Factors Related to Progression and Graduation Rates for RN-to-Bachelor of Science in Nursing Programs: Searching for Realistic Benchmarks

FACTORS RELATED TO PROGRESSION AND GRADUATION RATES FOR RN-TO-BACHELOR OF SCIENCE IN NURSING PROGRAMS: SEARCHING FOR REALISTIC BENCHMARKS SUE ROBERTSON, RN, PHD⁎, CHERYL WESTLAKE CANARY, RN, PHD†, MARSHA ORR, RN, MSN‡, PAULA HERBERG, RN, PHD§, AND DANA N. RUTLEDGE, RN, PHD║ Measurement and analysis of progression and graduation rates is a well-established activity in schools of nursing. Such rates are indices of program effectiveness and student success. The Commission on Collegiate Nursing Education (2008), in its recently revised Standards for Accreditation of Baccalaureate and Graduate Degree Nursing Programs, specifically dictated that graduation rates (including discussion of entry points, timeframes) be calculated for each degree program. This context affects what is considered timely progression to graduation. If progression and graduation rates are critical outcomes, then schools must fully understand their measurement as well as interpretation of results. Because no national benchmarks for nursing student progression/graduation rates exist, schools try to set expectations that are realistic yet academically sound. RN-to-bachelor of science in nursing (BSN) students are a unique cohort of baccalaureate learners who need to be understood within their own learning context. The purposes of this study were to explore issues and processes of measuring progression and graduation rates in an RN-to-BSN population and to identify factors that facilitate/hinder their successful progression to work toward establishing benchmarks for success. Using data collected from 14 California schools of nursing with RN-to-BSN programs, RN-to-BSN students were identified as generally older, married, and going to school part-time while working and juggling family responsibilities. The study found much program variation in definition of terms and measures used to report progression and graduation rates. A literature review supported the use of terms such as attrition, retention, persistence, graduation, completion, and success rates, in an overlapping and sometimes synonymous fashion. Conceptual clarity and standardization of measurements are needed to allow comparisons and setting of realistic benchmarks. One of the most important factors identified in this study is the potentially prolonged RN-toBSN timeline to graduation. This underlines the need to look beyond standardized educational norms for graduation rates and consider the realities of “persistence” by which these students are successful in completing their studies. It also raises the question of whether student success and program success/effectiveness are two separate measures or two separate events on one

⁎Assistant Professor, Nursing, California State University, Fullerton, CA. †Associate Professor, Nursing, California State University, Fullerton, CA. ‡Lecturer, Nursing, California State University, Fullerton, CA. §Professor, Nursing, California State University, Fullerton, CA. ║Professor, Nursing, California State University, Fullerton, CA. Address correspondence to Dr. Robertson: Assistant Professor, Nursing, California State University, Fullerton, 800 N. State College Blvd, EC-190, PO Box 6868, Fullerton, CA 92834-6868. E-mail: [email protected] 8755-7223/09/$ - see front matter Journal of Professional Nursing, Vol 26, No 2 (March–April), 2010: pp 99–107 © 2010 Elsevier Inc. All rights reserved.

99 doi:10.1016/j.profnurs.2009.09.003

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progression timeline. While clarifying our thinking about success in this population of students, the study raised many questions that warrant further research and debate. (Index words: RN to BSN; Benchmarking; Retention and graduation rates) J Prof Nurs 26:99–107, 2010. © 2010 Elsevier Inc. All rights reserved.

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CADEMIC PROGRAMS IN nursing traditionally keep track of progression and graduation rates for students as measures of program effectiveness. This is in line with the new Commission on Collegiate Nursing Education (CCNE; 2008) accreditation standards that mandate calculated graduation rates for all degree programs. Such measures are expected to guide schools of nursing in monitoring how successful their programs are and allow feedback to improve or maintain strategies to facilitate student success. Although this seems straightforward, our review of the literature indicated the subject does not receive much attention or discussion. In addition, most research failed to distinguish between generic baccalaureate and other programs, such as RN-to-bachelor of science in nursing (BSN) completion programs. What is discussed in the literature has more to do with student support strategies (Jeffreys, 2004) than with actual measurement processes or establishing realistic and academically sound benchmarks. Moreover, the literature documents a lack of standardization of terms and measurement processes used and the lack of national nursing standards. Recent articles (Jeffreys, 2007; Papes & Lopez, 2007) have begun to address this topic in more depth. Campbell and Dickson (1996) reported attrition rates for baccalaureate degree nursing students that varied from 15.9% to 44%. Jeffreys (2007) reported a 75% retention rate for associate degree students over a 6-year period, with 67% graduating within 2 1/2 years of entry. Papes and Lopez (2007) found persistence/graduation rates of 77% and 83% in two cohorts of RN-to-BSN students. Seldomridge and DiBartolo (2005) reported a 10% attrition rate for accelerated students, whereas Rosenberg, Perraud, and Willis (2007) found the attrition rate for accelerated students to be 10%–20% below that of the traditional BSN students in their program (but did not indicate the latter rate).

Background The RN-to-BSN student cohort represents 26% of the total students enrolled in baccalaureate nursing programs across the country (Fang, Htut, & Bednash, 2008; Fang, Wisniewski, & Bednash, 2007). California State University, Fullerton (CSUF), has a large RN-to-BSN program with on-campus and distance cohorts. Because our students primarily study part-time and our program takes 3 years of part-time study to complete, we had selected an outcome target of 70% graduation rate within 3 years of entry to the program as a reasonable measure of success. However, after several years of data collection, we concluded that our program was not effective because our graduation rates were lower than anticipated and our

attrition rates were higher (greater than 25% in some years). We tried a standardized testing service that provided benchmarks, but that service was only able to compare the scores of our students with those of generic BSN students. Our faculty felt that the RN-to-BSN population was distinct from generic prelicensure students and that it needed its own set of outcome measures and benchmarks of success in relation to progression and graduation rates. As each year's data were analyzed, we worked harder and harder on student support services to facilitate retention and graduation of students. These services were appreciated and used by students, but graduation rates remained around 65%–68%. At the same time, faculty members began to prepare the self-study for the 2006 CCNE site visit. Following much discussion, we were convinced these rates did not reflect the real success (eventual graduation) of our RN-to-BSN population and that we needed more evidence to determine what benchmark to use instead of assuming that what we had set was indeed a “reasonable” outcome. We agreed we needed to better understand the measurement concepts and processes used to determine rates and to study how this population's unique characteristics might influence their success in the program.

Development of the Study As a first step, we had a lengthy meeting with the campus Institutional Research and Analytic Studies department to discuss how they measured attrition, retention, and graduation rates. We also reviewed the nursing education literature. We agreed that it would be useful to look at what the other programs in our state (specifically those with substantial RN-to-BSN cohorts) were doing and what strategies they used to define, measure, and assist students to be successful. Therefore, we devised a survey asking schools to describe the following: (a) definitions of and measures of attrition or retention, and graduation rates; (b) established targets or benchmarks, if any; (c) initiatives to enhance retention and their perceived effectiveness; and (d) other measures used to demonstrate achievements of graduates (given that National Council Licensure Examination scores were not relevant in this population).

Definitions and Measures of Success Our initial introduction to the complexity of measurement concepts came from our discussion with Analytic Studies on campus. The conceptual base from which campus measurements are taken derives from the National Center for Education Statistics (2008) Integrated Postsecondary Education Data System (IPEDS).

PROGRESSION AND GRADUATION RATES IN SCHOOLS OF NURSING

Table 1 indicates some of terms found in the IPEDS glossary. From our discussion, we learned that the term attrition, although discussed, is seldom measured on a campus level and not included in IPEDS. Retention rate was defined as “those who are enrolled from 1 year to the next.” Retention is a measure of persistence (but persistence is not an IPEDS term). Graduation rates, per IPEDS standard, are based on 150% normal time to graduate in a designated program (i.e., 4-year baccalaureate degree), and retention/persistence rate is mea-

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sured at the end of 150% normal time to graduation for those who have not yet graduated but are still persisting toward their degree. Success on our campus is defined as those graduated plus those still persisting. By campus definition, 150% of normal time to graduation is 6 years for freshman cohorts and 3 years for transfer cohorts (such as RN-to-BSN students); persistence is measured as those who are still on campus into their seventh or fourth year, respectively. The Analytic Studies Department for the CSU Chancellor's Office calculates system-wide and

Table 1. Definitions of Terms for Tracking Students Throughout Course of Studies (IPEDS, 2008) * Term Cohort

Bachelor's degree program

Cohort exclusions

Graduation rate (GRS)

Normal time to completion of degree

Program

Retention rate

Transfer in student

Definition Number of students entering institution as degree- or certificate-seeking undergraduate students (full time; part-time) in a particular year Course of studies designed to be completed in minimum of 4 years (8 or 12 semesters) to obtain a specific degree Institutions can adjust original cohorts by reporting exclusions (number of students who left institution) for the following: ■ Death or total/permanent disability ■ Service in armed forces/called to active duty ■ Service with foreign aid service of federal government, such as Peace Corps ■ Service on official church mission Measure of rate, expressed as percentage, of students (completers) who finish program of studies within 150% of normal time to completion of degree divided by adjusted cohort (minus exclusions) Standard length of time identified by institution/ program for completing degree/certificate. For example, program states it takes four semesters to complete course of studies on a full time basis. Or a 4-year degree program Course of studies (courses and related activities) designed to meet an institution's defined educational objectives Measure, expressed as percentage, of rate of progression or persistence through identified course of studies at academic institution For 4-year institutions (in contrast to community colleges), this is percentage of students within a degree-seeking program who were enrolled the previous fall semester and are now enrolled in current fall semester

Student who has previously attended an academic institution at the same level (i.e., undergraduate) and is now entering program for first time

⁎ Adapted from The IPEDS Glossary found at http://nces.ed.gov/ipeds/Glossary/.

Comments

Number of students excluded is subtracted from original cohort before calculating retention rate

Initiated in 1997 as part of Student Right to Know legislation

Graduation rate measures 150% of standard time to completion. Thus, GRS for 4-year degree would measure rate of those completing degree within 6-years

Measured annually. Reports persistence from one year to the next (continuous enrollment or re-enrollment). Equation for retention rate is (current fall year cohort/adjusted previous fall year cohort) × 100

If institution admits to summer semester, students enrolled for first time that summer included in previous summer/fall cohort If institution uses year round cohort, measure 3 month period from August 1 through October 31 to define retention cohort Student may transfer with or without specific credits

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per-campus retention and graduation rates through the Consortium for Student Retention Data Exchange (The California State University, Consortium for Student Retention Data Exchange [CSRDE], 2008a). We were informed that the “whole set of measures are somewhat more complicated when monitoring within discipline retention/graduation rates.” In the literature on progression1 and graduation rates in nursing programs, a variety of terms are used. Jeffreys (2007) defined attrition as loss of students from a program and identified three attrition pathways: (a) voluntary, students who dropped out of a program for nonacademic reasons; (b) first semester failure; students who failed the first nursing course and did not retake the course; and (c) involuntary, or dismissal. Other authors (Bean & Metzner, 1985; Hoyt & Winn, 2004) categorize attrition as (a) dropouts (also called stayouts), (b) stopouts, and (c) transfer-outs. Dropouts are students who take classes for one or more semesters, then stop registering and do not return to complete the program. Stop-outs begin the program, do not take courses for one or more semesters, but do return to finish. Transfer-out students begin a program at one institution and complete at another institution. A form of attrition discussed by IPEDS as “cohort exclusions” include students leaving programs for reasons such as death, disability, military or foreign service, or missionary work. By IPEDS definition, retention is an annual rate calculated to show the proportion of students who return to their studies from 1 year to the next. However, in the nursing literature, it is rarely measured in that way. Jeffreys (2007) identified three retention pathways to account for stop-outs and returns over time. Ideal retention was successful completion of required courses in a specified period (e.g., 24 months for a six-semester program), with no failures or withdrawals. Continuous retention referred to completion of courses (including repeating courses if needed) to meet graduation requirements while enrolled full- or part-time but outside the expected 150% graduation timeline. Interim retention differed from continuous retention in that students had stop-outs (breaks in continuous enrollment) for one or more semesters. Recently, Papes and Lopez (2007) identified persistence rates as a way to track retention and provide data regarding program effectiveness. Using IPEDS definitions to help clarify retention/graduation, these authors defined persistence rate as “the number of admissions and the amount of time it takes a student to graduate, within a consistent framework” (p. 241). Over 8 years, they developed and refined a system to track persistence rates that was consistent with the IPEDS higher education standard of student success (150% of typical time to graduate). It appears that persistence is both a measure of

1

For the purpose of this article, progression refers to all measures of students' progress within a program and includes the concepts of attrition, retention, and persistence.

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progression and graduation in this model. Both Jeffreys and Papes and Lopez defined an entry point (enrollment in first nursing/clinical nursing course) and considered the time to graduation as important factors in measuring retention, persistence, or graduation rates. This conforms to the new CCNE (2008) standards, which state that nursing programs should specify the entry point and timeline to completion used to calculate the graduation rate for their students. Both authors used the IPEDS norm of 150% time to graduation as their baseline for “successful” graduation for baccalaureate students. However, neither indicated what percent of students were expected to achieve the targeted graduation rate.

Facilitators/Barriers to Academic Progression/Success In one model of student attrition (Bean, 1980; Bean & Metzner, 1985), it was shown that nontraditional students —older than 24 years, commuters, studying part-time, and those more interested in academics than social offerings of the institution—were affected by several factors that influenced decisions to drop out. The following propositions were proposed by Bean and others: 1. Students whose performance was poor were

expected to drop out more readily than those with good academic performance. 2. Intention to leave was influenced by psychological and academic variables such as study habits, commitment to a goal, and institutional fit. 3. Background factors such as previous academic performance and age-predicted future success. A phenomenological study of RN-to-BSN students (Megginson, 2007) identified previous negative academic experiences as an important deterrent to success, with these experiences having a “lasting, almost traumatic effect on their vision to attain a BSN” (p. 53). 4. Environmental/Contextual factors such as family responsibilities, work hours, finances, and social support had the most significant effect on student decision making (Bean & Metzner, 1985; Reilley, 2003; Trainor, 2000). Causes of attrition include unsatisfactory academic performance related to the faster pace and greater intensity of baccalaureate nursing programs, poor lifestyle choices, unforeseen personal issues, even isolation (Rosenberg et al., 2007). Physical isolation might be experienced by students in “distance” programs (e.g., satellite sites, online programs, or hybrid programs with online content; Bollinger & Martindale, 2004). Male students may face gender isolation when in classes with primarily female students. In Stott's (2007) qualitative study, feeling isolated or excluded was the central theme for male students who were afraid of “appearing silly or less academically able in a female dominated context” and verbalized not wanting to “be shot down in flames by a group of women” (p. 328).

PROGRESSION AND GRADUATION RATES IN SCHOOLS OF NURSING

Increasing diversity in the nursing applicant pool along with increasing numbers of nontraditional students led Jeffreys (2004) to develop a retention model with a focus on identifying what factors affect student retention and success. Given her population of associate degree students, who in turn become RN-to-BSN students, the model was seen as particularly useful to us. Jeffreys identified six key elements affecting undergraduate retention: (a) student profile characteristics; (b) affective factors; (c) academic, professional integration, and environmental factors; (d) academic outcomes; (e) psychological outcomes, and outside surrounding factors. Student profile characteristics denoted attributes present prior to beginning the program such as age, gender, language, prior educational experience, ethnicity, and work experiences. Academic factors referred to study skills, time spent studying, attendance, class schedule, and availability of support services. Professional integration factors, such as advisement, faculty support, professional events, peer friendships and mentoring, and enrichment programs, increased student interaction with the program. Environmental factors external to the educational process included financial support, family responsibilities, work schedule, social support, and transportation. Student affective factors were cultural beliefs and values, self-efficacy, and motivation. Outside factors included social, political, economic, and professional factors that could influence retention. Academic outcomes were course grades and overall grade point average (GPA); psychological outcomes were satisfaction and stress. In Jeffreys' framework, all factors were either directly or indirectly interrelated.

Methods Sample We aimed to sample all programs in California with an RN-to-BSN program. To determine programs, we used two sources, the Web site for the California Board of Registered Nurses (BRN) and a member list of the California Association of Colleges of Nursing (CACN). In September 2007, the BRN listed 9 programs (5 private, 4 public). The fall 2007 list of CACN member schools included all nine BRN-listed programs plus others that we identified as possibly having an RN-to-BSN program. An announcement was made at a CACN meeting that we would be contacting schools with RN-to-BSN programs. As a result, our survey was sent to 35 programs. We heard from 3 programs indicating they were too new to be able to respond to our survey; 1 program reported not having a current program. Thus, our final sample of potential program respondents was 31 schools.

Survey Investigators created a three-part survey to gather information about the study aims. Information about each program was obtained using five questions. The Progression/Graduation Success section (16 items) asked for definitions of retention/attrition, estimates of annual retention rates and graduation rates, and lists of specific

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retention strategies undertaken along with a rating of their utility. Other Measures of Program Effectiveness items (8 items) had participants indicate what measures they used, if any to demonstrate achievements of graduates, to specify how portfolios were used (if they were) and to report how often annual achievement data were summarized at their university. A draft survey was sent to five RN-to-BSN programs in southern California for evaluation of feasibility and clarity. Based upon minor suggestions from three programs, the survey finalized and put into a computerized format to allow data collection via the internet.

Procedures CACN members were invited to respond to the survey with an email invitation during late summer 2007 as well as with a personal invitation and flyer during an October meeting. The email invitation included a copy of the survey, allowing participants to gather information before actually filling out the online version. Three follow-up emails were sent. Because the survey was done anonymously, reminders went to those who had already completed it as well as those who had not.

Results Fourteen respondents (response rate 45%) representing California universities that have RN-to-BSN programs responded. Of these, 86% (n = 12) represented either a California State University program or a privately operated, not-for-profit university. Two other programs were a University of California and a faith-based, not-forprofit respondent. Programs included those wherein curricula was provided in full- and part-time formats with an average length of time for completion ranging from 1–2 years for full-time study to 3–4 years for parttime study. Further, universities used a variety of methods by which the curriculum was delivered (Table 2), from traditional on-campus formats to fully online programs. Only programs that kept separate data on RN-to-BSN students, distinct from generic BSN students (n = 10), completed the remainder of the survey. In most of the programs (80%), most students worked full time (75%–100%), whereas in two programs, only 20%– 50% of students worked full time. In addition, in six programs reporting marital status, most students were married (60%–80%), whereas two (33%) described 40%–50% of students as married. The ethnicity of the student populations varied (Table 3). Student financial support varied with some students receiving up to 100% tuition reimbursement. We asked respondents to describe required prerequisite courses. Numbers of courses and specific content areas varied (Table 4). Three programs required a common set of eight courses including oral communication, written communication, critical thinking, mathematics or quantitative reasoning, anatomy with laboratory, physiology with laboratory, microbiology with laboratory, and chemistry with laboratory. Some programs required these prerequisites plus additional

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Table 2. Curriculum Delivery Methods for 14 Programs Methods

n

%

Traditional, on-campus classes Distance classes with “on-site” classrooms Web augmentation (e.g., use of learning management platform such as Blackboard or WebCT with video streaming and other Web-based resources) Video-conferenced augmentation (e.g., lectures broadcast to sites) Fully online class Other (on-site classes are conducted in “core weeks”; we have no students in this program)

10 7 9

30.3 21.2 27.3

3 2 2

9.0 6.1 6.1

courses in sociology, psychology, or statistics; other programs required only limited prerequisite courses. Further, nine programs allowed students to enter without completion of one or more of prerequisites. Additional entry requirements are summarized in Table 5.

Attrition, Retention, and Graduation Definitions and Rates The definition of attrition and retention differed across programs. Some described attrition as students who failed to complete the program. Others described attrition as only those who totally withdrew from a course or the program. Several programs suggested that they did not calculate attrition rates for RN-to-BSN students. Retention definitions considered both numbers of students working on degree requirements, whether in nursing or other courses, and numbers of students enrolled only in nursing courses. Finally, some programs defined retention as students completing coursework with a passing grade or as graduates of the RN-to-BSN program. Most programs (n = 6) did not indicate a time frame for successful progression to graduation. Of those for which a time frame was defined, the period ranged from 1 to 5 years. Reported program retention rates ranged from 50% to 100%, and graduation rates ranged from 49% to 100% for the prior 3 years. When asked to identify if there were specific periods noted when students were lost, most mentioned the first semester or quarter of the program or at a time of personal crisis. Further, most programs reported no specific benchmarks for appropriate attrition, retention, or graduation rates. The two benchmarks

reported were (a) 70% for graduation within 3 years and (b) 95% for graduation without any timeline indicated.

Retention Initiatives Initiatives that programs used to enhance retention (Table 6) included academic factors such as a nursing orientation session and course scheduling. One program offered courses on a core week schedule so students had an intensive week of classes followed by 4 weeks of mentorship. In this program, admission dates were not set, and courses not sequenced to facilitate flexibility. Another program planned 1-day-per-week courses. Environmental factors to enhance retention included program flexibility, allowing students to “step out” and return. Most programs allowed part-time study facilitating slower progression, with writing and reading assistance offered. Professional integration factors included fostering of supportive relationships among faculty/staff and students and enhanced access (allowing faculty and staff to know students personally). Finally, having students progress as a cohort was a strategy reported to facilitate peer support and interstudent relationships.

Other Graduate Achievements as Program Effectiveness Measures In addition to graduation rates (10 programs), program effectiveness indicators included senior capstone achievement (4 programs), awards/honors (3 programs), Educational Benchmarking, Inc., surveys (3 programs), job placement rates at graduation (2 programs), reflective summary by graduating seniors (2 programs), certification rates (2 programs), progression to graduate school

Table 3. Student Ethnicity by Program * Program Ethnicity Asian, % Hispanic, % Black (not Hispanic), % Caucasian (not Hispanic), % Native Indian or Alaskan, % Native Hawaiian or other Pacific Islander, % Mixed/Other, % Note. na = not applicable.

1 26 27 7 40 na na na

⁎ Four programs did not describe their student's ethnicity.

2 3 3 6 88 na na na

3 25 35 3 35 1 1 1

4 27 16 7 50 na na na

5 7 18 10 37 b1 10 18

6 15 10 3 70 na 2 na

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Table 4. Prerequisite Courses Listed by Study Participants (N = 9) Programs 1 8 prerequisites required Introductory biology Sociology Introductory psychology Developmental psychology Less than six units of GE lacking Religious studies course Interdisciplinary course 70 units from basic skills courses, AND ≥2.0 GPA Humanity credit

2

3

4

5

X

6

7

8

X X X

X X X

9 X

X X X X

X X

X

X

Note. GE = general education; GPA = grade point average.

(2 programs), faculty developed surveys (2 programs), Health Education Systems comprehensive examinations (1 program), and student portfolios (1 program). Eight programs measured outcomes annually with cumulative summaries every two (3) or five or more years (3). Seven schools identified predictors of success (graduation) for RN-to-BSN programs. These included flexible work schedules, nondemanding family responsibilities, financial and personal (family/friends) support, realistic agency expectations, personal motivation, GPA (higher is predictive of graduation), and fewer hours worked per week.

Discussion Setting standards for progression and graduation rates for RN-to-BSN programs should be based upon the real context of the learner's environment and the best evidence about how this population of nurses progresses toward graduation (success). An emerging literature (Jeffreys, 2004; Jeffreys, 2007; Papes & Lopez, 2007) indicates interest in the topic of measuring rates more accurately and highlights the need to better understand, track, and interpret progression and graduation data in nursing students as measures of both student success and program effectiveness. The literature demonstrates that a variety of terms are used interchangeably to discuss progression and graduation rates. These terms are not always well defined or differentiated and include progression, retention, continuation, completion, persistence, graduation, and success. Student success is sometimes seen as a measure of retention or persistence and yet may also be described in the same article in terms of graduation or completion. It is not clear whether student success and program

effectiveness are or are not synonymous. Our study shows heterogeneous conceptual and operational definitions used by California nursing programs that may or may not reflect national educational measurement standards. Respondents did not seem to be aware of IPEDS or CSRDE standards for data collection within the CSU, although most respondents were from that system. Although the various CSU campus officials responsible for collecting and analyzing data would most likely know the standards, none of the nursing respondents seemed to understand the connection between the norms (150% timeline for example) and the outcome measures they are reporting. The lack of conceptual clarity and standardized measures contributes to confusion about what evidence is being produced to describe this population as successful or not. The lack of standardization means programs cannot be compared on outcome data. Much more needs to be done before any national or broad-based benchmarks can be determined. It seems clear that the RN-to-BSN population can be characterized as a distinct group of learners who are older than generic BSN students, working, studying part-time, stopping out and coming back, concerned with childcare and other family responsibilities, and dealing with financial/employment constraints. This learning context has bearing on the definitions used to measure success (both progression and graduation) in nursing programs and raises several questions about the usefulness of the IPEDS standards as a baseline for measurement with this cohort of students. As currently defined in the CSU system, graduation rates based on IPEDS norms for baccalaureate programs may be less than optimal indicators to define program effectiveness

Table 5. Entry Requirements N (%) California registered nurse license in good standing Minimal GPA from prelicensure program, 2.0–2.5, 3.0 preferred Associate degree in nursing 1-Year experience as RN Eligibility for California RN licensure within the first semester of admission or before first clinical course

10 (77) 8 (62) 8 (62) 2 (15) 3 (23)

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Table 6. Initiatives Reported by Participating Programs to Enhance Student Success and if Used, Perception of Helpfulness Helpful for Students Initiatives

Yes

Reading center Writing center Tutors Peer support program Scholarship support Advising center Staff/Faculty support (beyond instruction) Cohort model (2)—trying to keep students in cohort for peer social support; Advising center—working on more nursing specific advisors, as University acknowledges Nursing as unique in its needs for higher education; Faculty feedback—faculty providing timely feedback in Blackboard courses

1 (7) 5 (36) 4 (29) 4 (29) 7 (50) 8 (57) 11 (79) 3 (21)

No 2 1 0 2 2 2 0 0

(14) (7) (0) (14) (14) (14) (0) (0)

Not Sure

Not Applicable

2 (14) 2 (14) 4 (29) 2 (14) 1 (7) 1 (7) 1 (7) 2 (14)

9 (64) 6 (43) 6 (43) 6 (43) 4 (29) 3 (21) 2 (14) 9 (64)

Note. Values are expressed as number (percentage).

for this nontraditional student population. They do not seem to reflect the real likelihood of success over time with this unique population of nurses. One respondent offered that… …graduation rates are not good indicators of success because the population (working adults) (is) NOT like traditional undergraduate students. Their lives are very busy with work, family, and their own health. We have recently had several students have to drop (they returned later) because of serious health problems. Give[n] the health care delivery, one never know(s) when as assignment will change, an advancement may be offered, or an opportunity may be offered for a nurse. These issues have nothing to do with the quality of the program and should not effect (sic) the value or success of the program. An evaluation of the IPEDS benchmarks (Table 1) shows that successful graduation (and therefore program effectiveness) is based solely on the ideal time to graduation as determined by the program. It has been argued here that the RN-to-BSN cohort does not progress in an ideal fashion. If the “normal” time to graduate from an RN-to-BSN program (full time) is 2 years and the graduation rate allows 3 years (150%) for “successful graduation,” then students who persist in their studies beyond the norm are not counted as successful within a program. Papes and Lopez (2007) argue that the 150% norm is required to justify academic standards. However, we are not convinced of their argument and wonder why a student who takes more than the 150% timeline for graduation would be labeled unsuccessful. This is especially true in light of Jeffrey's (2007) description of the nontraditional RN student. Perhaps they are talking about “program success” and not “student success.” From the students' perspective, their persistence has paid off by allowing them to graduate with a degree. Are we saying that having students who “linger” in the program beyond the academic standard (IPEDS 150% timeline) indicates that a program is unsuccessful in

facilitating graduation in a timely manner? Given the number of support systems in place to assist students and the multidimensional issues identified by Jeffreys (2007), should the program deem itself unsuccessful if students do not graduate within the given timeframe? We do not think so. In California, the CSU Chancellor's Office (Ssemakula, 2003) participated in a series of surveys looking specifically at California Community College (CCC) transfer students' retention and persistence rates over a 7year period. Data were collected on students in both parttime and full-time studies across the CSU campuses. The results indicated that CCC transfer students had a long persistence history and that 50% graduated in just over 5 years from time of admission. In further studies over 10 years, the graduation rate for upper division transfers (such as RN-to-BSN students) was 68%. Also documented in these studies (CSRDE, 2008b) was a step dropout rate in the first year (20%), which is supported with our study data for RN-to-BSN students. Data for Cal State Fullerton (CCC Transfer Rates Fullerton, 2008) for a 6-year period from 2000 to 2006 showed that 56% of transfer students graduated within 3 years of admission, and 75% graduated within 6 years of admission (2% still enrolled). One-year retention rates ranged from 82% to 87%. CSU Fullerton had the highest graduation rates among the seven large CSU campuses (CSUF, 2005). In 2007, California State University, Fullerton Analytic Studies reported a graduation rate of 68% for upper division transfers (cohort graduated summer/fall 2005 and spring 2006) with average time to degree of 3.3 years (California State University, Fullerton Analytic Studies, 2007). Given data available for CSU transfer students, it would seem the 150% timeline might be an inappropriate benchmark of “success.” Although it is a nationally accepted educational standard, we believe it should not be accepted in a particular cohort of students without further study and debate. Therefore, we argue that for our population of students and for the CSU population as well, setting a longer timeline to graduation (6 years)

PROGRESSION AND GRADUATION RATES IN SCHOOLS OF NURSING

would yield a higher and more accurate success rate (graduation rate) overall. Perhaps measuring graduation rates at both 3- and 6-year intervals would show more clearly how students progress over time in this cohort. This would also more accurately reflect the effect of voluntary attrition—with later program completion— that many students require due to school and life events. Finally, the establishment of “when to measure what” still does not get at the real issue of establishing a benchmark for “success” from a program perspective. “What proportion of students are expected to finish within 3 years or within 6 years as indicators of program effectiveness?” is the underlying question. Our very limited data suggest that perhaps 50% at 3 years and 75% at 6 years would be realistic. Much more research and discussion at a national level needs to be done to answer this question.

Recommendations Nursing programs need to become familiar with national education standards (IPEDS, 2008) for measuring retention and graduation rates and be able to justify whether these standards are appropriate for nursing populations. In any case, progression and graduation measures should be clearly defined and operationalized. Further discussion is needed at state, regional, and national levels to determine whether standardized definitions and calculation formulas can be developed for each degree cohort. Longitudinal studies using data from multiple schools would be helpful in determining realistic and feasible benchmarks for success for RN-to-BSN students.

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