Use of the professional nurse case study as a method to earn credit in an RN to BSN program

ABNF Journal, The, July-August, 2003 by Dolores Brown Hall

Abstract: This article describes the author's experience in developing a professional nurse case study as a means of allowing registered nurse students enrolled in a baccalaureate degree nursing program to satisfy the clinical requirement at a public institution in New Jersey. The author used a survey to assess the lower level competencies of their RN students. In addition, a survey was mailed to the BSN graduates who completed the program within the past five years to determine if they would have selected an alternative to the clinical examination. Results showed that the PNCS could validate prior learning of basic nursing competencies for RNs returning to obtain a BSN degree.

Key Words: RN-BSN students, Non-traditional College

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The concern of returning RN students about meeting a lower level clinical nursing requirement in an RN-to-BSN program led to the development of a non-clinical option to satisfy the clinical requirement. The external degree nursing program offered by Thomas Edison State College, which is one of 12 senior public institutions in New Jersey, is the only one of its kind in the State.

The College gives RN students the opportunity to use a variety of methods to earn credits without receiving traditional classroom instruction. Some of these methods provide credits for college level knowledge students may already have; whereas, other methods provide new learning opportunities. This makes it possible for students to complete the entire nursing program by examination.

As part of the curriculum for the professional nursing component, students were required to take a two-and-a-half day clinical performance examination. The exam tested the basic knowledge and skills students acquired by the end of a two-year professional nursing program. During the exam, students provided care to acutely ill children and adults. In caring for their clients, students had to demonstrate the use of the expected nursing competencies of critical thinking, diagnostic reasoning and therapeutic communication. The plan of care developed by the students for their clients is based on the nursing process, professional nursing standards of practice and scientific rational from nursing and related disciplines.

Since students frequently questioned the need for practicing RNs to take the lower level examination in an upper-division program, we reviewed the exam results after each administration and found that during a ten-year period, the majority of students passed the exam on the first attempt. Given these results, the writer began to explore alternatives to the exam. The overall goal was to find a method that could be used to document prior learning, which was comparable to the content assessed on the clinical exam. However, the method had to remain within the established philosophy, objectives, and curriculum framework, and credit distribution of the BSN program. There was no provision within the curriculum for students to waive the clinical exam. Many of the students, graduates of associate and diploma nursing programs, in the real world were functioning at or beyond the level of the beginning BSN. In fact, these nurses were in administrative or supervisory positions, and some had bachelors degrees in other disciplines. Finding a tested and accepted method for these nurses to demonstrate their clinical proficiency was the challenge.

METHODOLOGY

To determine how their RN to BSN programs assessed the lower-level competencies or basic nursing skills of their RN students, a questionnaire was mailed to the 118 randomly selected National League for Nursing accredited RN to BSN programs. The focus of the survey was to identify what self-directed learning activities were being used in their curriculum. Most of the respondents reported using advanced placement, a few required a clinical exam, while several others required students to repeat lower-level nursing courses previously taken in their basic program. The programs also reported using the following self-directed learning activities: 1) computer assisted instruction; 2) paper and pencil surveys; 3) student assessment profiles; and 4) clinical simulations.

In addition to surveying the RN-to-BSN programs, we also surveyed the Thomas Edison BSN graduates. All 65 graduates who completed the program within a five-year period were mailed a questionnaire and asked if they would have selected an alternative to the clinical exam had one been available when they were students in the program. The participants were given five alternatives including the category of "other" from which to choose. They were also asked to rank order their responses.

RESULTS

Forty-five or 69 percent of the graduates returned their completed questionnaires. Their responses to the question regarding an alternative to the clinical exam when they were students in the program reported in rank order: 1) portfolio assessment; 2) paper and pencil test; 3) interactive video; and 4) video clinical simulations. A basic nursing skills course and use of a simulated laboratory were the major recommendations reported in the "other" category.