Building an Evidence-Based Graduate Nursing
Program: A Feasibility Study in Tennessee, USA
Shu-li Chen, PhD, RN
Mary Anne Modrcin, PhD, RN
Sandra McGuire, EdD, RN
Lincoln Memorial University
Caylor School of Nursing
Harrogate, Tennessee, USA
Research Purpose
• The purpose of this survey study was to examine the
feasibility of starting a graduate nursing program at a
new university service area in a rural area of USA.
• This is the forth feasibility survey completed by the
Caylor School of Nursing (CSON) at the Lincoln
Memorial University, Harrogate, Tennessee, USA, to
examine feasibility of graduate nursing programs in
rural areas.
Caylor School of Nursing (CSON)
Mission Statement
• In agreement with the University’s mission and goals, the
Faculty of the Caylor School of Nursing strives to instill
responsibility and high moral/ethical standards in the
preparation of quality nurses, at multiple levels of nursing
education, through superior academic programs at the
undergraduate and graduate level.
• Specifically, the mission of the Faculty is to prepare nurses
with the ASN, BSN, and MSN degree, to assist individuals,
families, communities, and society as they adapt to changes
in physiological needs, role function, self-concept, and
interdependent relationships during health and illness.
Caylor School of Nursing (CSON)
Mission Statement
• The Caylor School of Nursing seeks to
respond to the needs of nursing education and
healthcare in the surrounding communities by
preparing nurses at multiple levels and by
providing continuing education/professional
development opportunities that are rooted in
knowledge, research, and other scholarly
activities.
Building an Evidence-Based
Graduate Nursing Program
2004
Nurse
survey
2010
Nurse and
Employer
Feasibility
Studies
2007
Nurse Survey
2005 Employer
Survey
2006
FNP
2008
CRNA
2011
PMHNP
Background – 2004 Nurse Survey
• In 2004, Caylor School of Nursing at LMU conducted
a survey of BSN prepared nurses (N=216) in the
university service areas.
• The findings indicated a desire for an increase in
advanced practice nursing education opportunities in
Appalachia.
– 1) 80% desired a nurse practitioner gradate degree
– 2) 75% of which respondents wanted an FNP
– 3) The majority of them planned to start pursing this option
within three years
– 4) The majority requested a program with both seat and webbased courses in addition to clinical experiences
Background – 2005 Employer Survey
• In 2005, a Nurse Practitioner Employment Survey was
distributed to selected regional health care facilities in
the university service areas.
• 73% of the responding agencies reported utilization of
NPs (preferring FNPs) and planned to continue using
NPs within their agencies
MSN program established – FNP in 2006
• In 2006, the MSN degree program was first
established to offer nurses further educational options
and provide surrounding communities with Family
Nurse Practitioners to meet identified health care
needs.
• The MSN program, FNP concentration, provides a
flexible format for either part-time or full-time nursing
students currently working in area hospitals and
health care facilities.
• The program allows full-time students to complete the
MSN degree in a minimum of 17 months.
Background – 2007 Nurse Survey
• Similar to the 2004 Surveys of RNs and RN students
(N=216), the 2007 survey of nurses (N=176)
continued to report the desire for an increase in
advanced practice nursing education opportunities in
Appalachia.
– 1) the 2007 survey reported that 75% desired to get an MSN
with a Nurse Anesthesia focus.
– 2) two focus groups of LMU health care agencies met with
LMU administration in Spring 2007 to discussion health care
workforce needs. The number one need of all participants
from LMU’s service area was “CRNAs”
MSN program expanded – NA in 2008
• In 2008, the nurse anesthesia concentration (NA) was
added to the MSN degree program.
• The nurse anesthesia concentration at LMU can be
completed in 28 months of full-time study and
requires 88 credit hours of graduate course work
including six semesters of clinical practice.
• Full-time status is required.
• The Post-Master’s Certificate option is available.
2010 Feasibility Survey
• This study required a one-time completion of the
survey questionnaire, either by nurses or employers
of nurses.
• The study included a convenience sample of 29
nurses and 14 potential employers of advanced nurse
practitioners.
• It took approximately 5 minutes to complete each
questionnaire.
• Participation was strictly voluntary. Completion of the
questionnaire was used to verify participants’ consent
to participate in the study.
Data Analysis
• Data collection were completed in the fall of 2010.
• Data analysis were completed in the spring of 2011
• Descriptive statistics are used to better understand
the needs and wants of local nurses and potential
employers of nurses with graduate degrees.
Nurse Sample (n=29)
Nurses
with Interest
Nurses
without Interest
Total
Female
17 (81%)
8 (100%)
25 (86%)
Male
4 (19%)
0 (0%)
4 (14%)
High School
3 (14%)
2 (25.0%)
5 (17%)
AD/ASN
8 (38%)
1 (12.5%)
9 (31%)
BSN
10 (48%)
4 (50.0%)
14 (49%)
Graduate
0 (10%)
1 (12.5%)
1 (3%)
30.24*
53.63*
36.69*
Gender
Education
Mean Age
* t=-4.5, p<.001
Findings about Degrees
Yes
Are you interested in obtaining
additional nursing education?
No
Total
21 (72%)
8 (28%)
29 (100%)
4 (19%)
17 (81%)
21 (100%)
MSN
13 (62%)
8 (38%)
21 (100%)
DNP
6 (29%)
15 (71%)
21 (100%)
PhD
2 (9%)
19 (91%)
21 (100%)
RN-to-BSN
Findings about Specialty Interest
Yes
No
Total
What specialty are you interested in?
Family Nurse Practitioner
15 (71%)
6 (29%)
21 (100%)
Psychiatric Mental Health Nurse Practitioner
5 (24%) 16 (76%)
21 (100%)
Pediatric Nurse Practitioner
5 (24%) 16 (76%)
21 (100%)
Adult Health or Geriatrics
4 (19%) 17 (81%)
21 (100%)
Women’s Health
3 (14%) 18 (86%)
21 (100%)
Certified Registered Nurse Anesthetists
1 (5%) 20 (95%)
21 (100%)
Nursing Administrator
1 (5%) 20 (95%)
21 (100%)
Critical Care Nurse Specialist
1 (5%) 20 (95%)
21 (100%)
Findings about Application Interest
Yes
No
Total
What specialty would you apply for?
Family Nurse Practitioner
14 (67%)
7 (33%)
21 (100%)
Psychiatric Mental Health Nurse Practitioner
4 (19%) 17 (81%)
21 (100%)
Pediatric Nurse Practitioner
5 (24%) 16 (76%)
21 (100%)
Adult Health or Geriatrics
4 (19%) 17 (81%)
21 (100%)
Women’s Health
5 (24%) 16 (76%)
21 (100%)
Certified Registered Nurse Anesthetists
1 (5%) 20 (95%)
21 (100%)
Nursing Administrator
1 (5%) 20 (95%)
21 (100%)
Critical Care Nurse Specialist
1 (5%) 20 (95%)
21 (100%)
Findings about interest in LMU
When would you like to begin
your nursing program?
About
1-2
years
About About 6 or
2-5
more
years years later
14
(67%)
7
(33%)
0
(0%)
Total
21
(100%)
Findings about start time
If LMU were to offer a Family
Nurse Practitioner (FNP) program
in Kingsport, would you apply?
Yes
No
Not
Sure
Total
10
(48%)
6
(29%)
5
(24%)
21
(100%)
Findings about location
At what location
would you prefer to
attend classes?
Kingsport
Knoxville
Johnson City
Total
17 (81%)
3 (14%)
1 (5%)
21
(100%)
Findings about program length
What time frame do
you prefer to
complete this
degree?
Within 12
months
Between
12 & 18
months
1 (5%)
9 (43%)
Between
No
18 months Preference
&
2 years
7 (33%)
4 (19%)
Findings about program delivery
What delivery method
do you prefer to
obtain this degree?
Classroom
Courses
Online
Courses
Combined
Courses
Total
6
(29%)
6
(29%)
13
(62%)
21
(100%)
Findings about class hours
What time of day
would you prefer for
class instruction?
Daytime
Classes
Evening
Classes
Weekends
Block
scheduling
13
(62%)
9
(43%)
5
(24%)
5
(24%)
Findings about employer’s interest
Yes
No
Total
Does your facility utilize nurses with
graduate degrees?
10 (71%)
4 (29%)
14 (100%)
Would your facility hire a nurse
practitioner?
12 (86%)
2 (14%)
14 (100%)
Would your facility hire a new
graduate as a nurse practitioner?
12 (86%)
2 (86%)
14 (100%)
Specifics about employer's Interest
Yes
No
Total
What position do you have for them?
Family Nurse Practitioner
3 (21%)
14 (100%)
1 (7%) 13 (93%)
14 (100%)
Pediatric Nurse Practitioner
2 (14%) 12 (86%)
14 (100%)
Adult Health or Geriatrics
2 (14%) 12 (86%)
14 (100%)
Women’s Health
6 (43%)
8 (57%)
14 (100%)
Other
2 (14%) 12 (86%)
14 (100%)
Psychiatric Mental Health Nurse Practitioner
11 (79%)
Findings about employer’s need
Would your facility
need a nurse
practitioner?
Full-time
(32-40
hours per
week)
Part
(less
than 32
hours
per
week)
No need
at
present
time
Total
7
(50%)
1
(7%)
6
(43%)
14
(100%)
Difference between nurses and employers
by Pearson Chi-Square
Yes
Family Nurse Practitioner
Nurses
Employers
No
p value
24 (77.4%)
14 (66.7%)
10 (100%)
7 (22.6%)
7 (33.3%)
0 (0.0%)
0.04*
Psychiatric Mental Health NP
Nurses
Employers
4 (12.9%)
4 (19.0%)
0 (0%)
27 (87.1%)
17 (81.0%)
10 (100.0%)
0.14
Pediatric Nurse NP
Nurses
Employers
7 (22.6%)
5 (23.8%)
2 (20%)
24 (77.4%)
16 (76.2%)
8 (80.0%)
0.81
* Person Chi-square=4.3, p<.05
Difference between nurses and employers
by Pearson Chi-Square
Yes
Adult Health or Geriatrics
Nurses
Employers
Women’s Health
Nurses
Employers
* Person Chi-square=3.9, p<.05
No
P value
6 (19.4)
4 (19.0%)
2 (20.0%)
25 (80.6%)
17 (81.0%)
8 (80.0%)
0.95
11 (35.5%)
5 (23.8%)
6 (60.0%)
20 (64.5%)
16 (76.2%)
4 (40.0%)
0.049*
SWOT Analysis
Strengths (S)
• Included both nurses and
employers
• Allow comparisons by
using same rating scale
• Including open-ended
questions
•
•
•
•
Weaknesses (W)
Small sample size (Nurse
N=29; Employer N=14)
Convenience sample
Single healthcare facility
Low response rates
among employers
(36.8%)
SWOT Analysis (continued)
Opportunities (O)
• Preparing nurses at the
graduate level
• Responding respond to
the needs of nursing
education and healthcare
in the surrounding
communities by preparing
nurses at graduate level
Threats (T)
• Recent economic
recession in USA
• Several existing FNP
programs in the nearby
areas
• Newly launched FNP
program in the service
area
Why not FNP?
Four main reasons for us
not launching our new FNP
program
in the new service area
Small Sample
Size
Single Survey
Site
Recent
economic
recession
Newly launched
FNP program
nearby
Program expanded further – PMHNP in 2011
• As we continued to live up to our mission in seeking
to respond to the needs of nursing education and
healthcare in the surrounding communities, the
school received phone calls and inquiries for
Psychiatric Mental Health Nurse Practitioner.
• In January 2011, the Psychiatric Mental Health Nurse
Practitioner was added to our MSN degree program.
• The PMHNP concentration at LMU can be completed
in 12 months of full-time study and requires 41 credit
hours of graduate course work including 500 clinical
hours.
• The Post Master’s Certificate option is available.
Implications
• The knowledge gained may also allow nurse
researchers to utilize this knowledge to plan,
implement, and support culturally sensitive
educational initiatives for graduate nursing programs.
• Understanding gained from this survey study will aid
nurse educators and clinicians in identifying
systematic ways to support nursing education through
graduate studies.
• Lastly, the survey data are important for approval and
accreditation processes and should be incorporated in
the systematic plan for evaluation of graduate nursing
programs.
Program Develop Cycle
Mission
Outcome
Evaluation
Feasibility
Studies
Program
Development
Focus
Groups
SWOT
Analysis
Conclusion
• The findings from this feasibility study provides
information about the most effective and efficient
ways to design, development, implement, and
evaluate a graduate nursing program for nurses
serving rural communities.
• Conducting such feasibility studies assists the
educational institution in establishing if a need for
educational programs exists in an area before
proceeding with instituting a program.