Clinical Scholars: Onboarding the Future Wave of Nurses · 2018-11-07 · Average # of Patients...

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

2© 2018 Centura Health

Current State of Nursing in Colorado

© 2018 Centura Health 3

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


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


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


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


Purpose


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


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

April, 27 2018 © 2018 Centura Health 10

0.23

0.35

0.32

0.9 FTE

Clinical RN during peak season Orienting, mentoring newly licensed nurses

Clinical faculty with students

© 2018 Centura Health

Beneficial for all Parties

11April, 27 2018

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


Benefits of New Clinical Scholar Preceptor Model


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



Clinical Scholar Financial Model

16April, 27 2018

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


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


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


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



Implications

22April, 27 2018

Clinical Scholars

Well-rounded clinical

experience for nursing students

Recruit, support, retain top

talent

Comprehensive orientation

experience for NLRN

Promotes safe, high

quality care


References

23

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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Clinical Scholars: Onboarding the Future Wave of Nurses · 2018-11-07 · Average # of Patients...

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