Best Practices Among High Performing Nursing Institutions In CALABARZON Region

In CALABARZON Region Cornelia Rafa Catalla College of Nursing San Pablo Colleges The study delved on the best practices of high performing nursing institutions in CALABARZON Region. The study dealt with NLE board performance for the last five years (2008-2012) in terms of the first timers and re-takers; best practices of the deans and clinical coordinators in student admission, selection and retention, faculty standards, instruction, board examination preparation and accreditation status; and administrative support in terms of facilities and equipment, library, and faculty development program. The descriptive method of research, case analysis and focus group discussion were employed in the study and utilized frequency distribution and weighted mean in the statistical analysis. The best practices by the deans and clinical coordinators, strengthened with the administrative support are contributory factors to the high performance of the nursing institutions in the National Licensure Examination for Nurses. Keywords: high performing nursing institutions; best practices The nurse assumes the caring role in the promotion of health, prevention of diseases, restoration of health, alleviation of suffering and, when recovery is not possible, in assisting patients, towards peaceful death. Moreover, the nurse works with the individuals, families, population groups, community and society in ensuring active participation in the delivery of holistic care. Within the context of the Philippine society, nursing education with caring as its foundation, subscribes to the following core values which are vital components in the development of a professional nurse and are emphasized in the Bachelor of Science in Nursing (BSN) program: (1) love of God; (2) caring as the core of nursing; and (3) love of people. The Bachelor of Science in Nursing (BSN) curriculum is composed of the theoretical/didactic and experiential/ related learning experience (RLE). The RLE is composed of clinical and skills laboratory that a nursing student should experience and pass to earn the degree of Bachelor of Science in Nursing. This is expected from all Colleges of Nursing offering the BSN program to assure the passing of their graduates in the nurses licensure examination. Under the Philippine Nursing law, to ensure the provision of safe and quality practice, only by passing the Nurses Licensure Examination can one become a registered Nurse (RN). However, problems arise when nurses become in demand with high-paying jobs in developed countries, resulting to mushrooming of nursing schools all over the country, so everybody wants to become a nurse. Yet, when one examines the quality of the programs SPC Research Journal

schools and colleges offer, it is below standard (Palaganas & Divinagracia, 2011). One of the reasons was that majority of faculty lack advanced education and training. Another reason was that due to influx of nursing students, one (1) patient to two (2) nursing students in 1990s became one (1) patient to fifteen students in 2000. In this case, the quality of RLE that the nursing students should have experienced is affected when there are too many of them attending to one patient. This then translates to an appalling decrease of passers in the Nurses Licensure Examination from 54 percent in 2001 to 46-33 percent in the succeeding years (Divinagracia, 2010). Despite the foregoing situations, there are consistent top performing nursing institutions particularly in CALABARZON Region which continuously spearhead in offering quality nursing programs. The researcher wants to characterize these nursing institutions and showcase their best practices. The best practices of Deans and Clinical Coordinators in high performing nursing institutions in view of the board performance, were focused on the synergy in the delivery of excellent education in terms of student admission and retention, faculty, instruction, board examination preparation and accreditation, the administrative support through facilities and equipment, library and faculty development program. As expected of the high performing nursing schools, the board examination ratings of both the first timers and the retakers are important indicators of the kind of best practices by the deans and clinical coordinators. An analysis of the nurse licensure examination (NLE) by Palaganas et al. (2012) was conducted to describe the performance of the examinees for policy development and enhancement. The study revealed the following: (1) the number of examinees increased through the years with the passing percentage ranging from 35.26 percent to 49.15 percent; (2) that accreditation status has a strong predictive ability and those examinees who graduated from schools with Level 3 accreditation status obtained high passing percentage in all NLEs. With the same concern, Malijan (2010), identified the determinants of board examination performance of nursing graduates of academic year 2006-2007 through determining relationships and predicting board examination performance among professional nursing grade point average GPA, professional subjects GPA, general education GPA, the enhancement program, and final grade. The samples were 282 graduates of College of Nursing that underwent the enhancement program as one of their preparations in the nursing licensure examination. Results showed that participants accumulated grades have significant relationship with their performance in the board examination and also identified predicted values in the nursing licensure examination from the given values of the participants academic variables. On top of the educational preparation in passing the nurses licensure examination, the following shall be fully complied with a) an examinee must obtain a general average of at least seventy-five (75 percent) or higher with a rating of not below sixty (60 percent) in any subject, b) any examinee who obtained an average rating of 75 percent or higher but with a rating of below 60 percent in any subject shall be required to take examination again but only on subjects where he/she is rated below 60 percent. However, in order to pass the succeeding examination, the examinee must obtain a rating of at least 75 percent in the subject repeated, c) removal examination shall be taken within two years after the last failed examination. Enhancement and/or board examination preparation is essential in passing the licensure examination. SPCRJ/ 2

Part of the best practices of excellent school is the strong faculty workforce for quality and/or excellent teaching. On faculty selection and retention, Section 11 of CHED CMO No. 14 S 2009 required that the faculty members should have academic preparation appropriate to their teaching assignment. In addition, to being a Filipino citizen and having good moral character, the following considerations must be observed: a Registered Nurse in the Philippines with current/valid PRC ID; a holder of master s degree in nursing (MAN, MN, MSN) or allied medical and health sciences conferred by a college or university duly recognized by the Commission on Higher Education; shall have at least one year of clinical practice and a member of good standing and accredited professional nursing organization. The most important support for a dean and clinical coordinators must be from the administration in the following areas: facilities and equipment, library, faculty development program. Nursing schools are mandated to have nursing skills laboratory that simulates major areas in the hospital setting and equipped with basic instruments, equipment and supplies, to aid in the development of the competencies in performing nursing procedures. In the acquisition of knowledge and competencies, libraries are considered very significant in the learning environment, Section 12 of CHED CMO No. 14 series of 2009, asserted that Library services shall provide the institutional research needs of the staff and students making it one of the most important service units within a higher education institution. As a whole, the library enables the individual to obtain spiritual, inspirational, and recreational activity through reading, and therefore the opportunity of interacting with the society s wealth and accumulated knowledge. The library services are needed to help the skills that have been acquired through literacy classes alive by the provision of good literature (Adio et al., 2011). The study considered four (4) models, namely: Conceptualizing Service quality in Education, Fitzgerald Model, Context for Quality, Leading Student Achievement (LAS) Theory of Action, and CMA Trust Model. The First Model, Conceptualizing Service Quality in Education by Jain, Sinsa, and Sahney (2011) underlines the quality and excellence in education Service through program quality and quality of life. The program quality is defined by several dimensions such as: industry interaction, input quality, academic facilities and curriculum; while quality of life affected by non-academic process such as support facilities, interaction quality and campus. The theory of Fitzgerald (2009), Context for Quality (Strategic Management in Education) aligns with the assurance of quality and excellence in management practices through strategic management in education. The plan which involves goals, concept models, with measurable objectives, resources and methods, has a mission geared to continuous improvement that it needs to inform, train, institutionalize, DO: teach and CHECK and ACT: measure and adjust. Another model used in this study is the Leading Student Achievement (LAS) Theory of Action by Leithwood (2012). The model justifies the processes involved in infusing student learning which is vital in safeguarding the of board takers. The conceptual framework (Figure 1) of the study is an adoption of Conceptualizing Service Quality in Higher Education by Jain, Sinha, and Sahney (2011). To showcase the best practices of high performing nursing institutions in the CALABARZON, the following concerns are highlighted: First, the of board passers for the last five (5) years (2008-2012) with the first timers and re-takers as classified as: below; above the national passing percentage and between 95 percent to 100 percent passing percentage. Second, the best practices of the SPCRJ/ 3

deans and clinical coordinators in the following aspects: student admission; selection and retention; on faculty: faculty qualification and faculty loading; on Instruction: instructional standards, related learning experience, utilization of research in instruction, board examination preparation, and accreditation status. And the third, the administrative support in terms of facilities and equipment, library, and faculty development program. The research output is a continuing high performing nursing institutions as a model for other nursing institutions. First Timers Industry Interaction Input Quality Academic Facilities Curriculum Non- Academic Process Support Facilities Interaction Quality Campus Program Quality Qua- Lity of Life S E R V I C E Q U A L I T Y Passing Rate in NLE Best Practices Administrative Support Re-Takers Student Admission, Selection & Retention Faculty: - Faculty Qualification - Faculty Loading Instructions: - Instructional Standards - Related Learning Experience - Utilization of Research in Instruction Board Examination Preparation Accreditation Facilities and Equipment O U T P U T Continuing High Performing Nursing Program Library Faculty Development Program Figure 1. The Conceptual Framework of the Study: an adoption of Conceptualizing Service Quality in Higher Education by Jain, Sinha, and Sahney (2011). SPCRJ/ 4

Method The study employed the descriptive method of research, focus group discussion and case analysis. Descriptive method of research is an organized attempt to analyze, interpret and make a report on the present status on the institutions, programs or things, group of persons, acts or conditions or any other phenomenon which a researcher wishes to study (Aquino 2006). Focus group is another name for a group interview or a group discussion, where the focus is on a particular topic or interest-usually a health problem or a response to a situation or issue. Using a discussion outline, information is elicited from the group on a given topic or situation (Howe, Degaling, & Hall, 1994). Case analysis followed six steps to crystallize the best practices of high performing nursing institutions which are: 1) The case/the situation; 2) identify the problem to be solved; 3) Arranging the facts and skills necessary for holding the problem; 4) Suggesting possible solution and testing and elaborating on solution that seem to be the best; 5) Verifying the Conclusion; and 6) extending the solution. The participants were the deans and clinical coordinators of the four (4) high performing nursing institutions in CALABARZON Region. These institutions were chosen because of its continuing above the national in the nursing licensure examination for the last five years (2008-2012). The survey instrument was prepared based on CM No. 14 s. 2009 in the form of rubrics and checklist specifically for accreditation status, facilities and equipment, library and faculty development program. Frequency, and percentage distribution and weighted mean were used in analysis of data. Results Table 1 shows the of Schools A,B,C, and D in the NLE, CALABARZON Region for the last five years (2008-2012) in terms of first timers. There was consistent passing rate of 60-94 percent for School A in December 2008 to July 2012. But in July 2008 there was between 95-100 percent. For School B, the for the last five years reflects beyond the CHED percentage of 30 percent. In July 2008 to December 2009 the above national between 60-to 94 percent was attained. In July 2010 the recorded was from 95 percent to 100 percent and repeated in July 2011. The for the first timers of School C was beyond the CHED standard of passing percentage. In July 2009, December 2010, and July 2012, the was from 95 percent to 100 percent and in July 2008, December 2008, and December 2011, the passing rate was from 60 percent to 94 percent. In School D, the NLE taken in July 2008, July 2009, July 2010, and July 2012 registered the above national while the NLE in December 2008, December 2009, December 2010, July 2011 and December 2011 recorded the of 95 to 100 percent. SPCRJ/ 5

Table 1 Passing Percentage of School A,B,C,D, in the NLE CALABARZON Region for First Timers (July-December 2008-2012) 2008 2009 2010 2011 2012 SCHOOL July Dec July Dec July Dec July Dec July Dec A b. above the national 60%-94% c. Between 95%-100% B b. above the national 60%-94% c. Between 95%-100% C b. above the national 60%-94% c. Between 95%-100% D b. above the national 60%-94% c. Between 95%-100% SPCRJ/ 6

Table 1 (Cont.) Passing Percentage of School A,B,C,D, in the NLE CALABARZON Region for Re-takers (July-December 2008-2012) 2008 2009 2010 2011 2012 SCHOOL July Dec July Dec July Dec July Dec July Dec A b. above the national 60%-94% c. Between 95%-100% B b. above the national 60%-94% c. Between 95%-100% C b. above the national 60%-94% c. Between 95%-100% D b. above the national 60%-94% c. Between 95%-100% As indicated in Table 1, the for the re-takers in School A, B, C, and D for the last five (5) years (2008-2012) indicated above the national of 60-94 percent. SPCRJ/ 7

Table 2 Summary of Best Practices of Deans and Clinical Coordinators of High Performing Nursing institutions (School A to D) in CALABARZON Region DEANS CLINICAL COORDINATORS INDICATORS AWM Verbal Description Verbal Interpretation AWM Verbal Description Verbal Interpretation 1. Student 5.00 Always Excellent 4.75 Always Excellent Admission, Selection and retention 2. Faculty Standards 2.1 Faculty 4.55 Always Excellent 4.94 Always Excellent Qualification Selection, Hiring and Retention 2.3 Faculty 5.00 Always Excellent 5.00 Always Excellent Loading 3. Instruction 3.1 Instructional 4.64 Always Excellent 4.72 Always Excellent Standards 3.2 Related 4.82 Always Excellent 4.94 Always Excellent learning Experience 3.3 Utilization of 4.93 Always Excellent 4.5 Most of the Very Research in times Satisfactory Instruction 4. Board 4.57 Always Excellent 4.66 Always Excellent Examination Preparation 5. Accreditation 5.00 Always Excellent 5.00 Always Excellent 6. Facilities & 4.64 Always Excellent 4.64 Always Excellent Equipment 7. Library 4.96 Always Excellent 4.96 Always Excellent 8. Faculty 5.00 Always Excellent 5.00 Always Excellent Development Program GENERAL 4.85 Always Excellent 4.80 Always Excellent AVERAGE WEIGHTED MEAN Scale Weight Verbal Description Verbal Interpretation 5 4.51 5.00 Always Excellent 4 3.51 4.60 Most of the times Very Satisfactory 3 2.51-3.50 Occasionally satisfactory 2 1.51 2.50 Seldom Needs improvement 1 1.00 1.50 Not frequent Poor SPCRJ/ 8

Table 2 presents the summary of best practices of deans and clinical coordinators of high performing nursing institutions (School A-D) in CALABARZON region. On student admission, selection and retention, the deans and clinical coordinators agree with AWM=5.00 and 4.75, respectively. In terms of faculty qualification, selection, hiring, and retention, deans (AWM=4.55) and clinical coordinators (AWM=4.94) with verbal description of Always also agree of their best practices. When it comes to faculty loading; instructional standards; related learning experience; board examination preparation; accreditation; facilities and equipment; library; and faculty development, both the deans and the clinical coordinators indicated Always in their best practices. However, the deans (AWM=4.93) and clinical coordinators (AWM=4.5) did not agree in the utilization of research in instruction with the verbal description of Always for the deans and Most of the times for the clinical coordinators. In terms of administrative support on facilities and equipment; library; and faculty development program, the deans and clinical coordinators certified the excellent support of the school administration and a school management in the provision of facilities and equipment over and above CHED requirements supported by their accreditation status. They always have available facilities on (1) anatomy and physiology; (2) microbiology and physiology; (3) nutrition and diet therapy laboratory; (4) chemistry and biochemistry laboratory; (5) nursing skills laboratory; and (6) available virtual nursing skills laboratory. The deans and clinical coordinators affirmed the 100 percent administrative support in making the library truly a learning resource center in all media of knowledge acquisition. The library is manned by a registered librarian with master s degree in library science, with a total of more than 6,000 accessioned books consisting of professional books and Filipiniana books; professional foreign journals such as maternal and child nursing, general nursing, nursing research, psychiatric nursing, nursing management/leadership, pediatric nursing, medical-surgical nursing, and local journals. Furthermore, the library has internet access and networking with other library web site. The deans and clinical coordinators described the full support by the administration on Faculty Development Program. The faculty program may be in the form of: (a) faculty study grants; (b) graduate studies; (c) scholarship and research grants; (d) in-service and continuing training program; and (e) clinical skills enhancement. And these programs have administrative support, namely: (1) stipend, transportation allowance; (b) book allowance; and (c) research grants. Schools A,C,D divulged that they are given 75 percent support from the administration while School B is given 100 percent support from the administration. Discussion The passing percentage rate in the NLE of Schools A to D for the last five years (2008-2012) in terms of first timers and re-takers marked the performance of above the national of 60 94 percent and between 95-100 percent consistently for five (5) years and have earned and claimed the high performing nursing institutions in CALABARZON Region. Listed as High Performing Nursing Schools by the CHED their best practices were closely investigated to showcase and be the model to raise the NLE performance of other nursing institutions. The high performance of the graduates in the NLE ( above the national passing percentage and between 95 to 100 percent) are clear learning results or outcomes-based education, that they demonstrated their competence in using content information, ideas and SPCRJ/ 9

tools successfully: the end of the significant learning experience in the College of Nursing (Spady, 1994). On Student Admission, Selection and Retention, Schools A to D hold on to the CHED CMO No. 14 series 2009 and school policy to the extent of sacrificing quantity yet assured of quality education in nursing program. And quality education can be through moving towards meaningful learning that will result in successful student, part of it is a well prepared workforce that will have integral development and better opportunities based on knowledge that can lead to high quality of life, (Canas &Novak, 2010). On Faculty, Schools A and D adhere to the CHED CMO No 14 series of 2009 and school policy to the extent of administrative support on the continuing professional education at its own expense as requested just to ensure efficiency and effective teaching workforce. On instruction, the Deans and Clinical Coordinators of School A to D closely monitor the instructional standards to maintain the outcomes-based performance of both students and faculty; the RLE, the hands-on teaching experience where the future practitioners are oriented at present and prepare them for tomorrows workplace; the utilization of research in instruction as part of the academic endeavor for the much needed updates in the field of nursing with focus on the technology-driven learning environment; the board examination preparation where students experienced the three (3) kinds of exposure: (1) Pre-board review, (2) During the NLE, and (3) After the NLE, to keep in touch with the re-takers as to the waiting period of the NLE results; and the Accreditation Level II and III, which sealed the commitment of Schools A and D in turning the institution to University status Level IV with the following benefits : a) all the benefits for Level I, II, and III; b) grant of full autonomy for the program the duration of its Level II accredited status; and c) authority to offer new graduate program allied to existing Level IV courses, open learning/distance education and extension classes without need for prior approval from CHED provided that the concerned CHEDRO is duly informed (PACUCOA, 2010) On the administrative support of School A and D in terms of facilities and equipment, Library and Faculty Development Program, all are in place as recommended by the Deans and Clinical Coordinators to reach the Level II and Level III Accreditation Status, with Most of the Times and Always practices or Very Satisfactory practices to excellent practices. Capturing all the best practices, School A to D are considered high performing schools with the following characteristics: high passing percentage in the nurse licensure examination (NLE) consistent for the last five (5) years; strong student admission, selection and retention policies; strong faculty selection that embraces research in teaching and learning; excellent and all-out support from the school administration in terms of facilities and equipment, library and faculty development program. The best practices as described by Deans and Clinical Coordinator on student admission, selection and retention equated with the faculty qualification, instruction, board examination preparation, and accreditation status and strengthened with the administrative support on facilities and equipment, library, and faculty development program are contributory factors to the high performance of the nursing institutions in the National Licensure Examination thus earning the title: High Performing Nursing Institutions in CALABARZON Region. Thus, it is recommended that the best practices of these high performing nursing institutions be adopted by all nursing schools in CALABARZON Region. SPCRJ/ 10

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