1
Byrdine F. Lewis School of Nursing
Academic Program Review Self-Study
Review Period: 2002-2005
A. Unit Assessment of Strengths and Weaknesses
Quality of Instruction, Research, & Service: The quality of instruction in the Byrdine F. Lewis School of Nursing (BFLSON) is very good. We have expert clinicians and teachers instructing our students at all program levels. Indicators that support the quality of our instruction include outcomes such as improved first time pass rates on the NCLEX licensure examination by undergraduate (UG) students, advanced practice nursing certification rates of greater than 90% by our master’s students, faculty research and scholarly productivity, and leadership positions held by faculty and alumni in the community.
One area for improvement is related to our teaching performance. An overview of individual instructor evaluations for nursing courses indicates that current student satisfaction with instruction is good to very good; however, student and alumni reports via the OIR (see Section D. Curriculum Quality), indicate that the quality of instruction related to the preparedness and class presentations of some faculty is of concern. Our aim is foster teaching excellence, thus we will continue to sponsor educational opportunities for faculty development in teaching, encourage new faculty members to attend professional development workshops to improve the quality of instruction, and mentor new nurse educators in the art of instruction.
We are pleased with the increase in research and scholarly productivity in the BFLSON (see Table B-2 and discussion in Section B. Current Context), yet there is room for improvement. We are excited about the initiatives we have implemented to support research and scholarly productivity. In the last 2 years two tenure track faculty members with research expertise and who have obtained federal funding have joined the faculty. In addition, a faculty member with expertise in statistics has joined the faculty part-time. Measures are in place to support the research development of new doctoral-prepared faculty and the productivity of senior faculty (e.g. consultation with a research consultant, support for a mock grant review, faculty release time, development of a research interest group). A mentorship program for new doctoral-prepared faculty was instituted two years ago. The challenge is a time issue for faculty: increasing research and scholarly productivity while managing teaching workloads. The amount of external funding is acceptable, yet an increase in grants, particularly at the federal level is desired. The opportunity for promotion of our non-tenured track (NTT) faculty is now available and includes the expectation of scholarly productivity through publication. With this new expectation for publication to obtain NTT promotion, the BFLSON will need to develop support systems to assist NTT faculty in meeting this criterion. We have a research and scholarly productivity interest group that is lead by an expert nurse researcher consultant and that supports grant writing and publication. However, a mentorship program for NTT faculty seeking promotion would likely increase their scholarly productivity while supporting promotion.
Faculty service to the BFLSON, College of Health and Human Sciences (CHHS), the University, the greater Atlanta area and professional nursing is exceptional. Faculty members serve on an average of two committees in the BFLSON. Many serve on College committees and on the Senate and Senate sub-committees. As noted in Appendix F5, faculty members are involved in professional nursing organizations, serving on national, state, and regional boards and committees. Faculty service to the greater Atlanta community ranges from volunteer clinical practice to service as members of community boards and committees. In addition, the BFLSON Health and Wellness Collaborative serves the community by conducting back-to-school physicals for underserved children, providing flu shots to state employees, and offering other health screening activities. Faculty service to the community is varied and extensive.
Centrality of Programs to University: The BFLSON contributes to the mission of the University through the successes of its graduates who “contribute to the economic, educational, social, professional, and cultural vitality of the city, the state, and the region.” Nursing students and graduates address social and human welfare issues and promote innovation in health care. Similarly “the mission of the College of Health and Human Sciences is to engage in teaching, scholarly endeavors, and service activities that improve health and well-being and address social justice issues within a multi-cultural society.” Faculty members in the BLFSON teach students in the art and science of nursing, are engaged in a wide range of scholarly activities, and are involved in service activities within the University and the community. In addition the BFLSON meets a key need in the state of Georgia. With the current nursing shortage that is expected to leave Georgia with a 23% nursing shortage in 2010, graduates of our programs make significant contributions to the health and welfare of Georgia citizens. In summary, the BFLSON makes significant contributions to the University, to Atlanta’s health care community, and to the citizens of Georgia.
Viability of Programs: The undergraduate (UG), master’s (MS), and doctoral (PhD) programs in the BLFSON are viable. Admissions to the UG program have doubled in three years since the initiation of the accelerated program. The number of UG graduates has increased from 61 per year in Spring 2003 to 104 per year in Spring 2005; see discussion in Section B and Table B-3. Applications for admission range between 400 – 800 applicants per year; many qualified applicants are denied admission due to lack of faculty and clinical resources. Managing the costs for the UG clinical nursing courses is challenging from the perspective of the expense of hiring part-time clinical instructors who are necessary to meet state and agency regulations that dictate clinical instructor to student ratios in clinical agencies; see Section B, Current Context. In summary, the UG program is viable with increased enrollments and graduations and improved student outcomes (higher first time NCLEX pass rates), however, the expense of part-time clinical instructors is a significant resource issue.
Consistent with the BFLSON mission of a focus on graduate education, enrollment in the master’s program is also strong and has increased steadily over the last three years, ranging from 176 students enrolled in the MS program in 2003 to 246 students enrolled in 2005. The number of MS graduates over the last three years has averaged 86 graduates per year; see Table B-3. We are pleased that our graduates have a very high rate of certification and are employed in advanced practice nurse (APN) roles; see Section B, Indication of Program Relevance. However, two resource issues prevail. Although the availability of certified advanced practice nurses at the doctoral level is limited, we have a strong cadre of master’s prepared advanced practice nurses who teach in specialty courses. The limited availability of doctoral-prepared clinical nurse specialists (CNS) and nurse practitioners (NP) in specialty areas restricts our ability to increase the tenure/tenure track (T/TT) to NTT faculty ratio. In addition, with the increased enrollment in the master’s courses and greater restrictions regarding MS trainees in clinical sites, recruiting qualified advanced practice nurses and physicians to serve as preceptors can be challenging and has limited enrollment in one of the specialty tracks (Family Nurse Practitioner [FNP]). In summary, student enrollment and graduations indicate that the MS program is viable. The two resource issues are continually being addressed.
The number of students in the PhD program has remained steady over the last three years, averaging 27.6 students per year. Annual graduations average three per year. See Table B-1. These numbers reflect the attempt by the BFLSON to decrease the number of doctoral students as recommended by the Academic Program Review Committee (APRC) at the time of the 1993 review (n = 50). The quality issue associated with the PhD students is related toGRE scores. Over the last three years, the mean total score by matriculated students for the verbal and quantitative sections was 965; mean verbal score = 493; mean quantitative score = 471; see Table E-1b and discussion in Section E. The GRE website reports that the general test percentage distribution of scores within nursing based on seniors and non-enrolled college graduates for verbal and quantitative performance are as follows: verbal—mean = 454; quantitative—mean = 519. Our average student admission verbal score exceeds that reported by GRE, while our quantitative mean score falls considerably below that reported by GRE. A potential explanation for lower quantitative GRE scores is the fact that our PhD applicants apply for doctoral education approximately 15-20 years post-baccalaureate degree. The time lapse of many years between completion of the baccalaureate degree and exposure to formal mathematics courses and application to the PhD program likely contributes to lower performance on the GRE. However, our experience with PhD students indicates that students with lower quantitative scores can be successful in the program, particularly those who have research interests consistent with their faculty mentors.
From a resource perspective, we have recently employed three faculty members who are seasoned researchers, one of which is a statistician. Their expertise enhances our program and will allow some expansion of the PhD program with additional faculty to serve as committee chairs. In summary, enrollments and graduations from the PhD program support its viability. Although GRE scores are less than optimal, student success has been excellent.
Strategic Focus: Our strategic focus is on excellence in our nursing programs. The critical nursing shortage will plague health care in the United States for decades to come. Our nursing programs produce nurses who lessen the impact of that shortage in Georgia. In the last 3-4 years, our UG program has undergone many changes that have enhanced student outcomes in regards to ERI Exit Examination and NCLEX performance. With a strong program in place, we were able to offer an accelerated program to qualified students who could successfully complete the BS in nursing in four semesters. We have succeeded in almost doubling the number of nursing graduates per year with the implementation of this new track. From student application numbers for RN licensure in Georgia, we estimate that about 90% of our new graduates accept nursing positions in Georgia, making a significant contribution to health care in Georgia.
At the master’s level, we offer a MS degree with the option of choosing one of five specialty tracks (adult health clinical nurse specialist [AHN CNS], women health nurse practitioner/clinical nurse specialist [WHNP/CNS], pediatric nurse practitioner/clinical nurse specialist [PNP/CNS], psychiatric mental health clinical nurse specialist [PMH CNS], and family nurse practitioner [FNP]. The rationale for choosing these specialty areas was based on the need for advanced practice nurses that could function in primary care (e.g. clinics, health departments, etc.) or acute care (e.g. hospitals, etc.) settings. Advanced practice nurses offer cost-effective alternatives to physicians; these nurses can manage common health complaints and chronic illness seen in primary care or they can direct the care of patients with multiple and complex health care needs. Our graduates practice in both acute and primary care settings throughout Georgia and in many cases provide their services to the underserved.
The shortage of doctoral-prepared faculty in nursing mirrors the shortage of nurses in patient care positions. The BLFSON provides a strong research base in the PhD program that prepares nurses to conduct research that adds to the body of knowledge in nursing and health care. In addition, many of these graduates are employed in academic institutions. Of the 28 PhD graduates from 2000 to 2005, we were able to determine that 18 out of 20 (90%) are employed in academic institutions, 12 (60%) of these graduates are employed in Georgia institutions. Thus the BFLSON helps to meet the demand for qualified PhD prepared faculty.
Financial Resource Analysis: The School has received small budgetary increases during FY 2002, 2003, and 2004; a budget reduction was experienced in FY 2005 due to a one-time give back to the university; see Table A-1 and Appendix G3. Supplies remained stable until FY 2005 when a $5,000 increase was received. The travel budget has remained the same over the last four years. The BFLSON has been able to greatly increase credit hours during this period of time due to additional funding from ICAPP and Tenet to support the accelerated BS program. Tenet and ICAPP funds have supported three new FT faculty positions and have provided additional funds for part-time instructor (PTI) expenses. When the ICAPP and Tenet funds expire in 2006, the school will not be able to maintain this level of credit hour production without additional financial resources. In addition we have two faculty members funded by Tenet and will lose funding for these positions in Spring 2006. Although we have been very pleased with the increased enrollments, faculty scholarly productivity has been negatively influenced by heavy teaching assignments created by increased enrollment. Another critical issue related to financing the UG program is the cost for part-time clinical instructors (PTIs) who supervise students in clinical sites. Budget allowances for PTI costs are insufficient to cover the total cost for PTI services. See discussion in Section G. Resource Adequacy, Faculty Resources.
Table A-1. Byrdine F. Lewis School of Nursing Budget Summary FY 2002-2005
FY 2002 / FY 2003 / FY 2004 / FY 2005Personal / $2,455,516 / $2,491,555 / $2,565,934 / $2,550,558
Supplies / $100,973 / $100,973 / $100,973 / $105,973
Travel / $23,000 / $23,000 / $23,000 / $23,000
Total / $2,679,531 / $2,694,907 / $2,620,528 / $2,579,489
1
B. Historical and Current Contexts
Historical Context: The Department of Nursing was established in 1968 and offered an associate degree in nursing and a RN completion program (RN-BS). In 1973-1974, the masters program (MS) was initiated with multiple nursing specialty tracks approved including the AHN CNS, WHNP/CNS, PNP/CNS, PMH CNS, and FNP. In 1979 the associate degree program was eliminated and a generic baccalaureate nursing program (BS) was offered. By 1981 the Department of Nursing became the School of Nursing. The doctoral program (PhD) in nursing began in 1986 and has graduated 86 students as of Summer 2005. Due to the nursing shortage and the demand for enrollment in nursing programs, the BS accelerated track was initiated in Fall 2002. In 2003 the School of Nursing was renamed the Byrdine F. Lewis School of Nursing (BFLSON) following a generous donation by a benefactor.
Current Context: Current context is presented for academic years 2002-03, 2003-04, and 2004-
05. Currently, the BFLSON includes the Director, Associate Director for the Graduate Program, Associate Director for the Undergraduate Program, 31 full-time faculty (including Dr. Susan Kelley, Dean, CHHS), a business manager, and eight staff. Table B-1 displays a summary of the information on the rank, tenure status and minority status of faculty and Appendices B-4 shows the current faculty roster and summary tables. On the average for the three years, the faculty consisted of 30.6 full-time faculty, including Dean Kelley. Of these, tenured/tenure-track positions averaged 15.0 (45 T/TT/3 years) while non-tenure track positions averaged 15.7 (47 NTT/3) positions. During this time UG enrollment doubled with the initiation of the accelerated track, increasing from about 50 admissions per year to a current average of 110 per year. Monies from ICAPP and Tenet grants helped us manage the increased workload with a relatively stable faculty and the use of part-time clinical instructors. One benchmark school of nursing (SON), the University of Tennessee (UTN) at Knoxville reported a similar number of UG students (N = 249) and a smaller number of MS and PhD students. UTN reported a full-time faculty complement of 44 faculty, 10 more than we have in the BFFSON; see Appendix B6-a.
Table B-1 Faculty Distribution for FY 2002-2004
Tenure / Tenure Track / Non Tenure Track / Total^Year / Status / Prof. / Assoc. / Assoc. / Asst. / Clin. Assoc / Clin. Asst. / Clin Instr. (FT) / Acad Prof* / Clin Instr.** (PT)
F 02-03 / 3 / 8 / 2 / 2 / 2 / 8 / 2 / 3 / 0 / 30
Female / 3 / 8 / 2 / 2 / 2 / 8 / 2 / 3 / 0 / 30
Minority / 0 / 0 / 0 / 0 / 0 / 1 / 0 / 1 / 0 / 3
Tenure / Tenure Track / Non Tenure Track / Total^
Year / Status / Prof. / Assoc. / Assoc. / Asst. / Clin. / Clin. / Clin / Acad / Clin
Assoc / Asst. / Instr. / Prof* / Instr.**
(FT) / (PT)
F 03-04 / 3 / 9 / 0 / 2 / 2 / 8 / 2 / 2 / 0 / 28
Female / 3 / 9 / 0 / 2 / 2 / 8 / 2 / 2 / 0 / 28
Minority / 0 / 1 / 0 / 0 / 0 / 1 / 0 / 1 / 0 / 3
F 04-05 / 4 / 8 / 1 / 3 / 2 / 9 / 5 / 2 / 0 / 34
Female / 4 / 8 / 1 / 3 / 2 / 9 / 5 / 2 / 0 / 34
Minority / 0 / 1 / 0 / 0 / 0 / 1 / 1 / 1 / 0 / 4
Average / 3 / 8.3 / 1 / 2.3 / 2 / 8.3 / 3 / 2.3 / N/A / 30.6
* Academic Professional ** Part-time Clinical Instructors (PTIS) are not included in this table; see discussion in text.
On average 20 part-time clinical instructors (PTIs) supervise students in approximately 27 clinical rotations per semester during Fall and Spring semesters and 13 PTIs provide clinical teaching services in the summer semester. These PTIs are not considered part of the regular faculty complement. In a clinical course, 1 to 7 PTIs may be hired; they supervise 6-8 students in the clinical setting. To assure patient safety, small group supervision is regulated by the Georgia State Board of Nursing and to some degree by clinical agencies that can only accommodate a specified number of students within a clinical unit. The course administrator (full-time faculty member) for the course oversees the PTIs. Hiring of the PTIs is done on a semester basis by the Associate Director for the Undergraduate Programs in conjunction with the faculty teaching in the course. Each PTI is paid approximately $4200 per clinical rotation (i.e. 12 hours/week x 7 weeks). The cost of these PTIs is a drain on the BFLSON budget, as they do not directly generate credit hours. During Fall 2004, Spring 2005, and Summer 2005, 52 PTIs covered 65 clinical rotations at the cost of $274,700. With the addition of new full-time faculty we expect these costs to drop slightly, however, projected costs for PTIs in Fall 2005 is $96,000 (17 PTIs covering 23 clinical rotations). The expert clinical PTIs are essential for keeping enrollment numbers stable. They are a more cost-effective and practical alternative to hiring full-time faculty for clinical rotations. The numbers and cost of FT faculty to meet the needs for clinical instructors for UG students would be exorbitant. Our utilization