Most nursing students and educators would agree that being a student in a prelicensure baccalaureate program carries its own unique set of rewards and challenges. For those nursing students who are also student athletes, these rewards and challenges are multiplied, often exponentially (Forst, 2015). Many nursing education programs expect students to choose between being student athletes and being nursing students, rather than allowing them to combine the two roles. There is a scarcity of nursing literature addressing the subset of nursing students who are also student athletes.

This article is based on experiences in a prelicensure baccalaureate nursing program in central South Carolina that is set in a private, church-affiliated, liberal arts four-year college where more than half of the college's student body are athletes involved in National Collegiate Athletic Association (NCAA) Division 2 sports. As a result of the high percentage of the overall student body involved in athletics, student athletes can constitute as many as 30 percent of nursing majors. The most popular sports for nursing students at this school are women's soccer, softball, volleyball, and cheerleading (not an official NCAA sport but does compete on an intercollegiate basis) and men's baseball, football, and soccer.

This article offers the characteristics of successful nursing student athletes (NSAs); the challenges they encounter; the advantages to including athletes in the nursing student body; and the student-centered, program-centered, and institution-centered strategies that must be in place for their success. This information should be of particular interest to nurse educators as well as to nursing students.

NSA CHARACTERISTICS

Our nursing program consists of two years of pre nursing and College Core coursework, followed by nursing (NUR) courses taught in the junior and senior years. Prenursing students in the freshman and sophomore years are similar to the other student athletes in the college, trying to juggle the expectations of their individual sport, traditional classroom-based courses, and science laboratories. Nursing majors in the last two years also must deal with classes and on-campus labs that may not conform to the college's usual time frames, as well as off-campus clinical experiences that take place outside the traditional daytime in-class parameters.

Nursing majors who are also student athletes can be described as having several characteristics. In general, they have high grade point averages (GPAs), with women's soccer, softball, and volleyball reporting team averages of > 3.2 and men's baseball and soccer reporting team averages of > 3.0. Because student athletes at our institution who play their sport after the freshman year tend to persist through to graduation, our NSAs have completed the four semesters of NUR courses and graduated on time with their original nursing cohorts. NSAs tend to have strong GPAs when entering the sequence of NUR courses, which they often maintain through to graduation. (At graduation in May 2015, the average GPA of five NSAs was 3.44 compared to the average for nonathletes of 3.22.) A recent NSA graduate who was on the volleyball team was president of two honor societies on campus during her senior year, and many NSAs are on academic scholarships as well as, or instead of, purely athletic scholarships. Two NSAs who graduated in 2012 were co-captains of the football team. (GPA data were taken from prioritization process reports written by head coaches of each sport.)

Based on observation, NSAs often will submit assignments early, which allows them to focus on their upcoming athletic competitions. They are able to react quickly to patient changes in the clinical setting, because they are required to respond rapidly to the actions of their competitors on the field/court. They are used to following directions and bring this habit with them to the clinical setting. They are team players who know their role(s) and strive not only for mastery but for excellence.

We have found that NSAs frequently possess leadership experience within their teams, serving as team captains or position leaders. Their strong time management and prioritization skills have grown out of the need to successfully juggle school, athletic, and personal responsibilities (Forst, 2015). NSAs are able to view situations holistically and understand how their actions fit within the big picture. They have also developed strong observation skills from watching game films. Overall, NSAs are confident in their abilities and are perceived as being goal-directed students who know what they want to accomplish in a specified time.

NSAs confront numerous stressors in trying to balance requirements between athletics and academics. Study time, social time, and personal time are all decreased. NSAs may have increased class absences due to games/competitions, and their grades may drop when their sports are in season. Because of games, they may miss not only classes but also clinical experiences that can be difficult to replicate, especially in small schools. Their support groups often are composed of teammates and may not include other nursing students; non-NSAs may not appreciate what it takes to be successful as a nursing major who is also an athlete. Poor physical health, including loss of sleep, poor nutrition, and constant stress, may result from attempting to juggle multiple segments of their lives.

There are advantages to having student athletes included in the nursing program's student body. Including NSAs helps bring diversity into the nursing workforce, with more African American, Hispanic, and international students majoring in nursing. Athletics also brings an increase in the number of male students as nursing majors; we have had as many as one third of our graduating class as men. NSAs often serve as recruiters and peer mentors to other students who may be undecided about their majors or who are curious about nursing as a career. NSAs frequently model leadership and time management skills for prenursing and other nursing students.

STUDENT-CENTERED STRATEGIES FOR SUCCESS

There are several student-centered strategies for success as an NSA. Because of the high level of stress they must deal with, NSAs must work toward taking care of themselves physically, mentally/emotionally, and spiritually. Minimizing class absences is important for all students but is especially important for NSAs; the NCAA expects student athletes to be held to the same attendance standards of all students at the institution (Newberry College, 2015). Therefore, NSAs must work with individual faculty to prearrange class absences and make up work they missed in a timely manner (Forst, 2015; Maheady, 1989). They should submit assignments early, if possible, and take advantage of athletic travel time to study, share driving duties or carpooling to clinical experiences to decrease stress and/or to have the time to review preparatory materials.

NSAs should utilize study halls and tutors as needed to maintain and/or improve grades and are encouraged to choose nursing students as roommates or suite mates to increase their social support network. Pairing up with a nursing "study buddy" can be helpful. It is also advantageous if NSAs are not employed while school is in session and do not engage in numerous other extracurricular activities. However, many students must be employed while in school in order to remain in school.

PROGRAM-CENTERED SUCCESS STRATEGIES

As feasible, the nursing program considers the athletic schedule when arranging clinical experiences for athletes. That includes giving priority for morning labs and clinicals for NSAs as most practice times are in the afternoon. We have found that some sports are easier to schedule around than others. For example, football is easier to accommodate as travel takes place on Friday afternoons and games take place on Saturday. Men's and women's golf are the most difficult sports to work with; golfers leave campus on Sundays and return late on Tuesdays, so NSAs miss Monday classes plus Tuesday clinicals. To date we have been able to make all sports work.

Allowing flexibility in testing times so students can take tests before or after games as they choose has proven to be helpful, but requiring NSAs to take a test without having adequate study time is not desirable. Another complication is that some sports (e.g., wrestling, cheerleading, and men's and women's basketball) cross over both semesters; therefore, NSAs in these sports do not have definite semesters where they are "in season" versus "off season."

Promoting open communication between faculty and coaches is an important strategy for the success of NSAs (Forst, 2015; Maheady, 1989). Nurse faculty and staff demonstrate their support of NSAs by attending athletic events and recognizing athletic accomplishments as well as academic successes.

There are also institution-centered strategies for NSAs. It is a given that all colleges and universities with student athletes must know NCAA rules thoroughly; student athletes in any major should not have the added pressure of having to interpret NCAA rules and policies for themselves. Allowing NSAs to take lighter course loads during the athletic season is also helpful when possible. Some NSAs who are red-shirted in a sport (i.e., they don't play their first year in college and save that year of athletic eligibility until later) know early that they will be on campus for more than the traditional four years for a baccalaureate degree so they use the extra semesters to complete their general education requirements, a double major, and/or one or more minors before beginning their NUR courses. In this way, they are able to focus on just their NUR courses and their sport during their final two years at the college.

Identifying common practice times for all sports, and then scheduling single-section classes outside those times, is another success strategy for NSAs. However, this can be difficult for a small institution with limited numbers of sections for many specialized courses. Another success strategy that was introduced at our institution recently is the Faculty Guest Coach program. Here, athletes in a particular sport invite a faculty member to spend a week "walking in their shoes," attending practices, team meetings, and conditioning/weight training sessions and sitting on the sidelines during the game at the end of the week. This program assists the faculty member to appreciate what the student athletes must accomplish outside the classroom. It might be helpful if this strategy were reversed, so coaches can experience what NSAs are expected to complete when they are not involved in their sport-related activities.

In summary, allowing nursing majors to also be student athletes has benefits that outweigh the disadvantages. This article presents the characteristics of successful NSAs, the challenges that NSAs encounter, the advantages to including student athletes in the nursing student body, and suggested strategies to promote NSA success.

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