Students’ college life adaptation experiences in the accelerated second-degree bachelor of science in nursing program in South Korea

Article information

J Korean Acad Soc Nurs Educ. 2022;28(2):167-178
Publication date (electronic) : 2022 May 31
doi : https://doi.org/10.5977/jkasne.2022.28.2.167
1) Assistant Professor, College of Nursing, Catholic University of Pusan
2) Assistant Professor, College of Nursing, Catholic University of Pusan
Address reprint requests to: Lee, Nayoon College of Nursing, Catholic University of Pusan, 57, Oryundae-ro, Geumjeong-gu, Busan, 46252, Republic of Korea Tel: +82-51-510-0722, Fax: +82-51-510-0747, E-mail: nayoon@cup.ac.kr
*

This paper was supported by the RESEARCH FUND offered by Catholic University of Pusan in 2020.

Received 2022 February 14; Revised 2022 April 25; Accepted 2022 April 25.

Abstract

Purpose:

South Korea has expanded its accelerated second-degree Bachelor of Science in Nursing program to resolve its supply-demand imbalance in nursing, although how these students are adapting to and performing in college after admission remains unclear. Therefore, this study aimed to conduct an in-depth exploration of how Korean accelerated second-degree Bachelor of Science nursing students interact with society and adapt to college life for establishing further supportive educational policies and programs.

Methods:

Participants comprised 20 South Korean accelerated second-degree Bachelor of Science in Nursing students. The data were collected via online or offline in-depth interviews and analyzed using Strauss and Corbin’s grounded theory and by applying a constant comparative method to achieve theoretical saturation.

Results:

The core category, derived using open, axial, and selective coding, was “process of the uncharted journey toward a new dream.” The participants’ college adaptation processes were found to involve three phases: trial and error, adjustment, and acceptance and integration.

Conclusion:

These findings can be used to develop, apply, test, and improve various support programs for accelerated second-degree Bachelor of Science in Nursing students and to advance the nursing profession by nurturing a workforce with diverse academic backgrounds and faster college life adaptation.

Introduction

A sufficient nursing workforce is required to improve public health and provide high-quality healthcare services [1]. According to a report by the Organization for Economic Cooperation and Development (OECD), the number of practicing nurses (professional nurses and associate professional nurses) per 1,000 people in South Korea was 7.94 in 2019, which is lower than the OECD average of 9.40. In addition, the number of strictly professional practicing nurses per 1,000 people in South Korea was only 4.16, which is also lower than the OECD average (7.90) [2]. To resolve this supply–demand imbalance in nursing, the South Korean government temporarily increased the admissions quota for non-nursing degree holders in an accelerated second-degree Bachelor of Science in Nursing (ABSN) program from 10.0% to 30.0% for five years starting in 2019 [3]. Consequently, the number of ABSN students is expected to continue to increase [4], thereby contributing to the growth of the nursing workforce. To ensure a seamless adaptation of non-nursing students into the field, it is necessary to study their program experiences holistically and to provide effective recommendations.

The ABSN program began in the United States (US) in 1971 and has reportedly helped increase the nursing workforce there by educating new nurses through intensive courses completed within 11–18 months [5]. Following in the footsteps of the American Association of Colleges of Nursing [6], Europe, Australia [7], and South Korea have also adopted ABSN programs. In South Korea, the number of students enrolled in this program has been steadily increasing since 1998 [8].

ABSN students possess the advantages of having diverse life experiences and knowledge beyond nursing, which they acquired during their previous education programs and by virtue of being more mature than typical Bachelor of Science in Nursing (BSN) students [9]. Such advantages have been reported to positively affect nursing performances in actual clinical practice [9]. However, ABSN students are required to take on a relatively heavy academic workload, as compared with students in other major fields of study, given the nature of the professional curriculum [10]. They also experience a significant amount of stress due to the strict code of conduct demanded by healthcare professionals and by clinical practice in unfamiliar environments [11]. In addition, new college cultures, difficulties in forming personal relationships with BSN students due to age gaps, and confusion about academic identity due to possessing a mixed knowledge from their previous major and their current studies in nursing have been identified as factors that negatively affect their adaptation to college life [8,12,13].

In South Korea, there are no independent ABSN programs for ABSN students; instead, ABSN students are admitted as second-year transfer students into a BSN program and are required to complete the remaining 36 months of the program together with second-year BSN students [4,14]. However, because ABSN students have not completed any first-year courses, they must complete both the first- and second-year requisite courses in the BSN curriculum within the first year. As a result, these students face difficulties in their academic studies due to not encountering course content in its natural order (i.e., first year and then second year), while also experiencing difficulties with a disproportionate academic workload and alienation from or conflict with BSN students when working on group assignments or participating in practice classes [10,15,16]. Therefore, it is necessary to understand their experiences and establish effective strategies in nursing education to ensure their successful adaptation to college life.

Some studies have used content analysis or phenomenological approaches to assess ABSN students’ characteristics and, perceptions of and satisfaction with their curriculum [17], first-semester experiences [12,18], identity development [19], and college life experiences [14,18]. While these studies are helpful in providing an understanding of the college life experiences of these students, studies that have taken a comprehensive approach on the overall process of college life adaptation are still lacking. It is also important to understand how ABSN students interact with other members of society, including friends and family, while participating in college life, for developing effective adjustment programs and policies for such students who experience an unfamiliar curriculum, a college culture different from what they are used to, and difficulties in building new personal relationships.

Grounded theory allows participants to recognize over time the issues shared within the social structures and environments they inhabit, while also exploring the social-psychological processes of these issues [20]. Based on the grounded theory proposed by Strauss and Corbin [21], the present study aimed to conduct an in-depth exploration of what changes occur in the lives of South Korean ABSN students, how they interact with other members of society while undergoing these changes, and how they adapt to college life. The study aimed to use its findings to gain a broader understanding of the overall experience of the college life adaptation of Korean ABSN students and to provide basic data for revising the present curriculum and for implementing college life adjustment programs for such students. The research question for achieving such an objective was “How are South Korean ABSN students adapting to and performing in college life after admission?”.

Research Methods

Research Design

This study used the qualitative methodology of grounded theory [21] for the in-depth identification of the structures and processes of ABSN students’ college life adaptation. Grounded theory [21] generates a conceptual framework to understand complex and diverse human phenomena through a microscopic focus on individuals’ social behaviors [22].

Participants and Setting

Participants were ABSN students from four colleges in three regions of South Korea. The initial interviews were conducted with three participants who contacted the research team after the recruitment announcement. These participants subsequently recommended other participants. We also tried to identify participants who could represent important theoretical constructs in the data collection and analysis process. Participants who had obtained a degree in a major other than nursing at a four-year college/university and completed at least one semester of the ABSN program were included in the study. Participants were selected with consideration of gender, age, and grade level, among other variables, to best reflect the ABSN students’ college life adaptation process. Students who transferred into the ABSN program while pursuing nursing or another major at their previous institution and those who were in their first semester of the program were excluded. A total of 20 ABSN students participated, none of whom withdrew from the study.

Data Collection and Procedure

Data were collected using in-depth interviews for each participant from June 4, 2020 to January 5, 2021. Given the ongoing coronavirus disease (COVID-19) pandemic and the resulting limited mobility, the initial interviews for 12 of the 20 participants were conducted on mobile phones and lasted for approximately 40 to 90 minutes. In person interviews for 8 participants took place in vacant classrooms during school breaks, and both the researchers and participants wore face masks during the entire interview process. To create a more comfortable atmosphere under the COVID-19 pandemic, researchers started the interview with brief greetings, introductions, and a reassurance of confidentiality. Interviews began with an unstructured question: “What can you tell us about your experience as an ABSN student?” As the interviews progressed, the researchers asked the following additional questions to derive a variety of concepts and categories. (1) “What problems did you face at the beginning of the ABSN program, and how did you feel about them”? (2) “What are some interesting, difficult or rewarding experiences you have had while attending school”? (3) “How has your school life been since the program started? Have there been any changes”? and (4) “What kinds of experiences have you had with friends, professors, and family while being in the ABSN program”?

Additional interviews, which lasted for approximately 10 to 30 minutes each, were conducted over mobile phones with three participants to clarify ambiguous responses. All the interviews were recorded with consent from the participants, and non-verbal reactions were recorded in field notes. There were limitations to identifying non-verbal cues; however, certain characteristics such as tone of voice, speech rate, pauses, and interjections were noted and considered as data. The transcribed data were verified and revised by the researcher and were then used for data analysis.

Data collection was completed when it was determined that no new information about participants’ college life adaptation experiences could be obtained. When no further meaningful data appeared and no more attributes and dimensions of data categories were discovered, it was concluded that the data had reached theoretical saturation.

Based on the contents transcribed in Korean, the researchers analysed the data and wrote this paper. An English language translation and academic editing of the main results were reviewed and modified by professional translators and editors. Finally, the research results were reviewed by bilingual translators with experience in reverse translation who had received master’s and doctorate degrees in English literature after obtaining a bachelor’s degree in nursing.

Data Analysis

To identify the meaning and structure associated with participants’ college life adaptation experiences, data collection and analysis were performed iteratively. The NVivo Pro 12.0 (QSR International, Burlington, Massachusetts, USA) is a qualitative data analysis program. It was used to ensure that data categorization and organization were conducted efficiently and accurately.

Data analysis was conducted in the following three stages: open coding, axial coding, and selective coding. In the open coding stage, raw transcribed data were read repeatedly to identify commonly mentioned experiences. Next, for a more specific analysis, raw data that had been saved with the NVivo Pro 12.0 program were opened, and concepts were derived from the participants’ meaningful statements about their experiences and then named and formed into nodes. In the axial coding stage, a paradigmatic model was used to create links among the nodes. This allowed researchers to explain college life adaptation experiences more comprehensively and enabled them to use the analysis process to identify how participants’ experiences changed over time. In the final selective coding stage, core categories were derived, and an action/interaction strategy was applied to observe how various situations and conditions influenced the consequences.

Rigor and Researchers’ Preparation

The quality of this study was ensured using the evaluative criteria for grounded theory studies proposed by Charmaz [23]. For credibility, recorded data were transcribed verbatim by the researcher who conducted the interview within three days after an interview, whereas concepts and categories were derived by constant comparisons. Moreover, the results were shown to four participants to confirm that their experiences were sufficiently and accurately reflected. For originality, the researchers highlighted the contexts and situations experienced by ABSN students that had not been emphasized in prior nursing research. When there was a difference of opinion in the process of comparing and integrating the meanings derived from the data analysis, the researchers held discussions and made adjustments accordingly. For resonance, the researchers attempted to recruit participants through various sampling methods and recruited two non-participating ABSN students (one male and one female) to externally validate the derived concepts and statements. For usefulness, the researchers assured that an integrated analysis was conducted through continued meetings and discussions with a nursing professor with qualitative research experience concerning the study’s entire process.

The researchers steadily enhanced their research capabilities by being regularly involved in qualitative research associations. One of the researchers gives lectures on the methodology of qualitative research at a graduate school, and both researchers have published papers that apply various qualitative research methods in numerous academic journals. Being nursing professors, the researchers were also able to build rapport and trust with the ABSN students throughout the interview process.

Ethical Considerations

This study was approved by the Institutional Review Board of Catholic University of Pusan (IRB No. CUPIRB-2020-008). Before data collection, all participants were informed of the objectives, processes, and data storage conditions of this study. We also emphasized the values of confidentiality, freedom of refusal to participate, and freedom of withdrawal of consent and obtained informed consent forms before data collection. Each participant received a small reward of appreciation after completing the interviews.

Results

The study population comprised 20 participants (14 females and 6 males). Twelve participants (60.0%) were aged 20–29 years, whereas eight were aged 30–39 years. Two participants were married. Two of the participants were sophomores, eleven were juniors and seven were seniors. Eight participants (40.0%) had a Bachelor of Science degree, whereas 12 had a Bachelor of Arts (BA) degree. Moreover, 12 participants had prior work experience.

Overall, 17 categories encompassing 45 sub-categories were derived by open coding. A paradigmatic model was constructed using axial coding to link the relationships among the derived categories (Table 1). The model revealed that participants’ college life adaptation processes involved the three phases of trial and error, adjustment, and acceptance and integration (Figure 1).

Relationships among Categories in the Paradigm Model

Figure 1

Students’ college life adaptation experiences in the accelerated second-degree bachelor of science in nursing program

Core Category: The Uncharted Journey toward a New Dream

The core category was experiencing the “process of the uncharted journey toward a new dream,” which could be explained as the process of embarking on new dreams and taking steps toward realizing them.

Participants did so by forming relationships with BSN students, accepting unfamiliar cultures, and adjusting to their daily lives, while struggling as newcomers.

However, although this process was found to include the aforementioned three phases, the students did not experience them sequentially; rather, the phases overlapped with one another. In some cases, the process did not proceed beyond the trial-and-error or adjustment phases, resulting in participants “ending the journey.” Thus, these phases influenced and interacted with each other.

Phase I: Trial and Error

The “trial-and-error” phase represented participants’ initial efforts to adapt to unfamiliar environments and a new curriculum, while experiencing a lack of consideration and available information. Participants’ motivations for enrolling in the ABSN program included uncertainty about the future, aspirations to achieve unfulfilled dreams, and the advantages of being professionals. After being admitted, they experienced conflicting emotions, such as happiness and excitement, as well as fear and concern. They were apprehensive about the financial burden of being students again while their peers were engaging in revenue-generating activities and about balancing the responsibilities of studying while being employed or parenting. Moreover, despite studying diligently, they repeatedly experienced challenges to achieve success in the program, given the institutional lack of consideration and information combined with health problems arising from high stress due to poor academic performances. Some of the responses noted were as follows:

(When admitted) I wanted to get into nursing ever since I was young, although my grades were not very good. Thinking about doing something now that I could not do before made me excited and happy beyond words. However, I worry about whether I can do a good job, which is complicated. (Participant 2)

I am short on time and just trying to get used to school life, although when I go home, I have to take care of my child. It is tough because I have many roles other than being a student. (Participant 20)

BSN students learn medical terminology during their first year and adult nursing during their second year. We learned adult nursing first, followed by medical terminology. It was perplexing to hear medical terms for the first time during the adult nursing class. (Participant 8)

I heard BSN students have an incoming student orientation, although we did not have an orientation. There was no one to tell us where the lecture hall and the library were. By the first lecture, BSN students were already close to each other, although we were just thrown into the situation with no one introducing themselves. (Participant 9)

No one told us how to prepare for the exams. I was nervous, although because there was no other way, I just studied. However, I was so disappointed with my grades that I could not even imagine. (Participant 4)

In this phase, participants commonly experienced difficulties in forming relationships with BSN students or departmental faculty. They thought that BSN students had biases against them and did not want to form good relationships with them. They also perceived that this prejudice was attributed to their relatively easy admission process compared with the tougher BSN admission process. In such situations, some participants experienced a sense of alienation and attempted to become closer to other transfer students who were in the same situation, whereas other participants took the first steps to becoming acquainted with BSN students.

I do not think the BSN students view us as equals. They think that we are freeloaders and losers who were lucky to get admitted, unlike themselves who studied hard to get into nursing school. Given this prejudice, we became timid and hesitant about forming relationships. It would also be difficult to be comfortable with each other because of age differences. (Participant 7)

In the early days of admission, an orientation only for ABSN students was provided to us and we met with ABSN seniors. We became mentors-mentees, which gave us a sense of belonging, and it was very helpful. Senior ABSN students knew exactly what we were wondering about and provided a lot of information. (Participant 5)

First, we used to hang out only with transfer students. We empathized with each other because we were all facing the same situation and had no information. However, doing so would make it difficult for students to become familiar with school life. Therefore, I tried to start conversations with BSN students who were assigned to the same team during practical training. I also bought them coffee to get closer to them. (Participant 15)

Phase II: Adjustment

The “adjustment” phase, which typically occurred after the trial-and-error phase, represented participants’ active adjustments to college life. Whenever they faced academic challenges, they consoled and motivated themselves. Moreover, they adjusted their regular habits by, for example, changing their learning methods, better managing their leisure time, asking for financial assistance from family, and taking care of their health. During this phase, they had a broader view of college life than during the trial-and-error phase, wherein they had used the strategy of comparing their ongoing college experiences to previous ones or to the lives of their peers who had stable lives, including marriage or career aspects.

After the first semester, I thought that this was not working out. Given that I have a BA degree, I could not understand almost everything during the physiology and pharmacology classes. Therefore, during the vacation period, I studied high school biology and chemistry through Internet lectures. As I started doing clinical practical training, I could not continue with my part-time job. Thus, I asked my parents for help, promising to pay them back when I get a job. (Participant 13)

I have some friends who are already married and raising children; thus, when studying becomes difficult, I sometimes think to myself, “What am I doing?” When that happens, I encourage myself to be stronger, knowing that I will become a nurse once this process comes to an end. (Participant 18)

In this phase, some participants focused on self-care and naturally formed relationships with not only ABSN students but also BSN students. They also demonstrated their strengths or proposed improvements in the programs. However, some participants felt burdened from receiving negative attention because of the prejudice against transfer students, and at the same time, they were unable to be assertive about the unreasonable treatment and wanted to not be considered a transfer student. As described, the participants gradually adapted themselves to school life through an adjustment process, wherein they expressed or, contrarily, hid their feelings and thoughts. Participants went through this phase more comfortably when they had a stronger support system and a more flexible and active attitude toward college life.

We would inevitably have lower grades than BSN students because we take more required courses than they do during a semester. Therefore, we proposed to the school to offer major courses during summer school. There are people like me who proposed that to the school, although there are other students who said nothing because they do not want to hear people say that transfer students are demanding. (Participant 13)

Phase III: Acceptance and Integration

The “acceptance and integration” phase was the final phase in participants’ experiences of college life. Along with employing the strategies used in the aforementioned two phases, participants also accepted, to a certain degree, the limitations of being transfer students, such as difficulties in forming relationships and the disadvantages of being older while preparing for employment.

Participants who successfully chose and adopted positive strategies felt a complete sense of belonging as nursing students. They experienced a sense of accomplishment by adjusting to college life and having begun to achieve their dreams. In particular, this tendency was higher among participants who had a stronger support system, were flexible in terms of forming relationships, or were actively engaged in school life.

I took part in a mentoring contest held at the school, and because I had experience from my previous college, I taught how to study for TOEIC by using computers. I won a second-place prize in the contest. After that, the BSN students were interested in me. I was really happy to help BSN students, and this became an opportunity for me to be closer to BSN students. (Participant 15)

There is nothing I can do about limitations in becoming closer to the BSN students because of the age difference, although I have to accept that… I have adapted completely to school life, and my grades are in the top percentile. BSN students treat me as their real older sister and often tell me about their worries. (Participant 16)

However, some participants compromised their original dreams, replacing them with the goal of just graduating, and were conflicted about whether to continue or terminate their studies. They were unable to completely integrate with BSN students and remained outsiders, stuck in the adjustment phase. Meanwhile, a few participants ended the “process of the uncharted journey toward a new dream” by choosing to withdraw or drop out of the ABSN program during the trial-and-error or adjustment phases.

I should have come a bit sooner. At my age, by the time I graduate, get married, and have children, it will be difficult to raise my children while doing shift work. I think it is inefficient to endure three difficult years just to work as a nurse for 1–2 years… (therefore, I decided to withdraw). (Participant 1)

Discussion

This study attempted an in-depth exploration of how South Korean ABSN students interact with their friends and family and how they adjust to their college lives with an aim of establishing supportive policies and programs for such students. The “process of the uncharted journey toward a new dream” for ABSN students’ college life adaptation included three phases—trial and error, adjustment, and acceptance and integration. These phases occurred sequentially but also reverted and overlapped with each other, with some participants ending their journeys without reaching the acceptance and integration phase.

The trial-and-error phase represented participants’ struggle to adapt to the unfamiliarity of college life while lacking information or support. They joined the program due to reasons that included uncertainty about the future, unfulfilled aspirations, and social recognition as a nursing professional. These findings are consistent with those of previous studies [18,19,24], which reported that students chose to enroll in such programs due to dissatisfaction with their current jobs, wanting to pursue their dreams, and achieving stability as a nursing professional. Based on a previous study [25], people who work in nursing choose their jobs due to professionalism, easy employment, stability, and high salaries. It is believed that the motivations for choosing to study nursing are similar between BSN and ABSN students.

In line with previous studies that reported high stress among students during the first semester of the ABSN program [12,18,26], most participants in this study stated that they struggled due to difficulties in academic demands and in forming relationships with BSN students. They struggled with academics as they were learning completely different content from their previous academic programs. In particular, participants with a BA degree had difficulty in understanding anatomy and physiology and medical terminology, which has been reported in previous studies as well [8,18]. Moreover, similar to a previous study’s findings [12], this study’s findings revealed that ABSN students in South Korea had struggled due to learning basic and advanced courses simultaneously as compared with learning courses in the correct order. In the US, students are required to take prerequisite courses (which can be offered online [27]) before starting ABSN programs, and basic courses, such as physiology, can be taken throughout [26]. Notably, students’ prerequisite grades for anatomy and physiology have been found to influence their overall first semester grades [26]. Therefore, the opening of online courses for anatomy and physiology that can be repeated until certain scores are achieved and the provision of specialized support to students who struggle with those courses, along with academic consulting or counseling programs, could facilitate their initial adaptation to the program. Completing basic courses, such as anatomy and physics, through online learning prior to taking advanced courses in the ABSN course would not only enhance students’ understanding of academic nursing knowledge, but would also help prevent the difficulties related to taking basic and advanced courses simultaneously or in reverse order.

Shin et al. [8] suggested the need for curriculum reform, as ABSN students struggle with the non- sequential offerings of courses, which has not been rectified in 19 years. It is necessary to reflect on why such an important problem has not improved and has continued for 19 years. If the curriculum for ABSN students is reorganized in the future, it will also be necessary to introduce a regular evaluation system with the Korean Accreditation Board of Nursing Education to maintain and improve the program’s quality of education.

Another major experience during this period was participants’ inability, as newcomers, to integrate into the existing culture and to build personal relationships. Most participants attempted to make their presence known or took the first step to mingle with the BSN students, although they became timid due to various prejudices that BSN students had about them. To the best of our knowledge, while this has not been reported in studies outside of South Korea, participants stated that BSN students thought that ABSN students were freeloaders who had gained admission through a relatively easy route, unlike the BSN students who were admitted based on their academic success, including high Scholastic Assessment Test results, high school records, and various extracurricular activities. Such prejudices created difficulties in forming and maintaining relationships between ABSN and BSN students and negatively influenced the ABSN students’ early adaptation to college life. Considering that peer relationships have been found to be the strongest predictor of college life adaptation [28], improving these relationships is required in ABSN programs. Introducing ABSN students on the first day of classes, explaining how they can contribute to advancing the nursing profession, and frequently providing opportunities for BSN and ABSN students to participate in practical training or learning activities together would be beneficial interventions.

In the adjustment phase, participants used various strategies to adjust to academic requirements and personal relationships. They motivated themselves to learn and modify their daily lives, such as changing their learning methods and asking for financial assistance from their families, while taking care of their health. They also used the strengths they had acquired through previous educational and professional experiences to contribute to team projects, which provided them opportunities to become closer to BSN students. In the adjustment phase, schools need to provide ample opportunities for ABSN students from various backgrounds to perform leading roles in various extracurricular programs based on their experiences. Through those successful experiences, they will have the opportunity to become closer with BSN students, regain their confidence, and ultimately adapt more successfully to college life.

Findings also showed that those students with stronger support systems and more flexible and active attitudes toward college life were able to navigate this phase more smoothly. Previous studies have reported similar findings, highlighting that social support is an essential element required for adjustment by college students [29] and that support among transfer students facilitates their adjustment [8,14]. Some participants in our study reported that orientation for ABSN students only and mentoring between seniors and juniors provided opportunities for ABSN students to meet each other and gain a sense of belonging as well as social support.

However, such programs were offered in only one of the four colleges attended by the participants of this study. Therefore, it is necessary to establish and expand mentorship and orientation programs and conduct status surveys to assess their impact on the established programs.

The acceptance and integration phase was the final phase in participants’ college life adaptation process. They used various action/interaction adjustment strategies but also accepted their limitations.

Experiences in the prior two phases, especially the adjustment phase, also influenced the consequences of their adaptation experiences. Students who used active strategies, such as making efforts to integrate with college members and speaking their minds, taking the initiative in peer relationships, actively participating in various activities, and achieving good grades, made significant strides toward realizing their dreams. Such findings could be viewed as being similar to those of previous studies describing ABSN students’ college life experiences as a “rolling stone finding its own place” [14] and “assimilating to nursing student culture” [19]. In contrast, participants who downsized their dreams to graduating as soon as possible continued to be conflicted about their career choice and remained outsiders. These findings reflect those of a previous study that reported that such students maintained a distance from both BSN and ABSN students and “built their own world” [19]. A few participants who had failed to adapt during the trial-and-error or adjustment phases chose to withdraw or drop out of their programs.

ABSN students’ failure to adapt to college life and dropping out can cause significant losses at a personal level due to not their getting any return for the time, cost, and effort they invested, as well as failing to address the supply problem in nursing. Therefore, it is necessary to analyze their challenges by conducting qualitative research on how and why they dropped out of the ABSN program. This could be employed as basic data for a strategy to minimize the number of ABSN dropouts.

In studies that evaluated ABSN performance in the US [25,30], ABSN students had higher average grades than BSN graduates, adapted better to clinical practice, and had longer tenures. These results indicate that expanding the ABSN program could not only resolve the supply–demand imbalance in nursing but could also contribute to advancements in the nursing profession. Future studies should be conducted on employment rate, tenure, interpersonal relationships in clinical practice, and job satisfaction among South Korean ABSN graduates to verify the outcomes of ABSN programs and to develop long-term strategies for improving them.

This study analyzed data from a limited number of participants; therefore, there are limitations in generalizing its findings. There were also difficulties in identifying non-verbal cues such as facial expressions and gestures when conducting interviews over the phone, a measure taken due to the COVID-19 pandemic. However, the significance of this study is that it used the grounded theory to explore how ABSN students in South Korea interacted with other students and adapted to college life. This methodology enabled in-depth and diverse discussions of their experiences. Moreover, the findings reflect the unique academic culture of South Korea and thus provide a culture-specific perspective. In addition, as the number of ABSN students in South Korea continues to increase in the effort to resolve the supply–demand imbalance in nursing, this study is more meaningful because various considerations are needed to supplement the current ABSN system. Based on the results of this study, it is expected that the ABSN curriculum could be revised, that programs that can help ABSN students’ adaptation could be developed, and that systematic supplementation for quality management of the ABSN curriculum could be made.

Conclusion

This study was conducted to assist in the college life adaptation of ABSN students in South Korea, who are increasing in number, through an in-depth exploration of the college life adaptation experiences of ABSN students and by examining the improvement measures for and problems associated with the South Korean ABSN program. The findings in this study should be used to improve the ABSN curriculum and for developing various support programs for ABSN students that can then be applied and tested. Institutional sponsorship of such efforts in nursing education is expected to ultimately improve self-esteem among ABSN students and promote their college life adaptation. Such support could also be expected to contribute to the advancement of the nursing profession through the development of a nursing workforce with diverse academic backgrounds.

Notes

No potential conflict of interest relevant to this article was reported.

Funding

This paper was supported by the RESEARCH FUND offered by Catholic University of Pusan in 2020.

Acknowledgements

We would like to thank all the ABSN students who participated in this study. We truly appreciate their time and effort.

Supplementary materials

None

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Table 1

Relationships among Categories in the Paradigm Model

Paradigm element Categories Sub-categories
Causal conditions Uncertain future ∙ Repeated failure
∙ Unstable employment
Aspiration for unfulfilled dream ∙ Regret about the career not chosen
Social recognition for the nursing profession ∙ Advantages of being a professional
∙ Image of the nursing profession
Phenomenon Struggling on a difficult journey as a newcomer ∙ Mixed emotions
∙ Difficulty in forming relationships
∙ Playing various roles
∙ Financial burden
∙ Signs of health problems
Contextual conditions Completely new learning environment ∙ Unfamiliar major
∙ Tight curriculum
∙ Atmosphere catering to returning students
Prejudice against transfer students ∙ Failure in life
∙ Freeloader
∙ Greedy new competitor
Intervening conditions Support system ∙ Camaraderie among transfer students
∙ Consideration from school members
∙ Programs for transfer students
∙ Encouragement from family and friends
College life attitude ∙ Flexibility
∙ Activeness
Action/interaction strategies Attempting to fit in ∙ Observing
∙ Taking the first step
Self-care ∙ Motivating
∙ Adjusting daily life
∙ Taking care of health
Comparing ∙ Comparing to previous college life
∙ Comparing to the daily lives of people in the same age group
Expressing ∙ Honest expression of emotions
∙ Highlighting strengths
∙ Proposing a system for transfer students
Hiding ∙ Staying quiet
∙ Erasing the title of transfer student
Accepting ∙ Accepting difficulties in forming relationships
∙ Accepting the difficulties that come with age
Consequences Continuing the journey toward the destination ∙ Sense of accomplishment
∙ Confidence about the choice made
∙ Maintaining a self-led college life
∙ Become a full member
Holding on with mixed feelings ∙ Compromise with reality
∙ Continued conflicts
∙ Remaining an outsider
Ending the journey ∙ Take a break
∙ Disembark from the ship

Figure 1

Students’ college life adaptation experiences in the accelerated second-degree bachelor of science in nursing program