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Factors Associated with Student Success in Online and Face-to-Face Delivery of Master of Science in Nursing Programs
Teaching and Learning in Nursing 14 (2019) 203–207
Contents lists available at ScienceDirect
Teaching and Learning in Nursing journal homepage: www.journals.elsevier.com/teaching-and-learning-innursing
Factors Associated with Student Success in Online and Face-to-Face Delivery of Master of Science in Nursing Programs Daisha J. Cipher a,⁎, Regina W. Urban a, Mary E. Mancini b a b
College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, TX 76019-0407, USA Undergraduate Nursing Programs, College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, TX 76019, USA
a r t i c l e
i n f o
Article history: Accepted 30 March 2019 Keywords: Online Face-to-face delivery Master of science in nursing programs
a b s t r a c t Background: The purpose of this study was to identify academic and demographic characteristics of master's-level nursing students that predict successful program completion in face-to-face and online master's of science in nursing (MSN) programs. In addition, information was sought regarding online MSN students' retrospective appraisals of their program experience. Method: This article reports survey results of 125 former students enrolled in 1 of 3 MSN programs: Family Nurse Practitioner, Nurse Educator, and Nursing Administration. Survey data collected included appraisals of quality, rigor, and preparation. Results: The final survey sample included 125 respondents, of whom 92 were formerly enrolled in an online MSN program and 33 in an in-seat MSN program. Online and in-seat students did not significantly differ on any demographic or academic variables, nor the likelihood of graduation or discontinuation. Significant predictors of graduation included lower numbers of withdrawn classes and higher numbers of dropped classes. Program graduates reported moderate levels of confidence in their expanded career roles and moderate levels of certification examination preparation. Conclusion: Understanding the association between dropped classes, withdrawn classes, and persistence in MSN programs can assist academic program leaders to develop strategies to help their students to be successful. Identifying personal characteristics, situational variables, and academic factors that characterize persistence and predict graduation in MSN students is an area of study that requires further research. © 2019 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Introduction Nurses at all educational levels play an important role in supporting the health and well-being of Americans. In the United States, there are more than 3.6 million registered nurses (RNs). Together, they make up the largest segment of the nation's health care system (McMenamin, 2016). The US Bureau of Labor Statistics (2018) projects growth in nursing employment by 15% for RNs and 16% for advanced practice RNs from 2016 to 2026, compared with 7% growth projected on average for all other occupations. Because of the continuing projected demand for nurses, schools and colleges of nursing seek to prepare nurses at all levels: from diploma to doctor of philosophy. This is also in line with the recommendations made in the Future of Nursing report, in which nurses ⁎ Corresponding author. Tel.: +1 817 272 2776; fax: +1 817 272 5006. E-mail addresses: [email protected], (D.J. Cipher), [email protected], (R.W. Urban), [email protected]. (M.E. Mancini).
are encouraged to achieve higher levels of education and training in an academic setting that promotes seamless progression to advanced degrees (Institutes of Medicine, 2010). When considering the progression of education in nursing, an entry-level nursing degree is typically earned in diploma, associates' degree, or bachelor's degree programs. Once students have obtained a bachelor's degree, an option exists to pursue a master's of science in nursing (MSN) degree in various concentrations such as nursing education, nursing leadership, administration, or as an advanced practice RN. RNs who choose to return to school to pursue a master's degree are working adults with multiple professional and personal responsibilities. They are more likely to be female, over the age of 26 years, and to attend school part-time (Cipher, Shrestha, & Mancini, 2017; National League for Nursing, 2016). In light of these responsibilities, RNs will evaluate the benefits and barriers when deciding to return to school for a graduate nursing degree. MSN programs are offered in traditional face-to-face, hybrid, and fully online settings. Some working adult learners may find online
https://doi.org/10.1016/j.teln.2019.03.007 1557-3087/© 2019 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
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learning to be more appealing as they try to achieve a balance of professional, academic, and individual needs while pursuing a nursing degree (Hampton & Pearce, 2016; Reinckens, Philipsen, & Murray, 2014). Potential deterrents to nurses' pursuit of graduate degrees using an online platform are preferences for traditional instruction methods and face-to-face interaction with faculty and peers, fear of interruptions at work or home, and concerns regarding the quality or reputation of online instruction (Carpenter, 2016). In a sample of MSN leadership and nurse practitioner students, graduating grade point averages (GPAs) and family nurse practitioner (FNP) certification pass rates were comparable between online and in-seat programs (Cameron, 2013). Once enrolled in a graduate program, the goal of students is to complete the courses required for their course of study and graduate. Successful completion of courses, progression through a nursing program, and graduation with a nursing degree are all connected to the concept of academic persistence. Initially conceptualized as being the opposite of student attrition, student retention and academic persistence are defined in many ways at the course and program level in the literature and are influenced by the interaction of multiple variables (Hart, 2014; Jeffreys, 2015). Research variables associated with academic success and persistence in the literature include personal characteristics associated with the student, the external environment of the student, and the influence of the academic environment. Personal characteristics associated with student persistence include demographics, individual personality characteristics, and previous academic experiences that they bring with them when they start a program of nursing study (Jeffreys, 2015). In a sample of online undergraduate nursing students, Hart (2014) identified student perceptions of their own stress levels and support, motivation levels, and goal attachment as attributes that were positively connected to academic persistence. Richard-Eaglin (2017) reported that significant positive relationships existed among a student's verbal, quantitative, and total graduate record examination scores on admission to an Nurse practitioner (NP) program and program progression and completion. Another study revealed that learning to navigate between home, work, and academic cultures positively influenced their academic persistence in nursing graduate programs (Veal, Bull, & Miller, 2012). In a study of an online NP program, students with lower undergraduate GPAs and those students who were over the age of 40 years were more likely to experience attrition (Knestrick et al., 2016). Situational variables that are external to the academic process have an influence on student academic performance and persistence. These variables include the availability of financial resources, the presence of supportive others, employment demands, and experiencing family crisis (Jeffreys, 2012). An ongoing panel survey of MSN applicants identified environmental variables such as daytime shifts, voluntary overtime, or working multiple jobs as predictors of successful completion of an MSN (Kovner, Brewer, Katigbak, Djukic, & Fatehi, 2012). In contrast, a qualitative study of students who voluntarily withdrew from an RN-to-BSN program was conducted by Girard, Hoeksel, Vandermause, and Eddy (2017). Participants reported competing priorities between work and home and life events such as assisting ill family members, procuring adequate childcare, and coping with spousal addiction or divorce as contributing to their lack of academic success. No studies have been published that qualitatively explore the reasons for MSN student discontinuation or withdrawal. Academic factors at the course and program or university level are also thought to contribute to MSN student persistence. At the course level, academic factors that contribute to student persistence include high-quality course content and presentation, student feelings of connectedness with instructors, and promptness of instructors
when following up with students (Gazza & Hunker, 2014; Hampton & Pearce, 2016). In addition, several studies identified the importance of a student connectedness to their peers as having a positive influence on academic persistence (Gazza & Hunker, 2014; Hart, 2014; Veal et al., 2012). Program and university-level variables that may contribute to nursing student persistence are academic advising services and access to student support departments such as the library, computer support, and counseling services. The outcome variable for persistence is often an individual course grade, nursing or overall GPAs, and graduation rates (Jeffreys, 2015). At every level of nursing education, it is important to understand student characteristics that contribute to course and program-level success or persistence. In the available nursing research on persistence, only a small number of studies focus specifically on persistence in MSN students (Hampton & Pearce, 2016; Richard-Eaglin, 2017; Veal et al., 2012). To better understand the characteristics of former MSN students and their educational outcomes, University of Texas at Arlington College of Nursing and Health Innovation undertook a survey of students who were enrolled in one of the three accelerated online MSN programs within the past three academic years. The study aims were as follows: 1) What academic and demographic variables of MSN students predicted graduation? 2) What are former MSN students' retrospective appraisals of their programs? By identifying the variables associated with academic persistence in this population, it is believed that graduate nursing programs can better understand the factors that may contribute to program-level success. In addition, student retrospective appraisals may offer valuable information that can be utilized for program improvement.
Methods Student demographic characteristics (gender, race, age, residency) and academic variables (degree history, dropped courses, failed courses, withdrawn courses, financial aid, RN-to-BSN/BSN) were collected via university records for MSN student cohorts who were enrolled during three academic years (2014–2015, 2015– 2016, 2016–2017). A course was recorded as “dropped” if a student left a course prior to the census date and “withdrawn” if a student left after the census date. Students met criteria for study inclusion if they were not currently enrolled or progressing, and their MSN program resulted in graduation, discontinuation, or failure. Discontinuation was defined as the absence of enrollment in courses for an entire calendar year (365 days). A total of 2,481 students met inclusion criteria and were e-mailed a Qualtrics survey, an informed consent document, and a request to participate in the study. Of those, approximately 10% of the e-mails were returned to the sender because of a nonfunctioning e-mail address. The final sample included data from a total of 125 fully consented survey respondents. This study was reviewed and approved by the university's institutional review board. Survey questions included the following: 1) Did you complete your program? (yes, no, or still progressing/ intending to finish) 2) How did you obtain your BSN? (RN-to-BSN vs. BSN) 3) How long did it take you to find employment in your area of nursing specialization (number of months)? 4) Did you feel more confident in your expanded role upon graduation? (1 = not at all confident, 2 = somewhat confident, 3 = moderately confident, 4 = very confident, 5 = completely confident) 5) Did you pass certification on the first attempt? (yes, no, or not applicable to my career goals)
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Table 1 Demographic and academic characteristics of survey sample Respondent characteristic
Online (n = 92)
In-seat (n = 33)
Total (n = 125)
Age, XðSDÞ Male, n (%) Ethnicity⁎ White Black/African American Hispanic/Latino Prior baccalaureate Prior master's degree In-state residency Obtained financial aid Obtained RN-to-BSN (vs. BSN)
39.6 (10.2)
35.7 (8.2)
38.6 (9.9)
GPA at last term of enrollment, XðSDÞ MSN Administration Program MSN Education Program Nurse Practitioner Program Graduated Program
p .070
7 (7.6%)
2 (6.1%)
9 (7.2%)
.768
58 (63%) 14 (15.2%) 15 (16.3%) 15 (16.3%) 2 (2.2%) 85 (92.4%) 71 (77.2%) 51 (55.4%) 3.5 (.5)
18 (54.5%) 9 (27.3%) 4 (12.1%) 12 (36.4%) 0 33 (100%) 32 (97.0%) 12 (36.4%) 3.5 (.4)
76 (60.8%) 23 (18.4%) 19 (15.2%) 27 (21.6%) 2 (1.6%) 118 (94.4%) 103 (82.4%) 63 (50.4%) 3.5 (.5)
.317 .140 .537 .016 .393 .103 .010 .060 .067
26 (28.3%) 22 (23.9%) 44 (47.8%) 54 (58.7%)
1 (3.0%) 0 32 (97.0%) 21 (63.6%)
27 (21.6%) 22 (17.6%) 76 (60.8%) 75 (60.0%)
.003 .002 b .001 .619
⁎ Seven students did not specify their ethnicity.
6) Only respond to this question if you were in the online program: If you could change any aspects of your online education experience, would it be: improved course communication, improved communications with the lead teacher, improved communications with the academic coaches, or all of the above? 7) Only respond to this question if you were in the online program: Do you believe that the rigor of your online program was: more rigorous than the in-seat program, less rigorous than the in-seat program, or equally as rigorous as the in-seat program?
discontinued. Of those that were discontinued, 34% identified as “still progressing” even though they were not currently enrolled. Of the three MSN programs, most were enrolled in the FNP program (60.8%, n = 76) followed by the Nursing Administration program (21.6%, n = 27) and the Nurse Educator program (17.6%, n = 22, Table 1). The Nursing Administration respondents had the highest graduation rate at 66.7%, followed by the FNP respondents (56.6%), and the Nursing Education respondents (45.5%). In this sample, there were no program failures.
Statistical Analysis
Aim 1: What academic and demographic variables of MSN students predicted graduation?
Continuous parameters are reported as mean ± standard deviation, and discrete parameters were reported as n and %. Tests of normality were performed with the Shapiro–Wilk test. Mann–Whitney U tests were computed for comparisons of online and in-seat students on the continuous variables, and Pearson chi-square tests were computed for nominal variables. Multiple logistic regression models using the macro by Bursac, Gauss, Williams, and Hosmer (2008) were utilized to determine which factors were statistically related to the likelihood of graduation. The SAS algorithm by Bursac et al. (2008) automated the variable selection process for multiple logistic regression analysis. Any variable having a significant univariate test at the p value of .25 was selected as a candidate for the multivariate analysis. In the iterative process of variable selection, covariates were removed from the model if they were nonsignificant and not a confounder. Significance was evaluated at the .10 alpha level, and confounders were defined as any variable resulting in a parameter change of 15% or greater. Any that were significant at the .10 level were retained in the model, and the models were iteratively reduced. Analyses were performed using SPSS 22.0 for Windows and SAS 9.3 for Linux. Results The demographic characteristics of the sample are displayed in Table 1. The sample was composed of 92 respondents who were formerly enrolled in an online MSN program and 33 who were enrolled in an in-seat program. Most of the respondents were female (93%), and the mean age was 38.6 ± 9.9 years. The ethnic breakdown of the sample was primarily White (60.8%), followed by Black/African American (18.4%), and Hispanic/Latino (15.2%). In this sample, 49.6% of respondents had completed a BSN program as entry into the profession, whereas 50.4% had obtained their BSN through an RN-to-BSN program. Sixty percent (n = 75) graduated from their respective MSN program, and 40% (n = 50) were
The respondents were compared on whether they were enrolled in an online versus in-seat program. There were no significant differences between former online and in-seat students on gender, ethnicity, age at enrollment, cumulative GPA (at the time of last semester), graduation rates, or discontinuation rates (Table 1). The percentage of in-seat respondents were more likely to have entered the profession through a BSN program (as opposed to an RN-to-BSN; 63.6%) as opposed to online respondents (44.5%), a difference that approached significance, χ 2(1) = 3.53, p = .06. In addition, the inseat respondents were composed of mostly those enrolled in the FNP program (97%), whereas the online respondents were composed of 47.8% FNP enrollees, χ 2(1) = 24.61, p b .001 (Table 1). Multiple regression analyses using the purposeful selection algorithm by Bursac et al. (2008) tested the associations between predictor variables (program type, age, gender, ethnicity, financial aid
Table 2 Predictors of persistence: initial and final models Predictor
Crude OR
Adjusted OR
p⁎
95% CI⁎
Initial model Online program (vs. in-seat) Male White/nonminority background Age at enrollment Number of failed courses Number of dropped courses Number of withdrawn courses Obtained financial aid
.81 .51 1.20 .97 .90 1.08 .57 1.31
.97 .58 1.49 .97 .96 1.25 .45 1.48
.942 .468 .336 .155 .879 .085 .008 .463
.39–2.38 .13–2.53 .66–3.37 .93–1.01 .57–1.61 .97–1.62 .25–.81 .52–4.21
Final model Number of dropped courses Number of withdrawn courses
1.08 .57
1.26 0.46
.080 .010
.97–1.62 .25–0.83
⁎ p Value and confidence interval (CI) associated with adjusted Odds ratio (OR).
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history, in-state residency, number of dropped classes, and number of withdrawn classes) and the likelihood of graduation. The results of the iterative models indicated that the number of withdrawn classes and the number of dropped classes significantly predicted the likelihood of graduation. As shown in Table 2, higher numbers of withdrawn classes were associated with a significantly lower likelihood of graduation (adjusted OR = .46, p = .01), regardless of whether the student was in-seat or online. However, higher numbers of dropped classes were associated with a significantly higher likelihood of graduation, after controlling for withdrawn classes (adjusted OR = 1.26, p = .08). Aim 2: What are former MSN students' retrospective appraisals of their programs? Respondents who graduated from their program (n = 75) reported an average length of 2.9 months (range: 0–24) elapsed between graduation and employment in a new role. Graduates reported a moderate level of confidence in their expanded role upon graduation (X = 3.1, SD = .96). More than half (58.7%; n = 44) passed their certification examination on their first attempt, and 1.3% (n = 1) failed. The other 40% of the respondents reported that the certification was not applicable to their career goals. Those graduates who took the examination reported a moderate level of preparation (X = 3.4, SD = 1.0). The graduates of the online program were compared with the graduates of the in-seat program on the survey questions. There were no significant differences between former online and in-seat students on how long it took to find employment (z = .37, p = .71) nor the level of perceived preparation for the national certification examination (z = 1.52, p = .129). However, the online graduates reported significantly higher levels of confidence in their expanded roles than the in-seat graduates (X= 3.21 vs. 2.67; z = 2.28, p = .023). Upon further investigation, we noted that the in-seat graduates were former FNP students (100%). When FNP graduates were compared with the graduates from other programs, confidence levels were significantly lower among the FNP graduates (z = 4.85, p b .001), regardless of whether respondents were in-seat or online. Among only those former students who were in an online MSN program (n = 92), the most commonly reported change that respondents would recommend was “all of the following: improved course communication, improved communications with the lead teacher, and improved communications with the academic coaches” (62.2%). This response was followed by “improvements only in course organization” (24.4%). Appraisals of the program's level of rigor were most commonly reported to be equally as rigorous as the in-seat program (62.9%), followed by more rigorous than the in-seat program (27.4%) and less rigorous than the in-seat program (9.7%). Discussion This survey study of formerly enrolled students in MSN programs revealed that online and in-seat students did not significantly differ on any demographic or academic variables, nor the likelihood of graduation or discontinuation. Significant predictors of graduation included lower numbers of withdrawn classes and higher numbers of dropped classes. Survey respondents reported an average of 2.9 months to find employment postgraduation. Program graduates reported moderate levels of confidence in their expanded career roles and moderate levels of certification examination preparation. In this study, higher numbers of dropped classes were associated with a significantly higher likelihood of MSN student graduation. The association between dropped courses and higher likelihood of graduation replicates the findings of Cipher, Mancini, and Shrestha (2017) among a sample of RN-to-BSN students. A dropped course is defined as a course that a student has enrolled in prior to the start date, but
has been dropped prior to the official census date. In this study's setting, the census date occurs a few days after the official start date of a course and the specific census date varies based on the length of the course. It should be noted that there was no univariate association between dropped classes and persistence; rather, the association was significant only when adjusted for other model variables (such as withdrawn classes). Therefore, these results (and the prior findings of Cipher, Mancini, et al., 2017) suggest that dropped classes only predict persistence after controlling for withdrawn and failed classes. Students who drop a course may have reviewed the course requirements; compared them to their available time, work schedule, family needs, and responsibilities; and made a personal decision to leave the course prior to the census date. The shortened, accelerated course schedules of the University of Texas at Arlington College of Nursing and Health Innovation actually facilitate this choice and may not be perceived as a huge delay when students are only waiting 6 weeks for the course to be offered again. Students with higher numbers of withdrawn classes were associated with a significantly lower likelihood of graduation. Withdrawing from a course is defined as a student's request to leave a course after the census date. Students can often be encouraged to withdraw from courses by faculty when their academic performance is low and concerns exist about their ability to earn a passing grade. Under extenuating circumstances (i.e., medical or other personal emergencies), a petition for withdrawal from a course can be granted for a student after the drop date. The association between withdrawn courses and lower graduation rates also replicates the findings by Cipher, Shrestha, et al. (2017) among RN-to-BSN students. Identifying which academic and demographic variables may predict graduation in MSN students would assist MSN programs to identify those students who are more likely to persist in reaching their academic goals. In this study, there were no significant differences between former online and in-seat students on gender, ethnicity, or age of enrollment and graduation rates or discontinuation rates. This is in contrast to the findings of Knestrick et al. (2016) who identified age over 40 years as being twice as likely to leave an FNP program prior to graduation. The percentage of in-seat respondents that were more likely to have earned a BSN, as opposed to an RN-to-BSN, was 63.6%. In online respondents, only 44.5% reported earning a BSN, a difference that approached significance. There were no significant differences between online and in-seat students on cumulative GPA (at the time of last semester) and graduation rates or discontinuation rates. Cameron (2013) also reported no difference in cumulative GPA when comparing online and in-seat students in an MSN program. Study participants who persisted to graduation reported an average of 2.9 months between graduation and employment, with no significant differences between online and in-seat students on the length of time it took to obtain a new position. For those students who were required to obtain additional certification to work in their new role, there were no significant differences between former online and in-seat students on the level of perceived preparation for the national certification examination. All but one student reported being successful on their national certification examination on the first attempt. Students were not required to report which certification examination they took, so comparisons between this sample and nationally reported pass rates cannot be made. The majority of the subjects in this study who participated in the online MSN program (90.3%) viewed the online program's level of rigor to be equal to or more than the rigor of the in-seat program. Upon graduation, both in-seat and online students in this sample reported at least a moderate level of confidence in their expanded role upon graduation. However, online graduates reported significantly higher levels of confidence in their expanded roles than their inseat counterparts. Because the in-seat respondents were largely composed of graduates from the FNP program, we investigated further
D.J. Cipher et al. / Teaching and Learning in Nursing 14 (2019) 203–207
and also found that FNP graduates were significantly less confident in their expanded roles, regardless of whether they were enrolled in an online or in-seat program. Online nursing students in this sample also provided programlevel feedback. They recommended improvements in course communication and in communication with the lead teacher and coaches. Hampton and Pearce (2016) suggested that online student engagement is heavily influenced by meaningful communication and personal connections made within online courses. Students described higher levels of engagement when course instructors utilized multiple channels of communication within a course. Timely, frequent, and effective communication within a course and with the instructor contributes to student satisfaction and success and helps to create a sense of community in online learners (Claywell, Wallace, Price, Reneau, & Carlson, 2016; Stott & Mozer, 2016). Limitations of this study include the utilization of a single-site convenience sample, thereby limiting the results' generalizability to other nursing programs. The low response rate and limited data set of demographic and academic variables available for analysis may also limit the generalizability of the results. An additional limitation of this study is that only online students were asked for their retrospective appraisal of program rigor and what they would choose to improve in the program. Asking both in-seat and online students open-ended questions regarding program rigor and satisfaction may have yielded more detailed student responses.
Conclusions Because only a few studies have been conducted that focus specifically on variables that contribute to MSN student academic success, research should continue in this area. Research can also contribute to the development of program-driven interventions to track and retain these students. No studies have been specifically focused on the reasons behind attrition in MSN students. Elucidating the factors that contribute to discontinuation in these students may assist MSN programs to identify students who may be at risk and offer program and university-based interventions to assist them to be successful. Identifying academic and demographic variables that characterize persistence and predict graduation in MSN students is an area of study that requires further research. Understanding the relationship of dropped classes to persistence to graduation and withdrawn classes to attrition from a program is useful to MSN programs as they develop a structure of support systems to help their students be successful. Eliciting students' retrospective program appraisals is useful when considering academic factors that can promote student retention and success. Acknowledgments The study was funded by a grant from Academic Partnerships.
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Contents lists available at ScienceDirect
Teaching and Learning in Nursing journal homepage: www.journals.elsevier.com/teaching-and-learning-innursing
Factors Associated with Student Success in Online and Face-to-Face Delivery of Master of Science in Nursing Programs Daisha J. Cipher a,⁎, Regina W. Urban a, Mary E. Mancini b a b
College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, TX 76019-0407, USA Undergraduate Nursing Programs, College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, TX 76019, USA
a r t i c l e
i n f o
Article history: Accepted 30 March 2019 Keywords: Online Face-to-face delivery Master of science in nursing programs
a b s t r a c t Background: The purpose of this study was to identify academic and demographic characteristics of master's-level nursing students that predict successful program completion in face-to-face and online master's of science in nursing (MSN) programs. In addition, information was sought regarding online MSN students' retrospective appraisals of their program experience. Method: This article reports survey results of 125 former students enrolled in 1 of 3 MSN programs: Family Nurse Practitioner, Nurse Educator, and Nursing Administration. Survey data collected included appraisals of quality, rigor, and preparation. Results: The final survey sample included 125 respondents, of whom 92 were formerly enrolled in an online MSN program and 33 in an in-seat MSN program. Online and in-seat students did not significantly differ on any demographic or academic variables, nor the likelihood of graduation or discontinuation. Significant predictors of graduation included lower numbers of withdrawn classes and higher numbers of dropped classes. Program graduates reported moderate levels of confidence in their expanded career roles and moderate levels of certification examination preparation. Conclusion: Understanding the association between dropped classes, withdrawn classes, and persistence in MSN programs can assist academic program leaders to develop strategies to help their students to be successful. Identifying personal characteristics, situational variables, and academic factors that characterize persistence and predict graduation in MSN students is an area of study that requires further research. © 2019 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Introduction Nurses at all educational levels play an important role in supporting the health and well-being of Americans. In the United States, there are more than 3.6 million registered nurses (RNs). Together, they make up the largest segment of the nation's health care system (McMenamin, 2016). The US Bureau of Labor Statistics (2018) projects growth in nursing employment by 15% for RNs and 16% for advanced practice RNs from 2016 to 2026, compared with 7% growth projected on average for all other occupations. Because of the continuing projected demand for nurses, schools and colleges of nursing seek to prepare nurses at all levels: from diploma to doctor of philosophy. This is also in line with the recommendations made in the Future of Nursing report, in which nurses ⁎ Corresponding author. Tel.: +1 817 272 2776; fax: +1 817 272 5006. E-mail addresses: [email protected], (D.J. Cipher), [email protected], (R.W. Urban), [email protected]. (M.E. Mancini).
are encouraged to achieve higher levels of education and training in an academic setting that promotes seamless progression to advanced degrees (Institutes of Medicine, 2010). When considering the progression of education in nursing, an entry-level nursing degree is typically earned in diploma, associates' degree, or bachelor's degree programs. Once students have obtained a bachelor's degree, an option exists to pursue a master's of science in nursing (MSN) degree in various concentrations such as nursing education, nursing leadership, administration, or as an advanced practice RN. RNs who choose to return to school to pursue a master's degree are working adults with multiple professional and personal responsibilities. They are more likely to be female, over the age of 26 years, and to attend school part-time (Cipher, Shrestha, & Mancini, 2017; National League for Nursing, 2016). In light of these responsibilities, RNs will evaluate the benefits and barriers when deciding to return to school for a graduate nursing degree. MSN programs are offered in traditional face-to-face, hybrid, and fully online settings. Some working adult learners may find online
https://doi.org/10.1016/j.teln.2019.03.007 1557-3087/© 2019 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
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learning to be more appealing as they try to achieve a balance of professional, academic, and individual needs while pursuing a nursing degree (Hampton & Pearce, 2016; Reinckens, Philipsen, & Murray, 2014). Potential deterrents to nurses' pursuit of graduate degrees using an online platform are preferences for traditional instruction methods and face-to-face interaction with faculty and peers, fear of interruptions at work or home, and concerns regarding the quality or reputation of online instruction (Carpenter, 2016). In a sample of MSN leadership and nurse practitioner students, graduating grade point averages (GPAs) and family nurse practitioner (FNP) certification pass rates were comparable between online and in-seat programs (Cameron, 2013). Once enrolled in a graduate program, the goal of students is to complete the courses required for their course of study and graduate. Successful completion of courses, progression through a nursing program, and graduation with a nursing degree are all connected to the concept of academic persistence. Initially conceptualized as being the opposite of student attrition, student retention and academic persistence are defined in many ways at the course and program level in the literature and are influenced by the interaction of multiple variables (Hart, 2014; Jeffreys, 2015). Research variables associated with academic success and persistence in the literature include personal characteristics associated with the student, the external environment of the student, and the influence of the academic environment. Personal characteristics associated with student persistence include demographics, individual personality characteristics, and previous academic experiences that they bring with them when they start a program of nursing study (Jeffreys, 2015). In a sample of online undergraduate nursing students, Hart (2014) identified student perceptions of their own stress levels and support, motivation levels, and goal attachment as attributes that were positively connected to academic persistence. Richard-Eaglin (2017) reported that significant positive relationships existed among a student's verbal, quantitative, and total graduate record examination scores on admission to an Nurse practitioner (NP) program and program progression and completion. Another study revealed that learning to navigate between home, work, and academic cultures positively influenced their academic persistence in nursing graduate programs (Veal, Bull, & Miller, 2012). In a study of an online NP program, students with lower undergraduate GPAs and those students who were over the age of 40 years were more likely to experience attrition (Knestrick et al., 2016). Situational variables that are external to the academic process have an influence on student academic performance and persistence. These variables include the availability of financial resources, the presence of supportive others, employment demands, and experiencing family crisis (Jeffreys, 2012). An ongoing panel survey of MSN applicants identified environmental variables such as daytime shifts, voluntary overtime, or working multiple jobs as predictors of successful completion of an MSN (Kovner, Brewer, Katigbak, Djukic, & Fatehi, 2012). In contrast, a qualitative study of students who voluntarily withdrew from an RN-to-BSN program was conducted by Girard, Hoeksel, Vandermause, and Eddy (2017). Participants reported competing priorities between work and home and life events such as assisting ill family members, procuring adequate childcare, and coping with spousal addiction or divorce as contributing to their lack of academic success. No studies have been published that qualitatively explore the reasons for MSN student discontinuation or withdrawal. Academic factors at the course and program or university level are also thought to contribute to MSN student persistence. At the course level, academic factors that contribute to student persistence include high-quality course content and presentation, student feelings of connectedness with instructors, and promptness of instructors
when following up with students (Gazza & Hunker, 2014; Hampton & Pearce, 2016). In addition, several studies identified the importance of a student connectedness to their peers as having a positive influence on academic persistence (Gazza & Hunker, 2014; Hart, 2014; Veal et al., 2012). Program and university-level variables that may contribute to nursing student persistence are academic advising services and access to student support departments such as the library, computer support, and counseling services. The outcome variable for persistence is often an individual course grade, nursing or overall GPAs, and graduation rates (Jeffreys, 2015). At every level of nursing education, it is important to understand student characteristics that contribute to course and program-level success or persistence. In the available nursing research on persistence, only a small number of studies focus specifically on persistence in MSN students (Hampton & Pearce, 2016; Richard-Eaglin, 2017; Veal et al., 2012). To better understand the characteristics of former MSN students and their educational outcomes, University of Texas at Arlington College of Nursing and Health Innovation undertook a survey of students who were enrolled in one of the three accelerated online MSN programs within the past three academic years. The study aims were as follows: 1) What academic and demographic variables of MSN students predicted graduation? 2) What are former MSN students' retrospective appraisals of their programs? By identifying the variables associated with academic persistence in this population, it is believed that graduate nursing programs can better understand the factors that may contribute to program-level success. In addition, student retrospective appraisals may offer valuable information that can be utilized for program improvement.
Methods Student demographic characteristics (gender, race, age, residency) and academic variables (degree history, dropped courses, failed courses, withdrawn courses, financial aid, RN-to-BSN/BSN) were collected via university records for MSN student cohorts who were enrolled during three academic years (2014–2015, 2015– 2016, 2016–2017). A course was recorded as “dropped” if a student left a course prior to the census date and “withdrawn” if a student left after the census date. Students met criteria for study inclusion if they were not currently enrolled or progressing, and their MSN program resulted in graduation, discontinuation, or failure. Discontinuation was defined as the absence of enrollment in courses for an entire calendar year (365 days). A total of 2,481 students met inclusion criteria and were e-mailed a Qualtrics survey, an informed consent document, and a request to participate in the study. Of those, approximately 10% of the e-mails were returned to the sender because of a nonfunctioning e-mail address. The final sample included data from a total of 125 fully consented survey respondents. This study was reviewed and approved by the university's institutional review board. Survey questions included the following: 1) Did you complete your program? (yes, no, or still progressing/ intending to finish) 2) How did you obtain your BSN? (RN-to-BSN vs. BSN) 3) How long did it take you to find employment in your area of nursing specialization (number of months)? 4) Did you feel more confident in your expanded role upon graduation? (1 = not at all confident, 2 = somewhat confident, 3 = moderately confident, 4 = very confident, 5 = completely confident) 5) Did you pass certification on the first attempt? (yes, no, or not applicable to my career goals)
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Table 1 Demographic and academic characteristics of survey sample Respondent characteristic
Online (n = 92)
In-seat (n = 33)
Total (n = 125)
Age, XðSDÞ Male, n (%) Ethnicity⁎ White Black/African American Hispanic/Latino Prior baccalaureate Prior master's degree In-state residency Obtained financial aid Obtained RN-to-BSN (vs. BSN)
39.6 (10.2)
35.7 (8.2)
38.6 (9.9)
GPA at last term of enrollment, XðSDÞ MSN Administration Program MSN Education Program Nurse Practitioner Program Graduated Program
p .070
7 (7.6%)
2 (6.1%)
9 (7.2%)
.768
58 (63%) 14 (15.2%) 15 (16.3%) 15 (16.3%) 2 (2.2%) 85 (92.4%) 71 (77.2%) 51 (55.4%) 3.5 (.5)
18 (54.5%) 9 (27.3%) 4 (12.1%) 12 (36.4%) 0 33 (100%) 32 (97.0%) 12 (36.4%) 3.5 (.4)
76 (60.8%) 23 (18.4%) 19 (15.2%) 27 (21.6%) 2 (1.6%) 118 (94.4%) 103 (82.4%) 63 (50.4%) 3.5 (.5)
.317 .140 .537 .016 .393 .103 .010 .060 .067
26 (28.3%) 22 (23.9%) 44 (47.8%) 54 (58.7%)
1 (3.0%) 0 32 (97.0%) 21 (63.6%)
27 (21.6%) 22 (17.6%) 76 (60.8%) 75 (60.0%)
.003 .002 b .001 .619
⁎ Seven students did not specify their ethnicity.
6) Only respond to this question if you were in the online program: If you could change any aspects of your online education experience, would it be: improved course communication, improved communications with the lead teacher, improved communications with the academic coaches, or all of the above? 7) Only respond to this question if you were in the online program: Do you believe that the rigor of your online program was: more rigorous than the in-seat program, less rigorous than the in-seat program, or equally as rigorous as the in-seat program?
discontinued. Of those that were discontinued, 34% identified as “still progressing” even though they were not currently enrolled. Of the three MSN programs, most were enrolled in the FNP program (60.8%, n = 76) followed by the Nursing Administration program (21.6%, n = 27) and the Nurse Educator program (17.6%, n = 22, Table 1). The Nursing Administration respondents had the highest graduation rate at 66.7%, followed by the FNP respondents (56.6%), and the Nursing Education respondents (45.5%). In this sample, there were no program failures.
Statistical Analysis
Aim 1: What academic and demographic variables of MSN students predicted graduation?
Continuous parameters are reported as mean ± standard deviation, and discrete parameters were reported as n and %. Tests of normality were performed with the Shapiro–Wilk test. Mann–Whitney U tests were computed for comparisons of online and in-seat students on the continuous variables, and Pearson chi-square tests were computed for nominal variables. Multiple logistic regression models using the macro by Bursac, Gauss, Williams, and Hosmer (2008) were utilized to determine which factors were statistically related to the likelihood of graduation. The SAS algorithm by Bursac et al. (2008) automated the variable selection process for multiple logistic regression analysis. Any variable having a significant univariate test at the p value of .25 was selected as a candidate for the multivariate analysis. In the iterative process of variable selection, covariates were removed from the model if they were nonsignificant and not a confounder. Significance was evaluated at the .10 alpha level, and confounders were defined as any variable resulting in a parameter change of 15% or greater. Any that were significant at the .10 level were retained in the model, and the models were iteratively reduced. Analyses were performed using SPSS 22.0 for Windows and SAS 9.3 for Linux. Results The demographic characteristics of the sample are displayed in Table 1. The sample was composed of 92 respondents who were formerly enrolled in an online MSN program and 33 who were enrolled in an in-seat program. Most of the respondents were female (93%), and the mean age was 38.6 ± 9.9 years. The ethnic breakdown of the sample was primarily White (60.8%), followed by Black/African American (18.4%), and Hispanic/Latino (15.2%). In this sample, 49.6% of respondents had completed a BSN program as entry into the profession, whereas 50.4% had obtained their BSN through an RN-to-BSN program. Sixty percent (n = 75) graduated from their respective MSN program, and 40% (n = 50) were
The respondents were compared on whether they were enrolled in an online versus in-seat program. There were no significant differences between former online and in-seat students on gender, ethnicity, age at enrollment, cumulative GPA (at the time of last semester), graduation rates, or discontinuation rates (Table 1). The percentage of in-seat respondents were more likely to have entered the profession through a BSN program (as opposed to an RN-to-BSN; 63.6%) as opposed to online respondents (44.5%), a difference that approached significance, χ 2(1) = 3.53, p = .06. In addition, the inseat respondents were composed of mostly those enrolled in the FNP program (97%), whereas the online respondents were composed of 47.8% FNP enrollees, χ 2(1) = 24.61, p b .001 (Table 1). Multiple regression analyses using the purposeful selection algorithm by Bursac et al. (2008) tested the associations between predictor variables (program type, age, gender, ethnicity, financial aid
Table 2 Predictors of persistence: initial and final models Predictor
Crude OR
Adjusted OR
p⁎
95% CI⁎
Initial model Online program (vs. in-seat) Male White/nonminority background Age at enrollment Number of failed courses Number of dropped courses Number of withdrawn courses Obtained financial aid
.81 .51 1.20 .97 .90 1.08 .57 1.31
.97 .58 1.49 .97 .96 1.25 .45 1.48
.942 .468 .336 .155 .879 .085 .008 .463
.39–2.38 .13–2.53 .66–3.37 .93–1.01 .57–1.61 .97–1.62 .25–.81 .52–4.21
Final model Number of dropped courses Number of withdrawn courses
1.08 .57
1.26 0.46
.080 .010
.97–1.62 .25–0.83
⁎ p Value and confidence interval (CI) associated with adjusted Odds ratio (OR).
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history, in-state residency, number of dropped classes, and number of withdrawn classes) and the likelihood of graduation. The results of the iterative models indicated that the number of withdrawn classes and the number of dropped classes significantly predicted the likelihood of graduation. As shown in Table 2, higher numbers of withdrawn classes were associated with a significantly lower likelihood of graduation (adjusted OR = .46, p = .01), regardless of whether the student was in-seat or online. However, higher numbers of dropped classes were associated with a significantly higher likelihood of graduation, after controlling for withdrawn classes (adjusted OR = 1.26, p = .08). Aim 2: What are former MSN students' retrospective appraisals of their programs? Respondents who graduated from their program (n = 75) reported an average length of 2.9 months (range: 0–24) elapsed between graduation and employment in a new role. Graduates reported a moderate level of confidence in their expanded role upon graduation (X = 3.1, SD = .96). More than half (58.7%; n = 44) passed their certification examination on their first attempt, and 1.3% (n = 1) failed. The other 40% of the respondents reported that the certification was not applicable to their career goals. Those graduates who took the examination reported a moderate level of preparation (X = 3.4, SD = 1.0). The graduates of the online program were compared with the graduates of the in-seat program on the survey questions. There were no significant differences between former online and in-seat students on how long it took to find employment (z = .37, p = .71) nor the level of perceived preparation for the national certification examination (z = 1.52, p = .129). However, the online graduates reported significantly higher levels of confidence in their expanded roles than the in-seat graduates (X= 3.21 vs. 2.67; z = 2.28, p = .023). Upon further investigation, we noted that the in-seat graduates were former FNP students (100%). When FNP graduates were compared with the graduates from other programs, confidence levels were significantly lower among the FNP graduates (z = 4.85, p b .001), regardless of whether respondents were in-seat or online. Among only those former students who were in an online MSN program (n = 92), the most commonly reported change that respondents would recommend was “all of the following: improved course communication, improved communications with the lead teacher, and improved communications with the academic coaches” (62.2%). This response was followed by “improvements only in course organization” (24.4%). Appraisals of the program's level of rigor were most commonly reported to be equally as rigorous as the in-seat program (62.9%), followed by more rigorous than the in-seat program (27.4%) and less rigorous than the in-seat program (9.7%). Discussion This survey study of formerly enrolled students in MSN programs revealed that online and in-seat students did not significantly differ on any demographic or academic variables, nor the likelihood of graduation or discontinuation. Significant predictors of graduation included lower numbers of withdrawn classes and higher numbers of dropped classes. Survey respondents reported an average of 2.9 months to find employment postgraduation. Program graduates reported moderate levels of confidence in their expanded career roles and moderate levels of certification examination preparation. In this study, higher numbers of dropped classes were associated with a significantly higher likelihood of MSN student graduation. The association between dropped courses and higher likelihood of graduation replicates the findings of Cipher, Mancini, and Shrestha (2017) among a sample of RN-to-BSN students. A dropped course is defined as a course that a student has enrolled in prior to the start date, but
has been dropped prior to the official census date. In this study's setting, the census date occurs a few days after the official start date of a course and the specific census date varies based on the length of the course. It should be noted that there was no univariate association between dropped classes and persistence; rather, the association was significant only when adjusted for other model variables (such as withdrawn classes). Therefore, these results (and the prior findings of Cipher, Mancini, et al., 2017) suggest that dropped classes only predict persistence after controlling for withdrawn and failed classes. Students who drop a course may have reviewed the course requirements; compared them to their available time, work schedule, family needs, and responsibilities; and made a personal decision to leave the course prior to the census date. The shortened, accelerated course schedules of the University of Texas at Arlington College of Nursing and Health Innovation actually facilitate this choice and may not be perceived as a huge delay when students are only waiting 6 weeks for the course to be offered again. Students with higher numbers of withdrawn classes were associated with a significantly lower likelihood of graduation. Withdrawing from a course is defined as a student's request to leave a course after the census date. Students can often be encouraged to withdraw from courses by faculty when their academic performance is low and concerns exist about their ability to earn a passing grade. Under extenuating circumstances (i.e., medical or other personal emergencies), a petition for withdrawal from a course can be granted for a student after the drop date. The association between withdrawn courses and lower graduation rates also replicates the findings by Cipher, Shrestha, et al. (2017) among RN-to-BSN students. Identifying which academic and demographic variables may predict graduation in MSN students would assist MSN programs to identify those students who are more likely to persist in reaching their academic goals. In this study, there were no significant differences between former online and in-seat students on gender, ethnicity, or age of enrollment and graduation rates or discontinuation rates. This is in contrast to the findings of Knestrick et al. (2016) who identified age over 40 years as being twice as likely to leave an FNP program prior to graduation. The percentage of in-seat respondents that were more likely to have earned a BSN, as opposed to an RN-to-BSN, was 63.6%. In online respondents, only 44.5% reported earning a BSN, a difference that approached significance. There were no significant differences between online and in-seat students on cumulative GPA (at the time of last semester) and graduation rates or discontinuation rates. Cameron (2013) also reported no difference in cumulative GPA when comparing online and in-seat students in an MSN program. Study participants who persisted to graduation reported an average of 2.9 months between graduation and employment, with no significant differences between online and in-seat students on the length of time it took to obtain a new position. For those students who were required to obtain additional certification to work in their new role, there were no significant differences between former online and in-seat students on the level of perceived preparation for the national certification examination. All but one student reported being successful on their national certification examination on the first attempt. Students were not required to report which certification examination they took, so comparisons between this sample and nationally reported pass rates cannot be made. The majority of the subjects in this study who participated in the online MSN program (90.3%) viewed the online program's level of rigor to be equal to or more than the rigor of the in-seat program. Upon graduation, both in-seat and online students in this sample reported at least a moderate level of confidence in their expanded role upon graduation. However, online graduates reported significantly higher levels of confidence in their expanded roles than their inseat counterparts. Because the in-seat respondents were largely composed of graduates from the FNP program, we investigated further
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and also found that FNP graduates were significantly less confident in their expanded roles, regardless of whether they were enrolled in an online or in-seat program. Online nursing students in this sample also provided programlevel feedback. They recommended improvements in course communication and in communication with the lead teacher and coaches. Hampton and Pearce (2016) suggested that online student engagement is heavily influenced by meaningful communication and personal connections made within online courses. Students described higher levels of engagement when course instructors utilized multiple channels of communication within a course. Timely, frequent, and effective communication within a course and with the instructor contributes to student satisfaction and success and helps to create a sense of community in online learners (Claywell, Wallace, Price, Reneau, & Carlson, 2016; Stott & Mozer, 2016). Limitations of this study include the utilization of a single-site convenience sample, thereby limiting the results' generalizability to other nursing programs. The low response rate and limited data set of demographic and academic variables available for analysis may also limit the generalizability of the results. An additional limitation of this study is that only online students were asked for their retrospective appraisal of program rigor and what they would choose to improve in the program. Asking both in-seat and online students open-ended questions regarding program rigor and satisfaction may have yielded more detailed student responses.
Conclusions Because only a few studies have been conducted that focus specifically on variables that contribute to MSN student academic success, research should continue in this area. Research can also contribute to the development of program-driven interventions to track and retain these students. No studies have been specifically focused on the reasons behind attrition in MSN students. Elucidating the factors that contribute to discontinuation in these students may assist MSN programs to identify students who may be at risk and offer program and university-based interventions to assist them to be successful. Identifying academic and demographic variables that characterize persistence and predict graduation in MSN students is an area of study that requires further research. Understanding the relationship of dropped classes to persistence to graduation and withdrawn classes to attrition from a program is useful to MSN programs as they develop a structure of support systems to help their students be successful. Eliciting students' retrospective program appraisals is useful when considering academic factors that can promote student retention and success. Acknowledgments The study was funded by a grant from Academic Partnerships.
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