By Debra Wood, RN, contributor
July 11, 2013 - With the health care system evolving, new delivery models coming to the fore and a transition to a more collaborative team-based focus, nursing remains a career full of opportunities, albeit in different settings and with varying responsibilities. And nursing schools are busy preparing students for the changes to come.
“We are trying in every way possible to respond to what is current and what is on the horizon,” said Jane M. Kirschling, PhD, RN, FAAN, dean and professor at the University of Maryland School of Nursing in Baltimore and president of the American Association of Colleges of Nursing (AACN), which has produced the Essentials documents, outlining the necessary curriculum content and expected competencies of new graduates.
Melinda Mitchell Jones, MSN, JD, RN, indicates additional curriculum content helps prepare nurses for future responsibilities.
Texas Tech University Health Sciences Center School of Nursing, in Lubbock, has incorporated curriculum content to prepare student nurses for the future, including courses about quality improvement, risk management, legal and ethical issues, diverse patients and perspectives, informatics, and population health, which covers caring for homeless and other groups in the community, reported Melinda Mitchell Jones, MSN, JD, RN, associate professor and chair of the school’s department of non-traditional undergraduate studies.
Robert L. Anders, Dr PH, CS, CNAA, FAAN, ANEF, said classroom activities incorporate all modes of learning theory and must link to real patient care situations.
“Becoming a nurse today is a major change from what was required even 10 years ago,” said Robert L. Anders, Dr PH, CS, CNAA, FAAN, ANEF, vice president of nursing at Fortis Colleges and Institutes, based in Baltimore. “The explosion of health care knowledge means educating nurses today requires a focus on ensuring competency to provide safe, cost-effective treatment within the context of caring.”
Fortis students learn to think critically, prioritize patient needs and communicate on a personal level with patients and families in community-based clinics and other facilities in addition to acute-care hospitals.
The University of Texas Arlington transitioned its public health program to a community health focus--home health, hospice, court visitation, missionary nursing, parish nursing, free charity clinics and other outpatient experiences. It teaches students about resources.
Susan Cherry, BSN, MSN, has developed numerous community clinical rotations to prepare students for a future where more people are cared for at home.
“The future of nursing will be out in the community,” said Susan Cherry, BSN, MSN, the lead instructor in the community health nursing course in the BSN program at UT Arlington. The goal is “to try to keep people in their homes longer.”
Advanced practice nurses
With the looming shortage of physicians, the expected influx of aging and newly insured patients, and the field becoming more dependent on technology, the need for advanced practice nurses has grown.
Texas Tech also is preparing BSN students with research and writing skills to continue with their education.
Elda Ramirez, PhD, RN, FNP-BC, FAANP, associate professor of clinical nursing at the University of Texas School of Nursing in Houston, discussed the need for more advanced practice nurses.
“Programs are increasing the number of nurse practitioner (NP) and doctor of nursing practice students,” Ramirez said. “Funding is becoming available for preceptors to have a financial incentive to support clinical training of NP students.”
Vanderbilt University School of Nursing in Nashville, Tenn., offers various routes to become an advanced practice registered nurse, and these students are exposed to a variety of mentors and professors.
Mavis N. Schorn, PhD, CNM, FACNM, said students are very focused at obtaining the knowledge and training necessary to be a safe nurse practitioner or nurse midwife.
“Students have course work in health policy, which helps them understand the health care landscape and how it is changing,” said Mavis N. Schorn, PhD, CNM, FACNM, senior associate dean for academics and an associate professor at the Vanderbilt University School of Nursing. “They explore challenges and opportunities at the state and federal level to work in the advanced nursing practice role.”
Recognizing the need for nurses with information technology skills, Kaplan University offers a nursing informatics graduate certificate, designed to help professional nurses prepare for a variety of roles in health care, corporate and education settings.
Teams and technology
Technology also is being used to educate students. Simulation offers consistent experiences--of births, myocardial infarctions and uncommon emergency situations--in a safe environment, where no patient can be harmed. Florida International University (FIU) in Miami is participating in a National Council of State Boards of Nursing (NCSBN) study to determine the optimal level of simulation training for nursing programs.
“We will see how they have done with their school curriculum and how they do when they transition to the work environment,” said Helen Cornely, EdD, PT, associate dean of administration at the FIU College of Nursing and Health Sciences. “This will be an important study for college education.”
At Texas Tech and FIU, students train on simulators with students from other disciplines.
“Our institution has a huge focus on inter-professional teamwork,” Jones said.
FIU received a Health Resources Services Administration (HRSA) grant to use simulation to assist in teaching communication across disciplines with a culturally competent based approach. Learning teamwork has become critical in health care delivery.
Multiple organizations, including AACN, developed the report Core Competencies for Interprofessional Collaborative Practice in 2011. Kirschling called it a critical document, clarifying how to prepare the right workforce for the future.
“Team-based care is where we are headed in this country to be able to optimize the care of people in complex situations, where no one discipline can meet the care needs,” Kirschling said.
Ensuring a successful transition
Simulation training also holds the possibility of helping students with the transition to practice, traditionally a difficult time for new graduates. Cornely reported that employers often comment on how well prepared FIU graduates are, something she attributed to the extensive simulation training they receive.
“It makes them critically think and self-reflect about their actions, which is one of the most important things they have to learn on their regular jobs,” Cornely said.
The Institute of Medicine’s Future of Nursing: Leading Change, Advancing Health report recommended implementation of more residency programs to support the transition to practice. University HealthSystem Consortium and AACN’s Nurse Residency Program have reported significant reductions in turnover rates among first-year nurses. The National Council of State Boards of Nursing is conducting a “Transition to Practice” study to investigate the effect formal programs have on patient safety and quality outcomes.
“It’s a critical time to secure their success long-term in the profession,” Jones said. “Residency programs help us accomplish a nurturing period.”
Jane M. Kirschling, PhD, RN, FAAN, called this an exciting time for nurses and nursing schools preparing them for the future.
Kirschling reports greater interest in establishing residency programs among private employers as evidence continually points to better retention when new graduates enter the profession through a formal program.
“Residency programs support nurses in that transition to practice,” Kirschling said. “It increases the chance of graduates to be successful.”
Texas Tech leadership was so committed to residency programs that when they found alumni had an easier time landing a residency position in the winter, they changed the school’s admission for the accelerated program to the spring to give graduates--who would then would finish in December--a better chance of securing a residency.
University of Texas Arlington students who expect they will not be able to enter a residency program often complete an externship between semesters to gain experience.
Charting a successful career path
Some students go to nursing school with a pre-determined idea of their planned specialty, but that often changes as they experience different specialty areas, said Kirschling, who described it as an interactive process.
“The faculty work hard to engage the students in the learning they are exposed to that semester,” she added. “It is a process, further complicated when the market is tight.”
Elda Ramirez, PhD, RN, FNP-BC, FAANP, cited opportunities for nurse practitioners and DNPs.
Ramirez reported that all nursing programs have counselors and professional courses that support students getting jobs, but some employers seem hesitant to spend money on training newcomers.
“Sadly, most students have to get what they can as new grads,” Ramirez said.
That’s not always the case, however. Cherry has seen more interest in hiring new graduates from the University of Texas Arlington School of Nursing from community agencies, including companies that offer internships. Yet many students want to work in the emergency department or intensive care.
Universally, educators seem ready to prepare the next generation for the challenges of an evolving health care system.
“We remain deeply committed to meeting the needs of student learners,” Kirschling concluded. “It’s an exciting time.”
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