Outcome Measures for Traditional and Accelerated Nursing Graduates: An Integrative Literature Review
By Mullen, Patricia | |
Proquest LLC |
doi: 10.5480/12-1008.1
Abstract
AIM The purpose of this article is to examine research studies that compared outcome measures of students/graduates of traditional and accelerated BSN programs.
BACKGROUND Accelerated postgraduate baccalaureate nursing programs are popular. It is important to compare outcome measures and explore equivalence between traditional and accelerated programs.
METHOD Peer-reviewed research articles published within the last six years were identified in ERIC, CINAHL, and MEDLINE.
RESULTS Seven research studies involving 1,159 traditional students and 576 accelerated students were included in this review.
CONCLUSION Findings indicate that although there were some statistically significant differences in outcomes between groups, research methodologies used in several of the studies were not ideal. Future research needs to be geared toward practice pattern differences between the two groups as well as research exploring evaluation methods.
key Words
Educational Outcomes - Accelerated Bachelor of Science in Nursing Programs - Nursing Education
Accelerated postgraduate bachelor of science in nursing (ABSN) programs for students who have obtained a bachelor's degree in another field have been in existence in
Predictors of successful completion of an accelerated program are well documented (Abbott, Schwartz, Hercinger, Miller, & Foyt, 2008; Carty, Moss, Al-Zayyer, Kowitlawakul, & Arietti, 2007; Stuenkel,
method
The articles for the current integrated litera- ture review were identified through the elec- tronic database search engines of CINAHL, ERIC, and MEDLINE. Peer-reviewed research articles published within the last six years were targeted. The key search terms were "accelerated nursing program," "accel- erated baccalaureate," "second-degree bac- calaureate," and "accelerated nursing grad- uates." This search resulted in 51 citations. The results from the search were further screened with inclusion and exclusion crite- ria. The inclusion criteria for this review were research studies comparing outcome mea- sures, programs based in
<p>resuLts
A total of 1,159 traditional students and 576 accelerated students were included in this body of research (Table 1). For this article, the included studies were sorted accord- ing to the type or classification of outcome researched. Based on the results, the outcome measures were divided into four categories: a) academic achievement, b) transition to pro- fessional role, c) clinical competencies, and d) employment characteristics (Table 2).
Academic Achievement
Three of the seven articles included a com- parison of academic achievement between groups (Aktan et al., 2009; Bentley, 2006; Korvick, Wisener, Loftis, & Williamson, 2008). These included a grade point average (GPA) score in the major, a National Council Licensure Examination (NCLEX®) pass rate,
Korvick et al. (2008) wanted to directly compare accelerated and traditional students to determine whether any academic differ- ences were present. They compared the aca- demic performances of 32 traditional and 29 accelerated students enrolled in an iden- tical course within the same semester. The researchers compared total points earned on five examinations and clinical applications (quizzes reflecting laboratory skills) between the groups. The average of total points earned was 86 percent (SD = 3.7) for the traditional group and 91 percent (SD = 3.1) for the accel- erated group. Results demonstrated that the accelerated students performed statistically better than their traditional counterparts (t = 4.95, p = < .05) (Korvick et al.). Although the researchers looked at the GPAs of prenurs- ing students and found no statistical differ- ences, this study may have been strengthened by comparing the actual GPAs in nursing courses between the two groups.
To explore faculty perceptions, Bentley (2006) developed a retrospective correla- tional study to determine whether a differ- ence was present between traditional and accelerated students in select academic vari- ables and NCLEX performances. Although the faculty at their institution anecdotally believed that the accelerated students were academically superior, research did not vali- date this belief, and no significant difference (no statistical values given) in science GPAs was seen between the two cohorts. A conve- nience sample of 224 student (172 traditional and 52 accelerated) graduates between the years 2000 and 2004 was used in this study. Although this study explored science GPA as a factor or predictor of educational success, the educational outcome variables were the number of C, D, and F grades in nursing courses, HESI specialty assessment exam- ination scores (administered after individual courses), and the HESI exit examination (administered at the end of the program). This study also explored predictors of success on the NCLEX examination; however, an indi- vidualized model was not created for each program (traditional/accelerated); rather, the models created combined both programs.
Concerning outcome variables, the Bentley (2006) study found that the acceler- ated students performed significantly better on the psychiatric (t105.38 = 3.394, p < .001), pediatric (F1,219 = 20.16, p = .000), and exit HESI (F1,219 = 9.589, p = .002) tests. The accel- erated students also had significantly fewer Cs in courses (t116.29 = -4.645, p = < .001). Although the accelerated students did have a higher NCLEX pass rate, it was not statisti- cally significant (?2 = 0.346, p = .388). Scores on all of the HESI examinations (maternity [r = 0.205, p = .005], medical-surgical [r = 0.211, p = .007], psychiatric [r = 0.181, p = .017], pediatric [r = 0.205, p = .005], and exit [r = 0.274, p = .006]) were correlated with pass- ing the NCLEX in the traditional group; by contrast, only the exit (r = 0.419, p = .002) and medical-surgical (r = 0.292, p = .036) specialty HESI tests were correlated with a NCLEX pass rate among students in the accelerated group.
Bentley (2006) created a model to test the effect of the exit HESI, number of Cs, and sci- ence GPA on the NCLEX pass rate; scores on specialty HESI examinations were subgroups of the exit examination and were intention- ally omitted from the model. The model, with three variables, resulted in an R 2 of 0.109 (F = 8.947, p = .000); only the exit HESI signifi- cantly contributed toward the prediction of success on the NCLEX. To explore predic- tors that could be influenced throughout the course of study (the exit examination was administered at the end of the program), a second, more restrictive model was created with only the number of C's and the science GPA. It resulted in an R2 change of 0.068 and an F change of 8.100. Both the number of C's (t-2.538, p = 0.12) and the science GPA (t2.158 , p = 0.32) were found to be significant predic- tors of passing the NCLEX.
The Bentley (2006) study could have been strengthened by providing the GPAs on nursing courses as well as the science GPAs (prerequisite) as it was stated that the study was interested in differences in "aca- demic achievement" in nursing schools. The removal of HESI specialty examinations in the predictive model was seen as a weakness. Although all of the specialty examinations were correlated to NCLEX success in the traditional students, this was not true in the accelerated student group. It may also have been beneficial for the authors to complete the predictive models for each cohort in addi- tion to the combination of the two programs to provide insights on potential differences in predictors.
Transition to Professional Role
Oermann, Poole-Dawkins, Alvarez, Foster, and O'Sullivan (2010) were interested in exploring the difference in the transitions of traditional and accelerated students into the professional nursing role. Specifically, the researchers were interested in the perceptions of managers about new graduates' readiness to practice, transition to the professional role, and progression through orientation within one hospital system. The system had hired 96 traditional and 42 accelerated graduates within the last 18 months. The research- ers queried nurse managers through focus groups about the readiness of these graduates to begin practice. The managers in this study perceived that new graduates, of either a tra- ditional or accelerated program, lacked the clinical education for adequate independent patient care. They also implied that students in an accelerated program lacked the essen- tial amount of time to process clinical expe- riences and develop the "art of nursing." The authors suggested that including more sim- ulation during their educational experience might help counteract this deficit.
According to these focus groups (Oermann, Poole-Dawkins et al., 2010), students in the accelerated programs tended to transition into the new role more quickly than their traditional counterparts. However, both traditional and acceler- ated graduates were similarly acclimated to the new role by the end of the first year. Differences, if any, were thought to be due to "generational differences." In summary, this qualitative study found that both the traditional and accelerated graduates were not educationally prepared for practice, and that accelerated students transitioned to their new role more readily, and both groups progressed similarly through their first year of clinical practice. The research- ers acknowledge that this study was limited due to the research design (focus groups) and the fact that each focus group met only once. In addition, several managers chose to not participate.
Oermann, Alvarez, O'Sullivan, and Foster (2010) explored differences between accelerated and traditional graduates in per- formance, job satisfaction, and transition into their new professional role. This descrip- tive study surveyed 28 traditional and 11 accelerated new graduates, orienting within a specific health care system, about their perceptions of their own job performance, confidence, and satisfaction. The 39 partici- pants completed an online survey developed by the researchers following orientation and then again after one year of employment. The surveys were composed on a Likert scale and consisted of three sections: leadership, job satisfaction, and work demographics. Although the study found that graduates did not see themselves as competent when they entered the work force, no statistical differ- ence was found between the accelerated and traditional cohorts. Similarly, graduates of both cohorts improved throughout the year, again with no statistical difference between the two groups. The Oermann, Alvarez et al. (2010) study has many limitations. Methodologically, it is unclear where the data about the beginning perceptions were obtained. It must be assumed that the par- ticipants rated themselves at the beginning and at the end of the first year on the same survey and at the same time. The study would have been strengthened had the researchers administered the survey at the beginning of employment and then again after the first year. Although the researchers report that the survey reliability was established through an expert panel review, no Cronbach's alphas were given and there was no mention about validity. No statistical numbers were given to establish the lack of significance between the groups.
Clinical Competencies
Rafferty and Lindell (2011) wanted to deter- mine whether nurse managers had different perceptions of the clinical skills between traditional and ABSN graduates. They used an adapted version of Schwirian's Six Dimensional Scale of Nursing Performance to compare managers' perceptions of the clin- ical competencies of 107 traditional and 93 accelerated graduates. The researchers pro- vided managers with the validated scale at a conference and instructed these managers to evaluate a "typical" accelerated or traditional graduate in their first year of performance. This Likert-type tool measured leadership, critical care, teaching/collaboration, plan- ning/evaluation, interpersonal relations/com- munications, and professional development.
The Rafferty and Lindell (2011) study found no statistical difference between the managers' perceptions of graduates on any of the variables. The study also has acknowl- edged limitations, including methodologic weakness (anonymous questionnaire), sam- pling (convenience), and the fact that it relied on the memory of conference participants to rate a "typical" graduate.
Employment Characteristics
Brewer et al. (2009) utilized a cross-sectionally designed study to explore outcomes in newly licensed registered nurses (5-18 months) from 60 geographic regions in 35 states. The stated purpose of the study was to compare out- comes between graduates of traditional BSN programs with graduates of ABSN programs. The authors queried 691 traditional and 309 accelerated graduates with a 16-page survey. The questions were divided into four areas: a) demographics, b) work environment and type of setting, c) attitudes about work, and d) per- ceived job opportunities. The outcome vari- ables explored included income, hours and/ or overtime worked, number of jobs since graduating, length of time intending to stay at the person's first job, patient load, job title, union membership, type of shift, work sched- ule, paid time off, and medical insurance pro- vided. The only statistical differences found were in the number of hours worked, yearly income, length of time intending to stay in position, and job title. The study found that accelerated students had higher incomes (t940 = 2.05, p =.04), worked fewer hours (t951 = -2.55, p = .004), intended to stay longer in their current job (t5 = 13.00, p = .02), and held the title of manager more frequently (t2 = 10.09, p =.007) than their traditional counter- parts (Brewer et al.).
dIsCussIon
Students enrolled in accelerated programs in this integrative review were found to have significantly higher GPAs (Aktan et al., 2009; Bentley, 2006), superior academic performance (Korvick et al., 2008), and higher HESI pediatric, psychiatric, and exit scores (Bentley). No difference was found in NCLEX pass rate between the two groups; however, the data were self-reported and more objective assessment is warranted. There was a correlation between HESI spe- cialty and exit examinations, exit examina- tion performance, and NCLEX pass rates in the traditional group. Only the exit and medical-surgical HESI examinations were correlated with the NCLEX pass rates in the accelerated group (Bentley).
No difference was found in clinical com- petence, transition to a professional role, and NCLEX pass rate. There were some differ- ences seen in employment characteristics between the two groups, with accelerated students having higher job satisfaction, yearly income, and quicker advancement to an ele- vated clinical nursing role. The accelerated group also worked fewer hours per week than their traditional counterparts (Brewer et al., 2009).
In the study by Bentley (2006), all the HESI specialty tests were correlated with the NCLEX pass rate in the traditional group; however, in the accelerated group, only the medical-surgical specialty HESI examina- tion results were correlated with the NCLEX pass rate. This result implies that adminis- tering other individual HESI examinations may not be helpful in predicting success in an accelerated program. Hence, it would have been beneficial for Bentley to create a model that included these specialty examinations.
Ongoing research, including curriculum review of traditional and accelerated tracks, should be performed at all institutions to pro- vide evidence that specialty assessment tests can predict both accelerated and traditional student performance on the NCLEX. Tools or grading schemes that have been validated as predictors or measures of success in a tra- ditional program may not prove to be valid in an accelerated program. Perhaps modi- fied versions of nationally normed specialty examinations should be developed for use by accelerated programs.
Although age was not associated with academic performance in either group in the Korvick et al. (2008) study, the manag- ers in the Oermann, Poole-Dawkins et al. (2010) study found that differences between students were more dependent on age than educational preparation. Lack of competency in informatics was a concern expressed in relation to older graduates. Because students enrolled in accelerated programs have con- ventionally been older than their traditional counterparts (Walker et al., 2007), it may be beneficial for accelerated programs, which have significantly older students, to explore the possibility of including more informat- ics content (Korvick et al., 2008; Oermann, Poole-Dawkins et al.).
Further research exploring the first year of practice of traditional and accelerated students is also needed. Simply relying on the perceptions of managers through focus groups or through surveys is insufficient (Rafferty & Lindell, 2011), and more rigorous research is required. Perhaps reviewing and comparing performance evaluations through- out the first year may provide more sound data regarding potential differences between graduates of the two programs. Practice pat- terns of accelerated students should also be explored. Future research questions may include whether accelerated students leave their initial jobs sooner than traditional stu- dents or whether institutions have any reser- vations about hiring accelerated students.
Previous studies have shown that nurs- ing students with higher GPAs have higher passing rates on the NCLEX (
ConCLusIon
ABSN programs are recognized as a suc- cessful method of educating nurses. Because most nursing programs change to meet the needs of nursing graduates due to an ever-changing health care system, it is imper- ative to evaluate educational and professional outcomes between the traditional and accel- erated programs to ensure equivalence and ongoing success. However, rigorous research should include both evaluation methods used in ABSN programs and practice patterns.
referenCes
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About the Authors
Copyright: | (c) 2014 National League for Nursing, Inc. |
Wordcount: | 4053 |
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