New Pathways from ADN to BSN: The Blended Learning Model to Build Capacity in the Incumbent Nursing Workforce
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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 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 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 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 Conference
16 *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.
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