Nursing programs have continually evolved over the years, in an attempt to accommodate the growing demands of the health-care industry. Nurses have been required to expand their knowledge beyond the basic technical skills needed at the bedside. The ability to engage in research and apply evidence based practice in the clinical setting, is now a requirement for many nursing positions. Based on the request for more educated nurses, The Institution of Medicine is calling for an increase in the number of Baccalaureate prepared nurses to 80% of the nursing population (Institute of Medicine, 2010). Also, by 2018, The Bureau of Labor Statistics is estimating that there will be a need for approximately 580,000 new and replacement nurses (American Association of Colleges of Nursing, 2015). Due to the increasing demands for nurses, specifically baccalaureate nurses, nursing schools have had to be creative in regards to producing competent nurses in a short period of time. The second degree accelerated Bachelor of Science in nursing program has allowed schools to produce more nurses per year than ever before. How these accelerated nursing programs compare to their traditional counterparts, has been a topic of debate since the inception of accelerated programs. However, the research has lacked in regards to the effectiveness of students that complete these accelerated nursing programs. The purpose of this paper is to analyze the effectiveness of accelerated nursing programs, and their ability to produce safe and quality nurses.
Accelerated nursing students are a unique group of people who bring with them unique expectations and challenges. Nursing schools must be aware of these expectations and challenges in order to effectively teach these students.
Characteristics of Accelerated Nursing Students
In comparison to traditional nursing students, second-degree accelerated students tend to be older, more motivated individuals with high expectations for themselves and the faculty that teach them (Driessnack, Mobily, Stineman, Montgomery, Clow, and Eisbach, 2011). Students often bring previous educational and life experiences that can be incorporated into their nursing practice, and is often recognized and appreciated by faculty (Rico, Beal, and Davies, 2010). Many nursing school administrators know that accelerated nursing students can be a challenge for many faculty members. The faculty that have the hardest time tend to be those who do not know how to effectively teach these students (Rico, Beal, and Davies, 2010). Administrators may need to find faculty that enjoy teaching these students, and who can respect what they can bring to the nursing profession (Rico, Beal, and Davies, 2010).
Challenges of Accelerated Nursing Programs. There are many challenges that accelerated nursing students can face when they enroll in second-degree accelerated nursing programs. Challenges include, high stress levels, heavy workloads, financial strain, and mental and physical exhaustion. Although high stress levels are common in all nursing programs, accelerated nursing programs add a new level of stress to the mix. According to one graduate of an accelerated nursing program, ‘there was often undue stress- the expectation for stress was greater than the actual program’ (Weitzel & Mccahon, 2008). Many accelerated students enter into these programs with the notion that it will be the hardest year of their life. While this may be the case for some, others may feel that that this statement brings undue stress to an already stressful situation. Another major challenge accelerated student’s face is a heavy workload which can often include seemingly unimportant busy work. Many graduates may find that content is not evenly distributed and assignments such as group projects can be tedious and cumbersome (Driessnack, Mobily, Stineman, Montgomery, Clow, and Eisbach, 2011). Faculty may want to review the curriculum on a yearly basis to make sure that all the assignments, readings, tests and papers are relevant and necessary (Weitzel & Mccahon, 2008). Financial strain is another big issue for many students in the accelerated program. According to information received during follow-up interviews, students who drop out site finances as the main reason for their decision (Rouse & Rooda, 2010). One of the last major challenges that many accelerated nursing student’s site is mental and physical exhaustion. Accelerated students not only have to worry about meeting the demands of the program, they may also have several responsibilities outside of school. Learning to find a balance between school life and home life can be very challenging and can also be very exhausting.
Theory plays a huge role in all aspects of nursing and patient care therefore, it is important that theory be incorporated into all accelerated nursing program curriculums.
Betty Neuman Systems Model
The nursing theory I chose to reference for this paper is Betty Neuman’s Systems Model. ‘The Neuman Systems Model views the client as an open system that responds to stressors in the environment’ (Neuman & Reed, 2007). Stressors have the ability to penetrate a person’s normal lines of defense, which can result in either a positive or a negative outcome for the client (Neuman & Reed, 2007). The overall stability of the client will ultimately determine how the stressor is handled by the body (Neuman & Reed, 2007). Clients are encouraged to engage in primary prevention practices in order to prevent these stressors from disrupting their lives (Neuman & Reed, 2007). The goal of nursing in Neuman’s theory is to, ‘facilitate optimal wellness through the use of primary, secondary and tertiary prevention’ (Neuman & Reed, 2007). Primary prevention practices that accelerated nursing students could engage in include; exercise, healthy eating, and adequate sleeping. Secondary prevention for accelerated nursing students could include learning coping mechanisms for dealing with the many stressors that students may encounter on a daily basis. Tertiary prevention for accelerated nursing students could include initiating the learned coping mechanisms and adjusting them as necessary so that they are as effective as possible.
Hans Selye General Adaptation Theory. The second theory I chose to reference for this paper is Hans Selye’s General Adaptation Theory. The General Adaptation Theory states that, ‘any event that threatens an organism’s well-being, such as a stressor, leads to a three stage bodily response’ (Selye, 1976). The first stage is the alarm stage during which the fight or flight response is initiated and the sympathetic nervous system is activated (Selye, 1976). The second stage is the resistance stage during which physiological functions are returned to normal levels, however, the body still remains on alert (Selye, 1976). The last stage is the exhaustion stage during which the stressor over takes the body causing the organism to exhaust all its resources leaving it vulnerable to illness and disease (Selye, 1976). Accelerated nursing students may find that they will proceed through each one of these stages as they progress in the nursing program. Students need to be aware of the fact that once they reach the exhaustion stage stressors may have a greater impact on their body.
Assessment of the Healthcare Environment
There are many policies, resources, and quality and safety issues related to accelerated nursing programs. Accelerated nursing students must be aware of these issues and how they are related to nursing.
There are several policies in place to ensure that accelerated nursing programs produce quality nursing graduates. Due to the intensity of accelerated nursing programs, high admission standards have been put in place at many of the colleges that offer these programs. At some colleges, accelerated nursing students are not only evaluated on their grades, they are also evaluated on their pre-admission interview. The goal of the pre-admission interview is to determine if students will be able to handle the intensity of the accelerated nursing program. Students need to have an excellent understanding of what the curriculum entails, and have an ability to learn in a fast paced environment (American Association of Colleges of Nursing, 2015). By having high admission standards, schools are able to weed out students that may not be motivated and committed enough to completing the program and become competent nurses. Another way that accelerated nursing programs ensure quality nursing graduates is through national accreditation. Accelerated nursing programs can be accredited by either the Accreditation Commission for Education in Nursing or the Commission on Collegiate Nursing Education (American Association of Colleges of Nursing, 2015). These commissions ensure the quality and integrity of nursing schools by supporting continuous quality improvement in nursing schools (American Association of Colleges of Nursing, 2015). Nursing schools are required to meet a specific set of standards in order to receive and retain their accreditation.
Resources. There are several resources available to accelerated nursing students to help ensure their success in accelerated nursing programs. Smartphone applications are one of the newer resources that have become available to nursing students. Smartphone applications such as Nursing Central, which allows students to quickly look up medications, diagnoses and lab values can be a great resource. Students are able to access this information during their clinical rotations without having to carry several heavy books with them. Another resource available to nursing students is the American Nurses Association. The American Nurses Association can provide students and graduates with many resources, industry information, as well as, networking opportunities with working professionals (American Nurses Association, 2015). Student nurses may find associations to be a great help after graduation as a networking tool for finding a job. Nursing blogs and discussion boards can also be very helpful resources for nursing students. These sites allow students to connect with other nursing students around the state and country to discuss all issues related to nursing. Students are able to share their experiences and their knowledge with others which can be a good stress outlet for some and a great resource for others.
Quality and Safety. Quality and safety are at the forefront of both nursing education and nursing practice. The deciding factor on whether or not a graduate will be able to provide the safe and quality care they need to is the NCLEX-RN exam. According to the National Council of State Boards of Nursing, the NCLEX-RN is designed to test knowledge, skills, and abilities essential to the safe and effective practice of nursing at the entry level (National Council of State Boards of Nursing, 2015). The test determines whether a person passes or fails by using the 95% Confidence Interval Rule (National Council of State Boards of Nursing, 2015). The computer will stop asking questions when it is ‘95% certain that the candidates ability is clearly above or clearly below the passing standard’ (National Council of State Boards of Nursing, 2015). Although the NCLEX-RN exam allows new graduates to practice at the entry level, many graduates lack the necessary self-confidence to do so (Oermann, Poole-Dawkins, Alvarez, Foster, & O’Sullivan, 2010). Some new graduates report that they are not prepared for practice and lack essential knowledge and clinical competencies (Oermann, Poole-Dawkins, Alvarez, Foster, & O’Sullivan, 2010). The areas of main concern include, caring for multiple patients, administering medications to large groups of patients, performing procedures, prioritizing care, supervising others and delegating tasks (Oermann, Poole-Dawkins, Alvarez, Foster, & O’Sullivan, 2010). A way to address some of these concerns may be to offer more new graduate programs. New graduate programs allow new nursing graduates to expand on the knowledge they have already received in nursing school. Graduates are able to perform all the skills of a registered nurse under the direction of an advisor that provides support as needed.
According to the research that has been done regarding accelerated nursing programs, there are several aspects of the accelerated nursing curriculum that need to be addressed. Lack of financial aid and corresponding financial strains can have a huge impact on prospective and current students. Due to a lack of financial aid, students may be forced to take out private loans for the cost of the program in its entirety. Some students may have previous student loans they still owe on which makes finding a loan for this program so difficult. ‘Availability of grants and loans which could be paid back with a service commitment to a clinical role’, is one implementation that can be made to deal with this issue (Rouse & Rooda, 2010). ‘Nurse educators need to work on government policy at both the state and federal levels’ (Rouse & Rooda, 2010). Another aspect of the accelerated nursing program that should be addressed is the heavy workload. One suggestion is that ‘faculty across the curriculum map out the number of readings, tests, clinical papers, and classroom assignments and review as a group what collectively they are asking of the accelerated nursing students’ (Weitzel & McCahon, 2008). By eliminating some of the unnecessary work, the students may be able to spend more time focusing on the content instead of the large number assignments that can be very time consuming. One last aspect of the curriculum that may need to be addressed in some programs is the lack of quality clinical hours. Some nurse managers speculate that ‘although the total number of clinical practice hours in accelerated BSN programs may be similar to the number in traditional BSN programs, there is not enough time to process the experiences’ (Oermann, Poole-Dawkins, Alvarez, Foster, & O’Sullivan, 2010). One suggestion to address this concern may be to spread the clinical hours out over the semester more efficiently so that students do not have to go weeks without clinical experiences. Accelerated programs may also want to look into having clinical three days a week for eight hours each day instead of two days a week for twelve hours a day.
Recommendations for Quality and Safety Improvements
There are many quality and safety improvements that can be made to improve accelerated nursing programs. Nursing schools should be aware of these quality and safety issues and address them accordingly.
The Quality and Safety Education for Nurses Program
Based on the research that was reviewed, the main quality and safety concerns for accelerated programs are the effectiveness of the curriculums, and the lack of clinical competencies. One way to address these concerns is to incorporate The Quality and Safety Education for Nurses program (Dolansky and Moore, 2013) into their nursing school curriculums. The Quality and Safety Education for Nurses program has been created to help student nurses prepare for their prospective futures in nursing (Dolansky and Moore, 2013). The first goal of QSEN is to provide patient centered care which is ‘recognizing the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs’ (Dolansky and Moore, 2013). The second goal of QSEN is to establish teamwork and collaboration which includes, ‘functioning effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care’ (Dolansky and Moore, 2013). The third goal of QSEN is evidenced based practice which involves, ‘integrating the best current evidence with clinical expertise and patient and family preferences and values for delivery of optimal health care’ (Dolansky and Moore, 2013). The fourth goal of QSEN is quality improvement which involves, ‘using data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems’ (Dolansky and Moore, 2013). The fifth goal of QSEN is safety which involves, ‘minimizing the risk of harm to patients and providers through both system effectiveness and individual performance’ (Dolansky and Moore, 2013). The last goal of QSEN is informatics which involves, ‘using information and technology to communicate, manage knowledge, mitigate error, and support decision making’ (Dolansky and Moore, 2013).
American Nurses Association Standards of Practice. The American Nurses Association standards of practice, similar to the QSEN competencies, address safety and quality for working nurses. All nurses are required to be aware of these standards and incorporate them in their care on a daily basis. The standards that apply in regards to this paper are standards eight through ten. Standard eight, education, requires the registered nurse to, ‘attain knowledge and competence that reflects current nursing practice’ (American Nurses Association, 2010). Registered nurses need to make sure that they are continuing their education long after graduation to stay informed on the latest information. Standard nine, evidence based practice and research, requires the registered nurse to, ‘integrate evidence and research findings into practice’ (American Nurses Association, 2010). Registered nurses need to be informed of the best practices according to the research in order to provide the best possible care to their patients. Standard ten, quality of practice, requires the registered nurse to, ‘contribute to quality nursing practice’ (American Nurses Association, 2010). Registered nurses need to make sure that they are providing the safe and quality care that is expected of them at all times, regardless of situation or circumstance.
According to the research, after accelerated students graduate, ’employers report high levels of satisfaction with their performance as they tend to be strong problem solvers, have a greater maturity with a variety of life experiences, and become lifelong learners’ (Rico, Beal, and Davies, 2010). Based on this information, accelerated nursing programs have the potential to produce the safe and quality nurses that the healthcare system needs. Nursing school administrators need to continuously analyze their accelerated programs to make sure that they are meeting the needs of the healthcare system. Nursing schools also need to address the many challenges students site in regards to completing these programs so as to assure continued success.
...(download the rest of the essay above)