LPN to BSN Online Program Best Option for Many to Accomplish Goals

Susan Patton told December graduates of the online LPN to BSN program at the University of Arkansas that many of them were graduating thanks to the tenacity of Hilary Bowling.

Bowling had the vision for launching the online LPN to BSN program, said Patton, former director of the Eleanor Mann School of Nursing at the U of A. Patton addressed the graduates during the school's pinning ceremony. The online program created a path for licensed practical nurses to earn a degree and advance their careers while working full time in their hometowns, Patton said.

Bowling, Patton and many others provided educational opportunities and access for working LPNs in the program that is finishing its fifth year this spring.

While it empowers LPNs, it also helps to meet the health-care industry's demand for more higher-skilled nurses as well as addressing the university's land-grant mission of educating more registered nurses in Arkansas, nursing school officials said.

“I think it's one of the most important programs at the university,” Patton said in an interview later. “We are producing nurses for the state of Arkansas who have an educational background that is going to improve patient outcomes.”

According to the American Association of Colleges of Nursing, RNs prepared at the bachelor's degree level hold the skill and abilities to holistically assess the community, including social determinants of health, and provide leadership and guidance to set improvements in motion for better health-related outcomes. More than 60 Arkansas residents have earned a bachelor's degree through the U of A's online program for LPNs.

Natasha Holzhauser received her nursing pin and a big hug on the stage that night. It was a special evening, the culmination of much hard work and determination as she pursued her dream of becoming a registered nurse.

“All I wanted to do was take care of people,” Holzhauser said. “I love to be a part of having people trust me during a vulnerable time, being part of sad and happy times during people's lives.”

Holzhauser, who lives in Gravette, Arkansas, was pinned by Diana Dunbar, a clinical instructor in the program. Graduates could choose a faculty member, friend or family member to put their pins on the lapel of their white coats when they crossed the stage.

 

How it Started

Patton retired in the summer of 2022 as director of the nursing school, but she stays connected in various ways. She serves on the Dean's Advisory Council for the College of Education and Health Professions, of which the nursing school is a part, and she teaches one class a year online. She was invited to speak at the pinning ceremony traditionally held for nursing graduates the evening before commencement exercises.

Bowling, a clinical instructor in the nursing school, persisted where a less-determined person might have given up, Patton said.

Bowling began teaching full time in the online RN to BSN program in 2014 and soon recognized the need to create an option for LPNs. She led the initiative, and the program accepted its first students in the fall of 2019.

But, that makes it sound easy.

Starting the program was extremely challenging, Patton recalled. Bowling was intent on getting approval from administrators at the nursing school and College of Education and Health Professions. Patton herself turned down Bowling's proposal initially.

“She presented a proposal to leadership for a LPN to BSN pathway several times, and they didn't support it,” Patton said. “At first, I was reluctant as well because it would be a lot of work. Hilary came up through that pathway as an LPN first. She said a lot of LPNs she worked with would love to have a BSN, but they can't move to campus.”

Many LPNs want the opportunity to get a bachelor's degree, Bowling said.

“Especially in the state of Arkansas, I have known and worked with some really exceptional LPNs that didn't have the opportunity to further their education,” Bowling said. “We started doing our research on online LPN to BSN programs. There weren't many at the time, but there was one in Indiana that did not serve our state. We called them for advice. We had no idea it would take off so quickly.”

The U of A's online LPN to BSN program is one of a kind in Arkansas and was the second of its kind in the United States to provide access to nursing education for this population completely at a distance, according to Bowling. 

“The nursing school has always been stretched pretty thin,” Patton said. “I didn't know if we could handle more students. We were told we would get resources, but it took a while. Then, a surge in interest coincided with the pandemic.”

The Eleanor Mann School of Nursing had several factors going for it, Patton said, including faculty experienced with teaching online in the bachelor's and master's programs and a new Doctor of Nursing Practice offered online. The school also had the backing of the U of A Global Campus, a unit that supports U of A academic colleges with the development and delivery of online degree programs.

Global Campus staff accompanied her to meet with other departments to convince them they could teach sciences courses online, Patton said, providing them assistance to create courses nursing students needed to graduate. Some of these departments had no online presence at the time, she said.

 

Pathways for Advancement

Bowling started her nursing career as an LPN and now holds bachelor's and master's degrees in nursing from the U of A and a doctorate in health systems executive leadership from the University of Pittsburgh. Her graduate degrees were earned through online delivery.

“One of the things I saw early on as an LPN is that a lot of LPNs felt stuck,” Bowling said. “A lot of times people choose that route based on time to completion. They can get into the profession quicker than an RN-BSN level program would allow. Many felt stuck because they needed to provide for their families. They needed to work full time.”

Because a nurse's work shifts can vary by the job, sometimes three days a week with long shifts, sometimes Monday through Friday, sometimes evenings, getting a nursing degree doesn't fit the mold of being able to work and go to school in the traditional way, Bowling said. She worked 16-hour shifts on weekends to free up daytime hours to study on other days getting her bachelor's degree in the U of A's on-campus program.

“In 2014, we only had the RN to BSN online program, and I was hired to work in that program,” Bowling recalled. “I started asking questions about why we weren't meeting the needs of LPNs in our state. Distance education is my passion and access to education is very important. One of the first things I learned as an LPN was that getting a higher education was often met by a roadblock of some sort.”

It can be challenging to fit in full-time work needed to support yourself while paying for school, even as a single person, she said. LPNs need flexibility.

“LPNs are willing to do the work, but they can't be in two places at one time,” she said. “Everybody who has the desire to advance their career, which will be better for patient populations, should have the opportunity and access.”

 

Assessing the Need

Bowling received permission to put up a notice by the time clock at a long-term-care facility in Arkansas. She asked on the sheet whether LPNs working in the facility would be interested in an online LPN to BSN program. Her belief that LPNs wanted an online program was borne out by all the signatures she collected. Nearly every nurse working at one of the larger homes signed the sheet, Bowling said, and the company committed to paying tuition for a limited number of LPNs to go through the program each year.

Retaining RNs can be a challenge for some long-term-care facilities, she said, and this was an opportunity for LPNs to further their education and continue working in the facilities if that's where their passion lay.

“It was the best of both worlds,” Bowling said, “to further their education and improve services. We are meeting our clinical partners' needs.”

Data from the Arkansas State Board of Nursing show the concentration of LPNs and the concentration of RNs working in each county of the state in the maps pictured at the bottom of this story.

“There are huge areas in the state not being served by RNs,” Bowling said. “Our land-grant mission includes the whole state. Every time I look at that, I think we have got to do more. There are nurses in those counties who just can't go to school two hours away. Rural hospitals can't stay fully staffed.”

 

LPN Experiences

Andrea Howard, an academic adviser in the College of Education and Health Professions, previously advised students in the online LPN to BSN program.

“Almost everyone was working full time, the majority had children and families, and if it weren't for the program being online, they would not have been able to go back to school and finish a degree,” Howard said. “Knowing they would increase their future earnings by completing a degree made the cost of going back to school well worth it for students. There are not a lot of online programs like ours out there, too – I heard that time and time again from students. So, overall, students were very thankful and verbalized how happy they were to be accepted into the program and able to finish their degree at that point in their lives.”

One of those students was Kristen Peek of Little Rock. Nursing was a second career for her. After graduating from another university with a bachelor's degree in biology, she worked in pharmaceutical sales until the stock market crash of 2008. She realized people and community were more her passion, and she wanted a more direct role in health care, Peek said.

“I want to help people,” she said. “I want to help patients. I want to be there as an advocate when it comes to disease and medications.”

She got her LPN credentials and worked for 10 years in nursing. She wanted to go back to school but, until the U of A began its online LPN to BSN program, the options just didn't work for her, Peek said.

“Everybody has those missed opportunities,” she said. “I don't think I would have gone back to school for my BSN if it weren't for online.

Peek earned her BSN online in December of 2020. She works now as an operating room nurse circulator in central Arkansas, which means her job is to keep everything flowing, kind of like the ringleader under the big top of a circus. She's there to respond if the surgeon or technicians need anything and to make sure the patient is stable.

“There are so many different opportunities now with having a bachelor's degree, and there's increased pay,” Peek said.

She advises other LPNs who are thinking about pursuing a bachelor's degree online to do it.

“You will make the time,” she said. “Your professors are there readily available. They want you to succeed. Do this for yourself. After practicing as an LPN for several years, I had more confidence and the skill level to pursue this.

“I am very blessed this program existed,” Peek continued. “I wouldn't be where I am today if it wasn't something you could do all online.”

Natasha Holzhauser started her nursing career right out of high school in 2015 with a CNA program. She earned her LPN while working in a cardiac unit at a hospital on Friday, Saturday and Sunday, with in-person classes at a local technical school on the other days of the week.

Not working while furthering her education was not an option for her, Holzhauser said. She chose the online LPN to BSN program so that she could continue working at a primary care office during the weekdays and do schoolwork at night and on weekends.

Holzhauer said she would advise LPNs considering the online BSN program to jump in with both feet.

“It is going to be scary at first,” she said. “It is going to be a commitment. One of the hardest parts is just starting. Once you have started, there is no turning back and you will have your RN.”

In her position now, Holzhauser is using more advanced skills, she said.

“After I graduated with my RN, I got a promotion in the office,” she said. “I primarily handle all incoming messages from patients and providers. It is a desk job with not a lot of hands-on patient care, but it's good because I feel like it allows me to use my critical thinking skills, and I have autonomy to make clinical decisions.”

 

What's Next?

Bowling recently stepped away from directing the online LPN to BSN program, five years after it accepted its first students and almost that many years working to get it started. Fernanda Zayas, a clinical instructor in the program, has taken over coordinator duties.

“It was the hardest decision I have ever made,” Bowling said. “It is very much my passion. My plan is to learn more and contribute in whatever meaningful way to build different pathways for students, whether it's partnerships between different schools or health-care organizations that help students see their potential.”

She recalled one of her instructors telling her early on when she was a student, “ ‘You know, you can go all the way.' So many people need to hear that. They may not even know what their options are at each level of nursing. Pathways and access to higher education in nursing are still going to be at the forefront of what I do next.”

The online LPN to BSN program has graduated 173 students since it began. Of the 62 who are Arkansas residents, 41, or 66%, are first-generation college students; and 12, or 19% are minorities, according to data from the Global Campus, and the average age of graduates from Arkansas is 35.5.

The program recently moved to accepting only students in Arkansas, partly to focus on the state's needs, Bowling said. She put out a call for more clinical partners in the state who can provide preceptor experiences for students, in which they are paired one-on-one with an RN.

“We need more clinical partners, particularly in rural areas,” she said. “We want to be able to have more partners in all counties so we will be able to take more students and best serve our state.”

Wanted: New Clinical Partners throughout Arkansas

Contact nursing@uark.edu if you would like to partner with the Eleanor Mann School of Nursing on precepted experiences for students.

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U of A online LPN to BSN program

In the fall of 2019, the Eleanor Mann School of Nursing accepted the first cohort to the LPN to BSN option. This program is one of a kind in Arkansas – and was the second of its kind in the United States – to provide access to nursing education for this population completely at a distance. Its strengths include:

• Diverse student population in demographics, education, and experience; 160 Arkansas in-program students covering 45 counties in 2022.
• Rigorous, part-time format allows working nurses access to the BSN level of education while simultaneously caring for their communities.
• Preceptor model in which a student is paired one-on-one with an RN allows students to gain valuable hands-on clinical experiences in their own geographic area.
• Elevating the educational level of the nursing workforce in counties across the state.
• Many graduates go to work in the same facilities in which they complete their clinical rotations or earn promotions where they are currently working.

Source: University of Arkansas

Arkansas nursing workforce demographics

• 90% of Arkansas acute-care facilities report demand exceeds the supply for both new and experienced RNs.
• Nurses under age 35 are leaving the workforce at a higher rate than older nurses, which will widen the experience-complexity gap.
• The average salary for an RN is $65,810 compared to $43,040 for the LPN.

Source: Arkansas Center for Nursing

Additional challenges rural communities in Arkansas face

• In 2018, the average earnings per job in the rural region was 14% lower than in urban areas.
• Poverty rates and food insecurity are higher in rural versus urban areas.
• Health-related factors are worse in rural areas of the state, with the worst health outcomes such as obesity and infant mortality found in the Delta region.
• Only 23% of adults in rural areas have earned an associate's degree or higher compared to 35% in urban areas.
• Median age and population of older adults rising, increasing needs for health care in rural areas.

Source: University of Arkansas Extension Service

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LPN compared to RN

A licensed practical nurse (LPN) performs tasks such as taking vital signs, administering medication, placing catheters, dressing wounds, and carrying out health care instructions created by the registered nurse (RN), physician, and other care team members. An LPN typically works under an RN's direct supervision and assists patients in daily routines like eating, dressing, and bathing. RNs receive more training than LPNs and, as a result, have more responsibilities. A registered nurse works with physicians, advanced practice registered nurses, and a team of specialists to develop a patient care plan that the LPN helps to execute.

Source: American Nursing Association

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