WITH PROJECTIONS OF the need for more than a ANALYSIS OF GRADUATES' PERCEPTIONS SCIENCE PROGRAM IN NURSING OF AN ACCELERATED BACHELOR OF

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1 OF AN ACCELERATED BACHELOR OF SCIENCE PROGRAM IN NURSING MARTHA KEMSLEY, PHD, LINDA MCCAUSLAND, EDD, JANICE FEIGENBAUM, PHD, AND ELIZABETH RIEGLE, MS Rapid expansion of second-degree programs as one approach to addressing the nursing shortage by increasing the number of graduates in shorter periods of time prompted the need for program evaluation to identify the outcomes, strengths, and best practices of these programs. This study used both quantitative and qualitative methods of inquiry to analyze the responses of 28 of 56 recent graduates of an accelerated baccalaureate program. Respondents rated components of the program from preadmission to graduation on a Likert scale and responded to open-ended questions regarding strengths and weaknesses of the program. Analysis included descriptive statistics for quantitative data and content analysis for qualitative data. The analysis showed a high degree of similarity between the quantitative and qualitative data. Highly rated program components, that is, opportunity for graduate course work and integration with graduate students, clinical skill practice and experiences, variety of teaching methodologies, peer and faculty support, were reflected in the themes of cohort bonding, variety of clinical experiences, and supportive faculty and staff. Outcomes of program satisfaction, National Council Licensure Examination pass rates, successful nursing employment, and graduate school attendance were supported by the data. (Index words: Accelerated baccalaureate nursing; Second degree; Analysis; Student perceptions; Outcomes) J Prof Nurs 27:50 58, Elsevier Inc. All rights reserved. WITH PROJECTIONS OF the need for more than a million new and replacement registered nurses by the year 2016, nursing schools around the country are exploring creative ways to increase student capacity by quickly producing competent nurses while maintaining the integrity and quality of the nursing education provided (American Association of Colleges of Nursing, 2008). Accelerated degree programs for nonnursing graduates at both the baccalaureate and master's degree levels are one such approach. These programs build on previous learning experiences and transition individuals with undergraduate degrees in other disciplines into nursing. Accelerated baccalaureate programs have Clinical Associate Professor, University at Buffalo, Buffalo, NY. Funding for the program and this program evaluation was provided by the Health Resource and Services Administration Grant 5DI1HPO , Address correspondence to Dr. Kemsley: University at Buffalo School of Nursing, 317-C Wende, 3435 Main Street, Buffalo, NY kemsley@buffalo.edu /10/$ - see front matter existed since 1971, with a significant increase in number in the last 10 years. Currently, 205 accelerated bachelor of science in nursing (BSN) programs are operating, and the number of generic master's programs has increased to 56 (American Association of Colleges of Nursing [AACN], 2008). According to AACN's database, 37 new accelerated BSN programs are now in the planning stages. Thirteen new generic master's programs are also taking shape. As noted by Beal (2007) and Cangelosi and Whitt (2005), most of the studies published have focused on the profiles of enrolled students and comparisons with traditional baccalaureate nursing students with little evaluation of quality and outcomes. The need to better understand what works to facilitate success of accelerated baccalaureate students was the impetus for a 3-day invitational conference in March 2007, which was sponsored by Duke University School of Nursing. The focus of this conference was discussion of the state of the science on accelerated nursing programs and the establishment of a research agenda. The outcome of the conference was the establishment of four domains 50 doi: /j.profnurs Journal of Professional Nursing, Vol 27, No. 1 (January February), 2011: pp Elsevier Inc. All rights reserved.

2 51 for the research agenda: student recruitment and support, best practices in classroom instruction, best practices in clinical instruction, and transition to practice (Beal, 2007). The study presented in this article addresses the domain of best practices in classroom and clinical instruction and focuses on students' perceptions of outcomes and program evaluation. Background In 2004, the School of Nursing at the University at Buffalo began a program whereby individuals with a degree in another field could complete a 12-month intensive program leading to a baccalaureate degree in nursing. The aims of the accelerated baccalaureate program (ABS) are to combat the nursing shortage by efficiently and effectively preparing professional nurses to enter the workforce more quickly and to attract students with strong and diverse academic and life backgrounds who will contribute to the practice of professional nursing. Students in the ABS program meet the program objectives for the baccalaureate in nursing degree and complete the same number of clinical hours as the traditional baccalaureate students (Hamner & Bentley, 2007). The ABS program provides 1:1 advisement during the application process and completion of nine prerequisite courses. It is worth mentioning that many of these courses may be taken online at various universities and colleges around the country. This provides students the autonomy to fulfill these program requirements based on their learning needs and study habits before the beginning of the program, which runs May to May. During the initial 14 weeks of the program, students take courses with other members of their cohort (essentially the content of the junior year). Then, during the next two semesters, they are blended into courses with other students, including the traditional baccalaureate students, those in the RN/bachelor of science (BS) program, and graduate students. The advantages and disadvantages of this type of curriculum format have been addressed by Johnson and Johnson (2008), Korvick, Wisener, Loftis, and Williamson (2008), and Seldomridge and DiBartolo (2008). To date, 96 students have completed the program. An increasing number of students have been in each class, 17 in the first cohort to a current cohort of 42 students. Outcomes of the first two cohorts included a 97% retention rate and a 94% first-time National Council Licensure Examination (NCLEX) pass rate. Retention rates remain similar for subsequent cohorts; however, NCLEX pass rates for the third and fourth cohorts decreased to 86%. Many of the approaches incorporated into the ABS program were based upon the experiences of others such as Shiber (2003) or have subsequently been described in the literature (Cangelosi & Whitt, 2005). Admission interviews have been used since beginning the program and although much more time consuming given the increase in the size of admitted classes, have been found to provide valuable information helpful in making admission decisions and have potentially contributed to the high retention rate. The process used incorporates many of the components described by Rosenberg, Perraud, and Willis (2007) and addressed the rigors of the program (Meyer, Hoover, & Maposa, 2006). Incorporating increased technology, online course work, and implementation of PDAs are approaches described in the literature (Jeffries, 2001; Kearns, Shoaf, & Summey, 2004; Pank, 2007; Suplee & Glasgow, 2008; Teeley, 2007) that have been incorporated. Professional socialization and retention issues described by others (Miklancie & Davis, 2005; Suplee & Glasgow, 2008) have been experienced as well. Approaches used in our program have included regularly scheduled brown bag lunch discussions and focus group sessions with students to provide the opportunity for feedback and exposure to professional issues. Topics include cultural diversity issues, advanced practice roles, stress management, nursing research opportunities, exposure to the nursing student organizations, and opportunity to dialogue with graduates of the program. More recently, presentation of the returning-to-school syndrome model (Utley-Smith, Phillips, & Turner, 2007) with discussion and subsequent reflection has been utilized with the students. Purpose Given the challenge of identifying best practices in the classroom and clinical instruction, the purposes of this study were to elicit and analyze the perceptions of graduates of our ABS program. The survey was developed with a focus on processes from application and advisement to satisfaction as well as program content and outcomes. Demographic data were collected to compare respondent characteristics with overall cohort characteristics to determine whether generalization of results could be made. Methods Study participants were graduates from our ABS degree program, 8 months to 2 years or more after their graduation. After the study had received exempt status from the university's institutional review board, letters were mailed to invite the graduates to complete a survey that had been constructed to analyze their perceptions of the program, including classroom and clinical instruction. The letter also explained that their participation was voluntary and anonymous and that the survey would take about 30 minutes to complete. The purpose of the study was described as a method to identify the programs' strengths and areas needing improvement to assist in program revision. This study is a mixed-method design using both quantitative and qualitative methods of inquiry. These data were entered into SPSS, version 15, for frequency and descriptive statistical analysis. Descriptive statistics were used to analyze the quantitative data, and qualitative responses were analyzed using content analysis to identify themes.

3 52 KEMSLEY ET AL Table 1. Specific Field of Previous Degree (n = 25) Field No. of respondents Psychology and social work 8 (32%) Biology and other biological sciences 5 (20%) Other health majors (exercise science, health) 3 (12%) Business administration 2 (8%) Environmental sciences 2 (8%) Others: Japanese, East Asian studies, media communications, education, engineering 5 (20%) Missing data for three respondents. The survey was prepared by the authors based on questions identified in the literature (Cangelosi, 2007a, 2007b) and curriculum-based questions about key components of the program. Twenty-five statements regarding perceptions and opinions of the program were developed with a 5-point Likert scale of strongly agree, agree, neutral, disagree, and strongly disagree. A no opinion option also was offered. Other questions were added to provide a profile of the respondents. The survey additionally included three open-ended questions. The questions were the following: What did you like most about the program? What did you like least about the program? and What suggestions would you make to improve the program? The graduates' responses to these questions were analyzed via the process of content analysis. Each person's comments were examined to identify the specific themes within them. A theme was defined as a significant or major point that the individuals appeared to be implying in their comments (Warren, 1994). The words used to label a theme were cautiously selected in terms of the words used by the respondents themselves. After the graduates' comments were reviewed and the themes identified within them, similarities between their responses were noted. This process determined which themes were demonstrated by which respondents. Further, every theme derived from the analysis of the data was perceived as being meaningful, even if a theme was found in only one graduate's comments. Results Profile of Respondents Of the 56 graduates, 28 responded to the survey, for a response rate of 50%. Nearly all respondents (98.4%) were employed as registered nurses at the time of the survey. Most (85.7%) of the graduates' positions were Table 2. Sources of Support (n = 28) Support No. of respondents Peers in the nursing program 26 (92.4%) Partners 14 (50.0%) Parent, other family 9 (32.1%) Friends 3 (10.7%) Faculty 1 (3.5%) Totals more than 100% because of directions to select all that apply. hospital based with 12 (42.9 %) in the medical surgical area and 9 (32.1%) in critical care; 26 (92.9%) worked as staff nurses. The respondents were primarily from western New York prior to entering the program and where many remained after graduating. Originally, 25 (89.3%) of the respondents lived in the western New York area, 2 (7.1%) lived in a state outside New York, and 1 (3.5%) lived in an area of the state other than western New York. At the time of the survey, 22 (78.6%) lived in western New York, 1 (3.5%) lived elsewhere in New York State, and 5 (17.9%) lived in other states. Questions regarding previous academic degrees and fields of study were open ended. In general, respondents had a BS (15) or a bachelor of arts (9); 3 had two bachelor's degrees, and 3 had master's degrees (2 master of business administration, 1 master of science in biology). The specific fields of study are listed in Table 1. How the respondents learned of our program was of interest. Some indicated more than one source of information. The UB Web site was the most frequently cited resource by 18 (64.3%) respondents. Nine (32.1%) learned from acquaintances, 2 (7.1%) from a university advisor, 1 (3.5%) from Allnursingschools.com, and 1 (3.5%) from the newspaper. Most respondents (92.9%) indicated that their peers in the nursing program were their most important sources of support while attending the program. See Table 2 for all the sources of support. Nearly half of the respondents (48.1%) were employed part time while attending the program despite being highly discouraged from doing so. Table 3 displays the number of hours employed during the program. Regarding the NCLEX examination success of the respondents, 24 (85.7%) passed on their first attempt, whereas 4 (14.3%) did not. The length of time after graduation until the NCLEX was taken was also asked. Thirteen (46.4%) respondents took the examination 1 to Table 3. Hours Employed During the Program (n = 27) Hours per week No. of respondents 0 14 (51.9%) (14.8%) (11.1%) (22.2%) N20 0 One respondent did not answer.

4 53 Table 4. Highest Rated Program Components (n = 28) Program components No. of respondents Internship opportunities to practice skills 26 (92.8%) Presentation of graduate-level course work 26 (92.8%) Internships offered opportunities to explore special interest areas 26 (92.8%) Clinical experiences provided opportunities to apply knowledge and skills 24 (85.7%) Integration with graduate students enhanced the program 24 (85.7%) Clinical skill practice and testing facilitated learning 24 (85.7%) Preadmission faculty interview provided direction 24 (85.7%) Variety of teaching methodologies facilitated learning 23 (82.2%) 2 months after graduation, 9 (32.1%) 2.5 to 3 months, and 6 (21.4%) up to 5 months. Eight (28.6%) respondents were pursuing graduate study in nursing at the time of this survey; 4 were at the University at Buffalo, 2 elsewhere in New York State, and 2 in other states. The areas of nursing being studied were women's health or midwifery (3 graduates), anesthesia (2), adult health nurse practitioner (1), and critical care (1); 1 graduate did not specify an area. Future graduate study was being considered by an additional 12 (43%), whereas 7 (25%) were unsure. A 5-point Likert scale with corresponding statements was used to assess 25 areas reflecting the components of the ABS program from initial advisement through NCLEX preparation and program satisfaction. Each question addressed a unique area. Of the 25 questions posed, 20 questions received positive responses of agree or strongly agree and were selected by 67% 93% of the respondents. Most respondents (93%) agreed that internships and graduate-level course work were very important components of the ABS program. See Table 4 for the listing of the eight program components with the highest rate of respondent agreement (N82%). Questions were asked regarding whether the profession met the graduates' expectations and if they would recommend the program to others. In both instances, 24 (86%) of the respondents either agreed or strongly agreed. The results of two areas regarding faculty interactions were interesting. Although 21 (75%) of the respondents felt faculty recognized and respected their previous education and life experiences, only 16 (57%) thought faculty assisted them in incorporating their prior experiences into the nursing role. Although 23 (82%) of the respondents felt that the program had prepared them adequately to begin practice as a graduate nurse, only 20 (72%) felt that the program prepared them to take the NCLEX. Twenty-one (75%) individuals credited the Kaplan review course as a contributor to their NCLEX success. During their senior year in the ABS program, students take courses with other undergraduate-level students (traditional and RN/BS) in the clinical and classroom settings. This integration was felt to enhance the program by only 15 (57%) of the respondents. This was contrasted by 26 (93%) of respondents who felt integration in class with the graduate students enhanced the program. Due to cost and limited financial resources for the students, the investigators were interested in whether the financial burden of pursuing the program was greater than expected. Nine (32 %) of the respondents felt that the financial burden was greater than expected, whereas 13 (46%) did not. Six (21%) indicated neutrality. Analysis of Students' Responses to Open-Ended Questions Question 1. What Did You Like Most About the Program? The analysis of the graduates' responses to this question on the survey identified six themes. All 28 persons who returned the survey responded to this question. Theme 1: Fast-Paced, 12-Month Program. Of the 28 graduates, 12 (42.8%) commented on the fact that the ABS program was a 1-year program that moved quickly as a positive aspect of the program. Comments reflecting this theme included the following: What I liked most about the program was that it was fast. The length of the program was perfect just what I was looking for. I liked the fact we were able to graduate in one year. I didn't think it was ever too much to handle. Theme 2: Supportive Faculty/Staff. Another 12 (42.8%) persons identified the concern of the faculty/staff as a positive aspect of the program. Statements showing this theme included the following: Very supportive staff who knew you personally. SON [School of Nursing] feels small even among the UB [University at Buffalo] campus as a whole. Some of the professors treated us with respect of being professionals, not just young students. Theme 3: Bonding Within the Cohort of ABS Students. Meanwhile, 11 (39.2%) respondents specified bonding within the cohort of ABS students as a strength of the program. Responses demonstrating this theme included the following:

5 54 KEMSLEY ET AL The cohort of students going through the program. I liked how the school organized us to feel like a cohort. Having a small class-perceived great support. Small classes during the summer facilitated learning and provided opportunity to form a close knit peer support group. Theme 4: Variety of Experiences. Ten (35.7%) individuals acknowledged the variety of experiences as a positive aspect of the program. Comments expressing this theme included the following: Variety of teaching styles by staff (especially during the summer courses). Clinical experiences. Skills practice time and skill/ testing simulations. Freedom to approach the field of nursing from my own perspective. Theme 5: Online Experiences. Three (10.7%) graduates specifically noted the emphasis on online experiences as a strength of the program. Comments identifying this theme included the following: Kaplan review and online access. Online course activities and tests that could be taken over a week's time slot really helped with time management. Theme 6: Qualities of ABS Students. Two (7.1%) individuals addressed the qualities of the ABS students as a positive part of the program. These statements exhibit this theme: Background of other ABS students, quality of participants in program. The diversity of my fellow students. Question 2. What Did You Like Least About the Program? The analysis of the graduates' responses to this question on the survey identified seven themes. A total of 21 of the 28 individuals, who returned the survey, responded to this question. Theme 1: Course Content Issues. Six (28.6%) respondents identified course content issues as an area that was problematic in the program. These comments specify this theme: Too much focus on geriatrics, management theories should have had more bio/physiology emphasis in courses. Group projects just because [they are] tedious. Some of the online material seemed cumbersome. Theme 2: Clinical Experiences Issues. Six (28.6%) other persons addressed clinical experiences issues as an area of concern. These statements illustrate this theme: Lack of significant practical experience, more lab work would be good. I felt that I missed out on a lot of clinical experiences; I realize that I need a lot more clinical skills that I do not possess now. I wish that we had more hospital clinical time. I don't think that the community based clinical was as helpful when it came to practicing skills. Theme 3: Problems Integrating With BSN Students. Four (19.0%) respondents identified problems integrating with the other undergraduate nursing students. These comments show this theme: Integration with the undergraduates was not smooth. Classes together with basic RN students [were not] any value. Poor integration/relation to 4 year students. Theme 4: Preference to Be With Just ABS Students. Two (9.5%) persons specifically noted their preference to have classes with only their cohort of ABS students. These statements identify this theme: The Friday discussion groups during our last semester as part of the critical care course should have either been just ABS or deleted altogether. If possible, keep classes apart. Theme 5: High Level of Stress. Two (9.5%) other respondents discussed the high level of stress during the year-long program. These comments illustrate this theme: There was often undue stress the expectation for stress was greater stress than the actual program. It felt like a constant state of panic. Spring semester. It was too packed. I did not retain a lot of information in N478 Concepts of Acute Complex Care or N440 Critical Elements of Nursing Leadership. I found myself postponing the NCLEX so I could relearn N478. Question 3. What Suggestions Would You Make to Improve the Program? The analysis of the respondents' responses to this question on the survey identified seven themes. A total of 21 of the 28 graduates who returned the survey responded to this question.

6 55 Theme 1: Additional Clinical Time/Experiences. Nine (42.9%) respondents who answered this question specified the need to add additional clinical time and experience. These statements show this theme: Adding more clinical experiences would benefit students. Try to teach more skills, not so much management. The accelerated program should be focused as much as possible on the clinical aspects of being a nurse. Theme 2: Emphasis on Transitions Between Roles/ Opportunities in Nursing. Seven (33.3%) persons addressed the need for an emphasis on the transition between being a student and becoming a nurse. These comments show this theme: Better guidance in transitioning between roles (previous employment to student to nurse) better discussion of nursing opportunities outside of the hospital. In our ABS class, there was an assumption of knowledge of the field and for those of us from disciplines outside medicine, there was an overview lacking at the inception of studies. Consequently, the pieces taught over the summer seemed disparate without large general concepts about the field from which to attach the knowledge. More talk of graduate programs/job markets for NPs etc. More shadow experiences. Keep students enthusiastic about the profession with stories of your own experiences. Assign faculty advisor to follow student before and during program to help choosing clinical placement, exploring interest and specialties, thinking about grad school, to talk about issues that arise during program. Theme 3: Faculty Issues. Three (14.3) individuals noted issues related to the faculty that might enhance the program. These statements demonstrate this theme: Have clinical instructors be more demanding. That's the main way to integrate theory with practice. Emphasize critical thinking, promote adaptability, priority setting, utilize available resources, team building. Theme 4: Maintenance of Small Program/Focus on ABS Students. In addition, 3 (14.3%) other respondents identified the importance of keeping the ABS program a small one and especially focusing on the ABS students once they are integrated with the other undergraduate students. These statements demonstrate this theme. Keep it small the intimacy of the group contributed to our success. There should be a meeting with the ABS students to get their opinions before they graduate. Once the summer was over and we integrated with the other students, there was never much follow up to see how we were progressing. Theme 5: Curriculum Issues. Three (14.3%) other respondents noted issues related to the curriculum that need to be addressed. These comments illustrate this theme: People who already earned their BS do not need to spend time on the liberal arts part of getting a degree. Cut out wasted time spent watching movies in a little room. Limitations Several limitations to this study affect the ability to generalize the findings in relation to instituting improvements in classroom and clinical instruction. Students in only one university ABS program were surveyed, and although the response rate was respectable, only 50% of the eligible students responded to the survey. The small sample size was also a limitation that affected generalizability. Despite these limitations, valuable insight was obtained related to students' perceptions about their ABS program that will, hopefully, inspire faculty to consider the findings of this program evaluation when evaluating their own programs. Discussion The analysis of the 28 students' responses to the survey questions showed a high degree of similarity between the quantitative and qualitative data. The findings showed that 96% of the respondents were employed as registered nurses at the time they completed the survey, which was 8 months to 2 years following their graduation from the program. Ninety-three percent of respondents were employed as staff nurses primarily on medical surgical or critical care units in hospitals. Eighty-two percent noted their belief that the program had prepared them adequately to begin practicing as graduate nurses. These results are similar to those of numerous other studies that have shown that accelerated programs for individuals with a prior bachelor's degree are an effective way to address the nursing shortage (Brewer et al., 2009; Johnson & Johnson, 2008; Korvick et al., 2008; Seldomridge & DiBartolo, 2008). Eight respondents identified that they were in a graduate nursing program at the time that they completed the survey. In addition, 12 more individuals were considering this option. The interest in graduate study in nursing by 20 respondents is intriguing in light of two specific findings of the study. First, one of the two highest rated aspects of the program (92.9% of the respondents) was the opportunity to take

7 56 KEMSLEY ET AL graduate-level courses. Second, 85.7% identified that their being integrated with graduate students enhanced their satisfaction with the program. It should be noted that inclusions of three graduate courses, nine credits, into the ABS degree is a unique feature of our program. These courses include Health Care Systems, Policy and Ethics and Health Promotion and Risk Reduction, which are taken at the beginning of the program, and Research Methods for the Practice Professions, which is taken during the last semester. The influence of being exposed to graduate-level nursing courses and students on the respondents' decisions to pursue additional graduate work are seen as a best practice and merit study. Seldomridge and DiBartolo (2008) identified the need to explore the reasons graduates of accelerated programs choose to pursue advanced nursing education. The findings indicated that 42.8% of the respondents liked the fast-paced nature of the 12-month program. However, only 9.5% of 21 graduates identified the high level of stress as an issue. Meanwhile, the faculty teaching in this program were acutely aware of the high levels of stress endured by the students throughout the year and anticipated that more respondents would address this issue. Hegge and Larson (2008) concluded that 84 (61.3%) of 137 students identified that they had experienced extensive or extreme (p. 27) levels of stress during the program. Students interviewed by Kohn and Truglio-Londrigan (2007) discussed feeling scared (p. 391). In addition, 45.3% of their group cited that having to learn a large amount of material in a short span of time was the major stressor they experienced in the program. Similarly, Weitzel and McCahon (2008) identified heavy workload as the primary stressor for their students. Seldomridge and DiBartolo (2008) correlated the fast pace of their program with an increase in attrition rates. So far, the outcomes of the first three cohorts of our ABS program included a 97% retention rate, which indicates that few students have left or not completed the program. Another best practice in the classroom and clinical instruction is the use of a variety of teaching methods, which was rated highly by 82.2% of the respondents. Use of technology and active learning strategies are inherent in our program, as well as our university, allowing for variety and innovation in teaching methods. Online course work allows students to study at their own pace, within their own schedule (Cangelosi & Whitt, 2005; Kearns et al., 2004). This flexibility is important to those with a heavy course load, such as ABS students. The use of skill practice and testing to facilitate learning was rated highly as a program component by 85.7% of the respondents. Although this teaching method is the same as that used for teaching the traditional students, this may be new to the ABS students if their previous degree did not require practical application. Perhaps, this is the reason that 85.7% of the respondents highly rated the opportunity to apply knowledge and skills in clinical experiences, again reflecting best practice in clinical instruction. In addition, many of our ABS students avail themselves of the opportunity for a 2-week clinical experience during the winter break. This internship was rated highly as an opportunity to explore a special clinical interest by 89.3% of the respondents and to apply skills and knowledge. Peers in the program were identified as the greatest support by 92.4% of the respondents. In addition, themes related to the graduates' desire to take classes primarily with their own cohort were found in their answers to all three open-ended questions. Bonding within their cohort of the ABS students was what was liked best about the program by 39.2%. Two individuals specifically highlighted the qualities of the ABS students that they believed were important. Then, four (19.0%) of the respondents specified the problems integrating with the traditional or RN/BS students as what they liked least about the program. In addition, 2 (9.5%) of 21 participants noted their preference to be with just ABS students. Finally, 3 (14.2%) of 21 graduates expressed their desire for the maintenance of small program/focus on ABS students. The concept of a cohort and small classes, in all probability, enhanced classroom and clinical instruction. As discussed, the faculty was aware of the problems created when the cohort of ABS students was integrated with those in both the traditional baccalaureate and the RN/BS programs. Issues related to teaching courses just for the accelerated cohort versus blending this group with others have been noted by Johnson and Johnson (2008), Korvick et al. (2008), and Seldomridge and DiBartolo (2008). Definitely, this issue needs further examination. As addressed by Hegge and Larson (2008), as well as by Seldomridge and DiBartolo (2008), the faculty had acknowledged that the financial burden of getting a second degree is problematic due to limited financial aid resources. Preparing the students for this via discussion during their interview appears to have resulted in a positive benefit because only 9 (32.1%) of 28 respondents acknowledged that the financial burden was greater than they had expected. Meanwhile, 13 (48.1%) respondents were employed part time during the program. Seldomridge and DiBartolo (2008) especially cautioned that students who work more that 10 hours weekly while pursuing an accelerated program are at a higher risk for dropping out of the program. Although several students worked more than 10 hours per week, our attrition rate did not reflect this dropout tendency. Students with a wide variety of majors, backgrounds, and experiences have successfully completed our program. Thirty-two percent of 25 respondents had earned a degree in a biological science field and 32% in a behavioral science field such as psychology, social work, and health and wellness. Thirty-six percent of respondents had degrees in other fields such as business administration, education, environmental science, and engineering. This distribution is consistent with the profile of the entire three cohorts, which is 25% bioscience, 41% behavioral science, and 36% other

8 57 degree background. After completing a review of literature on accelerated second-degree programs, Cangelosi and Whitt (2005) concluded that students tend to have a first degree in a biological science. Clearly, students in our program tend to have a much wider scope of educational backgrounds and have successfully completed the program. Anecdotally, students have reported teaming up with classmates whose background differed from theirs to balance areas of strengths and weakness. Two additional areas are worthy of discussion. One relates to faculty interactions reflected by the finding that although 75% of the respondents felt faculty recognized and respected their previous educational and life experiences, only 57% felt faculty assisted them in incorporating their prior experiences into the nursing role. This may relate to the variety of backgrounds with some more easily translated to nursing, for example, biological and behavioral sciences versus engineering and business. The second finding related to the difference in responses to preparation for practice and preparation for the NCLEX examination (82% and 72%, respectively). This may relate to the balance of teaching concepts integral to professional nursing and teaching to the NCLEX examination. In addition, although the Kaplan Total Testing program was used throughout the program, students often do not fully use its resources until after graduation when the NCLEX examination review course is taken. Finally, although there were no large percentages of responses to areas of least satisfaction and recommendations for improvement, the themes of emphasis on role transition, clinical experiences, listening to student feedback, and program flexibility will be shared with faculty to ensure that the students' voices are heard. Recommendations for Future Research Recommendations for future research include continued surveys of graduates to compare findings of this study with subsequent cohorts that are larger in size. Exploration of the impact of life experiences on perceived program success and students' perceptions of stress experienced in the program could be considered. A faculty survey could provide insight into perceived differences and successful approaches used with ABS students. Since these areas can impact best practices in both the classroom and clinical instruction, it is important to explore in future studies whether a significant number of students feel these areas are important to creating an environment that is conducive to enhancing classroom and clinical instruction. Given that this study utilized survey methods, a higher level research method would provide stronger evidence-based teaching methods to evaluate the best teaching practices for ABS students (McCartney & Morin, 2005). Methods such as random assignment of students to groups for implementation of different teaching strategies are necessary. Conclusion Based on these survey results of graduates of our ABS program, the strengths of the program noted are the preadmission interviews that provided direction, the graduate-level course offerings, integration with graduate students, and cohorting of students. Other strengths included the variety of teaching methods including opportunities to apply knowledge and practice skills and opportunity for an internship. Overall satisfaction with the program and the profession was evident. The identified aims of the program that addressed nursing shortage effectively and efficiently are supported by these findings. The uniqueness of offering graduate-level courses is supported by the high level of interest in graduate study and enrollment. We believe these findings reflect best practices and considerations for the future. Acknowledgments The authors acknowledge the support and editorial comments provided by Dr. Mary Ann Jezewski, Associate Dean, Center for Nursing Research. References American Association of Colleges of Nursing. (2008). Accelerated programs: The fast-track to careers in nursing. Retrieved February 8, 2009, from Publications/issues/Aug02.htm. Beal, J. A. (2007). Accelerated baccalaureate programs: What we know and what we need to know Setting a research agenda. Journal of Nursing Education, 46, Brewer, C. S., Kovner, C. T., Poornima, S., Fairchild, S., Kim, H., & Djukic, M. (2009). Comparison of second-degree baccalaureate and traditional-baccalaureate graduate RN's: Implications for the workforce. Journal of Professional Nursing, 25, Cangelosi, P. (2007a). Voices of graduates from seconddegree baccalaureate nursing programs. Journal of Professional Nursing, 23, Cangelosi, P. (2007b). 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