WEBVTT 00:00:04.930 --> 00:00:12.040 position:50% align:middle We're going to be talking about the national database that we have developed about quality indicators and 00:00:12.040 --> 00:00:15.920 position:50% align:middle nursing education programs, as well as demographics. 00:00:15.920 --> 00:00:19.520 position:50% align:middle It is the first ever database like this. 00:00:19.520 --> 00:00:22.258 position:50% align:middle And I have to say, we're pretty excited about it. 00:00:24.090 --> 00:00:26.910 position:50% align:middle So how did this start? 00:00:26.910 --> 00:00:30.720 position:50% align:middle Well, first of all, you're probably wondering about quality indicators. 00:00:30.720 --> 00:00:34.110 position:50% align:middle "Where did they get these... idea of quality indicators?" 00:00:34.110 --> 00:00:39.320 position:50% align:middle And it all started from our wonderful Board of Directors. 00:00:39.320 --> 00:00:47.610 position:50% align:middle And what they requested is a development of quality indicators for nursing education programs that the 00:00:47.610 --> 00:00:52.260 position:50% align:middle boards of nursing can use when they approve the programs. 00:00:52.260 --> 00:00:57.800 position:50% align:middle But basically, and this was the important part, they wanted them to be legally 00:00:57.800 --> 00:01:00.620 position:50% align:middle defensible and evidence-based. 00:01:00.620 --> 00:01:03.970 position:50% align:middle And by evidence-based, we're not talking about one study 00:01:03.970 --> 00:01:05.620 position:50% align:middle with 40-some students. 00:01:05.620 --> 00:01:11.850 position:50% align:middle There's a study going around about the two-to-one ratio of clinical hours to simulation. 00:01:11.850 --> 00:01:16.820 position:50% align:middle It was one study done in one area, 3 schools with 42 students. 00:01:16.820 --> 00:01:18.990 position:50% align:middle And yet that's used all over the place. 00:01:18.990 --> 00:01:21.480 position:50% align:middle "That's why we need this two-to-one ratio." 00:01:21.480 --> 00:01:23.150 position:50% align:middle That's not what we're talking about. 00:01:23.150 --> 00:01:30.950 position:50% align:middle We're talking about robust studies at the hierarchy of research. 00:01:30.950 --> 00:01:33.430 position:50% align:middle We actually thought this would be pretty easy. 00:01:33.430 --> 00:01:37.830 position:50% align:middle We know there are requirements from the U.S. Department of Education. 00:01:37.830 --> 00:01:46.450 position:50% align:middle There are many, but the three important ones are graduation, passing the NCLEX, and getting a job. 00:01:46.450 --> 00:01:47.540 position:50% align:middle Right? 00:01:47.540 --> 00:01:51.310 position:50% align:middle So we had a committee together on this. 00:01:51.310 --> 00:01:55.930 position:50% align:middle We had the U.S. Department of Education on a call and we said, "Now, where is your research? 00:01:55.930 --> 00:02:01.090 position:50% align:middle We thought we could get that research together, and then look for other things as well." 00:02:01.090 --> 00:02:03.270 position:50% align:middle Well, they said, "Oh, it's not based on any research at all. 00:02:03.270 --> 00:02:09.640 position:50% align:middle That's what we need in order to give funding to the schools, and to give funding to the students." 00:02:09.640 --> 00:02:11.090 position:50% align:middle So there was no research there. 00:02:11.090 --> 00:02:13.320 position:50% align:middle So then we went to the accreditors. 00:02:13.320 --> 00:02:18.520 position:50% align:middle And we know that the national nursing accreditors require the same kinds of things. 00:02:18.520 --> 00:02:21.120 position:50% align:middle These are requirements that schools have to do. 00:02:21.120 --> 00:02:26.790 position:50% align:middle So, again, and we met with each of them, all three of them individually, and we said, 00:02:26.790 --> 00:02:28.680 position:50% align:middle "Where is your research?" 00:02:28.680 --> 00:02:33.255 position:50% align:middle But because they have to be recognized by the U.S. Department of Education, 00:02:33.255 --> 00:02:35.730 position:50% align:middle they had to use their requirements. 00:02:35.730 --> 00:02:43.320 position:50% align:middle So there was really no big research in either of these areas on it. 00:02:43.320 --> 00:02:49.710 position:50% align:middle So we went to our board, our wonderful Board of Directors, 00:02:49.710 --> 00:02:54.400 position:50% align:middle that really helped us and supported us in this initiative. 00:02:54.400 --> 00:03:03.270 position:50% align:middle And we said, "We're going to have to do this research, because there isn't anything out there with that high 00:03:03.270 --> 00:03:10.880 position:50% align:middle quality and robustness of research that we need if we want to be legally defensible." 00:03:10.880 --> 00:03:16.500 position:50% align:middle So we asked for an integrative literature review, a Delphi. 00:03:16.500 --> 00:03:20.710 position:50% align:middle These are all national, five years of annual reports. 00:03:20.710 --> 00:03:23.130 position:50% align:middle That's the quantitative part of the study. 00:03:23.130 --> 00:03:27.360 position:50% align:middle And then five years of site visit reports. 00:03:27.360 --> 00:03:34.410 position:50% align:middle And that would be the qualitative part of the study, because it kind of tells you what's going on if the 00:03:34.410 --> 00:03:35.930 position:50% align:middle program is beginning to fail. 00:03:35.930 --> 00:03:41.050 position:50% align:middle It's kind of the story of the program, whereas the annual reports are the quantitative data. 00:03:41.050 --> 00:03:43.010 position:50% align:middle What are the graduation rates? 00:03:43.010 --> 00:03:45.000 position:50% align:middle What are the credentials of faculty? 00:03:45.000 --> 00:03:46.740 position:50% align:middle That kind of thing. 00:03:46.740 --> 00:03:51.883 position:50% align:middle So we went to the literature first, and again, kind of like the U.S. Department of Education 00:03:51.883 --> 00:03:54.410 position:50% align:middle and accreditors, we thought we'd find a lot there. 00:03:54.410 --> 00:03:59.630 position:50% align:middle We didn't really find too much there that was that high level of research. 00:03:59.630 --> 00:04:05.770 position:50% align:middle We used the Johns Hopkins levels of evidence to rate each of the studies. 00:04:05.770 --> 00:04:12.650 position:50% align:middle We came out with 65 published studies, but nothing was high enough that it would really make 00:04:12.650 --> 00:04:14.090 position:50% align:middle it legally defensible. 00:04:14.090 --> 00:04:20.080 position:50% align:middle So we were able to use the data, but we couldn't say that this would change policy. 00:04:20.080 --> 00:04:22.890 position:50% align:middle So then we did the national Delphi. 00:04:22.890 --> 00:04:29.220 position:50% align:middle And what I loved about the national Delphi was we had three different contingencies in it. 00:04:29.220 --> 00:04:37.890 position:50% align:middle We had experts in education, experts in regulation, and experts in those nurses that work with new 00:04:37.890 --> 00:04:41.110 position:50% align:middle graduates and see what they're doing. 00:04:41.110 --> 00:04:47.080 position:50% align:middle And I have to tell you, I think that last group really helped us with this. 00:04:47.080 --> 00:04:52.300 position:50% align:middle And that report of the Delphi is in that supplement that came out in 2020. 00:04:52.300 --> 00:04:58.630 position:50% align:middle I really suggest you might want to look at it because there's some really great evidence in there. 00:04:58.630 --> 00:05:08.730 position:50% align:middle And then we asked the poor boards that are tirelessly working for five years of their annual reports, 00:05:08.730 --> 00:05:14.881 position:50% align:middle because we wanted to look at that quantitative data across a timeline like that. 00:05:14.881 --> 00:05:26.240 position:50% align:middle And we got more than 11,000 annual report pages from 43 boards of nursing that actually gave us these. 00:05:26.240 --> 00:05:28.530 position:50% align:middle And it was a lot of work for some of them. 00:05:28.530 --> 00:05:35.610 position:50% align:middle We were able to collect the data in a secure database from an outside vendor, 00:05:35.610 --> 00:05:38.130 position:50% align:middle because we never would have been able to do this. 00:05:38.130 --> 00:05:44.660 position:50% align:middle We, inside, did the analysis of the data, but they were able to collect it for us. 00:05:44.660 --> 00:05:53.240 position:50% align:middle And then 5 years of site visits again, we had about 31 boards that were able to give us this 00:05:53.240 --> 00:05:56.380 position:50% align:middle because not all boards do site visits. 00:05:56.380 --> 00:06:02.750 position:50% align:middle And we, again, had about 1278 site visit documents. 00:06:02.750 --> 00:06:07.910 position:50% align:middle And these were very valuable too, because what you really need to know is what's going 00:06:07.910 --> 00:06:14.980 position:50% align:middle on in the program, number-wise, quantitatively, but then in the background, what might be causing it, 00:06:14.980 --> 00:06:18.120 position:50% align:middle or the story of the program. 00:06:18.120 --> 00:06:23.110 position:50% align:middle So we had all of these data from those four different sources. 00:06:23.110 --> 00:06:32.050 position:50% align:middle And then we brought in a panel of regulators, educators, and the educators were from AACN, NLN, 00:06:32.050 --> 00:06:35.740 position:50% align:middle and OADN, and researchers. 00:06:35.740 --> 00:06:42.830 position:50% align:middle And the attorneys were really very helpful because some of this comes out, "Well, 00:06:42.830 --> 00:06:44.520 position:50% align:middle in research we found this and this." 00:06:44.520 --> 00:06:50.020 position:50% align:middle And then the attorneys would say, "No, you can't do this because of SEC," or whatever the 00:06:50.020 --> 00:06:51.660 position:50% align:middle reason would be. 00:06:51.660 --> 00:06:54.220 position:50% align:middle They helped us a lot. 00:06:54.220 --> 00:07:01.790 position:50% align:middle Each of the quality indicators had to have at least two of the foreign national studies to provide 00:07:01.790 --> 00:07:03.020 position:50% align:middle evidence for them. 00:07:03.020 --> 00:07:09.510 position:50% align:middle So that is how all of these quality indicators were developed. 00:07:09.510 --> 00:07:14.020 position:50% align:middle And so, again, this is all written up, all four of those studies, 00:07:14.020 --> 00:07:23.240 position:50% align:middle and the quality indicators in that 2020 journal article, JNR article, supplement from the summer. 00:07:23.240 --> 00:07:26.710 position:50% align:middle And remember, all our supplements are free. 00:07:26.710 --> 00:07:30.168 position:50% align:middle However, we also have the approval guidelines. 00:07:30.168 --> 00:07:36.760 position:50% align:middle It's more of a summary of those quality indicators, but then it has a table showing how each 00:07:36.760 --> 00:07:38.460 position:50% align:middle one is supported. 00:07:38.460 --> 00:07:40.180 position:50% align:middle And I think that's really valuable. 00:07:40.180 --> 00:07:41.190 position:50% align:middle That's pretty short. 00:07:41.190 --> 00:07:45.920 position:50% align:middle It's not the 60-page article, and a supplement article. 00:07:45.920 --> 00:07:54.310 position:50% align:middle And it really is helpful in being able to say to your legislators, or whoever you're talking to, 00:07:54.310 --> 00:07:57.070 position:50% align:middle "This is the evidence for what we're doing." 00:07:57.070 --> 00:08:00.490 position:50% align:middle And that's online on our website. 00:08:00.490 --> 00:08:09.510 position:50% align:middle But also, I do have paper copies if anybody needs any, just email me, and I'm happy to send it to you. 00:08:09.510 --> 00:08:17.430 position:50% align:middle So we did all of that research, and felt really good about those quality indicators. 00:08:17.430 --> 00:08:18.470 position:50% align:middle But then what do you do? 00:08:18.470 --> 00:08:22.380 position:50% align:middle Do you just report it in the article, and who reads it? 00:08:22.380 --> 00:08:25.930 position:50% align:middle And where does it go from there? 00:08:25.930 --> 00:08:34.280 position:50% align:middle So we thought, we'll have an annual report program where, for the participating boards of nursing, 00:08:34.280 --> 00:08:38.360 position:50% align:middle we can't require it of them, but for those that participate, 00:08:38.360 --> 00:08:45.770 position:50% align:middle we will collect for them the core data, which are the quality indicators and the demographics. 00:08:45.770 --> 00:08:51.910 position:50% align:middle We have 50 questions of the core data, but then also any additional questions that they 00:08:51.910 --> 00:08:56.630 position:50% align:middle might have, because what we found is many boards have additional questions, 00:08:56.630 --> 00:09:01.200 position:50% align:middle and maybe they wouldn't have participated if we didn't answer additional questions. 00:09:01.200 --> 00:09:06.610 position:50% align:middle So we now do that in our annual report program. 00:09:06.610 --> 00:09:10.870 position:50% align:middle This map is of the states now that are participating. 00:09:10.870 --> 00:09:15.740 position:50% align:middle And as you might know, down the line, we're hoping to get all of the states participating 00:09:15.740 --> 00:09:19.180 position:50% align:middle because it's pretty much a national database now. 00:09:19.180 --> 00:09:24.100 position:50% align:middle But you can see areas like the Northeast, anybody here in from the Northeast, 00:09:24.100 --> 00:09:27.610 position:50% align:middle that we need more data from. 00:09:27.610 --> 00:09:30.280 position:50% align:middle But it is looking pretty good now. 00:09:30.280 --> 00:09:36.680 position:50% align:middle And what we do then is develop that survey for the boards of nursing. 00:09:36.680 --> 00:09:41.020 position:50% align:middle And it's those 50 core questions, as well as their additional questions. 00:09:41.020 --> 00:09:44.850 position:50% align:middle We send them a link, they send it out to their programs. 00:09:44.850 --> 00:09:52.210 position:50% align:middle Then through Qualtrics, we get the data back, we clean the data, we develop a report for them. 00:09:52.210 --> 00:10:00.820 position:50% align:middle And then annually we do an aggregate report, so that we can look nationally at what is going 00:10:00.820 --> 00:10:03.580 position:50% align:middle on with quality indicators. 00:10:03.580 --> 00:10:08.530 position:50% align:middle Now, one of the things that you might think about... 00:10:08.530 --> 00:10:11.570 position:50% align:middle Let's see if we can get... 00:10:11.570 --> 00:10:16.710 position:50% align:middle One thing you might think about as well then, "Okay, they have this aggregate report. 00:10:16.710 --> 00:10:17.680 position:50% align:middle How can they use it?" 00:10:17.680 --> 00:10:24.070 position:50% align:middle Well, it's a great way for schools to go to their higher administration and say, "Look, 00:10:24.070 --> 00:10:26.360 position:50% align:middle here's what nationally the schools are doing. 00:10:26.360 --> 00:10:29.390 position:50% align:middle We need to do this because these are outcomes." 00:10:29.390 --> 00:10:39.110 position:50% align:middle And then they can maybe not have poor outcomes, maybe not having poor NCLEX pass rates because they can 00:10:39.110 --> 00:10:45.810 position:50% align:middle take care of it before the NCLEX pass rates go down, or other outcomes go down. 00:10:45.810 --> 00:10:51.440 position:50% align:middle And just so that you know, the NCLEX is a lagging indicator. 00:10:51.440 --> 00:10:59.380 position:50% align:middle That means it doesn't fall until some of the other elements in the program have gone down. 00:10:59.380 --> 00:11:05.020 position:50% align:middle So these are the types of programs that we're looking at in the annual report program. 00:11:05.020 --> 00:11:13.340 position:50% align:middle And it's really nice because we categorize, then, each program what kinds of factors are involved. 00:11:13.340 --> 00:11:17.430 position:50% align:middle So these are the demographics that we collect. 00:11:17.430 --> 00:11:26.070 position:50% align:middle So the geographic, institutional ownership, is it for profit, not for profit, public, etc. 00:11:26.070 --> 00:11:31.090 position:50% align:middle Then learning modalities, online simulation, the kind of simulation, 00:11:31.090 --> 00:11:40.390 position:50% align:middle if they have administrative help, if they have dedicated support from the administration. 00:11:40.390 --> 00:11:47.620 position:50% align:middle And then orientation of adjunct, part-time, full-time faculty, and mentoring a full-time faculty. 00:11:47.620 --> 00:11:51.090 position:50% align:middle Now, what Nicole was saying, every study has limitations. 00:11:51.090 --> 00:11:57.570 position:50% align:middle And one of the limitations for that question is it's all self-report. 00:11:57.570 --> 00:12:01.570 position:50% align:middle So, of course, a lot of them say they have this mentoring. 00:12:01.570 --> 00:12:08.910 position:50% align:middle But I just remember, when I was teaching, orientation of adjunct faculty would mean coffee and 00:12:08.910 --> 00:12:11.290 position:50% align:middle donuts on the last day, saying thank you. 00:12:11.290 --> 00:12:14.051 position:50% align:middle And is that really orientation? 00:12:14.430 --> 00:12:17.296 position:50% align:middle So that's our limitation. 00:12:18.060 --> 00:12:24.880 position:50% align:middle The other area that we really have looked at, because there's been a huge change in clinical hours 00:12:24.880 --> 00:12:31.900 position:50% align:middle since 2010, when Jennifer Hayden first looked at the number of clinical hours nationally. 00:12:31.900 --> 00:12:39.840 position:50% align:middle So we look at direct patient care hours as opposed to simulation hours and skills lab hours. 00:12:39.840 --> 00:12:42.950 position:50% align:middle And a lot of parts of the study surprised me. 00:12:42.950 --> 00:12:48.800 position:50% align:middle And one of the surprises for me was direct patient care hours and simulation hours. 00:12:48.800 --> 00:12:53.720 position:50% align:middle I was going to expect a bunch of simulation hours, and not that many direct care. 00:12:53.720 --> 00:12:57.640 position:50% align:middle And it's really, as you'll see, I'm going to show you the new aggregate data in just 00:12:57.640 --> 00:12:59.874 position:50% align:middle a minute, that's just not the case. 00:13:00.910 --> 00:13:04.470 position:50% align:middle So here are the key quality indicators. 00:13:04.470 --> 00:13:08.770 position:50% align:middle These are the ones that really make a difference, we have found. 00:13:08.770 --> 00:13:15.860 position:50% align:middle Accreditation is really linked to outcomes, and we have done studies on that. 00:13:15.860 --> 00:13:22.100 position:50% align:middle And the approval status that all of the boards of nursing do, we found that from our site visit study. 00:13:22.100 --> 00:13:23.800 position:50% align:middle Very important data. 00:13:23.800 --> 00:13:26.010 position:50% align:middle NCLEX trends. 00:13:26.010 --> 00:13:29.800 position:50% align:middle Now remember, the NCLEX is a lagging factor. 00:13:29.800 --> 00:13:36.300 position:50% align:middle So what we're trying to do is prevent that from falling by looking at some of these other indicators. 00:13:36.300 --> 00:13:38.080 position:50% align:middle Director turnover. 00:13:38.080 --> 00:13:44.490 position:50% align:middle You can have more than three directors in five years, and that is bad for your outcomes. 00:13:44.490 --> 00:13:52.540 position:50% align:middle Major organization changes are things like merging programs together, laying off faculty and staff. 00:13:52.540 --> 00:13:56.310 position:50% align:middle Less than 50% direct patient care, this was one of my predictors. 00:13:56.310 --> 00:14:01.180 position:50% align:middle I was sure that we'd see a lot of this, and we almost saw none of this. 00:14:01.180 --> 00:14:08.430 position:50% align:middle So most programs now have more direct patient care than I thought they would have in relation to all the 00:14:08.430 --> 00:14:14.170 position:50% align:middle clinical experience, but not in relation to the hours because hours have gone down. 00:14:14.170 --> 00:14:19.925 position:50% align:middle And then another part that surprised me, having been faculty before I came to NCSBN, 00:14:19.925 --> 00:14:23.230 position:50% align:middle less than 35% full-time faculty. 00:14:23.230 --> 00:14:27.670 position:50% align:middle Our research department found that, and I thought it's just that then we didn't have 00:14:27.670 --> 00:14:30.250 position:50% align:middle consistent data, but that'll go way up. 00:14:30.250 --> 00:14:35.530 position:50% align:middle Well, we're looking at the annual report surveys. 00:14:35.530 --> 00:14:39.380 position:50% align:middle Some schools have 10% full-time faculty. 00:14:39.380 --> 00:14:43.950 position:50% align:middle Now, if you think about it, it's the full-time faculty that do the syllabus, 00:14:43.950 --> 00:14:50.390 position:50% align:middle and prepare for the accreditation, and take care of the clinical spaces, etc. 00:14:50.390 --> 00:14:57.720 position:50% align:middle So that is a really important lagging indicator that we're seeing in nursing education. 00:14:57.720 --> 00:15:02.640 position:50% align:middle The other thing that surprised me, but this may have been the pandemic coming into view, 00:15:02.640 --> 00:15:05.690 position:50% align:middle I don't know. We'll have to see with the future. 00:15:05.690 --> 00:15:12.470 position:50% align:middle Less than 70% graduation rates, much less than I had ever thought there would be. 00:15:12.470 --> 00:15:15.650 position:50% align:middle And then the younger programs, they aren't seasoned yet, 00:15:15.650 --> 00:15:19.790 position:50% align:middle some of them just need to be monitored more. 00:15:19.790 --> 00:15:23.160 position:50% align:middle But there's other quality indicators as well. 00:15:23.160 --> 00:15:29.500 position:50% align:middle Disability support and services for those with low socioeconomic status, those were handled pretty well. 00:15:29.500 --> 00:15:31.970 position:50% align:middle But English as a second language. 00:15:31.970 --> 00:15:39.990 position:50% align:middle Do you know that less than 50% of the programs have English as a second language services or resources, 00:15:39.990 --> 00:15:44.570 position:50% align:middle when we're trying to enhance the diversity of our nursing workforce? 00:15:44.570 --> 00:15:47.260 position:50% align:middle So we really do need to work on this. 00:15:47.260 --> 00:15:52.850 position:50% align:middle And we asked not only about the program, but then we said, or your parent institution. 00:15:52.850 --> 00:15:57.500 position:50% align:middle So less than 50%. That really surprised us. 00:15:57.500 --> 00:16:00.580 position:50% align:middle And then another thing that surprised me having... 00:16:00.580 --> 00:16:05.420 position:50% align:middle we've worked with our three-year study on errors and near misses in nursing programs, 00:16:05.420 --> 00:16:09.460 position:50% align:middle is remediation for students making errors and near misses. 00:16:09.460 --> 00:16:13.430 position:50% align:middle Only about 85% of the programs do this. 00:16:13.430 --> 00:16:18.640 position:50% align:middle And this is something that really, from the regulatory perspective especially, 00:16:18.640 --> 00:16:21.210 position:50% align:middle needs to be considered. 00:16:21.210 --> 00:16:25.310 position:50% align:middle And certified simulation faculty, and accreditation, and simulation labs. 00:16:25.310 --> 00:16:29.360 position:50% align:middle This came out as a quality indicator on our research. 00:16:29.360 --> 00:16:31.850 position:50% align:middle We are not seeing much of this right now. 00:16:31.850 --> 00:16:36.890 position:50% align:middle So it's really something that we can tell faculty for the future. 00:16:36.890 --> 00:16:42.340 position:50% align:middle So we did the aggregate report, it's on our website from 2020, 2021. 00:16:42.340 --> 00:16:48.020 position:50% align:middle We just finished, I'm still doing a little editing, of the 2021, '22. 00:16:48.020 --> 00:16:53.760 position:50% align:middle And you can see that we have almost 1000 programs in that aggregate report. 00:16:53.760 --> 00:17:00.960 position:50% align:middle So it is really creating a nice national database, not only for the programs to use but also for the 00:17:00.960 --> 00:17:08.410 position:50% align:middle boards of nursing to use, and look across our programs, and seeing in their area what might be improved. 00:17:08.410 --> 00:17:16.466 position:50% align:middle Now, one of the things I'd like you to see on here is look at all of the clinical adjunct faculty, 8822. 00:17:16.466 --> 00:17:24.200 position:50% align:middle This is one of the reasons we're seeing the decrease of full-time faculty, because they're using so 00:17:24.200 --> 00:17:26.150 position:50% align:middle many adjunct faculty. 00:17:26.150 --> 00:17:31.470 position:50% align:middle And many times adjunct faculty is just brought in from the local hospital or whatever. 00:17:31.470 --> 00:17:35.250 position:50% align:middle And they don't know a lot about the program. 00:17:35.250 --> 00:17:42.990 position:50% align:middle So these are some of the demographics that we have found in our '21, '22 survey. 00:17:42.990 --> 00:17:49.480 position:50% align:middle And you can see, interestingly, you know, we always hear that these programs serve the rural, 00:17:49.480 --> 00:17:53.100 position:50% align:middle and these programs serve the urban, but this is data to support it. 00:17:53.100 --> 00:18:00.730 position:50% align:middle You can see that the LPN programs and the ADN programs do definitely serve the rural population, 00:18:00.730 --> 00:18:06.560 position:50% align:middle where mostly the bachelor's programs serve the urban population. 00:18:06.560 --> 00:18:10.650 position:50% align:middle Not mostly, but that's the majority of what they serve. 00:18:10.650 --> 00:18:14.720 position:50% align:middle What was interesting to me, but there were only seven master's entry programs, 00:18:14.720 --> 00:18:18.740 position:50% align:middle but it was interesting that they serve the suburban element. 00:18:18.740 --> 00:18:26.440 position:50% align:middle And you can see for the private for-profit, because sometimes we have thoughts from our boards 00:18:26.440 --> 00:18:28.460 position:50% align:middle of nursing on those programs. 00:18:28.460 --> 00:18:36.780 position:50% align:middle You can see that it's the diploma programs that are the highest on that, and the accelerated BSN programs. 00:18:36.780 --> 00:18:44.040 position:50% align:middle So now, in terms of the learning modalities, again, you hear so much about online-only, 00:18:44.040 --> 00:18:44.840 position:50% align:middle that's what they have. 00:18:44.840 --> 00:18:52.420 position:50% align:middle Look at online-only there's almost none except for the accelerated BSN online-only programs. 00:18:52.420 --> 00:19:00.040 position:50% align:middle There's a number of hybrid programs that use both, and mostly in-person programs. 00:19:00.040 --> 00:19:02.900 position:50% align:middle Most of them use simulated clinical experiences. 00:19:02.900 --> 00:19:07.530 position:50% align:middle Though, as you can see, the LPNs are on the low side for that, 00:19:07.530 --> 00:19:16.000 position:50% align:middle and I thought more of the programs would be responsible for allied health, but not too many are at all. 00:19:16.000 --> 00:19:22.490 position:50% align:middle So as far as assistant directors, not too many have assistant directors 00:19:22.490 --> 00:19:26.990 position:50% align:middle in that area, probably the BSN programs are the highest. 00:19:26.990 --> 00:19:33.340 position:50% align:middle But they do all mostly have administrative support, somebody there answering the phones, 00:19:33.340 --> 00:19:34.970 position:50% align:middle and that kind of thing. 00:19:34.970 --> 00:19:41.920 position:50% align:middle And then you can see big on orientation of adjuncts, and part time again. 00:19:41.920 --> 00:19:50.380 position:50% align:middle We might have to ask a further question about what is that orientation, because I'm a little questioning, 00:19:50.380 --> 00:19:53.120 position:50% align:middle especially the adjunct orientation. 00:19:53.120 --> 00:19:54.216 position:50% align:middle Oops. 00:19:55.690 --> 00:20:01.130 position:50% align:middle And then orientation of full-time faculty and mentoring of full-time faculty is pretty good, 00:20:01.130 --> 00:20:03.591 position:50% align:middle at least reported that way. 00:20:04.690 --> 00:20:06.970 position:50% align:middle Clinical experiences. 00:20:06.970 --> 00:20:10.423 position:50% align:middle This is one of the areas that really surprised me. 00:20:10.423 --> 00:20:16.080 position:50% align:middle The direct patient care, you can see, that is not very high. 00:20:16.080 --> 00:20:21.410 position:50% align:middle If you think about the National Simulation Study, every program in that, remember we had 10 programs, 00:20:21.410 --> 00:20:25.990 position:50% align:middle and 5 for ADN programs and 5 for BSN programs. 00:20:25.990 --> 00:20:30.320 position:50% align:middle Every program had to have 600 hours of clinical because, at the time, 00:20:30.320 --> 00:20:33.020 position:50% align:middle that was the average number of hours. 00:20:33.020 --> 00:20:40.680 position:50% align:middle Look at the programs now, they've gone down in hours for direct patient care. 00:20:40.680 --> 00:20:42.340 position:50% align:middle Simulation hours. 00:20:42.340 --> 00:20:45.610 position:50% align:middle I was really surprised at this. 00:20:45.610 --> 00:20:49.170 position:50% align:middle I keep hearing when I go to conferences, "Oh, there's so much simulation going on. 00:20:49.170 --> 00:20:50.100 position:50% align:middle It is so huge." 00:20:50.100 --> 00:20:55.650 position:50% align:middle Look, there is actually more hours in skills labs than in simulation. 00:20:55.650 --> 00:20:59.500 position:50% align:middle And it's all under 100 hours of simulation. 00:20:59.500 --> 00:21:05.910 position:50% align:middle So I have a feeling, part of that is because of faculty not quite knowing 00:21:05.910 --> 00:21:08.770 position:50% align:middle what to do with simulation. 00:21:08.770 --> 00:21:12.390 position:50% align:middle Then the trend of direct care clinical hours. 00:21:12.390 --> 00:21:16.007 position:50% align:middle And we started this in 2010. 00:21:16.007 --> 00:21:21.740 position:50% align:middle And you can see the trend from 2010 to 2021, '22. 00:21:21.740 --> 00:21:28.760 position:50% align:middle And you can see how it's just decreased, particularly it has decreased with the 00:21:28.760 --> 00:21:30.940 position:50% align:middle associate degree programs. 00:21:30.940 --> 00:21:36.280 position:50% align:middle And now there are almost 200 hours behind the BSN programs. 00:21:36.280 --> 00:21:41.820 position:50% align:middle So one of the things that we may be as regulators, and those in practice, 00:21:41.820 --> 00:21:49.560 position:50% align:middle and educators need to do is work together on how to enhance the direct care clinical hours. 00:21:49.560 --> 00:21:55.500 position:50% align:middle One of the things I hear when I go out is, "Oh, well, students just stand around, and they are no good." 00:21:55.500 --> 00:22:00.290 position:50% align:middle But those people don't know how to teach, because there's a great way of teaching direct 00:22:00.290 --> 00:22:01.460 position:50% align:middle care clinical hours. 00:22:01.460 --> 00:22:08.730 position:50% align:middle And I do think it is something we should maybe focus on in nursing education. 00:22:08.730 --> 00:22:13.440 position:50% align:middle So here are the quality indicators, the key quality indicators. 00:22:13.440 --> 00:22:18.170 position:50% align:middle And at the end there, we have a grand total, but you can see each of the groups. 00:22:18.170 --> 00:22:26.070 position:50% align:middle For accreditation, probably it's the LPN programs that really need to come up to speed on that. 00:22:26.070 --> 00:22:26.595 position:50% align:middle Approval. 00:22:26.595 --> 00:22:33.490 position:50% align:middle I loved this one because it's only about 10% of the programs across the nation that don't 00:22:33.490 --> 00:22:34.730 position:50% align:middle have full approval. 00:22:34.730 --> 00:22:37.690 position:50% align:middle And a lot of times you hear, "Well, that's the board of nursing's fault. 00:22:37.690 --> 00:22:41.960 position:50% align:middle Nobody's getting approved in our state," when you go out to conferences. 00:22:41.960 --> 00:22:45.690 position:50% align:middle But these are good data to show that's just not the case. 00:22:45.690 --> 00:22:48.080 position:50% align:middle Major changes in organization. 00:22:48.080 --> 00:22:53.900 position:50% align:middle Remember, I told you about that means they merge programs together, and they put people 00:22:53.900 --> 00:22:56.860 position:50% align:middle on layoffs, huge area. 00:22:56.860 --> 00:23:02.580 position:50% align:middle And it also hugely affects the outcomes of programs. 00:23:02.580 --> 00:23:08.600 position:50% align:middle Director turnover, not so bad, but in some of the programs, a little worse, 00:23:08.600 --> 00:23:14.060 position:50% align:middle like the ADN programs and the accelerated BSN programs. 00:23:14.060 --> 00:23:18.008 position:50% align:middle In ADN programs, that might be related to salary. 00:23:19.650 --> 00:23:23.210 position:50% align:middle So then less than 50% direct care. 00:23:23.210 --> 00:23:24.590 position:50% align:middle I thought that would be huge. 00:23:24.590 --> 00:23:31.400 position:50% align:middle And you can see, not big at all because we aren't seeing much simulation. 00:23:31.400 --> 00:23:35.190 position:50% align:middle Less than 35% full-time faculty. 00:23:35.190 --> 00:23:41.680 position:50% align:middle Now, that is more than a quarter of the nursing programs nationally have less 00:23:41.680 --> 00:23:43.810 position:50% align:middle than 35% full-time faculty. 00:23:43.810 --> 00:23:45.190 position:50% align:middle That is very worrisome. 00:23:45.190 --> 00:23:51.010 position:50% align:middle And that is something that boards of nursing maybe need to stand up to to the programs. 00:23:51.010 --> 00:23:54.280 position:50% align:middle And then look at those 70% graduation rates. 00:23:54.280 --> 00:24:04.890 position:50% align:middle I mean, we have 54.6% that have less than 70% graduation rates. 00:24:04.890 --> 00:24:10.420 position:50% align:middle So, again, this is something that we need to see what's going on in the program. 00:24:10.420 --> 00:24:15.220 position:50% align:middle And again, that probably goes back to those, looking at the... 00:24:15.220 --> 00:24:17.830 position:50% align:middle Okay, I have to rush here a little bit. 00:24:17.830 --> 00:24:23.080 position:50% align:middle And then the younger programs, which are just the programs that don't have the 00:24:23.080 --> 00:24:28.240 position:50% align:middle seasoned faculty, and probably need a little bit more monitoring. 00:24:28.240 --> 00:24:31.300 position:50% align:middle So some of the other quality indicators. 00:24:31.300 --> 00:24:36.990 position:50% align:middle The only one here that really kind of surprised me was academic support. 00:24:36.990 --> 00:24:40.350 position:50% align:middle And this is academic support when students are failing. 00:24:40.350 --> 00:24:42.190 position:50% align:middle I think that should be zero, don't you? 00:24:42.190 --> 00:24:47.930 position:50% align:middle I mean, when students are failing, we have to go there and support, and see if we can bring them up. 00:24:47.930 --> 00:24:54.150 position:50% align:middle And look at this, it's about 15% of the programs report that they don't give any academic support. 00:24:54.150 --> 00:24:59.030 position:50% align:middle So students are failing, and then they just fail out, I guess. 00:24:59.030 --> 00:25:01.250 position:50% align:middle And then looking at some of the others. 00:25:01.250 --> 00:25:08.480 position:50% align:middle Look, there is the English as a second language, 56.3% of the programs don't have that at all. 00:25:08.480 --> 00:25:12.550 position:50% align:middle Again, something we really need to look at. 00:25:12.550 --> 00:25:20.480 position:50% align:middle And again, 18% of the programs don't have any kind of resources for errors and near misses about what 00:25:20.480 --> 00:25:23.870 position:50% align:middle maybe occurred, and how they can prevent it in the future. 00:25:23.870 --> 00:25:28.120 position:50% align:middle And you can see, as I told you, the simulation certification, 00:25:28.120 --> 00:25:35.560 position:50% align:middle and the simulation accreditation are really low at this point, but it's something we can really promote for the 00:25:35.560 --> 00:25:38.070 position:50% align:middle future for them. 00:25:38.070 --> 00:25:44.930 position:50% align:middle So for the summary of the aggregate results, more time is needed for clinical experience. 00:25:44.930 --> 00:25:52.030 position:50% align:middle And I think we can work together with our colleagues in all areas to get this to go. 00:25:52.030 --> 00:25:57.520 position:50% align:middle And we have to stop thinking that clinical experience in a hospital does nothing because 00:25:57.520 --> 00:25:58.700 position:50% align:middle student stands around. 00:25:58.700 --> 00:26:01.540 position:50% align:middle It absolutely is not the case. 00:26:01.540 --> 00:26:04.700 position:50% align:middle It's just that they don't know how to teach. 00:26:04.700 --> 00:26:09.780 position:50% align:middle Increased resources for students with English as a second language. 00:26:09.780 --> 00:26:13.060 position:50% align:middle LPN programs accredited at a higher level. 00:26:13.060 --> 00:26:20.960 position:50% align:middle And the issue there is probably cost of accreditation, but it certainly does help with outcomes. 00:26:20.960 --> 00:26:26.520 position:50% align:middle Looking at the full-time percentage of faculty, and I think probably programs haven't really looked 00:26:26.520 --> 00:26:27.570 position:50% align:middle at that before. 00:26:27.570 --> 00:26:32.380 position:50% align:middle So maybe once this comes down as a quality indicator, that'll be looked at. 00:26:32.380 --> 00:26:37.280 position:50% align:middle And I think it'll improve outcomes, graduation rates. 00:26:37.280 --> 00:26:40.700 position:50% align:middle Higher administrative support of nursing programs. 00:26:40.700 --> 00:26:46.050 position:50% align:middle This is that merging programs, laying off faculty, bringing in adjunct because they are cheaper 00:26:46.050 --> 00:26:47.850 position:50% align:middle than a full-time faculty. 00:26:47.850 --> 00:26:53.590 position:50% align:middle And then you don't have that support, and you have your programs failing. 00:26:53.590 --> 00:27:00.780 position:50% align:middle And then the certified simulation faculty and accredited centers. 00:27:00.780 --> 00:27:02.800 position:50% align:middle So we do have additional questions. 00:27:02.800 --> 00:27:08.950 position:50% align:middle What we ask the boards with their any additional questions is that these be questions that you're 00:27:08.950 --> 00:27:10.180 position:50% align:middle really will use. 00:27:10.180 --> 00:27:14.120 position:50% align:middle You'll use the answers, not just you want to see the questions there, 00:27:14.120 --> 00:27:15.380 position:50% align:middle but you'll use the answers. 00:27:15.380 --> 00:27:21.160 position:50% align:middle And many of the boards have pared down their additional questions, because faculty complain when they get 00:27:21.160 --> 00:27:23.550 position:50% align:middle too many questions. 00:27:23.550 --> 00:27:28.770 position:50% align:middle We did have 16 COVID-19 questions during the pandemic. 00:27:28.770 --> 00:27:32.400 position:50% align:middle And that ended, as it says, in the fall of 2022. 00:27:32.400 --> 00:27:38.460 position:50% align:middle And that publication has been accepted in the "Journal of Nursing Education," and will be out one 00:27:38.460 --> 00:27:40.210 position:50% align:middle of these days, I'm hoping. 00:27:40.210 --> 00:27:46.780 position:50% align:middle And what we found for that, a big thing we found from that was in 2021, 00:27:46.780 --> 00:27:54.330 position:50% align:middle we had almost 50% attrition of students during the pandemic, almost 50%. 00:27:54.330 --> 00:27:58.180 position:50% align:middle Remember, this is a large number of schools. 00:27:58.180 --> 00:28:03.610 position:50% align:middle And about, I think it was 19% of faculty attrition because of the pandemic. 00:28:03.610 --> 00:28:08.460 position:50% align:middle So that was really an interesting finding that we had not expected. 00:28:08.460 --> 00:28:10.830 position:50% align:middle So what are the advantages of all of this? 00:28:10.830 --> 00:28:13.140 position:50% align:middle The consistency of the data. 00:28:13.140 --> 00:28:17.610 position:50% align:middle Brendan was the one that did the analysis of our original one. 00:28:17.610 --> 00:28:20.840 position:50% align:middle And boards were just collecting different things at different times. 00:28:20.840 --> 00:28:29.050 position:50% align:middle And it was very hard to come to one particular thing, and be able to statistically analyze it. 00:28:29.050 --> 00:28:35.690 position:50% align:middle So five years after the start, so in 2025, we'll be doing another statistical analysis 00:28:35.690 --> 00:28:43.290 position:50% align:middle of these data, which are going to be very sophisticated, that sophisticated statistical model. 00:28:43.290 --> 00:28:50.520 position:50% align:middle And then also, being able to benchmark, not only the programs but across the boards. 00:28:50.520 --> 00:28:58.220 position:50% align:middle And being able then, to me this is the beauty of it, to make evidence-based changes before programs 00:28:58.220 --> 00:28:59.290 position:50% align:middle fall below standards. 00:28:59.290 --> 00:29:05.480 position:50% align:middle This ought to go well with their legislators, because they always come up...as Linda Aiken 00:29:05.480 --> 00:29:06.850 position:50% align:middle was saying, "They come up with money. 00:29:06.850 --> 00:29:13.180 position:50% align:middle And in some states, they want to decrease credentials of faculty because that would bring in more students, 00:29:13.180 --> 00:29:15.810 position:50% align:middle because we'd have more faculty." 00:29:15.810 --> 00:29:20.750 position:50% align:middle But it's looking at things like this that are much more important. 00:29:20.750 --> 00:29:24.500 position:50% align:middle So the future, we want all the boards of nursing in this. 00:29:24.500 --> 00:29:28.230 position:50% align:middle We'll certainly be doing webpage updates. 00:29:28.230 --> 00:29:31.110 position:50% align:middle And we're hoping to create, I've talked to Phil about this, 00:29:31.110 --> 00:29:35.880 position:50% align:middle a sophisticated dashboard that we could use this for. 00:29:35.880 --> 00:29:42.100 position:50% align:middle And right now, the international boards of nursing would really like to be a part of this. 00:29:42.100 --> 00:29:47.410 position:50% align:middle We just have to have more of our boards of nursing participate until then. 00:29:47.410 --> 00:29:50.030 position:50% align:middle And I can see Jen is looking at me. 00:29:50.030 --> 00:29:52.740 position:50% align:middle These are my credentials. 00:29:52.740 --> 00:29:59.100 position:50% align:middle Please feel free to call me or to email me if you would like anything from this, 00:29:59.100 --> 00:30:02.200 position:50% align:middle including if you want those guidelines that we have. 00:30:02.200 --> 00:30:04.716 position:50% align:middle Thank you so much. You've been a great audience.