HEA 630 Milestone One Guidelines and Rubric Selecting a Nee

HEA 630 Milestone One Guidelines and Rubric: Selecting a
Need for Change
As a higher education administrator, you will consider,
encounter, potentially initiate, and possibly help to manage
change initiatives within your institution. By
examining situational cases involving change at other
institutions, you will be better prepared to predict, understand,
and work through changes that will affect
you, your students, and your colleagues at your college or
university.
As you consider which case to select for the final project, think
about the institutions described in each case study and consider
why different institutions react
differently to changes initiated both internally and externally.
Use your own experiences as a student and as an administrator
to help guide the selection process.
The starting point in any change initiative begins with a
reflection of the institution itself as each college or university
has its own “personality” that influences all
decisions, reactions, and outcomes. As you work through this
milestone and those that follow, consider how each aspect of the
critical elements posed influence
student success, retention, and persistence within the
institution. While your specific role as a higher education
administrator may not directly relate to these
elements of the institution’s mission, they are a part of the
guiding foundational role of each institution and you should use
that as your focus in the final project.

Prompt: In Module Two, you will review the required case
studies (see the syllabus for a link to the coursepack and a list
of case studies) and select one case
study that interests you most since this will be the focus of your
work for the final project. Throughout this course, this case
study will frame your responses for
all tasks related to the final project. As you delve into the case,
your introduction of it will serve as a backdrop for the
description of the need for change and why
the change agent has concerns related to the change. This
milestone submission addresses critical element I (Introduction)
and critical element II, section A (new
president as a change agent) of the final project, and it serves as
an initial draft for these elements. Substantial instructor
feedback will be provided for
foundational support of the final project.
As you consider the case study you selected and work through
course content, identify ways to build on this milestone
submission to expand your analysis,
assessment, and application of these pieces of the project for
your final submission in Module Nine. As you work on your
milestone submission, it is important to
note that not every critical element of the final project will be
addressed by your milestone submission. When preparing your
milestone and final project
submissions, be sure to support your work with supplemental
information and additional resources beyond the required
resources and readings.
The following critical elements must be addressed in your
paper:
why you have selected the case, and

describe personal relevance, if any. This explanation will assist
your instructor with
understanding your goal and motivation so that relevant and
meaningful feedback can be provided.
de an overview and description
of the institution, including but not limited to demographics,
classification, student success,
persistence and retention rates, affiliation, and mission and
vision.
nd
describe the need for change and to support your conclusions
with evidence from the case
study.
Rubric
Guidelines for Submission: Your paper must be submitted and
formatted as per the APA Manual, as a three- to four-page
Microsoft Word document with double
spacing, 12-point Times New Roman font, one-inch margins,
and at least three sources cited in APA format. Ensure you have
a cover sheet and reference sheet.
Cover sheet and reference sheet are additional pages.
Critical Elements Proficient (100%) Needs Improvement (70%)
Not Evident (0%) Value
Selected Case Explains why the case was selected and
provides personal relevance to support

selection
Explains why the case was selected Does not explain why the
case was
selected
20
Institution Description Describes the institution as profiled in
the case study
Describes the institution as profiled in
the case study but description is cursory
or has inaccuracies
Does not describe the institution as
profiled in the case study
30
Need for Change Describes concerns about the state of
the institution that drive change based
on the impact on student success,
retention, and persistence
Describes concerns about the state of
the institution that drive change but
details either lack impact on student
success, retention, and persistence or
are cursory
Does not describe concerns about the
state of the institution that drive change
30

Articulation of Response Submission has no major errors related
to citations, grammar, spelling, syntax, or
organization
Submission has major errors related to
citations, grammar, spelling, syntax, or
organization that negatively impact
readability and articulation of main ideas
Submission has critical errors related to
citations, grammar, spelling, syntax, or
organization that prevent understanding
of ideas
20
Earned Total 100%
9 - 6 0 1 - 0 3 9
A U G U S T 1 5 , 2 0 0 0
_____________________________________________________
_____________________________________________________
______
Professor Clayton Christensen and Research Associate Sarah
Thorp prepared this case. HBS cases are developed solely as the
basis for class
discussion. Cases are not intended to serve as endorsements,
sources of primary data, or illustrations of effective or

ineffective management.
Copyright © 2000 President and Fellows of Harvard College.
To order copies or request permission to reproduce materials,
call 1-800-545-7685,
write Harvard Business School Publishing, Boston, MA 02163,
or go to http://www.hbsp.harvard.edu. No part of this
publication may be
reproduced, stored in a retrieval system, used in a spreadsheet,
or transmitted in any form or by any means—electronic,
mechanical,
photocopying, recording, or otherwise—without the permission
of Harvard Business School.
C L A Y T O N C H R I S T E N S E N
S A R A H T H O R P
Developing Nurse Practitioners at the College of St.
Catherine
I had a view that there should be a greater role for non-
physician health care providers in delivering care. St.
Catherine’s would be a place for me to explore the notion of
creating new leaders for healthcare.
— Margaret McLaughlin, Dean of Health Care Professions, St.
Catherine’s College
February 2000
It was a cold winter morning in St. Paul, Minnesota, and
Margaret McLaughlin had just unpacked

the last box of files in her new office at The College of St.
Catherine. After a six-month transition
from her former position as Associate Director of the Magee-
Womens Research Institute and
Professor of Obstetrics, Gynecology and Reproductive Sciences
at the University of Pittsburgh
College of Medicine, she was finally able to devote her full
time and attention to her new charge as
Dean of Health Professions. In anticipation of a meeting she
was about to have with the head of the
nursing department, she leafed through a pile of article
clippings and pulled out a study from the
most recent issue of The Journal of the American Medical
Association. The headlines read:
Some Patients have Comparable Short-Term Health Outcomes
When Treated By A Physician or
Nurse Practitioner.1
The article provided key findings of a study that had compared
outcomes for patients randomly
assigned to nurse practitioners or physicians for primary care
follow-up and ongoing care after
visiting a hospital emergency department or urgent care center
within the Columbia Presbyterian
Medical Center System. The authors concluded: “Who
provides primary care is an important policy
question. As nurse practitioners gain in authority nationally
with commercially insured and Medicare
populations now accessing nurse practitioner care, additional
research should include these
populations.”2 The study had triggered considerable discussion
and debate in the national health
care community. With great excitement, McLaughlin
contemplated the implications this might have
for the future of their own graduate programs for nurse

practitioners at St. Catherine’s.
1 Mary O. Mundinger, Dr. PH., et al., The Journal of the
American Medical Association, issue 283 (January 5, 2000):
59–68.
2 Ibid.
This document is authorized for use only by Deanna Buchanan
in HEA-630-Q3137 Leading Change in Higher Ed 21TW3 at
Southern New Hampshire University, 2021.
601-039 Developing Nurse Practitioners at the College of St.
Catherine
2
No sooner had McLaughlin completed the article when Alice
Swan, the Chair of the nursing
department, Brenda Canedy, Graduate Program Director, and
Patricia Dooley Eid, a graduate
nursing faculty member, entered her office. They began the
meeting by updating McLaughlin on
progress in the graduate nursing department. Then Swan
mentioned the Mundinger article and said:
“After hearing about this nurse practitioner-run clinic in New
York, the faculty in our department are
all wondering about creating our own clinic. Imagine, a clinic
run by our own St. Catherine’s nurse
practitioners and students in development!”
McLaughlin delighted in the idea. She had always thought that
nurse practitioners made excellent

teachers. She knew from personal experience. Two years ago,
her colleague Jane Butler, a certified
nurse midwife with a Master’s in Public Health who taught
obgyn at Magee Women’s Hospital to
University of Pittsburgh medical students, had been voted by
her students as “teacher of the year.” It
had been the first time at Magee that any faculty other than a
trained physician had won the
prestigious award. If medical students are learning effectively
from nonphysician-faculty, why
couldn’t nurse practitioners?
McLaughlin knew she did not have the empirical evidence to
give Swan, Canedy and Dooley Eid
a thoughtful response. She knew that at St. Catherine’s, students
training to be health professionals
were placed in local Minneapolis–St. Paul-based clinics that
were run by health provider systems—
HMOs, hospitals, or community-based clinics. Though most of
their education had been with nurse
practitioners, physicians also had played a role in their
education. Further, in a physician-dominated
health care community, none of these faculty or administrators
had ever owned and operated their
own clinic.
Eager to be supportive, McLaughlin wondered how to respond
to Swan’s request. She knew such
an initiative would be a tremendous opportunity for the college.
“If successful, a program like this
could put us on the map as innovators in this kind of training
and organization. More important, it
could serve as a catalyst for empowering our students.”
Health Care Reform

The 1990s brought with it a paradigm shift in the way health
care services were provided in the
United States. Market-driven economic policy, dramatic
technology developments, changing
demographics, and the knowledge explosion, were all creating a
climate of continuous rapid change.3
At one time focused on illness and highly specialized treatment,
the U.S. health care system was now
having an increasingly greater emphasis on primary health
care.4 One consequence of this was
changes in those professionals who provided health care, the
skills they needed, and the educational
institutions that prepared them. One health professional that was
impacted by this was the nurse
practitioner. Cost pressures discouraged the traditional family
physician from working in primary
health care, and encouraged them to move into specialty areas.
Nurse practitioners (NPs), who
traditionally had their greatest emphasis in primary care, were
now in greater demand. Representing
3 Carol A. Lindeman, PhD, RN, FAAN (Professor, Emeritus,
Oregon Health Sciences University, School of Nursing,
Portland,
Oregon), “The Future of Nursing Education,” Journal of
Nursing Education, vol. 39, no. 1 (January 2000): 5–12.
4 According to the World Health Organization, primary health
care is based on five principles: community participation,
equitable distribution, multi-sectorial cooperation,
appropriateness, and health promotion and disease prevention.
Primary
Health Care emphasizes collaboration of health professionals
and community members, focuses on the development of health-
promoting policies, and advocates for access to care for all

people. (Nursing and Health Care Perspectives, The World
Health
Organization, p. 116.)
Developing Nurse Practitioners at the College of St. Catherine
601-039
3
the largest group of health professionals in the United States,
NPs provided a largely untapped
resource to meet the primary health care needs of the nation.
Nurse Practitioners
Scope of Practice and Training
By 2000, nurse practitioners were registered nurses (RN) who
had completed an accredited
program of advanced nursing education. Most NPs had a
Master’s Degree in nursing and were
certified by a national nursing certification organization to
practice as a nurse practitioner. They
provided primary care services to a wide diversity of
populations, often specializing in family, adult,
geriatric, women’s health, school or pediatric nursing. Medical
and nursing literature suggested that
nurse practitioners could provide up to 80% of the primary care
services traditionally provided by a
primary care physician.5 (For nurse practitioner glossary, see

Exhibit 1.)
As patient care became more complicated and demanding, the
nursing profession demanded
higher knowledge, and accordingly, higher credentials. In the
1970s, the first certificate programs
were developed for nurses. Once trained in hospitals, nurses
were now moved off-site to universities
to develop a better understanding for a more sophisticated
practice. Nurse training and preparation
came to include a balance of university-based coursework in
basic science and theory, and
experienced-based apprenticeships (called “preceptors”) in local
area clinics or hospitals.
The 1970s was the era of role definition for NPs. At work, NPs
focused on diagnosing patients and
operated under strict protocol before administering any care.
The doctor was the medication
manager. In the policy arena, emphasis was on developing
Scope of Practice Statements that
described who NPs are and what they do. Studies were
conducted to see if NPs were able to provide
safe and effective care that was equal to medical doctors.
Practice protocols were developed to guide
the nurse practitioner and were approved by the supervising
doctors. State protocols were developed
to guide the nurse practitioner and were approved by the
supervising doctors. State practice acts
were beginning to acknowledge that NPs could diagnose and
treat the common health problems in
primary care.
The 1980s was the era of role differentiation. NPs were
identifying how they provided unique
contributions different than the doctors. On a national level,

economists were predicting an
oversupply of doctors so the NP’s jobs were threatened. State
practice acts permitted nurses to make
prescriptions and to select drugs. As a result, NPs had more
autonomy in taking care of patients. For
example, a nurse practitioner could prescribe antibiotics for
strep throat. If serving a patient with
diabetes, the nurse practitioner could prescribe the insulin and
order more without consulting a
doctor.
The 1990s introduced managed care and outcomes. The health
care system demanded more
affordable care with more cost effective workers. There was
more focus on disease management, and
NPs focused on prevention of illness because research showed
the value of tight control to prevent
complications. Nurse practitioner roles serving patients
expanded and their essential competencies
5 This paragraph was taken from, “Expanding the Horizons of
Healthcare: A Reference Guide,” 2nd edition, published by the
Minnesota Partnerships for Training, Minneapolis, p. 1.
Catherine
4

evolved to include a broader range of diagnoses—some similar
to those made by physicians in
primary care.6 Soon enough, managed care realized that NPs
could provide primary health care.
To prepare NPs for these changing responsibilities, nursing
programs acclimated. They first
offered diploma degrees, which were the norm in the 1990s.
They were housed in hospitals and were
funded similar to the Graduate Medical Education (GME). In
the mid-1950s the nursing profession
determined that education of nurses needed to be delivered in
institutions of higher learning. While
master’s education in nursing had always been located in
colleges and universities, nurse
practitioners were often prepared in these schools at the post-
baccalaureate certificate level. In the
early 1990s, the standard for nurse practitioner education was
changed to master’s level. Funding for
converting certificate programs to master’s programs was
awarded through the Department of
Health and Human Services. (Though a national accrediting
body set the bar of quality for these
programs and the federal government provided some sources of
funding, individual states governed
precisely what a nurse practitioner’s specific scope of practice
could include.) Shortly thereafter, most
nurse practitioners could see patients without consulting with a
doctor. With changes in the
healthcare infrastructure (e.g., the rise of managed care and the
decrease in hospitals), the setting for
work became community-based clinics. Clinics were required to
demonstrate outcomes, and they
generally had a specialty focus.
The Rise of Community-Based Clinics

NPs began to run their own clinics. By 1999, there were
approximately 76 nurse practitioner-run
clinics in the country. Since the early 1990s, the most
successful clinics that served as models
demonstrated the following characteristics:
1. Community Responsiveness: the models selected address a
documented health need faced by
vulnerable and under-served populations;
2. Innovation: creativity in program design, implementation and
sustaining factors;
3. Collaboration/Integration: effectiveness in collaboration and
coordination among various
partners;
4. Outcomes: measurable improved access to care, health status
and economic outcomes;
5. Replication/Sustainability: potential for program replication,
or adaptation, and sustainability in
other communities;
6. Administrative Effectiveness: quality and effectiveness in
administrative systems.7
Pressures on Higher Education Institutions
Institutes of higher education reinvented themselves to
accommodate the changes NPs were
experiencing in their work-settings and the higher levels of
knowledge and decision-making
authority they now required. (See Exhibit 2.) Most experts
agreed that as their role expanded, so did

the number of clinical hours required to educate them. When it
came to the balance of classroom
6 Katherine Crabtree, DNSc et al., “Analysis of Student Nurse
Practitioner Primary Care Practice Patterns in the Northwest,
Midwest, and South,” The American Journal for Nurse
Practitioners, September/October 1999, p. 10.
7 Models that Work Campaign Clearinghouse, Health Resources
Services Administration and the Department of Health and
Human Services, http://www.bphc.hrsa.dhhs.gov/mtw/mtw.htm,
phone: (800-859-2386).
601-039
5
work and clinical practice, the weight began to shift more
toward the clinical practicum.8 This was
easier said than done, as clinical education was expensive and
payers were becoming increasingly
unwilling to pay for the extra costs associated with the purchase
of services at teacher facilities. Some
schools tried to offset these costs by creating faculty-run health
clinics to bring revenue to the
institution. In a report about the future of nursing education,
one health care educator cautioned:
It will not be easy in the current climate for nursing to produce

significant revenue through
services provided by students and faculty. It will not be easy
because of reimbursement issues,
because these services may have a history of being provided
without cost, or because other
faculties are also trying to develop reimbursable services. The
process of developing revenue
producing services requires faculty and administrators to alter
the conception of the role of
faculty to include revenue generation. In addition to securing
research and training grants,
faculty may be expected to produce a minimum amount of
tuition revenue from their teaching
or clinical activities.9
Another issue was the faculty who taught the NPs. Some argued
that having the students work
under the supervision of a licensed nurse practitioner—not the
regular physician—afforded the
students the chance to “become more independent and able to
function with less supervision.”10 An
analysis of student nurse practitioner primary care practice
patterns revealed that “nurse practitioner
preceptors were significantly more likely to allow the student
independence than were physician
preceptors . . . (perhaps) . . . because the NP preceptors
understood the wider scope of their roles.”11
(See Exhibit 3 for highlights of the scope and content of nurse
practitioners’ work.)
By the late 1990s there were close to 54,000 NPs in the United
States and a proliferation of nurse
practitioner programs—exceeding 300 nationwide. One
thousand two-hundred of these NPs were in
Minnesota, most of whom were working in the Twin Cities.

Healthcare in the Twin Cities of Minneapolis and St. Paul
Healthcare Costs
Boasting one of the highest health insurance coverage rates per
capita in the United States, in 1999,
95% of Minnesota residents had health insurance. In spite of
this, health care delivery costs kept
insurance premiums at an all time high. In the 1990s, the state
legislature introduced two programs to
improve the situation: 1) A health insurance program called
Minnesota Cares addressed the people
who needed help affording the insurance premiums, and 2) A
waiver which allowed insurance
companies and medical providers to merge and integrate hoping
to bring about economic
efficiencies. Some hospitals closed as a result, and five years
later costs were still high. Janet Martins,
the Vice President of Operation at a clinic in the Twin Cities,
commented: “Despite its best intentions,
it is clear that a shift in the Minnesota Health Care Delivery
System must occur. Patient-care centers
are becoming productivity-care centers.” And, while the supply
side was focusing on efficiencies,
8 Katherine Crabtree, DNSc et al., “Analysis of Student Nurse
Practitioner Primary Care Practice Patterns in the Northwest,
Midwest, and South,” The American Journal for Nurse
Practitioners, September/October 1999, p. 11.
9 Carol A. Lindeman, “The Future of Nursing Education,”
Journal of Nursing Education, vol. 39, no. 1 (January 2000): 5–
12.
10 Crabtree, p. 11.

11 Crabtree, p. 18.
Catherine
6
consumers were valuing personal choice over economy. To
make matters worse, by the late 1990s,
cuts in Medicare meant declining reimbursement by third-party
providers.
Labor Shortages
The labor market was tight. Minnesota had an unemployment
rate of 2%, one of the lowest in the
country, putting pressure on health care delivery systems to
think more carefully about how to
recruit and compensate a work force. There was a shortage of
nurses. The Minnesota Board of
Nursing reported it would need 17.5% more nurse in 2005 than
it had in 1994, and supply was not
keeping up with demand. Nurses were older (average age 44)
and nearer retirement age; more nurses
were choosing part-time employment, and fewer people were
choosing nursing as a career.
Registered Nurse (RN) program enrollments were down.
Leaders in every part of the health care
delivery industry were looking for alternatives for efficient and

effective alternatives for servicing the
consumer.
An Opportunity for Nurse Practitioners
Despite the declining enrollment in RN programs, trends
indicated that those who were already
Registered Nurses were increasingly interested in moving to
Nurse Practitioner careers.12 State
regulations about the scope of a nurse practitioner’s work made
the job more attractive. A Minnesota
statute in 1999 authorized the nurse practitioner the following
rights: “Nurse practitioner practice
means, within the context of collaborative management: 1)
diagnosing, directly managing, and
preventing acute and chronic illness and disease; and 2)
promoting wellness, including providing
nonpharmacologic treatment. They can provide pharmacologic
treatment with a collaborative
agreement with a physician.” Prospective NPs could prepare for
this practice in one of the state’s six
graduate programs to train NPs.13 Together, the schools
graduated 120 to 130 NPs per year. Seventy
percent of the graduates worked in urban areas in primary care
settings. The balance served rural
communities. Half of the graduates became family NPs.
Funding for nurse practitioner training programs came from
public and private sources. In 1999,
federal money was available through the Department of Health
and Human Services for schools
which prepared a significant percentage of their graduates to
practice in rural areas or for expansion
of programs. Some of the universities were awarded grants to
convert their nursing programs from
certificate based curriculums to master’s level programs. State

money supported the state university
programs, but private colleges were for the most part tuition
dependent. The Minnesota Education
and Research Costs Trust Fund was established in 1977 by the
Minnesota legislature to provide
support for certain medical education and research activities in
Minnesota that had historically been
supported in significant part by patient care revenues. Still,
some private companies and foundations
were offering some financial support. Health care manufac turers
and foundations at hospitals and
health plans that recognized the importance of training
supported the initiatives.
Changes in reimbursement from health plans were also allowing
NPs to play a larger role. Put
differently, as NPs took on responsibilities more similar to the
physician, some insurance companies
were beginning to put processes in place to allow for the
reimbursement of services provided by NPs.
12 “Expanding the Horizons of Healthcare: A Reference Guide,”
2nd edition, The Minnesota Partnerships for Training,
Minneapolis, p. 8.
13 The six schools included: The College of St. Catherine,
College of St. Scholastica, University of Minnesota, Winona
State
University, Minnesota State University, Metropolitan State
University. Planned Parenthood of Minnesota also had a
program.
All but the College of St. Catherine offered the family nurse
practitioner program.

601-039
7
The Medicare Act of 1998 made this possible, authorizing NPs
in Minnesota to bill for their services.
Medicare promised it would pay NPs 85% of the rate of a
normal physician. Specifically, the Code
entitled the following: “Provider reimbursement under
Medicare in any location for services ‘which
would be physicians’ services is furnished by a physician . . .
which are performed by a nurse
practitioner . . . under the supervision of a physician . . . and
which the provider is legally authorized
to perform by the State in which the services are performed.”14
Martins explained one opportunity
the law had enabled: “At the time and still today, most
insurance companies recognized ‘physician-
only’ clinics and services. Still, some were warming to the idea
because of the lower rates. Blue Cross
Blue Shield, for example, did considerable work in the rural
areas where a shortage of physicians had
always opened doors for NPs to take on more responsibilities.
They saw a need for it.” With this, one
enterprising nurse practitioner in the Twin Cities decided to
start her own clinic. In 1999, Kathleen
Pasqualiani, R.N. and Certified Nurse Practitioner, launched
Care Plus, the first independently
owned and operated clinic in the State of Minnesota.

Care Plus
Care Plus was an adult primary care clinic located in downtown
Minneapolis. Martins explained
how they reached a decision about the model:
We had to make a variety of choices when thinking about our
model. First was location. We
knew that we wanted to be a pure primary and preventative care
clinic, but we didn’t want to
go head-to-head with physicians. Steering away from the
suburbs, we looked at the metro area
where people were under-served. At first, we found so many
free clinics and community
clinics that we didn’t see a clear pocket of unmet needs. At the
same time, we had to consider
regulatory changes explaining the scope of practice for a nurse
practitioner, and about
insurance company plans and how willing they would be to
support us.
It would also be critical for us to have a relationship with a
physician, and our medical
director—though he does not provide any service at our clinic—
is one. In a physician-
dominated community, it’s hard to even get financing from
investors and loans from banks if
you are not connected to a physician. Face it, it’s a lot easier
for a doctor to walk into a bank to
get a loan than a nurse practitioner. Insurance companies have
denied us because we didn’t
have a physician on site.
We also had to think about costs and our proximity to hospitals
or clinics that housed
expensive medical equipment. It was better for us to partner

than buy it ourselves. When
thinking about financial viability, our two largest on-going
operating expenses are personnel
compensation and benefits, and medical technology.
Care Plus had broken ground, paving the way for other NPs in
the Twin Cities to consider running
their own clinic.
14 “Expanding the Horizons of Healthcare: A Reference Guide,”
2nd edition, The Minnesota Partnerships for Training,
Minneapolis, p. 23.
Catherine
8
The College of St. Catherine
The College of St. Catherine was a Catholic college with
campuses in St. Paul and Minneapolis.15
Founded in 1905 by the Sisters of St. Joseph of Carondelet,16
by 1999 the college had 4,372 students
and 230 full-time faculty. The college offered bachelor’s
degrees to women in liberal arts and sciences
and certificate, associate and graduate degrees to men and
women in health-care and human-service
professions. (For list of accredited programs, see Exhibit 4.)

The school aimed to prepare students to become ethical,
effective leaders in their professions, their
communities and their world. The college honored a strong
commitment to faith and community
service and adhered to its Roman Catholic identity: “Affir ming
its Catholic Heritage . . . the college
maintains its conviction that religious and ethical values build a
framework for living, its
commitment to the liberal arts as the broad base for all learning,
and its pursuit of excellence for its
students.” These guiding principles informed a program that
enjoyed a city-wide reputation for
community action. Its connection to the community was
strengthened because many of the faculty,
especially those who taught technical skills and professional
education programs, were full-time,
clinically based practitioners. Service and experiential learning
strengthened the college’s educational
programs. The curriculum involved real-life situations in a
variety of ways, including clinical
laboratory settings, internships and fieldwork assignments.
In recent years, the student body of the college had transformed,
reflecting the changing
demographics of the Twin Cities. An increasing number of
students were on financial aid, and
represented a diverse set of races, ethnic backgrounds, and
cultures. In keeping with the founding
purpose of the college, the student body included a number of
students who were working to
overcome such barriers to higher education as economic
disadvantage; a physical, perceptual or other
form of disability or deficits in educational background. The
campus community benefited from the
experience of the range of human diversity among its students

and gained an appreciation for those
who had a variety of abilities and backgrounds.17
In 1998, new leadership was brought to the college in hopes of
strengthening the college’s
programs and its reputation in the community. Said Vice
President and Dean Mary Margaret Smith,
“St. Catherine’s was perceived in the community as a quietly
distinguished liberal arts college and
yet with over 4,300 students and a variety of programs we are
truly a comprehensive institution.”
Under the direction of the new president, Sister Andrea Lee, the
school set forth the following
campus goals: “The value of the faculty and staff collaboration
for the short-and long-term good of
the college shall be reflected in all of the work of the campus
with special emphasis on increasing: the
quality of our human relationships; the language of
collaboration; the community’s learning capacity;
distribution of decision-making; and resource stewardship and
sharing.”18 They created Centers of
Excellence for women and health; women and economic justice
and public policy; women and
spirituality; and women and science and technology. The
Centers’ organizational mechanisms were
designed to strengthen interdisciplinary learning and teaching;
to engage action research; to involve
and respond to community partners in the work; and to engage
faculty and students actively in
collaborative work. They also launched a capital campaign to
raise $100 million and restructured the
15 The present St. Catherine’s was the result of a merger in
1986 between a junior college in Minneapolis (St. Mary’s)and a
four-

year liberal arts college in St. Paul (St. Catherine’s).
16 In January, 2000, 50% of the Board of Directors were Sisters
of St. Joseph.
17 Most of this paragraph was taken from the College of St.
Catherine catalog, 1998–2000, p. 6.
18 These were the campus goals for 1998–1999.
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9
management. Three new Academic Deans were hired to oversee
the college’s programs, one for Arts
and Sciences, one for Professional Studies, and McLaughlin, for
Health Professions.
The Health Professions Department
Smith outlined the challenges for the Health Professions
Department: “One area where we had a
great deal of work to do was with our programs in the health
profession. Despite the fact that we
have 20 health programs19 and educate a significant portion of
the health professionals in the state, if
you ask around no one cites it as a strength. We wanted to make
it so.”

New Leadership
According to Smith, President Lee, the board, and the faculty
search committee had chosen
McLaughlin for the job for several reasons:
Margaret represented a different kind of experience and saw the
big picture in health care,
and she had some concrete suggestions for what we could do.
She believed we should be
asking ourselves: 1) what does the industry need in terms of
professionals in healthcare, and 2)
how will we prepare our students to become leaders in
healthcare in the future?
We saw in her candidacy some real potential for us to do
exactly the things we saw
possible; not simply to get some recognition for the college, but
to create for our students a real
sense of opportunity and leadership; to understand their place in
the healthcare system, and
the leadership role they might play. This is critical because
typically the positions our students
take are in what might be considered pink collar aspects of the
profession, populated largely
by women, generally at the lower end of the hierarchy in terms
of healthcare.
The Programs
The Health Professions department included 20 programs to
prepare students for future careers as
health care providers (see Exhibit 5 for list of programs). For
generations, the programs had relied on
partnerships between the university and local area hospitals and

community-based clinics. This way,
training in theory and basic science and structure could be
taught by faculty in the college classrooms
and the skills could be taught by on-site, real-life experiences
under the supervision of a physician or
practitioner.
The Clinics
Students from St. Catherine’s engaged over 400 clinics every
year. The bulk of these were small
specialty community-based clinics which served as internships
for one or two students. Called
“preceptorships,” many were one-time internships, where an
interested student would work with the
organization for a year or two at most. Other clinics were at
some of the large hospitals, HMOs, or
other more established health delivery systems which had
offered more funding for and placement of
St. Catherine’s students and graduates over the years.
19 Allied health professions is a term used to describe those
who work in non-physician health professions; e.g., nurse
practitioners, occupational therapists, physical therapists.
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10

Traditionally, the preceptors were coordinated by a college
administrator or faculty member. A
contract was signed, enabling a logistical and legal arrangement
for the students. Then, the health
care provider would provide facilities such as a laboratory, and
medical equipment. St. Catherine’s
faculty designed their course and communicated their goals and
intentions to the hospital physicians
or specialty providers. The student’s experience was largely
determined by the physician.
In recent years, some new programs developed to accommodate
full-time health professionals
who wouldn’t need to make the commute to the college. In these
“off-site” clinics, a clinic or hospital
would provide the classrooms and even the marketing for the
program. St. Catherine’s faculty would
manage the design of the curriculum—whether it be for an
associate degree, certificate or continuing
education program. Robertson explained, “The faculty enjoyed
these programs where they didn’t
have to be responsible for administrative work, budgets or
marketing materials. They could focus on
their teaching.”
Pressure to Innovate
By 1999, both changes in the marketplace and pressures on
higher education to raise the
credentials of their graduates forced the educators to consider
new kinds of preceptorships. Smith
provided background on the increasing expectations of
credentialing:
In the current environment, if we don’t graduate students who

are professionally trained—
who hold a master’s degree and if it’s required, a doctorate—
then they won’t be taken
seriously in the national and local conversations about care.
For example, it used to be enough to have a baccalaureate
degree in occupational therapy.
But now, the profession is moving in a direction that is
demanding a master’s degree. For this
reason, we have reconfigured our baccalaureate program to
offer occupational science.
Students will receive certification, the OTR (occupational
therapist registered), at the master’s
level. Despite long waiting lists for the program, and the fact
that this was one of our bread
and butter programs—we’ve done what we can to ensure that we
are doing what we can for
our students so that when they graduate they will be on a level
playing field with their co-
workers. We roll the dice. . . .
“At the same time,” Smith continued, “the managed care market
is putting pressure to hire those
who cost less, and have fewer credentials. But they are also
asking them to provide more services.”
Joan Robertson, Director of New Program Initiatives, described
some specific pressures this put on
the program:
We’ve had trouble accessing some internships because of the
increase in programs and the
decrease in health-care workers available to teach on-site.
Health care providers can’t afford to
take their staff away from patient care to work with trainees.
Over the last few years, we’ve
noticed that fewer students are going to hospitals where the

physicians prescribe their
experiences, and more are going to community-based clinics
which are often in modest
consultation with physicians.
Programs at St. Catherine’s needed to be designed to prepare
students for more direct service.
Robertson continued: “One way around this dilemma is to have
health professionals at some clinics
allow our students to actually perform the service.” She pointed
to one example:
Last year, the master’s in physical therapy program began a
partnership initiative with the
Institute of Sports Medicine. This is the closest of any college
affiliation with a clinic where the
students and faculty are actually a part of the clinic team. It’s
more than just the students doing
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11
the clinical rotation; they are actually a part of the clinic. The
students are already physical
therapists so they can function independently—as independent
care providers.
In Robertson’s view, this was the best kind of preceptorship:

“When all is said and done, the
student who has had the experience of direct service ends up
being better off—more competent and
feeling more a part of the team. They are the ones who are best
prepared to enter and succeed in the
workforce.”
Aware of the tension between all of these competing issues and
dynamic trends, Smith pointed
out their dilemma as leaders of the organization:
The question becomes for us, which direction do we follow?
Further, even if we see change
as part of our work, there is only so much that everyone can
handle at once. Our institutional
resources and our human resources are stretched thin . . .
everyone has a dozen plates
spinning.
And, to top it all off, consider institutions of higher education.
They are known for being
stodgy: there are tensions and noises that can slow things
down. Faculty groups ask many
questions and form many committees. This raises questions with
our external partners and
whether we can be facile when a new idea comes forth.
The Nursing Department
The Program
The nursing program at St. Catherine’s offered both
undergraduate and graduate degrees in
nursing. The Minneapolis campus graduated 135 associate
degree program graduates per year, and
the St. Paul campus, 80 bachelor and 30 master’s degrees. Since

they graduated their first diploma
degree20 nurses in 1890, they had responded to trends in the
marketplace: first offering an associate
degree program, then a baccalaureate degree. In 1990, they
created a master-level program.
The graduate programs prepared NPs. A full-time student could
complete the program in four
semesters and two January terms. There were four specialty
areas within the master’s program:
neonatal, pediatric, adult and gerontological. “We have always
had the specialty options, rather than
the more generalist family practitioner nurse,” Swan observed,
“this way, you have more depth.”
Upon completion of the program, students took the nurse
practitioner certification exam in their
specialty area. Since 1992, the American Nurses Association
and the National Association of Pediatric
Nurse Associates and Practitioners had required that all nurses
writing the pediatric, adult and
gerontological nurse practitioner exams hold a master’s degree
in nursing. In 2000, all nurses writing
the neonatal nurse practitioner exam would be required to hold
a master’ s degree in nursing (for
more details on coursework and program objectives, see Exhibit
6). In 1999, legislation made it clear
that NPs could only serve clients for which they were certified.
In response to this, the faculty had
20 Degrees ranking from lowest to highest are: diploma degree,
associate degree, bachelor’s degree, and master’s degree.
Diploma programs were the norm in the mid-1990s. They were
housed in hospitals and funded similar to the Graduate
Medical Education (GME). In the mid-1950s the nursing

profession determined that education of nurses needed to be
delivered
in institutions of higher learning. While master’s education in
nursing had always been located in colleges and universities,
nurse practitioners were often prepared in these schools at the
post-baccalaureate certificate level. In the early 1990s, the
standard for nurse practitioner education was changed to
master’s level.
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12
designed three “bridge” courses to allow NPs certified in one
area to take a shorter, customized
course to prepare them for another specialty area.
The Vision for Nurse Practitioner Preparation
Swan, who had been designing graduate programs in nursing for
the college for over 10 years,
shared her thoughts about preparing nurse practitioners:
Today, we need to prepare people who are team players and who
can take on the systems
view. They need to be more multi-skilled with less rigid
boundaries between the kinds of
diagnoses and services they can provide. We need people who
can think critically about what

it means if someone is not on the right pathway for care; who
can trouble shoot and say, “What
does this mean? What can I do to get them back on the path?”
Robertson agreed with Swan’s observations, adding:
We need health professionals to be trained in a way so that
when a problem arises with a
patient, they aren’t thinking, “I can’t do this because I wasn’t
trained; or I can’t do this because
it’s not in my scope of practice.” Rather, they need to have the
kind of mindset that is open
enough and flexible enough that if you get into a setting and the
need is for a certain kind of
skill, that they are open to seeking out the right training they
need. They need to be confident
in their ability to master new skills.
Similar to the other health professions, the nursing department
too was witnessing a change in the
marketplace:
It’s been tough since managed care came to Minnesota. Some of
the large systems providers
where we’ve offered preceptorships will suddenly lay off
employees. When we approach them
with our specialty model for what we think is the proper design
for clinical education, some
turn it down for a cheaper model. We need to be creative about
how we design programs and
work with others. We also need to consider our student body.
The profile is changing. There is
a more multicultural mix, more need financial aid, and there are
more single mothers.
A Clinic of Their Own?

In February, 2000, Swan and Dooley Eid scheduled an
appointment with McLaughlin to discuss
this idea. Speaking on behalf of the entire graduate school of
nursing faculty, Dooley Eid explained
the concept:
The idea of developing an independent nurse practitioner run
clinic came to us when we
were working on The Collaborative Rural Nurse Practitioner
Project. This was a state-funded
grant awarded to the college with five other schools to place
NPs in rural areas. The groups of
schools had to find NPs who were strong in their communities,
and we recruited them to come
to one of the schools for training and to then return to serve
those communities. We began this
initiative in 1993 and to date have graduated approximately 700
NPs with close to 25% of them
finding employment in the rural areas of Minnesota. It was
successful and now we wanted to
do more.
As a faculty, we came up with this concept of developing our
own clinic. We have such a
rich variety of NPs and so it makes a lot of sense. We have the
history and are a strong group.
601-039

13
Through The Rural Collaborative we experienced what it was
like to share a lot of the effort.
We had to access clinical sites and deal with issues of
reimbursement; dealing with the issues
one faces in having to make sure that the clinics produce.
After listening, McLaughlin asked them about the goals of such
a clinic. Swan replied:
The whole object of the clinic would be to provide access to
care and to an under-served
population and also to make it possible for NPs to bill for their
own services. We would not
give our time; rather, the program would support itself. Perhaps
we could figure out how to
partner with others to make this happen—to help us with some
of the financial and
administrative burden that our faculty find tiring.
McLaughlin wondered who the clinic might serve. This
triggered a discussion about four possible
options for clinic models.
Option A
The first option was to set up a pediatric primary clinic in a
public school in the St. Paul area. The
schools had a diverse student population, and in many cases had
high absenteeism rates. It was
common knowledge that many of the students disappeared from
school because they were sick and
wound up in emergency care for treatment. A school-based
clinic would alleviate this problem and

curb absenteeism.
Swan liked this idea. She explained:
This plan fits with the college’s mission and would be terrific
for the school system in St.
Paul. It would be easy for us to do because school-based clinics
are not new to the school
system—I can think of a few already that serve them. In
addition, we might be able to find a
partner in Health Partners,21 who are right across the street.
This would also ensure good
physician support. Fifty percent of the students are HMO
Medicaid covered and Health
Partners would probably be delighted if we took responsibility
for caring for the children.
Further, we could get grant money from foundations easily
because of the cause—school
children in need.
Dooley Eid added: “This model would also be great for us
because of the educational component.
Working alongside local area schoolchildren would force our
faculty and students to become
culturally competent care providers.” She then outlined the
possible challenges of implementation:
This could be tough because the school district we would want
to serve is a bit north of St.
Paul and may cross over district lines. We’ve also heard that
Health Partners might be starting
a family practice unit in this area, and we would not want to
create any conflict with them.
Another problem is that using grant money to get ourselves
going might not be the best idea—
you never know how long it will serve you.

Option B
The next idea was to partner with a Catholic Charity in the city.
One of these was St. Mary’s
clinic—a place for people to come who have nowhere else to go.
It was run by the Sisters of St. Joseph
21 Health Partners is health delivery system which was already
an active partner of the St. Catherine’s.
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14
of Carondelet. There was no doubt there was a need for this,
and the Sisters were already connected
to the college, so it would be a logical move.
Still, there were concerns. All three agreed with Swan that there
were problems with the model.
The clinic was based on a physician-run model. They agreed it
might be better to go to an area where
they could have the best chance of creating success for NPs.
Dooley Eid added, “If we did this one,
we would most likely have to provide our services on a
volunteer basis.” This raised an important
issue for the college. McLaughlin elaborated: “This idea of

charging fees for services may not rest
well with the central tendency in this college, which is to give
because giving is a valued thing to do
and so doing pro-bono work is what is valued. Do we really
want to move away from that if we
begin a clinic where we charged for our services?”
Option C
Dolly Eid had been investigating other nurse practitioner
models outside of Minnesota. One was
CAPNA (Columbia Advanced Practice Nurse Associates) which
had a clinic positioned near Central
Park in New York City. It was the site of the recent Mundinger
study. Dooley Eid had visited with
Karen Piacentini, who had been recruited from Prudential
Insurance Company by Mundinger to
oversee CAPNA. The six NPs who staffed the clinic had joint
clinical and academic appointments
and had been handpicked for this model in the national eye. She
explained what she knew about it:
This clinic provides primary preventative care for business
women in Manhattan. The
group received start-up funds from Columbia Presbyterian
Hospital. They provide a
continuum of care. NPs can admit patients to Columbia
Presbyterian Hospital where the
physician can take over care. Then, the nurse practitioner can
do all of the work around the
patient’s discharge.
The group has a great financial person on site and the NPs have
autonomy to structure the
clinic as they wish. It is a research model, so their practice is
designed to research all of the

questions about themselves and what is working and what is
not.
For us, the problems with the approach is that the model i sn’t
interdisciplinary in the way
that St. Catherine’s would probably want ours to be. They don’t
allow students into the model.
And, it is an independent model. You could argue that Columbia
would help them out if they
had problems, but they haven’t organized themselves in a way
that formally links them to
partners and collaborators.
Option D
The last model was a clinic similar to one offered at
Georgetown University in Washington, D.C.
This was a primary clinic that was launched with grant money
from national foundations. It was a
collaborative model in which patients could go to the clinic for
one-stop shopping. One site—an old
school redesigned and turned into a primary care clinic—housed
everything from after school
programs for children to prenatal care offered by nursing
midwives. They bill for all of the services—
educational and healthcare related.
Swan explained why they liked this one:
Health care practitioners in Minnesota are beginning to explore
alternative health care
delivery systems in the community that match the lifestyles of
the population, and this
particular model would fit well with it. Further, in this kind of
clinic you are meeting a broad

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15
set of education needs: it serves a broader lifespan—not just
children, but adults—and it
provides a good place for everyone to learn. It could also be
multidisciplinary. With this, we
might be able to include some of our other health professionals
at St. Kate’s, such as our
occupational therapists.
Food for Thought
After discussing these ideas, McLaughlin suggested that they
spend some more time thinking
about exactly how this would work and what questions would
need to be answered before moving
forward. She remembered the conversation she had with
Brainerd, who had helped her develop a list
of criteria by which she would evaluate the four options:
1. They would need to determine how to organize the clinic in a
way that it had links with a
medical group, particularly for patients who were not well
enough or who needed
hospitalization.
2. There would be opportunities for financial support. Would it

be better to fund the operation
through fees and reimbursement, or through tuition and grants?
3. Liability issues were a concern. Would it be easier to deal
with these as a small independent
group, or with links to a larger organization that already had
systems in place?
4. There were logistical challenges in terms of location and
proximity to resources. They would
need to consider the administrative structure, partnerships, and
how much it would all cost.
On top of this list, McLaughlin considered her own set of
criteria as Dean of Health Professions:
1. This needed to make sense for The College of St. Catherine.
And if it did, the nursing
department needed to have a broad enough vision for what it
could become. It should be
different from other clinics in Minnesota and the rest of the
world.
2. It ought to have an optimal vision of reward for the college’s
generous and enthusiastic
faculty.
McLaughlin could not wait to find some answers.

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16
Exhibit 1 A Snapshot of Nurse Practitioners in Minnesota
Nurse Practitioner (NP)
Education
The standard for nurse practitioner education is at the graduate
level; however the few certificate
programs remaining are with Planned Parenthood. Nurse
practitioners hold a Master’s Degree from a
graduate nursing program offering preparation as a nurse
practitioner. Programs are accredited by the
National League for Nursing and follow standards and
guidelines developed by the National
Organization of Nurse Practitioner Faculty.
Licensing/Registration
Must be licensed as a Registered Nurse by the Minnesota Board
of Nursing. Licensing requirements
include graduating from an approved nursing program and
passing the NCLEX exam. Nurse
practitioners do not have another license as a nurse practitioner.
Certification
There are four national nursing credentialing organizations
which certify nurse practitioners through
an examination. Applicants must be registered nurses and have
graduated from an accredited nurse
practitioner program. One of the credentialing organizations
requires that the NP have a Master’s Degree

in nursing (American Nurses Credentialing Center). Practice
and continuing education hours are required
to maintain certification.
Scope of Practice
Nurse practitioners provide common primary care services to a
wide diversity of populations. They
may have a general focus on the family or specialize in the care
of children, women, or elders; some may
specialize in mental health. As independent practitioners, NPs
may establish their own practices or work
as collaborative partners with physicians and other health care
team members. Common service delivery
locations include clinics, nursing homes, hospitals, and schools.
NPs perform physical examinations,
conduct holistic and comprehensive health assessments,
diagnose and treat common acute illnesses and
injuries, provide immunizations, manage a variety of common
chronic health problems, order and
interpret x-rays and other diagnostic tests, and counsel patients
on disease prevention and health
promotion. Nurse practitioners work in collaboration with all
members of the health care team, which
involves consultation and referral when a problem is beyond
their scope of practice and their individual
expertise.
Prescriptive Privileges
NPs have had legislative authority since 1990 to prescribe drugs
including controlled substances and
therapeutic devices. To be eligible for prescriptive authority,
the NP must be certified by a national
nursing certification organization recognized by the Board of
Nursing. In addition, the NP must have a

signed written agreement between a physician and the NP. The
written agreement defines the prescribing
responsibilities of the NP and the categories of drugs the NP
can prescribe. The agreement is based on
standards established by the MN Nurses Association and the
MN Medical Assn.
Source: “Expanding the Horizons of Health Care, A Reference
Guide,” 2nd edition, The Minnesota Partnerships for Training,
University of Minnesota, Minneapolis, pp. 36 and 37.
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17
Exhibit 2 Predicted Changes for Nursing Education between
1999 and 2025
McBride’s Prediction
McBridea predicts major paradigm shifts in health care delivery
and academia. Based on these
shifts, she predicts the following ten changes in nursing
education between now and 2025:
1. Schools will focus on the concept of lifelong learning, not
just on academic degrees, with
alumni becoming as important as students in degree-granting
programs.

2. Career counseling will become increasingly important with
emphasis on having a “full”
career, assuming positions beyond the discipline specific, and
nursing as good baccalaureate
preparation for all aspects of the health care industry.
3. Centers of excellence will take shape, and with them a
growth in postdoctoral training and in
scholarship congruent with the institutional mission.
4. Consortium education will grow; programs and schools will
join forces across state and
national boundaries to offer collectively the full range of
academic opportunities.
5. Schools/programs will increasingly operate in terms of the
principles of responsibility-
centered management, with a corresponding emphasis on bench-
marking, economic
modeling, overhead management, and entrepreneurial activities.
6. “Best practices” in health education will be established and
nurses will take the lead in
designing life style-change programs and a broad array of
learning products.
7. There will be renewed interest in recruiting young adults into
nursing, particularly in
supporting research career trajectories straight from
baccalaureate education through to
postdoctoral.
8. Faculty roles will continue to evolve, with increasing
emphasis on the concept of “faculty
mix.”

9. The role of the dean will become substantially external, with
emphasis on forgoing
community/business partnerships and fund raising.
10. Links between nursing education and nursing service will
continue to grow.
McBride also believes nurse educators will have to resolve
“entry into practice” and the
relationships among baccalaureate, masters, and doctoral
education.
Source: Carol A. Lindeman, “The Future of Nursing Education,”
Journal of Nursing Education, vol. 39, no. 1 (January 2000):
8–9.
aA.B. McBride, “Breakthroughs in Nursing Education: Looking
Back, Looking Forward,” Nursing Outlook, 47 (3), 1999, pp.
114–119.
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18
Exhibit 3 Analysis of Student Nurse Practitioner Primary Care
Practice Patterns in the Northwest,
Midwest, and South

Overview This analysis was conducted to examine the adequacy
of clinical preparation of nurse
practitioner students for their complex roles as primary care
providers. The content and scope of
practice patterns of NP students from four universities with
well-established NP programs were
examined. Data were collected using a standardized form for
8,027 patient encounters reported by 30
adult NP and 42 family NP students in primary care settings
during one year of the program.
Similarities were numerous across NP specialties and
educational programs despite geographical,
regulatory, and curricular differences.
Exhibit 3A The 20 Most Common Reasons for Visits to
Physicians Offices
Note Acute problems were the most frequent (52%) reason for a
visit, followed by chronic
problems (27%). Health promotion and health maintenance
visits accounted for 22% of the total
visits.
Rank Reason for Visit
1. General medical examination
2. Acute upper respiratory infection
3. Hypertension
4. Prenatal care
5. Acute otitis media
6. Acute lower respiratory tract infection
7. Acute sprains and strains

8. Depression and anxiety
9. Diabetes mellitus
10. Lacerations and contusions
11. Malignant neoplasms
12. Degenerative joint disease
13. Acute sinusitis
14. Fractures and dislocations
15. Chronic rhinitis
16. Ishemic heart disease
17. Acne and disease of sweat glands
18. Low back pain
19. Dermatitis and eczema
20. Urinary tract infections
Source: Adapted from Katherine Crabtree, “Analysis of Student
Nurse Practitioner Primary
Care Practice Patterns in the Northwest, Midwest, and South,”
The American Journal
for Nurse Practitioners, September/October 1999, p. 11.

601-039
19
Exhibit 3B Nursing Diagnoses and Interventions Made by
Students
Note The most frequent nursing interventions (horizontal axis)
reported were teaching,
monitoring and surveillance, counseling, health promotion, and
advice concerning over-the-counter
(OTC) medication. The nursing diagnoses reported most
frequently are in descending order (vertical
axis). The diagnoses complemented the top five medical
diagnoses made by NP students, which the
study found to be, in descending order of frequency:
hypertension, pregnant woman, diabetes,
sinusitis, and upper respiratory infection.
Teaching
Monitoring/
Surveillance Counseling
Health
Promotion Prescription OTC Med
Nursing Diagnoses n (%) n (%) n (%) n (%) n (%) n (%)
Health Maintenance 256 (18.7) 133 (9.7) 35 (9.7) 158 (11.5) 30
(2.2) 2 (.2)
Altered Health
Maintenance

208
(33.9) 119
(19.4) 83
(13.6) 78
(12.7)
53
(8.6) 19
(3.2)
Health Seeking 574 (47.8) 164 (13.6) 149 (13.3) 200 (16.6) 51
(4.1) 5 (.4)
Health Management
Deficit
70
(48.3) 20

(13.8) 20
(13.2) 12
(8.3)
9
(6.3) 0
Knowledge Deficit 661 (73.5) 10 (1.1) 157 (18) 19 (2.1) 13
(1.4) 2 (.2)
Pain 202 (31.2) 136 (21.0) 82 (12.9) 20 (3.1) 123 (19.0) 48
(6.8)
Impaired Tissue
Integrity
0
0
0
0

0
0
Potential for Infection 95 (31.1) 49 (16.1) 60 (19.8) 28 (9.2) 50
(16.4) 9 (3.0)
Totals 2066 631 586 515 329 85
Nurse Practitioner Primary Care Practice Patterns in the
Northwest, Midwest, and South,” The American Journal for
Nurse Practitioners, September/Oc tober 1999, p. 17.
“n” = number and % = percent.
Exhibit 3C Differences in Students Level of Responsibility and
Preceptor Type
Note Nurse practitioner preceptors fostered independent
decision-making more than physicians
did.
Preceptor Type
Exam by Student;
Decisions by
Preceptor

Exam by Student;
Decisions Jointly
with Preceptor
Exam and
Decisions by
Student, Preceptor
Validates
Exam and Decision
by Student
Independently
Nurse Practitioner 6.9% 23.6% 54.4% 15.0%
n = 324
Physician 9.0% 44.9% 42.7% 3.4%
n = 178
X2=38.08; p<.001
Nurse Practitioner Primary Care Practice Patterns in the
Northwest, Midwest, and South,” The American Journal for
Nurse Practitioners, September/October 1999, p. 18.
“n” = number.

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Exhibit 4 Accredited Programs at St. Catherine’s
History and Accreditation
The College of St. Catherine-Minneapolis offers health-care and
human-service career
opportunities through associate degree and certificate programs.
Founded in 1964 as St. Mary’s
Junior College, the institution merged in 1986 with the College
of St. Catherine, a four-year liberal
arts college located in St. Paul. As a result, the College of St.
Catherine-Minneapolis is in the process
of expanding its educational mission and continues to offer
innovative, high-quality educational
programs responding to the ever-changing needs and
technological advancements in health-care and
human-services careers.
Accreditation and Approval
• The College of St. Catherine is accredited institutionally by
the North Central Association of
Colleges and Secondary Schools.
• The Nursing program is accredited by the National League for
Nursing Accreditation
Commission.
• The Occupational Therapy Assistant program is accredited by

the Accreditation Council for
Occupational Therapy Education (American Occupational
Therapy Association).
• The Phlebotomy program is approved by the National
Accrediting Agency for Clinical
Laboratory Sciences, the Commission for the Accreditation of
Allied Health Education
Programs and the American Medical Association.
• The Respiratory Care program is accredited by the Committee
on Accreditation for
Respiratory Care, Commission for the Accreditation of Allied
Health Education Programs,
American Medical Accreditation and American Medical
Association.
• The Health Information Management program is accredited by
the Commission for the
Accreditation of Allied Health Education Programs in
cooperation with the Council on
Education of the American Health Information Management
Association.
• The Physical Therapist Assistant program is accredited by the
Commission on Accreditation
in Physical Therapy Education (American Physical Therapy
Association).
• The Radiography program is accredited by the Joint Review
Committee on Education in
Radiology Technology.
• The Sonography program is accredited by the Joint Review
Committee on Education in
Diagnostic Medical Sonography and the Commission on

Accreditation of Allied Health
Education Programs.
• The Chemical Dependency Family Treatment Counselor
program is accredited by the
Institute for Chemical Dependency Professionals of Minnesota.
• The Center for Contemporary Montessori Programs is
affiliated at all levels with the
American Montessori Society.
Source: St. Catherine’s College.
601-039
21
Exhibit 5 Programs in the Health Profession Department
College Program
Chemical Dependency Family Treatment
Coding Specialist
Exercise and Sport Science
Health & Wellness/Holistic Therapies
Health Care Interpreter
Health Information Management
Medical Records/Health Information Specialist
Medical Transcription

Nursing Program (AAS)
Nursing Program (BSN)
Nursing Program (MANU)
Occupational Therapy Assistant
Occupational Therapy
Masters in Occupational Therapy
Phlebotomy
Physical Therapist Assistant
Physical Therapist (MPT)
Radiography
Respiratory Care
Sonography
Catherine
22
Exhibit 6 St. Catherine’s College Masters of Arts in Nursing:
Program Overview
Course Work
The 40-credit Master of Arts in Nursing program consists of
core content in critical decision
making, ethical leadership, cultural diversity, health promotion
and maintenance, nursing theory,
nursing research, administrative problem solving and health

policy, and practice-specific content in
the chosen area of nurse practitioner specialization: neonatal,
pediatric, adult or gerontological
nursing.
A full-time student can complete the program in four semesters
and one January term. Priority is
given to applicants who wish to pursue full-time study. Upon
completion of the program, you will
be eligible to write the nurse practitioner certification
examination in your specialty area. Since 1992,
the American Nurses Association and the National Association
of Pediatric Nurse Associates and
Practitioners have required that all nurses writing the pediatric,
adult and gerontological nurse
practitioner exams hold a master’s degree in nursing. In 2000,
all nurses writing the neonatal nurse
practitioner exam will be required to hold a master’s degree in
nursing.
Advanced Practice
The Master of Arts in Nursing program builds upon the existing
skills and experience of the
professional nurse, providing preparation for advanced practice
in the health-care system. Nurse
practitioners implement the nursing process through expanded
assessment, planning, intervention
and evaluation modes and incorporate a holistic approach
toward the care of clients. Advanced
practice is based upon an extended knowledge base, advanced
decision-making skills, research
experience, a conceptualization of advanced nursing practice
and a well-developed ethical
framework. The program addresses each of these areas.

Clinicals
Students complete more than 600 hours of an advanced clinical
practice experience. Clinical
coordinators work together with students to secure preceptors
prior to clinical course work. The
option coordinator approves all clinical placements for students
with that option. Faculty supervise
clinical placements by making visits to each site and arranging
conferences with students and their
preceptors. The nursing faculty is committed to providing
health care to underserved populations,
including consumers in rural areas. Students who wish to
pursue clinical experiences in these areas
are supported in their efforts.
Prior to the beginning of clinical course work, students must
verify that they have an active
Minnesota nursing license and malpractice insurance.
Thesis
The program includes a thesis requirement. The student will
complete a thesis based upon a
research project focusing on an advanced practice clinical issue,
defend the thesis and then make a
public presentation of the research findings.
601-039

23
Schedule
Courses in the Master of Arts in Nursing program are offered in
a semester format. Fall semester
begins in September and winter semester in February. Classes
are block scheduled weekly or
biweekly in late afternoon/early evening time frames on
Wednesdays and Thursdays. Clinical
experiences are arranged to meet student and preceptor
schedules. In the second year, there is an
intensive clinical experience during the month of January.
Degree
Through the Master of Arts in Nursing program, you can earn a
master of arts degree with a
major field in nursing in one of four areas of specialization:
neonatal, pediatric, adult or
gerontological nurse practitioner.
Program Objectives
After completing the course work in the Master of Arts in
Nursing program, you should be
able to:
1. Synthesize knowledge from nursing theory, nursing research,
primary care and health policy
in advanced nursing practice;
2. Demonstrate ethical decision making and professional
accountability in the advanced practice
nurse role;

3. Utilize nursing research to promote care of clients in
advanced nursing practice;
4. Incorporate components of leadership theories to promote
quality health care in advanced
nursing practice;
5. Contribute to the development of advanced nursing practice
as a collaborative member of the
primary health-care team;
6. Use written and verbal communication to present substantive
strategies to support advanced
nursing practice;
7. Provide primary health-care services using a holistic
approach;
8. Demonstrate advanced nursing practice that integrates
theoretical knowledge from nursing
and other disciplines;
9. Manage clients with acute, chronic and/or complex
alterations in health using the advanced
practice role set; and
10. Demonstrate caring in the delivery of comprehensive
primary health-care service to
individuals, families and aggregates.

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HEA 630 Milestone One Guidelines and Rubric Selecting a Nee

HEA 630 Milestone One Guidelines and Rubric Selecting a Nee

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HEA 630 Milestone One Guidelines and Rubric Selecting a Nee