EVALUATION OF THE REGULATORY PROCESS FOR NURSING EDUCATION ...€¦ · NURSING EDUCATION PROGRAM...

Simplifico Inc. 1755 Rathburn Rd E., Unit 89 416-712-8216 Mississauga, ON L4W 2M8 www.simplifico.ca

May 13, 2016

EVALUATION OF THE

REGULATORY PROCESS FOR

NURSING EDUCATION

PROGRAM APPROVAL IN

ALBERTA For: Cathy Giblin, Registrar & Director, QA

College & Association of Registered Nurses of Alberta

Prepared by: Bruce G. Matthews, P.Eng. [email protected]

Evaluation of the Regulatory Process for Nursing Education Program Approval in Alberta

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Executive Summary The College & Association of Registered Nurses of Alberta (CARNA) is a regulatory body established under the Health Professions Act, with a mandate to protect the public by ensuring effective, safe and ethical care from registered nurses. CARNA retained Simplifico Inc. to conduct a comprehensive review of its regulatory process for nursing education program approval, including an examination of issues of governance, structure, process, standards, criteria and outcomes. Simplifico reviewed the legislation, bylaws and other documentation relevant to nursing education program approval by CARNA and its internal Nursing Education Program Approval Board (NEPAB). Further, Simplifico completed an environmental scan of the processes used by other regulators, a literature review and an extensive stakeholder consultation, seeking input from educators, employers, government, CARNA leadership, CARNA staff and NEPAB members on a range of issues impacting nursing education program approval. Simplifico found that NEPAB is generally well regarded by those who interact with it. It is seen as organized, thorough, consistent and fair. Stakeholders had positive things to say about the composition of NEPAB and about the CARNA staff who support it. It was found that NEPAB is very strongly focused on process, but employs no meaningful measures of effectiveness. The relationship between CARNA and NEPAB was found to be a source of confusion for many stakeholders. CARNA’s Provincial Council (PC) has ultimate responsibility and accountability for the performance of NEPAB, yet it has obviated those duties by maintaining a very “hands off” approach with minimal oversight. Reporting from NEPAB to the CARNA PC is viewed as perfunctory at best – a very short annual report with no meaningful content to support accountability. Among CARNA PC members, the current level of awareness of NEPAB’s processes is disturbingly low. Most of the issues associated with the CARNA / NEPAB relationship appear to be rooted in the Bylaws and their interpretation. NEPAB’s process for education program approval was described almost universally as “onerous”. While a certain level of rigour is required, it was evident that the current processes are more burdensome than necessary. Some of the Standards and Criteria used by NEPAB are vague and subjective. Some of the processes do not reflect proportionality relative to the underlying risk issues, and they do not take into consideration various risk mitigation factors. Overall, CARNA is employing an approach to education program approval that is among the most labour intensive and expensive options available. Given the universality of nursing regulation in Canada and the multitude of nursing education programs across the country, a national-level approach to education program approval would seem to be in order. It is recommended that the CARNA Bylaws be modified to address the CARNA / NEPAB relationship issues. It is further recommended that NEPAB’s standards and criteria be modified to enhance specificity and measurability, and that NEPAB’s processes be modified to better reflect risk issues. Lastly, CARNA should champion an effort to establish a national-level nursing education approval body and stand down NEPAB once that body is in place.


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Introduction

The College & Association of Registered Nurses of Alberta (CARNA) established a project to review its regulatory process for nursing education program approval. As a regulatory body established under the Health Professions Act (the Act), CARNA’s mandate is to protect the public by ensuring that Albertans received effective, safe and ethical care from registered nurses. One way it achieves that is through the establishment of standards of qualification, including standards of education, for applicants. In furtherance of that role, CARNA established the Nursing Education Program Approval Board (NEPAB), which sets standards, criteria, policies and processes for the approval of nursing education programs offered by educational institutions in Alberta. At present, 11 colleges and universities across Alberta have one or more programs approved by NEPAB.

CARNA had observed significant variability in the governance, process and outcomes for nursing education program approval across Canadian jurisdictions. More specifically, pass rates of the National Council Licensure Examination – Registered Nurse (NCLEX RN) for graduates of NEPAB-approved programs seemed to suggest systemic challenges in meeting the appropriate outcomes for Alberta graduates. Based on these observations, the scope of the project included a comprehensive review of the regulatory process for nursing education program approval in Alberta, including issues of governance, structure, process and outcomes. While it was accepted that there is consistency in the entry-to-practice competencies that underlie nursing program approval across Canadian jurisdictions, the existing NEPAB Standards and Criteria also fell under the scope of the review. The output of the project is this detailed report based on documentation review, broad consultation and detailed analysis, and it contains recommendations regarding the future of nursing education approval by CARNA, plus a high-level implementation plan. CARNA has embraced the philosophy of “right-touch regulation” (RTR), which is a risk-based perspective on professional and occupational regulation first espoused by the Professional Standards Authority (PSA) in the United Kingdom. The fundamental tenet of RTR is proportionality – meaning that the extent to which a regulator exerts its regulatory authority (or applies “regulatory force”, as it were) to an issue must be in proportion to the risks associated with that issue. Excessive force is a waste of resources and interferes with the practice of a profession. Insufficient force fails to adequately address the risk issues and hence fails to protect the public interest. Adoption of RTR requires a regulator to have a very good understanding of the root causes of the problems it is attempting to solve through regulation, and it requires a regulator to be able to describe and quantify the risks associated with those problems. In support of the RTR philosophy, the PSA developed “Performance Review Standards”, also referred to as “Standards of Good Regulation”, which serve as the basis for the review of the performance of a range regulatory processes. The Performance Review Standards describe the outcomes of good regulation for each of the regulators’ functions. They also set out how good regulation promotes and protects the health, safety and well-being of patients, service users


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and other members of the public and maintain public confidence in the profession. The execution of this project was based in part on the “Education and Training” section of the Performance Review Standards (see Appendix A). Simplifico Inc. was retained by CARNA to carry out the project. In doing so, Simplifico has reviewed the legislation, bylaws and other documentation relevant to CARNA and NEPAB in respect of the process for reviewing and approving nursing education programs in Alberta. Further, Simplifico has conducted an environmental scan of the processes used by other regulators in Alberta and across Canada, and performed a literature review. The most significant effort in the project was an extensive stakeholder consultation, seeking input from educators, employers, government, CARNA leadership, CARNA staff and NEPAB members on a variety of issues associated with nursing education program approval. The specifics of the methodology employed by Simplifico is described in the next section. This report captures Simplifico’s efforts described above and includes its analysis, findings, commentary and recommendations for both the short term and long term future of nursing education program approval in Alberta.


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Methodology

Simplifico’s approach to the project consisted of the following seven activities:

1) Backgrounding Simplifico read and became familiar with the relevant portions of the foundational documents associated with CARNA and NEPAB. This included the Act, the relevant portions of the Registered Nurses Profession Regulation made under the Act, the relevant portions of the CARNA Bylaws, the other defining documents for NEPAB, plus information on the CARNA website regarding its purpose and mandate, and that of NEPAB. As the standards for education are inextricably linked to the performance standards for registered nurses, the backgrounding also included a familiarization with the current Entry-to-Practice Competencies for the Registered Nurses Profession and recent summary statistics regarding the results of the NCLEX RN exam. A “kick-off meeting” with CARNA staff was held to finalize details of the methodology and identify relevant documentation and stakeholders.

2) Environmental Scan In consultation with CARNA, Simplifico identified 10 professional regulatory organizations within Alberta, across Canada and in the United States, for the purpose of comparatively examining their approach to education program approval. The organizations represented a mix of health and non-health regulators. The comparative examination focused on the approach to governance, the mechanisms for the development of standards and criteria, the development and execution of processes and the outcomes associated with the education approvals programs. The comparative examination included a review and assessment of the information made available on the websites of the selected regulators, plus discussions with a responsible senior staff member at each of the selected regulators regarding the issues listed above. A list of the 10 regulatory organizations is found in Appendix B.

3) Literature Review The Journal of Nursing Regulation (JNR) is a peer-reviewed, academic/professional journal that is published quarterly by the National Council of State Boards of Nursing in the U.S. It provides a worldwide forum for sharing research, evidence-based practice, and innovative strategies and solutions related to nursing regulation and practice. Simplifico searched current and back issues of JNR to identify articles relevant to the regulatory process of nursing education program approval. Further, Simplifico surveyed the “grey literature” with respect to the assessment and approval of education providers in the context of professional and occupational regulation. This included a search of existing presentations and papers from regulatory conferences, and blogs related to issues of overall framework and governance, processes, procedures and operations, standards and


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criteria, and outcomes. While no relevant material was found in the grey literature, Appendix C identifies and provides summaries for five relevant articles from JNR that were published between 2011 and 2015.

4) Review and Assessment of Documents Simplifico conducted a detailed review and assessment of the following documents: - NEPAB foundational documents (including relevant portions of the Registered Nurses

Profession Regulation and CARNA By-laws, and other defining documents); - CARNA Entry-to-Practice Competencies for the Registered Nurses Profession; - NEPAB Standards for Alberta Nursing Education Programs Leading to Initial Entry to

Practice as a Registered Nurse; - Detailed statistics regarding the results of the NCLEX RN exam; - Agendas and minutes of NEPAB meetings; - Policy and procedure documents (prepared directly by NEPAB or others); - Guideline documents (prepared by NEPAB or others); - Training materials intended for NEPAB members; and - Reports published by NEPAB regarding the assessment, approval or revalidation of

education programs.

The purpose of the review and assessment of this documentation was to assist in the determination of whether the governance, structure and processes associated with nursing education program approval are transparent, objective, impartial and fair. It also assisted with the determination of whether the NEPAB standards and processes map effectively to the standards of competence and conduct for registered nurses, and whether they reflect the philosophy of right-touch regulation.

5) Stakeholder Consultations Simplifico planned, prepared, scheduled and conducted interviews, in person or via telephone, with relevant stakeholders as follows (see Appendix D for a complete list of the 55 individuals interviewed): a) CARNA Provincial Council – All members of the CARNA Provincial Council were

interviewed; b) CARNA Staff – The three CARNA staff members who support NEPAB, plus two staff

from the Office of the Registrar, were interviewed. In addition, these staff members took part in a focus group at CARNA’s offices to reflect on the past, consider the present and imagine the future of nursing education program approval in Alberta;

c) NEPAB Members – All current members of NEPAB were interviewed, plus one past public member;

d) Educational Institutions – For each of the 11 educational institutions currently offering approved nursing programs, the Deans responsible for nursing program compliance (and/or their designate) were interviewed;


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e) Nursing Employers – Four senior staff from the Alberta Health Service and two senior staff from Covenant Health were interviewed;

f) Government – Four individuals from the Ministry of Health, including the Deputy Minister, plus one individual from the Ministry of Advanced Education, were interviewed.

The purpose of the interviews was to glean information from a diverse range of perspectives, each of which is impacted in some way by CARNA’s framework for nursing education program approval. It was deemed important to obtain a 360-degree perspective on nursing education program approval and its associated issues. The information provided context for the documentation review activity described earlier, and the analysis and findings activity that is described below. The perspectives of the stakeholders formed a significant input into the future model of nursing education program approval.

In addition to the interviews, the stakeholder consultation activity included on-line surveys of three groups: 1) current 4th-year nursing students (17 respondents), 2) recent graduates from Alberta nursing education programs (86 respondents), and 3) nursing employers (45 respondents). The on-line surveys sought input regarding the perceived readiness to practice of senior students / graduates in categories relevant to the entry-to-practice competencies set by CARNA and the major areas of the NCLEX RN exam. Survey results can be found in Appendix E (comments have been edited to remove references to specific educational institutions).

6) Analysis, Findings & Commentary

Subsequent to the completion of the all the prior activities, Simplifico conducted analyses, arrived at findings and developed commentary in support of the central purpose and objective of the project. Specifically, this activity, the results of which are detailed in the next section of this report, supported the determination of recommendations for the future of nursing education program approval within CARNA, including the future for governance, structure, standards, criteria and process, and a high-level implementation plan associated with the recommendations.

7) Reporting Simplifico submitted brief bi-weekly written updates, via email, to the assigned CARNA project authority. Each update summarized the activity undertaken during the previous period, the activity anticipated for the period ahead, and any open issues or concerns regarding the project.


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A brief oral presentation was made by Simplifico to CARNA Provincial Council at their meeting on March 10, 2016, providing an overview of the project scope and methodology. This final report summarizes the methodology used in the project and captures the findings (including analysis and commentary), and recommendations related to governance, structure, standards, criteria and measures for nursing education program approval. This report also provides a high-level short-range (i.e., less than 12 months) and long-range (i.e., more than 12 months) implementation plan for the recommendations arising from the analysis, findings and commentary. Simplifico will make a formal presentation of the report to NEPAB via webinar on May 31, 2016, and to CARNA Provincial Council in person at their meeting on June 3, 2016.


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Analysis, Findings & Commentary General While CARNA has adopted the philosophy of RTR, with its risk-based approach and focus on proportionality, most of CARNA’s current regulatory processes, including the current process for nursing education program approval, were developed at a time before RTR and hence were not predicated on issues of risk. This review has been conducted through the lens of RTR and the associated Performance Review Standards relating to Education and Training, as published by the PSA. The need to identify and assess the underlying risk issues played a central role during the analysis of the information obtained in the course of the review, and in making findings. Under RTR, excellence in professional regulation is defined as a function of three things: 1) the application of good practices, 2) consistency – both in the application of those practices and in the resultant decisions arising from them, and 3) a culture that embraces continuous improvement. The processes and practices of a regulator do not need to be “excellent” in and of themselves, or reflect “best practice” or “leading practice”, so long as they are considered “good” and are applied consistently with a view to periodic review and the regulator is responsive to change where change is needed. The fact that CARNA has undertaken this independent review suggests a desire for continuous improvement and a willingness to change. Issues of good practice and consistency are discussed below. Good practice reflects fairness to the applicant, transparency of process and an appropriate level of openness of information that is made available to the public. In general, NEPAB is very well respected by those who interact with it. It is viewed as being well-organized and thorough, and as having excellent staff support. NEPAB’s composition, being made up of a mix of practitioners, employer representatives, educational institution representatives and a public representative, is seen as being key to its fairness and integrity. From the perspective of the educational institutions, the level of transparency regarding NEPAB’s processes is very high. From the perspective of most of the other stakeholders, however, there is a significant perception of opacity. Similarly, the educational institutions generally have no issue with the openness of information from NEPAB – reports arising from the approval process are seen as being comprehensive and additional information is always provided on request. For others, however, NEPAB appears very closed and guarded. Other than knowing whether an existing program is approved or not, little information is made available to someone who is not a direct party to the approval process, including to CARNA staff who are not directly supporting NEPAB. This is contrary to the standards of good regulation for education and training as found in the PSA Performance Review Standards document. NEPAB is perceived as being consistent in the application of its processes and in its decision making. Since the composition of NEPAB changes over time (members are generally appointed for a five-year term), the success in consistency is largely attributable to the CARNA staff who directly support NEPAB. Various processes have been defined, developed and implemented by


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staff over the years and their adherence to those processes is viewed by many as “rigourous”. The CARNA staff who support NEPAB exercise considerable control over the processes, which accounts for very good consistency. On the surface, there is an argument to be made that CARNA achieves regulatory excellence in relation to nursing education program approval, notwithstanding some issues of openness. However, when the RTR principle of proportionality is considered, there appear to be a number of issues and concerns. Almost everyone interviewed as part of the stakeholder consultations described the current nursing education approval process as “onerous”. Some suggested that it was onerous by necessity, given the risk issues involved, but the consensus was that it is more burdensome than it needs to be, given the context within which the university and college programs operate. It would appear that the current process does not adequately take into consideration several risk mitigation factors. These concerns will be addressed in more detail in the subsection entitled “NEPAB Process”. Similarly, another measure of a “good” regulatory process is one which includes outcome measures. How can NEPAB know if it is doing a good job? The review found that NEPAB is highly process oriented. New processes would be created to address scenarios where certain aspects of an educational program didn’t fit the traditional mould. Unfortunately, NEPAB does not focus much on outcome measures. NEPAB has no meaningful way of determining its effectiveness. As stated in the introduction, the initial results of the NCLEX RN exam in Canada were a trigger point for this review. The pass rates for the prior CNRE exam were sufficiently high as to give everyone a sense of satisfaction (arguably a false one) that the educational institutions were producing graduates with the necessary competencies. However, it would appear that the pass rate of the CNRE exam was so high as to provide no diagnostic information with respect to differentiation among education programs within Alberta. The initial NCLEX RN results indicated some level of differentiation, including disconcerting underperformance in some areas, among programs that have all been approved by NEPAB. An explanation of the initial NCLEX RN results was outside the scope of this review. It should be noted, however, that a registration exam of this type should never be the sole measure of effectiveness of education program approval. It is worth noting that, in the interviews with nursing employers, there was no perception that the graduates from one Alberta program are significantly more or less prepared for nursing practice than any another Alberta program. Similarly, the on-line surveys do not suggest deficiencies in perceived preparedness as might be inferred from the initial NCLEX RN results. The issue of outcome measures will be discussed further in the subsection entitled “NEPAB Process”. There was a general sense from nursing employers that graduates are not practice ready – especially for assignments in acute care or in rural locations where a breadth of challenges will


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be encountered. The consensus was that a recently graduated, newly minted RN will require about a year of experience before being seen as ready for unsupervised work. The underlying issues don’t relate to core nursing competencies of knowledge and skill, but relate more to a lack of sufficient practical experience and working in a team environment. This finding is tempered by the fact that in most regulated professions, newly licenced or registered practitioners are often not perceived as being fully practice ready. A professional licence is often seen as a “licence to learn” – even in professions where an internship or articling period of one to four years may be required before licensure. The fact that there is no internship or work experience requirement after completing an approved nursing education program, but before becoming licensed, is a risk issue that must be considered by CARNA both in the context of nursing education program approval and overall registration requirements. There is no single “correct” or “best” way that every regulator should be using to perform education program approval. There are many possible approaches that can achieve the desired risk mitigation and risk management objectives in an efficient manner. The spectrum runs from having no formal program approval at all – and therefore rigourously assessing knowledge and skill competencies at time of initial registration – to having a regulator approve programs in its own jurisdiction, to having approval done by some type of national body. The best approach for a particular regulator will be a function of the size of the profession, the number of educational institutions offering relevant programs, the universality of regulation of the profession across the country, and the corporate culture within the regulator. These issues will be explored further in the subsection entitled “Approach to Education Program Approval”. This review did not identify any systemic problems within the current nursing education program approval process to suggest that immediate, drastic action is required in order to maintain proper protection of the public interest. There are, however, two areas where the findings support making changes in the short term, and one area where the findings support making changes in the longer term. These are expanded upon herein. CARNA / NEPAB Relationship There is significant confusion amongst all the groups of stakeholders regarding the relationship between CARNA and NEPAB. Many erroneously believe that NEPAB is fully independent of CARNA. Others, including some on the CARNA PC and on NEPAB, erroneously believe that NEPAB operates “at arm’s length” from CARNA. The phrase “at arm’s length” relates to dealings between two parties who are not related or not on close terms and who are presumed to have equal bargaining power in a transaction and no fiduciary duties between them. This phrase is clearly inappropriate considering that NEPAB was fundamentally established through a CARNA by-law, that the CARNA PC appoints the members and approves the budget for NEPAB, and that the CARNA PC approves the standards and criteria to be used by NEPAB. NEPAB is not a separate legal entity from CARNA.


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The more correct phrase would be that there is a “Chinese wall” (or “ethical wall” or “screening mechanism”) between CARNA and NEPAB to ensure that the decisions made by NEPAB are free from any influence by CARNA. Having such a screening mechanism is completely appropriate as long as it is applied solely in the context of the consideration and decision making with respect to program approvals. It should not be used to prevent a thorough understanding of policies and processes. Unfortunately, the confusion about the relationship between CARNA and NEPAB has been exacerbated by two things. First, the CARNA PC has obviated its responsibility and accountability with regard to nursing education program approval. This became very evident during the interviews with the members of the CARNA PC wherein everyone was asked to rate their level of awareness of the current process for nursing education program approval on a scale of zero to five (with zero indicating “not at all aware” and five indicating “intimately aware of the details”). The mean rating was 2.1 (the median was 2.0). Individual ratings ranged from 0.5 to 4.0. On two separate occasions, a CARNA PC member changed their rating by the end of the interview, going from a higher number to a much lower number. It was apparent that the issues discussed during the interview revealed the individual’s lack of awareness of the current process. This level of awareness is much too low for a body that has the ultimate accountability and responsibility for the process. There is no problem with the CARNA PC trusting NEPAB, but the CARNA PC needs a higher level of awareness and it needs to occasionally verify that things are happening the way they are supposed to be happening. At present, the CARNA PC receives an annual report from NEPAB, including a short written document and a brief presentation at a meeting. This level of reporting can best be described as perfunctory. It is very high-level with no meaningful content that would allow the CARNA PC to assess how well things are working. The annual report does not assist the CARNA PC in fulfilling any sort of accountability requirement. The by-law that establishes and defines NEPAB includes a requirement for an annual report, but does not specify what is to be included in that report. The second major contributor to the confused relationship between CARNA and NEPAB is NEPAB’s broad interpretation of its confidentiality obligations under the by-law. Part of the problem is the wording of the confidentiality provisions, which were cut and pasted from the confidentiality provisions applying to the tribunals within CARNA. NEPAB is not a tribunal and does not handle personal, private information. The need for a tribunal to protect the personal information of an applicant or an RN facing allegations is understood – especially when the tribunal oversees an adversarial process to which CARNA is a party. That is not the case for NEPAB. NEPAB handles institutional information and CARNA is not a party to its process. CARNA staff report that information held by NEPAB is required for their regulatory role, yet it cannot be obtained because of NEPAB’s interpretation of its confidentiality provisions. All CARNA staff and CARNA PC members are subject to overarching confidentiality provisions and therefore there does not appear to be a public interest risk basis for non-disclosure within CARNA.


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In summary, there is a major disconnect between CARNA and NEPAB. This stems from issues of governance, as defined in the Bylaws, and from a “hands off” approach taken by the CARNA PC. There do not appear to be any issues with respect to the composition of NEPAB. Its diverse composition is seen as a strength and a source of confidence and integrity for those on the outside. Certain aspects of the Bylaws dealing with the appointment of NEPAB members could be tightened to give the CARNA PC a more active role in the selection of NEPAB members, and thereby more opportunity for demonstrating accountability. NEPAB Process As previously noted, the current nursing education program approval process has been described almost universally as “onerous”. It was further described by many as “time-consuming”, “labour intensive” and “expensive”. While participants in the program understand the need for rigour, there was consensus that the current approach is somewhat heavy-handed and not reflective of any consideration of real risk issues. It would appear that the objective of the current process is to ensure, beyond a shadow of a doubt, that a given nursing education program meets the established Standards and Criteria (S&C). As a result, efficiencies appear to be sacrificed to guarantee effectiveness. This would suggest that the “law of diminishing returns” is at work. It is important to understand that under RTR, the risk associated with a regulatory issue can never be completely eliminated, it can only be mitigated and managed. So let us assume that a level of effort of “1.0x” results in 80% of the risk being mitigated. If we increase the level of effort to 1.25x, we might only see 90% of the risk being mitigated. A further increase in effort to 1.5x might get us to 95%. Each incremental increase in effort will result in lower additional amount of risk being mitigated. At some point, the regulator has to say “it’s good enough”. The costs associated with any additional effort will ultimately outweigh the incremental risk reduction. This attitude and approach is not inconsistent with CARNA’s mandate to regulate in the public interest, and reflects the RTR principle of proportionality. Contributing to this problem are the S&C’s themselves. There are four Standards and a total of 36 Criteria under the Standards. According to NEPAB, in order for a Standard to be “met”, all of the underlying Criteria must be “met”. Ostensibly, the S&C’s were developed to ensure that education programs created graduates who would meet the entry-to-practice competencies established by CARNA. However, an examination of the S&C’s reveals that the connection between them and the competencies is, in many cases, nebulous. While three of the four Standards make direct reference to the competencies, the specific Criteria relating to a standard are sometimes vague, representing high-level motherhood statements. In other places, they are specific to the point of being prescriptive. Goods standards and criteria need to be specific, measurable, achievable, realistic and relevant.


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The other principal critique of the current NEPAB process is that it does not take into consideration other risk-mitigating aspects of the overall framework within which the educational institutes operate. One example is the existence of the Canadian Association of Schools of Nursing (CASN) and its accreditation of nursing education programs. All of the 11 educational institutions that have NEPAB-approved education programs are members of CASN and seven of them have programs that are currently accredited by CASN. Nonetheless, CASN accreditation means nothing in the context of NEPAB’s approval process. The educational institutions reported that there is a significant overlap in the information requested by NEPAB for its approval process and that requested by CASN for its accreditation process. NEPAB’s response to this is to say “accreditation is not the same as approval”, and they are correct. However, it is hard to imagine that a CASN-accredited education program presents just as much risk as one which is not CASN-accredited. Time and effort could be saved if the S&C’s (and/or the processes) applied to a CASN-accredited program were a subset of those used for a non-CASN-accredited program, with no corresponding increase in risk. Similarly, post-secondary education programs in Alberta are subject to the Campus Alberta Quality Council (CAQC), a quality assurance agency that makes recommendations to the Minister of Advanced Education on applications from post-secondary institutions seeking to offer new degree programs in Alberta. Virtually all degree programs offered in Alberta must be approved by the Minister. The CAQC also conducts periodic evaluations of approved degree programs to ensure that quality standards continue to be met. The opportunities for synergy between NEPAB and CAQC are plentiful, but NEPAB continues to operate as if CAQC doesn’t exist, other than engaging in a chicken-and-egg game regarding new nursing education programs where one group will only approve the program if the other is going to do so as well (with both going through their independent processes). A secondary concern expressed about the current NEPAB process is that all re-approvals appear to be treated the same, with no consideration of relative risk issues. For example, a new program first approved five years ago goes through the same re-approval process as one that has been in place for 30+ years and has had repeated successful re-approvals since NEPAB was formed. Similarly, the re-approval period is fixed at five years (assuming no significant changes to a program have taken place in the interim) with no consideration of relative risk issues. The majority of the stakeholders interviewed indicated that the re-approval period (and/or the re-approval process) should be a function of risk issues relevant to the program in question. As noted in the “General” subsection above, NEPAB is highly focused on process, with little, if any, consideration of outcomes. While there was no evidence identified to suggest that any existing nursing education program is deficient nor to suggest that there are systemic problems with the current process in terms of achieving its objective, the fact remains that NEPAB has no reliable means of determining its own effectiveness. Interestingly, some of the S&C’s used by NEPAB require an education program to undertake outcome measures (e.g., consideration of registration examination results, evaluations by employers and self-evaluations by graduates), yet NEPAB does not undertake such a breadth of actions itself.


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It is a credit to both CARNA and NEPAB that the CARNA staff assigned to directly support NEPAB are so well regarded. They are viewed as being highly knowledgeable and very willing to provide explanations and additional information when asked. They have a reputation for responding promptly and thoroughly to inquiries. They are stalwart gatekeepers of the approval process and they ensure that NEPAB has all of the necessary information required to make a decision regarding the approval of a nursing education program. While a couple of the educational institutions observed that they would sometimes get slightly different answers to the same question depending on which staff person they spoke to, there is no doubt that the knowledge and experience of the assigned staff members contributes to the solidly consistent application of the approval process. As noted earlier, NEPAB members generally serve a five-year term and appointments are designed to be staggered so as to maintain a balance of experienced versus new members. Due to unforeseeable circumstances, the current composition of NEPAB includes a majority of members with less than two years of service. The current median length of service is only 1.5 years. While this is less than ideal, any associated risks are mitigated by virtue of the knowledge and long experience of the CARNA staff assigned to support NEPAB. Current NEPAB members rely on the staff as the “corporate memory” of NEPAB. While this is a good thing, and ultimately necessary, it does represent a risk issue at the moment because the significant majority of that corporate memory rests with one individual – a staff member who has been supporting NEPAB for almost as long as it has existed. Should that staff member retire or leave, there would no doubt be an adverse impact on the efficiency, and possibly the effectiveness, of NEPAB. This problem is exacerbated by the siloed nature of NEPAB within CARNA and the overzealous interpretation of the confidentiality provisions of the Bylaws. Approach to Education Program Approval As discussed earlier, there is no single “right” way for a regulator to address education program approval. However, the approach currently being used by CARNA is among the most labour intensive and inefficient of the options available. Consider the following:

1) Nursing is regulated in every province across Canada; 2) Entry-to-practice competencies are consistent across nursing regulators in Canada; 3) Nursing schools exist in every province across Canada; 4) In terms of the number of regulated professionals, nursing is at or very near the top in

every province across Canada; and 5) All of the other regulated professions in Canada that have large numbers of

practitioners use a national-level organization to undertake education program approval, including those professions that do not have relevant educational institutions in every province.


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Given that Canadian nursing regulators long ago embraced the notion of a national registration examination, it is difficult to understand why they have not similarly embraced the notion of a national organization to evaluate and approve nursing education programs within Canada. While establishing such a national organization from a blank sheet of paper may seem daunting, it would not require CARNA to “reinvent the wheel” as there are numerous models of national-level education program approval to use for reference (e.g., engineering, law, medicine, pharmacy). While it is unlikely that one of those models could be copied without modification, elements of the various frameworks could be selected to save significant development time and effort. Evidence from the environmental scan and the stakeholder consultations would suggest that the time is ripe for the establishment of a Canadian national nursing education program approval body. Moving forward on this activity is something that falls squarely within the wheelhouse of the Canadian Council of Registered Nurse Regulators (CCRNR), a body of which CARNA is a member. The existence of CASN may also mitigate the time and effort required to establish a national nursing education program approval body. It was noted earlier that the existence of CASN represents a factor in risk mitigation with respect to the nursing education programs that it has accredited, and that NEPAB’s approach to approval / re-approval should be different for those programs as compared to non-CASN-accredited programs. However, CASN, as it is currently constituted, should not serve as the national nursing education program approval body recognized by the nursing regulators across Canada. There are two reasons for this: First, as noted by many during the stakeholder consultations, “CASN accreditation” is not the same as “NEPAB approval”. CASN’s accreditation focus is on excellence in nursing education and scholarship, not specifically on ensuring that the graduates possess the entry-to-practice competencies agreed amongst the Canadian nursing regulators. Second, CASN’s present membership and governance is made up solely of representatives of the nursing schools. Its stated mission includes elements of advocacy on behalf of the nursing schools. This would create an apprehension of bias in the approval process. A national education program approval body must, as is the case with the individual regulatory bodies, regard the public interest as paramount. Its composition and governance must reflect a range of stakeholders. This is not to say that CASN has no role in the formulation of a national education program approval body. Indeed, it is difficult to envision a future where both CASN and a national education program approval body exist simultaneously. The amount of overlap between the two organizations would be substantial and be viewed as wasteful. At the end of the day, however, “approval” would be viewed as mandatory if a nursing education program wants to attract students, but “accreditation” would be viewed as optional. Even if CCRNR was to decide later this year that it would undertake a project to establish a national education program approval body, it would likely take several years before such a body


16

would be up and running. Based on this review, there is no evidence to suggest that CARNA needs to move to any other model of education program approval in the meantime. By addressing the concerns identified herein with respect to the CARNA / NEPAB relationship and the NEPAB Process, the current model can serve the public interest and reflect the standards of good regulation as described in the PSA’s Performance Review Standards for Education and Training.


17

Recommendations CARNA / NEPAB Relationship

1) Revise Part VIII of the CARNA Bylaws to address the issues and concerns associated with the current lack of clarity regarding the relationship between CARNA and NEPAB, specifically addressing the following:

a. Roles b. Responsibilities c. Accountability d. Confidentiality e. Openness and Transparency f. Reporting.

Appendix F contains a first draft of suggested revisions to the CARNA Bylaws (in both revision control and clean formats) that would begin to address these issues.

2) Review the current staffing model for CARNA staff supporting NEPAB to reduce the reliance on one or two individuals as the “corporate memory” of NEPAB.

NEPAB Process

3) Conduct a comprehensive review and re-drafting of the Standards and Criteria used by NEPAB as the foundation for its approval / re-approval of nursing education programs. The revised Standards and Criteria must be:

a. Specific b. Measurable (objective measures are preferred, subjective measures may be

acceptable in some circumstances) c. Achievable d. Realistic e. Relevant to the entry-to-practice competencies identified by CARNA.

The review and re-drafting should be undertaken by a group made up of select NEPAB members, CARNA PC members and CARNA staff. The review and re-drafting process should also include consultation with stakeholder groups including the educational institutions, employers and government. The group should consider whether separate sets of Standards and Criteria should be developed for initial program approval versus re-approval. Consistent with the Bylaws, any revised Standards and Criteria will have to be approved by the CARNA PC.

4) Modify NEPAB processes (i.e., add, change, delete) to reflect the re-drafted Standards

and Criteria and to reflect known factors of risk mitigation and risk aggravation, including but not limited to:


18

a. Whether an education program is accredited by CASN; b. Whether an education program was recently approved or reviewed by CAQC; c. How long the education program has been in existence and its history with

respect to change and quality assurance;

5) Modify NEPAB polices and processes to make the re-approval period a function of relevant risk issues.

6) Establish outcome measures for NEPAB reflecting multiple inputs and perspectives. Approach to Education Program Approval

7) Move to a national-level system of nursing education program approval. Options include:

a. Have CCRNR work in concert with CASN to modify its accreditation process (and its governance) to create an approval process acceptable to CCRNR; or

b. Have CCRNR establish its own national nursing program approval body and process.

8) Maintain the current model of nursing education program approval (as modified by

recommendations #1 through #6) until such time as an acceptable national-level system is up and running.


19

Implementation Action Plan Short Term (within 12 months)

1) Immediately form a task group, consisting of two CARNA PC members and two NEPAB members, to review the draft revised Bylaws in Appendix F and propose a final revised version for consideration and adoption by the CARNA PC at their September 2016 meeting.

2) Immediately form a task group made up of select NEPAB members, CARNA PC members and CARNA staff to undertake a comprehensive review and re-drafting of the Standards and Criteria used by NEPAB as the foundation for its approval / re-approval of nursing education programs. This group will consult with stakeholders, consider risk issues and present updated Standards and Criteria to the CARNA PC for approval at its March 2017 meeting.

3) CARNA staff to review and assess the staffing model re: NEPAB support, and implement any changes deemed necessary once the revised Bylaws have been adopted.

4) One the revised Bylaws have been adopted, form another task group, made up of CARNA PC members, NEPAB members and CARNA staff, to research, develop and implement various outcome measures for NEPAB. First reporting to CARNA PC on the new outcome measures to be at the March 2017 meeting.

5) NEPAB to modify its processes to reflect the re-drafted Standards and Criteria and to

reflect known factors of risk mitigation and risk aggravation (as per Recommendations #4 and #5). The modified processes to be in place and applied to any program approval / re-approval commencing in or after June 2017.

6) Consult with the other larger nursing regulators in Canada to spearhead a motion for

CCRNR to establish a national-level body for nursing education program approval.

Long Term (longer than 12 months)

1) Offer and provide support for any and all CCRNR efforts to establish a national-level body for nursing education program approval. CARNA should be seen as a champion for the cause.

2) Once a national-level body is in place, modify the Registered Nurses Profession Regulation and CARNA’s registration process to recognize all nursing education programs approved by the national-level body. Stand down NEPAB.


20

List of Appendices Appendix A – PSA Performance Review Standards – Education and Training Appendix B – List of Organizations Researched and Contacted for the Environmental Scan Appendix C – Literature Review Summaries Appendix D – Stakeholder Consultation List Appendix E – Results of On-Line Surveys E.1 – Employers E.2 – Recent Graduates E.3 – 4th-Year Students Appendix F – Draft Revision to Part VIII of CARNA Bylaws F.1 – Revision Control Version F.2 – Clean Version

The Performance Review Standards Standards of Good Regulation

June 2010

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Appendix A - PSA Performance Review Standards - Education and Training

The Standards of Good Regulation document has been updated in light of the changes brought about by the Health and Social Care Act 2012.

4. Section 3: Education and Training

Introduction

4.1 The regulator has a role in ensuring that students and trainees obtain the required skills and knowledge to be safe and effective. They also have a role in ensuring that, once registered, registrants remain up-to-date with evolving practices and continue to develop as professionals.

4.2 As part of this work, the regulators quality assure and, where appropriate, approve educational programmes which students must complete in order to be registered. Some also approve programmes for those already on the register who are undertaking continuing professional development, a particular qualification or specialist training.

The standards of good regulation relating to education and training

1. Standards for education and training are linked to standards for registrants. They prioritise patient and service user safety and patient and service user centred care. The process for reviewing or developing standards for education and training should incorporate the views and experiences of key stakeholders, external events and the learning from the quality assurance process

2. Through the regulator’s continuing professional development/revalidation systems, registrants maintain the standards required to stay fit to practise

3. The process for quality assuring education programmes is proportionate and takes account of the views of patients, service users, students and trainees. It is also focused on ensuring the education providers can develop students and trainees so that they meet the regulator’s standards for registration

4. Action is taken if the quality assurance process identifies concerns about education and training establishments

5. Information on approved programmes and the approval process is publicly available.

How does good regulation through education and training promote and protect the health, safety and well-being of patients, service users and other members of the public and maintain public confidence in the profession?

Assures the public that those who are registered have and/or continue to meet the regulator’s standards

Assures the public that those providing education and training to students, trainees and registrants give them the required skills and knowledge so that they can practise safely and effectively

Effective stakeholder involvement in the education and training process increases everyone’s trust, confidence and knowledge of health professional and social work regulation.

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What evidence could be provided?

4.3 We need to know:

How the regulators have met the Standards of Good Regulation

How they have evaluated the impact of their work in this area.

4.4 The following evidence could be provided:

The standards to be met by students and how they link to the standards of competence and conduct for registrants

Where available, evidence of the regulator’s mechanisms, which enable them to be aware of action taken by training establishments against students on fitness to practise issues and a system for learning from these outcomes, for example, are outcomes taken into account in the quality assurance process and revision of standards

The standards to be met by education and training providers, how these reflect patient and service user centred care and protect the public, and how they link to standards of competence and conduct for registrants

Guidance given to education and training establishments to help ensure that disabled students do not face unnecessary barriers to successful careers in health

The plans for reviewing or developing standards for students and education and training providers, including what stakeholders were approached, how their views and experiences and other areas of learning are taken into account. The outcomes of this work and how the learning from this work is used within and outside of the education function

Details of the monitoring and approval processes for the education and training providers including how the views and experiences of stakeholders and other quality assuring bodies are taken into account

Details of how many assessments were undertaken, how many concerns were identified through the quality assurance process and what action was taken to address these concerns

Details of how stakeholders can access the regulator’s final assessments of education and training providers and the regulator’s approval process. For example, through publication on its website

Details of the regulator’s revalidation proposals

Details of how the regulator ensures that continuing professional development is targeted towards the registrant developing their skills and knowledge in their areas of practice and that public protection is prioritised. For example, how many audits were carried out, were issues identified and how were these addressed?

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The mechanisms used by the regulator to assess how they are performing andhow they use the results to improve their practices.

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Appendix B – List of Organizations Researched and Contacted for the Environmental Scan

Alberta College of Optometrists

Alberta College of Pharmacists

Association of Professional Engineers and Geoscientists of Alberta

Canadian Association of Schools of Nursing

College of Nurses of Ontario

College of Physical Therapists of British Columbia

College of Registered Dental Hygienists of Alberta

College of Registered Nurses of British Columbia

Law Society of Alberta

Texas Board of Nursing

Appendix C – Literature Review Summaries

C - 1

Journal of Nursing Regulation

Volume 2 / Issue 1 – April 2011 Challenges for Boards of Nursing with Multiple New Nursing Program Applications Tish Smyer, DNSc, RN, CNE, and Roseann Colosimo, PhD, RN This article discusses the dramatic increase in the number of nursing schools in the state of Nevada and the challenges faced by their board of nursing (BON) to approve these new programs. Although these nursing programs began opening to alleviate the nursing shortage, they are now opening in the face of faculty shortages, clinical placement shortages, and a severe downturn in the economy causing state budget deficits and cuts. Nevada mandates national nursing accreditation from the National League for Nursing Accrediting Council or the Commission on Collegiate Nursing Education, which the BON believes enhances and strengthens the quality of Nevada’s nursing programs. The article includes the strategies used, the lessons learned, and recommendations on how other BONs can ensure the quality of nursing programs and protect the health, safety, and welfare of the public.

Volume 2 / Issue 4 – January 2012 Program Approval: Minnesota’s Case for an Accreditation Requirement Ann Jones, PhD, RN; Jane Foote, EdD(c), MS, RN; and Sharon Ridgeway, PhD, RN Efforts to increase the number of accredited programs for practical nursing and associate-degree nursing and efforts to improve the board of nursing rules for approving education programs led to a requirement that all programs in Minnesota must obtain national accreditation. This article describes the two distinct processes that produced this significant change.

Volume 3 / Issue 4 – January 2013 A Collaborative Model for Approval of Prelicensure Nursing Programs Nancy Spector, PhD, RN, and Susan L. Woods, PhD, RN, FAAN Currently, boards of nursing (BONs) use seven different models for approving nursing programs, and nursing education rules and regulations in BONs are not consistent across jurisdictions. In 2010, the National Council of State Boards of Nursing’s (NCSBN) Board of Directors convened a committee to assess the state of prelicensure nursing program approval in BONs and to make recommendations to the NCSBN’s board based on current and future needs. This article describes the committee’s collaborative engagement with national accreditors and the recommendations that resulted.

Volume 4 / Issue 4 – January 2014 National Accreditation as a Criterion for Ongoing Approval of Education Programs Janice I. Hooper, PhD, RN, FRE, and Mary Beth Thomas, PhD, RN, FAAN State boards of nursing (BONs) are evaluating the role of national nursing accrediting agencies in the ongoing approval of nursing education programs. In 2007, the Texas legislature required the Texas BON to conduct such an evaluation. The statute directed the BON to select one or more national nursing accrediting agencies with standards acceptable and equivalent to the BON's standards. To determine equivalency, the BON staff compared BON rules with accreditation standards. After a careful analysis, the BON staff concluded that generally many areas were comparable. Consequently, the BON approved a model in which nursing programs accredited by a national nursing accrediting agency are exempt from BON education rules except for those related to public safety. This research project examined the

Appendix C – Literature Review Summaries

C - 2

perceived satisfaction among nationally accredited nursing programs with the model that accepts nursing accreditation as a criterion for ongoing program approval while the BON monitors requirements related to public safety.

Volume 6 / Issue 2 – July 2015 Nursing Education Program Evaluations: Onsite Visits vs. Document-Only Reviews Crystal Tillman, DNP, RN, CPNP The North Carolina Board of Nursing (BON) compared two approaches to nursing education program evaluation: the existing approach using onsite visits and a new approach using documents only. The project involved using a newly designed evaluation tool to assess seven prelicensure programs using both approaches and then comparing the findings. The results led the BON to adopt the document-only approach at a substantial cost savings without jeopardizing program quality.

Appendix D – Stakeholder Consultation List

D - 1

CARNA Provincial Council (In-person or Telephone Interviews)

Shannon Spenceley (President) Jerry Macdonald (Pres.-Elect)

Tracy Humphrey Jeannie Hare

Alison Landreville Derrick Cleaver

Wendy Carey Elva Hammarstrand

Amie Kerber Andria Marin

Tyler Burley Christine Davies

Penny Kwasny Doug Romaniuk

Elaine Andrews George Epp

Marlene Pedrick

CARNA Staff (In-person Interviews plus Focus Group)

Cathy Giblin Lori Kashuba

Margareth Mauro Darlene Niederhaus

Debra Allen

NEPAB Members (In-person or Telephone Interviews)

Cydnee Seneviratne Dianne MacGregor

Jerard McKenna Safiya Nanji

Tracy Oosterbroek Barbara Roemer

Heather Richardson Melanie Snider

Doug Fletcher (former public member)

Educational Institutions (In-person or Telephone Interviews)

Athabasca University – Margaret Edwards, Dean, Faculty of Health Disciplines

Grande Prairie Regional College – Shirley Pasieka, Dean, School of Health, Wellness & Career

Studies, plus Deena Honan, Chair, Department of Nursing Education

MacEwan University – Christie Raymond-Seniuk, Acting Associate Dean, Nursing Programs

Keyano College – Vincella Thompson, Dean, School of Health, Wellness & Human Services

Lethbridge College – Debra Bardock, Dean, Centre for Health and Wellness

Medicine Hat College – Elizabeth Pennefather-O’Brien, Interim Dean, Division of Science & Health

Appendix D – Stakeholder Consultation List

D - 2

Mount Royal University – Dr. Pam Nordstrom, Director of School of Nursing & Midwifery

Red Deer College – Linda Moore Martin, Dean, School of Health Sciences, plus Jennifer Cross,

Associate Dean for Nursing

University of Alberta – Anita Molzahn, Dean, Faculty of Nursing

University of Calgary – Dianne Tapp, Dean, Faculty of Nursing

University of Lethbridge – Christopher Hosgood, Dean, Faculty of Health Sciences

Nursing Employers (Telephone Interviews and On-line Survey)

Alberta Health Service

Carol Anderson, Executive Director for Continuing Care, Edmonton Zone

Janice Stewart, Senior Operating Officer, Peter Lougheed Centre

Cathy McDonald, Senior Operating Officer, Central Zone South

Sean Chilton, Chief Zone Officer, South

Covenant Health

Jo Ann Molloy, Senior Director of Operations, EGCCC

Cindy Mulherin, Senior Director of Operations, Rural Acute Care

NB: On-line survey was sent to a broader range of individuals within AHS and Covenant Health (45

responses received).

Ministry Staff (In-person or Telephone Interviews)

Ministry of Health

Carl Amrhein, Deputy Minister

Anita Paras, Director, HHR Applied Research and Education

Valerie Grdisa, Senior Nursing Advisor

Shawn Knight, Acting Executive Director, Health Human Resources

Ministry of Advanced Education

Laura Schneider, Manager Health Programs, Post-Secondary Branch

On-Line Surveys of:

4th-Year Nursing Students in Alberta: 17 responses received

Recent Graduates from Alberta Nursing Programs: 86 responses received

Appendix E.1 – Results of On-Line Survey of Employers

E.1 - 1

NEPAB survey: Employers (Completion rate: 55.7%)

How ready are new nursing graduates in terms of their knowledge and awareness of the professional responsibilities and accountabilities of an RN?

Completely ready 0.0% 0

Mostly ready 42.2% 19

Somewhat ready 37.8% 17

Not very ready 13.3% 6

Not at all ready 6.7% 3

Don’t know/not sure /no opinion 0.0% 0

Total Responses 45

Comments

1. Appear to lack confidence in leadership roles and responsibilites

2. They are book smart but are not practically ready or ready with what the needs of the patients and the other staff on the floor need

3. Often lack of accountability for their actions is an issue. Despite the employer having policies, procedures, guidelines available the employee does not take ownership of their decisions.

4. My expectation is that they would not be "completely" ready - that would be unrealistic and I accept that the employer has a responsibility to support new graduates in the practice setting - I ma a very high level of confidence in the graduates from Alberta nursing education programs

5. there is a degree of variability from person to person and it can also be noticed between programs they come from but overall mostly ready

6. There is little demonstration of the reality of practice in a clinical environment. More and more educational institutions are relying on the employer to provide basic education as part of clinical orientation.

7. This survey may be skewed because i tend to hire only new grads who have done their final focus on my unit. Often they have also done a 3rd year clinical session here. So they are miles ahead of a new grad who has no experience on my units.

8. Some maybe aware of their responsibilities, but not neccasrily applying it to practice

9. They do not take professional responsibility and accountability seriously at all - they feel a sense of entitlement as new grads that responsibility & accountability is assumed, not earned.


E.1 - 2

How ready are new nursing graduates in terms of their knowledge and skills related to ongoing comprehensive patient assessment?







Total Responses 45

Comments

1. Lacking in "hands on" patient procedures. Many simulation labs which teach processbut not as critical as hands on

2. DEPENDS ON CLINICAL HOURS DURING PRACTICUMS

3. Appears to require additional training in terms of reviewing laboratory critical thinking skills

4. they again have book knowledge but havent' practiced on patients enough nor do they know the subtle things to look for

5. Context based learning is only as good as the weakest student. Often the response when asked to perform a duty which may be basic nursing care or care for a specific condition is I did not learn about that at school.

6. If they have done their final practicum in the unit, it is very helpful.


8. great at doing initial assessments but not always on the need for ongoing assessments based on findings

9. This is limited by the clinical exposure and hours of clinical rotations.

10. They rarely engage in head to toe or focused assessments without being prompted to do so. They focus on treating the one concern (e.g. fever with Tylenol) than the underlying cause or person's needs.


E.1 - 3

How ready are new nursing graduates in terms of their knowledge of health-care planning?







Total Responses 44

Comments

1. Care planning is always a challenge to ensrue done accurately and captures what the client directive is. Need to be more client focus versus compliance focus

2. as ready as they can be. this takes experience and differs so much between areas of our health care system.


4. generally have a basic understanding but often reluctant to actually take on the role of doing planning

5. Students are provided very limited exposure to the continuum of care and the patient /care provider roles as they move through

6. Less than novice knowledge. When I graduated in 2006 this level of knowledge of health-care planning would have been unacceptable. They are are completely unaware of community resources and options available and do not inquire or offer such.


E.1 - 4

How ready are new nursing graduates in terms of their general knowledge and skills in providing nursing care?







Total Responses 45

Comments

1. Varies per department such as oncology-maternity


3. have the skills & knowledge but time management in terms of taking care of mutltiple patients can be a factor

4. Further clinical experience and exposure is needed

5. The knowledge is mmostly there, it's a matter of applyin git to practice

6. All of my recent interviews of new graduates identified that graduates lack critical thinking and did not even know what the nursing process was from assessment to evaluation!


E.1 - 5

How ready are new nursing graduates in terms of their knowledge and skills related to the evaluation of patient care?







Total Responses 45

Comments

1. This would be part of basic nursing process however noticing MDS training of outcome scores is lacking.


3. most can relate assessment to evalutate pt care but many also need coaching with this. Not sure if this is a knowledge deficit or a confidence issue. i suspect the altter.

4. This will align with established indicators to measure and increased clinical exposure

5. There doesn't seem to be a real drive to care plan for their patients- they seem to want to leave that to the Charge RN or rest of multi-disciplinary team

6. I don't feel that patients are safe in the care of new graduates with or without supervision - they don't come well prepared at all.


E.1 - 6

How ready are new nursing graduates in terms of their knowledge and judgment related to ethical nursing practices?







Total Responses 45

Comments

1. Ethics remains a challenge for everyone

2. A challenge is presented in LTC, especially with younger residents

3. this takes experience and differs between areas greatly. Typically new grads are very "text book" and learn to be more patient specific as time goes on.


5. Theoretically prepared but limited practical exposure

6. They don't have enough of a foundation to know what is ethical, and what is not nor how to stand up to unethical practices. If a more senior person is telling them that an unethical practice is ethical, they will proceed without even questioning it.


E.1 - 7

How ready are new nursing graduates in terms of their knowledge about RN duties to the public?







Total Responses 45

Comments

1. Need to improve greeting everyone/public with respect once they are in our establishment

2. Too much face book and social media comments about workplace and residents.


4. i think most are ready but many have difficutly articulating this

5. They rarely know their scope of practice and that their duty is to person-centered care not arguing & calling residents or families "non-compliant" or "unreasonable" when really they are simply in vulnerable positions being in care.


E.1 - 8

How ready are new nursing graduates in terms of their knowledge and skills related to management of care?







Total Responses 44

Comments

1. A challenge in LTC for most graduates

2. Don't know conditions or treatments. Learn on the job when they should have the knowledge already.


4. as above re: care planning

5. They struggle greatly in this area, especially in terms of prioritization. They are so task oriented the patient with an oxygen saturation of 72% is treated last because they are in room 106 and the nurse was starting at room 100 to go in order and started with the patient with a blood sugar of 5.7, family at bedside, and watching tv.


E.1 - 9

How ready are new nursing graduates in terms of their knowledge and skills related to safety and control of infection?







Total Responses 45

Comments


2. many still struggle with donning & doffing of isolatino PPE but not really any moer than the regular staff on teh Unit

3. PPE & hand hygiene is rare at best.


E.1 - 10

How ready are new nursing graduates in terms of their knowledge and skills related to health promotion and maintenance?







Total Responses 45

Comments

1. Classes seem to be more focused on prevention of disease than treatment.


3. Theoretically prepared but rarely prepared for clients who are not compliant or in agreement

4. this tends to be a focus of the education program as apposed to managing the acutely ill patient

5. Focus is on symptom management not health promotion or illness prevention. If the person has no active symptoms, there is nothing to be done with them or for them.


E.1 - 11

How ready are new nursing graduates in terms of their knowledge and skills related to psychosocial integrity?







Total Responses 45

Comments

1. May want to consider defining this term for future surveys

2. Again, this in in reference to LTC


4. Their sense of entitlement to be a nurse and the associated respect as opposed to earning such status and respect overshadows any potential for psychosocial integrity.


E.1 - 12

How ready are new nursing graduate in terms of their knowledge and skills related to basic care and comfort?







Total Responses 44

Comments

1. Basic care and comfort does not seem to be a focus in classes. New graduates have indicated that other health providers provide this portion of care.

2. I feel that many of the new graduates are able to chart etc. very well but have very little hands on nursing skills and/or the desire to perform them. This often depends on where they did their practicums and if they worked during the summers.


4. Some are great where as some think that the NA will provide all basic comfort and care to the patient

5. Some are really great at providing holistic care while others tend to focus on the "tasks" rather than caring for the patient

6. They treat the patients as a checklist with items to be checked off; rarely is a patient asked if they are comfortable, require anything further, or placing call bells in reach. If there is a nursing aide present, basic care is below them and their ability whereby a patient will be made 20 minutes to toilet for the nursing aide to assist while the RN completes mid-day charting or goes for break. It is unacceptable.


E.1 - 13

How ready are new nursing graduates in terms of their knowledge and skills related to pharmacological and parenteral therapies?







Total Responses 45

Comments

1. They do know how to access resources when unsure.

2. Don't know the condition, or the treatments of the same.


4. Reliance on memory limits ability of students to willingly look up info or seek out a second resource to ensure safety first

5. There is quite a difference in the knowledge and skills of new grads. I don't think they can all be lumped together like this.

6. It is more important to new graduates to get the task complete than to actually understand what they are giving & what it is for. Not a single recent graduate has known all of the medications they are giving immediately prior to administration, but rather state "it is the patient's ordered medication" as an acceptable response.


E.1 - 14

How ready are new nursing graduates in terms of their knowledge and skills related to reduction of risk potential?







Total Responses 45

Comments


2. Lack of insight in this area on part of new grads.

How ready are new nursing graduate in terms of their knowledge and skills related to physiological adaptation?







Total Responses 45

Comments


2. They are unaware completely of what this means & entails.


E.1 - 15

Are you an RN?

Yes 93.0% 40

No 7.0% 3

Total Responses 43

What is the work setting for the RNs under your area of responsibility? Select all that apply:

Primary care facility 41.9% 18

Secondary care facility 7.0% 3

Tertiary care facility 20.9% 9

Community care 16.3% 7

Other, please specify: 16.3% 7

Total Responses 43

Other, please specify:

1. Ambulatory care

2. LTC - young adults to seniors

3. Continuing care now. Have managed from ICU to obstetrics, OR and surgery in recent years.

4. Long Term Care

5. community hospital in a city

6. Continuing Care

7. Continuing Care

Appendix E.2 – Results of On-Line Survey of Recent Graduates

E.2 - 1

NEPAB survey: Recent graduates

Which university or college did you attend?

Athabasca University 2.3% 2

Grande Prairie Regional College 2.3% 2

Keyano College 0.0% 0

Lethbridge College 0.0% 0

MacEwan University 11.6% 10

Medicine Hat College 5.8% 5

Mount Royal University 20.9% 18

Red Deer College 12.8% 11

University of Alberta 22.1% 19

University of Calgary 17.4% 15

University of Lethbridge 4.7% 4

Total responses 86

Prior to graduating from your program, were you aware of CARNA and its mandate?

Yes 52.3% 45

Somewhat 37.2% 32

No 10.5% 9

Total responses 86

How ready did you feel to begin practice as an RN in terms of your knowledge and awareness of the professional responsibilities and accountabilities of an RN?







Total responses 75


E.2 - 2

How ready did you feel to begin practice as an RN in terms of your knowledge and skills related to ongoing comprehensive patient assessment?







Total responses 75

How ready did you feel to begin practice as an RN in terms of your knowledge of health-care planning?







Total responses 75

How ready did you feel to begin practice as an RN in terms of your general knowledge and skills in providing nursing care?







Total responses 75


E.2 - 3

How ready did you feel to begin practice as an RN in terms of your knowledge and skills related to the evaluation of patient care?







Total responses 75

How ready did you feel to begin practice as an RN in terms of your knowledge and judgment related to ethical nursing practice?







Total responses 74

How ready did you feel to begin practice as an RN in terms of your knowledge about RN duties to the public?







Total responses 74


E.2 - 4

How ready did you feel to begin practice as an RN in terms of your knowledge of the self-regulatory framework governing the nursing profession?







Total responses 75

How ready did you feel to begin practice as an RN in terms of your knowledge and skills related to management of care?







Total responses 75

How ready did you feel to begin practice as an RN in terms of your knowledge and skills related to safety and control of infection?







Total responses 75


E.2 - 5

How ready did you feel to begin practice as an RN in terms of your knowledge and skills related to health promotion and maintenance?







Total responses 75

How ready did you feel to begin practice as an RN in terms of your knowledge and skills related to psychosocial integrity?







Total responses 75

How ready did you feel to begin practice as an RN in terms of your knowledge and skills related to basic care and comfort?







Total responses 75


E.2 - 6

How ready did you feel to begin practice as an RN in terms of your knowledge and skills related to pharmacological and parenteral therapies?







Total responses 74

How ready did you feel to begin practice as an RN in terms of your knowledge and skills related to reduction of risk potential?







Total responses 75

How ready did you feel to begin practice as an RN in terms of your knowledge and skills related to physiological adaptation?







Total responses 75


E.2 - 7

Do you have any other thoughts, perspectives, issues or concerns about your educational program and your preparation with the knowledge and skills necessary to practice as an RN?

1. The entire program at XXX feeds into the bully mentality. You can physically and emotionally feel the change in cohorts of how they treat & judge other nurses. Bullying isn't unit related, it is taught and bred within the nursing school at XXX. My experience there was my third post secondary I have graduated from, and I could not believe the way in which the program handled themselves and their students.

2. Could be more education regarding the wide variety of roles and places that nuses work within. I felt there was a huge emphasis on hospital settings. not much exploration into other roles and workplaces where nurses work in.

3. I feel that the program at XXX prepared me very well to practice as a registered nurse. The practicum portion of the course was very helpful in preparing me as it covered a lot of different areas of nursing throughout the four years, and we were expected to know our patients and skills in depth before being able to care for patients. The classroom portion was very well executed, too, however we did not have a course to focus specifically on pharmacology, which I know has now been implemented. I felt very ready to become a registered nurse, especially during my final practicum, where I was able to become very independent and feel more comfortable in a leadership role. I feel the program at XXX does afantastic job in shaping students into the best possible nurses they can be. We learned hands on skills, critical thinking, ethics and so much more. We were expected to cooperate to teach ourselves, ask questions when needed and be competent before interacting with patients.

I did not, however, feel very prepared for the NCLEX exam, as I do not feel XXX implemented NCLEX style questions or learning/preperation programs until too late in the program to be beneficial. I do not believe this is the fault of XXX or its instructors, due to the fact that XXX and the nursing students and instructors were not aware we would be writing the NCLEX until we were already in our second year of nursing and were expecting to write the CRNE. Two years was an unresonable amount of time to expect a program to be able to change to fit the learning needs and question style to sufficiently prepare for the NCLEX. I feel the XXX program was excellent in preparing me to be a registered nurse, but I think implementing the NCLEX in such a short period of time really set the college and nursing students up to fail, and I hope something will be done for those struggling with the NCLEX to ensure they are able to fulfill their dream of being registered nurses, even if they happen to 'fail' three times. The nursing students are not the ones failing; the system is failing the nursing students.

4. As an after-degree student, I feel that there could have been more supportive clinical educators. I was a hard-working, mature student, and felt that the culture of fear was detrimental to my learning and view of the nursing profession. As well, I feel that there could have been more clinical instructors. It was frequently difficult to gain skills practice since the instructors had many students (who were often on more than one unit).

5. It would help to have two semesters ( or one year) with a preceptor before beginning to practice as a RN. At XXX, we had one semester ( three to four months) of a final preceptorship. It would have been more helpful to have two semesters or one year in the final rotation of the nursing program to gain more experience and guidance from


E.2 - 8

experienced professionals. One semester is not enough time for new nurses. More clinical experience equals better prepared nurses when they enter the work force. The final preceptorship experience when you learn the most of what it means to be a nurse, and extending the time period would extremely beneficial.

6. If this survey is in response to NCLEX results, I will say that XXX informed students of the test change half way through our program, giving us ample time to mentally prepare ourselves for the change of test. The school also tried their best to prepare us for the NCLEX, by example providing book suggestions, trying to encourage us to include NCLEX style questions in our CBL classes, and suggesting prep courses.

I do; however, feel that each content areas from the NCLEX, for example "psychosocial integrity" were not well explained in what content they are actually testing. The idea of a computer based test was well explained, I however had to seek extra explanation through webinars from KAPLAN. In summary, the faculty could improve how they explained/taught each content area from the NCLEX. Students were left to discover what the test was testing on their own.

That being said! The NCLEX was a fine test. I do not think RN's should be rash and quickly switch back to a Canadian based test. The NCLEX is applicable to Canadians and to the Canadian RN. I actually quite enjoyed how in preparation for my NCLEX exam I learned prioritization skills just through studying/question answering which I could apply to real life work scenarios. The test was fair.

I do believe though that my education from XXX was very community health based, which the NCLEX does shy away from. The faculty will have to adjust what clinicals are available if the country continues on offering the NCLEX exam. Clinical instructors will also have to have some kind of knowledge of the exam as well in order to help their students. This should be mandated in some way and monitored by the faculty.

The XXX CBL/clinical instructors who invested in my education helped prepare me to handle the challenges of becoming and RN. A faculty cannot be blamed when an individual is having difficulty adjusting to change.

7. New grad nursing rights. We get screwed over in the first year of working as a new nurse. We have to earn vacation unlike anyone else ever. If you were at any other company we would get vacation and sick time after 3 months.

8. The biggest change was preparing for the NCLEX vs the CRNE. I felt that my program did not offer enough preparatory computer-based exams or 'sudden death' like exams that covered all of the information in the 4 years. We were primed to write a traditional, multiple choice, pen and paper exam.

9. I thought I had very good tutors that taught me the appropriate clinical skills and that is why I was prepared. I really didn't learn much in the classroom, it was all while in the clinical setting.


E.2 - 9

10. Hands on experience for me was key in feeling prepared and understanding concepts learned in the classroom. I am very concerned to hear that clinical opportunities are being decreased and not being made a priority in the nursing program.

11. There is way too much fluff in the bn program. It's ridiculous the amount of time wasted when I could have been learning important things. The amount of "self-reflection" is useless also. I needed more know about medicine!!!

12. I think our education is grossly inadequate and doesn't prepare us to work well in the majority of nursing areas. Way too much time in nursing school is spent on teaching students what is in reality the most difficult to learn, i.e. how to interact with human beings, empathy, ethics, how to be a good human being. These qualities are learned overtime with life experience and working with patients as a health care provider. Moreover, many student already posses many of these qualities going into nursing; for students that already have, and for those that are severely lacking, these qualities, all the time spent reading and writing about this stuff really doesn't help them grasp or learn it, while traveling to see the world, having a family, and working with healthy, sick, or dying people does. We go out into the working world with a piss poor understanding of our roles and responsibilities. In my opinion, the standards that warrant graduation are poor. Way more time and resources should be spent on teaching new nurses to understand physiology and pathophysiology (and I don't mean in their first year). I.e. What to do if your patient is actually crashing, confidence in emergency situations, critical care and emergency medicine. Skills can be learned or taught in the working world. But students need to have the background knowledge of why we de what we do. Because at the end of the day, the families don't care about how much you "care", but whether or not you know how to protect and keep their loved ones safe from anything bad that could happen, i.e. from dying (when they are suppose to be recovering), etc. Nursing school in too many ways is a joke. After finishing nursing school in critical care, it became apparent to me how inadequate my education was; I spent the next year in the library on my days off, took courses and taught myself basic knowledge so to be better prepared for my job. Fourth year nursing taught me that we need to teach ourselves what it is we want to know, prepare ourselves for where we want to work. Nursing school in general taught me to jump through hoops. Public health and maternity should be omitted from our education, and should be taught as completely separate careers/specialties, as they are so completely different and to pretend that you can adequately prepare a student in one semester of education for these areas is laughable and depressing. The world is changing: nursing is not what it was 100 years ago, nor 50 years ago... We have respiratory technicians for example, ultimately to specialize individuals so as to provide the best care to the public. My point: to believe that nursing should continue to include public health and maternity is to think in the past and be stuck in tradition. To add, after getting an A in my maternity rotation, I asked my preceptor if I wanted a job in maternity after I graduated if they would consider me for it... The answer was no (I'm a male). I have no problem with that, I can accept the reality: young healthy women prefer to have a female caring for them when they are giving birth. Again, we spend way too much time appeasing and jumping through hoops in our professional nursing education than actually learning the essentials. CARNA should not be focused on "increasing RN scope of practice", what a joke... It should be focused on helping RNs and preparing students to be more proficient under their existing scope of practice. Consider streamlining the ciricumlum, omitting useless fluffy theory and public health and maternity... Increasing emphasize on physiology and pathophysiology throughout


E.2 - 10

the four years... And potentially making our last year of education one where students can specialize thier careers, i.e., if I want to work in med/surg, in my last/fourth year I focus on everything related to med/surg prior to doing my rotation in med/surg; if I am interested in critical care, potentially spending a fourth and extra year learning about critical care before working in critical care; if I want to go to maternity, spending my fourth and an extra fifth year learning about maternity before going into maternity. Ciricumlum could mirror that of the competencies outlined by the CNA specialty certifications, which appear to delineate a much better, well rounded (and better educated) RN.

13. I would have liked to experience more clinical time throughout my nursing studies. I felt the review of theory was quite extensive which was very important, however, certain work situations as a new grad would have better prepared me, if I had more work experience in the field. For example, I was required to take on charge duties only after a few months of receiving my RN. I feel if we could better prepare our upcoming new grads for these situations, through more education or all around experience, it would be less stressful and help with the transition from student to working Registered Nurse.

14. I feel as though more control should be given to hospitals to the education of future nurses.

15. Theory was well taught, but at the expense of teaching a practicing skills. I was not prepared for the demands of working in a hospital full time upon graduation. My education left far too many skills to be taught by staff straining once in the workforce. Fine for me that got a job at a major urban hospital but dangerous for my friends who went rural and had very little training and were expected to know a lot more than they actually did. Our labs were also counted as clinical hours but they were in way similar to clinical practice. Out actual clinicals days in the hospital were also cut short every day for pre and post conferences which were somehow also counted as clinical hours and in my opinion, should not have been. Clinical time hour be clinical time- we needed it.

16. There should be more exposure to the vast array of different areas nurses can practice. Like I icu, the or, and clinics. Perhaps a residency program would aid new grads in grasping the options.

17. i felt more prepared to practice as and RN as i transitioned from an LPN to an RN, so much of my basic knowledge came from that and has grown through experience. I felt that what i took to become an RN in school made little difference to my ability to handle situations in an acute care setting as nothing was based on nursing skills in a hospital it was all about community health nursing, public health, and writing papers.

18. I feel that in addition to admission based high school marks (82% + avg) there should also be an interview process. I feel like some of the people may have the marks to get in to the program, however, they do not have the heart that makes a good nurse. Dental hygiene, medicine and dentistry all have an interview process for their programs and it works well. It helps identify appropriate candidates for their programs. Nursing should be on par with the other health profession university programs when it comes to admission and have admissions interviews as well.

19. Educational program goals and focus was incongruous with the licensing exam

20. No


E.2 - 11

21. After degree program extremely disjointed and needs to be reviewed. Need more clinical time and less wasted time in the classroom

22. Clinicals are not difficult enough and do not adequately prepare us. Need a pharmacology course

23. Depending on practical placements some graduated with much more experience in clinical skills than others.

I ended up graduating with having done one catheter and no IV initiation in four years of school. As such my comfort working in a medical unit post graduation was very very low.

Felt very unprepared to write NCLEX exam after CBL style education. Felt I had to learn fundamental knowledge from prep courses that I should have learned back in first or second year but missed because it didn't come up in tutorials.

Anatomy/physiology courses were rushed. Did not even touch on important aspects like learning muscles, reproductive system.

24. I feel the roles of LPNs and HCAs have changed and evolved relatively quickly and are difficult for a lot of new, younger nurses. This has also made me feel insecure in my role as an RN, as my special skills are passed down to lesser roles.

25. XXX has a great nursing program compared to XXX. I see the vast difference between the program styles now that I have to work along side and manage students. XXX did assist in preparing me for working as an RN, however, I did not have the "typical school exeperience". I worked as a Health Care Aide after completing my first year and this experience assisted when I started working as an Under Graduate Nurse after completing second year. The experience I gained from working as a UNE was invaluable and helped me tremendously! I cannot recommend this enough! It was a steep learning curve but I felt more prepared going into further clinicals. It helped me in every aspect of becoming a well rounded nurse. My grades improved in school as a result because I was able to apply and bring the knowledge gained from working in the hospital into the classroom. I would not have been as confident working as a grad nurse if I had not had the experience of working as an UNE.

26. After degree program needs to be tailored better, hands on in clinical a helps but the classes need to be tailored to help expand knowledge that the 4 year program has time to teach

27. I feel that most new graduate nurses are working with clients in the hospital or long term care and while it was essential to learn about health promotion and disease prevention, nursing theories, and community based health strategies, it was over emphasized in my degree. The importance of strong nursing assessment skills, such as the head to toe assessment was not emphasized nearly to the extent I feel that it should be. Understanding pathophysiology is great but being able to actually detect subtle changes to the human body through assessment is an invaluable skill which after a year of independent practice I am just being to feel competent with.

28. The XXX program was very limited as far as the variety of clinical rotations therefore limiting the areas of nursing one can attempt to enter.


E.2 - 12

29. I feel like my program gave me self direction so that I was able to study what I needed to know for my NCLEX, but I think my program completely missed the boat on giving me the education I needed to pass that test.

30. I am concerned that there is not a required amount of clinical hours for the following areas: Maternity, Pediatric, and Critical care. I work in rural where some clinical background in all of the above areas are a necessity. There is heavy focus on psychosocial integrity and health promotion. Despite this, I find my education still did not prepare me for interdisciplinary and inter-agency work as an RN. There is a lack of focus on time management, safe pharmacology, management of the physiological aspects of pt care, including reviewing a complex pt as a whole based on medication, hx, lab values, home and social supports. Hands on assessment skills in specific patient populations are absent or very limited. Use of technology is under emphasized. Clinical experience is highly variable between each student, and there are not enough opportunities in acute care where the majority of jobs are and new grads work. I think the poor NCLEX results accurately portray the weaknesses of nursing education in Alberta and Canada. This should be rectified by addressing clinical experience, teaching methods, content coverage, and evaluation of knowledge. The issue with NCLEX is not the test itself or the students, but the lack of emphasis on basic skills and care in nursing education, and the overemphasis on management issues which are equally important, however, not useful without a strong base of nursing experience, knowledge, and skills. Content based learning is not an appropriate method of teaching because there is limited quality control of the information being brought, taught, and discussed, by students of limited experience to other students of equally limited experience.

31. I felt that XXX provided a comprehensive preparation for the nursing profession. While it can take quite some time before entry level nurses feel that they are competent in their profession, I felt that I was prepared with the knowledge, skills, and background necessary to provide safe, competent care. In addition, I was taught critical thinking skills that have guided my practice and have been sufficient to overcome any hurdles I have experienced thus far.

32. The XXX Nursing program leaves graduates at a disadvantage in the work place. There is a lack of training about pharmacological and surgical interventions, no introduction to the various areas/specialities in nursing, as well as the lack of medical knowledge in the program leaves a large communication gap between physicians and nurses in the workplace. They need to remove the fluff courses and replace them with rigorous training about physiological changes that occur with disease.

33. I felt very adequately prepared for basic nursing skills...basic care, a simple understanding of most of the common health problems in the population, health promotion, a good understanding of common medications, etc. However, there were some skills that I did not feel ready/adequately prepared for because I didn't have much chance to practice them in any clinical settings (ex: inserting an NG tube, doing bloodwork, working with G tubes, chest tubes, etc.) I also didn't feel prepared for the management side of nursing care, such as processing orders, being charge, coordinating with the interdisciplinary team, etc. I think that a lot of that side of nursing just comes with time and experience, but I would have liked my nursing program to touch a bit more on that side of things.


E.2 - 13

34. Everyone had different clinical and tutorial experiences. I personally would NEVER recommend XXX nursing program. I feel as though both the tutorial and clinicals have disappointed me severely and I have learned far more after graduation nursing independently with the support of my coworkers than I EVER did in school. I know they were planning to (or have) modified the program since I have graduated and I hope that it's working better for current students because as far as i'm concerned it was terrible.

35. The XXX program did not prepare me to write the NCLEX exam. Students were made aware of the exam, but in depth preparation was neglected. I feel that I would have made a smoother transition into the RN role if I was first prepared to pass this hard exam.

36. I believe the main problem with the educational program is the culture of nursing, which creates an environment where students are penalized and embarrassed for asking questions. Often instructors and nursing staff during practicums have somewhat hostile attitudes towards students, and often instead of having time and attention to properly instruct students on essential skills, students often serve as convenient extra hands for simple personal care tasks. Also, during our in-school skills labs, often we were simply instructed to watch a video at home and then 'try' the skills in the lab. Many skills were never demonstrated by an instructor, where we as students were unsure of whether we were in fact performing a skill well. I believe that in nursing it is essential to have a skilled instructor demonstrate using the available equipment how to perform a task, since there are so many little details that require mastery in order to perform a skill safely and effectively. I believe the lectures at XXX were excellent, and the level of education was above what I even expected. I believe the academic program prepared me well for the the NCLEX exam, however, the NCLEX exam in itself I believe is not a very valid exam to test the comprehensiveness of nursing knowledge. Also, since everyone taking the test has essentially a different set of questions based on an algorithm that no one seems to fully understand, I believe there is inherent unfairness to this test. That said, I do believe that the difficulty of the NCLEX ensures a higher level of preparedness by graduating nurses, which is possibly a positive effect of this new test. Generally, I believe the main problem is the nursing culture which is often antagonistic, with many senior nurses degrading the profession. It is difficult for students to learn and continue to have a passion for this new career path under so much constant negativity. I believe nursing can be a very rewarding profession, and deserves much more respect especially by the people who work within it.

37. School can't teach you everything and I didn't expect to feel completely ready after graduation. Experience helps prepare more than school work.

38. More lab/clinical time is needed in order to become familiar with even basic nursing skills and assessments. Many of the students in my cohort graduated without ever inserting a foley catheter.. it comes down to the opportunities you get in your individual clinical experience and every student's experience is different. However, after graduating it expected by other RNs, patients, employers, etc. that an RN can confidently perform these "basic" skills. In order for the new graduate to feel confident, more lab/clinical time is needed to perfect these skills before being thrown to the wolves. As a new graduate, you are most likely to get your first job on the floor working directly with patients and their families. As a new BSCN graduate and RN, I can say with confidence that I have a firm grasp of the readings from Plato's Phaedo, but I still cannot insert an NG tube with


E.2 - 14

confidence...therefore I would have benefited from more practice of the clinical skills that are the foundation to basic nursing practice.

39. Entirely too much focus on pseudoacademic "nursing theory" and communications, nowhere near enough emphasis on practical skills. Further, the lack of a comprehensive skills training block meant that we were often entirely unprepared in clinical to perform bedside nursing until our weekly skills education caught up.

The XXX program left me entirely unprepared for practice as an RN, and I have actively encouraged others to attend other programs.

40. I think the Transitional RN program needs to be more available. There needs to be staff available to adequately cover for the growth of the new grad so that it is possible to learn the new skills necessary to an adequate level according to nursing standards without compromising patient care or overextending the other nursing staff. It would also be helpful to have a CNA representative explain the rights and responsibilities of a new nurse because it is easy to be taken advantage of in regards to overtime and mandating and fair pay. There also needs to be more practical time in the hospital as apart of the nursing program with a realistic patient load. if not the leap from school to the working field is quite steep.

Appendix E.3 – Results of On-Line Survey of 4th Year Students

E.3 - 1

NEPAB Survey: Students (Completion rate: 45.16%)

Which university or college are you attending?

Athabasca University 5.9% 1

Grande Prairie Regional College 29.4% 5

Keyano College 0.0% 0

Lethbridge College 0.0% 0

MacEwan University 0.0% 0

Medicine Hat College 0.0% 0

Mount Royal University 5.9% 1

Red Deer College 58.8% 10

University of Alberta 0.0% 0

University of Calgary 0.0% 0

University of Lethbridge 0.0% 0

Total Responses 17

Prior to starting this survey, were you aware of CARNA and its mandate?

Yes 47.1% 8

Somewhat 29.4% 5

No 23.5% 4

Total Responses 17

How ready do you feel to begin practice as an RN in terms of your knowledge and awareness of the professional responsibilities and accountabilities of an RN?







Total Responses 16


E.3 - 2

How ready do you feel to begin practice as an RN in terms of your knowledge and skills related to ongoing comprehensive patient assessment?







Total Responses 16

How ready do you feel to begin practice as an RN in terms of your knowledge of health-care planning?







Total Responses 15

How ready do you feel to begin practice as an RN in terms of your general knowledge and skills in providing nursing care?







Total Responses 14


E.3 - 3

How ready do you feel to begin practice as an RN in terms of your knowledge and skills related to the evaluation of patient care?







Total Responses 15

How ready do you feel to begin practice as an RN in terms of your knowledge and judgment related to ethical nursing practice?







Total Responses 14

How ready do you feel to begin practice as an RN in terms of your knowledge about RN duties to the public?







Total Responses 15


E.3 - 4

How ready do you feel to begin practice as an RN in terms of your knowledge of the self-regulatory framework governing the nursing profession?







Total Responses 15

How ready do you feel to begin practice as an RN in terms of your knowledge and skills related to management of care?







Total Responses 15

How ready do you feel to begin practice as an RN in terms of your knowledge and skills related to safety and control of infection?







Total Responses 15


E.3 - 5

How ready do you feel to begin practice as an RN in terms of your knowledge and skills related to health promotion and maintenance?







Total Responses 14

How ready do you feel to begin practice as an RN in terms of your knowledge and skills related to psychosocial integrity?







Total Responses 15

How ready do you feel to begin practice as an RN in terms of your knowledge and skills related to basic care and comfort?







Total Responses 13


E.3 - 6

How ready do you feel to begin practice as an RN in terms of your knowledge and skills related to pharmacological and parenteral therapies?







Total Responses 14

How ready do you feel to begin practice as an RN in terms of your knowledge and skills related to reduction of risk potential?







Total Responses 14

How ready do you feel to begin practice as an RN in terms of your knowledge and skills related to physiological adaptation?







Total Responses 15


E.3 - 7

Do you have any other thoughts, perspectives, issues or concerns about your educational program and your preparation with the knowledge and skills necessary to practice as an RN?

1. XXX has done an excellent job in preparing me for the work force. The only thing that I do not feel as prepared for is the NCLEX- I have found that in my resarch about the exam it is more knowledge based and no longer critical thinking based and in XXX we were taught and tested about critical thinking scenarios. Our program is also context based learning, not lecture based and I think that for future students there should be some thought put into possibly changing the program structure to more of a knowledge based- lecture style format so that these students are more prepared to write the NCLEX.

2. Context based learning has prepared me to be a critical thinker and has made me very good at finding current and relevant information from which to base my practice. One concern with it is that I simply don't know if I know what I need to know and I feel like I am still lacking crucial knowledge related to pharmacology and the implication of lab values just to name a couple. The variety of placements we have had available to us I believe has been an asset, however, I believe that some students have not challenged themselves to expand their knowledge base and when given the choice have repeatedly picked the same sorts of environments. If I was to restructure the program I would change the tutorial sessions from twice a week (for 3 hrs each) to once a week and then break up the other 3 hours into either more lab/sim or lecture based classes that give us the information we need to know. As opposed to us finding information that is good, but we are not clear if we need to know it or not. I believe in terms of incorporating CARNA's principles and the self-regulatory process in the courses it has been great.

3. Through the program at XXX I do not feel as comfortable as I would like to be with pharmacology as preparing for graduation; due to there being no pharmacology course. I feel as though it creates an obstacle to advocating, health promoting and assess the effects of medication. Despite great personal efforts to research, review, ensuring safe medication administration, and looking up medications that I am unfamiliar with. Additionally, I feel as though the CBL method of learning at XXX is not as effective as lecture based programs. Through our education we are novice practitioners and the guidance of very knowledgeable and well experienced RNs would be an asset to learning; as this not the case with CBL based learning. I feel as though lecture based learning would offer more guidance and would assist in developing confidence in knowledge and skills and greater certainty in guiding patient care.

4. not having a pharmacology course

5. I do not feel XXX program prepared me as well as I could have been prepared with lectures. I am aware that the CBL XXX program is highly recognized however, each group going through the program focuses on such different aspects of patient care and sometimes large components of care are missed in small self-directed groups.

I am largely disappointed that I did not receive any formal education on pharmacology in this program. Pharmacology is a huge component of nursing that is overwhelming and complex. This is a area of study that I feel needs to be addressed in a lecture-type environment in order to ensure nursing students have knowledge about medications.

Unfortunately, If I was to take the BScN program again, I would never do a self-directed program and would opt for a lecture-based program where you are taught what you need to learn and testing on materials you have for sure been taught in class.


E.3 - 8

6. We definitely would have benefitted from more mental health work and from a pharmacology course

7. Coming from a CBL program I was unable to receive much direction towards what I should have been learning. Often in CBL, we are given topics and it is up to us to learn and prepare what we believe is fundamental for class discussion. I would easily spent countless hours on certain topics to prepare for class, but by the time class discussion came the topics I had prepared for were irrelevant to the discussion. I would have benefitted from having more direction in areas such as pharmacology, disease process and regulatory bodies for RNs integrated into my program.

Appendix F.1 – Draft Revision to Part VIII of CARNA Bylaws – Revision Control Version

F.1 - 1

Part VIII – Nursing Education Program Approval Board (NEPAB)

30. NEPAB

30.1 Purpose of Bylaw

The purpose of Article 30 is

(a) to continue the membership and functions of the Nursing Education Program Approval Board

(NEPAB) as an impartial decision making body entity of the College to perform the functions

related to nursing education program approval required of it under the Act, Regulations and this

Article;

(b) through the membership and operation of NEPAB:

i. to continue a collaborative process to serve the interests of the public and the nursing

profession in the delivery of nursing education;

ii. to maintain effective links among those having an interest in the development and

delivery of nursing education;

(c) to confirm that Provincial Council’s duties and powers under the Regulations to approve

nurse practitioner education programs are delegated to NEPAB; and

(d) to confirm that Provincial Council’s duties and powers under the Regulations to approve

nursing refresher education programs are delegated to NEPAB; and

(e) to confirm that ultimate accountability and responsibility for nursing education program

approval, including the policies and procedures established by NEPAB, rests with Provincial

Council.

30.2 Duties and Powers

NEPAB mayshall:

(a) Establish policies and processes respecting any matters that are required to secure effective

nursing education programs:

i nursing education programs leading to initial entry to practice as a Registered Nurse;

ii nursing education programs leading to initial entry to practice as a Nurse Practitioner;

iii nursing refresher education programs; and

iv nursing education programs and/or courses for RNs who will be authorized to

prescribe Schedule 1 drugs;

(b) Establish policies and processes respecting:


F.1 - 2

i who is entitled to apply for approval of a nursing education program;

ii the times at which an application may be made;

iii the process by which an application is to be reviewed and by whom, including

requirement for self-assessment by the applicant;

iv the nature of the decisions made on an application;

v the periodic review and re-approval of nursing education programs; and

vi confirmation of on-going compliance with nursing education standards and criteria;

(bc) Submit all policies and processes established under subsections (a) and (b) to Provincial

Council for review and comment prior to implementation; Establish policies and processes

respecting any matters that are required to secure effective nursing refresher education

programs.

(c) Establish policies and processes respecting any matters that are required to secure effective

nursing education programs and/or courses for RNs who will be authorized to prescribe

Schedule 1 drugs.

(d) Establish the minimum appropriate nursing education standards and criteria required to

obtain and maintain the designation of “approved nursing education program”, which must

beand submit such standards and criteria to ratified by Provincial Council for review and

approval before they become effective;

(e) Grant to and withdraw from a nursing education program the designation “approved nursing

education program”, based on the nursing education standards and criteria ratified approved

under subsection (cd), with or without conditions, terms, limitations and restrictions;

(f) Verify compliance with any all policies and processes established under subsections (a), (b)

and (c);

(g) Provide for the publication of any all policies, processes, procedures and rules made under

subsections (a) and (b), (b) and (c);

(h) Maintain a continuing review of compliance with nursing education standards and criteria;

(i) Establish policies and processes respecting

i who is entitled to apply for approval of a nursing education program

ii the times at which an application may be made


requirement for self-assessment by the applicant

iv the nature of the decisions made on an application

v the periodic review of approved nursing education programs;


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(j) Perform any other functions required in order to meet the requirements of the Act,

Regulations or this Article;

(kh) Establish any dispute resolution mechanisms it considers desirablean appeal mechanism for

any decisions made regarding the granting or withdrawing of the designation “approved nursing

education program”, including decisions respecting conditions, terms, limitations and

restrictions; and

(li) Establish policies and processes procedures to receive and process complaints or concerns

expressed by the public about approved nursing education programs.

30.3 Composition

(1) NEPAB is to be composed of persons appointed as follows:

(a) three persons appointed by Provincial Council from a list of at least six names provided by

the educational institutions delivering nursing education programs leading to entry to practice

as a Registered Nurse;

(b) two persons appointed by Provincial Council from a list of at least four names submitted by

employers of Registered Nurses, excluding CARNA;

(c) one member of the public appointed by Provincial Council; and

(d) three Registered Nurses appointed by Provincial Council.

(2) The chair of NEPAB is shall be selected from and by the members of NEPAB, who will determine the

manner in which the chair is to be selected, and the term of office of the chair at the time of selection.

(3) The chair of NEPAB must shall designate one or more members of NEPAB to act as chair in the event

of a vacancy in the office of chair or in the event of the chair’s absence or inability to act.

(4) NEPAB will shall establish policies and processes for chair succession.

(5) Nothing in this section affects the application of section 30.5 (3).

30.4 Prohibition on Membership

No member of NEPAB shall be a member of Provincial Council, a Hearing Tribunal, the Complaint Review

Committee, Reinstatement Review Committee, Registration Committee, Registration Review Committee

or Competence Committee.

30.5 Term of Office

(1) With the exception of the public representative, members of NEPAB hold office for a five-year term,

unless earlier terminated by Provincial Council under section 30.13(3).


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(2) The public member of NEPAB holds office for a two and a half year term, unless earlier terminated by

Provincial Council under section 30.13(3).

(3) If a member of NEPAB ceases to hold office before their term expires, Provincial Council may shall

appoint a person as a member of NEPAB for the balance of the unexpired term in accordance with the

composition requirements of section 30.3(1).

(4) The term of office of a member of NEPAB who has been part of a decision regarding an application

for approval, re-approval and/or assessment, shall continues until the decision regarding that

application is has been made, unless the member has been terminated from office by Provincial Council

under section 30.13.

30.6 Quorum

A majority of the persons who are appointed as members of NEPAB from time to time constitute a

quorum of NEPAB.

30.7 Voting

(1) Decisions regarding the granting or withdrawing of the designation “approved nursing education

program”, including decisions respecting conditions, terms, limitations and restrictions, shall be made

via a simple majority vote at a meeting of NEPAB.

(2) Each member of NEPAB has one vote, except the chair, who may only vote in the event of a tie vote.

30.8 Conduct of Meetings

(1) Subject to the Act, Regulations and these Bylaws, NEPAB may determine its own rules respecting the

calling of and conduct of its meetings, or the handling of matters within its jurisdiction including the

appointment of individuals or committees, or both, to assist or advise NEPAB.

(2) NEPAB meetings are held in camera unless otherwise determined by NEPAB.

30.9 Confidentiality

(1) Where a member of NEPAB receives information of a confidential nature in connection with the

conduct of NEPAB duties and powers, he/she shall preserve confidentiality of such informationEach

member of NEPAB shall keep information received by him/her as a member of NEPAB confidential.

(2) Confidential Iinformation given to NEPAB shall be disclosed only in accordance with the Act,

Regulations, this Article, direction from Provincial Council, and NEPAB policy or as otherwise required by

law.


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(3) NEPAB may authorize the disclosure of information for statistical use when the information cannot

be attributed to a particular individual or facility.

30.10 Collaborative Decision Making

(1) NEPAB mustshall, when required by the Act and at any other time it considers appropriate to do so,

invite comment and give consideration to any comment received from the Minister of Health and

Wellness and the Minister of Advanced Education.

(2) Before granting or withdrawing approval from a nursing education program, including the stipulation

of conditions or terms on an approval, NEPAB must provide the persons concerned with:

(a) its preliminary views, and

(b) a reasonable opportunity to discuss these preliminary views with NEPAB;

(3) After considering any response it receives to its preliminary views and giving the matter any further

consideration it considers warranted, including providing any additional forum for giving and receiving

information it considers necessary:

(a) NEPAB may shall make a final decision whether or not to approve the nursing education

program and whether or not to impose conditions, terms, limitations and restrictions on the

approval, and

(b) NEPAB must shall notify the Minister of Health and Wellness and the Minister of Advanced

Education of its decision.

30.11 Annual Budget

(1) NEPAB must annually submit to the Chief Executive Officer of the College an action plan outlining its

objectives, in general terms, for the coming fiscal year of the College, including its estimated budget

requirements to meet these objectives.

(2) NEPAB is responsible for performing its functions within the resources allocated by Provincial

Council.

30.12 Annual Reporting

(1) On or before April 1 of each year, NEPAB must submit an annual report to:

(a) The President of Provincial Council;

(b) The Chief Executive Officer of the College;

(c) Each of the nominating bodies having members on NEPAB, ; and

(d) Any other persons NEPAB considers necessary.


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(2) The annual report shall contain information sufficient to demonstrate NEPAB’s compliance with, and

fulfillment of, its duties and powers under this Bylaw and with the other requirements of this Bylaw. In

addition to a written report, NEPAB shall provide a presentation to Provincial Council on these matters

at its first meeting after April 1 of each year.

(3) On a semi-annual basis, or more frequently as determined by Provincial Council, NEPAB shall report

to Provincial Council regarding its outcome measures or other measures of effectiveness of the

regulatory process for nursing education program approval.

30.13 Resignations and Terminations

(1) The chair of NEPAB may resign by giving the President of Provincial Council 30 days written notice.

(2) Other members of NEPAB may resign by giving written notice to the chair who will notify the

President of Provincial Council and request a new appointment.

(3) A member of NEPAB appointed pursuant to section 30.3(1)(a), (b) or (c) may be terminated from

office by resolution of Provincial Council if it receives a report from NEPAB that any of the following

conditions exist. The member:

(a) has failed to comply with the requirements for confidentiality required by the Act or these

Bylaws;

(b) has failed to comply with NEPAB’s ethical conduct policy; or

(c) has failed to attend three meetings of NEPAB without reasonable cause.

(43) A Registered Nurse member of NEPAB appointed pursuant to section 30.3(1)(d) may be terminated

from office by resolution of Provincial Council if it receives a report from NEPAB that any of the

following conditions exist. The member:

(a) is has been suspended or who has ceases ceased to be a Registered Nurse,;

(b) has been found to be guilty of unprofessional conduct;

(c) is has faileddisciplined for failure to comply with the requirements for confidentiality

required by the Act or these Bylaws;

(d) fails has failed to comply with NEPAB’s ethical conduct policy; or

(e) fails has failed to attend three meetings of NEPAB without reasonable cause. may be

terminated from office by resolution of Provincial Council; or

(f) fails to meet the NEPAB membership requirements.

Appendix F.2 – Draft Revision to Part VIII of CARNA Bylaws – Clean Version

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Part VIII – Nursing Education Program Approval Board (NEPAB)

30. NEPAB

30.1 Purpose of Bylaw

The purpose of Article 30 is

(a) to continue the membership and functions of the Nursing Education Program Approval Board

(NEPAB) as an impartial decision making entity of the College to perform the functions related

to nursing education program approval required under the Regulations and this Article;

(b) through the membership and operation of NEPAB:

i. to continue a collaborative process to serve the interests of the public and the nursing

profession in the delivery of nursing education;

ii. to maintain effective links among those having an interest in the development and

delivery of nursing education;

(c) to confirm that Provincial Council’s duties and powers under the Regulations to approve

nurse practitioner education programs are delegated to NEPAB;

(d) to confirm that Provincial Council’s duties and powers under the Regulations to approve

nursing refresher education programs are delegated to NEPAB; and

(e) to confirm that ultimate accountability and responsibility for nursing education program

approval, including the policies and procedures established by NEPAB, rests with Provincial

Council.

30.2 Duties and Powers

NEPAB shall:

(a) Establish policies and processes respecting any matters that are required to secure effective:

i nursing education programs leading to initial entry to practice as a Registered Nurse;

ii nursing education programs leading to initial entry to practice as a Nurse Practitioner;

iii nursing refresher education programs; and

iv nursing education programs and/or courses for RNs who will be authorized to

prescribe Schedule 1 drugs;

(b) Establish policies and processes respecting:

i who is entitled to apply for approval of a nursing education program;


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ii the times at which an application may be made;


requirement for self-assessment by the applicant;

iv the nature of the decisions made on an application;

v the periodic review and re-approval of nursing education programs; and

vi confirmation of on-going compliance with nursing education standards and criteria;

(c) Submit all policies and processes established under subsections (a) and (b) to Provincial

Council for review and comment prior to implementation;

(d) Establish appropriate nursing education standards and criteria required to obtain and

maintain the designation of “approved nursing education program”, and submit such standards

and criteria to Provincial Council for review and approval before they become effective;

(e) Grant to and withdraw from a nursing education program the designation “approved nursing

education program”, based on the nursing education standards and criteria approved under

subsection (d), with or without conditions, terms, limitations and restrictions;

(f) Verify compliance with all policies and processes established under subsections (a);

(g) Provide for the publication of all policies, processes, procedures and rules made under

subsections (a) and (b);

(h) Establish an appeal mechanism for any decisions made regarding the granting or

withdrawing of the designation “approved nursing education program”, including decisions

respecting conditions, terms, limitations and restrictions; and

(i) Establish policies and procedures to receive and process complaints or concerns expressed by

the public about approved nursing education programs.

30.3 Composition

(1) NEPAB is to be composed of persons appointed as follows:

(a) three persons appointed by Provincial Council from a list of at least six names provided by

the educational institutions delivering nursing education programs leading to entry to practice

as a Registered Nurse;

(b) two persons appointed by Provincial Council from a list of at least four names submitted by

employers of Registered Nurses, excluding CARNA;

(c) one member of the public appointed by Provincial Council; and

(d) three Registered Nurses appointed by Provincial Council.

(2) The chair of NEPAB shall be selected from and by the members of NEPAB, who will determine the

manner in which the chair is to be selected, and the term of office of the chair at the time of selection.


F.2 - 3

(3) The chair of NEPAB shall designate one or more members of NEPAB to act as chair in the event of the

chair’s absence or inability to act.

(4) NEPAB shall establish policies and processes for chair succession.

(5) Nothing in this section affects the application of section 30.5 (3).

30.4 Prohibition on Membership

No member of NEPAB shall be a member of Provincial Council, a Hearing Tribunal, the Complaint Review

Committee, Reinstatement Review Committee, Registration Committee, Registration Review Committee

or Competence Committee.

30.5 Term of Office

(1) With the exception of the public representative, members of NEPAB hold office for a five-year term,

unless earlier terminated by Provincial Council under section 30.13.

(2) The public member of NEPAB holds office for a two and a half year term, unless earlier terminated by

Provincial Council under section 30.13.

(3) If a member of NEPAB ceases to hold office before their term expires, Provincial Council shall appoint

a person as a member of NEPAB for the balance of the unexpired term in accordance with the

composition requirements of section 30.3(1).

(4) The term of office of a member of NEPAB who has been part of a decision regarding an application

for approval, re-approval and/or assessment, shall continue until the decision regarding that application

has been made, unless the member has been terminated from office by Provincial Council under section

30.13.

30.6 Quorum

A majority of the persons who are appointed as members of NEPAB from time to time constitute a

quorum of NEPAB.

30.7 Voting

(1) Decisions regarding the granting or withdrawing of the designation “approved nursing education

program”, including decisions respecting conditions, terms, limitations and restrictions, shall be made

via a simple majority vote at a meeting of NEPAB.

(2) Each member of NEPAB has one vote, except the chair, who may only vote in the event of a tie.


F.2 - 4

30.8 Conduct of Meetings

(1) Subject to the Act, Regulations and these Bylaws, NEPAB may determine its own rules respecting the

calling of and conduct of its meetings, or the handling of matters within its jurisdiction including the

appointment of individuals or committees, or both, to assist or advise NEPAB.

(2) NEPAB meetings are held in camera unless otherwise determined by NEPAB.

30.9 Confidentiality

(1) Where a member of NEPAB receives information of a confidential nature in connection with the

conduct of NEPAB duties and powers, he/she shall preserve confidentiality of such information.

(2) Confidential information given to NEPAB shall be disclosed only in accordance with the Act,

Regulations, this Article, direction from Provincial Council, and NEPAB policy or as otherwise required by

law.

30.10 Collaborative Decision Making

(1) NEPAB shall, when required by the Act and at any other time it considers appropriate to do so, invite

comment and give consideration to any comment received from the Minister of Health and the Minister

of Advanced Education.

(2) Before granting or withdrawing approval from a nursing education program, including the stipulation

of conditions or terms on an approval, NEPAB must provide the persons concerned with:

(a) its preliminary views, and

(b) a reasonable opportunity to discuss these preliminary views with NEPAB;

(3) After considering any response it receives to its preliminary views and giving the matter any further

consideration it considers warranted, including providing any additional forum for giving and receiving

information it considers necessary:

(a) NEPAB shall make a final decision whether or not to approve the nursing education program

and whether or not to impose conditions, terms, limitations and restrictions on the approval,

and

(b) NEPAB shall notify the Minister of Health and the Minister of Advanced Education of its

decision.

30.11 Annual Budget

(1) NEPAB must annually submit to the Chief Executive Officer of the College an action plan outlining its

objectives, in general terms, for the coming fiscal year of the College, including its estimated budget

requirements to meet these objectives.


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(2) NEPAB is responsible for performing its functions within the resources allocated by Provincial

Council.

30.12 Reporting

(1) On or before April 1 of each year, NEPAB must submit an annual report to:

(a) The President of Provincial Council;

(b) The Chief Executive Officer of the College;

(c) Each of the nominating bodies having members on NEPAB; and

(d) Any other persons NEPAB considers necessary.

(2) The annual report shall contain information sufficient to demonstrate NEPAB’s compliance with, and

fulfillment of, its duties and powers under this Bylaw and with the other requirements of this Bylaw. In

addition to a written report, NEPAB shall provide a presentation to Provincial Council on these matters

at its first meeting after April 1 of each year.

(3) On a semi-annual basis, or more frequently as determined by Provincial Council, NEPAB shall report

to Provincial Council regarding its outcome measures or other measures of effectiveness of the

regulatory process for nursing education program approval.

30.13 Resignations and Terminations

(1) The chair of NEPAB may resign by giving the President of Provincial Council 30 days written notice.

(2) Other members of NEPAB may resign by giving written notice to the chair who will notify the

President of Provincial Council and request a new appointment.

(3) A member of NEPAB appointed pursuant to section 30.3(1)(a), (b) or (c) may be terminated from

office by resolution of Provincial Council if it receives a report from NEPAB that any of the following

conditions exist. The member:

(a) has failed to comply with the requirements for confidentiality required by the Act or these

Bylaws;

(b) has failed to comply with NEPAB’s ethical conduct policy; or

(c) has failed to attend three meetings of NEPAB without reasonable cause.

(4) A member of NEPAB appointed pursuant to section 30.3(1)(d) may be terminated from office by

resolution of Provincial Council if it receives a report from NEPAB that any of the following conditions

exist. The member:

(a) has been suspended or has ceased to be a Registered Nurse;

(b) has been found to be guilty of unprofessional conduct;


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(c) has failed to comply with the requirements for confidentiality required by the Act or these

Bylaws;

(d) has failed to comply with NEPAB’s ethical conduct policy; or

(e) has failed to attend three meetings of NEPAB without reasonable cause.

EVALUATION OF THE REGULATORY PROCESS FOR NURSING EDUCATION ...€¦ · NURSING EDUCATION PROGRAM...

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