Program Review: School Nurse Certification Program. New Jersey City University. Introduction

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1 Program Review: School Nurse Certification Program New Jersey City University Introduction The School Nursing Program at New Jersey City University (NJCU) is a unique hybrid program that combines certain elements of teacher education and nursing education to create a healthcare professional that can bridge the two disciplines. The reviewer was engaged to review the program in preparation for the upcoming Teacher Education Accreditation Council (TEAC) accreditation process. TEAC does not perform audits of educational services programs and the university was charged with finding a professional who could address this unique program. The reviewer is a former certified school nurse and state school nurse consultant who holds a BA degree in health education and a MA in curriculum and instruction and who is a nationally certified health educator (CHES). The reviewer has been actively engaged in both school nursing and health education at the local, state, and national levels for more than 25 years. Methodology The reviewer consulted with the program coordinator and studied the TEAC requirements. The reviewer also consulted with personnel at the New Jersey Department of Education and with individuals in universities that had already undergone a TEAC review. However, no one could advise the reviewer on how to conduct a review of a school nursing program since many of the colleges that had already undergone the TEAC process did not have similar programs. Similarly, an online search did not uncover a template or format for the review. The reviewer also studied the Standards for School Nursing Practice published by National Association for School Nurses (NASN) and the American Nurses Association (ANA) as well as the New Jersey Professional Teaching Standards Finally, the reviewer studied the New Jersey Core Curriculum Content Standards and related requirements for health education found on the NJDOE website On August 18, 2011, the reviewer spent a day on the NJCU campus. She interviewed the program coordinator, met other University officials, toured the facilities and classrooms, and reviewed important documents. The reviewer also interviewed several students about the program. After the campus visit, the reviewer created and sent several short surveys to collect more information about the program from current and former students, cooperating teachers, and supervisors. She perused the NJCU website, examined promotional materials for the program, and reviewed course descriptions, syllabi, resources cited, and other program documents. 1

2 The most difficult and frustrating part of the process was getting input from current and former students. In some cases, they were too busy to respond. In other cases, they simply chose not to participate or did not fully address the questions. Thus, contact with students and alumni was limited and their comments should be considered in that context. Finally, the reviewer tried to make some sense of the information in the context of the TEAC requirements. Since the TEAC process is very teacher oriented and the NJCU program is primarily an educational services model, it was like trying to fit a square peg in a round hole! The reviewer attempted to align with the TEAC structure but there are items that simply cannot be addressed by an external review of this kind and that will require scrutiny by faculty and staff to address in a TEAC Brief. Summary of Findings Overall, the reviewer found a strong correlation between the NJDOE requirements and the NJCU school nurse certification program. There is also a strong correlation to the National Standards for School Nursing Practice. It is important to note that this review was conducted using materials provided by the program coordinator and that the reviewer did not observe classes or students engaged in field experiences. The health education component of the program appears to be less aligned to current requirements established by the New Jersey Core Curriculum Content Standards for Comprehensive Health and Physical Education (2009) and the NJDOE s emphasis on twenty-first century skills. Program Overview The School Nursing Program at New Jersey City University (NJCU) is a unique hybrid that combines certain elements of teacher education and public health education with the goal to create a healthcare professional that can bridge the two disciplines. The program resides in the Health Sciences Department in the College of Professional Studies and prepares registered nurses to provide nursing services in the school setting and to teach health education to students in grades K-12. Successful completion of the program leads to an Educational Services Endorsement in School Nursing/Instructional issued by the New Jersey Department of Education. Candidates are eligible for school nursing/health teaching positions in the state s public schools, private schools for the disabled, charter schools, and other P-12 educational settings. The program is open to individuals who already possess a current professional registered nurse license and hold a bachelor s degree in any area from an accredited institution of higher education (the degree does not need to be in nursing). Prospective students are also required to have at least three years of work experience in nursing. NJCU s School Nursing Program requires students to complete prescribed coursework, usually graduate credits. Students entering with a Bachelor of Science in Nursing (BSN) may use 2-3 specific courses from their undergraduate studies towards certification. In general, the program can be completed in months with all graduate level courses applicable to a 36 credit Master of Science in Health Sciences Program with a concentration in School Health Education. It is important to note that the program, as aligned with current NJDOE requirements, seeks to prepare an entry-level school nurse and an entry-level health education teacher within the constraints of the 2

3 same program. Students participating in this program do not engage in the 450 hours of student teaching required for the health education instructional certificate and they do not take the Praxis exam. It is also important to note that the NJDOE does not require mentoring programs for entry level school nurses as it does for entry level teachers. Accreditation The New Jersey Department of Education required all educational services programs in the state, including the NJCU program, to complete a review process prior to September 1, The NJCU program was approved as an undergraduate program in Subsequently, the program was revised and submitted for program approval as a graduate-level program in January 2005 and approved in June The undergraduate and post-baccalaureate programs have been discontinued. Guiding Philosophy The School Nurse certification program at NJCU is built on the principle that healthy children achieve greater academic success. Well-prepared and certified school nurses can be change agents to improve the quality of health care and reduce health and educational disparities. Certified school nurses use evidence-based practice and clinical proficiency to serve in leadership roles in the schools and communities where they work. Program Areas The NJCU program is grounded in the requirements for the school nurse/instructional educational services endorsement set forth by the NJDOE in N.J.A.C. 6A: Licensing and Credentials (available at and and in the Standards for School Nursing Practice, jointly published in 2005 by the National Association for School Nurses (NASN) and the American Nurses Association (ANA). Students engage in coursework in nursing, public health and education. Field experiences in various K-12 settings authenticate the coursework for students and help them transition from acute or long-term healthcare preparation to the unique needs of the school community. In addition, nurses enrolled in the program engage in a methods of teaching course and supervised field experience that takes them out of the health office and into the K-12 classroom. Specific course content and the relationship of those courses to accepted standards will be discussed later in this document. History The NJCU has been educating school nurses since Initially, the school nursing program resulted in a bachelor s degree in health sciences; additionally, courses were offered towards a post-baccalaureate certificate. Based on national discourse about nursing education and school nursing in particular, the NJCU program evolved into the graduate level program that it is today. 3

4 Demographics Currently, there are 80 students enrolled in the program, mostly women. (Note: The information provided did not indicate gender, race or ethnicity but it was assumed that based on names alone, most of the candidates are women and this, of course, is supported by the number of women in the nursing profession in general.) There are another students not currently enrolled in courses; these students have not yet completed certification requirements. Students represent all geographic areas of the state and come to NJCU because of the availability of online courses and the cost of a public education versus private college tuition and fees. Many of the enrollees are working at least part-time, have families, and have varied years and kinds of nursing experiences. The program coordinator estimates that English is not the first language of approximately 15% of current students in the program. Many of these nurses are currently working in private, charter or public schools in urban areas near Jersey City. Review Process The reviewer began by searching the TEAC website for information on how to conduct a TEAC Audit for a school nursing certification program. There was little information available for educational services programs. The reviewer consulted with experts who had experience conducting or participating in a TEAC review process. Ultimately, the reviewer determined that the TEAC process was not entirely applicable to this hybrid program and essentially, she would have to create a structure that better suited the program while still trying to address the TEAC requirements. Subsequently, the reviewer spent a day on the NJCU campus, speaking with the program director, meeting university officials, interviewing students, and reviewing materials provided by the program director. Following that visit, the reviewer developed surveys to gather additional information from current and former students, cooperating teachers and nurses, and supervisors. Course descriptions, support materials, web-based materials, and other sources of data on the program were studied. It is important to note that graduates of this program do not take a Praxis exam as part of the certification process; therefore, no hard data is available to address the relative achievement or success of graduates. 4

5 TEAC Principles and Standards 1. Quality Principle I: Evidence of Candidate Learning: Programs must provide sufficient evidence that candidates have learned and understood the teacher education curriculum. This evidence is verified through audit and evaluated for its consistency and sufficiency. Each component and cross-cutting theme of Quality Principle I must contribute to the overall goal of producing competent, caring, and qualified teachers. 1.1 Subject Matter Knowledge: Candidates for the degree must learn and understand the subject matters they hope to teach. TEAC requires evidence that the program s candidates acquire and understand these subject matters. Candidates seeking a health education instructional endorsement are not required in New Jersey to take and pass a health education content knowledge Praxis exam. Only those seeking a dual health and physical education instructional endorsement are required to take and pass a content knowledge Praxis test (20856). Health educators can opt to sit for a national credentialing exam known as the CHES examination. It is a competency-based tool used to measure the possession, application and interpretation of knowledge in the Seven Areas of Responsibility for Health Education Specialists. The exam reflects the entry-level sub-competencies of the Areas of Responsibility and successful passing of the exam permits the individual to use the designation Certified Health Education Specialist (CHES). A similar process has recently been instituted for Master s prepared individuals leading to designation as an MCHES. These designations are not teaching certifications but national professional credentials; they are not a replacement for teaching certification as required by the NJDOE. Similarly, because school nurse certification is an educational services endorsement, there is no standardized or state-approved test available or required by the NJDOE. There is, however, a national school nurse credential sponsored by the National Board for Certification of School Nurses (NBCSN). Professional certification in school nursing provides an ongoing, quality credentialing process for eligible school nurses and represents a national standard of preparation, knowledge, and practice; however, the NBCSN process is not accepted by the NJDOE as an equivalent process. Therefore, there is no valid and reliable measure of graduate s content knowledge in either health education or school nursing that is accepted or used by the NJDOE. Based on a review of course requirements, it appears that the NJCU school nursing courses rely on multiple and diverse means to assess student knowledge of relevant issues, laws, and procedures and require a significant amount of reflection. However, courses focused on health education appear to rely more on multiple choice mid-term and final exams rather than more authentic and reflective assessment practices. Neither aspect of the program uses assessment processes that lend themselves towards standardization. 1.2 Pedagogical Knowledge: The primary obligation of the teacher is representing the subject matter in ways that his or her students can readily learn and understand. TEAC requires evidence that the candidates for the program s degree learn how to convert their knowledge of a subject matter into compelling lessons that meet the needs of a wide range of students. 5

6 There are two courses that focus on the application of content knowledge in authentic context. The first course, HLTH 641 Methods and Curriculum in Health Education, is described as providing instruction on the methodology, design, implementation, and assessment of health education lessons and programs. There appears to be an emphasis on sensitive issues and diverse populations as well as addressing the cognitive and affective domains. It is unclear if this course has been specifically designed for the school nursing program or if it is offered to anyone seeking a degree in health education. This is important since the school nurse certification candidates must hold a registered nurse license and have at least three years nursing experience. Registered nurses should have a strong background in foundational health information and content but most likely lack professional experience in formal classroom teaching particularly with children and adolescents. Comments from field experience supervisors seem to validate that claim. HLTH 641 introduces students to professional organizations focused on health education in all settings. The course also focuses on national health education certification but does not mention New Jerseyspecific organizations that support school-based health education. Most of the organizations mentioned are not focused on school-based instruction but are more focused on public health education and may be of little help to school nurses. The master course proposal shows that the first three weeks of the course are dedicated to topics that are tangential to success as a school nurse/teacher. For example, the New Jersey Core Curriculum Content Standards for Comprehensive Health and Physical Education (NJCCCS) are the basis for what all students must know and be able to do in New Jersey s public and charter schools yet they are but one item on a laundry list of topics covered in week three of the course (Note: The NJCCCS were initially adopted in 1996 and revised in 2004 and 2009; the resource list includes a 2006 version which does not exist.) The course syllabus states that students will be able to compare, contrast and apply the National Health Standards to the New Jersey Comprehensive Health Education and Physical Education Curriculum Framework into health lessons. As a primary author and editor for the NJCCCS and Framework and a contributing author on the National Health Education Standards (2007), there is no connection between these two documents. Further, while the use of the Curriculum Framework is admirable to help educators find lesson ideas, the Framework is aligned to the 1996 NJCCCS and therefore has limited applicability to the twenty-first century approach now espoused by the NJDOE. The Framework provides some ideas on instructional adaptations that remain viable and there are many lesson ideas in the document but it is unclear how the Framework is actually being used in the course. The NJCCCS (2009) are the basis for curriculum development and unit and lesson planning for any New Jersey K-12 health education teacher. Similarly, the NJDOE has published on its website a suggested lesson and unit plan format based on the Understanding by Design (UBD) model developed by Wiggins and McTighe ( The Classroom Application Documents (CADS) and sample Unit Plans posted on the NJDOE website address various standards and strands and provide concrete examples of the UBD model including essential questions, enduring understandings, and sample assessments. The UBD model is complex and requires intensive training for even seasoned education professionals. The model is simply mentioned in week 6 along with assessments and grading and there is no reference to the specific NJDOE website except in the list of resources. (Note: NJPEP no longer exists.) However, it appears that emphasis is placed on the use of the HE-CAT (Health Education Curriculum Assessment Tool) published by the Centers for Disease Control 6

7 and Prevention (CDC) and used to evaluate health education programs often purchased by schools such as textbooks, topical programs, or online health education programs. (Note: The use of the term curriculum in the HE-CAT has been debated; in New Jersey curricula are developed at the local level by the district and supported by instructional materials that may be part of a program; therefore, the HE- CAT should be used to evaluate programs.) While this may be a valuable exercise, it does not appear that sufficient time has been devoted to developing the background knowledge in New Jersey s requirements to be able to use this tool successfully. Training by CDC consultants in the use of the HE- CAT takes about four hours. The rest of the course appears to be dedicated to an assortment of health topics that have not been aligned with those in the NJCCCS. (Note: The strands in the NJCCCS help to identify many of the topics for instruction.) It is unclear why a group of registered nurses would need an entire week dedicated to disease prevention issues. There is little explanation of how candidates are taught to assess student learning (or assessment for learning rather than of learning), or to address student-centered or learner centered-practices. The Greenberg text used was created for health educators in general and not specifically for school health educators. During the course, it appears that the focus is more on writing and critiquing lesson plans rather than learning critical pedagogical skills needed by a novice teacher regardless of content area. The second course that addresses pedagogy is HLTH 643 Graduate School Nurse/Health Education Practicum. This course serves as a capstone experience, providing time in elementary and secondary school health offices and health education classrooms. (Note: Page 6 states that there are two tracks, graduate and undergraduate. This is confusing but I believe the undergraduate program is no longer operational.) Students begin this course by developing personal objectives that will be used as part of a self-assessment required at the end of the course. Focusing on the health education component of this course, students must complete ten lesson plans that reference the NJCCCS; however, the format for lesson plans does not mirror that promoted by the NJDOE, it does not use the UBD format supposedly addressed in the Methods course. The UBD format seems to be the most popular format used, with modifications, by many New Jersey school districts. Listing the NJCCCS on a lesson plan has been shown to serve as a weak link to actual instruction grounded in the Core Standards; teachers need to know the standards, strands, and indicators not just the broad concepts of the Core Standards themselves. There does not seem to be an emphasis on the use of twenty-first century skills and in fact, one cooperating teacher suggested that every student teacher should be required to bring a laptop computer to health education classes to use as part of instruction. The cooperating teacher felt that incorporating technology was not sufficiently addressed. The supporting materials provided for the course seem to emphasize informal health teaching rather than structured health education lessons based on standards, locally-developed curriculum, and research- or evidence- based programs and materials. The support materials do not include materials from the NJDOE website. Candidates only teach ten lessons as part of this experience, simply because most of their field experience is spent in the health office. Of those ten lessons, the university supervisor observes only 3-4 lessons. Unlike traditional teacher education candidates that are required to spend 450 hours in a classroom, school nurse candidates do not have the responsibility for a full marking period of instruction and have limited experience conducting assessments and grading. It appears that it would be difficult for a supervisor to determine student progress since the nurse appears to teach a series of disconnected lessons over time rather than 7

8 a cohesive, topical unit. The cooperating teacher must complete two online evaluations of each candidate as well, and confers with the University supervisor and school nurse candidate as necessary. However, one cooperating teacher expressed concern about find time during the school day to meet with the student and supervisor. 1.3 Caring Teaching Skill: Above all, teachers are expected to act on their knowledge in a caring and professional manner that would lead to appropriate levels of achievement for all their pupils. Caring is a particular kind of relationship between the teacher and the student that is defined by the teacher s unconditional acceptance of the student, the teacher s intention to address the student s educational needs, the teacher s competence to meet those needs, and the student s recognition that the teacher cares. Although it recognizes that the available measures of caring are not as well developed as the measures of student learning, TEAC requires evidence that the program s graduates are caring. The NJCU School Nurse Practicum Competencies address this area. As part of field-based experiences, students use this assessment tool to evaluate the nurse s ability to collaborate with colleagues, provide care that is culturally and ethnically sensitive, and address language barriers. Students must assess learning needs and adapt messages, as necessary, and interact with students, parents, other healthcare providers, and educators in a professional manner. School nurses are expected to maintain compassionate relationships with peers and colleagues and to protect the rights and dignity of students and staff they treat. School nursing students are rated as novice, progressing, or master for each subcompetency. The School Nursing Program also requires every candidate to complete a three-part online course produced by the Office of Minority Health and based on the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care. 1.4 Cross-Cutting Themes: In meeting each of TEAC components , the program must provide evidence that its candidates have addressed the following three cross-cutting liberal education themes: Learning How to Learn: Candidates must demonstrate that they have learned how to learn information on their own, that they can transfer what they have learned to new situations and that they have acquired the dispositions and skills of critical reflection that will support life-ling learning in their field. Most of the courses required for school nurse certification at NJCU require students to take responsibility for their own learning. Since students in the school nurse certification program are essentially second career adult learners, the courses have been designed to allow for a mix of online, hybrid, and face-to-face classes. Students are required to set personal objectives, submit a reflective journal while doing fieldwork, and participate in on-line discussions that require concise and directed thought. Students must also submit REQLIs which require students to read critically, pose questions about the reading, state what they have learned, and submit additional issues that arose from the reading. This type of assignment is required throughout the program. Students are also required to complete a self-assessment at the end of the practicum experience. In addition, students are required to 8

9 attend a professional meeting or workshop and write about the experience, thus gaining insight into the need for continuing professional learning Multicultural Perspectives and Accuracy: Candidates must demonstrate that they have learned accurate and sound information on matters of race, gender, individual differences, and ethnic and cultural perspectives. The School Nursing Program at NJCU is located in an ethnically and culturally diverse urban area of the state. Diverse cultural and religious beliefs may be difficult to address when dealing with sensitive health topics such as sexuality or addressing access to healthcare for illegal immigrants or limited English speaking populations. The NJCU program requires every candidate to complete a three-part online course produced by the Office of Minority Health and based on the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care. In addition, the University attempts to place school nurse certification candidates in urban school districts where they will be able to better understand the role diversity plays in the state s schools. In addition, HLTH 642 The Role of the School Nurse in the Coordinated School Health Program II addresses culturally sensitive school nursing practice. This class focuses on working with marginalized populations including race, ethnicity, sexual preference, socio-demographic disparity, or other at-risk populations. It also addresses children in foster care, incarcerated youth, the homeless, and LGBTQ students. (Note: Sexual preference should be changed to sexual orientation and the issue of gender, in general, should be included.) HLTH 647 Health Disparities among Diverse Populations: Class, Race and Gender also addresses this issue as it focuses on access and quality of health care. It is an online course which requires students to post questions and comments online (which counts for 33% of the course grade) as well as submitting a portfolio of brief essays (which appear to be assessed using a writing rubric) and which also count for 33% of the grade. Finally, students must evaluate a health organization, clinic, agency, or program using the CLAS standards Technology: Candidates must be able to use appropriate technology in carrying out their professional responsibilities. Students in the NJCU program are required to use Power Point for presentations and are expected to participate in various forms of on-line learning. They are required to participate in state and national list servs, conduct online literature reviews and conduct basic research. It appears that in HLTH 641, students are required to videotape a lesson and critique it but there is insufficient information provided to determine how this is accomplished. As previously noted, one cooperating health education teacher suggested that every nurse have his/her own laptop for use during the field experience. There is no mention of twenty-first century skills and no direct connection to materials developed by NJDOE to support that approach to instruction. There is no mention that students are encouraged to use social media or podcasts as part of their teaching repertoire and no instruction in the use of tools such as whiteboards or Smart Boards. However, one student mentioned that whiteboards were used in her methods class. It does not appear that nurses are taught how to evaluate online materials for accuracy 9

10 and reliability. (Note: This might be accomplished by using the HE-CAT but it is impossible to tell if this process is taught from the materials submitted.) 1.5 Evidence of Valid Assessment: The program must provide evidence regarding the trustworthiness, reliability, and validity of the evidence produced from the assessment method or methods that it has adopted. No evidence was provided to address this issue. The school nursing courses (HLTH 636, 642 and 643) all use multiple measures of student progress, including reflection and self-evaluation. There are numerous rubrics used by the instructors to evaluate assignments. HLTH 641, HLTH 630 and SPEC 605 rely heavily on multiple choice mid-terms and final exams. HLTH 647 uses rubrics for writing, discussion, and an assignment rubric; however, content rubrics were not made available for other courses. There is no evidence of standardized rubrics or grading criteria across all courses. 2.0 QUALITY PRINCIPLE II: Evidence of Faculty Learning and Inquiry: There must be a system of inquiry, review, and quality control in place through which the faculty secures evidence and informed opinion needed to improve program quality. Program faculty should be undertaking inquiry directed at the improvement of teaching and learning, and it should modify the program and practices to reflect the knowledge gained from its inquiry. 2.1 Rationale for the Assessments: There must be a rationale for the program s assessment methods that explains why the faculty selected the assessments it used, why it thinks its interpretations of the assessment results are valid, and why the criteria and standards the faculty has set as indicating success are appropriate. The program coordinator is aware that more feedback is needed from students in the program as well as recent graduates. The plan is to revise the program outcomes chart so that better feedback can be obtained. The program coordinator acknowledged that the scoring gradients need to be more specific and need to address the differences between a novice, emerging/progressing, and master school nurse. Student surveys have been used to evaluate course offerings and field experiences but have not specifically addressed assessment measures. The multiple measures used in many of the courses provide students with opportunities to reflect on their learning and practice and to pose new questions; however, they do not provide raw data that can be quantified as a measure of success. There are inconsistencies across courses with grading policies and forms of assessment. There was no evidence provided that any discussion of those inconsistencies has occurred. 2.2 Program Decisions and Planning Based on Evidence: Where appropriate, the program must base decisions to modify its assessment systems, pedagogical approaches, and curriculum and program requirements on evidence of candidate learning. As part of the field experience, students engage in self-assessment and are evaluated at least two times by both a cooperating health education teacher and a cooperating school nurse. They are also evaluated by the university supervisor. It would appear that there is sufficient information from these evaluations to assess these experiences and determine if changes need to be made. Based on interviews with 10

11 current and former students, the program could do a better job teaching students how to manage time in the health office. It does not appear that current assessments or surveys actually address this issue. 2.3 Influential Quality Control System: The program must provide evidence, based on an internal audit conducted by the program faculty, that the quality control system functions as it was designed, that it promotes the faculty s continual improvement of the program, and that it yields the following additional and specific outcomes: Curriculum: The curriculum meets the state's program or curriculum course requirements for granting a professional license. The program was approved by the New Jersey Department of Education in June The document, Alignment of N.J. Board of Education Licensing and Credentialing Topics, outlines how the requirements are embedded in various courses. A review of the course descriptions and related materials verifies this Faculty: The Inquiry Brief, as endorsed and accepted by the faculty, demonstrates the faculty s accurate and balanced understanding of the disciplines that are connected to the program. The reviewer cannot address this item Candidates: Admissions and mentoring policies encourage the recruitment and retention of diverse candidates with demonstrated potential as professional educators, and must respond to the nation s needs for qualified individuals to serve in high demand areas and locations. The program must monitor the quality of the support services provided to candidates to ensure that student support services contribute to candidate success in learning as required by Quality Principle I. Candidates for admission to the program must hold a registered nurse license and have at least three years of work experience in nursing. (Note: The experiential requirement exceeds that of the NJDOE and is commendable since nursing experience in other healthcare venues is critical to success as an independent school nurse.) Candidates must also hold a bachelor s degree in any field. Those who enter with a BSN or MSN are able to use certain courses from their previous studies towards fulfilling the requirements (approximately 6-9 credits). Applicants must submit an essay on why they want to become a school nurse and an interview is required. Prospective students must have a 2.75 or better GPA as an undergraduate. Many candidates are employed in health care institutions and some are employed by private schools. The program has adapted to meet their needs by offering on-line asynchronous courses, hybrid courses, and face-to-face courses and attempting to schedule them in an alternating way so courses can be readily completed. Students take, on average, months to complete the program. NJCU has developed two types of practicums experiences to address the specific needs of nurses already employed full-time in schools and those not employed in schools. This enables those already engaged in full-time school nursing to structure the work situation to meet the health education requirements and to gain some new knowledge and experiences in school nursing that may be outside the scope of 11

12 current employment (e.g. a school nurse employed in a K-5 school may need some experience in a secondary school). If a student appears to be struggling in the program, the program coordinator meets with the student to discuss the problem and develops a plan to address it. Sometimes the university supervisor or cooperating nurse/teacher may be asked for input and assistance. Students are encouraged to be reflective about their practice and to raise questions and concerns on their own and share them with their program advisor. Students who continue to struggle have an improvement plan developed and are monitored. It is important to note that because this program is relatively small, the program advisor knows every student and each student has several mentors provided by the university and during the field experience, in the schools. Students may need assistance with the use of technology. Instructions for the use of the online systems, assignment submissions, and other relevant information are clearly represented with additional contacts for those that need more help. In addition, students are provided with the University s Academic Integrity Policy, guidance for the use of APA formatting, links for NJCU Online Learning Assistance and Support, and NJCU library information. Some courses provide a detailed explanation of grading policies and scoring of assignments while others provide some explanation of the same Resources: The program faculty must monitor and seek to improve the suitability and appropriateness of program facilities, supplies, and equipment and to ensure that the program has adequate financial and administrative resources. Because this is a hybrid program, it is difficult to evaluate this item. Based on interviews with current and former students, it was clear that the program director was often so busy that students did not want to bother her. Over the years, internal conflicts have developed among various departments for the placement of this program (e.g., does it belong in education or nursing?) and subsequently, staffing and resources become an issue. The program relies on collaborative working relationships between the staff of health sciences and the program coordinator for the school nursing program, which has been strained at times due to philosophical differences. Based on the site visit, it appears that some of those issues may be resolving and changes may be underway. However, based on interviews with the adjunct staff that are used as school site supervisors, it is clear that they only have a relationship with the program coordinator and have limited or no contact with others teaching in the program. It would appear to be difficult to conduct a true assessment of the program and its components without that kind of interaction taking place. On the day of the site visit, there was some discussion about funding to add another instructor to the school nursing program. It was clear that the budget was very tight and that hiring additional personnel was a priority. 3.0 QUALITY PRINCIPLE III: Evidence of Institutional Commitment and Capacity for Program Quality: The program faculty must make a case that overall it has the capacity to offer a quality program, and it does this by bringing forth evidence in the ways described below. 12

13 3.1 Commitment (Program Parity with the Institution): In assessing whether a program has demonstrated the existence of adequate and appropriate facilities, equipment, and supplies, the auditors, Accreditation Panel, and Accreditation Committee consider a variety of factors, most notably whether the program s facilities, equipment, and supplies are proportionate to the overall institutional resources and whether the program s financial and administrative resources are proportionate to the overall institutional resources. TEAC requires parity or proportionality in six areas: Curriculum: The curriculum does not deviate from, and has parity with, the institution s overall standards and requirements for granting the academic degree. The School Nurse Certification Program does not grant an academic degree unless the individual chooses to complete additional coursework for a Master s in School Health Education. Students do not participate in the traditional 450 hour student teaching experience because it is not required for the educational services endorsement. This, however, may place school nurses graduating from the program at a distinct disadvantage as they have limited classroom teaching experience when compared to traditionally certified health and physical education teachers or school health educators Faculty: Faculty qualifications must be equal to or better than the statistics for the institution as a whole with regard to the attributes of the members of the faculty (e.g., proportion of terminal degree holders, alignment of degree specialization and program responsibilities, proportions and balance of the academic ranks, and diversity). See also The School Nursing Program faculty is very small. The program coordinator is completing a doctorate in nursing education at Columbia University and brings to the position valuable experience as a certified school nurse in New Jersey. She teaches HLTH 636, 642, and 630. HLTH 641 and HLTH 647 are taught by a health educator with a terminal degree from Columbia University and who holds national health education credentialing (CHES). SPEC 605 is taught by an associate professor from the Department of Special Education. HLTH 643 is taught by a nurse/teacher/registered dietician who holds a master s degree and certification as a school principal. She serves the dual role of online instructor and practicum supervisor along with nine other adjuncts (all former school nurses or school nurse supervisors) who supervise students in schools and classrooms Facilities: The facilities, equipment, and supplies allocated to the program by the institution, at a minimum, must be proportionate to the overall institutional resources. The program candidates, faculty, and staff must have equal and sufficient access to, and benefit from, the institution s facilities, equipment, and supplies. The reviewer cannot fully address this item. It appears that the program is in need of an additional full or part-time instructor to address the demand for school nursing courses. This was being 13

14 discussed during the review process. It also appears that the program could significantly benefit from the resources provided to the nursing education program such as specialized equipment for nursing demonstrations and emergency training Fiscal and Administrative: The financial and administrative resources allocated to the program must, at a minimum, be proportionate to the overall allocation of financial resources to other programs at the institution. The reviewer cannot address this item Candidate Support: Student support services available to candidates in the program must be, at a minimum, equal to the level of support services provided by the institution as a whole. All academic and specialized services are available to any NJCU student and information can be accessed via the University s website. Contact information for the Office of Specialized Services is provided in the course outline for HLTH Candidate Complaints: Complaints about the program s quality must be proportionally no greater or significant than the complaints made by candidates in the institution s other programs. The reviewer cannot address formal complaints about the program. The reviewer did interview several current and former students and supervisors about the program. Responses to requests for information were very limited, yet those who responded spoke favorably about the program. At this time, it appears that the NJCU program that is preparing students for school nursing includes the educational and practical basics to have a nurse provide health services in the school setting. I believe that the students are prepared, academically and practically, to provide the basics of health services K Sufficient Capacity for Quality: The program must also show that it has adequate and sufficient capacity in the same areas. The curriculum is adequate to support a quality program that meets the candidate learning requirements of Quality Principle I. The program must also demonstrate that the faculty members associated with the program are qualified for their assigned duties in the program consistent with the goal of preparing competent, caring, and qualified educators. The program must demonstrate that the facilities provided by the institution for the program are sufficient and adequate to support a quality program. The program must have adequate and appropriate fiscal and administrative resources that are sufficient to support the mission of the program and to achieve the goal of preparing competent, caring, and qualified educators. The program must make available to candidates regular and sufficient student services such as counseling, career placement, advising, financial aid, health care, and media and technology support. The institution that offers the program must publish in its catalog, or other appropriate documents distributed to candidates, accurate information that fairly describes the program, policies and procedures directly affecting admitted 14

15 candidates in the program, charges and refund policies, grading policies, and the academic credentials of faculty members and administrators. The quality of a program depends on its ability to meet the needs of its candidates. One effective way to determine if those needs are met is to encourage candidates to evaluate the program and express their concerns, grievances, and ideas about the program. The faculty is asked to provide evidence that it makes a provision for the free expression of candidate views about the program and responds to candidate feedback and complaints Curriculum: The curriculum must reflect an appropriate number of credits and credit hour requirements for the components of Quality Principle I. An academic major, or its equivalent, is necessary for subject matter knowledge (1.1) and no less than an academic minor, or its equivalent, is necessary for pedagogical knowledge and teaching skill (1.2 and 1.3). As a hybrid program, no degree is granted. Required courses appear to fulfill state certification requirements. Specific information about courses was addressed in items 1.1 and Faculty: Faculty members must be qualified to teach the courses in the program to which they are assigned, as evidenced by advanced degrees held, scholarship, advanced study, contributions to the field, and professional experience. TEAC requires that a majority of the faculty members must hold a graduate or doctoral level degree in subjects appropriate to teach the education program of study and curricula. The program may, however, demonstrate that faculty not holding such degrees are qualified for their roles based on the other factors than those stated above. The credentials of the program coordinator and the professor teaching health education courses were addressed in Those individuals serving as adjunct supervisors are all experienced certified school nurses and school nurse supervisors holding Master s degrees in education or nursing. The reviewer was not provided with the credentials of the associate professor who teaches the special education course and those credentials could not be found on the University s website but she is listed as an associate professor Facilities: The program must demonstrate that there are appropriate and adequate budgetary and other resource allocations for program space, equipment, and supplies to promote success in candidate learning as required by Quality Principle I. Please see response to Fiscal and Administrative: The financial condition of the institution that supports the program must be sound, the institution must be financially viable, and the resources available to the program must be sufficient to support the operations of the program and to promote success in candidate learning as required by Quality Principle I. The program must demonstrate that there is an appropriate level of institutional investment in and commitment to faculty development, research and scholarship, and national and regional service. Faculty workload obligations must be commensurate with the institution s expectations for promotion, tenure, and other program obligations. The reviewer cannot address this item. 15

16 Student Support Services: Student services available to candidates in the program must be sufficient to support successful completion of the program and success in candidate learning. In cases where the program does not directly provide student support services, the program must show that candidates have equal access to, and benefit from, student support services provided by the institution. Please see response to Policies and Practices: The program must distribute an academic calendar to candidates. The academic calendar must list the beginning and end dates of terms, holidays, and examination periods. If the program s academic calendar coincides with the institution s academic calendar, it may distribute the institution s academic calendar. Claims made by the program in its published materials must be accurate and supported with evidence. Claims made in the Inquiry Brief regarding the program must be consistent with, and inclusive of, the claims made about the program that appear in the institution s catalog, mission statements, website, and other promotional literature. The program must have a fair and equitable published grading policy, which may be the institution s grading policy. The program must have a published transfer of credit and transfer of student enrollment policy. The institution is required to keep a file of complaints from its candidates about the program s quality and must provide TEAC with access to all complaints regarding the program and their resolution. Students are given a descriptive course outline and weekly schedule. Students have access to the academic calendar on the University s website. Instructors appear to provide sufficient direction for students taking an asynchronous online course with detailed explanations of submission methods and due dates. There is a notable lack of consistency with the grading practices of those teaching in this program. As previously stated, several courses require the use of multiple measures to assess student learning and to determine student progress. Other courses seem to use more traditional methods of assessment such as multiple choice mid-term and final examinations which result in 40% of a student s grade. Considering the widespread use of authentic forms of assessment and the needs of K-12 students, using multiple choice tests does not reflect sound educational practice or role modeling for students charged with teaching in today s classroom. In addition, in some classes, students are significantly penalized for handing in late assignments. Once again, this does not reflect the theory that students should be held accountable for what they learned not when it was turned it. Further, several writing assignments appear to be assessed using a writing rubric that has little or no focus on actual content. Assuredly, the University wants students to be effective communicators; however, the rubric does not address the focus of the class: health disparities. The assignment seems disconnected from the intent of the class State and National Standards: The program is clearly aligned with many of the New Jersey Professional Standards for Teachers as published by the NJDOE. However, there are a few areas that are not clearly addressed in the materials reviewed. Subject Matter Knowledge: 1.3 and 1.4 Literacy and Numeracy skills across content areas were not evident in any courses or emphasized as part of student teaching. With the national emphasis on 16

17 literacy, health literacy has become a more common term. In addition, all educators need a basic understanding of the Common Core Standard and how they impact what gets taught, when it is taught, and how it is taught and assessed. Human Growth and Development: 2.8-The belief that all children and adolescents can learn at high levels and can achieve success. This belief is an integral part of urban education and while the program speaks volumes about students at-risk and diversity issues, there is no reference to an all kids can learn mindset that is critical to success in any urban school. It is alluded to in several areas but there is no affirmation of this as a basic and necessary belief for all educators. Instructional Planning and Strategies: In general, the approach to the classroom teaching/health education part of the program does not appear to sufficiently prepare students for classroom experiences. One University supervisor stated: Even though teaching the patient is much of the nurses practice in the clinical setting, teaching in the classroom or to an audience is not the first love of most of the nurses. They admit to their discomfort with teaching and their general affect when teaching can be lacking. Their comfort level in this area needs nurturing. Reviewing the lessons prior to the classroom presentations and coaching the nurses through mock presentations while time consuming can usually be of benefit. Most of the nurses improve, but they are usually glad when this part of the program is completed. Course descriptions rely heavily on developing lesson plans and not on what constitutes effective teaching in today s classroom. The words student centered do not appear in any of the materials provided except the learner-centered textbook. Key words in today s health education include rigor and relevance and skill development is critical to impact behavior change. It is unclear if candidates are taught how to teach health skills, even though there are references to undefined developmentally and culturally appropriate skills. In addition, with time limits on health education, teachers need adequate preparation to conduct interdisciplinary lessons and must learn how to help other teachers seize those opportunities. I did not see this addressed in the materials provided. Assessment: I did not see an adequate discussion of assessment processes for classroom instruction and specifically, I did not see any materials that addressed bias and scoring concerns, modifying assessments for students with disabilities, or using various forms of assessments based on student strengths. I also did not see any instruction on questioning techniques, assessment for learning or effective grading practices (e.g. notable authors might include Stiggins, William, Guskey and others). Rather I saw a list of names associated with lesson plan templates, none of which are aligned with the templates on the NJDOE website. It is unclear why these particular models were chosen. Learning Environment: Standard 6.1 addresses classroom management skills. One survey respondent felt that students were not well-prepared to address classroom management issues. Perhaps this issue is addressed as part of reflection or during the videotaping that occurs. 17

18 National Standards for School Nursing Practice: The program coordinator aligned the program to meet the national school nursing competencies. (Note: The Standards have been updated in 2011.) It is important to note that the health education standard (5B) is designed for school nurses who teach incidentally not on a regular basis and usually not in a classroom with responsibility for grading and planning. It appears from the materials provided and the respondent s comments that the program meets these standards and prepares most students as novice school nurses with a few, based on previous experiences in schools, achieving at a higher level. This would be parallel to the claim that undergraduate education prepares teachers as novice educators or entry level practitioners. Notable Comments from Students, Supervisors, Cooperating Teachers and Graduates I chose NJCU because it offered online classes. I liked the variety of courses and the practicum was great. If there is anything to change, it would be offer more help with time management. I also think that prospective students should be required to spend a day with a school nurse before enrolling in the program. All school personnel have been readily available to answer all questions and assist with any issues that may develop throughout the courses. The school nurse program provided courses detailing age-specific education models and lesson plans. The program also provided overall information on special needs and cultural competence and teaching techniques. The required books will help me throughout my career. NJCU prepares nurses for working in the school environment with the course work and practicums and discussions. However, each school/district will have its own unique personality which can only be learned when working full time in the particular school/district. It appears that the coordinator of the school nursing program for NJCU monitors and evaluates the program on an ongoing basis. She is also involved with continuing education. She shares pertinent nursing and health information with New Jersey school nurses. You should have access to a laptop for the students if they need to do a lesson on powerpoint. One should be available for them if they don t have a laptop. That I think would be handy in a classroom setting. So many lessons are being taught in classrooms using this technique. I worked as a sub nurse before the program so I knew what to expect; nurses need to know more about how to deal with administrators and the lack of understanding about medical issues; this wasn t really covered in my classes I took the methods class in person and I think it needs to be that way; Hospitals are more similar but schools are not; I think this is a great program and the scheduling makes it easier to accommodate everyone s needs. 18

19 Program Strengths 1. The program has a well-developed core of courses for school nurses that integrates the NJDOE requirements and the National Standards for School Nursing Practice in a way that makes sense to students and seems to prepare them for entry-level positions in schools. 2. The program uses its location in an urban center to recruit and prepare school nurses for urban schools. It uses diversity as a theme to frame the work and make it authentic. Students seem to enjoy the school placements and find the experiences invaluable. 3. The mix of online, hybrid and face-to-face courses maximizes flexibility for students and allows the university to recruit students from all over the state. This adds to the diversity and makes for rich discussion about the readings and issues. 4. Several of the courses use multiple measures to assess student learning and encourage selfreflective practice. Students are encouraged to become active professionals in both health education and school nursing. Program Recommendations 1. The assessment system used across the program should be consistent. The use of traditional testing as a means of assessment should be discouraged as professors should be role models for prospective teachers, using alternative and authentic assessments as much as possible. Emphasis should be on the learning and not on completion of tests and projects for a grade. The use of late penalties for grading should be discouraged. 2. Some of the resources listed in the materials are dated or inaccurate. The reviewer already discussed outdated references to the NJCCCS and NJDOE website materials. However, HLTH 642 lists resources dating from which should be reviewed for relevancy. While some of these journal articles and books may be historic in nature, there may be more recent materials on the topics. Similarly, many journals are now available online; if they are not available to students through the University library, the instructor should explain how to access them as part of the resource list. (Note: Seventeen journals are listed as resources for HLTH 641; some may be available online.) Some of the websites listed as resources are incorrect (e.g., not asha.web; not education/aps). 3. Because this is a blended program, the University needs to support a more collaborative approach with all instructors involved. With online courses across various departments, it is conceivable that the instructors do not meet, discuss and plan how to improve the program. When looking at course content, it appears that segments of the program operate independently. A sequential and coordinated approach would help eliminate what appears to be redundancies and focus the limited time with students on critical issues facing today s school nurse and health teacher. 4. Because all candidates are professional nurses with job experience when they are admitted to the program, the University should reconsider the content of the Methods class. It 19

20 appears that much time is spent covering topics that are integral in basic nursing education such as the stages of grief and death and dying, communicable and chronic health conditions, and anatomy and reproduction. This might free up more time to delve into UBD and the NJCCCS in particularly meaningful ways. The NJCCCS lay out the required content by strands and this could be used as a framework for the Methods class rather than using a college textbook designed for pure health education majors. Conclusion The NJCU School Nurse Certification Program provides registered nurses aspiring to serve students and educators in K-12 settings with high-quality and varied experiences grounded in national standards and state requirements. While there is always room for improvement, the suggested changes will serve to strengthen an already strong program. Review conducted by Linda L. Morse, RN, MA, NJ-CSN, CHES, FASHA August-October