ADVANCED NURSING EDUCATION: CRITICAL FACTORS THAT INFLUENCE DIPLOMA AND ASSOCIATE DEGREE NURSES TO ADVANCE DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Nursing Barry University Rose McGhie-Anderson 2016 ADVANCED NURSING EDUCATION: CRITICAL FACTORS THAT INFLUENCE DIPLOMA AND ASSOCIATE DEGREE NURSES TO ADVANCE DISSERTATION by Rose McGhie-Anderson 2016 APPROVED BY: ____________________________________ Claudette R. Chin, PhD, ARNP Chairperson, Dissertation Committee _____________________________________ Jessie M. Colin, PhD, RN, FRE FAAN Member, Dissertation Committee Program Director, College of Nursing and Health Sciences _____________________________________ Ann-Lynn Denker, PhD, ARNP Member, Dissertation Committee ____________________________________ John McFadden, PhD, CRNA Dean, College of Nursing and Health Sciences Copyright by Rose McGhie-Anderson, 2016 All Rights Reserved Abstract Background: Advanced nursing education needs to be pursued along the continuum of the nursing career path. This education process is indispensable to the role of the nurse as educator, manager, nurse leader, and researcher who will effect policy changes and assume leadership roles as revolutionary thinkers in addition to implementing paradigmatic shifts.
Purpose: This grounded theory study sought to unearth the critical factors that motivate nurses to advance academically. The study aimed to gain an understanding of the social processes associated with the decision of diploma and associate degree nurses to advance their nursing education. Philosophical Underpinnings: A qualitative methodology in the tradition of grounded theory using the constructivist and interpretivist approach was used to conduct the study. Method: Data were collected from two groups of participants using a face-to-face semi- structured interview.
The first group was diploma and associate degree nurses, and the second group was a focus group comprising of baccalaureate, masters, or doctoral degree nurses who have progressed academically from diploma or associate degree level. Results: Emerging from the thick rich data that were collected from the research participants were the following core categories that ground the theory: rewarding, motivating, and supporting for diploma and associate degree nurses to advance academically. Conclusions: The study concluded by elucidating that professional advancement was the social process that grounds. Hence, the emergent theory was; The Theory of Professional Advancement.
iv ACKNOWLEDGEMENTS It is with gratitude that I acknowledge the inspiration and support provided by the members of my dissertation committee. This heartfelt appreciation goes to Dr. Ferrona Beason and my committee chairperson Dr. Claudette Chin and members Dr.
Jessie Colin and Dr. Ann- Lynn Denker. Thanks for the guidance, support, and coaching throughout my dissertation. To the faculty members who all imparted their knowledge so clearly and freely, I am very grateful for the wise directives and patient guidance you gave during my PhD courses at Barry University.
There is no doubt that you all cared about my success and quality performance. Without the support of my family, pursuing this course would have been more challenging or impossible. Thanks to my mother Mae McGhie, husband Martin Anderson, and my sisters and brothers who believed and encouraged me throughout this milestone and who were moms and dads many days when assignments and deadlines demanded my full attention. Thanks to my daughter Emily Anderson and my son Kyle Anderson who were constantly asking, “Mom, aren’t you going to the library to do your work?” and who were continuously praying for me each night.
Thanks to Donna Joseph and Kellany Codgan-Nolan for their assistance with my diagrammatic illustrations. I am grateful for my friends and colleagues who believed in me and have also been praying for my success. Thank you all. Ultimately, thanks to God the giver of all wisdom, knowledge, and understanding who has allowed me to realize this accomplishment.
v DEDICATION I would like to dedicate this dissertation to my wonderful mom, sisters, brothers, and husband Martin, who were my source of encouragement to pursue doctoral studies from the moment I mentioned that I had an interest in doing so. For all the love and support they have willingly showered me with. I dedicate this also to my children Emily and Kyle as an encouragement that they will pursue excellence in all their career endeavors and life goals. vi TABLE OF CONTENTS TITLE PAGE ………………………………………………………………….ii COPYRIGHT PAGE…………………………………………………………….
vi TABLE OF CONTENTS. vii LIST OF TABLES. xii LIST OF FIGURES. xiii CHAPTER ONE.
1 Background of the Study. 2 Statement of the Problem. 5 Purpose of the Study. 14 Significance of the Study.
18 Implications for Nursing Education. 18 Implications for Nursing Practice. 19 Implications for Nursing Research. 20 Implications for Health/Public Policy.
21 Scope and Limitations of the Study. 24 vii CHAPTER TWO: Review of the Literature. 26 Motivations to Advance. 30 Perceptions of Advanced Education.
36 Benefits of Advanced Nursing Education. 52 CHAPTER THREE: Methods. 54 Sample and Setting. 60 Access and Recruitment of the Sample.
66 Ethical Considerations/Protection of Human Subjects. 66 Data Collection Procedures. 82 CHAPTER FOUR: Findings of the Inquiry. 83 viii Describing the Grounded Theory Process.
84 Results of Data Collected. 89 Demographic Representation of the Study. 89 Characteristics of the Individual Sample Participants. 97 Transcriptions of the Data.
97 Characteristics of the Focus Group Participants. 100 The Emergent Categories. 109 Formulation of a Theory. 117 CHAPTER FIVE: Discussion and Conclusion of the Inquiry.
118 ix Exploration of the Meaning of the Study. 119 Relationship of Hertzberg Motivation-Hygiene Theory to the Study. 125 Relationship of Maslow’s Motivation Theory to the Study. 125 Relationship of Self-Determination Theory to the Study.
126 Interpretive Analysis of the Findings. 135 Significance of the Study to Nursing. 137 Implications for Nursing Education. 138 Implications for Nursing Practice.
139 Implications for Nursing Research. 140 Implications for Public Health Policy. 140 Strengths and Limitations of the Study. 141 Recommendations for Future Research.
146 APPENDIX A: BARRY UNIVERSITY BARRY INSTITUTIONAL REVIEW BOARD APPROVAL. 165 APPENDIX B: BARRY UNIVERSITY INFORMED CONSENT FORMS. 168 APPENDIX C: BARRY UNIVERSITY LETTER OF REQUEST FOR ACCESS. 175 APPENDIX D: BARRY UNIVERSITY RECRUITMENT FLYER.
176 APPENDIX E: BARRY UNIVERSITY GUIDE FOR INTERVIEW QUESTIONS. 177 APPENDIX F: BARRY UNIVERSITY GUIDING QUESTIONS. 181 APPENDIX G: BARRY UNIVERSITY DEMOGRAPHIC QUESTIONNAIRE. 184 APPENDIX H: BARRY UNIVERSITY INTERVIEW PROTOCOL FOR RESEARCH PARTICIPANTS.
188 x APPENDIX I: BARRY UNIVERSITY DOCUSIGN SECURITY ASSURANCE. 189 APPENDIX J: BARRY UNIVERSITY SKYPE INTERNET PROTOCOL. 191 APPENDIX K: BARRY UNIVERSITY GO DADDY SECURE CERTIFICATE. 192 APPENDIX L: BARRY UNIVERSITY LINKEDIN USER AGREEMENT.
194 xi LIST OF TABLES Table 1 Demographic Characteristics of Diploma, ADN, BSN, MSN, and Doctoral Degree Nurses as Frequency and Percentage (N = 22). 90 Table 2 Primary Codes. 102 xii LIST OF FIGURES Figure 1. Schematic representation of symbolic interactionism and pragmatism (McGhie- Anderson, 2014, adapted from Blumer, 1969).
Grounded theory process schema (McGhie-Anderson, 2013, adapted from Strauss & Corbin, 1998). Diagram illustrating the impact of the core category (McGhie-Anderson, 2015, adapted from Strauss & Corbin, 1998). 112 xiii 1 CHAPTER ONE Advanced nursing education is used synonymously with the terms academic progression or professional progression. Academic progression refers to articulation models that promote lifelong learning through the addition of academic credentials (National League for Nursing [NLN], 2011).
It is therefore a movement of advancement by degrees (Birks, Chapman, & Francis, 2010; Institute of Medicine [IOM], 2011). Having qualified faculty and advanced practice nurses to manage new and emerging environments of care in various settings will be unattainable if approximately 60% of new nurses are associate degree graduates (NLN, 2011). Worldwide, nurses are called to work in an environment where there are increasing health care reforms, complicated patient care needs, technological advancements, and improved evidence- based practices. These ongoing changes call for nurses who are competent in leadership, health policy, system improvement, research, evidence-based practice, and collaboration.
This is essential in facilitating the delivery of high-quality care (NLN, 2011). Internationally, there are over 14,465,439 nurses. Nationally, there are over 3 million nurses of whom 2.7 million are employed (Health Resources and Services Administration [HRSA], 2010). In the United States, the nursing profession is considered the largest segment of the health care industry with nurses accounting for 55% of the workforce (Sigma Theta Tau International [STTI], 2006).
Of this workforce, only 50% hold a baccalaureate degree or higher (IOM, 2011). The IOM recommends that by 2020, 80% or more of the nursing population should be baccalaureate educated (IOM, 2011). This indicates that 465,000 diploma and associate degree nurses are to return to school by 2020 (HRSA, 2010). Studies such as Effects of hospital care environment on patient mortality and nurse outcomes Aiken, Sean, Sloane, Lake, and Cheney (2008), have shown that the nurse who is academically advanced improves patient 2 outcomes.
It was revealed that surgical mortality rates exceed 60% in hospitals with lower educational level nurses, whereas hospitals with higher educated nurses have better patient outcomes (Aiken, Sean, Sloane, Lake, & Cheney, 2008). Background of the Study The recommendation from the National Advisory Council on Nurse Education and Practice (NACNEP, 1996) is for at least two-thirds of the nursing population to hold a baccalaureate degree. The number of diploma-educated nurses in 1980 was 63.7%, the associate degree nurses (ADN) represented 18%, and 34.2% had a bachelor of science in nursing (BSN) degree or higher (National Sample Survey of Registered Nurses [NSSRN], 1980-2008). In 2008, three decades later, diploma and associate degree nurses account for 50% of registered nurses (RNs), those with a bachelor of science in nursing (BSN) represented 36.2% of nurses had a master’s or doctoral degrees (Bureau of Labor Statistics, 2012).
The magnitude in the complexity of the problem and the great demand for nurse educators, specialist researchers, experts in community and public health, geriatrics specialists, leadership, inter-professional collaboration, systems improvement, and quality and safety in health care require a far greater number of nurses to advance academically (Sportsman & Allen, 2011). Furthermore, limited studies have been done within the past decade regarding nurses advancing academically from entry-level status (Osterman, Asselin, & Cullen, 2009). Entry-level pathways in nursing to become a registered nurse are presently one of three different conduits: the Bachelor of Science in nursing (BSN), the associate degree in nursing (ADN), and the diploma in nursing (IOM, 2011). In 1965, the American Nurses Association position paper called for the baccalaureate degree to be the entry level into nursing.
The Surgeon’s General Consultant Group Document entitled Toward Quality in Nursing: Needs and 3 Goals Report (U. Public Health Service, 1963) and the National Commission for the Study of Nursing and Nursing Education (1970) reported that all nurses are to be baccalaureate prepared. Nationally, nursing education levels vary from one region to another; the East-South Central Region has the smallest percentage of registered nurses who have at least a BSN degree, while the Pacific has 52.8% BSN nurses and New England region has 55. In contrast, more than 68% of internationally educated registered nurses with at least a BSN degree (National Survey Statistics for Registered Nurses [NSSRN], 2008).
Countries such as Canada, Sweden, Portugal, Brazil, Greece, Iceland, and the Philippines, all require a 4-year undergraduate degree to practice as a registered nurse (AACN, 2010). Nationwide, the Veterans Association, the nation’s largest employer of registered nurses, has established that the baccalaureate degree is the minimum preparation of its nurses for promotion beyond entry level (NACNEP, 1996). Magnet hospitals also require all managers and nurse leaders to have a BSN degree or higher by 2013 (American Association of Nursing, 2010). A new proposal was introduced in New Jersey and New York, requiring a BSN degree for all nurses with 10 years of experience since their initial entry level RN program; however, the number of ADN and diploma educated nurses is at an alarmingly high rate, 65.
A lack of advanced education impacts the nursing shortage. Approximately 75,000 qualified applicants were turned away from accessing a professional nursing program in 2011.