University of Wisconsin Oshkosh, College of Nursing

This EIN “Grantee Spotlight” features an interview with team members who evaluated the University of Wisconsin, Oshkosh College of Nursing’s ACCEL program, a 12-month accelerated bachelor’s to BSN program that uses a technology-rich model. EIN interviewed co-principal investigators Dawn Pope, BSN, MS and Jaya Jambunathan, PhD, RN, along with program evaluator Chere C. Gibson, PhD, and Terry L. Gibson, PhD, professors emeriti of the University of Wisconsin-Madison. As one of its technology tools, the ACCEL program utilizes the virtual world of Second Life as a means to provide experiential learning to their students. We’ve included two short video segments to illustrate how ACCEL has integrated Second Life as it is used by faculty and students.

EIN: Can you tell us about the status of the ACCEL program, the educational innovation that your team is evaluating?

Oshkosh Team: ACCEL is a successful 12-month accelerated online bachelor’s to BSN program that began in 2003 at the University of Wisconsin Oshkosh, College of Nursing (UWOCON). The program, accredited by the Commission for Collegiate Nursing Education (CCNE), is designed for students who hold a minimum of a bachelor’s degree in a field other than nursing. More than 300 BSN-prepared nurses have graduated from the ACCEL program as of May 2010 with a low attrition rate of less than 4 percent for all cohorts since 2003 and a high NCLEX first-time pass rate. ACCEL now enrolls about 60 students a year, in cohorts of 30 with admission in May and October. These numbers represent an increase in the College of Nursing’s capacity to graduate BSN prepared nurses.

EIN: There are several second-degree programs around the country now. How does ACCEL compare with them?

Oshkosh Team: ACCEL differs from most such programs in three important ways. First, the course material is offered completely online. Second, the student’s clinical hours are spent working one-on-one with preceptors who work in clinical facilities near the student, rather than in a central facility near our campus. Third, while other programs require students to move to campus, ACCEL students are allowed to complete course requirements in their own geographical region, which is usually where they plan to practice as an RN. We should add that one major requirement for accelerated programs – and this includes the ACCEL option – is for the entering student to have a bachelor’s degree completed in another field.

EIN: The ACCEL program has been implemented for a number of years and you’ve told us that the pilot cohort began in 2003: is there anything you have found surprising in your work thus far with the program?

Oshkosh Team: It is a little surprising that the number of applicants continues to grow without a considerable amount of formal marketing. We now average 100-120 applicants for each cohort.

EIN: We have two more questions related to the history of the program: were there any organizational obstacles during the design and development of the ACCEL program? And did you face any regulatory challenges?

Oshkosh Team: The biggest organizational obstacles during the design and development were trying to coordinate timing with various campus support services for a program that was run year-round with a very semester oriented schedule. On the regulatory question, we did need to submit our plan for an alternative option for our undergraduate program to the State Board of Nursing. The option was supported by the Board without any major issues or challenges. For our students who are from a state other than Wisconsin, we contact their State Board of Nursing, explain our program, describe the sequencing and requirements of various course and clinical experiences and seek acceptance from the Board to place students in precepted clinical experiences in agencies in their home states.

EIN: About the ACCEL model, the coursework is online and the clinical is close to home, so how much time do students spend physically on campus?

Oshkosh Team: They are required to be on campus for three weeks in all. They’re here for a one-week orientation period, during which they’re introduced to all the technology that they will be expected to use during the program. Then there’s a second residency that lasts for two weeks, which we describe as a “boot camp,” in which students have intense lab sessions covering the assessment techniques and psychomotor skills they will need throughout the clinical courses. They also experience their first acute care clinical experience. The clinical is done in sections of 4-5 students with a seasoned clinical instructor from the CON in various local health care agencies.

EIN: One of the program’s teaching tools uses the on-line virtual community called Second Life. Tell us about that, please.

Oshkosh Team: Sure. Each student creates an avatar and then uses it to interact with faculty and classmates online. The software allows them to interact and learn from each other while they are geographically distant. Of course, our instructors also create avatars and then use the Second Life (SL) platform for a variety of purposes: as a place to hold office hours, deliver lectures, participate in such activities as a virtual health assessment, assess the safety of an elderly person’s home, visit a public health department, meet as groups to complete a group assignment, or spend time in a disaster scenario triaging patients.

EIN: Several of us who have reviewed the model are particularly interested in what makes the use of a faculty avatar interacting with a student avatar a powerful teaching tool. It’s been said that it provides a kinesthetic experience that is missing from other communication forms, e.g., telephone contact. How would you explain the elements of using an avatar to achieve engagement for both faculty and student?

Oshkosh Team: Even though students and faculty are meeting in avatar form, there is a real presence that takes root, the sense of being in the same place at the same time via synchronous communication. It’s much more personal than talking on the phone. And we have found that the more time spent in SL, the more proficient the faculty become at using the virtual space for a range of activities and interactions.

EIN: How much time in each specific course do students and faculty spend in Second Life? How much time is actually spent in Second Life to conduct faculty-student consultations (e.g., office hours)?

Oshkosh Team: The time that is spent in each course varies. Some instructors use very limited resources from SL, while others have assignments and activities on a much more active schedule. For faculty office hours with students, again this area varies from instructor to instructor. Some meet very infrequently while others meet on a daily basis.

EIN: Some faculty and students may be more technologically savvy than others. Do some have challenges in working with Second Life and avatars, etc.?

Oshkosh Team: As your question anticipates, it can be a problem for faculty, not just students. But as we’ve mentioned earlier, the experience has been that the more time spent in Second Life, the more proficient faculty become. That’s true of students, too, although they usually have the advantage of youth! The school has a tech support staffer dedicated to offering technology help to both students and faculty if problems arise.

EIN: The ACCEL program uses clinical preceptors: how does the program prepare staff nurses for the clinical preceptor role? How are the clinical preceptors supported by the school’s clinical faculty?

Oshkosh Team: It varies from agency to agency, but most frequently the student service coordinator works with educators at the agencies to identify and prepare preceptors. As part of their preparation, each preceptor receives a flash drive with a “preceptor module” that introduces them to the program, adult learner needs, the art of being a preceptor and expectations for the student and preceptor. The school’s faculty clinical instructor also receives contact information for the preceptor and contacts the preceptor prior to the clinical to introduce him/herself and let the preceptor know what to expect from the instructor. Then the faculty member sets up two face-to-face site visits with the preceptor and students during the course, ideally one very early in the course and the second toward the end of the course. The clinical faculty instructor also makes contact by phone/email/Skype weekly on the weeks that a site visit is not scheduled.

EIN: Is there a large burden on the UWO Clinical Faculty that comes from their supervising of the clinical preceptors?

Oshkosh Team: Regarding additional burden, the most significant one is the time for travel to remote clinical sites in order for the UWO Clinical Faculty to make site visits.

EIN: Let’s discuss the question of faculty work life and issues of faculty burden a bit more. In what ways is faculty burden reduced in the ACCEL program? Does teaching in a technology-rich program afford more flexibility to faculty than those using traditional teaching methods?

Oshkosh Team: We are in the early data collection phase with ACCEL faculty but we’re sensing that the key is not the decrease in faculty burden [it may remain the same or even increase] but other factors that have an impact on work-life issues, satisfaction, productivity, etc.

ACCEL students, like other BS to BSN students in other programs, are highly motivated and prepared for BSN course work according to faculty, clinical instructors and preceptors. More than one faculty member has mentioned the joy of teaching a mature, motivated student with clear goals and aspirations who is willing to put in the time and effort to make the goal of becoming an RN a reality. In many ways this decreases the burden of teaching – at least the remediation, pushing and prodding aspects.

Teaching with technology is a burden – one has to master the technology, suffer through any technology ‘crashes’ etc. That said, technology provides a variety of means to communicate with students both for teaching and other communications. Skype, audio conferences, email and Second Life provide venues for communication at all hours of the day and night, if a faculty member chooses to be that available. For the most part faculty members have time, place and pace flexibility usually driven by the course schedule, synchronous communications and other facets that they control within the larger ACCEL year long schedule.

EIN: Regarding the ACCEL students, are there differences in their specific educational needs?

Oshkosh Team: Some. They tend to be a little older and very committed. They’re not afraid to ask questions or challenge an answer. That means instructors need to be confident in their own knowledge and ability to give suitable answers or justification to student inquiries. They expect the instructors to be just as dedicated to them as they are to their success in the program.

EIN: Do ACCEL students require a different type of teaching style than traditional students?

Oshkosh Team: Our students tend to be more independent learners; however, they do expect close supervision and support when needed.

EIN: How does the “one-on-one” precepted clinical model affect student performance? Student satisfaction?

Oshkosh Team: That’s an area where we are hoping to capture significant data during the evaluation. We have anecdotal information from both students and preceptors that the experience is very positive for both, and we have testimonials from employers that the ACCEL students perform exceptionally well and are highly desired as new hires.

EIN: What about after the ACCEL students graduate?

Oshkosh Team:It’s difficult to compare ACCEL students to traditional students as a whole without more data. What we understand so far is they have scored very well on NCLEX exams, and have been able to get jobs earlier than the traditional students have. But we hope to have better data as part of the evaluation.

EIN: Would you describe your EIN evaluation plan?

Oshkosh Team: The goal is to assess the ACCEL program’s overall quality and to identify those program components that are essential to increasing teaching productivity and enhancing faculty work-life balance and satisfaction, while providing a quality online nursing education to those whose first degree was not in nursing. More specifically, the overall evaluation will explore the efficacy of using a range of technologies coupled with block scheduling and a preceptor model of clinical instruction to extend the reach and resources of nursing schools, including faculty.

During the evaluation, we’ll gather data that allows us to compare ACCEL with a number of other programs. Specifically, we’ll compare:

  1. Student outcomes from the ACCEL program and the University of Wisconsin-Oshkosh’s traditional BSN program;
  2. ACCEL student outcomes before and after the infusion of technologies beyond the online environment, including Second Life, into the ACCEL program;
  3. Student outcomes across three online and one face-to-face bachelor’s to BSN programs with their varying models of clinical instruction and course scheduling;
  4. Faculty work-life balance, satisfaction, productivity, recruitment and retention across three online and one face-to-face bachelor’s to BSN programs with their varying models of clinical instruction and course scheduling; and
  5. Alumni and employer perspectives on the programs and their outcomes.

EIN: What can you tell us about your project’s comparison schools?

Oshkosh Team: Three other schools/colleges of nursing serve as comparisons, with each offering a BS to BSN accelerated program as part of their larger nursing degree offerings of BSN, MS, PhD and/or DNP. The three BS to BSN programs include: Samuel Merritt University with its face-to-face accelerated program with traditional clinical instruction and course scheduling; Texas Tech University’s online BS to BSN program, with coach model of clinical instruction and traditional course scheduling, and the University of Oklahoma’s online accelerated program in California with its traditional model of clinical instruction and block scheduling of classes.

EIN: What kind of evidence do you hope to gather from your project?

Oshkosh Team: Both quantitative and qualitative data are being collected from students, faculty, clinical instructors, coaches and preceptors as well as from alumni and employers. Student data include student applications, acceptance rates and matriculation, scores on various tests, including the ATI Test of Essential Academic Skills, the EIN Breadth of Education survey for students, the ATI RN Comprehensive Predictor Exam and NCLEX. In addition we’ll interview ACCEL students about program features that enhanced and detracted from their learning, and the role of technology in their degree pursuit.

We’ll gather data from faculty across programs using a modification of the EIN National Survey of Nurse Faculty. And we’ll interview ACCEL faculty focusing on, for example, the impact of technology and block scheduling on their satisfaction, productivity and work-life balance.

Other interviews will include those of clinical instructors, coaches and preceptors about their perceived roles, teaching strategies, perceptions of accelerated students’ preparedness and motivation in contrast to traditional BSN candidates. The clinical nurse educators (CNE) will be asked about the impact of serving in their role as a CNE on their professional life, personal life and growth and development as a nurse.

And finally, we’ll gather data from alumni and employers to assess: 1) alumni’s evaluation of their learning outcomes, effectiveness of institutional resources and their overall education experience, and 2) employers’ perspectives on the preparedness of graduates for practice, including strengths and areas for improvement.

EIN: Can you get into some more detail about your research? For example, currently there is a great deal of interest in the roles and responsibilities of the clinical preceptor. In what ways might this model have an impact on clinical preceptors’ work life satisfaction, professional development, leadership and job retention, compared to traditional staff nurses?

Oshkosh Team: We have not compared our preceptors to traditional staff nurses to date but a number of quotes from the ACCEL preceptors themselves perhaps provide a perspective on the impact of serving as a preceptor on work-life satisfaction, professional development and leadership. One can only assume that if there is a sense of personal growth and satisfaction retention may be enhanced. The quotes that follow come from an online survey completed by 120 of 179 ACCEL preceptors surveyed in spring 2011. The question these responses come from is as follows: How has serving as an ACEEL preceptor impacted your professional life, if at all?

One-on-one relationship the preceptor has with a student in contrast to a 1:8-12 ratio of a clinical instructor to a student: “It has impacted my professional life in a positive way. I find intrinsic value in improving future psychiatric nursing care through being a nursing preceptor. Also I feel I make more of an impact with an ACCEL student because of the amount of 1:1 time ACCEL students get with preceptors like me.”

Work-life satisfaction: “In my experience, these students are more eager to learn and gain experience than some of the traditional students with whom I have worked. They have a goal in mind, therefore I am able to put myself out to them in the most full [sic] capacity and I feel extremely valued in my role. I do not mind sharing my whole professional self and giving my all to these students because it comes back to me 100% and more.

Professional development: “I have really enjoyed it. I wasn’t sure, at first, due to the on-line aspect of their training, but your students have all been very bright, interested learners. I love to teach and it helps me to review my practice, keep up to date on changes in Nursing, and also learn myself from a different, more technologically advanced generation of nurses, than I am.”
Leadership: “It has made me more confident as a supervisor and each staff member has shown responsibility in providing experiences for the [ACCEL] students which has helped in their development as practitioners, it strengthens the overall practice of the department, and as a department we show leadership in Public Health.

EIN: Do you have any preliminary data on the ACCEL program that you would like to share?

Oshkosh Team: There’s a lot more data to gather, of course. But so far, interviews with students reaffirm the critical importance of the one-on-one precepted clinical experience. They express feelings of competence and confidence at the end of their clinical experience, which they describe as superior to those of the students who complete their clinical rotations with a traditional clinical instructor who may have as many as eight to twelve students. The ACCEL students also express the importance of being able to live in their own communities with their families, thanks to the technologies that support their learning and the availability of local preceptors.

EIN: We thank you for your time and look forward to hearing more about your research findings in the coming months.