academic/ practice partnerships: creating solutions for … · 2019-05-13 · partnerships...
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Academic/ Practice Partnerships: Creating Solutions for Workforce Challenges
Edna Cadmus PhD, RN, NEA-BC, FAAN
Objectives
• Describe an effective transition into practice (TPP) program for new graduates in post-acute settings.
• Identify how academic and practice partnerships strengthen new graduates transitioning into practice.
• Discuss challenges and lesson learned in the process of implementation of a TPP.
Objectives
• Evaluate satisfaction and financial outcomes of implementing a TPP.
• Describe how academic/practice partnerships influence geriatric education at the undergraduate level in nursing.
• Describe how nursing competency of the student and staff improved care of the elderly.
How it All Began
• Nursing students are encouraged to work in hospitals for at least 2 years after becoming an RN
• Most Schools of Nursing do not offer a rotation in Geriatric care although majority of patients are geriatric
• DONs reported frequently that they invested time and talent in onboarding new graduates, they left as soon as a hospital position became available
Challenges
Nursing Centers were reluctant to hire based
on past history
Administration was not thrilled about replacing days out of building for preceptor and new RN
Administration felt the program cost them too
much money
DONs believed new RNs would leave them once they had experience on
their resume
Academia Challenges
Geriatrics not taught as a specialty
Few rotations for clinical
practice
Nursing educators still
advising students to go
to hospitals
Share your knowledge
Nurses working together can facilitate change
Nurses are the Number 1 trusted profession for 17
years
Collaboration and Respect
NJ Environmental Scan
• NJ Population =8,944,469 • US Census Bureau
• 7% of RNs in state employed in nursing homes, assisted living, extended care
• NJCCN Workforce Report (2018)
• Every county has had increase in elderly
Background
• Recommendation 3: Implement nurse residency programs
• Health care organizations, HRSA, CMS, and philanthropic organizations should fund the development and implementation of nurse residency programs across all practice settings.
• Health care organizations that offer nurse residency programs and foundations should evaluate the effectiveness of the residency programs in improving the retention of nurses, expanding competencies, and improving patient outcomes. (S-10)
• IOM (2011) The Future of Nursing: Leading Change Advancing Health.
Phases of Academic/Practice Partnership
LTC Nurse Residency Program *(2013-2016)
1LTC, Assisted Living & Acute Rehab Residency* (2016-2017)
2Out of hospital residency for School of Nursing*(2016-2022)
3Undergraduate integration population health into curricula*(2016-2017)
4
Partnership Model
NJAC
LTC Associations
HeldrichCenter at Rutgers
University
NJDOH/CMS
Nursing Homes
Rutgers University
Nursing
Funders
NJCCN HCANJNJHALeading Age
Statistics on RNs
Nursing Home
Turnover of RNs NJ=37.7%US=41.0%
Retention Rates NJ=53.8%US=49.5%
Vacancy Rates NJ 4.8%US=7.0%
AHCA,2010, Nursing Facility Staffing Survey
Costs
• High cost recruitment and replacement
• 1st year turnover rates of new nursing school graduates between 35%-61%. (Pine & Tart, 2007)
• Replacement of an RN =75-125% of an RNs annual salary. ( Jones, 2007; Silvestre, J., 2017)
ROI
Financial impact of
poor patient outcomes
Nursing staff impact :• Resident satisfaction • Staff responsiveness • Nursing
communication • Pain management
Can you afford not to invest?
Phases of Academic/Practice Partnership
1
LTC Nurse Residency Program *(2013-2016)
2
LTC, Assisted Living & Acute Rehab Residency* (2016-2017)
3
Out of hospital residency for Rutgers School of Nursing*(2016-2020)
4
Undergraduate integration population health into curricula*(2016-2017)
Goals
– Ensure evidence-based practices are employed to improve resident outcomes
– Reduce workforce instability
PIs & Faculty
Unique Aspects
Focused on quality and safety
Focused on the application for
older adult
Standardized curricula and
practicum experiences
Incorporated simulation technology
Preceptor education
Provided organizational data
to help improve quality outcomes
Contact hours awarded
3 Components
Preceptor Education
Nurse Residency
Learning Collaboratives
EnrollmentCohort Number of
facilitiesNumber of nurse residents enrolled
Number of preceptors enrolled
1 15 14 15
2 22 23 24
Preceptor Education
Day 1 Day 2 Day 3 Day 4 Day 5
How to be a preceptor
GRN Competencies
GRN Competencies
Nurse of the Future Core Competencies ©
Nurse of the Future Core Competencies©
New Nurse Residency Education
CONTENT 19 DAYSOverview of Program and Reality Shock
1
Geriatric Resource Nurse Competencies
4
Dementia Certification Course 2
INTERACT Education with Simulation
2
NOFCC © 10
August 26, 2014
COLLABORATIVES
• Advanced Care Planning• Medication Pass • New Models in Long Term Care• Psychotropic Medication
Management• Reducing Hospital Readmissions
through Disease Management• Resolving Conflict• Role of the Nurse in Survey• Transitions in Care
EVALUATION
Organizational Characteristics Job Satisfaction
Nursing Home Survey on Patient Safety
Culture
Casey-Fink Survey Geriatric Institutional Assessment Profile –
Nursing Home VersionQualitative Interviews
Organizational Characteristics
Type: 16 for-profit
15 not-for-profit1 government owned5 facilities were in both cohorts
Bed size: Mean=141 beds Range (40-406)
AHRQ Culture of Safety SurveyNational NJ
Top 3 Overall perceptions of resident safety
Overall perceptions of resident safety
Supervisors expectations and actions promoting resident safety
Supervisors expectations and actions promoting resident safety
Organizational learning Feedback and communication about incidents
Bottom 3 Non-punitive responses to mistakes
Non-punitive responses to mistakes
Staffing Staffing
Communication openness Compliance to procedures
Casey-FinkSurvey Tools Pre- (%
Positive)Post- (% Positive) Variance
n=25 n=26
Support 93% 92% -1%
Patient Safety 73% 79% 6%
Stress 18% 15% -3%
Communication/Leadership 91% 96% 5%
Personal Satisfaction 88% 96% 8%
Casey, K., Fink, R. Krugman, M., & Propst, J. (2004).
Job Satisfactionn=41 n=36 Variance
Personal Satisfaction 65% 73% 9%
Satisfaction with Workload
50% 56% 6%
Satisfaction with Professional Support
71% 71% 0%
Satisfaction with Training
51% 56% 5%
Satisfaction with Pay 45% 40% -5%
Satisfaction with Prospects
60% 61% 1%
Standards of Care 76% 75% -1%
Overall Satisfaction 75% 66% -9%
Traynor, M., & Wade, B. (1993).
Modified Preceptorship Tool
Modified Preceptorship Program evaluation tool
n=36
Impact on Role Development 95%
Value and Sustainability 77%
Engagement with Preceptor 84%
Impact on Clinical Practice 95%
Marks-Maran, D., Ooms, A., Tapping, J., Muir, J., Phillips, S. & Burke, L. (2013).
Focus Group Comments
Faculty support Faculty had good presentation skills and the learning collaboratives were well laid out.
Program materials and length Dementia, delirium videos, MedPasstraining and the Alive Inside video were particularly helpful. The new nurses asked for more simulations and role playing to teach critical thinking skills along with more focus on documentation. New nurses felt the program could be shortened.
Retention RateNJ Retention Rate for 20101
Cohort Nurse Residents Enrolled/Completed
% Retention Rate 1 year
53.8% 1 14 12 86%
2 23 20 87%
1.AHCA (2010) Nursing Facility Staffing Survey
Phases of Academic/Practice Partnership
1
LTC Nurse Residency Program *(2013-2016)
2
LTC, Assisted Living & Acute Rehab Residency* (2016-2017)
3
Out of hospital residency for Rutgers School of Nursing*(2016-2020)
4
Undergraduate integration population health into curricula*(2016-2017)
Cohort 3 and 4Completion Rates: Cohort 3 Start End Percent Completed Facilities 15 11 73% Preceptors 16 13 81% Nurse Residents 19 15 79% Cohort 4 Start End Percent Completed Facilities 8 6 75% Preceptors 11 10 90% Nurse Residents 13 9 69% Cohorts 3 and 4 Start End Percent Completed Facilities 23 17 79% Preceptors 27 23 85% Nurse Residents 32 24 75%
Lessons Learned-Recruitment
Long Term Care facilities require long lead times to commit to a nurse residency program
Return on Investment was important to the administrators
Selection criteria using the 5 star quality ratings was not an important contributor
Preceptor selection important
Lessons Learned Implementation
Offering the program face to face was more effective than using on-line modalities
Offering the program in the summer created staffing challenges
In long term care release time one day per week was the most that could be tolerated
Implementation Continued
Integrate the collaboratives into the program
The QAPI projects were an important aspect
Preceptors would benefit from a longer educational program
Lessons Learned Evaluation
Reducing the number of surveys
Time for survey participation is not
common place
Mixed methods approach is much richer
to understanding the data
Focus on Leadership
Deliverables
Curricula for nurse residents and
preceptors developed
86% retention rate for the nurse residents that
participated for 12 months
Training and virtual dementia kits provided to
facilities
Video for INTERACT simulation
produced and distributed
Certification of nurse residents
and preceptors as GRNs 83
Certification of nurse residents,
preceptors and other staff as
certified dementia practitioners 107
Phases of Academic/Practice Partnership
1
LTC Nurse Residency Program *(2013-2016)
2
LTC, Assisted Living & Acute Rehab Residency* (2016-2017)
3
Out of hospital residency for Rutgers School of Nursing*(2016-2022)
4
Undergraduate integration population health into curricula*(2016-2017)
In Progress
Helene Fuld grant-Academic/Practice Partnership in progress• 2017 1st cohort• BSN prepared
Expansion beyond LTC, Psych, Home Care, Insurance Agency
Progression
Externship Winter Course
Elective Course
Nurse Residency
Two Graduate Courses
Phases of Academic/Practice Partnership
1
LTC Nurse Residency Program *(2013-2016)
2
LTC, Assisted Living & Acute Rehab Residency* (2016-2017)
3
Out of hospital residency for Rutgers School of Nursing*(2016-2022)
4
Undergraduate integration population health into curricula*(2016-2017)
Goals
Advance behavioral changes in self management of chronic illnesses
01Facilitate transitions in care across settings
02
Undergraduate Curricula
Unfolding Case Studies• Adult I• Adult II• Community• Pediatrics
• Emergency Dept• 24 Observation Unit• Home• Community Clinic• Outpatient Cardiac Cath • Home Care Visit• Community Clinic• Palliative Care Visit• School Nursing
Learning Strategies
• Pre-Assignment– Patient Video Vignette– Student Guide
• In Class Debriefing• On Site Clinical Simulation
– Pre-Assignment– Pre-briefing– Simulation– Post Simulation
Graduate Leadership
Practicums in Associations, Non-
Hospital Sites
Community Engagement
Projects
NJAC Match.com Projects
Age Friendly Communities
Conversations of Your LifeMHFA
Why Academic/Practice Partnerships Important
• Associations have pulse on industry issues
• Can identify gaps experienced
• Access to members/faculty• Bring credibility • Help navigate challenges• Connect to content experts
Our Publications
• Cadmus, E., Salmond, S., Hassler, L., Black, K., &Bohnarczk, N. (2016). Creating a long-term care nurse residency model JCEN. 47 (5): 234-240.
• Cadmus, E., Salmond, S., Hassler, L., Bohnarczyk, N., &Black, K. (2017). Developing a Residency in Post-Acute Care. Indianapolis, IN: Sigma Theta Tau International.
• Salmond, S., Cadmus, E., Black, K., Bohnarczk, N. & Hassler, L. (2017). Long-term nurse residency program: Evaluation of new nurses experiences and lessons learned. JCEN. 48(10): 474-484.
References
Anderson, G. Hair, C., Todero, C. (2012). Nurse residency programs: An evidence-based review of theory, process, and outcomes. Journal of Professional Nursing. 28 (4), 203-212.
Adlam, K., Dotchin, M., Hayward, S. (2009). Nursing first year of practice past, present and future: document the journey in New Zealand. Journal of Nursing Management. 17(5), 570-575.
American Health Care Association (2012). Nursing Care Center Staffing Survey. Retrieved from http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/National HealthcareRNRetentionReport2014.pdf
Blegen, M, Goode, C., Park, S., Vaugn, T., Spetz, J. (2013). Baccalaureate education in nursing and patient outcomes. Journal of Nursing Administration. 43 (2), 89-94..
ReferencesBratt, M. (2009). Retaining the next generation of nurses: the Wisconsin nurse residency program provides a continuum of support. Continuing Education in Nursing 40(9), 416-425.
Bureau of Labor Statistics. Occupational wages and employment, May 2013. Retrieved from http://www.bls.gov/oes/current/oes291141.htm#st
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Registered Nurses. Retrieved from the Internet at http://www.bls.gov/ooh/healthcare/registered-nurses.htm (visited December 04, 2014).
Cimiotti, J., Aiken, L, Sloane, D., & WU, E. (2012). Nurse staffing, burnout and healthcare associated infection. Am. J. Infect Control. 40(6): 486-490.
Fox, K. (2010). Mentor program boots new nurses’ satisfaction and lowers turnover rate. Journal of Continuing Education in Nursing. 41 (7), 311-316.
ReferencesIOM (2011). The Future of Nursing Leading Change Advancing Health. Washington: DC, National Academies Press.
Jones, C., Gates, M (September 30, 2007). “The Costs and Benefits of Nurse Turnover: A Business Case for Nurse Retention “OJIN: The Online Journal of Issues in Nursing, 12 (3), Manuscript 4.
Kovner, C., Brewer, C. Fairchild, S. Poornima, S., Kim, H., & Djukie, M. (2007). Newly licensed RNs characteristics, work attitudes, and intentions to work. Am. J. Nursing. 107 (9),58-70.
Kutney-Lee, A., Sloane, D., Aiken, L. An increase in the number of nurses with baccalaureate degrees is linked to lower rates of post-surgery mortality. Health Affairs, 32, (3), 579-586.
Massachusetts Department of Higher Education (2010). Nurse of the future nursing core competencies. Retrieved from http://www.mass.edu/currentinit/documents/nursingcorecompetencies.pdf
ReferencesNeddleman J., Buerhaus P., Pankratz, S., Leibson, C., Stevens, S., Harris, M. (2011). The New England Journal of Medicine. 364, 1037-45.
NJLWD (2014). Quarterly Census of Employment and Wages, Annual Averages.
Pine, R., Tart, K., 2007. Return on investment: benefits and challenges of a baccalaureate nurse residency program. Nursing Economics. 25 (1), 13-39.
Rush, K., Adamack, M., Gordon, J., Lilly, M., Janke, R. (2013). Best practices of formal new graduate nurse transition programs; An integrative review. Internat Jl of Nursing Studies. 50, 345-356.
Silvestre, J., (2017). A multisite study on a new graduate registered nurse transition to practice program: Return on Investment. Nursing Economics. 35 (3): 110-118.
Srocyznski, M., & Gravlin, G. et al. (2011). Creativity and connections: The future of nursing education and practice: The Massachusetts initiative. Journal of Professional Nursing, 27, (6); e64-e70
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