Clinical Scholars: Onboarding the Future Wave of Nurses
Sara Sweetser MSN, RN, RN-BC
Lusine Sarkisian MSN, RN, RN-BC
Peter Jones BSN, RN
November 2, 2018
Background/Significance
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Current State of Nursing in Colorado
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Shortage of newly licensed registered nursing graduates in Colorado
Experience pipeline is dry, reliant on newly licensed registered nurses
Population growth
30% of nurses in are retirement risks
Current State of Nursing at Parker
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Impact on quality and turnover
Increased demands on Medical Surgical nurses
Constant orientation is draining for Acute Care
Acute Care RNs transition to Intensive Care, Perioperative, Obstetrics, Emergency Department
Time to fill upwards to 180 days
Vacancies and competition in our area
Baccalaureate Education Needs
• Constant changes and advances in healthcare require new nursing stewards from practice areas
• Learning occurs best in a variety of environments
• Utilization of out-of-classroom instruction and partnerships with community resources is lacking
• Partnerships between educational and practice leaders can provide a more well-rounded clinical education for students
• Clinical scholars can assist students with role formation and creation of their professional identities
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Nursing Faculty Shortage
• Nursing schools have denied admission to qualified applicants due to faculty shortages and lack of clinical placements, hindering efforts to rectify the US nursing shortage
• Expansion of clinical faculty roles and hospital partnerships can help meet nursing education demands
• Need to increase nursing school and clinical training capacity in most cost-effective manner
• Use of hospital’s own nurse experts to train clinical students can attract them to faculty positions while maintaining a competitive salary
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Preceptor Burnout
• Preceptors fulfill several roles simultaneously – bedside nurse, role model, charge nurse, supervisor, educator
• Many preceptors describe this experience as stressful
• Difficult to balance caring and teaching roles without compromising either
• Preceptor training, administrative support, and recognition can help reduce preceptor burnout
• Preceptors will be more effective teachers if they have clearly defined roles, balanced workloads and professional networking opportunities
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Purpose
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What is a Clinical Scholar?
• Highly educated, skilled experienced RNs who work with a nursing school to instruct students in a clinical setting
• Remain employed and train nursing students at their current facility
• Provide hands-on instruction and evaluate nursing students
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Creatively Resourcing our Growth at Parker0.9 FTE includes:
• Onboarding, precepting and mentoring new Parker Acute Care nurses
• Consistent preceptor invested in new nurses = higher RN one-year retention rates
• Clinical RN placed in Acute Care staffing during peak season
• Assists in maintaining clinical scholar’s bedside knowledge and skills
• Clinical faculty time with nursing students
• Reimbursed by academic partners
• Offers recruitment opportunity for new graduate nurses
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0.23
0.35
0.32
0.9 FTE
Clinical RN during peak season Orienting, mentoring newly licensed nurses
Clinical faculty with students
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Beneficial for all Parties
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Facilities Schools Clinical Scholars Students
• Clinical scholars can
recruit new nurses who
have already been
introduced to their
hospital’s culture and
are familiar with their
procedures
• Facilities have greater
confidence in their own
employee’s clinical
competence than an
outside school’s faculty
member
• More faculty members
are available for
classroom instruction
• Saves cost of orienting
faculty to clinical
facilities
• Reduce nursing
burnout and expands
career development
opportunities
• Increased confidence
in their own clinical
expertise
• Better learning
experience from
clinical scholar who is
familiar with the
nursing unit
• Pipeline to obtaining a
new graduate RN
position
New Clinical Scholar Preceptor Model
• Clinical Scholar assigned to 3 NLRNs
• Focus will be on the NLRN becoming proficient with skills and not necessarily progression of patient assignment
• Expectation is for NLRN to gradually take on and identify responsibilities while the preceptor supports orientee and keeps remaining responsibilities
• Once the NLRN reaches phase 7 (approximately week 6- 8) the NLRN will be transitioned to an individual preceptor where the focus will be on building patient assignment
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Benefits of New Clinical Scholar Preceptor Model
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Allows for more consistent, thoughtful,
structured transition experience
NLRN masters fundamental skills
first to gain confidence and
competence
Focus is on efficiency, quality, and safety rather than speed and
doing more
Offers a more supportive and safe
learning environment
Decrease variation and improve quality
of orientation
Methods
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Clinical Scholar Financial Model
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Traditional Model Clinical Scholar Model
Patient Ratio: RN/Preceptor Dyad during Orientation 1.2 1.92
Average # of Patients Cared for per new grad 2.4 2.4
Preceptor to New Grad Ratio 1:1 1:4
Average New Grad $/hr 28.00$ 28.00$
Average Preceptor / clinical scholar pay 37.50$ 43.00$ Preceptor Teaching Students On the Floor
# Weeks of labor impact 10 10 0.35 0.32 0.23
# Hours of labor impact per new grad 720 450
Dollar Cost per New Grad RN 23,580$ 13,950.00$
For 12 New grads 282,960$ 167,400$
Two Cohorts of 12 New grads (Annual Cost) 565,920$ 334,800$
Cost/Patient for 10 Weeks 9,825$ 5,813$
Reimbursement from School ($55/hr) 37,125$
Cost of Student Teaching 29,025$
3 0.9 FTE Clinical Scholars Refund (at 675 hrs/yr) 111,375$
3 0.9 FTE Clinical Scholars Salary (Student Teaching
Portion at 675 hrs/yr)
87,075$
Clinical Scholar, potential savings (3 RNs) = 255,420$
Results/Outcomes
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Outcomes
• ROI depends on orientation models
• Reduction of end of shift overtime
• First year turnover
• Career advancement – retention of highly skilled and experienced nurses as clinical scholars
• Improve the quality of orientation by decreasing variation
• Decrease preceptor burnout
• Clinical scholars noted more opportunities to promote and evaluate critical thinking
• NLRN satisfied with new model of increasing tasks/skills gradually over time, rather than quick progression of patient load
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Qualitative Feedback
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“I really enjoyed having one patient to focus on at the
beginning to become proficient
with skills and documentation.”
“Preceptors are supportive and
provide opportunities to
learn.”
“I like orienting with other new grads at the same time; I am
able to listen to other new grads
questions and learn from what they are
asking.”
“I have a very receptive preceptor and feel like they are someone I
aspire to be, a role model, and a very
seasoned experienced nurse.”
Discussion/Implications
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Discussion
Other Potential Metrics
• Track recruitment of newly licensed RNs utilizing our own clinical scholar vs. school scholar
• Compare Casey-Fink Graduate Nurse Experience Survey results –traditional vs. new preceptor model
• Track quality measures• Patient safety events• Medications errors• Patient complaints• End of shift overtime• Completion of documentation and care
Other Opportunities
• Clinical scholar and CNA student program collaboration –recruit nursing externs
• More robust selection process for senior practicum students
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Implications
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Clinical Scholars
Well-rounded clinical
experience for nursing students
Recruit, support, retain top
talent
Comprehensive orientation
experience for NLRN
Promotes safe, high
quality care
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References
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Beal, J. A., & Riley, J. M. (2015). The development of a clinical nurse scholar in baccalaureate education. Journal of Professional Nursing,
31(5), 379-387. doi:10.1016/j.profnurs.2015.03.005
Colorado Center for Nursing Excellence. (2018). Colorado Center for Nursing Excellence. Retrieved from
http://www.coloradonursingcenter.org/colorados-nursing-shortage/
Valizadeh, S., Borimnejad, L., Rahmani, A., Gholizadeh, L., & Shahbazi, S. (2016). Challenges of the preceptors working with new nurses: A
phenomenological research study. Nurse Education Today, 44(2016), 92-97. doi:10.1016/j,nedt.2016.05.021
Wyte-Lake, T., Tran, K., Bowman, C. C., Needleman, J., Dobalian, A. (2013). A systematic review of strategies to address the clinical
nursing faculty shortage. Journal of Nursing Education, 52(5), 245-252. doi:10.3928/01484834-20130213-02
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