Slaying the Dragon of Curriculum Review

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.

QThe faculty and I are in the midst of a major curriculum review.  After an intensive literature search and thorough review of our student learning outcomes and program outcomes, we are aware that our program needs updating.  As recommended at a recent self-study forum that many of us attended, we spent recent faculty meetings discussing the “heaviness” of our curriculum. Over the past several years, it has become easy for us to say that based on our licensure examination rates, which have been at expected levels, we only need to add or update the content, particularly the pharmacology content, but, honestly, we have not really engaged in a comprehensive review of the curriculum in more than ten years.  I will admit that we are often heard to say, “Why mess with something that is working?”  However, you and the other speakers made it clear that a curriculum based on competencies that are more than ten years old is not preparing graduates for contemporary practice.  So, where do we go from here?  Do we need to report the work that we are doing?  Or do we wait until the project is totally completed?

AYou are to be congratulated for slaying the dragon of curriculum review.  I once accepted a position at a college in which several seasoned faculty members told me that they “inherited” the program philosophy, conceptual framework, and terminal objectives when they arrived more than 20 years ago, and “it had been working ever since.” Needless to say, I was not popular for suggesting that perhaps we needed to examine the curriculum and do a little more than “tweaking” of content. Taking on the challenge of a “real” curriculum review can seem formidable, but it is absolutely necessary in today’s healthcare and education environments.  I often find that programs adjust content by moving it from one academic term to another, or they add some new information or content here and there without ever really conducting a comprehensive review.  Trust that it is obvious during on-site interviews with administrators and faculty when a piecemeal review has been a program’s primary approach to curriculum revision.  However, your strategy of beginning with an intensive literature search is a solid one.  Often, programs do not take the time needed to examine the evidence or even analyze their own data.  I hope that you have engaged all of your stakeholders in the review process, particularly your clinical partners and students.  Their contributions can be invaluable to a review process if you take the time to dialogue and not simply depend on the standard employer and graduate satisfaction surveys, which tend to be insufficient in providing the qualitative data that you will need to guide the decision-making process.

In terms of reporting to the NLNAC, it is important that you keep us informed of your plans.  It sounds as if you may have a new mission/philosophy/core values in the formative stages that will need to be reported once approved through your internal channels.  Any changes in the program of study that includes new courses, course sequencing, change in credit hours/allocations, learning outcomes, etc. will also need to be included in a substantive change report.  It is essential that all curriculum changes be reported a minimum of four months in advance of implementation.  If you plan to begin the revised/new curriculum with an incoming class, you may have more than one program of study being taught within the same academic year.  While this may challenge your faculty’s flexibility, it is common practice to finish one curriculum plan and start a new one with an incoming class.  How you implement the change will be up to you and the faculty; however, you will need to be clear about the implementation date in your report.  I would encourage you to utilize the Guidelines for the Preparation and Submission of Planned and Unplanned Substantive Change Reports available on the NLNAC Web site at www.nlnac.org.

Please be certain to include the accreditation standards and criteria, particularly Standard 4 Curriculum, in the review process.  As you know, the standards are currently undergoing their own review, and new standards will be released in January 2013.  I would recommend that you include the draft document of the 2013 standards as you discuss changes to ensure that the revised curriculum will be in compliance with the standards.  Although minimal changes have been recommended for this standard by the subcommittees and by the comments received through the open review periods, the language in the standard is quite clear in terms of expectations about the use of current professional guidelines and competencies to guide the curriculum.  Also, you and the faculty should strive to ensure that the student learning outcomes, if revised, are stated in specific and measurable terms to guide the curriculum, learning activities, and evaluation methodologies.  Best wishes to you in this important work!

QTotal program credit hours have become the latest topic of conversation at our college as our state is proposing a cut to 60 credit hours for associate degree programs and a maximum of 120 hours for baccalaureate programs.  As a faculty, we are close to a hysterical state as we think about cutting 15% of our program.  How can we maintain accreditation if our program is slashed to this level?  We may lose ten nursing credits, so we believe there is no way that the content can be covered adequately.

AYou and your colleagues are facing a scenario that is similar to that being repeated in a number of states as the state governments and higher education agencies attempt to balance budgets with disappearing resources.  It can be overwhelming to think that resources may be cut by 5, 10, or 15% over the next few years and to consider the consequences this may cause.

However, please know that decreases in total program credits have been accomplished successfully in the past.  One state in which all degree-granting programs have been successfully accredited for many years faced this situation over ten years ago.  The deans and directors of the nursing programs worked cooperatively to carefully examine each course and credit hour allocation to determine an agreed-upon reduction in credits.  They were also able to successfully defend a slight increase in the credit hours such that nursing was allowed a ten percent higher allocation of credits for associate degrees and also an increase in the number of credits (over the 120) for baccalaureate degrees.  I will not tell you that it was a painless process to decrease total credits in highly successful programs, but it was handled well by the nurse administrators and faculty.

One of the issues that became apparent very quickly in the reduction process was the fact that a content-laden curriculum would not survive the cuts in credit hours.  The faculty accepted the challenge of redefining their approaches and teaching strategies in the classroom and clinical areas.

At recent meetings in Washington related to federal financial aid programs, we were reminded of the need for all of higher education to be good stewards of student aid monies. The credit creep and lengthening of program time that has occurred is an issue for many programs, particularly certificate and associate programs. The NLNAC Board of Commissioners has been engaged in dialogue about NLNAC’s role as Title IV Gatekeepers. Additionally, your colleagues on the standards and criteria subcommittees have worked on determining national standards of quality related to program length.

I would encourage you to network with colleagues who are facing similar challenges as you seek best practices within the prescribed number of credits. This is also an ideal time for you to engage in a comprehensive curriculum review and begin to develop strategies for a well-constructed curriculum that can be delivered in less time with maximum effectiveness in terms of instructional methods and assessment of student learning.

This is a non-final version of an article published in final form in the NURSE EDUCATOR Journal.  November/December 2012 Vol.37, No.6 http://journals.lww.com/nurseeducatoronline/toc/2012/11000