Journal of Nursing Education

Major Article 

Serving Those Who Serve Their Country: Preparing Military Veterans for Nursing Degrees

Gloria McNeal, PhD, MSN, FAAN; Tyler C. Smith, PhD; Paul Tontz, PhD

Abstract

Background:

Challenges remain for integrating Veterans into civilian occupations postservice. This article describes an innovative project affording military service personnel serving in health occupational specialties the opportunity for completion of a Bachelor of Science in Nursing (BSN) degree.

Method:

The Vets2BSN project, launched in July 2014, has achieved several years of enrollment and graduation success using standardized measures and assessment of student modifiers to establish project success.

Results:

Nearly 80 eligible students holding current or former rank as corpsmen or medics have enrolled in the program with 59 conferrals and an NCLEX pass rate of 98% (48 of 49). Prospective assessment of progress allows real-time intervention and remediation to achieve successful graduation rates.

Conclusion:

Collaboration of university administration and faculty has provided a foundation for reintegration of military health professionals possessing skills allowing for educational credit and acceleration of studies toward earning the BSN and joining the workforce as nursing professionals. [J Nurs Educ. 2019;58(8):444–453.]

Abstract

Background:

Challenges remain for integrating Veterans into civilian occupations postservice. This article describes an innovative project affording military service personnel serving in health occupational specialties the opportunity for completion of a Bachelor of Science in Nursing (BSN) degree.

Method:

The Vets2BSN project, launched in July 2014, has achieved several years of enrollment and graduation success using standardized measures and assessment of student modifiers to establish project success.

Results:

Nearly 80 eligible students holding current or former rank as corpsmen or medics have enrolled in the program with 59 conferrals and an NCLEX pass rate of 98% (48 of 49). Prospective assessment of progress allows real-time intervention and remediation to achieve successful graduation rates.

Conclusion:

Collaboration of university administration and faculty has provided a foundation for reintegration of military health professionals possessing skills allowing for educational credit and acceleration of studies toward earning the BSN and joining the workforce as nursing professionals. [J Nurs Educ. 2019;58(8):444–453.]

Traditionally, U.S. Armed Forces service men and women are afforded many training and educational opportunities during their service commitment. Combined with their extensive training and adapting to experiencing real-life occupational and familial deployment stressors, they have been traditionally sought after by nonservice-related employers. However, reports of deployment-related mental and physical injuries over the past decade have brought about a change in the perception of employability of military members postservice (Burnett-Zeigler et al., 2011; Cohen, Suri, Amick, & Yan, 2013; Crowther, Marshall, Bond, & Huxley, 2001; Hoge, Auchterlonie, & Milliken, 2006; Hoge et al., 2004; Horton et al., 2013; Jacobson et al., 2008; Resnick & Rosenheck, 2008; Smith et al., 2008; Wells et al., 2010). Public and Veteran concern stemming from the employment opportunities for our Veterans returning from the wars in Iraq and Afghanistan have prompted programs and initiatives to better prepare military Veterans, including incentives for employers to hire Veterans (Faurer, Rogers-Brodersen, & Bailie, 2014).

Innovative nursing education approaches have been documented in an attempt to meet the current shortage of nurses (Alameida et al., 2011; Cole & Adams, 2014; Frith, Sewell, & Clark, 2005; Newton, Harris, Pittilgio, & Moore, 2009; Pressler & Kenner, 2012). One area deserving of subsequent focus is the area of military-related competency, which offers a unique opportunity to a subgroup of the U.S. military personnel who trained as medics and corpsmen. These individuals have significant training and experiences that begin with an introductory nursing course training lasting approximately 14 weeks, followed by more advanced training to include didactic and clinical hours, ranging from 50 days to 12 months depending on the military branch (Wilson et al., 2016). The Accelerated Track for Vets to BSN (Vets2BSN) Project is a federally funded initiative, (“National University Receives $1.05 Million Federal Grant to Enhance Veteran Preparation for Nursing Career,”), which is designed to increase the number of medics and corpsmen who apply to, enroll in, and graduate from the Bachelor of Science in Nursing (BSN) program at National University. Through competency-based educational credit assessment and granting of credit when approved, military members with the requisite training and experience will save tuition costs and time en route to obtaining a BSN degree. The objective of this article is to describe an innovative project providing a more streamlined approach for completion of a Bachelor of Science in Nursing (BSN) degree for a unique subgroup of military service men and women serving in health occupational specialties.

Method

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®.

Cohort Recruitment

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.

Figure 1.

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

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

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

Table 3:

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.

Data

Data are the cornerstone of assessing the benefit of this project. As such, multiple data elements have been included into the program to assess progression and probability for successful completion and graduation, as well as employment.

Demographics

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.

NCLEX-RN

The National Council of State Boards of Nursing maintains the NCLEX-RN, which is a measurement tool used to measure the entry-level minimum knowledge, skills, and abilities requirements for the licensing of professional nurses in the United States (National Council of State Boards of Nursing, 2014) The NCLEX is administered online in a testing center and has varying lengths of questions and forms and relies mainly on multiple choice responses. The NCLEX has been reported to have good readability (Wendt & Worcester, 2000) and is a valid instrument for the measurement of entry-level nursing (Woo & Dragan, 2012). To date, of the current 78 medic and corpsmen who have enrolled into the project, 49 have taken the NCLEX-RN and 48 have passed, achieving a 98% passage rate.

Privacy of Data

The data of interest in this study are of a confidential nature, and strict procedures were followed to protect the confidentiality of the data. Although personal identifiers were kept to ensure proper linkage, they were protected so that no individual is identified in any report. The database was stored on the existing University information systems network, which meets current industry standard security requirements. Access to the confidential database was granted to only those study personnel with a need-to-know status. All data were carefully guarded and used only to meet the stated study objectives.

Statistical Analyses

Descriptive and bivariate analyses of cohort demographics were conducted. Data management and analyses were performed using SAS® software (version 9.1.4).

Results

Although the project is ongoing, preliminary numbers have been accumulated and presented. Table 4 includes demographic characteristics of the four cohorts (n = 78) participating in the project. Close to 50% of the participants were between 30 and 40 years old, 64% were male, 66% were Veteran or retired, and approximately half were self-indicating of White non-Hispanic. There were no statistical differences in the four cohorts regarding age, gender, military status, and ethnicity (p values from Pearson chi-square statistic not < .05).

Characteristics of 78 Vets2BSN Participants by Cohort Statusa

Table 4:

Characteristics of 78 Vets2BSN Participants by Cohort Status

Table 5 presents some of the academic measures assessed in this project. The final GPA for those graduating with a BSN degree (N = 59) was 3.61 (SD ± 0.2), indicating a population with a high GPA at graduation. The Assessment Technology Institute (ATI) Test of Essential Academic Skills (TEAS) measures ranged from 70.6 to 82.5 with the high being in the leadership component. The TEAS measures ranged from 72.7 in English language to 83.0 in reading. Nearly 20 contacts during this time period checked in on students if they failed to achieve above a B- or if they did not progress in a timely fashion.

Academic Measures of Success of Those Who Have Graduated (n = 59)

Table 5:

Academic Measures of Success of Those Who Have Graduated (n = 59)

Discussion

Veterans face myriad challenges and barriers to successful integration into civilian society, including occupational and family stress (Horton et al., 2013; Institute of Medicine, 2013). Emotional fallout from the war and financial instability can result in homelessness and represents just two of the many struggles Veterans face on an ongoing basis when they separate from military service (Elbogen, Sullivan, Wolfe, Wagner, & Beckham, 2013). Hallmark conditions including posttraumatic stress and traumatic brain injury affecting combat Veterans pose additional challenges to some in pursuit of higher education (Hoge et al., 2006; Hoge et al., 2004; Hoge et al., 2008; Smith et al., 2008; Wells et al., 2010). Although there may be a strong desire to pursue an education as a means to creating a more stable life, meeting other challenges often becomes a higher priority out of simple necessity and urgency. Therefore, it is essential that institutions of higher education address these personal needs and challenges in order to successfully enroll, retain, and graduate Veteran students.

The literature is replete with calls for curriculum reform in nursing education, advocating for curricula that are responsive to changes in the health care delivery system, as well as research-based and collaborative, and apply pedagogical innovation (Benner, Sutphen, Leonard, & Day, 2010; Lenburg, 1999). Traditional approaches to education focus on teacher-centric course objectives, lectures, and evaluation methods. Re-orientation of the focus on student performance outcomes and addressing the needs of the contemporary practice setting continue to be met with resistance (Lenburg, 1999).

To potentially improve affordability by requiring fewer courses needed and to more accurately measure student learning, the Vets2BSN project has included a component featuring competency-based education (Rivenbark & Jacobson, 2014), providing an opportunity for instructors to measure attainment of the program learning outcomes through simulation (McNeal, 2010), obviating the need for student time in the classroom. This is a critical benefit for military corpsmen and medic Veterans who have significant amounts of time in the field but do not have the needed verification of the specific learning outcomes to obtain their nursing license. In this setting, medics or corpsmen could take an examination to prove their competency in an area that they have been previously field and classroom trained for in the military. If they attain those competency measures via testing, then they are granted academic credit for the course without needing to spend time in the classroom and thus progress to the next course in the program sequence. The current time to graduation is 22 months, and this assessment method has the potential to reduce time to graduation, improve affordability, and better measure those competencies we seek to instill in nurses.

As presented in Figure 1, this project depicts the impact along each broad area of the continuum that comprises a student's educational pathway toward success. In the early stages of the student pathway, the academic counselor and nursing admission team recruit and engage with medics and corpsmen who seek to apply to nursing school. They provide meeting time, meeting space, contact and links to writing and math centers, assistance with TEAS examinations, and assignment of a mentor, if requested. As stated previously, the TEAS is commonly used as a nursing admissions tool to predict successful completion and academic success in nursing school. Although our TEAS examination measures were consistent with other populations, no available literature reported the TEAS characteristics of Veterans entering nursing school. In theory, these efforts increase the odds of acceptance into the program and are measured and compared with other population acceptance rates. After acceptance into the program, National University's unique monthly format permits near real-time assessment of the student's achievements and progress and allows for rapid engagement with students who may need extra mentoring or help. Although participants of the program are integrated with all other nursing students, the academic counselor uses a touch point with project students who receive a B- in a course or if they have not completed a course in 2 consecutive months (standard course duration is 2 months), allowing for a meeting and conversation with the military student to determine whether he or she continues on the correct successful track. This level of pro-activity in normalizing help-seeking behaviors when needed is important because Veterans, particularly female Veterans, may hold strong beliefs enculturated in the military of not asking for help and may view help seeking behaviors as a weakness (DiRamio, Jarvis, Iverson, Seher, & Anderson, 2015). These touch points allow for additional mentoring resources to be focused on those individuals to ensure progression in the program. National University facilities offer state-of-the-art electronic testing centers and study areas. Newsletters have been developed to engage Veterans and their family members in communication of events and upcoming training, as well as progress of project participants. Tracking of standardized test scores is ongoing, along with the assessment of NCLEX pass rates and employment rates via participant and employer assessment of satisfaction. For example, this population showed high scores in ATI leadership and management, which has a large focus on rules of behavior and interaction, delegation, and chain of command—all components defined by a typical military work environment (Bennett et al., 2015). Further, this finding is not surprising as each military branch devotes particular time and resources into leadership development and training centers for its unit leaders (Kirchner & Akdere, 2017).

Determination of Project Success

Successful reintegration of military health professionals into the civilian workforce requires innovative educational approaches. Advances in competency-based models will allow retrospective assessment of training and time served in military occupational specialties defining the learning outcomes necessary for receiving credit for course work needed to achieve a BSN degree. New efforts should investigate the possibility of standardizing credit for occupations and training experiences, as well as offer credit for occupational events that further refine future educational needs. Determination of success will ultimately be assessed through the end goal of employment as a nurse. Enhanced competency-based learning opportunities, such as what this program offers to our Veterans and military students, are critical elements for building a strong pool of potential nurses.

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Academic Credit for Military Training and Experience

Name of Document/ExaminationDescriptionCredit Awarded
AARTS Transcript (Army ACE Registry Transcript); CCAF Transcript (Community College of the Air Force Transcript); and, SMART Transcript (Sailor/Marine American Council on Education [ACE] Registry Transcript).Credit for military education, Military Occupational Specialties Rankings and Military Experience with recommended baccalaureate/associate or graduate degree category units.National University awards lower and/or upper division units as specified in the ACE credit recommendations with a maximum of 30 semester/45 quarter units*
JST (Joint Services Transcript)JST 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.*See above
CLEP (College Level Examination Program)CLEP is a group of standardized tests created and administered by College Board. These tests assess college-level knowledge in thirty-six subject areas and provide a mechanism for earning college credits without taking college courses (https://clep.collegeboard.org/history-and-social-sciences/american-government).Maximum of 45 semester/67.5 quarter units
DSST (DANTES Subject Standardized Test)A form of prior learning assessment, DSSTs offer students a cost-effective, timesaving way to use their knowledge acquired outside of the classroom (perhaps from reading, on-the-job training, or independent study) to accomplish their educational goals (https://www.aiuniv.edu/military-students/transfer-military-college-credit-dsst-dantes).Maximum of 15 semester/22.5 quarter units of DSST examination credit based on ACE Guide credit recommendations in effect at the time the examination was completed.
Straighter LineEducational company that offers low-price, online higher education courses that are equivalent to general courses required for a bachelor's degree. ACE's College Credit Recommendation Service has evaluated and recommended college credit for StraighterLine courses (https://www.straighterline.com/about-us/).12 semester/18 quarter units (Anatomy and Physiology I/II with labs and Microbiology with lab)
Competency-Based EducationCompetency-based learning is a system of education, often referred to as proficiency or mastery-based, in which students advance and move ahead in their lessons based on demonstration of mastery. In order for students to progress at a meaningful pace, schools and teachers provide differentiated instruction and support (http://www.ncsl.org/research/education/competency.aspx).Any nursing course with proper passage of skill demonstration, standardized testing, and simulation experiences

Credit by Examination Option

Types of CreditaCredit by ExaminationACE-Approved Courses
Pre-entry program sequence (9 units)
  NSG-198 Transition CourseSkills Validation
  NCLEX-PNLVN Licensure Awarded
Area A: English & Communication (15 units)
  ENG-100-Effective College English ICLEPCollege Composition
  ENG-101-Effective College English IICLEPCollege Composition
  ENG-240-Advanced CompositionCLEPCollege Composition
  COM-103-Public SpeakingDSSTPrinciples of Public Speaking
Area B: Mathematical Concepts and Quantitative Reasoning (4.5 units)
  BST-322-Intro to Biomedical StatisticsDSSTPrinciples of Statistics
  MTH-204-Mathematics for ScienceCLEPCollege Math
Area C: Information Literacy and Technology (4.5 units)
  ILR 260-Information LiteracyILR-260-Information Literacy
Area D: Arts, Humanities, & Languages (4.5 units)
  PHL-337-EthicsDSSTEthics in America
Area E: Social & Behavioral Sciences (9 units)
  PSY-100-Introduction to PsychologyCLEPIntro Psychology
  SOC-350-Cultural DiversityCLEPIntro Sociology
Area F: Physical & Biological Sciences (24 units)
  BIO-201/201A-Anatomy and Physiology I w/LabStraighterLineA&P I w/Lab
  BIO-202/202A-Anatomy and Physiology II w/LabStraighterLineA&P II w/Lab
  BIO-203/203A-Microbiology w/LabStraighterLineMicrobiology w/Lab
  CHE-101/101A-Chemistry w/LabStraighterLineChemistry w/Lab
Area G: Lifelong Learning and Self Development (4.5 units)
  COH-317-Public Health NutritionStraighterLineIntro to Nutrition
Area A-G: General Education (4.5 units)
  Any Approved GE for Area A-G
Preparation for the Major
  NSG-280-Human Lifecycle DevelopmentCLEPHuman Growth and Development
  HTM-310-Health Informatics

Skill Competency Testing for Blood Glucose Monitoring

Skill CompetencyaDone
Nursing process
  Assessment phase
    1. Verify the medical order and verify specific policy regarding specific procedural requirements.a
    2. Check client identification band.a
    3. Assess for history of previous pancreatic disorders.
    4. Assess the client's knowledge of procedure, comfort level, and anxiety.
    5. Assess client's most recent blood glucose level.a
  Planning phase
    1. Follow manufacturer's guidelines for maintaining quality control, date glucose solution and discard when expired, and perform quality control measurement as directed.
    2. Gather equipment: Blood glucose monitor, lancet device, lancets, nonsterile gloves, blood glucose log, control solution, and cotton balls.
    3. Explain the procedure to client and to report any discomfort.a
  Implementation phase
    1. Wash hands.a
    2. Don gloves.a
    3. Select and clean finger for puncture.
    4. Prick the finger and obtain drop of blood.
    5. Place drop of blood on test strip.a
    6. Apply pressure to puncture site.
    7. Follow manufacturer's directions to wipe off excess blood and place into glucose monitoring device for reading, and obtain a reading.a
    8. Remove gloves
    9. Wash handsa
  Evaluation phase
    1. Evaluate client for allergies and reactions.a
    2. Evaluate client response to procedure.
    3. Monitor blood glucose levels.a
  Reporting and documentation
    1. Report any untoward reaction immediately.a
    2. Report patient response.a
    3. Record blood glucose levels.

Characteristics of 78 Vets2BSN Participants by Cohort Statusa

CharacteristicTotal PopulationCohort 1 (N = 20), n (%)Cohort 2 (N = 20), n (%)Cohort 3 (N = 19), n (%)Cohort 4 (N = 19), n (%)p*
Age, years.597
  < 3026 (33.3)3 (15)7 (35)8 (42.1)8 (42.1)
  30 to < 4040 (51.2)13 65)10 (50)8 (42.1)9 (47.4)
  ≥ 4012 (15.4)4 (20)3 (15)3 (15.9)2 (10.5)
Gender.161
  Female28 (35.9)7 (35)11 (55)6 (31.6)4 (21)
  Male50 (64.1)13 (65)9 (45)13 (68.4)15 (79)
Military status.5931
  Veteran or retired48 (65.8)15 (75)14 (70)11 (57.9)8 (57.1)
  Active or active Reserve25 (34.3)5 (25)6 (30)8 (42.1)6 (42.9)
Ethnicity.3168
  Asian8 (10.8)3 (20)0 (0)4 (21.1)1 (6.3)
  Black or African American4 (5.4)1 (0)1 (5)0 (0)2 (12.5)
  No response/missing1 (1.4)0 (5)0 (0)1 (5.3)0 (0)
  Hispanic15 (20.3)5 (15)5 (25)3 (15.8)2 (12.5)
  Native Hawaiian/Pacific Islander1 (1.4)0 (5)0 (0)1 (5.3)0 (0)
  Two or more races7 (9.5)0 (15)1 (5)3 (15.8)3 (18.8)
  White38 (51.4)10 (40)13 (65)7 (36.8)8 (50)

Academic Measures of Success of Those Who Have Graduated (n = 59)

MeasureMeanSDNational Mean
Final grade point average3.610.2
Assessment Technology Institute
  Fundamentals73.16.364.1
  Medical–surgical76.45.868.5
  Leadership82.55.472.2
  Community82.25.072.4
  Children71.78.364.2
  Pharmacology70.613.564.8
  Mental75.96.269.1
  Newborn74.38.467.6
  Nutrition76.86.465.7
Test of Essential Academic Skills
  Reading83.08.175.6
  Mathematics80.511.673.9
  Science73.110.563.4
  English language72.710.670.4
Authors

Dr. McNeal is Dean, School of Health and Human Services, Dr. Smith is Professor and Chair, Department of Community Health, and Dr. Tontz is Academic Counselor, Department of Nursing, and National University, San Diego, California.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UF1HP26986, Nurse Education, Practice, Quality and Retention—Veterans' Bachelor of Science in Nursing Program (NEPQR-VBSN). The total grant award is for $1.4 million. Twenty-seven percent of the financial support for this project is from nongovernmental sources. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. The authors thank the Vets2BSN participants and the Vets2BSN Advisory Board, which included the President of REBOOT, and leadership of the National University Office of Student Services, the Veterans Center, the Associate Regional Dean for Military Affairs, the Marketing Department, the Nursing Department Chair and Faculty, the Director of Skills and Simulation, and the School Office of Enrollment and Student Support Services.

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

Address correspondence to Tyler C. Smith, PhD, Professor and Chair, Department of Community Health, School of Health and Human Services, National University, 3678 Aero Court, San Diego, CA 92123-1788; e-mail: tsmith@nu.edu.

Received: August 30, 2018
Accepted: May 21, 2019

10.3928/01484834-20190719-03

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