WEBVTT 00:00:11.861 --> 00:00:14.646 position:50% align:middle - [Nancy] Hello, everyone? I hope you had a good break. 00:00:14.646 --> 00:00:19.211 position:50% align:middle And now, we're going to talk about the site visit study. 00:00:19.211 --> 00:00:22.511 position:50% align:middle You know, I know that I've mentioned that a bit previously. 00:00:22.511 --> 00:00:25.861 position:50% align:middle The site visit study was just an excellent study. 00:00:25.861 --> 00:00:32.430 position:50% align:middle I'm so glad that we were able to do that because it really built in some of the 00:00:32.430 --> 00:00:37.760 position:50% align:middle details that you see sometimes or we saw in the quantitative study, 00:00:37.760 --> 00:00:40.230 position:50% align:middle but that was just a little bit more general. 00:00:40.230 --> 00:00:43.905 position:50% align:middle The site visit study really built things out a bit. 00:00:43.990 --> 00:00:49.210 position:50% align:middle So, in the site visit study, the question was, what are the warning 00:00:49.210 --> 00:00:51.790 position:50% align:middle signs when programs begin to fall? 00:00:51.790 --> 00:00:57.470 position:50% align:middle Remember, the NCLEX pass rate is a lagging indicator, so it comes sometimes 00:00:57.470 --> 00:00:58.760 position:50% align:middle after they've fallen. 00:00:58.760 --> 00:01:03.495 position:50% align:middle So, that was a question, and then it was a qualitative descriptive 00:01:03.495 --> 00:01:08.643 position:50% align:middle design with blended directed content analysis. 00:01:08.643 --> 00:01:11.321 position:50% align:middle Dr. Allison Squires, some of you may know her, 00:01:11.321 --> 00:01:15.275 position:50% align:middle she does a lot of reviewing for the Journal of Nursing Regulation. 00:01:15.275 --> 00:01:19.180 position:50% align:middle She's really well known nationally, and some internationally, 00:01:19.180 --> 00:01:21.057 position:50% align:middle in qualitative analysis. 00:01:21.057 --> 00:01:26.834 position:50% align:middle She did the analysis of this study, and she really just did a phenomenal job. 00:01:26.834 --> 00:01:32.462 position:50% align:middle She worked all summer with one of her doctoral students on this. 00:01:33.434 --> 00:01:37.971 position:50% align:middle So, you can see that, thanks to all of you, 00:01:37.971 --> 00:01:41.695 position:50% align:middle we really had a great response rate to this. 00:01:41.695 --> 00:01:45.289 position:50% align:middle Now, I have to tell you, in terms of background, we had really planned on 00:01:45.289 --> 00:01:47.184 position:50% align:middle five years of the annual reports. 00:01:47.184 --> 00:01:51.438 position:50% align:middle And we got to the board of directors, and, you know, they have to approve all 00:01:51.438 --> 00:01:54.735 position:50% align:middle of our studies, and they said, "Well, why don't you do a site visit 00:01:54.735 --> 00:01:56.237 position:50% align:middle documents as well." 00:01:56.393 --> 00:02:00.069 position:50% align:middle And I was a little worried about that because I didn't think many of the boards 00:02:00.069 --> 00:02:04.505 position:50% align:middle really did site visits or had those documents for five years. 00:02:04.505 --> 00:02:09.805 position:50% align:middle So, we said we'd look into it and we looked into it, and boards were willing, 00:02:09.805 --> 00:02:13.068 position:50% align:middle and look at what we got. 00:02:13.068 --> 00:02:18.462 position:50% align:middle We got 1000 in the end, after all of the exclusions, 00:02:18.462 --> 00:02:24.072 position:50% align:middle 1278 documents for site visits. 00:02:24.072 --> 00:02:30.206 position:50% align:middle Now, remember, many of those documents are very long, and Allison was poring 00:02:30.206 --> 00:02:32.772 position:50% align:middle through all of those in one summer. 00:02:33.477 --> 00:02:38.917 position:50% align:middle Of those, there were 139, and that kind of is on track with what 00:02:38.917 --> 00:02:45.276 position:50% align:middle Brendan had found with the number that didn't have full approval, about 10%, 00:02:45.276 --> 00:02:47.700 position:50% align:middle that were problem programs. 00:02:47.700 --> 00:02:52.869 position:50% align:middle So, they either weren't approved or, you know, the approval 00:02:52.869 --> 00:02:58.623 position:50% align:middle was conditional, provisional, or she also looked at NCLEX pass rates. 00:02:58.987 --> 00:03:06.774 position:50% align:middle Now, we did have a expert panel that came together and looked at all of our results, 00:03:06.774 --> 00:03:09.451 position:50% align:middle and they asked an excellent question. 00:03:09.451 --> 00:03:12.045 position:50% align:middle I always think when you do big studies like this, you should have 00:03:12.045 --> 00:03:15.769 position:50% align:middle an expert panel, just to ask those questions that maybe you 00:03:15.769 --> 00:03:16.626 position:50% align:middle didn't think about. 00:03:16.626 --> 00:03:21.538 position:50% align:middle And one of the questions came from an outside organization, and she said, 00:03:21.538 --> 00:03:27.723 position:50% align:middle "Well, if you only looked at 139..." now, remember, these were 5 years of a lot 00:03:27.723 --> 00:03:31.269 position:50% align:middle of documents, "But if you only looked at that, how do you know some of these 00:03:31.269 --> 00:03:36.736 position:50% align:middle factors didn't also occur in the programs that, you know, were approved, 00:03:36.736 --> 00:03:37.871 position:50% align:middle in the rest of them?" 00:03:37.871 --> 00:03:43.033 position:50% align:middle And so, we got to Allison and they actually had gone through all 00:03:43.033 --> 00:03:50.579 position:50% align:middle of the reports, they focused on those 139, but they went through all of them. 00:03:50.579 --> 00:03:57.561 position:50% align:middle And any of the factors that came out were only factors from the failing programs, 00:03:57.561 --> 00:04:04.017 position:50% align:middle as well as 50% of the programs had to have the factors in order for them 00:04:04.017 --> 00:04:05.224 position:50% align:middle to be included. 00:04:05.224 --> 00:04:12.147 position:50% align:middle So, we're pretty convinced that what this study found was really very accurate. 00:04:14.807 --> 00:04:23.583 position:50% align:middle So, Allison and her colleague looked for saturation, as you do with, you know, 00:04:23.583 --> 00:04:25.339 position:50% align:middle any kind of qualitative study. 00:04:25.339 --> 00:04:30.987 position:50% align:middle And, you know, that's when the themes, you know, are no longer appearing. 00:04:30.987 --> 00:04:38.309 position:50% align:middle And they used this wonderful MaxQDA, which is a cutting-edge software that is 00:04:38.309 --> 00:04:43.461 position:50% align:middle out of Berlin, and it really is used in the analysis of both 00:04:43.461 --> 00:04:46.238 position:50% align:middle qualitative and quantitative studies. 00:04:46.238 --> 00:04:49.485 position:50% align:middle So, it's kind of used in mixed analysis. 00:04:49.485 --> 00:04:55.451 position:50% align:middle And remember, at least 50% of these programs had to have each of these. 00:04:57.069 --> 00:05:01.115 position:50% align:middle So, here are some of the overall observations in this study. 00:05:01.115 --> 00:05:05.770 position:50% align:middle And again, I'm sure you're really anxious to have the full reports of these studies. 00:05:05.770 --> 00:05:10.458 position:50% align:middle And I will let you know as soon as those are going to be available. 00:05:10.735 --> 00:05:16.023 position:50% align:middle So, for overall, for-profit programs have more sanctions. 00:05:16.145 --> 00:05:19.670 position:50% align:middle I don't think any of us are surprised about that. 00:05:19.829 --> 00:05:24.291 position:50% align:middle You will notice, in the approval guidelines, we don't say anything 00:05:24.291 --> 00:05:25.894 position:50% align:middle about for-profit programs. 00:05:25.894 --> 00:05:27.514 position:50% align:middle Do you remember that discussion, Jan? 00:05:27.514 --> 00:05:27.935 position:50% align:middle - [Jan] Yes. 00:05:27.935 --> 00:05:32.085 position:50% align:middle - We, you know, did originally have something, but remember, 00:05:32.085 --> 00:05:37.318 position:50% align:middle we had our attorneys there, and because of, you know, 00:05:37.318 --> 00:05:41.135 position:50% align:middle just Federal Trade Commission issues, we did not include that, 00:05:41.135 --> 00:05:44.331 position:50% align:middle but it does come out in studies, it came out in this study. 00:05:44.331 --> 00:05:49.041 position:50% align:middle It also came out in, if you remember, the Pittman study, 00:05:49.041 --> 00:05:55.393 position:50% align:middle which was another national study that was published, I think was 2019, in JNR. 00:05:55.685 --> 00:06:01.820 position:50% align:middle Also, the younger programs, now, Allison, when she did the analysis, 00:06:01.820 --> 00:06:04.631 position:50% align:middle says less than 10 years are at risk. 00:06:04.631 --> 00:06:09.600 position:50% align:middle Remember, Brendan also found that with a quantitative study, definitely the younger 00:06:09.600 --> 00:06:14.091 position:50% align:middle programs is, you'll notice...and when we get to the approval guidelines, 00:06:14.091 --> 00:06:16.273 position:50% align:middle we say less than seven years. 00:06:16.663 --> 00:06:20.924 position:50% align:middle So, we took it down a notch based on what Brendan had found, 00:06:20.924 --> 00:06:23.306 position:50% align:middle but it's in that area. 00:06:23.915 --> 00:06:27.033 position:50% align:middle And then triggers for site visits. 00:06:27.033 --> 00:06:31.176 position:50% align:middle Eighty percent or lower NCLEX in four years or more. 00:06:31.176 --> 00:06:34.100 position:50% align:middle That kind of makes sense because if it's in their rules, 00:06:34.100 --> 00:06:35.905 position:50% align:middle it's going to trigger a visit. 00:06:36.149 --> 00:06:39.721 position:50% align:middle Then clinical complaints, again, complaints are coming out. 00:06:39.721 --> 00:06:42.371 position:50% align:middle Remember, they came out before as well. 00:06:42.538 --> 00:06:45.710 position:50% align:middle And public complaints as well about programs. 00:06:45.710 --> 00:06:49.591 position:50% align:middle So, this will be, you know, a clinical facility might call a board 00:06:49.591 --> 00:06:52.323 position:50% align:middle and say, "We don't think this program belongs here." 00:06:52.323 --> 00:06:54.557 position:50% align:middle I think you've had some of those calls in the past, right? 00:06:54.557 --> 00:06:55.219 position:50% align:middle - Yes. 00:06:55.219 --> 00:06:56.132 position:50% align:middle - Yes. 00:06:56.793 --> 00:07:01.178 position:50% align:middle So, you'll see here that we are seeing patterns. 00:07:04.245 --> 00:07:10.040 position:50% align:middle With the site visit study, then, they found administrative processes. 00:07:10.040 --> 00:07:14.186 position:50% align:middle Now, remember, we're looking at those 139 that were failing programs. 00:07:14.231 --> 00:07:15.951 position:50% align:middle Poor record keeping. 00:07:15.951 --> 00:07:19.721 position:50% align:middle You've probably seen these when you've gone and made visits, right? 00:07:20.721 --> 00:07:24.762 position:50% align:middle Lack of policies and procedures, written policies and procedures. 00:07:24.762 --> 00:07:26.064 position:50% align:middle - Yes. - I know that was one of the things... 00:07:26.064 --> 00:07:26.648 position:50% align:middle - That's a big one. 00:07:26.648 --> 00:07:31.615 position:50% align:middle - Yeah, that you were really strong on and promoting in our approval guidelines. 00:07:32.218 --> 00:07:38.064 position:50% align:middle And then lack of quality improvement if there were problems that occurred. 00:07:38.719 --> 00:07:44.532 position:50% align:middle And then lack of faculty and student input into the policies coming from above. 00:07:44.532 --> 00:07:47.154 position:50% align:middle And you see this in some of these programs 00:07:47.154 --> 00:07:50.568 position:50% align:middle Everything comes from above, no input. 00:07:51.023 --> 00:07:57.411 position:50% align:middle And then the students...this was really kind of a sad ones, the students weren't 00:07:57.411 --> 00:08:00.309 position:50% align:middle even able to have educational materials. 00:08:00.309 --> 00:08:02.339 position:50% align:middle Some of the students didn't even have books. 00:08:04.006 --> 00:08:05.608 position:50% align:middle The use of data. 00:08:05.608 --> 00:08:11.875 position:50% align:middle Now, this came out in a site visit study, we didn't include this kind of detail 00:08:11.875 --> 00:08:15.161 position:50% align:middle in the approval guidelines, partly because we didn't find it 00:08:15.161 --> 00:08:16.661 position:50% align:middle in some of the other literature. 00:08:16.661 --> 00:08:23.430 position:50% align:middle But it does make sense, I think, just administrative and faculty competence 00:08:23.430 --> 00:08:27.385 position:50% align:middle in being able to look at the data and interpret the data. 00:08:27.385 --> 00:08:28.711 position:50% align:middle Have you seen that as well, Jan? 00:08:28.711 --> 00:08:32.806 position:50% align:middle - Yes, I know some programs subscribe to Mountain Measurement, 00:08:32.806 --> 00:08:34.578 position:50% align:middle but they don't know how to read the data. 00:08:37.293 --> 00:08:42.475 position:50% align:middle - And, along with that, no internal statistical support for that. 00:08:43.041 --> 00:08:49.332 position:50% align:middle And, you know, that none of their decisions were really based on the data. 00:08:49.332 --> 00:08:53.496 position:50% align:middle So, not good use of data in these failing programs. 00:08:54.922 --> 00:09:00.752 position:50% align:middle I think in terms of students, some of these were a little bit sad. 00:09:00.933 --> 00:09:06.153 position:50% align:middle I thought students being afraid of retaliation from faculty is really sad, 00:09:06.153 --> 00:09:11.292 position:50% align:middle and certainly, you know, student-school relationship. 00:09:11.292 --> 00:09:17.353 position:50% align:middle But one of the things that they found, and more so in practical nurse programs, 00:09:17.353 --> 00:09:22.256 position:50% align:middle was poverty and family issues, and that was really sad, 00:09:22.256 --> 00:09:24.915 position:50% align:middle to find this in some of these failing programs. 00:09:26.093 --> 00:09:29.819 position:50% align:middle They also had, you know, just lack of support 00:09:29.819 --> 00:09:31.718 position:50% align:middle from the program director. 00:09:31.845 --> 00:09:38.951 position:50% align:middle And, you know, in terms of the faculty, you know, not just being there 00:09:38.951 --> 00:09:40.484 position:50% align:middle for the students. 00:09:45.464 --> 00:09:50.659 position:50% align:middle So, as with the literature, and with the quantitative study, and the Delphi, 00:09:50.659 --> 00:09:55.876 position:50% align:middle we have a lot of issues with faculty, but a little bit different issues here, 00:09:55.876 --> 00:09:57.730 position:50% align:middle I think, that we saw. 00:09:59.686 --> 00:10:04.514 position:50% align:middle The thing that really surprised me was lack of basic pedagogies. 00:10:04.514 --> 00:10:08.570 position:50% align:middle Now, I'll go out and make these visits to these failing programs. 00:10:08.570 --> 00:10:14.360 position:50% align:middle So, I tend to go to conferences like NLN or AACN, and I see these really good 00:10:14.360 --> 00:10:17.970 position:50% align:middle faculty that are looking for the new cutting-edge pedagogies. 00:10:17.970 --> 00:10:23.253 position:50% align:middle But what I'm finding, what Allison found, is they didn't even have the basic 00:10:23.253 --> 00:10:25.980 position:50% align:middle pedagogies or they were way behind. 00:10:25.980 --> 00:10:27.130 position:50% align:middle Have you seen that as well? 00:10:27.130 --> 00:10:27.590 position:50% align:middle - Right. 00:10:27.590 --> 00:10:33.505 position:50% align:middle Some have never had any courses in curriculum or education 00:10:33.505 --> 00:10:35.693 position:50% align:middle and they're in teaching. 00:10:35.693 --> 00:10:36.435 position:50% align:middle - Yeah. 00:10:37.245 --> 00:10:44.190 position:50% align:middle And just that transition from practice to teaching was very difficult. 00:10:44.190 --> 00:10:47.881 position:50% align:middle You know, and we see a lot of DNPs now going into programs and 00:10:47.881 --> 00:10:54.729 position:50% align:middle becoming directors, really needing that transition with understanding, you know, 00:10:54.729 --> 00:10:57.474 position:50% align:middle what a pedagogy is even. 00:10:57.474 --> 00:10:59.325 position:50% align:middle Limited mentorship. 00:10:59.325 --> 00:11:05.091 position:50% align:middle Again, these programs, you know, often had faculty who didn't have any 00:11:05.091 --> 00:11:09.973 position:50% align:middle orientation program, you know, much less mentorship for them. 00:11:09.973 --> 00:11:12.144 position:50% align:middle And then lack of graduate degree. 00:11:12.144 --> 00:11:17.509 position:50% align:middle And again, for the PN programs, it was lack of a BSN degree. 00:11:17.509 --> 00:11:20.983 position:50% align:middle And then for the RN programs, a graduate degree. 00:11:21.178 --> 00:11:25.757 position:50% align:middle So again, there is a lot about faculty in the site visit study. 00:11:27.134 --> 00:11:29.959 position:50% align:middle Again, a heavy workload of faculty. 00:11:29.959 --> 00:11:31.946 position:50% align:middle I'm sure you've seen that as well, Jan. 00:11:31.946 --> 00:11:33.684 position:50% align:middle I saw it when I was teaching. - Yes. 00:11:33.684 --> 00:11:34.567 position:50% align:middle - Yes. 00:11:35.133 --> 00:11:37.876 position:50% align:middle The faculty are expected to just do everything. 00:11:38.525 --> 00:11:43.902 position:50% align:middle And sometimes, a board coming in and communicating that to administration 00:11:43.902 --> 00:11:45.031 position:50% align:middle can help them. 00:11:45.887 --> 00:11:47.692 position:50% align:middle Lack of faculty development. 00:11:47.692 --> 00:11:54.735 position:50% align:middle This was very big in the site visit study, that faculty didn't either take any 00:11:54.735 --> 00:11:58.504 position:50% align:middle faculty development or they were offered it by administration. 00:11:58.504 --> 00:12:01.540 position:50% align:middle It wasn't pushed by administration. 00:12:01.645 --> 00:12:04.967 position:50% align:middle And then, you know, we all know faculty turnover. 00:12:07.490 --> 00:12:12.034 position:50% align:middle In our approval guidelines, we don't really have what a specific 00:12:12.034 --> 00:12:14.773 position:50% align:middle turnover is, but we do have it for directors. 00:12:14.773 --> 00:12:17.623 position:50% align:middle You know, not more than three directors in five years. 00:12:17.623 --> 00:12:18.640 position:50% align:middle I love that. 00:12:18.640 --> 00:12:24.168 position:50% align:middle If we could, with our new data collection tool, if we could come to actually what 00:12:24.168 --> 00:12:28.435 position:50% align:middle a turnover would be and calculate it, I think that would be very valuable. 00:12:28.596 --> 00:12:34.180 position:50% align:middle And then, you know, again, this is where we found clinical faculty 00:12:34.180 --> 00:12:36.060 position:50% align:middle more than five years out. 00:12:36.060 --> 00:12:41.771 position:50% align:middle And as you know how I feel about that, they need to be, you know, 00:12:41.771 --> 00:12:44.368 position:50% align:middle have more experience than that as well. 00:12:44.368 --> 00:12:49.705 position:50% align:middle Think of the John Kavanagh situation, you know, that I talked to you about earlier. 00:12:53.671 --> 00:12:58.901 position:50% align:middle So now, in terms of resources, teaching and learning resources, 00:12:58.901 --> 00:13:04.870 position:50% align:middle the quality of syllabi and other materials really was interesting to me. 00:13:05.532 --> 00:13:07.468 position:50% align:middle And this goes to faculty too. 00:13:07.468 --> 00:13:10.599 position:50% align:middle Sometimes faculty didn't even know how to write an objective. 00:13:10.620 --> 00:13:12.728 position:50% align:middle They didn't know how to create a syllabus. 00:13:12.830 --> 00:13:18.590 position:50% align:middle The syllabus was, you know, not related to the overall philosophy. 00:13:18.590 --> 00:13:23.460 position:50% align:middle And when the regulators would go into the classroom and visit the classroom, 00:13:23.460 --> 00:13:28.410 position:50% align:middle what was being said in the classroom, the content, wasn't even similar to what 00:13:28.410 --> 00:13:30.347 position:50% align:middle the description of the course was. 00:13:30.347 --> 00:13:34.034 position:50% align:middle So, you can see these are definitely those failing programs. 00:13:35.167 --> 00:13:41.111 position:50% align:middle Then, faculty, especially adjunct faculty, and part-time faculty, 00:13:41.111 --> 00:13:45.637 position:50% align:middle they might not have their own private office, but they need some kind of office 00:13:45.637 --> 00:13:50.394 position:50% align:middle space to talk to students about, you know, sometimes issues come up that you just 00:13:50.394 --> 00:13:52.320 position:50% align:middle can't talk in the middle of everybody. 00:13:52.780 --> 00:13:57.570 position:50% align:middle And conference rooms available for the adjunct faculty. 00:13:57.570 --> 00:14:01.243 position:50% align:middle And then we go, again, to accredited simulation labs. 00:14:01.243 --> 00:14:05.585 position:50% align:middle And, you know, as I promised in the last Q&A, I will look into how 00:14:05.585 --> 00:14:06.961 position:50% align:middle you get accredited. 00:14:06.961 --> 00:14:07.798 position:50% align:middle Do you... 00:14:07.798 --> 00:14:09.051 position:50% align:middle You weren't there, Jan. 00:14:09.315 --> 00:14:11.026 position:50% align:middle - I was watching you. 00:14:11.026 --> 00:14:12.343 position:50% align:middle - Yes, okay. - Yes. 00:14:13.533 --> 00:14:16.143 position:50% align:middle First of all, it takes funding to do that. 00:14:16.143 --> 00:14:19.430 position:50% align:middle I think you've got to convince someone that it's worth doing. 00:14:20.063 --> 00:14:24.563 position:50% align:middle I was thinking, as you're talking, that these things cannot be found 00:14:24.563 --> 00:14:26.481 position:50% align:middle other than by a site visit. 00:14:26.776 --> 00:14:29.387 position:50% align:middle This is not going to show up on the annual report. 00:14:29.387 --> 00:14:30.903 position:50% align:middle - Right. It isn't, yeah. 00:14:30.903 --> 00:14:34.468 position:50% align:middle - We may have some complaints so that we know their problems, 00:14:34.468 --> 00:14:36.503 position:50% align:middle but you have to go and visit the program. 00:14:36.503 --> 00:14:37.274 position:50% align:middle - Yeah. 00:14:37.274 --> 00:14:39.561 position:50% align:middle And, you know, I think that's... 00:14:39.561 --> 00:14:43.310 position:50% align:middle We put some of these things in the annual report, so we're hoping to get some 00:14:43.310 --> 00:14:46.984 position:50% align:middle of them for those boards are just don't have the resources to do that. 00:14:46.984 --> 00:14:49.532 position:50% align:middle But, you know, I think you made a good point. 00:14:49.532 --> 00:14:54.256 position:50% align:middle And I think also, that's one of the reasons I found this site visit study 00:14:54.256 --> 00:14:55.508 position:50% align:middle to be so valuable. 00:14:57.473 --> 00:15:04.830 position:50% align:middle Then, again, when we come to leadership of the program, this is where we found that 00:15:04.830 --> 00:15:09.725 position:50% align:middle if the director was put in charge of allied health and did not have 00:15:09.725 --> 00:15:14.481 position:50% align:middle an assistant to take care of the day-to-day problems of a nursing program, 00:15:14.481 --> 00:15:15.947 position:50% align:middle there were problems. 00:15:16.057 --> 00:15:19.744 position:50% align:middle So, you know, again, this is in the core data template 00:15:19.744 --> 00:15:21.372 position:50% align:middle that we'll be looking for. 00:15:21.372 --> 00:15:23.393 position:50% align:middle The director did not have a doctorate. 00:15:23.393 --> 00:15:31.723 position:50% align:middle And interestingly, Allison found they weren't really sure what the reason was, 00:15:31.723 --> 00:15:36.493 position:50% align:middle but she kind of went from what her thoughts were, and that was, 00:15:36.493 --> 00:15:42.184 position:50% align:middle even if the person as a director was not experienced, but they had a doctorate, 00:15:42.184 --> 00:15:47.308 position:50% align:middle it seemed to make up for it a little bit, maybe what was in their past experience. 00:15:47.308 --> 00:15:49.359 position:50% align:middle So that was really important. 00:15:49.404 --> 00:15:53.288 position:50% align:middle And then, again, the director, I talked about this previously, 00:15:53.288 --> 00:16:00.085 position:50% align:middle was not an RN, and especially, as I said, happened in for-profit programs that 00:16:00.085 --> 00:16:01.520 position:50% align:middle didn't value RNs. 00:16:01.520 --> 00:16:05.630 position:50% align:middle Now, I don't want you to all think that I don't like all for-profit programs, 00:16:05.630 --> 00:16:09.910 position:50% align:middle but there are some out there that have given problems to boards. 00:16:09.910 --> 00:16:12.609 position:50% align:middle There are others that are very good. 00:16:15.970 --> 00:16:18.722 position:50% align:middle Then the organization. 00:16:19.516 --> 00:16:27.278 position:50% align:middle Major organizational changes in the name of efficiency, making it more efficient, 00:16:27.278 --> 00:16:33.310 position:50% align:middle was really kind of masked by saying, "We're going competency based," 00:16:33.310 --> 00:16:38.593 position:50% align:middle but they were really getting rid of faculty and masking that. 00:16:38.593 --> 00:16:43.304 position:50% align:middle Oftentimes, if they made one of those major organizational changes, 00:16:43.304 --> 00:16:47.710 position:50% align:middle "We're going to, you know, competency based, we don't need all these 00:16:47.710 --> 00:16:52.539 position:50% align:middle faculty in one, two, three years," then they found NCLEX pass rates, 00:16:52.539 --> 00:16:54.315 position:50% align:middle and again, lowering. 00:16:54.315 --> 00:16:56.684 position:50% align:middle And again, that shows that lagging factor. 00:16:56.684 --> 00:17:00.437 position:50% align:middle - Yes. When they make those big changes, it trickles down. 00:17:01.003 --> 00:17:05.383 position:50% align:middle The faculty become disenchanted with their jobs, so they start leaving. 00:17:05.383 --> 00:17:10.164 position:50% align:middle students start feeling the effect of it, and then it affects their performance. 00:17:10.164 --> 00:17:14.512 position:50% align:middle - Yes. And it affects who they draw into their program. 00:17:14.512 --> 00:17:15.607 position:50% align:middle - Yes, it does. 00:17:18.103 --> 00:17:19.789 position:50% align:middle - This may have been... 00:17:19.789 --> 00:17:22.286 position:50% align:middle Somebody asked what my biggest surprise was, and I really hadn't 00:17:22.286 --> 00:17:24.711 position:50% align:middle thought about that before, so it was a great question. 00:17:25.269 --> 00:17:30.277 position:50% align:middle But this was the finding that warmed the cockles of my heart. 00:17:30.381 --> 00:17:35.204 position:50% align:middle And that is the state regulatory context. 00:17:35.214 --> 00:17:40.667 position:50% align:middle What they found in the site visit study was that it really made a difference 00:17:40.667 --> 00:17:42.651 position:50% align:middle when you approve nursing programs. 00:17:42.651 --> 00:17:46.855 position:50% align:middle Now, there are some of you out there that maybe have had legislators go to the board 00:17:46.855 --> 00:17:50.077 position:50% align:middle and say, "Why do you need to be in the business of approval if your 00:17:50.077 --> 00:17:51.778 position:50% align:middle programs are accredited?" 00:17:51.778 --> 00:17:56.741 position:50% align:middle This finding showed why it really made a difference in those programs, 00:17:56.741 --> 00:17:59.301 position:50% align:middle even when the programs were accredited or not. 00:17:59.301 --> 00:18:03.994 position:50% align:middle And I've talked a little bit to Jan about this, just about approval 00:18:03.994 --> 00:18:05.490 position:50% align:middle protecting the public. 00:18:05.490 --> 00:18:06.315 position:50% align:middle - Yes. 00:18:06.443 --> 00:18:13.604 position:50% align:middle It also...because we do have the power to approve, people listen. 00:18:13.893 --> 00:18:20.038 position:50% align:middle And I know in my experience recently on a survey visit, I found that there was not 00:18:20.038 --> 00:18:22.538 position:50% align:middle an administrative assistant there. 00:18:22.538 --> 00:18:25.318 position:50% align:middle And the director really needed someone. 00:18:25.449 --> 00:18:31.329 position:50% align:middle So, I made that a requirement for that program, and I saw her a couple of days 00:18:31.329 --> 00:18:33.664 position:50% align:middle ago and asked her how it's going, she said, "I got my 00:18:33.664 --> 00:18:35.037 position:50% align:middle administrative assistant." 00:18:35.037 --> 00:18:39.403 position:50% align:middle For some reason, if they feel that it might affect their approval, 00:18:39.551 --> 00:18:41.108 position:50% align:middle then they listen... 00:18:41.108 --> 00:18:43.094 position:50% align:middle - They do, yes. - ...and they do things. 00:18:44.762 --> 00:18:45.431 position:50% align:middle - Great. 00:18:45.431 --> 00:18:49.316 position:50% align:middle So that was my favorite finding, if anybody wanted to ask that question. 00:18:51.801 --> 00:18:57.136 position:50% align:middle From the site visit study, then, we developed a site visit template 00:18:57.136 --> 00:18:57.814 position:50% align:middle for all of you. 00:18:57.814 --> 00:19:01.172 position:50% align:middle Now, this isn't going to be the same thing as the annual report template where 00:19:01.172 --> 00:19:03.488 position:50% align:middle we could, you know, collect that data for you. 00:19:03.488 --> 00:19:08.695 position:50% align:middle This is just for your use if you maybe have a new education consultant that 00:19:08.695 --> 00:19:13.110 position:50% align:middle comes on or, you know, you might want to look at it in terms of what you 00:19:13.110 --> 00:19:14.543 position:50% align:middle normally do now. 00:19:14.694 --> 00:19:19.661 position:50% align:middle And so, just briefly, I'm going to go through highlights, 00:19:19.661 --> 00:19:22.991 position:50% align:middle some of the data that you might collect for there. 00:19:22.991 --> 00:19:27.594 position:50% align:middle So, I think, first, Jan, did you want to talk a little bit 00:19:27.594 --> 00:19:29.824 position:50% align:middle just about conducting a site visit? 00:19:29.824 --> 00:19:31.754 position:50% align:middle - I do. This is my favorite subject, of course. 00:19:31.754 --> 00:19:32.847 position:50% align:middle - I know. 00:19:32.847 --> 00:19:37.641 position:50% align:middle - In order to have an effective site visit, you have to be prepared. 00:19:37.641 --> 00:19:40.832 position:50% align:middle And this is where I like to see the template because, especially, 00:19:40.832 --> 00:19:44.539 position:50% align:middle new consultants may wonder, "What am I supposed to do 00:19:44.539 --> 00:19:45.582 position:50% align:middle when I get there?" 00:19:45.582 --> 00:19:50.048 position:50% align:middle So, if they know they need to look at certain standards and get 00:19:50.048 --> 00:19:53.107 position:50% align:middle certain information, they will prepare ahead of time. 00:19:53.107 --> 00:19:57.038 position:50% align:middle And some of that preparation involves looking at documents from the program. 00:19:57.038 --> 00:20:02.496 position:50% align:middle They send all their syllabi, their basic philosophy and mission, 00:20:02.686 --> 00:20:07.851 position:50% align:middle they send their clinical plan, their total program evaluation plan. 00:20:07.851 --> 00:20:12.702 position:50% align:middle And so, we can look at it and get an idea of the effectiveness of their program 00:20:12.702 --> 00:20:14.053 position:50% align:middle as we go. 00:20:14.053 --> 00:20:18.823 position:50% align:middle And then if you go with specific things you want to find out, you have a plan, 00:20:18.823 --> 00:20:20.452 position:50% align:middle you're much more efficient. 00:20:21.050 --> 00:20:25.400 position:50% align:middle And you can get information by talking to people, by observing, 00:20:25.400 --> 00:20:27.205 position:50% align:middle by looking at documents. 00:20:28.686 --> 00:20:29.694 position:50% align:middle - Yeah. 00:20:29.979 --> 00:20:35.837 position:50% align:middle So, some of the things that we have in our site visit template. 00:20:35.837 --> 00:20:38.803 position:50% align:middle And just to let you know, the approval guidelines, 00:20:38.803 --> 00:20:41.856 position:50% align:middle which we haven't talked about yet, but we're going to talk about next, 00:20:42.467 --> 00:20:44.605 position:50% align:middle are available now. 00:20:44.605 --> 00:20:48.468 position:50% align:middle We are going to...when we send you out, if you... 00:20:48.871 --> 00:20:54.564 position:50% align:middle Well, I think I'm just going to send to all the participants the PowerPoint, PDF, 00:20:54.564 --> 00:20:57.056 position:50% align:middle and a PDF of the approval guidelines. 00:20:57.056 --> 00:21:03.534 position:50% align:middle In the approval guidelines, in the back, in an appendix, is both the template 00:21:03.534 --> 00:21:08.073 position:50% align:middle for the site visit, and also the template for the annual report. 00:21:08.073 --> 00:21:10.854 position:50% align:middle So that'll all be available to you, and I'll send it out. 00:21:10.854 --> 00:21:14.498 position:50% align:middle Now, depending on some firewalls, I might get something back. 00:21:14.498 --> 00:21:18.474 position:50% align:middle If you don't get it, why don't you email me and I'll try to get 00:21:18.474 --> 00:21:20.073 position:50% align:middle it to you in a different way. 00:21:20.073 --> 00:21:23.444 position:50% align:middle But that template kind of looks like this on your screen. 00:21:23.444 --> 00:21:27.827 position:50% align:middle And just ask questions under the different areas. 00:21:27.827 --> 00:21:31.952 position:50% align:middle So, we look at some of the program demographics, for example, 00:21:31.952 --> 00:21:38.649 position:50% align:middle and then some of the areas of the program and of the administration. 00:21:38.693 --> 00:21:44.762 position:50% align:middle And then, you know, looking at some of the directors, for example, 00:21:44.762 --> 00:21:48.252 position:50% align:middle the number of directors, do they have an administration? 00:21:48.252 --> 00:21:50.025 position:50% align:middle Do they have policy? 00:21:51.527 --> 00:21:54.878 position:50% align:middle When, you know, Brendan went over the quantitative study in terms 00:21:54.878 --> 00:21:58.586 position:50% align:middle of directors, and I just want you to know, I don't think he said this, 00:22:00.419 --> 00:22:04.219 position:50% align:middle we actually hired a temp, and they went through all those annual 00:22:04.219 --> 00:22:08.029 position:50% align:middle reports and counted the number of directors in a year, 00:22:08.029 --> 00:22:12.899 position:50% align:middle and that's how we came up with three directors in five years is really 00:22:12.899 --> 00:22:14.109 position:50% align:middle a warning sign. 00:22:14.109 --> 00:22:19.896 position:50% align:middle So, you know, what we would do with the both the site visit template, 00:22:19.896 --> 00:22:25.315 position:50% align:middle and also the annual report is look at the numbers of directors because that makes 00:22:25.315 --> 00:22:27.112 position:50% align:middle such a big difference. 00:22:28.539 --> 00:22:35.342 position:50% align:middle Then also, in the site visit template, we'll look at faculty, you know, 00:22:35.342 --> 00:22:37.391 position:50% align:middle what are the credentials of faculty? 00:22:37.391 --> 00:22:39.563 position:50% align:middle Do they have faculty development? 00:22:39.563 --> 00:22:44.917 position:50% align:middle And oftentimes, you can gather that, if they had faculty development, you just, 00:22:44.917 --> 00:22:46.839 position:50% align:middle you know, ask them about that. 00:22:46.839 --> 00:22:51.488 position:50% align:middle And then, in terms of students, are the resources available? 00:22:51.488 --> 00:22:55.167 position:50% align:middle You know, some people were saying, "Well, the program can't really provide 00:22:55.167 --> 00:22:56.060 position:50% align:middle all students. 00:22:56.060 --> 00:22:58.388 position:50% align:middle If they didn't have their books, they didn't buy their books, 00:22:58.388 --> 00:23:00.004 position:50% align:middle and what can the program do?" 00:23:00.004 --> 00:23:04.273 position:50% align:middle But there are students out there, we saw students had poverty 00:23:04.273 --> 00:23:06.650 position:50% align:middle and family issues, etc. 00:23:06.650 --> 00:23:11.964 position:50% align:middle There are ways that programs can work with students to make sure they get 00:23:11.964 --> 00:23:14.086 position:50% align:middle the resources that they need. 00:23:14.884 --> 00:23:20.126 position:50% align:middle And then, you know, they have, looking at the equality, 00:23:20.126 --> 00:23:24.204 position:50% align:middle clinical experiences, the curriculum. 00:23:24.204 --> 00:23:28.296 position:50% align:middle And then what teaching resources are available? 00:23:28.296 --> 00:23:30.230 position:50% align:middle What does that syllabus look like? 00:23:30.230 --> 00:23:33.460 position:50% align:middle Have you ever seen a syllabus that looked like it? 00:23:33.460 --> 00:23:34.600 position:50% align:middle - And are they consistent? 00:23:34.600 --> 00:23:35.930 position:50% align:middle - Yes, yes. 00:23:35.930 --> 00:23:40.420 position:50% align:middle And Allison found that too, a lot of times, the syllabus just wasn't 00:23:40.420 --> 00:23:42.507 position:50% align:middle consistent with what it should have been. 00:23:44.360 --> 00:23:48.516 position:50% align:middle So, we're going to start here with the approval guidelines. 00:23:52.150 --> 00:23:57.280 position:50% align:middle And this is what we did, putting everything together. 00:23:57.280 --> 00:24:01.765 position:50% align:middle So, remember, we had the literature, we had had the three studies, 00:24:01.765 --> 00:24:05.215 position:50% align:middle putting everything together, everything went to the board. 00:24:05.693 --> 00:24:09.085 position:50% align:middle I think I have four appearances in front of the board, you know, 00:24:09.085 --> 00:24:12.210 position:50% align:middle after the literature review and each of the studies. 00:24:12.210 --> 00:24:15.910 position:50% align:middle And, you know, I finally said to the board, "I feel like the Eveready bunny, 00:24:15.910 --> 00:24:17.589 position:50% align:middle that I keep coming back to you." 00:24:18.265 --> 00:24:23.169 position:50% align:middle And then beyond that, we had an expert panel, 00:24:23.169 --> 00:24:24.768 position:50% align:middle as I have alluded to. 00:24:24.795 --> 00:24:31.022 position:50% align:middle We had all of the education organizations, some boards of nursing representatives, 00:24:31.192 --> 00:24:38.061 position:50% align:middle and then our attorneys, who especially looked at the FTC issues. 00:24:38.306 --> 00:24:43.856 position:50% align:middle So, those were, you know, just...I think it was just an excellent 00:24:43.856 --> 00:24:48.319 position:50% align:middle expert panel to help us develop from all of this what the 00:24:48.319 --> 00:24:50.063 position:50% align:middle approval guidelines will be. 00:24:50.276 --> 00:24:54.179 position:50% align:middle Now, as I said, I will send these out to all of you, you'll be the first 00:24:54.179 --> 00:24:55.051 position:50% align:middle to get them. 00:24:55.249 --> 00:24:59.826 position:50% align:middle And they will be also prepared, it'll be a little booklet, 00:24:59.826 --> 00:25:03.569 position:50% align:middle it won't be just a little PDF, at mid-year meeting. 00:25:03.569 --> 00:25:09.623 position:50% align:middle And we're going to send a copy of the booklet to each of the boards of nursing. 00:25:09.662 --> 00:25:14.325 position:50% align:middle And so, if you remember, in it, we'll have the approval guidelines, 00:25:14.325 --> 00:25:19.083 position:50% align:middle and then how each guideline relates to the evidence. 00:25:19.178 --> 00:25:24.646 position:50% align:middle In order to be a guideline, it had to have at least two pieces of our 00:25:24.646 --> 00:25:29.010 position:50% align:middle four pieces of evidence we collected: the literature review, the Delphi, 00:25:29.010 --> 00:25:33.291 position:50% align:middle the site visit study, or the annual report study. 00:25:33.291 --> 00:25:39.818 position:50% align:middle So, how each of them are linked are included in there, as well as the template 00:25:39.818 --> 00:25:43.006 position:50% align:middle for the site visit and the annual report. 00:25:43.149 --> 00:25:45.542 position:50% align:middle So, we start with warning signs. 00:25:45.542 --> 00:25:48.395 position:50% align:middle These came out very strong. 00:25:48.395 --> 00:25:51.874 position:50% align:middle Complaints to boards of nursing about the program. 00:25:51.874 --> 00:25:57.723 position:50% align:middle That was one of the biggest issues that Allison had seen in the site visit. 00:25:58.017 --> 00:26:01.039 position:50% align:middle It also came up in the literature, came up in the Delphi. 00:26:01.906 --> 00:26:05.728 position:50% align:middle More than three program directors in a five-year period. 00:26:05.728 --> 00:26:09.878 position:50% align:middle So, that is something that you can really look at specifically. 00:26:09.878 --> 00:26:13.936 position:50% align:middle And Brendan would be able to show you how he got to that. 00:26:14.679 --> 00:26:17.789 position:50% align:middle And remember, we counted every single director. 00:26:17.789 --> 00:26:22.101 position:50% align:middle The directors were all listed on the annual reports, so it wasn't even 00:26:22.101 --> 00:26:24.411 position:50% align:middle a guessing situation. 00:26:24.498 --> 00:26:29.335 position:50% align:middle And then frequent faculty turnover, we don't quite have the specifics on that, 00:26:29.335 --> 00:26:32.164 position:50% align:middle so you'll kind of have to judge for yourself. 00:26:32.164 --> 00:26:36.972 position:50% align:middle And then a decrease trend in NCLEX pass rates. 00:26:36.972 --> 00:26:42.611 position:50% align:middle We didn't go to a specific percent decrease trend, remembering that 00:26:42.611 --> 00:26:46.941 position:50% align:middle the NCLEX, certainly, you have to pass the NCLEX in order to be licensed, 00:26:46.941 --> 00:26:48.264 position:50% align:middle in order to practice. 00:26:49.109 --> 00:26:55.414 position:50% align:middle And as we saw in many of our indicators, it was important, but it's not the 00:26:55.414 --> 00:26:59.713 position:50% align:middle only thing, and looking at the trend is important, remembering that it's 00:26:59.713 --> 00:27:02.046 position:50% align:middle a lagging indicator. 00:27:03.597 --> 00:27:11.521 position:50% align:middle So, we then look for the quality indicators 00:27:11.521 --> 00:27:15.025 position:50% align:middle and the administrative requirements. 00:27:15.025 --> 00:27:20.771 position:50% align:middle The program has criteria for admission, and progression, and student performance, 00:27:20.771 --> 00:27:24.757 position:50% align:middle and written policies and procedures in place. 00:27:24.757 --> 00:27:28.543 position:50% align:middle And these are vetted by students and the faculty. 00:27:28.543 --> 00:27:33.418 position:50% align:middle - And Nancy, I was mentioning this to you earlier that all boards have education 00:27:33.418 --> 00:27:37.589 position:50% align:middle rules for compliance, but these are different because 00:27:37.589 --> 00:27:39.959 position:50% align:middle these are quality indicators. 00:27:40.097 --> 00:27:45.246 position:50% align:middle So, the education consultant can look at each one and measure the program against. 00:27:45.246 --> 00:27:46.355 position:50% align:middle - Right. 00:27:46.355 --> 00:27:52.394 position:50% align:middle And you know, one of the things I wanted to go back here to is, 00:27:52.394 --> 00:27:56.002 position:50% align:middle these are really all programs that have been in place for a while, 00:27:56.002 --> 00:27:58.958 position:50% align:middle because there's faculty turnover, decrease NCLEX pass rates, 00:27:58.958 --> 00:28:00.117 position:50% align:middle complaints, etc. 00:28:00.117 --> 00:28:01.568 position:50% align:middle So they've been in place. 00:28:01.568 --> 00:28:09.570 position:50% align:middle If a program is seven years or younger, then we also had recommended, 00:28:09.570 --> 00:28:11.938 position:50% align:middle and for some reason, I didn't get it in the PowerPoints, 00:28:11.938 --> 00:28:15.332 position:50% align:middle but it's in the approval guidelines, that those programs have 00:28:15.332 --> 00:28:17.051 position:50% align:middle more frequent oversight. 00:28:17.051 --> 00:28:21.423 position:50% align:middle And we would think, you know, we talked at the expert panel about what 00:28:21.423 --> 00:28:25.740 position:50% align:middle that might be, we would think maybe every six months, checking in with a program, 00:28:25.740 --> 00:28:30.756 position:50% align:middle seeing if they still have their director or if their faculty are turning over, etc. 00:28:32.062 --> 00:28:35.240 position:50% align:middle - And I think that's important enough to have a rule change. 00:28:35.240 --> 00:28:37.916 position:50% align:middle - A rule change, you heard that. 00:28:42.071 --> 00:28:49.942 position:50% align:middle So then, for the program director, has an RN degree and doctorally prepared. 00:28:50.692 --> 00:28:53.897 position:50% align:middle And then the PN program, the graduate degree, 00:28:53.897 --> 00:28:55.896 position:50% align:middle and a degree in nursing. 00:28:55.896 --> 00:28:59.712 position:50% align:middle So, again, this was supported by the literature, the annual report, 00:28:59.712 --> 00:29:01.381 position:50% align:middle and the site visit study. 00:29:02.108 --> 00:29:06.764 position:50% align:middle And, again, all of these links are included in those approval guidelines. 00:29:08.085 --> 00:29:10.752 position:50% align:middle Thirty-five percent of the faculty are full time. 00:29:10.752 --> 00:29:13.474 position:50% align:middle You remember, I'm hoping that'll go up a little bit. 00:29:13.933 --> 00:29:16.145 position:50% align:middle What is your feeling about that 35%? 00:29:16.145 --> 00:29:17.465 position:50% align:middle It just seems low to me. 00:29:17.465 --> 00:29:18.425 position:50% align:middle - I think it's low. 00:29:18.425 --> 00:29:19.634 position:50% align:middle - Yeah, I do too. 00:29:19.634 --> 00:29:23.109 position:50% align:middle - That means the rest of them are part time. 00:29:23.109 --> 00:29:23.988 position:50% align:middle - Yeah. 00:29:24.157 --> 00:29:29.782 position:50% align:middle And, you know, I think some of the boards have in their rules 75%, even. 00:29:29.782 --> 00:29:32.420 position:50% align:middle So, it does seem a little low to me. 00:29:32.420 --> 00:29:36.640 position:50% align:middle So hopefully, with more consistent data, if you all participate in the annual 00:29:36.640 --> 00:29:39.819 position:50% align:middle report collection, that would be helpful. 00:29:40.174 --> 00:29:48.333 position:50% align:middle And then RN faculty holding a BSN, and RN faculty, a graduate degree. 00:29:48.333 --> 00:29:52.124 position:50% align:middle So again, these are the guidelines themselves. 00:29:52.263 --> 00:29:58.605 position:50% align:middle And then faculty demonstrate that they have instruction in teaching and learning 00:29:58.605 --> 00:30:00.829 position:50% align:middle principles and curriculum development. 00:30:00.829 --> 00:30:05.475 position:50% align:middle You saw that came out very, very clear in the site visit study, 00:30:05.475 --> 00:30:07.681 position:50% align:middle it's also come out in the literature. 00:30:08.396 --> 00:30:12.241 position:50% align:middle I know, for example, I think North Carolina has some 00:30:12.241 --> 00:30:13.901 position:50% align:middle requirements on that. 00:30:15.002 --> 00:30:17.367 position:50% align:middle What do you do in Texas? 00:30:17.367 --> 00:30:19.721 position:50% align:middle Is there another way besides taking a course? 00:30:19.721 --> 00:30:22.233 position:50% align:middle - We don't have any requirement like that. 00:30:22.839 --> 00:30:24.428 position:50% align:middle I would like to see one. 00:30:27.076 --> 00:30:30.379 position:50% align:middle When you bring in someone who has no experience in teaching, 00:30:30.379 --> 00:30:34.473 position:50% align:middle no knowledge of education, you can't teach them everything 00:30:34.473 --> 00:30:35.974 position:50% align:middle to be effective. 00:30:35.974 --> 00:30:36.647 position:50% align:middle - Right. 00:30:36.647 --> 00:30:42.176 position:50% align:middle And I'm thinking, even maybe a good mentoring process with somebody 00:30:42.176 --> 00:30:43.229 position:50% align:middle who's seasoned. - Yes. 00:30:43.229 --> 00:30:48.577 position:50% align:middle - But oftentimes, what you see are the novices transitioning the novices. 00:30:49.113 --> 00:30:52.878 position:50% align:middle But, you know, if you can't even develop an objective, I just don't know how you're 00:30:52.878 --> 00:30:56.338 position:50% align:middle going to be able to make it in teaching these students. 00:30:58.405 --> 00:31:01.790 position:50% align:middle Then faculty participation in continuing... 00:31:01.790 --> 00:31:07.616 position:50% align:middle And again, maybe if they participate in continuing at this related to teaching, 00:31:07.616 --> 00:31:09.182 position:50% align:middle that would be helpful as well. 00:31:09.182 --> 00:31:11.038 position:50% align:middle And they could point that out. 00:31:11.437 --> 00:31:15.893 position:50% align:middle So, if it's faculty that are really clinically oriented and they want to go, 00:31:15.893 --> 00:31:19.494 position:50% align:middle "My area was respiratory," they want to go to all these respiratory sessions, 00:31:19.494 --> 00:31:23.502 position:50% align:middle they should be going instead to education sessions. 00:31:25.363 --> 00:31:30.936 position:50% align:middle Then, to continue with faculty, the school provides 00:31:30.936 --> 00:31:32.755 position:50% align:middle substantive faculty development. 00:31:32.755 --> 00:31:35.278 position:50% align:middle Faculty development really came out strong. 00:31:35.278 --> 00:31:40.384 position:50% align:middle So it's not only the faculty participates, the school provides it for them. 00:31:40.384 --> 00:31:45.933 position:50% align:middle And then formal mentoring is in place for full-time and part-time faculty. 00:31:45.933 --> 00:31:50.692 position:50% align:middle Sometimes, I think part-time faculty get left out a little bit. 00:31:50.692 --> 00:31:53.527 position:50% align:middle And if you're relying on a lot of part-time faculty, that's 00:31:53.527 --> 00:31:55.077 position:50% align:middle really very important. 00:31:55.332 --> 00:32:02.080 position:50% align:middle And then, you know, and I saw this when I used to teach adjunct faculty, 00:32:02.080 --> 00:32:03.782 position:50% align:middle not having any orientation. 00:32:03.782 --> 00:32:07.107 position:50% align:middle You know, sometimes adjunct faculty didn't even know what the program was about. 00:32:07.598 --> 00:32:11.200 position:50% align:middle I taught at Loyola University in Chicago, we were a Jesuit university, 00:32:11.200 --> 00:32:12.600 position:50% align:middle and they didn't even know that. 00:32:12.600 --> 00:32:17.589 position:50% align:middle And, you know, your whole philosophy and, you know, everything kind of depends 00:32:17.589 --> 00:32:19.466 position:50% align:middle on that, your theoretical framework. 00:32:19.483 --> 00:32:24.083 position:50% align:middle And so, I, you know, really felt that we should have been doing 00:32:24.083 --> 00:32:25.093 position:50% align:middle a better job. 00:32:25.093 --> 00:32:26.777 position:50% align:middle Have you seen that as well? 00:32:27.070 --> 00:32:27.519 position:50% align:middle - Yes. 00:32:27.519 --> 00:32:32.310 position:50% align:middle And I think that when programs bring an adjunct, they just expect that they're 00:32:32.310 --> 00:32:33.583 position:50% align:middle going to know what to do. 00:32:33.583 --> 00:32:34.883 position:50% align:middle And they're not. 00:32:36.522 --> 00:32:38.369 position:50% align:middle Excuse me, I have to make a confession. 00:32:38.369 --> 00:32:41.148 position:50% align:middle When I started teaching, it was as adjunct. 00:32:41.861 --> 00:32:46.722 position:50% align:middle I had no idea that there were faculty meetings or what I was expected to do. 00:32:46.994 --> 00:32:51.143 position:50% align:middle I got the clinical assignments, showed up for clinical. 00:32:52.057 --> 00:32:56.134 position:50% align:middle The really good thing that happened to me was I also was working part time 00:32:56.134 --> 00:32:57.664 position:50% align:middle in that same hospital. 00:32:57.664 --> 00:32:59.868 position:50% align:middle So, I had my own clinical lab. 00:33:00.519 --> 00:33:05.633 position:50% align:middle And that turned out to be a good experience, but the next year, 00:33:05.633 --> 00:33:08.784 position:50% align:middle when I became full time... and that's adjunct should be used 00:33:08.784 --> 00:33:10.749 position:50% align:middle as a road to full-time people. 00:33:11.048 --> 00:33:15.879 position:50% align:middle Then I realized there was a lot I didn't know about, and I had no voice 00:33:15.879 --> 00:33:16.931 position:50% align:middle at that time. 00:33:18.782 --> 00:33:19.618 position:50% align:middle - Right. 00:33:19.618 --> 00:33:25.385 position:50% align:middle So, you know, I just think focusing on adjunct faculty, especially if you do have 00:33:25.385 --> 00:33:30.965 position:50% align:middle this 35% of faculty that are full time, you really need to focus on them more. 00:33:30.965 --> 00:33:36.422 position:50% align:middle And you know, what came out in the Delphi was some of these, and we're pretty sure 00:33:36.422 --> 00:33:40.547 position:50% align:middle it was the clinical educators, said, "We would like to be a part of the program 00:33:40.547 --> 00:33:45.436 position:50% align:middle and a part of planning what they're doing with their curriculum, but instead, 00:33:45.436 --> 00:33:49.618 position:50% align:middle they bring us at the very end to say, 'Thank you for the clinical placements,' 00:33:49.618 --> 00:33:50.798 position:50% align:middle and that's all they do. 00:33:50.798 --> 00:33:55.495 position:50% align:middle They don't get information from us to plan where they should be going." 00:33:55.840 --> 00:34:02.565 position:50% align:middle And so, I think that whole participation can be almost a win-win situation. 00:34:02.565 --> 00:34:07.374 position:50% align:middle It doesn't have to be just on the backs of the program, but it can help the program. 00:34:09.419 --> 00:34:15.520 position:50% align:middle And then, you know, remember the five years clinical faculty should have 00:34:15.520 --> 00:34:17.576 position:50% align:middle practiced in the last five years? 00:34:18.240 --> 00:34:22.895 position:50% align:middle We just didn't think that was enough time or, you know, we thought it was 00:34:22.895 --> 00:34:25.246 position:50% align:middle too much time, actually, after they practice. 00:34:25.246 --> 00:34:31.108 position:50% align:middle So, we kept that one to clinical faculty have up-to-date clinical skills. 00:34:31.108 --> 00:34:35.851 position:50% align:middle So, you know, it really will be the judgment of the board, I think. 00:34:35.851 --> 00:34:37.429 position:50% align:middle I don't know, do you look at that, Jan, or... 00:34:37.429 --> 00:34:40.633 position:50% align:middle - One of the schools in Jersey and St. Louis, where I got 00:34:40.633 --> 00:34:42.684 position:50% align:middle three degrees, requires... 00:34:42.684 --> 00:34:44.028 position:50% align:middle - How many degrees do you have, by the way? 00:34:44.028 --> 00:34:49.297 position:50% align:middle - No, no, no...requires their faculty to have one day in practice a week, 00:34:49.297 --> 00:34:51.491 position:50% align:middle and they give them that day. 00:34:52.924 --> 00:34:54.905 position:50% align:middle So, I think that's a wonderful plan. 00:34:54.905 --> 00:34:56.156 position:50% align:middle - I think so too. 00:34:56.221 --> 00:34:57.680 position:50% align:middle I think that's excellent. 00:34:57.680 --> 00:34:59.406 position:50% align:middle - It's counted as a part of their workload. 00:34:59.406 --> 00:35:00.307 position:50% align:middle - Yes. 00:35:01.871 --> 00:35:05.816 position:50% align:middle And then simulation faculty are certified. 00:35:05.816 --> 00:35:07.271 position:50% align:middle Now, we have talked about this before. 00:35:07.271 --> 00:35:09.950 position:50% align:middle And maybe the next question will be, what do faculty have to do 00:35:09.950 --> 00:35:10.957 position:50% align:middle to be certified? 00:35:10.957 --> 00:35:13.522 position:50% align:middle I'm not exactly sure what they have to do. 00:35:13.522 --> 00:35:15.957 position:50% align:middle I think it's through one of those organizations? 00:35:15.957 --> 00:35:17.169 position:50% align:middle - Yes, yes. 00:35:17.517 --> 00:35:21.832 position:50% align:middle - But, you know, that would be helpful in terms of learning about teaching 00:35:21.832 --> 00:35:24.588 position:50% align:middle and learning, because if you become certified, you certainly learn 00:35:24.588 --> 00:35:27.919 position:50% align:middle pedagogies and, you know, how to develop syllabi, etc. 00:35:27.919 --> 00:35:30.054 position:50% align:middle So, I think that would be very important. 00:35:30.054 --> 00:35:34.867 position:50% align:middle - I think we're so eager to have 50% of our clinical time and simulation, 00:35:34.867 --> 00:35:37.972 position:50% align:middle but not so eager to provide the training for the faculty. 00:35:37.972 --> 00:35:38.911 position:50% align:middle - Yes. 00:35:38.911 --> 00:35:41.709 position:50% align:middle Well, that's what I've heard a lot from the boards. 00:35:42.176 --> 00:35:43.828 position:50% align:middle Faculty want to just step up. 00:35:43.828 --> 00:35:50.285 position:50% align:middle I remember I was at a conference once and the faculty member got up and said her 00:35:50.285 --> 00:35:54.711 position:50% align:middle Dean said, "Here's a book, I want you to start a simulation lab." 00:35:54.711 --> 00:35:56.240 position:50% align:middle And, you know, it's just not that easy. 00:35:56.240 --> 00:35:56.919 position:50% align:middle - No. 00:35:57.367 --> 00:36:00.239 position:50% align:middle - And they called it Simulation on the Fly. 00:36:00.356 --> 00:36:01.497 position:50% align:middle - Yes. 00:36:02.649 --> 00:36:07.236 position:50% align:middle - So next, we have students for quality indicators. 00:36:07.578 --> 00:36:11.532 position:50% align:middle English-as-a-second-language assistance is provided. 00:36:11.532 --> 00:36:17.020 position:50% align:middle That came out very strong in the site visit study as well, that students, 00:36:17.020 --> 00:36:21.874 position:50% align:middle especially the programs with a lot of students that were minority or 00:36:21.874 --> 00:36:25.492 position:50% align:middle from different cultures, and then there was nothing 00:36:25.492 --> 00:36:27.051 position:50% align:middle provided for them. 00:36:27.505 --> 00:36:32.131 position:50% align:middle And so, you know, you kind of look at your student population, but if there's a lot 00:36:32.131 --> 00:36:35.092 position:50% align:middle of those types of students, expecting that. 00:36:35.775 --> 00:36:39.344 position:50% align:middle And then, the same with students with learning disabilities, 00:36:39.344 --> 00:36:43.438 position:50% align:middle assistance being available at the program. 00:36:43.438 --> 00:36:48.096 position:50% align:middle And you know, that would be something that would be pretty easy for them to get. 00:36:48.323 --> 00:36:53.037 position:50% align:middle And then, you know, we've talked about this, students being able to have books or 00:36:53.037 --> 00:36:56.778 position:50% align:middle the resources necessary to get the books. 00:36:57.192 --> 00:37:02.273 position:50% align:middle And I know that I've talked about remediation strategies being in place 00:37:02.273 --> 00:37:06.189 position:50% align:middle in terms of remediating errors and near misses in the clinical. 00:37:06.189 --> 00:37:12.007 position:50% align:middle But, you know, that safe student report study is just so important with that 00:37:12.007 --> 00:37:17.416 position:50% align:middle because it sets them up with how to track that, and it sets them up with a network 00:37:17.416 --> 00:37:18.917 position:50% align:middle of others involved. 00:37:18.917 --> 00:37:23.439 position:50% align:middle We have conference calls quarterly, where they can learn about improvement. 00:37:23.439 --> 00:37:28.838 position:50% align:middle So, if you haven't sent that out to your faculty, I think that would 00:37:28.838 --> 00:37:29.618 position:50% align:middle really be helpful for that. 00:37:29.618 --> 00:37:32.938 position:50% align:middle - You know, Nancy, if programs do have helps for students 00:37:32.938 --> 00:37:36.883 position:50% align:middle with disabilities or for English as a second language, that should be a part 00:37:36.883 --> 00:37:39.920 position:50% align:middle of their evaluation plan to see if it's being effective or not. 00:37:39.920 --> 00:37:42.266 position:50% align:middle - Yeah, absolutely. 00:37:42.872 --> 00:37:45.704 position:50% align:middle And, you know, another area for remediation, though, 00:37:45.704 --> 00:37:51.776 position:50% align:middle are those students that just aren't doing well, giving them a chance before you just 00:37:51.776 --> 00:37:55.467 position:50% align:middle fail them out completely, giving them a chance for remediation. 00:37:55.467 --> 00:38:00.318 position:50% align:middle You know, when I talk to the people, for example, at ATI and HESI, 00:38:00.318 --> 00:38:03.623 position:50% align:middle that supposedly is what those progression exams are about. 00:38:03.623 --> 00:38:07.592 position:50% align:middle It's not about putting it at the end, and if they don't pass, then, you know, 00:38:07.592 --> 00:38:12.471 position:50% align:middle you don't graduate them, but it's to provide them with remediation 00:38:12.471 --> 00:38:13.921 position:50% align:middle throughout the program. 00:38:17.536 --> 00:38:24.435 position:50% align:middle So, we have, then, our curriculum and clinical experiences. 00:38:25.115 --> 00:38:29.829 position:50% align:middle Certainly, the literature came out with 50% of clinical experiences and each 00:38:29.829 --> 00:38:32.649 position:50% align:middle clinical course are direct patient care. 00:38:32.649 --> 00:38:38.872 position:50% align:middle But also, then you're able to have 50% of simulation, but that direct patient care 00:38:38.872 --> 00:38:39.687 position:50% align:middle is important. 00:38:39.687 --> 00:38:40.329 position:50% align:middle - Yes. 00:38:40.329 --> 00:38:43.608 position:50% align:middle And when we make survey visits, we usually ask the students, 00:38:43.608 --> 00:38:46.014 position:50% align:middle "What is something you would like more of?" 00:38:46.265 --> 00:38:49.232 position:50% align:middle And the answer is always more clinical. 00:38:49.232 --> 00:38:50.420 position:50% align:middle - I know. 00:38:50.420 --> 00:38:53.362 position:50% align:middle Yes, I've seen that, too, come out. 00:38:54.955 --> 00:38:58.900 position:50% align:middle You know, and I know that a lot of places will say, "Well, there's no clinical 00:38:58.900 --> 00:39:03.112 position:50% align:middle spaces to be had, so we need to, you know, do with what we do." 00:39:03.112 --> 00:39:08.080 position:50% align:middle But, you know, I think faculty could be more resourceful and more innovative 00:39:08.080 --> 00:39:12.378 position:50% align:middle in what they come up with in terms of clinical placements. 00:39:12.378 --> 00:39:15.772 position:50% align:middle There are some excellent possibilities out there. 00:39:15.772 --> 00:39:19.842 position:50% align:middle Is there anything, any alternative experiences in Texas that... 00:39:19.842 --> 00:39:23.955 position:50% align:middle - We constantly are encouraging programs to go out and find them. 00:39:24.917 --> 00:39:27.611 position:50% align:middle And when they start looking, they do find them. 00:39:27.611 --> 00:39:30.576 position:50% align:middle There are settings that are not included. 00:39:30.576 --> 00:39:35.771 position:50% align:middle And I think one setting that is not included a lot is long-term care. 00:39:35.908 --> 00:39:41.056 position:50% align:middle And I think it's because faculty don't choose to teach in those settings. 00:39:41.056 --> 00:39:42.455 position:50% align:middle That's kind of sad. 00:39:42.455 --> 00:39:43.892 position:50% align:middle - Yeah, I know. 00:39:43.892 --> 00:39:48.463 position:50% align:middle And those can be excellent settings for clinical experiences. 00:39:48.463 --> 00:39:52.604 position:50% align:middle I remember I took students there at one point and it was just really excellent. 00:39:54.458 --> 00:40:00.437 position:50% align:middle And then the variety of clinical settings and diverse patients. 00:40:00.437 --> 00:40:02.800 position:50% align:middle Many times, they go one place. 00:40:02.800 --> 00:40:07.441 position:50% align:middle And I know that in some of the rural areas, there's not a lot of selection. 00:40:07.441 --> 00:40:09.541 position:50% align:middle So, that might be difficult. 00:40:09.541 --> 00:40:14.026 position:50% align:middle In some of the rural areas of Texas, is there any suggestions that 00:40:14.026 --> 00:40:15.419 position:50% align:middle they have or... 00:40:15.419 --> 00:40:18.457 position:50% align:middle Maybe we'll talk about it at that next conference you're having. 00:40:18.457 --> 00:40:22.074 position:50% align:middle - It's not as difficult as you might think, because there are not a lot 00:40:22.074 --> 00:40:24.258 position:50% align:middle of programs in the rural communities. 00:40:24.258 --> 00:40:28.658 position:50% align:middle So they usually have access to whatever hospitals are there and they're usually 00:40:28.658 --> 00:40:29.865 position:50% align:middle allowed to do more. 00:40:29.865 --> 00:40:30.811 position:50% align:middle - Yeah. 00:40:31.977 --> 00:40:36.973 position:50% align:middle - And then some of them have to travel if they want an OB or peds experience. 00:40:36.973 --> 00:40:41.174 position:50% align:middle They will travel several hundred miles and spend a weekend or something. 00:40:41.518 --> 00:40:44.503 position:50% align:middle So, the creative ones can do it. 00:40:44.503 --> 00:40:46.126 position:50% align:middle - Yes. Right. 00:40:46.328 --> 00:40:49.880 position:50% align:middle And the ones that have that background in teaching and learning, you know, 00:40:49.880 --> 00:40:52.438 position:50% align:middle that have gone to some of those sessions. 00:40:53.409 --> 00:40:58.100 position:50% align:middle And then opportunities for quality and safety education are 00:40:58.100 --> 00:41:00.567 position:50% align:middle integrated into the curriculum. 00:41:00.567 --> 00:41:05.306 position:50% align:middle I am sure that people like QSEN and are going to be very happy with what we found, 00:41:05.306 --> 00:41:08.704 position:50% align:middle because we not only found it, we found it in the literature, and the 00:41:08.704 --> 00:41:13.603 position:50% align:middle site visit studies, and also in the Delphi. 00:41:13.603 --> 00:41:18.995 position:50% align:middle So, it's really very strong that quality and safety being integrated 00:41:18.995 --> 00:41:20.138 position:50% align:middle into the program. 00:41:20.138 --> 00:41:24.690 position:50% align:middle It doesn't just have to be using QSEN, but I think that's a good way for programs 00:41:24.690 --> 00:41:25.928 position:50% align:middle to get started. 00:41:26.490 --> 00:41:29.677 position:50% align:middle Do you have programs that are using QSEN or... 00:41:29.677 --> 00:41:30.625 position:50% align:middle - We do. 00:41:31.161 --> 00:41:35.421 position:50% align:middle You know, we have competencies in our state, and QSEN is a part of the 00:41:35.421 --> 00:41:40.559 position:50% align:middle development of those, but I think that all clinical faculty 00:41:40.559 --> 00:41:43.652 position:50% align:middle should ask their students, at the end of a clinical day, 00:41:43.652 --> 00:41:47.411 position:50% align:middle "Could you have done something to make this patient safer?" 00:41:47.411 --> 00:41:50.909 position:50% align:middle Or, "Is this patient safe when you go in the room?" 00:41:51.468 --> 00:41:55.476 position:50% align:middle And you have to think that, it's not something that comes naturally. 00:41:55.476 --> 00:41:56.217 position:50% align:middle - Right. 00:41:58.634 --> 00:42:03.533 position:50% align:middle And then there's that systematic evaluation plan of the curriculum 00:42:03.533 --> 00:42:04.861 position:50% align:middle being in place. 00:42:05.677 --> 00:42:09.921 position:50% align:middle That was something that we, you know, found very strongly, 00:42:09.921 --> 00:42:14.789 position:50% align:middle especially in regulation, I think, and accreditation, have found that 00:42:14.789 --> 00:42:16.132 position:50% align:middle to be so important. 00:42:17.694 --> 00:42:20.173 position:50% align:middle I know you always speak about the... 00:42:20.624 --> 00:42:22.552 position:50% align:middle - Yes, I think that's the key. 00:42:22.552 --> 00:42:23.131 position:50% align:middle - I know. 00:42:23.131 --> 00:42:28.693 position:50% align:middle - Right, if they were doing that from Day 1 and did it as a regular process, 00:42:28.693 --> 00:42:32.232 position:50% align:middle they would catch some of those warning signs early on. 00:42:32.232 --> 00:42:32.697 position:50% align:middle - They would, yes. 00:42:32.697 --> 00:42:34.821 position:50% align:middle - And they would make quality improvements. 00:42:34.821 --> 00:42:39.975 position:50% align:middle But it's a lot of work to maintain a total program evaluation plan. 00:42:39.975 --> 00:42:40.812 position:50% align:middle - It is. 00:42:41.233 --> 00:42:43.450 position:50% align:middle - And a lot of people don't know how to do it. 00:42:43.450 --> 00:42:44.202 position:50% align:middle - Right. 00:42:45.214 --> 00:42:46.632 position:50% align:middle It is a lot of work. 00:42:46.632 --> 00:42:51.124 position:50% align:middle And I think that, you know, we talked to Marilyn Orman, 00:42:51.124 --> 00:42:56.977 position:50% align:middle when...she's really an expert in that area, our committee talked to her and got 00:42:56.977 --> 00:43:03.289 position:50% align:middle some resources, and there are some good quality improvement chapters out there 00:43:03.289 --> 00:43:06.846 position:50% align:middle in books that I found very useful. 00:43:06.846 --> 00:43:11.214 position:50% align:middle I think I can... 00:43:11.214 --> 00:43:17.134 position:50% align:middle What is that book that, it's about nursing education, Halstead? 00:43:17.134 --> 00:43:21.320 position:50% align:middle Billings and Halstead, it is a 2020 edition too, 00:43:21.320 --> 00:43:26.426 position:50% align:middle and I think they have an excellent chapter on systematic evaluation of a program. 00:43:26.426 --> 00:43:30.479 position:50% align:middle So, you know, you as educators, education consultants can go in and, 00:43:30.479 --> 00:43:32.177 position:50% align:middle you know, teach them that. 00:43:32.706 --> 00:43:36.825 position:50% align:middle Do you find a lot of teaching goes on when you go into make visits? 00:43:37.973 --> 00:43:40.120 position:50% align:middle - You mean from us? 00:43:40.120 --> 00:43:42.446 position:50% align:middle - Yeah. - Definitely. 00:43:42.446 --> 00:43:47.083 position:50% align:middle I don't know why more faculty groups don't just have lunch once a week and just talk 00:43:47.083 --> 00:43:49.045 position:50% align:middle about best teaching practices. 00:43:50.099 --> 00:43:53.245 position:50% align:middle I guess working that into their schedule is difficult. 00:43:57.473 --> 00:44:02.336 position:50% align:middle - So, teaching and learning resources. 00:44:02.601 --> 00:44:06.709 position:50% align:middle You know, how many times have we said simulation lab is accredited? 00:44:06.709 --> 00:44:08.548 position:50% align:middle You can see that that is important. 00:44:08.548 --> 00:44:14.242 position:50% align:middle And yet it's probably one of those areas that you're going to be looking 00:44:14.242 --> 00:44:14.784 position:50% align:middle to the future. 00:44:14.784 --> 00:44:18.400 position:50% align:middle I think you had said, "Focus on the guidelines, 00:44:18.400 --> 00:44:21.396 position:50% align:middle the NCSBN simulation guidelines." - Yes, yes. 00:44:22.483 --> 00:44:26.444 position:50% align:middle If you don't know what to do to have a quality simulation lab, 00:44:26.444 --> 00:44:27.836 position:50% align:middle look at that first. 00:44:27.836 --> 00:44:28.731 position:50% align:middle - Right. 00:44:29.471 --> 00:44:37.315 position:50% align:middle And, you know, that students have access to technology, library, other resources. 00:44:37.315 --> 00:44:44.360 position:50% align:middle And again, those programs need to assess students with learning disabilities and, 00:44:44.867 --> 00:44:48.240 position:50% align:middle you know, students English as a second language. 00:44:48.471 --> 00:44:52.971 position:50% align:middle So again, you know, those are all very important. 00:44:53.291 --> 00:44:56.201 position:50% align:middle So, it looks like Jan, we finished this section a 00:44:56.201 --> 00:44:57.624 position:50% align:middle little bit earlier. 00:44:58.271 --> 00:45:03.716 position:50% align:middle We are going to break now, and right after break, 00:45:03.716 --> 00:45:08.968 position:50% align:middle which will be 3:15 Central Time, we're going to have a 00:45:08.968 --> 00:45:10.640 position:50% align:middle question and answer session. 00:45:10.640 --> 00:45:16.066 position:50% align:middle And in the question and answer session, really type in your questions now. 00:45:16.066 --> 00:45:21.283 position:50% align:middle We're also going to be asking you, besides any questions you might have, 00:45:21.283 --> 00:45:29.394 position:50% align:middle how might you use the approval guidelines, the annual report template, 00:45:29.394 --> 00:45:31.647 position:50% align:middle the template for site visits? 00:45:31.647 --> 00:45:35.085 position:50% align:middle How might you be able to use some of this information? 00:45:35.085 --> 00:45:36.740 position:50% align:middle What would you like to do? 00:45:36.740 --> 00:45:41.138 position:50% align:middle So, if you would type some of that in, I know we're going to ask Jan that, and, 00:45:41.138 --> 00:45:45.097 position:50% align:middle when we get back as we're going to be talking about the future with this, 00:45:45.097 --> 00:45:47.867 position:50% align:middle but we'd like to hear from all of you as well. 00:45:47.867 --> 00:45:49.765 position:50% align:middle So we hope to hear from you soon. 00:45:49.765 --> 00:45:54.157 position:50% align:middle - If you have nothing else to say, just put down what has stood out to you 00:45:54.157 --> 00:45:55.894 position:50% align:middle from the last three hours. 00:45:55.894 --> 00:45:56.934 position:50% align:middle - Yeah. 00:45:57.597 --> 00:46:03.805 position:50% align:middle So, we will again see you at 3:15 Central Time. 00:46:03.805 --> 00:46:04.743 position:50% align:middle Thank you.