Teaching and Learning in Nursing (2010) 5, 149–153

www.jtln.org

A formalized mentoring program for LPN-to-RN students1

Charman L. Miller MSN, APRN, BC, CNE⁎, Camille Leadingham MSN, APRN, BC, CNE

Ohio University- Chillicothe, P.O. Box 629, Chillicothe, OH 45601, USA

1 This study was presented at the ONursing Educators Annual Conference,

* Corresponding author.E-mail address: millerc3@ohio.edu

1557-3087/$ – see front matter © 2010doi:10.1016/j.teln.2010.03.002

Abstract Nursing programs across the United States are faced with the challenge to admit greaternumbers of students and improve retention and progression rates of enrolled students. Associate degreenursing (ADN) programs produce the largest percentage of registered nurse (RN) graduates incomparison with other basic RN programs (National League for Nursing, 2006). Many states andacademic institutions have begun to realize that the large pool of licensed practical nurses (LPNs) is aviable source of quality ADN students. LPN students in LPN-to-RN completion programs can oftencomplete degrees and be eligible to take state board RN examinations in half the time of a traditionalADN student. Faculty at Ohio University-Chillicothe (OU-C) examined strategies to enhance the LPN-to-RN transition program on the campus and to promote retention and progression of this uniquepopulation of nursing students in the ADN program. The faculty researchers developed the NursingSuccess program after a review of the literature and with support from an internal grant from the OU-CFaculty Summer Research Fund. This article describes this formalized, faculty-driven student mentoringprogram designed for LPN-to-RN students at OU-C and the outcomes of the initial implementation.© 2010 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rightsreserved.

KEYWORDS:Mentoring program;Associate degree nursing;Retention rate

1. Introduction

Nursing programs across the United States are faced withthe challenge to admit greater numbers of students andimprove retention and progression rates of enrolled students.Associate degree nursing (ADN) programs produce thelargest percentage of registered nurse (RN) graduates incomparison with other basic RN programs (National Leaguefor Nursing, 2006; Tatem & Payne, 2000). Many states andacademic institutions have begun to realize that the largepool of licensed practical nurses (LPNs) is a viable source ofquality ADN students. This is evidenced by the Ohio'sNursing Articulation Model (Ohio Nursing Collaborative for

hio Council of Associate DegreeColumbus, Ohio, April 2007.

National Organization for Associate Deg

Educational Mobility, 2003–2005), which was developed atthe recommendation of the Ohio Collaborative Project:Nursing Workforce 2000 (1996–2000). This model wasdesigned to enable optimal educational mobility for nurses inOhio. Under this model, LPNs are granted a minimum of30% of the nursing credits required by the receivingacademic institution or program for the ADN. This translatesinto the fact that LPN students in LPN-to-RN programs canoften complete degrees and take state board RN examina-tions in half the time of a traditional ADN student. Faculty atOhio University-Chillicothe (OU-C) examined methods toenhance the LPN-to-RN transition program on the campusand to promote retention and progression of this uniquepopulation of nursing students in the ADN program.

Undergraduate nursing student retention is a complex,dynamic process influenced by multiple factors (Jeffreys,2004). Students are entering into their nursing education witha more diverse range of experiences, backgrounds, and

ree Nursing. Published by Elsevier Inc. All rights reserved.

150 C.L. Miller, C. Leadingham

personal and environmental factors that stand to have asignificant impact upon their ability to progress andpersevere in the environment of higher education (Jeffreys,2004). Regional campuses of major universities, like OU-C,were created to provide outreach services in higher educationto rural, nontraditional, and otherwise underserved students.OU-C has experienced an increase of over 50% in thenumber of LPN-to-RN students that the ADN programadmits annually since 2005. This increase is due to severalfactors including a targeted marketing strategy to thispopulation and university partnerships with local technicalschools and health care institutions that employ LPNs.Faculty had voiced concerns about the increased stress anddifficulties that the LPN-to-RN students seemed to beexperiencing with their role transition which were felt tohave the potential to affect progression. The challenge ofincreasing the contemporary nursing workforce makes itimperative that nursing faculty examine strategies to supportretention and progression of nursing students enrolled inADN programs. The researchers developed the NursingSuccess program after a review of the literature and withsupport from an internal grant from the OU-C FacultySummer Research Fund. This article describes the NursingSuccess program designed for LPN-to-RN students at OU-Cand the outcomes for the initial implementation.

2. Review of the literature

Student retention in undergraduate programs has beenwidely studied and reviewed in the literature. Tinto's (1975)findings suggested that both academic and social integrationinto the institution were essential to promote progression.Tinto's (1975) findings laid the foundation for the develop-ment of programs, with a focus on fostering integration intoboth areas. More recently, Tinto (1993) proposed a theory ofstudent retention with the assumption that student persistenceis related to the degree of integration that students attainwithin an institution. Tinto (1993) described integration asthe feeling experienced by the individual that they fit into thecommunity in which they are a part. It is associated with boththe academic and nonacademic or social domain of theinstitution. According to Tinto (1993), the degree ofintegration determines whether students perceive the benefitof persisting in the program to be greater than the cost ofpersisting. If the student does not perceive that the benefit isgreater than the cost, various dropout behaviors may result,including transfer to another institution, leaving highereducation or academic failure (Tinto, 1993). It is importantto note that Tinto's (1995) work was based on traditionalstudents, and caution may be warranted when applying theseconcepts to nontraditional students (Bers & Smith, 1991).

Bean and Metzner (1985) were the first to define anddisseminate findings related to the nontraditional student andnoted differences in attrition between this group and thetraditional student. Bean and Metzner identified three

variable sets—student characteristics, academic variables,and environmental variables—which have the potential tointeract and influence persistence and retention (p. 493).Smith (1990) reported that the top five ranked factors asidentified by returning nursing students following attritioninvolved time management problems. Smith also suggestedthat adequate preparation of students concerning the personaland financial costs of nursing education may decreaseattrition.

Jeffreys' (2004) Nursing Undergraduate Retention andSuccess model focuses specifically on undergraduate nursingeducation and may be applied to both traditional andnontraditional students. Jeffreys ascertained that academicoutcomes are important to be successful in a nursing coursebut only result in successful retention when accompanied bypositive psychological outcomes and professional integrationfactors (p. 11). Shelton (2003) reported that students whoperceived greater faculty support were more likely to persistthroughout a nursing program. These findings providesupport for the need to provide a caring and supportiveatmosphere and for utilizing the mentoring relationshipbetween faculty and student to facilitate persistence anddecrease attrition (Shelton, 2003).

Mentoring has long been used to support nurse graduatesas they transition into the professional role (Candela, Cyriel,Kowalski, & Warner, 2004; Donovan, 1989; McGann &Thompson, 2008). Mentoring has been defined as “helpinganother reach his or her potential” (Finke, 2005, p. 6).Mentoring has been increasingly viewed as a vital retentionand enrichment strategy for nursing students (Andrews &Wallis, 1999; Colalillo, 2007; Jeffreys, 2001, 2004, 2007).The research findings provide ample support for the conceptthat strategies and programs designed to support and mentorundergraduate nursing students are a vital component ofimproving retention rates in nursing education.

3. The Nursing Success program

The Nursing Success program was designed to workwithin the existing LPN-to-RN transition courses at OU-C.The LPN-to-RN program begins with potential studentsapplying and being accepted into the program based onestablished admission criteria. These admission criteriainclude the following: current valid Ohio LPN licensure;completion of required support courses in biology, chemis-try, and algebra; grade point average of at least 2.75 out of a4.0 scale, and completion of a statement of education andcareer goals. The Nursing Success program was introducedto students during orientation for potential LPN-to-RNstudents and was presented as an optional, formal, structured,faculty-directed mentoring program available to all enrolledLPN-to-RN students. Approval for the study was obtainedfrom the institution's internal review board and school ofnursing director.

Table 1 Learning obstacles list

Learning obstacles Number of students

Reading skills 2Math skills 5Self-confidence/Self-esteem 6Time management 11Stress management 13English as a second language 0Test anxiety 7Test-taking skills 11Critical thinking 1Motivation 1Role confusion 6

151LPN to RN

The study utilized a quasi-experimental design to collectdata to examine whether a formal, structured, faculty-directed mentoring program would promote student progres-sion and to examine student perceptions of the programitself. The convenience sample was drawn from thepopulation of enrolled LPN-to-RN students who voluntarilyparticipated in the Nursing Success program. At thecompletion of the program, questionnaires were used toevaluate student's perception of the effectiveness of theprogram. Additional outcome measures included successfulclinical completion, passing course grades, enrollment in thesubsequent nursing course within 1 year of completing thetransition coursework, and program completion.

Phase I (Orientation) of the Nursing Success programbegan at the orientation sessions held before the beginning ofclasses. To attend the session, the student must have receivedofficial notification of acceptance into the LPN-to-RNprogram. The students were provided a comprehensiveorientation to the university, the regional campus, the ADNprogram, and the school of nursing. Students were addressedby representatives from the campus library and technologycenter, introduced to student support services includingacademic advisors, counselors, and financial aid andadditional academic support services. Students were provid-ed verbal and written information on accessing theseresources and given a walking tour of the campus. Theprimary goal of Phase I was to promote student integrationinto both the social and academic systems of the institutionthrough fostering relationships with faculty, staff, and fellowstudents. The concept of the student being in control of his orher educational experience was emphasized.

Phase II (Assessment) involved students taking theAssessment Technologies Institute's (ATI) Self-AssessmentInventory (SAI). The SAI is a standardized assessmentexamination that assesses learning style, professional char-acteristics, work values, coping, and critical thinking. Theinventory is a Likert-type assessment designed to beadministered to adult nursing program populations. Thisinventory has been reviewed by content experts and evaluatedfor relevance and content validity of material to the identifiedconstructs (ATI, 2000). Reliability of the assessment inventorywas found to be .9144 using coefficient alpha (ATI, 2000).Scores on the student's university entry examination readingand math skill assessments were also analyzed.

Phase III (Diagnosis) consisted of students voluntarilyparticipating in mentoring sessions with faculty mentors. Thestudent and mentor analyzed and discussed the results of thestandardized examinations and the student responses to theNursing Success Data Form, which included informationregarding the student's number of hours worked andstudent's perceived obstacles or challenges to success inthe nursing program. On the basis of these data, the studentand mentor selected and prioritized learning obstacles(Table 1). The list of learning obstacles was developedfrom a review of the literature on variables that affect successand persistence.

Phase IV (Planning) involved students and mentorsdeveloping a comprehensive plan to address each of thelearning obstacles identified in Phase III. For example, astudent identified that a learning obstacle was test anxiety. Agoal for this learning obstacle was developed by the student as“I will feel less anxious before and during exam by Week 3.”Interventions planned for this learning obstacle included (a)practice progressive muscle relaxation, (b) engage in positiveself-talk the morning before the examination, and (c) get oncampus at least 30 minutes before the scheduled class starttime to avoid feeling rushed. These interventions weredeveloped by the student with consideration of his or herown individual factors perceived to be contributing to his orher test anxiety. This student also had time management as anidentified learning obstacle, and the issues of adequate out-of-class preparation and study time planning were addressed inthe plan. The interrelationship of the learning obstacles waspointed out by the mentors and discussed with students.

Phase V (Implementation) involved the student complet-ing the planned activities and maintaining a reflectivejournal. Students and mentors determined frequency of thementoring sessions individually. Most students met withtheir mentors every 1–2 weeks. The learning obstacles andinterventions were reviewed and revised as needed at eachmentoring session.

Phase VI (Evaluation) involved the final mentoring sessionof the quarter, which was completed after final grades weresubmitted. At this final session, learning obstacles and planswere evaluated and students completed the poststudyquestionnaire. The poststudy questionnaire was a 15-itemsurvey utilizing a 5-point Likert-style scale, with stronglydisagree (1), agree (2), undecided (3), disagree (4), andstrongly agree (5). The survey was developed by theresearchers and reviewed by four experienced educators.

4. Results

Attendance at the orientation program ranged from 87%to 100% of accepted LPN-to-RN students over fouracademic terms. Participation in the Nursing Successprogram was 62% (n = 31) of the total number of enrolled

Table 2 Demographic data (n = 31)

Characteristic Students, n (%)

GenderMale 3 (10)Female 28 (90)Age (years)18–24 7 (23)25–34 9 (29)35–44 7 (23)45–54 4 (13)Over 54 4 (13)Years experience as LPNLess than 1 5 (16)1–3 7 (23)4–6 3 (10)7–10 9 (29)More than 10 7 (23)Hours worked per weekLess than 12 4 (13)12–20 6 (19)Greater than 20 21 (68)Highest degree held (other than LPN/licensed vocational nurse)None 26 (84)Associate degree 3 (10)Baccalaureate degree 2 (6)Master's degree 0 (0)Doctoral degree 0 (0)

Table 4 Comparison on outcome measures for nursingsuccess and nonnursing success student participants

Nursing Successparticipantsn = 31

Non-NursingSuccess participantsn = 19

Passed transition courses 31 (100) 19 (100)Passed clinical component 31 (100) 19 (100)Enrolled in subsequent

nursing course within1 year

31 (100) 18 (95)

Completed program 30 (97) 16 (84)

Note. Values are presented as n (%).

152 C.L. Miller, C. Leadingham

students in the LPN-to-RN transition courses over fouracademic terms. Table 2 contains demographic data from thesample. All students who participated in the Nursing Successprogram were asked to complete a questionnaire at thecompletion of the program. Ninety-seven percent of studentswho participated in the Nursing Success program completeda poststudy questionnaire (n = 30). A summary of thepoststudy questionnaire results is provided in Table 3. Theresults of the survey indicate that overall students' percep-tions of the program were positive. The lowest rated areaswere the remediation of skills, helpfulness of peer tutoring,and the audiovisual media. The students' written comments

Table 3 Nursing success student poststudy survey results

Survey item M

1. The faculty mentor was approachable. 4.92. The faculty mentor was supportive. 4.93. The assessment tools helped me identify my

weaknesses/obstacles.4.2

4. The learning interventions were helpful. 4.65. The Nursing Success program was worthwhile. 4.96. The Nursing Success program increased my

self-confidence as a student.4.4

7. The standardized exams were helpful. 4.18. I would continue the program if available. 4.29. The skills remediation was helpful. 3.610. The writing and/or math center was helpful. 4.111. The peer tutoring was helpful. 3.212. The online tutorials were helpful. 4.513. The DVD/CD-ROMs were helpful. 3.914. The mentoring experience was helpful. 4.715. I would recommend this program to others. 4.7

suggest that the issue was peer tutor and skills remediationavailability at convenient times. The items for students'perceptions of the program being worthwhile and theindication that they would continue the program if it wereavailable suggest student satisfaction with the program. Ananalysis of the written comments from the questionnairesindicated that students felt that identifying individuallearning styles, having the mentors help develop a plan ofaction, completing the assessments to help guide remediationfor National Council on Licensure Examinations review, andhaving mentor support as being helpful to attain success.Suggestions for improvement of the program includedcontinuing the program into subsequent quarters, havinggroup review sessions for complex classroom materials, andhaving extended hours for mentoring sessions to fit betterinto work schedules.

Transition course and clinical pass rates for LPN-to-RNstudents who were mentored as opposed to nonmentoredstudents were compared as were enrollment in the subse-quent nursing course within 1 year and program completion(Table 4). Neither the transition course pass rates nor theenrollment in the subsequent courses indicate a significantdifference between the groups. However, it is noteworthythat students participating in the mentoring program weremore likely to persist to program completion.

5. Limitations

Limitations of the study include the relatively smallconvenience sample size. A larger and more diverse sampleis needed to adequately assess the outcomes of this program.The voluntary enrollment in the program is also a concern asit is entirely possible that the students who participated in theprogram were the more motivated students who were alreadymore likely to persist in the program.

6. Discussion and plans

Mentoring programs serve as a viable strategy forfostering student integration into both the social and

153LPN to RN

academic domains of an institution. Student success isfostered in an environment of caring, supportive faculty.Although the results of this study were inconclusive as towhether a structured faculty-directed mentoring program hasa significant impact on retention or progression from LPN-to-RN courses into subsequent ADN courses or programcompletion, it is noteworthy that the program itself wasperceived as valuable and effective in promoting successwithin this unique student population. Results of this studywere shared with all ADN faculty, and plans were made toreview and improve audiovisual holdings and to make upperlevel student laboratory assistants available for skillsremediation for the LPN-to-RN students. Plans for thisprogram include continued use and assessment with theLPN-to-RN transition students and possible implementationwith all ADN students at the institution.

References

Andrews, M., & Wallis, M. (1999). Mentorship in nursing: A literaturereview. Journal of Advanced Nursing, 29, 201−207.

Assessment Technologies Institute. (2000). Technical manual for the SelfAssessment Inventory. Overland Park, KS: ATI.

Bean, J. P., & Metzner, B. S. (1985). A conceptual model of nontraditionalundergraduate student attrition. Review of Educational Research, 55(4),485−540.

Bers, T., & Smith, K. (1991). Persistence of community college students:The influence of student intent and academic and social integration.Research in Higher Education, 32, 539−556.

Candela, L., Cyriel, D., Kowalski, S., & Warner, D. (2004). Meeting the at-risk challenge: Empowering nursing students through mentoring.International Journal of Nursing Education Scholarship, 1(1), 1−13.

Colalillo, G. (2007). Mentoring as retention strategy in a diverse,multicultural, urban associate degree nursing program. Teaching andLearning, 2(2), 28−33.

Donovan, M. S. (1989). The “high-risk” student an ethical challenge forfaculty. Journal of Professional Nursing, 29(9), 412−414.

Finke, L. M. (2005). Teaching in nursing: The faculty role. In D. M.Billings, & J. A. Halstead (Eds.), Teaching in nursing: A guide forfaculty (pp. 3−20)., 2nd ed. St Louis: Elsevier Saunders.

Jeffreys, M. (2001). Evaluating enrichment program study groups:Academic outcomes, psychological outcomes, and variables influencingretention. Nurse Educator, 26, 142−149.

Jeffreys, M. (2004). Nursing student retention: Understanding the processand making a difference. New York: Springer Publishing.

Jeffreys, M. (2007). Nontraditional students' perceptions of variablesinfluencing retention: A multisite study. Nurse Educator, 32(4),161−167.

McGann, E., & Thompson, J. (2008). Factors related to academic success inat-risk senior nursing students. International Journal of NursingScholarship, 5(1), 1−15.

National League for Nursing. (2006). Registered nurse graduates by programtype. Retrieved from http:www.nln.org/research/slides/pdf/AS0607_14on September 25, 2009, 12:43 pm.

Ohio Nursing Collaborative for Educational Mobility. (2003-2005). OhioNursing Articulation Model.

Shelton, E. (2003). Faculty support and student retention. Journal ofNursing Education, 42(2), 68−76.

Smith, V. (1990). Nursing student attrition and implications for pre-admission advisement. Journal of Nursing Education, 29(5), 215−218.

Tatem, E., & Payne, J. (2000). The impact of a college of nursing retentionprogram on the graduation rates of nursing students. ABNF Journal, 11(3), 59−63.

Tinto, V. T. (1975). Dropout from higher education: A theoreticalsynthesis of recent research. Review of Educational Research, 45(1),89−105.

Tinto, V. T. (1993). Leaving college: Rethinking the causes and cures ofstudent attrition, 2nd ed. Chicago: University of Chicago Press.