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AAQEP Accreditation 2022

Standard 3 Aspect E

3e.   Engages in continuous improvement of programs and program components, and investigates opportunities for innovation, through an effective quality system.

The school Nurse Services Program engages in continuous improvement using feedback from candidates, preceptors, faculty and stakeholders.  In the past three years program review has led to significant upgrades and improvements including the following:



SNSC Visibility and Recruitment

CSNO Conference presentations
CSNO Breakouts to meet candidates/preceptors
Program brochure
Update website, course catalogs


Program Capacity

Doubled number of candidates and faculty to improve access



Moved to improved online learning platform
Online Resources
Zoom technology



Preceptor handbook



Revision of evaluation forms


Masters Options

SON discussion of potential options and pathway for proposal.

Curriculum Changes in Progress
The School Nurse Services Credential Program currently requires all candidates to have completed a BSN in Nursing, including coursework in Community Health, Nursing Research, Special Education, Counseling and Audiology.  After careful review of the curriculum to ensure alignment with the CCTC curriculum standards, it was determined that counseling coursework was adequately covered in the seminar and practicum courses and it was decided to recommend Counseling be dropped in 2022 as a requirement.  In addition, as all our school nurse candidates are working in the school districts in communities, it was determined additional community health fieldwork hours were not necessary.  These changes will significantly reduce cost and time for our candidates in program completion.  A proposal was placed before the SON Graduate Committee, SON faculty, and Continuing and Global Education Department, and after careful review and discussion, it was decided that counseling  would be dropped from the program.

In addition, discussion has started to determine if the SNSC could have a Masters Level pathway to allow candidates to continue with their education after obtaining the credential in school nurse areas.

Candidate Internal Audit Process: (Appendix D)
The SNSC program follows a tight admissions and support process in order for our candidates to proceed through the program towards their final credential.

Outcome from Audit Process
In reviewing the pathways of the four candidates noted above, one strength of the program is flexibility and the ability to tailor the program components and timelines to the needs of the candidates.  A second strength is program candidates have direct access to the program coordinators and their instructors for consultation and questions. Before submitting a program application and admission, program coordinators interact with potential candidates via email and personal phone call, reviewing transcripts for course completion, refer and recommend needed coursework and assist with program registration. We feel the application process and use of the rubric helps us to focus on the best candidates. However, as a whole our candidates have already achieved multiple educational levels.  Many are nurse practitioners, and very few are denied entry to the program or asked to reapply the following year. 

At any point in the SNSC program candidates may make changes to their schedules, request assistance with practicum documents, placement and/or request recommendations for new experiences.  If problems arise, consultation with program coordinators and instructors can result in increased flexibility with assignment deadlines, etc. If a candidate experiences a medical or family emergency the candidate can formally request to drop a course in the semester and make it up later.  This allows them continuity and the ability to move forward, but eases the workload.  If needed, program coordinators may write on behalf of the candidate to the CCTC for a credential extension request to allow an additional year of time to complete the program. 

The richest experience noted by candidates is working with a school nurse preceptor in the practicum classes. Candidates overwhelmingly praise their preceptors and love having someone to work side-by-side with them during this time.  As the SNSC program has two distinct practicums (elementary and secondary), if needed, candidates can choose to switch preceptors midway through the program to gain new experiences and resources.

Although the cost of the Fresno State SNSC program is below other universities offering the credential, one difficulty for candidates is a lack of scholarship or grants common in graduate level programs.  We have had candidates drop out of the program due to financial difficulties.  However, California has directed new funding for nursing education in August 2021 that might help our candidates and we will investigate this as a grant opportunity. A second area we need to investigate is the development of a standardized online End of Program Survey for candidates.

Process for Ensuring Data Quality through Validity, Reliability, Trustworthiness, & Fairness:
The majority of the measures used to evaluate our program in this QAR are key assignments students complete as part of their coursework. Each assignment was created to align with course expectations, which align with the CCTC Program Standards for the School Nursing Credential. In this way, we believe the assignments do serve as valid measures to assess our candidates’ learning. (See Appendix E)

Moving forward, we intend to engage in a deeper analysis to ensure that what we believe about the assignments’ validity is, in fact, true. As a program faculty, we intend to begin analyzing both the assignment expectations and the tools used to measure those assignments to ensure that they are, in fact, valid. Additionally, for tools such as the Preceptor Checklists and the Knowledge-Based Questionnaire, we intend to solicit feedback from our site supervisors and share them with our advisory board members to ensure that the knowledge and skills they believe are needed by successful school nurses are appropriately captured.  

Once we have the revised assignments and assessment tools in place, we will pilot them in our courses. In order to establish reliability, as a program faculty, we will engage in joint scoring of student samples using the revised rubrics to ensure that we are all in agreement on how the assignments should be scored. Where disagreements arise, we will work to come to a common understanding. We will repeat this process on (an annual, biannual, regular) cycle to ensure the ongoing reliability of the measure.

As a program faculty, we do believe that the assignments we provide to candidates are fair in that we always provide specific instructions along with rubrics to provide details for how the assignment will be scored. Moving forward, we will also work to collect student samples from successful candidates that can serve as models for current candidates.

Summary of Findings 3e
The School Nurse Services Credential Program engages in continuous improvement of programs and program components, and investigates opportunities for innovation, through an effective quality system.

Data show Candidates receive support at every stage of the program from program coordinators, faculty and preceptors to ensure that transition throughout the SNSC program is seamless and candidates achieve a high level of learning.

Aspect F →