NLN Nursing EDge Unscripted

Scholarship – Facilitators and Inhibitors of LPN-to-RN Student Transition: A Cross-Sectional National Survey

November 03, 2022 Amanda Cornine Season 2 Episode 40
NLN Nursing EDge Unscripted
Scholarship – Facilitators and Inhibitors of LPN-to-RN Student Transition: A Cross-Sectional National Survey
Show Notes Transcript

This episode of the NLN Nursing EDge Unscripted Scholarship track features Amanda Cornine. Learn more about Dr. Cornine's work, "Facilitators and Inhibitors of LPN-to-RN Student Transition: A Cross-Sectional National Survey."

Cornine, Amanda E.; Crawford, Sybil L.; Sullivan-Bolyai, Susan. (2022). Facilitators and Inhibitors of LPN-to-RN Student Transition: A Cross-Sectional National Survey. Nursing Education Perspectives,  10.1097/01.NEP.0000000000001051

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[Music][Music] Welcome to this episode of NLN podcast Nursing EDge Unscripted the Scholarship track.  I'm your host, Dr Steven Palazzo, a member of the NLN editorial board for Nursing Education  Perspectives. Nursing EDge Unscripted and our track entitled Scholarship celebrates the  published work of select nurse educators from the NLN's official journal, Nursing Education  Perspectives and the NLN Nrsing EDge blog. The conversations embrace the author's unique  perspectives on teaching learning innovations and the implications for nursing program development  and enhancement. We will discuss the author's article, "Facilitators and Inhibitors of LPN-to- 

RN Student Transition:

A Cross-sectional National Survey." This discussion will focus on the unique  findings of the author. Our guest speaker today is Dr. Amanda Cornine who is an assistant  professor in the Lillian R. Goodman Department of Nursing Worcester State University, Worcester,  Massachusetts. Good morning. Thank you so much for having me. Well, we're happy to have you here and  we're excited to discuss your article if you could would you please summarize the purpose of your  study and the choice of using Meleis's theory of transition as a framework for your study.  Absolutely, so to start off my co-authors and I really wanted to study LPN to RN students  because LPNs tend to be a little more racially and ethnically diverse than our RN population and so  if we can really focus on bringing more LPNs in to become RNs, we have an opportunity to increase  diversity in in our profession, which is really obviously in line with national calls. We  were also interested in the specific population because we recognize that they can be educated  much more quickly in times of nursing shortage. Sometimes a LPN can skip an entire year of an ADN  nursing program and become an RN in as little as a year, so when we have opportunities or need  for increased numbers of RNs, this is an amazing population to focus on. The purpose of the study  was to describe transition conditions experienced by licensed practical nurses or LPNs who are in  registered nurse or RN educational programs. Transition conditions are those things that help  or hinder someone in whatever transition they're experiencing and in this case it would be  facilitators and inhibitors of the transition from LPN to a student RN. We chose to look at  Meleis as our guiding framework because there were a lot of nice parallels between the LPN to  RN student experience and Meleis's transition theory. We really wanted to know what LPN to RN  students felt helped them or hindered them. So when when we looked at Meleis, we  saw a central part of this transition theory is the transition conditions and those are the  facilitators and inhibitors so it really aligned well with our question and area of interest. It  also is widely used in nursing research including educational research so it really has  been through a lot of evaluation and proven useful in many other applications. We also ultimately  would like to see programs developed to support LPN to RN students that are evidence-based and  we liked that Meleis really showed a link between those facilitators and Inhibitors and knowing how  to intervene with the population of interest, which in this case would be LPN to RN students. We  look at this as a foundation for hopefully developing evidence-based interventions to help  support LPN to RN students and Meleis's theory really, really aligned with that goal as well.  Great well thank you for clarifying that for us. Your study found generally positive attitudes  from LPNs about transitioning to the RN role, but there were concerns regarding faculty  support and transition stressors entering an RN program midway through. Please elaborate on these  findings and what current LPN to RN programs can  tomorrow to facilitate transition for LPN students. So I'll start with faculty support what we really looked at in part of our study was how frequently  did LPN to RN students report experiencing specific facilitators or specific inhibitors. When  we looked at facilitators, the things that helped our students: three out of the four least commonly  reported facilitators were faculty-centered, so these were facilitators that were potentially  helpful for our students but our students weren't finding they were part of their experience as  often as other facilitators. These least commonly reported facilitators were emotional  support from faculty, faculty recognizing prior LPN experience, and academic support from faculty.  What our study really added to the knowledge on this topic was that all of these had been  reported in the literature previously but this was the first study to our knowledge that really  showed that these were particularly uncommon or relatively uncommon in our student experience.  So what can we do to help make those more commonly experienced by LPN to RN students? I think the  first thing is awareness - knowing that these are less commonly reported than other facilitators  helps us target our interventions toward those three areas: academic support, emotional support,  and recognizing prior LPN experience. Certainly, one way we could intervene would be education to  train faculty to provide effective emotional and academic support. Something like a coaching program  to provide those opportunities for interactions for that support to take place. If we never have  the interaction between faculty and students, then we lose those opportunities for the emotional or  academic support to take place. I'd also really like to see faculty who are teaching  in LPN to RN programs show that they value LPN experience through something as simple as during  class asking their students what is your prior experience with this topic and that goes beyond  just our LPN to RN students. If we're teaching a group that has students with a wide  variety of backgrounds it really helps them feel validated and build on their prior experience.  As far as entering midway, what we specifically asked about was sharing classes with non-LPNs  so we don't know for sure that these LPNs who are sharing classes with non-LPNs entered  midway, but we can guess that most of them probably did based on how programs tend to be  designed for LPNs seeking RN education. When LPN to RN students shared classes with other  students who weren't LPNs, they were less likely to report that faculty members recognize their past  LPN experience. They were less likely to report emotional support from their faculty and they were  more likely to report finding it difficult to fit in with classmates. Some of these make sense, right?  Of course it's difficult to fit in with a cohort if that cohort has already been moving along  through a curriculum and then LPN to RN students join that cohort. I don't have national level data  on how often that happens but having looked at the curriculum for many, many of these programs  nationally it seems pretty common oftentimes there are students who start a pre-licensure program  without the LPN and then they are joined at some point by the LPNs. This was reported previously  in the literature as being a difficult place for students to match. So what can we do  tomorrow to fix that? As educators, we need to acknowledge that this difficulty exists  to our students. Welcome our LPNs when they are joining an already  established cohort and provide opportunities for students to get to know each other  even though it may not be the entry point to the program for all students.  Additionally, I think there's any sort of cohesiveness or team building  intervention that can be implemented is a wonderful idea. There certainly could be  more robust evidence-based programs out there but something as easy as finding commonalities  between all students in a class. One thing I do at the beginning of my classes is when I have a new  cohort coming together I have them do a word cloud about why they're here, why do you want to be an RN, and those those common themes come up bigger and remind students that their reasons may be very  similar to their peers. Certainly there can be simple interventions that can  happen tomorrow. Overall, we'd like to see interventions be evidence-based, but because there  isn't a broad evidence-based specific to LPN to RN students, evaluation of any kind of programs or  interventions becomes all the more important. Yeah, I remember...I graduated over 20 years ago  from an ADN program and we had a transition pass pathway for LPNs where they came into I believe  our third quarter of a seven quarter program and we really didn't engage with that  group of maybe six or seven pretty much at all, even in the clinical setting. They kind of  separated themselves into a small clique, which is understandable from what what we learned,  but I think about the lost opportunity there not only for them but for us as students to kind  of share that experience that they've had in their prior knowledge. It wasn't really acknowledged or  brought into the program. I remember some of our instructors would say like they need to  reprogram them or erase their LPN background and would say that kind of out loud and so  you can see where some of the the difficulties lie. Absolutely and in prior literature  some of the interactions between LPNs and non-LPNs in this situation have been reported as  just flat out uncivil or really like a lateral violence kind of situation  and so I think we have room for improvement there and having this national level data to  say that this is a potential problem for our LPN to RN students is that first step. Well, as we know, there's a shortage of RNs and we certainly don't want to discourage  people from moving in that direction, but I'm not aware though - is there also a shortage of LPNs?  That's a great question and I haven't looked at the data on that but I think that  there there must be. I think if RNs are leaving the profession post-Covid or post-acute phase of the pandemic in the way that they are, I can't imagine that LPNs would be immune to that. Yeah, especially in a long-term care setting where a lot of them are employed and the stressors in the last few years specifically in that setting too. Were your findings different for LPN to RN versus LPN to BSN or did you  find any LPN to BSN transition pathways? Great question, so about 20 of  the students who we had responses from were in baccalaureate programs so there  certainly are programs nationally. They're not as common in the baccalaureate level as in the  ADN but they exist and their students responded to our survey too. We didn't find many differences.  The two areas where there were difference were for LPN to RN students in a baccalaureate  degree program, they were more likely to say the distance they had to travel to school made it  hard to do well in school. If you just look at how common those programs are geographically  compared to an ADN program that makes sense. It's more likely that a student may need to travel to  reach a baccalaureate program as opposed to an ADN program so that makes a lot of intuitive sense as well. LPN to RN students in a baccalaureate degree program were also less likely to say they  felt support from their classmates. That wasn't something I was really expecting but some of the  reasons I thought might be behind that are because baccalaureate programs tend to be in  larger institutions oftentimes compared to an ADN program so it's a little harder to stick with the  same cohort. It's more likely that students are interacting with a wider variety of students  during their time at school as opposed to the same core group and so I think that in and of itself  can lead to a lack of support from classmates. But I think that one was a little interesting it  might bear further digging and a transition talking about transition isn't complete  without talking about transition in the clinical space too. How did the nurses actually treat the LPNs versus the non-LPNs in that transition pathway? Yeah that's a great question  and I think that that's something that would be a fantastic follow-up study to really see  and when we're talking about students who are still in school, in clinical, oftentimes,  the nurses don't know if they're an LPN versus not especially if you have a program where the two mix  and so it's interesting there but certainly after graduation and when a graduate is on orientation  that's more likely I think to be recognized that, hey, they're an LPN. I remember in my new graduate  program there was a student who was an LPN and had worked as an LPN but had gone through an RN  program and she really advocated her for herself to say I need to be in this new grad program. I'm  still a new grad RN and she met some pushback against that but ultimately the facility  did recognize that it is a different role and supported her in going into that program. Again, going back to my personal experience, I do remember the LPNs that were in our clinical  rotation many times the nurse that was working with them gave them a pretty wide  platform to perform their duties and also the instructors intentionally or unintentionally  spent less time with them, I'm assuming under the assumption they know how to do many of the  task oriented things, you know, not necessarily in the RN mindset but that when they got busy the  LPNs seemed to be the first that kind of were like left to the side as the instructor spent time with  the students who didn't have the previous background. Yeah, and anecdotally having done  those sorts of clinical rotations with both types of students, I find that certainly needs  may be different between my LPNs and non-LPNs but everyone has a lot of needs and you  mentioned one of the things that the mind space and the critical thinking aspect that is  it oftentimes a big transition for our LPNs coming back to become RNs. So what's the main takeaway you would want the readers to go away with after reading this article? One main takeaway. I think the biggest takeaway is just to be intentional in how we integrate LPN to RN students into  existing cohorts and that particularly rings true to me because of the national level  data that says that this is hard for our LPN to RN students to integrate  with non-LPNs but also because having read wider literature and having taught this population,  I see those difficulties and how hard they can be and so I think that's a good starting point.  I think there's lots of great jumping off points from this study but that in particular,  if we have a student who's feeling excluded or marginalized in their education they're not  prepared to flourish academically, socially, or professionally. Any further comments you have? I don't think so. I really appreciate the opportunity to be on the podcast and to share this work.  Well thank you so much for joining us for this conversation. I really appreciate your time and  expertise in sharing your work and broadening our understanding of this work and how we can  begin to introduce this into our own institutions and really be mindful of this phenomenon, this transition, the different needs of the transition from LPN to RN versus a student who doesn't have any previous healthcare experience going into the RN or BSN  program. To our listeners, if you've not had the opportunity to read about this work, please make  sure you read the article, "Facilitators and Inhibitors of LPN to RN Student Transition:  A Cross-Sectional National Survey." I want to thank the listeners and especially you Dr. Cornine  for joining us today and sharing your expertise in this area. We really appreciate it. Thank you.[Music]