Journal of Nursing Education

Educational Innovations 

Developing Innovative On-Campus Intensives to Enhance Distance-Based Nurse Practitioner Programs

Blanca Iris Padilla, PhD, APRN, FNP-BC; Elizabeth K. Rende, DNP, APRN, CPNP-PC, PMHS-BC; Kathryn Evans Kreider, DNP, FNP-BC, BC-ADM

Abstract

Background:

The delivery of higher education has changed dramatically in recent years due to the shift toward distance learning, resulting in a need for creative education delivery methods. This article describes the implementation of on-campus intensives (OCIs) within a revised curricular framework for nurse practitioner (NP) students. Sequential OCIs are designed to promote role transition and professional and clinical development throughout the NP student's coursework.

Method:

The OCIs were established using a core curriculum framework. The development of the OCIs was an extensive process that requires widespread collaboration between faculty and staff.

Results:

The OCIs have been successfully implemented over multiple semesters. Faculty, staff, and students have suggested benefits along with opportunities for improvement.

Conclusion:

The OCI experiences promote engagement, clinical competency, and professional development to prepare NP students to lead in today's complex and evolving health care system. [J Nurs Educ. 2019;58(9):543–547.]

Abstract

Background:

The delivery of higher education has changed dramatically in recent years due to the shift toward distance learning, resulting in a need for creative education delivery methods. This article describes the implementation of on-campus intensives (OCIs) within a revised curricular framework for nurse practitioner (NP) students. Sequential OCIs are designed to promote role transition and professional and clinical development throughout the NP student's coursework.

Method:

The OCIs were established using a core curriculum framework. The development of the OCIs was an extensive process that requires widespread collaboration between faculty and staff.

Results:

The OCIs have been successfully implemented over multiple semesters. Faculty, staff, and students have suggested benefits along with opportunities for improvement.

Conclusion:

The OCI experiences promote engagement, clinical competency, and professional development to prepare NP students to lead in today's complex and evolving health care system. [J Nurs Educ. 2019;58(9):543–547.]

The delivery of higher education has changed dramatically in recent years due to the shift toward distance learning and educating a new generation of students (Williams, Medina, Medina, & Clifton, 2017), resulting in a need for creative teaching and education delivery methods. Although schools of nursing are embracing distance education because it provides accessibility and flexibility, faculty evaluation of student's knowledge and skills is imperative to their readiness to practice (Mackavey & Cron, 2019).

The National Organization for Nurse Practitioner Faculty (2016) published a report regarding the congruency and consistency of nurse practitioner curriculum with national standards for advanced practice RN graduate education, including guidelines for distance learning. Despite an abundance of literature surrounding the delivery of online nursing education, a paucity of literature exists describing the actual logistics and programmatic incorporation of these skill-based activities during on-campus, face-to-face time. Reconceptualization is an important aspect of transitioning to an online program and requires deliberate consideration in the weaving of curricular core concepts into the on-campus activities. Moreover, faculty should consider hands-on-skills, community/team building, and scholarly opportunities in face-to-face structured activities.

The purpose of this article is to describe a private university's school of nursing (SON) implementation of on-campus experiential and scholarly learning activities during on-campus intensives (OCIs), within its revised curricular framework, following the transition to a distance-based education. Although this new model was developed for all programs within the SON, this article focuses on the nurse practitioner (NP) program.

Background

In the past decade, the popularity of distance education has increased substantially. This increase is partially due to the demand for NPs in the workforce due to the changes in the health care delivery systems and the aging of the current U.S. population (Health Resources and Services Administration, 2013). Although NPs are in position to become leaders in health care, skepticism exists among some nurse educators regarding the effectiveness of distance education, asserting that nursing is a practice discipline requiring hands-on learning. In contrast, Colella and Beery (2014) suggested that distance education does not necessarily render the use of pedagogical approaches used with face-to-face students difficult.

Two areas of importance in NP education are clinical competency and role transformation. Results from a recent study assessing NPs' perceptions of preparedness for transition into practice noted NPs reported feeling least prepared in hands-on skills such as electrocardiogram reading, diagnostic interpretation, and office procedures (Hart & Bowen, 2016). Notably, the areas of perceived unpreparedness are hands-on skill related. Therefore, providing and engaging NP students with more experiential activities, as well as scholarly activities, may increase confidence, enhance learning, and promote application of theoretical knowledge.

Development of Curricular Core Concepts and Model

Prior to development of the OCI, an extensive curricular revision was initiated across each of the four programs (Accelerated Bachelor of Science in Nursing, Master of Science in Nursing [MSN], Doctor of Nursing Practice, and PhD). This process was led by the Curriculum Pathway Initiative (CPI) committee, who met regularly (one to two times per month) for 4 years in scheduled meetings, forums, and retreats. In addition, the CPI committee presented their ongoing work at an all-faculty retreat, internal and external presentations, and an informal Lunch and Learn to provide information, updates, status, and any internal or external challenges.

To provide perspective and understanding of the expectations of higher education in nursing, the CPI committee conducted an in-depth review of 28 documents and resources, such as The American Association of Colleges of Nursing Essentials of masters education in nursing (AACN, 2011) and Institute of Medicine, Future of Nursing Report (IOM, 2010). In addition, the CPI committee examined the mission, goals and philosophy statements from both the university and SoN. All documents and statements were culled for congruency between concepts in the Mission, Goals, and Philosophy statements and the major curricular concepts (Duke University School of Nursing: Curriculum Pathway Initiative Committee, 2010).

A list of broad, cross-program critical skills, competencies, and behaviors was categorized into seven cross-program concepts (Figure 1). The seven cross-program concepts (Scholarship, Professional Identity Formation, and Care Management, Contextual Relevance, Leadership, Collaboration, and Information Management) were operationalized and formed the basis of the conceptual framework for the curricula. The aim was to develop and operationalize program outcomes into course objectives, learning activities, and assessment and evaluation methods. Once the core curriculum concepts were operationalized, they became the basis for formulating all program outcomes (Valiga, 2018). The Master of Nursing (MSN) program outcomes were used as a guide for developing all subsequent MSN curriculum work and on-campus intensives OCIs (Duke University School of Nursing: Curriculum Pathway Initiative Committee, 2010).

Duke University School of Nursing Core Curriculum Concepts. Adapted from “Final Committee Report,” by Duke University School of Nursing: Curriculum Pathway Initiative Committee, 2010, p. 18. Copyright 2010 by Duke University School of Nursing. Adapted with permission.

Figure 1.

Duke University School of Nursing Core Curriculum Concepts. Adapted from “Final Committee Report,” by Duke University School of Nursing: Curriculum Pathway Initiative Committee, 2010, p. 18. Copyright 2010 by Duke University School of Nursing. Adapted with permission.

On-Campus Intensive. Once all MSN majors were transitioned to a distance-based format, NP students were required to attend a 2- to 5-day OCI at the start of their clinical management courses. The new curricula required that each NP student's matriculation plan include three required OCIs over the course of their program of study. Each OCI provides NP students with interactive activities with faculty and other experts that cannot be delivered in an online platform. The OCI also provides faculty the opportunity to evaluate tacit and skill knowledge as students transition into the role of the NP. Each of the OCIs are carefully planned and orchestrated by the CPI committee, faculty, and staff.

Method

Implementation and Logistics

The OCI is fundamentally distinguished from the Advanced Physical Assessment and Diagnostic Reasoning course, which focuses on course-specific physical assessment skills and return demonstration and requires several on-campus sessions. While the OCIs are not directly associated with a specific course, each OCI includes content that is strategically designed to promote role transition and professional and clinical development during the NP students' progression through the MSN program. Due to the complex nature of the OCIs, resource identification and allocation is essential.

Faculty and Clinical Instructors. Prior to the implementation of the OCIs, a group of MSN faculty conducted a needs assessment of the resources, including space and cost. Faculty and clinical instructors (CIs) were designated to lead specific clinical and professional development activities. Although many of the CIs are full-time clinicians, some have more flexible schedules and are able to assist in the OCIs.

A sign-up request to participate in each OCI is sent via e-mail to faculty and CIs in the MSN program. In any given semester, the SON has approximately 45 full-time regular-rank faculty that are affiliated with the MSN program. In addition, the SON has over 70 adjunct faculty and CIs. In the first 2 years since the OCI inception, faculty spent a great deal of time engaged in the organizing and refining of the OCI activities. With subsequent OCIs, the logistics were honed, and faculty spent less time in the logistical planning stages and more time on the planning, coordinating, and refining of activities.

Staff. The MSN program is the largest of all the programs at the SON. Therefore, having NP students on-campus for OCIs requires a significant effort from all, including staff. Four key staff members oversee all logistical flow of the event planning and implementation. The key staff are the MSN program administrator, the program assistant, a clinical placement staff specialist, and the assistant director for the Center for Nursing Discovery simulation laboratory. These individuals hold regular meetings throughout the year to prepare for the OCIs. These individuals oversee approximately 30 staff members that assist with the OCIs.

Setting. The SON has 19 classrooms and conference rooms with over 15,000 square feet of meeting space, excluding the simulation laboratory. Despite that fact, when hundreds of students are on campus, additional meeting space is required throughout the campus to accommodate all student activities. The additional space is secured up to a year prior to an OCI to ensure that all activities have a designated location that can accommodate the number of students who are scheduled to attend.

Cost. As a distance program, the MSN program aims to provide students with a sense of community. During the OCI, the SON provides students, faculty, staff, and other guests with breakfast and lunch, creating an environment of connection with faculty and staff. In addition, the MSN program provides gifts and parking passes for speakers and CIs. Other costs include supplies and the use of Cvent, a Web-based scheduling program to schedule the activities. The average cost of each OCI (excluding staffing) at our institution is approximately $15,000 per semester, or $68 per student, with an average of 220 students per semester.

Scheduling Overview. With the Core Concepts at the front and center, content is planned each semester for each OCI. NP students are provided with an individual schedule that relates to their major and progression in their program. The schedule is accessible via website and can be accessed on a computer or a smartphone. There are several types of software used to organize the OCI. For example, Excel® is used for organizing the calendar of events, Sign-Up Genius® or Volunteer Sign-Up® to recruit faculty and staff participation, and Cvent for system scheduling.

Clinical and Learning Activities. Hands-on activities and clinical training are the crux of the OCI. Local and national experts are invited as speakers and facilitators to provide scholarly learning opportunities. There is a combination of clinical training and teaching and assessment of student progress. Activities include wound management, primary and acute care procedures, high-fidelity simulations, and objective standardized clinical encounters using standardized patients, diagnostic testing (radiographs and ultrasounds), mock interviews, pharmacology cases, mock Coumadin® clinics, and many more.

In addition to the experiential activities, NP students engage in professional development activities such as ethics cases, scholarly writing, billing and coding, and professional interviews. These activities are intentionally selected to provide NP students with meaningful learning that will allow them to apply and expand on their knowledge and prepare them as nurse leaders. Additionally, these activities are intended to demonstrate a progression of growth throughout the program. For example, the selected activities in student's first OCI are markedly different from those in the third OCI. Table 1 provides a list of some of the activities the NP students engage in during an OCI.

On-Campus Intensive Activities

Table 1:

On-Campus Intensive Activities

Community-Building Activities. Early on, the faculty recognized that one of the most important aspects of bringing distance-based students to campus was engaging them in the community of the school. Several activities incorporate community building into each OCI. These include, but are not limited to, social hours, communal dining, and excursions out onto the main campus. A sense of community is particularly important for distance-based students and efforts are made to make the on-campus experience engaging and community oriented.

Results

Since the inception and initial implementation of the OCI over the past 3 years, multiple lessons were learned that have ultimately improved the process. Many challenges were identified related to the needs of the students, faculty, and staff. Faculty and staff examined some lessons learned below.

Lecture-Based Format. Avoid activities that can be delivered online. For example, an invited speaker who simply provides a straight lecture with no audience engagement proved frustrating for students who are yearning for interaction, discussion, and hands-on learning. All activities are formatted to optimize time spent on campus. Active learning techniques increase engagement, quality learning, motivation, and positive learning environments (Jeppesen, Christiansen, & Frederiksen, 2017).

Streamline Communication With Faculty and Students. Communication structures are now better streamlined for optimal communication with students, faculty, CIs, staff, and guest speakers. Timely communication provides everyone with the opportunity to plan for time away from work and family responsibilities. Advanced planning promotes student satisfaction.

Back-Up Plan. Having a back-up activity if an invited speaker is unable to attend.

Provide OCI Dates in Advance. Requesting assistance one semester in advance allows for planning and recruitment for activities. Clinical instructors often must request time off work well in advance.

Promote Student Engagement on Campus. Providing students with a sense of community provides them with a sense of belonging. Encouraging activities across campus allow students to discover and enjoy the local surroundings. Planning time during lunch or longer breaks can allow students the freedom to explore.

Start Simple. Developing OCIs for distance-based students is a significant undertaking. If OCIs are new to an institution, it is recommended to start with 1 day of activities that may be tied to specific courses. Using the on-campus time to both teach and assess students is a valuable addition to online learning that can greatly enhance student engagement and learning.

Table 2 highlights initial evaluative data provided by NP students regarding OCI experiences. Although a separate article describing the full evaluation data is planned, these findings reflect that most NP students were overall pleased with the OCI experience. If distance-based MSN programs are requiring students to attend an on-campus experience, it is essential that students perceive significant value added from the time and money spent to attend the on-campus session. Overall, these data reflect many of the students who reported that the OCIs will contribute to their development as NPs and that the activities could not have been replicated well in an online environment.

2016 OCI Evaluation

Table 2:

2016 OCI Evaluation

Conclusion

The development and implementation of the OCIs was the result of a complete curricular transformation, including the transition to distance-based education for NP students. A core curriculum framework guided these curricular and pedagogical changes. This article describes the experience of one private institution in making the transition to a distance-based program while creating on-campus experiences that promote engagement, clinical competency, and professional development to better prepare NP students to lead in today's complex and evolving health care system. SONs may consider the development or enhancement of on-campus intensives or sessions as it may provide rigor and strength to the curriculum and enhance NP readiness for practice.

References

  • American Association of Colleges of Nursing. (2011). The essentials of master's education in nursing. Retrieved from http://www.aacnnursing.org/portals/42/publications/mastersessentials11.pdf
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  • Duke University School of Nursing: Curriculum Pathway Initiative Committee. (2010). Final committee report. Durham, NC: Author.
  • Hart, A.M. & Bowen, A. (2016). New nurse practitioners' perception of preparedness for and transition into practice. Journal for Nurse Practitioners, 12, 545–552. doi:10.1016/j.nurpra.2016.04.018 [CrossRef]
  • Health Resources and Services Administration. (2013). Projecting the supply and demand for primary care practitioners through 2020. Retrieved from https://bhw.hrsa.gov/health-workforce-analysis/primary-care-2020
  • Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf
  • Jeppesen, K.H., Christiansen, S. & Frederiksen, K. (2017). Education of student nurses—A systematic literature review. Nurse Education Today, 55, 112–121. doi:10.1016/j.nedt.2017.05.005 [CrossRef]
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  • National Organization for Nurse Practitioner Faculty. (2016). Criteria for evaluation of nurse practitioner programs: A report of the National Task Force on quality nurse practitioner education (5th ed.). Retrieved from https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/Docs/EvalCriteria2016Final.pdf
  • Valiga, T.M. (2018). Curriculum models and development. In Oermann, M.H., De Gagne, J.C. & Phillips, B.C. (Eds.), Teaching in nursing and role of the educator: The complete guide to best practice in teaching, evaluation, and curriculum development (2nd ed., pp. 321–330). New York, NY: Springer.
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On-Campus Intensive Activities

OCI 1OCI 2OCI 3

Standardized patient experiences

Primary care procedures

Women's health procedures

Case presentations

Wound management

Radiology overview

Genetics ethics

Interprofessional education exercises

Wound management

Clinical writing

Pharmacology hot topics: prescriber role issues, legal, ethical, and access to medications

Caring for highly vulnerable populations

Population-specific content

Billing and coding

Interprofessional education exercises

Gerontology content

Self-care for the provider

Professional transitions (alumni panel)

Pathway to practice: population specific

Contracts/contract negotiation

Mock interviews/career preparation

Faculty/student clinic

Summative simulation

2016 OCI Evaluation

StatementStudent FeedbackSpring 2016 (n = 133)Summer 2016 (n = 113)Fall 2016 (n = 88)
I will be a more effective clinician after attending this OCI.Strongly agree109 (81.9)53 (46.9)67 (76.1)
Unsure11 (8)46 (40.7)13 (14.7)
Strongly disagree13 (10.1)14 (12.4)8 (9.2)
The OCI provided me with skills and knowledge that could not be acquired online.Strongly agree99 (74.4)51 (45.1)63 (71.4)
Unsure16 (12)37 (32.7)14 (15.4)
Strongly disagree18 (13.5)25 (22.1)11 (1.2)
Authors

Dr. Padilla is Assistant Professor, Dr. Rende is Assistant Professor, and Dr. Kreider is Assistant Professor, Duke University School of Nursing, Durham, North Carolina.

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

The authors thank Theresa M. Valiga, EdD, RN, CNE, ANEF, FAAN, Professor Emerita, Duke University School of Nursing, for her leadership and pedagogical contribution during the development of the curriculum revision and design of the framework. They also thank the Curricular Pathway Initiative committee, clinical instructors, staff, and other faculty within the school of nursing for all the hard work in making the On-Campus Intensive a realization.

Address correspondence to Blanca Iris Padilla, PhD, APRN, FNP-BC, Assistant Professor, Duke University School of Nursing, DUMC Box 3322, 307 Trent Drive, Durham, NC 27710; e-mail: Iris.padilla@duke.edu.

Received: February 18, 2019
Accepted: June 10, 2019

10.3928/01484834-20190819-09

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