Introduction
The Nursing Division at the College of Health Sciences (CHS) provides a diverse range of nursing programs at basic and post-basic levels to meet the health service needs in Bahrain and the Gulf Cooperative Countries (GCC). It offers a 3-year pro- gram in General Nursing at basic level (Associate Degree) that graduates about 90- 100 registered nurses annually. Also, 1-year specialized nursing programs at post- basic level, i.e. Nursing Midwifery, Psychiatric Nursing, Community Health Nursing, Critical (Cardiac Care), etc. that graduate 6-10 students annually and a 2- year Bachelor of Sciences program graduates about 18-20 students are offered for Associate Degree program graduates.
The nursing faculty consists of 41 faculty with one Chairperson and are divided among the different programs as follows:
This shows an unequal distribution of faculty between the programs and created frustration and dissatisfaction among the faculty in the General and BSc. Nursing Programs as they compare themselves with the post-basic program., not to say a waste of resources and inefficient utilization of manpower which is not cost-effective. The pressure of the BSc. and General Nursing faculty felt could hinder their ability to teach effectively, especially in clinical teaching.
Only 2 full time nursing faculty (in addition to non-nursing faculty teaching non- nursing courses) are needed to teach a post-basic program consisting of 6-10 stu- dents, whereas there are 3-5 nursing faculty employed at present to teach each post- basic program. The goal of this project is to reduce this number from 3-5 to 2-3 for each post-basic program by December 2001 (Academic year 2001).
Root Cause Analysis
The team, consisting of 8 members (7 female, 1 male) and identified based on Belbin’s team roles, was selected from the Nursing Division with an age range of 28- 50 years and teaching experience of 2-24 years. Six members hold BSc. in Nursing, out of which four also hold post-basic diploma in their specialized program, and two had MSc. in Nursing.
The problem was analyzed using the Fishbone and Pareto models. A variety of methods were used to investigate the problem which included:
Program
General Nursing (3yrs.) BSc. Nursing (2yrs.) Post Basic (1yr.) • Psychiatric • Community • Midwifery
• Critical (Cardiac Care)
14 3 4 4 3 5-8 5-6 8-10 8 1 : 1.6-2.6 1 : 1.2-1.5 1 : 2-2.5 1 : 1.6 No. of Faculty 25 276-300 1 : 11/12 2 36-38 1 : 18/19 No. of Students Faculty- Student Ratio
1. Review of literature, policy and standards: Each nursing faculty is responsible for classroom and clinical teaching, course preparation, committee work, student’s evaluation, counseling/advising students and administrative duties according to CHS job descriptions (see table). Each post-basic program has Head of program and 2-3 faculty, where each faculty has to teach 12 hrs. (contact) per week and the Head of the program 10 hrs. per week. So the total teaching hours per semester (16 weeks) should be 192 hrs. for faculty and 120 hrs. for Heads of programs. Classroom teach- ing (1810 hours) in the programs is implemented by full time Nursing faculty and part time faculty (guest speakers), and clinical teaching (2430 hours) is implement- ed by full time Nursing faculty and nursing personnel at the service (practice). According to the job description, faculty in post-basic programs should have 476 hours of student teaching (classroom/clinical) for the whole academic year (3 semesters/40 weeks). If we leave aside the part time faculty and divide 1810 teach- ing hours by 14 full time faculty, each faculty will have 129 hours for the whole year and divide 2430 hours of clinical teaching without the nurses in clinical areas, each faculty will have 174 hours - a total of 303 hours for the whole year. This shows that each faculty has 173 hours less than the expected standard (476 hours) or 14-15 weeks free without teaching. If the hours that part time faculty and nurses in clini- cal areas are added, the number of free weeks of teaching for each faculty will increase!
2. Semi-structured interviews: These were conducted with the Heads of post-basic programs and focused on 2 areas.
a. Their perception about the actual number of full time faculty required to teach each course. The data from these interviews showed that the number of full time faculty for any post-basic program should not exceed 2, even if the number of enrolled students reached 12 (which has never happened in any post-basic program).
b. The procedure for allocating faculty to post-basic programs. Most said that ‘it was the same for many years and maybe when a faculty went for higher studies another was recruited as replacement!’
Another interview was conducted with the Head of the staff/faculty recruitment section of the Ministry of Health (MOH), which revealed that there were no policies or standards at MOH or CHS on the number of faculty required. The procedure implemented depends on the Nursing Division Administration’s views, which was automatically forwarded to MOH. MOH officials are mainly concerned with the total number of faculty in the Nursing Division and the distribution of faculty was the responsibility of the Chairperson of the Division. So if the Chairperson is not knowledgeable about each course, how can the number of faculty required be known?
3. Questionnaire: A form was distributed among all nursing faculty to identify non-teaching activities and the time spent on each. The result revealed that the same amount of time was spent on these activities by post-basic faculty and BSc. and General Nursing faculty. However, some post-basic faculty spent less time on these activities than other faculty in BSc. and General Nursing programs.
All the data indicated that there were 14 faculty in post-basic nursing programs where there should be 8 faculty. It was obvious that these causes were all related to the system and people categories.
Alternative Solution
In order to reduce the number of faculty, there was a need to tackle some causes immediately (short term solution) and other causes later (long-term solutions) as follows:
1. Post-basic programs: Shift 1-2 faculty from each post-basic program to General and BSc. nursing programs for the current academic year, conduct workshops for all heads of programs on “Control in Management”, and the Chairperson should reinforce job descriptions (standards) for heads and faculty of post-basic programs.
2. Nursing Division: Formulate a committee to design a system for allocating faculty to each program in the Nursing Division, the chairperson along with the heads of programs should work on designing a control system for the Division and a task force committee should be formed to work on strategy for replacing faculty on study leave without recruiting new faculty.
3. College of Health Sciences: A copy of the breakdown of teaching hours for each post-basic program in ratio to faculty number should be available in the Chairperson and Dean’s offices and a committee should be formed in CHS to design a system for recruiting faculty to standardize a mechanism for control. 4. Ministry of Health: A committee should be formed in MOH with at least 2
CHS members to establish policies/standards for CHS full time faculty.
Implementation
Solution one was selected as it had a major role in solving the problem and was dis- cussed with the Chairperson who shifted 4 faculty to the General and BSc. pro- grams: 2 from the Community Nursing, 1 from Midwifery and 1 from Critical Care Nursing Programs (2 were assigned to BSc. and 2 to General Nursing programs). This reduced the teaching load on General and BSc. program faculty, reduced inter- nal tension in the Division and the faculty/student ratio was reduced. Formal rules and regulations were needed to standardize the number of faculty in post-basic pro- grams, and this change was reinforced again by standardizing the post-basic pro- grams with the number of faculty during semester one (Sep. - Dec. 2001) leaving 2- 3 faculty in Midwifery, 2 in Community, 2 in Critical Care and 2 in Psychiatric Nursing programs.
The driving forces of confidence, open-mindedness, cooperation and the level of understanding of the new Chairperson played a positive role in implementing this solution. However, it would have been better if more than one solution was imple- mented, but it was not possible due to the time limitation of this project.
Recommendation
To assist in improving the quality of Nursing Education at CHS, it is proposed that additional research is needed to examine the relationship of the variables identified to the proportion of part time faculty in nursing programs. This study could be implemented in all other CHS Divisions/Programs (English Department, Social and Behavioral Sciences, etc.) for better utilization of faculty and reducing costs. All Post-Basic program curriculum need to be evaluated by taskforce committees. Reduce the number of Head positions in Post-Basic programs (combine at least 2 programs under 1 Head) as number of students are limited. This will enhance bet- ter utilization of faculty and be more cost-effective as these programs are based on the needs of MOH and have only 1 head position (G-7) as Head for Critical Care Programs as there is only 1 Critical Care program every year. Faculty from General and BSc Nursing programs should have some Nursing Specialization (Midwifery,
Community, Critical, etc.), so the teaching needs of post-basic programs can be met by these faculty whenever necessary rather than recruiting new faculty (faculty can attend these specialization programs at CHS itself). Committees should be formu- lated to help design control system allocating faculty for each Nursing program, to develop strategy of faculty replacement during study leave without new recruit- ment and to establish policies/standards for CHS faculty at MOH level.
Results
The implemented solution benefited faculty in the General and BSc Nursing Programs by reducing the number of students assigned to each faculty by reassign- ing faculty from the Post-Basic programs as illustrated in the table below:
* This program had 3 faculty; one went for higher study and the other two were moved to General Nursing Program as this program has been cancelled for the academic year starting Sep. 2001.