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Running head: FACTORS INFLUENCING NURSING PROGRAM CHOICE 1
EXPLORING FACTORS INFLUENCING NURSING PROGRAM CHOICE:
A QUALITATIVE STUDY OF DUAL ENROLLMENT NURSING STUDENTS
by
SHEILA GENTRY
COMPREHENSIVE FINAL
FACTORS INFLUENCING NURSING PROGRAM CHOICE 2
INTRODUCTION
Background of the Problem
Empirical research has revealed that increasing the number of baccalaureate-prepared
nurses at the bedside results in lower mortality rates, fewer medication errors, positive outcomes,
and financial savings for healthcare institutions (Aiken, 2014; Aiken, Clarke, Cheung, Sloan, &
Silber, 2003; Blegen, Goode, Park, Vaughn, & Spetz, 2013). Nursing in the 21st century is more
complicated than ever before. The complexity of today’s healthcare system requires a well-
educated nursing workforce (Institute of Medicine [IOM], 2010). The Institute of Medicine
recommendation for having a well-educated workforce has emerged from a body of research
over the last decade examining nurse education levels and patient outcomes (IOM, 2010).
Preparation of graduate nurses for an evolving healthcare system is a fundamental
requirement for nursing academe. Nurse educators have been urged to undertake strategic
changes in nursing education to meet this need (IOM, 2010). To address the IOM
recommendation to create a seamless academic progression, and help nurses overcome barriers
to obtaining advanced degrees, innovative collaborative nursing education models were created.
These innovative educational models include; RN to BSN degree from community college, state
or regionally shared outcomes-based curriculum, accelerated RN to MSN, shared statewide or
regional curriculum, and shared baccalaureate curriculum (Campaign for Action.org).
The concurrent enrollment or dual degree nursing program is an example of the shared
baccalaureate curriculum model. Concurrent associate degree in nursing [ADN] to bachelor of
science [BSN] degree nursing programs are collaborative partnerships between four-year
institutions and community colleges. There are several variations and titles for this shared BSN
curriculum model across the United States, but in general, the concurrent programs allow nursing
FACTORS INFLUENCING NURSING PROGRAM CHOICE 3
students to be enrolled in both ADN and BSN programs at the same time. The significant
differences identified relates to the timing of classes in the curriculum and when the student can
take the national nursing certification exam [NCLEX-RN]. Early reports indicate that concurrent
enrollment programs offer a worthwhile approach to meet the IOM recommendation for having a
BSN-prepared nursing workforce to meet the demands of a more complex healthcare setting
(Close & Orlowski, 2015; Florida Center for Nursing, 2015; Gorski, Farmer, Sroczynski, Close,
& Wortock, 2015; Pittman, Kurtzman, & Johnson, 2014).
According to the Campaign for Action Dashboard, the percentage of employed nurses
with a baccalaureate or higher degree in nursing has increased to 54% (Campaign for Action.org,
2017; Buerhaus, Auerbach, & Staiger, 2016). The increase in BSNs in the workforce may be in
part attributed to one or all of five promising educational models developed to help nurses
overcome barriers to obtaining advanced degrees. Yet, despite research revealing that these
programs are providing early access to BSN education and have shown promise for increasing
the percentage of nurses educated at the baccalaureate level in the workforce; universities and
nursing programs have been slow to adopt the dual degree model (Close & Orlowski, 2015;
Florida Center for Nursing, 2015, Oregon Consortium for Nursing Education, 2016).
An extensive literature review in peer-reviewed academic journals and scholarly research
databases for concurrent or dual degree nursing program returned limited research. The relative
newness, limited programs, and variation among these implemented education models could be
likely reasons for these findings. More specifically, the search identified a gap in the literature
exploring dual degree nursing student experiences considered when choosing a nursing program.
It is central for institutions of higher learning and nurse leaders to examine and understand
student experiences and explore factors that influence students to choose a nontraditional
FACTORS INFLUENCING NURSING PROGRAM CHOICE 4
educational approach to attain a bachelor’s nursing degree. This study will explore and seek to
understand how the dual degree nursing student’s experiences influence nursing program choice.
It will be able to add valuable insight to the nursing literature on the appeal of dual degree
nursing programs. Additionally, information obtained can provide nurse leaders with
foundational information necessary to present holistic information to institutional administrators
and other stakeholders of the benefits this particular model can potentially have for students,
communities, and healthcare settings in general.
Problem Statement
The need to have a well-educated nursing workforce is not merely that it is desired, it is
well documented throughout the literature review that it is necessary for today’s complex
healthcare setting. A well-educated nursing workforce equates improved or better patient
outcomes (Aiken et al., 2003; O’Brien, Knowlton, & Whichello, 2018). Likewise, the literature
review supports the necessity of academic progression to streamline educational pathways to
attain BSN and beyond nursing degrees. The dual degree program, an innovative collaborative
education model, offers an optional pathway to increase the number of BSN graduates. A search
of CINAHL, EBSCO Host, ERIC, JSTOR, ProQuest Dissertations and Theses, and Google
Scholar resulted in the discovery of gaps in the literature addressing dual degree nursing
programs. The search failed to identify any studies that specifically addressed dual degree
nursing students’ experiences of factors that influenced their decision to enroll in a dual degree
program instead of a traditional associate or bachelor’s degree nursing programs.
This study aims to explore the phenomenon of dual degree nursing programs by
discovering and richly describing student experiences that influenced their choice to enter a dual
enrollment nursing program.
FACTORS INFLUENCING NURSING PROGRAM CHOICE 5
Purpose of the Study
The purpose of this study is to explore the experiences of nursing students’ that
influenced or impacted their decision to enroll in a dual degree nursing program. Rich, detailed
accounts of student experiences will facilitate a better understanding of why they choose this
educational model to enter the nursing profession. This information will provide valuable insight
into higher education administration, nurse leaders, and stakeholders when contemplating
program implementation or when improvement of existing shared curriculum models are
undertaken.
Literature Review
The purpose of the review was to explore the available literature on innovative education
models created to address the goal of having a BSN and beyond nursing workforce. The review
of this phenomenon was begun with a general internet web search of concurrent or dual
enrollment nursing programs. The information obtained yielded a primary starting point that
provided the researcher a basic understanding and terminology for which to conduct a more
extensive literature review. The online databases of CINAHL, EBSCO Host, ERIC, JSTOR,
ProQuest Dissertations and Theses, and Google Scholar were utilized to search for the following
keywords: seamless transition, shared baccalaureate curriculum, dual degree nursing program,
concurrent enrollment, innovative nursing program model, nursing student experience, nursing
curriculum, baccalaureate-prepared nursing workforce, and higher education. When reviewing
the literature, a gap was identified addressing shared BSN curriculum models. More specifically,
of interest to the researcher, was the lack of information addressing the appeal of this new model
and understanding how student experiences influenced program choice.
FACTORS INFLUENCING NURSING PROGRAM CHOICE 6
A pragmatic approach (Creswell & Creswell, 2017) was employed to conceptualize the
phenomenon, construct knowledge and real-world practice understanding, and explore the best
methodology that would allow for a better understanding of the student appeal of the dual degree
nursing program. The literature review is divided into five sections; education debate, benefits
of baccalaureate nursing workforce, barriers/challenges to higher education, nursing curricula
variability, and shared curriculum model.
Education Debate
Historically and currently, there are multiple educational pathways, which lead to a
license to practice nursing in the United States. Nursing students have three different options
available to become a registered nurse: the diploma in nursing, associate degree in nursing
(ADN), and the bachelors of science in nursing (BSN) (Orsolini-Hain, & Waters, 2009).
According to Aiken et al. (2003), in 1950, 92% of the nursing workforce was educated in 3-year
diploma programs affiliated solely with hospitals. However, by 2001, this number dropped to a
mere 3%. Historically since the implementation of the associate degree programs in the 1950’s,
the most common method to become an RN was to obtain an associate degree in nursing with the
second to obtain the BSN degree. This phenomenon has been discussed and repeatedly studied
in nursing literature (Aiken et al., 2003; Benner, Sutphen, Leonard, & Day, 2010).
The requirements for entry in nursing practice and of associate or diploma degree nurses
pursuing a bachelor’s degree have been both a challenge and a subject of debate in academia for
decades. In 1965, the American Nurses Association (ANA) first expressed the need for having a
bachelor’s prepared nursing workforce with the following statement:
Such practice requires knowledge and skill of high order, theory oriented, rather than technique oriented. It requires education, which can only be obtained through a rigorous course of study in colleges and universities. Therefore, minimum preparation for
FACTORS INFLUENCING NURSING PROGRAM CHOICE 7
beginning professional nursing practice at the present time should be baccalaureate degree education in nursing. (American Nurses Association, 1965, p. 107).
Surrounded by the controversy that erupted with their position statement the ANA
continued to support BSN entry-level requirements into nursing practice.
However, in 2008 the focus shifted again. The ANA instead began to support the
recommendation that ADN and diploma nurses should obtain a BSN degree within ten years of
their initial program completion (ANA, 2008). States such as New York, New Jersey, and Rhode
Island have introduced legislation that requires an associate degree or diploma nurses to obtain a
baccalaureate degree within ten years of graduation (Senate Bill S628, 2013-2014).
Subsequently, after fourteen years of lobbying, New York recently became the first state to make
the “BSN in 10” a legal requirement. The New York “BSN in 10” was signed into law in
December 2017. The implications are yet to be seen as we await the opportunity to evaluate the
impact this new requirement will have on nursing education institutions and the nursing
workforce in New York.
Benefits of Baccalaureate Nursing Workforce
Considerable research has been devoted to establishing the need and benefits of having a
highly educated nursing profession (Aiken et al., 2003; Aiken et al., 2014; Altmann, 2011; IOM,
2010). The assertion regarding the association between educational level and patient outcomes in
hospital settings was based on the seminal research of Aiken, Clarke, Cheung, Sloane, & Silber
(2003), a number of smaller European studies, and other international studies (Alspach, 2014).
Subsequently, in 2015, Aiken et al., and the European Union RN4CAST consortium conducted a
3-year observational study, which provided more evidence to support an educational level and
patient mortality connection. This study, the largest of its kind in the European Union consisted
of 422,730 patients and 26,516 nurses. The findings propose that increased nurse workload and
FACTORS INFLUENCING NURSING PROGRAM CHOICE 8
less than bachelor prepared nurses are directly associated with patient mortality (Aiken et al.,
2014). This new research further supports the position of the IOM and other professional
nursing organizations. The advancement of the BSN degree is a requirement not only forfor
today’s complex healthcare system not
Barriers/Challenges to Higher Education
Nursing literature is abundant with research discoursing barriers for the lack of ADNs and
diploma nurses pursuing higher education (Spetz & Bates, 2013; Warshawsky, Brandford, Arica,
Barnum, & Westneat, 2015). Common barriers identified include lack of time, financial burden,
lack of compensation, relevance, and rewards/benefits (Warshawsky et al., 2015). Sarver,
Cichra, and Kline (2015) published a descriptive study that attempted to identify benefits,
motivators, and barriers for RNs returning to school to pursue a BSN. The researchers created an
anonymous cross-sectional survey and emailed it to 1,348 RNs within their large urban medical
facility, and 332 RNs participated in the study. The findings were consistent with previous
studies that identified the most substantial barriers this group and included time-commitment,
expenses, and lack of tuition reimbursement (Duffey et al., 2014). Additionally, a finding noted
in the study relevant to supporting concurrent or dual enrollment ADN to BSN was the average
number of years worked from initial licensure as a nurse to return to school. Of the 332 nurses
surveyed, 129 reported that they had worked 9-11 years before returning to school (Sarver,
Cichra, & Kline, 2015).
Other studies have identified ADN programs as the preferred educational pathway for
entering into the workforce. The ADN pathway is quicker and more appealing because of its
financial reasons. Time, child care constraints, and flexibility are also identified as a priority for
both degree-seeking students and practicing nurses (Sarver, Cichra, & Kline, 2015). Likewise,
FACTORS INFLUENCING NURSING PROGRAM CHOICE 9
many nurses have the perception that there are no pay differences between the associate degree
nurse and the bachelor degree nurse. Therefore, they do not see a need to return to school,
especially if there are no incentives offered (Sarver, Cichra, & Kline, 2015; Altmann, 2011;
Spetz & Bates, 2013). Exploration of additional studies of perceived barriers to returning to
school indicates that nurses value furthering their professional educational level, but they need
more supportive initiatives to help achieve the degree.
Nursing Curricula Variability
The multiplicity of the nursing education programs in the United States has created
fragmentation and confusion within the nursing profession. There are multiple viable alternate
educational pathways to assist the non- BSN RNs with a more accessible path to achieving a
BSN or higher (Giddens & Meyer, 2016; Close, Gorski, Sroczynski, Farmer, & Wortock, 2015;
Giddens, Keller & Liesveld, 2015; Anbari, 2015; Bastable & Markowitz, 2012; Bargagliotti,
West-Sands, Burchum & Selbe, 2002). These varied pathways are providing momentum in
meeting the IOM recommendations for a more highly educated nursing workforce (McMenamin
& Davis, 2015). However, these programs or pathways are not without challenges and barriers.
According to Benner, Sutphen, Leonard, and Day, (as cited by Giddens & Meyer, 2016) the
inconsistency in prerequisite nursing courses is a result of the many pathways into the nursing
profession. Ultimately, recognizing barriers that make academic progression cumbersome
should be at the forefront of discussion in both community college and university settings.
Giddens and Meyer (2016) presented an analysis of findings from a workgroup
assembled to discuss and identify solutions to enhance efficiency for academic progression for
the baccalaureate degree in nursing. These findings are based on an analysis of curricula from
nine states with one or more collaborating institutions offering academic progression programs.
FACTORS INFLUENCING NURSING PROGRAM CHOICE 10
Commonalities and differences discovered and discussed included variations and inconsistencies
in credit hours or content area, arbitrary requirements unique to a college or university, and
prerequisite course requirements. The integrated concepts discussed in this study identified a
need to reduce barriers and offered a foundational course solution to reduce some of the barriers
identified (Giddens & Meyers, 2016).
In 2014, a qualitative study by Pittman, Kurtzman, and Johnson examined the
fragmentation of nursing education in the United States. The study described the most promising
practices for academic progression for nurses in the United States. Additionally, the researchers
examined the challenges associated with implementing these practices in academia. The authors
used semi-structured interviews with 31 educational institutions in the United States. They
selected four exemplars to represent the common and different challenges faced to implement
progression pathways. The cases included shared state-wide curricula, employer incentives,
community college granting BSN degrees, and competency-based education. Subsequently, the
researchers found multiple variations of educational pathways into the nursing profession
ranging from degrees offered, admission criteria, work experience, to program implementation.
The researchers concluded there are many possibilities to support the academic progression of
associate degree nurses. However, a clear need for an evaluation agenda to assess each of these
strategies was found (Pittman, Kurtzman, & Johnson, 2014).
Shared Curriculum Model
The Shared Curriculum Model (SCM) is a seamless ADN to BSN degree program that is
based on a collaborative, unified curriculum for both community colleges and universities.
There are varied forms of this educational model, but all of the models allow students to be
exposed to BSN coursework while they are enrolled in their ADN coursework. Two
FACTORS INFLUENCING NURSING PROGRAM CHOICE 11
fundamental differences identified from the literature were the timing of when the student could
take the BSN coursework and when the student is allowed to sit for the NCLEX-RN exam.
The SCM approach has demonstrated that it can be a viable option to help increase the
number of bachelor prepared nurse in the workforce (Close, Gorski, Sroczynski, Farmer &
Wortock, 2015; Hall, Causey, Johnson, & Hayes, 2012). Another additional benefit includes the
potential ability to dismantle educational silos that exist between community colleges and
universities. Close et al. examined state and regional ADN to BSN programs that utilized a
SCM. Their research discussed attributes and successful examples of SCM for ADN to BSN
education. These included: The Oregon Consortium for Nursing (OCNE), The North Carolina
Regionally Increasing Baccalaureate Nurses Project (RIBN), The New York Regionally
Increasing Baccalaureate Nurses Project, The University of Texas at Arlington Professional
Nursing Pathways Program, The New Mexico Nursing Education Consortium, and The
California Collaborative Model for Nursing Education. The SCM can help provide a cultural
shift that BSN educational preparation regardless of the initial path of educational attainment is
what is necessary for the nursing profession to be contributors to an advancing health care
system. Furthermore, Close et al., offer that the development of a SCM for ADN to BSN
education can increase rural access to education (Close, et al., 2015).
Bastable and Markowitz (2012) shared the success of a unique articulation model. The
model is called the Dual Degree Partnership in Nursing (DDPN). It is the first model of its kind
and was established in 2005 in New York. Unlike any other curricula, it is designed with the
first year of liberal arts and science courses, two years of prelicensure associate degree nursing
courses followed by the last year of upper-division coursework to complete the BS degree. This
FACTORS INFLUENCING NURSING PROGRAM CHOICE 12
model was designed to attract high school students as well as offering the opportunity to earn
two degrees an ADN and a BSN.
This particular model has proven to be popular with traditional-aged students. Data
collected over six years indicate that applications increased 175% and the total number enrolled
since its beginning increased by 84% (Bastable & Markowitz, 2012). In addition to quantitative
findings discussed supporting this model, interviews with students before graduation revealed
high levels of satisfaction- 100% replied they would choose the program again. The authors
conclude that the positive indicators lead to the conclusion that this model can and should be
replicated (Bastable & Markowitz, 2012).
Lastly, Heglund, Simmons, and Wink (2017) provide a discussion paper examining the
outcomes of a concurrent ADN/BSN enrollment program. The paper describes the University of
Central Florida’s 13-year experiences with their Concurrent Enrollment Program. This particular
exemplar offers the advantage of allowing the student to complete the BSN “three to four
semesters quicker that a student enrolled in a traditional RN to BSN program” (Heglund,
Simmons & Wink, 2017 p. 443). The program outcomes, NCLEX scores, and student
satisfaction indicate a high level of completion and student satisfaction. This model’s success is
attributed to the understanding that all persons involved in the program are fully committed to
student success, and a successful collaborative partnership must exist between both community
college and university granting the degrees.
Summary
The IOM committee recommended in 2010 that academia and healthcare institution
create solutions to help alleviate the barriers preventing BSN attainment. This study will explore
one of the solutions offered by academe that was created to form a seamless progression for
FACTORS INFLUENCING NURSING PROGRAM CHOICE 13
ADNs to obtain a bachelor or beyond nursing degree (IOM, 2010). The literature review
identified a gap in the literature utilizing a phenomenological framework to explore experiences
of student’s who have participated in a dual degree nursing program. More specifically, a gap
exists that explores factors that students impart as the motive behind their decision to enter a dual
degree nursing program instead of a traditional ADN or BSN program to attain a nursing degree.
The dual degree model can mesh both associate and bachelor degree nursing programs
together and moves beyond the age-old debate of how nursing could or should educate its nurses.
Dual or concurrent degree models can layer the best of both educational experiences and allow
the student an affordable option for a four-year degree (Bargagliotti, West-Sands, Burchum, &
Selbe, 2002). A combined program could give students the best of both pathways. The dual
degree program allows ADNs a viable option for BSN attainment and can address the 80% by
2020 recommendation of having a well-prepared nursing workforce. Therefore, shared BSN
curriculum models, such as the dual degree programs warrants further study.
Theoretical Framework
Phenomenology
This study will employ phenomenology to understand better the factors that influenced
the student’s decision to enter the dual degree nursing program to attain a nursing degree.
Phenomenology explores experiences from the first-person point of view and allows the
researcher to attempt to find the meaning of an individual’s lived experiences (Merriam &
Tisdell, 2016). According to Marshal and Rossman (2016), a phenomenological approach can
be employed to explore the individual ’s lived experiences and meaning of those experiences to
develop a rich and deep understanding of the phenomena. Utilizing a phenomenological
FACTORS INFLUENCING NURSING PROGRAM CHOICE 14
approach where interviews or conversations with participants are conducted, the researcher can
extrapolate shared meanings of the participant's experiences.
The researcher chose phenomenology as a framework for the study due to the interest of
understanding how students came about choosing a dual degree nursing program and what they
perceive as factors that influenced their decision. Therefore, in keeping with phenomenological
tradition, the researcher is attempting to look at what is common among student experiences that
led them to choose the dual degree nursing program (Creswell, 2013).
A Heideggerian interpretive phenomenological approach will be utilized for this study
because of the interest in better understanding the factors influencing student decision from the
representation of several student participants. Heidegger believed that our activities are always
“in the world,” and our being is “being-in-the-world” (Smith, 2018). Additionally, in the
Heidegger approach the researchers’ own experiences are essential for interpreting and
understanding the human experience; therefore, unlike Husserl, Heidegger did not believe
“bracketing” was necessary or entirely possible for phenomenological inquiry (Polit & Beck,
2008).
The framework proposed by Heidegger (1962) situates or immerses the researcher into
the participants’ world and assumes that the researcher’s preconceptions and personal
experiences will help provide perspective into the interpretation of the findings. Additionally,
interpretative phenomenology can help nurse educators use student experiences to evaluate the
curriculum to bring about change and or improvements (Diekelmann, 1993).
Nested Process Model of College Choice
It is financially vital for institutions of higher learning to understand influencing factors
for prospective students’ choice of college. Student recruitment in higher education is a well-
FACTORS INFLUENCING NURSING PROGRAM CHOICE 15
discussed phenomenon. Higher education professionals have a vested interest in student
recruitment. Students are the key to college, university, and program success (Han, 2014). To
identify factors affecting the student’s decision to enroll in a college many studies have used
economic and human capital models (Perna, 2006). Others such as Chapman’s (1981) Model of
Student College Choice, examines student characteristics and external influences. Understanding
students’ decision to enter higher education and college choice has encouraged the development
of sophisticated recruitment strategies over the decades. Therefore, understanding factors that
influence a nursing student’s choice to enter a dual degree nursing program instead of traditional
ADN or BSN programs is equally essential for the success and further implementation of these
programs in areas that are not utilizing them.
Perna (2006) suggests that even though college-choice research has traditionally been
restricted to quantitative analysis, qualitative methodologies are critical for developing and
theoretically understanding student college-choice. Therefore, this study will utilize Perna’s
Nested Process Model of College Choice to assist with identifying and understanding factors that
influence nursing program choice.
In this model, Perna found that adding measures of social and cultural capital improved
the explanatory power of the more traditional models (Perna, 2008). Perna’s model has four
contextual layers; habitus, school and community, higher education, and social, economic, &
policy. According to Perna, looking at the emphasis of the four contextual layers, this model can
help recognize differences across students that can shape college choice (Perna, 2006).
FACTORS INFLUENCING NURSING PROGRAM CHOICE 16
Research Questions
The overarching questions of this study examine dual degree nursing students’ experiences
that influenced their choice to enter a dual degree nursing program. More specifically, the study
will include the following questions:
1. What were the decisional factors deemed most important by the student when choosing a
nursing program?
2. How do students relate that their experiences impacted their choice for the dual degree
program?
3. What are dual degree students’ experiences enrolled in a dual degree nursing program?
4. How do students describe the advantages of entering the dual degree nursing program?
5. How do students describe the disadvantages of entering the dual degree nursing program?
Methodology
A qualitative approach will be utilized to achieve a broader perspective and richer
portrayal of the dual degree nursing program. Qualitative research is a means used to explore
and understand the meaning of human or social issues within individuals or groups (Creswell,
2013). According to Creswell, qualitative research allows the participant's voices to be heard,
incorporates researcher reflexivity, provides a complete description and interpretation of the
issue, and allows contribution to the literature (Creswell, 2013). This format is viewed as a
traditional approach to qualitative research and can be linked to the early writing of Immanuel
Kant, who in 1781 published the Critique of Pure Reason. Kant argued that direct observation
was not the only way of “knowing” about the world. He argued that knowledge of the world was
based on understanding which evolves from reflecting on what happened (Kant, 1998).
FACTORS INFLUENCING NURSING PROGRAM CHOICE 17
More specifically, the researcher will employ Heideggerian phenomenology to
understand better the dual degree student experiences of factors that influenced their selection of
the dual degree model. This approach allows the researcher to be able to give meaning to the
student experiences to gain insight into processes. Another benefit of using this framework in
this study will be to allow the researcher to rely heavily on the participant's views and
experiences they find to be relevant to their decision to enter a dual enrollment program rather
than a traditional ADN or BSN nursing program.
Research Design
The proposed study will employ the use of interpretative phenomenology to explore
student experiences and factors that influence students’ choice to enroll in a dual degree nursing
program.
Setting and participant selection
The site of this study will be a public university in the south that has a collaborative dual
enrollment program agreement with eleven surrounding community colleges. The researcher
will gain entrance into the university through a colleague that is faculty in the college of nursing.
A purposive sampling strategy will be used to select students for interview. According to
Maxwell (2013), purposeful selection allows for “particular settings, persons, or activities to be
deliberately selected to provide information relevant to the researcher’s study goal” (Maxwell,
2013, p. 97). The researcher will solicit students currently enrolled in the dual enrollment
partnership offered through the university. Also, the researcher will strive to have at least one
student representative from each of the community colleges and strive to represent different ages,
genders, ethnicities, and races when possible. The researcher will email a letter of
invitation/recruitment to prospective Deans of nursing from each of the collaborating colleges
FACTORS INFLUENCING NURSING PROGRAM CHOICE 18
requesting them to share the study recruitment letter and contact information with students
enrolled in the dual enrollment program at the university. The letter will include an explanation
of the study and reason for solicitation.
To provide a thick, rich narrative for the study, the researcher plans to secure twelve
students willing to participate in a semi-structured interview. A letter discussing the purpose
study, researcher’s contact information, and participation consent form will be obtained before
beginning the interview process. Participant selection and recruitment will follow The
University of Alabama’s Institutional Review Board (IRB) which governs the ethical treatment
of human subjects.
Data Collection
A semi-structured interview protocol following Rubin and Rubin’s (2012) responsive
interviewing model will be created (Creswell, 2013). Seidman (2006) argues that interviews are
not intended to obtain answers, test hypotheses, or evaluate; instead, interviews are intended to
“help understand the lived experience of other people and the meaning they make of that
experience” (Seidman, 2006, p. 9). He further posits that interviewing allows the researcher
access to the context of the participant’s behavior and provides a means for the researcher to
understand the behavior (Seidman, 2006). Accordingly, Seidman suggests interviewing is a
powerful way to investigate and gain insight into an educational organization, institution, or
process (Seidman, 2006).
The interview protocol will utilize information obtained from the literature review and
Perna’s (2008) Nested Model of College Choice as a guide for developing questions. The semi-
structured interview protocol will include demographic information and open-ended questions
allowing for discussion on student experiences, and exploration of regarding the decision to enter
FACTORS INFLUENCING NURSING PROGRAM CHOICE 19
the dual enrollment program. The 60-90 minute interviews may take place in person, by phone,
Skype, or Zoom. This method will allow the researcher to utilize the audio/video recordings of
the interviews to ensure accurate transcription (Marshall & Rossman, 2016). A second follow-
up interview may be employed if necessary. The primary researcher will conduct the interviews.
Additionally, the researcher will incorporate memoing throughout the study and take field notes
during each of the interviews to capture the researcher’s thoughts and impressions experienced
during the interviews.
Data Analysis
The researcher will approach the data with an open mind, seeking what immerges from
the text and utilize inductive analysis. The study will employ the Colaizzi (1978) constant
comparison method for data analysis. The Colaizzi (1978) method utilizes seven steps for
phenomenological data analysis: attaining a general/logical sense of the transcript; extrapolating
words or statements of significance; formulating meaning; organizing meaning into categories,
clusters of themes, and themes; providing a thorough description of phenomenon; providing
description of the basic phenomena structure; and validation of the findings through returning to
the participants.
The researcher will establish and follow an organizational plan for incoming data. The
interviews will be transcribed by converting digital or video recordings and field notes into
narratives (Seidman, 2006). Due to the small size of this study, the researcher will transcribe
each participant interview into a Word document. Transcriptions will be read over several times
before beginning analysis for error in transcription.
The primary researcher will begin analyzing the data by concurrently watching and or
listening to the interviews while reading over the transcriptions to gain a general sense of the
FACTORS INFLUENCING NURSING PROGRAM CHOICE 20
information. The researcher will pay close attention to participant facial cues (if video), voice
inflection, and or pausing that may have occurred during the interview. Notes and extrapolation
of keywords or statement found to be significant will be identified in the transcripts and
organized into categories and themes to formulate meaning through a coding process. The
coding process will help the researcher establish categories and make connections between
threads that will emerge as themes. Completed transcriptions and themes will be emailed to the
participants for validation and accuracy and corrections will be made if indicated. Lastly, the
researcher will link common themes to research identified from the literature review.
Significance of the Study
While much is written about seamless transition, the literature review undertaken for this
research study discovered the existence of a gap in the literature that provides research data to
support the dual or concurrent degree model and its variations. The dual degree model can mesh
both associate and bachelor degree nursing programs together and moves beyond the age-old
debate of how nursing could or should educate its nurses (Close, et al., 2015). Dual or
concurrent degree models layer the best of both educational experiences and allow the student an
affordable option for a four-year degree (Bargagliotti, West-Sands, Burchum, & Selbe, 2002).
The findings of this study will help provide a better understanding of why nursing
students choose a dual enrollment nursing program over a traditional associate or bachelor
degree programs. The use of the qualitative method will allow students to share their thoughts
and feelings regarding the impact these available programs have on their ability to pursue a
bachelor degree in nursing. Additionally, this information may potentially provide valuable
insight for higher education administration officials, nurse leaders, and stakeholders when
FACTORS INFLUENCING NURSING PROGRAM CHOICE 21
contemplating program implementation or when improvement of existing shared curriculum
models are undertaken.
Collectively and individually there are extensive benefits found in the literature
discussing benefits of ADN programs as well as benefits for BSN programs. The associate
degree program provides excellent foundational knowledge, skills, and attitudes required for
beginning practice while the bachelor’s degree program has the advantage of time and length to
allow students to develop advanced critical reasoning, leadership skills, and a deeper
understanding of community health and health policy. Therefore, findings from this study can
potentially strengthen the dual enrollment model as an alternative educational pathway for
nursing and offer another means to assist academia in meeting the IOM initiative of having a
highly educated nursing workforce.
FACTORS INFLUENCING NURSING PROGRAM CHOICE 22
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