Implementation of a Unique, Fully Online, Asynchronous LPN to RN BS Program: Successes and Barriers

Online nursing programs are arguably one of the most cutting edge modalities of emerging education. At this time, there are very few distance education programs in the United States that offer a licensed practical nurse (LPN) the opportunity to advance to the baccalaureate level.  With the increased pressures within hospitals to obtain magnet status and the literature indicating that higher education levels of nursing staff result in better patient outcomes, it is more important than ever to offer methods of career advancement for existing LPNs to the registered nurse (RN) to BS echelon.  

Employment settings for LPNs have been shifting away from the hospital setting and physician offices while trending towards nursing care facilities, outpatient care centers, and home health (HRSA, 2013) thus marginalizing these nurses and reducing their ability to have upward, professional mobility. This workforce has seen a 15.5 percent increase through the last decade and is now 690,000 (HRSA, 2013) strong with a projected growth of 20% by 2020 (DPE, 2012), thus further fueling the intent to address the educational progression and related needs of this population. Of this workforce, 24 percent reside in rural areas. Approximately 25.2 percent of these LPNs identify as Black/African Americans, 10.6 percent as Hispanic/Latino, and 5.1 percent as Asian (DPE, 2014). Likewise, males account for 8.5% of this workforce (DPE, 2014).  The LPN has an average age 43.6 years and earns and average salary of $39,360.64 as a full time employee (HRSA, 2013).

Addressing the call from the Institute of Medicine (2011) for 80% RN BS by 2020, the Sullivan Commission’s (2004) call for a greater minority workforce in healthcare and community needs, the program sought to transition LPNs to RN BS program through an asynchronous, fully online, education pipeline that is currently offered in 37 states. Implementation strategies began with face to face traditional programming which later shifted as program needs expanded geographically. Enrollment in into the LPN to RN BS option has experienced steady growth starting with its first graduate in 2004.  Since this time, the program has seen continual increases in enrollment culminating with approximately 45 students per cohort biannually for the past year.

Based on student profile demographics, four T’s have been identified as significant burdens to the LPN in pursuit of a higher education; these include time, travel, tuition, and tradition. Creating time for a rigorous educational process and allowing time away from personal priorities (children, employment) can be an insurmountable obstacle. Travel is also a burden as this factor requires time and also incurs expense. The lower economic level of an LPN creates a significant roadblock to affording tuition for the lengthy process of LPN to RN BS. A final level to these burdens is tradition as this non-traditional, culturally diverse student may possess inherent value systems that may not align to the representative professional value system (Porter-Wenzlaff & Froman, 2008). All of these burdens may not carry equal weight from student to student but, any one of these T’s can be exponentially magnified depending on one’s personal situation. Given these constraints, an extensive, rigorous, education is limited and/or prohibitive. The program recognized the need to manage these burdens and create a process towards the equitable goal of a bachelor’s degree in nursing.

Additional barriers include programmatic constraints.  In order to offer our program in other states, the LPN to RN BS seeks approval from the entity overseeing higher education within a respective state. This approval process can be swift and immediate or long and tedious requiring a lengthy application process. Additionally, some entities request a fee per student. In some instances this can be cost prohibitive.  All potential states also require consent from their board of nursing. Requirements, rules, and provisions for approval from the various boards also differs dramatically making the process cumbersome. These factors, which allowed growth of our program, have also inhibited our reach.

Demographic information should be considered when comparing and reviewing outcomes. With the ever increasing need to diversify the baccalaureate prepared RN workforce, this LPN to BS option provides an opportunity to help achieve this goal.  HRSA (2013) reports that Caucasians make up approximately 80% of the RN workforce whereas LPNs are approximately 63% Caucasian. The ethnic composition of the LPN to BS program described is more ethnically diverse with 97 (45%) of the 218 currently enrolled students self-reporting ethnicity as non-Caucasian. Thus, this high representation of diversity can be identified as a success of the program.

Graduation rates have also remained relatively steady since the program’s inception.  To date,   the graduation rate is approximately 71% with 5% of the students being dismissed for academic issues and 24% leaving the program in good standing for a variety of reasons including financial and family obligations.

Lastly, pass rates on the NCLEX-RN exam are seen as a strength of the current program.  Pass rates of all graduates have remained relatively close to the national average with an overall pass rate of 86% since inception of the program in 2004.