CAAL 5/2/2013 Agenda Item 3k New Program Proposal Master of Science in Nursing, Clinical Nurse Leader Lander University Summary Lander University requests approval to offer a program leading to the Master of Science degree in Nursing, Clinical Nurse Leader to be implemented in Spring 2014. The proposed program is to be offered through online instruction. Lander currently offers an online RN to BSN. The following chart outlines the stages for approval of the proposal; the Advisory Committee on Academic Programs (ACAP) voted to recommend approval of the proposal to the Committee on Academic Affairs and Licensing (CAAL). The full program proposal is attached. Stages of Consideration Date Comments Program Planning Summary 10/22/2012 Staff asked Lander to describe USC Upstate’s received and posted for proposed MSN CNL program in more detail comment and discuss the similarities and differences between the two proposed programs. Staff also requested more information about how coursework taken at other accredited graduate nursing programs would be evaluated. Staff suggested mentioning the RN to BSN completion program offered online to show faculty are qualified and prepared to offer an online program of this nature. Staff also requested that the full proposal address faculty load to show how current faculty will take on master’s level teaching assignments. Staff also requested evidence that two MSN CNL programs would be able to engage qualified faculty to support both programs. Comments by electronic review from ACAP members also asked for a comparison with USC-Upstate’s program, address competition between the two programs, availability of qualified faculty, and encouraged Lander to collaborate with USC-Upstate rather than offer a competing program. Program Proposal Received 1/15/2013 Lander University, M.S.N., Clinical Nurse Leader, Program Proposal, CAAL 5/2/2013 - Page 1 CAAL 5/2/2013 Agenda Item 3k Comments and suggestions 2/1/2013 Staff asked whether the BSN would be able to from staff to the institution cover the cost of additional faculty needed at the BSN level due to the implementation of the proposed program. Staff suggested additional information about clinical placement and letters of support; electronic library resources available to students since the proposed program will be offered online, including listing nursing titles and databases available to students online; and communications with USC Upstate regarding possible collaboration. Revised Program Proposal 2/25/2013 Revisions addressed the questions and received suggestions of the staff. Program Proposal posted to 2/28/2013 ACAP members for review ACAP Consideration 3/21/2013 ACAP members asked whether the program needed a faculty member with CNL certification, but decided that one was not needed as any faculty member with a doctorate would be able to teach the skills necessary for the program and because the accrediting body does not require CNL certified faculty. ACAP members also asked about clinical sites; Lander representatives stated that additional clinical sites would be identified in the areas in which students reside and that those currently employed by hospitals could complete clinical experiences in hospitals that employ them. ACAP members also discussed at length collaboration with USC Upstate’s proposed program and ultimately decided that collaboration was not necessary because there would be sufficient demand to support both programs. The institution has addressed all of the questions from other institutions and the staff. Recommendation The staff recommends that the Committee on Academic Affairs and Licensing commend favorably to the Commission the program leading to the Master of Science degree in Nursing, Clinical Nurse Leader at Lander University, to be implemented in Spring 2014, provided that no additional “unique cost” or other special state funding be required or requested. Lander University, M.S.N., Clinical Nurse Leader, Program Proposal, CAAL 5/2/2013 - Page 2 320 Stanley Avenue Greenwood, South Carolina 29649-2099 New Program Proposal Master of Science in Nursing: Clinical Nurse Leader Submitted January 15, 2013 Daniel W. Ball, President Program Contact Information Dr. S. David Mash Interim Vice President for Academic Affairs 864.388.8320 Dr. David A. Slimmer Dean, College of Science and Mathematics 864.388.8386 Dr. Robbie South Director, School of Nursing 864.388.8337 Lander University, M.S.N., Clinical Nurse Leader, Program Proposal, CAAL 5/2/2013 - Page 3 1. Classification: a) Name of Proposed Program: Master of Science in Nursing with a track of Clinical Nurse Leader (CNL) b) Academic Unit in which the program resides: School of Nursing in the College of Science and Mathematics c) Proposed Date of Implementation: Spring 2014 d) CIP Code: 51.3820 e) Site: Online f) Qualifies for supplemental Palmetto Fellows Scholarship and Life Scholarship awards: No g) Delivery Mode: Online h) Area of Certification: Graduates will be eligible to seek national certification as a Clinical Nurse Leader (CNL). 2. Institutional Approvals: a) Nursing Faculty Organization of School of Nursing: December 5, 2012 b) Dean of College of Science and Mathematics: December 7, 2012 c) General Education Committee: December 13, 2012 d) Vice President for Academic Affairs: December 17, 2012 e) Faculty Senate Curriculum Committee: January 7, 2013 f) President: January 11, 2013 g) Faculty Senate: January 14, 2013 h) Board of Trustees: March 5, 2013 3. Purpose: a) The CNL program is designed to prepare an expert nurse generalist as a clinical leader in various health care settings. The curriculum is based on The Essentials of Master’s Education in Nursing (American Association of Colleges of Nursing, 2011). Accreditation for the program will be sought through the Commission on Collegiate Nursing Education (CCNE), the accrediting body of the baccalaureate nursing program. b) The program outcomes (objectives) are listed in the table below. The outcomes are matched to the courses through which they will be accomplished. Table A-Program Outcomes Matched to Courses within Curriculum Courses Program Outcomes 0 1 2 3 0 0 5 0 5 1 0 5 011123344567 666666666666 1. Effects change through advocacy for the profession, X X X X X X X X X interdisciplinary health care team and the client. 2. Communicates effectively to achieve quality client outcomes and lateral integration of care for a cohort X X X X X of clients. 3. Actively pursues lifelong learning as the CNL role, X X needs of clients, and the health care system evolve. 4. Delegates and utilizes the nursing team resources and provides leadership when partnering with the inter- X X X X X professional health care team. 5. Identifies clinical and fiscally responsible outcomes X X X X X Lander University, M.S.N., Clinical Nurse Leader, Program Proposal, CAAL 5/2/2013 - Page 4 Courses Program Outcomes 0 1 2 3 0 0 5 0 5 1 0 5 011123344567 666666666666 that improve safe, quality, client-centered care. 6. Uses information systems and technology at the point X X X X X of care to improve health care outcomes. 7. Participates in systems review by evaluating client X X X X X safety risks to improve quality of client care. 8. Assumes accountability for health care outcomes, recognizing systems influences on a specific group of X X X X X X X X X clients. 9. Utilizes information to design, implement and X X X X X evaluate client plans of care. 10. Synthesizes evidence to evaluate and achieve optimal X X X X client and care environment outcomes. 11. Uses appropriate teaching/learning principles, strategies, and technology to facilitate the learning of X X X X X clients, groups, and the other health care professionals. 4. Justification: a) Lander University School of Nursing has provided nursing education for over 55 years. The baccalaureate program graduates both pre-licensure and RN-BSN students twice each year. Many of these graduates have expressed an interest in continuing their nursing education and have requested that Lander offer a Master of Science in Nursing program. In May 2012, the School of Nursing hosted a focus group of local nurse leaders to discuss the proposed graduate program. The focus group included leaders from acute care, long-term care, education, and public health. The feedback of the group was positive and affirmed the need for nurses prepared at the graduate level to function in the roles designated to Clinical Nurse Leaders. In the summer of 2012, the School of Nursing explored interest of both Registered Nurses and chief nursing officers (CNO) in the Clinical Nurse Leader program. Surveys were developed, distributed, and analyzed using an online survey tool. Nurse administrators from South Carolina hospitals, long-term care facilities, and community organizations were invited to participate in the survey via an email containing a hyperlink to the online survey. Registered Nurses were invited to participate through social media website posts that included a hyperlink to the online survey site. Both surveys could be completed anonymously, as no identifying information was collected. Although most CNOs responding to the survey (n=17) were not familiar with the CNL track, the majority expressed a need for clinical leaders educated in the topics to be included in the proposed curriculum such as disease management, evidence-based practice, team coordination, leadership, and quality improvement. The CNOs believed the proposed educational curriculum would prepare leaders who functioned as nurse administrators, nurse managers and quality/risk managers. In response to the question if their facility would need staff meeting the description of the CNL, 86.7% responded “yes”. A copy of the survey is included in Appendix A. Lander University, M.S.N., Clinical Nurse Leader, Program Proposal, CAAL 5/2/2013 - Page 5 In July 2012, the survey with practicing Registered Nurses produced a response of n=78. A copy of the survey is included in Appendix B. Highlights of the survey results included:  96% plan to pursue graduate education  45% plan to begin graduate school in 1-3 years  62% expressed an interest in the CNL role when it was described  94% prefer a program delivered completely online or online with periodic immersion experiences  76.9% would consider applying for a CNL program if offered by Lander According to the Office of Healthcare Workforce Research for Nursing (2011), only 8.8% of nurses in SC have an advanced degree and several regions in the state have lower numbers of graduate level nurses per capita. This percentage is 4% lower than the national average. Evolving health care needs necessitate an increase in nurses prepared at the master’s level and working registered nurses desiring graduate studies need the flexibility of an online program. Today’s health care environment is in need of strong leadership from various health care disciplines. The Institute of Medicine (1999) report, To Err is Human: Building a Safer Health System, called for improved outcomes by increasing quality through client- centered care. With the aging of America, our nation is faced with a significant nurse shortage which will create critical workforce issues. Not only must the nursing profession address the nursing shortage by educating more professional nurses, but the level of education and the preparation must be in response to the needs of the 21st century healthcare arena. Nurses must be educated to serve in clinical leadership roles, to implement outcome-based practice, to guide quality improvement strategies, and to manage microsystems of care (AACN, 2007). Master’s education in nursing is critical to “address gaps resulting from growing healthcare needs” (American Association of Colleges of Nursing, 2011, p.3). During the next decade, according to the US Bureau of Labor (2012), the demand for occupations requiring a master’s degree for entry is expected to increase by 21.7%. The proposed CNL program at Lander University will provide graduates with the educational preparation to perform this new expanded role. The CNL role would produce a nursing expert with a diverse skill set demanded by the evolving healthcare needs of this millennium. Employment opportunities for CNLs across the nation are posted on the website of the American Association of Colleges of Nursing (AACN). A search of job postings for “clinical nurse leader” on the website www.nurse.com/jobs produced over 8,000 results. According to the US Bureau of Labor Statistics (2012), occupations in healthcare and social assistance are expected to have the fastest job growth through 2020 with an increase of 5.6 million jobs. One third of the fastest growing occupations are related to healthcare. This fact supports the prediction of an increased demand of healthcare providers in all disciplines as the population ages and Baby Boomers retire. A review of websites for 10 major hospitals in SC and the Charlotte, NC, region produced 747 jobs posted for registered nurses. CNLs could fill positions posted for RNs and provide expert bedside care. The CNL credentials would advance the graduate in the clinical ladder programs provided by most hospitals and would provide an increased quality of care for consumers. b) Lander’s mission statement refers to education being a liberating force that prepares graduates to live a meaningful life with personal satisfaction and service to others. The Lander University, M.S.N., Clinical Nurse Leader, Program Proposal, CAAL 5/2/2013 - Page 6 mission statement also refers to preparing graduates in advanced study to respond to critical needs of the immediate region and the state. The proposed MSN program is designed to prepare an expert nurse generalist as a Clinical Nurse Leader in various health care settings. The CNL role is needed in today’s health care arena to meet the needs in the region and the state. The nursing profession is a discipline of service and meets health care needs in local, state, regional and national settings. c) The College of Education at Lander offers three graduate degrees: Master of Art in Teaching in Art Education, Master of Education in Montessori Education, and Master of Education in Teaching and Learning with various concentrations. The proposed Master of Science in Nursing will be the only graduate program in the College of Science and Mathematics. The proposed MSN program would be offered in addition to the existing nursing pre-licensure and RN-BSN baccalaureate programs. d) Currently, there is no MSN Clinical Nurse Leader program offered in the state; however, USC Upstate has submitted a proposal for a Clinical Nurse Leader program beginning fall 2014. Lander has extended an offer of collaboration to USC Upstate. Both programs are required to provide a considerable amount of clinical practicum hours (450-500 hours). We offered to share clinical database information regarding facilities that are able to accommodate CNL students. In addition, when site visits are needed to evaluate a clinical facility for its ability to meet our program objectives and clinical expectations, we could assist one another in performing the site visits, thereby alleviating the necessity of making visits from both universities. In addition, because both programs will be offered online, we could develop an articulation agreement between the two institutions for transferability of coursework. Although a MSN Clinical Nurse Leader Program is not currently offered in the state, several institutions offer MSN programs. These programs include a MSN at Clemson University; MSN Nurse Educator and MSN Family Nurse Practitioner programs at Francis Marion University; MSN programs in Family Health Care Systems, Individual Health Systems, and Nursing Health Care Systems at the Medical University of South Carolina; MSN programs in Clinical Nursing, Community Mental Health & Psychiatric Nursing, Health Nursing (primary care), and Nursing Administration at USC Columbia; and a MSN Nursing Education program at Charleston Southern University. Proprietary institutions such as the University of Phoenix, South University, and Walden University also offer online MSN degrees, but these programs can be very expensive and often rely on students to find local preceptors to provide them with hands-on experience. e) AACN and CCNE provide guidance and specific requirements for any new Master of Science in Nursing programs that plan to seek accreditation; therefore, proposals from similar tracks of study would contain similar or identical elements. We compared our proposed program with the program proposed by USC Upstate. Both proposed programs have planned a curriculum that includes similar coursework. The core courses of Theory, Research, Advanced Pathophysiology, and Advanced Pharmacology are included in both proposals. The remaining courses in both programs appear similar although the required content is included in the courses in different ways. Both programs include practicum experiences with the recommended hours as specified by AACN and CCNE. These similarities are expected due to both schools using recommendations from AACN, CCNE, and the CNL certification test blueprint to design the program. The faculty needs of the two programs appear different. USC Upstate describes a need to hire one new faculty member with a terminal degree; however, Lander University, M.S.N., Clinical Nurse Leader, Program Proposal, CAAL 5/2/2013 - Page 7 Lander plans to hire Master’s prepared faculty to teach in the BSN program and assign faculty with terminal degrees teaching assignments in the graduate program. The cost of hiring two Master prepared faculty for the BSN program are shown as faculty cost in this proposal. Lander currently has enough faculty with terminal degrees (more than 50% of the faculty) who are tenured or in tenure-track positions available to teach in the CNL program. Lander is prepared to begin a program in January 2014 and USC Upstate has proposed a start date of fall 2014. Both USC Upstate and Lander conducted surveys to determine the interest in SC for a CNL track. The response of the surveys indicated that one program would be unable to accommodate the number of students seeking the proposed master’s track. In addition, the online mode of delivery could potentially attract students from other states, especially Registered Nurses licensed in the 24 states that are included in the Nurse Licensure Compact. With the potential for a greater demand than indicated on the survey results of the two schools, more than one program would be needed. CNL programs in Georgia, North Carolina, and Florida were examined and compared to the proposed program. All programs had similar coursework and required clinical hours. All programs had courses in physical assessment, Pharmacology, and Pathophysiology as recommended by CCNE. Various programs in the nation were examined and some were post-master programs with fewer required courses. Programs that were not post-master certificate programs had similar admission criteria, coursework and clinical components. A program for CNL was not offered through the Southern Regional Education Board’s Academic Common Market. 5. Admission Criteria: Applicants for the CNL program will be required to apply to Lander University and to the School of Nursing. Copies of all undergraduate and graduate transcripts will be required. Admission criteria for the proposed program will include the following: a) Graduate of a baccalaureate nursing program accredited by National League of Nursing Accrediting Commission (NLNAC) or Commission for Collegiate Nursing Education (CCNE) b) Overall grade-point average (GPA) of 3.0 on 4.0 scale on baccalaureate course work c) Current unencumbered registered nurse license to practice in South Carolina d) Satisfactory scores on the verbal and quantitative portions of the GRE General Test (old format or new revised format) or a satisfactory score on the Miller Analogies Test. e) Two letters of recommendation from master’s level or doctoral level nurses attesting to applicant’s potential for graduate study success f) Current CV or resume with evidence of one year of clinical experience g) Written statement, 300-500 words, discussing applicant’s career goals and reasons for seeking admission to the CNL program h) Satisfactory criminal background check, drug screen and physical examination certifying applicant’s ability to complete clinical requirements i) Completion of undergraduate statistics course with a grade of C or higher j) Applicants not meeting standardized exam requirements or GPA requirements may be considered for conditional admission with the following provision: Students would be required to demonstrate successful graduate work with a GPA of 3.0 at the end of the first semester in order to progress in the program. Students not achieving a 3.0 GPA at the end of the first semester would be dismissed from the program. Lander University, M.S.N., Clinical Nurse Leader, Program Proposal, CAAL 5/2/2013 - Page 8 6. Enrollment: a) Projected total enrollment for five academic years is shown in Table B. Table B-Projected Total Enrollment Projected Total Enrollment Fall Spring Summer Year Credit Credit Credit Headcount Headcount Headcount Hours Hours Hours 2013-2014 0 0 12 108 12 72 2014-2015 12 72 24 180 24 144 2015-2016 24 144 30 234 30 180 2016-2017 30 180 36 270 36 216 2017-2018 36 216 36 270 36 216 Assumptions for projected total enrollment:  New students will enter the program in the spring semester  Students will enroll in the recommended courses in order to complete the program in two years  All students will take courses in summer school  There will be no internal transfer students. b) The projected total enrollment numbers are calculated based an estimated enrollment of 12 students for the first two academic years (2013-2014, 2014-2015) and an enrollment of 18 for the last three academic years (2015-2018). Initial enrollment is projected for spring 2014. c) The projected number of students expected to enroll in the MSN program will be new students. There is not another master’s-level nursing program on the Lander campus; therefore, students are not expected to transfer into this program from existing graduate programs. 7. Curriculum: a) Table C- Clinical Nurse Leader Curriculum Course Credit Course Name Semester Number Hours NUR 600 Theory and Conceptual Foundation 3 Spring NUR 611 Advanced Clinical Assessment 3 (2,1)* Spring NUR 612 Advanced Pharmacology 3 Spring NUR 613 Advanced Pathophysiology 3 Summer NUR 620 Health Care Structure and Finance 3 Summer NUR 630 Health Promotion and Disease Prevention 3 Fall NUR 635 CNL Practicum I 3 (2,1)* Fall NUR 640 Management of Clinical Outcomes 3 Spring NUR 645 CNL Practicum II 3 (2,1)* Spring Lander University, M.S.N., Clinical Nurse Leader, Program Proposal, CAAL 5/2/2013 - Page 9 Course Credit Course Name Semester Number Hours NUR 651 Research for Evidence-based Practice 3 Summer NUR 660 Leadership in Health Care 3 Summer NUR 675 CNL Immersion Practicum III 6 (2,4)* Fall Total *clinical hours included 39 hours b) The courses for the CNL program are all new courses. They are listed below with catalog descriptions. In courses with a clinical component, the ratio is 1 hour of didactic instruction equal to 6 hours of clinical time. Example: NUR 611 is a 3 (2,1) credit hour course with 2 hours of didactic and 1 credit hour of clinical (6 hours of clinical time) weekly. The program will require 500 hours of clinical. Clinical placement sites, clinical preceptors and clinical contracts with facilities will be arranged and maintained by the School of Nursing. One letter of support from Self Regional Healthcare in Greenwood is included with this proposal; however, other clinical placement sites will be arranged based on students’ residences after a class is admitted. Clinical placement sites should be located within a reasonable driving distance for students; therefore it is necessary to first identify the location of students prior to securing clinical placement sites. Lander School of Nursing currently has approximately 50 clinical contracts with healthcare facilities in SC, NC and VA for its BSN options. Negotiating the addition of clinical placements for MSN students will be pursued with these clinical partners. NUR 600: Theory and Conceptual Foundation Introduction to the theoretical foundations of nursing and leadership. Orientation to and conceptual analysis of the Clinical Nurse Leader role. Explores issues of professional values, patient and population advocacy, and ethical codes. Prerequisite: Admission to the Clinical Nurse Leader program. Three semester hours NUR 611: Advanced Clinical Assessment Nursing theory and practice associated with various modalities for clinical assessment of individuals, families, communities, and groups. Enhances knowledge and clinical experience in advanced assessment of diverse clients across the life span within the context of the Clinical Nurse Leader role. Includes utilization of information systems technology for exploring health care outcomes, application of the nursing process through various technologies, therapeutic communication with diverse clients/groups, and patient education. Prerequisite: Admission to the Clinical Nurse Leader program or permission of the instructor. Three semester hours (2, 1) NUR 612: Advanced Pharmacology Overview of the principles of pharmacological and non-pharmacological therapies with an emphasis on therapeutic uses of broad categories of drugs. Explores variations in management of pharmacologic and non-pharmacologic treatment modalities with diverse patient populations across the lifespan. Includes analysis of legal, ethical, policy, and cultural issues pertinent to the use of various pharmacologic and non-pharmacologic therapies. Prerequisite: Admission to the Clinical Nurse Leader program or permission of the instructor. Three semester hours NUR 613: Advanced Pathophysiology Exploration of pathologic mechanisms of disease across the lifespan, incorporating concepts of advanced clinical assessment and management of common, episodic and chronic conditions. Emphasis on chronicity and sequelae of various illnesses. Prerequisites: Grade Lander University, M.S.N., Clinical Nurse Leader, Program Proposal, CAAL 5/2/2013 - Page 10