September 25-26, 2003

EXPANSION OF NURSING PROGRAM BOZEMAN UPPER DIVISION CAMPUS

OBJECTIVES AND NEEDS

Centrality to or enhancement of the institutions approved mission and institutional objectives to be achieved by the addition of this program.

As an integral part of Montana State University - Bozeman, the College of Nursing fulfills its mission "to serve the people and communities of Montana by sharing our expertise and collaborating with others to improve the lives and prosperity of Montanans." The faculty of the MSU-Bozeman College of Nursing accepts as its primary responsibility the preparation of persons for the practice of professional nursing at the baccalaureate and masters degree levels.  Liberal education at the University provides a solid foundation and framework of learning in the arts and sciences and helps ensure that nurses practice within a context of broad-based knowledge.  Baccalaureate nursing education builds upon and integrates foundational knowledge with nursing knowledge in the preparation of professional nurses.

As the seventh largest generic baccalaureate nursing program in the United States, the College of Nursing is a multicampus system, educating nurses in five locations including Bozeman, Billings, Great Falls, Missoula and Kalispell.  Currently, both lower and upper division nursing courses are offered on all campuses except Bozeman.  Until this time, Bozeman was not considered to be a large enough community to provide the necessary numbers and variety of clinical experiences for baccalaureate nursing education. However, in the past ten years, the City of Bozeman and Gallatin County have grown significantly in terms of the population and the health care system.  This growth  resulted in a College of Nursing faculty assessment and conclusion that clinical educational opportunities now exist which will support upper division coursework in this community.

Description of the Program

A.   Goals and Objectives

The goal of this proposal is to increase access and enrollment to the College's baccalaureate nursing program by offering all junior and senior nursing courses at the MSU - Bozeman campus.  A cohort of sixteen students will be admitted beginning Fall Semester 2004, and each year thereafter provided there is continued student interest and the resources in the College of Nursing to sustain the program.  Ultimately, the implementation of this proposal will  increase the numbers of graduates from the College of Nursing by 16 per year.  This will increase the state-wide pool of professional nurses for Montana at a time when a nursing shortage is critical.

B. Intellectual basis for the curriculum.

The nursing curriculum leading to a Bachelor of Science in Nursing is rigorous and based on required prerequisite courses in the natural sciences, arts, and humanities.  The curriculum standards are set forth by the Montana Board of Nursing, the Commission on Collegiate Nursing Education and the American Association of Colleges of Nursing guidelines for the essentials of baccalaureate nursing education.

C. Course of study

The Course of study for the nursing curriculum is uniform across campuses.  Therefore, the plan of study for Bozeman upper division students will be the same as for junior and senior students on other campuses in the College of Nursing (Appendix A Plan of Study).

D. Prospective instructional methods or delivery by telecommunications.

I. If telecommunications will be used, indicate:

a.       The types or levels of courses within the program which would be appropriate for telecommunications

A collaborative model between the Bozeman Campus and the Great Falls Campus is being  developed.  Faculty at these two campuses will share in the didactic teaching responsibilities through the use of interactive video technology.  This model allows for an efficient and appropriate utilization of faculty expertise between campuses.  At the same time, faculty will be needed for the clinical supervision of students at each campus.

The primary technologies for distance delivery of courses will be interactive video and internet applications.  Plans are to use a PolyCom system for teaching via interactive video.  This system will be in place at all College of Nursing campuses by  Fall 2003.  This is an interactive video system which uses phone lines and has the future capacity for connection through the internet. Such technology has the potential to save costs for line charges. In addition to interactive video, the College of Nursing faculty are incorporating the use of WebCT to augment course delivery.

b.       The percentage of total credits for the program which would be taught via telecommunications

The percentage of coursework offered via distance delivery methods is estimated to be 40  percent, accounted for by the shared teaching of lectures between the Great Falls and Bozeman campuses

The estimated frequency and duration of face-to-face contact, if any, between the individual student and faculty, as well as the possibility for face-to-face contact among students

Students in Bozeman will be meeting face-to-face with clinical faculty in every clinical course.  Opportunities for face-to-face contact with faculty who are teaching didactic content from the distant campus (Great Falls to Bozeman) will be determined as needed to enhance student learning.

Need for Program

A. Student interest or demand

The number of applications for the upper division placement across campuses have increased significantly in the past two application cycles.  Students seeking placement for the 2003-2004 academic year numbered 387 for the 152 available slots.   Applications for 2004-2005 numbered 410.  With the addition of 16 slots at Bozeman, 184 of these applicants can be placed.  

Numbers of Upper Division Applicants (Summary by Year)

      1999-2000 - 206 applications

      2000-2001 - 231 applications

      2001-2002 - 229 applications

      2002-2003 - 280 applications

      2003-2004 - 387 applications

      2004-2005 - 410 applications

Consistent with placement procedures for all campuses, the College of Nursing policy for Upper Division Placement will be utilized for student placement on the Bozeman campus. (Appendix F) In April 2003, seventy-five students seeking upper division placement requested Bozeman as their first choice campus. 

In addition to a high level of student interest in nursing, a well-documented serious national nursing shortage exists.  The  underlying causes of the shortage are multi-faceted and complex (Bureau of Health Professions 2002 Kimbal and ONeil 2002 ).  A recent report from the Governors Blue Ribbon Task Force on Health CareWorkforce Shortage related that surveys conducted in 2001 and 2002 by the Montana Hospital Association, the Montana Health Care Association and Indian Health Service all found shortages as well as difficulties in recruiting and retaining nurses. (Governors Blue Ribbon Task Force 2002).

One of the suggested solutions is for  nursing education programs  to increase enrollments.  Because Montana has a number of nursing education programs already in existence, current programs are challenged in their ability to expand nursing education opportunities.  One way to do this is to increase enrollment through expansion of programs to communities which can support the clinical educational needs of students and where nursing education opportunities do not currently exist.  While the Montana State University-Bozeman campus has provided  lower division courses, it has not provided upper division nursing courses.

B. Manpower needs and reciprocal benefits to the institution

As part of the 1995-2000 College of Nursing Strategic Plan, a  goal was established to determine the feasibility of the Bozeman area supporting  an upper division campus.  Part of the impetus for this action was the changing structure of the College.  As the offering of lower division courses to placebound students on the upper division campuses began, it was necessary  to determine a strategy to continue to maintain a strong undergraduate presence in Bozeman.  Another major stimulus was the fact that the population of Bozeman and surrounding areas had grown significantly and the number and types of health care services had also increased.  At the same time, a study of students applying for upper division placement in the College showed significant student interest in Bozeman as an upper division site (Osen 1999).  Most importantly, the expansion of upper division to Bozeman would assist the nursing workforce needs and at the same time provide the reciprocal benefits to the institution.

Feasibility Study

April 2001:    A committee of College of Nursing faculty presented its in-depth assessment and recommendation to the Dean which read: "With reservation, Bozeman could support the clinical education for a small group of students, no more than sixteen (two clinical groups) admitted once a year."   The following strengths and areas of concern were identified:

Strengths:   

$        There are appropriate clinical placements for sixteen students to meet the objectives of all courses with the exception of psychiatric/mental health.

$        Bozeman area health care agencies and organizations are very supportive of an MSU upper division campus.  For example, Bozeman Deaconess Hospital Foundation helped provide the funding for the feasibility study.

$        There is a high degree of interest and support from the Bozeman faculty to have an upper division campus in Bozeman.

$        Place bound Bozeman students as well as out of state students would benefit from such  an arrangement.

Areas of concern:

$        The psychiatric/mental health clinical objectives cannot be met in Bozeman.  Students and   faculty will have to travel to Warm Springs or other surrounding areas to meet the course objectives.

$        Curricular issues pose difficulties.  An overlap will exist for the utilization of clinical agencies in the Community Health and Family-Child courses.  This overlap may also exist during the final senior  semester between the Community Health and Leadership/Management courses.  This overlap could lead to agency overload and affect clinical experiences.

$        The last semester courses require that students be placed with BSN preceptors. Availability of sufficient preceptors may be problematic.

$        Clinical site development will take time.       

On receipt of the feasibility study,  the Bozeman campus director and faculty reviewed the areas of concern and determined that they were not insurmountable.  With regard to the psychiatric/mental health issue, they felt there were a number of community sites where students could gain valuable experience in outpatient psychiatric nursing and then possibly spend time at Warm Springs for their acute, inpatient experience.  Overall, it was determined that the health care community was continuing to grow and the College was assured from the major health care providers that they would work collaboratively to assist the faculty in finding adequate clinical placements for the Colleges nursing students.  Subsequently, faculty at the  Bozeman campus determined the adequacy of clinical placements was addressed.

May 2002. The Executive Council of the College of Nursing unanimously accepted the motion that, pending Board of Regents and Board of Nursing approval,  beginning  Fall 2004, 16 students will be admitted as juniors in Bozeman.

June 2002.  A request was forwarded to the Universitys Facilities Services Department to evaluate the current space in Sherrick Hall based on the need for more faculty office and classroom space.  Following an initial report from Facilities Services, a request was sent to the Provost for a Space Utilization Study of Sherrick Hall.

August 2002.  The Provost approved the Space Utilization Study which allowed a plan to be developed which would require additional approval prior to implementation. The College of Nursing completed and approved the master resource outlines for courses in the new undergraduate curriculum.

January 2003. The proposal received approval from the Montana State Board of Nursing.

 

ADEQUACY, ACCREDITATION, AND ASSESSMENT ISSUES

1. Adequacy of present faculty, facilities, equipment and library holdings in support of program, compared to known or anticipated minimum standardsfor accreditation.

Utilizing a model of distance delivery, faculty from the  Great Falls campus of the College of Nursing will share in the teaching of upper division students at Bozeman.  Additional faculty with a required qualification of a masters degree and preferably doctoral degree will be hired for clinical teaching.  (Appendix D)

The capacity for the Bozeman area to meet accreditation standards for baccalaureate nursing education has been thoroughly examined with the conclusion that 16 students per year can be admitted to this proposed campus.  As indicated earlier, the Bozeman area at large is a dynamic region, which, according to the 2000 Census data encompasses over 67,000 people with diverse backgrounds ranging from cattle ranches to white collar workers. One in five Gallatin County workers is now employed in health, educational, or social services.  A thirty-four percent growth rate has occurred between 1990-2000.

Gallatin County is the largest county in the region and leads the five counties with the most significant growth in Montana (Gallatin, Flathead, Lewis and Clark, Missoula, Yellowstone and Cascade).  (Appendix B)

The other counties that are considered part of the Bozeman Vicinity include Broadwater, Madison, Meagher, Park, and Sweet Grass. Health Profiles of each of these counties are included in Appendix C.

Accompanying this rapid increase in population and economic development, health care services have also grown in number as well as nature and scope.  Bozeman has chosen to respond actively to this change. The groups in the forefront are Bozeman Deaconess Health Services (BDHS), The Gallatin County Community Public Health Alliance, and The Gallatin City-County Health Department.                                                                    

Bozeman Deaconess Health Services:

Bozeman Deaconess Health Services,  is a community owned, not for profit organization responsible for the operations of Bozeman Deaconess Hospital and Highland Park Medical Campus.  This organization has been experiencing a dramatic growth pattern in the past few years.

Bozeman Deaconess Hospitals primary service area includes Gallatin County and parts of Park and Madison Counties.  The hospital is a licensed 86-bed acute care facility providing services not always found in rural communities.  Some of the more recent services added include a cancer treatment center, a sleep disorder clinic, and cardiology services, including a cardiac catheter laboratory.

As part of its current strategic planning process, the BDHS has been conducting a needs assessment for all of its divisions and departments.  In addition, it is working with other agencies in the community to plan together to meet the assessed health care needs of this rapidly growing area.  In conjunction with BDHS, Gallatin County Mental Health Services and the state of Montana are planning to build a free-standing inpatient psychiatric unit operated by Western Montana Mental Health. Gallatin Community Clinic is also planning a move to the Bozeman Deaconess Hospital campus, a much larger space, to provide for additional providers and services.

The Gallatin County Community Public Health Alliance:

The Gallatin County Community Public Health Alliance has brought together numerous groups and individuals through data collection and idea generation.  In December of 1997, Montana was one of fourteen states awarded a Turning Point Initiative Grant from the Robert Wood Johnson Foundation. The Kellogg Foundation funds this initiative at the local level in four communities in Montana. The process initiative seeks to increase the capacity of Montanas public health system to meet changing health needs, to promote collaboration among agencies and organizations interested in improving the health of the public, and to improve accountability for publicly-funded health systems decisions and actions.

The Gallatin County Turning Point Initiative has involved three steps, 1) an assessment of the communitys capacity to provide essential public health services, 2) development of a community public health improvement strategic plan, and 3) the development of a strategic plan for the Gallatin City-County Health Department.

In May and June 2000 The Gallatin Community Alliance conducted a major community health assessment.  The final data report, Gallatin County Community Public Health Alliance Health Assessment, was published in August 2000.  This data is being used to: assist the community in the formation of a coordinated Health services Safety Net, in the development of a Health Information Clearinghouse, and in the creation of a community website to share information and available resources.  The health care agencies are now prioritizing issues identified and developing Action Plans to address them.

The Gallatin City-County Health Department

In 1999, over the course of several months, the Gallatin City-County Health Department compiled a report entitled A Profile of Gallatin Countys Community Health. The report contains information about local demographics as well as indicators of health in the community.  The top five public health issues identified were: affordable health care, affordable dental care, sexually transmitted diseases, poverty, and growth in Gallatin County.

As a consequence, The Gallatin City-County Health Department has developed Strategic Activities for FY 2003. Some of the activities include:

·         Develop a three year strategic plan

·         Prepare for the 2004 Community Health Assessment

·         Continue to participate in public health improvement activities at the state and local levels

·         Assist in developing a coordinated health services delivery system in the town of West Yellowstone

·         Implement adolescent immunization clinics in schools

·         Improve communicable disease surveillance and communication with health care providers

·         Complete a school nursing contract satisfaction survey and needs assessment

·         Select specific community health indicators and monitor data

·         Continue community collaborations that promote public health

2. If special accreditation is sought, timetable and costs associated with attaining and sustaining full accreditation status.

The Montana State University- Bozeman College of Nursing undergraduate professional nursing program is approved by the Montana State Board of Nursing which allows graduates of the program to  to take the national licensing examination for registered nurses. (NCLEX-RN).  The proposal, "Expansion of Nursing Program: Bozeman Upper Division Campus", was approved by the Montana State Board of Nursing in January 2003.

The Montana State University-Bozeman College of Nursing is nationally accredited by the Commission on Collegiate Nursing Education.

3. Assessment plan: how the program will Afit@ within the institutions internal, approved assessment process

The College of Nursing will review the program based on the following factors:

$        Quality of education evidenced by  graduation rates, success in  NCLEX-RN pass rates, and findings based on faculty and student assessment of quality indicators within  the master evaluation plan for the College of Nursing. 

$        Cost effectiveness as determined by anticipated costs versus actual costs and ability to offset expenses realistically

$        Support from Bozeman and vicinity as determined through community and Health Care Agency input

$        Continued interest by potential students evidenced by numbers of students wishing to accept their upper division placement on the Bozeman Campus

$        Ability to increase the pool of professional nurses in Montana and the nation, thereby positively impacting the nursing shortage as evidenced by a lower RN vacancy rate based on  an increased number of graduates who take RN positions in Montana. .

IMPACT ON FACULTY, FACILITIES, COSTS, STUDENTS AND OTHER DEPARTMENTS AND CAMPUSES

There are no other nursing programs in the Bozeman area that require negotiation of clinical sites.  The two closest programs in Butte (University of Montana, Montana Tech) and Helena (Carroll College) are each 90 miles away.  Letters of support from the administrators of these programs are attached.

1. Additional faculty requirements, including qualifications, salary, and recruitment. 

A. Names and qualifications

Appendix D includes the list of faculty currently teaching on the Great Falls and Bozeman campuses.  Additional faculty will be required to teach the upper division students as delineated in Appendix D.

B. Specific qualifications sought, the projected availability of such candidates, and the anticipated salaries each will command

Current faculty who are teaching in the lower division courses at the  Bozeman campus will participate in teaching upper division courses appropriate to their expertise.  In addition, three  faculty will be recruited for the first year of the expansion to cover the nursing specialty areas of psych/mental health, community health, and family-child nursing.  By the second year of the program, an additional 2.5 clinical faculty  FTEs will be needed bringing  the total number for the proposed expansion to  5.6 (Appendix I).  Budget projections for additional faculty are estimated using a salary base of $50,000 per FTE.   The search for additional faculty will begin during the 2003-2004 year using the established search policies and procedures in the College of Nursing.

2. Impact on facilities.

A. Library

It will not be necessary for the library to add more journals/books to the collection since the current collection is adequate. 

B. Computer services

As new faculty are hired, new computers including software and printers will be needed.

C. Telecommunications

Two Poly-com Telecommunication Systems are in the process of being purchased for the Bozeman campus and the Great Falls campus to allow interactive video between the two campuses.  These systems are being purchased with grant monies.

D. Space/capital requirements

A space utilization study has been completed for Sherrick Hall and a fund raising  campaign is in process to fund the renovations.  In the meantime, Bozeman Deaconess Health Center has agreed to work with the College of Nursing to provide possible office and/or classroom and conference room space.

E. Support services

With the recent hiring of a receptionist and the reconfiguration of support staff assignments, the need for additional support is not anticipated to support the proposed expansion.

Anticipated Costs

Appendix I provides information about all of the projected annual costs based on the assumption that students will begin junior level course work in August 2004. Costs of the program will increase as the number of students increase.  Beginning in year three (2006-2007) it is anticipated that costs will stabilize with any  increases being due to market adjustments.

Letters of Support

Appendix G contains letters of support from:

·         Bozeman Deaconess Hospital

·         Gallatin Mental Health Center

·         Gallatin Community Clinic

·         Gallatin City-County Health Department

Appendix H  includes letters of support from the two closest RN nursing programs:

·         Carroll College, Helena Montana

·         Montana Tech of the University of Montana, Butte, Montana    

Bureau of Health Professions.  Health Resources and Services Administration. U.S. Department of Health and Human Services (2002). Projected supply, demand and shortages of registered nurses: 2000-2020. [Online] Available http://bhpr.hrsa.healthworkforce/rnproject/default.htm.

Governors Blue Ribbon Task Force on Health Care Workforce Shortages (2002). Findings and proposals for montanas health care workforce. Helena: Governors Office.

Kimball, B. and ONeil, E. (2002). Health cares human crisis: The American nursing shortage. Princeton, New Jersey: The Robert Wood Johnson Foundation.

Osen, K. (1999). A study of upper division placement in the college of nursing. Unpublished masters thesis, Montana State University, Bozeman, Montana.

(available upon request)

     APPENDIX A

          Sample Plan of Study

 

     APPENDIX B

           Map of Bozeman and Vicinity

 

     APPENDIX C

           County Health Profiles

 

      APPENDIX D

            Qualified Faculty

 

      APPENDIX E

            Clinical Resources

 

      APPENDIX F

             Upper Division Placement

 

      APPENDIX G

             Letters of Support (Agencies)

 

      APPENDIX H

             Letters of Support (Nursing Programs)

 

      APPENDIX I

             Anticipated Costs