There are 168 second-degree BSN-accelerated nursing programs in the United States, with 46 more being planned.1 Thirty-five states have at least 1 second-degree BSN program.2 Schools of nursing have embraced this approach for educating new nurses as one way to address the nursing shortage.3 Some accelerated BSN programs that have been in place over a decade.4 Auburn University School of Nursing (AUSON) is one such school. Its first second-degree BSN class graduated in 1994. Called the Accelerated Nursing Degree (AND) program, it was the first program of its kind in the state. Program design allows students to complete the professional nursing curriculum in 15 months.
With 12 years of working with AND students, faculty identified 2 major challenges: (a) How can the AND students' need to be recognized as different from the traditional students and their need to be socialized into the school of nursing and the nursing profession be balanced? (b) What methods can be used to efficiently teach AND students, given that their curriculum is condensed, without double-teaching content? This article describes the evolution of the AUSON AND program and focuses on the learning by experience that took place among faculty in addressing these 2 challenges.
With 12 years of working with AND students, faculty identified 2 major challenges: (a) How can the AND students' need to be recognized as different from the traditional students and their need to be socialized into the school of nursing and the nursing profession be balanced? (b) What methods can be used to efficiently teach AND students, given that their curriculum is condensed, without double-teaching content? This article describes the evolution of the AUSON AND program and focuses on the learning by experience that took place among faculty in addressing these 2 challenges.
Background of Second-Degree Accelerated Nursing Programs
Nursing students with previous baccalaureate degrees have always attended baccalaureate nursing programs. However, in 1960, Frances Reiter from the Graduate School of Nursing at New York Medical college began a program based on the belief that students with a liberal arts degree who had a high level of motivation could develop the "values, attitudes, and intellectual skills essential for professional nursing practice. 5(p99) In 1972, St. Louis University School of nursing and Allied Health Professions reportedly developed a curriculum specifically for these students.6 In 1974, Yale University implemented a program for nonnurse college graduates that took 3 years and offered a graduate degree.7
Wu and Connelly8(p35) defined the accelerated baccalaureate nursing program as "a specially designed nursing program for non-nurse college graduates to obtain a bachelor's of science in nursing (BSN) degree within 12 to 16 months." The nursing shortage of the 1980s increased the popularity of these programs.8 In 1990, there were 31 such programs. In the last few years, there has been yet another proliferation of these types of programs, again related to the nursing shortage. Students receive the same education as traditional students, except in a highly compressed fashion. Graduates are highly valued by the employers because of their many layers of skills and education.9
Traditional and Nontraditional Nursing Students
Most nursing programs are a mix of both traditional and nontraditional students; however, the nontraditional nursing student's background varies. The traditional student is one considered to have graduated high school and chose nursing as a first career.10 Accelerated nursing students are considered nontraditional students. Seidel10 found that nontraditional students have their own strengths and weaknesses but are unlike the traditional baccalaureate nursing student. Traditional nursing students are typically between the ages of 17 and 22 years and come to college right after high school, whereas nontraditional students are 25 years and older, may not be high school graduates, or may have studied previously at the college level.10 Nontraditional students may have a slightly lower grade point average (GPA) on admission; however, they tend to have higher GPAs in the beginning nursing courses than the traditional nursing student. Toth et al11 found that the attitude toward nursing is no different for the accelerated nursing student than the traditional nursing student and that they choose nursing for the same reasons. Seidl10 indicated that traditional nursing students scored lower on judgmental ability than did the nontraditional nursing students. This "suggests that non-traditional students in general may have acquired skills that facilitate judgmental ability in professional contexts."(p17)
Studies describing second-degree BSN students reveal that students come from a multitude of educational backgrounds including basic sciences, human and social sciences, liberal arts, education, and business. Their work backgrounds are just as varied, with many having no healthcare experiences at all.8,12 Most accelerated students are between the ages of 22 and 29 years and return to school within 3 to 7 years after completion of their first degree.8,12-14
AND Program Outcomes
A few studies have compared the outcomes of second-degree accelerated nursing students who complete the program in a shorter time frame to their traditional counterparts. One study15 examined 226 accelerated graduates and 204 traditional graduates. Findings indicated that there were no significant differences among the groups in performance in specific courses, on achievement tests, and National Council Licensure Examination for Registered Nurses (NCLEX-RN) pass rates. This study also found that there was no significant difference in passing rates or assessment tests results between accelerated and traditional students.15
In 1995, McDonald16 compared the performance of students in an accelerated baccalaureate nursing program for college graduates and a traditional nursing program; however, only a small sample was used. The accelerated students completed the program in 13 months. The accelerated students performed better with a 90% pass rate on the NCLEX-RN as compared with the traditional students with 70%. Beeson and Keesling17 also found that nontraditional second-degree nursing students had a higher NCLEX-RN pass rate with 96% as compared with traditional students who had 88.3% passage.
Profile of the AUSON AND Student
During the past 12 years, we have graduated 170 AND students. The attrition rate is approximately 12%. Consistent with findings in the literature,8,18 the reasons Auburn AND students chose to go into nursing falls into 2 major categories: economic reasons, that is, their first degree had not provided adequate job opportunities, and altruistic reasons, that is, they have always wanted to be a nurse or in a "people profession" and made a mistake in the choice of their first bachelor's degree.
Criteria for admission to the AND program include a bachelor's degree in another field with an overall GPA of 2.5. Certain prerequisites are required including 2 social sciences, microbiology, human anatomy and physiology, statistics, ethics, chemistry, human development, and nutrition. Admission is very competitive and based on a formula that focuses on overall GPA and performance in the prenursing science requirements. Despite the fact that there is almost no recruiting or advertising of the AND program, the applicant pool continues to grow in quality and quantity. For example, the class admitted in Fall 2005 had an average GPA of 3.5. There were 50 applicants; 28 students were admitted. Of these 28 students, only 19 actually enrolled, illustrating a pattern we have noted with AND students, that is, AND students tend to change their mind about coming to nursing school at the last minute. Students deciding not to enroll report that they realized that they could not manage family and financial responsibilities and attend the AND program or that their application was impulsive and not something they were ever really serious about. Because it is difficult to forecast how many admitted students will actually enroll, we have learned to admit 10 to 12 more students than we actually want to enroll, anticipating these last minute mind changes.
As Table 1 illustrates, most of our students are women, although the AND classes have a higher percentage of men in comparison to our traditional classes, which are typically only 5% to 10% male. The AND students backgrounds include a variety of majors with human/social science backgrounds such as psychology, sociology, and family and child development, and science majors including zoology and biomedical sciences. We have discovered students from varied educational backgrounds perform well as a nursing student, similar to findings by others.8,12-14
From the first class, it was obvious to faculty that the AND students were different from the traditional students. Most traditional students have parental financial support. However, as recent high school graduates, many times traditional students are still making the transition from childhood to adulthood. Although average American College Test (ACT) scores and GPAs of AND classes trend a bit lower than our traditional student, AND students generally are paying their own way through the program and are highly motivated and focused.
Since the inception of the AND program, faculty believed these students were more successful academically and on the NCLEX-RN than traditional students. A study was done to determine if there is a significant relationship among selected variables and success on the NCLEX-RN licensure examination in the traditional and the AND students. Variables studied included science GPA, Health Education Systems Incorporated (HESI) specialty examination scores, Exit HESI examination scores, and clinical nursing course grades.
There were no statistically significant differences in the success on the NCLEX-RN of traditional and the accelerated degree students; however, the accelerated students did have a higher pass rate (92.3%) than the traditional students (89.5%). This study also revealed that the accelerated students were more successful than the traditional students on the psychiatric HESI, the Exit HESI, and the pediatric HESI examinations.19
Socialization of the AND Students
A new and completely separate curriculum was implemented for 10 AND students comprising the first class admitted in 1993. Students progressed through the curriculum together, becoming a cohesive group quickly. However, as a result of this separation, from the traditional students, the AND students voiced concerns of being isolated from the School of Nursing. They did not participate in or feel a part of the school of nursing traditions and culture.
Comparable to the conclusions of Miklancie and Davis,20 faculty realized that socialization of AND students into the school of nursing could not be left up to chance. A formal plan aimed at increasing AND student involvement in the school was implemented. Accelerated Nursing Degree students were encouraged to elect representatives to the faculty, curriculum and evaluation committees, as well as the student government association and association of nursing students. A separate convocation was instituted where special awards specifically for AND students were given. The slide show at the junior/senior banquet began to include AND students, thus promoting participation in the banquet. Rather than having separate senior photograph composites, AND students were included with traditional students. Regular chat sessions between administration and AND students were scheduled.
Although these strategies improved AND student's perceptions of being a part of the School of Nursing, faculty came to believe that continuing to teach ANDs completely separated from the traditional students was promoting an atmosphere of division and inhibiting professional socialization. Therefore, in the Fall of 2000, the School of Nursing implemented a curriculum that integrated AND students into certain classes with traditional students. In the first semester of implementation, AND students were in classes as well as clinical and laboratory sections with traditional students. As a result, it was the second semester before AND students were separated into an AND-only class. Students quickly verbalized the need to get to know their AND colleagues before the second semester; therefore, the AND students were integrated into certain classes with traditional students- certain classes were AND-only classes and all laboratories and clinical sections were AND-only groups. Clinical in the AND program is intense and starts at the sixth week of class. In the spring and summer semester, AND students have 3 days of clinical compared with the 2 required in the traditional program. Their preceptorship and leadership clinical rotations are 300 hours combined, which is the same as that of the traditional students.
Faculty learned that socialization of AND students into the profession happens in the same manner as socialization of traditional students through clinical experiences21 and inclusion in nursing traditions' and culture.11 By implementing a plan that encouraged AND participation in School of Nursing activities, integrated AND students with traditional students in many classes, and included concentrated clinical experiences, socialization to the profession is fostered. A common comment from employer surveys regarding AND graduates is that "These students are well prepared for the practice of nursing, they are capable of entering the workforce upon graduation," which suggests that AND students have socialized into the profession.
A Curriculum That Integrates AND Students With Traditional Students
Another issue resulting from the original and completely separate AND curriculum was that faculty work load was doubled. That is, concepts were taught one semester to AND students and retaught the next semester to traditional students. The integrated classes decrease much of the double teaching required by the original curriculum. Figure 1 outlines the integrated AND curriculum model still in use today. In the first fall semester, AND and traditional students are in the same classroom for the theory courses but different sections for laboratory and clinical. In the spring semester, AND students take maternal infant nursing in an AND-only group and adult health/geriatric nursing, pediatric nursing, and pharmacology with traditional students. Again, all clinicals are separate. A special pediatric clinical that takes place in a large metropolitan pediatric hospital 2 hours away and requires overnight stays has been implemented for the AND students. Students are challenged by this rotation and have easily made arrangements with nearby hotels for reduced price rooms and transportation to the hospital. A seasoned nurse who works at this pediatric hospital is hired as a clinical associate by AUSON to instruct students.
The summer term is a condensed 10-week term in which the AND students take mental health nursing with the traditional students and also take critical care, advanced community health, and nursing research separately. The first summer AND students were required to take these courses resulted in frustration because the amount of work associated with these 4 concepts was almost more than could be done in 10 weeks. Similar to the approach reported by Miklancie and Davis,20 faculty examined the courses and learning experiences and reduced course assignments. For example, the case management project required in critical care/advanced community health was combined with the nursing research project so that these 2 concepts were addressed with 1 project. Assignments perceived as busy work such as weekly computer-assisted instructional case studies were reduced. What was a 14-page assessment was reduced to 8 pages with a problem focus. In the final semester, AND students are on campus the first 6 weeks taking a professional seminar course and a leadership course that includes a 3-week leadership clinical rotation. Eight weeks is spent in a preceptorship where students work one on one with a registered nurse in a clinical setting of their choice. The last week of the semester, students come back to campus for a wrap-up session.
Summary of Lessons Learned
Twelve years of working with AND BSN students has provided valuable lessons to the AUSON faculty. All agree that the focus and motivation of these students make teaching them challenging and rewarding. Regardless of the AND students' educational background, they tend to excel. We have learned to admit more students than we hope to enroll due to the pattern of these students changing their mind at the last minute. Socialization to the culture of nursing school cannot be left up to chance. Active inclusion of AND students into the activities of the school is needed. Although the AND program is one semester shorter than the traditional program, intense clinical experiences and interaction with traditional students encourage socialization in the profession. A curriculum where AND students are integrated into certain classes with traditional students, take other classes in AND-only groups, and have separate clinicals results in efficient use of faculty resources and also allows for AND students to identify with their AND peers.
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