arlene O'Callaghan, MSN, MSEd, RN, assistant dean of special initiatives at Saint Xavier University, Chicago, encourages nurses who have been out of practice for some time to select an RN refresher program with an adult learning theory foundation.
"These are professional nurses with an RN license, and courses need to be taught with that in mind," she said. "I'm concerned about programs that are too regimented; as an adult, life throws things at you, so we try to provide ways RNs can make up lost opportunities. Three or four of our class sessions are provided online, so nurses can study at home using PowerPoint slides and handouts on the online Blackboard system."
Diane Beatty, BS, RN, manager of the RN refresher program at the University of Delaware, Newark, advises nurses to research state-specific regulations by their respective board of nursing.
"When we set out to expand our program in 2004 to reach a broader audience through online courses and clinical practice in the nurses' home states, we researched the literature and did a national survey of all state board of nursing licensure requirements," she said. "We focused on Delaware and the other compact states, and raised the bar by providing more didactic and clinical hours required by those state boards of nursing."
Beatty urges nurses to consider how the RN refresher program will fit into their lives.
"Decide whether you want to take an online course or prefer an on-site program," she said. "Look at accessibility, affordability, flexibility, time commitment and other practical issues."
The University of Delaware's online program builds on the assumption that nurses have mastered basic RN knowledge, and it focuses on providing participants with current and relevant evidence-based knowledge from both academic and clinical content experts. Beatty, herself a program graduate, acknowledged, "It can be intimidating for nurses re-entering the profession to face the changes in technology and clinical care. Our program is designed to help them develop confidence and competence by providing them with the latest information and the opportunity to utilize this information and sharpen their nursing skills in the clinical setting."
Beatty shared advice for RNs opting for a web-based program.
"With an online course, especially, it is important that the student feels connected," she said. "We recently changed the way we deliver the course to a learning management system, which offers students greater access than before to faculty feedback on submitted assignments. Students are also connected to each other through asynchronous discussion forums and live chat rooms. It is great to see the camaraderie among the online students who come to campus to take the final."
Originally designed to reflect a now-defunct mandatory curriculum established by the Illinois Division of Professional Regulations, the RN refresher program at Saint Xavier is focused heavily on adult med/surg nursing.
"We believe it's very important to look at what nurses need for practice," O'Callaghan said. "Nursing process and assessment skills are critical, so we provide the theory, a laboratory to practice skills and then supervised clinical experiences. Nurses also need the opportunity to look at new technology and how it functions. We talk a lot about discharge planning and focus on pharmacology, as well as ethical and legal issues."
RN refresher students are given a list of recommended adult med/surg textbooks and are encouraged to purchase one to use during the course and beyond. "We also show them our library, so they know how to find both the basic information they need and the latest evidence-based practice," O'Callaghan said.
Tony Paterniti, PhD, RN, director of education at the Methodist Health System RN refresher program, Dallas, described how nurses re-entering the workforce can benefit from the array of resources available through a hospital-based program.
"We are atypical; the Texas Board of Nursing told us that RN refresher programs are usually based in community colleges," he acknowledged. "But our trauma center designation is a big draw for RNs looking for a program. We also have a rapport with our nursing staff because we're employees here, and our nurses are used to having student nurses and RN refresher students on their units."
Cheryl Huffman, BSN, RN, project coordinator for the Methodist program, noted, "There's a lot of concern about computer charting when nurses return to the workforce. Most have not even seen computer charting. There's also an underlying question: 'Will I be able to find a job after the program?' But they tell me that when they look across the room and their neighbors are going through the same thing, it brings comfort to them. They exchange telephone numbers and e-mails, staying in touch to support one another."
Louise Outlaw, MSN, RN, former project coordinator at Methodist, urged would-be students to examine every aspect of the refresher program before making a commitment. "Some programs don't have clinical placements set up, so the student then has to go out and locate a clinical site," she said. "The students pay quite a bit of money for the program, but don't benefit from an established clinical placement. When RN refresher students are on the nursing units [here], they actually realize how much nursing has changed. Patients are much sicker, the units are busier, the pace is much faster and the 12-hour shifts are longer. It's a wake-up call for all of them."
Outlaw urges nurses to consider what the program offers for the money. "When you consider what our hospital-based program offers - a didactic component in the classroom, online course, supervised skills practice and clinical check-off before the student goes to the unit - they get a lot for a modest cost," she noted.
O'Callaghan described the real-life perspective RNs in the Saint Xavier program gain during their clinical placements.
"When selecting a program, look at the clinical training to see if it's enough to make you comfortable in the hospital environment," she advised. "It's important to look at ratios during clinical practice. We maintain a 1-to-8 or 1-to-10 ratio, which allows instructors to guide the RNs but not do their critical thinking for them. They work a full shift, carrying a patient load under the close supervision of a faculty member. If nurses want to go into a specialty like peds or OB, we provide a day or two of training in those areas as well."
Landing a Job
The Saint Xavier program has been highly successful for nurses who want to re-enter the job market. "Some of them are hired even before completing the program, and others call back to say they've obtained the jobs they wanted," O'Callaghan said. "No one has called to say they weren't able to find a job."
Beatty believes the University of Delaware program provides graduates with the knowledge and skills they need to land a job in today's competitive healthcare environment. "With the downturn in the economy, that's tougher than it used to be," she acknowledged. "The clinical component of the course actually provides the students not only with recent clinical experience, but great exposure that could lead to employment."
Hospital-based programs may offer an additional advantage. "Out of the four classes I have instructed, which averaged 15-20 students in each class, we have hired a total of 11 of the nurses after they completed our RN refresher program," Outlaw said.
Sandy Keefe is a frequent contributor to ADVANCE.