Needl Lpn to Rn Program Evaluation

September 2012, Jane Lister Reis, Evaluator

NEEDL LPN TO RN PROGRAM EVALUATION

SECTION 1: STUDENTS AND SURVEY INFORMATION

1. NEEDL Student Demographics (24 students) a. Gender 7 Men (30%) 17 Women (70%) b. Race/Ethnicity 14 Caucasian (58%) 10 Students of Color (42%)

Last Name First Name Gender Ethnicity Anamelechi* Tochukwu M African immigrant (coded as African American) Asfha* Selamawit F African immigrant – (coded as “other race”) Baharudin* Roziawati F Asian Butts Desiree F Caucasian Curtis* Lori - Ann F Caucasian Furlong Elizabeth F Caucasian Gibbs Mark M Caucasian McGuire Travis M Caucasian Olivares Annelaraine F Asian Omotuyole* Benson M African immigrant (coded as African American) Oung Joanne F Asian Pac Denise F Caucasian Peltzer Christine F Caucasian Riewe* Thidarat F Asian Robinson* Brian M Caucasian Severide Shane M Caucasian Ta-Asan Kathryna Marie F Asian Torres Stefan M Hispanic Tufui Litia F Hispanic (coded as Asian) Wachtler Tami F Caucasian Walker Tammy F Caucasian (not coded) Williamson Breanne F Caucasian Willis Kristen F Caucasian Wilson Megan F Caucasian c. Students who didn’t graduate and/or complete the LPN to RN NEEDL program *7 students (29%) did not complete the program. Five (5) of these 7 students were students of color (71%).

1 September 2012, Jane Lister Reis, Evaluator

2. Evaluation Methodology

Twenty-four (24) students were emailed asking them to participate in an evaluation of the NEEDL program. Students were given three choices on how they could participate:

a. online survey (using Survey Monkey) with three questions

b. on-site focus group

c. face to face personal interview

Thirty-six (36) NEEDL nursing faculty were also sent an email asking them to respond to the same three questions with one additional question added by the dean (see question #4, page 6).

3. Number of Respondents

a. Nine students (38%) responded to the online survey.

b. Three students (12.5%) asked for a personal interview.

c. Eight faculty (22%) responded to the online survey.

SECTION 2: ONLINE SURVEY - THEME ANALYSIS (STUDENTS AND FACULTY)

QUESTION 1: WHAT WORKED WELL? (FULL RESPONSES ON PAGES 6-7) THEMES NUMBER OF STUDENT NUMBER OF FACULTY RESPONSES RESPONSES Flexibility (online format) 5 (56%) 2 (25%) Helpful/Knowledgeable 3 (33%) 1 Instructors Extra time in clinicals 2 (25%) Tegrity 2 (22%) 1 Communication 1 4 (50%) Provision of Course Materials 1 0 Course Organization 1 0 Having previous instructor 1 talk about students; care plan; math assessment Support of Program Manager 1 0 Materials related to exams 1 0 Clinical Sites 1 1 Tutoring Help 1 On-Campus Lectures & Labs 1 QUESTION 2: WHAT DIDN’T WORK WELL? (FULL RESPONSES ON PAGES 8-9) THEMES STUDENT RESPONSES FACULTY RESPONSES Too many books (reading 2 (22%) 2 (25%) amount too high) Clinical Labs: more time, 3 (33%) 2 (25%) long hours, too rushed, better arranged for more hands-on learning and practical demonstrations; skill check list provided earlier to faculty Not having face to face 1:1 3 (33%) 2 (25%) with instructor Some instructors 2 (22%) Fully online format (includes 1 2 (25%) email) ANGEL (down time) 1 Lack of lectures 1 Quality of lecture notes 1 Case Studies – not relevant 1 PowerPoint – lacking content 1 Too much homework and 1

3 September 2012, Jane Lister Reis, Evaluator tests in too short of period of time Tests not related to reading 1 Faculty teamwork and 1 guidance to support students Course Design 1 Instructions for students and 1 timely feedback Lack of certain clinical sites 1 QUESTION #3: WHAT CHANGES DO YOU SUGGEST? (FULL RESPONSES ON PAGES 10—13) THEMES STUDENT RESPONSES FACULTY RESPONSES More online video lectures (with 5 (55%) lecture notes) Instructors – Quality & 3 (33%) Consistency; Teachers as Trainers More class time on campus. 2 (22%) Less online – suggest hybrid. More days, but short for lab. LPN program face to face; RN 2 (25%) program online or hybrid Prepare students for what is 1 expected of them at clinical sites (what is failure) Better prepare students for the 1 challenge Redesign clinicals for more 1 training and skill development Plan to support students’ 1 learning (don’t let them drop out) – extra training and assessment Create shadow program at 1 students’ work site to assist clinical skill development (preceptor) Fund tutors for students taking 1 tough classes Stay in touch with students; 1 visit clinical sites Reduce work hours to 0.4 FTE 1 Better funding 1

Consistent online audio/video 1 lectures

Union involvement needs to 1 improve Connect PPT to tests 1 More class time 1 Structure courses more closely 1 to the on campus program, including lab and clinical Skill testing in lab sessions 1 similar on campus cohort Improved communication, both 1 between instructors teaching in the same quarter (so the student work load is more evenly distributed) and between clinical and theory instructors. Improved communication 1 between on-line theory instructors and students. Learn better communication via 1 email (netiquette) Consider more face-to face time 1 in lab. Students needed more time in 1 the clinical settings: 1) Create less on-line educational material for them and balance it with some in class lectures. 2) Create several lab sessions for them so they can practice the skills. 3) Have the same faculty that teaches the class do the lab sessions with the students. 4) Allow more clinical days for the students. 5) Allow more social networking for the students so they can support each other in order to make it through. On- line social networking is very crucial for these students.

6) Provide more faculty support in the clinical setting and on-line setting.

QUESTION 4: (FACULTY ONLY): What human resource was needed in order to effectively implement this program? (Human resource is defined as: time-effort, availability of time to commit to mentoring, administration, preparation for courses, student-faculty ratios, available faculty personnel to teach, etc.) See Page 14 for faculty responses.

QUESTION 1: What worked well in this program to support your learning? (themes highlighted)

A. SUMMARY OF STUDENT RESPONSES  Flexibility with schedule, online video/audio lectures at the end of the program

 It helped many hospital workers to become nurses.

 Effective communication among teachers and student. Materials that are related to and consistent to the test/exam.

 The fact that it was an on line program made it possible for me to participate in it, its flexibility with my schedule at work, and opportunity to plan my own study hours enabled me to control my schedule and study time to a reasonable extent. The provision of study materials, lectures, monthly stipends and appropriate texts helped a great deal. Some of the instructors were very helpful, ready to assist if approached. This is the pilot program and so I highly commend the organizers, the school and the instructors for it. Provision of some lectures in audio format on the Angel website by Denise Filiatrault-the lead instructor, for example, was helpful, [it was the only one] this was introduced towards the middle or end of the LPN program. Selection of the right Instructors for any program plays an important role, and we did have some who I consider right for the program: The right instructors here mean the right person with the right knowledge and skill of teaching and training, the patience and tolerance; who is wholeheartedly committed to students’ success rather than just teaching. Denise Filiatrault, Jessica Gonzales, Melanie Jorgenson are excellent Instructors and deserve commendations. Melanie Jorgenson for example is gifted and endowed with the natural ability to teach at clinical labs; what stands out in her is that she has this strong desire to see students succeed and willingness to devote time to teach what a student does not understand without losing her cool. She just wants to see students succeed, she is just fantastic. An instructor like her is a great asset to the program. In the campus, having someone like Belinda Tillman as the NEEDL Program Manager was an excellent decision. Belinda was always available for consultation and assistance in helping you navigate around difficult issues and administrative matters that students found difficult to handle. She inspired me and other students; and was always willing to help locate appropriate resources that would enhance student performance in the program.

 The flexibility of the online class has helped me manage my time well.

 Accessing information online and learning online.

 In general, the ability to learn via an online format. This enabled me to work and attend class although it was at times challenging.

 Course outlines of assignment deadlines in syllabus and for view on calendar in Angel -Unit outlines to guide learning/reading/highlighting most important information regarding that system -Skills labs -Clinical sites were for the most part appropriate to our learning -Flexibilty of when we could take our unit exams -Tegrity -Theory instructors for the most part were all very flexible and encouraging (Denise, Marti) –

B. SUMMARY OF FACULTY RESPONSES (themes highlighted)

 flexibility of office hours and tutoring help

 clinical experiences, on-campus lectures and labs

 I appreciated the online availability. it was nice being able to talk to the students and super easy to do online.

 Communicating often with them and having them on campus as much as possible.

 Effective communication

 Extra time provided in clinical was very helpful for student learning.

 I cannot think of anything other than having the previous instructor talking about the students. Short care plans worked for the students but still they were very confused what they needed to do. The math exam helped to assess the students strength and weakness and it was helpful to guide them better.

 The interaction that the students had with Denise Filiatrault worked well, but I think Denise went above and beyond the call of duty to make the students feel connected. I think the Videoed lectures that Denise provided worked well. I also think the all day labs were effective.

QUESTION 2: What didn’t work well (to support your learning)? (themes highlighted)

A. SUMMARY OF STUDENT RESPONSES  Lack of lectures during most of the duration

 Limited face- to- face interaction between the students and the instructors, especially, in the theory portion. Students have to read a lot. To many case studies with limited realistic approach. Long hours for labs.

 Too many homework and test not enough time to absorb material especially when student are working at the same time. Not enough lab time, or lab time is too rush to do individual hands on Teaching materials such as power point lack the important content, usually insufficient information. Too many books to study from. Full time Online classes do not work for me.

 The fact that it was an on line program presented a natural challenge and so required well prepared lectures notes by instructors to guide students success. Some instructors lecture notes, in my opinion were not prepared in such a way that students who are basically doing this program on line would grasp the most important details needed for success. The quality of lecture notes should be of the highest standard bearing in mind that the instructors may not have the chance of seeing the student and vice versa. Lecture notes must address the critical areas of the subject- the "why and how" of each topic. The clinical labs needed more time and practical demonstration. The clinical aspect of the program needs better arrangement so that there will be more hands-on training, demonstrations at clinical labs, to enhance student’s knowledge and performance at clinical sites. Inadequate clinical labs practice was a challenge to me.

 It would have been nicer to have more face time with our instructors, meaning more classes on campus.

 Not having the 1 on 1 with the instructor.

 Not all instructors had the same level of commitment to teaching the courses. The content that came from Lower Columbia Community College appeared to be not reviewed or correlated with reading and some of the testing really was not related to the reading creating a challenge.

 -Lack of pediatric clinical sites -Lack of clinical opportunity in areas such as ED, ICU -Some theory instructors gave the vibe that they did not care about our success and were impersonal

B. SUMMARY OF FACULTY RESPONSES: (themes highlighted)

 confusion with ANGEL, downtime of systems

 volume of reading required

 the most problems I had was also with communicating via email. sometimes the etiquette was off and wrong impressions were given which led to tension. definitly meeting the students face to face at least once helped out.

 Too much reading and not enough time with theory instructors.

 Confusion is instructions for students from their theory was very challenging. Also, students reported that they didn't get their questions adequately answered nor in a timely manner regarding their online theory for Family Nursing (OB and Peds)

 The clinical days were very short. These students needed more clinical hours. The skill check list should have been provided to the faculty much earlier so they student could have more time to work on the skills. Many students were doing a lot of skills for the first time and that is very sad for the last quarter of med-surg before graduating. The faculty team work and understanding and guidance to support the student. The previous faculty knew the students very well therefore that information about each and everyone helped me to know them better and ways to approach them.

QUESTION 3: WHAT SUGGESTIONS DO YOU HAVE FOR CHANGING THE PROGRAM? (themes highlighted)

A. SUMMARY OF STUDENT RESPONSES:

 Consistent online audio/video lectures

 More class work in the school. More days, but short for labs.

 Consistency among instructors. Teaching material such as power point should contain information relevant or apply to the test/exam and help one to learn. More class time.

 It has been said that the greatest room in the world is the room for improvement. By all standards I consider the program a success. Well, as we all know, “the road to perfection is always under construction” here are some suggestions for improvement. Select more Instructors who are dedicated to the nursing profession, and have demonstrated previous commitment to student's success; Instructors who are willing to go the extra-mile to assist students to succeed. This program needs Trainers not just Teachers. The essence of training is learning. Take this: A program like this requires instructors who will say to themselves “If my student hasn’t learned, I have not taught." It requires Instructors who will treat all students equally and assist them develop confidence in themselves, and in their chosen career. While teaching, they should always bear in mind that every student is different. Online video-with lecture notes: Instructors should be made to provide online video lectures to assist students- this would make this program a huge success and one of the best around here. Lecture notes and books alone are not enough, we are dealing with people's lives and we need to do it right. Getting it right the first time is very important. Knowledge is essential, and combination of lecture notes with online video lectures will be an excellent improvement. How about having 1 -2 days each quarter for students to meet in the class room with each instructor for a face to face chat and ask questions?

 Prepare all future students for the challenges ahead.[This was done but requires more emphasis with new students] Tell them all the hard truths they need to know to succeed- this program is fast-paced: May be reducing working hours to 0.4 FTE. to enhance concentration and performance would not be a bad idea. Funding is required, to give little more stipends than is currently applicable. This I know is a hard nut to crack and may continue to be a challenge to the program.

 Success at clinical sites: Inform students ahead of time what would constitute failure at the clinical sites and prepare their minds on what the remedies would be. Instructors are at clinical sites in my opinion to ensure student's success as well as guarantee patients safety. A new approach to student's in ability to perform certain skills at clinical sites is needed. Inability of student to perform to instructors’ standard at clinical site in my opinion indicates need for more training and skills development- a

major reason why the student is in school, and why Clinical Instructors are on site. The current approach adopted creates fear in students rather than making them look forward with joy and happiness to clinical days, they go with fear and trepidation[Not all Clinical instructors in my experience do this, just that you need only one instructor to mess you up and you are done]. Students should not be in this mode for clinical. Organizers of this program should have a plan to handle and provide opportunity for such students to relearn and move on rather than dropping out. It is not enough to get students into the program; even if a student has to drop out, shouldn’t the school, the organizers and the student(s) have a little conference to see possible ways of helping the student succeed? This is hard to take but a student’s failure indicates more than shortcomings on the part of the student alone. How about providing extra training and assessment of such student to demonstrate required skills to ensure compliance rather than allowing students to drop out of school. Such student needs training and NOT dropping out of school. A win-win approach is needed here in my opinion. The question should be" how do we help such students to do the excellent job that is required of them ; how about setting up skills program he /she has to attain to be able to complete the program rather than dropping out of school. This requires attention because the chances of this occurring in every cohort group are ever present. If there is a will on the part of the school and organizers of this program, there will be a way.

 How about a "shadow" program at the student's place of employment as part of this program. This could be made possible thru their employers to assist student develop clinical skills. If they “shadow" along, while in the program, this will enhance clinical skills development and help perfect performances.

 An idea from the education fund: An excellent approach is that which the education fund make tutors available for students taking "tough classes" it works wonders! If this program is seen as partnering with a school for students success, charge selected instructors for this program with students success, let them know they have to pay attention to not only the best students, they need to focus attention on students who are considered above average too.[This may be a problem if the school is seen as doing the organizers of NEEDL a favor by admitting their students]. Permit me to borrow the saying of one of the most caring person whoever walked on the surface of the earth- The Lord Jesus Christ who said “I did not come because of those who have eyes but to give sight to those who cannot see”. Above average/average students are just like those who have eyes but are not seeing clearly, a second touch might be needed from their instructors. I see nurses at work who said they were just average students in their program but who are excellent nurses in practice. Everyone deserves equal chance. [This does not relieve the students of the obligation to work hard to succeed in the program].

 Stay in touch with students as always to know if they are having challenges, visits to clinical labs session will help here. Students are likely to discuss their academic challenges in such situations. In the final analysis, I am short of words to fully appreciate all the people that have taken part in putting this program together. They should be very proud of their achievement. It has been said that there are three types of people in this world; those who watch things happen, those who ask “what happened?”,

and those who make things .Y O U ALL MADE THIS TO HAPPEN … THANK YOU!!!

 The Tegrity video that Denise F. put out was as huge help for us since we don't have a lot of face time with our instructors.

 All lectures available on Tegrity.

 My initial suggestion would be to set a different level of expectation regarding the union involvement. Telling people that the union was working with our supervisors to make sure we would be allowed to attend classes and clinicals just wasn't realistic. My manager was never contacted and had no idea about this program. Unfortunately another result was constant complaining about I need to work I can't do this or that. The reality is we are in school, work can't be an excuse when this was supposed to be a priority commitment.

 -More time in classroom and less online, more like a hybrid, so areas of importance can be highlighted. -More tegrity videos -Online instructors that actually want to teach online

B. SUMMARY OF FACULTY RESPONSES  course prep time

 since I only had 2 quarters of conntact with the students early in the program, I don't feel I have the perspective to offer suggestions for change.

 i am not sure if there can be any suggestions. learning to communicate via emails is tricky and etiqutte and directions need to be empahsized.

 I recommend that we do the online or hybrid program for RNs only, after they have been in a traditional face to face LPN program.

 Courses could be structured more closely to the on campus program, including lab and clinical. NEEDL had two consecutive quarters away from medsurg clinicals, would not recommend this for future online program. Also, recommend skill testing in lab sessions similar on campus cohort. There seemed to be a lot of confusion about the PN boards, going forward the requirements could be more clearly stated to understand that either the boards are required or are not required, this cohort had some extenuating circumstances that were not identified early on.

 Improved communication, both between instructors teaching in the same quarter (so the student work load is more evenly distributed0 and between clinical and theory instructors. Also, improved communication between on-line theory instructors and their students. perhaps also consider more face-to face time in lab.

 These students were very slow in clinical and they needed more time in the clinical settings. My suggestions are as follow: 1) Create less on-line educational material for them and balance it with some in class lectures 2) Create several lab sessions for them so they can practice the skills 3) Have the same faculty that teaches the class do the lab sessions with the students 4) Allow more clinical days for the students 5) Allow more social networking for the students so they can support each other in order to make it through. On-line social networking is very crucial for these students. 6) Provide more faculty support in the clinical setting and on-line setting.

 I think the LPN portion of the program needs to be on-campus, and the RN portion online.

QUESTION 4 (FACULTY ONLY): WHAT HUMAN RESOURCE WAS NEEDED IN ORDER TO EFFECTIVELY IMPLEMENT THIS PROGRAM? (HUMAN RESOURCE IS DEFINED AS: TIME- EFFORT, AVAILABILITY OF TIME TO COMIT TO MENTORING, ADMINISTRATION, PREPARATION FOR COURSES, STUDENT FACULTY RATIOS, AVAILABLE FACULTY PERSONNEL TO TEACH, ETC.)

SUMMARY OF NURSES RESPONSES

 exp.on-line instructors

 I think a ratio of 1:8 for lab and clinical is maximal. Since my exposure was lab and clinical, I can't comment on administration or availability of faculty personnel.

 time preparing for classes is crucial.

 Every human resource mentioned above! Time, commitment, availability, preparation, faculty, clinical sites, laboratory, classrooms, patience and diplomacy in working with outside entities, like unions and training fund.

 Recommend an additional full time faculty dedicated to the NEEDL program, we tried to manage an additional cohort without adding a FT faculty member

 Preparation for clinical was a great assistance. Student ratio (5 students per clinical group) provided excellent learning opportunities with increased instructor/student interaction time.

 I was not involve in this part of it. if anything they experienced less human resource need throughout this program.

 an incredible amount of mentoring, consultation regarding stress managment, course prep, time management. The students were really challenged with applying what they read to real world situations. I think a lot of sucess in nursing programs compes from interaction with fellow students and instructors. This is what this program lacked. I also feel like WAY to mush responsibility was put on D. Filiatrault to make this program a success.

SECTION 2: PERSONAL INTERVIEWS (FACE TO FACE OR PHONE)

Face to Face Interview I – student who did not graduate Student interview took place at Barnes & Noble, Northgate, September 4, 2012 Julia Ramos, Case Manager of the NEEDL program at SEIU Training Fund was present.

What worked well in the NEEDL program to support you as a learner?

 Increased understanding and empathy for what nurses go through on a daily basis

 Shifted perspective – could begin to understand the demands put on a nurse

 As a CN-A, now able to help the nurses

 With additional knowledge from the program, student was able to more fully understand the complexity of skills needs in a nurse/patient relationship

 Critical thinking and judgment skills have improved dramatically – able to assess clinical situation more fully rather than just from a CN-A perspective

 Able to take better care of patient as a CN-A

 Addition of Tegrity provided greater learning potential for student.

What didn’t work well to support you as a learner in the program?

 Because the clinical part of the course was short (only 2-3 hours/week), student needed more time in the clinical labs to practice the skills required.

 The high demand/intensity and pace of the clinical environment caused anxiety and therefore loss of confidence (student stated that this was shared by most students). Student felt you had to be perfect. Mistakes were seen as egregious rather than opportunities for deeper learning. Stated that fear and high anxiety stopped the learning process.

What suggestions do you have for change?

 Make the clinical experience more of a learning environment – like the classroom.

 Allow mistakes which provide “teachable moments” for the student to realize error and support deeper learning of the need to be careful

 Need theory and clinical instructors together in the clinical environment to support students in their learning; theory instructor could see what students are missing or not understanding to support deeper learning

 Need supportive environment to learn. Learning curve is steep but there’s a great deal of will by the students to succeed. Provide deep academic support for students in a rigorous yet supportive environment.

 Have the lectures focus on the key concepts and/or skills from each chapter – what are the most important skills and concepts for students to master?

 Support the teach/demonstrate/apply model of learning. Clinicals support theory as part of the overall learning process.

What suggestions do you have for the Training Fund and/or college?

 Have a stand-by instructor who is thoroughly versed in the subject area to be able to step in and provide content support as needed.

 Pre-teach critical thinking and critical reading skills to prepare students for the high amount of reading

 Provide tutors for weekly small groups of students to discuss reading. Tutors could facilitate group and assess student learning in particular areas. This information could be shared with case manager who could work with tutoring staff to provide additional support as needed.

 Have a clinical lab open for students to practice. Need much more practice time. Students are aware of the life/death situation in nursing. They want to get it right. Just need more practice time.

 Assign a preceptor to students in their own clinical setting so that they have someone who will mentor/support their learning process. This would tie their everyday working experience to the class. Students would become more critical learners and observers of what nurses go through and need as skills.

 Make sure clinical instructors are as available as the theory instructor.

Face to Face Interview 2 – student who graduated

Interview took place at Starbucks, Northgate on September 11, 2012. Belinda Tillman was present.

1. What worked well (to support your learning)?

 Financially accessible. As a single person, the grant was able to cover my book and tuition costs. Couldn’t have done the program without this kind of support.

 Working in healthcare, I came into the program with a base knowledge of the terms and concepts in healthcare.

 Tegrity (although student commented that it would have been better if it had started earlier)

 Lead clinical instructor – great listener

2. What didn’t work (to support your learning)?

 Disorganized/fragmented program – no one seemed to talk with each other; emails would come from different places where knowledge should have been shared. Communication breakdown.

 Students didn’t know their instructor. Would show up at clinical site not knowing who the instructor was or looked like.

 Many instructors didn’t know how to use Angel.

 Clinicals – nightmarish lack of organization. Some clinical faculty didn’t support student success. Why were they teaching?

 Amount of reading – because student had to retain health benefits and pay living expenses (continued to work at .075 FTE), they found the reading amount to be exhaustive. (Student commented that they were a fast reader.)

 Loss of a life – because school took so much time (besides work), student found themselves in a burn-out situation – health, relationships, etc. Quality of life diminished.

 Third quarter labs – seemed as if college needed to fill time. Some skills were checked off in 2nd quarter; not needed in 7th quarter. Could have used time for other things.

 Go more in depth on each subject matter rather than learn a little about a subject in the LPN curriculum only to return to it later in the RN curriculum.

 Students heard all of the time that the curriculum issues were Lower Columbia’s fault. Didn’t model the same level of accountability expected of students.

3. Suggestions for change

 More institutional accountability. Student wanted to provide faculty evaluations for each quarter.

 Listen to your students. When they are upset, it’s because something needs to be addressed. Students became afraid of pushback or in some cases retaliation. Creates stressful learning environment.

 Treat us with respect and as adult learners.

Personal Interview 3 – student who did not graduate

Interview took place over the phone, September 11, in Belinda Tillman’s office.

When asked about what worked well, student began talking about what didn’t work well:

 Online stressful – some things better done in person

 Had to work .75 FTE in order to keep medical benefits

 A lot of homework; overwhelming; a lot of reading to prepare for tests on Saturday/Sunday

 Some instructors were available to answer questions; others not.

 PPT in the LPN section were better – related to tests

 Concepts better explained in person

 Online is not a good way to learn

 Experienced burn out

 Clinical experience very stressful; between work, study and clinicals only sleeping a few hours a night; became very stressed for fear of making mistakes; felt not prepared; wanted to do well for the patient

 “Shattered” – confidence went down in program; currently rebuilding confidence by working as an LPN and receiving cross-training

Suggestions for change:

 Have students stop at LPN and work for a quarter to build confidence, passion for patient care and skills before getting RN degree

 Always ask, “did I do okay for my patient?”

 Create consistency among instruction – some students receiving different levels of homework than others