Nursing faculty and administrators are aware of the continuing and projected nursing workforce shortage in the nation and in its region, the legislative changes in the health care system and their effect on the nursing workforce, and the trend for preparing advanced practice nurses at the clinical doctorate (DNP) level. They have anecdotal information that employers of nurses prefer baccalaureate or higher degree nurses owing to the complexity of the acute care setting, the shortages of nurses prepared to practice in primary care and community settings, and the Institute of Medicine (IOM) (2010) recommendation on The Future of Nursing that recommends the baccalaureate as the threshold for professional nursing.
The nursing program has a basic bachelor of science in nursing (BSN) undergraduate program, (N=200), a registered nurse (RN) to BSN program (N=30), and a master of science in nursing (MSN) program with specialties for family nurse practitioners (FNP), adult/geriatric acute care nurse practitioners, and clinical nurse leaders (N=90). The faculty numbers 30 full-time and 15 part-time members with a dean and two associate deans for the undergraduate and graduate programs. There are five faculty members who have released time to coordinate the five tracks in the program. Three administrative assistants and one information systems and instructional support administrator provide management.
The nursing program is affiliated with a religious-based health care organization of the same denomination as its parent organization. The health care organization is a managed care system and has facilities located throughout the institution’s region and the nation. It has been supportive of the nursing program in the past by offering clinical sites for student practice and scholarship or loan forgiveness programs for its staff and students who come to its facilities after graduation. With this information in hand, the dean asks the faculty to conduct a needs assessment for expanding the nursing program by increasing enrollments for entry-level nurses and/or expanding the graduate program to provide additional advanced practice nurses.
Using the Guidelines for Assessing External Frame Factors (See Table 6.1) the faculty initiates a needs assessment. The faculty divides the work into teams of two or three, each to collect information on one of the nine external frame factors. Once the data are collected, they will be presented to the faculty group who will refine the data and analyze them according to the need for the proposed program expansion.
The team assigned to community assessment decides to assess the metropolitan area and its surrounds, which includes six major suburban areas and the adjacent three-county rural area. Of the six suburban areas, half are incorporated as towns or cities. The team conducts a community assessment using portions of the Kazda et al. (2009) framework that uses interviews of key stakeholders and also analyzes GIS data to provide demographic and socioeconomic information according to specific locales. Additionally, the team finds the city, suburban communities, and county websites useful in providing much of the information they seek. The major industries and employers in the area include:
1.The state government
2.Two small but expanding alternative energy manufacturers
3.Several food-processing plants
4.A large inland port
5.A railroad center that serves the region in the transportation of goods and some commuter services
6.An airplane parts manufacturer
7.A rocket engineering and manufacturing plant
8.Retail and recreation/entertainment industry (including two Native American-managed casinos)
9.Primary and secondary education systems
10.Several large health care systems that serve the city, suburbs, and rural neighbors
All of the industries have a long history in the area, are financially stable in spite of the recent recession, and the alternative energy manufacturers plan to expand and employ at least 2,000 additional workers over the next 5 years. The nonhealth-related industries support the business and engineering programs of the parent institution and send many of their workers to the programs for advanced preparation. In the past, two of the manufacturers gave grants to the parent institution for computer engineering scholarships and one manufacturer donated a $25 million grant toward a new business administration building on the home campus.
A state-supported baccalaureate and higher degree program with a nursing program is located in the city. Additionally, there are three state-supported community colleges in or near the city with nursing programs, there is one large university-based medical center with a PhD nursing program to prepare nurse scientists, and the closest private college (without a nursing program) is 300 miles away. The parent institution has existing articulation agreements with all of the community colleges and the state school. There are no DNP programs in the nearby region.
Results from statewide achievement tests reveal that the city’s kindergarten through 12th grade system ranked in the 60th percentile. Most of its students prefer to remain in the local area and the majority of those who continue schooling after high school (40%) go to the local community colleges. Students in the three-county area ranked from the 50th percentile (agricultural areas) to the 82nd percentile (suburban areas) on statewide achievement tests. Fifty-five percent of the suburban students continued their education in either community colleges or higher educational institutions; however only 15% of students in rural areas continued their education after high school.
The public transportation system within the city includes buses and a light rail system. The light rail system extends into the three surrounding counties with carpool parking lots available for suburbanites to commute to the city. Three major highways intersect with the city providing easy access for automobile travel. There is a mid-sized airport with commuter planes and major airlines and AMTRAK services are available. Greyhound Bus has a terminal in the city with buses providing interstate transportation. The metropolitan buses and light rail system fares are reasonable and there are discounts for students and senior citizens. There is one major daily paper, several suburban papers, at least 25 radio stations, five major television stations, TV cable service, and telecommunication services for computer access. There are many mailing services in addition to the U.S. Postal Service such as UPS, FedEx, and Pak Mail located throughout the area.
The capital city is located on a major river with three surrounding small lakes and there are several state and city recreation parks for picnicking, swimming, boating, and hiking. The city lies between the ocean and mountains; thus winter, summer, and beach sports are no more than 2 to 3 hours away. Low-rent housing facilities are plentiful owing to the economic recovery owing to more people buying homes. Utilities are fairly reasonable in cost. There are municipal systems for the incorporated cities and county services for delivery of utilities that are for the most part reliable in the delivery of services.
There are four major health care systems that serve their enrolled members. With a projected modest population growth, two of the systems have plans for expansion. Students and/or their parents who are enrolled in these programs are eligible for services. There are public health clinic services for students who do not have health coverage and who are eligible for state-supported health care program The city has an elected city council with a mayor, while the smaller incorporated cities are managed through part-time mayors and city councils with fulltime city managers. The counties have elected boards of supervisors and each has a county chief administrator/manager. At the present time, in the urban areas, the Democratic Party has the most representatives in the government. However, the rural areas are more conservative and have elected Republicans to the local governments and representatives to Congress. The three surrounding counties are governed by boards of supervisors with some of the larger suburban communities having local fire department and community services. The three counties have sheriff departments supplemented by state highway patrol services for highway traffic control and serious felonies.
Although the parent institution’s board of regents has only one representative in the public government, the president of the college meets periodically with ad hoc committees of the city councils and boards of supervisors to discuss higher education issues that affect their populaces. He has been in the position of president for more than 15 years and is well known and respected throughout the region. This activity on his part contributes to the presence and image of the parent institution in the region.
Preliminary Conclusions
The location and size of the regional community indicate feasibility for expanding the program. The infrastructure of the city and its surrounds and the population base of the region for potential student and health care services support the existing program and could accommodate additional nursing students and graduates. There is only one baccalaureate and higher degree competitor for the nursing program and one university PhD nursing program. However, there are three community colleges with potential applicants to the BSN and RN to BSN programs. These issues will be examined in the Characteristics of the Academic Setting frame factors that follows.
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