to The George Washington University from fall 2008 to fall 2010. All 121 MSN nurse practitioner students who started coursework within this time frame were eligible for inclusion in the study. Fifteen students were excluded due to missing admission applications, yielding a final data set of 106. Manual data extraction from student applications was used to document years of nursing experience, educational background, and demographic information. The George Washington University Institutional Research Department provided all educational outcome information.

Variables

The key variable of interest was the number of years of prior RN clinical experience. This was calculated from the applicants’ resumés at the time of application. Four educational outcome variables were included in the analysis: (a) MSN cumulative GPA, (b) clinical course GPA, (c) graduation status after 4 years, and (d) having failed any courses or having been put on probation (cumulative GPA of <3.0 in any semester) during the course of their studies. Clinical courses were considered to be those that included both practicum hours and didactic material. Two categories of control variables were included—educational background and demographic information. The educational background control variables were (a) type of nursing degree, (b) history of prior master’s or doctoral degrees, (c) nursing degree from a “top 100” university or college nursing program (as listed in 2014 U.S. News and World Report), (d) years since nursing degree, and (e) prior nursing degree GPA. Demographic variables included gender, age, ethnicity, and mean income. Mean income within the student’s zip code was used as a proxy for student income.

Analytic Approach

The authors first examined descriptive statistics for the demographic, educational background, and educational outcomes. For bivariate analyses, one-way analyses of variance were computed to examine the relationships between RN direct care experience and the GPA outcomes, as well as the control variables and the GPA outcomes. Chi-square analyses were conducted to examine the relationships between RN experience (and the control variables) and success in graduating within 4 years and having failed a course or been placed on academic probation.

Multiple regression analyses were conducted to examine the relationship between prior RN clinical experience and the educational outcomes, controlling for educational background. Also included were demographic characteristics that were consistently related to the outcomes in bivariate analyses. Ordinary least-squares models were used for the continuous dependent variables (overall GPA and clinical GPA), and logistic regression models were used for the dichotomous dependent variables (graduation within 4 years and having failed a class or been put on probation).

Results

Table 1 shows that the majority of the sample were women (87.7%) and White (70.8%). Most of the sample had a bachelor of science in nursing (BSN) degree without a previous RN associate’s degree (72.6%), and few had a master’s or doctoral degree (8.5%). The students had a wide range of ages, prior nursing GPA, and years since last nursing degree. Although the majority of students (57.6%) had more than 3 years of prior RN clinical experience, 18.9% had 1 year or less of experience. Students had an average GPA of 3.8 overall and 3.7 for clinical courses. More than three quarters (77%) graduated within 4 years, and 9% had either failed a course or been put on probation.

Demographics of Graduate Students Matriculating 2008–2010 (N = 106)

Table 1:

Demographics of Graduate Students Matriculating 2008–2010 (N = 106)

In bivariate analyses (Table 2), no relationship was found among years of prior RN clinical experience and any of the educational outcome variables. In other words, students with 1 year or less of experience did not significantly differ from their more experienced peers in terms of GPA, graduation rates, or likelihood of failed classes or probation. However, a trend indicating that those students with higher undergraduate GPAs (>3.5) had higher overall GPAs in graduate school was observed, but it did not reach conventional levels of statistical significance.

Bivariate Relationship Between Education and Nursing Background and Performance in Graduate Nursing Programs

Table 2:

Bivariate Relationship Between Education and Nursing Background and Performance in Graduate Nursing Programs

A strong association was observed among student race/ethnicity and all four educational outcomes (Table A; available in the online version of this article). White students had significantly higher GPAs than African American and Asian students (3.8 versus 3.4 and 3.5, respectively), and they were significantly more likely to graduate within 4 years (86.7% versus 44.4% and 50%, respectively). In addition, White students were less likely to have been on probation or to have failed a class.

Bivariate Relationship Between Demographic Characteristics and Performance in Graduate Nursing Programs

Table A:

Bivariate Relationship Between Demographic Characteristics and Performance in Graduate Nursing Programs

The multivariate regression findings were consistent with the bivariate findings on years of prior RN clinical care experience and the educational outcomes (Table 3). Such experience was not related to educational outcomes when controlling for other factors in the model, with one exception—those with more than 6 years of experience had substantially lower odds of graduating within 4 years than did those with 1 year or less. Consistent with the prior literature, undergraduate GPA was predictive of graduate GPA. Those with undergraduate GPAs above 3.75 had graduate GPAs that were 0.24 and 0.40 points higher for overall GPA and clinical GPA, respectively, compared with those who had undergraduate GPAs below 3.25. However, undergraduate GPA was not related to graduating within 4 years or being on probation or failing a class. Controlling for undergraduate GPA and the other factors, White students had significantly better educational outcomes than African American and Asian students.

Multivariate Relationships Between Prior RN Clinical Experience and Performance in Nurse Practitioner Programs

Table 3:

Multivariate Relationships Between Prior RN Clinical Experience and Performance in Nurse Practitioner Programs

Discussion

The purpose of this study was to investigate the relationship between prior RN clinical experience before graduate school admission and academic performance of NP students. No relationship was found among students’ experience and three measures of academic performance. For the fourth measure, those with the most prior RN clinical experience were found to be less likely to graduate in 4 years, compared with those with 1 year or less of experience.

Whether prior RN clinical experience is vital for success in graduate studies is frequently debated in graduate nursing programs, and the dialogue is often informed by personal experience and observation (Crosby et al., 2003). The evidence presented in the current article may be useful for helping to guide future decision making in the development and revision of admissions criteria.

The finding that undergraduate GPA was a significant predictor of academic success is consistent with prior research and confirms that undergraduate GPA should remain a critical consideration in the admissions process (Ortega et al., 2013; Suhayda et al., 2008). However, findings related to minority student performance are concerning but are consistent with prior research (Amaro, Abriam-Yago, & Yoder 2006). African American and Asian students had poorer academic outcomes than White students across all four measures. Of particular concern is the lower graduation rate. In probabilities based on the regression model, African American and Asian students had predicted graduation rates of 54% and 58%, respectively, compared with a 92% rate for White students. This highlights the need for additional supports to ensure that minority students are successful in the online learning environment.

Limitations

The study findings should be interpreted in light of its limitations. The George Washington University is a single institution, and the graduate nursing programs are offered as distance education online in primary care, thus limiting generalizability of the findings to other institutions, educational modalities, and areas of focus. The study was also limited by a small number of students without any previous clinical RN experience (3%). Instead, the nearly 20% who had limited experience (1 year or less) were examined. This was still a relatively small number (n = 20), which means that the study had power to detect significant differences for only large differences in outcomes from those with more experience. However, those with 1 year or less of experience did not have worse outcomes, except for one measure, and the magnitude was so small that even if it was statistically significant, it would not be a meaningful difference (0.02 lower in overall GPA, compared with those between 1 and 3 years of experience). In addition, many students gain RN experience while enrolled in preclinical courses, which was not measured. Further research should use larger samples to explore the success of students who have no previous RN clinical experience or who gain experience during graduate nursing education.

Conclusion

This study contributes important new evidence that having RN clinical experience prior to graduate school admission does not significantly predict academic success in an NP program. Work force projections suggest there will be a shortage of primary care providers as more patients gain access to health care under the Affordable Care Act (Health Resources and Services Administration, 2013). Given this anticipated shortage, the nursing community should consider reducing barriers to advanced nursing education. One way to reduce barriers would be to reexamine the application requirements for NP programs, particularly the prior RN clinical experience requirements.

References

  • Amaro, D.J., Abriam-Yago, K. & Yoder, M. (2006). Perceived barriers for ethnically diverse students in nursing programs. Journal of Nursing Education, 45, 247–254.
  • Burns, S.M. (2011). Predicting academic progression for student registered nurse anesthetists. AANA Journal, 79, 193–201.
  • Columbia University School of Nursing. (2015). Admission and financial aid: How to apply to MS programs. Retrieved from http://nursing.columbia.edu/admissions-and-financial-aid/how-apply/ms-programs
  • Creech, C.J. (2011). Developing a selection method for graduate nursing students. Journal of the American Academy of Nurse Practitioners, 23, 404–409. doi:10.1111/j.1745-7599.2011.00626.x [CrossRef]
  • Crosby, F.E., Dunn, J.D., Fallacaro, M.D., Jozwiak-Shields, C. & MacIsaac, A.M. (2003). Preadmission characteristics of advanced practice nursing students. Journal of the American Academy of Nurse Practitioners, 15, 424–431. doi:10.1111/j.1745-7599.2003.tb00417.x [CrossRef]
  • Haritos, G., Shumway, S.H., Austin, P.N. & Ellis, W.E. (1995). Nurse anesthesia admission qualifications. AANA Journal, 63, 244–248.
  • Health Resources and Services Administration. (2013). Projecting the supply and demand for primary care practitioners through 2020: In brief. Retrieved from http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/primarycarebrief.pdf
  • Katz, J.R., Chow, C., Motzer, S.A. & Woods, S.L. (2009). The graduate record examination: Help or hindrance in nursing graduate school admissions?Journal of Professional Nursing, 25, 369–372. doi:10.1016/j.profnurs.2009.04.002 [CrossRef]
  • Locke, T.A. (2014). Predicting academic success in a graduate nursing program: A pilot study (Unpublished doctoral dissertation). California State University, San Marcos, CA.
  • Ortega, K.H., Burns, S.M., Hussey, L.C., Schmidt, J. & Austin, P.N. (2013). Predicting success in nurse anesthesia programs: An evidence-based review of admission criteria. AANA Journal, 81, 183–189.
  • Rich, E.R., Jorden, M.E. & Taylor, C.J. (2001). Assessing successful entry into nurse practitioner practice: A literature review. The Journal of the New York State Nurses’ Association, 32(2), 14–18.
  • Suhayda, R., Hicks, F. & Fogg, L. (2008). A decision algorithm for admitting students to advanced practice programs in nursing. Journal of Professional Nursing, 24, 281–284. doi:10.1016/j.profnurs.2007.10.002 [CrossRef]
  • Vanderbilt University School of Nursing. (n.d.). MSN admission requirements. Retrieved from http://www.nursing.vanderbilt.edu/msn/admission_req.html
  • Yale School of Nursing. (2015). Yale University’s graduate nursing programs: Admission frequently asked questions. Retrieved from http://nursing.yale.edu/frequently-asked-questions-0

Demographics of Graduate Students Matriculating 2008–2010 (N = 106)

DemographicPercent
Gender
  Female87.7
  Male12.3
Age (years)
  ⩽3039.6
  31–4034
  ⩾4126.4
Race/ethnicity
  White70.8
  African American8.5
  Asian9.4
  Other/no response11.3
Mean income (zip code)$95,303.60
Educational background
  Nursing degree
    ADN only7.6
    ADN and BSN18.8
    BSN only72.6
  Years since nursing degree
    ⩽127.4
    2–441.5
    5–1016
    ⩾1015.1
  Top 100 university/college
    Yes22.6
    No77.4
  Prior master’s or doctorate degree
    Yes8.5
    No91.5
  Prior nursing degree grade point average
    <3.2524.5
    3.26–3.5030.2
    3.51–3.7525.5
    3.76–4.0019.8
Years of RN patient care experience
  ⩽118.9
  1–323.6
  3–623.6
  ⩾634

Bivariate Relationship Between Education and Nursing Background and Performance in Graduate Nursing Programs

VariableOverall GPA (Mean)Clinical GPA (Mean)Graduated Within 4 Years (%)Probation or Failed a Class (%)
Total study sample3.83.777.49.4
Years of prior RN clinical experience
  ⩽13.83.7855
  1–33.73.68016
  3–63.93.8804
  ⩾63.83.769.411.1
Educational background
  Nursing degree
    ADN only3.83.887.512.5
    ADN and BSN3.83.78114.3
    BSN only3.83.7778
  Years since nursing degree
    ⩽ 13.83.775.910.3
    2–53.83.779.611.4
    5–103.83.988.25.9
    ⩾103.83.762.56.3
  Top 100 university/college
    Yes3.93.891.7a8.3
    No3.73.773.29.8
  Prior master’s or doctorate degree
    Yes3.63.866.722.2
    No3.83.733.377.8
  Prior nursing degree GPA
    <3.253.7a3.676.915.4
    3.26–3.503.83.8759.4
    3.51–3.753.83.781.57.4
    3.76–4.003.93.976.24.8

Multivariate Relationships Between Prior RN Clinical Experience and Performance in Nurse Practitioner Programs

VariableRegression CoefficientsOdds Ratios


Overall GPAClinical GPAGraduated Within 4 YearsProbation or Failed a Class
Years of prior RN clinical experience
  ⩽1(1.00)(1.00)
  1–30.02−0.060.361.81
  3–60.190.160.220.83
  ⩾60.000.010.03*1.91
Educational background
  Nursing degree
    ADN only(1.00)(1.00)
    ADN and BSN0.040.032.430.59
    BSN only0.100.160.200.14
  Years since nursing degree
    ⩽1(1.00)(1.00)
    2–5−0.07−0.022.531.68
    5–100.020.2042.58a0.21
    ⩾100.120.249.260.12
  Top 100 university/college
    Yes0.01−0.053.753.46
    No(1.00)(1.00)
  Prior master’s or doctorate degree
    Yes0.000.220.303.57
    No(1.00)(1.00)
  Prior nursing degree GPA
    <3.25(1.00)(1.00)
    3.26–3.500.15a0.190.480.25
    3.51–3.750.20*0.29a2.000.13
    3.76–4.000.24*0.40*0.360.08
Race/ethnicity
  White(1.00)(1.00)
  African American−0.43**−0.84**0.09*13.38*
  Asian−0.39**−0.79**0.11*11.82a
  Other/no response0.020.120.18*1.00
R20.350.340.260.25

Bivariate Relationship Between Demographic Characteristics and Performance in Graduate Nursing Programs

Overall GPA (mean)Clinical GPA (mean)Graduated Within 4 Years (%)Probation or Failed a Class (%)
Gender
  Female3.83.778.57.5
  Male3.73.669.223.1a
Age (years)
303.83.783.37.1
31–403.83.775.013.9
413.83.871.47.1
Race/ethnicity
  White3.8**3.8**86.7**6.7*
  African American3.43.144.433.3
  Asian3.53.150.020.0
  Other/no response3.93.966.70.0
Mean income (zip code)
  Lowest tercile3.83.888.9*5.6
  Middle tercile3.83.762.98.6
  Highest tercile3.73.780.014.3

10.3928/01484834-20150417-05

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