Shasta College Division of Science, Industry & Natural Resources/Health Occupations. Vocational Nursing Program Review

Transcription

1 Shasta College Division of Science, Industry & Natural Resources/Health Occupations Vocational Nursing Program Review December 2005

2 Table of Contents Program Review Committee Members...1 Summary Meeting Dates...2 Program Mission/Philosophy...3 Curriculum Update Curriculum Articulation...4 Curriculum Diversity Curriculum Competencies...5 Theory Competency...5 Clinical Competency Curriculum Strengths and Limitations Text Analysis Course Scheduling and Sequencing...12 Instructional Methodology...13 Staffing Facilities/Equipment...14 Advisory Committee Needs Assessment...15 Program Success and Performance...15 Student Satisfaction Student Support Services...16 Future Direction of the Vocational Nursing Program Analysis of Quantitative Data Appendices: Vocational Nursing Mission Statement (A) Vocational Nursing Philosophy (B) Division Mission Statement (C) Certificate of Accreditation (D) Sample Study Guide (E) Mastery Performance Criteria (F) Clinical Expectancies for Acute Care (G) Clinical Evaluation Form (H) Text Book List and Costs (I) Student Letter (J) Quantitative Data (K) Committee Level 1 and 2 Meeting Minutes (L)

3 Program Review Committee Members First Level Committee Ally Keene Connie Winkler Kathy Morrissey Bobbie Foote Julie Gee Cathe Ledford Joan Bosworth Second Level Committee Sue Hess Sue Loring Sonya Kent Cathe Ledford Julie Gee 1

4 Shasta College Division of Science, Industry & Natural Resources/ Health Occupations Vocational Nursing Program Review Summary Meeting Dates The First-Level team met on October 7, October 21 and September 2, 2005 to discuss the review process and to determine individual assignments. A meeting was held on September 16, 2005 with the First-Level Team to obtain data gathered from committee members and revisions were incorporated into the draft for the Second-Level Team to review. A meeting was held with the Second-Level team on November 16, Input was gathered from committee members and revisions were incorporated into the final draft. 2

5 Program Mission and Philosophy The Vocational Nursing Program mission statement parallels the Division of Science, Industry, and Natural Resources/Health Occupations mission. See Appendix #A Shasta College Vocational Nursing Program Mission Statement See Appendix # B Shasta College Vocational Nursing Program Philosophy See Appendix # C Division of Science, Industry, Natural Resources and Health Occupations Mission Statement Curriculum Update The curriculum for the Vocational Nursing Program meets the regulations of the Board of Vocational Nursing and Psychiatric Technicians (BVNPT) for the State of California. Curriculum content is presented over three semesters: VOCN 160, Nursing Fundamentals; VOCN 161 Nursing of Adults and; VOCN 162, Nursing of Adults and Children. The program is subject to announced, on-site surveys by the BVNPT. The last Program Record Survey was completed in December In remaining in compliance and accreditation, the program qualifies for its graduates to take the NCLEX-PN test to become licensed as a Vocational Nurse. The current accreditation expires in May The entire curriculum was updated and reviewed by the BVNPT in Prior to 2001, Shasta College Curriculum Council approved it. The curriculum is reviewed yearly. See Appendix #D, Certificate of Accreditation Analytical approaches used to review curriculum for currency routinely include: Review of textbooks, audiovisual and interactive computer software materials. Regular attendance at both nursing and professional conferences and workshops. 3

6 Networking with nursing professionals within the community and throughout the state. Networking with other vocational nursing instructors within California. Current trends and information are incorporated into the curriculum study guides to reflect changes in practice. See Appendix #E, Sample Study Guide. Course descriptions, program philosophy, curriculum threads, programs hours for theory content and clinical experience and terminal objectives for the Vocational Nursing Program are on file, up-to-date, and in compliance with the BVNPT. Curriculum Articulation Vocational nursing students must be Certified Nursing Assistants (CNA s) and CNA s will be granted credit for fifty (50) hours of clinical credit during the first semester of the program. Mastery Performance Criteria (MPC's) for nursing procedures have been developed by the health occupations faculty and are used in the Certified Nurse Assistant and Vocational Nursing. The Vocational Nursing Program accepts successful completion of these criteria when students advance through the nursing career ladder. The LVN-RN Upgrade Program at Shasta College accepts licensed Vocational Nurses that have met the requirements and are eligible for placement in the third semester of the Associate Degree Nursing Program. Curriculum Diversity The Vocational Nursing curriculum integrates cultural diversity into a variety of health and illness practices including: Family roles and health care beliefs. Verbal and nonverbal communication practices. Nutritional preferences. Death and dying rites. Spiritual practices and beliefs. Cultural aspects of patient care. Complementary and alternative therapies. 4

7 The exposure to cultural and ethnic diversity as it relates to health care practice will assist the student to develop sensitivity and tolerance to others. This will enhance the delivery of health care within our community and the world at large. Curriculum Competencies Upon completion of the Vocational Nursing Program the student will be able to demonstrate and provide safe bedside nursing care, infection control, medication administration, therapeutic treatments and procedures within the vocational nursing scope of practice as outlined by the Vocational Nurse Practice Act. In addition they will be able to communicate effectively, recognize and individualize care to the special needs of others and assume responsibility for their professional behavior. The student under the supervision of a registered nurse will be able to utilize the nursing process to plan, implement and evaluate safe, competent care within the vocational nurse s scope of practice. The student will communicate effectively with the supervising registered nurse and/or physician to coordinate patient care and report patient status. Theory Competency The tools used to measure competency of theory are written tests, papers, care plans, interviews with patients, group projects and oral quizzes. These have an emphasis on critical thinking skills and application of the nursing process. The minimum passing score for each test is 75% of the total possible points. The first grade achieved on the test will be the grade entered. If less than 75% is achieved, the student is required to review missed content, provide the correct answer and cite the appropriate reference page. The student must achieve 75% of the total semester points to successfully complete the semester. Letter grades as they relate to scores are: A= 92% to 100% B= 83%-91% C= 75%-82% All tests are reviewed, revised and updated on an ongoing basis. 5 Clinical Competency

8 Clinical competency is evaluated by observing student performance in the Clinical Skills Laboratory (CSL) and in the health care setting. In the CSL the student learns and practices skills in a safe, fully equipped, simulated patient care environment with instructors providing guidance and formal evaluation. MPC s are the tools used to evaluate the student's ability to perform nursing procedures. The MPC provides an objective step-bystep description of a specific skill to enhance student mastery of clinical competency. Each skill is initially demonstrated by the instructor following the MPC format, after which the student is given time in the CSL for guided practice. Students assist other students to learn through peer evaluations. Videos of selected skills are also provided for reinforcement. In order to evaluate competency, each student is assigned a return demonstration time during which they perform the MPC skill before the evaluating instructor. Each student is required to demonstrate skill competency prior to entering into the clinical rotation. Skills are leveled from the simple to the complex. An interdisciplinary health occupations committee, which includes Certified Nursing Assistant/Home Health Aide faculty, Vocational Nursing faculty and Associate Degree Nursing faculty, develops, reviews and updates MPC s on a yearly basis. See Appendix #F, MPC-Enema Large Volume Clinical competency is evaluated in the health care setting. The clinical sites provide a "reality-based" opportunity for students to use critical thinking skills and hands-on application of mastered skills to provide patient care under faculty supervision. The student is provided with Clinical Expectancies prior to the clinical experience. These expectancies outline the purpose and the clinical objectives for each of the rotations. See Appendix #G, Clinical Expectancies for Acute Care Twice a semester each student will meet with the instructor and review his/her progress using a clinical evaluation form. The clinical evaluation defines course objectives, which have been delineated into measurable clinical behaviors. The first evaluation is scheduled mid- 6

9 semester to apprise the student of his/her clinical standing and provide sufficient time to demonstrate improvement in potential problem areas. The second evaluation is scheduled upon semester completion during finals week. The evaluation tool is to be reviewed and updated on a yearly basis. See Appendix #H, Clinical Evaluation Form. Curriculum Strengths and Limitations Strengths 1. The graduate from this program is prepared to take the NCLEX- PN test. Success rate in the program is shown not only by the number of students who complete the class but also in the pass rate on the NCLEX-PN. The state pass rate for this time period varies from 76% to 82% while the pass rate for Shasta College students is from 95% to 100%. Upon completion of the course and the NCLEX-PN, entry-level positions offer an average salary of about $ $20.00 per hour. Graduates of the program are actively recruited by surrounding health care agencies (e.g., community health centers, long tem care, physician offices, home health settings) for employment in an occupation with high demand. 2. The faculty is full-time and utilizes adjuncts in the CSL and at clinical sites. The faculty remains current on nursing issues and practices by attending various continuing education courses. They have been implementing curriculum changes and adding the curriculum to WebCT as a hybrid class. The students access the syllabus, schedules, outlines and handouts online from either a computer at home or on campus. The students also utilize to communicate with the faculty. This will be greatly enhanced next semester, Spring 2006, when all Shasta College students will have accounts. The instructors have strengths that complement each other in teaching methodology and are advocates for student success. Many of the classes employ the team-teaching method. 3. The faculty and students working collaboratively participate in a wide variety of community events such as the College Festival, 7

10 Health Fair sponsored by Shasta College Wellness Services, Sierra Pacific Health Fair and various career days offered by the health facilities in the area. 4. The well-equipped CSL provides a reality-based educational opportunity for the student to practice and perfect skills prior to patient care delivery. CSL hours are flexible in order to provide the students with maximum usage possible. The lab is staffed by an RN who is available three evenings a week until 8:00 pm and on Saturday from 10:00 am to 2:00 pm. These hours vary depending on class needs during the semester. 5. The clinical agencies utilized provide the students with the opportunity to participate in a variety of health care settings including acute care, long-term care, outpatient clinics, community health centers and home health care. These settings allow the student to be part of a broad range of patient care experiences. Agency staff develops rapport with the students that promotes self-esteem and student confidence as they learn the vocational nursing role. 6. There is an active and supportive Nursing Advisory Council for the Vocational Nursing Program. 7. The college provides one counselor to advise the students who might be interested in the Vocational Nursing Program. That counselor attends the Vocational Nursing meetings and is an active liaison with the Program Director and Faculty. Limitations 1. Problem Academic Preparation: Students are allowed to enroll in the program, after prerequisites, without the usual math and English services. The student is then at a disadvantage as support services for remediation are delayed. Students have a difficult time meeting the math goals necessary for the administration of medications. Also students do not see a counselor prior to admission to the program or immediately thereafter which may prohibit or slow the process of accessing support services in a timely manner. 8

11 Solution: Pre-registration orientation meetings are to be scheduled the semester prior to starting VOCN 160, to outline course requirements and pertinent information prior to open enrollment. Faculty acts as student advocates providing individual assistance, making available student resources known and referrals as needed as soon as classes begin (e.g., student counseling services and the Learning Resource Center). Implement in school catalog that English 190, Math 220, and Medical Terminology 110, are recommended courses that may assist students throughout the vocational nursing program. Problem Student Support: The financial impact of the program creates a significant hardship for the student. Childcare issues due to the requirements of clinical hours also cause hardship for the student. A need has been identified regarding Financial Aid services and the lack of efficiency for students to obtain the granted monies. Solution: Faculty will actively network with CalWorks, Private Industry Council, Financial Aid Office and EOPS to facilitate student support services (Financial Aid, childcare, EOPS, Wellness and Health Services and Counseling). Faculty recognizes the great expense incurred purchasing books and is sensitive to this. Presently faculty is reevaluating the required book list in hopes of decreasing costs. Faculty has also spread out the purchase of books between the first two semesters so students will not have to buy all texts at the onset of the first semester. Additionally texts will be placed in the library on reserve status. Due to the library being closed on weekends, books will placed on an expanded time frame i.e hour reserve. Appendix #I, Textbook List and Costs 9

12 2. Problem Electronic Access and Use: With the onset of increased utilization of computers in health care settings (e.g., electronic records, charting) the student must have some preparation to ease into the work-world. Also the NCLEX-PN is given on the computer. Solution: Initiate on-line testing so students have more practice and experience in computerized test taking preparing them for the NCLEX-PN. Work with Web-CT experts on campus regarding possible security issues regarding on-line testing. Presently students do use computer to access certain lecture information. Students request ready access to their grades throughout the semester. Faculty could use a function in WebCT to provide this resource for students. Time needs to be given to faculty to achieve this. 3. Problem Yearly Evaluation Tool: It has been identified that the yearly evaluation tool needs to be more in line with the clinical expectancies. Solution: Revise the clinical evaluation tool at the end of each semester. Faculty needs time to achieve this. 4. Problem On-going Education for Faculty: Faculty are often unable to attend nursing conferences and seminars because they take place during clinical day. Faculty needs to have the ability to use release time to attend these conferences and seminars that keep them current in their profession. Solution: Provide for one day per semester for conferences and seminars for faculty. 5. Problem Evaluation of Program Success: Presently there is an informal way to accrue data regarding program success. The faculty receives numerous calls on a regular basis from a variety of health care facilities looking for the caliber of student they have come to expect from Shasta College. Surveys are mailed to students who have graduated from the program but only a small amount of the surveys are returned. 10

13 Solution: Continue sending questionnaires to clinical sites, and obtain feedback from Nursing Advisory Council and utilize an electronic survey. Access the research office to survey (and compile data): o Students who have completed the program. o Directors of Nursing at the clinical sites. o Human Resource Directors. o Others that employ our graduates. 6. Problem 15: 1 Student/Instructor Ratio. During the entire three semesters there is 15:1 ratio of students to instructor. Students often take longer during the first semester to complete the MPC check off in the laboratory and miss performing important clinical skills in the clinical facilities because the instructor has so many students to supervise. Patient safety, quality care and prevention of errors are essential in the clinical setting. It s difficult for students to progress and frustrating because there are many missed opportunities for patient care activities in the clinical setting. It may take three clinical days before all the students can be giving oral medications. More instructors during the first semester would allow students more clinical time to increase their patient contact experiences, practice medication administration and other skills in the clinical site thus facilitating increased safe patient care experiences. Solution: Implement a 10:1 ratio for the first semester of the VN Program during the clinical hours. Research the availability for grant money to facilitate a 10:1 ratio for the first two semesters of the program. Faculty would need to be allowed time to do perform the research. Text Analysis Representatives from the major publishers of nursing texts make announced visits to Shasta College twice a year and meet with VN faculty. Additionally new textbook editions from the major publishers are routinely sent to instructors for preview. 11

14 The selection process includes: Recency of materials Currency of trends in nursing practice and health care delivery Readability Ancillary materials Compliance with Title 22 Regulations Compliance with BVNPT Price Students who have used the books are also part of focus groups to evaluate the books. The faculty assigns to the student alternative materials relative to theory. These materials include videos, journal articles, software appropriate to course objectives, computer assisted instruction, and study guides. Appendix #I, Textbook List and Costs Course Scheduling and Sequencing Course information is provided in the Shasta College Catalog and scheduling is listed in the Shasta College Schedule of Classes. There are no concurrent required courses. The following are the prerequisite courses: BIOL 5 Introduction to Human Biology 3 units BIOL 6 Introduction to Human Biology Lab 1 unit ECE 1 Human Development 3 units FSS 25 Nutrition 3 units PSYC 14 Understanding Human Behavior 3 units o PSYC 1A serves as alternate for PSYC 14 HEOC 180 NA/HHA 13 unit *Or current CNA certification The scheduling for these course hours are reviewed to avoid overlapping with other required courses. Course scheduling of clinical hours is governed by the BVNPT and includes a day and evening rotation. 12

15 Instructional Methodology Vocational Nursing curriculum includes both theory and clinical components, which totals 1702 hours. The hours of both theory and clinical are governed by the BVNPT. Minimum hours required are: Theory 648 hours (which includes the prerequisites) Clinical 954 hours Instructional methodologies for the theory portion of the curriculum include lecture, discussion, critical thinking exercises, individual and small group projects, occasional use of guest speakers, audiovisual aids, and handouts. It also includes use of the computer to access the Internet and PowerPoint presentations, interactive CD ROMs on pertinent topics, transparencies, assigned textbook reading and interviews with patients. In addition WebCT is used so that students can access pertinent information from their home computers. Instructional methodologies for the clinical portion of the curriculum include faculty demonstrations, audiovisual aids for reinforcement, videotapes of practice, and assigned time in the CSL for active student participation, guided practice, role playing and peer evaluation. Clinical experience is scheduled for 21 hours a week the first semester and 16 hours per week the following two semesters. Clinical sites include Shasta Healthcare, Shasta Regional Medical Center, Northern California Rehabilitation Center, Mercy Medical Center, St. Elizabeth Hospital, Medical Home Care Professionals, Mercy Hospice, Shasta Community Health Center, Mercy Maternity Clinic, and Canyonwood Care Center. Staffing The BVNPT regulates staffing for the Vocational Nursing Program. It is mandated that the staffing ratio must be no greater than 15:1 in the clinical setting. In order to teach in this program, faculty must receive BVNPT approval. The qualifications include either a bachelor's degree in Nursing and two years of full-time occupational experience OR an associate degree in Nursing and six years of full-time occupational experience. Faculty are required to 13

16 complete mandated continuing education hours in order to maintain current licensure with the California State Board of Registered Nursing. Faculty must also maintain current CPR certification. The current faculty for the Vocational Nursing Program possess the requirements. One faculty has a Masters degree and over 30 years experience including many years of management and experience with nursing computer applications. The other faculty has a BSN, is currently working on a Masters degree and over 23 years experience in many areas of nursing including informatics and critical care. They are members of the California Vocational Nurse Educators Association. The faculty are involved with the college and local community as active member of various committees and boards. Facilities/Equipment The Vocational Nursing and two other programs utilize the CSL. At times this curtails availability and access. The Program looks forward to moving to the new Health Science Building to alleviate overcrowding. Clinical Facilities the students rotate through a variety of clinical agencies. However, due to the increasing student enrollment with other nursing programs, access is tight and at time schedules must be changed to accommodate the current needs. More clinical sites need to be found both for present use and for the future to allow expansion and flexibility. Classrooms The classroom presently utilized is a smart classroom that seats 30 students. With the potential growth and expansion of the program there will be a need to increase classroom size to accommodate more students and possibly use ITV. Equipment No deficiencies in this area. Advisory Committee The Vocational Nursing Program is part of the Shasta College Nursing Advisory Council. Membership includes representatives from local hospitals, skilled nursing facilities, home health agencies, Shasta County Public Health Department and community members. This Board meets twice a year with the health occupations programs. This committee is very active and provides input on current and local health care trends, local workforce needs and the success of the 14

17 employed graduates. They provide recommendations that are incorporated in program planning and development. Needs Assessment The Vocational Nursing Program is continually assessing student and employer needs through advisory board meetings, conferences with agency staff and formal student feedback during the clinical evaluations. The program also uses a graduate survey. There are two student representative chosen each semester that are members of the Vocational Nursing Department Committee. In addition classroom evaluations are done on the instructors. Program Success and Performance Over the last 5 years (since 2000) the program has had 3 graduating classes resulting in 75 graduates. The students have a 95% NCLEX-VN pass rate as compared to the state pass rate of 76-82%. Some are now enrolled in the LVN-RN upgrade of the Associate Degree Nursing Program. Of these students, many are currently employed in the tri-county area that Shasta College serves. Another way to measure program success is through community satisfaction and employment opportunities. The faculty receives numerous calls on a regular basis from a variety of health care facilities looking for the caliber of student they have come to expect from those completing the program at Shasta College. The demand for Vocational Nurses locally, throughout the state and nationally is great in many types of health care settings. According to U.S. Bureau of Labor Statistics published in the February 2004, Monthly Labor Review, more than one million new and replacement nurses will be needed by The average age of a nurse is 47 years, which also presents huge problems. For the first time, the US Department of Labor has identified Nursing as the top occupation in terms of job growth through the year Student Satisfaction Student satisfaction with the Vocational Nursing Program is assessed by several means including informal student feedback gathered by faculty during individually scheduled clinical evaluation meetings twice a semester, formal student evaluations of individual instructors and the course, as prescribed by the college. Two student 15

18 representatives are elected each semester to present course concerns at the monthly Vocational Nursing faculty meetings. The faculty uses this feedback to assess and modify learning activities to enhance educational opportunities and promote positive mastery of curriculum. Appendix #J, Letter from Vocational Nursing Students Student Support Services Students are encouraged by faculty during general course orientation sessions and throughout the program to access the numerous support services available to them at Shasta College. Specific information is available in the college catalog and within numerous fliers available at multiple sites on campus. As mentioned previously support services available to the students include Student Health/Wellness Services, Disabled Student Services, Learning Resource Center (LRC), Counseling Services and Financial Aid services. Future Direction of the VN Program Telecommunications with ITV and the Internet provides an avenue for the student to obtain theory content of the Vocational Nursing Program in the outreach areas of Red Bluff, Burney, Weaverville, Corning and Los Molinos. This will minimize the travel currently required. Development of adjunct faculty positions based in each of the outreach areas would allow the student to obtain their clinical experience in their local areas. The faculty are exploring a 16 week compressed schedule. In order to achieve this we would need to revise curriculum and present it to the BVNPT before changes could be implemented. A combined first and second committee meeting held on November 16, 2005, made the following recommendations for future programs. 1. The faculty is to proceed with ITV to provide easy access for more outreach students. 2. Faculty will actively integrate access and utilization of interpreters into the theory and clinical site instruction. 16

19 3. New Health Sciences building will provide more laboratory and classroom space to accommodate an increase in the number of students. 4. Clinical sites need to be developed in outlying areas such as Burney, Weaverville, and Tehema County. Perhaps facilities in these areas will fund a clinical instructor. 5. Reinstate Math for Meds class. It is no longer being offered and a need has been identified for this class to be available to the students as an elective. 6. Implement a 10:1 instructor to student ratio for the first two semesters of the program during clinical hours. Analysis of Quantitative Data The data requested for this program review was specifically for the Vocational Nursing program. The data appears to be accurate but does need some explanation. For example, the course enrollments from 2002 to 2005 identify 52, 52, 60, as class enrollments. For that period of time 30 students were admitted into each class but the program begins every third semester. Therefore in December 2002, 24 students completed the program, in May 2004, 23 and in December 2005, 25 are expected to finish. The semester student contact hours for students in VOCN 160 is 522 hours, consisting of 8 hours of lecture and 21 hours of laboratory or clinical hours per week. The faculty have 29 hours of student contact per week. VOCN 161 is 432 hours, consisting of 8 hours of lecture per week and 16 hours of laboratory or clinical hours per week. The faculty have 24 hours of student contact per week. VOCN 162 student contact hours are the same as VOCN 161. The faculty have 24 hours of student contact per week. Total program hours are 1702 hours 648 of theory and 954 of clinical. All of the sections were filled to capacity and none of the sections were cancelled. The GPA has decreased significantly since Most of the students have outside jobs and families, which decreases study time. The class of shows 3.6% of the students had an F. This represents two students. These students were counseled from the 5 th week of the semester and were informed they were failing the class. Both students elected to continue and risked failing the course. 17

20 The high number of drops (9.8%) in the is because students tend to drop in the first semester if they are failing rather than obtain an F grade. Success rate in the program is shown by the number of students who complete the class but also in the pass rate on the NCLEX-PN. The state pass rate for this time period varies from 76% to 82% while the pass rate for Shasta College students is from 95% to 100%. Appendix #K, Quantitative Data