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TABLE OF CONTENTS Introduction ....................................................................................................................................... 1 Standard I. Program Quality: Mission and Governance Element I-A Element I-B Element I-C Element I-D Element I-E Element I-F Element I-G ....................................................................................................................................... 6 ..................................................................................................................................... 11 ..................................................................................................................................... 13 ..................................................................................................................................... 14 ..................................................................................................................................... 15 ..................................................................................................................................... 16 ..................................................................................................................................... 18

Standard II. Program Quality: Institutional Commitment and Resources Element II-A Element II-B Element II-C Element II-D Element II-E Element II-F ..................................................................................................................................... 20 ..................................................................................................................................... 27 ..................................................................................................................................... 30 ..................................................................................................................................... 31 ..................................................................................................................................... 34 ..................................................................................................................................... 35

Standard III. Program Quality: Curriculum and Teaching-Learning Practices Element III-A Element III-B Element III-C Element III-D Element III-E Element III-F Element III-G ..................................................................................................................................... 38 ..................................................................................................................................... 42 ..................................................................................................................................... 45 ..................................................................................................................................... 49 ..................................................................................................................................... 55 ..................................................................................................................................... 57 ..................................................................................................................................... 60

Standard IV. Program Effectiveness: Aggregate Student and Faculty Outcomes Element IV-A Element IV-B Element IV-C Element IV-D Element IV-E Element IV-F ..................................................................................................................................... 66 ..................................................................................................................................... 71 ..................................................................................................................................... 81 ..................................................................................................................................... 88 ..................................................................................................................................... 92 ..................................................................................................................................... 99

INTRODUCTION: OVERVIEW OF THE PROGRAM

THE UNIVERSITY OF ARIZONA

The University of Arizona (UA) College of Nursing is part of a premier, student-centered and researchintensive institution that embraces excellence in teaching, research and public service. Established in Tucson in 1885, the UA was organized as the sole land grant college in Arizona under the Morrill Act of 1862 by action of the Legislative Assembly of the Territory of Arizona. Today, the UA enrolls over 38,000 students and offers a wide variety of academic programs, many of which are among the nation's best. Students can choose from more than 150 undergraduate and more than 200 graduate degree programs offered through 18 colleges and 12 schools on three campuses. From a beginning campus of 40 acres, one building and six faculty members in 1891, today the UA has more than 1900 teaching faculty, 185 buildings, and encompasses 388 acres. As a member of the Association of American Universities, the UA is internationally known for its excellent faculty, groundbreaking research and top ranked prorgrams. The State of Arizona and the UA continue to demonstrate strong commitment and support for the UA College of Nursing, which in 1957 was established as a Bachelor of Science Program with the admission of 42 students.

THE ARIZONA HEALTH SCIENCES CENTER

The UA College of Nursing (CON) is a constituent of the Arizona Health Sciences Center (AHSC), which is a network of health-related entities that are based on the campus of the UA in Tucson and more recently, the AHSC has a growing presence on the Phoenix Biomedical Campus in downtown Phoenix. The AHSC includes the Colleges of Nursing, Pharmacy, Public Health and Medicine (in Tucson and Phoenix in partnership with Arizona State University); and the University Physicians Health Care, which includes a practice plan, a health care plan and the UPH Hospital; the University Medical Center; and the National Cancer Institute-designated comprehensive Arizona Cancer Center. In FY2008, the AHSC garnered $128 million in grants and contracts.

THE HISTORY OF THE NURSING PROGRAM WITHIN THE INSTITUTION

In the Fall of 1956, on the recommendation of the President of the University of Arizona, the Arizona Board of Regents authorized the establishment of the School of Nursing and approved a baccalaureate program in nursing. In 1961, the National League for Nursing granted initial accreditation to the baccalaureate nursing program.

In 1967, the Master of Science degree with a major in nursing was authorized with the first graduate courses offered in 1968-1969. The PhD program in nursing, with a major emphasis in research, was approved by the Arizona Board of Regents in February 1975. The Doctor of Nursing Practice degree was implemented in 2006.

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Currently, the College of Nursing offers programs of excellence that lead to the Bachelor of Science in Nursing (BSN), a Master of Science with a major in nursing, a Doctor of Nursing Practice (DNP) and a Doctor of Philosophy (PhD) with a major in nursing science. The baccalaureate programs are recognized for their academic and clinical strength. Both doctoral programs are designed to optimize the use of online delivery. Graduates of the CON doctoral programs are nurse scientists and practitioners who are shaping health care across the nation and around the world.

Baccalaureate Program

Entry to practice baccalaureate preparation is offered through two pathways: an upper division 1st Degree BSN Pathway and a 2

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Degree BSN Pathway for people with a minimum of a baccalaureate

degree in another field. Outcomes of this program include graduating 150 to 200 students per year with NCLEX-RN® pass rates, which have been 5% to 9% higher than national and state rates.

1st Degree BSN Pathway Effective Fall, 2009, we implemented a revised delivery plan for the 1st Degree BSN Pathway, moving it from five to four semesters of upper division study. The revised program was approved by a unanimous vote of the College Faculty on October 20, 2008. The overall competencies and expected outcomes remain unchanged, apart from minor revisions that reflect the language of the 2008 Essentials of Baccalaureate Education. No changes were made to number of professional nursing credits (i.e., 61) or the total credits (i.e., 120) required for the degree.

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Degree BSN Pathway

A College partnership with area health care systems has provided funding to offer a 14-month sponsored pathway to nursing RN licensure open to students who hold at minimum a baccalaureate degree in a field other than nursing. The pathway began in June 2003 and was originally called the Accelerated BSN Partnership Program for College Graduates or "APP". The pathway represented our response to a state Senate Bill to mandate to reduce the nursing shortage by doubling graduation rates by 2007. Initially, we partnered with two health care systems who provided tuition and fees for the entire the 4-semester program in return for two years of RN employment. In 2004 a third health care institution partnered with us, and in 2008 a fourth partner was added although the work payback commitment for students rose to three years. Beginning with sponsorships for 48 students, this peaked with sponsorships for 95 students in 2008. With the current economic downturn, one sponsoring partner elected to withdraw support. For 2010, the program has become a blend of tuition-based and sponsored positions with three health systems continuing to sponsor at least 40 student positions. With the decision to provide advanced practice education at the doctoral level, we are currently planning for a transition of this program from a second baccalaureate degree to a master's-entry generalist practice degree.

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Master of Science with a Major in Nursing Degree Program

Nurse Practitioner Specialty Options In the Spring of 1970, the National League for Nursing granted initial accreditation to the Master of Science (MS) with a major in nursing program. During the 1990's, several graduate specialty options for advanced practice preparation were initiated including adult, family, geriatric, and psychiatric-mental health. Master of Science education in nurse case management was also added in the 1990's. The College discontinued the geriatric nurse practitioner specialty option in 2001 due to low enrollment and loss of faculty with expertise in the specialty. From 2001 to 2005, three nurse practitioner specialty options were offered as a Master of Science degree and post-master certificate: i.e., adult, family and psychiatric mental health. In 2005, the adult acute care nurse practitioner (ACNP) option was added. In Fall 2009, following ACNP competitive renewal federal funding, a subspecialty in Palliative Care was added for graduate students. Students may select Palliative Care as a subspecialty within their advanced practice program. The coursework, coupled with clinical preparation, is designed to meet the certification competencies tested through examination by the National Board for Certification of Hospice and Palliative Nurses (NBCHPN). Doctoral students also may select Palliative Care as a minor. Healthcare Systems Master's Option The Healthcare Systems Master of Science option was initiated in the early 1990s in response to a community need for advanced education for nursing administrative leaders. The perceived need was for systems specialists for a variety of roles, including nursing managers, nursing director, systems manager, quality improvement manager, among others. In 1998, a health informatics specialty was added to prepare nurses as specialists for emerging nursing informatics roles, as well as to provide additional relevant content to the systems option. The healthcare systems option has been closed as a specialized option, but Healthcare Informatics has been integrated as core into all advanced practice study.

Doctorate of Nursing Practice ­ Advanced Clinical Practice

Looking to the future and in response to the American Association of Colleges of Nursing October 2004 recommendation that advance practice preparation occur through the Doctorate of Nursing Practice (DNP) degree by 2015, in 2005, the MS advanced practice pathways were transitioned to a DNP degree. The DNP curriculum was approved by the Arizona Board of Regents on March 10, 2006 and the first class was admitted in the Fall 2006. Nine students, both full and part-time were enrolled in the first cohort. The first graduate from this class occurred in May 2009. Admission to Master degree preparation (as a stand alone degree) was discontinued as of Fall 2009. Beginning Fall term 2009, we are admitting students to the family and acute care nurse practitioner options at the practice doctorate level. We have temporarily stopped admitting to the adult and psychiatric/mental health (P/MH) nurse practitioner options due to low enrollment. Going forward, all

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advanced practice admissions, with one exception, will be admitted through the DNP degree (The exception is a special partnership arrangement with the Banner Healthcare System in Phoenix, Arizona through which a cohort of ten Banner employees, who met admission requirements, are being prepared as ACNPs with a post-master certificate.)

PhD Program

We also offer a PhD degree with a major in nursing science. The PhD program provides a learning environment of coursework, collegial relationships, community networks, mentored research, and collaboration in scholarship. Most of the coursework is offered online, enhanced by a yearly 5-to-10 day Research Intensive Summer Experience (RISE) each year for the first three years of doctoral study. RISE is also provided for DNP students.

Characteristics of Students

The 2009-2010 academic year represents the 53rd year of nursing education at the University of Arizona. Undergraduate and graduate students enrolled in the College of Nursing represent diverse educational and cultural backgrounds. During the 2009 Fall Term, more than a quarter (26.7%) of BSN students enrolled report themselves as belonging to an ethnic minority population. At the advanced practice level (MS, DNP, PhD and Graduate Certificates), the proportion of students from an ethnic minority population is only slightly less (25.5%). In 2009, a wide variety of baccalaureate degrees were held by 2

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Degree BSN students, including

degrees in biology, English, Spanish, nutrition, theatre, economics, linguistics, math, and psychology. Another enrollment highlight is the number of Native Americans enrolled in the DNP program. The five Native American students enrolled in the DNP program comprise a significant portion of all Native Americans enrolled in DNP programs across the nation according to the recent AACN Enrollment and Graduation Reports. Enrollment of men mirrors national figures, with an average of 11% across our nursing programs. Arizona residents comprise 84.3% of the student population enrolled in the 1st Degree BSN Pathway and 75% of the BSN 2

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Degree BSN Pathway, while only 65.2% of students at the advanced practice level

are Arizona residents. Current DNP students reflect diversity in gender (12% are men); ethnicity (31% total, including 12% Native Americans), and state of residence (24% are out-of-state). The PhD program draws the largest group of non-residents (65%). International student enrollment is limited because of increasing visa restrictions due to the online delivery of our graduate programs; the average current enrollment is 2% across programs, with the highest percentage in the PhD program at 7%. The number of BSN students enrolled in the University of Arizona Honors Program and those students graduating with Phi Kappa Phi distinction (top 10% of UA undergraduates invited to join the organization) exceeds other undergraduate majors. For example, the Spring 2009 graduating class of 51 had 10

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students (20%) and the Fall 2009 graduating class of 48 had 7 students (15%) invited to join Phi Kappa Phi. The numbers of Honors students comprised 10% of each of these graduating classes.

ACCREDITATION STATUS

The University of Arizona is accredited by the North Central Association of Colleges and Schools. The most recent accreditation visit was in Spring 2000; the university was accredited for 10 years and will be revisited in 2010. In 1994, the College of Nursing received National League for Nursing continuing accreditation for eight years for both the baccalaureate and Master of Science programs. In February 1998, the College applied for and received preliminary approval by the Commission on Collegiate Nursing Education. In Spring 2002 the College of Nursing received accreditation from the Commission on Collegiate Nursing Education. Since the last Self-Study Accreditation Report prepared in 2001, the CON has established a 2nd Degree BSN pathway (originally called the Accelerated BSN Partnership Program (APP) for College Graduates), and a Doctorate of Nursing Practice (DNP); transformed MS, DNP and PhD programs to online formats; and increased the numbers of entry-level degrees awarded by 75%. In 2007, the College awarded 164 BSN (1 and 2 Degree Pathways), 24 MS, and 19 PhD degrees, while at the same time accomplishing its five-year pledge to double the annual BSN graduates. In academic year 2008-2009, there were 192 BSN (including 92 2

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Degree BSN Pathway graduates), 23 MS, 1 DNP,

and 17 PhD degree graduates from the College of Nursing.

SUMMARY

Throughout the past five decades, we as the faculty have pursued our missions in teaching, research and practice/service. The College is among the leading institutions in the baccalaureate and graduate education of professional nurses. The UA College of Nursing is currently ranked among the top 6% of graduate nursing programs in the nation according to U.S. News and World Report (April, 2009). We are dedicated to providing a premier educational experience for our students at the baccalaureate and doctoral levels while decreasing the national nursing shortage. We have also made a commitment to enhance the availability of educational opportunities to communities through the use of online and telecommunication teaching methods with state-of-the-art laboratories and technology support for teaching and scholarly endeavors. The College of Nursing is recognized for its scholarly and dynamic leadership in teaching, research and scholarship, and service throughout the State of Arizona, the Western Region, the United States, and in the global community. The College of Nursing is seeking continuing accreditation of the baccalaureate program, MS-NP program, and initial accreditation of the DNP program.

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STANDARD I

PROGRAM QUALITY: MISSION AND GOVERNANCE

parent institution and nursing program clearly support the program's mission, goals, and expected outcomes. The faculty and students of the program are involved in the governance of the program and in the ongoing efforts to improve program quality. I-A. The mission, goals, and expected student outcomes are congruent with those of the

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he mission, goals, and expected aggregate student and faculty outcomes are congruent with those of the parent institution, reflect professional nursing standards and guidelines, and consider the needs and expectations of the community of interest. Policies of the

parent institution and consistent with relevant professional nursing standards and guidelines for the preparation of nursing professionals. Elaboration: The program's mission statement, goals, and expected student outcomes are written and accessible to current and prospective students. A mission statement may relate to all nursing programs offered by the nursing unit or specific programs may have separate mission statements. Program goals are clearly differentiated by level when multiple degree programs exist. Expected student outcomes are clear and may be expressed as competencies, objectives, benchmarks, or other language congruent with institutional and program norms. The program identifies the professional nursing standards and guidelines it uses, including those required by CCNE and any additional program-selected guidelines. A program preparing students for specialty certification incorporates professional standards and guidelines appropriate to the specialty area. A program may select additional standards and guidelines (e.g., state regulatory requirements), as appropriate. Compliance with required and program-selected professional nursing standards and guidelines is clearly evident in the program.

PROGRAM RESPONSE

Congruence of Mission and Goals Mission The College of Nursing mission is presented on the College of Nursing website (www.nursing.arizona.edu click on "Mission" link) and stated in the UA CON Undergraduate and Graduate Student Handbooks (http://www.nursing.arizona.edu/studenthandbooks.htm.) The mission is congruent with the purposes and mission of the University of Arizona and the Arizona Health Sciences Center, with each focusing on the roles of education, research, and service to improve

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the lives of the people of Arizona and beyond. This is evident in the missions of each (see underlined statements below and Appendix I-A-1). The College of Nursing is a professional college of the University of Arizona focused on envisioning, engaging and innovating to provide contemporary and futuristic teaching/learning, research/discovery and practice/service scholarship. The mission of the College of Nursing is to provide baccalaureate and graduate education, generate and expand nursing knowledge, and provide service to the community (From the CON Mission Statement, reaffirmed by the CON Faculty, March, 2009, Appendix I-A-1). The Arizona Health Sciences Center (AHSC) at The University of Arizona is a thriving academic health sciences center with a growing network of health-related organizations and activities unique in the state and region. It is the State's only academic health science center, with a mission to provide state-of-the-art patient care, healthcare education, research, and service for the people of Arizona and beyond (http://www.ahsc.arizona.edu/vpha). The AHSC includes 4 colleges: College of Nursing; College of Medicine, Tucson program, and the College of Medicine ­ Phoenix in partnership with Arizona State University at the Phoenix Biomedical Campus in downtown Phoenix; the College of Pharmacy; and the Mel and Enid Zuckerman College of Public Health. AHSC also includes University Medical Center; University Physicians Healthcare (the UA physicians practice plan, a health plan and UPH Kino Hospital); and the comprehensive Arizona Cancer Center as well as other centers of excellence. At the University of Arizona, we aspire to create an exceptional learning environment to prepare and inspire students for their future roles in the world as thinkers, learners, leaders and responsible citizens; to extend the frontiers of knowledge, discovery, and creativity; and to link scholarship and creative expression to its land-grant mandate to serve communities. The University of Arizona mission is to improve life for the people of Arizona and beyond through education, research, creative expression and community engagement (www.arizona.edu).

Strategic Goals The University of Arizona mission and priorities are met through its strategic planning process and goals. The UA strategic planning process was influenced by dynamic administrative and economic changes at the UA, beginning in 2006, when Dr. Robert Shelton was appointed President of the University (October 2006). A search for a Provost and Vice President of Academic Affairs followed soon after, with an Interim Provost serving from May 2007 to May 2008. Dr. Meredith Hay was appointed as Executive Vice President and Provost in May 2008. In 2008, to consolidate and realign colleges and departments to build on the University strengths in strategic areas while also advancing its teaching, research, and service mission, a Transformation Plan (http://provost.arizona.edu/transformation information) was initiated. See the links for detailed information about these changes: http://provost.arizona.edu/transformation implementation. In October 2008, William Crist, MD, was appointed into a re-constituted position as Vice President of Health Affairs for the Arizona Health Sciences Center.

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In 2007, the Arizona Board of Regents (ABOR) approved a five year strategic plan (2009-2013) for the University of Arizona. The Arizona Health Sciences Center was functioning under a five-year strategic plan, adopted for 2005 to 2009. Its strategic plan is currently under revision. The current College of Nursing Strategic Plan (2009-2013, Appendix I-A-2) was developed to be congruent with the UA FiveYear Strategic Plan (2009-2013) and was approved by faculty in Fall 2008. See Exhibit I-A-1in the Resource Room). In December 2008, the ABOR asked the UA to adjust this plan to reflect the ABOR 2020 Vision, Mission and Goals. In 2009, the UA adopted a new Five-Year Strategic Plan (2010-2014) Expanding Our Vision, Deepening our Roots. The link to the current 2010-2014 UA Strategic Plan is at: http://plan.web.arizona.edu/strategic-plan.pdf. The College of Nursing along with other AHSC Colleges are revising their strategic plans in view of the most recent change in the UA Strategic Plan. To focus College efforts toward accomplishment of its mission, a Strategic Planning Committee consisting of College of Nursing faculty, administrators, and staff identified goals for the College and developed strategies for their achievement. This strategic planning process resulted in four College of Nursing strategic goals, which were approved by the College faculty in 2008 (see Appendix I-A-3). Appendix I-A-4 illustrates the congruence of College of Nursing strategic goals with those of the University of Arizona and the Arizona Health Sciences Center. With a new dean, the strategic plan is undergoing ongoing assessment and scrutiny and stands to be re-shaped or expanded as time progresses.

Congruence Between Program Outcomes and Professional Standards The following documents are used as the primary professional standards for development and evaluation of the Bachelor of Science in Nursing, Master of Science, and Doctor of Nursing Practice degree programs: · The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 1998 for the BSN Program during academic years 2006 ­ Spring 09; AACN, 2008 for the 4-semester 1st Degree and 2 · · ·

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Degree BSN Pathways)

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The Essentials of Master's Education for Advanced Practice Nursing (AACN, 1996) The Criteria for Evaluation of Nurse Practitioner Programs (3 ed.) (NTF, 2008) The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006)

Secondary professional standards include the Arizona State Board of Nursing criteria, the American Nurses Association (ANA) Code of Ethics, and the competencies for nurse practitioner education and for each Nurse Practitioner specialty. See Exhibit I-A-2 in the Resource Room).

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Expected Aggregate Student Outcomes/Objectives of the Baccalaureate Program Two sets of BSN Outcomes are evident in the College of Nursing materials: 1. BSN Outcomes 2006 to Summer 2009 that were active during the Self-Study period, and are applied throughout this Self-Study report, listed below, and 2. BSN Outcomes from Fall 2009, that are currently active and on the website. They were developed according to the 2009 AACN Baccalaureate Essentials and with the implementation of the new 4-semester 1st Degree BSN Pathway, also listed below.

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1st and 2

Degree BSN Pathway Student Outcomes (2006 - Spring 2009)

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The 2006-Fall 2009 Outcomes of the baccalaureate (BSN) program (for both the 1st Degree BSN 5semester pathway and the 2 the following outcomes: 1. Synthesize knowledge from general education, professional nursing education, and life experience as a basis for professional nursing practice. 2. Use competencies of critical thinking, communication, assessment and technical skills to provide nursing care that promote health to individuals, families, groups and communities in the context of their environment. 3. Apply nursing knowledge in the core areas (health promotion/disease prevention; illness management; information and health care technologies; ethics; human diversity; global health care; and health care systems and policies) in enacting professional nursing roles. 4. Use research/scholarship to enhance human health to advance professional nursing practice. 5. Demonstrate the values and standards associated with the roles of provider of care, manager of care and member of a profession.

Adopted 12/96; Revised 4/99 Reaffirmed 3/01

Degree BSN Pathway) were to prepare graduates who are able to meet

Appendix I-A-5 illustrates the congruence of the Baccalaureate Program Outcomes (2006 ­ Spring 2009) with AACN The Essentials for Baccalaureate Education for Professional Nursing Practice (1998).

Listed below are the BSN Program Outcomes for the current newly implemented 4-semester 1st Degree BSN Pathway as well as the 2 Degree BSN Pathway as revised to maintain congruence with the 2008 AACN Baccalaureate Essentials. Changes were made to provide greater focus on key system-level aspects of contemporary professional nursing (such as leadership, quality improvement, information management, and interprofessional collaboration) while maintaining other core outcomes of baccalaureate education.

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The Program Outcomes of the Baccalaureate Program are derived from the Mission of the College of Nursing and framed within the context of The Essentials of Baccalaureate Education for Professional Nursing Practice (2008). The Program Outcomes guide the development of expected individual student learning outcomes at the course level. 1. Synthesize knowledge from liberal education, professional nursing, and life experiences as a basis for professional nursing practice. 2. Apply leadership, quality improvement, and patient safety skills to improve patient care outcomes. 3. Integrate information management and patient care technology to deliver, manage, and evaluate quality patient care. 4. Incorporate knowledge about healthcare policy, finance, and regulations into professional nursing practice. 5. 6. Demonstrate effective professional communication and collaboration behaviors. Implement health promotion, disease prevention, and health restoration strategies to improve individual and population health. 7. 8. Model professional values and personal wellness behaviors. Implement culturally sensitive, evidence-based, holistic care for patients across the lifespan and across healthcare environments.

Faculty Approved 10/17/09

Expected Aggregate Student Outcomes/Objectives of the Master of Science As approved by the faculty, the objectives are to prepare graduates who are able to do the following: 1. 2. Evaluate the quality of available evidence to improve patient outcomes. [I. Research] Apply evidence-based advanced practice nursing knowledge* to improve the health of individuals, families and groups. [IV. Professional Role Development; VII. Health Promotion and Disease Prevention] 3. Collaborate interprofessionally to improve the equality, safety and cost-effectiveness of the health of individuals, families and groups. [II. Policy, Organization, and Financing of Health Care] 4. Contribute to the development and exchange of advanced practice nursing knowledge*. [IV. Professional Role Development] *Advanced practice nursing knowledge includes: Graduate Core Curriculum Content: III. Ethics, V. Theoretical Foundations of Nursing Practice, and VI. Human Diversity and Social Issues.

Adopted 5/97; Revised 4/99 Reaffirmed 3/01 and 5/09

Appendix I-A-6 illustrates the congruence of the objectives of the MS-NP program with the AACN Essentials for Master's Education for Advanced Practice Nursing Practice (1998).

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Expected Aggregate Student Outcomes/Objectives of the Doctor of Nursing Practice Program In final approval by the faculty (Spring, 2009), the outcomes/objectives of the doctor of nursing practice (DNP) program are to prepare graduates who are able to do the following: 1. Generate and disseminate nursing practice knowledge to stimulate research and improve clinical outcomes. 2. Improve health outcomes through scientifically-based advanced practice within a specialty. 3. 4. Engage in and lead collaborative practice teams. Influence clinical practice transformation and policy initiatives.

The AACN DNP Essentials were used to guide program development and program outcomes to achieve the goal of preparing advanced practice nurses for the highest level of nursing practice. Appendix I-A-7 illustrates the congruence of the objectives of the DNP program with the The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006).

I-B.

The mission, goals, and expected student outcomes are reviewed periodically and revised, · ·

as appropriate, to reflect: professional nursing standards and guidelines; and the needs and expectations of the community of interest.

Elaboration: There is a defined process for periodic review and revision of program mission, goals, and expected student outcomes. The review process has been implemented and resultant action reflects professional nursing standards and guidelines. The community of interest is defined by the nursing unit. The needs and expectations of the community of interest are reflected in the mission, goals, and expected student outcomes. Input from the community of interest is used to foster program improvement. The program afforded the community of interest the opportunity to submit third-party comments to CCNE, in accordance with accreditation procedures.

PROGRAM RESPONSE

The mission, strategic goals, and outcomes are reviewed approximately every five years (reviewed in 2001 and then in 2006, and more often as needed) to ensure that they reflect current professional standards and the needs and expectations of the community of interest. The College community of interest includes both internal constituencies (students, faculty, staff and appointed personnel, and the university as a whole) and external constituencies (college alumni; the health care community including leaders, employers and other collaborators in nursing education and research; and advisory boards, including the CON Advisory Board and Alumni Council Board of Directors). The strategic goals were reviewed in 2006 and 2007, based on changes at both the college level (changes in curricular offerings)

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and AHSC and university levels (development of new strategic plan with appointment of a new president, provost, and AHSC Vice President), and then revised as approved by faculty in Fall 2008 in response to a request from the President to revise and develop a strategic plan congruent with the University new strategic plan. The BSN Program Outcomes were reviewed and revisions were approved in Fall 2009 in reference to the (2008) Essentials of Baccalaureate Education for Professional Nursing Practice document. Similarly, the MS-NP and DNP Program Outcomes were most recently reviewed and approved in Spring 2009 to ensure congruence between program outcomes and the professional standards for each degree program.

The advanced clinical practice curricula are driven by the professional standards and are developed with faculty and student input on college curriculum committees as approved by the faculty. Informal feedback from preceptors and clinical agency personnel concerning students, nursing courses and changes in nursing practice is also obtained for discussion during baccalaureate and graduate faculty forums. Needs and expectations of the community of interest are considered as the faculty pursues the continuing advancement and improvement of the nursing programs.

There are several examples of the interface between the college programs and community of interest. Curricular change to establish the Acute Care Nurse Practitioner specialty in 2005-2006 occurred in response to input from the Tucson Nurse Executive group, a collaborative group of heads of health systems and nursing school that meets regularly and can offer advisory input. A proposal to fund development of a Palliative Nursing care core of courses was influenced by needs expressed in the clinical community and among students. Project-specific community advisory groups helped define need for various specialty learning or the logistics needed to implement a program, for example, distance modalities crucial to rural recruitment and retention. When the College was mandated to increase its enrollment to respond to the State need for more nurses, meetings with faculty, potential students and potential agency partners were held to discuss development of an Accelerated Partnership Pathway. When the Doctor of Nursing Practice degree program was developed, and the undergraduate 5-semester curriculum was revised, close attention was given to the expectations of the community of interest and to congruence with the relevant Essentials documents. Joint meetings were arranged between several community groups, academic institutions, health care agencies, and College of Nursing administrators and faculty. The purpose of these meetings was to assure changes and innovations were congruent with professional standards and guidelines, local and state health care needs, national and state nursing issues, and the professional community demand/need for academically prepared professional nurses.

The College community of interest was informed of the opportunity to provide third party comments to CCNE. They were informed through board and faculty meetings, email announcements and other electronic postings. Announcement of the dates of the on-site visit was highlighted on the College website

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and members of several community of interest were invited to meet with the CCNE visitors on campus. (See Agenda for Visit)

In summary, the mission, strategic goals, and expected student outcomes are reviewed in reference to professional standards and community of interest requests and needs. Data from several sources both internal and external to the College are examined and considered on an ongoing basis and are used as input when the College mission, goals, and program and student outcomes are reviewed and revised.

I-C.

Expected faculty outcomes in teaching, scholarship, service, and practice are congruent

with the mission, goals, and expected student outcomes. Elaboration: Expected faculty outcomes are clearly identified by the nursing unit, are written, and are communicated to the faculty. Expected faculty outcomes are congruent with those of the parent institution.

PROGRAM RESPONSE

The CON follows the guidelines in the University Handbook for Appointed Personnel concerning policies for Promotion and Tenure for tenure-eligible faculty. The expected faculty outcomes for tenure track faculty are presented in the following documents: CON Faculty Handbook, under Tenure Track Promotion and Tenure Guidelines at: (http://www.nursing.arizona.edu/IntraNet/facManual/chapter2/tenure-criteria.pdf). Guidelines for Reappointment and Promotion for clinical track faculty are published in the CON Faculty Handbook at: (http://www.nursing.arizona.edu/IntraNet/facManual/chapter2/clinical-criteria.pdf). The CON guidelines are congruent with the University based guidelines for tenure-eligible and non-tenure eligible faculty. The CON criteria provide details about expected evidence that is appropriate for tenure and clinical track faculty. In addition, the process for annual and continued review is in the CON Faculty Handbook (http://www.nursing.arizona.edu/IntraNet/facManual/other-pdf-files/internal-process-for-annualcontinued-review.pdf) The Guidelines for preparing the Annual Review Report are posted for faculty through the intranet at the site, Faculty Annual Report, which is accessible year-round for faculty to update information into their online Annual Report. The expected faculty outcomes are congruent with the missions and goals of the University and College. Emphases on faculty roles and responsibilities in teaching, research/scholarship and service provide a framework for identifying and evaluating the faculty outcomes.

I-D.

Faculty and students participate in program governance.

Elaboration: Roles of the faculty and students in the governance of the program, including those involved in distance education, are clearly defined and promote participation.

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PROGRAM RESPONSE

The roles of the faculty and students in the governance of the nursing program are clearly defined and enable their meaningful participation. Faculty roles are clearly defined in the University of Arizona Faculty Handbook which is available on the university website (http://web.arizona.edu/~uhap/). The organizational and governance structures of the College of Nursing were last revised in 2002 under the leadership of then Dean Marjorie Isenberg. The College of Nursing Organizational Chart illustrates reporting and communication lines within the College (Appendix I-D-1); the University Organizational Chart illustrates the relationship of the College to other components of the University (Appendix I-D-2 and (http://provost.arizona.edu/files/Visio-UAReorganization ProvostWeb 061209 0.pdf); The Arizona Health Sciences Center Organizational Chart illustrates the relationship of the College to other colleges and units within the Arizona Health Sciences Center (Appendix I-D-3). The Faculty Bylaws guide the implementation of a faculty governance model and are used to operationalize faculty accountabilities and participation in governance activities. The College of Nursing voting faculty is defined as persons involved in teaching, research and service who hold full or a minimum of 0.49 FTE appointments. The faculty elects the Faculty Chairperson to a one-year term; the Faculty Chair-Elect is elected by the faculty for a one-year term and then assumes the position of Faculty Chairperson. The faculty chairpersonship is rotated each year generally between representatives of the clinical and tenure tracks. Meetings of the total faculty are held a minimum of four times per year. The Dean of the College, faculty, and staff participate in the governance of the Arizona Health Sciences Center and the University of Arizona as well as the College of Nursing. The College is represented on the University Senate and on numerous appointed and elected university and Arizona Health Sciences Center Committees. In addition, several nursing faculty members have joint appointments with other university departments. A table displaying the list of faculty and their participation on University, Arizona Health Sciences Center and College of Nursing committees for academic year 2008-09 is in the Resource Room, Exhibit I-D-1. Documentation of faculty participation on committees for the 2008-09 academic years is available through the minutes of faculty committee meetings (see Exhibit I-D-2 in the Resource Room), and faculty curriculum vitae (see Exhibit I-D-3 in the Resource Room) provide additional evidence of their committee and other professional service activities. There is baccalaureate, master and doctoral student representation and participation on four standing College committees; most student representatives live near enough to be able to attend meetings on-site and others attend via conference call. Students also participate in governance activities at the University of Arizona and the Arizona Health Sciences Center (AHSC). Nursing students serve on the AHSC Library Committee and provide input related to library resources and services. Graduate student representatives at the MS-NP and doctoral levels serve as liaisons between administration and faculty at the College and participate in the Graduate and Professional Students Association. This university-wide student organization fosters a cohesive graduate community through which students may voice issues and concerns. Graduate and baccalaureate students also serve on

14

faculty standing committees to represent all students whether living in Tucson or elsewhere, in accord with college by-laws (Exhibit I-D-4). Coordinating baccalaureate courses and faculty committee meeting schedules have presented some challenges for baccalaureate student participation in curriculum committee meetings. However, baccalaureate students have representation through an active Student Nurses of the University of Arizona (SNUA), the formal representative body of baccalaureate students in the College of Nursing and liaison between administration and faculty. A copy of the SNUA constitution and by-laws is available in the Resource Room in Exhibit I-D-5. Documentation of student participation on committees is available through College of Nursing minutes (Exhibit I-D-2), particularly a sample of minutes of College of Nursing committee meetings such as the Doctoral Program Committee, Research and Clinical Scholarship Committee, and the Curriculum and Instructional Support Committee (Exhibit ID-6). While graduate student participation has been good, baccalaureate student participation has been somewhat limited because of clinical and course scheduling conflicts. Efforts to improve this using teleconferencing and alternative scheduling will be explored. In summary, faculty and student roles in the governance of the nursing program are clearly specified and generally enable their meaningful participation in the governance process of the College of Nursing.

I-E.

Documents and publications are accurate. References to the program's offerings,

outcomes, accreditation/approval status, academic calendar, recruitment and admission policies, transfer of credit policies, grading policies, degree completion requirements, tuition, and fees are accurate. Elaboration: A process is used to notify constituents about changes in documents and publications. Information regarding licensure and/or certification examinations for which graduates will be eligible is accurate.

PROGRAM RESPONSE

All documents, publications and web-based information pertaining to College of Nursing educational programs, student services, degree requirements, tuition and fees, and policies relevant to admission and progression are accurate and available to students and faculty online. The majority of information is on the following websites: College of Nursing website at http://www.nursing.arizona.edu/ 2009-2010 General Catalog at http://catalog.arizona.edu/allcats.html Graduate Catalog at http://grad.arizona.edu/Catalog/ In addition, prospective students have access to applications for admission and relevant admission requirements through the College Online Student Information System at https://osa.nursing.arizona.edu/inquiryRegistration.asp. This system requires the potential applicant to register an email address to gain access to the online portal.

15

Online processes are available to the Offices of Academic and Student Affairs to update changes as they occur in both the General and Graduate Catalogs. Units within the College are responsible for reviewing and updating information about their respective sections of the College of Nursing web site to ensure accuracy. Grading and attendance policies are incorporated in course syllabi in addition to online reference to pertinent academic policies. University of Arizona transfer policies and a comprehensive online transfer credit resource (http://aztransfer.com/home) provide accurate information on how courses taken at Arizona community colleges, tribal institutions, and state universities transfer, meet requirements and apply to degree programs. This information is easily accessible and ensures a smooth transition between state institutions of higher learning. Institutional liaisons and nursing personnel have direct access to the statewide system to ensure accuracy and the latest information for the transfer student. Changes in documents, publications, and web-based information are processed and generally disseminated to appropriate constituents electronically. A listserv is available for faculty and each student degree program and level. Prospective students' correspondence regarding the College educational offerings is maintained through the Online Student Information System (https://osa.nursing.arizona.edu/inquiryRegistration.asp) which allows for immediate information distribution to appropriate constituents. An important change in baccalaureate admission policy from a 2.75 to 3.0 as the minimum cumulative grade point average for nursing prerequisites was recently implemented and disseminated to multiple groups. The faculty committee, Student Recruitment, Admission and Progression-Undergraduate (SRAPU) reviewed admission grade point average data for the past 10 years and found the higher minimum GPA reflected what is necessary to be competitive within the applicant pool. In addition to the change being posted on the College website, notification of the change was disseminated electronically to all students who inquired about the BSN program through the Online Student Information System during the past two years. At the same time an electronic message was sent to a pre-nursing listserv, the University Academic Advising Committee, UA Undergraduate Council, UA Registrar, the statewide Arizona Articulation Task Force, and the Arizona State Board of Nursing.

I-F.

Academic policies of the parent institution and the nursing program are congruent. These

policies support achievement of the mission, goals, and expected student outcomes. These policies are fair, equitable, and published and are reviewed and revised as necessary to foster program improvement. These policies include, but are not limited to, those related to student recruitment, admission, retention, and progression. Elaboration: Nursing faculty is involved in the development, review, and revision of academic program policies. Differences between the nursing program policies and those of the parent institution are identified and are in support of achievement of/he program's mission, goals, and expected student outcomes. Policies are written and communicated to relevant constituencies. Policies are implemented

16

consistently. There is a defined process by which policies are regularly reviewed. Policy review occurs and revisions are made as needed.

PROGRAM RESPONSE

The College academic policies are congruent with the mission, goals, and student expectations of The University of Arizona and the College. The majority of academic policies and student expectations are the same as those of the University. The following are examples: · · · · · · · grading (http://www.registrar.arizona.edu/gradepolicy/policy/htm) grievances (http://deanofstudents.arizona.edu/rightsandresponsibilities) disability (http://drc.arizona.edu/about/index.html) harassment (http://equity.arizona.edu) academic integrity (http://deanofstudents.arizona.edu/policiesandcodes/codeofacademicintegrity) right to privacy (http://www.registrar.arizona.edu/ferpa/) student conduct (http://deanofstudents.arizona.edu/policiesandcodes/studentcodeofconduct).

A review and comparison of academic policies and student expectations found in the University 20092010 General Catalog (http://catalog.arizona.edu/allcats.html), the Graduate Catalog (http://grad.arizona.edu/Catalog/), and current College of Nursing BSN and Graduate Handbooks (http://www.nursing.arizona.edu/studenthandbooks.htm) confirm the congruency of University and College policies and their support of the mission and goals of the College and the University of Arizona. When policies of the College differ from those of the University, the differences in policy are justifiable and exemplify a higher standard for nursing. Personnel in the College Office of Student Affairs work collaboratively with established faculty committees [Student, Recruitment, Admission and ProgressionUndergraduate (SRAP-U), Student, Recruitment, Admission and Progression-MS (SRAP-M) and the Doctoral Program Committee (DPC)] responsible to develop, revise, and routinely review University and College policies pertaining to student recruitment, admission, and progression to foster quality improvement to degree programs. An example of a more rigorous standard than University policy is related to admission/enrollment criteria. The appropriate faculty committee (SRAP-U, SRAP-M, DPC) reviews applications for admission to baccalaureate and graduate programs not only for the applicant's potential to be successful in a demanding educational program but also for suitability for the profession and the match among student educational goals, faculty expertise, and College mission and goals.

Additional admission requirements for enrollment to a nursing program include the following: Arizona Department of Public Safety Fingerprint Clearance Card in accordance with Arizona Revised Statute (A,R.S. § 15-1881 found at the following website, http://www.azleg.state.az.us/FormatDocument.asp?inDoc=/ars/15/01881.htm&Title=15&DocType=ARS), health immunization requirements for clinical practice, and notarization of ability to meet Essential Qualifications for Nursing Candidates. In addition we have policies concerning a line of communication to resolve

17

academic issues that may arise in the classroom and/or at the clinical site. A College Instructional Rules and Decorum Policy represents an expansion of the University policy for behavior in the educational setting. Together, all of these policies (found in BSN and Graduate Student Handbooks http://www.nursing.arizona.edu/studenthandbooks.htm) facilitate a learning environment that supports the mission and expected student outcomes. Personnel in the Offices of Academic Affairs and Student Affairs in conjunction with the appropriate faculty committee members monitor adherence to recruitment, admission and progression policies and recommend policy change when necessary. This practice ensures consistency in policy implementation, timeliness in policy revision when needed to foster program improvement, and fair and equitable treatment for all students. The Assistant Dean, Office of Student Affairs is responsible for updating and disseminating policies through orientation programs, the College website, and other electronic means.

I-G.

There are established policies by which the nursing unit defines and reviews formal

complaints. Elaboration: The program's definition of a formal complaint and the procedure for filing a complaint are communicated to relevant constituencies. The program follows its established policies/procedures for formal complaints.

PROGRAM RESPONSE

Policies providing guidance for appropriate student behaviors and student due process are found within several documents as follow: · · · · The University Student Code of Conduct (http://deanofstudents.arizona.edu/policiesandcodes/studentcodeofconduct) Grade Appeal Policy (http://deanofstudents.arizona.edu/policiesandcodes/studentcodeofconduct) Disruptive Behavior in the Classroom Policy (http://deanofstudents.arizona.edu/policiesandcodes/studentcodeofconduct) Policy for Threatening Behavior by Students, and Academic Integrity Policy (http://deanofstudents.arizona.edu/policiesandcodes/studentcodeofconduct.

Additional University resources available to receive, review, and recommend appropriate action for formal complaints are as follow: · · · ·

Ombudsperson Committee (http://ombuds.web.arizona.edu/homepage) General Petitions Committee (http://www.registrar.arizona.edu/petitions) Graduate College Petitions (http://grad.arizona.edu/academics/degree-certification/forms) Dean of Students Office (http://deanofstudents.arizona.edu/ )

18

In addition, the Office of Institutional Equity (http://equity.arizona.edu/) is available to the University community for formal complaints dealing with harassment, discrimination, retaliation, and employment equity. These policies and resource information are maintained on the University web site. The University and College policies are designed to promote communication between individuals, solve problems, and resolve conflicts often before a formal complaint is issued. In addition to the University policies and resources for formal complaints, BSN and Graduate Student Handbooks (http://www.nursing.arizona.edu/studenthandbooks.htm) outline the process for an Academic Appeal of Disqualification from the College and a Grade Appeal Policy. A formal process is in place for undergraduates to request review and approval from the faculty committee SRAP-U for readmission to the BSN program and re-entry into a clinical course when student progression is adjusted due to earning an unsatisfactory grade in a professional nursing course. Student comments are solicited during a student/faculty meeting when a Progress Report is issued for unsatisfactory academic and/or clinical performance. Student comments are included in the report.

STANDARD I SUMMARY

Strengths: · · · There is mutuality in values and focus regarding the mission and goals between College of Nursing and the university. College goals and faculty and student outcomes are congruent with the needs of the community of interest. Faculty bylaws support participation of faculty, staff, and students in governance of college programs.

Areas for Improvement: · Use opportunities presented by Current revisions in the University Health Sciences Center Strategic Plan to assess the College of Nursing Strategic Plan.

Action Plan · Refine and clarify the College of Nursing Strategic Plan in reference to program planning and evaluation needs.

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STANDARD II PROGRAM QUALITY: INSTITUTIONAL COMMITMENT AND RESOURCES

T

II-A.

he parent institution demonstrates ongoing commitment and support for the nursing program. The institution makes available resources to enable the program to achieve its mission, goals, and expected aggregate student and faculty outcomes. The faculty, as a

resource of the program, enables the achievement of the mission, goals, and expected aggregate student outcomes.

Fiscal and physical resources are sufficient to enable the program to fulfill its mission,

goals, and expected outcomes. Adequacy of resources is reviewed periodically and resources are modified as needed. Elaboration: The budget enables achievement of the program's mission, goals, and expected student and faculty outcomes. The budget also supports the development, implementation, and evaluation of the program. Compensation of nursing unit personnel supports recruitment and retention of qualified faculty and staff. Physical space is sufficient and configured in ways that enable the program to achieve its mission, goals, and expected student and faculty outcomes. Equipment and supplies (e.g., computing, laboratory, and teaching-learning) are sufficient to achieve the mission, goals, and expected student and faculty outcomes. There is a defined process for regular review of the adequacy of the program's fiscal and physical resources. Review of fiscal and physical resources occurs and improvements are made as appropriate.

PROGRAM RESPONSE

Fiscal Resources Budget: The College receives funds for operations from a variety of sources that can be classified as state funds, sponsored funds and other funds including auxiliary, designated and restricted funds. The dollar amounts by fund group between fiscal year (FY) 2007 and FY 2010 appear in Table II-A-1. Table II-A-1 Revenues by Category, FY 2007-FY 2010 FY 2007 FY 2008 FY 2009 FY 2010 State 6,309,310 6,436,554 6,049,636 6,049,636 Sponsored 4,779,747 4,334,280 4,925,287 4,974,539 Other 4,425,430 5,517,103 5,662,302 5,662,302 15,514,487 16,287,937 16,637,225 16,686,477 Total State funds, which are derived from tuition and fee revenue and State appropriations, are unrestricted operating funds that are not limited to a specific purpose by the Arizona Board of Regents (ABOR) or the University administrative leaders. The College receives a consistent allocation of unrestricted state funds legislatively appropriated for higher education through the central administration of the UA and AHSC.

20

These are used to support academic programs and general operations. Sponsored funds are from project grants and contracts from governmental agencies and private organizations. These funds have restrictions for specific purposes, and they can only be used for intended purposes established between the sponsor and the UA. Other funds include: 1. auxiliary funds, which are operating funds from an established auxiliary enterprise; 2. designated funds, which are operating funds that have been limited for a specific purpose by ABOR, the UA or an administrative unit of the UA, e.g. funds for the Arizona Area Health Education Centers (AHEC) program (currently administered by the College; and 3. restricted funds, which are operating funds from outside sources that have specific restrictions on how the monies are spent. The projected budget for the College in FY 2010 (ends June30, 2010) is $16,686,477. This reflects no anticipated increase in state or other funding and includes a 1% increase in sponsored revenue from new awards. At this time, and into the foreseeable future, non-state sources of funding significantly exceed state appropriations with non-state resources representing 64% of the total budgeted revenue and associated expenditures. In FY 2009 the total expenditures for the College were $16,637,225; the expenditures by funding group for FY 2009 appear in Figure II-A-1. Expenditures for FY 2007 through FY 2009 by the main categories of salaries/employee-related expense (ERE), operations and other types including travel, capital equipment, student support and indirect costs appear in Table II-A-2. Consistent with most educational institutions, the single largest category of expenditure of resources is related to personnel costs. Figure II-A-1. Expenditures by Fund Group, FY 2009

FY 09 Expenditures by Fund Group UA College of Nursing with AHEC

26% 36%

State Designated Sponsored Other - Restricted

30% 8% Total Expenditures equal $16.6 M

Table II-A-2 Expenditures by Category, FY 2009-FY 2010 FY 2007 FY 2008 FY 2009 FY 2010 Salaries/ERE 9,458,592 10,098,029 10,237,218 10,286,470 Operations 3,406,164 3,681,536 3,883,096 3,883,096 Other 2,649,731 2,508,372 2,516,911 2,516,911 Total 15,514,487 16,287,937 16,637,225 16,686,477 The UA annually prepares a budget that is reviewed and approved by the ABOR. Budget development and ongoing review occurs at the administrative level. The UA presidential executive cabinet and finance committee are aided by the UA Faculty Strategic Planning and Budget Advisory Committee (SPBAC). The mission of SPBAC is to support and enhance the University through thoughtful and informed advice related to strategic planning, assessment of institutional priorities, review of budgetary policies, evaluation

21

of programs and services. Budget review also involves new budget requests for specific activities that are proposed by Colleges alone or in collaboration. The Dean of the College interacts in an ongoing manner with the administrative team at the UA and AHSC regarding budget. Her input, which includes that of key members of the College administrative team and faculty, contributes to the ongoing review of the adequacy of resources. Cost recovery funds come from the indirect cost recoveries on grants and contracts. The UA negotiated indirect cost rate for FY 2010 is 51% with the rate increasing to 51.5% in FY 2011. For FY 2008, total indirect cost recovery to the UA from funds associated with College grants and contracts was $340,987. Of this total, the College of Nursing received $85,246. Data on indirect cost recovery for FY 2009 will be available after the annual audit.

Compensation: In December 2009, the College of Nursing employed 65 faculty members of which 21 were tenured or tenure-eligible, 40 were appointed into non-tenure eligible clinical track positions, and 4 appointed into non-tenure eligible research track positions. Most faculty are appointed into 9-month academic year appointments. All tenure-track faculty are fulltime (holding 1.0 FTE), while 30 of the clinical-track faculty members and 1 of the research faculty members are fulltime. All of the tenure-track and research-track faculty members hold doctoral degrees. Among the clinical-track faculty members, 13 hold doctoral degrees. In July 2009, the College tenure-track and clinical-track faculty salaries were compared to mean salaries obtained from the AACN survey (Tables 17 and 96 containing 2007/2008 data) for tenure eligible faculty on academic appointments and for clinical faculty on academic appointments. The mean salaries in dollars appear in Table II-A-3.

Table II-A-3 Faculty Salary Comparisons (9-month academic year appointments) Track Rank Number UA CON Mean 63,333 73,842 98,617 54,222 55,838 63,342 74,011 AACN Mean 67,117 79,322 104,374 48,409 57,488 68,581 90,921 AACN 25 Percentile

th

AACN 50 Percentile

th

AACN 75 Percentile

th

Tenure

Assistant Associate Professor Instructor Assistant Associate Professor

3 11 5 3 15 17 3

61,400 71,792 90,000 45,000 51,500 60,385 74,183

65,455 77,131 100,302 46,635 55,240 64,845 89,200

th

71,119 85,352 113,736 51,450 61,355 72,772 95,087

Clinical

The mean salaries of the UA College of Nursing tenure-track faculty are below the 50 percentile values found in the AACN Survey Data for all ranks; the mean salaries of the clinical-track faculty in the instructor and assistant professor rank are above the 50 percentile values, while those in the associate and full professor rank fall below the 50 percentile values.

th th

22

Student support: We assist students with scholarships, traineeships and Nurse Faculty Loan Program funds that we assume rival most other institutions. The 2009-2010 allocations exceed $1.7 million in student scholarships.

Physical Resources Space: The College and most entities of the AHSC are located on about 48 acres of the UA campus in Tucson. The College building is a free-standing, 4 story building with 67,018 square feet of which 41,791 square feet are assignable for teaching (20,018 square feet), research (2,478 square feet), faculty and staff offices (19,475 square feet) and other relevant uses (see Appendix II-A-1 for Floor Plans). We also use state-of-the-art classrooms within neighboring AHSC Drachman Hall, which opened in 2006; one investigator has assignable space for biological research in the Medical Research Building (500 square feet). The Arizona Area Health Education Center (AHEC) Program, administratively led by Associate Dean Reel, is housed in a separate building (1975 square feet). Physical space at the UA is managed by the Office of Real Estate Administration under the direction of Bruce M. Vaughan, Interim Director, Real Estate Administration. In 2003, the consulting firm of Ayers/Saint/Gross that specializes in campus architectural and organizational concerns developed a Comprehensive Campus Plan for the UA. The Arizona State Board of Regents (ABOR) requires that the UA Master Plan be updated every 5 years. The AHSC Facilities Committee, which is appointed by the President of the University and Vice President for the AHSC, monitors the implementation of the AHSC portion of the UA Comprehensive Campus Plan and all site and facilities development on the AHSC campus. The AHSC team that was assembled to update the plan includes College members Donna Cochran, Assistant Dean, Finance and Administration, and Sarah Swanson, Building Operations Coordinator. In the College, space in the aggregate is overseen by the administrative leadership team (deans [associate and assistant] and division directors) and discussed within their regular meetings (Administrative Council). More particularly, offices and conference room space is overseen by the Division Directors, each of whom has a faculty advisory group. Classroom and other core space is overseen by Dean with input from the Assistant Dean for Academic Affairs and faculty committees as relevant. Research space is overseen by Carolyn Murdaugh, PhD, RN, FAAN, Associate Dean for Research, who has a committee for faculty input. Space within the College is adequate in volume for the moment, certainly for the educational components. However certain areas require upgrading for electronic teaching/learning and some spaces are ill-configured for matching the strategic directions for research and practice/service initiatives that will develop over time. Research space is currently sufficient, but as research capacity grows, more or reconfigured space will be needed.

Computer and Audiovisual Physical Resources: The College faculty and students benefit from and have access to state-of-the-science computing and audiovisual facilities and equipment available through

23

the UA, AHSC and College. At the University-level, the University Information Technology Services (UITS) is the recent merging of several existing units including: (1) Office of Student Computing (OSCR) and (2) Learning Technologies Center (LTC); and (3) Units formerly known as Center for Computing & Information Technology (CCIT). The UITS has the space, network technology, equipment and other computing infrastructure to provide campus-wide computing and data services that support instructional, research and administrative computer needs throughout the UA. Details on computer and audiovisual resources are elaborated under Standard II-B. More extensive information on the facilities, services and equipment of UITS is available at the UITS site http://uits.arizona.edu/about/aboutus and exploring the drop-down menus and links.

The College also benefits from resources under the auspices of the AHSC. An important resource is Biomedical Communications which offers a comprehensive range of media planning, creation, production and support services to assist in the instructional, research, patient care and public service missions in the College as well as the rest of AHSC. The College relies on Biomedical Communication for research poster presentations, computer and technology support in the Drachman classrooms, and connecting to national teleconferencing events.

College technological support services are provided by the Information Technology Group (ITG) and under the direction of Assistant Dean, Donna Cochran. The ITG is headed by Mr. Kevin Button and consists of 5 full-time staff associates, including a computing (help-desk) manager, a media specialist, an applications system analyst and 2 support analysts. Their roles and responsibilities include assistance with online course development, functioning and training; web-casting and video-archiving; website development, maintenance and oversight; system and network administration and security; PC procurement, installation and maintenance; educational software procurement and training; among other duties. The ITG offices and associated equipment occupy 1,377 sq ft on the 3 floor of the College. The space is divided into 4 offices, 3 cubicles, a "garage" for equipment staging and configuration, a temperature-controlled server room; and diagnostic, testing and storage areas. The ITG oversees the Student Computer Lab on the first floor. This is a 664 ft sq facility for student and classroom use with 25 workstations and 1 instructor station. One classroom (Rm 470) is completely wired for videoconferencing and distance synchronous learning. The remaining classrooms have complete A-V hardware. The College has software for conducting the many meetings and classes online with visual and audio capabilities. ITG members are often involved with facilitating student-faculty interactions via internet in room 351E1 which is set-up for Web-based conferencing meetings and room 470, a state-of-the-science Video Conferencing Suite that is equipped for real-time video conferencing, live webcasting and videorecording. Building-wide wireless network access is also available. The ITG is responsible for the maintenance of these computers, printers, and all other related classroom and information technology services within the College.

rd

24

Steele Innovative Learning Center: Donna Semar, PhD, RN, BC is the Coordinator of our state-of-theart Steele Innovative Learning Center (SILC), built in 2007 with 1.3 million dollars in private donations. The SILC is the nexus of simulated learning for both entry-level and advanced practice programs. She is assisted by Yvette Matheson, BSN, RN. The mission of the SILC is to support student learning objectives related to delivering competent, comprehensive patient care. This mission is accomplished by providing a safe learning environment in which both simulation of clinical experiences and practice of discrete skill elements can occur. Teaching in the simulated nursing care environments of SILC allows us to offer students an array of tools ranging from basic skill acquisition through participation in complex, realistic scenarios designed to enhance the link between critical clinical thinking and actions. The High Acuity Nursing Wing Rooms 250A, B, and C house three Sim ManTM manikins, 10 lower fidelity manikins, and 3 virtual IV simulators, among other equipment. The SILC also has a Health Assessment Laboratory area (Room 275A) equipped with 10 stretchers, wall-mounted oto-ophthalmoscopes, air and simulated oxygen delivery at every station. The Universal Patient Care Area (Room 275B) houses 10 Vital Sim manikins, encompassing low to mid-level fidelity technology for practicing patient care procedures such as assessment, turning, positioning, bed-making, wound care, and nasogastric tube and Foley catheter insertion and removal. Details on our comprehensive SILC resources are in Exhibit II-A-1. Dr. Semar and Ms. Matheson coordinate the logistics of implementing scenarios and guide instructors in assuring that individual students and small groups of students meet their learning outcomes. All 1 and 2

st nd

Degree BSN students benefit from using the SILC for initial learning of skills, for application

of psychomotor and critical thinking skills, and in their final year for reinforcement or remedial learning. Graduate level students use SILC to learn advanced health assessment and to practice procedures.

Research Laboratories: The College has 2 research laboratories, the Biological Studies Laboratory and Clinical Research Suite, that provide space and equipment for faculty and students to conduct research and research training related to biological and behavioral clinical science. The Biological Studies Laboratory includes 2 biochemistry laboratories, a laboratory equipped for cell culture, a histology laboratory, and a new molecular biology laboratory. Details on the specific resources of this laboratory are described in Exhibit II-A-2. The Clinical Research Suite provides designated space for faculty who conduct research involving human subjects. The space accommodates faculty and research staff to conduct, analyze and disseminate clinical research. A large, state-of-the-art conference room is used for group meetings and conferences with on-site and distance participants. A smaller conference room is used for group meetings, focus groups and other small group research activities. The suite also includes an intervention room, and a clinical measurement room to conduct research protocols and perform measures such as cognitive testing, as well as offices for research staff, including eight computer stations. The research laboratories

25

are sustained mainly by extramural funded research projects and primarily are used for funded faculty or student research projects. Many of these projects include baccalaureate and graduate student workers.

Fiscal and Physical Resources Review and Improvement The review of both fiscal and physical resources is a continuous and ongoing process with different parts being led by various members of the administrative leadership team. For the most part, monitoring and strategies for change and shifting of resources are discussed in Administrative Council (dean, associate and assistant deans and directors) and decisions are implemented by the appropriate leader. At present, programs are sized to match our resources. However, the state resources continue to exhibit fragile stability. Review of fiscal resources has been especially scrutinized since the Fall of 2008 due to severe deficits in the state appropriations. Another round of cuts to academic units was made this fiscal year but the Nursing College was held harmless in those cuts. This was due to the negotiations that occurred with the selection of a new Dean and the desire to prevent further impact on the nursing shortage. At the time of this writing (2/23/10), the state had not yet closed its budget gap for this fiscal year. The administrative leadership team has engaged in and continues to plan and develop a variety of strategies to garner resources from sources beyond state funds. As examples, because the nursing doctoral programs are wholly online they have been placed in the UA Outreach College, which returns a designated proportion of the tuition collected; the 2

nd

Degree BSN Pathway, an accelerated BSN degree,

has become a blended tuition or fee-based and sponsored program whereby a majority of fee is returned to the College, and a total fee has been increased to be competitive with other programs; in addition, we are in the talking phase of a new degree program that will use a public-private partnership model for delivery if pursued. The UA Colleges have not typically had their state funding linked to the tuition and fees they have generated but Provost Hay has indicated that we will be adopting a responsibility-centered management type of model over time and currently this is in planning stage. Thus, the fiscal processes will continue to change.

In the College, we have strengthened peer support for grant and contract writing and expect to increase our external funding. Moreover, the College has not engaged in many entrepreneurial initiatives for education outside of classic degrees or practice, leaving many options to be pursued. Securing further partner and donor support is ongoing. The College was able to build its Steele Innovative Learning Center ($1.3 Million renovation) through private philanthropy and continues to increase endowment funds through private sources. Planned estate gifts to the College are already earmarked for a variety of endowed faculty chairs. In February 2010, the College established a new endowment to build capacity for future nursing science professorships and chairs. There is also an endowment to build capacity for student scholarships.

26

II-B.

Academic support services are sufficient to ensure quality and are evaluated on a regular

basis to meet program and student needs. Elaboration: Academic support services (e.g., library, technology, distance education support, research support, admission, and advising services) are adequate for students and faculty to meet program requirements and to achieve the mission, goals, and expected student and faculty outcomes. There is a defined process for regular review of the adequacy of the program's academic support services. Review of academic support services occurs and improvements are made as appropriate.

PROGRAM RESPONSE

UA Academic Support Services Library: The Arizona Health Sciences Library (AHSL) is an excellent and important partner in the education of all students in the College. Core services include the following: 1.Provision of electronic access to vast stores of biomedical literature (on-site and online); 2. Maintenance of a Liaison Librarian program, providing on-site librarians to all Colleges of the AHSC; 3.Participation as instructors in the curricula of all Colleges of the AHSC in collaborating with faculty to develop innovative curricula that foster information literacy; 4.Sharing of expertise in information management and partnership with faculty and students to advance learning and facilitate research; 5.Provision of document delivery of journal articles and books outside of the library's collection that is timely and cost effective; 6.Assistance with reference and information seeking; and 7.Provision of comfortable space for small group collaboration and quiet studying n a collegial atmosphere. An example of how the librarians participate as instructors is librarian Ms. Sandy Kramer's participation in NURS735 Emerging Diseases, Genetics and Health Trends in the Fall 2008 semester. Ms. Kramer participated in an audio-recorded podcast of a discussion with the instructor, a PhD student and a librarian of strategies to research current trends in asthma. The students listened to the podcast, as well as reviewed a module developed by Ms. Kramer on APA guidelines and levels of scientific information. Furthermore, she was available for student consultation.

Computer, Distance Education and Research: Academic support services provided under the auspices of University Information Technology Services (UITS) include mainframe and microcomputer open access facilities; Courseware Library for Instructional Computing (CLIC); a wide variety of training; consultation on the use of the University's computers and various microcomputers; communications and networking between user-owned equipment and the University's systems; computer facility planning and preparation; mainframe and microcomputer training facilities; programming and applications support; dissemination of information through user publications, manuals, and program library documentation; and assistance in user acquisition of computing facilities. Details of UA-wide technology services are described in Exhibit II-B-1. More information on UA the facilities, services and equipment are described at the UITS site http://uits.arizona.edu/about/about us. Specific to the College of Nursing, the UITS provides D2L support to setup online support for

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undergraduate classes offered face-to-face and online. We had CCIT support (a 9-person team) for development of our online doctoral program, including instructional design, multimedia, and programming through a state grant.

College Support Services Office of Student Affairs: The Office of Student Affairs (OSA) is directed by Vickie Radoye, Assistant Dean, and is staffed by three support/recruitment staff associates and three advising staff associates. The OSA personnel work collaboratively with and under the auspices of the Office of Academic Affairs. The goal of the OSA is to support the educational mission of the College by maximizing the educational environment and experiences of nursing students. The OSA is responsible for student services including academic advising, recruitment, admissions, progression, graduation, student centered events, teacher course evaluations, class and room scheduling, and dissemination of scholarships, fee waivers, traineeships and fellowships. Prospective students and students can access many of these services online https://osa.nursing.arizona.edu/inquiryRegistration.asp through the College Online Student Information System (OSIS). OSIS provides an automated contact management tool for prospective students so they can complete online applications, and send and receive electronic messaging as to status and scholarship or financial aid information. Prospective 1 Degree and 2

st nd

degree BSN Pathway students seeking admission enter the application

process by creating an online account and password within OSIS. They complete the application process and submit most materials online (official transcripts are received by mail). Information is automatically entered into a computerized data base enabling staff associates to verify the application materials. Faculty review all completed applications online. Following in-person interviews of top candidates by faculty members, applicants are reviewed by SRAP-U and recommendations are made to either: 1. recommend admission; 2. place on a waiting/alternates list; or, 3. deny admission. Prospective DNP and PhD students also apply online. Completed applications are reviewed and scored within by two faculty members who teach in the doctoral programs. Top applicants participate in telephone interviews by DPC members and additional College tenure-track faculty members. Once interview scores are electronically submitted, the DPC members make recommendations of candidates who are to be offered admission. The Division Directors facilitate a student-mentor match process of qualified applicants. After reviewing recommendations from the Division Directors, the Director of the DNP Program and Chair of the DPC finalize the list of admitted students in collaboration with the administrative leadership team.

Technology Support At the College level ,the Information Technologies Group (ITG) provides a variety of services (detailed in a list in Exhibit II-B-2), including local and web-based access to email; email security; network management for connectivity with UA and the internet; filing system and printing; video conferencing; video streaming and live webcasting; technology procurement; and database development. All faculty

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and staff members have web and CON network-connected desktop computers with printer access for their use, and ITG provides expert and timely desktop support. In addition, ITG provides instructional support services that range from assistance with a PowerPoint presentation to the production and delivery of a live webcast of a lecture or guest presentation. A full-time Media Specialist provides management of and assistance with classroom technology related to audio and video presentation. Drachmann Hall adds a number of large capacity classrooms with the latest classroom presentation technology along with a new interactive audience response system. These resources and services play a significant role in the support of our educational mission. Further, as part of the overall instructional support function, ITG supports all online faculty and students enrolled in the graduate programs. Support staff have a repertoire of tools available to assist students and faculty at a distance. In addition to one-on-one support through the Internet or face to face for local students, hands-on group training is provided for all doctoral students during their first Research Intensive Summer Experience (RISE). Questions ranging from basic connectivity issues to specific D2L learning management system platform functionality are answered on a daily basis. ITG performs a wide variety of web services. Information distributed via the web has becoming increasingly important for those seeking information about the College. In a typical month approximately 70,000 visitors peruse the College of Nursing website. Similarly, grants and projects easily disseminate findings, advertise for subjects and even utilize web technology to collect and manage research data. Rich media and instructional content are all delivered via the web. ITG hosts, designs, manages, and maintains several sites (See Exhibit II-B-2) ITG also provides research support services for grants and projects including consultation on hardware and software and data analysis and storage.

Process for Evaluation of Fiscal and Physical Resources Students and faculty are invited to evaluate several academic services. Upon degree completion, students in all Programs receive an Alumni Survey in the mail. The survey for those completing the baccalaureate program contains items for assessment of a number of academic support services, however until recently, graduate students are asked only to rate their advisement. In Fall 2009, the ITG sought input for service improvement through an online survey of users (faculty, staff associates, and students). Overall positive comments were made of the services with only a few suggestions for improvement, largely in the area of timely production of database development services.

Review and Improvements The alumni survey is given to all students upon graduation. Survey results are reviewed by the administrative leadership team and issues are addressed by the appropriate unit head. Beginning in the summer of 2009, questions regarding academic services are now asked of graduate students attending RISE and reviewed by the Doctoral Program Committee.

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II-C.

The chief nurse administrator: is a registered nurse (RN); holds a graduate degree in nursing; is academically and experientially qualified to accomplish the mission, goals, and expected student and faculty outcomes; is vested with the administrative authority to accomplish the mission, goals, and expected student and faculty outcomes; and

provides effective leadership to the nursing unit in achieving its mission, goals, and

expected student and faculty outcomes. Elaboration: The chief nurse administrator has budgetary, decision-making, and evaluation authority that is comparable to that of chief administrators of similar units in the institution. He or she consults, as appropriate, with faculty and other communities of interest, to make decisions to accomplish the mission, goals, and expected student and faculty outcomes. The chief nurse administrator is perceived by the communities of interest to be an effective leader of the nursing unit. The program provides a rationale if the chief nurse administrator does not hold a graduate degree in nursing.

PROGRAM RESPONSE

In July 2009, Joan Shaver, PhD, RN, FAAN became the sixth Dean of the UA College of Nursing. Dr. Shaver is internationally known and a national leader in nursing administration, education and research (see her curriculum vitae in Appendix II-C-1). She is a nationally recognized scientist in women's health, sleep science, fibromyalgia and chronic fatigue syndrome. Prior to joining the UA, Dr. Shaver served for 13 years as Professor and Dean at the University of Illinois at Chicago (UIC), a top-10 College according to U.S. News and World Report rankings in 2007. Dr. Shaver is a registered nurse in the State of Arizona. She received her BSN from University of Alberta and both the Master of Nursing and PhD in Physiology and Biophysics from the University of Washington. Dr. Shaver has worked as a faculty member in Colleges of nursing for nearly 35 years and has held administrative positions for the past 20 years. She continues to maintain an outstanding publication record through numerous manuscripts and book chapters. She has a long-standing history of national funding in both nursing research and training. She currently serves on the editorial boards of the Journal of Nursing Scholarship and the Canadian Journal of Nursing Leadership, and she reviews manuscripts for numerous journals in nursing, women's health and sleep. Dr. Shaver is a past-president of the American Academy of Nursing. She served a four-year term on the National Advisory Council for the National Institute of Nursing Research at the National Institutes of Health, and on the Nursing Science Review Committee for National Research Service Award pre- and post-doctoral training grants. During her tenure at UIC, she was co-director of the Research Core at the UIC National Center of Excellence in Women's Health from 1997 to 2004. Dr. Shaver is the 2004 recipient of the Lifetime Achievement Award for

30

Research, Midwest Nursing Research Society, and the 2007 recipient of the North American Menopause Society/Duramed Pharmaceuticals, Inc. Menopause and Sleep Research Award presented through The North American Menopause Society. Dean Shaver serves as the chief administrative officer of the College and as such is responsible for facilitating its growth, and productivity of the faculty and students. Primary responsibilities of the Dean include: providing leadership for the faculty in evolving excellence in teaching, research and practice/service; interpreting the College goals and programs to internal and external constituencies; providing leadership in resource acquisition, resource management and strategic planning; facilitating faculty and staff development; representing the College and University in statewide and national health care arenas; and creating a positive environment for learning and growth in the College. The specific functions of her position are in the CON Faculty Handbook in the Resource Room in Exhibit II-D-1. UA and College organizational charts may be viewed both at websites http://www.president.arizona.edu/campus.cfm and http://www.nursing.arizona.edu/PDF/Admin-Org-Chart.pdf, respectively, and in Appendices I-D-1, I-D-2 and I-D-3. Dean Shaver is accountable to William Crist, MD, the UA Vice President for Health Affairs but also directly accesses Provost Hay for matters of education. Having assumed her post in July 2009, Dean Shaver is currently consulting with faculty and the communities of interest. Based on her past relationships with the faculty and communities of interest, it is anticipated the she will be an active and a well-respected participant in shaping positive changes at the College and positioning the College even more strongly in the health sciences. It is important to point out that while at UIC, she was active with the community such as being a member of the Metropolitan Chicago Healthcare Advisory Committee to confront the nursing workforce shortage; she led the development a Comprehensive Nursing Education Plan for the State of Illinois with her counterparts from 36 Illinois schools that granted baccalaureates or higher in nursing; and she was on the Board of Directors of Advocate Health Care, a large, faith-based, integrated health care system. Dr. Shaver has an outstanding national reputation in the nursing and scientific community. Dean Shaver is clearly academically and experientially qualified to accomplish the mission and to achieve the goals and expected outcomes of the UA College of Nursing students and faculty. In her past places of employment, she was active at the local and state-levels, and she received awards and recognition. Based on this history, it can be expected that she will achieve high standing, respect and be influential at the UA, in Tucson and throughout the State of Arizona. Clearly, Professor and Dean Shaver is a definite strength for the UA College of Nursing. The position of Dean gives her budgetary, decision-making and evaluative authority within and for the College. II-D. Faculty members are: sufficient in number to accomplish the mission, goals, and expected student and faculty outcomes; academically prepared for the areas in which they teach; and experientially prepared for the areas in which they teach.

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Elaboration: The full-time equivalency (FTE) of faculty involved in each program is clearly delineated, and the program provides to CCNE its formula for calculating FTEs. The mix of full-time and part-time faculty is appropriate to achieve the mission, goals, and expected student and faculty outcomes. Facultyto-student ratios ensure adequate supervision and evaluation and meet or exceed the requirements of regulatory agencies and professional nursing standards and guidelines. Faculty are academically prepared for the areas in which they teach. Academic preparation of faculty includes degree specialization, specialty coursework, or other preparation sufficient to address the major concepts included in courses they teach. Faculty teaching in the nursing program have a graduate degree. The program provides a rationale for the use of any faculty who do not have a graduate degree. Faculty who are nurses hold current RN licensure. Faculty teaching in clinical/practicum courses are experienced in the clinical area of the course and maintain clinical expertise. Clinical expertise may be maintained through clinical practice or other avenues. Faculty teaching in advanced practice clinical courses meet certification and practice requirements as specified by the relevant regulatory and specialty bodies. Advanced practice nursing tracks have lead faculty who are nationally certified in that specialty.

PROGRAM RESPONSE

Tables listing the tenure-track, clinical track, and research track faculty appear in the Appendices II-D-1, II-D-2, and II-D-3. There are 21 faculty members on the tenure-track, 40 on the clinical track and 4 members on the research track lines. Faculty who teach in the 2

nd

Degree BSN Pathway program hold 12

month contracts (in contrast to other clinical faculty with 9 month contracts) and their teaching assignments involve teaching across all courses (with the exception of the forums) within a given level of the curriculum. Faculty in the tenure-track teach across programs, whereas the majority of clinical track faculty members teach in the Baccalaureate Program. All tenure-track faculty members have graduate degrees in Nursing. Except for David Apgar, PharmD and Sara Byron, PhD, who teach pharmacology courses within the College, clinical track faculty also have graduate degrees in Nursing. Among the tenure-track faculty there is diversity among the doctoral degrees and among those with postdoctoral training. The educational and experiential background of the faculty match student needs and facilitate attainment of the mission and goals of the CON, as well as expected student and faculty outcomes. A full-time equivalent (FTE) is defined by the UA as a person paid fulltime to work 40 hours per week. Within the tenure-track faculty, all members are full-time, whereas some members of the clinical track faculty are part-time. Faculty and Division Director discuss workload assignments during the annual review process and then workload is confirmed with faculty by a letter in late Spring. Faculty sign and return the workload letter to indicate their understanding of the assigned work. Contracts are sent in late Spring or early summer for signature. Non-administrative tenure-track and clinical faculty members typically have academic year appointments that begin in mid August and end in mid May. Work assignments during the summer are reimbursed by supplemental compensation.

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A typical workload assignment for tenure-track faculty is 40% teaching, 40% research/scholarship, and 20% service. For clinical track faculty, a typical workload for those teaching in the Baccalaureate Program is 80% teaching and 20% combined service and scholarship, while a typical workload for doctorally prepared clinical track faculty teaching in the Graduate Program is 50% teaching, 30% scholarship, and 20% service. The ratio of students to faculty in clinical practica of direct patient care is not more than ten to one, which is congruent with the Rules of the Arizona State Board of Nursing. As shown in Appendices II-D-4 and IID-5, all faculty members in the College, with three exceptions, maintain current Registered Nurse Licensure with the Arizona State Board of Nursing. The three exceptions are David Apgar, PharmD, and Sara Byron, PhD, both of whom teach Pharmacology; and David Montgomery, PhD, who is a Research Professor, with primary research responsibilities, though he has taught NURS350, Pathophysiology, in the past, and continues to give guest lectures in that course.

All faculty members have the academic preparation to teach in the programs to which they are assigned and are qualified to teach the courses in which they participate. In some cases, faculty members attain expertise in response to program needs. For example, Dr. Carrie Merkle, who has a MS in Adult Health Nursing and a PhD in Zoology, has taught NURS350 Pathophysiology for over 20 semesters. With the development of the DNP Program, there was a need to offer a course that included emerging diseases and population health. To meet this need, Dr. Carrie Merkle has attended workshops and conference sessions that include topics such as community preparedness, global health, and genetics. Her attainment of this knowledge has assisted in making NURS753 Emerging Diseases and Population Health (formerly entitled Emerging Disease, Genetics, and Health Trends) an informative and well-rated course. Many of the clinical faculty members have certifications in their specialties (see Appendix II-D-2). Certification by the various national agencies assures that practice requirements are met. The Director of the Nurse Practitioner and DNP Programs is Sally J. Reel, PhD, RN, FNP, BC, FAAN, FAANP. Dr. Reel is an FNP, certified by the ANCC, and a Clinical Professor. In addition to serving as Director for the Nurse Practitioner Programs, she serves as Associate Dean, Academic Practice. Dr. Reel is very qualified to direct the nurse practitioner programs and faculty members. Currently, the advanced practice tracks have the following specialty clinical track faculty: (1) Dr. Donna Velasquez, who is an FNP and is ANCC certified; (2) Dr. Ted Rigney, who is an ACNP and is ANCC certified; and (3) Ms. Mary Vincenz, who is a PMHNP and is ANCC certified. During the study period, Dr. Karen Greco was the lead of the ANP track. She is an ANP who is ANCC certified. All faculty complete annual reports to document their teaching, research/scholarship, and service accomplishments and goals. The reports include items such as certification, teaching and course evaluation scores by the students, teaching development activities, awards and honors in teaching and research, grants and manuscripts, and service activities. The faculty annual reports are peer reviewed and scored by members of the FRAP committee and the Division Directors. The development and

33

achievement of annual goals, tracked by the annual reports, assist in maintenance of faculty excellence in teaching, research/scholarship and service and are used to determine salary increases when salary raise monies are available.

II-E.

When used by the program, preceptors, as an extension of faculty, are academically and

experientially qualified for their role in assisting in the achievement of the mission, goals, and expected student outcomes. Elaboration: The roles of preceptors in teaching, supervision, and student evaluation are clearly defined; congruent with the mission, goals, and expected student outcomes; and congruent with relevant professional nursing standards and guidelines. Preceptors have the expertise to support student achievement of expected learning outcomes. Preceptor performance expectations are clearly communicated to preceptors.

PROGRAM RESPONSE

UA Nursing Undergraduate and Graduate Programs benefit from use of preceptors as extensions of the faculty in facilitating learning outcome achievement by students. Preceptors have been used in the 1st Degree BSN Pathway course NURS486 and in the MS-NP and DNP Programs NP clinical management courses (NURS615 and 616) and internship/residency courses (NURS693). Dr. Sally J. Reel, Associate Dean, assisted by staff associates, is responsible for assuring the qualifications and expertise of preceptors. Currently, records are maintained for over 600 preceptors of whom 430 are participating in the graduate program (see Exhibits II-E-1 and II-E-2). Contracts between the preceptors assisting with graduate student education and the College are negotiated and obtained by Ms. Carol Mangold. Then, Ms. Lynda Rau, Staff Associate, verifies qualifications, credentials and insurance. Preceptors receive the relevant course syllabi, course and clinical objectives (student course outcomes), and preceptor and clinical faculty handbooks. The handbooks may be found in Exhibit II-E-1, in the Resource Room) and contain summaries of responsibilities and evaluation forms used by faculty, preceptors, and students. For the nurse practitioner programs, the role of the preceptor "as clinician and educator" includes directing the overall goals and objectives for the practicum experience, based on student outcome objectives provided by the student, and/or College faculty" (Preceptor & Clinical Faculty Handbook, p. 2). The preceptors stay in email contact with the clinical supervising faculty member and have instructions for contacting the clinical supervising faculty member, the course chair and Sally Reel, Director of the DNP Program. When the preceptor and clinical site are within 2 hours of driving time, on-site visits are made by College clinical supervising faculty according to the Distance Learning Policy (available in Exhibit II-E2 in the Resource Room). If the preceptor and clinical site are outside of the 2 hour driving area, the clinical supervising faculty member conducts a phone evaluation using clinically-focused conversations

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with students and preceptors. The clinical supervising faculty member also evaluates the preceptorstudent experience. Students submit weekly patient notes and assignments to faculty for assessment and evaluation. Students maintain a clinical log TYPHON, an electronic student tracking system. The TYPHON software program de-identifies patient/client information, but tracks and summarizes patient/client characteristics and demographics, procedure codes and time. The software program enables patient complexity and student decision-making to be quantified and measured. CON faculty use these data to evaluate student progress and progression in learning outcomes and the student-preceptor experience. Description of TYPHON. Each student has a unique password that enables data to be entered onto an encounter form. Encounter forms contain mandatory and optional pre-determined data fields. Approximately 20 mandatory data fields include assigned preceptor and clinic, amount of per-patient time and level of student involvement, patient demographics, ICD codes, CPT codes and medications associated with each encounter. Students may view any of their own encounters, or may view their own aggregated encounter data in a variety of ways, such as by specific class, encounter type or demographic type. Faculty may view specific encounters or aggregate encounter data for any (or all) students within their purview. TYPHON displays an on-going comparison of aggregate data to the required clinical hours of each specific course; aggregate data can additionally be displayed in spreadsheet or chart format. Faculty use specific and aggregate encounter data to assure that students are attaining the clinical practice portion of course objectives. An expected student learning outcome for each clinical course is to assess, diagnose, manage, monitor, and coordinate primary health acute and chronic health needs of clients over time and across the lifespan. TYPHON records help faculty monitor the complexity, ages, and diagnoses of clients cared for by the student. If the student is not seeing clients appropriate for learning needs (i.e. across the lifespan, complexity not appropriate for the level of the student, or the types of diagnoses are too narrow or inappropriate) clinical placements can be adjusted if needed to ensure students receive optimal clinical experiences to meet learning needs.

We have an outstanding pool of preceptors for both baccalaureate and graduate education programs. Excellent materials have been developed for preparing preceptors and tracking NP students. Within the past year, an identified area for improvement has been the lack of information on the total years of specialty practice by preceptors participating in the NP programs. This resulted in an action plan so that number of years in specialty is now requested and tracked. II-F. The parent institution and program provide and support an environment that encourages

faculty teaching, scholarship, service, and practice in keeping with the mission, goals, and expected faculty outcomes. Elaboration: Institutional support is available to promote faculty outcomes congruent with defined expectations of the faculty role and in support of the mission, goals, and expected student outcomes. For example:

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Faculty have opportunities for ongoing development in pedagogy. If research is an expected faculty outcome, the institution provides resources to support faculty research. If practice is an expected faculty outcome, opportunities are provided for faculty to maintain practice competence, and institutional support ensures that currency in clinical practice is maintained for faculty in roles which require it. If service is an expected faculty outcome, expected service is clearly defined and supported.

PROGRAM RESPONSE

The UA, AHSC and College provide and support an environment that encourages faculty teaching, research, and practice/service in keeping with the mission, goals and expected outcomes. Both the UA and College provide numerous opportunities for ongoing faculty development. First, annual travel funds to improve scholarship in teaching, research or practice/service are made available to all faculty members. In 2009-2010, for those with an FTE of 1.0, the dollar is $1,200 for assistant professors, $600 for associate and full professors, and $450 for clinical track faculty. For those with FTEs less than 1.0, the amount is prorated according to their percent time. Secondly, the University and College provide numerous seminars and training workshops that are designed to improve teaching, research and practice/service. A list of these appears in Exhibit II-F-1 in the Resource Room. Thirdly, the UA permits tenured faculty members to apply for sabbatical leaves to focus of research and/or improve teaching every six years. One semester of salary for sabbatical leave is covered by the University, and a second sabbatical term may be requested with grant or self-support if granted. During the study period, 5 faculty members were granted sabbatical leaves. Dr. Judith Effken, Professor, is an example of a faculty member who was on sabbatical leave and made excellent progress in her research plans during the self-study period. Dr. Effken was on sabbatical leave during the Summer and Fall semesters of 2006. During this time, she was able to focus on her research involving informatics and hospital systems. She was able to submit 4 papers on informatics-related topics and prepare a grant on the project entitled "DyNADS: A Dynamic Network Analysis Decision Support Tool for Nurse Managers", which was funded as an R01 by the NIH in 2007. In addition, she gave a plenary presentation, entitled "Philosophical Basis for Nursing Intuition" at the 10th International Philosophy Symposium in Dublin, IR. The College maintains a strong research environment for faculty members and students. A highlight research-related event during this self-study period was the College's 50th Anniversary Research Conference that featured podium presentations from internationally-renown leaders in Nursing including Drs. Ada Sue Hinshaw, Merle Mishel, Gayle Page, and Carmen Portillo.

The UA provides mechanisms for research support that includes small grant mechanisms, such as the Vice-President's Research Award, CCIT funds for innovation in teaching technology, and international travel funds to present research. The College makes research funds available through the Laurence B.

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Emmons Small grant mechanism (9 faculty members received Emmons Awards during the self-study period) and provided summer support to fund manuscript and grant writing. For new faculty joining the CON, start-up research funds are available. For example, when joining the clinical-track faculty in 2007, Dr. Donna Velasquez, was given funds to support her project entitled "Influence of GABRA6 polymorphism on cortisol in elderly nursing home residents reporting pain: a feasibility study". During the study period, the NIH NINR-sponsored Center for Injury Mechanisms and Related Responses within the College provided feasibility study funds for projects related to biological mechanisms that involved injury. Additionally, various Programs and Centers throughout the UA have calls for research funds and research opportunities. Additional information on research support (extramural and intramural) is available in Exhibit II-F-2 in the Resource Room. Community and professional service is a component of the defined workload statement each faculty member receives each academic year. The percent effort on faculty work statements is typically 20%. Service expectations are clearly delineated in the criteria for rank. Faculty members develop and work towards goals that are included in the annual reports required of all faculty.

STANDARD II SUMMARY

Strengths: · · · · Faculty members are highly qualified in education, research/scholarship and/or practice. Dean Joan Shaver is internationally known and a well recognized nursing leader in research and education. College and University physical and academic resources support the college mission. The College of Nursing ITG and computer and technology resources provide excellent support for online and on-site teaching needs and research/scholarship endeavors. Areas for Improvement: · · Increase faculty salaries. Continue to build a research base, particularly in extramural federal funding. Improve tracking of the specialty experience of NP preceptors.

·

· · ·

Action Plans: Explore innovative approaches to improve faculty salaries, to recruit and retain qualified faculty. Continue implementing faculty research career development strategies. Develop an efficient system of data collection for evaluation of NP preceptors.

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STANDARD III

PROGRAM QUALITY: CURRICULUM AND TEACHING-LEARNING PRACTICES

are congruent with expected individual student learning outcomes and expected aggregate student outcomes. The environment for teaching-learning fosters achievement of expected individual student learning outcomes.

T

he curriculum is developed in accordance with the mission, goals, and expected aggregate student outcomes and reflects professional nursing standards and guidelines and the needs and expectations of the community of interest. Teaching-learning practices

III-A. The curriculum is developed, implemented, and revised to reflect clear statements of expected individual student learning outcomes that are congruent with the program's mission, goals, and expected aggregate student outcomes. Elaboration: Curricular objectives (course, unit, and/or level objectives or competencies as identified by the program) provide clear statements of expected individual student learning outcomes. Expected individual student learning outcomes contribute to achievement of the mission, goals, and expected aggregate student outcomes.

PROGRAM RESPONSE

Programs for students at all levels of nursing education are based upon the appropriate AACN Essentials documents and reflect the College of Nursing (CON) Mission. Program development includes the integration of the content of the AACN Essentials documents into program outcomes and expected individual student learning outcomes. A brief historical background of the CON Programs is presented in the Introduction: Overview of the Program. The curriculum and teaching-learning practices for the BSN, MS, and DNP programs are presented in the following sections. Baccalaureate Program The baccalaureate program outcomes for the review period are based on The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 1998). The program outcomes were revised in 2009 to reflect the 2008 version of The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008). We have two pathways to achieve the baccalaureate program outcomes. The 1st Degree BSN Pathway curriculum is designed to meet the educational needs of students enrolled in courses toward earning their first academic degree. The 2 educational needs of students with a prior College degree. The current 1st Degree BSN Pathway curriculum was initiated in 1998 and is taught over five semesters. This pathway recently underwent revision to become an upper division, four semester curriculum. The first student group was admitted to this revised pathway in Fall 2009. The 2

nd nd

degree pathway is focused on meeting the

degree BSN Pathway

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curriculum was initiated in June 2003 and is taught over 14 continuous months, with an integrated approach to content and clinical practice. A sample curriculum for the nursing major in each pathway is in Appendix III-A-1a & b (1st Degree BSN Pathways, 06-09 and revised) and III-A-2 (2

nd

Degree BSN

Pathway).Course-specific expected individual student learning outcomes are congruent with the baccalaureate program outcomes. An example of the manner in which an expected individual learning outcome supports the 1st Degree BSN Pathway program outcomes is in NURS374 Nursing Care of Families Across the Lifespan. In this course, the expected individual student learning outcome "Use critical thinking, communication, assessment and technical skills to provide nursing care that promotes the health of mothers, infants and their families" supports the aggregate program outcome #3, "Use competencies of critical thinking, communication, assessment and technical skills to manage nursing care that promotes health to individuals, families, groups and communities in the context of their environment". Additional examples of how expected individual student learning outcomes support expected 1 and 2 Degree BSN Pathway program outcomes are provided in Appendix III-A-3. Our baccalaureate program outcomes recently underwent revision in response to the 2008 Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008). The program outcomes provide the foundation for the content in both pathways. The 1st Degree BSN Pathway curriculum revision was initiated in response to aggregate student evaluations and the University's focus on upper division majors in undergraduate programs leading to the completion of a baccalaureate degree in four years. This revision is based on the 2008 Essentials document and is in alignment with the revised baccalaureate program outcomes. The 2 curriculum revision. Faculty in the 2

nd nd st nd

degree BSN Pathway evaluation in 2006 guided minor

Degree BSN Pathway reviewed current expected individual student

learning outcomes in relation to the newly revised program outcomes. One example of a curricular change for both BSN pathways is the consistent integration of interdisciplinary education activities that include students from the Colleges of Medicine, Nursing, Pharmacy, Public Health, and Law. In the past three years topics covered in these educational activities have included inter-professional communication, cultural communication, CPR team activity, error reduction, and pandemic flu. Additional examples of course and pathway revisions in response to the 2008 The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008) are available in Exhibit III-A-1 in the Resource Room.

Master of Science (MS-NP) Program Currently, students are enrolled in our MS-NP program in the following advanced practice specialties: Psychiatric Mental Health (PMHNP), Adult (ANP), Family (FNP), Acute Care (ACNP). The Master of Science (MS) program outcomes are framed within the context of The Essentials of Master's Education for Advanced Practice Nursing (AACN 1996) and Criteria for Evaluation of Nurse Practitioner Programs (NTF, 2008) (Prior to publication of the revised NTF Criteria in 2008, the curriculum was framed by the 2002 NTF Criteria). The NP specialties were also designed to meet the competencies described in the following supplementary documents (hereafter referred to as "supplementary NP specialty documents"):

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· · ·

National Panel for Psychiatric Mental Health NP Competencies, (2003). Psychiatric-mental health nurse practitioner competencies. Washington, DC National Organization of Nurse Practitioner Faculties. Available online: http://www.nonpf.org/finalcomps03.pdf National Panel for Acute Care Nurse Practitioner Competencies, (2004). Acute care nurse practitioner competencies. Washington, DC: National Organization of Nurse Practitioner Faculties Available online: http://www.nonpf.org/ACNPcompsfinal20041.pdf

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U.S. Dept. of Health and Human Services. Health Resources and Services Administration, BrPH, Division of Nursing. (April, 2002). Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, Family, Gerontological, Pediatric and Women's Health. Available online: http://www.nonpf.org/finalaug2002.pdf.

We discontinued admissions into the Health Care Systems specialty in 2005 and discontinued admissions into the PMHNP and ANP specialties in 2008. The ANP and PMHNP specialties were discontinued in 2008 as a result of low enrollments and challenges in recruiting full-time faculty, especially in the PMHNP specialty given that academic salaries are not competitive with local industry salaries. The students currently enrolled in the ANP and PMHNP specialties are expected to finish their programs in 2010, therefore information related to these specialties is included in this Self Study. Curricula overviews for each specialty in the MS-NP program are in Appendix III-A-4 to III-A-7 or online at http://www.nursing.arizona.edu/academics.htm. Starting in Fall 2009, we discontinued the Master's program as a stand-alone program and the FNP and ACNP specialties are currently offered within the Doctor of Nursing Practice program (see DNP program below).

Expected individual student learning outcomes within our Master's program support the Master's program outcomes. An example of an expected individual student learning outcome that supports the Master's program outcome #3, which focuses on improving the equality, safety, and cost-effectiveness of the health of individuals, families and groups, is provided in NURS505 Health Policy, Finance, and Health Promotion. In this course, the expected individual student learning outcome is an application paper, in which students begin to design a health promotion program based on their individual interest, but one that is relevant to the leading health indicators in Healthy People 2010. The student must incorporate the knowledge and skill of advanced practice nurses in their health promotion design, identify what health care trends make their program important, and identify potential policy barriers.

Examples of students' application papers from this course and other Master's courses are in Exhibit III-A2 in the Resource Room. Additional examples of the manner in which expected individual student learning outcomes support the expected aggregate Master's program outcomes is in Appendix III-A-8.

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Doctorate of Nursing Practice (DNP) Program Admissions to The Doctorate of Nursing Practice (DNP) program began in Fall 2006. The first DNP student graduated in May 2009. We currently have 42 students enrolled, including 22 BSN-DNP (the majority focused on the FNP specialty followed by the ACNP), and 20 students entering at the master's level. The DNP is offered for students with baccalaureate preparation (BSN-DNP) and for two types of Master's prepared students: those who have obtained Master's level advanced practice certification and wish to obtain the DNP (MS-DNP) and those students with a Master's in nursing seeking a first or second advanced practice specialty and the DNP (MS-DNP with specialty). Because graduate degrees are required by all APN certifying bodies and by many state practice acts, including Arizona, students earn an MS from our University when they complete the coursework required for the MS degree. In addition, offering the MS degree facilitates transition from the MS to the DNP since several state nurse practice acts actually require the MS degree for licensure. In our College, the DNP is the primary degree or the program into which students are admitted, and the MS degree is considered a secondary degree. A historical overview of the DNP program development, implementation and curricular revisions is in Appendix III-A-9. Admissions into the ANP and PMHNP advanced practice specialties were discontinued in 2008. Sample curricula (2008 curricula are used as an example) from the DNP program from 2006-2009 are in Appendix III-A-10a-d (BSN-DNP) and Appendix III-A-11a-d (MS-DNP with specialty) and Appendix III-A-11e (MS-DNP). Additional sample curricula (2006-present) are available at: http:www.nursing.arizona.edu/academics.htm. Documents supporting DNP program development, implementation, and curriculum review and revisions (also described in III-G) are provided in Exhibit III-A-3 in the Resource Room.

The Doctorate of Nursing Practice (DNP) program outcomes are framed within the context of The Essentials of Master's Education for Advanced Practice Nursing (AACN 1996;, The Essentials of Doctoral Education for Advanced Nursing Practice (AACN 2006); the NONPF (2004) Acute care nurse practitioner competencies; the U.S. D.H.H.S. (2002) Nurse Practitioner Primary Care Competencies in Specialty Areas of Adult, Family, Gerontological, Pediatric and Women's Health; and Criteria for Evaluation of Nurse Practitioner Programs (NTF, 2008). The NP specialties were also designed to meet the competencies described in the supplementary NP specialty documents. Expected individual student learning outcomes in the DNP program support the expected aggregate DNP program outcomes. For example, DNP program outcome 1, "Generate and disseminate nursing practice knowledge to stimulate research and improve clinical outcomes," is supported by expected individual learning outcomes in NURS501 Advanced Physiology and Pathophysiology. An expected individual student learning outcome in this course is to synthesize knowledge related to a pathophysiologic phenomenon. The students complete a paper in which they identify a phenomenon from their nursing practice, critique original research articles on that phenomenon, and discuss findings in terms of

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meaningfulness and applicability to DNP practice. In another example, DNP program outcome 4, "Influence clinical practice transformation and policy initiatives" is supported by the following expected individual learning outcomes in NURS642 Health Policy and Economics. In this course, students assess and evaluate major contextual factors and policy triggers that influence health policy-making at the various governmental levels, analyze health policies from the perspective of consumers, nursing, and other health professions to improve health care outcomes, and translate knowledge necessary for analyzing and providing cost-effective health care in a variety of settings. These outcomes are achieved through online discussions and a group presentation of their policy assessments and evaluations. An example of the syllabi and student's papers/presentations from these courses and other DNP courses is in Exhibit III-A-4 in the Resource Room. Additional examples of the manner in which individual student learning outcomes support the expected aggregate DNP program outcomes is in Appendix III-A-8. III-B. Expected individual student learning outcomes are consistent with the roles for which the program is preparing its graduates. Curricula are developed, implemented, and revised to reflect relevant professional nursing standards and guidelines, which are clearly evident within the curriculum, expected individual student learning outcomes, and expected aggregate student outcomes. Baccalaureate program curricula incorporate The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008). Master's program curricula incorporate professional standards and guidelines as appropriate. a. All Master's programs incorporate the Graduate Core Curriculum of The Essentials of Master's Education for Advanced Practice Nursing (AACN, 1996) and additional relevant professional standards and guidelines as identified by the program. b. All Master's-level advanced practice nursing programs incorporate the Advanced Practice Nursing Core Curriculum of The Essentials of Master's Education for Advanced Practice Nursing (AACN, 1996). In addition, nurse practitioner programs incorporate Criteria for Evaluation of Nurse Practitioner Programs (NTF, 2008). Graduate-entry program curricula incorporate The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008) and appropriate graduate program standards and guidelines.

DNP program curricula incorporate professional standards and guidelines as appropriate. a. All DNP programs incorporate The Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006) and incorporate additional relevant professional standards and guidelines as identified by the program.

b. All DNP programs that prepare nurse practitioners also incorporate Criteria for

Evaluation of Nurse Practitioner Programs (NTF, 2008).

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Elaboration: Each degree program and specialty area incorporates professional nursing standards and guidelines relevant to that program/area. The program clearly demonstrates where and how content, knowledge, and skills required by identified sets of standards are incorporated into the curriculum. Advanced practice Master's programs (Clinical Nurse Specialist, Nurse Anesthesia, Nurse Midwife, and Nurse Practitioner) and DNP programs with a direct care focus incorporate separate graduate level courses in health/physical assessment, physiology/pathophysiology, and pharmacology. Additional content in these areas may be integrated as needed into specialty courses. Separate courses in physical assessment, physiology/pathophysiology, and pharmacology are not required by CCNE for students enrolled in post-Master's DNP programs who hold current national certification as advanced practice nurses, unless the program has deemed this necessary.

PROGRAM RESPONSE

The curricula are based on the 2008 Essentials for the Baccalaureate, Master's, and DNP programs. Program outcomes are based on the Essentials appropriate for the educational level. All expected individual student learning outcomes reflect these Essentials. In the following sections, the baccalaureate and the graduate (MS and DNP) programs are presented. Baccalaureate Program Appendix III-B-1 (AACN BSN Essentials 1998 and 1st Degree BSN Pathway Courses) and Appendix IIIB-2 (AACN BSN Essentials 1998 and 2

nd

Degree BSN Pathway Courses) describe in detail the

integration of course content specific to The Essentials, which served as the basis for curriculum development and evaluation. All course syllabi and course evaluation grids are in Exhibit III-B-1 in the Resource Room. Examples of course work reflecting the Essentials are also in the Resource Room.

In Fall 2009, baccalaureate program outcomes were revised to incorporate The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 2008). Additionally, expected individual student learning outcomes for all 1st Degree BSN Pathway courses were revised to reflect the 2008 Essentials. Expected individual student learning outcomes for all 2

nd

Degree baccalaureate courses

have either been reviewed and reflect the 2008 Essentials or are in final review in relation to the 2008 Essentials. Using the 2008 Essentials as a basis for curriculum content revisions has strengthened each pathway in its ability to prepare professional nurses for roles of provider of care, manager/coordinator of care, and as a contributing member of the profession.

MS-NP and DNP Programs The standards outlined in The Essentials (AACN 1996, AACN 2006), the NTF Criteria 2008, and relevant NONPF standards or certification guidelines for each advance practice subspecialty are incorporated into the MS-NP and DNP programs. Appendix III-B-3 provides evidence of how the MS-NP and MS-DNP

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programs meet the 2008 NTF Criteria. Appendix III-B-4a-m provide examples of how expected individual student learning outcomes for courses within the programs articulate with The Essentials and NONPF Specialty Competencies. Individual Course Evaluation Grids detail how expected individual student learning outcomes for the course articulate with The Essentials and are in Exhibit III-B-3 in the Resource Room. Individual course syllabi detailing the expected individual student learning outcomes can also be found in the Resource Room. Selected examples of the relationships between expected individual student learning outcomes and The Essentials are provided in the following paragraphs.

In our Master's program, expected individual student learning outcomes in NURS530 Methods in Nursing Research support the Essential related to Research. In this course, students are expected to describe the relevance of nursing research and clinical scholarship to nursing practice and theory. They utilize information systems (for the storage and retrieval of data) consistent with the particular population focus. Students analyze the strengths and weaknesses of different types of research designs and demonstrate understanding of the logical progression of steps in a research study and the interrelationships among the steps. In addition, they identify a clinical problem, demonstrate an understanding of the research related to this problem, critically analyze the problem and current knowledge, and develop a strategy for the incorporation of the research into the treatment regimen. Finally, students utilize new knowledge to analyze the outcomes of nursing interventions, to initiate change and to improve nursing practice.

In our DNP program, expected individual student learning outcomes in NURS620A support the Essential related to inter-professional collaboration to improve health outcomes. Students are expected to develop a plan of care that includes consultation and referral to other providers as appropriate and to incorporate interdisciplinary collaboration, referral, networking and resource use in providing culturally competent nurse practitioner care for families and /or individuals within families. In another example, NURS726 Theories of Health Promotion & Risk Reduction (an elective course that many DNP students elect) supports the Essential related to research and scientific underpinnings. Students are expected to discuss the relevance of health promotion and risk reduction theories to nursing science, and analyze interpersonal and community theories of health promotion and risk reduction. In addition they contrast individual, interpersonal and community theories of health promotion and risk reduction and synthesize selected literature to develop a theoretical basis for inquiry about health promotion or risk reduction. III-C. The curriculum is logically structured to achieve expected individual and aggregate student outcomes.

The baccalaureate curriculum builds upon a foundation of the arts, sciences, and humanities. Master's curricula build on a foundation comparable to baccalaureate level nursing knowledge.

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DNP curricula build on a baccalaureate and/or Master's foundation, depending on the level of entry of the student

Elaboration: Baccalaureate program faculty and students articulate how knowledge from courses in the arts, sciences, and humanities is incorporated into nursing practice. Post-baccalaureate entry programs in nursing incorporate the generalist knowledge common to baccalaureate nursing education as delineated in The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN,2008) as well as advanced course work.

PROGRAM RESPONSE

Our baccalaureate and graduate programs are logically structured in order to achieve expected individual and aggregate student outcomes and are described below. Baccalaureate Program Both of our baccalaureate pathways require a foundation of general education classes and specific prerequisites for nursing. Degree requirements include either the requirements for the Arizona General Education Curriculum or an earned baccalaureate degree. Appendix III-C-1 links BSN Courses and Prerequisites. Course syllabi, which contain course descriptions and prerequisite courses, are in Exhibit III-B-1 in the Resource Room. The 1st Degree BSN Pathway to the baccalaureate degree (2006-2009) is a five semester course of study that provides students with general nursing knowledge and skill development and incorporates the clinical nursing areas of adult medical-surgical nursing, family care, pediatrics, mental health, high acuity nursing, and community health nursing. Students in this pathway have an academic load of 11-13 credits in nursing per semester and may take additional credits to complete their University requirements. Each semester of this pathway provides foundational knowledge and skills for the next. A total of 120 credits, including 61 nursing credits, are required for graduation.

The first semester of the 1st Degree BSN Pathway builds a strong foundation for nursing practice and includes courses in pathophysiology, pharmacology, nursing inquiry, and clinical care. This knowledge builds upon the prerequisite coursework in biology, chemistry, microbiology, and anatomy and physiology. In addition, foundations in nursing practice are built upon general knowledge in arts, social science and humanities. The second semester incorporates the theoretical basis of nursing management of developing families and individuals with chronic illnesses, an overview of nursing role components, and nursing skill development across the lifespan. The third semester builds upon this knowledge and focuses on the care of children and adults with acute and chronic illnesses. The fourth semester focuses on the nursing management of complex populations with mental health and high acuity health care problems. The fifth semester focuses on synthesis and application of nursing knowledge to populations in community and acute care settings. During the fifth semester, students learn to apply leadership and management skills within a capstone clinical practice experience.

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One example of the linkage between general education and nursing science is the use of basic chemistry and physiology to understand pharmacologic treatments and human responses to them in a variety of clinical settings. The 1st Degree BSN Pathway curriculum uses a Clinical Preparation Tool that assists students to learn about individualized pharmacologic treatments for patients and specific indications and assessment for adverse responses. Examples of completed Tools for pediatric patients (3 semester) and adults with high acuity care needs (4 semester) is in Exhibit III-C-1 in the Resource Room.

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The 2

Degree Pathway to the baccalaureate degree is a four-level course of study (Levels I, II, III, IV)

over four semesters (two summer and two academic year semesters) in 14 months that provides students with general nursing knowledge and skill development and integrates nursing specialty areas that include geriatric nursing, adult medical-surgical nursing, obstetric and gynecological nursing, pediatric and family nursing, behavioral health, high acuity nursing, and leadership and management in acute care and community health nursing. Each level of this pathway provides foundational knowledge and skills for the next. Students in this pathway have an academic load of 10 to 16 credits in nursing per semester. A total of 120 credits are required for graduation, which includes 27 prerequisite credits, 40 transferable credits from a prior degree, and 53 nursing credits.

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The 2 Degree BSN Pathway reflects the 2008 Essentials for Baccalaureate Education for Professional Nursing Practice (2008) emphasis on generalist nursing practice, with integration of content on quality care, patient safety, scholarship, information management and technology, healthcare policy and finance, inter-professional collaboration, population health, and professionalism. An example of content on quality care and patient safety is in NURS468 Manager of Care: Concepts for Healthcare Delivery across the Care Continuum, with specific assignments relevant for public health nursing and for acute care nursing. An example of content on scholarship is in NURS462 Professional Nursing Forum II, in a class on "Evidence Based Practice: Using Research to Guide Practice". An example of content on information management and technology is in NURS467 Manager of Care: Nursing Assessment and Skill Development, in a class on "Nursing Informatics", about hospital data base systems. Content on healthcare policy and finance, for example, is found in NURS468 Manager of Care: Concepts for Healthcare Delivery across the Care Continuum, in components on "Health Care Finance: Public Health" and "Health Care Finance: Hospital Systems". Faculty address inter-professional collaboration through the interdisciplinary education activities mentioned above, didactic content throughout the curriculum, and in clinical post-conferences. Content on population health, for example, is in NURS468 Manager of Care: Concepts for Healthcare Delivery across the Care Continuum and NURS469: Manager of Care: Competencies for Health Care Delivery across the Care Continuum, where there is a major focus on population health, including application in the community health clinical rotation. Faculty address professionalism throughout the curriculum, beginning in Level I, in NURS347 Provider of Care I: Professional Nursing Forum I, with content on professional standards.

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MS-NP Program Admission to our MS-NP program was discontinued in Fall 2009. Because students are still enrolled in the MS-NP program, a description of this curriculum is included in this self-study. Our curriculum is logically structured to achieve expected individual and aggregate student learning outcomes and builds on a foundation of baccalaureate level nursing knowledge. Appendix III-C-2 details the articulation of the BSN and MS courses. Course syllabi, which contain course descriptions and prerequisite courses, is in Exhibit III-B-3 in the Resource Room and online at http://www.nursing.arizona.edu/academics.htm. Sample curriculum overviews for each advanced practice specialty in the MS-NP program can also be found at the same online site and in the Resource Room.

Each advanced practice specialty of our MS-NP program can be completed in four semesters (two years) of full time study. The minimal number of credits in the MS-NP program ranges from 40-43 credits depending on the specialty. The number of clinical hours in the MS-NP program ranges from 720-810 depending on the specialty. The MS-NP program includes courses in theory, methods, foundational science, clinical practice, and research. In each advanced practice specialty, the first semester curriculum builds a strong foundation for advanced nursing practice and includes courses in diversity and ethics, nursing conceptual models, advanced assessment and advanced physiology/pathophysiology. In the second semester, courses include research, health policy and finance health promotion, pharmacology, and the introductory courses to advanced clinical practice. The second semester courses provide the foundation for the second year courses, which include the second-tier advanced clinical practice courses, electives and the Master's report. All clinical courses are taken consecutively.

DNP Program Our DNP curriculum is logically structured to achieve expected individual and aggregate student outcomes. Course syllabi, containing course descriptions and prerequisite requirements are in Exhibit IIIB-3 in the Resource Room. The DNP curriculum builds on a baccalaureate and/or Master's foundation, depending on the level of entry of the student (e.g., post-baccalaureate or post-masters entry) and is described in Appendix III-C-3-4. Curriculum overviews for each advanced practice specialty in the DNP program (BSN-DNP and MS-DNP) are in Appendix III-A-10a-d and III-A-11a-e and online at http://www.nursing.arizona.edu/academics.htm. The Arizona Board Of Regents (ABOR) approved our DNP program as a full-time program. At the present time, the majority of students in our DNP program are enrolled in full time study.

Students enter the DNP program with preparation in nursing at the baccalaureate or Master's level. The DNP program curriculum is based on the DNP Essentials and prepares students at the highest level of nursing practice. Students gain foundational outcome competencies central to all advanced nursing practice roles, and preparation in specialty competencies, content and practice experiences needed for

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specialty practice. A particular strength of the DNP program at the University of Arizona is the integrative, innovative curriculum that ensures the academic preparation, described below.

The BSN to DNP curriculum may be completed in approximately 8 semesters (4 years) of full time study. For the baccalaureate student entering the program, 74-77 credits are required, depending on the advanced practice specialty. The first year course work includes advanced physiology/pathophysiology, diversity and ethics, conceptual models, health assessment, policy and finance, research methods, pharmacology, and the introductory course in advanced clinical practice. The second year course work builds on these foundational courses and includes advanced clinical practice courses. The third year includes advanced coursework builds on and synthesizes the foundational coursework and includes epidemiology, emerging diseases, advanced statistics, health care informatics, advanced methods in evidence-based practice, and DNP role. The last year includes elective coursework, quantitative methods and the Practice Inquiry.

The Master's to DNP student who is seeking an advanced practice specialty (MS-DNP with specialty) can complete the program in approximately 6 semesters (3 years) of full time study. A total of 71-74 credits are required, depending on the practice specialty. There are slight differences in coursework across specialties; typically the first year course work can include advanced physiology/pathophysiology, health assessment, pharmacology, statistics, and the introductory course in advanced clinical practice. The second year includes the advanced courses in clinical practice, evidence-based practice methods, electives and epidemiology. The third year coursework includes quantitative methods, health care informatics, emerging diseases, and the Practice Inquiry.

The Master's to DNP student not seeking an advanced practice specialty (MS-DNP) can complete the program in 4 semesters of full time study. A total of 43 units is required. The first year course work includes statistics, DNP role, emerging diseases/health trends/genetics, minor coursework, and evidence based practice. The second year courses include epidemiology, practice evaluation, informatics, quantitative methods and the Practice Inquiry.

In addition to the coursework described above, students in our DNP program (BSN-DNP and MS-DNP taking an advanced practice specialty) begin specific course work during the intensive Summer Experience (RISE). In year 1 RISE students begin coursework for NURS609a Health Assessment which includes an on-site clinical skills lab. In year 2 RISE students being coursework for NURS620b Advanced Primary Care of the Adult, NURS612 Pediatrics in Primary Care (in FNP specialty) or NURS616 Diagnosis and Management of Chronic and Acute Illness (in ACNP specialty), which include an on-site Clinical Skills Intensive (CSI) experience. All DNP students are required to attend RISE for the first three years of their DNP program. In addition to offering specific course-related work, RISE offers a unique,

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face-to-face, faculty-mentored learning experience held for a week each summer preceding the start of the academic year. RISE activities provide the framework for building mentored scholarly practice and knowledge translation, socialization with peers, and initiation or completion of specific course-related learning experiences. The activities in RISE include Research Think Tanks, faculty-advisor mentorship, student-advisory committee meetings, research poster sessions, and research and scholarly presentations by faculty, students and nationally known nurse leaders. Selected activities in RISE are specific to the level of student whether 1 , 2 , or 3 year student. For example, 1 year DNP students attend sessions that explore the DNP role, 2

nd st nd rd st

year students attend sessions in which they synthesize course work and identify

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the Practice Inquiry project, and 3 year students attend sessions that focus on the Practice Inquiry. RISE and CSI objectives and schedules are available in Exhibit III-C-2 and Exhibit III-C-3 respectively in the Resource Room. BSN to DNP students and MS to DNP students taking an NP specialty have specific course work in RISE. YR 01 = N609a Health Assessment; YR 02 = NURS 620b and NURS 616. III-D. Teaching-learning practices and environments support the achievement of expected individual student learning outcomes and aggregate student outcomes. Elaboration: Teaching-learning practices and environments (classroom, clinical, laboratory, simulation, and distance-education) support achievement of expected individual student learning outcomes identified in course, unit, and/or level objectives.

PROGRAM RESPONSE

The College of Nursing uses a wide variety of teaching-learning practices and environments to facilitate baccalaureate and graduate expected individual student learning outcomes. The following sections present the baccalaureate and graduate (MS and DNP) programs.

Baccalaureate Program Classroom experiences in both the 1 and 2 Degree BSN pathways include content delivered through traditional methods such as lectures, as well as case discussions, and small group discovery and application exercises. Additionally, faculty use course websites in the Desire 2 Learn (D2L) platform for web-based discussions, communication of essential content, turning in assignments, and evaluation of individual student written assignments. Faculty have also integrated use of new technology into the classroom setting such as using "clicker" technology that allows students to actively participate in knowledge application in the classroom and receive immediate feedback. Faculty incorporate practice NCLEX-RN® questions as content review and knowledge application exercises to solidify knowledge and assist students in knowledge application. Faculty also incorporate elements of the Kaplan Integrated Testing Program into courses to support student practice with content and question structure relevant for preparation for the NCLEX-RN® examination.

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The 1 and 2

st

nd

Degree BSN pathways use supervised clinical experiences across clinical areas and care

of patients across the lifespan. Supervised clinical experiences include the management of patients with acute and chronic illnesses, pediatric and geriatric patients, developing families, patients with high acuity care needs, and vulnerable populations that include frail elders and those requiring palliative care. Clinical experiences take place in a variety of settings, including acute care facilities, long term care, home care, outpatient clinics, community agencies, and community residential settings. The clinical sites for the baccalaureate program provide rich opportunities for clinical learning within the cultural context unique to southern Arizona.

Faculty tailor teaching-learning practices in the classroom to the level and type of learner in each BSN pathway. Faculty teaching students in the 1st Degree BSN Pathway use traditional teaching-learning practices early in the curriculum and assist students to transition into self-directed, independent learners. In the first semester, students learn content through lectures, video viewing and discussion, group learning exercises, and faculty-led learning experiences within the laboratory setting. In contrast, students in the fifth semester learn through the application of leadership principles within an individual clinical experience with a preceptor, interaction with community and professional groups, and student-led small and large group activities. Students in the 2

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Degree BSN Pathway have prior degrees and are

experienced learners. Faculty incorporate teaching-learning practices as in the 1st Degree BSN Pathway but with strategies for independent learning initiated early in Levels I and II. Both curricula integrate clinical nursing with the 2008 Essentials' conceptual basis. Students care for patients with increasingly complex conditions and experience increasingly intensive clinical immersion as part of their learning.

Faculty use clinical simulation to help students to achieve expected individual student learning outcomes. In clinical simulations, faculty integrate basic science principles with nursing science. One example of the use of clinical simulation is to provide students with a standardized multidimensional palliative care experience. High fidelity simulation is used to simulate a patient with terminal cancer with multiple symptoms who progresses through the dying process. Faculty- facilitated discussion focuses on principles of palliative care, legal and ethical issues at the end-of-life, family responses to end-of-life, the impact of culture and beliefs on end-of-life care, and personal experiences in holistic care at the end of life. Student responses to this simulation indicate that teaching and learning occur at the psychomotor, cognitive, and affective levels.

The final clinical experience in each BSN pathway introduces students to a real-world clinical nursing practice schedule through two to three 12 hour days per week for several weeks. Students experience full shifts while applying nursing knowledge and skills across patient cohorts, managing care of usually higher numbers of patients than in early semesters. The 12 hour shift experience gives students the opportunity to organize a full patient load and to begin to manage professional nursing practice at the novice level.

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Generally, students have positive responses to this "real-world" approach to learning and gain valuable insights into professional nursing practice roles.

MS-NP and DNP Programs A noted strength of our MS-NP and DNP programs is the innovative use of both online and on-site teaching-learning practices to support the achievement of student learning outcomes. In addition, the College's online teaching-learning practices provide access to high quality nursing education to students where they live and are most likely to practice. Master's courses have been delivered online since 2004 and the DNP course content has been delivered online since the program began in 2006. The online teaching environment is a particular strength of the graduate programs, as it is based on sound theoretical distance educational pedagogy. Our graduate programs use the Desire 2 Learn (D2L) platform. Of note is that our College of Nursing was one of only two University of Arizona Colleges that pioneered the Desire to Learn (D2L) online educational platform for their online graduate programs. As a result of the College of Nursing leadership and successes with online teaching, the University of Arizona adopted D2L as their distance education platform. Our online program was developed in partnership with the University's TRIAD technology team, which was funded by a state grant. The doctoral program was one of two University programs developed through a collaborative effort of faculty with this team, which included instructional designers, programmers, multimedia specialists, and an assessment specialist. The overall design of our online program is based on a variety of constructivist theories, but most predominately, on the Community of Inquiry Model.

The Community of Inquiry Model, described in a recent publication by College of Nursing Professor Judith Effken and colleagues (Journal of Asynchronous Learning Networks, Vol. 13, Issue 4, in press) suggests that the student's online educational experience can be enhanced by providing an environment in which social presence, cognitive presence, and teaching presence are optimized. Much of the coursework is accomplished through discussion, either in small groups or as an entire class with the faculty as a mentors and guides. Teaching presence describes the activities faculty engage in to design the course to facilitate the other two kinds of presence, but also describes the virtual presence of the faculty throughout the online course environment as they help students synthesize material within and across courses and practice experiences.

A specific example of this type of online teaching learning practice can be seen in a set of courses NURS736 Technology to Expand Healthcare Capacity, NURS737 US-Mexico Border Health Issues and NURS738 Translational Research, each of which uses which the Ecological Psychology Approach to Instructional Design (EPAID), all of which are based on a constructivist theoretical perspective. These courses are designed to engage students in real-world situations through multiple instructional techniques. For example, students work in dyads to solve a set of "challenges" and present their solutions

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to the class for feedback. The courses also feature an interactive course map, which shows course modules are linked. In two of the courses, clicking on the module takes students to the description of the challenge and then to the resources available to use during the challenge. The map allows students to quickly visualize the structure of the course and what is expected of them.

Additional online teaching learning practices in our MS-NP program include student engagement in both synchronous and asynchronous discussions as well as in interactive video sessions to clarify issues and to conduct final project presentations. In the DNP program, students use a variety of online teaching learning practices such as Skype, chat, texting, and discussion boards to communicate with each other and with faculty. Students often present narrated PowerPoint presentations to their cohorts then discuss these in an interactive video session. DNP students also successfully use videoconference software for committee meetings, oral examinations, and Practice Inquiry proposal defenses. DNP Practice Inquiry final defenses are video-streamed (transmitted in real-time) and are combined with a live online Q&A session so that distance students and audiences can participate in the defense. This successful use of technology has allowed students who live across the state, the nation and abroad to "virtually" be present with faculty, students, and audiences.

We provide significant technology support to students and faculty to ensure the achievement of expected individual student learning outcomes and aggregate student outcomes (also see Standard II). For example, support staff are available at all times (either from the University or from the College of Nursing) to problem-solve D2L issues, specific technology problems, assistance with preparation of PowerPoint presentations, and troubleshooting with interactive video and other media. In addition, support staff provide individual video recordings of students' teaching presentations done during RISE, and the media expert provides some of the instructional content related to audio-visual presentations. Students consistently provide highly positive evaluations of the technology support team. In addition, faculty development workshops related to principles of online education and to new technology-related educational approaches (e.g., Second Life) are provided by the College of Nursing technology team.

Teaching learning practices related to advanced clinical practice content in our and DNP programs occur in settings appropriate to the NP specialty. For all clinical experiences, students apply for clinical placement to the Office of Academic Practice (OAP) in the semester prior to the desired experience. We have been very successful in recruiting and orienting qualified nurse practitioner clinical preceptors. The OAP determines the appropriateness of preceptors and clinical sites to meet the expected learning objectives for the clinical course. Preceptors are selected based on a minimum of one year of full-time experience and 1) appropriate licensure as an MD or NP as required by the Arizona State Board of Nursing and 2) criteria described in NTF Criteria 2008. Realistically, until transition to the DNP is complete nationally, Master's prepared licensed and nationally certified NPs may serve as clinical preceptors for

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students until a significant cohort of DNP prepared NPs is available. Prior to students beginning their clinical experience, preceptors receive information about the specific clinical course in which the student is enrolled as well as the College guidelines for precepting. Clinical sites are selected that match the clinical learning experience to the course objectives. We currently contract with more than 200 clinical facilities and 322 preceptors. Many affiliates, including the University Medical Center and the Arizona Telemedicine Network, have received numerous national awards for excellence in clinical care in a variety of specialty areas. All clinical specialties are available and contracts are also in place with agencies that serve rural, border, tribal, minority and underserved populations. Distant students are placed in clinical sites near their home communities. The same rigor is applied for selecting preceptors and clinical agencies for distant students. Preceptors for distant students must be approved by faculty and must meet criteria to serve as a preceptor as defined by the Arizona State Board of Nursing and the NTF Criteria. The OAP manages preceptor and site contracts for the clinical experiences. Clinical placement and preceptor policies are available in Exhibit III-D-1 in the Resource Room.

One of the strengths of our DNP program is the emphasis on rural health. We have a significant history of funding from the U.S. Dept. of Health and Human Resources, Health Resources and Services Administration (HRSA), Division of Nursing for advanced education nursing projects. The goals of these projects include the reduction of health disparities through improved access by Arizona's rural and underserved populations. These funded projects include: 1. 2. 3. Rural Health for Advanced Practice Nurses Grant # 1D09 HP 00497 with Direct Costs of $840,573 for Budget Period 7/1/03 through 6/30/06; Distant Acute Care Nurse Practitioner: Bridging the Rural-Urban Gap Grant # D09HP05317 with Direct Costs of $ 954,132 for Budget Period 7/1/05 through 6/30/08; Distant ACNP & Palliative Care: Closing the Rural Urban Gap II Grant # D09HP05317 (competitive continuation) with Direct Costs of $582,827 for Budget Period 7/1/08 through 6/30/10; Rural Advanced Education in Arizona: The DNP Grant # D09HP07331 with Direct Costs of $1,083,570 for Budget Period 7/1/06 through 6/30/10.

4.

Teaching-learning practices concerning selection of clinical placements, have been significantly enhanced as a result of the HRSA funding. From Fall 2005 through Fall 2008, 69 nurse practitioner students were placed in rural and border areas as part of their clinical experiences. During this same period, a total of 22,855 rural visits provided by nurse practitioner students were recorded in our clinical reporting system (TYPHON). Additionally, current work locations have been identified for 59 NP students who graduated from June 2007 through August 2009; of these, eight (13.5%) currently work in a rural setting. In addition, online teaching learning practices improves the ability of rural communities to "grow their own" nursing workforce. This is significant, as research indicates that persons who come from rural areas are more likely to return to the rural area to practice. The college has a commitment to continue a rural health focus through funded efforts.

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In addition to the clinical hours required for the given advanced practice specialty in the MS-NP and DNP programs, students are required to attend a mandatory intensive on-site clinical skill session entitled "Clinical Skills Intensive (CSI)". CSI is included during RISE in the required on-site experience for NURS620b Advanced Primary Care of the Adult and NURS616 Diagnosis and Management of Chronic and Acute Illness. Students attend the 3-4 day CSI at the beginning of the second year of their program. The CSI includes high-fidelity simulation experiences, faculty-supervised assessments, and facultyfacilitated discussions. In addition, faculty instruction and demonstration, with student practice and return demonstration, is provided for clinical skills such as wound care for all NP students and airway management, lumbar puncture and tube thoracostomy for ACNP students. NONPF's (2002) Guidelines for Distance Learning in Nurse Practitioner Education specifically, NONPF's recommendations for clinical evaluations of nurse practitioner students guided the development of CSI. CSI schedules are found in Exhibit III-C-2 in the Resource Room.

All students in our DNP program complete a minimum of 1,000 hours of combined clinical and practice immersion hours as described in The DNP Essentials (AACN, 2006). Clinical and practice immersion hours are summarized in Appendix III-D-1. The BSN-DNP students or Master's students seeking a second advanced practice specialty achieve a total of 720 to 810 supervised direct patient care practice (clinical) hours depending on the NP specialty. MS-DNP students who already have advanced specialty certification do not take additional courses with direct patient care hours and receive a minimum of 500 practice immersion hours in our DNP program. Practice immersion activities are aligned with the NONPF advanced practice specialty competencies and are synthesized throughout the DNP courses. The relationships between the NONPF advanced specialty competencies and the DNP courses with practice immersion activities are described in Appendix III-D-2

An additional detailed description of practice immersion course activities is available in Exhibit III-D-2 in the Resource Room. As an example, practice immersion occurs in NURS753 Emerging Diseases and Population Health through assignments such as working in groups to 1) assess community preparedness for a disaster/ terrorist attack and prepare a critique of an existing preparedness plan and 2) prepare a course content outline for training nursing students to teach villagers in Kenya safe sex practices to prevent HIV infection. In NURS684 Neurology, Trauma, & Emergency Care students complete facultydesigned case studies by synthesizing history and physical examination findings and laboratory and diagnostic data in order to formulate an appropriate differential diagnosis and comprehensive management plan for selected critical acute health states. Practice Immersion is also achieved in NURS922 Practice Inquiry. The Practice Inquiry is the terminal, faculty-mentored learning experience that synthesizes knowledge at the highest level of practice. This practice immersion course is designed to prepare a graduate with the ability to carve out, synthesize and apply a distinct advanced practice knowledge domain. Thus far, two students have completed the Practice Inquiry and DNP program. One

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Practice Inquiry entitled "Project GENESIS: Community Assessment of a Rural Southeastern Arizona Border Community" has recently been accepted in the peer reviewed Journal of the American Academy of Nursing Practitioners. Additional examples of Practice Inquiry topics are provided in Appendix III-D-3.

III-E. The curriculum and teaching-learning practices consider the needs and expectations of the identified community of interest. Elaboration: Teaching-learning practices are appropriate to the student population and build on prior learning. Teaching-learning practices consider the needs of the program-identified community of interest (e.g., use of distance technology, simulation, adult learner needs, second language students).

PROGRAM RESPONSE

The teaching-learning practices of the BSN, MS-NP and DNP programs address the needs and expectations of the communities of interest, which include the internal community, i.e., students and faculty, and the external community, i.e., clinical institution and agency staff, preceptors, alumni, Advisory Board, and Tucson area community members.

Baccalaureate Program The teaching-learning practices throughout all levels of nursing education are carefully selected to match the learners in each pathway. Our BSN program uses a blend of face-to-face classroom experiences and course web support to deliver essential nursing content. The teaching-learning practices of the 1 and 2 Degree BSN pathways reflect the characteristics of the learners in each pathway. Faculty teach the 1st Degree BSN Pathway curriculum in a carefully planned step-wise approach paced according to traditional semester timeframes over 16 months. The curriculum builds on foundations of nursing knowledge, including pathophysiology, pharmacology, nursing inquiry and principles of professional nursing. Learners in this pathway are generally novice adult learners. Students are required to develop skills in knowledge acquisition and appropriate application, discipline-specific critical thinking, communication, selfevaluation, and quality improvement. One example of this is the use of a personal health promotion contract which is done in NURS263 Nursing Processes I. The purpose of this assignment is to illustrate the use of the nursing process in a personal way using social contracting and to examine an individualized approach to the promotion of health and wellness. Students conduct an in-depth, holistic self assessment, analyze data, set appropriate goals, develop a comprehensive plan for achieving these goals and evaluate the implementation of the plan. A sample of this assignment is in Exhibit III-E-1 in the Resource Room.

nd st nd

The 2 Degree BSN Pathway provides an integrated curriculum approach paced over 14 consecutive months for the experienced adult learner with a prior undergraduate degree. The 2

nd

Degree BSN

curriculum builds on the foundation of a prior College degree and prerequisites for the nursing major.

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Courses integrate the Essentials' concepts with clinical practice. For 2

nd

Degree BSN students through

the 2009 class, primary clinical sites for care of patients with acute and chronic illness are those of the Partner sponsoring each student. For 2009-2010 the Partners are University Medical Center, Tucson Medical Center, and Northwest Medical Center. For 2

nd

Degree Pathway community clinical experiences

such as pediatric nursing, the college has contracts with elementary schools, community pediatric clinics, community-based behavioral health agencies, and additional clinical facilities in Tucson and southern Arizona. (Exhibit III-E-1). An example of teaching-learning practices based on prior learning and appropriate for the 2

nd nd

Degree

BSN student population occurs in NURS469 Manager of Care: Competencies for Health Care Delivery across the Care Continuum, in the community health nursing clinical rotation. Because 2 Degree BSN

students have prior degrees and work experiences, many with community groups, faculty rely on rapid student assimilation of community assessment, interviewing techniques, ability to work in a group, and program planning, intervention, and evaluation. Students quickly assume interdependent responsibility for their community contacts and accomplish the goals of the community health nursing clinical experience in four intense weeks. In contrast, in the 1st Degree BSN Pathway, in NURS481: Communities: Health Experiences of Human Systems, the community health nursing experience occurs over 15 weeks, with close faculty initiation of students into the conceptual and clinical aspects of community health nursing. MS-NP and DNP Programs Our MS-NP program transitioned to online non-clinical course delivery and clinical course experiences in the student's home environment in 2004. This provided students across the State of Arizona and the US the flexibility to remain in their own environments, an important factor for nurses choosing to pursue an advanced practice Master's degree and who will likely work in their home environment when they complete their education.

As part of the preparation for a HRSA grant, a DNP Workforce Needs Assessment was conducted in 2005 to determine whether a potential student pool was available. Of the 6500 surveys mailed, 480 calls were received (7.4% response rate). This Workforce Needs Assessment is available in the Resource Room. The results of the survey indicated that nurses in the State of Arizona supported the need for a university-based program to prepare advanced practice nurses at the doctoral level. Subsequent to this survey, the DNP program at The University of Arizona was developed and implemented in 2006. The survey indicated that 24% of the respondents lived in rural areas, reflecting the population of our state, thus indicating a need for online education delivery. Building on the successes achieved in online teaching-learning practices in the existing PhD and MS-NP programs, this need was readily met. In addition to meeting the above needs, we have successfully met and continue to meet the technology needs of students and faculty who have diverse technology skills. The technology support in the graduate programs is described in detail in Standard II-B and Standard III-D.

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During the development and revisions of our graduate online programs, both students and faculty expressed a need for on-site learning experiences in addition to the need for online course offerings. As discussed previously (see IIID), the on-site teaching learning practices for DNP students (specifically, RISE and CSI) are integral to the success of the students in the graduate programs. Students and faculty evaluate these on-site learning experiences as extremely valuable (see III-G).

Thus, the graduate program's unique combined online and on-site teaching-learning practices clearly meet the needs of students and faculty. Online learning experiences based on sound distance-learning pedagogy provide unique academic enrichment to students that may be more difficult to achieve in a face-to-face setting. For example, when every student is expected to participate actively in a discussion conducted online, the breadth and depth of the discussion benefits from the increased level of participation. Because most discussions are conducted asynchronously, students have time to do the necessary reading, thinking, and synthesis that leads to an informed contribution. As a result, many faculty have commented that Master's student discussions are at the level of doctoral students, and those of doctoral students are much richer than they were when the class was conducted on site. Another benefit of the online learning environment is that the student community at the College of Nursing is geographically and culturally diverse, providing valuable socio-cultural enrichment to the programs. Students in the MS-NP and DNP programs hail from diverse geographical locations such as Alaska, Hawaii, California and New York and live and work in rural, border, and Native American communities.

III-F. Individual student performance is evaluated by the faculty and reflects achievement of expected individual student learning outcomes. Evaluation policies and procedures for individual student performance are defined and consistently applied. Elaboration: Evaluation of student performance is consistent with expected individual student learning outcomes. Grading criteria are clearly defined for each course, communicated to students, and applied consistently. There are processes by which the evaluation of individual student performance is communicated to students. Student performance is evaluated by faculty. In instances where preceptors facilitate students' clinical learning experiences, faculty may seek input from preceptors regarding student performance, but ultimately faculty are responsible for evaluation of individual student learning outcomes. The requirement for evaluation of student clinical performance by qualified faculty applies to all students, including those enrolled in post-Master's DNP programs. CCNE recognizes that faculty evaluation of student clinical performance may be accomplished through a variety of mechanisms.

PROGRAM RESPONSE

We have defined evaluation policies and procedures that are consistently applied in faculty evaluation of individual student performance, to reflect achievement of expected individual student learning outcomes. General grading criteria and student evaluation policies are defined and communicated to all students

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through online student handbooks and course syllabi. Each syllabus details specific grading criteria used for measuring the achievement of expected individual student learning outcomes. Expectations for clinical performance are carefully described for each student level of practice through detailed clinical performance objectives. Faculty use course-based evaluation of expected individual student learning outcomes and University-based course and teaching evaluation in the baccalaureate and graduate (MS and DNP) programs. Baccalaureate Program Faculty evaluation of expected individual student learning outcomes in our baccalaureate program incorporates multiple methods as evident in course syllabi. Student knowledge of the theoretical basis for specific nursing content is generally measured by NCLEX-RN® like testing methods. Clinical application of theoretical concepts is measured using several different methods. Faculty use detailed clinical performance evaluations to both communicate expected individual student learning outcomes and to evaluate clinical performance. Faculty in both BSN pathways evaluate achievement of expected individual student learning outcomes through a pass/fail system. Faculty conduct summative evaluations of select clinical competencies at critical points during clinical courses. Procedures for evaluation of student performance include critical behavior checklists and grading rubrics. Faculty develop these checklists and rubrics, and apply standards equally to all students in each course of the program.

Faculty meet with students periodically throughout a clinical rotation to discuss areas of strength and needed improvement and at the end of each clinical rotation for a summative evaluation, which is placed in the student record. Preceptor feedback is incorporated into the summative evaluation in NURS486 Coordinator of Care in Diverse Settings, which uses a preceptor approach. In addition, faculty use clinical papers and concept maps to assess students' ability to integrate key concepts in nursing, articulate knowledge in writing, and develop a comprehensive plan of care. Clinical competency evaluations are done at each level of learning and may include simple skill demonstration or demonstration of integration in a simulation experience.

Faculty evaluate students in each course using multiple methods, including written papers, multiple choice exams, skill demonstration, group projects, individual and group presentations, clinical journaling, care plan development, comprehensive clinical patient summaries. For example, in the 1st Degree BSN Pathway course NURS475 Care Provider in Complex Health Experiences, students write a clinical integration paper that provides an opportunity for demonstration of ability to use information from multiple sources to integrate pathophysiology, pharmacology and nursing science for the care of a specific patient with complex care needs. An example in the 2

nd

Degree BSN

pathway Level III course NURS465 Provider of Care III: Clinical Competency for Vulnerable Populations, an Oral Nursing Process Evaluation is used to evaluate students' application of the nursing process in a behavioral health setting. To meet achievement of expected individual student learning outcomes in

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NURS465, students address evaluation criteria on a client's health history, socio-cultural factors, treatment, assessment, nursing diagnoses, interventions, and evaluation plan.

In both BSN pathways, students who do not achieve expected individual student learning outcomes receive a Student Progress Report that serves as a written warning of unsatisfactory performance. This report facilitates the collaborative development of a plan by faculty and student for achievement of expected individual student learning outcomes for the specific course. This method gives students an opportunity to improve their performance to meet expected individual student learning outcomes and achieve a successful course outcome.

MS-NP and DNP Programs In our MS-NP and DNP programs, individual student performance is evaluated by the faculty and reflects achievement of expected individual student learning outcomes. Evaluation policies and procedures are consistently applied. For all courses in the graduate programs, evaluation policies and procedures are described in detail in each course syllabus. The syllabi for all courses are available in Exhibit III-B-3.

In reference to didactic content, students are evaluated with multiple methods including participation in discussions, journaling, concept papers, presentations, and examinations. For example, NURS646 Health Care and Information Systems, taken by both MS-NP and DNP students, employs a variety of evaluation metrics: Short papers are shared with peers for discussion and/or feedback and graded by the instructor; group discussions are graded for the quality of the postings and the degree to which they inform the discussion or stimulate further responses or questions; a group project is completed in which students select their own evaluation criteria then use those criteria to evaluate a health website (one of these was subsequently published); and a project is completed in which students work together in small groups to identify a need for technology, then develop a plan to obtain the technology, implement it, and evaluate it. Students present preliminary drafts of the project for critique by faculty and peers and then prepare a narrated PowerPoint presentation to stakeholders, an executive summary of the project, and a complete paper. Rubrics are provided for all projects (and discussion) so students have a clear idea of expectations.

For MS-NP and DNP student clinical performance, the College of Nursing faculty ultimately have direct responsibility to assure that learning experiences are appropriate for students and for evaluating student's progress and competencies. When possible, a minimum of one site visit per semester is conducted by the faculty member, and for more novice students additional visits are made if deemed necessary by faculty and/or preceptors. However, some students may be located in geographically remote from the College of Nursing site visits that make site visits impractical. Arizona is the 6 largest state and its geography impacts the feasibility of site visits; for example, because it is about 400 miles from Tucson in

th

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the south to Page at the northern border--an equivalence of distance from Washington DC to Boston. Where site visits are not feasible, communication among faculty, student and preceptor is essential and is performed by frequent telephone and email contact, with telephonic and formal written evaluations completed by the instructor twice per semester. Students are also formally evaluated by the clinical preceptor twice a semester and conduct informal evaluations with faculty as needed. Students submit weekly patient notes and course assignments to faculty for assessment and evaluation. Students maintain a clinical log through a unique electronic student tracking system, the TYPHON Student Tracking System (TYPHON). TYPHON, described in Standard II Key Element E, is a software program used to track patient encounters provided by Nurse Practitioner students who are enrolled in a clinical class.

DNP student progress is evaluated annually in the Fall semester by the Doctoral Program Committee with assistance from the Office of Academic Affairs (OAA), Graduate Advisor, who monitors submission and review of the students' annual reports. The DNP Student Annual Report includes program benchmarks such as dates of course completion, names of committee members and comprehensive exam completion. In addition, information such as awards, publications, and presentations is requested. An example of the DNP Student Annual Report is in Exhibit III-F-1 in the Resource Room. When students do not progress according to the Benchmarks for Satisfactory Progression published in the Graduate Student Handbook, http://www.nursing.arizona.edu/PDF/Graduate Student Handbook 2009 2011 v5.27.09.pdf the DPC, student advisor, and student address the situation to facilitate progress. III-G. Curriculum and teaching-learning practices are evaluated at regularly scheduled intervals to foster ongoing improvement. Elaboration: Faculty use data from faculty and student evaluation of teaching-learning practices to inform decisions that facilitate the achievement of individual student learning outcomes. Such evaluation activities may be formal or informal, formative or summative. Curriculum is regularly evaluated by faculty and other communities of interest as appropriate. Data from the evaluation of curriculum and teachinglearning practices are used to foster program improvement.

PROGRAM RESPONSE

Faculty evaluate curricula and teaching-learning practices of all academic programs on a regular basis.

Baccalaureate Program Baccalaureate program faculty evaluate pathway curricula and teaching learning practices in relation to their effectiveness in supporting student achievement of individual expected student learning outcomes. Faculty evaluate course content and teaching-learning practices for each course each semester, with a goal of ongoing quality improvement. The 1 and 2

st nd

Degree BSN Pathway faculty for each course

conduct formative and summative evaluation of their respective curricula each semester. Undergraduate

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Council meetings, held once a month, are open to all faculty who teach baccalaureate students and provide a forum to discuss evaluation as well as issues relevant for both pathways. The 1st Degree BSN Pathway faculty who co-teach a course meet weekly to discuss student-related issues, ongoing educational activities, and evaluation and revision of course activities for the future. In addition to the ongoing discussion among those who co-teach a course, 1st Degree BSN Pathway faculty meet as a group at least twice a semester for overall review of the curriculum. All 2

nd

Degree BSN

Pathway faculty meet regularly as a faculty group, usually about every two weeks during a semester, to evaluate progress of the semester's curriculum and teaching-learning practices and to plan revisions based on faculty and student feedback. At the end of each semester, the faculty meet as a group to evaluate all 2

nd

Degree BSN courses completed that semester and teaching- learning practices. All

faculty evaluate and plan the curriculum and teaching-learning practices for each pathway in conjunction with Division Directors, and the offices of Academic Affairs and the office of Student Affairs.

In 2008-2009, the 1st Degree BSN Pathway faculty and students identified several areas for improvement in the curriculum. These areas included but were not limited to increasing geriatric content, increasing focused practice through simulation, and increasing the pace of clinical learning to facilitate degree completion in four semesters. This pathway underwent a major revision that was implemented in the Fall 2009 semester. The curriculum revision features a four semester pathway of study in which students are immersed into professional nursing for 15­16 credits per semester. The revised curriculum is being phased in over four semesters, with the first class to graduate from this curriculum in Spring 2011. The revised curriculum integrates the 2008 Essentials for Baccalaureate Education for Professional Nursing Practice (2008), using a lifespan approach and the Essentials' emphasis on generalist nursing practice and principles of quality care, patient safety, scholarship, information management and technology, healthcare policy and finance, inter-professional collaboration, population health, and professionalism. Additionally, students will gain experience in clinical nursing practice areas that include health promotion and illness prevention, adult and pediatric acute and chronic care, family health and wellness, geriatric care, psychiatric mental health care, high acuity care, and community health. Most of these clinical areas were included in the previous curriculum and were identified by both faculty and students as strengths of the curriculum.

nd

The 2

Degree BSN Pathway evaluation completed in 2006 resulted in "Curriculum and Course/Teaching

Revisions" and "Programmatic Revisions" (Exhibit III-G-1 Summary Report 2006, in Resource Room). Regarding Curriculum and Course Revisions, the Summary Report recommendations included more emphasis on ethics and cultural diversity/sensitivity, which faculty subsequently implemented across Levels. Examples of increased emphasis on ethics are: Level II:NURS460 Provider of Care II: Nursing Assessment and Skills for Altered Health Conditions, interactive learning on legal and ethical issues and NURS462 Professional Nursing Forum II, emphasis on ethics in research, including completion of the

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Human Subjects Training (Collaborative Institutional Training Initiative (CITI) examination required for researchers, to enhance student comprehension of protection of human subjects in research. Additionally, 2 Degree BSN Pathway faculty incorporated emphasis on professional ethics in Levels I, II, III, and IV clinical courses, with specific emphasis on HIPAA. Examples of increase in emphasis on cultural diversity/sensitivity are: Level II, NURS460 incorporation of an inter-professional education experience on culture and communication, and Level III, NURS466 Provider of Care I: Nursing Forum III, emphasis on border crosser health and U. S.-Mexico border health. In clinical courses, faculty assign students to patients of diverse cultures and incorporate discussion of cultural diversity into clinical postconferences. In 2008 and 2009 Level IV in NURS469 Manager of Care: Competencies for Health Care Delivery across the Care Continuum, faculty incorporated a community health nursing clinical rotation in Nogales, AZ, on the U. S.-Mexico border.

nd nd

The 2

Degree BSN Pathway evaluation resulted in adjustments in scheduling. Students, faculty, and

agency partners supported decreasing the number of clinical placements per student so students would have more time in each clinical site and less site rotation. Consequently faculty revised clinical schedules. Students, faculty, and agency partners have expressed satisfaction with the new scheduling. Other scheduling changes occurred in response to recommendations for less concentration of Level III frontloading and implementation of 12 hour clinical days in Level IV NURS469, both of which produced a positive response. In response to other recommendations, faculty increased participatory teachinglearning practices and use of simulation and enhanced geriatric content. Faculty are reviewing expected individual student learning outcomes in relation to the 2008 Essentials document.

The University and College of Nursing use student ratings obtained with the Teacher-Course Evaluations (TCEs) (http://aer.arizona.edu/teaching/Guide/TCEGuide.asp) to improve teaching and document teaching performance. Faculty also informally request student input for quality improvement of each course through discussion with students and occasional written questions for student to express opinions on courses. Through the TCE system, students evaluate individual faculty teaching, faculty teaching teams, and courses and provide feedback on teaching-learning practices, assignments, clinical placements, and classroom experiences. One example of the value of TCE data was in the use of collective faculty data as an information source for curriculum revision. In NURS364 Nursing Processes II, clinical scheduling was adjusted to provide increased faculty supervision in skill acquisition practice in the SILC based on student feedback. In addition, faculty teaching in NURS475 Care Provider in Complex Health Care Experiences increased the use of clinical simulation as a method for clinical experience, peer critique, and practice improvement. Also, 1st Degree BSN Pathway faculty collaborated in a major revision of student-based Clinical Learning Tool that facilitates a consistent, step-wise approach to learning between levels of practice acquisition across the curriculum.

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Examples of 2 Degree BSN Pathway faculty use of TCE results and student informal feedback to revise curriculum and teaching learning practices are: Level III, NURS464 Provider of Care III: Concepts of Care for Vulnerable Populations, evaluation feedback confirmed the effectiveness of Software for Nurses case studies; NURS464, faculty revised a paper assignment, to a scholarly paper format rather than care plan; and Level IV, NURS469 Manager of Care: Competencies for Health Care Delivery Across the Care Continuum, based on TCE results, faculty changed a large report requiring many hours of computer work that limited work with community, to two smaller reports.

nd

MS-NP and DNP Programs Similar to the baccalaureate program faculty, graduate program faculty evaluate curricula and teachinglearning practices in relation to their effectiveness in supporting student achievement of expected individual student learning outcomes. During the review period, faculty as a whole evaluated curricula and teaching-learning practices through the work of the Graduate Forums and the Doctoral Program Committee (DPC). Graduate Forums were convened as needed by the Associate Dean of Academic Affairs or the DPC, and involved informal discussions open to all graduate faculty. Issues raised in Graduate Forums were discussed in the DPC, which met bi-monthly. As needed, curricular and/or teaching-learning issues were brought by the DPC to the entire faculty for discussion and vote. In addition, as part of the HRSA grant evaluation process, the DNP curriculum was evaluated by external reviewers in 2007 (Appendix III-A9 and External Reviewer Summaries in Exhibit IIIA-3 in the Resource Room). The DPC, Graduate Forums and the external reviewers identified the following areas for improvement in the MS-NP and DNP programs:

1.

There was a gap in the provision of evaluation methodology content in NURS752 (Patient Safety and Quality Management and Evaluation Methodologies).

2.

The statistics courses (NURS630 and NURS631) required re-sequencing to ensure sequential knowledge building.

3.

Documentation was needed to demonstrate that all DNP essential competencies were addressed in the curriculum. The original curriculum was written as the Essentials document was being developed and we admitted students prior to the publication of the final draft of the Essentials in October 2006).

In response, the following curricular revisions were made:

1. 2. 3.

Content in NURS752 was substantially revised to include evaluation methods Statistics courses were re-sequenced (NURS630 to Fall and NURS631 to Spring) Course evaluation grids across the DNP program were completed to document that the DNP essential competencies were addressed. Course grids are in the Resource Room (Exhibit III-B-3) Master's and DNP Program course syllabi and course evaluation grids

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In addition, NP faculty responsible for advanced practice specialty courses meet regularly, typically about twice a semester, to evaluate progress and plan revisions based on faculty and student feedback. For example, in 2006 the content selected for CSI was based, in part, on NP faculty input about the clinical skills/procedures that required faculty instruction and demonstration and student practice and return demonstration, such as central venous catheter insertion for ACNP students and suturing and chest radiograph and ECG interpretation for all NP students.

Individual graduate faculty also conduct formative and summative evaluations of course content and teaching-learning practices for each course each semester for ongoing quality improvement. These evaluations occur through Teacher Course Evaluations (TCEs) and through surveys collected during the on-campus CSI and RISE sessions. TCEs are used in the graduate program in the same manner as described above in the baccalaureate program. Examples of TCEs that resulted in positive changes in teaching learning practices include: 1. NURS726 Theory of Health Promotion and Risk Reduction: In response to student requests for discrete guidelines for evaluating theory, the module was strengthened on theory analysis by providing critical readings on theoretical substruction and activities that include a newly developed PowerPoint lecture on Theory, Concepts, and Relationships as well as an activity for students to develop three concepts of interest for their Project Inquiry and its corresponding propositions; 2. NURS615 "Diagnosis and Management of Chronic and Acute Illness": In response to student requests to increase live instruction for specific clinical content, faculty provided multiple links to University of Arizona clinical department Grand Round and webcast presentations; and 3. NURS730 "Quantitative Methods in Clinical Nursing Research": In response to student need to develop skills to critique research, the faculty developed an activity to critique three practice-based research articles in reference to both the methods used and interpretation of results given strength of the evidence. One example of the value of the CSI survey data was in the presentation of radiology content. Students rated highly the chest and extremity radiology seminars; they commented that an additional lecture on radiology test selection would be useful. Based on those comments a "What Test Do I Order?" seminar was developed. Based on student evaluation comments, the seminars have been scheduled so that the basic chest radiology seminar (which covers basic radiology concepts) is held prior to this new seminar and all radiology seminars have been revised to make them more interactive. CSI surveys are available in Exhibit III-G-2 in the Resource Room.

A striking finding from the RISE surveys is the number of hours that students work outside the DNP program. In 2008, students reported that they worked approximately 40 hours/week and in 2009, approximately 32 hours/week. This finding has led the DPC and administrative team to add a part-time study option beginning in Spring 2010. Individual comments in the RISE evaluations also identified potential areas for improvement within the DNP program. Students indicated a need for additional clinical

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courses related to NP specialties, fewer non-clinical courses in general, a different curriculum for new graduate BSNs vs. experienced MS prepared NPs, and better articulation of the differences and similarities between the DNP and PhD programs.To address this last concern, a new course, NURS 695a "The Science and Practice of Nursing," was developed and implemented in the summer RISE 2009. This course brought all new doctoral students together and focused on the current state of nursing science and the College's program goals and expectations for both DNP and PhD prepared nurses. The course received excellent evaluations.

Another important change in the curriculum was implemented in Fall 2009. As the initial cohorts of students progressed toward their Practice Inquiry, it became apparent to faculty working with them that they were having difficulty applying theory and developing their research methodology. Based on this, DPC proposed and faculty agreed to modify the curriculum and reverse the ordering of some course to include theory and methods courses earlier in the curriculum to better equip students with conceptual tools needed to connect theory, research, scholarship and practice. This revision also enabled students to apply foundational knowledge in subsequent courses and integrate this learning in work toward their Practice Inquiry. The 2010 DNP curriculum is in Exhibit III-G-3 in the Resource Room and online at http://www.nursing.arizona.edu/academics.htm. The DPC is currently planning to formally evaluate the additional concerns voiced by students. The RISE survey data also identified several strengths of the DNP program and the online teaching learning practice receives consistent positive feedback that: 1. Faculty expertise is strong; 2. Faculty-student interactions and mentoring are strengths; and 3. Course rigor is very good. RISE surveys are available as Exhibit III-G-4 in the Resource Room.

STANDARD III SUMMMARY

Strengths: · · The baccalaureate and graduate curricula are well defined and are specifically designed to meet the needs of our community of interest. We are leaders in innovative teaching-learning practices and environments that support the expected aggregate and expected individual student-learning outcomes. Areas for Improvement: · · Student engagement and a sense of community can be strengthened within those teaching learning practices that are technology-rich. Faculty-faculty and faculty-student communication of program and expected individual student outcomes relative to our new and rapidly evolving curricula can be improved. Action Plan: · Continue to develop and implement plans to foster student engagement and a sense of academic community within those teaching learning practices that are predominately technology-driven.

·

Develop and implement specific plans to enhance communication of program and individual student outcomes among faculty and students.

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STANDARD IV

PROGRAM EFFECTIVENESS: AGGREGATE STUDENT AND FACULTY OUTCOMES

accomplishments of graduates of the program attest to the effectiveness of the program. Actual aggregate faculty outcomes are consistent with the mission, goals, and expected faculty outcomes. Data on program effectiveness are used to foster ongoing program improvement. IV-A. Surveys and other data sources are used to collect information about student,

®

T

he program is effective in fulfilling its mission, goals, and expected aggregate student and faculty outcomes. Actual aggregate student outcomes are consistent with the mission, goals, and expected student outcomes. Actual alumni satisfaction data and the

alumni, and employer satisfaction and demonstrated achievements of graduates. Collected data include, but are not limited to, graduation rates, NCLEX-RN pass rates, certification examination pass rates, and employment rates, as appropriate. Elaboration: Processes are in place for regular collection of aggregate student outcome data. For entrylevel programs, the program indicates whether NCLEX-RN® pass rate data represent first time takers and/or repeat takers. The program is expected to demonstrate how RN-to baccalaureate program graduates as well as pre-licensure graduates achieve the expected outcomes of the baccalaureate program. Certification pass rates are obtained and reported for those graduates taking each examination, even when national certification is not required to practice in a particular state. Program evaluation data are collected on a regular basis. For each degree program, the program calculates graduation rates (number of students completing a program divided by number of students entering a program). The program specifies the entry point and the time frame used in the calculation of graduation rates. Individual programs may collect additional aggregate outcome data related to other aspects of their mission, goals, and expected student outcomes (e.g., enrollment in further graduate education).

PROGRAM RESPONSE

The College of Nursing regularly and systematically collects aggregate student, alumni and employer data to evaluate programmatic effectiveness based on the University and College missions, goals, and strategic action plans as well as program-specific outcomes identified in Standard I Key Element I-A. Data are collected to provide evidence of student, alumni, and employer satisfaction as well as achievements of program graduates and faculty. Data collection methods include student and alumni surveys, employment satisfaction surveys, licensure and certification examination results (NCLEX-RN® and certification), graduation rates, time-to-completion data, student progression data, employment rates, graduate employment demographic data, and doctoral student and faculty annual reports. Appendix IV-A-1 links evaluation methods and metrics for each

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program with the responsible College entity and the interval/timeline for the data collection processes. Copies of each data collection instrument can be found in Exhibit IV-A-1 in the Resource Room. The processes used to collect data collected from evaluative surveys across all programs will be described in this key element. Surveys across all of our programs are conducted using an online format. Responses are captured into Access databases on a secure CON server and are then imported into SPSS for analysis and report generation by designated research specialists in the Office of Nursing Research. Qualitative data are imported into Excel or Word files for content analysis. Baccalaureate Program Student Satisfaction To evaluate student satisfaction of the entry-level BSN students (1 and 2

st nd

Degree Pathways),processes

and data sources are used as noted in Appendix IV-A-1. At the end of each semester, all current BSN students are encouraged to evaluate their progress towards achievement of program outcomes and comment on issues, trends and/or problems with the program. Students respond to a number of questions related to satisfaction with clinical experiences, resources, and quality of the BSN program. In addition, students are asked to identify what learning experiences were particularly valuable, to identify suggested program improvements, and to provide additional comments for program improvement. To evaluate satisfaction with clinical preceptor experiences, the 1st Degree BSN Pathway students are surveyed at the end of their senior preceptorship. Their RN preceptors are also surveyed regarding their satisfaction with the preceptored experience. Alumni Satisfaction Data are collected from BSN alumni one year post-graduation. Alumni complete an online survey accessed through the CON website, http://www.nursing.arizona.edu/StudentSurveys.htm. Alumni are asked to respond to a number of questions related to their satisfaction with how well they were prepared to perform in the professional nursing role. In addition, alumni are asked to identify their satisfaction with the overall quality of the BSN program, and provide additional comments for program improvement. Data are also collected on various professional activities achieved since graduation. Employer Satisfaction Employers are surveyed about their satisfaction with and opinions about the competencies of employed graduates about one year after graduation of the employee. Employers also are asked to identify the strengths and weaknesses of the BSN program for program improvement. Achievements of Graduates Graduation Rates and On-Time Degree Completion Rates: The Office of Student Affairs (OSA) maintains student records and calculates these rates annually for baccalaureate students. NCLEX-RN® First-time Pass Rates: Aggregate data are reported quarterly to the CON by the Arizona State Board of Nursing as numbers of candidates passing the exam on the first attempt divided by the

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total number candidates that were examined. Findings are used by faculty and administrative units for program improvement in both pathways within the BSN program. Employment Rates: Employment rates for BSN graduates are difficult to obtain at the time of graduation. However, when data are available, the Office of Academic Practice (OAP) and the OSA calculate employment rates within the first year of graduation. These are determined by identifying the number of graduates employed one year post-graduation divided by the total number of baccalaureate graduates annually in each pathway. Academic Distinction of Graduates: Additional achievements of BSN graduates, such as inductions into Phi Kappa Phi and Sigma Theta Tau International and those graduating with Honors from the Honors College, are collected at time of graduation These data are updated through alumni surveys and student data by pathway for each graduating student cohort are reported using descriptive statistics (total N and percentage of graduating class). Graduate Programs (MS and DNP) Evaluation of the Graduate Programs (Masters with NP option and DNP with multiple pathways) is conducted using similar data collection methods and processes to those described above. Because the Doctor of Nurse Practice Program (DNP) is a new program that has only graduated two (2) students, evaluation of the DNP program has been formative to date although summative evaluation strategies (i.e., program effectiveness) have been identified since the program's inception ( See Exhibit IV-A-2 in the Resource Room). Student Satisfaction (MS-NP Option Program) At the end of each semester, all students enrolled in the MS-NP program are asked to participate in an online student survey (accessed through http://www.nursing.arizona.edu/StudentSurveys.htm) to evaluate their achievement of program outcomes as they progress across the curriculum, satisfaction with academic and clinical experiences, satisfaction and effectiveness of CON/academic resources, and the overall quality of the MS-NP program. Student Satisfaction (DNP Program) From 2006 through Spring semester 2009, all students in the DNP program participated in the online student survey (accessed through http://www.nursing.arizona.edu/StudentSurveys.htm) to evaluate their achievement of program outcomes as they progressed across the curriculum, satisfaction with academic and clinical experiences (as appropriate), satisfaction and effectiveness of CON resources, and the overall quality of the DNP program. In August, 2009, the Doctoral Program Committee (DPC), which has oversight responsibility for doctoral curriculum development and evaluation as well as student and faculty program evaluation, moved to an annual evaluation process for all DNP students (student satisfaction surveys and annual student reports) based on: (a) feedback from students that they felt burdened by the ongoing evaluation processes and (b) decreasing participation rates (100% to 55.5%).

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The student satisfaction survey is administered via SurveyMonkey. Students are sent a request by the OSA to participate in the annual DNP evaluation and to submit their annual student report. Students are provided the SurveyMonkey access URL via the CON email system. Once students access SurveyMonkey and participate in the survey, data are deposited into a deidentified online database that is accessed by doctoral program faculty or staff support personnel who compile the results. Alumni Satisfaction (MS-NP Option Program) Data from alumni (at 1 year post graduation) are used to evaluate the programmatic effectiveness in preparing graduates to function in today's health care system in advanced nursing roles. Alumni complete an online survey accessed through the CON website, (http://www.nursing.arizona.edu/StudentSurveys.htm) and are asked to rate their ability to function as a nurse practitioner, perform advanced nursing skills and procedures, utilize and disseminate research findings, and collaborate in an interdisciplinary team. Alumni are also queried about certification rates, participation in professional activities (memberships, offices held, awards, publications, and presentations), enrollment in doctoral programs, as well as program satisfaction information. Alumni Satisfaction (DNP Program) Although no alumni surveys have yet been conducted for the DNP, our plan is to implement the alumni survey process in Spring 2012 once the pool of DNP alumni has reached a sufficient size (n>5). DNP alumni will be surveyed at 1 and 3 years post-graduation about program satisfaction and employment, and at 1, 3 and 5 years post-graduation about achievement of professional outcomes. Employer Satisfaction (MS-NP Option Program) Employer/Mentor satisfaction is surveyed one year post-graduation to evaluate satisfaction with program graduates and their ability to function in the advanced practice role. Alumni responding to the alumni satisfaction survey are asked to provide the name and contact information for their supervisor/mentor. The employer/mentor is sent a survey through email and asked to respond to an online survey, which can be viewed at (http://www.nursing.arizona.edu/EmployEval.htm). Employer Satisfaction (DNP Program) Although data have not yet been collected from employers of DNP graduates, the plan is to interview selected employers on-site or by telephone identified by alumni responding to the 1-year post graduation survey. Achievement of Graduates Graduate student achievements are evaluated in several ways. Some data distinguish outcomes for the MS-NP and DNP programs; other data are aggregated across all graduate programs. Some data are aggregated because reporting agencies do not distinguish between these students. For example, the same certification examinations are taken by students in the MS with NP option and DNP programs (BSN-DNP and MS with NP option pathways). Scores are provided by the certifying agencies for all UA students, without specifying the certificant's academic program.

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Time Enrolled to Graduation (MS and DNP Programs): Time to graduation data are collected and reported by the OSA in annual reports to administrative units within the CON and the University. Data are reported in total number of years to graduation for students in a particular cohort, based on their admission date. Nurse Practitioner Certification Pass Rates (MS and DNP Programs): Three student cohorts are eligible to take national nurse practitioner specialty certification examinations. The MS-NP option graduates are eligible to take the following examinations: 1. FNP examination offered by either the American Nurses Credentialing Center or the American Academy of Nurse Practitioners (Family Nurse Practitioner option); 2. ANP examination offered by either the American Nurses Credentialing Center or the American Academy of Nurse Practitioners (Adult Nurse Practitioner option); 3. Adult ACNP examination offered by American Nurses Credentialing Center (Adult Acute Care Nurse Practitioner option); and 4. Adult PMHNP examination offered by the American Nurses Credentialing Center (Adult Psychiatric Mental Health Nurse Practitioner option). Students in the BSN-DNP pathway and MS-DNP with NP option pathway must pass their specialty certification examination as one of the comprehensive examinations required for graduation. We receive data annually in aggregate (i.e., for all graduates of the UA program ­ either MS or DNP) from the American Nurses Credentialing Center and the American Academy of Nurse Practitioners. Aggregate percent pass rates (candidates passing divided by candidates sitting for the exam) are reported for all UA graduates, if more than six candidates take the exam. For examinations with fewer candidates, scores are not reported. These data are used to evaluate the MS-NP and DNP programs' effectiveness in preparing graduates to serve as advanced practice nurses and the effectiveness of core NP courses that are taken by both MS-NP and DNP students. Individual certification results are also used to monitor DNP student progression toward graduation and as a formative evaluation strategy to assess the program's processes, requirements, and identified benchmarks. Employment Data (MS and DNP Programs): Employment data for the graduate programs are collected by three mechanisms: (a) graduates self-report employment on the alumni survey; (b) OSA monitors employment after graduation by students whose education has been supported by federal traineeships; and (c) OAP identifies employment by telephonic interviews with graduates from the MS-NP Option Program. These mechanisms provide data for different purposes. The alumni data are collected and analyzed by program type (MS, DNP) and document the percentage of respondents who report employment (full-time or part-time) within 1 year of graduation. Traineeship data are collected and analyzed by MS-NP and Doctoral (PhD, DNP) program type, as required by HRSA to report the number of graduates working in various types of health care facilities. Clinical placement of NP graduate data collected by the OCP are used in reports submitted to the Arizona State Board of Nursing and the

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University of Arizona administration documenting contributions of the CON to the primary care provider pool for the state of Arizona. Professional Achievements of Graduates (MS and DNP Programs): Professional achievements, including publications, presentations, scholarly activities, service/leadership positions, and funding/support of MSNP program graduates are also collected during the alumni survey. Achievements of DNP graduates (elements similar to above) will be collected from curriculum vitae that will be submitted at the time of the alumni survey at 1, 3, and 5 years post-graduation.

Additional Formative Evaluation Strategies Used by the DNP Program Additional evaluation strategies have been used by the faculty to evaluate the DNP program to document program effectiveness and achievements of students. Aggregate Student Retention: Retention data for the DNP program by student cohort (Summer 20062009) are continuously monitored via reports that are assessed by the DPC and DNP program director. Frequency data for each pathway list the number of students who were admitted, enrolled, withdrew, and continue to enroll/progress. These data have been followed carefully through the DNP-nascent period as indicators of satisfaction with the program. Aggregate Student Progression: OSA personnel prepare aggregate reports that summarize student progression data for the DPC and the DNP program director each semester. These data summarize progression toward and achievement of program milestones by each student cohort using descriptive statistics (frequencies, percentages). The percentage of students failing to progress are used as potential indicators of deficiencies and used in ongoing analyses to determine whether the causes are attributable to individuals or the program. DNP Student Outcomes: All DNP students submit annual student reports in August as a summary of academic progression and professional accomplishment markers (e.g., participation in professional meetings, dissemination activities, professional leadership positions, funding, honors and awards). Each Fall semester, the DPC examines these individual reports and uses aggregate results to evaluate program effectiveness. Students are requested via CON email to update their online annual report through the College intranet. Individual student reports can be monitored by advisors, all graduate faculty, and College administrators. Aggregate data are compiled from a CON online database that can be accessed by DPC members, OSA, OAP, and the DNP program director. https://osa.nursing.arizona.edu/DNPAR/DNPReportsCCNE.asp IV-B. Aggregate student outcome data are analyzed and compared with expected student

outcomes. Elaboration: Actual student outcomes data are analyzed in relation to expected student outcomes to identify areas of discrepancies. Discrepancies may indicate areas for program improvement.

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PROGRAM RESPONSE

Methods used to analyze evaluation data vary by metric and method. Therefore, responses to this section will be reported by program (baccalaureate and graduate­MS and DNP) and measure. When there were fewer than 5 respondents, data are not reported. Baccalaureate Program Student Satisfaction Summative evaluation data are reported using descriptive statistics (score range, mean, and standard deviation). A 5-point Likert-type scale is used with responses ranging from 1-not at all satisfied to 5-very well satisfied, with scores of three or less considered problematic. Responses to open-ended questions are categorized using content analysis and reported by category, with exemplar statements using the raw data. Survey outcomes have been included in an overall report to the Dean for dissemination to the faculty. Benchmarks for this survey are internally determined by the faculty and are dependent upon the measurement scale for each item, which on a 5-point scale is at least at 3.0 Senior BSN students in their last semester of study, of both pathways, reported high satisfaction with the overall quality of the CON BSN Program. Program satisfaction scores from students in their last semester within the 1st Degree BSN Pathway (see Table IV-B-1), ranged from 3.62 to 4.06 out of 5 possible, exceeding the expected outcome of 3.0. Program satisfaction scores from students in their last semester within the 2 Degree BSN Pathway, ranged from 3.56 to 3.88, exceeding the expected outcome of 3.0. Table IV-B-1 BSN Program Student Satisfaction Outcomes: 2006-2009 Question Expected Outcome Fall 2006 Mean (SD) Range N 1st Degree BSN Pathway 3.70(0.5) 3-4 10 2 Degree N=<5

nd nd

On a scale of 1-5 (1=not satisfied at all; 5=very satisfied), how satisfied are you with the overall quality of the CON BSN Program?

>3.0

Spr 2007 Mean (SD) Range N 1st Degree BSN Pathway 3.62(1.3) 1-5 8 2 Degree N=<5

nd

Fall 2007 Mean (SD) Range N 1st Degree BSN Pathway 3.82(0.9) 2-5 11 2 Degree No Data Available

nd

Spr 2008 Mean (SD) Range N 1st Degree BSN Pathway 4.00(0.8) 2-5 18 2 Degree 3.88(0.8) 2-5 24

nd

Fall 2008 Mean (SD) Range N 1st Degree BSN Pathway 4.06(1.1) 1-5 16 2 Degree 3.64(1.0) 1-5 28

nd

Spr 2009 Mean (SD) Range N 1st Degree BSN Pathway 4.05(0.7) 3-5 20 2 Degree 3.56(0.9) 2-5 43

nd

As mentioned, the 1st Degree BSN Pathway students and their preceptors are surveyed at the end of the senior preceptorship. Qualitative survey questions inquire as to the level of satisfaction with the experience, what was most helpful, and suggestions for program improvement. The expected outcome has been identified as "satisfaction with the experience". Data are reviewed by preceptorship faculty at

72

the end of the semester and course and corrective actions are taken. Preceptorship improvements are implemented for the following semester. Copies of each data collection instrument can be found in the Resource Room. Alumni Satisfaction Analyses for these survey data include descriptive statistics (score range, mean, and standard deviation). A 4-point Likert-type scale is used with responses ranging from 1-not very well to 4-very well. Scores of three or less are considered problematic. Responses to open-ended questions are categorized using content analysis and reported by category, with exemplar statements using the raw data. Benchmarks for these surveys are internally determined by the faculty and are dependent upon the measurement scale for each item. Forty-one percent of the CON BSN alumni (1st Degree and 2

nd

Degree) graduates from

Fall 2007 and 20% of alumni graduating Spring 2008 submitted alumni survey data. When asked how well the CON coursework, including clinical coursework, prepared them to perform the professional nursing competencies, almost all areas met the expected outcome of 3.0 or greater. Alumni satisfaction outcomes are reported in Table IV-B-2 and full survey data are available in Exhibit IV-B-1 in the Resource Room. Table IV-B-2. BSN Alumni Satisfaction Outcomes, 2007-2008 Question Expected Outcome 2007 Mean (SD) Range N 4.05 (0.9) 2-5 37 2008 Mean (SD) Range N 4.27 (0.7) 3-5 22

On a scale of 1 to 5 (1=not satisfied at all; 2=somewhat satisfied; 3=satisfied; 4=mostly satisfied; 5=very satisfied), how satisfied were you with the quality of the College of Nursing 1st Degree BSN Pathway? On a scale of 1 to 5 (1=not satisfied at all; 2=somewhat satisfied; 3=satisfied; 4=mostly satisfied; 5=very satisfied), how satisfied were you with the quality of the College of nd Nursing 2 Degree BSN pathway? On a scale of 1 to 5 (1=not satisfied at all; 2=somewhat satisfied; 3=satisfied; 4=mostly satisfied; 5=very satisfied), how satisfied were you with the partnership opportunities and employment situation resulting from nd your enrollment in the 2 Degree BSN pathway? Employer Satisfaction

>3.0

>3.0

3.42 (1.0) 2-5 24

3.73 (1.4) 1-5 11

>3.0

3.88 (1.4) 2-5 16

4.43 (1.0) 3-5 7

Analyses for these survey data include descriptive statistics (score range, mean, and standard deviation). A 4-point Likert-type scale is used with responses ranging from 1-not very well to 4-very well. Scores of three or less are considered problematic. Responses to open-ended questions are categorized using content analysis and reported by category, with exemplar statements using the raw data. Primary preceptors for the BSN graduates were contacted by email and asked to complete and submit the

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Employer Satisfaction survey. Benchmarks for these surveys are internally determined by the faculty and are dependent upon the measurement scale for each item. Employer satisfaction survey data are available for the May 2008 and August 2008 BSN graduate group (of both pathways) from one healthcare facility. Questions request respondents to indicate how well nurses graduating from The University of Arizona College of Nursing are performing at this time. On a scale of 1(not at all) to 4 (very well), all areas exceeded the expected outcome mean of 3.0. Survey outcomes are available for review in Appendix IV-B-1. Achievement of Graduates Graduation Rates and On-Time Degree Completion Rates: OSA personnel calculate on-time degree completion rates annually for baccalaureate students and report the findings in an annual report to Administrative Council and the UA administration (Refer to Exhibit IV-B-2 in the Resource Room). We have identified 90% or greater as the benchmark for on-time graduation rates in our strategic plan. The BSN program consistently maintains an on-time completion rate of over 92% for the 1st Degree BSN Pathway, ranging from 98.8% to 92.9% (Table IV-B-3). The 2

nd

Degree BSN pathway has maintained a

100% on-time completion rate for the 2006-2008 time periods.

Table IV-B-3. BSN Graduation and On-Time Completion Rates: 2006-2009 Program Expected Outcomes 2006 Completion Rate (N completed) 2007 Completion Rate (N completed) 2008 Completion Rate (N completed) Spring 2009 Completion Rate (N completed)

Baccalaureate 1st Degree BSN Pathway

nd

>90%

98.8% (85/86)

93.8% (91/97)

92.9% (92/99)

92.0% (46/50)

2 Degree

>90%

100% (62/62)

100% (64/64)

100% (78/78)

100% (91/91)

NCLEX-RN® First-Time Pass Rates. Examination results are assessed by graduating class and UA NCLEX-RN® pass rates are compared to national and state pass rates as benchmarks. The first-time pass-rate goal for the CON is identified in the strategic plan. Currently our expectation is that UA pass rates will exceed the state and national average. The first-time NCLEX pass-rate for the CON BSN program for both pathways has consistently exceeded expected outcomes for both the national first-time BSN pass rate as well as the Arizona first time NCLEX pass rates for 2006 through Spring 2009 timeframe (Table IV-B-4). Student outcomes for each pathway can also be determined from these reports because of the variations in graduation dates (May/December for the 1st Degree BSN Pathway and August for the 2

nd

Degree BSN Pathway). This more specific data can be found in Exhibit IV-B-3 in the

Resource Room.

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Table IV-B-4. NCLEX® First Time BSN Pass Rates: 2006-2009 Year 2006 Expected Exceed National & State Pass Rates Exceed National & State Pass Rates Exceed National & State Pass Rates Exceed National & State Pass Rates Actual CON 95.52% National 89.41% Arizona 90.30%

2007

94.12%

85.47%

85.98%

2008

94.89%

86.73%

88.58%

2009 3rd Quarter

95.00%

88.91%

89.68%

Employment Rates: When data are available, we calculate employment rates by identifying the number of graduates employed 1-year post-graduation divided by the total number of baccalaureate graduates annually in each pathway. While benchmarks are not specifically identified for this measure and vary dependent on the current employment environment, there is a general expectation that almost 100% of the graduates from the 1st Degree BSN Pathway will be employed within three months of RN eligibility. Preceptorship faculty informal polling data indicate close to 75 % of the students are reporting employment commitments prior to graduation during the current economic downturn. Between 2006 and 2009, 100% of the graduates from the 2

nd

Degree BSN Pathway would be expected to

be employed following graduation due to the contractual arrangement between the CON and the hospital partners that existed during this timeframe. Academic Distinction of Graduates: Academic achievements of BSN graduates, such as induction into Phi Kappa Phi and Sigma Theta Tau International and graduating with Honors from the Honors College, are collected at time of graduation. While there are few benchmarks for academic achievements of BSN graduates, faculty are interested in continual growth in this area. The CON strategic plan expects to maintain 5% of the BSN 1st Degree BSN Pathway student body in the Honors Program. The 2

nd

Degree

BSN pathway is not eligible for the honor's program due to the expectations and scheduling of that pathway. Academic achievement data are reported by pathway for each graduating student cohort using descriptive statistics (total n and percentage of graduating class). These data are provided in Exhibit IV-B4 in the Resource Room. Appendix IV-B-2 summarizes BSN academic distinction rates on graduation. Graduate Programs (MS and DNP) Student Satisfaction (MS-NP Option Program) Student satisfaction data are reported using descriptive statistics (score range, mean, and standard deviation). A 5-point Likert-type scale is used with responses ranging from 1-not at all satisfied to 5-very well satisfied, with 3.5 identified as the desirable outcome. These benchmarks are internally determined

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by the faculty. Responses to open-ended questions are categorized using content analysis and reported by category, with exemplar statements using the raw data. Survey outcomes are reported to the dean for dissemination to faculty. Program satisfaction scores between 2006 and 2009 (reported in Table IV-B-5) met or exceeded the established benchmark. Overall program satisfaction scores ranged from 3.50 to 4.33 out of 5 possible points. Scores for curriculum satisfaction ranged from 3.57 to 4.17 out of 5 possible points. Table IV-B-5. MS Program Satisfaction Student Survey Result: 2006-2009 Question Expected Outcome Fall 06 Mean (SD) Range N No data reported n>5 Spr 07 Mean (SD) Range N No data reported n>5 Fall 07 Mean (SD) Range N 4.33 (0.5) 4-5 6 Spring 08 Mean (SD) Range N 3.82 (0.8) 2-5 17 Fall 08 Mean (SD) Range N 3.50 (1.4) 1-5 14 Spring 09 Mean (SD) Range N 3.94 (1.0) 2-5 18

On a scale of 1-5 (1=not satisfied at all; 5=very satisfied), how satisfied are you with the overall quality of the College of Nursing MS Program? On a scale of 1 to 5 (1=not satisfied at all; 5=very satisfied), how satisfied are you with the overall curriculum

>3.5

>3.5

No data reported n>5

No data reported n>5

4.17 (0.8) 3-5 6

3.82 (0.6) 3-5 17

3.57 (1.3) 1-5 14

3.79 (1.0) 1-5 19

Student Satisfaction (DNP Program) Student satisfaction data for the DNP program between 2006 and 2009 are analyzed using descriptive statistics (score range, mean, and standard deviation). A 5-point Likert-type scale is used for overall program satisfaction questions, with responses ranging from 1-not at all satisfied to 5-very well satisfied, with 3.5 identified as the desirable outcome by the faculty. Responses to open-ended questions are categorized using content analysis and reported by category, with exemplar statements using the raw data. Survey outcomes are reported to the Dean. Although, overall program satisfaction scores from 3 of 4 semesters did not meet the benchmark, scores between Fall 2008 and 2009 did improve (3.22 to 3.85). Scores indicating overall satisfaction with the DNP curriculum also improved between Fall 2008 and 2009 (2.89 to 3.46. (See Table IV-B-6.) In spite of this initial improvement, there was another drop in scores in Spring 2009 (3.85 to 3.31 on overall program satisfaction and 3.46 to 2.88 on overall curriculum satisfaction). Through the DPC faculty leaders, we are in the process of program improvement, as described in Key Element IV-D. Data from formative evaluation questions (Exhibit IV-B-5 in the Resource Room) did not provide additional information about the curricular areas of greatest concern. In most areas, mean scores increased or stayed the same between Fall 2008 and Spring 2009. However, qualitative comments from the Spring 2009 survey do provide insight into student concerns and potential causes for decreased

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overall satisfaction scores (Exhibit IV-B-6 in the Resource Room). These will be further discussed in Key Element IV- D. Table IV-B-6. DNP Student Satisfaction Data: 2007­2009 Fall 2007 Mean (SD) Range N 3.22 (1.4)* 1-5 9 Spring 2008 Mean (SD) Range N 3.43 (1.6)* 1-5 7 Fall 2008 Mean (SD) Range N 3.85 (1.5) 1-5 13 Spring 2009 Mean (SD) Range N 3.31 (1.3)* 1-5 16

Question

Expected Outcome

On a scale of 1-5 >3.5 (1=not satisfied at all; 5= very satisfied), how satisfied are you with the overall quality of the College of Nursing DNP program? On a scale of 1-5 >3.5 (1=not satisfied at all; 5= very satisfied), how satisfied are you with the overall curriculum? *Denotes a deviation from benchmark

2.89 (1.4)* 1-5 9

3.14 (1.6)* 1-5 7

3.46 (1.2) 1-5 13

2.88 (1.3)* 1-5 16

In August 2009, student satisfaction scores from the revised annual student survey were analyzed using descriptive statistics (frequency, range and mean). Overall student satisfaction with the program is measured on a 4-point Likert-type scale where 0 equals meets none of my expectations and 3 equals exceeds my expectations. The benchmark was set by the DPC at 2.0 (meets most of my expectations). Responses to open-ended questions were also analyzed using content analysis. Mean student satisfaction scores (1.75, range 1-3) in Fall 2009 did not meet the stated benchmark (2.0). Results (Exhibit IV-B-7 in Resource Room) are reviewed annually by the DPC during the Fall semester. Open-ended comments again provided additional data that help to explain these results and will be further discussed in Key Element IV. D. Alumni Satisfaction (MS-NP option) Summarized data for this survey are reported using descriptive statistics (score range, mean, and standard deviation). A 5-point Likert-type scale is used for overall program satisfaction questions, with responses ranging from 1-not at all satisfied to 5-very well satisfied; 3.5 has been identified by faculty as the desired outcome. Responses to open-ended questions are categorized using content analysis and reported by category, with exemplar raw data statements. Historically, response rates for graduate program alumni surveys have been low. Between 2006 and 2009, only 11 graduates responded to requests for data, representing a total response rate of 18.6%.

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Only data from the class graduating in Fall 2008 are reported (Table IV-B-7) due to the low number of responses. Table IV-B-7. MS-NP Option Alumni Satisfaction Outcomes: Class 2006-2008 Class 2006 Class 2007 Class 2008 Expected Mean (SD) Mean (SD) Mean (SD) Question Outcome Range Range Range N N N On a scale of 1 to 5 (1=not satisfied at all; 5= very satisfied) how satisfied were you with the following in your program: Overall curriculum >3.5 No data n<5 No data n<5 No data n<5 No data n<5 2.50 (2.0)* 0-5 10 3.43 (1.0)* 2-5 7

Overall quality of the College of Nursing program *Denotes a deviation from benchmark

>3.5

Overall satisfaction scores for the MS with NP option program indicate that the benchmark (3.5) was not met. Alumni rated satisfaction on overall curriculum at 2.50 (range 0-5, S.D. 2.0). Alumni rated overall program satisfaction as 3.43 (range 2-5, SD 1.0). Qualitative comments provide additional insight into the reason for these scores and will be discussed in Key Element IV-D.

Alumni Satisfaction (DNP Program) No alumni surveys have been conducted for the DNP program because there have been only two graduates. Employer Satisfaction (MS-NP Option Program) No employer satisfaction surveys have been returned between 2006 and 2008. This finding will be further discussed in Key Element IV. D. Employer Satisfaction (DNP Program) No employer satisfaction interviews have been conducted for the DNP program because the two DNP graduates are within 1 year of graduation.

Achievement of Graduates Time Enrolled to Graduation (MS and DNP Programs): Time enrolled to graduation data are reported by student cohort based on their admission date. The Graduate College at the UA has designated time limits for the MS-NP program (6 years) and DNP (10 years) that serve as rudimentary benchmarks. While the CON formally adopted the MS benchmark set by the University, the CON has not yet identified time to graduation benchmarks for the DNP program. Time to graduation benchmarks for the DNP program will be determined based on evidence gathered (median time to graduation) from the first 3 admitted cohorts (2006-2008) and will be identified for full-time and part-time students in each DNP option.

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Table IV-B-8. Time Enrolled to Graduation: MS-NP and DNP Programs 2006-2009 Program 2006 Number completing Years to Graduation 13 2.3 years N/A 2007 Number completing Years to Graduation 23 2.67 years N/A 2008 Number completing Years to Graduation 23 2.52 years N/A 2009 Number completing Years to Graduation

MS DNP

24 2.60 years

2 2.0 years

Time to graduation data are described in Table IV-B-8. Between 2006 and 2009, students in the Master's programs required approximately 2.5 years or 5 semesters of full-time study to complete the degree. These data are consistent with CON/UA benchmarks (no longer than 6 years from admission to graduation). Only 2 students have completed the DNP program (MS-DNP pathway), doing so in 2.0 years. Although no official DNP time-to-graduation benchmark has been determined, faculty originally estimated that the MS-DNP pathway would take a minimum of 1.5 years to complete (Exhibit IV-B-8 in the Resource Room ­ ABOR/UA Program Proposal documents). A 2006 DNP curriculum revision (described in St. III) added one semester to the original plan of study, suggesting that the minimum timeto-graduation in the MS-DNP pathway for full-time students would be 2 years. Therefore, the 2 graduates from the DNP are well within the UA time-to-graduation doctoral program benchmark (<10 years) and met the minimal time-to-graduation originally proposed for the MS-DNP program. Certification Pass Rates (MS and DNP Programs): Aggregate percent pass rates (candidates passing divided by candidates sitting for the examination) are reported for all candidates from the UA CON (MS graduates, BSN-DNP students and MS-DNP with NP option students) if more than six candidates take the exam. For examinations with fewer total candidates, scores are not reported. Benchmarks for this examination are established by the credentialing organizations and are provided with each report. Appendix IV-B-3 identifies 2006-2009 results for all examinations. Certification pass rates for UA CON candidates exceeded the identified benchmark for all examinations, with two exceptions: In 2007, the ACNP pass rate fell to 75% (national rate = 86.19%) but increased in the following year to 100%. In 2008, The PMHNP fell from a 100% pass rate in 2007 to a 58.3% pass rate in 2008. Data are not yet available for testing that occurred in 2009. Employment Data (MS and DNP Programs): Employment data (collected by the OAP and OSA) are reported as the percentage of employed graduates. Employment data from alumni surveys are reported as the percentage of employed alumni respondents to that survey. Benchmarks for general employment rates are market driven and based on the current national and state employment environments. Other employment drivers include nursing workforce shortage; the need in Arizona is significant and exists in almost every community. Further, as a land grant University, the UA CON has a commitment to provide health care resources to the state of Arizona, including nurse practitioners and DNP graduates.

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Therefore, we anticipate that 80% of all graduates (MS-NP option and DNP) will be employed within one year of graduation and after successfully completing the NP certification examination. Although employment data for the graduate programs (Exhibit IV-B-9 in the Resource Room), indicate varying and seemingly conflicting rates of employment for MS-NP graduates, considered together, the data provide a fairly clear picture of employment of MS - NP graduates between 2006 and 2009. Fifty percent (50%, n=7/14 respondents) indicated full or part-time employment 1 year after graduation on the alumni survey (classes of 2007-2008). These data do not meet the established program benchmarks, but given the response rate (18.6%), these results are questionable. Additionally, data collected by the OSA and reported to HRSA as outcomes data for Federal Traineeships (2006-2009) indicate that, on the average, 64.4% MS-NP graduates were employed in underserved populations, including Community Health Centers, rural health clinics, and Indian Health Services. Data collected by the OAP indicated an employment rate for MS-NP graduates (2007-2009; n=80) of 80.1%. Both DNP alumni (100%) report being employed full-time. One graduate is self-employed as ownerpartner in a community-based primary care practice in a rural setting and the other graduate is relocating from an international assignment and has accepted employment in a large urban acute care facility in an urban setting. Professional Achievements of Graduates (MS-NP Option Program): Data from 13 graduates from 20052008 on open-ended questions on the alumni survey indicate that 1 graduate has published, 1 provided presentations, and 1 has served in a leadership position. Because the response rate for this survey is very low, anecdotal data were provided by faculty and indicated additional alumni accomplishments of these Master's graduates, including 2 additional publications, 3 presentations at regional or national conferences, 2 who have published clinical guidelines for use in practice settings, and 2 additional graduates serving in leadership positions in professional organizations. Additional Formative Evaluation Outcomes for the DNP Program Aggregate Student Retention: Frequency data for each pathway list the number of students who were admitted, enrolled, withdrew, and continue to enroll/progress. (Exhibit IV-B-10 in the Resource Room). While no benchmarks have been officially identified by the DPC, 100% continuation of enrolled students is the ideal goal. Of the first cohort (2006), 100% of students admitted to the BSN-DNP (n=1) and MS-DNP with NP option (n=2) students withdrew. Of the six admitted and enrolled in the MS-DNP (post NP certificate) pathway, 4 continued and 1 has graduated (retention=66.6%). Retention of the 2

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DNP cohort (2007) improved

significantly. Of the BSN-DNP cohort, 100% (n=4) continue to be enrolled. Of the MS-DNP 2007 cohort, 7 of 9 (77.8%) continued and 1 has graduated. In the 2008 DNP cohort, 5 (100%) of the BSN-DNP/MSDNP with NP option students continue to progress toward graduation, while 7 of 8 (87.5%) of the MSDNP cohort remain enrolled. Thus retention in the DNP continues to improve with each cohort. Aggregate Student Progression: OSA reports progression toward and achievement of program milestones by student cohort using descriptive statistics (frequencies, percentages). Specific

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benchmarks/program milestones have been set by the DPC in 2009 for completion of coursework, completion of comprehensive examinations (written and orals), completion of the Practice Inquiry proposal and defense of their final Practice Inquiry project report. Time to benchmarks varies by pathway (i.e., time to minor exam for the MS-DNP with NP certification pathway is 1.5 years, while it is 2.5 years for the BSN-DNP pathway) although failure to continue to progress to the next benchmark within 2 semesters is considered outside of the program standard. Appendix IV-B-4 provides data about progression toward graduation and completion of program milestones. Of 21 students enrolled since the inception of the DNP program, 85.7% (n=18) have met progression benchmarks. Progression delays were experienced by the first cohort of students admitted in 2006. This was the only cohort that included part-time students. Of those, 3 of 4 did not meet initial benchmarks, although 100% of these students are now on track. Two are completing their Practice Inquiries and one student will complete oral comprehensive examinations in January 2010, progressing to the Practice Inquiry upon successful completion of her oral examination. Of particular note, 100% of the students admitted in the 2007 and 2008 cohorts have met all program benchmarks, with 100% of the BSN-DNP 2007 cohort successfully passing their certification examinations in 2009. DNP Student Outcomes: Descriptive statistics (frequency, percentages) and exemplars are used to summarize findings from these reports. Although only two benchmarks have been identified relative to student reports (number of student/faculty co-authored papers increase by 5% annually; number of students co-presenting with mentors increase by 5% annually), as the DNP program matures specific benchmarks (% of DNP student productivity in specific areas) will be identified. Appendix IV-B-5 summarizes student outcomes. Eight DNP students report publications between 2008 and 2009, two (2) with faculty mentors (meeting the CON benchmark). Eight students received awards or honors and one (1) student secured external funding for her work. Five (5) students indicated presentations at conferences. None indicated that they co-presented with faculty mentors (CON benchmark), however, in some case the format of the presentation lists faculty who were co-authors as advisor. IV-C. Aggregate student outcome data provide evidence of the program's effectiveness in

achieving its mission, goals, and expected outcomes. Elaboration: The program reports aggregate data related to its expected outcomes. Reported data include student, alumni, and employer satisfaction; graduation rates; NCLEX-RN® pass rates; certification examination pass rates; employment rates; as well as data related to other program-identified expected outcomes.

PROGRAM RESPONSE

Outcomes data demonstrating program effectiveness will be reported by program (baccalaureate and graduate ­ MS-NP and DNP) and by type of data collected.

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Baccalaureate Program Student Satisfaction: Senior BSN students of both pathways reported high satisfaction scores of 3.5 to 4.0 out of 4 possible, exceeding the expected outcome relating to their satisfaction with the overall quality of the BSN program. The 1st Degree BSN Pathway satisfaction scores have been greater than 3.62 since 2006, and greater than 4.0 since 2008. In reference to satisfaction with nursing skills, scores in the 1st Degree BSN Pathway for Fall 2007 and Spring 2008 were less than the expected outcome of 3.0. This may be partially attributable to attitudes and practices of former SILC staff and/or faculty members. Changes in faculty and SILC staff, as well as more aggressive implementation of a consumer satisfaction and continuous quality improvement philosophies, had positive results, as indicated in survey means exceeding the expected outcomes. The 2

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Degree BSN Pathway satisfaction has met or exceeded the

expected outcome since program inception.

As a result of direct student observation, student responses, and informal needs assessment of students, SILC staff implemented the following changes: extended evening laboratory hours for both informal and structured, focused practice; orientations to simulation (process and technology) were provided; SILC staff worked with new and existing faculty to provide orientation to updated technology and resources. Both senior nursing students and their RN preceptors for Fall 2008 and Spring 2009 were surveyed regarding their satisfaction with the preceptorship experience. Qualitative preceptorship satisfaction data support the 1st Degree BSN Pathway students and their preceptors having positive outcomes regarding the preceptorship experience. Information obtained regarding preceptor assignments and learning environments lead to improvements in preceptor selection, role expectations and an improved preceptorship placement/ preceptor assignment process. Alumni Satisfaction: Forty-one percent of the CON BSN alumni (1st Degree and 2

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Degree) graduates

from Fall 2007 and 20% of alumni graduating Spring 2008 submitted alumni survey data. When asked how well the CON course work, including clinical, prepared them to perform the professional nursing competencies, almost all areas met the expected outcome of 3.0 or greater. When asked how satisfied they were with the quality of the CON 1st Degree BSN Pathway, graduates reported being very satisfied, with scores ranging from 4.05-4.27 out of 5. When asked how satisfied they were with the quality of the 2

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Degree BSN Pathway, 2 degree graduates indicated being satisfied with

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mean scores ranging from 3.42-3.73. An additional question regarding the 2

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Degree pathway question

inquires how satisfied were they with the partnership opportunities and employment situation resulting from their enrollment in the 2 Degree pathway. Mean scores related to that question indicated

satisfaction ranging from 3.88-4.43 out of 5. Alumni from both pathways identified four areas, although very close to the expected outcome score, that fell below the expected outcome with scores of 2.83-2.98: coordinate the healthcare of patients/families across the continuum, delegate nursing care to health care members, supervise care given by other team

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members and organize and manage care provided to patients/families by the care team. These outcomes will be discussed further in Key Element IV-D. Employer Satisfaction: Employer satisfaction survey data are available from the May 2008 and August 2008 BSN graduate group from one healthcare facility. Questions request respondents to indicate how well nurses graduating from The University of Arizona College of Nursing are performing at this time. On a scale of 1 (not at all) to 4 (very well), all areas were above the expected outcome mean of 3.0. The highest mean scores were in the following areas: the employee is prepared for current nursing practice (3.4); employee uses effective communication and interviewing skills (3.54); employee provides for continuing care as needed (3.69); employee documents care appropriately (3.54); employee works effectively with interdisciplinary teams (3.54); employee maintains a positive attitude (3.85) and employee is willing to learn and seeks out learning experiences (3.62). Although very close, only one area did not meet the expected outcome, that area being, the employee uses research findings in nursing practice (2.92). It is believed this is an area in which most new graduates struggle during their first year of employment.

Achievement of Graduates On-Time Degree Completion Graduation Rate: The BSN program consistently maintains an on-time completion rate of over 92% for the 1st Degree BSN Pathway, ranging from 98.8% to 92.9%. The 2

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Degree BSN pathway has maintained a 100% on-time completion rate for the 2006-2008 time periods (OSA annual reports). NCLEX-RN® First-time Pass Rates: The first-time NCLEX pass-rate for the CON BSN program has consistently met and exceeded expected outcomes for both the national first-time BSN pass rate as well as the Arizona first time NCLEX pass-rate for 2006 through Spring 2009 timeframe. The first-time pass rates for the CON BSN program ranges from 95.52 to 92.31 consistently exceeded national pass rates ranging from 85.47 to 89.41, and Arizona pass rates ranging from 85.98 to 90.30 for this time frame. The consistently high pass rates having exceeded the expected outcome during this period, further demonstrates the BSN program effectiveness. Employment rates: Graduates from the CON BSN program have been highly recruited and it was the exception for a graduate not to have obtained employment. Due to the current economic downturn in the healthcare arena, the number of new graduate RN positions has become scarce. Preceptorship faculty informal polling data indicated the vast majority of students received employment commitments at the time of graduation prior to the current financial crisis. Since the financial downturn, it has been noted the number of employment commitments at graduation has dramatically decreased. However, postgraduation, many students report having found positions within four to six months. The 2 Pathway graduates continue to maintain a near 100% employment rate. Of those graduates responding to the alumni survey one year post-graduation between Spring 2007 to Spring 2009, 84% reported having been employed. Between 2006 and 2009, 100% of the graduates from

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Degree BSN

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the 2

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Degree BSN Pathway would be expected to be employed following graduation due to the

contractual arrangement between the CON and the hospital partners that existed during this timeframe. Anecdotally, preceptorship faculty reported one student during this time period who chose not to be employed after graduation. Academic Distinction of Graduates: Although the CON currently has no expected outcome rates for academic distinction, 50% of the graduates of the BSN program have consistently obtained academic distinction honors upon graduation. Academic honors include Summa Cum Laude, Magna Cum Laude, and Cum Laude. Also included in the academic achievement is induction into Phi Kappa Phi and Sigma Theta Tau International. Academic achievement ranges from over 50% to 72.6% of the graduates in both pathways obtaining one of the previously mentioned academic achievements. The CON strategic plan asserts to maintain 5% of BSN students in the honors program. Due to the time commitment of the honors program, only the 1st Degree BSN Pathway students are eligible to participate. We have consistently exceeded the benchmark except early 2008 when the percent experienced a slight dip during the transition of a new CON Honors Program Advisor. The following data reflect the percentage of 1st Degree BSN Pathway students graduating with honors from the Honors College: Fall 2006 (14.2%), 2007 (6.1%), 2008 (4%); Spring 2009 (7.8%). Of the BSN graduate alumni completing the program one year ago from Fall 2007 and Spring 2008, 43.% reported considering graduate education, 5.8% reported having applied and were accepted for graduate study, and 5.8 % were currently enrolled in a graduate program. Eighteen percent of the alumni completing surveys for this time period also reported having specialty organization membership. Thus, BSN graduates are prepared for graduate education and indicate a value for life-long learning. Graduate Programs (MS and DNP) Student Satisfaction (MS-NP Option Program) Students in the MS-NP option program consistently reported satisfaction with the quality of the program. Scores for overall program satisfaction consistently met or exceeded the stated benchmark (range 3.54.33, on a 5-point Likert). Responses on specific role preparation questions (Exhibit IV-C-1 in the Resource Room) indicate that students in this option program felt prepared to practice professionally, integrate research findings into their clinical practice and provide health promotion/risk reduction services to clients with relative effectiveness (scores means 3.0-3.76, on a 4-point Likert). Students commented on the faculty's skill using distance education technology: "the multimedia presentations really "pushed" me to do something out of my comfort zone with the individual project." The use of case studies "made the online classes come alive". Ongoing student contact with faculty and "excellent feedback" was deemed particularly helpful. Students in Fall/Spring 2008 reported lower confidence with their preparation to (a) care for clients with complex health/illness problems (2.79), (b) identify appropriate nursing intervention methods (2.93), (c) prioritize care needs (2.93), and (d) perform advanced skills (2.76); all below the established benchmark (3.0 on a 4-point scale). By Spring 2009, all scores, with the exception of skills proficiency (2.72) met or

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exceeded the benchmark. Comments indicated that students wanted more clinical time, more diverse clinical skills experiences, and greater assistance with clinical placements. Although the MS-NP option was discontinued and merged into the DNP, outcomes from these data will be considered in future planning for the NP core courses within the DNP program. Further interpretation of these data is offered in Key Element IV-D. Student Satisfaction (DNP Program) Overall satisfaction scores for the DNP program (Table IV-B-6, page 84) steadily rose between Fall 2007 and Fall 2008 (3.22-3.85 and 2.89 to 3.46); satisfaction scores met or exceeded the established benchmark in Fall 2008. However, scores dropped below the benchmark again in Spring 2009 (3.31 and 2.88). Transition to the new evaluation form also elicited satisfaction scores below the benchmark. Responses on specific role preparation questions (Exhibit IV-C-2 in the Resource Room) indicate that as the program matured, student satisfaction increased. Individual item scores increased for each competency statement between 2007 and 2009; in 2007 scores ranged from 1.67 to 3.00 on a 4-point Likert-type scale and by Spring 2009, scores ranged between 2.31 and 3.62. Areas showing greatest improvement included student confidence in ability to: (a) engage in continued self-assessment and professional development (+1.17), (b) critique nursing knowledge (+1.06), (c) disseminate practice initiatives through publications (+0.94), (d) collaborate with nursing colleagues (+0.92), and (e) influence the thinking about nursing and health care (+0.92). Students' comments provide additional insight into these satisfaction ratings. Strengths of the program were identified as "talented faculty with important information and experiences to share"; "scheduling options, technical support, name recognition in Arizona, and intensive periods on campus"; "the distance learning environment is well organized and supported by extremely competent and caring individuals"; "faculty support of the DNP program and encouragement for our group to take advantage of the opportunities before us to develop the DNP into an amazing role"; "its focus on research. Any student who graduates from this program will undoubtedly be capable of carrying out research"; and "the student group bonded the 1st time we met, and despite the distance we are helping each other."

These data indicate that we have fostered an active community of scholars (faculty and students) committed to developing the DNP role and excellence in advanced nursing practice, building on the advantages of a diverse student population, flexible distanced education pedagogy, and creative teaching-learning strategies. Areas for improvement will be further discussed in Key Element IV-D. Although overall satisfaction scores from the first annual student survey (August, 2009) did not meet the benchmark, the response rate (27%) creates questions about the reliability of these data. And, in spite of overall satisfaction scores that did not reach the benchmark, an in-depth examination of responses to additional questions in that survey (Exhibit IV-C-3 in the Resource Room) indicates that the majority of students completing 1 year of doctoral study felt somewhat competent to use evidence in practice (83.3%) and provide leadership to improve the health of society (100%), while 67% felt very competent to

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provide advanced practice to a specific population. Of those in the 2

nd

year of the program, 100% (n=2)

felt very competent across all program outcomes. These findings indicate program effectiveness and improved student confidence in practice role specific behaviors. Alumni Satisfaction (MS-NP Option Program) Due to the low response rates on alumni surveys (18.6%), data are only available for one graduating class (Fall 2008). Therefore, data should be interpreted with caution. Overall program satisfaction scores (mean 3.43; range 2-5 on a 5-point scale) indicated that alumni were generally satisfied with the program although were not as satisfied with the MS-NP option curriculum (mean 2.50; range 0-5; SD 2.0). Ratings on specific role behaviors (Exhibit IV-C-4 in the Resource Room) provide insight into these general satisfaction scores. Alumni felt well prepared in the areas of communication, health promotion/risk reduction, evidence-based practice, collaboration, and problem-solving (mean scores 3.0-3.43), but less prepared for (a) complex health/illness intervention (mean 2.67); (b) needs identification (mean 2.89); (c) performance of advanced skills (mean 2.62); and (d) prioritization of care (mean 2.83). Further discussion of these data are provided in Key Element IV-D. In addition, low response rates affected the ability to collect employer satisfaction data between 2006 and 2008. Implications of linking these two data collection processes as well as reasons for the lack of responses will be further discussed in Key Element IV-D. Alumni Satisfaction (DNP Program) There have been no alumni surveys for the DNP program. Achievement of Graduates Time Enrolled to Graduation (MS and DNP Programs): The MS-NP program consistently meets UA time to graduation benchmarks. Students graduated 2.57 years from time of admission/matriculation. The first cohort of DNP students (100%) also are on schedule to exceed the UA time to graduation benchmarks; 100% of these students have completed coursework and are in the process of completing their scholarly inquiry. Two DNP graduates completed the program in 2.0 years (mean time enrolled to graduation), well within the UA benchmark for doctoral study and close to proposed minimal time to graduation at the program's inception. Certification Pass Rates (MS and DNP Programs): Data from certification pass rates indicate support that the CON is meeting its mission/goals to prepare a workforce that can meet the needs of the state of Arizona and the nation. Certification pass rates for students from the UA CON have consistently met or exceeded the benchmarks between 2006 and 2009 with two exceptions. In 2007, the ACNP pass rate fell to 75% (national rate = 86.19%) but this rate represented only 1 candidate failure (out of 4 total candidates). The ACNP pass rate the following year increased to 100%, indicating program effectiveness. In 2008, The PMHNP pass rate fell from 100% in 2006 and 2007 to 57.1%. Program faculty suggest several reasons for this sudden change in scores, including (a) one candidate (a recent immigrant with English language difficulties) who took the examination a total of three times in 2008 (accounting for 25% of 12 candidates), failing twice and passing once; (b) revised certification test competencies that are more closely aligned with CNS psychiatric/mental health practice (psychotherapy) than the PMHNP role

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(diagnosis and pharmacological intervention); and (c) changes in regulation of Nurse Practitioner licensure by the Arizona State Board of Nursing, increasing the number of previous graduates now taking the examination. Although programmatic/curriculum changes were made to accommodate changes in testing focus, these were not in time for the 2008 graduates. In addition, the de-identified reporting procedures make it impossible for faculty to determine the actual causes for this high failure rate. Results from 2009 are not yet available to determine if this rate represented an aberration or a trend. Employment Data (MS-NP option and DNP Programs): Employment data indicate that we are very effective in meeting our mission to educate health care providers for the state of Arizona and the nation, including medically underserved populations. Employment data indicate that 80% of the MS-NP option graduates are employed 1 year following graduation serving in acute care facilities, rural/frontier primary health care clinics, community health center clinics, Indian Health Services, the Veterans Administration, and urban primary health care delivery sites. Current data also indicate that 100% of DNP graduates (n=2) were employed immediately following graduation. One graduate is owner/partner in a primary care clinic in an underserved rural area in southern Arizona; the second is assuming an acute care position in an urban setting. While benchmarks are not yet identified for this metric, these data indicate that the DNP program is effective in meeting its mission/goal to (a) prepare nurse practitioners at the doctoral level to increase the nursing workforce, (b) increase the number of DNP graduates practicing in a rural or medically underserved setting, and (c) prepare a workforce that meets the needs of the state of Arizona and the nation. Professional Achievements of Graduates (MS-NP option Program): Professional achievements of our MS-NP option graduates indicate program effectiveness. Graduates contribute to the profession of nursing by adding to our literature, disseminating knowledge and serving in leadership positions.

Additional Formative Evaluation Strategies Used by the DNP Program Aggregate Student Retention: Retention data for the MS-DNP program have continuously improved between 2006 and 2008 (66.6% in 2006; 77.8% in 2007; 87.5% in 2008) indicating continually improved programmatic effectiveness. Retention data for the BS-DNP and MS-DNP with NP option have similarly improved (0.0% in 2006; 100% in 2007; 100% in 2008), indicating that the program is now meeting/exceeding its goal to retain 100% of the students admitted to the program. Aggregate Student Progression: Student progression data also support program effectiveness in achieving the CON goal/mission to encourage on-time student graduation to meet the health care needs of Arizona and the nation. Data from the MS-DNP 2006 student cohort indicate that 100% of the enrolled students met/exceeded program benchmarks and were able to progress satisfactorily through the program. Similar results from the 2007 BSN-DNP and MS-DNP cohorts also support program effectiveness. One hundred percent (100%) of the students in the BSN-DNP 2007 cohort successfully passed their certification examinations in 2009. Further, 100% of the MS-DNP 2007 student cohort have passed their comprehensive examinations (written and oral) and are currently preparing their scholarly

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inquiry proposals. One student from the MS-DNP 2006 cohort graduated in June 2009 and 1 from the MS-DNP cohort graduated in December 2009. DNP Student Outcomes: Data from the annual student reports support program effectiveness in preparing students for the role of advanced practice leadership at the doctoral level. Several students report publications in peer-reviewed journals (8) and presentations of their work at professional meetings (5). Eight (8) students were recognized by honors/awards. One student is completing a predoctoral fellowship in the NIH/NCCAM sponsored T-32 Arizona Complementary and Alternative Medicine Research Training Program. Her Practice Inquiry focuses on treatment of chronic pain in Native American populations, completing a community needs assessment that will lead to the development of an integrative pain clinic for native populations in an Indian Health Services outpatient clinic.

IV-D. Aggregate student outcome data are used as appropriate, to foster ongoing program improvement.

Elaboration: The program demonstrates use of aggregate student outcome data for program improvement when actual outcomes are not consistent with expected outcomes. Adjustments to foster ongoing program improvement are deliberate and congruent with the mission, goals, and expected student outcomes.

PROGRAM RESPONSE

Between 2001 and 2009, the evaluation methods (metrics and collection tools) have remained stable. However, the processes and procedures for data collection, analysis, and dissemination have varied considerably due to changes in (a) the academic environment at UA and workload and (b) the administrative structure and personnel. The evaluation process (data collection, analysis, and dissemination of findings) was decentralized in 2006 after the Associate Dean for Academic Affairs retired and the Dean retired in 2008. These events and the resulting administrative changes significantly impacted dissemination of evaluation data to appropriate faculty and administrative units between 2006 and 2009. Therefore, program improvements were often based on curriculum evaluation methods (Teacher-Course Evaluation (TCE) results, course/activity evaluation processes, RISE surveys), faculty teaching expertise, information from students, faculty, and employers about student/alumni outcomes, and recommendations from program consultants rather than systematic dissemination of and response to the full complement of evaluation data. This section will provide descriptions of program changes that address issues raised by student/alumni outcomes data.

Baccalaureate Program Student Satisfaction Although overall program satisfaction exceeded the expected outcomes, various areas for program improvement appeared with preceptorship satisfaction outcomes and alumni satisfaction outcomes which

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will be discussed in the following section. Qualitative preceptorship satisfaction data supports the 1st Degree BSN Pathway students and their preceptors having positive outcomes regarding the preceptorship experience and also provided an opportunity for improvements in preceptor selection, and an improved preceptorship placement/ preceptor assignment process. The process for implementing and overseeing the preceptorship placements and RN preceptor selection was given to the Office of Academic Practice (OAP) for oversight and coordination to improve upon the timeliness of work schedule retrieval from the practice settings. The OAP has now implemented a timeline to assure timely notification of preceptorship placement needs, RN preceptor requirements, schedule requirements, student names, contact numbers, rotation time frame and faculty supervision. Alumni Satisfaction Graduates of Fall 2007 and Spring 2008 were surveyed and asked to respond how well the CON course work, including clinical, prepared them to perform the professional nursing competencies. Almost all areas met or exceeded the expected outcome of 3.0. Four (4) areas, although very close to the expected outcome score, fell below the expected outcome with scores of 2.83-2.98 respectively: coordinate the healthcare of patients/families across the continuum, delegate nursing care to health care members, supervise care given by other team members and organize and manage care provided to patients/families by the care team. Although the scores are very close to the expected outcome scores, it was important to review current practice in the BSN program to assure continuity and improved student confidence. Graduates of both pathways were surveyed and were not identified by pathway; therefore, aggregate data are reported. Due to the fact that faculty did not receive survey results, we could not/did not base revisions on survey outcome results. We based improvements upon teaching/ learning outcomes received from student feedback, course evaluation outcomes and TCE evaluation outcomes. The 1st Degree BSN Pathway graduates evaluated the extensive 150 hour clinical preceptorship which provides opportunities for the coordination/ management of care experience. Both senior nursing students and their RN preceptors were surveyed regarding their satisfaction with the preceptorship experience. Qualitative preceptorship satisfaction survey data supported the 1st Degree BSN Pathway students having positive outcomes regarding the content areas discussed above. Baccalaureate faculty council meetings, pathway level meetings, or course chair meetings were used by faculty to discuss curricular issues, to review current expected clinical outcomes and to identify opportunities for improvement. Examples of improvements that occurred within the 2 Degree BSN Pathway, where practice in coordination of care was reviewed and expected learning outcomes and content are being revised, are: For Levels III and IV, faculty plan to emphasize coordination of care of families; and Level IV coordinators' review of data and student input and subsequent decision to provide greater emphasis on supervision of care by team members is planned for summer 2010 courses.

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Graduate Programs (MS-NP and DNP) Student and Alumni Satisfaction (MS-NP Option Program) While overall student program and curriculum satisfaction scores met or exceeded the CON benchmark, alumni satisfaction scores did not. Responses to specific questions about role performance indicated concerns with performance of advanced nursing skills, ability to care for individuals with complex health/illness processes, patient intervention and evaluation skills, and organization/prioritization of care. Comments from alumni and students indicated that the online format and distance learning environment made skills teaching/learning more challenging: "Several of my clinicals were in combination with residents, making it very difficult to learn this independent skill; despite asking repeatedly for classtime [sic], more skills, and clinical experience, nothing changed;" "should provide more skills practice and more clinical time". Enhanced attention to the TYPHON documentation and tracking system helped to address these issues, facilitating the faculty's ability to monitor students' progression and competency/experiences with a variety of clinical situations, monitor students' clinical experiences to assure that they are building on previous attained competencies, and gaining needed experience in advanced clinical decision-making and skills acquisition. Additional programmatic changes in the MS-NP option program based on these satisfaction data have not been made for several reasons, including (a) transition of the current MS-NP program to a DNP without a Master's-exit option; (b) additional student/graduate outcomes indicating that the program is successful in meeting its mission and goals; and (c) poor response rates and therefore questionable reliability/validity of the data. While student/alumni data indicated issues with role performance in specific areas, certification data for the same cohorts indicate that CON MS-NP option graduates were, in fact, well prepared for their clinical specialty examinations, with pass rates (2006-2009) exceeding the national norm. Therefore, while some students/alumni might perceive that they lack the skills/knowledge to practice in their role, in fact they are very well prepared, as evidenced by these pass rates on national certification examinations. Compared to peers across the nation, UA CON NP graduates have a longstanding history of excellence. Employment rates (>80%) similarly support that graduates from this program are able to perform in the advanced practice role, often in remote areas with underserved populations with highly complex health care needs and social situations. While employer satisfaction data (2006-2009) are not available to corroborate these conclusions due to poor response rates, evaluation process improvement plans will enhance and improve these data in the future. Faculty have discussed the low response rates and the need for accurate data to systematically evaluate programs. Several changes in the evaluation process have already been made and the DPC (responsible for curriculum and program evaluation processes) continues to discuss how to more successfully address the evaluation needs of the graduate program. Changes to the evaluation process in 2009 include: (a) adopting annual student evaluations to decrease student burden and encourage participation; (b) adopting an online survey format (SurveyMonkey) to facilitate data analysis and dissemination to faculty; (c) conducting routine discussions about evaluation data in the DPC with action plans as needed.

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Proposed changes under consideration by the DPC and doctoral faculty include: (a) moving to an outside vendor for summative evaluation surveys of DNP students and alumni rather than using internally constructed instruments; (b) adopting an online portfolio system with analysis capabilities to facilitate ongoing evaluation of student/alumni outcomes; and (c) adopting a "focused" evaluation process whereby cohorts of students volunteer to fully participate in ongoing student/alumni/employer evaluation. Student Satisfaction (DNP Program) While overall DNP student satisfaction scores (2006-2007) did not meet the identified benchmark, they did show increasing satisfaction with the DNP program by 2008, demonstrating effectiveness of programmatic changes made during that same period. Student comments indicated that issues affecting satisfaction included the lack of role clarity, the lack of clarity about the relationship between research, theory, and advanced practice at the doctoral level, what students perceived as a lack of focus on practice and a disconnect between theory, research and practice (identified as a "PhD-lite curriculum" in comments), difficulty differentiating academic preparation between the DNP and PhD programs, and inconsistent student expectations when entering the program. While some of these issues reflect the larger disciplinary dialogue about the evolving DNP role, faculty also made concerted efforts to address these concerns through several changes. External consultants for the DNP program helped faculty clarify DNP roles, educational needs/requirements, the nature of scholarly practice inquiries appropriate for the DNP, and student evaluation methods. Ongoing faculty discussions in graduate faculty retreats and regularly scheduled graduate faculty forums between 2006 and 2009 have also helped faculty to: (a) articulate a unified "UA perspective" on the DNP role and the requisite knowledge, skills, and attitudes for this role, (b) clearly identify shared and unique knowledge and contributions of PhD and DNP graduates to health care; (c) mentor students in scholarly inquiries that are more consistent across students in the program; and (d) model and facilitate scholarly advanced practice at the highest levels. We have engaged in a concerted effort to clarify program outcomes and the nature of scholarly practice during the application and admissions processes and ongoing student advising/mentoring. Faculty discussions and program improvement activities also resulted in a re-conceptualization of the DNP curriculum so that theory and research are more fully integrated into the advanced practice role. A revised DNP curriculum (referred to in Standard III, Key Element G and available in Exhibit III-G-3 in the Resource Room) was developed and adopted by faculty in Spring 2009 and the first cohort of students was admitted to this program in August 2009. In addition, we have identified scholarly practice activities across the curriculum and are now clearly communicating the integration of theory, research, and clinical practice in individual courses. Revised, focused curriculum and programmatic evaluation will help to determine whether these changes result in improved satisfaction scores. Program satisfaction dipped again in 2009. Again, individual formative evaluation items did not provide clarity about specific issues but additional data and students comments did. RISE survey data from 2008 and 2009 indicated that DNP students across cohorts were working full-time (40.3 mean hours/week).

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Students noted a "lack of flexibility" in scheduling and the "lack of a part-time option" in this program. Students also indicated a "reluctance to take out loans during these times, incurring more debt". Responding to these concerns, the faculty adopted a part-time study option that will allow students to enroll for a minimum of 6 credits/semester beginning in Spring semester, 2010.

IV-E.

Aggregate faculty outcomes are consistent with and contribute to achievement of the

programs mission, goals, and expected student outcomes. Elaboration: Aggregate faculty outcomes reflect the program's mission, goals, and expected student outcomes. For example, if research is an identified element of the program's mission, faculty research productivity should be assessed as an expected faculty outcome. If research is not part of the identified mission, it would not be expected as a faculty outcome. Evaluation of faculty outcomes is consistent with the institution's and program's definition(s) of faculty role expectations. There is congruence between expectations of the faculty in their roles and evaluation of faculty performance.

PROGRAM RESPONSE

Faculty outcomes are consistent with and contribute to the achievement of the University of Arizona's and the College of Nursing's mission, goals and expected outcomes through excellence in teaching, research/scholarship/creative activity, and service/practice/outreach. Faculty and student accomplishments are regularly featured in the College of Nursing Newsletter (http://www.nursing.arizona.edu/NursingNews.htm). Faculty expectations and evaluation processes are based on the University and College's mission in these three areas and 100% of the faculty are expected to achieve satisfactory ratings in each of these three categories during each year of employment. Faculty expectations are based upon the University of Arizona expectations of faculty and upon the College of Nursing criteria for achievement of roles for tenure track and clinical track faculty. Consistent with University policies, faculty outcomes in teaching, service, and research and scholarship are evaluated annually by peers and administrators, and faculty are also evaluated for reappointment, promotion and tenure as appropriate to the faculty rank and track. The evaluation of faculty is congruent with their expected outcomes and roles in the College. Process for Evaluation of Faculty Outcomes The process for annual review is in the CON Faculty Handbook (http://www.nursing.arizona.edu/IntraNet/facManual/other-pdf-files/internal-process-for-annual-continuedreview.pdf). The Guidelines for preparing the Annual Review Report are posted for faculty through the intranet at the site, Faculty Annual Report, (http://www.nursing.arizona.edu/intranet/annualreports/), accessible year round for faculty to update information into their online Annual Report. A process for evaluation of faculty outcomes has two components: the annual review process and the promotion and tenure process.

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Annual Review of Faculty: Faculty prepare their annual report based on outcomes for a calendar year. These reports are prepared at the beginning of each year; the annual review of all faculty occurs during the Spring semester. Faculty prepare their Annual Reports through an online process. These reports are submitted and reviewed by an elected committee of peers, who provide a recommendation to the faculty member's Division Director. Division Directors also provide an evaluation and discusses the peer and division director evaluation reports with the faculty at the end of the Spring semester each year. The faculty and Division Director determine next year's faculty goals in teaching, research/scholarship and service. The outcomes of the evaluation process are forwarded to the Dean. Recommendations for merit or for other actions are based upon the annual review outcomes. Promotion and Tenure Review: Tenure Track: The CON's evaluation processes for promotion and tenure follow the guidelines in the University Handbook for Appointed Personnel concerning policies for Promotion and Tenure for tenure-eligible faculty (http://vprovacf.web.arizona.edu/p&t/). Tenure-eligible faculty prepare their dossiers according to University guidelines and submit them for review at the College level in the Fall semester. An elected Promotion and Tenure Subcommittee of the CON Faculty Reappointment and Promotion Committee conduct a formal review of the faculty and submit their recommendation to the Dean by the end of the Fall semester. The Subcommittee and Dean's recommendation are forwarded to the University of Arizona Associate Provost where an appointed University-wide committee reviews the faculty dossier and recommendations, and then forwards their recommendation to the Associate Provost. The Associate Provost reviews the materials and makes a recommendation to the Provost, who makes the final decision. The expected faculty outcomes for tenure track faculty are congruent with University guidelines and are presented in the CON Faculty Handbook, under Tenure Track Promotion and Tenure Guidelines. (http://www.nursing.arizona.edu/IntraNet/facManual/chapter2/tenure-criteria.pdf). Promotion Review: Clinical Track: Non-tenure eligible (clinical track) faculty are reviewed for promotion by an elected Clinical Track Subcommittee of the CON Faculty Reappointment and Promotion Committee. Faculty members prepare their dossiers for review and the Subcommittee makes recommendations to the College of Nursing Dean during the Spring semester according to Guidelines for Reappointment and Promotion for clinical track faculty published in the CON Faculty Handbook (http://www.nursing.arizona.edu/IntraNet/facManual/chapter2/clinical-criteria.pdf). The CON criteria are generally congruent with University guidelines for non-tenure eligible faculty and provide for more specific criteria regarding expected outcomes appropriate for clinical track faculty in the College of Nursing. The entire review occurs within the College of Nursing and the final decision rests with the Dean.

Evidence of Faculty Outcomes Faculty outcomes are summarized in Exhibit IV-E-1 in the Resource Room. Data indicate that we meet/exceed established teaching, scholarship/research, and service/practice performance benchmarks across all years of data collection, with the exception of two instances in 2007 and 2008 when 1 faculty

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member received evaluation scores below 3.0. Exemplar faculty outcomes and summary data are provided for each of the performance evaluation areas and demonstrate how the CON faculty contribute to the mission, goals and strategic plans of the University of Arizona and College of Nursing.

Excellence in Teaching All faculty at the CON contribute to the teaching mission in one or more of the College's programs: BSN, MS, DNP, or PhD. Students and alumni satisfaction data identify that one of the College's strengths is its faculty excellence in providing a challenging, rigorous, and creative academic environment. We engage baccalaureate students using diverse teaching/learning strategies that include simulation, lecture/seminar, agency- and community-based clinical experiences, and asynchronous online experiences. Students in the graduate program interact with through on-site intensive experiences (clinical skills and research experiences) and a technology-supported curriculum that students describe as "creative", "innovative", "flexible", "intense", and "scholarly". Students evaluate teaching excellence by participation in the University-wide Teacher-Course Evaluation (TCE) process conducted by the Office of Institutional Research and Planning Support (OIRPS) at the conclusion of each semester. Forms are available at http://aer.arizona.edu/AER/questionnaires/ques.asp. These evaluation data are used as previously described in Standard III, and as aggregate measures of teaching effectiveness for the CON. Used in a summative format, TCE reports are generated to summarize performance by CON programs (graduate and undergraduate) across all courses for the past 6 years. This summative 6-year report is considered to be highly stable, reliable and valid (with excellent precision) as a measure of program effectiveness. Of particular note, the CON has a large N and good participation rate from students. These reports provide sound data for interpreting teaching effectiveness (http://aer.arizona.edu/teaching/Guide/TCEGuide.pdf, accessed 11/20/09). Forms are submitted by students directly to the Office of Institutional Research and Planning Support (OIRPS) which generates and reports individual data to each faculty member. Aggregate data are reported for a 6 year period and are available to administrative units (Division Directors, OAA, and OSA) at the CON. OIRPS recommends using the mean score of the items, the standard deviation for each score. And the calculated margin of error (the difference between the upper and lower confidence levels) for evaluation purposes. Used as a summative evaluation tool, the TCE is a criterion-based evaluation process, as opposed to a normative evaluation. The standard benchmark for undergraduate university academic units is 3.0 on a 5-point scale, where 1 means "almost never effective", 3 means "sometimes effective" and 5 means "almost always effective." The standard benchmark across the graduate university academic units is approximately 4.0. The desirable margin of error is 0.5 or less, given the 5 point scale (https://aer.arizona.edu/testscoring.asp) last assessed 12/1/09) One hundred percent (100%) of the faculty were individually rated at satisfactory or above by students in the BSN and graduate faculty between 2006 and 2009. Table IV-E-1 provides the current teaching effectiveness data for the CON

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based on TCE data from 2003 to 2009. Faculty at the CON exceed the University benchmark for teaching effectiveness, positively contributing to the teaching mission of the CON.

Table IV-E-1: CON Teaching Effectiveness Data: 2003-2009

Class Type Sections Mean Benchmark S.D. 95% LCL 95% UCL Difference Baccalaureate Upper Division 315 Lecture Upper Division 189 Lecture (Summer) Lower Division 43 Lecture Upper Division Web 22 Delivery Discussion/Seminar 48 Laboratory/Clinical 778 Laboratory/Clinical 151 (Summer) Graduate Seminar/Lecture 35 Seminar/Lecture 33 (Summer) Web Delivery 192 LCL = Lower Confidence Level

4.0 4.3 4.4 3.9 4.6 4.4 4.3 4.5 4.7

3.0 3.0 3.0 3.0 3.0 3.0 3.0 4.0 4.0

0.54 0.53 0.60 0.82 0.38 0.56 0.70 0.44 0.27

3.95 4.21 4.25 3.51 4.51 4.36 4.22 4.31 4.63 4.19

4.07 4.36 4.61 4.19 4.73 4.44 4.44 4.65 4.85 4.43

0.12 0.26 0.36 0.68 0.22 0.08 0.22 0.34 0.22 0.24

4.3 4.0 0.53 UCL = Upper Confidence Level

During the past three years, the CON faculty have been recognized for teaching excellence at the local, state and national levels (Exhibit IV-E-2 in the Resource Room). Exemplar awards by state and national organizations include recognition by the Geriatric Nursing Education Consortium, American Association of Colleges of Nursing (2007, 2008), the Wakonse Organization (2008), The March of Dimes, State of Arizona Chapter (2009), and The American Heart Association (2008). Appendix IV-E-1 provides a description of exemplar faculty teaching awards and recognitions. Further evidence of the CON's excellence in teaching/academics is demonstrated through the award of 12 new Health Resources and Service Administration (HRSA) training grants between 2006 and 2009. The HRSA grants reflect the CON's leadership role in developing programs that meet the needs of Arizona's population in areas that include the Doctor of Nursing Practice with ACNP and Pediatrics foci, developing a diverse workforce, and implementing online doctoral education. In addition, CON faculty have been co-investigators and core faculty on 2 interdisciplinary training grants; one funded by Arizona Area Health Education Center, Visionary Interprofessional Health Sciences Training in Arizona (VIHSTA) to train rural health care providers in the US-Mexico border region and one funded by the National Institutes of Health/National Center for Complementary and Alternative Medicine (NIH/NCCAM T-32) to train researchers studying complementary/alternative/integrative therapies. Appendix IV-E-2 provides additional description of educational/academic grants awarded to CON faculty (2006-2009).

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Excellence in Research, Scholarship, and Creative Activity Faculty contribute to the research/scholarship mission of the University through a variety of activities. Faculty (n=27) and students (n=11) at the CON contribute to this Research I institution's research mission, having been awarded a total of 61 externally funded projects. External funding provides support for studies about vascular injury, bio-behavioral responses to acute and chronic disease, vulnerable populations, consequences of aging, health promotion and risk reduction in vulnerable populations, innovations for health care systems, and health response and symptom management in chronic illness. Funding sources include the National Institutes of Health, National Library of Medicine, American Cancer Society, American Heart Association, American Academy of Nurse Practitioners, Department of Defense, and the American Diabetes Association. Exhibit II-F-2 in the Resource Room provides a complete list of faculty intramural and extramural grants 2006-2009. Faculty, particularly those on the clinical track, are also engaged in additional scholarly and creative activities that include development of educational tools (podcasting, computer simulation, digital recordings), for use in baccalaureate education, end-of-life educational training for use in graduate and undergraduate curricula, development and implementation of a post-baccalaureate residency curriculum, palliative care nurse resource teams, and evidence based practice models for asthma. We actively assist undergraduate student scholarship by facilitating collaborative faculty-student research projects. Faculty (n= 24) chaired 27 honors thesis research projects (2006-2009) in areas such as healthy lifestyle among College freshmen, oral care in preventing ventilator-associated pneumonia, communication between deaf patients and hearing providers, and health care systems effects on patient decision making during cancer. Two students in the honors program have applied for and received funding for international research from the University of Arizona Biological Research Award Vista Open (BRAVO!) program. (http://www.ubrp.arizona.edu/bravo/default.cfm?id=about). This program is supported by the NIH National Center on Minority Health and Health Disparities and the Howard Hughes Medical Institute.

Faculty are active in the dissemination of knowledge. Table IV-E-2 identifies the number of faculty publications and presentations between 2006 and 2009. In 2008, 31 faculty published 209 articles in peer reviewed journals that included Supportive Cancer Care, Annals of Oncology, The Japanese Journal of Nursing Research, Journal of Clinical Sleep Medicine, Nursing Science Quarterly, Clinical Journal of Oncology Nursing, Journal of Professional Nursing, Advances in Nursing Science, Molecular Cancer Research, Applied Nursing Research, Journal of Transcultural Nursing, Journal of Medical Informatics, Heart and Lung, Nursing Outlook, Nursing Clinics of North America, Journal of Pediatric Health Care, Journal of Holistic Nursing, Biological Research for Nursing, Nursing Research, Family Medicine, Journal of Nurse Practitioners, Journal of Cancer Education, Blood Coagulation and Fibrinolysis, Journal of Alternative and Complementary Medicine, Diabetes Educator, and the Journal of Supportive Cancer Care. We also contribute to texts and reference book publications, including Essentials of Nursing Research, Psycho-Oncology, Encyclopedia of Family Health, Genetics and Ethics in Health Care, Corsini

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Encyclopedia of Psychology and Behavioral Science, Pathophysiology: Concepts of Altered Health States, Nursing Theories and Nursing Practice, and Everyone's Guide to Cancer Therapy. In 2008-2009, 5 faculty members were primary authors for textbooks, including Perspectives on Nursing Theory (5th ed.), Clinical Guidelines for Palliative Care, Transcultural Perspectives in the Nursing Care of Adults (5th ed.), Maternal-Newborn Nursing: The Critical Components of Nursing Care, Business and Legal Essentials for Nurse Practitioners. Appendix IV-E-3 provides exemplars of dissemination activities by faculty across tenure and clinical tracks (2006-2009). Table IV-E-2. Knowledge Dissemination Activities by Faculty: 2006-2008 Dissemination Activity Peer Review Publications National/International Presentations 2006 N 81 64 2007 N 118 80 2008 N 209 85

Excellence in faculty research/scholarship has been recognized by professional organizations. In the past three years, 5 faculty members have been inducted into the American Academy of Nursing, 2 have been inducted into the American Academy of Nurse Practitioners, and 1 has been inducted into the National Academies of Practice, Nursing. Faculty were also recognized by the American Academy of Dermatology, Interdisciplinary Network of CAM Researchers in Canada, the US Army Nurse Corps, Japan Society for the Promotion of Science, University of California, San Francisco, Duke University Center for Theology, Spirituality and Health, Oncology Nursing Society, the American Public Health Association, and Friends of the National Institute of Nursing Research for their contributions to knowledge development. Appendix IV-E-4 provides exemplars of external recognition of excellence in scholarship among faculty. The CON considers increased scholarship to be a central goal and has established several strategic benchmarks to track increases in faculty productivity in this area. (See Table IV-E-3 below.) IV-E-3. Expected vs. Actual Aggregate Faculty Research/Scholarship Outcomes: 2006-2009 Scholarship Benchmark % increase in extramural funding % increase in total research funding % Tenure Track faculty funded % increase in faculty publications/ citations % increase in faculty co-authored publications with students * Denotes a deviation from benchmark Expected outcome >10% >10% No benchmark >5% >5% 2006 -40%* -11%* 56% (13/23) 58.3% 58.3% 2007 30% 17% 47% (11/24) 31.4%% 52.6% 2008 6%* 9%* 45% (9/20) 43.5% 34.5% 2009 62% 19% 60% (12/20) No data yet No data yet

Funding decreases in 2006 can be linked to transitions in the Office of Nursing Research. In 2008, decreases in funding were primarily related to the number of no-cost extensions of several major grants and naturally-occurring multi-year grant cycles. Research productivity for the 4-year period has increased

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significantly, although it remains a critical focus for the CON, the Arizona Health Sciences Center, and the UA. Excellence in Service Faculty contribute to the service mission of the College of Nursing, and the goal of engaging partnerships to address healthcare needs, through public and professional service activities, University service at the College, Health Sciences Center, and University levels, and professional practice. Exhibit IV-E-4 in the Resource Room provide a complete description of service activities by faculty 2006-2009. The CON faculty have a strong presence in local, regional, national, and international public and professional service. We also actively support the local, regional, national, and international professional associations through their service activities. Over 40% of us currently serve as peer reviewers for publications or grants. Faculty have served in leadership positions for national/international professional organizations, including the American Medical Informatics Association, Chair Nursing Informatics Working Group; American Psychosocial Oncology Society, President; American Nurses Credentialing Center, Chair Commission on Accreditation; American Nurses Association, Board of Directors; International Society of Complementary Medicine Researchers, Executive Secretary; Multinational Association of Supportive Care in Cancer, Chair Fatigue Study Group; American Diabetes Association, Scientific and Medical Oversight Committee. Faculty are currently engaged in international professional/service activities in South Korea, Japan, India, Nepal, Tanzania, Italy, Mexico, Norway, Switzerland, Belgium, and Canada. Faculty are equally committed to the support of local efforts, contributing to the health education of southern Arizonans. For example, we teach life skills at the El Rio Clinic Homeless Project; provide leadership at community neighborhood associations; provided health and safety education for the Women in Transition Program; provided instruction at the Annual Science and Math Conference for 7 through 12 grade Women in Southern Arizona, provided health education for seniors residing at Tucson House; provided community education with the American Heart Association; provided parenting classes for the Community Outreach Program for the Deaf; and provided support for the International Rescue Committee Tucson. Faculty serve as members of boards of directors and officers for several local health-related organizations, including Southern Arizona AIDS Foundation (SAAF), Academy Village, Ben's Bells, Our Family Services, Southern Arizona Mental Health Corporation, and Food Service in Child Care Task Force. In addition to community and professional leadership, we provide leadership within the CON, the AHSC, and the UA. A total of 30 faculty members have served as leaders in University governance, including service on Faculty Senate, University Promotion and Tenure Committee, the University Hearing Board, Arizona Health Sciences Center Library Advisory Board, Learning Technologies Center Faculty Board, Arizona Health Sciences Center Interprofessional Education Planning Committee, Arizona Cancer Center Psychosocial Oncology Leadership Committee, the University General Education Committee, and the

th th

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Interprofessional Practice Work Group. Appendix IV-E-5 provides exemplar intramural and extramural service activities of faculty between 2006 and 2008. IV-F. Information from formal complaints is used, as appropriate, to foster ongoing program

improvement. Elaboration: If formal complaints indicate a need for program improvement, there is evidence that action has been taken to address that need.

PROGRAM RESPONSE

Between 2006 to 2009, there were 11 formal complaints at the CON, including grade appeals, admission/readmission appeals, and other academic issues. While the majority of these complaints did not indicate a need for program improvement (i.e., the grievance/complaint was found without merit after investigation per CON/UA policies/procedures identified in Standard I, (pgs. 18-19), two complaints did result in programmatic changes. Investigation of the grievance filed when a student challenged an instructor's charge that she violated the UA/CON policy on academic integrity created an opportunity for faculty and program administration to examine methods to provide objective feedback to students about the correct way to cite references, use information provided by outside resources to prevent plagiarism when writing papers and assignments. The Assistant Dean for Student Affairs, Vickie Radoye, researched various methods to assist faculty and students in their assessment of written materials and to help students self-monitor their work. She recommended that the CON require students to use an online service, TurnItIn (http://www.turnitin.com/static/index.html), to be used across all CON programs. We adopted this program in 2006 (refer to policy 3.06 in the UA CON Faculty Handbook, (http://www.nursing.arizona.edu/IntraNet/facManual/faculty-manual.htm) and continue to successfully use it across the curriculum. TurnItIn instructions are provided to students in the syllabus for every course (evidence provided in the Resource Room course files) and links to this service can be found in on the homepage for all online graduate courses. A second complaint about the admission process provided an opportunity for faculty with assistance from the Assistant Dean for Student Affairs and personnel in the OSA to: (a) review the application questions; (b) review questions used by faculty during applicant interviews; (c) orient faculty committees that are actively involved in the student recruitment processes/procedures; (d) identify ways to engage faculty in ongoing education about federal, state, and University rules and regulations about the admissions process. These materials (provided in Exhibit IV-E-4 in the Resource Room) are reviewed and updated by the OSA prior to each application cycle. Faculty participating in the admissions processes (baccalaureate and graduate programs) attend training/orientation session prior to each admission cycle. Finally, evaluation of the admissions processes is conducted by the OSA and results are shared with faculty committees following the admissions process.

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STANDARD IV SUMMARY

Strengths: · · · · The programs are effective in preparing graduates to meet the diverse health care needs of the state and nation. The faculty use a variety of outcomes data designed to improve the quality of the academic programs. The faculty engage in productive scholarship that improves the human condition. The faculty and students partner with and serve diverse communities at the local, state, national and international levels. Areas for Improvement:

·

· ·

De-centralized evaluation process with some unclear lines of accountability and responsibility. Consistent and timely dissemination of evaluation outcomes data to faculty for the purpose of program improvement. Response rates to alumni and employer satisfaction surveys indicate the need for revised evaluation methods across programs.

Action Plans: · · · Streamline evaluation processes and clarify accountability/responsibility for data collection, analysis, and dissemination of outcomes to facilitate ongoing use of data. Explore new ways to evaluate alumni satisfaction and engage increasing numbers to respond to evaluation methods. Explore new ways to engage employers of graduates in the evaluation processes of the CON.

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