Many institutions of higher learning engage in numerous quality assessment activities designed to demonstrate their educational offerings to meet or exceed outcome expectations. Traditional measures of academic quality include graduation rates, NCLEX-RN pass rates, employment after graduation and graduate program evaluation surveys. Student’s perception of the quality of the educational experience should be included in the comprehensive evaluation of an educational program (Chen & Lo, 2012). The researchers for this study are curious to investigate the impact of a recent complete program curriculum change to the graduates’ perception of their nursing education and the subsequent transition to practice.
Current nursing literature supports evaluation of nursing education for a variety of reasons such as investigation of the relationship of nursing education to job satisfaction and subsequent effect to nurse turnover rates. Also, various studies reveal the most stressful and challenging time for the new nurse is within the first few months of practice when they are transitioning from the student role into the nursing role (Andrews, 2013: Thomas et al., 2012: Zinsmeister & Schaefer, 2009). Median turnover rates for graduate nurses during their first year of employment in the U.S. ranges from 55% to 61% (Casey et al., 2004). With the millennial generation defined as a those being born in the years 1981 to 1996, millennial's are the largest generation in the world today. The millennial generation surpasses the baby boomer generation by three million. This gap will continue to increase, and by 2030 millennial's will outnumber the baby boomer generation by 22 million. Today, as the millennial's are entering nursing education programs and the workforce, the need for educators and employers to study and understand how the millennial generation functions is significant in order to understand and possibly impact their transition to the workplace (Shatto et al., 2016). Additional studies include the belief that improvements in the work preparation by nursing education programs has been supported in the literature as a related factor for new graduate job satisfaction (Kenny et al., 2016). Thus, it is critical for both educators and employers to understand how the millennial generation functions to impact their transition to practice. Background and Significance: The Donabedian conceptual framework (1966) introducing the concepts of structure, process and outcome will be used as a framework to the study. Donabedian's seminal work on evaluating the quality by looking at constructs was applied. The construct of structure represents the characteristics of the setting (school), processes are the student activities created by the faculty for the purpose of education and outcomes validate the effectiveness of the curriculum/educational activities. The concepts of structure, process and outcome are inter-related. Strong structures lead to strong processes, while strong processes lead to strong student outcomes (Donabedian, 1988). For this study, the third concept, outcome, will be assessed. The study will incorporate the Nursing Student Satisfaction Scale (NSSS) created by Dr. Hsiu-Chin Chen and her research team (Chen & Lo, 2012). The survey instrument was developed after Chen (2012) found a review of the literature revealed some educational outcome instruments were outdated while others did not reflect the complexities involved in nursing student satisfaction. The NSSS was developed after a review of the models and theories of program evaluation and student satisfaction focusing on curriculum, faculty, social interaction, and the learning environment (CFSE) to describe the critical factors in nursing student satisfaction. Student satisfaction is seen as a dynamic process involving the student-faculty and teaching/learning environment with satisfaction proposed to be directly affected by the content and structure of the curriculum, faculty teaching strategies, social interaction among students and faculty, and the learning environment (Chen & Lo, 2012). The goal for a comprehensive assessment tool was realized through the development of a 47 item questionnaire based on the CFSE model. Content validity was achieved through expert panel evaluation for conceptual clarity, appropriateness of the nursing program and relevance with the final version of the NSSS containing a 30 item scale of overall student satisfaction evaluation items (Chen & Lo, 2012).
Methods:
The study will have a descriptive, correlational design utilizing the NSSS standardized, assessment tool created by Chin and Lo (2012). Permission for use of the tool has been granted by the authors. A recent three year process of curriculum re-design was completed in 2015 with the new curriculum implemented in Fall, 2015 at a local nursing program. Prior to the curriculum re-design, the school was in excellent shape with steady leadership, qualified faculty, and strong institutional support with an impressive outcome of > 93-95% pass rate on the NCLEX-RN exam reflecting a powerful educational experience for the students. Obviously, some things were going very well as the school enjoyed a phenomenal reputation and consistently high application rates each application session. However, the school leadership felt the antiquated, mammoth, curriculum design was in need of an updated shift to a modified, concept based curriculum to decrease redundancy and replication, and move the curriculum to a timely and applicable program-wide curriculum with pertinent content for each module. Since the inception of the new curriculum, the NCLEX-RN scores have improved even more with four consecutive classes reporting a 100% NCLEX-RN pass rate. However, no post curriculum re-design comprehensive evaluation studies have been conducted. The study will use the three section survey tool (NSSS) with a fourth researcher created survey section addressing demographics, descriptive participant content with specific assessment of graduate nurse evaluation of program satisfaction, and possible influence to decision making for higher educational goals.
Data collection will occur in the spring of 2019 with data analysis, results and conclusions to be ready and reported at the STTI Research Congress, Summer, 2019. The convenience sample will be composed of graduates grouped into the six most recent graduating classes of the program, all of which experienced the new curriculum design. Participants will remain anonymous and be grouped by cohort group for statistical comparison possibilities. A letter of consent will be emailed to the graduate explaining the study and requesting the graduate to participate. Once consent is obtained, the surveys will be made available to the participant. Graduate personal email addresses will be collected from the school past records. The survey program Survey Monkey will be utilized for creation of the assessment tool. The assessment tool will include the Dr. Chen permission approved three factor sections of the NSSS with a fourth researcher created section containing graduate demographics, cumulative GPA, work setting, number of jobs held since graduation, and graduate perception of satisfaction of RN program followed by the decision making employed related to attaining further education and program type. Institutional Review Board (IRB) approval will be sought from the schools’ governing institution. The researchers have particular interest to the responses of the millennial graduates and will utilize date of birth for statistical analysis of millennial responses in relation to other graduates and their nursing school program satisfaction.
Results: The researchers believe the study will yield comprehensive data to provide deeper assessment of the impact of the new curriculum design. The decision for a school of nursing to undertake a complete curricular re-design is complex and many schools simply press the decision to the future particularly when one of the key outcome indicators, the NCLEX-RN pass rate is so strong. These researchers believe, as Dr. Chen believed, there are more comprehensive outcomes to assess when assessing impact of a total program curriculum redesign and looking to provide the highest quality nursing education.
Conclusion:
The support in the literature stating studies of the experiences and job satisfaction of new graduate nurses have identified issues associated with the transition from student to registered nurse (Finkman & Salantera, 2014; Parker et al., 2014; Unruh & Nooney, 2011) and have associated work readiness with job satisfaction and interventions (Walker & Campbell, 2013). The Kenny et al., (2016) study reports an investigation into the degree to which graduates who were dissatisfied with their training and work preparation are also dissatisfied with their first job, and whether this flows on to intentions to leave their first employer and/or the nursing profession. The results of the study will provide additional support and understanding to the impact of nursing education on new nurse transition to the professional nurse role with particular focus on the millennial graduate outcomes.