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pdfEVALUATION OF THE GRADUATE NURSE EDUCATION DEMONSTRATION
PROGRAM
QUANTITATIVE DATA COLLECTION PROTOCOL
(Contract No. CMMI-393-2012-0117)
February 25, 2013
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocol
Definition and/or Instruction
(1) This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
(2) This template should be completed by those preceptors who train APRN students.
Preceptor Characteristics (from each clinical site and hospital, if appropriate)
Hospital or Clinical Site Name:
Preceptor ID Number: (In order to de-identify the information provided, please assign ID numbers to all preceptors)
Year and Academic Period of
Reference
Year and academic period of
Refers to the academic year and the semester/quarter for which the preceptor is responding to this survey
reference
Precepting Site
Type of site and name of site where
preceptor trains students
Profession
Physician (MD or DO)
Answer Value
Frequency of Collection
Year and quarter (fall,
winter, spring) or year and
semester (fall or spring)
Once each semester or quarter,
depending on the program's
structure
Type (hospital or Clinical
site) and Name of the site
Once each semester or quarter,
depending on the program's
structure
Choose One
A physician is a professional who practices medicine, which is concerned with promoting, maintaining, or Yes/No
restoring human health through the study, diagnosis, and treatment of disease, injury, and other physical and
mental impairments. Physicians may focus their practice on certain disease categories, types of patients, or
methods of treatment (known as specialist medical practitioners) or assume responsibility for the provision
of continuing and comprehensive medical care to individuals, families, and communities (known as general
practitioners). Medical practice properly requires a detailed knowledge of the academic disciplines (such as
anatomy and physiology), underlying diseases, and their treatment—the science of medicine—and a decent
competence in its applied practice, the art or craft of medicine.
Physician's assistants (PAs) are health care professionals licensed to practice medicine with physician
Yes/No
supervision. PAs employed by the federal government are credentialed to practice. As part of their
comprehensive responsibilities, PAs conduct physical exams, diagnose and treat illnesses, order and
interpret tests, counsel on preventive health care, assist in surgery, and (in virtually all states) write
prescriptions. Within the physician-PA relationship, PAs exercise autonomy in medical decisionmaking and
provide a broad range of diagnostic and therapeutic services. A PA's practice may also include education,
research, and administrative services.
Advanced Practice Registered Nurse From the "Consensus Model": "An APRN is a registered nurse who has completed a graduate degree or
Yes/No
(APRN)
postgraduate program that has prepared him/her to practice in one of the four advanced practice roles (i.e.,
CRNA, CNM, CNS, or CNP). This includes the advanced knowledge and skills to provide direct patient
care in the health promotion and maintenance of individuals." "APRN education must be formal education
with a graduate degree or post-graduate certificate (either post-master's or post-doctoral) that is awarded by
an academic institution and accredited by a nursing or nursing-related accrediting organization recognized
by the U.S. Department of Education (USDE) and/or the Council for Higher Education Accreditation
(CHEA)" (pg 10). (www.aacn.nche.edu/education-resources/LACE_FAQ_8_11.pdf)
Response
Once each semester or quarter,
depending on the program's
structure
Physician's Assistant (PA)
Registered Nurse (RN)
A registered nurse is a graduate of an approved education program leading to a diploma, an associate
degree, or a bachelor's degree and also has met the requirements of experience and exam passage to be
licensed in a given state.
Yes/No
Other, please specify
If "Yes," insert professional
title
Specialty
Pediatrics
Select All That Apply
Yes/No
Family Medicine or Health
Yes/No
Internal Medicine or
Adult/Geriatrics
Yes/No
Prepared by Optimal Solutions Group
2/25/2013
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter
depending on program
structure
Once each semester or quarter
depending on program
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
1
Graduate Nurse Education Demonstration Evaluation
Quantitative Protocol
Answer Value
Frequency of Collection
Hospital or Clinical Site Name:
Preceptor ID Number: (In order to de-identify the information provided, please assign ID numbers to all preceptors)
Obstetrics or Midwifery
Yes/No
Anesthesiologist or Anesthetist
Yes/No
Other, please specify
If "Yes," insert name of
specialty
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Data Element Name
Instructions
Definition and/or Instruction
(1) This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
(2) This template should be completed by those preceptors who train APRN students.
Preceptor Characteristics (from each clinical site and hospital, if appropriate)
Experience
Experience precepting APRN
students
Length of time the individual identifies as having precepted APRN students. Experience precepting will be XX.Y years
measured in number of years (rounding up or down to the closest half-year; e.g., 3.3 years will become 3.5
years) and measured as of the last day of the corresponding 6-month period for the current calendar year
(e.g., if the survey is completed in May, then experience is measured as of June 30 of the current calendar
year, and if the survey is completed in October, then experience is measured as of December 31 of the
current calendar year).
Experience precepting any type of Length of time the individual identifies as having precepted any type of students. Experience precepting will XX.Y years
students
be measured in number of years (rounding up or down to the closest half-year; e.g., 3.3 years will become
3.5 years) and measured as of the last day of the corresponding 6-month period for the current calendar
year (e.g., if the survey is completed in May, then experience is measured as of June 30 of the current
calendar year, and if the survey is completed in October, then experience is measured as of December 31 of
the current calendar year).
Experience as a health care provider Length of time the individual identifies as having been a health care provider with his or her current
XX.Y years
professional title (MD, DO, PA, APRN, RN, other). Experience precepting will be measured in number of
years (rounding up or down to the closest half-year; e.g., 3.3 years will become 3.5 years) and measured as
of the last day of the corresponding 6-month period for the current calendar year (e.g., if the survey is
completed in May, then experience is measured as of June 30 of the current calendar year, and if the survey
is completed in October, then experience is measured as of December 31 of the current calendar year).
Clinical Hours
On average, how many clinical
hours per week do you spend
providing health care?
On average, how many clinical
hours per week do you spend
precepting APRN students?
On average, how many clinical
hours per week do you spend
precepting any type of students?
Clinical hours practicing is the total number of hours the individual spends providing clinical care. Clinical XX hours/week
hours practicing will be measured as average number of hours per week for the current academic period
(semester or quarter). Minutes should be approximated to the closest whole hour (e.g., 3 hours and 45
minutes become 4 hours).
Clinical hours precepting is the total number of hours the individual spends precepting APRN students.
XX hours/week
Clinical hours precepting will be measured as average number of hours per week for the current academic
period (semester or quarter). Minutes should be approximated to the closest whole hour (e.g., 3 hours and
45 minutes become 4 hours).
Clinical hours precepting is the total number of hours the individual spends precepting any type of students. XX hours/week
Clinical hours precepting will be measured as average number of hours per week for the current academic
period (semester or quarter). Minutes should be approximated to the closest whole hour (e.g., 3 hours and
45 minutes become 4 hours).
Prepared by Optimal Solutions Group
2/25/2013
Response
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
2
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocol
Definition and/or Instruction
(1) This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
(2) This template should be completed by those preceptors who train APRN students.
Preceptor Characteristics (from each clinical site and hospital, if appropriate)
Answer Value
Frequency of Collection
Response
Hospital or Clinical Site Name:
Preceptor ID Number: (In order to de-identify the information provided, please assign ID numbers to all preceptors)
Employment Type (full-time or part- Full-time employment is employment in which a person works a minimum number of hours as determined Choose One
time)
by his or her employer. Full-time employment often comes with benefits that are not typically offered to parttime, temporary, or flexible workers, such as annual paid time off, sick leave, and health insurance. Fulltime jobs are often considered careers. They generally pay more than part-time jobs and usually require
more hours per week.
The Fair Labor Standards Act (FLSA) does not define full-time employment or part-time employment. This
is a matter generally to be determined by the employer (U.S. Department of Labor). The definition by
employer can vary and is generally published in a company's employee handbook. Companies commonly
require an employee to work at least 30 to 35 hours per week to be defined as full-time and therefore
eligible for benefits
Part-time
Yes/No
Full-time
Yes/No
Race/Ethnicity
Choose One
Yes/No
Non-Hispanic White (Caucasian)
Description of an individual who indicates that he or she is a person having origins in any of the original
peoples of Europe, the Middle East, or North Africa.
Non-Hispanic Black or African
American
Description of an individual who indicates that he or she is a person having origins in any of the black racial Yes/No
groups of Africa.
Hispanic/Latino
Description of an individual who indicates that he or she is a person of Cuban, Mexican, Puerto Rican,
South or Central American, or other Spanish culture in origin, regardless of race.
Non-Hispanic Asian
Description of an individual who indicates that he or she is a person having origins in any of the original
Yes/No
peoples of the Far East, Southeast Asia, or the Indian subcontinent (e.g., India, Pakistan, Bangladesh, Sri
Lanka, Nepal, Sikkim, and Bhutan). This includes, for example, Cambodia, China, Japan, Korea, Malaysia,
Pakistan, the Philippines, Thailand, and Vietnam.
Description of an individual who indicates that he or she does not identify with any of the race/ethnic
Yes/No
categories above or does not choose to provide the information.
Other/Unknown
Yes/No
Gender
Male
Choose One
Yes/No
Female
Yes/No
Date of Birth
Date of birth
Date an individual was born; please provide year, month, and day.
Prepared by Optimal Solutions Group
YYYY/MM/DD
2/25/2013
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
3
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
This template should be completed for each academic period (e.g.,
quarter, semester) beginning with Fall 2007. This template should be
completed for all APRN students enrolled in an academic period.
APRN Student Characteristics
Answer Value
Frequency of Collection
Response
SON Name:
Student ID Number: (In order to de-identify the information provided, please assign ID numbers to all students)
Year and Academic Period of Initial
Enrollment
Year and academic period of initial
Refers to the academic year and the semester/quarter of initial enrollment.
enrollment
Previous Degrees Received
Associate Degree RN or Diploma RN
BSN
BA
MA
MS
PhD
Other, please specify
Initial Location or Residence
Year and quarter (fall, winter,
spring) or year and semester (fall or
spring)
Select All That Apply
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
If "Yes," specify previous degree
name
Insert name of city
Insert name of county
Insert state two-letter abbreviation
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Refers to the institution attended of place of employment prior to enrollment
in APRN program.
Name of institution/place of employment
Insert full name
City
County
State
Insert name of city
Insert name of county
Insert state two-letter abbreviation
APRN Specialty Pursued
Certified Nurse Midwife (CNM)
Certified Registered Nurse Anesthetist
(CRNA)
Certified Nurse Practitioner (CNP)
CNP Specialty: Acute Care Nurse
Practitioner
CNP Specialty: Adult/Gero Nurse
Practitioner
CNP Specialty: Family Nurse Practitioner
Choose All That Apply
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
CNP Specialty: Pediatric Nurse
Practitioner
CNP Specialty: Other
Clinical Nurse Specialist (CNS)
CNS Specialty: Adult/Gero
CNS Specialty: Other
Other, please specify
Prepared by Optimal Solutions Group
Once per admission cycle
Refers to the location of residence prior to enrollment in APRN program.
City
County
State
Previous Institution Location
Select All That Apply
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
If "Yes," insert name of specialty
2/25/2013
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
4
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
This template should be completed for each academic period (e.g.,
quarter, semester) beginning with Fall 2007. This template should be
completed for all APRN students enrolled in an academic period.
APRN Student Characteristics
Answer Value
Frequency of Collection
Response
SON Name:
Student ID Number: (In order to de-identify the information provided, please assign ID numbers to all students)
Enrollment Type
Part-time
Semester-based school with mostly 3-credit-hour courses: Most institutions
consider 9 credit hours as full-time and 6 credit hours as half-time.
Semester-based school with mostly 4-credit-hour courses: Most institutions
consider 8 credits as full-time and 4 credit hours as half-time.
Quarter schools: Most institutions consider 6 credits as full-time and 3 to 5
credit hours as half-time.
Full-time
Semester-based school with mostly 3-credit-hour courses: Most institutions
consider 9 credit hours as full-time and 6 credit hours as half-time.
Semester-based school with mostly 4-credit-hour courses: Most institutions
consider 8 credits as full-time and 4 credit hours as half-time.
Quarter schools: Most institutions consider 6 credits as full-time and 3 to 5
credit hours as half-time.
Yes/No
Once each semester or quarter,
depending on the program's
structure
Yes/No
Once each semester or quarter,
depending on the program's
structure
Online classes
Yes/No
On-site classes
Yes/No
Both online and on-site classes
Yes/No
Program Type
DNP, MSN
Precepting Site
Type of site and name of site where
preceptor trains students
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
DNP/MSN
Once per admission cycle
Type (hospital or Clinical site) and
Name of the site
Once each semester or quarter,
depending on the program's
structure
Race/Ethnicity
Non-Hispanic White (Caucasian)
Non-Hispanic Black or African American
Hispanic/Latino
Prepared by Optimal Solutions Group
Description of an individual who indicates that he or she is a person having Yes/No
origins in any of the original peoples of Europe, the Middle East, or North
Africa.
Description of an individual who indicates that he or she is a person having Yes/No
origins in any of the black racial groups of Africa.
Description of an individual who indicates that he or she is a person of
Yes/No
Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish
culture in origin, regardless of race.
2/25/2013
Once per admission cycle
Once per admission cycle
Once per admission cycle
5
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
This template should be completed for each academic period (e.g.,
quarter, semester) beginning with Fall 2007. This template should be
completed for all APRN students enrolled in an academic period.
APRN Student Characteristics
Answer Value
Frequency of Collection
Response
SON Name:
Student ID Number: (In order to de-identify the information provided, please assign ID numbers to all students)
Non-Hispanic Asian
Description of an individual who indicates that he or she is a person having Yes/No
origins in any of the original peoples of the Far East, Southeast Asia, or the
Indian subcontinent (e.g., India, Pakistan, Bangladesh, Sri Lanka, Nepal,
Sikkim, and Bhutan). This includes, for example, Cambodia, China, Japan,
Korea, Malaysia, Pakistan, the Philippines, Thailand, and Vietnam.
Other/Unknown
Date of Birth
Date of birth
Gender
Male
Female
Prepared by Optimal Solutions Group
Description of an individual who indicates that he or she does not identify
with any of the race/ethnic categories above or does not choose to provide
the information.
Yes/No
Date an individual was born; please provide year, month, and day.
YYYY/MM/DD
Choose One
Yes/No
Yes/No
2/25/2013
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
6
Graduate Nurse Education Demonstration Evaluation
Quantitative Protocols
Data Element Name
Instructions
Definition and Instruction
Answer Value
This template should be completed for each academic period (e.g., quarter, semester)
beginning with Fall 2007.
Demographic Characteristics of All Applicants (these are to be collected for the aggregate of applicants and not for each individual applicant)
SON Name:
Year and Academic Period of
Application
Year and academic period of
application
Total Number of Applicants to APRN
Program
Total number of applicants to APRN
program
Frequency of Collection
Select All That Apply
Refers to the academic year and the semester/quarter of initial enrollment, if accepted
Year and quarter (fall, winter,
spring) or year and semester (fall or Once per admission cycle
spring)
Number of Applicants
Total number of applicants to APRN program during the academic year and the
semester/quarter in reference
Number of applicants
Once per admission cycle
Number of Applicants by Degree
Received
Previous Degrees Received
Associate Degree RN or Diploma RN
Number of applicants
Once per admission cycle
BSN
BA
MA
MS
PhD
Other
Number of applicants
Number of applicants
Number of applicants
Number of applicants
Number of applicants
Number of applicants
Number of Applicants by Race
Group
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Number of applicants
Once per admission cycle
Number of applicants
Once per admission cycle
Number of applicants
Once per admission cycle
Number of applicants
Once per admission cycle
Number of applicants
Once per admission cycle
Race/Ethnicity
Non-Hispanic White (Caucasian)
Non-Hispanic Black or African
American
Hispanic/Latino
Non-Hispanic Asian
Other/Unknown
Description of an individual who indicates that he or she is a person having origins in any
of the original peoples of Europe, the Middle East, or North Africa.
Description of an individual who indicates that he or she is a person having origins in any
of the black racial groups of Africa.
Description of an individual who indicates that he or she is a person of Cuban, Mexican,
Puerto Rican, South or Central American, or other Spanish culture in origin, regardless of
race.
Description of an individual who indicates that he or she is a person having origins in any
of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent (e.g.,
India, Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan). This includes, for
example, Cambodia, China, Japan, Korea, Malaysia, Pakistan, the Philippines, Thailand,
and Vietnam.
Description of an individual who indicates that he or she does not identify with any of the
race/ethnic categories above or does not choose to provide the information.
Age
Age
Response
Age will be measured in years and measured as of the date of intended initial enrollment
(rounding up or down to the closest whole year; e.g., 43.5 years old will become 44 years
old).
Number of Applicants by Age
Group
- Younger than 21 y.o.
- 22–25 y.o.
- 26–29 y.o.
- 30 y.o. and older
Gender
Number of Applicants by Gender
Male
Female
Number of applicants
Number of applicants
Prepared by Optimal Solutions Group
2/25/2013
Once per admission cycle
Once per admission cycle
Once per admission cycle
7
Graduate Nurse Education Demonstration Evaluation
Quantitative Protocols
Data Element Name
Instructions
Definition and Instruction
Answer Value
This template should be completed for each academic period
(e.g., quarter, semester) beginning with Fall 2007.
Demographic Characteristics of Alumni (these are to be collected for the aggregate of applicants and not for each
SON Name:
Year and Academic Period of
Graduation
Year and academic period of
graduation
Total Number of Students
Graduating as APRNs
Total number of students
graduating as APRNs
Race/Ethnicity
Non-Hispanic White
(Caucasian)
Non-Hispanic Black or African
American
Refers to the academic year and the semester/quarter during which Year and quarter (fall, winter,
the APRN students graduated as APRNs,
spring) or year and semester
(fall or spring)
Number of Graduating
APRNs
Total number of APRN students graduating during the academic Number of graduating
year and the semester/quarter in reference,
APRNs
Number of Graduating
APRNs by Race Group
Description of an individual who indicates that he or she is a
Number of graduating
person having origins in any of the original peoples of Europe, the APRNs
Middle East, or North Africa.
Description of an individual who indicates that he or she is a
Number of graduating
person having origins in any of the black racial groups of Africa. APRNs
Description of an individual who indicates that he or she is a
person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture in origin, regardless of race.
Number of graduating
APRNs
Non-Hispanic Asian
Description of an individual who indicates that he or she is a
person having origins in any of the original peoples of the Far
East, Southeast Asia, or the Indian Subcontinent (e.g., India,
Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan).
This includes, for example, Cambodia, China, Japan, Korea,
Malaysia, Pakistan, the Philippines, Thailand, and Vietnam.
Number of graduating
APRNs
Age
Age
Gender
Response
Select All That Apply
Hispanic/Latino
Other/Unknown
Frequency of Collection
Description of an individual who indicates that he or she does not Number of graduating
identify with any of the race/ethnic categories above or does not APRNs
choose to provide the information.
Number of Graduating
APRNs by Age Group
Age will be measured in years and measured as of the last day of - Younger than 21 y.o.
- 22–25 y.o.
the academic period of graduation (rounding up or down to the
closest whole year; e.g., 43.5 years old will become 44 years old). - 26–29 y.o.
- 30 y.o. and older
Number of Graduating
APRNs by Gender
Prepared by Optimal Solutions Group
2/25/2013
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
8
Graduate Nurse Education Demonstration Evaluation
Quantitative Protocols
Data Element Name
Instructions
Definition and Instruction
Answer Value
This template should be completed for each academic period
(e.g., quarter, semester) beginning with Fall 2007.
Demographic Characteristics of Alumni (these are to be collected for the aggregate of applicants and not for each
SON Name:
Female
APRN licensure type
Alumni Employment
Postgraduation employment
Employment type (full-time or
part-time)
Response
Number of APRN graduating Once each semester or quarter,
depending on the program's
students
structure
Number of APRN graduating Once each semester or quarter,
depending on the program's
students
structure
Male
Certification and Licensure
Certification
Frequency of Collection
Number of graduating
Number of graduating students during the academic period of
APRNs
reference who passed a national certification examination that
measures APRN, role, and population-focused competencies and
who maintains competence, as evidenced by recertification in the
role through national certification programs
Number of graduating students during the academic period of
reference who have obtained a license to practice as an APRN in
one of the following four APRN roles: Certified Registered Nurse
Anesthetist (CRNA), Certified Nurse Midwife (CNM), Clinical
Nurse Specialist (CNS), or Certified Nurse Practitioner (CNP)
Questions about alumni employment refer solely to the first
employment after graduation from the APRN program
Number of graduating APRNs who had secured employment at
the time of their graduation
Full-time employment is employment in which a person works a
minimum number of hours as determined by his or her employer.
Full-time employment often comes with benefits that are not
typically offered to part-time, temporary, or flexible workers, such
as annual paid time off, sick leave, and health insurance. Full-time
jobs are often considered careers. They generally pay more than
part-time jobs and usually require more hours per week.
Number of APRNs licensed
to practice as:
- CRNA
- CNM
- CNS
- CNP
Number of graduating
APRNs
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Number of graduating
APRNs who, at graduation,
had secured employment:
- Full-time
- Part-time
The Fair Labor Standards Act (FLSA) does not define full-time
employment or part-time employment. This is a matter generally
to be determined by the employer (U.S. Department of Labor).
The definition by employer can vary and is generally published in
a company's employee handbook. Companies commonly require
an employee to work at least 30 to 35 hours per week to be
defined as full-time and therefore eligible for benefits.
Prepared by Optimal Solutions Group
Once each semester or quarter,
depending on the program's
structure
2/25/2013
Once each semester or quarter,
depending on the program's
structure
9
Graduate Nurse Education Demonstration Evaluation
Quantitative Protocols
Data Element Name
Instructions
Definition and Instruction
Answer Value
This template should be completed for each academic period
(e.g., quarter, semester) beginning with Fall 2007.
Demographic Characteristics of Alumni (these are to be collected for the aggregate of applicants and not for each
SON Name:
Alumni employment type
Location of First Employment
After Graduation From APRN
Program
Rural or urban
Medically underserved area
Number of graduating APRNS with employment type from the
following categories: clinical, teaching, research, administrative
The Census Bureau identifies two types of urban areas:
Urbanized Areas (UAs) of 50,000 or more people; and
Urban Clusters (UCs) of at least 2,500 and fewer than 50,000
people.
The term “rural” encompasses all populations, housing, and
territories not included within an urban area.
From the Health Resources and Services Administration:
"Medically Underserved Areas/Populations are areas or
populations designated by HRSA as having: too few primary care
providers, high infant mortality, high poverty and/or high elderly
population. Health Professional Shortage Areas (HPSAs) are
designated by HRSA as having shortages of primary medical care,
dental or mental health providers and may be geographic (a
county or service area), demographic (low income population), or
institutional (comprehensive health center, federally qualified
health center or other public facility)." (http://muafind.hrsa.gov/)
Prepared by Optimal Solutions Group
Number of graduating
APRNs who, at graduation,
had secured employment of
types:
- Clinical
- Research
- Teaching
- Administrative
Number of graduating
APRNs who, at graduation,
had secured employment in
locations:
- Urban
- Rural
Number of graduating
APRNs who, at graduation,
had secured employment in
medically underserved
locations
2/25/2013
Frequency of Collection
Response
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
10
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
Characteristics of Partner Hospitals and Main Hospitals
Answer Value
Frequency of Collection
Insert name of city
Insert name of county
Insert state two-letter abbreviation
Urban/Rural
One time
One time
One time
One time
XX.xx%
Every 6 months
XX.xx%
Every 6 months
XX.xx%
Every 6 months
XX.xx%
Every 6 months
XX.xx%
Every 6 months
XX.xx%
Every 6 months
XX.xx%
Every 6 months
XX.xx%
Every 6 months
XXX physicians
XXX RNs
Every 6 months
Every 6 months
XXX LPNs/LVNs
Every 6 months
XXX full-time employees
Every 6 months
Response
Hospital Name:
Location
City
County
State
Rural or urban
The location information will be collected only once.
Inpatient Days by Type of Payer
“An inpatient is a person who has been admitted to a hospital for bed occupancy for purposes of
receiving inpatient hospital services. Generally, a patient is considered an inpatient if formally admitted
as inpatient with the expectation that he or she will remain at least overnight and occupy a bed even
though it later develops that the patient can be discharged or transferred to another hospital and not
actually use a hospital bed overnight.” —CMS, IOMs, Publication 100-02, Chapter 1, Section 10
Private
Percentage of total inpatient days paid for by private payers by semester. Measured in percentage of the
total number of inpatient days for each semester, rounded to two decimal places.
Percentage of total inpatient days paid for by Medicare by semester. Measured in percentage of the total
number of inpatient days for each semester, rounded to two decimal places.
Percentage of total inpatient days paid for by Medicaid by semester. Measured in percentage of the total
number of inpatient days for each semester, rounded to two decimal places.
Percentage of total inpatient days paid for by other sources (that are not private, Medicare, or Medicaid)
by semester. Measured in percentage of the total number of inpatient days for each semester, rounded to
two decimal places.
There are two types of outpatient care:
1. An outpatient (or out-patient) is a patient who is not hospitalized for 24 hours or more but visits a
hospital, clinic, or associated facility for diagnosis or treatment. Treatment provided in this fashion is
called ambulatory care. Sometimes surgery is performed without the need for a formal hospital admission
or an overnight stay. This is called outpatient surgery.
Medicare
Medicaid
Other
Outpatient Visits by Type of Payer
Private
Medicare
Medicaid
Other
The Census Bureau identifies two types of urban areas:
Urbanized Areas (UAs) of 50,000 or more people; and
Urban Clusters (UCs) of at least 2,500 and fewer than 50,000 people.
The term “rural” encompasses all population, housing, and territory not included within an urban area.
2. “The use of a bed for physician periodic monitoring and active monitoring by the hospital's nursing or
other ancillary staff, for the patient care which are reasonable and necessary to evaluate an outpatient's
condition or determine the need for an inpatient admission. ” —Novitas, Local Coverage Determination
(LCD) L27548
Percentage of total outpatient visits paid for by private payers by semester. Measured in percentage of the
total number of outpatient visits for each semester, rounded to two decimal places.
Percentage of total outpatient visits paid for by Medicare by semester. Measured in percentage of the
total number of outpatient visits for each semester, rounded to two decimal places.
Percentage of total outpatient visits paid for by Medicaid by semester. Measured in percentage of the
total number of outpatient visits for each semester, rounded to two decimal places.
Percentage of total outpatient visits paid for by other sources (that are not private, Medicare, or
Medicaid) by semester. Measured in percentage of the total number of outpatient visits for each semester,
rounded to two decimal places.
Organization Size
Number of physicians employed
Total number of physicians employed by the hospital during each semester.
Number of Registered Nurses (RNs) Total number of RNs employed by the hospital during each semester.
employed
Number of Licensed Practical Nurses
(LPNs) or Licensed Vocational
Total number of LPNs and LVNs employed by the hospital during each semester.
Nurses (LVNs) employed
Total number of full-time employees
Total number of full-time employees employed by the hospital during each semester.
Prepared by Optimal Solutions Group
2/25/2013
11
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
Characteristics of Partner Hospitals and Main Hospitals
Answer Value
Frequency of Collection
Total number of staffed beds during each semester.
XXX staffed beds
Every 6 months
XXX RNs
XXX APRNs
Every 6 months
Every 6 months
XXX CNMs
XXX CRNAs
Every 6 months
Every 6 months
XXX NPs
Every 6 months
Acute Care Nurse
XXX Adult Care NPs
Every 6 months
Adult/Gero Nurse
XXX Adult/Gero NPs
Every 6 months
Family Nurse
XXX Family NPs
Every 6 months
Pediatric Nurse
XXX Pediatric NPs
Every 6 months
XXX other NPs
XXX CNSs
Every 6 months
Every 6 months
XXX Adult/Gero CNSs
XXX other CNSs
XXX nurses
Every 6 months
Every 6 months
Every 6 months
- Primary
- Secondary
- Tertiary
- Quaternary
One time
Response
Hospital Name:
Staffed bed size
Staffed beds: Beds that are licensed and physically available for which staff is on hand to attend to the
patient who occupies the bed. Staffed beds include those that are occupied and those that are vacant
(http://archive.ahrq.gov/research/havbed/definitions.htm).
Number of Nurses by Type (RN,
APRN )
Registered Nurse (RN)
Advanced Practice Registered Nurse Total number of APRNs employed by the hospital for each semester, including all specialties. The total
(APRN)
number of APRNs should equal the sum of CNMs, CRNAs, NPs, and CNSs.
Certified Nurse Midwife (CNM)
Certified Registered Nurse
Anesthetist (CRNA)
Total number of NPs employed by the hospital for each semester, including all specialties. The total
Nurse Practitioner (NP)
number of NPs should equal the sum of Acute Care, Adult/Gero, Family, Pediatric, and other NPs.
NP Specialty:
Practitioner
NP Specialty:
Practitioner
NP Specialty:
Practitioner
NP Specialty:
Practitioner
NP Specialty:
Other
Clinical Nurse Specialist (CNS)
Total number of CNSs employed by the hospital for each semester, including all specialties. The total
number of CNSs should equal the sum of Adult/Gero and other CNSs.
CNS Specialty: Adult/Gero
CNS Specialty: Other
Other, please specify
Are other types of nurses employed by the hospital? If so, please include the type and specialty and the
total number of nurses for each semester.
Other Hospital Characteristics
Primary, secondary, tertiary, or
quaternary care
- Primary care: The general health care that people receive on a routine basis that is not associated with
an acute or chronic illness or disability and may be provided by a physician, NP, or PA.
- Secondary care: Secondary health care services are provided by a physician specialist (such as a
pediatrician or internist) upon referral by a primary care physician/NP.
- Tertiary care: Tertiary care is specialized consultative health care, usually for inpatients and on referral
from a primary or secondary health professional, in a facility that has personnel and facilities for
advanced medical investigation and treatment, such as a tertiary referral hospital. Examples of tertiary
care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe
burns, advanced neonatology services, palliative, and other complex medical and surgical interventions.
- Quaternary care: Quaternary care provides for the most complex level of medical and surgical care and
is available only in a limited number of academic health science centers. Some of these centers are
regional or national centers that offer more specialized care.
Prepared by Optimal Solutions Group
2/25/2013
12
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
Characteristics of Partner Hospitals and Main Hospitals
Answer Value
Frequency of Collection
Response
Hospital Name:
For profit: A business or other organization whose primary goal is making money (a profit), as opposed
- For profit
to a nonprofit organization that focuses on a goal, such as helping the community, and is concerned with - Nonprofit private
making only as much money as necessary to keep the organization operating. Most companies considered - Nonprofit public
to be businesses are for-profit organizations; this includes anything from retail stores to restaurants to
insurance companies to real-estate companies.
For profit, nonprofit private,
nonprofit public
One time
Nonprofit private: Nonprofit health care organizations are primarily responsible and accountable to the
communities and populations they serve. They are legally and ethically bound to “do good” for the
benefit of their communities. Their governing bodies comprise leaders from the communities they serve.
Rather than inuring to the benefit of private owners, the earnings and reserves of nonprofit health care
organizations are reinvested to benefit the community. A portion of those investments is made to improve
quality, service, and efficiency, usually in highly competitive environments. The remaining investments
are made in a variety of community programs, services, or products that do not cover their costs to
improve the health status of vulnerable populations and the broader community. A private nonprofit
organization receives most of its funds from private sources.
Nonprofit public: A public nonprofit health care organization is a nonprofit health care organization that
is funded wholly or in part by public sources, such as a city, county, tax district, or state.
Did the hospital lose accreditation provided by The Joint Commission (TJC), formerly the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO), in the last 10 years?
Did you lose accreditation in the last
10 years?
Hospital accreditation: A self-assessment and external peer-assessment process used by health care
organizations to accurately assess their level of performance in relation to established standards and to
implement ways to continuously improve.
Outpatient visits
Total number of outpatient visits per semester
Inpatient days
Total number of inpatient days per semester
Total Number of Staff Available for
Seeing Patients
Physicians (MD or DO)
Total number of physicians employed by the hospital during each semester
Physician's Assistant (PA)
Total number of PAs employed by the hospital during each semester
Advanced Practice Registered Nurse Total number of APRNs employed by the hospital during each semester
(APRN)
Registered Nurse (RN)
Total number of RNs employed by the hospital during each semester
Number of staff who are not physicians, PAs, APRNs, or RNs employed by the hospital during each
Other, please specify
semester
Number of Preceptors
Full-time employment is employment in which a person works a minimum number of hours defined as
such by his or her employer. Full-time employment often comes with benefits that are not typically
offered to part-time, temporary, or flexible workers, such as annual paid time off, sick leave, and health
insurance. Full-time jobs are often considered careers. They generally pay more than part-time jobs and
Number of full-time employees who usually require more hours per week.
are preceptors for APRN students
The Fair Labor Standards Act (FLSA) does not define full-time employment or part-time employment.
This is a matter generally to be determined by the employer (U.S. Department of Labor). The definition
by employer can vary and is generally published in a company's employee handbook. Companies
commonly require at least 30–35 hours per week to be defined as a full-time employee and therefore
eligible for benefits
Prepared by Optimal Solutions Group
2/25/2013
Yes/No
One time
XXX outpatient visits
XXX inpatient days
Every 6 months
Every 6 months
XXX physicians
XXX PAs
XXX APRNs
Every 6 months
Every 6 months
Every 6 months
XXX RNs
XXX staff
Every 6 months
Every 6 months
XXX full-time preceptors
Once each semester or quarter,
depending on the program's
structure
13
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
Characteristics of Partner Hospitals and Main Hospitals
Answer Value
Full-time employment is employment in which a person works a minimum number of hours defined as
such by his or her employer. Full-time employment often comes with benefits that are not typically
offered to part-time, temporary, or flexible workers, such as annual paid time off, sick leave, and health
insurance. Full-time jobs are often considered careers. They generally pay more than part-time jobs and
usually require more hours per week.
XXX full-time precerptors
Frequency of Collection
Response
Hospital Name:
Number of full-time employees who
are preceptors for all types of
students (medicine, PA, etc.)
The Fair Labor Standards Act (FLSA) does not define full-time employment or part-time employment.
This is a matter generally to be determined by the employer (U.S. Department of Labor). The definition
by employer can vary and is generally published in a company's employee handbook. Companies
commonly require at least 30–35 hours per week to be defined as a full-time employee and therefore
eligible for benefits
Full-time employment is employment in which a person works a minimum number of hours defined as
such by his or her employer. Full-time employment often comes with benefits that are not typically
offered to part-time, temporary, or flexible workers, such as annual paid time off, sick leave, and health
insurance. Full-time jobs are often considered careers. They generally pay more than part-time jobs and
Number of part-time employees who usually require more hours per week.
are preceptors for APRN students
The Fair Labor Standards Act (FLSA) does not define full-time employment or part-time employment.
This is a matter generally to be determined by the employer (U.S. Department of Labor). The definition
by employer can vary and is generally published in a company's employee handbook. Companies
commonly require at least 30–35 hours per week to be defined as a full-time employee and therefore
eligible for benefits
Full-time employment is employment in which a person works a minimum number of hours defined as
such by his or her employer. Full-time employment often comes with benefits that are not typically
offered to part-time, temporary, or flexible workers, such as annual paid time off, sick leave, and health
insurance. Full-time jobs are often considered careers. They generally pay more than part-time jobs and
Number of part-time employees who usually require more hours per week.
are preceptors for all types of
students (medicine, PA, etc.)
The Fair Labor Standards Act (FLSA) does not define full-time employment or part-time employment.
This is a matter generally to be determined by the employer (U.S. Department of Labor). The definition
by employer can vary and is generally published in a company's employee handbook. Companies
commonly require at least 30–35 hours per week to be defined as a full-time employee and therefore
eligible for benefits
Student-to-Preceptor Ratio by Type Ratio should be given at an individual level (aka three preceptors per one APRN student)
of Student
All types of students, including
Total number of preceptors devided by the total number of students
APRN, medical students, PA
students, etc.
Total number of preceptors divided by the total number of APRN students
Advanced Practice Registered Nurse
(APRN)
Total number of preceptors divided by the total number of CNM students
Certified Nurse Midwife (CNM)
Certified Registered Nurse
Anesthetist (CRNA)
Total number of preceptors divided by the total number of CRNA students
Total number of preceptors divided by the total number of NP students
Nurse Practitioner (NP)
Total number of preceptors divided by the total number of Acute Care NP students
NP Specialty: Acute Care
Prepared by Optimal Solutions Group
2/25/2013
Once each semester or quarter,
depending on the program's
structure
XXX part-time preceptors
Once each semester or quarter,
depending on the program's
structure
XXX part-time preceptors
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
XXX preceptors per one APRN student Once each semester or quarter,
depending on the program's
structure
XXX preceptors per one CNM student Once each semester or quarter,
depending on the program's
structure
XXX preceptors per one CRNA student Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
XXX preceptors per one NP student
depending on the program's
structure
XXX preceptors per one Acute Care NP Once each semester or quarter,
depending on the program's
student
structure
XXX preceptors per one student
14
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
Characteristics of Partner Hospitals and Main Hospitals
Answer Value
Frequency of Collection
Total number of preceptors divided by the total number of Adult/Gero NP students.
XXX preceptors per one Adult/Gero NP Once each semester or quarter,
depending on the program's
student
structure
Once each semester or quarter,
XXX preceptors per one Family NP
depending on the program's
student
structure
XXX preceptors per one Pediatric NP Once each semester or quarter,
depending on the program's
student
structure
Once each semester or quarter,
XXX preceptors per one other NP
depending on the program's
student
structure
XXX preceptors per one CNS student Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
XXX preceptors per one Adult/Gero
depending on the program's
CNS student
structure
Once each semester or quarter,
XXX preceptors per one other CNS
depending on the program's
student
structure
Response
Hospital Name:
NP Specialty: Adult/Gero
Total number of preceptors divided by the total number of Family NP students.
NP Specialty: Family
Total number of preceptors divided by the total number of Pediatric NP students.
NP Specialty: Pediatrics
NP Specialty: Other
Total number of preceptors divided by the total number of NP students. "Other" refers to NP students
who have a specialty other than acute care, adult/gero, family, or pediatrics.
Total number of preceptors divided by the total number of CNS students.
Clinical Nurse Specialist (CNS)
Total number of preceptors divided by the total number of Adult/Gero CNS students.
CNS Specialty: Adult/Gero
CNS Specialty: Other
Total number of preceptors divided by the total number of other CNS students. "Other" refers to CNS
students who have a specialty other than adult/gero.
Financial Incentives Offered to
Preceptors
Does the hospital offer financial incentives to preceptors based on:
Select All That Apply
Experience of the preceptor
The number of years of experience precepting?
Yes/No
Specialty
The specialty of the preceptor?
Yes/No
Number of students/week precepting The number of students each individual precepts per week?
Yes/No
Number of hours/week precepting
The number of hours each individual spends precepting each week?
Yes/No
Location of training
The location and type of training site?
Yes/No
Other
Other characteristics/aspects? If so, please specify.
If "Yes," insert other type of basis for
financial incentives
Prepared by Optimal Solutions Group
2/25/2013
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
15
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
Answer Value
This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
Characteristics of Schools of Nursing
Frequency of Collection
Response
SON Name:
Structure of Program
Semester/quarter
Is the academic year structure based on semesters or quarters?
Number of Students Who Applied,
by Degree
Doctor of Nursing Practice (DNP)
Total number of applicants to the DNP program per admission cycle
Semester/quarter
One time
XXX applicants
Once per admission cycle
Master of Science in Nursing
(MSN)
Other graduate degrees, please
specify
Number of Students Admitted, by
Degree
Total number of applicants to the MSN program per admission cycle
XXX applicants
Once per admission cycle
Total number of applicants to graduate programs other than DNP and MSN
XXX applicants to
Once per admission cycle
Doctor of Nursing Practice (DNP)
Total number of students admitted to the DNP program per admission cycle
XXX admitted students
Once per admission cycle
Master of Science in Nursing
(MSN)
Other graduate degrees, please
specify
Number of Students Enrolled, by
Degree
Total number of students admitted to the MSN program per admission cycle
XXX admitted students
Once per admission cycle
Total number of students admitted to graduate programs other than DNP and MSN
XXX admitted students to
Once per admission cycle
Doctor of Nursing Practice (DNP)
Total number of students enrolled in the DNP program per admission cycle
XXX enrolled students
Once per admission cycle
Master of Science in Nursing
Total number of students enrolled in the MSN program per admission cycle
(MSN)
Other graduate degrees, please
Total number of students enrolled in graduate programs other than DNP and MSN
specify
Number of Students Graduated, by
Degree
XXX enrolled students
Once per admission cycle
XXX enrolled students in
Once per admission cycle
Doctor of Nursing Practice (DNP)
Total number of students graduated from DNP programs
XXX graduated students
Master of Science in Nursing
(MSN)
Total number of students graduated from MSN programs
XXX graduated students
Other graduate degrees, please
specify
Total number of students graduated from graduate programs other than DNP and MSN
XXX graduated students from
Number of Students Who Applied,
by Specialty
Advanced Practice Registered
Nurse (APRN)
Certified Nurse Midwife (CNM)
Certified Registered Nurse
Anesthetist (CRNA)
Nurse Practitioner (NP)
NP Specialty: Acute Care
NP Specialty: Adult/Gero
NP Specialty: Family
NP Specialty: Pediatric
NP Specialty: Other
Clinical Nurse Specialist (CNS)
CNS Specialty: Adult/Gero
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Total number of APRN applicants per admission cycle
XXX applicants
Once per admission cycle
Total number of CNM applicants per admission cycle
XXX applicants
Once per admission cycle
Total number of CRNA applicants per admission cycle
XXX applicants
Once per admission cycle
Total number of NP applicants per admission cycle
Total number of Acute Care NP applicants per admission cycle
Total number of Adult/Gero NP applicants per admission cycle
Total number of Family NP applicants per admission cycle
Total number of Pediatric NP applicants per admission cycle
Total number of NP applicants for specialties other than acute care, adult/gero, family, or pediatrics,
per admission cycle
Total number of CNS applicants per admission cycle
Total number of Adult/Gero CNS applicants per admission cycle
XXX applicants
XXX applicants
XXX applicants
XXX applicants
XXX applicants
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Prepared by Optimal Solutions Group
2/25/2013
XXX applicants
Once per admission cycle
XXX applicants
XXX applicants
Once per admission cycle
Once per admission cycle
16
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
Answer Value
This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
Characteristics of Schools of Nursing
Frequency of Collection
Total number of CNS applicants for specialties other than Adult/Gero CNS per admission cycle
XXX applicants
Once per admission cycle
Total number of APRN applicants admitted per admission cycle
XXX admitted students
Once per admission cycle
Response
SON Name:
CNS Specialty: Other
Number of Students Admitted, by
Specialty
Advanced Practice Registered
Nurse (APRN)
Certified Nurse Midwife (CNM)
Certified Registered Nurse
Anesthetist (CRNA)
Nurse Practitioner (NP)
NP Specialty: Acute Care
NP Specialty: Adult/Gero
NP Specialty: Family
NP Specialty: Pediatrics
Total number of CNM applicants admitted per admission cycle
XXX admitted students
Once per admission cycle
Total number of CRNA applicants admitted per admission cycle
XXX admitted students
Once per admission cycle
XXX admitted students
XXX admitted students
XXX admitted students
XXX admitted students
XXX admitted students
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
XXX admitted students
Once per admission cycle
Clinical Nurse Specialist (CNS)
CNS Specialty: Adult/Gero
Total number of NP applicants per admitted admission cycle
Total number of Acute Care NP applicants admitted per admission cycle
Total number of Adult/Gero NP applicants admitted per admission cycle
Total number of Family NP applicants admitted per admission cycle
Total number of Pediatric NP applicants admitted per admission cycle
Total number of NP applicants for specialties other than acute care, adult/gero, family, or pediatrics
admitted per admission cycle
Total number of CNS applicants admitted per admission cycle
Total number of Adult/Gero CNS applicants admitted per admission cycle
XXX admitted students
XXX admitted students
Once per admission cycle
Once per admission cycle
CNS Specialty: Other
Total number of CNS applicants for specialties other than adult/gero admitted per admission cycle.
XXX admitted students
Once per admission cycle
Total number of new students enrolled in the APRN program
XXX enrolled students
Once per admission cycle
Once per admission cycle
NP Specialty: Other
Number of Students Enrolled, by
Specialty
Advanced Practice Registered
Nurse (APRN)
Certified Nurse Midwife (CNM)
Certified Registered Nurse
Anesthetist (CRNA)
Nurse Practitioner (NP)
NP Specialty: Acute Care
NP Specialty: Adult/Gero
NP Specialty: Family
NP Specialty: Pediatrics
NP Specialty: Other
Clinical Nurse Specialist (CNS)
CNS Specialty: Adult/Gero
CNS Specialty: Other
Number of Students Graduated, by
Specialty
Total number of new students enrolled in the CNM program
XXX enrolled students
Total number of new students enrolled in the CRNA program
XXX enrolled students
Once per admission cycle
Total number of new students enrolled in the NP program
Total number of new students enrolled in the Acute Care NP program
Total number of new students enrolled in the Adult/Gero NP program
Total number of new students enrolled in the Family NP program
Total number of new students enrolled in the Pediatric NP program
Total number of new students enrolled in NP programs other than acute care, adult/gero, family, or
pediatrics
Total number of new students enrolled in the CNS program
Total number of new students enrolled in the Adult-Gero CNS program
Total number of new students enrolled in CNS programs other than adult/gero
XXX enrolled students
XXX enrolled students
XXX enrolled students
XXX enrolled students
XXX enrolled students
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
Once per admission cycle
XXX enrolled students
Once per admission cycle
XXX enrolled students
XXX enrolled students
XXX enrolled students
Once per admission cycle
Once per admission cycle
Once per admission cycle
Advanced Practice Registered
Nurse (APRN)
Total number of students graduated from APRN program
XXX graduated students by academic
period
Certified Nurse Midwife (CNM)
Total number of students graduated from CNM program
XXX graduated students by academic
period
Certified Registered Nurse
Anesthetist (CRNA)
Total number of students graduated from CRNA program
XXX graduated students by academic
period
Nurse Practitioner (NP)
Total number of students graduated from NP programs
XXX graduated students by academic
period
Prepared by Optimal Solutions Group
2/25/2013
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
17
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
Answer Value
This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
Characteristics of Schools of Nursing
Frequency of Collection
Response
SON Name:
NP Specialty: Acute Care
Total number of students graduated from Acute Care NP program
XXX graduated students by academic
period
NP Specialty: Adult/Gero
Total number of students graduated from Adult/Gero NP program
XXX graduated students by academic
period
NP Specialty: Family
Total number of students graduated from Family NP program
XXX graduated students by academic
period
NP Specialty: Pediatric
Total number of students graduated from Pediatric NP program
XXX graduated students by academic
period
NP Specialty: Other
Total number of students graduated from NP programs other than acute care, adult/gero, family, or
pediatrics
XXX graduated students by academic
period
Clinical Nurse Specialist (CNS)
Total number of students graduated from CNS programs
XXX graduated students by academic
period
CNS Specialty: Adult/Gero
Total number of students graduated from Adult/Gero CNS program
XXX graduated students by academic
period
CNS Specialty: Other
Total number of students graduated from CNS programs other than adult/gero
XXX graduated students by academic
period
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Number of Faculty
Full-time employment is employment in which a person works a minimum number of hours defined as
such by his or her employer. Full-time employment often comes with benefits that are not typically
offered to part-time, temporary, or flexible workers, such as annual paid time off, sick leave, and
health insurance. Full-time jobs are often considered careers. They generally pay more than part-time
jobs and usually require more hours per week.
Part-time
The Fair Labor Standards Act (FLSA) does not define full-time employment or part-time employment.
This is a matter generally to be determined by the employer (U.S. Department of Labor). The
definition by employer can vary and is generally published in a company's employee handbook.
Companies commonly require at least 30–35 hours per week to be defined as a full-time employee
and therefore eligible for benefits.
Full-time employment is employment in which a person works a minimum number of hours defined as
such by his or her employer. Full-time employment often comes with benefits that are not typically
offered to part-time, temporary, or flexible workers, such as annual paid time off, sick leave, and
health insurance. Full-time jobs are often considered careers. They generally pay more than part-time
jobs and usually require more hours per week.
Full-time
The Fair Labor Standards Act (FLSA) does not define full-time employment or part-time employment.
This is a matter generally to be determined by the employer (U.S. Department of Labor). The
definition by employer can vary and is generally published in a company's employee handbook.
Companies commonly require at least 30–35 hours per week to be defined as a full-time employee
and therefore eligible for benefits.
Prepared by Optimal Solutions Group
2/25/2013
Total number of part-time faculty by
academic period
Once each semester or quarter,
depending on the program's
structure
Total number of full-time faculty by
academic period
Once each semester or quarter,
depending on the program's
structure
18
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
Answer Value
This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
Characteristics of Schools of Nursing
Frequency of Collection
Response
SON Name:
Tenure track is an employment structure whereby the holder of a post, typically an academic one, is
guaranteed consideration for eventual tenure.
Tenure track
Once each semester or quarter,
Total number of tenure-track faculty by
Tenure is a status granted after a trial period to a teacher that gives protection from summary
depending on the program's
academic period
dismissal and affords the right not to be fired without cause after an initial probationary period.
structure
Tenure systems are usually justified by the claim that they encourage academic freedom by preventing
instructors from being fired for openly disagreeing with authorities or popular opinion.
Non-tenure-track faculty are members of a postsecondary institution's faculty who are either not on
the tenure track or whose institution does not offer a tenure program.
Non-tenure-track
Total number of non-tenure-track
Tenure is a status granted after a trial period to a teacher that gives protection from summary
faculty by academic period
dismissal and affords the right not to be fired without cause after an initial probationary period.
Tenure systems are usually justified by the claim that they encourage academic freedom by preventing
instructors from being fired for openly disagreeing with authorities or popular opinion.
Clinical part-time
Total number of clinical part-time
faculty by academic period
Clinical full-time
Total number of clinical full-time
faculty by academic period
Adjunct faculty leading course
sections
An adjunct professor is a professor who does not hold a permanent or full-time position at the given
academic institution. This may be someone with a job outside the academic institution and teaching
courses in a specialized field or someone hired to teach courses on a contractual basis (frequently
renewable contracts). Adjunct faculty may give guest presentations, serve on graduate research
committees, or serve as preceptors. The position generally includes a teaching load below the
minimum required to earn benefits (health care, life insurance, etc.), although the number of courses
taught can vary.
Total number of adjunct faculty by
academic period
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Number of Faculty, by Degree
Doctor of Philosophy (PhD)
Total number of faculty with PhD by
academic period
Doctor of Nursing Practice (DNP)
Total number of faculty with DNP by
academic period
Practice Doctorate
Total number of faculty with Practice
Doctorate by academic period
Master of Arts (MA)
Total number of faculty with MA by
academic period
Master of Science in Nursing
(MSN)
Total number of faculty with MSN by
academic period
Other
Total number of faculty with degrees
other than the ones listed above by
academic period
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
XXX course credits
XXX clinical credits
One time
One time
Clinical/Didactic Hours Required
for Graduation as an APRN
Number of course credits
Number of clinical credits
How many course credits are required to graduate with an APRN degree?
How many clinical credits are required to graduate with an APRN degree?
Prepared by Optimal Solutions Group
2/25/2013
19
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
Answer Value
This template should be completed for each academic period (e.g., quarter, semester) beginning
with Fall 2007.
Characteristics of Schools of Nursing
Frequency of Collection
Response
SON Name:
Number of clinical hours
How many clinical hours are required to graduate with an APRN degree? Clinical hours should be
approximated to the nearest half-hour.
HH.hh clinical hours
One time
Number of clinical hours in
practicum settings
Of the total number of clinical hours required to graduate with an APRN degree, how many hours
need to be spent in a practicum setting? Hours should be approximated to the nearest half-hour.
HH.hh practicum hours
One time
Number of didactic credits for
courses with a clinical practicum
How many didactic credits for courses with a clinical practicum are needed to graduate with an
APRN degree?
XXX didactic credits for courses with a
One time
clinical practicum
Prepared by Optimal Solutions Group
2/25/2013
20
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitiave Protocols
Definition and Instruction
Answer Value
This template should be completed for each academic period (e.g., quarter,
semester) beginning with Fall 2007.
Characteristics of SON Faculty (these are to be collected for the aggregate of SON faculty and not for each individual)
Frequency of Collection
Response
SON Name:
Gender
Male
Total number of male SON faculty
Female
Total number of female SON faculty
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
XX female faculty per academic period depending on the program's
structure
YY male faculty per academic period
Race/Ethnicity
Non-Hispanic White (Caucasian)
Non-Hispanic Black or AfricanAmerican
Hispanic/Latino
Non-Hispanic Asian
Other
Age Profiles
20–29
30–39
40–49
50–64
65+
Once each semester or quarter,
XXX non-Hispanic White (Caucasian)
depending on the program's
faculty per academic period
structure
Once each semester or quarter,
Total number of SON faculty who indicate having origins in any of the black racial XXX non-Hispanic Black/Africandepending on the program's
groups of Africa.
American faculty per academic period
structure
Once each semester or quarter,
Total number of SON faculty who indicate being of Cuban, Mexican, Puerto Rican, XXX Hispanic/Latino faculty per
depending on the program's
South or Central American, or other Spanish culture in origin, regardless of race. academic period
structure
Total number of SON faculty who indicate having origins in any of the original
Once each semester or quarter,
peoples of the Far East, Southeast Asia, or the Indian Subcontinent (e.g., India,
XXX Asian faculty per academic
Pakistan, Bangladesh, Sri Lanka, Nepal, Sikkim, and Bhutan). This includes, for
depending on the program's
period
structure
example, Cambodia, China, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
Once each semester or quarter,
Total number of SON faculty who do not identify with any of the race/ethnic
XXX other faculty per academic period depending on the program's
categories above or do not provide the information.
structure
Age will be measured in years since birth, rounding up or down to the closest
whole year (e.g., 43.5 years old will become 44 years old). Age will be measured as
of the last day of the corresponding 6-month period for the current calendar year
(e.g., if survey is filled in May, then experience is measured as of June 30 of the
current calendar year, and if the survey is filled in October, then experience is
measured as of December 31 of the current calendar year).
Once each semester or quarter,
XXX number of faculty ages 20–29 per
depending on the program's
academic period
structure
Once each semester or quarter,
XXX number of faculty ages 30–39 per
depending on the program's
academic period
structure
Once each semester or quarter,
XXX number of faculty ages 40–49 per
depending on the program's
academic period
structure
Once each semester or quarter,
XXX number of faculty ages 50–64 per
depending on the program's
academic period
structure
Once each semester or quarter,
XXX number of faculty ages 65 or
depending on the program's
older per academic period
structure
Total number of SON faculty who indicate having origins in any of the original
peoples of Europe, the Middle East, or North Africa.
Prepared by Optimal Solutions Group
2/25/2013
21
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitiave Protocols
Definition and Instruction
Answer Value
This template should be completed for each academic period (e.g., quarter,
semester) beginning with Fall 2007.
Characteristics of SON Faculty (these are to be collected for the aggregate of SON faculty and not for each individual)
Frequency of Collection
Response
SON Name:
Years Teaching as Faculty
Length of time the individual has taught at a SON as a faculty member. Teaching
experience will be measured in number of years (rounding up or down to the
closest whole year; e.g., 3.5 years will become 4 years) as of the last day of the
corresponding 6-month period for the current calendar year (e.g., if survey is filled
in May, then experience is measured as of June 30 of the current calendar year, and
if the survey is filled in October, then experience is measured as of December 31 of
the current calendar year).
<1
1–2
3–5
6–10
11+
Years of Any Type of Clinical
Practice
XXX number of faculty with less than 1
year of teaching experience per
academic period
XXX number of faculty with 1–2 years
of teaching experience per academic
period
XXX number of faculty with 3–5 years
of teaching experience per academic
period
XXX number of faculty with 6–10
years of teaching experience per
academic period
XXX number of faculty with 11 or
more years of teaching experience per
academic period
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
XXX number of faculty with up to 3
years of clinical experience per
academic period
XXX number of faculty with 4–7 years
of clinical experience per academic
period
XXX number of faculty with 8–12
years of clinical experience per
academic period
XXX number of faculty with 13–20
years of clinical experience per
academic period
XXX number of faculty with 21 or
more years of clinical experience per
academic period
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Length of time the individual identifies as being a healthcare provider with his or
her current professional title (MD, DO, PA, APRN, RN, other). Clinical practice
will be measured in number of years (rounding up or down to the closest whole
year; e.g., 3.5 years will become 4 years) and measured as of the last day of the
corresponding 6-month period for the current calendar year (e.g., if survey is filled
in May, then experience is measured as of June 30 of the current calendar year, and
if the survey is filled in October, then experience is measured as of December 31 of
the current calendar year).
0–3
4–7
8–12
13–20
21+
Prepared by Optimal Solutions Group
2/25/2013
22
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
Answer Value
This template should be completed for each academic period
(e.g., quarter, semester) beginning with Fall 2007.
Characteristics of Partner Community-Based Care Settings (CCSs)
Frequency of Collection
Response
CCS Name:
Organizational Characteristics
Date CCS was open to provide health
care for first time
Did the CCS partner with hospitals
prior to the demonstration?
Did the CCS partner with SONs prior
to the demonstration?
Type of CCS
Federally qualified health center
Federally qualified health center lookalike
Chronic care practice
Rural health clinic
Primary care clinic/practice
Nurse-run clinic
Multispecialty practice
Public health facility
Long-term-care setting
Home health agency
Mental health facility
Other, please specify
Location of CCS
City
County
State
Provide the date CCS was open for first time as year, month, and
day.
YYYY/MM/DD
One time
Yes/No
One time
Yes/No
One time
Choose all that apply
Yes/No
One time
Yes/No
One time
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
If "Yes," please specify type of CCS
One time
One time
One time
One time
One time
One time
One time
One time
One time
One time
Insert name of city
Insert name of county
Insert state two-letter abbreviation
One time
One time
One time
The Census Bureau identifies two types of urban areas:
Urbanized Areas (UAs) of 50,000 or more people; and
Urban Clusters (UCs) of at least 2,500 and fewer than 50,000
Urban/rural
Rural or urban
people.
The term “rural” encompasses all population, housing, and territory
not included within an urban area.
Semester is defined in this context as a period of 6 months, from
Number of APRNs Trained per Site by
either January through June or July through December for a given
Specialty
year.
Advanced Practice Registered Nurse
(APRN)
Total number of APRNs in training at the CCS for each semester,
XXX APRNs for first/second semester of
including all specialties. The total number of APRNs should equal
year YY
the sum of CNMs, CRNAs, NPs, and CNSs.
Certified Nurse Midwife (CNM)
XXX CNMs for first/second semester of
year YY
Certified Registered Nurse Anesthetist
(CRNA)
XXX CRNAs for first/second semester of
year YY
Nurse Practitioner (NP)
Total number of NPs in training at the CCS for each semester,
XXX NPs for first/second semester of year
including all specialties. The total number of NPs should equal the
YY
sum of Acute Care, Adult/Gero, Family, Pediatric, and other NPs.
Prepared by Optimal Solutions Group
2/25/2013
One time
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
23
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
Answer Value
This template should be completed for each academic period
(e.g., quarter, semester) beginning with Fall 2007.
Characteristics of Partner Community-Based Care Settings (CCSs)
Frequency of Collection
Response
CCS Name:
NP Specialty: Adult/Gero
NP Specialty: Family
NP Specialty: Pediatrics
NP Specialty: Other
Clinical Nurse Specialist (CNS)
Total number of CNSs in training at the CCS for each semester,
including all specialties. The total number of CNSs should equal
the sum of Adult/Gero and other CNSs.
CNS Specialty: Adult/Gero
CNS Specialty: Other
Other, please specify
Total Number of Patient Visits
Total number of patient visits
Percentage of Patient Visits by Payer
Private
Medicare
Medicaid
Other
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
XXX Adult/Gero NPs for first/second
depending on the program's
semester of year YY
structure
Once each semester or quarter,
XXX Family NPs for first/second semester
depending on the program's
of year YY
structure
Once each semester or quarter,
XXX Pediatric NPs for first/second semester
depending on the program's
of year YY
structure
Once each semester or quarter,
XXX other NPs for first/second semester of
depending on the program's
year YY
structure
Once each semester or quarter,
XXX CNSs for first/second semester of year
depending on the program's
YY
structure
Once each semester or quarter,
XXX Adult/Gero CNSs for first/second
depending on the program's
semester of year YY
structure
Once each semester or quarter,
XXX other CNSs for first/second semester
depending on the program's
of year YY
structure
Once each semester or quarter,
XXX nurses for
depending on the program's
first/second semester of year YY
structure
XXX Adult Care NPs for first/second
semester of year YY
NP Specialty: Acute Care
Are other types of nurses being trained at the CCS? If so, please
include the type and specialty and the total number of nurses for
each semester.
Total number of outpatient visits per each semester
Measured in percentage of the total number of patient visits for
each semester, rounded to two decimal places
Percentage of patient visits paid for by private payers
Percentage of patient visits paid for by Medicare
Percentage of patient visits paid for by Medicaid
Percentage of patient visits paid for by other sources (that are not
private, Medicare, or Medicaid)
XXX number of patient visits
Every 6 months
XX.xx%
XX.xx%
XX.xx%
Every 6 months
Every 6 months
Every 6 months
XX.xx%
Every 6 months
Total number of physicians employed by the CCS during each
semester
XXX Physicians
Every 6 months
Total Number of Staff Available for
Seeing Patients
Physicians (MD or DO)
Physician's Assistant (PA)
Total number of PAs employed by the CCS during each semester
XXX PAs
Every 6 months
Advanced Practice Registered Nurse
(APRN)
Total number of APRNs employed by the CCS during each
semester
XXX APRNs
Every 6 months
Registered Nurse (RN)
Total number of RNs employed by the CCS during each semester
XXX RNs
Every 6 months
Other, please specify
Number of staff who are not physicians, PAs, APRNs, or RNs
employed by the CCS during each semester
XXX staff
Every 6 months
Prepared by Optimal Solutions Group
2/25/2013
24
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
Answer Value
This template should be completed for each academic period
(e.g., quarter, semester) beginning with Fall 2007.
Characteristics of Partner Community-Based Care Settings (CCSs)
Frequency of Collection
Response
CCS Name:
Full-time employment is employment in which a person works a
minimum number of hours defined as such by his or her employer.
Full-time employment often comes with benefits that are not
typically offered to part-time, temporary, or flexible workers, such
as annual paid time off, sick leave, and health insurance. Full-time
jobs are often considered careers. They generally pay more than
part-time jobs and usually require more hours per week.
Total Number of Preceptors
The Fair Labor Standards Act (FLSA) does not define full-time
employment or part-time employment. This is a matter generally to
be determined by the employer (U.S. Department of Labor). The
definition by employer can vary and is generally published in a
company's employee handbook. Companies commonly require at
least 30–35 hours per week to be defined as a full-time employee
and therefore eligible for benefits.
Number of full-time employees
precepting APRNs
Total number of full-time employees who are preceptors to APRN
students during each academic period
Number of part-time employees
precepting APRNs
Total number of part-time employees who are preceptors to APRN
XXX part-time preceptors
students during each academic period
Number of full-time employees
precepting any type of students
Total number of full-time employees who are preceptors to any type
XXX full-time preceptors
of students during each academic period
Number of part-time employees
precepting any type of students
Total number of part-time employees who are preceptors to any
type of students during each academic period
Student-to-Preceptor Ratio by Type of
Student
Ratio should be given at an individual level (e.g., three preceptors
per one APRN student).
Total number of preceptors devided by the total number of students XXX preceptors per one student
All types of students, including APRN,
medical students, PA students, etc.
XXX full-time preceptors
XXX part-time preceptors
Advanced Practice Registered Nurse
(APRN)
Total number of preceptors divided by the number of APRN
students
XXX preceptors per one APRN student
Certified Nurse Midwife (CNM)
Total number of preceptors divided by the total number of CNM
students.
XXX preceptors per one CNM student
Certified Registered Nurse Anesthetist Total number of preceptors divided by the total number of CRNA
(CRNA)
students
XXX preceptors per one CRNA student
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Nurse Practitioner (NP)
Total number of preceptors divided by the total number of NP
students. 'Other' refers to NP students that have a specialty other
than acute care, adult-gero, family, or pediatrics.
XXX preceptors per one NP student
Once each semester or quarter,
depending on the program's
structure
NP Specialty: Acute Care
Total number of preceptors divided by the total number of Acute
Care NP students
XXX preceptors per one Acute Care NP
student
Once each semester or quarter,
depending on the program's
structure
Prepared by Optimal Solutions Group
2/25/2013
25
Graduate Nurse Education Demonstration Evaluation
Data Element Name
Instructions
Quantitative Protocols
Definition and Instruction
Answer Value
This template should be completed for each academic period
(e.g., quarter, semester) beginning with Fall 2007.
Characteristics of Partner Community-Based Care Settings (CCSs)
Frequency of Collection
Response
CCS Name:
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
Total number of preceptors divided by the total number of Family
XXX preceptors per one Family NP student depending on the program's
NP students
structure
Once each semester or quarter,
Total number of preceptors divided by the total number of Pediatric
XXX preceptors per one Pediatric NP
depending on the program's
NP students. Ratio should be given at an individual level (e.g.,
student
structure
three preceptors per one Pediatric NP student).
Total number of preceptors divided by the total number of
Adult/Gero NP students
XXX preceptors per one Adult/Gero NP
student
NP Specialty: Other
Total number of preceptors divided by the total number of NP
students. "Other" refers to NP students who have a specialty other
than acute care, adult/gero, family, or pediatrics.
XXX preceptors per one other NP student
Clinical Nurse Specialist (CNS)
Total number of preceptors divided by the total number of CNS
students.
NP Specialty: Adult/Gero
NP Specialty: Family
NP Specialty: Pediatrics
CNS Specialty: Adult/Gero
CNS Specialty: Other
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
Total number of preceptors divided by the total number of
XXX preceptors per one Adult-Gero CNS
depending on the program's
Adult/Gero CNS students
student
structure
Total number of preceptors divided by the total number of other
Once each semester or quarter,
CNS students. "Other" refers to CNS students who have a specialty XXX preceptors per one other CNS student depending on the program's
other than adult/gero.
structure
XXX preceptors per one CNS student
Financial Incentives Offered to
Preceptors as a Function of (choose all Does the CCS offer financial incentives to preceptors based on:
that apply)
Experience of the preceptor
The number of years of experience precepting
Yes/No
Specialty
The specialty of the preceptor
Yes/No
Number of students precepting
The number of students each individual precepts per week
Yes/No
Number of hours precepting
The number of hours each individual spends precepting each week Yes/No
Location of training
The location and type of training site
Yes/No
Other
Other characteristics/aspects? If so, please specify.
If "Yes," insert other type of basis for
financial incentives
Prepared by Optimal Solutions Group
2/25/2013
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
Once each semester or quarter,
depending on the program's
structure
26
| File Type | application/pdf |
| Author | Lais Miachon |
| File Modified | 2013-02-28 |
| File Created | 2013-02-25 |