Blog 006: The Impact of the 2018 CCNE Standards Changes on You and Your Students

Consistent with expectations for nursing programs, CCNE regularly reviews all Standards and key elements; revisions occur as needed. The incorporation of the community(ies) of interest is a thread that runs throughout all of the Standards. The current CCNE Standards for Accreditation of Baccalaureate and Graduate Nursing Programs (2018) reflect four Standards comprised of a variety of key elements that break down the standard into clear, succinct, and measurable components which, in turn, guide each program’s self-assessment. An elaboration accompanies each key element and is provided to help the reader understand the expectations of the key element and guide a program’s response (CCNE, 2018).

In the most recent revision (2018), “Standard I Program Quality: Mission and Governance” was expanded to include some material previously located in other Standards. As a result, the number of Key Elements increased from six (6) to eight (8). “Standard II Program Quality: Institutional Commitment and Resources” was increased from six (6) to seven (7) key elements, again due to the re-allocation of integral information.

“Standard III: Program Quality: Curriculum and Teaching-Learning Practices and Standard IV: Program Effectiveness: Assessment and Achievement of Program Outcomes” were substantively redesigned. Standard III increased from eight (8) key elements to 10 and Standard IV was restructured comprehensively. Some material from Standard IV moved to earlier standards and new information was embedded. The significant restructuring of Standard IV enhances the focus on outcome measurement and use of data to support program effectiveness (CCNE, 2018).

The remainder of this article will focus on the substantive changes in Standards III and IV. These revisions were accepted in 2018 and went into effect in January, 2019. All programs that were scheduled for review on or after January 1, 2019 are subject to these revised standards (CCNE, 2018).  

Standard III: Program Quality: Curriculum and Teaching/Learning Practices

“The curriculum is developed in accordance with the program’s mission, goals, and expected student outcomes. The curriculum reflects professional nursing standards and guidelines and the needs and expectations of the community of interest. Teaching/Learning practices are congruent with expected student outcomes. The environment for Teaching/Learning fosters achievement of expected student outcomes.” (CCNE, 2018)

The community of interest component was expanded with the most recent revisions and currently appears in multiple key elements within Standard III. Communities of interest are defined by the program and may include internal (faculty, administration, students) and external (interested stakeholders in surrounding communities, professional nursing organizations, and certification agencies) components.

In order to become accredited, program faculty members and administrators must describe how the curriculum was developed and how this process reflects the needs of the communities of interest. These descriptions are to be provided in the Self Study document and during the on-site review. As part of the process, many of the nursing faculty members must conduct an extensive reflective review of the curriculum to assure its currency and consistency. And, the program must also demonstrate that the expected student outcomes reflect the program’s mission and goals

Specific curricula focused on the baccalaureate, master’s, doctor of nursing practice, and post-graduate certificate were formerly incorporated into a single key element. The 2018 revisions resulted in these being separated into key elements III-B through III-D The elaborations for each of these three key elements are virtually the same: “the {BSN, Master’s, DNP, or post-graduate APRN certificate} program incorporates professional nursing standards and guidelines relevant to that program and each track offered. The program clearly demonstrates where and how content, knowledge, and skills required by identified sets of standards are incorporated into the curricula” (CCNE, 2018).

The separation of this material allows, and even encourages, faculty to engage in reflection and careful consideration of the content specific to each degree program. The expansion of attention within Standard III toward these degree programs affects the specificity of the explanations within the Self Study document and suggests that programs provide more detail in their responses. Prior combinations of these key elements may have led faculty to focus their efforts on one program while not providing enough about the others. This separation allows the applicant to provide a comprehensive discussion of each program and may result in more opportunities for program development and quality improvement.

The remainder of the key elements in Standard III are basically as they existed in the previous cycles; only the identifying letters and numbers were changed.  

Standard IV: Program Effectiveness: Assessment and Achievement of Program Outcomes

“The program is effective in fulfilling its mission and goals as evidenced by achieving expected program outcomes. Program outcomes include student outcomes, faculty outcomes, and other outcomes identified by the program. Data on program effectiveness are used to foster ongoing program improvement.” (CCNE, 2018)

Key elements within Standard IV require that the program under review use a specific, written, systematic, on-going data collection process to assess program effectiveness. Evidence must be provided that the process is reviewed on a scheduled basis and revised based on the results of the review. The key elements for this standard require integration of multiple data collection points in the review process. The data required includes program completion rates for key element IV-B, licensure and certification examination passing rates for graduates for key element IV-C, and employment rates of graduates for key element IV-E. Applicants must describe the process of data collection, the response rate associated with each data source, and the method used to calculate the rate (completion, pass, and employment). Key elements IV-G through IV-J require programs to provide faculty outcomes and other program results. Both qualitative and quantitative data may be collected and analyzed including a comparison of expected and actual outcomes.

Completion Rates

In the previous version of the Standards, the completion rate for each of the three most recent calendar years was required. With the 2018 revisions, the program must specify the entry point(s), the time required for completion, and the formula used to calculate the completion rate. Note that the term completion rate is used rather than graduation rate. This designation does not indicate a change, rather a reflection of the fact that non-degree programs are included in the Standards and while individuals may not “graduate” per se, they do complete the program. 

In the 2018 revisions, programs have the option of complying with this key element in ONE of a number of ways: “completion rate for the most recent calendar year (January 1 through December 31);  the completion rate over the three most recent calendar years;  the completion rate for the most recent calendar year when excluding students who have identified factors such as family obligations, relocation, financial barriers, and decisions to change major or to transfer to another institution of higher education; or the completion rate for the three most recent calendar years when excluding students who have identified factors such as family obligations, relocation, financial barriers, and decisions to change major or to transfer to another institution of higher education” (CCNE, 2018).

In order to calculate the completion rates for this key element, the program must identify the group being described by the entry point, the time required for completion and the formula used to calculate the completion rate. In many nursing programs, multiple methods of completing the program may exist. For example, in a baccalaureate program, an individual student may pursue a “traditional” option while others may pursue an accelerated, post-licensure, or other variation of the program. Some faculty may find it desirable to separate the outcomes by completion option, especially if the outcomes of one option are significantly more positive than the outcomes of the others. However, the Standards indicate that completion outcomes must be reported for the program, rather than each of the completion options even if the completion options occur on different campus sites.

Additionally, a program must provide the exclusionary factors cited in the key element, as well as the number of students excluded from the calculation. For example, a program might cite that two students from a cohort were academically unsuccessful, two more had personal issues that prevented them from continuing in the program, and two others re-located, forcing them to transfer to a different program. Providing these data requires the program/faculty to track each individual student throughout their program of study and record any factors that prevent timely completion of the program. A process for tracking these data must be in place prior to a student group entering the program in order to deliver consistent results. 

Licensure Pass Rates

Calculating licensure pass rates has presented some challenges for faculty in the past as the process was not always straightforward. For example, first-time test takers typically perform differently on the licensure examination than repeat test takers, as do students attending classes at different locations. In order to effectively present their program for review, applicants have struggled with how to accentuate the successes of their program’s performance.

The 2018 revisions allow faculty and administrators to address this key element in ONE of the following ways: expressing the pass rate for each campus/site

• and track’s first-time test-takers for the most recent calendar year;
• and track’s first-time test-takers and repeaters for the most recent calendar year;
• and track’s first-time test-takers over the three most recent calendar years; or
• and track’s first-time test-takers and repeaters over the three most recent calendar years (CCNE, 2018, p 20).

The program must describe the sampling strategy (from above) used to calculate the pass rates (CCNE, 2018). These revisions allow the individual program to select the sampling strategy that fits their program best. Although the Standards do not address this explicitly, programs should use the same sampling strategy over an extended period of time. Changes to the strategy should only be made when substantial changes to the program occur since the sampling strategy changes can greatly impact the interpretation of performance.  

Certification Pass Rates

Certification pass rates now exist as an independent key element, Standard IV-D, a change from previous versions. Calculating these pass rates promotes the measurement of program outcomes using national certification data. The key element requires that this data must be collected and reported even if “national certification is not required to practice in a particular state” (CCNE 2018, p 20).

As with the licensure pass rate, programs can elect to track certification pass rates using ONE of the four different ways highlighted previously. Each individual program must describe the selected method for calculating the pass rates and may combine data for a program of study in which more than one certification examination is available for a single role and patient population. For example, Family Nurse Practitioner and Pediatric Nurse Practitioner graduates can elect to seek certification from two different agencies. Additionally, not all graduates seek certification. In either of these cases, faculty and administrators may elect to combine the certification results for a single group of students to best reflect program effectiveness. It is important to note that, regardless of the overall number of test-takers, the CCNE Standard requires programs to provide certification pass rates.

As with the licensure pass rates described in the previous key element, the program must provide the method of calculation and whether the data presented reflect the results of a single certification examination or a combination of examinations. The process used and the options for calculation are identical to those used for licensure pass rate data.

Employment Rates

Key element E stipulates that applicants demonstrate program effectiveness by presenting employment rates by degree or program type. Employment data can be collected at the end of a program of study or at any point within one year of program completion. Collecting data to support this key element can be difficult. Many programs use a process wherein students complete a graduation/completion survey at the end of their program and a separate survey one year following graduation.

Sometimes graduates do not seek employment within the first 12 months after program completion for a variety of reasons. The 2018 revisions to the Standards allow programs to exclude graduates who elect not to be employed from employment rate calculations. However, the data on graduate employment still need to be collected from all graduates.

Quality Improvement related to Student Outcomes

Key element I requires program faculty to use student outcome data for quality improvement. Data collection and the use of that data to promote program improvement can present some challenges for nursing faculty. Frequently data collection is the responsibility of a few key faculty members serving on the evaluation committees and the administrators who have responsibility for the overall process. The broader faculty group may not be fully aware of the data, nor the importance of basing decisions on the available outcome data for their program. Modifications to this key element will motivate nursing programs to revise their data collection process and data use so that faculty, as a whole, are fully engaged in the process.

Faculty Outcomes

Key element H indicates that programs integrate faculty outcomes, as determined by the program, into the annual program evaluation process. Many programs track faculty outcomes along the traditional faculty roles of scholarship, service, and teaching. In the past, individual faculty members were challenged to meet desired levels in all of these roles because their roles shifted with rank and expertise. For example, advanced practice nursing faculty are generally engaged in practice as a part of their workload and may not have a significant scholarship trajectory. Similarly, higher-ranking faculty often far exceed the individual publication standard while practicing less than some of their colleagues.

Another change in the 2018 revisions to the Standards is that aggregate rather than individual faculty outcomes must be presented. This change improves the ability of the program to effectively showcase all faculty activities and provide evidence of balance within the roles. Using aggregate faculty data to drive program improvement clearly connects faculty, individually and collectively, to the process. Faculty can then be a deliberate source of change with regard to workload and roles, among other evaluation factors, linking them to program effectiveness and quality improvement in a new, different way. 

Other Program Outcomes

As cited earlier, graduation rates, licensure and certification pass rates, employment rates, and aggregate faculty outcomes are stipulated as required outcomes. Key element J outlines the requirements for many other outcomes which are immensely important to nursing programs and are significant measures of quality and ongoing improvement, especially with regard to communities of interest. These outcomes are as individual as the program and can range from local to global concerns. For example, some programs advocate for a more global community and showcase the number of graduates who have worked with global communities. Other programs may focus on community action with regard to diversity. The inclusion of ‘other’ program outcomes as a key element in the review process provides a mechanism for faculty and administrators to describe how they demonstrate program effectiveness through specific, valued outreach that is necessarily traditional. The key factors in completing this requirement are that the program identifies the outcome, measures success, compares outcomes to expectations, and finally, provides evidence that the program is effective in this area.

Quality Improvement related to Faculty and Program Outcomes

Key Element G of Standard IV indicates that programs use faculty and program outcome data to further program improvement. Key components are that these data are collected, analyzed, compared to expected outcomes and used as a factor in overall program improvement. Consistent with other aspects of the accreditation process, nursing faculty must be fully engaged in overall quality improvement processes.

Accreditation Preparation: Impact on Program Activities, Planning and Evaluation

The impact of the changes on program activities was specifically addressed within each key element. There are some common themes to these revisions. Using aggregated, outcome-focused data and fully involving faculty in all processes is integral to the preparation for an accreditation review. These themes require that faculty and administrators be strategic in planning each aspect of the program, while simultaneously evaluating the outcomes to assure that they are “on the right track”. Involving the communities of interest in the processes also provides a different perspective on program planning and development. For example, changes in healthcare may be a catalyst for a new option or program of study. Alternatively, low student enrollment numbers or shifts in population may cause an older option to be retired.

Accreditation can be challenging and very time consuming as it requires a different viewpoint to be used to examine the program. Faculty and administrators are required to look through a long-term lens rather than the day-to-day resulting in a shift of perception. Using the accreditation process as a cornerstone in all program decisions and curricular option development will facilitate closer adherence to projected outcomes and will ease transitions. Empowering each faculty member to assume ownership of the nursing program and become involved in program planning, development, evaluation and, eventually, accreditation is essential to success and moving forward in a positive way.

In conclusion, the 2018 revisions to the Standards for Accreditation of Baccalaureate and Graduate Nursing Programs have been well received by the broader nursing education community. Faculty and administrators frequently asked for clarification related to the 2015 Standards, and I generally feel that these revisions have addressed some ‘murky’ areas for them. Personally, I believe that the 2018 Standards document offers a great deal of clarity, guidance, and structure to the processes embedded in the accreditation journey while providing the flexibility for each applicant to describe their program. The structure provides a framework, not a set of directions, to faculty seeking a way to showcase their program, even if their program is different than others.

References

Accreditation Commission for Education in Nursing (ACEN). www.acenursing.org

Commission on Collegiate Nursing Education (CCNE) (2018). Standards for Accreditation of Baccalaureate and Graduate Nursing Programs.

Fressola, M. C. & Patterson, G. E. (2017) Transition from clinician to educator: a practical approach. Burlington, MA: Jones and Bartlett Learning