1 Assessment of the Associate Degree Nursing Program St. Charles Community College Academic Year By Patti Williams MSN, RN Director of Nursing Programs St. Charles Community College March 2012
2 Table of Contents MISSION AND GOALS A. College Mission Statement B. Nursing Program Mission and Philosophy C. Nursing Program Goals PROGRAM ASSESSMENT INSTRUMENTS A. Preceptorship Evaluations B. HESI Exit Exam for Nursing C. CAAP Critical Thinking Test D. NCLEX-RN E. Graduate Survey F. Program Survey PROGRAM ASSESSMENT DATA A. Preceptor Evaluations B. HESI Exit Exam C. CAAP Test D. NCLEX-RN Exam Results E. Graduate Survey Results F. Program Survey Results STATISTICAL PROGRAM DATA GOALS AND ACHIEVEMENTS PROGRAM REVIEW QUESTIONS PROGRAM SUMMATION COMMENTS
3 VOCATIONAL PROGRAM ASSESSMENT ASSOCIATE DEGREE NURSING PROGRAM I. MISSION AND GOALS College Mission and Vision Statement St. Charles Community College enriches our community by providing life-changing educational and cultural opportunities focused on personal growth and student success in a global society. We will be a community college recognized for leadership in academic excellence, student success, instructional and technological innovation, and community responsiveness. Nursing Program Mission and Philosophy In keeping with the mission of St. Charles Community College, the mission of the Associate Degree Nursing program is to meet the needs of the community by preparing competent graduates for entry level nursing practice in a variety of settings. The Associate Degree Nursing Graduate is prepared for entry level practice as a licensed registered nurse providing direct care, based on the nursing process of assessment, planning, implementation, and evaluation of care. The practice of the associate degree nurse encompasses three basic roles: provider of care, manager of care, and member of the profession of nursing, as outlined by the National League for Nursing. The associate degree nurse's approach to patient-centered care is reflected through a collaborative approach involving the client, family, significant others and other members of the health care team. To practice quality nursing care, it is essential that the nurse understand ethical and legal standards for practice, as well as lines of authority and communication within the work setting. Nursing education provides opportunities to gain current knowledge of nursing concepts, principles, processes, and skills. Students build on the necessary cognitive, psychomotor and affective abilities throughout the curriculum. Learning is a collaborative effort between the learner and the educator. The educator's role is to facilitate learning, foster critical thinking and evaluate students according to the specified competencies.
4 Nursing Program Goals The overall goal of the Associate Degree Nursing program is to educate competent graduates who are prepared for entry level nursing practice in a variety of settings. The Nursing Program also strives to prepare graduates who are successful in passing the National Council Licensing Exam for RN's (NCLEX-RN), and graduates who are prepared to continue their nursing education at a four year university. Terminal graduate competencies related to the role of the associate degree nurse are included in the Nursing Student Handbook. The goals for the nursing program assessment are summarized as follows: % of students who complete the clinical preceptorship experience in the last semester will receive clinical performance evaluations of at least "Satisfactory" or better, on the preceptor evaluation form. 2. The class average score for graduating students will be at or above the national average probability of passing score on the Health Education Systems, Inc. Exam (HESI). 3. The class average score for graduating students will be above the national norm on the Critical Thinking Module of the C.A.A.P. Academic Proficiency Test. 4. The aggregate graduating class pass rate for nursing students taking the NCLEX-RN licensure exam for first time candidates will be above the national average. 5. At least 90% of graduates contacted will be employed in a nursing role within six months of program completion % of students enrolled in NUR 103 (at midterm) will graduate from the ADN program within two years % of the graduating nursing students will rate their overall satisfaction with the nursing program as good or higher.
5 II. PROGRAM ASSESSMENT INSTRUMENTS A variety of instruments are utilized to assess the outcomes of the Associate Degree Nursing Program. Although student achievement and progress is continually assessed throughout each semester, the instruments chosen for program assessment represent the final outcomes after completion of the entire program. Preceptorship Evaluations The final clinical experience in the program is a "preceptorship", during which students work individually with an RN in a clinical setting. Students work a total of 80 to 84 hours according to the schedule of the mentoring registered nurse. Nursing students observe and function within the roles of provider of care, manager of care, and member of profession. This experience is designed as a transitional experience to help students identify the responsibilities of a registered nurse in a clinical setting. The RN preceptors evaluate the students according to clinical performance and professional behaviors. The preceptorship student evaluation form is included in the appendix. Based on the feedback from the RN preceptor evaluation and clinical site visits, nursing faculty will provide the final evaluation of the student for the clinical rotation. HESI Exit Exam for Nursing The HESI (Health Education Systems, Inc.) Exam is designed as an exit exam for all students enrolled in the last semester of a nursing program. The content covers all areas of the nursing curriculum, and the test questions are designed to be similar in content and format to the National Council Licensure Exam. The score received can predict the students' probability of passing the NCLEX-RN. The average national pass rate, for the last several years, on the NCLEX-RN has been approximately 86 percent. Students who receive a probability score below the national pass average on the HESI Exit Exam have a less than "average" probability of passing the NCLEX-RN. HESI predicts those with a 90% or above probability score should pass the NCLEX-RN. Those with a probability score below 90% should prepare carefully for the NCLEX-RN. Students with a probability score of 84% or less should plan remediation prior to the licensing exam. The institution aggregate score is reported as the average composite score which was 898 for this class. The national mean HESI composite score was 840. C.A.A.P. Critical Thinking Test Nursing students also participate in academic assessment by taking a portion of the nationally standardized C.A.A.P. (Collegiate Assessment of Academic
6 Proficiency) Exam. The students take the portion of this exam designed to assess "critical thinking" skills. Critical thinking is recognized as an area that is essential to success in nursing and is inherent in the nursing process approach to problem solving which is emphasized throughout the nursing curriculum. Critical thinking is essential in clinical practice, as well as the theoretical aspects of nursing. Students admitted into the nursing program take the critical thinking portion of the C.A.A.P. Test at the beginning of the first nursing course (NUR 103), and then again during the last semester (NUR 254). Results are then compared for students when beginning and completing the nursing program at this institution. SCC student results can also be compared to national averages of students across the country in similar programs. National Council Licensure Exam (NCLEX-RN) The National Council Licensure Exam (NCLEX-RN) is designed to test knowledge, skills, and abilities essential to the safe and effective practice of nursing at the entry level. NCLEX examination results are used by boards of nursing to make decisions about licensure. Only boards of nursing can release NCLEX examination results to candidates. To take the NCLEX examination, candidates must apply for licensure in the state in which they wish to be licensed, and meet all of the board of nursing's eligibility requirements for licensure. Students receive the NCLEX examination results within two weeks of completing the exam. A diagnostic profile is mailed to candidates who fail the examination. Using this information, failing candidates can determine their areas of strengths and weaknesses, and design their study accordingly, prior to retaking the NCLEX examination. Graduate results are reported to nursing programs quarterly, along with comparative statistics of passing rates from other schools and other states. Graduate Surveys Graduate surveys are mailed approximately six months after graduation. Responses to this survey provide information on employment and areas of practice. Over the past several years, the response rate for the surveys has been 25-35%. In 2009 and 2010 the response rate was 23%. The response rate for 2011 was only 19%. Graduates are also asked for feedback regarding their educational preparation for the role of a graduate nurse. Graduates rate their level of preparation on a scale of 1 (not at all), to 4 (well prepared), on each of the terminal graduate competency statements. Competencies are grouped according to the three roles of the associate degree nurse: provider of care, manager of care, and member of the profession of nursing. Survey results are tabulated and utilized for program evaluation and revision
7 SCC ADN Program Survey The associate degree nursing program survey is completed by students at the end of NUR 254, the last nursing course. Graduating students rate their knowledge and experience related to the three roles of provider of care, manager of care, and member of profession. They are also asked to rate their overall satisfaction with the nursing program on a scale of 1 (strongly disagree), to 4 (strongly agree). Results are aggregated along with student comments, and are utilized for program improvement. PROGRAM ASSESSMENT DATA A. RN PRECEPTOR EVALUATIONS Goal: 100% of students who complete the clinical preceptorship experience in the last semester of the nursing program will receive clinical performance evaluations of at least "satisfactory" or better, on the preceptor evaluation form. Number of students completing the clinical preceptorship experience: 55 Number of students with clinical evaluations of at least "Satisfactory" performance: 55 Percentage of students with clinical evaluations of at least "Satisfactory" performance for the clinical preceptorship experience: 100% Goal Met: Yes Comments/Conclusions: All students enrolled in the clinical preceptorship experience, received evaluations at or above satisfactory in all areas evaluated. Plan/Recommendations: Clinical preceptorship is a valuable experience for nursing students that provides a bridge between education and practice. It will continue for all nursing students who are enrolled in NUR 254 and have a satisfactory clinical grade. B. HESI EXIT EXAM FOR NURSING Goal: The class average HESI score for graduating students will fall within the range , indicating "Acceptable Performance" and probability of passing the NCLEX-RN
8 Number of students taking the HESI Exam: 55 Aggregate class HESI score: 898 HESI score category: Category Description: Acceptable Performance Goal Met: Yes Comments/Conclusions: The aggregate class score of 898 was achieved by SCC 2011 nursing graduates and represented an Acceptable performance" in relation to passing the NCLEX-RN exam on the first attempt. Individually, 17 students scored below the "Acceptable performance", with 2 students "needing further preparation to pass". Students have resources through HESI to remediate prior to taking the NCLEX. C. CAAP CRITICAL THINKING TEST Goal: The class average score for graduating students will be above the national average on the Critical Thinking Module of the CAAP Academic Proficiency Test. Number of students taking the CAAP Test: 56 Class average score at graduation: (Spring 2011) 63.5 National average at graduation (Spring 2011) 60.7 Class average on admission: (Fall 2009) 63.8 National average on admission (Fall 2009) 60.8 Goal Met: Yes Comments/Conclusions: The graduating nursing students scored 2.8 points above the national average on the CAAP Critical Thinking Exam. The average score for this group of students on the critical thinking
9 exam when they entered the program in the Fall of 2009 was 63.8 or 3 points higher than the national average. The critical thinking scores of SCC graduates were above the national average at graduation, however the scores indicate a.3 decrease from Fall 09 to Spring Plan/Recommedation: Continue to use the CAAP critical thinking exam to evaluate the ability of students to think critically, and to increase their skills on completion of the program. D. NCLEX-RN LICENSURE EXAM RESULTS Goal: At least 90% of graduates will pass the National Council Licensure Exam (NCLEX-RN), on the first attempt. Number of graduates taking the NCLEX-RN: Number of graduates passing the NCLEX-RN on the first attempt: Percentage of graduates passing the NCLEX-RN on the first attempt: SCC Percentage National Average: State Average: Goal Met: Yes % 87.73% 89.45% Comments/Conclusions: Missouri State Board pass rates are calculated from January 1, 2011 to December 31,2011. The total number of graduates is obtained by taking the total number of students who graduated and took their NCLEX-RN exam for the first time. A total of 52 students who graduated in May 2011 took the exam. Of those 52, 50 passed which is a 96.15% pass rate. This exceeds the program goals.
10 E. GRADUATE SURVEY RESULTS Goal: At least 90% of graduates contacted will be employed in a nursing role: Number of Graduates (surveys mailed): 52 Number of Graduates responding to mail survey 10 Number of graduates contacted employed in a nursing role: 10 Number of graduate's unemployed or working in another field: 0 Percentage of graduates employed in a nursing role within 6 months after graduation: 100% Goal Met: Yes Comments/Conclusions: Surveys were mailed to all 2011 graduates (52). Ten graduates responded (19%). All of the graduates who responded were employed in a nursing role. The goal was met. We will plan to institute an on-line survey for the next class with the hopes of improving the numbers of graduates responding to the survey. * Surveys were sent to students in October Graduation Rate Results Goal: 70% of students enrolled in NUR 103 (at midterm) will graduate from the ADN Program within two years. Number of students entering NUR at mid-term Number of students who failed or dropped 13 prior to May 2011 Number of bridge, transfer and returning Students entering after Fall Number of students entering fall 2009 and graduated May
11 Total number of graduates in May Overall Graduation rate 68.4% Grad Rate: those enrolled in NUR 65.7% Goal Met: No Comments/Conclusions: The overall graduation rate of 68.4% does not meet the goal of 70%, however, only 65.7% of those who started in NUR 103 (still in the program at midterm) actually graduated. This may be influenced by the admission standards of the nursing department. Students who meet the program requirements are then admitted on a first come, first served basis. Students are not ranked prior to admission to the program. Plan/Recommendations: The faculty will review admission requirements to ensure standards are effective in identifying students who have the academic ability to complete the program. Since there are only 80 students admitted, and we have well over 200 applicants, this is very important. A course "Tools for Success" is offered, not required for incoming students as a method to increase retention. Evaluation of the course (NUR 101) since its implementation in 2010 demonstrates a 10% increase in retention for students that took the course. Also, in review of requirements faculty determined that a grade "B" in the science (general education) would also be a way to potentially impact retention in a positive way. The requirement was shared with counseling/advising and has an effective date of There have also been conversations with regard to raising the GPA and ACT requirements in an effort to capture students whose academic ability might address retention issues. G. ADN Program Survey for Graduating Students Goal: 100% of graduating nursing students will "agree" or "strongly agree" that they were satisfied with the nursing program Number of graduating students 55 (54 responded) Number of students "agreed" or "strongly 40 agreed" that they were satisfied with the nursing program Percentage that agree or strongly agree 74%
12 Goal Met: No Comments/Conclusions: All 55 students completed the survey. The results indicate that on some questions there was not a 100% response rate. Specifically, on the question with regard to their overall satisfaction with the Nursing Program, there were 54 responses, not 55. Only 74% of the students expressed an overall satisfaction in The Academic Year was one of transition as 2 tenured faculty were leaving the program and 2 new faculty were adjusting to their new roles. Plan/Recommendations: The faculty values the information from the graduates and will continue to review the results of the program survey to gain relevant information about the program for the purpose of quality improvement of the program.
13 V GOALS AND ACHIEVEMENTS: SUMMARY OF RESULTS The St. Charles Community College Nursing Program met 5 of the 7 stated goals for the 2010/2011 academic year. Program Goal #1 100% of students who complete the clinical preceptorship experience in the last semester, will receive clinical performance evaluations of at least "satisfactory" or better, on the preceptor evaluation form. Goal Met A total of 55 students participated in the NUR 274 clinical preceptorship. One hundred per cent of the students received a grade of "satisfactory" by their clinical instructors. The five week 84 hour clinical experience provides students with a transitional experience bridging the gap between education and practice. Program Goal #2 The class average score for graduating students will be at or above the national "Acceptable Performance" score on the Health Education Systems, Inc. Exam (HESI). Goal Met The HESI exam is a nationally normed exam that compares graduates of all RN nursing programs. The SCC aggregate score of 898 fell into the "Acceptable Performance" related to passing the NCLEX-RN. This score indicates, as a class, the SCC graduates have an average or better than average probability of passing their licensure exam. This score is important when evaluating the effectiveness of the nursing curriculum in preparing graduates to pass their licensing exam and to effectively practice as registered nurses. Program Goal #3 The class average score for graduating students, will be above the national norm on the Critical Thinking Module of the C.A.A.P. Academic Proficiency Exam. Goal Met All students were testing at the beginning of the nursing program, and then again at the end of the final semester. The national average score was 60.7 for all students taking the exam. SCC nursing students had an average score of 63.8 on admission and 63.5 at graduation exceeding the national average. The critical thinking exam measures the ability of students to creatively problem solve which is akin to the nursing process method of
14 problem resolution utilized in the nursing setting. The ability to think more critically and creatively increased as they progressed through the program. Program Goal #4 The aggregate graduating class pass rate for nursing students taking the NCLEX-RN exam the first time, will be above the national average. Goal Met The class pass rate for the NCLEX-RN was 96.15% which exceeded the national level of and the state level of 89.45% as reported by the Missouri State Board of Nursing. Students must pass the NCLEX-RN in order to practice as a registered nurse. The exam may be repeated until the graduate successfully passes. Program Goal #5 At least 90% of graduates contacted by mail or telephone, will be employed in a nursing role within six months of program completion. Goal Met Surveys were sent to all 2011 graduates with a return rate of 19%. Of those returned, 100% of the graduates were employed in a nursing role. SCC nursing graduates have no difficulty obtaining nursing jobs in area health care institutions. The SCC nursing program graduates are highly recruited and employer surveys indicate that they function at or above expectations as new graduates. Program Goal #6 At least 70%of students enrolled in NUR 103 will graduate from the ADN Program within two years Goal Not Met The graduation rate of those who began the program in 2009 (and were still enrolled at midterm) was 65.7% and does not meet the goal of 70%. New students entered the program (bridge or returners) in Jan We ultimately graduated 52 students, 50 of those students were from the original class. Students who meet the program requirements are then admitted on a first come, first served basis. Students are not ranked prior to admission to the program.
15 Program Goal #7 100% of the graduating nursing students will rate their overall satisfaction with the nursing program as good or higher. Goal Not Met Program evaluations were completed by 55 nursing graduates. With regard to the question of "overall satisfaction with the program", we had 54 responses. Only 74% of graduates reported their satisfaction with the SCC nursing program as "good" or "very good". As referenced in Section III, program goal #7, this was a time of transition with tenured faculty retiring and new faculty becoming acclimated with the program. The goals for the nursing program for 2011/2012 are as follows: % of students who complete the clinical preceptorship experience in the last semester will receive clinical performance evaluations of at least "Satisfactory" or better, on the preceptor evaluation form. 2. The class average score for graduating students will be at or above the national average probability of passing score on the Health Education Systems, Inc. Exam (HESI). 3. The class average score for graduating students will be above the national norm on the Critical Thinking Module of the C.A.A.P. Academic Proficiency Test. 4. The aggregate graduating class pass rate for nursing students taking the NCLEX-RN licensure exam for first time candidates will be above the national average. 5. At least 90% of graduates contacted will be employed in a nursing role within six months of program completion % of students enrolled in NUR 103 (at midterm) will graduate from the ADN program within two years % of the graduating nursing students will rate their overall satisfaction with the nursing program as good or higher.
16 IV PROGRAM REVIEW QUESTIONS FOR 2010/ The nursing program admits 80 students each Fall semester into NUR 103 (100% capacity), and has done that for at least the last three years. Originally the program was approved for 120 admissions; however, the program does not have the resources to support that enrollment number. At our Missouri State Board of Nursing 5 year visit (October 2011) the program requested a voluntary limit for enrollment of 80 students per year. These 80 students are divided into three sections at 100% capacity. If there is space, LPN Bridge, LPN transfer and transfer students are admitted into Spring Courses NUR 104 and 105 (100% capacity). Second year enrollment remains fairly stable, but there is occasionally a return or transfer student who can be admitted. The average class section size has been students. The average clinical group is 8 students. 2. We compete with approximately 12 nursing programs in the St. Louis metropolitan area which lends itself to increased competition to secure qualified adjunct nursing faculty. Our program is approved by the Missouri State Board of Nursing which requires a minimum of a BSN, and is accredited by the National League for Nursing Accrediting Committee, which requires that nursing faculty have a minimum of an MSN. There is a shortage of master's prepared nursing faculty in this market. Thus only about 1/3 of our adjunct faculty has an MSN, with the remainder possessing the minimum requirement of a BSN. 3. Applicants to the nursing program continue to outnumber the numbers of students whom we can accept into the program. This leads to increased numbers of qualified students being denied access to the program and a growing number of waitlisted students. In order to educate greater numbers of students we would need more resources, specifically qualified full time and part time nursing educators, lab/simulation staff, additional clinical sites and clinical preceptors. We also lack the physical space required to house the students and the nursing lab. 4. General education requirements for nursing students include Anatomy and Physiology I & II, Intro to Chemistry, Intro to Psychology, English Composition I and II or Literature, Microbiology, and Intro to Sociology. 5. Enrollment has remained consistent for the last three years with a cap of 80 students for admissions to the program. There is some attrition, so overall enrollment for all sections combined for Level 1 and Level 2 ranges between The Missouri State Board of Nursing was recently on campus (October 2011) for our 5 year review. There discussed in detail with faculty and administration the difficulties surrounding recruitment and retention of qualified nursing faculty. Although the programs enrollment approval had been set at 120, there have never
17 been 120 students admitted due to these constraints. The nursing program requested a voluntary limitation of 80 admissions per year. 7. For the 2010/2011 Academic year, there were 7 full time faculty: Ginny Daugherty, Linda Cole, Marilyn Miller, Meghan Ames, Joetta Drake, Jean Curry and Amy Koehler. Joetta Drake and Ginny Daugherty retired at the end of Spring Bernadette Moody stepped down as the Director of Nursing Programs at the end of Spring Bernadette Moody and Liza Willis assumed the 2 full time faculty positions (effective Fall 2011) created by the retirees. 8. Two hours of release time is given to 2 full time faculty to act as course coordinators each semester. In Fall 2011 (2) faculty were given 5 hours of release time to work on the NLNAC self-study in preparation for Fall 2012 visit. All faculty, have a combined clinical and classroom academic load. 9. Due to the economy and job loss in 2010/2011 many nurses that were working part-time, or planning to retire decided to increase hours and delay retirement. This created a situation in which there were less full time jobs available for graduates. This has started to shift somewhat in the later part of 2011; however, clinical partners are continuing to advise our students to accept any job offer they receive as an entry into the field. The other "key topic" for nursing is the "BSN in Ten" requirement that was generated out of the IOM study. Many of our clinical partners are seeking Magnet Status, which requires that over 50% of their nurses hold a BSN. In order to stay relevant and continue to meet the needs of our students, clinical partners and community we will need to seek articulations that allow for collaboration.
18 V Program Summation Comments In 2010/2011, we met 5 of our 7 stated goals. The goals that were not met relate to retention and student satisfaction. These topics are of great concern to faculty and are not taken lightly. Faculty continues to provide quality instruction, additional remediation and computerized programs of study to our students. Many of the students are working, some even full time, which greatly impacts their ability to meet the demands of the program and the required hours of study. With regard to retention; the data related to "Tools for Success" course (NUR 101) demonstrated a 10% increase in retention. However, it is important to also factor in that some of the students who did not graduate left the program for reasons other than academic. We continue to use technology, simulation and links to our clinical partner websites for electronic health records. With regard to student satisfaction; upon review of student comments related to satisfaction there were a few themes that surfaced. Those themes were "negativity of faculty, lack of organization, too much drama in the nursing department, too much change in the program, not enough staff in the lab". The comments and feedback from students (verbally) in Fall 2011 was much more positive with regard to these specific themes. However, students are still requesting more staff in the lab. Students also continue to express concerns about clinical. They do not always have opportunity to perform a "specific skill" and thus they think they are not learning. We, as a program, do not have any control over some of these clinical concerns. Faculty always try to seek out learning opportunities; they emphasize the theory related to the clinical, not just the task. However, from the student's point of view, they see it as "something they won't know how to do when they graduate". We reassure students that with regard to "tasks" or "skills", they will have opportunity to learn many things "on the job". Overall, the ADN program current health and viability is strong. We continue to have students waiting to enter the program based on the space available. As a program we will continue to pursue partnerships with health systems in the area and continue to look at other collaborations that will have a positive effect on student outcomes.
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