Overcoming barriers to role transition during an online post LPN to BN program

Overcoming barriers to role transition during an online post LPN to BN program
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Citation

Melrose, S. & Gordon, K. (2011). Overcoming barriers to role transition during an online Post LPN to BN program. Nurse Education in Practice, 11(1), 31-35.

Abstract

Canadian Licensed Practical Nurses continuing their education in an online Bachelor of Nursing program face unique barriers as they transition towards a new and more complex nursing role. This qualitative descriptive study explored Post Licensed Practical Nurse to Bachelor of Nursing (Post LPN to BN) students’ perceptions of their experiences during their education. George Kelly’s (1955/1991) psychology of personal constructs, which seeks to understand how individuals perceive the world around them, was the theoretical framework for this three year longitudinal project in which 10 Post LPN to BN students were interviewed at the beginning, middle and end of their program. Transcripts from the interviews were analyzed and three key themes are presented to illustrate barriers that Post LPN to BN students faced and the strategies they implemented to overcame them. First, workplace mentors helped Post LPN to BN students apply their learning. Second, personal learning goals sustained their motivation. Third, time management strategies included terminating full time employment.

Keywords: Licensed practical nurse, Enrolled nurse, Post LPN to BN, Role transition

Introduction

Vocationally prepared Licensed Practical Nurses (LPN’s) who enter an online university to continue their education by earning a Bachelor of Nursing (BN) degree face unique challenges (Melrose and Gordon, 2008; Porter-Wenzlaff and Froman, 2008; Ramsey et al., 2004). And yet, educational research examining both the barriers that these adult learners face and the strategies they implement to overcome them is limited. In Canada, two separate levels of nurse training exist. A Licensed Practical Nurse program can be completed in one or two academic years at a vocational college; and a Baccalaureate degree in nursing, which is required for entry to practice as a Registered Nurse (RN), can be completed in three or four academic years or two years in an advanced standing accelerated program (Canadian Institute for Health Information CIHI, 2006). Traditionally, university programs have not offered nurses the opportunity to bridge between vocational and higher education sectors.

This article describes findings from a qualitative descriptive study that applied Kelly’s (1955/1991) psychology of personal constructs to investigate the transitional experiences of 10 Canadian Post LPN to BN students during their education. The project spanned three years and involved thematic analysis of interview data collected at the beginning, middle and end of participants’ program of study. By illustrating students’ views and using their own words to describe their transition over time, this longitudinal study begins to offer insight into an emerging group of non-traditional learners.

Background/literature

Strategies that LPN’s or Enrolled Nurses (EN’s) implement to cope with the challenges they encounter during their process of upgrading their nursing credentials have been understudied. Existing literature begins to describe some of the difficulties they can expect to encounter. However, few studies are available to illustrate the personal efforts that Post LPN or Post EN learners are making to overcome barriers.

The initial time of transitioning to student status has been identified as stressful for LPN’s (Rapley et al., 2006). They may perceive that their previous experience as qualified nurses has not been acknowledged (Allan and McLafferty, 2001; Kenny and Duckett, 2005). They may begin their studies with unrealistic expectations regarding program rigor and flexibility (Brown, 2005). The magnitude of academic studies can be shocking (Claywell, 2003). Post LPN to BN students can associate gains from their university education with a loss of their hands on nursing role (Melrose and Gordon, 2008). Some LPN’s seem to have approached their university education with a belief that they were “already functioning as RN’s and have little to learn beyond RN-specific tasks and that they are essentially just getting the credential to support their current practice” (Porter-Wenzlaff and Froman, 2008, p. 233).

During their program, arranging employment leaves and traveling away from home to complete clinical practicums were problematic for LPN’s (Rapley et al., 2006). Participating in upgrading courses was associated with changes in home and work life (Dowswell et al., 1998). LPN’s experienced negative peer pressure and sabotage from co-workers occurred (Claywell, 2003). The experience involved a cultural transition and required learners to question traditionally held values and adopt a critical stance to professional practice (Milligan, 2007). Students appreciated recognition for their previous accomplishments (Melrose and Gordon, 2008) and they valued opportunities to reflect on their wealth of experience (Dearnley, 2006). Instructors noted the importance of early identification of students at academic risk (Ramsey et al., 2004). Textbooks are available to articulate transitional processes and to support LPN to RN students (Claywell, 2008; Harrington and Terry, 2009; Kearney-Nunnery, 2009).

After graduating, Post LPN students found the working role of the RN was more complex, broad and mentally and physically trying than they expected (Kilstof and Rochester, 2004). An early study concluded that the actual process of identifying with the RN role did not occur until graduates returned to the work setting (Schultz, 1992).

The present project, part of an overarching program of research examining Post LPN to BN transitions, explored the following questions: What barriers do Licensed Practical Nurse students transitioning to the role of Registered Nurse encounter during their university education? What strategies help overcome these barriers?

Method

This longitudinal study was framed from George Kelly’s (1955/ 1991) psychology of personal constructs. Personal construct theory seeks to understand how individuals perceive the world around them, what their experiences have been and how these experiences influence their beliefs and actions. The theory, and the methodology which extends from it, repertory grid methodology, invites research participants to use their own words to illustrate unique interpretations of events and personal ways of constructing knowledge. This approach, with its underlying assumption that individuals have their own personal ways of construing meaning, was chosen for its relevance to adult learners who bring practical nursing experience to their academic studies.

Researchers collected audiotape − recorded transcribed interview data from 10 Post LPN to BN students in a Canadian online university at the beginning, middle and end of their program. The study included three phases. Phase One reported students’ views of transitioning to a new nursing role at the beginning of their program and explained how George Kelly’s (1955/1991) Repertory Grid Methodology (Fransella, 2005) was used to establish a baseline interviewing guide (Melrose and Gordon, 2008). Phase Two, the present study, analyzed transcripts from the interviews for themes and reports on students’ views in the middle of their program. Specifically, both the barriers students encounter and the strategies that help overcome these barriers are discussed. Phase Three is in progress and will report students’ experiences at the end of their program. Full ethical approval was granted by the university’s Research Ethics Board. Participants signed a consent form and were free to refuse to participate or withdraw from the study at any time. QSR International’s NVivo 8 software was used to organize the data collection and analysis. Trustworthiness was established through ongoing interaction and member checking with participants to ensure authenticity.

The following three themes emerged from thematic analysis (Denzin and Lincoln, 1994; Lincoln and Guba, 1985; Loiselle et al., 2007; Speziale and Carpenter, 2007) of the interview data and they were confirmed with participants. Verbatim comments are italicized. First, workplace mentors helped Post LPN to BN students apply their learning. Second, personal learning goals sustained their motivation. Third, time management strategies included terminating full time employment.

Results

Theme one: workplace mentors helped Post LPN to BN students apply their learning

Participants viewed isolation as a barrier as they sought to apply their learning to practice. They often felt they had “no one to talk to about the courses” or to answer their questions about “how [course information] was relevant to practice.” Their program offered prior academic credit for LPN experience and required completion of elective and non-clinical nursing courses in an asynchronous online environment where they worked individually and at their own pace. This method of course delivery made the program accessible to students from across Canada and allowed them to remain in their own communities until they joined a clinical group for their in-person practicum experiences. While optional opportunities for peer and instructor interactions such as e-mail, forum discussions and chat room were built into all their online courses, in-person discussion was limited. However, as these students were employed, they did have occasion to meet RN’s or other university educated health care professionals in their workplace.

Unlike either traditional undergraduate nursing students or after degree nursing students, Post LPN to BN students brought professional skills and competencies to their learning process. But, when academic credit for this prior practical learning was allocated, as it was in these participants’ program, LPN’s may face the barrier of participating in senior level university classes with only limited opportunities to complete introductory undergraduate courses. As one participant explained “I did a 14 month bridging program from Health Care Aid to Licensed Practical Nurse before I came to the Post LPN to BN program, so I didn’t have the [introductory] undergraduate time that some university students have.” In this study, although three participants had earned degrees in other countries, four bridged from Health Care Aid programs.

When elective and non-clinical nursing courses are completed asynchronously online, informal dialogue among teachers and peers may be limited. Lack of opportunity to discuss application of theory to practice can be a barrier to transitioning beyond the LPN role and towards the more complex role of RN. In this project, students created opportunities to talk about what they were learning and how it applied to practice by discussing course material with colleagues at work and by seeking out workplace mentors. Some students found their supervisors were a valuable resource.

“What helped me bring book smarts [theory] to life − mentors-leaders in [my] department. I’ve got a couple of mentors that are RN’s who really encourage me and support me in that role of transitioning, you know, verbally, and saying that they would like to see me take on that role. Mostly the mentorship, you know.”
“My manager has been really supportive. Sometimes she even read over my papers. She went back to school to do her masters so she knows what the profs want.”
“My boss helped me look for information and also guided me through some of the more theoretical work.”

Other students turned to co-workers.

“Co-workers at my current job were supporting and encouraging me to continue. Even though it’s difficult, you need to complete. You need to go through. And eventually after awhile, the support that you have there, the people encouraging you to do it − helps.”
“I had the chance to work with a very qualified RN that I learned a lot from. Talking to her made some things more clear than just reading them.”
“I think about some [RN co-workers] like role models, I want to be where they are, so I can mentor other LPN’s. The encouragement when somebody else says that you can do it, you can do it.”

One participant felt her colleagues believed in the value of her assignments and reading when “they would say e take this opportunity e get your homework done. Let me look after a couple of your patients.”

Theme two: personal learning goals sustained their motivation

Participants consistently expressed the same individual goals during the three year data collection period. Each student had personal reasons for undertaking their university education and they reiterated these goals during the research interviews. Five participants discussed how they had “always wanted to be an RN,” but explained that difficulties completing RN programs, life events such as relationships, children/family commitments and financial issues “got in the way.” One participant chose to become an RN by attending a vocational program, “practicing the one year needed for this program” and then enrolling immediately. Three participants earned university degrees in other countries and always intended to undertake university studies in Canada. The remaining participant had also always planned to attend university for “career advancement, I wanted to improve my own knowledge and go further.” While all of the participants commented on the financial gains associated with transitioning from LPN to BN, they also all emphasized time and again that this was not their primary motivation. Rather, they were continuing their education to fulfill personal learning goals.

These individual personal learning goals sustained students during times when they felt their motivation waning. Isolation was a barrier they frequently commented on.

“I find [the pre-clinical asynchronous courses] very hard. I felt disconnected from [the program], from camaraderie with other people that are going through and struggling, who are having outside life interfere with school life.”
“When I failed an exam, I felt like nobody really cared whether I passed it or didn’t pass it. I didn’t feel that personal connection where you’re seeing somebody everyday in a classroom, they get to know you as a person. I felt like I was just a number.” “When I was inactive for a year and a half, no one even called or sent me an e-mail.”

Family and workplace demands left some participants with little time to take advantage of opportunities the program offered for establishing connections among classmates and teachers.

“I don’t use the communication part much. I don’t communicate with my tutor. I don’t go on the chat sites or the discussion boards. If I don’t have to do it, I0 d rather not talk to anybody. I don’t have time. I try to do the minimum amount of work that I have to do to be able to pass the courses. I know I’m not taking full advantage of the course work.”
“I missed the socialization. But, there were times when I’m like − I just don’t care. I don’t want to make friends. I’m here to work. I’m here to get this job done − just leave me be.”
“There were days when I missed having interactions. There was help but we have to do things by ourselves.”

In the absence of motivational support from fellow students, participants drew strength from the personal goals that led them to university.

“I have a clear goal. Whatever mountains are in my way, whatever clogs in my wheel, I know they are temporary − I want to get this done.”
“This is my degree, my goal − I want this.”
“I will finish to prove to my son that I can do it, even if I am older, so he can do it too.”
“I look to my goal; I’m trying to achieve something better.”

Theme three: time management strategies included terminating full time employment

Balancing full time employment with required attendance at practicums that extended from two through to ten weeks and taking needed time for completing assignments presented a particularly difficult challenge. Employers may not grant educational leave to LPN’s. In one participant’s words: “I can get leave for stress, I can get leave to get married or have a baby − but I can’t get leave for education.” While many individuals who students worked with were an invaluable source of help, workplace policies and agency requirements often prohibited staff absences. Five of the ten participants in the present study were unable to acquire leaves and chose to terminate their full time employment in order to continue their program.

Loss of full time employment was a significant sacrifice.

“Leaving my job and selling my home so I could get my last year done was one of the scariest things I’ve ever done.”
“I was kind of forced to leave my position. The employer was very happy with my performance, but for the comfort of the bosses, they wanted me in the building all the time. So they didn’t approve the one month off for my practicum. I left. There are a lot of jobs, school has to be finished first.”
“I was working full time and then I switched to part time, and then eventually I had to go to casual because I wanted to complete the courses.”
“My barrier was my employer not giving me the time off, making me choose between keeping my job or giving up my line.”
“I had to stop working; I just figured I couldn’t combine my children, my home, and my schooling. My husband’s salary is enough to keep the home going so we decided I should just stop at that point, because it was becoming too stressful for me. The last two years of my program have been so critical for me.”

Relinquishing employment to continue her education was not an option for one participant and as a consequence, she was not active in her program for nearly two years.

“I found the biggest challenge was financial. Especially when I completed some of the practicum courses, it required me to be away from work and I needed my full time income. And also my husband was laid off you know, during this economy, and so I had to go back to work full time then. I couldn’t continue keeping up with my studies.”

Of the five participants who terminated their full time employment, three graduated during the data collection period and one expected to graduate the following term. None of the participants who graduated remained in the workplaces they were employed in as LPN’s. One of the graduates remained with the same employer but changed departments. Clearly, maintaining full time employment while continuing their nursing education through an online university was a barrier for LPN’s. In this very small sample, half of the study participants identified that terminating their full time employment was the only viable strategy available to them.

Discussion

The aforementioned three themes, developed from interviews with Post LPN to BN students at the beginning, middle and end of their program, begin to illustrate how this group of adult learners are overcoming the barriers they face. Listening attentively as students discussed their experiences revealed useful ways of looking at the issues of how asynchronous, self paced courses may limit opportunities to discuss the application of theory to practice; how online learning can incite feelings of isolation among students; and how combining full time employment and university studies can put some adult learners in the position of having to terminate one or the other.

Some of the barriers that this group of students described are consistent with those experienced by other LPN’s who attended university to continue their education. Porter-Wenzlaff and Froman (2008) also noted how Licensed Vocational Nurses (LVN) to BSN students can be challenged by disadvantaged academic backgrounds and life responsibilities. Similarly, Rapley et al. (2006) described how some EN to BN students also felt isolated and chose not to use the online tools that were available for communicating with fellow students. Further, the difficulties students experienced when they requested work release to study or attend practicums have been documented consistently (Dowswell et al., 1998; Kenny and Duckett, 2005; Rapley et al., 2006).

However, some of the challenges that this group of vocationally prepared nurses faced when they completed a university degree are unique. Undergraduate academic skills, such as reading professional literature and writing papers may be underdeveloped. Time management skills were carefully balanced to target priorities and eliminate course activities not directly identified with earning marks. So, optional conversations among classmates and teachers in pre-clinical and elective courses may be minimal. Therefore, supplemental opportunities for students to talk about how theory can be applied and viewed as relevant to actual workplace practice are needed. Motivation can be impacted by relentless family and workplace demands, living through previous efforts to complete an RN program and battling lack of recognition for an out of country degree. Feelings of isolation and abandonment can occur when university programs, unlike vocational programs, may seem ‘not to care’ when students fail or leave. Here, integrating opportunities to create and re-visit students’ own personal learning goals into different courses and at different times throughout the program are needed to sustain motivation. And, perhaps most important of all, this group of nurses had considerably less employment flexibility than full time university students. As a result, this restriction must been taken into consideration when scheduling practicums.

The present investigation suggests expanding our ideas about facilitating learning with online Post LPN to BN students to include acknowledging the barriers they face and the strategies they may already be engaged in to overcome them. In turn, this acknowledgment can guide us toward a deeper understanding of how best to support this new group of learners and to create meaningful and relevant learning activities in their courses and programs. Knowing that their workplace can be expected to provide Post LPN to BN students with access to RN’s, assignments can be created that require inclusion of interview comments from these colleagues. Thus, although online interaction may not be occurring with classmates and teachers, students could demonstrate aspects of their application of theoretical course content by submitting a record of their workplace conversations. Further, knowing that reflecting on the individual personal goals that led them to university can help Post LPN to BN students sustain their motivation throughout their program, course objectives can expect learners to maintain an ongoing Learning Plan that articulates these personal goals as well as course specific goals. Despite feeling unable to take advantage of optional course activities designed to reduce isolation and sustain motivation, students can find that much needed motivation internally. Finally, knowing that some students must terminate full time employment in order to complete their studies, program schedules must recognize the restrictions that LPN employers impose.

Conclusions

This article presented findings from a longitudinal study that explored online Post LPN to BN students’ transitional experiences during their university education. The research investigated barriers that this group of non-traditional learners faced and the strategies they implemented to overcome these barriers. In contrast to other studies that identified the experiences of LPN’s and EN’s when they continue their education in nursing, this project extends our knowledge of how learners themselves are coping with the challenges they encounter. The research found that students turned to workplace mentors for help applying their learning, that they reflected on personal learning goals to sustain their motivation and that they could even terminate their full time employment as a time management strategy. Implications for teaching include creating assignments that require workplace interaction with RN’s or other university educated professionals, course objectives that expect articulation of personal goals and schedules that accommodate employment. The article calls for the creation of more opportunities to understand the barriers these students face and continued attention to constructing teaching approaches that support and encourage students’ own solutions.

References

Allan, I., McLafferty, I., 2001. The perceived benefits of the enrolled nurse conversion course on professional and academic advancement. Nurse Education Today 21 (2), 118-126.

Brown, K., 2005. A Case Study of the First Year of a New Online RN from LPN Program: Evaluation of Program and Student Outcomes. Unpublished PhD Dissertation. Central Michigan University, Mount Pleasant, Michigan, USA.

Canadian Institute for Health Information CIHI, 2006. Workforce trends of Licensed Practical Nurses in Canada, 2005 Author, Ottawa Canada.

Claywell, L., 2003. The Lived Experience of Licensed Practical Nurse (LPN) to Registered Nurse (RN) Transition. Unpublished PhD Dissertation. University of Missouri, Saint Louis, Missouri, USA.

Claywell, L., 2008. LPN to RN transitions, 4th ed. Mosby, St Louis.

Dearnley, C., 2006. Knowing nursing and finding professional voice: a study of enrolled nurses converting to first level registration. Nurse Education Today 26 (3), 209-217.

Denzin, N.K., Lincoln, Y.S., 1994. Handbook of qualitative research. Sage, Thousand Oaks.

Dowswell, T., Hewison, J., Millar, B., 1998. Enrolled nurse conversion: trapped into training. Journal of Advanced Nursing 28 (3), 540-547.

Fransella, F. (Ed.), 2005. The essential practitioner’s handbook of personal construct psychology. Wiley, Chichester.

Harrington, N., Terry, C., 2009. LPN to RN transitions: achieving success in your new role, 3rd ed. Lippincott Williams & Wilkins, Philadelphia.

Kearney-Nunnery, R., 2009. Making the transition from LPN to RN Philidelphia, Davis.

Kelly, G., 1955/1991. The psychology of personal constructs, Vols. 1 & 2. Reprinted by Routledge, London, Norton, New York. 1991 version used for citation purposes.

Kenny, A.J., Duckett, S., 2005. An online study of Australian enrolled nurse conversion. Journal of Advanced Nursing 49 (4), 423-431.

Kilstof, K., Rochester, S., 2004. Hitting the ground running: transitional experiences of graduates previously trained as enrolled nurses. Australian Journal of Advanced Nursing 22 (1), 13-17.

Lincoln, Y.S., Guba, E.G., 1985. Naturalistic inquiry. Sage, Thousand Oaks.

Loiselle, C., Profetto-McGrath, J., Polit, D., Beck, C., 2007. Canadian essentials of nursing research, 2nd ed. Lippincott, Toronto.

Melrose, S., Gordon, K., 2008. Online Post LPN to BN students’ views of transitioning to a new nursing role. International Journal of Nursing Education Scholarship 5 (1), 14.

Milligan, M., 2007. Enrolled Nurses’ Experiences of Conversion to First Level.
Unpublished PhD Dissertation. University of Stirling, Stirling, Scotland.

Porter-Wenzlaff, L., Froman, R., 2008. Responding to increasing RN demand: diversity and retention trends through an accelerated LVN-to-BSN curriculum. Journal of Nursing Education 47 (5), 231e234.

Ramsey, P., Merriman, C., Blowers, S., Grooms, J., Sullivan, K., 2004. Community partnerships for LPN to BSN career mobility project. Nurse Educator 29 (1), 31-35.

Rapley, P., Nathan, P., Davidson, L., 2006. EN to RN: the transition experience preand post-graduation. The International Electronic Journal of Rural and Remote Health Research, Education and Policy 6 (1), 1-13.

Schultz, P., 1992. The Lived Experience of Licensed Practical Nurses Enrolled in an Upgrade Degree Nursing Program. Unpublished EdD Dissertation. Peabody College for Teachers of Vanderbilt University. Nashville, Tennessee, USA.

Speziale, H., Carpenter, D., 2007. Qualitative research in nursing: advancing the humanistic imperative, 4th ed. Lippincott, Williams & Wilkins, Philadelphia.

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