FOCUSED VISIT REPORT Fortis College - Centerville

Centerville, Ohio Program Type: Associate Purpose of Visit: Focused Visit Date of Visit: March 12, 2013 GENERAL INFORMATION

Nursing Education Unit School of Nursing 555 East Alex-Bell Road Centerville, OH 45459

Governing Organization Fortis College - Centerville 555 East Alex-Bell Road Centerville, OH 45459

Nurse Administrator Terri Harville, MSN, MS, RN Dean of Nursing Telephone: (937) 433-3410 Fax: (937) 435-6516 E-mail: tharville@fortiscollege.edu

Chief Executive Office Richard S. Rucker, PhD Campus President Telephone: (937) 433-3410 Fax: (937) 435-6516 Email: rrucker@fortiscollege.edu

State Board of Nursing Approval Status Agency: Ohio Board of Nursing Last Review: July 26, 2011 Outcome: Full Approval Next Review: November 2016

Accreditation Status (Program) Agency: NLNAC Last Review: Fall 2011 Outcome: Continuing Accreditation with

Warning Next Review: Spring 2014

Accreditation Status (Governing Organization) Agency: Accrediting Commission of Career

Schools and Colleges (ACCSC) Last Review: May 2008 Outcome: Continuing Accreditation Next Review: May 2013

Fortis College - Centerville Associate 2 SITE VISIT INFORMATION I. INTRODUCTION Focused Visit Team: Chairperson Sharon J. Tanner, EdD, MSN, RN Chief Executive Officer National League for Nursing Accrediting Commission 3343 Peachtree Road NE, Suite 850 Atlanta, GA 30326 Telephone: (404) 975-5000 Fax: (404) 975-5020 E-mail: sjtanner@nlnac.org

Member Cordia Starling, EdD, MS, RN Associate Director National League for Nursing Accrediting Commission 3343 Peachtree Road NE, Suite 850 Atlanta, GA 30326 Telephone: (404) 975-5000 Fax: (404) 975-5020 E-mail: cstarling@nlnac.org

NLNAC Criteria Used: 2008 Program Demographics: Year nursing program established: 2005 Faculty: Number of faculty teaching full-time in the associate program: 11Number of faculty teaching part-time in the associate program: 6 Students: Total enrollment: 304Full-time: 270Part-time: 34 Length of program: Generic: 106 quarter credit hours; eight (8) quarters Additional program options/tracks: LPN to RN Additional locations: No additional locations Interviews: Individual Conferences Terri Harville, MSN, MS, RN, Dean of Nursing Group Conferences College Administrators Richard Rucker, PhD, Campus President Claude Smith, MS, Director of Education

Fortis College - Centerville Associate 3 Student Services Lynda Lindsey, BA, Director of Financial Aid Stephanie Rostron, MLIS, Manager of LRC Robert Laheta, BS, Director of Career Services Char Moderwell, RN, Student Mentor Fernando Smith, MBA, Director of IT Sean Kuhn, BA, Director of Admissions Faculty Linda Francis, MSN, RN, SIM and Lab Coordinator Amanda Fox, MSN, RN, NP Jeannette Gains, MSN/MHA, RN Karen Hartman, MSN, RN, CRRN Lena Jackson, MSN, RN Fran Koubek, MSN, RN, CHPN Cynthia Mangen, MSN, RN, LNC Rosalee Montes, MSN, RN Benita Woodegeard, MSN, RN Students Meeting 1, n=8 Meeting 2, n=23 Documents Reviewed: Catalogs, Handbooks, Manuals College Catalog, 2013 Faculty Handbook, 2013 Education Affiliations Employee Handbook, July 2012 Student Handbook, 2013 External Constituencies State Board of Nursing Report and Approval Letter State Board Report on Licensure Exam Pass Rates Nursing/Governing Organization Documents NLNAC Self-Study Report, Site Visitors’ Report, Follow-up Report Systemic Evaluation Plan with trended data and related documentation Budget and fiscal reports Information/documentation in support of expansion of simulation laboratory Student Files Faculty Records Written Clinical Agreements Faculty Policies Student Policies Listing of all available learning resources available to students Program of study term-by-term listing all courses including pre-requisites, contact hours, and credits Current Faculty Profile Number of full-and part-time students by cohort Fortis College School of Nursing Constitution and Bylaws, revised January 2013 List of Student Services Default Rates Records for Title IV Programs Student Financial Aid Records

Fortis College - Centerville Associate 4 Nursing Unit Minutes Faculty Meeting minutes, 2010-present Curriculum Committee Meeting minutes (local, regional, national), 2010-present Advisory Board Meeting minutes, 2010-present Admissions Committee Meeting minutes, 2010-present Simulation Committee Meeting minutes, 2010-present Course Materials Syllabi and instructional materials Program materials-class schedules, course syllabi, and clinical schedules Evaluation tools

Fortis College - Centerville Associate 5 II. EVALUATION OF THE STANDARDS AND CRITERIA STANDARD 1 Mission and Administrative Capacity The nursing education unit’s mission reflects the governing organization’s core values and is congruent with its strategic goals and objectives. The governing organization and program have administrative capacity resulting in effective delivery of the nursing program and achievement of identified outcomes.

1.1 The mission/philosophy and outcomes of the nursing education unit are congruent with those of the governing organization.

1.2 The governing organization and nursing education unit ensure representation of students, faculty, and administrators in ongoing governance activities.

1.3 Communities of interest have input into program processes and decision-making.

1.4 Partnerships exist that promote excellence in nursing education, enhance the profession, and benefit the community.

1.5 The nursing education unit is administered by a nurse who holds a graduate degree with a major in nursing.

1.6 The nurse administrator has authority and responsibility for the development and administration of the program and has adequate time and resources to fulfill the role responsibilities.

1.7 With faculty input, the nurse administrator has the authority to prepare and administer the program budget and advocates for equity within the unit and among other units of the governing organization.

1.8 Policies of the nursing education unit are comprehensive, provide for the welfare of faculty and staff, and are consistent with those of the governing organization; differences are justified by the goals and outcomes of the nursing education unit.

1.9 Records reflect that program complaints and grievances receive due process and include evidence of resolution.

For nursing education units engaged in distance education, the additional criterion is applicable: 1.10 Distance education, as defined by the nursing education unit, is congruent with the mission of

the governing organization and the mission/philosophy of the nursing education unit. Commentary: A Focused Visit was conducted at Fortis College - Centerville (FCC) as a result of a planned substantive change that was not reported to the NLNAC in accordance with Policy #14 Reporting Substantive Changes. The change involved the addition of a generic entry option to the associate nursing program. The generic track began in July 2012; the first cohort of students started in the general education sequence of courses in October 2012. The program also converted from the semester to quarter system with the curriculum change. The program had been reviewed and accredited as an LPN-RN mobility (only) program and is currently on warning with the NLNAC following a Fall 2011 Cycle visit and findings of non-compliance with Standard 2 Faculty and Staff, Standard 4 Curriculum, and Standard 6 Outcomes. The next scheduled site visit is Spring 2014.

Fortis College - Centerville Associate 6 The mission, philosophy, and outcomes of the nursing education unit are congruent with the mission and philosophy of the governing organization. The College seeks to provide postsecondary career education to traditional and nontraditional students to enhance career opportunities and contribute to the economic growth and social well-being of the area. The associate nursing program helps to fulfill the College mission by providing an educational option that leads to employment and career opportunities for area residents and serves the healthcare needs of the community. Components of the College’s goals are integrated into the student learning outcomes (SLOs) of the program. Interviews with students and faculty revealed that representation in the governance activities of the College is limited. The faculty reported that they do not serve on College committees, and no structure for faculty involvement in governance could be identified by the nursing faculty members. Students are not active on any College committees and could not identify opportunities for involvement in student governance. The opportunity for student participation in governance activities of the nursing program was evident in a review of faculty meeting minutes. The Nursing Student Handbook (2013) also stipulates student representation on the Nursing Curriculum Committee and the Student Advisory Committee. The program has also taken steps to begin a Student Nursing Association on campus. The President confirmed in interview that the Dean of Nursing’s input is sought in the decision-making of the College especially regarding the nursing program. A Nursing Advisory Board exists that consists mainly of representatives from the clinical facilities utilized by the program. Nursing and general education faculty members, student services representatives, and local and regional College administrators were noted in the minutes as attendees at the meetings. Documentation of meetings occurring from one (1) to three (3) times per year was also verified via Board minutes. The minutes reflected the sharing of program information with the Board and requests for input into the program from the Board members. There were no partnerships identified by College administrators, the nurse administrator, faculty, or students to promote excellence in nursing, enhance the profession, and benefit the community. The School of Nursing is administered by a master’s-prepared nurse who has held the position of Dean of Nursing since October 2012. The nurse administrator served as Regional Dean of Nursing for Education Affiliates-Ohio for two (2) years previous to her appointment as Dean of Nursing at Fortis College - Centerville. The Dean has been affiliated with the nursing programs of the College since 2006. She began as an instructor and clinical coordinator and later became the Director and administrator of the practical nursing program. She has also had clinical experience as a staff nurse and director/manager. Authority and responsibility for the development and administration of the program was verified upon interview with the Dean and College President. Administrative and management responsibilities for the nursing education unit are designated the Dean’s job description. The Dean has no teaching workload and is supported by a Practical Nursing Program Director and an RN-BSN Program Director. Input into and management of the nursing unit budget is a responsibility of the Dean as outlined in the job description. The President confirmed that whatever is requested and needed by the program as communicated by the Dean with input from the faculty is provided. The President spoke of the addition of the new simulation laboratory as an example of input from the Dean and faculty into the budget to meet the nursing student learning needs. The policies of the nursing education unit are commensurate with those of the College as stated in the Fortis College Nursing Faculty Handbook (2013) and the Education Affiliates Employee Handbook (July 2012). The faculty verified upon interview that policies are consistent and provide for the welfare of the faculty and staff. Variances in policies are related to Ohio Board of Nursing licensure, practice requirements, and clinical agency affiliation contract agreements.

Fortis College - Centerville Associate 7 A chain of command policy for communications is outlined for students in the Fortis College Student Handbook (2013) should there be student complaints or grievances. The Nursing Student Handbook also refers students to the College Catalog for the policy on grade challenges and academic appeals. During interviews, the students confirmed the grievance process and were able to verbalize the steps in the process. No formal student complaints or grievances have been received since the last NLNAC site visit. The program provides no courses via distance education and therefore has no definition of the concept. The program has no course management system or platform to deliver the curriculum in any format other than face-to-face as confirmed by the nurse administrator and faculty. Summary: Compliance: The program is in compliance with the Standard with the following area needing development:

• Ensure faculty and student representation in ongoing governance activities of the College.

Fortis College - Centerville Associate 8 STANDARD 2 Faculty and Staff Qualified faculty and staff provide leadership and support necessary to attain the goals and outcomes of the nursing education unit.

2.1 Full-time faculty are credentialed with a minimum of a master’s degree with a major in nursing and maintain expertise in their areas of responsibility. 2.1.1 The majority of part-time faculty are credentialed with a minimum of a master’s degree

with a major in nursing; the remaining part-time faculty hold a minimum of a baccalaureate degree with a major in nursing.

2.1.2 Rationale is provided for utilization of faculty who do not meet the minimum credential.

2.2 Faculty (full- and part-time) credentials meet governing organization and state requirements.

2.3 Credentials of practice laboratory personnel are commensurate with their level of responsibilities.

2.4 The number and utilization of faculty (full- and part-time) ensure that program outcomes are achieved.

2.5 Faculty (full- and part-time) performance reflects scholarship and evidence-based teaching and clinical practices.

2.6 The number, utilization, and credentials of non-nurse faculty and staff are sufficient to achieve the program goals and outcomes.

2.7 Faculty (full- and part-time) are oriented and mentored in their areas of responsibilities.

2.8 Systematic assessment of faculty (full- and part-time) performance demonstrates competencies that are consistent with program goals and outcomes.

2.9 Non-nurse faculty and staff performance is regularly reviewed in accordance with the policies of the governing organization.

For nursing education units engaged in distance education, the additional criterion is applicable: 2.10 Faculty (full- and part-time) engage in ongoing development and receive support in distance

education modalities including instructional methods and evaluation. Commentary:

Faculty Academic Credentials – (Highest Degree Only)

Number of Faculty

Doctoral Master’s Baccalaureate Associate Other

Nursing Non-

nursing Nursing

Non-nursing

Nursing Non-

nursing Nursing

Non-nursing

Nursing Non-

nursing

Full-Time 11 Part-Time 3 3

Fortis College - Centerville Associate 9 At the time of the onsite review, there were eleven (11) full-time faculty teaching in the nursing program. All of the full-time faculty listed in the faculty profile are credentialed with a minimum of a master’s degree with a major in nursing. Faculty members reportedly attend professional development activities and must accumulate 24 continuing education units every two (2) years to maintain nursing licensure in the state. The College provides webinars for faculty development as well. A few of the faculty members reported attendance at national conferences, and one (1) faculty member stated that she will be going to Rome, Italy, to study cultural aspects of the city. The faculty expressed that their teaching workload occupies much of their time, and several only recently completed their graduate degrees; these factors have been impediments to attendance of workshops, seminars, and other professional development opportunities. The expected level of achievement (ELA) in the systematic plan for evaluation (SPE) related to professional development only requires that 30% of the faculty be involved in scholarly activities. Three (3) of the six (6) part-time/adjunct faculty currently used by the program are master’s-prepared with a major in nursing. One (1) of the three (3) part-time faculty credentialed with the nursing baccalaureate degree is enrolled in a master’s program. One (1) of the master’s prepared part-time faculty members was listed as being on leave at the time of the visit. Review of faculty files verified licensure and credentials. All faculty, both full- and part-time/adjunct, meet governing organization and state requirements for nursing program employment at the time of the visit. It was noted, however, that several of the faculty members upon hire had not met the requirements of two (2) years of active clinical practice as a registered nurse by the Ohio Board of Nursing. According to the nurse administrator, full-time faculty members staff the skills and simulation laboratories. As noted, there are eleven (11) full-time faculty members for the 304 currently enrolled students. Faculty-to-student ratios were reported as approximately 1:35 in the classroom and 1:10 in the laboratory and clinical settings. Nine (9) full-time faculty members currently teach in the didactic and clinical components of the program. The Dean reported that she had very recently hired two (2) additional full-time faculty members who will join the associate program in the near future. According to College policy, the full-time faculty members to spend 24 hours “in front of” students and 16 hours in their offices prepping for class and/or advising students for a 40 hour work week. This requirement was reported to be the same for general education full-time faculty members. Currently, six (6) student cohorts in different program options are being simultaneously taught in order to teach-out those students who were enrolled in the old (LPN mobility only) curriculum and accommodate those in the new (generic) curriculum. At FCC, nursing students are accepted into the program every term. The faculty reported that webinars and inservices provided by the corporate office are held on effective teaching strategies and course management. Teaching is evaluated by the students and is a part of the annual faculty evaluation. Three (3) support staff are utilized by the program to facilitate the effective delivery of the program. One (1) staff member is the registrar, who manages student files; schedules classroom space; assists students with class schedules; files records; and manages transcripts. The other two (2) staff members are an administrative assistant and office manager. The Dean, faculty, and students reported that the staff are essential in providing the services and processes that enable the program to run smoothly. An orientation process specific to nursing was found in the Nursing Faculty Handbook; the process includes assignment to a mentor. The faculty confirmed that they had been oriented and mentored, and several faculty members reported that they had served as mentors to new faculty members. According to

Fortis College - Centerville Associate 10 the faculty, part-time faculty members are oriented to their clinical responsibilities and facilities by the person who coordinates the clinical experiences for a given course. The School of Nursing policy stipulates that faculty members receive a written performance evaluation at least once annually; part-time faculty members are evaluated in the clinical settings through unannounced clinical site visits by the clinical coordinator. Staff are also evaluated annually as specified by the Education Affiliates Employee Handbook. Review of faculty files verified a documented orientation and annual evaluations. Professional development is considered as a component in the evaluation process. Summary: Compliance: The program is in compliance with the Standard with the following areas needing development:

• Ensure the majority of part-time faculty members are credentialed with a minimum of a master’s

degree with a major in nursing. • Ensure the number of full-time faculty is sufficient to achieve program outcomes. • Ensure adequate time and resources for faculty members to pursue professional development

activities to maintain expertise in both classroom and clinical settings.

Fortis College - Centerville Associate 11 STANDARD 3 Students Student policies, development, and services support the goals and outcomes of the nursing education unit.

3.1 Student policies of the nursing education unit are congruent with those of the governing organization, publicly accessible, non-discriminatory, and consistently applied; differences are justified by the goals and outcomes of the nursing education unit.

3.2 Student services are commensurate with the needs of students pursuing or completing the associate program, including those receiving instruction using alternative methods of delivery.

3.3 Student educational and financial records are in compliance with the policies of the governing organization and state and federal guidelines.

3.4 Compliance with the Higher Education Reauthorization Act Title IV eligibility and certification requirements is maintained. 3.4.1 A written, comprehensive student loan repayment program addressing student loan

information, counseling, monitoring, and cooperation with lenders is available.

3.4.2 Students are informed of their ethical responsibilities regarding financial assistance.

3.5 Integrity and consistency exist for all information intended to inform the public, including the program’s accreditation status and NLNAC contact information.

3.6 Changes in policies, procedures, and program information are clearly and consistently communicated to students in a timely manner.

3.7 Orientation to technology is provided and technological support is available to students, including those receiving instruction using alternative methods of delivery.

For nursing education units engaged in distance education, the additional criterion is applicable:

3.8 Information related to technology requirements and policies specific to distance education is

clear, accurate, consistent, and accessible. Commentary: Nursing students follow the same College student policies as all other FCC students. Differences in policies for the nursing students are related to admission, progression, grading, health, background checks, drug screening, certification, uniforms, and confidentiality. The variances are incorporated into the program to aid in student success and adhere to the mandates of clinical affiliate contract agreements. Student policies are publically accessible via the College Catalog and Nursing Student Handbook, non-discriminatory, and consistently applied as confirmed by the students in interviews. Student services such as financial aid, advising, tutoring/mentoring, career counseling, and disability support are available to all students enrolled at the College. These services are readily accessible and located in the same building that houses the program. Students confirmed the use of the services, especially financial aid and tutoring. Of note, the nursing programs have a full-time staff member designated as the student mentor. The mentor stated that she counsels students regarding academic and personal issues. Students reported that the mentor is readily available and has been utilized in many instances when they were having difficulties that impacted their abilities to be successful in the program.

Fortis College - Centerville Associate 12 In interviews, the student mentor confirmed her role as a counselor and reported that she had on several occasions assisted students in finding social and legal services in cases of financial hardships and domestic violence. Other College support services personnel reported that they had referred students other than those in nursing to the mentor as well. The site visitors noted that the mentor is a registered nurse with no counseling credentials. The Director of Financial Aid confirmed that the College is in compliance with the policies of the governing organization and state and federal guidelines regarding financial records and financial aid policies in accordance with the Higher Education Reauthorization Act Title IV. The Director reported that the last financial aid audit was conducted in December 2012, and no irregularities or issues of compliance were found. The students and Director of Financial Aid confirmed that financial aid information is provided upon admission and that counseling and monitoring exists, informing students of the financial aid process and their ethical responsibilities regarding financial assistance. The two-year default rates are 6.4% for FY2012; 9.9% for FY2009; and 6.7% for FY2008. The default rate for three (3) years is 16.6% for FY2009. A random review of eighteen (18) student records representing various cohorts and program options was conducted by the site visitors. The records consistently contained admission testing results; licensure verifications; admission checklists; health records; photo identifications; clinical evaluations; policy acknowledgements and waivers; transcripts; and background check and drug screen results. The records are located in lockable file cabinets in the nursing office, which houses an administrative assistant and the nursing registrar. An issue with the integrity and consistency of information intended to inform the public, particularly regarding the program’s accreditation status, was noted. The current NLNAC accreditation status is not publicly displayed in the College Catalog, the Nursing Student Handbook, or on the College website. Further, the listing of the NLNAC accreditation and contact information in the Nursing Student Handbook, College Catalog, and College website implies that all of the nursing programs provided by the College are NLNAC-accredited programs when, in fact, the LPN-RN transition program is the only accredited program. When asked about the issue related to the misleading information, the College President pointed out that the accreditation information in the Catalog refers to the associate program. However, in other documents, the information is not specific and clearly implies that all nursing programs hold accreditation with the NLNAC. The students and faculty verbalized that changes in policies, procedures, and program information are clearly and consistently communicated to the students in a timely manner. The notification of changes occurs through written documents, which are signed by students and placed in their files acknowledging receipt, and also through classroom announcements. The faculty reported that the curriculum changes were communicated to students in formal classroom announcements/presentations well in advance of the change to the new curriculum implemented in 2012. Orientation to technology is provided mainly by the librarian during classroom orientation to the Learning Resource Center or individually when students are in the library seeking computer assistance. Technical support is available through the Information Technology Department up to 12 hours per day throughout the week. Tech support help desk services are available via a contracted agency to serve student technology needs. Student Meeting: Meetings with students were conducted with two (2) groups of students: one (1) consisting mainly of students admitted to the generic program option (new curriculum) and one (1) consisting of students in the transition program option (old curriculum). Eight (8) students attended the first meeting; all but one (1) student were in the generic option. The students expressed concern about the warning status of the program and the implications for their futures as nurses if they graduate from a non-accredited program.

Fortis College - Centerville Associate 13 Students stated that when admission personnel were questioned about the warning status, they were told, “it was an administrative situation stemming from the previous RETS administration that would be easily resolved and did not affect their programs of study or impact their futures as graduates from the program.” The one (1) student in the transition program attending the student meeting reported that she thought the practical program was accredited based on information from the College. Twenty-three (23) students were in attendance at the second meeting. All attending were transition students slated to graduate in May 2013. All students reported their status as full-time day students. The students raised several questions for the site visitors concerning the warning status of the program. Those with questions asked for clarification of what the accreditation status meant and if the program would be accredited at the time of their graduation. The students expressed overall satisfaction with the program and reported that they chose the College because there was no waitlist for acceptance; lower costs in comparison to similar colleges offering nursing; flexible scheduling; convenient location; and most were familiar with the College as they had attended the practical program at FCC. Summary: Compliance: The program is not in compliance with the Standard as Criterion 3.5 is not met, as evidenced by: • There is a lack of evidence that integrity and consistency exist for all information intended to inform

the public, including the program’s accreditation status. With the following area needing development: • Ensure counseling services are available and provided by professional, appropriately credentialed

personnel.

Fortis College - Centerville Associate 14 STANDARD 4 Curriculum The curriculum prepares students to achieve the outcomes of the nursing education unit, including safe practice in contemporary health care environments.

4.1 The curriculum incorporates established professional standards, guidelines, and competencies, and has clearly articulated student learning and program outcomes.

4.2 The curriculum is developed by the faculty and regularly reviewed for rigor and currency.

4.3 The student learning outcomes are used to organize the curriculum, guide the delivery of instruction, direct learning activities, and evaluate student progress.

4.4 The curriculum includes cultural, ethnic, and socially diverse concepts and may also include experiences from regional, national, or global perspectives.

4.5 Evaluation methodologies are varied, reflect established professional and practice competencies, and measure the achievement of student learning and program outcomes.

4.6 The curriculum and instructional processes reflect educational theory, interdisciplinary collaboration, research, and best practice standards while allowing for innovation, flexibility, and technological advances.

4.7 Program length is congruent with the attainment of identified outcomes and consistent with the policies of the governing organization, state and national standards, and best practices.

4.8 Practice learning environments are appropriate for student learning and support the achievement of student learning and program outcomes; current written agreements specify expectations for all parties and ensure the protection of students. 4.8.1 Student clinical experiences reflect current best practices and nationally established

patient health and safety goals.

For nursing education units engaged in distance education, the additional criterion is applicable: 4.9 Learning activities, instructional materials, and evaluation methods are appropriate for the

delivery format and consistent with student learning outcomes. Commentary: The new curriculum was developed, according to the substantive change report, with input from the faculty of all Fortis College locations nationwide; the curriculum was not solely developed by the nursing faculty at the program. Reportedly, the changes were determined by reviewing and analyzing students’ HESI scores to identify weaknesses in the current curriculum and utilizing Elsevier textbooks, clinical excursions, and test banks as a further evidence-based mechanism for revisions. In the interviews with the faculty and in discussions with the Dean, it was stated that the curriculum was changed to a generic entry program to decrease student expenses by allowing students to directly enter the associate program without having to first complete the practical program. They also reported that the job market for LPNs in the area is declining, and the program change affords students the opportunity to become RNs through a direct route.

Fortis College - Centerville Associate 15 As explained in the substantive change report and confirmed onsite by the nurse administrator, the new curriculum adds general education courses in math to strengthen dosage calculation skills; humanities to strengthen critical thinking, problem-solving, and community building; and informatics to integrate nursing, computer, and information sciences to support nursing practice. Additional nursing courses include a health assessment course to provide greater emphasis on the bio-psycho-social and cultural assessment of individuals across the lifespan; a community nursing concepts course to provide exposure to rural and home healthcare nursing concepts and the diverse roles of the community health nurse; and a transition to practice course to increase critical thinking skills, confidence, and competence in preparing for nursing practice. The curriculum also was converted from a semester- to a quarter-hour-based program. The former LPN-RN transition program will no longer be offered once the currently enrolled students complete the program. The program in the new generic format will allow some practical nursing courses to be transferred into the program after review by the Admission Committee. The substantive change report states that the curriculum changes will enhance and strengthen the students’ education by providing a broader education, which better prepares them for practice in an ever-changing workforce and for transition and success at the baccalaureate level. Further, since the curriculum change is for all Fortis College locations, the changes will standardize the course syllabi by course title, number, description, objectives, credits, hours, course length, and delivery across all Education Affiliates schools. This standardization will also provide for system-wide collection and evaluation of data to improve the curriculum over time. There is no mention of the established professional standards, guidelines, and competencies used to develop the curriculum in the program’s mission, philosophy, or conceptual framework. In interviews, the faculty members could not identify or discuss the professional standards, guidelines, or competencies used to guide the curriculum. Instead, the faculty reported that Orem’s self-care deficit theory of nursing was utilized to guide the curriculum. Concepts associated with Orem’s theory such as human beings; nursing and nursing practice; health; environment; and teaching and learning have been used. Supporting concepts of critical thinking; nursing process; therapeutic interventions; caring and advocacy; ethical-legal principles; professional accountability; and leadership and management are also embedded within the curriculum and formulate eight (8) student learning outcomes (SLOs). No program outcomes are included in the mission, philosophy, or conceptual framework. The eight (8) SLOs are articulated and were identified in each nursing course syllabus. However, it was not evident that the SLOs organize the curriculum, guide instructional delivery, direct learning activities, and evaluate student progress. There are still some elements of the curriculum, such as tests and clinical evaluation tools, that are yet to be developed. A draft of the clinical evaluation tool for NUR 205 Medical-Surgical Nursing II was reviewed. Although the SLOs and the course objectives were linked in the tool to the broad concepts with competencies for evaluation, there was no direct indication that the SLOs as stated are being evaluated within the clinical tool. Only elements of the SLOs and parts of the concepts associated with Orem’s theory could be identified in the assessment statements within the evaluation tool. In addition, it was noted the draft evaluation tool included nine (9) instead of eight (8) SLOs. Teaching strategies include lecture; projects; papers; audiovisual aids; group activities; online/electronic instruction such as case studies and practice tests; and actual and simulated clinical experiences. These activities were noted to be a part of each course. Some degree in progression from similar to complex can be seen in the course objectives and levels of knowledge and skill required to complete the course. No new exams have been developed for the new courses, however, to truly discern if the courses progress in complexity as evidenced by the level of test questions utilized throughout the curriculum. The faculty did not report the use of test blueprints to develop tests but stated that they have used test banks to generate

Fortis College - Centerville Associate 16 portions of the exams. No formal analysis of tests is utilized except Scantron analysis of the percentages of correct and incorrect responses. Standardized testing is also used in the determination of grades. The faculty verbalized a process for input into the curriculum through the “local” Curriculum Committee as described in the Nursing Faculty Handbook. According to the faculty, the Committee can bring forth questions and concerns regarding the curriculum to the faculty or vice versa, take a vote, and send decisions through the proper channels up to the corporate levels. However, this process is not clearly described in the Nursing Faculty Handbook. The faculty and the Dean confirmed that the new curriculum was essentially “sent down from corporate,” and the faculty had no choice other than to incorporate the curriculum into the program. The faculty also reported that there are prescribed lessons plans with suggested guidelines for course delivery, which include the PowerPoint presentations that have been prepared for them to use in their classrooms. However, the faculty stated that the plans and presentations can be altered as determined by the individual faculty member teaching the course. Books for the courses were also determined through the corporate structure and cannot be changed without corporate approval. There is evidence of cultural, ethnic, and socially diverse concepts incorporated throughout the curriculum. Concepts are noted in one (1) of the SLOs and in course descriptions, activities, and objectives. The students could readily identify with examples how cultural diversity is integrated into the learning activities of courses, laboratory, and clinicals. General education faculty members teach the general education courses required in the curriculum. As reported by the nursing faculty, the general education faculty members teach specific cohorts of nursing students in the program based on the option in which the students have been admitted. In interviews, the students were very complimentary of some of the general education faculty members and their commitment to student success in their courses. Students in the generic track are required to complete 106 quarter hours, which can be accomplished in eight (8) quarters and 96 weeks inclusive of the prerequisites. The program can be completed in 12 quarters for part-time students and in six (6) quarters for LPN-RN students. One (1) quarter credit equals ten (10) hours of classroom or direct faculty instruction plus out-of-class student work; 30 clock hours of laboratory activities; and 45 clock hours of clinical/externships. One (1) clock hour is defined as 50 minutes of class. Currently, a week-end and evening option for the LPN-RN track exists. All LPN-RN options will be taught-out over time until only students in the generic full-time track remain in the program. There are seven (7) active clinical agreements with hospitals, long-term care, and school settings. Maternity and psychiatric/mental health clinical opportunities are provided within some of the contracted facilities. Pediatric experiences are provided in the school settings. The contracts are current, specify the expectations for all parties, and ensure the protection of students. Classroom Observation There was no scheduled class in session at the time of the Focused Visit. However, students were engaged in a test review during a scheduled laboratory period before the student meeting. The instructor was explaining how to answer an alternative item test question and demonstrated placement of the hands when assessing for lung excursion. Students interacted with the instructor and asked several questions during the period in which the laboratory session was observed by the site visitor.

Fortis College - Centerville Associate 17 Summary: Compliance: The program is not in compliance with the Standard as Criteria 4.1, 4.2, 4.3, and 4.7 are not met, as evidenced by: • There is a lack of evidence that the curriculum incorporates current established professional

standards, guidelines, and competencies.

• There is a lack of evidence the curriculum is developed by the faculty and regularly reviewed for rigor and currency.

• There is a lack of evidence that student learning outcomes are used to organize the curriculum, guide

delivery of instruction, direct student learning activities, and evaluate student progress.

• Program length is not consistent with national standards and best practices. With the following areas needing development: • Ensure the clinical evaluation tools reflect established professional practice competencies and

measure achievement of the student learning outcomes. • Ensure evaluation methods, including content examinations, are conducted utilizing research and best

practice standards.

Fortis College - Centerville Associate 18 STANDARD 5 Resources Fiscal, physical, and learning resources promote the achievement of the goals and outcomes of the nursing education unit.

5.1 Fiscal resources are sufficient to ensure the achievement of the nursing education unit outcomes and commensurate with the resources of the governing organization.

5.2 Physical resources (classrooms, laboratories, offices, etc.) are sufficient to ensure the achievement of the nursing education unit outcomes and meet the needs of faculty, staff, and students.

5.3 Learning resources and technology are selected by the faculty and are comprehensive, current, and accessible to faculty and students, including those engaged in alternative methods of delivery.

For nursing education units engaged in distance education, the additional criterion is applicable: 5.4 Fiscal, physical, technological, and learning resources are sufficient to meet the needs of faculty

and students and ensure that students achieve learning outcomes.

Commentary: Based on the information provided by the program, it was unclear to site visitors if the fiscal resources are sufficient to ensure the achievement of the program’s outcomes and commensurate with the resources of the College. A profit-and-loss FY2012 budget sheet was provided onsite. However, the budget sheet did not include useful documentation that delineated the funds appropriated to nursing and the line item expenses budgeted from the available fiscal resources. The President and other College administrators reported that nursing is the largest program provided by the College. Out of 866 students enrolled at FCC, approximately 600 are enrolled in the nursing program. Three hundred and four (304) of the 600 nursing students are enrolled in the associate nursing program. During discussions with the President, it was mentioned several times that the College would do whatever is necessary to ensure the nursing program is provided the fiscal resources needed to comply with the Accreditation Standards. The College consists of one (1) large building, and all the programs and services offered by the College are located within the building. Nursing is housed in the back portion of the building. A small nursing office is shared by an administrative assistant and program registrar. The office is connected to a large work area that contains equipment and provides for storage of supplies. The space is also used for part-time faculty members as needed. Two (2) or three (3) full- and part-time faculty share small office spaces. The offices that were observed provided a work station with a laptop computer, telephone, and filing cabinets. There was very limited storage space, making the offices appear cramped, crowded, and cluttered. The faculty reported that even though office space is shared, many of the faculty members are on different schedules so that when one (1) faculty member is in the office, the other member is not. Faculty members leave the office momentarily if privacy is needed by their officemate for student conferencing. The student mentor was noted to be the only nursing personnel other than the Dean with a private office. The Dean and President stated that a build-out is being planned that will relocate some of the non-nursing programs, faculty, and staff elsewhere to provide additional spaces for nursing. Two (2) large classrooms that seat approximately 70 students are utilized by the program. Long table desks with chairs provide student seating. A projector and large screen as well as computer station were noted in each classroom. Seating was arranged in a manner that would impede visualization of the screen if students were seated at the far ends of the available seating.

Fortis College - Centerville Associate 19 Two (2) skills laboratories are also utilized by the program. The laboratories contained static mannequins in older, crank-style hospital beds along with equipment and supplies necessary to practice skills. Audiovisual equipment utilized to view various learning resources was also noted in the laboratories. The smaller laboratory contained an obstetrical mannequin that simulates birth and heart, lung, and fetal heart tones. A pediatric mannequin that simulates vital signs was also in the laboratory as well as a newborn mannequin placed in a warming unit. In addition, a new, state-of-the-art simulation laboratory is being utilized by the program. Two (2) high-fidelity simulation mannequins located in two (2) simulation rooms separated by a control room and two (2) debriefing rooms compose the simulation laboratory area. Simulation scenarios are a part of the clinical component of the curriculum, and all students were reported to have simulation experiences at some point in the program. Two (2) full-time faculty members are assigned simulation and/or skills laboratory responsibilities. A student lounge and refreshment area was noted in the building. The bookstore, Learning Resource Center, student services, and computer laboratories are also located within the building in various areas. A small Learning Resource Center provides students with books, professional journals, and access to electronic databases. A tour of the Center revealed a small nursing book section with books dating from 2002 to the present. The librarian confirmed that she is responsible for keeping the collection current with input from the nursing faculty. A deletion list is generated and submitted to the faculty before books are culled from the shelves. No budget information regarding learning resource allocations and expenditures was provided. The students have access to professional nursing, medical, and health-related databases 24/7 through a library access system. Orientation to the Center and its resources is provided to all students during their first term at the College in an English course. Center staff are also available during hours of operation to help students access resources. The Center provides limited study space in the form of large tables with chairs and six (6) computer stations. Hours of operation are varied and include evenings and week-end hours. Summary: Compliance: The program is in compliance with the Standard with the following areas needing development:

• Ensure fiscal resources are sufficient to support the achievement of the nursing outcomes and

commensurate with the resources of the College consistent with the student enrollment in nursing. • Ensure classrooms, laboratories, and offices provide sufficient space, equipment, technology, and

supplies to ensure achievement of program outcomes and meet the needs of the faculty, staff, and students.

• Ensure learning resources are selected by the faculty and are comprehensive and current.

Fortis College - Centerville Associate 20 STANDARD 6 Outcomes Evaluation of student learning demonstrates that graduates have achieved identified competencies consistent with the institutional mission and professional standards and that the outcomes of the nursing education unit have been achieved.

6.1 The systematic plan for evaluation emphasizes the ongoing assessment and evaluation of the student learning and program outcomes of the nursing education unit and NLNAC standards.

6.2 Aggregated evaluation findings inform program decision-making and are used to maintain or improve student learning outcomes.

6.3 Evaluation findings are shared with communities of interest.

6.4 Graduates demonstrate achievement of competencies appropriate to role preparation.

6.5 The program demonstrates evidence of achievement in meeting the following program outcomes:

− Performance on licensure exam − Program completion − Program satisfaction − Job placement

6.5.1 The licensure exam pass rates will be at or above the national mean.

6.5.2 Expected levels of achievement for program completion are determined by the faculty

and reflect program demographics, academic progression, and program history.

6.5.3 Program satisfaction measures (qualitative and quantitative) address graduates and their employers.

6.5.4 Job placement rates are addressed through quantified measures that reflect program demographics and history.

For nursing education units engaged in distance education, the additional criterion is applicable: 6.6 The systematic plan for evaluation encompasses students enrolled in distance education and

includes evidence that student learning and program outcomes are comparable for all students.

Commentary: The program’s systematic plan for evaluation (SPE) is framed utilizing the NLNAC Standards and Criteria; the SPE includes the program outcomes. However, the SLOs are not incorporated into the evaluation plan. Discussions regarding the SPE and making revisions to the plan such as clarifying ELAs and ensuring all of the Standards and Criteria are included, assessed, and evaluated were noted in a review of faculty meeting minutes. However, the discussions are not documented in the SPE nor were action plans noted. Discussions regarding improving data collection methods were also noted, but specific data collection plans were not addressed in the evaluation plan. Scant data are provided in the plan, making it difficult to discern how the results and analysis of the data are used to inform program decision-making by the faculty. Little to no data were found in the faculty meeting minutes to support a link between the data and program documentation where the decision-

Fortis College - Centerville Associate 21 making process was reported to be available for review. There is also little information in the SPE regarding the plan of actions when the ELAs are not achieved. For example, licensure examination pass rates have been below the national mean, and the survey results have indicated a low graduate satisfaction rate, but no action plans to improve pass rates or graduate satisfaction are noted in the SPE. The faculty reported that they created the SPE and have taken ownership of the plan. Faculty members have been assigned specific areas of the plan, and the SPE was reported to now be addressed at each faculty meeting. Review of the SPE from the last SSR provided onsite did confirm that some efforts have been made to improve the plan especially in revising the ELAs and stating them in measureable terms. However, many of the ELAs in the plan remain vague; repeat the criteria; and/or not stated measureable terms. Some of the ELAs do not directly relate to the component being assessed and evaluated and include faculty agreement as the standard of measure to determine if the ELA was achieved or not. Some of the measurements are not realistic or within professional best practices for the component being assessed. As an example, only 30% of the faculty members are required to participate in scholarly activities, and not all (90%) of the advertising and recruitment materials, catalogs, and student handbooks are required to be current, accurate, clear, and consistent. Students in the part-time program option have the same ELA of graduating within three (3) years from the program as those in the full-time option. Further, the ELA for licensure examination pass rates is not consistent with the NLNAC Criterion. Also, the time/frequency for assessment of some of the components is questionable in ensuring that ongoing, consistent assessment and evaluation is guided by the evaluation plan. Many of the components that are stated as assessed every two (2) years should be assessed every year to ensure information is correct and congruent, such as the Nursing Student Handbook and advisement and recruitment materials. Program outcome data are not collected according to cohorts and program track/options. Presently, there are six (6) program tracks as those students in the old curriculum are finishing their programs of study. Also, a cohort of students begins the program each semester. Most of the data such as course and faculty evaluations, student and graduate satisfaction, program completion, and job placement are collected by the College using standardized tools (DataMark and Wonderlic) and processes to aggregate the data as a whole for the College. Thus, for some of the data, there is no method in place to separate students by program options or tracks. Nursing Advisory Board minutes include discussions about evaluation findings to some degree. Mention of licensure examination pass rates and job placement rates being shared with the Board were noted in the minutes. Discussions about the need to collect better and more data were also noted. However, other program outcomes were not included in the documentation as having been presented and/or discussed. In its present form, the SPE does not provide a means to assess and evaluate achievement of competencies appropriate to role preparation. The component does not exist in the plan and therefore cannot be assessed and evaluated by the program. Licensure Examination Pass Rates The ELA for licensure examination pass rates is 85% of graduates will meet or exceed the national pass rate on the licensure examination as first-time test takers. Pass rates are 88.05% (2012); 86.33% (2011); and 85.67% (2010). Pass rates are not aggregated and analyzed according to cohorts or tracks/options and have not met the national mean in the past three (3) years. Program Completion The ELA for program completion is 70% of full-time day students will graduate within three (3) years from the start of the full-time program. The ELA for part-time student program completion is 70% of the part-time evening/week-end students will graduate within three (3) years of admission. The SPE records an 87% completion rate but does not specify for which track/option of students this rate applies, and the

Fortis College - Centerville Associate 22 data are not generated by student cohort or option. The data are collected and aggregated by the College as a whole from term to term (semester/quarter), and the methodology includes re-entry students. Job Placement The ELA for job placement is 85% of graduates will be employed in nursing within six (6) months of graduation. The SPE shows a 95% job placement rate for the year to date for both day and evening program graduates. Again, the placement rate is not aggregated and analyzed according to cohorts, and the data were generated from the graduate survey that was returned by only 22 students for an unspecified timeframe. Graduate Satisfaction The ELA for graduate satisfaction is 85% of graduates will rate the quality of curriculum, classroom, and clinical use in attaining program outcomes an average of a 4.0 or higher on a seven-point Likert scale. For the end-of-program survey of graduate satisfaction, there are no data found in the SPE because nursing data cannot be separated from the total population of FCC students surveyed. The nurse administrator reported that a new survey is being developed specifically for end-of-program nursing graduates to obtain the data. According to the SPE, 58.6% of the 22 graduate surveys returned indicated satisfaction with the program. There is no separation of the data based on program track/option or cohort. Also, there were no specific actions noted to address the low satisfaction findings. Employer Satisfaction The ELA for employer satisfaction is 85% of employers will rate graduates’ ability to perform therapeutic nursing interventions, effectively communicate, and critically think in the structured healthcare setting a 4.0 or higher on a seven-point Likert scale. The SPE reports that 18 employer surveys were returned, but no information regarding the data is provided. The SPE reports that there are no areas of concern; however, the site visitors could not confirm the sufficiency or reliability of the findings as reported in the SPE.

Fortis College - Centerville Associate 23

Program Outcomes

Area Year

Expected Level of

Achievement Current Year One Year Previous Two Years Previous

Licensure Exam Pass Rates 85% meet or

exceed the national pass rate mean.

88.05% 86.33% 85.67%

Program Completion Rates

70% full-time day students graduate

within 3 years from program

start; 70% part-time

evening/week-end student graduate within 3 years of

admission.

87% 98% Not Available

Job Placement Rates

85% employed in nursing within 6

months of graduation.

95% Not Available 86%

Graduate Satisfaction

85% rate quality of curriculum,

classroom, and clinical in

obtaining program outcomes 4.0 on 7.0 Likert scale.

58.6% Not Available Not Available

Employer Satisfaction

85% employers rate graduates

ability to perform therapeutic

interventions, effectively

communicate, and critically think 4.0 on 7.0 Likert scale.

Not Available Not Available Not Available

Fortis College - Centerville Associate 24 Summary: Compliance: The program is not in compliance with the Standard as Criteria 6.1, 6.2, 6.4, 6.5, and 6.5.1 are not met, as evidenced by: • There is a lack of evidence that the systematic plan for evaluation emphasizes the ongoing assessment

and evaluation of the student learning outcomes and program outcomes. • There is a lack of evidence that aggregated evaluation findings inform program decision-making and

are used to maintain or improve the student learning outcomes.

• There is a lack of evidence that graduates demonstrate achievement of competencies appropriate to role preparation.

• There is a lack of evidence the program demonstrates achievement in meeting program completion,

program satisfaction, and job placement.

• Licensure examination pass rates have not been at or above the national mean for three (3) years.

With the following areas needing development: • Implement strategies to ensure data are collected, analyzed, and trended by cohort and program

track/option before aggregation as a whole. • Ensure documentation reflects that evaluation findings are shared with the communities of interest.

• Ensure all expected levels of achievement are measurable and appropriate for the components being

assessed.

• Implement strategies to ensure sufficient job placement and graduate and employer satisfaction data are obtained to inform program decision-making.

Fortis College - Centerville Associate 25 III. RECOMMENDATION FOR ACCREDITATION STATUS Recommendation: Maintain continuing accreditation with warning status as the program is in non-compliance with Standard 3 Students, Standard 4 Curriculum, and Standard 6 Outcomes. Next visit in Spring 2014.