Developing Future RN Workforce and
Addressing Educa:onal Redesign
A Community Based New RN Transi:on to
Prac:ce New Program in Hospice SeDngs
L. Jessie Jones-‐Bell MSN, RN
[email protected]; [email protected] University of San Francisco
California Ins:tute for Nursing & Healthcare SuPer Care at Home
• By the end of the presenta:on, the par:cipant will be able to:
• Iden:fy 2 major strategies in developing entry to prac:ce programs in hospice care seDngs.
• Iden:fy 2 major educa:on strategies for New RN graduates that assist in their professional role development and support a
successful transi:on from student to nursing professional.
• Benefits of developing community partnerships for RN Residency Programs to develop the future hospice RN workforce.
•
Building the Case for Transition
Programs in California – high
unemployment rate, IOM report
•
Nursing Education Redesign White
Paper and Recommendations
•
Taking notes from past programs-
San Diego Hospice, Buffalo Hospice,
and VNA Program
1. ACADEMIC/SERVICE PARTNERSHIPS & STANDARDS
2. PROFESSIONAL AND CLINICAL ROLE FORMATION &
COMPETENCIES
3. COLLABORATIVE EDUCATION MODEL: EDUCATION HIGHWAY
4. FACULTY DEVELOPMENT/RECRUITMENT
5. SIMULATION, INFORMATICS, TECHNOLOGY 7. CENTER FOR KNOWLEDGE
21st CENTURY RN
WORKFORCE
Institute of Medicine Future of Nursing Report Recommendation #3:
Implement
Nurse Residency
Programs
Start-‐ups Ambulatory Care Transi:on to Prac:ce Programs-‐Why this area?
• Care is shi\ing to outpa:ent care areas
1. fewer posi:on in the inpa:ent care area for New RNs
2. Insurance reimbursing for shorter inpa:ent care days
3. Services are moving to outpa:ent care services
4. Learning specific skill sets and model of pa:ent
centered care for outpa:ent seDngs
5. Having a variety of ambulatory care sites ac:ve learning
What can hospice prac:ce areas provide:
• Need for new entry to prac:ce areas
• Ensure future RN workforce for outpa:ent care areas
• Fewer inpa:ent New RN Programs
• New areas to learn shi\ of care model paradigm to
learn care management and collabora:on
• Provide increase exposure to pediatric popula:on
• Mul:disciplinary services help prevent unnecessary
readmissions
• ACA promotes outpa:ent and primary care
expansion
• Aging of our baby boomer popula:on
• More adults & children living with chronic condi:ons
• Hospice / Homecare / pallia:ve seDngs provide
prac:ce areas that don’t compete with pre-‐licensure
Steps to Program Development
• Researching new scope and standards of prac:ce
specific to outpa:ent care
• Finding money to support cost of the program
• Program current cost is approximately $4,300 per
par:cipant
• Decrease cost with a standardized hybrid curriculum
to reach more par:cipants.
• Currently successful resident receives a s:pend at
end of the program and partners receive an honoraria
Steps to Developing a Hospice RN Transi:on Program
• Developing post licensure assessment tool
using Quality & Safety Educa:on for Nursing
• Developing standardized applica:on process and
requirements specific to ambulatory care sites
• Faculty recruitment, development, new skill sets,
curriculum and model of care delivery
• Recruitment and educa:on to clinical service
partners-‐ a labor of love
• Developing incen:ves for partners-‐working together
for shared governance, support for management and preceptors
Internal Structural Needs
• Support internally from university team
• Developing regular communica:on with university
team, grant funders, managing partners, clinical partners
• Have a clear process for tracking grant funds
• Contracts, honoraria payments, cost, and invoicing
templates
• Crea:ve use of facility use to keep costs down
• Ini:al investment from University to cover cost above
External Needs
• Communica:on-‐promo:ng open communica:on &
partnership with service partners, state departments, grant funders
• Helping with candidate selec:on with partners to
develop a formal selec:on process
• Preceptor and management support
• Preceptor Pearls and Guidelines-‐Benner’s model,
Neal’s Theory
• Preceptor support and training –new area of
Benner’s Model
Novice to Expert Progression of professional
Role Development
1.
Novice
2.
Advance Beginner
3.
Competent
4.
Proficient
5.
Expert
Neal’s Theory of HH Nursing Prac:ce
•
Stage One-‐
•
Dependence stage (lack confidence, insecure)
•
Lasts 1-‐2 years in HH prac:ce
•
Unasser:ve, anxious, afraid of missing
something
•
Concrete Thinker-‐ difficulty understanding
• Stage Two-‐
• More experienced becoming confident over :me with
decision making and how pa:ent learn
• Moderately dependent
• Worked in HH over 2 years
• S:ll does not fully understand organiza:onal and
regulatory issues
• Learning how to manage caseload-‐s:ll need support at
:mes
• Easily reverts back to stage one if a new or stressful
Neal’s Theory HH Nursing
•
Stage Two-‐
•
Calmer, learning asser:veness,
communica:on skills, adap:ng
•
Ask fewer ques:ons, serves as resource
•
Picking things previously missed, less fearful of
new clinical situa:ons
•
Defines own role and role of team, can self
• Stage Three-‐
• Feel increasingly independent-‐autonomy, asser:ve
• Can s:ll move back to stage 2 to a new challenge
• When assigned a new role may ini:ally become more
dependent for a :me (preceptor, supervisor, etc.)
• Has global understanding or system and processes
(problem solver, organized, rapid decisions)
• Accepts own limita:ons with humor
Challenges in Ambulatory Programs
• Support to Preceptors and Management-‐Labor
intensive
• Staff and Management turn over, decreased
preceptor produc:vity, finding the :me for check ins
• Developing brand new curriculum
• Determining compensa:on paid from grant funding
• Breaking the myth a New RN needs one year acute
experience-‐HOW and WHERE?
Partner Successes in Ambulatory Care Programs-Filling a Need
•
New prac:ce areas for New RNs (may start as
MA, per diem, transferable skills, new
recruitment pool for home health and hospice)
•
Changing mind set of new RNs about the role of
what a nurse is, learning to network, ongoing
coaching post program
•
Working with the State Department of Public
Health to develop a standardized entry to
prac:ce program
Ongoing Pearls for Sustainability of Ambulatory Program
• Communica:on is key!
• Get Help finding the money-‐consider different fee structures
• Ongoing educa:on demys:fying the myth that New RNs need one year acute care.
• Con:nue to improve support and training to clinical partners and share resources
• Start to develop formal ongoing contracts with outpa:ent care partners which outline the benefits of such partnerships
• Advocate for changes in the way we educate nurses
• Change the image and expecta:on of pre-‐licensure students about entry prac:ce areas for nursing-‐be visionary!
Why New Nurses Can’t Find Jobs (No Really!)
• Between 2011 & 2012 employment in healthcare has seen
a net gain of 340,000 jobs
• New-‐graduate nurses can find work in rural seDngs
• In most U.S. ci:es, especially on the West coast, a nursing
glut exists
• > 40% of recent grads failed to find jobs this year!
• Supply of nurses has spiked at both ends of the age scale! • Aging Nurses
• Students in their early 20’s are earning nursing degrees at a
rate not seen in decades
• Advance degree programs have increased the number of
Importance of Transi@on Programs in Ambulatory SeEngs
IOM Report is a roadmap for healthcare reform
Greater % of nursing care will be provided in the
community to help meet the needs of burgeoning popula:on of seniors
Community care may provide improved:
Models of Wellness and Preven:on services
Diagnosis & Management of uncomplicated acute
illnesses
Chronic Disease Management
Importance of Ambulatory Transi@on Programs-‐Timely
Bridging the Gap to Prac:ce:
• Development of transi:on programs in ambulatory
care to keep newly graduated RNs in the workforce and facilitate employability
• Fastest area of job growth over the next 5-‐10 years will
be in outpa:ent seDngs
• Innova:ve strategy that ensures RNs maintain and gain
competencies during employment lull
• Provides addi:onal educa:on & clinical experience
Why
Ambulatory Transi@on Programs are Important
Improving Pa:ent Outcomes by:
•
Preserving knowledge, experience & competence
gained during 1st year of professional prac:ce
•
Increased clinical judgment & performance EBP
•
Improves staff stability that promotes pa:ent
safety & increases pa:ent sa:sfac:on
•
Contributes to con:nuity of care
•
Transforma:ve organiza:onal change = Posi:ve
influence on pa:ent care
Program Strategies for Professional Development
• Quality and Safety Educa:on for Nursing (QSEN)
• Quality Improvement Project
• SBARR-‐ reflec:on, EBP, case studies
• Simula:on-‐ Scenario development using EBP
• Skills Review
• E-‐Learning Components
• Casey-‐Fink, Kim Preceptorship experience
• Professional guest speakers
QSEN
Follow Quality and Safety Educa:on for Nurses
(QSEN) competencies for Professional Prac:ce
QSEN improves pa:ent care quality and
content
Develops the knowing, skills, aDtudes to work
in a variety of ambulatory care seDngs
QSEN Competencies-‐Pa:ent centered care,
Informa:cs, Teamwork & Collabora:on, EBP,
Quality Improvement, Safety
QSEN Tool
•
Pa:ent Centered Care
•
Safety
•
Evidence Based Prac:ce
•
Teamwork and Collabora:on
•
Professionalism
•
Quality
Quality Improvement Project
A major educa:on strategy for transi:on RNs
Par:cipants iden:fy an area of need in individual
agencies and design a quality improvement project to meet that need
Secondary benefit is preceptor, agency staff
peripheral learning about the importance of Quality Measurement and Outcomes in EBP development
Quality Improvement
•
How need determined for change
•
What types of outcomes projected to improve
•
System, Pa:ent, agency or a combina:on
•
How will outcomes be measured
•
What EB informa:on are being used to research
and develop
•
What other disciplines are working on QI
•
What is your part
•
What did you learn, were QSEN Competencies
SBARR Case Reflec@on
•
Another major educa:on strategy for transi:on
RNs
•
Organizes pa:ent informa:on
•
Clarifies communica:on
•
Tool for reflec:on upon pa:ent care
•
Peer-‐Reviewed ar:cle that depicts pa:ent care
issue, EBP interven:ons
•
Secondary peripheral learning for agency staff
SBARR Case Study
• Situa:on-‐ Brief intro and demographic info
• Background-‐ History & what is happening, what has
been happening, and who is involved
• Assessment-‐ Compare to previous, subjec:ve &
objec:ve findings, global, tools used
• Recommenda:on-‐ What was done, suggested, what
EBP resources used
• Reflect-‐ What did you learn, preceptor response,
pa:ent, family response, communica:on, culture
1. QI-‐What could have been done differently, how will
Laboratory and Clinical Components
• Skills Lab
• Simula:on
• Blackboard /Canvas Courseware
• Par:cipa:on in Professional Organiza:ons-‐Local level
• Mini Teaches
Casey-‐Fink Tool
•
Build confidence through Na:onally-‐
recognized tool: Graduate Nurse Experience
Survey which was modified for Transi:on to
Prac:ce Programs
A Process of Transi@on to Workforce
•
Content Experts as guest speakers
1.
Relevant to par:cipants’ clinical experiences
2.
Facilitates employability
3.
Broadens understanding of EBP and improved
outcomes
4.
Provides a broader world view-‐ a way of
knowing
5.
Promotes collabora:on, support, and
Employability
•
4 flex waivers from the State Department of
Health and Safety for direct hire into
homecare
•
Cross over employment of Transi:on RNs
•
Those who were not hired in their pediatric
seDngs during program went on to be hired in
other pediatric areas in inpa:ent and
Employment Trends
• Spring 2012
1. 13 par:cipants-‐ 10 employed
2. 10 in HH Hospice
3. Of those in HH and hospice
4 accepted posi:on with agency
1 clinic RN hired inpa:ent hospice
1 hired as Triage RN (hopes to go back to hospice)
2 hired specialty inpa:ent New Grad programs
1 hired as school nurse
1 had a baby
Employment Trends
• Fall 2012
1. 17 total; 15 obtained jobs; 2 le\ personal reasons
2. Seven in hospice / HH
4 hired into hospice
1 was hired in Pediatric Specialty Program inpa:ent as
her preceptorship was a small inpa:ent pedi hospice
1 hired VA Inpa:ent New Grad program
Current Cohort
Fall 2013
•
18 Transi:on RNs, 6 hospice Sites
•
UCSF Clinics, SFDPH Urgent Care Clinic,
Transi:onal Care Program, 2 primary
preven:ve care community clinics, Kaiser
Clinic, 2 School Districts
Evalua@on: Next Steps
• Ongoing curriculum revision and standardiza:on
• Adult and Pediatric Track
• Preceptor Support & training
• Standardiza:on of preceptor experience for
par:cipants
• Expansion of transi:on program following
demonstra:on project
• Post Licensure Program as part of Nursing Educa:on
Redesign
• Develop cost effec:ve program design to reach more
Par:cipant Tes:monials
“I think that I got the job because of this
program. Being in the program helped me to
feel more confident during the interview!”
Par:cipant Tes:monials
“I want to say that I would NEVER have been
hired in my current posi:on without the help
of the New RN Transi:on program. No way.
The skills, the experience, and the confidence
and mentoring this program gave me were
Par:cipant Tes:monials
“ I am working as a school nurse for LA county, working with students with specials needs… and I love it. I also started working as a hospice nurse. I eventually want to be a public health nurse in LA county but it requires 2 years so I am star:ng on my second year…I am very grateful to you and the program because it taught me about other fields of nursing, it helped me get a job, it con:nued my nursing educa:on, it provided support to us new grads, increased my confidence in myself to not "act" like a nurse but actually "be" a nurse, and it gave me a sense of purpose in a :me that felt hopeless. If you ever need anything, please let me, I would love to help in anyway.”
Par:cipant Tes:monials
“Even though I worked in a Primary Care HIV
Clinic during the program, I was hired into a small
inpa:ent hospice program because of the
hospice content and focus that was included in
our curriculum. I was just offered my dream job
as a diabetes coach RN full :me. I will be keeping
my per diem hospice job while working as a
diabetes coach as I love what I am doing. It
wouldn’t have happened without the program
and I can’t thank you enough.”
Par:cipant Tes:monial
•
“Without the program I would never have
been able to start in my dream job as a
hospice nurse. I enjoyed learning the skills in
acute care during my nursing educa:on but
always knew I did not want to work as an
inpa:ent nurse. I love working closely with
my pa:ents and their families outside the
hospital.”
Contact Informa:on:
Lillian Jessie Jones-‐Bell MSN, RN, PHN
Program Director University of San Francisco
Community Partnership between the University of San Francisco and Local Hospices
