TWO- YEAR REVIEW Vocational Training Programs. Division Chair: Lynn Yamakawa, MSN, RN Academic Year:

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1 Name of Program: Nursing, RN (Health Sciences) TWO- YEAR REVIEW Vocational Training Programs Division Chair: Lynn Yamakawa, MSN, RN Academic Year: What do the data indicate about the desired student outputs at the program level? a) Documents and labor market data from professional organizations, government agencies, and community groups related to needed skills and demand for future workers. According to the Bureau of Labor Statistics, the employment of registered nurses (RNs) is projected to grow 19% from , faster than the average for all occupations. Growth will occur because: Demand for healthcare services will increase because of the aging population and there will be a need for nurses to educate and care for patients with a variety of chronic diseases (e.g., dementia, diabetes). The number of individuals who have access to healthcare services will increase due to the Affordable Care Act As acute care hospitals face increased pressure to discharge patients as soon as possible, more nurses will be needed in long-term facilities, outpatient care, and home care. Job growth is expected in facilities that provide long-term rehabilitation for stroke and head injury patients and in facilities that care for Alzheimer s disease and dementia. Job prospects will be better for RNs with at least a bachelor s degree in nursing (BSN). The landmark Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health (October, 2010) recommended that 80% of the nursing workforce be prepared at the bachelor s level by the year This, coupled with the fact that most health care agencies are striving for Magnet status which also calls for RNs with a BSN, is increasing the demand for nurses prepared at this level of education. At Los Angeles Harbor College, RNs are ranked 1 st in the top 20 jobs requiring an AA degree in the LAHC service area (Educational Master Plan, ). In addition, the nursing program fulfills two out of three priorities for the college: Career Technical Education (CTE) and transfer. b) Data from Advisory Committee regarding appropriateness of current outcomes and needs for entry and upgrade level training. The Nursing Advisory Committee meets annually in June. Minutes from meetings reflect that all agencies are satisfied with graduates from the LAHC nursing program. We have received many positive comments about how well prepared our graduates are for the

2 workforce and the difference in the care that they provide is apparent compared to graduates from other nursing programs. Advisory Committee members have stated that LAHC nursing program graduates are professional and that they provide safe and competent nursing care. One member summed it up with There is a difference that graduates possess and it is noticed. With regard to hiring new graduates, community agencies have told us that an RN must be committed to continuing their education to a BSN degree; some agencies have required that students sign a commitment to this upon hire. This has changed in the past year; agencies will now ONLY hire those with a BSN completed (see June 2013 minutes). Both Torrance Memorial Medical Center and Providence Little Company of Mary Torrance have advised that they will only interview graduates with a BSN. Providence Little Company of Mary San Pedro has hired a number of our graduates within the past few years and Harbor-UCLA acknowledged that they will continue to hire RNs with an Associate Degree. The representatives from BSN programs in the community have advised us of the importance of program graduates continuing their education as seamlessly as possible. To that end, CSUDH and LAHC developed a roadmap for transfer that was presented at the June 2012 Advisory Committee meeting. c) Data from Employers As part of its Systematic Program Evaluation Plan, the nursing program measures employer satisfaction every two years by means of an electronic survey. Employers are asked to rate graduates that they have hired in each of the program student learning outcomes and also overall satisfaction with the nursing graduate. The last survey was distributed in Spring, 2012 and the response rate was very low (n=5). All employers rated graduate performance of SLOs as >3 (on a scale of 1-4, with 1 being very dissatisfied and 4 being very satisfied). 100% of them indicated satisfaction with program graduates. Because of the historically poor response rate to employer surveys, the nursing program also utilizes qualitative data from s, Advisory Committee input, and phone calls to measure employer satisfaction. Phone conversations, correspondence, and Advisory Committee input have indicated employer satisfaction with program graduates. See question 1b for employer requirements for workforce preparation. d) Data from Students via focus groups, and surveys/questionnaires The Systematic Program Evaluation Plan incorporates multiple assessment measures from students: end-of-course evaluations, Student Exit Survey and New Graduate Survey:

3 Assessment Method Data Yielded Responsibility End-of-Course Survey (at the conclusion of each course in curriculum) Student Exit Survey (within 10 days of graduation) New Graduate Survey (6-12 months after graduation) Course content, textbook, assignments, teaching strategies, course materials, course instructor(s), clinical facility, simulation, suggestions for improvement Campus/program resources, simulation, program adherence to mission statement, course review, program satisfaction, strengths of program, areas for improvement Preparation for practice, program satisfaction, job placement Course Instructor(s) Evaluation Committee Evaluation Committee End-of-Course surveys provide an opportunity for instructors to evaluate and improve courses within the nursing curriculum. For example, in June, 2012, one of the core nursing courses, Nursing 321, was revised based on a trending of below benchmark scores for a number of items in the course. The syllabus, course materials, and examinations were revised and the teaching methodology was changed to engage more student participation. In addition, an intersession workshop was developed to introduce students to the material before the course began. Student Exit Surveys provide data for the evaluation of numerous program resources and courses. Benchmarks for all queries have been established and met for the past academic years. The analysis of data is too voluminous to include in this report, but some generalizations that can be made are: students indicate that the nursing program mission statement is apparent throughout the curriculum; simulation experiences are a helpful teaching strategy; all courses in the curriculum are rated above benchmark, and an overwhelming majority of students are satisfied with the education that they received. Many students comment on how difficult the program is but that they appreciate the high standards of the program because it made them strive for excellence. New Graduate surveys assess preparation for practice and program satisfaction. All benchmarks have been met in these areas: 1) integrate the nursing process to promote the adaptation of individuals and groups in each of the four modes: physiologic, self-concept, role function, interdependence; 2) internalize professional behaviors within nursing

4 practice; 3) assimilate effective therapeutic communication skills verbally, non-verbally, and in writing; 4) formulate clinical decision making that is accurate and safe and that moves the patient and significant others towards positive outcomes; 5) integrate caring interventions that assist patients in meeting their bio-psychosocial needs; 6) determine teaching and learning processes to promote health and reduce risk; 7) collaborate as part of an interdisciplinary team to deliver-patient centered care to individuals and groups; 8) manage health care to assist the patient towards positive outcomes. In addition New Graduates overwhelmingly express satisfaction with the nursing program. **Note- Surveys and data analysis can be found in the Nursing Division office. e) Review and comments from a local South Bay Workforce Invest Board (N.B- Required by LACCD Board Regulation)- in process at the time of this writing. Evidence of Students Attainment of Intended Learning Outcomes (Ed Code (a) (3) Is of demonstrated effectiveness as measured by the employment and completion success of its students. How and why is the program/discipline effective? Analyze student performance indicators and patterns of student success in the course and/or the program. Provide evidence regarding progress toward and achievement of desired student outputs. Where appropriate, please indicate not applicable. a) Success and Retention rates. 1) What is the overall trend in success and retention rates in your program (have they increased/decreased?) Cite evidence from assessment of student learning outcomes. Data from the California Community Colleges Chancellor s Office (CCCCO)indicate retention/success rates: Term Retention % % % % Data reported from the CCCCO is obtained from students who declare Nursing as a major at LAHC; they are not actually enrolled in the nursing program.

5 The nursing program is required to monitor completion and attrition rates. Aggregated data from the past five years are shown in the table below: Academic Yr Admitted Voluntary WD Completed Not Completed CompletionRate AttritionRate % 22% % 34% % 40% active 28 69% 31% **Voluntary withdrawal: any student who exits the program for reasons other than academic/clinical reasons (e.g., change of major, personal/family issues, finances, etc) 2) How do these rates compare to the college and/or comparable programs? Attrition in the nursing program has been a long-standing concern. The nursing program has implemented a number of success strategies. The major thrust of these strategies were implemented from 2011 on (Family Night, tutoring, mentoring, Early Alert, etc) so we will need to carefully monitor attrition rates in the coming years to see if these resources have had a significant impact. Attrition rates vary by program type and are highest among ADN programs. In , the Board of Registered Nursing (BRN) reported that overall attrition rate for ADN programs was 14%, which was at its lowest in ten years. Nationally, the average attrition rate has been reported to be 47% for ADN programs. The completion/attrition rate for the LAHC nursing program will be discussed in the sections below. 3) Analyze course specific trends in success and retention. Most of the nursing program attrition occurs in the first and second semesters. In both of these semesters, there are at least a few voluntary withdrawals. There are more students who are unsuccessful in the first semester compared to the second semester and the most common reason is academic (vs. clinical) failure. The first semester of the program requires students to quickly adjust to an academically rigorous program and long hours in both the classroom and clinical areas. If students are unable to make this adjustment, they are at risk of failing the semester and are not eligible for readmission (Administrative Guideline E-10). The second semester builds upon the first semester and due to the content area, there is more reading and a faster pace involved. Students who cannot adjust to this faster pace risk not being successful. However, they are eligible to remediate and apply for readmission to the program during this semester. Our nursing program data indicates that if students can persevere through the first and second semesters of the nursing program, they have an excellent chance of completing the program. Attrition in the third and fourth semesters of the program is minimal.

6 4) Are there any courses where the trend over the past two years deviates from the program trend? What explains any observed differences? No, data has been consistent throughout the years. 5) Do some courses tend to have higher or lower success and retention rates than other courses? See the discussion in #3 above b) Degrees and Certificates 1) Describe the types of awards (degrees/certificates) available through your program. Upon the successful completion of the program, graduates receive an Associate of Science Degree, Professional Nursing. Graduates are qualified to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Successful completion of this examination leads to licensure as a Registered Nurse in the state of California. 2) What is the general trend in program awards over the past three to five years and how does this compare to the college as a whole? Year Number of Degrees Awarded Comparison to College As Whole nd (Liberal Arts #1) nd (Liberal Arts #1) nd (Liberal Arts #1) nd (Liberal Arts #1) rd (Liberal Arts #1, Science #2) Nursing has consistently awarded the most degrees second only to the Liberal Arts degree. In , the number of degrees awarded decreased which coincides with the conclusion of some partnerships and grants that increased enrollment capacity.

7 c) Certifications Examination Results 1) Is there a governing board that provides certification exams for students in your program? Yes, students take the National Council Licensure Examination for Registered Nursing (NCLEX-RN). This process takes place within the Department of Consumer Affairs and the California Board of Registered Nursing (BRN). 2) What was the most recent pass rate and how does this compare to the pass rates over the past 3 to 5 years? What factors affecting pass rates are relevant for program planning? The nursing program has consistently maintained first time NCLEX-RN pass rates well above the national average of ADN programs. Year # Candidates First Time Pass Rate LAHC First Time Pass Rate ADN % 87.5% % 88.6% % 87.4% % 89.8% % 88.8% Programs (National) d) Job Placement Rates 1) Do you track job placement of students in your program or use external data? Yes, we track job placement rates through our New Graduate Survey. If graduates do not respond to the survey, we attempt to contact them by or telephone to get data that is most accurate. 2) How do your rates compare to external criteria or standards? Year of Graduation # of Graduates # Employed % Employed Unable to Contact % % % % student deceased

8 The BRN tracks data of employment of recent program graduates by academic year. The percentages of those unable to find employment were as follows: %; %; %; and %. LAHC program graduates very closely mirror what is happening in the state. According to the Pre-licensure Nursing Program Annual School Report published by the BRN, Associate Degree Registered Nurses (ADNs) are least likely to work in hospitals (50%) as compared with bachelor s prepared RNs (66%). ADNs are more likely to work in long-term care facilities compared to BSN graduates. Other Program Review Findings Not Covered by Preceding Discussion: The nursing program continues to receive many more applications than space available Since 2013, the entire nursing faculty has been involved in a minor curriculum revision to increase quality and safety concepts in the curriculum The program has designed a student success program from grant funds. This includes weekly tutoring, skills lab practice, intersession workshops, and a Remediation specialist. Grant funds continue to support the nursing program by allowing us to buy new equipment, incorporate success strategies, and have a state-of-the art Simulation laboratory for student experiences. The nursing program has applied for funds for a Nursing Transfer Counselor in response to our Advisory Committee recommendations and the drop in job placement rates in new graduates. The assessment of Student Learning Outcomes continue for each nursing course in the curriculum. Some examples of changes that have been made in courses/curriculum include: 1. Developing an intersession introduction to APA format in response to plagiarism and student difficulty in writing college-level papers in Nursing Adding head-to-toe assessment as an item that is tested in the Nursing 315 Practicum based on course feedback from students. In the clinical setting, this nursing skill must also be verified by the clinical instructor at the bedside. 3. In Nursing 325, standardized testing revealed that students were below benchmark in the area of assessment. This area was a focus for the classroom and an increased number of assessment items were added to unit examinations 4. In Nursing 335, it was assessed that students did not take a written assignment having to do with internet research (informatics and technology) seriously. The instructor incorporated informatics and technology as questions on unit examinations. It was also assessed that students were not competent in the skill of reconstitution in lab practice, so this concept was reinforced in the tutorial portion of the class. Each student now has their own vial that must be reconstituted before it can be done in clinic. 5. In Nursing 339, the History and Physical examination was revised based on the most current evidence-based information. 6. In Nursing 345, an intersession practicum was started in 2009 because instructors assessed that student skills were weak in the clinical area. The weak areas are now tested before the start of each semester. We have evaluated this change and have found that students appreciate the review and testing, even though it is stressful. They indicate that they feel more confident in clinic. Instructors have also found that students do not struggle with complex clinical issues as they did before. 7. In Nursing 302, it was found that students were not engaged and often the same students responded to attempts by the instructor to engage the class. The use of

9 clickers was incorporated into the lecture and now each student must respond to questions posed by the instructor. 8. In Nursing 321, standardized testing revealed that assessment did not meet benchmark scores. In response to this, two intersession workshops were developed one to preview the material for students new to the program and one to review the material for students continuing in the program. Student evaluations have been positive and assessment scores have improved on standardized testing. 9. To improve student success in the first semester of the program, the time to complete unit examinations was increased from 60 minutes to 75 minutes. Program Review Summary: The demand for Registered Nurses will continue. However, there has been a change in educational standards for entry into the profession a bachelor s degree with a major in nursing is now required. The Institute of Medicine Report which calls for 80% of the nursing workforce be prepared at this educational level and the increasing number of hospitals seeking Magnet status are causative factors for this change. The LAHC nursing program continues to receive more applications than space available. Students are accepted on a random lottery basis after meeting pre-qualifications and they represent the diversity of the surrounding community. The program s attrition rate is above the state average and most attrition occurs in the first and second semesters of the program. The attrition rate for the third and fourth semesters are minimal to none so if a student gets to these semesters, they are likely to complete the program. The nursing program has awarded the most degrees in the college, second only to the Liberal Arts degree. The NCLEX-RN first time pass rate of the nursing program consistently exceeds the national benchmark and is one of the highest in the state of California. Graduate and employer satisfaction are regularly assessed and meet established benchmarks. Job placement has decreased in the past few years, but follows the hiring pattern that is occurring throughout the state. As we plan and prioritize for the future of the nursing program, we need to focus on: Maintaining Accreditation Commission For the Education in Nursing (ACEN) accreditation. This is a mark of excellence in nursing education and allows us to stand out as an Associate Degree Nursing program (approximately 25% of ADN programs in California are accredited). Educate and recruit students from feeder high schools about nursing and health sciences as the demand for diverse and underrepresented nursing students will continue Establishing collaborations with private and public institutions for students to obtain their bachelor s degree with a major in nursing (At the time of this writing, we have submitted a grant for a Nursing Transfer Counselor to assist our students) Continue with success strategies and monitor completion rates to decrease attrition in the first and second semesters Possibly, change the admission policy of our program to a multi-criteria screening process (AB 548). The intent of this legislature is to maximize the number of students that graduate so that they can meet the needs of their region. Our District admission policy (Administrative Regulation E-10) applies to all 7 nursing programs. However, our attrition data would be strong evidence to allow LAHC to change its admission criteria so that we can select students who have the greatest possibly to succeed.

10 The turnover of faculty and staff has been detailed in the unit plan for Nursing. The program must attract and retain faculty to carry on the nursing program s reputation in the community. As more and more hospitals are applying for Magnet status, we must be diligent in looking for alternate clinical placements for our students.

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