The Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health in 2011 challenges nurse educators to reexamine entry into practice for nurses. The same report has prompted nurse educators to work together toward the goal of increasing the percentage of baccalaureate nurses in the United States from 50 percent to 80 percent by 2020. There is widespread consensus that associate degree (ADN) and baccalaureate nursing (BSN) programs must partner toward innovative collaborations that foster higher levels of education for nurses, with seamless transition between academic institutions (Babbo, Fought, Holk, Mulligan, & Perrone, 2013; Bastable & Markowitz, 2012). This article details a successful collaboration to design a dual enrollment (DE) program that addresses IOM recommendations.
Although the "causal relationship between the academic degree obtained by RNs and patient outcomes is not conclusive in the research literature" (IOM, 2011, p. 169), the IOM report contends that there is need for an all-BSN workforce within the next decade. The report argues that, despite the current debates regarding nursing education, an "all-BSN workforce at the entry level would provide a more uniform foundation" (p. 170) for providing care in the ever-changing health care environment. One limitation to reaching the 80 percent by 2020 goal is the time frame in which ADN-prepared nurses return to academia for their BSN degree, which is typically 7.5 years (US Department of Health & Human Services, 2010).
PROGRAM IMPLEMENTATION
DE programs provide one option for nursing students who wish to pursue the BSN degree. Nursing leadership from an ADN program at a community college and a BSN program at a university, located in the same town, approximately four miles apart, met to discuss a DE collaboration. Both schools of nursing are public institutions governed by the statewide Department of Education. The primary goal was to assist students to obtain the BSN degree more rapidly and efficiently than with traditional RN-BSN programs. Additional goals were to produce more BSN graduates for the workforce, increase the pool of applicants for the ADN program, and provide a cost-effective pathway for students to obtain the BSN.
The community college employs six full-time nurse faculty and has an average yearly enrollment of 50 students (average age = 22; 7 percent male; 23 percent ethnically diverse); the cost of the ADN program is approximately $13,000. The university employs 26 full-time nurse faculty and has an average yearly enrollment of 150 students (average age = 24, 6 percent male; 11 percent ethnically diverse); the cost of the BSN program is approximately $41,000. Both programs are led by nursing directors who report to a non-nursing dean.
Process
The nursing program directors in the community college and university discussed the proposal with the appropriate leadership at their respective schools. A Memorandum of Understanding was developed and signed by each entity. The document addressed the dates of the agreement, obligations and responsibilities of each school, the parameters of concurrent enrollment, and the number of students for each cohort; admission requirements, prerequisites, and plan of study were addressed in the appendix.
After the Memorandum of Understanding was signed, meetings took place between the registrar and financial aid directors at both organizations to work out the details of registration and the disbursement of financial aid. The director of residential housing on the university campus helped ensure that students in the DE program were eligible to live in university dormitories.
The institutions agreed upon the following prerequisite courses for admission into the DE program: Anatomy and Physiology I and II, Microbiology, Nutrition, Growth and Development, Statistics, and English. The DE students would also have to fulfill the university requirement of 40 credit hours of general education courses. Detailed academic advising starting two to three semesters prior to enrollment is critical to guide the applicants in completing the required coursework.
To be eligible for the DE program, a student must meet the admission requirements for both the community college and the university. Initially, applicants are screened and admitted to the ADN program. Once admitted, the applicant is given the opportunity to apply to the university program for the DE option. Approximately 70 percent of the ADN cohort chose to enroll in the DE option the first year, with 90 percent enrollment in subsequent years. DE students are integrated with other ADN students for the lower division nursing courses; upper division nursing courses are taken only by the DE cohort.
Curriculum Model
The curriculum is designed so that students take courses in the ADN program and the BSN program concurrently. Students progress through the program in a cohort model. The entire program is completed in eight semesters (four semesters full-time and four semesters part-time; see Figure, Supplementary Digital Content 1, http://links.lww.com/NEP/A4). The ADN courses are offered face-to-face; the BSN courses are offered in a hybrid format (approximately 25 percent face-to-face, 75 percent online).
After completion of the ADN coursework and five BSN courses, students are eligible to take the NCLEX-RN exam; students are not allowed to continue in the DE program until the exam is passed. The remaining two semesters of part-time BSN coursework focus on public health, leadership, and evidence-based practice courses.
CHALLENGES AND BENEFITS
One of the major identified challenges was the integration of two nursing curricula without redundancy. For example, students learn basic information about health assessment within the first semester of the ADN program and take a health assessment course for the BSN program the next semester. Faculty met to ensure that the BSN health assessment course focused on advanced concepts, more thorough assessment, and additional practice time.
Students reported feeling overwhelmed by the amount of coursework, presenting a second challenge. Faculty responded by evaluating the quantity of assignments and the timing of exams and assignments; they also scheduled hybrid meeting times to correlate with times students were already on campus. Expanded faculty office hours were scheduled for students who needed additional assistance.
The DE program was found to offer multiple advantages while providing a more efficient route to the BSN and ultimately increasing the number of BSN graduates in the workforce. Students welcomed a substantial total cost savings for tuition and fees, estimated at $10,000 to $15,000. Students are eligible for Pell grants and federal student aid for the ADN program and for federal student aid and private loans to subsidize costs at the BSN level. Scholarship and workplace-related tuition reimbursement programs are sources of additional funding. To ensure that students fully understand the costs of the program as well as their responsibilities associated with receiving financial assistance, financial aid representatives are available to students to answer questions.
Nurse faculty from the community college and the university have found that working on this program together has led to a shared value for BSN education. The collaboration between the two institutions has led to a stronger curriculum, a supportive environment for students, and greater respect for each school's curriculum.
DISCUSSION
In a health care environment that is constantly evolving, nurse educators must be prepared to develop programs and curricula that support the goals of the IOM report. Specifically, academia should focus on the creation of educational initiatives that increase the number of BSN nurses that enter the workforce. It is necessary for educators and administrators to break away from historical thinking that education must happen in incremental steps. With DE programs, education is truly seamless and students can enter these programs and complete both the ADN and BSN degree with no break in their academic progression.
Development of DE programs must be inclusive and involve all key stakeholders to ensure success. Variables such as the housing needs of students, financial aid requirements, nursing articulation agreements between institutions, and other aspects of the educational experience must be considered. Candid conversations allow both entities to work together toward the resolution of issues that have the potential to affect student progression.
The historical entry into practice debate created a climate in which ADN and BSN nursing programs were competitors in educating new nursing graduates. DE initiatives change the climate of competitiveness and focus on the opportunities for collaboration. This partnership creates an atmosphere in which academic entities can generate innovative ideas and work together to develop new programs.
CONCLUSION
This creative partnership between educational institutions can be emulated by other nursing programs to support the IOM goal of having 80 percent of the RN workforce BSN-prepared by 2020. Our initiative succeeds in helping to meet workforce demands while providing a cost-effective avenue for students to achieve the BSN degree in a timely and efficient manner. By combining the strengths of two educational programs, ADN students obtain an excellent foundation in nursing knowledge and skills while achieving advanced competencies in leadership, community health, and evidence-based practice in their BSN courses. It is hoped that the implementation strategies and lessons learned regarding this DE initiative provided by this article will foster the potential for similar programs in other community colleges and universities.
REFERENCES