Nursing Graduates on Quality of Education and Readiness for Clinical Practice
Jones, Virginia L.
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Session presented on Saturday, April 9, 2016, and Friday, April 8, 2016: There is an increasing use of distance learning (DL) being utilized for nursing education. Accelerated second-degree Bachelor of Science in nursing (ASDBSN) programs have increased rapidly from 31 in 1990 to 230 in 2013 with 33 more programs in the planning stages according to the American Association of Colleges of Nursing (2013). There are currently three identified online pre-licensure, ASDBSN programs. There are research studies focusing on graduates from this type of nursing program using the traditional format, which is the face-to-face college experience, but a lack of literature regarding graduates of the online learning format. The perception of nursing students in an accelerated program is important to the future of students' practice and the quality of the program. Penprase (2012) analyzed graduates of accelerated second-degree nursing programs regarding their job satisfaction during transition to the role of nurse and perceptions of their educational preparation. The study found that 67% of the graduates felt educationally prepared, 11% felt somewhat prepared and 22% did not feel prepared at all. The ones who felt prepared gained that confidence mainly from their 210 clinical hour final preceptorship that was completed prior to graduation. Those who did not feel adequately prepared or not at all prepared cited the primary reason was not gaining enough clinical experience. Three months after graduation, the same nurses were asked if they felt competent to practice as an RN at the time they completed the survey. The results were that 52% felt competent and 48% felt somewhat confident. The subject of quality in nursing education is of great importance when it comes to distance learning. The expanded use of DL across the continuum of nursing education, from pre-licensure to graduate nursing programs leading to master's and doctoral degrees, prompts a closer look at quality in distance education for nursing. The learning experiences shared by recent online nursing program graduates will benefit distance education programs in maintaining quality. The research questions used in this qualitative descriptive study were developed to explore the perceptions of recent graduates from two online, accelerated, pre-licensure second degree nursing (ASDBSN) programs. The focus of the research was with regard to the quality of their educational experience and their feelings of readiness for clinical practice. Individual interviews were conducted with eleven recent graduates, all practicing registered nurses, in an online HIPPA protected video/audio conference room. The data were analyzed using the inductive approach to content analysis as described by Elo and Kyngas (2008): open coding, coding sheets, grouping, categorization, abstraction, and reporting the analyzing process and results. This study utilized the framework of main themes, sub-themes, and descriptors, which are the participant's words, for categorizing the data. This study's main findings indicated that all participants felt they received a quality education. In addition, the participants felt they graduated from quality programs. The study also found that recent graduates of online ASDBSN programs expressed confidence and verbalized being well prepared for clinical practice, which is different from what is reported in the literature for typical graduates of traditional programs. A major point made throughout the interviews was that this was a fast-paced, twelve month program with no time to forget what one was learning before having the ability to apply the learned knowledge. Given the fact that the online accelerated programs emphasize the clinical aspect of learning, which includes the one-on-one preceptorships, students are able to apply new knowledge immediately. This aids in bridging the typical theory-practice gap felt by graduates when transitioning to the registered nurse role. This study indicated that the participants felt they received a quality education, that the program "prepared me to be a nurse," was "valuable content wise, education wise, and skill wise," and "focused on what needed to be focused on," There were descriptions about the completion of the program of, "a sense of satisfaction," it was "clinically strong," "they had high standards," and "you had direction from day one." Perceptions of program quality are important indicators for current and future nursing programs. The results of this study indicated how all of those aspects came together as described by the participants. The graduates described feeling prepared to practice as registered nurses when they began to work, whereas the literature notes that the traditional graduates often don't feel prepared to practice clinically. Participants described their clinical preparation as one-on-one preceptorships, whereas traditional nursing students typically have a faculty member teaching/monitoring up to eight students in the clinical setting. Having one-on-one teaching allows for increased learning opportunity and more attention to detail, as one participant related, "you had direction, you weren't waiting on someone else to have an experience and then waiting for the instructor to do something with you, that preceptor was yours." A few others explained that by the end of their program, they were taking care of five or six patients with their preceptor "just looking over their shoulder." This is in contrast to other programs with students doing their clinical and only providing care to one or two patients. Every one of the participants of this study felt prepared to practice clinically. This is a very important finding derived from this research. One implication for nursing practice is that nurses prepared for practice through the use of one-on-one preceptors typically feel clinically prepared to practice at the bedside, as was demonstrated in this study. A study by Caldwell, Tenofsky, and Nugent (2010) supported that ASDBSN students who received clinical immersion with one-on-one preceptors, enhanced their opportunities for professional socialization and identification, as well as introduced them to critical thinking and use of clinical judgment. Many new graduates express the feelings that what they learned in nursing school did not prepare them for what they experienced when they began working as a nurse (Duchscher, 2012). They need to have more time and hands on experience with patients, families, staff and physicians to increase their comfort level, develop their nurse thinking, and to gain skill and understanding of nursing. In summary, the results indicate that online ASDBSN programs can provide a meaningful quality route for educating future nurses. Perceptions of program graduates can contribute much needed information to aid in student preparation for a nursing career. The data from this study provides knowledge helpful for developing strategies to prepare graduates for practice that will also apply to traditional nursing program formats. In addition, this qualitative research supplies much needed background information useful for future studies with online ASDBSN graduates. This study supports the use of online education in nursing and demonstrates satisfaction and success many students experience with online learning.