The Vets2BSN Project uses a multidimensional framework that implements strategies that lead to augmented efforts in the recruitment, retention, and graduation of military corpsman and medic students enrolled in the BSN program. More specifically, the structure of this framework (a) implements outcome measures used to evaluate recruitment, retention, and graduation rates of Veteran nursing students; (b) develops an accelerated program of study that recognizes prior military training and experience in the field of health care; (c) uses military personnel, faculty advisors, alumni Vets2BSN, and senior Vets2BSN students to create social support mechanisms and mentoring programs that leverage military nurses to better communicate with program participants; and (d) prepares graduates to successfully pass the NCLEX-RN®.
Criteria for recruitment included prior or active duty military corpsmen or medics with at least 1 year of active duty service and participation in a basic military nursing school program as part of his or her initial Military Occupation Specialty training. Participants were recruited through a multitiered approach consisting of (a) preadmission open house recruitment events, (b) postadmission to the nursing program, and (c) referrals from military mentors serving in the Military Student Nurse Mentoring Organization.
First, on a bimonthly basis, the Vets2BSN Project team hosted an open house to discuss the nuances of the program and the support services offered to each participant. From that group, many students enrolled in the institution and applied for the secondary admission process in place for nursing. The academic counselor then worked closely with the nursing admissions team to identify those corpsmen and medics who applied to nursing. The counselor then tracked student admissions and offered information and invitation to the program for those who qualified.
Second, participants were recruited from prior nursing cohorts who had already began the program after the Vets2BSN Project was in place and confirmed that each had met the sampling criteria using the Joint Service Transcripts. A third approach for recruitment included snowball sampling referrals from the Military Student Nurse Mentoring Organization mentors. Vets2BSN students were integrated into existing new student cohorts as the Board of Registered Nursing did not support additional, separate cohorts above and beyond the current enrollment counts. Thus, no separate courses or clinicals were solely designated for Vets2BSN students.
Modifiers of the education experience (Figure 1) were monitored and included the areas of first contact and recruitment; orientation and preparation; monthly completion of courses with contact and remediation, as needed, for those not meeting assessment benchmarks and/or passing grades; monthly progress; availability and engagement of student financial and accessibility support services; top-of-the-line educational environment and facilities; ready access to math and writing centers; ready access to nurse tutors; access to additional academic and core enrichment seminars; professional civilian or military nurse mentoring; faculty and staff who maintain credentials and clinical expertise, as well as a strong orientation toward cultural diversity (McNeal, 2010) and military cultural competence; placement opportunities, job-seeking preparation and council opportunities; and follow-up satisfaction surveys.
Modifiers of the education experience.
Awarding Academic Credit
Military Education and Experience. National University awards quarter-hour credit for military education, military occupational specialties, rankings, and military experience with recommended baccalaureate/associate or graduate degree category units (one semester hour credit equals two thirds of a quarter-hour credit). National University awards lower and/or upper division units as specified in the American Council on Education (ACE) credit recommendations. Acceptable forms of documentation include AARTS Transcript (Army ACE Registry Transcript), CCAF Transcript (Community College of the Air Force Transcript), and SMART Transcript (Sailor/Marine ACE Registry Transcript) (Table 1).
Academic Credit for Military Training and Experience
Joint Services Transcript. Joint Services Transcript is part of an automated transcript system that combines Army, Marine Corps, Navy, and Coast Guard detailed personal service member data, military course completions with descriptions, military experience, and other learning experiences. The transcript includes college credit recommendations for ACE Guide completed evaluations. The transcript also includes college-level test score data for examinations such as College Level Examination Program (CLEP), DANTES Subject Standardized Tests (DSST), Defense Language Proficiency Test (DLPT), and Excelsior/Regents credit. These standardized and validated examinations are available for all Army, Coast Guard, Marine Corps, and Navy Active Duty, Reserve, and Veterans (Table 2).
Credit by Examination Option
Nontraditional Credit and Transcripts. Credit by Examination Option details the course equivalencies that will be awarded as college credit for the general education course requirements. Accepted examination options are described below.
- CLEP (College Level Examination Program): National University requires an official transcript to award credit for approved CLEP examinations. A complete list of recognized CLEP Subject and General Examination Credit is listed in the NU general catalog. A maximum of 67.5 quarter units may be awarded.
- DSST Program tests: National University will award up to 22.5 quarter units of DSST examination credit based on ACE Guide credit recommendations in effect at the time the examination was completed. National University awards lower division and upper division credit consistent with ACE Guide lower or upper division baccalaureate credit recommendations.
- Straighter Line: National University will award up to 22.5 quarter units for the Straighter Line physical and social science courses.
This innovative approach to nursing education maximizes the ability to award college credit. Advanced Placement, CLEP, DSST, and Straighter Line examinations are used to assess cognitive learning. With these standardized and validated tools, prior theoretical learning of the general education prerequisite courses is assessed and evaluated.
Competency-Based Demonstration and Model. Not observing and awarding credit for the competencies military medics and corpsmen already possess from extensive military training and education is in violation of the State of California Board of Registered Nursing mandate, specifically stating that:
SB 466 (Hill, Chapter 489, Statutes of 2015), approved by the Governor and filed with the Secretary of State on October 4, 2015, includes expanded requirements of registered nursing education programs specific to awarding student applicants credit in the field of nursing for military education and experience, internet posting of such information, and adoption of relevant regulations by the Board.
In accordance with this new regulation, the curriculum of study for this project complements and adheres to evidence-based nursing practice with a competency-based model of nursing education, focusing primarily on developing and measuring specific learning outcomes (competencies) that reflect the skill sets required for basic nursing practice in the contemporary professional setting using simulated learning activities (McNeal, 2010). With the existing full-time and adjunct faculty serving as competency-based education coaches, eligible students are matched to demonstrate competency for courses to be challenged.
The conceptual framework supporting this educational approach is based on the Competency Outcome, Performance Assessment (COPA) model for curriculum development in competency-based education. The eight core competencies of this model define practice and are universally applicable to both the academic and practice arenas. These essential core competencies are assessment and intervention, communication, critical thinking, teaching, human-caring relationships, management, leadership, and knowledge integration skills. Each category of competency can be further divided into skill subsets that specify the required performance measure to be achieved. This framework has been used to drive curriculum development in nursing education, continuing education, and health care programs for patients (Anema & McCoy, 2010; Lenburg, 1999). The competency-based coaching curriculum mirrors the standardized course content and syllabi but is customized to the student's learning, experience, and skills.
Adhering to the tenets of the COPA model, this project incorporates teaching–learning practices that consist of an array of methods, which also adhere to adult learning principles (Knowles, Holton, & Swanson, 2011). Methodologies include case studies, video simulations, group discussions and projects, seminars, journal writings, research projects, formative and summative assessments, and traditional lectures and presentations. Currently, most of the courses at National University are taught using hybrid, onsite, and online modes of instruction.
To assess the acquisition of nursing clinical skills, military nursing students demonstrate clinical competency in simulated laboratory settings using standardized patients and human patient simulators. Faculty-designed clinical evaluation tools are used to validate clinical proficiency, thereby obviating the need to repeat clinical courses for which clinical performance has been demonstrated.
More specifically, during the competency-based learning experience, students are expected to demonstrate performance of selected nursing procedural skills. In a simulated laboratory setting, students are given an opportunity to practice with return demonstrations until proficiency is achieved. To promote the concept of competency-based education, a skills procedure manual was developed to provide guidelines for expected levels of performance and measurement of psychomotor skills. A skills checklist is used to evaluate student competency and to maintain consistency among the faculty evaluators. Identified skills are assigned to each clinical nursing course and outlined in the skills manual. The simulation laboratory is open during select times of the week so that students may practice all the skills. Mandatory skills practice time in the simulation laboratory has been incorporated into the students' schedules. Table 3 depicts the required skills to be performed demonstrating competency in blood glucose monitoring, which is a required skill in the nursing foundations course. Students set up times with the simulation laboratory director to practice the steps delineated for each skill to obtain a passing score demonstrating proficiency. During the formal testing session, all steps in the checklist must be successfully completed without prompting from the instructor. Failure to demonstrate any of the critical elements in the checklist marked with an asterisk will result in a nonpassing score. Students may retake a performance examination one time. If the student continues to be unsuccessful, the student must enroll in the course and follow the traditional classroom mode of instruction.
Skill Competency Testing for Blood Glucose Monitoring
Credit by Examination. To test the student's theoretical nursing knowledge, the National League for Nursing RN Achievement Examinations are administered, for which a passing score must be achieved. Veteran students are awarded credit for their knowledge of pediatrics, maternal and newborn, and foundations in nursing courses. These examinations are administered in a secure and proctored setting. Students who are unsuccessful in achieving a passing score on the National League for Nursing examination must enroll in the traditional classroom mode of instruction.
As described above, the Vets2BSN Project affords the military nursing student significant savings in the cost of tuition with the granting of college credit for military experience and education, credit by examination, and credit for competency-based proficiency testing. Although there may not be a decreased time to graduation, as military students prefer to progress in their program of study as members of a cohort consisting of military and nonmilitary classmates, there will be a significant savings in the cost of tuition for the challenged general education and nursing courses. The current undergraduate cost per quarter unit for all courses is $362, with an additional cost of laboratory fees equal to $675 per clinical nursing course and a laboratory fee of $90 for all general education laboratory courses taken in the traditional classroom mode of instruction. National University permits a maximum of 67.5 quarter units—which may be awarded using the credit by examination option—to satisfy general education requirements, yielding a cost savings of over $24,000.
The National University Institutional Research Team maintains demographic data obtained at enrollment into the University. These include gender (male/female), birth date (to calculate age), race/ethnicity (White non-Hispanic, Black non-Hispanic, Asian non-Hispanic, Hispanic, and two or more races), and military status (Veteran—a person who has served in an active status, retired after at least 20 years of service, active—currently serving of active duty, or Reserve—currently serving in Reserve status).
Retention Data. Electronic data available for this project include demographics and educational metrics. Educational metrics are assessed monthly and include graduation, current National University grade point average (GPA), current combined GPA, grade in most recent course, initial grade in first course, and number of units completed. Monthly data allow for the near real-time assessment of progress in the program and allow for rapid contact and remediation, if needed. For project participants, a threshold of a course grade of B- or less, course incomplete, or fail to progress in cumulative units triggers contact with faculty and the development of a learning support plan. In addition, the project's academic counselor meets with students not meeting benchmark for individualized tutoring and follow up. All current project enrollees have been retained yielding an attrition rate of zero.