Saturday, January 26, 2013

DACC’S NURSING PROGRAM AND ITS CHANCES OF LOSING STATE ACCREDITATION


[NOTE: The blog has two parts.  The first, which copies today’s column in the Las Cruces Sun-News, analyzes a report on the DACC nursing program’s loss of national accreditation.  The second assesses the chances that the program will lose state accreditation after an April review].


DACC Nursing Program Report Conceals Mismanagement

As a public disservice, Michael Morehead, Dean of NMSU’s College of Education has produced a useless report on DACC’s loss of national accreditation for its nursing program.  It investigates nothing; it provides no history or analysis of the events, no description or evaluation of the problems, and thus no foundation for its findings and recommendations.  Worse, it ignores the chances that the state will downgrade or withdraw the program’s accreditation this spring—two reasons: losing national accreditation and misleading students and the public about the consequences of that loss—and postpone or preclude national re-accreditation.  The report says nothing about these ominous possibilities.

The deficiencies of this report, entitled “Commission on Nursing Accreditation Oversight,” reflect the problems which it should, but does not, address.  The report lacks facts connecting itself to DACC or NMSU.  Its first, or title, page states that the “Final Report” was “submitted by” Morehead, but not to whom.  Its second page states that “The Commission was charged” but not by whom.  It lists “Committee [sic] Members” but without identifying their positions (some are interested parties).  The last page lists “Individuals Interviewed” but without identifying their positions.  Worse, the report minces words in stating the first of the Commission’s three stated purposes: not only to “investigate” DACC’s loss of accreditation, but also to develop a transparent and complete report to inform a concerned public.

The omission of this information reflects efforts throughout the report to avoid assigning responsibility or making judgment, without which it does not provide insight into, or teach lessons about, the issues.  It reflects the same lack of connections among individuals and organizations which characterizes DACC’s and NMSU’s management failures.  Revealingly, the report never uses the word “manage” or its cognates, and its use of the passive voice avoids identifying accountable officials or positions.

The report avoids the history of DACC’s nursing program and its problems for at least the past 16 years, the 8 most recent of them under DACC President Margie Huerta.  It mentions that the program has had long-standing problems but omits that it has also received many notices of jeopardy warning that its national accreditation was at risk.

The report says nothing about DACC’s history of problems with its nursing program.  Superior management proactively anticipates or identifies problems and takes steps to prevent or mitigate them.  Competent management reactively addresses them to remediate their effects and to prevent their repetition.  The report does not say that anyone during this period did anything proactively or even reactively.  It does not mention one exception.  Worried about its accreditation because its first-time pass-rate on the national nursing examination failed to meet the state’s 80-percent standard, DACC spent money for a course on test-taking.  DACC has recently met the standard but not addressed the underlying and other problems.  By avoiding history, the report avoids the obvious question: why did DACC officials fail over many years to act to avoid what was inevitable if they did not act?

The report says nothing about those who failed to act, why they failed to act, or even whether they felt obliged to address problems.  To identify them would not aim to blame them, but to elicit information about positions and their responsibilities, programs or institutions, and the management culture.  Pursuing none of these issues, the report reflects DACC’s and NMSU’s approach to management problems: avoid rocking the boat and save the crew, though the boat might sink and the passengers drown—the story of DACC’s loss of its nursing program’s national accreditation.

The result is a failed investigation.  The report does not describe what went wrong, explain why, or analyze why it stayed wrong.  It lacks information about actual actions by actual agents of those actions.  Its findings repeat what is known or state what is obvious.  Its recommendations are bureaucratic, banal, bland.  For example, the report emphasizes the need for improved communication in formal ways, but omits identifying anyone responsible for ensuring this management function.  It fails to identify the problem as stovepiping or consider why it exists and why officials do not communicate with each other.

Without explicitly identifying management as a problem, the report offers one “key recommendation” in a vacuum, without critical management details: “the NMSU system [should] create and institute a system-wide ‘Nursing Council’ to provide oversight and coordination of nursing programs throughout the system”—another committee but no management.  The report, which details subsequent and subordinate recommendations (most best left to the committee), says nothing about who in the system establishes this council, to whom it is responsible, who presides over it, who sits on it, and what authority it has—thereby reflecting in its key recommendation commonplace DACC and NMSU management failures: no chain of command and no channels of communication.

The report unwittingly demonstrates what is incompetent or corrupt about DACC’s and NMSU’s management.  If the state enforces its minimum standards for a nursing education program, downgrading or withdrawal of accreditation looms.


The Chances of Losing State Accreditation

An issue of great local concern, DACC’s loss of national accreditation of its nursing program, continues to roil Las Cruces and southern New Mexico.  My 15 and 21 August blogs have discussed various aspects of the issue; this Saturday’s column, which I send you Thursday, when I submit it to the Sun-News, addresses NMSU’s Dean Michael Morehead’s report on DACC’s loss of accreditation.  In this letter, I detail some important matters which bear on DACC’s state accreditation and national re-accreditation.

A major deficiency of Morehead’s report is its avoidance of a most important, urgent fact: loss of accreditation by the National League for Nursing Accrediting Commission (NLNAC) increases the chances of a loss of accreditation by the New Mexico Board of Nurses (NMBON) when it reviews DACC’s nursing program in April.  In that event, no state accreditation means no national re-accreditation—and no DACC nursing education program.  DACC’s nursing program faces big trouble, but neither DACC nor NMSU officials are saying so.

But I am skeptical that, despite long-standing, overwhelming evidence of non-compliance with its standards for accreditation, NMBON will withdraw DACC’s accreditation.  In New Mexico, state boards rarely hold anyone accountable according to public criteria.  In this case, political pressure to maintain a major nursing program in and serving southern New Mexico is likely to deter NMBON from enforcing its standards.  NMBON will either do nothing except scold a few likely targets and rap a few knuckles or, as a sop to local anger, downgrade DACC’s accreditation to a 2-year “conditional approval,” then restore full accreditation after enough time to give the appearance of finding DACC’s responses satisfactory.  I may be naive to think that NMBON will accept, perhaps with diplomatic mumbled grumbles, the status quo.

If Morehead’s report is any indication, DACC and NMSU cannot forthrightly or effectively address their fundamental management flaws.  In the next 4 months, DACC is unlikely to do anything much affecting NMBON’s determination; in a maximum 2-year probationary period, it will likely not do much better: bureaucratic shuffling, speeches, meetings, press releases, but little real change.  But, at some point in that period, NMNOB may credit DACC and NMSU for expending a lot of energy.

Bad news not delivered by Morehead’s report is that, during this period, even the first step of the two-step NLNAC re-accreditation process will be postponed.  Its first step ascertains program readiness for application; its second step evaluates the application.  But while DACC awaits NMBON’s April review, it will not be ready for the first step of the NLNAC accreditation process.  More bad news: if NMBON downgrades its accreditation of DACC’s nursing program to provisional status, NLNAC is not likely to regard that status as indicating readiness for the first step of its re-accreditation process, which takes about 2 years.  Still more bad news: serial accreditation may take until about 2018, when NMNOB will begin to require all state nursing programs to have national accreditation as a pre-requisite of state accreditation.

Problems which the Morehead report does not even mention are unlikely to be greatly ameliorated, much less solved, by patchwork responses.  Moreover, with Margie Huerta remaining as president in 2013, NMBON reviewers of DACC’s nursing program are less likely than DACC’s and NMSU’s interested parties to think that she can initiate, much less effect, the necessary changes, or to give DACC’s efforts the benefit of the doubt.  Perhaps NMBON will quietly suggest that she make an earlier departure from the presidency.

The Regents have posted Morehead’s December report in January on their website, have sent a press release announcing it and its availability to the media, but have not sought public comment or participation.  Worse, they appear to have accepted this report as a fulfillment of their promise to the public at last fall’s public meeting on DACC’s lost of accreditation that they would ensure a full investigation and complete report—all in the name of accountability and transparency.

Yet the Regents response avoids accountability, transparency, and, most of all, public participation.  (Please, someone tell me—I have asked Ben Woods, their clerk, but he refuses to respond—why Regents do not provide the public with phone numbers and email addresses, as elected officials do.)  Their response signifies their inability to handle DACC’s loss of accreditation except to try to limit political discomfort to DACC, NMSU, and state officials.  At the same time, it does not reflect well on their comprehension of the issue and its implications or their concern to save DACC’s nursing program.  I expect that their incompetence or dereliction will doom DACC’s nursing program in the future, when they and everyone else involved today have moved on to greater glory.

Final comment, I have not explored the she-said/she-said question whether Huerta told or did not tell then-NMSU’s President Barbara Couture about DACC’s problems.  Many have accused Huerta of serial lying.  I am also not going to explore that issue in any depth.  However, I noticed in Sun-News articles covering DACC’s loss of accreditation and in the fall meeting before the Regents many allegations of Huerta’s dishonesty as well as her other failings as a leader.  NMBON will address these allegations because the veracity of public statements about nursing programs is a criterion for NMBON accreditation.  It may even be that the failure of the Regents or Morehead to investigate the issue will not count in DACC’s or NMSU’s favor.  For what they want to conceal, the NMBON review might uncover, further handicapping DACC’s chances of retaining accreditation.

But one disparity between one NMBON measure of student performance and Huerta’s statements about student success is relevant to this allegation.  The disparity is that between NMBON standards and Huerta’s favorable claims about the quality of DACC’s nursing program and the record of its students’ success.

Every year, NMBON reports on the performance of state nursing education programs as measured by its standard: a first-time pass rate of 80% on the NCLEX national examination.  It reports its results in a tabulation entitled “Percentage of Successful First Time RN (Registered Nurses) Candidates.”  Its September 2011 report gives DACC’s percentages for its entire 16-year history of reported data:

1996     1997  1998  1999  2000  2001  2002  2003
70.0      93.8   91.3   86.7   80.8   71.9   92.3   92.3
(2 out of 8 years under 80%)

2004     2005  2006  2007  2008  2009  2010  2011
55.6      78.3   62.5   54.6   68.1   95.7   91.2   86.4
(5 out of 8 years under 80%)

DACC did not meet the 80% standard from 2004, when Huerta was hired, through 2008.  The scores were a matter of great concern, for failure to meet this NMBON standard prompts a notice of non-compliance and demands an assessment of possible problems (1 year) or a plan of corrective action (2 consecutive years).  After 2008, DACC used grant money to fund a semester course in NCLEX preparation—which, more than a dramatic improvement in curriculum or instruction likely accounts for the sharply higher scores from 2009 through 2011.  However, before Huerta arrived, comparable scores occurred in 1997 through 1999 and in 2002 and 2003, presumably without benefit of such a course.

Meanwhile, in response to challenges to, or questions about, the quality of DACC’s academic performance, Huerta has consistently assured staff, students, and the public that DACC’s nursing program meets high standards and graduates well-prepared nurses.

Given the many complaints along these and other lines in the aftermath of DACC’s loss of accreditation, and Huerta’s contrary claims, NMBON will have its work cut out for it in addressing the discrepancies.  If—big “if”—NMBON finds that Huerta has been dishonest with students, faculty, and the public, it will find that DCAA has violated another of its standards of accreditation.

Website addresses:

My blogs:
NMBON standards:
Search path - NMBON website, Approval and Accreditation, Rules, Part 3, section 16.12.3.8, “Types of Approval”
NMBON percentages:
Search path - NMBON website, Nursing Education, NCLEX RN Nursing Rates

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