EVALUATION TEAM REPORT ON THE ACCREDITATION REVIEW OF THE BACCALAUREATE AND MASTER S DEGREE PROGRAMS IN NURSING AT UNIVERSITY OF SAN FRANCISCO

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EVALUATION TEAM REPORT ON THE ACCREDITATION REVIEW

OF THE BACCALAUREATE AND MASTER’S DEGREE PROGRAMS IN NURSING AT

UNIVERSITY OF SAN FRANCISCO

COMMISSION ON COLLEGIATE NURSING EDUCATION ON-SITE EVALUATION: April 7-9, 2008

EVALUATION TEAM:

Margaret Faut-Callahan, PhD, RN, FAAN, Team Leader Lynn Babington, PhD, RN

Deborah Garrison, PhD, RN Eileen Grigutis, MS, RN, FNP

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TABLE OF CONTENTS

INTRODUCTION ... 1 MEETING OF CCNE STANDARDS ... 3 Standard I. Program Quality:

Mission and Governance ... 3 Standard II. Program Quality:

Institutional Commitment and Resources ... 9 Standard III. Program Quality:

Curriculum and Teaching-Learning Practices ... 18 Standard IV. Program Effectiveness:

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Introduction

This report presents the findings of the evaluation team from the Commission on Collegiate Nursing Education (CCNE), the accrediting body devoted exclusively to the evaluation of baccalaureate and master’s degree programs in nursing, regarding the Bachelor of Science in Nursing (BSN) and the Master of Science in Nursing (MSN) programs at the University of San Francisco and their compliance with CCNE’s standards for accreditation. This review constitutes the evaluation of the nursing programs for continuing accreditation by CCNE. Both the BSN and the MSN programs were initially accredited by CCNE in 2003.

The University of San Francisco (USF) is a private university founded in 1855 by the Jesuit Fathers and originally named Saint Ignatius Academy. In 1930, the name of the university was changed to its current name, University of San Francisco. USF enrolls more than 8,500 students. The university has evolved and today offers sixty-eight majors in six colleges. Governed by a board of trustees consisting of 44 individuals, USF is authorized by the California Board of Higher Education to offer baccalaureate and master's degrees in the arts and sciences and in various professional fields. USF was reviewed by the Western Association of Schools and Colleges in 2007, using a two step process. The second step of the process is ongoing. The institution’s Carnegie Classification is Doctoral/Research University.

With a 55-acre campus located in San Francisco, USF is grounded in the Jesuit tradition of service. "The University of San Francisco will be recognized as a premier Jesuit, Catholic, urban university with a global perspective that educates leaders who will fashion a more humane and just world." As such, USF makes important contributions to the community it serves. A strong commitment to social justice was palpable in faculty, student, and administrative group discussions. University officials and other constituents who met with the evaluation team reported that USF School of Nursing (SON) faculty and students are deeply involved in all aspects of the university and are excellent examples of individuals both committed to and living the mission.

The SON opened in 1940 to offer a baccalaureate for registered nurses. This was a cooperative effort with St. Mary’s Hospital. The SON began offering baccalaureate

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degrees for non-nurses in 1954 and graduated its first class in 1958. At that time, the SON was accredited by the National League for Nursing. The SON started the Master of

Science in Nursing (MSN) program in 1984 and the Doctor of Nursing Practice (DNP) in 2007. Today, there are 599 students enrolled in the baccalaureate program, and 171 students enrolled in the master’s program. In addition, there are 29 students enrolled in the DNP program in either the Family Nurse Practitioner (FNP) track or Healthcare Systems Leadership track. There are 28 full-time and 52 part-time faculty members in the SON, representing 50 full-time equivalent (FTE) positions. The BSN program is approved by the California State Board of Nursing; the next state review is scheduled for 2009. The MSN program was reviewed by the California State Board of Nursing in 2000/2006 and is scheduled for review in 2009.

As part of the review, the team verified that the program afforded the opportunity for constituents to submit third-party comments directly to CCNE. CCNE did not receive any third-party comments for the programs.

The team was afforded full cooperation in its efforts to assess the programs and to verify the self-study document. The team found that the self-study did not adequately describe the efforts of the faculty in conducting the nursing program. A great deal of information was found, clarified, and verified on-site, and examples are included throughout the summary report.

The team would like to take this opportunity to thank program and university

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Meeting of CCNE Standards

While visiting USF, the evaluation team had an opportunity to interview school and

university officials, program faculty, students, alumni, and community representatives. The team reviewed information in the self-study document and in the resource room, as well as other materials provided at its request. In addition, the team also observed classroom and clinical activities. The following assessments were made regarding compliance with the Standards for Accreditation of Baccalaureate and Graduate Nursing Programs by the BSN and the MSN programs at the institution.

STANDARD I. PROGRAM QUALITY: MISSION AND GOVERNANCE

The mission, goals, and expected outcomes of the program are congruent with those of the parent institution, reflect professional nursing standards and

guidelines, and consider the needs and expectations of the community of interest – all in the pursuit of the continuing advancement and improvement of the

program. Policies of the parent institution and nursing program clearly support the program’s mission, goals, and expected outcomes. The faculty and students of the program are involved in the governance of the program and in the ongoing efforts to improve program quality.

This standard is met for the baccalaureate program. This standard is met for the master's program.

I-A. The mission, goals, and expected outcomes of the program are written, congruent with those of the parent institution, and consistent with professional nursing standards and guidelines for the preparation of nursing professionals.

Compliance Concerns? Baccalaureate: No

Master’s: No

Rationale:

The mission, goals, and outcomes of the program are clearly delineated and

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vision and mission in 2001 under the leadership of the president. The university’s tagline is “Educating minds and hearts to change the world.” The faculty, students, and staff of the SON articulate the university mission, vision, and core values.

The SON has developed its own vision, mission, and values that are consistent with the university statements. Using the Jesuit tradition as its foundation, the SON values relate to creating an environment that promotes excellence, demonstrating key personal values, and positively influencing nursing practice and health care environments. The faculty, students, and staff demonstrated a high level of community commitment and dedication to service and to each other. Students clearly articulated their goals and objectives in each clinical and didactic course and were especially impressive when discussing their clinical decision-making and the outcomes they expected to meet for their patients.

The SON uses all appropriate professional standards in the preparation of their students at all levels.

I-B. The mission, goals, and expected outcomes of the program are reviewed periodically and revised, as appropriate, to reflect professional standards and guidelines.

Master’s: No

Rationale:

The SON’s mission, vision, and values were all reviewed in the Fall of 2006 when the new dean engaged the faculty and staff in her 100 Days of Progress planning initiative. The final documents were approved on January 17, 2007 through established faculty procedures. Following this, the curriculum was reviewed in the context of the changes being made in nursing education nationwide. The goals and expected outcomes for each program were reviewed and included in a major curriculum revision across the SON.

The current BSN program is been based on AACN’s The Essentials of Baccalaureate Education for Professional Nursing Practice (Baccalaureate Essentials). A new BSN

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program that is being developed also follows the Baccalaureate Essentials as well as the Quality and Safety Competencies (QSEN) initiative. The Clinical Nurse Leader (CNL) track in the MSN program is based on AACN’s Clinical Nurse Leader Guidelines and The Essentials of Master’s Education for Advanced Practice Nursing. The “direct” care track of the DNP program is based on the NTF Criteria for Evaluation of Nurse

Practitioner Programs (2002) and the National Organization of Nurse Practitioner Faculties (NONPF) Domains and Competencies (2006). The “indirect” care track of the DNP was developed using the Council on Graduate Education for Administrative

Nursing’s (CGEAN) Essentials of Master’s Level Education in Nursing Systems (1995).

I-C. The mission, goals, and expected outcomes of the program are reviewed periodically and revised, as appropriate, to reflect the needs and expectations of the community of interest.

Master’s: No

Rationale:

The SON demonstrates its commitment to the community of interest by fully engaging the institutions and agencies in activities related to strategic planning, curriculum

innovation, and programmatic evaluation. Nursing leaders from the community met with the reviewers and described many opportunities in which they have provided feedback to the school. When the dean began her tenure, she met with the chief nursing officers (CNOs) of her community partners in their facilities to generate a sense of inclusion. The CNOs described close relationships with the faculty and gave clear examples of how both faculty and students contribute to the respective missions of their organizations.

During visits to clinical site visits, it was obvious that faculty are well known and respected in the environments that the SON uses for clinical experiences for students. What was remarkable was the way faculty are recognized throughout very large

agencies. The new degree programs (CNL and DNP) are meeting the needs of several of USF’s partner institutions, as there are a number of employees from those hospitals (such as San Francisco General Hospital and Stanford Medical Center) in the programs.

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The CNOs reported their commitment to working with the faculty to further develop the CNL role in the San Francisco Bay area.

The dean utilizes the External Advisory Committee (EAC), School Advisory Board, and the Nursing Dean’s Circle to assist her in the development of strategic initiatives and to obtain input from a number of constituencies including the alumni, community nursing and healthcare leaders, and others.

The dean meets with students three times during fall and spring semesters and once during the summer. These meetings afford the students an opportunity to discuss concerns, new ideas, and topics in professional nursing with the dean.

Overall, it was quite apparent that the USF SON faculty and administration are integrally involved in their community. The dean, SON leadership, and faculty use many strategies to engage their communities of interest in the education of their students.

I-D. Roles of the faculty and students in the governance of the program are clearly defined and enable meaningful participation.

Master’s: No

Rationale:

The SON faculty and students have many opportunities to be involved in the governance of the school and the university. The university faculty organization is the University of San Francisco Faculty Association (USFFA), an exclusive collective bargaining organization. Faculty involvement in governance is delineated in the by-laws of the USFFA. SON faculty serve on many university committees as well as Board of Trustee committees.

The Administrative Council of the SON includes the dean, associate dean, four

departmental chairpersons (Adult Health Nursing, Family Health Nursing and Capstone, Community and Psychiatric Nursing and Leadership, and Advanced Practice Nursing),

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the chair of the Faculty Association of the School of Nursing (FASON), and the director of Student Affairs.

The SON standing committees are outlined in the FASON by-laws and include: Curriculum Committee, Faculty Development Committee, Program Evaluation

Committee, Peer Review Committee, and the Academic Standards Committee. Minutes of all committees are available for faculty review on the internal SON server. Review of meeting minutes revealed that SON faculty are actively involved and provide leadership for SON and university committees.

I-E. Documents and publications are accurate. Any references in promotional materials to the program’s offerings, outcomes, accreditation/approval status, academic calendar, admission policies, grading policies, degree completion requirements, tuition, and fees are accurate.

Master’s: Yes

Rationale:

The team found inconsistencies between the learning outcomes and program options listed for the MSN program in the USF general catalog (print material), USF SON Website, in the student handbook for the MSN program (on the Blackboard Website), and those listed as evidence for Standard III in the resource room on site. The dean and associate dean are aware of these inconsistencies and have plans to correct them.

I-F. Policies of the parent institution and the nursing program are congruent with and support the mission, goals, and expected outcomes of the program; these policies are fair, equitable, published, and are reviewed and revised as necessary to reflect ongoing improvement. These policies include, but are not limited to, those relative to student recruitment, admission, and retention.

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Rationale:

Congruence between institutional and SON policies and procedures was seen. Evidence of revision of policies and procedures as necessary was found in the minutes of various committees. Extensive student policies are published in the university catalog and other publications.

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STANDARD II. PROGRAM QUALITY: INSTITUTIONAL COMMITMENT AND RESOURCES

The parent institution demonstrates ongoing commitment and support. The institution makes available resources to enable the program to achieve its mission, goals, and expected outcomes. The faculty, as a resource of the

program, enables the achievement of the mission, goals, and expected outcomes of the program.

II-A. The parent institution and program provide and support an environment that encourages faculty teaching, scholarship, service, and practice in keeping with the mission, goals, and expected outcomes of the program.

Master’s: No

Rationale:

In interviews, the president, provost, dean, faculty, staff, and students validated that members of the campus community embody the mission of USF of “educating minds and hearts to change the world.” This university mission correlates effectively with the mission of the SON, “to advance nursing education within the context of Jesuit tradition, and to effectively link classroom and clinical experiences with expectations for

competence, compassion, and justice in health care within the context of the highest academic standards.” In discussions, university administration, as well as SON faculty and students validated the support for the missions of the university and the SON. The president, vice presidents, and deans go on a retreat together every other year to disadvantaged areas of the world such as Nicaragua and Belize for the purpose of sensitizing university leadership to the issues faced by people who subsist on meager resources. Faculty in the SON conduct mission trips twice annually to Guatemala for the purpose of assisting to decrease maternal and infant death rates in that country. At a

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local level, faculty and students integrate service learning projects within the

undergraduate curriculum of the SON to benefit the citizens of the San Francisco Bay area.

Teaching

The infrastructure at USF supports and advances teaching through an equitable assignment of teaching responsibilities, faculty support for innovations in teaching, awards for teaching excellence, and generous funding for faculty development. Teaching assignments for full-time faculty who are tenured or tenure earning are calculated based upon 15 teaching units per semester. Of these, three units are allocated for committee work, and three units are designated for research and scholarship. Thus, tenured and tenure earning faculty teach nine units per semester. Both full and part-time faculty are eligible to apply for faculty development funds in the amount of $64,050 for full-time and $12,280 for part-time. One hundred percent of the faculty in attendance at the faculty session had received faculty development funding, and documentation in the exhibit room demonstrated a comprehensive listing of faculty projects. Projects include support for professional effectiveness, such as conference participation; research funding, for expenses associated with the conduct of research studies; and research related funding, to cover the expenses associated with dissemination of research findings. The Faculty Development Committee accepts proposals twice annually and makes

recommendations for awards. The process is clearly outlined on the Faculty Blackboard Portal, and applications are readily available.

Faculty reported strong support from the Center for Instructional Technology. Faculty members in the SON received the university-wide “Innovation and Excellence in Teaching with Technology” award in 2003 and 2006. Observations during the on-site evaluation demonstrated faculty excellence in integration of technology that has stemmed from this support.

Tuition remission is available for both full-time and part-time faculty, which supports knowledge acquisition among faculty clinical instructors who wish to enhance their teaching effectiveness. Five current nursing faculty are using the benefit to pursue doctoral studies.

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Scholarship

A robust collection of peer-reviewed articles and documentation of invited presentations, attested to the scholarship of the faculty. One area of concentration for scholarship focused on innovation in teaching, particularly focusing on the use of technology in the classroom and simulation of clinical scenarios. The university supports research through the faculty development funds that were discussed previously. In addition, the SON’s Faculty Grant Program supports faculty research, with $20,000 awarded annually for the past two years.

Service

Service learning is an integral component of the undergraduate curriculum. Students reported their satisfaction with service learning and its support for social justice. They clearly articulated the USF mission statement as a reason for selecting the university, and described the contributions they are making. For example, students, in collaboration with a community clinic and their faculty member, are writing a grant to support the continuation of diabetes education after they leave the clinical setting. USF funds the development of service learning through the Service Learning Fellowship program, which provides $2,500 to support the integration of service learning into existing or new courses. One faculty member also received a $25,000 grant from the Kaiser Foundation to support the Guatemala Immersion Program, in which students spend two weeks working with native health care providers to enhance women’s health outcomes.

II-B. Fiscal and physical resources are sufficient to enable the program to fulfill its mission, goals, and expected outcomes. These resources are reviewed, revised, and improved as needed.

Master’s: No

Rationale:

Fiscal resources are sufficient to enable the program to fulfill its mission, goals, and expected outcomes, as are physical resources; however, space for faculty, staff, and

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classrooms is at a premium and has been noted by university administration as well as SON administration, faculty, staff, and students as the primary limitation to future growth.

Fiscal Resources

Review of documents and interviews with the SON budget officer substantiated the total SON budget of $4,825,457 allocated across three major accounts. The instruction account ($3,742,169) covers personnel, general operations, travel, entertainment, and capital expenditures. The skills laboratory account accrues revenue ($76,227) from undergraduate and graduate student fees associated with clinical courses. The dean’s account ($1,097,061) covers staff, general operations, budget, and capital expenditures.

The university budget is developed annually and is aligned with the university’s mission, vision, values, and strategic initiatives. In addition, it includes enrollment and tuition projections. The dean proposes a budget for continuing operation of the SON, as well as proposals for new or innovative projects. In an interview, the provost substantiated the addition of one new full-time faculty position for the academic year 2006-08, two new full-time faculty positions for academic year 2007-08, and three new full-time faculty positions for academic year 2008-09 resulting from the proposal submitted for the new DNP program. The president and provost communicated their strong support for the SON; generally university administration will approve expenses associated with revenue producing projects that cover their costs with a resultant contribution to the university. The SON generates a positive contribution margin, with $5,197,410 documented for fiscal year 2007.

The dean is recognized across campus for enthusiasm and innovation in the area of fundraising. The Office of Advancement collaborates with the dean to support efforts to reach out to alumni and others who have the inclination and means to provide financial support to the SON. In particular, she was complimented on the creation of the dean’s circle, a group of individuals who make a three-year commitment to provide substantial fiscal support for the SON. This group is in addition to the more traditional School Advisory Council comprising chief nursing officers and directors of education who assemble on a regular basis to provide input to the curricula and programs of the SON.

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Physical Resources

USF is located on a 55-acre campus near Golden Gate Park in the western part of San Francisco. The main campus houses administration, classrooms and offices, as well as administrative and support services in a collection of 20 buildings. In addition, there are four regional campuses, two of which are used by the SON.

The SON is located on the main campus on three floors of Cowell Hall. Administrative offices are located on the first floor, with 27 offices on the second and third floors. Each full-time faculty member has a private office, while part-time faculty share two offices for on campus work. Classes are taught in classrooms across the campus and are

scheduled through a centralized system.

Physical resources are recognized to be a constraint for growth, particularly at the pre-licensure, undergraduate level. Therefore, recruitment and programming are aimed primarily at the post-licensure populations, including associate degree graduates, second degree graduate-entry, and master’s students. The SON has pursued space in other locations as an innovative strategy to supplement space on the USF campus, including a shared simulations space at St. Mary’s Medical Center, which is adjacent to the campus, as well as classroom space at remote sites in San Ramon, Santa Rosa, and San Francisco General Hospital. The master’s programs are offered at the remote locations, which are convenient for the populations of students residing or working in those areas. All members of the community of interest concurred that space is the primary issue for the SON at USF.

II-C. Academic support services are sufficient to ensure quality and are evaluated on a regular basis to meet program and student needs.

Master’s: No

Rationale:

USF offers a comprehensive array of academic support services to support the faculty and students in the accomplishment of the mission and goals of the university. These academic support services include USF Academic and Enrollment Services, the

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Learning and Writing Center, Student Disability Services, Career Services Center, Health Promotion Services, Counseling Center, University Ministry, Residence Life, Living and Learning Communities, International Student Services, Learning Resource Center, The Gleeson Library/Gescheke Learning Resource Center, Center for

Instruction and Technology, Computer Laboratories, and the Learning Management System, Blackboard.

In interviews, the Dean for Enrollment Services substantiated the support provided for these services, most of which are within the purview of this dean. Students reported their tremendous satisfaction during interviews, including strong praise for the Learning and Writing Center and the Career Development Center. Several students described the benefits of reviewing papers with staff in the Learning and Writing Center, including assistance with publication format. The Career Development Center was credited with support for resume preparation, interview techniques, and identification of professional attire. Other students described the strong support they receive from the librarian assigned to support the SON, including guidance with searching on-line databases. The evaluation team visited the library and learned of the substantial additions to the

electronic collection in preparation for the DNP program; these additions also support existing graduate and undergraduate students in their quest for current literature.

The Learning Resource and Simulation Center is staffed by 23 undergraduate teaching assistants. These teaching assistants, after validation of skills by the director of the LRC, are available 51 hours per week to review and validate skills of the undergraduate students. This provides a great deal of flexibility for students who need to practice skills, or have their skills validated. Students serving as teaching assistants reported their satisfaction with this role, indicating that they have gained tremendous confidence from this experience. In fact, several of them are already thinking about continuing with graduate education so they can move into faculty positions.

II-D. The chief nurse administrator is academically and experientially qualified and is vested with the authority required to accomplish the mission, goals, and

expected outcomes. The chief nurse administrator provides effective leadership to the nursing unit in achieving its mission, goals, and expected outcomes.

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Master’s: No

Rationale:

The dean is academically and experientially qualified to serve in this position. She joined USF in June of 2006, and, although in this role a short time, she is recognized for her leadership, vision, and collaborative style. The president and provost spoke of her contributions with enthusiasm, as did faculty and staff in the SON. She was described as energetic, enthusiastic, collaborative, as well as a champion of the SON and the

profession of nursing. The CNOs and directors of education reported that she visited with them to learn their perspectives on the SON and to obtain their input and support even prior to assuming the role of dean. Their support for her innovative leadership was abundantly clear during the visit with the evaluation team.

Academically, the dean is superbly qualified to lead the SON. She holds a BSN from the University of Iowa, MSN from Rutgers, MS in psychology from the University of

Massachusetts, and a PhD in psychology from New Mexico State University. Review of her curriculum vitae confirmed numerous publications in peer-reviewed journals, as well as a plethora of professional presentations. Additionally, she was well-funded for

research projects in prior years.

Review of the dean’s curriculum vitae also confirmed her strong academic leadership background. She served for four years as chief academic officer of the Department of Nursing at New Mexico State University, followed by six years of service as associate dean for academic affairs in the College of Nursing at the University of South Florida. She is a proven leader with demonstrated expertise in curriculum development,

innovative program development, and leadership. She has been building on this strong foundation during her first two years as dean at USF, and has effectively led her team to implement a new DNP degree program and to reshape the master’s programs to follow national trends with adoption of the clinical nurse leader.

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II-E. Faculty members are academically and experientially qualified and sufficient in number to accomplish the mission, goals, and expected outcomes of the program.

Master’s: No

Rationale:

Faculty teaching theory and clinical courses are educationally and experientially prepared in the relevant nursing specialties. There are 28 full-time faculty and 52 part-time faculty in the SON, as well as a full-part-time, 12-month coordinator for the Learning Resource and Simulation Center. When calculated on an FTE basis, this translates into 50 FTEs in the SON, with 32.5 devoted to undergraduate education and 17.5 to

graduate education. Review of the curricula vitae of the faculty in the SON confirmed that all full-time faculty members have a minimum of a master’s degree in nursing, with 21 of the faculty members (75 percent) possessing earned doctorates. Six faculty members are enrolled in doctoral study.

All full-time faculty members are contracted for 15 work units per semester; three of these work units are devoted to service, committee work, and professional activities. In addition, tenured or tenure earning faculty are awarded three units for research release time. Thus, tenured and tenure earning faculty are assigned nine work units each semester. On-site review of the policy for workload assignment, as well as examination of the teaching assignments for each faculty member, confirmed both the intent and the implementation of this strategy for assignment of workload.

Faculty salaries at USF are competitive with regional AACN salary comparisons, with the USF median salary for instructors, assistant professors, associate professors, and professors consistently exceeding the 75th_{percentile. However, the salaries are not} competitive with the service sector, where new graduates are earning $80,000 to $90,000. University administration, including the president and provost are aware of this discrepancy and are contemplating solutions for more competitive professions, such as nursing, computer science, accounting, and business.

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II-F. The faculty roles in teaching, scholarship, service, and practice are identified clearly and are congruent with the mission, goals, and expected outcomes of the program.

Master’s: No

Rationale:

Review of the nursing faculty roles and responsibilities, set forth in the SON faculty handbook, demonstrated that they are clearly identified and congruent with the mission, goals, and expected outcomes of the program. Annually, each full-time faculty member meets with the dean to review accomplishments and goals related to teaching,

scholarship, service, and practice. Both faculty and the dean expressed satisfaction with this comprehensive process. It is described as a collaborative process, which forms the basis for faculty preparation for tenure and promotion. Faculty confirmed that their goals are congruent with the mission and goals of the university and the SON.

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STANDARD III. PROGRAM QUALITY:

CURRICULUM AND TEACHING-LEARNING PRACTICES

The curriculum is developed in accordance with the mission, goals, and expected outcomes of the program and reflects professional nursing standards and

guidelines and the needs and expectations of the community of interest. There is congruence between teaching-learning experiences and expected outcomes. The environment for teaching, learning and evaluation of student performance fosters achievement of the expected outcomes.

This standard is met for the baccalaureate program. This standard is met for the master’s program.

III-A. The curriculum is developed, implemented, and revised to reflect clear statements of expected student learning outcomes that are consistent with professional nursing standards and guidelines and congruent with the program’s mission, goals, and expected outcomes.

Master’s: No

Rationale:

The learning outcomes articulated by the SON for both the baccalaureate and master’s programs provide clear statements of expected results and are derived from the

program’s vision, mission, and values. Initially, there was some confusion regarding the baccalaureate program learning outcomes, as the self-study documents presented BSN program goals for the new baccalaureate curriculum that is currently under development; however the undergraduate student handbook (accessed through a blackboard on-line Website) and the materials in the resource room contained learning outcomes and expected behaviors for the BSN program currently offered.

The MSN curriculum has recently undergone several changes. The master’s specialty program was reconfigured as a Doctorate of Nursing Practice (DNP) program with two tracks; the “direct care track and an “indirect track.” The MSN track for the Family Nurse

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Practitioner (FNP) graduated its last student in December 2006, and the Healthcare Systems Leadership (HCSL) track (master’s entry option students) admitted its last class in May 2007. The last cohort of these students will complete the MSN program in

December of 2009. Students in these two tracks are admitted to the DNP program. The joint degree programs (MSN/MPA and MSN/MSIS) have been phased out, and faculty are considering developing an option for DNP students with a HCSL (indirect) focus to obtain a DNP/MPA or DNP/MSIS); however this option is not available at this time.

The generalist CNL master’s has replaced the specialty master’s tracks. The CNL program was developed in 2005 in accord with AACN CNL guidelines. There are four options for entry into the CNL program: 1) MSN for registered nurses with a BSN (BSN-CNL); 2) MSN for registered nurses with a baccalaureate degree in another discipline (RN+BS-CNL); 3) MSN for registered nurses without a bachelor’s degree (RN-CNL Accelerated option); and 4) MSN for the Non-Nurse-CNL. The program plans and credit requirements are found in Appendix P.

Students in the HCSL track take pre-licensure courses with basic baccalaureate students and take their NCLEX-RN exam prior to completing the MSN. As this track is phased out, the only one available in the MSN program at USF is the CNL track. Students in the CNL track do not take undergraduate pre-licensure courses; the knowledge and skill expectations are integrated into graduate CNL courses. These students do not take the NCLEX-RN licensing exam until they graduate from the MSN program. RNs with a BSN, a BS/BA degree in another field or RNs with an associated degree are all eligible for entry to the CNL master’s option.

Courses in the curriculum for both the baccalaureate and master’s programs are

consistent with stated program goals and learning outcomes. Course syllabi (available in the resource room and on the on-line Blackboard Website) provided evidence of the integration of mission, philosophy, program goals, and objectives. In the group interview and in the clinical setting, students articulated the integration of the university’s and the SON’s mission and philosophy in their learning experiences. There was evidence that identified professional nursing standards and guidelines are incorporated in the process of curriculum development and include AACN’s Baccalaureate and Master’s Essentials, the American Nurses Credentialing Center (ANCC)’s Guidelines for the CNL, the Council

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on Graduate Education of Administration in Nursing’s (CGEAN) guidelines, and ANCC’s Guidelines for Advanced Nursing Administration. The BSN program plans to incorporate Quality and Safety Competencies as outlined by the Quality and Safety in Nursing (QSEN) initiatives in its new curriculum.

III-B. The curriculum is developed, implemented, and revised to reflect

professional nursing standards and guidelines. These standards and guidelines are clearly evident within the curriculum structure and expected learning

outcomes. Course/unit/level outcomes are consistent with the roles for which the program is preparing its graduates.

1. The baccalaureate curriculum incorporates knowledge and skills identified in The Essentials of Baccalaureate Education for Professional Nursing Practice (AACN, 1998).

Compliance Concerns? Baccalaureate: No

Rationale:

The incorporation of professional nursing standards and guidelines in the baccalaureate nursing curriculum was evident in review of the program goals and outcomes and individual course syllabi (accessed on the Blackboard site on-line). Professional standards include The Baccalaureate Essentials and the standards established by the California Board of Registered Nursing.

For example, critical thinking is a core competency taught in many of the undergraduate courses, including conceptual foundations for professional practice (232), nursing research (323), and all of the clinical lab courses. Technical skills, assessment, and communication are core concepts in the family health courses (331, 341), nursing

therapeutics (430), assessment of human responses courses (240, 241), and the clinical lab courses (250, 251, 350, 351). Health promotion, risk reduction, and disease

prevention are core to the concepts taught in the community nursing course and practicum (505, 506). The core curriculum of the university includes requirement in the areas of communication, cultural diversity, ethics, and service learning.

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2. The master’s curriculum incorporates knowledge and skills identified in The

Essentials of Master’s Education for Advanced Practice Nursing (AACN, 1996).

Any specialty standards adopted for the master’s program are incorporated into the curriculum. In addition, nurse practitioner program curricula demonstrate implementation of the Criteria for Evaluation of Nurse Practitioner Programs (NTF, 2002).

Compliance Concern? Master’s No

Rationale:

Review of the self-study document, the graduate catalog, individual course syllabi and the minutes of the Curriculum Committee provided evidence of the incorporation of knowledge and skills identified in The Master’s Essentials into the master’s curriculum. There is intended overlap in the master’s level standards used in the CNL program. AACN Baccalaureate Essentials and Master’s Essentials are incorporated into this curriculum, along with CNL core competencies articulated within the Essentials documents. Similarly, the CGEAN guidelines, and ANCC’s Guidelines for Advanced Nursing Administration guide the HCSL track in the master’s program, which currently is being phased out.

Graduate core curricular content from the Master’s Essentials is found in the following CNL courses: research (634), healthcare systems leadership (614), financial resource management (629), healthcare policy and ethics (648), introduction to the CNL role (613), disease management and secondary prevention (626). Human diversity and social issues are woven into all clinical courses in the curriculum.

III-C. The curriculum is logically structured to meet expected program outcomes.

1. The baccalaureate curriculum builds upon a foundation of the arts, sciences, and humanities.

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Rationale:

The self-study document, undergraduate catalog, and on-site materials reflected a baccalaureate curriculum that builds on the arts, sciences, and humanities in alignment with the core curriculum of the university. The nursing curriculum was planned to guide students through the learning process from a simple to complex approach over the four years. The USF Learning Core consists of 11 courses in six areas that embody the Jesuit tradition. In addition to completing the core courses, undergraduate students must complete two courses that integrate service learning and cultural diversity. These

requirements can be fulfilled within the nursing curriculum or by taking elective courses. Special immersion program opportunities are available that allow students to meet the service learning and cultural diversity requirements and include the Erasmus Project (enrichment project that brings together students from the SON, business &

management, and arts & sciences), Guatemala Immersion Program, and the Belize & Emerging Immersion Program.

2. The master’s curriculum builds on the baccalaureate level foundation.

Compliance Concern? Master’s: No

Rationale:

The MSN curricula are designed to build on basic baccalaureate nursing competencies. The various entry options into the MSN program achieve this differently. For example, for the master’s entry level students (students with a non-nursing baccalaureate degree) in either the HCSL (currently being phased out) or CNL track, the coursework prepares the graduate to integrate pre-licensure knowledge and skills with those required to meet the MSN program outcomes. Students in the HCSL track take pre-licensure courses with basic baccalaureate students and take their NCLEX-RN prior to completing the MSN. Students in the CNL track do not take undergraduate pre-licensure courses; the knowledge and skill expectations are integrated into graduate CNL courses. These students do not take the NCLEX-RN until they graduate from the MSN program. RN’s with a BSN, a BS/BA degree in another field or RNs with an associate degree are all able to gain entry to the CNL master’s option.

III-D. Curriculum and teaching-learning practices are evaluated at regularly scheduled intervals to foster ongoing improvement.

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Master’s: No

Rationale:

The MSN and BSN curricula are regularly evaluated using an array of information sources. Students complete course and clinical evaluations each semester. Results are shared with faculty who individually prepare summaries with a response plan and share these at departmental meetings. Review of monthly departmental meeting minutes provided evidence that curricular review occurs regularly. At monthly Curriculum Committee meetings, faculty representatives from each department and student representatives review ongoing curriculum issues including analysis of current nursing and healthcare issues, feedback from clinical facilities and communities of interest, and university initiatives. A modification in teaching-learning practices resulting from this process includes the change from on-line to paper journals as recommended by

students. At the departmental level, a change in exam schedules so that multiple exams were not given on the same day resulted from discussions at a departmental meeting. During a meeting with the community of interest representatives, the group provided several examples of their input into the CNL curriculum as it was developed and implemented.

In addition, the Curriculum Committee takes a proactive stance as part of the continuous quality improvement process. Examples of initiatives resulting from this process include development of the CNL program in 2005; the DNP program in 2006, and the current BSN curriculum revision underway to include the emerging revision of The

Baccalaureate Essentials and the QSEN competencies.

III-E. The didactic and clinical teaching-learning practices and learning environments support the achievement of student learning outcomes.

Master’s: No

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The curriculum is organized with didactic and clinical teaching-learning practices and related learning environments to support achievement of student learning outcomes. Nursing faculty employ a variety of teaching practices to capture the learning needs of contemporary students. Students participate in class discussions with clickers, power point presentations, live demonstrations, small group presentations, pod casts, quizzes and tests. Classroom visits by the evaluation team verified these findings. The HESI exam is used to not only test knowledge, but to reinforce test taking strategies with students to better prepare them for the NCLEX-RN exam.

The SON uses simulated clinical cases to supplement clinical experiences for pre-licensure students. The SON houses its simulation lab in St. Mary’s hospital (across from the university). For example, in pediatric nursing, in addition to inpatient clinical experiences, students complete four simulated cases. These cases involve complex patient care situations (well child, asthma, spina bifida, and leukemia). A formal process guides the simulations and requires specific student responsibilities. Objectives for each case have been developed, and students are tested on their knowledge and skill. This method has added to the richness of clinical experiences for students.

Clinical placements for the CNL students have been based on the academic-practice partnership model. Hospital partners include Kaiser, UCSF, Stanford, San Francisco General Hospital, and Seton Hospital. Students must complete a 300 hour

internship in the CNL role. Post-licensure clinical placements for the HCSL MSN (currently being phased out) students are extremely diverse, including inpatient, clinic, community, and corporate settings. Students must complete 240 hours in role

development and implementation practica.

III-F. The curriculum and teaching-learning practices consider the needs and expectations of the identified community of interest.

Master’s: No

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Input is sought from the community of interest in the development and improvement of the curriculum and the teaching-learning environment. This is obtained through the SON advisory committee, dean’s circle, and informal communications with clinical partners. In the San Francisco Bay area, there is a centralized clinical placement system to secure clinical placements for students. This was developed to enhance the quality of nursing education and improve patient care by streamlining the process of matching clinical site availability with various schools of nursing and student needs. The associate dean for USF SON chairs this group.

Another example of the SON responding to the needs of the communities of interest is the partnering of clinical facilities and the SON. One of the partners, St. Mary’s Hospital expressed concerns regarding their inability to successfully hire new graduates and the impact of so many new students constantly receiving orientation at the hospital. As a result, the SON launched the Innovation Initiative (II) in 2007. The premise of II was, instead of students moving from one facility to another to have wide “breadth” clinical experiences and be exposed to numerous health care systems, they would have a “depth” experience in which they would choose one facility and remain there for the bulk of their clinical work. The goal is that the students would have an opportunity to develop an identity and relationship with the staff and to understand the climate. In addition, the II uses a “nurse” verses “patient” focus. In this model, the student is assigned to a nurse rather than to a patient and is expected to take on mastery of a nursing skill set that is identified in relation to the professional role, rather than a focus on the patient’s

individual nursing needs. Two cohorts of students started at St. Mary’s and in response to student feedback and agency interest, a third cohort has been started Kaiser, San Francisco. Preliminary results of the impact of the II demonstrated that participating students rate the nursing staff significantly more positively than students in a traditional clinical practicum group.

Other examples of the SON’s responding to the needs of the communities of interest are the development of the CNL and DNP programs. In 2005, the SON along with the Moore Foundation and practice partners in the Bay Area worked to develop the CNL program. In 2006, the DNP program was developed based on input from the community. The team interviewed representatives of the community of interest, including students, alumni, and employers who verified these findings. Clinical agency representatives

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shared multiple examples of their involvement into the development of new programs (CNL and DNP) and review and revision of nursing curricula.

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STANDARD IV. PROGRAM EFFECTIVENESS: STUDENT PERFORMANCE AND FACULTY ACCOMPLISHMENTS

The program is effective in fulfilling its mission, goals, and expected outcomes. Actual student learning outcomes are consistent with the mission, goals, and expected outcomes of the program. Alumni satisfaction and the accomplishments of graduates of the program attest to the effectiveness of the program. Actual faculty outcomes are consistent with the mission, goals, and expected outcomes of the program. Data on program effectiveness are used to foster ongoing

improvement.

IV-A. Student performance is evaluated by the faculty and reflects achievement of expected outcomes. Evaluation policies and procedures are defined and

consistently applied.

Master’s: No

Rationale:

The SON has a School of Nursing Evaluation Plan that is intended to provide a

systematic evaluation of program quality as supported by student performance. Faculty consistently evaluate student performance, and these evaluations reflected achievement of expected outcomes. The evaluation policies and procedures are listed in each course syllabus as well as the SON student handbooks-BSN and MSN. The SON faculty developed the criteria used in the student evaluations. It is reviewed and revised on an ongoing basis by the SON Program Evaluation Committee. Students are able to obtain course syllabi from the university bookstore or on-line via Blackboard.

Evaluation of student performance is completed using a variety of instruments and measures. These include course-specific examinations developed by the faculty, written and oral group and individual presentations, papers, posters, computerized

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comprehensive tests, and clinical performance. HESI specialty exams are used in some courses. The SON has been using the comprehensive HESI exam since 2000. As a result of feedback from students and faculty regarding the helpfulness of standardized testing, several faculty have included the specialty exams in course expectations, and the scores are configured as a portion of students’ grades.

Grading policies and scales for both the undergraduate and graduate programs were found in the SON student handbook. University grading policies were found in the USF catalog and the student handbook. SON students earn a letter grade in all theory courses. Clinical courses are graded as Satisfactory or Unsatisfactory. If a student is unable to achieve a “B” or better or an “S” on the second attempt in a theory or clinical course, the student is disqualified from the nursing program. In order to remain in “good standing” at USF, graduate students must maintain a 3.0 GPA on a 4.0 scale and must earn a grade of “B” or better in each nursing course.

The SON has set a goal for demonstration of student mastery of content that is measured in N481 and N647. The goal is for 100 percent of students to successfully pass these courses the first time they are taken. The goal hasn’t been achieved yet, but the SON has implemented new strategies designed to help students be successful in this endeavor. Examples of these strategies include: review of profile of incoming students to the SON, enforcement of academic progression policies, and adding more value to exams and less value to homework assignments.

Academic Difficulty Forms (ADF) are used when a faculty member identifies that a nursing student is experiencing difficulty with meeting the expectations of the course. The faculty member and student meet to review the form, explore options, and come to an agreement on an action plan for improvement.

IV-B. Surveys and other data sources are used to collect information about student, alumni, and employer satisfaction and demonstrated achievements of graduates. Student outcome data include, but are not limited to, graduation rates, NCLEX-RN® pass rates, certification examination pass rates, and job placement rates, as appropriate.

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Master’s: No

Rationale:

The SON Program Evaluation Committee is responsible for review of the Educational Benchmark Instrument (EBI) graduating student survey, theory course evaluations, a survey of course learning activities, HESI exam results, clinical course evaluations, the employer assessment project, the alumni assessment project, and the overall SON Evaluation Plan. They make reports on the findings to the appropriate group. The SON Evaluation Plan was recently reviewed and revised to better reflect the CCNE guidelines for accreditation.

USF alumni surveys were most recently conducted on-line during the spring of 2007. Nursing graduates comprised 8.5 percent of the total responses. Overall, 95.8 percent of alumni from the SON indicated they would “recommend USF to others” and 97 percent reported they were satisfied with “academic coursework experience while at USF.” In regard to “meeting mission”, 97 percent of SON graduates reported they were skilled in assisting the underserved and marginalized population, and 100 percent indicated they felt that they can contribute positively and act ethically, being a “person for others.”

The SON administered an alumni survey on-line for BSN and MSN graduates during Fall 2007. The surveys were based upon specific program outcomes, employment

information, and professional/academic plans and accomplishments. A total of 39 graduate and 60 undergraduate alumni replied to the survey. Overall, the respondents reported that the MSN program prepared them “extremely well” or “very well” to fulfill the stated learning outcomes of the program. The majority of the BSN respondents reported that they were “very satisfied” with the BSN program in preparing them to fulfill the stated learning outcomes of the program. Both BSN and MSN respondents reported lower satisfaction rates with the advising process, bookstore, financial aid office, and the registrar’s office. These findings were also reported by SON students during meetings with the CCNE evaluation team. These findings led to the creation of the “One Stop Office” by Academic Services—this allows students to go to one person in one

designated place for all their registrar, financial aid, and admission questions. The SON responded to these concerns additionally by creating a Nursing Student Portal on the

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USF SON computer Website. The portal contains information on all SON scholarships and financial aid. In addition, the associate dean developed a “Faculty Advising Handbook” and holds workshops for faculty members each semester in order to

standardize information given to students and to clarify expectations for faculty. A SON Advising Task Force has also been developed to explore the issues that contribute to satisfaction and dissatisfaction with the advising process.

The EBI graduating nursing student survey is administered to all students who are completing their coursework. It provides student perceptions of their experience and allows the SON to benchmark with other schools. The most recent response rate was 62 percent. The results show that the overall SON program effectiveness was “good to excellent”. The lowest rated items relating to satisfaction were with tuition level and financial aid. These concerns are currently being addressed at the provost level. The most recent data available showed that the six-year graduation rate for SON undergraduate students is 71.4 percent and 97.5 percent for graduate students.

The NCLEX-RN pass rates for the SON are consistently high. Between the years 2003-2007, the pass rate ranged between 93.06-96.85 percent with an increase yearly since 2004.

The most recent certification pass rates were 100 percent for the ANCC FNP exam and 74 percent for the AACN CNL exam.

Job placement rates remain high in the San Francisco area for USF students. The average starting salary is $85,000 for a new BSN graduate. Employment patterns obtained in a recent alumni survey showed 81 percent of BSN respondents and 53 percent of MSN respondents are working in hospital settings.

A meeting was held with nursing executives and representatives from the area hospitals that provide clinical settings for USF SON students. There was 100 percent agreement that USF SON students are “a cut above”, “demonstrate compassion and

professionalism,” and all in attendance said they hire USF SON graduates consistently and are very pleased with their performance.

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IV-C. Program outcome data are analyzed to provide evidence of program effectiveness and are used to foster ongoing program improvement.

Master’s: No

Rationale:

The SON Evaluation Plan was developed in 2007 and is used to provide an outline for monitoring and enhancing program effectiveness. Key data for analysis are identified, and a mechanism for data collection has been implemented. Follow-up steps are activated as needed that indicate who is responsible and the time frame available. Actions for improvement can be implemented by an individual or at the department level. A recommendation that will affect the entire SON or the curricula is referred to the

appropriate standing committee for review and recommendation to the full faculty. Follow-through is then done via an assessment of impact.

The Program Evaluation Committee reviews the data from the alumni, graduating

student, and employer surveys. The committee reports on the findings to the appropriate group. Findings related to student advising were discussed in the Program Evaluation Committee, and recommendations were made to the Administrative Council for action by the dean, associate dean and director of student affairs. This process is discussed in detail in Element IV-B.

Employment rates are reported to funding agencies and used as input for students, faculty and Bay area employers.

Students complete course evaluations at the end of each course. The course faculty member prepares a written summary that is reviewed at department meetings. If needed, a planned response is then developed. The course evaluations have recently been moved from paper/pencil to on-line. Faculty reported some concern with response rates since the switch occurred. An example of an ongoing program improvement was found from a response to a course evaluation. In N450, a community/mental health clinical course, students indicated they needed additional help in connecting didactic material to their clinical setting. The Community/Psych Department responded by

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presenting case studies to students via Blackboard to all clinical sections. Students mentioned during a meeting with the evaluation team that they found the faculty to be very responsive to their course evaluations and suggestions.

There is ongoing evaluation of data regarding clinical placements. The data are reviewed at the department level. Proactive discussion within the context of QSEN guidelines and concerns about patient safety led the SON faculty to implement three standardized risk reduction simulations for all sophomore II students.

IV-D. Faculty outcomes demonstrate achievement of the program’s mission, goals, and expected outcomes and enhance program quality and effectiveness.

Master’s: No

Rationale:

SON faculty outcomes in teaching, scholarship, service, and practice clearly demonstrated achievement of the USF and SON mission, goals, and expected

outcomes and contribute to the enhancement of program quality and effectiveness of the SON programs. Since 2005, the SON faculty have published three books, four book chapters, and over 54 articles/manuscripts in journals and have been awarded more than 1.4 million dollars in grant funding. Also, faculty have made multiple presentations both nationally and internationally.

Many faculty are certified nationally in a specialty and maintain an active nurse practitioner or nurse-midwife practice. Part-time faculty are not required to have a master’s degree. The minimum educational requirement for teaching at the SON is a BSN degree.

SON faculty actively participate in school, university, and professional service. Service is a major part of the USF mission and vision. Nine faculty members are reviewers for professional journals, and several hold local, regional, and national office in professional organizations. The dean is also very active in service. She co-chairs the Academic-Practice Partnership sub-committee for the state-wide BIMNI Thought Leaders Initiative;

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she is the vice president of the local chapter of the Association of California Nurse Executives; and represented the SON in a hosted international nursing visit to China. A number of faculty developed “immersion service learning programs” for their students. Most recently, they took students to Belize and Guatemala.

Students evaluate faculty teaching after every course using paper/pencil method.

Summary evaluations of nursing faculty are consistently within the range of mean scores for USF units and national norms. Evaluation ratings figure in the Academic Career Prospectus (ACP), which is the evaluation process and planning mechanism for faculty. The ACP provides an opportunity for faculty to discuss their contributions in the areas of teaching, research, practice and service with the dean and to collaboratively develop an academic agenda for the upcoming year. The dean does all faculty evaluations on an annual basis. Faculty who receive low scores on their evaluations are asked to do a self-assessment regarding which classes and which students are involved, and what factors may be contributing to the scores. Plans are made with the dean to address and follow-up the findings with future evaluation results and potential mid-term evaluations, peer coaching, and/or referral to a master teacher.

SON faculty have been awarded teaching excellence awards and recognized at the university and regional level for innovation and high quality instruction.

IV-E. The program has established policies and procedures by which it defines and reviews formal complaints; analyses of aggregate data regarding formal complaints are used to foster ongoing program improvement.

Master’s: No

Rationale:

The SON has policies and procedures regarding formal complaints, and these are listed in the USF general catalog 2007-2009, pgs.55-64. The policies include Institutional Policy on Freedom of Expression, Student Academic Honesty Policy, Appeal Process of Change of Course Grade, Non-Academic Student Conduct and Disciplinary Procedures, Drug-Free Policy, Administrative Guidelines on HIV Disease, Privacy of Student

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Records, and Prevention of Sexual and Other Unlawful Harassment Policy. Each of these policies is clearly defined, and the process for making a formal complaint is comprehensively detailed. At any stage of a formal complaint, either the faculty or the student may invite the university ombudsperson to help facilitate an agreement.

As a university executive officer, the SON dean is responsible to report any formal complaint to the appropriate office including the Office of General Counsel.

In 2002, a student filed a complaint against a faculty member regarding a grade change. No other complaints or suits have occurred since that incident. Detailed analysis of this incident was done. Subsequently, ongoing program improvement in several areas resulted: clearly understanding the importance of well-kept notes regarding decisions relating to student actions, and assuring that written expectations for students remain consistent.