The Institute of Medicine and Robert Wood Johnson Foundation Initiative on the Future of Nursing advocated for nurses to achieve higher levels of education and promoted seamless academic progression (Institute of Medicine, 2011). In response, the Nursing First Program was established to support a smooth transition between associate and baccalaureate (BSN) degree programs of nursing while also promoting strong academic performance. As per Nursing First guidelines, high-performing students accepted into an associate of science (AS) degree in nursing program at a downstate New York community college may transition into the registered nurse (RN) to BSN program at a nearby university upon completion of their AS degree. Prior to the implementation of the program, the community college completed a redesign of its nursing curriculum, changing it from associate of applied science to the AS curriculum. Following is a detailed description of the program with early results.
CRITERIA FOR PARTICIPATION
Once curriculum updates were complete, all first-time, matriculated freshman enrolled in the AS in nursing day program at the community college were eligible to apply to the Nursing First Program. Participants were selected based on the following criteria for matriculation into the university:
* Cumulative grade point average (GPA) of at least 3.1 and earned grades of C+ or higher in all courses required for the AS degree.
* Completion of three college credits in general chemistry, with an earned grade of C or higher.
* Participation in periodic seminars coordinated by a faculty liaison from the university and the associate dean and academic chairs of the community college.
* Completion of the AS degree, with RN licensure within 11 weeks from the start of the university RN to BSN program.
MANDATORY PROGRAM COMPONENTS
The Nursing First Program requires students to attend mandatory onsite seminars scheduled during each semester. The seminars are designed to provide information and establish a sense of camaraderie within the cohort, with the aim of ensuring student success throughout both programs (Perfetto, 2015). Session topics, chosen with student needs in mind, include academic writing, developing a resume, assembling a portfolio, and finding employment. The university's grading rubrics for academic papers and presentations are reviewed and made available to students. They are encouraged to use the guidelines to improve their writing skills and academic performance (Hewitt, 2016). They are also given access to library resources at both institutions. Deans and faculty from both programs attend the seminars to advise students and offer support. Previous graduates of the AS program, including those currently enrolled in the university, participate and share insights regarding academic success, the NCLEX exam, transition to professional practice, and work-life balance. Seminars include time for discussion and questions.
TRANSITION TO BACCALAUREATE PROGRAM
Because Nursing First students are granted conditional seats in the BSN program, they are not required to complete the lengthy application for university admission. Rather, they complete a short intent-to-enroll form during their third seminar, and official transcripts are submitted upon graduation from the AS program. This reduces student stress and encourages immediate enrollment and completion of the BSN program (Jeffreys, 2020). Students who maintain a GPA of 3.1 or higher and complete a three-credit chemistry course with a grade of C or higher are offered admission into the university program. Students enter in May, immediately following graduation from the AS program. They are given up to 11 weeks to pass the NCLEX exam. Those who fail to obtain their RN licensure within that time frame are permitted to finish a summer session course before taking a leave of absence of up to one year to pass the NCLEX. Once passed, students resume their studies with a revised pathway. Those who do not achieve licensure within one year are terminated from the program but may reapply to the university upon passing the NCLEX-RN.
Given that time constraints, financial issues, and family obligations often hinder RN to BSN students (Perfetto, 2015; Warshawsky et al., 2015), Nursing First students are placed on a part-time pathway. Courses are continuous and distributed over a two-year period, allowing students to work while earning their baccalaureate degrees. The predominately online, asynchronous university program provides flexibility for students with families and other obligations. The option to transition to a slower pathway, if requested by the student or deemed necessary by faculty, is also available.
NURSING FIRST COHORTS
The Nursing First Program began in September 2017 with an initial cohort of 64 students. Just prior to graduation from the AS program, 54 students (84 percent) were eligible to transition into the RN to baccalaureate program. Of those eligible, 48 accepted seats in the program, which began immediately in May 2019. Ineligibility to transition to the university was attributed to the following: inability to maintain a GPA of >=3.1, failure to complete the three-credit chemistry course, unsuccessful completion of the AS degree, or personal decision.
Students who transitioned into the university were well qualified for the rigors of the BSN program. All 48 passed the NCLEX exam on their first attempt and successfully completed Pharmacology, the first BSN course. Four transitioned to three-year pathways, citing new jobs and stresses brought on by the COVID-19 pandemic, and one student did not register for the fall 2019 semester. The 43 students who remained on the original pathway graduated with their baccalaureate degrees in May 2021. Following COVID-19 guidelines, the second and third cohorts of Nursing First students participated in online mandatory seminars and activities during 2020 and 2021. However, student interest remained high, with 85 percent of eligible students transitioning to the university in May 2020. That class achieved a 98 percent NCLEX pass rate. In May 2021, 83 percent of eligible students from the 2019 cohort began their baccalaureate degrees at the university and achieved a 100 percent NCLEX pass rate.
Although enrolled in a predominately online program, many Nursing First students became very active in campus life. Several served as representatives for the university's chapter of the National Student Nurses' Association and other committees within the school of nursing. They also took part in the school's annual flu vaccination clinic and volunteered to speak at future Nursing First seminars, providing incoming students with valuable insights regarding their experiences. Nursing First graduates have also excelled at their places of employment. Several were hired into the nurse residency program at the university's affiliated hospital, working in intensive care, the operating room, the emergency department, and other specialty areas. In addition to being named Rookie of the Year at the affiliated hospital, one member of the inaugural class won first place in the research competition held annually for new nurses hired into the residency program and presented findings at a national conference.
CONCLUSION
Although it is too early to determine whether the change in the community college curriculum and/or the initiation of the Nursing First Program resulted in improved NCLEX scores and success in the baccalaureate program, it is evident that student performance has been enhanced. Because of the lack of published data, it has not been possible to compare results of this innovative program to others. Instead, Nursing First students admitted to the university in 2019 and 2020 were compared to students admitted from the same community college in 2017 and 2018, prior to the implementation of the program. It was found that the number of students transitioning directly into the baccalaureate program from the community college in 2019 and 2020 increased by more than 45 percent when compared to the previous years. This was significant, given that New York State passed the BSN-in-10 law in December 2017 (New York State Senate, 2017), just after the initiation of the Nursing First Program. Likewise, the first-time NCLEX pass rate increased by 12 percent, and the May 2021 graduation rate increased by 11 percent.
Faculty leaders from both schools continue to assess the program, making minor revisions to strengthen it academically. Feedback from students and faculty has been positive. It is believed that the program inspires community college students to maintain good grades and to reach their highest potential. The redesigned curriculum and the high standards set for Nursing First students prepare them to successfully transition to the university's BSN program. Furthermore, the development of Nursing First cohorts, complemented by planned seminars, is thought to provide students with needed support. Finally, the seamless transition has reduced anxiety and encourages students to continue their academic studies immediately following the completion of their associate degree.
A formal evaluation of the program was completed in 2021. Statistics from the first three years were examined and evaluated at that time. The Nursing First Program was deemed essential to student success. It is hoped that this and other collaborations between area schools will be developed, ensuring the support and success of future generations of nursing students and the profession.
REFERENCES