Class Action Suit Hits at Core of Popular Online Nursing Program

NursingIn February, 17 students from 11 states filed a class-action lawsuit against Excelsior College alleging some details of the distance learning program for the accredited nursing associate degree (ADN) were withheld and others misleading. The students, who are seeking $10 million in damages, claim they were not given adequate details about fees and failure rates prior to enrolling. They further claim Excelsior was motivated by profit because students pay an annual registration fee and also have to pay to retake the final exam.

Although not part of the initial complaint, allegations have also been raised about racial bias in the administration of the final exam.

It is noted on Excelsior’s website: “Excelsior’s unique exam-based program is specifically designed to provide a pathway to a nursing degree for LPNs (licensed practical nurses), LVNs (licensed vocational nurses), paramedics, and individuals who hold degrees in clinically oriented health care fields.”

No one from Excelsior would comment on the lawsuit, but they would answer questions about the college’s nursing programs.

According to William M. Stewart, assistant vice president of Excelsior College, the ADN is a self-paced program where students study on their own. Although the college is an open-enrollment institution, there is admission criteria for the ADN program, which is limited to individuals with defined health care experience.

“While students do progress through the program at their own pace and most complete it in an average of three years, there is a seven-year limit to degree completion,” says Dr. Mary Lee Pollard, dean of Excelsior’s school of nursing. “Progress for students in the AD program is monitored by both academic advisors and faculty.

“In addition, students in the AD program have the opportunity to participate in online conferences to help them structure their study in preparation for taking examinations and the capstone clinical assessment,” she continues. “The online conferences support independent learning through self-paced learning modules and the use of an electronic discussion board for questions and answers. Students participating in the conferences receive valuable feedback and guidance in preparing for their examinations.”

Pollard says students are encouraged to maintain frequent contact with their academic advisors, all of whom are credentialed at the master’s level.

“Advisors are available to students at any point in the program via phone and the student communication method referred to as the Message Center,” Pollard says. “Students may also schedule appointments with members of our faculty for one-on-one consultations and help with any portion of the academic program.”

Jillian Phelan, one of the plaintiffs, said she was not an LPN, LVN or paramedic, but she had attended North Central Michigan College and was allowed to transfer her credits.

“I had some clinical courses at the previous college. Those are the credits that transferred over. How are they to say that’s good enough?” says Phelan.

Phelan says her work wasn’t supervised, she received little feedback and she needed to schedule appointments to speak with advisors. Those calls were approximately 30 minutes in length and were subject to availability of staff, and there were sometimes long delays. Furthermore, she was only allowed a certain amount of calls per month.

“Later, I found out that the ‘staff’ were not of EC, they were outside hired RNs of different areas, such as the CEs [clinical examiners who administered the final],” Phelan says. “I thought I was speaking to EC professors, but this was untrue.”

Phelan says there were no benchmarks at which a student was required to communicate with an advisor. She says she received no feedback on the online Focused Clinical Competency Assessment that preceded the final, despite requesting it.

The complaint, filed in United States District Court for the Eastern District of New York (Excelsior is headquartered in Albany, N.Y.), alleges violation of New York General Business Law.

The complaint states that after enrolling in the program students would learn there was an annual registration fee of approximately $500 and asserts that annual fee motivates Excelsior to prolong the time it takes a student to finish the program. Plaintiffs also allege Excelsior does not disclose to consumers and potential students its associate’s degree nursing program graduation rates. There are additional fees each time a student takes the exam.

A series of online examinations are given over the course of study, including the Focused Clinical Competence Assessment, which tests knowledge on certain clinical aspects of nursing. Graduation is defined by passing the Clinical Performance in Nursing Examination (CPNE), which assesses a student’s clinical competence. That is an intensive two-and-a-half day examination conducted one-on-one with clinical examiners (registered nurses) at an acute care facility.

“The CPNE is an objective measurement of their ability to perform at the level that would be expected of a day one registered nurse from any program,” Stewart says.

The lack of objectivity of the CPNE is at the core of what plaintiffs are claiming, alleging that students were treated subjectively at the whim of the clinical examiners. “Some students would inherently face different scenarios than other students, and that the examiners and the test criteria vary from site to site,” is written in the complaint.

“The Defendant completely controls the design, administration and outcome of the CPNE without policing, or assurance of neutrality, by a detached third party of the exam-taking process,” is also noted in the suit.

A student must pass the CPNE before Excelsior will provide the paperwork necessary for the student to sit for the National Council Licensure Examination for Registered Nurses (NCLEX), passage of which is mandatory to work as a registered nurse.

Phelan did pass the CPNE, but in the complaint she states she was “permitted to pass solely because of the Examiner’s discretion.”

“I felt that the four Caucasian women [Phelan being one] were treated better than the two Hispanic women,” Phelan tells Diverse. “One Latina girl was crying after being scolded by the clinical administrator [the nurse who oversees the CPNEs] out in the hallway, and the other was cut and took the first flight home to California.

“The Caucasian women spoke of being ‘helped’ during their PCSs including myself,” she adds. “Later, I was told that it was not allowed for students to congregate after our testing days.”

She says she believes the no congregating rule was meant to stop the test takers from sharing their experiences. As she and several other Excelsior students taking the CPNE were staying at the same hotel near the test site, they talked about what they’d experienced.

When asked by Diverse, Stewart says 60 to 65 percent of Excelsior students pass the CPNE the first time they take it. The pass rate for second-time exam-takers is 52 percent and those taking it a third time pass at the rate of 54 percent. He notes that Excelsior students who pass the CPNE go on to pass the NCLEX at a rate comparable to the national pass rate.

Phelan did pass the NCLEX, but says she was only able to do it after additional assistance, including paying for a prep course.

Dr. Suzanne Marnocha, professor, assistant dean and pre-licensure director of the College of Nursing at the University of Wisconsin Oshkosh, is not familiar with Excelsior’s nursing programs, but is familiar with distance learning since UWO has an accelerated bachelor’s in nursing program held predominantly online. Students in that program participate in clinical study near where they reside. She says experience as an LPN is not a substitute for supervised clinical instruction as part of registered nursing education. Working alongside registered nurses in the workplace does not equal supervised clinical learning.

“I believe strongly that nurses need clinical experience, both simulated and face-to-face human clinical experience, that is supervised by a professional instructor,” says Marnocha. “You need to select a program that would help you know even the most minute things you’re doing wrong early on so you can correct them.”

In practical terms, students don’t know what they don’t know and therefore at times wouldn’t know what questions to ask. It’s up to a trained instructor, not a co-worker, to educate and inform nursing students.

Excelsior graduate Megan Keenan has another opinion. She says her background as an LPN combined with her high degree of self-motivation allowed her to thrive in the Excelsior program. She says to prepare for the CPNE she used all of Excelsior’s study materials and guides and applied them in her daily work as an LPN.

“We’re not traditional students because we have to come into it with a certain level of clinical competency, then use the tools that Excelsior provides to be able to pass the test with a certain level of clinical competency,” says Keenan.

Keenan says she called her advisors multiple times prior to the CPNE and participated in a preparatory workshop (the complaint notes there is a separate fee for this workshop). She says the exam was intense, but the examiners were very clear. She passed the NCLEX soon after finishing her work at Excelsior and works full-time in the vascular surgery practice at Albany Medical Center. She is currently enrolled in Excelsior’s master’s in nursing program working toward a master’s in clinical systems management.

“If it wasn’t for a program like Excelsior, there is no way that I would have been able to get my RN,” says Keenan, who was a single mother during her ADN studies. “I came out of that program as such a strong nurse because I had no choice but to be self-motivated and dedicated to the schoolwork.”

Excelsior’s ADN program has been continuously accredited since 1975 by the Accrediting Commission for Education in Nursing (previously known as the National League for Nursing Accrediting Commission). Request for comment from ACEN received no reply.

The Excelsior College School of Nursing has been designated a 2011-16 NLN Center of Excellence in Nursing Education by the National League for Nursing (NLN).

“The NLN Center of Excellence designation is given to schools that demonstrate excellence in one specific area or category. COE designation is about creating environments that promote excellence. In the case of Excelsior, that category is Creating Environments that Enhance Student Learning and Professional Development,” wrote Karen R. Klestzick, chief communications officer of NLN, in an email.

“Schools and programs go through a rigorous application process. A review panel comprising faculty from other COE designees rates each applicant based on specific criteria related to the one category the school selects,” she adds. Additional information is available on the NLN website.

Stewart says 42,000 individuals have earned associate degrees in nursing from Excelsior to date.

“It is difficult to say how many of our 42,000 AD nursing graduates are still practicing RNs,” says Pollard. “Given that the program has been in existence since 1975 and the average age of our AD nursing students has been in the mid-30s, those who graduated 20 years ago may have retired by now. We do, however, conduct one- and three-year exit surveys of our graduates and, on these, we know that after three years more than 90 percent of our graduates are still in the profession. National data show that many nursing graduates leave the profession after just one year.”

Phelan, who is currently working toward her bachelor’s degree, says she loves nursing, but feels stymied in her job search.

“I want to work with the best, but unfortunately with Excelsior on my résumé no hospital wants to hire me,” says Phelan, who currently works at a rehabilitation facility. “I haven’t been able to find work in a hospital that’s willing to train me the right way.”