Blog
Feb 24, 2010
By Pioquinto "Skip" Voluntad, Director of Development for New Populations, Inc., Media, PA
As a 79 year-old Asian American with diabetes and resulting kidney failure, I know firsthand the importance of managing my care and getting the help that I need, especially from nurses. Like other diabetics, I work with a primary care physician and a kidney specialist. Because of their skilled medical care, I am alive today to share my experiences.
However, nurses, too, have been critical to maintaining my health. Answering my health questions and helping me understand my treatments and what to expect, I feel confident about the care they provide.
As a parent, I know that a strong health care team includes nurses. Over the course of a year, my son, Christopher, had several heart surgeries to repair his aortic valve. During this time, we were cared for by nurses. And when Christopher lay dying and we were unable to return to the hospital in time, we were comforted to learn that a nurse held his hand and talked to him. Beyond providing highly-skilled health care, the nurses were there for us in our sorrow.
As a community activist, my exposure to the health care system helped me understand that many Asian Americans in my community were not using the health care services provided by our area hospital, Delaware County Memorial Hospital. To find out why and to remove barriers to care, I teamed with nurses and other Asian community activists. The language barrier was chief among the challenges the Asian community faced—obvious, yet largely ignored until nurses and activists became involved. The solutions to this problem required no new technology development, no complex information systems, and no new funding formulas. Just care, common sense, and commitment. Nurses and other health care professionals created a Neighborhood Response Team and arranged English for Speakers of Other Languages (ESOL) classes throughout the various hospital departments and in the Asian community. They developed a 'Welcoming Program' available for all community members in eight different languages.
Why were they successful? Because trying to understand patients' needs—medical and otherwise—is what nurses do. They recognized how important it was to learn more about Asian cultural beliefs, including the philosophy of Ying and Yang, the importance of family relationships, dietary differences and food practices, the differences in philosophies between Eastern and Western medicine, and how the Asian community traditionally cares for their terminally ill members. The result: the hospital saw a 20 percent increase in patients from the Asian community.
Is this kind of effort enough to solve the enormous health care access challenges we face? Certainly not. But just as certainly, without including nurses as a key part of the solution, we cannot succeed.
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Feb 17, 2010
By
- Susan Reinhard, PhD, RN, FAAN, Senior Vice President and Director, AARP Public Policy Institute; Chief Strategist, Center to Champion Nursing in America
- Brenda Cleary, PhD, RN, FAAN, Director, Center to Champion Nursing in America
Note: This perspective was originally published in the November 2, 2009 edition of Community College Week.
In light of the work of the RWJF Initiative on the Future of Nursing at the IOM and its upcoming February Forum on the Future of Nursing: Education, we feel it is important to highlight the innovative approaches to redesign nursing education being implemented across the country by the Center to Champion Nursing in America (CCNA) and our 30 state teams across the country.
The United States faces a nursing shortage, perhaps like none we’ve experienced: by 2025, the shortfall in registered nurses is expected to reach 260,000, according to Dr. Peter Buerhaus of Vanderbilt University. And, as baby boomers age and require greater attention and care, this shortage poses a growing threat to the quality and availability of health care services in our system.
This shortage is not due to a lack of qualified aspiring nurses. In fact, would-be nursing students are flooding admissions offices with applications every year; there is simply no place for them to go. In 2008, almost 99,000 qualified applications were turned away by U.S. nursing schools, according to the National League for Nursing.
We do not have enough nurses, in part, because of systemic problems in nursing education in the U.S. In order to stem the tide of this shortage, colleges and universities need to be equipped to graduate tens of thousands of additional nurses each year. This is no small feat. The current system is beset by too few faculty, a lack of strategic partnerships between community college and university programs, and insufficient clinical sites to provide the hands-on experience that is required for competency development.
To address these specific challenges in nursing education, the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation, is working with 30 state teams across the country to redesign the system to enable new graduates to enter the workforce with the skills they need to serve patients in hospitals and long term care facilities as well as in the community, and to become faculty members themselves. The Center seeks to spread best practices from around the nation that are ensuring the best in clinical education, as well as sharing innovative approaches to building the teaching capacity in nursing schools. In late 2009 in Portland, Ore., the Center brought together teams of nurses and other leaders from 11 states to demonstrate how they are addressing these challenges. The Oregon Consortium for Nursing Education (OCNE) was co-host of the conference and a featured model program, considered one of the most innovative nursing education redesign approaches in the country.
Oregon was one of the first states to respond to this critical need to redesign nursing education. Formed as a part of the state’s 2001 strategic plan to combat the nursing shortage, OCNE is a unique statewide partnership that includes faculty from eight community colleges and Oregon Health & Science University School of Nursing. As a part of its charge, it created a shared curriculum for nurses based on necessary core competencies. All consortium campuses teach the same courses, helping students move seamlessly from Associate’s degree to Bachelor’s degree programs, without having the take additional prerequisites, thus decreasing the time needed to graduate and begin direct patient care.
All of the Oregon consortium members have increased enrollment in their programs, and greater numbers of nursing students are opting to pursue higher-level degree programs. At Rogue Community College in Oregon, for example, enrollment has nearly doubled, according to Linda Wagner, the head of the college’s nursing department. During the first year that associate degree students had the option to continue on in their program, some 22 percent chose to pursue their Bachelor’s; this year, that number had risen to 44 percent.
Perhaps most beneficial to the state is that these new nurses who graduate all have the skills required to care for an aging population, whether they obtain a bachelor’s or an associate’s degree. The end goal is to increase both the number and skill level of new nurses to manage the needs of the 21st century patient in a reformed U.S. health system as well as to create a pipeline for the faculty that are desperately needed by all levels of nursing education programs.
In California, as well as Oregon and other states, many aspiring nurses have faced roadblocks in finding the necessary clinical education necessary to meet their degree requirements. The state’s shortage is expected to reach 109,00 next year, yet current rates of graduation will only produce half the required number of new nurses to fill the gap. Thus, the state has recently implemented the Centralized Clinical Placement System (CCPS), a web-based tool that is streamlining the clinical placement process, helping nursing students secure rotations in hospitals and other previously untapped medical facilities. So far, the system has helped increased Bay Area nursing student enrollment by 47 percent over the last five years.
To be sure, combating the nursing shortage and building a 21st century nursing workforce is not solely the responsibility of educators. However, we do know that within the education system, there are deliberate steps we can take to ensure that greater numbers of students enter the workforce with the skills they will need to succeed in this ever-changing health care landscape. The more we can work together and learn from each other – across communities, states and the nation – the more likely we are to reduce the nursing education bottleneck and create a nursing workforce ready to care for today’s patients and for generations to come.
Feb 12, 2010
Lessons Learned
Thirty state Champion Nursing teams are committed to increasing nursing education capacity to educate, build, and deploy the nurse workforce of the future. Teams are comprised of representatives from nursing education, state workforce offices, state departments of labor, consumers (often AARP state offices), local business, philanthropies, and others. The Center to Champion Nursing in America (CCNA) provides ongoing technical assistance and fosters collaborative learning experiences that link the teams and allow them to share best practices and lessons learned with their peers in other states.
In December 2009, teams from across the country gathered in Arlington, TX to explore the use of simulation in nursing education. Teams visited the University of Texas-Arlington’s (UTA) School of Nursing Smart Hospital. Participants were impressed that this simulated hospital could actually accommodate “real” patients in a disaster situation. The group's blog entry describes their site visit experience, the questions that it raised, and the application possibilities in their own states. We thank Mary Lou Brunell of Florida, Lisa Wright Eichelberger and Ben Robinson of Georgia, Martha Conrad and Jane Mahowald of Ohio, Gail Stuart and Susan Williams from South Carolina, and Sondra Flemming from Texas for this submission.
Clinical Education
Texas is grappling with many of the same issues that nurse educators are facing around the country. In HB 3961, the Texas legislature has called for research related to the outcomes importance of supervised clinical experiences. With required clinical hours ranging from 400 to 1400, it is hard to justify the funding for such a wide variance, without adequate evidence.
The Texas Board of Nursing does not have the 25% limit on simulation in nursing education program. UTA uses up to 50% simulation (30% undergraduate) with a 98% NCLEX pass rate, 90% retention rate and a 40% minority student population.
The AARP/CCNA visit to UTA’s School of Nursing Smart Hospital affirmed that the work we are doing in South Carolina with regard to simulation education is headed in the right direction. Specifically we need to continue our effort to identify the highest priority clinical experiences without exposure to which we would not want our students to graduate. The UTA Dean and faculty reinforced the importance of defining what we want our students to learn and master rather then focusing on number of hours devoted to clinical time. It makes far more sense to build simulation scenarios around selected experiences and desired competencies so that all students can be guaranteed the same or similar content.
Faculty Resources
UTA started out with nursing faculty running their own simulations but are now moving to clinical simulation staff which consists of BSN prepared nurses. Ongoing development of faculty is critical to the success of integrating simulation into the curriculum. We discussed the value of partnering with local agencies that can also use the smart hospital as well as other disciplines that can help financially support the continuing operation of the site.
Ah-Hah Moments/Take-aways
I realized how much I didn’t know about simulation but am delighted to hear about the great things going on in the use of simulation in nursing curricula. I learned about the example of how students could be helped to perform nursing intervention in a constructive manner so that retention in the nursing program, graduation and successful nursing practice could occur. Otherwise the students would have failed out of the nursing program because the differences in practice would not be identified in the usual clinical practice setting (what a fantastic contribution to nursing education!) I had several take-a-ways from this great opportunity: 1) Success remains in the human factor—don’t forget it. How you orient and transition faculty to incorporate simulation is critical. Possible use of simulation practice faculty. 2) Research must be done—we need to know the outcomes and what is required to be competent. 3) There is not strong evidence that simulation expands education capacity. In programs that have already doubled enrollment it is allowing them to maintain at that higher capacity. 4) Use of standardized patience actors provides the human factor. 5) Sustainable funding—consistent challenge.
Other Musings and Questions
What struck me most about this visit were not the differences but the similarities in what colleges of nursing are wrestling with in relation to simulation. Issues of needs assessment, faculty training and setting up a laboratory are common to all of us. We need more opportunities and forums to exchange ideas and lessons learned. It also is clear that we need to think strategically and regionally (and ultimately nationally) in order to make the best use of scare resources. And most of all we need an evidence base for this new teaching methodology. I believe the most important outcomes related to simulation will be focused on quality of care and patient safety. But to research this we need clarity of expected competencies, ways to measure them and agencies to fund this research. The potential is enormous. We need the focus and collaborative sharing to make simulation transformative for nursing and this we surely can do?
Simulation effectiveness is not about simulation and space. It’s about designed learning activities that generate the development of clinical reasoning skills in the learner. What are the resources needed to effectively develop simulation education? How do we develop faculty to deliver effective simulation? Is simulation effective? Will simulation advance the nursing workforce? Can we use simulation to develop faculty?
The CCNA created an opportunity to explore high level simulation. The idea exchange generated many questions… beyond individual schools, colleges and universities. How can states work collectively to increase the nursing workforce and what do we do nationally to create new venues to prepare the nurse for tomorrow’s needs?
Simulation is interesting…it’s exciting…it’s even fun…and nearly everyone is jumping on board but does it make a difference? Do we get a return on investment of technology and other resources?
Do we all need to create a unique model of simulation? What are the lessons learned?
Effective simulation in nursing education begins with assessing the need of the student. What will it take to education competitive nurses? Can simulation advance nursing practice and education? We think so… it’s time to add research to the answer.
We must study the impact of simulation on student competency. What about using simulation to develop faculty? What is fundamental to teaching /learning using the tools of simulation education?
Next Steps
Georgia needs to conduct a statewide survey of simulation services so that we can determine the need for regional centers and also the potential for collaboration on research and sharing of resources such as funding for technical support personnel. Our state AARP office may have funds to help convene a state wide meeting.
The site visit stimulated me to proceed with the state assessment of stimulation activities and sites in Ohio so that regional and interdisciplinary partnerships can develop.
As the Department Chair of a new BSN program (SC) in the process of developing and expanding the program’s simulation center, the UTA faculty and visit to the Smart Hospital provided me with an additional way to use our home care room, for example, as a setting to practice health promotion and teaching or having crucial conversations, even delivering “bad news” to a patient or family member.
Feb 1, 2010
When the Center to Champion Nursing in America (CCNA) was launched in 2007, the top priority for us was expanding education capacity for nurses.
With the need for improving access to affordable and quality care for all Americans becoming more urgent each day, getting more nurses into the career and teaching pipeline was—and still is—an urgent challenge. Because education and workforce development in any field are generally coordinated locally, we immediately went to work supporting state level efforts to help grow a highly trained national nurse workforce.
What’s happening in states around the country is the subject of the second in an exciting series of articles appearing in the American Journal of Nursing (AJN) called “Uniting States, Sharing Strategies.” The first article in the series discussed the major messages that emerged from two national summits on education capacity with state teams of stakeholders; the current article, The Technical Assistance Program of the CCNA: How a national organization is helping to expand nursing education capacity state by state, drills down into the nuts and bolts of CCNA’s work with 30 state teams. The remaining articles will look in depth at five states that are exemplars in redesigning and expanding nursing education.
As someone who’s spent much of my career working at national and state levels to address the inequities in access to, and the quality of, health and long-term care, I am so pleased to see this article in print and share it with our CCNA blog readers. I have directed national initiatives that provided states with incentives to help consumers of all ages live in their homes and communities and still receive quality health care. As director of a national technical assistance center created to assist states and U.S. territories re-design their long-term care systems, I know first-hand the importance of sharing strategies, and CCNA is well positioned to serve as a conduit for this technical assistance program as we work to support expanding education capacity for nurses. In this article, my co-authors (and valued colleagues) and I detail CCNA’s efforts to support 30 geographically diverse state teams in expanding nursing education capacity through our Technical Assistance Program. The program is designed to support states that are finding solutions to their nurse shortage, and help other states adapt and build on the experiences of those that have found success.
From the rigorous process of selecting the original 18 lead state teams to site visits, evaluations and the all important mechanics of facilitating communications among the 30 teams, this article describes how CCNA is implementing its vision of a national movement to increase awareness of the need to expand nursing education capacity and support the changes required for success.
