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REPORT OF AN

ADVISORY VISIT FOR THE PRESIDENT AND THE BOARD OF TRUSTEES

OF THE HIGHER LEARNING COMMISSION

TO

NEW MEXICO STATE UNIVERSITY – DONA ANA COMMUNITY COLLEGE Las Cruces, NM

May 30-31, 2013

The Higher Learning Commission

A Commission of the North Central Association of Colleges and Schools

EVALUATION TEAM Dr. Linda F. Samson, Professor of Nursing & Health Administration, Governors State

University, Highland Park, IL, 60035 Dr. James O. Smith, Professor of Business, Ivy Tech Community College of Indiana,

Bloomington, IN 47404 Dr. Gayle A. Kearns, Chief Academic Officer of Academy of Contemporary Music, University

of Central Oklahoma, Edmond, OK 73034 (Chairperson)

Advisory Visit Report NMSU-DACC/2884

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CONTENTS

I. Context and Nature of Visit ........................................................................................3 II. Areas of Focus ………………………………………………………………………6 III. Summary Statement…………………………………………………………………24


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I. CONTEXT AND NATURE OF VISIT

A. Purpose of Visit To review compliance with Criteria Three, Four and Five

B. Accreditation Status

New Mexico State University – Dona Ana Community College currently holds initial accreditation from The Higher Learning Commission as an Associate Degree granting institution.

C. Organizational Context Dona Ana Community College (DACC) is a public, open-door and

comprehensive community college in southern New Mexico. DACC serves a demographic of students in who are considerably poorer than either the state or the country. DACC was founded in 1973 as a branch community college of New Mexico State University and has held initial accreditation with the Higher Learning Commission since 2008. DACC offers 39 associate degree programs as well as general education courses. DACC provides an accessible and supportive learning environment that offers academic, career and personal development opportunities as well as workforce development efforts to more than 101,047 residents of the City of Las Cruces and 214,445 from Dona Ana County. DACC is governed by the Board of Regents of New Mexico State University through an operating agreement between the university and the Boards of Education of Gadsden, Hatch and Las Cruces School Districts in Dona Ana County. There is a central campus and several satellite locations. Programs at DACC are divided into four (4) divisions which are led by Division Deans. The nursing program is one (1) of thirteen (13) programs in the Health and Public Services Division (HPSD).

D. Unique Aspects of Visit This is an advisory visit to review compliance with Criteria Three, Four and Five.

This visit is based on the loss of NLNAC accreditation in August 2012 due to continued non-compliance related to faculty credentials for part-time faculty, sufficiency of full-time faculty, consistent orientation for part-time faculty, and consistent evaluation of all faculty.

E. Interactions with Organizational Constituencies President Interim VP Academic Affairs Associate VP for Institutional Effectiveness & Planning


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VP for Business and Finance VP for Student Services Dona Ana Community College Advisory Board (5) Program Director for Nursing Division Dean for Health and Public Services Nursing faculty (4FT) Nursing Student Advisor Academic Leadership Team (24) NMSU Associate Provost System-wide Accreditation, Academic Planning and

Program Review & Outcomes Assessment DACC HLC Accreditation Committee (20) Criterion 3 Subcommittee (9) Criterion 4 Subcommittee (9) Criterion 5 Subcommittee (6) Enrollment and Records Administration Staff (14) Students Open Forum (10) Faculty and Staff Open Forum (40) Community Open Forum (4) F. Principal Documents, Materials, and Web Pages Reviewed

Assurance Section: Report of a Comprehensive Evaluation Visit for Initial Accreditation, April 2008

Advancement Section: Report of a Comprehensive Evaluation Visit for Initial Accreditation, April 2008 Higher Learning Commission to Dr. Margie Huerta, Initial Accreditation

Letter, October 2008 Multi-location Visit, April 2011 Initial Accreditation – Institutional Response, September 2011 Eligibility Process, Reviewer Analysis, May 2006 Higher Learning Commission Staff Action – Action Letter, September, 2010 Higher Learning Commission Request for Information – NLNAC Action, April 2012 Higher Learning Commission Pathways Letter – April 2012 Higher Learning Commission Pathways Letter – December 2011 Higher Learning Commission Staff Action – Report and Analysis, September 2010 Higher Learning Commission Change Visit, Team Report, October 2011 Higher Learning Commission Change Visit, Institutional Response, October 2011 Higher Learning Commission Staff Action, Memorandum for the Record, April 2010 Higher Learning Commission Initial Accreditation, Review Committee, September 2008


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Higher Learning Commission Progress Report – Report and Analysis, July 2010 Higher Learning Commission Monitoring Report – Report and Analysis, July 2010 Higher Learning Commission Desk Review – Action Letter, June 2011 Higher Learning Commission Change Visit – Action Letter, December 2011 Higher Learning Commission Change Panel – Triage Form, September 2012 NLNAC Additional Information, September 2012 Report on NLNAC Action, September 2012 Higher Learning Commission Non-financial Indicators – Letter, October 2012 Non-financial Indicators – Institutional Response, December 2012 Higher Learning Commission Change Panel – Panel Analysis Report, January 2013 Change Panel – Institutional Response, January 2013 Higher Learning Commission Change Panel – Action Letter, January 2013 Higher Learning Commission Advisory Visit – Letter, April 2013 Dona Ana Community College – HLC Nursing Special Monitoring Report, May 2013 Dona Ana Community College – 2013 NMBON Self Study Repot, May

2013 Dona Ana Community College – HLC Nursing Special Monitoring Report, Non-Nursing Institutional Activities and Processes, May 2013 Dona Ana Community College – Letter to HLC Re Monitoring Report, May 2013 Dona Ana Community College – NMBON Site Visit Final Report and Certificate Special, May 2013 Dona Ana Community College 2012 – 2013 Catalog Office of Institutional Effectiveness and Planning Website – PRIP reporting 5-year budget for nursing program Curriculum Change Form Minutes of Academic Leadership Team Admissions Progression Committee Minutes Nursing Load credit document NMSU DACC Associate Degree Nursing Faculty Retention/Incentive Agreement Memorandum for DACC Associate Degree Nursing Faculty Salary Proposal


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II. AREAS OF FOCUS

A. Concerns identified by the Commission President

The Commission received notice that New Mexico State University – Dona Ana Community College lost accreditation by the National League for Nursing Accrediting Commission (NLNAC) in Spring 2012 after a period of warning with the agency. The issues identified in the NLNAC action raise concerns about the College’s compliance with the Criteria for Accreditation and Core Components not only in the nursing program, but also across the institution. NLNAC raised concerns with the following issues:

• Faculty. Concerns included the following: sufficient credentials for part-time faculty; sufficiency of full-time faculty, consistent orientation for part-time faculty, and consistent evaluation of all faculty;

• Outcomes. Documentation was insufficient or incomplete to provide evidence of the following: consistent implementation of the evaluation plan; incorporation of the evaluation of outcomes in the systematic plan for evaluation; aggregated evaluation findings for all components of the evaluation plan; and decision-making to improve student learning outcomes.

These concerns relate to the following Criteria and Core Components:

• Criterion Three: Teaching and Learning: Quality, Resources, and Support, specifically Core Components 3.C.1, 3.C.2, and 3.C.3, with regard to concerns about the sufficiency of faculty, qualifications of faculty, and evaluation of faculty;

• Criterion Four: Teaching and Learning: Evaluation and Improvement,

specifically Core Components 4.A.1 and 4.A.5, with regard to the maintenance of a practice of regular program reviews and the maintenance of specialized accreditation for its programs as appropriate to its educational purposes; Core Component 4.B with regard to the institution demonstrating a commitment to educational achievement and improvement through ongoing assessment of student learning; and Core Component 4.C with regard to the institution demonstrating a commitment to educational improvement through ongoing attention to retention, persistence, and completion rates in its degree and certificate programs;

• Criterion Five: Resources, Planning, and Institutional Effectiveness,

specifically Core Component 5.B with regard to the institution’s


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governance and administrative structures promoting effective leadership and supporting collaborative processes that enable the institution to fulfill its mission; and Core Component 5.C with regard to engagement in systematic and integrated planning.

B-1. CRITERION THREE, TEACHING AND LEARNING: QUALITY,

RESOURCES, AND SUPPORT. The institution provides high quality education, wherever and however its offerings are delivered. Core Component 3.C: The institution has the faculty and staff needed for effective, high-quality programs and student services.

• The institution has sufficient numbers and continuity of faculty members to carry out both the classroom and non-classroom roles of faculty, including oversight of the curriculum and expectations for student performance; establishment of academic credentials for instructional staff; involvement in assessment of student learning.

• All instructors are appropriately credentialed, including those in dual credit, contractual, and consortial programs.

• Instructors are evaluated regularly in accordance with established and

institutional policies and practices.

Team findings on Core Component 3.C1

• As noted, the DACC Nursing program currently employs three full-time and eight part-time faculty. These individuals serve the needs of 21 program students. This allows for a faculty to student ratio of 1.9 students per faculty member. Student to faculty ratios are in compliance with standards set by the New Mexico Board of Nursing (NMBON).

• Both full and part-time faculty teach clinical rotations and part-time faculty is supervised by master’s prepared full-time faculty members. The majority of core didactic courses are taught by full-time faculty with usage of part-time faculty reserved for areas where they have unique experiences or expertise that enhances the delivery of content within a course. This evidence implies the institution currently has sufficient numbers and continuity of faculty members to carry out both the classroom and non-classroom roles of faculty, including oversight of the curriculum and expectations for student performance; establishment of academic


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credentials for instructional staff; involvement in assessment of student learning.

• At the time of the report to the Commission, the DACC nursing program

employed three full-time and eight part-time faculty. By the time of the visit a fourth full-time faculty member had been hired and two additional positions were still posted. According to the May 1, 2013 report these individuals served the needs of 21 program students. At the time of the visit the program had 23 students and planned to admit and additional 16 in Fall, 2013, and again in Spring, 2014. Although the report to the NM Board of Nursing indicated a faculty to student ratio of 1.9 students per faculty member, in reality the ratio of full-time faculty to full-time students is currently 1 faculty position to 7 students. Student to faculty ratios are in compliance with standards set by the New Mexico Board of Nursing (NMBON) and meet the established nursing accreditation standards. (Note: NLNAC became ACEN—Accrediting Commission for Education in Nursing in May, 2013). Both full and part-time faculty teach clinical rotations and part-time faculty are supervised by master’s prepared full-time faculty members. The majority of core didactic courses are taught by full-time faculty with usage of part-time faculty reserved for areas where they have unique experiences or expertise that enhances the delivery of content within a course. This evidence implies the institution currently has sufficient numbers and continuity of faculty members to carry out both the classroom and non-classroom roles of faculty, including oversight of the curriculum and expectations for student performance, establishment of academic credentials for instructional staff; involvement in assessment of student learning.

• The program plans to admit 15-16 students to each cohort. Cohorts are admitted to Levels 1 and 3. Admission cycles are twice per year. The Level 3 admissions are only enough to complete the cohort of 15-16 so is dependent on those that exit at LPN level and those who may be unsuccessful in progressing from Levels 1 or 2. According to the enrollment data provided, there were 23 students in nursing in Spring, 2013. That number will increase to 35-36 in Fall, 2013 and may be as high as 50-51 in Spring, 2014.


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• If full complements are admitted in AY2014 faculty resources will be sufficient only if the additional faculty members being recruited are hired. This is related to the workload calculations for full-time faculty where clinical and labs are not awarded credit based on contact hours but rather a formula. This means that faculty working enough hours to approach the 15 credits per semester load may have up to 30 direct contact hours per week. Since the nursing program is currently in compliance with the specialized accreditation faculty requirements, the program may wish to carefully and deliberately consider the movement through candidacy based on the availability of additional to support program growth.

• Nursing full-time faculty and the nursing advisor are all recent hires with

experience at DACC ranging from 6 months to 2 years. Although they are new to the institution they have a range of prior experiences qualifying them to assume the roles and responsibilities of their positions. Interview questions validated their familiarity with the program and an ability to articulate curriculum framework, professional standards, and the links between student learning outcomes and construction of the curriculum.

• In meetings with DACC faculty, Interim VP Academic Affairs, Associate

VP for Institutional Effectiveness & Planning, and the VP for Business and Finance a process for approving faculty positions could not be elicited. The lack of understanding of institutional processes for faculty recruitment was of particular concern to DACC faculty. Several specifically cited concerns about approval for new or replacement positions, advertisements of vacant positions, and the methods of selection of search committee membership.


• Since spring 2012, Doña Ana Community College (DACC) lost their nursing programming accreditation with the National League of Nursing (NLN). Evidence provided in the National League of Nursing Reaccreditation Commission Progress and Plans (NLNAC) dated May 2013 indicated the college employs three full-time and eight part-time faculty. The three full-time faculty are credentialed with a minimum of a Master of Science in Nursing. Of the part-time faculty, three are credentialed with a Master of Science in Nursing, two with a nursing


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doctoral degree, and three with a Bachelor degree in Nursing. The evidence provided in the HLC Special Monitoring Report submitted 1 May 2013, while demonstrating an overall commitment for student learning, needs to express how DACC will develop processes necessary to sustain effective nursing undergraduate education particularly in the faculty credentialing area.

• Reports submitted to the New Mexico Board of Nursing and the Higher

Learning Commission validate that all full-time nursing instructors hold unencumbered licenses to practice as registered nurses in the State of New Mexico. All full-time faculty members hold the minimum of a master’s degree with a major in nursing and one is PhD prepared and credentialed as a Clinical Nurse Specialist (CNS). The program director and another faculty member are currently enrolled in a PhD program with anticipated completion in 2016.

• Although DACC has made progress in credentialing of part-time faculty since the NLNAC withdrew accreditation in Spring 2012, less than 50 percent hold the master of science in nursing degree as required by NLNAC. In the report to the New Mexico Board of Nursing and the letter of response granting 3 years of full approval (April, 2013) the nursing program met the requirement that all part-time nursing faculty hold the baccalaureate degree in nursing. However, at the time of the most recent report to NLNAC only 33 percent were credentialed with an MSN. This number is not sufficient to meet the requirement that the majority of part-time nursing faculty hold the MSN.


• DACC provided evidence in the NLNAC progress report that faculty receive an orientation plan, student handbook, faculty handbook and orientation manual upon hire. The orientation plan covers their first full year of employment with DACC and included interim performance evaluations. These evaluations are in excess of those required by DACC policy. In addition, an orientation meeting is held prior to every semester to review any changes in policy and provide training on new equipment or technology. New faculty is also assigned a mentor to help with procedural questions or concerns and to assist with the completion of a checklist of items related to teaching responsibilities. Documentation of orientation to the program, curriculum, theoretical framework, organization structure, and policies can be found in all current faculty files.


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• DACC provided evidence that part-time faculty receive invitations to attend a college-wide convocation at the beginning of each semester that they are required to attend. Department chairs and program directors assisted by full-time faculty provide pertinent information inclusive of student support in their respective classes. DACC included processes for the mentor of and evaluation of part-time faculty; however, the evidence does not demonstrate a consistency of implementation across the college. This leaves the impression that mentorship and evaluation quality depends on the particular division that an adjunct faculty is assigned. Given its vision to provide quality undergraduate education, DACC now needs to develop and formalize institutional and academic policies and processes necessary to sustain and ensure effective undergraduate education generally and nursing education in particular.

• Evidence was submitted in the HLC Special Monitoring Report that

DACC students are given an opportunity once a semester to voluntarily and confidentially evaluate the courses in which they are enrolled. The process stipulates that the Office of Institutional Effectiveness and Planning (OIEP) process and analyze the data and return summary results of their findings to faculty once grades are posted. While DACC did not present sample results for any of their programs, the institution stipulates this is one tool to evaluate faculty. DACC needs to consider how to use this information in their accreditation responses.

Summary Criterion 3C:

The team did not find the Institution to be in compliance. Recommendation: Follow-up required.

B-2. CRITERION FOUR: TEACHING AND LEARNING: EVALUATION AND

IMPROVEMENT. The institution demonstrates responsibility for the quality of its educational programs, learning environments, and support services, and it evaluates their effectiveness for student learning through processes designed to promote continuous improvement. Core Component 4.A: The institution demonstrates responsibility for the quality of its educational programs.

1. The institution maintains a practice of regular program reviews.


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5. The institution maintains specialized accreditation for its programs as appropriate to its educational purposes.

Team findings on Core Component 4.A

4.A.1. The Institution maintains a practice of regular program reviews

• DACC implements four major planning processes: The Program Review and Institutional Planning (PRIP) process; the Strategic Planning process; the Facilities Master Plan; and the Budget and Equipment Request process.

• Each process supports the others and is used in decision-making and

resource allocation; all planning efforts support the fulfillment of the DACC mission and are coordinated through the Institutional Effectiveness and Planning Office, the Business and Finance Office and the Vice President of Academic Affairs Office.

• The Program Review and Institutional Planning (PRIP) process is

implemented to produce and review operational action plans for all academic and non-academic units every two years. Although there were numerous examples of the ways in which individual programs conducted reviews, interviews with a variety of stakeholders and review of documents could not demonstrate how aggregate data are used to inform overall institutional decision-making related to programs. Furthermore, there does not appear to be a process for the sunset of outdated programs only the addition of new ones.

• Each office and program is required to submit a bi-annual program

review and planning document that reflects on strengths and concerns and possible improvement activities to address concerns. The action plan asks programs to connect their improvement activities to the institution’s Strategic Plan and/or to one or more of the Higher Learning Commission’s criteria. The action plan identifies numeric performance targets, strategies for evaluating or assessing the success of the activity and fiscal and human resource needs.

• DACC maintains a web site for program learning outcomes,

assessment plans, and program reviews. During a review of the DACC assessment web site for nursing it was noted that nursing had plans on the site for the academic years 2006-7 through 2010-11 and 2012-13. There was not a plan for the year 2011-12, the year in which NLNAC accreditation was withdrawn. Reports of findings were only present for the years 2006-2007 and 2007-2008. The evaluation plan posted for


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2012-2013 was posted in February, 2013 and is the evaluation of only the capstone course. No data were present on the web site.

• A review of the assessment plans and reports for other programs in the

Health and Public Services division, Business and Information Technology division, and in the General Studies division verify that plans and reports are present for all years listed. There is inconsistency in the level of reports, some are reports of activities, some benchmark against student learning outcomes, and some for 2012-2013 are activity based where they are targeted to individual assessment activities. It was unclear from the available materials whether there is a systematic process for the review of assessment data to inform institutional decisions.

• The Dona Ana Community College 2012 – 2013 Catalog presented

evidence that the institution is accredited independently of New Mexico State University by the Higher Learning Commission of the North Central Association of Colleges and Schools and maintains appropriate program accreditation appropriate to its educational purposes. It is also noted the Catalog contained representation that the institution is accredited by National League for Nursing Accreditation Commission, which is currently not the case. The 2012-2013 catalog was printed and distributed on 12 July 2012. The official notice of the loss of accreditation from NLNAC was on 30 July 2012. The new online 2013-2014 Catalog has the following statement about accreditation “Accreditation/Approval - The DACC nursing program is not currently nationally accredited. Students are encouraged to explore their employment and education options prior to submitting an application.” DACC is engaged in a process to reestablish this accreditation with the NLNAC.

• DACC’s 2012 – 2016 Strategic Plan began in July 2011with the

presentation of five presidential goals. The planning process culminated in five strategic priorities that included (1) Improve Student Achievement; (2) Intrusive Student Support; (3) Academic Curriculum Development & Redesign; (4) Workforce for the Future; and (5) Operational Efficiency & Effectiveness. As part of the strategic process, DACC produces the Program Review and Institutional Planning (PRIP) reporting for all academic and non-academic units every two years. This plans tie performance indicators,


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research, and assessment results into the planning process and resource allocation. However, evidence from the monitoring report and website does not indicate that DACC has developed the necessary outcomes necessary to evolve undergraduate education in a culture of evidence. Further, this evidence does not provide any clear learning outcomes of the undergraduate programs. Given its vision for a the school, DACC may need to develop and formalize institutional and academic policies and processes necessary to develop, sustain, and ensure how these program reviews are effectively used in their undergraduate education improvements.

4.A.2. The institution evaluates all the credit that it transcripts, including what it

awards for experiential learning or other forms of prior learning.

• Students can also earn credit for prior learning through the COLL 185 Prior Learning: Professional Portfolio class, which was developed in 2003. Students who enroll in this class receive assistance in developing a portfolio and gain credit as appropriate for substantiated professional and educational experiences equivalent to one or more career/technical courses. The guideline is one credit of COLL 185 is equal to a 4-credit course on the transcript. COLL 185 can be taken for up to 6 credits, so that translates to a maximum on 24 credits on the transcript

Core Component 4.B: The institution demonstrates a commitment to educational achievement and improvement through ongoing assessment of student learning. Team findings on Core Component 4.B 4.B.1. The institution has clearly stated goals for student learning and effective processes for assessment of student learning and achievement of learning goals.

• The institution has an ongoing assessment of student learning. The Assessment of Student Learning (ASL) Committee has been active since 1997 and works in tandem with the General Education Assessment Committee and smaller working assessment taskforces to ensure the continuance of assessment within specific programs and across the college. A culture of assessment has developed that supports efforts in college-wide assessment, program assessment and classroom assessment projects.


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• The extensive content included in the monitoring report leaves the distinct impression that DACC has an overarching commitment of improving education achievement through ongoing assessment of student learning. DACC evidenced a multitude of activities and processes that includes engagement with the New Mexico Higher Education Assessment Association (NMHEAA), Peer-to-Peer Assignment Evaluation Project, workshops and an assortment of germane activities. The institution included two charts displaying evidence of satisfactory student experiences with their coursework. Nonetheless, while DACC discussed many activities and processes, they provided little evidence of real student learning in an organized manner. DACC may need to develop and formalize institutional and academic policies and processes necessary to develop, sustain, and ensure how the assessment reports drive the program reviews to ensure they are used effectively in their undergraduate education improvements.

4.B.2. The institution assesses achievement of the learning outcomes that it claims for its curricular and co-curricular programs.

• Outcomes measures are selected by faculty and are included in the program’s systematic plan of evaluation (SPE). The SPE has clearly identified estimated levels of achievement (ELOA) that are based on NLNAC standards, NMBON rules, national standards, trends within the state, program history and items of interest to the governing organizations. Data is gathered utilizing a variety of quantitative and qualitative methodologies including surveys, focus groups and analysis of standardized exam data. Aggregated evaluation findings are utilized to inform program decision-making and to improve student outcomes.

4.B.3. The institution has the information gained from assessment to improve student learning.

• The systematic plan of evaluation (SPE) has been implemented in the Nursing Education Unit (NEU) to assist with continuous quality improvement for the past 18 years. Program evaluation has evolved from a focus on gathering data relevant to accreditation standards and criterion to a focus on continuous improvement. This change was prompted by a series of years where NCLEX-RN pass rates declined and a change in the curriculum in Fall 2011 to align the curriculum with Quality and Safety Education (QSEN) based student learning


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outcomes. With these changes and focus by faculty and administration over the past three years, achievement of student learning outcomes (SLOs) have improved.

4.B.4. The institution’s processes and methodologies to assess student learning reflect good practice, including the substantial participation of faculty and other instructional staff members.

• The nursing faculty meet once monthly to discuss institutional, departmental and student issues. These meetings are organized according to the NLNAC standards and criteria so that processes are more thoroughly and effectively documented, tracked and evaluated.

• The Student Learning Outcomes are fundamental to the systematic evaluation process. The institution participates in the HLC Program to Evaluate and Advance Quality (PEAQ) which is a systematic, on-going approach to institutional accreditation based on continuous quality improvement. Nursing program outcomes tie very closely to college assessment as evidenced by the Program Review and Institutional Planning (PRIP) reports that link elements of the program systematic plan of evaluation (SPE) to the college’s strategic plan and HLC criterion. The elements measured over the past three years included NCLEX pass rates, faculty professional development and improvement of curriculum through review of aggregated data (see appendix G).

• The program utilizes a comprehensive systematic plan of evaluation

(SPE) to assist with program decision-making processes. The plan includes a variety of assessment methodologies and includes measures from communities of interest. Measures include, surveys, standardized testing, classroom assessment, curriculum assessment and a community advisory council. Information gathered from the SPE has been utilized to revise admission, progression and graduation policies, revise curriculum, implement policies and procedures, and update estimated levels of achievement.

• Changes to the program curriculum have been made based on data

noted in the SPE. The data showed that program pass rates on the NCLEX-RN exam did not meet the national mean in 2004 and remained below the mean until 2009. A review of curriculum took place in 2007 and again in fall 2012 to ensure pass rates remain strong. Changes in fall 2012 included movement of course content between courses, consolidation of courses with redundant material, and an


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increased focus on assessment of student learning based on course competencies.

• During the past three years, after identifying that course competencies

were not linked to national standards and the program theoretical framework, new nursing student learning outcomes have been implemented. After implementation of the student learning outcomes, there was still concern with the NCLEX scores. After reviewing the information from the aggregated outcomes data, it was determined that curriculum changes were still needed. A continuous low score regarding lifespan competencies or patient centered care was identified as an issue for DACC graduates. The institution is now including a course on the care of the older adult.

Core Component 4.C: The institution demonstrates a commitment to educational improvement through ongoing attention to retention, persistence, and completion rates in its degree and certificate programs. Team findings on Core Component 4.C

• With the implementation of their strategy process, DACC provides the impression of their commitment in retention, persistence, and degree completion. The overall report would have been strengthened by the inclusion of evidence of progress in these goals.

4.C.1. The institution has defined goals for student retention, persistence and completion that are ambitious but attainable and appropriate to its mission, student populations, and educational offerings.

• As a commitment to increasing retention and graduation rates, all students are required to declare career-technical majors and/or indicate degree or certificate expected to earn. Advisors and associated literature communicate how the Associate of General Studies (AGS) degree can be valuable to students, including enhancing academic confidence, increasing self-esteem and extending financial aid benefits. DACC identifies eligible students within the cohort and actively encourages them to apply for the AGS degree. The number of AGS degrees has steadily increased each year, from 154 during the 2008 HLC accreditation visit to 433 in Academic Year 2010-2011 (DACC 2011 Factbook, p 31). The AGS degree allows students to tailor an associate degree to their own specific needs. It allows students to include courses from a variety of program areas.


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• During the development of the Strategic Plan, a strategic goal was to improve graduation rates. By doing so, the institution has incorporated two strategic priorities that align with the goal: Improve Student Achievement which will focus on graduation rates, retention, transfer, and transition and Intrusive Student and Academic Support Services which will focus on intrusive student services, academic support services, academic preparation and advising.

• Complementary efforts, especially those aimed at heightening student confidence through the provision of basic skills, have been developed to increase retention. Examples include General Studies Division’s successful implementation of a one-credit hour COLL 101-College Success course, providing students with an opportunity to cultivate the skills, values, and attitudes necessary to become confident, capable students, and contributing community members.

• Additionally, the General Studies Division successfully implemented the New Mexico Common Core Certificate as an alternative for students who are undecided as to their major or program choice. This 36-credit program prepares a student to transfer to any four-year college or university in the state while also satisfying many or all of the core requirements contained in the associate degree career programs offered at DACC. The 2012-2016 Strategic Plan also includes a transfer initiative and aims to expand participation of expected DACC graduates in the annual Transfer Fair.

4.C.2. The institution collects and analyzes information on student retention, persistence, and completion of its programs.

• Recruiting and retaining students from our community’s diverse background is also a priority. Nearly half (47.6 percent) of DACC’s student population are first-generation students, with neither parent having attended college (2011 Factbook, p. 32). Retention of first-time students, both full-time and part-time, is consistent with our peer institutions and higher than other institutions in New Mexico. New Mexico Higher Education IPEDS data report that 62% of full-time DACC students who began their studies in fall 2010 returned in fall 2011; 41% of part-time students returned.

4.C.3. The institution uses information on student retention, persistence, and completion of programs to make improvements as warranted by the data.

• Learning Communities, accelerated courses, and fast-track workshops are also a part of the DACC 2012-2016 Strategic Plan. Objective 1 under Strategic Priority 1: Improve Student Achievement is to increase


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graduation and completion rates. The institution identified four actionable strategies to accomplish this objective: • Hire a Learning Communities Coordination • Increase the number of sections offered in Learning Communities and

paired classes • Increase the number of students who take Developmental Math Fast

Track workshops • Increase the number of students who take Developmental English Fast

Track workshops • Since these best practices have been implemented, course completion

rates have increased. For example in 2008 there were 707 first-year, first time students enrolled in a developmental course. The pass rate in fall 2008 was 62%; in fall 2009 the percent increased to 70%; and in fall of 2010 and fall of 2011, the rate increased to 71%.

4.C.4. The institution’s processes and methodologies for collecting and analyzing information on student retention, persistence, and completion of programs reflect good practice. (Institutions are not required to use IPEDS definitions in their determination of persistence or completion rates. Institutions are encouraged to choose measures that are suitable to their student populations, but institutions are accountable for the validity of their measures).

• Upon reviewing the website and an interview with the Academic Leadership team, it was determined that DACC’s Office of Institutional Effectiveness and Planning coordinates and conducts studies that collect and analyze information on student retention, persistence and completion of programs.

• DACC has benefited from the work of an organized planning process. This group has worked together for approximately a four-year period and has developed and implemented a number of practices aimed at furthering student success.

Summary Criterion 4:

The team found the Institution to be in compliance with the quality of its educational programs, learning environments, and support services, and it evaluates their effectiveness for student learning through processes designed to promote continuous improvement.

Recommendation: No Follow-up Required

B.3 CRITERION FIVE. RESOURCES, PLANNING, AND INSTITUTIONAL EFFECTIVENESS. The institution’s resources, structures, and processes are


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sufficient to fulfill its mission, improve the quality of its educational offerings, and respond to future challenges and opportunities. The institution plans for the future. Core Component 5.B. The institution’s governance and administrative structures promote effective leadership and support collaborative processes that enable the institution to fulfill its mission. Team findings on Core Component 5.B

• The nursing director has administrative responsibility for the oversight of the nursing program as documented in the systematic evaluation plan for the program. The responsibility and accountability has been included in the director job description and compliance is monitored annually. Nursing faculty are engaged in the review of the annual requested budget prior to submission by the director.

• The nursing program director reports to the division dean for Health and Public Services. The division dean currently reports an Interim Vice President for Academic Affairs. The division dean is one of nine direct reports. The organizational chart reflects the direct reporting structure of DACC.

• Interviews with the Academic Leadership Team and Executive Team identified

that faculty and administrators are engaged in the governance process.

• The team is left with a strong impression that faculty are engaged in creating and updating curricula. While the exact approval processes remain unclear among some of the faculty, they are actively engaged in the instructional delivery for the College.

• During a meeting with the faculty, individual members indicated that they

felt they were not able to actively participate in the governance process. One member indicated extreme difficulty in getting access to the institutional policies in order to create a faculty handbook with links to relevant NMSU policies. Several faculty members described their inability to participate in the faculty hiring process. Concerns raised included inability to customize the information in the job description for the disciplinary needs, search committees no longer having the opportunity to make recommendations for faculty hires at the end of the search process (indicating that deans made the recommendations to the VPAA), or in some cases even get appointed to a search committee if they had challenged the administration.


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• Faculty, staff and administrators genuinely are engaged in their upcoming reaffirmation process with the Higher Learning Commission.

• The team is left with the impression that new programs, new construction

and additional learning centers are mainly the initiative of executive leadership – principally the President of Dona Ana. Once approved, faculty again are engaged in the crafting and delivery of curricula.

• The executive leadership of the College appears to be the principal

decision makers regarding the allocation of resources. With this visit there is not much evidence presented of the degree of interaction among the stakeholders of the College.

• With the exception of the associate provost assisting with Dona Ana’s

reaffirmation process and the recent appointment of an interim-President, the interaction between the College and New Mexico State University appears more reactive. The team is left with an impression that the prior President kept communication close-hold.

• The DACC Advisory Board is devised to levy local property taxes. The

Advisory Board did not seem engaged in the day-to-day operations of the College except to the extent of their possible interaction with the local high schools.

• There is not evidence provided or found where the University’s Board of

Regents were any more actively involved in the College than with any other function of the larger institution.

• The team did not leave the institution with any feeling that their nursing

accreditation as merely a one-off event. The College or the University presented any evidence that such a similar event could not happen elsewhere at Dona Ana.

• The DACC Advisory Board indicated they approve at some level the

College’s overall budget. However, their description appears to the team to be of a more perfunctory event rather than participative engagement in the institution.

• At all levels with which the team engaged the College and the University

provides an impression that the overall institution has been very effective at reacting to and addressing issues, but has not necessarily proactively engaged to insure that Dona Ana achieves its goals and mission. The


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executive leadership of the College seems to have avoided confronting the brutal facts that may have averted some of its negative experiences.

• For example, the College does not have a practice at this point in time of

reviewing programs for possible discontinuance. In times of economic uncertainty, reviewing programs for discontinuance is at least one strategy leadership might employ to ensure sufficiency of resources.

Core Component 5.C. The institution engages in systematic and integrated planning. Team findings on Core Component 5.C

• The planning process at DACC is described as including four distinct processes: the Program Review and Institutional Planning (PRIP) process; the Strategic Planning process; the Facilities Master Plan; and the Budget and Equipment Request process. The report submitted to the HLC on May 1, 2013 identifies that all processes support each other and are linked to resource allocation. Interviews with the Executive Cabinet and the Academic Leadership team verify that the processes are linked. The PRIP process is designed to review program information on a bi-annual basis with interim reports at 6 and 12 month intervals.

• The Strategic Planning process has resulted in an updated plan for 2012 -

2016. Although priority areas related to student retention and graduation are evident it does not appear that there are any strategic goals related to CQI or faculty needs in programs.

• Information available on site and in the self-study material does not

validate how and if DACC engages in systematic and integrated planning. The turnover in numerous key leadership positions and the tight control of information exercised by the now former President of DACC did not allow for clear understanding of the way in which planning was conducted and the integration of any planning efforts into budgeting processes. The efforts to allocate additional money to nursing faculty came only after the withdrawal of the NLNAC accreditation and not during any of the years of warning. Similarly there were no plans evident to improve the program, recruit faculty, or consider programmatic capacity limitations in response to NLNAC findings beginning several years before the loss of accreditation.


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Summary Criterion 5: The team found the Institution to be in compliance with Criterion 5.A and 5.C.

The team found the institution to not be in compliance with Criterion 5B with regard to governance and administrative structures that promote effective leadership and support collaborative processes that enable the institution to fulfill its mission.

Recommendation: Follow-up Required

C. Other Accreditation Issues [If applicable] - NA

D. Items that need additional organization attention but are not related to the institution’s compliance with the Criteria for Accreditation and do not require Commission follow-up.

• Following the departure of the team, an interim-President was appointed for the College. This signals the near certainty that a new President will be appointed. The College is in a position of leadership transition just prior to a reaffirmation visit by the Higher Learning Commission. Also noted, New Mexico State University appointed a new President for the University. The College may want to exercise great care during this planning period to ensure that it is responsive to the team visit in 2014.

• Given issues surrounding their nursing accreditation, the College may want to affirmatively provide evidence to the next visitation team that its other program accreditations are in good form.

• Although DACC is proceeding with efforts to regain program accreditation and intends to apply for candidacy sometime before September 2013, the institution is urged to carefully use the candidacy period to strengthen the nursing program to assure its long-term sustainability. Candidacy once granted, can be continued for up to two years before a visit for initial accreditation. Visits for initial accreditation must demonstrate compliance with all of the standards since conditions are not allowed at that time. Because the program has had long-term difficulty in maintaining adequately credentialed full-time faculty and has been consistently below the required ratio of MSN prepared part-time faculty until after the loss of accreditation, it would appear that taking the time to rebuild the program’s full and part-time faculty and to address faculty development for the current new program faculty should occur before the rigors of the initial accreditation visit.


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E. Summary Statement After review of Institutional documents and meetings with DACC administration,

faculty, reaccreditation team members, nursing faculty and President of the New Mexico State University system, it was determined that the Institution is completing the requirements as outlined by the National League of Nursing Accreditation Council to be reaccredited. Recommendation: During meetings with Executive Leadership, the Academic Leadership Team and the Advisory Board, there was a consensus that Dona Ana’s budget provided by the State of New Mexico was flattening out with a decline anticipated in future years precipitated by a decline in enrollments. At the same time the College is adding programs such as an aerospace program, hospitality, and increasing services to their high school stakeholders by implementing early college agreements. Sun-setting programs are not a common practice at the College. Recommendation: While evidence was not presented on their current budget methodology or about budget allocations across the college as a whole, our conclusion is that their current budget is or will be in the near future contracted for their existing programs. Accordingly, DACC will need to be more intentional in their funding of programs and services across their institution to ensure that resource constraints will not result in the loss of another program accreditation. DACC may need to be intentionally prepared to provide evidence of sufficient resources to the Higher Learning Commission in its submission for the upcoming comprehensive evaluation. The college should consider providing estimates of their future revenue streams, an explanation of their budget methodology, and certain evidence that would confirm the sufficiency of these resources for their current programs. This evidence could also include anticipation of adding new programs along with rationale of how these new programs would be funded in the future. While DACC takes great pride in obtaining Carl Perkins funding for new programs, inevitably these grants are short-term in nature, and the College would need to absorb these costs in its operating budget within three years. The College may want to consider providing such evidence of its ability to absorb new programs with flat operating revenues.

For example, during several interviews at the campus, discussions revolved around the number of students in DACC’s pre-nursing program. The number ranged from 381 to 691 depending on the faculty and staff interviewed. The actual number of students recorded in pre-nursing was 518 in Spring 2013. These students are currently competing for approximately 16 slots. The current


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evidence suggests that given the current resources that DACC cannot accommodate the total students enrolled in pre-nursing. Recommendation: DACC needs to consider its communication strategy that provides to their students full knowledge of the likelihood of their admission into the nursing program so that students can also plan alternative educational paths. Fiscal year 2007 to the estimated fiscal year 2013 were examined in summary to determine if there are sustained resource commitments to the nursing program in light of a leveling of revenues that are accrued to the institution overall. This review was undertaken especially since a number of individuals commented that faculty left the program for better paying positions with the university. The following data provides the most recent three year perspective for the budget of the nursing program. The fiscal year 2011 – 2012 was the year with the greatest level of resources allocated in the amount of $1.373 million. DACC’s federal Department of Labor grant funding expired after FY11-12. This grant provided $0.565 million to prepare students for the nursing program. The purpose of the grant was to increase the number of qualified students in the professional nursing pipeline by providing the prerequisite courses for students to gain admittance in to the nursing program. Funds were also used for one-time expenditures for supplies and services, including purchases of small equipment to equip a computer laboratory in support of the program. When these funds are subtracted from the overall nursing program budget the adjusted actual expenditures was $0.808 million. The actual for fiscal year 2012-2013 is $0.809 million. The estimated budget for fiscal year 2013 – 2014 is $0.930 million. While the budget is relatively stable over the past three years, we understand that full-time and part-time faculty have increased. The team notes the budget allocation is down from the peak year but is a modest increase over the previous year. The College will need to continue to affirmatively demonstrate that it can commit adequate resources to the program to ensure reaccreditation. DACC did not provide in the Monitoring Report nor through other evidence during the campus visit an overview of faculty credentials for its non-nursing programs. Further, during several of the interviews, faculty and staff indicated the college had dual credit and early college agreements with their high schools. Recommendation:


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DACC will need to provide sufficient evidence to document faculty credentials and early college faculty credentials for the reaffirmation visit by the Higher Learning Commission. It is evident during the interview process that not all faculty have a clear understanding of the process to change curricula. Depending on the magnitude of change, curricula have to be reviewed by the NMSU Associate Dean’s Academic Council (ADAC) that resides at the system level. In at least one instance a nursing curricular change was taken directly to the New Mexico Board of Nursing that may have required approval by ADAC. Recommendation: DACC will need to consider types of evidence it will need to provide to the Higher Learning Commission describing the management of curricular change within the College. Dona Ana is governed by the New Mexico State University Board of Regents, but also has an Advisory Board. The DACC Advisory Board, comprised of representatives of the three school boards, approves the budget, initiates mill levy and bond issue elections, and advises the college on program needs. While the Advisory Board does not generally oversee the College, these members occupy an important position of public and institutional trust. While the board has mainly tax levy duties at DACC, this board plays an important role in representing the community college to the broader university complex – especially the University Board of Regents. Trustees represent an “important formal link to the president’s supporting public” (Fisher & Koch, 1996, p. 231). Recommendation: This Advisory Board is an important advocate for the College. By significantly participating in the planning process, the Advisory Board is likely to assume the appropriate ownership of the strategic plan’s priorities and goals. The College and the University Board of Regents may want to consider self-improvement opportunities for the DACC Advisory Board that would increase their effectiveness in representing the College to their constituents. With the increasing public desire to increase higher education accountability, the Advisory Board could be in a strong position to answer from its public stakeholders’ questions on academic programs, student learning outcomes, as well as overall questions about graduation rates and student persistence.


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Summary of Findings: Based on the review conducted by the team and in the absence of significant material requested from the institution, the team believes that DACC is currently not in compliance with Core Components 3.C and 5.B. Comments from Team: The Advisory Board was asked its role, if any, in the lead-up to the nursing accreditation issue. Generally, the Advisory Board indicated they were not involved in any discussions prior to the situation appearing in the newspapers. They made it clear their primary purpose was to approve tax levies. It is clear that the college’s leadership did not advise the board with any general of specific information that the nursing accreditation was going to lose their accreditation with the NLNAC. The team viewed this as an unfortunate lapse on the part of the College leadership to keep the Advisory Board informed. However, the Advisory Board did indicate that it was in negotiations with the NMSU Board of Regents to increase the Advisors’ role in presumably certain aspects of governance for the community college.

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