Academic/ Practice Partnerships: Creating Solutions for … · 2019-05-13 · partnerships...

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?


1


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

Available @ www.mass.edu/nursing

Curricular ConceptsNurse of Future

http://www.mass.edu/nursing

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


1


2


3


4


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


1


2


3


4


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


1


2


3


4


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..

http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/National%20HealthcareRNRetentionReport2014.pdf

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.

http://www.bls.gov/oes/current/oes291141.htm#st

http://www.bls.gov/ooh/healthcare/registered-nurses.htm

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

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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