1 Accelerated Bachelor s Program Provides New Nursing Option Jesus A. Hernandez, assistant professor, and Tama Morris, associate nursing professor, Presbyterian School of Nursing at Queens University of Charlotte Accelerated bachelor s of science in nursing (ABSN) programs provide an opening into professional nursing and have been described as a clinical strategy for addressing the expected nursing shortage of 1.2 million registered nurses by ABSN programs are in great demand and provide an education comparable to traditional bachelor s of science in nursing (BSN) programs but at a faster pace.² Within the Blair College of Health, the Presbyterian School of Nursing (PSON) at Queens University of Charlotte in North Carolina offers three options in the BSN program: traditional undergraduate BSN, registered nurse (RN) to BSN and ABSN, the newest option. Queens offers the only 12-month ABSN program in the region and is one of six schools in North Carolina to offer it. 3 In May 2010, 32 students started the first ABSN class at PSON. The diverse class of traditional and underrepresented groups in nursing progressed as a cohort. Three dedicated faculty and support faculty provided guidance. The initial cohort included two males, four African-American students, one Asian student, one Hispanic student and five other students from Ghana, Liberia, Nigeria and Russia. Their ages ranged from 21 to 54. Of those admitted, three withdrew early in the first semester, citing difficulties with the program s fast pace. One student was academically unsuccessful at the end of the first term. Two students eventually transitioned to the traditional pre-licensure BSN program. Two other students withdrew from the program during the second semester due to personal concerns. The retention rate for the first cohort was 81%. Admission criteria for the ABSN option remained consistent with that of the traditional pre-licensure BSN program. In addition, ABSN applicants must have a bachelor s degree in another field. The students had a variety of earned degrees, including in psychology, philosophy, theology, business, nutrition, education, pre-med and fashion design. 4 The ABSN curriculum includes 58 credit hours and nearly 600 hours of clinical practice in multiple inpatient and community settings. The conceptual curriculum is identical to the traditional pre-licensure BSN option, which is offered throughout four semesters in two academic years. The Commission on Colleges of Nursing Education accredited curriculum is based on the Essentials of Baccalaureate Education for Professional Nursing Practice of the
2 American Association of Colleges of Nursing. 5 The curriculum also incorporates safe competent practice, therapeutic interventions, communication, critical thinking, population or global perspectives, cultural diversity, advocacy or access to healthcare and technology. These topics are threaded between the pillars of evidence-based care and values-based practice advocated by William K. Cody, author of Philosophical and Theoretical Perspectives for Advanced Nursing. 6 Program of success To practice in the United States, all nurses are required to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN). From the beginning of the program, students were immersed in a culture of NCLEX-RN success. Philosophical tenets of the NCLEX-RN culture build the reflective practice model elements that challenge faculty and students to reflect on actions, assess outcomes and seek ongoing improvement. 7 This plan assumes that as culture is transmitted to new generations, a system of values, beliefs and traditions that promote NCLEX-RN success can be transmitted to nursing students. Using transformational leadership principles, this culture can be elevated, transmitted, taught and modeled to students in ways that motivate all toward a common goal in a systematic, intentional and persistent manner. Communicating this expectation in a positive and proactive cultural manner removes the punitive signals often perceived by students in regards to remediation activities and the additional efforts required outside of class to ensure success. NCLEX-RN success is something all students can attain. ABSN students consider themselves self-directed learners and have greater expectation for faculty guidance. 8 The plan challenges the students and faculty to reflect on testing progress and take action for remediation toward improving NCLEX-RN outcomes. This pilot program, developed by the core ABSN faculty team, is designed to promote a culture that values and plans for NCLRX-RN success from the first day of enrollment and provides resources to support success. The goal of the NCLEX-RN success plan is to consistently achieve a 100% NCLEX-RN first-time pass rate. The NCLEX success plan s values and strategies use the letters of NCLEX as an acronym: N = nurturing success. C = collaborating effectively.
3 L = learning testing skills and plan. E = examining item rationales. X = expecting and expending effort. The NCLEX-RN test plan and web links were presented on the day of ABSN orientation, during which students discussed and initiated the plan for success. Inherent in the plan for success are student commitment, focused testing, end-of-semester integrative testing, remediation, review books, completion of 2,500 NCLEX-RN-style questions, NCLEX-RN-style course test items, gaming, faculty-led testing sessions and a comprehensive NCLEX-RN review. The PSON faculty and administration chose to implement the NCLEX Test Prep and Admissions program designed by Kaplan Testing Services in 2009 as a vendor for NCLEX-RN preparation and testing. 9 The ABSN faculty used up to 100 tests and case studies to prepare students for the NCLEX-RN. A faculty member was assigned the role of Kaplan coordinator, and a Kaplan plan was constructed that determined which products would be offered in designated courses throughout the curriculum. ABSN faculty agreed to incorporate focus and integrated tests within the course syllabus and course schedules to ensure accountability and follow through with the plan. Kaplan representatives met with students to assist them in making the best use of the products available. Faculty advisors met regularly with students to gauge progress in completing the individualized NCLEX-RN success plan and to keep students abreast of their progress and predictors for success. The plan includes a table in which students record their integrated test percentile scores and compare the scores to class and national means. In addition, students and faculty can add comments about student performance. The plan lets students reflect on and evaluate their progress and specific strategies used for success. Individualized remediation identifies student-learning needs and targets areas for improvement. Online Kaplan remediation and other interventions were required of all students achieving below the national mean for each integrative test. Students were informed of Kaplan s recommendation that scores above the 60th percentile on integrated tests suggested NCLEX- RN success and that remediation was required for scores below this threshold.
4 The PSON initiated an additional faculty-led program to support test-taking skills called NCLEX-RN Reflex. ABSN students were required to attend at least one session each semester and more if it was determined they were at risk for failing the NCLEX-RN. Commercial NCLEXstyle question games also were used. All students completed a required comprehensive Kaplan NCLEX review immediately after graduation. Initially, eight students were at risk for NCLEX-RN failure based on integrative testing scores. Five brought their overall mean above the at-risk average by the end of the program. Predictors based on final mean percentile scores below 50% on Kaplan diagnostic assessment testing identified four of these students as continuing to be at highest risk of failing at the completion of the option. Twenty-six graduates completed the rigorous ABSN program with a minimum gradepoint average of 3.0. Despite remediation efforts continuing until graduation, only one of the four at-highest-risk students was successful in passing NCLEX-RN. The remaining three at highest risk were the only students to fail NCLEX-RN the first time. Overall, the NCLEX-RN pass rate for the cohort was 89%, which exceeded the state and national averages. Looking ahead One goal for the second ABSN cohort is to explore additional early identification and remediation strategies to ensure all at-risk students are successful. With student feedback, the faculty made improvements to the NCLEX-RN success plan and procured new Kaplan products, including additional resources on medication calculations. One caveat that students and faculty identified was the need to reduce testing fatigue by reducing the number of electronic platforms and learning management systems expected to be used by students. The success of the ABSN can be attributed to many factors. Queens mission is to provide educational experiences that transform students' lives and foster personal and professional success. Administrative resources supported the ABSN s development and quality. Highly qualified faculty encouraged students to think critically and creatively, develop a valuesbased practice and provide evidence-based care as they became assertive, novice nurses. Partnerships with an array of excellent inpatient and community agencies provided effective environments for clinical practice and development. Frequent student surveys, student-faculty class meetings, student participation in school committees and clinical reflections empowered
5 students and provided a student-centered approach to learning. As of September 2010, 75% of graduates have started their nursing careers in several specialties, including primary care, critical care, adult nursing, neonatal and emergency nursing. ABSN programs and options attract a talented pool of applicants to the nursing profession and have the potential for alleviating the predicted nursing shortage. Innovative strategies and partnerships can promote student success and increase coveted first-time NCLEX-RN pass rates often used as outcome criteria for program success. The Queens University of Charlotte inaugural ABSN class of 2010 is poised to meet the society s healthcare needs and provide new perspective and leadership to America s most trusted profession. References 1. Bobbie Siler, Nancy DeBasio and Karin Roberts, Profile of Non-Nurse College Graduates Enrolled in Accelerated Baccalaureate Curricula Results of a National Study, The Free Library, of non-nurse college graduates enrolled in accelerated...- a , Nov. 1, Pamela R. Cangelosi and Karen J. Whitt, Accelerated Nursing Programs: What Do We Know? The Free Library, nursing programs: what do we know?-a , March 1, Queens University of Charlotte, Undergraduate Nursing Programs, 4. Ibid. 5. American Association Colleges of Nursing, The Essentials of Baccalaureate Education, William K. Cody, Philosophical and Theoretical Perspectives for Advanced Nursing, fourth edition, Jones and Bartlett, Charles Walker, Donna Scott Tilley, Suzanne Lockwood and Mary Beth Walker, An Innovative Approach to Accelerated Baccalaureate Education, The Free Library, innovative approach to accelerated baccalaureate education.- a Nov. 1, Jean T. Walker, Tina M. Martin, Lisa Haynie, Anne Norwood, Jill White and LaVerne Grant, Preferences for Teaching Methods in a Baccalaureate Nursing Program: How Second-Degree and Traditional Students Differ, The Free Library, for teaching methods in a baccalaureate nursing program:...-a , Sept. 1, Kaplan Test Prep and Admissions, Kaplan Nursing,
6 Jesus A. Hernandez is an assistant nursing professor and accelerated bachelor s of science in nursing option coordinator for Presbyterian School of Nursing at Queens University of Charlotte in North Carolina. He is a doctoral candidate at Duquesne University in Pittsburgh and a certified family nurse practitioner. Tama Morris is an associate nursing professor and bachelor s of science in nursing program chair for Presbyterian School of Nursing at Queens University of Charlotte. She holds a doctorate in nursing curriculum and instruction from the University of North Carolina at Charlotte.
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