Abstract
The expansion of RN-to-BSN (registered nurse to Bachelor of Science in Nursing) education is addressing the need for nursing workforce development. However, little is known about what RNs expect from their RN-to-BSN education experience. Lack of understanding of student expectations could lead to student-perceived gaps in service quality. The aim of this study was to explore students’ expectations of the RN-to-BSN program compared with the faculty’s perceptions of what students expect. A descriptive qualitative research study using structured interviews was conducted at a school of nursing in the Midwest region of the United States. Student and faculty reports revealed the common themes of workload, flexibility, coursework, and support. Congruencies were noted in the areas of workload and coursework, and differences were identified in the areas of flexibility and support. Conducting a gap analysis can be a worthwhile endeavor for educators seeking to understand the needs of their student population. Acknowledging RN-to-BSN student expectations and addressing gaps between their expectations and reality early in the program could improve student perceptions of program quality.
Introduction
To promote workforce development, many nursing leaders encourage nurses to pursue higher levels of education. Evidence from a significant body of research links better patient outcomes to nurses having baccalaureate and higher degree preparation (Aiken, Clarke, Sloane, Lake, & Cheney, 2008; Blegen, Goode, Park, Vaughn, & Spetz, 2013; Friese, Lake, Aiken, Silber, & Sochalski, 2008; Kutney-Lee, Sloane, & Aiken, 2013). In the United States of America, most health-care organizations now encourage nurses who hold an Associate Degree of Nursing (ADN) to obtain a Bachelor of Science in Nursing (BSN), and most hospitals now require new hires to have a BSN (American Association of Colleges of Nursing [AACN], 2016). The additional coursework in baccalaureate education—in the physical and social sciences, nursing research, community health, nursing leadership and management, and the humanities—provides a solid foundation for nurses caring for today’s patient population. In 2010, the Institute of Medicine (2011) published a landmark report in the United States calling for increasing the number of baccalaureate-prepared nurses to 80% of the nursing workforce by 2020. At present, only 56% of the nation’s nurses hold degrees at the baccalaureate or higher level (AACN, 2019 b).
In response to the need for more BSN-prepared registered nurses (RNs), there has been a proliferation of online RN-to-BSN programs to facilitate ADN nurses’ obtainment of a BSN degree. Of the 777 RN-to-BSN programs in the United States, more than 600 offer programs that are at least partially online (AACN, 2019a). The RN-to-BSN student is a unique student with complex needs. Compared with traditional BSN students, RN-to-BSN students generally are older, going to school part time, working full time as a nurse, and juggling family responsibilities (Robertson, Canary, Orr, Herbart, & Rutledge, 2010). Time constraints related to family and work obligations have been identified as the principal reason for RNs’ inability to complete a baccalaureate program (Robertson et al., 2010). In addition, many RNs return to school due to employer expectations rather than internal motivation. However, Duffy et al. (2014) found that funding or financial support by employers via tuition benefits, monetary compensation, or bonuses for BSN completion are incentives for nurses to return to school. They further assert that the value of obtaining a BSN can be articulated by some nurses who express they have gained an increase in critical thinking skills, appreciation for research and evidence-based practice, increased autonomy, better patient outcomes, and a feeling of personal achievement. While common characteristics of RN students are described in the literature, less is known about what they expect of an RN-to-BSN program. Understanding the needs and expectations of RN-to-BSN students and particularly any differences between student expectations of a program and faculty perceptions regarding what students expect are needed to assist in developing effective strategies for program completion and satisfaction.
Literature Review
Ensuring quality education and student satisfaction with their choice of distance learning programs are of importance to educators and administrators today. Service quality is an essential dimension in the field of higher education and as educational institutions strive to remain viable, a student as customer approach assists in meeting the needs of students in this ever-changing environment (Latif, Latif, Farooq Sahibzzada, & Ullah, 2017).
Previous research has found that student-perceived service quality influences student satisfaction (Silva, de Morales, Makiya, & Cesar, 2017). The GAP Model of Service Quality is a model that has been widely used to study service quality in a broad range of service sectors including retail, health care, and higher education (Parasuraman, Zeithaml, & Berry, 1985). This model uses customers’ values, preferences, and needs to define quality. Within the model, there are five major satisfaction gaps that an organization may need to address when attempting to improve the service quality. Parasuraman et al. (1985) viewed quality as a comparison between customer expectations and actual service performance and posit that customer expectations of service are influenced by personal needs, past experiences, and word-of-mouth communications. When the actual experiences of customers meet or exceed their expectations, the service is viewed as quality service (Parasuraman et al., 1985). Identification of gaps is important because once identified, corrective action and process improvement can take place (Foster, 2017).
When assessing service quality through the eyes of the student, it is important to note that students assess the overall quality by comparing the service they received with the service they expected. Thus, a nursing program can achieve a strong reputation for quality service when it consistently meets student expectations (Berry, Zeithaml, & Parasuraman, 1990). A previous study of RN-to-BSN student expectations found that students reported the highest expectations in the areas of E-learning quality (quality and clarity of instruction as well as website feature functionality) and assurance (faculty’s knowledge, courtesy, and ability to convey trust and confidence; Dabney, Linton, Duncan, & Koonmen, 2019). It stands to reason that poor student satisfaction stemming from unrealistic student expectations can be a contributor to attrition from nursing programs. Therefore, becoming aware of student expectations, including unrealistic expectations, is of importance.
Gap 1 of the GAP Model of Service Quality was chosen for this study because it specifically addresses the evaluation of student expectations compared with faculty perceptions of what students expect. Four other gaps are identified in the model but were deemed to be outside the scope of this study. Gap 1 proposes that when there is a discrepancy between customer expectations and service provider ideas or perceptions of what customers expect, there is an impact on the consumer’s evaluation of service quality (Parasuraman et al., 1985). This is because the incorrect understanding of customer desires is then translated into the service quality specifications, external communications to customers, and the delivery of service (Foster, 2017). Applied to academia, a gap between the true expectations of students and what faculty perceive students expect from their education program can have a detrimental effect on students’ perceptions of the overall quality of their educational experience (Jackson, Helms, & Ahmadi, 2011; Parasuraman et al., 1985). For the purposes of this study, the model has been modified to address the RN-to-BSN student population (see Figure 1).
Gaps in service quality.
A review of the literature using MEDLINE, CINAHL, and PubMed did not reveal prior research examining gaps between RN-to-BSN student expectations of baccalaureate education and faculty perceptions of student expectations. The aim of this study was to explore students’ expectations of the RN-to-BSN program compared with the faculty’s perceptions of what students expect.
Methods
Design and Research Questions
A qualitative research design employing content analysis was chosen for this study. The research questions explored were as follows:
How do students describe their expectations of the RN-to-BSN program? What are faculty perceptions of student expectations of the RN-to-BSN program? What similarities and differences exist between student expectations of the RN-to-BSN program and faculty perceptions of what students expect?
Sample
This study was conducted at a School of Nursing located in the Midwest region of the United States. The sample for this study consisted of RN-to-BSN students and faculty. Current students who had completed at least one core program course (N = 385) and faculty who taught in the RN-to-BSN program for 2 or more years (N = 15) were eligible to participate. Inactive students, faculty with less than 2 years of teaching in the RN-to-BSN program, and faculty conducting this study were excluded. Recruitment e-mails were sent to eligible students and faculty inviting them to participate in a telephone interview. Although face-to-face qualitative interviews are generally considered better quality, telephone interviews were selected for our study in order to be inclusive of our geographically dispersed population of online students (Drabble, Trocki, Salecdo, Walker, & Krocha, 2016). All e-mails were sent to university e-mail addresses. Of the 50 initial e-mail responses, 15 students and 5 faculty completed interviews. Initial e-mail responders not completing interviews were all students who did not schedule a time with the interviewer.
Institutional Review Board
University institutional review board approval was obtained prior to data collection. Participants were consented and students instructed that participation was voluntary and would not have an effect on student evaluations. The interviews were conducted by graduate research assistants who did not record participant identifiers.
Data Analysis
A directed qualitative content analysis approach was applied to data collection and analysis (Hsieh & Shannon, 2005). Using the Gap Model of Service Quality, the researchers began by identifying key concepts as initial coding categories. Next, operational definitions of the categories were determined using the model. Semistructured phone interviews were then used for data generation. Open-ended questions were asked followed by targeted questions about the predetermined categories. Students were asked: What educational experiences do you think an RN-to-BSN program should provide? And what did you expect this experience to be like? Faculty were asked: What do you think your RN-to-BSN students expect from their educational program? and What do you think RN-to-BSN students expect from you? Additional questions were asked based on the responses until no new information was gained. The duration of the phone interviews ranged from 20 to 40 minutes.
Following independent descriptive coding of the interview transcripts by three researchers and a discussion of meanings, relevant data were grouped together so that patterns and contradictions could be seen easily. Codes were redefined as needed, and codes with similar meanings were grouped during a series of data analysis meetings attended by all researchers. Text that was not categorized within the initial coding scheme was given a new code (Hsieh & Shannon, 2005). Major themes were derived from the data and identified by categorical aggregation. Student data and faculty data were initially analyzed separately and then comparisons were sought. To maintain trustworthiness, the authors discussed the interview text, codes, and themes continuously throughout the interpretation process.
Findings
Sample Characteristics
The sample included 15 students and 5 faculty. Most of the students were female (93%), Caucasian (80%), and between the ages of 36 to 45 years (47%). The majority were part-time students (73%). Most students were seniors in the final one to two semesters of their RN-to-BSN program (87%). All faculty were female and Caucasian with 60% aged 46 or older.
Research Question Results
Four common themes emerged from the analysis of student and faculty interview data: workload, flexibility, coursework, and support. Congruencies were noted in the areas of workload and coursework, whereas differences were identified in the areas of flexibility and support. The following sections include theme descriptions with selected illustrative student and faculty quotes.
Workload
For students, the concepts of stress, busyness, and difficulty were found within the workload theme. Most students felt that their online learning experience should be less difficult or equal in difficulty to their ADN programs. Several students referred to their ADN program as nursing school and tended to view the RN-to-BSN program as an addition to nursing school. Following are a collection of typical student quotes regarding the program’s workload: I expected it to be easier than it actually is. It should be one that we as nurses can look forward to and we can pass on the word that, “Oh it’s not as stressful as going to nursing school” (ADN program), but I feel it is just as stressful … We already are nurses, we just need that extra education, that extra/to … guide us along in our practice and making sure that we have … evidence-based practice. (S3) I actually expected it to be a lot like nursing school, it wasn’t. It was a lot busier. I understand the theories behind nursing care and diagnoses now, so I feel it was mostly beneficial. (S5) I did expect it to be doable, I didn’t expect it to be very hard. (S7) I think they expect less work than what I actually give them. I think that students think that the online classes will be easier and then they are frustrated when they are not … we get a lot of students who have been out of their ADN programs for a very long time and have never taken any online classes, and then we put them into a program with online class that requires a lot of work and hours, and it’s an unwelcomed surprise. (F4) Sometimes they expect that the program, because it is mostly online … will be easy. Also, they may think the program is going to be easy because they are already a nurse. (F1)
Flexibility
Many students expressed appreciating the flexibility provided by online courses. With students’ busy schedules, the online option provides the flexibility they need to be able to go back to school. One student stated, “I’m doing everything online. I think you get a better degree of flexibility by doing it that way than by actually going to a school and following a set program schedule” (S7). Although most students viewed the availability of completely online instruction as a benefit, some expected a variety of course delivery options: online, mix-mode, or face-to-face classroom instruction. Two students stated, “I think more long-distance classes should be offered at the satellite campus” (S14), and “I think the option to take courses on campus should be available and made known to students who prefer the classroom setting” (S15).
Faculty recognized students’ need for flexible course delivery to fit their complex lives. One faculty reported: I think that they want to get their stuff done, on their schedule. Meaning, really so many of them are working full-time, have families, they want to fit it in when they can fit it in, and they want to be able to get their questions answered so they can do their work when they can get it done. (F5)
Coursework
Students expected to have content that expanded their knowledge in leadership, community health, research, current issues or trends, and nursing theory. They expected their education to meet BSN essentials while incorporating general education courses. Following are a selection of representative student quotes about the coursework: This kind of gets into what is the difference between what an RN and a BSN is. I know that technically … community health nursing and management courses are essentially the big differences. But I think rounding out an education to include community health is very important … I also think that legal [and] ethical aspects of nursing, and I like that the nursing trends and research, too. If you want to do anything advanced, you certainly have to know how to use a database, and do APA formatting, and scientific research. (S9) I expected to learn something different than what I learned in ADN training … more leadership and nursing theory … I received what I expected from this program. (S10) I expected to have to take some general education courses and nursing theory/leadership as well. (S11) I feel that the only experience that should be provided is the course/classwork needed to fulfill the BSN essentials and theories. (S4) Well, most of them just really expect to get that degree after their name, that’s what they are really after. If there are some bonus things, they are really happy, too. I think they realize that being a leader is a major role, no matter what actual position they are in—that leadership is what nursing is all about. (F3) I think most students are just getting their bachelors to get their bachelors. I hope that students leave the program appreciative of going through the steps in realizing that something in them has changed because of the BSN. (F4)
Support
The data set showed that students expected to receive support from faculty. From helping them navigate American Psychological Association (APA) formatting to assisting them in tracking their courses, students expect faculty to be available and willing to assist them. Three students stated, “I am supposed to have support” (S1), “I expected a tracked program, [with] more guidance” (S2), and “I expected an organized curriculum, with support and resources available for students” (S15).
While faculty recognized that students expected support, they reported that some had unrealistic expectations of their availability. Following are a selection of representative faculty quotes about support. I think that they expect me to be able to guide them through the semester and through the assignments, and I sometimes think that they expect me to be online 24 hours a day. (F1) I think they just want what most students want … to be taught the material and then if they don’t understand it, they want to be able to ask somebody some questions so they do understand it. On occasion, I might run into students … expecting me to answer them right away. (F5) Particularly when grading assignments, they think that we should be doing them at some super-human speed, and that since the online course is always available, that I should also always be available, and I wish I was always available, but I’m not. (F4)
Discussion
This study was a preliminary investigation of similarities and differences between RN-to-BSN student expectations of baccalaureate education and faculty perceptions of student expectations using qualitative methodology. Faculty perceptions of student workload expectations were accurate. Faculty recognized that students often expect the online environment to be easier than it is. In addition, because these students are already RNs, they often expect the coursework to be no more difficult than their previous associate degree nursing program. This is likely because their prior program experiences were perceived as quite difficult. The provision of clear workload expectations upon program entrance could help to dispel any unrealistic student expectations that may lead to decreased student satisfaction.
Faculty also correctly perceived that students value the flexibility of online education due to their busy schedules. However, with regard to the theme of flexibility, faculty did not mention that some students desire to have the option of mixed-mode or on-campus courses. Metasynthesis of RN-to-BSN student experiences of returning to school found that some students would rather be in a traditional face-to-face classroom; however, because of other obligations including family and work, they chose an online venue (Perfetto, 2015). Previous research has proposed the provision of both classroom and online education options as supportive of BSN completion (Duffy et al., 2014). Determining which courses might benefit from a multimodal delivery format and projecting the number of students who would choose this structure would require detailed evaluation as well as fiscal analysis. Student input in the decision-making process should be sought for optimal outcomes.
Both students and faculty spoke about the expectation of students taking leadership and community health courses especially in the RN-to-BSN program. Student expectations varied in that some felt the program should provide only what is needed to fulfill BSN degree requirements, while others expected to obtain advanced knowledge in leadership and community health, nursing theory, and research. Faculty also acknowledged that, while some students are interested only in obtaining their degrees, others wanted to expand their knowledge in specific areas.
Although faculty acknowledged that students require their support, they perceived that students often had an unrealistic expectation of their availability. Faculty believed that responding to student questions and providing grading feedback take more time than students realize. These findings are similar to previous research, using a modified SERVQUAL survey tool to measure customer perceived service quality gaps, indicating that students perceive the highest gap in service in the area of responsiveness—faculty’s willingness to help students and provide prompt service (Dabney et al., 2019). Previous research has found that faculty who lack time and space boundaries with students can experience problems. Students may believe that faculty teaching online courses can work anywhere at any time, a perception that could result in them having unreasonable expectations of their instructors (Wingo, Peters, Ivankova, & Gurley, 2016).
Strengths and Limitations
A strength of this study is the provision of both student and faculty perspectives. This approach provides more insight than student interviews alone by drawing attention to areas of congruence and discrepancies. One limitation of the study is the small sample size (n = 15) students and (n = 5) faculty. However, data saturation was obtained with the repetition of similar reports. In addition, the demographics of the sample were similar (within 5% points) to those of our student and faculty populations. A further limitation is the retrospective reporting requiring students to recall their initial expectations of the program. Further study would benefit from interviewing students upon admission to the RN-to-BSN program.
Implication for Practice
Understanding student expectations of their educational experience can benefit both the instructor and the student and create an optimal learning environment. It is essential for faculty members to address student expectations by setting clear boundaries about when they will be available and how long it will take them to provide feedback (Wingo et al., 2016). It is also recommended that faculty monitor their availability and responsiveness to ensure that they are in accordance with what they have communicated to students.
Interventions such as an orientation program may prove to be beneficial in managing expectations (Gilmore & Lyons, 2012). In addition, peer mentorship programs could be designed and tested to determine whether they have the potential to allow experienced students to mentor incoming students in communication, workload expectations, time management, and planning strategies.
Conclusion
Analysis revealed that gaps do exist. Knowledge obtained from this type of exploration will help educators develop awareness and sensitivity to discrepancies. Such analysis should be conducted in various regions to explore the unique expectations of nurses in that locality. If gaps exist between expectations and reality, it may be necessary to address these gaps early in the program using a student-centered approach. RN-to-BSN students become frustrated with faculty who fail to acknowledge the needs of adult learners but are appreciative of faculty demonstrations of flexibility and respect (Perfetto, 2015). We found that response time is a potential issue. Further research is needed regarding the contributors to student expectations of RN-to-BSN education stemming from word-of-mouth communications, personal needs, and past experiences. Research related to faculty awareness of and responses to student expectations also is needed. Venues for communication of student expectations, faculty awareness of these expectations, dialogue on realities and planning, and implementation of strategies to close gaps could increase students’ overall perceptions of program quality.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
