By Seena Simon

Nationally, there’s a shortage of nurses, and it’s getting worse. Current estimates are that there will be a 20 percent shortfall in the number of nurses needed by 2020. Obviously, the country can’t afford to lose any qualified student who wants to be a nurse. For that reason, the UTMB School of Nursing (SON) is trying to boost the odds that students vying for a Bachelor of Science in Nursing (B.S.N.) degree actually graduate.

So far, approximately 12 to 14 percent of the students who have entered UTMB’s B.S.N. program have dropped out before completing it. SON administrators believe that most students who withdraw during the first semester do so because they discover that the nursing profession just isn’t for them. But to dissuade those who might leave the first year or later for preventable reasons, SON officials are attempting to address their problems in advance by, among other approaches, providing more guidance counseling, offering lectures on time management, and teaching the latest information technology. In addition, nursing students now may opt from the start to lighten their weekly coursework load by taking three years instead of the traditional two to complete their degrees.

Students entering in the fall 2004 B.S.N. class now carry handheld personal digital assistants (PDAs)—Palm Pilots and similar devices—that can put clinical reference databases at students’ fingertips. To assess pertinent information, instead of thumbing through a hefty textbook, students evaluating a patient at the bedside now may refer to their wallet-sized PDAs. To enhance patient safety and ensure more accurate treatment, nurses no longer need to rely on memory alone, said Trish Richard, SON assistant dean for nursing informatics and distance education. PDAs allow students to double-check medical information, such as drug dosage.

These innovations recognize that nursing students and the way health care is provided have changed. Their goal is to help nursing students stay on track toward graduation, said SON associate dean of student affairs and admissions Ruth Marcott.
In the past, some nursing students have struggled with the program. Today’s students often lead complex lives. Many are older. Some have family and other responsibilities. The coursework may be harder than the junior-college curriculum that many SON students are used to. Sometimes students can’t juggle jobs or family responsibilities with the heavy time commitments demanded by clinical rotations. The nursing education program must help students meet their goals while maintaining busy lifestyles, Richard said.

UTMB is receiving some financial aid to help SON students overcome these hurdles. It has won two grants from the Texas Higher Education Coordinating Board and the Texas Gulf Coast Workforce Commission totaling about $305,000 to help retain students. That includes $276,000 from the Texas Higher Education Coordinating Board for projects to better familiarize students with information technology. SON officials think that today’s students, who have grown up with the Internet and video games, will benefit from a technology-friendly curriculum. In addition to textbooks and lectures, many may need three-dimensional animation or “learning objects” such as PDAs that serve as electronic references with guidelines on drugs or diagnoses, said Zena Mercer, an SON faculty associate who instructs students in new technology. Other methods range from streaming video or online calculators to interactive methods such as patient-simulation mannequins.

“The students have changed,” Marcott said. She continued: “They don’t think in black and white. They want their learning aids in color, and moving, and with music. What we’re trying to do is tap into the different learning styles of today’s students.” For example, students in a class on pathophysiology (the study of functional changes brought on by various diseases) might better absorb material with multicolor web-based animation that integrates embedded images, sounds, movies, and text to show how a failure of the left side of the heart is different from a failure of the right side of the heart. The animation also might include interactive pop quizzes that students can take immediately after viewing the image of a moving heart.
The SON curriculum also is adapting to changes in health care. Because hospital stays now are shorter thanks to managed care, a patient may be out of the hospital before a student nurse gets much of a chance to observe him or her. The grant from Texas Higher Education Coordinating Board includes about $20,000 to keep the patient simulation center open evenings and weekends. Increased time with mannequins that mimic patients’ symptoms and conditions will better hone students’ clinical skills, Richard said.

“Health care technology is exploding at an exponential pace,” Richard said. In this environment, she added, students who are comfortable using information technology are more likely to succeed. Last May, three months before incoming B.S.N. students’ first semester started, Richard led a week-long information-technology “e-Camp” for them. There, students were assessed on their ability to do advanced Internet searching and to develop PowerPoint presentations. They also attended a lecture on managing time. Moreover, the students were taught study skills and about working in groups with students who have different learning styles. The e-Camp also featured social events, consistent with the belief that friendships and camaraderie help provide the moral support students need to succeed.

E-Camp put incoming students in touch with their faculty advisors months before the students formally entered the degree program. Since fall 2003, the SON has had a full-time academic advisement coordinator, Lana Payton, serving as the liaison between students and their assigned faculty advisors. This early intervention already has helped some students, said Payton, who has counseled some students on issues such as time management and who has put others in touch with faculty to steer them onto the right path.

Most students seeking bachelor’s degrees in nursing are older than freshman students at typical four-year colleges or universities, and many have families or jobs. In fact, about 80 percent of UTMB’s B.S.N. students are older than twenty-one. About 17 percent are between ages twenty-six and thirty. Still others are in their thirties or older. Nikki Crouch, a resident of Angleton returning to school after raising four children as a housewife, said she found the e-Camp sessions “very beneficial.”

As noted, another option being tried is to let B.S.N. students decide up front whether to do a three-year program in lieu of the customary two-year track. (Previously students were switched to the three-year program only after they were already faltering.) The three-year course costs an extra $610 in tuition and fees, plus living expenses for the three additional semesters. In fall 2003, only eight incoming students enrolled in the three-year program. The number jumped to twenty students in fall 2004. With more students across the country returning to school mid-career or attending school part-time while working, taking extra time to finish a college degree has become a common experience.

“It’s not a stigma anymore,” Marcott said. “It’s a way to do it that’s realistic. The goal is to get them through the program successfully.”