Toolkit for Deans and Directors

This section provides resources and references that will help alert you to basic administrative issues occurring within a nursing program.

• Policies and Procedures
• Nursing Care Quality Assurance Commission Requirements
• Oversight by Other State Regulatory and Budget Authorities
• Accreditation Requirements
• Sample Job Descriptions and Detailed Job Expectations for Deans and Directors

Policies and Procedures

Policies and procedures of an institution provide guidance in administrative decision-making.  There are college-wide policies that are relevant to all programs within the institution.  Additionally, nursing programs have program-specific policies and procedures in place.  A new dean or director will find it essential to understand both sets of policies and procedures in order to effectively lead the program.  Additionally, a new director may encounter the need to examine these policies and procedures and lead efforts toward change.

Nursing programs have unique needs and demands related to their state approval, specialized accreditation and the demands of the dean/director role.

Nursing Care Quality Assurance Commission (NCQAC, Nursing Commission)

Oversight by Other State Regulatory and Budget Authorities

State Board for Community and Technical Colleges (SBCTC)

Accreditation Requirements

Accreditation by the Northwest Commission on Colleges and Universities (NWCCU)
Both community colleges and baccalaureate and higher degree granting educational institutions are accredited by the regional accrediting body for the Northwest, which is the Northwest Commission on Colleges.  Nursing programs, their deans/directors, and faculty are expected to participate in the processes required by regional accreditation. This involves a campus-wide self-study, the use of the evaluation results for quality improvement, submission of a report, a campus site visit by a NWCCU team, and subsequent follow-up as recommended. This accreditation is essential for student academic credits to be transferred to other accredited academic institutions across the country. A new dean/director would be wise to inquire about the most recent recommendations from the NWCCU and any ongoing actions being taken in response to the college accreditation process. Substantive changes in degrees or programs offered must be communicated in advance to the NWCCU.

Accreditation by a Specialized Nursing Education Organization
Specialized accreditation represents a process for demonstrating that a program meets a given set of national standards regarding nursing education. This process requires the faculty to complete a comprehensive self-study of the program including its structure, processes, and outcomes and to use this self-study in quality improvement. Specialized accreditation is not required but considered positively by those students and community members who are aware that national standards exist. There are some continued education and employment opportunities that are only available to graduates of an accredited program. Substantive changes in an accredited nursing program must be communicated in advance to the accrediting body.

CCNE
Information on CCNE and its accreditation standards

NLNAC
Information on NLNAC and its accreditation standards

Job Descriptions for Deans/Directors

Job descriptions for deans/directors vary greatly based on individual institutions and programs.  For example, a program director in a setting with a total of 48 students in a single program will have a very different job description from a setting with multiple nursing programs and hundreds of students.  In some instances the director of the nursing program also serves as the dean of a college division which may include other health related programs.  In the larger baccalaureate programs there may be associate deans and job duties such as research that may be required in addition to managing the educational program.

The requirements for a program director found in the WAC and in the standards and criteria of nursing accreditation bodies provide a starting framework from which to evaluate a job description.

• Requirements of nursing directors according to WAC
• Requirements of nursing directors/deans according to nursing accreditation standards and criteria: NLNAC, CCNE

A variety of sample job descriptions for deans and directors will be provided here upon availability.

This section provides assistance in managing the many clinical sites used for student learning.

Information is provided here regarding:

• Clinical Placement Expectations
• Contracts with Clinical Agencies
• Clinical Agency General Meetings
• Clinical Placement Consortia in WA
• Clinical Placement without a Consortium

Clinical Placement Expectations

The basic requirements for clinical placements relate to the requirements of the Nursing Commission, accrediting bodies, and the adequacy of the site as related to the outcomes of the individual program.

Information from the Nursing Care Quality Assurance Commission regarding clinical facilities
WAC 246-840-560, 246-840-575, 246-840-455 Standard III. Resources, facilities, and services for approved nursing education programs:

“3) Clinical facilities.

(a) A nursing program shall utilize a variety of sites for learning experiences to enable the student to observe and practice safe nursing care of persons at each stage of the human life cycle. These experiences must include opportunities for the student to learn and provide nursing care to clients in the areas of acute and chronic illnesses, promotion and maintenance of wellness, prevention of illness, rehabilitation, and support in death. Clinical experiences shall include opportunities to learn and provide care to clients from diverse ethnic and cultural backgrounds. The experiences may include, but need not be limited to, hospitals, clinics, offices of health professionals, health centers, nursery schools, elementary and secondary schools, rehabilitation centers, mental health clinics, public health departments, and extended care resources.

(b) Clinical facilities must be selected to provide learning experience of sufficient number and kind for student achievement of the course/curriculum objectives. The number of hours of class and clinical practice opportunities and distribution of these shall be in direct ratio to the amount of time necessary for the student at the particular stage of development to accomplish the objectives.

(c) Clinical facilities must be approved by the appropriate accreditation or licensing evaluation bodies, if such exist.

(d) Throughout the program the total hours of class and required clinical practice opportunities may not exceed forty hours per week.”

Updating/creating a list of all clinical facilities in current use
Develop a list of current clinical sites, including information on

• the name and title of the individual who arranges placement for nursing students (often an education coordinator or in a smaller facility the director of nursing),
• the names of other nursing programs that use the same sites and their directors,
• the specific units of the facility and the courses, instructors, and times of use by your program,
• the possible types of clinical experiences available there, including the ones you use and others available at that site.

Evaluating Clinical Facilities
Evaluations of existing clinical facilities should be developed as part of the comprehensive program evaluation required by the Nursing Commission and by accreditation agencies. Evaluations may include student as well as faculty voices.

Clinical facilities should be evaluated in relationship to:

• Types of experiences available for nursing students
• Adequacy of staff to maintain standards of care and work with students
• Facilities available for instruction such as conference rooms, libraries, and so forth
• Institutional support for the educational process
• Appropriate accreditation/approval of the agency

Although accreditation of the hospitals within Washington State is not a concern, long-term care facilities pose some issues. If a long-term care facility has had a state visit and was found to be not in compliance with important standards, they may be placed on a “Stop Placement” order. This means that new residents cannot be admitted until standards are met and the order is lifted. The law also indicates that facilities with a “Stop Placement” order should not serve as sites for clinical teaching. Monitoring the status of long-term care facilities is an ongoing necessity. While some have never had a “Stop Placement”, others have had more difficulties with maintaining standards. Nursing home status for an individual institution and information on all facilities in a certain area can be obtained at . You can also access quality information at Nursing Home Compare, a website operated by CMS. Any nursing home that has had repeated problems will be identified on this site.

Logistical Information:

• Distance from the college
• Parking or access by public transportation
• Requirements for faculty members and students who practice in the facility, i.e. immunizations, background checks, drug screens, TB testing, and orientations. These may be quite extensive in some hospitals.

Selecting Clinical Facilities
Available clinical facilities are compared with program and course outcomes/objectives to determine which available facility should be used for a particular course.

Types of clinical facilities that might be used:

• Hospitals
• Long-term care facilities
• Ambulatory clinics
• Schools
• Other—creative approaches to patient contact may be needed in some situations. The examples provided below are only two of many that nursing programs have developed. Clinical hours may be given for these types of experiences. They are usually documented by some type of journal or log.

o   A program posted a notice on campus asking for pregnant students to meet with a nursing student throughout the semester to discuss their pregnancy, issues relating to pregnancy, and their feelings as they moved through the process. Because this was a large campus, this resulted in students having longitudinal experiences in meeting with a pregnant woman. The program developed specific objectives and a structure for the process to guide students in learning. This provided valuable experience in meeting outcomes relative to the ante partum woman.
o   A program sought well older adults living in retirement settings to meet weekly for a set number of weeks with a nursing student. Through this planned program each student had an opportunity to discuss wellness and participate in health teaching for an older adult. They met outcomes relative to communication as well as outcomes related to aging, assessment, health teaching, and health promotion.

Site selection must often be adjusted based on:

• Time or shift availability in relationship to class time requirements on the campus,
• Availability in relationship to the quarter in which the course will be taught,
• Presence of other programs at the site,
• Competing needs of differing levels within the program.

Contracts with Agencies

A formal contract between the school and the clinical agency is required for each clinical agency. Developing these contracts and getting them signed will take many weeks. All contracts must be reviewed and updated so that they are current.

Each college usually has a standard contract.  Approval of any changes in a contract must often come from a higher administrative office at the college.  In some instances a change will be taken to the college’s legal representative. In the state colleges that would be the appropriate assistant attorney general.

Many of the larger hospitals have their own standard contract that they require. The college may require higher review of a contract presented by a clinical agency.

General Provisions of Contracts

• Timeframes—multi-year contracts are common, but all have timelines for renewal.
• Educational decisions remain the prerogative of the college.
• The agency has the right to deny access to any person based on their standards regarding background checks, immunizations, etc.
• Requirements for faculty and students to abide by policies and procedures of the agency, including HIPAA, infection control requirements, and others.
• Statements about severability and notice before severing the contract.  There needs to be adequate notice so that the students currently enrolled in clinical experiences can complete their term.
• Liability responsibilities: Many colleges require students to carry malpractice insurance, and this may be required by the clinical agency. Faculty may be covered by the college, but may also carry personal malpractice insurance. The clinical agency usually does not assume liability for the faculty or students.

Clinical Agency General Meetings

Many larger clinical agencies, such as hospitals, hold an annual planning meeting to discuss student clinical issues and future placement plans.  At these meetings, information on changes at the agency, new requirements, and placements are discussed. This may be the place to present the need for a new or different clinical experience or time schedule.  With representatives present, it may be possible to negotiate an exchange of time and site use.

These meetings are held early in spring quarter and on occasion at the end of winter quarter. Attendance at these meetings by the director or designee is essential in maintaining clinical sites and effective relationships with clinical agencies.

Clinical Placement Consortia

A clinical placement consortium is a collaboration of nursing programs and clinical facilities in a specific geographical area whose purpose is to arrange for the effective use of available clinical sites in order to enable all programs to provide appropriate clinical experiences for students.

A consortium usually has a staff member who serves to track clinical site availability, develops advanced placement schedules, provides a single point of contact and assists with navigation of the process for facilities, schools and students.  The programs who are members of a particular consortium agree to seek clinical placements through the consortium only and not independently.

When a program needs a new site, the following steps are recommended:

• Develop a clear statement of the level of student, the type of experience needed, the objectives to be met, and the time schedule for the clinical experience. Consider what flexibility you have in the time schedule.
• Identify any clinical sites you will no longer need.
• Provide this information to the consortium staff member.

This section provides basic resources and references that will help you navigate the legal issues found in an educational setting.

Information provided here is NOT to be construed as specific legal advice. This site provides general information and resources as a background for the decision making process.

You will find information and links in regard to the following:

• Campus Resources for Assistance
• FERPA—Family Educational Rights and Privacy Act
• Avoiding Grievances/Litigation Regarding Grading Decisions and Disciplinary Actions
• Criminal History Background Checks
• Drug Screening/Testing
• Sample Policies
• Washington State Human Rights Commission 

Campus Resources for Assistance

When developing policies and procedures in regard to any legal issue, a director/dean needs an understanding of the official approval avenues within the institution and knowledge of the personnel on campus who can provide guidance regarding legal issues. This may be the dean of a particular division or it may be a vice-president of student affairs (or similar title).

In some instances a college may decide that a legal opinion from the college attorney is needed. In the case of state colleges and universities this would be the state-appointed assistant attorney general for the institution.  Private institutions have their own processes for attorney consultation. Access to an attorney is usually restricted and a specific process is needed for approval for accessing attorney services.

In some settings, risk managers for the clinical agency are in contact with health professional education programs regarding students, expected behaviors, and agency access. When issues arise that involve student behavior in the clinical setting, the risk manager may expect to be consulted regarding decisions. Clinical agencies do control who practices within the agency and administrators may react strongly if they are not informed of issues that occur within their setting.

FERPA—Family Educational Rights and Privacy Act

Definition:  
"The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education."

FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level. Students to whom the rights have transferred are "eligible students."

Text of the act is available online.

Amendments: FERPA Rule Changes—34 CFR Part 99—effective January 8, 2009

73 Federal Register 15574; 73 Federal Register 74806; 74 Federal Register 400 can be accessed online.

A PowerPoint presentation highlighting the changes from the 2009 amendments can be found online.

Policy information related to FERPA may be found online.

The main provisions of FERPA important for nursing programs are:

1. The right of the eligible student to inspect all records related to his/her academic process.
2. The right of the eligible student to request a change in records they believe to be incorrect or misleading. If that is denied, they must receive a formal hearing about the matter. If the record is not being changed, the eligible student has the right to add a note to the record.
3. The right to privacy of the records of the student.  These records can be shared only with the student’s written permission OR without the student’s permission to an entity specified in the law. The right to privacy of the records affects how you store records and who has access to records. It also affects how faculty use records and transport or transmit those records.

Privacy also relates to the use of readily identifiable personal information. Schools are prohibited from using social security numbers for student identification numbers. Clinical agencies may require social security numbers for conducting background checks.  The best option in these cases is to have the student provide the number directly to the agency, rather than the school providing the number.

Compliance Official: Most colleges and universities have an administrative official who is charged with assuring compliance with FERPA.  This individual is often the registrar or similar position. When questions arise, it is wise to seek the counsel of this administrative official.

State approval and national accreditation bodies expect nursing programs to have clear policies that conform to FERPA regarding student records.

If anyone other than the student, including parents or spouses, requests information from the academic file (is the student enrolled, how is the student doing, what classes is the student taking, etc.), the best practice is to take the contact information from the inquirer and then consult with the appropriate office on campus to determine what may be discussed and if the student’s permission is required.

Avoiding Grievances/Litigation Regarding Grading Decisions and Disciplinary Actions

Grading decisions relate to academic performance and include passing or failing clinical practice as well as the grade in the theoretical course. [Some schools also assign a letter grade in clinical.]

Disciplinary actions are those that result in warnings, suspension, expulsion, or other penalties based on misconduct, which is inappropriate behavior other than academic performance.

Disciplinary actions often involve different processes and requirements than grading decisions. Campus policies must be followed.

In nursing, the distinction between grading decisions and disciplinary actions is often blurred.  Traditional disciplinary concerns often fall under professional behavior, which may be a graded item in nursing clinical courses.  Clearly delineated course expectations are critical.  Consultation with the disciplinary officer on campus can help identify strategies to enforce professional expectations.

Just as in clinical malpractice actions, the likelihood of grievances and even legal action in an educational setting is often related to interpersonal relationships and perceptions of fair and considerate treatment.

Major concerns revolve around:

1. Effective policies and procedures
2. Due process is generally seen as including:
   a. Standards communicated in advance.
        i. For grades the standards are clear statements of what is required to obtain a given grade whether letter, numeric, or pass/fail
        ii. For discipline the standards contain clear prohibitions against cheating, plagiarism, and other issues that are important to the program
   b. Communication of deficiencies and opportunity to improve before final grade in the case of grading decisions. Notification and a hearing in the case of disciplinary action.
   c. Clear description of deficiencies relative to standards and resulting actions taken provided to student
   d. Grievance/appeal process
3. Confidentiality and privacy throughout the process
4. Fair Treatment/Non-discrimination—Actions that could be construed as arbitrary and capricious are considered actionable. Discrimination relates to protected classes or groups of individuals but may also be related to perceptions of discrimination based upon personal factors unrelated to performance.  Procedures for handling discrimination complaints need to be clearly spelled out and carefully followed.

References:
Boley, P. and Whitney K., (2003), Grade disputes: considerations for nursing faculty.  Journal of Nursing Education 42.5: 198-203. CINAHL with Full Text. EBSCO. Web. 9 Feb. 2010.

Johnson, J. G. & Halstead J. A., (2009) The academic performance of student: Legal and ethical issues, pp. 41-66 in Billings, D. M. & Halstead, J. A. (eds) Teaching students in nursing: A guide for faculty 3rd  ed., St. Louis, MO: Elsevier Saunders.

Osinski, K., (2003), Faculty forum. Due process rights of nursing students in cases of misconduct.  Journal of Nursing Education 42.2: 55-58. CINAHL with Full Text. EBSCO. Web. 9 Feb. 2010.

Westrick, S. J., (2007), Legal challenges to academic decisions.  Journal of Nursing Law 11.2: 104-107. CINAHL with Full Text. EBSCO. Web. 9 Feb. 2010.

Legal Cases of interest:
Dixon v. Alabama State Board of Education, 294 F. 2d 150 - Court of Appeals, 5th Circuit 1961—relating to due process—Case link

Tarka v. Cunningham, 917 F. 2d 890 - Court of Appeals, 5th Circuit 1990—regarding recorded grades in relationship to FERPA—Case link

Russell v. Salve Regina College, 890 F. 2d 484 - Court of Appeals, 1st Circuit 1989 —relating to actions taken in regard to an obese student—Case link

RJJ By Johnson v. Shineman, 658 SW 2d 910 - Mo: Court of Appeals, Western Dist. 1983—relating to assigning a failing grade—Case link

Board of Curators of Univ. of Mo. v. Horowitz, 435 US 78 - Supreme Court 1978—regarding failure in medical school—Case link

Olsson v. BD OF HIGHER EDUC, 49 NY 2d 408 - NY: Court of Appeals 1980—regarding academic failure—Case link

Susan M v. Law Sch., 76 NY2d 241 - NY: Court of Appeals 1990—regarding academic failure—Case link

Clayton v. Trustees of Princeton Univ., 608 F.Supp. 413 (D.N.J.1985)—relating to cheating—Case link

Criminal History Background Checks

Washington State Law
Child/Adult Abuse Information Act, RCW 43.43.830 through 43.43.845

This act requires that anyone having unsupervised contact with a vulnerable adult or a child must have a criminal history background check.  If this check reveals a conviction for a crime against a vulnerable adult or child, the nature of the crime and the time since the conviction of the crime are both significant in a determination of whether contact can be permitted.

Based on this requirement, both faculty and students in nursing programs will need to have background checks for access to patients in most clinical agencies. 

General Guidelines
Create clear policies on background checks, including

• who must have them,
• how they will be conducted,
• who will manage them,
• when they will be done,
• with whom they will be shared and
• the consequences of identified felony convictions.

Follow through consistently regarding the policy.

Policy Notes

• Make policies on background checks public knowledge.
• Written permission from the applicant is required before performing a background check for screening.
• If you intend to take action against someone based on the results of a background check, including but not limited to termination or failure to admit, you should do the following prior to taking the action:

1. Provide the subject of the report with a copy of the report, along with contact information for the background check entity
2. Allow the subject to dispute the findings and reconsider his or her status after the dispute is resolved if the resolution results in different findings.

The specific type of background check may be a requirement of a clinical agency and may be conducted through the agency.  Many agencies expect the nursing program to manage background checks for students and communicate results to them.  All types of checks take time and must be requested far enough in advance for information to be received before a clinical rotation begins. Students usually pay for their own background checks when there is a fee. Faculty background checks are usually paid for by the employer.

Processing results:
The laws (federal and state) and regulation indicate which criminal convictions will disqualify a person from working with children and vulnerable adults. Check with your clinical agency contact person. You can also check with the Nursing Commission about what would preclude licensure. The office of Aging and Adult Services provides the following list of convictions and their consequences. There are three groups of convictions listed. While these lists are binding for DSHS agencies only, other agencies often follow these as guidelines.

Group 1: If the individual’s record shows a conviction for the listed crimes, the person is automatically disqualified from employment at DSHS-regulated agencies.

Group 2: If the individual’s record shows a conviction for any of these listed crimes, the person may be hired without department action against the facility if the conviction date (court date) is three (3) or five (5) years (depending upon the nature of the crime) before the employment application date.

Group 3: If the individual’s record shows a conviction of any of these listed crimes, the facility may choose to disqualify the person.

The complete list is found online.

NOTES

• Automatically disqualifying felony convictions would make the student ineligible for any clinical agency and ineligible for licensure.  Based on this, most programs have a policy that the student will not be admitted to the program or if admitted, admission will be withdrawn.
• Other felony convictions, based on the date– Talk to the student, then contact the agency where you want to place the student with any letter of explanation from the student and a copy of the background check and seek permission to place the student. Remember the law states that an agency may deny an individual with these convictions but it is not required to do so.
• All students with any positive finding of a felony conviction should be notified that the program cannot guarantee the ability to place them in clinical settings throughout the program as individual agencies are in control of who they allow to provide care in their facility.

Commercial Background Check Companies: Cost is borne by students.
“The private data providers and screening services are considered consumer reporting agencies under the federal Fair Credit Reporting Act (FCRA) and state consumer reporting laws […] The commercial databases are not complete because not all states, and not all agencies within individual states, make their records available to such databases; nor does the FBI make its federal or state criminal records available to such databases. In addition, the information in the commercial databases may only be updated periodically. The commercial databases may also be missing important disposition information that is relevant to a conviction record’s use for employment suitability purposes, such as sealing and expungement orders or entry into a pre-trial or post-trial diversion program. Checks of these databases are based not upon positive, biometric identification (such as fingerprints), but upon personal identifiers such as names and other information that can help confirm a person’s identity. Nevertheless, these databases provide a source of information that is significantly broader than going to individual county courthouses in the counties where an applicant indicates that he or she has lived.”   (US Attorney General, 2006).

The following are known to be in use in Washington State Nursing Programs. Many others are available and may be in use.

Certified Background

Intelius

Verified Credentials

American DataBank

WATCH - Washington Access to Criminal History
The Washington State Patrol Identification and Criminal History Section (WASIS)

This covers convictions within the State of Washington.  When using the form without a thumbprint, these records can be accessed through an online system and therefore results are immediately available.  This is of limited use for persons who have been residents of other states.  When there is a question about the person’s identify, a thumbprint will be required.  This site specifically states:  “WASIS cannot guarantee the records you obtain through this site relate to the person on whom you are seeking information. Searches based on names, dates of birth, and other identifiers are not always accurate. The only way to positively link someone to a criminal record is through fingerprint verification.”
There is a resource of Frequently Asked Questions at: http://www.wsp.wa.gov/information/faqs.htm
Non-profit organizations can do free checks through the WSP.

FBI Fingerprint Checks
These are considered the most extensive of all background checks because they include nationwide data and are based on biometrics (fingerprints) but are also the most expensive. They also take 8-10 weeks for processing. These are required for some federal facilities.

Background Check Central Unit (BCCU) of DSHS
Because the WSP Background Check (see above) has been found to not contain some important data that is contained in the Judicial System Information (JSI) system, nursing homes and other DSHS supervised case settings now use the BCCU which checks the JSI for background checks. The BCCU will also process requests that include a thumbprint for WSP or fingerprints for FBI. Only the clinical agencies supervised by DSHS can process through the BCCU.

Background Checks for Graduates Seeking RN Licensure
The National Council of State Boards of Nursing (NCSBN) provides information on the requirements of the various states (December, 2008). Some states require background checks as part of the licensure application process. Many require self-disclosure of criminal history background and then investigate those with a positive history.  Failure to self-disclose is considered fraud and sufficient reason to deny or remove a license. Students should be informed of this. In Washington State, candidates for licensure with an out-of-state address are required to provide fingerprints at the time of application.

References
US Attorney General (2006), The Attorney General’s Report on Criminal History Background Checks. U.S. Department of Justice, Office of the Attorney General, online.

Farnsworth, J. & Springer, P.J. (May-June, 2006) Background Checks for Nursing Students: What Are Schools Doing? Nursing Education Perspectives. 27(3), online.

Jones, M. M. & Weninger, R. A. (2007), Student criminal background checks: considerations for schools of nursing. Journal of Nursing Law 11.3: 163-170. CINAHL with Full Text. EBSCO. Web. 9 Feb. 2010.

Drug Screening/Testing

Routine drug screening without specific causation
Some clinical sites now perform routine pre-employment drug screening on applicants for employment.
Based on this pattern, these agencies are now asking that nursing students be pre-screened and demonstrated to be drug-free before coming to the clinical agency. This is within the rights of the clinical agency.  An example of a type of screening is the 10 Panel:  Drugs that may be detected by these tests include: amphetamines, cocaine metabolite, marijuana metabolite, opiates, phencyclidine, barbiturates, benzodiazepines, methadone, methaqualone, propoxyphene, PCP and others.

Student Refusal of Routine Screening for Drugs:
A student refusing to be tested for routine drug screening cannot be placed in a clinical agency that requires testing.

The nursing program would be wise to not make assumptions regarding the reason for refusal in the absence of demonstrated behavioral issues (see below).

The response of the nursing program may vary based upon the availability of alternative sites. A student’s refusal to test would need to be managed in a manner consistent with due process if there are other sites available. If no other sites are available, then the student needs counseling as to the effect of refusal on the ability to continue in the program.

Drug Screening Based Upon Behavioral Concerns
When appearance and behavior lead an instructor to believe that a student may be impaired by drugs or alcohol, the instructor has a positive duty to patient safety to act.

As in all disciplinary situations, there should be policies in place to guide the action of the instructor. Many nursing programs use policies based on those used for registered nurses in clinical agencies and by the Nursing Commission. Many of these policies are based on differentiating the individual with a personal substance abuse problem and an individual who obtains drugs for others.  With those who have personal substance abuse problems, the goal of programs for all health professionals, including registered nurses, is treatment and rehabilitation.  The Department of Health has a comprehensive program for chemically impaired professionals and standards for response.  Information is available online. While this program is not open to students, its processes provide helpful approaches.

The National Council of State Boards of Nursing (NCSBN) has developed a set of Uniform Core Licensure Requirements for Boards of Nursing.  This document provides further information regarding chemical dependency.

Common policies include the following topics

1. Symptoms that would trigger investigation: WHPS provides a list of symptoms that could be included in a policy. While some individual symptoms would trigger an investigation, many of these as individual instances would not trigger an investigation, but a pattern of them would.
2. Immediate actions to be taken by instructor.
3. Referral for evaluation and treatment, including student requirements for compliance with and payment for evaluation.
4. Actions to be taken by the program subsequent to information obtained from evaluation.  Remember to consider due process.
5. Documentation of entire process.

References
American Association of Colleges of Nursing (1996). Policy and guidelines for prevention and management of substance abuse in the nursing education community. Journal of Professional Nursing, 12, 253-257. Online

Asteriadis, M., Davis, V., Masoodi, J., & Miller, M. (1995). Chemical impairment of nursing students: A comprehensive policy and procedure. Nurse Educator, 20(2), 19-22.

Clark, C. M. (1999). Substance abuse among nursing students: Establishing a comprehensive policy and procedure for faculty intervention. Nurse Educator, 24 (2), 16-19.

Coleman, E. A., Honeycutt, G., Ogden, B., McMillan, D. E., O’Sullivan, P. S., Light, K. & Wingfield, W. (1997). Assessing substance abuse among health care students and the efficacy of educational interventions. Journal of Professional Nursing, 13. 28-37.

Finke, L., Williams, J. & Stanley, R. (1996). Nurses referred to a peer assistance program for alcohol and drug problems. Archives of Psychiatric Nursing, 10(5), 319-324.

Kalb, C. (2002, April 9). Playing with pain killers. Newsweek, CXXXVII (15), 45-48.

Marion, L. N., Fuller, S. G., Johnson, N. P., Michels, P. J. & Diniz, C. (1996). Drinking problems of nursing students. Journal of Nursing Education, 35(5), 196-203.

Naegle, M.A. (1989). Patterns and implications of drug use by students of nursing. Imprint, 36(2), 85, 87-88.

Polk, D., Glendon, K. & DeVore, C. (1993). The chemically dependent student nurse: Guidelines for policy development. Nursing Outlook, 41, 165-170.

Smardon, M. (1998). An integrative review of substance abuse among nurses from 1981 to 1997. Online Journal of Knowledge Synthesis for Nursing, 5(doc1), no pagination.

Spier, B. E., Matthews, J. T., Jack, L. J., Lever, E. J. (2000).  Impaired student performance in the clinical setting: A constructive approach, Nurse Educator 25(1) 38-42.

Trinkoff, A. M., & Zhou, Q. (2000). Workplace access, negative proscriptions, job strain, and substance use in registered nurses. Nursing Research, 49(2), 83.

Trossman, S. (2003) Nurses' Addictions: Finding alternatives to discipline, American Journal of Nursing 103(9),  27-28.

This section provides basic resources and references that will help you manage a variety of student-related issues found in a nursing education setting.

Information is provided here regarding:

• Admission Policies
• Student Grievance Policies
• Problematic Student Behavior—Disruptive Behavior, Inappropriate Conduct, and Anger/ Hostility
• References

Admission Policies

A wide variety of admission policies and procedures are used by nursing programs throughout Washington State. Specific admission requirements tend to be more similar within program types such as practical nursing, associate degree nursing, and baccalaureate and higher degree nursing.

Common components of admission requirements are:

• Grade point average (GPA) requirement
• Completion of specified college level courses at a specified grade level
• Score on a standardized examination—Examples of those in use include:
  - TEAS  (Test of Essential Academic Skills)
  - COMPASS  (Placement test for math and English)
  - NET  (Nursing Entrance Test)
  - Critical Thinking Test
• Evidence of volunteer or paid work in a health care setting
• Evidence of a clear criminal history background check

Other components, included less commonly, are:

• Interview
• Essay/writing portfolio
• Computer skills
• Letters of recommendation
• Evidence of HIV/AIDS education
• Completion of a nursing assistant program and the credential of certified nursing assistant
• Medical clearance, immunizations, TB testing (In most schools these are required after admission.)
• Meeting essential functional components of the nursing role (This may be published but not assessed until after admission or may be assessed in an interview.)

Concerns Regarding Admission

• Is the process non-discriminatory?
• How does the program manage the essential functional components of the nursing role in a way that provides access but also recognizes the needs of patients and the limitations of college resources and clinical sites?
• Does the individual admission requirement (such as the score on a test) relate to potential for success in the program?
• Does the overall result produce a class with a high likelihood of successfully completing the program?
• Does the overall result produce a class meeting the public need for providers from a variety of racial, ethnic, and community backgrounds?
• Does the process and outcome conform to the college or university’s expectations?
• Are the college/program resources consumed by the admission process appropriate and how are they met?

Example of Admission Requirements and Procedures
Nursing Programs in Washington State post their admission policies and procedures on their websites as public information.  They can be accessed from the Washington Center for Nursing website under Education—Where can I go to school in Washington.

Student Grievance Policies

Grievance policies are a mechanism for an individual to seek redress for actions and/or decisions that the individual sees as adverse.  Grievance policies apply to violations of grading policies, disciplinary actions taken, failure to provide an appropriate educational environment (which would include sexual harassment), and discrimination.

Every college or university has a grievance policy for students.  Key to these policies are the administrative procedures used to process student grievances. The main points are:

• Due process for the student
• Clear directions as to with whom and how to file a grievance
• Identification of decision making authority and appeal avenues
• Specific timelines both for the student processing the grievance and the college representatives responding
• Record keeping of all aspects of the grievance process.

Sample grievance policies are found in the references.

A nursing program may create a grievance policy within the program.  This usually provides what is called a “first level” process before the matter is taken to the college-wide grievance avenues.  This may be considered an “informal” part of the process. Even when this is the case, the grievance policy must conform to the college-wide policy and should include the same main points as the college-wide policy.  In some instances, the student is free to bypass the individual department process and proceed directly to the college wide representative. This is usually true for situations involving discrimination and sexual harassment.

A student may choose to take a grievance to an attorney for a legal suit.  While this is not common, it is more likely to occur when a student does not perceive that the college process would be fair and impartial. If this occurs or is threatened, the nursing director/dean should seek immediate consultation with the appropriate administrative person before taking any action or meeting with a student or attorney.

Problematic Student Behavior

Many college faculty report an increase in disruptive and aggressive student behavior that mar the learning environment for other students and make it difficult for the faculty member to teach. This has been so widespread that many colleges have published suggestions for faculty members on how to prevent, recognize early signs, and respond to disruptive behaviors.

A dean/director can lead faculty in determining a program-wide set of behavioral expectations and consequences for disruptive or inappropriate behavior. These should be in conformity to college-wide standards but may be more detailed reflecting the differences in settings in nursing courses.

Mentoring new faculty in relationship to classroom management, implementing student conduct policies, and responding to challenges in the classroom provides an essential foundation for effective instruction.

Disruptive Behavior
Disruptive behavior includes:

• Talking during class
• Surfing the Internet during class
• Cell phone use in class: receiving cell phone calls—sending text messages
• Responding to other students in disrespectful language or with disrespectful gestures (sighing, rolling of the eyes, giggling about difficulties and so forth)
• Intimidation of other students
• Challenging the faculty member  (not simply disagreeing or posing an alternative viewpoint)
• Refusal to cooperate within the classroom

Inappropriate Conduct
Inappropriate conduct includes:

• Cheating
• Plagiarism
• Excessive absenteeism
• Excessive tardiness

Prevention of Disruptive Behavior and Inappropriate Conduct
Most authorities strongly advise that preventing disruptive behavior and inappropriate conduct should be the first avenue of action. Prevention includes:

• Set clear behavioral expectations for all settings in college/program policies and in the course syllabus.  These expectations should include a positive statement regarding respectful behavior towards others and doing one’s own work when that is expected, not only what one should not do.
• State the consequences of failing to abide by behavioral expectations.
• Assure that your own behavior is respectful of both students and colleagues—model the behavior you wish to see.
• Monitor students so that you do not make it easy for students to cheat or plagiarize. The honest students are offended when cheating is easy and those inclined to cheat are deterred when the chance of discovery is great.
• Follow your own policies regarding assignments/grading for everyone so that students do not perceive favoritism or discrimination.
• If there is latitude for special circumstances, this should be stated in writing, and the mechanism to seek latitude needs to be available to all.
• Create a classroom environment in which participation and attention are key components in doing well in the class.

See Examples of general student policies and procedures in Washington State (below) for statements to make regarding behavior and suggestions for classroom management. The examples also include possible consequences of failing to abide by standards.

Intervention for Disruptive Behavior
Not all disruptive behaviors can be prevented. Some students have not been held to standards in past settings and/or regard standards as unimportant in relationship to their own freedom to do whatever they choose.  The following is a general overview of an intervention approach. 

• Intervene early—do not let problem behaviors continue unaddressed. This distresses other students and creates an environment in which students do not take policies seriously.
• Use respectful but firm language when correcting behavior.
• When possible, correct behavior in private rather than in front of the entire class.
• When correcting behavior:
  - Describe the inappropriate behavior (Example: "You were on your cell phone texting during class. That is disrespectful toward me, distracting to other students, and is inappropriate." Avoid arguing about the behavior.)
  - State the expected appropriate behavior (Example: "I expect your cell phone to be put away and you to be attending to the content throughout the entire class.")
  - State the consequences of continuing the inappropriate behavior (Example: "If I note this behavior again, I will ask you to leave the classroom.")
  - Ask for the person’s agreement to abide by program/course expectations (Example: "Will you agree to meet this expectation and put away your cell phone during class?")
• Follow through on consequences for disrespectful behavior if it reoccurs.

See the references for more detailed discussions of classroom management.

Aggression and Hostility
Aggressive and hostile behaviors can escalate and become a danger to the faculty member, other students, and staff.  Instances of this have made headlines across the country.  Responding to aggressive or hostile behaviors of students has much in common with responding to aggressive or hostile patient behavior in the psychiatric care setting. Judgment and responsiveness in the setting are essential.

• Allowing ventilation of feelings may be useful, but try to limit verbal attacks on others. Sometimes expressing anger is not helpful as it allows the person to escalate their anger.
• Delaying discussion until another time—after class, during office hours—may help the individual to gain self control before the discussion. However, the angry person may resist and resent any delay in attending to their concern and an attempt to delay may result in increased anger.
• Active listening may help the person speak about their concerns and lessen the anger.

Personal safety for self and others in the environment should be a paramount concern.

Some common recommendations for maintaining safety:

• Speak calmly and quietly, acknowledging the person’s distress
• Listen carefully for cues in formulating your own responses
• Avoid confrontations or arguing with an out-of-control or close to out-of-control student.
• Keep your own movements slow and non-threatening
• Do not move toward or touch the hostile/aggressive person
• Do not allow the hostile/aggressive student to maneuver you into a place where you have no ability to exit.
• Seek assistance/the presence of other staff or campus security if you feel threatened.  Pay attention to “gut” responses.

Establishing an environment where faculty members are respected when they express concerns about safety and where victims of hostile/aggressive behavior are not blamed for their victimization is essential.

The official criminal justice system should be used in addition to college disciplinary processes when a faculty member is the recipient of threats or physical acts such as pushing or shoving. These are not actions that can be adequately addressed by academic discipline alone.

Examples of general student policies and procedures in Washington State

Bellevue College, Student Code
2050 Student Code and to 2050P Student Code Procedures

Clark College, Chapter 132N-120 WAC

Faculty Resources on Grading (FROG) University of Washington
This University of Washington site includes information on matters in addition to grading:

• Plans for Grading
• Grading Practices
• Academic Conduct
• Students with Disabilities
• Policies

Student Conduct Code for the University of Washington: This has been adopted as a WAC and is available online.

WAC 478-120-020 Standards of conduct is especially useful in examining legal language for identifying appropriate and inappropriate conduct.

Student Conduct Codes for Washington State University
This site contains standards for general student conduct and a specific section on academic dishonesty. A downloadable booklet written for students and their families contains:

• Notification of Student Rights Under FERPA
• Academic Integrity
• Freedom of Expression
• Computing and Network Use
• Alcohol and Drug Policy
• Sexual Harassment
• Sexual Assault Risk Reduction Strategies
• Standards of Conduct for Students
• Reporting Violations

Examples of Nursing Program policies in Washington State will be added upon availability.

References – Student Management

Center for Instructional Development and Research, University of Washington, Promoting Civil Behavior in the Classroom.
Provides a link to suggestions for conducting a discussion in which strong views are expected.
Provides links to recommended articles for promoting civility and managing incivility.

Many of these articles provide very specific suggestions for strategies for managing common problems.  See especially Reed, Rosalind, (1997) Strategies for Dealing with Troublesome Behaviors in the Classroom California State University, Chico

Center for Research on Learning and Teaching, University of Michigan, Teaching Strategies: Incivility in the College Classroom.
This site provides links to helpful information including the following recommended articles:

Reducing Incivility in the University/College Classroom (Morrissette, 2001)
This article defines incivility in the classroom as “offensive, intimidating, or hostile behavior that interferes with students’ ability to learn and with instructors’ ability to teach”. This article discusses contributing factors to incivility and suggests strategies for both avoiding and managing conflicts.

Managing Hot Moments in the Classroom (Warren, 2000)
When topics engender strong opinions in different directions, a heated discussion can occur. This article suggests classroom management strategies when approaching such topics.

Managing the Classroom and Relating to Students (Appendix A from The Penn State Teacher II – scroll down to pg. 138)
This article addresses many different aspects of teaching including classroom management and helping individual students.

UC-Santa Clara’s Teaching Toolbox: Classroom Civility
Definitions and resources related to incivility in higher education; includes a section about responding to specific kings of incivility, including: 1. Annoyances and minor disruptions, 2. Dominating discussion, 3. Aggressive challenging of teacher, and 4. Disputes between students and demeaning comments.

Managing Classroom Conflict (University of North Carolina, 2004)
Newsletter from UNC Center for Teaching and Learning addressing classroom conflict. Includes a section about preventing incivility by promoting social cohesion in the classroom.

Hernandez, Thomas J. & Fister, Deborah L. (2001) Dealing with disruptive and emotional college students: A systems model, Journal of College Counseling 4(1), 49-62 © ACA. Retrieved online.

This article identifies different types of disruptive behavior and recommends different approaches to each. The use of a college wide set of policies and procedures are identified as essential to support coordinated faculty action and avoid isolated non-effective responses. The authors emphasize the role of counseling personnel in assisting faculty in managing disruptive student behavior.

Incivility in the Classroom: Bibliography of Print Resources (1999), Compiled at the University of Michigan, These are from older literature but many still have application.

Amada, G. (1999). Coping with misconduct inn the college classroom: A practical model. Asheville, NC: College Administration Publications.

Boice, R. (1996). Classroom incivilities. Research in Higher Education, 37(4), 453-486.

Carbone, E. (1999). Student behaving badly in large classes. In S.M. Richardson (Ed.) Promoting civility: A teaching challenge (pp. 35-43). New Directions for Teaching and Learning Vol. 77. San Francisco: Jossey-Bass.

Delucia, R., & S. Iasenza. (1995). Student disruption, disrespect, and disorder in class: QA seminar for faculty. Journal of College Student Development, 36(4), 385-388.

Downs, J.R. (1992). Dealing with hostile and oppositional students. College Teaching (40)3, 106-108.
Kuhlenschmidt, S.L. & Layne, L.E. (1999). Strategies for dealing with difficult behavior. In S.M. Richardson (Ed.) Promoting civility: A teaching Challenge (pp. 45-57). New Directions for Teaching and Learning Vol. 77. San Francisco: Jossey-Bass.

McKeachie, W.J. (1999). Problem students (there’s almost always at least one!). In W.J. McKeachie Teaching tips: strategies, research and theory for college and university teachers (10th ed., pp. 235-247). Lexington, MA: D.C. Heath.

Parten, D. (1993). Responding to student disruptions: incorporating supported education. Journal of American College Health, (41), 227-229.

Schneider, A. (1998, March 27). Insubordination and intimidation signal the end of decorum in many classrooms. Chronicle of Higher Education 44, A12.

Sorcinelli, M.D. (1994). Dealing with troublesome behaviors in the classroom. In K.W. Prichard & R.M. Sawyer (Eds.) Handbook of college teaching: Theory and Applications (pp. 365-173). Westport, CT: Greenwood Press.

This section provides basic resources and references that will help you manage resource issues found in an educational setting.

Financial Resources Management

Information is provided here regarding:

• Introduction
• Sources of Funding
• Nursing Program Budgets
• Funding Pathways
• Budgeting Processes
• References

Introduction

Managing financial resources includes developing budgets and monitoring them through the budget approval process, assuring that spending is in accord with the budget as approved by the institution, and evaluating the effectiveness of the budget in meeting the goals and objectives of the nursing program. In many settings, managing resources includes seeking resources outside of the regular budget process from grants and community organizations in order to enable meeting goals and objectives.

Funding pathways differ for community and technical colleges, the state baccalaureate and higher degree institutions and the private colleges. Because the community and technical college system has the greatest number of programs, the most directors and the most frequently changing directors, more details about that system are provided.

The WSAC Master Plan for Higher Education in Washington State 2011 Update, the 10-year implementation plan and WSAC System Design Plan provide information on overall state goals and directions.

Sources of Funding

Operating Budgets—These are basic funds allocated by the college or university for the program to carry out its mission.

Capital Budgets—These are funds allocated to improving the infrastructure in the program. This may include new buildings, but can also include the renovation and upgrading of existing facilities.

Grant Funds—Grants are awarded by state agencies, private foundations, individuals, and businesses. Grants are usually targeted toward very specific activities or projects. Grants are more likely to be available for research, equipment purchases, or special projects rather than basic program needs.

Nursing Program Budgets

Many nursing programs operate within a variety of budgets.

Operating budgets
The operating budget technically covers the day-to-day operations associated with sustaining a nursing program. In educational institutions operating budgets may be split between different administrative authorities and may not all be controlled by the dean/director of the program. Effectively managing resources demands knowledge of the various budgets that impact the nursing program. General program operating budgets, faculty/staff budgets, equipment budgets, and skills laboratory budgets may all be part of an overall operating budget or may be administered as different operating budgets.

General program operating budget: This includes copying, supplies, accreditation fees, travel to clinical sites and other such matters. Skills laboratory funding may be included in this budget.

Faculty/staff budget: The budget that covers salaries and benefits for full-time and/or part-time faculty or staff may be separate from the general operating budget for the nursing program. That salary/benefit budget may be managed by another administrative officer of the college. While the dean/director may be responsible for managing the personnel, the financial aspects may not be under the control of the dean/director. In some settings the director of the nursing program is not the administrative evaluator of the faculty or staff in the department. This responsibility may lie with the dean of the division.

Equipment budget: The budget for instructional equipment may be managed independently of the general program operating budget. For example, classrooms may be shared and therefore, classroom projectors and other equipment must be requested from those making allocations from the equipment budget. For community and technical colleges there are often two avenues to equipment purchase. One is through the regular state allocation for equipment and the other is through Carl Perkins funds for professional/technical programs. In some institutions, these are managed as a unit, in others there is separation of their management. Management and allocation of Carl Perkins funds varies widely from institution to institution.

Skills Laboratory budget:  For some schools the operating expenses for the skills laboratory are derived in a large part from student fees for supplies. These may be managed from an independent budget that must show that student fees were used for expendable supplies in the laboratory.  Other expenses for the laboratory, such as personnel, equipment, and even laundry are managed through the general operating or equipment budgets discussed above.

Other budgets:  Institutions may have a variety of budget categories to fund priorities of the institution. These budgets are most often controlled by the leadership team (president, vice-presidents). Learning about institutional priorities, concerns within the institution, and developing effective working relationships with administrative leadership may help a nursing director to become aware of the potential for specific resources for a need in the nursing program.

Capital Budgets
Capital budgets are used for major infrastructure. Capital projects in state schools are approved at the state level for the biennium. A nursing program would need to have any request for a capital project approved by the college or university and included in its state capital project request. While the nursing dean/director may have input into the capital project, the facilities administrative personnel manage this budget and oversee its implementation. State funding of capital improvements is often on a 5-7 year approval cycle. Construction time is outside of this timeframe (i.e. it could take upwards of 9-10 years from conception to actual new buildings).

Funding Pathways

Community and technical college funding pathways

CTC operating budgets

• Biennial legislative allocation for community and technical colleges
• State Board of Community and Technical Colleges (SBCTC) determines the overall budget allocation for each college under its jurisdiction based upon a formula for projected FTE enrollment targets.  (Full-time Equivalent Students—one FTE reflects 15 quarter credits)
• Additional allocations are made for SBCTC special priorities—these include funding new or start-up programs.
• Individual colleges determine their own budgets based on college needs and priorities which are linked to enrollment FTEs but not enrollment equivalent. These differences are possible because some high enrollment, low cost departments, such as sociology, receive less in order to help fund lower enrollment, high cost programs, such as nursing.
• Note on tuition: CTC tuition goes to the state and does not go directly to the college EXCEPT for tuition for international students.  The tuition of those students (which is out-of-state tuition level) is kept by the college and the amounts over what is used for direct educational costs are used to support the library and other services of the college.
• Self-support: Courses or other offerings in which the tuition or fee charged covers all cost of providing the offering are termed “self-support”.  Individuals attending self-support offerings are not counted in the college FTEs and no state funds are used for the self-support offerings.  All funds taken in for self support remain with the college. Self-support is commonly used for continuing education courses, workshops, and community enrichment offerings. The majority of self support offerings are taught by part-time faculty. These courses cannot be counted in the regular faculty load for a full-time faculty member but may be taught as “moonlight” (in addition to the full-time load) by a full-time faculty member.  Some self-support offerings may return a small profit that may be used by the sponsoring department for departmental needs. In some colleges, any profits from self-support offering accrue to a common budget line.

For more information, click here.

CTC capital budgets:

• Colleges submit plans for major capital improvements to the SBCTC
• Priorities for funding of capital projects across the state are determined
• State legislative allocation for capital projects for community and technical colleges is created
• SBCTC allocates capital funds to approved major capital projects to the extent that funds are available
• SBCTC also allocates capital funds to colleges for use in maintenance, replacement, and upgrades to the physical plant.

For more information, click here.

Carl Perkins Career and Technical Education Act funds
These funds originate with the federal government and are distributed through the state to the colleges. Each college must have a formal plan based upon the provisions in the Act for use of the Carl Perkins funds. Each CTC submits a plan to the SBCTC for approval.  Involvement in developing this plan is valuable towards having nursing included as a recipient of funds. The Act is directed at preparing individuals for “occupations in high skill, high wage, or high demand business and industry”. This is done through:

• Direct student services, such as counseling for identified student groups to enable them to complete a career training program
• Program support fund
• Faculty development funds—these can be a valuable resource for nursing faculty and have offered opportunities for faculty members to work in their fields with financial support as well providing support for attending both credit and non credit educational offerings.
• Special emphasis is given to
  Services preparing students for non-traditional fields,
  Services for students in rural areas,
  Areas with high percentages and/or high numbers of career and technical education students
• Specific performance indicators are included in the Act.

A nursing director needs to be familiar with the college plan for its use of Carl Perkins funds and be active in identifying ways in which the nursing program can participate in the use of these funds.

State University Funding Pathways
The state universities of Washington receive direct allocations from the legislature through the Washington Student Achievement Council (WSAC). Tuition is set by the state legislature.

At this time the entire funding model for higher education in Washington is under review. The state universities have been described by some as “state-assisted” rather than as “state-funded” because so much of their income is from grants and contracts.

Because the baccalaureate and higher degree nursing programs have research grants and other funding sources, the funding pathway doesn’t lend itself to a simple description.  Biennial legislative allocations for each university are made by the legislature. These legislative allocations relate to FTEs but also include a wide variety of capital projects and special funding priorities from the legislature.

• Allocation for each university includes specified funds directed toward health sciences.
• Each individual university determines its own budget based on college needs and priorities which are related to enrollment FTEs but are not enrollment equivalent.
• Note on tuition:  Major proposals have been made that would un-link tuition from legislative decision-making. This un-linking would also mean that whatever tuition was charged by the university would stay at that university.

Private University Funding
Private universities are funded through tuition, endowments, and grants. Because of their more direct connection to tuition, they are sometimes able to make changes in programs more rapidly than state institutions which must wait for legislative appropriations.

Each university has its own unique funding pathway.

Budgeting Processes

Budget Cycles
Budgets are planned and used on recurring calendar patterns. For state institutions these are biennial.  The legislature approves budgets for the biennium, and the process for each college or university derives from that process. While there may be some changes in either increased or decreased funding for the interim year, in most cases the funding is stable for the biennium.

Each college or university has its own local budget planning process. In most instances for state institutions this begins during the last year of the biennium.  Budgets are usually requested from the “bottom up”, meaning that each department determines its budget requests and submits them to the next level in the institution, which may be a division.  Divisional budgets then go to a college-/university-wide level.  At each level compromises and adjustments are made. Knowing the individual institutional budgeting processes is critical. Directors/deans will need input from the faculty and staff of the program in beginning this process. Overall budget decisions are eventually approved by the Board of Trustees.

The entire budgeting process may take place without specific information on available state allocations. There may be information regarding the bills submitted to the legislature, but until the final legislative decisions are made and SBCTC and WSAC determinations are made, these can only be tentative. This sometimes results in a need for a college to re-examine and re-do a budget.

Private colleges and universities operate on their own budget cycles. These may include annual budgets but may also include longer-term planning horizons.

References – Financial Resources Management

Curtin, M. & Dupuis, M. (2008). Development of human patient simulation programs: achieving big results with a small budget. Journal of Nursing Education, 47(11), 522-523. Retrieved from CINAHL with Full Text database.
This article focuses on how outcomes can be maximized when funds for simulation programs are limited.

Hyland, J. & Hawkins, M. (2009). High-fidelity human simulation in nursing education: a review of literature and guide for implementation. Teaching & Learning in Nursing, 4(1), 14-21. Retrieved from CINAHL with Full Text database.
This article includes information on costs and budgeting for simulation.

Kanter, M. (2010). Higher ed in the Obama years. New England Journal of Higher Education, 24(3), 28-29. Retrieved from Academic Search Premier database.
This provides insights into emphases for federal funding that may become available to nursing programs as legislation moves forward. Knowing about these potential resources can help with future planning.

Schwartz, M. & Laughlin, A. (2008). Partnering with schools: a win-win experience. Journal of Nursing Education, 47(6), 279-282. Retrieved from CINAHL with Full Text database.
This article focuses on how a nursing program can augment its resources for instruction through a partnership.

Telles, C. (2008). A step-by-step guide to videoconferencing. Nurse Educator, 33(4), 168-171. Retrieved from CINAHL with Full Text database.
Many programs in Washington State have more than one campus. Maintaining coordination and collegiality across many miles can be enhanced by videoconferencing which is much lower in cost than allocating travel dollars and time to these same efforts.

Zierdt, G. (2009). Responsibility-centered budgeting: an emerging trend in higher education budget reform. Journal of Higher Education Policy & Management, 31(4), 345-353. doi: 10.1080/13600800903191971.
Administrators of nursing programs may be facing new methods and challenges of budgeting in times of reduced resources. Understanding the issues around different approaches to budgeting can help a director participate more effectively on behalf of the nursing program.

This section provides basic resources and references that will help you manage resource issues found in an educational setting.

Human Resources Management

Information is provided here regarding:

• Essential Information and Tools
• Faculty
• Staff

Essential Information and Tools

Basic documents available in the institution are essential to managing human resources within that setting. The following are essential.

Job descriptions for staff faculty positions

• In some settings all faculty may be covered by one general job description, while in others there may be different job descriptions for faculty who have different roles.
• Background information on positions for:
  - Tenured individuals
  - Tenure track individuals
  - Faculty hired on different types of contracts such as grant funds
• Different types of part-time teaching positions
  - Associate faculty who regularly work for the program
  - Part-time faculty who work only one term or type of rotation
  - Guest lecturers
  - Adjunct faculty (usually indicates an individual who is employed and paid by a clinical agency but provides some teaching for the college)
• Job descriptions may be included in the most recent accreditation materials for a program that has national accreditation
  - Job announcements provide an overview of roles and responsibilities and recent job announcements may be of value

Benefits available to faculty and staff

• Full-time faculty and full-time staff usually have a standard benefits package of health insurance, sick leave, vacation, and retirement.
• Part-time faculty and staff may have some benefits, possibly depending on how much they work and how long they have worked for the institution. Knowing the parameters of this will be important in making decisions.

Contracts with any group covered by a union contract:  faculty, staff

• Community and technical college faculty are unionized in Washington State
• Staff members in Washington state colleges and universities are unionized
• Faculty are not unionized in the baccalaureate programs in nursing in Washington state
• In the private colleges and universities neither faculty nor staff are unionized.
• Matters of salary and working conditions, which include workload, are part of the contract document for unionized groups.

Faculty Handbooks

• The College faculty handbook (if there is one) may provide basic information for faculty members on resources for teaching as well as policies and procedures affecting employment as a faculty member.  This handbook may provide an overview of the tenure process for faculty hired into tenure track positions.
• Some nursing programs provide a faculty handbook that provides basic information specific to program issues such as grading standards, clinical sites, and teaching expectations.

Employee Handbooks

• Staff may have a general handbook used for all employees in the college that addresses work place issues.

Forms/documents used for evaluation processes

• Evaluation processes are usually identified in the union contract.
• For non-unionized colleges, evaluation processes may be a part of staff or faculty handbooks.
• There may be procedural handbooks/documents and specific forms in addition to the overall processes described in the contract or faculty/staff handbook.

Faculty

Hiring
Job announcements. These may be written in conjunction with the human resources department.  Faculty job announcements for a given college or university usually have a prescribed order and focus with some college-wide statements required (such as equal opportunity statements or college mission and goals.)  While job announcements may seem superficial and brief to those familiar with nursing education, those who are considering a career move into nursing education examine them closely for information regarding what this position will require. Differentiating between required and desirable characteristics of applicants will be essential to broadening the applicant pool.

Recruitment
Advertisements in professional journals, in local newspapers, and on internet job sites may be the first avenue for recruitment. Some of these, such as professional journals, are quite costly. A nationwide search may result in more applicants. Unfortunately, the majority of community and technical colleges in Washington are not able to offer incentives such as moving expenses to enable hiring of applicants from other geographic areas unless those individuals are already planning to relocate.  

While formal advertising avenues continue to be important, many nursing programs report that their most significant source of applicants is recruitment by current faculty members. Engaging the entire faculty in discussing the teaching role, informing individuals at clinical sites of the vacancy, and specifically asking individuals to apply for open positions encourages those in the nursing community to consider the faculty role.

Recruiting part-time faculty is enhanced when some benefits are available to the individual. For example, in the state community and technical colleges, health care benefits are available to those who teach more than a certain load after they have been employed for a specified number of quarters. The availability of health care coverage may be a strong incentive for part-time employment as a faculty member even if the salary is not high. On the other hand, there is a cost to the college and some college administrators encourage keeping part-time loads low enough to avoid triggering this benefit.  Part-time faculty who teach for more than one state supported college can combine work at two or more institutions to become eligible for benefits. Alternatively, those who work for clinical agencies at 50 percent or more are often eligible for benefits. If a schedule can be developed that supports an individual to continue working at a clinical agency where benefits are received, that individual may be interested in being a part-time faculty member.

Orientation
Full-time faculty orientation.  Many colleges and universities have formal orientation programs for new full-time faculty.  These orientations may be focused on the overall institutional processes. Unfortunately, these college-wide programs are often available only for those who start fall term.  When faculty members begin during other terms, they sometimes miss important information. Learning about the content of these programs will help a director/dean plan a supplemental orientation focused on the nursing program and assure that those beginning at other times will be provided with the information they need. When there are no college-wide orientation programs, the nursing program will be responsible for developing the entire orientation.  

Part-time faculty orientation:  Unfortunately, time schedules, availability of payment for orientation, and other constraints affect what can be required for part-time faculty orientation. An orientation handbook for part-time faculty (either in print on online) will help to provide a resource for information.  

Mentors:  Some colleges have official mentoring programs for new full-time faculty. These are very useful. Every program should seek to provide a mentor to new part-time or full-time faculty members. This most commonly is someone teaching in the same course, but in the case of a small faculty that may not be possible. Mentors ideally are volunteers who enjoy assisting new people and have in depth knowledge of the nursing program and are themselves excellent faculty members. In small programs, the director serves as the mentor to all new full-time faculty members.  

Assignments and Workload
For a detailed discussion of the issues and concerns around faculty workload and how the different ways it is calculated across the state see the document Nursing Faculty Workload in Washington State (Ellis, 2009) available from the WCN site here.

Official college requirements regarding workload are basic to considering faculty assignments. All assignments for nursing faculty must conform to the rules in place at the individual college.  However, there may be flexibility in making these assignments from term to term or based on special needs of the program. Faculty may be involved with making decisions about specific assignments and ways to modify them for better outcomes. At a minimum discussing an assignment with an individual faculty member before it is changed or adapted will result in better relationships.

Faculty Development
Faculty development includes all activities that enhance an individual’s abilities and knowledge for their role. In order to be able to attend workshops, conferences, or classes faculty will need assistance and support, e.g. in modifying schedules, trading assignments, etc.
    
Faculty Development Funds:
Dedicated college/university funds based on a contract may be available. These may specify a guaranteed amount for each faculty member. Prior approval from a designated office is usually required to use these funds.

Some nursing programs have a dedicated pool of funds available for distribution to faculty for professional development.  All faculty should clearly understand the rules for the use of these funds. There need to be clear criteria for application and awarding the funds to avoid the appearance of favoritism. For example, a college may support attendance at a conference only if the individual is also presenting at that conference. Individuals who know this in advance might apply to present a poster or in other ways contribute to the conference.

Carl Perkins funds for community/technical colleges are usually awarded to a college as a blanket amount with criteria for their use.  This usually includes a maximum grant but there is no guarantee of an amount per person.  These funds are most often awarded on a first come, first served based.  Faculty need to be encouraged to consider this early in the academic year to be able to use these funds. Prior approval takes time , which needs to be factored into the application process.

Professional Development Resources:
Faculty need to consider professional development in both their clinical area and in their educational role.  Some individuals may need encouragement to focus resources on the scholarship of teaching in addition to their clinical enhancement.

Certification as a Nurse Educator is available from the National League for Nursing.  Information about this certification is available online.

NLN Faculty Development Resources include a variety of conferences, webinars, and publications.  Information on NLN resources is available online.

ANA Resources for Faculty are found online.


References on nursing education:
A program might make selected books and journals available for faculty use.

General Nursing Education Periodicals (articles catalogued in CINAHL database)
Journal of Nursing Education
Nurse Educator

General Higher Education References
Chronicle of Higher Education
American Council on Education
American Association of Community Colleges

Books
Bastable, S. (2008)  Nurse as Educator: Principles of Teaching and Learning for Nursing Practice, 3rd Ed,
Jones & Bartlett Publishers

Caputi, L. Teaching Nursing: The Art & Science, 2nd ed. –All from College of Dupage Press,
Teaching Nursing: The Art & Science, Volume 1
Teaching Nursing: The Art & Science, Volume 2
Teaching Nursing: The Art & Science, Volume 3
Teaching Nursing: The Art & Science, Volume 4 It's All About Student Success!

Emerson, R. (2006).  Nursing Education in the Clinical Setting, St. Louis, Mosby Inc.

Gaberson, K. B. (2007). Clinical Teaching Strategies in Nursing, Springer Publishing.

Iwasiw, C. L., Goldenberg, D., Andrusyszyn, M.A. (2008) Curriculum Development in Nursing Education 2ND ED, Jones and Bartlett Publishers

McDonald, M. E. (2007). Nurse Educator's Guide to Assessing Learning Outcomes 2nd ed. , Jones & Barlett.

Moyer, B . A. & Wittmann-Price, R. (2007) Nursing Education: Foundations for Practice Excellence, F.A. Davis.

Oermann, M. H.  & Gaberson, K.B. (2006).  Evaluation and testing in nursing education, 2nd ed., Springer Publishing.

Online Courses
Brosche, T.A.M., (2010). Clinical Instruction Online Course.  Jones & Bartlett Publishers (“Clinical Instruction Online Course is a series of online modules available for continuing education credit, designed to bridge the gap and ease the transition for the novice, competent, and expert clinician to function efficiently and effectively in the role as a clinical educator. Each module focuses on a different aspect of clinical education and can be used collectively or singularly.” [From the website.])

Clinical Instruction Online Course: Assist in Making the Clinical Learning Environment Effective and Efficient, Brosche / 9780763773069 / © 2010

Clinical Instruction Online Course: Caring Learning Environment, Brosche / 9780763773090 / © 2010

Clinical Instruction Online Course: Databases & Technology for the Clinical Setting, Brosche / 9780763773137 / © 2010

Clinical Instruction Online Course: Formative Versus Summative Evaluation, Brosche / 9780763773076 / © 2010

Clinical Instruction Online Course: Legal Considerations for Nursing Faculty & Their Students, Brosche / 9780763773120 / © 2010

Clinical Instruction Online Course: Strategies to Facilitate Learning for the Visual, Auditory, & Psychomotor Learner, Brosche / 9780763773052 / © 2010

Clinical Instruction Online Course: Strategies to Minimize Barriers of Learning in the Clinical Setting, Brosche / 9780763773106 / © 2010

Clinical Instruction Online Course: Student-Centered Versus Teacher-Centered Learning Strategies, Brosche / 9780763773045 / © 2010

Clinical Instruction Online Course: The Challenging Student ,Brosche / 9780763773113 / © 2010

Clinical Instruction Online Course: The Post-Clinical Conference ,Brosche / 9780763773083 / © 2010

Specific Articles
O'Keefe T; Forrester DA, (2009, Jul-Sep) A successful online mentoring program for nurses. Nursing Administration Quarterly 33 (3), 245-50.
 
Tenure Processes
All tenure processes are governed by the institution as a whole, although the specific program or department has a strong role in that process.

Community and Technical Colleges

Tenure processes are part of the faculty contract.
Tenure is a 3-year process in which evaluations must be completed and standards met. These standards usually relate to teaching effectiveness and service to the institution. A few include service to the community.

A tenure committee guides the process. The make-up of the tenure committee is based on the contract language and often includes members from outside of the department. Tenure committee members include only tenured faculty and often an administrative representative.

The Board of Trustees makes final tenure decisions during winter quarter of the third year (or equivalent if the person did not begin during a fall quarter) based on recommendations from the tenure committee, but it is not bound by their recommendations.

Baccalaureate and Higher Degree Institutions
The department usually has greater influence as all tenure committee members come from the same department.

Standards for tenure usually include research and scholarly productivity as a major component. Other components are teaching effectiveness and community and institutional service.

Tenure processes are typically much longer than in community and technical colleges.

Performance Evaluation

Community and Technical Colleges
Faculty evaluations outside of the tenure process are also part of the contract, which determines the frequency, methods, and evaluators. Nursing Programs can institute evaluations for courses, clinical sites, and other program aspects independently. Nursing Program faculty members can participate in designing campus-wide faculty performance evaluation systems and thus help to create effective processes across campus.

Baccalaureate and Higher Degree Institutions
Institutional policy on faculty performance evaluation outside of tenure may differ widely.
The nursing program may be able to establish internal faculty performance evaluation processes.

Establishing a pool of part-time and adjunct faculty

Part-time faculty are often needed for particular quarters or courses only. Recruiting part-time faculty is therefore an ongoing process.  When an individual has been hired for a particular quarter, evaluation of effectiveness in the role and then follow-up to discuss future employment on a part-time basis is essential to developing an ongoing pool of individuals who are interested in teaching part-time.

Directors/deans of nearby colleges may provide suggestions of individuals who are not needed by that program currently but have taught there part-time in the past.

Because of the changing schedules and needs of a program, it may be essential to have more individuals in a part-time pool than can be used at any one time.

Retaining part-time faculty
Key issues for retention of part-time faculty are:

• Orientation to the role—hiring individuals who work or have worked at a clinical agency to be a clinical instructor at that agency helps greatly with the orientation demand. Clinical agencies often have specific time requirements for faculty orientation. In addition, the part-time faculty member needs orientation to the specific course and its requirements and grading standards. Some colleges have a defined mechanism for paying for orientation time for a part-time person. In other colleges, there is no standard mechanism for this process and the director must consult with administration to enable orientation. It is recommended to pay for the time it takes part-time faculty to get oriented to a new clinical agency and/or course.
• Support on an ongoing basis—this includes opportunities to consult with other faculty, ask for advice, and receive coaching. This may be through an individual mentor, a team assignment, or the director.
• Predictability in teaching assignments—faculty should know if they will be employed on an ongoing basis, for roughly what amount of time and what salary.  People plan their work lives with expectations and do not like uncertainty.
• Clear expectations—All job expectations need to be addressed “up front” so that a person unfamiliar with the teaching role is not surprised by expectations that reach beyond the direct student contact hours.
• Compensation— should be commensurate with the demands of the position. This is often difficult to assure because with planning, papers to grade and conferences with students, the time demand flexes and is not the same for every person who teaches the same course. The availability of a health care benefit or access to a retirement program is an important compensation incentive for many people. Sometimes adjusting schedules and assignments can result in individuals teaching enough to be eligible for benefits.

Staff

A critical component for managing a nursing program is staff support.  Staff support varies widely from college to college and is somewhat dependent upon the size of the program.  Staff support involves those positions that are not designated as faculty or administration. In state institutions, staff members are part of the civil service system and as such have precise job titles, classifications and salaries governed by union contracts. In smaller settings one individual may assume a variety of staff support roles.

Shared staff
Staff for a nursing program may be part of staff for an entire division rather than specific to the program.  For example a division senior secretary may manage personnel records and payroll documents for all programs within the division. When this is true, the nursing program director may not be the official supervisor of the staff member who provides program services. A faculty support pool of clerical staff may provide keyboarding, copying, and other services to support instruction for all faculty members within the division. This type of support pool is usually under the supervision of the head of the division.  Understanding how priorities are determined for time use by shared staff is essential. Without clear guidelines, the staff member may simply respond to those who use the most pressure rather than in relationship to program and division priorities.

Common staff support roles
Understanding the specific job description of any position is critical to managing that position. Below are some general common categories. A large university program may have many more positions.

Office staff—Office staff provide record keeping, tracking and maintenance, preparation of documents, response to telephone calls and general email, and other such tasks. There are multiple levels of office staff with different titles, duties, and salary levels in the state system. In larger programs, there may be a secretary who provides support to the office of the director of the nursing program in addition to other clerical staff who support instruction.  In smaller programs one support staff person may be expected to meet all office type support within the program. Common titles include secretary and office assistant.

Program assistant or coordinator—Positions with these types of titles usually require greater skill and involve more far-reaching decision-making. In many nursing programs with only one support staff person, this person is a program assistant because of the many higher level responsibilities this person must undertake.

Skills laboratory coordinator—This position may be held by a registered nurse who is not in a teaching role. This person may maintain the lab, order supplies, help with choosing equipment, support the teaching faculty, and maintain the lab for open times. In some settings this individual may assist students with practice of skills, but clear lines need to be kept in separating this from the faculty responsibility for planning instruction, teaching skills, and evaluating skills. A person who plans, teaches and evaluates is considered faculty and assigning a person without faculty qualifications to that role may result in adverse responses from unions, accrediting bodies, and the Nursing Commission. When the skills laboratory coordinator is a faculty position rather than a staff position, there may be lab assistants who are staff and not faculty.

Adequacy of Staff Support for a Nursing Program
There is no simple answer to how much staff support is needed by a nursing program.  Some tasks are the same regardless of program size, such as reports to the state and accreditation agencies.  Some tasks differ in quantity based on the number of students such as tracking of health information. Others differ based on the number of programs, such as practical nursing, associate degree nursing, and nursing assistant.  It is sometimes difficult to determine how much staff support time is available when services are shared within a division.

A key for evaluating the adequacy of staff support is to determine how much of the program administrator’s time is spent on what are essentially clerical tasks. When the nursing program dean/director is spending his/her time performing data entry, preparing documents, and answering routine phone calls and emails, questions should be raised about time allocation. The nursing program dean/director needs time for overall program management and direction, analyzing data, leading the faculty in program design, mentoring new faculty, and solving problems and concerns. When these responsibilities are pushed aside for tasks that could be performed by someone with lesser qualifications and pay, there may be a basic problem with staff design.

Seeking Additional Staff Support
When evaluation determines that a program needs additional staff support, a plan for requesting that support is essential.  New positions are costly to an institution and there is understandable resistance to expanding the non-teaching staff.  Changes must often be in process for a long time before being implemented.

Some suggestions for a process are:

• Begin early discussion of the possibility of more staff with the dean or vice-president who would be involved.
• Make sure that you know the budget process on campus and how such a decision would officially be made, but also try to become aware of informal organizational pathways for influence and decision making.
• Gather data for evaluation of program support needs:
  - Look at the needs of the nursing program, for example, work related to specialized accreditation, state approval requirements, number of community agency contracts, number of students, number of full and part-time faculty, method of managing selective admission, number of pre-nursing students being served, any grants/projects underway
  - Comparison of the needs of the nursing program with the needs of other programs on campus—Look at the same attributes for other programs on campus and compare their staff support.
• Summarize evaluation data that support the need for additional support
• Identify the specific tasks that would be undertaken by a new position
• Identify the specific title and classification that would be required to meet these specific tasks
• Identify the cost of the new position
• Begin the process of presenting your request within the structure of your campus.

Sometimes individuals strive to present their needs to an accrediting or approval body with the hopes that this organization will put pressure on the college to grant the request. This may or may not prove successful. It may be counter-productive in terms of campus relationships and if the college decides to ignore the outside body, your program accreditation or approval may be jeopardized.  Great care should be taken if this avenue is attempted.

Keep in mind: 

• Budgets of an institution are limited.
• There are many competing interests.
• Logic and rational thought are not always at the basis of decision-making in large organizations.
• Informal organizational pathways may be significant in decision-making.

You may truly NEED more staff support; you may have a sound argument; and you still may not achieve your goal.

Evaluation of Support Staff
Evaluation processes for support staff differ from those for faculty.  There are usually very specific institutional processes, time tables, and instruments that can be used for staff evaluation.  If the staff is evaluated by another administrator, a nursing program director may be able to provide input into that evaluation.

Promotions and salary increases for support staff are a part of union contracts in state-supported colleges and universities. Private institutions will have other guidelines regarding these issues.

This section provides basic resources and references that will help you lead your faculty in improving and developing curriculum for the nursing program. It provides general information and resources as a background for the decision-making process.

• Key Administrative Concerns for a Director When Changing Curriculum
• Washington State Nursing Care Quality Assurance Commission and Washington State Law
• Accreditation Requirements
• CNEWS Competencies (2002)
• NCSBN Test Plan
• Other Resources

Key Administrative Concerns for a Director When Changing Curriculum

The following are questions designed to assist you in managing the curriculum change process in your unique environment.

1. What are the driving forces for this curriculum change?

a. Is there evaluation data or other data to support the need for curricular change?
b. Are the proposed changes based on evidence-based practice?
c. Has your advisory committee provided input based on changes in the practice arena?

• Note that all accreditation bodies expect data-driven decision-making, especially in relationship to something as major as curriculum revision.
• How will you document the process to demonstrate this to outside accrediting bodies?

2. How will this change fit with the current Nursing Program philosophy and framework?

a. Are there changes that need to be made in the philosophy or curriculum framework model?
b. Have faculty had sufficient input into the need for change?
c. Have you reviewed current accreditation and state curriculum requirements?

3. What timelines need to be established to take in the following groups/processes?

a. Approval of changes to curriculum by college bodies. Most of these meet monthly and agendas are prepared in advance. Often one must be completed before the next, but it may be possible to place items on agendas with the expectation that they will be approved by prior group and thus move along more quickly.
- Nursing Program Curriculum Committee (may be whole faculty for small programs)
- Division Curriculum Committee
- College-wide Curriculum Committee

b. Approval of changes to curriculum by Nursing Commission NPAP
c. Notification of changes to accrediting body, such as NLNAC or CCNE
d. Implementation demands (see below)

4. Clinical site requirements:

a.Will clinical sites need to change? How?
b. What new sites will be needed?
c. Will new schedules for current sites be needed?
d. With whom do these changes need to be negotiated?
e. What is the timeline for this?
f. Will more experience with Simulation be desirable?

5. Faculty scheduling/assignment:

a. How will the changes affect faculty needs?
b. If there is a change in credits, will this increase or decrease number of faculty needed?
c. If new faculty are needed, what are the processes to obtain additional faculty or additional part-time faculty support?
d. Will faculty be required to change to new schedules/topics/teams/clinical sites, etc.?
e. How will you arrange and manage these changes to minimize faculty stress?

6. Classroom assignments:

a. How will times and sizes of groups for classes change?
b.What resources will be needed that are not currently used?
c. With whom do you need to collaborate for classroom changes—other programs?
d. What is the timeline for this planning?

7. Planning processes:

a. How can you assure that all faculty members have an opportunity for meaningful contribution in planning the curriculum?
b. How can you assure that faculty continues to be cognizant of the whole program when changing parts? (For example: moving or removing one topic may have repercussions for other topics that relied on this prior knowledge.)
c. How can you help faculty members to consult appropriate resources? See those listed here. It is also useful to consult the Annual Report of Nursing Education Programs Summary from the Nursing Care Quality Assurance Commission. These reports provide useful background, such as average clinical hours in the various program types.
d. What other departments on campus will need to be consulted, such as technology support, library, counseling?

8. Implementation planning:

a. When will the change be initiated?
b. Will the change affect any current students?
c. How can the classes/clinical for those in the old curriculum be managed alongside those entering the new curriculum?
d. What program documents, web site, catalog, etc., will need to be changed, and what are the timelines for those?

9. Evaluation Planning

What evaluation processes will be needed to evaluate the effectiveness of the new curriculum?

How will the new curriculum be compared to the old curriculum for evaluation?

Washington State Nursing Care Quality Assurance Commission (NCQAC) and Washington State Law

RCWs (Revised Code of Washington) and WACs (Washington Administrative Code) for Nursing Education Programs both contain material of relevance to nursing curriculum planning.

• Nursing Care: RCW Chapter 18.79
• WAC Standards: All nursing education programs preparing individuals for licensure must meet the requirements of the state in order for graduates to be eligible for the licensing examination. There are many different approaches to meeting these standards, but they must be kept in mind and checked with any curriculum change decisions. These requirements are found in WAC 246-840-575.
• WACs regarding Standards of Nursing Conduct and Practice: All graduates will be expected to meet the standards of practice as described in the WACs. Therefore, referencing this material when planning curriculum is useful.
• Other Washington Laws pertinent in the education of nursing students include:
  o    RCW 18.130 Regulation of Health Professions: Uniform Disciplinary Act
  o    RCW 26.44.030 Abuse of Children and Adult Dependent Persons
  o    RCW 34.05 Administrative Procedures Act
  o    RCW 42.17 Public Disclosure
  o    RCW 70.02 Medical Records-Health Care Information Access and Disclosure
  o    RCW 74.34 Abuse of Vulnerable Adults

Approval of Curriculum Changes
All major curriculum changes for pre-licensure programs must be approved by the Nursing Program Approval Panel—NPAP (a committee of the NCQAC) BEFORE being implemented. This group meets monthly. The time required for this review and approval process must be included in your timeline for planning.

The process for submitting curricular changes to the NCQAC includes:

1. Consult with Nursing Education Advisor Usrah.Claar-Rice@DOH.WA.GOV at the NCQAC. She will help you determine your steps and timeline to receive NPAP approval.
2. Work with faculty to prepare the overall outline and plan for the curricular change, including an implementation plan.
3. Be sure that all aspects of the required WAC Standards are included in the new curriculum plan. It is often helpful to have a reference guide showing where in the curriculum each of the required elements will be found.
4. Submit the plan to the Nursing Education Advisor. She will review the plan and let you know if more information will be needed by the NPAP.
5. The Nursing Education Advisor schedules the presentation of your curriculum change for the NPAP review.
6. You receive the response from the NPAP and can begin the next steps to receive approval on your own campus and from your accrediting body.
   a.  Sometimes these approvals can be moving forward simultaneously. The difficulty with this is managing approvals if one group requests changes.
   b.  Some individuals choose to get all approvals on their own campus before submitting information to the NPAP. You need to be aware of how the campus groups will respond if changes are requested by the NPAP.
    
7. Evaluation Plan: As the curriculum plan is being developed, the Evaluation Plan should be developed or modified to fit with it. Each accrediting group as well as the NCQAC requires that the Nursing Program have a comprehensive evaluation plan. Expectations of the evaluation plan are found in the accreditation standards and for the NCQAC in WAC 246-840-548.

Accreditation Requirements

AACN/CCNE – Baccalaureate and Higher Degree Standards
The Commission on Collegiate Nursing Education (CCNE), an autonomous accrediting arm of the American Association of Colleges of Nursing (AACN), provides accreditation for Baccalaureate and higher degree programs.

CCNE Standards for Accreditation
CCNE Procedures for Accreditation

The Essentials of Baccalaureate Education for Professional Nursing Practice
The 2008 Essentials outline the necessary curriculum content and expected competencies of graduates from baccalaureate education programs and provide an important framework for designing and assessing these programs. The document describes:

• The role of the baccalaureate-prepared nurse
• Professional values for baccalaureate nursing education
• An outline of essential curriculum contents
• Baccalaureate core competencies and knowledge
• Suggested teaching strategies

Faculty Toolkit
This document provides resources for the implementation of the baccalaureate essentials. It includes learning strategies and exemplars to assist the faculty.

NLNAC
The National League for Nursing Accrediting Commission (NLNAC) accredits all types of post-secondary and higher degree education nursing programs.

Standards for practical, associate degree, baccalaureate, and higher degree programs in nursing
Curriculum standards are outlined in Standard 4 for each program type.

Accreditation Manual 2008 Edition
This manual provides directions for the accreditation process, a glossary of terms, as well as the Standards for all program types.

CNEWS Competencies

In 2002 the Council on Nursing Education in Washington State (CNEWS) published a document entitled Washington State Nursing Education Articulation Plan and Competency Statements. This document was the result of a collaborative effort of all nursing programs in Washington State and described competencies at each level of nursing education preparation, including practical, associate, baccalaureate, and master’s degree. The goal of the project was to provide guidance for facilitating articulation between programs and to systematize the expectations for graduates at each level.

While this document is now aging, it remains a useful tool and can best be seen as describing minimum competencies. Graduates of many programs are expected to have greater competencies than those described.

National Council of State Boards of Nursing (NCSBN) Test Plan

It is important to consider information regarding the NCSBN Test Plan for the NCLEX-PN and/or the NCLEX-RN as students expect to be prepared for the demands of the licensing examination.

Other Resources of Interest

• National League for Nursing: The NLN provides a wide range of educational resources for faculty and program development.
• ANA’s Nursing: Scope & Standards of Practice, (Note: new 2nd edition available August 2010) Available for purchase here
• ANA’s Guide to the Code of Ethics for Nurses: Interpretation and Application
• Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics
• Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care
• Institute of Medicine’s guidelines for preparing health professionals in the 21st century
• The IOM Health Quality Initiative

The purpose of this section is to provide basic resources and references that will help you lead your faculty in addressing issues of diversity in the nursing program.  These include examining the need for increasing diversity in both the workforce and education, and identifying strategies toward meeting that need.

• Terminology
• Background & Rationale for Promoting Diversity in Nursing Education
• Strategies
• Legal Concerns
• Resources
• Further Reading

Terminology

“Diversity” is a broad term with no single definition, but generally is used to refer to demographic attributes of persons and communities such as race, ethnicity, national origin, language, gender, age, sexual orientation, disability, and other aspects. “Inclusion” is a term being used in some industries to reflect the type of organizational climate that they envision and work to create.

Another key term used in this context is “under-represented minorities” (URM). This term refers to members of the above groups that are under-represented in the profession in proportion to the general population.   As can be seen in the ‘Background and Rationale’ sections below, within the field of nursing at this time, the priority communities of under-representation are African-Americans, Latinos/ Hispanics, Native Americans, and Pacific Islanders.

Background and Rationale for Promoting Diversity in Nursing Education

Racial and ethnic minorities are under-represented in all health professions, including nursing.  There are also significant disparities in the burden of illness among the US population.  These two facts are linked: one of the factors producing health disparities is a healthcare workforce that does not reflect the population; a more representative healthcare workforce can help reduce health disparities.  In addition, the under-representation of minorities in nursing is inconsistent with our professional values.  A more diverse workforce and more inclusive work environment benefit all of us, not just persons from minority groups.

The shortage of non-white nurses has multiple causes. One of those is the legacy of racism, and the persistent effects of this history. Schools can be inhospitable places for minority students for many reasons, as can workplaces and neighborhoods.

Issues of individual racism and prejudice overlap with institutional and systemic factors, including the effects of poverty and unequal schools. The paucity of teachers, role models, peers, and mentors from similar backgrounds exacerbates the difficulties minority students experience. Minority and underrepresented students historically have had higher rates of attrition in education and in the transition to practice. The effort to develop a more diverse nursing workforce therefore needs to focus on retention as well as recruitment of students, faculty, and practicing nurses.

WCN Briefing Paper on Diversity in Nursing (2009)
WCN Talking Points on Diversity (2009)
AACN Diversity Fact Sheet (2010)
Faculty Diversity Survey (2010)

Strategies

Current ‘best practices’ for promoting increased diversity in nursing and nursing education emphasize a comprehensive and multi-faceted approach. It can be helpful to think about the following elements, which are discussed in detail below, as part of constructing a comprehensive plan for your program:

• Recruitment
• Admissions
• Financial Aid
• Academic Support
• Social Support
• Minority Faculty and Administration
• A Climate of Inclusion

All schools have a “student diversity” office or coordinator, often as part of Student Affairs. Nursing deans, directors, and faculty are encouraged to collaborate with these programs and staff in developing, implementing, and evaluating their diversity efforts. We offer the following guidelines for each school to develop its own plans and strategies, and references to additional resources.

Recruitment
Recruitment includes outreach to underserved and under-represented communities and individuals, publicity about your program, and representations of your program in various media and settings.

• To what extent do your recruitment efforts target minority and under-represented students?
• How effective are your efforts in reaching those potential students?
• What do you know about your current students from diverse populations about what attracted them to your program?
• What are you doing that is already successful?
• What barriers impede interest and application in nursing and in your program?
• What changes could you make that might increase the proportion of under-represented students in your applicant pool?
• What could you do that would help make those applicants more competitive?

Recruitment efforts are more likely to be successful in attracting under-represented applicants if they:

• specifically and thoughtfully target minority communities, families, and leaders,
• involve minority students, faculty, and community leaders,
• and address the specific concerns of under-represented students in their promotional materials, as well as more general issues of the nursing profession.

Admissions
Admissions concern a school’s policies and procedures for admitting students to the nursing program.

• To what extent do your admissions policies and procedures encourage or impede the admission of larger numbers of qualified minority and under-represented students?
• What changes could you make that might increase the proportion of under-represented students who are admitted to your program?

Admissions programs are more likely to be successful in attracting under-represented applicants if they:

• use criteria or review standards that are more comprehensive or ‘holistic’, rather than focused on single data points such as GPA or standardized test scores,
• include under-represented students, faculty, and/or community representatives in admissions committees,
• include plans for financial, social, and academic support in the admission of under-represented students who may face challenges in the program.

Financial Aid
Under-represented and minority students are more likely than white students to be financially challenged. Effective recruitment and retention programs should incorporate financial assistance resources as one component of a comprehensive diversity plan.

Academic Support
Under-represented and minority students are more likely than white students to be from lower quality schools. Effective recruitment and retention programs should incorporate plans for academic support resources as one component of a comprehensive diversity plan.

Academic support may include:

• remedial classes for prerequisite coursework,
• tutoring and study sessions for current classes,
• classes and supports for basic study skills,
• use of learning technology,
• and building relationships with staff and faculty.

Social support
Just like academic support, social support can take many forms, including

• peer support,
• mentoring by faculty or community leaders,
• connections to minority student associations on your campus,
• and practical assistance with such issues as child care, transportation, and technology resources.

Minority Faculty and Administration
Increasing the supply of faculty from under-represented minorities is crucial to increasing the supply of under-represented students. Mentoring, scholarly support, and networks across schools are some of the tools that can be used to enhance the viability and visibility of minority faculty.

A Climate of Inclusion
In addition to all of the above elements, an important part of a successful diversity effort includes addressing the ‘climate’ of the school to promote a more welcoming, inclusive, supportive environment for minority students, faculty, and staff.

This can include, but is not limited to,

• helping faculty and staff to understand their own views of racial and ethnic differences,
• having leadership that is explicit about its philosophy, policies, and procedures related to having an inclusive environment, reducing or eliminating racism and other discriminatory practices in teaching
• addressing gaps, stereotypes, and inaccuracies in the curriculum,
• eliminating oppressive and discriminatory aspects of the informal aspects of the school experience, such as the ‘hidden curriculum’ and the social milieu,
• and evaluating and reporting progress on this work.

Promoting a more positive and diverse experience for all students, including under-represented minorities, during their academic career will encourage and foster continuing education and advancement, and thereby increase the pool of potential minority faculty, administrators, and researchers.

Legal Concerns

The following is intended as general information only. Educators and administrators are encouraged to communicate and collaborate with the legal and human resources departments at their own schools for guidance and advice on particular situations.

Washington State Law on Discrimination and Human Rights
RCW 49.60 contains the provisions that relate to human rights and freedom from discrimination.
A Human Rights Commission was established whose role it is to oversee policies and actions that will support human rights in Washington State.

Of special interest to nursing program deans and directors are the sections listed below.

1. The Purpose (RCW 49.60.010) – which establishes the ‘protected classes’ under the law. These protected classes include: race, creed, color, national origin, families with children, sex, marital status, sexual orientation, age, honorably discharged veteran or military status, or the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service animal by a person with a disability. Discrimination based on those characteristics is prohibited.
    
2. The law relating to employees (RCW 49.60.180). Care must be taken in all hiring, evaluation, and other practices to assure that discrimination does not occur.
    
3. The law mandating non-discrimination (RCW 49.60.400) also prohibits affirmative action or “preferential treatment.”  All individuals must be considered equally based on a common standard. This section was added based on a 1998 initiative.

Resources

Resources - Schools

• Multicultural Student Services Directors Council (MSSDC)
  In Washington’s 34 community and technical colleges, Multicultural Student Services promotes the recruitment, retention and successful completion of educational programs for students of color.
• Integrated Basic Education and Skills Training (I-BEST)
  I-BEST pairs workforce training with Adult Basic Education (ABE) or English as a Second Language (ESL) so students learn literacy and workplace skills at the same time. Adult literacy and vocational instructors work together to develop and deliver instruction. Colleges provide higher levels of support and student services to address the needs of non-traditional students.
• Discussion of activities at several of Washington’s community & technical colleges to promote diversity.
• AACN Issue Bulletin:  Effective Strategies for Increasing Diversity in Nursing Programs (December 2001)

NOTE: The following are examples of college resource pages. Program directors and faculty are encouraged to consult the diversity resources within your own school as well as those listed here.

• UW Office of Minority Affairs and Diversity
• WSU – Vancouver: Student Diversity
• SPU: The Racial and Ethnic Diversity Initiative
• PLU: The Diversity Center
• South Puget Sound Higher Education Diversity Partnership Institute
• Seattle University: Diversity and Multi-Cultural Resources

Resources – Other Professions and Disciplines

• Diversity Rx: Improving Health Care for a Diverse World
• American Speech Language Hearing Association: Minority Student Recruitment, Retention and Career Transition Practices: A Review of the Literature
  (Note: This is an excellent review of the issues, evidence, and strategies involved in increasing diversity in professional education.)
  References (for above review)
• American Association of Colleges of Pharmacy: Cultural Competence and Diversity Resources
• American Association of Medical Colleges

Resources – State Government

• Diversity in Washington State
• Washington State Department of Personnel
  Information about legal rules and regulations, as well as HR strategies and cultural factors
• FAQs on cultural competency & diversity

Further Reading

Major Documents

• Institute of Medicine (2004). In the Nation's Compelling Interest: Ensuring Diversity in the Health Care Workforce. BD Smedley, A Stith Butler, & LR Bristow (Eds.); Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the U.S. Healthcare Workforce. Washington, DC: National Academies Press. – Executive Summary
• Missing persons: Minorities in the health professions. A Report of the Sullivan Commission on Diversity in the Healthcare Workforce. (2004). WW Kellogg Foundation.
• Summary Proceedings of the National Leadership Symposium on Increasing Diversity in the Health Professions, 2007.
  Note: this conference was a follow-up to the previous report, and includes very useful list of:

Other References

• American Association of Colleges of Nursing (2008). Fact Sheet: Enhancing Diversity in the Nursing Workforce
• Andrews DR. (2003).  Lessons from the past: Confronting past discriminatory practices to alleviate the nursing shortage through increased professional diversity. Journal of Professional Nursing, 19(5): 29-294
• Buchbinder, H. (2007). Increasing Latino participation in the nursing profession: Best practices at California nursing programs. Los Angeles: The Tomás Rivera Policy Institute, University of Southern California, 2007
• Bureau of Health Professions (2006). The rationale for diversity in the health professions: a review of the evidence. U.S. Department of Health and Human Services, Health Resources and Services Administration
• Grumbach K., Coffman J, Muñoz C, Rosenoff E, Gándara P,  Sepulveda E. (2003). Strategies for Improving the Diversity of the Health Professions. San Francisco, CA: The California Endowment
• Hassouneh D. (2006). Anti-racist pedagogy: challenges faced by faculty of color in predominantly white schools of nursing. Journal of Nursing Education, 45(7): 255-262.
• Katz J (2007). Native American high school students’ perceptions of nursing. Journal of Nursing Education, 46(6): 282-286.
• Mkandawire-Valhmu, L., Kako, P., & Stevens, P. (2010). Mentoring women faculty of color in nursing academia: creating an environment that supports scholarly growth and retention. Nursing Outlook, 58(3), 135-141.
• Noone J. (2008).  The diversity imperative: Strategies to address a diverse nursing workforce. Nursing Forum, 43 (3): 133-143.
• Seago, J., & Spetz, J. (2005). California's minority majority and the white face of nursing. Journal of Nursing Education, 44(12), 555-562.
• Skillman SM, Andrilla CHA, Tieman L & Doescher MP (2008). Demographic, Education, and Practice Characteristics of Registered Nurses in Washington State: Results of a 2007 Survey.  Final Report #120. Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington. 

The purpose of this section is to provide basic resources and references that will help you develop your own leadership of faculty and your nursing program and to assist in the development of leadership in faculty members.

This site provides general information and resources as a background for the decision-making process.
You will find information and links in regard to the following:

• Overview
• Faculty Growth/Development
• Mentoring
• Strategic Planning
• Succession Planning

Overview

The following definitions focus on the broad conceptual issue of leadership.

“A simple definition of leadership is that leadership is the art of motivating a group of people to act towards achieving a common goal.

Put even more simply, the leader is the inspiration and director of the action. He or she is the person in the group that possesses the combination of personality and skills that makes others want to follow his or her direction.”


“In its essence, leadership in an organizational role involves (1) establishing a clear vision, (2) sharing (communicating) that vision with others so that they will follow willingly, (3) providing the information, knowledge, and methods to realize that vision, and (4) coordinating and balancing the conflicting interests of all members or stakeholders. A leader comes to the forefront in case of crisis, and is able to think and act in creative ways in difficult situations. Unlike management, leadership flows from the core of a personality and cannot be taught, although it may be learnt and may be enhanced through coaching or mentoring.”


Developing Your Own Leadership Knowledge, Skills and Abilities
In order to effectively lead a nursing program, a director/dean needs a wide array of knowledge and skills. A leader in a nursing program must also be an effective manager of that program. The entire Toolkit for Deans and Directors is designed to help with accessing important background knowledge.  

Self-assessment to determine needed areas of growth is the first step in leadership development. Assess your own:

• Current level of knowledge and skills in leading a nursing educational program.
• Leadership skills learned in another setting such as a clinical environment.
• Leadership is interpersonal in nature. Reflecting on your own interpersonal skills and abilities and your own interpersonal deficits will be an important component of developing your leadership skills.

Sources of Leadership Development:

• Seek a mentor: Who within the organization or in a similar organization would be a helpful mentor and role model? Someone within your organization may mentor you in navigating that system. For deans and directors within Washington State, CNEWS is an important resource for mentoring.
• Identify educational offerings that may help with specific needs. For example, your institution may hold workshops to help you learn to interpret budget materials. The Nursing Commission offers education to new deans/directors in relationship to its requirements. Accrediting organizations offer workshops relevant to meeting their requirements.

Faculty Growth/Development

Because the excellence of the nursing program rests in its faculty, their expertise and continued development is essential. 

Facilitating the ability of faculty members to attend workshops and other educational offerings in their field will support the maintenance of excellence in the various faculty roles discussed below.

It is rare for there to be funds to pay substitute instructors when an individual wants to leave to attend a workshop. A variety of strategies may be used, but all require the active support of the dean or director.

• Faculty may need to work cooperatively to trade assignments and cover for one another. Establishing an environment of trust and mutual support will be important to this effort. A dean/director must be aware of which individuals are asked to substitute and cover for others. Maintaining equity will support this environment of trust. Trading time frames may be essential in the case of clinical teaching.
• In some instances a guest may be asked to provide a lecture. A guest should always have someone from the program available for support in introductions, accessing technology, and assuring that the process goes smoothly.
• Alternative assignments such as online class, an observation experience, or student directed discussions (especially in the case of graduate students and upper class levels students) may be effective.

Funds for registration fees and travel may come from a variety of resources. Early application for any special funds will be essential to obtaining them.

• Negotiated professional development funds
• Special vocational funds in the community and technical colleges.
• Program designated funds

Education of faculty regarding the requirements for accessing funding support will be important. They need to be made aware of time deadlines, whether there is a requirement that they present a poster or other professional work, and any other requirements designated by the institution.

Clinical Practice Role
Faculty members must maintain their knowledge and skills in their clinical practice role. For those with certification, this may require a designated number of hours of direct clinical practice.

Maintaining clinical practice in those with clinical teaching responsibilities is essential.

• Working with students in the clinical area may meet this demand. The oversight, decision-making, and constant involvement in current practice while with students may help to maintain their expertise.
• Some colleges and universities have the ability to make one day per week available for clinical practice in the individual’s area of specialty. This may be especially true for those who are nurse practitioners and need to maintain their expertise and certification. How this fits into the faculty load determination will be a matter of institutional policy.
• For those who would have only a limited time available, there may be other options.
  - For those in community and technical colleges, “Back to Industry” grants (funded from Perkins funds at the state level) provide compensation to faculty for working alongside the staff in a clinical setting. For example, a faculty member who supervised students in long-term care was able to obtain a grant to spend two weeks with the nurse responsible for completing the MDS (minimum data set) on residents of a long-term care facility. She did this in the summer.
  - In a four-year college or university, a dean may be able to arrange for a faculty member to be free of other responsibilities for a week or two to enable that individual to spend concentrated time in the clinical setting.
• Those on less than 12-month contracts may be able to obtain employment in clinical practice when not involved in college responsibilities.

Instructional/Teaching Role
Individuals new to the faculty role may focus their professional identities in their clinical areas of expertise. This results in their focusing on professional development in clinical practice. While important for their continued credibility as a teacher of that clinical practice, this may leave out the importance of professional development in the faculty role.

In order to fulfill the role of nursing faculty as distinct from their nursing practice role, nursing faculty must develop expertise in roles related to their faculty assignment:

Instructional/teaching practices

• Classroom management
• Course organization
• Classroom teaching strategies
• Online teaching skills
• Management of computerized simulation
• Clinical teaching strategies

Assessment and testing of students

• Evaluation of students in clinical practice
• Development of tests
• Development and use of rubrics for grading papers
• Use of standardized tests (diagnostic and predictive) within the program

Curriculum development

• Ability to view the “whole” curriculum
• Understanding of scope and sequence in curriculum planning
• Authoritative resources to guide curriculum development
• Differentiating learning needs relative to the level of the student

Quality improvement strategies as applied to the program itself

• Developing evaluation plans
• Data gathering strategies
• Using data for decision making

A faculty may be well-served if different faculty members focus on different aspects of the instructional role.  They may then lead the rest of the faculty in relationship to that area. For example, an individual may develop expertise in test construction and be willing to consult with others as they develop tests.

Sources of professional development in the instructional role

• College-wide departments or offerings regarding teaching and learning
• System-wide offerings and conferences in the community-technical college system
• Workshops and course offerings
• Individual study using texts—this is often enhanced by a regular discussion group.  Purchasing resource texts for the use of the faculty may be a useful strategy.

Scholarly Role
Research and scholarship are most often required in four-year colleges and universities. Those new to the faculty may need to develop this role.

Areas needing development may include:

• Understanding the type and level of scholarship required in the institution
• Resources within the institution for support of scholarship
• Processes involved in obtaining outside funding for research including organizations and agencies that fund projects
• Skills associated with their scholarship
• Skills for presentation of their scholarship:  posters, podium presentations, scholarly articles

Service Role
In all higher education institutions faculty members are expected to participate in governance activities for the institution and the program. Some institutions also require service to the community.

Areas needing development may include:

• Participation in program and college governance
  - How to seek membership on program/college committees
  - How to be engaged in program/college accreditation activities
  - Avenues for representing the program/college in the wider academic community
• Participation in service to the community
  - Knowledge of relationships in the community that have already been established that may need faculty participation

Mentoring

Mentoring is a one-to-one relationship between an experienced individual and a novice. Through a mentor an individual receives support for developing expertise in the role. Mentoring is closely related to coaching.

• Some institutions establish formal mentoring relationships between an experienced faculty member and a new one.
• More common is the development of mentors in an informal manner. A dean/director may encourage mentoring through asking experienced individuals to work with someone who is new. This generally starts as orientation and then may expand into other areas.
• New faculty members can be encouraged to seek mentoring as they self-identify areas in which they need growth. A dean/director may encourage new faculty to express needs and then suggest a faculty member to consult for assistance and guidance.

See the Free Management Library for resources and information on mentoring.

Strategic Planning

A strategic plan focuses on where an institution or program is going and how it will know when it gets there. A strategic plan may encompass one year, five years, or ten years. Most commonly, a plan is for 3 to 5 years. With a shorter period, you are spending more time setting up a plan than implementing it.  With a longer period, circumstances may change so that the plan becomes irrelevant.

Not all institutions use the term “strategic plan”. They may focus on goals and objectives or a vision for the future. Whatever the terminology, the purpose is to get beyond managing the day-to-day needs and to look forward.

Institutional Strategic Plans
Many educational institutions have a strategic plan for the institution. This is likely to guide spending priorities and allocation of other important resources. Whenever possible, individuals from the nursing program should be involved in working on an institution-wide strategic plan. 

Knowledge of the institutional plan will enable a dean/director to contribute to the goals and objectives of the institution through the activities of the nursing program.

Nursing Program Strategic Plan
When an institutional strategic plan is already in place, knowledge of that plan will help the nursing program determine its own goals and objectives. When there is congruence between the institutional planning and the nursing program planning, there is more likely to be support for the nursing program’s efforts. Carefully wording nursing program goals and objectives to clearly articulate how they are congruent with the institution will facilitate others’ understanding.

Resources regarding Strategic Planning:

• McNamara, C. (2010). Adapted from the Field Guide to Nonprofit Strategic Planning and Facilitation.  This web resource features very detailed information on strategic planning and does not limit itself to one approach.
• Strategic Planning (in non-profit or for-profit organizations)
• Basic Overview of Various Models for Strategic Planning
• How to Start Strategic Planning: A Plan for the Plan.

Succession Planning

Succession planning involves thinking ahead to identify and prepare those who will replace current leaders. Key to this is identifying the skills and abilities needed for the leadership position involved. Only when this is identified can you proceed to think about succession. Sometimes the skills and abilities needed for the future will be different than the skills and abilities of the current holder of the role.

Replacement of Leaders within the Program
Succession involves the replacement of leaders within the program as they move on to other positions or roles. If a program has team leaders, coordinators, or other leadership positions, individuals can be mentored to develop the skills they will need to move into leadership roles. Sometimes the current person can effectively mentor a potential successor. An awareness of the skills and abilities of the various faculty members underlies the ability to do this.

Replacement of the Dean/Director
In the majority of institutions, the current dean or director is not charged with managing a replacement. However, in the current nursing faculty climate, promoting from within for such a position is common. In this case, the current dean/director may help to mentor others in understanding the requirements of the dean/director role and preparing to move into that position.

Resources regarding Succession Planning:

• Heathfield, S.M., Succession Planning. About.com Guide
• Schoonover, S.C., Succession Planning Best Practices

The purpose of this section is to provide basic resources and references that will help you develop and implement quality-improvement strategies for a nursing program.

• Establishing a Quality Improvement Plan
• Determining Assessment Methods
• Identifying Record Keeping Strategies
• References

Establishing a Quality Improvement Plan

Quality improvement is a strategy for identifying how well a program is meeting its vision and goals as well as a mechanism to improve all aspects of the program.

In Washington State, the Nursing Care Quality Assurance Commission requires that every nursing program have a comprehensive evaluation plan.

WAC 246-840-548 Standards and Evaluation of Nursing Education
“The nursing program shall meet minimum standards established by the commission as detailed in WAC 246-840-550 through 246-840-575. The nursing program shall implement a written, comprehensive, systematic plan for ongoing evaluation that is based on program outcomes and the input of faculty, students and consumers, and which incorporates continuing improvement.”

For programs accredited by the NLNAC, Standard 6 requires a comprehensive evaluation plan.
For programs accredited by the CCNE, Standard 4 requires evaluation of program effectiveness.

Evaluating Outcomes
Desired outcomes must be identified as part of the quality improvement plan.  Because not every aspect relating to the program can be tracked with the resources available, most institutions identify a set of outcomes that are termed Quality Improvement Indicators that will be tracked.

Quality improvement indicators are those attributes that can be measured to provide guidance and direction for more intensive assessment and for determining needed change.

Identifying Key and Required Indicators

• Key indicators are those quality improvement indicators identified as representing major, important aspects that reflect other aspects of the program. Some key indicators are required (see below) while others can be chosen by the program. For example, a program with a large emphasis on service might identify a key indicator reflecting service of graduates that would be included in the QI plan.
• Required indicators are key indicators that are determined by accrediting and approval bodies and that must be included in any evaluation plan.  These usually include:
  - Attrition/Graduation  rates
  - NCLEX or certification examination passing rates.
  - Employment rates
  - Employer satisfaction with graduates
  - Graduate satisfaction with program

Evaluating Structure
The structure of the program includes those fixed infrastructure attributes such as numbers and qualifications of faculty, physical facilities, libraries and other such resources.  Both state boards of nursing and accrediting bodies have standards related to these aspects of any nursing program.

Evaluating Processes
Processes include the policies, educational strategies used, and other actions taken within the nursing program.

Determining Assessment Methods

Many different methods can be used for assessment of the structure, processes and outcomes. An important consideration is that data gathered from any assessment method must be aggregated and trended over time in order to provide information that can be used for decision making.

Tools for Evaluation

• Review of Records: Some data is found in student and faculty records. These records may be accessed and data extracted.
• Employer Surveys: These would be developed by faculty. Returns on employer surveys are often poor. Identifying the appropriate person to ask to complete an employer survey is important. Clinical agency personnel are often reluctant to spend time on surveys from colleges. Making the survey very brief helps. You may also be able to have surveys completed by members of an advisory committee – this may even be done during an advisory committee meeting.
• Testing Services: There are several sources of outside testing that can be used to examine student learning outcomes. These are most useful when they can be used for individual student guidance as well as aggregated for program planning needs. These services provide a variety of pre-program, in-program, and NCLEX preparation testing. Aggregated results of external testing may be used for competency measures.
  - ATI (Assessment Technology Inc.):  Provides TEAS (Test of Essential Academic Skills and ATI branded testing.
  - Center for Nursing Education Testing
  - Evolve-Reach, Elsevier Publishing (HESI)
  - NLN Testing Service
• NCLEX-RN pass rates are provided to the program by the Nursing Commission. State and national averages are available to use for comparison.
• NCLEX Program Reports An Annual NCLEX Program Report may be ordered from the company that prepares the NCLEX. These program reports reflect graduate performance in relationships to the competencies as tested by the NCLEX examination. These reports may be valuable for a large program. For a small program, there may be too few individuals responding to certain areas of the test plan to provide meaningful statistics.
• Pass rates on certification examinations may be provided by students.
• Student Satisfaction Surveys Include only aspects the students could meaningfully evaluate. Online surveys that are brief and easy to complete are more often completed.
• Faculty Surveys A faculty survey may be used to examine adequacy of classroom resources, clinical sites, and other such attributes.

Designing Surveys
A well-designed survey has makes it easy for the respondent while providing data that can be analyzed in meaningful ways to inform decision-making. 

• Information on designing surveys
• Survey Share

Implementing Surveys
Tabulating results from surveys is very labor-intensive if it must be done by hand.  There are other options that make it easier:

• College resources
  Some colleges have online resources for the development and distribution of surveys. Others have support for developing printed surveys that may be scanned by machine and data aggregated.
• Online services
  Online services provide for survey development, survey distribution via email invitations, survey completion on the web, and a wide variety of statistical analysis techniques on the results. It may take time to learn to structure your survey using any online service, but it is worthwhile to invest the effort.
  - Educational Benchmarking (EBI) offers 50+ national benchmarking studies in ten areas of study. EBI has partnered with other industry-leading organizations in many of these areas in order to ensure that studies are relevant and reliable for continuous improvement efforts.
  - Survey Monkey has a free option with a limited number of questions and limited participants and a paid option that allows for longer, more complex surveys, more participants and more detailed analysis.
  - SurveyShare is a paid service that has a wide range of options.
  - Key Survey is a paid service.
  - Zoomerang provides both a free limited service and a paid service.
  - eSurveysPro is a paid service.

Qualitative Strategies

• Direct observations may be used for such things as the facility may be completed and documented.
• Comparative review of documents such as the college mission statement and the nursing program mission statement may be used.
• Student portfolios may be used to reflect competencies.

Identifying Record Keeping Strategies

Managing the quality improvement process requires that the plan be in writing and housed in a file that is accessible to those who must use it. This is often in a folder on a shared drive that faculty can access. Some programs put this in a notebook or in a designated file.

Data need to be collected, aggregated and then reviewed to determine the meaning of the data and what, if any, action will need to be taken based on the information revealed. Depending upon the nature of the data, a program might choose to have it on a shared drive, in a file, or in notebooks. Ease of retrieval and use are important.

References

• CCNE, (2010), Standards for Accreditation of Baccalaureate and Graduate Degree Nursing Programs.
• Billings, D. M., (2007), Using Benchmarking for Continuous Quality Improvement in Nursing Education" Annual Review of Nursing Education. Ed. Marilyn Oermann and Kathleen Heinrich. New York, New York: Springer, 2007. 173-182.
• Institute for Healthcare Improvement. Reinventing Nursing Education.
• Kyrkjebø , J.M. (2006). Teaching Quality Improvement in the Classroom and Clinic: Getting it Wrong and Getting it Right, Journal of Nursing Education 45(3).
• NLNAC, (2008). Standard 6 in NLNAC Standards and Criteria. Available at www.nlnac.org.
• Nursing Care Quality Assurance Commission, WAC 246-840-548 Standards and Evaluation of Nursing Programs.
• Oermann, M.H., Gaberson, K.B., (2009). Chapter 17 Program Assessment in Evaluation and Testing in Nursing Education.

The purpose of this section is to provide basic resources and references that will help you to develop and implement technology strategies for a nursing program.

• Nurse Educator Listserv
• Classroom Teaching Technology
• Hand-held Computers
• Course Management Software
• Online Teaching Software
• Webcasting/Podcasting
• Information Technology
• Computerized Human Patient Simulators

The director or dean must often be the catalyst for using technology and for identifying mechanisms to obtain technology desired by faculty. Data regarding changes in outcomes based on the use of technology is scarce. Students often express increased interest and focus when technology is used.  Some technology use is dependent upon the entire college adopting a particular technology while others can be adopted independently by the nursing program.

Nurse Educator Listserv

The Nurse Educator listserv is a moderated email discussion of topics relevant to nursing education.  An individual posting a question or concern to the listserv will receive responses from nursing educators from across the country. An individual who subscribes will receives the emails of other subscribers. You can choose to receive each email individually or to subscribe to a single email each day that will contain all the emails from individuals.  There is an archive of past emails accessed by topic. 

Especially beginning nurse educators may find this a useful resource. Any nurse educator may join the email list.

Classroom Teaching Technology

Classroom teaching technology involves both hardware and software. All faculty need to be oriented to the classroom technology available to them. Many colleges have a technology department or faculty development department that will assist instructors in learning all of the hardware and software available in the classroom. When classrooms have multiple users, there may be options for sharing costs of adding technology with other departments. In community colleges, Perkins funds may be available.

Hardware for classrooms

• Classroom projection systems – projector, screen, and controllers
• Classroom internet access, either wired or by wireless technology
• Classroom computer system for instructor use that controls the projection system and internet access. This allows presentations, videos, and internet sites to be projected.
• DVD player wired to projection system.
• Document camera that allows individual documents or small actions (such as filling a syringe) to be projected onto the screen. This serves the same purpose as an overhead projector with added capabilities.

Software for classroom use
Presentation Software for slide development and display:

• PowerPoint is the most common program. If you wish to place a presentation online, students can obtain a free PowerPoint viewer downloaded from Microsoft.
• Open Office Impress is the presentation program included in the Open Office Suite of programs.
• Prezi is an online program for developing dynamic, interactive presentations.
• Apple Keynote is available for Mac computers.
• PowerPlugs Charts creates excellent charts and graphs for use in PowerPoint.
• Color Schemer Online is for use with PowerPoint to create different color schemes than those available in the PowerPoint program.

Classroom Response Technology
The instructor has the main hardware that provides projected questions for student response and then records and reports student responses in the aggregate. Each student has a handheld “clicker” to enter a response to an instructor question. Simple statistics may be developed from responses. This facilitates an interactive classroom.

• I<Clicker
• Turning Point
• H-ITT

References:

• Bruff, D. (2010) Classroom Response System ("Clickers") Bibliography.
• Deal, A. (2007), Classroom Response Systems: A Teaching With Technology White Paper.
• Fies, C. & Marshall, J. (2006), Classroom Response Systems: A Review of the Literature, Journal of Science Education and Technology, Vol. 15, No. 1, March 2006 (©2006) DOl: 10.1007/S10956-006-0360-1.

Handheld Computers

A variety of different types of handheld computers are available. Each type has a different way of accessing data and different types of programs and data available. As these develop, more overlap is occurring and the distinctions may become irrelevant.

Personal Digital Assistants (PDAs)
Palm and Pocket PCs are two common PDAs.

• PDAs were the first handhelds and still have the most applications within the healthcare arena. All manage calendars, address books, calculators, and to-do lists and can load a variety of application programs. Some of the most common programs are versions of word processing and spreadsheets.  In addition, reference books are marketed for use on PDAs and some reference programs are available without cost.
• PDAs have touch screens or use a stylus for access. All can be connected to a computer in order to load programs. They have infrared communication between devices. Some have WiFi capabilities.
• Use in nursing programs has included use by faculty and students to have a variety of reference books immediately available.  Faculty have also used them to manage student data during clinical experiences. Students have used them to gather patient data and manage documentation required for the course. Concerns about confidentiality of protected health information must be addressed if PDAs are used in the clinical setting. Unless faculty are willing to learn to use PDAs and integrate them into their teaching, only a few technology adept students will choose to use them.
• Costs of PDAs are managed in different ways. In some settings students purchase them as an optional aid. In others they are required. Decreased costs of some reference books may somewhat alleviate the overall cost. Still other programs have accessed grant funds for PDAs. Purchasing them for “check-out” to students has been used in some places but concern for loss, damage, and obsolescence are a deterrent to this approach.
• References:
  Zurmehly, J. (2010). Personal Digital Assistants (PDAs): Review and Evaluation, Nursing Education Perspectives 31(3), 179-182.

Smart Phones
Black Berry, I-Phone, Droid, and Palm Pixi are smart phones. Each has a different operating system and thus has different applications available.

• In addition to telephone features, smart phones access the internet using telephone technology. The telephone connection feature may be turned off to enable them to be used in environments where telephones are not permitted.
• There are many applications for smart phones just as there are for PDAs. Some professional reference materials for health care are available in one format but not another.
• The phones themselves are costly and require an ongoing subscription to a telephone plan that includes data access.

 
I-Pod Touch
This expansion of the I-Pod has the ability to connect to the internet through WiFi and contains basic calendar, address book, to-do list and calculator as well as music and video storage. There are many applications available, but as yet, professional health care references are not available.

Course Management Software

Standard Office Products
Word Processing, Spreadsheets, Presentations, Email, and Internet Access are essential tools for faculty.  These may be the Microsoft Series, the Open Office series, the WordPerfect series, or any other. Proficiency in using these tools is essential for all.

Specialized Reference Management Software 
Many faculty members will find that their work is greatly eased by the use of reference management software. By keeping track of references and managing format, these dedicated data base systems facilitate scholarly work. Wikipedia provides a list of and evaluation of reference management software.

Specialized Test Construction Software:

• Text Book Test Banks: Most text book publishers in the field of nursing provide testing software and question banks for their texts. Most of them are designed so that an instructor may add questions to the test bank.
• Scantron-Par System (Scantron Grading Machines, ParScore/ParTest): The Scantron grading machine can be used with the specified test answer sheets for grading conventional paper and pencil tests.  Their test construction software is combined with the scanner that grades multiple choice tests completed on special answer sheets. The software then provides a variety of statistical analyses of the student responses. This company has software that can be used for testing in computer test locations.

Online Teaching Software

Each college or university providing online education will purchase online education software to be used by the whole institution. Below are some common examples.

• Blackboard
• Angel: Angel has been purchased by Blackboard.
• Second Life: This is a virtual world in which an instructor can set up a setting in which students can participate There is a cost to setting up an online class presence.  There is a Virtual Hospital set up in Second Life. An electronic record system has been developed for the Virtual Hospital.
• Virtual Hospital A service of the University of Iowa College of Medicine.
• Breakaway Games: Virtual Learning Lab for Health Care.
• Software for Online Presentation Use
  - Adobe Flash—creates presentations for use on web sites. Has animation effects and can import video. Has a reputation as difficult to use.
  - Power Converter—Converts PowerPoints to Flash to enable posting them online.
• Camtasia Studio: Free-to-try program for creating and producing screencasts for the Web, mobile phones, and DVDs. For ongoing use a paid version is required.  Many colleges have purchased Camtasia for use in online courses.

Webcasting/Podcasting

Digital sound recordings may be posted on a website and can be listened to online or downloaded to a computer or to an MP3 player to listen to at a later time.  – A digital recorder that will create an mp3 sound file is required.

• Audacity software can be downloaded and placed on a computer with a microphone input. The software will convert the input to a digital file that can be posted on a web site. 

Digital recordings of lectures may be placed on a course website or on a online learning class site.  Recorded lectures may be used as a study aid for students in regard to content in settings where classroom work focuses on interactive, problem-solving strategies.  If the website supports the technology, the digital recording can be posted as a webcast and as a podcast.

• Listen to a webcast: Simply click on the MP3 icon and a window will open with your computer’s audio listening program.  Usually it starts playing immediately. You can control it on-screen by pausing, changing the volume, or turning it off.
• List to a podcast: If you would like to download the audio file to your own computer to either listen to on the computer whenever you choose without being online or would like to load it on your MP3 player or iPod, you can subscribe to the sermons.  If you subscribe, your computer will receive what appears to be an email containing the sermon file—this is called an RSS feed.
  
  To subscribe:
  In the box where the items are posted you will see a small orange icon.  Click on this box.  A window should pop up for you to make subscription decisions. There is a pull-down menu where you can indicate where you want the podcast to go on your computer – this is usually your email program or it may be your browser.  Then you click on the “Subscribe” button. That is all there is too it.  Each time a new item is posted in that series you will receive a new MP3 file.  You can transfer them to another device from your computer, listen to them and delete them when you choose.
  Beard, K. & Morote, ES, (2010) Using Podcasts with Narrative Pedagogy: Are learning objectives met? Nursing Education Perspectives 31(3), 186-187.

Information Technology

Information technology includes the use of electronic health care/medical records and technology for managing nursing sensitive information in a way that can be retrieved in a meaningful way.

All students must become familiar with the use of electronic health care records. Health care agencies may provide opportunities for faculty and staff to learn to use these systems. In some settings, this presents difficulties for students and faculty alike. Simulation systems on campus may provide an alternative learning resource.

• Electronic Health Care Records Simulation:
  Academic Electronic Health Care Records: An online subscription service for an EHR that can be used in the academic setting for teaching purposes.

Computerized Human Patient Simulators

Computerized simulators provide realistic problems and responses. They are costly, require carefully organized space, and skillful operators to be successful. 

Major Brands of Simulators:

• SimMan by Laerdal 

Resources for Simulation Experiences
Because developing effective simulation experiences is time consuming and requires considerable faculty education, many schools seek simulations that have been developed by others.  In some areas, schools are working collaboratively to share simulations developed. Some are available for purchase from the simulator manufacturers.

• Simulation Innovation Resource Center (SIRC) is “an online e-learning site where nursing faculty can learn how to develop and integrate simulation into their curriculum, and engage in dialogue with experts and peers.”  It was developed as a cooperative venture between the NLN and Laerdal. The resources on this site may be purchased online.
• Kansas State Board of Nursing – Simulation Scenario Library;
• NLN Nursing Scenarios
• Simulation Scenarios for Nurse Educators 2008, Campbell and Daley, Springer Publishing.
• Associate Degree Curriculum Improvement Project, North Carolina,
• Clinical Simulation in Nursing Journal