Johns Hopkins University
The School of Nursing was formally established in 1983 as the eighth academic division of the University. An initial class of 27 baccalaureate students was admitted in the fall 1984. Currently, 570 students are enrolled in academic programs ranging from baccalaureate through post-doctoral. The School enjoys an active alumni and a rich nursing heritage dating back to the Johns Hopkins Hospital-based diploma program that began in 1889.
As the School of Nursing expanded its academic programs after 1983, its original classroom space was no longer sufficient. In December 1997, the School moved into a new education and research building on the East Baltimore campus. To accommodate the increased need for student, faculty, and research space, the School is planning an addition to its building.
The baccalaureate curriculum is undergoing a thorough evaluation by a Task Force on Curriculum Review and Revision in 2003-04 as part of the overall Evaluation Plan for the School, found in the 2002 NLNAC Self-Study Report. A report is anticipated in March 2004, and any recommendations for change will be reviewed by the Baccalaureate Curriculum Committee. In response to the current severe and prolonged national nursing shortage, an evaluation of the School's capacity to expand baccalaureate class size is underway. Consideration of classroom space and utilization, and availability of additional clinical sites, faculty, and support staff will be important factors.
The School continues to evaluate strategies to provide effective teaching and student services for a baccalaureate program that includes mostly second-degree students with an average age of 27. The current capital campaign entitled, "Who Will Care for Us?," highlights the need to raise funds to support an addition to the School of Nursing, to increase scholarship support, to increase funding for new academic and research initiatives, and to increase the overall endowment to lessen dependency on tuition dollars.
In 2004, the School of Nursing will celebrate its first 20 years as a University division through a series of milestone events. There is much to celebrate. The School has admitted its largest and most accomplished baccalaureate class in its history. Graduates of the program have the highest pass rate on National Council Licensure Examination (NCLEX) among Maryland baccalaureate programs; the School is ranked ninth among Schools of Nursing in funding from the National Institutes of Health, National Institute on Nursing Research (NINR); and graduate programs are ranked in the top five by U.S. News & World Report.
The School looks forward with optimism to its many challenges — increasing the diversity of its students and faculty, educating increased numbers of students while anticipating a severe nationwide shortage of faculty, creating opportunities for international collaboration for research and education, maintaining fiscal stability in the midst of multiple unfunded federal regulation mandates, and decreased state support — to name a few.
Johns Hopkins University has continuously adhered to the philosophy of Daniel Coit Gilman, the University's first president: teaching and research are inseparable components of a university, and the objective of the University should be the creation as well as the collection and dissemination of knowledge. The University's commitment to research and professionalism remains constant throughout its constituent parts. The University is decentralized in that it has eight schools and several independent institutes and centers, each of which has a high degree of autonomy. This characteristic also is found at the departmental- and faculty-level, such that independence is vigorously exercised throughout the organization's layers. Each school has a full and somewhat parallel administrative structure where a large majority of the work is done.
The mission and philosophy of the School of Nursing are congruent with the mission and purposes of the governing organization. The mission of the Johns Hopkins University is many-faceted and includes the highest quality of teaching for students; the recognition that learning is a lifelong process; a creative and relevant sense of public service; and a pervading involvement in the international scope of scholarship, education and training.
The mission and philosophy of the School are to provide leadership to improve health care and advance the profession through education, research, practice and service. A thorough comparison of selected examples of congruent statements from the Johns Hopkins University mission statement and the mission and philosophy of the School of Nursing can be found in the 2003 Commission on Collegiate Nursing Education (CCNE) Self-Study Report and the 2002 National League of Nursing Accrediting Commission (NLNAC) Self-Study Report.
The School of Nursing's Baccalaureate Curriculum Committee has reviewed the institution-wide undergraduate mission statement recommended by the Commission on Undergraduate Education. The Committee believes that most of the content is included in the existing School of Nursing mission and philosophy statement. However, the institution-wide statement will be included as part of the ongoing committee discussions on Curriculum review and revision, according to the Evaluation Plan.
The School of Nursing's mission and philosophy are published in the School's catalog and on the School's website. Both are updated annually by the Offices of the Senior Associate Dean for Academic Affairs and the Associate Dean for Student Affairs. Goals for the baccalaureate program are outlined in the appropriate academic manual and on the School's website. The Faculty reviews and revises, when indicated, the mission, philosophy, and goals/objectives of the programs (program outcomes) through a systematic evaluation process as outlined in the Evaluation Plan. According to the Evaluation Plan, the mission and philosophy are evaluated every four years, under the direction of the Chair of the Steering Committee of the Faculty Senate.
Baccalaureate program outcomes were formally reviewed in 2001 in the Baccalaureate Curriculum Committee and are again under review during 2003-04. The most recent formal review of the School's mission and philosophy took place in the fall 2002, when the School completed a self-study in preparation for an accreditation evaluation by the National League for Nursing Accreditation Commission (NLNAC). Ongoing discussions pertaining to congruency of curriculum content with program objectives, as well as the School's mission and philosophy, are an important activity of each curriculum committee. Data are collected regularly via course evaluations, end of program outcomes measurement, graduation and alumni Surveys, employee surveys, and focus groups used for program improvement.
The institution seeks to admit students whose interests, goals, and abilities are congruent with its mission.
As noted under Standard 1, the mission of the School of Nursing is to provide leadership to improve health care and to advance the profession through education, research, practice, and service. Graduates are expected to set the highest standards for patient care, exemplify scholarship, be sensitive to changing societal needs for nursing care, be committed to health care for all individuals and populations, and provide a positive and innovative force in the evolution of the nursing profession and the changing health care system.
As stated in the School of Nursing catalog and on the School of Nursing website, the School seeks to admit students who will bring qualities of scholarship, motivation, and commitment to the student body. Admissions criteria and application procedures for the baccalaureate program are fully explained in the School of Nursing catalog and on the School's website. The academic program, including prerequisite requirements, transfer of lower- division credit, challenge examinations, special instructions for evaluation of international coursework, and description of the program of study, is fully explained in the School of Nursing catalog. The catalog is reviewed and updated yearly and receives final approval from the Senior Associate Dean for Academic Affairs as is outlined in the School's Evaluation Plan.
Program outcomes for the baccalaureate program are included in the School of Nursing catalog and on the website. These outcomes include the expectation that, upon completion of the program, the graduate will be able to:
Assess, plan, implement and evaluate nursing activities for individuals, families and communities, based on principles derived from biological, physical, psychological and social sciences, the humanities, and from financial, management and nursing theories;
Assist individuals, families and communities, in a culturally competent manner to promote health, prevent illness, and to cope with health problems;
Use available resources for the benefit of individuals, families and communities;
Function as a member of a multidisciplinary healthcare team, based on knowledge of the interrelationships of roles of the professional nurse and other providers of care;
Make professional decisions in nursing practice;
Integrate principles of leadership in nursing practice in diverse health care settings;
Use knowledge of the research process in applying findings to nursing practice;
Demonstrate continued growth in the profession of nursing; and
Demonstrate professional commitment in nursing by being accountable for our actions, by maintaining standards of practice, and by adhering to professional values.
As noted in the Evaluation Plan, the Baccalaureate Curriculum Committee, a standing committee of the Faculty Senate, is responsible for reviewing courses within the curriculum every four years to ensure that courses give clear evidence of being based on School of Nursing philosophy and identified program outcomes. The 2003-04 Baccalaureate Curriculum Committee is currently reviewing all coursework, program outcomes, and the organizing framework.
The Baccalaureate Admissions Committee, another standing commitef of the Faculty Senate, reviews all completed applications and determines eligibility for admission based on established criteria. To inform its decision-making, both the Baccalaureate Curriculum and the Admissions Committees review graduation and retention data for admitted cohorts and passage rates on the National Council Licensure Examination (NCLEX) for its graduates. Data for the most recent years are presented below.
The Director of the Baccalaureate Program and the Chair of the Baccalaureate Curriculum Committee review the records of those baccalaureate students failing the NCLEX examination for common predictors such as entering GPA and performance in specific nursing courses. Poor performance in three courses - Pathophysiology, Pharmacology, Principles & Application of Nursing Technologies II - has, in the past, been correlated with NCLEX failure. Implications for student advisement are being discussed currently in the Baccalaureate Curriculum Committee.
The Baccalaureate Admissions Committee plans to review the academic records of students dismissed for academic reasons or placed on academic probation to see if there are common denominators within the prerequisite coursework that may help predict poor performance. One concern is that the "age" of prerequisite courses such as Anatomy and Physiology, if greater than five years, may be a factor.
The School of Nursing is concerned about the enrollment of minority students, including men, to all academic programs. Statistics for fall 2003 baccalaureate enrollment are presented in the following two charts.
The University is committed to increasing the diversity of the undergraduate student body. The School of Nursing has undertaken the following steps towards meeting that goal:
Hired an additional minority recruiter in the Office of Admissions and Student Services (two of 3 recruiters are African-American; one is a male African- American);
Revitalized the Black Student Nurses Association through the Office of Student Services; series of guest speakers has been arranged; spring event with Black alumni being planned;
Developing an articulation agreement with Morgan State University (Baltimore, MD), a traditionally Black institution;
Exploring the development of an articulation agreement with Spelman College, another traditionally Black institution;
Planning a recruitment event geared towards men with the help of male alumni and faculty;
Participating in the Baltimore Scholars Program to be initiated in fall 2004; and
Highlighting accomplishments of minority alumni, students and faculty (including men) in School of Nursing publications, including the School of Nursing magazine.
Information about financial aid, scholarships, grants, loans, and refunds is available to both prospective and current students and their families on the website, in the catalog and in the financial aid informational pamphlets mailed to applicants. Website changes are made whenever new opportunities become available. In addition, the Office of Student Financial Services is available to speak with prospective applicants and their families about the financial aid process. The Office participates in School of Nursing Recruitment Open Houses by offering a seminar on financial aid and has participated in West Coast recruitment events. This information is reviewed annually for accuracy.
The Office of Student Financial Service presents a yearly report that informs the School of Nursing leadership team of students' average indebtedness and sources of funding. In addition, this information is shared with the School's Development Office, potential donors, the School of Nursing's National Advisory Council, and the Maryland State Legislature (on invitation) to underscore the increased need for scholarship monies for baccalaureate students. Of great concern is the student who borrows heavily to attend the School and must work while attending school. Too often, this combination can lead to poor academic performance, inability to complete the program "on time," or withdrawal.
Graduation rates and NCLEX passage rates are published in the School of Nursing catalog.
In keeping with the decentralized nature of Johns Hopkins University, each School offers many of its own student support services while sharing others that can be more easily centralized.
Under the direction of the Associate Dean for Student Affairs, the School of Nursing has its own Office of Admissions and Student Services, Office of the Registrar, and Office of Student Financial Services. A part-time career specialist is available on-site two days each week, and a clinical psychologist from the Homewood campus Counseling Center is on-site one day each week with availability at all other times on the main campus. International students are assisted by the Office of International Services which is located on the East Baltimore campus and which also provides services to the Schools of Medicine and Public Health. School of Nursing students receive healthcare through the Student Health and Wellness Center on the Homewood campus. The Associate Dean for Student Affairs also serves as the disability coordinator for students. A more complete description of student support services can be found in the 2002 NLNAC Self-Study Report. All student support services are provided by qualified professionals. Student support services also are described in the School of Nursing catalog.
At the present time, the School of Nursing does not offer programs at locations other than the East Baltimore campus, and there are no distance education programs. A Task Force has been convened by Dean Hill to examine the feasibility of distance education. Should such programs be developed, feasibility of delivery of student support services to this audience would be a major consideration.
Student academic advisement is provided by the faculty. Assignment of faculty advisors is made by the Admissions Office in consultation with the Director of the Baccalaureate Program. Expectations for advisors and advisees are outlined in the Faculty Manual and in the Baccalaureate Academic Manual.
A need to improve academic advising was recognized by the faculty and the Senior Associate Dean for Academic Affairs largely as the result of student program evaluations. This need is consistent with recommendations from CUE. In August 2003, a Faculty Advisement workshop was held for all faculty under the direction of the Senior Associate Dean for Academic Affairs and the Associate Dean for Student Affairs. These workshops will be held each year. A method for evaluating academic advisement and for recognizing excellent advisement is under discussion.
The School of Nursing offers no sports teams of its own, but nursing students may participate in teams offered on the Homewood campus. Currently, one senior is a member of the Johns Hopkins University Women's soccer team.
Procedures for student grievances are outlined in the Baccalaureate Academic Manual as are nursing students' rights and responsibilities. Student complaints or concerns about the baccalaureate program are submitted to and reviewed by the Associate Dean for Student Affairs or the Senior Associate Dean for Academic Affairs.
All student academic records are maintained in the Office of the Registrar. The Statement Regarding the Privacy Rights of Students is located in the Baccalaureate Academic Manual and in the School of Nursing catalog. See the NLNAC Self-Study Report for a detailed description of maintenance of student educational and financial records.
Student support services are evaluated by each graduating class. In the past, this evaluation was in the form of an open-ended questionnaire. In 2003, questions were added to the EBI (Educational Benchmarking, Inc.) Nursing Student Program Assessment Questionnaire. Three areas for improvement were identified:
The need for more information about student housing and roommates. The School of Nursing offers no residential housing except for one dormitory (Reed Hall) on the East Baltimore campus. During the summer 2003, additional information about housing and links to a variety of websites were added to the School of Nursing website. In addition, rental agents from local real estate companies and apartment complexes were invited to the annual Accepted Students Day.
Services provided by the uniform vendor. Students were displeased with the disorganized business practices of the current vendor and the poor quality of the new uniform. To date, three new vendors have been interviewed, and a new one will be chosen for 2004-05.
Slow reimbursement by the health insurance provider (Chickering Group). Students expressed frustration with billing practices. The providers are reviewed each year by a University-wide committee that includes student representation. Comments from our students will be forwarded to this group.
Career services have been greatly improved for School of Nursing students with the addition of a Career Specialist during the 2002-03 academic year. Opportunities for summer internships have been developed and communicated on the web, a series of "Lunch & Learn" sessions with nursing professionals in a variety of clinical specialties has drawn large crowds of students to the career website, resources have been greatly expanded, and networking with potential employers has increased. Many of these changes were made possible by the strong message of need identified during the CUE process and the willingness of School of Nursing administration to fund the position. A newer area of development will be increasing international opportunities for students.
As of January 15, 2004, there are 175 faculty members: 75 full-time and 100 part-time. The part-time faculty consists of 89 clinical instructors, five lecturers, and six adjuncts. The full-time faculty includes 42 full-time on rank (assistant professor or higher). Thirty-nine of the full-time faculty hold doctoral degrees. All faculty are experts and qualified in their teaching area and the courses to which they are assigned
Evidence that the faculty are appropriately prepared and qualified for the positions that they hold can be seen in the 2002 NLNAC Self-Study Report. Forty-three faculty currently have advanced practice certification. Many faculty have received federal, local, and private funding for their research. One faculty member received a Fulbright Teaching Scholarship for teaching in Zarqa, Jordan in fall 2000. Faculty of the School are members of national, regional, and local nursing organizations and research review boards, advisory panels, and editorial boards. Faculty have received national recognition for excellence in teaching, community or professional service, and nursing practice. Twelve faculty are fellows in the Academy of Nursing. An additional two faculty members were inducted into the Academy of Nursing in fall 2003; two new faculty members are already members. Faculty productivity has been exceptional in the area of scholarly presentations and publications.
It must be noted that in 1999 the Academic Council approved a recommendation that all ranked faculty who did not have an earned doctorate must be enrolled in an approved doctoral program by July 1, 2002. The faculty member would be expected to complete the degree by the end of seventh contract year of continuous appointment. Ten faculty members are currently enrolled in doctoral programs; at least two will complete programs in May 2004.
One of the teaching responsibilities of the faculty is that of designing, implementing, and evaluating the curriculum. The Baccalaureate Curriculum Committee is responsible for developing policy, courses of study, making decisions about curricular issues, and reviewing and evaluating all baccalaureate courses. The committee consists of the Director of the Baccalaureate Program, two voting members of the Faculty Senate, a Chairperson appointed by the Dean or a delegate of the Dean, and course coordinators of all required baccalaureate courses. The Senior Associate Dean for Academic Affairs serves as an ex-officio member, and student representatives are non-voting members. The committee meets bi-monthly. Courses are reviewed and presented regularly. Task groups are formed as necessary to examine and analyze content placement within and across courses. Recommendations for major curricular changes are brought to the Faculty Senate by the Curriculum Committee for approval by voting faculty. The School's plan for systematic evaluations and assessment of educational outcomes can be found in the 2002 NLNAC Self-Study Report. This Evaluation Plan guides the School's assessment of baccalaureate and master's curricula.
All faculty who hold the rank of Instructor, Assistant Professor, Associate Professor, or Professor are expected to be actively contributing not only to teaching but three other areas as well: scholarship, service, and professional practice. A faculty member is appointed by the Dean, at a rank of Instructor through Professor, to one of two tracks in the School: the Research Education Track or Practice Education Track. Faculty appointed to the Research Education Track are involved predominantly in discovery scholarship and focus on activities related to the conduct of research projects, teaching of research methods, advising doctoral students, and assisting with dissertations and other research-related scholarly activities. Faculty appointed to the Practice Education Track are predominantly involved in clinical practice and focus on activities that include teaching related to clinical practice and research and scholarly products related to clinical outcomes. The well-delineated roles for faculty in the two tracks are a strength of the program. There are 14 Research Education Track Faculty and 32 Practice Education Track Faculty.
The choice of track and assignment of rank are based upon the match of the faculty member's interests and qualifications, using the established criteria and performance examples for each of the four areas, as detailed in the School of Nursing Faculty Manual. The Preamble to this document, which specifically addresses Standard 10, is as follows: "The appointment and promotion criteria developed by faculty and approved by the Academic Council provide guidance for achieving each academic rank within the School."
The criteria and guidelines for faculty appointment and promotion, as found in the Faculty Manual, are intended to provide recognition of different forms and measures of achievement for faculty engaged primarily in research and for those involved in clinical practice. Faculty are expected to provide local, state, regional, national, and international leadership in nursing and health care within teaching, scholarship, service, and professional practice arenas. At each successive rank, an expanding scope of influence is expected. This expectation has several dimensions, from instructors evaluated for their contributions and influence at the local level to full professors at the national and international levels. In addition, the criteria also embrace different professional and scholarly audiences, the context of health care, and other major venues of faculty activity. Moreover, the materials prepared by faculty, when being considered for appointment or promotion to a rank, should illustrate the faculty member's impact and contributions, not mere quantity of activity. Faculty members also are expected to demonstrate continuing contributions commensurate with rank at each evaluation point.
The Dean, Senior Associate Dean for Academic Affairs, and the Associate Dean for Faculty Affairs each serve in a mentoring role to faculty by reviewing CVs and annual faculty reports that document a commitment to expertise in teaching, scholarship, practice, and service. The role of Associate Dean for Faculty Affairs was initiated specifically to assist faculty with scholarly productivity and mentoring. At the end of each academic year, all full- time faculty complete an annual Faculty Activity Report outlining accomplishments in the four key areas not only within the School but also across the University, state, nation, and globe. Goals for the ensuing year also are stated. These reports are kept on file in the Senior Associate Dean's Office. Each full-time faculty member then meets with the Senior Associate Dean to review performance and accomplishment of goals. This review has multiple purposes. Faculty productivity is evaluated for merit raises. Decisions regarding assignments for the next academic year are discussed. Administrative decision-making regarding faculty reappointment is facilitated. The review also serves as a guide to full-time faculty regarding promotion. Guidance is provided as needed, and faculty are assisted in achieving their goals. For example, if service to the University is needed, the Provost's Office is made aware of faculty who should be considered for membership on University-wide committees.
Although the faculty in the Research Education Track and Practice Education Track constitute the core of faculty directly responsible for the educational programs of the School, they are supported in the clinical teaching mission by a group of faculty with the title Clinical Instructor. The clinical expertise of the Clinical Instructors and other part-time faculty is invaluable to the baccalaureate program. Clinical Instructors also lead by example and set standards for learning in their interactions with students. They also are active participants in the affairs of the School. Though they are non-voting, they enrich the discussions in Faculty Senate meetings and in other ad hoc groups. They, too, are evaluated and reviewed annually by course coordinators and the Senior Associate Dean for Academic Affairs.
The Faculty Manual provides written information needed by all full-time, part-time, and clinical instructors: Academic Council Policies and Procedures; Appointment and Promotion; Faculty Senate Standing Committees and Membership; Faculty Practice Plan; and Grievance Procedures, Conflict of Interest and Advisement Guidelines. In the event changes occur prior to the next scheduled publishing of a specific academic manual, the changes are sent to students and/or faculty in writing. Academic freedom, within the institutional mission, is adhered to.
Faculty recognize that nursing exists in a dynamic state of interaction with its internal and external environments. Nursing is a part of a complex health care system and as such is subject to contemporary influences. Preparation of graduates who can practice in a rapidly changing and diverse world requires a curriculum grounded in evidence- based practice and a faculty with a futuristic perspective. Baccalaureate and master's students in the School are taught in a manner that meets or exceeds the scope of nursing practice as defined by Maryland Law and Statutes on Scope of Practice. The baccalaureate and master's curricula, program purposes and objectives/competencies are based on core standards of practice put forth by the American Association of Colleges of Nursing in their publications: The Essentials of Baccalaureate Education for Professional Nursing Practice (1998) and The Essentials of Master's Education for Advanced Practice Nursing (1996). Likewise, the faculty used the Baccalaureate Essentials as a framework to shape and evaluate the baccalaureate curriculum with respect to program purposes and objectives while paying close attention to the current scope of nursing practice and contemporary professional values and beliefs. This document helped the faculty shape the competencies expected of the baccalaureate nursing student. The Essentials are consistent with the School's philosophy and have represented the organizing framework for the baccalaureate and master's programs. (See the report of the Task Force on Baccalaureate Curriculum Review and Revision; available after March 2004.)
There are two options for the B.S. degree with a major in nursing, as represented by the figure below.
Options for Bachelors of Science Degree
The Traditional Option is two academic years (four semesters) and is available to students with and without a previous bachelor's degree. This option begins annually in September. The School has articulation agreements with eleven colleges and universities in six different states. These agreements allow students to obtain essential pre-nursing coursework in an affiliated institution and to receive preferential admission. In some cases, when requirements for another major have been met in addition to the nursing prerequisites, the students earn a degree from each institution within five years of study.
The Accelerated Option is offered over 13.5 months (four semesters) and is available to students with a previous bachelor's degree in any non-nursing major. This option begins annually in June and includes two summer sessions and one academic year. The same material in each of the courses is covered as in the Traditional Option. The upper-division baccalaureate curriculum (Levels II and III) is composed of the nursing major and, for the non- degreed student, nine credits of electives.
Outcomes for each level are listed and linked with program outcomes. Coursework in Levels II and III is sequential and planned for full-time study. Level II courses build on knowledge from Level I coursework. Courses focus on the acquisition of knowledge, situation/context analysis, and application in nursing practice. Level III courses provide students with greater depth in analysis, synthesis, and evaluation. The curriculum is organized so the student initially focuses on the health care needs of individuals, then on families, and finally on communities. The NLNAC Self-Study Report provides a detailed description of the School's plan for evaluation and assessment of educational outcomes. Additional information regarding program effectiveness can be found in the CCNE Self-Study Report. At graduation, baccalaureate students are evaluated on their attainment of three program outcomes: critical thinking, communications, and therapeutic intervention skills.
In general, the requisite knowledge, theory, and technology needed for practice are taught in upper-division theory courses. Clinical nursing courses focus on synthesis and application of knowledge and skills from a variety of disciplines to meet the nursing care needs of various patient populations. For example, in Level II, there are eight theory courses and three clinical courses. Theory relevant to pathophysiology and pharmacology is taught, respectively, in NR100.313 Principles of Pathophysiology and NR100.314 Principles of Pharmacology. Nursing theory and concepts (e.g., collaboration, use of resources, and the health care system) are taught in NR100.301 Context of Nursing in the Health Care System. Mastery of nursing psychomotor skills and complex nursing and healthcare technologies are taught in NR100.304/312 Principles and Application of Nursing Technologies I and II. Utilization and application of information technology and statistical tests in nursing practice are taught in NR100.494 Introduction to Information Technology, NR100.316 Information Technologies in Nursing, and NR100.308 Biostatistics. Clinical courses build on didactic coursework through knowledge and skill application in target populations and health care settings.
Clinical resources for the baccalaureate courses are varied and plentiful. In the baccalaureate program, where the focus is primarily on inpatient care, there are from 14 to 20 inpatient sites located throughout the Baltimore/Washington metropolitan area available for each course. The faculty to student ratio varies from 1:4 to 1:8, depending on the rotation. Enrichment experiences associated with key rotations include placements at a variety of ambulatory and home care sites, in operating rooms, intensive care units, emergency departments, and detention centers. Depending upon the number of students, rotations in Community Health use from 11 to 18 clinical sites throughout the city and surrounding counties and also use many additional sites for enrichment experiences. For example, students may visit the state capital or Washington, D.C. to view the legislative process, or travel to the federal offices of the Indian Health Service or the Pacific Asian Health Organization to explore the variety of national and international public health initiatives being pursued. The final clinical practicum, NR100.407 Leadership in Contemporary Nursing, a seven credit hour course, is divided into three credit hours of theory and four credit hours of clinical practice. Students choose a practice setting from an extensive list of sites in Virginia, Washington, D.C., Maryland, Pennsylvania, and Delaware. During this seven week clinical practicum, students work with a clinical preceptor in their assigned practice setting for 32 hours/week, or 224 total hours. The clinical practicum is managed by assigned faculty mentors from the School. Students involved in the community outreach track also have a wide variety of clinical sites (over 25) from which to choose.
Faculty and students systematically evaluate the curriculum and teaching-learning practices. Individual course evaluations are presented each year to the Baccalaureate Curriculum Committee. This committee meets every two weeks (September through June). Aggregated student evaluations and course coordinator recommendations are reviewed. Relevant concerns about the content or teaching/learning practices are discussed and addressed. In addition, the entire Baccalaureate Curriculum is being reviewed during 2003-04 with input from an external consultant. Coursework is enriched by the participation of a number of interdisciplinary guest lecturers drawn from other Hopkins divisions and the community. For example, community health faculty invite nurses from the Bloomberg School of Public Health to address environmental health and the health care delivery system. Other guest lecturers include the Baltimore City Commissioner of Health and the Program Director for the State Lead Program. Three lectures in the pharmacology course are taught by a pharmacist affiliated with the School of Medicine.
The traditional and accelerated baccalaureate options utilize the same faculty, the same coursework and clinical sites and the same number of clinical hours. Differences lie in prerequisite requirements (accelerated students must have a previous baccalaureate degree in another field) and vacation. Traditional students have no classes in the summer and the January Intersession. Accelerated students attend class year round. Graduation, NCLEX passage, and employment rates are compared under Standard 14.
Technology and Library Resources for Faculty, Staff and Students
Computer technology resources are located in several sites across the campus, with dedicated computer labs for nursing students available in two larger computer labs, one small doctoral lab, and a tiered teaching lab located on the third floor of the School. Students receive formal class instruction on the use and integration of computer technologies and health care through courses at both the baccalaureate and master's levels (NR100.316 Information Technologies in Nursing, NR 100.494 Introduction to Information Technologies in Nursing, and NR100.515 Nursing Informatics). Faculty and staff may participate in computer software courses offered by the Welch Medical Library and the computer services department within the School. Assistance also is available to students, faculty, and staff from both the School's computer services department and Welch Medical Library.
Baccalaureate students use a variety of technologies throughout their courses of study. A major new initiative is the integration of personal digital assistants (PDAs) and pocket PCs into the clinical experiences of students and practice sites of faculty. In collaboration with the School of Medicine, students have access to six infra-red ports that allow them to use synching technology to download free software to their PDAs. Frequently used software includes drug and clinical management databases.
The School has current and comprehensive library resources available at a variety of sites not only within the building, but at multiple sites on the East Baltimore campus, including both clinically-based and school-based satellites, at the University's extensive library system, and through full access to other libraries' resources across the country.
The Nursing Information Resource Center (NIRC), located on third floor of the School, is a satellite of the William H. Welch Medical Library and is 1,297 square feet with 13 study carrels, two eight seat desks, a 15-seat group study room, and two copy machines. This reserve room contains over 1,100 books; four print journals; and many audiovisuals, pamphlets, and reserve readings targeting specific study needs of the student population. In spring 2003, the School moved from hard copy reserve material to electronic reserves. Students are able to access key reserve journal articles via an e-reserve site within each course website. Required textbooks as well as other supportive course materials are available in the NIRC. The NIRC has two computer workstations to search the Welch Medical Library as well as Sheridan Libraries' databases and online catalog.
The William H. Welch Medical Library is the central information resource for the Johns Hopkins Medical Institutions. The library's mission is to provide the institutions on the East Baltimore campus (Schools of Nursing, Medicine, and Public Health; the Johns Hopkins Hospital; and Kennedy-Krieger Institute) with information services that advance research, teaching, and patient care. The library collection contains over 2,600 nursing books and nearly 400,000 books overall. Total journal holdings exceed 2,400 with 111 nursing journals, of which 48 are available online as well as in print and another 31 only online.
Other satellites of the Welch Medical Library open to students and faculty are the Lillienfeld Library, housing public health resources; the Meyer Library, housing collections in psychiatry, neurology and anesthesia/critical care; and the Population Information Resource Center, a collection of population dynamics information.
On the Homewood campus, the Sheridan Libraries provide a wealth of print and electronic resources. Together its collections provide the major research library resources for the University and its academic programs worldwide. The Sheridan Libraries have over 2.5 million books and 14,000 print journals with specialized facilities and collections in international affairs, medicine, public health, and music. Electronic resources include more than 3,000 e- journals, 500 e-books, and 300 e-databases available for searching. The Sheridan Libraries' Digital Library Program employs emerging technologies and staff expertise to develop new information resources, advance distance education opportunities, and experiment with emerging technologies including robotics.
Books and journal articles not available on the East Baltimore campus may be requested from other libraries through interlibrary loan. This service has recently merged with document delivery, allowing faculty and students to request and receive books and documents free of charge. Faculty and students can search the literature and all of the University's holdings through a wide array of search mechanisms. The ability to search from a home computer via Remote Access to University Libraries (RAUL) is available to students and faculty.
The Library Committee meets quarterly and includes representation from faculty, administration, library staff and students. The committee evaluates current library holdings, discusses additional resources and services needed, and identifies new acquisitions and services available to faculty and students. Requests for new acquisitions may be submitted at any time either directly to the Acquisitions Director, to a faculty committee representative, or online. Student input is gleaned through periodic surveys and direct discussion with library staff or administrative/faculty representatives. All course coordinators are encouraged to submit required course books and other resources to library staff for prompt purchase and accession.
The Associate Dean for Finance and Administration is the School's representative to the Welch Medical Library Advisory Committee Financial Group. Administrative decisions including budgetary considerations are made by the committee. The School contributes to the overall budget of the Welch Medical Library and the NIRC according to a formula applied to all East Baltimore campus schools. The Senior Associate Dean for Academic Affairs serves on the Welch Library Advisory Committee Service Group.
There is an active education program for students and faculty addressing the services and resources provided by the Welch Medical Library, the library search systems and databases, reprint file management, and use of Internet resources. The School has a designated library liaison responsible for meeting the learning needs of students, faculty, and staff. The library liaison also is charged with improving and expanding collection development; increasing faculty, student, and staff use of library resources; and supporting teaching, research, and clinical needs of library users. Over the past year the library liaison has provided approximately 30 sessions for students covering topics such as Welch Library orientation and resource training. The liaison also attends all library meetings and, at least annually, meets with faculty and staff to review and update services available and to respond to requests and questions. The Welch liaison recently developed Internet resources and associated links useful for students as they begin to search the World Wide Web on health-related topics.
Many course coordinators have created course websites that allow student access to online syllabi and other course materials including practice quizzes, case studies, and chat rooms. Assuring web support for all courses and adding e-reserves to course websites were goals for this academic year.
Course syllabi are distributed for each course and include expected learning outcomes. Current syllabi will be available for review by the Evaluation Team during the March visit.
The School of Nursing seeks students who bring qualities of scholarship, motivation, and commitment. Applicants are required to have a strong academic record for acceptance. There are two options for entry: First degree option and Second degree option.
First Degree Option
Student progression through the baccalaureate curriculum includes prerequisite (foundational) coursework which is general education. Foundational coursework is referred to as Level I coursework. Level I coursework supports the upper-division nursing major and is a prerequisite to the student's matriculation. For non-degreed students, this includes 60 prescribed credits in the humanities (9 credits), social sciences (15 credits), natural sciences (6-8 credits with lab requirement), and electives (15-18 credits). All applicants must complete anatomy and physiology (all systems) and microbiology. Students are held accountable for any information from the prerequisite coursework not part of their initial bachelor's degree (e.g., nutrition). Their coursework in the upper-division (Levels II and III) is composed of the nursing major and nine credits of electives that can be focused on nursing electives or electives in general education offered in other schools in the University.
Second Degree Option
This is an option for students who have completed a bachelor's degree in another field and now choose to pursue a career in nursing. There are fewer prerequisites in the second degree option. The program requires coursework in Anatomy and Physiology covering all body systems (usually 2 semesters, 6-8 credits) and 3-4 credits of Microbiology. Courses that may enhance the student's applications but are not required include courses in Nutrition, Chemistry, Human Growth and Development, and basic Biostatistics.
The general education courses, either in the first two years of a baccalaureate degree for non-degreed students or in the backgrounds of the already degreed students, are essential to success and to the achievement of the ultimate program outcomes for nursing practice. Level II and Level III outcomes build on those achieved in general education courses.
As was previously noted under Standard 8, all policies and procedures for prerequisite coursework, transfer of lower- division credit, challenge examinations, special instructions for evaluation of international coursework are explained in the School of Nursing catalog.
The School of Nursing affirms the educational standards of the 1998 American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education for Professional Nursing. The Essentials describe liberal education as providing a "solid foundation for the development of clinical judgment skills required for the practice of professional nursing." Prerequisite coursework (and/or previous baccalaureate degrees in other fields) are designed to provide the professional nurse with the ability to:
Develop and use higher- order problem-solving and critical thinking skills;
Integrate concepts from behavioral, biological and natural sciences in order to understand self and others; Interpret and use quantitative data;
Use the scientific process and scientific data as a basis for developing, implementing and evaluating nursing interventions;
Apply knowledge regarding social, political, economic, and historical issues to the analysis of societal and professional problems;
Communicate effectively in a variety of written and spoken formats;
Engage in effective working relationships;
Appreciate cultural difference and bridge cultural and linguistic barriers;
Understand the nature of human values;
Develop and articulate personal standards against which to measure new ideas and experiences; and
Appreciate and understand the character of professions.
Upper-division nursing courses are designed to enhance oral and written communication, scientific and quantitative reasoning, critical analysis, synthesis and evaluation. Clinical nursing courses focus on synthesis and application of knowledge and skills from a variety of disciplines to meet the nursing care needs of various patient populations.
Review of admissions criteria, including prerequisite requirements, for congruence with upper-division courses occurs at least every three years by the Senior Associate Dean for Academic Affairs in conjunction with the Director of the Baccalaureate Program and the Baccalaureate Curriculum Committee.
The School of Nursing's mission is to provide leadership to improve health care and to advance the nursing profession through education, research, practice and service. Faculty affirm the educational standards of the American Association of Colleges of Nursing's The Essentials of Baccalaureate Education for Professional Nursing Practice (1998). Baccalaureate program outcomes flow directly from the Essentials and are leveled to reflect prerequisite knowledge as well as outcomes at the end of the junior and senior years. Course outcomes flow logically from the level outcomes.
In recent years, the School has placed greater emphasis on the use of outcome data as a means of evaluating program effectiveness and student achievement. Outcome data include number of graduates per class admitted, along with attrition rates; success of graduates on NCLEX; positions and settings in which graduates are employed; employers' satisfaction with graduates; and graduates' positions of leadership in state, regional, national and international organizations; scholarly productivity; and other forms of recognition attained.
Assessment of student achievement on the program-level is reflected in the School of Nursing Evaluation Plan. In the section titled "Program Effectiveness," the following anticipated outcomes are identified:
On an internally developed instrument that measures critical thinking, communication, and therapeutic intervention skills, a mean score of 3.0 or above (on a 4.0 scale) will be achieved in each area by graduating baccalaureate students;
Baccalaureate — 95% of students who matriculate will graduate in 2 years;
Baccalaureate — 90% of graduates will pass NCLEX on first attempt;
At least 95% of graduates who seek employment will obtain jobs or enter educational/experiential programs commensurate with their educational preparation within 6 months of graduation;
Within six months of graduates being employed, employer satisfaction will be at an 80% level;
At least 70% of baccalaureate graduates will report achievements in professional public service and scholarship; and
Data are to be gathered every year, and data synthesis and development of findings, recommendations, and decision-making are to occur every four years.
Course Evaluation of Baccalaureate Students
Students are evaluated throughout their program of study via multiple measures of achievement of course objectives and level outcomes, with such strategies as teacher-made tests, written and oral assignments, and clinical performance tools. Course coordinators and clinical faculty/preceptors determine the appropriate use, content validity and reliability, and applicability of student performance measures. Clinical evaluation of student performance includes both faculty evaluation of the student and student self-evaluation. Academic advisors, who are regularly notified of their advisees' progress by course coordinators, monitor students' academic progress. Course coordinators refer students who have end-of-course academic failures to the Baccalaureate and Master's Progression and Graduation Committee for discussion and action.
Students must achieve at least 70% in order to pass a course. If the course evaluation measures include both examinations and other assignments, the student must achieve at least a 70% average in the examination component. Academic probation or dismissal may be assigned to any student who earns a semester GPA below 2.0 (C), whose cumulative GPA falls below 2.0 (C), or who does not achieve a minimum grade of C in both theory and clinical components of nursing courses. Students placed on probation must regain good standing within the next academic semester in which they are enrolled. Failure to do so may result in dismissal from the School.
At graduation, students are evaluated on their attainment of three broad program outcomes: critical thinking, communications, and therapeutic intervention skills. The Program Director is responsible for data collection and summarization, data synthesis, and development of findings that are presented to the Baccalaureate Curriculum Committee for development of recommendations, action, and reporting to the Faculty Senate.
baccalaureate Program Graduation Rates
Graduation rates are noted under Standard 8. Attrition rates are reviewed by the Baccalaureate Curriculum Committee and their implications for admissions, curriculum, and evaluation are identified and addressed by the Committee. The high graduation rates are believed to be the result of the excellent pool of candidates who apply to the program and an admission process that includes careful evaluation of applicants so that those selected are most likely to be successful in the program. Graduation rates are noted in the School of Nursing catalog.
The average pass rate on the national licensing examination (NCLEX) over the past four years has been 93.8%. The 2002- 03 pass rate was the highest for baccalaureate graduates in Maryland.
The Director of the Baccalaureate Program and the Chair of the Baccalaureate Curriculum Committee review the academic records of those graduates who fail the NCLEX exam in order to identify predictors of failure. These perceived predictors are then used to better screen applicants to the program, to provide additional academic services, and to monitor progression through the curriculum.
Program Evaluation by Students, Alumni, and Employers
During fall 2002, the Baccalaureate Curriculum Committee compared the AACN/EBI (Educational Benchmarking, Inc.) Nursing Student Survey with the Program Assessment Questionnaire, a School-generated form which had been used in past years to measure student satisfaction with the baccalaureate program. The Committee adopted the EBI form, with questions added to address student services issues. Among the questions on the form are several which address the degree to which students perceive they have met program/learning outcomes. The survey was administered to classes graduating in May and July 2003. The highest mean ratings for students were in the categories of technical skills, core competencies, professional values, and role development, all of which reflect satisfaction with their attainment of program outcomes.
The Baccalaureate Curriculum Committee also adopted the EBI Alumni Survey for administration to the May and July 2002 graduates. This survey replaced a School-generated form which had been used in past years to determine alumni satisfaction with the program. The EBI form, additional questions, and a letter from the Program Director were mailed in October 2003. The Committee anticipates receiving returned forms by the end of the calendar year. Results of the EBI Survey will be made available for the Evaluation Team's review.
Employment of Graduates
During graduation week, students are surveyed about employment. If they do not have a job at the time of graduation, they are given an addressed, stamped postcard to send to the Associate Dean for Student Affairs when they have secured employment. The rates of employment at the time of graduation for baccalaureate students who completed the program in years 1999-2003 are listed below.
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