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Nursing
Louise Timmer, Lead Discipline Faculty
California State University, Sacramento
Summary of Identified
Issues
The second year of IMPAC nursing discussions occurred at five
regional meetings in Oakland, San Diego, Fresno, Cerritos
and Sacramento between November 17, 2001 and January 19, 2002.
Present were 55 participants: 47 faculty, 7 Chairs/Directors
and one Articulation Officer, Jane Church, who is assigned
to the Nursing discipline. There were representatives from
26 community college nursing programs, 13 CSU generic BSN
programs, 1 CSU RN to BSN program, and the UCLA RN to BSN
program.
The statewide meeting, April 12-13 at the Los Angeles Sheraton
Gateway was attended by 30 nursing faculty/chairs/directors,
a representative from the Board of Nursing, a representative
from the California Strategic Planning Committee, and a representative
from Kaiser Permanente Health System. They represented 13
community college nursing programs, one UC campus and 10 CSU
campuses. Meetings were well attended by faculty and chairs
from the CC, CSU and UC systems.
Among the issues identified were these six:
(1) Retention and Remediation in the ADN nursing programs:
Jim Comins, Director Ed>Health Net Care Initiative, financed
a study entitled "ADN Prerequisite Validation Study."
The study investigated predictors of success in completing
the ADN nursing program. The study, reviewed at the final
meeting, April 12-13, reviewed the data on 5000 nursing students
from 1994-98. The study, while it did not investigate subjective
factors affecting retention (e.g., students' income, family
factors, etc.) found that overall GPA, English score and Biology
courses GPA were probable predictors of success in completing
the ADN nursing program. IMPAC participants will continue
to discuss the implications of these findings for our programs.
(2) Integrated Chemistry Course: A committee
was formed to develop a prototype for an integrated chemistry
course. The committee was comprised of the following faculty
from the UC, CCC and CSU systems:
1. James Armstrong, Chemistry, CCSF (Chair)
2. Chris Riegle, biology, Irvine Valley College
3. Carmen Zellhoefer, biology, Merced Community College
4. Beverly Shue, biology, Harbor Community College
5. Sharon Roberts, biology, CSU Bakersfield
6. Joe Brundage, chemistry, Cuesta Community College
7. Robert Dietz, chemistry, Bakersfield Community College
8. Allen Leung, chemistry, Rio Hondo College
9. James Postma, chemistry, CSU Chico
10. Edward Alexandar, chemistry, San Diego Mesa College
11. Wendy Hollis, nursing, LA Harbor Community College
12. Bonnie Walker-Raingruber, nursing, CSU Sacramento
13. Julia Schovein, nursing, CSU Chico
14. Anthony McGuire, nursing, Long Beach City College
15. Kay Baker, nursing, UCLA
In addition, two articulation officers volunteered for the
subcommittee to answer any questions regarding developing
the course to satisfy the community college GE pattern, to
ensure transferability to the UC and CSU systems, and to meet
requirements for CANning. These officers were:
16. Jane Church, Chabot College
17. Carol E. Lee, Imperial Valley College
The integrated chemistry course is intended to prepare nursing
students for physiology, pathophysiology, nutrition, and for
pharmacology content and medication conversions in the nursing
program. The committee members considered a 4-5 unit integrated
chemistry course with a lab and content that includes conversions,
systems of measurement and ratios and solution problems in
a lab session, and then reviewed six integrated chemistry
courses currently taught in the CSU and CC systems. The committee
identified the integrated chemistry course taught by James
Armstrong, City College of San Francisco as such a prototype
course. The committee and other chemistry, biology and nursing
faculty present at the statewide IMPAC meeting reviewed the
integrated chemistry course prototype as well as the nursing
competencies, skills and content proposed by the nursing faculty.
Sample course proposals will be made available to nursing,
chemistry and biology faculty in the CC, UC and CSU systems
for discussion on their local campuses. Finally, the CAN 6
integrated chemistry course will be reviewed for relevancy
and currency by faculty in the chemistry, biology and nursing
departments in all three systems.
(3) Math competencies for Nursing Programs: The nursing faculty
met with the math faculty at 4 of the 5 regional meetings.
Consensus among the math faculty was that the math competencies
for the nursing programs do not fit in the basic math course
required by the community college and CSU systems. The nursing
faculty believed that students should have dimensional analysis
in the basic math course, that this content is college level,
and that instruction in this content would assist the nursing
students in calculating solutions, medication dosages and
IV drip rates. The math faculty were given sample math problems
applicable to nursing courses. More discussion is needed next
year.
(4) Statewide Database of Nursing Applicants: At all regional
meetings, both the community colleges and CSU nursing faculty
discussed the need for a statewide database of qualified nursing
applicants. In the Fresno area, two ADN nursing chairs described
the surplus of 1000 pre-nursing students in that region who
have no nursing program to attend. More discussion is needed
on the methods to develop a statewide database for both higher
education systems.
(5) Survey to all California community college Nursing Programs:
Wendy Hollis is conducting a survey of all California community
college Nursing Programs requesting from the chairs/directors/deans
a detailed description of all nursing courses. She will compile
a grid and description of all 72 nursing programs and provide
a report at the 2002-03 IMPAC regional meetings. The faculty
are exploring common sequencing of the nursing courses in
the community college programs to facilitate the intercampus
student transfer process.
(6) Collaborative Nursing Programs between California community
college and CSU: The five collaborative nursing program projects
between the CSU and the community college nursing programs
were discussed. Additional information about these programs
and contact individuals will be made available to future IMPAC
nursing participants. These projects are additional examples
of recent intersegmental collaboration between the community
college and CSU systems. The five collaborative nursing programs
include CSU Sacramento and Sacramento City College, CSU Fullerton
and Saddleback Community College, CSU Los Angeles and local
community colleges, CSU Stanislaus and four local community
colleges, and CSU Bakersfield and three local community colleges.
(7) Meetings with Board of Registered Nursing and NLN Accreditation
Consultants: The review of the GE pattern and the nursing
courses in the community colleges continued throughout the
second year. Wendy Hollis is collecting additional data that
describes the GE courses required by each campus. The GE grid
reveals a variance in required GE courses among the CC campuses.
The faculty addressed the concern that the high number of
required GE courses poses a barrier to the limit of 72 total
units permitted for NLN national accreditation. As additional
information is still needed, the meetings with the education
consultants from the BRN and the NLN did not occur. Pending
review and discussion next year at the regional IMPAC meetings
of the nursing and GE courses in the community colleges nursing
programs next year, more specific recommendations will be
made.
Identified Trends/Future
Directions
CSU Core Alignment Project
Arising from the CSU Core Alignment project in nursing are
several proposals that are being shared with UC and California
community college faculty for discussion and possible multi-lateral
adoption.
In particular are:
(1) Courses Commonly Required for Admission to CSU Nursing
Programs
These courses CSU recommends to be taken prior to admission
into a nursing program:
· Anatomy w/lab
· Physiology w/lab
· Microbiology w/lab
· Integrated chemistry course with lab
· English Comp
· Speech
· Math
· Nutrition
· Growth & Development
· Sociology
· Psychology
(2) Common GE Pattern and Common Admissions Requirements
The CSU Core Alignment Committee is reviewing the admission
requirements and the GE courses to determine a common general
education pattern of coursework and common admissions criteria
among the CSU 13 generic nursing programs and the RN to BSN
nursing programs. This report will be discussed at the next
year's IMPAC Nursing Discipline regional meetings, recognizing
that General Education programs for community college AA/AS
degrees are locally determined by community college faculty.
More generally, IMPAC faculty have been discussing California's
nursing shortage and its implications for nursing education,
curriculum, and admissions practices.
· Increase Demands for Nursing Services:
The nursing shortage has worsened in the last two years. Simultaneously,
California has two problems; limited capacity in pre-licensure
nursing programs and a declining interest in pursuing nursing
as a career.
· Enrollment Capacity: Enrollment continues to be limited
in all of the 94 pre-licensure and 26 master's degree nursing
programs, both state-supported and private, and over the past
5 years, applications to pre-licensure nursing programs have
declined throughout the state.
· Changes Needed in Nursing Education
For the past five years, several nursing organizations have
met with nursing faculty in the state supported and private
universities and colleges to explore and develop better systems
of education and articulation as one strategy to address the
critical nursing shortage in California. The goal is to create
a career ladder mechanism whereby individuals may progress
through an education process that begins with the licensed
vocational nursing (LVN) and ends at the PHD level. The intent
is to align curricula in the LVN and RN nursing programs to
reflect the level of education required for nursing practice.
Nursing curricula are based on California law as administered
by the California Board of Vocational Nursing and the California
Board of Registered Nursing.
Unlike previous nursing shortages, health care employers not
only predict an increased need for registered nurses but also
a need for bachelor and master prepared nurses. In addition,
there is a shortage of nurse educators in California, and
the average age of nursing faculty is 56 years. Nurse educators
hold Master's and doctoral degrees as a minimal level for
college and university employment. Approximately, 73% of nursing
admissions are to associate degree programs and while these
admissions are expected to increase, admissions to BSN programs
are decreasing each year . At present, only 16% of associate
degree RNs continue their nursing education and obtain higher
degrees. Changes in nursing education must occur to ensure
that California has a nursing work force with the appropriate
education and skills to meet the state's health care demands.
The Institute of Medicine study in 1994 concluded that the
educational mix of nurses is inadequate for current and future
delivery of nursing services. The education of nurses needs
to be aligned with the levels of professional judgment required
of nurses in all health care settings. Nurses must be able
to work in complex health care systems that demand a high
level of clinical judgment, management skills, and increasing
clinical autonomy to supervise other health personnel. Articulation
and alignment are the key components in nursing education
to reduce the barriers to transfer among the CC, CSU and UC
nursing programs.
Recommendations
for the Discipline
The agenda for the academic year 2002-2003 was developed at
the final meeting in Los Angeles. The agenda included the
following issues arising from prior discussions:
1. Develop an articulated set of lower division nursing courses
and courses required for admission into the Associate Degree
in Nursing (ADN) and Bachelor of Science in Nursing (BSN)
programs and reduce matriculation barriers between ADN and
BSN programs. Specifically,
· Create grids with course descriptions for the courses
required for admission and lower division courses in the ADN
and BSN programs in California.
· Create a grid for community college ADN programs
that describes the number and composition of units to the
degree currently stipulated at each college.
· Discuss which existing or new courses would serve
as California Articulated Number (CAN) courses, and which
currently CANned courses need revisions to their descriptors.
· Survey BSN programs, public and private, to determine
matriculation barriers to admission for the ADN transfer students.
2. Where feasible, work with chemistry faculty to encourage
local creation of an integrated chemistry course suitable
for all nursing and other allied health programs. Specifically,
· Work with local chemistry faculty to determine content,
competencies, and skill sets serviceable to nurses for an
integrated chemistry course.
· Encourage nursing faculty to hold campus meetings
with the local chemistry department and science faculty to
discuss the components of an integrated chemistry course.
· Discuss feasibility of the integrated chemistry course
as a CAN course.
3. Review the General Education Patterns on the college/university
campuses with ADN and BSN programs. Specifically,
· Discuss the number of GE courses and units required
for general education patterns at each campus.
· Create a grid for the general education patterns
on campuses with ADN and BSN programs (CC, CSU, UC, private
university systems)
· Review the grid for similarities and differences.
· Discuss the barriers that high GE units pose for
NLN accreditation to CC nursing programs
4. Review preparation of students for admission to nursing
programs. Specifically,
· Create grid of admission requirements for ADN and
BSN programs,
· Review grid to determine similarities and differences.
· Review retention and attrition rates for ADN and
BSN programs.
· Review services offered for students needing additional
academic preparation in ADN and BSN programs.
· Review passage rate for state board licensure exam
for nursing programs.
5. Discuss the purpose of, pragmatic considerations of, and
need for pre-entrance assessment testing for admission to
ADN and BSN programs.
6. Review the CAN course descriptors for the nursing prerequisite
courses to determine currency and relevancy.
7. Discuss the grid of nursing courses for all CC nursing
programs to determine the feasibility of a standardized sequencing
of nursing courses to facilitate intercampus transfer, while
acknowledging the multiple allied health programs these programs
may simultaneously serve.
8. Discuss the possibility of a community colleges statewide
Core Alignment Nursing Committee for the nursing programs
similar to CSU Core Alignment Nursing Committee.
9. Continue to pursue a career ladder approach, beginning
with CNA to PHD in the public higher education system of California.
10. Meet with the interdisciplinary faculty from psychology,
human development and English departments in future IMPAC
meetings. Specifically,
· Discuss with psychology faculty the prerequisite knowledge
and competencies needed for the study and practice of mental
health and geriatric nursing.
· Discuss with the faculty teaching human development
courses the knowledge and competencies needed for the study
and practice of obstetric and pediatric, as well as geriatric
nursing.
· Discuss with the English faculty the students' need
to have reading and writing proficiency in English for the
study and practice of nursing (research, scientific journals
and textbooks, care plans, reports, charting, etc).
Recommendations
for Support Courses
1. The biology, chemistry and nursing faculty agreed to
· conduct local discussions of the prototype 4-5 unit
integrated chemistry course prepared by James Armstrong, Chair,
Chemistry Department at City College of San Francisco. Additionally,
the chemistry content, competencies, and skills developed
by the nursing faculty will be locally shared;
· review the CAN 6 course for currency and relevancy.
· review all the courses required for admissions to nursing
programs and recommended as electives for those programs to
determine the currency and relevancy of their CAN descriptors.
Nursing faculty will make recommendations to the appropriate
discipline faculty if revision seems warranted from a nursing
perspective:
Courses Required for Admission to CSU Nursing
Programs
Anatomy w/lab CAN Bio 10
Physio w/lab CAN 12 or both as CAN BIO SEQ B
Micro w/lab CAN 14
English comp CAN Engl 2
Math (Stats) CAN STAT 2
Nutrition CAN FCS 2
Growth & Dev Depends-CAN has a Child Dev description
Socio CAN Soc 2
Psych CAN Psy 2
Topics for Further
Discussion
All of the recommendations listed above need further discussion
to further facilitate student articulation and transfer process
among and between the community college, UC, and CSU systems.
In addition, further discussion of the following points is
also needed:
· recruitment and retention issues in the nursing programs
to discover what quantitative and qualitative factors impact
on recruitment and retention of students in the nursing programs
in the community college, UC, and CSU systems.
· CAN numbers for the lower division nursing courses
and other courses required for admission to nursing programs
· Discussions with the accrediting organizations (NLN,
BRN) for the nursing programs of the community colleges of
essential content, competencies, skills.
· A career ladder model for a nursing curricula (such
as the Connecticut model) beginning with the LVN and progressing
to the BSN, MS and PhD.
Suggestions Forwarded
to/to be Forwarded to:
CAN The CAN descriptors
for recommended electives and courses required for admissions
will be reviewed by all UC, CC and CSU nursing programs as
well as the biology and chemistry faculty for currency and
relevancy.
ASISST
The prerequisite courses can be sent to ASSIST for the CSU
nursing programs. The community colleges nursing programs,
during 2002-2003, will be asked to make local determinations
about the adoption of these same prerequisite courses in subsequent
years.
CIAC Nursing
faculty on each campus are encouraged to meet with their articulation
officer, campus counselors, and science faculty to discuss
the proposal for the integrated chemistry course and the courses
required of students entering nursing programs in the community
colleges, CSU, and UC.
ICAS IMPAC
faculty will be asked to document and submit concerns regarding
administrative barriers to articulation and transfer in the
collaborative nursing programs between the community colleges
and transfer nursing programs.
1. Determine what higher education system
receives FTES for the collaborative nursing courses and GE
courses offered in the collaborative nursing programs in the
community colleges and CSU systems.
2. Consider more efficient and cost-effective
methods to enroll nursing students concurrently in the collaborative
nursing programs between the CSU and community colleges' nursing
programs.
(e.g., dual enrollment, concurrent enrollment, cross-enrollment,
open access enrollment methods)
Community College
Academic Senate
The regional IMPAC meetings recommended that a Community College
Core Alignment Committee be established among the nursing
programs similar to the CSU Core Alignment Committee. This
request was presented to the chairs/directors/deans at the
March 7, 2002 COADN statewide meeting. The purpose is to reduce
the barriers to articulation and transfer among the community
colleges nursing programs. The nursing chairs/directors described
the difficulty eligible applicants have in transferring from
an impacted community colleges nursing program to another
community college nursing program that had space available.
A grant will be sought to further these discussions during
2002-2003.
Board of Registered
Nursing
Meet to discuss inclusion of chemistry in the required curriculum
regulations of Title 16.
IMPAC Outreach presentations made by members of this group:
Organization Date/Place Presenter's Name Attendees
1. Statewide mtg. of chairs/directors
CC & CSU Nsg Programs Sacramento 10/10/01 Timmer/Hollis
100
2. Calif. Gov't. Sen. Speier Sacramento, 3/19/02 Louise Timmer
15
3. American Nurses Association
of California(ANA\C) San Diego, 2/25/02 Louise Timmer 40
4.Calif Senate: Legislative hearing
Gov't -Senator Scott Sacramento, 4/9/02 Louise Timmer 50
5. Calif. Chairs/Director Mtg. Santa Clara 3/7/02 Timmer/Hollis
71
6. CIAC Conference Sacramento 4/23/04 Timmer/Clark/Fink 53
7. CSUS Comm. Adv. Mtg. Sacramento, 4/20/02 Louise Timmer
25
8. Board of Reg. Nursing Sacramento, 6/14/02 Louise Timmer
30
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