LIBRARY Michigan State University This is to certify that the dissertation entitled A STUDY OF ORGANIZATIONAL PATTERNS AND FACULTY RESOURCE REQUIREMENTS FOR CLINICAL NURSING INSTRUCTION IN BACCALAUREATE NURSING PROGRAMS presented by Elmer W. Moisio has been accepted towards fulfillment of the requirements for Ph . D. degree in Educat ional Admin is t rat ion £11" 'V Khmer; Major professor Date M “f":- n- AWN...“ A ’ I" it - I . . o-‘m‘ MSU LIBRARIES Ana—'— \— RETURNING MATERIALS: Place in bookfidrop to remove this checkout from your record. FINES will be charged if book is returned after the date stamped below. A STUDY OF ORGANIZATIONAL PATTERNS AND FACULTY RESOURCE REQUIREst FOR CLINICAL NURSING INSTRUCTION IN BACCALAUREATE NURSING PROGRAMS By Elmer W. Moisio A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Administration and Curriculum 1986 ~ )f-El-h C730 ‘1 /< 4<(|‘ Copyright by ELMER W. MOISIO 1986 ABSTRACT A STUDY OF ORGANIZATIONAL PATTERNS AND FACULTY RESOURCE REQUIREMENTS FOR CLINICAL NURSING INSTRUCTION IN BACCALAUREATE NURSING PROGRAMS By Elmer W. Moisio The purpose of this study was to identify the organizational patterns that baccalaureate nursing programs use for clinical nursing education and the effect they have on the faculty resource require- ments for that education. The writer specifically posed five ques- tions: ‘What are the organizational patterns of clinical nursing instruction? What are the variations and combinations of organiza- tional patterns? 'What effect do the organizational patterns have on faculty resource requirements? What was the academic preparation of the faculty? and Was there a relationship between organizational patterns of clinical nursing instruction and faculty resource require- ments. based on selected demographic variables? Using a descriptive research design. 195 NLN-accredited baccalaureate nursing programs were randomly selected for survey by mailed questionnaire. Responses from the deans. chairpersons. directors. or heads of 120 baccalaureate programs provided data on 694 clinical nursing courses for inclusion in this study. Elmer W. Mbisio Statistical analysis provided information for each of the research questions. It was found that an overwhelming,majority of clinical nursing courses were taught using the organizational pattern of Supervised Clinical. Simulated Laboratory. Preceptor/Role Model. Independent Study. and Practicum/Internship were found to be used on a more limited basis. When organizational patterns were combined. the most frequent combination involved a heavy use of Supervised Clinical with lighter use of Simulated Laboratory. Student/faculty ratio. number of hours in clinic per week. full-time faculty. and academic preparation of faculty were used to determine the faculty resource requirements for each organizational pattern. Each organizational pattern generated significantly different resource requirements. .An analysis of the demographic factors of college/university size. program size. type of curriculum. and presence of a graduate program demonstrated that they had little to no effect on the organizational patterns and faculty resource requirements. To Dad Whose value and respect for education inspired me to pursue this degree. ACKNOWLEDGMENTS I would like to express my appreciation and gratitude to Dr. Eldon Nonnamaker. my chairperson. for his guidance and encourage- ment. and to the members of my committee. Dr. Richard Gardner. Dr. Ray White. Dr. Louis Hekhuis. and the late Dr. Richard Featherstone. I also want to thank the deans. Chairpersons. and directors of the baccalaureate nursing programs who so willingly gave their time and effort. Without their participation. this study would not have been achieved. I am particularly grateful to my wife. Marie.‘who as my mother used to say "stuck with me through the thick and the thin of it“! Thank you to Sara and Erik. who. though at times confused by a father who has become a "doctor-nurse." were always generous with their love. Thanks to my peers and friends for their time and encourage- ment as they reviewed. critiqued. and supported my efforts. I espe- cially appreciated Dr. Sara Doubledee and Lulu Ervast. who "paved the ‘way” to Michigan State. and Phoebe Crouch. Dr. Betty Hill. Mae Mark- strom. Dr. Marian Olson. Dr. Mary Ellen Powers. and Margaret Rettig for their technical and professional advice. Ifam most thankful to Dr. Sheila Burns for her statistical and editorial guidance. vi Very special appreciation and thanks to my Mother and Dad. who had the wisdom and vision to encourage my educational endeavors. Their support and guidance live on in my accomplishments. Thank you to the members of my family for their years of love and support. .A special thanks to my mother-in-law. Vicky. who helped make my absences from home much more tolerable. Last but not least. I am most grateful to two very important individuals. Sue Churchville and Sue Cooley. Without your skill. putting these words on paper would have been an ominous task. vii TABLE OF CONTENTS LIST OF TABLES O O O O O O O O O O O O I O O 0 Chapter I. II. III. Statement of the Problem . . . . . . Significance of the Study . . . . . Research Methodology . . . . . . . . Design of the Study . . . . . . . Subjects . . . . . . . . . . . . . Method for Data Collection . . . . Assumptions . . . . . . . . . . . . Delimitations . . . . . . . . . . . Definition of Terms . . . . . . . . Summary . . . . . . . . . . . . . . RWIW OF LITERATURE O O O C O O O O 0 Evolution of Nursing Education . . . Effect on Cost of Nursing Education Current Climate in Nursing Education on Clinical Education . . . . . . Cost-Effective Clinical Education . Organizational Patterns for Clinical Supervised Clinical . . . . . . . Preceptor/Role Model . . . . . . . Simulated Learning Laboratory . . Independent Study . . . . . . . . Practicum or Internship . . . . . Faculty Resource Requirements for Clinical Instruction . . . . . . . . . . . Other Health Disciplines . . . . . . DES IGN OF “I E SWDY O O O O O O O O 0 Subjects . . . . . . . . . . . . . . Instrument for Data Collection . . . Protection of Human Rights . . . . . Procedure for Collecting Data . . . viii INTRODUCTION TO THE PROBLEM AND THE STUDY and Its Effect Instruction . . Nursing Page H oommouoaom H H N 12 13 15 17 19 20 22 25 27 29 33 33 35 37 38 Returned Questionnaires . . . . . . . . . . . . Methods for Data Analysis . . . . . . . . . . . IV 0 MMJYS Is OF DATA 0 O O O O O O O O O O O O O O O O V. SU APPENDICES Survey Return and Data Handling .. .. .. .. Data Related to Research Questions . . . . . . . Research Question 1 . . . . . . . . . . . . . Research Question 2 . . . . . . . . . . . . . Research Question 3 . . . . . . . . . . . . . Research Question 4 . . . . . . . . . . . . . Research Question 5 . . . . . . . . . . . . . Other Program Characteristics . . . . . . . . . Collective Bargaining and Clinical Workloa . Credit Hour/Clock Hour Ratios . . . . . . . . Special Fees for Clinical . . . . . . . . . . Use of Practicing Nurses . . . . . . . . . . . Payment for Clinical Instructors . . . . . . . MMARY. CONCLUSIONS. AND IMPLICATIONS . . . . . . smary O O O O O O O O O O O O O O O O I O O O m]. or Findings 0 O I O O O O O O O I O O O O O 0 Organizational Patterns for Clinical Instruction Combinations of Organizational Patterns . . . Organizational Patterns and Faculty Resource Requirements . . . . . . . . . . . . . . . . Academic Preparation of Clinical Faculty . . . Selected Demographic Factors . . . . . . . . . Practicing Nurses in Clinical Instruction . . Conclusions . . . . . . . . . . . . . . . . . . Recommendations . . . . . . . . . . . . . . . . Implications for Nursing Practice and Education Recommendations for Future Research . . . . . . A. SAMPLES OF COVER LETTERS TO ACCOMPANY THE QU ESTIONNAIRES O O O O O O O O O O O O O O O O O O B O QUESTIONNAIRE O O O O C I O O I O O O O O O O I O C. LETTERS OF PERMISSION FOR CARRYING OUT THE STUDY . REFERENCES ix Page 41 42 46 51 51 67 74 105 112 126 126 127 129 129 130 132 132 133 133 135 136 136 137 138 139 140 141 142 144 148 158 160 .m . n: ‘ . r'. 1"?“ Ir”. LI u: 8. 9. 10. 11. 12. 13. 14. LIST OF TABLES Page Return Rate of the Initial and Follow-Up Mailings to Selected Baccalaureate Nursing Programs . . . . . . . 39 Number of Required Clinical Nursing Courses. by Title . 48 Distribution of Required Clinical Nursing Courses by Year Taken 0 O O O O O O O O O O O O O O O O O O 0 50 Distribution of Credit Hours for Required Clinical nut-Sing courses 0 I O O O I C C C O O O I O I O O O O 51 Reported Use of Each Organizational Pattern for Required Clinical Nursing Courses . . . . . . . . . . 53 Frequency of Organizational Pattern. by Year Course Is Taken 0 O I O O O O O O O O O O O O I O O O O O O O 55 Number of Courses Reporting 1002 Use of Each Organi- zational Pattern O O O I O O O O O O O I O O O O O O O 56 Grouped Frequencies of Percentage Use of Organiza- tional Patterns 0 I O O O O I O O O O O O O O O O O O 58 Grouped Frequency of Percentage Use of Organizational Patterns by Course. All Cases . . . . . . . . . . . . 6O Combination of Organizational Patterns. All Cases . . . , 68 Reported Student/Faculty Ratio for Required Clinical Nursing Courses . . . . . . . . . . . . . . . . . . . 75 Mean Student/Faculty Ratio. by Organizational Pattern . 77 Mean Student/Faculty Ratio for Each Organizational Pattern. by Year Taken-A11 Reported Cases . . . . . . 78 Mean Student/Faculty Ratio for Each Organizational Pattern. by Course. for All Reported Cases . . . . . . 79 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. Reported Clock Hours in Clinic Per Week for Required Clinical Nursing Courses . . . . . . . . . . . . . . Mean Clock Hours in Clinic Per Week Reported for Each Organizational Pattern . . . . . . . . . . . . . . . Mean Clock Hours in Clinic Per Week Reported for Required Nursing Courses. by Organizational Pattern andYearuAIICaseB.o.............. Mean Clock Hours in Clinic Per Week for Each Organi- zational Pattern. by Course. for All Reported Cases Mean Student/Faculty Ratio and Mean Hours Per Week in Clinic. by Organizational Pattern. in Reported Cases Where the Percentage of Use Was 50% or More for All Reported Cases . . . . . . . . . . . . . . . . . . . Full-Time Faculty Per Student for Each Clinical Course by Organizational Pattern When the Percentage of Use Was 50% or More for All Reported Cases . . . . . . . Reported Number of Faculty. by Academic Preparation. for Each Clinical Course . . . . . . . . . . . . . . Reported Number of Faculty. by Academic Preparation. for Each Organizational Pattern When Used 50% of the Time 0 I C O O O C O O O O O O O O O O O O O C I Number of Courses Reporting Use of Each Academic Level of Faculty and Mean Number of Faculty Per Course. by Academic Preparation. for All Reported Cases . . Reported Use of Organizational Patterns by Size of College/University--All Cases . . . . . . . . . . . Reported Mean Student/Faculty Ratio and Mean Clock Hours in Clinic Per Week by College/University Size-'-A11C8828.c................ Reported Use of Organizational Patterns by Program Size-"MICBBESo............o.... Reported Mean Student/Faculty Ratio and Mean Clock Hours in Clinic Per Week by Program Size--A11 Cases Mean Reported Use of Organizational Patterns by Type Of Curriculum-”A11 C6898 e o o e o o o o e o o o e 0 xi Page 87 89 90 91 99 103 106 109 111 114 115 117 118 120 29. 30. 31. 32. 33. Page Reported Mean Student/Faculty Ratio and Mean Clock Hours in Clinic Per Week by Reported Curriculum TYPE'“A11C8888 e'ooooooeoeoeoeooooo 121 Mean Reported Use of Organizational Patterns by Programs With and Without Graduate Education . . . . . 123 Reported Mean Student/Faculty Ratio and Mean Clock Hours in Clinic Per Week in Programs With and Without Graduate Education--A11 Cases . . . . . . . . 125 Reported Credit Hours Given to Each Faculty Member for Each Clock Hour Spent in Clinical Instruction . . . . 128 Reported Credit Hours Given to Students for Each Clock Hour Spent in Clinic . . . . . . . . . . . . . . . . . 129 xii CHAPTER I INTRODUCTION TO THE PROBLEM AND THE STUDY In the past two decades. baccalaureate nursing programs have experienced considerable growtin This growth has been related to the high demand of students for nursing programs and the large supply of money available from government and other sources to support the development of such programs. Generally. it has been believed that nursing programs. though expensive. were reasonably safe from budget reduction. This has not proved to be true. With the continued waves of cuts in federal and state funding for nursing education and the decline in undergraduate enrollments (Morton. 1983). nursing adminis- trators and faculty have had to begin to deal with the issues of budget and costs in a much more cautious and responsible fashion. Farrell and Eckert (1979) stated that educators need to develop new approaches which serve to reduce the cost yet maintain the quality of nursing education. The issue of cost control in professional schools. such as nursing. is complicated by the educational process through which the student must go. This process involves the development of a theoreti- cal knowledge base and the clinical application of that knowledge in various health care settings. In most curricula the clinical practice accounts for at least 50% of the students! learning experiences (Meleca. Schimpfhauser. Witteman. & Sachs. 1981; Porter & Feller. 1979). In discussing this issue. Dienemann (1983) stated that nursing curricula have more clinical experience than any other baccalaureate first professional degree program. In addition. she indicated that nursing clinical experience. unlike other professional programs. is usually directly supervised by university faculty at the clinical- site. 'This clinically intensive educational process limits the number of students who can be taught and consequently must be blamed for the high costs of nursing programs. Various nurse educators have discussed alternative organiza- tional structures for clinical nursing education. It is not clear. however. how widely used they are or what effect these have had on the faculty resource requirements committed for clinical instruction and. in turn. the cost of instruction. This study is an attempt to analyze various organizational patterns for clinical nursing instruction and their effect on the faculty resource requirements for that instruc- tion. Statement of the Problem Understanding the effect that various organizational patterns for clinical nursing education have on the cost of the nursing program is a major concern of the faculty of baccalaureate nursing programs. The cost results from the personnel necessary for clinical nursing instruction and is a significant budget issue that must be addressed. The purpose of this research is to determine the most commonly used organizational patterns and what effect they have on faculty resource requirements for that instruction. The primary concern and question that emerges is‘what organizational patterns are being used in bacca- laureate nursing programs and how each pattern affects the faculty resource requirements for clinical instruction. Once the faculty resource requirements have been identified for each organizational pattern. it will then be possible. by using the data already available on nursing faculty salaries. to begin to compute the dollar costs of clinical nursing instruction. The following questions are examined in this investigation: 1. What are the organizational patterns of clinical nursing instruction in baccalaureate nursing programs? 2. What are the variations and combinations of organiza- tional patterns found in baccalaureate nursing programs? 3. What effect do the organizational patterns have on faculty resource requirements in baccalaureate nursing programs? 4. ‘What are the resource requirements in terms of academic preparation of faculty used to staff clinical instruction in baccalau— reate nursing programs? 5. Is there a relationship between organizational patterns of clinical nursing instruction and faculty resource requirements in baccalaureate nursing programs. based on selected demographic data? Significance of the Study The expense of baccalaureate nursing programs to colleges and universities has become a significant issue. 'The demand for cost- effective nursing instruction is and will continue to be a major concern to administrators and faculty. Therefore. if nursing is to continue to survive and grow in the academic setting. it must be f'fllr‘ —' assured that the most cost-effective and educationally sound alterna- '1!__ . tives for instruction are used. The information gained in this study will expand the knowledge about the existing organizational patterns for clinical instruction. This study will also provide some indication of the faculty work load generated by the various patterns of clinical nursing instruction. Since the faculty resource requirements generated by clinical instruction are a major cost factor in the budgets of schools of nursing. it is intended that this study will add to the data base on which nursing faculty and administrators can make decisions concerning clinical nursing instruction. Research Methodology This section consists of a brief discussion of the research methodology used in conducting this study. The design of the study. the subjects. and the methods for data collection are presented. Design of the Study In a discussion of the various types of research design. Isaac and Michael (1977) stated that the purpose of descriptive research is to "describe systematically the facts and characteristics of a given population or area of interest. factually and accurately” (p. 18% They further indicated that research authorities do not agree on what constitutes "descriptive research” and therefore tend to consider all forms of research descriptive. except historical and experimental. This broad definition is used to cover survey studies. In discussing the purpose of survey studies. Isaac and Michael cited the work of Van Dalen and Meyer (1966). who described survey studies as doing the following: 1. Collect detailed factual information that describes existing phenomena. 2. Identify problems or justify current conditions and practices. 3. Make comparisons and evaluations. 4. Determine what others are doing with similar problems or situations and benefit from their experiences in making future plans and decisions. (p. 18) Descriptive research. therefore. can do more than simply describe the status of the subject under study. Through interpretation. synthesis. and analysis it becomes possible to describe important issues and interrelationships. This study is a descriptive-design study. Subjects The population for this study comprises randomly selected baccalaureate nursing programs that are accredited by the National League for Nursing. The source of the selected programs was the National League for Nursing publication entitled Baccalaureate Education in Nursing; Key to a Professional Career in Nursing_1983- 84--Information about NLN-Accredited Baccalaureate Programs in Nursing. The NLN-accredited programs were selected because they represent successful completion.of a review process which requires the meeting of commonly accepted nursing academic standards. Therefore. no judgment was made on the part of this researcher regarding academic standards and principles. The NLN publication lists approximately 399 accredited programs. Sample size was determined by using a table for determining sample size described in an article by Krejcie and Morgan (1970) entitled "Determining Sample Size for Research Activities." Based on their analysis. a suitable sample size for a population of 399 is 195. Therefore. 195 programs were selected at random from the list. The specific individuals t0'whom the study was focused included individuals who were serving as dean. chairperson. director. or head of the baccalaureate nursing program. Method for Data Collection Data were collected through the use of a mailed questionnaire. The intention of the questionnaire was to gather data concerning the use of the five organizational patterns for clinical instruction found in the review of the literature. They are: supervised clinical. preceptor/role model. simulated learning laboratory. independent study. and practicum/internship. Faculty resource data included look- ing at such factors as student/faculty ratios. number of hours of clinical instruction per week. class size. number of faculty. and level of faculty preparation. Demographic data included college or university size. program size. type of curriculum. and the presence of a graduate program. The specific methodology for the development and implementa- tion of the survey questionnaire was that described by Dillman (1978) in the book Mail and Telephone Surveys: The Total Design Method. Dillman described a specific methodology that consists of two parts: 1. Identify each aspect of the survey process that may affect the quality or quantity of response and to shape each of them in such a way that the best possible responses are obtained. 2. Organize the survey efforts so that the design intentions are carried out in complete detail. (p. 12) The methodology described by Dillman includes many strategies for development of a questionnaire that rewards the respondent. reduces the costs to the respondent. and establishes trust in the researcher. He clearly described how to develop questions in a manner that facilitates response and leads to a high return rate. His research indicated that using this method will result in a 70% and above return rate. (In addition. he gave specific instructions for the size. shape. and format of the questionnaire. Further. he described the sequence for mailing the questionnaire. as well as guidelines for follow-up mailings to nonrespondents. Confidentiality and anonymity of the respondent were carefully guarded. Questionnaires were coded by number strictly for identifica- tion of response for follow-up purposes. Individual school data are not identified in the study. Assumptions This study was based on the following assumptions: 1. Deans. chairpersons. directors. or heads of baccalaureate nursing programs understood the organizational patterns and faculty resource requirements of their baccalaureate nursing programs well enough to provide accurate data. 2. Deans. chairpersons. directors. or heads of baccalaureate nursing programs were interested in improving the data base on which faculty and administrators can make decisions concerning clinical nursing instruction. 3. The survey tool yielded an accurate description of each baccalaureate nursing programfs organizational patterns and faculty resource requirements. 4. Despite their unique characteristics. baccalaureate nursing programs have common courses. organizational patterns. and faculty resource requirements that can be studied. 5. Despite its complexity and difficulty. study of this area will produce data that can lead to a better understanding of the administrative problems related to clinical instruction in baccalau- reate nursing programs. Delimitations This study was limited to: l. Baccalaureate nursing programs that have been accredited by the National League for Nursing (NLN. 1983). “III! :m- r mar .v:o"'r Irv “p 2. Deans. directors. chairpersons. or department heads of baccalaureate nursing programs as respondents. to delineate a single accessible respondent capable of responding for the total program. 35 The use of the mail survey method because it is recog- nized as being an effective method for obtaining data from a large sample (Dillman. 1978L Definition of Terms The following conceptual definitions were used: Qgggnizational pattern--The structure used to teach student nurses clinical or practice skills. Supervised clinica1--Faculty members accompany a group of students into a health care agency and provide direct supervision of them while they care for patients. Simulated laboratory--Structured learning experiences in caring for patients that simulate real-life situations. A faculty member or laboratory assistant provides supervision of the students. Preceptor/role model-~Facu1ty members identify practicing nurses who work with students on a one-to-one basis. Faculty member does not directly supervise the student. but periodically checks with the student and preceptor to evaluate learning experience. Faculty member may or may not be present in the clinical agency. Such learn- ing may not be confined to patient care but also may incorporate direct observation of key nursing personnel. Independent study--Student is responsible for planning the specific objectives and activities of the experience and for 10 fulfilling the learning needs. iculty member serves as an advisor to the student. is not present during the experience. and does not pro- vide direct supervision. Practicum/internship--Concentrated and extended blocks of time in the clinical setting caring for patients and functioning autono- mously in a staff nurse role. Faculty may or may not be present in the clinical agency. Practicing nurses may or may not be used as resource people. Faculty resource requirements--Factors that demonstrate the 'work load. qualifications. or numbers of faculty used to teach student nurses in clinical or practice settings. Summagy This is a descriptive study of a random sample of 195 bacca- laureate nursing programs in which deans. chairpersons. directors. or heads of departments were asked to supply data about the organiza- tional patterns used to instruct student nurses in clinical or prac- tice settings. as well as the faculty resource requirements for that instruction. Data were gathered between October 1984 and January 1985 to answer the following questions: 1. What are the organizational patterns of clinical nursing instruction in baccalaureate nursing programs? 2. What are the variations and combinations of organiza- tional patterns found in baccalaureate nursing programs? ll 3. What effect do the organizational patterns have on faculty resource requirements in baccalaureate nursing programs? 4. What are the resource requirements in terms of academic preparation of faculty used to staff clinical instruction in baccalau- reate nursing programs? 5. Is there a relationship between organizational patterns of clinical nursing instruction and faculty resource requirements in baccalaureate nursing programs. based on selected demographic data? CHAPTER II REVIEW OF LITERATURE Evolution of NursingTEducation The movement of nursing education into the college and univer- sity setting is a very recent phenomenon. ‘The establishment of colle- giate nursing education has essentially occurred in the last 30 or so years. Ikufil about 1950 there were few baccalaureate degree nursing programs in American colleges and universities. Most nurses were "trained" in three-year hospital-based programs that tended to use the apprenticeship approach to education (Sams. 1976). An analysis of the system of nurse training in the United States from 1873 to 1948 found that educational standards "did not even conform to those set for high schools" (Jacox. 1976. p. 35). and nursing schools were found to provide hospital service instead of education. Christy (1980) stated that most hospital-based nursing programs were there. not to educate nurses. but instead existed for the primary purpose of providing care to hospitalized sick. Jacox.(1976) stated that the education of nurses was about 95% service to the hospital and less than 52 instruction in theory. Essentially. nursing schools existed for the services students pro- vided to the hospital to save it labor cost and provide a supply of nurses. The hospital used the nursing program to meet its needs 12 13 rather than the needs of the students (Curran & Metcalf. 1983L Porter and Feller (1979) stated that in hospital-based schools of nursing. clinical experiences were dictated by hospital needs. Stu- dents. through an apprentice—type program. were trained to fill staff nurse positions within the hospital conducting the program. Gen- erally. it can be said that throughout nursing's history the clinical- education component was not based on any logical or sound educational practice but instead was used to provide a large supply of cheap laborers to the hospital. Effect on Cost of Nursing:Education The early data regarding costs of nursing education and budgeting methodologies were much influenced by the state of the profession. First. the budgeting process of the school was mixed in with the total hospital budget. which confuses the cost data. As a result. it is not always clear what costs were truly generated by nursing education. Second. part of the cost of education was covered by the services the students provided to the hospital. How carefully. fairly. and appropriately this was shown as income for the program remains a question. Third. frequently the clinical instructor was also a practicing nurse who was supervising students as well as providing care to patients or functioning as the administrative head of a nursing unit. Direct accounting of the cost of this instruction *was not clearly separated from nursing service. Fourth. since the primary mission of the early schools was service and not education. the applicability of those data to today's educational system is. at 14 best. highly questionable. INot only was teaching given a low prior- ity, there also was practically no support for activities such as research. publication. and consultation. The confusion regarding the costs of nursing education in the hospital-based program continues to present many problems (Brown. 1982). As late as 1972 it was discovered that questionable cost- analysis methods were resulting in decisions to close hospital-based programs (Bryson. 1982). ‘Even the hospitals themselves were unable to accurately assess budgeting methods and costs data. In addition, the analysis of faculty workload done by hospital-based programs reflects an entirely different mentality than that found in modern colleges and universities. Faculty workload is analyzed. not in terms of teaching. research. or service activities. but in terms of a 40-hour work week and‘whether faculty are putting in enough hours to fill it (Bryson. 1982). It seems appropriate to conclude that the nature and characteristics of nursing's educational history do not provide a great source of reliable data upon‘which to base today‘s budgeting practices. .As a result. nurse leaders must work to establish new budgeting systems and practices that are applicable to the mainstream of education. Developing budgeting methods that effectively express the needs of modern nursing education and assure nursing a secure place in colleges and universities is a major task of the current generation of nurse educators. 15 Current Climate in NursinggEducation and Its Effect on Clinical Education The first university-based school of nursing was established at the University of Minnesota in 1908 (Anderson. 1981). However. it was not until the 19608 and 19708 that most nursing education programs had moved from the hospital to the college and university setting (Curran & Metcalf. 1983L Lysought (1979) reported that in 1966. 65% of all graduating nurses were from hospital-based diploma programs. but by 1978. 73% of all graduating nurses were coming from two- and four-year college-based programs. The college- and university-based programs provide much less experience in the day-to-day hands-on patient care practices. Since the majority of practicing nurses are graduates of the hospital-based diploma programs. this movement has caused considerable conflict between nursing service and nursing education regarding what is an appropriate type and amount of clinical education for nursing students. Wagner (1980) reported that the pendulum has swung from expecting that students will spend almost 40 hours per week in clinical practice and using students to replace paid staff to a situation in which we have removed the student nurse from the realities of the employment setting. Blanchard (1983) reported that this problem has resulted in nursing service having to assume a large amount of the responsibility for teaching new graduates how to practice. He reported on a study which indicated that new graduates felt they did not have adequate clinical exposure in school. Blanchard (1983). Werner (1980). Johnson (1980). and numerous other ,f‘"' 16 authors have described possible solutions to this dilemma. They recommended increasing cooperative efforts between hospitals and schools of nursing which will result in improved clinical experiences and instruction for students. Many have suggested increasing the number of clinical experiences. greater sharing of resources and increased planning between nursing service and nursing education. and developing a more cooperative relationship between education and service. The movement away from the hospital-dominated educational system and toward the collegiate system has released nursing students from many of the abuses of the apprentice-type system. It has changed the focus of school of nursing from "training“ to "educating" nurses. It has resulted in the recognition of nursing as a member of the "community of scholars)‘ The price for this movement has been isolation of nursing faculty and students from the day-to-day realities of nursing practice (Curran & Metcalf. 1983). The question must be asked: What can nursing education do to improve the clinical-practice component of its educational system and yet maintain high academic standards and professional autonomy? Is there a simple answer? For many in nursing practice. the solution is simply increasing the number of hours the student spends in the clini- cal setting. .A1though this solution sounds simple. the administrator of any nursing education program will immediately raise many critical issues that need to be addressed. A few might be: 17 1. When nursing already is one of the most expensive programs on a campus. how will I get additional faculty positions for increased clinical instruction? 2. What educational logic would support such a move? 3. Can we rely on some other method to provide clinical instruction? 4. Which method of clinical instruction is most cost effective? Cost-Effective Clinical Education Although several authors have expressed concern and have sug- gested strategies for strengthening and improving budgetary management in schools of nursing (Brown. Lasher. & Embrey. 1979; Crosby. 1985; Farrell & Eckart. 1979; Knopf. 1982; Langstrom. 1981). little has been written related to the cost of clinical nursing education. Ozimek and Yura (1977). in a publication entitled Considerations for the Effec- tive Utilization of NursinggFaculty_in Baccalaureate and Higher Degree Programs. began to address this issue by stating. "In times of economic retrenchment such as these. as pressures to cut costs in higher education mount. the effective utilization of nursing faculty becomes increasingly higher in priority" (p. 1). They stressed that the need for cost-effective use of faculty has never been greater. They also stated that the literature on nursing faculty workload is very limited. Lazinski (1979). in an article entitled ”The Effects of Clini- cal Teaching on the Budgets of Schools of Nursing.” discussed a number 18 of factors that affect the faculty workload in clinical instruction. She demonstrated how the student-faculty ratio in clinical instruction affects the budget and how small increases in them convert to real dollar savings. Iazinski also raised a number of issues related to clinical-instruction methods that nursing faculty need to analyze. She stated that although many of these would not result in a real dollar savings. they would result in reducing faculty workload in clinical instruction. thus allowing them more time to pursue scholarly activities. In addition. she stated that probably "nursing. more than any other school or college within a university setting. spends more hours in teaching a comparable number of credits than other faculty" (p. 22). She called for nursing faculty to look at the rationale for the way in which they instruct clinically and to evaluate how they can meet their instructional objectives in a much more cost-effective manner. Dienemann (1983) also discussed the issue of reducing nursing faculty workload without increasing costs. She suggested that there is a need for nursing programs to study and compare the way in which they organize their clinical-instruction component. She stated. One possible source for reducing faculty workload is the examination or comparison.of how professional schools provide didactic instruction and assist students in acquiring psychomotor skills. clinical judgment. and socialization into their future wgrkiffles while at the same time controlling faculty workload. She further stated that through a review of university catalogs and some interviews it was determined that this is being done in some 19 programs by "(a) diversification of income. (b) the structure and modalities of teaching. and.(c) mixture of types of faculty positions" (p. 111). The ideas regarding altering the structure and modalities of teaching and developing a different mixture of the types of faculty positions suggest that we look more to computer-assisted instruction. large discussion groups. more part-time adjunct faculty. and a sig- nificant increase in the use of teaching assistants. Dienemann (1983). in studying ten types of schools and departments at 88 universities. discovered that nursing programs had the fewest teaching assistants. In reviewing her work. it becomes obvious that schools of nursing can implement many alternatives that will result in cost savings and still meet the instructional objectives. In summary. it can be concluded that the desire for cost- effective patterns for clinical nursing education is well documented. However. there appears to be a general lack of adequate data on the cost of nursing education. Lucille Knopf (1982). a research associate for the National League for Nursing. best described this problem when she reported that Hardly a week goes by that the NLN Division of Research does not receive a call from someone asking for a figure that represents the cost of educating a nursing student. . . . The caller is stunned and frustrated when told that there are no reliable data on the cost of nursing education at the national level. (p. 29) Qgganizational Patterns for Clinical Instruction Pugh (1983) reported that the majority of studies related to clinical education of nurses have focused on the perceptions of the 20 students in an attempt to identify teaching behaviors of the faculty. She further indicated surprise over the lack of reported studies on clinical teaching. given that it is such an important part of profes- sional education. In reviewing the literature. this researcher found that most studies on clinical nursing education related in one way or another to teaching strategies or methodologies to enhance the clini- cal educational experience. This included looking at various student activities or assignments and faculty behaviors that inhibited or facilitated the students' learning experiences (Brown. 1981: Cotanch. 1981; Dachelet et al.. 1981; Infante. 1975; Keen & Dear. 1983; Meleca et al.. 1981; Olson. 1983: O'Shea & Parsons. 1979; Taylor & Cleveland. 1984). The review of the literature failed to provide any studies that identified common organizational patterns for clinical nursing education. much less reports on the typical faculty resources commit- ted to clinical instruction. 'The literature did. however. give some indication of what individual programs are attempting to do. It appears that up to this point few questions have been raised regarding common organizational patterns for clinical education and their costs. The common organizational patterns for clinical nursing education reported in the literature are discussed in the following paragraphs. Supervised Clinical The supervised clinical is an organization pattern in*which the instructor takes a group of students into a health care agency and 21 provides direct supervision of them while they care for patients. The extent to which this organizational pattern is used was not reported in the literature. Based on this researchem‘s personal experience and suggestions from the literature. it is assumed that this pattern is by far the most common. Meleca et al. (1981) surveyed 672 nursing fac- ulty from 119 institutions. In asking them what type of teaching best typified their clinical teaching. 72% indicated clinical supervision. Although is is not clear if this means direct supervision of students in patient care. it may be safe to assume that. for the most part. it does. A 1964 publication of the U.S. Department of Health. Educa- tion. and Welfare entitled "Nursing Education Facilities: Programming Considerations and Architectural Guide" appeared to be addressing concern about the use of the supervised clinical. It stated: cal The nature of nursing practice and education is such that the faculty-student ratio is much lower than in curricula where the safety and well-being of people are not considerations. The location of the patient care areas. the need to utilize community resources to obtain student experiences. and the need for close supervision of the student in patient care experiences are some of the factors which influence the faculty-student ratio. (pp. 31-32) Dienemann (1983) discussed the effect of the supervised clini- on the nursing faculty workload. She stated. Nursing field experience. unlike in many programs. is frequently supervised by university teachers at the clinical site with a teacher-student ratio of approximately 1 to 10. As a result. Inembers of the nursing faculty have higher student contact hours than those of other professional schools or the arts and sciences. (p. 111) ‘m “m 22 Lazinski (1979) discussed the implication of the supervised clinical on the budget. She demonstrated that considerable savings can result when faculty-student ratios in the clinical area can be increased from 1:8 to 1:9 or 1:10. These increases. Lazinski implied. will not negatively influence effective teaching. In addition. she made a number of recommendations for reducing numerous time-consuming activities surrounding supervised clinical instruction. Other authors have reported a range of faculty-student ratios in supervised clinical. They ranged from 1:3 (Keen & Dear. 1983) to 1:10 (Olson. 1983). Preceptor/Role Model The preceptor/role model organizational pattern requires that the undergraduate faculty member identify practicing nurses who are willing to work with.students on a one-to-one basis. The faculty member does not directly supervise the student. but periodically checks with the student and preceptor to evaluate how the experience is going. The instructor is responsible for developing the objectives of the experience and assuring that the student is able to meet them through the preceptor. The recent literature has indicated that there is considerable interest in using this organizational structure in clinical instruction for undergraduate nursing students (Chicherella & Lutz. 1981: Clark. 1981; Maraldo. 1977: Turnbull. 1983; Walters. 1981). Turnbull (1983) defined preceptor as a "service-based nurse with clinical expertise and interest in student education‘who is willing to 23 sponsor or work with student nurses when an instructor may or may not be present in a given patient care setting" (p. 11). How this structure is implemented varies with different nursing programs. In some cases the preceptor is given faculty status ranging from adjunct professor to teaching assistant. It does appear that the preceptor usually receives no additional compensation. The academic credentials required of the preceptor also vary. It appears that some programs desire practicing nurses with a master's degree. while others simply desire a competent practicing nurse regardless of academic prepa- ration. Simulated Learning Laboratory The literature has reported several experiences in which clinical instruction has occurred through the use of the simulated learning laboratory (Dahl. 1984: McDowell. Nardini. Negley. &‘White. 1984: Taylor & Cleveland. 1984: Whitis. 1985L. The simulated learning laboratory may range in its meaning from one nursing program to another. All. however. appear to create structured learning experi- ences that simulate real-life situations. giving students opportuni- ties to learn new clinical skills. This allows the student the opportunity to practice and reduces the liability factor present in the health care setting. Taylor and Cleveland (1984) recognized the learning laboratory as an effective means of helping faculty cope with high numbers of students in the clinical area. They demonstrated how the learning 24 laboratory could be used on a rotational basis with the patient care areas. thus reducing the number of students the faculty member would have to supervise within the patient care setting. McDowell et a1. (1984) reported success in using simulated patients. They found that healthy individuals could be trained to enact the role of patients. They did indicate. however. that the project demanded considerable faculty time and resulted in additional costs because the individuals used to play the role of simulated patients were paid for the time spent in training and actual simulated situations. Dienemann (1983) discussed the use of on-campus laboratory simulation. computer simulations. and on-campus health clinics as alternatives to off-campus clinical facilities. She suggested that these are cost-effective both in terms of faculty and student time. She stressed that computer-assisted clinical instruction is a new alternative that is being found to be a successful alternative to clinical instruction. Whitis (1985) indicated that economic benefits can be realized when using simulation in teaching clinical nursing. ‘Using simulation allows for larger teaching groups. giving a larger student-teacher ratio. In addition. she felt that the students and instructor are not subjected to the interfering stimuli found in the patient care set- ting. She stated. ”The amount of time spent teaching a particular concept or concepts can be reduced because extraneous stimuli are reduced when using simulation" (p. 161). 25 Independent Study The use of independent study as a way in which students can learn clinical nursing skills has been discussed in the literature. Dear and Bartol (1984) conducted a study of the use of independent study in 40 baccalaureate nursing programs in the South. Of the 219 faculty members responding. "95% reported that their schools provided opportunities for independent study in nursing courses: of these 75% involved clinical nursing practice" (p. 243). Their findings also demonstrated that confusion existed about what independent study is and ‘Er * how it should be structured. Sommerfeld and Hughes (1980). Taylor and Cleveland (1984). Kilcullen (1985). and Bartol (1984) discussed the use of independent learning of clinical skills. Taylor and Cleveland (1984) expected students to be self-directive in learning clinical skills before actually practicing them on clients. However. they stated that many students were not prepared to assume this role and as a result came to the patient care areas unprepared. Sommerfeld and Hughes (1980) discussed how they implemented independent learning in the clinical setting. Independent study under their model required that the faculty member determine which.hea1th care agencies were to be used. whom the student'would work with. and ‘what the broad learning objectives were. The student assumed respon- sibility for planning the specific activities of the experience and being responsible for fulfilling his/her own learning needs. 26 The article mentioned that this approach was very successful. yet created a heavier workload for faculty. The effect on faculty workload appeared to have resulted from having to work with students on an individual basis rather than in groups. Although faculty did not provide direct clinical supervision. they met with students in weekly seminar groups and individually in order to provide them with a support system. The specific number of student contact hours was not indicated. Practicum or Internship The use of a practicum or an internship as an effective structure through which to provide instruction in clinical nursing has been reported in the literature (Hartin. 1983; Keen & Dear. 1983; Martin & Pashowitz. 1975; Porter & Feller. 1979L It was not possible to discover. however. how frequently it was used or what effect it had on costs. Practicum in clinical nursing seems to represent two or more consecutive eight-hour days in the clinical setting caring for patients and functioning in a role similar to a staff nurse. This organizational structure is unique because it allows the student the opportunity to remain in the clinical area for a full eight-hour day. and for more than one day a week. Keen and Dear (1983). in discussing the practicum-type experience. indicated that the student/faculty ratio ranged from 1:3 to 1:6. They also stated that this arrangement produced additional 27 anxiety for the instructor. They did indicate. however. that the faculty were present on the unit for shorter periods of time as the course progressed. The internship structure in clinical education does not appear as a component of undergraduate education. It does. however. appear to be a common.clinical nursing education pattern used by hospitals to prepare graduates for their role as staff nurses. This usually con- sists of two or three months of clinical experience in*which the graduate nurses work with experienced registered nurses. The litera- ture related to cost of such a program reflected costs to the hospital for orientation of new graduate nurses and was not applicable or useful to undergraduate programs (Kasprisin & Young. 1985; Wagner. 1980). Facultngesource Requirements for Clinical Nursigg:lnstruction The issue of faculty workload in nursing programs has been addressed in the literature (Andreoli. 1979; Andreoli & Musser. 1984; Coudret. 1981; Crawford. Laing. Linwood. Kyle. & DeBlock. 1983; Faucet. 1979; Holliman. 1977; Saylor. Kaylar. Genthe. & Otis. 1979L Each article attempted to address the issues of faculty workload and faculty productivity as it relates to the overall faculty resource requirements for teaching. research. and service. There was a general recognition of the complexity and difficulty encountered when measuring faculty resource requirements. little discussion.was 28 given to the needs generated by the clinical instruction of student nurses. Saylor et a1. (1979) indicated that the clinical setting generates a range of student/faculty ratios. They stated. The specific nature of the experiences demands a low student- faculty ratio; for example. experience in Intensive Care Units might require a one to one student-faculty ratio whereas an area of less intense care or other considerations as outlined in the faculty workload guidelines might permit a ten to one ratio. (p. 904) This certainly emphasizes the complexity in measuring faculty resource requirements in clinical settings. However. it appears that there has been a general lack of discussion beyond that point. Coudret (1981) stated that there has been a delayed emphasis on the workload determination when one compares nursing to other departments. ‘Yet. given the demands placed on faculty for doing research. as well as maintaining their clinical skills. there is a critical need to better understand the nursing facultyds‘workload. In a study of 166 associate-degree programs and 100 baccalaureate programs. Coudret found that in baccalaureate programs that reported faculty workload policies. "credit hour was most commonly used to determine workload" (p. 39). However. she found that clinical instruction was usually equated in a different manner. .A clinical hour of instruction was usually equated to one-half hour of classroom instruction. a model that appears to have come from the "two to one" ratio used in the biological and physical science labs. Generally. this method of determining clinical workload for nursing faculty was 29 felt not to reflect their true workload. and that the contact hour might better reflect the clinical teaching responsibilities. In addition. Coudret found that collective bargaining had ”less effect on faculty workload than was anticipated" (p. 41). The clinical teaching load of nursing faculty or other unique nursing workload problems were not reflected in the workload policies devel- oped through collective bargaining. Andreoli (1979). in a discussion of faculty productivity. described ways of measuring faculty workload components. She stated. "Measurable variables have been identified. tried and tested to provide a suitable method for productivity evaluation" (p. 48). The measurable variables identified were (a) credit hours. (b) contact hours. (c) student-teacher ratios. (d) average number of hours‘worked per unit of time. and.(e) percentage allocation of times for a par- ticular activity. She clearly emphasized that there are limitations in using these variables. She concluded her discussion by stating. Clearly. much time. thought. energy and research have been devoted to developing accurate methods to measure faculty 'workload. 'Unfortunately. progress has been slow. and academic administrators continue to work toward improving the measuring system. . . . (p. 49) Other Health Disciplines A search for literature in other health disciplines failed to produce significant materials that would shed light on their experi- ences with various organizational patterns and the resulting resource requirements for clinical instruction. Jason (1962) reported that there was an.absence of research in medical education related to the “F."- 30 teacher and teaching practices. Although his study. entitled "A Study of Medical Teaching Practices." began an examination of teacher behav- ior. little mention was made of the predominant organizational pat- terns of medical education or their effect on faculty. Stritter. Hain. and Grimes (1975) provided a definition of it; clinical teaching in medicine that appears to encompass similar char- If acteristics of nursing clinical instruction. They defined clinical teaching as "that which occurs in an individual or small-group setting. generally at the bedside but also in ward rounds and small seminars" : (p. 876). However. they went on to contrast a "traditional university hospital" and its full-time faculty with clinical instruction that occurs outside this setting in satellite campuses or community hospi- tals removed from the university using mostly volunteer and part-time clinical teachers. In this community-based instruction there appears to be a heavy reliance on the preceptor model of instruction. This description appears to allude to a much less tightly supervised clini- cal experience than that found in nursing. Bazuin and Yonke (1978) gave brief descriptions of medical clinical education. which provide some indication of the way it is organized. They indicated that medical students are taught by “practicing on students and by receiving guidance from senior faculty members" (p. 377). They described an experience in which I"the undergraduate student serves as the primary provider for the health care of approximately 75 families" (p. 377). In this experience the student is identified as the individual who has first contact with the 31 patient. while the faculty member "assists" the student in assuring that the patient is properly cared for. No discussion was found concerning the effect of this instructive process on faculty resources. such as student/faculty ratio. time. or other workload factors. Mayberry (1973). in a study of clinical teaching in dental schools. presented what appears to be comparable to a supervised clinical in a dental educational setting. Although the focus of his study was on student evaluation. he stated that "Each instructor has 12 or 13 students under his direct supervision in a 12- to 14-unit module during an entire semester" (p. 9). Although one could suspect that this structure leads to faculty resource demands comparable to those of nursing. it was not possible to find such discussion in the litera- ture. Kloth and Morrison (1983). in a study entitled "Supervised Versus Independent Study Laboratories." presented a comparison of two organizational patterns of instruction used in a classroom laboratory for physical therapy students. They were unable to find a difference in students' test scores on performance when comparing supervised instruction with independent. Finding that the amount of instructor supervision did not significantly influence student performance led them to suggest that a greater reliance on independent study be con- sidered. In addition. this would benefit the instructor because it would lead to a more effective use of the educators. 32 In summary. a review of the literature of other health disci- plines failed to provide a clear description of what the experience of other professions has been. However. it does appear that there are similar organizational patterns. problems. and concerns that can be examined and addressed in an effort to better understand the problems associated with the administration of the clinical educational compo- nent of a health discipline. CHAPTER III DESIGN OF THE STUDY This chapter consists of a discussion of the research methodology used in conducting this study. It gives a description of the subjects. the instrument used. the survey method. and the methods for data analysis. Subjects The sample for this study was limited to 195 randomly selected baccalaureate nursing programs taken from the 399 programs listed in the National League for Nursing (NLN) publication entitled Baccalau- reate Education in Nursing: Key to a Professional Career in Nursing l983-84--Information about NLN-Accredited Baccalaureate Programs in Nursing. The NLN-accredited programs were selected because they represent successful completion of a review process that requires the meeting of commonly accepted nursing academic standards. This selection relieved the researcher of making judgments regarding the academic standards and principles of the study sample. Since each program had achieved accredited status. it was felt that clinical instruction was being provided in a manner that met the accepted academic standards and principles of the profession. Therefore. all 33 If: ’T" ‘11 -. 34 programs. having gone through this process. demonstrated a comparable level of academic quality. Sample size was determined by using a table for determining sample size described in an article by Krejcie and Morgan (1970) entitled ”Determining Sample Size for Research ActivitiesJ' Their n.” sample size table was developed through application of a formula for determining sample size published by the research division of the 3 National Education Association. Based on this analysis. it was i determined that a suitable sample size for a population of 399 would be 195. ‘This number was required to be 952 confident that the sample 3 values would not deviate by more than .05 from the population values. Therefore. 195 randomly selected NLN-accredited baccalaureate nursing programs from across the United States were selected for inclusion in this study. The specific persons to whom the study was focused included those individuals identified in the NLN publication as the administra- tors of the baccalaureate nursing program. By administrative title. this included 98 (50%) deans or associate deans. 73 (372) chairper- sons. 19 (10%) directors. and 5 (3%) heads or coordinators. Since the data being sought dealt with the administrative issues concerning organization and staffing of clinical instruction. it was felt that these would be the most appropriate individuals to respond or to determine an appropriate respondent. 35 Instrument for Data Collection A two-part mailed questionnaire requesting five specific cate- gories of data was used as the data-collection instrument (Appendix B). The questionnaire was constructed by the researcher and was based on a review of the literature and input from a group of seven experienced nursing program administrators. Construction of the questionnaire. including booklet format and printing procedures. fol- lowed many of the principles and design methods identified by Dillman (1978) in the bodk Mail and Telephone Surveys: The Total Desigg Method. The first section of the two-part mailed questionnaire was designed to provide specific data on each required clinical nursing course. or the clinical portion of each required nursing course. in classes where the clinical component was not a separate course. This was accomplished by dividing Section 1 of the questionnaire into four distinct categories of data. The four categories were course data. organizational data. faculty workload data. and faculty preparation. The first category. course data. asked for a course title. the year the course was taken. and the number of credit hours allotted for clinical instruction. Organizational data. the second category. required that the respondent provide an estimate of the percentage of time each organizational pattern was used for clinical instruction in the course. The organizational patterns of supervised clinical. simulated laboratory. preceptor/role model. independent study. and practicum/ 36 internship were defined in the directions section of the questionnaire to clarify the meaning of each pattern. For example. a subject could respond by indicating that for a particular clinical nursing course 75% of the time was spent using a supervised clinical organizational pattern. and 25% was spent using a simulated laboratory organizational pattern. The third category of data provided information concerning the faculty workload generated by the clinical nursing course. It asked for the number of students. faculty/student ratio. number of clock hours per clinical section per week. number of clinical sections for current term or semester. and the total number of faculty (expressed in full-time equivalent) needed to teach the clinical nursing course. The fourth category of Section 1 asked for faculty prepara- tion. i.e.. academic preparation such as master's or doctorate. or status such as graduate assistant. laboratory assistant. or practicing nurse. Section 2 of the questionnaire provided a fifth category. general and demographic data about the respondent's nursing program. In addition. an area was provided for comments by the respondents. In addition to careful questionnaire construction. an attempt ‘was made to obtain as much validity and clarity as possible. .A group of seven experienced nursing program administrators were asked to review and evaluate the instrument. 'This review process was done to establish content validity. According to Polit and Hungler (1985). The content validity of an instrument is necessarily based on judgment. There are no objective methods of assuring the adequate ‘1 ‘_'..‘ ' " 37 content coverage of an instrument. Experts in the content area may be called upon to analyze the items to see if they adequately represent the hypothetical content universe in the correct propor- tions. (p. 247) A determination of the clarity of the items and the instructions for using the questionnaire was also made by the reviewing group. Each of the experienced nursing program administrators reacted to. and subsequently verified. the clarity of the items and the instructions for the questionnaire. This included the cover letters and post card sent with each mailing (Appendix A). Changes and adjustments in the instrument were made. based on this process. Protection of Human Rights The original proposal for the implementation of this dissertation was submitted to the guidance committee in May 1984. Approval was granted on May 31. 1984 (Appendix C). Following this. the proposal was submitted to the University Committee on Research Involving Human Subjects. On July 3. 1984. approval was granted for conducting the study (Appendix C). The following procedure was implemented to ensure the confi- dentiality and protection of the respondent. The questionnaire was given an identification number for mailing purposes. This was done so that the name of the respondent could be checked off the mailing list once the questionnaire was returned. The respondent's name or institution was never placed on the questionnaire. All individual responses remained anonymous. and only pooled or summarized data are reported in this dissertation. 38 Procedure for Collecting_Data The survey methodology used in this study was based on many of the principles recommended by Dillman (1978) in his book Mail and Telephone Surveys: The Total Design Method. Dillman recommended a seven-week. four-stage survey design with an initial mailing and three follow-up mailings. The following procedure was implemented: 1. Initial mailing of questionnaire with cover letter (Appendix A). 2. Post card reminder two weeks after initial mailing 5 (Appendix A). 3. Follow-up mailing four weeks after initial mailing with a different cover letter and a replacement questionnaire (Appendix A). 4. Follow-up mailing seven weeks after initial mailing with a different cover letter and a replacement questionnaire (Appendix A). Woolley (1984). in a study entitled "Questioning the Mailed Questionnaire as a Valid Instrument for Research in Nursing Educa- tion." asked deans and directors of baccalaureate and higher degree programs to rank a number of variables in order of their influence on the decision to complete a questionnaire. The variables were ranked as follows: The subject matter (salience factor) received the highest rates. The more important and significant the topic was. the more likely the questionnaire would be returned. Second in importance was the length of time it took to complete the questionnaire. The shorter the instrument. the better were its chances for return. The type of 39 question rated third in importance; multiple choice and rankings were preferred. The fourth important variable was identity/ status of sender. Doctoral candidates were noted among those as having the best chance of getting an immediate return. The nature of the cover letter was rated fifth. A letter that contained a personal and correct address and did not overstate the importance of the issue was most likely to be returned. 'Time of the year and format of the question- naire were rated as not important. However. neatness and quality of the questionnaire were noted to have an influence on return. Recognition of the significance of this topic seems to have been supported by the return rate. In total. 151 questionnaires were returned. Of that number. 120 bad data that were included in this study. (See Table 1.) Table 1.--Return rate of the initial and follow-up mailings to selected baccalaureate nursing programs (number and percentage of usable questionnaire) (Sample size N = 195) Mailing Number Percent Initial mailing of questionnaire. October 15 40 33.33 Post card reminder. October 29 46 38.33 Follow-up mailing with replacement questionnaire. November 13 16 13.33 Follow-up mailing with replacement questionnaire. December 4 18 15.00 Total 120 100.00 40 The time required to complete the questionnaire contributed to the return of some unanswered questionnaires. The researcher was careful not to make any statements regarding the amount of time it 'would take to provide the requested data. It was recognized that considerable time and effort were required. and respondents were thanked for it. Obviously. this complex topic was no small undertaking. a formidable task for bggh the respondent and the researcher. The nature of the data requested did not lend itself to easy “I 1 .-_‘—_.!'- “‘H" questions or answers. The questions'were developed*with considerable thought and input from others. An attempt was made to assure that they were as clear and easy to answer as possible. The identity and status of the researcher were clearly identified on both the questionnaire and all other attached cover letters and correspondence. One respondent wrote to the researcher. requesting a letter of verification from the dissertation advisor before completing and returning the questionnaire. The cover letter. post card. and all other correspondence were personalized with proper names and titles of the subjects. 'These were taken from the NLN publication and for the most part remained current. In addition to the questionnaire and cover letter. a stamped self- addressed return envelope was included. The researcher's place of employment was used for the return address on all correspondence. Caution was taken to avoid mailing questionnaires on dates that might result in their arriving during a holiday period. October 41 1985 was selected as the month to begin the study to ensure that arrival would occur well after the beginning of the academic year. The format of the questionnaire was done with the assistance of a graphics professional to assure that the cover. color. and layout of the questionnaire would appear attractive and appealing. In addition. n the instrument was professionally printed. Returned Questionnaires In total. 151 (772) out of 195 questionnaires were returned. VP 0f the 151 questionnaires. 120 (62%)*were found to have usable data. Table 1 identifies the order of return of usable questionnaires. Of the questionnaires returned. 31 (15%) were unanswered or lacked adequate data. Most individuals indicated a reason for their lack of response. 'The following is the number of incomplete questionnaires returned and the reason: 1. Nine returned the unanswered questionnaire. stating it was too long and would take too much time. 2. Eight returned the questionnaire with no comment or stated that they chose not to participate. 3. Seven returned unanswered questionnaires stating that they received too many requests for data and therefore could no longer respond to them. 4. Two were in the middle of curriculum changes. which would result in an unclear description of their program; therefore. they chose not to respond. 42 5. 'Two had incomplete data to the extent that they could not be included in the study. 6. One no longer had an undergraduate program. 7. One was in the process of an accreditation visit and could not respond. 8. One chose not to participate because the information requested was not available in one central location. In summary. 195 questionnaires were sent to NLN-accredited baccalaureate nursing programs randomly selected from across the United States. One hundred fifty-one (77%) were returned. One hundred twenty (62%) contained usable data and were included in this study. Methods for Data Analysis Because this study was descriptive in nature. the data were organized to present the findings for each of the following research questions: 1. What are the organizational patterns of clinical nursing instruction in baccalaureate nursing programs? 2. ‘What are the variations and combinations of organiza- tional patterns found in baccalaureate nursing programs? 3. What effect do the organizational patterns have on faculty resource requirements in baccalaureate nursing programs? 4. What are the resource requirements in terms of academic preparation of faculty used to staff clinical instruction in baccalau- reate nursing programs? ‘4". a Ill '1']: "III-n—l-nr-mu-L ‘l'lrr 43 5. Is there a relationship between organizational patterns of clinical nursing instruction and faculty resource requirements in baccalaureate nursing programs. based on selected demographic data? The data analysis for each question was done using several of the descriptive and statistical testing programs available from the .n Statistical Package for the Social Sciences (SPSS). In addition. a statistical consultant assisted in the analysis of data. Generally. the following rationale was used when selecting a specific approach for data analysis: 1. When data were extremely complex or hard to test. simple descriptive statistics were used. 2. ‘When the means for two groups of data were compared. a t-test was used. 3. In situations in which the means of more than two groups were being compared. one—way analysis of variance (ANOVA) and the Fisher least significant differences (LSD) test were employed. 4. ‘When an analysis of the relationship between variables was desirable. the Pearson correlation coefficient or the point-biserial correlation coefficient was used. All testing was done at the2.05 significance level. In Question 1. the independent variable consisted of the five organizational patterns. Each pattern was analyzed to determine the frequency of use and the percentage of time each was used. These variables were also analyzed by year taken and specific course cate- gory. Simple descriptive statistics were used. 44 In Question 2. the independent variable was identified as the dominant organizational pattern. The dominant pattern*was described as a pattern used 50% or more of the time. 'The data‘were then analyzed to determine what other patterns were used in combination with that dominant pattern. This analysis included frequency of use. as well as percentage of time used. Again. simple descriptive statistics were used. Mean student/faculty ratio and mean number of hours in clinic per week.were the two major dependent variables used for analysis in Question 3. 'These variables were analyzed to determine the effect each organizational pattern and course had on them. Simple descrip- tive statistics were used for a portion of the analysis. ‘When com- parisons were made between student/faculty ratios or hours in clinic and each organizational pattern. they were statistically tested with a one-way ANOVA and the Fisher LSD. Question 4 involved an analysis of faculty academic prepara- tion for each course category. as well as each organizational pattern. Using simple descriptive statistics. the number of doctorate-. master's-. and bachelor's-prepared faculty; graduate assistants; labo- ratory assistants; and practicing nurses was identified for each course and organizational pattern. Finally. Question 5 involved analyzing the effect that four demographic variables had on the percentage of use of each organiza- tional pattern and the faculty resource requirements of student/ faculty ratio and number of hours in clinic. For the analysis of the 45 relationship between the demographic variables of college/university size or program size and the selected dependent variables. Pearsonfis correlation coefficient was used. For type of curriculum and graduate program. a t-test was used to determine if a significant difference existed. 'To determine the degree of correlation that existed between these independent variables and the selected dependent variables. a point biserial correlation coefficient was used. CHAPTER IV ANALYSIS OF DATA This chapter presents a detailed description of the analysis of data. It begins with the results of the survey return and a description of how the data were handled for analysis purposes. ‘This is followed by the analysis of specific data to determine: 1. What are the organizational patterns of clinical nursing instruction in baccalaureate nursing programs? 2. What are the variations and combinations of organiza- tional patterns found in baccalaureate nursing programs? 3. What effect do the organizational patterns have on faculty resource requirements in baccalaureate nursing programs? 4. What are the resource requirements in terms of academic preparation of faculty used to staff clinical instruction in baccalau- reate nursing programs? 5. Is there a relationship between organizational patterns of clinical nursing instruction and faculty resource requirements in baccalaureate nursing programs. based on selected demographic data? Survey_Return and Data Handling One hundred twenty or 62% of 195 mailed questionnaires were identified as providing data for inclusion in this analysis. Part one 46 .’"I:"' “em-1m . 47 of the questionnaire provided data on 694 required clinical nursing courses. Part two provided a range of demographic and related data about 120 baccalaureate nursing programs responding to the question- naire. Based on the course title identified by the respondent. each course was classified into one of eight categories. (See Table 2.) This classification was determined by matching a course title with the appropriate category. It was possible to classify 361 of the 694 courses (52%) in this manner. For 333 courses (48%). it was not possible to determine. based on the course title. a specific category. Courses with titles such as Nursing Process II. III. or IV or Nursing the Child and Adult were placed into a ninth category labeled Other. (See Table 2.) To qualify for one of the eight categories. the title had to reflect a term that clearly identified it as one fitting the identified classification. Any doubtful or confusing titles caused the courses to be classified into the ninth category of Other. It was usually easy to identify. by course title. the intention of the course. The first category. Introduction to Nursing. Nursing I. or Fundamentals of Nursing.*was the easiest to identify. The most difficult courses to identify were those related to pediatrics or child nursing. They often appeared to be a mixture of child-adult or some other mixed clinical course. Courses in the ninth category (Other) reflected a mixed title. 14%. child-adult. well child/well adult. or reflected a title unique 48 to the program structure or some major concept from its curriculum model. such as stress adaptation. wellness. stages of growth and development. or an element of the nursing process. In summary. this process provided the researcher with 361 required clinical courses that fell into one of the eight categories identified in Table 2 and 333 courses in category nine (Other). Table 2.-Number of required clinical nursing courses. by title. All Cases Generic and BSN (N = 694) RNs Combined Completion Course Title No. I No. I No. 2 Intro./Fundamentals/ Nursing I 92 13.3 85 13.4 7 11.7 Adult/Acute/ Medical-Surgical 49 7.1 45 7.1 4 6.7 Maternal-Child/ Expanding Family 35 5.0 33 5.2 2 3.3 Pediatrics/Child 19 2.7 19 3.0 O 0 Psychiatric/Mental Health 34 4.9 32 5.0 2 3.3 Community Heal th 55 7 . 9 45 7 . 1 10 16 . 7 Management/Leadership 37 5.3 32 5.0 5 8.3 Senior Practicum/ Advanced Medical-Surgical 40 5.8 36 5.7 4 6.7 Other 333 48.0 307 48.8 26 43.3 Total 694 100.0 634 100.0 60 100.0 49 Of the 120 baccalaureate nursing programs that responded. 18 (15%) reported that they were strictly Bachelor of Science in Nursing (BSN) completion programs. This means that they only admit students *who are currently licensed registered nurses and who have returned to school to complete the baccalaureate degree. (It is possible to become eligible to write the registered nurse licensure examination upon graduating from a two-year associate degree program. a three-year diploma program. or a four-year baccalaureate degree progress) These 18 programs reported data on 60 (8.642) of the 694 required clinical nursing courses (Table 2). Ninety-five (79.2%) programs reported that they accepted both generic (beginning) students and registered nurses returning for a degree into the same program. Five programs (4.2%) reported that they did not accept registered nurses. Two (1.7%) gave no response to the question. These 102 programs reported on 634 courses and were placed together under the data heading of Generic and RNs Combined. The effect that the BSN completion programs had on the data appears minimal. ‘However. for a clearer indication of their effect. the data are reported separately where it seemed appropriate. It is ‘worthwhile to report the results because it will be of interest and value to nursing program administrators. In summary. the data for analysis are from 120 baccalaureate nursing programs from across the United States. The respondents from these programs provided data on 694 required clinical nursing courses. 0f the 120 programs. 18 were BSN completion programs that only 50 admitted students who had already completed a basic nursing program and held a license as a registered nurse. The distribution for the 694 courses by year taken reflects that the vast majority (87%) were taught in the junior or senior year. (See Table 3.) Less than 1% were intended for freshman students. Table 3.--Distribution of required clinical nursing courses by year year taken. All Cases Generic and BSN (N = 694) RNs Combined Completion Year Taken No. I No. 2 No. I Freshman 6 .9 6 .9 0 0 Sophomore 85 12.2 85 13.4 0 0 Junior 289 42.9 269 42.4 29 48.3 Senior 305 43.9 274 43.2 31 51.7 In.the BSN completion programs. none of the required clinical courses were taught as freshman or sophomore courses. ‘This occurs because all students entering these courses are transfer students‘who have completed the lower-division courses in.a basic nursing program elsewhere. Of the 694 courses. 561 (81%)‘were reported to be taught in a semester system and 120 (172) in a quarters system. There was no response for 13 courses. Table 4 gives the distribution of credit hours for the required clinical courses. The mean number of credits given to a required clinical course for all cases was 4.25. with a standard deviation of 2.20. Seventy-six percent of the required clinical nursing courses 51 ranged from two to six credit hours. This figure was similar for all programs. including those that were BSN completion courses. Table 4.--Distribution of credit hours for required clinical nursing courses. All Cases Generic and BSN (N = 694) RNs Combined Completion Credit Hours No. 2 No. 2 No. I l 33 4.8 28 4.4 5 8.3 2 119 17.1 107 16.9 12 20.0 3 111 16.0 102 16.1 9 15.0 4 110 15.9 95 15.0 15 25.0 5 103 14.8 98 15.5 5 8.3 6 86 12.4 77 12.1 9 15.0 7 15 2.2 15 2.4 0 0 8 17 2.4 15 2.4 2 3.3 9 19 2.7 19 3.0 0 0 10 7 1.0 7 1.1 0 0 ll 1 .l 1 .2 0 0 12 9 1.3 9 1.4 0 0 No response 64 9.2 61 9.2 3 5.0 Total 694 100.0 634 100.0 60 100.0 Mean = 4.25 Mean = 4.30 Mean = 3.70 SD = 2.20 SD = 2.24 SD = 1.74 Data Related to Research Questions Research Question 1 What are the organizational patterns of clinical nursing instruction in baccalaureate nursing programs? All 694 required clinical nursing courses were reported as using one or more of the five organizational patterns of supervised clinical. simulated laboratory. preceptor/role model. independent 1 u 52 study. and practicum/internship. Table 5 identifies the reported use of each organizational pattern. Note that two measures of use are being described. The first states the percentage of courses that used the organizational pattern at all. This is referred to as the "Z of N." The second indicates. when used. what percentage of class instruction fell under that particular organizational pattern. This second measure is labeled "1 of Use Mean." 0f the 694 courses. 575 (82.852) were reported using supervised clinical as an organizational pattern. This exceeded all other organizational patterns. In addition to being most frequently used. the mean percentage of use (81.59%) for supervised clinical exceeded all others. Therefore. supervised clinical was the most frequently used organizational pattern. and when it was used it was. on an average. used more than 80% of the time. Simulated laboratory was reported to be used in 266 courses or 38.32% of the total 694 courses. making it the second most frequently used. However. when looking at the mean percentage of time used. it was found to account for only 34.04% of the time in the course. Preceptor/ role model was the organizational pattern used in 119 (17.141) of the reported courses. When it was used. the mean percentage of use was 42.40%. Independent study was reported to be used in 103 or 14.84% of the courses. Its mean percentage of time used (26.37%) shows it to be the lowest of the five organizational patterns. Although it was used mzwfimflf 53 lonesomao was as sueflaomaum> on» no .sowusnwuumwn Sundanese o How m wanes mom omsmooo oswnmoamae on zme mso«HMfl>on nuonsoum nouuomou oaks .msoflu mm.mm mm.on oo.H n sv.hm Hm.mm om.m mm Ho.mm om.~¢ Hm.m mm masmsuousfl \anwuomum No.m~ mo.mm nw.mm 0H Hm.om mm.em mm.ma mm sh.mm mm.m~ vm.oa moa hosum usoosomonsH ma.mm mm.Ho mm.mm om om.mm mv.mm an.mH mm mn.mm ov.~v vH.hH mHH Hones oaou \uoumoooum mm.vm Hm.ov mm.mm ea HH.Hm mm.mm vh.mm mmm mm.Hm vo.vm mm.mm mom wuoumuoan noumHsEam om.m~ Hm.mb mm.mm mm mh.Hm ma.mm ha.mm oem mm.mm mm.am mm.mm mhm Honesaao noma>uomsm com: com: new: 0 o 0 am on: 2 m 2 am 0m: z m 2 mm mm: 2 m z m w m w m a m0 w mo s no a cumuums macs mussmmuo a. 5 38 u E 3.... u e H .u . haze soHuonEoo 2mm nosaosou max new oeuosow mommo Had .monusoo oneness Hmoacflao nonesoou How suouumm Hmsoflumwwsmmuo some mo on: nouuomomll.m magma 54 in 103 courses. it was on an average used to teach about one-fourth of the clinical experience in those courses. Practicum/ internship was reported as being the least fre- quently used organizational pattern. Thirty-nine or 5.61% of the clinical courses reported its use. The mean percentage time of use for courses using it was 42.2%. When the BSN completion programs were omitted from the data. slight shifts in the percentages were seen. In these generic programs. 85.17% of the 634 courses used the clinical supervision pattern to teach the clinical courses. This indicated a slightly greater use of this pattern when the BSN completion programs were factored out. Upon examination of the BSN completion programs. it was noticed that there was less frequent use of supervised clinical and simulated learning laboratory and a shift toward greater use of the organizational patterns of preceptor/role model and independent study. Practicum/ internship had a very low usage (1.0%) for this group. Table 6 shows the frequency of each organizational pattern by the year the course is normally taken. Since few required clinical nursing courses (six) were offered in the freshman year. little can be said about that. Supervised clinical and simulated learning labora- tory were the primary organizational patterns of the sophomore year. Simulated laboratory appeared most frequently in the junior year. The greatest use of preceptor/role model and practicum/ internship appeared at the senior year. Supervised clinical. however. continued as the “W . mm predominant organizational pattern in both the junior and senior years. Table 6.--Frequency of organizational pattern. by year course is taken. Supervised Simulated Preceptor/ Independent Practicum/ Year Clinical Laboratory Role Model Study Internship Taken N Z N Z N Z N Z N 2 Freshman N = 6 2 .3 3 1.1 l .8 0 0 0 0 Sophomore N = 85 71 12.3 60 22.6 9 7.6 9 8.7 1 2.6 Junior N = 298 255 44.3 136 51.1 26 21.8 40 38.8 11 28.2 Senior N = 305 247 43.0 67 25.5 83 69.7 54 52.4 27 69.2 Total 575 100.0 266 100.0 119 100.0 103 100.0 39 100.0 Table 7 shows the number of courses in which a particular organizational pattern was reported as being used as a sole organiza- tional pattern. 0f the 575 reported as using supervised clinical. 40% or 230 cases reported it was used 100% of the time. The other organi- zational patterns were found to be used far less often as the sole pattern. These findings were also consistent with the data from programs that accepted both generic and RNs into a combined program and the BSN completion. 56 m «.mH H mm o.m m an m.0H e mHsmcHoocH \Esowuomum mH ~.m H em o.m s mOH m.s m sea». uconsomonsH om o.mH m mm H.va ea mHH m.va ha Hence oaou \uoumoooam «H e.Hm m mmm m.~H mm mom H.MH mm aHonHoBMH nouoassam mm m.mv ma ovm m.mm mam mhm o.ov 0mm Hmowsflao nomfl>uomsm on: on: on: mommo nouuomom wooa mommu nouuomom mooa mommo oouuomom wooa moan: msHmD mean: Hence Hmuoe Hobos Hmuos . Hmuoe Hence . unwound mo w 2 mo w 2 no a z HmcoquNfismmHo wane seaumameou zmm nocflnfiou mzm new canosmw mommu Had .suouumm Hosoaumuacmmuo some we own wooa msauuomou monsoon mo HooEuzI|.b manna 57 The grouped frequency distribution for the percentage of use of each organizational pattern (Table 8) gives a clear indication of the range of the percentage of time a particular pattern was used. About 66.7% of the courses using supervised clinical used it from 61-80% or 81-1002 of the time when looking at all cases. However. when looking at only BSN completion cases. the usage dropped to 38.34% of the courses. For those cases using simulated laboratory. it was reported that 28.6% of the courses used it 40% of the time or less. whereas only 6.8% of the courses used it from 61-80% or 81-100% of the time. These data give an indication of the combinations of organizational patterns used. which is discussed later. Preceptor/role model. independent study. and practicum/intern- ship generally reflected the same frequency pattern as simulated laboratory. Their use was greatest in the l-ZOZ range. Their use in the 61-802 and 81-1002 ranges was generally low. The preceptor/ role model pattern. however. did appear slightly more frequently in the 81-1002 range. Upon examination of the BSN completion programs. slightly less reliance on supervised clinical was seen. Twenty-six percent of the courses reported they used supervised clinical 81-1002 of the time. compared to 47.7% of the courses for all cases and 49.7% for courses that included both generic and RNs. Preceptor/ role model appeared to be more used in the BSN completion courses than was true for the generic and RNs combined. It was used 13.32 of the time in the 1" (I: I 58 98H 8 98H 3.. 98H 3.. 98H 8 98H .3 98H 30 98H 8 98H 3o 98. x... 98H 8 98H .3 98H 23 98H 8 98H '3 98H 3. H32. H..H H H. H 9 H H.H H H.H o H.H a H.H H H.H H.H 9H HH H... o H.H HH 9H H.H H.HH HH H.H.H HHH H.H.v HHH H87: H.H H H. H H. H 9H H o o H. H H.HH H H. H 9H HH o o H.H v H.H H H..HH H. H.H: H2 92 HHH 8?; 9H H H.H H H.H HH H.H H m. H 9H H H.H H H.H 2 9H .2 a o H.H H.H H.H 2 92 o H.H Ho H.H S 8..-: H.H H H. H 9H H. H.H H H.H HH H.H 2 9H H H.H oH H.H H.H 92 H. H... 2 9H 8 92 o H.H HH H.H HH 8?: o a H.H HH H.H HH 9.: H H.H. Ho v.2 2 9H H H.H 3 H.H. 8 H.H H 9: H.HH 92 H.HH a o 9H HH H.H HH HHHH 98 2H 93 :8 H... 3.. H.HH 3 H.H. H3 93 H.H 93 8 H.H. HHH 9H. HHH 92. a. 98 H.H H.Ho H.H. H.H. H.H 9: 3 H.H.H 2H 8 H H. H H. H H. H H. H H. H H. H H. H H. H H. H H. H H. H H. H H. H H. H HH 3: Ag . 1!.ng noneu .HH'ou 10380 .0010 .Ha—Iou p.580 neoeu His... 90580 .800 .480 92:80 .800 al..-one: .5. Hz. H 2m- .3. Hz: 2H ad .3. Hz. HHS .5. Hz... HH .8 3... a... 2: .0 H In. 07-0600 ad Uuuzs V UTHOCUU -¢ 0430:00 ‘ “350:8 35.535338... .63. 2.9.8.9: H.Hx! 23:899.... . 33:33 H.338; H.858 8....83 .2330!— HesoHueuHH—ezo no on: 003.39.!» no egos-are: Eamon-.. 038. 59 61-80% range and 6.7% of the time in the 81-1002 range. In the generic and RNs group. it was found only .51 in the 61-80% range and 2.7% in the 81-1001 range. A grouped frequency of percentage of use of organizational patterns for each course is presented in Table 9. The grouped fre- quency distribution is presented for each of the nine categories of course titles. Of the courses related to Introduction/Fundamentals/ Nursing I. the mean percentage usage of supervised clinical was 62.56%. When compared to the 81.59% mean for all cases. it indicates that supervised clinical was used less in this course than in other courses. Simulated laboratory was the most frequently used organiza- tional pattern for the Introduction/Fundamentals/Nursing I course category. The mean use for this course was 59.98% compared to a mean of 34.04% for all cases. Little. if any. use of preceptor/role model. independent study. and practicum/ internship was found in this course. It is apparent that supervised clinical and simulated laboratory were the organizational patterns used in this course. Courses falling into the Adult/Acute/Medical-Surgical category reflected a high usage of supervised clinical. The mean percentage of use for this group was 86.10%. This was above the 81.59% for all cases. Simulated laboratory was the second most common pattern for this course. Its mean percentage of use was 20.33%. somewhat less than the 34.04% mean for all cases. Preceptor/ role model. independent study. and practicum/internship were used little. if at all. The mum 60 Table 9.--Grouped frequency of percentage use of organizational patterns by course, all cases. 4 Supervised Simulated Preceptor/ Independent Practicum/ of Use Clinical Laboratory Role Model Study Internship Course: Introduction/Fundamentals/Nursing I O4 34 17 88 84 0 1-204 4 8 2 6 0 21-404 8 27 O 0 0 41-604 14 8 O 0 0 61-804 22 4 2 0 0 81-1004 10 28 0 2 O I cases 92 92 92 92 92 O > 0 58 7S 4 8 0 Mean 4 all cases 81.594 34.044 42.404 26.374 42.204 ”a?“ ‘ cases “sad 62.564 59.984 39.254 33.624 0 this course Course: Adult/Acute/Hedical-Surgical 04 1 28 44 46 0 1-204 1 15 4 3 0 21-404 2 S 1 0 0 41-604 1 O O 0 0 61-804 13 l 0 O 0 81-1004 31 O 0 0 0 4 cases 49 49 49 49 49 I > O 48 21 5 3 0 Mean 4 all cases 81.594 34.044 42.404 26.374 42.204 ”e?" ‘ °"°s used 86.104 20.334 11.004 16.664 0 this course Course: Haternal-Child/Expanding Family 04 O 25 3O 30. 32 l-204 0 8 5 S 2 21-404 2 2 O 0 0 41-604 3 0 O 0 1 61-804 4 0 O 0 0 81-1004 26 O 0 0 0 0 cases 35 35 35 35 35 I > 0 35 10 S S 3 Mean 4 all cases 81.594 34.044 42.404 26.374 42.204 “‘9" ‘ °“°5 “"d 88.544 13.900 10.004 10.404 26-66‘ this course 61 Table 9.--Continued. 4 Supervised Simulated Preceptor/ Independent Practicum/ of Use Clinical Laboratory Role Model Study Internship Course: Pediatric/Child 04 1 15 18 17 17 1-204 0 4 l 2 0 21-404 0 0 0 0 1 41-604 3 0 0 0 1 61-804 3 0 0 0 0 81-1004 12 0 0 0 0 4 cases 19 19 19 19 19 4 > 0 18 4 1 2 2 Mean 4 all cases 81.594 34.044 42.404 26.374 42.204 ”9‘“ ‘ ““5 used 86.664 8.754 20.004 20.004 40.004 this course Course: Psychiatric/Mental Health 04 2 28 28 31 30 1-204 0 6 4 3 0 21-404 1 0 1 0 1 41-604 4 0 1 0 3 61-804 5 0 0 0 0 81-1004 22 0 0 0 0 0 cases 34 34 34 34 34 I > 0 32 6 6 3 4 Mean 4 all cases 81.594 34.044 42.404 26.374 42.204 “a?“ ‘ ““5 “sad 87.344 10.834 21.664 11.664 47.504 this course Course: Community Health 04 6 43 38 40 50 1-204 3 9 7 8 1 21-404 3 1 5 4 2 41-604 8 0 3 1 2 61-804 12 4 2 0 0 81-1004 23 1 0 2 0 O of cases 55 55 55 55 55 4 > 0 49 12 17 15 5 Mean 4 611 cases 81.594 34.044 42.404 26.374 42.204 ”9‘“ ‘ “59's used 76.694 22.254 32.944 32.664 34.604 this course 62 Table 9.--Continued. 4 Supervised -Simu1ated Preceptor/ Independent Practicum/ of Use Clinical Laboratory Role Model Study Internship Course: Management/Leadership 04 11 33 25 31 31 1-204 3 4 0 5 0 21-404 0 0 2 0 2 41-604 4 0 3 l 2 61-804 5 0 2 0 0 81-1004 14 0 5 O 2 I of cases 37 37 37 37 ‘ 37 4 > 0 26 4 12 6 6 Mean 4 all cases 81.594 34.044 42.404 26.374 > 42.204 Mean 4 cases used this course 76.614 8.004 70.004 18.834 61.664 Course: Senior Practicum/Advanced Medical-Surgical 04 13 33 22 33 36 1-204 0 6 5 3 1 21-404 1 0 3 0 1 41-604 1 1 2 l 1 61-804 6 0 l 2 0 81-1004 19 0 7 1 l 4 cases 40 40 4o 40 40 4 > 0 27 7 18 7 4 Mean 4 all cases 81.594 34.044 42.404 26.374 42.204 "a?“ ‘ cases “59d 89.074 16.004 57.224 47.144 47.504 this course Course: Other 04 51 206 282 279 318 1-204 1 79 22 37 9 21-404 14 25 7 8 0 41-604 32 11 9 4 2 61-804 62 2 4 1 3 81-1004 173 10 9 4 l 4 cases 333 333 333 333 333 4 > O 282 127 51 54 15 Mean 4 all cases 81.594 34.044 42.044 26.374 42.204 ”3‘“ ‘ ““5 “'3“ 83.504 27.394 43.214 24.774 37.534 this course 63 predominant organizational pattern for Adult/Acute/Medical-Surgical was supervised clinical. with some usage of simulated laboratory. Courses falling into the Maternal-Child/Expanding Family cate- gory reflected a high usage of supervised clinical. All reported courses identified it as an organizational pattern. The mean percent- age usage was 88.542. This. compared to the mean of 81.59% for all E?- cases. indicates that it was used more in this course than in all * courses. Simulated laboratory was used in less than one-third of the . courses in Maternal-Child/Expanding Family. In those cases the mean i5” percentage of use was 13.9%. compared to a mean of 34.04% for all cases. Preceptor/role model. independent study. and practicum/ internship were used on a very limited basis. When used. their percentage of use was very low. usually in the 1-202 range. There- fore. the predominant organizational pattern for the Maternal-Child/ Expanding Family category was supervised clinical. Simulated labora- tory was used on a limited basis. The use of the other three patterns was very limited. The Pediatrics/Child nursing courses used supervised clinical as the primary organizational pattern. It was reported to be used in almost all courses. The mean percentage of use was 86.66%. somewhat greater than the 81.59% reported for all cases. Simulated laboratory. preceptor/ role model. independent study. and practicum/ internship were reportedly used in a few courses and on a very limited basis. 64 Supervised clinical was found to be the predominant organi- zational pattern for the Psychiatric/Mental Health course category. Ninety-four percent of the courses reported its use. The mean per- centage of use was 87.3%. which was higher than the percentage reported for all cases. Only six courses were reported as using simulated laboratory and preceptor/role model. Their use was very limited. Only four cases reported use of the practicum/ internship pattern. For those courses identified as Community Health. supervised clinical was the predominant organizational pattern. However. the mean percentage of use was 76.69%. making it less than the 81.59% mean for all cases. In this course category. increased use of preceptor/ role model and independent study was found. More than 30% of the reported courses used preceptor/ role model. The mean percentage of use was 32.94%. which was less than the 42.40% reported for all cases. Over 27% of the courses were reported as using independent study. When independent study was used. the use was 32.66%. placing it above the mean percentage of 26.37 for all cases. Simulated laboratory was used in less than 22% of the courses. With a mean of 22.25%. it was less than 34.04%. the mean for all cases. The Management/Leadership category also reported supervised clinical as the primary organizational pattern for instruction. About 70% of the reported courses indicated its use. Of those reporting its use. the mean percentage of use was 76.61%. which was less than the mean of 81.59% reported for all cases. Thirty-two percent of the 65 reported courses used preceptor/role model. When used. the mean percentage of use was 70%. considerably higher than the 42.4% mean for all cases. Simulated laboratory was used less for Management/Leader- ship than for any other course. Practicum/internship was used in six courses. Although it was used on a very limited basis. its mean percentage of use was 61.66% compared with a mean of 42.2% for all cases. Independent study had very limited use. “.1m4 rf Courses that fell into the Senior Practicum/Advanced Medical- . Surgical category also reported heavy use of the supervised clinical. ‘fr‘r .477 1. 4 The mean percentage of use for this pattern was 89.07% compared to the 81.59% mean for all cases. Preceptor/role model was the second highest in use. with 18 courses out of 40 (45%) reported as using it. The mean percentage of use for this pattern was 57.22% compared with a mean of 42.4% for all cases. Although not heavily used. the mean percentage of use for independent study and practicum/internship exceeded the mean for all cases. Independent study was 47.14% and practicum/internship was 47.5%. compared to all cases of independent study. which was 26.37%. and all cases of practicum/ internship. which was 42.2%. Simulated laboratory was used on a very limited basis. The last category. Other. represented all courses that could not be categorized by their title into one of the previous eight courses. The usage of organizational patterns for courses in this category. for the most part. followed that found in all cases. Two exceptions were noted. First. the mean use of simulated laboratory for this category was much lower than the mean for all cases. Second. 66 the mean use of practicum/internship was less than the mean for all cases. In summary. the dominant organizational pattern for the instruction of required clinical nursing courses in baccalaureate nursing programs was supervised clinical. It was reported to be used in 82.85% of 694 courses. In only one category of course. Introduc- tion/Fundamentals/Nursing I. was it not found to be the dominant organizational pattern. Simulated laboratory was found to be the second most common organizational pattern for instructing required clinical nursing courses in baccalaureate nursing programs. It was reported to be used in 38.32% of the 694 nursing courses. In the Introduction/Fundamen- tals/Nursing I category. it was the most frequently used organiza- tional pattern. However. its mean percentage of use was slightly less than supervised clinical. Preceptor/role model was reported to be used in 17.14% of the 694 courses. placing it third in use among the organizational pat- terns. It was not found to be a dominant organizational pattern of any of the course categories identified. However. it was more preva- lent in Community Health. Management/Leadership. and the Senior Prac- ticum/Advanced Medical-Surgical courses. Independent study ranked fourth in reported use. It was reported to be used in 14.84% of the 694 reported courses. It was not a dominant organizational pattern in any nursing course category. It appeared to be evenly distributed across categories. 67 Practicum/internship was the least used organizational pattern for instruction of required clinical courses in baccalaureate nursing programs. It was used in 5.61% of 694 reported courses. It was not found to be a dominant organizational pattern in an individual course category. Research Question 2 What are the variations and combinations of organiza- tional patterns found in baccalaureate nursing programs? This section analyzes the variations and combinations of organizational patterns found in the instruction of required clinical nursing courses in baccalaureate nursing programs. The intention was to discover what overall combinations of organizational patterns were found in the data and what combinations might be seen in individual course categories. To look at combinations. it was decided that the primary organizational pattern should be defined. and then the second- ary patterns used in combination with that primary pattern could be described. .An organizational pattern was defined as primary if it was used 50% or more of the time for instruction in a particular course. Table 10 provides data on the combinations of organizational patterns that were reported as a function of the primary pattern. The table shows the combinations of organizational patterns used'when an individual pattern was used 50% or more of the time. This gives a breakdown.of the dominant organizational pattern and the extent to which the other patterns were used with it. 68 Table 10.--Combination of organizational patterns, all cases. Cases Where Supervised Clinical Mas Used 504 or More of the Time Supervised Clinical Simulated Preceptor/ Independent Practicum/ 504 of Time Laboratory Role Model Study Internship or Greater All cases N 531 195 60 68 18 Mean 4 used 86.074 19.564 18.414 18.444 29.614 SD 16.22 13.37 14.89 17.27 18.27 Generic and RNs combined N 502 189 59 62 15 Mean 4 used 86.254 19.384 17.884 17.584 27.704 50 15.99 13.43 14.43 17.49 18.77 W N 29 6 1 6 3 Mean 4 used 83.034 25.164 50.004 27.334 41.664 50 19.83 10.51 0 12.77 10.40 Cases Where Simulated Laboratory Has Used 504 or More of the Time Simulated Laboratory Supervised Preceptor/ Independent Practicum/ 504 of Time Clinical Role Model Studv Internship of Greater All cases N 67 29 1 S 0 Mean 4 used 82.114 37.204 10.004 19.004 0 50 21.41 14.93 0 17.46 0 Generic and RNs combined N 63 29 0 5 0 Mean 4 used 81.144 37.204 0 19.004 0 50 21.69 14.93 0 17.46 0 BSN completion N 4 0 l 0 0 Mean 4 used 97.504 0 10.004 0 0 SD 5.00 0 0 O O 69 Table 10.--Continued. Cases Where Preceptor/Role Model Was Used 504 or More of the Time Preceptor/ Role Model Supervised Simulated Independent Practicum/ 504 of Time Clinical Laboratory Study Internship or Greater All cases N 50 16 6 13 3 Mean 4 used 77.164 33.064 13.834 19.924 44.334 50 20.54 16.33 10.87 10.80 9.81 Generic and R85 combined N 36 11 4 8 3 Mean 4 used 76.724 34.454 10.004 18.624 44.334 50 22.23 18.52 7.07 6.39 9.81 BSN completion N 14 5 2 5 0 Mean 4 used 78.284 30.004 21.504 22.004 0 50 16.06 11.18 16.26 16.43 0 Cases Where Independent Study Was Used 504 or More of the Time Independent Study Supervised Simulated Preceptor/ Practicum/ 504 of Time Clinical Laboratory Role Model Internship or Greater All cases N 17 6 8 3 1 Mean 4 used 79.704 45.834 30.334 36.664 40.004 80 22.39 24.98 20.00 11.57 0 Generic and 8N5 combined N 12 5 8 0 1 Mean 4 used 82.504 50.004 30.334 0 40.004 SD 24.16 25.49 20.08 0 0 BSN completion N 5 1 0 3 0 Mean 4 used 73.004 25.004 0 36.664 0 50 17.88 0 0 11.54 0 Cases Where Practicum/Internship Was Used 504 or More of the Time Practicum/ Internship Supervised Simulated Preceptor/ Independent 504 of Time Clinical Laboratory Role Model Study or Greater All cases N 18 8 1 7 1 Mean 4 used 66.664 41.254 20.004 32.854 20.004 50 20.50 17.06 0 13.80 0 Generic and RNs combined N 14 7 1 5 0 Mean 4 used 65.004 40.004 20.004 38.004 0 50 20.56 18.02 0 13.03 0 BSN cggpletion N 4 1 0 2 1 Mean 4 used 75.504 50.004 0 20.004 20.004 SD 22.17 0 0 0 0 70 Supervised clinical was used 50% or more of the time in 531 courses. Of those. the mean percentage of use was 86.07%. In these 531 courses. supervised clinical was used most frequently in combi- nation with simulated laboratory. Of these 531 courses. 195 were reported as using simulated laboratory with supervised clinical. The mean percentage of use was 19.56%. Sixty cases reported the use of precepetor/ role model with supervised clinical. Independent study was used in 68 cases. Practicum/internship was used in combination with supervised clinical in only 18 cases. making it the least likely .- combination. Simulated laboratory was used 50% or more of the time in 67 courses. Of those. the mean percentage of use was 82.11%. When it was used 50% or more of the time. simulated laboratory was most frequently used in combination with supervised clinical. Twenty-nine courses were reported as using supervised clinical with simulated laboratory. When supervised clinical was used. it had a mean percentage use of 37.2%. Preceptor/ role model and independent study were used in very few courses. Practicum/ internship had no reported cases of combined use with simulated laboratory. Fifty courses were reported as using preceptor/role model 50% or more of the time. The mean percentage of use was 77.16%. It was used with supervised clinical in 16 courses. with a mean percentage of use of 33.06%. It was used with independent study in 13 courses. with a mean percentage of use of 19.92%. Simulated laboratory and practi- cum/ internship had limited use. six and three courses. respectively. 71 Independent study was used 50% or more of the time in only 17 courses. Its mean percentage of use was 79.7%. It was used in combination with supervised. clinical in six cases and with simulated laboratory in eight cases and with preceptor/role model and practicum/ internship in even fewer cases. Practicum/internship was used 50% or more of the time in 18 courses. Its mean percentage of use was 66.66%. Of those courses. it was used in combination with supervised clinical in eight courses and preceptor/role model in seven. Table 9. which shows the frequency of percentage of use of each organizational pattern by course. also provides data regarding the combinations and variations of patterns for each category of required nursing course. The table identifies the number of courses that were reported as using each organizational pattern and the mean percentage they were used. Although this information was presented earlier. the specific combinations for each course were not empha- sized. For those courses that fit into the Introduction/ Fundamentals and Nursing I category. the most common pattern was a combination of supervised clinical and simulated laboratory. Fifty-eight out of 92 courses were reported as using supervised clinical for a mean per- centage time used of 62.56%. Seventy-five of the 92 courses were reported as using simulated laboratory and had a mean percentage time used of 59.98%. Preceptor/ role model and independent study had little use. and practicum/internship was not used at all. 72 For the Adult/Acute/Medical-Surgical category. supervised clinical was used in 48 out of 49 courses. The mean percentage of use was 86.1%. Simulated laboratory was most frequently used in combina- tion with supervised clinical. 'Twenty-one out of 49 courses reported its use. The mean percentage of use was 20.33%. Preceptor/ role model and independent study were used in few courses. Practicum/ internship was not used in this course. Generally. for this course. a high usage of supervised clinical with a low usage of simulated laboratory was the most frequently used combination. In courses in the area of Maternal-Child/Expanding Family. the combination was a high use of supervised clinical and a low use of the other four patterns. There was no strong combined pattern. but rather a heavy reliance on the single pattern. Simulated laboratory. preceptor/ role model. and independent study all had mean percentages of use of around 10%. whereas supervised clinical's mean was 88.54%. The Pediatrics/Child courses presented a very similar pattern to that of the previous course. The combination. when it did exist. was a high use of supervised clinical. a mean of 86.66%. and a very low use of the other patterns. Clinical courses teaching the Psychiatric/Mental Health experience reflected a high reliance on supervised clinical and a combination with the other four organizational patterns that reflected a low level of use. In those cases that showed simulated laboratory as the combination pattern. the mean percentage of use was 10.83%. In those cases that identified preceptor/ role model as the second 73 pattern in the combination. the mean increased to 21.66%. Although practicum/ internship was used in only four cases. its mean of 47.5% reflected almost a 50/50 split with supervised clinical. Those courses that fell into the Community Health category reflected a greater distribution of combinations. Although there continued to be a high use of supervised clinical. 49 out of 55 courses. there was more frequent use of preceptor/ role model and independent study than was seen in the previous courses. The combi- nations of organizational patterns in this course were fairly evenly distributed between supervised clinical and simulated laboratory. pre- ceptor/role model. or independent study. In the Management/Leadership category. supervised clinical was reported to be the predominant pattern. with a mean of 76.61%. It was not clear which types of combinations existed in this course. Precep- tor/ role model and practicum/internship. when used. were used to a much higher percentage than was seen in the other courses. The mean percentage of use for preceptor/role model was 70%. and for practicum/ internship it was 61.66%. In these courses. preceptor/ role model or practicum/internship were seen as the dominant pattern. Therefore. the combinations were less clear. In the Senior Practicum/Advanced Medical-Surgical category. there was heavy reliance on supervised clinical. with a mean percent- age of use of 89.07% in combination with a low-level use of the other patterns. However. almost one-half of the cases used preceptor/role model to some degree. Therefore. the second most common combination 74 appeared to be preceptor/role model. which had a mean percentage use of 57.22%. and some other organizational pattern. In summary. the analysis of combinations of organizational patterns for clinical instruction found heavy reliance on supervised clinical and simulated laboratory. This pattern appeared to hold true for all courses except those in the categories of Community Health. Management/Leadership. and Senior Practicum/Advanced Medical-Surgical. In these three course categories. more frequent combinations were seen involving preceptor/role model. independent study. or practicum/ internship. Research Question 3 What effect do the organizational patterns have on faculty resource requirements in baccalaureate nursing programs? Two faculty workload variables were selected for analysis in order to determine what effect the organizational patterns had on faculty resource requirements for the instruction of required clinical nursing courses. The first variable was student/faculty ratio or the number of students assigned to each faculty member in the clinical course section. The second variable was the total number of clock hours per week the student and faculty member spent in the clinical course. The frequency distribution of the reported student/faculty ratios for the 694 required clinical nursing courses is presented in Table 11. The mean ratio for all cases was 9.48. with a standard 75 deviation of 3.24. The mode was a student/faculty ratio of 10:1 and was reported in 262 or about 38% of the courses. Table ll.--Reported student/faculty ratio for required clinical nursing courses. All Generic and BSN # of Cases RNs Combined Completion Students to Faculty # of # of # of Courses Courses Courses 1 2 2 0 3 6 6 0 4 3 3 0 5 l7 l6 1 6 43 37 6 7 42 38 4 8 126 116 10 9 48 43 5 10 262 251 ll 11 22 20 2 12 51 41 10 13 l l 0 l4 6 5 l 15 9 7 2 16 ll 10 1 l8 1 l 0 19 l 0 1 20 2 O 2 25 2 2 0 29 l 0 l 40 l 1 0 48 l l 0 No report 36 33 3 Total 694 634 60 Mean 9.48 9.39 10.42 SD 3.24 3.12 4.18 Mode 10 10 10 76 In the 60 courses reporting for the BSN completion programs. the mean student/faculty ratio was 10.42. making it slightly higher than the mean for all cases or for the generic and RNs combined (mean = 9.39). The difference between the BSN completion and generic and 811s combined means was found to be statistically significant (t 2.30. df = 656. p < .05). To determine the degree of relationship. If the t was converted into a point-biserial correlation coefficient. 5. The rpb was equal to .09. reflecting a very small effect. The mode for both groups was a ratio of 10. which was reported for about 18% of we - the BSN completion courses and 40% of the generic and R318 combined courses. The mean student/ faculty ratio for each organizational pattern is provided in Table 12. although there was not a great variation in the ratio for each organizational pattern. It does suggest that for all reported cases. supervised clinical had the smallest ratio. with a mean of 9.07. The highest ratio appeared in independent study. with a mean of 10.12. For the BSN completion program. the student/faculty ratio remained around 9:1 for supervised clinical but increased to around 11:1 for simulated laboratory. precepetor/role model. and independent study. While these and the following descriptions are suggestive. they were not tested at this point. It was felt that the differences as a function of dominant organizational patterns were more meaningful. Those are discussed later in this section. 77 Table 12.-Mean student/faculty ratio. by organizational pattern. Organizational All Generic and BSN Pattern Cases RNs Combined Completion Supervised Mean 9.07 9.06 9.14 clinical SD 2.46 2.48 2.13 f of courses 554 519 35 Simulated Mean 9.64 9.56 11.00 laboratory SD 3.51 3.44 4.42 f of courses 253 239 14 Preceptor/ Mean 9.94 9.68 11.35 role model SD 4.23 4.33 3.42 I of courses 111 94 17 Independent Mean 10.12 9.88 11.57 study SD 5.11 5.04 5.47 f of courses 96 82 14 Practicum/ Mean 9.63 9.77 8.50 internship SD 1.96 2.01 1.00 # of courses 35 31 4 W " “Sm“: -'.-H-)-I-‘"“Iu.fl V7 . Table 13 identifies the mean student/faculty ratio for each organizational pattern. by year taken. There was little difference in the student/faculty ratio from one year to the next. The ratio remained consistent for each organizational pattern. whether it was used in the sophomore. junior. or senior year. The only exception to this appeared to be in the preceptor/ role model pattern. The mean student/faculty ratio for this pattern in the junior year was 8.88. and for the senior year it was 10.43. 78 Table 13.-Mean student/faculty ratio for each organizational pattern. by year taken-all reported cases. Organizational Freshman Sophomore Junior Senior Pattern Supervised Mean 10.00 8.97 8.94 9.22 clinical SD 0 2.49 1.79 2.99 2 I of courses 2 68 245 239 Simulated Mean 10.00 9.35 9.84 9.46 laboratory SD 0 2.52 4.27 2.56 f of courses 3 57 128 65 Preceptor/ Mean 10.00 8.56 8.88 10.43 . role model SD 0 3.17 4.47 4.25 g # of courses 1 9 24 77 Independent Mean 0 9.50 10.43 10.00 study SD 0 2.00 7.01 3.67 f of courses 0 8 37 51 Practicum/ Mean 0 11.00 9.33 9.68 internship SD 0 0 2.65 1.73 i of courses 0 1 9 25 Table 14 provides the mean student/faculty ratios for each organizational pattern. by course. for all reported cases. It identifies the percentage of use of each organizational pattern by specific course title. This provides an opportunity to analyze the relationship between percentage of use of each organizational pattern in each course and the resulting mean student/faculty ratios. The 61-80% and the 81-100% columns give a clearer indication of the effect that each organizational pattern had on the student/ faculty ratio because in these courses the pattern was clearly 79 Table l4.--Mean student/faculty ratio for each organizational pattern. by course. for all reported cases. Percentage of Reported Use of Supervised Clinical Course 1-204 21-404 41-604 61-804 81-1004 Total Intro./Fundamentals/ Mean 12.25 9.50 9.62 8.18 9.10 9.14 Nursing I SD 1.71 3.42 .77 1.68 1.52 2.07 4 of courses 4 8 13 22 10 57 Adult/Acute/ Mean 8.00 10.00 12.00 8.15 8.90 8.79 Medical-Surgical SD 0 O 0 1.86 2.07 2.01 4 of courses 0 2 1 13 3O 47 Maternal-Child/ Mean 0 6.00 11.00 8.25 8.64 8.58 Expanding Family SD 0 O 1.41 50 1.96 1.94 4 of courses 0 2 2 4 25 33 Pediatrics/Child Mean 0 O 9.33 7.33 9.50 9.06 SD 0 0 3.06 1.15 1.35 1.35 4 of courses 0 O 3 3 10 16 Psychiatric/ Mean 0 10.00 8.50 8.80 9.45 9.23 Mental Health SD 0 O 1.91 1.10 1.64 1.57 4 of courses 0 1 4 5 20 30 Community Health Mean 10.67 10.67 9.13 8.17 9.29 9.15 SD 1.15 1.15 1.81 2.12 2.03 2.01 4 of courses 3 3 8 12 21 47 Management/ Mean 10.00 0 9.50 7.80 10.38 9.68 Leadership SD 0 O 1.00 2.49 5.27 4.01 4 of courses 3 O 4 5 13 25 Senior Practicum/ Mean 0 8.00 8.00 9.60 8.89 8.96 Advanced Medical- SD 0 O O .89 1.91 1.71 Surgical 4 of courses 0 1 1 5 19 26 Other Mean 1.00 9.21 10.19 8.96 8.95 9.08 SD 0 2.91 5.82 1.51 1.91 2.72 4 of courses 1 14 32 56 170 273 Column total Mean 10.00 9.26 9.79 8.58 9.05 9.07 SD 3.28 2.74 4.13 1.66 2.13 2.46 4 of courses 12 31 68 125 318 554 Mean Student/Faculty Ratio for Each Organisational Pattern. by Course. for Generic and RNs Combineda Column total Mean 10.00 8.84 9.85 8.52 9.10 9.06 SD 3.28 2.69 4.31 1.60 2.14 2.48 4 of courses 12 25 62 118 302 519 Mean Student/Faculty Ratio for Each Organizational Pattern. by Course, for BSN Completiona Column total Mean 0 11.00 9.17 9.57 8.25 9.14 SD 0 2.45 .98 2.44 1.81 2.13 4 of courses 0 6 6 7 16 35 .4! Win-I'li " ‘ 80 Table 14.--Continued. Percentage of Reported Use of Simulated Laboratory Course 1-204 21-404 41-604 61-804 81-1004 Total Intro./Fundamentals/ Mean 7.38 9.33 9.57 11.00 “10.54 9.67 Nursing I SD 2.13 2.57 1.13 3.92 2.79 2.72 4 of courses 8 27 7 4 26 72 Adult/Acute/ Mean 8.93 9.00 o 8.00 0 8.90 b“ ‘ Medical-Surgical SD 1.27 2.24 O O O 1.48 4 of courses 14 5 O 1 O 20 Maternal-Child/ Mean 8.75 7.00 O 0 O 8.40 Expanding Family SD 1.58 1.41 O O O 1.65 4 of courses 8 2 O O O 10 Pediatrics/Child Mean 9.25 O 0 0 0 9.25 SD 1.50 O O 0 O 1 SO 4 of courses 4 O O O O 4 Psychiatric/ Mean 9.83 O O O O 9.83 Mental Health SD 1.60 O 0 O O 1.60 4 of courses 6 0 0 O 0 6 Community Health Mean 8.00 20.00 0 10.00 6.00 9.00 SD 2.29 0 0 0 0 4.07 4 of courses 9 1 0 1 1 12 Management/ Mean 8.00 O O O O 8.00 Leadership SD 2.83 O O O O 2 83 4 of courses 4 O O O 0 4 Senior Practicum/ Mean 9.67 0 8.00 0 0 9.43 Advanced Medical- SD .82 O O O O .98 Surgical 4 of courses 6 O 1 0 O 7 Other Mean 9.36 9.04 13.18 11.00 13.88 9.98 SD 1.75 2.05 11.75 7.07 5.22 4.36 4 of courses 73 24 11 2 8 118 Column total Mean 9.05 9.29 11.58 10.50 11.17 9.64 SD 1.81 2.68 9.00 3.85 3.76 3.51 4 of courses 132 59 19 8 35 253 Mean Student/Faculty Ratio for Each Organizational Pattern. by Course. for Generic and RNs Combineda Column total Mean 9.06 8.80 11.58 10.50 11.39 9.56 ‘ SD 1.82 1.64 9.00 3.85 3.86 3.44 4 of courses 130 51 19 8 31 239 Mean Student/Faculty Ratio for Each Organizational Pattern. by Course. for ISN Completiona Column total Mean 8.50 12.38 0 O 9.50 11.00 SD .71 5.29 O O 2.65 4.42 4 of courses 2 8 ' O O 4 14 81 Table l4.--Continued. Percentage of Reported Use of Preceptor/Role Model Course 1-204 21-404 41-604 61-804 81-1004 Total Intro./Fundamentals/ Mean 10.00 0 0 14.50 0 12.25 Nursing I SD 0 0 0 7.78 0 5.19 4 of courses 2 O 0 2 0 Adult/Acute/ Mean 9.00 10.00 0 0 0 9.20 Medical-Surgical SD 1.41 0 0 0 0 1.30 4 of courses 4 O 0 0 0 5 Maternal-Child/ Mean 7.60 0 0 0 0 7.60 Expanding Family SD 3.05 0 0 0 0 3.05 4 of courses 5 0 0 0 0 5 Pediatrics/Child Mean 6.00 O 0 0 0 6.00 SD 0 0 O 0 0 0 4 of courses 1 0 0 0 0 1 Psychiatric/ , Mean 10.00 10.00 10.00 0 0 10.00 Mental Health SD 1.63 0 0 0 - 1.26 4 of courses 4 l l 0 0 6 Community Health Mean 8.57 9.80 9.33 13.00 0 9.59 SD 1.90 1.48 1.15 1.41 0 2.30 4 of courses 7 5 3 2 O 17 Management/ Mean 0 10.00 10.00 10.00 10.80 10.33 Leadership SD 0 0 0 0 5.97 3.73 4 of courses 0 2 3 2 S 12 Senior Practicum/ Mean 9.20 8.00 10.00 10.00 10.83 9.93 Advanced Medical- SD 1.10 0 0 0 2.71 2.02 Surgical 4 of courses 5 l 1 1 6 14 Other Mean 7.85 10.14 14.22 12.72 10.14 10.17 SD 2.72 3.29 10.76 1.50 3.53 5.70 4 of courses 20 7 9 4 7 47 Column total Mean 8.40 9.88 12.12 12.36 10.56 9.94 SD 2.32 2.20 7.99 3.11 3.88 4.43 4 of courses 48 17 17 11 18 111 Mean Student/Faculty Ratio for Each Organizational Pattern, by Course, for Generic and R85 Combineda Column total Mean 8.45 9.87 12.47 10.00 10.57 9.68 SD 2.32 2.23 8.48 0 4.15 4.33 4 of courses 47 15 15 3 14 94 Mean Student/Faculty Ratio for Each Organizational Pattern, by Course, for BSN Completiona Column total Mean 6.00 10.00 9.50 13.25 10.50 11.35 SD 0 2.83 .71 3.24 3.32 3.41 4 of courses 1 2 2 8 4 17 governs-ummnmullmllmngl 82 Table l4.--Continued. Percentage of Reported Use of Independent Study Course 1-20\ 21-404 41—60\ 61-80\ 81-1004 Total Intro./Pundamentals/ Mean 9.33 0 0 0 12.00 10.00 Nursing 1 SD 1.75 O 0 0 0 1.93 4 of courses 6 0 0 0 2 8 Adult/Acute/ Mean 7.67 0 0 O 0 7.67 Medical-Surgical SD 2.52 0 0 0 0 2.52 4 of courses 3 0 0 0 0 3 Maternal-Child/ Mean 8.60 O O 0 O 8.60 Expanding Family SD 1.67 O 0 0 0 1.67 4 of courses 5 O 0 0 0 5 Pediatrics/Child Mean 7.00 0 0 0 0 7.00 SD 1.41 0 0 0 0 1.41 4 of courses 2 0 0 0 0 2 Psychiatric/ Mean 8.67 0 O 0 0 8.67 Mental Health SD 1.15 O O 0 0 1.15 4 of courses 3 0 0 O 0 3 Community Health Mean 10.13 10.00 5.00 0 29.00 11.07 SD 2.53 0 0 0 O 5.65 4 of courses 8 4 l 0 1 14 Management/ Mean 9.20 0 10.00 0 0 9.33 Leadership SD 4.38 0 0 O 0 3.93 4 of courses 5 0 1 0 0 6 Senior Practicum/ Mean 9.33 0 10.00 8.00 10.00 9.33 Advanced Medical- SD 1.15 0 0 0 0 1.03 Surgical 4 of courses 3 0 l 1 1 6 Other Mean 10.40 8.57 18.50 6.00 7.50 10.59 SD 2.97 2.70 19.76 0 2.12 6.19 4 of courses 35 7 4 1 2 49 Column total Mean 9.73 9.09 14.14 7.00 13.00 10.13 SD 2.76 2.21 15.08 1.41 8.15 5.11 4 of courses 70 ll 7 2 6 96 Mean Student/Faculty Ratio for Each Organizational Pattern, by Course, for Generic and RNs Combineda Column total Mean 9.55 9.00 15.80 0 9.80 9.88 SD 2.79 2.31 18.14 0 2.49 5.04 4 of courses 62 10 5 0 5 82 Mean Student/Faculty Ratio for Each Organizational Pattern, by Course. for BSN Completiona Column total Mean 11.13 10.00 10.00 7.00 29.00 11.57 SD 2.17 0 0 1.41 0 5.47 4 of courses 8 l 2 2 l 14 83 Table 14.--Continued. Percentage of Reported Use of Practicum/Internship Course 1-20\ 21-404 41-604 61-80\ 81-100\ Total Intro./Fundamentals/ Mean Nursing I SD NO CASES REPORTED 4 of courses Adult/Acute/ Mean Medical-Surgical SD NO CASES REPORTED 4 of courses Maternal-Child/ Mean 6.00 0 12.00 0 0 8.00 Expanding Family SD 0 O 0 0 0 3.46 4 of courses 2 0 l 0 0 3 Pediatrics/Child Mean 0 6.00 12.00 0 0 9.00 SD 0 0 0 0 0 4.24 4 of courses 0 1 1 0 0 2 Psychiatric/ Mean 0 10.00 8.67 0 0 9.00 Mental Health SD 0 0 3.06 0 0 2.58 4 of courses 0 1 3 0 0 4 Community Health Mean 10.00 9.00 10.00 0 0 9.60 SD 0 1.41 2.83 O 0 1.67 4 of courses 1 2 2 0 0 5 Management/ Mean 0 10.00 11.00 0 10.00 10.33 Leadership SD 0 0 1.41 O 2.83 1.51 4 of courses 0 2 2 0 2 6 Senior Practicum/ Mean 10.00 8.00 0 O 0 9.00 Advanced Medical- SD 0 0 0 0 0 1.41 Surgical 4 of courses 1 l 0 0 0 2 Other Mean 9.89 0 10.00 11.00 10.00 10.58 SD 1.69 0 O 1.41 0 1.50 4 of courses 9 0 l 2 1 l3 Column total Mean 9.31 8.86 10.20 11.00 10.00 9.63 SD 2.02 1.57 2.20 1.41 2.00 1.96 4 of courses l3 7 10 2 3 35 Mean Student/Faculty Ratio for Each Organizational Pattern, by Course, for Generic and RNs Combineda , Column total Mean 9.31 8.67 10.75 11.00 11.00 9.77 SD 2.02 1.63 2.12 1.41 1.41 2.01 4 of courses l3 6 8 2 2 31 Mean Student/Faculty Ratio for Each Organizational Pattern, by Course. for BSN Completiona Column total Mean 0 10X00 8.00 0 8.00 8.50 SD 0 0 0 0 0 1.00 4 of courses 0 1 2 0 l 4 aColumn totals given for comparison. 84 the dominant organizational pattern. The column total mean tells that in those cases where supervised clinical was used 61-802 of the time. the student/faculty ratio was 8.58:1. and that ratio was 9.05:1 for those cases that used it 81-1002 of the time. When looking at the means listed in the 81-100% column for each course. the highest mean ratio was found for the Management/Leadership courses. which was 10.38. The lowest student/faculty mean ratio for supervised clinical appeared for the cases identified as Maternal-Child/Expanding Family. (Both of these were probably related more to conditions in the clini- cal setting rather than the specific organizational pattern; i.e.. small OB units in hospitals may limit the number of students.) Simulated laboratory was used 61-801 of the time in only eight courses and 81-100% of the time in 35 courses. The mean student/faculty ratios were 10.50 and 11.17. respectively. Its use was found to be most frequently in the Introduction/Fundamentals/ Nursing I courses. For preceptor/ role model. the column total for mean student/ faculty ratio reflects a higher ratio with increasing use. except for the 81-1002 column. where there is a decline in the mean ratio. The highest mean ratios appear in the 41-602 column and the 61-802 column. The mean student/faculty ratio for the 41-601 column was 12.12:1. for 61—802 a ratio of 12.36:l was found. and in the 81-100% usage column it dropped to a mean ratio of 10.56:1. This was most often reported for cases falling within Management/Leadership. Senior Practicum/Advanced Medical-Surgical. and Other. 85 The highest total mean student/ faculty ratio for independent study appears in the 41-602 and the 81-1002 columns. Seven courses were reported as using it 151-60% of the time. with a mean ratio of 14.14:1. Six courses were reported as using it 81-100% of the time. with a mean ratio of 13:1. Practicum/ internship had a very low usage as a predominant pattern. It was reported to be used 81-1002 of the time in only three courses. 61—801 of the time in two courses. and 41-601 of the time in ten courses. The column total mean ratios are 10:1 for the 81-1002. 11:1 for the 61-801. and 10.2:1 for the 41-602. Table 14 also provides the column totals for the courses reported by programs that had the generic and RNs in combined programs and the courses reported by programs that were BSN completion pro- grams. This provides an opportunity to compare the BSN completion with those that included both generic and RN students. When the mean student/ faculty ratio for cases in the BSN completion program were compared with cases in the generic and We combined programs. three of the five organizational patterns had higher faculty/student ratios. Simulated laboratory had a mean ratio of 11:1 for BSN completion and 9.56:1 for generic and We combined. Preceptor/ role model had a mean ratio of 11.35:1 for BSN completion and 9.68:1 for generic and RNs combined. Independent study had a mean ratio of 11.57 for the BSN completion and 9.83 for the generic and RNs combined. In examining the remaining two organizational patterns for comparison. the mean student/ faculty ratios were about the same. The 86 mean student/faculty ratio for supervised clinical for the BSN completion programs was 9.14:1. and for generic and RNs combined it was 9.06:1. This left little. if any. difference between the two. For practicum/internship. the mean ratio was smaller for the BSN completion programs when compared to the generic and RNs combined. Since there were only four cases reported from the BSN completion. it was not possible to make a reasonable comparison. When examining the individual column totals for each percent- age of use in Table 14. there appeared to be very little difference between the student/ faculty ratio for those required clinical nursing courses reported by BSN completion programs and those courses reported by generic and RNs combined programs. In summary. for all cases reported as using the supervised clinical organizational pattern. the mean student/faculty ratio was 9.07:1. for simulated laboratory it was 9.64:1. for the preceptor/ role model organizational pattern it was 9.94:1. for independent study the student/faculty ratio was 10.13:1. and for practicum/ internship it was 9.63:1. The number of clock hours in clinic per week reflects the number of hours a faculty member must be available to the students for supervision. Table 15 identifies the reported clock hours in clinic per week for reported clinical nursing courses. The mean number of hours for all cases was 11.03. with a mode of 12. The mean number of hours in clinic per week for those courses reported from BSN completion programs was 7. with a mode of 9. The mean for those cases 87 Table 15.--Reported clock hours in clinic per week for required clinical nursing courses. All Generic and BSN Cases RNs Combined Completion Clock Hours 4 of 4 of 4 of Courses Courses Courses 1 1 l 0 2 13 10 3 3 43 38 5 4 32 24 8 5 4 4 0 6 80 67 13 7 10 10 0 8 52 45 7 9 55 40 15 10 16 16 0 11 6 6 0 12 118 116 2 13 12 12 0 14 20 20 0 15 33 31 2 16 92 91 l 18 44 44 0 19 2 2 0 20 8 8 0 23 1 1 0 24 5 5 0 27 1 l 0 30 3 3 0 32 3 3 0 40 2 2 0 No report 38 34 4 Total 694 634 60 Mean 11.03 11.41 7.00 SD 5.52 5.54 3.21 Mode 12 12 9 88 reported from generic and RNs combined programs was 11.41. with a mode of 12. The difference between BSN completion and generic and RNs combined cases was significant (t = 5.86. df = 6.54. p < .01). The degree of relationship was determined by converting the t into a point-biserial correlation coefficient. The rpb was equal to .22, indicating only a weak relationship between program type and hours in clinic. Table 16 provides the mean clock hours reported for each organizational pattern. Simulated laboratory was reported as having the fewest hours. with a mean of 10.23 hours for all cases. For those courses reported from BSN completion programs. independent study was reported as using the fewest hours. with a mean of 6.57 hours. Practicum/internship provided the greatest number of hours in clinic. Preceptor/ role model was second in the number of hours in clinic for all cases and for cases reported from generic and We combined. This was not true for courses reported from BSN completion programs. 89 Table l6.-Mean clock hours in clinic per week reported for each organizational pattern. Organizational All Generic and BSN Pattern Cases RNs Combined Completion Supervised Mean 11.27 11.50 7.94 clinical SD 4.69 4.71 2.71 4 of courses 550 515 35 Simulated Mean 10.23 10.41 7.00 laboratory SD 5.19 5.21 3.67 4 of courses 246 233 13 Preceptor/ Mean 12.44 13.37 7.13 role model SD 7.73 7.86 4.01 4 of courses 108 92 16 Independent Mean 10.69 11.39 6.57 study SD 5.46 5.53 2.38 4 of courses 96 82 14 Practicum/ Mean 12.75 13.39 8.25 internship SD 6.36 6.54 1.50 4 of courses 32 28 4 -r Tjir‘ fl. Table 17 identifies the mean clock hours in clinic per week reported by all cases for clinical nursing courses for each of the five organizational patterns by year. Those courses taught in the sopho- more year required about 602 of the number of hours per week of those taught in the junior and senior years. The number of hours increased from the junior to senior year. as well. Supervised clinical was the organizational pattern reported as using the greatest number of hours in both the sophomore year. with a mean of 6.69 hours. and the junior year. with a mean of 11.12 hours. 90 Preceptor/role model was the organizational pattern reported as using the greatest number of hours in the senior year. with a mean of 14.11 hours. Table l7.--Mean clock hours in clinic per week reported for required nursing courses. by organizational pattern and year-a11 cases. Organizational Freshman Sophomore Junior Senior Pattern Supervised Mean 6.00 6.69 11.12 12.79 clinical SD 0 3.58 4.32 4.43 4 of courses 2 68 242 238 Simulated Mean 4.67 5.88 10.70 13.39 laboratory SD 2.31 3.69 4.86 4.26 4 of courses 3 56 123 64 Preceptor/ Mean 6.00 6.00 9.83 14.11 role model SD 0 1.00 4.68 8.33 4 of courses 1 9 23 75 Independent Mean 0 6.11 10.19 11.84 study SD 0 3.89 5.09 5.54 4 of courses 0 9 36 51 Practicum/ Mean 0 6.00 10.43 13.71 internship SD 0 0 6.48 6.24 4 of courses 0 1 7 24 The mean clock hours in clinic per week by the percentage of time that an organizational pattern was used are identified by course in Table 18. In looking at each course. it is possible to identify the mean number of hours in clinic per week reported for each course 91 Table 18.--Mean clock hours in clinic per week for each organizational pattern, by course, for all reported cases. Percentage of Reported Use of Supervised Clinical Course 1-204 21-40\ 41-604 61-804 81-100\ Total Intro./Fundamentals/ Mean 4.67 3.63 8.54 9.48 9.10 8.07 Nursing 1 SD 2.31 1.51 4.52 4.84 5.13 4.76 4 of courses 3 8 13 21 10 55 Adult/Acute/ Mean 3.00 3.00 5.00 10.69 11.37 10.51 Medical-Surgical SD 0 O O 3.01 4.19 4.27 4 of courses 1 2 1 13 3O 47 Maternal-Child/ Mean 0 12.50 6.00 12.75 12.11 12.03 Expanding Family SD 0 9.19 O 2.99 3.70 3.92 4 of courses 0 2 1 4 27 34 Pediatrics/Child Mean 0 O 12.50 13.33 12.55 12.69 SD 0 0 9.19 2.31 4.08 4.19 4 of courses 0 0 2 3 11 16 Psychiatric/ Mean 0 3.00 11.25 14.00 11.68 11.72 Mental Health SD 0 0 4.57 7.75 3.51 4.63 4 of courses 0 l 4 5 22 32 Community Health Mean 12.00 7.00 7.13 11.50 12.36 10.89 SD 5.66 4.58 2.47 3.40 4.66 4.45 4 of courses 2 3 8 12 22 47 Management/ Mean 15.33 0 14.00 12.20 14.23 13.92 Leadership SD 3.06 O 5.42 3.77 5.89 5.01 4 of courses 3 0 4 5 13 25 Senior Practicum/ Mean 0 16.00 16.00 13.20 13.58 13.69 Advanced Medical- SD 0 O 0 3.35 3.53 3.36 Surgical 4 of courses 0 l 1 5 19 26 Other Mean 6.00 10.00 8.47 12.96 11.57 10.41 SD 0 7.46 4.54 3.80 4.42 4.65 4 of courses 1 13 30 56 168 268 Column total Mean 9.30 7.67 8.98 12.02 11.84 10.27 SD 5.77 6.42 4.68 4.16 4.37 4.69 4 of courses 10 3O 64 124 322 550 Mean Clock Hours in Clinic Per Week for Each Organizational Pattern. by Course. for Generic and RNs Combined“ Column total Mean 9.30 7.54 9.19 12.27 12.02 11.50 SD 5.77 6.95 4.84 4.12 4.36 4.71 4 of courses 10 24 58 117 306 515 Mean Clock Hours in Clinic Per Meek for Each Organizational Pattern, by Course. for BSN Completion“ Column total Mean 0 8.17 7.00 7.71 8.31 7.94 SD 0 4.02 2.00 1.60 2.89 2.71 4 of courses 0 6 6 7 16 35 92 Table 18.--Continued. Percentage of Reported Use of Simulated Laboratory Course 1-204 21-404 41-604 61-804 81-1004 Total Intro./Fundamentals Mean 9.25 8.28 6.86 4.67 4.50 6.67 Nursing I SD 4.56 5.18 3.93 2.31 2.40 4.35 4 of courses 8 25 7 3 26 69 Adult/Acute/ Mean 11.14 7.20 O 3.00 0 9.75 Medical-Surgical SD 3.03 4.02 O O 0 3.91 4 of courses 14 5 O 1 0 20 Maternal-Child/ Mean 13.00 7.50 O O 0 11.91 Expanding Family SD 3.85 2.12 0 O 0 4.18 4 of courses 8 2 O 0 0 10 Pediatrics/Child Mean 15.00 0 O 0 0 15-00 SD 3.46 0 O 0 0 3.46 4 of courses 4 0 O 0 0 4 Psychiatric/ Mean 14.00 0 O 0 0 14.00 Mental Health SD 8.00 0 0 O 0 8.00 4 of courses 5 0 O O 0 5 Community Health Mean 12.33 3.00 O 3.00 6.00 10.25 SD 8.77 0 O O 0 5.01 4 of courses 9 l 0 1 1 12 Management/ Mean 13.00 0 0 0 0 13.00 Leadership SD 2.00 0 O O 0 2.00 4 of courses 4 0 O 0 0 4 Senior Practicum/ Mean 14.00 0 16.00 0 0 14.29 Advanced Medical- SD 3.58 O O 0 0 3.35 Surgical 4 of courses 6 O l O O 7 Other Mean 13.31 11.04 5.30 3.00 7.25 11.63 SD 3.73 4.94 2.87 O 6.73 4.94 4 of courses 72 24 10 1 8 115 Column totals Mean 12.84 9.23 6.50 3.83 5.17 10.23 SD 3.97 5.07 4.00 1.72 3.87 5.19 4 of courses 130 57 18 6 35 246 Mean Clock Hours in Clinic Per Week for Each Organizational Pattern, by Course, for Generic and RNs Combineda Column total Mean 12.94 9.30 6.50 3.83 5.29 10.41 SD 3.91 5.24 4.00 1.72 4.08 5.21 4 of courses 128 50 18 6 31 233 Mean Clock Hours in Clinic Per Week for Each Organizational Pattern. by Course. for BSN Completion“ Column total Mean 6.50 8.71 O O 4.25 7.00 SD 3.54 3.95 O 0 l 26 3.67 4 of courses 2 7 O 0 4 13 93 Table 18.--Continued. Percentage of Reported Use of Preceptor/Role Model Course 1-20\ 21-40\ 41-60‘ 61-80\ si-ioos Total Intro./Fundamentals/ Mean 6.00 O O 4.00 0 5.33 Nursing I SD 2.83 0 0 O 0 2 31 4 of courses 2 0 0 1 0 3 Adult/Acute/ Mean 7.50 14.00 0 0 O 8.80 Medical-Surgical SD 3.00 0 0 0 0 3 90 4 of courses 4 1 0 0 0 5 Maternal-Child/ Mean 10.20 0 O 0 0 10.20 Expanding Family SD 5.50 0 O O O 5.50 4 of courses 5 O 0 0 O 5 Pediatrics/Child Mean 12.00 0 O 0 0 12.00 SD 0 O O 0 0 0 4 of courses 1 O O 0 0 1 Psychiatric/ Mean 10.67 6.00 14.00 0 0 10.40 Mental Health SD 8.33 0 O O O 6.54 4 of courses 3 1 l 0 0 5 Community Health Mean 10.14 12.50 8.67 5.00 0 9.81 SD 4.56 3.42 3.06 1.41 0 4.71 4 of courses 7 4 3 2 O 16 Management/ Mean 0 8.50 14.67 14.00 7.50 10.82 Leadership SD 0 .71 2.31 2.83 7.19 5.42 4 of courses 0 2 3 2 4 11 Senior Practicum/ Mean 14.40 6.00 20.50 18.00 20.57 17.56 Advanced Medical- SD 3.58 O 16.26 0 12.53 10.07 Surgical 4 of courses 5 1 2 1 7 16 Other Mean 12.95 8.67 10.89 5.50 24.25 13.30 SD 4.24 6.19 7.61 1.00 10.26 8.30 4 of courses l9 6 9 4 8 46 Column total Mean 11.43 9.67 12.39 8.20 19.37 12.44 SD 4.77 4.73 7.55 5.20 12.01 7.76 4 of courses 46 15 18 10 19 108 Mean Clock Hours in Clinic Per Week for Each Organizational Pattern, by Course, for Generic and RNs Combined“ Column total Mean 11.56 9.46 13.13 15.33 22.07 13.37 SD 4.75 4.65 7.65 3.06 11.91 7.86 4 of courses 45 13 16 3 15 92 Mean Clock Hours in Clinic Per Week for Each Organizational Pattern. by Course. for BSN Completion“ Column total Mean 6.00 11.00 6.50 5.14 9.25 7.13 SD 0 7.07 3.54 1.07 5.62 4.01 4 of courses 1 2 2 7 4 l6 Table 18.-~Continued. 94 Percentage of Reported Use of Independent Study Course 1-20\ 21-404 41-604 61-80\ 81-1004 Total Intro./Fundamentals/ Mean 5.00 0 O O 3.00 4.50 Nursing I SD 2.68 0 0 0 0 2.45 4 of courses 6 O O 0 2 8 Adult/Acute/ Mean 11.33 0 O O 0 11.33 Medical-Surgical SD 5.03 O O 0 O 5.03 4 of courses . 3 O O O O 3 Maternal-Child/ Mean 12.60 0 O O 0 12.60 Expanding Family SD 6.15 O O 0 0 6.15 4 of courses 5 O 0 O O 5 Pediatrics/Child Mean 17.50 0 O O O 17.50 SD 2.12 O O 0 O 2.12 4 of courses 2 0 0 0 O 2 Psychiatric/ Mean 20.00 0 0 O O 20.00 Mental Health SD 4.00 O 0 0 O 4.00 4 of courses 3 O O 0 O 3 Community Health Mean 10.63 9.00 4.00 O 4.00 8.87 SD 4.03 4.76 O 0 O 4.45 4 of courses 8 4 l 0 2 15 Management/ Mean 11.20 0 16.00 0 0 12.00 Leadership SD 5.02 O 0 0 O 4.90 4 of courses 5 0 1 0 0 6 Senior Practicum/ Mean 14.67 0 9.00 6.00 12.00 11.83 Advanced Medical- SD 2.31 0 O 0 O 3.92 Surgical 4 of courses 3 0 1 1 1 6 Other Mean 11.47 14.00 4.75 9.00 7.25 10.88 SD 5.22 3.87 2.75 0 5.25 5.31 4 of courses 32 7 4 1 4 48 Column total Mean 11.55 12.18 6.86 7.50 6.11 10.69 SD 5.47 4.71 4.78 2.12 4.34 5.46 4 of courses 67 11 7 2 9 96 Mean Clock Hours in Clinic Per Week for Each Organizational Pattern. by Course, for Generic and RNs Combined“ Column total Mean 12.27 12.80 6.20 0 6.38 11.39 SD 5.29 4.47 5.67 0 4.57 5.53 4 of courses 59 10 5 O 8 82 Mean Clock Hours in Clinic Per Week for Each Organisational Pattern. by Course. for BSN Completion“ Column total Mean 6.25 6.00 8.50 7.50 6.57 6.57 SD 2.71 0 .71 2.12 2.38 2.38 4 of courses 8 1 2 2 14 14 .1 J-'—K'.‘ I” :m I! ‘3" " l~"'.'=.. If '1 ‘4. Table 18.--Continued. 95 Percentage of Reported Use of Practicum/Internship Course 1-20\ 21-404 41-604 61-80\ 81-100\ Total Intro./Fundamentals/ Mean Nursing I SD NO CASES REPORTED 4 of courses Adult/Acute/ Mean Medical-Surgical SD NO CASES REPORTED 4 of courses Maternal—Child/ Mean 12.50 0 0 O O 12.50 Expanding Family SD 9.19 0 O O 0 9.19 4 of courses 2 O O O O 2 Pediatrics/Child Mean 0 19.00 0 O O 19.00 SD 0 0 O 0 O 0 4 of courses 0 1 O O 0 1 Psychiatric/ Mean 0 16.00 7.50 O O 10.33 Mental Health SD 0 O 2 12 O O 5.13 4 of courses 0 1 2 0 0 3 Community Health Mean 8.00 11.00 9.00 O 0 9.75 SD 0 7.07 O O O 4.35 4 of courses 1 2 1 0 0 4 Management/ Mean 0 11.00 15.00 0 10.00 12.00 Leadership SD 0 7.07 4.24 O 1.41 4.43 4 of courses 0 2 2 O 2 6 Senior Practicum/ Mean 16.00 16.00 32.00 0 24.00 22.00 Advanced Medical- SD 0 O O O 0 7.66 Surgical 4 of courses 1 l 1 0 1 4 Other Mean 12.11 0 8.00 8.50 0 11.17 SD 5.30 O O 7.78 O 5.37 4 of courses 9 0 1 2 0 12 Column total Mean 12.15 13.57 13.43 8.50 14.67 12.75 SD 5.34 5.29 9.05 7.78 8.14 6.36 4 of courses 13 7 7 2 3 32 Mean Clock Hours in Clinic Per Week for Each Organizational Pattern. by Course, for Generic and RNs Combined“ Column total Mean 12.15 14.83 15.20 8.50 17.50 13.39 SD 5.34 4.49 10.45 7.78 9.19 6.54 4 of courses 13 6 5 2 2 28 Mean Clock Hours in Clinic Per Week for Each Organizational Pattern, by Course, for BSN Completion“ Column total Mean 0 6.00 9.00 0 9.00 8.25 SD 0 0 O O 0 1.50 4 of courses 0 1 2 0 1 4 a . ' . Column totals given for comparison. 1:“ 51‘ 96 and how the number of hours was affected by percentage of reported use of each organizational pattern. In reviewing the reported use of supervised clinical and the related effect on clock hours. it appeared that a usage of supervised clinical 61% or more of the time resulted in the greatest number of hours in clinic per week. The column total mean for all courses using supervised clinical 81-100% of the time was 11.84 hours. and for 61-801 of the time it was 12.02 hours. This can be compared to a mean of 8.98 hours for 41-602 of the time usage. 7.67 hours for 21-401. and 9.30 hours for 1-201. Simulated laboratory presented a very different pattern. The highest mean hours in clinic per week appeared when simulated labora- tory was used 1-202 of the time. a column total mean for all courses of 12.84. or 21-40% of the time with a mean of 9.23 hours. This relates to the influence that the organizational patterns of super- vised clinical and simulated laboratory had on each other because this appeared as the most frequent combination pattern. When simulated laboratory was used a higher percentage of the time. the mean number of hours in clinic per week declined. For example. the column total mean for usage of 41-602 of the time was 6.5 hours. and for 81-1002 of the time it was 5.17 hours. When preceptor/ role model was used 81-100% of the time. the greatest number of hours in clinic per week occurred. For example. when it was reported to be used 81-1002 of the time. there was a mean 97 of 19.37 hours of clinic per week. However. with a standard deviation of 12.01 there was a wide range of hours. When the organizational pattern of independent study was used. the effect on the mean hours in clinic per week appeared to be similar to that found with simulated laboratory. For example. when it was used 1-202 of the time. this resulted in a column total mean for all courses of 11.55 hours. This reflects the effect of this pattern combining with another. more dominant pattern. Only nine cases reported using this pattern 81-1002 of the time. This resulted in a column total mean for all courses of 6.11 hours per week in clinic. 7 Practicum/internship had few cases reporting a high usage. Therefore. little can be said about it. Its greatest use appeared in the 1-202 of time column. This produced 12.15 mean hours per week in clinic. Its use to a greater extent should result in a much larger number of hours in clinic per week because it is defined as concen- trated or extended blocks of time in clinic. Table 18 also provides the column totals reporting the mean number of hours in clinic for all courses reported from programs that included generic and RNs combined and those that were BSN completion. The number of hours in clinic per week for those courses reported from programs identified as BSN completion were considerably less than those reported from generic and R118 combined. In summary. the mean hours in clinic per week for required clinical nursing courses by organizational pattern for all reported cases were: supervised clinical. 10.27 hours per week; simulated 98 laboratory. 10.23 hours per week: preceptor/ role model. 12.44 hours per week; independent study. 10.69 hours per week: and practicum/ internship. 12.75 hours per week. The relationship between each organizational pattern and the faculty resource requirements was further analyzed by looking at those cases that reported there was use of a particular pattern 50% or more of the time. This analysis showed the effect of the organizational pattern when it was the dominant pattern used. Table 19 provides such an analysis. It presents the mean student/faculty ratio and the mean number of hours in clinic for those required clinical nursing courses that were reported as using a particular organizational pattern 50% or more of the time. For those courses that were reported as using supervised clinical 50% or more of the time. the mean student/faculty ratio was 9.04:1. with a mean of 11.53 hours per week in clinic. As can be seen in Table 19. simulated laboratory. when used 50% or more of the time. had a higher mean student/faculty ratio of 11.21:l with fewer hours in clinic per week. 5.44 hours. When preceptor/role model was the dominant pattern. the mean student/faculty ratio was ll.57:l. with a mean of 14.32 hours per week in clinic. Independent study. when the dominant pattern. was reported as having a mean student/ faculty ratio of 13.46:l. with a mean of 6.5 hours in clinic per week. Practicum/ internship. when used 50% or more of the time. had a mean student/ faculty ratio of 10.43:l and a mean for hours per week in clinic of 99 Table l9.--Mean student/faculty ratio and mean hours per week in clinic. by organizational pattern, in reported reported cases. cases where the percentage of use was 504 or more for all Mean Student/ Mean Hours Organizational 4 of Faculty Ratio 4 of Per Week Pattern Used Reported Reported in Clinic 504 or More Cases Mean SD Cases Mean SD Supervised All cases 510 9.04 2.42 509 11.53 4.45 clinical Generic and RNs combined 481 9.06 2.45 480 11.75 4.45 BSN completion 29 8.76 1.88 29 7.90 2.46 Simulated All cases 62 11.21 5.80 59 5.44 3.79 laboratory Generic and RNs combined 58 11.33 5.95 55 5.53 3.91 BSN completion 4 9.50 2.65 4 4.25 1.26 Preceptor/ All cases 46 11.57 5.59 47 14.32 10.15 role model Generic and RNs combined 32 11.40 6.38 34 17.27 10.31 BSN completion 14 11.93 3.29 13 6.62 3.62 Independent All cases 13 13.46 11.97 16 6.50 4.43 study Generic and RNs combined 9 13.56 13.14 12 6.33 5.00 BSN completion 4 13.25 10.63 4 7.00 2.45 Practicum/ All cases 14 10.43 1.95 11 13.28 8.48 internship Generic and RNs combined 12 10.83 1.80 9 14.22 9.18 BSN completion 2 8.00 .00 2 9.00 .00 Note: The actual number of reported cases varied slightly because a few reports omitted data. 100 13.28. (Note the standard deviations. which reflected a wide distri- bution.) These data were statistically analyzed to determine if there were significant differences between each organizational pattern when each served as a dominant pattern. This reflected the nature of each . . 3!] pattern when not influenced by other organizational patterns. These analyses were done by taking the reported courses in which an organizational pattern was reportedly used 50% or more of the time and grouping them by organizational pattern. Then a one-way -=l ANOVA was used to test for differences in student/faculty ratio and clinic hours per week as a function of organizational pattern. There were 645 cases represented in the student/faculty ratio analysis and 642 in the clinic hours analysis. These analyses showed that there were significant differences in student/faculty ratios (F = 13.64. df = 4.640. p < .01) and hours in clinic (F = 27.38. df = 4.637. p < .01) among the organizational patterns. Post hoc comparisons using the Fisher LSD test showed that supervised clinical had a significantly lower student/faculty ratio than simulated laboratory. preceptor/ role model. or independent study (all t's > 3.00. df = 640. p < .01). No significant difference was found between supervised clinical and practicum/internship. Super- vised clinical required more clinic hours than simulated laboratory (t = 6.13. df = 637. p < .01) or independent study (t = 2.74. df = 637. p < .01) and fewer clinic hours than preceptor/role model (t = 2.53. lOl df = 637. 1’ <.01). No significant differences were found between supervised clinical and practicum/internship. The data did not shift a great deal when looking only at those cases that were reported by programs that had generic and RNs com- bined. The major exception to this was the number of hours in clinic for the organizational pattern of preceptor/role model. which increased to 17.27 hours per week for generic and RNs combined. It should be noted that the standard deviation reflected a wide distri- bution. In analyzing only those cases that were reported by BSN completion programs. the mean faculty/student ratio was consistent with that found in all cases. except for the organizational patterns of simulated laboratory and practicum/internship. which had lower ratios. All patterns reflected lower mean hours in clinic except for independent study. which was slightly higher than what was found in all cases. This is also an appropriate time to analyze the effect that combinations of organizational patterns had on faculty resource requirements. By comparing Tables 12 and 16 with Table 19. it is possible to see that*when combinations were used. the resulting student/faculty ratios and the number of hours in clinic were influ- enced by the dominant pattern. Since supervised clinical‘was the overwhelmingly dominant pattern. its faculty resource requirements also dominated the results. 102 The student/faculty ratios for simulated laboratory. precep- tor/role model. independent study. and practicum/internship were much larger as dominant patterns (Table 19) than when they were used as secondary patterns (Table 12). In addition. a comparison of the number of hours in clinic per week identified in Table 16 with those in Table 19 showed much greater differences for simulated laboratory. preceptor/role model. independent study. and practicum internship. (This same effect can be seen by looking at the column totals of Tables 14 and 18d Logically. it was the dominant organizational pattern. when used in combination. that determined the faculty resources. Combining organizational patterns appeared to lead to a heavier use of faculty resources than occurred when the secondary pattern stood alone as a dominant pattern in its own right. Another analysis of the effect of the organizational patterns on faculty resource requirements is presented in Table 20. This table identifies the number of full-time faculty per student per course that organizational pattern generated. This was accomplished by using the following formula: Mean number of full-time equivalent faculty per Full-time equivalent clinical course = faculty per student Mean number of students per per clinical course clinical course This formula adjusts for both student/faculty ratios and hours in clinic. which combine to determine the number of faculty actually needed (FTEs) to teach a course. w a... 103 DIE-rt... onusoo «mowcmqo boa ucctsum son >Lmoocu uco~m>movm Defifiluuom Omuoou donacwau uoa mucocsum no nonfioz cow: omuoou ~m0wcwau moo xuaooom uc0~m>aovm oeufilmazh no uOnESZ coax "mouso-0u on» xn mouoaao~su n .momusc ocu0wuosua pom .mucmumwmme >u0usuons~ .mucmummmmm oucopsuo oc«o:~oc« .>u~:uou oouuomou ”no mooodocu nacho .sumo ecu oouuuso muuoaou sou m chanson >~uzom~m oouus> nsmoo oouuoosu no humans menace oak “sue: 83. oo. oo.~ ~ 8. 8.3 N 532986 :8 meme. mm.v mn.n mu hm.mv v~.mv ea occaAEOU mam use Ouuocou awzmcuoDCM mmmo. h~.v om.n mu ~0.vv mm.~v m~ nonso an: \anauoeua 33. so. on; v 5.3 8.3 v 533950 2mm vmmo. mm.” mm.” mm v~.m~ n~.mm mm oocwaeoo was one Oauocoo xpsum ammo. 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Nm.n mm.v mmv om.mn mm.mm mom nommo Add ponw>uooom somuoou sea om com: am one: on no UCQQQUW HQ“ ”@flh—JOU mmmmnu me30 HQ mwwmu UWSCHU 'Mm >u~=ooh uoa >u~ouom oeuuooom U a coupons: 0 D u» a mucoooum Hmcoauoncmsz 232,53 2.3-22.1 so . co .. . uo . cam: seweuduom no a com: .momoo oouuoaou HHe uOu uuoa uo «Om no) on: we oomucouuoa on» can: cuouuso Ascofiuuumcmouo >9 omusoo mmoacwmo some ham uncommon non aomsosu oswuuumzmnl.o~ canoe 104 Again. this analysis was done using only those cases that were reported as using a particular organizational pattern 501 or more of the time. so that it was possible to detect the influence of the dominant pattern. In looking at Table 20. it can be seen that for all reported cases it took .0894 of a faculty member per student per clinical course using supervised clinical. .0624 of a faculty member per student per clinical course using simulated laboratory. .0903 of a faculty member per student per clinical course using preceptor/role model. .0551 of a faculty member per student per clinical course using independent study. and .0825 of a faculty member per student per clinical using practicum/internship. Based on this calculation. preceptor/role model consumed the most faculty resources. followed by supervised clinical: third was practicum/role model. fourth was simu- lated laboratory. and least consumptive was independent study. Looking back to Table 19 for comparison. it can be seen that simply having a high student/faculty ratio did not lead to fewer faculty needed. The courses that used the lowest number of faculty had both a high student/faculty ratio and a low mean number of hours in clinic per week. For the organizational pattern of preceptor/role model. which had a student/faculty ratio comparable to simulated laboratory. the advantage gained in the student/faculty ratio appeared to be lost in the large number of hours per week in clinic provided by the pattern. A pattern that had both a high student/ faculty ratio and fewer hours in clinic required fewer faculty. :mb’ use. 105 In summary. preceptor/ role model consumed .0903 faculty (FTE) per student per clinical course. supervised clinical consumed .0894. practicum/ internship consumed .0825. simulated laboratory consumed .0624. and last. independent study was the lowest wi111.0551 faculty. In concluding this section. it is important to emphasize the difficulty in data analysis created by the overwhelming use of super- vised clinical and the very limited use of the other organizational patterns by comparison. While attempts were made to provide a care- ful analysis of the effect that each organizational pattern had on faculty resource requirements. this analysis was limited by the lack of clinical courses reported to be using patterns other than super- vised clinical. Research Question 4 What are the resource requirements in terms of academic preparation of faculty used to staff clinical instruction in baccalaureate nursing programs? The distribution of academic preparation of faculty teaching the reported 694 required clinical nursing courses is shown in Table 21 for all cases by each of the nine identified course categories. The academic preparation of clinical faculty appeared to reflect a mix of academic credentials with the overwhelming majority prepared at the master‘s level. 0f the 3.492 faculty identified in this study. 2.793 or 80% had a master's degree. Three hundred thirty-eight or 9.72 held doctorates. Seventy-nine or 2.3% had bachelor's degrees. Graduate assistants made up 108 or 3.1% of the reported faculty. One hundred thirty-six or 4% were reported to be practicing nurses. 106 .monmo vtuuoaou wzu ac £ch LC» ~¢.Lcctsuo en; La.) Ts.u_Lthm >._:Or» ac Lanszc tr. nuoo.uou >.cc yon wan co ave—mes Doc econ r.£bs we. N.c. cN N. . n . N N.. N m.ec as. c... a. co cc..o.asou 2mm a... N.» no. ... an N.n co. n.N he c.cc cch o.o cN. vNc soc.asou «as 0:. Dun-Etc Nov. 6.. on. ... c. ..n cc. ..N as c.cc mcsN N.o a.. was sou-o ..¢ n.e.os or o... o c c c o 4.. . c.es .m c... c 6N co.ou.asou 2mm ace. v.N so a. N. o.N on ..N .v o..¢ ..m. m.c. as. he. ooc.esou 4:: use Oauscsu one. c.N mm o. N. o.N em N.N we c.om Nam. m.o. ooN an. non-u ..a Noeuo o. o.Nm .. o o o o o o _.Nq : o c v co.uo.asoo 2mm .ou.ot:m ooN .... NN 6.. N v.N m m.. . m.cc an. m.m. N. on soc.asou nzu -.vor vmucu>ve n2... Uuhgtc \guuuuhl mNN 6.6. on m. N N.N m N.. . e.em «v. N.v. NM 6' uoauu ..a No.com oN o.mv a o o o o c o o.mv a o.:. N m co.uo.aeoo 2mm N.. o.m a m. . o o N.N n v.cc ca 6.: o N. 60:.asou nzx use 030ch gaseous Na. o.n. m. c. . o c n.N n c.mn ea n.c .. an soauo ..¢ \ocusooscax s. o o o o o o o.m . ..N¢ e. a... N o. co.oo.aEOu zmn om. ..n m n. . c o ... N c.e¢ cN. N.c. c. m. 66:.asoo n2: 08¢ DahOCUU £u~cvz so. 6.. m o. . o o a. m a... c: «A: x. mm .026 .2 3.5.5.8 v o o o c o o c c c.cc. e o c N co.oo.csoa 2mm .6 ..N N ... . o o c o ¢.N¢ NN 6.9. p. N. voc.asoo mzz use Omuocoo £u.os: «sucst as ..N N o.. . o o c c m..u .e v... a. v. souau ..a \u..ua.au>na o o o o o o o c o c c o o o cc.uo.asoo 2m: on ..N m 4.. . o.. . a.N N o.Na am ..v n a. ouc.nsou mze ecu o..ocsc 6..zo oh ..N m v.. . v.. . o.N N o.Na am ..v . o. guano ..a \nu..oo.ooa v o o o o o o c c c.c:. v c c N cc.oo.asou 2mm 4.. o.N n a. . m.. v ..m o m.Nc «o ..m c .N soc.nsoo nae >..e.a use buuocou ccmoceaxm m.. m.N n o. . v.n v ..m 6 ...¢ co o.« e m. nouuu ..¢ \o..ru-.acsouuz N o o o o ..v . c c ..N¢ v c.aN N c co.oo.asou 2mm moN m.m o v. . N.q N. m.» a N.m¢ ..N N.v N. mv 60:.asoo n2: .eu.u.am nut! Duhficwo I—¢U_1OI moN v.n o v. . o.m N. v.m o ¢.Ne N.N ..m 4. 6. sense ..< \osaoaxu.=o¢ m. o o N.o . N.o . o c :.ce a 6.6N v N co.uo.asou 2mm Nee N. . N.N N. N.o c. o.N o e..u vs. c.N .. ma eoc.nsou m2; . oc.n.:z coo omuoctc \nasucoEchou New N. . :.~ .. 7m 2 c.~ 6 Tc: .2 rs w» we «once 2.. 8030.693... 4 z o z a z o z s z a z >u~90cm menuscu vouuoavz smasz accummumt u:oum_¢m< touccc state: court: vvuucacm OmuDOU MO . AGuOh. Nunavuubflua >5C~Qh€£5 CLEJCKLC m.LC—L£...Qm "3.7:"...2 :NLCLLCC MC . e>u_=oca ho ELLELI .omuscc .eo.c..c some sou .co_ucscaouc 0.68ooue >2 .>u—oocm mo sensor vouuoatmuo.- o—neh 107 All course categories used doctorally prepared faculty. The mean percentage of doctorally prepared faculty was 9.72. The course categories of Psychiatric/Mental Health. Community Health. Senior Practicum/Advanced Medical-Surgical. and Other reported a percentage of doctorally prepared faculty greater than the mean. The course categories of Adult/Acute/Medical-Surgical. Maternal-Child/Expanding Family. and Pediatrics/Child were well below the mean. All course categories were reported as using master's-prepared faculty. Master's-prepared faculty comprised 802 of the faculty in all course categories except Management/Leadership and Senior Practicum/Advanced Medical-Surgical. Management/Leadership and Senior Practicum/Advanced Medical-Surgical were somewhat lower. with 75% and 64.42. respectively. Eight of the nine course categories were reported.using fac- ulty holding bachelor's degrees. This academic level included about 21 of the total for each category. Maternal-Child/Expanding Family was slightly more. with 5.1%. and Psychiatric/Mental Health had no reported use of bachelor's-prepared faculty. Six of the nine course categories‘were reported as using graduate assistants as clinical faculty. The greatest use was reported in Introduction/Fundamentals/Nursing I. in which 6.7% of the faculty were graduate assistants. In the Adult/Acute/Medical-Surgical category. they comprised about 5% of the faculty. In the remaining four categories. graduate assistants accounted for 3% or less of the 108 faculty. Psychiatric/Mental Health. Community Health. and Management/ Leadership had no reported use of graduate assistants as faculty. Laboratory assistantS‘were used as faculty in all of the reported course categories. Their use. however. appeared very lim- ited. For the most part. they made up about 1% or less of each course faculty. The exception was Introduction/Fundamentals/Nursing I. which had a usage of about 2.8%. Practicing nurses were used as clinical faculty in all course categories. They were reported to make up about 32 or less of the faculty in six of the nine categories. Their heaviest use was reported in Management/Leadership and Senior Practicum/Advanced Medical-Surgical. Table 22 provides the reported number of faculty by academic preparation for each organizational pattern. The courses reported in the table are those that were reported as using the specific organiza- tional pattern 50% or more of the time. This provides an opportunity to examine the relationship between the dominant organizational pat- tern and the academic level of the faculty. Upon examination of each individual organizational pattern. some differences appeared. For all organizational patterns except independent study. about 10% of the faculty held doctoral preparation. Independent study had only one reported doctorally prepared faculty member. Master's-prepared faculty comprised 802 of the faculty in those cases reporting that supervised clinical or simulated laboratory 109 sxtfimfl .._ .ooeoo U0uu0fl0h ecu «0 sons new «saucocouo one Sum) comuwucsom >uuoomu do noses: ozu meow—non >~=o yon NEE co you—won uo: mooo macho me. o.m~ mm c o o o v.~ a m.om mm n.m~ m. cm so.uo~a20u 2mm . . . . . . vocaasoo m2: comm n n mo. n . me n n mo. n N be N om nvmw m m m.n hum one UMNoaec oven n.v me. n.. no ~.n mo. m.~ on n.os mnhw h.m v~n nmm sense ~.< saouob o o o o o o o N.o. . 2.86 v 2.0. . o co.oo.aeoo 2mm mm m.m~ m. m.~ . o o o o ~.mm nv m.m o v~ voc.8loo nzm use oauocoo dazncuouc. eh ~.v~ m. v.. . o o 9.. . m.nm no m.o h m. soasu .~< \sso.uosud o. 0.6m o o o o o o o o.on a o o m co.uo.asou 2mm m~ o o ..h a c o ..n w m.~m «N m.n . m. oscaasou nzm moo ONuucou xooum mv m.m. a m.v N o o m.v m m.om mm ~.~ . a. cameo ..< ucovcsdomc. mm m.mm ON 0 o o o o o v.ov .m m.n n v. coauo.dsou 2mm mm. o.- «v m. o ... m m. . m.mm em. n... on on vocwnsou nzm use u.uocou .mp0! o.ou nv~ n.m~ on v. N m. a v. . h.mm we. v... m~ om sense aux \u0udououa n o o o o o o ~.v. . o.mv n m.~v n v coauoadlou 2mm can n. a o.n m o.m m. 5.. m c..m new o.m rm «0 vocwnlou nzx use vasecoo anusuoneH sen n. a m.~ m m.v m. o.~ 0 ..0m mow m.m on no sense «at mousqse.m no 0 o o o o o o o o..m .m 0.0. m. ow couusadsoo 2mm menu m.~ mv N.. am v.n um m.~ mm s..m v.- v.m emu mow vocaasoo was one cmuocwo .ou.c..o ~Nn~ n.~ me ~.. 0n n.n mm m.~ om n..m mmmn h.o mom .mm asses an: oom.>uodsm o x o z o z o z o z o x xuusosm on»: o o o monsoou 2222 2 . .u. mums... 2.2%”. . ”+2... .2... M H...“ M. .22.... 22.. uo . Noyce . «u a a one; a o o . .2; m . a x . a 0o no . o>u—:oou mo amass: .05.» 0:» no new use: can) cuouuoo mocoquou.coouo some new .cowueuodoua o—Eooeoo >3 .>u~:osu «o aegis: vouuodomua.- suns? 110 was its dominant organizational pattern. Preceptor/role model and practicum/ internship reported that the master's-level faculty made up from 58.72 to 63.5% of the total faculty. Independent study. when the BSN completion programs were subtracted. showed that 82.2% of its faculty were master's prepared. Bachelor's-prepared faculty were reported with all organiza- tional patterns but comprised a low percentage of the total faculty. Most frequent use was found in those courses that reported supervised clinical as the dominant pattern. Graduate assistants were found in only three of the five organizational patterns. They appeared most frequently with super- vised clinical and simulated laboratory. where they made up 3.3% and 4.92 of the total faculty. respectively. No use was reported with independent study or practicum/role model. Laboratory assistants. although seen with all patterns. most frequently appeared with supervised clinical and simulated laboratory and were infrequently seen in the others. The largest percentage of practicing nurses was found as faculty when preceptor/ role model. independent study. and practicum/ internship‘were the dominant organizational patterns. ‘When preceptor/ role model was used. 28.3% of the faculty were practicing nurses. for independent study 19.6% were practicing nurses. and for practicum/ internship 24.2% were reported to be practicing nurses. It must be noted. however. that the last two organizational patterns were used less often and represented very few faculty. .. =5 may w... 111 Table 23 has been included to provide an indication of the number of courses that were reported to have each level of academic preparation. This gives an indication of the number of courses that were staffed with each of the various levels of faculty and. when they were. the mean number in each course. Of the 694 courses. 218 or 31.4% reportedly had doctorally prepared faculty. Six hundred forty- four or 92.8% of the 694 courses had master's-prepared faculty. Bachelor's-prepared faculty were reported to be used in 59 or 8.52 of the courses. and graduate assistants in 66 or 9.5% of the courses. Laboratory assistants were found in 35 or 5%. and practicing nurses in 21 or 3% of the courses. The table also identifies the mean number of faculty per course for each academic level. when used. Table 23.--Number of courses reporting use of each academic level of faculty and mean number of faculty per course. by academic preparation. for all reported cases (N = 694). # of Courses Academic Reporting Use Mean 5 Preparation Per Course SD N 2 Doctorate 218 31.4 1.55 1.03 Master's 644 92.8 4.34 3.33 Bachelor's 59 8.5 1.34 .80 Graduate assistant 66 9.5 1.64 1.32 Laboratory assistant 35 5.0 1.09 .37 Practicing nurse 21 3.0 6.48 3.42 I v w . .pi’ ‘45.“; " W". .mm; 2 gm 2* 112 When a comparison of the data from Table 21 was made with Table 23. it‘was possible to determine that although doctorates made up only 9.7% of the total number of clinical faculty. they were found. to some extent. in 31.4% of the reported courses. Using the same comparison. laboratory assistants made up 1.11 of the total clinical faculty and were found in 5% of the reported courses. and practicing nurses made up 4% of the clinical faculty and‘were found in 3% of the courses. Comparison of the two tables certainly provides a greater understanding of the distribution of each level of preparation of faculty. In summary. 9.72 of all reported clinical faculty held doctorates. 80% held master's degrees. and 2.3% had bachelor's degrees. Graduate assistants comprised 3.12 of the total clinical faculty. Laboratory assistants and practicing nurses‘were reported to make up 1.1% and 4%. respectively. Research Question 5 Is there a relationship between organizational patterns of clinical nursing instruction and faculty resource requirements in baccalaureate nursing programs. based on selected demo- graphic data? Four demographic variables were selected for analysis to determine what. if any. relationship existed between the variables and the use of the five organizational patterns or the faculty resource requirements of student/faculty ratio and number of hours per week.in clinic. The four demographic variables were college/university size. 113 program size. type of curriculum. and whether the program included graduate study or not. College/university size. Table 24 presents the mean reported use of each organizational pattern as a function of college size. For presentation purposes. college size was grouped into seven categories in this table. Supervised clinical had a range for percentage of use from 78.27% to 85.81%. based on college size. The other four organi- zational patterns showed a much wider range. These data were tested with a nondirectional hypothesis. using Pearson's correlation coefficient. No significant relationships were found between college size and the percentage of use for any of the organizational patterns. Table 25 provides the mean student/faculty ratio and the mean number of hours in clinic per week by college/university size» The range of student/faculty ratios was 8.4:1 to 10.5:1. Clock hours in clinic per week reflected a similar situation. The range of clock hours per week in clinic was 10.28 to 12.83 hours. These data were also tested with a nondirectional hypothesis. using Pearson's correlation coefficient. A very weak relationship was found to exist between student/faculty ratio and college/university size. As the college size increased. so did the student/faculty ratio (r = .10. df = 565. p < .05). In addition. a very weak relationship was found between numbers of clock hours in clinic and college/ university size. As college/university size increased. so did the number of hours in clinic (r = .08. df = 654. p < .05). 3. z: “1.2;! 114 . . «fijfinau_ until? mm... na.nv n on..~ @¢.o~ cm nn.on h~.@v n~ vo.mn .n.0n am mn.o~ .m.mm an. +ooo.m. wv.n oo.s v .h.hn h..n~ o no.v oo.v m mo..~ oo.mn v. mv..~ mw..m v~ coo.m.u.0m.~. oh.n~ co..v o. om.m. mm.n~ h. no.6. h..o~ v~ mm.Nm mo.~v a. mh.m. oo.om av oom.-t.oo.o. .v.on oo.mo n -.o. o~.o. o. c~.hn oo.mm o o~.on O@.wm on mo.o~ n~.vm av ooo.o.uuom.h o o o co. oo.o~ . .n.0n oo.m~ o v0..n nn.~n .m vh.o~ oo.mm hv 00m.h u.oo.m vo.no oo.mm w m..nm m~.m~ v. nn.nn «m.nm m~ n..o~ mm.o~ ov ~n.- mo.om om coo.m noom.n n..o~ h..on N. an.nn n~.nn 0n om.nn h..mv mm ...o~ .>.o~ «m mv.n~ h~.mh no. oom.~ I. am on: us souuaou on: no sonusou on: no nonuaoo on: no nunusou on: no nonusou a can: no 0 am 0 cos: us 0 am 0 can: as . mm o use: no c on o cos: «a . ou.m >uquuu>uca mazncuoucu >caum .ovOt v.0: >uououonsq .mowcw.u \OUOAAOU \E:U.uosum acoocoaovc. \uOuuoooue ccus.:i«m vam.>uoa=m .nomoo ..snu>u.nuo>«c=\ooo..ou no sumo >n ncuouuoa .scoquonucmouo uo on: vauuoaoxnl.vm 0.318 115 Ahflfimk 2.: V, 43...? mv.0 hm... 5v. mu.v HN.0H 0m. +000.m. mm.m Nb... mm 00.. 0m.0H mm 000.mHIH0m.~H vm.m mm.0H H0 m¢.m vv.m H0 00m.mHIH00.0H «v.0 mm.mH hm sm.m mm.m om ooo.o.noom.s ma.m NH.HH hm 0N.N mm.w hm 00m.h IH00.m N0.m 05.0. mm m0.~ 0H.0H mm 000.m Iaom.m m0.m mv.0a nma 0H.N 00.0 mm. 00m.m I. x003 How momusoo oaumm huasomm momunou 0m Uficwau cw muzom no x 0m \wsmosum :00: mo * ouwm omoaaoo xooau com: .mwmmo Hasluwufim >uwmum>wss \oomHHoo >n x003 mom UHcflao cw muse: xooao some can Gauss huHSUMM\usmwsum some wouuommmll.mm wanna 116 Size of baccalaureategprograA. Table 26 shows the reported use of each organizational pattern. by program size. .Again. for presentation purposes. the programs sizes were grouped into five categories. Pearson correlation coefficients on the raw data were used to test for a relationship. A.very weak relationship was found to exist between program size and supervised clinical. as‘well as simulated laboratory. As program size increased. so did the use of supervised clinical (r = .09. df = 573. p < .05) and simulated labora- tory (r = .16. df = 264. p < .05). There was no relationship with size of baccalaureate program for the remaining organizational pat- terns. Table 27 presents the reported mean student/faculty ratio and mean clock hours in clinic per week by program size. The range of student/faculty ratio by program size was a ratio from 8.9:1 to IIL23:1. The range for clock hours per week in clinic ranged from JIL06 to 11.86 hours. These data were also tested to determine if there was a significant relationship between program size and student/ faculty ratio or the number of hours in clinic. .A very weak relation- ship was found to exist between program size and student/faculty ratio. The larger the program. the larger the student/faculty ratio (r = .10. df = 656. p < .05). No relationship was found to exist between program size and number of hours in clinic. Type of curriculum: Integrated versus nonintgggated. The third demographic variable was the type of curriculum the program reported itself to be. integrated or nonintegrated. For discussion a 22.22% I rt 1 I.j '.'."'l"'l: .7 EC: om.0n 00.0w m on.~. 00.v. a vv.o. 50.0. a 00.0n no..v m. s~.n~ mh.n0 vv +.00 0~.m. nn.nn n vv.v~ v0.0a 0. 0~.«n 90.0m ~. 00.mn 00.0n 0m vm.0~ mm.~0 hm 000:.mv 0n.mn 00.mh ~ no.0 00.v. 0 0v.nn 50.0N m. om..n mm.0n 0v 00.- vm..m >0 0mvu.0n ”U 00. 00.0w . 0..mn ms.0n v~ ~m.0n n0.nv 0m so.~n om.mn hm vm.s. h~.00 n0. 00nu.m. 1 no.0n 0n.vv o~ nu.n~ 05.m~ 00 no.0m mv.vv mm 00.0N 00.0N N0 00.nm sm.ms v0. 0m.-. cm on: no souusou am on: «o souusou am on: 00 nonusou mm on: no sonusou am an: no nouuaou 0 cost no . 0 cost no . a use: no a a cost no 0 a cool no 0 swam innocum 25.58.: 225.... :60: 2oz €333! 1.358 \Iso.uosua ucovssnovcn \uOunoooum vous.:l.m vouu>uoa=m .ovnsu ..ounow«n quooum >3 acuouusn .scouuuwucaouo «o on: vouuoauxuu.o~ o.nsa 118 mad-fl n. 4411’ 0..0 00... Om 00.. 00.0 00 +.00 00.0 mm... 00 00.0 m0.0. up 000I.m0 05.0 00.0. 00 00.0 00.0 00. om0|.00 0m.m 00... 0.0 0..0 00.0 0.0 00m|.m. 00.0 00.0. 00. .0.0 00.0 00. om.l. x003 “00 mmmuso 0a m 0 Sum mmmuso 00 0.0..0 :. muse: 0 U 00 .Hmms u.cmmm o o 00.0 8000000 x00.u :00: m a \u 0 um 2 m # .mmmmo ..muuw~.m Emumoum ma x003 “mm 0.0..0 a. 0050: xoo.o 0006 cam o.umu 00.nomw\ucmcsum :mmE Umunommmll.00 0.309 119 purposes. integrated usually reflected a blending of content across the nursing courses in the curriculum. with less division in the curriculum content; the nonintegrated was usually a more traditional. discipline-specific curriculum. Seventy-six or 63.32 of the 120 programs identified themselves as being integrated. Forty-three or 35.8 percent reported that they were nonintegrated. One program did not respond. Table 28 provides the mean reported use of each organizational pattern by type of curriculum. These data were analyzed using a t-test to determine if there was a difference in the percentage of use of each organizational pattern by those programs that considered their curriculum integrated. 0f the five organizational patterns. only supervised clinical. which was reported to be used 79.92% of the time with an integrated curriculum and 84.01% of the time with a noninte- grated curriculum. showed a significant difference (t = 2.17. df = 573. p < .05). All other t's were less than 1.52. To determine the degree of relationship between the use of supervised clinical by type of curriculum. the t was converted into a point-biserial correlation coefficient, This rpb was equal to .09. which suggested a very weak degree of relationship. Therefore. while the nonintegrated curriculum had a slightly higher use of supervised clinical. this represented a small effect. Table 29 provides the reported mean student/faculty ratios and hours in clinic per week. by curriculum type. The mean student/ faculty ratio for integrated was 9.48:1. and for integrated it was 2‘ '- 1? Tilt ' 1 ‘w’u: 1‘ I lJZO malnmu+. T 1.13”! O l I I O I O O I I ”guauo 0. 00 00 00 5. 0. 50 mm 00 .0 00 mm 0. 5m 00 00 on 00 on 00 00 00 .o 00 000 nou:.coz 0..0n 00.00 00 00.00 00.50 05 05.00 .0.00 50 5m... 05.00 05. 00.00 00.05 000 voussooucn DOD HO IOQQOU Om: NO 000.0500 003 MO OOmHSOU 00...— HO 0000200 on: HO aflnufiou 00 0 saw: 00 o 00 0 cow: 00 o 00 o :00: 00 u 00 o :00: 00 c 00 a cost no . I5.:u.uu=0 no o00s 0.zmcuouc. >c=um .ovoz 0.00 >uouunonuq .uu.c..u \l:0.uoaun acoccoaocc. \uOunoumum vuua.=a.w 000.>uua:m .nwnco ..muafi:.:o.uu=o 00 00>» 0n acuouuon .sco.usu.csouo 00 on: couuoauu :so:--.m0 o.nue 121 .000» .212: m0.m .0... .m0 00.0 50.0 vm0 nmum0mwuc.coz 0m.m 00... mow 5m.m 00.0 000 omumu0mucH £003 000 .. ...... .. ..... ...M... .. W..M.....MMM. ..MM.H. ...mew... x00.0 :00: w t u 0 pm 2 . 00000000 00 x003 000 0.00.0 .00000 ..0I|0000 25.50.0050 a. 0050: 000.0 0005 000 0.000 >0.5000\00005um c008 00000000I|.00 0.009 122 9.47:1. The mean hours in clinic per week for those courses reported from the integrated curriculum was 11.29. and for nonintegrated. 11.61. The t-test was used to determine if there were significant differences between student/faculty ratio or number of hours in clinic. based on curriculum types. There was no significant differ- ence between the student/ faculty ratios of those programs that were considered integrated when compared to those that were nonintegrated (t = .02. df = 656. p <.05). Also. no significant differences were found in number of hours in clinic between integrated and noninte- grated curricula (t = 1.56. df = 654. p < .05). Graduatejrms. Fifty-five or 45.8% of the 120 nursing programs reported that they had a graduate program. Sixty-five or 54.2% reported that they had no graduate program. Table 30 presents the mean reported use of each organizational pattern. by course. reported by those nursing programs that had graduate programs and those that had none. These data were also analyzed using a t-test to determine if there was a difference in the mean percentage of use of each organizational pattern by those nursing programs that reported they included graduate programs when compared to those that had none. 0f the five organizational patterns. only supervised clinical. which had a mean percentage of use of 83.82% for those with graduate programs and 79.59% for those with no graduate programs. showed a significant difference .(t = 2.28. df = 573. p < .05). All other t's were less than 1.12. The degree of relationship 3‘: B 1 D O 0 I l C O I n5~ghm 00 00 an 00 50 00 00 00 50 mm 50 00 on 00 00 00 .n 00 an 00. 50.00 00.05 000 00050000 02 . . . 01000000 0. mm 00 .0 0. 05 50 00.00 Om 00.00 00.00 00 00.00 0..0n 0.. 00.00 00.00 050 00050000 am on: 00 0000500 00 000 00 0000500 00 000 00 0000500 00 000 00 0000500 00 000 00 0000500 0 :00: .00 a o :00: 00 o o :00: 00 o o :00: 00 o o :00: 00 0 0.2000000. 50500 .000: 0.00 >000000£04 .00.c..u \l50.00000 0:00:000000 \000000000 0000.5E.0 000.500050 .co.000500 00050000 05050.) 0:0 :0.) 05000000 >8 0:00u000 .0:O.uou.00000 no 005 00000000 CUOII:.OM 0.309 124 between the use of supervised clinical and those nursing programs with graduate programs and without graduate programs was determined by converting the t into a point biserial correlation coefficient. This rpb was equal to .095. which suggested only a very weak degree of relationship. Therefore. those nursing programs that included a graduate program used supervised clinical slightly more than did those that did not have graduate programs. Table 31 presents the mean student/faculty ratios and mean number of hours in clinic reported by those programs with and without graduate study. The mean student/faculty ratio for courses from programs with graduate study was 9.86:1. which was slightly larger than the 9.14:1 found in courses from programs that had no graduate study. For mean number of hours in clinic per week the opposite was true: No graduate study produced a mean of 11.16 hours. which was only slightly larger than the 10.88 hours in those courses from pro- grams with graduate study. The t-test was again used to determine if there were signifi- cant differences between student/faculty ratios or number of hours in clinic. based on whether or not a nursing program had a graduate program. There was a significant difference in the student/ faculty ratio for those programs that included graduate study when compared with those that did not (t = 2.85. df = 656. p < .01). To determine the degree of relationship. the t was converted into a point-biserial correlation coefficient. The rpb was equal to ~11- VhiCh SUSSEStEd 3 weak degree of relationship. . Those nursing programs that had a 125 .F. ... _ r _. 05 . 8000000 0..0 0.... 00m 00.0 v. 0 00m 00000000 oz 5000000 00.0 00.0. 00m 00.m 00.0 000 00050000 0003 000 am 0.0..0 :. 00500 mmmw5o0 om W.“Mm5>0.wwwm 000M500 000.0 :00: 0 0 0 0 um m * 05000000 c. #003 000 0.0..0 .mmmmo ..0II00.000500 00000000 05030.3 000 50.3 a. 0000: xoo.o 0008 000 0.000 00.0000\0000000 0008 00000000:I..m 0.008 126 graduate program had a slightly higher student/faculty ratio. No significant difference was found in the number of hours in clinic for those nursing programs that had graduate programs and those that did not (t = .66. df = 654. p > .05). Other Program Characteristics Section 2 of the survey instrument also provided additional data related to clinical instruction in baccalaureate programs. which gave an idea of what was typically found in the 120 programs that completed the questionnaire. Collective Bargaining_and Clinical Workload Questions 1 through 3 of Section 2 of the survey instrument were intended to determine the effect collective bargaining had on the clinical setting. Twenty-seven or 22.5% of the 120 programs reported that they had a collective bargaining agreement with faculty. Of those 27 programs. 22 reported that the agreement specified a normal teaching load. Only three programs reported this collective bargain- ing agreement specified the size of clinical laboratory groups. In these programs the clinic size was eight or ten students per instruc- tor. Where there was no contract determination of clinic group size. the range was 7 to 15 students per instructor. For those reporting. the clinic size was determined by the following: 17 indicated that there were state regulations (Board of Nursing)‘which 127 determined the size. 18 cited accreditation standards as the rationale for size. and 29 reported other reasons affected clinic size. These reasons were: 1. Nineteen programs reported that either the university. the department. or the faculty determined the size of the clinics. based on choice and experience. level of student. own preference. or usual practice in their state. 2. Nine programs reported health agencies limited the number of students. either through written policy. competition from other nursing programs. or limited number of clients/patients because of small units. 3. Only one program cited budget as the factor that deter- mined clinic group size. Credit Hour/Clock Hour Ratios The number of credit hours a faculty member was given for the clock hours spent in a clinic was reported by 99 of the 120 programs. Table 32 shows the distribution of credit hours given for each clock hour spent in clinical instruction. The range was from .25 to 2.00 credits for each clock hour. The mean was .54 credits per clock hour. Forty-two programs reported thax:.33 of a credit hour was given for each clock hour. making the most frequent ratio one credit hour for every three clock hours in clinic. Twenty programs reported that .50 of a credit hour was given for each clock hour. making one credit hour for every two clock hours the second most frequent ratio. 128 Table 32.--Reported credit hours given to each faculty member for each clock hour spent in clinical instruction. Credit Hours for # of Programs Each Clock Hour Reporting .25 9 .33 42 .47 l .50 20 .55 l .67 8 .75 l .80 l 1.00 8 1.30 7 2.00 1 The number of credit hours a student is given for the clock hours spent in a clinic was reported by 112 of the 120 programs. Table 33 shows the distribution of credit hours given for each clock hour the student spent in the clinical setting. The range was .25 to 3.00 credit hours for each clock hour. with a mean of .40. Seventy- eight programs reported that they gave .33 of a credit hour for each hour spent in the clinical setting. This made one credit hour for every three clock hours the most common ratio. Eighteen programs reported that .50 of a credit hour‘was given for each clock hour in clinic. making the ratio of one credit hour for every two clock hours the second most common. 129 Table 33.--Reported credit hours given to students for each clock hour spent in clinic. Credit Hours for i of Programs Each Clock Hour Reporting .25 11 .33 78 .44 l .50 18 .67 1 1.00 1 2.00 1 3.00 1 Special Fees for Clinical Forty-eight or 40% of the 120 programs reported that they charged special fees beyond usual tuition for their clinical courses. Seven programs reported that they had fees that were on a per credit basis. These fees ranged from $8 to $150 per credit. with a mean of $40. Fourteen programs reporting had a supply or equipment fee. The range was from $10 to $50 per clinical course. with a mean of $25. Thirty programs reported that they had a flat fee or special assess- ment. The range was from $6 to $260. with a mean of $85. Use of Practicing:§urses Fifty-seven or 47.5% of the 120 programs reported that they used practicing nurses for clinical instruction. Of these. only 19 reported that they paid the practicing nurse for that instruction. Thirty-eight programs reported that they gave the practicing nurse 130 faculty status. The most frequent faculty status given was the rank of adjunct. followed by regular faculty status. .A few reported giving honorary status. When practicing nurses were used. 28 programs reported that they required the practicing nurse to have a master's degree. 25 programs reported that they required the bachelor's degree. and 6 programs reported that they had no degree requirements for their practicing nurses. Twenty-six programs reported that they gave their practicing nurses university benefits. Of the 26. 25 gave library privileges. 9 gave recreational privileges. and 7 gave a bookstore discount. Ten of the 26 programs reported other benefits. such as free or reduced tuition. free continuing education. and parking privileges. Payment for Clinical Instructors Thirty-three or 27.5% of the 120 programs reported that they hired clinical instructors on a per hour basis. Twenty-three of the 33 programs reported an hourly salary that ranged from $6 per hour to $34 per hour. with a mean of $15 per hour. Some programs reported that the hourly payment rate depended on the individual clinical instructors. Of the 120 programs responding to the survey. four reported that their union contracts prevented hiring hourly clinical instruc- tors. Ten reported that it was prohibited by university policy. and 18 reported that the hiring of hourly clinical instructors was pro- hibited by departmental policy. Twenty-six programs reported that 131 hourly hiring had not been considered as an alternative. and 12 reported that it had been considered but found not feasible. CHAPTER V SUMMARY. CONCLUSIONS. AND IMPLICATIONS Summary The purpose of this study was to determine the most commonly used organizational patterns of clinical nursing instruction in baccalaureate nursing programs and to determine what effect each has on faculty resource requirements for that instruction. The study was based on the belief that this information is of value to nursing faculty and administrators because the faculty resource requirements generated by clinical instruction are a major cost factor in the budgets of schools of nursing. 'Therefore. this information will add to the data base on which nursing faculty and administrators can make decisions concerning clinical nursing instruction. A descriptive research design. as defined by Isaac and Michael (1977). was used in conducting this study. The writer developed the survey instrument and survey procedure following the methodology iden- tified by Dillman (1978). In addition. a group of seven experienced nursing program administrators participated in reviewing and evaluat- ing the instrument. The data analysis provided information for each of the following research questions: 132 133 1. What are the organizational patterns of clinical nursing instruction in baccalaureate nursing programs? 2. What are the variations and combinations of organiza- tional patterns found in baccalaureate nursing programs? 3. What effect do the organizational patterns have on faculty resource requirements in baccalaureate nursing programs? 4. ‘What are the resource requirements in terms of academic preparation of faculty used to staff clinical instruction in baccalau- reate nursing programs? 5. Is there a relationship between organizational patterns of clinical nursing instruction and faculty resource requirements in baccalaureate nursing programs. based on selected demographic data? The major findings relevant to these research questions are discussed in the following pages. Major Findings Organizational Patterns for Clinical Instruction Because each pattern has a unique effect on the structure and faculty resource requirements of the educational program. it was important to identify the extent to which each organizational pattern was used in clinical instruction. The overwhelming majority (82.851) of the reported courses were taught using the organizational pattern of supervised clinical. When used. it was used for 81.59% of the class time. Therefore. supervised clinical was both used most often and represented a high percentage of the class time. Simulated 134 laboratory was reported as being used in 38.322 of the reported courses. When utilized. it was used for about 34.042 of the class time. making it the second most commonly used pattern. Preceptor/ role model was the third most frequently used organizational pattern; 17.14% of the reported courses used it and. when used. it represented about 42.4% of the class time. Independent study was the fourth most commonly used pattern (14.84%); when used. it was used 26.37% of the time. Last by a great distance was the pattern of practicum/intern- ship. It was reportedly used in 5.612 of the courses and. when uti- lized. was used 42.4% of the time. 8010 usage of each_pattern. The number of courses reported as using a pattern 100% of the time again reflected the heavy use of supervised clinical; 230 of the total 694 reported total reliance on it. By comparison. the other patterns had very low reported use as a solo pattern. Simulated laboratory was used 1002 of the time in only 35 courses. preceptor/role model was used 100% of the time in only 17 courses. independent study in only 8 courses. and practicum/ internship in only 4. Manizational pattern buourse category. Upon examination of the nine course categories identified. supervised clinical was found to be the dominant (used 50% or more of class time) organiza- tional pattern in eight of the nine categories. In only one category of courses. Introduction/Fundamentals/Nursing I. was it found not to be the dominant organizational pattern. For this course category the most frequently used organizational pattern was simulated laboratory. 135 It was reported to be used in 81.5% of the courses. However. when examining the mean percentage of use of both supervised clinical and simulated laboratory for this course category. they appeared to be almost equal. Supervised clinical was used 62.5% of the time. and simulated laboratory was used 59.98% of the time. Combinations of Organizational Patterns For the vast majority of courses. the combination of organiza- tional patterns occurring most frequently was supervised clinical in conjunction with simulated laboratory. This combination usually involved heavy use of supervised clinical. with lighter use of simu- lated laboratory. Five hundred thirty-one of the 694 courses were reported as using supervised clinical 50% or more of the time. Of the 531. 195 were reported using it in combination with simulated labora- tory. In the 195 cases. the mean percentage of use of simulated laboratory was 19.56%. This combination appeared to hold true for most course categories except for Introduction/Fundamentals/Nursing I. which reflected more equal use of the two organizational patterns. In three course categories. Community Health. Management/ Leadership. and Senior Practicum/Advanced Medical-Surgical. super- vised clinical remained the dominant organizational pattern. However. it was more frequently seen in combinations involving preceptor/ role model. independent study. or practicum/ internship than simulated lab- oratory. 136 Organizational Patterns and Faculty Resource Requirements Each organizational pattern generated different faculty resource requirements. To fully understand the faculty resource requirements. it is necessary to compare both the student/faculty ratio and the number of hours per*week in clinic. Supervised clinical had a mean student/faculty ratio of 9.04:1 and a mean of 11.53 hours in clinic per week. Simulated laboratory had a mean student/faculty ratio of ll.21:l. with a mean number of hours in clinic of 5.44. Preceptor/role model had a mean student/faculty ratio of 11.57:l. with a mean number of hours in clinic of 14.32. Independent study had a mean student/faculty ratio of l3.46:1 and a mean number of hours in clinic per week of 6.50. Practicum/internship had a mean student/ faculty ratio of 10.43:1 and a mean number of hours in clinic per week of 13.28. It is obvious that simply having a high student/faculty ratio did not mean that an organizational pattern required fewer faculty resources. The pattern that used the best faculty resources had both a high student/faculty ratio and a low mean number of hours in clinic per week. By these criteria. independent study had the lowest faculty resource requirements. followed by simulated labora- tory. practicum/internship. and supervised clinical. with preceptor/ role model having the highest faculty resource requirements. Academic Preparation of Clinical Faculty The vast majority. 80%. of all reported clinical faculty had a master's degree as their highest academic degree. Doctorates were 137 reported for 9.7% of the faculty. with 2.31 having bachelor's degrees. The remaining 8% included graduate assistants. laboratory assistants. and practicing nurses. who were used on a limited basis. Graduate assistants were most often used with organizational patterns of supervised clinical or simulated laboratory. Laboratory assistants were most frequently used with supervised clinical and simulated laboratory. Practicing nurses were most frequently used with the .. r..mqmfizy ”um..." I organizational patterns of preceptor/role model. independent study. and practicum/internship. ;, ‘fldL Selected Demographic Factors Collgie size. No relationship was found between the size of the college/university and its use of any organizational pattern. A weak relationship between college/university size and student/faculty ratio was found to exist. As college size increased. so did the student/faculty ratio. In addition. a weak relationship was found to exist between college/university size and number of hours in clinic. As the college/university size increased. so did the number of hours in clinic. Program size. .A weak relationship was found to exist between program size and the use of supervised clinical and simulated labora- tory. As program size increased. so did the use of supervised clini- cal and simulated laboratory. In addition. a very weak relationship was found to exist between program size and student/faculty ratio. The larger the program. the larger the student/faculty ratio. No 138 relationship was found between program size and number of hours in clinic. Type of curriculum. A very weak relationship was found to exist between type of curriculum and the use of the organizational pattern of supervised clinical. The nonintegrated curriculum had a slightly higher use of supervised clinical than did the integrated curriculum. No difference was seen in the use of faculty resource requirements. Graduate programs. When comparing schools that reported that their nursing programs included graduate study with those that did not. some differences were found. It was found that those nursing programs that had a graduate program used the organizational pattern of supervised clinical slightly more than those that did not have one. In addition. those nursing programs that had a graduate program had a slightly higher student/faculty ratio. No difference was found in the number of hours in clinic. Practicing Nurses in Clinical Instruction Practicing nurses were reported to be used for clinical instruction by 57 or 47.52 of the 120 programs. Of these. only one- third reported that they paid the practicing nurses for that instruction. This finding has particular importance for the organiza- tional patterns of preceptor/role model. independent study. and practicum/internship because in this study those patterns had the 139 heaviest use of practicing nurses. Twenty percent or more of the faculty in these organizational patterns were practicing nurses. Conclusions Based on the findings discussed in the preceding section. the following conclusions were drawn. 1. Supervised clinical was used as the dominant organiza- tional pattern in the vast majority of baccalaureate nursing programs. 2. The organizational patterns of simulated laboratory. preceptor/role model. independent study. and practicum/internship were used as a dominant organizational pattern on a very limited basis. and this made it difficult to determine their full effect on the faculty resource requirements for clinical instruction in baccalaureate nurs- ing programs. 3. ‘The most frequent combination of organizational patterns for clinical instruction was the use of supervised clinical in conjunction with simulated laboratory. 4. Baccalaureate nursing programs can reduce their faculty resource requirements for clinical instruction by increasing. where possible. the use of simulated laboratory and independent study. 5. The organizational pattern of preceptor/role model resulted in the greatest number of hours per week of clinical instruc- tion. 6. The majority of clinical nursing faculty had a master%: degree as the highest academic degree. 140 7. Graduate assistants. laboratory assistants. and practicing nurses were used on a very limited basis in the clinical education of baccalaureate nursing students. 8. The organizational patterns of preceptor/role model. independent study. and practicum/internship resulted in the heaviest use of practicing nurses for clinical instruction. 9. 'The majority of baccalaureate nursing programs that used practicing nurses for clinical instruction did not pay them for providing this service. 10. The demographic factors of college/university size. program size. type of curriculum. and the presence or not of a graduate program had little or no effect on the use of the five organizational patterns or the faculty resource requirements of student/faculty ratio and number of hours per week in clinic. Recommendations Based on this study. the following are recommended: 1. Baccalaureate nursing programs should explore alternative organizational patterns for clinical instruction in an effort to be more cost-effective. However. the desire for cost savings must not compromise the quality of the student's educational experience. 2. Baccalaureate nursing programs should explore the possi- bility of increasing the use of the organizational pattern of precep- tor/role model because this leads to an increase in the number of hours of clinical experience for the student without added expenditure of faculty resources. . g f. v . 0:00: 141 3. Because the organizational patterns of preceptor/role model and practicum/internship resulted in greater use of practicing nurses. baccalaureate nursing programs should consider these patterns as ways of expanding and enhancing the student's clinical experience and supplementing their clinical faculty resources. 4. Baccalaureate nursing programs should explore the indirect faculty resource requirements (paper work. counseling time. and so on) for independent study to determine the full effect that this model has on faculty workload to better evaluate its cost effectiveness. 5. Baccalaureate nursing programs should develop greater rewards for practicing nurses who contribute to the clinical educa- tional experiences of student nurses and encourage larger numbers of practicing nurses to participate in this process. 6. Baccalaureate nursing programs should explore the effect that increased use of graduate assistants and laboratory assistants has on the clinical education process and its costs. Implications for Nursing:Practice and Education This researcher attempted to examine the way in which clinical nursing education is organized and the requirements for faculty resources generated by that organization. The findings suggested that the heavy reliance on the organizational pattern of supervised clini- cal may. at least to some degree. contribute to the high consumption of faculty resources and thus the high cost of clinical nursing educa- tion. The findings also suggested that there is a general lack of use 142 of the other organizational patterns. This makes it difficult to determine the total effect that the other patterns had on faculty resource requirements. It seems logical that. given this situation. nursing education must become more involved in exploring its current practices and move to incorporate organizational patterns that are less resource consumptive and as cost effective as possible. without endangering the education of the student. This study was a beginning effort to look more closely at current practices and to question the rationale for these practices. This is not to imply that nursing suddenly turn students loose on the health care system with little or no supervision. It does. however. imply that nursing education develop and use better-equipped simulated laboratories. and allow more opportunities for independent clinical experiences and greater use of service-based role models. This educa- tional decision process should consider both cost effectiveness and instructional effectiveness. The findings of this study also implied that. together. nursing education and nursing service consider the development of a plan for greater use of the practicing nurses in clinical education. Practicing nurses need to recognize that the future of the profession lies in the clinical educational process. something in‘which they also have a stake. Educators need to recognize that greater use of prac- ticing nurses can lead to a better educational system. The effective use of educational resources must become an important issue to both nursing service and education. Tn rim, 7 3 iiifly 143 Recommendations for Future Research Based on the findings of this study. the following recommenda- tions are made for future research: 1. The reasons for the high use of supervised clinical and the lower use of the other patterns should be investigated. 2. The effect that combinations of organizational patterns have on faculty resource requirements should be more fully explored. 3. The organizational patterns of preceptor/role model and practicum/internship should be the subject of further investigation to more fully evaluate their effect on faculty resource requirements. 4. Programs that have successfully incorporated practicing nurses into their clinical educational system should be identified and studied in order to evaluate why they have succeeded. 5. A modified replication of this study. which would allow a more in-depth examination of fewer programs. may lead to a clearer comparison of the organizational patterns and the resulting faculty resource requirements. 6. The effect of each of these organizational patterns on educational outcomes should be explored. 7. The indirect faculty resource requirements (noncredit hours) of clinical nursing education should be more fully explored to determine their effect on clinical faculty time. APPENDICES APPENDIX A SAMPLES OF COVER LETTERS TO ACOOMPANY THE QUESTIONNAIRES 144 COVER LETTER Room 10F, Learning Resources Building Department of Nursing Northern Michigan University Marquette , Michigan 49855 Addresses: Chair of Nursing Address Dear There has been in increasing concern expressed by College and university Administrators for careful allocation and utilization of faculty resources by baccalaureate nursing programs. The purpose of this project is to study the organization structure and faculty resource requirements for clinical instruction in baccalaureate nursing programs. Your program is one of a representative number of baccalaureate nursing programs selected for this study. You were selected in a random sample of baccalaureate nursing programs accredited by the National League for Nursing. In order for the results to be truly representative of nursing programs, it is important that each questionnaire be completed and returned. You may be assured of complete confidentiality. The questionnaire has an identification number for mailing purposes only. This is being done so your name can be checked off the mailing list when the questionnaire is returned. Your name will never be placed on the questionnaire. All responses will remain anonymous and only pooled or summarized data will be reported. The results of this study will be used to complete the degree requirements for this doctoral candidate. You may receive a summary of the result by putting your name and address on the back of the return envelope. Please do not put this information on the questionnaire itself. I would be most happy to answer any questions you might have. Please write or call. My phone numbers are: Office (906) 227-2488, and Home (906) 226-3336 . Thank you for your assistance. Sincerely, Elmer W. Moisio, R.N.. M.S.N. Doctoral Candidate Enclosure 145 POST CARD WEEK 2 Date Last week a questionnaire seeking information about the organizational patterns and faculty resoruce requirements for clinical nursing instruction in your baccalaureate nursing program was mailed to you. Your program was selected as one of a random sample of baccalaureate programs accredited by the National League for Nursing. If you have already completed and returned it to me, please accept my sincere thanks. If not, I would appreciate your completing and returning the questionnaire at your earliest convenience. Because it has been sent to only a small, but representative, sample of baccalaureate programs, it is extremely important that yours also be included in the study if the results are to accurately represent what is currently happening in nursing programs. If by some chance you did not receive the questionnaire, or it got misplaced, please call me and I will get another to you in the mail today. Telephone numbers: Office (906) 227-2488, or Home (906) 226-3336. Sincerely, Elmer W. Moisio, R.N., M.S.N. Doctoral Candidate 146 FOLLOW UP LETTER - WEEK FOUR Room 10F Learning Resources Building Department of Nursing Northern Michigan university Marquette , Michigan 49855 Addresses: Chair of Nursing Address Dear I am writing to you about my study of organizational patterns and faculty resource requirements for clinical nursing instruction in baccalaureate programs. Since I have not received your completed questionnaire, I am writing to encourage you to respond. This research project was undertaken to determine the organizational patterns for clinical nursing instruction and their impact on faculty resource requirements for baccalaureate nursing programs. The results will be used to complete requirements for a doctoral degree. I am writing to you because of the significance each questionnaire has to the usefulness of this study. In order the for results of this study to be truly representative, it is essential that each program in the sample return their questionnaire. In the event your questionnaire has been misplaced, a replacement is enclosed. Your cooperation is greatly appreciated. Sincerely, Elmer W. Moisio, R.N., M.S.N. Doctoral Candidate Enclosure 147 FOLLOW UP LETTER - WEEK SEVEN Room 10F Learning Resources Building Department of Nursing Northern Michigan University Marquette , Michigan 49855 Addresses: Chair of Nursing Address Dear I am writing to you about my study of organizational patterns and faculty resource requirements for clinical nursing instruction in baccalaureate nursing programs. I have not yet received your completed questionnaire. The number of questionnaires returned is very encouraging. But whether I will be able to accurately describe the organizational patterns and their impact upon faculty resource requirements depends upon you and the others who have not yet responded. Your response is very important to the outcome of this study. It is for these reasons that I am sending this third and last mailing. If my other correspondence did not reach you, a replacement questionnaire is enclosed. May I urge you to complete and return it as quickly as possible. Your contribution to the success of this study will be greatly appreciated. Sincerely, Elmer W. Moisio, R.N., M.S.N. Doctoral Candidate Enclosure APPENDIX B THE QUESTIONNAIRE 148 ORGANIZATIONAL PATTERNS and Faculty Resource Requirements For Clinical Nursing Instruction in Baccalaureate Programs 149 A STUDY OF ORGANIZATIONAL PATTERNS AND FACULTY RESOURCE REQUIREMENTS FOR CLINICAL NURSING INSTRUCTION INIBACCALAUREATE PROGRAMS THANK YOU FOR YOUR TIME AND EFFORT ELMER N. MOISIO, R.N., M.S.N. DOCTORAL CANDIDATE ROOM 10F, LEARNING RESOURCES BUILDING DEPARTMENT OF NURSING ORTHERN MICHIGAN NIVERSITY AROUETTE, MI 4985 150 was; Directions for completion of the questionnaire section 1. COURSE DATA Under the section entitled Course Data please do the following: a. Under the column "Course Title" list each required clinical course or the clinicalgportion of each required course in the baccalaureate nursing curriculum. Under the column "Year Taken" circle the letter F, S. J. or Sr, indicating the year in which the student Would normally take the course. ie., freshman, sophomore, junior, or senior. Under the column "Credit Hours" identify the number of term or semester hours for the clinical course or the clinical portion of the course. Also indicate term or semester. ORGANIZATIONAL DATA Under the section entitled Organizational Data provide an estimate of the percentage of time each organizational pattern is used for clinical inStruc- tion in the course. The following definitions will apply: a. Supervised Clinical - Faculty members accompany a group of students into a health care agency and provide direct supervision of them while they care for patients. Simulated Laboratory - Structured learning experiences in caring for patients that simulate real-life situations. A faculty member or laboratory assistant provides super— vision of the students. Preceptor/Role Model - Faculty members identify practicing nurses who work with students on a one to one basis. Faculty member does not directly supervise the student. but periodically checks with the student and preceptor to evaluate learning experience. Faculty member may or may not be present in the clinical agency. Such learn- ing may not be confined to patient care but also may incorporate direct observation of key nursing personnel. Independent Study - Student is responsible for planning the specific objectives and activities of the experience and for fulfilling the learning needs. Faculty member serves as an advisor to the student. is not present during the experience and does not provide direct super- vision. Practicum/Internship - Concentrated extended blocks of time in the clinical setting caring for patients and functioning autonomously in a staff nurse role. Faculty may or may not be present in the clinical agency. Practicing nurses may or may not be used as resource people. 151 Page 2 (Section 1) FACULTY WORKLOAD DATA Under the section entitled Faculty W0rkload Data please put the following data in the appropriate column: a. b. Indicate the number of students currently enrolled in the clinical course. Identify the current Faculty/Student ratio for the clinical course, or clinical portion of the course. (ie., Number of students per clinical section.) Identify the current number of clock hours the student actually spends in the clinical section per week. Identify the total number of clinical sections for the course for the current term or semester. Identify the total number of faculty members (expressed in full—time equivalent) needed to teach the clinical course, or the clinical portion of the course in the current term or semester. FACULTY PREPARATION Under the section entitled Faculty Preparation please do the following: a. In each of the columns indicate the preparation of faculty used to teach each clinica1.course. State the number who have doctorates,masters or bachelors as their highest degree. Graduate assistant may include masters or doctoral students if appropriate. Laboratory assistants may include nurses or non-nurses. Practicing nurses include all levels of academic preparation. FACULTY PREPARAT IN .1552 FACULTY MD DATA ORGAN l “TIMI. DATA COURSE DATA zsum: DUDMJ UNIS ISSW xuowuom MISSY 3.:me 51101133" PLEASE IDENTIFY THE ROGERS Ill EACH CAWY (0013.104 IP3TUTTDT 358003 IHJ. Hm GI. Gm (WWO 3 alum-ms) “1.03%! h '08 1'10!- swans 8) H81!- manna ind SMIDIS ‘IYDIKI‘ID I) '0'! (1" I‘d) IDIJDZS 'IWDINI'ID nova 81¢! sunou IMO JO '0’! 1w (“OIAJOd I'DTUTIDI OIJNM WILLS/MM] 33am: ‘IVDINI'ID 31“. RI 0371wa SIM J) ’01! m drasuuzzax/wnariovua a gig rants zuanlzaznu: 3:3 Eigg? 1znow smoanuwunmsna a‘ 555 “'§.§ xuorvuoavu azrvunwzs 'IVDIKI'ID czsmuns (HOTzzoa IvOIUTIDI uses no azisawzs - sanoa rrczuo (zorues xo rotunc «(dos 'umu; 10; m M '13 1° 'c's'a 013113) 0.003 huh; H nun-:0: to Lane: H 0.000: H 0.000: COURSE TITLE FACULTY PREPARAT IOU FACULTY woaneao (“TA momma-ram. (“TA COURSE DATA m on: DIWd WIS 153V snowmen WSISSV autism summon PLEASE IDENTIFY THE mans IN EACH CATEGORY suvuomooa (uotzzod IPDIUIID) 258003 I)“ um 01. 0mm (WWO a nut-ma) “.1an.! i) 'ON 1w mass ‘3 Hill-l. mo DJ SMIDIS 'IYDIMI'ID I) '05 (Mm z.d) IDIJDSS 'IYDINI'ID m 13d men 1501:) 30 '00! m (1:013:04 TUSWTTD) 011.th WI H.103“! asunoo ‘IVDINI'ID m NI 037108!!! SAWS JO '0“ cum/mums mm 'naow non/ma PLEASE ESTIIA‘IB 10.1mm (mantras rascal-rm 0' TIM! USED IN EACH CLINICAL “DIMI'ID GZSIMIADS (uotzzod IDSIUTTD) wasnsaas-smounw (10qu 10 10th ~qdos 'ueumua 10; m um '15 so 'r's‘a 013113) H swam L035“ c.0303 Lin”; 0 swam 0.an COURSE TITLE 154 SECTION 2 Directions: Please answer the following general questions about your nursing program. 1. Is there a collective bargaining agreement with faculty? YES NO 2. Does the agreement specify a normal full—time teaching load? YES NO 2-a. If yes, what is the number of credit hours per academic year? 2-b. If no, what is considered to be a full-time teaching load in credit hours per academic year for your program? Does the collective bargaining agreement specify size of clinical laboratory groups? YES NO 3-a. If yes, what is the size? 3-b. If no, what is considered an acceptable size? 3-c. Is this size determined by STATE REGULATIONS ACCREDITATION STANDARDS OTHER Specify What is the ratio of clock hours to credit hours used to tabulate faculty clinical workload? (ie., 2 clock hours in clinical generate 1 credit hour of teaching load) CLOCK CREDIT What is the ratio of clock hours to credit hours used to tabulate the clinical experience for the student? (ie., 3 clock hours in clinical generate 1. credit) CLOCK CREDIT What is the total number of credits for required nursing courses in your undergraduate nursing major? CREDITS IN THEORY CREDITS IN CLINICAL Is faculty travel time to and from clinical areas of setting considered as part of the faculty workload? YES NO Does your program charge a special fee (beyond usual tuition) for clinical courses? YES NO 8a. If yes is it: Fee per Credit? YES NO AMOUNT Supply or Equipment fee? YES NO AMOUNT Flat Fee/Special Assessment YES NO Amount Other Page 2 (Section 2) 155 9. Does your program use practicing nurses for clinical instruction? YES 9—a. If yes, are they paid? YES NO AMOUNT 9-b. Are they given faculty status? YES NO TYPE 9-c. Do you require that they have a MASTERS BACHELORS NO REQUIREMENT FOR DEGREE 9-d. Are they given university benefits? YES NO 9—e. If yes, which of the following? LIBRARY RECREATIONAL MEMBERSHIP BOOKSTORE DISCOUNT OTHER Specify 10. Does your programlfilxzclinical instructors on a per hour basis? YES NO lO-a. If yes, what is the hourly pay? lO—b. If no, is it prevented by: UNION CONTRACT UNIVERSITY POLICY DEPARTMENTAL POLICY lO-c. If no, HAS NOT BEEN CONSIDERED AN ALTERNATIVE. HAS BEEN CONSIDERED AS AN ALTERNATIVE AND FOUND NOT FEASIBLE. 11. How many faculty do you employ in your undergraduate program? FULL-TIME PART TIME 12. Current enrollment in the undergraduate nursing program is . 13. Do you consider your undergraduate curriculum to be INTEGRATED 14. Does NON-INTEGRATED your school of nursing include a graduate nursing program? YES NO Page 3 (Section 2) 156 15. Does your baccalaureate nursing program include: ___GENERIC STUDENTS ONLY ____REGISTERED NURSE STUDENTS ONLY ___REGISTERED NURSE STUDENTS AND GENERIC STUDENTS _____THE R.N. STUDENTS ARE IN THE GENERIC PROGRAM ___THE R.N. STUDENTS ARE PART OF A SPECIAL COMPLETION PROGRAM 16. Is your program in a ___COLLEGE or ___UNIVBRSITY? 17. Is your institution PUBLIC or PRIVATE? 18. What is the size (total enrollment) of your college or university? 157 IF YOU HAVE ANY ADDITIONAL COMMENTS ON THIS SUBJECT, PLEASE INCLUDE THEM IN THE SPACE PROVIDED BELOW. OOOOOOOOOOOOOOOOOODIOOOOO..OIOOCOIOOOOCOOOOO IF YOU WOULD LIKE A SUMMARY THANK YOU AGAIN FOR PARTICIPATING IN THIS STUDY. OF THE RESULTS OF THIS STUDY, WRITE YOUR NAME AND ADDRESS ON THE BACK OF THE RETURN ENVELOPE. TO INSURE CONFIDENTIALITY PLEASE DO NOT WRITE YOUR NAME, INSTITUTION OR ADDRESS ON THIS QUESTIONNAIRE. APPENDIX C LETTERS OF PERMISSION FOR CARRYING OUT THE STUDY GSAO Ju.1y' 197_5~'~ . ,' : ‘ _ T, _‘.‘.I,.-.::; 2: 158 , APPROVAL or _ DISSERTATION PROPOSAL _ ‘_,. . ' 1 ‘~ ' 1“. LI; "-;~-";~ ' w... ‘ _ 'Comittee'. y TitrleWOf the Dissertation (may S‘C‘ceneaave‘iu. .hah‘a‘se”;ee..... and (descriptive): 5M9“ 07C ‘71:: Oresdl‘ts‘fé 04/ ”a #90): 0‘? QHZJCCAJ UJQSI‘h‘I N‘s-indie». 4,061 (EA/Q LMADAC+ GNU H’QUH’L. (£001.: 12;: uIT’aEMENITs 1'3 EA Goalmesm‘e Mme; 1L7 ? CiflAmJ' Anticipated date of completion: nupmb-a/Z. [“185— Y'SITS’L/ Student's major field: O‘2I(g%£ gafl K011211553? AJmm'n‘Ita‘IFOn) flags—74st- Student'sname: _E/mcl? (#03 HIH’M MOLSI‘D ‘ (please print legibly) Student's signature: WWO Guidance Committee Meff;;£/(Signatur:;sg:fgired): _’ Chair, ' U/u-nr/ I Date: 51:,“ 1 i2 Director: Date approved by Guidance Committee: Student number: prr" P / I. 7.: Date received in GSAO: ‘ ~ . L: 5 . r; .’ ‘ ’. 1.' ‘ " ' .IT ij ‘ "f’. :7" I "' " ... “T ‘ “a"? ‘ '--.:PI".‘."‘.‘-‘b"'.’f'-"" ..... . ”hp-u. . V .3... . 05”.”. . I .Jfllf; : 1,; ..~ 3‘ 'Twfiz‘vvo Elks, ual 4.! 159 MICHIGAN STATE UNIVERSITY UNIVERSITY COMMITTEE ON RESEARCH INVOLVING HUMAN SUBJECTS (UCRIHS) 238 ADMINISTRATION BUILDING (5133554180 July 3, I984 WWM'W$M°w4 Mr. Elmer w. Moisio Room lOF Learning Resources Building Department of Nursing Northern Michigan University Marquette, Michigan #9855 Dear Mr. Moisio: Subject: Proposal Entitled, ”A Study of the Organizational Patterns of Clinical Nursing Instruction and Their Impact on Faculty Resource Requirements in Baccalaureate Nursing Programs” I am pleased to advise that I concur with your evaluation that this project is exempt from full UCRIHS review, and approval is herewith granted for conduct of the project. You are reminded that UCRIHS approval is valid for one calendar year. If you plan to continue this project beyond one year, please make provisions for obtaining appropriate UCRIHS approval prior to July 3, l985. Any changes in procedures involving human subjects must be reviewed by the UCRIHS prior to initiation of the change. UCRIHS must also be notified promptly of any problems (unexpected side effects, complaints, etc.) involving human subjects during the course of the work. Thank you for bringing this project to my attention. If I can be of any future help, please do not hesitate to let me know. 'Sincerely, Henry E. Bredeck Chairman, UCRIHS HEB/jms cc: Nonnamaker MS U is on film Action/Equal Opportunity Inuit-ciao REFERENCES REFERENCES Anderson. Norma. "The Historical Development of American Nursing Education." Journal 91 Nursing Education 20 (January 1981): 18-360 Andreoli. Kathleen. "Faculty Productivity." Journal o_f_ Nursing Administration 9 (November 1979): 47-53. . and Musser. Leigh A. "Improving Nursing Faculty Workload." 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