Promoting and facilitating student success needs to be an essential core value for any academic institution. Although schools and departments of nursing have traditionally offered academic support programs for prelicensure nursing students, often in the form of remediation, literature describing broad-based organizational initiatives to support the academic and professional success of all students within a nursing school is limited. The Center for Academic and Professional Success (CAPS) program at the University of Rochester is one such innovative broad-based initiative.
CAPS: Origins and Development
The CAPS program was created in the spring of 2011 after the Dean of the University of Rochester attended an inspirational presentation regarding academic support services at the 2011 Robert Wood Johnson Foundation/New Careers in Nursing (RWJF/NCIN) Summit and wanted to replicate and expand this idea for University of Rochester students. During the spring of 2011, working with current RWJF scholars, the authors of the current study proposed the creation of an integrated, formal network of support that would consolidate and expand academic, clinical, and professional support services for students. Centralizing student support services under CAPS would allow for a team approach to students, increasing continuity, communication, and collaboration; improving effectiveness and efficiency of service delivery; and further facilitating the success of our students.
The first author was charged with building the CAPS team, comprised of faculty, staff, and students. In consultation with the Dean, team members were selected based on their awareness of student academic and professional challenges, as well as their expertise, job position, and previous experience with providing student support services. For example, the team included individuals such as the Director of the Accelerated Program for Non-Nurses (APNN), who is a nationally known faculty member who provides NCLEX consultation and training, and representatives from Information Technology and the library. Graduates from the RWJF/NCIN Scholarship Program (who had received scholarship monies to attend the APNN program) were hired to offer some of the services commensurate with their interest and experience (e.g., near peer mentors), providing them with leadership experiences as designed by RWJF. By the end of summer 2011, the 14-member CAPS team attended several brainstorming meetings, completed a literature review, and conducted a student survey to determine needed services. This work underscored the need for a center that would support all students while maintaining an emphasis on the special needs of APNN students due to their diversity and the intensity and rapidity of APNN programming.
CAPS: Theoretical Underpinnings
The literature review assisted CAPS committee members in determining the best practices and educational constructs to inform academic support initiatives in higher education in general and nursing education in particular. The theories of adult learning, (Knowles, 1970; Mezirow, 1991) and cognitive transitions in adults (Sargent & Schlossberg, 1988; Schlossberg, 2011; Schlossberg, Waters, & Goodman, 1995) provided initial grounding to understand academic support in nursing and higher education. Given that the University of Rochester offers a 12-month accelerated nursing program for second-degree students, understanding the many factors that influence the academic success of this nontraditional nursing student population was critical.
Schlossberg's transition theory was used to inform the development of CAPS. It addresses cognitive and affective aspects of student development and reminds us of the significant and, at times, overwhelming life transitions experienced by adult students as they return to school to start a new career, continue their nursing education, or begin graduate studies (Schlossberg, 2011; Schlossberg et al., 1995). The transition of the student in an accelerated nursing program is most significant due to the life alteration that occurs with the transitioning into a new career and becoming socialized into that new career (Bowie & Carr, 2013). This understanding underscored the importance of providing traditional academic support, as well as other critical supports to address stressors associated with the transitions experienced by nontraditional, working, and graduate nursing students (Schlossberg, 2011; Schlossberg et al., 1995).
The review of the literature also provided the CAPS development team with knowledge of other critical aspects of student academic and social needs, including mentoring (Penman & White, 2006; Rodger & Tremblay, 2003), stress reduction and timely referral to mental health counseling as needed (Trammel, 2005; Weitzel & McCahon, 2008), pet-assisted therapy (Adamle, Riley, & Carlson, 2009), writing assistance (Kuh, Kinzie, Schuh, & Whitt 2011), test-taking support (Mohler, 2013; Ross-Gorden, 2011), career development and career advancement (Delaney & Piscopo, 2004), and job assistance for new graduates (Rush, Adamack, Gordon, Lilly, & Janke, 2013). One key aspect of CAPS that cuts across all these services is role-modeling, an essential component of effective mentoring relationships (Eller, Lev, & Feurer, 2014) and overall professional socialization (Felstead & Springett, 2016). Role-modeling may be especially important for a large subgroup of APNN students who are from diverse cultural backgrounds. For example, prior research indicates that African American students have indicated the necessity of having mentors who are sincere, supportive, and true role models. They believe that seeing a faculty member that looks like them is reassuring and validates that they can be successful (Payton, Howe, Timmons, & Richardson, 2013).
CAPS: Assessment of Student Needs
Faculty identified that the APNN student population experienced the greatest academic and clinical support needs in comparison with RN-to-BS and graduate students due to the diversity of the students entering the program and the intensity and rapidity of the program. Therefore, an anonymous CAPS Student Survey was distributed to present and past APNN students (within the past year) to evaluate their academic and professional needs. Survey questions were developed to understand student characteristics, potential environmental stressors that could negatively influence academic performance and professional development, prioritization and likelihood of use of various CAPS services, any additional desired services, possible barriers to use of CAPS services, and degree of support from one's current advisor and the school regarding academic work and professional development.
Survey findings were based on a sample of 59 students who were predominantly women (80%) and White (73%). Many ethnically diverse students (27%), including African American, Asian American, African, Latino/Hispanic American, Foreign National (Moldava), and Multi-Ethnic students, also participated. The students identified several stressors that could adversely affect a student's academic success, including those in Table 1.
Stressors Adversely Affecting Student Academic Success
Open-ended responses also identified financial problems as an additional adverse effect on student success. Student responses supported their need for a school-based sense of belonging or connectedness with faculty and peers, particularly if they are at a geographic distance from loved ones. Responses also supported the need for support and understanding as related to the everyday challenges of making a transition—for example, balancing personal and professional demands or needs, transportation, and child care.
In terms of the prioritization of CAPS support services, students rated Academic and Clinical Skills Support, Test-Taking Assistance, and Mentoring by faculty as having the highest priority. With regard to likelihood of service use, findings revealed that students would be very likely to use Academic and Clinical Skills Support (52% and 75%, respectively), Test-Taking Assistance, (46%), and Mentoring (45%). In terms of prioritization of CAPS Career Advancement and Professional Development Support services, students rated assistance with job searches, professional career development services, help with resume/CV writing, and mentoring from faculty members as high priority areas. With regard to likelihood of service use, findings revealed that students would be “very likely” to use the following services: assistance with job searches, professional career development services, mentoring with a faculty member, and assistance with resume/CV writing. The majority of students noted that lack of time may be the biggest barrier to using services, followed by student perception of limited access to services, stigma associated with support, and concerns regarding a possible delayed response from CAPS faculty when a request is made for service.
CAPS Team Development and Operation
During its first year of development, the CAPS team spent time identifying CAPS team members; outlining its aims; developing and publicizing its academic, clinical, and professional services; and creating an electronic Web-based CAPS request page and anonymous satisfaction survey. Team members finalized the aims of CAPS as helping students to develop the learning strategies, improved study habits, critical thinking skills, and career management skills required for successful academic performance and professional advancement. They agreed that CAPS services should promote a healthy balance between personal and professional goals and be based on a belief that academic success and professional growth occur within strong mutual connections with peers and faculty. Team members also agreed that pet-assisted therapy could provide students an additional form of social support for transient periods of stress or anxiety. These beliefs are supported by theories regarding academic, career, and psychological development (Fletcher, 1999; Jordan, 2010; Lo, Reeves, Jenkins, & Parkman, 2016; Schlossberg, 2011). CAPS services include academic and clinical course support, mentoring by a faculty member, peer mentoring, career coach and resume writing, librarian assistance, test-taking skills, NCLEX preparation, writing coaches, math tutoring, stress management and wellness, pet-assisted wellness support, and social activities.
CAPS Program Outcome Data
CAPS began offering services in the fall of 2011. Data from September 2012 through May 2015 reveal that CAPS (individually delivered) services were used by 645 students and that, overall, services have been well received and have appropriately targeted student learning needs. Table 2 shows CAPS service use and faculty hours outcome data from 2011–2015.
CAPS Service Utilization and Faculty Hours Program Data, 2011–2015
Student requests for individually delivered services (e.g., clinical support, librarian assistance, mentoring, test-taking, stress management, writing coaches, and resume writing) increased over time. Faculty time spent delivering these services began at 439 hours in 2011–2012, peaked at 538 in 2013–2014 and then dropped back to 444 in 2014–2015. Number of academic–clinical group sessions (e.g., NCLEX, test-taking, academic–clinical support, and career coaching) decreased over time. NCLEX group sessions ranged from 25 to 36 per year over the 4-year period. CAPS workload for full-time faculty was initially based on team input and survey data regarding student needs. Workload assignments ranging from 10% to 30% (per full-time faculty member) have been adjusted over time according to CAPS direct service outcome data and faculty input about indirect time. Part-time CAPS team members (e.g., writing coaches and near peer mentors) are paid hourly for submitted time.
In addition, outcome data revealed that over the past 4 years, students most frequently requested the following CAPS services: Academic and Clinical Support, Writing Skills, Test-Taking Assistance, and Professional and Career Support. These findings are in alignment with the high student ratings assigned Academic and Clinical Support, Test-Taking Assistance, and Professional Career Support on the initial CAPS Student Needs Assessment Survey.
Student satisfaction with CAPS Academic and Clinical Support Group offerings has remained very high from 2011–2015. All students from 2011–2015 rated CAPS group-based services (e.g., NCLEX review, Comprehensive Nursing Assessment) as very satisfying or satisfying. Satisfaction comments regarding group-based services remain very positive (e.g., “The review sessions were well-organized and presented major concepts in a clear and concise manner. It was helpful to discuss concepts out loud and apply concepts by completing NCLEX-style questions. Thank you for your time!”). Data regarding student satisfaction with individually delivered services (e.g., course content/skills building, test-taking, writing, and professional and career coaching) showed that 97% rated individually delivered services as very satisfying or satisfying. Since September 2011, 3% of students rated individually delivered CAPS services as dissatisfying. These comments have included a wait time between a CAPS request and faculty response, an instructor's lateness for a CAPS session, and feeling an instructor was “congenial” but not really “hearing” the student. The following student comments exemplify the high student satisfaction with CAPS services:
- I have been out of school for so long…. The first time [I used CAPS] was for statistics and [the] second [time was] for writing. It has been a life saver.
- She was so helpful with teaching me skills to use on taking exams…. The support systems, like her, are what makes this program so special.
- I could not have asked for a better help with my paper. She was a great assistance and a huge inspiration for my future in nursing.
In general, CAPS outcome data have allowed us to track trends regarding service provision and high-use students. These students may need extra attention to ensure their program success, and monthly CAPS meetings provide an additional forum in which to ensure faculty are working together effectively and efficiently to coordinate support services. The data have helped us consider the costs for CAPS service provision, as well as the return on our investment in CAPS. For example, hours spent delivering individual services increased from 439 hours in 2011 to 538 hours in 2014. Although part of this increase related to increased need, data analysis and team discussion also revealed the need for dialogue with course coordinators regarding the timing of CAPS referrals. Students were reminded to initially connect with course instructors before self-referring to CAPS, and service delivery was reengineered to offer more group-based services. These actions led to a drop in individually delivered service hours to 444 in 2015 without compromising service quality and student satisfaction.
Finally, data collection on CAPS faculty effort led to a slight increase in the amount of allocated time. Core operating dollars ($225,000) have been used from the beginning to finance CAPS development, implementation, and ongoing support.
Future Implications for Nursing Education and Professional Development
Although the experiences with the CAPS program at the University of Rochester provide nursing leaders and faculty insight into the design, implementation, and evaluation of a formal, integrated, and comprehensive student support program, limitations of this experience must be addressed. Demographics and characteristics of the largest group of students seeking support—second-degree students—may be somewhat consistent nationally, but individual school demographics may also be a factor in transferability of these findings to other accelerated nursing programs as well. Nonetheless, schools of nursing can use the experiences from the CAPS program as a catalyst for more closely examining and meeting the academic and professional development needs of students.
Recent literature demonstrates the importance of both social and academic factors for academic support programming and their influence on the satisfaction and success of second degree or nontraditional nursing students in general (Beauvais, Stewart, DeNisco, & Beauvais, 2013; Zhang & Finch, 2012). Findings from the evaluation of the CAPS program support the theory that learning and learning support are socially rooted phenomena. They suggest that those services identified as important to student support, such as student–faculty/peer mentor interactions, transitions into a new career, and the importance of learning in small groups, can be explained from both adult learning theory, as well as adult transition perspectives. Findings from the CAPS student survey and follow-up evaluations emphasize the importance of social and academic support.
Experiences with the University of Rochester CAPS program raise awareness of the unique factors associated with students' needs, thereby offering nursing schools critical information not only about the necessity of support programs for the nontraditional students but also how to structure, position, and better develop activities to mitigate the stress (including social and academic) experienced by these students. The early identification of at-risk students (e.g., those from a non-STEM background) is critical to provide all students with additional assistance at the beginning of their program of study to ensure college success. Outcome data regarding the experiences of accelerated nursing students receiving a formal support program such as CAPS, as well as student experiences and reactions to an accelerated program structure and organization, provide nursing faculty and educational administrators with insight and information to better support this student population.
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Stressors Adversely Affecting Student Academic Success
|Imbalance between personal and professional life||71|
|Feeling disconnected from faculty||63|
|Lack of peer support at school||56|
|Being new to the area||53|
|Lack of primary emotional support||44|
|Primary support lives at a distance||41|
|Child care problems||37|
CAPS Service Utilization and Faculty Hours Program Data, 2011–2015
|Academic Year||Total Student Requests (Individually Delivered Services)||Faculty Time (Hours) Spent (Individually Delivered Services)||No. of Group Sessions Offered for Academic and Clinical Course Review||No. of Group Sessions Offered for NCLEX Preparation|
|2011–2012||267||439||94||Not separated as category|