II II I I I.II . If .r II.I LC III [III I I .. II I! I1: I I l I . I I II I I I II.I} .Illw” IIIIIIIII II” III . IIU- . II I III: \I f v II III I I I I, In. I” I IIII «IIIII III-II I III . I I I I III. I I‘\ I III I II I I3 I I II I I I I \HI I I I .. I I. I .IIIIIIIIIII III II. .11II4 III: I! III III .I - It I I.I II II I, I a I I III I I I... III IIII III. III. II III... I . I II II I . - I , I I I III I I I I. I. I . II. II I I III . \ . IIIIII .II II III II.II III . I IIII .IHIII I I I I I I. I IIIII III I I.. I.III I II I\IIII I‘I I III I; I . I II II IIIIM III N III .. Io IIII I IIIIIIIIIIILI, I III I .I I .IIIVIIIIII. III I .I... .IIIIu, II. III IIIII #III I h... I IIIII II IIIIn I II II ’IIII I I I- ‘. |I II I I IIIIIIIII III I I a IIIHII I III .I III fl . “I. I I. II II IInIIIrrIIIIIII II.I- IIII I IIIHIIII. I“ IN \I .I II I I I .I III III I I III“ II III I I I . I I I III I . I I I IIIIIIIII II I III I.IIv.IIIII¢III.II. IInI II I I I II II II( IIIIIII III .I’I IIIIluI IIII I II I . I III II I I .III III. III IIIIIHINIIHIIIMI II II I I I III. IIIII I I I I I. I I II I. I l u I III III III I \IIIIHIIUII a I (I I I I I. I IIIIIIu III In I. I IuIIIII‘I III : I IIIII IINI II I \u.I|:IIJIIWII|I I II - II III II I II IIII IH II IZFI “II-II J‘ III-II.IIIIIII II AI I I I I IIII I .I l I I II .II I .I I II. I III I I! III I II I II I lII I I III I I. IIIII I I III. I II I MI In III? - I I I III I. I -I .II I I III IIII l I. In I I III III . I II HI” IIIIIIIIIH III. I IIIIII I v I II" ILII.‘I.|JI'IIII I I . . I IHI I.).I/IIIIIIIIIIIIIIII . III I III II I u I I I I III IIUIIIIII I- II III I III IIIIIIIIIIII I .II II -I I IIIIIIII IIII . IIII III! I I I III I [III II I II I II I “II.I I. ("I I II II .I. III I I II III .I I . I I II. . .I.IIII(I#I II)- I? In III I I u I I I IIIHI .Iuh III - II.I... I . IIIIHII III: I I I I I I IIII IIIIIIIIIII I .I I. II II I I I III I I .III IIIII V .IIIII . III II I III II III] I I I. I I. I II I I II’IIII I I IlIIII II I III I III . II III. IIII II I III I I III II I I. II II II I III II II.IIIIII. III III I. II I I. III III I” III. I IIIII \III IIIIhIIIIIII IIIK... I I I II. III III“ III...IIIHIII IIIIIIIII “III In"... .. II IHI I. I. I III.IIIII In}... III. IIIIIIIIIII. IIII‘ III" I II I. II I I II/III. IIIIIIIIIIIIIIIIIIII I I I I II I I I . I III II . I III I. I I I H I IIIII I III IIIIIIIII I . .I II I I . I... I.. III-.- .JIuI I I II I III I I . III III! I I III I II “I III III I II I I I I I . III. .I II III III I I I III. I I.II I. .II III III. II I 4w wHI H I“ I IIIth HWM NV. IUWIL I I- I "III I I I . II. II .. IIHII II . II I I I I II II I I I III I .I. III I I I I- I .I I) I I III I _I IIHIII I I I I.“ H H. IHIIIIPPW I II I I II III I I w W H IIuIILHH I I I II I I I I IIMIIIILWHIII I III I II I III II I II I - I I h: I II.IIII IIIIIIII I“ IIII o . I I II. I: III] {III II II I I III!” III I I II II. MHIWIIN MHKVHW I I I I I II I I I IIIII III I I I II IIIJI IIIII .II .IIIII I III I I IIIII h. I IIw I. I I IIIUI II I III I w. I II.I I III.- In I I I III- II I ”II I III I .I II II IIIIII I | I!” I‘l‘II‘I'III I I II II.IIHII . - I IIIIIIIIIIIIIIIIIIIIIIHI ngwflIIIUIIWIWFI I .. - III .I I .. InIIII III IIIIIII III: III 30" I II I III- I-.. I III! II-IIIIHI IIIIUIWIIUIIHIIIIIIIE I. I III I III! I. I IIII‘II’III I III I I I II IIIIIIIIIHI .III I. III. III#: IIIIIIIIIIII III: -I IIIMIIIIHIIIIINIIIIIIIIIIHIIIIIIIIIIII IIIIIIIIIIIIIII II.III II.IIIfln IIIIIHI In. .. I .II II I. I I I III III I III I I II.. III II-I IIIIIIHIIIIUIIIII I - §HI IIIIQIIIII I I I . II I I “I I I IIIIIILIIIIIIIHHIIIQIII II.I I II I” IIIIHURIII III- .III III I r I I Mill \lllllllllllllllllllllll\lllllll g ‘293 LIBRARY This is to certify that the thesis entitled BACCALAUREATE NURSING SCHOOL ADMINISTRATOR'S PERCEPTIONS OF SELECTED ASPECTS OF LONG RANGE PLANNING FOR NURSING AND NURSING EDUCATION presented by Mary Grace Weisensee has been accepted towards fulfillment of the requirements for Ph.D. Higher Education degree in Major professor 0-7 639 . - . . wmzr‘f" "“ v.1 u.’*_ .1" .g‘ qr 1.0-4'h.’ .01.. OVERDUE FINES ARE 25¢ PER DAY PER ITEM Return to book drop to remove this checkout from your record. BACCALAUREATE NURSING-SCHOOL ADMINISTRATORS' PERCEPTIONS OF SELECTED ASPECTS OF LONG—RANGE PLANNING FOR NURSING AND NURSING EDUCATION By Mary Grace Weisensee A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Administration and Higher Education 1979 ABSTRACT BACCALAUREATE NURSING—SCHOOL ADMINISTRATORS' PERCEPTIONS OF SELECTED ASPECTS OF LONG-RANGE PLANNING FOR NURSING AND NURSING EDUCATION By Mary Weisensee The major problem focus for this study was to ascertain baccalaureate nursing-school administrators' perceptions of selected aspects of long-range planning for nursing and nursing education. A questionnaire was mailed to 286 nursing school administrators of accredited baccalaureate schools of nursing in the USA during the winter of 1978. There was a response rate of seventy-five percent. All regions of the nation showed similar representation with the midwest having a slightly higher response rate. The typical respondent was called a dean, was a female between the ages of forty-six and sixty, employed by a public institution having from 100-399 full-time equivalent students, held an earned doctoral degree, reported to a vice president or a dean, and had held the administrative position less than six years. No distinct pattern emerged regarding the ages of the respondents' programs; responses were distributed throughout the age span from less than five years to more than thirty-one years. Mary Weisensee The deans perceived long-range planning to be important and they expressed enthusiasm for efforts toward it. They viewed it as being useful, stimulating, and positive; however, they realistically viewed it as expensive and difficult. The majority of respondents indicated that long-range planning in their school ex- tended over a period of five to nine years. The deans perceived themselves as having the greatest potential influence on facilitation of long-range planning with faculty having the next greatest. The "vested interests" of each profession were cited as the factors most hindering long-range planning. The deans agreed strongly that the baccalaureate degree should be the initial requirement for professional nursing; however, the route to reach this goal was less clear. They agreed less strongly about advancement from technical to professional education. Agreement on entry levels and clarification of professional goals were both identified as highly important and urgent issues confronting the profession. There was strong agreement that the health care delivery system should change its focus from crises care to prevention, but less agreement on the role of the client in initiating an automated device to obtain a physical diagnosis. Clients were perceived to have a positive influence because they facilitated long-range planning. Mary Weisensee Interdisciplinary functioning as colleagues was viewed as being more important and urgent than providing for interdisciplinary student education. Finances and legislation were perceived to be the major factors that wlll influence long-range planning for nursing and nursing education by 1990, whereas the deans perceived that they (nursing school administrators) and faculty should have the greatest influence on long-range planning. Technology was perceived as having neutral influence on long-range planning. Several societal changes such as awareness of the need for long-range plan- ning, uncertainty in society, and time available for planning were believed to hinder long-range planning. It can be concluded that the respondents believed there are major differences between what should and wlll influence long-range planning. Deans perceived that they and faculty should be highly influential shapers of the future of nursing and nursing education. Meanwhile, high costs and legislation will have major influence. ACKNOWLEDGMENT I am indebted to a number of people for assistance, interest,anu1for their generosity in contributing to this research: My advisor, Dr. Richard Featherstone for assistance, personal interest, and encouragement throughout the study, Dr. Philip Marcus for many hours of assistance with development of the questionnaire, Dr. Isabelle Payne for sharing her wisdom from the administrative perspective of nursing, Dr. Marylee Davis for her creative suggestions in adding clarification for the non-nurse reader, My colleagues, friends and family who assisted and supported me through the many phases of the study, Last, but not least, to the 214 nursing school administrators who generously gave their time in completing the questionnaire. ii TABLE OF CONTENTS Chapter Page 1. INTRODUCTION . . . . . . . . . . . . . . . 1 STATEMENT OF THE PROBLEM . . . . . . . . 8 Significance of the Study . . . . . . . 10 Problem Statement . . . . . . . . . . . 11 Areas of Focus in the Study . . . . . . 11 PURPOSE OF THE STUDY . . . . . . . . . . 17 DEFINITIONS OF TERMS . . . . . . . . . . l8 LIMITATIONS AND DELIMITATIONS . . . . . . 22 Limitations . . . . . . . . . . . . . . 22 Delimitations . . . . . . . . . . . . . 22 DESIGN . . . . . . . . . . . . . . . . . 22 ASSUMPTIONS . . . . . . . . . . . . . . . 23 ORGANIZATION OF CHAPTERS IN STUDY . . . . 26 2. REVIEW OF LITERATURE . . . . . . . . . . . 31 INTRODUCTION . . . . . . . . . . . . . . 31 PART I: PREVIOUS RESEARCH . . . . . . . 33 RELATED LITERATURE . . . . . . . . . . . 34 PART II: THE CONCEPT OF PLANNING AND PLANS . . . . . . . . . . . . . . . 37 PROPERTIES OF A PLAN AND PLANNING . . . . 38 iii Chapter Page CLARIFICATION OF TERMINOLOGY . . . . . . 38 Decision-Making and Planning . . . . . 38 Comparison of Planning and Forecasting . . . . . . . . . . . . . 39 THE TIME DIMENSION . . . . . . . . . . . 4O PHILOSOPHY, VALUES, AND ATTITUDES TOWARD PLANNING . . . . . . . . . . . . 41 THE ACCEPTANCE OF PLANNING . . . . . . . 43 LIMITATIONS, BARRIERS, AND DIFFICULTIES IN LONG- RANGE PLANNING . . . . . . . 45 BENEFITS OF LONG RANGE PLANNING . . . . . 50 PART III: RELATIONSHIP OF PLANNING TO THE FUNCTIONS OF THE NURSING SCHOOL ADMINISTRATOR . . . . . . . . . 54 RELATIONSHIP OF PLANNING TO UNIVERSITIES AND BUSINESS . . . . . . . 55 RESPONSIBILITIES OF ACADEMIC DEANS . . . 57 FUTURE NURSING EDUCATION . . . . . . . . 61 PART IV: PERSONAL AND PROFESSIONAL OUTLOOKS OF DEANS . . . . . . . . . . . 63 EDUCATIONAL PRIORITIES . . . . . . . . . 66 Insufficient Leadership in Nursing . . 68 Preparation of Nursing School Administrators . . . . . . . . . . . 69 Anti-Intellectualism . . . . . . . . . 7O Barriers to the Advancement of Nursing Education . . . . . . . . . . 72 THE HEALTH CARE DELIVERY SYSTEM, INTERDISCIPLINARY COLLABORATION, CLIENTS, AND FINANCES . . . . . . . 72 iv Chapter Factors Contributing to Confusion . The Dean‘s Role . Changing Priorities TECHNOLOGY Technology in Education and Practice SOCIETAL CHANGES Politics--A Barrier to Long-Range Planning Changing Roles of Politics in Contemporary Society Social Priorities . Social Changes Influencing Nursing Education . SUMMARY . 3. DESIGN OF THE STUDY . Problem Statement . Design Population The Instrument Pilot Test Data Collection . Analysis of Data Summary . 4. ANALYSIS OF DATA Response Rate to the Questionnaire Page 75 76 77 80 81 82 83 84 85 86 89 107 107 107 109 109 112 113 113 114 116 116 Chapter Page PART I: RESPONSES TO QUESTION SET A . . 119 Types of Institutions Represented by Respondents . . . . . . . . . . . 119 Full Time Equivalent (FTE) Enrollment . 119 Regional Locations of Respondents . . . 122 Title of Administrative Position Held . 125 Length of Time Respondents Have Held Their Position . . . . . . . . . . 125 Ages of Respondents' Programs . . . . . 125 Title of the Person (Superior) to Whom the Nursing School Administrators Report . . . . . . . . 129 Ages of Nursing School Administrators . 129 Sex . . . . . . . . . . . . . . . . . . 131 Highest Earned Degree . . . . . . . . . 131 Summary . . . . . . . . . . . . . . . . 131 PART II: PRESENTATION OF FINDINGS . . . 135 Responses According to Extent of Agreement About Long-Range Planning . 135 Issues Confronting the Nursing Profession According to Importance, Urgency, and Degree of Progress by 1990 . . . . . . . . . . . . . . . 137 Summary . . . . . . . . . . . . . . . . 139 Amount of Agreement With Trends/ Potential Changes in Education and Health Care Delivery by 1990 . . . . 139 Nursing Education . . . . . . . . . . . 141 Summary . . . . . . . . . . . . . . . . 141 vi Chapter Page Health Care Delivery . . . . . . . . . 142 Summary . . . . . . . . . . . . . . . . 145 Responses to the Stimulus Phrase, "Long-range Planning" . . . . . . . . 145 Summary . . . . . . . . . . . . . . . . 147 Persons/Groups/Factors That May Influence Long-range Planning for Nursing and Nursing Education . . . . 147 Summary . . . . . . . . . . . . . . . . 150 Persons/Events/Conditions/and Policies which Hinder or Facilitate Long-range Planning in the Respondents' Schools . . . . . . . . 153 Summary . . . . . . . . . . . . . . . . 155 Long-range Planning in Each Respondents' School . . . . . . . . . 158 Summary . . . . . . . . . . . . . . . . 158 5. SUMMARY, IMPLICATIONS, CONCLUSIONS, AND RECOMMENDATIONS . . . . . . . . . . 160 Problem Statement . . . . . . . . . . . 160 Design . . . . . . . . . . . . . . . . 160 Demographic and Background Profile of Respondents . . . . . . . . . . . 160 Extent of Agreement About Long-range Planning . . . . . . . . . . . . . . 161 Issues Confronting the Nursing Profession According to Importance, Urgency and Degree of Progress by 1990 . . . . . . . . . . . . . . . 161 Trends, Potential Changes in Nursing Education and Health Care . . . . . . 162 Perceptions of Long-range Planning . . 162 vii Chapter Persons, Groups, Factors That May Influence Long-range Planning Nursing Education and Practice Persons, Events, Conditions, and Policies Which Hinder or Facilitate Long-range Planning Long-range Planning in Each Respondent's School . IMPLICATIONS CONCLUSIONS . RECOMMENDATIONS APPENDICES A. COVER LETTER QUESTIONNAIRE . B. POST CARD REMINDER 0. RAW DATA BIBLIOGRAPHY viii Page 163 163 164 164 166 169 173 174 181 182 193 Table 10. 11. LIST OF TABLES Summary of Response Rate to Questionnaire . Total Responses to the Question: Which is the Type of Institution in Which You Are Currently a Nursing School Administrator? . . . . Total Responses to the Question: What is the FTE Enrollment in your Baccalaureate Program? Total Responses to the Question: Which is Your Regional Location? . . . Return of Questionnaires from Respondents by Region Compared with the Target Population . . . . . . . . Total Responses to the Question: What is the Primary Title of the Administrative Position you Hold at Present? Total Responses to the Question: How Long Have you Held this Position? . . Total Responses to the Question: What is the Age of the Baccalaureate Program Where you are Currently Employed? Total Responses to the Question: What is the Title of the Person to Whom you Report? . . . . . . . . . Total Responses to the Question: What is your age as of Your Last Birthday? Total Responses to the Question: Which is your sex? . . . . . . . . . . ix Page 118 120 121 123 124 126 127 128 130 132 133 Table Page 12. Total Responses to the Question: What is your Highest Earned Degree? . . . . . 134 13. Rank, Standard Deviation, and Means* of Responses According to Extent of Agreement About Long-Range Planning . . . 136 14. Rank, Standard Deviation, and Mean Score on Statements of Issues Confronting the Nursing Profession According to Importance, Urgency and Degree of Progress by 1990 . . . . . . . . . . . . 140 15. Rank, Standard Deviation and Means* of Responses To Amount of Agreement with Trends/Potential Changes in Education and Health Care . . . . . . . . . . . . . 143 16. Ranks, Standard Deviations, and Means* of Responses to Phrase "Long Range Planning" . . . . . . . . . . . . . . . . 146 17. Ranks, Standard Deviation, and Means* to Statements According to Degree of Influence Persons/Groups/Factors Should Have and Will Have by 1990 . . . . 151 18. Rank, Standard Deviation, and Means* of Persons, Events, Conditions, and Policies According to Hindrance or Facilitation of Long-Range Planning . . . 156 19. Total Responses to the Question: Long range planning in my school means planning ahead for __ months or __ years . . . . . . . . . . . . . . . . . . 159 C-1 Total Responses to the Question: To What Extent Do You Agree With the Following Statements About Long Range Planning? . . . . . . . . . . 182 0-2 Total Responses to Statements According to Importance of Issues Confronting the Nursing Profession . . . . . . . . . . . 183 Table 0-4 C-5 C-6 Total Responses to Statements According to Agreement With Trends/Changes in Nursing Education and Health Care Delivery by 1990 Total Responses to Stimulus Phrase "Long Range Planning" Total Responses to Statements Influencing Long Range Planning for Nursing Education and Practice According to Degree of Influence They Should Have and Will Have by 1990 . . . . . . . . Total Responses to Statements According to Degree Factors Hinder or Facilitate Long Range Planning xi Page 186 188 189 191 LIST OF FIGURES Figure Page 1.1 Categories of Data Which Influence the Nursing School Administrator in Long Range Planning . . . . . . . . . . . .12 xii Chapter 1 INTRODUCTION We have arrived at a time in the academic world when real choices are about to be made. They can be forced upon us or we can direct them. And make no mistake about it, they will be forced upon us unless we act with more speed, initiative, intelligence, and ingenuity than we have hitherto displayed. 1 Samuel B. Gould A new breed of professional is emerging, the futurist. ‘COined by a German professor, Ossip Flechtheim, in the 1940's,2 1960's.3 futurology became a science during the Futurology is probably best placed as a division of sociology, opposite historical sociology, because it concerns itself with prospective developments.4 Yet, futurists penetrate almost every knowledge area and discipline. For future study to be beneficial to society, it must be wholistic. Therefore, any professional who wants to avoid the fate of the dinosaur must be concerned not only with the relevant knowledge and research of the past and present, but also of the future. The question is, should we Plan and create the future or be a victim of it? We face one of our greatest dilemmas: all knowledge is about the past, but all decisions are about the future. Due to the abstract nature of the futures study, there are differences in the traditional approaches. Amara defines futures research as "any activity that improves understanding about the future consequences of present 6 The literature can be somewhat development and choices." confusing as many futurists differentiate between prediction and forecast while others use the two words synonymously. The difference usually applied in futures literature is that a prediction refers to something that wlll happen, whereas a forecast is "a probabilistic, reasonable definite statement about the future, based upon an evaluation of alternative possibilities."7 In relation to futures research, Harmon maintains that: By 1994 the controlled experiment will not be Viewed as the only way to revealed truth. The new knowledge paradigm will foster open, participative inquiry. Truth is that which is inescapable. It is not a completely contemporary innovation to "research" the future, to predict, to speculate, to forecast and use various tools and techniques to determine future roles, fate, or destiny. Many tools of ancient days such as astrology charts, tarot, palmistry, graphology, crystal ball, numerology, and pendulum are still popular today. From time to time the popularity of psychic phenomenon such as extrasensory perception, telepathy, clairvoyance, precognition, and numerous other tangible and intangible methods and devices become more acceptable as tools for learning what our future will be. Prophets of biblical times had dreams that foretold important future events and the biblical admonishment from Proverbs 29:18 relates to the future and states: "where there is not vision, the people will perish." It can be easy for one to be misled in this mushrooming field. Hack optimistically states: "The new breed of futurist rejects the occult arts of the ancients in favor of more rational and scientific approaches."9 With this progressive View in mind, it seems incongruous to read in recent writings comments like Dator's: . . . we live by institutions and values which almost totally discount the future. They are hang- overs from the period when powerholders generally could not greatly predetermine the future, and it was not legitimate to question them.when they did. 10 One can ponder whether we as a race, civilization, and profession, are using Obsolete methods to cope with our surroundings. Are yesterday's coping patterns and skills leading us to a "dead-end street?" One can speculate about the causes of man's view of the pace of change and his bewilderment about the future. Possibly mankind has become so accustomed to an abundance of material possessions, concrete and tangible, that to ponder and deal with anything so abstract and intangible as the future seems a luxury the majority of today's population cannot fathom. Many persons immediately ask for concrete evidence, facts, proof, and statistics when confronted with any piece of information or concept that is not within their repertoire of knowledge. This brings to recollection accounts of scoff and severe ridicule that early scientists and eXplorers encountered when exposing their ideas and theories to the public. Many were hanged. Columbus had difficulty financing his ships because everyone ”knew" that the world was flat and that he would fall off the edge. According to Amara: "The crucial difference [nowl is the realization that the principle hazards that man faces are largely of his own making and .11 largely within his own control.‘ This is a threat as well as an exciting challenge. Nursing educators, like members of most other disciplines, tend not to take time to plan far ahead. They are so busy solving today's and yesterday's problems that they neglect to stOp and lift their heads and ponder seriously about tomorrow and beyond. Peter Drucker admonishes: "results are obtained by exploiting opportuni- "12 Nursing educators have ties, not by solving problems. continually responded to crisis after crisis by solving problems rather than by ingeniously latching onto opportunities that occur. Barritt, a contemporary dean of nursing, states that: "crisis intervention is one of her main tasks."13 Many rationalizations are given by educators for not planning. One of the frequent excuses is: "we do not know what people will want." Yet it seems that this myOpic vision compounds itself when the public does not observe the university taking leadership, it loses confidence in higher education and votes less legislative appropriations. The university cannot do more because it cannot afford adequate staff to meet public demands, and so the vicious cycle evolves. Earl Joseph emphasizes "that systematic reasoning about the future is a prime missing ingredient in all of today's educational systems, and, for that matter, "14 in all of society's institutions. He adds: ”So far, only a handful of colleges and universitites include futurology in their curricula; in a sense, we have been teaching and learning 'pastology."'15 Lamson describes the situation so well: We tend not to look and plan far enough ahead. We tend to ignore the long range, cumulative and synergistic effects of what we do. These impacts are often not perceived, not understood, not studied, and we do not adequately evaluate, anticipate, control of guide them. We tend not to consider a wide enough range of alternatives for specific policy problems nor do we consider a wide enough range of values and groups in calculating the costs and benefits of various alternatives.16 March and Simon discuss planning and innovation and mention Gresham's Law of planning: "Daily routine drives out planning,' and if an individual is given a choice, he will opt for programmed tasks as opposed to the unprogrammed tasks.17 McDanield and Mendell, in "What Futurists Can Learn From Creative Problem Solvers," discuss the controversy of soft versus hard research and express their concern: Such a split is dangerous and should be of great concern to futurists. The creation of two isolated groups, one overly concerned with probable futures, threatens our capacity to create preferable futures. We cannot afford to lose the benefits of both approafges. We must find a way to combine the approaches. Toffler suggests that we prevent future shock by describing the alternatives we think are possible, probable, and preferable so that we can make the most rational choices possible with the data currently available.19 Acceptance and utilization of knowledge in decision- making are impeded because we are "data bound" in so many ways. We have to have such extensive amounts of data that by the time we obtain "adequate" data to solve the problem, the problem has solved itself, someone else has solved it, or the data are not appropriate for the solution of the problem as it exists at the present time. In 1960, Russell spoke to this: The educated person must be skilled in these processes of tentative and precise reasoning about phenomena of inexact measurement. Most human actions must be based on evidence which, though not fully conclusive, is the best available at the time. One of the chief aims of higher education should be to cultivate habits which will prevent human beings from acting blindly with no facts, or procrastinating indefinitely because the last shred of evidence is not in. By comparison, Mitroff states in a more contemporary vein in 1973: they are . . . data bound types who wouldn't be able to save their own ass if a fire was burning next to them because they'd never have enough data to be sure the fire was really there.21 If we do not change our ways of thinking and methods of research in relation to accepting new knowledge, we may soon not be able to cope with tomorrow. Bronwell advises: . If society is to understand itself and deal wisely with its future, while preserving and enhancing its creative dynamism, it will have to break through the philosophy barrier and regard time as a continuum so that researching the future becomes just as acceptable as researching the past and present, even though it may require quite different strategies. The rules for accepting research conclusions and knowledge also need to be examined. Phillips discusses the criteria and rules for accepting knowledge into the body of sociological knowledge dealing with procedure and quality and asserts: . We do not consult what a proposition_proposes, we consult the rules used to decide if what thelproposition proposes is warranted."23 Many people feel that what has been and currently exists is right; they comfort themselves by thinking that if the status quo has been effective in the past, and if some rule will help them to substantiate it, they are satisfied with it. This is not to say that the past is invalid, but that past knowledge as well as new knowledge must be tested and scrutinized. Planning for nursing education poses many related deep philosophical issues and moot questions. Since nursing education has become a legitimate part of higher education, it inherits the doubts and troubles of overall higher education in addition to being a profession without a commonly accepted single route to the education of the registered nurse. The fact that there are no easy answers makes life very complex for the administrator of a school of nursing. In addition to the dilemmas mentioned above, the nursing administrator is frequently the only female in a male's world of administration. If the administrator did not have to spend so 24 mentioned much time in crisis intervention, as Barritt earlier, she/he would have time to plan for the future. If she/he and the faculty could set some priorities for long- range planning, their efforts should be utilized more advantageously for the benefit of the school and the profession. STATEMENT OF THE PROBLEM Nursing literature has few articles that focus attention upon future problems, but many recount the past are status quo reports with few recommendations, or reorient only for the short-term future. Even though each study contributed to the profession's knowledge of itself, few received careful attention and implementation. For example, Brown's 1948 study, Nursing for the Future, discusses many of the identical problems that still face the profession today, especially in academic preparation and professional 25 status concerns. The profession has no overall, extensive, ongoing, coordinating mechanism for the specified purpose of delineating future goals and directions. A 1975 publication written by a committe of the NLN, Perspectives for Nursing, focused on clients, changing roles of manpower, facilities for health care delivery, and education of health care personnel.26 This brief report presents a limited discussion on trends and changes needed in relation to the four previously stated areas, but does not elaborate on rationale or implications for long-range planning. Few planning efforts with other health care discip- lines have produced substantial evidence of problem assess- ment and solution. Indeed, communication between professionals about interdisciplinary health care is infrequent and occurs usually after a crisis has arisen. At present, to fill the intellectual void, many universities have begun a modest attempt to assess their role and mission for the next decade. Rushmer, for example, notes: "the concept of identifying long—range goals for desirable futures is attracting a great deal of favorable attention among organizations, institutions, 10 states, and regions."27 Belatedly, the nursing profession must grapple with the mammoth task of long-range planning as an integral part of higher education. Significance of the Study As leaders in higher education, administrators of nursing schools are in a unique and responsible position for giving direction and foresight to the advancement of the profession. They can make an unprecedented contribution by improving planning for the nation's future health care. Torres emphasizes the importance of nursing educators: "Throughout its history, nursing has been most influenced by its educators, who play a key role as change agents."28 These administrators, by authority of their position, should be of vital importance in initiating changes and shaping a desirable future. The need for a unified effort at long- range planning by nursing and other health professions is analogous to the currently emphasized need for energy planning; both are long overdue. The presentation and analysis of data should extend the knowledge of the profession, provide a rationale for decision making, and stimulate additional research. To the author's knowledge, no study of this type has ever been conducted. In fact, very little information about these nursing school administrators is evident in the literature on their preparation, activities, roles, ll beliefs, or characteristics. The educational literature on academic deans in higher education is also quite meager. Problem Statement The major problem focus for this study is to ascertain perceptions of baccalaureate nursing school administrators (deans, Chairpersons, directors) in regard to selected aspects of long-range planning for nursing and nursing education. Areas of Focus in the Study The organization of the content areas of the study in addition to selected demographics are divided into eight major categories which influence long-range planning as follows (see Figure 1.1): l. The personal and professional outlooks, values, and priorities of each administrator are important to consider because their views of the world generally and the future specifically, will influence their preparation aand imagination for conceptualizing the abstract and uncertain future. The ability to engage in long-range planning requires that certain questions be answered. For example, are nurses socialized as primarily a female profession to act only under conditions of certainty and in a prescribed manner? Does she" call "him," the physician, if conditions are uncertain? 12 Categories of Data Which Influence the Nursing School Administrator in Long Range Planning Societal Changes Personal (Value Shifts and Professional National Priorities) Outlooks (Values, Priorities) Educational Priorities and Technological Changes for Nursing Changes and Nursing Education L The Finances Dean Changing (Politics and Health Care Legal Controls) Delivery System Client Inter- Control disciplinary and Demands Collaboration Figure 1.1 13 Barzun discusses the temper of the administrator and the relationship between the amount of data, the sensing of time, and scholarship in his/her decision-making, and further elaborates: As for the academic men who have proved themselves as consultants to industry and government, they tend in their outside dealings to make allowances which they deny to their university. They let business people carry the burden of compromise which they refuse to take on at home.29 2. Another category is the educational priorities and projected changes which must occur to prepare the nurse to function in the health care delivery system of tomorrow. A constant conflict exists (as in most profes- sions) between nursing service and nursing education over which group should have greater influence on the educational decisions. The service persons feel that they are the ones who really know what should be taught because they are in actual contact with the patients (clients) and have the practical knowledge. On the other hand, the educators feel that through their past practice and advanced education, they know the theories and principles which will prepare the student for the longer range aspects of learningauuiproblem solving. The service agencies are usually more interested in the short-range immediately applicable skills. Since education is inherently a future-oriented activity, there must be a certain sense of hope for the future apparent in each educator. l4 3. The changes which should take place in the service areas, or the health care delivery system, are crucial to education as well as to cost consideration and a more humane concern for those seeking health services. The location and variation of services will and should change markedly by the end of the centry. Many of the accepted practices and institutions of today will seem primitive by 2000; i.e., the "modern" hospital of today may be extinct like the tuberculosis sanatorium and "pest- house" of past centuries. With technology the home may again be the locus of care. A home computer may give instructions or a picture phone may aid in diagnosis and treatment. 4. Interdisciplinary collaboration is important for avoiding duplication or omission, but also for providing the client with the best services and knowledge available. Much verbalization takes place about the necessity of working and learning together as students, but the ingrained traditions and vested interests of each discipline seem to defy change. In Maxmen's Post Physician Era, he discusses the 50 percent probability that by 1990 nurse practitioners will provide primary care, and by 2015 MD's will not provide clinical services except for surgery.30 5. Changes in societal values and technology in general influence the services that clients of the future expect and demand. Many institutions and agencies 15 are allowing and encouraging citizen participation in governance and policy determination. The new breed of client is an active participant in his/her health care, not necessarily a sick person (as the word "patient" signifies) or a passive recipient. Will the physician attempt to remain in control of access to the health care delivery system? Or will clients have direct access to the professional and location of their own choice? 6. Finances are receiving increased attention because high costs pose a barrier to many persons who should seek health services. High costs are attributed to lack of efficiency, expensive technology, additional and more highly educated personnel. This increased cost issue has led to the thrust for increased accountability by all health personnel and services. Education also has severe financial problems because of declining enrollments in many disciplines, but costs do not decrease appreciably due to inflation and other costs of maintaining an institution. The ultimatum to accomplish more with less is being issued from all sectors. Political and legal shifts are highly influential in this category. 7. Technolggical changes have provided for many highly advanced procedures to be performed which seemed impossible a few years ago. Yet though these changes are a blessing on one hand, the dilemmas and the new problems 16 of "technological success" are oppressive and have wide ethical, moral, and legal implications for health care personnel as well as the recipients and their families. Since the computer never forgets, more accurate health records should be available. This fact, of course, leads to the potential invasion of privacy and other unauthorized utilizations of information. 8. Societal changes, value and national priority shifts, especially the crisis of depleted resources previously accepted and taken for granted, have and will continue to influence travel, costs, acceptability, and practical aspects determining who can afford to seek and provide health care services. The implications of each are extensive and influence education, service, and the client. This category is to be differentiated from category five, the focus of the client on the system“ This area includes a broader range of influential national factors. These eight areas are obviously not mutually exclusive but portray the intense interrelationships and potential consequences of problems that are created when one aspect of a system.changes. This is an example of why planning for an uncertain future is such a monumental task in attempting to envision the results of introducing new practices or technology into the system. This brief introduction to these categories will be elaborated upon in Chapter II in the literature review. 17 PURPOSE OF THE STUDY It is the intent of this study to serve as an initial assessment of the current perceptions of the nearly 300 administrators of accredited baccalaureate nursing pro- grams in the USA. The information gained from this survey will be of both practical and heuristic value. It will help the nursing profession focus on some of their most pressing and crucial problems which are amenable to solutions and it will give clearer direction in areas which must receive long-term interdisciplinary discussion. In the author's opinion, the study will stimulate further thinking and research about the future and future planning by merely exposing administrators to the questionnaire. The potential benefits and need for the study are confirmed by Rushmer: The current health-care system evolved with little or no long-range planning or direction. Our main hope for the future lies in our ability to understand our history, assess our current status, and undertake realistic long-range planning that will yield the highest probability for attaining livable or attractive futures. Since we lack historical precedents for these procedures, our learning and accomplishment must be simultaneous. Therefore, the information gained will be of interest to planners and policy makers of other members of the health disciplines, since the actions of one member are intricately 18 related to the alterations in functions of other members of the team. Rushmer further states: An alternative approach is the concept of creating desirable futures by defining optimal long range goals for a future ten to twenty years hence, identifying the many options for reaching these goals, and evaluating their advantages, disadvantages, and consequences. It is intended that the combination of clearly defined goals and well-evaluated options will be utilized in appropriate decisions at many different decision points during the ensuing years.32 DEFINITIONS OF TERMS The definition of terms as specified in this study are as follows: 1. Associate degree nurse (technical nurse), ADN--a person who has graduated from a technical nursing program at a junior or community college. At the present time this individual is eligible to write licensure exams to become a registered nurse (RN). 2. Diploma nurse--a person who has graduated from a three-year program housed under the auspices of a hospital rather than a university or college. Usually referred to as technical rather than professional. At the present time is eligible to write licensure exams to become a registered nurse (RN). 3. Baccalaureate nurse-~a person who has graduated from a four-year college or university program and referred to as a professional nurse. At the present 19 time this individual writes the same state board exam as the associate degree and diploma graduates and becomes a registered nurse (RN). 4. Position paper--statements published by the American Nurses' Association in 1965 which recommended that the location of nursing education be based in colleges and universities. This would bring about the phasing out of the three-year diploma (hospital-based) schools of nursing. 5. ANA--American Nurses Association (only nurses are members). 6. NLN--National League for Nursing (anyone interested in nursing can become a member). 7. Nursing care--focus on assisting the individual to attain his/her optimum level of physical, social,and psychological state of health in any situation. 8. Medical care--pathology (disease) oriented with the diagnosis of the pathological complaint with prescription of treatment and cure as its goal. 9. Health care--the broader term including medical care and nursing care as well as the intervention of other members of the interdisciplinary team e.g. physical therapist, social worker, etc. 10. Change agent--a person or group that desires to effect an alteration in attitudes, behavior, and/or skills of another individual or group. 20 11. School of nursing administrator, nursing school administrator--the title of the person in the chief administrative position varies throughout the nation and depends upon the university structure and the relationship of the school of nursing to the total university. The person may be called dean, chairperson, director, department head, coordinator, or in one instance, president. 12. School of Nursing, nursing school--these terms will be used interchangeably and will refer to all units whether they are colleges, schools, divisions, or departments. All are of baccalaureate level and may or may not have a masters or doctoral level program in the same administrative situation. 13. Futurology--the term coined by Ossip Flechtheim referring to attempts to establish the credibility or mathematical probability of prospective developments.33 14. Futures research--includes data collection, decision making, planning, forecasting, and prediction. 15. Forecast--"a probabilistic, reasonably definite statement about the future, based upon an evaluation of alternative possibilities."34 l6. Prediction--refers to an event that wlll happen,e.g. "it will rain tonight." 17. Perception--outlook, view. 18. Crisis-~an event that is unusual and takes priority in one's attention. 21 19. A P1an--a tool of management.35 20. P1anning--the prearrangement of policy and guidelines toward objectives. It gives direction, establishes goals, and guides action.36 21. Conventional planning—-the type of planning which usually results in narrower ranges of alternatives than those provided by the futures-research (long-range) approach. 22. Short-range planning--planning for a span of approximately 1-5 years. 23. Intermediate-range planning--planning for a span of approximately 6-10 years. 24. Long-range planning (LRP)--planning for a span of 11 plus years; many authors use the span of up to 30-40 years. 25. Middle management--the occupants of these positions in an organization usually carry out many decisions made by higher officials, but also must display considerable initiative within their own administrative subunit. .26. Administrator, manager, chief executive, educational administrator, nursing school administrator-- all of these terms are interpreted as interchangeable. 22 LIMITATIONS AND DELIMITATIONS Limitations The study was limited to those nursing school administrators who chose to participate by responding to the mailed questionnaire. It has the inherent limitations of reliability and validity which exist in a newly developed tool and especially by the very fact that this type of research data consisting of judgments about the future can only be accepted for the present and verified by the test of time. Planning is a dynamic process, therefore there are only arbitrary points at which to stop and compare the projections made at an earlier date. Delimitations The study was delimited to the administrators of accredited baccalaureate schools of nursing in the USA which existed at the time that the questionnaires were mailed to the potential participants. DESIGN A questionnaire was mailed to 286 nursing admini- strators of accredited baccalaureate programs in the USA. The names and addresses of the population were obtained from the annual publication of the NLN, which lists the administrator of each school and certain characteristics about that school. 23 The questionnaires were confidential but not anonymous, which permitted follow-up reminders to be sent three weeks after the initial mailing through use of a code number which identified the participants. Regarding anticipated response rates for this study, 50 percent is usually adequate, 60 percent is good, and 70 percent or over is very good. Since the tool was developed by the author, the validity and reliability were dependent upon consultation and a pilot test of colleagues and previous nursing admini- strators. Treatment of data consisted of transfer to computer cards and application of selected tests from the (SPSS) Statistical Package for the Social Sciences.37 ASSUMPTIONS The nursing school administrators (deans, chair- persons, directors, etc.) are an often overlooked, under-utilized group of nursing leaders. Their energies are frequently taken up with clerical tasks that should be delegated to assistants in order that they might utilize their knowledge and expertise in long-range planning for the direction of the profession and in turn for the improvement of the health care delivery system for better client care. These persons are among the most highly educated in the 24 profession and should have a more forceful impact in regard to long-range planning. By participating in studies such as this, these nursing school administrators will be engaging in a concerted effort to pioneer in creating a more unified, systematic plan for nursing and nursing education, rather than to remain laggards, followers, and reactors to policies made by others. The author is assuming that there is a great deal of dissatisfaction with the health care delivery system, of which nursing is the largest professional group. In addition to the extremely high costs of health care, there are other conditions which must be changed for better care now as well as in the future. Some of these conditions have been publicized nationally from the NURSING 77 study in which many nurses did not give favorable ratings to current nursing care.38 The author assumes that if more time is spent in planning, less time will be required for implementation of changes and greater satisfaction will result. Therefore, "letting things happen is not the best approach to planning." There will always be those in opposition who argue that long-range planning will deprive them of spontaneous opportunities and serendipitous findings. This, however, is not the intent of long-range planning; it leaves room for constant revision and updating. 25 It is the author's assumption that merely by being exposed to the questionnaire, nursing administrators will be stimulated to think about the future. Esfandiary conveys his optimism: "We are daily surging ahead because somewhere, somehow, we believe in the future."39 This author would tend to agree with the more optimistic opinions about the future of the world in general. As for the turmoil in society, we read of it in Biblical times; the disciples lived through quarrels, murders, and unrest, and from this the church was born. There was maladjusted Moses who wandered in the wilderness for forty years; there are modern prophets today who have important knowledge on computer printouts instead of scrolls. Many famous, currently respected, and honored people seemed out of step with their times in history. Lincoln, Edison, Marconi, Churchill, and Einstein were so intelligent that they appeared to be maladapted in contrast to the majority of society. Obstacles to change are not simply lack of technology, education, or information. In fact, many inventions and technological changes evolve into problems of their own technological success. One example is the use of life maintenance equipment for unresponsive patients; these implications must be explored ngw_to avoid greater problems in the future. Other sources of obstacles to change and use of education and technology is summarized by Weisskopf: 26 There are two powerful elements in human existence: compassion and curiosity. Curiosity without compassion is inhuman; compassion without curiosity is ineffectual.4O Much of the controversy, power struggle, and ineffectiveness of the health care system occurs because we have not combined both compassion and curiosity (investigation and research) in nursing education and clinical practice. While no doubt the traditional caring, compassionate aspect is important, the profession must re-consider the present society we are servicing and also prepare for tomorrow. Unless research is included in any system, it will stagnate. It has been mentioned that nursing is a profession in a hurry.41 This is partially correct, but we have been too eager to be compassionate and present-task oriented; we have procrastinated against preparing for the future and considering theoretical aspects. For too many years nursing educators have been educating nurses for yesterday, using the same content and methods that they learned, creating nurses in their image using the "rearview-mirror" approach. ORGANIZATION OF CHAPTERS IN STUDY The study will consist of five chapters. Chapter One includes the introduction, statement of the problem, significance of the study, purposes of the study, definitions of terms, limitations and delimitae tions, assumptions and organization of the study. 27 Chapter Two will be a discussion of related and pertinent literature. The eight categories provide the framework for the items included in the questionnaire. The future-oriented literature will also be explored in relation to each area, and will include arguments for the advantages and disadvantages of long-range planning with special implications for the role of nursing school admini- strators, nursing education, and its role in higher education and health care. Chapter Three includes a description of the design of the survey and treatment of the data. Chapter Four will present analysis of the results with comparisons and contrasts and will utilize the demographic data to point out major areas of agreement and contrast where there are noteworthy findings. Selected statistical tests (SPSS) will be applied where relevant. Chapter Five will include the summary of the major findings of the study with conclusions and recommendations for long-range planning in nursing. Chapter 1 FOOTNOTES 1Samuel B. Gould, "Is Non Traditionalism the Tradition?" Today's Education, Vol. 61, No. 4 (April, 1972, p. 18. 2Ossip Flechtheim, "Futurology, the New Science of Probability?" in The Futurists, edited by Alvin Toffler (New York: Random House,_l972), p. 264. 31bid., p. 269. 4Earl Joseph, "An Introduction to Studying the Future,’ in Futurism In Education, edited by Stephen P. Hencley and James R. Yates (Berkeley: McCutchan, 1974), p. 2. 5Frank S. Hopkins, "The Postulated Future, The Invented Future and.an Ameliorated World," The Futurist, Vol. 7, No. 6 (December, 1973). P. 254. 6Roy Amara and Gerald R. Salincek, "Forecasting: From Conjectural Art Toward Science," The Futurist, Vol. 6, No. 3 (June, 1972), p. 112. 7 8Willis Harmon, "The Coming Transformation of Our View in Knowledge," The Futurist, Vol. 8, No. 3 (June, 1974). p. 127. 9Walter G. Hack, et gl., Educational Futurism (Berkeley: McCutchan, 1971y, P. 31. 10Jim Dator, "Decolonizing the Future," in The Next Twenty Five Years, edited by Andrew Spekke (Washington, D.C.: World Future Society, 1975), p. 165. Ibid. 11Roy Amara, "The Next 25 Years: Crisis and . Challenges,‘ in The Next Twenty Five Years, edited by Andrew Spekke (Washington, D.C.: World Future Society, 1975), p. 3. 12Peter Drucker, Managing For Results (New York: Harper and Row, 1964), p. 5. 28 29 13Evelyn Barritt, "The Art and Science of Being Dean," Nursing Outlook, Vol. 22, No. 12 (December, 1974), p. 750. 1['Earl Joseph, "An Introduction to Studying the Future," in Futurism In Education, edited by Stephen Hencley and J. Yates (Berkeley: McCutchan, 1974), p. 4. 15 16Robert Lamson, "Science, Technology and National Goals," World Future Society Bulletin, Vol. 9, No. 2 (March- April, 19757, p. 4. 17James G. March and Herbert A. Simon, Organizations (New York: John Wiley, 1958), p. 185. Ibid., p. 5. 18Michael MCDanield and J.S. Mendell, "What Futurists Can Learn From Creative Problem Solvers," AAUW Journal, Vol. 69, No. 3 (November, 1975), p. 38. 19Alvin Toffler, Future Shock (New York: Bantam, 1970), p. 460. 20Charles H. Russell, Liberal Education and Nursing (Columbia, N.Y.: Teacher's College, 1960), p. 11. 21Ian Mitroff, "On Studying the Moon Scientists," New Science (December 27, 1973), p. 901. 22Arthur Bronwell, "Can an Advanced Society Deal With Its Future?" The Futurist, Vol. 5, No. 3 (June, 1971). 23Derek Phillips, Abandoning Method (San Francisco: Jossey Bass, 1973) , p. 82. 24 Barritt, p. 750. 25Esther Lucille Brown, Nursing for the Future (New York: Russell Sage Foundation, 1948). 26NLN Perspectives Committee, Perspectives for Nursing (New York: National League for Nursing, July 1978), p. 20. 27Robert F. Rushmer, Humanizing Health Care: Alternative Futures for Medicine (Cambridge, Mass.: MIT Press, 1975), p. 18. 30 28Gertrude Torres, "Educators' Perceptions of Evolving Nursing Functions," Nursing Outlook, Vol. 22, No. 3 (March, 1974), p. 184. 29Jacques Barzun, The American University (New York: Harper & Row, 1968), p. 130. 30Jerrold S. Maxmen, The Post Physician Era: Medicine in the let CenturyTTNew York: John Wiley & Sons, 1976), p. 274. 31 Rushmer, p. ix. 321bid., p. 45. 33Flechtheim, p. 269. 34Amara and Salincek, p. 112. 35David W. Ewing, The Practice of Planning (New York: Harper & Row, 1968), p. 141} 36D. Kent Halstead, Statewide Planning in Higher Education (Washington, D.C.: U.S. Government Document, 1974), p. 3. 37Norman Nie, 35 gl., Statistical Package for the Social Sciences, 2nd ed. (New York: McGraw Hill, 1975). 386. Ray Funkhouser & Nursing 77, "Quality of Care" Nursing 77, Vol. 7, No. 1 (January, 1977), pp. 27-33. 39F.M. Esfandiary quoted by Wes Thomas and J. Wiesen, "The Case for Optimism," The Futurist, Vol. 6, No. 1 (April, 1972), p. 68. 40Victor Weisskopf, "The Significance of Science," Science, Vol. 176, No. 4031 (April, 1972), p. 176. 41Katherine Norris (ed.), Proceedings of the Third Nursing Theory Conference, U of Kansas, Dept. of Nursing Educ., TJanuary 29-30, 1970), p. 182. Chapter 2 REVIEW OF LITERATURE INTRODUCTION This chapter is presented in four parts. Part I includes a brief description of selected research and relevant literature which relates to the background and purpose of this study. Part II includes a discussion of plans and planning. Related subtopics are: the concept of plans and planning; the properties; clarification of terminology; the time dimension; the philosophy, values, and attitudes toward planning; the acceptance of planning; and the limitations and benefits of planning. Part 111 includes an exploration of the relation of planning to the dean (nursing school administrator), the relaton of planning to universities and business, the responsibilities of academic deans, and future nursing education. Part IV is an elaboration of the eight categories which have major importance to the administrator in long-range planning. They are: the personal and professional outlooks of the administrator, educational priorities, the health-care delivery system, 31 32 interdisciplinary collaboration, changing client roles, finances, technological changes,and broader changes in society which facilitate and/or hinder the planning process. 33 PART I PREVIOUS RESEARCH Research studies which focused on the future in nursing literature were non-existent until the 1970s and those now available are very limited in their scope and sample size. One example is a Canadian study which was conducted by Bramwell and Hykawy. The purpose of this four- round Delphi study was to forecast events which would occur during the next fifty years in nursing education. Consensus was reached on fifteen events that would occur by 2000. A major limitation was the small sample size of thirteen and a very limited geographical area.1 Another study focused on nursing research. Lindeman's four-round Delphi study on nursing research identified perceived impact as well as research priorities with data from a nationwide sample of 341 representing nurses in education, practice, administration, and research. It was thought that determination of priorities for nursing research could provide assistance to the profession in seeking funding for important research questions. There was no item on which all respondents were in agreement, however, the study represents an important initial step in establishing some priorities of the highest ranked items for nursing research.2 A survey by National Center for Higher Education Management Systems (NCHEMS) has some relevance'UOthis 34 study. Huckfeldt's five-round Delphi study on long- range directions in higher education included 385 respondents representing a nationwide variety of persons who have major influence on education and its future directions. It is of special interest to note findings regarding areas in which changes are forecasted to occur: Considering the impact of changes, the panel felt changes in planning and management would have the highest impact and changes in the educational structure the least impact. . The only area in which the panel consistently identified one force (the faculty) as most hindering change. Keys 23. gl. conducted a four-round Delphi study (adapted from the Huckfeldt study) which included the perceptions of eighty-eight deans of medical schools for the purpose of forecasting desirability, probability, and impact of changes in medical education and practice over the next twenty years. Of the fifty-four items that were considered by the deans, the highest ranked probability item was the occurrence of a mandatory, comprehensive, national-health insurance program and the lowest probability ranked item was that physicians would pay a Special tax on income to support medical education.4 RELATED LITERATURE Speculation as to why more research has not been future-focused in nursing as well as other disciplines 35 is infrequently addressed in the literature. Bronwell refers to the acceptance issue: Scholarly research in universities seldom concerns itself with the future in a philosophically exploratory projective context for this has no acceptability in presentations before learned society forums or publishability in their journals. Indeed, in many academic circles, such research is regarded as tainted and beyond the fringe.5 Additional reasons may be related to the traditional curriculum content which does not provide impetus for research on future-oriented t0pics. When the question of including futures content in various health science curricula is posed to faculty, they usually respond with the comment that their curriculum is already packed, there is no room to insert futures content. In response to this statement, Rich recommends: "One way to prepare for the future is to give futuristic studies a place of equal if not greater importance in the curriculum.as 6 historical studies now occupy." He further emphasizes: "The general public needs to learn the art of thinking about the future over a 30 to 40 year Span."7 Since Brown's 1948 publication, Nursigg for the Future,8 few authors have addressed the long-range concerns of the profession. Authors of nursing literature have only very recently begun to address issues related to the future of nursing. Many articles and texts conclude with a small paragraph or sentence regarding the future, but few have written extensively on the topic. 36 One prominant nursing leader and administrator who has ventured to elaborate on the tOpic is Leininger. She emphasizes the need to study, plan, and educate nurses 9 for the future. She is the only author located who describes five requirements for nurse futurists: First, a futurist must be a risk taker. . Second, a futurist must be an astute analyst of the past and present. Third, a futurist must not only be able to abstract from past and present events and experiences, but must also be able to predict, logically and explicitly goals and directions for the future on the basis of limited or non—verified data. Fourth, a futurist must not be intimidated by popular thinking or by the Opinion of the majority. Fifth, a futurist must be able to stand behind his or her hunches or predictions until proven mistaken. 37 PART II THE CONCEPT OF PLANNING AND PLANS This discussion will focus on the concept of planning and plans including the prOperties; clarification of terminology; the time dimension; the philosophy, values, and attitudes toward planning; the acceptance of planning; and the limitations and benefits of planning. Since many terms are used interchangeably and have different meanings for various authors, a comparison of selected authors and discussion of their views will follow. George Steiner, one of the foremost writers in the area of planning, conveys the confusion: "Today, there is no "11 generally accepted meaning of planning and plans. Kelly agrees about the difficulty of arriving at a definition. The word planning is not so easily dealt with on a definitional basis. There are probably as many different definitions of the term "planning' as 12 there are textbooks and articles on the subject. Ewing writes: I like to define planning as a method of guiding managgrs so that their decisions and actions affect tHE future of the organization in a consistent and_ 13 rational—manner, and in a way desiredgby manggement. Newman comments on the lack of clarity in planning. Planning is a broad concept; it embraces a wide range of ideas. In fact, much of the confusion concerning planning arises because peOple use the same words to cover quite different concepts. Newman concludes that planning is a widespread human behav- ior and defines it as deciding what is to be done in advance.15 38 PROPERTIES OF A PLAN AND PLANNING According to Steiner, planning is a mental process differentiated from the plan, which is the tangible evidence 16 of thinking. LeBreton and Henning describe the distinc- tive properties of a plan as: "futurity, action, and "17 personal or organizational causation. Steiner obviously agrees that futurity and action are properties of planning, as he states: "Planning inherently involves assessing the "18 future and making provisions for it. Also in agreement with Albright, who comments: "Thinking and doing something 19 about the future is planning." He further emphasizes: Typically, when people plan for the future (and there is no other kind of planning;no one thinks of planning for the past) they Baually extrapolate current trends into the future. The element of futurity in planning is emphasized by numerous other authors who seem to be in agreement with Longest, who concluded: "The very essence of planning is informed anticipation of the future "21 CLARIFICATION OF TERMINOLOGY Decision-Making and Planning There are those who define planning as decision- 22 which is an interesting making concerning the future, contrast to LeBreton and Henning's distinction between decision-making and planning: "A decision is the resolution of conflicting alternative choices. A decision need not 39 23 . . Dec1s1ons are used involve action or the future." in planning but decisions are not plans. According to Ackoff, "Planning is clearly a decision-making process; but equally clearly not all decision-making is planning."24 Steiner differentiates: "Planning is not making future decisions. Planning is concerned with making current decisions in light of their futurity."25 Comparison of Planning and Forecasting Because planning is done to help us make today's decisions about tomorrow's world, says Craver, all planning begins with a forecast about the future.26 Olaf Helmer agrees: "A forecast is not a plan, but all good planning begins with a forecast."27 LeBreton and Henning view planning and forecasting 28 Craver further examines as being very closely related. the interrelationship by observing that plans are based on forecasts, but that a forecast in itself does not auto- matically result in a plan. A forecast must be pertinent, credible, and feasible before it can be used in planning.29 Newman stresses the importance of forecasts in administrative planning, but one must recognize that unforseen events may occur; therefore, thinking in terms of probabilities or calculated risks is a necessity.30 Drucker approaches the definition of long—range planning by emphasizing what it is 395. The first contrast on his list states that forecasting is not long—range 40 planning and that "Long range planning is necessary precisely because we cannot forecast."31 Hussey considers the forecast as having a double use, that of serving as a base for planning and also as an outcome of the planning effort.32 THE TIME DIMENSION Much of the planning literature makes a distinction between short- and long-range planning. Long-range planning is frequently thought of as extending five years or beyond, with some being ten years and a few up to twenty years. A plan may extend for several months or years because of the lead time required for the plan to be implemented.33 Administration should be viewing the future and projecting trends not only to help in establishing plans to meet future conditions but also it can be striving to influence and create better conditions.34 Time as a dimension in planning has four important aspects which can be differentiated: preparation or develop- ment time, lead time, full implementation time, and the length of the planning range.35 Many factors influence the time dimension which an individual or organization will consider appropriate for accomplishing their mission. Among these are: the type of organization; its goals and commitments; the public and political pressures; its traditions, resources, values , and expertise; and the futurity of the administration . 36 41 Ewing discusses semantic labels of long—range, intermediate, and short-range planning which all fall under the same broad definition but differ in the time focus and the amount of change desired.37 Steiner concludes that research indicates that the time frame for planning has been increasing recently, though five years is the time frame most frequently mentioned when one surveys business administrators. Of course, there is wide variation on a continuum from no corporate plan to that of approximately one hundred years used by Weyerhaeuser when planting their trees.38 Kelly differs somewhat with the view that there is nothing sacred about five years. According to Hardy, typical long-range health-care planning will range from five to thirty years.40 Drucker's perspective on long-range planning takes yet a different stance than most other authors. He believes that long-range planning is a misnomer. To say, "long range" or "short range" planning implies that a given time span defines the planning; . But the essence of planning is to make present decisions with knowledge of their futurity. It is futurity {hat determines the time span, and not vice versa.4 PHILOSOPHY, VALUES, AND ATTITUDES TOWARD PLANNING Philosophy, values, and attitudes about the future tend to influence the type, relevance, time span, and scope of planning which an administrator will pursue. It then 42 seems relevant to exploreiknu:types of planning and the relationship of each to the future. Ackoff presents four general types of planning: inactive, reactive, preactive, and interactive which determine the individual's approach to planning. 1. Inactivists are described as those who hold a conservative philosophy and are satisfied with the way things are. They focus their energy on keeping changes from being made rather than striving to achieve any change. Their attitude toward the future is one of gloom and doomf'2 2. Reactivists are those who dislike complexity, are nostalgic, and believe that society is going from bad to worse. Their efforts are focused on recreating the past.43 3. Preactivists attempt to prepare for the future and believe that the future will be better than the present or past. Their attitude toward the future is that it is uncontrollable but the effects of the future can be controlled. The time-frame focus for planning by this group is the short-to-medium range future.44 4. Interactivists focus on designing a desirable future and inventing ways to implement it. They can be described as idealizers. They not only prepare for the future, they attempt to redirect it. This group gives attention to long-range planning and believes it is necessary to balance short- and long-run consequences.45 43 The issue of long-range planning always raises many moot and philosophical questions. Numerous choices confront planners. Plans must be made which will influence both the immediate and long-term future. Planning carries with it both an optimistic and a pessimistic component. The optimism is apparent in the individual's, group's, or organization's belief that the investment of time and energy in planning will create a more desirable future. The pessimism relates to the belief that unless some actions are taken to change the course of events, an undesirable future will occurf'6 Ewing elaborates on the importance of feelings and values and their influence on the merit a planner places on the facts available for use in the planning process. "Value judgments are sometimes like a small nagging voice from the corner, and other times like a large overbearing presence."47 Ackoff prefers interactivism, believing that our society can be improved because "problems and solutions are in constant flux; hence problems do not stay solved."48 THE ACCEPTANCE OF PLANNING If one term had to be selected to describe the issue of planning, whether it be long-range or not, it would be controversial. Ackoff's quote briefly serves as an example. 44 Most of the planning that I have seen in about 250 American and foreign corporations is like a ritual rain dance performed at the end of the dry season to which any rain that follows is attributed. Rain dancing has no effect on the weather even though it may have therapeutic effects on the dancers. Despite this, I find that as a so-called professional planner I'm repeatedly asked to help improve corporate dancing, not to help control the weather. It is apparent that long range planning is accepted by many types of organizations, individuals, and industries; however, the level of acceptance varies. One of the major variables influencing this acceptance is the elusive or intangible results which are not easily measured and that are attributable specifically to the process of long-range planning.50 Kelly further elaborates on the wide accepta- bility of planning to the business world during the last fifteen years, but also recognizes the ambivalence: "Long range planning is being hailed in some quarters as the savior of faltering companies. In other quarters it is being labeled as a waster of time with little payoff."51 Pennington mentions two reasons why there has been wide acceptance of planning as a management tool. One being that planning is an important function of the administrator and that it has great logical appeal, being better to control one's future than merely reacting to it.52 Steiner's overwhelming acceptance is expressed: That a case exists against long-range planning never occurred to me. Being in favor of long-range planning is something like being in favor of mother- hood. Who is or can be against it? . . . Any manager who does not plan ahead is clearly not performing one of his major functions.53 45 Weaver, who has conducted futuristic research, comments on the acceptance of statements about the future by saying the future is what one imagines it to be, somewhat analogous to the way one regards a work of art. It can be accepted or rejected by the critic, but cannot be proven false. What the future should be differs markedly with each person and with the assumptions and values they hold about the future.54 LIMITATIONS, BARRIERS, AND DIFFICULTIES IN LONG-RANGE PLANNING Long-range planning may be viewed unrealistically; it may be expected to provide a miraculous cure for the discontent of a profession or an organization.55 This unrealistic expectation may be an emotional approach lacking intellectual preparation. An administrator may lack the vision and ability to understand what is really meant by planning, to form realistic expectations of what it may accomplish, and to invest adequate resources and timing for it to be of value.56 Enarson is concerned that in many institutional settings, planning efforts focus on what is fashionable, 57 Schaefer identifies "58 whether it be feasible or not. this kind of planning as "poor management. Hilleboe discusses several human characteristics which inhibit planning. Among them is the tendency to 46 become excited about some unusual threat rather than examining daily practices which may have a greater and more serious potential. The provincialism of individuals is carried through into universities, which exhibit the same vested interests and internal conflicts. Universities allow their past habits to dominate their future thinking rather than include the vast array of variables such as values, economics, social changes, and politics, which influence all of the disciplines somewhat differently.59 Fuller writes from an academic perspective with many of the same characteristics. . The planning of alternative futures is of little apparent concern. The projection f current realities into the future is sufficient.68 Few people are terribly concerned about planning in our society of relative comfort, abundance, and complacency until a crisis presents itself which requires an immediate 61 Schaefer further comments solution for survival. regarding another, closely related factor to long-range planning: "Many universities seem largely organized for the work of the past and not of the future."62 This past orientation is often promoted in the guise of professionalism, as White calls it, one of the diseases of educators, "hardening of the categories." He further identifies the pitfalls of autonomy: " Each [profession] sees the other's discipline as being out of step with the world, while the real problem may be that neither has an accurate perception of the world."63 47 Kissinger writes in relation to planning limitations in government: What passes for planning is frequently the projection of the familiar into the future. . . . Lip service is paid to planning; indeed planning staffs proliferate . . . since planning staffs have a high incentive to try to be "useful," there is a bias against novel conceptions . . . true innova- tion is bound to run counter to prevailing standards. Mac Stravic introduces another major barrier to planning, that of the fear of making a mistake. He argues that errors should be not an indication of failure, but realization of the setting and environmental conditions 65 in which planning takes place. This fear is complicated with the uncertainty and abstract nature of having to plan without answers provided by numbers.66 Ewing adds the crucial roles are played by power and politics67 along with the personal threat of uncertainty which is emphasized repeatedly by LeBreton and Henning.68 Wedley refers to the attitudes of the persons in administration in that many executives have present- oriented personalities. They gravitate toward actions which yield quick feedback and closure, preferring the hustle and bustle of present problems over the agonizing complexities of future events.69 Newman would also add the psychological reluctance to change a decision, especially after a great deal of hard work and time 70 investment has been made. Planning is expensive and 48 71 It is the advantages may not outweigh the expenditure. a constant threat to the administrator who must answer and assume responsibility. Newman concludes: No enterprise can exist without some planning. The real question is, how much?--That is, how far 7 ahead and in what detail should planning be carried? As abasis for planning, the reliability of forecasts is of great concern. The limitations of forecasts and reliability 73 and also by Pennington, are discussed again by Newman who elaborates on three distinct problems of forecasts. They can be summarized thusly, the uncertainty of forecasts, the presentation of unpopular possibilities, and environ- mental crises which will alter the best of forecasts.74 In addition to ambiguities of planning for an uncertain future, also added is the confusion which relates specifically to planning for health care delivery in the decades ahead. This is highly dependent upon the administrators' priorities, values, and definition of health. There are conflicting points of view as to the amount of responsibility which should be assumed by the 75 There is professionals as well as by the consumers. always the fear of who will be in control and to what or whose value or detriment the possession of power will result.76 Change merely for the sake of change is not productive but it is the wisdom of the administrator of the nursing school or organization to maintain the sense 49 of balance between fads and adhering to a tradition, "just because we have always done it this way!" Hussey identifies merit in the restless person who will seek new opportunities and be able to cope with a rapidly changing world, whereas the complacent will rarely conceive of doing anything differently unless it is compulsory.77 Aydelotte addresses some of the dilemmas of the health care delivery system and inhibiting factors in relation to planning for nursing education, ”our problem is to make up our minds about what we will attend to."78 She also questions the reality which exists in contempor- ary educational programs.79 Since one of the health professions cannot drastically change its functioning, policies or directions without markedly influencing the other health care providers, it is essential that the universities who educate students begin to provide opportunity for interdisciplinary planning and education for achievement of optimal health care delivery. Several authors speak to this predicament and other barriers to long range planning. Zasowska refers to many of the previously mentioned barriers such as the lack of leadership, preparation, vision, interest, inappro- priate reward systems and economic incentives which are highly influential in the planning process.80 Hussey summarizes much of the underlying rationale which is often observed and expressed by those who wish to avoid or delay 50 the examination of plans which would obviously have a multiplicity of implications for change. Change of any type is anathema to most human beings. There is comfort and a feeling of false security in following the time-worn and well-known rut, often even to the extent that it goes deep enough for the sides to collapse and smother its occupant, killing all drive and initiative. One might almost define a natural law of human inertia which can only be overcome by the restlessness and creative urge possessed by men of vision." BENEFITS OF LONG RANGE PLANNING Actual and potential benefits of long range planning are discussed in relation to numerous aspects of business and the military. Karger expresses an extremely optimistic viewpoint: When one considers the evidence of results of planning it is hard to understand why more organi- zations do not take advantage of the procedure. It has long been conceded that well planned military campaigns are necessary to success. Research indi— cates that similar benefits accrue to the commercial organizations that engage in formal planning."82 Ritvo gives illustrationscflfadvantages to planning in health care. The benefits of planning are numerous. It affords more time to make a decision. It allows a perspective not given without time. Planning may allow more voices to be heard prior to conclusive actions. It may also define the problems that require solution. Planning also has the additional benefit of allowing the organization the opportunity to accumulate resources, train personnel, and restructuge, if mandatory, to accomodate a new technology."8 Among others who discuss advantages are Newman, who believes that planning provides opportunity to review the overall purposes of the organization, avoid delays, 51 O O O O O O 84 ant1CIpate cr1ses, and operate In a more eff1c1ent manner. Kelly voices similar agreement: planning forces the organi- zation to think beyond the current crisis and view the scope of their functioning more objectively. He summarizes, "Most managers are forced to agree that planning is a good thing."85 Kelly and Newman also agree about the evaluation of planning, even though there are both concrete and intangible 86 Kelly views long-range planning as a tool that factors. will improve performance.87 Many of the benefits are difficulte to evaluate, not only because of their abstract nature, but also because the time dimension and variables are so enormous that it is often impossible to know which variable influenced the change, or whether time itself has changed the persons who are now the evaluators, or whether the evaluators have changed their values and perceptions. The challenging problems of the 80's and 90's will make the need for long—range planning even greater than at present. Administrators must learn how to more effectively utilize future personnel and tools.88 Rushmer, a strong proponent of long-range planning in health care, charges that present methods are incapable of dealing with the contemporary predicament and recommends, "A more effective approach to long-range planning is sorely 89 needed for future health-care delivery." Rushmer is more optimistic about the effectiveness in health care of the 52 long-range plan over the short-range plan. He recommends: An alternative approach is the concept of creating desirable futures by defining optimal long range goals fOr a future ten to twenty years hence, identifying the many options for reaching these goals, and evaluating their advantages, disadvantages, and consequences. It is intended that the combination of clearly defined goals and well evaluated options will be utilized in appropriate decisions at many different decision points during the ensuing years." Leininger, one of the few leaders in nursing who writes with a futuristic point of view, states that, "Predicting and planning for nursing's future are very '19]. 92 difficult but also very necessary tasks. Both Skovie and Leininger93 advocate education of all health professionals to deal with the uncertainties of the future. Leininger further emphasizes: " it is timely to emphasize futurology in nursing and in other health fields, and to deal with uncertainties in nursing and health care."94 Platt explores the urgent need for solutions to several problems of crisis porportion in the United States and throughout the world and believes that many changes produced by technology are approaching limits. . . We may never have faster communications or more television or larger weapons or a higher level of danger than we have now. This means that if we could learn how to manage these new powers and problems in the next few years without killing our- selves by our obsolete structures and behavior, we might be able to create new and more effective social structures that would last for many generations.95 53 Platt's outlook expresses both optimism.and pessimism about society's attempt to deal with the future. The future always depends on what we do and can be made gorse or better by stupid or intelligent action.9 Traditional approaches do not provide contemporary administrators with the skills necessary to deal with the complexities as they currently exist. Mauksch, in The Future is Now, declares that we are totally unprepared to face the consequences of our actions. We have not learned or plannedtxncope with the current realities, let alone plan beyond them. Regional planning is probably twenty years overdue.97 The need for longer-range planning for nursing and health care is discussed from.numerous point of view Carmody's concise statement summarizes the intent and urgency for change. America's health problems cannot be solved by a patchwork of narrowly based federal programs or further infusions of money alone. A more comprehsgsive restructuring of the system is needed. 54 PART III RELATIONSHIP OF PLANNING TO THE FUNCTIONS OF THE NURSING SCHOOL ADMINISTRATOR Defining the functions of the manager or admini- strator of an organization causes much confusion. Longest states thattfluabasic function of the administrator is to manage the inputs of the organization to achieve the desired outputs.99 For the purposes of this study, the administra- tor will be defined as one who manages or performs the executive duties for the school of nursing (the dean). Although there is not universal agreement, most authors support the premise that an administrator in his/ her management duties will be engaged in planning. Longest widely surveyed notable authors who agree that management consists of five basic functions: planning, organizing, directing, coordinating, and controlling, and summarizes: "The primary management function is planning. . Logically, planning is the first of the management function."100 Others support the viewpoint that planning is an important function of the administrator. Karger points out, "Planning is the first and universally recognized "101 He then mentions two reasons function of management. why more executives do not engage in formal planning, one being that many administrators do not know what long-range planning really is, and the other that it is a difficult 55 complex, and sometimes ego—shattering process. As for the length of planning, Karger believes that, "One cannot have a good short range plan without a long range plan "102 LeBreton and Henning also agree that, "One of the most important functions performed by each executive is "103 that of planning. Newman also concludes that planning is an essential duty of every executive.104 Comments from a university president indicate that much planning is inadequate, being too narrow, too broad, focused on tangible, "countable" items, or obsessed with tools; nonetheless, it is inseparable from academic management.105 RELATIONSHIP OF PLANNING TO UNIVERSITIES AND BUSINESS Planning as a major function of management has received considerable attention in the business sector. There are important similarities and differences in admini- strative functions and expectations in the academic world. Riley and Baldridge explain: Colleges and universities are different from most other kinds of complex organizations. Their goals are more ambiguous and contested, they serve clients instead of seeking to make a profit, their technologies are unclear and problematic, and professionals dominate the work force and decision- making process. Thus colleges and universities are not standard bureaucracies, but 86n best be described as "organized anarchies."l 56 The differences are further elaborated on by Riley and Baldridge: The collegial leader presents a stark contrast to the heroic bureaucratic leader. The collegial leader is above all the "first among equals" in an organi- zation run by professional experts. . . . The basic role of the collegial leader is not so much to command as to listen, not so much to lead as to gather expert judgments, not so much to manage as to facilitate, 107 not so much to order but to persuade and negotiate." Barber also compares the roles of the university and business: Higher education has evolved into a big business and has cultivated close working partnerships with both the corporate and governmental sectors. Today' 8 university resembles a widely diversified nonprofit conglomerate more closely than any other organism on the contemporary scene. The changing conditions and needs of government and the general missions of universities; teaching, research and service have changed the university so that it resembles a business and acts as a force of change in the corporate world.109 Even though much of the management literature is focused on settings other than those related to education or health care, there seems to be much transfer of principles for the academic dean in his/her administrative duties. Longest points out the dilemma for many profes- sionals: One thing is absolutely certain -- being a good physician, nurse or technologist does not make one an effective manager. Two areas of knowledge (professional and managerial) are simply not the same. 57 Albright reiterates with the question: And what of the educational administrators, most of whom have had little, if any, preparation related to the performance of functions they are called upon to carry out.111 Roaden explains how the selection process conflicts with expectations: Deans usually have been selected on the basis of their scholarly achievements. Since knowledge is the unique domain of the scholar, the growth of knowled e has made "knowledge planners" of college deans.l 2 RESPONSIBILITIES OF ACADEMIC DEANS The responsibilities of the dean will vary in each situation and in every discipline. The duties of the dean in one setting may be similar to those of the department chairperson in another. In baccalaureate schools of nursing in the United States, the administrators have the following titles: Dean in 152 programs Chairperson in 129 programs Director in 45 programs Head in 15 programs Coordinator in 3 programs President in 1 program113 It is evident there is no uniform title for administrators in the baccalaureate nursing programs in this nation. The unit within which the nursing program functions may be called "college," "school," "department," 114 H or "division. In this study the term "school" will be used. 58 For any new administrator there are prodigious amounts of new responsibilities and relationships which are acquired and must be mastered. The administrator of a school of nursing is usually a woman and may be the only female in the predominantly male world of administration in the academic setting. In this middle-management, administrative role, at best, there are numerous difficulties and conflicts even for the male in the more traditional academic subject areas. Dressel t gl. only speak of the male and outline duties which may fall within the realm of department chairperson or dean. His overbearing list is as follows: Tradition and faculty demand require the chairman to be a scholar, but the demands placed upon the chairman include many functions; chairmen initiate action on budget formulation; selection, promotion, and retention of academic staff; faculty salaries; sabbatical leaves; interdepartmental relationships; research grants; educational development and innovation; university committee membership; discipline representation; professional growth; advise to dean on depart- mental matters; administration to faculty relationship; new faculty orientation; departmental meetings; adequate nonacademic help; student administration, student advising; class scheduling; student personnel records; faculty load; graduate student application approval; grading standards and practices; and curriculum changes. Also they have knowledge of the administrative routine of the college; institutional legislative organization; government grants procedures; policies relating to graduate students; and scholarly productivity of department faculty. Most new deans lack familiarity with many of these activities, and there is usually no ready way to acquire familiarity. They attain familiaiigy at the expense of their scholarly effort. 59 Baldridge studied roles and conflict in New York University. In relation to these middle management administrative positions, he recapitulates: The dean is caught between the expectations of the central administration and the local departments; the department head is caught between the dean and professors in the department; the central administration jockeys among the various schools; the individual professor struggles between the expectations of the university on one hand and his students on the other. There is great role strain in the university for each level exerts strong--and often contradictory--pressures on the role occupants. The dean is often described as the "man in the middle,‘ but it seems more accurate to say that literally dozens of "men in the middle" are scattered through- out the formal system. George Pollach, former vice president of NYU, called this the "sandwich theory" of administration because the behavior of individuals is often related to the levels between which they are sandwiched.116 The dean's position, as described by Gould, is indeed multifacted. He/she is: . prophet, prime mover, keeper of the status quo, skull collector, servant of the faculty, trail blazer, weather vane builder, housekeeper, maverick, and lackey. 1 Schlotfeldt, a former dean of nursing, recalls: A former dean colleague of mine subsequently was appointed to an academic vice president's post. While holding the latter appointment, he shared with me his opinion that the dean's role is the most difficult and demanding of any in the university. He justified his position by observing that a dean, to be successful, must steadfastly support his faculty associates, although sometimes he receives very little, perceptible sustained support himself from the persons holding central university administration posts. . . . The challenge to deans is to turn those dilemmas into delights by taking advantage of all the opportunities thlt can be found in executing the leadership ro e. -60- Articles by nursing school administrators describing their experiences in the literature are rather sparse, but it seems that they would echo the same or at least similar reactions of Gould and Baldridge. Samples of comments from nursing administrators follow. Barritt, Dean of Nursing at the University of Iowa, states that "crisis intervention is probably one of the main tasks in a deanship."119 Anna Gallagher, a former chairperson of nursing in Louisiana, believes that the greatest administrative responsibility is "leadership in the development of "120 curriculum. The broader view of the administrator with knowledge of educational trends must be used to guide faculty in a contemporary curriculum plan.121 Palmer, Dean of Boston University School of Nursing, emphasizes that one of the major capabilities of the dean must be in selection of first-rate faculty.122 Isabelle Payne of Michigan State University stated that much of her time is spent in recruiting faculty. 123 It is evident that the dean has many masters to serve and publics to please. This dilemma is described quite aptly by Buchen: "If he is not a swinger, the students won't listen to him; if he is, the faculty will not."124 Hanzeli discusses the middleman position of the dean and bemoans the fate that "very few conscientious -6l- deans are able to continue active scholarship in their "125 He further remarks that they can former disciplines. be no more than an enlightened reader in the discipline. In the academic deanship they become students in higher education.126 In conclusion, Roaden, Vice Provost and Dean, Graduate School of The Ohio State University, describes the deanship as the "uneasy role of middle managers" and lists three primary functions of the dean of today: "(1) giving academic leadership, (2) managing the control of activities, and (3) functioning as a member of a university policy making body."127 FUTURE NURSING EDUCATION Generally there is agreement that deans cannot abdicate their role as shapers of the future in their interaction with students whether they are in nursing or any other discipline. What remains unclear is how involved deans or other administrative officers should be in curriculum decisions. It is curious to speculate how much innovation is not ventured into because of ambiguity of who should be making and implementing curriculum decisions. Higgs concludes from her study that there is a trend for these decisions to be made by faculty.128 Ashley and LaBelle offer compelling suggestions for change and improvement of nursing education stating: 62 ”New ideas, exploration, innovation, and experimentation "129 They emphasize must be the focus of nursing education. a new focus is necessary to advance nursing from its primitive status. To accomplish this, "We need rebels, that is, teachers who are not afraid to ask questions with- out having preconceived answers, questions that will not perpetuate the existing order. We need students who can do the same."130 It seems ironical that educators, those who pur- port to assist in preparing individuals for the future, have become so tradition-bound. Dror reiterates: "education has no other important activity to perform, but to shape the future through the process of educating society's future members for their future roles and styles of life."131 63 PART IV PERSONAL AND PROFESSIONAL OUTLOOKS OF DEANS The personal and professional outlooks of deans of schools of nursing are obviously influenced by multiple factors. The abundance of references to values in the literature review has convinced the writer that there are numerous variables other than facts which influence an individual administrator or group assisting the administra- tor in planning priorities, the planning process, and finally in the credence given to the ultimate plan itself. The importance of values and their role on the impact of long-range planning is repeatedly emphasized. Hussey is emphatic that their existence will influence the success or failure of long-range planning: Unless a chief executive has a personal belief in the ability of long-range planning to help improve his results, he should not. 132 attempt to 1ntroduce it into his organizat1on. Albright poses the challenge to those in the de- canal role: "A most difficult yet essential problem in dealing with alternative futures is to estimate changes in ”133 When the administrator must set priorities values. for the uncertain decades ahead, as Albright explains it, "To get from here to there, when 'there' is different from 'here' means that policies must be formulated to effect that desired transition, to govern the future not the past."134 64 The priority of technology on planning is presented by Ackoff: The problems we select for solution and the way we formulate them depends more on our philosophy and world view than on our science and technology. Not all planners and/or administrators are aware or want to accept the importance and value-laden perspective which influences the acceptance or rejection of a plan. They feel much more comfortable and secure with the objec- 136 tive data of figures, charts and graphs. Drucker points out: . . it is not the 'facts that decide, people have to choose between imperfect alternatives on the basis of uncertain knowledge and fragmentary understanding.137 Albright presents the options to the academic administrator: Thus, the way, or how, we view the future-- whether we want to plan for a future, choose one, invent one, or simply let one happen--will have a great deal to do with the kind of ggllege and university we have to administer. Nursing, as a major profession in health care, must be more aware of the consequences of action or inaction for planning within the profession and in inter- 139 The various levels of disciplinary functioning. education and varying values of health providers are also a source of confusion. Tannen and Liebman discuss the impact of values on planning for health care. 65 Health planning is not a neutral force; it serves some parties to the neglect of others. Health planning methods are value-laden instru- ments used to determine which services should be offered, to whom, and to what degree. The values of both planners and those who implement the final plan are reflected in various parts of the planning process, such as problems definition, priority selection and the range of alternatives considered feasible.140 As has been mentioned in an earlier section, the roles and expectations of the person in the administrative role vary considerably; therefore, the question of who should identify areas for specific planning and how much time should be spent on this activity must be adduced. Albright, in addressing a conference on the decanal role, offers: Administration can rightly be expected to spearhead the identification of issues and problems, alternative solutions to them and current or fore- seeable institutional shortcomings that are indicated by careful analyses and reviews. 41 Fuller proposes that the most important and moot question facing administrators and planners is: ". . . Do large academic organizations, characterized by an enormous diffusion of power and decision making, have the ability to direct their destiny?"142 Weaver points out the ex- tremely long time lag between the initial plan in education and the observation of its impact, adding to the dean's problem of setting time, energy, and resource priorities. The dean must carefully budget all items and justify them to superiors in the university, the legislature, and the 66 public, as well as to the faculty and students who must live and work with them.143 EDUCATIONAL PRIORITIES As a billion-dollar industry, education has functioned without a great deal of attention to planning, cost analysis, and comprehensive evaluation in past 144 decades. Administrators have weighed the benefits and relevance of programs with "judgment, perception, experience k"145 as their aid. These traditions no and sometimes luc longer are adequate for the increasing cost, declining enrollments, intense competition, and changing environments which are testing the adaptive capacity of administrators and the educational institutions.146 Dill cautions that organizational environment is vital to survival. "Some organizations are set up in a way that permits them to respond effectively to new opportuni- 147 The roles and ties and challenges, but many are not." functions of deans will no doubt become more complex in years ahead, Abrell projects, as we move toward the let century. It seems certain that dedicated, intelligent, and sensitive educational leaders are destined to experience increased anxiety and stress.148 Thompson and McEwen point out that to avoid extinction, one must learn quickly and accurately in order 149 to permit organizational adjustments. Drifting from 67 one budget-planning period to the next will not suffice. Albright advises: "The formulation of explicit goals and planning will become increasingly important in educational leadership.”150 Weaver, who has conducted future research, apprises us, ”educational thinking must take into account more of "151 the future. The current priorities may be muCh more significant for dealing with the crisis of today than 152 the shaping of plans for the decade ahead. Rapidity of change and obsolescence of knowledge and persons will 153 The knowledge probably increase at an accelerating rate. explosion of scientific information and technology has great impact for those who are planning for the education of nurses and their relationship of meeting the societal demands and needs for health care. Schlotfeldt calls attention to the critical need for nursing research for the university schools of nursing: The opportunities and challenges facing nursing school deans demand their giving leadership that will be effective in enhancing research efforts in nursing. . . There is no social agency, other than university nursing schools, charged with responsi- bility for nursing's future and thus for the conduct of inquiry through which to make advances in knowledge and to verify and restructure the science of nursing. Nursing and higher education share many similar planning problems, traditions, dilemmas, and shortcomings, as are discussed by Reller and Corbally in Designing Education for the FUture: 68 Higher education has developed with less coordinated planning than has been the case in elementary and secondary education. Even in elementary and secondary education, however, there has been remarkably little comprehensive research and planned development. The educational system has grown substantially through experience and as a result of pressures to meet growing needs rather than through careful analysis and planning. The resources that have been devoted to planning have been regretably small--and have too frequently been available only for short intensive studies. Thus resources and efggrtness in planning have been extremely limited. Insufficient Leadership in Nursing An eternal cry in nursing is that there is a paucity of 1eadership--in both nursing service and nursing education. Schaefer emphasizes that it is "nursing's fore- ”156 As one reviews the literature most internal problem. in higher education, specifically the literature describing how nursing administrators are prepared, one finds few master's programs in nursing administration and no doctoral programs in nursing that explicitly purport to prepare a nursing school administrator. The focus of the few doctoral programs in nursing is research, teaching, and clinical practice. Therefore, the administrative gap is real and not soon to be ameliorated by existing professional doctoral programs. 69 Prgparation of Nursing School Administrators The earliest documentation of a program.to prepare a person for an administrative role in nursing schools is of a course called "Hospital Economics" offered by Teachers College of Columbia in 1899. This course began as a one-year course; a certificate was awarded upon com- pletion. In 1905, the course was extended to two years 157 It is difficult to trace the with a diploma awarded. final stages of the course through the various historical accounts, but since Teachers College later developed a Department of Nursing Education, it was probably included in their curriculum under a different title. During World War I, some departments closed. Christy indicates the influence of the Columbia course: ”graduates of the department were occupying positions of leadership in all fields of nursing in most parts of the world."158 In 1976 the NLN assisted administrators of nursing schools in better preparation for fulfilling the responsi- 159 Schaefer stressed: bilities of their role. the importance of deans anticipating the impact of future developments, suggested that a pool of managerial talent be created and that special atngtion be focused on interdisciplinary relations. 70 Anti-Intellectualism in Nursing Nursing administrators and educators have to work doubly hard at being accepted in the professional community of practicing nurses. The practicing nurses in service often feel that the faculty is far-off, isolated in an ivory tower above the ”real" world, dreaming up far-fetched and unworkable theories. Practicing nurses often feel that caring for patients is what is really important. This anti-intellectualism is not unique to nursing, but does not make the problem any easier to deal with; in fact it compounds it, according to Sizer, former Dean of 161 The conflicting relationship Education at Harvard. between nursing education and nursing service exists in almost every setting. Some of this conflict is an inherent, antitheoretical, anticonceptual trait that also exists in other disciplines of the so-called, innovators. Even though the university faculty may consider itself avant— garde in curriculum and many of its practices, there are those areas of "vested interest" that are supremely resis- Atant to change even though there is no theoretical rationale for adhering to the past traditional practice. Sizer expounds on his disappointment in those who "prefer to fiddle with things we understand and can manipu- 162 late." This is frequently seen as a method of procrastination, due to inability or fear of proceeding 71 into the abstract and making a mistake or statement that others may question and/or criticize. It is easier to deal with concrete, overt data than to plan for an abstract and uncertain future of nursing education. Sizer's comment that "we worship experience," certainly finds a corollary in nursing and nursing educa- tion. The hospitals and schools of nursing advertise for those who are "experienced." They must assume that quality is analogous with the quantity of years of work. The status of experience is almost as absurd as the opposite of the requirement of a certain degree to qualify for a position. This relates to Sizer's second frustration, "163 Because an that "education is more than schooling. individual has had ten years of experience, it may not mean that they have learned and grown with this experience each year. It is possible that the individual has had one year of experience ten times. That is to say that they always do things the same way they did them last year. Sizer's third frustration, "the relative inability of the education profession to connect the ideas of those working on curriculum matters with those involved with ”164 is frequently evident in schools of nursing. policy, This is a recurrent dilemma and exemplifies the adminis- trative-faculty schism caused by inadequate understanding of the pressures upon and expectations of each other for planning. 72 Barriers to the Advancement of Nursing Education The advancement of nursing education in status, though still chaotic and multifocused, has historically survived some monumental obstacles. In addition to the distinct disadvantage of being primarily a profession composed of females, nursing has struggled against the physicians (predominantly male) who have vigorously pro- tested the education of nurses in the university setting.165 The influential Dr. Charles Mayo of the famous Mayo Clinic believed that nurses spent too much time being educated and not enouth time alleviating the pain and suffering of humankind.166 Another barrier is pointed out in a recent article on the status of nursing. The socialization process of nurses (nursing education) "has served to stifle the initiative, creativity, and academic potential of the human resources of the profession."167 THE HEALTH CARE DELIVERY SYSTEM, INTERDISCIPLINARY COLLABORATION, CLIENTS, AND FINANCES In the interest of not boring the reader with repetition, this section will include the next four cate- gories of the health care delivery system, interdisciplinary collaboration, clients changing needs and demands, and finances. Although each possesses some unique 73 characteristics to be addressed, they will be discussed as a group because they are so intricately inter-related. Most references contain comments which include at least three of the categories in each of their articles. Since the provision of health care requires a complex array of professionals and clients functioning, ideally, collabora- tively in what is commonly referred to as the health care delivery system, and because this system is highly depen- dent on financial incentives, it seems artificial at this point to treat these categories separately. They were separated on the questionnaire for the purpose of insuring that all were included but consideration of them as a group is most feasible here because none exist in isolation. Claiborne reviews some of the weaknesses of health insurance presently mislabeled because in the majority of cases it is only "sickness insurance,’ covering no preven- tive health services. Once again, the choices that must be made are in the hands for the most part of the politicians and those who have power to influence them in enacting the legislation which will allocate the financial resources for health and sickness care programs. The choices are based upon values and priorities of these persons in power since there are not adequate resources to accomplish all projects and potential programs. The ulti- mate choices must be based upon the realization that: 74 No system for meeting people's health needs, indeed no economic system, can do everything for everybody. There isn't that much money in the world. And by choosing to spend the available money in one way rather than another, we are choosing--whether we care to recognize it or not-- who shall be sick and who shall not; on the 168 bottom line, who shall live and who shall die. Matek analyzes American health policy and practices. The greatest problems facing us in the proxi- mate future in health or in other fields-~are not problems of specific technology. They are matters of allocation and organization--that is, matters 69 ultimately of value, policy and social technique. Even though modern science and technology have made some of the most impressive accomplishments noted in history, Rogers notes an increasingly evident dilemma of the current system is that: . . we are confronted with a wholly inade- quate fit between our fine medical technology an? the health requirements of many of our citizens. 70 Finances are given priority, according to Richie. He opens his article with this statement: "One of the major concerns facing health care providers today is hold- ing down costs."171 Finances for illness care receive further attention from Bulger as being a major part of the nation's budget. The control of the purse strings continues to speak: it is through the budgetary process that our government gives final expression to signifi- cant parts of our philosophy and ethics regarding health care.172 The role of clients/patients/consumers in the health care system is changing from that of passive 75 recipient to active consumer as has been mandated by legis- 173 lation for planning. Ramey examines some of the causes of the health care crisis, which includes greater demands by consumers and inadequacies of the health care system, in themselves additional expenses, frequently discussed 174 under the name "fragmentation." Again, values are readily apparent in that the areas for which funds are appropriated for research are determined by the value orientations of politicians.175 Factors Contributing to Confusion Confusion exists for numerous reasons. New books and articles are published daily on various aspects of the "health care crisis focusing on the uses and abuses of the system by both providers and consumers of services. Basically, there is no agreement about the roles and inter- related goals of each professional provider in the system. Many vested interests and power struggles exist in the struggle to decide which profession has control over what piece of the activity. Dachelet presents the nursing point of view in planning: It would clearly be folly for planners, admin- istrators, physicians, or government to proceed to restructure elements of the health care system . 176 w1thout regard for the 1nternal changes 1n nurSIng. This, however, is not the accepted point of view in all 177 disciplines, especially physicians, and therein lies 76 much of the conflict undermining the ideal of a collabora- tive relationship between health care professionals.178 The ideals and strengths of the health-care team are frequently dissipated in energy-draining controversies when theoretically the diversity should enhance the quality of planning. Enarson emphasizes that diversity is usually ignored and the trouble with planning is that the problem 179 Hardy also supports the belief is too narrowly defined. that the complexity of the health-care planning process is best implemented by the skills of a team. "For major planning, at least eight to ten disciplines should be readily available to make their special and unique con- tributions."180 Another closely related factor is the lack of a clear definition of health. This is also closely associated with the incorrect, synonomous use of the terms "health 181 Conflict continues care" and "medical care" by many. when medical (illness) care is provided by the physician and the primary focus of nursing is the provision of care to enhance the health or adaptive potential of the individual.182 The Dean's Role Armiger presents an optimistic view of the dean's role in education and as a leader in future nursing practice. 77 The Dean of the future will exert leadership in health care delivery as well as in education er se. This will often be achieved indirectly. It will be possible because deans and faculty will have worked through old anxieties about the nursing service--nursing education dichotomy and will be able to begin to identify meaningful inter- relations for the clinical practice of faculty. 3 Armiger's optimism is again obvious in her view that a system of cooperation will exist; the future dean will "administer her school in a new health care delivery "184 system. for Roaden speaks to the dean's role: As higher education is being called on to deliver know-how for solving social problems, interdisciplinary efforts outside traditional academic departments are required. These efforts, if they are to be productive, require skillful and insightful leadership from the dean.135 Christman, a dean of nursing, refers to the need planning with other disciplines: The future of nursing does not exist in a vacuum but is closely keyed to the developments in the health field in general.1 Poulin would also be in agreement with this view: The future cannot be considered only within the framework of developments in nursing. The future of our health system will neither be determined by, nor depend on, nurses and the nursing profession alone. It is contingent on a multidisciplinary, provider-consumer approach and will be as sound and progressive as we wish to make it. Changing Priorities Margaret Walsh, NLN Executive Director, speaks out: 78 It's time to rethink some of your premises when life-saving services are talked about in terms of cost-benefit ratios. . . . We're in the midst of a health care crisis of the greatest magnitude. None of our old ways are working. I believe nursing holds the solution to all the difficulties we face. To meet this challenge, we must show through research that nursing care is not only indis- pensable but also cost-effective. . . . We must impress our theories and values on the system. . We must have more nurses in decision making positions. We need nurses in congress. Our work is cut out for us. But we have a rare opportunity to shape our future roles into whatever professional configurations we deem 188 necessary to meet the nation's health care needs. The American Nurses Association statement stresses that: . . it will not be possible to deliver quality health services to people [until] the potential for nursing' 3 contribution to the health and well being of people is fully inte—189 grated . . . 1nto the U.S. health care system. The mandates for the health providers to cut costs and provide necessary services has involved the public as potential clients who have an interest in the quality of services as well as the costs. Donabedian points out this is the strength of public input in "that clients and providers do not view that process or the product in the same way."190 Such reorganizations in the health care delivery system as the HMO (Health Maintenance Organization) which are a recent change of the past decade in an attempt to provide a more health-focused, economical option for many clients. A major potential threat to their success may be 79 due to physicians being reluctant to give up their fee- for-service system of functioning autonomously.191 From the vantage point of nursing, it may provide an increase in the use of nurses to engage in health teaching and . 192 prevent1ve care. As Zasowska points out, technology, humanism, and the health care delivery system are intricately related. The emerging priorities of this era--hea1th maintenance, comprehensive health care, and prevention--must be the focus of planning for health care delivery. Technology must serve to improve health conditions and increase options. The educational process must be used to inform people where the quality of life is dependent upon not only personal growth and material possessions, but also on what is done with available resources. Decisions must be made within the range of possible choices. Health education and health services must assume an equally important role in health care delivery.19 In summary, one must consider the numerous person- alities, values, traditions, and emotions which provide incentives for the provision of cost effective health care for the nation. The evaluation of the HMO will continue but vested interests can impede progress. Although it is unlikely that HMO's will replace the current method of health care delivery in the near future, they constitute an important recognition of the deficiencies in the current system and a major attempt to rectify the inade- quacies that prevail in the fee for service model.194 80 TECHNOLOGY Technology in nursing and health care can be a bane or a blessing. Zasowska relates the dilemma: A viable future society will have to be humanistically rather than technologically oriented. It is not a question whether we need technology, but rather how and in whose interests it is being used. Enarson skillfully articulates the complex relation- ship of technology and personal values. .tools tend not to be the neutral ser- vants we describe them to be. Techniques and tools are used, always, by persons operating in time, place, circumstance, culture, and power relationships. The tools and techniques are, of course, neutral. But the persons who use them are never neutral, for, as human beings, we have as our burden and our pride the legacy of a congested bundle of ideas, faiths, opinions, preconceptions, goals, and aspirations. Our tools have special allure for some of us, becoming part of our very identity. (Horse and man combine to make the man different, more powerful.) . . . The computer, brilliant achieve- ment and marvelous toy, has the same capacity to enthrall, captivate, and finally to imprison. And so it is that we witness a? gxcess of faith in the tool and the technique. 9 Technology has changed much of the day-to-day functioning in many aspects of our lives. There are those who cannot accept the benefits of technology and live in awe and fear that robots will replace them. Malone attempts to allay this fear by examining the potential capabilities and stresses the fact that we still have control over machines.198 81 Values and fears certainly influence the acceptance or rejection of technology as does the way in which one defines technOlogy. It would seem that the broad definition offered by Ferkiss would be more acceptable than a more specific "machine" oriented one. Technology includes both methods and machines. . . . a self-conscious organized means of affecting the physical and social en- vironment, capable of being objectified and transmitted to others, and effective largely independently of the subjective dispositions or personal talents of those involved. 99 Technology in Education and Practice Schlotfeldt speaks to the multiple uses of tech- nology and gives emphasis to its extreme importance in research which will have profound impact in the future. It is important to point out that technology is an important aspect of all professional prac- tice and that professional practitioners are expected to be highly competent, technically. They are also expected, however, to be highly knowledgeable, to be able to use knowledge creatively, to exercise exquisite judgment, and to be visi8nary with regard to practice and research.2 0 Zasowska views technology as a tool which will assist in improving the health status and also increase our Options in education.201 Technology in education can be viewed as a threat or as much of a benefit as attitudes and values will allow deans and faculty to accept and utilize it in their teaching methodologies. Meadows examines the use of computers in nursing education. To 82 achieve acceptance of computer-assisted instruction, it is absolutely essential to have administrative support. "In order to achieve this goal the administration must be visionary, willing to take risks and supportive of faculty 202 efforts." Computers have made a definite impact upon many areas in our society. A nurse may find that orienta- tion to her job will in part, be provided by way of a computer terminal . . . as will inservice education, and client education.203 Ritvo relates the benefits of planning and notes throughout his acticle that without adequate advance planning beneficial technology may not be appropriately utilized.204 Bulger summarizes the situation: Afterall, the challenge to the health care system is really the challenge to twentieth century America and perhaps all of modern western civilization, i.e., how to humanize a technocracy in a technocratic society. If we cannot succeed in the serving, caring professions, what hope can there be for the rest?205 SOCIETAL CHANGES In order to cope with or effectively change the directions of societal trends, we need to become a popula- tion of planners. Mauksch, in The Future is Now, states: Up until now we have not been a planning society. We have been infinitely more prone to put our heads into our hands or into the sand. We have not faced those realities which were indeed foreseeable, let alone cope with those which were perhaps a little more obscure.206 83 Sovie identifies four social factors which she believes have great impact on the way in which nursing will shape its future. They are, "the Women's Movement, consumerism, health planning and policy making, and the knowledge explosion and the learning society."207 Closely related to social changes for the roles of women are changes in legislation and politics which are influencing the dynamic impact that women are beginning to have today. In this respect nursing is a very young profession; in addition to coping with the uncertainties and confusion of the profession, the dean of the school of nursing must assist the faculty and students to prepare for an uncertain future.208 Politics--A Barrier to Long-Range Planning The political system contributes to the lack of involvement in long-range planning as indicated by Ramey in that most politicians' actions are focused on re- election rather than on long-range planning and comprehen- sive implementation of programs with adequate evaluation of the actual goals.209 Leininger emphasizes the crucial role of politics and economics in determining health care at all levels: federal, state, and local.210 84 Changing Roles of Politics in ContemporaryiSociety Anderson discusses political health relationships: . health care issues are no longer resolved exclusively in the arena of the health care worker. Rather, health care issues are increasingly decided upon in the political arena in competition with other demands related to defense, transportation, commerce, environment, recreation space, international relations, and the like.211 Politics, values, and economics and their influence are discussed by Mac Stravic: Ultimately, health needs are deter— mined by an intellectual, and political process which sets and modifies the goals and standards for health services; those goals and standards are then used 5? guide the development of the health system. 2 Ashley and LaBelle trace the changing social mission of nursing through the century and question the beneficial influence that specialization has caused for nursing and its influence on health care.213 Unrest within the profession and discontent with the role status have prompted some nurses to offer client services through private or independent practice. Dachelet notes the influence of this social change: "Whether or not independent nursing practice spreads is not the significant issue; what is more important to note is the new mood found among nursing professionals."214 Other educational changes which will influence and be influenced by society are the efforts to establish a common 85 entry level for the profession and mandatory continuing education.215 Social Priorities Zasowska aptly summarizes lifestyle changes: Standards of what is important are changing. Even upper-middle class Americans find that attainment of status and material goals is so relatively easy that the quest for them no longer offers a challenge. People at every level of life are seeking different goals with which are associated higher values. Society is experiencing a change from competitive care to sophisticated concern for self—growth and self actualization. The quality of life is as much a concern as life itself. All sectors of society seek and demand good health care. In the last analysis, this shift in fundamental values is hammering out the social policy regulating health service.2 5 Difficulties and challenges for health profes- sionals are pointed out by Anderson: . health no longer holds a favored position it enjoyed in the past. There is a need for strong health advocates and organiza- tions who can rekindle the public's interest in human life. The health professional's participation in political activities is an essential extension of his professional life if he hopes to see his values operationalized through the formation of public health policies which foster access to health care and upgrade the quality of health care services for all American citizens. Vested interests of professionals is referred to by Mac Stravic: Health professionals have also raised some valid objections to using need as a basis for planning, the most serious of which concerns its theoretical nature. Professionals are likely to specify needs for health services in excess of what people will ever seek. 86 The political lobbyists can have a profound influence as related by Anderson. The discipline of medicine has had strong legislative advocates, whereas the fields of nursing, social work, and pharmacy, only recently have had strong and organized professionil advocates of their causes and concerns.2 Social Changes Influencing NursipgTEducatIOn Social changes have had profound effect on higher education. Those of us whose academic careers began in the 1940's and 1950's, for instance, lived in a world where only one-fourth of 18-year olds entered college--a different world from today, where over 40 percent do so. Universities are now mass education systems and fast becoming universal ones. The changing role of student outlook and involve- ment in the educational process as well as legal requirements have influenced revision of some traditions and created new tensions for administrators. Fuller relates these changes to planning. Economic, social, and demographic changes have created situations which have promoted the relevance of academic planning. Academic planning is indeed gaining currency. However, the meaning of academic planning remains conceptually ambiguous. .221 Not only nursing is faced with the dilemma of lack of leadership and visionary planning for the future. Reif discusses the need for colleges and universities to anticipate problems rather than responding to them and suggests they might emulate progressive industries who 87 allocate great sums to advancement through research focused specifically on the future.222 DeTornyay comments on the dean's role: "The dean's job is to create an 223 224 225 and effective climate." Albright, deTornyay, Leininger view the rapid and radical social changes as an indication to the dean for the importance of planning within the profession as well as with other disciplines. Leininger reiterates, "Societal realities are forcing us to be futurists. . . . When sudden changes occur within a planned framework, there tends to be less anxiety than when sudden changes occur within an unplanned framework”?26 Drucker elaborates on the risk factors which merit consideration in planning for the social uncertainty of the long-range future. He identifies four kinds which would seem to have relevance for the nursing school administrator. They are: l. The risk one must accept. 2. The risk one cannot afford to take. 3. The risk one can afford to take. 4. The risk one cannot afford not to take.227 The mission, values, and priorities of the dean and the school of nursing may vary markedly when using Drucker's four-risk screening criteria. If a planning group used these criteria, possibly they could arrive at agreement and know why they were making one choice over another. 88 Hesburgh pp pl. point out some of the dilemmas of education in escaping past traditions and viewing future opportunities for lifelong education. Some view it as a threat but a more positive outlook can be that of seeking knowledge to contribute to both personal growth and to the welfare of society.228 A major social factor which has had an impact on the nursing profession is that of the changing role of women in society. Until recently women have not been viewed as being capable of creating new knowledge through 229 research and intellectual exploration. The educational socialization process is vital in that "The quality of our thinking and the quality of our actions are shaped by educational systems."230 Educators must learn and teach students to concep- tualize the future, as is recommended by a prominent nursing dean: Although it is difficult to conceptualize the world of nursing in the year 2000 and beyond, nevertheless it is essential to think about how we believe nursing to be in light of societal changes. Dubos summarizes the challenge and fascination for the future. As long as mankind is made up of independent individuals with free will, there cannot be any social status quo. Men will develop new urges, and these will require ever new solutions. Human life implies adventure, and there is no adventure without struggles and dangers.232 89 SUMMARY There is a paucity of research directly related to this study. Some of the reasons for this dearth are explored, such as the slow acceptance of futures-oriented research and studies in academia. The issue of long-range planning in relation to the nursing profession and its role in the decades ahead is beginning to receive atten- tion from only a few authors. Much ambiguity and confusion is associated with the definition and acceptance of planning and plans. The added dimension of time also is Open to criticism. Various levels of acceptance, understanding, and ability exist among administrators who use and participate in the planning process. Mbst authors who discuss management and/ or administrative functions seem to agree that planning is the one universal function of the person assuming this role. There are controversies as to the degree of involve- ment of the administrator as well as the time dimension about how far projections are realistic and economically feasible. The controversial nature of any type of planning is not soon to be resolved as there will always be the traditionalists who will adhere to the nostalgic past and the futurists and restless individuals who are discontent with the status quo. Proponents of long-range planning believe it is an idea whose time has come, whereas the opposition claims it is merely a fad that will pass by. 90 The roles and functions of the dean of the school of nursing are varied, numerous, and extremely demanding. The nursing school administrator must be a scholar in nursing as well as in administration and higher education to be able to most advantageously cope with the politics of the university system as well as being a leader of the nursing profession, as the largest group of the health care delivery team. Values are an extremely important factor which influence the planning process, whether it be short- or long-range, or for education, business, or health care delivery. The values and outlook an individual possesses will determine how optimistic or pessimistic he/she is and will thereby influence the degree of futurity evident in the content of the plan. Planning at any level and any time dimension is an extremely complex process. The interesting paradox exists that while promoting long-range planning on the one hand, it is frequently resisted on the other. Numerous factors influence this resistance. Among them are: personal and professional inertia, vested interests and power struggles, individual insecurity, fear of making mistakes, societal uncertainty, fear of control and/or being controlled, financial emergencies, attitudes, habits, values, attachment to traditions, inability to conceptualize the abstract, philosophical myopia, being accustomed to the 91 "hustle and bustle" activities (Gresham's Law), enthrall- ment with technology and tools, fascination with an abundance of facts and an "analysis paralysis,” lack of facts and evidence, inappropriate use of data, complex political processes, sexism, changing social priorities, professional parochialism, present-oriented time per- spectives, and action-oriented persons versus knowledge- oriented persons. When examining the consequences of a plan, it is frequently difficult to determine whether a given factor, event, or condition was the primary or secondary factor which hindered or facilitated an occurrence, since the variables are intricately interrelated. The persons evaluating the change are also entering the environment from a different perspective than the planners may have intended initially. In the past, the health care delivery system was not planned with the client's/patient's best interests always in central focus. A plethora of professional and lay articles on the current health care crisis are available. Most frequent criticisms of the health care delivery system concern the extremely high costs for inade- quate or impersonal services. The present system is not effective; it is even more complex to determine which professions should change or expand their roles and functions. A societal change that has recently influenced 92 planning is the changing role of consumers/clients who are now represented on numerous planning boards and committees. Another major societal change that cannot be over- looked, especially in relation to the nursing profession, is the changing role of women. The sexism that has been a hindrance to much of the progress within the profession has influenced how nurses view their longevity and commitment to the profession. The position of being a female dean in the primarily male world of academia is extremely challeng- ing. The dean's role requires an enormous amount of fortitude to maintain a balance of priorities between superiors who make demands and subordinates who look to the dean for leadership, scholarship, and support. Rapid changes in knowledge, technology, and society demand a discerning ability to plan for both a school and a pro- fession which will not be obsolete tomorrow. Chapter 2 FOOTNOTES 1Lillian Bramwell and Elaine Hykawy, ”The Delphi Technique: A Possible Tool for Predicting Future Events in Nursing Education," Nursipg Papers, Vol. 6, No. 2 (Montreal, Canada: McGill University, 1974), pp. 23-32. 2Carol A. Lindeman, "Delphi Survey of Priorities in Clinical Nursing Research," Nursing Research, Vol. 24, No. 6 (November-December, 1975), pp. 343-441. 3Vaughn E. Huckfeldt, A Forecast of Changes in Post Secondary Education (Boulder, Colorado: National CEnter for Higher Education Management Systems at Western Interstate Commission for Higher Education, 1972). 4Joseph A. Keyes, Marjorie P. Wilson, and Jane Becker, "The Future of Medical Education: Forecast of the Council of Deans," Journal of Medical Education, Vol. 50, No. 4 (April, 1975, pp. 319L327. 5Arthur Bronwell, "Can an Advanced Society Deal with its Future?"' FuturiSt, Vol. 5, No. 3 (June, 1971), p. 110. 6John Martin Rich, Challenge and Response: Education in American Culture (New York: John Wiley & Sons, 1973), PT'168. 71bid., p. 285. 8Esther Lucille Brown, Nursing for the Future (New York: Russell Sage Foundainn, 1948). 9Madeleine Leininger, "Futurology of Nursing: Goals and Challenges for Tomorrow," in The Nursing Profession: Views Thropgh the Mist, ed. Norma L. Chaska (New York: McGraw Hill, 1978), p. 382. 10 11George Steiner, Top Management Planning (New York: MacMillan Company, 1969), p. 5. Ibid., pp. 380-381. 94 12Lawrence Kelly, "Theory, Pitfalls and Payoffs of Long Range Planning," Managerial Planning, Vol. 25, No. 6 (May-June, 1977), p. 1. 13David W. Ewing, The Practice of Planning (New York: Harper and Row, 1968), p. 17? 1['William H. Newman, Administrative Action, (Englewood Cliffs, New Jersey: Prentice-Hall, 1963), p. 17. 15 16 17Preston P. LeBreton and Dale A. Henning, Plannin Theor (Englewood Cliffs, New Jersey: Prentice Ha , , p. 7. 18 19A. D. Albright, "Educational Administration: A Look to Futures," The Decanal Role in Baccalaureate and Higher Degree Education (Washington, D.C.: U.S. Department of Health, Education, and Welfare, March, 1975), p. 25—44. 20 2l'Beaufort B. Longest, Management Practices for the Health Professional (Reston, Va.: Reston’Pub. Co., Inc., 1976), p. 80. Ibid., p. 15. Steiner, Tonganagement Planning, 1969, p. 8. Steiner, (1969), p. 6. Ibid., p. 26. 22SpyrosMakridakis and Steven Wheelwright, ”Integrating Forecasting and Planning," Long Range Planning, Vol. 6, No. 3 (September, 1973), p. 59. 23 24Russell L. Ackoff, A Concept of Corporate Planning, (New York: Wiley Interscience, 1970), p. 2. 25 26Kenneth J. Craver, "The Effect of the Future on Today's Decisions," Long Range Planning, Vol. 6, No. 2 (June, 1973), p. 29. Le Breton and Henning, p. 7. Steiner, Top Management Planning, 1969, p. 8. 27Olaf Helmer, Long Range Forecasting, Roles and Methods (Middletown, Conn.: Instifute fOr the Future, , p. 9. 28 LeBreton and Henning, p. 7. 95 29 30 31Peter F. Drucker, "Long Range Planning," Management Science, Vol. 5, No. 3 (April, 1959), p. 238. 32David E. Hussey, Corporate Planning Theory and Practice (New York: Pergamon Press, 1974), p.759} Craver, p. 30. Newman, p. 130. 33LeBreton and Henning, p. 34. 34Ibid., p. 35. 35Ibid., p. 30. 36 Theodore Haimann and William G. Scott, Management in the Modern Organization, 2nd ed. (Boston: Houghton Mifflin Co., 1970), p. 76. 37 Ewing, p. 18. 38Steiner (1969), p. 21-23. 39Kelly, p. 1 40 Owen B. Hardy, "Systematic Processes Applied to Health Care Planning," Hospital Administration, Vol. 16, No. 1 (Winter, 1971), p. 11. 41 Drucker, p. 40. 42Russell L. Ackoff, Redesigning the Future (New York: John Wiley and Sons, 1974), p. 22. 431bid., p. 24. 441616., p. 25. 451bid., p. 26. 46Russell L. Ackoff, 1970, p. 4. 47Ewing, p. 28. 48 Ackoff, 1974, p. 31. 49Russell L. Ackoff, Footnotes to the Future, Vol. 7, No. 6 (Washington, D.C.: Futuremics, Inc., 1978), p. 2. 50 Kelly, p. 2. 96 51 52Malcom Pennington, "Why Has Planning Failed?" Long Range Planning, Vol. 5, No. 1 (March, 1972), p. 8. 53George Steiner, Managerial Long Range Planning, (New York: McGraw-Hill, 1963), p.71. 54W. Timothy Weaver, "The Delphi Forecasting Method," Phi Delta Kgppan, Vol. 52, No. 5 (January, 1971), p. 267. Ibid., p. 1. 55 56Roger N. Gaunt and Michael J. Haight, "Planning Models in Higher Education Administration," Journal of Education Finance, Vol. 2, No. 3 (Winter, 1977), p. 318. 57Harold L. Enarson, "The Art of Planning," Educational Record, Vol. 56, No. 3 (Summer, 1975), p. 171. 58Marguerite J. Schaefer, "Universities and Future Health Care," Health Care Issues, ed. M. Leininger (Philadelphia: F. A. Davi§j Fall, 1974), p. 123. 59Herman Hilleboe, "Preventing Future Shock: Health Developments in the 1960's and Imperatives for the 1970's," American Journal of Public Health, Vol. 62, No. 2 (February, 1972), p. 136. 60Bruce Fuller, "A Framework for Academic Planning,‘ Journal of Higher Education, Vol. 47, No. 1 (January- February, 1976), p. 66. 61 62 63David White, "Minds in a Groove," Chronicle of Higher Education, Vol. 16, No. 13 (May 22, 1978), p. 40. 6('Henry A. Kissinger, "Domestic Structure and Foreign Policy," Daedalus, Vol. 95, No. 2 (Spring, 1966), pp. 503-529. 65Robert E. Mac Stravic, Determining Health Needs (Ann Arbor, Michigan: Health Administration Press, 1978), p. 152. Hussey, p. 3. Ibid. Schaefer in Leininger, p. 122. 66Fuller, p. 70. 97 67 68 69William C. Wedley, "New Uses of Delphi in Strategy Formulation," Long Range Planning, Vol. 10, No. 6 (December, 1977), p. 70. Ewing, p. 60. LeBreton and Henning, p. 103. 70Newman, p. 62. 71Ibid., p. 64. 72Ibid., p. 68. 73Ibid., p. 59. 74 Pennington, p. 8. 75Michael L. Dolfman, "Health Planning: A Method for Generating Program Objectives,” American Journal of Public Health, Vol. 63, No. 3 (March, 1973), p. 238. 76Louis Tannen and Jane Liebman, "Population Based Planning as a Health Plan Development," American Journal of Health Planning, Vol. 3, No. 3 (July,l978): p. 49. 77 78Myrtle K. Aydelotte, "The Future Health Delivery System and the Utilization of Nurses Prepared in Formal Education Programs,” The Nursing Profession: Views Throu h the Mist, ed. Norma Chaska (New York: McGraw-Hill, 1978) p. 357. 79 80Sister M. Zasowska, "The Philosophy Index of Health Care Delivery in Our Culture," Health Care Issues, ed. Madeleine Leininger (Philadelphia: F. A. DaviE Company, 1974), p. 12. 81 82Delmar Karger, "Integrated Formal Long-Range Planning and How to Do It," Long Range Planning, Vol. 6, No. 4 (December, 1973), p. 347 83Roger A. Ritvo, "Implications of Technological Decision Making," Hospital and Health Services Adminis- tration, Vol. 23, N5} 3 (Summer, 1978), p. 50. Hussey, p. 38. Aydelotte, p. 350. Hussey, p. 31. 98 84 85 86 87 88 89Robert Rushmer, Humanizing Health Care: Alternative Futures for Medicine (Cambridge, Mass.: The MIT Press, 1975), p. 16. 9°Ibid., p. 45. 91 92Margaret D. Sovie, ”Nursing: A Future to Shape,” in The Nursing Profession: Views Thropgh the Mist, ed. Norma Chaska (New York: McGraw-Hill, 1978), p. 366. 93 94 95John Platt, "What We Must Do," Science, Vol. 166, No. 3909 (November 28, 1969), p. 111 . 96 97Ingeborg Mauksch, "The Future is Now," The Future is Now (New York: NLN, 1974), p. 3. 98Donald P. Carmody, "The Changing Federal Role in Health," The Future is Now (New York: NLN, 1974), p. 24. 99Longest, p. 14. 10Orbid., p. 42. 101 Newman, p. 38. Kelly, p. 9. Newman, p. 131. Kelly, p. 9. Ibid., p. 10. Leininger in Chaska, p. 395. Leininger in Chaska, p. 381. Ibid. Ibid., p. 1116. Karger, p. 32. 102 103 104 105 Ibid., p. 32. LeBreton and Henning, p. 319. Newman, p. 27. Enarson, P. 105. 99 106Gary Riley and J. Victor Baldridge, Governing Academic Organization (Berkely, California: McCutChan Pub. Co., 1977), p.423. 107 108Richard J. Barber, ”Business and Higher Education: The Emerging Alliance," The American Corporation (New York: E. P. Dutton and Company, 1970), p. 99-100. 109 110Longest, p. x. 111 112 113Bernadette Armiger, "The Educational Crisis in the Preparation of Deans," Nursing Outlook, Vol. 24, No. 3 (March, 1976), p. 166. 114 115Paul L. Dressel, F. C. Johnson, and Philip Marcus, The Confidence Crisis (San Francisco: Jossey-Bass, Inc., 1971), p. 13} 116Victor Baldridge, Power and Conflict in the University (New York: John WiIey & Sons, 1971), p. II3. 117John Gould, The Academic Deanshlp (New York: Columbia University TeaEHers College Press, 1964), p. 4. 118Rozella M. Schlotfeldt, "Opportunity in the Decanal Role," in The DecanalRole in Baccalaureate Nursig (Washington, D.C.: HEW, March, l975),p. 46. 119Evelyn Barritt, "The Art and Science of Being Dean," Nursing Outlook, Vol. 22, No. 12 (December, 1974), p. 750. Ibid., p. 21-22. Ibid. Albright, p. 35. Roaden, p. 273. Ibid. 120Anna Gallagher, Educational Administration in Nursing (New York: 'Macmillan, 1965), p. 9. 121 122Irene Palmer, "The Decanal Role in Academic and Institutional Leadership," in The Decanal Role in Bacca- laureate and Higher Degree Progpams (washington, D.C.: HEW), p. 87’ Ibid. 100 123Personal interview with Isabelle Payne, Director School of Nursing, January 28, 1977, Michigan State University. 124Irving H. Buchen, "The Swinging Mbnk, or the Dean of the Future," Intellect, Vol. 102, No. 2358 (May, 1974), p. 498. 125Victor E. Hanzeli, "Educational Leadership of the Academic Dean," Journal of Higher Education, Vol. 37, No. 8 (November, 1966), p. 427. 126 127Arliss L. Roaden, "The College Deanship: A New Middle Management in Higher Education," Theory Into Practice, Vol. 9, No. 4 (October, 1970), p. 273. 128Zana Rae Higgs, "Expectations and Perceptions of the Curricular Leadership Role of Administrators of Nursing Education Units," Nursing Research, Vol. 27, No. l (January-February, 1978), p. 62. 129JoAnn Ashley and Beverly LaBalle, "Education for Freeing Minds," Current Pergpectives in Nursing Education, ed. Janet Williams (St. Louis: C1 V. Mosby, 1976), p. 50. 130 131Rachel Elboim Dror, "The Resistance to Change of Educational Administration," Futures, Vol. 3, No. 3 (September, 1971), p. 201. Ibid., p. 427. Ibid., p. 57. 132Hussey, p. 10. 133Albright, p. 26. 134Ibid., p. 27. I35 Ackoff, 1970, p. 8. 136Enarson, P. 174. 137Drucker, p. 244. 138Albright, p. 27. 139Ibid. 140 Tannen and Liebman, p. 49. 101 141 142 143 144NCHEMS, Why a Center for Higher Education Management? (Boulder, Colorado: NCHEMS at WICHE, July, 1971), p. 1. 14Sum. 146David K. Wiles, "Policy Adaptation in Higher Education: Fundamental Issues of Allocation and Legitimacy," Journal of Education Finance, Vol. 2, No. 3 (Winter, 1977): pp. 301-302. 147W. R. Dill, The Impact of Environment on the Organization," Readingp in Organizational Theory, ed. J. G. Mauer (New York: Random House, 1971), p. 87. 148Ron Abrell, "Educational Leadership in the let Century," Education Tomorrow, Vol. 3, No. 5 (October, 1978), p. 4. Albright, p. 35. Fuller, p. 76. Weaver, p. 267. 149James D. Thompson, and William J. McEwen, "Organizational Goals and the Environment," Readings in Organizational Theory, ed. J. G. Mauer (New YOrk: Random House, 1971), p.4455. lsoAlbright, p. 37. 151Weaver, p. 267. 152Ibid. 153 Albright, p. 34. 154 155Theodore Reller and John Corbally, "Colleges and Universities and Their Relationships" in Designing Education for the Future, Number Two, ed. Edgar L. MOrphet and Charles 0. Ryan (New York: Citation Press, 1967), p. 145. 156Mar uerite Schaefer, "Toward a Full Profession of Nursing: T e Challenge of the Educator's Role," in Action in Nursing, ed. J. Lysaught (New York: McGraw-Hill, 1974), p.7350. Schlotfeldt, p. 50. 102 157Teresa Christy, Cornerstone for Nursing Educa- tion (New York: Columbia UhiVersity Teachers College Press, 1969), p. 40. 158 159NLN News and Reports, "Deans Prepare for Future Educational Challenges," Nursing Outlook, Vol. 24, No. 10 (October, 1976), p. 600. 160 161Theodore Sizer, "Three Major Frustrations," Phi Delta Kappan, Vol. 53, No. 10 (June, 1972), p. 634. 162 163 164 Vern Bullouth and Bonnie Bullough, The Ibid., p. 70. Ibid., p. 602. Ibid. Ibid. Ibid. 165 Emergence of Modern Nursing, 2nd ed. (New York: Macmillan, 1969): p. 170. 1661bid., p. 181. 167Christy Dachelet, "Nursing's Bid for Increased Status," Nursing Forum, Vol. 17, No. l (1978), p. 26. 168Robert Claiborne, "A Penny of Prevention: The Cure for America's Health-Care System," Saturday Review (January 6, 1979), pp. 17-22. 169Stanley J. Matek, "Some Key Features in the Emerging Context for Future Health Policy Decisions in America" (presented at Conference on Redesigning Nursing Education for Public Health sponsored by the Bureau of Health Manpower Education at the National Institutes of Health), Summer 1973, (mimeographed). 170D. E. Rogers, "The American Health-Care Scene: Views from a Foundation Perspective,” New England Journal of Medicine, Vol. 228 (June, 1973), p. 1379 17"Nicholas D. Richie, ”Health Planning: An Over- view," American Journal of Health Planning, Vol. 3, No. 2 (April, 1978), pp. 36-42. 103 172Roger J. Bulger, "Some Humanistic Issues in Health Professions," Health Care Issues, ed. M. Leininger (Philadelphia: F. A. Davis Co., 1974), p. 33. 173Steven Sieverts, Health Planning Issues and Public Law 93-641 (Chicago: American Hospital Association, , p. 7. 17"Irene Ramey, "The Crisis in Health Care: Fact or Fiction?" Health Care Issues, ed. M. Leininger (Philadelphia: ’FT’A. Davis, Fall, 1974), p. 22. 175 176 Ibid., p. 19. Dachelet, p. 20. 177Ibid., pp. 40-42. 1781bid., p. 21. 179 Enarson, p. 73. 180Hardy, p. 22. 181Dolfman, p. 258. 182Dachelet, pp. 19, 23. 183Armiger, p. 183. 184Ibid. 185 Roaden, p. 274. 186Luther Christman, "Alternatives in the Role Expression of Nurses That May Affect the Future of the Nursing Profession," The Nursing Profession: Views Through the Mist, ed. Norma ChaSka (New York: McGraw-Hill, 1978), p. 187Muriel A. Poulin, "Nursing Service: Change or Managerial Obsolescence,” Journal of Nursing Administration, Vol. 4, No. 4 (July-August, 1974). 188"Leagues in Action, " NLN News, Vol. 26, No. 6 (July-August,1978), pp. 5,8. 189NLN Joins ANA, AACH in Urging Wider Role for Nurses in Primary Health Care, " News, Vol. 1, No. 6 (New York: NLN, May, 1973), p. 2. 104 190Donabedian, p. 246. I 191"Health Maintenance Organizations,‘ in Public Affairs Advisony (New York: National League for Nursing, July, 1978), p. 4. 192 193 194 195 196 197 198Robert Malone, The Robot Book (New York: Push Pin Press, 1978), p. 148. 199Victor Ferkiss, Technological Man: The Myth and the Reality (New York: George Braziller, Inc.,FI969), p. 31. Ibid. Zasowska in Leininger, p. 13. NLN, July 1978, p. 4. Zasowska, p. 13. Enarson, p. 172. Ibid. 200Rozella Schlotfeldt,"0n the Professional Status of Nursing,” Nursinngorum, Vol. 13, No. l (1974), p. 25. 201 Zasowska, p. 12. 202Lynda S. Meadows, "Nursing Education in Crisis: A Computer Alternative," Journal of Nursing Education, Vol. 16, No. 5 (May, 1977), p. 20. 203Maryann Bitzer, "Nursing in the Decade Ahead: Computers Have Entered Our Lives," American Journal of Nursing, Vol. 70, No. 10, (October, 1970), pp. 2117-2118. 204Roger A. Ritvo, "Implications of Technological Decision Making," Hospital and Health Services Administra- tion, Vol. 23, No._34(Summer, 1978), p. 50. 205 206 207 208 209 Bulger in Leininger, p. 35. Mauksch, pp. 1-2. Sovie in Chaska, p. 367. Ibid., p. 373. Ramey in Leininger, p. 22. 105 210Madeleine Leininger, ”Humanism, Health, and Cultural Values," in Health Care Issues, ed. M. Leininger (Philadelphia: F. A. Davis Co., Fall, 1974), p. 51. 211Edith H. Anderson, "The Political Context and Process of Health Legislation," Health Care Dimensions, ed. Leininger (Philadelphia: F. A. Davis Co.,7I974), p. 107. 212 Mac Stravic, p. 8. 213Ash1ey and LaBelle, p. 51. 214Dachelet, p. 35. 215Ibid., p. 32. 216 Zasowska in Leininger, p. 9. 217 218 219 220Rheba de Tornyay, "Changing Student Relation- ships, Roles and Responsibilities," Nursing Outlook, Vol. 25, No. 3 (March, 1977), p. 188. 221 222F. Reif, "Where are the Leaders in Higher Education?" Chronicle of Higher Education, Vol. 14, No. 24 (February 28, 1977), p. 321 223 224Albright, p. 37. 225 226 227Peter F. Drucker, Managing for Results (New York: Harper & Row, 1964), p. 206. 228Theodore Hesburgh, Paul A. Miller and Clifton Wharton Jr., Patterns for Lifelong Learning (San Francisco: Jossey Bass, 1973), p. 59. 229 Anderson in Leininger, p. 112. Mac Stravic, p. 56. Anderson in Leininger, p. 111. Fuller, p. 66. de Tornyay, p. 193. de Tornyay, p. 193. Leininger in Chaska, p. 382. Ashley and LaBelle, p. 51. 106 230 231 Ibid., p. 55. Leininger in Chaska, p. 380. 232 Rene Dubos, Mira e of Health (Garden City, New York: Anchor Books, 1959), pp. 227-228. Chapter 3 DESIGN OF THE STUDY Problem Statement The major problem focus for this study was to ascertain baccalaureate nursing-school administrators' perceptions of selected aspects of long—range planning for nursing and nursing education. Design To collect the appropriate data as defined by the problem statement of this study, that of obtaining nursing- school administrators' perceptions of long-range planning, it was determined that survey research was the most suitable design. Kerlinger agrees that survey research is appropriate to collection of data pertaining to "personal and social facts, beliefs and attitudes."1 Kerlinger further discusses the relation of various functions of research to the purposes of this investiga- tion, namely, practical and heuristic values, and formation of a basis for further research.2 Warwick and Lininger compare various methods and conditions for accomplishing research goals. The purpose and conditions of this study qualify for the method of choice for survey research in that the type of data, the 107 108 familiarity of the respondents with the information requested, and the researcher's knowledge of the problem are all appropriate and met.3 It was explained in the cover letter to the administrators that the study was intended to have both practical and heuristic value. As to the purpose of providing practical information for long-range planning, it was explained that the data collected would provide deans with some degree of insight into how their percep- tions compared with those of other respondents in the study and would highlight areas where further research efforts might be directed in the future. Warwick and Lininger discuss the survey design and state that it can: . Lay the ground work for the pursuit of other objectives, including explanation and hypothesis testing, evaluation prediction, and the development of indicators.4 Because this was a descriptive study, no hypotheses were posed or tested. Instead, this investigation attempted to ferret out topics or questions for further research with data which challenge or verify previous trends or projections. It was intended that the heuristic aspect be realized in delineation of more specific, researchable problems for subsequent studies which would contribute to more, sophisticated, theoretical formula- tion focusing on long-range, futuristic issues in nursing and nursing education. 109 Population The target population for this investigation was the deans and directors of the accredited baccalaureate nursing programs in the United States. It was assumed that members of this group, although very busy people, would reply at a high rate as demonstrated by the leader- ship, scholarship, and research responsibilities inherent in their positions. It was decided that to eliminate sampling error and to have a potentially more meaningful and useful study, the entire population of deans and directors should be included in the study. Since the group of deans was assumed to be a rather homogenous group having small differences in per- ceptions in many areas, it was advisable to survey as large a group of respondents as possible.5 Because a mailed questionnaire was used as the data collection instrument, the expense of including all 286 potential respondents was not prohibitive. The Instrument The mailed questionnaire was an obvious choice of data collection instrument for this group of individuals located throughout the United States. (See Appendix A.) The cover letter encouraged the participation of the deans and directors and indicated the purposes and pOtential benefits of the study for the improvement of the 110 nursing profession. (See Appendix A.) Also, the respondents were offered a summary of the study results upon request. The cover letter requested that the nursing school administrator complete the questionnaire rather than delegate the task to another administrator or faculty member. This was done to provide for more meaningful results that would be of greater usefulness to the pro- fession. The conceptual content areas of the study, in addition to selected demographic data, were divided into eight major categories and included at various points in six major sets of questions. The eight major categories of content included were: 1. personal and professional outlooks of deans, including values and priorities 2. educational priorities and changes for nursing and nursing education 3. the changing health-care delivery system interdisciplinary collaboration client control and demands finances, including politics and legal controls technological changes CDNOU'ID sociological changes, value shifts, and national priorities These categories of content were explored in the literature and found to be intricately related to the lll planning process in which the nursing school administrator participates. Further, the content of these categories was found to have great impact on decisions influencing both short- and long-range planning in nursing and nursing education. A brief description of the instrument follows: Question Set A consisted of ten items of demo- graphic data, included as a basis for determining the generalizability of the results and for identifying a profile of the respondents. Question Set B was composed of eight statements regarding long-range planning to which the respondent was requested to reply according to his/her extent of agree- ment from very strong agreement to strong disagreement. Question Set C included nine selected statements representing current issues and dilemmas confronting the nursing profession. The responses were requested to be made according to the nursing school administrator's perception of their importance, urgency, and degree of progress by 1990. Question Set D attempted to ascertain the respon- dent's agreement or disagreement with twelve trends and/or potential changes in nursing education and health care delivery by 1990. Question Set E consisted of a series of twelve adjective pairs on a seven-point scale in the Semantic 112 Differential format to elicit attitudes toward the stimulus phrase, "long range planning." Question Set F was intended to elicit responses to a twenty-one item list of persons, groups, and factors that may influence nursing education and practice. It was requested that responses be made according to the dean's perception of the degree of influence that the persons, groups, or factors should have on nursing by 1990; and secondly, perceptions according to the influence these persons, groups, and factors nlll probably have on nursing by 1990. Question Set G requested the dean's perceptions of twenty-two items consisting of persons, events, conditions, and policies that hinder or facilitate long-range planning and that are presently taking place in his/her school of nursing. The responses were constructed on a seven-point scale from one, hindrance, through four, neutral, to the highest point of facilitation, seven. Question Set H consisted of one open-response question asking the length of time for which the school plans. This question provided a quantified, practical definition of planning for that school. Pilot Test The pilot test of the instrument was administered to a group of nurses who were similar to the target population and others with special expertise in the 113 research process. The purposes of the pilot test were to determine the clarity of instructions and questions, content validity, face validity, appropriateness of length, and to provide an estimate of the amount of time required for completion of the questionnaire. Data Collection The questionnaires were mailed to 286 deans (nursing school administrators) of accredited baccalaureate schools of nursing in the United States during the winter of 1978. Names and addresses of these persons were obtained from the National League for Nursing's publication, Baccalaureate Education In Nursing.6 The instrument was reproduced on green, standard— size paper. The cover letter was typed on white paper and attached to the front of the questionnaire. These items were enclosed with a hand-stamped, self-addressed envelope. The questionnaires were coded to determine who had responded and after three weeks a postcard reminder was sent to the non-respondents. (See Appendix B.) After two additional weeks, another questionnaire packet was mailed to the non-respondents. Annlysis of Data Returned questionnaires were edited for usefulness and notations were made regarding those who had sent requests for a summary of the results. There were 214 114 (74.8%) useable questionnaires returned in time for analysis. These questionnaires were sent to key-punch facilities where the data were transferred to computer cards and verified prior to computer analysis. Descriptive statistics and selected procedures were performed through use of the Statistical Package for the Social Sciences (SPSS).7 Summary In summary, the design of this investigation, to be accomplished through a mailed questionnaire, was considered a realistic and economically feasible approach for accomplishing the established purposes of this descriptive study. The research was designed to establish a basis for development of further inquiry and to provide practical information to members of the profession about the per- ceptions these deans had of long-range planning for nursing and nursing education. Chapter 3 FOOTNOTES 1Fred N. Kerlinger, Foundations of Behavioral Research (New York: Holt, Rinehart and Winston, Inc., 1973), p. 422. 2 3Donald P. Warwick and Charles A. Lininger, The Sample Survey: Theory and Practice (New York: McGraw Hill, 1975), p. 9. 4 Ibid., p. 7. Ibid., p. 49. 5Walter R. Borg and Meredith D. Gall, Educational Research (New York: David McKay Company, Inc., 1971), 123. p. 6Division of Baccalaureate and Higher Degree Programs, Baccalaureate Education in Nursing: Key to a Professionai Career in Nursing 1977;78 (New York: National League for Nursing, 1977). 7Norman Nie et a1., Statistical Packa e for the Social Sciences, 2nd ed. (New YorE: McGraw Hill, 1975). Chapter 4 ANALYSIS OF DATA The purpose of this chapter is to present results of the survey of baccalaureate nursing school administra- tors who responded to a mailed questionnaire regarding their perceptions of long-range planning for nursing and nursing education. Part I of this chapter contains a demographic profile of the respondents and related background data from Question Set A of the questionnaire. Part II contains a presentation of each set of the questions, pointing out major notable findings, and is followed by tables displaying a summary of the responses to items with means and standard deviations. In explana- tion of tables "term" and ”statement" are used interchangeably. The raw data for each question set will be found in Appendix C. Response Rate to the Questionnaire In Table 1 a summary of the response rate to the questionnaire can be found. The total usable number of questionnaires was 214 (74.8%). Three questionnaires (1.9%) were received too late for analysis and three were presumed to have been lost in the mail. Eighteen (6.3%) were returned unanswered with various notes of apology, 116 117 most mentioning the lack of time available as reason for not participating in the study. Only 48 (16.78%) of the target population did not respond. 118 Table 1 Summary of Response Rate to Questionnaire Status of Questionnaire Frequency Percent Usable questionnaires returned 214 74.82 Returned too late for analysis 3 1.04 Returned unanswered 18 6.29 Lost in mail 3 1.04 No reply 48 léllfi Total sent 286 99.97 119 PART I RESPONSES TO QUESTION SET A Types of Institutions Represented by Respondents Table 2 shows the number of respondents from public or private institutions and subdivides them into colleges and universities. By far the largest group, 99 of the respondents (46.3%), were from public universities. The next most frequently represented group was private colleges with 56 (26.2%) responding. They were followed by the private universities represented by 42 respondents (19.6%). The smallest group of respondents was from public colleges. Their numbers totalled 17 (7.9%). As could be expected, because of a larger potential target population, the public institutions were represented 8.5 percent more frequently than private institutions. Full Time Egyivalent (FTE) Enrollment The FTE enrollment of the schools represented is presented in Table 3. The majority, 121 (61.3%) of the schools, were indicated to possess a FTE enrollment of 100-399 students. There were 50 (23.4%) with 500 or more FTE students. The largest sub-category was composed of 49 schools (22.9%) with 200-299 students. Only 6 administra- tors were from schools which (2.8%) had fewer than 100 FTE students. 120 Table 2 Total Responses to the Question: Which is the Type of Institution in Which You Are Currently a Nursing School Administrator? Type of Institution University College Total >. >. >. o o o G U C“ U S 44 m c m c m G D o 5 o 5 0 c: o c: o a: o m H o H o H H m H o H m k. at h. 04 h: o« Public 99 46.3 17 7.9 116 54.2 Private 42 19.6 56 26.2 98 45.7 Total 141 65.9 73 34.1 214 99.9 121 Table 3 Total Responses to the Question: What is the FTE Enrollment in your Baccalaureate Program? FTE Enrollment in Baccalaureate Program Frequency Percent l - 99 6 2.8 100 - 199 44 20.6 200 - 299 49 22.9 300 - 399 38 17.8 400 - 499 23 10.7 500 or more 50 23.4 No Response 4 1.9 Total 214 100.0 122 Regional Locations of Respondents The frequency and percentage of total respondents found in nursing regional locations are presented in Table 4. The largest group of respondents was from the Midwest Alliance, 66 (30.8%); followed by the Southern Region (SREB) with 58 (27.1%); the New England Region (NERB) with 46 (21.5%); lastly the Western Region (WICHEN) with 31 (14.5%) and no response from 13 (6.1%). Since it was apparent that not all of the states were included in the original nursing regions as presented in the questionnaire in Question A-3, the code numbers of the respondents were compared with the geographical loca- tions of the target population, which included all states. This percentage of respondents by region compared with the target population is presented in Table 5. To preserve the anonymity of the respondents a more specific classi- fication (such as individual states) is not revealed, but the percentages of the respondents were compared with the target population for generalizability by geographical location. Utilizing a regional breakdown of Midwest (80%), North Atlantic (73.3%), South (73.2%), and West (71.1%), all of the states were included. The percentages show a very close rate of return by region with the Midwest being slightly higher than the other three regions. Total Responses to the Question: Which is Your Regional Location? 123 Table 4 Regional Location Frequency Percent SREB 58 27.1 NERB 46 21.5 Midwest Alliance 66 30.8 WICHEN 31 14.5 No Response _l3 6.1 Total 214 100.0 124 Table 5 Return of Questionnaires from.Respondents by Region Compared with the Target Population Number Number Percent Questionnaires Questionnaires Questionnaires Regions Sent Returned Returned Midwest 80 64 80.0 North Atlantic 75 55 73.3 South 86 63 73.2 West 45 32 71.1 Total 286 214 125 Title of Administrative Position Held Table 6 readily demonstrates that the majority of the nursing school administrators, 109 (50.9%), held the title "dean." A smaller number, 80 (37.4%), were called "chairperson." Twenty (9.3%) had the title "director." Two other titles, ”head" and ”coordinator” were used by one respondent each (0.5%), and two respondents (0.9%) possessed the title "president" in their position. Length of Time Respondents Have Held Their Position The length of time the respondents have held their positions is displayed in Table 7. The majority was six years or less by 156 (72.9%). The two largest subgroups were the "less than one year" group and the "1-3 years" group, represented by 53 (24.8%) and 54 (25.2%) respondents respectively. A close third was the "4-6 years” subgroup represented by 49 respondents (22.9%). The next largest subgroup, 26 (12.1%) have held their positions for ”7-9 years." Twenty respondents (9.3%) had been in their posi- tions for "10-12 years." Only eleven respondents (5.1%) had been in the administrative position for thirteen or more years. Ages of Respondents' Programs The ages of the respondents' programs are displayed in Table 8. The ages did not cluster, but covered a wide 126 Table 6 Total Responses to the Question: What is the Primary Title of the Administrative Position you Hold at Present? Title of Administrative Position Held Frequency Percent Dean 109 50.9 Chairperson 80 37.4 Director 20 9.3 Head 1 .5 Coordinator 1 .5 President 2 .9 No Response __l .5 Total 214 100.0 127 Table 7 Total Responses to the Question: How Lon Have you Held th1s Position? Length of Time in Position Frequency Percent Less than 1 year 53 24.8 1 - 3 years 54 25.2 4 - 6 years 49 22.9 7 - 9 years 26 12.1 10 - 12 years 20 9.3 13 or more years 11 5.1 No Response __l .5 C Total 214 100. 128 Table 8 Total Responses to the Question: What is the Age of the Baccalaureate Program Where you are Currently Employed? Age of Program Frequency Percent 5 years or less 15 7.0 6 - 10 years 58 27.1 11 - 15 years 25 11.7 16 - 20 years 15 7.0 21 - 25 years 34 15.9 26 - 30 years 23 10.7 31 or more years 41 19.2 No Response __3 1.4 Total 214 100.0 129 span; however, the youth of the profession is evident in that 73 programs (34.1%) were less than ten years old. The second largest grouping of respondents' pro- grams in the twenty-one to thirty years combination received 57 responses (26.6%). There were 41 programs (19.2%) which were thirty-one or more years old. The next grouping, eleven to twenty years, was composed of 40 (18.7%) of the respondents' programs. Title of the Person (Superior) to Whom the Nursing School Administrators Report The title of the person to whom the nursing school administrators report is presented in Table 9. The person (superior) to whom the nursing school administrators report was most frequently a vice-president for 80 respondents (37.4%), followed closely by a certain type of dean which was identified by 73 respondents (34.1%). Twenty-one respondents (9.8%) reported to various superiors in the "Other” category, followed by 16 (7.5%) who reported to a provost and 10 (4.7%) who reported to a president. Only 8 respondents (3.7%) reported to a chancellor. Ages of Nursing School Administrators The ages of the nursing school administrators are displayed in Table 10. The age range "51-55” included the largest subgroup of respondents, 54 (25.2%). The major- ity, 128 (59.8%), were between the ages of 46 and 60 years. 130 Table 9 Total Responses to the Question: What is the Title of the Person to Whom you Report? Title of Person (Superior) Frequency Percent President 10 4.7 Vice-president 80 37.4 Provost 16 7.5 Dean of 73 34.1 Chancellor 8 3.7 Other 21 9.8 No Response 6 2.8 TOTAL 214 100.0 131 The second largest subgroup of 55 respondents (25.7%) was composed of the age range 36-45, followed by equal-sized groups (12 respondents or 5.6%) of the young- estintiua30-35age range, and the oldest in the 61-65 age range. Only one person indicated that they were in the "66 or over" age group. Sex Table 11 illustrates the obvious fact that the group was overwhelmingly female 207 (96.7%) with only 4 of the respondents (1.9%) identified as male. Highest Earned Degree The highest earned degree of the respondents is shown in Table 12. It was clear that the majority, 146 (68.2%), have earned a doctoral degree. A11 held degrees above the baccalaureate level, 64 (29.9%) indicated that they held a masters degree followed by 2 (0.9%) in the "other” category. Summary A typical respondent; was a female, from a public university, held a doctoral degree, was in the age range 46-50, from a school of 100-399 FTE students, reported to a vice-president, and had held the administrative position less than 6 years. 132 Table 10 Total Responses to the Question: What is your age as of Your Last Birthday? AdmifiiBéghtor Frequency Percent 25 - 30 years 2 .9 31 - 35 12 5.6 36 - 40 30 14.0 41 ‘ 45 25 11.7 46 ' 5° 36 16.8 51 - 55 54 25.2 56 - 60 38 17.8 61 - 65 12 5.6 66 or over 1 .5 No Response 4 1.9 TOTAL 214 100.0 133 Table 11 Total Responses to the Question: Which is your sex? Sex Frequency Percent Male 4 1.9 Female 207 96.7 No Response 3 1.4 TOTAL 214 100.0 134 Table 12 Total Responses to the Question: What is your Highest Earned Degree? Highest Earned Degree Frequency Percent Baccalaureate O 0 Masters 64 29.9 Doctorate 146 68.2 Other 2 .9 No Response 2 .9 TOTAL 214 100.0 PART II PRESENTATION OF FINDINGS Responses According to Extent of Aggeement About LongeRange Planning Question Set B included the deans' personal and professional outlooks for nursing and nursing education as well as interdisciplinary collaboration. The responses to Question Set B are ranked from highest to lowest according to their mean scores as shown in Table 13. It was evident that the deans strongly agreed with the majority of the eight statements and most of all with "Long-range planning is becoming crucial to the nursing profession." The statement received the highest mean score of (4.64) out of the highest possible score of (5.00). The statement which received the lowest mean score (2.50) was: "Long-range planning is adequate in my school at present," placing it between the "somewhat agree" and "strongly agree" categories. For the most part, the future-focused statements (those with "should") were ranked higher (second, third, fourth and sixth) than the present-focused statements (those with "is"% receiving ranks by mean scores in first, fifth, seventh, and eighth places. In summary, the deans have indicated that they believe very strongly in the importance of long-range 135 136 Table 13 Rank, Standard Deviation,and Means* of Responses According to Extent of Agreement About Long-Range Planning Statement Rank Means* .D. Long range planning is becoming crucial to the nursing profession Nursing school administrators should participate in long range planning with other nursing schools in my region Nursing school administrators should participate with other heaIth care faculty in the region for long range planning Long range planning should be one of the primary activities of the nursing school administrator Long range planning is high on my ersonal list of activities for the school Long range planning should be more actively pursued in my school Long range planning is high on my institution's list of priorities for all programs Long range planning is adequate in my school at present 1 4.64 2 4.46 3 4.44 4 4.20 5 4.01 6 3.90 7 3.56 8 2.50 .55 .68 .66 .86 .92 .13 .05 .19 *Means are based on scale of disagreement, to five being the most N = 214 one being most agreement. 137 planning also realizing that it is not as adequate as they would desire in their schools. Issues Confronting the Nursing Profession According to Importance, Urgency, and Degree of Progress py 1990 Table 14 introduces the responses made to state- ments in Question Set C. The format is presented according to ranked means and standard deviations for the nine statements on issues confronting the nursing profession according to importance, urgency, and degree of progress by 1990. The ranking of the means according to importance and urgency agreed closely; however there were greater differences in ranking according to the degree of progress by 1990. There were two items which received the same ranking of eight and nine in each of the three areas of importance, urgency, and degree of progress. These were: ”Interdisciplinary student education with nursing, medicine, and pharmacy" with mean scores of (3.48), (3.30), and (3.71) respectively, and "Educational preparation for independent nursing practice at baccalaureate levels" at (3.09) importance, (3.00) urgency, and (3.45) for degree of progress by 1990. One item, "Agreement on levels of preparation for entry to professional nursing practice,‘ received the same or first ranking, (4.76), for importance and (4.28) for 138 degree of progress by 1990, and second ranking, (4.67), on urgency. Two items received equal rankings for importance and urgency. Receiving third rank, (4.47) and (4.17) respectively in these two areas, was the statement, "Nurses and physicians functioning as colleagues," and receiving sixth rank (3.85) for degree of progress by 1990. The seventh ranked item, "Continuing education credits for relicensure,‘ received (3.81) for importance and (3.66) for urgency. This item ranked second (4.19) for the degree of progress by 1990. The item, ”Direct payment to nurses for services rendered," was fourth ranked equally for both urgency (4.16) and for degree of progress by 1990 (4.10). This item received fifth rank (4.27) in importance. The item.which received the most variation in ranking in the three categories of importance, urgency, and degree of progress by 1990, was "Clarification and agreement on the goals and direction of professional nursing by the majority of the profession," being ranked second (4.75), first (4.70), and seventh (3.72), respec- tively. The remaining two statements fluctuated at mid— point rankings. The fourth ranked statement (4.31) on importance: "Colleague relationship with health profes- sionals other than physicians" was sixth (4.03) on urgency and fifth (4.09) for degree of progress by 1990. 139 The sixth rank statement on importance (4.21), "Separate state board exams for the designated levels of education," was fifth (4.14) on urgency and third (4.11) on degree of progress. Summary The issue of agreement on levels of preparation for entry to professional practice was perceived as being of high importance, urgency and that there was optimism that progress will be made toward resolution of the problem by 1990. Clarification and agreement on goals of the pro- fession was perceived with highest priority on urgency, but the possibility of progress being made by 1990 was not nearly in as high agreement. Other issues of interdisciplinary functioning and educational change, fee structure are all perceived with lesser importance, urgency, and lesser degrees of optimism for change. Amount of Agreement With Trends/Potential Changes in EducatiOn and Health Care Deliveny By 1990 Responses to Question Set D are included in Table 15 which is a presentation of the ranks by mean scores and standard deviations of responses to twelve trends/potential changes in nursing education and health care delivery. For ease of comparison the two areas are ranked and discussed separately. 140 AHHMODOmmmHumm co>aomox u O>Hu meme wagon mmouwoum n uaow whoa Scum uwcozo oz I mounu duodenbo vacuum I osu amaboue Houmouw a panama I moo we canon no woman cauZRRR .ucowus xaoaouuxo mafia: o>aw ou mucowu: o: wagon one we Damon co comma amazes .ucuuuomaa uuoa woaoo o>au cu ucmuuoeaa unwed waaon one no madam no woman sweat «aw I z mm.o nq.m o w~.~ oo.m m mm.H oo.n m mau>oa mucouoaauooam um ooauouue magmas: unoccueocow uou :oHuwuoeoue guacauuoavm no.o Ah.n m eo.~ on.n m co.H oq.m m Ramayana .ocaoavoa .wcamuao sues cowuaoavo uoouaua auocuaewooapHODoH Hm.o ma.¢ w no.a oo.n m mo.H Hm.m ououcooaauu you uuauouo coauuuovu wdaacauooo mm.o HH.¢ m no.a ¢H.¢ m mo.a H~.c o acaunoouo «0 mHu>OH cauucmuuov «no how nadxo canon canon ououmeom 1‘ es.o oa.¢ c om.o o~.< c mm.o n~.¢ m cuuoucou uuoa>uoa now manna: cu ucoaxun uuouua Ho.o oo.¢ n om.o mo.¢ o -.o Hm.¢ q nauseanuououe nuance sow: ammuwwwmwumucwuwawwuww om.c nm.n o no.o NH.¢ m oo.o sq.q m «onwaoaaou no wcacoauooaw acuaoauhnn can manuaz oa.o -.m n nn.o o~.¢ H on.o mn.¢ N .co«naououe osu mo huwu0qoa onu he wcwauoo Hoseauuowoum mo cowuoouuv can «Hmow ago so ucoaoouwu can acauaouuuuaao H~.o w~.q H no.0 ne.¢ N on.o on.¢ a .oouuouua wdwuuac Hoseaumowoun ou zuucu now noduouanuue mo aao>o~ co ucoaoouw< .mammmumm .amm. un.ua 8 8 9x. a H ¥ aaouwoum mo oouwoo hucowua oocuuuoeau ufldfiduuum coma Ab uaouwoum mo oouwon vow hucmwua .uoouuuomaH cu wowuuoou< scauuowoum mcamusz Ono wcaucouucoo «manna mo aucoaouuum co ouoom ago! new .zo«uow>oa pudendum .xcam «a manna 141 Nursing Education There was strong agreement on four of the five items with the highest ranked item (4.76), "Baccalaureate degree as the initial requirement for all professional nurses," indicated by 179 (83.6%) of the respondents. Items ranked second, third, and fourth deal with trends in baccalaureate, masters, and doctorate level education. The second and third items, "Baccalaureate education with a generalist focus” and "Specialization at the masters level," are almost identical in their mean scores, (4.55) and (4.54) respectively, while there is less agreement (4.06) with "Specialization at the doctoral level," although still qualifying for "strongly agree." The lowest or fifth ranked item in this section (3.65) falls at midpoint between "somewhat agree" and "strongly agree” being: ”Educational mobility allowing more orderly advancement from technical to professional education." Summary Strong agreement exists for the initial preparation of the professional nurse. However, the focus of higher educational programs has slightly less agreement, but the route to obtain this education is perceived with much less agreement. 142 Health Care Deliveny Seven statements focused on health care delivery. The highest ranked statement (4.70) "Focus on preventive rather than crises care” was in "very strong agreement" by the deans. The second highest ranked item (4.59) related to "More health care taking place in the home under the guidance of nurses." It is of interest to compare items ranked third (4.46) and the lowest of the seven statements (3.36) which focused on use of technology. The deans were in much more agreement with, "More effective utilization of technology which will make the cost of health care affordable to all" as contrasted to "Automated physical diagnosis that is client initiated and operated." "Strong agreement" was indicated (4.38) for "Baccalaureate nurses providing the majority of care in ambulatory centers with referral to other health care workers as needed." ”Provision of mobile care vans for those unable to travel" was ranked as fifth of the seven statements by its mean score of (4.20) placing it in "strong agreement.” The sixth ranked statement received a mean score of (3.87) which pertained to "Consolidation of current hospitals into regional centers" qualifying it in the "somewhat agree” category. 143 Table 15 Rank, Standard Deviation and Means* of Responses To Amount of Agreement with Trends/Potential Changes in Education and Health Care Statement Rank Means* S.D. Nursing Education Baccalaureate degree as the initial requirement for all professional nurses Baccalaureate education with a generalist focus Specialization at the masters level Specialization at the doctoral level Educational mobility allowing more orderly advancement from technical to professional education Health Care Delivery Focus on preventive rather than crises care More health care taking place in the home under the guidance of nurses More effective utilization of technology which will make the cost of health care affordable to all Baccalaureate nurses providing the majority of care in ambula- tory centers with referral to other health care workers as needed 144 Table 15 (continued) Statement Rank Means* S.D. Health Care Delivery (Continued) Provision of mobile care vans for those unable to travel 5 4.20 0.79 Consolidation of current hospitals into regional centers 6 3.87 0.97 Automated physical diagnosis that is client initiated and operated 7 3.36 1.02 *Means are based on the scale of one being the most disagreement, to five being the most agreement. N = 214 145 Summary There was strong agreement on the change of health care delivery to a preventive focus but much less agree- ment on the role of the client in initiating an automated device to obtain a physical diagnosis. Responses to the Stimulus Phrase, "Long-range Planning" Responses to Question Set E are displayed in Table 16. This question set consisted of twelve adjective pairs to which the deans were asked to respond according to their perceptions toward the stimulus phrase, "Long-range Planning.” The scale for this question extended from a low of one (Negative) to the highest possible of seven (positive) with four being considered neutral. The adjective pairs primarily focused on financial, personal, and professional perceptions of the respondents. Only two adjective pairs received mean scores in the negative range (below four). These were given for ”Difficult" (2.53) and "Expensive" (3.23). Only one mean score (4.79) was classified in the neutral area in response to "Constrained" versus "Free.” The remaining nine adjectives received responses on the positive side of neutral ranging from the lowest (5.05) for "Successful" to the highest (6.37) for "Useful." Therefore, the respondents perceive long-range planning to be: "Useful" (6.37); "Stimulating" (6.12); "Positive” (5.99); ”Rewarding" (5.84); ”Meaningful" (5.75); 146 Table 16 Ranks, Standard Deviations, and Means* Of Responses to Phrase'Long Range Planning” Negative Positive Rank Means* S.D. Worthless Useful 1 6.37 1.09 Boring Stimulating 2 6.12 1.03 Negative Positive 3 5.99 1.56 Unrewarding Rewarding 4 5.84 1.19 Meaningless Meaningful 5 5.75 1.54 Not Enthusiastic Enthusiastic 6 5.61 1.46 Incompetent Competent 7 5.51 1.17 Inexperienced Experienced 8 5.23 1.53 Unsuccessful Successful 9 5.05 1.18 Constrained Free 10 4.79 1.55 Expensive Inexpensive 11 3.23 1.51 Difficult Easy 12 2.53 1.43 *Means are based on a negative to positive scale (one being negative, four being neutral, and seven being the most positive). N = 214 147 "Enthusiastic" (5.61); "Competent" (5.51); "Experienced" (5.23); and "Successful" (5.05). Summary The deans showed enthusiasm toward long-range planning in that they perceived it to be highly useful but were also realistic as to its difficulty and expense entailed. Neutrality was expressed on the issue of its constraints as compared to freedom. Persons/Groups/Factors That May Influence Long-range Planning for Nursing and Nursing Education Table 17 displays twenty-one statements in order of mean scores with standard deviations according to the degree of influence the persons/groups/factors should have contrasted with the ranks of the amount of influence they will have on nursing and nursing education by 1990. Question Set F was based on a five point scale, the highest degree of influence being five. The most readily apparent observation that n9 agreement was expressed in the ranking by means for any of the statements in relation to the degree of influence they should have and will have by 1990. The deans perceived that they should have extrem— ely high influence (4.59) whereas the mean score rank for the degree of influence they will have was ranked fifth or (4.00). 148 Second, to the deans, "Teaching faculty in graduate programs" should have next highest influence (4.54) but ranked fourth (4.13) in amount of influence they will have. "Faculty teaching in baccalaureate programs" received the third highest mean score (4.36) in regard to influence it should have while being ranked seventh (3.76) in degree of influence it will have. The "ANA" was fourth ranked (4.28) for influence it should have versus fourteenth (3.48) for influence it will have. "Nursing research" ranked fifth (4.25) for influence it should have while eighteenth (3.34) in degree of influence it will have. Sixth ranked (3.96) in influence they should have were "Clients (the general public)" while being ranked nineteenth (3.19) in degree of influence they will have. The "NLN” ranked seventh (3.95) in degree of influence it should have and tenth (3.61) in degree of influence it will have. "Directors of nursing service in community health agencies" received eighth rank (3.89) for degree of influence they should have and seventeenth (3.43) for degree of influence they will have. Ninth ranked by mean (3.84) for the degree of influence they should have were "Directors of nursing service in hospitals" while ranking eleventh (3.56) in degree of influence they will have. 149 "Interdisciplinary teams" ranked tenth (3.71) for degree of influence they should have and ranked twentieth (3.14) for the degree of influence they will have. The eleventh ranked item (3.55) for degree of influence it should have was "The high cost of health care" while being ranked first (4.39) in degree of influ- ence it will have. "Nursing students in baccalaureate programs” were ranked twelfth (3.54) for degree of influence they should have while being twenty-first (3.07) in degree of influence they will have. "State higher education coordinating boards” were ranked thirteenth (3.53) in degree of influence they should have whereas they received ninth rank (3.64) in degree of influence they will have. The statement which received the closest rankings for both should and will was "State boards of nursing" which ranked fourteenth (3.52) in degree of influence they should have contrasted to being ranked fifteenth (3.45) in degree of influence they will have. "National legislation" ranked fifteenth (3.30) in degree of influence it should have and third in degree of influence (4.22) it will have. "The high cost of education” ranked sixteenth (3.25) in degree of influence it should have and second (4.28) in degree of influence it will have. 150 ”State manpower planning agencies” ranked seven- teenth (3.21) for degree of influence they should have while being ranked eighth (3.67) for degree of influence they will have. "State legislation" ranked eighteenth (3.19) for degree of influence it should have and sixth (3.97) for degree of influence it will have. "Foundation and grant sources" ranked nineteenth (3.03) in degree of influence they should have and twelfth (3.54) in degree of influence they will have. The twentieth ranked item was "Non-nurse profes- sional planners" (2.71) for the degree of influence they should have in contrast with being ranked sixteenth (3.45) for the degree of influence they will have. Ranked twenty-first were ”Hospital administrators" (2.51) for the degree of influence they should have and thirteenth (3.48) for the degree of influence they will have. Summary The persons/groups/factors which should have and will have influence on long-range planning were indeed a contrast. Persons (deans and faculty) and professional nursing organizations should have influence but costs and legislation will have the greatest influence on long-range planning. 15]. Hm.o co.m m No.0 mn.m ma acumen wcauuchuooo .vu nonwwm ouuum ow.o so.n Hm an.o «m.m NH mamuwoua mucouamaaoomn ca aucovaum wowauaz on.o mm.¢ a HN.H mm.m Ha uuuo guano: mo umoo swag one mm.o «H.n om hm.o H~.m 0H .ouo .nuoxuos Hmfioom .nz .mmmuzn mo vamomaoo Ewan humcaaawomwpumucH mm.o om.n AH om.c ¢Q.m m manuammon cw uow>uou wdwmusa mo mucuomuwo om.o mq.m NH om.o mm.m m mowocowm guano: muacsaaoo cw moa>uou weamuzc mo mucuoouwa Hm.o Ho.m ca mo.a mm.m n 242 oa.o mH.m ad em.o oo.m o Aunansa Hmuoauw mane mucaaso om.o «m.m ma om.o m~.¢ n soumommu wcwmusz cm.o m¢.m oa qw.o w~.¢ q mz Haas m>mx vasonm oocoaamcH mouwoa oucmaamcH owuwma ucoaoumom omaa an m>mx Hafiz can m>mm nHaozm muouumm\masouo\mcomumm mocmzamcH mo omuwon ou weavuooo< mquEmumum cu kmcmmz can .coHumH>mp numvcmum .mxcmm NH «Hook 3152 .oocwsamca swan hamsmuuxo wagon o>ww cu costHwa o: wagon mco .mo wamom o co comma mum mammzx «am I z mm.o w¢.m ma mm.o Hm.N Hm mucumuumwcaavm Hmuammoz am.o m¢.m ca mm.o Hm.~ om muocamHa Hmcowmmowoum omuscnaoz «o.~ cm.m NH mo.H mo.m ma amou30m ucmuw paw cowumvaaom Na.o ha.m o ~a.o as." an conumaanwua mumum mm.o no.n m ww.o a~.m NH moflocowm wcwccmaa Hosoacma oumum 4m.o m~.¢ N mH.H mN.m 0H conumuaoo mo “moo swan one um.o -.c m no.H om.m ma conumamammfl Hmconumz ~a.o m¢.n ma No.4 ~n.m an wcnmusc mo acumen «swam .3 "u x. "a "u x. . a a a a a a "u G a u . u x. u ya 5 S * ¥ m>mm Haas m>mm oaaocm mucosawcH common oocmSchH mouwoa unmaoumum Aconcnucoov NH magma 153 Persons/Events/Conditions/and Policies which Hinder or Facilitate Long-range Planning in the RespondentsT Schools Question Set G is presented in Table 18 and represents twenty-two items to which the deans were requested to respond in regard to the tendency of the persons/conditions/events/policies to hinder or facilitate long-range planning in the deans' schools. If the item was equally hindering or facilitating, the appropriate response was four or the mid-point on the seven point scale with one being the greatest hindrance to seven being the greatest facilitator. The placement of the items into rank order by mean scores seemed to rather naturally divide the twenty-two statements into thirds. The eight items which received the highest mean scores in descending order were: the first ranked item: "Myself" (5.88), the second ranked item: "The present curriculum" (5.26), the third ranked item: "Students in baccaluareate programs" (5.06), the fourth ranked item: "Nursing faculty at the baccalaureate level" (5.05), the fifth ranked item: ”Central administration in my institution" (4.98), the sixth ranked item: "Accreditation agencies, (NLN, State Board)" (4.94), 154 the seventh ranked item: "Rules and regulations in my institution" (4.91), and the eighth ranked item: "Clients, (consumers' demands)" (4.71). The middle group of items clustered in the range of four which indicated that they equally hindered and/or facilitated long-range planning in the respondents' institutions. These six statements are presented in descending order by their ranked mean scores: the ninth ranked item: "Rules and regulations in my institution" (4.42), the tenth ranked item: "Value changes in society” (4.46), the eleventh ranked item: ”Other administrators, (peers in other disciplines)" (4.36), the twelfth ranked item: "Rapid changes in tech- nology" (4.31), the thirteenth ranked item: "Other health related faculty" (4.10), and the fourteenth ranked item: "Hospital and agency administrators" (3.91). The remaining eight items had mean scores which indicated they tended to hinder long-range planning in the respondents' schools. These items are listed in order of descending mean 8 cores: the the the the the the the the Summary 155 fifteenth ranked item: "Awareness for the need for long-range planning by society in general" (3.79), sixteenth ranked item: ”Uncertainty in society" (3.45), seventeenth ranked item: "Financial conditions in my institution" (3.21), eighteenth ranked item: "Work load of faculty" (3.09), nineteenth ranked item: "National financial conditions" (3.01), twentieth ranked item: "Statewide financial conditions” (2.95), twenty-first ranked item: "Time available for planning" (2.71), and twenty-second item: "Each profession protecting his/her own 'vested interests'" (2.52). The items which were perceived to facilitate long-range planning tended to be primarily related to people (deans, faculty, students, and clients). The items perceived to be neutral tended to be related to policies, values, changes, and other administrators. The items which clearly were perceived to hinder long-range planning were finances, time available for planning and most of all ”vested interests" of each profession. 156 Table 18 Rank, Standard Deviation, and Means* of Persons, Events, Conditions, and Policies According to Hindrance or Facilitation of Long-Range Planning Statement Rank Means* S.D. Myself. 1 5.88 0.98 The present curriculum. 2 5.26 1.26 Students in baccalaureate programs. 3 5.06 1.02 Nursing faculty at baccalaureate level. 4 5.05 1.22 Central administration in institution. 5 4.98 1.68 Accreditation agencies, (NLN, St. Bd.). 6 4.94 1.35 Rules and regulations in my school. 7 4.91 1.27 Clients,. (consumers‘ demands). 8 4.71 1.05 Rules and regulations in institution. 9 4.42 1.36 Value changes in society. 10 4.46 1.17 Other administrators, (peers in other disciplines). 11 4.36 1.04 Rapid changes in technology, 12 4.31 1.10 Other health related faculty, 13 4.10 1.14 Hospital and agency administrators, 14 3.91 1.26 Awareness for the need for long range planning by society in general. 15 3.79 1.52 Uncertainty in society. 16 3.45 1.10 Financial conditions in my institution. 17 3.21 1.57 Work load of faculty. 18 3.09 1.39 157 Table 18 (continued) Statement Rank Means* S.D. National financial conditions 19 3.01 1.51 Statewide financial conditions 20 2.95 1.43 Time available for planning 21 2.71 1.36 Each profession protecting his/her own "vested interests" 22 2.52 1.21 *Means are based on one, being the greatest hindrance, to four being neutral, to seven being the greatest facilita- tion. N = 214 158 Long-range Planning in Each Respondents' School Question set H is presented in Table 19 and represents the length of time that each respondent perceived long-range planning to take place in their school. This was an open-response type of question to which the largest number 108 (50.4%) responded that they planned for a time span of "5-7" years. The second highest grouping of responses by time span was in the "8-10" years category which was indicated by 44 (20.5%) responses. Thirty, (14%) indicated that their school planned for "2-4" years followed by seven respondents (3.3%) who planned for less than two years. Five, (2.3%) respondents stated that their school planned for "14-16” years. Only one respondent indicated planning for twenty or more years. The number of blank spaces or non responses to this question was present on 15 (7.0%) of the questionnaires. Summary The majority of respondents indicated that long- range planning in their school extended over a period of 5 to 10 years. The large number of non-responses for this question was greater than some other categories of response. 159 Table 19 Total Responses to the Question: Long range planning in my school means planning ahead for __ months or __ years Years Frequency Percent Less than 2 years 7 3.3 2-4 30 14.0 5-7 108 50.4 8-10 44 20.5 11-13 4 1.8 14-16 5 2.3 17-19 0 O 20 and over 1 0.4 No response 15 7. 214 99.7 160 Chapter 5 SUMMARY, IMPLICATIONS, CONCLUSIONS, AND RECOMMENDATIONS SUMMARY Problem.Statement The major problem focus for this study was to ascertain baccalaureate nursing-school administrators' perceptions of selected aspects of long-range planning for nursing and nursing education. Desigg A questionnaire was mailed to 286 nursing school administrators of accredited baccalaureate schools of nursing in the USA during the winter of 1978. There was a response rate of seventy-five percent. All regions of the nation showed similar representation with the midwest having a slightly higher response rate. Demographic and Background Profile'offRespondents The typical respondent was called a dean, was a female between the ages of forty-six and sixty, employed by a public institution having from 100-399 full-time equivalent students, held an earned doctoral degree, reported to a vice president or a dean, and had held 161 the administrative position less than six years. No distinct response pattern emerged regarding the ages of the respondents' programs; responses were distributed throughout the age span from less than five years to more than thirty-one years. Extent of Agreement About Long-range Planning The deans agreed to some degree about all of the eight statements which included their personal and professional outlooks for nursing and nursing education and interdisciplinary collaboration. The future- focused, "should" statements tended to receive higher mean scores than the present-oriented, is" statements. Issues Confrontingthe Nursing Profession‘According to Importance, Urgency and Degree oflProgress by 1990 ' This question related to various phases of nursing and nursing education in addition to inter- disciplinary collaboration. The respondents answered according to three aspects of the statement: its importance, urgency, and degree of progress (or resolution) by 1990. Comparison of the three sets of responses generally indicated closer agreement about importance and urgency than about the degree of progress by 1990. The deans identified agreement on entry levels and 162 clarification of professional goals as the two most important and urgent issues confronting the profession. Trends, Potential Changes in Nursing Education and Health Care Nursinngducation. In response to the first five statements focusing on education, the deans agreed very strongly that the baccalaureate degree should be the initial requirement for all professional nurses. However, they agreed less strongly on the educational route that should be taken to reach this goal. Health Care Delivery. Responses to the seven statements relating to health care delivery issues tended to cluster into the two areas of highest agreement. The deans agreed strongly that the health care delivery focus should change from crises care to preventive care, but agreed less strongly on the role of the client in initiating an automated device (use of technology) to obtain a physical diagnosis. Perceptions of Long-range Planning The deans generally held positive perceptions of long- range planning as indicated by their characterizations of it as useful, stimulating, positive, rewarding, meaningful, enthusiastic, competent, experienced, and successful. 163 The negative perceptions indicated that long-range planning was expensive and difficult. Persons, Grogps, Factors That May Influence Long-range Planning Nursing Education and Practice There was a marked contrast between the two sets of ranked means showing which persons, groups, factors "should" have influence on long-range planning and which "will" have influence on long-range planning. There was g9 statement for which there was agreement for the two sets of ranked means. The deans perceived that persons (deans and faculty) and professional nursing organizations "should" have the greatest influence but that costs and legislation ”will" have the greatest influence on long- range planning. Persons, Events, Conditions, and Policies Which Hinder or FECilitate Long-range Planning The statements, when ranked according to means, clustered almost equally into thirds. The highest ranked items which were perceived to facilitate long-range planning tended to relate primarily to people: deans, faculty, students, and clients. The middle set of statements, perceived to be neutral, were related to policies, values, technology, change, and other administrators. 164 The lowest scored items that were clearly per- ceived to hinder long-range planning were finances, time available for planning, and, most of all, "vested interests" of each profession. Long-range Planning in Each Respondent's School The majority of respondents indicated that long- range planning in their schools extended over a period of five to ten years. IMPLICATIONS A most outstanding contradiction was apparent between the findings of this study and the results of the Huckfeldt study. In this study, the nursing school administrators perceived that the faculty had a highly positive influence on facilitating long-range planning. The Huckfeldt study in contrast, identified the faculty as the force most hindering change.1 Some caution is advised against directly comparing the two studies since nurses were not the subject of the Huckfeldt study and since the panel of participants in the Huckfeldt study was composed of persons other than administrators (al- though administrators composed the largest number of participants). Several questions with implications for nursing and nursing education are raised. Are nursing faculty different than other types of faculty? Are nursing 165 school administrators different than other types of ad- ministrators? Is the working relationship between the nursing school administrator and the nursing faculty different from other types of working relationships? A curious discrepancy can be noted between the deans' belief in the importance of interdisciplinary collaboration and their less strong support of inter- disciplinary education. One could ask how this relates to the perception that "vested interests” inhibit change most. How is one supposed to know how the other members of the professions function unless there is some sharing of common ideas in the basic student experience? Another observation which points out a major dilemma in the profession and which could be viewed as a note of pessimism, is that the deans perceived clarifica- tion and agreement on goals and direction of the profes- sion to be highly important and urgent but much lower in the degree of progress which will be made by 1990. Are the deans realistic or pessimistic in their perception? What actions by the profession are indicated? What will be the consequences to the profession if the factors which "should” influence and those which "will" influence long-range planning are not perceived to be the same? Is this an indication that nurses must influence legislation, increase their awareness and sophistication in politics and economics to have any 166 significant voice in long-range planning for the profes- sion? CONCLUSIONS The following conclusions were reached as a result of this study and are discussed according to the eight content areas of focus included in the study. 1. Personal and Professional Outlooks (a) Long-range planning was a topic of strong personal and professional concern to the deans. They perceived themselves as being highly influential in facilitating long-range planning. (b) The deans were positive and realistic in their perceptions of long-range planning. They expressed enthusiasm toward it while perceiving it as expensive and difficult. (c) Clarification of and agreement on professional goals was perceived to be an urgent and important issue. 2. Educational Priorities (a) The deans seemed to agree strongly with the generalist focus at the baccalaureate level and with specialization at the master's level. They agreed slightly less about specialization at the doctoral level. (b) The controversial nature of the issue of career mobility was confirmed in that there was some agreement 167 on proceeding from technical to professional education. This issue was also evident in that agreement on entry levels was high in importance and in urgency for the profession. (c) Educational preparation at the baccalaureate level for independent nursing practice was of least priority to the deans, possibly because many respondents believe that master's level preparation is preferable and necessary for independent practice. (d) Interdisciplinary education was perceived to be moderately important and urgent. 3. Changing Health Care Delivery System (a) The respondents agreed strongly that the focus should be changed from crises to preventive care and that more nurses should be providing health care in the home and in ambulatory care centers. 4. Interdisciplinary Collaboration (a) The respondents agreed moderately that interdis- ciplinary collaboration was important. (b) The deans agreed very strongly that baccalaureate nurses should provide care in ambulatory centers with referral to other health-care workers as needed. 5. Clients (a) The respondents indicated that clients ”should" have much more influence than they "will" have. 168 (b) Clients were perceived to have a positive in- fluence because they facilitate long—range planning. (c) Allowing clients to initiate and operate an automated device for physical diagnosis received a low mean score indicating ambiguous attitudes about the extent of client control. 6. Finances (a) The deans perceived that legislation and finances "will" have an extremely high influence on long- range planning, considerably more influence than they "should" have. (b) This finding also relates to the fact that the deans believed state and national legislation and financial conditions in the dean's institution would hinder long-range planning. 7. Technological Changes (a) Technological changes were perceived to have a neutral effect on long-range planning. (b) The deans agreed strongly that technology should be utilized effectively to make health care more afford- able. (c) Deans agreed only somewhat that technology should be available and initiated by clients for physical diagnosis. 169 8. Societal Changes (a) Several factors were perceived to hinder long- range planning in society: awareness of the need for long-range planning, uncertainty in society, and time available for planning. The factor perceived to be the greatest hindrance to long-range planning was "vested interests” protected by each profession. 9. The Instrument (a) A limiting factor of the study could have been the instrument and constraints imposed by the response options given to the nursing school administrators. If further studies are conducted with open-ended responses, other important and urgent items might possibly emerge. RECOMMENDATIONS Recommendations based on the findings of this research are presented to encourage more productive efforts toward long-range planning for the benefit of nursing and nursing education. 1. Deans and individual schools of nursing should examine their goals and purposes and the length of time needed and desired for engaging in long—range planning. 2. The profession must give educational priorities attention and must reach some consensus on 170 levels of preparation and long-term employment goals of graduates. Deans must examine their mission and obliga- tion to the current student and future graduate. Career mobility must be studied and some consensus about it reached by educators and employers of persons identified as ”nurses." 3. Factors that have been identified as hindrances to long-range planning should be examined and strategies designed to decrease or eliminate their negative influence. Efforts to decrease "vested interests" and increase trust levels within and between professions should be given high priority. Solutions should be explored and discussed openly so the profession can achieve the profes- sional goals they espouse to hold and practice. 4. Methods to enhance those factors identified as facilitators of long-range planning should be studied further. 5. More interdisciplinary educational programs and courses should be promoted to improve learning and collaboration between the disciplines and to arrive at the purported goals of providing high-quality care for clients/patients. 6. Major efforts in all facets of the profession (nursing and nursing education) must be made to enhance the positive factors, persons, and groups that the 171 profession believes should have high influence on nursing education and practice. 7. Further study of other populations perceived to be influential on the education and employment of nurses should take place with regard to their perceptions of long-range planning. 8. Further study of a practical definition of long-range planning for the profession should be pursued. 9. Based on the findings of this study and recognizing the factors which have been identified as having influence on future long-range planning, deans and faculty should become more knowledgable about and aware of economics and the political process so that they may acquire greater influence in these areas. These areas should also receive greater emphasis in undergraduate and graduate curricula. 172 Chapter 5 FOOTNOTES 1Vaughn E. Huckfeldt, A Forecast of Changes in Post Secondary Education (Boulder, Colorado: National Center for Higher Education Management Systems at Western Interstate Commission for Higher Education, 1972), p. 38. APPENDIX A COVER LETTER Michigan State University College of Education Department of Administration and Higher Education Dear Nursing School Administrator: With the growing recognition that the nursing profession needs to plan more systematically for the future, the focus of this study deals with the perceptions of Deans and Directors regarding long range planning. This subject was selected because of my own committment to the significance of establishing this knowledge base. This nationwide descriptive study includes all Deans and Directors of accredited baccalaureate schools of nursing. Little literature is available about the activities and perceptions of this group of influential nursing leaders in our nation relating to long range planning. Many of us recognize the lack of long range planning, (eleven or more years ahead. as defined in this study) in nursing education. Attempts to reach any concensus for future directions on either short or long range perspectives have produced a sporadic disarray of reports by commissions and study groups. Therefore. I believe this study will provide practical information for long range planning as well as providing heuristic value to the nursing profession. All responses will remain confidential and the code numbers will be used only to facilitate follow up communication. The data will be reported in group form. I will offer to present the results to the Deans and Directors Conference as soon as possible following completion of the study. If you personally desire a summary of the results you may send your request to me at: 444 30. Lexington Pky. , St. Paul. MN 55105. Even though there may be a designated person who is responsible for the baccalaureate program in your school of nursing, I am requesting the chief administrative person in nursing to complete the questionnaire. As I'm sure you understand, this will increase the meaningfulness of the data. The questionnaire should take about 30 minutes to complete. I would appreciate your response within the next three weeks. Thank you for your time and contribution to nursing research . Sincerely . % za- Mary eisensee. RN, MS PhD Candidate 173 174 QUESTIONNAIRE ON IONG RANGE PLANNING FOR NURSING fl Demographic and background data Please check the one most appropriate response which pertains to you or your institution . Which is the type of institution 6. in which you are currently a nursing school administrator? 1. Public University 2. Public College 3. Private University 4. Private College What is the FTE enrollment in your Baccalaureate program ? 1.1-99 7. 2.100-199 3. 200-299 4. 300-399 S. 400-499 6. 500 or more Which is your regional location? 1. SREB 2. NERB 8. 3. Midwest Alliance 4. WICHEN What is the primary title of the administrative position you 2. Chairperson 3. Director 4. Head 5. Coordinator 6. President 9. 7. Other, please specify 110$ Lug have you held this position? 10. 1. less than 1 year 2. 1 - 3 years 3. 4 - 6 years 4. 7 - 9 years 5. 10 - 12 years 6. 13 or more years I What is the age of the Baccalaureate program where you are currently employed ? l. 5 years or less 2. 6 - 10 years 3. 11- 15 years 4. 16 - 20 years 5. 21 - 25 years 6. 26 - 30 years 7. 31 or more years What is the title of the person to whom you report? 1. President 2. Vice-president 3. Provost 4. Dean of 5. Chancellor 6. Other, please specify llill What is your age as of your last birthday? 1. 25 - 30 years __2. 31 - 35 years 3. 36 - 40 years 4. 41 - 45 years 5. 46 - 50 years __6. 51 - 55 years 7. 56 - 60 years 8. 61 - 65 years __9. 66 or over Which is your sex? __l . male 2 . female What is your highest earned degree ? l. Baccalaureate 2. Masters 3. Doctorate 4. Other, please Specify 175 Note on definitions specific to this study. NURSING SCHOOL ADMINISTRATOR is used to include all participants in the study whether they are a Dean, Director, Chairperson or Department Head , as long as they are the Chief Administrator. LONG RANGE PLANNING refers to planning for the future 11 or more years ahead. Although the primary focus of this study is on baccalaureate education, other areas of nursing education and practice are included as they are related to long range planning which influence the basic preparation of professional nurses. Using the above definition of long range planning, to what extent do you agree with the following statements about long range planning? Please respond to each of the following statements by circling gag number for each statement. Very Strongly Agree Strongly Agree Somewhat Agree Slightly Disagree Strongly Disagree long range planning is adequate in my school at present. long range planning should be more actively pursued in my school. Nursing School Administrators should participate with other health care faculty in the region for long range planning. Nursing School Administrators should participate in long range planning with other nursing schools in my region. Long range planning is becoming crucial to the nursing profession. Long range planning should be one of the primary activities of the Nursing School Administrator. Long range planning is high on my personal list of activities for the school. Long range planning is high on my institution's list of priorities for all programs. 176 03000.35 05 N0 3:205 05 >0 050.50 302003000 No 0030020 000 2000 N N N v m N N N v m N N N v m 05 00 00.00000 000 003003320 .0 . 00000000 002200 N N n v m N N N v m N N n v m .NoN 000000 0N 000500 «0005 .m .30 Soefiuenn 05030.0 052:0 :33 N N N v m N N m e m N N N e m 533.60 0.003» 205382285 .N . 0N0>0N 3000020003 N0 0030000 05300 00000009: N N m 0 m N N N v m N N N v m 08 0030000000 300300000 .0 60803.30 005 0050 2002008000 N N n v m N N n v m N N n v m 0:00: 5:3 020003200 0:000:00 .m . «0:000:00 no N N m 0 m N N n v m N N N v m 05003003 000N0N0>£n 000 000.32 .0 0.5000020.— N N m e m N N N v m N N N v m 08 3:000 00300000 05003000 .N 00:00:00 No 0N0>0N 03000300 N N n v m N N n v m N N N v m 05 com 00.008 0.000 330 05300.0 .N 00300.5 050.50 302003000 o..— 300 08 N N N v m N N N v m N N n e n 025000000 No 0N0>0N 00 «00.00004 .N 8 8... 8.08 A HI 181 IAIS mmm»mwmwlmm WmmmmmmmNMmmmmwmwmmm 05300000005300300200500 mememo 1 sm. uflmam ma 0% 0.09 0A s 300300 >200: “mos 0023 000303 amamtu am: a 1.... :00 $3010 00 II Jazawmeoe A W aw wAwWw ea Nlo05053000050050:0002005 .099 869 MD. a Ma r. la... .M. m 9”. 1 .Mn 3 .rAI. m... n a K m 002th 10000000 No 00000Q .N .30005 .N 00030000: .N .82 >0 00 :0: 00000000 05 “000008 00> 00003 .N .002 .3 00:8 00 0002300 N05 >00000= No 000000 05. .N 5000.330 05 No 0003.500: 00 00330000. 05 3 050.5004 .N “933 0005 5 300.0330 050 05 0“ 0000000 00008 00808000 00.0.50 05 002000000 00.50020 000 00:02 “00:00 N0 N0: 0 2 053028 05. .U 177 How much do you agree with the following trends and/or potential changes in nursing education and health care delivery by 1990 ? Circle one number on the right which corresponds to the statement on the left. Very Strongly Agree Strongly Agree Somewhat Agree Slightly Disagree Strongly Disagree Nursing education 1. Baccalaureate degree as the initial requirement for all professional nurses. Baccalaureate education with a generalist focus. Specialization at the masters level. Specialization at doctoral level. Educational mobility allowing more orderly advancement from technical to professional education. Health care delivery 6. 10. 11. 12. Baccalaureate nurses providing the majority of care in ambulatory centers with referral to other health care workers as needed. More health care taking place in the home under the guidance of nurses. Automated physical diagnosis that is client initiated and operated. Focus on preventive rather than crises care. More effective utilization of technology which will make the cost of health care affordable to all. Consolidation of current hospitals into regional centers. Provision of mobile care vans for those unable to travel. E. 178 As you think about long range planning and your personal feelings toward the process, mark your response on the following adjective scale. For each item, place a check mark on the line corresponding to the scale which most nearly describes your feelings. Place check (J) on a line, NOT BETWEEN. If you are neutral, use the middle or fourth space. Long Range Planning 1 2 3 4 5 6 7 l. Constrained Free 2. Easy Difficult 3. Boring Stimulating 4 . Enthusiastic Not Enthusiastic 5 . Unsuccessful Successful 6 . Meaningful Meaningless 7 . Unrewarding Rewarding 8 . Positive Negative 9 . Incompetent Competent l 0 . Experienced lnexperienced 1 1 . Expensive Inexpensive 12 . Useful Worthless 179 N N N v N N N N 0 N .0000 05000 No 0000 00:. 05—. AN N N N N. N N N N v N 00300000 No 0000 005 05. .3 N N N v N N N N v N .000500 N080 000 0003000000 .NN N N N N. N N N N v N . 0002202 Nacozoz .3 N N N v N N N N v N 0002032 330 .5 N N N v N N N N v N .0053 05.550300 00300000 00052 330 00H. .3 N N N v N N N N v N .242 .NN N N N v N N N N v N .424 .3 N N N v N N N N v N 5000000.. 050.52 .NN N N N v N N N N v N 402000 N000000 00: 050:0 . NN .000 £00503 .000 .92 N N N v N N N N v N .0005: No 000000.00 0800“ 30025050035 . NN N N N v N N N N v N 0500000 050050 00300000. 0500. .3 N N N v N N N N N. N 05050 No 000000 330 . N 0500000 05002 N N N v N N N N v N 3505000 5 003000 05050 No 0090005 .N N N N v N N N N v N .2050000 5 005000 05050 No 0090059 . N N N N v N N N N v N . 0030555500 N05000: . N N N N v N N N N v N 0000050 308008000 0050.002 . N N N N v N N N N v N 00.000000 3005500000 5 300030 05052 .v N N N v N N N N v N .500 000 NS: 00.000000 3000000 5 >uN000N 0500009 . N N N N v N N N N v N 0.0000000 3005500000 5 050003 >NN000.N . N N N N 0 N N N N v N .000 No .000 .0000 No N000 00003 0030555804 .N I I I I I I I mmmmmmmmmmmmmmmmmmm n nenQnan n nenu.ne u N .. N N m N u N u .N N m 0 WT W W 0 0 0 1 0 to W a a a a A a a a a e a A 0003000 :03 05 No 0000 5 008000 0:3 20.00 mm m .32 >0 05952 20 023 0593000 NAN? 00908000000 u. 0. \0000000 05 N05 0000025 05 No 003000000 50> 3 0500000< . N , .82 .3 05052 20 ”$5 05000 2802\335 m> 0N 0500000< .N 0000025 00.53 .N 0000025 00000nN .N .0>03 0a 5 0805 053028 05 0» 000000.. 00020 0030000 000 00300000 05050 08 050050 0000.. 008 0000025 >08 00.2 000N08\000o..0\0000000 N0 N0: 0 2 053028 05. .0 180 G. How do you perceive the influence of the following persons, events, conditions, and policies on the future planning that takes place in your school of nursing at the present _tim_e? Please indicate whether the items listed tend more to hinder 9_r_ facilitate long range planning by circling one number which represents the majority of your experiences. If the items are equally hindering and facilitating circle the middle or number four. < ----Hinder ----------- Facilitate----> 1 . Central administration in my 1 2 3 4 5 6 7 institution . 2 . Myself. 1 2 3 4 5 6 7 3 . Nursing faculty at the l 2 3 4 5 6 7 baccalaureate level. 4. Other administrators, (peers l 2 3 4 5 6 7 in other disciplines). 5. Other health related faculty, (MD, 1 2 3 4 5 6 7 pharmacy, soc. workers, etc.). 6. Accreditation agencies, (NLN , l 2 3 4 5 6 7 State BD.). 7. Rules and regulations in my 1 2 3 4 S 6 7 institution. 8. Rules and regulations in my 1 2 3 4 5 6 7 college . school , department , or division . 9. Uncertainty in society. 1 2 3 4 5 6 7 10. Clients, (consumers' demands). 1 2 3 4 5 6 7 ll . Statewide financial conditions. 1 2 3 4 5 6 7 12. National financial conditions. 1 2 3 4 5 6 7 13. Financial conditions in my 1 2 3 4 5 6 7 institution . 14. Rapid changes in technology. 1 2 3 4 5 6 7 15. Value changes in society. 1 2 3 4 5 6 7 16. Students in baccalaureate l 2 3 4 5 6 7 programs . 17. The present curriculum. 1 2 3 4 5 6 7 18. Hospital and agency 1 2 3 4 5 6 7 administrators . 19. Work load of faculty. 1 2 3 4 5 6 7 20. Time available for planning. 1 2 3 4 5 6 7 21 . Awareness for the need for 1 2 3 4 5 6 7 long range planning by society in general. 22. Each profession protecting his/ 1 2 3 4 5 6 7 her own ”vested interests" . H. long range planning in my school means planning ahead for months or years. End of questionnaire Thank you APPENDIX B POST CARD REMINDER Dear Nursing School Administrator; In early February, I mailed a questionnaire to you which focuses on long range planning for nursing and nursing education. If you have not returned the questionnaire, I would appreciate your response within the next two weeks. If you have recently mailed it, please disregard this card and accept my thanks for participating in the study. Sincerely, Mary C. Weisensee 444 South Lexington Parkway St. Paul, Minnesota 55105 181 APPENDIX C RAW DATA Table C- 1 Total Responses to the Question: Extent Do You Agree With the Following Statements About Long Range Planning? To What Statement Very Strongly Agree (5) Frequency Percent Strongly Agree (4) Frequency Percent Somewhat Agree (3) Frequency Percent Slightly Disa ree (2 Frequency Percent Strongly Disa ree (1 Frequency Percent No Response Frequency Percent Long range planning is adequate in my school at present. Long range planning should be more actively pursued in my school. Nursing School Adminis- trators should partici- pate with other health care faculty in the region for long range planning. Nursing School Adminis- trators should partici- pate in long range planning with other nursing schools in my region. Long range planning is becoming crucial to the nursing profession. Long range planning should be one of the primary activities of the Nursing School Administrator. Long range planning is high on my ersonal list of activ1ties for the school. Long range planning is high on my institution's list of priorities for all programs. 12 5.6 75 35.0 114 53.3 118 55.1 145 67.8 92 43.0 70 32.7 42 19.6 13.6 80 37.4 78 36.4 73 34.1 60 28.0 83 38.8 93 43.5 76 35.5 32.7 31 14.5 20 9.3 19 8.9 29 13.6 17.8 38 63 29.4 20.6 14 6.5 24 11.2 58 27.1 12 5.6 1 (.5) 2 (.9) 2 (.9) 3(l.4) 1 (.5) 1 (.5) l (.5) 1 (.5) N - 214 1132 1i33 «AN u z Hmuoa a.H e o o o o m.m m w.na mm H.5m noH .cofimmowoum o u mo xuauonma «no An magmas: Hmcowmmmmou mo coHuooqu mam mamow msu co unwaomuwm mam coflumoHMflumHu q.H m m. N N.¢ a m.oH NN o.mm mm H.w¢ moa .vmuoucou moow>umm now momma: ou ucoahma uoouwn m.H s m.~ o o.qH cm “.mm o“ w.om so m.~H mm .somaumza .mafiosvma .wasmuac as“: coaumonvo ucovsum >uwcwaawomwmumucH o.n NH m.m~ «m q.mH mm «.mN on ¢.m~ on s.oa mm .mHo>mH oumousmauuomm um caduceus madman: ucoucmaovca How coauoumaoua docoaumuavu ¢.H m m. H q.H m ~.HH «N a.am mm m.ms mo .acmsofimssa nuns guano mamaosammmoua guano: saga masmaowumaou ozmmmaaou «.a m o o n. a m.m 0H n.nn on H.nm mHH .mosmmoaaoo no mafiaowuocam «cowofimmnm cam momusz m.m w s.n w H.m AH m.n~ an ¢.om ms H.5N mm .ousmcoofiamu Mom muwvouo couuouano maascaucou .m.n n ~.¢ a N.q m n.oa mm «.mu #n m.~m NHH .aoaumosno mo mHo>oH woumcwamov onu you mamxm vumon oumum mumumaom a. N m. H o o m.m A a.mH «m ¢.on aha .musuumua mcamusc Hmcoammwmoua as space you cowumuwaoum mo mHo>oH co ucoaoouw< .4 a. .d .a .a .a .d .a .4 a. .d .a a 1 a 1 a 1 a .1 a 1 a 1 1 a 1 a 1 a .1 a z a 1 a «u .b o .b o .b a .D 3 kg 3 .b a n a n a n .a n a n a n u a u a u a u .u u a u a «a u 3 u 3 u 3 u 3 nu 3 u o a a a o o .A .A .A .A ,A .A cocoa ucau ucmuuomEH uncommom -uoaau uuoaaH mason unauuomaw ucmuuogaH oz oz mo agonwwam -uavc: >uo> hamaouuxm ucoawumum Godunowoum wcwmuaz on» moaucoumcoo mozmmH mo mucouuoaaH cu wcgpuooo< mufiofimumum cu noncoamom Hmuoa «no canoe lEhfi caN u z HmuOH n.N m o o o o o.n NH N.wH mm w.mn me .cowmmmwoua mnu mo augmenma «so an wagons: Hmcowmmomoua wo cofiuoouaw mam mHmow mnu co ucoewmumm mam cowumoawwumao m.H c m. N m.N m o.mH Nq N.Nm on m.Nq aw .pououcou moua>uom How mmmusc cu ucoahmm uuouwo m.~ n n.¢ oH n.sH Hm w.wm ma ~.m~ mm o.¢H on .Nuaaumna .ocHUHcoa .wchua: nuH: coaumoavo ucmbsum mumcwaaaomwbumucu o.N ma «.0H mm o.¢a 0m o.mN No c.0N cs H.ma wN .mao>oH mucousoauoomm um oowuomua wawmusc ucovcmmovaa Mow cowumumaoua awcowumoavm n.N m a. N w.N o «.mN on n.nm cm o.nm mm .mcmwuwahna coca umnuo mausoammomoum guano: suds nasmcoNumHmu odwmmaaoo m.N n n. a m.N m N.wH on n.mm on H.H¢ mm .mmawooaaou no wcaaowuoaam «Guacammna can momuaz N.¢ m N.n m o.N m¢ N.Nn oh o.oN Nm N.mN mm .oHSmCouwHou you mufivouo cowumodvo mafiacaucoo n.m N N.¢ m m. N c.aa N¢ m.¢N mm N.N¢ aoa .coaumoavo mo mao>oa voumnwwmmv osu you mamxo bumon mumum oumumaom a. ~ m. H o o o.m NH H.o~ me ¢.- omH .ouHuoaua wcHausc Hmconaomoua ou Nuueo you cowumumaoua mo mHm>oH so ucoammuw< .a .d .a .a .d .a .d .a .d .a .d .a a .1 a 1 a 1 a z a 1 a 1 .1 a 1 a 1 a 1 a 1 a 1 a a NW a .m a .m a .m a .m a .m mammwmmmwmmm 3 3 3 D 3 O .A ,A .A .A .A .A uncommoa hoaowua Nocowus uaomus ucmmus anew»: oz oz mauuaq waouwuovoz >uo> haoaouuxm unassumum sowumomoum wcwmuaz onu wcwucouucoo moammH mo hocowua cu wcaouooo< «unassumum ou momcoaamm Houoa AuoaaHucoov ~-o «Hana 1185 «HN u z m.N o c.m NH q.H n N.mH oq N.oo omH N.oH mN .aOHmmowoua ago no muHMOHmE ecu zn waHmuac Hmconmmwoud mo COHuomuHo cam mHmow can no ucoEmmuwm cam coHumonHumHo m.N o m.H q a. N q.m NH N.oo omH N.nN ¢m .pououcmu mmoH>uoa you momusc ou ucoaxma uoouHa N.N o o o N.¢ OH N.NN Hm H.No mNH o.m NH .Nomauana .mcHoHnma .wchuac suH3 :oHumonvo ucovSua zumcHHaHomHoumucH n.N oH N.¢ oH N.HH «N o.NN no N.N¢ HoH m.~ 0H .aHo>oH oumouamHauomm um oOHuooua waHmusa ucmvcoaovcH Mom coHumumaoun Hm:0Huwonvm m.N n o o ¢.H m m.m HN o.mo mMH m.HN cc .mcmHonznm cwnu nonuo mHchHmaomoun nuHmon squ chchHumHou mawmmHHoo N.N m m.m N ¢.H m H.NH oN H.oN omH N.oH NN .moawamHHou an wchoHuossm uaaHUHmN:a ecu mmuuaz H.m HH m.N o w.N o n.o «H m.mq sm w.mm mm .ousmchHHmu now aUHvouo :oHuwoavo mcHacHuaou N.¢ 0H m. H m.m N o.nH Nm o.m¢ No o.mm Nu .GOHumoano mo mHo>uH woumcmemv onu now mamxo whoop oumum oumuoamm N.N N a. N a. N H.o NH N.on NOH N.Nn HN .moHuomua waHmusc Haconmmmoua ou zuuco now :oHumummoum mo mHo>oH no ucoaoouw< -. .a .a .d :& um 1. mu .4 .a .4 .a .a a 1 a 1 a 1 a 1 a 1 a 1 1 a 1 a 1 a 1 a 1 a 1 a ”.mwbnwmwnwaw u - a u m u a u a u a u a 3 u 3 u 11 u 3 u 3 u 3 u o a o a a a ,A .A .A .A .A .A aanoum nouwwuu ova: zHHuou uncommoz a ouoHomno m aH aoum weaom uumumHumm unassuwum oz osmoon cannon m cmnu oz ammuwoum ow>H0moz 4 conmowoum waHmudz «no wcHucouwcoo «mammH so camH zn umsuwoum mo mouwoa ou wchuooo< musmaoumum ou noncoammz Hmuoa 82.5389 To 33 1865 m. L H.m HH N.HH «N m.am mm m.mN so o.mH mN .vsumusao mam vsumHuHmH ocsHHo mH umnu mHmocmem Hmonzza usumaouad m. N o o o o m.N m 0.0m NN N.oc omH .msmuaa mo soamoHaw szu usmca sac: snu cu somHm wcmeo sumo onmsn suoz ¢.H n m. H N.m w n.N oH N.mm HN N.mm nHH .vsvssc mm musxuoa sumo nuHmsn usnuo ou Hmuusmsu nuHa musucso NuoumHanam :H sumo mo huHuOHma snu mchH>oua msmuzc sumsuanmoomm Nus>HHsm sumo nonsz q.H m m.N NH m.N NH w.m~ Hm m.mN so o.mN No .:0Humosos HmGOHmmsmoua ou Hmochosu aoum ucsasoam>om >Husmuo suoa mcHonHm zuHHHnoa HchHumodmm m.N o H.m HH o.N nH «.0H mm m.NH Nm <.Hn OHH .Hs>sH HmuOuoom um coHumNHHmHosam m. H m.H m ¢.H n m.o oH m.nN on m.co mmH .Hs>sH musumma snu um aoHummHHmHosmm n. H ¢.H m m. N m.N eH o.NN Nc w.No an .msoom umHHmuscsw m zuHa COHumoavs sumsuamHmoomm m. H m.H m m. H w.N c N.HH mN c.mw mNH .msmuac HchHmmswoum HHm uow ucsa usuHsasu HmHUHcH snu mm ssuwsm somsusmHmoomm :OHomosmm wchuaz .d .4 .4 .a 1. .a .d .d an .a a. a 11 a 1 a .1 a 1 a 1 a 1 1 a z a .1 a 1 a 1 a .1 a aw ”wawamamaw u a u a "u a u a u a u a 3u3u3u3u3u3u O 3 O O 3 O .A .A ,A .A .A .A ssuwd ssuw< ssuw< smcoamsz ssuwmmuo ssuwmmHn omza NH szaouom oz hchouum NHusmHHm usaom uwcouum Nus> unsasumum ONNH NN Nuo>HHon sumo nUHmom mam aoHumoamm wchusz :H mswcszNmmssua nuuz assassuw< ou wchuooo< mucsasumum ou msmcoamsz Hmoos mno anmH 187 «HN u z a. N n. H m. N n.NH Nm N.mm mm N.o¢ Nw .Hs>muu 0» anmcn smonu uom mcm> sumo sHHnoB mo GOHmH>oum a. N m. H m.o «H m.om no o.aN No N.Nm ON .musucso Hm:0stu cucH mHmanmoa unsuuao mo aOHumvHHOmcoo m.H m m. N a. N m.a ON o.NN an w.mm mNH .HHm cu anmmuowmm sumo nonsn mo umoo snu sxma HHH3 onn3 NwOHocnosu mo :oHomNHHHus s>Huosmms suoz m. H o o o o N.m w o.NN No w.MN me .sumo msmHuo cmzu uszumu s>Hucs>sua co mooom n. n; .d .a .d .a .d :1 .4 :1 .a .a a 1 1. 1 a 1 a 1 a 1 1 a 1 a .1 a 1 a 1 a 1 a a to o .b 1a .0 o .b a .b a .b :NNNNNNNNNN 3. w 3 u a. u 3 u 3 u 3 u D O 3 O 3 ,A .A .A .A .A .A ssuw< ssuw< ssuw< smcoamsm.ssuwmmHn ssuwmmHa ums3 NH Nchouum oz Nchouum zHuanHm usaom -wcouum zus> unsasumum 182.383 To «H115. 188 cHN I z HsNuma HN.oV H HH.NNV NNH HN..NV NN Ho.N V NH HN.N V N HN.N V N 1N.o V H 1N.o V N NaoHsuuoz o>Hacoaxo=H H..HV N N..H V N HN.N V NH HN.N V HN H..NNV N. Ho.HNV N. H..NNV on HN.NHV NN o>Hmcome NooaoHuoaxm HN.oV H NN.NHV N. HN.NNV NN No.NNV N. HN.N V NH NN.N V oN HN.N V NH 1N.H V .. NoucoHuoNxocH ucsosaaoo Ho.HV n n¢.nHV mm Hm.ncv no Ao.ONV as AN.HHV NN An.N V m Aw.N V o an.o V H ucsusaaoocH u>HuHNoN 1N.oV H HN.NNV NN HN.NNV NN Ne..HV oN 1N.N V NH HN.N V N 1N.o V N HN.o V H u>HuNNoz NcHNuasuN 1N.oV H HN.NNV NN HN.NNV HN HN.NHV NN H..N V NH HN.. V N HN.N V H 1N.o V H NcHNuNzuuca HNNNcHsauz 1N.NV H HN.o.V NN HN.HNV NN HN.HHV .N HN.. V oH 1N.N V .H 1N.N V N HN.N V N .NoHNsHaau: Hamoaouuam H..HV N HN.N V NH 1N.HNV NN 1N..NV .N Ho.NHV NN HN.N V NH HN.N V N o o Hsmumouoaaca oHuNNHN=NN:N HN.oV N 1N.NNV oN HN.HNV NN H..NHV NN HN.N V NN HH.N V HH 1N.N V N H..H V N oHuNNHNanNcm uoz maHNNHsaHuN 1N.oV N HN.N.V NN HN.NNV .N HN.NHV NN 1N.N V NH HN.H V . o o o o NaHuoN Noam HN.oV N 1N.H V . HN.N V N HN.. V NH HN.cHV NN HN.oNV .. NN.NNV HN HN.NNV .N NHaoHNNHa ouum 1N.NV N HN.NHV NN HN.NNV NN 1N.NHV H. Ho.NHV NN N..NHV NN 1N.N V NH HN.N V N NoaHmuuacoo N .d .5 .d I. .d .d .4 J .4 .5 .d .a J 1.. O a 1 a 1 a 1 a 1 a 1 a 1 a 1 1 3 1 a 1 a 1 a J a 1 a 1 a a 3 .D O .D O .D D .D D .D 3 .D 3 .D a a n a n a n a n a n a n a n 8 u a u a u a u a u a u a u a .d 3 u 3 u 3 u 3 u 3 u 3 u 3 u 0 3 D O 3 3 O 3 u (A I... A .A .A A (A u N N N . N N H msHuowsumo sHmom msHuowsomo :wcanmHm swcmzuwcoH: smmunm maHsaHum cu msmcoamsm Hmuoa coo mHmHv uo .ucsauumasm .Hoozom .swsHHoo Ne :H mCOHumHawsu mam msHsz H.o mH O.n NH O.mH Nm n.qN Nn H.NN On O.nH Nn N.¢ OH n.N n .:0Hu:UHum:H as :H chHumHawsu mam msHsz H.o NH 0.0 HN N.ON mm «.Om no n.qH Hm O.N OH N.¢ OH O. N .A.om sumom .zqzV .msHocsmm cOHumonsuoo< O.N NH O.H m N.. OH n.HN O. N.Om «O N.OH on H.m HH O.N O H.ous .musxuoa .o0m .Nomaumnm .nzv .NoHnomw vsumHsu £UHms£ uszuo H.m HH ¢.H n N.HH cN H.NN on N.Om mm N.OH ON N.m OH O O .AmscHHaHomHv uszuo :H mussav .muoomuumHsHamm usnuo o.n NH O.N OH O.NN OO n.ON HO H.ON m4 H.O NH O.H o O. N .Hs>sH somsuamHmoomn snu um NoHsomm wchusz H.n HH N.ON mm m.n¢ NO N.OH on o.n NH O.H c O O n. H .mHsmhz N.c OH N.OH Om n.ON HO O.nH Nn o.OH ON n.O ON O.N NH O.N o .COHoSuHumcH Na cH coHumuuNHaHsmm Hmuocso smcoamwm «N «m «N sh sN «m «N sh NH sh ss sh «N «m N o n s n N H sumuHHHomm Hmuossz usmcH: unsasumum wcuccmHm swamz wcoH sumoHHHomm uo usmcHz suouomb ssuwsn ou wchuooo< mucsasusum ou usmcoamsz Hmuoa 0:0 NHQz :36 usSNNHn mcHuosooua :onmsmouO nomm O.N OH N.O O 0.0 OH 0.0H OO 0.0N OO O.NH OO 0.0H HO H.O OH .HmuscsO cw NusHoON Np wchcmHn s :mu OGOH uom cos: snu uow mascsum3< H.O OH O. N O.N O O.N OH N.HH ON N.ON OO 0.0N NO N.OH HO .OcHacmH1H uou sHOmHHm>m saHH H.O OH O. H N.O O N.HH ON O.NH NO N.ON OO O.NN OO H.NH ON .Nanomw mo mmoH xuos O.N NH O. H O.N OH 0.0N HO 0.00 OO 0.0H OO 0.0 HN N.O O .Nu0umuuchHamm Nocswm cam HmuHamoz 0.0 OH H.OH ON N.NO OO H.NN OO 0.0H NN 0.0 OH O.H O O. H .asHsoHuuno ucsmsua s59 H.N NH H.N HH N.NN NN N.HN NN ..NN N. H.N HH N. H o o .3833 sumsuamHmoomn aH mucsvnum H.O OH 0.0 N 0.0H NO 0.0N NO 0.00 OO 0.0H NO 0.0 N O. H .NusHoom aH mswcmzo ssHm> N.N NH N.N N N.NH NN N.NN NN N.N .N N.NH NN N.N N N. N .NNOHSfiS CH mswcmSo vamm 0.0 NH O.N O O.N OH 0.0 HN 0.0H OO 0.0N OO 0.0N OO 0.0H ON .coHuauHumcH Na cH mGOHqusoo HmHocmch H.O OH O.N O N.O OH O.N NH 0.0H OO 0.0N OO 0.0N OO H.OH ON .chHuHano HmHocmch HmcoHumz H.O OH O.H O N.O O O.N OH 0.0H NO 0.0N NO 0.0N OO 0.0H OO .mcoHuHccoo HmHocmch sOHssumum smcoamsz NR «m «N sh ss sm *8 sh «N sh sN sh sx sh oz N O H sumuHHHomm Hmuussz usvcHz unsasumom stscHucOUV Ono HHM