Funding an Accelerated Baccalaureate Nursing ... - Nursing Economic

CNE Objectives and Evaluation Form appear on page 126.

SERIES

Gail P. Poirrier Melinda G. Oberleitner

Funding an Accelerated Baccalaureate Nursing Track for Non-Nursing College Graduates: An Academic/Practice Collaboration EXECUTIVE SUMMARY To expand nursing programs to better meet workforce demands, nursing education must offer nontraditional students more educational opportunities that are flexible, streamlined, and low cost. Accelerated programs, particularly programs tailored to attract individuals with degrees in other fields and looking for career changes, are great examples. The cost factors related to a successful accelerated degree program designed for non-nursing college graduates are described. Based on the experiences with a previously implemented accelerated BSN program offered from 1987-1994 at one university, a revised accelerated option model was developed that included ongoing involvement with four community hospitals, shared budget responsibilities, student stipends, and a 3-year work commitment by graduates at a sponsoring hospital. The investment of approximately $1.6 million over 7 years resulted in the education and graduation of 75 new registered nursing professionals to meet the health care needs of the citizens of the community.

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care reform efforts, our country will continue to face economic situations characterized by rising medical costs, an increasing aging population with huge health care needs, and a growing demand for highperforming professional nurses. Since 1988 to present, the demand for RNs far exceeds the supply chain. By the year 2000, nursing education was hard pressed to bear the brunt of expanding the RN workforce. Across the country, political factions, special-interest organizations, and health-related boards viewed nursing education as the entity to correct the “off-tilted” supply and demand issues of the nursing shortage by mass producing more and more professional nurses (Keeling, Brodie, & Kirchgessner, 2010). Expanding RN programs to increase graduation rates is not an easy task for nursing educators. Increased production of RN graduates for any type of program is hampered by shrinking state university budgets, professional staff reductions, and a shortage of qualified teaching faculty in nursing education. Specifically, finances and lack of qualified faculty are

the most significant barriers for nursing education to meet one of its pressing goals, that of strengthening the health care workforce (American Association of Colleges of Nursing [AACN], 2010a; Keeling et al., 2010). To expand nursing programs to better meet workforce demands, nursing education must offer nontraditional students more educational opportunities that are flexible, streamlined, and low cost. Accelerated programs, particularly programs tailored to attract individuals with degrees in other fields and looking for career changes, are great examples. Education must connect and develop relationships with government, industry, philanthropy,

GAIL P. POIRRIER, DNS, RN, is Dean, College of Nursing and Allied Health Professions, University of Louisiana at Lafayette, Lafayette, LA. MELINDA G. OBERLEITNER, DNS, RN, APRN, CNS, is Associate Dean, University of Louisiana at Lafayette, Lafayette, LA. NOTE: The authors and all Nursing Economic$ Editorial Board members reported no actual or potential conflict of interest in relation to this continuing nursing education article.

NURSING ECONOMIC$/May-June 2011/Vol. 29/No. 3

Funding an Accelerated Baccalaureate Nursing Track for Non-Nursing College Graduates: An Academic/Practice Collaboration

SERIES education centers, and other training sites to advance innovations in nursing education. Deans or chief nursing education administrators must have financial skills and marketing abilities to engage in creative fundraising with public and private institutions to implement these innovations (AACN, 2010a; Cronenwett & Dzau, 2010). There are no reports in the literature specific to funding of accelerated tracks or programs targeted to non-nursing college graduates (NNCGs). In this article, the cost factors related to a successful accelerated degree program designed for NNCGs are described. Based on the experiences with a previously implemented accelerated BSN program offered from 1987-1994 at our university, a revised accelerated option model was developed that included ongoing involvement with four community hospitals, shared budget responsibilities, student stipends, and a 3-year work commitment by graduates at a sponsoring hospital.

Background and Evolution of Accelerated Programs in Nursing Accelerated programs for NNCGs have been in place for almost 40 years. The initial program, offered by St. Louis University School of Nursing and Allied Health Professions in 1971, was started to enable college graduates enrolled in the school’s traditional baccalaureate program to progress at a faster pace through the undergraduate program. Additional accelerated option programs opened sporadically in the United States through the 1980s. However, as a response by nursing education to address the nursing shortage, new accelerated programs grew exponentially from 1994, when only 18 programs were in existence, to 158 in 2004 (Wink, 2005). Expansion continues today with the AACN reporting almost 12,000 students enrolled in approximately 250 accelerated baccalaureate pro-

grams in over 40 states, the District of Columbia, and Guam (2010b). Accelerated baccalaureate nursing programs for NNCGs generally have the following requirements and characteristics: • Completion of a previous bachelor’s degree is a prerequisite for entry into most accelerated programs. • Instruction is often intense with many programs compressing clinical and didactic nursing course work into 1115 months of instruction. • Students in this track are typically required to complete the same number of clinical clock hours as nursing students enrolled in traditional tracks. Students choosing to enroll in accelerated programs in nursing appear to fall into one of three general categories: (a) those who indicate they have always wanted to be a nurse, (b) graduates who have difficulty finding a job or position in the field related to their first degree, and (c) those who have decided to change career paths due to layoffs or burnout in a previous field (Allen, VanDyke, & Armstrong, 2010). Siler, DeBasio, and Roberts (2008) conducted a national study focused on NNCGs enrolled in accelerated baccalaureate curricula to determine their motivation to enroll in the program, to describe their academic backgrounds, and to identify the personal and educational needs of NNCGs matriculating in accelerated programs in nursing. A total of 993 subjects from 16 states participated in the study. Study findings included a higher percentage of men enrolled in accelerated programs (17.5%) as compared to male enrollment reported in American nursing programs (10.2%); a higher percentage of participants who categorized themselves as White or Caucasian (82.3%) as compared to total enrollment in all entry-level baccalaureate programs (74.8%); and a majority of students (56%) reporting an income level of less


than $16,000 per year once they started the accelerated program. This low income level is attributed to the inability of students to work once they are enrolled in the intense accelerated program and the inability of these college graduates to qualify for student loans, grants, and scholarships which are typically available to first-time college students. Fifty-six percent of students participating in the study had earned a previous science-related or behavior-related (e.g., psychology) degree as their first degree. Over 60% of the students reported they earned their first degree fewer than 5 years prior to enrollment in the accelerated nursing program. The final question of the survey attempted to discern the motivation of these second-degree seeking students in selecting nursing as a career. The perceived flexibility of nursing as a career in terms of a variety of nursing specialties or fields, the flexible work hours and work settings, and the perception of nursing as a familyfriendly career choice were the factors most frequently cited by the participants in this study as a reason to pursue a career in nursing (Siler et al., 2008). Instructors of students enrolled in accelerated programs generally report they are different from traditional students in that they are highly motivated, self-directed, focused, independent adult learners who often excel academically. For the most part, these students are committed to learning at an accelerated pace in an environment that is learner centered (Allen et al., 2010; Cangelosi, 2007; Hamner & Bentley, 2007; Hegge & Hallman, 2008; Lockwood, Walker, & Tilley, 2009). Various models exist for structuring accelerated programs in nursing. Some programs offer classes in which traditional students and NNCG are enrolled in the same classes while other programs run parallel or separate curricula for accelerated students

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SERIES (Cangelosi & Moss, 2010). Another approach is to offer most of the didactic course work for the accelerated program online. One approach reported in the literature is a collaborative model in which accelerated baccalaureate students are partnered with unit-based staff nurses, working the same shift as the nurses during their clinical nursing courses (Raines, 2009). Research validating the superiority of one approach over the others has not yet been conducted. In the past, some educators and administrators have expressed concerns regarding the ability of NNCGs in accelerated baccalaureate programs to acquire the complex and sophisticated knowledge, attitudes, and skills required of today’s professional nurse because of the compressed time period for the program of studies (Penprase & Koczara, 2009). Review of recent literature reveals students in accelerated programs often perform better academically than traditional students, and perform at statistically significant higher levels on standardized tests such as the National League for Nursing Baccalaureate Achievement Test and the HESI Exit Exam. In addition, graduates of accelerated programs tend to have higherthan-average NCLEX-RN pass rates (Bentley, 2006; Feldman & Jordet, 1989; Korvick, Wisener, Loftis, & Williamson, 2008; McDonald, 1995; Seldomridge & DiBartolo, 2005; Shiber, 2003; Vinal & Whitman, 1994). Raines and Sipes (2007) queried accelerated program graduates in the first cohort of graduates (n=17) from one program 1 year after its completion to determine the level of satisfaction with the program and the level of preparation as perceived by the graduate in three critical domains of nursing practice: interpersonal/communication skills, management of patient care, and clinical/technical skills. The researchers also quantified graduates’ work activities, analyzed employment pat-

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terns of graduates in the first year as new nurses, and also asked the graduates about their intent to remain in nursing. The respondents strongly agreed they were prepared to practice as RNs in the domains researched in the study. All of the graduates passed the NCLEX on the first attempt and were employed in acute care hospitals. Fourteen of the graduates were still employed in their first positions 1 year after graduation. Seven graduates planned to remain in the direct caregiver role for 10 years or longer. Six of the graduates were either currently enrolled in master’s of science in nursing programs or were planning to enroll in a graduate program shortly. More recently, Brewer and colleagues (2009) surveyed newly licensed RNs in 35 states and Washington, DC, to determine differences between traditional baccalaureate graduates (TBGs) and diploma and second-degree baccalaureate graduates (SDGs). These RNs (n=3,391) were licensed for 518 months prior to responding to the survey. Most of the respondents from both groups worked in hospitals. Results from this national survey indicated TBGs worked slightly more hours in a typical week than SDGs and were more likely to be employed in direct patient care positions. Most respondents from both groups worked full time. There were no significant differences between the groups for variables related to intent to stay in the current job and work motivation (Brewer et al., 2009).

Proposal Development In early 2001, the Louisiana Board of Regents for Higher Education, the Louisiana Workforce Commission, and the Nursing Supply and Demand Commission collaborated with state legislators to involve university presidents in developing plans that would expand existing RN programs in the state. As a response to these

statewide initiatives and to better meet local hospital RN workforce demands, a collaborative proposal to re-institute an accelerated option program for NNCG was presented to the university president in 2002. The proposal included a unique budget dependent upon the ability to (a) recruit and hire five additional full-time and/or part-time qualified clinical faculty; (b) recruit and hire one instructor to serve as coordinator of the accelerated option program; (c) hire one advisor/counselor to assist the students with admission, progression, and stipend/ work contracts with the sponsoring hospitals; and (d) establish collaborative agreements with area hospitals. The university contribution to the budget equated to the use of dollars resulting from tuition and assessment fees paid by each enrolled accelerated option student. No new state or internal institutional dollars were required to offer this program. The hospitals which agreed to partner with the university were asked to provide funding to hire necessary personnel and to provide financial support for program operating costs. The proposal, including the collaborative shared budget needs, was presented in 2003 at a meeting with nine area hospital CEOs, vice presidents of patient care services, and other hospital administrative staff personnel. The university president and vice president for academic affairs were also in attendance. Of the nine hospitals, two were small, for profit, private facilities offering unique services, such as psychiatric/mental health, two were police jury managed facilities in rural settings, one was a state teaching hospital, and four were large hospitals (three general and one women’s/children) in the city proper. The four largest hospitals in the city, along with the university, agreed to enter into a partnership to provide the funding of the accelerated option program for



SERIES Table 1. Accelerated Program: 5-Year Budget Total Cost Per Year

Project Years

Hospital #1 (349 beds)



$77,650 2004-2005

Year 1

$16,000

$16,000

$20,000

$5,650

$20,000

$263,330 2005-2006

Year 2

$67,775

$67,775

$40,000

$24,780

$63,000

$278,090 2006-2007

Year 3

$70,655

$70,655

$40,000

$24,780

$72,000

$278,090 2007-2008

Year 4

$75,155

$75,155

$40,000

$24,780

$63,000

$228,290 2008-2009

Year 5

$68,255

$68,255

$40,000

$24,780

$27,000

$297,840

$297,840

$180,000

$104,770

$245,000

Total $1,125,450


UL Lafayette

Table 2. Comparison of Sequence of Required Nursing Courses in Generic vs. Accelerated Programs Required Nursing Course Sequence Generic Program

Required Nursing Course Sequence Accelerated Program

Semester 1 – Nursing 102

Semester 1 – Nursing 240 (Transition Course)


Semester 2 – Nursing 208, 209, 319, 320


Semester 3 – Nursing 308, 309, 318, 404

Semester 4 – Nursing 208, 209, 210

Semester 4 – Nursing 403, 418, 419

Semester 5 – Nursing 308, 309, 310 Semester 6 – Nursing 318, 319, 320 Semester 7 – Nursing 403, 404 Semester 8 – Nursing 418, 419

5 years at a total cost of $1,125,450. The other five hospitals who chose not to enter into the partnership agreed to assist with clinical placement of the accelerated students particularly in the areas of obstetrics, pediatrics, and psychiatry. Each hospital and the university agreed to different annual and total amounts to fund the program (see Table 1).

Program Implementation Building on the experiences gained by implementing a previous fast-track BSN program, the reinstated accelerated program improved the earlier funding,

organizational, and management systems. The previous program provided some stipend dollars and counseling services for students for 5 of its 7-year course, which were funded by the Getting Ahead in Nursing (GAIN) grant, a Division of Nursing funded grant. Faculty doubled clinical and classroom teaching loads to make the previous program successful. At the time of the reinstatement of the accelerated program in 2004, the BSN student enrollment in the generic 4-year track had escalated to 1,450 students. To accommodate enrollment of additional BSN nursing majors, the traditional curriculum’s length


was modified for the accelerated program. The program was compressed into four semesters (from eight semesters) in length once prerequisite course requirements were satisfied (see Table 2). The accelerated students merged with the generic students in all didactic nursing courses. The goals of combining generic students with traditional students in courses were to (a) expose the accelerated students to the master’s teachers who were experts in specific fields of nursing; (b) maintain a long history of an average NCLEX-RN pass rate of 97%, thus not compromising learning; (c) assist with faster assimilation and socialization to

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SERIES Table 3. Accelerated Program: 2-Year Extension Budget Total Cost Per Year

Project Years





UL Lafayette

$254,780 2009-2010

Year 6

$70,000

$70,000

$35,000

$19,780

$60,000

$214,780 2010-2011

Year 7

$60,000

$60,000

$25,000

$9,780

$60,000

Total (Extension) $469,560

$130,000

$130,000

$60,000

$29,560

$120,000

Grand Total (All 7 Years)

$427,840

$427,840

$240,000

$134,330

$365,000

nursing; and (d) maintain a reasonable instructional faculty workload. Accelerated students had the same classroom and clinical experiences, including clock hours, as the generic students with the exception of clinical rotations in obstetrics, pediatrics, community, and mental health clinical components. For these clinical experiences, the accelerated students were in separate clinical groups. Different days and times for clinical experiences in these courses were necessary as the hospitals set limitations on student numbers per clinical rotations. A doctorally prepared, experienced faculty member who had graduated from the previous BSN accelerated program served as a mentor to the students. They received the same advising and counseling services as the generic program students. Each accelerated program graduate signed a work commitment contract with one of the four sponsoring community hospitals for 3 years. Key components of the program were to educate and graduate 70 additional BSN students over 5 years, retain them in the community, and thus improve the local RN workforce. In addition to the funds committed to the budget as delineated in Table 1, the four hospitals provided additional monies in the form of stipends to the students at a maximum of $5,000 per student

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annually. The stipends required a 3-year “guaranteed” work commitment at a sponsoring institution, a stipulation that had to be part of the admission policy for this program. In essence, each student admitted to the program signed the specific stipend/work commitment agreement with one of the sponsoring hospitals at the time of application for admission. Students applying for this program were held to the same admission standards and progression rules as the generic BSN students. A restricted university account was established for this project. Hospitals as well as the university were invoiced at the end of each academic year to submit their payment as per annual contract renewal for the 5-year period. This timeline gave the college at least 3 months prior to the start of a new academic year to recruit and hire the necessary fulltime temporary faculty. It allowed the budgeted faculty lines to have the appropriate funds for hiring purposes.

from prospective students in this fast-track program. The hospitals were somewhat hesitant about the extension, mainly due to declining federal and state allocations for reimbursement to hospitals relative to Medicare/Medicaid reimbursement. However, RN vacancy rates were still at a critical level at these four hospitals. After much discussion, new contracts and budget agreements were implemented for a 6th and 7th years as illustrated in Table 3. The university costs were relatively higher for the extension project. Overall budget considerations included a grand total of $10,000 for 2 years to cover department costs for operations and education supplies. Admission policies and numbers of NNCG students admitted every fall and spring semester remained the same as described earlier for the original 5-year project. The 2-year extension increased the grand total admitted to the program over a 7-year period from 70 to 100 accelerated students.

Program Extension

At of the end of the spring 2010 semester, there were 70 graduates from the original 100 students admitted to the accelerated option track. An additional five students are projected to graduate in the last class in December 2010 for a total number of 75 graduates. Four of the 75 students who have graduated or who are projected to

During the third year of the 5year project, there was growing interest among some of the collaborating partners to extend the project another 2 years. A 2-year extension would allow at least 3035 qualified applicants to enter and matriculate to graduation. There was continuing interest

Program Outcomes



SERIES Table 4. Accelerated Track Retention and Attrition Rate by Cohort Cohort

Semester Entered

Semester Completed

Retention Rate

Attrition Rate

1

Fall 2004

Spring 2006

90% (9/10)

10%

2

Spring 2005

Fall 2006

100% (10/10)

0

3

Fall 2005

Spring 2007

100% (10/10)

0

4

Spring 2006

Fall 2007

60% (6/10)

40%

5

Fall 2006

Spring 2008

60% (6/10)

40%

6

Spring 2007

Fall 2008

90% (9/10)

10%

7

Fall 2007

Spring 2009

90% (9/10)

10%

8

Spring 2008

Fall 2009

50% (5/10)

50%

9

Fall 2008

Spring 2010

60% (6/10)

40%

10

Spring 2009

Fall 2010

50% (5/10)

50%

graduate in the last semester were minority students (6%) and 16 (21%) were males. The graduation rate equates to a 75% graduation rate from the accelerated track compared to a 61% graduation rate from the traditional track. To date, 62 of 64 graduates have passed the NCLEX-RN exam on the first attempt for a 97% pass rate which is comparable to the pass rate of graduates in the traditional track in the BSN program. The estimated cost per semester to educate each student was calculated at $5,316.70 ($1,125,450 [original funding amount] + $469,560 [extension funding] ÷ 75 students = $21,267/student ÷ 4 semesters = $5,316.70). Ten students were admitted in each cohort every semester. Initially, most if not all of the students in each cohort completed the program through to graduation. The attrition rate began to rise in cohort four, decreased in cohorts 6 and 7, and increased again in cohorts 8, 9, and 10 (see Table 4). Reasons for these increased attrition rates include, but are not limited to, students’ inability to keep pace with an accelerated schedule, a decrease in the academic quality of the applicant pool, as well as financial and other personal issues. Most of the graduates have

been employed by their sponsoring facility upon graduation and continue to be employed in predominantly staff nurse positions. The employment rate of graduates from each cohort was 100%. Several graduates from earlier cohorts have already enrolled in and/or completed master’s programs in nursing in advanced practice tracks such as nurse practitioner and nurse anesthetist tracks. Benefits of the collaborative funding to the college included (a) hiring additional clinical faculty with salaries ranging from $40,000 to $50,000 over the 5-year period (as many as six in some academic years) without increasing the faculty teaching workload, (b) gaining an additional professional staff for advising/counseling purposes, (c) purchasing 18 computers for office use across the college, and (d) obtaining funds to cover operational costs such as phone lines and office materials. Perceived benefits to the participating hospitals included (a) guaranteed addition to their RN staff, (b) hiring new RN graduates each with 3-year work commitments, (c) being viewed by the public as an active partner with the university to solve community-wide shortage of RNs, and (d) increasing the retention of RNs in the community versus los-


ing new graduates to other states.

Lessons Learned The budget, a crucial component, met the financial needs of the program for the entire 7 years. Instructor rank salaries, including annual merit raises, were a major component of the budget. However, escalating fringe benefit costs and merit increases for faculty were not calculated in their entirety into the original budget, an omission that could have been detrimental to the entire program. As web site posting of the reinstated accelerated program was the only form of advertising done for the entire length of the program, publicity was not a budgeted line item. For any such future projects, a formal recruitment, advertising, and marketing plan will definitely be a high-priority budget item to ensure continual recruitment of quality students. As learned from the previous GAIN project, a mentoring program for accelerated students is a must. The current faculty managed well; however, a formal collaborative education/practice mentoring program would have been beneficial to the students for clinical learning and for enhanced opportunities for socialization into the professional role. The 3-

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SERIES year work commitment linked to the stipends was a win-win situation for hospitals and students. For three of the total four semesters of the program, the accelerated students were in a classroom/ clinical learning experience 40 hours weekly. Students had no time for outside work and did not qualify for educational loans since they already had degrees in other fields. The stipends provided for cost-of-living expenses in addition to the costs of tuition and fees. For the hospitals, the stipend costs were less than recruiting costs per individual RN candidate. The added benefit for the hospitals was a 3-year work commitment. The stipend/work commitment contracts were a component of admission and acceptance into the accelerated program. They were a key factor in keeping the RN graduates in the Louisiana community served by the university. However, the hospitals did not have input into the recruitment and selection of the individual stipend recipient. Each student met the same admission criteria as generic students, except for agreement to the stipend/work commitment. At the time of acceptance into the program, each student was assigned by the college advisor/counselor to report to one of the four hospitals to sign the 3-year stipend/work commitment contract. Requests for placement at each of these four hospitals were solicited from the students by the advisor/counselor at the time of application for admission, and most requests were fulfilled for students’ first and second hospital choices. All hospitals then accepted the assigned students. The number of stipends and guaranteed job positions per hospital were in proportion to the annual dollar amounts defined by the original contract for the 5-year project. The two largest and equal sponsors in terms of dollars contributed, were assigned three to four students every semester. Two

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students were assigned to the third sponsoring hospital, and one to the fourth hospital. This procedure/policy was not favored by the sponsoring hospitals. The hospitals did not have an opportunity to interview the assigned students. Some students never had a clinical rotation at their assigned hospital throughout their program of study and thus, opportunities for building relationships between employer and future employee did not occur. There were strong concerns about “improper fit” of the candidate with the mission and goals of the specific hospital facility. These concerns of “improper fit” may have contributed to unexpected events such as hospitals recruiting accelerated program students and graduates from another one of the sponsoring hospitals. When such events occurred, there was no “buy-out” or “pay-off” of the stipend dollars already expended to individual students. This practice created mistrust, anger, and resentment among the sponsoring hospitals. To the education unit, this was perceived as problematic and an area of concern. For the future, accountability statements that delineate legal and/or binding actions addressing the human/fiscal recruitment/stipend policies need to be considered carefully within contracts specific to collaborating facilities. For example, stipends should be addressed in contracts as awards/scholarships designed to assist students enrolled full-time in fast-track programs financially. Stipends should not be considered as an early payment of percentage of sign-on bonuses. Also, such contracts need to explain “buy-outs” and “pay-offs” in detail. Goals for the nursing unit include developing and planning future accelerated programs with or without collaborative funding sources. Collaborative-funded programs are difficult, and certainly problems identified, as delineated

earlier, would have to be addressed for similar projects undertaken in the future. Also, curricula redesign and summer offerings would be factors to consider. With additional didactic instructors and more classroom sections, greater numbers of students could be admitted. The summer course offerings would allow for an even faster matriculation of accelerated students to graduation with a BSN degree, thus adding to the workforce. Of course, future endeavors are very dependent upon the availability of funding, qualified nursing faculty, and appropriate clinical teaching sites.

Conclusion The last cohort of students in the accelerated track graduated in December 2010. Although the program has been deemed a success by students, graduates, sponsoring hospitals, and the nursing program, we have decided to phase out the current program. There is a different economic and employment climate now compared to 7 years ago when the program was re-initiated. Health care agencies, including community hospitals, and higher education in Louisiana have assumed the brunt of major cuts to the state’s operating budgets in the last 2 fiscal years, and the university and its collaborating partners are unable to financially sustain the program at this time. However, an investment of approximately $1.6 million over 7 years resulted in the education and graduation of 75 new registered nursing professionals to meet the health care needs of the community. $ REFERENCES Allen, P., VanDyke, Y., & Armstrong, M.L. (2010). “Growing your own” nursing staff with a collaborative seconddegree web-based program. Journal of Continuing Education in Nursing, 41(3), 118-122. doi:10.3928/00220124 -20100224-01 American Association of Colleges of Nursing. (2010a). Advancing higher education in nursing, 2009 annual report. Washington, DC: Author.



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