Incivility in nursing education has become an increasingly bothersome problem; however, it has especially become a nuisance in online education. Suplee, Lachman, Siebert, and Anselmi (2008) indicated that a faculty witnesses daily encounters in classes and clinical settings. Incivility is defined as behavior that is unprofessional, rude, and disrespectful. It can result in burnout and psychological and physiological distress for the parties on the receiving end, especially if left unaddressed (Butler & Strouse, 2022).
Another term that has especially been seen in the online realm is bullying, which can occur student-to-faculty and faculty-to-student. Unfortunately, it can also occur in faculty-to-faculty (Butler & Strouse, 2022). There has been an increase seen in student-to-faculty students’ displeasure with their achieved grades.
We must evaluate the reasons that the behavior is happening.
Stress from many walks of life can be the culprit, including working too many hours, mismanagement of work-life balance, stressful work assignments, financial strains, relationship strains, biases, and so on. Butler and Strouse (2022) also indicated that burnout and demanding workloads contribute to the greatest stressors. Personally, I have observed these behaviors displayed when providing constructive criticism. How can we, the faculty, help to ease the burden and create the traditional professional environment that many of us were able to participate in our educational journey?
As a part of a nursing faculty for ten years, I feel it is my calling. I enjoy helping deploy educated and competent novice nurses and advanced practice nurses into the workforce. However, the stress and incivility sometimes make one feel burned out. Many of us ponder going back into the clinical setting, feeling unappreciated and undeserved.
Caputi (2015) reported that the faculty can assist students in engaging in constructive evaluation of themselves and others. One factor is professional maturity, which can allow the students to analyze their own performance. As a faculty, providing feedback that is useful in the workplace and not hurtful can be helpful for growth and development. Self-reflection and guided introspection can be useful (Caputi, 2015). Discussing values, morals, attitudes, and the AACN essentials, pertaining to professionalism and leadership can be useful in developing students with incivility and assisting students in understanding (Caputi, 2015). However, the most important element is support from the administration and the appropriate follow-up and disciplinary actions.
In the world of nursing, consistent rates of students graduating from nursing programs, becoming licensed, and successfully entering the workforce are critical to the long-term viability of the nursing profession and the healthcare system itself. As the true lifeblood of healthcare delivery, nurses are central to patient care, from long-term and public health to acute care and home health. In that regard, nursing education is a pipeline to the future.
Nursing School Capacity
In May 2023, the American Association of Colleges of Nursing (AACN) released data showing that student enrollment in entry-level baccalaureate nursing programs decreased by 1.4% in 2022, the first decrease in 20 years. Overall, 844 colleges and universities offer a BSN education, and many turned away thousands of qualified candidates due to a lack of clinical training sites and faculty. In 2022, 66,261 candidates were rejected, and in 2021 applications by 76,140 candidates were turned down.
Alongside these disappointing numbers in the entry-level BSN category, the AACN identified other factors:
Enrollment in RN to BSN bridge programs has been declining over the last 4 years.
Master’s programs have seen a 9.4% decrease since 2021.
Nursing PhD program enrollment shrank 4.1% from 2021 to 2022.
DNP program enrollment is at a virtual standstill.
When it comes to nursing school capacity, there’s plenty of evidence that something isn’t right. This statement from an October 2021 article by National Public Radio says a great deal about one major hurdle: “One of the biggest bottlenecks in the system is long-standing: There are not enough people who teach nursing. Educators in the field must have advanced degrees yet typically earn about half that of a nurse working the hospital floor.”
Becker’s Hospital Review reported in August 2023 that the California Hospital Association and the Service Employees International Union (SEIU) have teamed up to introduce a bill that would hold community colleges accountable for reserving 15% of enrollment slots for healthcare workers looking to advance their education and move into higher-paying career tracks like nursing. Whether this bill can make it through Congress and become law is unknown.
The U.S. Department of Labor has issued $78 million in grants to expand nursing school enrollment in 17 states. The state of Maryland has awarded its nursing program grants to boost schools and address the long-standing and worrisome nursing shortage. New Mexico is also expanding its nursing school capacity through support for increased enrollment.
While legislation, grants, and expanding nursing school capacity are all valuable strategies to increase the nursing workforce, we can also keep more grassroots efforts in our sights.
In families from many different backgrounds, a multigenerational tradition of service in the nursing profession is often the norm. Aunts, mothers, fathers, siblings, and others can profoundly influence younger generations’ career choices. When the value of being a nurse is communicated from generation to generation, a familial line of nurses can extend over many decades as additional family members join the profession.
As nurses, speaking proudly of the profession and our work can generate interest in those considering their options. While twenty-first-century nursing and healthcare have enormous challenges, we can also tell the story of how nursing provides endless opportunities and flexibility. Of course, there is the potential to travel and see other parts of the country and see one’s education through to a terminal degree such as a PhD or DNP.
In communicating about the possibilities to be found in nursing, we can point out that, contrary to what the public and the media might think, not all nurses work in the hospital. There are expanding opportunities in the pharmaceutical, biotech, and medical device industries; public health; informatics; nurse entrepreneurship; medical writing; legal nurse consulting; nurse coaching; research; and many other fascinating areas. In the interest of our profession’s growth, we paint an expansive picture for those who think of nursing as solely hospital based.
Pipeline to the Future
Whether a new graduate nurse eventually becomes an operating room nurse, a biotech research nurse, or a self-employed legal nurse consultant, the nursing school remains the pipeline through which that individual must pass to realize their dream. No matter how one person’s professional journey unfolds, it all begins with admission to an accredited nursing program, successfully graduating and passing the NCLEX®, and then receiving a license to practice. The nursing school is the funnel for future nurses of every stripe and interest.
When nursing school capacity is hobbled, our profession and society suffer. Decreased graduation rates translate to a shrinking nursing workforce, staffing shortages, nurses working under stress, and the potential for compromised patient safety and outcomes. Burned-out nurses are more likely to leave the profession and less likely to encourage younger generations to pursue the same career path.
Addressing decreased nursing school capacity is paramount, and we can use our collective genius to find solutions, whether through grants, legislation, and public relations or the direct recruitment of faculty through the offer of increased salaries and improved work conditions.
We must use every available means to secure the flow of fresh talent through the pipeline to the future. Our society and the lives of those within it depend on the quality and quantity of the nursing workforce, and it’s our responsibility to see that the pipeline remains filled with the talented nurses of tomorrow.
For decades, online nursing education options offered nurses a different path to a nursing degree, but the choices were limited. Today’s nurses enjoy nursing degree program choices that provide variations in everything from how and when they take a course to the length of a program.
For many nurses, particularly those seeking advanced degrees, this expansion in online programs allows flexibility to balance work, school, and personal obligations. Despite the proliferation of programs, online coursework isn’t for everyone; some nurses work better in a more traditional classroom-based curriculum. The key is assessing each program you’re interested in, your learning style, and finding a match that sets you up for success.
For nurses considering this path, taking the time to find out essential details is time well invested. “There’s a growing number of online programs, so you have to know what you’re looking for,” says Patricia Bruckenthal, PhD, APRN-BC, FAAN, dean and professor at Stony Brook University School of Nursing, Stony Brook, New York. “You’re making one of the more important decisions in your life, and you have to place a high level of importance on how you’re going to fit that into your life and schedule.”
Assess the Program
Finding a program won’t be difficult, and they should be assessed carefully as any other program. “Students considering an online program should use the same criteria for selecting a program that they would use for assessing a traditional program, including choosing an accredited program, locating programs that will help you reach your professional goals, and finding schools that specialize in your primary area of interest,” says the American Association of Colleges of Nursing (AACN) president and chief executive officer Deborah Trautman, PhD, RN, FAAN.
In addition to considering the school’s reputation and accreditation, students are encouraged to use all the available information about the school and faculty members, says Bruckenthal. “Look at the level of experience the school has with online learning,” she says. “Are there any faculty who are published in online learning? Faculty who are that engaged will know students have different learning styles.”
Evaluate Your Lifestyle
Undoubtedly, online programs give a level of flexibility that makes a degree possible for nurses to juggle many obligations. “Due to the work and family responsibilities, working RNs often benefit from being able to attend class and complete coursework during non-traditional times,” says Mashawna Hamilton, DNP, RN, associate professor and associate director, RN to BSN Nursing at Ohio University, Athens, Ohio.
If students believe online learning offers flexibility, they still have to plan how to fit the class time and all the required work into their day. “It’s important to know what you’re looking for,” says Bruckenthal.
Online learning takes as much discipline as in-class courses. Look at your habits, motivations, and realities to decide if an online program will provide you with more opportunities for success or with unanticipated roadblocks.
Students working remotely must be highly motivated to complete the work when they have other obligations. There are other potential obstacles to be aware of, says Bruckenthal. Do you have quiet and sufficient study space? Do you have childcare if you need it? Is your family willing to take on additional duties such as cleaning or grocery shopping so you can carve out time for school?
Be Ready for a Challenge
Flexibility also doesn’t mean anything is simplified. “The biggest mistake a student can make is assuming that online courses are less rigorous than traditional programs,” says Trautman. “These programs take discipline, strong writing skills, and keen organizational abilities. Students in online courses are expected to answer all questions, provide regular feedback through discussion forums, and complete just as many assignments.”
If you’re looking for a program that fits your criteria, digging a little deeper into the school, the program, admission, and curriculum requirements will give the complete picture you need to make an accurate decision.
Here are some options to consider:
What is the program cost, and how will you pay for it?
What is the average program completion time?
Are online students ever required to be on campus?
What is the curriculum delivery (is it asynchronous or synchronous)?
What do postgraduate career outcomes look like?
What are the technology requirements?
What happens if you need more time to complete the program?
Knowing what happens for students postgraduation—from employment to alum networking—is critical to the whole program. “Students should consider the reputation of the online programs,” says Hamilton. “In doing so, consider comments from employers of previous graduates. What is the graduate employment rate? What accolades has the program received from national agencies?”
When you find a program that fits your learning expectations, schedule, and budget, some final details need clarification before committing to a program.
Trautman recommends contacting each school to assess how the learning format, clinical experience, and academic and professional development supports offered will help you. “School advisors will know what options and assistance is available to offset costs, including scholarships and loan repayment programs,” she says. “The only way to fully know what institution-specific programs are available is to contact the nursing school.”
And when planning when you’ll have that degree in hand, remember the course schedule of each school can vary. An average program completion time can indicate the pace of courses and flexibility, but sometimes required courses are offered only once or twice a year. If you aren’t aware of the schedule, it can derail your expected graduation date. “Students should also inquire about the frequency courses are delivered, the expected time dedication for courses, and requirements for part-time and or full-time enrollment,” says Hamilton.
Evaluating Supports
During your research, find out what assistance is offered to online students. Because a program is online, it may seem more difficult to access help when you can’t just go to a physical office. “The strength of student support programs can significantly impact the student’s success during their academic journey,” says Hamilton.
Good online nursing programs will have support, including online office hours for faculty members, remote technology support, online study, social groups, and even one-on-one student support from the college. Students may want to ask about online libraries, learning labs, online writing help, skill-building webinars, wellness services, and opportunities for online student engagement as well, says Trautman.
And students also have options that are outside the campus to help them succeed in an online program, including professional nursing organizations. For example, master’s and doctoral program students can access a free membership to AACN’s Graduate Nursing Student Academy, which provides focused support opportunities for students in online and traditional programs.
For many nurses, remote degree programs open possibilities and help bring more nurses into the workforce. “Since these programs are generally directed toward individuals who are already licensed registered nurses, most students are working and trying to juggle life’s many demands,” says Trautman. “Online programs make that possible.”
Have you ever felt like the energy you put into studying isn’t reflected in the outcomes you end up with? You aren’t alone. Like any other professional skill, studying is something you need to learn how to do. It might seem counterintuitive, says Regan A. R. Gurung, PhD, but taking the time and effort to learn top study skills is going to help you through school and in your professional life.
“There are two reasons why students need to learn to study,” says Gurung. “First, many of them do not know how to study. Second, many of the ways used to study are not effective. For example, most students believe that if they have time to study they should reread their notes (and data shows this is what they say they do and actually do). This is one of the least effective ways to study.”
Frequently, the study habits that let top students sail through high school will not work in college. And some graduate students find the same–their study skills developed as an undergrad aren’t working in their advanced degree courses.
Gurung says that different types of studying will lead to different outcomes. Students should understand that if they are struggling in a course, it’s not because they are a bad student. “Cramming the night before may help you do well on a test the NEXT day, but you will not remember the material well a week later or a month later,” he says. That’s a particularly important point for nursing students who will face the comprehensive NCLEX exams for licensure. “That learning takes work and can be challenging,” he says.
There are many myths about what good study skills look like, he says, and even some research offers conflicting advice. The most effective study habits will likely include a mix of several approaches so that you cover the bases and begin to think about the material in a different way.
Some top habits include dedicating time and space to studying so that you aren’t trying to do everything in marathon stretches. And this isn’t just a drop-it-in-the-calendar activity. Set aside study time and then protect it relentlessly so that something else doesn’t take priority. What you then do during that time will help you study smarter so that you can actually learn and retain more with less overall effort. It’s not taking the easy way out at all. Developing good study habits and sticking to them is the same as how athletes prepare for big events. You can’t expect to run a hilly race if you’ve only trained on flat ground; you might have been running all the time, but the preparation needs to match the race.
Investigate good study habits to see how they are different and how you can implement them. For example, although rereading material, even with multicolored highlighters in hand, seems like it should work, a better method is using practice tests or even making your own tests and taking them to assess your actual understanding.
As you begin trying new study methods, keep in mind that your old habits are hard to change, and that you’ll need to adapt your new habits to different situations. “One size such as retrieval practice, works for a lot of things,” Gurung says, “but different classes can need different types of approaches.”
As a nursing student, remember that the study skills developed in nursing school are going to be the foundation for your professional approach to learning on the job. “The techniques used to study better also help us understand and retain all kinds of knowledge in all the things we do,” says Gurung. “Especially when professional skills need a lot of different steps or knowing info, the same key study techniques can come in handy.”
Nursing school is challenging, and nursing students know the work they put into their academic path will reap big rewards over a career. But at some point in nursing school both new and advanced nursing students need assistance to navigate the tough areas of their academic path.
What happens if you know you need help and support, but you aren’t sure where to get it? It might take a little investigating, but check with your school to see what kinds of services they offer. If your school doesn’t offer a resource you need, there’s likely an office that can at least connect you with someone who can. The back-to-school period is a great time to formulate a plan.
Here’s where you might find the help you need from your school.
Help with Finances
The financial aid office of your school is the hub for everything you need to know about tuition and costs. The office is also a place to go if you need more financial support and want to ask if they have additional resources. If you’re eligible for a work study job and need to know what’s available, this office can help with that as well. And if a personal crisis or roadblock has necessitated a withdrawal from a course or even the need for a semester off, visit the financial aid office right away to ask about how it will impact any financial aid you are receiving. They are there to help and support you for success.
Help with Studies
If a class is especially difficult, approach the professor at the first signs that you’re having trouble or falling behind. Visit their office hours regularly and connect with any teaching assistants they may have. Attend study groups for different courses (some are online and some are in person) or start your own if needed. Many schools have tutoring available at a tutoring center and there may also be a writing center if you have trouble organizing your thoughts for a paper.
Help with Exam Accommodations
If you have a diagnosed medical condition that makes it harder for you to complete an exam in a certain time period or in a traditional classroom setting or if you need frequent or unexpected breaks (to visit the bathroom, for example), schools offer alternative exam and course work options. Get in touch with the student disability or accommodations office before you need help to find out what paperwork they need and what accommodations are offered. Frequently, there are resources you might not even realize, such as videotaped lectures or note takers for students.
Help with Mental Health
The pressure of nursing school is serious and sometimes you might find yourself feeling overwhelmed by it all. Or maybe you feel a pervasive sense of sadness or anxiety and it’s interfering with your school work and normal activities. Almost every school or university has mental health support available to students or they have the resources to lead you in the right direction of getting the help you need. Look for the school’s counseling, wellness, or health office to start.
Help with Housing and Food
The student affairs office and residential services office are your go-to offices for finding housing (if not on campus, they may have resources to help you find something off-campus), helping if you need food assistance, or for mediating roommate disputes. These offices frequently have a broad view of student needs across campus so they are able to refer you to the right office, support, or resource quickly.
As a nursing student, being able to focus on school is a top priority, so finding help you need is essential to your success. Find the right resources by reaching out to your school as soon as possible. Even if you don’t find the right person to help you initially, don’t give up. Look on your school’s website to help you connect with whatever assistance will get you on the right track.
Cleveland Clinic has received a gift of more than $12 million from The Howley Foundation to double the number of nurse scholars at Cleveland Clinic beginning in fall 2023.
In recognition of this new generous gift and the Foundation’s cumulative support, all programs within the ASPIRE initiative at Cleveland Clinic will be renamed to honor the Howley name, including the Howley ASPIRE Nurse Scholars Program.
The nursing program is for local high school and college students and seeks to increase diversity in healthcare, address opportunity gaps and reduce health disparities in the community.
“It’s essential that we diversify the pipeline of our future healthcare workforce, including nurses, to better represent our patients and the communities we serve,” says Tom Mihaljevic, M.D., CEO and President of Cleveland Clinic and the holder of the Morton L. Mandel CEO Chair. “We are grateful for the Howley’s continued support and passion for increasing diversity and equity in our next generation of caregivers.”
The gift will allow the nurse scholars program to double enrollment annually to approximately 50 students from Cleveland-area high schools.
Students enter the program as high school juniors and are taught an innovative curriculum that explores the nursing profession, socialization, and integration into healthcare. High school graduates then can earn a scholarship to pursue a bachelor of science degree in nursing from the Breen School of Nursing and Health Professions at Ursuline College.
Students work as patient care nursing assistants at Cleveland Clinic during the summer after high school graduation and throughout their college careers. They then can return to work as registered nurses at a Cleveland Clinic facility after college graduation and licensure.
“We feel strongly that a quality education is the best way to address social inequality and promote economic mobility,” says Nick Howley, chairman of The Howley Foundation and executive chairman and founder of Transdigm Group Inc. “We want students to be able to complete their nursing degrees poised for success.”
Launched in 2017, the program was the brainchild of Kelly Hancock, DNP, Chief Caregiver Officer of Cleveland Clinic, and the holder of the Rich Family Chief Caregiver Chair, and Lorie and Nick Howley. It has been sustained by The Howley Foundation’s generosity, which has committed more than 20 million dollars to date, and other donors, such as Beth E. Mooney and the KeyBank Foundation.
“We remain committed to cultivating a workplace that embraces diversity, inclusion and equity to better serve our patients,” says Dr. Hancock. “The Howley ASPIRE Program serves as a key element in supporting these efforts. This generous gift allows us to offer this wonderful opportunity to more nurse scholars in Northeast Ohio and increases public awareness about the vital role our nurses have in delivering high-quality healthcare.”
In December 2022, the nurse scholars program celebrated its first five graduates who are now employed as full-time registered nurses at Cleveland Clinic. More than 15 students are expected to graduate from Ursuline College with nursing degrees by 2024.
The Howley ASPIRE Program also offers additional pathways for other healthcare careers, including respiratory therapy, surgical technology, and sterile processing.
Cleveland Clinic is accepting nurse scholar applications from high school juniors through Oct. 1, 2023. To learn more and apply online, visit clevelandclinic.org/ASPIRE.
