Reports of Practice Responsive BScN Programming at Nipissing University: The Continuing Education of Ontario Nurses

University in North Ontario, is currently the only post-secondary institution in that province to offer a part-time Baccalaureate of Science in Nursing (BScN) program for Registered Practical Nurses (RPNs) through a blended learning model. This program represents a “bridge” from the nurse’s college diploma and offers a curriculum that enables students to continue to practice nursing as they study. Since the program’s inception in 2010, over 500 students have been admitted, attesting to its need. Flexibility, access, partnership, and excellence in teaching and learning comprise the heart of this complex, innovative, and student-centred program. As a blended learning program, it uses synchronous and asynchronous online technologies to deliver theoretical content; these experiences are balanced with

Nipissing University in North Bay, Ontario, is currently the only postsecondary institution in that province to offer a part-time Baccalaureate of Science in Nursing (BScN) program for Registered Practical Nurses (RPNs) through a blended learning model. This program represents a "bridge" from the nurse's college diploma and offers a curriculum that enables students to continue to practice nursing as they study. Since the program's inception in 2010, over 500 students have been admitted, attesting to its need. Flexibility, access, partnership, and excellence in teaching and learning comprise the heart of this complex, innovative, and student-centred program. As a blended learning program, it uses synchronous and asynchronous online technologies to deliver theoretical content; these experiences are balanced with Résumé L'Université Nipissing de North Bay, en Ontario, est présentement le seul établissement post-secondaire de cette province qui offre, au moyen d'un modèle d'apprentissage mixte, un programme de baccalauréat en sciences infirmières à temps partiel conçu pour les infirmières auxiliaires (inf. aux.). Ce programme représente un « pont » après le diplôme collégial en techniques infirmières et offre une formation qui permet aux étudiants de poursuivre leur pratique tout en étudiant. Depuis sa création en 2010, le programme a admis plus de 500 étudiants, signe d'un besoin est bien réel. La flexibilité, l'accès, le partenariat et l'excellence en matière d'enseignement et d'apprentissage sont au coeur de ce programme complexe, innovateur et centré sur les étudiants. Pour livrer son contenu théorique, ce programme d'apprentissage

Introduction and Context
Nipissing University's blended learning program enables Registered Practical Nurses (RPNs) to acquire their Baccalaureate of Science in Nursing (BScN) through distancebased part-time study. Nipissing University is a small institution in northern Ontario, and the program is an example of leveraging the benefits of being small and overcoming challenges to make things happen. In three years, this program has grown from an initial intake of 60 students to a current enrollment of over 500 students. Even with this substantive growth, Nipissing University is committed to providing a personalized student experience within a collegial learning community dedicated to creativity, innovation, and excellence in teaching, research, and scholarly activities. Such commitment to community and social presence within a blended learning program has been correlated with perceived learning in online nursing courses (Cobb, 2011).
This program is the only BScN program in Ontario for RPNs that combines the following three elements: a "bridge" from the nurse's college diploma; a part-time curriculum that enables students to continue to practice nursing as they study; and a blended delivery model. Structured as online theory-based courses complemented by clinical practice courses and supports provided by the nurses' employers and the university, this program is evidence of what healthy, partnership-based, technology-supported programs can be when designed and delivered by nimble and responsive organizations. In this paper, the authors reflect on the origins of the program, its overall structure, and face-to-face learning in the clinical setting. Clinical learning is facilitated through partnership agreements with the students' employers. This paper describes how this RPN to BScN blended learning program has brought Nipissing to a leading edge in continuing education for RPNs. It also demonstrates Nipissing University's commitment to drive change in the world of professional and adult education. mixte fait appel aux technologies en ligne avec accès synchrone et asynchrone. Ce type de formation trouve l'équilibre en offrant aussi un enseignement direct (en personne) en milieu clinique. En effet, l'apprentissage en clinique est possible grâce à des ententes de partenariat avec les employeurs des étudiants. Le présent article décrit comment ce programme d'apprentissage de baccalauréat en sciences infirmières pour inf. aux. a réussi à amener Nipissing à l'avant-garde de la formation continue pour les inf. aux. Elle démontre également l'engagement de l'Université Nipissing à provoquer le changement dans le monde de la formation professionnelle et de l'éducation permanente.

Origins and a Gap
The 50-year timeline of the College of Nurses of Ontario (2013) indicates two major changes in 2005: the education requirements for nurses changed to a baccalaureate in nursing for Registered Nurses (RNs) and to a diploma from a college of applied arts and technology for RPNs. This requirement ensures that nurses have the knowledge, skills, and personal attributes to practice in today's health-care system. The College of Nurses of Ontario (2011) has stated that "RNs study for a longer period of time, allowing for greater foundational knowledge in clinical practice, decision-making, critical thinking, leadership, research utilization and resource management" (p. 3). An immediate outcome of the baccalaureate requirement has been a proliferation of programs that enable diploma-prepared nurses to acquire their degrees. A further outcome of the 2005 requirement is interest by RPNs in continuing their education and achieving baccalaureate status.
Nipissing University's blended learning program for RPNs, which is grounded in a partnership model, is a timely response to the continuing education of Ontario nurses. In 2013, a media release by the Canadian Association of Schools of Nursing (CASN) reported that a valuable way of preparing new RNs to meet the complex health-care needs of Canadians is to partner with the service sector. This way, nurses are integrated into the health-care system while they pursue their professional development. CASN has supported the work of institutions and educators in rethinking the education of tomorrow's nurses through innovation and integration of current knowledge, research, and technologies.
The university's blended RPN to BScN program has taken on each of these challenges. Not only is the program designed and delivered to be student-centred, it also uses synchronous and asynchronous technologies and offers a curriculum grounded in evidence-informed practice and research. Of further importance is that, over the last few years, the Ontario Ministry of Education and Training has actively promoted new college-university pathways. Given the absence of an RPN to BScN program in northern Ontario, in 2010, the School of Nursing at Nipissing University began to design, develop, and deliver a program that would meet the needs of RPNs wanting to continue their education and respond to the needs of community partners in the healthcare sector. This one of a kind, online, part-time bridging program has experienced impressive growth that validates the decision to create a program built on the principles of partnership, access, and flexibility.

Program Overview
As noted earlier in the paper, this is a student-centred program. In general, the nurses enrolled in the program are working professionals who must balance family and community commitments with their studies (Carter, 2008). These students require a program that is flexible and permits course work to be completed at times that fit with busy personal and professional schedules. Moreover, these students need a program that does not require them to relocate or attend classes on the physical campus of the university.
Just as flexibility and access are hallmarks of the program, so too are excellence in teaching and learning and appropriate use of online tools and technologies. Regarding teaching and learning, support for instructors is available through other staff with expertise in online teaching and learning. Like their instructors, students are supported through the efforts of the Program Manager, the Clinical Education Leader, and the nursing faculty.
Online learning strategies are used in theory courses while clinical experiences are made possible through the partnership model negotiated by the School of Nursing with the students' employers. Together, the Clinical Education Leader and the Clinical Placement Officer find clinical placements that will allow the students to meet the accredited course learning outcomes. As much as possible, effort is made to use partner agencies for clinical practicums; however, when partner agencies do not offer services that align with the required clinical outcomes, the placement team will seek out clinical placements with agencies who are not partners.
So what does this program look like? It is open to all RPNs who have completed their RPN diploma in the past 10 years, have a minimum GPA of 3.0, and are registered with the College of Nurses of Ontario. The health-care agency where the nurse is employed must be supportive of his or her participation in the program and agree to be an educational partner with the university. Offered as a five-year, part-time program, it can be extended to a maximum of seven years. As discussed earlier, it is designed as a blended learning program with online theory courses delivered through synchronous and asynchronous technologies and face-to-face clinical courses. The program offers three intakes annually: in September and January, with a limited intake in May. The students take two courses per semester, with the program running three semesters per year.

Value of the Program
The program offers unique value not only to individual students but to the community and the health-care sector. As Canada's population continues to age, there is a need for nurses who are capable of providing care for an aging population. One possible solution to the nursing shortage is the training and retention of new nurses (Canadian Federation of Nurses Unions, 2013;Mitchell, 2003;Nevidjon & Erickson, 2001;Peterson, 2001). Notably, the number of RNs graduating from post-secondary institutions declined when the government mandated that a baccalaureate degree was required for entry to practice.
In this program, nurses are given credit for their previous education and preparation as RPNs. Thus, the nurses experience a nontraditional point of entry to university education. By valuing these nurses and their past experiences, Nipissing University is able to increase the number of potential graduates from the program. Increasing the number of degree-prepared RNs helps to address the nursing shortage; it further creates a greater number of nurses eligible for graduate studies, thus contributing to a pool of nurses available to sustain the future education of degree-prepared nurses.
The uniqueness of the program contributes to health care across the province and, in particular, in northern Ontario. Prior to 2010, there were no bridging programs available to RPNs in northern Ontario. Nipissing's program is, therefore, filling an obvious gap; not insignificant is that, in northern Ontario, the shortages of health professionals are greater than elsewhere in the province and, therefore, nurses are often required to perform tasks beyond their scope of practice (Killam & Carter, 2010). Providing a means for further education to nurses who work in the smaller communities of Northern Ontario is extremely important for increasing the number of nurses working in rural and remote areas.
Interest in the program has grown steadily since its beginnings in 2010. The program manager receives eight to 10 unsolicited inquiries from new health-care agencies per month. In addition to these unsolicited calls about partnering, multiple student inquiries are received by the staff in the School of Nursing and the university's Admissions office. As a result of the rising number of inquiries, the program has seen an increase in health-care agency partners from just 12 in 2010 to more than 100 in 2013.
The bridging program has been identified as a flagship program in line with Nipissing University's commitment to accessible and flexible education (Burge, Campbell-Gibson, & Gibson, 2011) and the educational needs of rural and remote northern Ontario. The following statement by a second-year student in the program conveys the impact it has on enrolled nurses: "The program is great. It has allowed me to go back to school when I never thought I would be able to" (Student A). Interestingly, the program has also seen an increase in transfer students who started their studies in other non-blended bridging programs.

Complexity
Mounting an online or blended program in any discipline is a complex undertaking. Doing so in a professional field where the curriculum must meet practice and licensure standards is a particularly sophisticated initiative. The key complexities of the program and how they are addressed are described below.

Negotiation of Partnerships with Health-Care Agencies
As previously mentioned, for an RPN to apply to the program, the applicant's employer must become a partner with the university. This partnership model allows the university to have a network of health-care agencies in which to place students for their clinical practicum experiences. By partnering with the university, the health-care agencies show their support of their RPN employees who are pursuing their BScN. This arrangement creates a win-win situation: The university can recruit new students in these organizations, and agencies can see their employees work toward reclassification to degreeprepared RNs while they continue to practice as RPNs.

Sensitivity to Diverse Learners
The program meets the same standards and competencies as all BScN programs in Canada. This compliance is essential since the students must, at the end of the program, pass the national exam to be licensed as an RN. At the same time, because these nurses may not have attended university previously, may have been out of school for many years, and may have little to no experience with academic writing, care is taken to employ teachers who understand these challenges and who are prepared to work with students to facilitate success.
Diversity within the student population in this program also relates to several other factors. These include: a) the geographic distances between students themselves and between students and their teachers, b) the differences between the rural and urban environments in which students and teachers live, c) the array of cultural and linguistic backgrounds from which the students come, which can lead to issues around English as a second language and different cultural understandings, and d) the different career stages of the students, ranging from new RPN graduates to seasoned or expert RPNs.

Computer Competence and Confidence
Early in the delivery of the program, it was evident that the nurse-students had differing levels of computer skills. Technical support is provided through the university, while resources are constantly in development to increase learners' competence with the tools in their courses and build their general online navigational skills.

Managing and Supporting Clinical Instructors at a Distance
As a response to the challenge of instructors who are at a distance from Nipissing University, the School of Nursing and the Centre for Flexible Teaching and Learning have recently developed an inclusive web-based portal serving the needs of all clinical teachers. This portal houses educational resources and provides an opportunity to connect teachers via discussion forums, where they discuss common issues. The Clinical Nursing Instructor Resource Manual is part of the portal. This comprehensive resource was created to prepare

Challenges
Like all new educational initiatives, this program has challenges from a number of points of view, including administrative, faculty-based, student-based, and quality assurance in the development and delivery of courses. Each of these areas will be considered in turn.
A significant administrative challenge is the planning and implementation of clinical practicum courses. Clinical placements are planned in groups based on the location of the students. However, when there is only one student in a remote or rural area, this type of group experience is not possible. In these instances, the learning environment is modified from a group setting to a one-to-one or preceptored experience, one that is often reserved for the last semester of a traditional nursing program. This situation requires the Clinical Placement team to collaborate with the nurse-preceptors who are working with the students to make sure that appropriate levels of support are maintained in the clinical setting to ensure safe patient care and to facilitate level-appropriate learning.
Another challenge experienced by staff and administration has been the difficulty in balancing the number of students with the number of staff who work on behalf of the program. Unfortunately, fiscal restraints and processes limit the number of administrators, support staff, and full-time faculty. Positively, in 2013, the number of administrators and support staff assigned to the program increased. The outcome has been a much needed placement team dedicated to the program. The creation of this placement team has significantly improved the clinical planning process and, in turn, increased student satisfaction. Importantly, clinical placement details can be provided sooner to students.
The program is further challenged by the fact that, to date, it has only one permanent full-time faculty. As a result, the program is taught largely by a group of highly skilled and invested part-time instructors. Because of this, there are potential issues with sustainability, although the leadership in the School of Nursing is working very hard to resource this program appropriately. Additionally, the program's success has caught the attention of senior administrators at the university over the past year.
Other challenges exist for faculty and students new to online learning. In general, faculty are required to shift from a teacher role to a facilitator role, while also bringing their subject matter expertise to the learning environment. This shift to a largely facilitative role leads to the creation of an online learning community in the theory courses, where learners are empowered to be active participants and share understandings of professional and personal relevance. Learning activities requiring reflection, critical thinking, and problem-solving skills are designed and incorporated into the online theory courses. As well, students are provided with opportunities to apply new learning to real-life scenarios, as they transition to the role of the degree-prepared RN. This orientation to learning is in line with the literature describing the role of the educator as building experiences that enable the learner to search for new knowledge, find resources to build on this knowledge, and solve problems (Huang, 2002;Legg, Adelman, Mueller, & Levitt, 2009). According to Palloff and Pratt (2001), "If an instructor is willing to give up control of the learning process and truly act as a facilitator, he or she may be amazed at the depth of engagement with learning and the material that can occur as a result" (p. 34).
The students are faced with specific challenges related to learning: these include learning to be an effective online student, adjusting to university-level education (often after being out of school for some time), and balancing the competing elements in their personal and professional lives with their studies. These challenges are not new in the e-learning and nursing education literature.
Not insignificant is that the vast majority of students in this program are women. There are, as McLean and Carter state (2013), more women than men returning to university to upgrade their professional and employment skills. These students require the flexibility that e-based courses and programs can provide. Given this trend and the demographic in the program, research is required into the concept of gender-specific attitudes and skills in relation to computer use and computer-assisted learning. As a possible starting point, in early research into e-learning and women as online learners, Burge (2000) stated that, in addition to general pedagogical and technical complications, issues exist around the readiness of adult learners, and women in particular; many female learners "don't have the time or the inclination to spend time trying to conquer the finer points of a software program" (p. 34). At the same time, the fact that women may be less interested in the technical aspects of e-learning is a gender-based "difference in learning style not [a] deficit in cognition" (p. 30). In relation to the blended learning program, there are important areas to research based on these ideas as well as the broader practice of e-learning.
Finally, because the program is new, the final courses are still in development, while courses developed earlier are now requiring revision. Positively, clearly defined development processes that incorporate internal and external peer review are in place. The two partners also enjoy a collegial working relationship. Additionally, the placement and administrative staff for the program and departments responsible for student services are actively developing supports to ensure that the nurse-learners are appropriately supported as students of Nipissing University.

Ingenuity and Innovation
While the term e-learning is relatively new, the term flexible learning is even more recent. In its essence, flexible learning is about providing accessible, appropriate, and effective learning experiences for all students, irrespective of the students' geographic location in relation to the university. Flexible learning is necessarily designed with awareness of students' lives and the need to balance study, work, and family responsibilities. It is also about alternate educational models, partnerships, and evidenceinformed teaching and learning practices (Carter & Salyers, 2013).
As a blended learning program, the RPN to BScN program is a commitment to a flexible learning experience for working adults. Thus, it uses educational technologies that support asynchronous learning through Blackboard Learn, and synchronous learning sessions that occur in real time through Collaborate and 3D Virtual Campus technologies. The Collaborate sessions can be archived for students to review when they cannot attend a live session. The 3D Campus experiences offer students the opportunity to interact in real time, and they hold particular promise for the development of nurses' interviewing and problem-solving skills.
The program uses a partnership model wherein the learner is supported as a learner and an employee. Too often, a person's pursuit of continuing education derails because the employer is either unaware or unsupportive of the student's educational goals. Moreover, in the case of the continuing education of a nurse, it is vital that the learners have appropriate clinical placements. The fact that Nipissing has forged more than 100 discrete partnerships with hospitals, long-term care homes, community health agencies, and other health-care settings in just over three years highlights Nipissing's efforts to put structures in place to ensure the success of the program and, most importantly, of students.
This program has brought Nipissing to a leading-edge position in continuing education for RPNs and has demonstrated the university's commitment to change in the world of professional education. As discussed, it is a blended program, with online theory courses and face-to-face clinical practicum courses. It is interesting that, although we use the Internet to bank, socialize, plan our vacations, and stay in touch with loved ones around the world, there are still resisters to the idea that an online learning experience can be as good as face-to-face learning. Some of these same individuals have even greater difficulty with the idea of learning about nursing online. Nipissing's blended program for RPNs is challenging this mindset. Through carefully designed and delivered online courses, the students are having valuable learning experiences.
Nipissing has, in fact, developed an innovative delivery model: technology is used for those parts of the program that are theoretical and discourse-oriented; clinical practice-based learning occurs in face-to-face contexts. Thus, the innovative and flexible character of this program is based on combinations of old and new and, of course, the needs of students. Finally, the facts that the delivery of the program is tied to strong partnerships, is part-time, and can be completed in five years are also evidence of the program's innovative nature.
In closing, this is a flagship program for continuing education at Nipissing University. It is a program in which a small university has flexed its operational, academic, and pedagogic muscles to ensure a high-quality professional program that Biographies Scott Fitzgerald has worked at Nipissing University as a clinical educator in the School of Nursing since 2010. He currently holds the position of Clinical Education Leader for the RPN to BScN Blended Learning Program. He will complete his Master of Science in Nursing from Laurentian University in 2016. Scott's clinical practice background includes pediatric oncology and adult medicine.
Lorraine Carter is a faculty member in the School of Nursing at Nipissing University. She is also a faculty member with the Northern Ontario School of Medicine and the School of Rural and Northern Health at Laurentian University. Lorraine's research interests include innovative models of education, online and technology-supported education, telemedicine, and interprofessional practice. She presents regularly at national and international venues and has an extensive publication record. Lorraine is the Past President of the Canadian Network for Innovation in Education (CNIE) and incoming President of the Canadian Association for University Continuing Education (CAUCE).
Wenda Caswell is the Program Manager for the RPN to BScN Blended Learning Program at Nipissing University. She has been actively involved in undergraduate nursing education in Ontario for over 15 years. Originally from Charlottetown, PEI, and a graduate of St. Francis Xavier University, Wenda maintains both family roots and a strong connection to the East Coast.