Institutional Effectiveness SACS 5-year Interim Report Tennessee Technological University Academic Nursing REVISED PER REQUEST 2/20/2013

Institutional Effectiveness SACS 5-year Interim Report Tennessee Technological University Academic Nursing REVISED PER REQUEST 2/20/2013 Academic Year: 2011-2012 Department/Unit: Whitson-Hester School of Nursing College: Agriculture and Human Sciences Contact: Dr. Sherry K. Gaines (until 12/31/2012); Prof. Bedelia Russell (after 12/31/2012); Revisions submitted by Prof. Bedelia Russell (2/20/2013) I. Department Mission: The mission of the Whitson-Hester School of Nursing (WH-SON) is a focused commitment on meeting the health care needs of the diverse population of the Upper Cumberland Region of Tennessee. The goal of the nursing program is to prepare graduates with a commitment to life long success as nursing leaders in rural and urban areas who are committed to professional nursing standards, open to the changes occurring in a global health care system, and motivated to improve the health status of individuals, groups, and communities. Through the department s mission, the WH-SON is accomplishing the mission of Tennessee Technological University as a provider of 1) outstanding programs in the sciences and 2) strong programs in nursing; with a commitment of 3) enriching the lives of people and communities in the Upper Cumberland region of Tennessee and 4) life-long success of students http://www.tntech.edu/about/mission/. II. Program Goals and Student Learning Outcomes: Program Goals (PG) A. Compliance with National Accreditation Agencies and the TN State Board of Nursing (PG-A) B. Maintainenance of RN Licensure Exam Scores above National Averages (PG-B) C. Graduation rates from the WH-SON program will meet or exceed university rates (PG-C) D. Graduates (alumni) and employers are satisfied with the program (PG-D) Student Learning Outcomes (LO) Graduates will: 1. Integrate knowledge and theories from the natural and social sciences, liberal arts, humanities, and nursing to develop a generalist professional nursing practice (1) 2. Provide professional nursing care, which includes health teaching and health promotion to individuals, families, groups, and communities throughout the life span along a continuum of health, illness, and/or disability within various health care settings (2) 3. Identify and apply knowledge of basic organizational and systems leadership for safe and high quality patient care (3) 4. Evaluate and utilize theory and research based knowledge in nursing practice for beginning scholarship for evidence-based practice (4) 5. Demonstrate professional nursing practice through critical thinking, clinical judgment, therapeutic nursing intervention and communication utilizing information management and patient care technology within the practice of the baccalaureate generalist (5) 6. Demonstrate basic knowledge of healthcare policy, finance, and regulatory environments, including local, national, and global trends (6) 7. Develop collaborative relationships and interprofessional communication with health care professionals and the health care consumer to promote and advance positive patient health care outcomes founded on evidence-based practice (7) 1

8. Utilize evidence-based practice for health promotion, risk reduction, disease prevention, and illness management of individuals, families, groups and communities (8) 9. Demonstrate quality nursing practice based on professional values, incorporating ethical, moral and legal standards, and human diversity (9) III. Assessments Program Goals CCNE Accreditation (2009 to 2019 Interim report due 2014) PG-A Full Approval of the Tennesssee State Board of Nursing (yearly) PG-A NCLEX-RN Pass Rates (quarterly reports and yearly aggregate reports) PG-A & PG-B WH-SON & University Graduation Rates (every fall and spring semester) PG-C Graduate (Alumni) and Employer Surveys (every year) PG-D Student Learning Outcomes HESI Exams PG-B & LO1-9 o Mid-Curricular HESI (Given at the end of the first year of upper division for each admitted class) o Specialty HESI (As needed with new course development or substantive course/curricular revisions or at the direction of the WH-SON Curriculum Committee) o RN Exit HESI (For each admitted class, given at the end of the second year of upper division in the final semester of the program prior to graduation. A second and up to a third RN Exit exam may be required for individual students based on HESI score) NCLEX-RN Pass Rates (quarterly reports and yearly aggregate reports) - LO1-9 Graduate (Alumni) and Employer Surveys (every year) 5 Process for Periodic Assessment Review Assessment tools are reviewed only when tool benchmarks or standards have not been met. Specific to program goals: o The NCLEX pass rate is reviewed with every graduating class. When the passing standards are adjusted every three years, the timing does not allow for the impacted graduating class to remediate prior to sitting for the exam. The School must wait to see the impact of passing standards on NCLEX pass rates. If there is a decrease in pass rates following adjustment of the passing standards, the Curriculum Committee within the WH-SON reviews the overall curriculum and any specific course content against the NCLEX Test Plan Blueprint https://www.ncsbn.org/1287.htm Specific student learning outcomes: o HESI Exams in terms of results are reviewed every semester and compared to student performance on course completion and course exams/evaluations. These results are used to develop a postgraduation NCLEX prep plan for the student. o HESI exams in terms of an assessment that warrants continued use, to date, has not been discussed among the Faculty Organization. o Because of the low response rate, graduate and employer surveys have been identified as a problematic assessment by both the accreditation visit in 2009 and the faculty aggregate. Efforts to address the response rate have been under discussion within the Faculty Student Relations Committee and Faculty Organization since 2009. 2

IV. Rationale for Outcomes and Assessments (Process for Data Analysis) Program Goals A. Compliance with National Accreditation Agencies and the TN State Board of Nursing RATIONALE: Ongoing accreditation through the Commission on Collegiate Nursing Education (CCNE) CCNE is an autonomous accrediating agency, officially recognized by the U.S. Secretary of Education as a national accreditation agency. The Commission ensures the quality and integrity of baccalaureate, graduate, and residency programs in nursing. CCNE serves the public interest by assessing and identifying programs that engage in effective educational practices. CCNE is a voluntary, self-regulatory process, which supports and encourages continuing self-assessment of nursing programs and supports continuing growth and improvement of collegiate profressional education and post-baccalaureate nurse residency programs. http://www.aacn.nche.edu/ccne-accreditation/about/mission-valueshistory RATIONALE: Ongoing full approval of the Tennessee State Board of Nursing the TN State Board of Nursing s mission and responsibilities center around three broad functions licensure, education, and practice. The board prescribes the minimum curriculum for all nursing programs on ground, online, distance, or via other electronie means and annual approves schools of nursing meeting board standars. Schools not meeting standards are investigated and the board is authorized to place the school on conditional approval or close the program if standards are not met. http://health.state.tn.us/boards/nursing/index.htm B. NCLEX-RN: Maintain RN Licensure Exam Scores above National Averages RATIONALE: BSN graduates cannot practice nursing without initial licensure. The National Council of State Boards of Nursing (NCSBN) is an independent, not-for-profit organization serving as the vehicle through which boards of nursing act and counsel together on matters of common interest. NCSBN was created to guard the safety of the public through member boards seeking to ensure that nurses entering the workforce have the necessary knowledge and skills to practice. To meet this goal, NCSBN develops psychometrically sound and legally defensible nurse licensure examinations consistent with current nursing practice. Specific to the WH-SON nursing program, our BSN graduates are eligible to test for the NCLEX-RN licensure examination upon graduation from the program and completion of a criminal background check. Utilizing current changes in U.S. health care delivery and nursing practice and the acuity level of patient care, the NCSBN Board of Directors evaluate the NCLEX-RN passing standards every three years, adjusting the difficulty level of the exam. Therefore, it is the preferred comparison benchmark for the WH-SON versus comparison to peer Tennessee institutions. The NCLEX-RN is completed through Computerized Adaptive Testing, with a minimum of 75 questions up to 265 questions answered based on the graduates ability to answer questions reflective of varying cognitive levels with emphasis placed on application or higher levels of cognitive ability described by Bloom s taxonomy for the cognitive domain. Graduates will receive a pass/fail if they have met the passing standards set by NCSBN. www.ncsbn.org/181.htm C. Graduation rates from the WH-SON program will exceed university rates RATIONALE: Provides a comparison between the WH-SON graduates and the rest of the university. This assessment can identify changes in student retention and attrition compared to the institution. D. Graduates (alumni) and employers are satisfied with the program RATIONALE: Graduate (alumni) and employer surveys (See Appendix A) - A survey developed, compiled and evaluated by the standing Faculty-Student Relations Committee and Curriculum Committee within the 3

WH-SON. Provides student and employer feedback on overall program satisfaction as well as job placement rates and location of employment and assists with evaluation of program quality from both the student and employer perspective around curriculum and individual student learning. As part of ongoing accreditation, evaluation of program satisfaction that includes both the student and employer is part of the Essentials of Baccalaureate Education. http://www.aacn.nche.edu/education-resources/baccessentials08.pdf Student Learning Outcomes RATIONALE: HESI Exams Health Education Systems, Inc. (HESI) is a testing company specializing in producing valid and reliable tests for nursing schools (See Appendix B - HESI Definition of Terms: Reports). They offer custom, specialty and exit exams. HESI exams are computerized based and timed, comparable to the delivery format of the NCLEX-RN. In addition, the exam questions are modeled after the NCLEX-RN test blueprint and can be utilized as a predictor for NCLEX-RN success. Each type of exam can provide individual student evaluation as well as class aggregate evaluation data. Additionally, the exam results can inform curriculum and course continuing development. o RATIONALE: Mid-Curricular HESI Provides assessment and evaluation data at the mid-point in the upper division curriculum reflects individual student and class aggregate performance o RATIONALE: Specialty HESI - Provides assessment and evaluation data regarding specific course content and indirect validation of individual course exams reflects individual and class aggregate performance o RATIONALE: RN Exit HESI Provides assessment and evaluation data at the completion of the nursing program and prior to student graduation from the program reflects individual and class aggregate performance RATIONALE: Graduate and Employer Surveys (See Appendix A) - A survey developed, compiled and evaluated by the standing Faculty-Student Relations Committee and Curriculum Committee within the WH-SON. The survey seeks to assess perceived individual student learning, curriculum, and teachinglearning practices through by both the graduate and the employer around three major criteria: 1) Critical Thinking, 2) Communication, and 3) Therapeutic Interventions. Process for Data Dissemination and Analysis Assessment data relative to CCNE accreditation and TN State Board of Nursing approval is reviewed by the Director of the WH-SON and disseminated to the WH-SON Faculty Organization for discussion and input. The Director of the WH-SON is an Ex-officio member of the WH-SON Faculty Organization. Faculties receive copies of completed accreditation reports. Faculty Organization meets monthly during the academic year. The annual report to the TN State Board of Nursing is accessible to faculty when requested. Assessment data relative to NCLEX-RN pass rates is reviewed by the Director and disseminated to the WH- SON Faculty Organization. As the NCLEX-RN passing standards change along with changes to the NCLEX- RN test blueprint, the blueprint is reviewed by individual Course Administrators as well as the WH-SON Curriculum Committee for gaps in content, concepts, etc. with necessary course and/or curriculum revisions when warranted. Three faculty of the WH-SON attend national updates on the NCLEX-RN and then in turn disseminate current information to the Faculty Organization. Monthly Faculty Organization meetings allow for formal and informal discussions around trends and changes in nursing education, health care, student characteristics, and assessment and evaluation of students. Minutes are recorded for each of these meetings. The WH-SON has a standing Curriculum Committee, Faculty-Student Relations Committee, and Admissions & Credits Committee. In addition, ad-hoc, working groups on Clinical Outcomes and the Scholarship of Teaching & Learning (SoTL) have been developed recently based on a perceived need by the Faculty Organization. Each of these committees receives assessment data for review either from the Director or when identified as a need from the Faculty Organization. Each Committee reports back to the Faculty Organization following data analysis for full faculty approval. The Director then completes necessary 4

operational and organizational processes and procedures as needed. Minutes are recorded for each standing and ad-hoc committee meeting. All faculty have access to assessment data generated from HESI exams. Data is accessible at any time due to online access through the EVOLVE learning site. The Mid-Curricular HESI Exam results are reported to the Faculty Organization every semester by the Course Administrator in NURS 3360. The Specialty HESI Exam results are also reported to the Faculty Organization by respective Course Administrators as needed. The RN Exit HESI results are reported to the Faculty Organization and to NCLEX Advisors approximately five weeks into the final semester of the student s program of study. Analysis is completed by the Course Administrator in NURS 4450 with high-risk students assigned to specific NCLEX faculty advisors. WH-SON and University graduation rates comparisons are reviewed annually by the Director of the WH- SON and shared with faculty during Faculty Organization meetings. Graduate and employer surveys are reviewed by the Faculty Student Relations Committee in the WH-SON with results presented to the Faculty Organization for feedback and recommendations. V. Results Program Goals CCNE Accreditation (PG-A) - RESULTS: Accreditation through the Commission on Collegiate Nursing Education (CCNE) - In 2009, the WH-SON completed a self-study in preparation for an onsite evaluation by its accrediting agency, the Commission on Collegiate Nursing Education (CCNE). At the October 2010 meeting of CCNE, the agency determined that the School met all four of its accreditation standards with no compliance concerns. CCNE accreditation standards include an assessment of compliance with University mission and standards. Consequently, CCNE granted full accreditation of the School s baccalaureate degree program in nursing, retroactive from February 5, 2009, when the on-site evaluation took place, until December 31, 2019. Full Approval Tennessee State Board of Nursing (PG-A) - RESULTS: Full approval of the Tennessee State Board of Nursing Last on site visit occurred in Spring, 2009 with annual reports submitted in December of each year. The WH-SON continues to maintain full approval by the Tennessee Board of Nursing. NCLEX-RN Pass Rates (PG-A & PG-B; LO1-9) RESULTS: Licensure Rates consistently above national averages (See Table 1) Table 1: NCLEX-RN Pass Rates Comparison to National Averages 2006 2007 2008 2009 2010 2011 2012 TTU WH-SON BSN Graduates 84.31% 95.3% 100% 97% 91.75% 95% 100% National Average, First Attempt, U.S. Educated, BSN 88.3% 86.4% 87.5% 89.49% 88.69% 89.09% 91.66% NCSBN Passing Standards Increased difficulty from -0.21 logits -0.21 logits Increased difficulty from -0.16 logits -0.16 logits Increased difficulty from -0. 28 to -0.21 logits -0.21 to -0.16 logits -0.16 logits to 0.00 logits 5

WH-SON and University Graduation Rates (PG-C) RESULTS: WH-SON graduation rates consistently meet or exceed graduation rates (See Table 2) Table 2: WH-SON to TTU Graduation Rates Comparison YEAR NUMBER NUMBER WH-SON GRADUATION RATE TTU GRADUATION RATE* ACCEPTED TO UPPER DIVISION GRADUATED 2006, Fall 50 47 88.89% 52.00% 2007, Spring 23 20 86.96% 52.00% 2007, Fall 47 45 95.74% 44.30% 2008, Spring 45 39 86.67% 44.30% 2008, Fall 47 43 91.49% 22.90% 2009, Spring 50 44 88.00% NA 2009, Fall 46 39 84.78% NA 2010, Spring 47 34 72.34% NA 2010, Fall 51 39 76.47% NA 2011, Spring 54 50 92.59% NA 2011, Fall 49 36 73.46% NA 2012, Spring 65 NA NA NA 2012, Fall 48 NA NA NA *Data by academic year NA = Data not available 6

Graduate (Alumni) and Employer Survey Results Program Satisfaction (See Tables 3 & 4 ) - PG-D Table 3: Graduates (Alumni) Results for Program Satisfaction Year Graduate Response Rate Graduate Score (Benchmark > 2.50) Graduate Comments: 2007 20.0% 4.00 Thematic analysis: Strengths of the program was focused on the instructors and knowledge gained based on teaching methods. Areas for improvement indicated fundamental clinical skills as necessary improvements. 2008 <1.0% 3.67 I have felt prepared with general information about disease process over the past year. The area that might help future students would be a little more focus on what the differences are in acute care versus critical care. Overview of ventilator settings and emergencydrugs would be helpful for students who are going to seek to be in critical care directly out of school. 2009 <1.0% 3.25 I think the program did a great job of exposing us to all ares of nursing. I would like to see an ICU/critical care class established, this is ht eonly are where I feel like I did not get much experience. I felt very prepared in my nursing knowledge as I began my career and felt ready to handle my first job with confidence. Good knowledge base for basic nursing. Pharmacology was great. Fundamentals covered well. Professors were generally very good with students and open to meet with students. Increase clinical experiences and help with job placement. Acute care course should be added. 2010 Not completed Not completed NA 2011 Not available NA NA 2012 Not completed NA = Data not available NA NA Table 4: Employer Results for Program Satisfaction Year Employer Response Rate Employer Score (Benchmark > 2.50) Employer Comments: 2007 <1.0% 3.00 Conscientious, works well independently, good leadership skills, not afraid to ask questions, well rounded in many clinical areas of nursing. They need help developing skills, which will increase their confidence. Some difficulty with public speaking but that will come with time. 2008 0.0% ND* ND* 2009 <0.5% ND* This graduate is an independent thinker but knows when to ask for help. Willing to learn new things and is a quick learner. 2010 Not completed Not completed NA 2011 NA NA NA 2012 Not completed NA NA *ND = No Data due to Response Rate NA = Data not available 7

Student Learning Outcomes Mid-Curricular HESI Exam Results (See Table 5) Table 5: Mid-curricular HESI scores linked to Learning Outcomes and Compared to s Nov 2008 Apr 2009 Nov 2009 Apr 2010 Nov 2010 Mar 2011 Nov 2011 Apr 2012 Nov 2012 1 2 3 HESI Category Liberal Education for EBP Provider of Care BSN Nsg Practice Leader for Quality Care & Pt Safety N/A N/A 994 N/A 948 846 963 846 954 843 972 843 981 856 967 856 917 858 N/A N/A 988 N/A 946 846 959 846 951 843 974 843 978 855 963 855 913 858 N/A N/A 991 N/A 946 846 951 846 944 843 970 843 979 856 970 856 914 858 N/A N/A 990 N/A 964 840 965 840 958 836 984 836 991 847 982 847 942 849 4 Scholarship for EBP N/A N/A 101 6 N/A 989 845 994 845 964 843 988 843 101 0 852 985 852 960 857 5 Critical Thinking 944 849 100 0 849 953 839 969 839 963 837 978 837 988 848 974 848 923 855 Therp Nsg Intvn Therp Comm 932 850 989 850 946 840 952 840 945 838 968 838 980 848 967 848 911 855 859 845 902 845 707 818 949 818 930 813 856 813 856 818 962 818 900 844 Pt Care Techn & Inf Mngmt N/A N/A 101 2 N/A 100 9 858 102 0 858 961 842 105 4 842 104 9 844 980 844 876 854 6 7 8 9 Healthcare Policy Designer/ Manager/ Coord of Care Interprof Comm Clinical Prevention & Pop Hlth Prof & Prof Values N/A N/A 943 N/A 831 833 940 833 933 823 952 823 862 812 916 812 849 819 N/A N/A 927 N/A 849 836 901 836 921 828 847 828 791 838 856 838 806 840 N/A N/A 863 N/A 766 840 870 840 922 828 914 828 817 851 846 851 807 855 N/A N/A 999 N/A 940 845 958 845 952 843 966 843 972 858 967 858 903 860 N/A N/A 845 N/A 682 818 886 818 894 827 696 827 742 791 737 791 695 808 8

RN Exit HESI Exam Results (See Table 6) Table 6: RN Exit HESI scores linked to Learning Outcomes and Compared to s Oct 2008 Mar 2009 Oct 2009 Feb 2010 Sep 2010 Feb 2011 Sep 2011 Feb 2012 Sep 2012 1 2 3 4 5 HESI Category Liberal Education for EBP Provider of Care BSN Nsg Practice Leader for Quality Care & Pt Safety Scholarship for EBP Critical Thinking Therp Nsg Intvn Therp Comm N/A N/A 870 N/A 829 821 903 821 881 833 921 833 895 842 947 842 907 844 N/A N/A 873 N/A 828 822 899 822 878 832 918 832 891 842 942 842 896 845 N/A N/A 870 N/A 831 821 902 821 882 832 918 832 894 841 950 841 905 845 N/A N/A 874 N/A 830 834 908 834 893 836 933 836 911 843 949 843 913 839 N/A N/A 866 N/A 826 815 915 815 935 826 954 826 954 845 961 845 934 845 871 830 872 830 833 817 907 817 889 833 920 833 894 842 948 842 904 844 873 829 874 829 833 816 906 816 901 837 934 837 920 843 950 843 918 846 872 830 863 830 750 827 828 827 810 802 784 802 703 835 841 835 743 838 Pt Care Techn & Inf Mngmt N/A N/A 797 N/A 875 805 917 805 103 1 851 986 851 984 852 985 852 970 859 6 7 8 Healthcare Policy Designer/ Manager/ Coord of Care Interprof Comm Clinical Prevention & Pop Hlth N/A N/A 941 N/A 838 841 900 841 842 847 835 847 942 831 950 831 863 839 N/A N/A 943 N/A 822 834 872 834 871 839 874 839 874 837 903 837 899 836 N/A N/A 865 N/A 815 834 864 834 833 814 805 814 761 839 834 839 821 840 N/A N/A 871 N/A 851 814 919 814 890 831 932 831 905 842 943 842 900 850 9 Prof & Prof Values N/A N/A 852 N/A 817 870 967 870 854 837 828 837 950 828 922 828 102 3 847 9

Graduate (Alumni) and Employer Survey Results Critical Thinking, Communication, and Therapeutic Intervention (See Tables 7 & 8 ) 5 Table 7: Graduates (Alumni) Results for Critical Thinking, Communication, and Therapeutic Intervention Year Graduate (Alumni) Response Rate Graduate (Alumni) Score: Benchmark > 2.50 Critical Thinking (CT) Communication (Comm) Therapeutic Intervention (TI) 2007 20.0% CT: 3.84 Comm: 2.85 TI: 3.75 2008 <1.0% CT: 3.20 Comm: 3.36 TI: 3.26 2009 <1.0% CT: 3.30 Comm: 3.35 TI: 3.34 2010 Not completed Not Completed 2011 NA NA 2012 NA NA NA = Data not available Table 8: Employer Results for Critical Thinking, Communication, and Therapeutic Intervention Year Employer Response Rate Employer Score: Benchmark > 2.50 Critical Thinking (CT) Communication (Comm) Therapeutic Intervention (TI) 2007 <1.0% CT: 3.15 Comm: 3.00 TI: 3.05 2008 0.0% CT: ND* Comm: ND* TI: ND* 2009 <0.5% CT: 3.50 Comm: 3.50 TI: 3.50 2010 Not completed Not Completed 2011 Not available Not available 2012 NA NA *ND = No Data due to Response Rate NA = Data not available 10

VI. Modifications and Continuing Improvement: Program Changes due to Assessments Program Goals For Progam Goals A and B no modifications needed at this time. A. Compliance with National Accreditation Agencies and the TN State Board of Nursing Accreditation through the Commission on Collegiate Nursing Education (CCNE) As required of all nursing programs accredited through CCNE, the school will submit a Continuous Improvement Progress Report (CIPR) at the mid-point of the accreditation term, December 1, 2014 to be reviewed by CCNE Spring 2015. The next on-site evaluation will occur Spring, 2019. Full approval of the Tennessee State Board of Nursing Continue to submit annual report every December. B. Maintain RN Licensure Exam Scores above National Averages The past two graduating classes have had a 100% on the licensure exam. However, with current increase in passing standards set by NCSBN (beginning April 1, 2013 through March 31, 2016), the May 2013 graduating class will have the changes reviewed with them by faculty in senior level courses. The impact on ongoing curriculum review and revision, and individual student licensure preparation will be necessary once the May 2013 graduating class licensure reports are completed (approximately August 2013). For Program Goal C (Graduation rates from the WH-SON program will meet or exceed university rates) Continuous improvement ongoing - Graduation from the nursing program once admitted to upper division consistently meets or exceeds university rates. However, analysis of retention from freshmen to senior year for declared nursing majors needs to be further explored for comparison. Analysis of barriers that prevent admission from lower division to upper division nursing need to be further examined. Factors that impact student attrition or progression through upper division nursing have not been examined. For Program Goal D (Graduates (alumni) and employers are satisfied with the program) Modifications necessary with continuous improvement ongoing - Revision of current assessment tool for program satisfaction is warranted immediately. This aspect of program evaluation was problematic at the CCNE accreditation visit in 2009. Based on the continued poor response rate, efforts to facilitate the survey have not been effective. One contributing factor to poor facilitation of the graduate and employer surveys is the frequent changes to members of the Faculty-Student Relations Committee and its Chair over the past four years. Failure to effectively orient to this important function of the committee have been noted and the overall process and procedure for committee aggregate and Chair transitions is currently being audited. The format delivery for the surveys has also been examined. Despite transition from a mail out, hard-copy format to an online format, the response rate from both the graduates and employers is insufficient to provide substantive data to assist with program evaluation. In 2012, the Faculty Organization has approved use of Educational Benchmark, Inc. (EBI) as an alternative to current assessment of Graduate and Employer Satisfaction. Packages and cost are currently being evaluated by the Director of the WH-SON to then be presented and approved through the Faculty Organization http://www.webebi.com/assessments/nursing. Student Learning Outcomes Despite consistently high NCLEX pass rates that provide a culminating summative assessment of learning outcomes, the HESI exam provides a reflection of student progression on identified learning outcomes throughout the students time in the nursing program. HESI Exam Categories are based on the Essentials of Baccalaureate Nursing Education developed by AACN. Because the Essentials were revised in 2008, exams did not evaluate these attributes of the baccalaureate educated nurse (N/A). 11

For Learning Outcomes 1-8 (excluding 5, Therapeutic Communication) no modifications needed at this time. Review of indirect measures within didactic and clinical practicum courses for comparison might be indicated to provide a more multi-faceted and qualitative view of these learning outcomes. The addition of EBI for graduates (alumni) and employer follow up could prove helpful in determining if graduates and employers perceive these attributes as gained from the program. For Learning Outcome 5, Therapeutic Communication continuous improvement ongoing. Review of additional sub-categories for communication are available through HESI and will be considered. Communication has been identified as a challenge for students by both faculty and students themselves and the HESI exams provide some validation of those anecdotal concerns and observations. Incorporation of verbal presentations, role-play, and simulation involving interprofessional, patient, and family communication has been implemented in all clinical practicum courses. Varied formative assessments outside of HESI exams will be discussed by the Faculty Organization. A review of literature for comparison to national trends and issues around therapeutic communication would help inform additional assessments and evaluation of this learning outcome. For Learning Outcome 9, Professionalism and Professional Values modifications necessary with continuous improvement ongoing. While the RN Exit HESI reflects improvements in Professionalism and Professional Values at the time of graduation, the Mid-Curricular HESI Exam reflects consistent deficits in this learning outcome at the mid-point of their time in the nursing program. Possibly, maturation from the junior to the senior year impacts this learning outcome. Faculty have anecdotally commented as well as provided observations and examples of difficulty with professional behavior of students and how to effectively evaluate this outcome in both the didactic and clinical setting. Some courses have integrated a professional behavior clause in clinical evaluation with an all-or-none component to clinical grading. The effects of social media on students and social networking are thought to contribute to this outcome being a consistent challenge. Varied formative assessments outside of HESI exams need to be examined and considered by the Faculty Organization. A review of literature for comparison to national trends and issues around professionalism and professional values would help inform additional assessments and evaluation of this learning outcome. VII. Improvements to Assessment Plan Educational Benchmark, Inc. (EBI) Developed Alumni and Employer Surveys: In 2012, use of EBI was approved by the Faculty Organization as an alternative to current assessment of Graduate and Employer Program Satisfaction. EBI will replace the graduate and employer surveys with packages and costs associated with EBI http://www.webebi.com/assessments/nursing being evaluated currently by the Director of the WH-SON for final approval through the Faculty Organization by the end of Spring 2012 semester. Use of IDEA for evaluation of faculty effectiveness towards learning outcomes: Data collected from IDEAs is underutilized by the WH-SON. Faculty will review the possible items to be scored on the IDEAs and come to a consensus on keying attributes that will match learning outcomes. 12

Tennessee Technological University School of Nursing Code EMPLOYER QUESTIONNAIRE Instructions Please click on the response that most closely corresponds to your opinion. There may be items that you have not had an opportunity to evaluate; if that is the case, you nay mark NA (not applicable). Please do not include the graduate s name on this survey as all surveys are anonymous. They are coded to compare graduate and employer responses but unidentifiable to faculty. I. CRITICAL THINKING The Graduate of Tennessee Technological University s School of Nursing that you are evaluating demonstrates the ability to: Strongly Disagree Agree Strongly Disagree Agree 1. Utilize the nursing process by making appro- 1 2 3 4 NA priate decisions based on the continuous collection of pertinent data. 2. Utilize the nursing process by developing 1 2 3 4 NA and implementing patient and family focused nursing care. 3. Apply the knowledge from the natural and 1 2 3 4 NA social sciences to clinical practice to improve client care. 4. Demonstrate effective decision making and 1 2 3 4 NA problem solving skills. 5. Use nursing research information to improve 1 2 3 4 NA client care. II. COMMUNICATION The Graduate of Tennessee Tech University s School of Nursing that you are evaluating demonstrates the ability to: Strongly Disagree Agree Strongly Disagree Agree 1. Communicate verbally in an effective and 1 2 3 4 NA professional manner. 2. Communicate in writing in an effective and 1 2 3 4 NA professional manner. 3. Develop and maintain therapeutic relation- 1 2 3 4 NA ships with each client, family or the community.

4. Works effectively and cooperatively with 1 2 3 4 NA other members of the health care team. 5. Is able to use computers effectively in the 1 2 3 4 NA role of a professional nurse. III. THERAPEUTIC NURSING INTERVENTIONS: The Graduate of Tennessee Technological University s School of Nursing that you are evaluating, demonstrates the ability to: Strongly Disagree Agree Strongly Disagree Agree 1. Accept responsibility and be accountable for 1 2 3 4 NA their actions. 2. Collaborate effectively with patients and 1 2 3 4 NA other health care providers to improve or optimize health services. 3. Act as a patient advocate. 1 2 3 4 NA 4. Practice in the role of the professional nurse 1 2 3 4 NA in a variety of settings. 5. Incorporate ethical and legal standards into 1 2 3 4 NA clinical practice. 6. Provide appropriate resources and referrals 1 2 3 4 NA to clients. 7. Demonstrate leadership skills and the use of 1 2 3 4 NA management principles in practice. 8. Demonstrate commitment to continuous 1 2 3 4 NA learning through participation in formal and informal continuing education. 9. Participates in facility committees which 1 2 3 4 NA enhance the nursing profession or the work environment. (EX. Unit Risk Management) 10. Identify and interpret policies, procedures 1 2 3 4 NA and protocols of the health care system in which they are employed. In my experience as an employer, TTU 1 2 3 4 School of Nursing graduates function at or above the level of graduates from other nursing programs. Please identify this graduate s strengths and recommended areas for improvement.

Approved: Faculty Organization, 4/23/96 Updated: DAF & SMC 12/15/04 Tennessee Technological University School of Nursing Code One year after graduation we survey our graduates. We compare how students rate their abilities (and thus their educational preparation) after one year of practice. These surveys provide valuable feedback to our program for current and future students. Please do not include your name or other identifying information on the questionnaire. NO INDIVIDUAL RESPONSES ARE USED only aggregate responses are reported. By completing the survey, you are giving consent to be a part of the study. Please click on the response that most closely corresponds to your opinion. GRADUATE QUESTIONNAIRE I. CRITICALLY THINKING As a Graduate of Tennessee Technological University s School of Nursing, I demonstrate the ability to: Strongly Disagree Agree Strongly Disagree Agree 1. Utilize the nursing process by making appro- 1 2 3 4 NA priate decisions based on the continuous collection of pertinent data. 2. Utilize the nursing process by developing 1 2 3 4 NA and implementing patient and family focused nursing care. 3. Apply the knowledge from the natural and 1 2 3 4 NA social sciences to clinical practice to improve client care. 4. Demonstrate effective decision making and 1 2 3 4 NA problem solving skills. 5. Use nursing research information to improve 1 2 3 4 NA client care.

II.COMMUNICATE: As a Graduate of Tennessee Technological University s School of Nursing, I demonstrate the ability to: Strongly Disagree Agree Strongly Disagree Agree 1. Communicate verbally in an effective and 1 2 3 4 NA professional manner. 2. Communicate in writing in an effective and 1 2 3 4 NA professional manner. 3. Develop and maintain therapeutic relation- 1 2 3 4 NA ships with each client, family or the community. 4. Works effectively and cooperatively with 1 2 3 4 NA other members of the health care team. 5. Use computers effectively in the role of a 1 2 3 4 NA professional nurse. III. INTERVENE THERAPEUTICALLY: As a Graduate of Tennessee Technological University s School of Nursing, I demonstrate the ability to: Strongly Disagree Agree Strongly Disagree Agree 1. Accept responsibility and be accountable for 1 2 3 4 NA my actions. 2. Collaborate effectively with patients and 1 2 3 4 NA other health care providers to improve or optimize health services. 3. Act as a patient advocate. 1 2 3 4 NA 4. Practice in the role of the professional nurse 1 2 3 4 NA in a variety of settings. 5. Incorporate ethical and legal standards into 1 2 3 4 NA clinical practice. 6. Provide appropriate resources and referrals 1 2 3 4 NA to clients. 7. Demonstrate leadership skills and the use of 1 2 3 4 NA management principles in practice. 8. Demonstrate commitment to continuous 1 2 3 4 NA learning through participation in formal and informal continuing education.

9. Identify and interpret policies, procedures 1 2 3 4 NA and protocols of the health care system in which I am employed. IV. 1. In what month after graduation were you first employed as a registered nurse? (Circle one.) May, June, July, August, September, October, November, December, January, February, March, April. I have not yet been employed. I was an RN when I graduated and have been continually employed. 2. What is your major area of practice: a. adult medical b. adult surgical c. maternal/infant d. pediatric e. geriatric f. psychiatric/mental health g. other (please specify) 3. In which type of facility do you work at present: a. acute care hospital b. skilled nursing facility c. home health care d. public health e. private clinic or physician s office f. other (please specify) 4. How long have you been employed in your present position: months 5. I am a member of the following nursing organizations: a. Local group b. State Nurses Association c. Specialty organization (EX. Critical Care Nurses) 5. Have you obtained certification in any specialty since graduation? Yes No If yes, what is/are the area(s) of specialization (i.e., ALS, CCRN, etc.)? Please list: 6. What are your intentions about graduate education in nursing? a. enrolled and/or taking classes b. applied but not yet accepted c. intend to apply this year d. intend to apply in the future e. I have no intention of attending graduate school 7. As of now, what is your career goal in nursing? a. staff nurse b. management c. educator type d. clinical specialization

type e. advanced practice nurse type f. informatics g. other V. Program Satisfaction Strongly Strongly Disagree Disagree Agree Agree 1. I am satisfied with my learning experience at TTU School of Nursing: 1 2 3 4 NA Please identify the strengths and recommended areas for improvement of your Tennessee Technological University School of Nursing Experience. Approved: Faculty Organization, 4/23/96 Updated: DAF & SMC 12/15/04 & 12/17/04

HESI DEFINITION OF TERMS : REPORTS Number of Students: The number of test-takers in the group. Number of Scored Test Items: The number of scored questions included on this exam. Number of Non-scored Test Items: The number of questions on this exam that are not included in the score. These are pilot test items and will be evaluated for inclusion on future exams if they meet HESI s stringent requirements. Highest HESI Score: The highest HESI composite (total) score (three-digit score) received within this aggregate. The HESI score reflects application of the HESI Predictability Model (HPM) to the composite score. Research studies have found the HPM to be highly accurate in predicting NCLEX success. HESI scores range from 0 to over 1000, and can be as high as 1500 (depending on the difficulty level of the exam). Lowest HESI Score: The lowest HESI composite score (three-digit regression score) received within this aggregate. Median HESI Score: The HESI score that separates the range of scores into equal halves, which is the middle value among the scores arranged in a lowest-to-highest hierarchy, i.e., the score exactly in the middle of all scores in the group. The median score may or may not be the same as the mean score of the aggregate, depending on the distribution of the scores at the extreme low or high ends of the range. Mean HESI Score: The average composite HESI score for this aggregate. The mean score may or may not be the same as the median score of the aggregate, but these values will likely be very similar if there are no extreme lows or highs within the range of scores. Range of HESI Scores: The scores at the extreme ends of the distribution, which are the lowest and highest scores. Mean HESI Conversion Score: The average weighted composite percentage score for this aggregate. This score considers the average difficulty of the exam and the average difficulty of the test items that were answered correctly. This score is not used for NCLEX prediction. Faculty may select this score for use if performance on the exam contributes to a portion of the final grade in a specific nursing course. Standard Deviation of Scores: The measure of variability among scores that identifies the extent to which scores cluster around the mean. At least 75%, and possibly 96%, of a group s scores will fall between 2 SD below the mean and 2 SD above the mean even if there is skewing of the score distribution. Reliability of Examination (KR20): A measure of reliability for this exam is based on the Kuder-Richardson 20 statistical formula. The KR20 ranges from a -1 to a +1, and the closer the KR20 is to +1, the more internal consistency the exam possesses. In other words, the formula measures whether or not the high-scoring individuals who took this exam are consistently answering the test items correctly, and the low-scoring individuals who took this exam are consistently answering the test items incorrectly. Percentile Rank: The Percentile Score Rankings measure your aggregate s level of performance as compared to the performance of a national standard or norm group. HESI Scoring Interval: Groupings of scores by categories ranging from highest composite HESI scoring range (category A includes scores of > 950) through the lowest composite HESI scoring range (category H includes scores of < 649). Performance Level: Qualitative designations for the scoring intervals. # of Students: The number of scores in the aggregate associated with each scoring % of Students: The percentage of scores in the aggregate associated with each scoring interval. The Percentile Score Rankings do not reflect the percentages of test items that were answered correctly. Instead, these rankings are useful for determining how many students in the nation scored below and above your aggregate's mean (average) HESI composite score.