This qualitative study examines the experience of the RN who pursues a bachelor of science to determine the meaning found by pursuit of a baccalaureate, the extent to which the pursuit of the degree influences one's perception of oneself as a professional, and the impact of the degree on one's practice. The participants found personal satisfaction in pursuing their degrees and developed a broader approach to nursing practice. Implications for staff development specialists are discussed.
One critical role of the staff development specialist is to facilitate competence and continued professional development of staff (American Nurses Association, 2000). One approach to this is to foster an environment which encourages staff to advance academically, be it from the diploma or associate's degree to the baccalaureate level or beyond. This is especially timely given the push for Magnet recognition in many hospitals and given the spotlight that has been placed on quality outcomes and a culture of safety. Furthermore, although hospitals struggle with fiscal challenges, the financial benefit of supporting nurses who pursue advanced education may not be immediately visible to administrators, but staff development specialists realize the value of such a move, especially about improving patient outcomes and enhancing patient safety.
When examining the impact of nurses' educational preparation on patient outcomes, Aiken, Clarke, Cheung, Sloane, and Silber (2003) recognized
a statistically significant relationship between the proportion of nurses in a hospital with bachelor's and master's degrees and the risks of both mortality and failure to rescue[horizontal ellipsis]Each 10% increase in the proportion of nurses with [bachelor's or master's] degrees decreased the risk of mortality and of failure to rescue[horizontal ellipsis]by 5%. (p. 1620).
Although this study has been the subject of some controversy within the nursing profession, most scholars agree that "[e]ducation makes a difference in nursing practice[horizontal ellipsis]education broadens one's knowledge base, enriches understanding, and sharpens expertise" (Long, Bernier, & Aiken, 2004, p. 48). The value of these educational benefits, when applied to patient care, is further clarified by the observation that
[n]urses constitute the surveillance system for early detection of complications and problems in care, and they are in the best position to initiate actions that minimize negative outcomes for patients. That the exercise of clinical judgment by nurses[horizontal ellipsis]is key to effective surveillance may explain the link between higher nursing skill mix[horizontal ellipsis]and better patient outcomes (Aiken et al., 2003, p. 1617).
The need for increasing numbers of baccalaureate-prepared registered nurses (RNs) becomes more obvious when viewed through the lens of the current emphasis on evidence-based practice. The critical-thinking skills that accompany bachelor of science in nursing (BSN) education are paramount to developing a nursing workforce that is able not only to review literature competently but also to apply true evidence-based practice changes at the bedside.
REVIEW OF THE LITERATURE
The current nursing workforce is composed of RNs with a variety of entry-level credentials-whether hospital diplomas, associate degrees, or baccalaureates-and 57.3% of nurses practicing in 2000 were doing so at the subbaccalaureate level (Spratley, Johnson, Sochalski, Fritz, & Spencer, 2000). These nurses often express a desire to "return for my BSN" and appear highly motivated to do so but find that full-time employment and family responsibilities place too high a burden on their time to allow them to pursue a baccalaureate. Delaney and Piscopo (2004) found that "competing priorities[horizontal ellipsis]multiple role demands, combined with limited resources, as the greatest barriers to their enrolling in a BSN program" (p. 158).
There has been little published research done within the last 10 years on the topic of RNs returning for their baccalaureates. What recent literature is available has centered on teaching and learning methods (Cangelosi, 2004; Cox, 1996; Hegge, 1995; Stringfield, 1993), variables of empowerment and autonomy (Horne, 1998; Malizia, 2000), and the meaning of having baccalaureate-prepared nurses in the practice setting (McCray, 1995). Much of the literature over the past 5 years has focused on nontraditional education, such as accelerated RN-to-BSN programs (Boylston, Peters, & Lacey, 2004), case study analysis in lieu of clinical requirements for experienced RNs (Hall, 2003), and online or distance learning programs (Huston, Shovein, Damazo, & Fox, 2001). Several doctoral dissertations have addressed the RN-to-BSN student, looking at such subjects as the motivation for returning to school (Corbett, 1997) or students' perceptions of curriculum content as related to their already-significant nursing experience (Clark, 2004).
It is critical to understand how the pursuit of a baccalaureate impacts one's self-perception as a professional and how it influences an individual's nursing practice to provide a work environment that fosters professional development, knowledge acquisition, and transfer of new knowledge to practice such that patient care is enhanced.
PURPOSE AND RESEARCH QUESTIONS
The purpose of this study was to describe the meaning of personal and professional growth for experienced RNs who return for a baccalaureate in nursing. An additional aim of the study was to identify ways in which the baccalaureate influences one's approach to nursing practice.
The following research questions served to guide the researchers in the choice of method and analysis of data:
1. What meaning does the RN find in the pursuit of a baccalaureate in nursing?
2. To what extent does the pursuit of a baccalaureate in nursing influence one's perception of being a professional nurse?
3. To what extent does the pursuit of a baccalaureate in nursing influence one's nursing practice?
RESEARCH DESIGN AND METHODS
A qualitative research design using in-depth interview as the principle method was chosen to elicit data in this research study. With this methodology, research questions focus on the perception and the experience of the RN returning for baccalaureate education. Because the focus of the research was to explore the meaning of pursuit of a BSN, a qualitative design was appropriate. Qualitative research seeks to understand phenomena from the participant's perspective and view of reality. In-depth interviews allow time and space for participants to share their perceptions, beliefs, and experience, thus allowing the researcher to gain an understanding of a particular phenomenon from the perspective of those who experienced it. The interview approach is based on the assumption that "understanding is achieved by encouraging people to describe their worlds in their own terms" (Rubin & Rubin, 1995, p. 2).
A purposive sample of 11 RNs volunteered to participate in this study. In purposive sampling, research participants are chosen based on their knowledge of the phenomenon under study. The 11 participants, who ranged from age 40 to mid-50 years, were all women and worked in an acute care hospital on a wide variety of patient care units including the emergency department, medical-surgical units, operating room, postanesthesia care unit, endoscopy unit, dialysis unit, and critical care unit. Participants' nursing experience ranged from 14 to 34 years, with a mean of 24 years of nursing experience. Most had as their basic nursing education an associate degree in nursing; 1 participant had a hospital diploma, and another participant began as a practical nurse. Two of the participants had bachelor's degrees in nonnursing fields: 1 in journalism and 1 in liberal arts. Seven participants attended the on-site baccalaureate program at the hospital (see the Setting section), and the other 4 participants attended other baccalaureate programs within the state. All participants were interviewed in their last semester of study or within 1 year of graduation from the baccalaureate in nursing program.
The study took place in a 275-bed community hospital in the northeast. The hospital has traditionally had a low RN turnover rate and a significant number of long-term RN employees; 25% of the RNs are older than the age of 55 years. There is a high percentage of associate degree nurses (54%) compared with that of baccalaureate-prepared nurses (26%). Nursing leadership has set a goal of increasing the number of baccalaureate-prepared nurses. The hospital has recently implemented structures to promote a professional practice model which has included a shared leadership model, RN professional advancement ladder, and a change from team to a modified primary model of care. To promote nurses' return to college for the baccalaureate, the hospital expanded its tuition reimbursement program to offer additional assistance for nurses who chose to return to school. In addition, the education department collaborated with a local university to create a hospital-based dedicated on-site satellite program for baccalaureate education in nursing.
Procedures and Data Analysis
Approval for the study was obtained through the institutional review board process. Participants were assigned code numbers to assure anonymity and confidentiality. Each participant was asked to share her thoughts regarding the research questions. Following the flexible interview design of Rubin and Rubin (1995), questions were added or probed to gain a better understanding of responses. Interviews were approximately 1 hour in length, conducted in a private conference room, audiotaped, and transcribed verbatim by a professional transcriptionist who was not employed by either the hospital or the participating academic institutions. The same researchers were present at all interviews.
With each interview, significant statements were identified. Significant statements were then grouped into themes based on the research questions. The researchers agreed on the analysis of each interview. Data across interviews were then analyzed for similar and contrasting themes based on the research questions. Saturation of data was reached at 11 participants.
Trustworthiness of data was determined by comparing audiotapes of interviews against transcripts. In addition, researcher-corroborated data analysis and member checks were used. Also, data were examined for coherence and consistency within and across interviews.
As data were analyzed, several factors emerged which reflected common perspectives of the participants. The participants all related examples of attending continuing education programs and inservice classes at the hospital. Primarily, these were attended on a voluntary basis-the nurses sought out education based on their assessed needs at that particular time. In a sense, this group could be viewed as "knowledge seekers." For these individuals, moving from inservice classes to classes leading to a degree was a natural progression of their lifelong learning philosophy.
Participants generally identified "support" as a key factor contributing to their success in achieving the degree. Various sources of support were identified including peers, family, and hospital-based sources. Participants tended to search out peers who had similar thinking. This tactic was useful as the program progressed because it formed a basis for peer support throughout the program. It was especially helpful to those participants who progressed through the baccalaureate program as a cohort and who worked together on either the same floor or the same shift.
The support groups also served as vehicles for critical discussion of class content, for expansion of one's view of other units, and for the development of new professional networks within the organization. One nurse stated,
I found that I met people that I've never had a relationship with before, and we developed [relationships]. I really enjoyed speaking with other nurses who were in the course with me because[horizontal ellipsis]you find out what they're doing in their department. So, we shared a lot of that stuff, about what everyone else does, and that was great.
Participants also spoke of support received from family members who picked up extra household responsibilities. The majority also identified support from their managers. One participant stated of the manager,
[She] always did whatever she had to with the schedule to make it easier for me to go to school. Unbelievable support.
Other participants spoke of the librarian's assistance in literature searches and the preparation of class presentations.
Participants considered several factors when choosing a baccalaureate program. Factors included
1. a fit between the student's work and class schedules,
2. issues at home,
3. anecdotal information about the program,
4. travel time to school,
5. perceived willingness of the program coordinator to "personalize" a course of study,
6. how many credits would be accepted,
7. length of time until degree completion, and
8. the degree of tuition assistance/personal financial status.
Research Question 1: The Meaning of Returning for the Bachelor of Science Degree
An interesting finding was that, on entering the program, participants gave little thought to what getting a baccalaureate would mean to the patients or the care they would deliver. However, the impact on practice and professionalism did emerge as they progressed through the program; this will be discussed later in this article.
Data related to meaning were grouped into two categories-meaning on entering the program and meaning on preparing to graduate or graduating. Participants, reflecting on their experiences when entering the baccalaureate program, presented themes related to meaning. These included waiting for the right time, being a means to a higher goal, addressing issues of aging and physical demands, role modeling for others, and testing one's ability to succeed. For most of the participants, waiting for the right time was a central theme that described their decision to return to school. Some described waiting for the right time from a personal perspective. One participant stated,
I had been single and had three children and just couldn't do it all, so I put that [the degree] on hold at that point. Now, the children are older.
For several participants, the impetus to seek the degree was spurred by other changes in their lives. For example, one participant stated,
[horizontal ellipsis]at that point I was getting older[horizontal ellipsis]I was going to be 55[horizontal ellipsis]I felt like I deserved it [the baccalaureate] at this time in my life[horizontal ellipsis]I felt I had a lot more to offer.
Others spoke of waiting until the right time from a professional perspective. Several nurses spoke of having worked on a particular unit for many years and having acquired an expert level of knowledge but knowing there was more to learn.
I felt that the associate degree program was excellent but basically focused a lot on clinical aspects, so I just felt there was more-just a little bit that I had been missing[horizontal ellipsis]Basically just seeing people [who] started as staff nurses, then assistant nurse manager, seeing other people go on[horizontal ellipsis]It was just the way that the other nurses who had the bachelor's degree behaved.
The decision of the hospital for which they worked to create an on-site degree program also played a role in "right timing."
When the program came along to me, it was an absolute no-brainer. The hospital is paying for the vast majority of it[horizontal ellipsis][The hospital is] bringing the professors to us. How could you turn down something like that?
For others, the meaning of returning for a degree was seen as a means to achieving a higher goal.
A CNS program is where I'm really heading, so of course I had to get the bachelor's degree first.
Other participants needed the degree to progress within the organization-for example, to work in a surgical unit or on an IV team.
Because most participants were older, several expressed concerns about the physical demands on the older staff nurses, and some saw the degree as a means of staying in nursing while doing less physical work.
I decided that, first of all to do anything in nursing, the minimum standard is going to be a bachelor's degree[horizontal ellipsis]looking to the future, I probably have another 15 years to work, and because we work physically hard on the floors, I want to have other options available to me[horizontal ellipsis]I know that in order to do that I need to have at least a bachelor's degree to be able to open more doors so that I don't have to work physically hard on the nursing units.
I need to start thinking about the future[horizontal ellipsis]prepare myself for physical changes.
By returning to school, several participants also saw themselves as role models for family members and other staff members. One participant who shares an attention-deficit disorder diagnosis with her son spoke of being a role model:
[horizontal ellipsis]when I went back to school, I did that to show my son that the ADD diagnosis doesn't mean anything. You can do whatever you set your mind to. It showed my son that you can do anything that you need to do[horizontal ellipsis]
Some nurses recognized that by returning for a degree, they were setting a good example for other nurses, whereas still others saw returning as a test of their ability to succeed.
Two other themes related to meaning emerged as the nurses graduated: an enhanced self-esteem and confidence.
It did a lot for [me] personally with self-esteem[horizontal ellipsis]thinking that I was [not] 'smart enough' to go to college was gone.
It has made me very proud of myself. I'm much more confident. If you can instill confidence in anyone, then you have accomplished everything because once you have made someone confident and proud of themselves [sic], they can do everything. I would never have applied for a management job[horizontal ellipsis]but now I would[horizontal ellipsis]
Research Question 2: How the Bachelor of Science Influences One's Perception of Being a Professional Nurse
In some cases, the participants identified a basic broadening of their own knowledge about the scope of professionalism. One participant, displaying admirable honesty, said,
I didn't know what professionalism was. I didn't know anything about theory. I didn't know there were nursing theories!
Learning how to use a computer for research-indeed, learning how to use a computer at all-was identified by some as an epiphany. Others identified an appreciation for the history of nursing, the value of research, and an understanding of an ethical code for nursing as areas that they believe increased their perceptions of themselves as professionals.
On a somewhat more sophisticated scale, research was identified as an element of their education that played a major role in the participants' perceptions of themselves as professionals. Not all "research" was scholarly inquiry; some was just grassroots investigation that would be used for public policy purposes. Even so, the desire to inquire, to find out, was recognized by the participants as a vital part of their educational growth. Some observations include the following:
It's research; some of it's knowing what the resources are out there. The associate degree program prepares you well for bedside care, but it doesn't show you the resources at a larger level and understanding that there may be legislation that bears on what you're doing[horizontal ellipsis]
I never really gave much thought to how the policies and procedures that we have now came about[horizontal ellipsis][It's] made me a little bit more aware of why we are doing what we're doing[horizontal ellipsis]You know, [it] comes down to patient care. You use evidence-based practice and [get] the best patient outcomes[horizontal ellipsis]Somebody studies it, there were better patient outcomes[horizontal ellipsis]
I was not familiar with the research process; just the concept of evidence-based practice was a fairly new concept to me[horizontal ellipsis]
In addition, the participants believed that baccalaureate education helped them answer long-standing questions concerning their professional practice and its scope. One of the areas where insight was most evident was in the roles of management and leadership:
I found there were several things in those [leadership and management] courses that gave me a better understanding of what some of the women I have worked for were doing and why they were doing things a certain way-I had a better understanding of what management does[horizontal ellipsis]
As a result of my education, I think that I would manage things a little differently[horizontal ellipsis]I would have more interaction with my staff[horizontal ellipsis]I would understand their concerns and try to help them work through[horizontal ellipsis]and find an answer[horizontal ellipsis]If you treat them with respect[horizontal ellipsis]they know what you have to accomplish[horizontal ellipsis][and] they are going to work harder and more diligently to help you accomplish what it is that you're doing.
I think that I'm more comfortable with leadership. I've always had a difficult time delegating to other people, and it [leadership education in the baccalaureate program] helped me understand a bit more why I can't be the one to do everything. So, it's helped me to share responsibilities.
One participant related an eye-opening experience watching two nurses interact with staff members. These insights were a direct result of the leadership component of baccalaureate education. She noted,
In observing two nurses[horizontal ellipsis]prior [to my return to school], I would have said, 'What a [expletive]. What a [expletive] that woman in the ER was,' but not think further to say, 'She just doesn't have natural leadership ability,' where this young nurse on the unit, in contrast, wasn't threatened, she wasn't intimidated. She just made it like a team effort, a teaching experience.
Another insight of participants was the value of challenging assumptions and, by doing so, broadening their perspectives:
I found a difference in speaking with each other. If there's something not quite right, I wouldn't hesitate to try to talk about it or try to resolve things[horizontal ellipsis]I feel I have a few more resources to be able to try to change something if something could be done better or in a different way that would be beneficial to patients.
Nobody likes change. I remember over the past year, having gone through change and we were all up in arms. But, you know, now, there's been research into it, and this is proven to be a better way to do it. Well, I have changed how I view change because now I can't say[horizontal ellipsis]'What a pain this is, adopting a whole new way.' Now, I know that there is probably a good reason that I never would have thought of before.
Many of the participants tied their beliefs of how the baccalaureate influenced their perceptions of themselves as professional nurses with their newfound ability to influence others:
You're trying to be proactive, and I think that by having that degree behind you [you have] that sense that you can be proactive without being a complaining individual[horizontal ellipsis]The way I approach things is different.
The participants in this study also identified an expanded awareness of others and a more mature type of empathy in their dealings with patients, peers, and members of the interdisciplinary team. A long-time preceptor, having returned for her bachelor of science (BS), made this observation about precepting new graduates:
Being a student myself has kind of made me step back and look more at why I'm doing that and think a little bit less of myself and my schedule.
The participants also noted that having nurses from other units in their classes helped them better understand the challenges faced by all nurses-that knowing one another's experiences increased empathy for each other.
[horizontal ellipsis]you kind of get to know what really their concerns are, what's going on on those different units that I would normally have no knowledge of, really[horizontal ellipsis]I think that definitely knowing and hearing what they're going through and how they're feeling about it definitely helps to say, 'Wow, they had to deal with this!' So, I think that it does kind of make me more empathetic to what's going on[horizontal ellipsis]
Finally, and perhaps most important, a common theme throughout the interviews was that of participants learning to reframe their thinking, seeing a big picture as a sign of their increased professionalism. Consider this observation from a preceptor, a seasoned RN who had returned for her baccalaureate:
I think that my approach to precepting is different this year than it was 3 years ago because 3 years ago, I was focused on the physical-the actual activity which is what you're doing for this patient. Now, [I] see things more as a whole picture. It's constantly saying to her or working with her to not just focus on all of the little things but to bring it all together. As graduates, they bring things in separately. Now, it's not just task oriented.
Research Question 3: How the BS Influences One's Nursing Practice
One of the findings in this section was that the curriculum focus specific to the school of nursing seemed to influence the participants' approaches to practice. One program appears to focus on disease and the physiological aspects of patient care, with a strong emphasis on peer and patient education. Another program seems to focus on more global issues and an evidence-based approach, where nursing theory and leadership are of paramount importance.
There were, however, some consistencies across the programs. All of the 11 participants, for example, indicated in some way that their studies enabled them to view patient care as the sum of many parts. Some refer to a "broader picture" or seeing "broader strokes;" others refer to "taking all things into account" or having a "wider perspective," but all mentioned that the baccalaureate has given them a greater awareness that enables them to focus on the entire patient.
I think my nursing role now is[horizontal ellipsis]not as task oriented as much as it was before. It's more education, it's more prevention. It's more not just taking care of that patient in the bed but the whole patient-everything about the patient.
You tend to see more sides[horizontal ellipsis]because of the things that I've learned though research, through community, through just learning about the history of nursing and transition[horizontal ellipsis]you start thinking about more than one avenue[horizontal ellipsis]
There was also a shift in thinking, from the technical to the professional, from practice that was automatic-almost by rote-to creative, intuitive problem solving.
I think that before, if a situation arose-any situation-you would almost take the avenue that you already knew; but now that I've been exposed to research and other venues of care and holistic nursing, community nursing, other things that I really hadn't even been exposed to before, I kind of view things from a different viewpoint now. I kind of take all things into perspective before I make an opinion of one certain situation.
[My education] enhanced the skills that I had so that instead of just listening to somebody's lung sounds, now, I'm listening to where they are and how do they change[horizontal ellipsis]If I make them cough, does it clear? Is it one particular spot?[horizontal ellipsis]I became more aware of why I was listening to certain things[horizontal ellipsis]
One of most prevalent concepts that filtered through each of the interviews is the participants' enhanced focus on education.
Perhaps by educating myself more, [it] helps me educate [patients] better and helps my coworkers by educating them also. I think that it all comes down to education. I think I'm more in tune to educating my coworkers, patients, families-promoting maybe a better atmosphere because they are now more educated and understand better.
[horizontal ellipsis]even though I have contacts with patients, I feel that I'm doing my fellow nurses more good, and I almost feel I'm helping my colleagues and coworkers[horizontal ellipsis]I like it when people ask me [my] opinion or ask questions and I find that people come to me first-a resource, and I like that!
[horizontal ellipsis]in informal ways when there is an opportunity to tell somebody, 'This is what I'm doing and I think it would be good if you do this.'
For some of the participants, particularly those from one college's program, there was a realization of the importance of applying the sciences to patient care:
I have a deeper understanding of the physiological aspects of some disease processes, and I am more apt to go after what I don't know as far as the disease process[horizontal ellipsis]I feel that I have a deeper knowledge than just the human body, and now I'm also more apt, if I don't understand it, I'm going to ask until I do understand it.
Whether through the fine-tuning of skills or the application of research to practice, participants frequently verbalized a new appreciation of research and scholarly thought.
I think that you need to pay attention to the research, which is not something that I ever did previously. You know, I think you do need to be current[horizontal ellipsis]and I just didn't pay attention to that very much before I went back to school.
Of course, not every attempt to implement research goes smoothly because such implementation involves change-change that is not always welcomed by those who have not had the exposure to the concept or value of evidence-based practice. One participant relates a story of how she tried to convince her peers on the postanesthesia care unit that the environment should be kept quieter for the well-being of the recovering surgical patients. At the time, it had not been unusual for a rock-and-roll radio station to be blaring loudly and for staff members to be holding noisy conversations. Having found research to support the value of a quieter environment, this nurse wanted to see a change in the unit's practice. She was not totally successful, but she changed her own practice and influenced a colleague as well:
[My peers] basically just disregarded it. One nurse actually said, 'Well, I don't believe in any of that stuff,' so now that I did that research project, I keep my little two units nice and quiet and slightly darkened[horizontal ellipsis]Well, there is one nurse who I work with[horizontal ellipsis]and she does that now, too[horizontal ellipsis]She puts the lights off.
DISCUSSION AND IMPLICATIONS
The study of Lillibridge and Fox (2005), which examined the perceptions of six RNs who returned for their BSN degrees, has some congruencies with this study, including the participants' desire for career mobility and the belief that the degree was instrumental in making this possible, significant peer resistance to the participants' pursuit of a degree, the improved ability to see the entire patient, interest in applying newfound appreciation for research and evidence-based practice in the clinical setting, and feelings of personal accomplishment.
However, participants in this study did not express the perception of not fitting in with inexperienced undergraduate students, as the participants of Lillibridge and Fox(2005) did. Neither did participants of this study express the cynicism shown by the participants of Lillibridge and Fox, which is thus best described by the question, "What do you think you can teach me that I don't already know?" Instead, most participants in this study began the baccalaureate course knowing that they had much to learn and looking forward to challenging themselves. Unlike the participants of Lillibridge and Fox, this group also felt that being role models and better patient and peer teachers were positive outcomes of the baccalaureate education.
One difference between the study of Lillibridge and Fox (2005) and this study may well explain these discrepancies. More than half of the participants in the current study participated in an on-site RN-to-BS program, so issues of travel and intermingling with inexperienced undergraduates were not concerns. An interesting finding was that those four participants who attended on-campus classes still did not mention the campus-related issues of the other study.
The reasons an experienced nurse returns for a baccalaureate are personal and varied, but in this study, each of the participants found a sense of betterment and enhanced professionalism as she progressed through the program. Staff development specialists are in a unique position to support both the organization and the nurse student in the education process.
Although it is not always possible for the hospital or agency to have a dedicated relationship with a school of nursing, doing so can provide advantages for all involved: For example, integration of the organization's mission, vision, and goals into the curriculum can further their realization while helping the nurse student to understand their value, and assistance with the transfer of knowledge from the classroom to the bedside brings applicability to the curriculum while enhancing patient care. Seven of the 11 participants in this study benefited from such an arrangement between a university and the hospital where they worked: The school provided faculty for classes on the hospital campus, and the hospital provided a generous tuition reimbursement that essentially made the program free for participating employees. In return, those employees promised to work for a minimum of two additional years at the hospital. The hospital found this to be a valuable retention strategy; the school was able to expand its nursing program at minimal cost; and the participants believed that the decision to become a nurse student was, in the words of one of them, "a no-brainer." Open communications between schools and agencies are, obviously, the foundation for such an arrangement, but if all parties are willing, they can establish an arrangement that benefits everyone.
Whether or not there is a dedicated relationship between school and agency, there must be support structures within the practice environment to ensure optimal outcomes. In addition to the aforementioned sharing of the organization's mission, vision, and goals so that these might be integrated into the curriculum; the provision of tuition assistance; and the accessibility of classes (e.g., on the hospital campus), there are other ways an agency can support the nurse student. An encouraging nurse manager can make a tremendous impact on the success of the nurse student, particularly if that manager is reasonable regarding the need for flexible work hours. The staff development specialist can work with both the manager and the student to determine the best ways to provide staffing coverage for the unit while allowing the student to attend classes or have time off to write papers or study.
Staff development specialists can especially provide structures to support the transfer of new knowledge and skills. Some of these include:
1. providing the nurse manager with information about the curriculum to encourage a parallel between what is being learned and what is being practiced in daily assignments;
2. advocating for administration, management, and physician support;
3. promoting a shared decision-making model and ensuring that nurse students participate;
4. using baccalaureate-prepared nurses as preceptors and resource nurses, giving them an opportunity to use and share their knowledge;
5. advocating for the inclusion of degree attainment in the performance evaluation and career development plan;
6. encouraging nurse students and recent baccalaureate graduates to participate on appropriate committees; and
7. planning organization-wide recognition programs for staff members who attain their baccalaureates.
Staff development specialists are ideally positioned to take the lead in promoting a "return for your baccalaureate" movement, of course, but there is so much more that they can do. Providing discussion/support groups for nurse students is of tremendous value, especially if run collaboratively with the schools of nursing. After graduation, it is the staff development specialist who can help new graduates synthesize and transfer what they have learned into the work setting. In addition, the staff development specialist can support, advocate for, or run interference for the new BS graduate who attempts to institute change but runs into barriers by providing evidence-based practice research, for example, or helping the graduate determine the best ways to approach change on his or her unit. With such occurrences fairly common, it might be wise for an agency to dedicate one staff development specialist as a "baccalaureate transition partner."
Regardless of the impetus that drove these participants back to school, each one reported tremendous satisfaction with degree attainment. One of those interviewed summed up the experience with these words:
The rewards are so great. I'm not even sure that you can enumerate properly all of the rewards. You can make a great salary, but there are things that are so much more[horizontal ellipsis]Did you ever think what it would be like without you? I can honestly go home at night and realize that it would be different without me-that I made a big difference. I'm really lucky to be able to say that.
The authors wish to thank the Delta Upsilon Chapter-at-Large of Sigma Theta Tau International for providing funding for this research.
Aiken, L. H., Clarke, S. P., Cheung, R. B., Sloane, D. M., & Silber, J. H. (2003). Educational levels of hospital nurses and surgical patient mortality. Journal of the American Medical Association, 290(12), 1617-1623. [Context Link]
American Nurses Association. (2000). Scope and standards of practice for nursing professional development. Washington, DC: American Nurses Publishing. [Context Link]
Boylston, M. T., Peters, M. A., & Lacey, M. (2004). Adult student satisfaction in traditional and accelerated RN-to-BSN programs. Journal of Professional Nursing, 20(1), 23-32. [Context Link]
Cangelosi, P. R. (2004). The tact of teaching RN-to-BSN students. Journal of Professional Nursing, 20(3), 167-173. [Context Link]
Clark, K. (2004). A qualitative study of faculty/student perceptions of RN to baccalaureate nursing degree curricula and instructional needs through focus groups and follow-up interviews. Dissertation Abstracts International-A, 65(6), 2109. (UMI No. AAI3135840). [Context Link]
Corbett, S. A. (1997). Factors that motivate RNs to return to school for the BSN and to remain in school to complete the degree. Unpublished doctoral dissertation [abstract], Florida International University. (UMI No. AAI9724561). Retrieved November 9, 2005, from http://digitalcommons.fiu.edu/dissertations/AAI9724561/[Context Link]
Cox, L. S. (1996). A comparison of two teaching delivery systems for registered nurse baccalaureate education: Traditional classroom setting and interactive video. Dissertation Abstracts International-B, 57(7), 4294. (UMI No. AAI9640309). [Context Link]
Delaney, C., & Piscopo, B. (2004). RN-BSN programs: Associate degree and diploma nurses' perceptions of the benefits and barriers to returning to school. Journal for Nurses in Staff Development, 20(4), 157-161. [Context Link]
Hall, D. B. (2003). Use of professional nurse case study as a method to earn credit in an RN to BSN program. ABNF Journal, 14(4), 86-88. [Context Link]
Hegge, M. (1995). Restructuring nursing curricula. Nurse Educator, 20(6), 39-44. [Context Link]
Horne, C. D. (1998). Alienation, self-esteem, and perceived self-efficacy: A comparison of returning registered nurse students, prelicensure nursing students, and non-nursing major students in baccalaureate programs. Dissertation Abstracts International-B, 59(3), 1047. (UMI No. AAI9828090). [Context Link]
Huston, C., Shovein, J., Damazo, B., & Fox, S. (2001). The RN-BSN bridge course: Transitioning the re-entry learner. Journal of Continuing Education in Nursing, 32(6), 250-253. [Context Link]
Lillibridge, J., & Fox, S. D. (2005). RN to BSN education: What do RNs think? Nurse Educator, 30(1), 12-16. [Context Link]
Long, K. A., Bernier, S., & Aiken, L. H. (2004). RN education: A matter of degrees. Nursing, 34(3), 48-51. [Context Link]
Malizia, E. E. (2000). Professional socialization of the registered nurse returning for a baccalaureate degree. Dissertation Abstracts International-A, 61(2), 524. (UMI No. AAI9964396). [Context Link]
McCray, J. M. (1995). Learning for meaning: The lived experience of returning registered nurse learners. Dissertation Abstracts International-B, 56(5), 2561. (UMI No. PUZ9527110). [Context Link]
Rubin, H. J., & Rubin, I. S. (1995). Qualitative interviewing: The art of hearing data. Thousand Oaks, CA: Sage. [Context Link]
Spratley, E., Johnson, A., Sochalski, J., Fritz, M., & Spencer, W. (2000). The registered nurse population: Findings from the national sample survey of registered nurses, March 2000. Washington, DC: U.S. Department of Health and Human Services. [Context Link]
Stringfield, Y. N. (1993). Perceptions of senior re-entry registered nurse students in baccalaureate nursing programs. Dissertation Abstracts International-B, 54(4), 1895. (UMI No. PUZ9326228). [Context Link]