Journal of Nursing Education

The Development of a Master's Degree Program Based on Perceived Future Practice Needs

Barbara A Hill, RNC, MS, EdD

Abstract

ABSTRACT

The need for an accessible master's degree program was determined through informal communication between practicing nurses and nursing educators. The purpose of the descriptive study was to project a master's degree program based on perceived future nursing practice needs. Forty-seven nurse administrators and staff nurses responded to a mailed survey (61.8%). The respondents were asked to make predictions regarding the probability of occurrence of 18 previously Delphi-generated events by the year 2000. Respondents also provided judgments regarding the degree of agreement/disagreement that various content items would be critical to survival in practice and best learned in a master's degree program. Most respondents agreed that general education content items were both critical to survival and best learned by master's education. Less strong agreement that nursing content items were critical to survival and best learned in a master's degree program was an unexpected finding. A multidisciplinary master's program for all health-care professionals was proposed.

Abstract

ABSTRACT

The need for an accessible master's degree program was determined through informal communication between practicing nurses and nursing educators. The purpose of the descriptive study was to project a master's degree program based on perceived future nursing practice needs. Forty-seven nurse administrators and staff nurses responded to a mailed survey (61.8%). The respondents were asked to make predictions regarding the probability of occurrence of 18 previously Delphi-generated events by the year 2000. Respondents also provided judgments regarding the degree of agreement/disagreement that various content items would be critical to survival in practice and best learned in a master's degree program. Most respondents agreed that general education content items were both critical to survival and best learned by master's education. Less strong agreement that nursing content items were critical to survival and best learned in a master's degree program was an unexpected finding. A multidisciplinary master's program for all health-care professionals was proposed.

Introduction

Long range planning is a critical administrative function. Goal directed behavior based on inaccurate, confusing data can threaten the position of the nursing education administrator in the academic arena. Forecasts of future events in health care with minimal uncertainty have been reported (Bauerschmidt & Furst, 1973; Hill, 1984; Johnson, 1977). Each of the reports that include many predictions have been generated by the use of the Delphi process. That process is characterized by a series of reiterative questionnaires interspersed with feedback data that promote convergence of participant opinions regarding the probability of occurrence of future events.

Hill (1984) conducted a survey of nursing administrators of midwestern baccalaureate programs accredited by the National League for Nursing to determine which of 40 predictive statements were believed to have certainty for occurrence by 1992. The findings of this study included attention to health maintenance and hospice services; marketing of services; widespread use of marketing and political expertise by nursing education administrators; and academic retrenchment programs. Respondent comments revealed utilization of adaptive strategies for anticipated future needs.

Kelly personal correspondence, 1987) conducted a threeround Delphi study to project to the year 2000 after adapting Hill's original instrument. Eighty-three nursing service administrators for hospitals accredited by the Joint Commission on Accreditation of Hospitals in a five-state region responded. The findings paralleled the earlier predicted events in health care, nursing practice, and nursing education.

The question of developing new master's degree programs has been a critical topic of discussion for the last few years at Indiana University-Purdue University at Fort Wayne, Indiana (IPFW). The nearest master's degree program in nursing is 70 miles away at Ball State University in Muncie, Indiana. In 1988, a campus committee of administrators and faculty published a long-range strategic plan. The plan included the establishment of a master's program in nursing. The purpose of this descriptive exploratory study was to identify the most appropriate program for IPFW as well as for the professional nurses caring for the health-care consumers in the community.

Related Literature

O'Koren (1979) presented the critical issue of preparation for nursing leadership. She stated that "the need for an increasing number of strong, dynamic, qualified nursing leaders in nursing education, nursing services, community agencies, and in top federal agencies is reaching crisis proportions" (O'Koren, 1979, p. 6). Shortly after, at the American Association of Colleges of Nursing semiannual meeting, Felton decried the pressure being placed upon nursing educators to prepare "novices for the jobs and tasks of the past" (Felton, 1981, p. 7). Felton claimed that these traditional approaches are inappropriate and totally inadequate for preparing people to work on "emerging systematic problems of nursing and health" (Felton, 1981, p. 7).

The identification of the need for more nurses who can lead others into the future has closely followed the demonstration of changing nursing roles. Those changes have been mete red responses to trends in health care and society, such as economic growth, governmental interventions, and political and population shifts. In a Bureau of Health Professions report to the United States President and Congress (1986), the following startling statistics were noted as glaring reminders of the need for educated nurse leaders. A 1980 survey revealed that 5% (or 81,752) of the 1.4 million employed RNs held a master's degree and only 1% (or 4,108) had earned doctorates. The conclusion was made that a small group of RNs had the impossible task of providing "the management structure and guidance necessary to the sound practice of nursing throughout the health-care system" (US Bureau of Health Professions, 1986, pp. 10-20).

Employers will be looking for nurse leaders who can function autonomously (O'Leary, 1986). O'Leary's description of autonomy is a further indication that nursing leaders must be prepared to function in the future. "Having autonomy means having a sense of responsibility for one's own behavior. Traditionally, women, and therefore most nurses, have been socialized to be passive. Such behavior is incompatible with the characteristics associated with autonomy" (O'Leary, 1986, p. 208).

The future autonomous role has been addressed by other nursing writers in more specific terms. For example, Spitzer and Davi vier (1987) stated that autonomous nurses will affect change by conducting research to identify consumer needs and designing programs to meet those needs, marketing their unique skills and contributions to health care, and competing for the prize of highest quality health care. Those activities were echoed by Daria and Moran (1985) who added to the growing survival kit the factors of fiscal accountability, assessment of the elderly and critically ill, and computer literacy.

Additional requirements for nurse leaders were identified by Christman (1987). Managers of the nursing staff will need expertise in financial planning, clinical investigation, organizational and communicative behavior, and collaborative strategies. Christman also predicted that "the economic rewards of practice probably will be tied more closely to keeping the population healthy than to attending to the cure process" (Christman, 1987, p. 7).

An assessment and analysis of current management training needs of middle managers was conducted by a group of nursing service administrators and educators from New York, New Jersey, and Connecticut (Vanee & Wolf, 1986). Essential skills reported in rank order were: fiscal management, communication skills, diagnosis/solving staffing problems, decision-making approaches, conflict management, leadership skills, application of power, influence and authority, evaluation strategies, management approaches, and team building. The authors suggested that the skills listed would be content most appropriately offered in a blended or multidisciplinary master's degree program.

Since the early 1980s, nursing education has taken action to correct the faults identified by O'Koren, Felton, and others, particularly at the graduate level. Lately, increasing attention has been directed toward societal trends that have had an impact on nursing (Bergman, 1986; Dunham, Carter, Keshock, Mondora, Rendano, & Torok, 1986; Hall & Allan, 1986; Roncoli & Whitney, 1986). Not only have master's programs in nursing increased in numbers, breadth, and depth, but other disciplines also have created master's programs that have become instrumental in meeting the needs of nurse leaders.

Professional development in the direction of marketing, finance and economics, strategic planning, and decision making may well be the ultimate test of the nurse's future skills (Dorsey & Hale, 1987; Isaac, 1985; Kirk, 1986; Norkett, 1985). Societal trends have been reflected in the recent development of master's degree programs that are more flexible and tend to focus more on the functional role preparation of nurses (McKevitt, 1986). McKevitt also noted that the American Nurse's Association's second position paper on graduate education called for pluralism, diversity, and flexibility. Sakalys and Watson described such a graduate program that prepares "health professionals with knowledge deriving from a holistic integration of knowledge from many disciplines" (Sakalys & Watson, 1986, p. 94).

The success of master's degree programs has generally been attributed to tailoring the program to meet a need that is a reflection of the attitude held by the prospective student. Watson and Wells (1987) conducted a survey to determine attitudes toward graduate education that promoted the desire to pursue a masters degree. The authors believed that the program must be designed to fit the target population. The findings of the study included a description of the benefits of a master^ program as perceived by the 524 respondents. The respondents were in leadership positions that normally require skills learned at the master's level; however, they did not hold the degree. The major personal benefits were believed to be intellectual stimulation, further specialization, and increased ability to practice autonomously with greater credibility.

The Indiana Commission for Higher Education published findings and recommendations relative to the "unmet demand for registered nurses in Indiana in 1987" (Indiana Commission for Higher Education, 1987, p. 1). The conclusion of the report was that further investment in graduate level education in nursing should be given a low priority. Although university presidents and deans objected on the basis of short changing the consumers of health care, the draft was adopted.

Projecting the future for an academic campus is a longrange planning strategy that requires input from a variety of sources. Another report, sponsored by the Fort Wayne Future and Greater Fort Wayne Chamber of Commerce, recommended that the IPFW mission statement and all academic programs concentrate on regional and local demands, which included master's degree programs in many disciplines, including nursing (Woolfey, 1988). Based on the review of the literature related to projecting future events in health care that would require changes in both the role and education of professional nurses, the needs assessment plan was developed and implemented. Survey information was gathered to augment effective long range planning by the IPFW nursing department and the Division of Health Sciences. The responses to the survey questionnaire were expected to answer the following questions:

* What future health-care and nurse practice events are likely to occur by the year 2000 in Fort Wayne and Northeastern Indiana?

* What skills/knowledge/abilities are considered to be both critical to survival and best learned in a masters degree program?

* What are the characteristics/attitudes of the prospective student that would be indicators of adequate enrollments?

Methodology

The population of interest was those RNs holding baccalaureate degrees and currently employed by hospitals within a 60-mile radius of Fort Wayne. The area included 11 Indiana counties, five nearby counties in Ohio, and three counties in Michigan. Both nursing administrators and staff nurses were in the target population. Each hospital nursing administrator was sent a packet containing four self-report questionnaires and a cover letter assuring confidentiality and explaining the procedure for distribution and completion. The pack included self-addressed stamped envelopes for the convenience of each respondent. Forty-seven of the 76 questionnaires were returned (61.8%) by 13 administrators and 34 staff nurses. Of 26 hospitals located in the designated area, 17 ( 76.4% ) were represented.

The instrument contained three sequential sections. The first section was a set of 18 predictive statements that had been established as findings in two earlier Delphi studies (Hill, 1984; Kelly, personal correspondence, 1987). Participants were instructed to estimate the percent of probability that the stated event would occur by the year 2000. The first section was designed to stimulate thinking toward future practice and learning needs.

The second section contained a list of 18 learning content items. For each item, the respondents were instructed to make and record their decisions using a four-point Likerttype scale. The first judgment was the degree to which the content was critical to survival; the second was related to the degree to which the same content item was believed to be best learned within a master's degree program. A master's in health administration with a major in nursing was suggested as a possible option, an example of a blended degree similar to the ones described by Vanee and Wolf (1986) and Sakalys and Watson (1986).

Demographic data were requested in the third section, which also included questions regarding masters degree education constraints and preferences. The instrument was pilot tested by twenty-one IPFW senior nursing students. Content validity was examined, alterations were made, and the final copy was then distributed to the targeted participants.

The survey questionnaires were distributed via the nursing administrators at the appointed agencies. Data were collected and analyzed in the following manner. Median percentages of probability were calculated after organizing the data according to the predictive statements. Findings in the first section included items to which a median percent of probability of 60 or higher had been calculated. Responses for each item in the second section of the questionnaire were organized by frequency distributions that were then calculated by percentages of total strongly agree/agree and disagree/strongly disagree categories to critical to survival judgments and best learned in a master's degree program judgments.

Findings

Of the 18 predictive statements, all but one was judged to be certain to occur by 2000 by the respondents at the median percent of probability of 60 or higher. Table 1 illustrates the relative certainty for the 18 statements. Three statements earned a median percent of probability of 80 to 83. Five predictive statements were very congruent judgments (median differences of 2.5% or lower) among administration and staff. Little congruence (medians of 15% or more difference) between the judgments of the nursing administrator group and the staff nurse group occurred related to three predictive statements.

Tables 2 and 3 have been organized to display relative rank of agreement that certain content items would be critical to survival and best learned in a master's program. The administrators respond that content related to business, management, and legal/government/ethical matters was both critical to survival and best learned in the masters degree program. Content specific to nursing earned somewhat lower percentage scores on the critical scale and considerably lower percentage scores on the master's scale. Staff nurses' reports were much like the administrators', except that the percentages of positive responses regarding nursing content on the critical scale were higher than those of the administrators on the same scale.

Demographic data and other responses to the third section of the questionnaire were organized by frequency distributions to determine modes. Of 13 administrators, six already held masters degrees; five of 34 staff nurses had earned a master's degree, and two are currently working on a master's. Spring of 1990 was the category most often selected by administrators and staff as the time they would like to begin study in evening classes. Most administrators and staff nurses preferred leadership as the clinical area; the next highest preference among staff nurses was critical care. Most administrators were willing to commute 60 miles, whereas most staff nurses were willing to commute 40 miles or less one way. Nine of 13 administrators would receive financial assistance through tuition reimbursement; 25 of the 34 staff nurses responded positively to the question of tuition reimbursement. Most of the administrators and staff nurses indicated they were between 30 and 49 years of age; most are married and female. Most nursing administrators and staff nurses reported that they did have certification in a specialty area.

Table

TABLE 1PERCEPTIONS OF NURSE ADMINISTRATORS AND STAFF NURSES REGARDING EVENTS IN HEALTH CARE, NURSING PRACTICE, AND NURSING EDUCATION 8Y THE YEAR 2000

TABLE 1

PERCEPTIONS OF NURSE ADMINISTRATORS AND STAFF NURSES REGARDING EVENTS IN HEALTH CARE, NURSING PRACTICE, AND NURSING EDUCATION 8Y THE YEAR 2000

Table

TABLE 2PERCENTAGES OF POSfTIVE RESPONSES REGARDING SPECIFIC KNOWLEDGE, SKILLS, AND ABILITIES PERCEIVED TO BE CRITICAL TO SURVIVAL AND BEST LEARNED IN A MASTER'S DEGREE PROGRAM BY NURSE ADMINISTRATORS

TABLE 2

PERCENTAGES OF POSfTIVE RESPONSES REGARDING SPECIFIC KNOWLEDGE, SKILLS, AND ABILITIES PERCEIVED TO BE CRITICAL TO SURVIVAL AND BEST LEARNED IN A MASTER'S DEGREE PROGRAM BY NURSE ADMINISTRATORS

Discussion

Small sample size and lack of reliability testing of the total instrument were identified as limitations. However, the first section of the instrument containing the findings of previous Delphi studies was judged reliable. The command of the literature and the pilot testing added to the validity. The return rate by individuals and by agencies was substantial.

The data suggest a tendency toward correlation between predictions and projected needs in practice and education. For example, the stronger predictive statements relative to creativity/adaptability, economic issues, care of the elderly, business and management in curriculum, decision-making skills, and counseling/teaching are reflected in perceived need for content in business, management, legal and governmental issues, ethical decision making, and gerontological nursing. All content areas except gerontological nursing were perceived to be best learned in a master's program. The reversed differences in scores for statistics and research content were not surprising considering nursing's traditional heritage.

Based on analysis of the data, a blended program rather than a master's degree in nursing would have the greatest probability of success in meeting the perceived needs of the nursing community. The future professional nurse's role, according to the responses, will be one of heavy responsibility and accountability in areas of marketing, economics, finance, communications, ethics, and legal and governmental concerns. The patient population density of the elderly will bring new concerns. To survive as a nurse professional in the future climate, the respondents have reported a need for content in the above areas that could most appropriately be offered in multidisciplinary programs leading to a master's degree.

Prospective students, according to demographic data, are females who have had a number of years of experience in hospital nursing. They are motivated to invest time, money, and effort to learn the new knowledge, attitudes, and skills necessary to achieve excellence in the nursing profession.

Based on analysis of the data, the master's degree program in nursing is not the most appropriate to meet the reported needs of the nursing community. The master's degree in nursing would mean that the program would fall under the close scrutiny and control of the National League for Nursing, an accrediting body that requires many hours in the major. The respondents did not express the need for nursing content nearly as strongly as the need for other content. In addition, the data indicated considerably less strong agreement that nursing content could be best learned in a degree program. Additionally, the philosophical climate of the Indiana Commission for Higher Education would preclude a decision to move in that direction.

Table

TABLE 3PERCENTAGE OF POSITIVE RESPONSES REGARDING SPECIFIC KNOWLEDGE, SKILLS, AND ABILITIES PERCEIVED TO BE CRITICAL TO SURVIVAL AND BEST LEARNED IN A MASTER'S DEGREE PROGRAM BY STAFF NURSES

TABLE 3

PERCENTAGE OF POSITIVE RESPONSES REGARDING SPECIFIC KNOWLEDGE, SKILLS, AND ABILITIES PERCEIVED TO BE CRITICAL TO SURVIVAL AND BEST LEARNED IN A MASTER'S DEGREE PROGRAM BY STAFF NURSES

Recommendations

The recommended curricular focuses were divided into three groups to represent core content, selective content, and a nursing component (Figure). Grouping was determined based on the analysis of the data. Content items that had the highest percentages of positive responses were included as core content. The core content areas are ones that should be open to all baccalaureate prepared individuals in all health-care disciplines. The second content set, also open to all students, would provide for options in various departments. Two courses with a clinical component in the designated health profession should be required of all students. The final six hours of the blended program should be conducted as a contract applied research practicum involving faculty and students on a one-to-one, or small groups of two or three, basis.

A formative and summative plan will be conducted prior to enrolling students. The significant difference between critical to survival nursing content scores and best learned in a master's degree program nursing content scores warrants further investigation. Perhaps that content should become a part of a package of in-house workshops to be marketed as staff education to hospitals in northeastern Indiana and surrounding areas.

Table

FIGURECORE, OPTIONS, AND SPECIALTY CONTENT AREAS ARRANGED ACCORDING TO PERCEIVED NEED OF NURSE ADMINISTRATORS AND STAFF NURSES EMPLOYED IN HOSPITALS WITHIN A 60-MILE RADIUS OF INDIANA-PURDUE AT FORT WAYNE

FIGURE

CORE, OPTIONS, AND SPECIALTY CONTENT AREAS ARRANGED ACCORDING TO PERCEIVED NEED OF NURSE ADMINISTRATORS AND STAFF NURSES EMPLOYED IN HOSPITALS WITHIN A 60-MILE RADIUS OF INDIANA-PURDUE AT FORT WAYNE

Although the findings of this study cannot be generalized, the concept of linking predictions of future events to future needs in the academic and work communities is valid. Further research in other geographical locations and in other disciplines may reveal similarities that would facilitate overall effective long-range planning for the health-care industry. An expected vicarious benefit would be better town/gown relationships as a result of meeting community needs.

References

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TABLE 1

PERCEPTIONS OF NURSE ADMINISTRATORS AND STAFF NURSES REGARDING EVENTS IN HEALTH CARE, NURSING PRACTICE, AND NURSING EDUCATION 8Y THE YEAR 2000

TABLE 2

PERCENTAGES OF POSfTIVE RESPONSES REGARDING SPECIFIC KNOWLEDGE, SKILLS, AND ABILITIES PERCEIVED TO BE CRITICAL TO SURVIVAL AND BEST LEARNED IN A MASTER'S DEGREE PROGRAM BY NURSE ADMINISTRATORS

TABLE 3

PERCENTAGE OF POSITIVE RESPONSES REGARDING SPECIFIC KNOWLEDGE, SKILLS, AND ABILITIES PERCEIVED TO BE CRITICAL TO SURVIVAL AND BEST LEARNED IN A MASTER'S DEGREE PROGRAM BY STAFF NURSES

FIGURE

CORE, OPTIONS, AND SPECIALTY CONTENT AREAS ARRANGED ACCORDING TO PERCEIVED NEED OF NURSE ADMINISTRATORS AND STAFF NURSES EMPLOYED IN HOSPITALS WITHIN A 60-MILE RADIUS OF INDIANA-PURDUE AT FORT WAYNE

10.3928/0148-4834-19890901-07

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