New Pathways from ADN to BSN: The Blended Learning Model to Build Capacity in the Incumbent Nursing Workforce

1 New Pathways from ADN to BSN: The Blended Learning Model to Build Capacity in the Incumbent Nursing Workforce Massachusetts Department of Higher Education Nursing Education Re-Design Grant Program Final Project Implementation Report Reporting Period: June 1, 2012 December 31, 2013 Principal Investigator: Dr. Stephanie Chalupka Submitted by: Worcester State University and UMass Memorial Medical Center December 31, 2013

2 I. Executive Summary/Overview of Project Accomplishments Worcester State University (WSU), the Central Massachusetts leader in providing ADN-to-BSN and ADN-to-MSN education for practicing registered nurses, and University of Massachusetts Memorial Medical Center (UMMMC) developed and implemented an innovative ADN-to-BSN educational program delivered in the blended-learning format on the UMMMC campuses. With only 52% of the nurses in Central Massachusetts prepared at the baccalaureate or higher degree level, WSU/UMMMC developed an easily replicated model as a method to reach the Institute of Medicine s goal of 80% of the RN workforce educated at the BSN level or higher and the corresponding goals for Massachusetts detailed in Nursing And Allied Health Workforce Development: A Strategic Workforce Plan for Massachusetts Healthcare Sector (MA DHE, 2012). Funding from the DHE Nursing and Allied Health Initiative supported the development, launch, and institutionalization of the ADN-to-BSN track promoting seamless, upward mobility for an incumbent workforce to advance their education from AND-to-BSN or higher. This program was based on a needs assessment conducted in December 2011 and a subsequent pilot study completed by the academic/practice (WSU/UMMMC) partners. This new pathway to BSN for associate degree-prepared nurses to the BSN is a model for seamless upward educational mobility that can easily be replicated by other academic/practice partnerships across the Commonwealth and nationally. With funding from this grant, the WSU/UMMMC partners were be able to: 1) Plan and develop ADN-to-BSN curriculum, to be delivered in the blended-learning format, and implemented by WSU on the UMMMC hospital campuses in Fall 2012 with 25 ADN-to BSN students; 2) Plan, develop, and implement effective academic success and retention strategies to increase ADN student readiness to undertake BSN (or ADN to MSN) studies thereby improving retention and graduation rates; 3) Increase the number of nurses in Central Massachusetts prepared with a baccalaureate degree (or higher) to promote better patient outcomes; 4) Disseminate best practices in ADN- to-bsn education delivered in the blended-learning format, using an academic/practice partnership model to other universities and hospitals through conference presentations and publications. The second ADN- to-bsn cohort entered in fall 2013 and the third will enter in January 2014. The final product is a sustainable and replicable model of nursing education for seamless upward educational mobility for associate degree-prepared nurses to earn a BSN.

3 II. Research Findings to Date Research Question 1: What role did support strategies implemented as part WSU/UMMMC Collaborative RN-to-BSN play in academic success and retention of first cohort? The support strategies included in the WSU/UMMMC Collaborative RN-to-BS Program were extremely effective in academic success and retention of first cohort with 90% of students strongly agreeing that the Strategies for Academic Success course both eased their transition into the student role (Please refer to Figure 1.) and 95% agreeing that the course was a significant factor in their success in completing the first year of studies (Please refer to Figure 2.). Learning in the electronic environment and learning to use electronic library data bases were overwhelmingly identified by the students as the most helpful topics within the course (Please refer to Figure 3). Figure 1: Strategies for Academic Success Course Helped to Ease Transition to Student Role The Strategies for Academic Success Course Helped to Ease My Transition to Student Role n=23 Strongly Agree 90% Agree 10% Neither Agree or Disagree 0% Disagree 0% Strongly Disagree 0%

4 Figure 2: Strategies for Academic Success Was a Significant Factor in Success in Year I of the Program Strategies for Academic Success Was a Significant Factor in My Own Sucess in Year I of the Program n=24 Strongly Agree 93% Agree 3% Neither Agree Nor Disagree 0% Disagree 0% Stronly Disagree 0% Figure 3: Most Helpful Component of Strategies for Academic Success Most Helpful Component of Strategies for Academic Success n=24 Learning in the Electronic Environment 39% Library Database Searching 30% Time Management 5% Presentation Skills 21% Other 5%

5 Research Question 2: What are the identified barriers to enrollment and incentives to persist in ADN-BSN (ADN-MSN) completion programs? Information about student identified barriers to enrollment and incentives to persist in ADN- BSN and AND-MSN are presented in Figures 4 and 5. Qualitative data derived from focus groups and in-depth interviews are provided in Figure 6. Figure 4: Barriers to Enrollment in ADN- to-bsn Program Barriers to Enrollment in ADN-to-BSN Program n=24 Financial 4% Personal Responsibilites 5% Ability to GetWork Schedule Accomodation 39% Difficulty with Transfer Process 52% Other, please specify 0% Figure 5: Perceived Incentives to Persist in ADN-to-BSN Program Perceived Incentives to Persist in ADN-to-BSN Program n=24 Encouragement Support from Employer 3% Support from Cohort 34% Support from WSU Advisor/Faculty33% Worksite Location Convenience 31% Cost 2% Other, please specify: 0%

6 Focus Groups and In-Depth Interviews Methods: Two types of qualitative research methods were employed: staff nurse/student focus groups (conducted at the end of the first semester) and in-depth interviews (conducted at the end of the conclusion of first year of studies). The intent of the focus groups and was to elucidate the general nature of the returning student experience particularly barriers and incentives to enroll and persist. The in-depth interviews sought to complement the focus groups by providing further insights into the student experience with emphasis on retention and progress toward completion after completing one year of the program. Recruitment of Focus Group Participants: We recruited volunteer participants from each hospital campus. The only criterion for participation in the focus group was that participants must have completed one semester in the WSU/UMMMC Collaborative RN-to-BS Program. Focus groups and interviews were conducted at each hospital campus. No participant participated on their work time and no stipend was paid, however, refreshments were provided. All focus groups were moderated by the same researcher, supported by assistants who took handwritten notes, oversaw tape recording, and performed other functional tasks. The typed transcripts were verified and analyzed thematically using NVivo10 qualitative research software.

7 Figure 6: Themes which Emerged from Focus Groups Advantages and Challenges of Academic Progression In Nursing Described in Focus Groups and Interviews Cited in: Focus Groups Interview Advantages Opportunity to fulfill personal goal X Onsite program provided important opportunity X X (may not have actually ever pursued degree without this program) Opportunity for advancement within organization X X Tuition and book benefit in union contract X X Support from cohort to keep going X X Strategies for Academic Success Course X X See new challenges and opportunities in current practice X X Feel re-energized about nursing X Greater job satisfaction X Challenges Financial (Return to school may mean need to forgo income or assume additional debt to pay tuition) X No pay differential with BS degree X X Limit on employers offered tuition assistance for part-time employees X Lack of flexibility in scheduling at work X X Disruption of family life (limited number of time requests per month means choosing between school or family) X

Research Question 3: Will the increased accessibility provided by an on-site blended-learning approach for ADN-BSN (or ADN-MSN) education promote an increase in the incumbent workforce able to advance their education? The actual number of qualified applicants to each program was 48 prospective students to the WSU On-Campus RN-to-BS Program and 25 qualified applicants to the WSU/UMMMC Collaborative RN-to-BS Program. One-hundred percent of those offered admission to the UMMMC program accepted but only 30 students accepted a place in the Fall 2012 incoming class and 100% of the 25 students who applied to the WSU/UMMMC Collaborative RN-to-BS Program accepted the offer of admission and matriculated. This willingness to accept the offer of admission, as well as increased percentage of students completing the first year of studies in the WSU/UMMMC Collaborative RN-to-BS Program, as compared (please refer to Figure 6) with the traditional on-campus WSU RN-to-BS Program offered in the fully face-to-face mode suggest that the on-site blended approach suggests that the increased accessibility facilitates academic progression in nursing. In addition, 3 of the 24 students in the WSU/UMMMC Collaborative RN-to-BS Program elected to matriculate in the RN-to-MS Fast Track Program while only 2 students of the 24 WSU on-campus students who persisted to the end of the first semester elected the RN-to-MS Fast Track option. 8 Research Question 3: Will increased accessibility and flexibility provided by this approach promote successful completion of an ADN-BSN (or ADN-MSN) program equal to or greater than existing traditional face-to-face on-campus RN-BSN completion programs? Enrollment trends for students entering the WSU on-campus RN-to-BS and the WSU/UMMMC Collaborative Program in Fall 2013 was compared. As illustrated in Figure 6, more students accepted the offer of admission to the WSU/UMMMC Collaborative RNto-BS program and significantly more persisted in the first year. One student in the WSU/ UMMMC Collaborative Program was counseled out of the program. The students in the WSU/UMMMC Collaborative RN-to-BS program are only in their second year of the program so completion data are not available at this time. However, data will continue to be collected to assess and complete completion rates.

9 Figure 6: Enrollment Trends in RN-to-BS Program on Worcester State University Campus (Delivered Fully Face-to-Face) Compared with Enrollment Trends in WSU/UMMMC Collaborative Program (Delivered in the Blended-Learning Format) 35 30 25 20 15 10 21 24 Acepted Offer of Admission for September 2012 Completing End of Semester I 5 0 BS Program on BS Program on WSU Campus UMMMC Campus

10 III. Changes Implemented and Plan for Sustainability Some curricular changes resulted from formative and summative evaluation by students. In particular, the clinical experience associated with NU 432: Advancing Perspectives in Chronic Illness was restructured to enable student to have clinical practicum on their scheduled class day. Additionally, changes were made in the method of delivery of NU 432: Health Assessment. This change resulted from limitations in the hospital physical environment for student practice activities. The decision was made by the students to have this single class held at the health assessment labs on the Worcester State University campus rather than at the hospital where facilities presented a challenge for practice sessions. Finally, resources from an additional $60,000 award from the Fairlawn Foundation of the Greater Worcester Community Foundation for AND-to-BS education have been directed toward the New Pathways from ADN to BSN: The Blended Learning Model to Build Capacity in the Incumbent Nursing Workforce program. This has greatly enhanced our ability to provide support services on the UMMMC campuses. In addition, in the first year of the grant UMMMC made an unanticipated contribution to support an additional 10 hours per month for academic advising and tutoring services on their campuses, greatly enhancing our scope of services. This project met or exceeded all goals and remained within our proposed budget. As a result of this successful academic-practice partnership and the overall satisfaction with the WSU/UMMMC Collaborative RN-to-BS program, both partners remain fully committed to continuing the collaborative program. In addition, this model has been extended to include all 5 partner hospitals in the UMass Memorial Health Care System, UMass Memorial Medical Center [University and Memorial Campuses], Wing Memorial Hospital, Marlboro Hospital, and Health Alliance Hospitals [Burbank and Fitchburg Campuses]. This provides opportunities for seamless academic progression to over 3,000 nurses system wide. IV. Barriers Encountered/Addressed In October 2012, Dr. Margaret Laccetti, UMMMC Associate Chief Nursing Officer and liaison with UMMMC nursing workforce left the employ of UMMMC. The role previously performed by Dr. Laccetti was assumed by Karen Utarro and later Carolyn Catton, Director of Nursing Professional Development. Jackie McGravey, Director of Workforce Planning and Analytics for the University of Massachusetts Memorial Health Care (UMMHC) has worked closely with both Ms. Utarro and later Carolyn Catton to facilitate both periods of transition. In the spring of 2013 labor unrest and the threat of an impending strike at UMMMC had a significantly adverse impact on our students recruiting efforts. Only 14 qualified students applied for admission to Cohort II. All qualified students were admitted and accepted the offer of admission. However, this uncertainty surrounding the impending strike resulted in our not meeting our enrollment goal of 35 for the class entering in September 2013. After the labor dispute was successfully concluded we began additional recruiting efforts. We admitted ten additional students who will join Cohort II in January 2014 bringing Cohort II to 25. We will offer the Strategies for Academic Success course in January and the Fall course that they missed in 2013 in Summer Session I (2014) to enable these additional 10 students to progress with the rest of Cohort II. We are pleased to report that interest has been strong at information sessions for Cohort III (Class entering Fall 2014).

11 V. Ongoing Project Dissemination Statewide Conference: On December 4, 2013, a state-wide conference on dissemination/replicability of the academic/practice partnership to promote seamless academic progression in Nursing was held at UMass Memorial Medical Center. At this conference, we collected and shared best practices that improve outreach, recruitment, and retention to assist students to advance their education and to insure diversity. The 57 conference attendees represented of 16 nursing programs in Massachusetts, Rhode Island and New Hampshire. One healthcare management consulting firm and four hospitals were represented. Conference evaluations were overwhelmingly positive. Conference Presentation November 22, 2013 New Pathways from RN-to-BSN: An Academic-Practice Partnership Using the Blended Learning Model to Build Capacity in the Incumbent Nursing Workforce Accepted for presentation at AACN Baccalaureate Conference Authors: Stephanie Chalupka 1, Jacquelyn McGravey 2, Gina Fleury 1, Sara Grady 1 Author affiliation: 1 Worcester State University, 2 UMass Memorial Healthcare November 7, 2013 New Pathways from RN-to-BSN: An Academic-Practice Partnership Using the Blended Learning Model to Build Capacity in the Incumbent Nursing Workforce Panel Presentation: Public Higher Education s Role in Workforce Development (David Cedrone, Moderator) Public Higher Education Statewide Board of Trustees Conference Co-Presenter: Cathy Jewell, UMass Memorial Medical Center See: http://www.mass.edu/forinstitutions/trustees/conference2013.asp Manuscript Under Review Program Publicity New Pathways from RN-to-BSN: An Academic-Practice Partnership Using the Blended Learning Model to Build Capacity in the Incumbent Nursing Workforce Authors: Stephanie Chalupka 1, Jacquelyn McGravey 2, Gina Fleury 1, Sara Grady 1 Author affiliation: 1 Worcester State University, 2 UMass Memorial Healthcare Manuscript Summited to Journal of Nursing Education December 10, 2013 New RN to BSN Program Attracts UMass Memorial Nurses; Commissioner Freeland, President Maloney Celebrate Program s Success Worcester State enews Available at: https://wp.worcester.edu/enews/new-rn-to-bsn-program-attractsumass-memorial-nurses-commissioner-freeland-president-maloney-celebrateprograms-success/ VI. Opportunities for Scale Up Projects/Replication This successful academic/practice partnership provides a sustainable and replicable model of nursing education for seamless upward educational mobility for associate degree-prepared nurses to earn a BSN.

12 VII. Lessons Learned The New Pathways from RN-to-BSN: An Academic-Practice Partnership Using the Blended Learning Model to Build Capacity in the Incumbent Nursing Workforce model allowed Worcester State University, in partnership with UMass Memorial Medical Center, to create a new seamless academic progression model and new pathway for the incumbent nursing workforce to achieve baccalaureate or higher degrees with the goal of rebalancing the nursing workforce (MA DHE 2012). As was noted in the Massachusetts DHE evaluation site visit in November 2013, some of the student nurses interviewed by the Commissioner Freeland stated that if not for the convenience of the worksite blended program, they may have never returned to school. The key lessons learned were about the nature of a true academic partnership. We learned the value and critical importance of frequent and meaningful engagement, mutual investment and commitment, joint accountability and transparency in developing and sustaining the academic/practice partnership throughout the process of developing, implementing and evaluating the WSU/UMMMC Collaborative RN-to-BS program. We further learned that collaborative academic/practice partnerships depend on mutual respect and on 1.) the establishment of formal relationships at the senior leadership level and practiced at multiple levels throughout both of our organizations; 2.) shared vision and expectations that are clearly articulated; and 3.) mutual goals with clearly set evaluation periods. VIII. Recommendations for DHE Seamless academic progression in nursing depends on transferability of previous coursework. As evidenced by the nurses in the WSU/UMMMC transfer issues presented a significant challenge. We would recommend that DHE provide the fullest support possible to the Nursing Transfer Compact and in particular to the schools receiving the transfer student from ADN programs to assure a smooth transition. IX. Summary Worcester State University is pleased to report that significant progress has been made in this project with all proposed activities completed. A complete update of activities outlined in the proposed timeline is contained in the appended table. Course evaluations and program evaluations completed by students have been overwhelmingly positive. In addition, both students and faculty identified the value of the Strategies for Academic Success course in promoting student readiness and academic success. The suite of academic support services provided to students in the workplaces has proven to be of great value to students in the program. Applications for the cohort entering fall 2014 are currently under review and we believe that the target goal for admissions in the next cycle will be easily achieved. Our partners at UMMMC have valued the successes of our collaboration and have worked with us to scale up the RN-BS program to move beyond UMMMC and bring RN-to-BS programming to all hospitals in the UMMHC system. Acknowledgements Worcester State University would like to thank Dr. Richard M. Freeland, Commissioner of Higher Education for Massachusetts and David Cedrone, Associate Commissioner of Higher Education for Massachusetts for their leadership in the Nursing and Allied Health Initiative. We would also like to thank Dale Earl and Patricia Crombie for their support in the development and implementation of the New Pathways from ADN to BSN: The Blended Learning Model to Build Capacity in the Incumbent Nursing Workforce program.

Evaluation: New Pathways from ADN to BSN: The Blended Learning Model to Build Capacity in the Incumbent Nursing Workforce Strategic Goal: Seamless ADN-to-BSN completion model that has potential for statewide and national replication. Objective 1: To plan, develop, and implement an RN-to-BSN curriculum to be delivered in the blended-learning format by WSU on the UMMMC hospital campuses to a cohort of 25 students. Resources/Personnel Activities Outputs Short-term Outcomes Long-term Outcomes Implementation Status Dr. S. Chalupka (WSU) Dr. S, Chalupka (WSU) Dr. S. Chalupka; S. Grady, WSU Admissions, Registrar, and Financial Aid; and Examine existing WSU RN-to-BSN curriculum. Redesign existing courses to be delivered in blended learning format in a manner that promotes identical student learning outcomes and program outcomes. Build faculty and staff capacity to teach professional nursing courses in the blended learning format. Collaborate with WSU admissions office to develop a process for RN-to-BSN applications. NU332: Transition to Professional Nursing NU 342: Health Assessment NU 430: Research Seminar NU 432: Advancing Perspectives in Chronic Illness NU 452: Professional Nursing Leadership in Organizations NU 472: Community Nursing Capstone Develop and conduct customized staff and faculty instructional technology training. Developed custom application for WSU/ UMMMC program. NU: 332, 342, and 432 were redesigned and fully developed for the delivery in the blended learning format by August 15, 2012. NU 452, 430, and 472 were redesigned and fully developed for delivery in the blended-format by January 1, 2013. All ADN-BSN faculty and staff completed 12-hour instructional technology professional development. Plan developed with WSU Admissions, Registrar, and Financial Aid departments. A new RN-to-BSN program developed in the blended learning format was fully developed and implemented on the UMMMC campuses for a cohort of 25 students in September 2012. Institutionalization of the program. Completed Completed Completed 13

14 UMMMC HR Dr. S. Chalupka, S. Grady and G. Fleury (WSU); Dr. M. Laccetti (UMMMC); J. McGravey (UMMMC) Develop marketing materials, conduct marketing activities, and recruit students. Twelve information sessions were be provided on the UMMMC campuses. First applications received, reviewed, and students accepted by July 1, 2012. Objective 2: Plan and develop effective academic success and retention strategies. Dr. S. Chalupka and G. Fleury (WSU) Dr. S. Chalupka and G. Fleury (WSU), Dr. M. Laccetti and J. McGravey (UMMMC), S. Grady (WSU) Dr. S. Chalupka and G. Fleury (WSU) Dr. S. Chalupka, G. Fleury, S. Alix, S. Grady (WSU) Develop student handbook/ success guide. Develop orientation session for matriculated students. Coordinate with offices of student and academic support services and of financial aid. Plan and develop Strategies for Academic Success course to increase ADN student readiness. Academic advising and tutoring will be provided on UMMMC campuses. Recruit, hire, and train academic tutor to work on site at UMMMC twice monthly. Students success/resource guide created by August 25, 2012 Orientation session attended by 25 matriculated students to promote success of RN- BSN students transitioning back into university environment. This course will be offered in August 2012 on UMMMC campuses. Academic advisors and tutors will be available twice monthly on each UMMMC campus. Students had handbook/success guide by start of academic year. Twenty-five students attended orientation. Twenty-five students attended this course. Academic advising and counseling institutionalized for students who have matriculated in the program. 90 % of students will persist from first to second year of three year curriculum (higher percentage than current student persistence). 24 of 25 (96%) students in WSU/UMMMC Collaborative RN-to-BS Program completed year I 80 % of students will persist through program to graduation (higher percentage than current student persistence). Completed Completed Completed Completed Completed

Objective 3: Increase the number of nurses in Central Massachusetts prepared with a BSN or higher degree. Dr. S. Chalupka and Applications received, G. Fleury (WSU), Dr. reviewed, and students M. Laccetti and J. accepted for both ADN- McGravey BSN and ADN-MSN (UMMMC), & S. programs annually by July Grady (WSU) 1 st. -Development and implementation of the WSU/UMMMC blended-learning, ADN- BSN curriculum. -Program will scale up in Fall 2013 to admit at least 35 students annually. -Work to identify students who may be candidates for ADN- MSN studies and provide appropriate academic counseling and support to meet goals. -Will have at least 25 students admitted by 2012; subsequently admit at least 35 students each year. -Students interested/ appropriate for MS study will be counseled and admitted to concurrent WSU ADN-MSN program. -Offer WSU ADN- MSN program information sessions By 2015 an additional 100 nurses will be enrolled in either ADN-BSN or ADN-MSN education. 25 students were admitted in fall 2012. The second cohort will reach 25 student by January 2014. Applications for fall 2014 currently being reviewed. Objective 4: Disseminate, through conference presentation and publication, best practices in RN-to-BSN education to other universities and hospitals using an academic/practice partnership model. Dr. S. Chalupka and Develop Presentations at nurse Recommendations and *Abstract G. Fleury (WSU), C. presentation and educator conferences to scalable model for nursing accepted for Jewell and J. McGravey (UMMMC), and S. Grady (WSU) materials for distribution. educate baccalaureate leadership and nursing faculty. Publication of articles in professional education redesign for statewide and national replication. presentation at AACN Baccalaureate Conference. journals. Disseminate information about building effective university/ hospital partnerships in order to develop educational pathways (ADN-BSN, ADN-MSN) that are appropriate and responsive to the needs of adult working professionals. Synthesize results, edit, and prepare articles for publication. *Invited presentation at MA Public Higher Education Statewide Trustees Conference 15

16 Dr. S. Chalupka and G. Fleury (WSU), C. Jewell and J. McGravey (UMMMC), and S. Grady Disseminate information about building effective university/ hospital partnerships conference to encourage nurses to advance their education from ADN to BSN or higher. A conference conducted December 2013, inviting baccalaureate nursing programs and hospital and health care systems for potential replication. Academic institutions and hospital/health care systems learn about model and explore collaborative possibilities. *Manuscript submitted for review to Journal of Nursing Education Fifty-seven participants attended statewide conference. Attendees represented 16 nursing programs in Massachusetts, Rhode Island and New Hampshire. One healthcare management consulting firm and four hospitals were represented. Conference evaluations were overwhelmingly positive.