KAPI OLANI COMMUNITY COLLEGE COMPREHENSIVE INSTRUCTIONAL PROGRAM REVIEW. Associate in Science Degree Nursing. Assessment Period:

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1 KAPI OLANI COMMUNITY COLLEGE COMPREHENSIVE INSTRUCTIONAL PROGRAM REVIEW College Mission Statement Associate in Science Degree Nursing Assessment Period: Program Mission Statement: Prepare students for careers as nurses to meet workforce needs in the health care industry in Hawaii. Part I. Executive Summary of Program Status Response to previous program review recommendations In 2005 the program review recommendations focused on improving the retention rate for students enrolled which was 81%. Since 2005 the on-time graduation rate fluctuated from 63% (Spring 2009) to 87% (Spring 2006). All strategies that were recommended in the past program review have been implemented such as identifying at risk students and requiring them to participate in remediate and supportive assistance through the Nursing Laboratory Resource Center. A full-time instructor is assigned to manage the Nursing Laboratory Resource Center and offer various learning resources. All courses have instituted math at the beginning of each course. Additional strategies have included referrals to Nursing Department Counselor for all failures in theory, clinical or laboratory requirements particularly before the withdrawal deadline. Another recommendation made in the last program review related to staff development and mentoring of new faculty by an experienced faculty. This recommendation has been developed more fully by the creation of the Academy for Nursing Faculty in The Academy s primary efforts is guided by the Hawaii State Board of Nursing specification of three major desirable abilities and experience of nursing faculty: teaching strategies, curriculum development, and evaluation. A previous recommendation to continue assessment of student learning using Assessment Technologies Institute (ATI) has been followed since Faculty and students are becoming more adept at utilizing the ATI resources. Professional Fees have been utilized to build the simulation laboratory, upgrade equipment, purchase current audiovisual material, and issue supplies to nursing students as recommended. All carry over Professional Fees are being saved for the establishment of satellite sites. 1

2 Part II. Program Description History: The Nursing Department initially began with the Practical Nursing Program more than 40 years ago. In response to community and industry need, the Department has developed various programs to meet workforce demands for various levels of nursing personnel. The Associate Science in Nursing Program was transferred to Kapi olani Community College from University of Hawaii-Manoa in 1988 when the University decided to have only the baccalaureate nursing program at the main campus. The AS Nursing Program graduated its first class of students in The AS Nursing Program received full re-accreditation for 8 years by the National League for Nursing Accrediting Commission (NLNAC) in Program Goals: The goals of the AS Nursing Program focus on aspects of KCC s Strategic Plan Goals, i.e.: 1. To promote learning and teaching student success (Goal 1, Objective 4) - Ensure that students graduate in a timely manner with the knowledge, skills and experiences that will prepare them to be effective and contributing members of the community; 2. To build a learning, partnering and service network for student success (Goal 2, Objective 3) - Strengthen curricular coherence across UH campuses. 3. Address underserved regions and populations (Second Decade Project); 4. To invest in the learning environment (Goal 6, Objective 4) - Develop studentcentered learning and teaching resources and approaches to ensure superior academic achievement and career training, anticipate and address changing economic and social conditions and provide access to all that seek these College resources; 5. To invest in people, e.g., professionals in a learning organization - Redefine faculty roles and rewards to promote scholarship of teaching (Goal 5, Objective 1). Occupations for which this program prepares students: The AS in Nursing prepares students to work as nurses in hospitals, clinics, and a variety of health settings. Program SLOs: Upon successful completion of the Associate in Science degree in Nursing, the student should be able to: Participate as a member of the health care team, communicating effectively with clients, families, and members of the team. Provide teaching to clients, families, and staff which is appropriate to learning needs, cultural values and beliefs, and level of life span development. Provide safe, competent nursing care based on integration of facts and principles of biological, psychological, sociological, cultural and spiritual functioning of clients throughout the life span. Function within the legal parameters and nursing standards, demonstrating an awareness of ethical issues related to nursing care in various settings. 2

3 Utilize all phases of the nursing process including the evaluation and modification of nursing care as appropriate. Be responsible and accountable for own learning and for participation in community and professional activities. Organize and manage the care of a small group of clients with alterations in wellness across the life span in various settings, participating as a member of the health care team. Admission Requirements: Special Admission Requirements for the AS degree in Nursing: Special application deadlines for the AS degree in nursing program are: Fall semester entry, December 1 - February 1; Spring semester entry, June 1 - September 1. Minimum requirements for admission to the nursing (Associate in Science degree in Nursing) program are based on satisfactory completion of specified prerequisite support courses, cumulative grade point ratio (GPR) of 2.0 or higher for all courses taken at Kapi olani Community College, grade point ratio of 2.5 in prerequisite and general support courses, and a National League for Nursing pre-admission examination score of 95 within the past three years. It is required that students have health care insurance. Selection is on a best-qualified basis using the following criteria: 1. Grade point ratio (GPR) for prerequisite and general support courses. 2. National League for Nursing Pre-Admission Examination score. 3. General support courses completed before the application deadline. Preparation for the AS in Nursing: Prerequisite courses that must be completed, with a grade of C or higher, prior to application to the program are: ENG 100; MATH 100; FAMR 230; ZOOL 141; ZOOL 141L; chemistry (1 year high school or 3 college chemistry credits); PSY 100. Applicants may take the remainder of the General Support Courses prior to entering the Nursing program to lessen the credit load during the program. All students admitted to the Associate in Science degree nursing program must have current First Aid and CPR certification prior to registration. The minimum requirement for First Aid is a standard first aid certificate. The minimum requirement for CPR is BSL- C (one and two rescuer CPR). It is the responsibility of each student to keep these certifications current throughout enrollment in the nursing program. Health clearance and immunizations must be completed before the start of classes. A grade of C or higher must be maintained in all courses in order for the student to continue in the AS degree nursing program and to graduate from the program. Time limits: Science courses have a 5-year time limit; there is no limit on Chemistry. Readmission to the Associate in Science degree program and repetition of nursing courses is limited. Priority is given to applicants who are qualified residents of the State of Hawai i. Prerequisite college courses must be completed before enrollment in the first nursing course. 3

4 Credentials, licensures offered: Students will be eligible to take the National Licensure Examination-Practical Nurse (NCLEX-PN) after the completing the pediatric course in the beginning of the second year of the program and then may exit the program or continue with the second year. Graduates of the program are eligible to take the NCLEX-RN to become registered nurses. Faculty and staff The minimum qualification for nursing faculty teaching in the AS Nursing Program is a master degree in nursing (MSN) and one year of nursing experience, current Hawaii State registered nurse license. The Nursing Department received additional 10 faculty positions: 4 in Fall 2007 and 6 in Fall There are 17 MSN faculty for a total of 31 nursing instructors including 2 counselors in the Nursing Department. Most of the faculty are new; 18 faculty were hired in 2007 or thereafter. There are 9 tenured faculty. All nursing positions were filled except for 3 positions in May However, the number of filled and vacant positions fluctuates widely due to difficulty hiring MSN faculty for 9-month salary pay; lengthy and cumbersome hiring process; frequent resignations. Retaining nursing faculty has been difficult due to family relocation; return to acute care facilities where MSN faculty become highly paid nurse practitioners, managers; transfer to University of Hawaii-Manoa School of Nursing to teach in the baccalaureate or master programs. Resources The Nursing Department receives general funds for faculty and staff positions. Additionally, the College allots additional account from tuition and special funds (TFSF) for casual hire lecturer, APTs, equipment and student assistants. In 2006 the University of Hawaii Board of Regents gave permission to all health career programs to collect Professional Fees from their students in order to purchase specialized instructional and laboratory equipment, materials and supplies. All AS in nursing students pay Professional Fees of $500 per semester for 4 semesters. Professional Fees are exclusively managed by the Department and may be carried over year by year. Professional Fees have been expended to purchase up-to-date instructional and medical equipment, hospital furniture, and supplies. A simulation laboratory was built in the library in partnership with the Emergency Medical Services Department in Furthermore, Professional Fees will fund the out-fitting of the satellite sites at Windward Community College and Leeward Community College with instructional equipment and supplies as well as medical equipment and hospital furniture. Articulated Agreements There is an articulated agreement with the University of Hawaii, School of Nursing and Dental Hygiene whereby KCC AS in nursing graduates are eligible for admission to the third year of the Bachelor of Science in Nursing program. 4

5 Community connections, advisory committees, Internships, Co-ops Windward Community College and Kamehameha Schools entered into a contract with KCC to have qualified students from a pilot program, Nursing Pathway, enter the AS nursing program. There are plans for 3 cohorts of 10 students to enter the program in Spring 2009, 2010, and The purpose of this special contract is to provide an avenue for under-represented population of students particularly Native Hawaiians to enter the AS in nursing program. The Nursing Department Advisory Committee is comprised of nurse educators and managers in various acute care and long term care facilities on Oahu. The Advisory Committee meet with nursing faculty at least once a year. Additionally, they are available for consultation via regarding special matters such as curriculum proposals. The Nursing Department initiated its first 80 hour pediatric Internship course at Kapiolani Medical Center for Women and Children in Fall It was a non-credit course offering to provide second year AS in nursing students and graduates an opportunity to spend more concentrated time on the pediatric unit and participate in the care of pediatric children in specialty areas such as the pediatric intensive care, emergency room, outpatient clinic, etc. Both student and faculty evaluations were positive and future internship programs will be scheduled. DOE connections The Nursing Department does not have any DOE connections but hopes to initiate contact in the future. It is desirable to establish affiliation agreements with DOE in order for KCC nursing students to conduct clinical rotations in the DOE special education classes for medically fragile children. It has been difficult for the Nursing Department to make effective connection with the appropriate department or section in the DOE to begin a dialog in order to generate an affiliation agreement. Distance delivered/off campus programs, if applicable Permission has been granted by regulatory and accrediting bodies to establish an off campus site for the AS in nursing program at Leeward Community College (LCC). The construction and renovation of two facilities at LCC are nearly complete. The first cohort of AS in nursing students will begin nursing classes at LCC in Spring Part III Quantitative Indicators for Program Review. (pls see cover sheet data) Part IV. Assessment Results Chart for Program SLOs (3-5 year trend) All students are required to successfully pass the Program s SLOs in order to graduate. Therefore, the results are the following: 5

6 Program SLO Pass Rate Spring 2006 to Spring 2009 Semester Graduated Students/Pass Rate Spring Fall Spring Fall Spring Fall Spring Part V. Curriculum Revision and Review All AS in nursing courses have been submitted for curriculum review within the past 5 years. Major curricular revisions focused on improving retention in the program and improving instruction in the classroom and clinical setting. Some students had very little health care experience and withdrew in the first semester after realizing that a career in nursing was no longer desirable. Therefore, a revision to the program admission criteria was submitted and approved by Curriculum and Faculty Senate in Fall Students with health care or care-giving experience will be afforded extra consideration in the admission criteria in order to decrease attrition rates and improve graduation rates. Another curriculum revision was instituted that included deleting combined maternity and pediatric courses and creating separate maternity and pediatric courses. Faculty believed that focused attention in each specialty area would be more advantageous. Moreover, clinical facilities began to require additional electronic medical record orientation and refused to orient students for only 4 weeks of maternity and 4 weeks pediatric clinical rotations. This section explains the curricular change that occurred in the AS in Nursing Transition Program for licensed practical nurses. The Practical Nursing Program was revised in Fall 2008 to prepare graduates for employment in long term care facilities and clinics. In order to improve a past history of high attrition rates and better prepare graduates for the AS in Nursing Transition Program, the PN pre-requisites and support courses were 6

7 revised to become the same courses as in the AS in Nursing Program. Additionally, the ATI TEAs test, a standardized national nursing examination, was instituted to provide an assessment of current knowledge of English, math, and science. Work experience prior to entry into the Transition Program was eliminated because nursing faculty believed that the revised PN curriculum would provide students sufficient preparation to be successful in the Transition Program. Part VI. Survey Results 1. Student Satisfaction Summary of Graduate Satisfaction Surveys * Each survey was ed to the student at two different times Graduating Semester *Total # of Student Responses/Total Surveys Sent Out Comments: Learning Experiences which Enhanced Professional Development Comments: Special Skills/Strengths Gained Responses for Program Competencies: Adequate to very well prepared for RN position Fall 06 25/25 N/A N/A Spring 07 26/26 N/A N/A Fall 07 8/24 Clinical time (medical surgical), important decisions regarding patient care, skill labs, various clinical sites Thorough assessments, administering medications, disease processes and therapies, basic nursing skills, aware of responsibilities as RN, communication, organization, time management. Spring 08 22/22 Clinical, lab, didactics, Clinical skills with emphasis on critical thinking and patient safety, confidence in my abilities, base nursing knowledge, foundation for various illnesses and diagnosis. Fall 08 2/23 Clinical hours, instructors with many years of experience Spring 09 5/39 Clinical (various sites, settings), lab, instructors, lectures, case studies, ATI, interacting with various nurses and members of the health care team, internships, Time management and good communication skills. Lots of clinical hours/skills, communication skills, medication administration, striving for excellence and being an advocate for patient. 7

8 2. Occupancy placement in jobs Graduating Semester Summary of Graduate Employment Surveys * Each survey was ed to the student at two different times * Total Surveys Sent Out /Total # of Student Responses/ Name of Facility Reason Why Not Employed as RN Fall 06 Not available Not available Not available Spring 07 Not available Not available Not available Fall surveys sent 9 responded 8 employed 1 not employed Queens (2), Blood Bank of Hawaii, Times Pharmacy, Hale Nani Rehab, Pali Momi, Kapiolani, Castle, Oahu Care facility, Hale Ola Kino, attention Plus Home Care, Spring 08 Fall surveys sent 2 responded 2 employed 0 not employed 23 surveys sent 6 responded 5 employed 1 not employed Nursefinders, Kaiser Moanalua, Queen s Queen s, Kaiser, Hiolani Care Center, Straub Clinic, Mauanalani Nursing & Rehab Center, North Vista Hospital Hospitals said they are not looking to hire new grads. Will possibly relocate to the mainland. none Waiting for a position at QMC, no RN Positions available. Spring 09 Not available Not available Not available 3. Employer satisfaction Summary of Employer Satisfaction Surveys Graduating Semester Fall 06 Spring 07 Fall 07 Spring 08 Fall 08 Spring 09 Total # of Surveys Sent Out/ Total # of Employer Responses Not available Not available 5 sent out 2 responses Not available 3 sent out 0 responses Not available Name of facility Queen s, Pali Momi Demonstrates nursing skills Appropriately All meets or exceeds each skill described 4. Graduate/Leaver (unknown) 8

9 Part VII. Analysis of Program The AS Nursing program continues to measure success by on-time graduation rates as demonstrated by the following table: ADN Graduation Rates Spring 2006 to Spring 2009 Semester Graduated On-time Graduation Rate Spring % Fall % Spring % Fall % Spring % Fall % Spring % The on-time graduation rates have been decreasing. The nursing faculty is reconsidering admission criteria, instructional strategies, and improving supportive learning resources. In spite of lower on-time graduation rates, those students who graduate are successfully passing the NCLEX-RN licensure exam. The nursing faculty attributes this success to computerized assessment testing throughout the program, continuous rigorous clinical rotations, laboratory practice, and remediation. ADN NCLEX-RN Pass Rates Spring 2006 to Spring 2009 Semester Graduated 1 st Time Pass Rate NCLEX-RN Pass Rate Spring % 96% Fall 2006 Spring 2007 Fall % Spring 2008 Fall % 96% Spring % 97% 9

10 Part VIII. Action Plan In order to address the declining on-time pass rate, various curriculum proposals and course actions were instituted throughout the 3 year period of program review. For example, the Spring 2009 graduating class began its cohort with 62 students; 39 graduated on-time. Several students decided to withdraw after realizing that they did not want to be nurses primarily because they did not have previous health care experience. A curriculum change was submitted in Fall 2008 and approved to give extra consideration to applicants with health care or care-giving experience in the selection criteria. Additionally, the Spring 2009 graduates had 10 (16%) students with low pre-admission NLN-RN scores of less than 115 (70% correct on exam) who later decelerated from the program. The nursing faculty submitted a curriculum proposal in Fall 2009 to increase the pre-admission NLN-RN score to be 115 or higher. In order to avoid continued high attrition rates, the nursing faculty have also directed all students who earn a theory exam grade of less than 72, do poorly in clinical, or are absent to receive remedial assistance from the Nursing Laboratory Resource Center and Counselor. Continued use of computerized assessment testing will be incorporated in all nursing courses. In the last Program Review, the Nursing Department presented its plan to establish satellite sites on off campus locations in order to increase access to nursing programs. Approval to establish a satellite site for the AS in Nursing Program at Leeward Community College and the Practical Nursing Program at Windward Community College was received by the Hawaii State Board of Nursing, National League of Nursing Accrediting Commission (NLNAC) accreditation, Accrediting Commission for Community and Junior Colleges (ACCJC) Western Association of Colleges and Schools. The AS in Nursing Program will be offered at Leeward Community College in Spring The external accrediting organization, NLNAC, will be sending a visitor to complete a focus site visit in Spring In order to prepare for the Accreditation site visit, a nursing consultant will be hired to prepare faculty and students from Fall 2009 to Spring The consultant will also review all pertinent documents and facilities in order to make recommendations for improvement. Maintaining high quality nursing education and course consistency for classes taught at both the main Diamond Head campus and the off-site campus at LCC are important. An action plan will be developed to have faculty meet regularly to prepare for classes and laboratory sessions at LCC and Diamond Head to be consistent. The Nursing Department received 10 faculty positions: 4 in Fall 2007 and 6 in Fall The minimum qualification for nursing faculty is a Masters Degree in Nursing (MSN) and 10

11 one year of acute care experience. The number of qualified MSN faculty fluctuates. In 2006 nursing faculty with the minimum qualification of a MSN and one year of nursing work experience received a salary adjustment based on comparative market salary. All MSN faculty are currently hired into 9-month positions. They have had difficulty working in the summer months to make up the $20,000 - $25,000 difference in pay if they worked 11 months in acute care facilities. Additionally, nurses with a Masters Degree in Nursing are highly sought after by health care organizations to be nurse practitioners, administrators and managers. During these difficult economic times, many MSN nurses are the primary bread-winners in families. For these reasons, it is difficult to hire qualified nursing faculty. It is recommended that MSN nurses be hired for 11-month positions rather than 9-month positions. The Office of Human Resources has reorganized the procedure for hiring nursing faculty. The Nursing Department is working to process all new applicants expediently. However, the lack of Nursing Department secretary since October 2008 has made hiring of new faculty difficult for the Nursing Department. Although the full-time APT has been reassigned many office duties, APTs are not fully experienced in secretarial matters. A new curriculum proposal was submitted to the Curriculum Committee in Fall 2009 to increase the NLN-RN composite score to 115. Nursing faculty believe that prospective students will be more successful if they have a larger verbal, math, and science knowledge base. Part VII. Budget Implications Additional revenue from Professional Fees began in Fall 2006 & continues. The Nursing Department has been setting aside most of the Professional Fees for the establishment of the nursing satellite sites at Windward Community College and Leeward Community College. Due to the expansion of the nursing satellite sites, faculty have been reassigned to be Satellite Site coordinator, Lab Resource Instructor, Assistant to the Chairperson to prepare and organize furnishings for satellite sites. Moreover, the Nursing Department Secretary transferred to UH-Manoa and the position remains vacant since Fall 2008 due to the State of Hawai i freeze on clerical positions. The permanent instructional support APT was given the responsibilities of managing the office, supervising the student assistants, and assisting the faculty and Department Chairperson. Two emergency hire APTs have been employed since Spring 2009 to perform instructional support duties such as compiling health documents for all students and faculty, managing assessment testing, ordering and coordinating the delivery and placement of furniture, equipment and supplies at the satellite sites. 11

12 Although this Program Review focuses on the AS in Nursing Program, the support staff and faculty work as a team in the Nursing Department in order to provide comprehensive and continuous service to all nursing students, including AS nursing students. There are two full time Counselors in the Nursing Department. One is an 11- month position and the other a 9-month position. The services of the 9-month Counselor was extended through the summer in order to provide support to the new Practical Nursing students; process new applications for the Windward Community College Practical Nursing Program and Surgical Technology Programs for Fall Summer overload for the 9-month Counselor will be required each year because there will be an increase in number of students and programs being offered through the summer as well new applications to process for Fall admissions. In Summer 2010 the nursing program and site will be the following: AS in Nursing at LCC AS in Nursing at Diamond Head Practical Nurse at WCC Practical Nurse at Diamond Head Surgical Technology Program. New applications to process during Summer 2010 for Fall entry: Practical Nursing at WCC and AS in Nursing for Diamond Head and LCC. The cost of 2009 summer overload for the 9-month Counselor was $10, With the regular salary of $47,760 for 9-months and summer overload of $10,268.40, the total salary cost was $58, The Nursing Department is uncertain about this Counselor s potential pay for 11-months but this amount should be evaluated and compared with the 9-month salary and summer overload. The lowest salary for an 11- month Counselor is approximately $47,004. The Nursing Department highly recommends that the 9-month Counselor position be changed to an 11-month position in order for students and faculty to have reliable, consistent, knowledgeable and experienced counseling services for its 400 students in the Nurse Aide, Adult Care Home Operator, Practical Nursing, AS in Nursing, Surgical Technology and non-credit classes at both Diamond Head campus and WCC and LCC satellite sites throughout the year. In order to manage and support faculty and students at the satellite sites on a long term basis, permanent APT staff and added student assistants are required. One full-time APT is necessary to manage the offices at WCC and LCC and supervise student assistants at both satellite sites. The cost of a full-time APT is approximately $36,000. The cost to hire nursing consultant to prepare for NLNAC accreditation focus site visit is approximately $