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The Second-Degree Accelerated Program As an Innovative Educational Strategy: New Century, New Chapter, New Challenge

Posted on: Thursday, 29 September 2005, 03:01 CDT

By Miklancie, Margaret; Davis, Theresa

ABSTRACT

This article discusses one institution's experience with a one- year, accelerated second-degree program and the role such programs play as part of a solution to the current nursing shortage.

Key Words Accelerated Nursing Education * Nursing Shortage * Nursing Curriculum * Second Degree

HISTORY TENDS TO REPEAT ITSELF. Here we are in the new century, challenged to meet the needs of an evolving, complex society. This is a place we have been before, and once again the second-degree program emerges as a possible solution to a growing problem. This article discusses the lessons learned following the introduction of a second-degree program at George Mason University in Virginia.

The Problem With the Bureau of Labor Statistics prediction that one million new registered nurses will be needed by 2012, the pressure is on to find rapid and effective ways to educate large numbers of RNs (1). But how do we, in a brief period of time, educate nurses who have the ability to deliver quality patient care in a dynamic and complex environment?

Recent events have triggered a desire in many individuals to find greater meaning in their work and to help others. Reevaluating their priorities, these individuals are seeking careers that involve caring for people in need and closer contact with the community. They see nursing as an alluring career option. The unpredictable economy has also contributed to changing priorities. People are yearning for stable careers.

These factors have led to escalating interest in second-degree programs. There were 31 accelerated BSN programs in 1990 compared with 168 today, and 46 more programs are being planned (1). The University of Wisconsin, which has had a second-degree program in place since 1991, has noticed a large increase in applications (2). Other universities across the nation have also experienced this trend.

Efforts to increase nursing student enrollments have also resulted from collaboration between health care organizations and universities. Sharing facilities, enabling expert practitioners to serve as faculty, and tuition reimbursement in exchange for work commitments are some of the strategies used to provide educational opportunities for nursing students (3). The challenge is to educate registered nurses who are safe and competent practitioners of nursing at a faster pace without compromising the value of educational programs.

Accelerated programs are offered in 35 states and provide the fastest track for individuals who already hold a four-year degree (4). Despite the growth of accelerated programs, Speziale reminds us that we need to proceed with caution. She states that fast-track education, while helping to provide immediate relief for the nursing shortage, may not be sufficient to meet the needs of our complex society (4). She recommends finding a balance between the needs of the system and the needs of the learner, keeping in mind the long- term goals of the nursing profession.

One Program's Experience In 2001, feeling pressure from the local community to help meet the increasing demand for nurses, George Mason University reinstituted an accelerated program originally initiated in 1989. The original program was closed in 1993 when the college of nursing changed the undergraduate curriculum to a community-based model. At the time this program was terminated, the supply of nurses in northern Virginia seemed to be in balance.

Although the only advertising for the current program was through the university website, more than 175 applications were received to fill 40 slots. The decision was made to look for applicants who met the entry criteria and had the prerequisite courses, could handle the one-year challenge, and were ready to make a commitment for the 2002-2003 academic year. Students were strongly advised not to work full time due to the demands and the fast pace of the program. (See Table.)

Second-degree students have been described as having more life experiences and being more inclined to take initiative in gaining clinical experiences than traditional students. They are chronologically older, exceptional learners, and are not afraid to confront their instructors (1). Bradshaw and Nugent (5) state that second-degree students view education more critically and often use a business-related style, focusing on a goal that will result in job advancement. Anderson describes these students as possessing the potential for talent in the future (6).

That these descriptions characterized the first George Mason accelerated class was apparent from the first day of the first semester. A faculty member, feeling anxious about meeting a whole new group of students, arrived at the classroom approximately 15 minutes before the scheduled starting time. Although the previous professor was preparing to gather his things and leave, the classroom was filled with students. After waiting in the hall for several minutes, the teacher entered the classroom and learned that the students were not from the previous class. They were, in fact, the new group of second-degree students, in place and ready to work.

Table. Accelerated BSN Curriculum for Second-Degree Students

The group consisted of 36 women aged 22 to 45 and four men aged 35 to 45. Eight of the 40 students had master's degrees in biology, communications, counseling, elementary education, psychology, public health, geology, and chemistry. The others had bachelor's degrees in health science, biotechnology, psychology, English, political science, government, exercise physiology, respiratory therapy, communications, biology, human services, and chemistry.

Students' past experiences were largely considered advantages but did present some challenges. Students could easily apply past experiences as lessons for particular situations. However, a student with experience in the business world had high expectations for applying management strategies to nursing, but had difficulty mastering the routine of the unit.

The second-degree students challenged the critical thinking of faculty and in many ways forced faculty to stay current in their teaching practices. Grading presented certain problems. Students had high expectations for themselves, which led to different perceptions with regard to performance outcomes.

Unlike traditional students, second-degree students were eager to visit patients' rooms and talk with patients and their families. They were also not afraid of physicians. They would ask for more information about diseases or treatment plans, which they would discuss with other nurses and their peers in postconference. This assertiveness should prove to be helpful for establishing multidisciplinary collaborations. (See Sidebar 1 for a graduate student's perspective.)

Teaching Strategies Inquiry-based learning as a teaching and evaluation method is introduced in the final semester during a medical-surgical preceptorship experience. During weekly postconferences, students, in couples, present a complex case to their colleagues. The group then analyzes the case and discusses learning issues that need to be addressed. Four students research the issue and present their findings at the next session.

A clinical evaluation tool developed by a faculty member is used across five clinical rotations. It is weighted to build on a foundation modeled on the 11 behaviors outlined in the AACN essentials for baccalaureate nursing education (7).

Campus labs build on one another. Following the study of basic fundamental skills during the first semester and intermediate skills during the second, students are introduced to complex practice skills. These include inserting IVs, blood draws via central venous lines, electrocardiogram scenarios, ventilators, and mock codes.

The students are evaluated in return demonstrations in which they are given scenarios that challenge them to think critically, prioritize, organize, and demonstrate three or more skills learned during the semester. They are not told in advance which skills they will need to demonstrate. (See Sidebar 2.) At the present time, return demonstrations are not part of the beginning and intermediate labs, but adding them is being considered.

Students take a national diagnostic test at the end of the spring semester and must pass with the score of 800 or above. Students who score less than 800 take a two-credit remediation course to prepare them for the NCLEX. Before the end of the summer semester, these students retake the national exam.

Observations and Recommendations One year is not enough time to socialize students into the nursing profession. During the second year of the program, opportunities such as monthly "brown bag" lunches and coffee hours with faculty were instituted to allow students to interact with faculty outside the classroom and laboratory setting. Time was also allotted to integrate students into the Student Nurses Association (SNA), and two second-degree students represented their program to the SNA Board of Directors. It is hoped that these strategies will enhance the quality of the program and help bridge relationships between second-degree and traditional students.

Also in the second year, effor\ts were made to decrease the amount of required reading, to be more selective in providing meaningful learning experiences, and to balance written and verbal assignments required to meet the objectives of the course. In line with Benner's (8) novice-to-expert approach, in which nursing knowledge builds on a scientific foundation and leads to informed decision making and critical thinking, it was considered important to eliminate busywork and develop a comprehensive approach to education. This has presented a conflict for some educators who feel a responsibility to share with students all that they themselves have learned.

A "blitz day" of orientation precedes each clinical rotation. This is a full-day working session that starts with a review of the syllabus and outlines grading criteria and course guidelines. Examples of real clinical situations are presented and worked through together to help students attain a broad picture of what they can expect in the clinical setting. Faculty present segments on such topics as critical thinking and personal safety issues in the workplace. An hour allotted for lunch provides an opportunity for faculty and students to socialize.

A spontaneous postconference on critical thinking skills in nursing conducted by a graduate student following a clinical day was very well received and made part of the normal curriculum in a structured classroom setting. Students reported that the session made them think about their behavior in the clinical setting, how to work more efficiently and effectively, and why it is important to look back, ask questions, and reflect on one's actions.

Due to the high intensity of the program, stress management strategies have been introduced as a valuable component of the curriculum. One technique involves participation in reflection and introspection at the end of the class. Using the arts to introduce a topic - poetry, a song, a story - adds meaning to the learning experience and is encouraged.

Sidebar I. A Graduate Student's Perspective

While working on a graduate internship toward a certificate in nursing education. I had the opportunity to observe traditional students and second-degree students. I spent alternate days during the spring semester with traditional students in a community-based setting and accelerated students in an acute care setting. The differences between the groups were evident from the start of the semester. The accelerated students appeared to value opportunities to expand on their patient teaching skills, while the traditional students expressed a greater interest in technical skills. They did not see the value of learning to teach and seemed to have a more narrow view of nursing. For traditional students, the purpose of the program was to learn how to perform the tasks of everyday nursing, while the second-degree students seemed to thrive on the broader aspects of nursing, such as teaching through presentations.

There also appeared to be differences in how the two groups approached working in teams. As the traditional students met with barriers to collaboration, generational differences and a variety of personal goals took time to overcome. However, by the end of the semester, they developed a strong, cohesive group. The second- degree students became a cohesive team very quickly. Although there were age differences and different lifestyles, these students depended on each other for support. Perhaps this was due to the high intensity of the program and the small number of students in the second-degree program. Staff nurses, patient care directors, and charge nurses consistently remarked how impressed they were with the second-degree students.

It was rewarding to watch the two groups evolve and move out on their own in the clinical areas. They became more confident with their assessment skills and decision making and showed pride in their accomplishments.

Sidebar 2.

Third-Semester Return Demonstration

Mr. J is admitted with chest pain, shortness of breath, fatigue, and a headache. The physician orders the following: an intravenous (IV) solution of dextrose 5 percent normal saline with 20 mEq of potassium chloride (KCI); a cardiac monitor; labs for complete blood count, arterial blood gases; and oxygen via nasal cannula at 2 L/ minute.

You need to prepare the IV. The KCI comes in a vial with 120 mEq/ cc. How/what steps will you take? Where will you start the IV? State the necessary steps in the procedure.

The blood gas results are pH = 7.1, P^sub a^CO^sub 2^ = 30, P^sub a^O^sub 2^ = 80, HCO^sub 3^ = 40. What nursing actions do you need to take and why?

When the student applies the leads for the EKG, the pattern is ventricular tachycardia. The patient codes. What steps are involved in the code? What are the different roles of the nurses?

The student uses three major skills: 1) starting an IV and hanging the solution; 2) drawing labs/accessing the vein with a step- by-step explanation (balloons filled with gelatin are used), and 3) calling a code as lead nurse, which requires knowing all parts/ roles of the health care team, defibrillator sequence, medication sequence, recording sequence, etc.

References

1. American Association of Colleges of Nursing. (2005). Accelerated programs: The fast-track to careers in nursing. AACN Issues Bulletin. [On-line]. Available: www.aacn.nche.edu/ Publications/issues/ Aug02.htm

2. Education News (2002). University of Wisconsin. Nursing Education Perspectives, 23(3), 111.

3. American Association of Colleges of Nursing. (2002). Using strategic partnerships to expand nursing education programs. MCN Issues Bulletin. [On-line]. Available: www.aacn.nche.edu/ Publications/ issues/Oct02.htm

4. Speziale, H. (2002). RN-MSN admission practices and curricula in the mid-Atlantic region. Nursing Education Perspectives, 23(6), 294-299.

5. Bradshaw, M. J., & Nugent, K. (1997). Clinical learning experiences of nontraditional age nursing students [News, Notes & Tips]. Nurse Educator, 22(6), 40-47.

6. Anderson, C. A. (2002). A reservoir of talent waiting to be tapped. Nursing Outlook, 50(1), 1-2.

7. American Association of Colleges of Nursing. (1998). The essentials of baccalaureate education for professional nursing practice. Washington, DC:Author.

8. Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley.

About the Authors Margaret Miklancie, PhD, RN, is an assistant professor at George Mason University College of Nursing and Health Science, Fairfax, Virginia. Theresa Davis, MSN, RN, is administrative director at Inova Fairfax Hospital and a graduate student in the Nursing Education Certificate Program, George Mason University. The authors are grateful to Dr. Christena Langley, assistant dean for undergraduate programs, and Terri Guingab, coordinator, Technology Simulation and Media Center, George Mason University, for their editorial assistance.

Copyright National League for Nursing, Inc. Sep/Oct 2005

Source: Nursing Education Perspectives

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