Program Length: Does Extended Length Equal Quality?

Sharon J. Tanner, EdD, RN
Chief Executive Officer, National League for Nursing Accrediting Commission

This column provides information on accreditation for nursing programs of all types. Readers may submit questions to the National League for Nursing Accrediting Commission. General questions of interest to a wide audience will be addressed in this column while more specific questions or those requiring confidentiality will be answered directly.

QIn a recent review by NLNAC of a substantive change related to an update of our curriculum, our program was asked to respond to a concern related to the length of our associate degree nursing program.  Our program is a two-year program that offers an associate of science degree.  The nursing courses are offered over five terms: four regular semesters and a summer session for the microbiology course, one of the medical-surgical nursing courses, and a two-credit pharmacology course.  There are general education courses along with the nursing courses each semester, but the concern appears related to the general education courses that are required as prerequisites to the program.  Students must complete these courses prior to admission to the first nursing course; some of the students take the courses full-time for three semesters, and others take longer if they are working or have family obligations.  There was a recent change in policy for our College, and an introductory course in biology is now required prior to the two semesters of anatomy and physiology that are part of the pre-admission requirements along with writing composition, psychology, and college-level math.  Because the nursing courses are completed in two years, the faculty and I are somewhat confused by the request for additional information about the program length.

AYour question is becoming more and more common at the individual program level, the state level, and also nationally.  You may have recently read about the national attention being focused on federal financial aid related to the number of credits that students are taking for a particular degree type; often the student wants to continue his or her education and discovers that eligibility for aid has been exhausted.  Also, in order to qualify for aid, students will often take “extra” classes so they will be considered full-time. In addition, students will repeat courses even when they have been successful in the courses to improve their overall GPA in an effort to be admitted to a selective admission program such as nursing.  There will be continuing conversation about these issues as institutions strive to enhance their accountability in terms of awarding federal aid.  These are critical issues to consider as nursing attempts to move associate graduates forward into baccalaureate and master’s programs to meet the goal of lifelong learning and prepare increasing numbers of nurses with additional education. As an accrediting agency and Title IV Gatekeeper approved by the U.S. Department of Education, the NLNAC assumes responsibility for ensuring that compliance with the financial aid regulations is documented at all institutions in which we accredit a nursing program.

Accreditation policies specify that a program include all required courses/credits in the program of study when determining the total number of credits and academic terms.  If it takes a nursing student a minimum of seven academic terms to complete all requirements of the nursing program, then the program is not a two-year nursing program.  Of course, students may elect to take courses part-time if that is an option to them, but the scenario you are describing requires a minimum of seven terms to complete.  Developmental courses (non-college level) are not considered in this total, as requirements related to these courses depend on when students completed high school and their academic readiness for college-level work.

A third important factor to consider is how the program is presented in its public information.  Often when we review a substantive change report or conduct a regularly scheduled accreditation review, we find that there are “hidden” credits within a program.  It is absolutely essential that all public information be accurate, clear, and current so that potential and current students are made aware of the time that will be involved in completing the program of study.  The U.S. Department of Education Regulations and accreditation policy address this for all types of programs, but particularly for those programs such as nursing that have multiple types of instruction including didactic, laboratory, and clinical aspects required for completion.

Also, I would mention that we have a number of initiatives in development and under review in regional and state-wide reforms that will change the focus of associate degree programs and students to a three plus one process or other alternative academic plan in an effort to prepare a greater number of baccalaureate nurses.  In these situations, we work with the consortiums or state higher education groups to ensure that seamless articulations are truly that, and they afford the student the opportunity to move forward without duplication of coursework or repeat of content.

QWe will soon be under a state-wide mandate to decrease the number of credits in our nursing program.  At present, our baccalaureate program has 131 total credits that are taken over eight semesters.  We have been told that all baccalaureate programs will be cut to a maximum of 120 hours; there may be a few exceptions allowed, but even then, we are not hopeful that more than 124 total program credits will be allowed.  This must be inclusive of all program requirements.  How will this impact our accreditation?  This obviously means that we will have to decrease nursing credits, as the general education credits within our curriculum are the minimum core courses required to be awarded a baccalaureate degree in our higher education system.  We are somewhat panicked that this means poorer student learning outcomes and program outcomes, jeopardizing the accreditation of our program.   Is it possible to “fix” this problem by simply changing the contact-to-credit ratios for our clinical experiences?

AThe NLNAC has worked with a number of states that have implemented credit reductions for associate and baccalaureate programs.  Whether the changes have been a means to limit spending, enhance articulation and transferability of credits, or control credit creep in various programs, several states have been successful in decreasing the number of credits in undergraduate degrees.
While it is difficult to “trim” an undergraduate curriculum, it is possible to do so and maintain a quality program.  In fact, we have not seen a negative impact on either student learning outcomes or overall program outcomes when this has occurred as a result of a system-wide change.  You may want to dialogue with your colleagues in states that have already undergone this type of “downsizing.”  Typically, a mandate aimed at lowering program credits serves as an incentive for the faculty to take a thoughtful look at the program of study and implement changes that lead to greater effectiveness in the delivery methods.  It is certainly understandable that you do not want to give up any contact hours in the nursing major courses, but perhaps you can eliminate repetitive content or change the way in which didactic time is currently utilized so that the impact will be lessened.

The choice of ratios for contact-to-credit hours is yours and, of course, the state’s.  However, when reporting the total credit hours for any accredited nursing program, we require that you convert the ratios you use to 1:1 for didactic and 1:3 for laboratory and clinical experiences so that all nursing programs use a consistent ratio in terms of accreditation-related reporting.  Also, before changing any contact-to-credit ratios, it will be necessary for you to confer within your institution as to the impact on tuition and fees for the nursing courses.

And please do not forget that any planned change in curriculum such as a reduction in overall credit hours must be reported to the NLNAC in accordance with Policy #14 Reporting Substantive Changes.  Once the faculty have made the necessary decisions related to the changes, the revised curricular plan will need to be submitted for review in advance of implementation.

This is a non-final version of an article published in final form in the NURSE EDUCATOR Journal. January/February 2013 Vol.38, No.1 http://journals.lww.com/nurseeducatoronline/toc/2013/01000