The American Nurses' Association (ANA) has stated that educational preparation for entry into professional nursing practice is to be at the baccalaureate level (ANA, 1965). Therefore, nursing is being challenged to make baccalaureate education available to both generic students and a large pool of registered nurses who do not yet have a degree and who wish to further their education.
In exploring how to meet this challenge in Maine, a primarily rural state, it was found that the critical problem was program accessibility, rather than availability. A large number of potential students, for personal or financial reasons, could not participate in baccalaureate education at its single location in southern Maine.
Recognizing this, the University of Southern Maine began exploring ways to provide its School of Nursing baccalaureate program at other campus sites within the University of Maine system. A primary interest was to learn the specifics of how baccalaureate programs in other universities were implementing their extended site programs. However, a review of the literature revealed little information. Therefore, the School of Nursing surveyed 187 publicly-funded baccalaureate School of Nursing serving primarily rural areas. A query letter was sent asking if the school had experience offering extensions of their basic program. Those giving a positive response were then asked if they would be willing to respond to a questionnaire seeking information about their program.
A questionnaire was developed to answer questions specific to the Sthool of Nursing's plans for extending to other sites. Questions also focused on a variety of areas depicting how extended site programs were implemented.
Of the original 187 schools surveyed, 48 answered affirmatively and were sent questionnaires. Thirty-six were returned. Of these, three indicated their extensions were either in the planning stage or had been terminated. Data from these schools were not included. For this study, 30 questionnaires were analyzed, representing information from a total of 58 extension sites. Three programs had implemented unique models. They are described separately.
Implementation of Extended Sites - An Overview
Data indicated variations in how extension sites were used, ranging from offering a single course to offering an entire program away from the lead campus. Of the 30 programs surveyed, in more than half, the demographic data indicated that their extension site was developed primarily for RNs. Prior to 1977, there were relatively few extended site programs. From 1978 to 1983, there was a mushrooming of extended site development. Combined with the major thrust of these programs being directed toward RNs, the mushrooming seems to indicate a positive response by nursing education and nursing students to the ANA position paper on nursing education (American Nurses' Association, 1965 1.
Distances between the lead campus and extension sites ranged from 18 to 600 miles. Surprisingly, half the extension sites were located less than 100 miles from the lead campus, with only six located at a distance greater than 200 miles. This contradicted our expectation that programs had been developed to provide greater accessibility to students in remote areas.
In all programs, administrative control was maintained by the Dean either directly or through an on-site coordinator. In the 15 programs that had an on-site coordinator, the role was described as that of managing day-to-day details, performing functional roles to assure curriculum equivalency, facilitating student advisement and teaching and generally coordinating the delivery of the program at the extension site.
Budget development and administration were the direct responsibility of the Dean or Associate Dean in two-thirds of the programs. Administrative matters such as personnel records including issuance of faculty contracts, signing clinical agency contracts, issuing student grades and final degree, and retaining student and faculty records were primarily the responsibility of the lead campus although there was some variation in these areas.
In the programs surveyed, the type of curriculum varied. Two-thirds classified their program as integrated; one-third as specialized. Because the National League of Nursing (NLN) accredits a program, not an individual site (National League of Nursing, 1977), the curriculum must be the same regardless of where it is offered. The ways in which this was operational ized varied. In general, course outlines, texts and exams were identical. Exams were the most likely to be individualized. It is speculated that faculty felt the need to correlate the exam questions with their individual teaching methodology. The cost of producing educational materials tended to be borne by the lead campus. Actual production occurred at both the lead and extended sites.
There were variations, regarding delivery of the curriculum. Half of the programs indicated they hired faculty with the understanding that they would teach on only one campus'^- However, in actual practice, twothirds of the programs indicated that lead campus faculty traveled to teach at the extension site. This seems to indicate, and indeed it was stated by one program, that "volunteers" are recruited from the lead campus faculty for extended site teaching.
While it varied whether faculty were stationary on one campus or traveled to extension sites, in all programs issues relating to faculty appointment and status remained the responsibility of the lead campus. Search and initial appointment and the provision for faculty salaries occurred on the lead campus. Generally, salaries were equal for both lead and extended site faculty. In cases where there was a discrepancy, salaries were higher at the lead campus. The lower salary for extension site faculty was attributed to a non-tenure track appointment. All faculty were subject to the criteria for reappointment, promotion and tenure which had been established at the lead campus.
In the majority of programs, extended site faculty were members of School of Nursing committees on the lead campus. In 11 programs, they were additionally involved in committee work at the extended site. This was true for both School of Nursing and university-wide committees. Faculty were reimbursed for travel related to teaching, but only eighteen programs indicated that faculty were reimbursed for travel related to committee work. Given the distances identified between lead and extension sites and the cost of travel, this raises the question of the degree, quality and cost of their participation. Similar questions are raised regarding faculty development which is, again, primarily the responsibility of the lead campus.
Thirteen programs stated that peer evaluation was soleîy the responsibility of lead campus faculty. It appears that extension site faculty did not have the opportunity or ability to serve as a member of this important committee. This has serious implications for the process and purpose of peer review.
Learning resource equipment, hardware, and software were, of necessity, available at both the lead campus and extended sites. Learning resource equipment and hardware tended not to be transient. Software was the commodity most often shared, frequently traveling from site to site with faculty- Not surprisingly, the lead campus most often had the largest and most complete library facilities. There was a concomitant reliance on intra-library loans to supplement the holdings at the extension sites. Given distances between lead campus and extension sites, it is surprising that only four programs indicated they used or had tried any special technological methods to enhance communication or curriculum delivery. Videotaping of lectures, used by two programs, was greeted with mixed enthusiasm. The common strength was that it expanded the expertise of extended site faculty. In one instance the videotapes were seen as facilitating better organized and better illustrated lectures. In the other instance, the videotapes were perceived as boring to students and of less quality than a live, "in the flesh" performance. A common limitation to videotapes was late or nonexistent communication between student and lecturer. The use of teleconferencing was mentioned by one respondent but was not evaluated. One program stated that guest lecturers were used to augment their faculty but noted that this was expensive.
Admission of students was the responsibility of the lead campus. However, in only two programs were students required to travel to the lead campus for an admission interview. Students were free to transfer between sites in a majority of programs. In 20 programs, students from extended sites participated in student organizations or faculty committees on the lead campus.
As stated previously, the majority of extended sites were developed to increase the accessibility of baccalaureate education to the RN population. Student enrollment at extended sites was stable or increasing in all but four programs for the period of 1980-1983. Following completion, all but one of the programs surveyed indicated that extension site graduates remain in the extension site location for employment.
Three unique methods were described in response to questions about curriculum. In the first, an extension circuit encompassed a 50-mile or three-county area. Different facilities, including agencies and schools, were used. The teaching site was selected based on where the majority of students were located at a particular time. Local libraries and resources were supplemented by resources brought by faculty. This program was designed for and used only by RNs. A second program had 11 outreach sites located within a 700-mile rural area. A single faculty member traveled to each site to offer content to 81 RN students. A third program began with extension sites but soon found the RN students wanted courses to be taught at the lead campus. In response, the course work was modularized to create a more flexible schedule and allow the students to study on an independent basis. Clinical experiences were precepted in agencies close to students' homes. A faculty member from the lead campus commuted between the preceptors.
The use of extension sites in baccalaureate nursing education has increased significantly since 1978. This survey found that the majority of extension sites were developed for RNs although large numbers of generic students are also served. The use of extension sites ranges from delivering selected courses away from the lead campus to delivering an entire program. Extension sites may be located on other university campuses or may be found in a store front setting or other community agency.
Administrative control of extension sites emanates from the lead campus. Faculty participation in faculty activities, such as school of nursing or university committees, is expected. The degree to which this is accomplished, however, may vary.
In order to maintain program integrity, the curriculum must remain the same regardless of where it is implemented. One of the primary ways of doing this is to use the same syllabi, texts and, in many cases, the same exams. Faculty may be stationary at established extended sites or may travel from the lead campus to teach, carrying with them educational materials.
Extension sites are a phenomenon of the here and now. They provide a way of delivering baccalaureate nursing education to students who might otherwise be denied this level of education. Extension sites may be operationally cumbersome, challenging, and costly, but they are meeting a need. With the advent of more sophisticated telecommunications and the continued demand for baccalaureate level education, the possibility exists for even greater variation and potential for this type of program.
- American Nurses' Association. (1965). A Position Paper.
- National League for Nursing. (1977). Criteria for the Appraisal of Baccalaureate and Higher Degree Programs in Nursing. New York: National League for Nursing.