Building an Evidence-Based Graduate Nursing Program: A Feasibility Study in Tennessee, USA

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Building an Evidence-Based Graduate Nursing

Program: A Feasibility Study in Tennessee, USA

Shu-li Chen, PhD, RN

Mary Anne Modrcin, PhD, RN

Sandra McGuire, EdD, RN

Lincoln Memorial University Caylor School of Nursing Harrogate, Tennessee, USA

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Research Purpose

• The purpose of this survey study was to examine the feasibility of starting a graduate nursing program at a new university service area in a rural area of USA.

• This is the forth feasibility survey completed by the Caylor School of Nursing (CSON) at the Lincoln

Memorial University, Harrogate, Tennessee, USA, to examine feasibility of graduate nursing programs in rural areas.

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Caylor School of Nursing (CSON)

Mission Statement

• In agreement with the University’s mission and goals, the Faculty of the Caylor School of Nursing strives to instill responsibility and high moral/ethical standards in the

preparation of quality nurses, at multiple levels of nursing education, through superior academic programs at the

undergraduate and graduate level.

• Specifically, the mission of the Faculty is to prepare nurses with the ASN, BSN, and MSN degree, to assist individuals, families, communities, and society as they adapt to changes in physiological needs, role function, self-concept, and

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Caylor School of Nursing (CSON)

Mission Statement

• The Caylor School of Nursing seeks to

respond to the needs of nursing education and healthcare in the surrounding communities by preparing nurses at multiple levels and by

providing continuing education/professional development opportunities that are rooted in knowledge, research, and other scholarly activities.

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2004 Nurse survey 2006 FNP 2011 PMHNP 2008 CRNA 2005 Employer Survey 2010 Nurse and Employer Feasibility Studies 2007 Nurse Survey

Building an Evidence-Based

Graduate Nursing Program

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Background – 2004 Nurse Survey

• In 2004, Caylor School of Nursing at LMU conducted a survey of BSN prepared nurses (N=216) in the

university service areas.

• The findings indicated a desire for an increase in

advanced practice nursing education opportunities in Appalachia.

– 1) 80% desired a nurse practitioner gradate degree – 2) 75% of which respondents wanted an FNP

– 3) The majority of them planned to start pursing this option within three years

– 4) The majority requested a program with both seat and web-based courses in addition to clinical experiences

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Background – 2005 Employer Survey

• In 2005, a Nurse Practitioner Employment Survey was distributed to selected regional health care facilities in the university service areas.

• 73% of the responding agencies reported utilization of NPs (preferring FNPs) and planned to continue using NPs within their agencies

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MSN program established

– FNP in 2006

• In 2006, the MSN degree program was first

established to offer nurses further educational options and provide surrounding communities with Family

Nurse Practitioners to meet identified health care needs.

• The MSN program, FNP concentration, provides a flexible format for either part-time or full-time nursing students currently working in area hospitals and

health care facilities.

• The program allows full-time students to complete the MSN degree in a minimum of 17 months.

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Background – 2007 Nurse Survey

• Similar to the 2004 Surveys of RNs and RN students (N=216), the 2007 survey of nurses (N=176)

continued to report the desire for an increase in

advanced practice nursing education opportunities in Appalachia.

– 1) the 2007 survey reported that 75% desired to get an MSN with a Nurse Anesthesia focus.

– 2) two focus groups of LMU health care agencies met with LMU administration in Spring 2007 to discussion health care workforce needs. The number one need of all participants from LMU’s service area was “CRNAs”

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MSN program expanded – NA in 2008

• In 2008, the nurse anesthesia concentration (NA) was added to the MSN degree program.

• The nurse anesthesia concentration at LMU can be completed in 28 months of full-time study and

requires 88 credit hours of graduate course work including six semesters of clinical practice.

• Full-time status is required.

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2010 Feasibility Survey

• This study required a one-time completion of the

survey questionnaire, either by nurses or employers of nurses.

• The study included a convenience sample of 29

nurses and 14 potential employers of advanced nurse practitioners.

• It took approximately 5 minutes to complete each questionnaire.

• Participation was strictly voluntary. Completion of the questionnaire was used to verify participants’ consent to participate in the study.

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Data Analysis

• Data collection were completed in the fall of 2010. • Data analysis were completed in the spring of 2011 • Descriptive statistics are used to better understand

the needs and wants of local nurses and potential employers of nurses with graduate degrees.

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Nurse Sample (n=29)

Nurses with Interest Nurses without Interest Total Gender Female 17 (81%) 8 (100%) 25 (86%) Male 4 (19%) 0 (0%) 4 (14%) Education High School 3 (14%) 2 (25.0%) 5 (17%) AD/ASN 8 (38%) 1 (12.5%) 9 (31%) BSN 10 (48%) 4 (50.0%) 14 (49%) Graduate 0 (10%) 1 (12.5%) 1 (3%) Mean Age 30.24* 53.63* 36.69* * t=-4.5, p<.001

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Findings about Degrees

Yes No Total

Are you interested in obtaining additional nursing education?

21 (72%) 8 (28%) 29 (100%)

RN-to-BSN 4 (19%) 17 (81%) 21 (100%)

MSN 13 (62%) 8 (38%) 21 (100%)

DNP 6 (29%) 15 (71%) 21 (100%)

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Findings about Specialty Interest

Yes No Total

What specialty are you interested in?

Family Nurse Practitioner 15 (71%) 6 (29%) 21 (100%)

Psychiatric Mental Health Nurse Practitioner 5 (24%) 16 (76%) 21 (100%)

Pediatric Nurse Practitioner 5 (24%) 16 (76%) 21 (100%)

Adult Health or Geriatrics 4 (19%) 17 (81%) 21 (100%)

Women’s Health 3 (14%) 18 (86%) 21 (100%)

Certified Registered Nurse Anesthetists 1 (5%) 20 (95%) 21 (100%)

Nursing Administrator 1 (5%) 20 (95%) 21 (100%)

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Findings about Application Interest

Yes No Total

What specialty would you apply for?

Family Nurse Practitioner 14 (67%) 7 (33%) 21 (100%)

Psychiatric Mental Health Nurse Practitioner 4 (19%) 17 (81%) 21 (100%)

Pediatric Nurse Practitioner 5 (24%) 16 (76%) 21 (100%)

Adult Health or Geriatrics 4 (19%) 17 (81%) 21 (100%)

Women’s Health 5 (24%) 16 (76%) 21 (100%)

Certified Registered Nurse Anesthetists 1 (5%) 20 (95%) 21 (100%)

Nursing Administrator 1 (5%) 20 (95%) 21 (100%)

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Findings about interest in LMU

About 1-2 years About 2-5 years About 6 or more years later Total

When would you like to begin your nursing program?

14 (67%) 7 (33%) 0 (0%) 21 (100%)

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Findings about start time

Yes No Not Sure

Total

If LMU were to offer a Family

Nurse Practitioner (FNP) program in Kingsport, would you apply?

10 (48%) 6 (29%) 5 (24%) 21 (100%)

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Findings about location

Kingsport Knoxville Johnson City Total

At what location would you prefer to attend classes?

17 (81%) 3 (14%) 1 (5%) 21 (100%)

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Findings about program length

Within 12 months Between 12 & 18 months Between 18 months & 2 years No Preference

What time frame do you prefer to

complete this degree?

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Findings about program delivery

Classroom Courses Online Courses Combined Courses Total

What delivery method do you prefer to

obtain this degree?

6 (29%) 6 (29%) 13 (62%) 21 (100%)

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Findings about class hours

Daytime Classes Evening Classes Week-ends Block scheduling What time of day

would you prefer for class instruction? 13 (62%) 9 (43%) 5 (24%) 5 (24%)

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Findings about employer’s interest

Yes No Total

Does your facility utilize nurses with graduate degrees?

10 (71%) 4 (29%) 14 (100%)

Would your facility hire a nurse practitioner?

12 (86%) 2 (14%) 14 (100%)

Would your facility hire a new graduate as a nurse practitioner?

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Specifics about employer's Interest

Yes No Total

What position do you have for them?

Family Nurse Practitioner 11 (79%) 3 (21%) 14 (100%)

Psychiatric Mental Health Nurse Practitioner 1 (7%) 13 (93%) 14 (100%)

Pediatric Nurse Practitioner 2 (14%) 12 (86%) 14 (100%)

Adult Health or Geriatrics 2 (14%) 12 (86%) 14 (100%)

Women’s Health 6 (43%) 8 (57%) 14 (100%)

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Findings about employer’s need

Full-time (32-40 hours per week) Part (less than 32 hours per week) No need at present time Total

Would your facility need a nurse practitioner? 7 (50%) 1 (7%) 6 (43%) 14 (100%)

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Difference between nurses and employers

by Pearson Chi-Square

Yes No p value

Family Nurse Practitioner Nurses Employers 24 (77.4%) 14 (66.7%) 10 (100%) 7 (22.6%) 7 (33.3%) 0 (0.0%) 0.04*

Psychiatric Mental Health NP Nurses Employers 4 (12.9%) 4 (19.0%) 0 (0%) 27 (87.1%) 17 (81.0%) 10 (100.0%) 0.14 Pediatric Nurse NP Nurses Employers 7 (22.6%) 5 (23.8%) 2 (20%) 24 (77.4%) 16 (76.2%) 8 (80.0%) 0.81 * Person Chi-square=4.3, p<.05

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Difference between nurses and employers

by Pearson Chi-Square

Yes No P value

Adult Health or Geriatrics Nurses Employers 6 (19.4) 4 (19.0%) 2 (20.0%) 25 (80.6%) 17 (81.0%) 8 (80.0%) 0.95 Women’s Health Nurses Employers 11 (35.5%) 5 (23.8%) 6 (60.0%) 20 (64.5%) 16 (76.2%) 4 (40.0%) 0.049* * Person Chi-square=3.9, p<.05

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SWOT Analysis

Strengths (S)

• Included both nurses and employers

• Allow comparisons by using same rating scale • Including open-ended

questions

Weaknesses (W)

• Small sample size (Nurse N=29; Employer N=14)

• Convenience sample • Single healthcare facility • Low response rates

among employers (36.8%)

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SWOT Analysis (continued)

Opportunities (O)

• Preparing nurses at the graduate level

• Responding respond to the needs of nursing

education and healthcare in the surrounding

communities by preparing nurses at graduate level

Threats (T)

• Recent economic recession in USA

• Several existing FNP programs in the nearby areas

• Newly launched FNP program in the service area

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Four main reasons for us not launching our new FNP

program

in the new service area

Small Sample Size Single Survey Site Recent economic recession Newly launched FNP program nearby

Why not FNP?

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Program expanded further – PMHNP in 2011

• As we continued to live up to our mission in seeking to respond to the needs of nursing education and

healthcare in the surrounding communities, the

school received phone calls and inquiries for Psychiatric Mental Health Nurse Practitioner.

• In January 2011, the Psychiatric Mental Health Nurse Practitioner was added to our MSN degree program. • The PMHNP concentration at LMU can be completed

in 12 months of full-time study and requires 41 credit hours of graduate course work including 500 clinical hours.

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Implications

• The knowledge gained may also allow nurse researchers to utilize this knowledge to plan, implement, and support culturally sensitive

educational initiatives for graduate nursing programs. • Understanding gained from this survey study will aid

nurse educators and clinicians in identifying

systematic ways to support nursing education through graduate studies.

• Lastly, the survey data are important for approval and accreditation processes and should be incorporated in the systematic plan for evaluation of graduate nursing programs.

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Program Develop Cycle

Mission Feasibility Studies Focus Groups SWOT Analysis Program Development Outcome Evaluation

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Conclusion

• The findings from this feasibility study provides information about the most effective and efficient ways to design, development, implement, and evaluate a graduate nursing program for nurses serving rural communities.

• Conducting such feasibility studies assists the

educational institution in establishing if a need for educational programs exists in an area before

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