NONPF's Interpretation of the Criteria for Evaluation of Nurse Practitioner Programs

Background

The NONPF Board of Directors and Membership, among other organizations, has viewed commitment to quality nurse practitioner (NP) education as a major thrust of NONPF’s mission since the inception of the organization and has provided leadership to that end.  In 1995, at the request of the National Council of State Boards of Nursing (NCSBN), NONPF provided leadership for a meeting in Colorado that served to convene a national consortium of NP stakeholders.  This meeting led to the establishment of the National Task Force (NTF) on Quality Nurse Practitioner Education.  The NTF was composed of representatives from NONPF, the specialty NP organizations, the NP certifying bodies and nursing accreditors, and regulators.

The NTF developed and promulgated the Criteria for Evaluation of Nurse Practitioner Programs, a set of criteria by which educators, regulators, accreditors, as well as individual schools and faculty, could monitor and evaluate the quality of nurse practitioner educational programs and tracks. The intent of the NTF was to put in place a set of standards by which accreditors could review graduate nurse practitioner (NP) education with the specificity needed to offer appropriate feedback and counsel to schools, administrators and faculty.  The National Task Force Criteria (NFTC) were first published in 1997 and, since that time, have been implemented by many entities in a voluntary way.

Since 1997, NONPF has received numerous requests from its membership for clarification on the NTFC.   Early in 1999, NONPF appointed Dr. Charlene Hanson to head a special task force for the purpose of developing recommendations on how to assist programs in utilizing the NTFC to enhance the quality of nurse practitioner education.  The special task force identified two levels of service that NONPF should provide to assist programs towards that end:   Level one offers an interpretation of key components of the NTFC, and Level two will offer a consultative service to NONPF members in the process of evaluating and monitoring NP educational programs.  The task force completed level one as part of its charge, and NONPF is establishing a new task force to develop level two.

The following interpretation of the NTFC reflects the views only of NONPF.  The special task force identified key areas of the criteria that have generated the most questions and discussion, and what follows is NONPF’s interpretation of the intent of these sections.  This interpretation is provided to assist programs as they implement the NTFC.  Please refer to the opening statements in interpretation for further clarification of the authorship and intend of these interpretive comments.  For additional information, please contact the NONPF office at nonpf@nonpf.org or (202) 289-8044. 

NONPF’s Interpretation of the National Task Force Criteria (NTFC) for Evaluation of Nurse Practitioner Programs 1997

The NTF’s charge was to develop nurse practitioner program review guidelines, and the NTFC were created by and are the property of the national consortium.  There is often confusion about the ownership of the NTFC because 1) NONPF was the convener of the national consortium composed of national specialty APN professional organizations, certification agencies and nursing accreditors and regulators, and 2) because NONPF published the final document.  However, it is not within NONPF’s purview, or any other sole contributor, to unilaterally change the criteria at this time.  The NTF carried out its work in 1995-1997 and published its report in 1997.

As faculty, programs and various regulators and reviewers have implemented the NTFC to either develop new programs or review existing ones, several questions have arisen regarding the interpretation of various sections. This corollary serves to assist users to better understand the intent of certain sections in the hope of making the NTFC document easier to understand and implement.  These comments are meant to be utilized as an interpretive guideline to the NTFC, as a companion to the NTFC and not in isolation.  NONPF developed these interpretive statements in an effort to clarify for our membership how to operationalize the NTFC.

Criteria for Evaluation of NP Programs – Interpretive Comments

General

The NTF developed the criteria with the intent of their implementation within a national nursing accreditation process. The NTFC provide the framework to evaluate individual NP educational programs regardless of specialty In addition, the NTFC provide the basis for the process for consultation and review provided by NONPF.  In some areas, the NTFC are very specific as to what components are needed to assure the ability of NP educators to prepare competent NP graduates. The criteria in other instances are flexible to allow for interpretation across specialties and programs without quantifying the criteria to the degree that it is difficult to achieve in a reasonable manner. Both the specificity and generality of the criteria have created a need for some interpretive comments.

Criterion I    Organization and Administration

The thrust of the first criterion deals with institutional support and understanding of NP education at the graduate nursing level.

Interpretation

The statement that “the NP educational component is directly coordinated by a qualified NP faculty member” (I.A) is based in the concern that curriculum and program development and oversight is carried out by faculty who understand the scope and direction of NP education.  In schools where there are several tracks, the NP Coordinator or Director may be credentialed in a particular specialty but oversee other NP tracts administratively. Thus, in larger schools, lead faculty in a specialty may have the NP specialty certification while the overall Director/Coordinator may be credentialed in another specialty. A qualified NP faculty member is: a) authorized by the state licensing entity to practice as a nurse practitioner; b) currently nationally certified and has current clinical practice sufficient to maintain certification in the APN specialty and c) meets qualifications for a faculty position in the school of nursing.

Supporting documentation includes:

• Curriculum Vitae;
• Credential as a NP in the state of practice;
• Proof of certification;
• Form #4 from Evaluation Criteria document;
• Examples of published papers relevant to NP practice (curricular, models, research) in journals or book chapters in past 5 years; demonstrates leadership/membership on advisory boards related to NP practice;
• Project director on NP training grants.

Interpretation

The intent of the requirement that “institutional support ensures that NP faculty obtain and maintain currency in clinical practice” (I.B) is to assure competent faculty role models for students and to provide faculty who can adequately evaluate students and interface with preceptors in the field. It is also intended to strongly encourage, though not require, administrative support for faculty to practice the required clinical hours for re-certification. It is suggested that deans, new NP program directors, and other new NP faculty utilize NONPF and other publications on faculty practice to develop models and information that can be tailored to each school/program.

Supporting documentation includes:

• Submission of institutional policies or guidelines that enable NP faculty to practice a certain percentage of time as part of their faculty load;
• A letter from Dean or copy of policy that allows faculty to practice as part of the teaching load;
• Evidence of faculty practice plan;
• Evidence of research and practice integration;
• Evidence of practice as part of promotion criteria.

Criterion II    Students

This criterion relates to student admission and progression requirements.  Questions primarily center on the extent of documentation a program should provide to meet the requirements that “admission criteria specific to the NP program, if present, are established by NP program faculty prior to admission” (II.A) and “progression criteria specific to the NP program, if present, are established by faculty” (II.B).

Supporting documentation includes:

• Submit a copy of criteria, if available, and admission packet.
• Submit a copy of student progression criteria and admission packet.
• Submit Program of study for both full and part time study which includes didactic and clinical progression, sequencing of courses, mechanism and process for students requiring remediation in order to progress.

Criterion III    Curriculum

NP program faculty members have ongoing dialogue and discussion regarding the NP track planning, development, evaluation, and revision.  See specialty program standards, American Association of Colleges of Nursing’s (AACN) Master’s Essentials for the specific content required for adequate curriculum. See NTFC for specific sub-sets of criteria for Curriculum section.

Interpretation

A clear curriculum plan (both didactic and clinical) consistent with the competencies required for the NP specialty should be in place. The NP curriculum specialty courses should build on the Master’s core courses and APN core courses (see AACN Essentials) and sequenced appropriately. National standards used in curriculum development should be identified.

Program should add methods used in delivery of the curriculum, including distance learning modalities.  Programs should clearly demonstrate 1) how nationally recognized quality standards are met, 2)  how the clinical component is being accomplished,  and 3) methods of evaluating student competence.

NP education overall requires a minimum of 500 supervised clinical hours.  Clinical hours are defined as patient contact for clinical management.

Post- masters students who are transitioning from one NP specialty to another must complete a sufficient number of clinical hours to establish competency in the new specialty. The national certification eligibility requirements for post-masters students should guide programs in setting the number of clinical hours for the specialty.  Post-masters students who are non-NPs must complete a minimum of 500 supervised clinical hours.

Blended role curricula prepare students who are eligible to take certification in two specialty areas.  The content of the two specialties are additive, meaning that content and clinical experiences in both specialties must be addressed and clinical experiences in both areas must be completed.  There is an expectation that the number of clinical hours will be higher than for a single specialty program.

Both the post-masters and blended role programs of study require careful advisement and transcript review to reduce redundancies.  Special consideration should be given to NPs expanding into other NP specialties by allowing them to challenge selected courses and experiences; however, didactic and clinical experiences shall be sufficient to allow the student to master the outcome criterion of the new area of NP practice and meet with certification eligibility requirements for both specialties.

Supporting documentation includes:

• Submit forms 1 and 2 of the NFTC;
• Submit curriculum committee minutes that demonstrate NP faculty course direction;
• Submit a list of national standards used to develop the curriculum;
• Submit the date of the School's last national accreditation and next visit;
• Submit syllabi, course objectives, etc. for specialty courses (e.g. Primary Care I);
• Submit process used to evaluate and accept credit transfer for post-master's students with NP preparation or to MSN students with NP preparation;
• Submit forms or process used to document student learning experiences and clinical hours.

Criterion IV    Resources, Facilities, and Services

The intent of this criterion is to assure that the institution has adequate resources, facilities, and services to support the planning development and on-going implementation of the NP program/track. See NTFC document for specific sub-sets of criteria for this section.

Interpretation

The faculty/student ratio is sufficient to assure adequate supervision and evaluation.  The intent of the ratio designation is based on the premise that preparing competent health care providers is a faculty intense process that requires considerable faculty role modeling and direct student evaluation to determine competence.  The issue is not about programs using a 1:6 vs. 1:7 faculty/student ratio but rather about programs using a 1:6 versus 1:15 ratio.

Factors to be considered by faculty:
It is incumbent upon the NP program to give clear rationale for the faculty support of the numbers of students enrolled in clinical courses at a given time. The intent of the faculty/student ratio was also to refer to one clinical course/experience.  For example, a faculty member could have 6 students in one course and 6 in another during the semester. Another factor is the cumulative teaching /administrative duties of the faculty member aside from the clinical course load. Ratios are determined based on whether faculty are directly supervising students in their own practice site (1:1 or 1:2) or indirectly supervising students who are working with other preceptors where the role of the faculty, in part, is to coordinate the experience, interact with the preceptor and evaluate the student   (~ 1:6).

Clinical preceptors should be oriented so that they understand the learning goals of the clinical experience and the level of progression that the student has attained. Overall responsibility for student evaluation is the responsibility of the NP faculty with input from the preceptor. Direct clinical observation of student performance is essential.  Direct observation can be supplemented by indirect evaluation methods such as student-faculty conferences, computer simulations, telephone, videotape sessions, written evaluations, and/or clinical simulations.

Adequate clinical sites are becoming an increasingly scarce commodity to obtain. Evidence of appropriate clinical sites based on the NP specialty should be submitted. Part of the NP faculty role is to interface closely with preceptors to assure appropriate clinical experiences for students.

Supporting documentation includes:

• Submit all forms as required in the NFTC;
• Describe institutional and clinical resources (library, lab, classroom, clinical);
• Describe student/faculty ration and rationale;
• Submit didactic and clinical evaluation forms used;
• Describe and submit material about preceptors' qualifications and orientation procedure.

Criterion V    Faculty - Full, Part-time, and Clinical

The intent of the faculty criterion is to assure that faculty who teach NP students have the needed knowledge and skills to implement the curriculum in the designated NP Specialty.  See NTFC for sub-sets related to faculty criteria.

Interpretation

The purpose of the faculty profile document is to confirm that faculty have the preparation, knowledge base and clinical skills appropriate to their area of teaching responsibility. Non-NP faculty teaching nurse practitioner graduate courses must have expertise in the area in which they are teaching.

An adequate supply of clinically expert faculty has been a concern in the face of the proliferation of programs nationwide. The intent of the faculty mentoring statement in A sub 3 (which relates to NP faculty having less than 800 clinical hours of practice as a graduate NP) is to assist in the building of an adequate faculty pool for programs that are developing and having difficulty attracting experienced faculty.  Mentoring new and inexperienced faculty from a clinical perspective is perceived by NONPF as a positive experience that assists new NPs into the role of NP faculty educators.  Indirectly it supports administration to allow adequate practice time to build competent faculty for a program or track.

Supporting documentation includes:

• Submit all forms as required in the NFTC that attest to credentialing, national certification, preparation and practice;
• Submit faculty development plan

Criterion VI    Evaluation

The intent of this criterion is to provide an evaluation process that fits within the school of nursing mission and structure.

Interpretation

Evaluation is always an area of concern for programs undergoing accreditation procedures.  This criterion speaks to the need for an evaluation plan that speaks directly to the NP program/track and how NP education fits within the overall school of nursing graduate program.   This plan should include evaluation of program outcomes, objectives, courses, faculty, students, clinical sites/preceptors regularly (at least once per year). As well, the overall curriculum and program of study should be formally evaluated every 3-5 years. The process of how evaluation is carried out within the school and NP program/track is an important component.

Supporting documentation includes:

• Submit all forms and processes used for evaluation as required in the NFTC;
• Submit didactic and clinical evaluations, student course evaluations, student teacher evaluations, and clinical evaluations;
• Submit School evaluation plan and how NP programs fit into this plan;
• Submit pass rates of students on national certifying exams;
• Submit and evaluation plan to measure outcomes of graduates at 1 year and 5 years post-graduation;
• Documentation of curricular decisions based on evaluation.