Five Years Later: Are Accelerated, Second-Degree Program Graduates Still in the Workforce?

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1 doi /ijnes International Journal of Nursing Education Scholarship 2013; 10(1): 1 6 Deborah A. Raines* Five Years Later: Are Accelerated, Second-Degree Program Graduates Still in the Workforce? Abstract: This retrospective study explores the work activities of graduates from an accelerated, seconddegree BSN program. There is documented growth in the number of accelerated, second-degree programs and the number of graduates from these programs. However, there are no published studies of whether or not these graduates are members of the workforce 5 years following graduation. This retrospective study found that the majority of the graduates are employed in nursing, and a large percentage have earned or are pursuing advanced degrees in nursing. Keywords: accelerated nursing programs, workforce, educational programs, longitudinal study *Corresponding author: Deborah A. Raines, School of Nursing, University at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA, Deborah.Raines.PhD@gmail.com The projected shortage of RNs in the workforce has generated concern about preparing enough nurses to meet workforce needs. The development of accelerated, second-degree programs of study in nursing was a response to the increased need for skilled nursing care providers. This need resulted from new technologies and the extended life-span of persons with chronic conditions, and the aging and approaching retirement of the working RN. The introduction of accelerated, second-degree programs of study was a strategy to add nurses to the workforce. Shifts in the economy, opportunities for stable employment as a nurse and upward mobility, and the desire to work with people and make a difference have increased interest in nursing among persons with bachelor s degrees in other disciplines who want a career change. However, a frequently-voiced concern in the development of accelerated programs was whether these nurses will remain in the nursing workforce or change careers again. Accelerated nursing programs offer a quick route to licensure as a registered nurse for individuals who have a bachelor s degree in another discipline. These programs accomplish the nursing program objectives in a shorter time interval by building on previous learning experiences. The typical second-degree nursing student is motivated, has high academic expectations, is anxious to gain clinical experience, and has a well-defined career goal (Seldomridge & DiBartolo, 2005). In 2011, there were 235 accelerated, second-degree baccalaureate nursing (BSN) programs in the United States (American Association of Colleges of Nursing [AACN], 2012). According to the AACN s 2011 survey, there were 14,124 students enrolled in accelerated BSN programs and 9,509 graduates in these programs in 2010 (AACN, 2012). The numbers provide evidence that these programs are adding new nurses into the workforce. In addition, the literature reports that graduates of accelerated, second-degree programs are motivated, do well on the NCLEX (licensure examination), and are valued by many employers as new graduate hires (AACN, 2012). However, whether these nurses remain in the nursing workforce or change careers again has not been studied. There are two questions raised about these nurses longevity in the workforce. The first is grounded in the thought that these might be individuals who are not committed to a career and therefore change careers every couple of years. The second thought is that an accelerated or condensed program of study does not result in a strong commitment to the profession or provide a solid foundation in nursing practice, both of which could culminate in frustration and leaving the workforce. This article presents data collected 5 years after the first two cohorts of students graduated from an accelerated, second-degree BSN program of study. The specific questions guiding this research were Are graduates in the nursing workforce 5 years after graduation? Do these nurses intend to remain in the nursing workforce? Background A career change is defined as an individual entering a new occupation which requires fundamentally different skills, daily routines and work environment from the present one (Feldman, 2002, p. 76). Enrollment in a nursing accelerated, second-degree program fulfills this

2 2 D.A. Raines: Accelerated, Second-Degree Program Graduates in Workforce definition. Mallon (1999) proposed that career change has become increasingly common in the work-life of adults and is a trend that will continue to grow. Two of the frequently-cited reasons for deciding to study in an accelerated, second-degree program are stable employment and upward mobility. Second-career nurses view nursing less as a calling than as a practical career for socioeconomic and accessibility reasons and as a chance to make a difference (Raines, 2010). Thus, the question must be asked, do these graduates contribute to the nursing workforce in the long-term? In other words, do second-career nurses view nursing as a stop on the journey through multiple career changes or does the desire to make a difference in the lives of others lead to a long-term commitment? The data on the number of programs, number of students enrolled, and the number of graduates provide evidence that these programs are introducing new nurses into the workforce, but whether these nurses are staying in nursing, filling the needs of the professional workforce, and enhancing patient outcomes have not been studied. In the past, a career progressed in a series of orderly and sequential stages within an occupation for the person s entire work-life (Levinson, 1978; Super, 1957). This career model, with the prevailing value of organizational loyalty having precedence over personal needs, is the exception today. Beginning in the 1980s individuals tended to have multiple employers, career changes, and occupational disciplines (Ginzberg & Baroudi, 1981; Van Maanen & Barley, 1984). The opportunity to change careers has been supported by population mobility, as well as opportunities to gain training and education in a new discipline. The phenomenon of multiple careers in one s work-life has been labeled as boundary-less career (Arther, 1994; Hall & Mirvis, 1995). This new model is driven by personally meaningful values and goals which are self-directed and proactively managed to achieve personal needs (Briscoe & Hall, 2006). Women are more likely than men to pursue a boundless career for its self-directedness and attainment of personally meaningful goals (Sullivan & Arthur, 2006). Understanding the psychology of a career change choice and whether or not an individual seeks to change careers is important in developing education programs to meet workforce needs. If educational programs are created to bring individuals into a discipline, such as the accelerated programs of study in nursing, but the graduates of these programs do not contribute to the profession s workforce, the effective use of programmatic resources must be questioned. There is a lack of longitudinal data about the work activities of graduates of accelerated, second-degree programs. There is a group of studies exploring topics such as NCLEX pass rate (Bentley, 2006; Seldomridge & DiBartolo, 2005), ability to multitask and to negotiate systems (Buonocore, 2002), employability (Shiber, 2003), intent to stay in their first job (Brewer et al., 2009), and activities at 1-year post-graduation (Raines & Sipes, 2007). The only published work looking beyond the first year is an investigation of the socialization of accelerated BSN graduates in the workforce at 2 3 years. Wolf (2007) in a small (n ¼ 8) phenomenological study found that accelerated graduates achieved professional socialization and felt like nurses. However, studies on the employment patterns, areas of practice, upward mobility, pursuits of advanced education in nursing, satisfaction with a nursing career, and intent to make another career change are lacking. This study examined if second-career nurses, prepared in an accelerated program of study, are in the nursing workforce 5 years after graduation. Theoretical framework Transitions are triggered by critical events impacting the individual. A transition is a process triggered by a change resulting in the passage from a fairly stable state to another fairly stable state. Leaving a previous career, entering the study of nursing, and joining the nursing workforce are a transition. The conditions of transitions influence the outcome. Meleis (2010) attributes unhealthy transition or ineffective transitions in relationships to role insufficiency. Transitions theory provides a broad view of successful transitions framed by three components: nature of the transition, conditions for the transition, and patterns of responses. Figure 1 illustrates how transition theory guided this study. The goal of healthy transitions is mastery of behaviors, cues, and sentiments associated with new roles, identities, and the related processes (Meleis et al., 2000). Exploring the 5-year post-graduation work patterns of accelerated program graduates will provide insight into the conditions that lead to an intent to stay in nursing.

3 D.A. Raines: Accelerated, Second-Degree Program Graduates in Workforce 3 Figure 1 Theoretical framework. Methods This retrospective study explored the first 5 years of the nursing careers of individuals who graduated from a new 12-month accelerated, second-degree BSN program. The participants were members of the first two cohorts of students graduating in April 2005 and May The specific foci of this study were the following: Are graduates currently employed as nurses? What type of position do the graduates hold after 5 years in the workforce? What are the reasons for job changes in the 5-year period? How satisfied are graduates with their careers in nursing? Do graduates anticipate changing careers in the next 5 years? This study used a descriptive, non-experimental survey design. The objective was to discover what graduates were doing 5 years after becoming a nurse. The population consisted of 66 students admitted to the first two cohorts of an accelerated, second-degree program at a state university in the southeastern United States. A valid address was available for 51 of the graduates. A message posted on Facebook resulted in nine additional addresses, yielding an accessible population of 60 graduates or 90.1% of the entire cohort of graduated students. The instrument was an investigator-developed survey designed to explore the concepts of interest. Nurse leaders and educators from other accelerated BSN programs reviewed the items for content validity. Study procedures were reviewed by the institutional review board. Data were collected in June 2010 from April 2005 graduates and in June 2011 from May 2006 graduates. Graduates received an explaining the research and the voluntary nature of participation. The message included a link to the on-line survey. Completion of the on-line survey constituted consent to participate. Following the initial message, a follow-up reminder which included a link to the surveywassentat6and10weekstoincreasetheresponserate. Data were downloaded from the on-line survey to a spread sheet for analysis. Descriptive statistics were generated to gain an overall picture of the data. Written comments to items on the survey were copied to a text file for referencing in discussion of the findings. Results Of the 60 graduates contacted, 54 completed the survey, yielding a 90% response rate. The participants were ethnically diverse and mirrored the composition of the entire cohort of students. Additional demographic characteristics of the respondents are displayed in Table 1. Table 1 Demographic characteristics. Demographic characteristics Number Percentage Age <30 years years years years Gender Male Female Years of work experience before becoming a nurse None years years years More than 10 years

4 4 D.A. Raines: Accelerated, Second-Degree Program Graduates in Workforce Individuals working as a nurse Forty-nine participants (91%) were employed in nursing at the time of data collection. Forty-six reported fulltime employment, defined as working h/week. Two of these individuals reported working a second job in nursing, in addition to holding a fulltime position. Three participants reported being employed part-time in nursing, working between 12 and 24 h/week, with no additional paid positions. Thirty-eight individuals (70%) were in direct patient care roles, three (5.5%) in management or administrative roles, five (9%) in educator roles, and three (5.5%) in non-direct patient care roles, but in the clinical setting. The non-patient care roles included informatics and clinical consultant roles. Employment sites were acute care hospitals (n ¼ 40, 74%), schools of nursing (n ¼ 5, 9%), and other which included an outpatient or community-based facility or an office setting (n ¼ 4, 7%). The identified clinical practice areas in order of frequency were 21 (43%) in ICU, 12 (25%) in Maternal Child (including NICU), 10 (20%) in Medical/ Surgical, 3 (6%) in OR/PACU, 1 (2%) in psychiatric/mental health, 1 (2%) in wound care, and 1 (2%) in informatics. Only 13 (23%) were working in the three counties surrounding the university that awarded the BSN degree, whereas 22 (40%) had moved to other states throughout the United States. Only seven individuals (13%) were still in the same nursing position; they had accepted following graduation. The remainder of those employed in nursing had changed jobs two or more times. For the purpose of this research, a job change was defined as a change of employers, not a change of position or unit within a healthcare organization. The most frequently-cited reason for changing jobs was family relocation. Other reasons included poor unit management, opportunity for specialty unit or promotion, desire to be a travel nurse, and a return to school necessitated a more flexible position. Overall, participants reported a high level of satisfaction with their nursing careers: 25 (51%) individuals were extremely satisfied; 21 (43%) were satisfied; and 3 (6%) were somewhat satisfied. None reported being dissatisfied and only one participant reported an anticipated career change in the next 5 years. A total of 19 (34.5%) respondents had completed or were enrolled in advanced nursing education programs: 10 had completed a MSN program; four were enrolled in a master s program, two in a DNP program, and three in a PhD program. Two of the students were enrolled in a BS to PhD program, and one had earned a MSN prior to enrolling in a traditional PhD program. Individuals not working in nursing Five participants (8%) were not employed in nursing at the time of data collection. Four of these had worked in a clinical position immediately after graduation but were not currently working and were not seeking employment in nursing. The reason given for leaving the workforce by two individuals was one to care for young children and other to care for aging parents. One left nursing after 2 years to return to school to study in another health sciences discipline. One respondent passed the NCLEX and holds an active nursing license but has never worked as a nurse. Discussion These findings provide evidence that 5 years post-graduation an overwhelming percentage of accelerated, second-degree graduates were active in the nursing workforce and demonstrate a positive response pattern to their career transition. A majority were in direct patient care roles, thereby validating the intention of the program, which was to increase the number of nurses at the bedside. A majority were working in specialty areas such as ICU, NICU, labor and delivery, or OR/PACU. This is consistent with the finding that secondcareer graduates often target working with specific patient populations such as specialty or critical care units (Hamner & Bentley, 2007). It also provides evidence that second-career, accelerated program graduates are prepared and socialized to enter the nursing workforce. These behaviors are evidence of mastery in the response pattern to the transition. Within the first 5 years of theirnursingcareer, a number of these graduates had moved into administrative, leadership, or educator positions. This is further evidence of mastery of the transition to a career as a nurse. The skills that secondcareer accelerated graduates bring from previous work experience, their ability to multitask, and interpersonal skills may be an explanation for their rapid advancement in the clinical setting. The skills that the second-degree student brings to the workforce may influence the conditions of the transition. While these individuals are learning how to be a nurse, they come to nursing with the skill of how to be part of the workforce. A number of participants had earned a master s degree in nursing within the first 5 years of becoming a nurse. Others were currently in a master s program in nursing, and a number had continued their educational journey to include study in DNP and PHD programs in nursing. Enrollment in advanced programs of study in nursing within the first 5

5 D.A. Raines: Accelerated, Second-Degree Program Graduates in Workforce 5 years following the awarding of the BSN is not a typical pattern in nursing, where lengthy clinical experience prior to pursuing an academic path is often encouraged by leaders in the clinical setting (Berlin & Sechrist, 2002). The average age of the respondents in this study who were enrolled in a PhD program was 37.5 years. This age is younger than the mean age at the awarding of the doctorate which is about 46 years (Berlin & Sechrist, 2002). Earning a terminal degree in the discipline signifies a commitment to the profession and may also address the workforce needs for nurse faculty. Participants in this sample experienced a number of job changes in the 5-year period. This is typical of findings in other studies with new graduates from traditional programs of study. Turnover rates of 35 55% in first years of employment have been reported in the US (Williams, Goode, & Krsek, 2007). In the sample studied, a number of these job changes were precipitated by extrinsic factors, not related to the nature of the job or the workforce, most often family relocation secondary to a spouse s/partner s work or educational commitments. Factors intrinsic to the job itself or the practice of nursing that resulted in job change included: opportunity for promotion, return to school and need for a more flexible schedule, and chance to work in a different specialty. The only negative factor cited as a reason for a job change was poor unit management, which was identified by four individuals. Overall, respondents reported being satisfied with a career in nursing. According to the American Hospital Association (2006), decreased staff satisfaction accounts for 52% of workforce shortage. In other words, satisfaction has a strong relationship to nurses staying in the workforce (Roberts, Jones, & Lynn, 2004). What was not clear from this study is what leads to satisfaction with this career choice in these individuals. Arther (1994) and Hall & Mirvis (1995) proposed the concept of the boundless career. The variety of opportunities within nursing may be a good fit for the individual who is looking for variation within their career trajectory. As seen in the 5-year career trajectory of the nurses in this study, individuals can change the focus of their job in nursing without changing careers. A small number of participants were not currently in the nursing workforce. The most common reason was family responsibilities, specifically caring for young children or aging parents. One graduate had never entered the nursing workforce. Yet, all these individuals maintain an active RN licenses which keeps the option of practicing at some time in the future open. One graduate is studying in another health sciences discipline, and another indicated a plan to change careers again in the next 5 years. Therefore, these findings support that with the exception of two persons, the individuals who studied in the accelerated program had made a commitment to their new career for at least a projected period of 10 years, post-graduation. Conclusions While the sample in this study is small and from a single university program, the high response rate provides insight into the contributions accelerated, second-degree graduates are making to the workforce. These findings begin to address the concern about whether career changers will remain in nursing or will change their careers again. This group of graduates provides evidence that career changers who complete an accelerated, second-degree BSN program are active and sustained contributors to the nursing workforce. In addition, these data indicate that many of these graduates return to school for graduate study, both masters and doctoral level study shortly after receiving a BSN. This trend, if more widespread, might also have an impact of the shortage of nursing faculty. While the generalizability of these findings is limited, it is encouraging to know that graduates from the accelerated program are continuing to contribute to the nursing workforce and that accelerated, seconddegree graduates are fulfilling the primary intention of these fast-track programs. These findings provide beginning evidence that an accelerated program of study is an efficient use of educational resources and produces nurses who fulfill workforce needs. References American Association of Colleges of Nursing. (2012). Accelerated baccalaureate and master s degrees in nursing. Washington, DC: Author. Retrieved June 25, 2013 from media-relations/fact-sheets/accelerated-programs. American Hospital Association. (2006, October). The state of America s hospitals taking the Pulse. Retrieved August 1, 2012 from pdf.

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