IIIIIH II‘III IHIIIIIIIH LIIIIIIIII THESIS L‘flflAkf 3 12 2931 Michigan State University This is to certify that the dissertation entitled A FRAMEWORK HITH WHICH TO ASSESS FACTORS CONTRIBUTING TO ORGANIZATIONAL DECLINE AND MANAGEMENT APPROACHES USED BY CHIEF EXECUTIVE OFFICERS OF NATIONAL LEAGUE FOR NURSING ACCREDITED GENERIC BACCALAUREATE NURSING PROGRAMS IN THE CONTINENTAL UNITED STATES presented by Sandra Jean Simmons has been accepted towards fulfillment of the requirements for Ph.D. degreein Educatlon mm hdaknpnfiesor Date 10/1 /85 “(II-‘1':- A%_ o: ‘ ‘ '- 1A - I - . 0.1277' MSU I LIBRARIES RETURNING MATERIALS: Place in book drop to remove this checkout from ‘ .-:—. your record. FINES will I be charged if book is i returned after the date 1 stamped below. . 2 , " 'é r I ,1 I t. r ,. C» ‘5' 1,1 ' . 1 MAY 1 0 I99. A FRAMEWORK WITH WHICH TO ASSESS FACTORS CONTRIBUTING TO ORGANIZATIONAL DECLINE AND MANAGEMENT APPROACHES USED BY CHIEF EXECUTIVE OFFICERS OF NATIONAL LEAGUE FOR NURSING ACCREDITED GENERIC BACCALAUREATE NURSING PROGRAMS IN THE CONTINENTAL UNITED STATES By Sandra Jean Simmons A DISSERTATION Submitted to Michigan State University in partial fulfiIIment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Educationai Administration 1985 ©1986 SANDRA JEAN SIMMONS All Rights Reserved ABSTRACT A FRAMEWORK WITH WHICH TO ASSESS FACTORS CONTRIBUTING TO ORGANIZATIONAL DECLINE AND MANAGEMENT APPROACHES USED BY CHIEF EXECUTIVE OFFICERS OF NATIONAL LEAGUE FOR NURSING ACCREDITED GENERIC BACCALAUREATE NURSING PROGRAMS IN THE CONTINENTAL UNITED STATES By Sandra Jean Simmons The study was designed to identify the current and future types of decline facing generic baccalaureate nursing programs, identify the causes of the decline, develop a predictive tool or assessment guide that could be used to assess a generic baccalaureate nursing program's poten- tial for decline, identify management strategies that were used to address decline, identify the number and types of generic baccalaureate nursing programs that had been proposed for or actually experienced program downsizing or discontinuance, and determine if there were differences in the management strategies used in those programs that had and had not been proposed for or actually experienced program downsizing or discontinuance. For this descriptive study, a questionnaire was mailed to 345 chief executive officers of National League for Nursing accredited generic baccalaureate nursing programs located in the continental United States. This constituted the entire population of the group under study. The overall response rate was 67 percent with 54 percent of those being usable. The major type of decline idenitified as present now and projected in the future was erosion which is the gradual reduction of resources needed to support the current level of activity and output. A smaller but consistent number of respondents identified contraction, which is a sudden reduction of resources, as a current and future type of decline of concern. Both of these types imply that the present output is appropriate only in smaller quantities. A profile of the type of generic baccalaureate nursing program most affected by decline was developed. The main cause of decline was decreased support from the external environment. The administrative climate of the unit was neither supportive nor non-supportive. Fifty-four programs had been proposed for downsizing over the last five years with forty-eight actually being downsized. Downsizing was most often proposed by the institutional administration due to low enrollments or high program costs. A profile of the institutions proposed for downsizing was developed. Ten programs were proposed for discontinuance with one actually being discontinued. A profile of that institution was also developed. There appeared no significant pattern or similarity in management strategies used by those chief executive officers whose programs had and had not been proposed for downsizing or discontinuance. ACKNOWLEDGMENT I am indebted to a number of people who provided support and assistance during my period of study. While each member of my committee provided input into the development of my topic and the nature of my research, a special thanks is due Dr. Barbara Given for her feedback and guidance. Thanks is also due Regina Tappin for providing typing assistance throughout the entire dissertation and Ruth Craig for seeing that all of my copying was done on time. Thanks is also due my friends for their patience and understanding each time they heard me say "I can't do that as I have to work on my dissertation." Special recognition is also due two very special people who on a daily and regular basis over these last several years made numerous allowances for me and pro- vided the ongoing support that kept me going - thanks to my mother and Amy. ii TABLE OF CONTENTS LIST OF TABLES . LIST OF FIGURES CHAPTER I. INTRODUCTION Overview II. Conceptual Framework Statement of Problem Significance Problem Statements . . Areas of Focus in the Study . Statement of Purpose Definition of Terms . . . Limitations and Delimitations . Limitations . . Delimitations . Design . . ...... Assumptions . . . . . Overview of Subsequent Chapters . . List of References REVIEW OF THE LITERATURE Introduction ..... Problems Facing Higher Education Overview ...... . . Financing of Higher Education . . Enrollments and Students Faculty. . . . . Diversity in Higher Education . . Summary ...... Higher Education's Response to Problems . Program Downsizing/Discontinuance . . . Summary . . . ...... PAGE viii xiv 22 22 24 25 26 28 28 29 29 34 34 36 41 41 42 42 46 51 60 62 66 67 77 82 TABLE OF CONTENTS CHAPTER II. REVIEW OF THE LITURATURE (continued) III. Nursing Education . . . . ...... . Hospital- Based Nursing Education Programs . University-Based Nursing Education Programs . Community College Based Nursing Education Programs Summary. Present Enrollment Patterns in Nursing Education Programs . ..... . . Summary. . ....... Faculty Qualifications/Workload. Summary. . ...... . Recent Factors Impacting on Trends on Nursing Education ........ Summary. Current Approaches to Declining Enrollments . Summary. . Organizational Decline Overview . Models of Organizational Decline Levine's Model of Decline . . . Cameron and Zammuto' 5 Model of Decline . Decline Models Applied to Higher Education Higher Education's Past Response to Decline . Summary. . . ..... List of References DESIGN OF THE STUDY . . Problem Statement . Design Population Instrument Scoring . . . . Pilot Test . . . Data Collection . . . Analysis of Data . Factors Impacting Results . Summary. . . ....... List of References iv 86 86 91 96 96 97 109 112 118 119 127 127 128 131 131 138 138 145 155 159 168 172 186 186 187 188 190 193 195 199 201 202 203 205 PAGE CHAPTER TABLE OF CONTENTS IV. ANALYSIS OF DATA . . Introduction ......... . Response Rate to Questionnaire . Profile Section of Non-Participants . . . I - Types of Decline . . . Summary . . Section II - Political Vulnerability. Overview . . . ........ Responses to Individual Questions Scoring .......... Management Tactics ..... . . . . . . . . Summary .......... . ...... Section III - Problem Depletion Overview . . . ......... Responses to Individual Questions Scoring ............ Management Tactics . ...... . . . . . Summary ................. Section IV - Environmental Entropy ..... Overview ................. Responses to Individual Questions . . . . Scoring ................... . Management Tactics ....... . ....... Summary ............ . . . . . . . Section V - Organizational Atrophy ........ Overview ............. . . . Responses to Individual Questions . Scoring ................. Management Strategies . . . . . Summary ............... . . . Section VI - Program Downsizing . . ..... . . Section VII - Program Discontinuance ....... Section Section Section Summary VIII - Personal Data . . . . IX - Factor Analysis . . . . . . . . . . . X - Incidental Findings . . . . ..... Respondents ...... . . .......... Decline ............... . . . Causes of Decline Using Levine' 5 Model ..... Program Downsizing ........ Program Discontinuance ...... Scoring . ....... PAGE 207 207 208 211 212 220 222 222 223 226 227 227 230 230 231 232 232 233 233 233 234 238 238 239 241 241 242 248 248 249 251 257 262 263 265 266 266 267 268 273 275 277 TABLE OF CONTENTS CHAPTER VI. ANALYSIS OF DATA (continued) Management Tactics . Factor Analysis Incidental Findings List of References . V. SUMMARY, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS Summary . Problem Statement Design . . . Findings . Decline . Causes of Decline Program Downsizing . . Program Discontinuance . Scoring Factor Analysis Management Tactics . . Implications/Conclusions . . Decline . Scoring on Causes of Decline . Management Tactics . . . Program Downsizing . . . Program Discontinuance . . Implications . . . Nursing Education Administration . Methodology Research . . Recommendations List of References APPENDICES Appendix A - List of States in Each National League for Nursing Geographic Region . . Appendix B - Frequency Count for Each Item Contained in Questionnaire . . . . . Appendix C - Initial Postcard Preceding Study Questionnaire ...... . Appendix D - Cover Letter Accompanying First Questionnaire . . vi PAGE 279 280 280 282 283 283 283 283 284 284 285 287 289 290 290 290 290 291 291 293 293 294 295 295 299 299 300 302 A1 81 C1 01 TABLE OF CONTENTS APPENDICES (continued) PAGE Appendix E - Follow-up Postcard Mailed One Week After Study Questionnaire ........ . . E1 Appendix F - Cover Letter Accompanying Second Questionnaire . . . . . ..... . . . . . . . . F1 vii TABLE 10 11 LIST OF TABLES PAGE Typology of Decline 9 Types of Decline in Various Categories of Nursing Education Programs Using Typology of Decline Developed by Cameron and Zammuto 11 A Typology of Decline Including Some Human Resource Issues and Managerial Responses to Conditions of Decline 12 Causes of Organizational Decline 15 Factors Contributing to Higher Education's Current Problems 17 Factors Contributing to Generic Baccalaureate Nursing Programs Potential Problems 18 Criteria Used to Review and Identify Academic Programs for Possible Discontinuance 19 Criteria Used to Review and Identify Academic Programs for Possible Discontinuance Incorporated into Levine's Model for Assessing Causes of Organizational Decline 19 Criteria Used to Identify Academic Programs for Possible Discontinuance Combined with Factors Lead- ing to Organizational Decline Reflecting Those Areas of Specific Concern to Institutions of Higher Education and Generic Baccalaureate Nursing Programs 20-21 Breakdown of Questions in Questionnaire Addressing Decline, Program Downsizing, Program Discontinuance and Personal Data of Responding Chief Executive Officers 30 Breakdown of Questions in Questionnaire According to Causes of Organizational Decline 31 viii TABLE 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LIST OF TABLES Breakdown of Questions in Questionnaire According to Management Tactics and Strategies 1978 Average Instructional Expenditures Per Full- Time Equivalent Student for Higher Education Insitutions With and Without Health Professional Programs Number of Live Births in United States 1945-1976 Factors that Affect Higher Education Enrollment Predictions Percent Change in 18-24 Year Old Population by Region and State, 1980-1985 National Undergraduate Student Characteristics 1960 and 2000 Warning Signs of Potential Institutional Distress Criteria Most Often Used by Institutions of Higher Education to Review Academic Programs for Possible Discontinuance Criteria Less Frequently Used by Institutions of Higher Education to Review Academic Programs for Possible Discontinuance Reasons Why Administrators in Higher Education Focus on Conservatism and Efficiency Criteria and Weights Used to Rate Schools of Nursing Ranking of Schools of Nursing Surveyed by the Committee to Implement the Brown Report Basic RN Programs and Percentage Change from Previous Year By Type of Program: United States 1963 to 1982 Graduations from Basic RN Programs and Percentage Change from Previous Year By Type of Program: United States 1962-1963 to 1981-82 ix PAGE 31 50 53 55 56 57 73 80 80 84 95 95 98 99 TABLE 26 27 28 29 30 31 32 33 34 35 36 37 LIST OF TABLES Basic RN Programs by National League for Nursing Region and Size of Student Enrollment: 1973 to 1982 Baccalaureate Nursing Programs by National League for Nursing Region and Size of Student Enrollment: 1973-1982 Associate Degree Nursing Progams by National League for Nursing Region and Size of Student Enrollment: 1973 to 1982 Diploma Nursing Programs by National League for Nursing Region and Size of Student Enrollment: 1973-1982 Distribution of Baccalaureate, Diploma and Associate Degree Nursing Progams by State in 1982 Admissions to Basic RN Programs and Percentage of Change from Previous Year by Type of Program: United States, 1962-63 to 1981-82 Vacancies Per Fall Admission for Basic RN Programs by Type of Program and National League for Nursing Region: 1974 to 1982 Number of Names on Waiting List Per Fall Admission for Basic RN Programs by Type of Program and National League for Nursing Region: 1974-1982 Full-Time Nurse-Faculty by Highest Earned Credential and Type of Program: Jurisdictions of the United States 1964 to 1982, Biannually Full-Time Nurse-Faculty in Reporting RN Programs by Highest Earned Credential and National League for Nursing Region: 1972 to 1982, Biannually Number of Students Per Faculty Member in the Average Nursing Course by Type of Setting, Type of RN Program, Primary Source of Financial Support, and National League for Nursing Region: January 1981 Hours Per Week of Direct Teaching by the Average Full-Time Faculty Member by Type of Setting, Type of RN Program, Primary Source of Financial Support and National League for Nursing Region: January 1981 X PAGE 101 102 103 104 106 107 108 110 113 115 116 117 TABLE 38 39 40 41 42 43 44 45 46 47 48 49 50 51 LIST OF TABLES Societal and Health Care Trends Needing Baccalaure- ate Education for Professional Nursing Practice Factors Which May Have Negative Impacts on Trends in Nursing Education Cutback Management Tactics to Smooth and Resist Decline in Public Organizations Structural Adjustments and Stretegic Responses Used in Various Types of Decline A Typology of Environmental Decline and Higher Education Institutional Responses to Enrollment Decline Resiliency-Inhibiting Characteristics of Adminis- trators in Institutions of Higher Education Factors Leading to Conservatism as a Response to Decline and Suggested Solutions Comparisons of Face-to-Face Interviews, Telephone Interviews and Mail Questionnaires for Selected Performance Characteristics Major Sections of Questionnaire with Inclusive Question Numbers Range of Scores for Each Section, II-V, of the Questionnaire Numbers of Persons Included in the Pilot Study Sample by Type of Institutional Control and Geographic Region Number of Responses to Pilot Study by Type of Institutional Control and Geographic Region Response Rates by National League for Nursing Geographic Region for Questionnaires Mailed (Percents have been rounded) Number of Questionnaires Returned by Time of Follow-Up xi PAGE 122 124 143 151 156 160 165 189 190 196 197 198 209 211 TABLE 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 LIST OF TABLES Comparisons of Respondents, Non-Respondents and Non-Participants on Selected Items Present and Future Types of Decline Affecting Generic Baccalaureate Nursing Programs Present and Future Types of Decline by National League for Nursing Geographic Region Present and Future Types of Decline by Type of Institutional Control Present and Future Type of Decline by Age of Generic Baccalaureate Nursing Programs Present and Future Type of Decline by Full-Time Equivalent Enrollment in the Institution Present and Future Type of Decline by Full-Time Equivalent Enrollment in First Level Nursing Course Scores of Respondents for Each Cell of Levine's Typology of Decline Rank Order of Management Tactics Selected by Respon- dents in Each Category of Possible Causes of Decline Extent to Which Respondents Believed Each Item is Impacting Current Enrollments Extent to Which Respondents Believed Each Item Will Impact Future Enrollments Statewide Mechanisms Present to Regulate Numbers of Generic Baccalaureate Nursing Programs and Enroll- ments Determination of Faculty Workload Percent of Respondents Indicating Percentages of Faculty Tenured or in the Tenure System Percent of Respondents Indicating Percentages of Faculty with Doctorates, Participating in Research and Publishing xii PAGE 213 214 215 216 217 218 219 226 228 231 232 236 244 245 246 TABLE 67 68 69 70 71 72 73 74 75 76 77 78 LIST OF TABLES Reasons for Proposed Downsizing of Generic Bacca- laureate Nursing Programs Mean Scores of Generic Baccalaureate Nursing Programs Proposed for or Actually Experiencing Downsizing on Levine's Causes of Decline Typology Generic Baccalaureate Nursing Programs Proposed for Downsizing by National League for Nursing Geographic Region Rank Order of Management Tactics Selected for Use by Chief Executive Officers in Generic Baccalaureate Nursing Programs Proposed for Downsizing by Cause of Decline Summary of Selected Characteristics of Generic Baccalaureate Nursing Programs Proposed for Discon- tinuance and Actually Discontinued Mean Scores for Each Cause of Decline as Defined by Levine for Generic Baccalaureate Nursing Programs Proposed for and Actually Experiencing Discontinuance Rank Order of Management Tactics Selected by Respondents Whose Progams had been Proposed for Discontinuance Personal Data about Respondents by National League for Nursing Geographic Region Characteristics of Generic Baccalaureate Nursing Programs Most and Least Affected by Decline Profile of Generic Baccalaureate Nursing Programs Proposed for Downsizing Characteristics of the Generic Baccalaureate Nursing Programs Proposed for Discontinuance Means Scores for Each of Levine's Causes of Decline for Generic Baccalaureate Nursing Programs Proposed for Downsizing or Discontinuance and Those not Proposed for Either xiii PAGE 252 254 256 257 259 261 262 264 268 275 277 278 FIGURE 1 2 LIST OF FIGURES Change in Size of Environmental Niche Change in Shape of Environmental Niche Generalized View of Higher Education Enrollments 1979-2010 Patterns of Organizational Decline Due to Organizational Atrophy xiv PAGE 52 142 CHAPTER I INTRODUCTION OVERVIEW Higher education is in the beginning of a new era -- one of no growth. This is in sharp contrast to the rapid growth that occurred in colleges and universities from the end of World War II to 1969.1 The 19605 growth was accompanied by extensive college building and expansion. Between 1960 and 1969, 702 new institutions for higher education were established. Of these, 534 were public institutions.2 In 1969, inflation began to depreciate available revenues, a recession occurred in the mid-19705 exacerbating an already severe economic picture, taxpayer revolts began in the late 19705 adding to financial problems, enrollments began to decline in the 19705 and federal and state support continued to be erratic and/or decline.3 The impact of inflation alone is devastating in that it erodes steady states so that just staying even actually requires extracting more resources from the organization's environment and effecting greater internal economies.4 At the state level, one important indicator of financial status is the size of the general fund balance. A state with a general fund balance exceeding its spending by 5 percent is considered fiscally prudent. In 1982, seventeen states had balances in excess of 5 percent and five states ended the year with negative balances. In January 1983, 1 forty-four states were projected to have balances below 5 percent and nineteen were expected to have deficits.5 Findings such as this mean that many states reduced allocations to higher education (as well as to other areas) and/or made mid-year cutbacks. Higher education's budget reductions ranged from 15 percent in Ohio (FY 83) to 0.6 percent in Oregon (FY 83) and Rhode Island (FY 83).6 Higher education is in a period of retrenching from the preceeding decades of unrestrained growth. The severity of the economic picture for higher education is compounded by predictions of significant enroll- ment declines for most of higher education over the next twenty years. During the mid-19705, the rate of growth of the 18-year old popu- lation declined and the size of the traditional college-age cohort stabilized.7 This ended the long post-war period of college age popula- tion growth and began the slowing of college enrollments. In the late seventies, the economy was recovering from the 1974-75 recession, thus making more job opportunities available and further reducing the pool of potential college students.8 Nearly one-third of all educational institutions underwent enrollment decline in the decade of the 19705.9 The Carnegie Commission Report of 1981 predicted that the enroll- ment decline would not come evenly, but in two slides: "Slide I (40%): Fall, 1983, through the academic year starting in Fall, 1988 (followed by a possible rise in 1989 and 1990). "Slide II (60%): From Fall, 1991, through10 the academic year starting in Fall, 1997." The expected low point for undergraduate enrollment will be in 11 1997. There will be a two-year plateau or slight recovery between the two slides and three years of recovery from 1998-2000.12 The decline in enrollment is not affecting all segments of the educational institution or all institutions equally. Some geographic areas such as the Northeast and upper Midwest will experience greater than average declines while the Southwest and several Southeastern states will do better than average, possibly showing modest enrollment increase.13’ 14 Areas of study will also be affected disproportion- ately. Students are moving from the liberal arts, social sciences, humanities, and education, into vocational, preprofessional and profes- 15, 16 sional programs. Enrollment in the physical sciences, health and life sciences, business and engineering are increasing.17’ 18 Thus segments of higher education are now facing a dire situation where two of the major resources, traditional age students and money, are declining. In addition, the nature of the fields of study sought are changing. In some cases, there may be changes in the size of various departments or programs; in other cases, there may need to be discontinuance of some programs and/or departments and development of new ones. Present and future management requires a new orientation - one focusing on no growth, retrenchment and possible decline rather than one focusing on growth and expansion. This new view is difficult to accept since there is a tendency to treat organizational growth as a sign of vitality and success and decline as a sign of senility and failure.19 How do these factors relate to nursing? Initially it may seem that nursing is in a favorable position in higher education institutions since the health related areas are ones of potential growth. There are, however, other factors to consider which make the position of nursing not as secure or enviable as it may first appear. Nursing education has gained an increasing share of educational benefits over the past thirty years. In 1958, there were only 171 generic baccalaureate nursing education programs in institutions of higher education; in 1982 that number was 402.20’ 21 The number of students admitted to generic baccalaureate nursing education programs grew annually from 1958-59 through 1977-78 when declines were noted which persisted through 1981-82 (with the excep- tion of 1980-81).22’ 23 In addition to decreases in enrollment, the latest Institute of Medicine study of nursing shows that there is not an overall shortage of nurses, but that the aggregate supply and demand for generalist registered nurses will be in reasonable balance in this decade.24 Nursing programs tend to be costly to the educational institution because of the close faculty supervision of students leading to low faculty-to-student ratios. This cost is further raised due to expen- sive laboratories and scientific equipment.25 Nursing education's portion of the $35 billion spent annually in higher education in recent years exceeded $350 million.26 Chief executive officers of generic baccalaureate nursing programs are in a difficult position. The health related field is one that is currently experiencing growth, the number of generic baccalaureate nursing programs is slowly growing, yet overall enrollments in generic baccalaureate nursing programs are stable to declining. The lack of growth in nursing enrollments may be reflective of the general decline in college enrollments, the increased number of generic baccalaureate nursing programs, student reaction to a depressed economic job market for nurses, greater educational opportunities open for women or some combination of these factors. Whatever the reason(s), it would seem that rather than being in an enviable position, generic baccalaureate nursing programs are prime candidates for review by academic administrators looking for ways and places to cut costs. Nursing programs: must limit enrollments due to the low faculty-to-student ratios required and limited clinical place- ment sites; are predominantly composed of female administrators and faculty; have faculty that are generally lesser academically prepared than their counterparts in other units; and generally receive fewer grants and produce fewer scholarly works than other units on the campus. For these reasons, generic baccalaureate nursing education programs would not seem to be in as secure a position as they initially appear, but rather in a vulnerable position to be reviewed in times of economic stress. As cutbacks and reviews become more commonplace, it behooves chief executive officers of generic baccalaureate nursing programs to position their units favorably so that they will not be the target of severe reductions or discontinuance. Changes in institutions and environmental conditions relative to no-growth states or decline require different sets of management strate- gies and actions than those associated with growth. Management in times of no growth or decline means management options are narrowed.27 Organizations such as institutions of higher education cannot cut back by merely reversing the sequence of activity and resource allocation 28 by which their parts were originally assembled. Thus even established generic baccalaureate nursing education programs may be reviewed and recommended for reduction in size or discontinuance. The best source of increased resources is improved internal management.29 Ways of achieving quality education with fewer resources must be found. This will lead to a re-examination of the mission of the institution, areas in which educational services are offered, elimina- 30 This tion of some programs and services, and addition of others. must also then lead chief executive officers of generic baccalaureate nursing programs to re-examine the current student recruitment and teaching approaches used as well as how to keep the curriculum focus in concert with future health care delivery trends, and at the same time upgrade faculty and become more involved with other campus units. Unless chief executive officers of generic baccalaureate nursing programs are aware of problem areas and future trends and management options appropriate for periods of decline and carefully implement a planned course of action, their units may be out of step with the environment inside and outside of the academic institution. Such units would then become prime candidates for cutback or discontinuance. The issues then become: how can the chief executive officers of generic baccalaureate nursing programs determine if their programs are vulnerable and what can they do to improve/maintain a favorable position for their programs within their academic settings? This researcher believes that two approaches to these questions include: (1) incor- porating a knowledge of organizational decline into the current and future departmental management strategies used; and (2) incorporating knowledge of the most common criteria used to review academic programs for possible discontinuance into departmental decisions and plans. This study contains a framework with which to assess the potential for organizational/departmental decline and the most common criteria used to review academic programs for possible discontinuance. These two items serve as the basis from which questions were derived which indicate possible problem areas to assess in developing future plans. CONCEPTUAL FRAMEWORK To understand decline, it is necessary to know the relationship between the organization and its environment. The environment may be considered as a mass of niches. Hutchinson describes a niche as that segment of the environment bounded by factors such as availability of resources to support organizational functions, technology, culture, and consumer demand for outputs.31 As these factors change over time, so does the performance of an organization. Changes may alter either the size or shape of an organization's niche or both. A change in niche size relates to decreased resource availability or a decreased demand for the organization's output.32 The output is the same only in lesser quantity. In contrast, a change in niche shape occurs when there is no longer a demand for the current output, thus necessitating an organization to acquire a new output to survive. Graphically, these changes can be seen in Figures 1 and 2. Changes in niche size and shape can occur suddenly or slowly over a long period of time. Those occurring slowly allow more time for an organization to predict what will occur and how to respond. Sudden change is more disruptive and requires a different response.33 Cameron and Zammuto have developed a typology of decline based on sudden (discontinuance) and slow steady (continuous) change in niche size and shape (Table 1).34 Figure 1. Change in Size of Environmental Niche A. Original niche size B. Size of niche with decreased resources/demands for output C. Size of niche with increased resources/demands for output Figure 2. Change in Shape of Environmental Niche A. Original niche shape B. Shape of niche when there is no longer demand for current output C. Area of overlap in change Table 1. Typology of Decline Continuous Change Discontinuous Change Change in niche Erosion Contraction size Change in niche Dissolution Collapse shape From: Cameron, Kim and Zammuto, Raymond. "Matching Managerial Strate- gies to Conditions of Decline.” Human Resource Management. Winter, 1983, p. 364. When erosion occurs, there is stagnation and steady reduction which produces conflict over the allocation of decreasing resources. If recog- nized and dealt with early, there is time to consider various alterna- tives. In contrast, when contraction occurs, there is a sudden decrease in resources available and survival is questioned. There is little time for consideration of options or for participation of staff in decisions. In both instances, there is no real impetus to change the organization's output, only the quantity of the output due to resource limitation. In contrast, when dissolution occurs, the organization's output becomes progressively less acceptable to the environment and there is pressure to produce a new output. Internally there then becomes con- flict over what that new product should be. When collapse occurs, the need for and/or acceptability of the organization's output is rapidly decreased and survival of the organization depends on the rapid identification of a new product/output. The critical points are whether the change occurs rapidly or slowly and whether the output is still acceptable/useful in the environment. To the extent that management monitors the environment(s) in which the 10 unit/organization functions, discontinuous change should be able to be avoided and continuous change dealt with in a timely manner. Using this framework, one could categorize the past, present and future changes relative to nursing education programs (Table 2). This researcher believes that the past and present changes in educational programs were predominately ones in niche size while those changes pro- jected for the future will alter niche shape as well as size. The out- come of this is that the continuation of each type of program will be dependent on alterations in the number and type of the present outputs (or type of graduates). These alternatives may range from restyling programs and curricula to the merger of some diploma nursing education programs with colleges or universities. This merged program produces a new output (graduate) for the diploma program and possibly for the educational institution, while in many instances carrying on the name of the diploma program. Cameron and Zammuto have further developed their typology of decline to include management tactics and strategies that are appro- priate for each type of decline based on their identification of the source of conflict present and the manager-subordinate relations (Table 3). The specific management tactics included in the model are proactive, reactive, enactive and experimental. Proactive tactics anticipate envi- ronmental changes and are implemented vigorously. Enactive tactics reflect the implementation of new activities and management behaviors. Reactive tactics are not initiated until the decline occurs and respond to various elements of it. Experimental tactics are random responses 11 Table 2. Types of Decline in Various Categories of Nursing Education Programs Using Typology of Decline Developed by Cameron and Zammuto Type of Past/Present Change Program & Reason Future Change & Reason Diploma Erosion - changes in Erosion - continued changes insurance reimburse- (decreases) in third party ment to hospitals. reimbursement to hospitals; increased program cost to student. Dissolution - begin- Dissolution - increased ning awareness of society emphasis on academic importance of academic degrees; increased movement degrees in society. toward baccalaureate degree as requirement for entry into practice. Associate Erosion - decreased Erosion - decreased money Degree funds available to available to institutions of educational institu- higher education; inability to tions. make programs cost effective in timely manner. Dissolution - increased move- ment toward baccalaureate degree as requirement for entry into practice; glut of RN's on market not prepared for new health care roles which require more background to work more autonomously. Bacca- Contraction - decreased Erosion - decreased money laureate money available to available to institutions of institutions of higher higher education; inability to education. make programs cost effective in timely manner. Dissolution - if educational programs do not change to keep pace with future nursing roles. 12 Table 3. A Typology of Decline Including Some Human Resource Issues and Managerial Responses to Conditions of Decline TYPE OF CHANGE IN NICHE CONFIGURATION Change in Niche Size Change in Niche Shape Continuous Change Discontinuous Change EROSION SOURCE OF CONFLICT Stagnation MANAGER-SUBORDINATE CONTRACTION SOURCE OF CONFLICT RELATIONS Consultative TACTICS Proactive STRATEGIES Domain Offense Threat MANAGER-SUBORDINATE RELATIONS Autocratic TACTICS Reactive STRATEGIES Domain Defense or Consolidation DISSOLUTION SOURCE OF CONFLICT Contention MANAGER-SUBORDINATE COLLAPSE SOURCE OF CONFLICT RELATIONS Coalitional TACTICS Enactive STRATEGIES Domain Creation Confusion MANAGER-SUBORDINATE RELATIONS Chaotic TACTICS Experimental STRATEGIES Domain Substitution From: Cameron, Kim and Zammuto, Raymond. "Matching Managerial Strate- gies to Conditions of Decline." Human Resource Management. Winter, 1983, pp. 364, 367. 13 undertaken on a trial-and-error basis with no overall alternative in mind.35 Domains refer to the population served by technology employed by and services rendered by the organization/unit in decline. These can be col- lectively called the "primary task" or core domain of the organization/ unit.36 When decline threatens this domain, responses vary from defend- ing the current domain to creating or substituting a new one. nggig offense strategies expand the current domain to create organizational slack. Domain defense protects the core domain while reducing it in size. Domain creation diversifies the present domain. Domain substi- tigg replaces the current domain with another. When these elements are put together and viewed by cell in Table 3, one comprehensive way of viewing different types of decline emerges. When erosion or continuous change in niche size occurs, there is stag- nation or lack of growth in the organization. Since this decrease is gradual, there is time to consult on appropriate courses of action and then implement a vigorous plan which includes expanding the current domain. This expansion does not mean producing more in a time when fewer outputs are called for, but identifying new similar outputs or markets which center around the present output. In contrast a sudden decrease in niche size, contraction, means an immediate threat to survi- val where decisions must be made immediately. This situation calls for centralized decision-making based on information available. To survive, the core domain must be defended while a new plan is developed. When a change in niche shape occurs slowly, dissolution, there is contention as to what the new focus or output will be. Coalitions form 14 around each major alternative. The survival of the organization faced with these circumstances is dependent upon diversifying the present domain in a timely but thoughtful manner. When an organization is faced with a sudden need to change its niche shape, collapse, there is confu- sion and chaos. Lack of advance notice or planning means there are no viable alternatives ready to consider, thus random, short-term decisions are made as to what the new output or domain should be. Some institutions of higher education that ignored the continuous signs of changes in niche size and shape, such as steady to decreasing enrollments, decreased funding coupled with increased inflation and changes in areas of students' interest, found themselves in the discon- tinuous areas of Table 3. Decisions made at these times will often require additional decisions to ensure long range viability of the organization. Some of these subsequent decisions may also involve revising or reversing the initial decisions made in the times of crisis. While this typology is useful in viewing decline relative to changes in niche size and shape and proposing managerial responses to decline, it does not give much assistance in what or how to assess the environment and predict or recognize decline before it occurs or iden- tify factors to address which may alter the course of the decline. A model of organizational decline developed by Levine does provide help in depicting the causes of public organization decline (Table 4). This model is readily applicable to non-public and stable-state organizations as well. The four-cell typology proposed by Levine divides causes of decline along two dimensions: internal and external to the organization and 37 political or economic/technical in nature. According to Levine 15 problem depletion is the most common cause of decline and occurs when an organization has short-term involvement in a crisis situation. It also accompanies demographic shifts or occurs when society redefines 38 or terminates a problem. Environmental entropy occurs when the organization's external environment no longer provides support for it at the accustomed levels.39 This may occur when there is a shift in the market or technology, or result from political actions such as not voting tax increases or supporting tax decreases.40 Both problem depletion and environmental entropy are not under the control of the organization, but external to it, yet readily affect the organization. Such external factors are often not considered when making programmatic changes. Table 4. Causes of Organizational Decline Internal External Political Political Problem Vulnerability Depletion Economic/ Organizational Environmental Technical Atrophy Entropy From: Levine, Charles. "Organizational Decline and Cutback Manage- ment." Public Administration Review. July/August, 1978, p. 318. Those events which occur inside the organization and can be totally or partially controlled by it represent the other set of factors to con- sider in decline. Political vulnerability occurs when an organization's structure is unable to resist environmental demands to contract.41 Conditions which predispose to political vulnerability include: organi- zations which are young and/or small, internal conflict, changes in 16 and/or weak leadership and lack of leadership experience. Organizational atrophy occurs when internal structures malfunction and do not send appropriate warning signals of existing problems. Causes of this may include: inconsistent or perverse incentives; decentralized authority with vague responsibility; weak leadership; role confusion; lack of appropriate evaluation procedures; stifled dissent and upward communi- cation; rationalization of poor performance; high turnover, suspicion of outsiders; continuous reorganization; and routine adherence to the past.42 Using Levine's model, the factors identified throughout the litera- ture as major causes of the current problems in higher education can be categorized (Table 5). The same model can also be used to identify major factors impacting generic baccalaureate nursing programs (Table 6). Viewing the factors impacting higher education and generic baccalaureate nursing programs within this framework does allow for organization of thought and a better opportunity to identify related factors in each category that may have particular significance to any one institution or program. It also provides a comprehensive means of exploring a wider range of factors than may ordinarily have been considered. This researcher believes that one more set of criteria needs to be considered which will provide an even broader assessment of the poten- tial for decline. These are the criteria identifed in the literature as being used to review academic programs for possible discontinuance (Table ”.43.-57 While some of these criteria are the same as or similar to those in Table 5, their addition to the assessment list will insure a comprehensive review of a program. It is possible to incor- porate these criteria into Levine's framework (Table 8) and then to 17 combine the items from Tables 5, 6 and 8 into one tool for the chief executive officers of generic baccalaureate nursing programs to use to assess the potential for decline in their programs (Table 9). Table 5. Factors Contributing to Higher Education's Current Problems INTERNAL EXTERNAL Political Vulnerability Problem Depletion applied in times of cutback. Decreased new faculty hired. Reliance on tenure versus evaluation of performance. High decentralization of units leading to lack of concensus across units on major decisions. Political Increased numbers of End of mandatory draft colleges/universities into military. in state. Decrease in ex-service More colleges/universities persons returning to of smaller size. colleges/universities. Increased conflict between Questionable value of administration, faculty, college degree to earn- and students. ing power. Decreased retention of students. Organizational Atrophy Environmental Entropy Economic/ Growth management strategies Decreased supply of col- Technical lege-age students (18-22 years). Declining city-state incomes in many places. Tax cuts being passed or tax increases being defeated. Changing career demands requiring more technical/ vocational knowledge/ skills. Adapted From: Levine, Charles. "Organizational Decline and Cutback Management." Public Administration Review. July/August, 1978, p. 318. 18 Table 6. Factors Contributing to Generic Baccalaureate Nursing Programs Potential Problems INTERNAL EXTERNAL Political Vulnerability Problem Depletion Political Small numbers of students Decreased hospital in- enrolled. patient cennsus leading to decreased demand for RN's in hospitals. Young age of many generic baccalaureate nursing pro- Overall equating of demand grams. with supply of ”first level generalists regis- High cost/graduate. tered nurses." Organizational Atrophy Environmental Entropy Economic/ Adherence to "traditional" More career opportunities Technical faculty-student teaching open for women. modes. Adherence to low faculty- student ratios. Rationalization of placement/ promotion of nurse faculty in academic setting without their having educational credentials equivalent to other campus faculty. Decreased involvement with or input from other campus units/outside agencies. Decreased attention to new health care trends relative to curriculum changes. Decreased earning power of RN over some other profes- sions open to women. Clinical agencies limiting students or instituting fees for student placement. Similarity of most/all programs in state prepar- ing generic graduate nurse. Steady or decreased num- bers of students entering generic baccalaureate nursing programs. Changing health care tech- nology requiring type of RN different than one being prepared. Adapted From: Levine, Charles. Management." 1978, p. 318. "Organizational Decline and Cutback Public Administration Review. July/August 19 Table 7. Criteria Used to Review and Identify Academic Programs for Possible Discontinuance Number of graduates from program in each of last 5 years Number of students enrolled Class Size Cost of courses integral to program Cost per program graduate or credit hour Faculty workload Program quality (faculty quality, national ranking) Total number of graduates of all other similar programs in state/region/nation (uniqueness of program) Future trends in society relative to program graduates Projected student interest/demand over next five years Appropriateness of program to institutional mission Connectedness of program to rest of institution Table 8. Criteria Used to Review and Identify Academic Program for Possible Discontinuance Incorporated into Levine's Model for Assessing Causes of Organizational Decline INTERNAL EXTERNAL Political Vulnerability Problem Depletion Political Number of graduates from program each of last five years. Number of students enrolled. Class size. Cost of courses integral to program. Cost of program/graduate. Connectedness of program to rest of institution. Appropriateness of program to institution mission. Organizational Atrophy Environmental Entropy Economic/ Faculty workload. Total number of graduates Technical Program quality. from all other similar programs in state/region/ nation. Future trends in society relative to program graduates. Projected student in- terest demand. Adapted From: Levine, Charles. "Organizational Decline and Cutback Management." Public Administration Review. July/August, 1978, p. 318. Table 9. 20 Criteria Used to Identify Academic Programs for Possible Discontinuance Combined with Factors Leading to Organiza- tional Decline Reflecting those Areas of Specific Concern to Institutions of Higher Education and Generic Bacca- laureate Nursing Programs INTERNAL EXTERNAL Political Political Vulnerability Age of unit/organization. Size of unit/organization. Internal conflict. Weak leadership. Number of students enrolled. Number of graduates of pro- gram in each of last five years. Attrition rate. Amount of involvement in broad campus activity/ committees. Cost/graduate or SCH. Relationship of program to institution mission. Class size Cost of courses. Connectedness of program to rest of institution. Problem Depletion Non-mandatory military service. Decrease in ex-service persons returning to higher education. Questionable value of college degree to earn- ing power. Decreased hospital in- patient census leading to decreased need for nurs- ing staff in hospitals. Redefinition of financing of health care by federal government. No more shortage of first level generalist RN's. More career opportunities open to women. Decreased earning power of RN over some other pro- fessions open to women. 21 Table 9. Continued INTERNAL EXTERNAL I Qgganizational Atrophy Environmental Entropy Economic/ Routine adherence to the Changing health care tech- Technical past in face of techno- nology requiring new type logical change. Stifled dissent and upward communication. Rationalization of poor performance. High turnover. No or inappropriate evalu- ation procedures. Adherence to low faculty- student ratios. Rationalization of place- ment/promotion of nurse faculty in academic set- ting without their having educational credentials equivalent to other campus faculty. Decreased attention to new nursing trends relative to curriculum. Faculty Workload. Program quality. of RN from that now being prepared. Fewer 18-24 year olds available to enroll in college and/or nursing programs. Increased tax cuts or decreased tax increases leading to less money for educational institutions. Clinical agencies limit- ing students or institut- ing fees for student placement. Increased emphasis on am- bulatory care and well- ness over acute and in- patient care. Difference/similarity ver- sus cost and number of all programs in state prepar- ing generic graduate nurses. Total number of graduates from all other similar programs in state/region/ nation versus need. Changing general student interests/demand. 22 The information gained from assessing a generic baccalaureate nurs- ing program using the factors and framework identified in Table 9 could (if stinguish whether the respondent considered all four spheres contained in the model when making future plans. Actions taken to address the items listed in Table 9 could be categorized according to the framework 1’ n the Cameron and Zammuto model (Table 3). This would provide infor- mat‘i on as to the predominate types of action taken (ie: reactive, Proactive, enactive or experimental) and how these actions related to the domain (ie: offense, defense, creative, substitution). The infor- mat-i on obtained would also indicate if the present and future courses of action being taken by respondents was in the direction of changes i n n 1° Che size or shape thus enabling one to project the future direction of some aspects of generic baccalaureate nursing education programs. IRS the environment continues to change in a rapid manner and the reSOUr-ces available continue to diminish, it is increasingly necessary to frequently and accurately reassess the present status and forecast the future. Since the current and immediate future of many institu- ti cons of higher education is tied to no growth or decline management, what better framework to use when assessing and forecasting than one based on an understanding of decline? It is such a framework that is de V3 1 oped and used in this study. STATEMENT OF PROBLEM Si ‘ ' ' 1 ficance As we face 20 years of enrollment problems in institutions of hi gher education and a current fiscal dilemma in many states which may "‘39 . fi"lively impact higher education funding, it is clear that changes in the higher education system will and must occur. 23 Taureate nursing programs to survive this period, proactive planning and actions will be needed based on firm and broad data. If a frame- work or model for obtaining data and responding to it is available, generic baccalaureate nursing programs should not only survive these next twenty years, but become even stronger and more secure. P ro b 1 em Statements I\ number of aspects of the effects of decline in higher education "" £J<3I1eric baccalaureate nursing programs will be described in this S‘tLthjlyr- :1. Primary among the major problems to explore are: To determine if a significant number of chief executive officers of generic baccalaureate nursing programs iden- tify their programs as being in or having the potential to experience decline. To determine the type of decline chief executive officers identify as currently affecting their generic baccalaureate nursing programs. To determine the type of decline chief executive officers identify as potentially affecting their generic bacca- laureate nursing programs within the coming five years. To determine whether chief executive officers of generic baccalaureate nursing programs assess a significant number of environmental factors outside of the larger academic institution when making future plans and developing manage- ment approaches. To determine whether chief executive officers of generic baccalaureate nursing programs assess a significant number of environmental factors within the larger academic institution when making future plans and developing management approaches. To determine which of a given number and type of strategies are most used by chief executive officers in generic bacca- laureate nursing programs in the administration of their units. To determine the number of generic baccalaureate nursing programs that have been proposed for or actually experienced downsizing or discontinuance. For generic bacca- 24 8. To determine if there are differences in the scores of inter- nal and external environmental factors assessed by chief executive officers in generic baccalaureate nursing programs that are and are not being proposed for or actually experienc- ing downsizing or discontinuance. 9. To determine if there are differences in the management tactics and strategies used by chief executive officers in generic baccalaureate nursing programs that are and are not being proposed for or actually experiencing downsizing or discontinuance. Areas of Focus in the Study There are three major areas of focus of this study: (1) current PrOD‘l ems facing higher education and contributing to its decline in some areas; (2) past and present trends in nursing education; and (3) Causes and management of decline. Within each of these major areas Severe] selected sub-areas will be developed. In the section on higher education the conditions that contributed to the current problems will be explored. The section will also contain specific information on enrollments, changing areas of student 1 nte Y‘est, and the changing college student. In addition, information w‘ 1 1 1 be presented regarding the past management strategies used to deal w. 1 th decline with particular emphasis on program downsizing and discon- ti h Dance. The nursing section contains information about the past and present tr- e""Cis in nursing education and provides background on how each type of "u - "s ‘l ng education program evolved. Information presented will also 1’0 Gus on enrollment trends, faculty preparation, teaching approaches an (1 Societal factors affecting nursing. In the section on decline, several models from which to view the 3 es and management of decline in general as well as the specific ab]:- - 1 1 cation of the causes and management of decline in higher education 25 ww‘ ‘l T be presented. A comparison will then be made as to how decline in “institutions of higher education has been handled versus the manage- ment modes recommended. STATEMENT OF PURPOSE This study will be an initial assessment of chief executive off ‘i cers of National League for Nursing (NLN) accredited generic bacca- I an... reate nursing education programs in the continental United States r‘egélrding their assessment of their programs and the management approach used viewed from several frameworks of organizational decline. The i n‘Fo rmation gained will be of immediate and long range use to chief eXec utive officers of generic baccalaureate nursing programs as they deve lop future plans for their units. First, the study will provide current information to baccalaureate ”UY‘S ing program chief executive officers about organizational decline, factors that lead to it, and management approaches that can be used "he h decline is experienced or expected. Second, the study will contain a framework that can be used to assess academic units/institutions for potential decline and assist Ch-i’ 91“ executive officers to develop strategic plans based on current and projected changes in their external and internal environments. Third, the study will provide information to chief executive off ‘3 cers of generic baccalaureate nursing programs as to the most common chi teria used to review academic programs for possible downsizing or dis- Cont “i nuance. Upon completion of this study, one should know the opinions of the ch - O O O O 1 ef execut1ve officers of gener1c baccalaureate nurs1ng programs as 26 tea ‘the prevalence of and potential for decline in their programs as hn291 1 as the present management tactics used by them to address this c1ee¢::1 ine. This information should also serve as a base and guide for future planning and management of generic baccalaureate nursing p r-ograms. DEFINITION OF TERMS Ch 1’ ef Executive Officer of a Generic Baccalaureate Nursing Progi - The chief academic officer (irrespective of title) in a generic baccalaureate nursing program. £7“? teria - Standards by which judgments can be made. Let: 7! ine - A cutback in the size of an organization's work force, pro- fits, budget, clients, etc. A general climate or orientation of decrease.58 E'Lniain Creation - Causing to come into existence the territory over which . . . . 59 dominion 1s exerc1sed. Main Defense - Shielding from attack the territory over which dominion is exercised.60 SHEEEEZSELiflLQIIEQEQ - Attacking the territory over which dominion is exercised.61 ElleEEjgijn Substitution - Putting new territory in the place of present territory over which dominion is exercised.62 'EIISELSELIEJXE - Tending or having efficacy to carry out in action or establish.63 E - ‘11311:1_1:Qnmental Entropy - A measure of the uncertainty of our external 4 Surroundings or circumstances.6 27 Experimental - Designation of or pertaining to that which is learned by experience.65 (3e2r1eerfic Baccalaureate Nursing Progpgm - Any unit in a four-year college or university which grants a baccalaureate degree in nursing to non-registered nurse students who enter the program. Institution of Higher Education - A four-year college or university, either public or private. NLN (National League for Nursing) - National organization of nurses and non-nurses which is the official accrediting agency for all types of nursing programs in the United States. 2 'i <::I'Ie Shape - Outward form, configuration, contour specially adapted to 66 I its occupant. Z 1. I 1::'I-|e Size - Measurement or extent or any position specially adapted to its occupant.67 Wnizational Atrghy - The lack of growth or development of individuals systematically united for some end or work.68 0\"‘_Q§nizational Decline - Decreases in resources available (ie: money, students) to organizations over a period of four or more consecu- tive years. £152_3!_j[3;ical Vulnerability - Assailability of public policy or administra- tion of government or unit.69 F’r- ‘-—1521§L§§tiyg - Combines ppp- forward; to or toward front from a behind position and active- abounding in action; lively; quick; brisk; therefore, defined as forward in action.70 p “-32152151;1gm Depletion - reduction or lessening of a perplexing question demanding settlement.71 28 Prwogram Discontinuance - Elimination of certain degrees or programs within departments; or closing of entire departments or units.72 T>r13gram Downsizing - Reduction in size of a unit either by decreasing enrollment, faculty, or deleting one segment of a unit but not the entire unit. Reactive - Tending to react or resulting from reaction; responsive to a stimuli.73 Stable State Organizations - Institutions showing some growth, some decline, and/or no change in available resources and output over a period of four or more consecutive years. LIMITATIONS AND DELIMITATIONS Limitations The study is limited to those National League for Nursing accredited generic baccalaureate nursing program chief executive officers who choose to return the mailed questionnaire. The questionnaire is a newly developed tool, thus has limitations as to its reliability and validity. Due to interfering events such as college/university administrative requests for budget reductions, program cutbacks and long-range plans regarding enrollments and costs and endogenous changes associated with increasing literature on and discussion of organizational decline, in- creasing unit costs and decreasing college enrollments, baccalaureate nursing program chief executive officers may acquire a heretofore absent knowledge of some information which may mask and/or overlap knowledge and/or use of actual criteria proposed in this study. Some baccalaureate nursing program chief executive officers may also feel compelled to indicate that they are knowledgeable of and using the criteria to guide their actions when in fact they may not be using them. 29 Del imitations The study is delimited to the chief executive officers of National Lxeague for Nursing accredited generic baccalaureate nursing programs in tjie continental United States (as indicated by the most recent NLN publi- cation) at the time the study takes place.74 DESIGN 1’ This will be a descriptive study using a mailed questionnaire to gather information. A census of the population of chief executive officers of National League for Nursing accredited generic baccalaureate nursing education programs in the continental United States will be taken. The National League for Nursing accredited programs will be identifed in the most recent annual National League for Nursing publica- tion listing these programs.75 A descriptive study was selected because the phenomenon of managing decline in academic institutions and in generic baccalaureate nursing programs is relatively new. Before hypotheses can be generated as to more or less successful courses of action to pursue, detailed factual information describing existing phenomena must first be collected. Current problems and practices must be identified across groups with similar problems and situations. Once this information is known, then recommendations can be made as to appropriate courses of action to take based on current practices and problems. The total population was chosen to study rather than a sample for several reasons: 1. The total population is small consisting of only 345 National League for Nursing accredited generic baccalaureate nursing programs; 30 2. In a sample, it would be difficult to insure adequate repre- sentation of these combined variables: various sized insti- tutions and nursing programs, each National League for Nursing geographic region, public and private institutions, institu- tions and programs of various ages. 3. The issue is of a sufficiently critical nature that all chief executive officers of generic baccalaureate nursing programs need to provide input. Questions contained in the questionnaire were developed to reflect each item contained in each section of Table 9 and to gather more specific information about program downsizing/discontinuance and some demographic data. The breakdown of questions into various categories is shown in Tables 10, 11 and 12. Responses to each question do not include all management options, but options of all management tactics and strategies are included in each section, two through five, of the questionnaire (Questions 3-77). Responses to questions in Table 10 were weighed so that an overall score could be determined as well as a score for each cell in the table. Table 10. Breakdown of Questions in Questionnaire Addressing Decline, Program Downsizing, Program Discontinuance and Personal Data of Responding Chief Executive Officers Area Questions* Decline 1, 2 Program Downsizing 78 - 87 Program Discontinuance 88 - 91 Personal Data 92 - 96 *See Appendix B for specific questions. Table 11. 31 Breakdown of Questions in Questionnaire According to of Organizational Decline* INTERNAL EXTERNAL Political Political Vulnerability 3, 4, 5, 6, 7, 8, 9, 11 12, 14, 15, 17, 18, 20, 21, 22, 24, 25, 26, 27, 29, 30 Problem Depletion 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 Economic/ Technical nganizational Atrophy 57, 58, 59, 60, 61, 63 64, 66, 67, 69, 70, 71, 72, 74, 75, 76 Environmental Entropy 43, 44, 45, 46, 47, 50, 51, 52, 53, 54, 55, 56 *See Appendix B for specific questions. Table 12. CHANGE IN NICHE SIZE CHANGE IN NICHE SHAPE Breakdown of Questions in Questionnaire According to Management Tactics and Strategies* Continuous Change Discontinuous Change Proactive/ Domain Offense 13-2, 16-4, 19-4, 28-2 31-2, 42-3, 48-2, 49-2 62-4, 68-3, 77-2 Reactive/ Domain Defense 10-1,2; 13-1, 16-1, 19-1, 23-1, 28-1, 31-1, 42-1, 48-1, 49-1, 62-1,3; 65-1, 68-1,4; 73-1,2; 77-1 Enactive/ Domain Creation 49-3, 62-2, 65-2,3; 68-2, 73-3 13-3, 16-3, 19-3, 23-2, 28-3, 31-3, 42-4, 48-3, Experimental/ Domain Substitution 10,3, 13-4, 16-2, 19-2, 23-3, 42-2, 48-4, 49-4, 65-4, 73-4, 77-3 *See Appendix B for specific questions Causes 32 While a formal hypothesis will not be generated, several sub- problems can be identified to study which are not part of the major problem statement. These sub-problem statements identify situations needing inquiry and discussion and seek to determine if and how several variables are related. The sub-problems are of a more limited 11ature than the major study problems and have no theoretical base. The information obtained in the study will, however, answer the questions posed in these sub-problems and provide added information and insights as to the extent and location of decline in generic baccalaureate nursing education programs. Sub-problems that can be answered from the data collected include the following: 1. 00 generic baccalaureate nursing programs located in private educational institutions experience more decline than those located in public educational institutions? Are generic baccalaureate nursing programs in private educational institutions being identified more often for downsizing and discontinuance than those in public educational institutions? Are there any specific geographic regions of the continental United States in which generic baccalaureate nursing programs are experiencing more decline, downsizing or discontinuance? The questionnaire will be pilot-tested on thirty-one chief execu- tive officers from non-National League for Nursing accredited generic baccalaureate nursing programs listed in the latest National League for Nursing official publication of approved nursing programs.76 The questionnaire and procedures for its administration will be submitted to the Michigan State University Committee on Research Involving Human Subjects for their approval. Revisions will be made as needed based on the input of both of the above groups. 33 Questionniare responses are to be treated confidentially but are ncrt anonymous. Each questionnaire will be assigned a code number to a] low follow-up via a second mailing of a letter and questionnaire with- ili three weeks of the mail date noted in the first letter. A stamped, scelf-addressed envelope will be included for return of the question- 11aire with both mailings. The data will be analyzed as follows: 1. Frequency count of generic baccalaureate nursing programs identified as now being affected by or having the potential to be affected by decline within the next five years. Frequency count of type of decline that chief executive officers now see affecting their generic baccalaureate nursing programs. Frequency count of type of decline that chief executive officers see potentially affecting their generic bacca- laureate nursing programs within the next five years. Mean score of responses by cell in Levine's typology of causes of organizational decline to determine which cells are most and least attended to. Frequency count by type of management tactic and strategy used to determine which approaches are most and least used. Frequency count and description of generic baccalaureate nursing programs that have been proposed for and/or actually experienced downsizing and/or discontinuance. Mean scores of internal and external factors assessed by chief executive officers of generic baccalaureate nursing programs that have been proposed for or experienced downsizing and/or discontinuance compared to those mean scores of chief execu- tive officers in generic baccalaureate nursing programs that have not been proposed for or experienced downsizing or discontinuance. Identification of management strategies and tactics used by chief executive officers in generic baccalaureate nursing programs that have been proposed for or actually experienced downsizing and/or discontinuance compared to those generic baccalaureate nursing programs that have not been proposed for or actually experienced downsizing or discontinuance. 10. 11. 12. 34 Frequency count of generic baccalaureate nursing programs in public versus private institutions that have been proposed for and/or actually experienced downsizing and/or program discontinuance compared to those that have not been proposed for or experienced downsizing or discontinuance. Cross-tabulation of items to determine if there are any specific geographic areas of the continental United States in which greater proportions of generic baccalaureate nursing programs are experiencing decline, downsizing or discontinuance. Frequency count for each item in questionnaire. Factor analysis of items in Table 11. ASSUMPTIONS This study is based on several underlying assumptions about socie- tal, fiscal and educational trends as well as some nursing education trends. 1. These assumptions include: The supply of traditional college age students will not markedly increase before the year 2000. The fiscal situation of institutions of higher education will not markedly improve until and unless specific state and/or institutional action is taken to reduce current and future costs. There will be no refutation of current nursing studies which show that there is no shortage of generalist registered nurses in the United States. Generic baccalaureate nursing programs in institutions of higher education will be in increasingly vulnerable posi- tions for review and possible downsizing/discontinuance due to limited enrollments and high costs. OVERVIEW OF SUBSEQUENT CHAPTERS In Chapter Two, pertinent literature in several major areas will be reviewed. These areas are: societal and educational conditions 9l11ing rise to considering educational institutions from a perspective 1?? decline as well as the need for considering program downsizing and 35 discontinuance; the establishment of generic nursing education programs in institutions of higher education; current trends in nursing education programs in institutions of higher education; causes of organizational decline; and management options and approaches to use in times of organizational decline. Chapter Three will include identification of the population and a description of the survey design and measures that will be used to analyze the data. The pilot study will also be described. The data analysis and a description of the findings will be covered in Chapter Four. Trends will be shown as to knowledge and use of environmental assessments and various aspects of organizational decline in the administrative approach of the chief executive officers of generic baccalaureate nursing programs. In Chapter Five, a summary of the major findings with conclusions and implications will be presented. The findings will be specifically related to generic baccalaureate nursing education. 10. 11. 12. 13. 14. 15. CHAPTER I LIST OF REFERENCES Cyert, Richard. "The Management of Universities of Constant or Decreasing Size." Public Administration Review. July/August, 1978, p. 344. Stadtman, V. Academic Adaptations. San Francisco: Jossey-Bass, 1980, p. 4. Ibid, pp. 11-13. Levine, Charles. "Organizational Decline and Cutback Management." Public Administrative Review. July/August, 1978, p. 317. The Effects of State Budget Reductions on Higher Education, Fiscal Year 1982-83. ECS. Denver, Colorado, December 1983, p. 3-6. Ibid, p. 6 Zammuto, Raymond. "Growth, Stability and Decline in American Colleges and University Enrollments." Educational Administration Quarterly. Winter, 1983, p. 84. Ibid, p. 85. Three Thousand Futures: The Next Twenty Years for Higher Educa- tion. San Francisco: Jossey-Bass, Inc. 1981, p. 45. Ibid, p. 45. Ibid, p. 45. Ibid, p. 45. Mingle, J., et.al. Challenges of Retrenchment. San Francisco: Jossey-Bass, 1981, p. 19. Ibid, p. 66. Stadtman, op. cit., p. 8. 36 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 343 35. 36. 37 Zammuto, Raymond; Whetten, David; and Cameron, Kim. "Environmental Change, Enrollment Decline and Institutional Response: Specula- tions on Retrenchment in Colleges and Universities." Peabody Journal of Education. Winter, 1983, p. 96. Stadtman, op. cit., p. 8. Zammuto, Whetten, and Cameron, op. cit., p. 96. Whetten, David. "Sources, Responses, and Effects of Organizational Decline." The Organizational Life Cycle. San Francisco: Jossey- bas, Inc., 1981, p. 343. National Leagge for Nursing Data Book 1983-84. New York: National League for Nursing, 1984, p. 1. Vaughn, John. "Educational Preparation for Nursing - 1982." Nursing and Health Care. October, 1983, p. 462. National League for Nursing, op. cit., p. 1. Vaughn, op.cit., p. 462. "IOM Report Offers 21 Recommendations for Nursing." American Nurse. March, 1983, p. 6. Norton, Paula. "The Financial Distress of Higher Education: Impact on Nursing." Image. Fall, 1983, p. 105. Ibid, p. 102. Brubacher, J. and Schibles, M. "Organizational Decline: Implications for Research." Paper presented at the Annual Conference Northeastern Educational Research Association, 25 October 1979. Levine, op. cit., p. 317. Cyert, op. cit., p. 345. Cyert, op. cit., p. 346. Cameron, Kim and Zammuto, Raymond. "Matching Managerial Strategies to Conditions of Decline." Human Resource Management. Winter, 1983, p. 361. Ibid, p. 361. Ibid, p. 363. Ibid, pp. 364-365. Cameron and Zammuto, op.cit., p. 367. Ibid, p. 368. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 38 Levine, op. cit., p. 318. Ibid, p. 318. Ibid, p. 318. Ibid, p. 318. Ibid, p. 319. Ibid, p. 319. Daugherty, E. "What is the Most Effective Way to Handle Program Discontinuance?” Case Studies from 10 Campuses. Presented at the American Association of Higher Education National Conference, Washington, D.C., 18 April 1979. Daugherty, Edward. "The Role of Institutional Research in Program Discontinuance." Paper presented at the 19th Annual Forum of Association for Instituttional Research, San Diego, CA, 13-17 May 1979. Davis, C. and Dougherty, E. “Program Discontinuance: Its Role in Strategies of Resource Allocation and Planning for Colleges and Universities." UM, March, 1978. Berdahl, Robert. "Criteria and Strategies for Program Discontin- uance and Institutional Closure.“ Paper presented at SHEEO Annual Conference, New Orleans, LA, 30 July 1975. Melchiori, Gerlinda. "Planning for Program Discontinuance: From Default to Design." AAAE-ERIC/Higher Education Research Report, No. 5, 1982. Schwerin, Ursula. "Institutional Mission in an Era of Retrench- ment." Paper presented at the Annual Meeting of the American Association of Colleges, Phoenix, AZ, 10-12 January 1980. Ishler, Richard. "Institutional Planning for a Declining Enroll- ment." Paper presented at the International Conference on Improving Higher Education, 5th London, England, July 1979. Heydinger, Richard. "Using Program Priorities to Make Retrench- ment Decisions: The Case of the University of Minnesota." SERB, 1983. Powers, David. "Reducing the Pain of Retrenchment." Educational Record. Summer, 1982, pp. 8-12. Wilson, Robert A. (Ed). Responses to Fiscal Stress in Higher Education. Papers presented at the University of Arizona 7th National Conference on Financing of Higher Education, Center for Study of Higher Education, College of Education, University of Arizona, Tucson, AZ, June, 1982. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71” 39 Mingle, James R., Norris, Donald. "Colleges Respond to Decline: Resistance Versus Application." Issues in Higher Education. Atlanta, GA, 1981. Nichols, James. “Meeting the Challenge of Implementing Genuine Academic Program Discontinuance in the 19805." Problems and Perspectives for Institutional Research in the 19805. Jones L. (Ed). Proceedings of Annual Conference of the Southern Associa- tion for Institutional Research, Lousiville, KY, 29-31 October 1980, pp. 34-42. Mortimer, Kenneth and Tierney, Michael. "The Three 'Rs' of the Eighties: Reduction, Reallocation and Retrenchment." American Association for Higher Education, Washington, D.C., ERIC Cleaning House on Education (Higher), Washington, DC, 1979. Ruddock, Maryann. "Assessing the Impact of Discontinuing a Program." Twenty-second AIR Forum. Association for Institutional Research, Denver, CO, 16-19 May 1982. "Educational Commission of the States: Coordination or Chaos." Report of Task Forum on Coordination, Governance and Structure of Post Secondary Education, ECS, Denver, CO, October, 1973. Zammuto, Whetten and Cameron, op. cit., pp. 345-346. Funk and Wagnalls Standard Dictionary. Funk and Wagnalls, New York, 1971, pp. 377, 303-304. Ibid, pp. 377, 335. Ibid, pp. 377, 877. Ibid, pp. 377, 1250. Ibid, p. 415. Ibid, p. 424. Ibid, p. 447. Ibid, pp. 855, 1156. Ibid, pp. 855, 1176. Ibid, pp. 92, 890. Ibid, pp. 978, 1411. Ibid, pp. 15, 1004. Ibid, pp. 1004, 344. 72. 73. 74. 75. 76. 40 Melchiori, op. cit., p. 6. Funk and Wagnalls, op. cit., p. 1049. National League for Nursing Approved Schools for Nursihg RN 1984. Pub. No. 19-1961. Ibid, Ibid, New York: National League for Nursing, 1984. CHAPTER II REVIEW OF LITERATURE INTRODUCTION The focus of this study is on the potential for decline in generic baccalaureate nursing programs located in institutions of higher educa- tion. Decline as used in this study does not mean that any one unit or institution is on the verge of closing, rather that it is no longer in a growth or possibly even a stable-state phase. The potential for decline in generic baccalaureate nursing programs exists for a number of reasons. I have chosen to divide these reasons into three major categories: (1) those problems facing many institutions of higher education which they in turn pass on to some extent to all of their institutional subunits; (2) those problems faced by the profes- sion of nursing in general and generic baccalaureate nursing education in particular; and (3) the causes and management of decline and how this is addressed by both the administrators of institutions of higher educa- tion and administrators of generic baccalaureate nursing programs. The literature reviewed will be divided into these same three major categories. The first segment will focus on the problems faced by institutions of higher education and how these have contributed to the Potential for decline. Specific areas to be addressed include financing; £H1rollments; changes in student composition and areas of study; changes in 41 42 faculty; the decreasing diversity within the higher education system; and finally, how administrators in higher education have chosen to deal with these problems. The latter segment includes information on retrenchment, program downsizing and program discontinuance. The second area of literature reviewed will trace the establishment of nursing programs in institutions of higher education and identify current issues and problems in generic baccalaureate nursing education. The third major area of literature reviewed addresses organizational decline. This segment will identify types and causes of organizational decline, how to assess factors leading to decline and strategies as to how to manage decline within an organization. PROBLEMS FACING HIGHER EDUCATION Overview To understand the current difficulties faced by institutions of higher education, it is necessary to describe the issues and trends in higher education over the past twenty years, as well as general societal happenings during that time. Higher education had slow growth from 1636 to 1870.1 Rapid growth was present from 1870 to 1970 with fast acceleration from the end of 2 The National Center for Education World War II through the 19605. Statistics indicates that between 1960 and 1969, 702 new institutions of higher education were established; of this number, 534 were public insti- tutions.3 In 1968 the Carnegie Commission on Higher Education report indicated that of the six million full-time equivalent students enrolled iii institutions of higher education, over one-half entered between 1958 and 1967. 4 43 Public confidence in higher education and its institutions was due to the nation's scientific achievements during World War II. The 6.1. Bill was partially responsible for making higher education available to more persons. Colleges and universities were seen as ”cultivators of higher culture and trainers of manpower and leadership for the productive pursuits of the nation."5 General prosperity was present in the country after World War II and the public supported the development and expansion of higher education. There was a national commitment to expand access to higher education, a growing belief that the nation's welfare depended on higher education, and an increase of service functions that higher educa- tion performed in areas such as agriculture, industry, and the profes- sions.6 Increasing forces were advocating that higher education be accessible to all qualified persons regardless of family income, sex, ethnic origin, religion or handicap. Enrollments soared and billions of federal, state, and private dollars went to higher education.7 This growth was not even in all parts of higher education. The public sector grew more rapidly than the private sector; two-year colleges grew more in numbers than did four-year ones.8 The average size of the institution increased and more "non-traditional" students enrolled (such as: part-time, low-income, minority, handicapped, older under- graduate, and graduate students).9 The academic ability of students, as measured by scholastic aptitude tests, declined and the secondary school preparation of students entering college decreased.10 During this growth period, new curricula were rapidly being added and old ones expanded. More vocational programs were added to community 11 colleges and to a lesser extent to comprehensive four-year institutions. Among entering full-time college freshmen, three-fourths indicated they 44 were considering vocational majors. At the baccalaureate level alone this mix was 61 percent vocational and 39 percent non-vocational.12 Faculty were also changing with their focus, becoming more special- ized and technical. They tended to focus more on research and scholar- ship within their specialty and to teach that specialized content more than focus on the broad cultivation of students as persons.13 By 1969, the positive picture of higher education had changed. The student activism, dissent and disruption of the decade of the 19605 peaked on campuses. The murder of Martin Luther King, Jr. in 1968 set off demonstrations of black students to improve their position. The Vietnam War was increasingly unpopular and the presence of military training programs on campuses as well as university-related defense research was viewed negatively. Students began protesting their lack of input in campus governance matters. The Watergate Scandal caused young and old alike to call for increased accountability to the public as to how all programs were run.14 Federal resources declined as a proportion of educational expenditures, income from gifts and endorsements declined due to economic instability; and public monies went primarily to commun- ity colleges or programs in health sciences and medicine.15 At the same time, higher education was impacted by the 1971 ratification of the 26th Amendment to the Constitution which lowered the voting age, thus increas- ing the impact of younger voters on education-related issues.16 The end of the compulsary military draft in 1973 eliminated student exemptions to military service, thereby decreasing the artificially high demand for higher education which this had previously caused.17 Since 1969-70, the system of American higher education changed in other ways: institutions became larger and less personal; academic 45 schedules were changed so students had less contact with faculty; more students from disadvantaged backgrounds were admitted and institutions were not able to deal effectively with them as well as the traditional students; the proportion of part-time and non-residential students in- creased and they could not benefit from all facilities and services designated for full-time residential students; the increased vocational interests of students combined with job market demands led to weakening the liberal component of higher education and the lowering of academic standards. The latter was not intentional, but due to benign neglect over the years associated with vastly increased numbers and diversity of students coupled with decreased financial resources.18 In the 19705, inflation continued and a recession occurred. Just as the recession ended, taxpayer revolts began and state governments were forced to reduce spending. This meant smaller appropriations for public higher education and dashed the hopes of private colleges to gain new or expanded state support.19 At this same time, enrollments began to decline, thus compounding the financial difficulties as less revenue from tuition was obtained. The decline in enrollment at this point was due primarily to the avail- able students being spread over more institutions rather than there being fewer students available. From 1970-78, enrollments increased 2.7 million full time equivalent students (a 46 percent increase). However, these students were spread over 3,100 institutions, many of which were not built or operating at full capacity in 1969.20 The larger number of students also reflects many who were over age twenty-two and attending school only part-time and others who enrolled but did not complete work toward a degree. 46 Changes in institutional autonomy were also taking place in the post World War 11 years. Many states chose to deal with the increased size and complexity of the higher education system by forming statewide coordinating and/or governing bodies to exercise some control over the public institutions. Thus there was a beginning loss of some degree of the past autonomy enjoyed by many institutions of higher education. Another factor decreasing institutional autonomy was the organized student protests of the late 19605, the result of which was increased student participation in institutional policy making. At the same time, students were becoming more important in their role of financing institu- tions of higher education. This financing came about directly from tuition and indirectly through states allocating money through formula funding based on enrollments and through the federal government giving financial aid directly to students rather than the institution. Thus an institution had to attract and retain students to maintain its financial sustenance. In this way, the students gained power in decid- ing curriculum, standards and resource allocations, all decisions once made by institutional leaders and the faculty.21 In this overview a general background of major issues and trends in higher education over the the past thirty to forty years, as well as several special areas which need more detailed attention have been iden- tified. These include enrollment trends; changes in students and their impact on higher education; changes in faculty; financing of higher education; and the decreasing diversity in higher education. Financingof Higher Education The fiscal condition of institutions of higher education relates directly to the fiscal conditions of the state within which each 47 institution is located. Thus it is necessary to understand the general financial condition of the states to see how this impacts higher educa- tion. From the end of World War II to 1970, the United States economy was strong. Higher education was enjoying a growth period as well as ample funding from the states, the federal government and private sources. The overall fiscal condition of most states reached their lowest levels in forty years as the 1983 legislative session began. The fiscal condition of a state is reflected by the size of its general fund balance. If that balance exceeds its spending by 5 percent, the state is generally considered fiscally prudent. In 1982, seventeen states had balances in excess of 5 percent, twenty-eight fell below the 5 percent excess and five states had negative balances. In January 1983, forty-four states were projected to have balances below the 5 percent excess and nineteen states were expected to face deficits.22 Twenty-three states reduced their 1982 budgets through across-the- board cuts of up to five percent with the areas of elementary and secon- dary education being cut in particular. Some states made short-term adjustments in revenue collections, five states raised their general sales taxes, and four states increased their income taxes. Seventeen states speeded up tax collections, thus producing a one-time windfall; eighteen states deferred some expenditures until future years; sixteen states resorted to interfund transfers; some states borrowed in the short-term credit market; and some states exhausted previously built-up surplus funds.23 The causes of these fiscal problems related modestly to a decrease in federal funds allocated to states, a generally weak economy, and 48 increased state spending. State spending increased more rapidly than the economy between 1940 and 1975.24 In the late 19705, states also began to reduce taxes through increased tax exemptions, income tax indexing, property tax relief and rate reductions. Between 1978 and 1982, state taxes decreased from 7.0 percent to 6.5 percent of personal income.25 The 1983 efforts to lower state expenditures repeated many of the 1982 actions and included reducing the number of state employees and limiting salary increases. Some states were also forced to make mid-year adjust- ments.26 The 1983 fiscal year percentage of budget reductions to higher education ranged from 15 percent in Ohio to 0.6 percent in Rhode Island. In nine states, the percent of reduction for higher education exceeded the overall state budget reduction; in twenty-six states, it was the same, and in eleven states higher education reductions were less than the overall state reductions. Compared to budget cuts required for elemen- tary and secondary education, higher education received a greater reduc- tion in thirty-seven states, an equal reduction in twelve states, and a smaller reduction in three states.27 The timing of the budget reductions determines, to a great extent, how those reductions are made. Early adjustments allow for selective reductions, while mid to late year adjustments are generally across-the- board. Typical actions taken to meet mid-year reductions include leaving positions vacant, delaying capital construction, delaying facility main- tenance and renovations, curtailing library services, and restricting and reducing travel. Other lesser used measures include tuition in- creases, decreasing support services and increasing student-faculty 49 ratios. The ultimate reductions include offering fewer courses, larger class sizes and program elimination.28 While the states were having financial difficulties and reducing allocations to higher education, the costs of higher education had in- creased and continued to rise. The end of the growth era in the 19705 meant an end to the institution autonomously allocating slack funds as it wished since there were no more slack funds. Funding formulas began to hurt rather than help as enrollments decreased; real overhead costs increased; new faculty positions were unavailable to adjust the size of those departments with increased enrollments.29 Added costs imposed on higher education between 1969-80 through social pressure and governmental mandate included: occupational safety and health regulations; provisions for handicapped; increasingly strin- gent building codes; increased fringe benefits; collective bargaining; affirmative action; the Buckley Amendment; women's athletics; environ- mental requirements; and demands for increasing statistical reports.30 The cost per student unit (in constant dollars) declined slowly between 1929-30 and 1949-50; rose rapidly from 1949-50 to 1969-70, and dropped again in the 19705. The period of rapid rise, often called the "golden years" of American higher education reflected the nation's need to both expand and improve higher education. Staff compensation rose during these years and there was an increase in the private sector.31 In addition to the general factors that have been identified as increasing the costs to all institutions of higher education, those institutions with one or more health professional programs had even higher costs. A 1982 study conducted through the National Center for Higher Education Management Systems reaffirmed previous information by 50 McCoy and Halstead that institutions of higher education with no first professional program in the health sciences have lower instructional expenditures per full-time equivalent student than those institutions with one or more such programs (See Table 13).32 While these data relate only to the medical, dental, optometry, and veterinary profes- sions, there is no reason to believe that institutions of higher educa- tion with generic baccalaureate nursing programs as their first or one of their non-medical health professional programs would not also have increased instructional expenditures by some percent above those institutions with no health professional program. Table 13. 1978 Average Instructional Expenditure per Full-Time Equiva- lent Student for Higher Education Institutions with and without Health Professional Programs TYPE OF INSTITUTION PUBLIC PRIVATE Medical School $13,615 $8,594 Major Research Institution With Medical Program $ 2,713 $4,641 Without Medical Program $ 2,011 $4,313 Other Doctoral Institution With Medical Program $ 2,448 $3,464 Without Medical Program $ 1,939 $2,006 Medical program includes MD, 00$, 00 and DVM From: Smith, John. Impact of Health Proghems on Instructional Expenditures in Higher Education. National Center for Higher Education Management Systems, Boulder, CO, 1982, p. 1. Comparisons of patterns of expenditures of more and less affluent institutions revealed: that more affluent institutions while spending more on everything spend less, on a percentage basis, on direct 51 instruction and physical plant and more on student financial aid, non- academic staff, and goods and services purchased from outside vendors. When the relationship of affluence to outcomes was studied, it revealed that while the impact of affluence on outcomes was positive, it was very small.33 This financial information reveals that as the costs of higher educa- tion (faculty salaries, goods and services, numbers and types of programs offered, physical plant) have continued to rise, the monies flowing into higher education from state and federal funds and tuition has decreased. During this same time, inflation continued to rise and added social and regulatory mandates also increased and imposed new additional costs. The end result of the interaction of these factors has been an overall decrease in money available to higher education which has forced cut- backs, reorganization and refocusing so that income and expenses are more equal. Since the institutional expense per full-time equivalent student is greater in educational institutions with health professional programs than in those institutions without these programs, health professional programs would seem to be obvious ones to review in times of budget problems. Enrollments and Students , The enrollment in higher education institutions has increased fairly steadily for the past three centuries. Points of significant increases were 1870 following the Civil War and land-grant college movement; 1945 following the passage of the G.I. Bill of Rights; and 1960 with students from the high birth rates following World War II. While projecting enrollments is difficult, the Carnegie Commission in 1980 projected a five to fifteen percent decrease in undergraduate enrollments between 52 1983 and 2000.34 The decline would not come evenly, but be divided as follows: "Slide 1: From Fall 1983 through the academic year starting in the Fall of 1998 (followed by a possible rise in 1989 and 1990); and then, Slide II: From the Fall of 1991 through the academic year starting in the Fall of 1997." 35 Slide I would account for 40 percent of the decrease; Slide II the remaining 60 percent. There would be plateau years for enrollments (1979, 1980, 1981, 1982) and increased enrollment years (1989, 1990, 1998, 1999, 2000). (See Figure 3) Figure 3. Generalized View of Higher Education Enrollments, 1979 - 2010 PLATEAU I 1979 1983 Slide I (40% OF DECLINE) PLATEAU II 198 1991 RECOVERY SLIDE II (60% OF ECLINE 1979 1983 1989 1991 1997 2010 From: Three Thousand Futures. San Francisco: Jossey-Bass Publishers, 1981, p. 47. The numbers of live births is the most significant predictor of the pool of potential college age students (See Table 14). The annual United States rate of live births showED a steady rise from 1946 to the 53 peak year of 1957. Rates then declined fairly consistently from 1958 through 1976 with the exception of 1969-1971. Projecting ahead eighteen years from the year of birth will provide one with the maximum number of potential college age students in the traditional age range. This number must then be factored by some percent of those persons area who may attend college. The past rule was that 50 percent of the white males and 40 percent of the white females and a steady but lower percent of non- whites would attend college.36 Thus a simple observation of just the declining birth rate alone should have been enough to predict the decreased enrollments beginning in the late 19705 and continuing through this century. Table 14. Number of Live Births in the United States 1945-1976 (in millions). 1945 - 2.86 1956 - 4.22 1967 - 3.52 1946 - 3.41 1957 - 4.31 1968 - 3.50 1947 - 3.82 1958 - 4.26 1969 - 3.57 1948 - 3.64 1959 - 4.26 1970 - 3.72 1949 - 3.65 1960 - 4.23 1971 - 3.56 1950 - 3.63 1961 - 4.27 1972 - 3.26 1951 - 3.82 1962 - 4.17 1973 - 3.14 1952 - 3.91 1963 - 4.10 1974 - 3.16 1953 - 3.97 1964 - 4.03 1975 - 3.15 1954 - 4.08 1965 - 3.76 1976 - 3.17 1955 - 4.10 1966 - 3.61 From: Anderson, Charles (Ed.) Fact Book on Higher Education U.S. Public Health Service. National Center for Health Statistics, Monthly Vital Statistics Report, 18 March 1977, pp. 1, 76.28. In addition to birth rates, other factors are also considered when projecting college enrollments (See Table 15). Though some factors in Table 15 may tend to offset others, the gains in enrollments will prob- ably not equal or exceed the losses from other factors mentioned. 54 Approximately 40 percent of all college students are second generation attendees within their families. This group is most likely to attend and remain in college. The other 60 percent of the students attending college are first generation attendees, second-generation attendees in two-year colleges, and masters level vocational students. The continued attendance of this 60 percent is hard to predict and makes a wide margin for error in predicting enrollments.37 Another significant impact on enrollment is the dropout rate. The current dropout rate in four-year colleges is 40 percent, with the major . 38 reason g1ven as "boredom." Twenty-nine percent of all colleges and universities experienced a decline in retention rates. Of those insti- tutions actually losing enrollments, private institutions rank low retention rates as the number one cause of decreased enrollments while public institutions rate retention decline as the number two factor.39 Therefore, one way colleges can help to maintain their enrollment is by identifying ways to decrease the dropout rate. There will be regional variations in the enrollment projections. Table 16 shows the percent of change in eighteen to twenty-four year olds by state and region based on live birth rates per state. The Carnegie Commission predicted that enrollments in the East and Midwest would decline approximately 10 percent while those in the South would increase by 5 percent and those in the West and Southwest would increase by 10 percent or more. A part of the difference in the two projections of regional variations includes the Carnegie Commission's consideration of migration patterns in addition to just live birth rates. Approximately 60 percent of the full-time equivalent enrollments in private colleges is 55 Table 15. Factors that Affect Higher Education Enrollment Predictions - Increased numbers of stop-outs and stop-ins. - Reduced dependence of young people on parental wishes and financial support. - Higher proportions of adults attending college. - Higher proportions of part-time students. - Higher percentages of students in two-year colleges who have more marginal commitments to attendance which shift with circumstances. - Higher proportions of students at graduate levels, particuarly the M.A. level, tied to immediate job prospects which fluctuate. - Changing inducements to attend college in the form of veterans' benefits, student subsidies, and opportunities in the labor market. - Changing private rates of return on a college education. - Changing military recruitment policies. - The historic shift from assured class to less certain mass attendance. - The rise and fall of geographic areas. - Increased cost of attending college. - Changes in job markets. - The addition of quality of life objectives of a recruitment and social nature to professional and vocational objectives. - More non-traditional institutions catering to specialized markets. From: Three Thousand Futures. San Francisco: Jossey-Bass, 1981, pp. 36-37. and "More Than Survival: Prospects for Higher Education in a Period of Uncertainty." Carnegie Council on Policy Studies in Higher Education. San Francisco: Jossey-Bass, 1980, p. 46. 56 Table 16. Percent Change in the 18-24 Year Old Population by Region and State - 1980-1985 Percent Percent Region and State Change Region and State Change NORTH ATLANTIC -3.8 SOUTHERN -4.6 Connecticut -5.2 Alabama -5.6 Delaware -3.4 Arkansas -4.8 Maine -3.7 Florida 2.9 Massachusetts -3.5 Georgia -3.5 New Hampshire -5.0 Kentucky -6.9 New Jersey -4.3 Louisiana -2.8 New York -4.8 Maryland -2.9 Pennsylvania -8.7 Mississippi -5.5 Rhode Island -5.4 North Carolina -4.6 Vermont -3.6 Oklahoma -5.8 Washington, D.C. 6.0 South Carolina -4.5 Tennessee -6.7 Texas -3.8 Virginia -3.6 West Virginia -10.3 MIDWEST -6.4 WESTERN -2.9 Illinois -3.9 Arizona 3.0 Indiana -5.2 California 1.1 Iowa -7.0 Colorado -3.3 Kansas -8.9 Idaho -6.2 Michigan -9.2 Montana -6.l Minnesota -5.4 Nevada -6.0 Missouri -6.2 New Mexico 3.2 Nebraska -6.6 Oregon -8.2 North Dakota -7.9 Utah -4.1 Ohio -7.0 Washington -3.5 South Dakota -4.5 Wyoming -2.2 Wisconsin -4.9 From: Anderson, Charles (Ed.). A Fact Book on Higher Education: First Issue/1976, pp. 76.16-76.17. 57 in states which will lose considerable enrollments while only 40 percent of the public enrollments is in these states.40 Concurrent with the level of enrollment changes over the years has been a change in the characteristics of the typical student. In the 19605 there was concern about making higher education available to per- sons other than white males from higher socioeconomic sectors of society; therefore, colleges opened their doors to women and racial minorities. By October 1979, for the first time in the history of American higher education, women constituted the majority of college enrollments at 50.7 percent.41 Older persons also began returning to college, some for degrees, others for mental stimulation or information. The "stopout" rate of students who interrupt traditional courses of study with work, leisure or travel, increased from 17 percent of all undergraduates in 1969 to 26 percent in 1976.42 Table 17 provides a comparison of the undergraduate student characteristics in the years 1960 and 2000. As can be seen, the undergraduate student body is becoming older, increas- ingly female, attending school more on a part-time basis and not living on the campus. Table 17. National Undergraduate Student Characteristics 1960 and 2000 CHARACTERISTIC 1960 2000 Women 37% 52% Minorities 4% 25% Part-time 30% 45% Non-Resident on Campus 40% 85% Over age 22 30% 50% From: Three Thousand Futures. San Francisco: Jossey-Bass, 1981, p. 54. 58 There have been other changes noted in the students as well. The ability of students has declined as was reflected in standardized test results (Scholastic Aptitude Test) which showed a drop on the verbal portion from 460 to 429 and on the mathematics portion from 488 to 468 between 1969-70 and 1977-78. To make up for these deficiencies, 85 per- cent of the American colleges and universities now offer remedial education programs.43 Changes in the composition of the student body do not take place over the years without impacting the curriculum and institutional poli- cies in a variety of ways. Prior to the 19605, the predominate way in which curricular policies in higher education were set was through administrative and faculty decisions. There was little attention given the student market or input because resources were plentiful and expansion was the focus. From the 19605 on, there has been increasing attention given to the student market in the development of curricula and policies. This change in focus came primarily as more financing went directly to students rather than the institution. At the same time institutional costs increased due to inflation and enrollments stopped increasing. In an enrollment-driven system, such as higher education, in times of expan- sion money is available and can be used to meet the needs of many vested interest groups (faculty, alumni, administration). However, in periods of contraction, many fixed costs cannot be reduced in proportion to enrollment declines, thus many or severe cuts must be made to remain financially sound and more students must be attracted to provide more funds to maintain the institution. In this way, the student market gains strength in dictating institutional courses of action.44 59 Other changes in the curriculum included less emphasis on the pro- duction of new knowledge and the cultural and social development of the learner and more emphasis on a practical and vocational orientation. Vocational courses have invaded the universities as students identify that their goal in attending a college or university is to get a detailed grasp of a special field and obtain training and skills for an occupation. This focus on vocational topics has meant big enrollment increases in business, the health professions, biology, agriculture and other techni- cal fields. Likewise, big enrollment declines have been noted in fields of study including education, the humanities and some social sciences.45 The number of hours required to obtain both associate and bacca- laureate degrees has dropped slightly. There is a shift away from breadth of study toward specialization as more electives are being added to the major field of study. There is a move away from specific course requirements toward the student selecting from among a more or less specified set of courses.46 Students should have options to take study areas of concentration of special interest to them and at the same time increase their potential value to employers. No student should be involuntarily penalized in the job market for studying a subject which is of great personal interest but in no obvious demand by potential employers.47 Majors are generally well handled by professional schools and depart- ments, but do have drawbacks such as being too oppressive and taking too much of a student's time; being too narrow and specialized; and leading to neglect of the department developing courses for non-majors.48 In summary, the information presented about enrollments has indi- cated that based on live birth rates alone it was clear that there was 60 going to be a decline in the numbers of traditional college age students beginning in 1976. This decline, while small initially, would persist every year through the end of the century with a few years where enroll- ment plateaus might be noted. The enrollment decline was predicted to have an unequal geographic impact with the Northeast and Midwest noticing the more severe declines. In addition to decreased live births, added social, economic and environmental factors were also contributing to decreased college enrollments. Even at a time when enrollments stabil- ize, it is clear that the level of enrollments would not equal those of the 19605, thus the key to future institutional survival would mean pre- paring for decreased enrollments and income. While enrollments were decreasing, changes were also occurring in the composition of the student body. Those institutions that were moni- toring the change noted that the student body was getting older, attend- ing college more on a part-time basis, living off-campus, and increasing in females. Students focused increasingly on vocational courses and pro- grams and the liberal arts curricula noted sharp and steady enrollment declines. The ability of students declined as reflected in standardized tests and to compensate for this, colleges and universities were forced to offer more remedial work. Faculty At the same time that changes were taking place in enrollments, students and curriculum, the faculty in institutions of higher education were also changing. A major concern facing colleges and universities today is the high percentage of older faculty with tenure and the small number of newly hired faculty. The last major hiring period of new faculty was from 1960-70 to accommodate the growth in enrollment.49 61 At the peak of academic activity in the 19605 new faculty were added at the rate of 20,000 or more per year. The current level of addition is zero and will likely remain that or less for the rest of this century.50 The modal age of tenured faculty in 1980 was 36 to 45 and in the year 2000 will be 56 to 65. There will be far more faculty aged 66 and older than aged 35 and younger in the year 2000. The next large faculty hiring period will be from 2000 to 2010. Potential disadvantages of an older faculty are that they are higher paid; less resilient to adjusting to new fields or changes; and farther removed from the age of the student.51 On the positive side, an older faculty will be more committed to the institution and adds stability to the governance system. Fewer faculty will tend to move as the problems in higher education worsen and job prospects elsewhere will be limited. As recently as 1969, tenure ratios were 50 percent. By 1980-81, approximately 75 percent of the faculty members at four-year institu- 52, 53 tions were tenured. A high percentage of tenured faculty decreases the flexibility of a unit and an institution and makes redeployment of resources more rigid and difficult.54 The scholarly focus of faculty is also changing. National surveys of college teachers conducted by the Carnegie Commission between 1969 and 1975 revealed that in 1969 three-quarters of all college and university teachers had not published or edited a book or monograph; by 1975 that percentage was two-thirds. In 1975, one-half of all faculty members who had published some professional writing had not done so within the pre- ceding two years. Faculty expressing a strong positive relationship between publishing and receiving tenure increased from 27 to 36 percent 62 between 1969 and 1975. During this time, there was also an increase from 15 to 35 percent of the faculty expressing a primary interest in research over teaching.55 Though faculty are older and thus more highly paid, salary increases in real dollars have been below those of some other occupational groups. Faculty and staff compensation between 1929-30 and 1949-50 (in constant dollars) increased at a rate of 0.29 percent per year; but from 1969-70 to 1977-79 it decreased at a rate of -O.53 percent per year.56 The lack of increase in real faculty compensation, cutbacks in resources available, closing of some courses, units or departments, and increased student- faculty ratios have given rise to an increase in faculty collective bargaining. The percentage of faculty unionized institutions of higher education, excluding religious institutions, rose from zero in 1960 to 6.7 percent in 1970 and 21.9 percent in 1979.57 While this percentage is not large, it does pose another condition with which administrators in higher education must cope. In summary, as changes have been occurring in enrollments and the composition of the student body, so have they been occurring with the faculty. Faculty now are older, more highly paid than new faculty, potentially less flexible, and farther removed from the age of the stu- dent. A very high percentage have tenure, thus ensuring job security even in the face of declining enrollments and resources. Diversity in Higher Education The problems faced by higher education could not be viewed compre- hensively without looking at their impact on the diversity present in the system. Diversity will be distinguished as to whether it is internal or external. Internal diversity results when an institution tries to fulfill 63 more than one mission or goal. External diversity relates to the differ- entiation among colleges and universities.58 Diversity is prized in American higher education according to Stadtman because it: "- Recognizes the differences in people - Increases the range of choices available to learners - Makes higher education available to virtually everyone despite differences among individuals - Matches education to the needs, goals, learning styles, speed and abilities of individual students - Enables institutions to select their own missions and confine their activities to those that are consistent with their loca- tion, resources, levels of instruction, and clienteles - Responds to the pressures of a society that is itself character- ized by great complexity and diversity - Becomes a precondition of college and university freedom and autonomy because the greater the differences are among institu- tions, the more difficult it is for a central authority to con- vert them ipgo instruments of indoctrination rather than of education." Threats to diversity in higher education in America include: closure of some institutions; centralized state or agency coordination; collective bargaining; and increased regulation.60 The diversity in higher education could also be impaired if certain kinds of institutions were to drastically decrease or go out of existence. These would include: institutions at the front of advanced learning and thought (doctorate granting institutions constituted only about 6 percent of institutions of higher education in 1976); institutions giving special attention to certain types of students (i.e.: single-sex, rural and religious institutions); and small, experimenting and developing 66 institutions. The critical point in terms of size seems to be an enrollment of 1000. Between 1970 and 1978, 124 of the 129 independent colleges and 64 universities that closed had enrollemnts of less than 1000 students.62 The large institution has come to dominate higher education. Most of these large institutions are public and located in the South and West. They are long standing elite institutions that draw the most academically able and financially wen-to-do.63 The largest segment of the public institutions of higher education, by headcount enrollment, in 1977 was sized between 2,500 and 9,999 (40 percent) while for the private insti- tutions it was sized between 500 and 2,499 (50 percent). Public insti- tutions between 10,000 and 20,000 grew from 0 percent to 18.2 percent between 1955 and 1977, while private institutions in the same size range grew from 0 percent to only 1.8 percent.64 In the 19705, 111 new institutions of higher education opened (78 two-year; 24 less selective liberal arts colleges; 9 comprehensive colleges and universities). During this same time, 107 institutions closed; 68 merged and 11 changed from private to public control.65 Only 15 of these institutions closing were under public control, all of the rest were private. Religious institutions were hardest hit with 48 Catholic schools closing or merging and only three opening; 18 Protestant colleges closed or merged and four opened.66 Less vulnerable private institutions include those with: high quality programs; a strong religious orientation; long standing traditions; loyal alumni; distinctive academic programs; special clienteles; and attractive locations. More vulnerable private institutions include those with: a heavy concentration on teacher education; urban comprehensive institutions that are not distinguishable from their counterparts except for higher tuition; small liberal arts colleges with restricted programs; and institutions in rural or depopulating areas.67 65 Value of the private sector in higher education is its independence of governance; diversity; long standing traditions; devotion to liberal learning; attention to individual students; and contribution to cultural 68 life. Private institutions have probably been more attentive to educational values than public institutions. With smaller enrollments, they can provide more personalized education. They also emphasize liberal education more than public institutions.69 In 1950, higher education was half public and half private as measured by enrollment; in 1980 it was four-fifths public and one-fifth private nationally, with great variations from state-to-state.70 One could question whether this percentage of private institutions is suffi- cient to serve as a check and balance for the public sector as well as to act as a model for the public sector or to serve as competition for it.71 Diversity is more likely to be seen now within institutions than be- tween them. Institutions in their entirety now are more alike with fewer 72 having any strong personality, mission or goal. It is doubtful that greater diversity within institutions balances out decreased diversity among them.73 In summary, the enrollment and economic problems faced by higher education are unevenly affecting various segments of the system with privately funded institutions feeling the impact more severely than publicly funded ones. This disproportionate impact means that a degree of the diversity present in American higher education is decreasing. In 1980, enrollments in private institutions constituted only 20 percent of all college and university enrollments. This is a 30 percent drop since 1950 and if the decline continues at this rate by 2000, there could be no 66 more privately funded institutions of higher education. This decrease in the private sector of higher education means that fewer options are and will be open to students who may desire some special focus or attention from higher education that could have been best provided through private institutions. Summary What has been revealed in the literature to this point is that the events of the past thirty to forty years have had a profound impact on higher education. The G.I. Bill of Rights following World War II resulted in immediate growth in enrollments in higher education followed by the increased birth rates which insured higher enrollments in the 19605. The launching of the Soviet space ship Sputnik created fear that America was falling behind the Soviet Union, thus creating a push for more higher education. Increased emphasis on equal access to higher education for women and minorities also favored the expansion of higher education through the 19505 and 19605.74 These factors were tempered by birth rates which steadily decreased after 1957, economic recession, increased inflation, student protests and revolts on college campuses across the country, the end of the compulsary military draft, and the change in student interests from general to voca- 75 Thus there was a period of rapid and steady expan- tional education. sion of higher education facilities and offerings in a good economic climate which favored and supported growth. This was followed by a period of declining resources of a significant nature and a changing environment regarding how higher education was viewed and valued. These changes and declines have led to institutions of higher educa- tion now being faced with excess physical capacity; an older, larger and 67 less resilient faculty; high fixed costs; and few slack resources after years of cutbacks and decreased funding. Enrollments are low and there are student demands for changing areas of study, some of which may not even fit the mission of the colleges and universities receiving them. As we approached the mid-19805, resources continued to decline or be scarce, and societal changes such as revolutions in technology, chang- ing demographic patterns, and decreasing productivity were creating new demands on higher education. It is critical to project the long term effects of resource decline and to develop organizational strategies to deal with this and to prevent institutional stagnation.76 Before project- ing future strategies, it is necessary to review the past approaches that have been used to deal with the problems identified to know which ones were successful and which may have contributed to or compounded those problems. higher Education's Response to Problems In 1974, the presidents of American colleges and universities were asked for their expectations of change from 1974-80. Aggregate responses revealed: 1. "Fewer seeing growth in enrollments from 1974-80 than saw it from 1968-74 with fewer also seeing declines; 2. Handling of enrollment declines by attracting adults, off- campus and evening students; 3. Funding problems not dominating the view with increased expectations of securing added funds from alumni, corpora- tions, foundations, and other private sources; 4. No major changes seen as presidents expressed confidence in their institutions to modify curricular offerings, reallocate resources and otherwise plan and manage resources available to them; 5. Little expansion in personnel assigned to recruitment and admissions; and 68 6. No changes in consolidation of courses, student- faculty ratios; faculty workloads; or use of plan-77 n1ng and management techn1ques." At the time of the survey in the summer of 1974, inflation was a severe problem, the market value of investment portfolios had declined, some foundations had announced cutback of grants, and state revenues had fallen (three-fourths of the states had allocated less to higher educa- tion in 1973 than in the immediately preceding years).78 In 1975 the Carnegie Foundation for the Advancement of Teaching in its report More Than Survival stated that because of decline in growth, problems that might have been bypassed must now be solved. Means to solve old and new problems were diminished and conflicts could arise due to financial rigidity, changing tenure rules and tightening employment practices. College administrators then predicted actions and outcomes to include: more centralization of authority; an increased number of students per faculty member; and a decline in the quality of programs, students and to a lesser extent, faculty.79 In a Carnegie Council survey of college and university presidents in 1978, 45 percent indicated financing was the major problem by 3:1 over the second concern which was decreasing enrollments. Of those who saw enrollment as the greatest problem, almost twice as many were in private 80 as public institutions. In this same 1978 survey, college and univer- sity presidents were asked to identify the most important issues facing American higher education between 1980-2000. The following topics were identified: "Financing Redefining goals of higher education Maintain enrollments Maintain autonomy Strengthen liberal arts Preserve private sector (”UT-FWNH 69 Maintain quality of higher education Strengthen career education Greater public confidence in higher education . . . n 81 Cont1nu1ng educat1on OGOQN 1 The differences between the 1974 and 1978 survey of college presi- dents are significant. The 1974 survey results may indicate that the presidents either had a lack of insight of current problems, an inability to use predictors to identify future problems, or a strong belief that their ability could avoid the problems predicted. One major factor which may have contributed to their lack of attention to problems then present may have been that until the 19705 the presidents had dealt only with growth. As Boulding wrote in 1975, higher education is now entering an era of slowdown and it is ill equipped to manage decline. Administra- tive skills that were highly desirable during the preceding thirty years may no longer be needed in the next thirty years. The skills of managing a declining institution are different and greater than those needed for managing a growing institution.82 Cyert noted that it is imperative that the univeristy be well managed when it is contracting. This is difficult because the better managers move to expanding organizations and academics resist being managed by expert managers and seek to have academics placed in top manangement positions.83 Involvement of all level of personnel within a university that is stagnating or contracting in size is necessary to: maintain excellence, stimulate high motivation from all participants, develop innovative programs, achieve fiscal equilibrium, and continue the viability of the organization.84 All persons need to readjust their thinking as to what constitutes success. Growth must no longer be the major criterion used to measure success. This will be a difficult barrier to overcome as the 70 market economy makes growth a measure of success. Growth is also seen as a creative force in society, creating new jobs and opportunity.85 In educational institutions facing decline or no growth, fewer opportunities for promotion and new hiring exist. This low probability for advancement means those first-rate persons outside the organization will not be attracted to it and those inside may consider moving to other organizations where they have better opportunities. As this occurs, the quality of education and the reputation of the institution declines and fewer or no top quality students are attracted. As fewer top students provide less faculty stimulation, more faculty will leave and thus a vicious cycle begins which may be repeated until the institution closes.86 In these times of no growth and decline, the institutional stance in higher education has changed from one of offense to defense. Emphasis is on contraction rather than expansion, survival rather than excellence. Signs of this increased emphasis on survival include: "The lowering of admissions requirements - The search for nontraditional students, who in the past have been least preferred - The increased emphasis on retention of students, some- times regardless of their performance - The rising level of grades to attract and retain students in courses and departments - The turn toward vocational and professional subjects following student demand - The introduction of new fields and courses that are highly popular with students - The faculty interest in collective bargaining to protect tenure and real income, and sometimes, to resist the impacts of affirmative action 71 - The effort to find top leadership which is good at cost accounting or at recruitment of students or at fund raising or at all three; to find managers for survival who will balance the books, recruit the students, and raise the funds instead of innovators andBplanners for a different and hopefully better future." As these survival actions persist, their impact on the institution is reflected by the following: "It is more difficult to start anything new with a non- market orientation, or to preserve the telic reforms of the 19605 - Supporting personnel, recruiters, admission officers, student financial aid officers, student counselors, become more important - Top leadership is more cautious, less visible - Consultation within the campus is more total, the search for consensus more insistent, the avoidance of contro- versy and of alienation of any important constitutency more avidly sought, the status quo more enshrined - Internal tensions are exacerbated; departments compete to survive; coalition58§orm over where the cuts should or should not be made. Institutions of higher education began experiencing no growth and/ or decline in the mid to late seventies and in may institutions this decline or stagnation is continuing well into the 19805. The change from growth to decline was not abrupt. Signs of changing times and impending decline were present as shown in the 1974 study but not necessarily needed. What were some of the warning signals of institu- tional distress that could or should have been seen and addressed? Glenny and Bowen have identified thirty indicators of enrollment and financial stress that could alert an institution to an imminent need for 89 changes in policies and activities. Change would be necessary if sufficient numbers of the indicators all pointed in the same direction. 72 The indicators are divdied into two major groups: those over which the institution has little if any control and those over which the institu- tion has some degree of control (Table 18). Those signs over which the institution has no control are often not identified or ignored if they are known. While these events may not be able to be controlled by the institution, their identification and consideration in short and long-range planning can greatly reduce their impact as they occur. The identification of these factors means that the external environment will have to be carefully assessed, trends predicted and contingency plans developed even if not implemented. Those indicators of distress that can be controlled by the institu- tion are more numerous than those that cannot be controlled. From a budget perspective, the higher the proportion of faculty supported by soft money, the greater the potential for instant trouble if those funds decrease. Hiring from within which includes an institution's own gradu- ates may be viewed as either money saving or conservative or both but tends over time to limit institutional capabilites. The rate of dropouts must be correlated with the economy to be meaningful as an economic down- turn usually leads to greater retention and increased enrollment.90 Faculty salaries constituting a disproportionate portion of the budget likely reflects cuts in other personnel and services. If continued, permanent damage may be done to all academic programs due to lack of adequate support. Once the potential for decline is identified, the decision must be made as to whether one will resist the decline or adapt to it. The resistance approach was common during the 19705. Typical resistance 73 Table 18. Warning Signs of Potential Institutional Distress INDICATORS INSTITUTION CANNOT CONTROL 1. Shifts in the Ethnic Mix of the Institution's Service Area. 2. Shifts in the Socioeconomic Mix of the Institution's Service Area. 3. Federal Subsidies. 4. Changes in Labor Demand in the College Service Area. 5. Live Births and the Demand for Teachers. 6. Source of Students by Geographical Area. 7. Changing Student Profiles. 8. Student Flow from High Schools. 9. Average Student Loads. 10. Uncertainty in Obtaining the Next Budget. INDICATORS INSTITUTION CAN CONTROL 1. Deteriorating Physical Environment of the Campus. 2. High Proportion of Total Budget Composed of Soft Money. 3. Decreasing Transfer Students from Two-Year Colleges. 4. Lower Admissions Standards. 5. Hiring from Within. 6. Increasing Unit Costs. 7. Increasing or Decreasing Percentages of Part-time Faculty. 8. Increasing Percentage of Faculty Teaching Outside Primary Specialty. 9. Regular Faculty Assigned to Unusual Teaching Hours. 10. Decreasing Rates of Funding for Additional Students. 11. Encouraging Unselective Early Retirement of Faculty/Staff. 12. Increasing Proportion of Faculty with Overloads or Underloads. 13. Decreasing Period Between Closing of Applications and Registra- tion. 14. Dropping Application Rates for Admissions. 15. Increasing or Decreasing Dropout Rates. 16. Overload of Career Counselors. 17. Low Placement of Certain Graduates. 18. Reduction in Supply, Equipment, and Travel Budgets. 19. Faculty Salaries Increasing Disproportionate to Total Budget. 20. Increasing Fees for Support of Selected Services. From: Glenny, L. and Bowen, F. "Warning Signals of Distress." Challenges of Retrenchment. Mingle, J. (Ed). San Francisco: Jossey-Bass, 1981, pp. 34-46. 74 approaches used included increasing advertising to secure new markets and expand present ones, decreasing attrition and increasing retention, improving student life and campus climate, tightening standards, and attracting new sources of revenue.91 Adaptation involves planning and recognition of the opportunities that accompany the problems. Peterson identifies seven R's of planning that can be used to respond in an adaptive way to decline. These in- clude: redefinition of mission; rethinking of administrative, leader- ship, and organizational models; reintegration of organizational pro- cesses; revitalizing members; reparations; recuperation and repartria- tions and recommitment.92 Reintegration is necessary when the effects of resource decline tend to remove organizational slack and central decision-making. The disintegration of associated horizontal and vertical capabilities limit an institution's capacity to innovate and require action. Reparations are needed when those areas that have previously been depleted are identified as still being vital to the organization. Types of damages that may occur during times of decline include: reducing academic programs which are later deemed to be necessary; defer- ring maintenance on a long-term basis, or decreasing library acquisitions over a long period of time. Such actions occur as a normal part of difficult periods and are brought about by lack of a well-organized plan for reductions, political pressures, poor forced choice selections, lack of information on which to base decisions or emphasizing traditional values.93 Sets of activities similar to those proposed by Peterson to use to respond to decline are also noted by Hall who adds changing the emphasis 75 of the organization from goals to the environment as survival stimulates 94 people to think ecologically. Cooke adds to the list focusing on the actual clientele with whom you are most successful and gearing programs to them while excluding marginally successful and expensive programs.95 Brantley, Miller and McAlpine advocate recruiting different student markets to be served while maintaining service to existing groups.96 Bieschke includes developing or maintaining open communications with faculty, staff, and students as a must in any plan involving cutbacks and retrenchment and developing administrative programs as alternatives to unions.97 In addition to maintaining open communications with faculty and staff, Mingle and Norris urge gathering substantial infor- mation on future enrollments and evaluating existing programs in view of the institutional mission.98 Mingle and Norris also advocated readjusting staffing by increasing the number of part-time and fixed-term non-tenured faculty; assigning faculty to teach outside of their own department; consoliding the admin- istrative structure; limiting course offerings in existing programs; and eliminating some academic programs. The personnel actions advocated by Mingle and Norris are not all of a voluntary nature through attrition since attrition decreases as economic times get worse.99 Mayhew includes in his list of activities more active recruitment of students and strengthening retention efforts.100 An increased empha- sis on retention is especially important as the majority of all institu- tions experience a 50 percent rate of attrition. No more than 50 percent of entering freshmen complete baccalaureate degrees and only 30 to 40 percent of entering freshmen graduate with associate degrees.101 76 Given the number and magnitude of problems faced by institutions of higher education and the slow recognition of these problems by some institutional presidents, what actions were actually taken by presidents to address them? The focus of major activity appeared to be on financial management. The short term and immediate response to decreased dollars was across-the-board cuts to all programs in the institution; cutting travel; decreasing spending on phones, equipment, energy costs, and library expenditures; placing hiring freezes on unfilled or newly vacated positions; deferring maintenance; scaling back student services; decreas- ing ancillary programs; cutting off-campus and non-traditional programs; and increasing faculty and staff loads.102’ 103’ 104 Another approach that received increased use was hiring more tem- porary and part-time faculty. Such action increased the potential of the institution to respond to more diverse areas of student interest more quickly but more importantly it reduced institutional cost. Part-time and temporary faculty are generally paid lower salaries, receive few, if any, fringe benefits and constitute only a short-term institutional commitment. Attractive as these advantages may seem, there are problems. Part-time and temporary faculty many not always meld with full-time faculty into one unit; they may not be familiar with or supportive of the institutional/program goals or mission; their standards may be different from regular faculty; they may need increased supervision; they may have less job commitment; and they probably do not participate in student advising, research or publication.105’ 106 Providing an "early retirement" option for selected personnel was another approach used to reduce costs. The intent of this action was to encourage senior and more highly paid staff members to retire early, thus 77 decreasing direct and indirect personnel costs. There were various criteria that had to be met to qualify for this option at various insti- tutions. A major probelm associated with this approach is that it pro- vides an unpredictable, uneven and uncontrolled exodus of persons which may leave needy units short of staff and overstaffed units still over- staffed. With position control regulations also in effect, it was not always possible to refill a vacant position. Additional problems arose in that as more senior faculty left, so did much of the expertise of various units they served.107 Long term use of any of these short term responses to decline makes institutions show wear and tear, may decrease enrollment and increase 108, 109 faculty dissatisfaction. Across-the-board cuts also lead to 110 There is little the potential of decreased quality in all programs. flexibility in many institutional budgets following several years of across-the-board cuts. The approach of cutting all units across the board was quite popular in public institutions where decision-making groups were all public and the political impact of closing a school or unit was too great.111 After several years of across-the-board cuts and use of other approaches noted, and with finances not improving, it then became necessary to consider other alternatives to decreasing costs. A major course of action then undertaken was program downsizing and discontinuance. Proghem DownsizingZOiscontinuance Historically, there are two major reasons for discontinuing an academic program: decreased academic viability and increased costs.112 Program discontinuance gained popularity during the eary 19705 when some states began considering the closing of some programs that had 78 proliferated in numbers during the growth years.113 It soon took on negative meaning as some programs were discontinued and faculty were relieved of teaching responsibilities. Program discontinuance had been used previously during the Nineteenth Century when many religious schools opened and the increased competition for students caused lowered enrollments in some institutions and forced programs to be cut. During the Depression (1932-34), financial and enrollment problems caused some institutions to discontinue programs.114 Thus the use of program discontinuance, rather than a positive ongoing check and balance within the higher education system, seems to be a course of action resorted to only in times of financial and/or enrollment decline. This could explain, in part, the negative connotations it carries. Though a course of action resorted to in times of crisis, program discontinuance will not save money in the short run (and possibly not in the long run), and it may reduce future budget commitments only if tenured faculty are released. If faculty are reassigned or if positions are vacated only as faculty voluntarily leave, personnel savings are minimal. Any savings gained through program discontinuance must also be weighed against the loss of student fees from the program(s) deleted; the time and energy of faculty and administration in making decisions; and possible legal fees if any suits are initiated.115 In addition, the impact of the discontinuance on various other campus offices (housing, special services, financial aids) must be considered. Another area of concern is courses in other departments which are taken by majors in the program being discontinued as well as any courses offered by the discon- 116 tinued program to non-majors. Program discontinuance cannot take 79 place immediately as some provisions must be made to allow students currently enrolled in the program to complete it.117 The decision to discontinue or downsize a program should come only after extensive review of programs based on specific criteria. A review of the literature on program discontinuance revealed a number of criteria used to evalute programs for possible discontinuance. Table 19 contains a list of the criteria most often used by institutions to review a program for possible discontinuance and Table 20 contains additional criteria less frequently mentioned.118”134 The criteria for programs undergoing review may be either quantita- tive or qualitative in nature, or more often a combination of both. Quantitative criteria include such items as costs, enrollments, size of classes, total production of graduates and faculty workload while quali- tative criteria examine areas such as the quality of instruction, quality of faculty and the national ranking of the program. The farther from the target unit that the review is done, the more the review criteria tends to be quantitative in nature.135 The establishment of criteria for the review is only one of four major factors to consider when contemplating program downsizing or dis- continuance. A second area of focus is when the review should be done. Under the most favorable conditions, reviews are conducted periodically on all units over a given number of years. Under the worst conditions, reviews are prompted by political, economic, employment or enrollment 136, 137 pressures. Program closure decisions are very time-consuming and are best not done in the midst of severe financial problems unless there is a well established process for the review.138 80 Table 19. Criteria Most Often Used by Institutions of Higher Education to Review Academic Programs for Possible Discontinuance Number of graduates from program in each of last five years. Number of students enrolled. Class size. Cost of courses integral to program. Cost per program graduate or credit hour. Faculty workload. Program quality (faculty quality, national ranking). Total number of graduates of all other similar programs in state/region/nation (uniqueness of program). Future trends in society relative to program graduates. Projected student interest/demand/enrollment over next five years. Appropriateness of program to institutional mission. Connectedness of program to rest of institution. Table 20. Criteria Less Frequently Used by Institutions of Higher Education to Review Academic Programs for Possible Discontinuance Change in student interest over last four years. Vitality of program (use of resources, educational methods, service activities, goals, clients served). Effectiveness of resources used. Value of program to society. Extent to which program serves other units/majors in institu- tion. Potential impact on public/external relations. Cost-revenue relationships. Job placement of graduates. Quality of students attracted. Does area attract continuing financial support. Attrition. A third question to be considered that is very closely tied to when the review will be done is what programs should be reviewed. The typical approaches have been to review logical clusters (institution or system wide) or those setting off “trip wires" by falling above or below pre- established quantitative limits in such areas as productivity, trends in student credit hours generated, enrollment, or costs.139’ 140 81 A fourth question that needs to be addressed when planning a pro- gram review is who will conduct the review. Reviews may be conducted by peers from within or outside of the institution. Costs may be a deciding factor in this decision as an outside review is more costly than a review conducted by institutional members. Most reviews are conducted involving only a liaison person from the program under review.141’ 142 In some states, the state agency responsible for the control or coordin- ation of higher education will conduct the review and has the authority for formulating review procedures and making discontinuance decisions.143 Data collected by the Carnegie Commission in 1979-80 regarding the level of program discontinuance revealed that of forty-six state agencies responsible for recommending, initiating or deciding program discon- tinuance, thirty-two state boards actually were involved in the review activity.144 Given these guidelines regarding program review for possible dis- continuance, what kinds of programs does the literature show actually have been selected for review? Those programs more often selected are ones that: (1) are considered in isolation from the institutional mission; (2) have records that show client contacts but do not equate these to student credit hours; or (3) are called to administrative attention due to some crisis such as questionable leadership, a decline in program quality, loss of external funds, or requests for added money.l45’ 146 Following reviews, what kind of programs were actually discontin- ued? The EXXON study of programs discontinued in major research univer- sities showed those programs to be ones that were: (1) outside the commonly accepted definition of the university (professional training 82 and/or service programs not contribuitng to the main research function); (2) not meeting the institutional mission; 3) receiving few outside grants; (4) showing decreasing student numbers; (5) in physical and/or intellectual isolation; (6) considered not vital to the continued func- tioning of other departments.147’ 148 Pseudo-discontinuance may occur when the institutional inventory of degree programs is reduced without a concurrent reduction in curriculum, staffing or the institutional budget. Davis and Dougherty have identified alternatives to program discon- tinuance. These include: (1) merging of the affected program with an- other viable unit; (2) transferring of the affected program to another unit; (3) developing a joint program with another institution; (4) trans- ferring of the affected program to another institution; (5) changing the affected program to decrease costs and/or increase quality and retaining it.149 Suggestions offered as to how to avoid program discontinuance include: setting program priorities on a clear understanding of the institutional mission; maintaining quality; keeping faculty size consis- tent with enrollment; developing faculty and curricular relations with other departments; doing long range departmental planning; maintaining strong unit level leadership; avoiding self-imposed financial difficulty; and building flexibility into the unit.150’ 151 Summary Thus it can be seen that a wide array of strategies have been used in dealing with the decline in higher education with varying degrees of success. These have ranged from across-the-board cuts to all units to program discontinuance. The issue may not be one of whether the strate- gies were good or bad, but rather were the managers prepared to manage the 83 decline. Present educational administrators have grown up in a period of rapid growth in higher education and presumably have been chosen because they were capable of dealing with growth. The skills and strategies associated with managing growth are different from those associated with managing decline. Values and idealogy of our culture emphasize growth and expansion as indicators of effectiveness. Dealing with stability and decline are foreign to the mainstream of management thought and practice. Without a background in the management of decline, administrators, when faced with decline, define the conditions as ones of resource allo- cation problems or efficiency and respond conservatively rather than 152 innovatively. They basically continue to do less of the same. This conservative orientation may be deadly for colleges and universities. This approach is not only contrary as to how to respond to decline, but in the private sector has often led to ineffective performance and organizational death. A study of forty institutions of higher education in 1981 revealed that those respondents classified as declining institutions: " . had significantly more standarized structures, relied on past conservative practices, perceived the external environment as lean in resources, and had perceived low organizational effec- tiveness in the core academic areas and low morale. Declining institutions did show high effectiveness in handling internal organizational concerns. Goals related to academic domain effectiveness were not highly valued. Administrators empha- sized finances, budgeting and fund raising. Little emphasis was given to interaction with external constituencies through153 public relations and public service." Administrators in institutions classified as growing emphasized the opposite characteristics. The behavior of administrators in declining institutions may perpetuate decline by eliminating the potential for expanding resources by not interacting with the environment proactively 84 and relying on past and possibly outdated standardized procedures. Some reasons projected as to why administrators in higher education may use the conservative approach and focus on efficiency have been identified (Table 21). Table 21. Reasons Why Administrators in Higher Education Focus on Conservatism and Efficiency 1. It is easier to define and measure efficiency than effectiveness. 2. Self-protective behaviors are commonly used and most always conservative. 3. New problems are interpreted through old frameworks and past successful alternatives applied. 4. Consensus is virtually impossible to reach among loosely coupled systems each protecting their own vested interests, therefore, conservative and satisficing strategies are used to lesson con- flict. 5. Administrators left to manage declining organizations tend to "play it safe." 6. Innovation is viewed by some as a cause for decline; therefore, in times of decline, past innovations are deleted and future innovations are not pursued. From: Cameron, K. "Responses to Fiscal Stress: Contrasting Higher Education and the Private Sector.“ In Responses to Fiscal Stress in Higher Education, Wilson R. (Ed.). Center for Study of Higher Education, College of Education, University of Arizona, Tucson, AZ, 1982, p. 54. Since it is necessary to be more accountable in times of decline than in times of growth, administrators tend to select courses of action that are more easily measured and have proven successful in the past. The problem is that past and present conditions are vastly different. Growth in higher education occurred despite actions taken by adminis- trations. These non-aggressive, non-risky past strategies are generally 85 the first ones chosen in times of decline. Conditions of decline are often viewed as caused by environmental factors outside the control of the administrator, therefore, conservative actions seem appropriate. There is no need to risk any of one's self if the factors causing the problem are out of one's control. Such courses of action may also be the only ones known to the administrator who may be someone left to manage the decline after the innovative leader has left for a job in a growing organization. In summarizing the response of higher education to the conditions of decline faced in the 19705 and 19805, it would seem that more conser- vative strategies that had been used with success in times of growth were applied first. These approaches proved less than successful in coping with the conditions of decline which have continued for almost ten years. These conservative, internal reallocation, efficiency- oriented strategies eventually gave way to approaches involving program downsizing and discontinuance as the economic and enrollment problems persisted. The use of management strategies not designed for decline was done with all good intentions by administrators who were not pre- pared to deal with decline, had experienced only growth situtations, and who were striving to protect the institutions as well as themselves. The decline in higher education and the strategies used to deal with it have brought higher education to its present state. Given this background, the researcher now wishes to explore what has happened to generic baccalaureate nursing education during this same difficult time. Following that, the literature on organizational decline will be reviewed so that one may identify courses of action that could 86 have been and can be taken to manage the decline in higher education and in generic baccalaureate nursing programs. NURSING EDUCATION Given a description of the issues and problems facing higher educa- tion now and in the immediate future, it becomes necessary to relate these to generic baccalaureate nursing education. To assist in this process, the literature review presented in this section will include a brief history of the development of nursing education, current and pro- posed trends in nursing, current information about enrollments and admissions into generic baccalaureate nursing programs, the need for nurses in the continental United States and the type of nurse needed to deliver care in the present and future American health care delivery system. Hospital-Based Nursing Education Progams Modern nursing as a forerunner of what we know today, began in 1633 in Paris when the Sisters of Charity was formed by Saint Vincent de Paul. One of the vows taken by the sisters was to care for the sick. The first American community of these sisters began in Maryland in 1809. Several other Catholic orders of sisters founded in Europe also established orders in the United States in 1843 and 1844. In 1836, one of the Protestant deaconess orders which had existed near the time of Christ was revived in Germany by a pastor who needed nurses for his new infirmary. In Europe, care of some ill persons was provided primarily by sisters or deaconesses through religious orders. While the scientific training of these women was non-existent, they were sincere in their efforts, kind, dedicated and observed principles of cleanliness. The 87 hospitals in Europe in the seventeenth and eighteenth centuries were not clean or sanitary and provided care primarily to the ill indigent. In this same time period in the United States, care of the ill existed in alms houses or pesthouses and hospitals, as known today, did not exist until 1751.154 The religious attendants in hospitals in the United States had been replaced by lay people who came from the criminal class, aged inmates, or women who could not obtain employment elsewhere. No training was given, no supervision was provided and even this pitiful attention was not available at night. These people, though unprepared in any way, were the nurses of the times. The establishment of the first formal nursing education program with any scientific base was in England in 1857 by Florence Nightengale. The training program was begun at St. Thomas Hospital in London. That program was opoosed by the vast majority of all physicians in London who indicated that since nurses occupied much the same position as housemaids, little formal education beyond poultice-making and cleanliness was needed.155 In the United States, physicians intermittently gave lectures to nurses and midwives at state hospitals in several large Eastern cities. While this did not constitute a formal nursing program, it was the best available in that time. In 1798, Dr. Valentine Seaman organized the first formal nursing program in a New York hospital. The program consisted of 24 nursing lectures. The focus of this program and several others that started soon after was on midwifery rather than general nursing. In 1849, the Massachusetts Legislature appointed a state sanitary commission to propose plans for promoting public health. The commission recommended that "institutions be formed to educate and 88 qualify females to be nurses of the sick.”156 In response, in 1850 for the three years it operated a hospital, the New England Female Medical College offered women the opportunity to attend medical lectures. In 1857, Dr. Marie Zakrzewska Opened the New York Infirmary for Women and Children and initiated a six month training program for nurses. Another six month nurse training program was started in 1861 in Phila- delpha by Dr. Ann Preston. In 1862, Dr. Zakrzewska left the New York Infirmary and founded the New England Hospital for Women and Children in Boston and established a six month nursing training program there.157 There were, however, few women willing to give the six months required of any nurse training program. During the 18605, the number of trained nurses were few with the majority of the care given in hospitals by uneducated and unfit women (also called nurses). In 1872, Dr. Horatio Storer wrote that ". . there must, sooner or later, be established, in connection with all large hospitals, scholarships, as it were, for nurses . ."158 In 1872, Dr. Susan Dimock who began medical training in Dr. Zakrzewska's school and completed her studies in Europe, rejoined Dr. Zakrzewska in Boston and together they developed and expanded a twelve month nursing training program. Dr. Dimock had visited Florence Nightengale while abroad and gained information from her about the essentials of a legitimate training school for nurses. This program was the first American nurse training school offering a graded course in scientific nursing. Students worked from 5:30 a.m. to 9:00 p.m. in the hospital and slept in rooms near the ward so they would be available for emergencies. In return, they received twelve lectures. The first 89 graduate, Linda Richards, completed her studies in 1873. This training program for nurses, improved as it was over all others, was extremely short and was not located in a general hospital.159 In 1873, three more nurse training programs opened with the one attached to Bellevue Hospital in New York being modeled after Florence Nightengale's St. Thomas Hospital program in London. The course of training at the Bellevue program was two years in length, one year of study and one year of supervised experience. Other programs based on the Nightengale model opened in 1873 in Connecticut and Boston. As these schools produced more nurses, they began to migrate to areas of the country without nursing programs. By 1890, the first program in the Western United States was started in Portland, Oregon, and by 1898 there were nearly 200 nurse training programs in the United States. By 1917, this number had increased to over 700 nursing programs. All nurs- ing training programs were attached to hospitals and were used by the hospital as a major means of staffing the wards with qualified persons at little cost. World War I increased the need for nurses and a number of different groups and efforts were initiated to attract more women into nursing. One of these efforts was a summer school started at Vassar College in 1918 where college graduates wishing to become nurses would enter Vassar's intensive preparatory course in nursing and then affiliate with one of the 33 cooperating hospital nursing training programs. The intent was to give the foundation science courses in college and then have the student complete the nursing instruction at a hospital school. The total time interval for this combined program would not exceed the regular hospital program length of time. Through this effort, it was also hoped 90 that a better quality of nurse could be prepared. Soon after the Vassar program began, five other universities set up similar joint programs aimed at high school students. The standard of teaching at the universi- ties exceeded that in the nursing school and many nurse educators believed that even after the war, it would be advantageous to have pre- nursing work conducted at or by recognized colleges or universities.160 In 1920 following World War I, there were 1,755 hospital-based nurs- ing programs, many of which could not attract sufficient numbers of applicants. The increased recruitment of nurses for the war had depleted many hospital staffs. Many nurses returning from the war chose to marry and leave nursing, thus adding to the shortage. The image of nursing was still one of being inferior to male dominated occupations, thus adding to recruitment problems. Despite these problems, more hospitals started nurse training programs as the main means of providing staffing for the wards and keeping the hospital open. By 1923, the number of nurse train- ing programs had increased to 1,964 and by l927 to 2,286. The enrollments in these programs rose from 54,953 in 1920 to 77,768 in 1927.161 Many of those graduating from these programs were poorly trained and highly exploited by the hospitals running the nursing programs. In 1918, some nursing educators stated that there was no hope for nursing education to advance until educational programs were removed from hospitals and administered separately. In 1912, Adelaide Nutting approached the Carnegie Foundation to fund a study of nursing education following its funding of Flexner's Study of Medical Education. The Foundation turned down the nursing request, but did fund subsequent studies in dental, legal and teacher education. Ms. Nutting then approached the Rockefeller Foundation and in 1919 the Foundation formed 91 and funded a Committee for the Study of Nursing Education. The Rocke- feller Study entitled Nursingand NursihghEducation in the United States was written by Josephine Goldmark and published in 1923. The 500 page study concluded, among other things, that it was desirable to have schools of nursing established in universities. It also noted that while the present hospital training schools had made remarkable progress, the instruction in the average school was too casual and uncorrelated, and that the educational needs, health and strength of students was often sacrificed to meet hospital needs. The report also advocated a "basic undergraduate training for all nurses which would lead to a nursing diploma."162 University-Based NursingEducation Proghems By the early 19205, only sixteen colleges and universities had in- corporated nursing education programs. These were generally organized as four or five year programs leading to a nursing diploma and a bachelor of science degree. The usual organization was for the student to spend two years at the university and complete preliminary work, then spend two years training in the university hospital followed by one year clinical work and study in some specialized area. By 1926, there were twenty-five such programs in the United States, but the total enrollment was only 368 as most women resisted this length of study.163 Following the Goldmark report, the Rockefeller Foundation awarded a five year grant to Yale University to establish a model university-based nursing education program. The program was to consolidate nursing theory and practice, eliminate non-nursing assignments, and emphasize preventive aspects. The Yale program opened in 1924 as a separate university depart- ment, with its own budget and dean. Hospital affiliation was arranged. 92 The course of study was twenty-eight months in length. The program was highly successful and in 1929, admission standards were elevated to require a bachelor's degree. The program then became thirty months in length and offered a Master of Nursing degree. There were 128 women students. In 1929, the Rockefeller Foundation awarded the school an endowment of $1 million, thus ensuring its permanency.164 Widespread duplication of the Yale program was not forthcoming. By 1925, only three other universities had initiated similar programs. Opposition to college-based nursing progams came from physicians who argued that college educated nurses were over-trained and provided too costly services. Hospital diploma training programs also opposed the college programs and stated that nursing education meant only technical skills and manual dexterity. Diploma educators believed that intelli- gence and a theory base were not only unnecessary, but may handicap prospective nurses.165 Since collegiate-based nursing education was not expanding and many of the hospital-based nursing programs were of poor quality, another study group was formed shortly after the Goldmark Report was published. This group, the Committe on the Grading of Nursing Schools, contained representatives from three major national nursing organizations, as well as representatives from several medical groups, the Hospital Association and the Public Health Association. In 1928, the first of its reports entitled, Nurses, Patients, and Pocketbooks, was published. It addressed nurse supply and demand and concluded that there was an over-supply of nurses and the numbers were rapidly increasing. It also identified poor pay for nurses and low educational standards in many programs.166 93 The second report from the Committe on Grading of Nursing Schools published in 1934 was entitled NursinghSchools Today and Tomorrow. In this report, present educational weaknesses were described and recom- mendations for improvement were made. The report identified lack of financial support as a major deterrent to placing nursing education on a higher level. Faculty in diploma programs were also noted as having low educational standards (42 percent were not high school graduates).167 A study of hospital schools of nursing in 1936 showed seventy collegiate nursing programs, most of which consisted of two years of general education before or after a regular three year hospital training program. Over half of these programs had been established between 1930 and 1936. By 1936, the number of hospital-based training programs had decreased from over 2,286 in 1929 to 1,472. This decrease in hospital programs is attributed both to the evaluation studies of nursing education and to the depression. By 1941, the number of hospital based nurse training programs was 1,400.168 In 1937, the third edition of the National League for Nursing's Curriculum Guide for Schools of Nursing was published. Two new assump- tions contained in the guide were: (1) the primary function of a school of nursing should be to educate the nurse, not provide nursing service for patients; and (2) the nurse should serve the whole community, not just the hospital. A reorientation from sick care to health care was proposed and more emphasis was to be placed on mental health care.169 At a national nursing meeting held in 1946, a panel of nurses gen- erally agreed that it would be wise to foster establishing schools of nursing in colleges and universities. (At this time, 91 percent of all nursing programs were hospital-based.) Senator Claude Pepper also spoke 94 at the meeting and said that ". . . nursing education, like other forms of professional education, should be directly financed by the individual and the family, by tuition grants, loans, scholarships, and fellowships paid for from private and government sources."170 In 1947, only four percent of all nurses graduating from training programs received university degrees. The American Medical Association at the same time was still debating the necessity and wisdom of nurses receiving any increase in theory. They believed that nurses were "legislating and educating themselves out of jobs."171 In 1948, a report funded by the Russell Sage Foundation written by Esther Lucille Brown entitled Nursing for the Future was published. Among its recommendations were that: nursing education programs should be moved from hospitals into colleges and universities; smaller weak hospital schools should be closed; and all schools should be officially examined and a list of all accredited schools be published with a re-examination taking place periodically. The Brown report was attacked at the 1948 American Medical Association meeting as ignoring the facts of life.172 A Committee to Implement the Brown Report surveyed all schools of nursing (96 percent participated) and classified them on a 100 point scale based on standards of nursing recommended by the professional organization (Table 22). Ranking of the schools using these criteria is shown in Table 23. Group I was the top 25 percent of all programs, Group II the middle 50 percent, and Group III the lower 25 percent. All 114 college-controlled schools participated in the study and all were classified in Groups I and II.173 95 Table 22. Criteria and Weights Used to Rate Schools of Nursing Criterion Weight Administrative policies 3 Financial organization 3 Faculty 22 Curriculum 16 Clinical field 22 Library 6 Student selection; provision for student welfare 13 Student performance on state board examination 15 TOTAL SCORE 100 From: Kalish & Kalish. The Advance of American Nursing. Boston: Little, Brown and Co., 1978, p. 510. Table 23. Ranking of Schools of Nursing Surveyed by the Committee to Implement the Brown Report Number of Schools Number of Students Group I 301 34,436 Group II 567 46,483 Group III 282 13,779 From: Kalish & Kalish. The Advance of American Nursing. Boston: Little, Brown and Co., 1978, p. 510. The accreditation process for schools of nursing proposed in the Brown Report was initiated under the auspices of the National League for Nursing in 1952. By 1957, the total number of accredited nursing pro- grams had increased by 72.4 percent while the total number of programs had dropped to 1,115. Between 1952 and 1957, the number of schools of nursing offering college degrees increased by 37 percent (to 161) while hospital-based diploma programs decreased to 936. There were also eighteen accredited associate degree nursing programs.174 96 Community College-Based Nursing Education Program In 1952, a project aimed at developing nursing education programs in junior and community colleges was announced by Columbia University. The purpose of the project was to determine whether a two year program could prepare nurses for beginning, general bedside positions. This approach would reduce the critical post-war shortage of nurses by shortening the training period and help move nursing education into the overall main- stream of American higher education. In 1958, the study of seven commun- ity college-based nursing education programs concluded that the two-year curriculum could prepare a registered nurse and that such a program could become an integral part of a college and be financed as any other college program.175 Thus began the third type of educational programs preparing registered nurses. Summary To this point, the development of nursing education in the United States has been briefly traced. The oldest type of education program developed to prepare nurses was the hospital-based diploma program established in 1872. University based baccalaureate nursing programs were then established in the early 19205 and the community college associate degree nursing program began in 1952. Graduates of all three types of educational programs wrote, and still write, the same state board licensing examination and were, and still are, viewed and used interchangeably by employers. The nursing component of both of the education programs based in academic institutions were (and many still are) variations of the hospital-based diploma nursing education programs with decreased clinical time and added science and general education 97 courses. Given this background, it now becomes appropriate to look at the present trends in nursing education curricula and enrollments. Present Enrollment Patterns in Nursihg Education Programs The total number of all types of basic nursing education programs in the continental United States increased each year until 1973. From 1973 through 1978, there was a slight decrease in the overall number of basic nursing education programs. This number began to slowly increase again in 1979 and continued through 1982 which is the last year for which data are available (Table 24). Table 24 also shows that there has been a greater change among the types of programs than in the overall number of programs. The unmistakeable trend is that hospital-based diploma pro- grams are decreasing in numbers while associate degree and baccalaureate programs are increasing. While the overall number of basic nursing education programs shows a slight increase, the overall numbers of graduates from all types of basic registered nursing education programs remained virtually constant between 1975-75 and 1978-79 and showed a decrease from 1979-80 until 1981-82 (Table 25). Among the three types of basic nursing education programs, graduations from diploma programs have been steadily decreas- ing; those from baccalaureate programs decreasing since 1978-79, and those from associate degree programs increasing except for 1978-79 and 1979-80. Thus when viewed from this persepctive, nursing education is in a steady (stagnating) or possibly slightly declining state. If there are fewer graduates from the same number or slightly more programs, either some programs are not admitting to the maximum of their potential, or more programs are reducing their capacity. 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Over two-thirds of all nursing education programs can enroll a maximum of 199 students each with this being almost equally divided between programs able to enroll under 100 students and those able to enroll 100 to 199 students. Schools able to enroll 300 or more students are in the minority. Tables 27, 28 and 29 contain the specific breakdown of potential enrollment by type of program and geographic region. Only the number of associate degree nursing programs has remained steady or increased in all size classifications, while the diploma and baccalaureate programs have shown increases and decreases in various sized programs over the years. The trend, however, for basic baccalaureate nursing programs is an increase in the number of programs enrolling up to 199 students. Associate degree programs show the greatest growth in programs enrolling from 100 to 299 students. 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ESE. mum NmmH Ou mnma “unmEHHoucm uzmcaum mo mNNm can mcfimuzz Mom mammmq Hmcowumz an mamumoum unamunz MEOHQNQ .mN mHnt 105 programs. In contrast, the number of diploma progams enrolling 300 to 399 students doubled between 1981 and 1982. The greatest decrease in numbers of diploma programs was those with enrollments under 100 students. Figures in Table 27 also show virtually no change in the overall number of baccalaureate programs in the North Atlantic and Western regions and a small increase in the numbers of programs in the Midwes- tern and Southern regions. The number of associate degree programs has increased in all regions, but only slightly in the North Atlantic region (Table 28). The number of diploma programs has decreased in all regions with the South and West showing the least decline (Table 29). In the regions with diploma programs, the majority of those programs are concen- trated in eight states, whereas the distribution of baccalaureate and associate degree programs is more even (Table 30). The total annual admissions to all three types of basic nursing programs increased for two years in a row (1980-81 and 1981-82) following three consecutive years of decline (Table 31). This two year gain for all types of programs last occurred in 1971-73. The increase in admissions to diploma programs must be considered in light of the decrease in the number of programs (Table 24). Figures in Table 31 also reveal that admissions to associate degree programs have steadily increased while those in baccalaureate programs decreased in 1978-79 and 1979-80. Despite the increases and decreases, the number of admissions to baccalaureate nurs- ing programs remained virtually unchanged from 1978-79 through 1981-82. Though the number of admissions to all types of basic nursing pro- grams has shown a recent increase, the number of vacancies in each type of program is still substantial (Table 32). While the overall vacancy 106 Table 30. Distribution of Baccalaureate, Diploma and Associate Degree Nursing Programs by State and National League for Nursing Geographic Region, 1982 NORTH ATLANTIC REGION SOUTHERN REGION ’ State Total _13. AD. 8A. State Total 913. _2. 8A. Connecticut 15 2 6 7 Alabama 37 4 20 13 Delaware 7 2 3 2 Arizona 20 2 11 7 Washington, D.C. 6 0 1 5 Florida 35 1 22 12 Maine 10 4 4 2 Georgia 32 3 19 10 Massachusetts 48 15 19 14 Kentucky 27 1 20 6 New Hampshire 11 4 4 3 Louisiana 17 3 6 8 New Jersey 38 18 13 7 Maryland 24 5 14 5 New York 98 20 47 31 Mississippi 23 2 14 7 Pennsylvania 95 46 21 28 N. Carolina 55 7 36 12 Rhode Island 7 2 2 3 Oklahoma 26 1 15 10 Vermont 5 O 4 1 S. Carolina 19 1 14 4 Tennessee 32 7 16 9 Texas 64 5 38 21 Virginia 37 13 15 9 W. Virginia 17 2 11 4 TOTALS 340 113 124 103 TOTALS 465 57 271 137 MIDWEST REGION WESTERN REGION State Total DIP. AD. 8A. State Total 913 AD 8A Illinois 79 24 34 21 Arizona 18 O 14 4 Indiana 30 6 14 10 California 90 4 67 19 Iowa 39 9 20 10 Colorado 12 2 7 3 Kansas 31 3 19 9 Idaho 6 0 5 1 Michigan 50 7 3O 13 Montana 4 0 2 2 Minnesota 26 4 12 10 Nevada 5 O 4 1 Missouri 38 10 19 9 New Mexico 11 O 10 1 Nebraska 11 5 2 4 Oregon 16 1 13 2 North Dakota 9 3 2 4 Utah 5 0 2 3 Ohio 71 29 28 14 Washington 22 O 16 6 South Dakota 9 2 4 3 Wyoming 4 O 3 1 Wisconsin 31 6 15 10 TOTALS 424 108 199 117 TOTALS 193 7 143 43 From: National League for Nursing Data Book 1983-84. New York: National League for Nursing, 1984, pp. 4, 5 & 6. 107 .ucwmczz Now ozone; chowumz uxco> 3oz .HN .a .¢wma .wmummma xoom mumowcmmcaz Lo; mammwN chowumz “so; .mucmNmH :chw> on» new .oumm opgmaa .emau .moemm :mqumE< mmuzpuxm m H H.m+ mNm.wH H.m+ mw¢.om m.o+ mNm.mm m.¢+ mmN.mHH NmnmeH m.m+ ¢m¢.na H.m+ www.mm H.H+ mom.mm o.¢+ HQN.OHH HmuommH o.m- NON.NN m.o+ NNN.NN m.o- ¢N¢.NN ¢.N- NNN.moN om-NNNN N.ON- NNN.NN N.o+ NNN.NN N.¢- NNm.mN N.N- NNN.NON NN-mNNN m.nu HH®.ON H.Hn Hmm.Nm m.H+ m¢m.nm ¢.Hn omm.OHH mmnuumfl m.ma m¢N.NN m.N+ oam.mm o.H+ 0mm.mm m.o+ mum.NHH unnmmma m.¢n www.mw m.m+ wa.Nm m.m+ owm.mm m.N+ ¢NH.NHH mhummma m.mu mmo.¢~ o.m+ mom.m¢ 5.5+ mmm.¢m m.H+ omo.mOH mmuemma m.mn m¢m.mN o.m+ o¢m.n¢ o.n+ H¢¢.Nm ¢.m+ ¢¢m.moa vhnman H.o+ mon.mN o.o~+ mmn.m¢ m.HH+ mwm.om N.HH+ www.m0H mnuNmmH o.m+ www.mw m.mm+ www.mm H.¢m+ mNN.NN m.ma+ ¢¢m.mm NNanmH a.mu Nmn.wN H.~H+ mm¢.m~ N.m+ mmN.om m.m+ #Nm.wn annomma m.m+ #ma.om m.mm+ N¢H.mN H.9H+ N¢m.ma m.hH+ mam.¢m onnmmmfl ¢.n: Hum.mw N.NN+ mmm.mH m.n+ Hom.ma m.¢+ mo¢.mm mmnmmmH m.¢n mmN.Hm m.om+ hmm.¢a n.m+ ma®.¢H m.¢+ mum.om mmunmmfl m.¢Hn www.mm m.om+ an.HH m.o+ NHo.¢H a.mn HNo.wm hmammmH m.Hn ¢¢m.mm a.mm+ ¢¢m.m o.HH+ moa.ma m.m+ HmH.om mmummmH ¢.¢+ mmm.mm m.nm+ ¢¢H.m N.mH+ oom.HH ¢.m+ oma.mm mmu¢mmH m.m+ Hum.nm m.hN+ Hm¢.¢ m.m+ N¢N.OH N.m+ ¢NN.Nm ¢mummmH m.¢| mma.mm ¢.mm+ om¢.m H.o+ mmm.m m.on mNN.m¢ mmnmmma «among mcowmmweu< mmcmcu mcowmmNEu< omcmcu mcommmweu< wmmmau mcommmweu< pcmucwm No conszz acoucmm No consaz ucmucma No Longsz ucougwa we Nonsaz m mz mzom>mgm sock omcmcu No mmmucwugwa ucm msmcmoca zm ommmm ow mcowmmweu< "Emgmoca .Hm mPQMP 108 Table 32. Vacancies Per Fall Admission for Basic RN Programs by Type of Program and National League for Nursing Region: 1974 to 1982 k1. mom‘s KW' MCCMUREATE "W ASSOCIHE DEGREE WOGMMS MW mus PW a nut: W o! Vnm Hun- d . Vow-u: W :1 W van Mom “r on Pawns l “3" ‘ on “room “L" as Mann: “‘2'" :- flesumo Pu Morn . _ Fm Ream-no Fal fireman I dun: Vm hams-on “was I an. Aamssm manta vat-a Mum vow“: VW human I h.- ‘97‘ 126 397! 1‘9 66 ll 29 “2 ‘ 2‘2 0 ‘7 ‘18 1 12 016 ‘975 303 3515 0‘9 63 670 40 “1 960 3‘3 '26 095 013 1970 139 0‘5 02 ' 9 19 12! ' 015 O ‘3 '29 M 0.13 1977 II £612 3‘! W ' 256 2! ‘62 ' NB 3'! '8‘ ' n 017 197' 5‘0 6740 02‘ "I 875 2‘ 224 2565 0 ‘9 2.1! 023 1979 655 7'39 022 ‘55 3509 26 020 0‘7 23 um 05 mo 52! 6.342 022 17‘ L37 1 a 262 2555 0 ‘8 ‘ 2047 021 M1 $7 7&7 323 207 309 2‘2 ' 377 015 1621 021 1m ‘91 6710 323 1% 1045 C 7! 534 0‘5 ‘ 7 ‘W 010 M 1974 97 ‘07! 3 ‘0 15 29‘ 29 ‘6 ‘12 O9 56 063 0 10 1975 M I! ‘315 ‘7 3.19 27 17 '16 009 50 270 01‘ 1976 SI 3‘2 ‘9 253 ‘7 19 42 009 , ~16 235 01“ '977 "6 ' 294 3 :3 20 523 23 92 3 ‘0 57 574 010 1970 '3‘ 979 32 26 . ‘ ‘8 3! 32' 327 67 707 017 '97! '62 ‘902 010 35 57! 19 40 346 3“ 57 B7B 025 M) ‘43 1302 3‘9 17 ’65 23 30 ‘5‘ 3 ‘6 50 550 0 19 1'1 '52 21! 02 57 ‘ ‘ 327 39 $21 016 56 510 021 1 32 2 024 ‘ 312 36 36 377 o M £6 :51 0.15 1074 "6 l 216 017 24 IO 26 33 318 017 9 . 013 ‘975 39 ‘ 120 .. ‘6 24 M9 27 2! 013 47 0‘7 0.13 1970 '23 ‘ 182 J“ 336 ‘5 37 017 56 m 012 1977 ‘u '- 0 ‘6 27 235 . 15 ‘1 477 0 ‘I 70 073 015 ' 7| ”I '93! ‘ 1! 3‘ 47! 25 53 302 011 91 ‘070 021 '979 200 27‘! 022 765 2‘ 64 70 017 94 ' 274 026 mo 20‘ 2 727 " 23 55 w 30 u 711 0 ‘7 TB 1010 08 l" '63 2017 02' 57 ‘m7 ‘ 3‘ 49 72 313 57 SI 019 m2 "7 1927 023 55 ' M 38 50 014 ‘2 HI 019 '07‘ 1 no N 21 £20 032 40 SB 0 l’ 11 245 0‘6 ‘ 97 1521 027 ‘9 056 073 50 36‘ 0‘6 20 20‘ 01‘ 1970 '01 n 0 ‘6 2‘ 372 0 2‘ 54 3“ 0 11 23 222 020 1’77 ‘37 l 022 31 I" 023 70 .1 02‘ 5 292 016 1970 van 2.316 023 H 0 2| 92 970 019 39 ‘51 0 2‘ 1979 220 335 026 57 ‘4!) 035 114 1265 020 09 010 026 El 3.021 020 ' ‘27 033 m: “72 oz: 0 £22 023 ‘I‘ '9 2.976 029 n 1 III 00 05 7“ 0.17 19 £31 023 ‘m ‘01 2.173 024 72 ' 347 032 63 627 0 ‘6 20 m 020 197‘ 2‘ 152 20 0 ‘13 S 15 029 3 1‘ 0fl 23 ‘3 015 3 010 19 1! 015 1 0 0.10 1'70 31 Z” 010 9 150 23 ‘0 ‘25 0 ‘7 4 ‘3 1107 1977 39 342 022 G 03 ‘I 015 5 053 1970 5‘ 515 020 I 117 022 4‘ J! 019 2 ‘2 0.24 1979 05 014 021 ‘3 110 20 45 52! 020 7 02‘ ‘U 75 792 0 In ‘7 275 02‘ SI ‘5 0 16 I 5‘ 025 ‘S‘ 54 m a II ‘9 331 023 31 237 a u 4 ‘2 024 7‘2 51 576 020 ‘9 377 011 29 17‘ 013 1 20 013 '11:.- From: National League for Nursing Data Book 1983-84. New York: National League for Nursing, 1984, p. 35. 109 rate per fall admission has remained constant, those in associate degree and diploma programs have been decreasing while those in baccalaureate programs have been rising. Figures in Table 32 also reveal that the vacancy rate for baccalaureate programs reporting exceeds that of both associate degree and diploma programs. By geographic region, baccalaure- ate programs in the North Atlantic and Midwestern regions showed higher vacancy rates in 1982 than in any previously reported year. The number of names on waiting lists for admission to the various types of basic nursing programs is noted in Table 33. Comparing the figures for baccalaureate program vacancies (Table 32) with the number of names on waiting lists for baccalaureate programs reveals that there are enough vacancies to accommodate all persons on the waiting lists and forty-one spaces to spare. By region, the North Atlantic and South show more vacancies in baccalaureate nursing programs than persons waiting to enroll while the Midwest and West regions show more persons waiting than vacancies. In contrast to the apparent overall equilibrium of persons waiting and vacancies in baccalaureate nursing programs, there are 1,000 more vacancies than persons waiting to enroll in diploma programs, thus re-enforcing their continued potential for decrease. At the same, there are approximately 15,000 more persons waiting to enter associate degree nursing programs than there are vacancies. Summary The information presented on numbers and types of basic nursing education programs shows that the majority of all of these programs are now located in institutions of higher education. The number of hospital- based diploma programs is showing a marked and steady decrease. The 110 Table 33. Number of Names on Waiting List Per Fall Admis- sion for Basic RN Programs by Type of Program and National League for Nursing Region: 1974 to 1982 411 WI: m moan! 0604:: ms 09710944 mus m 'n' 91 91 4.1. ’1‘" "' m a unna- "g: °' Mm- d 44mm m °' w 61 4.1.; I' m l.- u “W" Una a1 091 m m 011 “mam m 041 n- m hm 91-1. is m Wang F: WM 7.1 W Wang it I“ 041 L. m 19: us m m on 44919991? W °" Ann-m m ll Wang USI‘ WW [5‘ Wm us‘ 1 4| ‘ m4 599 249! 06‘ 96 409' 044 297 19099 099 .97 024 1979 590 29 on n 2699 036 297 23690 107 ‘93 3229 29 . 1919 519 29999 0 n a 3105 0 39 261 21160 1 16 '6! 014 . 1'77 4.41 2475? 079 79 334] 045 250 79954 H4 112 I455 ' 1919 390 21474 on 11 3104 046 239 '7670 1 13 90 700 016 1979 309 19709 099 59 7959 36 21' 11445 096 019 191 19910 099 53 1492 0 33 ‘97 12125 095 s1 353 o 11 1991 36 141: 092 a 1 245 0 37 299 2066 090 67 019 m2 519 21.949 051 91 4 004 0 49 349 ‘66“ 970 996 016 9991-: 1974 m 9992 0 41 :I 2 356 0 62 57 99:4 0 59 1.399 0.25 , 1975 777 9.743 52 997 019 59 441: 0 79 91 1435 on . 1979 so 4597 043 21 m :19 47 2.949 69 m oz: 1 125 4716 049 4 1297 057 49 ms 099 52 969 029 1979 no 4049 049 29 1991 1297 052 96 279 019 , 1979 2249 01 11 9:5 045 46 1902 099 11 121 014 I I 1491 on 19 915 094 997 099 19 94 010 ‘ 1991 99 1020 19 m 23 47 1,997 099 91 m 019 1 1m 1m 41m 049 19 1249 091 2.4:) 049 29 154 019 1 1974 169 7974 367 25 545 026 9999 1 '4 a '090 025 1975 199 10119 99' 74'. 040 79 9217 137 69 1949 027 1979 156 9m 5 24 693 29 7‘ 6945 ‘36 6' 1029 023 1977 125 7999 093 24 669 031 61 6424 147 40 606 022 1979 104 5702 092 22 103: 55 52 4 37‘ 39 30 299 016 1979 4949 092 20 363 026 54 4323 127 19 ‘62 015 1 102 5999 095 w 299 020 59 5469 150 26 196 010 1991 1921 063 10 379 059 2991 090 25 462 027 1 199 7192 052 21 1339 044 ‘01 5245 o 74 u 549 015 ' m4 152 0 57 21 999 016 109 5247 0 90 219 017 f 1915 159 9 711 0 n 21 907 0 24 1‘6 7929 0 94 19 249 0 23 1979 154 96 90 1097 040 104 7413 119 02:1 1 1977 142 7759 09' 29 1064 041 100 6540 109 14 151 019 129 7629 094 ‘6 290 019 100 120 2 010 1979 94 4 069 14 500 039 76 15's 0 79 4 93 031 um 101 4757 70 13 491 043 93 422 090 5 61 015 1991 112 5576 091 12 050 92 SW 095 9 009 it 152 6 091 29 m 034 '15 5972 73 9 92 012 on 64 4 106 '3 m 1 097 46 31 119 s 70 031 1975 59 3947 ~29 16 490 ‘ 092 u 32:7 ‘39 s 200 094 ‘976 55 4994 '33 v 645 : 090 99 3934 vs: 5 2‘5 1 102 '9.” 49 4 523 '9) 6 924 0 79 3' 4 064 7* e 135 0 44 1979 49 410- v4: 9 29: 04‘ 4‘ 3799 ‘95 2 6: 029 1979 43 10 ‘ '70 0 30 34 2 39: 24 ' 94 1 060 4w: m m 09.1 1 ‘ 25’ 0 4] .2 '539 ' Z 1 304 199‘ 43 2722 '2; ‘ 5' 0 14 3‘ 2600 ; '2~ 3 , 35 l 314 '99: 1 99 : 3943 ! 09c v: m: 065 '9 123': 093 * f L 00: "a 421*: .x: - 1M mm 4 W: V2711-" '51 «9.1 Inner-w '1’.- a— ~- «.x-ur 4v .‘r-os 5.. 44490-1 91 r: 1'1 ‘.'4 '4'. Jr- '9: 9 can a "4.- 'r ----n 9 pm at From: National League for Nursing Data Book 1983—84. New York: National League for Nursing, 1984, p. 36. 111 number of baccalaureate nursing programs is increasing, however, the percentage of enrollments is not increasing proportionately. Numbers of and enrollments in associate degree programs are showing steady increases. Overall, there are more persons on waiting lists to be admitted to basic nursing programs than there are vacancies. By type of program numbers of vacancies and numbers of names on waiting lists for baccalaureate nursing education programs are virtually in equilibrium, while vacancies exceed applicants in diploma programs and applicants far exceed vacancies in associate degree programs. Figures for numbers of graduates from baccalaureate nursing pro- grams show decreases while there are slight annual increases in the numbers of these types of pograms. It would thus seem seem that if the number of vacancies and names on waiting lists for baccalaureate nursing programs are now equal and more programs are opening annually that within several years, many programs could notice decreased enrollments unless some action is taken in the meantime to increase the marketing or demand for this type of program. By size of program, 35 percent of all basic nursing education pro- grams can accommodate a maximum potential enrollment of under 100 students, while 38 percent of the programs can accommodate between 100 and 199 students. Sixteen percent of the schools can serve between 200 and 299 students with the remaining 11 percent divided almost equally between schools serving 300 to 399 students and 400 or more. By National League for Nursing geographic region, the greatest numbers of generic baccalaureate nursing programs is located in the South and the smallest numbers in the West. The North Atlantic region has the highest percentage of large generic baccaluareate nursing programs while 112 the South has more programs serving 100 or fewer generic baccalaureate nursing students. The West has the lowest percentage of generic bacca- laureate nursing programs to total nursing education programs, while the North Atlantic and South have the highest. Generic baccalaureate nursing programs located in those states with high numbers of those programs have the greatest potential for review and potential downsizing or discontinu- ance due to the duplication of programs. Given this overview of the numbers and types of nursing education programs, it seems appropriate now to look at the faculty in those pro- grams. This overview will consider numbers and qualifications of faculty as well as their workload. FACULTY QUALIFICATIONS/WORKLDAD The acadmeic preparation of full-time nursing faculty teaching in all three types of basic nursing programs has been upgraded over the years (Table 34). In all types of programs, the percent of nurse- faculty with doctorates and master's degrees has increased while the percent with baccalaureate and lower degrees has decreased. Despite these increases, it is evident that there is only a small number of nurse faculty with doctorates. Doctorates were held by 71 percent of the nurse administrators in baccalaureate and higher degree programs.176 When educational preparation is viewed by type of program, it can be seen that over 90 percent of the full-time nurse faculty with doctor- ates are employed in baccalaureate and higher degree programs. Diploma programs employ the smallest percent of doctorally prepared faculty. Diploma programs also employ the largest percent of baccalaureate pre- 113 Table 34. Full-Time Nurse-Faculty by Highest Earned ' Credential and Type of Program: Jurisdictions of the United States, 1964 to 1982, Biannually F asymptomm. 70124. ' 11w 440.4711 l 000100470 MASTER‘S WT! I 4650044176 06131126 0411,0444 I 091. 0900074410 "0004-0 ' 1. 12509 m0 104 13 4,702 379 5.239 41 7 137 1 1 2 264 100 t 1. 13.470 1040 297 2 2 5.409 40 5 5 509 40 9 56 0 4 2.150 100 3 1. 14.074 1000 296 10 6.21: 415 6071 405 92 04 237 159 g 1000 15500 100.0 334 2 1 6 791 40.0 6.372 41 0 79 0 5 1 000 12 0 1 1072 10704 100.0 445 2 6 91:41 a 5 6.5. 39 2 40 o 4 1.566 0 3 ; 1974 10204 1000 002 3.9 0.009 520 7.110 370 110 06 1.3a 9.9 1 1970 20.572 1000 007 43 11007 500 9.075 300 139 07 005 43 1 1070 20177 10.0 1.002 5 3 12.037 92.5 5996 29 0 00 o 4 570 2.0 l 1. 20.. 100.0 1414 70 13.929 079 4.097 230 91 03 300 19 i 1. 10.742 M0 1067 94 14.. 71.3 3751 190 36 02 214 1.1 5 00099444000979 9440 44404100 0001460 I 1004 3.120 1000 1a 49 2502 000 475 152 0 00 9 02 g 1. 4073 101.0 250 04 3275 904 527 120 0 0.0 12 0.2 1 1. 4- 100.0 240 59 3406 901 907 141 2 01 5 01 ' 1070 4. m0 305 92 3- 701 .0 142 5 01 21 04 5 1972 5.534 m0 410 74 4.. 019 504 107 0 00 2 00 l 1074 7.044 11:10 021 0 0 5.570 702 033 110 _ 5 01 7 01 ' 1970 0.507 1401 0 917 0 5 0.737 70 7 004 11 5 19 0 2 10 0.1 : 1070 0704 1000 .2 113 7m n4 717 0.2 4 0 0 9 0.1 i 1. 0921 1000 1270 134 7.705 914 406 51 0 00 5 01 1002 9.. 1010 1539 191 7047 005 321 34 0 00 1 00 490004490 000099 "0000-9 1004 a9 1000 0 16 33 970 132 209 19 32 4 00 1. 004 1000 12 13 010 004 257 204 4 05 15 14 i 1. 1.0. 100.0 11 07 1021 020 574 340 0 04 34 20 ‘- 1070 2.491 mo 10 04 1444 597 047 as 24 10 n 14 ' 1072 3.500 1000 25 07 2.077 579 1401 300 27 00 50 10 : 1904 4. 1000 49 00 2024 505 1.002 393 60 12 10.1 21 1 M 5.. 11410 57 10 3109 502 2,147 370 00 11 1O 10 7070 5. mo 59 09 3.795 939 1027 325 50 09 1a 10 1. 0.. 1000 129 21 4210 II 1.593 294 34 00 a 11 1902 5.092 1040 109 19 4304 749 1.296 221 27 05 a 07 1 04940-0 "0004-0 1 1004 0.. 1000 11 01 1024 27 5 4020 519 121 14 2.254 252 , 1. 0. 11M 20 03 1572 105 4725 566 51 00 2125 250 . 1- 0.. 1:0 14 02 1.753 104 4. 541 54 09 2.320 257 ‘ 1070 0207 M0 10 02 1473 179 4.73:4 577 40 09 1.930 236 1972 7972 1040 12 01 15.92 200 4504 599 39 05 1409 105 1074 7106 m0 15 02 1500 221 4315 602 53 00 1100 167 1976 4325 1000 13 02 1049 290 3044 409 59 011 709 121 ”7| ' . 5404 1000 14 i 03 1770 323 3221 507 23 04 460 93 "1° 4 "I ‘ 1000 12 1 02 1047 390 2900 545 . 27 06 200 01 "I? 4 377 i 1000 19 I 03 2.044 49 7 2195 400 1 9 02 174 40 From: National League for Nursing Data Book 1983-84. Nengork: National League for Nursing, 1984, p. 2. 114 pared nurse faculty. When the educational preparation of full-time nurse faculty is viewed from a regional perspective, it is best in the West (more faculty with doctorates and master's degrees and fewer with bacca- laureate degrees and below), and worse in the Midwest (Table 35). Schools in the Midwest employ more faculty prepared at the baccalaureate level and fewer prepared at the master's level than those in the other geographic regions. In schools with both baccalaureate and higher degree programs, the percent of full-time nurse faculty assigned to teach exclu- sively in the baccalaureate program ranged from 52.6 percent in the North Atlantic region to 65.7 percent in the Midwest.177 The student-faculty ratios by type of program and geographic region is shown in Table 36. The faculty-student ratios for all programs com- bined was 1:16.5 for classroom (with 5.0. of 9.64) and 1:10.4 for clini- cal settings (with 8.0. of 3.89).178 Overall ratios tended to be lowest in the diploma programs and highest in associate degree programs. For baccalaureate programs, classroom ratios were lowest in the South; highest in the North Atlantic area and approximately the same in the West and Midwest. The average ratio for the clinical setting for bacca- laureate programs was 1:10.15 and was consistent among geographic areas. Ratios were lower in private than public baccalaureate and associate degree programs. The number of hours per week spent by full-time faculty in direct teaching for all basic nursing education programs combined was four hours per week in the classroom and nineteen hours per week in the 179 clinical setting. As shown in Table 37, diploma progams tended to exceed these averages, associate degree programs were at the average and .vm .m .vmma .mammnsz HON JJLS osmmmq HMGOflumz “xuow 3w: .vmlmmma xoom mung mcwmusz now osmmma Hmoowumz "Scum .uno» gone «a Abuse-n no uea=o< oz» cm gonzo: zupzomm so; macwosum we Lonsaz .mm mpnmh 117 .mm .m .smma .mcnmusz mom osmmmq Hmsowumz “xuow 3oz .wmlmmma xoom mama meamusz How osmmoq Hmsowumz "Eoum FNN «N c onN cm on mg on 8. 02 on 8 NoN : 9N 225m '2 a. N an... an 9 mg n. m NE NV 2 :N on an 95.5 3:290 VNN nN o o m. o m E o a. an 2 n 8 o N 3 c 2 r. n E 22.5 m ON 9‘ m: n 8 o v ONN v 9 n q .2 m 9 on as a a. N v 3.0. 9.3.... 858 2382 o8 on n. o2 an 3 N2 Km 5 NN. NV 3 o2 an 2. 825a .9 oN R o 2 o v on N 2 4.. N an o 9 n n Nn o 2 n n at 83¢ 225388 a 2N Na 2 m2 2 e 8.. N2 2 3. NE on at on. an '3 225a a? Z” N: 29 1. m; N2 3 no. a: Na 2N2 no. a. m: 932.. n .398... z: 33 .2 . 95.80: . . 95:8,. 4 _ . A . 9553: . . .. . 9.5081 . . . 05:83. .3 58 88326 sensed .83 a £8.35 “econ.“ _ .36 8 p.823 u 2.23.... .8 Eu ES 33 «E98... .3 c G $8.33 «82989. 3033 #5242: .o . ... .o .o .o no wucaw >135... 853. .o 8: .3632 933 .o 83 .861. _.. 883 B 8.» .3632 83% a 8.: .362. 3.23 .o 8: .853. 5 , 35.81.. 2: 252mm; 23:30.» 2.543.593. 0:25: 1302 macaw: 2.5 4.2 Hmma .zgmacmo "comuoz acpmeaz so; manna; pmcopumz ocm .ucooazm pmwocmcmu pa ougaom zgosmta .smsaoga 21 yo wax» .acmuuwm ho moxp an gonzo: xupaomu oemh1—pzu oamco>< man an newcomm» voogwn to xmoz Log meso: .Nm upon» 118 baccalaureate programs tended to fall below the average. Generally, there was slightly more clinical time provided to students in private than public baccalaureate nursing programs. Viewed by geographic region, classroom teaching hours per week for baccalaureate programs were lowest in the Midwest and West (3.2 hours per week). Direct teach- ing hours were also lower overall for baccalaureate nursing programs located in public rather than private institutions. Summary The information presented about the academic preparation of full- time nurse faculty shows that while the number of faculty with doctorates is increasing, these numbers are still small. The vast majority of these persons teach in baccalaureate and higher degree programs. Educational preparation of full-time nurse faculty is best in the West and worse in the Midwest. Graduates whose highest degree is an associate degree are employed in smaller numbers by all types of nursing education programs than those nurses with a diploma as their highest degree, although the employment of both types of nurses in any educational program is very small. Student-faculty ratios in baccalaureate nursing programs tended to be approximately at the mean for both the classroom and clinical areas. In contrast, the number of hours spent in direct teaching (classroom and clinical) per week by full-time faculty members tended to be lower than the mean in baccalaureate programs, and lower than both diploma and associate degree programs. Private educational institutions with generic baccalaureate nursing programs tended to show more faculty hours spent in direct teaching than public institutions. RECENT FACTORS IMPACTING 0N TRENDS IN NURSING EDUCATION The debate as to what should be the location (setting) for nursing education programs which was first initiated in 1923 by the Goldmark Report, continues to the present day. As was evident in the previous section on the history of nursing education, rather than resolving this question and having all nursing education take place in one type of educational setting as each new type of eductional program emerged, it was added to the other types already in place. Thus there are now three distinct types of educational programs located in three distinct types of settings (community and junior college; four-year colleges and universi- ties; and hospitals) where basic registered nurse education takes place. Graduates of all three programs are considered qualified to write the same state board examination and upon passing, receive the same license to practice. To help try to resolve this educational dilemma, the American Nurses' Association in 1965 issued its first definitive statement on nursing education, A Position Paper on Educational Preparation for Nurse Practitioners and Assistants to Nurses. That paper set forth the follow- ing: 1. "The education for all those who are licensed to practice nursing should take place in institutions of higher educa- tion. 2. Minimum preparation for beginning professional nursing practice at the present time should be baccalaureate education in nursing. 3. Minimum preparation for beginning technical nursing practice at the present time should be associate degree education in nursing. 119 120 4. Education for assistants in the health care occupa- tions should be short, intensive pre-service programs in vocational education insigbutions rather than on- the-job training programs." While the recommendations from the American Nurses' Assocation were to be in place by 1985, no implementation plan was developed and pre- sented. It was not until 1975 that the American Nurses' Association published Standards for Nursing Education which set forth basic assump- 181 The debate on tions about the profession's approach to education. the merits of the American Nurses' Association position on educational preparation for nurses has been widespread over the years and found little initial support outside of the baccalaureate nursing educators. Oppostion from diploma educators and graduates has been consistent. Not only has there been conflict within the profession over requirements for entry into the practice of nursing, but there have been strong statements from employers both for and against the proposal and general public confusion as to various types and categories of nurses. In 1978 and again in 1984, the American Nurses' Association House of Delegates urged the national organization to take definitive steps and propose legislation to see that the 1965 position was adopted across the states. In 1985, the American Nurses' Association House of Delegates at its annual business meeting, again addressed the issue of basic educational preparation and adopted the following resolutions: - "establish the baccalaureate with a major in nursing as the minimum educational requirement for licensure to practice professional nursing; - retain the legal title "registered nurse” for this person; 121 - establish the associate degree with a major in nursing as the educational requirement for licensure to practice tech- nical nursing with the provision that such degrees be awarded by state charted institutes of higher education such as community or junior colleges; - establish "associate nurse" as the legal title for the person licensed to practice technical nursing; and - assure that the scope of technical nursing practice is congruent with the educational preparation." 182 These resolutions are now to be discussed and potentially adopted by each of the state nurses' associations and then legislated into action in each state. This will be a long and time-consuming endeavor if it, in fact, occurs. Thus it becomes clear that the changes seen in the numbers and types of basic nursing education programs over the years have not come primar- ily from an organized force within the nursing profession. While the American Nurses' Association position papers have helped to focus atten- tion on the issue of educational preparation for nurses, they were not the major factors which caused the decrease in diploma nursing programs or the increases in baccalaureate nursing programs. Those factors were more related to general societal views of higher education as well as present and projected changes in health care delivery trends and financ- ing. In a publication entitled A Case for Baccalaureate Preparation in Nursing, the American Nurses' Association identified the societal and health related trends which they believed pointed to the need for baccalaureate preparation in nursing as the base in the future (Table 38).183 Despite a coordinated lack of movement within the profession to resolve the issue of basic educational preparation for nurses, external 122 forces are making some types of educational preparation for nurses more or less desirable than others. Table 38. Societal and Health Care Trends Needing Baccalaureate Education for Professional Nursing Practice. a. g. h. 1. Changing and expanding scope of nursing practice Increased older population experiencing more health problems. Increased educational level of population demanding more and better care. Increased access to health care for poor. Increased social problems needing attention (alcoholism, drug addiction, mental illness, etc.) Increased technology in health care. Increased emphasis on primary/out-patient care requiring counseling skills for registered nurse. Increased home care. Increased care given in settings other than hospitals. 2. Changing Societal Orientation a. Society more college oriented. b. Increased pressure from consumers, employers, legislators, and third party payors to upgrade nursing educational system to ensure quality. From: "A Case for Baccalaureate Preparation in Nursing." New York: American Nurses' Association, 1979, pp. 8-14. The health care delivery system is changing rapidly as more techno- logical advances are made and reimbursement mechanisms change, thus dictating changing locations and practice of care. These changes are requiring nurses of today and tomorrow to deal with more sophisticated 123 health assistive services and work in more autonomous settings where independent judgements are necessary. Such changes require a nurse with a broad background of scientific knowledge as well as a broad general education to better understand the social and political forces at work. The changes in third party reimbursement for health care services has also decreased payments to hospitals that previously were used to offset some of the educational expenses associated with having a hospital-based diploma nursing education program. This has caused a gradual increase in the tuition rates that students pay in hospital- based nursing education programs to the point where those costs now equal the costs of many associate degree nursing education programs. Thus a student now faced with making an educational choice between a hospital- based diploma nursing education program or an associate degree program may tend to select the college option as it is usually completed in two years rather than three years for many diploma programs, awards a college degree and is equal or less in costs. To this point, factors identifed as impacting the trends in nursing education have been predominately positive. There are, however, several factors present now or in the immediate future which may have negative impacts on nursing education trends (Table 39). The decreased enroll- ments in many colleges and universities is documented in the section on enrollments in higher education and Table 31 shows only slight growth in admissions in baccalaureate nursing progrms. Thus a general decrease in the pool of college students coupled with more job opportunities open now to women may tend to keep enrollments down in many academic-based nursing education programs. 124 Table 39. Factors Which May Have Negative Impacts on Trends in Nursing Education 1) Stable to decreased enrollments in some institutions of higher education with generic baccalaureate nursing programs. 2) Decreased federal money available for traineeships in nursing. 3) Decreased hospital employment opportunities due to changes in third party reimbursement to hospitals. 4) National studies showing current overall equal supply and demand of registered nurses in the continental United States with internal imbalances as to various types of nurses. 5) Potential decrease in clinical sites for nursing student placement. Clinical placements for students in nursing education programs has the potential to become a problem very soon for several reasons. New methods used by third party payors to compute reimbursement for health care services provided by clinical facilities (primarily hospitals) is decreasing the payments these agencies are receiving. This decreased payment coupled with the general trend of decreased in-patient admis- sions and increased costs of all goods and services means that some hospitals are closing units and laying off personnel (including nurses). With fewer patients in hospitals and fewer units in hospitals open, there are less available clinical placement sites for nursing students. Schools of nursing in institutions of higher education are also concerned that due to the increased fiscal pressures that hospitals are experienc- ing, that they may begin to bill educational programs for nursing students' use of their clinical facilities.184 125 The decreased hospital census, units closing and personnel being laid off also means fewer potential job openings for present and future registered nurses. A 1982 National League for Nursing survey of all registered nurses newly licensed within the preceeding six to eight months revealed that 96 percent of all respondents were employed in nursing and just under two percent were not employed and looking for work. This latter group has gradually grown since 1980. Of those nurses who were unemployed, 17 percent stated the reason was lack of jobs available. Ninety-two percent of those new graduates were employed in hospitals. (The survey was sent to 80,991 nurses with 70 percent responding.)185 Other factors that may influence nursing education trends are national studies which now show that there is no longer an overall shortage of nurses in the United States. The Report to the President and Conggess on the Status of Health Personnel indicates that by the year 2000, the estimated need for registered nurses will be from 1.6 to 2.3 million with the project supply between 1.6 to 1.8 million. Within this overall balance, there is a projected need for at least 964,800 baccalaureate prepared nurses with a projected supply ranging between 466,000 and 579,000.186 The extent to which this information will impact enrollments in basic nursing programs depends on whether the shortage of baccalaureate prepared nurses is equally publicized with the overall match in supply and demand of registered nurses. One other major factor which could have a negative impact on nurs- ing education is a marked decrease in (or elimination of) Nurse Training Act money, thus meaning more nursing students may have to drop out of 126 programs or attend school part-time while they work. Rationale cited by the Department of Health and Human Services for decreasing these funds in the proposed 1986 budget is that " . . . all major studies of supply and demand for health professionals conclude that virtually all health profession occupations are in excess supply and that supply growth will continue to outstrip demand increases for the remainder of the decade."187 As this statement clearly shows, not all parts of the Report to the President and Congress on the Status of Health Personnel may be equally emphasized when decisions are made. Among the twenty-one recommendations for nursing issued in 1981 by the Institute of Medicine in its Study of Nursingiand Nursing Education, were eight related to the question of continuing federal support for nursing education. The report stated that while no specific federal support was needed to increase the overall supply of nurses, federal, state and private actions were needed to alleviate particular kinds of shortages and maldistributions of nurses. States have the primary responsibility for analysis and planning of resource allocation for nurs- ing education. To assure a sufficient continued supply of new nursing applicants, the report urged nurse educators and national nursing organi- zations to adopt recruiting strategies aimed not only at high school graduates, but at non-traditional students. Another recommendation was that all licensed practical nurses who wished to upgrade their educa- tion should be able to do so without encountering barriers to admissions. In this vein, policies and programs to minimize loss of time and money should be developed by state education agencies, nursing education programs and employers.188 127 Summary A number of forces are interacting to bring about change in the types of basic educational preparation for registered nurses. These forces are both inside and outside of the profession. While the various segments of the profession internally debate the merits of different kinds of educa- tional preparation, the societal forces outside of the profession are having more direct impact. Changing patterns of financing and providing health care are making hospital-based diploma nursing education programs less viable options while directly or indirectly favoring baccalaureate preparation for nurses. Current Approaches to Declining_Nursing Enrollments One major means used to address the problem of declining enrollments in generic baccalaureate nursing programs is the acceptance of the regis- tered nurse student who wishes to obtain a baccalaureate degree in nurs- ing. ,The registered nurse student has completed a basic nursing program in either a hospital-based diploma program or an associate degree nursing program. This nurse now wishes to return to school to obtain a bacca- laureate degree in nursing. Registered nurse students are being admitted into many current generic baccalaureate nursing programs to keep enrollment levels up to the maximum allowed. In an effort to attract registered nurse students, some generic baccalaureate nursing programs are also establishing off- campus program sites which decrease commuting. Program curricula are also being made more flexible to enable study on a part-time basis, thus enabling the registered nurse student to continue to work part-time as well as maintain family and home obligations. 128 Registered nurse students are a desirable means of increasing enrollments because they: require less clinical supervision thereby enabling faculty to carry heavier clinical loads of students; and require only advanced nursing courses which do not require basic practice labora- tories or equipment. Thus they use fewer resources per student than generic nursing students. National League for Nursing surveys show that the number of regis- tered nurses graduating from baccalaureate nursing programs rose 11 per- cent in the 1981-82 academic year. Of the 9,344 registered nurse students graduating with baccalaureate degrees in nursing in 1981-82, 51.4 percent held previous associate degrees and 48.6 percent held diplomas in nursing. In fact, the current number of registered nurses who hold less than a baccalaureate degree in nursing and desire such a degree constitutes such a large market that many educational institutions are designing baccalaureate nursing programs solely for the registered nurse. In 1981-82, 37 percent of the 9,344 graduates were from nursing programs designed totally for the registered nurse and had no generic baccalaureate nursing program.189 SUMMARY This section of literature has provied an overview of the develop- ment and present status of nursing education in the United State as well as current and future factors which will impact educational trends. Several issues and trends emerge from this review. First, formal nursing education is in an early developmental phase with the first hospital-based diploma program being just over a hundred years old, baccalaureate nursing education being sixty years old and 129 associate degree education only thirty years old. Unfortunately, the development of nursing education is being hindered by the three types of educational programs all culminating in the same title and license. Not only is this difficult to explain to other professional groups and the public, but it segments the nursing profession into three vested interest groups. Recommendations aimed at resolving the basic educa- tional issue have been generated since 1923, but have yet to gain sufficient consensus for acceptance and implementation. Interestingly, though there are three different types of educa- tional programs which prepare registered nurses, the content of the various types of programs has been more similar then dissimilar. Over the years, the college and university-based nursing education programs developed by adding various amounts and types of science and general education background, and coordinating these with a fixed model of actual nursing content which evolved from the hospital-based diploma programs. It is only in recent decades that major curricular changes have occurred in colleges and universities that have deviated signifi- cantly from the original intent and structure of nursing education programs. This lack of significant early curriculum differences and identical titling and licensing of all types of graduates contributed to the present inability of the profession to adequately and clearly differentiate the scope of service and competencies among the graduates of the various programs. A second problem is that the multiple modes of basic nursing educa- tion have given rise to proliferation of these programs across the country. The numbers of programs per state now range from a low of 190 four in Montana to a high of ninety-eight in New York. This means 130 that there is a duplicaiton of various types of programs in most states, thus making each program more potentially susceptible to decreased enrollment and closure as financial stress increases in the institu- tion housing the program. Nationwide admissions to baccalaureate nursing education programs have been relatively stable since 1978-79, while the number of schools has been increasing and the number of graduates has been decreasing.191 There is currently approximate equilibrium of numbers of names on the waiting list for admission to baccalaureate nursing programs and 192 This would seem to be a critical time in vacancies in programs. baccalaureate nursing education to hold the Opening or expansion of any generic baccalaureate nursing program lest all programs become increasingly vulnerable to cutback or closure. The specially vulnerable geographic regions facing this situation are the North Atlantic and South. A third related problem is that basic nursing education programs are costly to the educational institutions in which they are located. Baccalaureate nursing education progams may be even more costly as data show that the hours per week of direct teaching by full-time faculty are lower in baccalaureate nursing programs for both clinical and classroom teaching than for either diploma or associate degree programs.193 Since only 16 percent of all faculty teaching in baccalaureate nursing programs are doctorally prepared, it is unlikely that the remainder of the faculty hours per week are devoted to research or publication. To help off-set the decline in enrollments of generic baccalaureate nursing students, recruitment efforts are now being aimed at current registered nurses who do not hold a baccalaureate degree in nursing but 131 desire to have one. Programs are being designed both on and off campuses to attract the registered nurse student to help fill program vacancies not filled by basic nursing students. This approach is working in most areas as graduations of registered nurse students rose 11 percent in 1981-82. This would seem, however, to be only a temporary solution to a long-range problem. What emerges then is a picture of generic baccalaureate nursing education which is at a critical period. Continued unrestrained program expansion without prior efforts to ensure increased enrollment, cut program costs, upgrade faculty, and present a unique course of study based on a well defined scope of function and competencies for the graduate, could seem self defeating. The future of generic baccalaure- ate nursing education will depend on action taken within the coming several years by those persons now in leadership positions in generic baccalaureate nursing programs. To be effective, leadership must consi- der management strategies that are effective in times of stagnation and potential decline. ORGANIZATIONAL DECLINE Overview The last section of literature to be reviwed focuses on organiza- tiona decline and management strategies suggested for use in decline situations. General information about decline will be presented as well as types and causes of organizational decline, models from which to view organizational decline, and management strategies applicable in various types of organizational decline. This general information about decline will then be applied to higher education. 132 Decline may be viewed from two perspectives, stagnation and cutback. Decline as stagnation is more of a decrease in the rate of increase rather than an actual decrease. This type of decline is more likely to occur in times of abundance. Decline and cutback occurs in times of scarcity and reflects actual decreases in some aspect(s) of the organi- zation.194 The focus of this study is on decline as cutback. Organizational decline is a topic that, until the late 19705 received little research attention. Organizational theories and assump- tions were based on growth (i.e., growth is synonymous with effective- ness; size is a desirable organizational characteristic; there is a positive correlation between size and age). Possible reasons for the emphasis on growth is that organizational theories and research accurately reflect current organizational reality as well as broader social ideology.195 Until recently, the United States enjoyed unprecedented prosperity since World War II and there was little interest in or opportunity to study decline. The climate was positive and society stressed the value of determination and self-confidence. No impediment was viewed as pre- venting one from achieving his/her goal. Thus to not achieve a goal was to fail and failure was and is a national taboo. This inability to admit failure increased the likelihood of large-scale failures as management would not drop losing ideas, services, or products or admit to being in trouble. Emerging trends in organizational theory have focused increased emphasis on several major developments. First, organizations are increasingly viewed as open systems in that they must interact with the 196 environment to secure resources and market outputs. To accomplish 133 this interaction, boundary spanning functions that link the organization with the environment become very important. The information obtained from the environment and feedback provided after interpretation of the information allows the organization to make ongoing adjustments which balance environmental needs, social norms, regulations and client needs.197 Second, organizational administration in an open system is becoming more viewed as a political activity. The focus of this activity is to balance and merge the interest of the internal and external interests groups that form and vie for control of resources to further their own goal(s). Third, decision-making in organizations is filled with tension between established and new courses of action.198 The assumption is that decision-makers tend to favor old programs and old solutions to problems to the possible exclusion of new ideas, approaches and programs. As this old approach is perpetuated and decisions as based on precedent, expediency and convenience, the decisions tend to become more political and less rational in terms of outcomes. When these three trends are viewed together, they represent a shift in approach from that of the closed-rational orientation to the Open- political orientation. With this change comes a focus on long-term solutions which addresses the economic and political viability of the organization rather than just a focus on short-term solutions and internal management and allocations. In the closed-rational approach, alternatives are weighed based on their inherent merits. Resource allocations to various programs are made to meet rationally selected goals as well as on a cost-benefit 134 basis. Organizational performance is maximized based on the best match between problems and solutions, processes and structures, personnel and positions. Administrators are assumed to have the needed authority to mandate the appropriate actions. Decisions are more analytically sound than politically judicious. The open-political model focuses on balanc- ing trade-offs, manipulating viewpoints, minimizing unintended conse- quences, selling ideas, building coalitions, and minimizing conflicts.199 This activity results in decisions that may be more politically judicious than analytically sound and recognizes that administrators do not always have sufficient authority to control all parties and elements involved. In today's society with the declining environmental conditions affecting a large number of major institutions (industrial complex; higher education; state, federal and local governments), the open? political model is a primary approach used to deal with changing environmental demands. High numbers of old and large organizations are faced with having to reduce their scale of operation or redefine their outputs to continue. In such an era, decline must be addressed and viewed not as failure, but as a condition to manage just as growth was in years past. When applied to the educational setting, the open-political approach allows the administrator to balance the demands of faculty, parents, legislators, school board members, industry and students. It provides a base for discussion of topics like promotion criteria and tenure in the face of decline. The open-political approach uses present or future scarcity as a means to spur innovation and redesign of the educational institution to match these times. 135 In a slightly different view of decline and organizations, Zammuto and Cameron believe one could more accurately refer to environmental decline and organizational response rather than to organizational decline.200 This view of organizational decline is that it is not caused by factors totally within or outside of the organization, but rather by the interaction of both. The approach also is based on an open-systems model and recognizes that the organization and adminis- tration cannot control all aspects of any situation. Research on organizational decline shows that the dynamics associ- ated with decline are unique and are not just the obverse of those associated with growth.201 Likewise, many structural design options used in organizational growth are not applicable to declining organiza- tions. Decline generally leads to more centralized decision-making as the environment demands rapid response and is often hostile. This centralization carries with it a great potential for information distor- tion and decreased alternative actions being generated.202 As the decline is recognized or increases, the stress of decision- makers also increases which leads to a decreased attention span, cogni- tive rigidity, shorter time perspective and an increased potential for group think. First responses are usually to increase efficiency by cutting organizational slack through eliminating personnel, selective across-the-board cuts and focusing more on short-term goal attainment. Internal units will compete more for limited resources, turnover becomes a problem, morale and climate worsen and the organization's potential to respond becomes even more impaired.203 As the decline worsens, retrenchment is often necessary. This usually occurs when there is an imbalance between the goals of an 136 organization and the resources it can mobilize to achieve these goals. Organizations more prone to decline regularly continue or present new programs based on their past successes and tend to become desensitized to environmental changes. As a result, the organizations that were most successful in the past may become most vulnerable to future failures.204 When faced with a decline situation if retrenchment or cutback is not the option chosen, the alternative may well be to eliminate the organization. Thus retrenchment should be viewed as one means of making an organization smaller, one that does less, but does it well and efficiently.205 One difficult part of retrenchment is to convince people within and outside of the affected organization that cutbacks are necessary and that a real and ongoing state of decline exists. Most people do not believe that cutbacks are necessary of if needed, that they can be restored within a year or two. The initial lack of acceptance that decline is occurring and will last many times forces a two stage approach to retrenchment. Initially, there are the short-run solutions of cross-the-board cuts and deferred maintenance. Unless the decline is temporary, however, this short-term approach must change or the organi- zation's physical plant and program vitality will quickly be destroyed.206 The second stage of retrenchment focuses on the long range goals of the organization and tries to match them with present and future resource inputs and output demands. This stage requires education of the staff and public not only to the need to cutback, but to the cost of not cutting back. 137 Once cutbacks are announced, conflict will arise. Each person or unit cut back will dramatize why the cut should not take place and what harm it will bring to all concerned. This phase of cutback management is highly political in nature and requires the formation and support of coalition groups. The cutback must be based on some firm future goals which focus on an end product of a smaller but more stable organization. This stable end point is necessary to ensure future stability and hold or attract qualified staff members. Without firm goals and a view of some end point to the decline and cutbacks, present qualified personnel will leave and new qualified personnel will not join the organiza- tion.207’ 208 Retrenchment erodes the morale of the staff affected. The security of one's job is in question which raises questions of personal security. As various parts of the organization may be targeted for deletion, the sense of worth of the affected people drops. Sacrifice is called for and the extent to which each person can sacrifice will be greatly affected by the shape and stability of the future organization. Cutback management requires an active and intrusive management style. This does not mean that an authoritarian approach must be used, just that there must be someone firmly in charge who sees that all actions taken support the agreed upon goals and that all key issues are addressed and resolved. Participative decision-making will not be an effective management mode as everyone will want input into a decision, but no one will want to take responsibility for making the cut. Thus management must assume responsibility for making the cuts realizing there will be only grudging acceptance of the act by those who were not 209 cut. Decisions, however difficult, must be made in a timely manner 138 for as slack resources decrease further, so does the margin for error in decisions made (or not made). Just as the rewards for making good decisions increase, so do the penalties for making bad ones.210 Organizational responsiveness to decline is also affected by whether the organization belongs to the public or private sector. Public organi- zations generally have less market exposure, more environmental cons- traints, are most subject to political influences, have more complex and contradictory goals, less autonomy, more turnover and greater variation in member characteristics and ability.211 Therefore, public organizations have a more difficult adjustment to decline than do private organizations. Given this overview of decline, its ramifications and management as it relates to organizations, it now seems appropriate to present two models of decline. The first model presented, developed by Levine, focuses primarily on causes of organizational decline and identifies categories of facotrs to assess which can contribute to the decline of organizations. The second model, developed by Cameron and Zammuto, classifies decline into various categories and identifies organizational ramifications of each class of decline. Both models present management approaches that may be used to address decline in organizations. MODELS OF ORGANIZATIONAL DECLINE Levine's Model of Decline The model of decline developed by Charles Levine focuses on the 212 Little is known about causes of decline in public organizations. the decline of public organizations and cutback management as all public management strategies are based on the assumptions of continuing enlargement of public revenues and expenditures. This focus on growth 139 is so pervasive that public officials and managers rarely acknowlege decline and how to address cutbacks. What is known about organizations in decline is that they cannot be cut back by just "reversing the sequence of activity and resource allocation by which their parts were originally assembled."213 Organizations are social wholes whose parts combine in such intricate ways that to cut back one part may jeopardize the functioning and equilibrium of the whole organization. Organizational management problems are compounded in times of decline. Just when management planning and use of information systems is needed, these may be some of the first areas cut back. Lack of growth or decline means fewer promotions and rewards and an inability to attract new and younger employees. The latter leaves the organiza- tion with older, more expensive and potentially less flexible and less creative employees. This remaining combination can be problematic in that during times of inflation when resources are scarce, staying even actually requires getting more out of the organization without putting in additional resources.214 To address decline in public organizations, Levine developed a typology of causes of public organization decline (Table 4). This typology categorizes the causes of decline in two ways: (1) whether they are primarily due to factors internal or external to the organiza- tion, and (2) whether they result from political or economic and/or technical factors. The most familiar external cause of decline in public organizations is problem depletion. This occurs when what was once considered a problem is no longer considered one. Thus, the resources that once flowed to address the problem diminish or cease as do the organizations 140 that were designed primarily or totally to meet that need. Problem depletion is beyond the control of the affected organization. Major areas to consider under the heading of problem depletion include problem redefinition, policy termination, and demographic shifts. The effects of demographic shifts can best be seen by the closing of neigh- borhood schools as the school age population decreases or moves from the city to suburban school districts. Problem redefinition is exemplified by the change in treatment approaches for mental illness from institutionalization to deinstitutionalization. Policy termination is becoming more common as the sunset laws now build in automatic review before the reauthorization of public programs.215 The other cause of decline which is external to the organization is environmental entropy. This occurs when the environment is no longer able to support the organization at its present level of functioning. This decreased level of support may include market and technology changes (securing more textiles and steel from abroad); transportation changes (decreased rail service); natural resource depletion (closed mines); changing population base (moves from cities to suburbs); and decreased finances (tax reduction proposals which voters approve).216 One factor internal to the organization which may cause decline is identified as political vulnerability. This denotes an organization with a high degree of fragility and uncertainty. It is unable to accommodate to decreased inputs. Factors which increase vulnerability include small size, young age, internal conflict, changes in leadership, lack of expertise, lack of a positive self-image, and a limited history of excellence. Of all of these factors, the most significant predictor of vulnerability is age. Younger organizations have developed a 141 narrowed range of adaptive skills, have fewer friends and allies, and may be less innovative. A bad decision or decreased inputs may not be able to be overcome because of these deficiencies.217 In 1970, one- third of all bankrupt businessess were less than three years old; 53 percent were less than five years old and only 23 percent were ten years old.218 The other factor internal to the organization which can cause decline is organizational atrophy. This atrophy or stagnation or lack of growth can come from any one or a combination of the following; inconsistent and perverse incentives, role confusion, separate or specialized units which are not integrated; decentralized authority with vague responsibility; increased numbers of inappropriate rules; lack of control or supervision; thwarted dissent and upward communica- tions; rationalization of poor performance; little if any self- evaluation and correction; high turnover; continuous reorganization; suspicion of outsiders; or routine adherence to the past in the face of change.219 Argenti identified patterns of organizational decline which can come about due to organizational atrophy (Figure 4). One trajectory shows a mercurial rise followed by a precipitous decline because managers overcome with success become careless. Management could not solidify gains, initiate rules and coordinate areas necessary for stability. Another pattern reflects an organization with a long and excellent performance record but one that has lost touch with its market, employees, or customers. This pattern is one of an old estab- lished organization like Rolls-Royce or Penn Central which believes that it is invulnerable. Such a view causes a slow and painful decline.220 142 Figure 4. Patterns of Organizational Decline Due to Organizational Atrophy As Fantastic Excellent Good Poor Failure W Years Excellentnh Good “"‘ "" Poor ’_\\\\\\1_ Failure —“\\\\\ % Years From: Whetten, D. "Sources, Responses and Effects of Organizational Decline." Organizational Life Cycle. Kimberly, J. (Ed) San Francisco: Jossey-Bass, 1981, p. 357. In addition to the causes of public organization decline, Levine proposed cutback management tactics to resist and smooth the decline which occurs (Table 40). The tactics proposed by Levine are also divided according to the causes of decline. Those responsible for manag- ing the decline will probably combine resisting and smoothing tactics. This is done because while no organization is anxious to make cuts, to totally resist the decline may mean losing the initiative of deciding when and where the cuts will take place. The tactics deisgned to address external causes of decline are aimed at "renewing the eroded economic bases, reducing environmental uncertainty, protecting niches, retaining flexibility and lessening 221 dependence. Those tactics which address internal causes of decline are designed to strengthen the organization and managerial control. The Table 40. EXTERNAL Political Economic/ Technical INTERNAL Political Economic/ Technical 143 Cutback Management Tactics to Smooth and Resist Decline in Public Organizations Tactics to Resist Decline Tactics to Smooth Decline (Problen Depletion) l. Diversify programs. clients 1. Make peace with competing agencies and constituents 2. Cut low prestige programs 2. Improve legislative liaison 3. Cut programs to politically weak 3. lducete the public about the clients agency's mission 4. Sell and lend expertise to other 4. Mobilize dependent clients agencies 5. Become "captured" by a powerful 5. Share problems with other interest group or legislator agencies 6. Threaten to cut vital or popu- lsr progress 7. Cut a visible and widespread service a little to demonstrate client dependence (Environmental Entropy) . 1. Find a wider and richer revenue 1. Improve targeting on problems (e.g., metropolitan reorganize- 2. Plan with preservative objectives tion) 3. Cut losses by distinguishing be- 2. Develop incentives to prevent tween capital investments and disinvestmsnt sunk costs 3. Seek foundation support 4. Yield concessions to taxpayers 4. Lure new public and private and employers to retain them sector investment 5. Adopt user charges for services where possible (Political Vulnerability) 1. Issue symbolic responses like 1. Change leadership at each stage forming study commissions and in the decline process task forces - 2. Reorganize at each stage 2. "Circle the wagons," i.e. 3. Cut programs run by weak subunits develop a seige mentality 4. Shift programs to another agency to retain esprit de corps 5. Get temporary exemptions from 3. Strengthen expertise personnel and budgetary regula- tions which limit discretion (Organizational Atrophy) 1. Increase hierarchical control I. Renegotiate long term contracts to 2. Improve productivity regain flexibility 3. Experiment with less costly 2. Install rational choice techni- service delivery systems ques like zero-base budgeting and 4. Automate evaluation research 5. Stockpile and ration resources 3. Mortgage the future by deferring maintenance and downscaling per- sonnel quality 4. Ask employees to make voluntary sacrifices like taking early retirements and deferring raises 5. Improve forecasting capacity to anticipate further cuts - 6. Reassign surplus facilities to other users 7. Sell surplus property. lease back when needed Exploit the exploitable Levine, C. Management." July/August, 1978, p. 321. "Organizational Decline and Cutback Public Administration Review. 144 idea of changing leadership often during decline is aimed at getting hard, unpopular decisions made by people who have few if any vested interests in various persons or departments and can be objective. After such decisions are made, it may be necessary to change leaders again for the stable or rebuilding organizational phase. The term "exploit the exploitable" means to take advantage of those persons in vulnerable positions for the overall strengthening of the organization. Such actions may include hiring personnel on a part-time or temporary basis, thus decreasing costs and forming no long term commitments. Such personnel action is best done in a buyer's market.222 The cutbacks that are made must be based on either equity or effi- ciency. Equity means that all units are cut equally while efficiency means that selective cuts are made, deeply in some areas with some units even being deleted while expansion may take place in other areas. Making cuts based on a principle of equity is easier for managers as it is more socially acceptable; however, in the long run, it may not be best for the organization.223 Levine believes that in the past, declines in public organizations have been met on a "crisis-to-crisis" basis. If declines are temporary or limited to one or several organizations, this approach may be appropriate. If, however, declines occur on a societal scale and long term, there must be a more orderly and widely used approach. Resources must be viewed as finite and problems must be solved on a long-range basis. Through use of Levine's model which views the organization and environment interacting, it is possible to consider a wide variety of factors when projecting actions for decline or growth. The more limited 145 the resources become, the more necessary it is to considere the external factors identified in Levine's model. Cameron and Zammuto's Model of Decline Another model of decline was proposed by Cameron and Zammuto in 1983 which views decline from the organizational and population levels.224 At the population level, attention is given to various populations of organizations, the forms of decline faced by them and the effects of this on the population dynamics. At the organizational level, the model attempts to explain why various organizations within a population experience decline differently and use a variety of tactics and strategies to deal with the decline.225 Two concepts basic to the Cameron and Zammuto model are those of ecological niche and organizational domain. A niche is that portion of the environment occupied by a population of organizations. There are physical, biological, and social conditions which provide both resources and constraints on what the organizational population does. The niche is also partially determined by the willingness of people to purchase the goods or services produced by the population of organizations. Thus the interactions among resources, constraints and demands define the basic or potential niche that could exist for a population of organizations. This does not mean that the organizations are always able to fully realize this potential.226 The components of a niche are constantly changing, thus the popula- tion of organizations must change to remain viable. Some changes may be controlled by the niche and some may not, just as some changes may lead to growth where others may lead to decline. Changes that may occur 146 which could lead to decline include decreased demand for goods and services, increased regulation and decreased resources.227 ‘ Organizational domain refers to the portion of the population niche occupied by each organization. It is defined by the clients served, technology used, and goods or services produced. The sum of all organizational domains is that portion of the potential niche actually occupied, used or realized by all of the organizations in that population.228 Ideally, the total of all organizational domains for all organizations within a given population would equal that potential population niche. The more the potential niche is realized, the greater the population niche density. The extent to which individual organizations can adapt their domains in response to population niche changes determines whether and how well they will survive. Depending on environmental factors, a niche may change in either size or shape (Figures 1 and 2). If the niche size increases, either all or some of the present organizations within that niche population must increase their domains or new organizations must emerge to fill the gap. If the niche size decreases, either all or some of the organizations within the niche population must decrease their domains or some organizations must cease to exist. Niche size reductions are generally due to reduced resources, reduced demand or increased con- straints. Changes in the size of a niche affects only the quantity of the output, they do not change the basic output.229 In contrast, the changes in niche shape mean that the output, in its present form, is no longer accpetable in the environment. Thus a different output must be developed. This new output may be slightly 147 or totally different from the original depending on the environmental forces. Changes in niche shape are usually due to decreased demand and technological innovations which make the present output obsolete.230 While both reductions in size and changes in shape of a niche reduce its potential capacity, a decrease in size may mean that there is limited, if any, potential to regain all of the previous potential niche space. It is also possible that there may be simultaneous changes in both the size and shape of a niche. Such changes would increase the pressure on individual organizations within that population niche to adapt. Given their development of the concepts of niche size and shape, Cameron and Zammuto then combine these with whether these changes occur in a continuous or discontinuous manner and evolve a typology of envi- ronmental decline (Table 1). Continuous change is long term, predic- table and consistent with the past while discontinuous change is sudden in nature, unpredictable and represents significant deviation from the past.231 Erosion is defined as a continuous decrease in niche size. It includes a gradual but steady decrease in resources and/or need for the output. The outputs are still acceptable in the environment. An example of this type of decline is reflected in decreased birth rates leading to a decreased enrollment in elementary and secondary schools. This type of change is predictable, thus can be planned for in terms of how to handle the decreased level of activity.232 In contrast, organizations that experience a sudden decrease in niche size, contraction, are unable to plan for this change. These changes are usually brought about by a sudden and unpredicted decrease 148 in the demand for the output. An example of contraction is the decreased demand for non-filter cigarettes after widespread information about smoking and cancer.233 Changes in niche shape that occur over a period of time are termed dissolution in this model. These changes can be addressed by an organi- zation as the change is occurring, thus enabling an orderly transition from one shape to another. An example of this type of change is the shift in college student enrollments from the humanities and social sciences to the physical and applied life sciences.234 When there is a sudden change in niche shape, the niche as presently in existence becomes replaced, totally or almost so, by another. This type of decline is called collapse. To the extent that an organization can survive such a sudden change, it can continue to exist but will remain or grow in some other form or shape. An example of this is the government banning of fluorocarbon propellants and coolants after scientists predicted they would cause great damage to the environment. Organizations making this propellant had to change their product or go out of business.235 Within each niche there are both specialist and generalists organi- zations. The distinction is that specialist organizations focus totally on one or a small number of related outputs while generalist organiza- tions have a greater breadth of outputs. Usually specialist organiza- tions will do better in changes in niche size as they have a higher level of efficiency while generalist organizations will do better in changes in niche shape as they have more diversity and other outputs to rely on when the demand for one decreases.236 149 Decline in any of the cells in Table 1 will stimulate competition among the organizations occupying that niche. The competition among organizations will slowly increase in time of erosion and rapidly increase in times of contraction. If there is not outside interven- tion, the most efficient organizations will survive a decrease in niche size. When there is a change in niche shape, the competition in times of dissolution will increase as organizations strive to gain an edge in the new market. If there is a collapse of the entire niche, competition is a moot point.237 The speed and accuracy with which an organization identifies and responds to environmental changes affect the degree of decline experi- enced. The greater the misperception of environmental conditions or the slower the response to them, the more pronounced the impact of the change will be. Thus instead of experiencing erosion, an organization may suffer contraction if the earlier signs of decline were ignored or overlooked. Likewise, if the changing shape of a niche is not compre- hended, collapse may be the only alternative if other organizations who heeded the signs of change have already acted and established themselves in the emerging niche. Organizations may respond to conditions of decline by two modes: structural adjustments and strategic responses. Structural adjustments are changes that occur within the organization while strategic responses focus on externally repositioning the organization through doman modification.238 Types of structural adjustments include deleting activities, sub- stituting or replacing activities, adding or increasing activities, and reallocating activities. Less dramatic changes are seen when the niche 150 change is continuous and addressed with adequate lead time. Changes in niche size usually lead to more consolidation and cutback than changes in niche shape. The scope of these adjustments can range from fine tuning to large scale changes (Table 41).239 Strategic responses are actions taken to alter an organization's domain and influence the niche within which it operates. These responses may be reactive or proactive depending on when they are implemented. The Cameron and Zammuto model identifies five types of strategic responses. Domain defense focuses on preserving and legiti- mizing the current domain. These efforts may include actions to change the current environment in which the organization functions. 999313 offense strategies increase activity in those areas in which the organi- zation already does well. This may be done through product development strategies (new, improved or differentiated products for present customers); market penetration strategies (present products for more customers); or market development strategies (present products for new customers). Domain creation activity supplements present domains with new ones through innovation or diversification. Domain consolidation is a reduction in size of the current domain, thus going toward some special- ization and deleting all but core activities central to the mission of the organization. Domain substitution refers to replacing one domain with another either totally or in part.240 Cameron and Zammuto believe that while an organization may pursue any strategy at any time, that certain ones are most effective under specific conditions of decline (Table 41). The major difference affecting which strategic response is applied is related to whether Table 41. 151 Type of change in Niche Configuration Niche Size Niche Shape From: Structural Adjustments and Strategic Responses Used in Various Types of Delcine Continuity of Environmental Changg Continuous Change Discontinuous Change EROSION STRUCTURAL ADJUSTMENTS - Change by redistribution - Small, incremental changes (fine-tuning) STRATEGIC RESPONSES CONTRACTION STRUCTURAL ADJUSTMENTS - Change by deletion - Substantial across-the- board or selective cutbacks STRATEGIC RESPONSES STRUCTURAL ADJUSTMENTS - Change by addition - Search for new alter- natives STRATEGIC RESPONSES - Predicted: Domain defense, then domain creation - Not Predicted: substitution Domain - Predicted: Domain - Predicted: Domain Offense Defense - Not Predicted: Domain - Not Predicted: Domain consolidation consolidation DISSOLUTION COLLAPSE STRUCTURAL ADJUSTMENTS - Change by substitution - Trial-and-error search for past solutions STRATEGIC RESPONSES - Predicted: Domain creation - Not Predicted: Domain substitution Cameron, K. and Zammuto, R. zational Response." press), p. 37. "Environmental Decline and Organi- Research in Orggnizational Behavior, (in 152 the type of decline being expereinced was predicted or not. The alter- native strategies posed in each cell of the model are to be used when the decline was not predicted. Strategies noted may be implemtned concurrently or sequentially.241 When erosion is predicted well in advance, domain offense strate- gies will allow the organization to expand its market base. This approach means that the organization will remain stable or even increase in times of a shrinking niche. When lead time is short and/or events were not predicted, consolidation strategies or reducing all activities peripheral to the core activities are used. The latter approach was used by many colleges and universities in the years when mid-year budget reductions were done.242 In periods of dissolution when there is ample lead time, domain defense is first used to ensure the legitimacy of the organization's place in the niche and inhibit the future decline if possible. As the domain defense is being carried out, domain creation strategies begin to develop new areas, thus insuring survival of the organization if the current output becomes totally unacceptable. The problems faced by liberal arts colleges fall into this mode of response. After noting changes in student demands for fields of study, liberal arts colleges engaged in debates and studies about the value of these schools and liberal arts in the overall scheme of higher education. At the same time they were expanding offerings in business, engineering, nursing, continuing education and executive development programs. If an organization is not proactive in periods of dissolution, the only courses left open to them are exit from system or domain substituion. The latter is usually then done on a more or less random basis and 153 may still not be insured if the market entered is already well estab- lished or highly competitive.243 In times of contraction which are predicted in advance, domain defense responses allow the organization to preserve its area and legitimacy. If contraction is not predicted, domain consolidation actions are most likely to preserve the core area of the organi- zation.244 In times of collapse, organizational change must be rapid and large scale. The structural adjustment that occurs will be substi- tuting the first likely alternative generated as there is not time for further study. The substitution will probably be within the organization's present area of expertise. If collapse is predicted, domain creation can be used which allows some lead time and nurturing of the new domain while maintaining support of the smaller older one. Lack of lead time means an early substitution of a new domain while probably not maintaining the previous one.245 Each organization within a niche population will probably respond differently to decline depending on its ability to predict environmen- tal changes and respond in a timely manner. The strengths and weak- nesses of each organization as well as those of its leaders will also influence which choice is selected. The management responses to the various types of decline were also studied by Cameron and Zammuto and then superimposed upon their typology of decline. The resulting typology of managerial responses to decline is contained in Table 3. This provides one comprehensive view of the course of conflict and manager-subordinate relations most likely to be seen in each type of 154 decline coupled with the most effective managerial response for that situation. When decline occurs, managers are faced with personel pressures as well as those from within the organization. The competence and credi- bility of the manager her/him may be questioned as various forces become more vocal. Managers will often review past successes to help offset the results of the present problems. Managers become more closed, rigid and self-protective. These actions usually precipitate more discord within the organization, decreased upward communication and lowered morale. Such defensive reactions are more common when the decline is discontinuance in nature, and when it affects niche size rather than shape. Changes in niche shape require more proactivity to lead the organization into new areas.246 In times of erosion, there is stagnation or gradual decline of resources. There is increased pressure to decide who will get less, but since there is no severe immediate threat, there is time to consider mutliple alternatives, remain consultive and be proactive. Proactive behaviors are ones which anticipate events and aggressively implement strategies to address them. Contraction is a sudden reduction in resources where the survival of the organization is in question. This threat produces conflict and autocratic management approaches are needed. There is little time for consultation and participative decision-making. Reactive responses such as across-the-board cuts, conservative and protective ideas are dominate. This is usually designed to protect and conserve the core domain until the environment changes or alternatives can be generated. 155 In dissolution there is a gradual change from one niche shape to another as the present outputs become less acceptable in the environment. Conflict will arise over what new directions the organization should take and coalitions will form around various alternatives. Enactive tactics are used when new activities are proposed and enacted.247 When collapse occurs, there is a rapid decline in the acceptability of outputs and the niche shape must change quickly. This promotes confu- sion over what the new output should be and invites chaos in relation- ships. Since time is crucial, alternatives cannot be generated systema- tically and studied, communications become garbled and turmoil abounds. Experimental tactics are used which are more trial-and-error than actions based on fact and study. The first satisfactory alternative encountered is usually accepted.248 This model provides an explanation of how to define and handle decline once it arises. It is not presented as a predictive model to identify when or which type of decline may occur. Once decline has occurred and is accurately classified, the model does provide direction as to management strategies and tactics that are most appropriate for use. Decline Models Applied to Higher Education The model of decline presented by Cameron and Zammuto has been applied specifically to enrollment decline and institutional responses in higher education (Table 42). In this context a change in niche size may occur due to a reduction in the supply of potential students, a change in the demand for higher education, or reduced financial aid available. A change in niche shape may occur due to shifts in students' fields of study, such as the decreased demand for the humanities, social sciences 156 and education, and the concurrent increased demand for engineering, phys- . . . . 249 ical and life sc1ences and bus1ness courses. Changes in niche shape may also occur as new areas of study, such as computer science, are introduced, thus reducing the student demand in other areas. Table 42. A Typology of Environmental Decline and Higher Education Institutional Responses to Enrollment Decline Continuity of Environmental Change Type of Change in Niche Continuous Change Discontinuous Change Confjggration Decline Type: EROSION Decline Type: CONTRACTION Example: Major doc- Example: Two-year colleges toral and comprehen- sive universities. NICHE SIZE Response: Minor Response: Reconstruction realignment Decline Type: DISSOLU- Decline Type: COLLAPSE TION Example: Specialist Example: General colleges (e.g., divinity) NICHE SHAPE baccalaureate colleges Response: Expansion Response: Experimentation From: Zammuto, R., Whetten, D. and Cameron, K. "Environmental Change, Enrollment Decline and Institutional Response: Speculations on Retrenchment in Colleges and Universities." Peabody Journal of Education. Winter, 1983, p. 98. When the changes in niche size are viewed as continuous in nature, the type of decline that occurs is erosion. Awareness of this type of decline is slow in coming and response is of a minimal nature such as making slight internal realignments of resources. A second course of action may be to try and increase the pool of potential applicants 157 through extension or continuing education programs. If neither action is effective or not taken at all, more rapid and severe readjustments may need to be made to consolidate operations and increase efficiency. The major types of educational institution affected by erosion are major doctoral and comprehensive universities. These institutions are generalist organizations and have enough breadth in program offerings that small internal readjustments are sufficient to accommodate small steady decreases in enrollments. They are, however, vulnerable to compe- tition for resources by other generalist schools as well as specialty schools.250 When changes in niche size are discontinuous in nature, contraction occurs. In this situation, there may be a sudden decrease in enrollments precipitated by such factors as rapidly fluctuating economic conditions or cuts in federal student aid. The type of educational institution that is most likely to notice this type of decline is the two-year college. Enrollments in two-year colleges decline as economic conditions improve.251 Two-year schools are more sensitive than four-year institu- tions because they rely on a more localized market and are heavily depen- dent on enrollment for tuition and as a formula-funding base. Since two- year institutions are so sensitive to enrollment changes, they are also more willing to take drastic actions to reconstruct educational programs affected. Since two-year colleges are generalists in that they offer a wide variety of programs, they are more easily able to alter the curricula. The two-year schools can also readily expand and contract since they usually employ a high proportion of part-time and temporary 158 faculty. Many of these schools have also increased their focus on life- long education programming to make up for decreased enrollments.252 Changes in niche shape are more threatening than changes in size and are more difficult to address. If the change in shape is slow in coming, administrators may tend to discount the early signs; however, awareness prolonged too long may mean institutional death. The schools most likely to be affected by a slow change in shape, dissolution, are the general baccalaureate colleges. These schools are considered specialist schools in that they offer a smaller range of programs than generalist institu- tions. Liberal arts colleges are an example of schools in this category. The strategy used to deal with dissolution is one of expansion. Once the administration recognizes a shift away from the programs offered, new fields of interest must be added to attract students. The addition of these programs must be immediate to capitalize on the new demand. Another strategy to insure survival is for two or more institu- tions to merge or form a consortium where the best parts of both schools could be used.253 If the change in niche shape is immediate, collapse may occur. In this situation, there is confusion and little if any plan as to what possible course of action to follow. The only alternative seemingly open is experimentation. New courses of action are pursued on a trial-and- error basis in hopes that one or more will work. The focus is on short- term survival while long-term alternatives may be sought. The type of institution most affected by this type of decline is the specialist college where only a very limited number and type of programs of study are available.254 159 This application of the Cameron and Zammuto applied to declining enrollment shows that the model can be used to classify decline in various areas and to propose management approaches. The model proposed by Levine can be used to identify present and predict future causes of decline. Both of these models provide some structure from which to project actions. Without such models to guide actions, what has been the response of many administrators in higher education to the conditions of decline which they have encountered? In the following section of literature, past administrative responses to decline in higher education will be identified. Higher Education's Past Response to Decline The conditions which favor decline in higher education have been present and increasing since the early 19705. The major factors have been decreased enrollments, inflation and changes in federal policies which affect higher education. The impact of these factors immediately following the expansion years of the 19505 and 19605 as been significant. In 1984, Zammuto reported that the death rate for colleges and uni- versities was 117.6 per 10,000 between 1971 and 1981. This rate of institutional death for colleges and universities exceeded that for busi- nesses and federal government bureaus.255 A major factor in the increased death rate in educational institu- tions is a response strategy which seems to be resiliency-inhibiting rather than resiliency-enhancing. This means that institutions have operated in times of prosperity and growth in ways which inhibit effec- 256 tive response as the environment changed and becam less supportive. Several resiliency-inhibiting characteristics are identified in Table 43. 160 Table 43. Resiliency-Inhibiting Characteristics of Administrators in Institutions of Higher Education 1. Over-expansion in times of abundance. 2. Inadequate management controls. 3. Lack of collaboration and self-protection. 4. Rigidity in problem-solving. 5. Curtailed long-range planning. From: Cameron, K. and Whetten, 0. "Models of the Organizational Life Cycle: Application to Higher Education." The Review of Higher Education. Summer, 1983, pp. 271-273. Over expansion in times of abundance is common and is prompted in part by past success which management believes puts the organization in a position of dominance. This over-confidence also causes manage- ment to ignore early signs of change in consumer preference and tech- nology. Chaffee identified that colleges that had expanded the most in the past decade (built too many dormitories, hired too many faculty, started too many programs) were having the most difficulty adjusting to precipitous drops in revenue.257 Periods of rapid expansion may also be associated with looser management controls. Chaffee also found that colleges having the most trouble recovering from declines in enrollment had only crude finan- cial controls.258 Thus it was not possible for them to know the magni- tude of their financial troubles when decline began because past records were inadequate. In times of abundance and growth, diversification and decentrali- zation is common. However, as resources shrink, each separate unit 161 then fights for its own survival and there is less potential for a unified response to meet the total organizational need. Administrators who have led the organization in periods of growth have little experience managing decline. They do not wish to be associated with decline, so they proceed cautiously and take little advice. This self-protective behavior leads to frequent misdiagnosis of the problem and few innovative alternatives being tried. Cameron found that administrators in declining organizations were internally focused, conservative in actions, and reactive in responding to change while administrators in stable and growing organizations were extern- ally oriented, innovative and proactive.259 Another common response to any crisis is loss of a long-range perspective as administrators in essence mortgage their future through eliminating planning and development functions in times of decline. Also, among other first cutback responses are: across-the-board cuts which potentially weaken all units; layoffs based on seniority thus causing the newest members with the newest ideas to leave first; and deferred maintenance, thus ensuring future malfuctions and repairs. These short-term savings rather quickly result in future expense and ensure the status quo.260 Without an orientation to conditions of decline and how to manage it, administrators define these conditions as ones of resource alloca- tion or problems with efficiency and respond conservatively rather than innovatively. This approach means that after action is taken " . educational organizations are basically doing less of the "261 same. Conservative, efficiency-oriented approaches may not be 162 the best long-range solutions and may lead to ineffective performance and even organizational death. The focus on efficiency may be the key problem in the conservative approach. Efficiency measures the ratio of some unit of input with 262 To be more efficient some unit of output (i.e., cost per student). is to decrease the unit of inputs per unit of output. This is usually accomplished through internal reallocations. Being more efficient does not mean doing something differently or changing what is done, but doing the same thing while using fewer resources. The scale on which a thing is done may be less but the overall focus and output remains the same. Whetten identified six reasons why adminstrators in colleges and universities focus on efficiency and respond conservatively rather than innovatively when facing decline.263 First, what is measured attracts attention and most institutions have in place mechanisms to monitor efficiency rather than effectiveness. Second, stress produced by conditions of decline prompt persons to behave in conservative and self-protective ways. Such activities would include acting to reduce anxiety rather than solving problems by restricting communications, reducing numbers of persons involved in decision-making, enforcing rules more strictly, rejecting information not consistent with what the decision-maker believes, and exhibiting group-think character- istics.264 Third, the present problems are viewed through old frameworks, thus old alternative solutions are tried first. In times of growth, resources were always available and the problem was in how to allocate them, thus in times of decline, the problem may also be viewed as one 163 of resource allocation rather than resource acquistion. In times of growth, there was less need for controls and a laissez-faire approach was common. In times of decline, this approach is highly ineffective and dangerous. Fourth, colleges and universities are organized as loosely coupled systems which are governed by committees and semi-autonomous subunits. These various groups have multiple vested interests, thus making any type of concensus difficult to achieve. Administrators may then use satisficing approaches to resolve conflicts which do not move the organization ahead. Yarmolinsky calls this inability of any one interest group having sufficient power to effect a change in organi- zational direction institutional paralysis.265 Fifth, competent and innovative leaders are many times the first ones to leave an organization in decline or if they stay, they act in such as way as to not “rock the boat." Not only do the more capable people voluntarily leave the organization early, but the first to be involuntarily terminated are the low-skilled, low-income, minority, very young (new employees) or very old (long term) staff members. All of these actions decrease the internal pool of variability within the organization, thus producing a “regression to the mean“ in labor pool qualifications.266 Sixth, since innovation itself is sometimes viewed as a cause of decline, administrators may be hesitant to try innovative approaches to manage decline for fear of compounding an already negative situa- tion. A study reported by Cameron in 1981 surveyed forty institutions of higher education in the Northeastern United States and classified them 164 on a continuum from declining to rapidly growing. What emerged was a distinct difference between the administrative approaches used in declining institutions and all other groups. Administrators in declining institutions had more standardized structures, relied on previous conservative approaches, perceived the external environment as having limited resources, focused on budget and financing, gave little attention to interacting with constituencies outside of the institution, and did not highly value goals related to improving the academic activities or morale. Administrators in stable and growing institutions focused on just the opposite approaches.267 When faced with conditions of decline similar to those now faced by higher education, the tobacco industry responded with a combination of domain defense, offense and creation strategies.268 Initially, all members of the industry joined together to lobby legislators, donate large sums of money for tobacco and health research and initiate self- imposed advertising controls. Thus somewhat insulated from the hostile environment, they had time to initiate domain offense strategies of expanding their product line and developing new markets. These actions were followed by domain creation activities of diversifying by purchas- ing new companies, thus broadening their base.249 In all, they responded aggressively and innovatively by manipulating their external environment. While there is no one strategy or set of strategies that is generally applicable across all types of decline, there is some evidence that conservative actions are not effective. The information presented in Table 44 identifies factors which may lead to a conserva- tive response and alternatives to the conservative response. Table 44. 165 Factors Leading to Conservatism as a Response to Decline and Suggested Solutions Condition’Leading to Conservatism Solution Leading to Effective ' C0ping s‘e 1. Little lead time 1. Domain defense is designed to create lead time. 2. Little problem clarity 2. Domain defense creates time to clarify threat. 3. Contrary consensus among 3. Domain defense is designed to constituencies counter consensus and diffuse it. 4. Little domain choice 4. Domain offense creates expansion flexibility within a prescribed domain. 5. Little political slack 5. Domain defense is designed to build political slack. . 6. Little severity of 6. Domain offense and creation are threat easier to implement when threat is less severe. 7. Short duration of 7. Domain defense helps institutions decline become buffered from short-term threats. 8. Uncontrollable threats 8. Domain defense is designed to buffer the institution from threats that it cannot control. 9. No economic slack 9. Domain offense creates slack. 10. No previous adminis- 10. Domain defense buys time to determine trator experience the best offense and long-term adapt- ation strategies. 11. Norms of equal distri- 11. Domain offense and creation help bution necessitate prioritizing and make resources availabe so across-the- board cuts are less likely. 12. One resource base 12. Domain offense and creation make available multiple resource bases 13. Administrators are 13. Domain offense and creation produce viewed as allocators conditions where administrators become resource generators. 14. Absence of strategic 14. Domain defense helps identify strate- competence gic competence and domain offense helps expand it. 15. Large size and 15. Domain defense helps buffer the in- complexity stitution from multiple, conflicting demands. From: Cameron, K. "Strategic Responses to Conditions of Decline: Higher Education and the Private Sector." July/August, 1983, p. 376. Education. Journal of Higher 166 The first eight factors listed are external to the organization. Contrary concensus among constituents is the extent to which important groups outside of the organization agree on a position detrimental to the organization. Domain choice flexibility refers to an organization's freedom to add or substitute domain activity rather than having it dictated. Political slack is the amount of loyalty of powerful consti- tuents to an organization. Uncontrollable threats are those threats to the organization that arise outside of the immediate environment of the organization and are, therefore, less able to be controlled by it.270 In each of these first eight situations, conservative actions are most likely to be taken first. Since all of these factors can lead to the potential for decline, conservative actions may not be sufficient to stop or reverse the events and thus stop the decline from progressing. Since these factors do not come totally, or even partially in some cases, under the immediate control of the organization any action that is taken may be only partially effective. Items nine through fifteen in Table 44 are factors that occur within the organization and are able to be more and immediately impacted by actions taken by persons within the organization. Economic slack is the amount of savings and uncommitted resources plus the diversity of sources from which resources are secured. The administrative experience of the person in charge may be limited in general, or specifically in that decline has not had to be addressed. Also related to the administration is whether that position is viewed within the organization as one which allocates rather than secures resources. Past and present equal distri- bution of resources across subunits leads to across-the-board cuts and other conservative actions. Larger and more complex institutions have 167 more vested interested groups that pressure for their own survival, thus making selective cutback decisions difficult. Likewise, the more all units are dependent on the same soruce for resources, the more competi- tive they are and the more administrators may try to satisfy them all. The internal competence of an organization greatly impacts the extent to which it proacts or reacts. Proactive strategies include innovations in domain activities rather than just reacting or defending a past activity.271 Conservative and efficiency oriented strategies should never be completely overlooked; however, they are best combined with more aggres- sive and externally focused strategies that also consider effectiveness. Domain defense strategies generate support for the institution among legitimizers and buy time to plan and secure the resources for domain offense strategies. During this planning time, the institution becomes somewhat buffered from the environmental threats. Domain defense strategies include activating alumni and Board of Trustee members, forming lobbying groups, and forming consortia.272 Domain offense strategies can be initiated concurrently with or immediately following the domain defense actions. These strategies are designed to expand the present institutional activities and broaden in- stitutional appeal to more persons and groups. Such actions often serve to increase organizational slack. Examples of domain offense activities include expanding current markets and applying or adapting current resources to non-traditional students while expanding the base or sources of funds and increasing public relations.273 Domain creation strategies focus on entering into new markets or programs. The focus here is to create new opportunities for success in 168 areas of the environment which will support such ventures. Activities falling into this category include offering new programs in high demand areas, acquiring subsidiaries, capital investments, or public service activities. Domain creation strategies should not be be tried before domain defense activities have been undertaken to increase institutional slack and legitimacy.274 SUMMARY The information presented in this chapter has been focused on three distinct areas which were interrelated in this study. The first section focused on higher education, the second on nursing education, and the third on decline. The section on higher education provided an overview of factors contributing to the present state of no growth and in some instances, decline in institutions of higher education. Information was provided as to how these problems developed and projections were made for the future in terms of enrollments. Specific areas addressed were past over- expansion, enrollments, faculty, student mix, financing and the growing disproportion between public and private and generalist and specialist institutions. Given the problems faced by higher education, information was then presented as to administrative actions that have been taken to address these problems. Special emphasis was placed on program down- sizing and discontinuance. The second section focused on specific aspects of generic bacca- laureate nursing education. To put this type of educational program in focus, a brief history of the development of various types of nursing education was initially provided. This was followed by a more detailed 169 description of selected aspects of generic baccalaureate nursing programs including enrollment trends, student-faculty ratios, faculty workload, faculty preparation, program costs, and selected means used to address enrollment declines. The intention of this section was to show that generic baccalaureate nursing education is currently in a no-growth state which, if not immediately and aggressively addressed, can turn into a decline. In the third section of the chapter literature related to decline was reviewed. General information was presented about the effects and management of decline. In addition, two specific models of decline were described in detail as to types, causes, effects and management. The information on decline was presented for two reasons. First to provide a theoretical base from which to compare how the decline in higher education has been handled to this point and to what extent the past management strategies prevented, reversed or contributed to the decline. The second reason was to provide information as to how to assess for the potential of decline and implement the appropriate actions necessary to prevent or reverse the decline should it occur. When the three areas of higher education, nursing education and decline are then viewed together, the following picture emerges. Higher education in general is now in a state of decline which the literature shows was predictable and which in fact was predicted in some studies. The predictions were not heeded in a timely manner by many college presi- dents, thus the decline came and many institutions were not prepared to deal with it. The untimely and conservative manner in which the decline in higher education was addressed actually made it worse and contributed to further deterioration and crises in many institutions. It was not 170 until the early 19805 in many instances that the decline in higher education began to be addressed in a positive, long-range, proactive manner. While the decline in higher education in general was occurring, generic baccalaureate nursing education was approaching a no-growth state which was unrecognized and not addressed in the nursing litera- ture. Growth, filled classes, and large waiting lists for admission had been the norm in generic baccalaureate nursing programs and any signs that this may change went mostly unheeded. The end result was that at the time institutions of higher education were ready to address decline at the institutional level, generic baccalaureate nursing programs were ready targets for review and possible downsizing and discontinuance as they had begun to deplete their backlogged waiting lists and were begin- ning to experience some of the same problems that the parent institution had been experiencing for several years. Thus the low enrollment, high cost generic baccalaureate nursing programs were and are extremely vulnerable. The literature on decline provides information about types of decline, factors to assess to determine one's potential for decline, and a range of management activities to implement to address pending or present decline. This study specifically relates this information about decline to generic baccalaureate nursing programs and provides a framework that can be used to assess the program's potential for decline. After the assessment is made, the chief executive officer of that generic baccalaureate nursing program can then select from the range of appro- priate mangement tactics and adapt them to that particular program. In 171 this way, decline in generic baccalaureate nursing programs should be able to be predicted and avoided or if not avoided, at least dealt with in a sound constructive manner. 10. 11. 12. 13. 14. 15. 16. 17. CHAPTER II LIST OF REFERENCES "More Than Survival: Prospects for Higher Education in a Period of Unvertainty." Carnegie Council on Policy Studies in Higher Educa- tion. San Francisco: Jossey-Bass, 1980, p. 46. Stadtman, V. Academic Adaptations. San Francisco: Jossey-Bass, 1980, p. 2. Ibid, p. 4. Ibid, p. 3. Ibid, p. 4. "More Than Survivial," op. cit., p. 47. Bowen, H. The State of the Nation and the Agenda for Higher Educa- tion. San Francisco: Jossey-Bass, 1982, p. 2. Ibid, p. 4. Ibid, p. 2. Ibid, p. 4. Ibid, p. 5. Ibid, p. 16. Ibid, p. 5. Stadtman, op. cit, pp. 5, 11-12. Henry, D. D. Challegges Past, Challenges Present: An Analysis of American Higher Education Since 1930. San Francisco: Jossey-Bass, 1975, p. 135. Stadtman, op. cit., p. 11. Ibid, p. 12. 172 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 173 Bowen, H. "The Costs of Higher Education." Carnegie Council on Policy Studies in Higher Education. San Francisco: Jossey-Bass, 1980, pp. 413-414. Stadtman, op. cit., p. 6. Ibid, p. 7. Bowen, H. The State of the Nation and the Agenda for Higher Educa- tion, op. cit., p. 6. The Effect of State Budget Reductions on Higher Education, Fiscal Year 1982-83. Education Commission of the States. Denver, 1983, P-3. Ibid, p. 6. Ibid, p. 6. Ibid, p. 7. Ibid., p. 8, 11. Ibid, p. 26. Ibid, p. 31, 39. Kramer, M. "The Venture Capital of Higher Education." The Carnegie Council on Policy Studies in Higher Education. San Francisco: Jossey-Bass, 1980, p. 426. Bowen, H. "The Costs of Higher Education," op. cit., p. 413. Ibid, pp. 412-413, 415. Impact of Health Programs on Instructional Expenditures in Higher Education. National Center for Higher Education Management Systems, Boulder, CO, 1981, p. 1. Bowen, H. "The Costs of Higher Education," op. cit., p. 414-415. Three Thousand Futures. San Francisco: Jossey-Bass, 1981, p. 35. Ibid, p. 45. Ibid, p. 36. Ibid, p. 37. Ibid, p. 43. Stadtman, op. cit., p. 260. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 174 Three Thousand Futures, op. cit., p. 66. Magarell, J. "Enrollments Up a Surprising 2.4 Percent." Chronicle of Higher Education. November 5, 1979, p. 6. Stadtman, op. cit., p. 20. Ibid, p. 21. Three Thousand Futures, op. cit., p. 30. Levine A. 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"Uncertainty in Public Higher Education: Response to Stress at Ten California Colleges and Universities." California Post-secondary Education Commission, January 1980. 104. Kershaw, J. "Government and Higher Education in New York State." Sloan Commission on Government and Higher Education, Cambridge, MA, 1980. 105. Brown, S. "Approaching Faculty Productivity as a Mechanism for Retrenchment." New Directions for Institutional Research. No. 24, 1979, pp. 45-54. 106. Mortimer, K. and Tierney, M. "The Three R's of the Eighties: Reduction, Reallocation and Retrenchment." American Association for Higher Education. ERIC Clearinghouse in Higher Education, No. 4, Washington, D.C., 1979. 107. Ibid, p. 107. 108. Schwerin, 0p. cit. 109. Mingle, op. cit. 110. Kershaw, op. cit. 111. Ibid. 112. Ruddock, M. "Assessing the Impact of Discontinuing a Program.” Annual Forum of Association for Institutional Research (22nd), Denver, CD, May 16-19, 1982. 113. Melchiori, G. 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"What is the Most Effective Way To Handle Program Discon- op. cit. 152. 153. 154. 155. 156. 157. 158. 159. 160. 161. 162. 163. 164. 165. 166. 167. 168. 169. 170. 171. 172. 173. 174. 180 Whetten, 0. "Organizational Responses to Scarcity: Exploring the Obstacles to Innovative Approaches to Retrenchment in Educa- tion." Educational Administration Quarterly. Summer 1981, pp. 80-97. Cameron, K. "Responses to Fiscal Stress: Contrasting Higher Education and the Private Sector in Responses to Fiscal Stress in Higher Education." Wilson, R. (Ed). Center for the Study of Higher Education, College of Education, University of Arizona, Tucson, AZ, June, 1982, p. 54. Kalish, P. and Kalish, B. The Advance of American Nursing. Boston: Little, Brown and Co., 1978, pp. 18, 20. Ibid, p. 43. Ibid, p. 77. Ibid, p. 85. Ibid, p. 83. Ibid, pp. 87-88. Ibid, p. 304. Ibid, p. 329. Ibid, p. 334. Ibid, pp. 327, 338. Ibid, p. 338. Ibid, p. 340. Ibid, p. 347. Ibid, p. 352. Ibid, p. 433. Ibid, p. 435. Ibid, p. 497. Ibid, p. 501, 502. Ibid, p. 508. Ibid, p. 511. Ibid, p. 548. 175. 176. 177. 178. 179. 180. 181. 182. 183. 184. 185. 186. 187. 188. 189. 190. 191. 192. 193. 194. 195. 181 Ibid, p. 594. National League for Nursing Data Book 1983-84. National League for Nursing, New York, 1984, p. 104. Ibid, p. 96. Ibid, p. 98. Ibid, p. 98. "Educational Preparation for Nurse Practitioners and Assistants of Nurses: A Position Paper." New York: American Nurses' Associa- tion, 1965, pp. 5-9. "A Case for Baccalaureate Preparation in Nursing." New York: American Nurses' Association, 1979, p. 4. Ibid, p. 4. Ibid, pp. 8-14. "NLN/ANA Present Senate Testimony on Education Funding by Medi- care." Nursing and Health Care. November 1984, p. 472. National League for Nursing Data Book, op. cit., p. 109. “Health Professions to be in Balance by Year 2000." Health Professions Report. July 11, 1984, p. 1. "Nursing Education, Research Frozen Out of HHS 1986 Budget." The American Nurse. March, 1985, p. 6. "IOM Report Offers 21 Recommendations for Nursing." American Nurse. March 1983, pp. 6-9. National Leegue for NursingiData Book, op. cit., p. 53. Ibid, pp. 4-6. Ibid, pp. 1, 21, 37. Ibid, pp. 35, 36. Ibid, p. 99. Whetten, 0. "Sources, Responses, and Effects of Organizational Decline." grgenizational Life Cycle. Kimberly, J., et.al, (Ed). San Francisco: Jossey-Bass, 1981, pp. 346-347. Whetten, 0. "Organizational Decline: A Neglected Topic in Organizational Science." Academy of Management Review, Vol. 5, No. 4, 1980, pp. 577-580. 196. 197. 198. 199. 200. 201. 202. 203. 204. 205. 206. 207. 208. 209. 210. 211. 212. 213. 214. 215. 216. 182 Hall, R. Organization Structure and Process. 3rd Ed. Englewood Cliffs, NJ: Prentice-Hall, Inc., 1982, pp. 219-238. Whetten, 0. "Organizational Response to Scarcity: Exploring Obstacles to Innovative Approaches to Retrenchment Education," op. cit., p. 81. Ibid, p. 82. Ibid, p. 83. Zammuto, R. "Organizational Decline and Management Ecuation." The Organizational Behavior Teaching Journal, Vol. 4, 1982, p. 6. Ibid, p. 7. Ibid, p. 7. Ibid, pp. 7-8. Whetten, 0. "Sources, Responses and Effects of Organizational Decline," op. cit., p. 355. Behn, R. "Leadership for Cutback Management: The Use of Corpor- ate Strategy." Public Administration Review. November/December, 1980, p. 614. Ibid, p. 615. Ibid, p. 617. Cyert, Richard. "The Management of Universities of Constant or Decreasing Size." Public Administration Review. July/August, 1978, p. 345. Vehn, R. "Leadership for Cutback Management," op. cit., p. 616. Whetten, 0. "Sources of Responese and Effects of Organizational Decline," op. cit, p. 369. Ibid, p. 351. Levine, C. "Organizational Decline and Cutback Management." Public Adminstration Review. July/August, 1978, pp. 316-325. Ibid, p. 317. Ibid, p. 317. Ibid, p. 318. Ibid, p. 318. 217. 218. 219. 220. 222. 223. 224. 225. 226. 227. 228. 229. 230. 231. 232. 233. 234. 235. 236. 237. 238. 239. 183 Ibid, p. 319. Whetten, D. I'Sources of Responses and Effects of Organizational Decline," op. cit., p. 356. Levine, C. "Organizational Decline and Cutback Management," op. cit. p. 319. Whetten, 0. "Sources Responses and Effects of Organizational Decline," op. cit., p. 356. Ibid, p. 320. Ibid, p. 320-322. Cameron, K. and Zammuto, R. "Matching Mangerial Strategies to Conditions of Decline." Human Resource Management. Winter, 1983, pp. 359-375. Zammuto, R. and Cameron, K. "Environmental Decline and Organi- zational Response." B.M. Saw and L.L. Cummings (Eds.). Research in Organizational Behavior. Greenwich, CT: JAI Press, pp. 3-4. Ibid, p. 5. Ibid, p. 6. Ibid, p. 7. Cameron, K and Zammuto, R. "Matching Managerial Strategies to Conditions of Decline,“ op. cit., pp. 361-363. Ibid, p. 361-363. Zammuto, R. and Cameron, K. "Environmental Decline and Organiza- tional Decline,” op. cit., p. 11. Ibid, p. 12. Ibid, p. 12. IBid, pp. 12-13. Ibid, pp. 15-16. Ibid, pp. 15-16. Ibid, pp. 20-22. Ibid, p. 32. Ibid, p. 34. 240. 241. 242. 243. 244. 245. 246. 247. 248. 249. 250. 251. 252. 253. 254. 255. 256. 257. 258. 259. 260. 261. 262. Education. Summer, 1983, p. 270. 184 IBid, pp. 35-36. Ibid, p. 36. IBid, pp. 37-39. Ibid, pp. 41-43. Ibid, pp. 39-41. Ibid, pp. 44-47. Cameron, K. and Zammuto, R. "Matching Managerial Strategies to Conditions of Decline," op. cit., pp. 366-367. Ibid, p. 370. Ibid, p. 371. Zammuto, R., Whetten, 0., and Cameron, K. "Environmantal Change, Enrollment DEcline and Institutional Response: Specula- tions on Retrenchment in Colleges and Universities." Peabody Journal of Education. Winter, 1983, p. 96. Ibid, p. 98. Ibid, p. 103. Ibid, pp. 103-104. Ibid, pp. 104-105. Ibid, p. 105. Cameron, K. and Whetten, 0. "Models of the Organizational Life Cyle: Applications at Higher Education." The Review of Higher Ibid, p. 271. Ibid, p. 271. Ibid, p. 272. Ibid, p. 273. Ibid, p. 273. Cameron, K. "Strategic Responses to Conditions of Decline: Higher Education and the Private Sector." Journal of Higher Education. July/August, 1983, p. 362. Ibid, p. 362. 263. 264. 265. 266. 267. 268. 269. 270. 271. 272. 273. 274. 185 Whetten, "Organizational Responses to Scarcity: Exploring the Obstacles to Innovative Approaches to Retrenchment in Education,“ op. cit., pp. 83-89. Cameron, K. "Strategic Respones to Conditions of Decline: Higher Education and the Private Sector, " op. cit., p. 363. Whetten, "Organizational Responeses to Scarcity: Exploring the Obstacles to Innovative Approaches to Retrenchment in Education," op. cit., pp. 86-87. Whetten, 0. "Sources, Responses and Effects of Organizational Decline," op. cit., pp. 369-370. Cameron, K. "Responses to Fiscal Stress: Contrasting Higher Education and the Private Sector.: Wilson, R. (EdO. Center for Study of Higher Education, College of Education, University of Arizona, Tucson, AZ, June 1982, pp. 53-54. Ibid, pp. 368-369. Ibid, pp. 370-371. Cameron, K. "Strategic Response to Conditions of Decline: Higher Education and the Private Sector," op. cit., p. 372. Ibid, pp. 372-373. Ibid, p. 374. Ibid, p. 374. Ibid, p. 375. CHAPTER III DESIGN OF THE STUDY Problem Statement This study is designed to survey and describe the impact of the pre- sent and immediate past period of decline in higher education on selected generic baccalaureate nursing programs located in institutions of higher education in the continental United States. Specifically, the study seeks information to address the following: 1. To determine if a significant number of chief executive officers of generic baccalaureate nursing programs iden- tify their programs as being in or having the potential to experience decline. To determine the type of decline chief executive officers identify as currently affecting their generic baccalaure- ate nursing programs. Ta determine the type of decline chief executive officers identify as potentially affecting their generic bacca- laureate nursing programs within the coming five years. To determine whether chief executive officers of generic baccalaureate nursing programs assess a significant num- ber of environmental factors outside of the larger academic institution when making future plans and develop- ing management approaches. To determine whether chief executive officers of generic baccalaureate nursing programs assess a significant number of environmental factors within the larger academic in- stitution when making future plans and developing manage- ment approaches. To determine which of a given number and type of manage- ment strategies are most used by chief executive officers in generic baccalaureate nursing programs in the adminis- tration of their units. 186 187 7. To determine the number of generic baccalaureate nursing programs that have been proposed for or actually experienced program downsizing or discontinuance. 8. To determine if there are differences in the scores of internal and external environmental factors assessed by chief executive officers in generic baccalaureate nursing programs that are and are not being proposed for or actually experiencing downsizing or discontinuance. 9. To determine if there are differences in the management tactics and strategies used by chief executive officers in generic baccalaureate nursing programs that are and are not being proposed for or actually experiencing program downsizing or discontinuance. 99.5192 The purpose of the study was to describe the current impact of the decline in institutions of higher education on generic baccalaureate nursing programs and what actions administrators of those programs were taking to meet this decline. In addition, information was also sought regarding these adminstrators' views of the potential for and type of future decline faced by their generic baccalaureate nursing programs. Data as to the number and type of generic baccalaureate nursing programs that had ever been proposed for downsizing and/or deletion in the past five years were also requested. Thus the study was designed to obtain information with which to describe the current status of generic bacca- laureate nursing programs relative to several areas of decline and the management of these programs. From this base of data, future areas of study could be identified. No hypotheses were generated or tested in this study. The most appropriate design for a study to achieve the purposes identified was that of survey research. Survey research is used to determine or describe what exists and how it exists in any given 188 population.1’2 Information so obtained may, but does not necessarily, identify or explain relationships, test hypotheses or make predictions.3 Survey research data collection tools are used to obtain the stan- dardized information needed. The most common means used to obtain the needed data are the personal or telephone interview, mailed questionnaire and examination of records.4 The major advantages and disadvantages of these first three means of collecting data are noted in Table 45. In view of the amount of information desired, and the size, homogeneity, and geographic distribution of the population to be be surveyed, the mailed questionnaire was selected as the most appropriate data collec- tion tool for this study. Population The papulation to be included in this study was the chief executive officer from each National League for Nursing accredited generic bacca- laureate nursing program in the continental United States. This popula- tion was identified by using the latest National League for Nursing publication containing such information at the date the study was con- ducted.5 It was decided to include the entire population rather than a sample in the study for several reasons: (1) the total population was small in size numbering only 345; (2) stratification of a sample of the popula- tion would be necessary to address some of the variables being studied and the information needed to accomplish this stratification was not readily available or easily obtainable. 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Instrument The data collection instrument used in this study was a questionnaire which was distributed by mail (Appendix B). The questionnaire was twelve pages long, front and back, contained 96 questions, and was divided into eight main sections (Table 46). The major sections of the questionnaire were developed to reflect either a central area of focus of the study (Sections I, VI, VII), operationalize a major concept covered in the literature (Sections II, III, IV, V), or collect personal data about the respondent (Section VIII). Table 46. Major Sections of Questionnaire with Inclusive Question Numbers Section No. Section Title Question Numbers I Types of Decline l, 2 II Political Vulnerability 3-31 III Problem Depletion 32-42 IV Environmental Entropy 43-56 V Organizational Atrophy 57-77 VI Program Downsizing 78-87 VII Program Discontinuance 88-91 VIII Personal Data 92-96 191 Section I contained descriptions of the four types of decline identified by Cameron and Zammuto and contained in their model of decline (Table 1). The two questions combined in this section sought the opinion of the respondents as to whether the generic baccalaureate nursing programs they administered were currently experiencing decline and, if so, the type. Also sought was the type of decline they anticipated within the coming five years. Sections 11 through V contained questions reflective of the four types of causes of decline as identified in the Levine model of causes of decline (Table 4) and responses to decline as identified in the Cameron and Zammuto model of decline (Table 3). Questions contained in each Section 11 through V were subdivided as to those addressing the causes of decline and those addressing administrative modes of action that could be taken to address the decline. Section II contained items which fell within the category of political vulnerability; items in Section III related to problem depletion; environmental entropy was the focus of Section IV; and organizational atrophy was the area addressed in Section V. Questions relating to the causes of decline for Sections 11 through V of the questionnaire were derived from the items in Table 9, which is a composite of: (1) the general factors contributing to decline as identified by Levine and then applied specifically to higher education; (2) these same general factors applied specifically to generic bacca- laureate nursing education; and (3) the most common criteria used to review academic programs for possible downsizing and discontinuance classified according to Levine's model. 192 The questions developed were based on readings from the three major areas in the study: decline, higher education, and generic baccalaureate nursing education. Depending on the information needed, questions were posed in either the past, present, or future tense. In instances where information about trends was needed, the same question may have been asked in more than one tense. The information sought was a combination of fact and opinion. In addition to identifying present and future causes of decline in their generic baccalaureate nursing programs, the chief executive officers of these programs were also asked to identify their actual or hypothetical responses to conditions of decline. The potential range of responses studied were those identified in the Cameron and Zammuto typology of decline (Table 3). Given the four types of responses described in this model, questions reflective of each mode of response were developed and placed immediately following selected questions in Section II through V. Not all response modes were included in the choices for each question, but all modes were included in each major section of the questionnaire. Sections VI and VII contained questions specifically addressing program downsizing and program discontinuance. These approaches are currently being used by some administrators in institutions of higher education to address problems of decreased enrollments and increased costs. Program downsizing and discontinuance were selected for more in-depth study because there is virtually no systematic data available as to the extent to which generic baccalaureate nursing programs have been downsized or discontinued. Section VI dealt with program downsizing 193 and contained questions as to who proposed the downsizing, the nature of the downsizing proposed, whether the proposed downsizing did occur and if so, the nature of the downsizing. Section VII asked only if the generic baccalaureate nursing program had been proposed for discontinued and actually discontinued. Section VIII was designed to obtain limited personal information about the respondent. This would enable a limited profile of all respon- dents to be made as well as provide a base for comparing respondent profiles for various subsets of questions. Responses to those questions in Section II-V, which addressed the causes of decline, were assigned weights of one or two. The purpose of the weighting was to be able to determine a score for each section, as well as an overall score for all four sections. The score would reflect each generic baccalaureate nursing program's potential for decline based on factors contained in Levine's typology of causes of decline. Scoring Weights of one or two were selected rather than a more extensive or zero-based weighting system for several reasons. First, in some areas, there is gross information presented as to which factors make an insti- tution more or less vulnerable, but fine distinctions in each area are not identified. For example, Levine states that young age and small size make an institution more politically vulnerable, but young and small are not defined.6 Fadil and Thrift noted that the decline rate of institu- tions of higher education with an enrollment below 1,000 was greater than those with a larger enrollment.7 Whetten indicated that the decline in institutions aged five years or less was greater than those for institutions older than five years.8 While these figures do 194 provide some distinctions, they are of a gross nature and not continuous along a range of options. Second, certain factors are noted to increase the potential for decline (i.e.: type of control of institution and geographic area).9’10’11 Thus while privately controlled institutions have had a greater incidence of decline and enrollment figures show greater potentials for decline in the North Atlantic and Midwestern regions of the country, this is not to say that public institutions and those located in the South and West will experience no decline, or a specific percentage of decline below the other institutions. For this reason, one may then assume that while certain circumstances make some types of institutions more vulnerable to decline than others, there is some degree of vulnerability for all insti- tutions, but this cannot be specifically quantified. Likewise, while certain environmental factors such as fewer college aged students, local, state and federal tax cuts, changing areas of student study, and certain organizational factors such as outmoded teaching approaches, weak leader- ship and lack of a relevant curriculum may increase an institution's potential for decline, that is not to say that all institutions are not affected by some or all of these factors to a certain extent. Thus it was felt that only gross distinctions in weighting could be made. Since the conditions that favor decline are present to a greater or lesser extent for all institutions of higher education and the generic baccalaureate nursing programs located in them, it was thought to be appropriate to give some points to all programs in the weighting of items. Thus the factors that were identified as contributing to the conditions of decline, though minimally or generally, were given a 195 weight of one while those factors identified as having a more direct or specific impact were given a weight of two. When it was possible to make substantiated distinctions from the literature between which weight an item should have, this was done, otherwise arbitrary decisions were made based on inferences derived from the literature. Using the two point weighting scale described, ranges were estab- lished for each Section II through V of the questionnaire (Table 47). The lower the section and total scores, the fewer factors present that would be potential causes of decline; the higher the score, the more factors present or potentially negatively impacting that generic bacca- laureate nursing program. This would be true for each individual section (II through V) as well as the total score for each program. It would, however, be important to note individual section scores as the overall score may be at the low end of the range while one section is higher with the others being low. Thus an overall sense of security could be offset by noting one particular area which needs attention. Pilot Test The pilot test of the questionnaire was administered in February, 1985 to 31 nurses who held similar positions to those persons in the target population. All were chief executive officers of generic bacca- laureate nursing programs located in the continental United States. The major difference between the pilot sample and the population to be included in the study was that the pilot programs were 222 accredited by the National League for Nursing. The breakdown of institutions included in the pilot study by type of control and geographic region is contained in Table 48. A list of states included in each geographic region is contained in Appendix A. 196 Table 47. Range of Scores for Each Section 11 through V of the Questionnaire SECTION 3 SCORE RANGE INDICATIONS ; & MIDPOINT II - Political Vulnerability 36 - 72 Low - Fewer areas of political 54 vulnerability present High More areas of political vulnerability present ~mm-fia o—va\0."‘- ) III - Problem Depletion 10 - 20 Low - Less awareness of impact of 15 societal definitions of factors affecting program/ organization .Ha-q—r ..—-'-‘—-m.-vv- (L- High - More awareness of impact of societal definitions of factors affecting program/ organization IV - Environmental 43 - 94 Low - Present environment suppor- Entropy 68.5 tive; organization recog- nizes environmental factors High - Present environment not supportive; organization does not recognize envi- ronmental factors V - Organizational 44 - 88 Low - Administrative environment Atrophy 66 supportive/progressive High - Adminsitrative environment not supportive/progressive II- V Total Score 133 - 274 Low - Some potential for decline 203.5 High Great potential for decline 197 Table 48. Numbers of Persons Included in the Pilot Study Sample by Type of Institutional Control and Geographic Region GEOGRAPHIC REGION Type of Institutional North Control Atlantic Midwest South West Total (N=7) (N=8) (N=12) (N=4) (N=31) Private 4 6 2 2 14 Public 3 2 10 2 17 The purposes of the pilot test were to determine: the clarity of the instructions and questions, face validity, appropriateness of the length of the questionnaire, and the amount of time required to complete the questionnaire. A breakdown of the number of responses to the pilot study is noted in Table 49. Information obtained from the pilot study revealed that that instructions for completion were clear. Several questions were identified as being confusing or unclear in wording or structure of the response options and these were changed. Several questions were also reordered for better flow of thought. The respondents indicated that the questionnaire was too long. In response to this criticism, several questions were deleted and the format of the questionnaire was changed. This latter change resulted in a decrease in the length of the question- naire by five pages. Initially, the questionnaire was developed along the guidelines and format of the total design method developed and described by Dillman.12 One aspect of this approach calls for introducing each new line of inquiry on a new page of a questionnaire.13 Thus in the pilot 198 questionnaire, each new section was started on a new page. This approach consumed more pages. In the study questionnaire, each new line of ques- tioning was started following a small space on the page and a bold line partially across the page. The next section heading was then placed in capital letters and the new line of questioning begun. This change in format accounted for the greatest reduction in total pages between the pilot and actual study questionnaires. Table 49. Number of Responses to Pilot Study by Type of Institutional Control and Geographic Region GEOGRAPHIC REGION Type of North Institutional Atlantic Midwest South West Total Control (N=7) (N=8) (N=12) (N=4) (N=31) Private (N=14) 2 (50%) 4 (66.6%) 1 (50%) 1 (50%) 8 (57%) Public (N=17) 2 (66.6%) 1 (50%) 5 (50%) 2 (100%) 10 (58.8%) Total (N=31) 4 (57%) 5 (62.5%) 6 (50%) 3 (75%) 18 (58%) The respondents indicated that completion of the questionnaire took approximately 35 minutes with the range of time taken falling be- tween 20 and 60 minutes. This was determined to be an acceptable length of time given the nature of the study and the type of informa- tion being sought. It was recognized that both the number of pages in the revised questionnaire and the length of the time needed to respond to the questions could decrease the response rate. 199 Responses to the questions asked covered the range of options pro- vided, thus indicating to the writer that all questions and response options had face validity. Content validity was not checked as the researcher believed that there were few colleagues available who were knowledgeable in the causes and management of decline. This may be an overall weakness in the study design. Scoring on the pilot study seemed to be appropriate in that a range of scores were obtained. Review of the responses did reveal that the majority of the pro- grams included in the pilot study were not accredited by the National League for Nursing because they were new programs that were not yet eligible for accreditation. Since most of the programs were new, the responses to some questions relative to decline and future plans were skewed in that the sample was not reflective of a range of program ages and programs were in a growth state. The data collection procedure used in the pilot study differed slightly from that used in the actual study. Pilot study participants did receive a postcard the week before the study indicating that they would be receiving a questionnaire the following week and a postcard was mailed one week after the questionnaire reminding them to return the survey form. A second follow-up letter and questionnaire were not mailed to non-respondents two weeks after the first questionnaire was mailed. Data Collection The study questionnaires were mailed to 345 chief executive officers of National League for Nursing accredited generic baccalaureate nursing programs located in the continental United States. The mailings took 200 place in April of 1985. Names and addresses of the chief executive officers and programs were obtained from the latest National League 14 Those for Nursing publication available at the time of the survey. receiving the survey constituted the entire population of this group. The typed questionniare was reproduced on white legal-sized paper, folded in the middle and assembled as a booklet. The booklet cover was light blue. Each questionnaire was coded by number to determine who had responded so follow-up reminders could be mailed to non-respondents. One week before the questionnaire was to be mailed, a postcard was sent to all persons included in the study (Appendix C). This postcard alerted the receiver that the following week he/she would be receiving a questionniare and provided a very brief description of the focus of the study. Each postcard was hand signed after reproduction. The follow- ing week, the questionnaire, a cover letter, and a stamped, self- addressed envelope were mailed first class to all persons in the study population. The typed cover letter was reproduced on white Michigan State University College of Education, Department of Administration and Curriculum letterhead and hand signed after reproduction (Appendix D). The letter provided a more detailed description of the study, its value on both a long and short range basis, information about confi- dentiality and non-participation in the study, and a date for return of the questionnaire. One week after the questionnaire was mailed, a second postcard was sent to all persons in the study population (Appendix E). Each post- card was hand signed after reproduction. The purposes of this postcard were to thank those persons who had completed and returned the survey questionnaire and to remind those who had not yet responded to do so. 201 Two weeks after the second postcard was mailed, each non-respondent was mailed first class, a second questionnaire, a cover letter and a stamped, self-addressed envelope. Each typed cover letter accompanying this questionnaire was also reproduced on white Michigan State University College of Education, Department of Administration and Curriculum letterhead and hand signed (Appendix F). This letter provided much the same information as the first one and included a stronger request for the non-respondent to complete and return the questionnaire. All mailings were posted on Tuesdays as this was the preferable mailing day identified by Dillman.15 Mailing on Tuesday avoids the backlog of mail from the weekend handled on Monday and allows out-of- state respondents time to receive and process the mail before the weekend. Analysis of Data Information from the returned questionnaires was transferred to optical scan sheets and then to the computer. Data were verified after transfer to the computer, but prior to any analysis. Descriptive statistics were used as the main information to be obtained from this study was a summary and description of certain present management practices as well as present enrollment and instructional trends and projections for the future. Descriptive statistics are a means of describing, summarizing or reducing to comprehensivle form certain aspects of a large mass of data.16 Numeric scores were also derived for Sections II-VI (by section and for all sections combined) for each respondent's program. The four individual scores and total score were used as indicators of decline. 202 The means of scores were included as part of the data which was summar- ized and described. Various sections and subsections were also cross compared and described. A factor analysis of questions in Sections II-V was done. Factors ImpactingResults Several extraneous confounding factors need to be identified which may have impacted the results of the study. First, there is always the potential of self-selection bias in those persons who return mailed questionnaires. This threatens the validity of the survey in that those persons who choose to respond may not be representative of the sample or papulation.17 Second, secular drift or relatively long-term trends in the country may effect responses.18 In this study, the long-term trends that may have affected the responses are a national level decreased college age student cohort, thus leading to decreased college enrollments; increased inflation; increased numbers of colleges and universities in financial and enrollment troubles; and a decreased national need for generalist nurses. Since these factors have now been present from 3 to 10 years, knowledge of them and responses to them have potentially been incor- porated into the daily action of many chief executive officers of generic baccalaureate nursing programs. Third, interferring events which are short term occurrences may effect responses.19 Thus a recent precipitous decline in enrollment or budget reduction in an institution may bring about a different set of responses than if that event had not just occurred. 203 Fourth, unreliability or the degree to which identical responses would be obtained if the data were collected again from the same subjects may be a problem. Sources of unreliability include the information gathering instrument, the response situation, and the respondent's mood at the time responding.20 For this study, the ques- tionnaire was newly developed and thus was possibly unreliable. A number of respondents indicated that they received four to seven ques- tionnaires per week, thus there was a potential for the respondent to feel pressure for time or overburdened when completing the questionnaire. Several respondents did indicate that the length of the questionnaire caused them concern when completing it and one respondent identified that she was completing the questionnaire at home after midnight when faced with a busy following day. Summary This descriptive study was accomplished through the use of a mailed questionnaire distributed to the entire population of potential respon- dents. This approach was deemed both economical and realistic in meet- ing the purposes of the study. The information obtained from the study will proivde chief executive officers of generic baccalaureate nursing programs with immediate and long-range facts about decline as it affects higher education in general and their nursing program in particular. It will provide information on the current management practices used to address decline so these or alternatives may be considered for broader application. The study will also provide current factual information as to the number and type of generic baccalaureate nursing programs that have been proposed for and actually experienced downsizing and 204 discontinuance. This information should serve as a base for further inquiry or proposed actions in the areas explored by this study. Also tested in this study is an instrument which, when refined, could serve as one means of assessing a generic baccalaureate nursing program, of if adapted, any academic program or department wishing to determine its potential for being proposed for program downsizing or discontinuance, as well as its potential for decline. 10. 11. 12. 13. 14. CHAPTER III LIST OF REFERENCES Kerlinger, F. Behavioral Research. New York: Holt, Rinehard and Winston, 1979. p. 151. Isaac, S. and Michael, W. Handbook in Research and Evaluation. San Diego: Edits Publishers, 1983, p. 46. Ibid, p. 46. Borg. W. and Gall, M. Educational Research. 3rd Ed. New York: Longman, 1979, p. 285. National Leegue for NursingiState-Approved Schools for Nursing RN 1984. New York: National League for Nursing, 1984. Levine, Charles. "Organizational Decline and Cutback Management." Public Administrative Review. July/August, 1978, pp. 316-325. Fadil, V. and Thrift, J.S. “Openings, Closings, Merges and Accredi- tations: Status of Independent Colleges and Universities.“ National Association of Independent Colleges and Universities, 1978, p. 6. Whetten, 0. "Sources, Responses and Effects of Organizational Decline.“ Organizational Life Cycle. Kimberly, J., et.al., (Ed). San Francisco: Jossey-Bass, 1981, p. 356. Three Thousand Futures. San Francisco: Jossey-Bass, 1981, pp. 72, 76. Ibid, p. 76. Mingle, J., et.al. Challenges of Retrenchment. San Francisco: Jossey-Bass, 1981, p. 19. Dillman, 0. Mail and Telephone Surveys - The Total Design Method. New York: John Wiley & Sons, 1978. Ibid, p. 147. National Leagye for Nursipg State-Approved Schools for NursingeRN 1984, op. cit. 205 15. 16. 17. 18. 19. 20. 206 Dillman, op. cit., p. 180 Hopkins, K. and Glass, G. Basic Statistics for the Behavioral Ibid, p. 183. Sciences. Englewood Cliffs: Prentice-Hall, inc., 1978, p. 3. Rossi, P. and Freeman, H. Evaluation: A Systematic Approach. Ed. Beverly Hills: Ibid, p. 170. Ibid, p. 173-174. Sage Publications, 1982, p. 171. 2nd CHAPTER IV ANALYSIS OF DATA INTRODUCTION The results of the questionnaire mailed to chief executive officers of National League for Nursing accredited generic baccalaureate nursing programs located in the continental United States regarding their percep- tions of decline in higher education, how this decline is impacting their programs, and management approaches they are employing to address the decline are presented in this chapter. The chapter will be divided into various sections, each of which focuses on a particular portion of the data collected. Information will also be presented about the response rate to the questionnaire as well as some information about non-respon- dents and non-participants. Section I relates to the present and future types of decline that the respondent identified as impacting on his/her generic baccalaureate nursing program. Cross-tabulation of the types of decline and selected questions in Sections II-V will also be presented. Sections II-V relate to the typology of causes of decline described by Levine. Responses to individual questions presented in each section will be presented as will the mean scores for each section. Section II relates to political vulnerability; Section III to problem depletion; Section IV to environmental entropy; and Section V to organizational 207 208 atrOphy. Information will also be presented in each section as to the type of management approach being used as contained in the Cameron and Zammuto model of decline.1 In Section VI information as to the number of generic baccalaureate nursing programs that have been proposed for and actually experienced program downsizing is presented. Some information as to the nature of the downsizing is also presented. Program discontinuance is addressed in Section VII. Data in both of these sections are cross referenced with selected items from Sections II-V. Section VIII presents personal data about the respondents which has also been selectively cross tabulated with other areas. Section IX contains the results of the factor analysis of selected items from Section II-V. Section X has incidental findings. Each section will be summarized and an overall summary will be presented at the conclusion of this chapter. The frequency count for all ques- tions included in the questionnaire is contained in Appendix B. RESPONSE RATE T0 QUESTIONNAIRE Questionnaires were mailed to chief executive officers in 345 National League for Nursing accredited generic baccalaureate nursing pro- grams located throughout the continental United States. For the purpose of grouping respones, the National League for Nursing geographic regions were used (Appendix A). The numbers of questionnaires mailed and responses returned, by National League for Nursing geographic region are presented in Table 50. The overall return rate for this study was 67 percent which is con- sidered good given the data collection approach used and the length of the questionnaire. This study used a modified total design approach in 209 that the series of follow-ups described was not implemented. The ques- tionnaire was twelve pages, two-sided in length and contained ninety-six items which required 193 separate responses. Fifty-four percent of the returns were usable and 11 percent of the respondents indicated they did not wish to participate in the study. Dillman reports that the average response rate for forty-eight surveys which used his total design method was 74 percent with no survey receiving less than a 50 percent response. When the total design method 2 Dillman was used only in part, the average response rate was 71 percent. also noted that questionnaires of more than twelve pages or 125 items received an average response rate of only 65 percent.3 The information presented by Dillman regarding questionnaire length is not clear as to whether the pages were one or two sided and whether all responses were usable. Table 50. Response Rates by National League for Nursing Geographic Region for Questionnaires Mailed (Percents have been rounded) NLN GEOGRAPHIC REGION Questionnaires I North 11 III IV Atlantic Midwest South West Totals Total Mailed 89 100 116 40 345 Total Returned 55 (62%) 75 (75%) 72 (62%) 29 (73%) 231 (67%) Usable Returns 41 (46%) 67 (67%), 52 (45%) 25((63%) 185 (54%) Non-usable 2 (2%) 1 (1%) 1 (1%) 2 (5%) 6 (2%) Returns Not Participate 12 (13%) 4 (4%) 19 (16%) 2 (5%) 37 (11%) Returned Too Late To Use - 3 (3%) - - 3 (1%) Not Returned 34 (38%) 25 (25%) 44 (38%) 11 (28%) 117 (34%) Baumgartner and Heberlein reported that salience had a major impact on response. Surveys judged highly salient to the respondent had a 210 response rate of 77 percent; those possibly salient a response rate of 66 percent; and those not salient a 42 percent response rate.4 For this study, it is possible that the length of questionnaire offset the salience or that, in fact, a number of respondents felt the topic had only possible salience to them. The breakdown of when the responses were received in relation to the number of various mailings is detailed in Table 51. It is evident that the final rate of return was greatly impacted by the follow-up mailings. Dillman reports that from 19-27 percent of the questionnaires are returned prior to the first follow-up mailing. Following the first postcard remin- der, 15 to 25 percent more responses are added.5 Baumgartner and Heberlein identified that each contact with the respondent increased the response rate by 7.4 percent.6 For this study, counting the postcard sent to all participants the week before the questionnaire was mailed, there was a total of 3 contacts with all participants who responded to the initial questionnaire and 4 contacts to those who did not respond to the first questionnaire. In this study, 51 percent of the total responses received came before the first postcard follow-up, 24 percent were received after the first follow-up postcard, and 25 percent were received after the second questionnaire and cover letter were mailed. The highest period of return was from the fourth through the tenth day following the mailing of the first questionnaire. The highest number of responses received on any one day was on the sixth day following the mailing of the first questionnaire. In Table 50 the response distribution shows an equal return of responses from each geographic regions with the North Atlantic and South 211 having almost identical rates as did the Midwest and West. Thus the data obtained should be representative across all geographic regions. Table 51. Number of Questionnaires Returned by Time of Follow-up TIME OF RESPONSE NLN After First Region Questionnaire After First After Second Total Before Follow-Up Follow-Up Questionnaire Returned North (N = 89) Atlantic 26 17 12 55 (62%) (N = 100) Midwest 39 17 19 75 (75%) ,(N = 116) South 37 13 22 72 (62%) (N = 40) West 16 8 5 29 (73%) (N = 345) Totals 118 (51%) 55 (24%) 58 (25%) 231 (67%) PROFILE OF NON-PARTICIPANTS Those generic baccalaureate nursing programs represented by chief executive officers who did not participate in the study have been grouped into two categories: non-participants - those who returned their ques- tionnaires and indicated that they did not wish to participate in the study; and non-respondents - those who did not respond to either questionnaire. A comparison of selected characteristics of respondents, non-respondents and non-participants is presented in Table 52. Since 212 limited information was available about those programs not participat- ing in the study, the areas for comparison are few and limited to public information. Type of institutional control was consistent among all groups. By age of the generic baccalaureate nursing program, more non-responding programs were aged 10 years or less and more non-participating programs were aged 40 years and older. By full-time equivalent enrollment in the first level nursing course in 1983, respondents represented programs of 200 or more students more than the other groups, while non-respondents represented programs with enrollments of 49 or fewer students. Non- participant programs had more students in the 100-149 enrollment size. By age of the nursing program, respondents and non-respondents were closely aligned except for those programs aged ten years and less. By enrollment in the first level nursing course there was mixed agreement between respondents and the other two groups. The numbers, which are not consistent among the three groups, do not vary so widely that informa- tion obtained from the respondents could not be generalized to all groups. SECTION I TYPES OF DECLINE The current and future types of decline the respondents saw as affect- ing their generic baccalaureate nursing programs are contained in Table 53. Erosion is the most frequently identified type of decline that is affecting and will affect the respondents' programs. Erosion is the gradual reduction of resources needed to support the current (or past) level of output. It implies that the product itself is acceptable in 213 Table 52. Comparison of Respondents, Non-respondents and Non-partici- pants on Selected Items by Percent of Respondents Item Respondents Non-Respondents Non-Participants (Usable) hnstitutional Control Public 53% 52% 59% Private 47% 48% 41% Age of Nursing Program 10 years or less 12% 20% 11% 11-19iyears 35% 34% 30% 20-29 years 21% 18% 1Q? 30-39iyears 15% 15% 19% 40-49 years 8% 6%' 1E% 50 years or more 8% 7% 16% Full-Time Equivalent Enrollment in First Level Nursing Course 1983 0-49 20% 41% 19% 50-99 35% 34% 35% 100-149 20% 14% 38%, 150-199 10% 8% 3% 200-249 5% 2% 0% 250 or more 7% 2% 3% National League for Nursing Geographic Region North Atlantic 46% 38% 13% Midwest 67% 28% 4% South 45% 38% 16% West 63% 28% 5% 214 the environment only not in as great a quantity. These respondents believe that the generic baccalaureate nursing graduate will continue to be needed in and supported by the environment only not in the present quantity and that the resources available to support this activity will continue to gradually decrease. Table 53. Present and Future Types of Decline Affecting Generic Baccalaureate Nursing Programs Presently Affecting Affecting Program Type of Decline Program Within Next Five Years N=185 N=185 Erosion 59 (32%) 76 (41%) Contraction 26 (14%) 24 (13%) Dissolution 5 (3%) 13 (7%) Collapse 1 (1%) 1 (1%) No Decline 86 (46%) 61 (33%) It is interesting to note the number of respondents who identified contraction, or the sudden reduction in resources needed to produce the output, as the type of decline they expect to experience. This means that 13 percent of the respondents anticipate a sudden withdrawal or decrease in resources within the next five years. A small but increasing number of respondents predict dissolution as a coming type of decline to be addressed. Dissolution is the gradual change in niche shape when the current output becomes progressively less acceptable in the environment and there is pressure to change the output. 215 Of interest is the decreasing number of programs indicating that they will experience no delcine within the next five years. This re-enforces the fact that the conditions of decline are present and, so these respon- dents believe, will continue with us for at least the next five years. The cross tabulation of present and future types of decline by National League for Nursing geographic region is shown in Table 54. All regions are and expect to continue experiencing erosion. Respondents form the North Atlantic region expect the greatest increase in erosion while those in the West and South project the least. Those in the West also show the lowest current and future levels of contraction with the South showing the highest future rates. All regions project a small in- crease in dissolution or that the product (generic baccalaureate nursing graduate) will become progressively less acceptable in the environment. Increases in dissolution are highest in the Midwest. The Midwest and North Atlantic regions project the greatest future potential for most types Of decline while the Western and Southern regions project the smallest. Table 54. Present and Future Types of Decline by National League for Nursing Geographic Region. "TYPE OF NORTH DECLINE ATLANTIC MIDWEST SOUTH WEST Present Future Present Future Present Future Present Future N=39 N=39 N=63 N=61 N=50 N=50 N=25 N=25 EROSION 28% 49% 32% 41% 34% 36% 44% 56% CONTRACTION 15% 10% 16% 16% 16% 20% 8% 0% DISSOLUTION 0% 3% 3.2% 12% 4% 6% 4% 8% NO DECLINE 54% 39% 49% 30% 46% 38% 44% 36% 216 When decline is viewed from the perspective Of type of institutional control, generic baccalaureate nursing programs located in public insti- tutions indicate less present and future decline than those located in private institutions (Table 55). Presently, only 39% of the generic baccalaureate nursing programs located in private institutions of higher education are not experiencing some type of decline and this percent is predicted to decrease to 25% within the coming five years. This is in sharp contrast to the 44 percent of public institutions that do not predict any type of decline. Ten percent of the generic baccalaureate nursing programs located in private institutions also project dissolu- tion as the type of decline projected within the coming five years. This is twice the percent predicted by public institutions. Programs located in private institutions also see a consistently higher potential for contraction, or the sudden decrease in resources, than those in public institutions. Table 55. Present and Future Types of Decline by Type of Institutional Control. PUBLIC PRIVATE TYPE OF Present Future Present Future DECLINE N=95 N=94 N=82 N=81 EROSION 29% 39% 39% 48% CONTRACTION 12% 11% 18% 17% DISSOLUTION 3% 5% 2% 10% COLLAPSE 0% 1% 1% 0% NO DECLINE 57% 44% 39% 25% Eighty percent of all of the educational institutions in which the generic baccalaureate nursing progams where located were aged 50 years and 217 older. The type of present and future decline cross tabulated with the age of the generic baccalaureate nursing program is shown in Table 56. Increased numbers of generic baccalaureate nursing programs of all ages indicated that they expected to experience some type of decline within the coming five years. Of the programs currently experiencing and expect- ing no decline within the next five years, the greatest changes were noted in the age ranges of 10 years and below and 40 years and older. Those nursing programs aged 10 years and under also indicated the most signifi- cant increase in dissolution within five years. Nursing programs aged 11 to 39 years seemed more stable in terms of the type or amount of decline predicted compared with other age ranges with the exception of the high percentage of future types of decline in the dissolution column for programs aged 10 years and less. Table 56. Present and Future Type of Decline by Age of Generic Bacca- laureate Nursing Program AGE OF GENERIC BACCALAUREATE NURSING PROGRAM TYPE OF 50 years + 40-49 yrs 30-39 yrs 20-29 yrs 11-19 yrs 10 yrs - DECLINE Now 5yrs Now 5yrs Now 5yrs Now 5yrs Now 5yrs Now 5yrs EROSION 29% 54% 4% 50% 39% 50% 34% 36% 32% 45% 29% 30% CONTRACTION 8% 15% 14% 0% 25% 18% 16% 18% 11% 10% 14% 20% DISSOLUTION 8% 8% 0% 8% 4% 7% 3% 5% 3% 5% 0% 20% COLLAPSE 0% 0% 0% 0% 0% 0% 3% 3% 0% 0% 0% 0% N0 DECLINE 46% 23% 64% 42% 32% 25% 45% 39% 53% 40% 57% 30% TOTALS 7% 8% 8% 7% 16% 16% 22% 22% 35% 36% 12% 12% Tables 57 and 58 contain the cross tabulation of type of decline with size of the institution and size of the generic baccalaureate nursing program. Forty-three percent of all generic baccalaureate nursing .218 Nme Nae aha aha xea NEH Nu as am Rm RNH NNH mnp mmmp co ooo.m_ooo.0Hiooo.m ooo.mHiHoo.oH ooo.omiHoo.mH ooo.m~iHoo.oN + ooo.m~ onhzhHhmzH zH hzmzanomzm hzmoahm hzm4<>Hzam wthinnaa cowpapmpmcH ecu cm acmeppoecm acouzpm ucmpm>macm OEePTPsz >3 mcmpuwo yo macaw means; new anemone .nm mpnmh 219 nmm nmm nem nmm now now noH noH n5 no nu no mnp oszmoz i hzmznnomzm hzmoohm hzmn<>~30m mszinnoe mmcaou ocwmesz Pm>on amend cm acwappoecm acousum acmpm>w3cm wsmpippza mo wcwpumo eo onzp misuse new pcOmwae .om mpnmh 220 programs were located in institutions with a full-time equivalent enroll- ment of 5,000 students or less. The size of the educational institution, by full time equivalent enrollment, that appeared to be most severly affected by decline now and in the coming five years was that with 10,001-15,000 or 20,001-25,000 students. The institutions with an enrollment over 25,000 students seemed to experience the least present and future decline. Those institutions with an enrollment below 5,000 did not express as high a potential for decline as the other groups. Those programs with an enrollment of 250 or more in the first level nursing course showed the least present and future potential for decline, while those with an enrollment of 50-99 seemed to have a greater potential for future decline (Table 58). Programs with an enrollment of 49 or fewer students appeared the most susceptable to contraction, or the sudden with- drawal of resources. SUMMARY The major type of decline currently affecting generic baccalaureate nursing programs is erosion or the steady and gradual reduction of resources. Respondents expect erosion to increase over its present level and also to be the major type of decline affecting them over the coming five years. A smaller but steady number of respondents also see contrac- tion, or the rapid decrease of resources, as a present and continuing type of decline with which to deal. Both of these types of decline are decreases in niche size thus implying that the present output is accept- able in the environment only in a lesser quantity. A small but increasing number of respondents indicated that disso- lution was a type of decline that would have to be addressed within the 221 coming five years. Dissolution is a change in niche shape which means that the current output is no longer acceptable in society. Thus for the producer to continue to be viable, a new or revised output must be developed. The percent of respondents indicating that no decline was present and that they expected no decline within the coming five years decreased from 46 to 33 percent. Thus at present 54 percent of the respondents were experiencing some decline and this was projected to increase to 67 percent within the next five years. Cross tabulations of decline by various characteristics revealed that the most vulnerable geographic areas for decline in generic bacca- laureate nursing programs were the North Atlantic and Midwest regions. Programs located in private institutions were experiencing and expected to continue experiencing significantly more decline of all types than those located in public institutions. By age of the generic baccalaureate nursing program, those aged 10 years and less and 40 years and older seemed to indicate the greatest potential for decline within the next five years. The programs aged 11 to 39 years reflected the highest degree of stability in terms of less change predicted from their current state in the coming five years. Pro- grams aged 10 years and less reflected the greatest potential for future dissolution. By size of institution, as reflected by full time equiva- lent student enrollment, those least affected by detline had more than 25,000 students and those most affected had an enrollment between 10,001 to 15,000, and 20,001 to 25,000. By size of the enrollment in the first level nursing course, the programs most affected by decline had 50-99 students and those least affected had 250 or more students. Nursing 222 programs with an enrollment of 49 or fewer students were most susceptible to contraction. Overall, all programs are experiencing erosion as the major type Of decline. Contraction was expressed as a concern by a small but consistent number of all respondents. Dissolution was a small but notable concern for generic baccalaureate nursing programs aged 10 years or less and located in private institutions in the Midwest and having a first year nursing enrollment of 50-99 students. Private institutions indicated more decline of all types than public institutions. SECTION II POLITICAL VULNERABILITY Overview Political vulnerability is an organization's internal fragility and uncertainty. Some factors increasing political vulnerability include small size, young age, internal conflict, changes in leadership, lack of experience, lack of a positive self-image, and a limited history of excellence. The most significant of all of these factors is age. Young organizations or units have fewer adaptive skills, fewer friends and allies and may be less innovative.7 Questions included in this section of the questionnaire were derived from the material on political vulnerability as described in Levine's typology of causes of decline (See Table 4). Using this model as a guide, factors contributing to problems or decline in higher educa- tion and generic baccalaureate nursing programs that met the description of political vulnerability were listed in Tables 5 and 6. Into this cell of the typology were also added those criteria which met the 223 description of political vulnerability used to review academic programs for possible discontinuance (See Table 8). All of these items were then combined into Table 9 and questions were generated to secure information from each respondent about each item included in the composite list. Numbers of the questions contained in this section are contained in Table 11. Responses to Individual Questions The majority of respondents came from an academic institution under public control, aged 50 years and above, with a full-time equivalent enrollment of less than 5,000 students. The generic baccalaureate nurs- ing program located in that institution was 11 to 19 years old with a full-time equivalent student enrollment in the first level nursing courses Of 50-99 students. The attrition rate at the end of the first year of nursing courses for 26 to 28 percent of the respondents was 3 to 5 percent. This is lower than the institutional attrition rate. On the other hand 13 to 17 percent of all respondents indicated they had an attrition rate of 12 percent or more at the end of the first year nursing courses. Twenty-four percent of the respondents did not know the insti- tutional attrition rate, therefore, could not indicate if the rate for their program fell above or below the institutional rate. Only 54 percent of the respondents indicated that they admitted the maximum number of students to the first level nursing courses that they were allowed to admit. At the same time, 44 percent of the respon- dents indicated that their recruitment efforts have remained unchanged while 22 percent indicated increased recruitment of traditional college aged students. Thirty-two percent of the respondents indicated that 224 they were refocusing their recruitment efforts from the traditional aged college student to older and non-traditional students. The current faculty-student ratio for classroom instruction was 1:35 or above for 37 percent of the respondents. Twenty percent Of the respon- dents in this study did indicate a classroom faculty-student ratio of 1:15 or below. Seventy percent of all respondents indicated that their current classroom ratios were statisfactory while 19 percent stated they should be higher and 10 percent indicated that they should be lower. The faculty-student ratio for clinical instruction was almost equally divided between those indicating a ratio of 1:8 or less (44 percent) and those with a ratio of 1:10 (38 percent). Seventy percent of the respondents indicated that they believed that their current ratios were appropriate and planned no future change. One way of increasing enrollment in selected nursing courses is by opening them to non-nursing majors. Respondents were asked what per- centage of their nursing courses were Open to non-nursing majors and how many non-nursing students actually enrolled in these courses on an annual basis. One to five percent of the nursing courses were open to non-nursing majors in 54 percent of the respondent's programs and no courses were open in 32 percent. Sixty-four percent of the respondents indicated that less than 20 non-nursing students per year enrolled in any open nursing courses. Another area explored was program costs. While forty-nine percent of the respondents indicated that they were aware of almost all of the data used to compute the cost per student or credit hour, 62 percent of the respondents replied that they did not have the total cost figures readily available. Despite this lack of specific information being 225 available, 44 percent of the respondents indicated that their generic baccalaureate nursing program had a higher cost per graduate or student credit hour than other professional programs in their institution. Forty-three percent of the chief executive officers replied that their cost per student or credit hour was as low as it could get while 28 per- cent stated that it could be lower but they had no specific plans to lower the cost. Only 22 percent of the respondents indicated that the cost could be lower and they had initiated plans to do so. When asked the degree of faculty involvement in committees and governance systems outside of the nursing department, 59 percent of the respondents indicated that over a quarter of their faculty served on inter-departmental committees, while 34 percent responded that over a quarter are represented on institution-wide committees. In 33 percent of the institutions, 5 percent or less of the faculty in the generic baccalaureate nursing programs serve in the institutional governance system and in 20 percent of the institutions that number is from 6 to 10 percent. Thus, representation of the nursing faculty outside of the nursing unit decreases as the membership or level of the committee broadens. Relatedness of the generic baccalaureate nursing program to the institutional mission was another area assessed. Ninety-four percent of the respondents indicated that the institutional mission supported or strongly supported baccalaureate level professional education while 6 percent indicated that this subject was not addressed in the mission statement. Ninety-three percent of the respondents stated that the mission supported or strongly supported research and scholarly activity with 6 percent indicating that this topic was not addressed. Public 226 and community service was supported or strongly supported in 95 percent of the mission statements and not addressed in 4 percent. Ninety-seven percent of the respondents believed that their generic baccalaureate nursing programs reflected the institutional mission while 2 percent believed that their programs did not. Scoring The questionnaire contained 22 questions which assessed political vulnerability (See Table 11). According to the scoring system developed, a low score indicated that a unit was less vulnerable while a high score indicated more vulnerability. The range and mean for the scores of respondents is presented in Table 59. The mean score for respondents in the political vulnerability cell fell just below the midpoint in the possible range. Thus overall respondents' programs should not be con- sidered highly politically vulnerable in terms of their potential for decline. The range of respondent's scores also tended to be almost equi- distant from both ends of the scale. TABLE 59. Scores of Respondents for Each Cell of Levine's Typology of Decline. CAUSE OF POSSIBLE RESPONDENT'S RANGE RESPONDENT'S DECLINE RANGE RANGE MIDPOINT MEAN Political 36 - 72 42 - 63 54 52 Vulnerability Problem Depletion 10 - 20 10 - 20 15 13.12 Environmental 43 - 94 61 - 87 68.5 74 Entropy Organizational 44 - 88 56 - 83 66 65 Atrophy 227 Management Tactics Eight questions contained in this section provided management responses to selected questions which assessed various areas Of political vulnerability (Table 12). These management tactics were identified by Cameron and Zammuto and are contained in their model of decline (See Table 3). Table 60 contains the rank order of management tactics selected by respondents. As is clear from the table, the reactive approach was most Often selected in the area of political vulnerability. The second most used management tactic was the experimental one which is described as random responses undertaken on a trial and error basis with no overall objective in mind. Enactive tactics reflect the actual implementation of activities to address a specific problem and were the third most used approach although this was selected much less frequently than the reactive or experimental approaches. The proactive approach of anticipating an event and having a plan ready to implement was the option used least often. Thus it would seem that for the major items contained in this sec- tion (costs and enrollments) the management approaches most frequently used are to wait until a problem is present and then react, often experi- mentally in terms of finding a solution or resolving the issue. Little before the fact action seems to be taken. Summary In summarizing the section on political vulnerability, several factors become evident. First, the items considered in this section can readily be divided into those that can and those that cannot be controlled by the chief executive officer of the generic baccalaureate nursing program. Items outside of that control are the geographic region 228 in which the program is located, the age and size of the institution in which the nursing program is located, and the age of the nursing program. All other items can be partially or totally controlled by the nursing program's chief executive officer. Table 60. Rank Order of Management Tactics Selected by Respondents in Each Category of Possible Causes of Decline Management Political Problem Environ- Organiza- Tactic Vulner- Depletion mental tional ability Entropy Atrophy REACTIVE (defend status quo, rationalize inactivity) 1 2 3 2 PROACTIVE (have identi- fied problem and have 4 4 2 4 specific plan ready to implement) ENACTIVE (have implemen- ted a specific plan) 3 3 l 1 EXPERIMENTAL (know some- thing should be done, 2 1 4 3 don't know what) Second, enrollment in the generic baccalaureate nursing programs emerged as a major problem area in that only 54 percent of the respon- dents indicated that they admitted the maximum number of students to the first level nursing courses that they were allowed to admit. Sixty-six percent of the respondents indicated that they were continuing to focus recruitment efforts on the traditional college age student. A third area that emerged was cast of the generic baccalaureate nurs- ing program. Forty-five percent of the respondents indicated that their 229 programs had a higher unit cost than most other professional programs in their institution. Sixty-two percent of the respondents indicated that they did not have annual cost data for their programs readily available. Forty- three percent of the respondents indicated that their unit cost was as low as they believed it could get even though only 49 percent stated that they were aware of almost all of the costs figured in this cost data. The major component of any unit's cost is salary for faculty and staff. While 37 percent of the respondents indicated a faculty-student classroom ratio of 1:35 or more, 20 percent had a ratio of 1:15 or below. Faculty-student ratios for clinical instruction were 1:8 or less for 44 percent of the respondents. Seventy percent of all respondents indicated that their current faculty-student ratios were appropriate. A fourth but lesser area of concern that emerged was the participa- tion of nursing faculty on committees outside of their unit. As the committees broadened in scope of membership, smaller numbers Of nursing programs had faculty represented. The vast majority of respondents did indicate that their institu- tional mission statements were supportive of baccalaureate level professional education and that they had a low attrition rate. The mean scores for this section were just below the midpoint in the range of possible scores. This would indicate that overall this is not an area that would be a major cause for concern, yet it is clear that the information obtained on costs and enrollments is not positive or even neutral. In the next chapter this discrepancy between scores and find- ing must be explored. The management tactics most often used to address items in this section were reactive and experimental. This means in both cases that 230 the problem arose before it was identified or before a plan to address it was developed. The responses used were to become reactive and defend the present domain after the problem arose or to randomly select course of action to address a current problem. SECTION III PROBLEM DEPLETION Overview Problem depletion occurs when support for an organization or program decreases or disappears because the need or issue addressed has been resolved or changed. Thus as changing societal or health care issues and problems impact on higher education and generic baccalaureate nursing education, so must the products of these programs change to remain viable. Definition of and support for problems arises outside of the institution and can only be impacted by it to a small extent. The administrator's responsibility is to monitor and forecast these changes and adjust the institution and programs accordingly. The ten questions contained in this section were derived from the items listed in the problem depletion section of Table 9. Table 9 is a composite of items contained in Tables 5, 6 and 8 which identify reasons why higher education and generic baccalaureate nursing programs are facing problems as well as the most common criteria used to identify academic programs for possible discontinuance. These items are all organized around the causes of decline as described by Levine (Table 4). Numbers of the questions included in this section are contained in Table 11. 231 Reeponses to Individual Questions Five questions were selected which reflect areas that have impacted or may impact enrollments in generic baccalaureate nursing programs. The central focus of these questions is that to the extent that the need for or status of generic baccalaureate nursing graduates is negatively impacted by these issues, enrollment, as well as societal and financial support could decrease. The questions were posed in the present and future tenses. Responses are contained in Tables 61 and 62. Table 61. Extent to Which Respondents Believed Each Item ie Impacting Current Enrollments Moderate Strong Item No Negative Negative Do Not Impac Impact Impact Know 32. Publicity that a college degree may 53% 24% 4% 18% not noticeably increase earning power. 33. Increased occpuational opportuni- 18% 44% 32% 4% ties open to women. ‘ 34. Publicity about there no longer 22% 49% 22% 6% being a shortage of registered nurses. 35. Publicity about wages paid to 24% 50% 20% 5% registered nurses being lower than some other professions. 36. Publicity about hospitals poten- tially having to close units due 19% 48% 22% 11% to low occupancy or cost contain- L ment. Fewer respondents believed that these items would have no impact in the future than believed they were having no current impact. The item that was most identified as having no impact on nursing enrollments was publicity that a college degree may not appreciably increase earning 232 power. The items most identified as having a negative impact on enroll- ments was publicity about there no longer being a shortage of registered nurses. Table 62. Extent to Which Respondents Believed Each Item Will Impact Future Enrollments. Moderate Strong Item No Negative Negative Do Not Impact Impact Impact Know 37. Publicity that a college degree may not noticeably increase earning 40% 39% 10% 10% power. 38. Increased occupational opportuni- ties open to women. 12% 41% 41% 5% 39. Publicity about there no longer being a shortage of registered 10% 52% 34% 2% nurses. 40. Publicity about wages paid to registered nurses being lower 14% 49% 32% 4% than some other professions. Al. Publicity about hospitals poten- tially having to close units due to 10% 44% 38% 7% low occupancy or cost containment. While the numbers of persons believing that any of thses items will have no impact decreased in Table 62, there are still significant numbers of administrators who either do not see or understand the relationship of external environmental factors on enrollment. Scoring The possible range of scores in this section and the respondent's range and mean is shown in Table 59. The respondents range of scores was the full range of scores possible. The mean was below the midpoint in the range which would indicate that the majority of respondents were aware of the societal impact of problem redefinitions. Mepgement Tactics The choice of management tactics used by respondents in the area of problem depletion is shown in Table 60. The predominate tactic chosen 233 was the experimental one. This means that should an issue noted in Tables 61 or 62 became a problem which requires action, the respondents have no plan ready to implement. The experiemtnal tactic as described in this study is one of trial and error actions taken in respond to a prob- lem with no overall goal in mind. Thus the number of respondents who indicated that the issue was or may be a negative factor were either unable or unwilling to develop plans to address the issue. Summar When presented with a list of five items that could impact generic baccalaureate nursing education in the future 81 to 86 percent of the respondents agreed that four of these items could have a moderate to strong negative impact on enrollments. At the same time, they indicated that they had no plan ready to address any of these issues if they should arise. The area of least present and future concern was that publicity about a college degree not necessarily increasing earning power may decrease enrollments. The area of greatest present and future concern was that publicity about there no longer being a shortage of nurses may nega- tively impact enrollments. The mean scores of respondents in this area was well below the mean which would indicate that problem depletion was not considered a problem by the respondents. This may account for why no plans were developed to address any issue. SECTION IV ENVIRONMENTAL ENTROPY Overview Environmental entropy is described as the uncertainty of the organi- zation's external environment to continue to provide support for it at 234 the accustomed levels. This change or decrease in support may be due to a changing population base, decreased finances or changes in the market or technology.8 Since these changes occur external to the organization, they are likely to be overlooked in planning for the future. Administra- tors are also likely to assume that they cannot change or impact these occurrances. The twelve questions contained in this section were derived from the items listed in the environmental entropy cell of Table 9. Table 9 is a composite of items contained in Tables 5, 6 and 8 which identify reasons why higher education and generic baccalaureate nursing programs are fac- ing problems as well as the most common criteria used to identify academic programs for possible discontinuance. These items are all organized around the causes of decline as described by Levine (Table 4). Numbers of the questions included in this section are contained in Table 11. Responses to Individual Questions To assist in predicting future enrollments or the future pool of potential applicants, respondents were asked whether or not they used a variety of factors as predictors. The least used predictor of future enrollments was the statewide birth rate with 42 percent of the respon- dents indicating they did not use it. Statewide figures on the percen- tage of high school graduates attending college, statewide figures on college enrollments, and statewide and national figures on enrollments and graduations from generic baccalaureate nursing programs were used to a great or some extent by 57 to 61 percent of the respondents and to a limited extent or not at all by 32 to 41 percent of the respondents. 235 Eleven to fifteen percent of the respondents did not use these latter figures at all. Asked to indicate what impact certain factors would have on future enrollments, 14 to 17 percent of the respondents indicated that decreased numbers of college age students, increased tuition and changes in federal financing of health care delivery would have no impact while 81 to 85 percent felt these factors would have a slight to strong negative impact. Only seven percent of the respondents stated that decreased federal monies for student aid would have no impact on future enrollments. In response as to whether the current number of graduates from all generic baccalaureate nursing programs in the state was equivalent to the need for nurses in the state, 44 percent of the respondents indicated that the need was greater than the number of graduates. Fifty-five percent stated that the need was equal to or less than the current number of graduates. Fifty-eight percent of the respondents indicated that 80 percent or more of their generic baccalaureate nursing graduates secured their first nursing position in their state. Thirty-one percent of the respondents said that 40-79 percent of their graduates secured their first nursing position in their state while 8 percent indicated that 39 percent or less did. Three percent of those responding stated that they did not know what percentage of their graduates secured their first nursing position in their state. In an attempt to determine the nature and extent of present efforts to coordinate or regulate the enrollment in, or number of, generic bacca- laureate nursing programs, information was sought as to the presence of any statewide mechanisms which addressed baccalureate nursing education 236 (Table 63). As is clear from the table, the only mechanism present to any extent is a voluntary effort among educational institutions in the state to provide and coordinate generic baccalaureate nursing programs. Table 63. Statewide Mechanisms Present to Regulate Numbers of Generic Baccalaureate Nursing Programs and Enrollments ITEM YES NO 1. A formal statewide nursing education plan which is the base for determining admissions to generic baccalaureate 10% 86% nursieg programs. 2. A voluntary but binding understanding among baccalaureate nursing program administrators to limit enrollments to 2% 94% meet state needs. 3. A mandatory system dictating number, types, and locations of generic baccalaureate nursing programs and/or enroll- 8% 89% ment levels in these programs. 4. A voluntary effort between employer representatives and educators to meet, but not exceed, statewide registered 7% 89% nurse needs. 5. A voluntary effort among educational institutions in state to provide and coordinate baccalaureate nursing 32% 66% education for current graduate/registered nurses. When respondents were asked if their generic baccalaureate nursing program differed significantly from other such progams in the state, from 64 to 79 percent answered that it did not. The least variation was in the amount of independent study and the most variation was in the design of the curriculum. Respondents were asked whether they had noted any changes in their students relative to age, desire for part-time study or grade point average. The majority of the respondents indicated that the age of the generic baccalaureate nrusing student had increased, the grade point average had not decreased, and more students were requesting part-time study. They also noted that the number of pre-nursing majors had decreased. 237 To address some of these changes occurring or predicted, respondents were asked whether they currently admitted part-time students into their generic baccalaureate nursing programs, whether any satellite programs were offered, and if registered nurse students were admitted either on- Or off-campus. Eighty-four to ninety-four percent of the respondents currently admit part-time and registered nurse students into their pro- grams. Only eight percent of the respondents do not have future plans to admit registered nurse students. Sixteen to seventeen percent of the respondents do not currently admit part-time generic students and do not plan to admit them in the future. Only 13 percent of the respondents currently have satellite programs for generic baccalaureate nursing students and this decreases to 12 percent in the future. Currently, 36 percent of the programs have satellite programs for registered nurse students and this number shows no change in the future. Another environmental issue which chief executive Officers will have to address is the present and future availability of clinical facilities for student experiences. The majority of respondents indicated the following as present concerns: agencies limiting the numbers Of students they will accept and the lack of clinical facilities to model new and emerging nursing roles. Areas not a present concern included: agencies instituting charges for clinical placement of students, lack of facilities using new technology, and lack of ambulatory or wellness orientated facilities for clinical placements. All of these areas except lack of facilities where new technology is used were identified as future areas of concern. When respondents were asked from what groups they obtained annual input for the purpose of curriculum revision, 76 to 96 percent indicated 238 they sought such input from representatives of agencies where students received clinical experience, nursing alumni, and current employers of new graduates. Only 37 percent of the respondents secured input from broad-based community advisory committees. Student input was obtained by all respondents. Scoring The possible range of scores in this section was forty-three to ninety-four. A high score indicated that either the present environment was not supportive of generic baccalaureate nursing education or that the respondents did not recognize and use environmental factors in planning. The range of scores and the mean for respondents is noted in Table 59. Scores in this section were high. The midpoint in the posssible range was 68.5 and the mean for respondents was 73.5. The mode was 71 which also is above the midpoint. Thus the scores indicate that there are either unfavorable external environmental factors and/or that the respondents are not using external environmental factors in their planning. Management Tactics Respondent's management tactics used to address the environmental problem present are noted in Table 60. The majority of respondents have taken or plan to take actions which seem to address the problems present in the environment in that they selected the enactive made first and proactive second. The enactive response mode means that new or differ- ent actions are being vigorously undertaken to address a present or anticipated problem while with the proactive response, a plan is ready to implement. Reaction tactics ranked third and experimental last. 239 The actions being undertaken by most respondents were to maintain but decrease enrollment of the traditional age, full-time college student and to add or expand one of the following: graduate program; registered-nurse completion program; off-campus program; weekend or evening studies program; or external degree program. Summary The mean scores for respondents in the environmental entropy section of causes of decline were five points above the midpoint of the range. This indicates that the external environment is not as supportive of generic baccalaureate nursing education as it once was. Fifty-five percent of the respondents stated that the number of generic baccalaureate nursing graduates from educational institutions in their states currently equals or exceeds the demand. Fifty-eight percent of the respondents indicated that 80 percent or more of their graduates secured their first nursing position in their state each year. At the same time, 31 percent of the respondents said that only 40 to 79 percent of their graduates received their first nursing position in their states. Data in Table 63 shows that there are few states with mandatory means for coordinating generic baccalaureate nursing education. The predominate means of coordination is a voluntary effort among educational institutions and this is only present in 32 percent of the states. Sixty-four to seventy-nine percent of the respondents indicated that their generic baccalaureate nursing curricula did not differ signifi- cantly from other such programs in the state. The area of greatest variation was in the design of the curriculum; the area of least varia- tion in the amount of independent study. 240 Respondents indicated that students enrolling in their programs were older and requested more part-time study. The grade point average of applicants had not dropped but the overall number of pre-nursing majors had decreased. In response to some of these changes, respon- dents were admitting more part-time and registered nurse students into their programs. Only 13 percent of the respondents currently have satellite programs off-campus for generic baccalauareate nursing students and this number will remain unchanged. In contrast, 36 percent of the progams have satellite progams for the registered nurse student. Fifty-seven to sixty-one percent of the chief excecutive officers indicated that they used the following enrollment predictors to a great or some extent: statewide figures on percentages of high school students attending college, statewide figures on college and university enrollments, statewide and national figures on enrollments in and graduations from generic baccalaureate nursing progams. Only 32 percent of the respon- dents used statewide birth rates to any extent in predicting enrollments. Fourteen to seventeen percent of the respondents indicated that decreased numbers of college age students, increased tuition, and changes in the federal financing of health care delivery would not negatively impact enrollments in their programs. Ninety-three percent of the the respondents indicated that decreased federal monies for student aid would have a negative impact on enrollments. Current issues which are of concern to chief executive officers include agencies limiting the numbers of students they will accept and the lack of clinical facilities to model new and emerging nursing roles. Areas which are not a present concern but will be in the future along with the two previous items are: agencies instituting charges for 241 clinical placement of students and lack of ambulatory or wellness oriented facilities for clincial placements. Lack of clincial facili- ties where new technology is used is not a current concern but half of the respondents feel it may be in the future. In terms of securing input for possible use in curriculum revision, 76 to 96 percent of the respondents regularly secured such input from representatives of agencies where students were placed for clinical experiences, nursing alumni, and current employers of new graduates. Student input was obtained by all respondents. Input from community advisory committees was sought in only 37 percent of the programs. The predominate management tactics used by respondents was the enactive one which means plans are already being undertaken to address problem areas. The second most used approach was the proactive one indicating that the problem is known and plans are ready to enact at the approprite time. The experimental mode was selected least often in this category. SECTION V ORGANIZATIONAL ATROPHY Overview Organizational atrophy is the non-function or malfunction of an organization's internal structures which then sends no or inappropriate warning signals of problems. In this way, problems are either not addressed or are addressed inappropriately. Factors contributing to this problem include: inconsistent or perverse incentives; decentral- ized authority with vague responsibility; weak leadership; role confu- sion; lack of apprOpriate evaluation procedures, stifled dissent and 242 upward communications; rationalization of poor performance; high turn- over; suspicion of outsiders; continuous reorganization; and routine adherence to the past.9 The 16 questions included in this section were generated from items contained in the organizational atrophy section of Table 9. This table is a composite of items contained in Tables 5 and 6 which identify problems in higher education and generic baccalaureate nursing education which are causing some of the current decline in these areas. In addi- tion, Table 9 includes the most common criteria used to identify academic programs for possible discontinuance (Table 8). Table 9 is organized around the causes of decline as identified by Levine (Table 4). Numbers of the specific questions contained in this section of the questionnaire are identified in Table 11. Responses to Individual Questions One segment of questions was focused on the extent to which the curriculum incorporated current and future health care trends and used new techniques for delivery. The only item listed which was covered to "a great extent" in the generic baccalaureate nursing curriculum was the concept of wellness. Those topics covered "to some extent" included: health policy, health economics and gerontology. Topics covered only "to a limited extent" were computers and marketing of nursing services. Eighteen percent of the respondents did not include the use of computers in their curricula, 11 percent excluded the marketing of nursing services, 4 percent did not address health economics, and one percent did not cover gerontology. All respondents covered wellness and health policy to some degree. Ninety-six percent of all respondents indicated that environ- 243 mental trends were discussed and overall curricular decisions made to address these at regular large faculty or curriculum meetings. Information about faculty workload and use of technology in the delivery of the curriculum was sought. Only 24 percent of the respon- dents indicated that over the past five years faculty time spent person- ally delivering lectures had decreased while use of audio-visual materials or computers for delivery of the same material had increased. Items computed as a regular part of the faculty workload by 54 to 65 percent of the respondents included: committee work, research and scholarly activity; student advisement; class preparation time; and clinical preparation time. It seemed evident that direct classroom and clinical teaching time would be included so these items were not listed. Thirty-seven percent of the respondents counted clinical practice exclu- sive of clinical instruction in the faculty workload and 34 percent included public and community service. When asked how faculty workload was determined, the greatest agree- ment was that it was not determined as a part of the collective bargain- ing process (Table 64). There was much less agreement as to whether faculty workload was computed via a standard institutional formula or a formula individualized to the nursing department. Respondents indicated that the faculty workload in the generic baccalaureate nursing program was greater than that for most other baccalaureate programs in the institution. Thirty-four percent of the respondents stated that though faculty workload was determined through the institution or collective bargaining, they could influence various components by manipulation of assignments and classification of activities. 244 Table 64. Determination of Faculty Workload ITEM YES NO 1. Workload for faculty in the institution is figured on a standard formula. 50% 44% 2. Workload for faculty in the institution is determined as a part of the collective bargaining process. 18% 72% 3. Faculty workload in the generic baccalaureate nursing program is figured in a formula individualized to our department. 58% 36% 4. Faculty workload in the generic baccalaureate nursing program is currently comparable to other baccalaureate programs througpeut this institution. 30% 59% 5. Faculty workload in the generic baccalaureate nursing program is currently greater than most other bacca- laureate programs in this institution. 51% 36% Twenty-eight percent of the respondents indicated that though faculty workload is not controlled by either the institution or collec- tive bargaining, they can manipulate few variables to change the past or present practice. Twenty-eight percent also indicated that they currently have a faculty group studying how the workload can be revised. Another factor which can affect the control of a chief executive officer is tenure. Chief executive Officers were asked what percentage of their faculty were currently tenured or in the tenure system and what percentage they believed should be. Responses to this question are contained in Table 65. The majority of the respondents would prefer that 50 to 69 percent of the faculty be tenured or in the tenure system. At this time, only 18 percent of the respondents indicated that 50 to 69 percent of their faculty were tenured or in the tenure system. Currently, more respondents had 80 percent or more of their faculty tenured or in the tenure than they believed should be. At the same time, more respondents also had below 40 percent of thier faculty tenured or in the tenure system then they desired to have. Forty-six percent of the respondents indicated that because institutional policies dictate tenure system status, there 245 was little that they could do except follow policies. Some respondents indicated that their institutions did not have a tenure system. Table 65. Percent of Respondents Indicating Percentages of Faculty Tenured or in the Tenure System Faculty 80% or Below More 70-79% 60-69% 50-59% 40-49% 40% Currently Tenured or in Tenure System 28% 7% 8% 10% 20% 32% Should be Tenured or in Tenure System 19% 10% 16% 24% 13% 11% Information about the academic preparation of faculty teaching in the generic baccalaureate nursing program and their participation in research and scholarly activity was also sought. Respondents were asked to identify the number of generic baccalaureate nursing faculty now in each category and the number that they believed should be in each category (Table 66). The numbers of faculty currently with and without doctorates is just the opposite of that desired by the chief executive officers as are the numbers of faculty who have published. While the chief executive officers believe that more faculty should be principal investigators of externally funded research than currently are, their expectations are at lower levels than they were for numbers of faculty who whould have doctoral preparation. Seventy-one percent of the respondents indicated that they had enacted a plan whereby some present faculty were obtaining doctorates. Thirty percent of the respondents indicated that they believed the publishing and research activities of the faculty would not increase 246 n2 nR n3... n4. new no nNN nm nu no n3 na 3358.63 to as imomumm>cm Fmawo Teena mm znpzumm .xoon oceans: ow gonzo iwgucoo no accuse nm nmN ne nHN nma noH nNH now nHH no now noH so Pmcezon pwcowm immeoen ”meowumc no women cm accuse mm zapsumm monocouuoo nN nan nm nNN nu n2 .3 nu. no nm n: 8. 5.5 3:6: o>m= o>mx w>mz m>mz o>mx o>mx o>m= w>mz o>m= o>m= o>mz a>m= upaozm 3°z uraosm 3°z upsozm 3oz opzocm 30: upaonm 30: upaozm zoz >¢oomhcm Ho.~H NH ~o.~a mo.~H NH.MH ma actuwpamo Empnoga 4m N¢.mm on.mm k¢.mm -.~m 4m xuw_wnmcmcpa> _muP¢wFoa unz can: men: 4m": mmfluz ammmm «CWPOoo umggsuuo ammoaoga umsgauuo uwmoaogm mpcwucoammm mpnwmmoa no wmsmu wucmzcwucoummo newNmmczoc PF< cw ucwoaumz mmmoum zm4 we comm so; mmcoom cam: .mn wFQMH 279 A score above the mean would indicate that the external environment was not as supportive Of generic baccalaureate nursing education as it had been previously. Mean scores for all classes of respondents fell below the midpoint in the range for organizational atrophy, thus indicating that the admin- istrative climate was neither supportive or not supportive but rather probably more focused on the status quo. The mean scores for all calsses Of respondents were below the mid- point in the area of problem depletion. The scores for those respondents whose programs had been proposed for downsizing or discontinuance were lower than the scores for those respondents whose programs had not been proposed for either. Mamanggment Tactics The rank order of management tactics selected by all respondents not proposed for downsizing or discontinuance is presented in Table 60. The tactics are divided into the responses chosen to address problems or issues in each cell of Levine's model. There was no one management tactic that was selected consistently as first choice across all causes of decline. The enactive approach was selected more Often than any other as the first choice with the proactive being selected as the last choice in three out Of four categories. There were no consistent choices of management tactics by whether the cause of the decline originated internal (political vulnerability and organizational atrophy) or external (problem depletion and environ- mental entropy) to the organization. 280 When responses in Table 60 are compared with those in Tables 70 and 73, no clear patterns emerge. The first choice of all groups is the same in the areas Of political vulnerability, problem depletion, and environmental entropy. Factor Analysis A factor analysis was attempted on the items contained in Table 11. The items did not cluster into the discrete groups as defined in the study. This may have been due to the factual nature of the questions; the wide range of answer choices or the fact that there were only subtle differences in many questions in different areas. The concepts as defined by Levine had not been subjected to factor analysis or the results had not been shared in any previous writings. Incidental Findingg Cost and enrollment questions were pulled from all categories of causes of decline and cross tabulated with whether or not the generic baccalaureate nursing program had been proposed for downsizing. This cross-tabulation showed that those programs that had been proposed for downsizing had greater numbers of older generic baccalaureate nursing students; more students with decreasing grade point averages; and fewer pre-nursing majors. Greater numbers Of programs proposed for downsizing had already initiated satellite programs for generic baccalaureate nursing students and registered nurse students. More programs proposed for downsizing were also located in states where the present supply of generic baccalaureate nursing graduates exceeded the present need or demand. In relation to cost information, programs proposed for downsizing had more chief executive Officers who were unaware of all components figured 281 in the cost data while at the same time had more chief executive officers who also figured their own data. More programs proposed for downsizing had higher program costs than other professional programs in their insti- tution. When looking at faculty workload, more programs that had been proposed for downsizing had fewer faculty regularly assigned to committee work, research and scholarly or public and community service as a part of their regular assignment. 10. CHAPTER IV LIST OF REFERENCES Cameron, Kim and Zammuto, Raymond. I'Matching Managerial Strategies to Conditions of Decline." Human Resource Management. Winter, 1983, p. 361. Dillman, D. Mail and Telephone Surveys - The Total Design Method. New York: John Wiley and Sons, 1978, p. 21. Ibid, p. 55. Baumgartner, Robert M. and Heberlein, Thomas. "Recent Research on Mailed Questionnaire Response Rates." Making Effectuve Use of Mailed Questionnaires, Daniel C. Lockhart, (Ed). San Francisco: Jossey-Bass, Inc., p. 67. Dillman, op. cit., pp. 185-186. Baumgartner and Heberlein, Op. cit., p. 67. Levine, Charles. "Organizational Decline and Cutback Management." Public Administration Review. July/August, 1978, p. 319. Ibid, p. 318. Ibid, p. 319. Levine, op. cit., pp. 316-325. 282 CHAPTER V SUMMARY, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS SUMMARY Problem Statement The problem addressed in this study was that of the decline currently affecting some segments Of higher education and generic bacca- laureate nursing education. The study was designed to identify the current and future types Of decline facing generic baccalaureate nursing programs, identify the causes of the decline, develop a predictive tool or assessment guide that could be used to assess a generic baccalaureate nursing program's potential for decline, identify management strategies that were used to address decline, identify the number and types of generic baccalaureate nursing programs that had been proposed for or actually experienced program downsizing or discontinuance, and determine if there were differences in the management strategies used in those programs that had and had not been proposed for or actually experienced program downsizing or discontinuance. m For this descriptive study, a questionnaire was mailed to 345 chief executive officers of National League for Nursing accredited generic baccalaureate nursing programs located in the continental United States. This constituted the entire population of the group under study. The 283 284 overall response rate was 67 percent with 54 percent of those being usable. Respondents from all National League for Nursing geographic regions of the United States were well represented. The study and questionnaire were developed around three main topics: decline, higher education and nursing education. Levine's model depict- ing the causes of decline served as one base for the study.1 Cameron and Zammuto's model which describes various types of decline and management actions that may be taken to address them served as another base for questions.2 Criteria used for assessing academic programs for possible downsizing or discontinuance were culled from the literature and incorporated into the questionnaire. The general information about decline and higher education was then focused on and adapted to generic baccalaureate nursing education. FINDINGS The findings will be presented in response to each proposed problem statement and subproblem as well as in response to major issues noted by the majority of respondents. Decline Erosion was the major type of decline identified by respondents as present now and projected over the next five years. Erosion is the gradual reduction Of resources needed to support the current level of activity and output and implies that the current output is appropriate. A much smaller but consistent number of respondents identified contrac- tion as another type of decline of current and future concern. Contrac- tion is the sudden reduction of resources needed to sustain the present 285 level of activity or output. In contraction, the current output is also appropriate. Decline was most frequently identified as a problem in those generic baccalaureate nursing programs located in the North Atlantic and Midwest National League for Nursing geographic regions. It is more common in private educational institutions with a full-time equivalent enrollment of 10,001 to 15,000 and 20,001 to 25,000. Most affected generic bacca- laureate nursing programs were aged ten years or less or forty years or more and had an enrollment of 50-99 students in their first level nursing courses. Causes of Decline Using Levine's model Of causes of decline, the area of environmental entropy received the highest scores. A high score in this area meant that the environment external to the organization was not supportive or not as supportive of generic baccalaureate nursing education as in the past or that the respondent did not recognize or assess environmental factors. The area with the lowest score was that of problem depletion which indicates that societal refocusing or redefining of aspects which may impact generic baccalaureate nursing education is not considered a problem. The scores for the areas of political vulnerability and organi- zational atrOphy clustered around the midpoint in those ranges. There were major problem areas identified from the responses to the causes of decline. First, enrollments in generic baccalaureate nursing programs are decreasing as was indicated by the fact that only 54 percent of the respondents state that they had admitted the maximum number of students allowed to their first level nursing courses each year over the last five years. Fifty-three percent Of the respondents indicated that 286 they had experienced a decline in the number of pre-nursing majors. The typical generic baccalaureate nursing student is also becoming older and requesting more part-time study. A second area of concern was the program costs. Forty-four percent of the respondents stated that their generic baccalaureate nursing pro- grams cost more than other professional programs in their institution. Forty-three percent of the respondents said that their programs costs were as low as they could be while 62 percent said that they did not have annual program cost data available to them. Forty-nine percent said that they were aware of almost all of the components figured in the program cost data. Information obtained revealed that chief exeuctive officers believed that current faculty workloads were appropriate despite the fact that 20 percent of the respondents had a faculty-student ratio of 1:15 or less for classroom instruction and 44 percent had a faculty- student clinical ratio Of 1:8 or less. Use of audiovisual media or computers had increased while direct faculty time had decreased in teaching in only 24 percent of the respondent's programs over the last five years. Faculty preparation and participation in research and scholarly activities was a third area of concern. Seventy-five percent of the respondents indicated that they had fewer doctorally prepared faculty in their programs than other professional programs in their institu- tions, while 86 percent said they had fewer doctorally prepared faculty than other non-professional programs in their institutions. In 61 percent of the respondent's programs, 19 percent or less of the faculty in their generic baccalaureate nursing programs held doctorates while the respondents believed that 50 percent or more of the faculty 287 should have doctorates. Ten percent or less Of the faculty had been the principal investigator in externally funded research while 19 percent or less had published in 46 to 77 percent of the respondent's programs. Fifty-six percent of the chief executive officers believed that over 50 percent of the faculty should have published and 10 to 39 percent should have been principal investigators. A fourth area of concern was curriculum issues focusing on potential lack of availability of the number and type of clinical placement sites needed for student experiences. The majority of respondents indicated that their generic baccalaureate nursing programs did not differ signifi- cantly from any other such programs in the state. They also stated that their programs required more contact hours for graduation than other programs in their institutions as well as higher grade point averages for progression and graduation. Program Downsizing Fifty-four generic baccalaureate nursing programs included among the respondents to the study had been proposed for downsizing within the past five years. Forty-eight Of those programs had actually been downsized. Downsizing was usually proposed by the institutional administration for the reason of the high cost of the nursing program to the institution. The second most common reason was low enrollment. Reductions in under- graduate students and faculty were also frequently accompanied by reductions in the clerical staff. Following the downsizing, 37 respondents indicated that the level of financial support for the nursing program had increased proportionately with other units across the campus. 288 A profile of those generic baccalaureate nursing programs proposed for downsizing revealed they are located in the Midwest in a private institution aged 50 years or more. They have a full-time equivalent student enrollment under 5,000. The nursing program is 11-19 years old with a student enrollment in the first level nursing courses of 49 or less. The nursing program has not admitted the maximal number of students allowed to its first level nursing courses over the last five years. The profile of the generic baccalaureate nursing programs actually downsized differs from this only in that the full-time equivalent student enrollemnt in first level nursing courses was evenly divided between 49 and fewer students and 50 to 99 students. Programs that had been proposed for downsizing also had greater numbers of Older generic baccalaureate nursing students; more student with a decreasing grade point average; and fewer pre-nursing majors. Greater numbers of programs proposed for downsizing had already initiated satellite programs for generic baccalaureate nursing students and regis- tered nurse students. More programs proposed for downsizing were also located in states where the present supply of generic baccalaureate nursing graduates exceeded the present need or demand. In relation to cost information, programs proposed for downsizing had more chief executive Officers who were unaware Of all components figured in the cost data while at the same time had more chief executive officers who also figured their own data. More programs proposed for downsizing had higher program costs than other professional programs in their institution. When looking at faculty workload, more programs that had been prOposed for downsizing had fewer faculty regularly assigned to 289 committee work, research and scholarly or public and community service as a part of their regular assignment. Scores in each cell of Levine's typology of causes Of decline did not differ significantly from those for all respondents. The score in the political vulnerability section was two points higher than all respondents. The pattern of management tactics chosen to address the causes of decline was the same as all respondents only in the first choice for political vulnerability, problem depletion and environmental entropy. The reactive mode was the first and second choice of responses in all areas. Program Discontinuance Of the 185 respondents, ten indicated that their programs had been proposed for discontinuance and one generic baccalaureate nursing program had actually been discontinued. That program was located in a private institution in the South. The institution was 50 years or more Old with a student enrollment Of under 5,000. The generic baccalaureate nursing program was aged 11 to 19 years, with a full-time equivalent student enrollment in the first level nursing courses of 49 or less. The nursing program had not had the maximum number of students allowed admitted over the past five years. Scores in the cells of Levine's causes Of decline for those generic baccalaureate nursing programs proposed for discontinuance did not differ significantly from those of all respondents or those programs proposed for downsizing. The mean score in the section on political vulnerability was three points higher than for all respondents. The first choice of manage- ment tactics selected by those respondents proposed for discontinuance was 290 the same as for those proposed for downsizing. No other pattern Of similarities emerged. Scoring The mean scores for all three segments of respondents was just below the midpoint in the range in all categories of causes of decline except environmental entropy. The mean scores in environmental entropy were four to five points about the midpoint for the range. Factor Analysis A factor analysis was attempted on the items contained in Table 11. The items did not cluster into the discrete groups as defined in the study. This may have been due to the factual nature of the qeustions; the wide range of answer choices or the fact that there were only subtle differences in some questions in different areas. The concepts as defined by Levine had not been subjected to factor analysis or the results had not been shared in any previous writings. Management Tactics The managment tactics selected by the three groups Of respondents showed the following similar patterns: the first choice of all groups in the political vulnerability section was the reaction tactic; for problem depletion the experiemtnal approach was selected first by all groups; and in the area of environmental entropy the enactive approach was the first choice for all groups of respondents. There were no other identifiable patterns. IMPLICATIONS/CONCLUSIONS The interpretations and conclusions will be presented in a format which addresses the problem and supbroblem statements. 291 Decline Decline is a common problem now being experienced in generic bacca- laureate nursing programs and will become an increasing problem to more programs over the coming five years. The major type Of decline being experienced and anticipated is erosion. While a greater incidence of decline was identified in the North Atlantic and Midwest regions, it was common in all geographic areas. More private than public educa- tional institutions were affected, but the incidence was high in both types. While certain enrollment levels for institutions and generic baccalaureate nursing programs showed a higher incidence of decline than others, all sizes of institutions and programs were affected. Scoringgon Causes Of Decline Scores for the causes of decline revealed mean scores higher than the midpoint in the range only for environmental entropy. This indicates that the respondents believe that the external environment is not as supportive as it has been. Mean scores in the areas of political vulnerability and organizational atrophy were just below the midpoint in the ragne. The mean scores in the area of problem depletion were well below the midpoint. Since the mean scores for three Of the four causes of decline clustered around the midpoint in the range, it would seem that either: there are no major problems in those areas; the tool was not sensitive enough to pick up problems; or the scoring was not appropriate enough to identify problem areas. In view of the number and severity of the problem areas identified, it would seem that the problem was more in the scoring than the sensitivity. Factors contributing to the major problem areas were spread across all four causes of decline. 292 Another interpretation of scores at the midpoint is that the respon- dents consider some aspects of problems and others not, thus presenting a neutral picture. If this line of reasoning is applied to the area of organizational atrophy where the respondent's scores were just and the mean of the potential range, then one could also interpret the socre as a desire to maintain the status quo. Thus rather than saying that the administrative climate is supportive in some areas and not in others, one could say that the administrative focus is on maintaining the status quo. Through use of the questionnaire, the chief executive officers were able to identify four problem areas which are or should be of current and future concern. The major problem areas identified were: decreasing enrollments; high program costs; academic preparation and research and scholarly productivity of faculty at lower levels than were deemed appropriate; and curriculum and student placement problems in the future. These problem areas have their origins both internal and external to the organization. Any one of these problem areas with the possible exception of faculty preparation, is sufficient to pose a threat to the stability and continued functioning of a generic baccalaureate nursing program. What most respondents indicated is that they were faced not with one but with some combination of these problems thus increasing the complex- ity and severity of the problems and solutions. These problems were common across all respondents whether or not their programs had been proposed for downsizing or discontinuance. 293 Management Tactics The pattern of management tactics selected for use was different, except in selected cells, for all three groups Of respondents (those whose programs had not been proposed for downsizing or discontinuance, those whose programs had been proposed for downsizing and those whose programs had been proposed for discontinuance). The area Of greatest similarity across all three groups Of respondents was in the first choice of tactics selected in the areas of pOliitical vulnerability, problem depletion and environmental entropy. There were no identifiable patterns of management tactics selected by whether the cause of decline was internal or external to the institution. Modes of response selected as first choice in various causes of decline by two groups of respondents include reactive and enactive. The experimental approach was the first choice once while the proactive tactic was not selected as the first choice by any group. The proactive response was most often selected as the last choice. Program Downsizing Twenty-nine percent of the respondent's programs had been proposed for downsizing with 26 percent of these acutally being downsized. Any pheonomonen that affects one-quarter Of the respondents needs to be con- sidered a problem of practical significance. Since the criteria most commonly used to review academic programs for downsizing are identified in this study, it would seem that all chief exeuctive officers would want to review them and incorporate them into their future planning. While there is a profile of more vulnerable generic baccalaureate nursing programs, program downsizing is common enough that it should concern all chief executive Officers. "i 294 Since past data as to the number and type of generic baccalaureate nursing programs porposed for downsizing are not available, it is not possible to identify if the number of programs proposed for and actually experiencing downsizing identified in this study is more less than in the past. The mean scores for three of the four causes of decline were similar for those programs proposed for downsizing and those not proposed. The area of environmental entropy contained respondent's scores with the greatest variations from the mean. Respondent's scores were up to six points higher thus indicating that the current external environment was not supportive of generic baccalaureate nursing programs. The first choice of management tactics chosen to address problem areas differed from those of respondents whose program were not proposed for downsizing only in the area of organizational atrophy. Prggram Discontinuance Program discontinuance is not a significant problem at this time. Only ten respondents indicated that their generic baccalaureate nursing programs had been proposed for discontinuance within the past five years, and only one program had acutally been discontinued. This is a small number, as it should be, since it represents the most severe and extreme action that can be taken. Since the number of programs pro- posed for discontinuance is so small, an accurate profile is not readily obtainable. Since nine of the ten programs proposed for discon- tinuance had also been proposed for downsizing, any program proposed for downsizing should also be considered a candidate for possible discon- tinuance. The criteria presented infthe study that are used to review 295 academic programs for possible downsizing should also be used to determine if a program is a candidate for discontinuance. The scores as to the causes of decline did not differ signifi- cantly for those respondents whose programs had and had not been pro- posed for discontinuance except in the area of environmental entropy where scores were higher. The first choice of management tactics selected for use by those respondents whose programs had been proposed for discontinu- ance was the same as the first choice of those respondents whose programs had been proposed for downsizing. This was also the same for three of the four causes of decline Of those respondents whose programs had not been proposed for either downsizing or discontinuance. No other specific pattern Of management emerged to distinguish this group from the other two groups of respondents. IMPLICATIONS NursingiEducation Administration It seems evident from the study findings that decline in generic baccalaureate nursing programs is and will continue to be a significant problem. As the erosion of resources continues, more direct and force- ful management actions must occur if many of these programs are to remain viable. In view of the prevalence of decline, now and in the future, chief executive Officers must become familiar with management responses geared toward the causes of decline and begin using these. The most common causes of decline were high costs and low enrollments. Respondents seemed least able or willing to take action to address high program costs. This was exhibited by the findings which indicated 296 that despite high program costs, many respondents indicated that these costs were as low as they could be when: they were not aware Of all of the components computed in the cost figures; faculty-student ratios for both classroom and clinical teaching in 20 to 44 percent of the insti- tutions were below national standard levels; and research scholarly activity is computed as a part Of faculty workload in 54 percent of the programs while the percentage of faculty actually participating in these activities is 19 percent or less. At the same time, use of audiovisual means or computers to replace personal instruction has occurred in only 24 percent of the respondent's programs over the last five years. In the area of decreasing enrollments, managment approaches were mixed. Respondents identified that changes in various societal views and definitions Of health care, financing, and higher education may negatively impact future enrollments, but that they had no specific plans identified to address these problems. At the same time respondents indicated that pre-nursing enrollments were down and they were not able to admit the maximum number of students to the first level nursing courses that they could. Respondents also indicated that their student body was becoming Older and requesting more part- time study. In response to these statements, chief executive officers indicated that more part-time students were being admitted; that they were maintaining or decreasing enrollment Of the traditional college- age student while increasing their focus on non-traditional students or approaches; and that their recruitment efforts have remained basically the same. These approaches contradict each other. 297 Chief executive officers must not only identify the causes of decline but be able to project new and different courses of action to address them. Presently, most of those chief executive Officers who have addressed the issue of declining enrollments have chosen to address it through the establishment of off-campus satellite programs for registered nurse students and by taking more registered nurse students into the generic baccalaureate nursing program. While these approaches are sound, if every generic baccalaureate nursing program initiates them, the current registered nurse market will soon be saturated and the problem of decreased enrollments will still be present. Thus more thought must be given to long range solutions. The problems are now known and others can be predicated using the information provided in this study. Management approaches were also mixed in the area of academic preparation and research and scholarly output. To address the academic preparation of faculty, respondents indicated a very active approach to the problem in that they had implemented plans whereby present faculty could secure doctoral degrees. At the same time, passive responses were selected to increasing research and scholarly output. These included answers that "more research and scholarly work cannot be accomplished until more faculty are doctorally prepared" and "once the faculty member expresses an interest in research and scholarly activity, this can be fostered." Such reSponses attempt to releive the chief executive Officer of having to take action by placing the primary responsibility for action on the faculty member. Inconsistent responses to various facets of the same problem may indicate a lack of clear understanding of the problem or are unwilling- ness or inability to address all aspects consistently or a different 298 interpretation as to the severity Of implications Of various aspects of the issue. Inconsistent responses may also be perceived as signs of uncertainty or lack of dedication to a course of action on the part of observers. In the long run, inconsistency may result in maintaining the status quo as gains in one area may be offset by losses or no movement in other areas. Since the decline can now be predicted, there is little reason why the experimental management approach should ever have to be used. The more often and accuratley a unit assesses itself and makes or readjusts its long and short range plans accordingly, the less likely that unit will be severly affected by decline. The areas to assess are identified in Table 9. Specific questions which can be generated from these topics are included in the survey ques- tionnaire used in this study. Areas of particular concern to chief executive officers are those in Table 7. The major types of decline identified by respondents reflected a change in niche size not shape, thus implying that the current output or graduate is appropriate, only not in as great a quantity. This view, while accurate in part, may relfect a complacency on the part of chief executive Officers which could lead to future difficulty. As long as future health care trends are accurately monitored and curri- culum changes are incorporated quickly, there will be no problems. If, on the other hand, current and future changes in health care are not incorporated into the curriculum, the current output will not be market- able. This area Of concern is raised because 36 percent of the respon- dents cover the use of computers in their curriculum only to a limited or no extent while 12 percent cover gerontology only to a limited or 299 no extent. These are current trends not being addressed, thus the graduate is less prepared for the real world. Methodology Discussion is also needed in relation to the scores respondents obtained for the various causes of decline. Since the mean score for all groups of respondents fell at approximately the midpoint on the range for three of the four causes of decline, this would seem to indicate that no major problems exist in these areas. Yet it is clear from the responses that several major problem areas exist for a number Of respondents. For the problem areas to be so clearly identified, the questions must be appropriate. The problem would then seem to be in the assignment of weights or the determination Of where in the range the critical point should be located. The area of political vulnerability stands out particularly as one in which there were significant problem areas identified, yet the mean score for respondents fell below the midpoint in the range. Thus, the determination of the critical point in each scale may need to be lowered or the weighting altered. Research The findings from this study were consistent with the literature in a number Of areas. Private educational institutions are more vul- nerable to decline than public ones.3 The Midwestern and North Atlantic areas project the greatest potential for future decline which is consistent with the Carnegie Commission's prediction of regional enroll- ment trends in higher education decreasing in these regions.4 Generic baccalaureate nursing programs under ten years of age noted a high increase in the potential for decline within the coming five years as 300 did programs aged 40 years and older. These findings are partially consistent with the literature which states that young age increases vulnerability.5’6 By size of institution experieincing decline, the literature states that small size increases vulnerability.7 In this study, the smallest sized institutions did not express the greatest potential for decline, thus not supporting the literature. By size of the generic baccalaureate nursing program, those programs with 99 and fewer students did express the greatest potential for decline thus supporting the literature. RECOMMENDATIONS Some questions developed from the items contained in Table 9 need to be refined and validated. The qeustions can then be developed into an assessment list for generic baccalaureate nursing programs to use in determinging their potential for decline. In the determination of the critical point in the range for each cell of Levine's model Of causes of decline needs to be reassessed and lowered. At this time, the nature of the problems identified in the areas are greater than are reflected by the scores. The items contained in Table 11 did not factor, thus implying that there were no pervasive content domains. The content areas as described in Levine's article are not totally discrete but do have either areas of close relationships or potentially overlap. Thus in future studies, attempts should be made to make these content areas more discrete. The analysis of these data needs to be more powerful through use of 301 statistical measures such as discriminate analysis, regression analysis or the Guttman scale. If this study were replicated, the management tactics should be correlated with the various types of decline as described in the Cameron and Zammuto model (Table 3). This would provide a further test of their model Of the causes and managment Of decline as well as a view of whether the chief executive officers were using appropriate management strategies for each type of decline (according to Cameron and Zammuto).9 This researcher found the management approaches as defined by Cameron and Zammuto to be very difficult to use. For example, the distinctions between proactive and enactive appears to be a fine line as to whether or not the plan has been initiated. Thus one may wish to redefine the present management tacitcs or select ones which are more easily and clearly differentiated. A follow-up research study based on this data would also be of interest. In this study, one could resurvey all schools and compare present and future data. One could also select schools with the lowest and highest scores and determine their future status compared to their present status. Another alternative would be to resurvey those programs which had been proposed for downsizing and a like number that had not and compare these two groups. In essence almost any subset of itmes which were identified as impacting decline (size, age location) could be selected as ways to categorize respondents for future studies. CHAPTER V LIST OF REFERENCES Levine, Charles. I'Organizational Decline and Cutback Management." Public Administration Review. July/August, 1978, p. 319. Cameron, Kim and Zammuto, Raymond. "Matching Managerial Strategies to Conditions of Decline.‘I Human Resource Management. Winter, 1983, p. 361. Three Thousand Futures. San Francisco: Jossey-Bass, Inc., 1981, pp. 72, 76. Mingle, J., et.al. Challenges of Retrenchment. San Francisco: Jossey-Bass, 1981, pp. 19, 66. Levine, Charles. "Organizational Decline and Cutback Management." Public Administrative Review. July/August, 1978, p. 319. Whetten, 0. "Sources, Responses and Effects of Organizational Decline." Organizational Life Cycle. Kimberly, J. et.al. (Ed). San Francisco: Jossey-Bass, 1981, p. 356. Fadil, V. and Thrift, J.S. "Openings, Closings, Merges and Accreditations: Status of Independent Colleges and Universities." National Association of Independent Colleges and Universities. 1978, p. 6. Levine, op. cit., p. 319. Cameron and Zammuto, op. cit., p. 361. 302 APPENDICES APPENDIX A LIST OF STATES IN EACH NATIONAL LEAGUE FOR NURSING GEOGRAPHIC REGION LIST OF STATES IN EACH NATIONAL LEAGUE FOR NURSING GEOGRAPHIC REGION JURISDICTIONS INCLUDED IN THE NLN REGIONS North Atlantic Connecticut Delaware District of Columbia Maine Massachusetts New Hampshire New Jersey New York Pennsylvania Rhode Island Vermont Southern Alabama Arkansas Florida Georgia Kentucky Louisiana Maryland Mississippi North Carolina Oklahoma South Carolina Tennessee Texas Virginia West Virginia Midwestern Illinois Indiana Iowa Kansas Michigan Minnesota Missouri Nebraska North Dakota Ohio South Dakota Wisconsin Western Arizona California Colorado Idaho Montana Nevada New Mexico Oregon Utah Washington Wyoming APPENDIX B FREQUENCY COUNT FOR EACH ITEM CONTAINED IN QUESTIONNAIRE FREQUENCY COUNT FOR EACH ITEM CONTAINED IN QUESTIONNAIRE SECTION I - DECLINE 1. Given the following types of decline, which, if any, do you see affecting your generic baccalaureate nursing program at this (check one) time? 32% 14% 3% 1) 2) 3) 4) 46% 2. Given the 5) Stagnation and steady reduction Of resources producing conflict over allocation of these decreasing resources. Product of program is acceptable in environment. Sudden decrease in resources available to support pre- sent range of services/programs. Product of program is acceptable in environment. Output of unit becoming progressively less acceptable to environment; pressure to produce new product. Output of unit becoming rapidly unnecessary or less acceptable to environment; pressure to produce new product. DO not see the nursing program in any type of decline. following types Of decline, which, if any, do you see affecting your generic baccalaureate nursing program within the next five years? (check one) _fll§_ 13% 33% 1) 2) 3) 4) 5) Stagnation and steady reduction of resources producing conflict over allocation Of these decreasing resources. Product Of program is acceptable in environment. Sudden decrease in resources available to support pre- sent range Of services/programs. Product of program is acceptable in environment. Output of unit becoming progressively less acceptable to environment; pressure to produce new product. Output of unit becoming rapidly unnecessary or less acceptable to environment; pressure to produce new product. DO not see the nursing program in any type of decline. Bl SECTION II - POLITICAL VULNERABILTIY 3. In which type of institution are you currently the chief executive officer Of a generic baccalaureate nursing program? (check one) 46% 1) Public Univeristy 22% 3) Private University 6% 2) Public College 25% 4) Private College 4. What is the age of the academic institution in which your generic baccalaureate nursing program is located? (check one) _Z§%_ 1) 50 years or more __Z%_ 4) 20 - 29 years __§%_ 2) 40 - 49 years __§%_ 5) 11 - 19 years __§%_ 3) 30 - 39 years __1%_ 6) 10 years or less 5. What is the age of your generic baccalaureate nursing program? (check one) __§%_ 1) 50 years or more _21%_ 4) 20 - 29 years __§%_ 2) 40 - 49 years _§§%_ 5) 11 - 19 years _1§%_ 3) 30 - 39 years _12%_ 6) 10 years or less 6. What is the FTE student enrollment in your academic institution? (check one) _;g§_ 1) 25,001 or above _1§%_ 4) 10,001 - 15,000 __§%_ 2) 20,001 - 25,000 _l§%_ 5) 5,000 - 10,000 __Z%_ 3) 15,001 - 20,000 _42%_ 6) less than 5,000 7. Over the last five years has the FTE student enrollment in your institution: (check one) _24%_ 1) Increased less than 10% per year _l}%_ 2) Increased 10% or more per year _2§%_ 3) Remained basically unchanged _2§%_ 4) Decreased less than 10% per year 10% 5) Decreased 10% or more per year 1% 6) DO not know if increased or decreased 82 10. 11. Over the last five years, please indicate the FTE enrollment in the first level nursing class in your generic baccalaureate nurs- ing program: (check one for each year) 250 or more zoo-249 150-199 '100-149 50-99! 0-49 1984-85 7% 6% 9% 19% 33% 23% 1983-84 7% 5% 10% 20% 35% 20% 1982-83 7% 6% 10% 22% 30% 23% 1981-82 7% 6% 9% 21% 30% 23% 1980-81 l 7% 6% 11% 19% 28% 24% Have you admitted the maximum number Of students to the first level nursing course each year that you are allowed to admit? (check one) 54% 1) Yes 44% 2) NO Over the last five years, which one of the following best reflects your recruitment efforts? (check one) _flfi%_ 1) Our recruitment efforts have remained basically the same. 22% 2) Our recruitment efforts have increased with the focus still on the traditional age college student. 32% 3) Our recruitment efforts have refocused from the tradi- tional high school age student to Older, part-time, minority, male and/or RN students. Over each of the last five years, what has been the approximate rate of attrition of students at the end of the first year of nursing courses in your generic baccalaureate nursing program? (check one each year) 0 - 2% 3 - 5% 6 - 8% 9 - 11% 12% or more 1984-85 18% 28% 18% 15% 16% 1983-84 18% 28% 17% 16% 17% 1982-83 21% 26% 19% 17% 13% 1981-82 21% 26% 18% 14% 16% 1980-81 L 21% 24% 18% 15% 15% B3 12. 13. 14. 15. Over the last five years, approximately how has the rate of attri- tion of students in your generic baccalaureate nursing program compared to the overall institutional attrition rate? (check one) 52% 1) Lower than institutional rate 14% 2) Same as institutional rate 9% 3) Higher than institutional rate 24% 4) DO not know Which Of the following best reflects your actions relative tO the attrition rate in your generic baccalaureate nursing program? (check one) 47% 1) Our attrition rate is as low as possible; no different action is planned. 10% 2) Our attrition rate is low but can be lowered through a plan that is now ready for implementation. 10% 3) Our attrition rate has been lowered through a new plan which has been enacted within the past twelve months. 31% 4) Our attrition rate could be lower but we have nO specific plan to enact at this time. Approximately what is the current student:faculty ratio for class- room teaching in your generic baccalaureate nursing program? (check one) 37% 1) 1:35 or above 18% 4) 1:20 10% 2) 1:30 12% 5) 1:15 15% 3) 1:25 8% 6) 1:10 or less Do you believe that the student:faculty ratio for classroom in- struction in your generic baccalaureate nursing program should: (check one) 19% 1) Increase (more studentszfaculty) 70% 2) Remain the same 10% 3) Decrease (less studentszfaculty) B4 16. 17. 19. 19. Which one of the following best reflects your actions relative to students:faculty classroom ratios? (check one) 68% 1) The ratios are appropriate; no future action is planned. 16% 2) The ratios will have to be increased/decreased, but at present we have no plan to address this. 11% 3) The ratios will have to be increased/decreased and we have a plan enacted to do so. 5% 4) The ratios will have to be increased/decreased and we have a plan ready to enact to do so. Approximately what is your current student:faculty ratio for clini- cal instruction in your generic bacCalaureate nursing program? (check one) 44% 1) 1:8 or less 1% 4) 1:11 14% 2) 1:9 3% 5) 1:12 38% 3) 1:10 1% 6) 1:13 or above DO you believe that the student:faculty ratio for clinical instruc- tion in your generic baccalaureate nursing program should: (check one) 18% 1) Increase (more students:faculty) 70% 2) Remain the same 12% 3) Decrease (less students:faculty) Which one Of the following best reflects your actions relative to student:faculty clinical ratios? (check one) 63% 1) The ratios are appropriate; no future action is planned. 17% 2) The ratios will have to be increased/decreased, but at present we have no plan to address this. 15% 3) The ratios will have to be increased/decreased and we have a plan enacted to do so. 6% 4) The ratios will have to be increased/decreased and we have a plan ready to enact to do so. 85 20. 21. 22. 23. 24. DO you have readily available to you annual data on the cost per graduate or per student credit hour for your generic baccalaureate nursing graduates? (check one) 37% 1) Yes 62% 2) No Which Of the following are true for you relative to the cost per graduate or student credit hour? (check each one) Yes No 1) I am aware of almost all of the components figured. 49% 26% 2) I supply information used to compute the cost. 41% 32% 3) I figure the cost. 11% 51% How does the cost per graduate or student credit hour for your generic baccalaureate nursing program compare with other bacca- laureate programs in your institution? (check one) 9% 1) Less than most professional programs. 24% 2) Approximately the same as most professional programs. 44% 3) More than most professional programs. 11% 4) Nursing is the only professional program. Which one of the following most reflects your current thinking? (check one) 43% 1) The cost/student or student credit hour in our nursing program is as low as it can get. 22% 2) The cost/student or student credit hour can be lower and we have initiated ways to lower that cost. 28% 3) The cost/student or student credit hour can be lower but we do not have a current plan to lower that cost. Over the past five years, what has been the trend in the number of student credit hours generated in other departments by generic baccalaureate nursing students? (check one) 27% 1) Increased 17% 3) Decreased 51% 2) Remained the same 4% 4) Do not know 86 25. 26. 27. 28. What percent of your baccalaureate level nursing courses are open to non-nursing major students? (check one) 2% 1) 20% or more 7% 4) 6 - 10% 2% 2) 16 - 20% 54% 5) 1 - 5% 4% 3) 11 - 15% 32% 6) none How many non-nursing students annually enroll in generic baccalaure- ate nursing courses open to non-nursing majors? (check one) 2% 1) 100 or more 2% 4) 4O - 59 1% 2) 80 - 99 9% 5) 20 - 39 2% 3) 60 - 79 64% 6) less than 20 What percentage of your nursing faculty serve on each of the follow- ing: (check one on each line) Over 25% 21-25% 16-20% 11-15% 6-10% 0.5% 1) Inter-departmen- 59% 8% 5% 5% 8% 11% tal Committees 2) Institution-wide 43% 15% 14% 11% 12% 5% Committees 3) Institutional Level Governance 18% 6% 6% 13% 20% 33% Systems Which Of the following best reflects your current thinking? (check one) 0% 1) In view of the present work schedule Of the faculty, they do not have the time or opportunity to serve on institu- tion-wide committees. 77% 2) While the present work schedule of the faculty is heavy, we do strongly encourage faculty to seek positions on institution-wide committees. 21% 3) Adjustments are made in departmental committee assignments for those faculty serving at the institutional level as one means of encouraging participation outside of this unit. 87 29. What is the position of the mission statement Of your institution relative to each item listed: (check each item Strongly Does Not DO Not Supports Supports Address Know 1) Baccalaureate level professional education 72% 22% 6% 0% 2) Research and scholarly activity of faculty 43% 50% 6% 1% 3) Public and community service 53% 42% 4% 1% 30. To what extent do you believe your generic baccalaureate nursing program reflects the institutional mission? (check one) _§§%_ 1) Strongly reflects (go to Question 32) _11%_ 2) Moderately reflects (go to Question 31) __2%_ 3) Minimally reflects (go to Question 31) 0% 4) Does not reflect (go to Question 31) 31. Which of the following best reflects action you are taking to achieve a better match between your program and the institutional mission statement? (check one) 38% 1) We are not currently undertaking action to change our program or our mission statement. 10% 2) We have one or more changes ready to implement in our program which will bring us more in line with the institutional mission statement. 1% 3) We are seeking changes in the institutional mission statement which will recognize our type of program. B8 SECTION III - PROBLEM DEPLETION TO what extent do you believe each of the following is having an impact on present enrollment in your generic baccalaureate nursing program? (check one option for each question 32-36) Moderate Strong No Negative Negative DO Not Impact Impact Impact Know 32. Publicity that a college degree may not noticeably increase 53% 24% 4% 18% earningfpower. 33. Increased occupational oppor- tunities open to women. 18% 44% 32% 4% 34. Publicity about there no longer being a shortage of registered nurses. 22% 49% 22% 6% 35. Publicity about wages paid to registered nurses being lower than some other professions. 24% 50% 20% 5% 36. Publicity about hospitals potentially having to close units due to low occupancy or cost containment. 19% 48% 22% 11% To what extent do you believe each of the following will have an impact on future enrollment in your generic baccalaureate nursing program? (check one) Moderate Strong No Negative Negative Do Not Impact Impact Impact Know 37. Publicity that a college degree may not noticeably increase 40% 39% 10% 10% earninggpower. 38. Increased occupational Oppor- tunities open to women. 12% 41% 41% 5% 39. Publicity about there no longer being a shortage of registered 10% 52% 34% 2% nurses. 40. Publicity about wages paid to registered nurses being lower 14% 49% 32% 4% than some other professions. 41. Publicity about hospitals potentially having to close 10% 44% 38% 7% units due to low occupancy. B9 42. In what way are you addressing each of the followi on each line) Do Not Consider It a Problem Something, but Am Not Sure May Have To Do What Yet Have a Definite Plan Ready to Implement ng? (check one Have Implemented a Plan To Address Problem 1) Publicity that a college degree may not noticeably increase earninggpower. 52% E u: a? to 32 2) Increased occupational oppor- tunities_gpen to women. 20% 54% E; 10% 3) Publicity about there no longer being a shortage of registered nurses. 13% 56% 14% 12% 4) Publicity about wages paid to registered nurses being lower than some other professions. 20% 61% 10% 5% 5) Publicity about hospitals potentially have to close units due to low occupangy. 15% 59% 10% 11% SECTION IV - ENVIRONMENTAL ENTROPY 43. To what extent do you use each of the following mechanisms to predict the future student enrollment trends? (check each option) To a TO Great To Some Limited 00 Not Extent Extent Extent Know 1) Statewide birth rate. 9% 23% 21% 42% 2) Statewide figures regarding percen- tages of high school graduates 24% 34% 25% 15% attending college. 3) Statewide figures on college/ univeristy enrollment. 25% 41% 21% 11% 4) Statewide figures on enroll- ment/graduations of generic 18% 42% 24% 14% baccalaureate nursing students. 5) National figures on enrollments/ graduations of generic bacca- 21% 36% 29% 13% laureate nursing students. 310 44. Over the last five years, have any Of the following occurred in your generic baccalaureate nursing programs? (check one on each line) Yes NO 1) Age of entering generic baccalaureate nursing students has increased. 72% 27% 2) Grade point average of students applying to generic baccalaureate nursingprograms has dropped. 41% 57% 3) Student requests for part-time study have increased. 69% 30 4) Number of pre-nursingma ors has decreased. 53% 41%, 5) Number of pre-nursipg ma ors has increased. 24% 64% 45. Do you currently: (check one on each line) Yes No 1) Admit part-time students into your generic bacca- laureate nursingprogram. 84% 16% 2) Admit graduate/registered nurse students into your generic baccalaureate nursingprogram? 94% 6% 3) Have any type Of off-campus satellite program for riggeneric baccalaureate nursingrstudents. 13% 85% 4) Have any type of off-campus satellite program for graduate/registered nurse students? 36% 62% If yes for all, go to Question 47. If no in any area, go to Question 46. 46. Do you have future plans to: (check one on each line) Yes No 1) Admit part-time students into your generic bacca- laureate nursing program. 48% 17% 2) Admit graduate/registered nurse students into your generic baccalaureate nursingrprogram? 55% 8% 3) Have any type of off-campus satellite program for generic baccalaureate nursingrstudents? 12% 72% 4) Have any type of off-campus satellite program for graduate/registered nurse students? 36% 41% 47. What impact do you believe each of the following factors will have on future enrollment in your generic baccalaureate nursing program? (check one on each line) Strong Slight NO Negative Negative Impact Impact Impact 1) Decrease in numbers of traditional collegg age students. 17% 32% 49% 2) Decrease in federal money for student aid. 7% 62% 30% 3) Increased tuition/room and board rates. 14% 42% 43% 4) Changes in federal financing of health care delivery. 15% 43% 39% Bll 48. Which of the following best reflects action your program has taken over the past five years? (check one) 17% 14% 55% 1) 2) 3) 4) We have chosen to maintain our undergraduate focus totally on the traditional age, full-time college student and to maintain or slightly decrease enrollment. We have chosen to maintain our undergraduate focus totally on the traditional age, full-time college student and to increase enrollment levels. We have chosen to maintain but decrease our enrollment Of traditional age, full-time college student and add/expand one or more of the following: graduate program; graduate/ registered nurse completion program; Off-campus program; weekend/evening studies program; external degree program. We have chosen to phase-out our generic undergraduate nursing program for traditional age, full-time students and substitute/expand one or more of the following in its place: graduate program; graduate/registered nurse com- pletion program; external degree program. 49. Which of the following best reflects action your program will take over the coming five years? (check one) 8% 10% 65% 3% 1) 2) 3) 4) We will/may choose to maintain our undergraduate focus totally on the traditional age, full-time college student and to maintain or slightly decrease enrollment. We will/may choose to maintain our undergraduate focus totally on the traditional age, full-time college student and to increase enrollment levels. We will/may choose to maintain but decrease our enrollment Of the traditional age, full-time college student and add/ expand one or more of the following: graduate program; graduate/registered nurse completion program; Off-campus program; weekend/evening studies program; external degree program. We will/may choose to phase-out our generic baccalaureate nursing program for traditional age, full-time students and substitute/expand one or more fo the following in its place: graduate program; graduate/registered nurse completion program; Off-campus program; weekend/evening studies program; external degree program. 812 50. 51. 52. Are any of the following statewide mechanisms present in your state? (check one on each line) Yes NO 1) A formal statewide nursing education plan which is the base for determing admissions to generic bacca- 10% 86% laureate nursing programs. 2) A voluntary but binding understanding among bacca- laureate nursing program administrators to limit 2% 94% enrollments to meet state needs. 3) A mandatory system dictating number, types and locations Of generic baccalaureate nursing programs 8% 89% and/or enrollment levels in these programs. 4) A voluntary effort between employer representatives and educators to meet, but not exceed, statewide 7% 89% registered nurse needs. 5) A voluntary effort among educational institutions in state to provide and coordinate baccalaureate 32% 66% nursing education for current graduate/registered nurses. In your Opinion, which of the following is most reflective of your state? (check one) 44% 1) The number of graduates from educational institutions in the state providing generic baccalaureate nursing educa- tion is less than the state need or demand. 37% 2) The number of graduates from educational institutions in the state providing generic baccalaureate nursing educa- tion is well matched with the state need or demand. 18% 3) The number Of graduates from educational institutions in the state providing generic baccalaureate nursing educa- tion exceeds the state need or demand. Approximately what percentage of your generic baccalaureate graduates secure their first nursing position in your state each year? (check one) 58% 1) 80% or above 5% 4) 20 - 39% 19% 2) 60 - 79% 3% 5) Less than 20% 12% 3) 4O - 59% 3% 6) Do not know B13 53. 54. 55. Does your generic baccalaureate nursing program differ significantly from other generic baccalaureate nursing programs in your state in any of the following ways? (check each item) Yes No 1) Focus of curriculum (i.e.: health vs. illness, inpatient vs. outpatient, etc.) 25% 74% 2) Curriculum design (i.e.: lockstep vs. flexible, ease of entry/re-entry, 3 years or 2 years of 35% 64% nursingrpourses, etc.) 3) Amount of independent study available in required courses. 16% 79% 4) Type of clinical facilities/experiences used. 26% 72% Which of the following mechanisms do you use at least annually to obtain input from present or potential employers for the purpose of curriculum revision? (check each one) Yes NO 1) Broad-based community advisory committee. 37% Siz— 2) Meetings with representatives from agencies where students have current clinical experiences. 96% 3% 3) Nursing alumni. 76% 20% 4), Current employers of nursingrprogram graduates. 88% 10% Which of the following are or are not concerns for your program at this time? (check each one) Is Present 15 Not Present Concern Concern 1) Agencies limiting numbers of stu- dents they will accept for clinical 68% 32% placement. 2) Agencies instituting charges for clinical placement of students. 18% 82% 3) Lack Of clinical facilities to model new and emerging nursing 52% 48% roles. 4) Lack of clinical facilities where new techniques/technolpgy is in use. 20% 80% 5) Lack of sufficient ambulatory and/or wellness-oriented facilities for 39% 61% clinical placements. 814 56. Which of the following do you believe will or may be future con- cerns for your program? (check each one) Will Be May Be Will Not Be Concern Concern Concern 1) Agencies limiting numbers of students they will accept for 62% 28% 10% clinical placements. 2) Agencies instituting charges for clinical placement of students. 35% 51% 13% 3) Lack of clinical facilities to model new and emerging nursing 38% 34% 26% roles. 4) Lack of clinical facilities where new techniques/technol- 24% 26% 48% ggy is in use. 5) Lack of sufficient ambulatory and/or wellness-oriented 28% 35% 36% facilities for clinical place- ments. SECTION V - ORGANIZATIONAL ATROPHY 57. TO what extent is each of the following covered in your generic baccalaureate nursing curriculum at this time? (check each one) To a Great To Some TO a Limited TO No Extent Extent Extent Extent 1) Use of Computers. 2% 31% 48% 18% 2) Wellness Concepts. 75% 21% 4% 0% 3) Health Policy. 28% 59% 12% 1% 4) Health Economics. 10% 56% 30% 4% 5) Marketing of Nursing Services. 8% 35% 46% 11% 6)Gerontology. 33% 56% 11% 1% B15 58. 59. 60. Which of the following is most reflective of the predominate way in which overall decisions are made in your program regarding addition or deletion of curriculum areas to insure program relevance to the environment? (check one) 3% 1) Each faculty member or course chairperson is responsible for making these decisions. 96% 2) There are regular large faculty or curriculum meetings were environmental trends and needs are discussed and decisions for change are made. 1% 3) Changes of this nature are made primarily by administra- tion. Over the past five years has faculty time spent personally doing lectures decreased while use of audio-visual materials or computers for the same subjects has increased? (check one) 24% 1) Yes 76% 2) NO Which of the following statements about faculty workload most apply to your institution and generic baccalaureate nursing program? (check each one) Yes No 1) Workload for faculty in the institution is figured on a standard formula. 50% 44% 2) Workload for faculty in the institution is determined as a part of the collective bargain process. 18% 72% 3) Faculty workload in the generic baccalaureate nursing program is figured on a formula individualized to our 58% 36% department. 4) Faculty workload in the generic baccalaureate nursing program is currently comparable to other baccalaure- 30% 59% ate programs throughout this insititution. 5) Faculty workload in the generic baccalaureate nursing program is currently greater than most other bacca- 51% 36% laureate programs in this institution. B16 61. 62. 63. 63. Which of the following are computed as a part Of faculty workload in your generic baccalaureate nursing program? (check each item) Yes No 1) Committee work. 61% 38 2) Research/Scholarly activity. 54% 44% 3) Student advisement. 65% 34% 4) Class preparation time. 56% 42% 5) Clinical preparation time. 56% 42% 6) Clinical practice (exclusive of clinical instruction. 37% 60% 7) Public and communityrservice. 34% 63% Which of the following best reflects your range of options in deter- mining or changing faculty workload? (check one) 5% 1) Since faculty workload is determined through the institu- tion or collective bargaining, there is little I can do to impact it. 34% 2) Though faculty workload is determined through the institu- tion or collective bargaining, I do influence various com- ponents at the unit level through mainpulation of assign- ments and how various activities are classified. 28% 3) Though faculty workload is not determined by the institu- tion or collective bargaining, there are few variables that I can manipulate to change the past or present practice. 28% 4) We currently have a faculty group studying how the work- load can be determined or revised in our department. What percentage of your undergraduate nursing faculty have doctor- ates? (check one) 4% 1) 50% or more 19% 4) 20 - 29% 5% 2) 40 - 49% 22% 5) 10 - 19% 12% 3) 30 - 39% 39% 6) Less than 10% What percentage of your undergraduate nursing faculty do you believe should be doctorally prepared? (check one) 71% 1) 50% or more 7% 4) 20 - 29% 8% 2) 4O - 49% 3% 5) 10 - 19% 9% 3) 30 - 39% 2% 6) Less than 10% 317 65. 66. 67. 68. If you believe that a greater percentage of your undergraduate nurs- ing faculty should be doctorally prepared than are currently, which of the following best reflects your major focus? (check one) 7% 1) We are unable to attract doctorally prepared nursing faculty and don't know what to do. 71% 2) We have implemented a plan whereby some present faculty are obtaining doctorates. 17% 3) We are undertaking vigorous selectively-focused recruit- ment to try and attract doctorally prepared faculty. 3% 4) We are employing doctorally prepared non-nurse faculty to fill some nursing faculty positions. What percentage Of your undergraduate nursing faculty is tenured or in the tenure system? (check one) 28% 1) 80% or above 10% 4) 50 - 59% 7% 2) 7O - 79% 10% 5) 40 - 49% 8% 3) 6O - 69% 32% 6) Below 40% What percentage Of your undergraduate nursing faculty do you believe should be tenured or in the tenure system? (check one) 19% 1) 80% or more 24% 4) 50 - 59% 10% 2) 70 - 79% 13% 5) 40 - 49% 16% 3) 60 - 69% 11% 6) Below 40% If the percentage Of undergraduate nursing faculty who are currently tenured or in the tenure system differs from what you believe it should be, what best reflects your current thinking? (check one) 46% 1) The institutional policies dictate tenure/tenure system status and we must follow those policies. 18% 2) We have a definite long range plan in action as to how we can increase/decrease the tenure system faculty at the undergraduate level. 4% 3) We know that we must increase/decrease the number of tenure system faculty but do not have a specific plan. 4% 4) Doctorally prepared faculty are not necessary to teach at the baccalaureate level. 818 69. 70. 71. 72. What percentage of your undergraduate nusing faculty have published in a state or national level professional journal or contributed to or authored a nursing book within the past three years? (check one) 10% 1) 50% or more 18% 4) 20 - 29% 6% 2) 4O - 49% 21% 5) 10 ' 19% 20% 3) 30 - 39% 25% 6) Less than 10% What percentage of your undergraduate nursing faculty do you believe should have published in a state or national level professional journal or authored or contributed to a nursing book within the past three years? (check one) 56% 1) 50% or more 13% 4) 20 - 29% 11% 2) 40 - 49% 4% 5) 10 - 19% 12% 3) 30 - 39% 3% 6) Less than 10% What percentage of your undergraduate nursing faculty currently 13 the principal investigator for any externally funded research or has been the principal investigator for funded research within the past three years? (check one) 1% 1) 50% or more 6% 4) 20 - 29% 0% 2) 40 - 49% 14% 5) 10 - 19% 3% 3) 30 - 39% 77% 6) Less than 10% What percentage of your undergraduate nursing faculty do you believe should have been the principal investigator for externally funded research in the past three years? (check one) 10% 1) 50% or more 22% 4) 20 - 29% 7% 2) 4O - 49% 24% 5) 10 - 19% 22% 3) 30 - 39% 12% 6) Less than 10% 819 73. 74. 75. If the percentage of undergraduate nursing faculty that you believe should be publishing or the principal investigators in funded research differs from the actual percentage, which of the following best reflects your current thinking? (check one) 25% 1) With the current teaching workload that undergraduate nursing faculty have, there is little time for publishing or research. 30% 2) The publishing/research activites of the faculty will not increase until the number of doctorally prepared faculty increases. 16% 3) Time for preparation of material to be published research proposal writing is planned in the work selected faculty to encourage this type Of activ 27% 4) Participating in research or writing for publica or of ity. tion depends on the interest and ability of the faculty member and, once expressed or shown, can be encouraged. Which of the following are true for your generic baccalaureate nurs- ing program compared with other professional programs in your institution? (check each one) Yes No N/A 1) We have a higher number of contact hours required for graduation. 64% 28% 5% 2) We have a higher grade point average required to progress/remain in the program. 50% 41% 6% 3) We have a lower number of doctorally prepared faculty. 75% 19% 5% 4) We have fewer students enrolled than most other programs. 14% 81 4% 5) Nursing requirements and faculty are compar- able to those of other professional programs in the institution. 44% 43% 9% 6) Nursing is the only professional program in the institution. 8% 82% 6% Which of the following are true for your generic baccalaureate nurs- ing program compared with other non-professional baccalaureate programs in your institution? (check each one) Yes NO 1) We have a higher number of contact hours required for graduation. 80% 18% 2) We have a higher grade point average required to remain in the program. 65% 31% 3) We have a lower number of doctorally prepared faculty. 86% 11% 4) We have fewer students enrolled than most other programs. 23% 74% 5) Nursing requirements and faculty are comparable to those of noniprofessional programs in the institution. 29% 66% 820 76. Which Of the following means of evaluation do you regulary seek and use to make administrative or curricular change? (check each one) Use Do Not Use 1) Faculty evaluations. 98% 2% 2) Student evaluations. 100% 0% 3) Administrative input of your superiors. 80% 17% 4) Input from faculty/administrators in other campus departments. 50% 48% 5) Lay and/or professional input from outsdie the institution. 72% 27% 77. If you were faced with a substantial reduction in your departmental budget, which of the following approaches would you be most likely tO select? (check one) 19% 1) Across-the-board cuts to all units. 34% 2) Selective deep cuts in some units and lesser or no cuts in other units. _44%_ 3) Elimination of some units/functions/persons while strenth- ening present and/or adding new units/functions/persons. SECTION VI - PROGRAM DOWNSIZING Using the definition Of program downsizing given below, please answer questions 78-81. (check each question) Program downsizing is defined as: reduction in Size of a unit either by decreasing enrollment, faculty or deleting one segment of a unit but not the entire unit. Yes No Uncertain 78. Has the nursing program within your institu- tion been proposed for downsizing within the 29% 70% 1% past five years. 79. Was the nursing program which was proposed for downsizing actually downsized. 26% 44% 2% 80. Have any programs in your institution other than nursing been proposed for downsizing 65% 22% 9% within the past five years? 81. Were any programs other than nursing which were proposed for downsizing actually down- 59% 18% 12% sized. 821 If any segment of the nursing program has been proposed for or actually downsized in the past five years, please answer Questions 82-87; if not, go to Question 88. 82. Downsizing of the nursing program was proposed by: (check one) 21% 1) College or university administration 8% 2) Nursing program administration 0% 3) Legislators 83. The main reasons for the proposed or actual downsizing of the nurs- ing program was: (check only one) 13% 1) Cost of program to institution 2% 2) Decreased need for nurses in state 1% 3) Duplication of other nursing education programs in the state 2% 4) Lack of relatedness of nursing program to mission of institution 12% 5) Other (specify) 84. The nature of the downsizing proposed in the nursing program included which of the following: (check all that apply) Remained Reduced Eliminated Same Expanded 1) Undergraduate student enrollment. 17% 2% 4% 2% 2) Graduate student enrollment. 1% 1% 6% 6% 3) Lifelong education Offerings. 2% 2% 10% 2% 4) Undergraduate faculty. 22% 2% 2% 0% 5) Graduate faculty. 2% 2% 7% 5% 6) Lifelong education. 2% 2% 8% 2% 822 The nature of the downsizing that actually occurred in the nursing program included which of the following: (check all that apply) Remained Reduced Eliminated Same Expanded 1) Undergraduate student enrollment. 15% 1% 4% 2% 2) Graduate student enrollment. 1% 5% 8% 0% 3) Lifelong education Offerings: 2% 2% 9% 2% 4) Undergraduate faculty. 21% 1% 3% 1% 5) Graduate faculty. 2% 1% 7% 6% 6) Lifelong education faculty. 2% 2% 9% 1% Which Of the following non-programmatic areas Of the nursing program have also been downsized? (check all that apply) Yes NO 1) Administration _,2% 14% 2) Clerical support 17%, f%_7 3) Work study or:graduate assistants 5% 16%—4 Has the level of financial support received by your department since downsizing was proposed or implemented increased propor- tionately with other departments across your campus? (check one) 20% 1) Yes 5% 2) No 823 SECTION VII - PROGRAM DISCONTINUANCE Using the definition of program discontinuance given below, please answer Quesions 88-91. Program Discontinuance is defined as: elminiation Of certain degrees or programs within departments, or closing entire departments or units. merger of related programs, Yes NO Uncertain 88. Has the total nursing program within your in- stitution been proposed for discontinuance 5% 90% 3% within the past five years? 89. Was the total nursing program which was pro- posed for discontinuance actually discon- tinued? 1% 62% 90. Have any programs in your institution other than nursing been proposed for discontinuance within the past five years? 60% 25% 8% 91. Were any programs other than nursing which were proposed for discontinuance actually 50% 29% 8% discontinued? SECTION VIII - PERSONAL DATA 92. What is your sex? 99% 1) Female 1% 2) Male 93. What was your age at your last birthday? 0% 1) Under 30 39% 4) 50 - 59 5% 2) 30 - 39 17% 5) 60 - 69 38% 3) 40 - 49 0% 6) 70 or above 94. What is your highest earned degree? 0% 1) Baccalaureate 14% 2) Masters in Nursing __2%_ 3) Masters not in Nursing _22%_ 4) Doctorate in Nursing _§§%_ 5) Doctorate not in Nursing __9%_ 6) Other (specify) 824 95. 96. How long have you held this position? 10% 1) Less than 1 year 16% 4) 7 - 9 years 29% 2) 1 - 3 years 7% 5) 10 - 12 years 33% 3) 4 - 5 years 5% 6) 13 or more years How many years of administrative experience in a departmental chair- person position or above did you have before assuming your current position? 25% 1) Less than 1 year 8% 4) 7 - 9 years 19% 2) 1 - 3 years 7% 5) 10 - 12 years 24% 3) 4 - 6 years 16% 6) 13 or more years 825 APPENDIX C INITIAL POSTCARD PRECEDING STUDY QUESTIONNAIRE INITIAL POSTCARD PRECEDING STUDY QUESTIONNAIRE April 2, 1985 Next week you will receive a questionnaire seeking your input on factors relative to the decline affecting some institutions Of higher education and some generic baccalaureate nursing programs. The data are being collected for my doctoral dis- sertation. I am seeking your input as chief executive officer in a generic baccalaureate nursing program as to factors you assess and actions you take in the areas identified in the questionnaire. One outcome from this study will be the development Of a framework to use when assessing an academic unit relative to it's potential for decline. I look forward to your participation in this survey. Sincerely, Sandra Simmons, R.N., M.S., Doctoral Student College Of Education, Michigan State University C1 APPENDIX D COVER LETTER ACCOMPANYING FIRST QUESTIONNAIRE COVER LETTER ACCOMPANYING FIRST QUESTIONNAIRE April 9, 1985 Dear Possibly you have been faced with the potential of no growth, retrenchment or even a slight decline in some of the resources available to the insti- tution of higher education in which you are located. I am interested in the impact these conditions are having on generic baccalaureate nursing programs and have chosen to explore this topic for my dissertation. The focus of my study is the identification of those factors which contribute to organizational decline. Decline is used in the sense of no growth as well as reduced output. Factors identified at the organizational level can be applied to unit level programs to determine their potential for decline. In academic institutions, a unit with increased potential for decline means that unit is a candidate for downsizing or discontinuance. Thus to the extent that an administrator knows what makes his/her unit vulnerable and uses this information to assess and plan that unit should do well within the institution. I am asking you as chief executive Officer of a generic baccalaureate nursing program to complete the enclosed questionnaire. Your response is necessary as you set the tone and climate for the unit and are the only one with sufficient vision and knowledge of some data sought. Completion Of the questionnaire will take approximately 30 minutes. I would appre- ciate your questionnaire being mailed by April 19, 1985. Return of the completed questionnaire implies your consent to participate in this collection Of data. All responses will be confidential. Grouped data will be presented in various ways, but at no time will any one in- stitution or respondent be identified or identifiable. The number appear- ing on the questionnaire is only to enable follow-up contact with those persons not responding initially. I believe that the data obtained from this study will be immediate and future use to chief executive Officers of generic baccalaureate nursing programs. Having available this framework to use when assessing your unit's status and planning future courses of action should enable your program to be more proactive and less vulnerable. If you wish a copy of the results Of the study, please put your name and address on the return envelope, not on the questionnaire. If you have any questions, please call me collect (616) 796-4956. Thank you again for your prompt response to this questionnaire. Sincerely, Sandra Simmons, R.N., M.S., Doctoral Student Enclosure D1 APPENDIX E FOLLOW-UP POSTCARD MAILED ONE WEEK AFTER STUDY QUESTIONNAIRE FOLLOW-UP POSTCARD MAILED ONE WEEK AFTER QUESTIONNAIRE April 16, 1985 Last week a questionnaire seeking your input about the effects of decline in higher education and what impact this was having on the administration of your generic baccalaureate nursing program was mailed to you. If you have already completed and returned it to me, please accept my sincere thanks. If not, please do so today. As you know, the quality of information generated is, in part, dependent upon the rate of returned responses. If by some chance you did not receive the questionnaire, please call me collect now at (616) 796-4956 and I will mail another one to you today. Sincerely, Sandra Simmons, R.N., M.S. Doctoral Student, College of Education Michigan State University E1 APPENDIX F COVER LETTER ACCOMPANYING SECOND QUESTIONNAIRE COVER LETTER ACCOMPANYING SECOND QUESTIONNAIRE April 30, 1985 Dear Approximately three weeks ago, I sent you a questionnaire seeking your input on the effects of decline in higher education and the impact this was having on the administration of your generic baccalaureate nursing program. As of this date, I have not recieved your completed question- naire. The information obtained from this study will have relevance to chief executive officers in generic baccalaureate nursing programs over the coming difficult years being faced by institutions Of higher education. Each response is vitally important as it makes the data obtained more useful. The questionnaire should be completed by you as the chief executive officer of a generic baccalaureate nursing program. In the event that the initial questionniare sent to you has been mis- placed, I have enclosed another for your use. Please complete and return it by May 10, 1985. Your cooperation is greatly appreciated. Sincerely, Sandra Simmons, R.N., M.S. Doctoral Student Enclosure F1