ArticlesMission Critical: Failure Is Not an Option.The Journey of Three Universitiesto Promote Military Student SuccessKaren M. Daley, PhD, RNPrincipal Investigator: Nurse Education Practice, Quality, and RetentionVeteran’s Bachelor of Science in Nursing ProgramDean, College of Health ProfessionsDavenport University6191 Kraft Avenue SoutheastGrand Rapids, MI 46512Tel: (616) 871-6160Email: [email protected] Oliver-McNeil, DNP, MSN, ACNP-BCPrincipal Investigator: Nurse Education Practice, Quality, and RetentionVeteran’s Bachelor of Science in Nursing ProgramAssociate Clinical ProfessorWayne State University College of Nursing5777 Cass AveDetroit, MI 48202Tel: (313) 577-0053Email: [email protected] A. Stahley PhD, RNAssociate Dean of NursingAssistant ProfessorDavenport University6191 Kraft Avenue SoutheastGrand Rapids, MI 46512Tel: (616) 871-6162Email: [email protected] Simon, PhD, MSN, RNPrincipal Investigator: Nurse Education Practice, Quality, and RetentionVeteran’s Bachelor of Science in Nursing ProgramAssistant Clinical ProfessorNicole Wertheim College of Nursing & Health SciencesFlorida International University11200 SW 8th St,Miami, FL 33199Tel: (954) 348-1788Email: [email protected] of Health and Human ExperienceVolume VI, No. 2 145

ArticlesAuthor NoteThis article reports on three university-based bachelor of science in nursing programs thatdeveloped recruitment and retention strategies to meet the objectives of the Health Resourcesand Services Administration (HRSA) Nurse Education, Practice, Quality and Retention(NEPQR) - Veteran’s Bachelor of Science in Nursing (VBSN) program. Funding for thisproject was made possible by HRSA. Grant numbers are as follows: Davenport UniversityUF1HP26488, Wayne State University UF1HP28521, and Florida International UniversityUF1HP26491. Research studies referenced in this article were under title “VBSN CohortSurvey,” IRB # 16110135, approved on 11/7/2016 by Davenport University InstitutionalReview Board.The opinions in this article are the authors and do not necessarily represent the official views ofthe institutions that were recipients of the HRSA grant funding. The authors have no financialconflicts of interest. In addition, the photographs in this article are used with the permission ofthe universities and students depicted.Special Acknowledgements: The authors wish to acknowledge all the faculty and staff atDavenport University, Florida International University, and Wayne State University for theirsupport with the VBSN grants and programs. Without them, the VBSN programs couldnot have been implemented. Finally, grateful thanks to the student veterans at DavenportUniversity, Wayne State University, Florida International University, and to Marian Smithey,Nurse Consultant and Project Officer at HRSA, for giving this work direction and purpose.AbstractThree universities – Davenport University, Wayne State University and Florida InternationalUniversity – embarked on a journey in response to a federal initiative calling for thecreation of pathways for veterans into the nursing profession. Based on existing research andrecommendations from veteran groups, these universities set up systems and supports forrecruitment and retention to ease the transition of military service members to a nursingprogram. The objective of these action steps was to help service members transition to becomesuccessful nursing students and eventually successful nursing graduates. Along the way, thenursing faculty at each university recognized the benefits of having military veterans in theclassroom as well as in the profession of nursing. The recruitment and retention of veterans ina competitive nursing program required targeted efforts of the nursing program faculty andadministration. Having support services in place and encouraging the veterans to use themhelped veterans succeed in their nursing program. Each university discusses strategies thathelped them address common challenges encountered in implementing their nursing programsfor veterans.Keywords: student veteran, nursing, recruitment, enrollment, retention146 Volume VI, No. 2Journal of Health and Human Experience

ArticlesIntroductionWere there none who were discontented with what they have,the world would never reach anything better.—Florence NightingaleIn any journey, moving forward takes one step at a time. Academia’s charge is to createpathways in which transformation can take place through learning. For the faculty and staff whoguide those on this journey, the work should also be transformative through their interactionswith students and their investment in each student’s success. For the universities that embarkedon a journey to create pathways for veterans and military-connected students to become nurses,failure was not an option as they stepped into unknown territory. The journey of transformingmilitary medical service members into bachelor-prepared nurses not only changed the career ofthe service members, but it changed the universities and faculty as well. This journey remainsmission critical for each university and school of nursing.The journey started with what we know. Veterans bring with them vast skills in leadership,accountability, trust, teamwork, and especially values central to nursing and healthcare. Theskills veterans learned in military life and service provide the potential student with criticallyneeded experience in leadership and teamwork. People look to veterans for guidance. Indeed,military life more than adequately prepares veterans for careers in healthcare. This is centrallytrue for those who served in the military medic and Hospital Corpsman communities.Compassion is also another key value. Military community life teaches a service member notto judge others, but rather to be compassionate regardless of differences and variation. Takenas a whole, these qualities are also the foundation to becoming a successful nurse (Cox, 2019;Hassan, Jackson, Lindsay, McCabe, & Sanders, 2010; Steele, Salcedo, & Coley 2010).Based on the Health and Human Services strategic plan for fiscal year 2013, HealthResources and Services Administration (HRSA) created a grant for developing pathways forveterans into nursing bachelor’s degree programs. Davenport University, Wayne State Universityand Florida International University received grants as part of the HRSA Veterans to Bachelorof Science in Nursing (VBSN) funding. Based on the original number of grants (nine), budgetsawarded, and project work plans approved, HRSA estimated that approximately 1,100 veteranswould obtain their BSN degrees by the end of the grant project period. Creating innovativeways to award credit to veterans for prior military medical training and experience was the maingoal of the program.Many universities have military-based recruitment, enrollment, and retention strategies.However, the question was how to recruit and retain military students within a rigorousnursing program. In this article, three universities share stories of their success and strategiesimplemented to address the challenges faced when helping veterans make the transition tobachelor-prepared nurses.The VBSN students had different backgrounds, service branches, and experiences. Earlyon, all three schools noticed that it was essential to listen to the voices of the veterans. Theschools needed to adjust and accommodate to students who had military service, employmentand other obligations. For example, students who were in the reserves had to drill on theJournal of Health and Human ExperienceVolume VI, No. 2 147

Articlesweekends. Others had returned recently to families and needed to maintain employment forfinancial reasons in addition to attending school. Overall, the experience of working with VBSNstudents helped faculty listen more closely to the needs of all nursing students. The purposeof this article is to describe the recruitment and retention strategies of three universities thatdeveloped VBSN programs.Recruitment Strategies: Opening the DoorEach of the universities has a long history of recruiting military service membersand veterans. However, recruitment into nursing programs can be challenging due to thecompetitive nature of admissions for university nursing programs. For example, many veteranshave found that their credentials were inadequate for acceptance into a typical nursing program.The recruiting strategies that had been used by each of the universities may have excludedveterans with minimal college credits or American Council on Education (ACE) approvedtransfer credits. (ACE evaluates post-secondary classes and assigns college credit by identifyingequivalent courses.) All universities involved in this grant found that identifying veteranswho were interested in enrolling in their BSN program was more difficult than anticipated.Identifying veterans or active military members who may want to transition to academiarequired a customized recruitment approach. All three universities found having recruiterswith military experience helped establish a trusting relationship between the veteran and theuniversity. Also, personalized and timely responsiveness was key to maintaining the trustingrelationship and essential to bringing students into each nursing program. Initially, strategiesfocused on how to help the student navigate the application process. As veterans entered thenursing programs, it became apparent that faculty needed to acquire a basic understanding ofmilitary culture.Davenport UniversityApplicants to the Bachelor of Science Pre-Nursing (BSN-PL), Mable Engle NursingProgram (MENP) at Davenport University (DU) are often recruited by multiple universities.Although DU has successfully recruited veterans since its founding shortly after the Civil War,this new nursing pathway required a different, more nuanced outreach to veterans. After ayear of struggling to identify viable applicants, grant funds were repurposed to include hiringa recruiter with military medical experience, thus enabling potential recruits to speak withanother military person throughout their recruitment to the university as the single pointof contact. The opportunity to speak with someone who could answer questions about theprogram and about the transition to life as a student in a civilian institution was invaluable. Thispersonal touch was often cited by VBSN students as the reason for finalizing their decision toattend school at DU. Building rapport with potential applicants was important for a successfulapplication submission. Quick turnaround and responsiveness helped develop a trustingrelationship between the veteran and the university. Because the recruiter was headquarteredin the Eastern Time zone, applicants were able to communicate with him about the VBSNprogram from Iraq, Afghanistan, Korea, Guam, etc. at a time that was feasible for them to talkon the phone.Because DU is not located near any active duty military installation, the marketing planincluded billboards throughout Michigan as well as digital and social media advertising on148 Volume VI, No. 2Journal of Health and Human Experience

Articlesmilitary bases nation-wide. Many applicants were unaware of DU’s multiple locations or itsproximity to major metropolitan areas. DU recruiters needed to explain the geographic areain detail and provide information that would assist an applicant in choosing one of the fourDU campuses that share one nursing program. Lifestyle for the applicant and their family wasimportant. Information about nightlife, school systems, and housing helped veterans make theirdecision to apply to a nursing program. While some applicants were originally from Michiganand knew what to expect, others came from as far away as Washington and California. Theseapplicants needed more information and guidance through texts, phone calls, emails, FaceTime,and in-person touring of the surrounding area.One of the largest barriers to overcome for applicants was academic preparation. Meetingthe requirement for admission testing was the initial challenge. Beyond testing, many militaryapplicants lacked a traditional educational background. To balance the shortcoming of acompetitive grade point average or high enough national standardized test scores, DU revisedthe BSN-PL admission requirements. These revised requirements gave credit for the knowledgemedics and Corpsmen obtained through military training and experience. Specific admissionpoints were awarded based on how many years’ experience the veteran had as a medic orCorpsman. This method of acceptance into the program honored the expertise that a militarymedical veteran brings to a nursing program and accelerated program progression by shorteninga four-year program to three years. One of the DU VBSN graduates explained, “Because oftransfer credits and prior college experience, receiving up to 45 credits for military experience isunheard of. The advanced standing and recognition for medic experience was enough to cometo Davenport as well as to stay” (Davenport University, 2015-2017).A key turning point in DU’s ability to demonstrate respect for the knowledge and skill thatveterans bring to an academic program was the expert help of the DU registrar’s office. Essentialto this method of credential evaluation during the admission process was a forward thinkingregistrar who was willing to see military training as equivalent to academic credit. Without this,many of the students would not have been admitted. In the case of the DU VBSN, credits weregranted toward the Bachelor of Science in nursing program. Since the close of the grant, themethod of granting credit for military experiences has expanded. Instead of assessing for transfercredits, a job classification such as an army medic or navy Corpsman, is transcripted as 45 creditsgranted toward the nursing degree.The combined efforts to enhance recruitment were successful. Over a five-year period,50 students were admitted to the MENP BSN-PL program. To date, 23 of these studentshave graduated, and the other students are progressing through the program. Moreover,the recruitment methods and practices described have become a permanent part of the DUrecruiting process for veterans. The revised admission requirements continue to make it possiblefor highly experienced veteran applicants to be admitted to MENP BSN-PL program.Wayne State UniversityFor approximately 75 years, Wayne State University (WSU) College of Nursing (CON),in Detroit, Michigan, has been committed to educating students to provide excellent care topatients living in an urban environment. Recruiting students for the BSN track for veteranswas initiated in collaboration with the Office of Military and Veteran Academic ExcellenceJournal of Health and Human ExperienceVolume VI, No. 2 149

Articles(OMVAE), which is the WSU military and veteran advising office that has been providingservices to military veterans since 1945. Using available resources, OMVAE contacted veteranorganizations in southeastern Michigan, notifying them of the opportunity for military andveteran students to apply to a nursing program that would focus on educating military veteransto become registered nurses. Monthly information meetings were scheduled and posted on theCollege of Nursing website. The WSU website announced the program to current studentsand alumni, informing them about the program. Pamphlets about the program were sent tolocal veteran vocational rehabilitation counselors. Due to the uniqueness of the program, theUniversity Board of Governors included the announcement of the program at their meeting,which provided for a university wide awareness of the program. OMVAE and CON academicadvisors worked together to identify potential students. Social media was utilized to notifymilitary veterans in the area about the WSU VBSN program designed to meet their specificneeds. Approximately 30 students responded to recruitment efforts for the first cohort.Applicants were required to apply to WSU prior to applying to the CON Veteran toBachelor of Science in Nursing (VBSN) track. The university evaluated all student transcripts,including their military courses that were documented on their Joint Service Transcripts( JST), through the American Council on Education (ACE). Students were granted credittoward general education and nursing prerequisites. Each potential applicant met with anacademic service officer to determine what courses the student needed to meet universitygraduation requirements.Like the other VBSN programs, a holistic admission process was implemented, providingstudents with previous military healthcare experience preference for admission. Applicants wererequired to write a personal statement, submit two letters of recommendation, and participate in aface-to-face interview. The WSU VBSN program did not require previous healthcare experiencein the military to be eligible for admission, but students were required to have completed 30credits of general education and nursing prerequisites with a 3.0 grade point average.Students were admitted as pre-nursing students with the intent that they would completeprerequisites and general education courses prior to starting nursing core courses. Pre-nursingstudents were assigned a peer mentor and had an opportunity to meet as a group and attendtutoring sessions (Elliot, 2015). After two cohorts, the admission process was revised, requiringcompletion of prerequisites and all university general education classes prior to applying tothe VBSN program. It was recognized that some students needed more than one year tocomplete the required courses, while other students were ready to start nursing core courses.This provided students with the opportunity to complete courses at a community college andallowed for additional time to transition from the military to an academic environment.Florida International UniversityThe mission of the Nicole Wertheim College of Nursing and Health Sciences at FloridaInternational University (FIU) in Miami, Florida includes teaching, conducting researchand serving the community. Preparing nurses skilled in veteran-centric care has been part ofthis mission for many years. In an effort to recruit more military students, several facets ofinformation dissemination were employed. An audio advertisement of the FIU Medic-to-Nurseprogram was aired during hold periods whenever calls were placed University wide. Further,150 Volume VI, No. 2Journal of Health and Human Experience

Articlesrecruitment materials that advertised FIU’s Medic to Nurse accelerated track program weredisseminated via print media to Army Times, Air Force Times, Navy Times and Military Edgepublications. Full page advertisements appeared in these weekly periodicals. In addition, threeGoogle advertisements were launched digitally via the worldwide web.A multi-pronged approach was necessary to supplement traditional recruitment strategies.Recruitment literature was published in a book that the military service members received onseparation from the military. A Facebook page was created and updated regularly to reflectthe current FIU VBSN student enrollment and cohort activities on campus and in the clinicalsetting. The enrolled FIU VBSN students were encouraged to “like” the Medic-to-NurseFacebook page and contribute postings and photographs of their former and present militaryexperiences as a form of advertisement and recruitment of additional students into the program.The FIU VBSN nursing faculty joined the Facebook page to share classroom experiences andpromote good rapport between students and faculty. Local military bases were contacted andvisited, recruitment activities were planned and conducted, and recruitment literature wasdistributed. Advisors and faculty met face-to-face with military service members.The FIU VBSN program academic advisor conducted recruitment sessions with interestedand prospective FIU VBSN program applicants. These sessions provided a brief history of theCollege of Nursing & Health Sciences, its mission and degree offerings, resources available toveteran students, an overview of the FIU VBSN program, the course of study, and admissionrequirements. Recruitment sessions were available as face-to-face presentations or as recordedsessions delivered virtually via YouTube for potential students who were located outside theSouth Florida region.The most successful recruitment strategy for enrolling FIU VBSN students was word-ofmouth. Enrolled FIU VBSN students as well as graduates of the FIU VBSN program directlyrecruited their friends, coworkers, and relatives. Not only was this an excellent recruitmentstrategy, it also served as a retention strategy because the new students knew someone whocould serve as an informal mentor for them after they entered the program.The Journey Begins .Overall, the recruitment strategies at all three universities were similar in method and spirit.Honoring the expertise and strengths of the veterans attracted them to each of the universities.Adapting to veterans’ needs, customizing recruitment approaches for a military service memberand veteran audience, and adjusting admission requirements to holistically evaluate applicantshelped the veterans successfully proceed through the admissions process. The intense focuson meeting the recruitment needs of the veterans started a transformation of the recruitmentprocesses for all three universities that has had a lasting effect on the recruitment processes usedtoday. The strategies implemented to address the challenges faced with recruiting and retainingveterans during the grant period continue to pave the way at these universities for more veteransto begin the journey of becoming a nurse.Journal of Health and Human ExperienceVolume VI, No. 2 151

ArticlesRetention: Pathway to SuccessOnce successfully enrolled, military service members and veterans arrived on campus. Withtheir unique military experiences, many adapted well and thrived. This background was seenas both a challenge and an opportunity. One student focused on the challenge: “The hardestpart about returning to school was my age. I was in my late 30s when I went back, and I felt likeI was in a classroom full of kids!” Another student focused more on the opportunity, saying“Many students are considerably younger and are in different profiles of life and this presents adiversified classroom environment (which is not bad) but can be the most challenging part ofreturning to school” (Davenport University, 2015-2017).For most nursing students, succeeding in a nursing program is challenging. Successfulveterans leveraged their past, present, and future opportunities into completing a nursingdegree. Each university committed to assuring the success of the military students. By strivingto understand the unique perspectives and needs of military nursing students, each universitycreated, expanded, or resourced existing services to support the retention of the veterannursing students.Davenport UniversityAs is true of many universities, the DU MENP has several layers of support in placefor veterans. Because the military is very different from a civilian academic environment,expanding these layers of support for veteran nursing students was a priority. It was importantto determine what constituted meaningful support from the perspective of the veterans. TheDU VBSN students explained that one of their challenges was transitioning from an “externalauthority-based environment toward developing self-authorship and establishing a postmilitary identity” (Davenport University, 2015-2017). Some veterans explained that a selfmotivated type of learning was hard to adjust to because of the structured environment theyhad in the military. On the other hand, the structured military environment helped prepareveterans for a rigorous academic program. Their desire to learn, coupled with a motivatedattitude, helped the veterans succeed.To help ensure that the needs of veteran nursing students were understood, an annual surveyabout support services was sent to all veteran students (Davenport University, 2015-2017). It wasimportant to hear the full story of DU VBSN students who were polite in person and respondedrespectfully with one- or two-word answers with faculty and staff, and who oftentimes would notreach out for support services even when needed. The survey results helped faculty understandthat essential to becoming more confident and secure as a veteran student were the needs tofind balance, find a new team, achieve a new structure for time-management, learn to navigatethe new environment, and define respect differently with faculty, staff and younger students. Itwas also discovered that a peer support system could have many benefits for the students. A DUVBSN student explained the benefit of veteran-to-veteran support:Having the VBSN cohort automatically established a team here at Davenport. Wework together, remind each other of deadlines and have an established connection andunderstanding from our service to begin with. We are older, married, have families, andjobs. We just have a bigger picture. Not that we don't talk to the other students, but ourlives just feel different (Davenport University, 2015-2017).152 Volume VI, No. 2Journal of Health and Human Experience

ArticlesOver the five years of grant funding, several new strategies were implemented to addresschallenges related to student retention. For example, the DU MENP faculty instituted the“Battle Buddy” system. New DU VBSN students were assigned a Battle Buddy and asked tosign a contract detailing the academic demands of the program. Clear expectations and solidsupport through the program proved effective in retaining students. Also, based on studentfeedback, a veteran-focused orientation was instituted. New DU VBSN students talked withcurrent students. These interactions helped remove some of the mystery about the program andgave the new DU VBSN students success strategies.Additionally, the DU MENP faculty found that surrounding the DU VBSN students witha support team was essential, including a focused advisor and teaching faculty who had militaryexperience. The DU MENP faculty assigned the DU VBSN students to distinct cohortsacross all campuses. Meeting for class and study sessions in person helped the students developa sense of connectedness though virtual meetings across all four of the DU nursing campuses.To assure faculty support and increased understanding of the experiences of the DU VBSNstudents, the DU MENP faculty and staff developed several new faculty and staff professionaldevelopment opportunities. These training sessions utilized information gleaned from theveterans themselves to create a simulation of students’ transition experiences called the MilitarySimulation and DU Green Zone training. The military simulation is an immersive simulatedexperience in which the participants take on the role of a student. The Green Zone trainingeducates faculty and staff about military culture, and possible transition challenges of militarystudents. Both trainings also emphasize the positive attributes military students bring with themto the campus community. These key trainings, initially created for the nursing department,were embraced university-wide, facilitating a much broader impact and cultural change.Retention of military nursing students in the DU MENP VBSN increased from 75% in2013 to 90% in 2019. The primary reason for this increased retention rate was thought to be thesupport team that was made possible by the funding of the VBSN HRSA grant. This dedicatedteam was composed of a Nursing Faculty Coordinator, a team advisor, a research associate and amilitary recruiter. Putting all the support services in place took substantial effort and resources.The team’s focus was to fully understand the needs of the medically trained service membersand create research-based interventions to support the cultural change necessary to ensure thesuccess of these students.Despite the retention successes, there were some common reasons for attrition of the DUVBSN students. The inability to adjust to a more independent and less team-based approachto academic work resulted in some cases in time management challenges. DU VBSN studentssometimes were reluctant to ask for help in a proactive manner (Davenport University 2017). Inaddition, there were students who needed to leave due to personal issues preventing them fromcontinuing in a nursing program. Although some students addressed these issues and returned,others did not. Overwhelmingly, the biggest challenges were transition issues related to workburden, veteran benefit issues, family concerns and lack of preparedness for the extensivecommitment a nursing program required (Davenport University, 2015-2017). Although similarto concerns verbalized by all non-traditional nursing students, a more individualized approachwas needed that incorporated military culture in the creation of a successful pathway formilitary nursing students.Journal of Health and Human ExperienceVolume VI, No. 2 153

ArticlesDavenport University VBSN Nursing StudentsWayne State UniversityOnce students were admitted to the WSU VBSN, multiple strategies were put into placeto retain the students (Elliot, 2015). It was recognized that for the WSU VBSN students tobe successful, the needs of veterans had to be anticipated. This was done in several ways. First,military and veteran students’ clinical experiences were Monday through Thursday to allowfor weekend reserve commitments. Second, the WSU VBSN students were assigned to thesame clinical group throughout the program. This was to build upon the military value ofcamaraderie and reduce the impact of weekend reserve responsibilities on other clinical groups.In addition, students were provided with an environment where they could share similarexperiences and support each other t

Wayne State University College of Nursing 5777 Cass Ave Detroit, MI 48202 Tel: (313) 577-0053 Email: [email protected] Amy A. Stahley PhD, RN . veterans into nursing bachelor's degree programs. Davenport University, Wayne State University and Florida International University received grants as part of the HRSA Veterans to Bachelor