New Pathways from ADN to BSN: The Blended Learning Model to Build Capacity in the Incumbent Nursing Workforce
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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, 20132
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 X
income or assume additional debt to pay tuition)
No pay differential with BS degree X X
Limit on employers offered tuition assistance X
for part-time employees
Lack of flexibility in scheduling at work X X
Disruption of family life (limited number of time requests X
per month means choosing between school or family)8
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.
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 RN-
to-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 24
21
20
Acepted Offer of Admission for
15 September 2012
Completing End of Semester I
10
5
0
BS Program on BS Program on
WSU Campus UMMMC
Campus10
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 Chalupka1, Jacquelyn McGravey2, Gina Fleury1, Sara Grady1
Author affiliation: 1Worcester State University, 2UMass 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
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 Chalupka1, Jacquelyn McGravey2, Gina Fleury1, Sara Grady1
Author affiliation: 1Worcester State University, 2UMass Memorial Healthcare
Manuscript Summited to Journal of Nursing Education December 10, 2013
Program Publicity
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-attracts-
umass-memorial-nurses-commissioner-freeland-president-maloney-celebrate-
programs-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.13
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 Examine existing WSU NU332: Transition NU: 332, 342, and 432 A new RN-to-BSN Completed
(WSU) RN-to-BSN curriculum. to Professional were redesigned and fully program developed in the
Redesign existing Nursing developed for the delivery blended learning format
courses to be delivered NU 342: Health in the blended learning was fully developed and
in blended learning Assessment format by August 15, implemented on the
format in a manner that NU 430: Research 2012. UMMMC campuses for a
promotes identical Seminar cohort of 25 students in
student learning NU 432: NU 452, 430, and 472 September 2012.
outcomes and program Advancing were redesigned and fully
outcomes. Perspectives in developed for delivery in Institutionalization of the
Chronic Illness the blended-format by program.
NU 452: January 1, 2013.
Professional
Nursing Leadership
in Organizations
NU 472:
Community
Nursing Capstone
Dr. S, Chalupka Build faculty and staff Develop and All ADN-BSN faculty and Completed
(WSU) capacity to teach conduct staff completed 12-hour
professional nursing customized staff instructional technology
courses in the blended and faculty professional development.
learning format. instructional
technology
training.
Dr. S. Chalupka; S. Collaborate with WSU Developed custom Plan developed with WSU Completed
Grady, WSU admissions office to application for Admissions, Registrar, and
Admissions, develop a process for WSU/ UMMMC Financial Aid departments.
Registrar, and RN-to-BSN program.
Financial Aid; and applications.14
UMMMC HR
Dr. S. Chalupka, S. Develop marketing Twelve First applications received, Completed
Grady and G. Fleury materials, conduct information reviewed, and students
(WSU); Dr. M. marketing activities, and sessions were be accepted by July 1, 2012.
Laccetti (UMMMC); recruit students. provided on the
J. McGravey UMMMC
(UMMMC) campuses.
Objective 2: Plan and develop effective academic success and retention strategies.
Dr. S. Chalupka and Develop student Students’ Students had 90 % of students will Completed
G. Fleury (WSU) handbook/ success success/resource handbook/success guide persist from first to
guide. guide created by by start of academic year. second year of three year
August 25, 2012 curriculum (higher
Dr. S. Chalupka and Develop orientation Orientation session Twenty-five students percentage than current Completed
G. Fleury (WSU), Dr. session for matriculated attended by 25 attended orientation. student persistence).
M. Laccetti and J. students. Coordinate matriculated 24 of 25 (96%) students in
McGravey with offices of student students to promote WSU/UMMMC
(UMMMC), S. Grady and academic support success of RN- Collaborative RN-to-BS
(WSU) services and of financial BSN students Program completed year I
aid. transitioning back
into university 80 % of students will
environment. persist through program to
Dr. S. Chalupka and Plan and develop This course will be Twenty-five students graduation (higher Completed
G. Fleury (WSU) Strategies for Academic offered in August attended this course. percentage than current
Success course to 2012 on UMMMC student persistence).
increase ADN student campuses.
readiness.
Dr. S. Chalupka, G. Academic advising and Academic advisors Academic advising and Completed
Fleury, S. Alix, S. tutoring will be and tutors will be counseling
Grady (WSU) provided on UMMMC available twice institutionalized for
campuses. monthly on each students who have
Recruit, hire, and train UMMMC campus. matriculated in the
academic tutor to work program.
on site at UMMMC
twice monthly.15
Objective 3: Increase the number of nurses in Central Massachusetts prepared with a BSN or higher degree.
Dr. S. Chalupka and -Development and -Will have at least Applications received, By 2015 an additional 100 25 students
G. Fleury (WSU), Dr. implementation of the 25 students reviewed, and students nurses will be enrolled in were admitted
M. Laccetti and J. WSU/UMMMC admitted by 2012; accepted for both ADN- either ADN-BSN or in fall 2012.
McGravey blended-learning, ADN- subsequently admit BSN and ADN-MSN ADN-MSN education. The second
(UMMMC), & S. BSN curriculum. at least 35 students programs annually by July cohort will
st
Grady (WSU) -Program will scale up each year. 1 . reach 25
in Fall 2013 to admit at -Students student by
least 35 students interested/ January 2014.
annually. appropriate for MS
-Work to identify study will be Applications
students who may be counseled and for fall 2014
candidates for ADN- admitted to currently being
MSN studies and concurrent WSU reviewed.
provide appropriate ADN-MSN
academic counseling program.
and support to meet -Offer WSU ADN-
goals. MSN program
information
sessions
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 Disseminate Develop Presentations at nurse Recommendations and *Abstract
G. Fleury (WSU), C. information about presentation and educator conferences to scalable model for nursing accepted for
Jewell and J. building effective materials for educate baccalaureate education redesign for presentation at
McGravey university/ hospital distribution. leadership and nursing statewide and national AACN
(UMMMC), and S. partnerships in order to faculty. Publication of replication. Baccalaureate
Grady (WSU) develop educational Synthesize results, articles in professional Conference.
pathways (ADN-BSN, edit, and prepare journals.
ADN-MSN) that are articles for *Invited
appropriate and publication. presentation at
responsive to the needs MA Public
of adult working Higher
professionals. Education
Statewide
Trustees
Conference16
*Manuscript
submitted for
review to
Journal of
Nursing
Education
Dr. S. Chalupka and Disseminate A conference Academic institutions and Fifty-seven
G. Fleury (WSU), C. information about conducted hospital/health care participants
Jewell and J. building effective December 2013, systems learn about model attended
McGravey university/ hospital inviting and explore collaborative statewide
(UMMMC), and S. partnerships conference baccalaureate possibilities. conference.
Grady to encourage nurses to nursing programs Attendees
advance their education and hospital and represented 16
from ADN to BSN or health care systems nursing
higher. for potential programs in
replication. Massachusetts,
Rhode Island
and New
Hampshire. One
healthcare
management
consulting
firm and four
hospitals were
represented.
Conference
evaluations were
overwhelmingly
positive.You can also read
