University of Hawaii Community Colleges
Instructional Annual Report of Program Data (ARPD)

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Review Year: College: Program:

College: University of Hawaii Maui College
Program: Nursing: Associate Degree

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The last comprehensive review for this program was on February 2007. The written report is in the Nursing Office. Next review will be Spring 2015., and can be viewed at:
http://www.acenursing.us/accreditedprograms/programsearch.asp
STEM Program

Program Description

Graduates of the University of Hawai’i Maui College Career Ladder Second Level (ADN) nursing program are educated to provide nursing care in agencies that provide appropriate orientation, on-going staff development opportunities, and professional guidance. They are primarily educated to function as members of the multidisciplinary health care team in direct nursing care roles with adult and pediatric clients on general medical/surgical, obstetrical, newborn nursery and psychiatric nursing units. They have been introduced to the concepts of nurse leader/manager and the role of the Registered Nurse in the physician’s office, clinics, long term care facilities and home health.

Graduates are eligible to take the National Council for Nursing Licensure Examination for Registered Nurses (NCLEX-RN), and upon demonstration of satisfactory performance, will be awarded a license to practice as an R.N.

The University of Hawai’i Maui College Career Ladder is a member of the Hawai’i State Nursing Consortium (HSNC). This is a standardized statewide curriculum which allows our graduates automatic admission to UH Manoa to complete their BSN year from here on our campus. We utilize a concept-based approach to teaching and learning, as well as employ practice level information systems and simulations to support preparation for practice.

The ADN graduate will assume responsibility for maintaining current evidence-based practice, ongoing professional growth, and life-long learning.

Part I. Quantitative Indicators

Overall Program Health: Healthy

Majors Included: NURS     Program CIP: 51.3801

Demand Indicators Program Year Demand Health Call
10-11 11-12 12-13
1 New & Replacement Positions (State) 306 305 376 Healthy
2 *New & Replacement Positions (County Prorated) 28 33 33
3 *Number of Majors 84.5 44 69.5
3a     Number of Majors Native Hawaiian 14 9 11
3b     Fall Full-Time 17% 26% 32%
3c     Fall Part-Time 83% 74% 68%
3d     Fall Part-Time who are Full-Time in System 1% 3% 10%
3e     Spring Full-Time 34% 56% 49%
3f     Spring Part-Time 66% 44% 51%
3g     Spring Part-Time who are Full-Time in System 4% 15% 4%
4 SSH Program Majors in Program Classes 1,308 848 1,345
5 SSH Non-Majors in Program Classes 27 456 23
6 SSH in All Program Classes 1,335 1,304 1,368
7 FTE Enrollment in Program Classes 45 43 46
8 Total Number of Classes Taught 18 17 11

Efficiency Indicators Program Year Efficiency Health Call
10-11 11-12 12-13
9 Average Class Size 36.5 22.1 20.6 Cautionary
10 *Fill Rate 87.3% 63.5% 64.8%
11 FTE BOR Appointed Faculty 7 7 12.5
12 *Majors to FTE BOR Appointed Faculty 12 6.2 5.5
13 Majors to Analytic FTE Faculty 63.4 24.2 46.9
13a Analytic FTE Faculty 1.3 1.8 1.5
14 Overall Program Budget Allocation $646,154 $418,857 $2,434,903
14a General Funded Budget Allocation $572,654 $243,275 $619,189
14b Special/Federal Budget Allocation $0 $0 $0
14c Tuition and Fees $0 $175,582 $1,815,714
15 Cost per SSH $484 $321 $1,780
16 Number of Low-Enrolled (<10) Classes 0 2 4
*Data element used in health call calculation Last Updated: January 27, 2014

Effectiveness Indicators Program Year Effectiveness Health Call
10-11 11-12 12-13
17 Successful Completion (Equivalent C or Higher) 96% 87% 92% Healthy
18 Withdrawals (Grade = W) 15 7 1
19 *Persistence Fall to Spring 85.9% 88% 88.6%
19a Persistence Fall to Fall     4.5%
20 *Unduplicated Degrees/Certificates Awarded 65 59 62
20a Degrees Awarded 65 59 62
20b Certificates of Achievement Awarded 0 0 0
20c Advanced Professional Certificates Awarded 0 0 0
20d Other Certificates Awarded 0 0 0
21 External Licensing Exams Passed   87% Not Reported
22 Transfers to UH 4-yr 5 1 5
22a Transfers with credential from program 5 1 5
22b Transfers without credential from program 0 0 0

Distance Education:
Completely On-line Classes
Program Year  
10-11 11-12 12-13
23 Number of Distance Education Classes Taught 0 1 0  
24 Enrollments Distance Education Classes N/A 24 N/A
25 Fill Rate N/A 60% N/A
26 Successful Completion (Equivalent C or Higher) N/A 92% N/A
27 Withdrawals (Grade = W) N/A 1 N/A
28 Persistence (Fall to Spring Not Limited to Distance Education) N/A No Fall Courses N/A

Perkins IV Core Indicators
2011-2012
Goal Actual Met  
29 1P1 Technical Skills Attainment 90.00 100.00 Met  
30 2P1 Completion 50.00 94.92 Met
31 3P1 Student Retention or Transfer 74.25 66.67 Not Met
32 4P1 Student Placement 60.00 69.57 Met
33 5P1 Nontraditional Participation 17.00 16.92 Not Met
34 5P2 Nontraditional Completion 15.25 11.86 Not Met

Performance Funding Program Year  
10-11 11-12 12-13
35 Number of Degrees and Certificates     62  
36 Number of Degrees and Certificates Native Hawaiian     11
37 Number of Degrees and Certificates STEM     62
38 Number of Pell Recipients     56
39 Number of Transfers to UH 4-yr     5
*Data element used in health call calculation Last Updated: January 27, 2014
Glossary | Health Call Scoring Rubric

Part II. Analysis of the Program

Even in economically tough times, the demand indicators are "Healthy." Still they do not accurately portray the current and future nursing workforce needs. A REPORT ON Hawaii’s Nursing Workforce Supply 2011 from the Hawai'i State Center for Nursing states on p.17:

“Nationally and locally registered nurses make up the bulk of practicing nurses. Employment of RNs is expected to grow 26 percent from 2010 to 2020, faster than the average for all occupations. U.S. Bureau of labor indicates this growth will occur primarily because of technological advancements; an increased emphasis on preventative care; and the large, aging Baby Boomer generation who will demand more healthcare services as they live longer and more active lives.” http://hawaiicenterfornursing.org/node/87

Need for Nurses in Maui County
The UHMC Nursing Program is the primary source for nurses in all Maui County health care facilities.  The Career Ladder format of the nursing program makes it possible for students to work at Nurse Aides, Licensed Practical Nurses while they continue in the Associate Degree Registered Nurse program.  It also allows them to accept employment in an agency even if there are not vacant Registered Nurse positions.   This advantage has been important over the 2012-2013 academic year.  Employment of the graduates is summarized in the attached table.  Several factors have slowed the employment of Registered Nurses: 

Two factors clearly predict a major increase in need for health care workers at a variety of levels. 

1. The recent funding of the West Maui Hospital and Medical Center predicts a major need in late 2016-2017 (see attached email from Brian Hoyle, Developer, Newport Hospital Corp president). 

                                                “Acute Care Hospital:  35 RNs, 9 LPNs, 8 NAs, 11 OR Tech”

                                                “Skilled Nursing/Assisted Living Facility 7 RNs, 10 LPNs, 20 NAs”

See Appendix pp. 1-2.

2. The major increase in the number of individuals with health insurance due to implementation of the Affordable Care Act in 2015.  Statewide predications are an increase in the State of Hawaii of 50,000 covered by Connector and 50,000 covered by Medicaid  (Kelley Withy, MD).

It is anticipated that the increase will be from Primary Care Providers (MD, NP), to RNs, LPN, NAs, Community Health Workers, and medical office staff. While the goal of the ACA is to increase community based care and avoid acute care, the large visitor industry in Maui County will result in a continued need for acute care.Currently 40% of patients at MMMC are visitor who injury themselves or experience an medical emergency while on vacation.

UHMC Allied Health Department Program Offerings            

 

Total Jobs

Median Salary

State of Hawaii

588,210

$36,350

Registered Nurses

10,060

$85,200

Licensed Practical Nurses

1,270

$44,490

Nursing Assistants

5,080

$30,190

Dental Hygienists

1,010

$69,610

Dental Assistants

1,640

$31,750

Pharmacy Technicians

1,260

$36,780

Medical Assistants

3,190

$34,830

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Jobs Explorer, Looking at Occupations in Hawaii by Median Salary http://www.uhero.hawaii.edu/static/dashboard/jobs.html
May 2012 State Occupational Employment and Wage Estimates Hawaii

The volatility of hiring in the Health Care environment is demonstrated by the recent Honolulu Advertiser announcement.
               “Queen's to recruit more than 200 workers at 2 job fairs By Star-Advertiser staff 10/25/2013 Queen's Health Systems will host two job fairs to recruit more than 200 workers for its West Oahu and downtown Honolulu campuses. The company anticipates many current employees to transfer to the Queen's Medical Center-West Oahu and intends to fill positions at both facilities. The openings are in nursing, clinical/technical and support services and will include full-time, part-time and call-in positions.  The company will be accepting applications at the University of Hawaii-West    Oahu (91-1001 Farrington Highway) on Nov. 2 from 9 a.m. to 2 p.m. and at Manoa Elementary School (3155 Manoa Road) on Nov. 9 from 9 a.m. to 1 p.m. Resumes required. Applicants also can apply online at www.queens.org.


The efficiency indicators are not correct. The average ADN class size in F12/Sp13 AY was 33, making the fill rate 82.5%; much healthier than the reported 20.6/class and 64.8% fill rate.

The effectiveness indicators are also healthy showing good retention and graduation numbers, and with a new stream of students transfering to earn the 4-yr BSN degree within the HSNC. We also have a healthy representation of Native Hawaiians earning degrees and certificates.

The Perkins IV Core Indicators also contain inaccuracies. The retention of the Fall 12 class to graduation in the Spring of 2013 was 100%. Just the Native Hawaiian participation and completion was 17.7%, higher than both the 5P1 and 5P2 goals for nontraditional students.

UHMC Nursing Program’s Response to UH Goals, UH Board of Regents “Hawaii Graduation Initiative,” and National Recommendations regarding nursing education
University of Hawaii Maui College in collaboration with Hawaii Statewide Nursing Consortium (HSNC) created a common Statewide Nursing Curriculum which allows seamless transition to the UH Manoa Bachelor’s in nursing degree, on Maui.  This is a direct response to the Institute Of Medicine Recommendations, RWJF Initiative on the Future of Nursing  2010,   Recommendation #4  “ Increase the proportion of nurses with BSN to 80% by 2020.” 1               

UH Transfer Rates
The UH Statewide Nursing Consortium also addresses the UH Strategic Plan Update discussed in Vice President for Community Colleges, John Morton’s Spring 2013 presentation on Maui, April, 2013 2 and the Board of Regents “Hawaii Graduation Initiative” strategy #2  “Ensure efficient transfer of students and credits”, and the UH Strategic Goal B “Function as a Seamless System.” 3

Based on the data presented by John Morton 2, UHMC had a 3.5% transfer rate in 2011 and a 4% rate in 2012.  The UHMC Nursing program had 22% of the Sp 12 AS graduates and 39% of the fall 12 AS graduates transfer for the Bachelor in nursing program at UHM. 

Academic Year/Semester

General UHMC Transfer %

UHMC AS Nursing Transfer % to UHM BSN Program

2011

3.5%

 

2012                            Sp 12

4%

22%  (6 of 27 AS graduates)

                                     F 12

2013                           Sp 13

 

39%  (11 of 28 AS graduates)
13%  (5 of 38 AS graduates)

 

Graduate data from UHMC University Center provides additional evidence of the “efficient transfer” of UHMC
nursing students to the UH Manoa and UH Hilo Nursing Programs for advanced degrees. 

Academic Year

BSN
Graduates

MSN
Graduates

PhD
Graduate

2010

3  UHH

 

 

2011

 

1 UHM

 

2012

5 UHH

 

 

2013

6 UHM

 

2 UHM

Promote College Preparation
Based on the belief, “Students who are college-ready are more likely to earn a degree/certificate,”3 the UHMC Nursing Program has competitive selection based on student performance in English, Math, and science courses necessary for success in nursing education.  Over the last four semesters 48% of the qualified applicants were accepted.  Nursing is a high demand program that results in approximately 50 % of the qualified applicants not being accepted and needing to reapply each semester.   
                                                              Associate Degree Nursing Program Admissions

Semester

Applicants

Qualified
Applicants

Number
 Admitted

% of Qualified Applicants Admitted

Fall 2012

103

85

40

47%

Spring 2013

57

52

38

66%

Fall 2013

82

73

30

37%

Spring 2014

75

70

30

40%

UH Graduation Rates
On April 26, 2013, VP John Morton presented the “UH Strategic Plan Update, Goal A Educational Effectiveness and Students Success.”  September 2013 the UH Board of Regents Resolution “Hawaii Graduation Initiative Strategy #3 Enable On-time Graduation” focused on graduate rates.  The UHMC Nursing Program graduation rates far exceed the current community college and UHM graduation rates.  The UHMC Nursing Program graduation rates are illustrated in the table below.  Over the 30 year period the Associate Degree Nursing Program graduate rate has averaged 88%.

           University of Hawaii Registered Nurse Program Enrollment & Graduate Rate

 

Year

Number

Number

Graduation

   

Enrolled

Graduated

Percent

 
 

1982-83

22

19

86%

 
 

1983-84

19

17

89%

 
 

1985-86

24

22

92%

 
 

1986-87

24

22

92%

 
 

1987-88

22

20

91%

 
 

1988-89

25

18

72%

 
 

1990-91

25

19

76%

 
 

1991-92

36

34

94%

 
 

1992-93

48

39

81%

 
 

1993-94

39

34

87%

 
 

1994-95

26

24

92%

 
 

1995-96

36

30

83%

 
 

1996-97

26

23

88%

 
 

1997-98

24

20

83%

 
 

1998-99

24

23

96%

 
 

1999-2000

26

23

88%

 
 

2000-01

32

28

88%

 
 

2001-02

36

33

92%

 
 

2002-03

36

30

83%

 
 

2003-04

22

20

91%

 
 

2004-05

38

33

87%

 
 

2005-06

42

38

90%

 
 

2006-07

40

39

98%

 

 

    2 Cohorts

       

Admitted

 F07-Sp08

31

30

97%

 

each year

 Sp08-F08

30

30

100%

 
 

 F08-Sp09

32

25

78%

 
 

 Sp09-F09

29

23

79%

 
 

2009-2010

     
 

 F09-Sp10

33

28

85%

 
 

 Sp10-F10

36

29

81%

 
 

 F10-Sp11

43

36

84%

 
 

 Sp11-F11

37

37

100%

 

HSNC

 F11-Sp12

24

23

96%

 
 

Sp 12-F12

28

27

96%

 
 

2012-2013

     
 

 F12-Sp13

39

38

97%

 

1. http://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of Nursing/Nursing%20Education%202010%20Brief.pdf
2.   http://maui.hawaii.edu/faculty/VPMortonVisitSpring2013MauC.pdf
3.http://www.hawaii.edu/offices/bor/regular/action_memos/20130919/11.%20System%20Resolution%20Endorsing%20Strategies%20to%20Improve%20Student%20Success.pdf

Summary
UHMC Nursing Program is high demand (competitive selection) program with less than 50% of the qualified applicants accepted each year.  Eighty-eight percent of the students graduate and earn more than twice the Median salary of those working in Hawaii.  Changes in health care financing, aging of the population, and plans to expand existing and build new health facilities on Maui predict increase demand for nurses on Maui, in Hawaii, and across the United States.

Response to CASLO Summary Report 2013
The University of Hawaii Maui College Nursing Program has three Writing Intensive (WI) courses, NURS 210 Health Promotion Across the Life Span, NURS 320 Health and Illness II-Family Health, and NURS 360 Health and Illness III.  After reviewing CASLO Summary Report, nursing faculty discussed strategies to enhance writing, provide experience with use of APA format for annotated bibliography, and avoid plagiarism (similarity).  Three courses, NURS 210 (1st semester of the nursing program), NURS 320, and NURS 360  (final semester of the nursing program) identified written assignments that students would be required to submit to Turnitin.com for the Fall 2013 semester.  The goal is to have each student self-identify areas needing correction.  Faculty in N210, 320, and N360 will meet at the end of the Fall 2013 semester to evaluate the use of Turnitin.  Based on this evaluation, faculty members in all courses will consider the value of this strategy for additional writing assignments.  The 2013 CASLO recommendation:

 “Faculty members need to look at re-evaluate and potentially need to change all  assignments to help ensure that older written assignments still meet the newer skill requirements of the profession of today…faculty need to know what is being done in previous courses and build upon the skills for the students to actually excel.”

was discussed in a nursing program meeting.  Nursing faculty members believe this CASLO recommendation may have been made without a full understanding of writing in the nursing program.  The attached tables outline the major written assignments in each course and the dates of creation/revision of the assignments.  The CASLO recommendation provided motivation for a full Nursing Program discussion of how writing was used in the nursing program.  

 

Major Writing Assignments in Nursing Programs AY 2012-13
Goal for AY 2013-14 is to discuss and consider development of common Rubrics for WI writing in the Nursing Program
Practical Nurse Program

Course

Assignments

WI

Course

Assignment

Created/Reviewed

Modifications

N210

Health Across the Lifespan

yes

 

 

 

Health Fair Written Assignment*

 

Created  Fall 10

reviewed each semester

Created template for data

 

Determinants of Health

 

Created Fall 10 reviewed each semester

Created template & hyperlink model

 

UHMC Student –Directed Portfolio

 

Created Fall 10

reviewed each semester

Draft submitted at Midterm

 

Adult Health Promotion Case Study

 

Created Fall 10
reviewed each semester

Template using Doenges Health Patterns

 

Child Health Promotion Case Study

 

Created Fall 10 reviewed each semester

Revise concepts  Sp 14

N211

Professionalism in Nursing I

no

 

 

 

 

 

 

 

N212

Pathophysiology

no

 

 

 

 

 

 

 

N220a

Health & Illness Ia

no

 

 

 

Concept Paper

 

To be introduced Sp 14

 

N220b

Health & Illness Ib

no

 

 

 

Concept Map & Brief Paper

 

Created Sp 11

 

N230

Clinical Immersion

no

 

 

 

Concept Map

 

Created SS 11

 

 

Thanatology Scholarly Paper

 

Created SS 11

Discontinued F13

 

Lifelong Learning

 

Created  SS 11

Revised SS 13

 

Evidence Based Practice EBP add to assignment+

Associate of Science Registered Nursing Program

Course

Assignments

WI Course

Created/Reviewed

Modifications

N320

Health & Illness II-Family Health

yes

 

 

 

Postpartum Concept Paper

 

Created Fall  11*

Instructions and rubric revised

 

L&D Concept Paper

 

Created Fall 12*

Instructions and rubric revised

 

Home Visit Concept Paper

 

Created Spring13*

Instructions and rubric revised

 

Pediatric Concept Paper

 

Created  Fall 11*

Instructions and rubric revised

N360

Health & Illness III

yes

 

 

 

Concept Map*

 

Created Spring 12

Reviewed 9/22/13

 

Increased weigh for quality of writing

 

Evidenced Based Practice*+

 

Created Spring 12

 

 

Patient Education

 

Created Fall 10

Revised Spring 12

Motivational Interviewing added

Additional Settings for Implementation

 

IP Reflection

 

Created Sp 2012

 

 

Heart, Brain, Vascular

 

Created Fall 2012

 

N362

Professionalism in Nursing II

no

 

 

*Assignment submitted to Turnitin.com Fall 2013
+EBP Evidence Based Practice Assignments require student to write in response to reviews of research about current nursing practice with the goal of instilling the need for and process of lifelong learning as a health care provider.

 

Part III. Action Plan

 “University of Hawaii Maui College is a learning-centered institution that provides affordable, high quality credit and non-credit educational opportunities to a diverse community of life-long learners.” The Career Ladder Nursing Program provides these educational opportunities in health care, affording the graduates of the program a lifelong career with meaningful contribution to the health of our community, and an above average income for them and their families.

The strategic action plans for the Associate Degree in Nursing Program in 2011 and progress during 2012:

Continue Implementation of the HSNC curriculum in collaboration with UHM, Kauai  and Kapiolani CC.

We have done much internal analysis, but the funding for the faculty to gather at UHM with all the faculty teaching the statewide curriculum was unavailable. Hence, course groups from UHMC  and Kauaui CC were unavailable to consult with the course groups from UHMN and Kapiolani. The department chairs attended and communicatied the high level issues, but the specific shared expereince teaching each course was lost. Though we have more expereince with this curriculum on our own campus, the synergy of numerous perspectives was lost. This has resource implications.

Standardize course documents throughout the program.

Syllabi and learning guides have been templated, as have the clinical remediation documents. This year we are aiming at Laulima standardization.

Mentor  faculty in concept based teaching, and testing and evaluation.

Measurable strides have been made in all categories.  We have integrated concepts into the learning guides, and we are integrating them into the test blueprints.  The standardized testing and the course level testing have both been more closely linked with the program and course SLOs so we can more clearly identify areas of strength and weakness. This is an ongoing process involving categorizing exam questions and blue printing exams maps to achieve objective evaluation of each category. It is an additional workload item that can only be accomplished by the faculty with expertise in the topic being tested. The faculty has been firmly supportive of the project and the department is clear about keeping expectation realistic. By the end of 2014, we should have the project well in hand. There are big resource implications to license the software tools to do this.

Grow the simulation program in step with local and national best practices and regulatory  initiatives.

We have developed several new simulations that address areas highlighted in last year’s employer evaluations: communication, prioritization and organization.  We will pull this through this year and have alrady expanded to another course. We also acquired a educational electronic medical record for the simulation lab. Staff training and beginning student training was accomplished in spring and summer 2013. This year we will roll it out progressivesly so the student in simulation lab will  have a bedside computer with all the required pateint data embedded to care for a patient expereincing a crisis.  It will also be used to teach and practice documentation, and for clinical preparation. This is resource heavy.

Part IV. Resource Implications

Funding for the faculty to travel to UHM once per semester is dearly needed.  We  are pioneers in the whole country with what were are doing as a state with nursing education, and not to be at the table is a huge loss.

We still need specific funding for a lab coordinator. It is either lecturer funds or overload for teaching faculty. In 2012, we centralized all supplies and standardized the ordering procedures. The financial analysis is not complete, but we are able to take full advantage of superquotes, have saved valuable faculty time in securing needed supplies for the labs and simulations, and all inventory for 5 labs is accounted for so there are no wasted supplies.

The implementation of the educational Electronic Medical Record (EMR) has been very exciting, and absolutely essential,  but  costly. The amount of “at the elbow” support required for both faculty and students is  measurable and mission critical. We have gotten grant money from 4 different sources to employ a nurse informaticist to get students and faculty quickly up to a working knowledge of the softwares, so they can concentrate on the teaching and learning! We have gotten $33,000 donated for this from May 2013-June 2014. This role needs a permanent funding source. The licensing of the EHR is about $50 per student per semester, for a program cost of ~$12,000 per academic year.

The standardized testing package which includes 9 exams mapped to NCLEX and benchmarking our students with the performance of the rest of the country, the NCLEX prepartion course, case studies used through out the program and numerous practice tests,  is ~$145 per student each semester, for a total program cost of ~$35,000 per academic year.  At the same time, we cancelled our contract with Kaplan Testing , which saved the program ~$38K annually.

We have also spent $50/student for Exam soft, or $8000 per year. This was for 160 licenses.  We have now decreased our admission class to 30 (from 40) so we will only need 120 licenses. In addition, the rest of the HSNC is adopting ExamSoft  spring 2014, and our price will drop to $35/student as a part of that, bringing our annual cost down to $4200.

In the future, we may need to pass these costs back to the students (~$235 per semester in addition to tuition, books and a $500 a semester professional fee) but for the  F13/Sp14 AY, these are department costs. Passing the costs to the students may be at odds with our mission:  “University of Hawaii Maui College is a learning-centered institution that provides affordable, high quality credit and non-credit educational opportunities to a diverse community of life-long learners.”

Program Student Learning Outcomes

For the 2012-2013 program year, some or all of the following P-SLOs were reviewed by the program:

Assessed
this year?
Program Student Learning Outcomes

1

Yes
Written Communication

2

Yes
Ethics

3

Yes
Leadership

4

No
Evidenced Based Practice

5

No
Information Retrieval

6

No
Clinical Judgment/Critical Thinking

7

No
Oral communication

8

No
Quantitative Reasoning

9

No
Health Care Systems

10

No
Collaboration with members of the healthcare team

11

No
Relationship-Centered Care

12

No
Reflection on Practice

A) Evidence of Industry Validation

 Employer Surveys

EXCELLENT       

ABOVE AVERAGE  

AVERAGE         

POOR              

% excellent  or above average

Please rate the graduate in the following areas:

4

3

2

1

 

Ability to

 

 

 

 

 

  1.  Apply the nursing process

11%

78%

11%

0%

89%

  2.  Communicate effectively

27%

64%

9%

0%

91%

  3.  Demonstrate professional attitude

33%

50%

17%

0%

83%

  4.  Work effectively as a team member

18%

73%

9%

0%

91%

  5.  Problem solve/Think critically

9%

73%

18%

0%

82%

  6.  Provide basic care

25%

58%

17%

0%

83%

  7.  Perform clinical assessments

12%

63%

25%

0%

75%

  8.  Perform clnical skills

11%

67%

22%

0%

78%

  9.  Administer medications

22%

56%

22%

0%

78%

10.  Document care

9%

73%

18%

0%

82%

11.  Organize care

18%

73%

9%

0%

91%

Compared to new graduates from other

 

 

 

 

 

nursing programs, please rate this UHMC

14%

71%

14%

0

85%

Graduate’s preparation.

 

 

 

 

 

 

Comments/Suggestions

B) Expected Level Achievement

2nd Year HSNC Bench Marks     

Ethical Practice

a.   Consciously incorporates each provision of the ANA Code of Ethics and Standards of Practice and the Hawaii Nurse Practice Act in practice

b.   Identifies when clinical practices and protocols may be at odds with individual patient’s rights

c.   Identifies dilemmas in which individual rights are in conflict with the greater good

d. Articulates dilemmas and identify stakeholders with pertinent facts.

e. Applies ethical principles to identify choices and possible consequences.

f.   Engages in reflection about choices, considering ethical frameworks, and the implications for future situations.          

Leadership

a.   Identifies characteristics of effective leadership.

b.   Engages in self-directed professional development to improve personal leadership characteristics and skills

c.   Understands consequence of making leadership decisions with limited information.

d.   Provides positive and constructive feedback on specific aspects of performance

e.   Delegates to, and evaluates others, ensuring that the task is within their scope of practice, that they are competent to perform the task, and that they receive clear communication and feedback in regard to their performance.

f.   Explains the purpose and desired outcome of the task and the time frame in which the task is to be completed.

g.   Provides leadership in the modification of client care and/or organizational issues toward identified outcomes.


C) Courses Assessed

The ethical portion of the Reflective Evaluation tool in N360 below contains examples of the student’s ethical practice.The students need scores of 3 or 4 to pass the clinical experiences and graduate from the ADN program. Every student who graduated successfully completed this exercise.

The Leadership Experience in N360 contains specific clinical examples of the student’s leadership against the HSNC benchmarks. The students need to pass the leadership experience to graduate from the ADN program. Every student who graduated successfully completed this experience.

D) Assessment Strategy/Instrument

NURS 360 REFLECTION / EVALUATION TOOL

The purpose of this Reflection / Evaluation tool is to guide the student in the development of behavior consistent with excellent nursing practice, and to facilitate faculty evaluation of student progress. Effective reflection is an engine that drives growth and improvement.

The Reflection / Evaluation Tool should be submitted by the student to the student’s clinical instructor after each clinical week. Monday at 0900 is the usual time for submission. The student must pass all categories of the Reflection / Evaluation Tool with a score of 3 (proficient) by final evaluation to pass the course. Grading for each category is according to, but is not limited by, the contents of the rubric. The student is expected to give meaningful and appropriate examples where examples are required. Additional examples may be assigned at the instructor’s discretion, if the student’s examples are not deemed adequate by the instructor. Lapses must be addressed in the R/E Tool submission after the lapse.

 

  1. PROFESSIONALISM AND ETHICAL PRACTICE

 

Scoring Guide

1

2

3

4

Students must receive a level 3 or better for a Pass. A score of 1or 2 in any area will result in a clinical fail and a fail for the N360 Course.

1.Professionalism  and Ethical Practice

Applies to any scheduled lab or clinical activity and includes, but is not limited to, the following:

Unsatisfactory

 

 

 

Novice Developing

Proficient

Exemplary

Meeting Deadlines

Turn-in of clinical papers late >3 times (without previous arrangement). Prep not complete > x 3. Paper work is disorganized and/or incomplete > x 3.

Turn-in of clinical papers late up to 3 times (without arrangement). Prep not complete x 3. Paper work is disorganized and/or incomplete x 3.

Turn-in of clinical papers late up to 2 times (without arrangement). Clinical prep not complete x 2. Paper work is disorganized and/or incomplete x 1-2.

No late submission of clinical papers (without previous arrangement).Clinical Prep 90% done. Demonstrates organization and thoroughness in paper work.

Attendance

Absent, Late or leaves early >3 times (without previous arrangement or medical release)

Absent, Late or leaves early 3 times (without previous arrangement or medical release)

Absent, late or leaves early up to 1-2 times (without previous arrangement or medical release)

No absence, tardy, or leaving early (without previous arrangement with instructor or medical release)

Policy (includes uniform regulation, safety, ethical standards, etc)

>3 lapses in UHMC Nursing Program Policy

 

3 lapses in UHMC Nursing Program Policy

1-2 lapses in UHMC Nursing Program Policy

No lapse in UHMC Nursing Program Policy

 

Dependability

 

 

 

Does not read, listen to, and follow written and verbal instructions. Does not seek clarification as needed.

Occasionally  reads, listens to, and follows written and verbal instructions. Occasionally seeks clarification as needed.

Frequently reads, listens to, and follows written and verbal instructions. Seeks clarification as needed.

Consistently reads, listens to, and follows written and verbal instructions. Seeks clarification as needed.

 

Initiative/Feedback

 

Moderate disruption when under stress. Defensive when offered constructive suggestions and does not take responsibility for own actions. Does not improve after feedback.

Occasionally does not demonstrate eagerness to learn or take initiative to enhance learning. Not consistently cooperative. Much guidance needed in new/stressful situations. Does not consistently improve after feedback.

Frequently demonstrates eagerness to learn and takes initiative to enhance learning. Minimal to moderate guidance in new/stressful situations. Does improve after feedback.

Consistently demonstrates eagerness to learn and takes initiative to enhance learning, Always cooperative. Self-aware. Anticipates stress and plans for it. Does improve after feedback.

Communication

Is not truthful in verbalizations and behaviors, and shows unprofessional communication and demeanor. Negative relationships reported by staff, others, or observed. by instructor.

Occasionally is not truthful in verbalizations and behaviors, and shows un-professional communication and demeanor. Negative relationships reported by staff, others, or observed.

by instructor.

Truthful in verbalizations and behaviors, and shows professional communication and demeanor. Positive relationships reported by staff, others, or observed by instructor.

Truthful in verbalizations and behaviors, and shows professional communication and demeanor. Positive relationships reported by staff, others, or observed by instructor.

 

ANA Code of Ethics

 

 

 

 

 

 

 

 

Disregards ethical behavior in accord with the ANA Code of Ethics, disregards defined standards of practice and hospital regulations,  does not identify when clinical practices and protocols may be at odds with individual patients rights, does not identify dilemmas in which individual rights are in conflict with the greater good, does not factually articulate dilemmas and stakeholders’ interests.            

Occasionally demonstrates ethical behavior in accord with the ANA Code of Ethics. Occasionally observes defined standards of practice and hospital regulations. Occasionally identifies when clinical practices and protocols may be at odds with individual patients rights, occasionally identifies dilemmas in which individual rights are in conflict with the greater good. Has difficulty  factually articulating dilemmas, and stakeholders’ interests.            

Consistently demonstrates ethical behavior in accord with the ANA Code of Ethics, observes defined standards of practice and hospital regulations, identifies when clinical practices and protocols may be at odds with individual patients rights, identifies dilemmas in which individual rights are in conflict with the greater good, factually articulates dilemmas and stakeholders’ interests.           

Consistently demonstrates ethical behavior in accord with the ANA Code of Ethics, observes defined standards of practice and hospital regulations, identifies when clinical practices and protocols may be at odds with individual patients rights, identifies dilemmas in which individual rights are in conflict with the greater good, factually articulates dilemmas and stakeholders’ interests.            

 

Ethical Reflection

 

 

 

 

 

 

 

Does not apply ethical principles to identify choices, and possible consequences. Does not

engage in reflection about choices, and the implications for future situations. Does not complete example.

Occasionally applies ethical principles to identify choices, and possible consequences. Occasionally engages in reflection about choices, and the implications for future situations. Incomplete example in tool..  Example does not demonstrate insight.

Consistently applies ethical principles to identify choices, and possible consequences.

Engages in reflection about choices, and the implications for future situations. Completes example in tool. Example demonstrates insight.

Consistently applies ethical principles to identify choices, and possible consequences.

Engages in reflection about choices, and the implications for future situations. Complete examples in tool.. Example demonstrates insight.

Professional Activities

 

 

 

Not an SNA member.

 

Not an SNA member.

 

Not an SNA member

 

SNA member** or officer, >2 volunteer activities

** Attach documentation of SNA membership

Give an example of a complex ethical problem/situation/dilemma that you encountered in clinical this semester.

What did you notice that you interpreted as requiring ethical decision-making?

What additional information did you need to gather?

How did you interpret this situation?

What was your response?

What is your reflection on your choice and the outcomes?

List volunteer activities, if any, below:

 

1. ______________________________________________________

2. ______________________________________________________

List below, lapses in ethical or professional behavior, if any.  State what improvements you will make as a result of reflection. No examples of lapses are required if no lapses in professional and ethical behaviors occurred.


Below is a sample of a 360 student's leadershsip expereince:

Student

4. Leadership

Refer to the rubric in the R/E Tool.

Student Performance consistent with a score equal to or greater than 3 in the R/E Tool, adequate preparation and organization, and appropriate examples is considered satisfactory in this category.

 

4. Leadership

Score of 20 points possible

Score

Student Self-Score

 

17

Faculty Score of Student

 

19

The student’s preparation is appropriate. Yes

The student demonstrates appropriate planning of care. Yes

The student uses nursing process appropriately. Yes

Give a specific example of how you demonstrated leadership during the Leadership Experience. State what the situation was, who was involved, what action you took, and how your management of that situation demonstrated leadership.

At the end of our last shift a call light was on and the patient in isolation needed help to the bedside commode.  I checked with the patients nurse to inquire about ambulation issues, then assisted the patient to the bedside commode.  She also told me she didn’t like her lunch and wanted a new one.  When she was done on the commode I assisted her back to bed, cleaned up, and let the charge nurse know about her request for another meal, which she was able to put the order in for. OK

Give an example from TL Evaluation Day of how you appropriately prioritized your actions and organized your care to complete it in a timely fashion.

Each day I created a mapped out time schedule on my brain for each patients scheduled meds/treatments/procedures, etc. and the times due.  Although I was not always able to abide strictly to this schedule, it definitely helped me to stay organized and prioritize my time and actions. Yes. You also told your classmate about how you organized your time and wrote reminders on a particular area of your prep during a previous post conference.

Give an example from your TL Eval Day of how you appropriately set time limits on your discussions with patients, family members, and staff during your first rounds in order to get baseline assessments done, and at the same time adequately addressed the concerns you encountered.

In the morning, I went in to say “hi” and explain our plan for the day.  I let the patient and family know that I would be back in a little while and to let me know if they had any immediate questions.  I think by informing the patient of what’s going on for the day and what to expect can help calm nerves. OK

The student ensures comprehensive care is given.

Give an example from your TL Evaluation Day of how you took responsibility to ensure comprehensive client care was given.

Although I wasn’t able to complete all aspects of care for my patients on my own, I asked another nurse to do an IV start for me while I changed a PICC line dressing, in order to get both tasks done before the end of my shift.  I also did my intentional rounding hourly throughout the day. Was there any info that you sought from your PMA about care that was done?

Give 3 examples from your TL Evaluation Day in which you appropriately delegated tasks to personnel trained for them, communicated delegated tasks in a specific, clear, calm, and confident  manner, and followed up to be sure delegated tasks were completed.

1.  Asked another nurse to do an IV start for me, then I went in to the room to check placement and location.  The other nurse and I both documented our actions in the flow sheet.

2.  Asked a PMA to assist a patient with a shower, patient was obviously showered the next time I saw him.

3.  Asked my classmate to take a blood glucose for me so I could suction another patient.

Give an example from your TL Evaluation Day of how you collaborated with other team members to improve or adjust the patient’s plan of care, prepare peers for new experiences, or contribute to group learning.

I discussed with RT and my RN the orders for ambulation with portable vent that had been ordered for my patient that had not been getting done.  Upon asking the patient if she desired getting up and walking she stated “yes.”  I believe ambulating will greatly improve her chances of recovery and possibility for discharge and that this order needs to be done with more frequency. 

Give an example from your TL Eval Day of how you were able to direct and coordinate nursing care utilizing members of other disciplines such as respiratory therapy, physical therapy, social work, nutrition, case management, or utilizing family members.

In the morning I went in to do my morning assessment with my patient on a vent.  She was a priority because of her respiratory status, however, after suctioning and before I was able to complete my assessment, RT came in to give her her inhalers and place her on a trach collar.  I was able to go and get a few other assessments done during this time because I knew RT was there to monitor her. OK

 

E) Results of Program Assessment

Feedback from the employer survey on the graduate’s performance in the “percentage of above average and excellent summary” are very good.  See Industry Validation.  The 3 lowest areas evaluated are performing clinical assessements, performing clinical skill and administrering medications. These are the expected areas of difficulty for the novice nurse as psychomoter based skills require repetition to gain proficiency. If they were assessed at the 1 year mark of practice, these measures would be high too.

The categories relating to leadership and ethics were scored very high: Communicating effectively and working effectively as a team member were both excellent or aboce average 91% of the time. Last year these were  excellent or above average only 54% and 71% of the time respectively. To address this, we added specific communication and team work components to several simulation labs as well as initiated a "Sim Day" where the students practice taking care of a group of patients and seeing how communication and team work are essential to be effective as an RN.

This improvement is also shown in the exemplary performance of the students in their leadership expereince and in their ethical reflections during their final clinical of the ADN year. We are very proud of the progress our nursing students have made in these areas.

HESI RN Exit Exam Scores for UHMC N360 students are comparable to the national comparison by program scores for all RN’s.

NCLEX-RN scores followed the entire country's results. The NCLEX RN Exam was updated on 4/1/3013, after the customary 3 year review of practice. The review highlighted the increased complexity and acuity of the acute care environment, which more than 50% of new nurses enter, thus increasing the difficulty of the exam. The pass rate dropped nearly 10% through the US.

https://www.ncsbn.org/887.htm?search-text=pass+rates

The scores for our students mirrored this trend. See Appendix pp.3-5.

Program Strengths:

Program Weaknesses:

Community engagement.

The UHMC Nursing Program is closely engaged in the community through a variety of activities including:  directly clinical learning in community sites, special projects with the agencies, volunteer activities in collaboration with community partners, and faculty participation on community boards and committees.

    Direct clinical learning in Community sites- List of agencies and sites:

Special Projects:

Volunteer Activities:

F) Other Comments

UHMC-Allied Health Department Community Engagement:

According to Campus Compact, a national coalition of almost 1,200 college and university presidents committed to fulfilling the civic purposes of higher education, public and community service assists and develops students’ citizenship skills, helps campuses forge effective community partnerships, and provides active experiences in integrating civic and community-based learning while meeting community and student needs.  UHMC-Nursing program recognizes the positive outcomes in its relationship with our community and our students as engagement builds community capacity and assists our students in broadening their communication, education, and service skills.  Our program engages in the community in three significant ways of service; by providing trained volunteers to provide free or low cost health screening services to individual agencies and special events, by hosting public health events and sharing important disease prevention information with community members, and by seeking out vulnerable populations and addressing their health care concerns through culturally sensitive and appropriate activities and health fairs.

Tracking of agency requests and volunteer hours and the nursing skills provided is being monitored more carefully thorough the UHMC nursing program volunteer coordinator.   When community agencies request assistance for health screening, first aid, or other health related services they are placed into contact with the volunteer coordinator.   Direct contact and collaboration with the coordinator helps meet the community agency needs and ensures that volunteer requests are safe, appropriate and meaningful for the students.  Post volunteer evaluations are sent out to the student volunteers and also the requesting agencies ensure that the experience has been successful for both parties.  During the past year the feedback obtain from the agencies and students indicate that UHMC nursing program volunteer experiences are a positive learning experience and community engagement opportunity.

During the past year, the nursing program has engaged with over thirteen agencies throughout Maui County.  Another way that the Allied Health department engages with the community is through the UHMC-Health Center.  The health center is a free-standing and grant funded health clinic that outreaches to community residents through flu clinics, screenings to various businesses, hotels, Maui police departments, and county government agencies.  The health clinic also provides Nurse Practitioner provider healthcare to non-student individuals of the community on a fee service scale basis.

Once every semester the nursing program invites Advisory Board members and employers of the healthcare community agencies to meet and articulate their perspective of the quality of nursing graduates and their viewpoint of the nursing program in the community.  The last Advisory Committee Meeting was held on April 29th, 2013.  Feedback received from the committee members included the following; the quality and skill noted and held by nurse graduates, successful hiring and retention of nurse graduates of UHMC, future hiring numbers of nurse graduates.                

 

Volunteer Activities: 2012-13

Agencies served by the nursing department alone include;

Habitat for Humanity Build-A-Thon 2013

Maui Memorial Medical Center

March of Dimes Walk

Car Show Auto Fest 2013

National Kidney Foundation of Maui, Hawaii (Da Kidney Da Kine)

Camp Imua and the Kahului Canoe club 2013

Maui Marathon 2013

Lions Club- White Cane Walk

NAPA Golf Tournament

Kiwanis Track Meet

Tween Camp (along with UHMC Health Center NP)

County Fair First Aide station

South Maui Children & Youth Day in Kihei

 

Flu Shot and Clinic Services Administered by the UHMC-Health Clinic: 2012-13

Maui News

Kalama Heights

Hale Mahaolu-Elu

Wailuku Police Department

Lahaina Police Department

Ka’anapoli Beach Hotel

County of Maui

Roselani

Maui Adult Day Care- Oceanside and Kahului (Kihei and Lahaina adults included)

DMV Kahului

TSA (AM and PM shift)

Dollar Rent-A Car

Senior Citizen Fair

GoodFellow Brothers Company

Tween Camp

 

G) Next Steps

The steps for the Acamenic Year 2013-2014 include:

  1. Implementation of the Quality and Safety Education in Nursing (QSEN) Informatics standards
  2. Produce qualitiative and quantitative data by which to evaluate this project.
  3. Prepare self-study document for 2015 ACEN Accreditation.

INFORMATICS

Definition: Use information and technology to communicate, manage knowledge, mitigate error, and support decision making.

Knowledge

Skills

Attitudes

Explain why information and technology skills are essential for safe patient care

Seek education about how information is managed in care settings before providing careApply technology and information management tools to support safe processes of care

Appreciate the necessity for all health professionals to seek lifelong, continuous learning of information technology skills

Identify essential information that must be available in a common database to support patient careContrast benefits and limitations of different communication technologies and their impact on safety and quality

Navigate the electronic health recordDocument and plan patient care in an electronic health record

Employ communication technologies to coordinate care for patients

Value technologies that support clinical decision-making, error prevention, and care coordinationProtect confidentiality of protected health information in electronic health records

Describe examples of how technology and information management are related to the quality and safety of patient careRecognize the time, effort, and skill required for computers, databases and other technologies to become reliable and effective tools for patient care

Respond appropriately to clinical decision-making supports and alertsUse information management tools to monitor outcomes of care processes

Use high quality electronic sources of healthcare information

Value nurses’ involvement in design, selection, implementation, and evaluation of information technologies to support patient care

http://qsen.org/competencies/pre-licensure-ksas/#informatics