AGENDA ITEM III A PROPOSED ACADEMIC PROGRAMS LOUISIANA STATE UNIVERSITY HEALTH SCIENCE CENTER M.S. IN NURSING - NURSE ANESTHESIA OPTION

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1 AGENDA ITEM III A PROPOSED AADEMI PROGRAMS LOUISIANA STATE UNIVERSITY HEALTH SIENE ENTER M.S. IN NURSING - NURSE ANESTHESIA OPTION BAKGROUND INFORMATION Since the early 1900s, a post-baccalaureate ertificate program in Nurse Anesthesia has been offered through harity Hospital in New Orleans. In 1985, an academic partnership between harity and Xavier University was formed to award graduates of this program a M.S. degree in Nurse Anesthesia. Following the transfer of the State Hospital System to the LSU Health Science enter in 1997, arrangements were made to continue this program between LSUHS and Xavier. In the Fall of 2000, however, Xavier informed LSUHS that it would cease accepting new students beginning January, 2001 and that the last Xavier student would graduate from the program in May, Upon notification of Xavier s plan, the LSUHS immediately began preparations to institute its own RNA program. A Letter of Intent for the projected M.S. program in Nursing - Nurse Anesthesia at the LSUHS was approved by the Regents in March, 2001, and a full program proposal was submitted in August, The staff assessment which follows is presented in two sections: first, a summary of the proposal; and second, comments and suggestions of an external reviewer with responses from the LSUHS. I. Need The proposal stated the following rationale of need: PROPOSAL SUMMARY State of RNA Practice Nationally, more than 27,000 RNAs provide cost-effective, high-quality patient care that is essential to America s healthcare system. By the year 2010, it is projected that the nation will need over 30,000 more RNAs. This suggests a strong need for educational opportunities for registered nurses who desire to pursue RNA education. Louisiana has a total population of 4,349,556 persons living in 64 parishes. Approximately, 801,930 (18%) of the population rely on Medicaid and 595,588 (14%) rely on Medicare to pay for their health care expenditures. The provision of these health care services relies heavily on an adequately prepared nursing workforce to deliver care

2 inclusive of anesthesia. The 1999 report prepared by the Louisiana State Board of Nursing indicates that approximately 36,751 registered nurses are licensed and reside in Louisiana to provide nursing care. Only 1,736 (4.7%) registered nurses in Louisiana hold a Masters degree in nursing as their highest educational credential. There are a total of 682 (1.8%) nurse anesthetists in Louisiana that comprise the nurse anesthetist workforce. Of these RNAs, there are 375 (54.9%) certified nurse anesthetists who are recognized by the LSBN as advanced practice registered nurses, with the majority holding a master of science degree, not in nursing, as their highest educational credential. In comparison, there are 282 anesthesiologists serving the total Louisiana population, which results in a RNA to anesthesiologist ratio of 2.4:1. In the metropolitan areas, there are 601 RNAs and 262 anesthesiologists for a 2.3:1 ratio. This workforce supply of nurse anesthetists and anesthesiologists provides health care to about 3,262,167 (75%) Louisiana residents. In non-metropolitan and rural areas, 87 RNAs and 20 anesthesiologists (4.4 to 1 ratio) provide anesthesia for 1,087,389 (25%) Louisiana residents. In about 24 parishes with a population ranging from 13,000 to 91,000, there are 57 RNAs and no anesthesiologists for these parishes with a total population size of 717,173 (16% of the state). In 1999, there were an estimated total of 120,889 anesthesia cases in these parishes. (American Association of Nurse Anesthetists, 2000). This anesthesia care was provided in multiple types of settings. Ninety-four percent of Louisiana RNAs are in clinical practice with 42% employed by a hospital, 37% employed by a physician group, and 11% as contractors. Five percent work in hospitals with less than 500 anesthetics administered per year and 10% work in medically underserved areas. Nurse anesthetists administer about 70% of the regional anesthesia in Louisiana. The mean age of the RNAs in Louisiana is 48 years, which suggests that in the next few years, a large number will be retiring which will compound the RNA shortage. urrently, RNA clinical faculty reports a critical shortage in the New Orleans area and throughout the state. Programs in Louisiana urrently Xavier University, as an academic affiliate with the Louisiana State University Health Sciences Services Division, comprises the only Nurse Anesthesia program in Louisiana. As of May 2002 Xavier University will graduate the last RNA class. No new students have been accepted since January Typically, the program admits approximately 50 nurse anesthesia students a year and graduates approximately students a year. Termination of this program has created a void for Nurse Anesthesia educational preparation within Louisiana that severely impacts the ability of the current RNA workforce to deliver anesthesia care to the citizens of Louisiana especially to medically underserved communities.

3 Louisiana has six Master of Science in Nursing programs and one Master of Nursing program. Presently, there are no academic institutions within the state of Louisiana, public or private, that award a Master of Nursing degree with a specialization in Nurse Anesthesia. The nearest academic institutions that award a Master s degree in Nursing with a specialization in Nurse Anesthesia are University of Texas Health Sciences enter School of Nursing at Houston, Baylor University, University of Alabama at Birmingham, and the Medical ollege of Georgia which are approximately 346, 346, 342, 608 miles from New Orleans, Louisiana, respectively. II. Mission/Objectives The proposal provides the following regarding program mission/objectives: Louisiana State University Health Sciences enter (LSUHS) provides education, research, patient care services and community outreach. LSUHS encompasses six professional schools the School of Medicine in New Orleans, the School of Medicine in Shreveport, the School of Graduate Studies in New Orleans and Shreveport, the School of Nursing, the School of Dentistry, and the School of Allied Health Professions in New Orleans and Shreveport, as well as, a nine public hospital system through Health are Services Division. Louisiana State University Health Sciences enter School of Nursing has objectives specific to the Master of Nursing degree. The purpose of the Master of Nursing (MN) is to prepare graduates with advanced knowledge in an area of clinical specialization with a foundation for doctoral study. All LSUHS SON Masters degree graduates achieve these objectives. Upon completion of the requirements for the master's degree, graduates will be able to: 1. Apply knowledge and theories to advanced nursing practice, 2. Assume responsibility and accountability for advanced nursing practice, 3. Interpret research findings for nursing practice, 4. Design and evaluate nursing research, 5. Participate in research studies in advanced nursing practice, 6. Maintain independence within a collaborative relationship with other professionals to meet the health needs of a multicultural society, and 7. Function effectively in roles of practitioner, educator, or administrator. Louisiana State University Health Sciences enter School of Nursing has approved program specific objectives that are in compliance with the ouncil on Accreditation of Nurse Anesthesia Educational Programs (OA). Faculty members from the School of Nursing and the harity/xavier Program have carefully reviewed these objectives, and the objectives are seen as complementary to the MN objectives.

4 III. urriculum The proposal indicated the following curricular plan: The nurse anesthesia plan of study consists of 115 credit hours in the curriculum. The program is planned such that academic credit is allotted for clinical experience time that will include clinical conferences. The nursing specialty courses have a total number of 3,615 clinical clock hours and 820 didactic clock hours in the 32 month curriculum. An annual calendar and annual tuition fee schedule will maximize student experience opportunities. The special degree requirements in the proposed plan of study are consistent with the requirements from the ouncil on Accreditation of Nurse Anesthesia Programs. The following are special degree requirements for the graduates from an accredited nurse anesthetist program. Minimum of 24 months in length Minimum of 450 anesthesia cases The LSUHS proposed 32 month program has been planned for students to complete over 450 anesthesia cases with the expectation that each student will complete cases. The new proposed OA standards, if adopted, will increase minimum degree requirements. The experience levels planned for each student will be sufficient to meet proposed standards A formal thesis is not required for the Master of Nursing degree at LSUHS School of Nursing, and a thesis will not be required for the Master of Nursing with a specialization in Nurse Anesthesia. Nurse Anesthesia linical Practicum VII offers the student an individualized clinical capstone in nurse anesthesia practice. Students will be engaged in a project related to developing evidence-based practice guidelines, and to apply research findings in a specific anesthesia environment. The proposal also provided a complete description of all courses and a proposed plan for sequencing of coursework to assure timely completion of degree requirements. Both of these documents can be found in the Office of Academic Affairs. IV. Students The proposal provided the following information regarding students: Historically, the Xavier University program has admitted 48 to 50 students per year with an average annual enrollment of 48 students. The number of yearly graduates from Xavier

5 University Nurse Anesthesia program ranged from 47 to 49 with an average attrition rate of 2%. Projections on admission, enrollment and potential graduates for the first five years of the proposed program are based on the number of operating rooms available to the students for supervised clinical experience and the number of operations conducted at the clinical facilities. Admission Enrollment Potential Graduates Year Year Year * Year * Year * Potential graduates calculated based on an average completion time of 32 months with a 2% attrition rate based on historical attrition rate of Xavier University. urrently there exists a pool of over 140 potential applicants who have inquired about a nurse anesthesia program at LSUHS SON. A database has been developed to record inquiries received by the Student Records Office of the School of Nursing. In addition, there are 92 individuals who had applied to the harity/xavier program who would meet the admission requirements planned for the Master of Nursing with a specialization in Nurse Anesthesia curriculum. V. Faculty The proposal provides a full description of all current faculty who will participate directly in the proposed program. The proposal summarizes existing faculty resources as follows: LSUHS School of Nursing has ten faculty who are educationally prepared to teach Advanced Practice Nursing courses. Faculty teaching in the Nurse Anesthesia Support ore courses have specialized competence in the areas of anatomy, physiology, and pharmacology. Other faculty expertise will occur from the departments of anatomy, physiology, pharmacology, and anesthesiology. Over 30 certified registered nurse anesthetists have agreed to serve as clinical preceptors and faculty. The proposal projects the following faculty needs: The LSUHS School of Nursing projects the need for 2.2 FTE additional faculty in year 1, 2.9 FTE in Year 2, and 1.2 in year 3 to assist with teaching Nurse Anesthesia Specialization courses and for support of other faculty teaching Advanced Practice Nurse courses and

6 Nurse Anesthesia Support courses. This cadre of full-time faculty should be sufficient to sustain the program for the future. The 6.3 FTE faculty needed in the first three years will consist of a Program Director and an additional 5.3 FTE faculty. Besides additional salary expenses, some recruitment dollars will be required. Additional costs for new faculty resources, consultants, and associated travel are estimated as follows: Year 1 $ 363,804 Year 2 $ 557,842 Year 3 $ 635,143 Year 4 $ 681,628 VI. Library/Learning Resources The proposal states that current library holding and other learning resources are sufficient to begin the program. Additional professional journals will be required, along with some reference text in future years. ost estimates for these additional resources are as follows: Year 1 $5,000 Year 2 $3,000 Year 3 $3,000 Year 4 $2,000 Year 5 $2,000 These costs are not reflected in the budget. VII. Facilities and Equipment The proposal notes the following regarding facilities: At this time, no new facilities...will be needed. Minor remodeling may occur to reconfigure carrel areas to accommodate nurse anesthesia simulation equipment. Additional equipment will be required, however, and these costs are not unsubstantial: Year 1 $78,399 Year 2 $12,575 Year 3 $10,220 Year 4 $10,223 VIII. Administration The proposed program will be housed in the School of Nursing, Department of Adult Health Nursing. A

7 Program oordinator will assume administrative responsibilities for the program. The Program oordinator will report to the hair of the Department of Adult Health Nursing, who in turn will report to the Dean of the School of Nursing. IX. Accreditation The LSUHS indicates that the program is required to seek appropriate accreditation through the ouncil of Accreditation of Nurse Anesthesia Educational Programs. In May, 2001, the LSUHS successfully petitioned to have the OA accreditation for the former Xavier program transferred to the proposed LSUHS program. The program will face reaccreditation review in X. osts The proposed program is quite expensive and costs anticipated for the first four-years of program operations are as follows: Year 1 $442,203 Year 2 $570,417 Year 3 $645,363 Year 4 $691,851 (See Appendix I.) The LSUHS proposes to address these costs in several ways: A significant event during the development of this proposal was the successful application by the LSUHS School of Nursing for a grant through the U.S. Department of Health and Human Services Health Resources and Service Administration-Division of Nursing. This 3-year grant provides funding to the LSUHS for program implementation as follows: Year 1 $309,416 Year 2 $276,396 Year 3 $265,526 TOTAL $851,338 Additional tuition income: Year 1 $ 84,990 Year 2 $195,477 Year 3 $287,143 Year 4 $309,763 Other funding (reallocations within existing budgets, etc.)

8 Year 1 $ 39,325 Year 2 $ 49,078 Year 3 $ 51,040 Year 4 $ 88,471 Yet, even with funding promised above, deficits will result. Year 1 -$ 8,472 Year 2 -$ 49,466 Year 3 -$ 41,653 Year 4 -$293,618 The LSUHS believes that the most reasonable way to address the long-term funding problem would be to raise tuition for the program from the current graduate nursing level of $1,131/semester to the same level at that paid by medical students of $4,290/semester. If this increase was instituted, the LSUHS estimates program surpluses as follows: Year 1 $ 69,168 Year 2 $166,507 Year 3 $462,904 Year 4 $400,479 (See Appendix II.) Yet, while LSUHS provides evidence that the requested new tuition rate would be lower than that compared to comparable programs in the southeast US, these additional tuition monies cannot be expected immediately. Neither the LSUHS nor the Board of Regents has the authority to approve increased tuition charges; this type of request must be approved by the Legislature. Hence, program deficits remain. EXTERNAL ONSULTANTS REVIEW In addition to the proposal summary above, the staff sought the services of a knowledgeable external consultant to review the proposed program. Dr. Michael Fallacaro, Professor and hairman of the Nurse Anesthesia Program at Virginia ommonwealth University, assessed the LSUHS proposal. He noted significant strengths in the areas of: Program Need Program Structure urricular Design Accreditation Requirements Faculty Projections Facilities Equipment Projections His one area of concern was the budget:

9 Service Savings in the Proposed Budget ost-sharing of Needed Technologies Staff Note: It is relevant to note that Dr. Fallacaro comments were based on a preliminary budget which has undergone substantial revision. He concluded his review by stating I see no critical areas of concern with this proposal and recommend that it be approved. STAFF SUMMARY The staff and the external consultant support the implementation of this program at LSUHS: Need is evident, if not critical. The program is appropriate to the role, scope and mission of the institution. The proposed program of study is strong. Student interest is strong. Resources (faculty, facilities) are available to assist in program implementation. Accreditation issues have already been resolved. Administrative structure is appropriate. Despite these positive points, the budgetary demands of this program are worrisome. After thorough analysis of the proposed budget, the staff directed its concerns regarding anticipated deficits and the amount and timing of projected tuition increase with the administration of the LSUHS. Dr. Mary Ella Sanders, Acting hancellor, responded by submitting a letter which commits the institution to cover any budgetary shortfalls for Years 1 and 2. (See Appendix III.) The staff believes that this two-year period of financial assurity would be enough time for the LSUHS to present its argument to the Legislature for an appropriate tuition increase. However, any proposed tuition increase should be financially neutral, covering only actual costs of the program and avoiding excess revenues. The staff notes that the Board of Regents in January, 1998 faced a similar situation with a proposed Doctor of Pharmacy program at the University of Louisiana at Monroe wherein a tuition increase was deemed necessary to assure adequate funding for program implementation. The staff recommendation below, with appropriate changes, reflect the procedure which the Regents utilized in this previous case. STAFF REOMMENDATION The staff recommends that the Academic and Student Affairs ommittee grant conditional approval for the proposed M.S. program in Nursing - Nurse Anesthesia Option at the Louisiana State University Health Science enter, to be implemented beginning January, 2002, with the following stipulations:

10 1. Prior to submittal of a request to the Louisiana Legislature for a tuition increase to support this program, appropriate staff of the Board of Regents and representatives from the LSUHS shall meet to review the proposed budget and recommend a proposed tuition increase. The tuition increase recommendation shall take into account additional expenses incurred as a result of program implementation as compared to additional revenues generated by a required tuition increase to meet the Southern Region Educational Board average for similar programs. 2. Upon agreement of a proposed tuition increase, the Board of Regents shall consider requesting from the Legislature necessary action needed to increase tuition levels for the program consistent with average costs for similar programs in the SREB region. This request shall be consistent with the recommended goal of a ration of cost sharing between the State and the student. If the Legislature elects not to grant this increase, then the Regents shall reconsider the program in light of available funding. 3. Beginning August 1, 2002, and for four years thereafter, LSUHS shall submit an annual report to the ommissioner of Higher Education which updates efforts to fully implement the proposed program and provides a complete annual budget for the upcoming academic year.

11 APPENDIX I

12 APPENDIX II

13 APPENDIX III