The Institute of Medicine (IOM, 2011) provided a key recommendation in the Future of Nursing (FON) report, to increase the proportion of baccalaureate-prepared nurses to 80 percent by 2020 through the promotion of seamless academic progression. The IOM recognized the multiple pathways for nursing education, noting the pivotal role that community colleges play in attracting diverse students with modest financial resources, as well as community college presence in rural and underserved areas. Approximately 50.2 percent of registered nurse graduates who take the National Council Licensure Exam for the first time are from associate degree nursing (ADN) programs (National Council of State Boards of Nursing, 2019). It is imperative that graduates from these programs advance their education through ADN partnerships with BSN programs or RN-bachelor of science in nursing (BSN) programs. This article discusses a seamless dual admission program in northeast Ohio, demonstrating a cost-effective partnership that reduced academic progression barriers for students with positive student outcomes.
BACKGROUND
A key initiative supporting the FON report was the formation of action coalitions in each state and the District of Columbia. Ohio's Action Coalition was split into three regional work groups, including one in Northeast Ohio (Sharpnack et al., 2017). Nursing programs in this region were motivated beyond the FON report to develop seamless progression models. The major Northeast Ohio hospitals in the Cleveland area require that ADN graduates attain their BSN within two to five years of hire.
The Northeast Ohio Action Coalition (NEOAC) was composed of academic leaders from two RN-BSN programs, three ADN programs, and one clinical partner, with a goal of developing a dual admission model. The target audience was students matriculating to the ADN program. Eligible students would apply to both programs simultaneously. Once admitted, they would immediately begin with courses that would result in an associate degree in applied science in nursing within five semesters and a BSN within as little as three additional semesters. The team identified three major subgoals: develop a dual admission curriculum, identify admission criteria, and streamline processes for admissions. National accreditation and state approval bodies were informed of and approved the dual progression model.
DUAL ENROLLMENT CURRICULUM
The NEOAC team's first action was to compare the curricula of the ADN and RN-BSN programs. The goal was to develop a curriculum that would reasonably allow students to take courses in both the ADN and RN-BSN programs simultaneously, while minimizing cost and decreasing redundancy. This process was relatively easy as students could take RN-BSN general education courses online during times when they might not be enrolled in ADN nursing courses, such as the summer. The 32-hour residency requirement from the BSN-granting institution would be met by general education core and nursing core requirements. Remaining general education requirements exceeding the 32-hour residency could be taken at the community college, thus decreasing cost. Both escrow and transfer credits were awarded based on the BSN institutions' transfer guide.
The next step was integration of theory nursing courses. The team was interested in increasing student interest in the RN-BSN program and building on content learned in the ADN program. A decision was made to offer students the option of enrolling in the RN-BSN Foundations of Professional Practice course immediately following completion of the first nursing semester of the ADN program. This approach not only built on recently learned concepts but also exposed ADN students to practicing RNs who were also enrolled in the course. Student feedback after course completion included: "The BSN curriculum furthers my theoretical knowledge and builds my confidence as I move forward in my nursing education." Students commented on how differences in perspective on a shared topic viewed from a prelicense and postlicense lens were valued. Students continue to take BSN nursing core and general education courses throughout the ADN program. As ADN students are unable to take clinical courses in the RN-BSN program until they obtained an RN license, these courses were placed at the end of the RN-BSN curriculum.
The team noted that the RN-BSN program required a health assessment course if students did not take a standalone course in their ADN program. Many ADN programs integrate health assessment into other courses. The need to retake health assessment resulted in redundancy of content and increased cost and time for students. The NEOAC team jointly developed an assessment competency evaluation that was administered in the final medical-surgical course of the ADN program. Students who passed the competency would receive two credits for health assessment in the RN-BSN program; others were required to take health assessment in the RN-BSN program (Goliat et al., 2020). Students provided written permission for sharing their names and competency results with RN-BSN chairs so that escrow credit could be granted for health assessment.
ADMISSION CRITERIA AND PROCESS
The NEOAC team wanted to eliminate as many barriers as possible so the establishment of simple admissions processes was essential. The directors of both programs had professional relationships with their respective admissions and financial aid representatives. Each director requested the development of a joint task force to develop admission processes. The task force developed an "Intent to Enroll" form, to be generated by either community college counselors or the nursing program director. The form included a student signature indicating that all information in the student's academic and clinical health records could be shared with the RN-BSN institution. The clinical health record included all student vaccines and background check information. This transfer of information decreased workload for the student and the BSN program, requiring students to update information and testing as needed. The community college admissions office sends the form to the RN-BSN admissions department, which can then begin processing student information.
The NEOAC team realized the rigor of a dual program and course audit planning. Consequently, the grade point average (GPA), which had been 2.5 for RN-BSN program admission, was raised to a cumulative GPA of 3.0 for the Dual Admission Progression Program (DAPP) applicant. Initially, the envisioned progression student was a college-ready high school graduate. However, the primary applicant profile came from three main demographics: high school student with transferable college credit, second-degree student returning for a nursing degree, and current associate degree midprogram nursing student.
Initially, the DAPP student applies to the RN-BSN program and, once admitted, schedules an orientation session with the RN-BSN coordinator. During orientation, complete graduation plan coordinating curricula from both programs are developed. The DAPP students take only one BSN course during the fall and spring semesters of the ADN program to ensure the student's schedule and workload are manageable. Summer semesters are open to more BSN coursework; the ADN program does not offer summer courses. Students often take liberal arts and core degree courses during summer semesters.
IMPLEMENTATION, GROWTH, OUTCOMES
The first students started the DAPP in the fall semester of 2017. Both applicants were second-degree students. Because of the generous transfer credit for this type of student, they were only required to complete 25 credits in the RN-BSN program. A student without a four-year degree completes approximately 34 credits of RN-BSN coursework. The program expanded to 20 active DAPP students by spring of 2020. Four students have transitioned to postlicensure standing in the program. On average, DAPP students complete the RN-BSN degree within 9 to 12 months from ADN graduation. The program decreases the time for ADN newly licensed nurses to complete the BSN, thus supporting and promoting the IOM goal of advancing education.
LESSONS LEARNED
Three major lessons have been learned through implementation of the RN-BSN DAPP. The most important is that success of the partnership is based on strong relationships. Regular communication between the RN-BSN coordinator, the ADN program director, and admissions counselors is key for operational flow. The RN-BSN coordinator serves as the student advisor to maintain consistency with communication; a combined traditional RN-BSN and DAPP dedicated advisor is recommended. The next lesson is that DAPP student demographics are different than originally anticipated. Therefore, the RN-BSN coordinator must develop individualized graduation plans to meet student needs. Coordination of student records is critical for degree tracking and registration for BSN courses. Lastly, it is essential to learn to say no. Accepting applicants who do not meet admission GPA requirements may set them up for failure. Encourage them to reapply after ADN graduation. Students may want to take more than the recommended BSN coursework during the fall and spring semesters. Taking too many courses too soon does not guarantee success.
In addition to collaborative partnerships for degree completion, future models of progression programs could incorporate the blending of learning opportunities in simulation and laboratory experiences. Peer mentoring between post- and prelicensure students to extend collaborative learning beyond the traditional didactic classroom can also be beneficial.
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