Preparing Nursing Leaders: Curriculum Outcomes of a Clinical Redesign

1. Preparing Nursing Leaders:Curriculum Outcomes of a Clinical Redesign Pamela R. Jeffries, PhD, RN, FAAN, ANEF Johns Hopkins University School of Nursing

2. Objectives of the Session:The participant will be able to: • Discuss distinct characteristics of developing and implementing a dedicated education unit • Describe an approach to work in partnerships/collaborative to develop and implement a clinical redesign • Explore the evaluation data and results from a DEU partnership over a 3 year timespan

3. Clinical-Academic Partners Johns Hopkins University School of Nursing • Anne E. Belcher, PhD, RN, AOCN, CNE, FAAN, ANEF • Pamela Jeffries, DNS, RN, FAAN, ANEF • Jo Walrath, PhD, RN Johns Hopkins Hospital • Linda Costa, PhD, RN Howard County General Hospital • Debbie Fleischmann, MPA, BSN, RN, NEA-BC Johns Hopkins Bayview Medical Center • Mary Ann Greene, DNP, RN, NEA-BC Frederick Memorial Hospital • Cheryl Cioffi, DNP, CRNP, OCN, NEA-BC Franklin Square Hospital • Vicki L. Krohn, MSN, RN, NE-BC

4. The Challenge • How do we prepare more nurses for “real world” clinical practice? • How do we address the need to increase capacity of students? • How an we be cost effective in our nursing education programs?

5. The Dedicated Education Unit • Maximizes expertise of staff nurses by actively engaging them in education or nursing students while delivering patient care • Successful DEUs are built on partnerships and require that each partner (preceptor and faculty) be prepared to function in new roles within the unit.

6. The JHUSON CAPP Model Our Goal Nursing faculty and staff nurses shift from parallel roles to working in integrated teams Based on the theory of “belonging”

7. Overall Planning for the CAPP: The Development Phase • Clinical Academic Practice Partnership (CAPP) with 3 hospitals • Executive CAPP Committee: specific tasks, deliverables, and outcomes • Representation from each entity • Biweekly meetings • Culture of collaboration

8. Nuts and Bolts of Implementation • Getting all players “on board” • Meeting with key players, including all nursing and support staff • Listening to the concerns of the clinical agencies and building sense of collaboration: • will this add to the workload of our nurses? • how can they be expected to take two students? • who will pay for the preceptors’ time?

9. More Nuts and Bolts • How many students on a unit? • Dealing with realities – other schools sharing the sites • Matching the unit characteristics with the educational objectives of the baccalaureate program • Letting go of “sacred cows” • Clinical conference the “old way” won’t work

10. Orientation of Preceptors • Workshops focus on processes of teaching • All attendees given CEUs • SON clinical faculty attend workshops to meet with and dialogue with new preceptors to forge the partnership • Specific guidelines for evaluating students • Who does what? • Ongoing evaluation and revision of workshop

11. The Evaluation Data of the CAPP • Evaluation of stakeholder perceptions of the CAPP experience • 5 key stakeholders • Academic faculty • Students • Hospital-based preceptors • Staff Nurses • Nursing Leadership

12. Purpose of the study • To determine how the DEU environment would provide opportunities for students to achieve specific learning outcomes • Integrating theory and clinical practice • Improving clinical reasoning • Technical competency • Professional identity • Thinking and acting like a nurse

13. Setting • 8 CAPP units • Academic medical center, two teaching hospitals, one community hospital • One to one CAPP preceptor to student ratio • Student assigned to preceptor’s patient assignment • One academic faculty assigned to each CAPP unit

14. Data Collection • Year 1 – five evaluation surveys • CAPP RN Staff • CAPP and non-CAPP faculty • CAPP and non-CAPP students • CAPP leadership evaluation • CAPP preceptor • Year 2 – preceptor evaluation survey only

15. CAPP Preceptor Evaluation • Two evaluation times set-up for the preceptors (year 1 and year 2) • 28% response rate returned- even with a low response rate – we could identify trends • N -= 9; 13 preceptors accessed the survey • Preceptors – all were BSN prepared; 4 partners represented • Majority of preceptors had 2-5 years experience

16. Perception of Preceptors’ Support

17. Preceptor Perception of the Benefits and Rewards

18. Preceptors Commitment to the Preceptor Role

19. Staff Evaluation of the CAPP and a Control

20. CAPP Faculty Evaluation of the CAPP

21. CAPP Faculty Evaluation continued

22. Students Evaluation of CAPP and a Control

23. Student Evaluations Continued

24. CAPP Leadership on the Unit

25. Student Outcomes • Integration of Theory and Practice • The clinical experience helped me to provide safe and appropriate care to my patients (5.79) • This clinical experience has taught me skills which help me set priorities in providing care to my patient (5.51) • Engaging in Direct Patient Care • This clinical experience helped me assess the needs of my assigned patients (5.62) • This clinical experience has helped me to solve clinical problems on this unit (5.04) (6-point Likert scale)

26. Mean Score of Overall Satisfaction with CAPP

27. Recommendations/Next Steps • Longitudinal study • Cost benefit analysis • Study preceptor workload • Clarify role of academic faculty • Exploring a new members for our executive board • Recruiting more CAPP partners

28. Funded by “Who Will Care?” • Investing in a Comprehensive Solution to the Nursing Shortage • Maryland Hospital Association

29. Questions?? Pamela R. Jeffries, PhD, RN, FAAN, ANEF Johns Hopkins University School of Nursing 525 N. Wolfe St. Room 133 Baltimore, MD 21205 Email: pjeffri2@jhu.edu