Rock Springs, Wyoming. Self Study. Accreditation Commission for Education in Nursing, Inc. (ACEN)

Transcription

1 Rock Springs, Wyoming Self Study Accreditation Commission for Education in Nursing, Inc. (ACEN) December 2014

2 Western Self Study Report to ACEN Table of Contents Page Executive Summary... 1 Summary of Standards and Criteria Standard 1: Mission and Administrative Capacity Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Standard 2: Faculty and Staff Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Standard 3: Students Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion

3 Criterion Criterion Criterion Standard 4: Curriculum Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Standard 5: Resources Criterion Criterion Criterion Criterion Standard 6: Outcomes Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion Criterion

4 List of Tables Table Faculty and Staff... 6 Table Full Time/Part Time Enrollment... 6 Table Student Enrollment... 6 Table 1.1 Philosophies and Outcomes Comparison Table 1.2 Director and Faculty Representation in Governance Activities Table 2.1 Additional Faculty Certifications Table 2.2 Criteria to Meet Hiring Requirements Table 2.3 Information Available to Preceptors Table 2.4 Faculty Load Table 2.5 Faculty/Student Ratios in Classroom, Lab, and Clinical Table 3.1 Location of Selected Student Policies Table 3.2 Admission Criteria-Western/Nursing Program Comparison Table 3.3 Transfer Admission-Western/Nursing Program Comparison Table 3.4 Student Safety Policy-Western/Nursing Program Comparison Table 3.5 Available Student Services Table 3.6 Noel Levitz Survey Results Table 3.7 Default Rate Comparison Table 3.8 Nursing Student Satisfaction with Technology Orientation Table 4.1 Goal Description-Western/Nursing Program Comparison Table 4.2 Professional Standards / Western s Goals and Nursing SLOs Table 4.3 Sample Progression of SLOs Table 4.4 Coordination of SLOs to Case Objectives And Clinical Theory Assignments Table 4.5 Student Comments from Immobility Experience Table 4.6 Types of Learning Table Program of Study for Associate Degree in Nursing Table Program of Study for Associate Degree in Nursing Table 4.9 Contact Credit Hour Formula by Contact Hours Table 4.10 Credit Hour Formula by Minutes Table 4.11 Theory, Lab, and Clinical Credit Hours by Semester Table 4.12 Nursing Program Credit Hours Comparison To Other Western Programs Table 4.13 Comparison of Credit Hour Requirements to Other Wyoming Nursing Programs Table 5.1 New Funding Allocation Table Yearly Salary Comparison for Western Table 5.3 Student Satisfaction with Physical Resources

5 Table 5.4 Student Satisfaction with Learning Resources Table 5.5 Distance Student Satisfaction with Resources Table 6.1 Role Competencies/Apply Therapeutic Nursing Interventions Table 6.2 ATI Clinical Topics Table 6.3 Communicate Competently Outcomes Table 6.4 ATI Pharmacy Scores Table 6.5 ATI Safety & Infection Control Scores Table Qualitative Data End of Program Table 6.7 NCLEX Pass Rates by Year/Cohort/Delivery Type Table 6.8 NCLEX Three Year Mean Table 6.9 Western s Student Cohorts Table 6.10 Program Completion Data for Past Three Years Table 6.11 Graduate Satisfaction Survey Results Table Graduate Qualitative Comments Table 6.13 Employer Satisfaction Survey Results Table Employer Survey Qualitative Comments Table 6.15 Job Placement Rates Table 6.16 Patterns of Employment Appendices A. HLC Statement of Affiliation Status Worksheet B. WSBN Full Approval Letter and Points Given C. President s Organizational Chart D. Faculty and Staff Profile Form E. Faculty Scholarship and Maintenance of Expertise F. Student Learning Organizational Chart G. Faculty Workload by Semester H. Progression of Student Learning Outcomes I. Example of Case Objective J. Curriculum Table for Culture and Diversity K. Nursing I-IV PBL Rubrics L. Budget Comparison to Similar Programs M. Nursing Program Budget N. Full-time Faculty Salary Schedule O. Program Outcomes Survey

6 EXECUTIVE SUMMARY General Information Western Wyoming Community College 2500 College Drive Rock Springs, Wyoming Nursing Program Description: Associate Degree in Nursing Purpose of Visit: Initial accreditation Date of Visit: Feb 3-5, 2015 Administrative Officer: Karla Leach, Ed.D. President Accreditation: North Central Accreditation. Last site visit: Fall, 2013 Next site visit: 2020 Systems Portfolio report due in (See Appendix A for the HLC Statement of Affiliation Status Worksheet) Nursing Administrator: Western Wyoming Community College Nursing Program Kathy Luzmoor, MS, RN, CNE Director of Nursing Section F- Box College Drive Rock Springs, Wyoming ; Fax: kluzmoor@wwcc.wy.edu - 1 -

7 Wyoming State Board of Nursing Approval: Last site visit: February, 2009 Action: Full Approval Next site visit: Spring, 2017 Cynthia LaBonde, MN, RN Executive Director Wyoming State Board of Nursing 1810 Pioneer Avenue Cheyenne, WY (See Appendix B for the WSBN Full Approval Letter and Approval Point Documentation) ACEN Standards and Criteria: 2013 Year Established: 1989 Faculty : 8 Full-time faculty 1 Part-time faculty 2 Full-time positions (vacant) Student Enrollment, Fall 2014: First year: 24 Second year: 36 Length of Program: : Six semesters : Five semesters - 2 -

8 Western Wyoming Community College (Western) is a public, tax-supported, twoyear institution serving Southwestern Wyoming. Established in 1959, Western operates under an elected seven member Board of Trustees. The administrative staff is comprised of the President and three Vice Presidents, who represent the three divisions of the college: Student Success, Student Learning and Administrative Services. Western employs over 160 full-time and 400 part-time employees. (See Appendix C for the Presidents Organizational Chart) Western offers 48 degrees for transfer, and 36 technical and certificate programs. Western offers two-year associate s degrees in Arts, Fine Arts, Nursing, Science, and Applied Science. Western provides technical education, developmental education, workforce training, adult basic education, graduate equivalency ESL instruction, and noncredit programs. In fiscal year (FY) 2013, Western enrolled over 3900 credit students, and 2264 non-credit students per semester. Twenty-eight percent are full time students, 72% parttime. Forty-six percent are from Sweetwater County and 39% are from Carbon, Lincoln, Sublette and Uinta Counties. The Rock Springs Full-Time Equivalent (FTE) is 62%, and the outreach FTE is 27%. The average age of all credit hours students is 24.9 years. In May 2014, Western graduated 463 students with 563 degrees and certificates. Western serves five counties, covering a distance of 29,000 square miles of Southwestern Wyoming. Western's main campus is in Rock Springs, Sweetwater County, roughly in the center of the service area, and the largest of the five counties served. With - 3 -

9 respect to this large service area, Western s main campus is located in Rock Springs, a center is located in Green River, and there are multiple outreach centers in Carbon, Lincoln, Sublette and Uinta Counties. Rock Springs is the largest city of the service area with a population of approximately 24,000. Local attractions of the area include historic sites, museums, fishing, hiking, and scenic Red Desert vistas. The main industries of Southwestern Wyoming are mining and energy. Wyoming has been designated as a frontier state by the United States Department of Agriculture due to its large area, distance between communities, distance from metropolitan areas, and sparse population. The primary implications of being a frontier state for nursing education are limited access to education for students who are site-bound, and availability of clinical resources. Overview of Nursing Program Western s Associate Degree in Nursing (ADN) program is the major supplier of nurses to the service areas workforce. The majority of students enrolled in the program are residents of Southwest Wyoming. Most students in the Nursing Program are nontraditional, Caucasian, and female. More than half of the students attend full-time, and 50% are from the outreach service area. Western's Nursing Department consists of the Director, eight full-time and one part-time faculty, one instructional assistant, and three office assistants. Six faculty members, the Director, instructional assistant and a full-time office assistant reside in Sweetwater County, two faulty members and one part-time office assistant reside in - 4 -

10 Carbon County (Rawlins Outreach), and one faculty and one part-time office assistant reside in Uinta County (Evanston Outreach). Recruiting and retaining qualified faculty is an ongoing challenge in our frontier area. Two faulty positions are currently vacant due to the low number of qualified applications for the year. (See Appendix D for the Faculty and Staff Profile Form and Appendix E for Faculty Maintenance of Expertise) The Associate Degree program is a 67 credit program. Sixteen of the credits are prerequisites. Historically, students completed the prerequisite courses in two or more semesters due to the sequencing of courses. Beginning in Spring 2015, the prerequisites can be completed in one semester with General Biology (BIOL 1010) and Anatomy & Physiology I (BIOL 2015) being offered in eight-weeks blocks. Once admitted into the Nursing Program, coursework is completed in four semesters. Western is one of seven community colleges in the state that offers an Associate Degree Nursing program. Wyoming's only four-year university, the University of Wyoming (UW), offers undergraduate and graduate nursing programs. The undergraduate nursing programs are a basic BS in Nursing and a BSN completion. College students are allowed to meet full-time status with concurrent enrollment in community college courses and UW courses. Wyoming is also exploring strategies to streamline nursing education. In 2010, the Wyoming Center for Nursing and Health Care Partnerships (WCNHCP) formed a steering committee to revolutionize nursing education in Wyoming, known as ReNEW. The goal of ReNEW is to create a statewide competency-based nursing curriculum in which students can start at any Wyoming community college, earn an associate degree - 5 -

11 and continue seamlessly on to the UW and earn a bachelor s degree (or higher). This curriculum is projected to be implemented in Tables 1-3: show information relative to program staffing and student enrollment: Table 1: Faculty and Staff Location Rock Springs Rawlins Evanston Director 1 Full-time Faculty 5 (2 vacancies) 2 1 Instructional Assistant 1 Part-time Faculty Adm Assistant 1 full-time 1 part-time 1 part-time *On campus faculty provide theory using distance technology as well as face-to-face delivery. Table 2: Full-Time/Part-Time Enrollment Full-Time Part-Time Fall 2014 Students First Year 15 (62.5%) 9 (37.5%) Second Year 22 (61%) 14 (39%) * Data not available by location/distance. Table 3: Student Enrollment Capacity: 64 students Enrollment: 60 students Face-to-face Rock Springs /Rawlins Distance First Year Fall /0 9 Second Year Fall /4 16 Western s Nursing Program has evolved over the years in response to community needs. It in 1978 as a practical nursing program (PN), but the program was converted to an Associate Degree (AD) program in The AD program was designed with a PN spinoff course at the end of the first year to allow students to exit and practice as licensed - 6 -

12 practical nurses (LPNs). LPNs were also allowed to enter into the second year as advanced placement students. In 2008, Western initiated a PN program at the outreach center in Evanston. In 2011, the AD program stopped offering the PN spin-off option, students who wanted the PN option could apply to the third semester of the AD program. During Spring 2013 to Spring 2014 Western s total credit head count was down 7.16% and FTE was down 7.86%. In Fall 2014 the nursing program had a decrease in total qualified applicants. In response to this decline, Western suspended the PN program in Evanston. Approval to suspend the PN program for one academic year was granted by the Wyoming State Board of Nursing (WSBN). (See Exhibit A for WSBN PN suspension correspondence) Originally, the AD program began with a total enrollment capacity of 32 students. In 2003, the Wyoming Legislature provided funding for the expansion of nursing programs through Wyoming Investment in Nursing (WyIN) funding. Each time a program expands by eight students, WyIN monies pay one full-time faculty position. Currently the total enrollment capacity when all available faculty positions are filled is 80 students. Western has four faculty positions funded for through WyIN. Western s two main outreach sites in Evanston and Rawlins are significant to the Program s success. In 1989 the Wyoming State Hospital in Evanston, Wyoming requested that Western offer the first year of the AD nursing program there to meet community needs. Funding was obtained from the state legislature. The first year of the AD program was offered in Evanston outreach from 1991 to 2000, when it was suspended. In 2004, a consortium of Evanston health care agencies, the Board of Cooperative Educational - 7 -

13 Services (BOCES), and Western formed to provide a mechanism for eight qualified students from the Evanston area to attend the AD nursing program in Rock Springs. The consortium paid the salary and benefits for one full-time faculty position and provided funding for eight students to participate in the program. One faculty position is based in the Evanston Outreach Center. The first year of the AD program was offered to students in the Rawlins outreach site was 1997, with an enrollment of eight students. This outreach effort was discontinued in Western re-established the Rawlins outreach site in In 2004, the community of Rawlins passed a mill levy to fund the full AD nursing program at the Rawlins Outreach Center. The center is maintained by the Board of Cooperative Higher Education Services (BOCHES) of Carbon County. The Rawlins outreach site grew to sixteen students with two faculty positions. In 2010 a faculty vacancy, and the inability to fill the position with qualified faculty, made it difficult to maintain complete program availability in Rawlins. Meeting the needs of the students at the Rawlins outreach site led to the development of the distance delivery option. After a four year vacancy, a qualified faculty member was hired in Fall Two faculty positions are based at Rawlins Outreach Center. Western s Nursing Program instruction is divided into three main components: theory, lab, and clinical. In response to meeting the needs of the increasing numbers of students in outreach sites the program decided to offer the theory, or classroom component of the course, via distance technology. This allows students in outreach areas - 8 -

14 to attend class synchronously from their home community. To differentiate between these two modes of attendance, the program refers to theory taught on campus in a physical classroom as face-to-face, and theory taught synchronously in a virtual classroom as distance. The course design, schedule, and assignments are identical for all the students despite method of delivery. Distance and face-to-face students spend the same amount of time in class with their peers and instructors. The distance theory option has proven to be successful and the number of students served in outreach has increased. The face-to-face theory option is offered on the main campus and, when student enrollment allows, at the Rawlins Outreach Center. The distance theory option is available to the full service area. Lab, clinical, and simulation experiences are available in outreach areas when comparable experiences are available to meet the lab and clinical objectives of the program. Availability is dependent upon the availability of resources within the outreach area and census of the clinical sites. The Associate Degree Nursing Program received initial accreditation from NLNAC in Spring, Accreditation was granted for five years. In Spring 1999, the program was accredited for two years, but with a warning. In 2009, the program was granted continuing accreditation from NLNAC with a follow up conditional report due in two years for non-compliance with Standard II, Faculty Criterion 5 (graduate preparation). After the follow-up report in 2012 the NLNAC Board of Commissioners voted to withdraw accreditation. The program applied for Candidacy in 2013 and was deferred due to length of program. Candidacy was accepted in

15 Summary of Standards and Criteria Standard I: Mission and Administrative Capacity Western s Nursing Program mission and philosophy are congruent with the governing organization. The Nursing program utilizes Western s Goals for Student Success to organize the program. The Director is qualified as noted by her position description, and meets the Wyoming State Board of Nursing and ACEN requirements. She has authority and responsibility for the program, including the budget, as well as adequate time and resources. Faculty and students have and take the opportunity to participate in the governing organization. The program has an active advisory board and a supportive college board of trustees. The Director and program are involved in statewide partnerships to promote excellence in nursing education, including close relationships with the sole four year state university and seven community colleges. Standard II: Faculty All full-time and part-time faculty hold Masters Degrees and meet Western s and the WSBN requirements. The number of faculty is sufficient to ensure student learning and program outcomes are met. Faculty are not expected to work overload. The faculty strive to remain clinically proficient and seek professional development opportunities. The program utilizes preceptors who are qualified, oriented and mentored; their roles and responsibilities are clear in the Preceptor Manual. New faculty are oriented and mentored. All faculty are evaluated by the Director regularly. Western provides good support and development for instructional and distance technologies

16 Standard III: Students Student policies and services support the achievement of the Student Learning Outcomes and program outcomes. Student policies are congruent with governing body except where related to needs of public safety in health care agencies. Student services are comprehensive and available to all. The College is in compliance with Title IV. The sole grievance that the program has had in the past three years was resolved and handled with due process. Western and the Program provide orientation and support to technology, the technology policies and information are clear and available on the website, student handbook and in syllabi. Standard IV: Curriculum The curriculum is innovative and robust and has met the Student Learning and program outcomes for many years. Problem-Based learning (PBL) assists the student to become competent communicators, problem solvers, and lifelong learners. The curriculum is developed and updated regularly by the faculty. The theory, lab and clinical are very deliberately timed to help the student tie their learning together and exhibiting sound educational theory. The program has expanded clinicals to include conceptual experiences as well as traditional. These experiences are evidence-based and reflect contemporary practice. The program provides face to face and synchronous web delivery formats, all students complete the same requirements. Standard V: Resources Western s resources are sustainable and adequate for the maintenance of the

17 Nursing Program. The physical resources on the main campus and two outreach centers provide good learning environments for the students. The faculty have input into the learning resources and technology used by the program. The College supports the fiscal needs of the Nursing Program. Standard VI: Outcomes The Nursing Program has a multi-dimensional method to obtain ACEN required program outcomes, as well as other outcomes, to assist the program s curricular improvement. Using quantitative and qualitative data the program can trend student outcomes. The program s NCLEX pass rates have exceeded state and national averages for past four years. The NCLEX pass rates at the three year national mean has been met for the past three years. Program completion has met its 70% goal for two of past three years. Graduate and employer satisfaction are high, as is the job placement rate. Analysis and Summary of Strengths and Areas Needing Improvement Strengths A college administration that is supportive of the nursing department Strong support from health care agencies and the communities in the service area Wyoming Investment in Nursing (WyIN) has provided funding for expansion and educational support for faculty and students Faculty that are educationally and experientially qualified and willing to be creative, innovative, and technologically progressive Strong leadership from the Director who supports high quality for the faculty and students Faculty and Director are politically active and influential in healthcare issues at the local and state level Problem-Based Learning Curriculum promotes active, self-directed learning,

18 interpersonal skill as a group member, and fosters meaningful self-evaluation Traditional and innovative clinical experiences throughout the service area prepare students for practice Incorporation of technology including distance delivery, computerized testing and high-fidelity simulation Access for outreach students to participate in the program, including use of outreach service area clinical facilities. Support for students from the Western Wyoming College Foundation for student travel and conferences. Graduates achieve program outcomes: licensure pass rates, job placement and graduate and employer satisfaction Areas Needing Development Increase use of simulation within curriculum, including permanent faculty support Additional faculty member needed in Evanston to meet student demand Additional lab and simulation (physical room and simulators) needed in Evanston to meet demand Improved utilization of ATI (Assessment Technologies Institute, a web based learning tool) within the curriculum Electronic Medical Record (EMR) documentation system for use in lab and simulation Policy for load calculation that realistically accounts for lab and clinical work hours Plans for the Future Implementation of state wide curriculum in 2016 Master Plan calls for capital construction for new department and increased simulation space dependent on funding (2018) Increase use of simulation in the curriculum

19 STANDARD 1: Mission and Administrative Capacity The mission of the nursing education unit reflects the governing organization s core values and is congruent with its mission/goals. The governing organization and program have administrative capacity resulting in effective delivery of the nursing program and achievement of identified program outcomes. 1.1: The mission/philosophy and program outcomes of the nursing education unit are congruent with the core values and mission/goals of the governing organization. The mission/philosophy and outcomes of the nursing education unit are congruent with those of the governing organization. The philosophy, mission and outcomes of the Western Wyoming Community College s (Western) AD Nursing Program are congruent with Western s vision, mission and Goals for Student Success. Western's fundamental purpose is to provide high quality learning opportunities to students who are at various stages of life and have differing needs and expectations. Committed to quality and success, Western encourages flexibility, innovation, and active learning for students, faculty and staff. The College understands that learning occurs inside and outside the classroom and, therefore, seeks to create an environment where lifelong learning is encouraged and where students and employees interact in an atmosphere of mutual respect. The Nursing Program s mission mirrors that of the College s fundamental purpose. Our mission is: To educate students to become competent, beginning nurses; Create an environment that facilitates independent learning, critical thinking, mutual respect, and free expression; Provide access to nursing education throughout southwestern Wyoming; Design learning experiences to reflect current health care trends, nursing practice, and

20 research; Cultivate intellectual and personal growth in faculty and students; Promote student appreciation for lifelong learning to maintain competence and reach maximum potential; Provide and promote mechanisms for student educational mobility among the levels of nursing. (See page 3, Nursing Student Handbook) Western has six guiding principles: Learning is Our Purpose, Students are Our Focus, Employees are Our Most Important Resource, The Community is Our Partner, Adapting to Change Defines Our Future, and Ethical Standards Guide Our Actions. Western s purpose is to provide quality experiences that foster lifelong learning in an environment that encourages success for a diverse student population. Western believes growth opportunities and recognition are important in creating leaders and professionals and in enhancing employee satisfaction. Western must meet the changing needs of our community, students, and employees by encouraging and supporting innovation and informed risk-taking; and Western is committed to treating all individuals with respect, demonstrating integrity and professionalism, developing and implementing fair solutions to problems, and assuming responsibility for our work (See Western's Guiding Principles). The Nursing Program philosophy is congruent with Western s mission and guiding principles as well as emphasizes the key professional attributes the programs values. The professional nurse provides care across the lifespan of diverse patients, families and communities. The health of the community, family and environment shapes the person's health experience; the environment is influenced by a global society. Health is unique to each person and fluctuates across the health-illness continuum. Interactive

21 communication is utilized to construct therapeutic nurse-patient relationships and to promote teamwork to enhance the delivery of safe, patient-centered care. The nurse is devoted to ensure the delivery of safe, culturally sensitive care within the values, ethics, and standards of professional nursing practice. Nursing students are diverse learners who bring unique perceptions and experiences to an interactive teaching-learning relationship. Nursing students are challenged and supported in the development of critical inquiry, analysis of evidence, independent thinking, and clinical decision making. Faculty strive to role model leadership and excellence in nursing. Open communication, teamwork, and quality are valued and fostered in the preparation and practice of nursing in a dynamic healthcare environment. (See Nursing's Philosophy and Mission) Western has developed a curriculum designed to introduce students to multiple modes of intellectual inquiry that are believed to be fundamental to human knowledge and to successful learning. Western has established five Goals for Student Success in which to assess student success. Western s five Goals for Student Success: to expand their capacity to solve problems both critically and creatively (Solve Problems), to consider multiple perspectives (See Issues for Multiple Perspectives), to retrieve relevant information (Retrieve Information), to communicate clearly (Communicate Competently), and to develop life skills that promote health and wellbeing (Develop Life Skills). The Nursing Program added a sixth goal to incorporate the fundamental principles that are unique to the art and science of nursing (Apply Therapeutic Nursing Interventions). The

22 Nursing Program has incorporated these six goals into the framework of the nursing curriculum. The Nursing Program s Student Learning Outcomes (SLO) are embedded within these broader concepts. The following table outlines the congruency of Western s Mission and Philosophy, the Nursing Program s Philosophy and examples of End of Program SLOs. Table 1.1: Philosophies and Outcomes Comparison Western s Mission & Philosophy Seeks to create an environment where lifelong learning is encouraged and where students and employees interact in an atmosphere of mutual respect. Provides quality experiences that foster lifelong learning in an environment that encourages success for a diverse student population. Encourages flexibility, innovation, and active learning for students, faculty and staff. Provides high quality learning opportunities to students who are at various stages of life and have differing needs and expectations. Nursing Philosophy Open communication, teamwork, and quality are valued and fostered in the preparation and practice of nursing in a dynamic healthcare environment. Nursing students are diverse learners who bring unique perceptions and experiences to an interactive teachinglearning relationship. The professional nurse provides care across the lifespan of diverse patients, families and communities. Ensure the delivery of safe, culturally sensitive care within the values, ethics, and standards of professional nursing practice Example of End of Program Student Learning Outcomes Employ enhanced communication techniques to foster a caring relationship with client. Utilizes appropriate channels of communication within the health care team. Design effective, creative teaching techniques for clients. Incorporates the cultural uniqueness of clients and colleagues into practice. Practices within the ethical and legal framework of the discipline of nursing.

23 Western s Mission & Philosophy Believes growth opportunities and recognition are important in creating leaders and professionals and in enhancing employee satisfaction. Commits to treating all individuals with respect, demonstrating integrity and professionalism, developing and implementing fair solutions to problems, and assuming responsibility for our work. Nursing Philosophy Nursing students are challenged and supported in the development of critical inquiry, analysis of evidence, independent thinking, and clinical decision making. The health of the community, family and environment shapes the person's health experience; the environment is influenced by a global society. Example of End of Program Student Learning Outcomes Utilizes extensive knowledge base when making clinical decisions. Consistently uses the nursing process to provide safe, competent care to maximize health potential for clients. 1.2 The governing organization and nursing education unit ensure representation of the nurse administrator and nursing faculty in governance activities; opportunities exist for student representation in governance activities. Western and the Nursing Program ensure representation of student, faculty, and administrators in ongoing governance activities. Western has three main areas of operations: Administrative Services, Student Learning, and Student Success. Academic instruction is part of Student Learning and is divided into divisions: Nursing, Technology and Industry, Business and Humanities, Social Sciences and Fine Arts, and Science and Math. The Nursing Director is a member of the Academic Council (an advisory council to the Vice President of Student Learning). The Academic Council is comprised of academic department directors (Distance Learning/ Outreach, Library, Learning Center, Nursing and Work Force Services) and division chairs

24 (Humanities/Business, Fine Arts/Social Science, Math/Science, and Technology and Industry), and is chaired by the Vice President of Student Learning. Academic Council minutes are shared and distributed via to all faculty members. (See Appendix F for the Student Learning Organizational Chart) To ensure equal representation of interests throughout the institution from the ground up, committee appointments are balanced by area, divisions, and position. Committee membership is made up of Professionals, Faculty and Paraprofessionals. The Nursing Director represents Professionals as well as the Nursing Department on committees. The full-time faculty members are active in other committees across the institution, with current representation in: Academic Grievance, Academic Leave, Academic Rigor, Academic Technology, Advising, Curriculum, Outstanding Graduate, Policy and Procedures, Horizontal Advancement, Safety, Scheduling, Senate, and Student Assessment (See Table 1.2). Part-time faculty, and full-time faculty in their first year of employment, are not required to serve on committees. Faculty have the opportunity to participate on additional committees and professional standards boards (PSBs) throughout the year. As new opportunities arise, the divisional Senate representative solicits names for nomination. The Boards of Trustees agenda and meeting minutes, and other committee meeting minutes are announced and available to all employees on Western s intranet. All Western staff is welcome to attend Board of Trustee workshops and meetings

25 Table 1.2: Director and Faculty Representation in Governance Activities Committee Academic Council Academic Leave Academic Rigor Academic Technology Advising Assessment Curriculum Food Service Horizontal Advancement Policy & Procedures Safety Scheduling Senate Strategic Enrollment Nursing Program Staff Kathy Luzmoor Carla Lee Patty Nieters Deanne Garner Patty Nieters Jenny Daniel, Shelly Tholl Deanne Garner Kathy Luzmoor Carla Lee Heidi Brown Patty Nieters Sunny Thomas Heidi Brown Kathy Luzmoor, Shelly Tholl All Western Planning students are eligible and encouraged to participate in college governance, clubs, and activities. The Associate Student Government (ASG) is the student body government that acts as a conduit for communication between students, faculty, administration, and community. ASG sponsors multiple clubs across the campus and service area, one of which is the Student Nurses Association (SNA). SNA designates a member to represent their interest in ASG. The SNA has a Nursing faculty advisor and student representatives in ASG. Nursing students are encouraged to participate in SNA to facilitate socialization into the nursing profession. SNA meets monthly, with meetings available to outreach students through telephone conferencing. The group sponsors activities on campus and in outreach areas. Most recent activities included participation in the Tree of Sharing program, collecting donations for the YWCA Safe House, and

26 sponsoring information tables to promote flu clinics. Meeting times and events are communicated to faculty and students through Blackboard announcements and . At the department level the faculty have monthly meetings to discuss departmental business, share in planning and decision making, and to review program progress utilizing the systematic plan for evaluation. Outside of faculty meetings, faculty are responsible for distributing their respective committee reports to department members via as they become available; committee reports are further discussed during faculty meetings as needed. Student representation is sought for monthly faculty and bi-annual advisory board meetings. All Nursing students are notified and highly encouraged to attend monthly faculty meetings. Student attendance to faculty meetings is sporadic. Meeting times, agenda items that may directly affect students and program events are posted on Blackboard in course announcements and by . Faculty and students in outreach areas attend faculty meetings through telephone conferencing. Faculty meeting minutes are published and made available to faculty via the nursing server and to students via Blackboard. Faculty work together in groups at the program level. These groups include faculty at each program level (Nursing I, II, III, and IV) working together to plan the semesters; Theory coordinators work together to ensure scaffolding of assignments; and faculty ad hoc groups meet as needed. Each semester, the faculty work in groups according to the level they teach to plan for and/or wrap up the semester. Instructors in outreach often work with both faculty groups each semester. Typically, the working groups are Nursing I

27 and III in the fall semester, Nursing II and IV in the spring semester, and coordinator meetings several time per semester. In Spring 2014 an ad hoc group of theory coordinators and faculty representative for each level was formed to address content creep. The group worked together to review the entire curriculum and made recommendations at the May 2014 faculty meeting. At that time, faculty discussed recommendations and minor curricular changes were implemented. During Spring 2014, the Nursing I group worked together to redesign Nursing I content to include self-care deficit, to be implemented Fall This was discussed, and changes accepted, in the August 25, 2014 faculty meeting. 1.3 Communities of interest have input into program processes and decision making. Communities of interest have input into program processes and decision-making. Communities of interest such as students, Advisory Board members, clinical agencies, preceptors, employers, Board of Trustees and WSBN will have input into the program through annual meetings and reports. The Nursing Program seeks and incorporates input from their communities of interest to guide program decisions. The program s Advisory Board is made up of clinical partners, nurse educators, nursing directors, and employers from the large service area. Meetings are held on the main campus in the Fall and Spring semesters. The meetings are well attended, with the service area being well represented by the attendance of members from Green River, Evanston, Kemmerer, Rawlins, and Rock Springs. As new agencies are added as partners, their representatives are invited to participate. The Advisory board provides ideas for curricular changes, program

28 improvement, and the addition of clinical offerings. In the past three years, input from the Advisory Board has resulted in the addition of clinical sites; an increased emphasis on delegation in the curriculum (Spring 13); and a suggestion the Nursing Program hold a preceptor meeting to more succinctly address the roles of students, preceptors and faculty as well as explain the types of precepted experiences preceptors could expect. A meeting was held with Rock Springs hospital nursing leaders and Western s Nursing Director and faculty in June 2013, resulting in the preceptor and faculty collaboration and creation of new a Preceptor Manual in Fall (See Preceptor Manual) (See Exhibit B for Advisory Board Minutes) Program satisfaction surveys are sent to graduates and employers annually in January. Western requests input from employers and graduates. Employers are asked to critically review a particular graduate s initial job performance in such areas relating to Westerns' Goal for Student Success and the Program s SLOs. Graduates are also surveyed on how Western prepared them to meet Program goals and SLO. In response to poor Employer Survey return rates, the faculty divided employer groups among themselves and contacted the employers individually via phone, or in person to increase the rate of employer survey completion. Student input is solicited through course and clinical evaluation each semester and program evaluation yearly. The information is shared with faculty. If there are changes or areas that need to be addressed, it is discussed and action taken during a faculty meeting. Student feedback from clinical evaluations has resulted in program

29 changes related to clinical assignments. Most recently Nursing II and III student surveys and faculty discussion noted that clinical assignments and care planning and documentation needed to be adapted for shorter patient stays and EMR charting. Care plans and DAR documentation was then replaced with CareMaps and SBAR documentation (Fall 2014). Nursing IV student clinical surveys showed the students found the Management of Care (MOC) clinical to be valuable, yet felt it did not allow adequate time to focus on the actual management of care. The experience was then changed to three resident care days and one management day (Spring 2013). 1.4 Partnerships that exist promote excellence in nursing education, enhance the profession, and benefit the community. Partnerships exist that promote excellence in nursing education, enhance the profession, and benefit the community. Western s ADN program maintains partnerships with a variety of constituents that enhance the profession and benefit the community. The Nursing Program partners with multiple clinical agencies, professional organizations and other academic institutions. Memorial Hospital of Sweetwater County (MHSC), Carbon County Memorial Hospital (CCMS), and Evanston Regional Hospital (ERH) have been long standing partners with Western's Nursing Program. The program strives to have a mutually beneficial relationship with these facilities. In the Fall semester each year nursing students participate in flu clinics throughout the service area, partnering with MHSC, CCHS, ERH, as well as Public Health Departments and the State of Wyoming health fair. The SNA participates in wellness event for the College and community including Western s Free

30 Day (blood pressure clinic) and sponsoring wellness information tables on campus. Partnerships exist to enhance the nursing profession. The faculty work to incorporate activities and assignments that enhance leadership development and participation in professional organizations into the curriculum. In their final semester nursing students attend Legislative Day in Cheyenne, Wyoming to experience the nurses influence in politics and legislation. In Fall 2014 second year students participated in leadership development by attending Wyoming Nurses Association Nursing Summit which focused on leadership development. Support for students to attend this event was obtained from Western s Foundation. The program strives to strengthen the nursing profession by promote lifelong learning on several levels. To facilitate advancement of nursing education Western has a strong articulation agreement with the UW for RN-BSN completion. Faculty coordinate advising with UW s RN-BSN criteria. Students are allowed concurrent Western and UW credit hours to meet the full-time status requirement for financial aid. The program is partnered with a statewide consortium of clinical and educational entities to reform nursing education in the state. The ReNEW initiative seeks to create a statewide competency-based nursing curriculum through participation in faculty workshops and curriculum planning for the past four years. The faculty and director are actively involved. The ReNEW curriculum is planned to be implemented in The nursing education unit is administered by a nurse who holds a graduate degree with a major in nursing. The nursing education unit is administered by a nurse who holds a graduate

31 degree with a major in nursing. Western s AD program employs a program director with a Master s degree in nursing education. The Director holds a Master s Degree in Nursing Education from the University of Wyoming (2009) and is certified as a Nurse Educator. Her non-thesis project was titled "Enhancing Conflict Management Skills of Nursing Students". She successfully completed requirements to be designated a Certified Nurse Educator in June 2013, and continues her Nurse Case Manager Certification. The Director began her career in nursing education in 2006 after 28 years in a variety of other nursing specialties. Prior to nursing education she was a hospital based case manager for twelve years. The Director is the founder of Hospice of Sweetwater County. In 1983 she was instrumental in establishing the first hospice in Sweetwater County. Areas of clinical practice prior to becoming case manager include Family Practice office, hospice, emergency department, PACU, ICU, and one year as supervisor of a 30-bed general medical unit. (See Exhibit C for the Director s CV) 1.6 The nurse administrator is experientially qualified, meets governing organization and state requirements, and is oriented and mentored to the role. The nurse administrator is experientially qualified, meets governing organization and state requirements, and is orientated and mentored to the role. Nursing administrator s personal file specifies she is experientially qualified, and meets Western s and WSBN requirements and has been oriented and mentored to the role. (See WSBN Administrator Regulations, pages 6-8) (See Exhibit D for the Nursing Program Director Job Description and Exhibit E for the Director Mentoring Processes)

32 The program Director meets the College and WSBN requirements for a nurse administrator. The Director holds a Master s Degree in Nursing Education from the University of Wyoming and has an active license to practice as a RN in Wyoming. The Director exceeds the WSBN minimum requirement of clinical and teaching experience with 30 years of clinical experience, and eight years of instructional experience prior to accepting the administrator role. She has taught theory in all levels of the program. She acted as Nursing IV Clinical Coordinator, which involved arranging new clinical experiences, and being the contact person between the program, students, and agencies. She was a clinical instructor for Nursing IV students, and was instrumental in developing and facilitating the Management of Care experience. The Management of Care experience allows fourth semester students the opportunity to develop patient and staff management skills in a long term care facility. The Director has extensive leadership experience at the local and state levels. She served on the Western s Faculty and Professional Senate for six years; during that period she served as President-elect, President and past President. During her time on the Senate, the group increased their visibility and effectiveness on campus. One significant Senate accomplishment during her term was the addition of Senate representation on Western s Leadership Team. She served as the Vice President of the Wyoming Nurses Association (WNA) from and In her second term she co-chaired the Nurses Day at the Wyoming State Legislature held annually during the legislative session in Cheyenne, Wyoming. The Director is proactive in promoting colleague and

33 student participation in the Wyoming legislative process. She alternated between serving as President and Vice-president of the WNA District #6 continuously from In light of her extensive leadership activities, in 2012 the Director was asked to serve as cochair for the Professional Development Committee of ReNEW to prepare faculty for the concept based curriculum that will begin across all community college nursing programs in As co-chair she has worked on a developing the annual Nursing Education Summit, locating speakers and planning the agenda. In 2013 she received an award for Outstanding Service to the Wyoming Nurses Association. The Director has been oriented and mentored to the administrator role. She attended the New Deans and Director Workshop at the Colorado Center of Nursing Excellence in October 2013, and ACEN s New Director Workshop in January The Director participated in a formal orientation program, weekly mentoring, and on-site support from the previous director and the former Vice President of Student Learning (VPSL) for the first academic year in her new role. For example, in February 2014 the new Director was mentored and supported by the former VPSL and previous director when addressing the annual budget. An outline of the mentoring process can be found in Exhibit E, as referenced above. The Director continues to receive support from colleagues across the state. She is a member of the Nurse Educators of Wyoming, which is comprised of all directors from nursing programs throughout the state. The group engages in meetings and phone conferences to answer questions, support each other and promote nursing education

34 The Director is in regular contact with the Vice President of Student Learning. This includes involvement in Academic Council with other division chairs. This year the Director and the VP of Student Learning have set up twice monthly meetings to visit about nursing program issues. 1.7 When present, nursing program coordinators and/or faculty who assist with program administration are academically and experientially qualified. Western s Nursing Program does not use program coordinators to assist with administration. 1.8 The nurse administrator has authority and responsibility for the development and administration of the program and has adequate time and resources to fulfill the role responsibilities. The nurse administrator has authority and responsibility for the development and administration of the program and has adequate time and resources to fulfill the role responsibilities. Western s Nurse Administrator job description and WSBN Rules, Chapter 6, Sec 7, (b) (i) specifies that the nurse administrator has the authority and responsibility to administer the program. The primary responsibility of the Director is to direct the operation of the Nursing Program. The Director is the sole administrator of the program and has the entire authority and responsibility, by job description, to manage it. (See Exhibit D for the Nursing Program Director Job Description) She reports directly to the Vice President of Student Learning. (See Appendix C for the 2014 Presidential Organizational Chart and Appendix F for the Student Learning Organizational Chart) These responsibilities include supervising all aspects of the AD nursing program, practical nursing program administrator (currently vacant), and nursing assistant and Medical

35 Terminology instructors. The Director does not have assigned instructional duties. The Director coordinates the planning, development and evaluation of materials, equipment, space, human resources and curriculum for the program. She facilitates program development and advancement, by encouraging innovation and creativity in faculty, and optimizing resources to support growth in the program. She brings a vision for the growth, development, and optimal use of resources throughout the service area. Recently the Director facilitated faculty and divisional collaboration with the biology department to address course sequencing, as the Nursing Program changed to a five semester program of resources. The Director regularly coordinates outreach faculty teaching and clinical assignments to effectively utilize faculty resources. For example in the spring semester an outreach faculty member will have a Nursing IV teaching assignment and clinical assignments that include both Nursing II and Nursing IV students. The Director s coordination and planning of resources is further discussed in criterion 1.9. The Director supervises and evaluates the teaching and clinical performance of all Nursing instructors in relation to curriculum development, instruction and nursing standards. The Director strives to evaluate faculty each semester, and assists faculty with planning, obtaining and evaluating their goals. The Director ensures that requirements promulgated by the State Board of Nursing and other accrediting agencies are duly attended to and met. She keeps WSBN updated on the program compliance with standards, projected program changes, faculty changes, student application and number, and program pass rates. The Director also

36 assures the College is meeting the requirements of WyIN which covers four faculty positions. The Director collaborates with appropriate personnel at the Outreach sites to deliver an effective, quality nursing program. She visits outreach sites each semester and communicates with outreach faculty weekly. 1.9 The nurse administrator has the authority to prepare and administer the program budget with faculty input. The nurse administrator has the authority to prepare and administer the program budget with faculty input. The Nursing Program Director job description requires the Director has the authority to prepare and administer the program budget with faculty input; all faculty minutes in 2014 show faculty involvement. The Director follows the same process as all other Division Chairs for budget requests and processes for spend out/carryover. Faculty have the ability to request items and are encouraged to do so in meetings and via . Budget requests are discussed in faculty meetings and, collectively, priorities are established. Budget requests are submitted in January of each year to the Vice President of Student Learning. Faculty discussion and prioritization of budgetary requests involves consideration of availability of resources throughout the service area discussions identified and prioritized budgetary expenditures for: nursing simulation space on the main campus, student s access to computers in clinical sites, replacement of aging lab and simulation equipment, and simulation training for faculty

37 When planning the budget, careful consideration is taken to collaborate with funding sources in the outreach areas to best utilize all available resources. The Rawlins Outreach Center is primarily funded by Carbon County Higher Education Center (CCHEC) (all physical resources and the salary for one faculty member). The Director is consulted by the CCHEC executive director in preparing the budget for nursing at the Rawlins location. The Director and faculty in Rawlins collaborate on major purchases. With implementation of lab in the Evanston outreach, the Evanston faculty member will request lab supplies from the AD budget. The Director was able to obtain support for a simulation lab remodel to improve the effectiveness of the simulation experience. Perkins money became available, and was applied to faculty professional development, funding two days of onsite simulation training in August Budget was added to faculty minutes as an ongoing conversation Policies for nursing faculty and staff are comprehensive, provide for the welfare of faculty and staff, and are consistent with those of the governing organization; differences are justified by the goals and outcomes of the nursing education unit. Policies for Nursing faculty and staff are comprehensive, provide for the welfare of faculty and staff, and are consistent with those of the governing organization; differences are justified by the goals and outcomes of the nursing education unit. Western s policies for Nursing faculty are consistent with other Western faculty, where they differ is due to clinical agency requirements and public safety. Policy and procedures are readily accessible on the Western employee intranet

38 The College expects full-time faculty to carry a normal teaching load, hold office hours, be available to advise students, to serve on committees, and to complete other related duties. Western faculty have three variations on how teaching loads are satisfied. Western recognizes the uniqueness of Nursing Faculty, maintaining a Professional license, supervising students in the clinical environment, and the responsibility of working as an instructor and a professional nurse simultaneously. The full time teaching load for Nursing faculty is at least 24 load hours, but less than 28 load hours per academic year; and one is doing other service or research for the benefit of the College, community or profession; and this course reduction has been authorized in writing by the Vice President for Student Learning. (See Exhibit F for Policy 4410B) The faculty are encouraged to continue to practice clinically. The difference in policies for Nursing faculty compared to other faculty at Western relates the role of the Registered Nurse. Faculty are required to maintain licensure as a Registered Nurse in Wyoming, meet immunization requirements, maintain Health Care Provider CPR certification, and pass a drug screen and back ground check prior to hire. In addition to the Western's institutional requirements, the Nursing faculty must meet the institutional requirements of the agencies where they provide clinical instruction. The Nursing Program has an additional Faculty and Student Handbook that address situations unique to nursing. Clinical requirements can found on page 30 of the Faculty Handbook Distance education, when utilized, is congruent with the mission of the governing organization and the mission/philosophy of the nursing education unit. Programming for distance education is congruent with the philosophy and

39 purposes of the governing organization and nursing education unit. Western s five Goals for Student Success and the Nursing Program s SLOs are implemented consistently in all areas of program delivery (face-to-face and synchronous web based deliver). Western has increased distance offerings to meet increasing student population in outreach, while maintaining quality is a priority. All the prerequisites and general education courses required for the Nursing Program are available to the service population in outreach centers or online. The Nursing Program has provided nursing theory through distance technology since All program policies, standards, assignments, and outcomes are the same for students who attend class by distance technology. Students attending class by distance have the same schedule and contact hours as student attending class on campus (face-toface). Distance theory classes are synchronous, and have the same attendance and behavior expectations as a face-to-face theory class. To maintain congruency with our mission and philosophy specifically related to developing and implementing fair solutions to problems, and assuming responsibility for our work, the faculty strive to clarify or create policy to ensure program integrity. One issue that arose with the distance delivery that faculty and students had to address was defining and protecting the learning environment. With the synchronous classroom extending into the home of the distance student, expectations had to be defined to minimize disruptions, protect learning, and ensure fairness to all students. Faculty clarified a policy on classroom etiquette to assure that the expectations for distance

40 students were comparable to face-to-face students. The Problem-Based Learning (PBL) grading rubric was modified to reflect these expectations. To maintain program integrity, lab and clinical courses are not guaranteed to be delivered in outreach. Lab and clinical experiences are available in outreach areas when program standards and clinical objectives can be met. Great effort is made to minimize student travel and to utilize opportunities at the outreach sites

41 STANDARD 2: Faculty and Staff Qualified and credentialed faculty are sufficient in number to ensure the achievement of the student learning outcomes and program outcomes. Sufficient qualified staff are available to support the nursing education unit. 2.1: Full-time faculty hold a minimum of a graduate degree with a major in nursing. Full- and part-time faculty include those individuals teaching and/or evaluating students in classroom, clinical, or laboratory settings. Full-time faculty hold a minimum of a graduate degree with a major in nursing. There are eight full-time faculty employed within Western s Nursing Program. Each of these people hold a Master s Degree with a major in Nursing (See Appendix D for the Faculty and Staff Profile Form) Three full-time faculty have also obtained Certified Nurse Educator designations. Refer to the following table for additional certifications: Table 2.1: Additional Faculty Certifications Faculty Certifications/Certificates Jeannette Daniel Deanne Garner Sunny Thomas Heidi Brown Patricia Nieters Shelly Tholl Carla Lee Marsha King Certified Nurse Educator BLS Certified Nurse Educator BLS ONS Chemotherapy/Biotherapy Provider Certificate in Gerontology (Allegra, LLC) BLS, ACLS, PALS Trauma Nursing Core Course (TNCC) ACLS & PALS Instructor BLS, ACLS, PALS BLS, ACLS, PALS BLS BLS, PALS, NALS, NRP BLS

42 2.2: Part-time faculty hold a minimum of a baccalaureate degree with a major in nursing; a minimum of 50% of the part-time faculty also hold a graduate degree with a major in nursing. When used, Western s part-time faculty hold a minimum of a baccalaureate degree with a major in nursing; a minimum of 50% of the part-time faculty also hold a graduate degree with a major in nursing. Currently, there is one part-time faculty member in the Program who holds a graduate degree with a major in Nursing as well as BLS, ACLS and PALS certifications. 2.3: Faculty (full- and part-time) credentials meet governing organization and state requirements. Western s Nursing faculty (full- and part-time) credentials meet governing organization and state requirements. The organizations which determine faculty requirements for Western s Nursing faculty include the Higher Learning Commission (HLC), Western, and the WSBN. All credentials are verified by the Human Resources department and the Director upon hire. The HLC requirement which pertains to faculty qualifications (located under Assumed Practices, B. Teaching and Learning: Quality, Resources, and Support; Item 2, Faculty Roles and Qualifications at HLC Policy Link) states that faculty must have a degree in the area that they teach and that they must possess a degree at least one level above what they teach (see HLC standard below). All Western Nursing faculty meet this requirement by possessing Master s Degrees in Nursing Education. HLC Criteria for Accreditation: Instructors possess an academic degree relevant to what they are teaching and at least one level above the level at which they teach, except

43 in programs for terminal degrees or when equivalent experience is established. In terminal degree programs, faculty members possess the same level of degree. When faculty members are employed based on equivalent experience, the institution defines a minimum threshold of experience and an evaluation process that is used in the appointment process. All faculty hired must meet the credentialing requirements of the WSBN and Western. Both require a Master s Degree, but the WSBN allows five years for degree completion after the initial date of hire. Western does not allow the same five year educational exception; all Nursing faculty must have their degree completed prior to hire. Refer to WSBN Rules and Regulations (Chapter 6, Sec 7, (c) pg. 6-9) for faculty requirements which are also linked here: WSBN Faculty Requirements. Western s credentialing requirements are available within the Faculty Job Description. (See Exhibit G for Faculty Job Description) Table 2.2: Criteria to Meet Hiring Requirements Western Licensed as RN in WY Master s Degree of Science in Nursing Two years of relevant clinical experience Comprehensive knowledge of concepts, technologies, principles and practice of nursing Ability to exercise sound judgment in all facets of the student-teacher relationship and to teach a diverse group of community college students WSBN Licensed as RN in WY Master s Degree in Nursing (five years to obtain) Two years of clinical experience or national certification relevant to responsibility Ten clock hours in principles and methods of teaching learning and evaluation to performance outcomes

44 Western Ability to establish and maintain effective working relationships with students, staff and administrators. Demonstrated effective verbal and written communication skills Ability to pass pre-employment drug screening and background check. Evidence of continued professional development WSBN 2.4: Preceptors, when utilized, are academically and experientially qualified, oriented, mentored, and monitored, and have clearly documented roles and responsibilities. Preceptors, when utilized, are academically and experientially qualified, oriented, mentored, and monitored, and have clearly documented roles and responsibilities. Western s preceptor polices, roles, responsibilities and resources are located both in the Preceptor Manual as well as the Preceptor website. In addition, all preceptors have clearly documented roles and responsibilities as required by WSBN policy (Chapter 6, Sec 7, (c) (viii) pg. 6-10). Western meets all of the preceptor requirements outlined in the WSBN policy to include: Clinical preceptors may be used to enhance clinical learning experiences after a student has received clinical and didactic instruction in all basic areas specific to the learning experience. Criteria for selecting clinical preceptors shall be in writing. Clinical preceptors shall be licensed at or above the level for which the student is preparing. Clear delineation of functions and responsibilities of the clinical preceptor, the student, and the faculty member must be in writing. The faculty member shall retain responsibility for the student s learning experiences and meet periodically with the clinical preceptor and student for the purposes of monitoring and evaluating learning experiences

45 The WSBN website is utilized to verify preceptor licensure. Preceptors qualifications are also confirmed to ensure they are educated at or above the end-ofprogram education of students; and have, at minimum, an Associate Degree in Nursing. The program utilizes two different classifications of preceptors: short-term preceptors and long-term preceptors. Short-term preceptors are those nurses who are paired with a student from a few hours to a few days. At the beginning of each academic year (or throughout the year as needed), Clinical agency department leaders are provided with a list of current preceptors within their department. The department leader verifies that each preceptor continues to meet the established qualifications and has the opportunity to add to the list of approved preceptors, or to remove a preceptor from the list if needed. The list is sent back to the department and the Program Director and/or Faculty verify that each preceptor meets the established qualifications. After the verification from the Director or faculty has occurred, and the Office assistant has verified RN licensure, the name of the preceptor is then placed on the Approved Preceptor List which students have access to via their Blackboard course shell. Before a student is permitted to contact a preceptor, clinical objectives are reviewed and students are instructed as to which preceptors would be acceptable for the particular clinical. Students are then directed to contact the approved preceptor to arrange the clinical experience. At the beginning of each experience, the student provides the preceptor with a Preceptor Feedback of Student form (see Exhibit H) and presents the clinical objectives for discussion

46 Short-term preceptor orientation is facilitated via the Nursing Program website Preceptors (link above). This site contains documents useful to the preceptor, along with the Nursing Preceptor Manual. This manual clearly identifies the role of the preceptor, student, and Nursing faculty. It further delineates the expectations and responsibilities of the preceptor. Also located on the Preceptor area of the Programs website is the voiceover Power Point Presentation entitled Western Nursing Program Preceptor Orientation which further augments the information in the Preceptor Manual. Finally, all preceptors are highly encouraged to view the UW Preceptor Orientation Modules located on the Preceptor webpage. The University made the modules available as a means to orient and prepare their preceptors for the role. The Fay W. Whitney School of Nursing gave Western permission to utilize these highly useful modules for the same purpose. These modules give the nurse skills needed to successfully manage the role of the preceptor. The modules address the following topics: Introduction: Pay it Forward Module 1: Roles and Responsibilities Module 2: Principles of Teaching Module 3: Clinical Reasoning Module 4: Communication, Coaching, and Feedback In addition to the resources discussed, Table 2.3 presents other resources which are readily available to Western s preceptors

47 Table 2.3: Information Available to Preceptors Location Preceptor Manual Chapter 1: Introduction Preceptor Manual Chapter 2: Guidelines for Clinical Preceptors Preceptor Manual Chapter 3: The Preceptor Process Preceptor Manual Chapter 4: Forms Required for Clinical Preceptors Preceptor Manual Chapter 5: Helpful Resources for Working with Student Nurses Preceptor Website (Link here) Nursing Program Website Nursing Program Faculty Page Content Mission, Philosophy, Clinical Experience Description Policies, Roles and Responsibilities, Legal Considerations Selection, Orientation, Mentoring, Monitoring Preceptor Feedback of Student form, Student Feedback of Preceptor form Clinical Tips, Medication Administration for Students, Dress Code Policy Student Handbook Preceptor Manual Approved Preceptor List Preceptor Feedback of Student form Med-Surg Rubric Western Preceptor Orientation Power Point UW Preceptor Orientation Modules Faculty Contact Information Mentoring of preceptors takes place through , phone calls or face-to-face visits. Preceptors are encouraged to contact the Nursing Department if an issue arises with a student or if they need direction or guidance in regard to their role. Often, preceptors who need mentoring are again encouraged to view the UW Preceptor Orientation Modules. Short-term preceptors are monitored through several mechanisms. Students are required to complete the Student Feedback of Preceptor form (see Exhibit I) at the end of

48 each clinical experience where a short-term preceptor was utilized. The forms are reviewed by Nursing faculty and any concerning feedback of a preceptor is addressed either with the preceptor or with the clinical agency department leader. Through this mechanism, preceptors can be removed from the Approved Preceptor List. Clinical agency department leaders also contribute to the monitoring of preceptors in that they can determine a nurse in their department is unsuitable to be a preceptor. Long-term preceptors are currently comprised of five select nurses who work on the Medical/Surgical unit at Memorial Hospital of Sweetwater County. Long-term preceptors receive a small stipend from the College and have an expanded role from that of the short-term preceptor. They are selected based on the positive comments from students as well as from the recommendation of the medical/surgical department leader. (See Exhibit J for Preceptor MOU) Long-term preceptors are utilized only for Nursing IV in the Spring semester. All students are required to complete 48 hours with a long-term preceptor. These preceptors are skilled in guiding the clinical experience while letting the student gain confidence in caring for multiple patients with a variety of needs. These preceptors have the added responsibility of completing the more detailed Clinical Feedback Tool for each student, as well as the Med/Surg Rubric which is used for trending student competency in the areas of Communicate Competently, Solve Problems and Apply Therapeutic Nursing Interventions. Long-term preceptors do not directly evaluate student performance or assign grades. Rather, they provide input that the faculty can use to assess competency

49 They are asked to give the student feedback in regard to strengths and weaknesses in the clinical setting. Long-term preceptors are oriented in much the same way as short-term preceptors with information on the Preceptor webpage. They are also invited to campus at the beginning of each Spring semester to attend an orientation/mentoring session with nursing faulty. Assignments and forms are discussed during this session. Long-term preceptors are encouraged to share tips with each other as well as ask any questions they might have. Clinical objectives are reviewed and recommendations from the preceptors are solicited in order to keep the objectives current and relevant. Monitoring for long-term preceptors is much the same as for short-term preceptors. Additional monitoring occurs through frequent s, phone calls and visits with each preceptor. It is not uncommon to speak to each preceptor multiple times during the semester. At the end of the spring semester, the long-term preceptors are again invited to campus to debrief on the semester and discuss points of interest. Clinical agencies and preceptors are a vital resource to the Nursing Program. Communication is essential to maintain safety and a solid working relationship. The role of the student for each semester is clearly outlined in a flyer. These fliers are laminated and sent to the clinical agencies as a reminder to what the student can do in the clinical setting (see Exhibit K). In addition, feedback is solicited from clinical agencies as it applies to the preceptor process and clinical objectives. In 2013, nursing leadership from Memorial Hospital of Sweetwater County provided feedback which was used to revise the

50 Preceptor Manual. Recommendations received about the preceptor process during the semiannual Advisory Council meeting are utilized as appropriate. 2.5: The number of full-time faculty is sufficient to ensure that the student learning outcomes and program outcomes are achieved. The number of full-time faculty is sufficient to ensure that the student learning and program outcomes are met. Program outcomes are consistently achieved with Western s current complement of eight full-time faculty. Western adheres to the WSBN requirement of the 1:8 ratio (faculty to students) in the clinical setting (Chapter 6, Sec 7, (c) (iii) (A)). The College expects full-time faculty to carry a normal teaching load which is defined in Policy 4410B (See Exhibit L for Policy 4410B Workload for Instructional Faculty). The Nursing faculty adhere to the load requirements outlined in Option B of the Policy which states, In addition to teaching, faculty members must hold office hours and must be available to advise students, to serve on committees, and to complete other related duties. Nursing faculty meet Western s load requirements by teaching at least 24 load hours per academic year and by doing other service or research for the benefit of the College, community or profession. In addition to a teaching load that adheres to Western s policy, Nursing faculty invest a significant amount of time in interdepartmental and interagency collaboration. Program collaboration is essential in planning clinical experiences, maintaining the integrity of theory instruction and managing the laboratory supplies and lab availability. A sampling of other departments on campus reveals similar expectations for load

51 For example, faculty in the English department teach 5 three credit hour courses each semester with very little deviation. Science faculty typically teach twelve credit hours per semester with an additional four credit hours for lab instruction. Faculty within other divisions are given similar allowances for additional responsibilities much like Nursing faculty have for intradepartmental coordination. For example, an English instructor has been given three credit hours to oversee the Honor s Program. Similarly, a Communications instructor has been given three credit hours to direct the English as a Second Language program. Table 2.4: Faculty Load Load Theory Lab Clinical Simulation Contact Hours 15 hours contact time = 1 credit 25 hours contact time = 1 credit hours contact time = 1 credit 25 hours contact time = 1 credit Ratio 1:1 2:3 2:3 2:3 Faculty workload is determined equitably within the Nursing Program. Faculty are assigned a combination of PBL facilitation (theory), practice laboratory instruction, clinical instruction, and/or simulation instruction. Expertise and preference are taken into account when determining load. Typically, part-time faculty are utilized in the lab and/or clinical setting. The current part-time faculty is utilized to fill gaps that full-time faculty cannot fit into their load. This academic year the part-time faculty member is assigned primarily to simulation as she has a strong back-ground in simulation. This allows for consistency in simulation experiences across the groups. She was assigned to simulation by the Program Director at the request of the faculty. It is difficult for full-time faculty to

52 maintain simulation expertise in conjunction with a full teaching load in theory, lab and clinical. In addition to teaching responsibilities, full-time faculty members also participate in committee assignments, student advising, course coordination and program accreditation processes. All faculty members participate in monthly Nursing faculty meetings. Committee assignments, advising, and course coordination are not accounted for in load. (See Appendix G for Faculty Workload by Semester) The Western Nursing Program currently employs eight full-time faculty members and one part-time faculty member. This number of faculty assures compliance with the WSBN minimum faculty: student ratio of 1:8 for clinical experiences. For PBL theory, the preference is also to utilize a 1:8 ratio. At times the preferred ratio has increased, but to no more than 1:10. The 1:8 ratio is the primary determinant in how many students are admitted into the Nursing Program based on available faculty. Although the 1:8 ratio is a standard within the Program, some clinical experiences may use a lower ratio based on the complexity of the clinical experience. For example, the long-term care Management of Care (MOC) experience uses a ratio of 1:4 due to the large number of residents assigned to students and the complexity of managing those residents. The outreach hospitals often do not have a census or acuity to support 1:8, so smaller ratios may be used then as well. Some concept based clinical experiences such as the IV clinical may be 1:1 or 1:2 based on the ability to meet the required number of IV starts in a given setting. Faculty to student ratios in lab varies based on student

53 enrollment and lab complexity. The Nursing III intravenous lab may utilize an instructor/student ratio less than 1:16. (Refer to following table for ratios) Table 2.5: Faculty/Student Ratios in Classroom, Lab, and Clinical Course Nursing I (NRST 1610) Nursing II (NRST 1620) Nursing III (NRST 2630) Nursing IV (NRST 2640) Classroom Faculty/Student Ratio Lab Faculty/Student Ratio Clinical Faculty/Student Ratio Simulation Faculty/Student Ratio 1:8 1:16 1:8 no simulation 1:8 1:16 1:8 1:4 1:8 1:16 1:8 1:4 1:8 no lab 1:8 1:4 The Nursing faculty work load has not exceeded 28 credits/year for last three years. The number of full-time faculty is sufficient to meet the learning needs of the students, the program outcomes and is also sufficient to support the Nursing Program. 2.6: Faculty (full- and part-time) maintain expertise in their areas of responsibility, and their performance reflects scholarship and evidence-based teaching and clinical practices. Faculty (full- and part-time) maintain expertise in their areas of responsibility, and their performance reflects scholarship and evidence-based teaching and clinical practices. Boyer s Model of Scholarship (1990) is a framework that can be applied in the community college setting. The components of this model reflect both the maintenance of expertise as well as the use of evidence-based practice. This model has four areas of scholarship in which the Nursing faculty perform. Since Boyer s Model is so vast in its inclusivity, there are multiple examples of how the faculty demonstrate scholarship. The following are

54 several, of the many ways, faculty demonstrate scholarship. Scholarship of Discovery: new and unique knowledge is generated The scholarship of discovery is exemplified several ways. The faculty regularly engages in peer evaluation both in the classroom and in the clinical setting. In addition, Western Nursing faculty Heidi Brown conducted a presentation about PBL at the 2013 Nurse Educator Summit. One of the bigger areas of discovery that the program faculty have participated in is the development of an on-line or distance PBL format. The development was initiated to meet the needs of our entire service area. Initially, very few faculty participated in the pilot online cohorts. As methods were tested and analyzed, the distance delivery method was then made available to more faculty and students. Each semester, feedback is received from both faculty and students in which the distance delivery method is fine-tuned. Based on this scholarship of discovery, nursing education has become more accessible to the harder to reach student demographics in this frontier region. Scholarship of Teaching: teacher creatively builds bridges between his or her own understanding and the students' learning The scholarship of teaching is demonstrated through the implementation and use of the PBL, a student-centered, constructivist approach which employs Socratic questioning (i.e., students are guided to find meaning in course content that is valuable to them). Since its introduction to the Program in 2003, the faculty have extensively

55 developed and refined PBL into the process that it is today. As mentioned in the Scholarship of Discovery, the Program piloted its first PBL course in an online format with the use of BigBlueButton, a synchronous web-conferencing tool in With careful implementation and feedback from both students and faculty, the distance sections of PBL have become overwhelmingly popular option for providing instruction to a large, rural service area. Another example of the scholarship of teaching is the Program s commitment to mentor graduate students from various universities. In , three graduate students were paired with two faculty and the director who mentored them in the final semesters of their graduate programs. While the graduate students benefited from observing program faculty, the faculty also benefited. Two of the students completed a needs assessment of the program and developed tools that could potentially be implemented. These tools were for simulation evaluation tool and a clinical evaluation. While the faculty did not adopt these tools, they did initiate a philosophical debate. These discussions served to build bridges between what the faculty knows and what the students need. Further examples of scholarship of learning include teaching that the faculty does in addition to their assigned teaching load. For example, Sunny Thomas teaches Advanced Cardiac Life Support for the community. Deanne Garner taught health care providers in Pinedale, Wyoming about refilling and managing intrathecal pumps

56 Scholarship of Application: emphasis is on the use of new knowledge in solving society's problems The scholarship of application is exemplified in that three full time faculty have earned the Certified Nurse Educator (CNE) designation. A long term care clinical instructor also completed a gerontology certificate in All faculty members belong to both the American Nurses Association as well as the WNA. The Program Director spent many years in leadership positions with the WNA including Vice President. The Program Director and three other faculty serve on committees for ReNEW. One Nursing faculty member oversees the SNA, thereby fostering the professional growth of students. Students are encouraged and, in some years, reimbursed for attending Nurses Day at the Legislature at the state capitol. In 2014, the Director procured funding to pay for all full-time Nursing faculty to attend the WNA convention and helped arrange their teaching schedules to facilitate attendance. Under the example that the Program Director has set in regard to political action, the program places a high importance on political action as a way of solving healthcare concerns. Scholarship of Integration: new relationships among disciplines are discovered. The scholarship of integration can be evidenced by the program s extensive use of technology within the program. As technology has progressed in both healthcare and nursing education, the program has stayed current in technology. The Program faculty devote an entire portion of program orientation to orient

57 students to program technology. All Program faculty are adept at utilizing Blackboard, Assessment Technologies Institute and BigBlueButton (synchronous web conferencing tool utilized as a virtual classroom). Faculty are also educated in both moderate and high fidelity simulation. In August 2014, the Program Director arranged for an on-site seminar for all faculty on the topic of simulation provided by a Laerdal representative. In the summer of 2014, the simulation lab was completely redesigned and updated to reflect current evidenced based practice regarding the implementation of simulation in nursing education. In November 2014, the Director and one faculty member conducted a roundtable discussion at the STEMtech conference in Denver, Colorado. The title of their session was Problem-Based Learning: Increase Clinical Reasoning for Health Science Students. This is an example of integrating knowledge into other disciplines in the healthscience field. Another example of the scholarship of integration is the effort which was made to integrate evidence based literature into teaching methodology. A literature review about reflective practice, completed by a faculty member in 2011, influenced the nursing curriculum. It was found that reflective practice helps the student to bridge the gap between the classroom and clinical practice. Students who have been required to complete reflective assignments report satisfaction in being aware of how clinical experiences actually relate to what they learn in class. Finally, several Nursing faculty participate on college-wide committees in

58 order to represent the Nursing Department and to develop new relationships among disciplines. Some of these committees include the Instructional Technology, Academic Rigor, Curriculum, Senate and Scheduling Action committees. In addition, campus-wide presentations from the Nursing faculty have been provided on the topic of PBL, as a means to possibly integrate this modality into other disciplines. All faculty who engage in clinical instruction also maintain employment in various areas of nursing. Except for two instructors, faculty who teach in the acute care setting are also currently employed either part time or casual part time in acute care. The faculty member not working in acute care works as a part time staff education and quality assurance nurse for a long term care (LTC) agency, the other just joined the faculty and has a recent strong medical/surgical clinical background. A faculty member working in LTC also instructs in the LTC clinical experiences for the Nursing Program. Faculty who work in acute care areas also complete facility specific competency check-offs annually. To further clinical competence, all faculty engage in facility specific orientation each year along with students. The faculty who instruct in the chronic or LTC setting are employed in the health care areas other than long term care; one as a hospital case manager, one as a home infusion nurse, and one in OB. In order to maintain expertise in LTC, these faculty attend meetings with the LTC administration/staff, shadow nursing staff and attend training within the LTC facility. In addition, one faculty has obtained a certificate in Gerontology to better increase clinical competence. The Western Nursing Program is proud of the faculty

59 for making an effort to maintain expertise in their area of clinical teaching responsibility. (See Appendix E for Faculty Scholarship and Maintenance of Expertise) 2.7: The number, utilization, and credentials of staff and non-nurse faculty within the nursing education unit are sufficient to achieve the program goals and outcomes. The number, utilization, and credentials of staff and non-nurse faculty within the nursing education unit are sufficient to achieve the program goals and outcomes. There are no non-nurse faculty employed in the Nursing Program. Program outcomes are achieved and supported by the Nursing Office assistant and an instructional assistant. The Office assistant fulfills the applicable job description and competently meets student and faculty needs. She has no formal duties beyond the Nursing department and was extensively trained for the position. In light of the complexity of program logistics, the College administration approved the previous administrative assistant to mentor the current assistant for three months. Nursing faculty in Rawlins and Evanston outreach sites each have adequate office assistant representation on site. While the office assistants in the outreach sites are not dedicated solely to the Nursing Program, they meet the needs in these locations. The program also employs one student worker who is required to sign a confidentiality agreement upon hire and at the beginning of each academic year. The student worker is under the direction of the Office assistant and completes only those tasks delegated to her. The Nursing Program temporarily employs one instructional assistant; this person was previously a nursing instructor in the PN program and is completing her graduate degree. Due to the lack of student applicants in , the PN program was

60 suspended for the academic year. She was then moved to the ADN program as an instructional assistant and has no teaching or evaluation responsibilities. She works on retention efforts, fills a valuable role as a student success advisor, and assists faculty with logistics and set-up in the lab and in clinical. The following are the job duties as outlined in her Job Assignment: Support/advise nursing students to include opportunities for students to meet in person or via distance technology. Support Nursing faculty with lab and simulation logistics. Orient new faculty member to Memorial Hospital of Sweetwater County Orient to the role of Nursing 1 & 4 clinical faculty at long term care facility in preparation for role as ADN instructor upon completion of MS degree (anticipated May 2015) The support that the program staff provides to the Nursing faculty helps to achieve the program goals and outcomes. 2.8: Faculty (full- and part-time) are oriented and mentored in their areas of responsibility. Faculty (full- and part-time) are oriented and mentored in their areas of responsibility. Western s new faculty are oriented and mentored utilizing the Nursing Program Plan for Orientation of New Faculty Checklist located in the Faculty Handbook (page 7) and by attending college wide orientation. The Faculty Handbook is a useful tool for orientation. It is an electronic document that is available to all faculty members and is updated at least annually and as needed. Faculty routinely contribute helpful education techniques to the handbook, which are then shared in a collaborative faculty discussion. The Plan for Orientation of New Faculty Checklist is maintained to assure orientation has taken place and is kept in each faculty member s personnel file

61 During the academic year, new faculty are mentored by the Director and by more experienced faculty. Experienced faculty willingly assist new faculty with understanding theory, lab and clinical components. Seasoned faculty also grade assignments in tandem with new faculty to ensure grading standards are maintained. Faculty orientation within a frontier region presents unique challenges. Travel may be required to fulfill orientation requirements. In the Spring of 2014, Shelly Tholl (based in the Evanston outreach location-100 miles from the main campus), joined the program. Shelly was oriented and mentored extensively to all program components before taking an independent load. She attended LTC clinical rotations with 2 other experienced faculty prior to conducting an independent clinical. In the fall semester, Shelly shadowed experienced faculty in the acute care setting as well. Additionally, an experienced faculty person traveled to Evanston to assist Shelly with the first days of lab. In the Fall of 2014, Shelly was mentored into the PBL facilitator role by the Director and maintained an open line of communication to the seasoned faculty for mentoring. To complete an agreement with the Board of Cooperative Higher Education Services (BOCHES) in Rawlins (107 miles from the main campus), Marsha King was hired in August of Due to low student enrollment this year, her load consists mainly of orienting with other faculty. She provided medical/surgical clinical instruction for two sections of Nursing II students in Rock Springs after being oriented by shadowing other faculty. The instructional assistant, who is also a hospital employee, attended clinical for her first several rotations to help orient her to the facility

62 The level of ongoing orientation and faculty development is the standard in the program. To ensure that new faculty, and even seasoned faculty, maintains the high standard set by the Director, peer evaluations are done at routinely. This dedicated mentoring process ensures that high standards are maintained and that expectations are met. 2.9: Systematic assessment of faculty (full- and part-time) performance demonstrates competencies that are consistent with program goals and outcomes. Systematic assessment of faculty (full- and part-time) performance demonstrates competencies that are consistent with program goals and outcomes. All full-time faculty are evaluated in accordance with Western s policy (by students, by the Director, by self, and by faculty goals). The College does not have a policy for the evaluation of part-time faculty. The Nursing Director evaluates the part-time faculty each semester as do students. Faculty are evaluated at the program level as well as the institutional level. On the program level, seasoned faculty are evaluated by students each semester in the theory, lab and clinical portions of the course. Per Western policy new faculty are evaluated twice per semester for the first two years. (See Exhibit M for the Evaluation Plan for Faculty) Faculty are provided with these evaluations and utilize them for improvement. The nursing department utilizes a different evaluation tool for lab and clinical evaluation. Also at the program level, peers evaluate each other using the SLOs of the program. At the institutional level, faculty complete self-evaluations at the end of each year based on the individual goals they established at the beginning of the year. The goals are

63 decided upon by faculty in a manner that supports the attainment of program goals and outcomes. The Program Director reviews the goals and evaluations of each faculty and submits the final report to the Vice President of Student Learning. These are then made part of the faculty files in Human Resources (See Exhibit N for Human Resources Faculty Files). 2.10: Faculty (full- and part-time) engage in ongoing development and receive support for instructional and distance technologies. Faculty (full- and part-time) engage in ongoing development and receive support for instructional and distance technologies. As noted in the Scholarship of Integration, faculty engage in ongoing technology development. As a college that serves a large rural area, sound distance technology is vital. Not only does the technology have to be in place, but the faculty must know how to utilize the technology to its highest potential. Western is efficient in ensuring that both of these requirements are met. Training takes place through instructional technology courses (Facilitating On-line Learning), conferences, college in-services, and mentoring. Prior to teaching any online course, faculty are required to take the course Facilitating On-line Learning (EDCI 2526) which is offered by the Distance Learning department and prepares faculty to navigate the online format with ease. Nursing faculty also regularly attend Blackboard in-services and updates, which are recorded and able to be viewed at later times. BigBlueButton is a synchronous web-conferencing platform that is specific to the Nursing Program for the distance PBL option. Support for this technology is offered by a paid contractor as well as by experienced faculty

64 The Nursing Program has implemented the use of high and moderate fidelity simulation into each semester. Simulation training and support is primarily facilitated through onsite sessions conducted by simulation company representatives or by attending simulation conferences nationally. In August of 2014, Laerdal training was paid for with Perkin s grant money to present on-site training. The College provides $650 per faculty member each academic year for professional development. The College receives Perkin s grant money each September which can be used for equipment and training needs in the Nursing Department. Other money within the College and department budget can be used for technology equipment needs as well. A recent simulation lab remodel was fully funded through one time college funds

65 STANDARD 3: Students Student policies and services support the achievement of the student learning outcomes and program outcomes of the nursing education. 3.1: Policies for nursing students are congruent with those of the governing organization, publicly accessible, non-discriminatory, and consistently applied; differences are justified by the student learning outcomes and program outcomes. Policies for nursing students are congruent with those of the governing organization, publicly accessible, non-discriminatory, and consistently applied; differences are justified by the student learning outcomes and program outcomes. The Nursing Program operates under Western s student policies; differences for the Nursing Program are justified (public protection/clinical partner requirements). Both Western and Western s Nursing Program policies are publicly accessible, non-discriminatory and consistently applied. Some differences for the program are in place to meet clinical partner requirements. Nursing students, potential students, agency partners and the public have ready access to college policy information by using the College website (Western's Policy & Procedure Website), catalog (College Catalog), or College student handbook (Western's Student Handbook). Student policies that are unique to the program are outlined in the Nursing Student Handbook and Nursing course syllabi (see Exhibit O). Course syllabi are provided at the beginning of each semester and refer the student to the Nursing Program Student Handbook for program policies. Nursing student program-specific files contain proof of student understanding of nursing policies. These policies are reviewed by the faculty each April as described in the Systematic Plan of Evaluation Calendar. Table 3.1 identifies the location of selected student policies

66 Table 3.1: Location of Selected Student Policies Policy Nondiscrimination Selection and Admission Academic Progression Student Evaluation/ Grading Western Catalog Western Web p. 19 Current Students/ Registration and Records/ Student Information/ Student Rights pp Current Students/ Registration and Records/ Forms pp Current Students/ Registration and Records/ Academic Advising pp Current Students/ Student Policies & Procedures Nursing Student Handbook pp Nursing Program Web Site Admission Criteria Other WWCC Student Handbook pp pp Syllabi - Nursing I-IV and PN Roles WWCC Student Handbook p. 11 Retention p. 36 Syllabi Nursing Withdrawal/ Dismissal Graduation Requirements p. 30 pp pp Current Students/ Registration and Records I-III p. 48 Program Nursing Admission Criteria Handout Grievance / Complaints and Appeal Procedures Transfer of Credit Health Validation of Prior Learning / Articulation p. 32 Current Students/ Policies an d Procedures pp. 11, Drugs & Alcohol p ; & Student Insurance p. 26 Student Services pp. 9-14; Health Sciences pp Current Students / Academic Support Current Students/ Policies and Procedures Current Students/ Current Students/ Student Policies & Procedures p. 32 WWCC Student Handbook, p. 13, p. 35 and WWCC Student Nurse Substance Abuse Policy pp p. 48 Program Admission Criteria Program and Admission Criteria Syllabi - Nursing I-IV and PN Roles WWCC Student Handbook pp WWCC Student Handbook pp ; 42

67 In December 2013 a former student requested readmission to the Program, reporting she had left the program for health reasons in Spring In the January 7, 2014 faculty meeting, a discrepancy was found between the Nursing Program and Western s medical withdrawal policy. The discrepancy was corrected in the Nursing Program Student Handbook and students were notified during the Spring 2014 orientation and through distribution of faculty minutes. The definition of first degree relative was expanded in Fall 2013 to match the definition that Western uses for employees. Recent losses experienced by nursing students brought the issue to light. In the December 17, 2013 faculty meeting, a stricter policy for students desiring to re-enter the program following academic dismissal was adopted by faculty. The policy was changed to state that a student may only return to the program after failing one time. This update was distributed to students in January Changes in clinical agency requirements were discussed in the April 2012 faculty meeting. Following this discussion, TDaP was added to the list of required immunizations for faculty and students. The Nursing Program historically is not able to admit all students who meet the program s admission criteria. Prior to 2014, approximately qualified students applied each year and were admitted. The main reason the Nursing Program is not able to select all qualified applicants is because of the clinical component. The frontier population limits the number of clinical facilities available for clinical experiences. Therefore, the Nursing faculty have developed additional admission criteria to identify the most qualified students who have the greatest chance of successfully completing the

68 program. (See Admission Criteria) The Program had only 29 qualified applicants for the academic year, 24 were admitted. Prospective students are aware the Nursing Program has additional admission criteria. Nursing faculty advisors, ACE-IT (advising center) staff, and advisors in outreach inform students of the criteria when consulted. In addition, the admission criteria are available and easily accessible in the College catalog, on the College Nursing Program webpage and in the Admission Criteria Handout available in the nursing department. Table 3.2 identifies the differences in admission policies between Western and the Nursing Program. At this time, there is not a minimum TEAS score for admission to the Nursing Program. Faculty members have discussed setting a limit for TEAS score, specifically for science, but are currently gathering enough data to support the specific score. The low application numbers for 2014 and the new requirement for Math 1400 were other factors that led faculty not to set a minimum score for the TEAS test. Table 3.2: Admission Criteria - Comparison between Western and Nursing Program Western Admission Criteria Open Door Policy Age 16 High School Graduate or GED Math and English COMPASS or ACT/SAT exemption Admitted even if minimum scores not obtained-developmental course work may be done after admission. Nursing Program Admission Criteria Competitive Admission Policy No specific age policy GPA of 2.5 or above on a 4.0 scale on prerequisites Complete prerequisite courses with a C or better Take TEAS test Students may seek admission as advanced placement students if they are

69 currently an LPN, or have completed a PN Certificate Program. Applicants must meet the GPA requirement, pass required courses, and pass the LPN-Step test at the national level. Advanced placement students are admitted on space available basis. Western does not have an advanced placement admission policy. (See Admission Criteria Advanced Placement) Western s program accepts nursing students in transfer from other schools. There are few requests for this option. As all nursing programs have varying curricular plans, the Nursing faculty compares the student s previous program nursing courses to Western s to assess for equivalency. If nursing programs are comparable, space is available, and students meet the requirements, they are admitted. The Registration and Records Department determines transferability of general education credits on an individual basis. (See Admission Criteria Transfer Student) Table 3.3 compares the difference in policy between Western s transfer admission and the Nursing Program transfer admission. Table 3.3: Transfer Admission - Comparison between Western and Nursing Program Western Transfer Admission Policy Accepts all grades D or better except for Freshman English, US Government, and first college level Math class. Accepts all earned credits in semester hours from other accredited two year colleges and four year colleges in the U.S. Course work completed longer than 10 years ago is subject to review. Nursing Program Transfer Admission Policy Transfer students are admitted on space available basis if requirements have been met. Achieve a 2.5 or better on a 4.0 scale from prerequisite and nursing courses. Must earn a C or better in all prerequisite and nursing courses. Previous nursing courses must be comparable to Western s nursing courses. (For a complete list of transfer admission criteria for Western, refer to pp of the College Catalog)

70 Safety policies are in place for the safety of the student and clients and to comply with agency requirements. Most general college students do not have a clinical component in their educational program and do not have to comply with agency standards. The Nursing faculty acknowledges their role in protecting the public from illegal, unethical, unprofessional, or unsafe practice, thus part of the Nursing Program responsibility is to ensure that its students are mentally and physically fit to provide nursing care. Table 3.4 compares student safety and drug and alcohol policies for Western and the Nursing Program. Table 3.4: Student Safety Policy and Drug & Alcohol Policy Comparisons between Western and the Nursing Program Western Student Safety Policy No Written Policy. See Campus Safety Information for Student Safety Brochure and other campus security information. Western Nursing Program Student Safety Policy Maintain professional liability insurance through Western (no extra student charge) Show evidence of current immunizations. MMR Varicella (have had or immunized) Hepatitis B (recommended) or waiver TB skin test TDaP Physical Exam within 6 months Health Care Provider or Professional Rescuer Certification for adults, children, and infants Background screening for offenses against persons Rationale for Student Safety Policy Professional liability insurance protects the student from litigation Immunizations are current to protect students from exposure in the clinical setting as well as protect public from exposure from the student Students must be physically capable of completing course requirements Current CPR certificate is a standard for nursing practice Background screening protects the public Orientation policies at clinical sites ensure that the student is educated to the clinical site, as well as the policies and procedures

71 Western Drug and Alcohol Policy Prohibits possession, manufacture, use or distribution of alcoholic beverages, and/or illicit drugs on its property or as a part of any student activity supervised or sponsored by the College. Process not specified if violation occurs. Consequences: Possible expulsion and prosecution. Comply with orientation policies at clinical sites Students may be required to meet additional agency requirements Western s Nursing Program Drug and Alcohol Policy Nursing students must be free of chemical impairment during participation in any part of the nursing program including classroom, laboratory, and clinical settings. Nursing students will participate in drug screening after admission to program. Specific process is outlined if violation occurs. Consequences: Professional Performance Policy is enacted. Plan for correction may include rehabilitation Vice President for Student Learning will be notified. Wyoming State Board of Nursing will be notified. Rationale for Student Safety Policy Students who are free of chemical impairment are an essential component of public safety. (Refer to College catalog pdf. p or Western's Student Handbook page 19-20, for complete description of drug & alcohol policies. Refer to Nursing Program Student Handbook, pp , for program substance abuse policies.) 3.2: Public information is accurate, clear, consistent, and accessible, including the program s accreditation status and the ACEN contact information. Public information is accurate, clear, consistent, and accessible, including the Program s accreditation status and the ACEN contact information, as well as information

72 on the WSBN. Public information is clear, accurate, and accessible. The Program is a candidate for ACEN accreditation; this information can be found on Western s Accreditation / Approval Website and the final page of the Student Handbook, and includes ACEN s address, phone, fax, website, and . The Director and Office assistant annually, and as needed, review and update the program information for the public in the following documents: College catalog, Nursing Program application packet, website, Nursing Student Handbook, information sheet, brochure, and as well as Nursing faculty meeting minutes. 3.3: Changes in policies, procedures, and program information are clearly and consistently communicated to students in a timely manner. Changes in policies, procedures, and program information will be clearly and consistently communicated to students in a timely manner. Students are notified of changes via Blackboard announcements and within one week of the faculty meeting when the changes were made. Faculty meeting dates and times are posted on the Announcement page of Blackboard. (See Exhibit P for Nursing I-IV Announcement examples) Nursing Program policies, procedures, and program information are reviewed according to the SPE on an as needed basis and annually in April. When a policy change becomes necessary, the following steps are taken: 1. The faculty examines the issues by asking for information from involved sources. 2. Faculty review the data collected. 3. The faculty make changes based on the data to ensure consistency with the program philosophy. The faculty may consult with expert sources, and/or

73 encourage participation from students during the process. 4. The faculty develop a new policy and notify students by The change is added to the appropriate document as an addendum or added to the Nursing Program Student Handbook available on the Nursing Program website. 6. After the new policy has been implemented, faculty evaluates effectiveness after receiving input from faculty and students. This data is aggregated and collected over time. Trends are identified by faculty and appropriate revisions are made as necessary. 3.4: Student services are commensurate with the needs of nursing students, including those receiving instruction using alternative methods of delivery. Student services are commensurate with the needs of nursing students, including those receiving instruction using alternative methods of delivery. Students utilize a variety of college support services, before and after admission. A list of services is available in the College catalog or website and included in Table 3.5. Frequently used and selected services are listed in the Nursing Student Handbook. Student support service personnel consult with Nursing faculty for feedback. Student support service personnel and the Nursing Program maintain good working relationships. For example, the Hay Library continues to make strides in orienting students to library services and maintains a variety of nursing references in the collection. The Library Director has various tutorials on the Library website and continues to enlarge the electronic offerings. She has also implemented Book a Librarian for appearances in face-to-face presentation either on

74 campus or in distance. She visited with all first year students during the Fall 2014 orientation. She offered services to Nursing students during scheduled times both on campus and in outreach in 2012 and Table 3.5: Available Student Services ACE-IT Center * (Advising Center) Available Student Services Rock Springs Campus Director Credentials Molly Murray Doctoral Candidate, University of Wyoming; Expected May 2016; Master of Science Degree, University of Kansas Admissions Erin Grey Master of Arts Degree, Argosy University Bookstore * Natalie Lane Bachelor of Arts Degree, University of Wyoming Children's Center * Distance Learning Amber Hamblin Nancy Johnson Bachelor of Science Degree, Boise State University Master of Education Degree, American Intercontinental University Financial Aid * Javier Flores Master of Arts Degree, Fordham University Hay Library * Health & Wellness Center Information Technology Learning Center * (Encompasses Peer Tutor Center) Janice Grover-Roosa Dorothy Harton Derek Robinson Brian Kaumo Master of Library Science Degree, Emporia State University Master of Science Degree, University of Wisconsin Master of Science Degree, Kaplan University Master of Arts Degree, University of New Mexico Media Center Eric Hamm Associate of Arts Degree, DeVry University Protective Services Mark Padilla Numerous certifications and training Registration Kay Leum Master of Science Degree, Indiana University Student Housing & Dining Support, Disability, and Counseling Center * Dustin Conover Kim Drane Master of Arts Degree, University of Wyoming Master of Science Degree, University of Arkansas Veteran's Services Steve Davis Bachelor of Science Degree, Mount Marty College * Denotes services frequently utilized by Nursing Program students. Survey results of student support services can be found in Table 3.6. The Noel Levitz Student Satisfaction Inventory is conducted at Western on even years and indicates

75 student satisfaction with student support services. Table 3.6: Noel Levitz Survey Results Noel Levitz Student Satisfaction Survey Question Western Wyoming National Community College Community Colleges Mean Mean Number of Respondents Child Care facilities are available on campus. The career services office provides students with the help they need to get a job. The student center is a comfortable place for students to spend their leisure time. Adequate financial aid is available for most students. Admissions staff are knowledgeable. Admissions counselors respond to prospective students' unique needs and requests. The personnel involved in registration are helpful. Library staff are helpful and approachable Bookstore staff are helpful Scale Legend: 1 - Not satisfied at all; 2 - Not very satisfied; 3 - Somewhat dissatisfied; 4 - Neutral; 5 - Somewhat satisfied; 4 - Neutral; 5 - Somewhat satisfied; 6 - Satisfied; 7 - Very satisfied Each nursing syllabus contains the Students with Special Needs statement required by the ADA. Nursing faculty comply with the College wide ADA policy as student accommodations are needed. The ADA Learning Specialist meets with the individual to prepare a plan for success. The Nursing faculty and Director s input may be considered when developing the plan. Any ADA information and documentation is part of the Nursing Program student s file, and is stored in a locked cabinet in the nursing department

76 Students at Western enjoy a safe environment. The Western Safety Brochure details the policies and procedures that the College uses to deter and respond to crimes on campus and also provides information to help students maintain personal safety. Students receive this brochure during college orientation or a copy of the latest brochure can be found on-campus at the Library or Information Desk. The safety brochure can be viewed on the Western website at Campus Safety. Full-time counselors offer individual assistance to students with personal concerns that impact school and work success, help minimize obstacles to student success, and offer assistance in educational planning and career goals. Students with documented disabilities may qualify for reasonable accommodations. To obtain services, students who believe they qualify should contact the Disability Support Services program. Depending on availability of peer tutors, help can be obtained in general education and nursing courses in Evanston, Rawlins, and Rock Springs. Peer tutoring may be available face-to-face or via distance. The Peer Tutor Center is also utilized for testing for students with accommodations. The Behavioral Intervention Team (BIT), formed in 2010, identifies and tracks patterns, trends and disturbances in individual or group behavior according to an established protocol. This team has done extensive training with college faculty and staff related to reporting anything out of the ordinary with students. BIT then uses the reports to recognize patterns of behavior that could compromise student success or campus well

77 being by proactively intervening. A reporting form is available on the home page College Webpage; click on the red R for reporting. The ACE-IT (Advising, Career, Employment, Internships, Transferring) Center provides an effective advising system by educating and empowering students to make informed and responsible decisions about their academic futures. Their Student Success Advisors assist students in identifying their academic interests and selecting a major, as well as determining a career path and transferring to a four-year institution. A children's center is available for credit students at a nominal fee. The Center on the Rock Spring campus is open whenever school is in session. Nursing students may be able to make special arrangements for child care during their clinicals by contacting the Director of the Children s Center. The number of hours of child care allotted to each student depends upon the number of credits for which the student is registered. This service is available only on the Rock Springs campus. Distance Education staff manage Blackboard and are the campus link with outreach services. Distance education students have access to all student support services. Student services are available in outreach sites, and/or via phone, , web, or face-to-face visits from campus experts for distance students. Several services are available on-site in Rawlins and Evanston for students, including academic advising, financial aid, peer-tutoring, career evaluations, delivery of books from the Bookstore, copier service, computer support staff. Other services are provided via a combination of phone, , and one-on-one web conferencing. The Librarian visits outreach areas to

78 discuss the library services when requested. Outreach coordinators travel to campus twice a year for training that is provided by all campus student services. The Nursing Program Director attends the Outreach meetings on campus to update about the Nursing Program. The Director also travels to outreach locations several times during the year to meet with students and outreach directors. The Director makes contact with Student Services yearly to confirm that available student services are commensurate with the needs of Nursing students, including those receiving instruction using alternative methods of delivery. In March 2014, the Nursing Director confirmed with Financial Aid Director, Distance Learning Director, Director of Support, Disability and Counselling, and the Librarian that distance students and students in outreach areas have access to services in preparation for the April discussion during the faculty meeting of Standard : Student educational records are in compliance with the policies of the governing organization and state and federal guidelines. Student educational records are in compliance with the policies of the governing organization and state and federal guidelines. Western has written policies regarding educational records and maintains 100% compliance with policies related to FERPA and other state and federal guidelines. The Registrar verifies that student educational records are in compliance. Students have the right to access their records at any time, and may copy any information in the file, but original material must remain in the file. The Nursing Program keeps program specific student records in locked file cabinets in the department storage area, or on the secure Nursing web server. Faculty

79 members have access to files. The Nursing faculty decided several years ago to maintain Nursing Program records (program application, proof of immunizations, letters sent to and from students, and TEAS or LPN-Step results) for one year post graduation and then shred them. Nursing faculty respect the confidentiality of student records. The student must provide written permission before faculty can provide references. The written permission is kept in the student file. Students who have declared nursing as a major, but are not currently enrolled in the Nursing Program, are advised by Nursing faculty. Students are informed of their FERPA rights on page 19 of the print College catalog or Western Student Privacy Rights. As per Western policy the Nursing Program student worker signs a Statement of Understanding related to FERPA if they handle student files. The Nursing Program makes it a practice not to hire pre-nursing or nursing students as the student worker. The Nursing Program has access to the Datatel s Colleague Administrative System, a computer program that provides access to student information. College administration determines who has access to the information available in Colleague. Colleague accessibility has been given to the Nursing Director and Office assistant. A confidentiality statement appears whenever Colleague is accessed in compliance with federal student privacy guidelines. The nursing faculty have access to student advisee schedules, transcripts, and the degree audit via Mustang WebAdvisor, a user interface of Colleague

80 3.6: Compliance with the Higher Education Reauthorization Act Title IV eligibility and certification requirements is maintained, including default rates and the results of financial or compliance audits. Compliance with the Higher Education Reauthorization Act Title IV eligibility and certification requirements is maintained, including default rates and the results of financial or compliance audits. Western has written policies regarding compliance with the Higher Education Reauthorization Act Title IV eligibility certification and is 100% compliant with requirements. The Department of Education has renewed Western s Program Participation Agreement and the Eligibility and Certification Approval Report: their renewal signifies that the Department of Education has determined that Western maintains compliance with the Higher Education Reauthorization Act, and Title IV eligibility and certification requirements. Financial and Compliance reports are maintained by the College. Table 3.7: Default Rate Comparison Western Wyoming Community College National Two Year Public Colleges Wyoming Community College Average FY FY FY The College created a default rate management plan that has gone into effect for FY14. It requires more counseling with students prior to taking loan dollars and provides for greater follow-up and monitoring. See also Western's Federal Compliance Packet

81 3.6.1: A written, comprehensive student loan repayment program addressing student loan information, counseling, monitoring, and cooperation with lenders is available. Western s Financial Aid department has a comprehensive default prevention program that provides student loan information, exit counseling, repayment options, and repayment status monitoring. Additionally, the department regularly receives Borrower reports from the loan servicers. The Student Loan Default Prevention Plan includes the following: 1. A comprehensive exit counseling information packet is provided to students who separate from the College 2. The Financial Aid department contacts students who are delinquent in their loan repayment to educate them about options available and implore them to take action that will prevent them from going into default 3. Counseling is provided to students that have defaulted, educating them about rehabilitating the loan. Western s student loan repayment program is available in the Student Loan Default Prevention Plan (see Exhibit Q) and on the Financial Aid Website : Students are informed of their ethical responsibilities regarding financial assistance. All Western students receiving financial aid are informed of their ethical responsibilities regarding financial assistance through the College website, pre-loan and exit counseling. Students are informed of responsibilities regarding financial assistance,

82 specifically for student loans. The students receive this information during orientation, entrance counseling, various workshops, and exit counseling : Financial aid records are maintained in compliance with the policies of the governing organization, state, and federal guidelines. Financial aid records are maintained in compliance with Federal, State, and Institutional guidelines as attested to through third-party audit. Organizational, State, and Federal guidelines are maintained and are in compliance for Financial Aid records. Information regarding compliance can be found in Western's Federal Compliance Packet. 3.7: Records reflect that program complaints and grievances receive due process and include evidence of resolution. Records reveal that complaints and grievances receive due process and include proof of resolution. Western s Nursing students follow the College grievance procedure which assures due process. The grievance policy is available in Western's Student Handbook (page 21) and on the Consumer Information Website. The Nursing Program Director follows the Higher Learning Commission Complaints/Resolution process. (See Exhibit R for the HLC Complaints/Resolutions Form) The Nursing Program has received one written grievance in the past three years. The policy was followed and it was handled timely and with due process. The grievance file will be available to Program evaluators on site. 3.8: Orientation to technology is provided, and technological support is available to students. The Western Information Technology (IT) Department provides and maintains computer hardware, software, and networking needs of faculty and students on the Rock

83 Springs campus. The IT Help Desk is available to all students and faculty via and telephone, including a toll-free number. Technicians are available for troubleshooting and hardware and software upgrades. Faculty and student services and resources, the IT staff directory, and maps of available personal computers and computer labs at the Rock Springs campus are available on the Western IT Website. Members of the Distance Education staff are available to students for assistance with the course management system employed by Western. The Course Management system (Blackboard) has a tutorial available for all students. Distance Education personnel are available for technology support. Western offers the class Introduction to Online Learning, which students registered for online courses are encouraged to take. Orientation to technology specific to the program is provided. Students are initially oriented to technology during the Nursing I orientation. Ongoing orientation is provided by nursing faculty and available from Distance Learning staff. The Program uses a contract company to provide liberal faculty support for the web-based platform for synchronous discussion (BigBlueButton). Faculty then provide orientation and support to students for the web-based platform for synchronous discussion (BigBlueButton). Technology support is available to 100% of the students, those on campus and in outreach areas. Table 3.8 shows Nursing student satisfaction with their technology orientation in Spring 2014 (first year surveyed)

84 Table 3.8: Nursing Student Satisfaction with Technology Orientation Spring 2014 Nursing student satisfaction with technology orientation 84 % Response Rate 4.3 / 5 Likert Scale Orientation to technology used by clinical partners is provided in a variety of ways. In the Rock Springs Hospital and Green River Convalescent Center, the faculty receive initial training and annual updates and are responsible to share those with the students. In Evanston, at both the nursing home and hospital, the agency staff provides students with the orientation needed for technology. In Rawlins, the hospital provides training to the faculty and students annually while the nursing home provides training to the faculty who in turn train the students. 3.9: Information related to technology requirements and policies specific to distance education are accurate, clear, consistent, and accessible. Western s technology information and policies are accurate, clear, consistent and accessible. Technology requirements are posted in the syllabi and Nursing Program webpage. Students have access to requirements and policies on Blackboard (Course Information). The requirements are consistent with college wide requirements which are located on the website and in schedule of classes. All students have a secure sign in to their course management shell. Due to the frontier settings of our distant locations, students are well-known in their Outreach offices so they are not required to show ID prior to testing. All tests are proctored. All proctors in the small outreach offices who are proctoring tests have been oriented with a document Outreach Proctor Agreement (see Exhibit S for the Outreach Proctor

85 Agreement) provided by the Program and taken to the site by the student. It is the student s responsibility to have this document read and signed by the proctor and themselves. Rock Springs campus tests are proctored by nursing faculty who are familiar with the students. Testing in Evanston and Rawlins is also proctored by faculty when faculty schedules allow. In these areas, if faculty are not available outreach staff proctor the tests. The hardware, software, and networking needs of the Rawlins and Evanston outreach facilities are addressed by the IT staff in those areas at times in conjunction with IT staff from the Rock Springs Campus

86 STANDARD 4: Curriculum The curriculum supports the achievement of the identified student learning outcomes and program outcomes of the nursing education unit consistent with safe practice in contemporary health care environments. 4.1: The curriculum incorporates established professional standards, guidelines, and competencies, and has clearly articulated student learning outcomes and program outcomes consistent with contemporary practice. The Nursing Program at Western has clearly articulated Student Learning Outcomes and Program outcomes consistent with contemporary practice. Western s Nursing curriculum incorporates relevant and current professional nursing standards and guidelines from the WSBN, ANA, QSEN, NPSG, and has clearly articulated Student Learning and Program outcomes. Program outcomes measured are the ACEN required program outcomes. Western s Nursing faculty have developed a curriculum that is organized around a framework that enables the nursing student to apply concepts in an organized, logical manner. The Nursing Program has taken the goals of the governing institution and creatively blended them into the conceptual framework. Western s five Goals for Student Success are: Communicate Competently, See Issues from Multiple Perspectives, Develop Life Skills, Solve Problems, and Retrieve Information. These goals for student success assist students in developing abilities that will help prepare them to succeed in the world today and meet the challenges of the future. These goals are addressed in courses across the curriculum at Western; the methods of instruction and assessment are varied. A sixth goal was added by the faculty to address the body of knowledge unique to nursing: Apply Therapeutic Nursing Interventions. The Student Learning Outcomes (SLO s) of the Nursing

87 Program reflect these goals. As the nursing student develops skill in each area, at increasingly complex levels throughout the Program, the student becomes a competent beginning nurse. Table 4.1 outlines Western s Goals for Student Success, followed by the College and Nursing Program descriptions of the goals and finally select End of Program Student Learning Outcomes. Table 4.1: College / Nursing Program Goal Description Comparison to SLOs Western s Goals For Student Success Communicate Competently Western s Description of Goals At Western Wyoming Community College the ability to communicate competently requires that students express ideas clearly and effectively, and receive meaning and interpret ideas through various modes of communication Nursing Program Description of Goals The ability to provide accurate information, insightful observations, effective teaching, and caring behaviors. Select End of Program Student Learning Outcome Modify therapeutic communication techniques. Employ enhanced communication techniques to foster a caring relationship with client. Utilizes appropriate channels of communication within the health care team See Issues from Multiple Perspectives Seeing issues from multiple perspectives indicates an understanding of issues involved with diversity. The idea of seeing any issue from multiple perspectives, not necessarily only from a non- Western or global perspective The ability to provide culturally and ethically competent nursing care to a variety of individuals Practice assertive communication skills with "difficult people" to resolve conflict. Incorporates the cultural uniqueness of clients and colleagues into practice. Explain how family structure and patterns of functioning affect clients. Incorporate multiple techniques to practice the advocacy role. Develop Life Skills The ability to be responsible and take control of their lives is demonstrated as students learn to deal with bureaucracy, make decisions, and follow through. Establishing life goals, educational goals, and career goals is an important part of The ability to practice within an ethical and legal framework of the discipline of nursing. Generate a pro-active plan to address ethical dilemmas. Demonstrates flexibility in an ever changing health care environment. Practices within the scope of nursing according to the Nurse Practice Act. Demonstrates accountability for nursing

88 Western s Goals For Student Success Western s Description of Goals developing life skills. Nursing Program Description of Goals Select End of Program Student Learning Outcome care provided by self or delegated to others. (From employer survey) Demonstrate life-long learning (curiosity, preparedness, thorough investigation, changing decisions based on changing knowledge). Solve Problems Problem solving requires students to be able to analyze and interpret various kinds of data including quantitative and qualitative, objective and subjective information. The ability to sort and organize information, make decisions, and draw conclusions are all necessary ingredients to solving problems. The ability to demonstrate reflective thinking in which ideas and concepts are applied logically and creatively to make client care decisions Make competent decisions with guidance. Examine the skill of intuition in providing nursing care/clinical judgment. Consistently challenge assumptions in client care situations. Retrieve Information Nursing Program Goal: Apply Therapeutic Nursing Interventions The ability to identify, evaluate and use reliable resources from a variety of sources, such as libraries, databases, internet, and interviews provides students with the skills to know how and where to locate the material necessary to help them in their professional and personal lives. The ability to utilize technology and accurate information to augment human intellect. The ability to provide safe, competent care utilizing both the art and science of nursing in practice. Consistently anticipates priorities of care. (From survey) Incorporate Evidence Based Practice. Competent in retrieving data from definitive reliable sources including experts. Consistently uses the language of the profession of nursing. Consistently uses the nursing process to provide safe, competent care to maximize health potential of clients. Consistently utilize focused assessment techniques. Practice utilizing varied interview skills to establish a comprehensive data base. Consistently develop comprehensive nursing diagnoses

89 The framework was originally developed in 2000 and continues to be a stable framework for the continuously evolving curriculum. There is value in using the Goals for Student Success identified by Western to frame curriculum as students are familiar with these goals from all courses. The faculty recognizes the importance for nursing students to continue to use the language they have used throughout their educational preparation. Revision takes place in the PBL case objectives each semester to reflect currency and contemporary practice. Western is a leader in nursing education related to contemporary nursing practice. As Western s Goals and the Nursing Program s definition of those goals exemplify, the students are constantly preparing for their future. Problem-Based Learning is preparing them to be retrievers and analyzers of data to make decisions. The Program began emphasizing SBAR communication last year in clinical experiences; this was enhanced with the use of a care map. For example, under Communicate Competently, a student would be working to meet the SLO of utilizes the appropriate channels of communication with other members of the health care team by using SBAR communication. SBAR is only one example of the contemporary practices the Program has incorporated. Patient-centered care, another contemporary term, though not specifically utilized in the language of the Program, it is most certainly emphasized in all Program aspects and can be found under the goals and student learning objectives of: Communicate Competently - Design effective creative teaching techniques for complex clients or small groups Sees Issues from Multiple Perspectives - Support family as caregivers Apply Therapeutic Nursing Interventions - Develop appropriate, specific,

90 individualized nursing interventions with relevant and measurable clientcentered outcomes Emphases in nursing and in health care change rapidly. It is important to have a framework that supports change without disrupting the integrity of the curriculum. The Program has adapted to meet the changes in health care in multiple ways. For example, contemporary objectives were added in several semester case studies related to Core Measures and Discharge Criteria as well as the creation of a Minimum Data Set assignment for the Management of Care clinical experience. These up-to-date objectives and assignments emphasize to students both the complexity of care and also the complexity in receiving reimbursement for that care. Contemporary practice is exemplified in PBL. Health care information is evolving at a rapid rate. It is not possible to teach all that is needed for a nurse to know. There are no reading assignments in PBL. In utilizing PBL methodology, students discover how to learn through inquiry and research using all available resources: print, web based and experts. Students of PBL become lifelong learners with the tools necessary to find the appropriate and most contemporary information quickly. Because they depend on each other for their learning, they are adept at working in teams, a skill that is very important for health care. Current trends in nursing education encourage faculty to continue this student-centered learning approach as well as find additional ways to improve collaboration in the classroom. These methods aid to emphasize the importance of lifelong learning for contemporary practice. The professional standards the Program incorporates in the curriculum include:

91 Quality and Safety in Nursing Education (QSEN), the ANA Code of Ethics and National Patient Safety Goals. Table 4.2 gives examples of how the ANA Code of Ethics and QSEN are incorporated into Western s Goals and the Programs Student Learning Outcomes. Table 4.2: Professional Standards / Westerns Goals and Nursing Program SLO s ANA Code Ethics QSEN Western Goals for Student Success with Nursing Program Descriptions Western Nursing Program s Student Learning Outcomes Provision 1:Respect for Human dignity Relationships/selfdetermination Provision 2: Primary commitment is to the patient, whether individual, family, group, or community Patient and Family Centered Care: Recognize the patient or designee as the course of control and full partner in providing compassionate and coordinated care based on respect for patient s preferences, values, and needs. Communicate Competently: The ability to provide accurate information, insightful observations, effective teaching, and caring behaviors. Sees Issues from Multiple Perspectives: Provides ethically and culturally competent care to clients. Solves Problems: The ability to demonstrate reflective thinking in which ideas and concepts are applied logically and creatively to make client care Employ enhanced communication techniques to foster a caring relationship with client Support families as care givers. Provision 3: The nurse promotes, advocates for and strives to protect the health safety and rights of the patients Safety: Minimize risk of harm to patients and providers through both system effectiveness and individual performance. Consistently challenge assumptions in client care situations. Examine the skill of intuition in providing nursing care/clinical judgment. decisions. Develop Life Skills: Practices within the ethical, legal, regulatory, and professional framework of the discipline of nursing. Apply Therapeutic Nursing Interventions: The ability to provide safe, competent care utilizing both the art and science of nursing in practice. Practices within the scope of nursing according to the Nurse Practice Act. Competently and consistently uses the nursing process to provide safe, competent care to maximize health potential for clients

92 ANA Code Ethics QSEN Western Goals for Student Success with Nursing Program Descriptions Western Nursing Program s Student Learning Outcomes Evidenced Based Practice: Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care. Quality Improvement: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Retrieves Information: The ability to utilize technology and accurate information to augment human intellect. Incorporate Evidence Based Practice. Competent in retrieving data from definitive reliable sources including experts. Provision 6: The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action. Provision 7: The nurse participates in the advancement of the profession through contributions to practice, education, administration and knowledge development. Informatics: Use information and technology to communicate, manage knowledge, mitigate error, and support decisionmaking. Develop Life Skills: The ability to practice within an ethical and legal framework of the discipline of nursing. Solves Problems: The ability to demonstrate reflective thinking in which ideas and concepts are applied logically and creatively to make client care decisions Retrieves Information: The ability to utilize technology and accurate information to augment human intellect. Effectively manages self, time and resources to provide quality, cost effective health care! Explore state or national health care issues that affect nursing. Consistently challenge assumptions in client care situations. Incorporate Evidence Based Practice. Competent in retrieving data from definitive reliable sources including experts. Expertly use the language of the profession of nursing. Since 2012, the Western Nursing Program and faculty have been working in conjunction with a statewide initiative to standardize nursing education in Wyoming. The goal of this program is to streamline nursing education and increase the number of Bachelor s degree nurses in the state. As even minor curricular changes impact the entire

93 curriculum, it has been decided to limit the amount of change until the statewide curriculum is initiated. The new curriculum will be four nursing semesters preceded by a prerequisite semester. It will be no more than 68 credits in length (flexibility based on number of credits given to a freshman seminar across colleges). Each nursing semester will be nine credits with program flexibility to divide into more than one course. QSEN, NLN and the BSN Essentials have been used as guidelines in the development of the curriculum. The timeline for initiation of a new curriculum is the fall of The student learning outcomes are used to organize the curriculum, guide the delivery of instruction, direct learning activities, and evaluate student progress. The student learning outcomes are used to organize the curriculum, guide the delivery of instruction, direct learning activities, and evaluate student progress. The five Western Goals for Student Success and the Nursing Program SLO s are consistently used to guide the delivery of teaching/learning in every course and correlate with the evaluation of student achievement and performance. The SLO s for each semester can be found by students in each course syllabi (see Exhibit O). Nursing II and Nursing IV SLO s are also considered end of first year and end of program learning outcomes and can be found in the Student Handbook on page 13. They articulate the expectations of the students at the end of each semester. The curriculum progresses from basic to complex. Students begin to use each of the five Goals for Student Success at a basic level at the beginning of the Program and progress to using them in complex situations by Program completion. Expectations for mastery in each of

94 the SLO s are leveled as the student progresses in the Program. This progression is clearly demonstrated in the syllabi, case objectives, and clinical evaluation tools for each Nursing course. Table 4.3 shows an example of progression, of the student goal of Solve Problems across the curriculum. (See Appendix H for the Progression of Student Learning Outcomes) Table 4.3: Sample Progression of SLO s across the curriculum Solve Problems Demonstrate reflective thinking in which ideas and concepts are applied logically and creatively to make client care decisions. Nursing I Nursing II Nursing III Nursing IV Critical Thinking in Critical Thinking in Critical Thinking in Critical Thinking in Decision Making 1. Identify the importance of critical thinking in meeting the needs of clients. 2. Relate critical thinking skills to clinical decisions. Decision Making 1. Apply rational problem solving skills when discussing the plan of care. Decision Making 1. Make theoretical nursing judgments based on knowledge, experience, standards of practice Decision Making 1. Make competent decisions with guidance. 2. Examine the skill of intuition in providing nursing care/clinical judgment. Challenging Challenging Assumptions Challenging Assumptions Challenging Assumptions Assumptions 3. Acknowledge 2. Identify own 2. Challenge 3. Consistently how assumptions assumptions that affect assumptions in client challenge assumptions affect the care of decision making. care situations. in client care the client. situations. Prioritize Prioritize Prioritize Prioritize 4. With direction recognize client's priority needs. 3. Addresses priority needs. 3. Prioritize client care situation 4. Consistently anticipates priorities of care The Program s conceptual framework further assists students and faculty to visualize the importance of each goal and corresponding SLO s to the progression of beginning student to competent beginning nurse. The conceptual framework can be found in the Student Handbook page 12. The program connects clinical experiences,

95 assignments and theory to SLO s and has leveled the outcomes across the four semesters. The students progress from theory, lab, and clinical with deliberate purpose to help them connect the learning. Table 4.4 is an example of one case related to Maternal Newborn nursing in Nursing III: Table 4.4: Coordination of SLO s to Case Objectives and Clinical/Theory assignments. NIII SLO s Educator Evaluate the discharge teaching needs of clients. Formulate teaching plans. Case Objectives: NIII Christine Natal Educator *Evaluate the discharge teaching needs of the patient and family in this case. *Prepare a prenatal education plan to include nutritional, exercise and safety during pregnancy. *Create a teaching plan addressing nutritional needs of the newborn Hospital Precepted clinical experience Minimum competencies include: Observe one laboring mother Observe one delivery Assess one postpartum patient Assess one newborn Participate with preceptor in discharge teaching for one postpartum and newborn patient. Theory Assignment ATI Practice Assessments: RN Maternal Newborn Online Practice A RN Maternal Newborn Online Practice B Complete prior to Case B exam Last Day of Case assignment Present concept map for one patient in Post Clinical Discussion, post concept map to group thread prior to post-clinical The clinical experiences for this maternal/newborn case are completed by the student with preceptors prior to taking the exam for that case. As discussed above, Western provides a nursing education exclusively utilizing PBL, an innovative methodology that embodies all elements of student-centered learning to prepare graduates for contemporary practice. Each semester includes five PBL cases

96 that incorporate all of the curriculum content in an integrated format. The curriculum content map assists the director and faculty members to monitor curricular content to minimize repetition and prevent content saturation. (See Curriculum content map). The Nursing Program s Goals for Student Success and SLO s are organized further in case objectives. The first page of objectives for each case in each course includes the category of need, primary and related nursing diagnoses and exemplars included in that case. The following pages of the objectives describe the behavioral objectives organized by the Goals for Student Success and the sub-categories that the student is expected to meet at the end of that case. (See Appendix I for an example of Case Objectives Christine Natal ) Each semester of Nursing is organized into a nine or ten credit course having a theory and lab/clinical component. Theory is evaluated in many ways. At the end of each case (four or more three-hour class periods) the instructor utilizes the PBL rubric to score each student. Each case is also followed by an end of case exam. To pass the semester the students must first earn a 75% average on tests. The remaining scores from theory and clinical assignments are added into the exam scores for the final semester grade. The clinical and theory assignments for each semester with the corresponding SLO can be found in the Abbreviated Syllabi / Point Distribution document. Each exam is prepared based on several factors. The 50 question PBL exams and 100 question cumulative final utilize the 2013 NCLEX test plan, Bloom s taxonomy for analysis level of difficulty, nursing process, correlation to case objectives/content area,

97 and are proportionate to content areas for that case. The faculty re-evaluates each test at the beginning and conclusion of each semester. Questions are examined for currency, clarity, and relevance. Changes are made accordingly. (See Exhibit T for a Sample Exam and Plan) 4.3: The curriculum is developed by the faculty and regularly reviewed to ensure integrity, rigor, and currency. The curriculum was developed by the faculty and regularly reviewed for integrity, rigor and currency. Western s ADN curriculum is developed by the faculty and each Nursing course is reviewed at the end of each semester for rigor and currency. The program began implementation of PBL in The cases were completely revised in 2007 & Different aspects of the curriculum are reviewed monthly at faculty meetings. Core groups, Nursing I and IV faculty or Nursing II and III faculty, or Theory coordinators meet as needed to ensure consistency in level and avoid content overlap. In 2010 the faculty began using conceptual clinical experiences during most case studies. Since that time the faculty have added or changed conceptual clinical experiences to evolve and improve them. An example of a conceptual clinical experience that continues to be a powerful learning experience is to visit the home of a person suffering from severe immobility (spinal cord injury or advanced MS). The purpose is to understand that person s lived experience with immobility, including but not limited to: affect, social challenges, ADL issues, response to medication, and what it is like to have an autonomic dysreflexic episode. The students often ask what does the nurse need to know to care for you? A

98 meaningful response included: listen to me; I know what works and what does not!. Another large lesson learned from this experience is how to communicate with a patient with a major disability. This is often not an experience that can be counted on in a random day on an acute hospital unit. The students leave with a much greater understanding of this lived experience. Spring 14 student comments from this experience are shown in Table 4.5. Table 4.5: Student Comments from Immobility Experience I loved seeing the pt not in the hospital but in their own environment. I liked hearing their side of care, and how little things can make a difference. This was a great clinical experience. What an honor it was to be able to sit down with this individual and ask questions. He is a great person for turning his situation into a positive learning experience. Being able to view an immobile person in their home was great. It really brought home the teachings for being holistic for a patient. Thinking of when they get home and further down the road really cements things in my mind. The program continually strives to make clinical, lab and simulation experiences meaningful to the students. In Fall 2014, the Nursing III faculty adapted the way they did the intravenous lab experience by dividing the students into stations. Both faculty and students were very receptive to this change and felt it was a great improvement. As of Fall 2014 we have a new simulation area. The Nursing I faculty adapted the first day of the clinical experience in Fall 2014 to put a stronger emphasis on communication and recognition of self-care deficit in residents and not about passing medication. They were very pleased with the results. The Nursing III students will have a capstone simulation for the first time at the end of the Fall 2014 semester. Student satisfaction surveys usually mention their excitement for simulation and wishing more was in the curriculum

99 4.4: The curriculum includes general education courses that enhance professional nursing knowledge and practice. The curriculum includes general education courses that enhance professional nursing knowledge and practice. Western s Nursing Program requires general education courses that provide a strong science base and the communication skills needed for professional nursing practice. A well-rounded education is important to Western. All degree seeking students have general education classes included in their program of study and those required by the College and State. Included in the Associate Degree of Nursing are requirements in Biology, Human Anatomy and Physiology I and II, General Psychology, English Composition I and II, College Algebra or higher, and US Government. This illustrates the Program s strong emphasis on science, math, psychology and communication, all of which are essential for contemporary nursing practice. Students are encouraged to take sixteen credit hours a semester for full-time status to complete their course of study in a timely manner. Faculty meet with each individual student to encourage courses that enhance professional and personal growth as well as required courses if they are interested. Several courses were removed from the program to meet a five semester program length beginning in Spring These included Computer Science and Anthropology or Sociology. Our students use computers on a daily basis for their course work and thus learn proficiency. Anthropology and Sociology were eliminated as the faculty knew these courses, though important, will be taken as part of a bachelors program if students chose to continue. Abstract thinking and the ability to accurately solve math problems led the faculty to increase the math

100 requirement to College Algebra. 4.5: The curriculum includes cultural, ethnic, and socially diverse concepts and may also include experiences from regional, national, or global perspectives. The curriculum includes include cultural, ethnic, and socially diverse concepts and may also include experiences from regional, national, or global perspectives. Cultural, ethnic and socially diverse concepts are addressed in each semester of the Western Nursing curriculum and include experiences from a regional perspective. Wyoming is primarily white (92%), the next highest ethnic group is Hispanic. African Americans make up less than 2% of our population. It is important for Western to introduce students to persons of other races, ethnic groups, and cultures. The concepts of cultural, ethnic, and social diversity are added into the curriculum in the form of assignments such as interviews, papers, theory, and clinical practice. The students experience the care of patients whose disease processes fall into the regional, national, and global current trends. Students experience different religious beliefs, age groups, races, and cultural topics such as rural health, aging populations, sexual orientation and lifestyles, and national and world views such obesity, depression and suicide, alternative medicine, and infectious disease. Fourth semester students have a clinical experience at the Sweetwater County jail and are able to interview clients with mental illness and substance abuse issues. Early in the first semester, the students interview an elderly resident who lives in a rural setting. Their questions are to focus on how a frontier area impacts a person s life. Themes that emerge are self-sufficiency, a strong work ethic, and a hesitancy to seek

101 health care. An important purpose of this assignment is to work on therapeutic communication. A second assignment that was added to the curriculum in the past three years is a cultural interview, also in Nursing I. The student is to describe the cultural characteristics, how the person s culture affects their health, reflect on their understanding of culture and how it will affect their beginning nursing practices. They are also asked to discuss any assumptions or prejudices they recognized in themselves. An outcome of this assignment several years ago alerted the students to the high degree of prejudice and inappropriate care suffered by persons who do not speak English in our community. In Nursing II, the students are introduced to Native Americans, poverty and global obesity. In Nursing III they learn of the non-blood acceptance of Jehovah Witness followers, homosexuality, and HIV/AIDS globally and in the US. Nursing IV has experiences in domestic violence and how that differs globally, sexual assault and differences globally, undocumented persons and their impact on the health care system. Also in Nursing IV addiction and mental illness are discussed with a world view. The program maintains a culture table, like a content map it assists us to keep track of the cultural experiences we have in the program. (See Appendix J for the Curriculum Table for Culture and Diversity) 4.6: The curriculum and instructional processes reflect educational theory, interprofessional collaboration, research, and current standards of practice. The curriculum and instructional processes reflect educational theory, interprofessional collaboration, research, and current standards of practice. Problem-Based

102 Learning, which encourages the understanding and resolving of problems, is a good example of Adult Learning Theory (relevant, self-directed, and active participation). The problems, or cases, are designed to challenge and satisfy the student s strong need to know by learning how to discover, reflect, and apply knowledge from past personal experiences to accomplish learning goals. By continuously testing hypotheses through a constructive process, the students create their own method of discovery and mental representations. The curriculum is centered on investigating evidence-based research through a variety of avenues. The students gain knowledge in inter-professional collaboration by visiting a variety of clinical sites and working with staff and preceptors who practice under current standards of care, best practices, and safety goals. Students learn to collaborate in small groups, which ultimately promotes socialization and teamwork, and develops interpersonal communication skills, personal growth, and supports the learning process. In the clinical and lab setting, students use a variety of mediums to construct knowledge. For example, the ATI Skills Modules Series gives the students the opportunity to apply their critical-thinking skills to patient care before they even enter the lab. This assessment-driven, online, self-study learning package is continually updated and includes how-to videos of nursing skills, practice challenges, evidence-based research summaries and much more. Additionally, the Program covers situations that may not arise in actual clinical time, so nursing students will be prepared for the unexpected as well as the expected. Table 4.6 shows the types of learning Western s Nursing students receive in each semester of the program

103 Table 4.6: Types of Learning Active and Collaborative Learning Self-Reflective Learning Simulation Interdisciplinary collaboration EBP/Current standards of practice Nursing 1 Nursing II Nursing III Nursing IV PBL / Lab / Simulation Students provide their definition of caring at the beginning of semester and again at the end of the semester. *Cultural and Elderly rural interviews to increase communication skills and reflect on any assumptions or prejudices they may have. Clinical capstone: Students share reflections of a clinical experience that made an impact on their practice Used for head to toe assessments as final lab experience Clinical in LTC PBL Learning issues (adult learning theory/inquiry/refl ection/student directed learning) PBL / Lab / Simulation Professionalism in Nursing paper Post clinical discussions Diabetes Clinical on MS *Surgery clinical experience *Dialysis, home health or podiatry clinic for diabetes *Respiratory assessments with Respiratory therapist PBL Learning issues Present a research article for post clinical discussion PBL / Lab / Simulation Leadership paper Post clinical discussions Cardiac Pediatric dehydration Clinical on MS *Maternal newborn clinical experiences *Experience with case managers, view their role with a vulnerable adult PBL Learning issues IV Lab and Clinical *Cardiac clinical and lab experiences PBL / Lab / Simulation Students have 3 reflective journals during the semester based on their clinical experiences (Immobility/Mental Health/clinical experience of their choosing). *Clinical capstone: Students share reflections of a clinical experience that made an impact on their practice *Emergency Department clinical Trauma Liver failure/alcohol PE *Conflict paper *MS capstone clinical *Clinical experiences: one of choosing, ED, Home health, LTC, Mental Health, school nurse *Legislative paper and experience at state legislature PBL Learning issues Management of Care Assignment s: MDS assignment

104 Nursing IV students travel to the state legislature while in session to observe this citizen legislature at work, they are given the opportunity to hear from and visit with legislators to see how important their voice is in our frontier state. 4.7: Evaluation methodologies are varied, reflect established professional and practice competencies, and measure the achievement of the student learning outcomes. Evaluation methodologies are varied, reflect established professional and practice competencies, and measure the achievement of the student learning outcomes. Western s Nursing Program utilizes various evaluation methodologies appropriate to the students semester placement, increasing in difficulty and reflecting established professional practice competencies and measure the achievement of the SLO s. In PBL the facilitator utilizes the PBL rubric. Each item of the rubric is scored either 0, 0.5, or 1 for a possible 24 points at the end of each case. (See Appendix K for the Nursing I-IV PBL Rubrics) In Nursing I students begin to verbally evaluate themselves in PBL. As they progress through the program they are encouraged to evaluate their group effectiveness and their peers. This information is utilized by the facilitator in the scoring process. The ability to self-assess is a contemporary issue in educational literature relating to professional competencies in the area of leadership. Self-assessment is used to help the students reflect on their learning and articulate their thinking process. Assignments are chosen carefully to enhance learning, be contemporary in nature and be of sufficient variety to account for different learning styles. In accordance with a continuing focus on writing by Western, each semester has a written paper. As the benefits of self-reflection became more concrete in educational literature, reflective

105 journaling and capstone discussions have been incorporated in the first and final semesters. Reflection is evident in Nursing II-IV as each group discusses their individual clinical experiences in a post clinical discussion held on the last day of their case. As the students may have experiences in different communities, and the curriculum allows for a menu approach to meeting objectives for most cases, these discussions can be very rich in learning. A Minimum Data Set (MDS) assignment, centering on care planning and reimbursement has been added to Nursing IV while SBAR documentation with concurrent care planning has been added to Nursing II and III. These assignments relate to the clinical settings utilized and the concepts under study in PBL as well as being reflective of contemporary issues of concern in nursing. Objective examinations to measure achievement of understanding of didactic content are conducted at the end of each PBL case with a cumulative final at the end of each semester. While there is some controversy regarding the benefits and accuracy of examinations in terms of true measurement of understanding, they remain the best alternative at present and so the program continues to use them. Testing policies may be found in the syllabi (see Exhibit O) and on page 21 of the Student Handbook. The only examinations conducted in the Skills Lab portion of the program are Math exams done in Nursing I and III. Otherwise, student achievement of SLO s are verified through competency check offs performed by instructors. Students have up to three attempts to check off, with time for remediation between. Competency check offs are based upon a nationally recognized software program (ATI) and therefore reflect

106 current standards of practice competencies. The Clinical Evaluation Tool is utilized by both instructors and students in the clinical setting to evaluate achievement of SLO s. The tool is used for each week of clinical. First students evaluate their perceptions of themselves, and then turn the tool in to their instructor who then gives them feedback. Only the instructor grade is used in determining course grade. All clinical grades are Pass/Fail in an attempt to minimize the inherent subjectivity of grading in the clinical setting. The tool is designed around the Goals for Student Success, including Apply Therapeutic Nursing Interventions, with specific nursing sub-concepts and subcategories to organize the expected clinical student learning outcomes. While the goals and sub-concepts remain the same each semester, the SLO s increase in both complexity and difficulty with each semester until the end of the fourth semester the student will complete objectives that are congruent with being a competent beginning nurse. (See Exhibit U for N I-IV Clinical Evaluation Tools) In Nursing IV, when a student has finished a 48 hour M/S capstone rotation, the assigned preceptor completes a Clinical Feedback Tool. (See Exhibit V for the Clinical Feedback Tool) These preceptors are in close contact to the Nursing IV faculty and student issues are taken care of in a timely manner. The preceptors who utilize this tool have received training in its use by faculty, and are closely mentored and monitored by faculty. For shorter precepted experiences a concise Preceptor Feedback of Student forms is used, it includes only two questions: What did this student do well? and What advice would you give this student for improvement in their clinical performance?

107 are evaluated. The syllabi and point distribution tables assist the student to understand how they 4.8: The length of time and credit hours required for program completion are congruent with the attainment of identified student learning outcomes and program outcomes and consistent with the policies of the governing organization, state and national standards, and best practices. Program length and credit hours will be congruent with the attainment of identified outcomes and consistent with the policies of the governing organization, state and national standards, and best practices. The program of study for the Nursing Program is shown in Table 4.7. Table 4.7: Program of Study for Associate Degree in Nursing Western Wyoming Community College Program for Associate Degree in Nursing * Prerequisites Credit General Biology (BIOL 1010).. 4 Human Anatomy & Physiology I (BIOL 2010)... 4 General Psychology (PSYC 1000)... 4 College Algebra (MATH 1400 or higher) To apply for fall admission, students must complete all prerequisites by the end of spring semester. All prerequisites are offered in the spring semester to allow for completion in one semester. Fall Semester* Nursing I (NRST 1610) Human Anatomy & Physiology II (BIOL 2015) First Year Credit Spring Semester Credit Nursing II (NRST 1620)... 9 English Composition I (ENGL 1010) Fall Semester Nursing III (NRST 2630) English II (ENGL 1020, 1111, or 2010) Second Year Credit Spring Semester Credit Nursing IV (NRST 2640)... 9 US Government... 3 *Assessment Requirement... _ *Available for student entering the nursing program in the Fall of 2015 Total: credits All above courses must be completed with a C or better to earn Associate Degree in Nursing. All general education courses may be taken prior to admission into the nursing program. General education courses taken while in nursing program must be taken evenings, Internet or other asynchronous format with the exception of Human Anatomy & Physiology II. Students must be admitted to the program to enroll in nursing courses. The Associate Degree Program is available face to face in Rock Springs and via distance modalities. Portions of the program may also be available in Rawlins. * The Assessment Requirement may be met by taking a 1 credit course or meeting assessment portfolio requirements (0 credits).

108 For the nursing class admitted in Fall 2015, it will be possible to complete the Program in five semesters, which is the suggested national standard for maximum length of program. For the students accepted into the Fall 2014 class, the required courses and credit hours are as described in the program of study shown in Table 4.8. Table 4.8: Program of Study for Associate Degree in Nursing Western Wyoming Community College Program for Associate Degree in Nursing Prerequisites Credit General Biology (BIOL 1010).. 4 Human Anatomy & Physiology I (BIOL 2010)... 4 Human Anatomy & Physiology II (BIOL 2015)... 4 General Psychology (PSYC 1000)... 4 English Composition I (ENGL 1010)... 3 Precalculus Algebra (MATH 1400 or higher) To apply for fall admission, students must complete all prerequisites by the end of spring semester. First Year Fall Semester* Credit Nursing I (NRST 1610) Spring Semester Credit Nursing II (NRST 1620)... 9 English Composition II (ENGL 1020, 1111 or 2010) Second Year Fall Semester Credit Nursing III (NRST 2630) US Government Spring Semester Credit Nursing IV (NRST 2640)... 9 *Assessment Requirement... _ The Nursing Program uses theory/lab/clinical hour formula of the College, as illustrated in Tables 4.9 and

109 Table 4.9: Contact Credit Hour Formula by Contact Hours Type Of Course Theory Lab Clinical Minimum Hours Attached to Type of Course 1 credit hour = 15 contact hours 1 credit hour = 30 contact hours 1 credit hour = 45 contact hours Table 4.10: Credit Hour Formula - by Minutes Type of Course Theory Lab Clinical Minimum Hours Attached to Type of Course 1 credit hour = 750 minutes 1 credit hour = 1500 minutes 1 credit hour = 2250 minutes The Nursing Program s breakdown of theory, lab and clinical hours can be seen in Table 4.11, below. Table 4.11: Theory, Lab, and Clinical Credit Hours by Semester Semester Theory credits Lab credits Clinical credits Nursing I Nursing II Nursing III Nursing IV The Nursing Program s credit hours are congruent with other Western Programs of Study, as illustrated in Table Table 4.12: Nursing Program Credit Hours Comparison to Other Western Programs Program of Study Credit Hours to complete Associate Degree in Nursing credits ( & ) General Studies AS credits General Studies AA 66 credits Business Administration AS 68 credits Biology AS credits Archaeology AA credits

110 The WSBN does not specify minimum or maximum credits for ADN Programs. Western s Nursing Program s credit hours are congruent with other Wyoming ADN Programs, as shown in Table Table 4.13: Comparison of Credit Hour Requirements to Other Wyoming Nursing Programs College Western Wyoming Community College Central Wyoming College Casper College Northern Wyoming College Northwest Community College Laramie County Community College Credit Hours to complete credits 76 credits 72 credits 70 credits credits 74 credits Western s Nursing Program curriculum supports the achievement of the identified SLO s and Program outcomes of the nursing education unit. The curriculum is also consistent with safe practice in contemporary health care environments as evidenced above. 4.9: Practice learning environments support the achievement of student learning outcomes and program outcomes. Practice learning environments support the achievement of student learning outcomes and program outcomes. The Nursing Program has Cooperative Education Agreements with 54 agencies (see Clinical Affiliates) to use as practice learning environments. Service area communities are very generous with their time and expertise to assist the Nursing Program in the development of competent beginning nurses. The learning environments range from the typical hospital and long term care (LTC) facilities to the county jail. The clinical sites for Nursing I are limited to the long term care area and

111 one community based experience (adult vaccination clinic). All clinicals in Nursing I are faculty led. Each semester has instructor-led clinical experiences: Nursing I (as mentioned above), Nursing II at the state psychiatric hospital and general hospitals (medical/surgical), Nursing III at area hospitals (medical/surgical), and Nursing IV at area long term care sites (management experience) and the home of a client who suffers from immobility. Nursing II-IV utilize RN preceptors as well as other clinical partners to meet the student learning outcomes. Tables for each semester s practice learning environments, clinical experiences with learning outcomes and a list of agencies can be found in the document Practice Learning Environments. The following criteria are used for the selection of practice learning environments utilized for student experiences: The institutions/agencies are reasonably accessible geographically. The institutions/agencies hold the licenses required by the state of Wyoming and are fully accredited by the appropriate bodies. The administration and nursing staff are supportive of associate degree education and there is an interest and a willingness to cooperate in providing a climate for student learning. The nursing staff is comprised of sufficient professional nurses who demonstrate quality nursing care and who serve as effective role models for student learning. The resources utilized for learning experiences include the quantity, quality, and variety needed to meet the clinical objectives and student learning outcomes. The institution/agency provides space for instructional purposes

112 Current policy/procedure manuals are available for use. The Nursing faculty use student evaluations and professional experience to evaluate the appropriateness of practice learning environments for continued use. Approximately eight years ago a local nursing home received poor reviews from both students and faculty. We discontinued the use of that facility for the Nursing I instructor-led experience. Concerns related to students in a practice learning environment or with the facility or staff of that agency are addressed as they arise by the faculty and/or director. The Nursing Program s practice learning environments support the achievement of Program outcomes as evidenced by successful Program outcomes over the past three years. 4.10: Students participate in clinical experiences that are evidence-based and reflect contemporary practice and nationally established patient health and safety goals. Clinical experiences will be evidence-based and reflect contemporary practice and nationally established patient health and safety goals. Students participate in clinical experiences that are evidence-based and reflect contemporary practice and nationally established patient health and safety goals. Clinical experiences are chosen to relate to the concepts currently being studied in theory. For example, Nursing I is focused upon chronic, but common and predictable problems so students attend clinical in LTC facilities. Flu shot clinics are also incorporated when students are studying infection control for the purpose of emphasizing the critical contemporary practice of primary prevention for health promotion. Nursing II begins to introduce students to a broader age range of clients with less predictable problems thus students begin practicing in the

113 hospital setting under the guidance of an instructor. These are the traditional clinical experiences commonly referred to in the educational literature and are instructor-led. All instructor-led clinical experiences have no more than an 1:8 ratio as per WSBN requirements. An instructor-led experience unique to Western is the Management of Care experience in Nursing IV. In order to prepare students for the demands of multiple patients and delegation in the work setting, students are assigned 6-10 patients in a LTC facility. They are responsible for everything within the RN role including supervision of direct care staff, medication administration and documentation. This experience has consistently received positive accolades from students regarding the benefit of preparing them for the future. For this intense clinical experience, the student to instructor ratio is 1:4 or 5. While not instructor-led, the Clinical Capstone Precepted experience is also reviewed by students as highly beneficial. Again in Nursing IV, students are paired with a small cohort of experienced preceptors to work for 48 hours in a hospital setting. During this time, they become responsible for the full patient load of the nurse, under his/her direct guidance. The low population base of frontier sites creates a challenge for nursing educators in terms of volume, variety and complexity of client availability for students. The Western Nursing faculty have overcome this challenge by using two creative approaches to clinical experiences: Conceptual Clinical and the Menu Approach. When combined, these

114 approaches allow students, regardless of physical location, to obtain equivalent experiences to meet SLO s, minimize travel required, promote development of individual interests, maximize use of faculty expertise, and prevent overloading of clinical sites. Conceptual clinical, as explained in the educational literature, refers to going where the patients with the concepts under study are, instead of waiting for the patients to come to you, i.e. at the hospital. The Menu Approach allows the student to choose which of the conceptual clinical experiences they are interested in and what best fits with their individual schedule. When studying Diabetes Mellitus (DM) in Nursing II, students may interview a client with DM about living with the disease, spend time at a dialysis center or with a podiatrist, attend a Diabetic Support Group meeting. Not all experiences are offered in community, but each student may go to any location they choose. (See Practice Learning Environments) The variety of clinical experiences bring rich learning environment to the student s. The Clinical Coordinator s and faculty thorough expertise and familiarity with the clinical learning environments are able to assure the students receive comparable experiences that achieve the SLO s. Each clinical experience, whether conceptual or traditional, has a post clinical discussion. During this discussion students share their experiences, explain their application of the standards of QSEN, National Patient Safety Goals, and facility specific criteria, as well as reflect on and synthesize their learning

115 4.11: Written agreements for clinical practice agencies are current, specify expectations for all parties, and ensure the protection of students. The Cooperative Education Agreements with clinical practice agencies clearly specifies the expectations of and protections for all parties involved. The Cooperative Education Agreements were renewed by Western and the agencies in 2013 after the College revised their agreements. The agreements remain in place until either party chooses to change or dissolve the agreement with appropriate written notice. In the case of several of the larger agencies the agency contract has a specified renewal date. (See Exhibit W for the Cooperative Education Agreement) 4.12: Learning activities, instructional materials, and evaluation methods are appropriate for all delivery formats and consistent with the student learning outcomes. All learning activities, instructional materials, and evaluation methods are appropriate for all delivery formats and are consistent with the student learning outcomes. Biannual discussion of learning activities, materials and evaluation methods occurs after each semester. PBL is offered in both face-to-face and synchronous distance format using Blackboard as the support platform and BigBlueButton as the synchronous web conferencing platform. Both modalities use the same instructional materials, classroom format and evaluation methodologies and thus provide consistent SLO s. Distance delivery options are available to students at distant sites, and, depending upon enrollment numbers, to some students on the main campus. All students, whether faceto-face or distance, must participate in skills lab, simulation and clinical experiences as well as didactic/theory PBL

116 When physical and faculty resources allow, the skills lab, simulation and clinical are made available at outreach sites. Skills labs are offered at the main campus in Rock Springs, and the outreach sites of Evanston and Rawlins for Nursing I and II. Students may choose to attend skills lab at whatever site is most convenient for them in terms of distance to travel. Faculty work closely to ensure that instructional materials, learning activities and evaluation methods are consistent site to site and enable the student to meet the SLO s. Simulation opportunities are based upon faculty and equipment availability. High fidelity simulation mannequins are only available in Rock Springs and Rawlins so students must travel to those sites for simulation experiences. The faculty does consider the amount of travel required when devising schedules and attempt to minimize student travel as much as possible while still providing the best student learning experiences possible. Travelling for clinical is an accepted part of nursing education in frontier communities. It is necessary for students to go to where the experiences and faculty are. Various clinical opportunities are located in various communities and, at some point, all students will travel for a clinical experience. For example, while geriatrics and management of care are offered at all three primary locations, the mental health Wyoming State Hospital experience is only offered in Evanston and the precepted capstone medical surgical experience is only offered in Rock Springs. Some precepted experiences are offered in locations other than Rock Springs, Evanston and Rawlins. As

117 previously discussed, different types of clinical experiences have different types of evaluation methodologies, but all are consistent site-to-site

118 STANDARD 5: Resources Fiscal, physical and learning resources are sustainable and sufficient to ensure the achievement of the student learning outcomes and program outcomes of the nursing education unit. 5.1: Fiscal resources are sustainable, sufficient to ensure the achievement of the student learning outcomes and program outcomes, and commensurate with the resources of the governing organization. Fiscal resources are sustainable, sufficient to ensure the achievement of the student learning outcomes, program outcomes, and commensurate with the resources of Western. Western s Nursing Program budget is adequate to ensure the achievement of SLO s and positive program outcomes. The College provides the program with an annual operating budget for the upcoming fiscal year. (See Appendix M for the Nursing Program Budget) The College is funded through a variety of sustainable resources. Approximate percentages from the various sources of funding include: 20% institutional funding 33% state funding 42% local tax revenues 3% carryover funds. In the biennium, Western received 14.37% of the funding available from the State of Wyoming for the seven community colleges throughout the state. This amount increased slightly to 14.57% for the biennium. The Vice President of Finance for Western expects this amount to remain in this approximate area in the foreseeable future. See Table 5.1: New Funding Allocation

119 Table 5.1: New Funding Allocation New Funding Allocation Biennium Biennium Biennium Biennium Casper College State Appropriation 38,181,239 43,224,265 State Appropriation 20,189,642 22,050,607 Local Appropriation 13,244,067 11,649,698 Local Appropriation 7,695,668 7,856,754 Total Allocation Funds 51,425,306 54,873,962 Total Allocation Funds 27,885,310 29,907,361 Central Wyoming College Northwest College Northern Wyoming Community College District State Appropriation 15,049,095 15,770,248 State Appropriation 25,162,982 26,966,204 Local Appropriation 8,237,455 8,922,476 Local Appropriation 4,362,364 4,647,569 Total Allocation Funds 23,286,550 24,692,725 Total Allocation Funds 29,525,346 31,613,773 Eastern Wyoming College Western Wyoming Community College State Appropriation 14,184,407 15,737,509 State Appropriation 10,156,709 11,488,171 Local Appropriation 1,671,393 1,450,146 Local Appropriation 23,858,346 24,055,662 Total Allocation Funds 15,855,800 17,187,655 Total Allocation Funds (14.57%) (14.37%) Laramie County Community College System State Appropriation 40,625,962 44,089,582 State Appropriation 163,550, ,326,586 Local Appropriation 10,892,583 9,451,782 Local Appropriation 69,961,876 68,034,087 Total Allocation Funds 51,518,545 53,541,364 Total Allocation Funds 233,511, ,360,673 The resources allocated to the Nursing Program are commensurate with the resources of other College programs focused on preparing students for entry level positions in the workforce, such as Welding and Workforce Development. The attached budgets (See Appendix L for Budget Comparisons to Similar Programs and Appendix M for the Nursing Program Budget) demonstrate the equitable distribution of resources while considering the cost of disposable consumables and equipment depreciation. The Nursing Program follows the budgeting process required by the College. Budgeting begins in February when the Director submits the faculty supported annual budget request to the Vice President of Student Learning. The request is then submitted to the Executive Council and finally to the College Board of Trustees. Discussion and changes may occur at any point in the process. Once the overall budget is approved, the

120 Director of Nursing administers the program budget. The Director obtains faculty input on budget items through two primary methodologies. The first is through a reminder in December to give the faculty time to contemplate needed resources and her back with specific requests. The faculty will also discuss desired resources during the regular monthly faculty meetings, the second methodology. This discussion allows for input from all members and prioritization of department needs, which includes allocation of faculty across the curriculum. The Director uses this information when developing the final budget request for the College. In 2013 the faculty requested, and the Nursing Program received, extra funding to purchase two laptops and monitors to be utilized in the simulation lab. The Gaumard simulator and simulation lab remodel were funded with one time monies requested by faculty and the Director. In 2014, Perkins grant funding also paid for two days of on-site simulation education for faculty. The Nursing Program provides services to students on the Rock Spring campus and on two outreach campuses, Evanston and Rawlins. The Board of Cooperative Education Services (BOCES) in Evanston provides educational opportunities to community residents in this physical location through an ongoing contractual agreement. BOCES provides financial remuneration to Western for their services, but no specific funds are allocated to the Nursing Program. The Board of Cooperative Higher Education Services (BOCHES) in Rawlins has a Memorandum of Understanding (MOU) with Western regarding the Nursing Program

121 This agreement enumerates that BOCHES will provide not only fiscal support for one fulltime faculty member and office space and furniture for a second, but also the physical resources of dedicated classrooms, a testing room, a nursing skills lab, 2 simulation rooms and a small scale nursing library. Subsequently, there is a budget for the Rawlins site that is administered by the BOCHES Director with input from the nursing faculty and Director as above. (See Exhibit X for an example of a completed MOU) The faculty is currently composed of eight full-time faculty members and the Director. Two allocated faculty positions currently remain open due to the low enrollment numbers the program has recently experienced. Four of the eight faculty positions have been secured through WyIN, a state program funded through June of 2016 (WyIN Program Link). It is anticipated that the legislature will continue to fund this program, and grassroots efforts by multiple educational and healthcare entities within the State are working toward this outcome. In the event the WyIN funding is not continued, the Western administration has made a commitment to find resources to replace WyIN funding should the legislature choose not to continue funding after Of the faculty positions funded by WyIN, two are in Rock Springs, one is in Evanston, and one is currently open. The Director, three faculty positions in Rock Springs (one of which is open), and one faculty position in Rawlins are funded by the general operating fund. Funding for one faculty position in Rawlins is provided by BOCHES and is expected to be ongoing. All College faculty remuneration is based upon the FT Faculty Salary Schedule

122 (See Appendix N for the Full-time Faculty Salary Schedule) and administered as per the College policy and procedure. (See Exhibit Y for Policy and Procedure 4220B-Promotion, Transfers, and Demotions). All salaries are commensurate with other departments within Western. Western has devoted approximately 75% of its unrestricted fund budget toward salaries. See Table 5.2 for Western s yearly salary comparison. Table 5.2: Yearly Salary Comparison for Western Western Wyoming Community College Yearly Comparison for Salaries Adjusted Budget 2014 Actuals 2014 Adjusted Budget 2013 Actual 2013 Salaries and Benefits for the Unrestricted Fund $ 18,796,136 $ 13,081,038 $ 19,838,995 $ 18,943,912 Total Expenses for the Unrestricted Fund $ 26,445,989 $17,591,340 $ 27,510,016 $ 25,484,725 % of Salaries to Total 71.07% 74.36% 72.12% 74.33% In addition to salary, each faculty member receives $ Professional Development money yearly. This money may be utilized by the faculty member for books, continuing education, association and licensing fees, etc. The faculty member may pay for the desired service and request reimbursement after receiving approval from their department head, or may submit a purchase request to their department head in advance of purchase. Faculty and staff members may take unlimited classes from Western, and one three-credit hour class per semester from the University of Wyoming free of charge, via a tuition reimbursement agreement

123 5.2: Physical resources are sufficient to ensure the achievement of the nursing education unit outcomes, and meet the needs of the faculty, staff, and students. Physical resources are sufficient to ensure the achievement of the nursing education unit outcomes, and meet the needs of the faculty, staff and students. Beginning in May 2014 student satisfaction with physical learning environments was assessed using an anonymous survey using primarily Likert scales for scoring. The faculty set an ELA of >3.5 on 5 point Likert scale for students to rate that classroom, lab and simulation promoted achievement of learning needs. These student evaluations are reviewed by the Director at the end of the semester and discussed with faculty as needed. The faculty discuss physical resources at least annually, in March. Additionally, all of the faculty agree that physical resources are sufficient to meet the learning needs of the students, another ELA set by faculty. The Western s Rock Springs campus is a modern, spacious facility that is wellmaintained. The Director, the Office Assistant, and three nursing faculty members occupy a suite of offices on the second floor. In addition, two faculty members occupy individual offices, in close proximity to each other, on the first floor. All faculty offices are private and lockable, allowing for security of student conversations and information. All offices are equipped with a speaker telephone, a printer, a personal computer with a webcam and microphone for classes and meetings at a distance. All faculty members, the Director and the Office Assistant, have Western accounts and access to facility-wide software tools and the Internet. Nursing Program publications, shared working files, and other information are kept on secure Western file

124 servers; all faculty members have access to this shared working space from the Rock Springs Campus intranet or from any remote location via individual Virtual Private Network (VPN) connections. The second floor office suite includes a conference room where meetings can be held. This area includes a speaker phone that enables distant faculty to easily participate in meetings. A storage area adjacent to the conference room houses office supplies, curriculum materials, and current nursing program student files. This storage area is locked, thereby limiting access to faculty and the Office assistant. The office suite is also kept locked when unoccupied, thus maintaining student files in a doubly secured environment. All faculty, staff and students have adequate access to facsimile and copy machines as well as Internet-enabled computer workstations. A print shop that copies and assembles large printing orders for the Nursing Program is also available. Classrooms that accommodate students comfortably are scheduled each semester though the Western office of Registration and Records. The Director may request specific classrooms when submitting course schedules; however, classroom assignments are not guaranteed. Thus classrooms may vary semester to semester, but all classrooms are in good condition, with seating and fixtures adequate to student and faculty needs. Classrooms in use for Fall 2014 include room 1206 which is 12 7 x It holds two large rectangular tables surrounded by nine comfortable chairs. It has a SmartBoard with a separate kiosk holding a computer with wireless mouse, an overhead projector and a

125 wireless keyboard. Wireless Internet connectivity is provided. Room 1348 is slightly larger in size at 29 7 x Seven rectangular tables and fifteen comfortable chairs can be reconfigured into many formats. One small round table and a kiosk holding a computer with a wireless mouse complete the furnishings. Wireless Internet connectivity, a SmartBoard, an overhead projector and a wireless keyboard provide for technological needs. The Nursing skills lab is located on the first floor on the north end of the building. This lab is spacious at 27 6 x 37, sunny, and well-equipped and well maintained with all equipment in good repair. It contains eight electrically powered hospital beds with overbed tray tables and bedside tables. Two Laerdal Adult and one Pediatric VitalSim mannequins with SimPad controls and monitors are housed in the lab. A birthing simulation mannequin is also available but has not yet been utilized. All mannequins are up-to-date. Two computer workstations are available for student use during lab. In addition, a storage and preparation area is across the hall from the lab. Supplies are replenished annually, and the students have consistent access to use of consumables for lab experiences. The lab is also utilized by students in the Nursing Assistant course. The lab is accessible to students when faculty is scheduled and available and locked when not in use. The recently renovated simulation lab is located adjacent to the primary lab. The simulation lab, 20 X 12, is functionally equipped and houses a Laerdal SimMan highfidelity simulation mannequin purchased in 2007 and a Gaumard high-fidelity simulation

126 mannequin purchased in 2014 with monitors and computer charting station. A separate control room overlooks the simulation lab. The lab is only available during scheduled simulation times. Beginning Spring 2014, student s satisfaction with physical resources was added to the end of semester survey tool. On the Spring 2014 evaluation (n=45, 88% response rate), the results of all students were as follows: Table 5.3: Student Satisfaction with Physical Resources Classroom (including web based) promoted achievement of the 4.4 / 5 learning outcomes. Lab space promoted achievement of the learning outcomes. 4.0 / 5 Simulation space promoted achievement of the learning outcomes. 4.8 / 5 5.3: Learning resources and technology are selected with faculty input and are comprehensive, current, and accessible to faculty and students. Learning resources and technology are selected with faculty input and are comprehensive, current, and accessible to faculty and students. The faculty set the ELA at greater than 3.5 on a 5 point Likert scale for this outcome. On the Spring 2014 survey tool students rated their satisfaction with learning resources at 4.8/5 on the Likert scale (n=51, 100% response). The learning resources at Western Wyoming Community College are comprehensive and current. The Hay Library at Western is spacious, beautiful, and provides an environment conducive to study. There are individual and group study rooms available to students during all open hours. The Library houses approximately 135,000 print volumes and audiovisual materials, 100,000 electronic books, and paid subscriptions

127 to 153 print periodicals. Online access to numerous reference resources as well as 173 comprehensive periodical databases, 33 of which are dedicated to study in the Health Sciences, is available to students and faculty, at all sites, 24 hours a day. Many databases include complimentary mobile applications. (See Exhibit Z for the Library Periodical and Database lists) Students receive general and subject-specific research instruction from library professionals during a mandatory library orientation in Nursing I. Students may also request individual assistance/orientation from the library staff at any time, and library staff are willing to travel to distant sites to provide extra orientation or education when requested. Online orientation tutorials are available on the Hay Library website and can be accessed via Mustang Cruiser or via the Tools tab in each course Blackboard shell. The Hay Library provides interlibrary loan services to all students at no charge. The Library is open 80.5 hours per week: Monday - Thursday 7:30 a.m. to 11 p.m., Friday 7:30 a.m. to 5 p.m., Saturday 1 p.m. to 5 p.m., and Sunday 5 p.m. to 10 p.m. Library professionals and staff are available by phone, , and through instant messaging. All Hay Library services, including research instruction, are available to all students regardless of geographical location. More information is available on the Hay Library Website. The Nursing faculty participates in the Hay Library collection development by submitting requests for new materials from September to April. The College Library book budget is $32,000 per year, with no set allocations for particular subject areas. All nursing materials in the Hay Library collection are reviewed yearly by the nursing faculty. Library

128 materials older than five years are discarded unless nursing faculty determine the content is still relevant to nursing practice. The Western ITS Department provides and maintains computer hardware, software, and networking needs of faculty and students. The IT Help Desk is available to all students and faculty, including distance, via and telephone, and a toll-free number is provided. Technicians are available for troubleshooting and hardware and software upgrades. Contact information can be found on Mustang Cruiser and in Blackboard course shells. Hours are Monday through Friday, 8 a.m. to 5 p.m. There are approximately 200 computers available for student use on campus. Faculty and student services and resources, the IT staff directory, and maps of available computer kiosks and computer labs are available on the Western's IT Website. Students may utilize the computers whenever the buildings are open and wireless Internet service is provided. The Western Distance Learning Department supports the Nursing Program faculty, staff, and students with technological assistance for the Blackboard course management system employed by Western as a whole. This system is utilized as a framework for both face-to-face and distance delivery nursing classes. Members of the Distance Learning staff also assist the nursing faculty in the development and maintenance of Program-wide internet-based classes and components and by promoting individual skill development. Skill development is provided through collaborative faculty classes, online and in person, which are also taped and archived for future reference. The Distance Learning staff

129 provides students and faculty with contact information via postcards, and in Blackboard class shells at the beginning of each semester. This information includes an address as well as a toll free telephone number that is answered from 8 a.m. to 8 p.m. seven days per week. A 2011 program review of the Distance Learning department showed very high levels of student satisfaction with the performance of the Distance Learning staff (knowledge, helpfulness, responsiveness) and the Western IT Help desk (hours, responsiveness, helpfulness, and knowledge). The Nursing Program utilizes third-party Internet-based services and products in both ad hoc and integrated capacities. Examples of these resources include YouTube video clips used by faculty for training/support and ATI Nursing Education, used for curriculum augmentation and quality assurance. The faculty chose ATI for its excellent resources and the ability to complement our PBL curriculum. Primary support for thirdparty resources is provided through the resources themselves. Supplemental support is provided on an as-needed basis by the Western IT and Distance Learning departments and faculty/student peers. As Table 5.4 shows the students believe the learning resources utilized by the program and available at the college meet their learning needs. Table 5.4: Student Satisfaction with Learning Resources Learning resources (required texts, ATI, library databases, etc.), including web based resources, sufficient to meet my learning needs. 4.8/5 (n= 51 students, 100% response rate)

130 5.4: Fiscal, physical, technological, and learning resources are sufficient to meet the needs of the faculty and students engaged in alternative methods of delivery. The fiscal, physical, technological and learning resources are sufficient to meet the needs of the faculty and students engaged in alternative methods of delivery. The faculty have set the ELA for this outcome at >3.5 on 5 point Likert scale as per the end of semester survey tool. Beginning in May 2014 distant students were asked to rate satisfaction with classroom (including web based), lab and simulation space using the Clinical Facilities Evaluation Tool. See Table 5.5 for the distance student satisfaction results. Table 5.5: Distance Student Satisfaction with Resources CATEGORY RESULT Classroom Resources 4.2 / 5 Lab Resources 4.1 / 5 Simulation Resources 4.2 / 5 Learning Resources 4.2 / 5 Technological Resources 3.8 / 5 (n=27, response rate 100%) Cases, assignments, objectives and evaluation methodologies are identical regardless of the site or delivery method utilized. Equivalency between distance and on campus is demonstrated by equal attainment of SLO s and congruent NCLEX pass rates by students. In 2013, distance students had a NCLEX pass rate of 94% while on-campus students had a pass rate of 92%. At the time of this writing, 2014 pass figures are not finalized. The graduating class of 2013 is the first cohort to have had an option for two or more semesters as distance students. Students from Rawlins have been followed for the

131 past three years. Prior to the 2013 graduating class, formalized distance delivery options were not available except as a face to face option in Rawlins. (Refer to Section 6.4.1) The discussion below demonstrates that while resources at each delivery site are not exactly the same, they are similar enough to provide equivalent learning experiences to those offered on the Rock Springs campus. The fiscal support Western provides to the Nursing Program finances alternative methods of delivery with the addition of some funding from community-based sites in Rawlins and Evanston, Wyoming. These funds are made available through the BOCHES and the BOCES respectively. Much of the disparity between the resources (described below) offered between the Rawlins and Evanston sites is explained by the financial support offered by and the agreements between the respective BOCHES, BOCES and Western. A combination of student enrollment, student choice and faculty availability is utilized in determining the method of delivery for classes each semester. Fiscal resources required are the same for the provision of face-to-face classes and distance delivery classes as each necessitates 1 instructor for 8 students in a PBL class and in clinical settings. The Rawlins faculty members have offices located near the nursing lab, nursing classrooms and simulation rooms in Rawlins. The Evanston faculty member has an office located near the Nursing lab and simulation room in Evanston. All faculty offices, at all sites, are private and lockable, allowing for security of student conversations and

132 information. All offices are equipped with a speaker telephone, a printer, a personal computer with a webcam and microphone for classes and meetings at a distance. The physical spaces in Rawlins and Evanston have meeting areas located near the nursing faculty offices. All physical locations have adequate access to facsimile and copy machines and Internet-enabled computer workstations for faculty, staff, and students. The dedicated classroom spaces available in Rawlins at the Carbon County Higher Education Center Career and Technical Center (CATEC) are near the nursing lab, simulation rooms and faculty offices. Room A113 is 16 5 x 26 8 and holds 1 large rectangular table and 8 comfortable chairs in the center of the room. Along two outside walls are 10 computer stations for testing. One perimeter wall is composed entirely of window, while another has a white board. One computer is connected to an overhead projector and equipped with a wireless keyboard and mouse. Room A112 is much larger at 21 4 x 17 8 and has 6 rectangular tables and 18 comfortable chairs. The tables and chairs may be repositioned for better learning experiences as classes require. A double whiteboard occupies one wall. At_16 x 20 Room A114 is the smallest classroom available for instruction. It holds 4 rectangular tables and 12 comfortable chairs. A whiteboard encompasses one wall. Portable overhead projectors and laptops are available for use in these classrooms. All Evanston didactic instruction is provided via distance technology, thus no dedicated classroom space is assigned at this site. Distance didactic instruction is utilized by students in their homes. Distance

133 testing is performed at Western Outreach facilities suitably equipped and staffed to administer and proctor exams. With the exception of the main outreach sites of Evanston and Rawlins, all outreach sites must apply for, and receive approval from the program, prior to being allowed to administer and proctor exams. This ensures both exam security and testing efficacy and equivalency for the students. The Rawlins site Nursing skills lab, 16 5 x 33 4, contains four electrically powered hospital beds with over-bed and bedside tables, and includes a storage area. There is one Laerdal Adult VitalSim mannequin and two standard nursing training mannequins in this lab. A birthing simulation mannequin is also available but has not yet been utilized. All lab equipment is up to date and in good repair. Students have consistent access to consumables for lab experiences. The lab is accessible to students when faculty is scheduled and available and locked when not in use. This lab is also utilized by the students in a nursing assistant course. Two low incidence, high acuity simulation rooms and a control room are adjacent to the skills lab. Each simulation room is 11 8 x 14 8, and is functionally equipped. One room houses a Laerdal SimMan high-fidelity simulation mannequin while the other houses a Laerdal pediatric VitalSim with Sim Pad and monitor. The simulation control room is 9 3 x 10 5 and allows oversight of the simulation rooms via one way glass and 2 way microphones. These locations are only available during scheduled simulation times, and are locked except when in use. The lab and physical resources at the Evanston site are shared with a nursing

134 assistant course based in Evanston. The Evanston lab is 23 2 x 22 8 with a small storage area to the side. It has three electrically powered hospital beds with over-bed and bedside tables. There are nursing skills training mannequins in each of these beds. All lab equipment is up-to-date and in good repair. Students have consistent access to consumables for lab experiences. The lab is accessible to students when faculty is scheduled and available and locked when not in use. Near the nursing lab is a Simulation lab, 15 x The simulation lab is functionally equipped and houses a Laerdal Adult VitalSim mannequin with a SimPad control and monitor. This lab is only available during scheduled simulation times, and is locked except when in use. While each lab differs significantly in size and equipment, all physical resources are more than adequate to accommodate the number of students utilizing the site. Rock Springs has between 16 and 32 students at each level, while Evanston has between six and twelve students at each level and Rawlins one to six students per level. All laboratory and low fidelity simulation experiences are equivalent at all sites. High fidelity simulation experiences are offered only in Rock Springs and Rawlins, due to the availability of resources and faculty experienced in the provision of this type of simulation. Evanston students must travel to Rock Springs or Rawlins when experiences requiring the use of a high fidelity mannequin are scheduled. The faculty recognize the extra burden this places on the students and attempt to schedule these experiences when travel for other reasons is already required. In addition to the distance access to Hay Library, students also have access to

135 nursing text resources at the Rawlins site. At the Rawlins site the Nursing Library is housed in x 14 8 lockable room with the books and videos on shelves. The room key is available from the receptionist during regular hours, Monday-Thursday 8 a.m. to 9 p.m., and Friday 8 a.m. to 5 p.m. Books may be checked out as students desire. The availability of a physical library is per the BOCHES agreement referenced in Section 5.1. The BOCES agreement with the Evanston site is slightly different and does not provide for the resources of a physical library. Students are welcome to use text resources of the Evanston faculty member when she is on site. Rawlins and Evanston sites maintain IT Departments that work closely with the Western IT Department to provide integrated services for students. In addition to the distance access available for the Western IT Department, students and faculty at these sites may also utilize the local IT Department personnel for assistance with computer hardware, software and networking needs. Local faculty advise students of the availability of these resources. Hours at both sites are also Monday through Friday, 8 a.m. to 5 p.m. The Rawlins site has three computer labs, two that can accommodate ten students and one that can accommodate fifteen students. The Evanston site has a computer lab that can accommodate fifteen students. In addition, the Evanston site has three computers for student use located in a Student Lounge area within the building. Students at all locations may utilize the computers whenever the buildings are open and wireless Internet service is provided throughout all locations. As the PBL distance learning modality was executed, it became apparent that

136 existing campus web conferencing resources could not support the change. After exploration, faculty specified BigBlueButton as an alternate system and implemented it. BigBlueButton, in conjunction with the Blackboard course management system, is the methodology utilized for the delivery of the synchronous distance learning didactic courses. Students and faculty interact through BigBlueButton, while course information, resources, and student work are accessed through Blackboard. The combination of these systems allows students and faculty to collaborate in a manner that provides an experience equivalent to a face-to-face classroom setting. BigBlueButton support for students is provided through the resource website and faculty. The faculty receive support through a third party contractual agreement. Utilization of these systems requires that students have access to a computer with a webcam, a microphone and Internet connectivity. These requirements are specified in each Blackboard course shell and in each class syllabus. Students admitted to the program are alerted of the technology requirements in their acceptance packet. Prospective students may access the requirements from the Nursing Program Website. Students may access the necessary technology at the Western campus, at the Evanston site or at the Rawlins site if personal equipment is unavailable

137 STANDARD 6: Outcomes Program evaluation demonstrates that students and graduates have achieved the student learning outcomes, program outcomes, and role-specific graduate competencies of the nursing education unit. 6.1: The systematic plan for evaluation of the nursing education unit emphasizes the ongoing assessment and evaluation of each of the following: Student learning outcomes; Program outcomes; Role-specific graduate competencies; and The ACEN Standards The systematic plan of evaluation contains specific, measurable expected levels of achievement: appropriate assessment methods; and a minimum of three (3) years of data for each component within the plan. The Western Wyoming Community College Nursing Program utilizes a systematic plan of evaluation to self-monitor progress with national accreditation standards, student learning outcomes, program learning outcomes and role-specific graduate competencies. The systematic plan has been modified most recently to address the updated (2013) ACEN standards and criteria. Each standard is addressed at least yearly in an assigned month during a faculty meeting. The Master plan for Program evaluation guides our process. The faculty is committed to ongoing assessment and evaluation of Program data based on the SPE in support of the achievement of student and Program outcomes. In order to effectively address achievement of our SLO s, we utilize multiple measures including End of First Year and End of Program student surveys, Graduate and Employer surveys (eight months post-graduation), preceptor rating of Nursing IV students, ATI results on Comprehensive predictor of passing NCLEX administered in the

138 final Nursing semester, and the ETS Proficiency Profile (administered to all Western Students). Expected levels of achievement have been met for the past three years. This is further supported by higher than national pass rates on NCLEX and high rates of graduate employment. Role competencies, as well as Western s Goal Apply Therapeutic Nursing Interventions, are addressed using information from the ATI Comprehensive predictor including scores on Clinical Topics and the Nursing Process. Western expects their students to score at or above national average when given. National levels not met for all areas of nursing process in 2014, but this is not a trend and will be followed. No discernable trends in clinical topics were noted over the past three years. Tables 6.1 and 6.2 show three years of ATI results, as described above. Table 6.1: Role Competencies/Apply Therapeutic Nursing Interventions ATI Sub Scores Expected Level of Achievement at or above National Mean Assessment Analysis/ Diagnosis Plan Implement Evaluation 2014 (n=26) 60.8* * 68.1* 66.9* 2013 (n=40) (n=30) (* indicates below national mean) Table 6.2: ATI Clinical Topics (No National Mean Faculty Monitor Trends) Maternity Med/Surg Pediatrics Mental Health 2014 (n=26) (n=40) (n=30) The systematic plan of evaluation contains specific, measurable expected levels of achievement and contains appropriate assessment methods and of three years of data for each component within the plan

139 6.2: Evaluation findings are aggregated and trended by program option, location, and date of completion and are sufficient to inform program decision-making for the maintenance and improvement of the student learning outcomes and the program outcomes. Evaluation findings are aggregated and trended by program option (ADN only), location, and date of completion and are sufficient to inform program decision-making for the maintenance and improvement of the student learning outcomes and the program outcomes. Aggregated data is used to make decisions to maintain, develop or improve student learning outcomes and are documented in the SPE. Aggregated quantitative evaluation findings for SLO achievement are compiled from the tools discussed in 6.1 as well as results of the reports from the WSBN NCLEX-RN report. Table 6.3 is an example of how the Program evaluates the student learning outcomes corresponding to Communicate Competently. (See Evaluation Findings to Inform Program Decision Making) Table 6.3: Communicate Competently Outcomes Communicate Competently The ability to provide accurate information, insightful observations, effective teaching, and caring behaviors. End of First Year Survey Results Goal is a rating of > 3.5 / 5 on a five-point Likert scale. 2014: 4.2 / 5 (25 students surveyed, 100% response rate) 2013: 4.2 / 5 (22 students surveyed, 100% response rate) 2012: 4.1 / 5 (39 students surveyed, 100% response rate) End of AD Program Survey Results Goal is a rating of > 3.5 / 5 on a five-point Likert scale. 2014: 4.5 / 5 (25 students surveyed, 100% response rate) 2013: 4.3 / 5 (32 students surveyed, 100% response rate) 2012: 4.6 / 5 (30 students surveyed, 100% response rate) Nursing IV Preceptor Survey Results Goal is a rating of > 3.5 / 5 on a fivepoint Likert scale for the Med/Surg Rubric. 2014: 4.5 / 5 (n=24, 100% response rate) 2013: 4.4 / 5 (n=38, 97% response rate) 2012: 4.0 / 5 (n=26s, 100% response rate) Graduate Survey Results Goal is a rating of > 3.5 / 5 on a fivepoint Likert scale. 2013: 4.3 / 5 (20 graduates surveyed, 51% response rate) 2013 ELA Met: 4.1 / 5 (Fourteen 2012 graduates surveyed, 47% response rate) 2012 ELA Met: 100% responded with at least a 4.0 / 5 on the Likert scale* (Eight 2011 graduates surveyed, 27% response rate) *Surveys not Employer Survey Results Goal is a rating of > 3.5 / 5 on a five-point Likert scale ELA MET: 4.5 / 5 Twenty-one employer surveys were received (54% response) from the 2013 graduation class covering all areas of service area and cohort type ELA Met: 4.3 / 5 (Sixteen responses/30 grads, 53% response rate) 2012 ELA Met: 100% responded with at least a 4.0 / 5 on the Likert scale* 2011 Graduates, 2

140 End of First Year Survey Results Goal is a rating of > 3.5 / 5 on a five-point Likert scale. End of AD Program Survey Results Goal is a rating of > 3.5 / 5 on a five-point Likert scale. Nursing IV Preceptor Survey Results Goal is a rating of > 3.5 / 5 on a fivepoint Likert scale for the Med/Surg Rubric. Graduate Survey Results Goal is a rating of > 3.5 / 5 on a fivepoint Likert scale. available/information from graphs done by previous director. Results were reported as satisfied if students answered 4 (agree) or 5 (strongly agree). Employer Survey Results Goal is a rating of > 3.5 / 5 on a five-point Likert scale. employer responses. *Surveys not available/information from graphs done by previous director. Results were reported as satisfied if students answered 4 (agree) or 5 (strongly agree). Western s Nursing Program has trended NCLEX pass and completion rates by cohort and location for the past four years. Graduate and employer surveys will be trended by cohort and location beginning in January 15. Evaluations findings related to student satisfaction were not trended by location/cohort prior to Spring Students evaluate facilities by name and as such we are able to evaluate and make changes with specific facility use. No facility changes have been made in the past three years. The Nursing Program uses measurement tools for each of the six Goals for Student Success and the corresponding SLO s. The data obtained from these tools are used to make program and curricular decisions. The expected levels of achievement for each area are evaluated on an annual basis as prescribed in the SPE and decisions are made by the faculty based on whether the results indicate a trend or a serious enough variation from desired to warrant curricular revision. An example of trended, aggregated data that was used to improve student learning include ATI Pharmacology scores. The faculty have been trending ATI sub scores since Over the past three years pharmacy scores have begun to decrease:

141 Table 6.4: ATI Pharmacy Scores 2014 (n=26) (n=40) (n=30) 73.1 Pharmacology is incorporated into all of the PBL cases; it is not a stand-alone course. The faculty began discussing adding a 5 point pharmacology quiz during each case at the May 14, 2014 faculty meeting. These conversations continued in August and September, These quizzes were incorporated into each PBL case in each course this semester. The points will be added as bonus points. The faculty anticipates that this will increase student motivation to take pharmacology more seriously. Also discussed in the August work-days sessions were questions to lead the students to a deeper understanding of what is important for them to know related to pharmacology, these include: a. What does the medication do? b. How do I monitor/how do I know it s working? c. What do I teach? Also noted this past year were Safety & Infection Control scores decreased: Table 6.5: ATI Safety & Infection Control Scores 2014 (n=26) (n=40) (n=30) 67.6 After discussion during the May 14, 2014 faculty meeting the Director was charged with making changes to case objectives where the content was appropriate. An example of an objective added is: Describe methods to keep patient/self/and public safe

142 from infection. Again, it is anticipated that this will lead students to a deeper understanding of infection protection. In 2012 faculty discussed student s poor skills on medication math exams. The Director discussed this issue with her statewide peers and the Math faculty. Other community college nursing programs and the University of Wyoming planned to increase the Math requirement. At the November 2012 faculty meeting, faculty agreed to make Math 1400 the prerequisite for the Program. This began in the Fall Qualitative data are obtained on clinical evaluation surveys given at the end of each semester of the program related to the students perceptions on what helped them to achieve Western s goals clinically as well as on each clinical experience and their simulation experiences. The End of First Year and End of Program surveys also ask for a qualitative response for their degree of agreement with the questions related to Western s Goals/SLO s, as well an explanation to their satisfaction that the program is preparing them to be a competent beginning nurse and what changes they would like to recommend. Graduate and employer surveys have a comment section asking them to comment on Western s Nursing Program. (See Exhibit AA for Graduate / Employer Surveys). Data show the students are generally satisfied with their experience. In the Spring 2014 after review of student clinical evaluations and faculty discussion and research clinical assignments, care planning and documentation were adapted for shorter patient stays and EMR charting. CareMaps and SBAR documentation was used to replace previous clinical assignments. Also based on student qualitative data the forth semester

143 management of care clinical experience was revised as discussed in Standard 1.3. Eight years ago a clinical agency was dropped due to student and faculty dissatisfaction with availability of needed supplies for patient care. The following are examples of the qualitative data received from the 2014 End of Program report: Table 6.6: 2014 Qualitative Data End of Program Communicate Competently (communicator, educator, caring) Throughout my clinical experience I have had the opportunity to educate patients, show how much I care, and I have improved greatly in my communication skills. I also think the situation type questions that were asked in PBL were helpful in developing how I would communicate with a patient or fellow employee. Yes, i am able to communicate competently. I feel the program did help me in this area. I had to be able to communicate about my work, to my patients, through assignments, to my classmates, to facility staff members, as well as to Faculty members. I believe that I have learned the skills to communicate competently as a beginner nurse. I think that I have come a long way from where I started and still have a long way to go. I still need improvement in this area. I could still improve in this area with difficult situations that may arise. Solves Problems (critical thinking in decision making, prioritize) I can use my knowledge to make educated decisions and when I don't know the answer I know where to find reliable evidence based information. Strong facilitator helped students learn both rationales for decisions as well as prioritization I work well under pressure. I can think logically through problems and come up with the best solutions. I prioritize effectively. I learned how to prioritize and mange time quickly and it has been very helpful, my critical thinking skills have improved and have helped me look at the whole picture instead of just focusing on one thing. I feel fairly confident in my decision making skills, I know I will feel even more so after I am in the field for a while What changes would you like to recommend? I would recommend having more direct answers during our Problem Based Learning sessions when questions arise and are left open ended. Overall I have had a great experience at WWCC nursing program More clinical care time, especially in med/surg. I would have benefited more by having ongoing opportunities to put into practice, the knowledge and skills learned thru PBL. There is too great a lapse in time from N3-N4 M/S clinical. Hard to retain all of the info and skills over that stretch. Overall the program is very well adapted to our learning needs. I would recommend having more direct answers during our Problem Based Learning sessions when questions arise and are left open ended. Overall I have had a great experience at WWCC nursing program

144 6.3: Evaluation findings are shared with communities of interest. Evaluation findings are regularly shared with the Board of Trustees, Nursing Program Advisory Board, students, WSBN, and Outreach staff. Program outcomes are shared in person with our Advisory Board and Board of Trustees each year in the spring semester. As well as hearing our program outcomes, the May 8, 2014 discussion with our Advisory Board included our reapplication for candidacy, an update on the statewide curriculum and our retention plan. The Advisory Board also reviews our list of clinical agencies during the Spring meeting, no changes were recommended. At the April meeting of the Board of Trustees the Director discussed the plan for candidacy application in May and subsequent plan if accepted, Director and faculty meetings in the service area to promote the program, faculty and staff awards and changes. The WSBN requires an annual report with proof of compliance with their standards, student demographics and retention data, faculty and preceptor information each fall. Students receive information from the Director and faculty during each semester s orientation and by throughout the year as appropriate. The faculty and Director visit clinical agencies/employers and several community and college groups (Western Outreach staff, high school counselors, Chambers of Commerce, Rotary, Lions Club and Kiwanis) and share evaluation findings. The program outcomes are also posted on our website

145 6.4: The program demonstrates evidence of achievement in meeting the program outcomes : Performance on licensure exam: The program s three-year mean for the licensure exam pass rate will be at or above the national mean for the same three-year period. ELA: The Program s three-year mean for the licensure exam pass rate will be at or above the national mean for the same three-year period. Western s first time NCLEX pass rate is at or above the national mean. The Nursing Program has had NCLEX results at or greater than the annual national mean and the three year mean for the past three years. Table 6.7 shows the NCLEX pass rates by year, cohort and delivery type. Table 6.8 shows the NCLEX pass rate compared to national by three year mean. Table 6.9 gives Western s Nursing Program s definition of cohorts; students may be in two cohorts (i.e. Rawlins and distance delivery or Rock Springs and distance delivery) Table 6.7: NCLEX Pass Rates by Year/Cohort/Delivery Type All Rock Advanced Distance Rawlins students Springs placement delivery % n-25 80% n=15 75% n=4 100% n=1 90% n= % n=37 92% n=24 83% n=6 75% n=4 94% n= % 94% 100% 88% n=28 n=16 n=4 n=8 n/a *cohorts have at least two semesters in category to be counted in category Table 6.8: NCLEX Three Year Mean Western National

146 Table 6.9: Western s Student Cohorts All Students Rock Springs campus students with face-to-face delivery Rawlins students (may receive one or two semesters face to face in their home community and rest of semesters via web based technology) Advance placement students (LPN s or PN graduates that enter in the third semester) Distance students (those who have two or more semesters via web based technology) We do allow, but rarely have, a transfer student. The Rock Springs, Rawlins, and Distance cohorts all exceeded the three year national mean. The Advanced placement graduates (between three-eight grads/year) pass rates are consistently lower than the total 75-88% pass rates; the variance is attributed to the very small cohorts. The Program is proud of their NCLEX results and will continue to monitor and make changes as needed to maintain high pass rates : Performance completion: Expected levels of achievement for program completion are determined by the faculty and reflect student demographics and program options. Expected levels of achievement for Program completion are determined by the faculty and reflect student demographics and program options. ELA: Western s completion rates will be greater than or equal to 70% of 150% of program time (6 semesters). This completion rate was determined by the faculty after trending data, considering our demographics, and consulting other programs in the state. The program completion for the past three years:

147 Table 6.10: Program Completion Data for Past Three Years % % % Expected level of completion has been met in all but the group. This class started with 40 students and had significant attrition for students whose first language was not English (three) and those who were under 30 (six). The Director began working on a retention plan in In the Fall of 2013 it was assigned to a staff member, additional research and surveys were begun. This faculty member contacted those students who did not get accepted into the Program to mentor and support them, with good results. Seventeen of thirty students plan to reapply to the Program at a later time. Faculty were also surveyed about their own personal and cultural beliefs. Data from student surveys and faculty surveys will be compared to better understand how student and faculty differing beliefs/culture impact attrition. Plans were made and implemented in June 2014 to have advising for pre-nursing students separate from the general College population to better inform these students of the rigors of the Program as well as encourage them that adequate support is available for Nursing. In the Fall 2014 several strategies were implemented: A student mentoring program was initiated with Nursing III students mentoring Nursing I students; an area of the Rock Springs campus and the distance delivery tool (BigBlueButton) was made available with instructional assistant support one evening each week. This strategy was abandoned in October due to no

148 student participation. Three phases of test taking strategies are being offered, workshops on stress management and finances are planned as well as increased effort to maintain contact with pre-nursing students through meetings and advising sessions. (See Nursing Student Retention) 6.4.3: Graduate program satisfaction: Qualitative and quantitative measures address graduates six to twelve months post-graduation. Qualitative and quantitative measures address graduates satisfaction eight months following graduation. ELA: Western s graduates surveyed eight months following graduation report >3.5 on 5 point Likert scale that they are satisfied they have the ability to Communicate Competently, See Issues from Multiple Perspectives, Develop Life Skills, Solve Problems, Retrieve Information, Apply Therapeutic Nursing Interventions and that they are prepared to be a beginning competent nurse. Graduates and employers are also given an opportunity to comment on Western s Nursing Program. Table 6.11 indicates the levels of student satisfaction. Response rates improved after 2012 when the Program Director initiated an opportunity for graduates to win a gift card if they responded to the survey. Response rates in January %, %, and %. Table 6.12 follows with graduates comments from the same survey

149 Table 6.11: Graduate Satisfaction Survey Results Graduate Satisfaction Survey Results 2014 Graduate Survey (2013 Graduates) 20 Responses 51% Response Rate 2013 Graduate Survey (2012 Graduates) 14 Responses 47% Response Rate 2012 Graduate Survey (2011 Graduates) 8 Responses 27% Response Rate Communicate Competently 4.3 / / 5 100% * See Issues from Multiple Perspectives 4.2 / / 5 100% * Develop Life Skills 3.9 / / 5 100% * Solve Problems 4.2 / / 5 100% * Retrieve Information 4.5 / / 5 100% * Apply Therapeutic Nursing Interventions 4.2 / / 5 100% * Prepared to be a Beginning Competent Nurse 4.0 / / 5 N/A ** * Surveys not available, information derived from graphs done by previous director. Results were reported as satisfied if students answered 4 (agree) or 5 (strongly agree). ** This information was not gathered in the 2012 Survey (2011 Graduates). Table 6.12: 2013 Graduate Qualitative Comments 2013 Graduate Survey Qualitative Comments Western has a fantastic nursing program. I wish that the NLNAC had not withdrawn their accreditation but I understand that it is a requirement to have all Master's prepared staff, although every instructor at Western was qualified to teach, in my opinion. Instructors at Western were friendly, willing to help, and very knowledgeable. More is needed on burns and cardiac. I felt prepared to take NCLEX and can problem solve. A little more time should be spent by professors on the cattiness of nurses about patients and to other nurses that is a hard adjustment and I have been in workforce a long time. I appreciate my education at WWCC. The program was super difficult, but I definitely believe it prepared me for my nursing career! I do not recommend this program. I do not agree with the PBL learning The program was a rigorous and thorough preparation for becoming a competent beginning nurse. My only suggestion to improve is to assist first semester students more to transition them from a typical lecture based classroom to PBL. Myself and my classmates felt that we were floundering with the process and not learning as well as we could have, and a little more guidance would have made the transition less of a shock. I feel that WWCC's nursing program prepared me to be a competent beginning nurse in many areas, however I wish we could have spent a little more time on proper documentation. I feel this is a very important area of nursing : Employer program satisfaction: Qualitative and quantitative measures address employer satisfaction with graduate preparation for entry-level positions six to twelve months post-graduation. Qualitative and quantitative measures address employer satisfaction with graduate preparation for entry level positions eight months following graduation. ELA:

150 The employers of Western s graduates surveyed eight months following graduation report >3.5 on 5 point Likert scale that they are satisfied graduates have the ability to Communicate Competently, See Issues from Multiple Perspectives, Develop Life Skills, Solve Problems, Retrieve Information, Apply Therapeutic Nursing Interventions and that they are prepared to be a beginning competent nurse. The following table indicates very good levels of employer satisfaction. Response rates for these surveys were a challenge. After receiving only two responses in 2012 the Director and faculty decided to make direct contact with the employers of graduates. Our frontier culture and small class sizes allows us this freedom. The surveys are sent to the direct line supervisors vs. the agency heads. Some faculty hand deliver, others send by . The response rate has risen dramatically as the table shows using this strategy. In January of 2014 there were several out-of-state employers who did not respond to multiple contact attempts. A permission form was developed to allow the Program permission to survey graduates employers. All 2014 graduates were willing to sign this form. See Tables 6.13 and Table 6.13: Employer Satisfaction Survey Results Employer Satisfaction Survey Results 2014 Employer Survey 21 Responses 54% Response Rate 2013 Employer Survey 16 Responses 53% Response Rate 2012 Graduates Surveyed 2 Responses Response Rate Unknown Communicate Competently 4.5 / / 5 100% See Issues from Multiple Perspectives 4.5 / / 5 100% Develop Life Skills 4.6 / / 5 100% Solve Problems 4.5 / / 5 100% Retrieve Information 4.4 / / 5 100% Apply Therapeutic Nursing Interventions 4.5 / / 5 100% Prepared to be a Beginning Competent Nurse 4.6 / / 5 100% * Surveys not available, information derived from graphs done by previous director. Results were reported as satisfied if students answered 4 (agree) or 5 (strongly agree)

151 Table 6.14: 2013 Employer Survey Qualitative Comments 2013 Employer Survey Qualitative Comments Do they all come out this way, no - depends on the individuals effort. is blossoming and thriving She does a good job. She is great. I believe the WWCC Nursing Program did an effective job in preparing my employee for real world nursing practice. I have been please with her performance this past year. The professional and personal growth is evident in the approach she takes to her work assignments, interactions with coworkers and providers as well as her readiness to take on new roles within the facility. Great Job! Do you have any more like her? Lots of potential. Would be very sad if she left As a new RN, she was able to trouble-shoot better than expected. has been a wonderful addition to our unit. She is an excellent nurse and is very patientcentered. Have a great day! Has had to do a lot of IVs. Just needs support. Does really well. Didn't think all the way through idea of room changes Definitely helped that she worked as an LPN. Heightens their self confidence has come out well prepared, if he doesn't know, he seeks the information. He is a leader and takes a strong patient advocacy role : Job placement rates: Expected levels of achievement are determined by the faculty and are addressed though quantified measures six to twelve months post-graduation. Expected levels of achievement are determined by the faculty and are addressed though quantified measures six to twelve months post-graduation. ELA: Within eight months 90% of Western graduates seeking employment in nursing will be employed in nursing. Western s Nursing Program graduates are employed at high rates due to the frontier nature of our communities. For the past three graduating classes those seeking employment in nursing met the expected level of achievement. The response rates and results for these classes are shown in Table Table 6.15: Job Placement Rates Graduating Year Response Rate % Employment % n=20 100% % n=14 93% % n=8 100%

152 Adjustments for response rate discussed above. The program also surveys graduates for their areas of employment to assure that we are meeting the needs of our clinical partners. These results are shown in Table Table 6.16: Patterns of Employment Acute Care* Psych Long Term Care Home Health/ Public Health School Clinic/ Office 2013 (n=20, 51% response) 2012 (n=14, 47% response) 2011 (n=8, 27% response) 16 (64%) 2 (8 %) 2 (8%) 3 (12%) 0 2 (8%) 14 (43%) 1 (7%) 2 (14%) 2 (14%) 0 1 (7%) 5 (63%) 0 2 (25%) (13%) * Multiple Units: Med/Surg, OB, ICU, Ambulatory Surgery, Emergency Department + Some graduates have multiple jobs and/or work multiple units Western and the Nursing Program are very proud that program outcomes are consistently achieved. (See Appendix O for the ACEN Program Outcomes Summary)

153 Appendices

154 Appendix A

155

156 150 Appendix B

157 151

158 -152- APPENDIX C

159 -153- Western s Associate Degree Nursing Program Faculty Profile Form APPENDIX D Faculty Name F/T or P/T Date of Initial Appt. Primary Location Rank Bacc Degree (credential) Institution Granting Degree(s) Graduate Degree* (credential) Institution Granting Degree(s) Areas of Clinical Expertise Academic Teaching (T) and Other (O) Areas of Responsibility T O Jeannette Daniel F/T 07/03 Rawlins Outreach Center Associate Professor BSN University of Wyoming MS Nursing Education University of Wyoming Home Health, Long-term Care w/administration, Med/Surg PBL N III & IV, Lab N I-III, Clinical N I, II & IV, Simulation N II-IV Theory and Clinical Coordination; Advisor Deanne Garner F/T 01/07 Rock Springs Campus Assistant Professor BSN University of Wyoming MS Nursing Education University of Wyoming Med/Surg w/administration Oncology, Infusion Therapy, Home Health PBL Nursing I, IV; Lab Instruction Nursing I; Clinical Instruction Nursing I, IV; Theory, Lab & Clinical Coordination; Advisor Sunny Thomas F/T 09/07 Rock Springs Campus Instructor BSN University of Wyoming MS Nursing Education University of Wyoming Med/Surg, Emergency, Critical Care, Nursery, Physician s Office PBL Nursing II, III; Lab Instruction Nursing II, III; Clinical Instruction Nursing II, III; Simulation Clinical Coordination; Advisor Heidi Brown F/T 08/08 Rock Springs Campus Instructor BSN University of Wyoming MS Nursing Education University of Wyoming Med/Surg, Emergency, OR PBL Nursing II, III; Lab Instruction Nursing II, III; Clinical Instruction Nursing II, III; Simulation Theory Coordination; Advisor

160 -154- Faculty Name F/T or P/T Date of Initial Appt. Primary Location Rank Bacc Degree (credential) Institution Granting Degree(s) Graduate Degree* (credential) Institution Granting Degree(s) Areas of Clinical Expertise Academic Teaching (T) and Other (O) Areas of Responsibility Patty Nieters F/T 8/10 Rock Springs Campus Instructor BSN University of Wyoming MS Nursing Education University of Wyoming Surgical, ICU, Cardiac Cath Lab, Dialysis, Trauma, Registry PBL Nursing II, III; Lab Instruction Nursing II, III; Clinical Instruction Nursing II, III; Simulation Lab Coordinator Advisor Shelly Tholl F/T 8/13 Evanston Outreach Center Assistant Professor BSN University of Phoenix (online) MSN- Education University of Phoenix (online) Hospital staff nurse; Long term care & DON, PACU, OR, Inpatient Dir; Staff Educator; Dir/Case Management Lab Instruction Nursing I, II; Clinical Instruction Nursing I, II, IV; Simulation Advisor Carla Lee F/T 8/11 Rock Springs Campus Instructor BS Idaho State University MS Nursing Education University of Wyoming OB, OR, Med/Surg PBL Nursing I, IV; Lab Instruction Nursing I; Clinical Instruction Nursing I, IV; Theory, Lab & Clinical Coordination; Advisor Marsha King F/T 8/14 Rawlins Outreach Center Assistant Professor BSN University of Phoenix MSN University of Phoenix Med/Surg, Oncology *First Year Faculty- Orientation to faculty role Nursing III Clinical Patricia Green P/T 2/13 Rock Springs Campus Instructor BSN University of Wyoming MS Nurse Educator University of Utah Surgical, Hospice, Med/Surg, ICU, LTC, Home Health, Clinic Lab Instruction Nursing I; Simulation Nursing II, III,IV; Clinical Instruction Nursing I, IV * = add doctoral degree after master s degree if applicable

161 -155- Faculty Scholarship and Maintenance of Expertise APPENDIX E Faculty Member Certifications Current Maintenance of Practice and Expertise Scholarly Activities and Continuing Education 9/25-26/14 Nursing Summit and Convention Growing the Leader Within (11.25 contact hours); WNA 8/22 & 23/2014 Laerdal Sim Pad and HF Sim training, WWCC 6/5/14 Rocky Mountain Alzheimer s Summit (11.5 contact hours); Wyoming Hospital Association 6/3/14 Geriatric Health (15 contact hours); Wyoming Hospital Association 5/20/14 Nursing Education Summit: The WY Center for Nursing and Health Care Partnerships Jeannette Daniel Certified Nurse Educator, BLS Kindred Nursing and Rehabilitation Center Staff Nurse (part-time, 10 hours/mos) Memorial Hospital of Carbon County Annual education 2/13-14/14 Nurses Day at the Legislature: Health Care Transformation: The Affordable Care Act & More ; (6.75 contact hours); Wyoming Nurses Association 1/11/14 Corporate Compliance, Code of Conduct, Conflict of Interest, MRI & Radiation Safety (1.2 contact hours); Memorial Hospital of Carbon County 1/11/14 Safety Storm Clinical (3.0 contact hours); Memorial Hospital of Carbon County 9/23/13 Facebook: Know the Policy before Posting (1 contact hour); ANCCCA Carbon County Senior Center Monthly BP Clinics 5/26-28/13 National Institute for Staff and Organizational Development Annual Conference (12 contact hours); University of Texas at Austin Presented Problem-Based Learning or Pretty Baffling Logistics 5/19-21/13 - Nursing Education Summit: The WY Center for Nursing & Health Care Partnerships 3/10/13 - Web-based course: Protecting Human Research Participants 1/24-25/ Nurses Day at the Legislature: Health Care Legislation: What does it mean to me? 7 contact hours; Wyoming Nurses Association 9/11/12 - Safety Storm Beta, Gamma, Alpha, Radiation & MRI (2.9); Mem Hospital Carbon Co., Rawlins, WY 7/2008 Facilitating Online Learning; Western Wyoming Community College (1 credit)

162 -156- Faculty Member Certifications Current Maintenance of Practice and Expertise Scholarly Activities and Continuing Education 9/25-26/14 Nursing Summit and Convention Growing the Leader Within (11.25 contact hours); Wyoming Nurses Association 8/22/2014 Laerdal Sim Pad training, Western Wyoming Community College Allegra Learning Solutions Certificate in Gerontology 4/2014- Allegra Learning Solutions - Aging and Disorders of Communication Rock Springs IV Center Chemotherapy Provider (PRN) 4/2014- Allegra Learning Solutions - Alzheimer s Disease: Mysteries and Possibilities 4/2014- Allegra Learning Solutions- Death and Dying 4/2014- Allegra Learning Solutions- Elder Abuse Infusion Therapy (PRN) 4/2014- Allegra Learning Solutions- Healthy aging Deanne Garner BLS, ONS Provider, Certified Nurse Educator, Certificate in Gerontology (Allegra Learning Solutions) Intrathecal Pump Maintenance (4x/month) Mission at Castle Rock Electronic Medical Record Training (8 hrs) Annual orientation Shadow nurse 6 hours before each clinical rotation 4/2014- Allegra Learning Solutions- Introduction to Gerontology 4/2014- Allegra Learning Solutions- Mental Health 4/2014- Allegra Learning Solutions- Pain Assessment in the Aging Population 4/2014- Allegra Learning Solutions- Sleep and Aging 4/2014- Allegra Learning Solutions- Physiology of Aging 4/2014- Allegra Learning Solutions- The Healthy Woman 2/5/13 - How to Prepare for and Pass the CNE Exam, 1 contact hr, Assessment Technologies Institute (ATI) 2012 Training in management of Medtronic intrathecal pumps 10/12 - NLNAC Conference, Orlando, FL 5/2007 Facilitating Online Learning; Western Wyoming Community College (1 credit)

163 -157- Faculty Member Sunny Thomas Certifications Current Maintenance of Practice and Expertise Sweetwater Surgery Center Preop & Recovery (CPT, 12 hours/mos; 2 days wk/summer) Memorial Hospital of Sweetwater County Med/Surg- Orientation to census and departmental changes (4 hours before each clinical rotation) Scholarly Activities and Continuing Education 9/25-26/14 Nursing Summit and Convention Growing the Leader Within (11.25 contact hours); Wyoming Nurses Association 5/20/14 Nursing Education Summit: The WY Center for Nursing and Health Care Partnerships 12/2013 Facilitating Online Learning; Western Wyoming Community College (1 credit) 5/19-21/13 - Nursing Education Summit: The Wyoming Center for Nursing & Health Care Partnerships & WNA 3/13/13: Empowering Students to Be Critical Thinkers, Webinar presented by Jo Anne Carrick, D.Ed., RN, CEN, CNE and Margie McLain, MSN, BS, CNE; ATI Faculty Member BLS, ACLS, PALS, TNCC ACLS & PALS Instructor Certifications Facility Annual Orientation WWCC Community Workforce Center ACLS and PALS Instructor Current Clinical Practice Continuing Education Heidi Brown BLS, ACLS, PALS Memorial Hospital of Sweetwater County OR & PACU (CPT, 20 hours/mos) OR department meetings 9/25-26/14 Nursing Summit and Convention Growing the Leader Within (11.25 contact hours); Wyoming Nurses Association 8/22-23/2014 Laerdal Sim Pad and High Fidelity Sim training, Western Wyoming Community College 4/30/14 Multiple Organ Dysfunction Syndrome (MODS) and Disseminated Intravascular Coagulation (DIC) (2.1 contact hrs), Shock (1.6 contact hrs); Healthstream Med/Surg- Orientation to census and departmental changes MHSC Inservices: 1/28/14: Pyxis Superuser Training; 4/28/13 Blood transfusions; 1/26/13 Global Harmonizing Systems (GHS) and Hazard Communication

164 -158- Faculty Member Heidi Brown (cont d) Certifications Current Maintenance of Practice and Expertise (4 hours before each clinical rotation) Facility Annual Orientation Scholarly Activities and Continuing Education 5/19-21/13 - Nursing Education Summit: The Wyoming Center for Nursing & Health Care Partnerships & WNA 4/30/13 Recognizing & treating 5 shock states, Helping your Patient survive Sepsis; 4/26/13 Lippincott Education Program: Psychiatric nursing assessment, Dying patient care, pain assessment, pain management; Healthstream Education program 4/30/13 - Multiple Organ Dysfunction Syndrome (MODS) & Disseminated Intravascular Coagulation (DIC) (2.1 CEUs), Shock (1.6 CEUs); Healthstream; ANCC 10/12 - NLNAC conference, Orlando, FL 5/20-22/12 - Nursing Education Summit: The Wyoming Center for Nursing & Health Care Partnerships & WNA 5/23/12 Wound Healing (2.1 contact hrs); Heathstream 10/09/2014 MHSC, EMTALA for Nurses Patricia Nieters 9/25-26/14 Nursing Summit and Convention Growing the Leader Within (11.25 contact hours); Wyoming Nurses Association BLS, ACLS, PALS Memorial Hospital of Sweetwater County OR & PACU (CPT, hours/mos) OR department meetings Med/Surg- Orientation to census and departmental changes (4 hours before each clinical rotation) 09/15/2014 MHSC Adverse Drug Reaction Reporting 8/22-23/2014 Laerdal Sim Pad and High Fidelity Sim training, Western Wyoming Community College 4/26/2014 MHSC SSI, CLABSI, and other HAI s 2014, Introduction to Emergency Management with NIMS, Blood Product Safety I: foundations; RN Falls Education 2014, Special Topics 2014 Annual Education, Blood Product Safety II: Administration 04/24/2014 MHSC - Rapid Reg. Compliance: Clinical II: Slips/Trips/Falls, Gen/Fire/Elec/Back/Rad./MRI Safety, Ergo, Lift/Transp, LatexAllergy, HazComm, WorkplaceViol., EmergPrep, Infec.Contrl:HAI, HandHyg, Facility Annual Orientation Bloodborne, StdPrec, Air/Contact/Drop Prec, PPE Rapid Reg. Compl.: Clinical I: Compl., Ethics, Sexual Har., Patient Rights, Informed Consent, Adv.Directives, Organ Don., EMTALA, Grievances, Dev. Approp. Care, Cult.Competence, Restraint/Seclusion, Patient Abuse/Neglect - 01/28/14-04/10/2014 MHSC Management of Difficult Airways, Organ Donation Mock Run Through,-DCD Training, Glucometer Validator Testing 2014, Super Pyxis training, Organ Donation

165 -159- Faculty Member Certifications Current Maintenance of Practice and Expertise Scholarly Activities and Continuing Education Patricia Nieters (cont d) 5/20/14 Nursing Education Summit: The WY Center for Nursing and Health Care Partnerships 11/12/13 Global Harmonizing Systems (GHS) and Hazard Communication 12/2013 Facilitating Online Learning; Western Wyoming Community College (1 credit) 6/28/13 MHSC-Blood transfusions; 4/30/ Sepsis Education OR/Oncology 4/30/13 - Multiple Organ Dysfunction Syndrome (MODS) & Disseminated Intravascular Coagulation (DIC) (2.1 CEUs), Shock (1.6 CEUs); Healthstream; ANCC 4/29&30/13 Recognizing & treating 5 shock states, Helping your Patient survive Sepsis; 4/26/13 Lippincott Education Program: Psychiatric nursing assessment; Healthstream Education program 10/12 NLNAC conference, Orlando, FL 5/19-21/13 - Nursing Education Summit: The Wyoming Center for Nursing & Health Care Partnerships & WNA 5/20-22/12 - Nursing Education Summit: The Wyoming Center for Nursing & Health Care Partnerships & WNA 2/23-24/12 - Nurses Day at the Legislature: Advocating for Professional Accountability, Cheyenne, WY (7.25 contact hrs); Wyoming Nurses Association Shelly Tholl BLS Evanston Regional Hosp. Case Manager (CPT, 20 hours/mos) Outpatient Infusion Therapy (CPT) Med/Surg- Orientation to census and departmental changes (4 hours yearly) RMC/LTC-General Nursing Orientation (4 hours yearly) : President, Wyoming Nurses District #17 8/22/2014 Laerdal Sim Pad training, Western Wyoming Community College 9/25-26/14 Nursing Summit and Convention Growing the Leader Within (11.25 contact hours); Wyoming Nurses Association 8/2014: General Nursing Orientation and Training at Rocky Mountain Care Long Term Care Center 3/2014: Participated in Uinta County Community wide table top drill and debriefing for Emergency Management & Disaster Planning

166 -160- Faculty Member Shelly Tholl (cont d) Certifications Current Maintenance of Practice and Expertise Facility Annual Orientation Scholarly Activities and Continuing Education 3/2014: Participated in Uinta County Community wide table top drill and debriefing for Emergency Management & Disaster Planning 1/2014: General Nursing Orientation Evanston Regional Hospital 12/2013 Facilitating Online Learning; Western Wyoming Community College (1 credit) Courses: 1/ /2014 (7.87 CEU s) Community Health Systems Advanced Learning Center: Code of Conduct; Case Management Training; Fall Prevention; Workforce Information Security; Bladder Scanning; Blood Transfusion & Blood Components; Physical Restraints; Managing Patients with MDRO s; Acute Coronary Syndrome; and Event Reporting. Environment of Care: Safety, Security, and Emergency Management, Hazardous Waste; Equipment and Utilities Management; and Fire Safety. Clostridium difficile, Hand Hygiene, Safe Medication Administration, Suicide Risk Assessment, Overview of Stroke, Hazardous Waste. 4/1/13 - Hand Hygiene & Standard precautions; 9/2/13 Influenza; 10/6/13 - Cultural Competence, Effective Communication Every Time and Event Reporting System Lesson; CHS Advanced Learning Center 10/3/13 - EMTALA Essentials, (1 c.h.), Pain Management (1 c.h.), Insulin Therapy (1 c.h.); ANCCCA 9/22/13 - Catheter Care ( 1 contact hr); Heparin Protocol (1 contact hr); Moderate Sedation (1 contact hr); Patient Restraints (1 contact hr); ANCCCA 9/22/13 - MENCE: Transfusion of Blood and Blood Components (0.8 contact hr); Elsevier/Mosby Approver: ANCCCA 2012: Completed National Incident Management System (NIMS) training FEMA.gov: NIMS 100, 200, 700, 800 for Emergency/Disaster Management Memorial Hospital Sweetwater County OB Staff Nurse 9/25-26/14 Nursing Summit and Convention Growing the Leader Within (11.25 contact hours); Wyoming Nurses Association Carla Lee BLS, NRP Univita Care Coordinator (Longterm care insurance assessments) 8/22-23/2014 Laerdal Sim Pad and High Fidelity Sim training, Western Wyoming Community College 8/ AWHONN Intermediate Fetal Monitoring; University of OB AirMed Team 4/2014 MHSC Annual Education: Rapid Regulatory Compliance, Blood Product Safety, Aseptic Technique,

167 -161- Faculty Member Certifications Current Maintenance of Practice and Expertise Scholarly Activities and Continuing Education RN Falls Education 12/2013 Facilitating Online Learning; Western Wyoming Community College (1 credit) 8/13- Castle Rock Convalescent Center Electronic Medical Record Training; Castle Rock Convalescent Center Marsha King BLS, ACLS Western Wyoming Community College Nursing Instructor 9/25-26/14 Nursing Summit and Convention Growing the Leader Within (11.25 contact hours); WNA 8/22-23/14 Western s Great Teachers Seminar 9/2013 Simulation Training University of Miami-Laerdal Company Patricia Green BLS, ACLS, PALS Sweetwater Medics Ambulance Nurse (CPT) Rock Springs IV Center Infusion Therapy Visits Mission at Castle Rock Electronic Medical Record Training (8 hrs) Facility annual orientation Shadow nurse 6 hours before each clinical rotation 8/22-23/2014 Laerdal Sim Pad and High Fidelity Sim training, Western Wyoming Community College 9/13- Castle Rock Convalescent Center Orientation and Training 8/13- Castle Rock Convalescent Center Electronic Medical Record Training 4/14- Oncology Nursing Society-Chemotherapy Provider

168 -162- Appendix F

169 -163-

170 Hours per semester Assignment Total Simulation Lab Clinical PBL Spring Typical Spring Semester Teaching and Coordination Load Appendix G Faculty Semester Assigned Instruction (credit hours) Intra-program Coordination Jenny Daniel Deanne Garner Sunny Thomas Heidi Brown Patty Nieters Shelly Tholl Carla Lee Marsha King Patricia Green (PT Faculty) N2 N NI-IV outreach area clinical liaison N N4 Clinical Coordinator 60 N N2 Clinical Coordinator 48 N N2 Theory Coordinator 30 N N2 Lab Coordinator 20 N2 N NI-IV outreach area clinical liaison N * N4 Theory Coordinator 20 *First Year Faculty orient to role N

171 Hours per semester Assignment Total Simulation Lab Clinical Theory Typical Fall Semester Teaching and Coordination Load Faculty Semester Assigned Instruction (credit hours) Intra-program Coordination Fall Jenny Daniel N1 N NI-IV outreach area clinical liaison 20 Deanne Garner Sunny Thomas N N1 Theory Coordinator 20 N N3 Clinical Coordinator 90 Heidi Brown Patty Nieters N N3Theory Coordinator 30 N N3 Lab Coordinator 20 Shelly Tholl N1 N NI-IV outreach area clinical liaison 20 Carla Lee Marsha King *First Year Patricia Faculty Green (PT Faculty) N N *First Year Faculty orient to role N1 Clinical and Lab Coordinator 30

172 -166- Western's Student Learning Outcome Progression Communicate Competently Provide accurate information, insightful observations, effective teaching, and caring behaviors. Nursing I Nursing II Nursing III Nursing IV 1. Demonstrate basic openended therapeutic communication techniques. APPENDIX H Communicator Communicator Communicator Communicator Therapeutic Communication Therapeutic Communication Therapeutic Communication Therapeutic Communication 1. Utilize varied therapeutic communication techniques. 2. Identify appropriate channels of communication within the health care team. 3. Recognize group dynamic behaviors. 1. Utilize effective communication skills to enhance a therapeutic relationship. 1. Modify therapeutic communication techniques. 2. Employ enhanced communication techniques to foster a caring relationship with client. Collaboration Collaboration Collaboration Collaboration 2. Consult with health care 2. Incorporate feedback from experts. health care experts. 3. Utilizes appropriate channels of communication within the health care team. 3. Recognize conflict. 3. Identify options to resolve conflict. 4. Practice assertive communication skills with "difficult people" to resolve conflict. Documentation Documentation Documentation Documentation 4. Begin to share relevant data in writing with health care team members. 5. Identify different learning styles in self and others. 4. Document relevant data when communicating with health care team members. 4. Document to meet standards of the profession. 5. Document nursing care provided based on standards of care, outcomes, and reimbursement. Educator Educator Educator Educator 5. Evaluate standardized 5. Evaluate the discharge teaching plans. teaching needs of clients. 6. Design effective creative teaching techniques for complex clients or small groups.

173 -167- Communicate Competently (cont d) Provide accurate information, insightful observations, effective teaching, and caring behaviors. Nursing I Nursing II Nursing III Nursing IV Caring Caring Caring Caring 7. Discuss the value of caring behaviors in nursing practice. 8. Discuss caring in relation to "doing for", "doing with", "being with", and "concern for/concern about". 9. Recognize role of caring while maintaining professional boundaries. 7. Value caring for self and each other. 8. Differentiate caring and competence. 7. Identify techniques that convey caring and noncaring behaviors. 8. Analyze own unique caring practice. See Issues from Multiple Perspectives Provide culturally and ethically competent nursing care to a variety of individuals. Nursing I Nursing II Nursing III Nursing IV Culture Culture Culture Culture 1. Define culture. 1. Examine the influence of culture on the clients' health. 2. Describe health and illness within cultural and ethnic context. 3. Examine rural culture characteristics. 1. Recognize the influence of culture on client and colleagues. 1. Incorporates the cultural uniqueness of clients and colleagues into practice. Rural Rural Rural Rural 2. Examine mental health 2. Examine ways to adapt issues in the rural culture nursing care to meet the that are affected by needs of special populations bias/prejudice. in the rural culture. 4. Examine the unique nature of the nurse s role in rural culture. 2. Explore the concept of hardiness. 3. Begin to identify own assumptions of bias. Family Family Family Family 5. Describe the individual as a client within the family. 4. Apply growth and development theories to family units. 3. Analyze the influence of the family unit on discharge planning. 3. Explain how family structure and patterns of functioning affect clients.

174 -168- See Issues from Multiple Perspectives (cont'd) Provide culturally and ethically competent nursing care to a variety of individuals. Nursing I Nursing II Nursing III Nursing IV 6. Discuss how the term family can be defined to reflect family diversity. 5. Examine current trends in the American family. 4. Discuss the way family members influence one another's health. 4. Support families as care givers. 7. Assess families as care givers. 6. Assess families as care givers. 5. Assess families as care givers. Ethics Ethics Ethics Ethics 8. Identify ethical behaviors within the discipline of nursing. Advocate Advocate Advocate Advocate 9. Identify the nurse's role in protecting client's rights. 7. Practice assertive communication techniques in protecting client's rights. 6. Identify strategies to advocate for client's rights. 5. Incorporate multiple techniques to practice the advocacy role. 10. Identify components of ethical dilemmas. 11. Clarify personal values 8. Acknowledge the impaired nurse from a legal/ethical perspective. that will affect decision making. 12. Identify client care situations where ethical issues are raised. Dilemmas Dilemmas Dilemmas Dilemmas 9. Discuss evidence of prejudice/bias in clinical setting. 6. Identify contemporary ethical issues and nursing implications. 6. Generate a pro-active plan to address ethical dilemmas. Psycho-Social Dimensions Psycho-Social Dimensions Psycho-Social Dimensions Psycho-Social Dimensions 10. Identify growth and development theories.

175 Describe the psychosocial implications for clients who enter the health care system. a. growth & development b. social interaction c. spirituality d. coping e. end of life issues 11. Consider psychosocial needs of clients within the health care continuum addressing: a. growth & development b. social interaction c. spirituality d. coping e. end of life issues 7. Describe how complex health problems affect: a. growth & development b. social interaction c. spirituality d. coping e. end of life issues 7. Explore how nurses can assist clients to meet their needs related to: a. growth & development b. social interaction c. spirituality d. coping e. end of life issues 8. Explore how nurse managers can create a culture that promotes psycho-social nursing care. Develop Life Skills Practice within an ethical and legal framework of the discipline of nursing. Nursing I Nursing II Nursing III Nursing IV Discipline of Nursing Discipline of Nursing Discipline of Nursing Discipline of Nursing 1. Begin to develop a definition of the nursing role. 2. Discuss the roles of nursing with differing educational preparation. 3. Discuss accountability in the professional role. Demonstrates flexibility in an ever changing health care environment. (from employer survey) Accountability Accountability Accountability Accountability 1. Practices within the 1. Practices within the scope scope of nursing according of nursing according to the to the Nurse Practice Act Nurse Practice Act with With assistance. supervision. 4. Discuss practicing within the scope of nursing according to the Nurse Practice Act. 1. Practices within scope of nursing according to the Nurse Practice Act. 2. Demonstrates accountability for nursing care provided by self or delegated to others (from employer survey)

176 -170- Develop Life Skills (cont d) Practice within an ethical and legal framework of the discipline of nursing. Nursing I Nursing II Nursing III Nursing IV Lifelong Learning Lifelong Learning Lifelong Learning Lifelong Learning 5. Begin to develop life-long learning skills. 6. Examine the history of nursing. 2. Demonstrate lifelong learning (curiosity, preparedness, thorough investigation, changing decisions based on changing knowledge). 2. Demonstrate a commitment to lifelong learning (curiosity, preparedness, thorough investigation, changing decisions based on changing knowledge). 3. Demonstrate a commitment to lifelong learning (curiosity, preparedness, thorough investigation, changing decisions based on changing knowledge). Political Activity Political Activity Political Activity Political Activity 3. Discuss the role of 3. Examine the influence of politics in nursing. social and economic changes 4. Explore state or national health care issues that affect on nursing practice. nursing. Manager Manager Manager Manager Organization Organization Organization Organization 7. Discuss ways to manage self by appropriate use of time and resources. 4. Examine different management styles applicable to health care settings. 4. Develop strategies to effectively implement change in the workplace. 5. Compare various leadership models. 6. Explain how staff can be organized to meet client care needs. Delegation Delegation Delegation Delegation 8. Define delegation. 5. Discuss the five rights of 5. Describe the assessment delegation. the nurse must conduct prior 9. Identify scope of practice for RN, LPN, UAP. 10. Describe how delegation facilitates the efficient use of resources. 6. Discuss examples of appropriate delegation. 7. Explain how failure to delegate impacts the RN/employer. to delegation. 6. Discuss expected outcomes of delegation. 7. Discuss common barriers to delegation. 7. Role play communication techniques to ensure effective delegation. 8. Discuss relationship building skills that promote teamwork, collaboration, and safety. 9. Develop strategies to increase motivation in self and others.

177 Differentiate assignment and delegation. 8. Explain how failure to delegate impacts the UAP. 10. Discuss circumstances where delegation is difficult. 9. Discuss legal ramifications of delegation. Cost Effective Care Cost Effective Care Cost Effective Care Cost Effective Care 11. Recognize effect of cost on health care services. 9. Differentiate reimbursement methods for 10. Discuss cost effective referral resources. 10. Effectively manages self, time and resources to provide quality, cost effective health care. health care. 10. Examine differences in prospective payment plans. Solve Problems Demonstrate reflective thinking in which ideas and concepts are applied logically and creatively to make client care decisions. Nursing I Nursing II Nursing III Nursing IV Critical Thinking in Decision Making 1. Identify the importance of critical thinking in meeting the needs of clients. Critical Thinking in Decision Making 1. Apply rational problem solving skills when discussing the plan of care. Critical Thinking in Decision Making 1. Make theoretical nursing judgments based on knowledge, experience, standards of practice. Critical Thinking in Decision Making 1. Make competent decisions with guidance. 2. Relate critical thinking skills to clinical decisions. 2. Examine the skill of intuition in providing nursing care/clinical judgment. Challenging Assumptions Challenging Assumptions Challenging Assumptions Challenging Assumptions 3. Acknowledge how assumptions affect the care of the client. 2. Identify own assumptions that affect decision making. 2. Challenge assumptions in client care situations. 3. Consistently challenge assumptions in client care situations. Prioritize Prioritize Prioritize Prioritize 4. With direction recognize client's priority needs. 3. Addresses priority needs. 3. Prioritize client care situation 4. Consistently anticipates priorities of care (from survey)

178 -172- Retrieve Information Utilize technology and accurate information to augment human intellect. Nursing I Nursing II Nursing III Nursing IV Research Research Research Research 1. Familiarize self with basic research resources. 1. Differentiate nursing research versus nonresearch articles. 2. Read a research article with understanding of its basic components. 1. Examine current nursing research and its application to clinical practice. 2. Begins to apply Evidence Based Research. 1. Incorporate Evidence Based Practice. 3. Recognize role of research in establishing protocols. Informatics Informatics Informatics Informatics 2. Begin to access technological sources for learning. 3. Familiarize self with clinical records and resources. 4. Begin to use the language of the profession of nursing. 4. Develop skill in accessing Internet resources for nursing. 5. Use the language of the profession of nursing. 3. Identify community/ internet resources to assist clients in meeting their health care needs. 4. Use the language of the profession of nursing. 2. Competent in retrieving data from definitive reliable sources including experts. 3. Consistently uses the language of the profession of nursing. Apply Therapeutic Nursing Interventions Provide safe, competent care utilizing both the art and science of nursing in practice. Nursing I Nursing II Nursing III Nursing IV Nursing Process Nursing Process Nursing Process Nursing Process 1. Understands phases of the nursing process 2. Discuss/practice basic physical assessment for clients with common, predictable problems. 1. Begins to utilize phases of the nursing process 2. Discuss/Practice components of physical assessment. 1. Utilizes all phases of the nursing process 2. Discuss/Practice ways to modify assessment techniques. 1. Consistently uses the nursing process to provide safe, competent care to maximize health potential for clients. 2. Consistently utilize focused assessment techniques.

179 -173- Apply Therapeutic Nursing Interventions (cont d) Provide safe, competent care utilizing both the art and science of nursing in practice. Nursing I Nursing II Nursing III Nursing IV 3. Practice utilizing basic interview skills to gather data. 4. Begin to use nursing diagnoses. 5. Discuss prioritizing client needs based on assessment data. 6. Begin to establish realistic outcomes. 7. Begin to develop appropriate, nursing interventions. 8. Recognize importance of outcomes for clients. 9. Recognize nursing principles of pharmacology for safe medication administration including action, adverse action, teaching, monitoring, and rationale. 3. Practice utilizing varied interview skills to gather data. 4. Consistently phrase prioritized nursing diagnoses correctly based on assessment findings. 5. Prioritize client health problems based on assessment findings. 6. Establish realistic outcomes specific to assessment findings. 7. Develop appropriate, specific, nursing interventions. 8. Begin to evaluate attainment of outcomes for clients. 3. Practice modifying interview skills to gather data. 4. Consistently develop appropriate nursing diagnoses. 5. Prioritize client health problems based on comprehensive assessment data. 6. Establish realistic outcomes based on comprehensive assessment findings. 7. Develop appropriate, specific, individualized nursing interventions. 8. Evaluate attainment of outcomes. 3. Practice utilizing varied interview skills to establish a comprehensive data base. 4. Consistently develop comprehensive nursing diagnoses. 5. Consistently prioritize client health problems based on comprehensive assessment data. 6. Consistently develop realistic outcomes based on evolving assessment findings 7. Develop appropriate, specific, creative, individualized nursing interventions. 8. Revise nursing plan based on evaluation of outcomes. Pharmacology Pharmacology Pharmacology Pharmacology 9. Identify nursing 9. Apply nursing principles principles of pharmacology of pharmacology for safe for safe medication medication administration administration including including action, adverse action, adverse action, action, teaching, monitoring, teaching, monitoring, and and rationale. rationale. 9. Consistently apply nursing principles of pharmacology for safe medication administration including action, adverse action, teaching, monitoring, and rationale.

180 -174- Apply Therapeutic Nursing Interventions (cont d) Provide safe, competent care utilizing both the art and science of nursing in practice. Nursing I Nursing II Nursing III Nursing IV Pathophysiology Pathophysiology Pathophysiology Pathophysiology 10. Describe basic pathophysiology of each health problem. Interdisciplinary Intervention 11. Identify the usual interdisciplinary interventions to supplement nursing interventions. 10. Correlate basic pathophysiology with disease process. Interdisciplinary Intervention 11. Integrate the usual interdisciplinary interventions with nursing interventions. 10. Integrate pathophysiology with the nursing process. Interdisciplinary Intervention 11. Incorporate interdisciplinary interventions with nursing interventions. 10. Competently integrate extensive knowledge of pathophysiology, pharmacology, and assessment. Interdisciplinary Intervention 11. Competently incorporate interdisciplinary interventions with nursing interventions.

181 APPENDIX I Western Wyoming Community College * Fall Semester 2014 Nursing III NRST 2630) Christine Natal Case B Objectives (Revised 8/24/14) The professional nurse provides care across the lifespan of diverse patients, families and communities. The health of the community, family and environment shapes the person's health experience; the environment is influenced by a global society. Health is unique to each person and fluctuates across the health-illness continuum. Open communication, teamwork, and quality are valued and fostered in the preparation and practice of nursing in a dynamic healthcare environment. Primary Objective: The student will be expected to begin to manage the mother and family experiencing a normal childbearing experience and common complications: Category of Need Primary Nursing Diagnosis Related Nursing Diagnosis Exemplar Health Management Deficient Knowledge Imbalanced nutrition: Less than body requirement s Fatigue Constipation Disturbed sleep pattern Readiness for enhanced childbearing process Prenatal Care Term Pregnancy Oxygen/Circulation Safety/Security Excess fluid volume Risk for injury Risk for deficient fluid volume Acute pain Anxiety Fear Preeclampsia Preterm labor Active Labor Health Management Deficient Knowledge Risk for Infection Sexual dysfunction Fatigue Postpartum adaptation Readiness for enhance parenting Risk for interrupted family processes Imbalanced nutrition: Less than body requirements Ineffective breastfeeding Anticipatory grieving Ineffective thermoregulation Normal Newborn Neonatal Jaundice

182 Christine Natal Case Objectives, Case B, Nursing III (NRST 2630) 2 Communicate Competently Communicator Therapeutic Communication Utilize effective communication techniques to enhance a therapeutic relationship for patients and families during the childbearing experience. Identify nursing interventions to meet the special needs of parent and families related to perinatal loss and grief Collaboration Incorporate feedback from health care experts. Utilize appropriate channels of communication to share relevant, prioritized data verbally and in writing with health team members. Documentation Document to meet the standards of the profession using standards of care and clinical pathways. Educator Evaluate the discharge teaching needs of the patient and family in this case. Prepare a prenatal education plan to include nutritional, exercise and safety during pregnancy. Create a teaching plan addressing nutritional needs of the newborn Caring Identify techniques that convey caring and non-caring behaviors to patients and families during the childbearing experience. See Issues from Multiple Perspectives Culture Rural Examine ways to adapt nursing care to meet the needs of patients and families during pregnancy and childbirth in the rural culture. Discuss cultural factors that may influence pain during labor and childbirth. Family Explain how family structure and patterns of functioning affect the health of family members. Assess families as care givers. Identify families at risk for interrupted family processes or risk for impaired parenting. Ethics Advocate Identify strategies to advocate for patient s rights in this case. Dilemmas Discuss ethical issues encountered in maternal/newborn nursing. Examine own feelings regarding maternal choices that risk fetal or maternal health. Examine the process of working through an ethical dilemma. Psycho-Social Dimensions Explore how pregnancy and childbirth affect: Coping Compare psycho-social adjustments of mother and partner during pregnancy and postpartum period. Compare maternal adjustment to paternal adjustment to parenthood. Identify strategies to promote family/newborn attachment. Growth and Development Describe common approaches to alleviate interrupted family processes related to sibling rivalry after the birth of a new infant. Identify the effects of pregnancy on the adolescent mother, her infant, and the family

183 Christine Natal Case Objectives, Case B, Nursing III (NRST 2630) 3 Develop Life Skills Discipline of Nursing Accountability Discuss practicing within the scope of nursing according to the Nurse Practice Act. Lifelong Learning Demonstrate life-long learning (curiosity, preparedness, thorough investigation, changing decisions based on changing knowledge). Manager Cost Effective Care Compare the options for payment of health care for a pregnant teen/woman. Discuss cost effective referral resources. Solve Problems Critical Thinking in Decision Making Make theoretical nursing judgments based on knowledge, experience, and standards of practice. Challenging Assumptions Challenge assumptions related to the nursing care of patients and families during the childbearing experience. Prioritize Consistently address priority needs in the nursing care of the patient throughout this case. Complete the following statement: All families experiencing childbirth are... Retrieve Information Research Examine current nursing research and its application to clinical practice. Begin to apply Evidence Based Practice. Informatics Identify community/internet resources to assist patients in meeting their health care needs. Use the language of the profession of nursing. Apply Therapeutic Nursing Interventions Nursing Process Discuss assessment techniques and appropriate assessment tools for: Antepartum Intrapartum Postpartum Neonate: APGAR, physical assessment, gestational age, and newborn reflexes. Practice modifying interview skills to gather data. Consistently develop appropriate nursing diagnoses. Prioritize patient health problems based on comprehensive assessment data. Establish realistic outcomes. Develop appropriate, specific, creative, individualized nursing interventions. Identify nursing interventions to support infant viability during labor Discuss essential components of discharge teaching for newborn care. Evaluate attainment of outcomes. Discuss the nursing management of women in the postpartum period

184 Christine Natal Case Objectives, Case B, Nursing III (NRST 2630) 4 Pharmacology Discuss application of nursing principles of pharmacology for safe medication administration including action, adverse action, teaching, monitoring, and rationale to this case: Contraceptives: hormonal, implants and post-coital pills Opioid agonists analgesics, Opioid agonist-antagonist analgesics Prenatal vitamins AquaMephyton Erythromycin ophthalmic ointment Pitocin Rh Immune Globulin Over the counter medication Calculate appropriate dosages and safety precautions for medication administration. Pathophysiology Integrate pathophysiology, with nursing process in the care of patient in this case. Explore the advantages and disadvantages of commonly used method of contraception Differentiate between spontaneous and induced abortions. Describe vulnerable embryonic and fetal development periods and potential teratogens. Identify the presumptive, probable and positive signs of pregnancy. Discuss supine hypotension syndrome. Discuss tests used to determine fetal well-being. Describe signs and symptoms of impending labor. Describe the physiology of the four stages of labor Discuss components of intrapartum fetal assessment (position, presentation, FHR patterns). Identify indications for a cesarean section. Compare and contrast a vaginal birth to a cesarean birth for mother and neonate Describe the physiological adaptation of the neonate to extra uterine life. Discuss physiological adjustment of the mother during the postpartum period. Describe the physiology of breastfeeding. Explain pathophysiology of SIDS. Explore the effects of cold stress on the neonate

185 Christsine Natal Case Objectives, Case B, Nursing III (NRST 2630) 5 Interdisciplinary Intervention Integrate interdisciplinary interventions with nursing interventions by: Preparing for lab\diagnostic testing Caring for patient pre/post procedure epidural amniocentesis circumcision phototherapy Discuss implications of lab/diagnostic findings: o Prenatal screening o Glucose tolerance test o Alpha-fetoprotein Implement medical orders Recognizing common complications: o Preeclampsia o Placenta Previa o Postpartum Hemorrhage o Preterm labor o Newborn jaundice

186 Curriculum Table for Culture and Diversity APPENDIX J Culture/Ethnicity Religion Age Group Sex Concept(national trends/world views) Nursing I Donna Nurse Art Pendleton Rural Elderly Male Ray Newton Catholic Elderly Male World views of care of elderly/ global view of infection Lucille Young elderly Female Cost of health care Melva African/American Baptist Elderly Female Ethno pharmacy. Diet quality r/t ethnicity and socioeconomic status Nursing II George Beck LDS Middle Adult Male Nontraditional therapies/cancer incidence globally Herb Native American Late Middle Adult Male Global obesity Witherspoon Ed Radosevich Rural-Rancher Retribution Elderly Male Trudy Troubled Young Adult Female Global suicide ideation Patty Pedi Hispanic Mr. Mom Native American Toddler/Preschoo l 1-? Multiple Native American Healing Poverty Nursing III Frieda Ubetcha Jehovah Elderly Female Witness Christine Natal Single Mother Young Adult Female Toby Townsend Gay Lifestyle Illiterate Young Adult Male Incidence and Prevalence of TB & HIV/AIDS Global perspective Emma Goldblum Elderly Female Ellie Infant/Toddler Nursing IV Roseanna Dana Rural Elderly Multiple Mavis Montgomery Jewish Middle Adult Female World view domestic violence Diane Duncan Middle Adult Female Undocumented persons. Addiction and mental illness perspectives world view Travis Espejo Hispanic Young Adult Male Sue Marm School Age/Adolescent Multiple Childhood obesity national & world view. National and world view of sexual assault

187 Western's PBL Rubric (Each statement scored at 0,.5 or 1 for a total possible 24 points/case) Communicate Competently Provide accurate information, insightful observations, effective teaching, and caring behaviors. Nursing I Nursing II Nursing III Nursing IV 1. Provides relevant examples of basic communication techniques for therapeutic communication, teaching, or caring. 1. Provides relevant examples of varied communication techniques that convey therapeutic communication, teaching, or caring. 1. Modifies relevant examples of communication to enhance therapeutic relationships in the case. APPENDIX K 1. Provides examples of communication techniques that foster therapeutic communication, teaching, or caring. 2. Utilizes basic communication techniques to participate in group discussions. *Including use of professional discretion in chat box. 3. Utilizes basic communication techniques to discuss learning issues. *Including accommodating communication technique when technology problems arise. 4. Begins to provide meaningful evaluation for self-using specific examples. 2. Begins to integrate into role as group member. *Including use of professional discretion in chat box. 3. Utilizes effective communication techniques to discuss learning issues. *Including accommodating communication technique when technology problems arise 4. Begins to provide meaningful evaluation for self and others using specific examples. 2. Integrates into role as group member. *Including use of professional discretion in chat box. 3. Uses effective communication techniques to discuss learning issues. *Including accommodating communication technique when technology problems arise. 4. Consistently provides meaningful evaluation for self and others using specific examples. 2. Stimulates discussion to meet learning needs of the group. *Including use of professional discretion in chat box. 3. Utilizes effective communication techniques to discuss learning issues. *Including accommodating communication technique when technology problems arise. 4. Insightfully evaluates self and others using specific examples. See Issues from Multiple Perspectives Provide culturally and ethically competent nursing care to a variety of individuals. Nursing I Nursing II Nursing III Nursing IV 1. Values differing points of view of group members. 2. Recognizes cultural uniqueness of persons in the case. 3. Identifies psycho-social needs of the client in the case. 1. Begins to challenge/examine own beliefs about nursing, patients, and health. 2. Examines the influence of culture on the client's health. 3. Analyzes how the psycho-social needs of the client are affected when entering the health care system. 1. Works within value systems other than own. 2. Recognizes cultural uniqueness of special populations in the case. 3. Analyzes how the psycho-social needs of the client re affected in complex cases. 1. Verbalizes self-reflection of changing belief systems. 2. Verbalizes acceptance/comfort with cultural diversity. 3. Competently and independently addresses the psycho-social needs of the client in complex cases. 4. Abides by group rules. 4. Abides by group rules. 4. Abides by group rules. 4. Abides by group rules.

188 Develop Life Skills Practice within an ethical and legal framework of the discipline of nursing. Nursing I Nursing II Nursing III 1. Enthusiastically demonstrates a "need to know" philosophy to address learning issues. 2. Begins to recognize the nurse's role in the case. 3. Abides by Professional Performance Standards. 4. Identifies knowledge gaps, expectations for learning, and personal responsibility for learning. 1. Enthusiastically demonstrates a "need to know" philosophy to address learning issues. 2. Recognizes the ethical and legal responsibility of the nurse's role in the case. 3. Abides by Professional Performance Standards. 4. Focuses on own responsibility in group learning process for selfdirected learning. 1. Enthusiastically demonstrates a "need to know" philosophy to address learning issues. 2. Articulates how the nurse can meet ethical and legal responsibilities. 3. Abides by Professional Performance Standards. 4. Addresses gaps in knowledge base independently. Nursing IV (Management of Care) 1. Enthusiastically demonstrates a "need to know" philosophy to address learning issue. 2. Integrates ethical and legal responsibilities of the nurse. 3. Abides by Professional Performance Standards. 4. Independently identifies discrepancies in conflicting knowledge within group. Solve Problems Demonstrate reflective thinking in which ideas and concepts are applied logically and creatively to make client care decisions. Nursing I Nursing II Nursing III Nursing IV 1. Applies beginning knowledge base to problems in the case. 2. Address priority problems in the case. 1. Applies knowledge base to problems in case. 2. Consistently addresses priority problems in the case. 3. Acknowledges assumptions. 3. Identifies own assumptions that affect decision making. 4. Makes appropriate decisions based on consequences of options. 4. Begins to formulate own questions to stimulate learning. 1. Applies advancing knowledge base to make decisions in the case. 2. Addresses priority problems in complex cases. 3. Challenges assumptions using critical thinking methods. 4. Challenges peers to think critically. 1. Competently applies knowledge base to make decisions in case. 2. Competently addresses priority problems in complex case. 3. Consistently challenges assumptions. 4. Engages in professional dialogue throughout case development.

189 Retrieve Information Utilize technology and accurate information to augment human intellect. Nursing I Nursing II Nursing III Nursing IV 1. Retrieves data from a variety of reliable resources, including experts. 2. Discusses learning issues using the language of the nursing profession. 1. Retrieves data from a variety of reliable resources including experts. 2. Discusses learning issues using the language of the nursing profession. 1. Consistently formulates search strategies for comprehensive retrieval of information, including experts. 2. Discusses learning issues by integrating sources of information for a broad perspective. 1. Competent in retrieving data from definitive reliable resources including experts. 2. Competently discusses learning issues by integrating sources of information for a broad perspective. 3. Refers to protocols of nursing care found in the literature. 3. Recognizes role of research in establishing protocols. 3. Begins to use evidence based practice as a frame of reference for nursing care. 3. Competently individualizes Evidence Based Practice using data to support decisions. 4. Data retrieved is relevant to case. 4. Begins to see relationships in data from various sources. 4. Sees relationships in data in complex cases. 4. Competently identifies relationships in data in complex cases. Apply Therapeutic Nursing Interventions Provide safe, competent care utilizing both the art and science of nursing in practice. Nursing I Nursing II Nursing III Nursing IV 1. Utilizes all phases of the nursing process when analyzing the case. 1. Utilizes all phases of the nursing process when analyzing the case. 1. Consistently applies all phases of the nursing process when analyzing complex cases. 1. Competently applies all phases of the nursing process when analyzing complex cases. 2. Applies basic nursing principles of pharmacology to the case. 3. Applies basic knowledge of pathophysiology regarding the disease processes in the case. 2. Applies nursing principles of pharmacology to the case. 3. Correlates basic pathophysiology with the disease process. 2. Applies nursing principles of pharmacology to the case. 3. Integrates knowledge of pathophysiology regarding the disease processes in the case. 2. Competently applies nursing principles of pharmacology to the case. 3. Integrates extensive knowledge of pathophysiology in the case. 4. Identifies interdisciplinary interventions in the case. 4. Identifies interdisciplinary interventions impact on nursing interventions. 4. Integrates interdisciplinary interventions with nursing interventions in the case. 4. Integrates interdisciplinary interventions with nursing interventions in the case.

190 Fiscal Year: 2015 Western Wyoming Community College Account Availability Report Ending 06/30/2015 Options - Available/Met/Exceeded Budget FUND: 10 - UNRESTRICTED OPERATING FUND APPENDIX L GL Account Nursing Program Electrical Technology Welding Technology Workforce Training Allocated Budget Allocated Budget Allocated Budget Allocated Budget xxxxxx-9110 SUPPLIES EDUCATIONAL $ 1, $ 3, $ 6, $ 10, xxxxxx-9123 COMPUTER SOFTWARE $ - $ - $ - $ xxxxxx-9140 SUPPLIES OTHER $ - $ 5, $ - $ xxxxxx-9141 GENERAL SUPPLIES $ $ $ 12, $ 4, xxxxxx-9142 STUDENT SUPPLIES $ 7, $ 8, $ 38, $ xxxxxx-9211 CONTRACTED SERVICES $ 5, $ - $ $ 38, xxxxxx-9231 BUILDING REPAIR $ - $ - $ 5, $ xxxxxx-9232 EQUIPMENT REPAIR $ - $ 2, $ 1, $ xxxxxx-9241 MAINTENANCE CONTRACT $ - $ - $ - $ xxxxxx-9310 DUES/MEMBERSHIPS $ 3, $ - $ $ xxxxxx-9320 EMPLOYEE TRAVEL-IN STATE $ 2, $ - $ - $ xxxxxx-9340 STUDENT TRAVEL-IN STATE $ - $ - $ - $ xxxxxx-9365 CATERING SERVICES $ - $ - $ - $ 15, xxxxxx-9421 STATE WORKERS COMPENSATION $ 17, $ 5, $ 6, $ xxxxxx-9700 OTHER OPERATING EXPENSES $ 2, $ - $ - $ 10, xxxxxx-9709 PROFESSIONAL DEVELOPMENT $ - $ - $ - $ xxxxxx-9730 SPECIAL EVENTS $ $ - $ - $ xxxxxx-9811 EQUIPMENT $ - $ - $ - $ - Totals for LOCATION: ROCK SPRINGS $ 40, $ 25, $ 69, $ 77,750.00

191 APPENDIX M