THE “RONE” OPTION

1. THE “RONE” OPTION The “Grow Your Own” Registered Nursing Program

2. Why Was RONE Developed? • The demand for registered nurses continues in rural/remote areas in Washington. • There were no nursing education programs meeting the need. • LCC has demonstrated it can deliver nursing education to distant sites and create clinical opportunities at the local level.

3. The Critical Access Hospital Perspective: Administrator, Critical Access Hospital, Rural Washington: • In 2001, a very remotely-located hospital began seeking a solution to the shortages of licensed nurses in the area. Apprenticeship and other models were explored and deemed not appropriate. In 2006 they asked for assistance from “any college or university” in Washington to develop a solution to the shortage of nurses in rural areas. Local residents were not able to leave their communities to attend nursing school. • The demand for registered nurses continues in rural/remote areas in Washington. • LCC responded to the request because it has demonstrated it can delivery nursing education to distant sites and create clinical opportunities at the local level.

4. Benefits for Rural Communities • This program helps create a positive and rewarding experience for loyal staff. • This is a very high quality program offered at low cost to reward CNAs who are already committed to the community. • Clinical nurse managers who love to teach and love their jobs are able to do both.

5. Benefits for Rural Communities • The CNA will complete the required pre-requisites and apply to the program. • The community college will screen the applicant and determine eligibility. • The hospital will determine the number of students they want to be enrolled at a time (most likely 2 or 3).

6. Benefits for Rural Communities • The college will be the guide and will direct the instructors when they are working as the clinical instructor. • The college will employ the clinical instructor for their teaching hours; will give appropriate in-service and on-going monitoring and comprehensive evaluation.

7. Who are the RONE partners? • Critical Access Hospitals • Workforce Development Council • Area Health Education Centers • Higher Education Coordinating Board • Community College • State Board for Community and Technical Colleges • Association of Community and Migrant Health Centers • Association of Public Hospital Districts

8. RONE partners (continued) • Washington Center for Nursing • State Hospital Association • State Department of Health • State Labor Council

9. What is RONE? • RONE is a program: • of collaboration between rural communities and Lower Columbia College’s Nursing Program • that allows students to stay in their community while they learn • built to support small numbers of current workers in a given community • that utilizes online delivery of didactic instruction and local clinical instruction • that has the identical student learning outcomes as the Lower Columbia College campus-based courses • that utilizes mobile high fidelity patient simulation for student and community use

10. RONE in a Nutshell • Lower Columbia Community College will provide online nursing courses. • Local communities commit to supporting students and financial support for local RNs who meet LCC clinical faculty qualifications (BSN or MS educated RNs) to become clinical faculty. • LCC will provide clinical coordination and site visits to rural partners. • Both didactic and clinical faculty will be responsible for remediation activities.

11. Basic Pathway

12. Myths and Facts of Online Courses MYTH: Online courses are condensed versions of traditional courses. FACT: Online courses cover the exact same content that traditional course covers. MYTH: Online courses are easier than traditional classroom courses. FACT: Online courses are at the very least as rigorous as face-to-face courses. Students spend more time reading and writing than listening or speaking. MYTH: Since online classes are so flexible, it is okay if I have to miss an entire week or two. I can always make it up. FACT: It is true that online courses are flexible; however, deadlines are deadlines. Falling behind may mean a “zero” on the assignment or the inability to make it up.

13. MYTH: My online course will teach me everything I need to know about using the computer for the course. FACT: Students must have prior skills in word-processing, e-mail, Internet use and some researching skills of the internet, and minimal typing skills because of the nature of online courses. These skills should be in place before the course begins. MYTH: In an online course, there is no real “teacher” or the teacher doesn’t really interact with students. FACT: All online courses have instructors who interact with students. Instructors can tell when and how long a student is “logged on”. This is like taking class attendance. E-Learning students take an active role in their courses and have expressed they feel more connected to their instructors than in traditional classrooms.

14. Program Admission Criteria • HS Diploma or GED • Current NA-C or Equivalent Patient Care Skills • Required College Courses (Cumulative 2.8 GPA)

15. Program Admission Criteria (Cont’d) • Required College Courses • Intermediate Algebra • Introduction to Psychology • Developmental Psychology • English Composition • Anatomy and Physiology with lab (full sequence) • Microbiology with lab

16. Program Admission Criteria (Cont’d) Required College Courses – cont’d • General Chemistry with lab • Introduction to Sociology • Minimum scores on TEAS (Test of Essential Academic Skills) and Critical Thinking Tests

17. Where Are Prerequisite Courses Taken? Courses can be taken through: Local Community or Technical College Through Washington Online (WAOL) www.waol.org Through Lower Columbia College’s Online Courses www.lcc.ctc.edu Accredited schools

18. StudentSelection Process Because students are Incumbent Workers and will utilize the hospital for clinical experiences, they are endorsed by the sponsoring hospital. The selection process includes an interview by Community College Nursing Program Director and an assessment of their ability to be effective students in an online environment.

19. First Year of RONE LPN Nursing Level • Distance delivery of theory courses taught by LCC faculty utilizing an online format • Clinical instruction given at a local facility(Conducted by qualified staff RN employees of the facility who are trained and employed by LCC as adjunct clinical faculty) • Patient Simulation scenarios and technical skills • Student remediation for theory as well as clinical

20. Site Selection Process • Sites/Communities are selected using the following criteria: • Sites must have at least 2 viable students; • Sites must have the required clinical experience opportunities (or be in close proximity to that experience); • Community must be committed to support program.

21. Agency/Community Obligations Recommend and make available qualified clinical instructors Cover the cost of clinical instruction Provide time for RONE students to complete course work Cost of prorated portion of simulation costs (shipping, warranty) Room for simulation equipment

22. Agency/Community Obligations (cont’d) Cost of training simulation instructors Provide student mentor/case manager Provide high speed internet access if required Provide remediation instruction for RONE students Room for students to practice competencies

23. AHEC Responsibilities • Initial Screening Process • Talk with employer and student about realities of the program and the commitments involved • Facilitation of Steering Committee • Identify & encourage sponsoring facilities • Identify & develop additional clinical training sites

24. Nursing Education PerspectiveHelen Kuebel, MSN, RN, Director of Nursing Programs Lower Columbia College Community Asset Mapping As described by Kretzmann and McKnight, there are three levels of assets to be considered: 1. “Gifts, skills and capacities" of the individuals living in the community 2. “Citizen associations" through which local people come together to pursue common goals 3. Institutions present in community, such as local government, hospitals and health service agencies, schools and colleges, business and industry, and human service agencies

25. Community Asset Map (source:  Kretzmann and McKnight) Figure 1.

26. Where is RONE now? • Enroll first cohort; started in January 2009. • There were 12 students in four rural sites. One student left the program in the first quarter. • All 11 students completed course work and clinical education for their first year. Several are now in process of taking their LPN exams. • First cohort began second year of classes January 2010. • Three current LPN students joined the cohort group to complete educational requirements to become RNs • Second cohort started in January 2010. • Two additional sites entered the program. The total cohort number for this group is 12.

27. RONE Cohorts 2009 2010 Republic Friday Harbor Pt. Townsend Chewelah +Seattle +Spokane Morton Lower Columbia Community College Goldendale

28. Allan Ferguson, RN, BSN, Clinical Instructor with RONE students in Republic, Washington

29. SimulationHigh fidelity human simulators: adult, pediatric and infant sent to rural communities; funded through the Hospital Employees Education and Training Grant

30. How is RONE financed? • Tuition and fees paid by student. Scholarships available through State Loan Repayment & Scholarship Program. Contracts for support vary by employer. • Financial support is needed from rural partners for clinical faculty salary and training. • Community college supports RONE online classes and technology / clinical skill supplies. • Start up has been funded by multiple grants.

31. Sources of Start-up Funding $20,000 to CAH from FLEX dollars for exploration $25,000 to Networks of CAHs from DOH, ORH dollars for development of business plan and steering committee $20,000 from Hospital Association from FLEX for curriculum development $25,000 from WCN/J&J Promise for Nursing for curriculum development $105,000 from HECB E-Learning for curriculum development $45,000 from AWPHD $60,000 from AWPHD – legal assistance $300,000 from Governor WIA Discretionary for simulators $135,480 from Regence Foundation for staffing, clinical faculty, faculty training, travel of simulators TOTAL: $735,480

32. Possible Financial Help for Students • Scholarships are available through Health Professionals Scholarship Program • $5,000/year for 2 years = $10,000 with agreement to serve 3 years in a rural area. • Workforce Investment Act funds (WIA) • Agency Reimbursement or Service Obligation

33. Costs to Community College • Pre-nursing student advising in rural areas • Maintaining online nursing courses, student services and faculty to teach the courses while meeting regulatory standards for the college and the nursing program • Providing professional partners ( LCC nurse educators) to mentor new clinical faculty • Maintaining and upgrading local e-learning infrastructure as part of the local and State Board for Community/Technical College system

34. Costs to Community College • Salary for faculty who teach online courses • Nursing Distance Education Coordinator • oversees quality and integrity of all nursing online RONE courses; • coordinates RONE clinical activities with rural clinical faculty; • travels to rural areas to ensure that clinical outcomes are met; and • will provide project evaluation. • Online technology maintenance and upgrades • Supply kits sent to each student to practice skills

35. Costs to Rural Partners(each site having 2-10 students) (2009-2010) Based on 2 years to complete the Associate Degree (RN level) Salary for each clinical faculty (tuition & stipends) Year One 1st quarter January-March $4,078 2nd quarter April-June $4,078 3rd quarter June-August $4,078 4th quarter September-December $4,078 Year Two 5th quarter January-March $1,419 6th quarter April-June $4,078 7th quarter June-August $4,078 8th quarter September–December $4,078 Total Clinical Faculty Cost $29,965

36. Costs to Rural Partners (continued) • Clinical Faculty Training/Travel $ 2,000 • METI Conference and Training $ 1,800 • Cost of transporting METI Equipment $ 200(per move) • Prorated share of extended METI warranty ($13,920/yr) estimate for five site participation $ 2,784 Estimated Total (based on 2009-10 figures) =$36,749

37. Cost Savings to the Facilities Investing in your employees reduces recruitment costs and per diem “travel” nurse costs to bring in licensed nurses to fill positions. Program may meet eligibility requirements as deductible expense of nursing education and training for the Critical Access Hospital. Agencies Invest in their local Community Resources

38. For more information, contact Western Washington AHEC Laurie Wylie, MA, RN, NP CEO/Executive Director 2033 Sixth Avenue, Ste. 310 Seattle, WA 98121 laurie@wwahec.org 206-441-7137 AHEC of Eastern Washington Bettie Rundlett Project Associate PO Box 1495 Spokane, WA 99210 rundlett@wsu.edu 509-358-7646