Laurie M. Lauzon Clabo, PhD, RN Dean, College of Nursing ... · meet the high quality standards...
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Laurie M. Lauzon Clabo, PhD, RN Dean, College of Nursing Wayne State University
Transcript of Laurie M. Lauzon Clabo, PhD, RN Dean, College of Nursing ... · meet the high quality standards...
Laurie M. Lauzon Clabo, PhD, RN Dean, College of Nursing Wayne State University
Plan for Today � Describe the work of the AACN APRN
Clinical Training Task Force
� Overview the recommendations of the APRN CTTF
� Highlight relevant exemplars
� Describe potential opportunities moving forward
APRN Clinical Training Task Force
Laurie M. Lauzon Clabo MGH Institute of Health
Professions Chair
Roy Addington University of New Mexico
Barbara J. Berner University of Alaska
Patricia Clinton University of Iowa
Chris Esperat Texas Tech University
Susan Stone Frontier Nursing University
Sharon J. Hawks Duke University
Robin Lawson University of South Alabama
Patti R. Zuzelo Drexel University
Task Force Charge “The AACN Board of Directors charges the task force with the development of a white paper that re-envisions clinical training for advanced practice registered nurses (APRNs). “
To meet the charge the task force should: 1. Describe the current state of APRN
clinical training, challenges, and regulatory requirements.
To meet the charge the task force should: 2. Describe the nature of the collaborative
relationship that should be established with clinical training sites to facilitate the development of quality opportunities for students, including clinical training expectations for the school of nursing, patient care site, and preceptor.
To meet the charge the task force should:
3. Consider competency assessment as an emerging and potential element of a re-envisioned approach to APRN clinical training.
To meet the charge the task force should: 4. Develop a set of recommendations for
restructured or re-envisioned clinical training, including alternative models for APRN clinical training that: o maximize clinical resources; o consider current and potential financial
implications; o provide opportunities to prepare APRNs with the
full graduate, role and population-focused competencies; and
o highlight opportunities and innovations for interprofessional learning and practice.
Activities � Appointed in April 2013 � Began work in May 2013 � Meetings primarily by teleconference with
one face-to-face meeting in Washington, DC in January, 2014
� Hosted an invited stakeholders’ meeting in Washington October, 2014
� Presented final paper and recommendations to the AACN Board in January, 2015
Current State of APRN Clinical Training � Increased demand for APRN services � Many programs report being at capacity,
with clinical training (along with faculty shortages) cited as a major constriction in the pipeline
� > 13,000 qualified applications not accepted for graduate programs annually (AACN, 2015)
Current State of APRN Clinical Training � competition and scarce resources
for clinical training sites and preceptors
� mounting regulatory issues for in-state and distance-learning students
� inadequate or unstandardized preceptor training
Current State of APRN Clinical Training � compensation for preceptors
� variable student competence when entering clinical training
� productivity impact on preceptors
I. Simulation should be used to enhance APRN clinical education and the use of simulation to replace more traditional clinical experiences should be explored. � Demonstration projects � Funding for development of simulations;
national center of faculty innovation, preparation and certification
� National repository for valid/reliable simulations
� Develop and test simulations for APRN core competencies
II. AACN-AONE principles for academic-practce partnerships should be adopted by all APRN programs. � Co-development of clinical experiences � Incentives for practice sites and
preceptors � Develop and test models of academic-
practice regional consortia � Repository for preceptor orientation
manuals
III. APRN clinical education should be competency-based.
� Common taxonomy: competence, competencies and competency framework
� Identify common, measurable APRN competencies that cross the four roles
� Identify progression or milestones across each of the common competencies
� Develop standardized assessment tool for common competencies
IV. Support the development of alternative or innovative APRN clinical education models.
� Encourage regulatory body support for testing new models
� Support IPE experiences, use of technology, front-loading didactic
� Funding to develop and evaluate innovative clinical education models
Collaboration Between Academic Programs and Clinical Sites
� University of Pennsylvania Graduate Nurse Education (GNE) initiative
� Building Academic-Practice Partnerships: The Rush University GNE Model which featured Kathleen Delaney, Professor at Rush University College of Nursing
� The Clinical Excellence Initiative: A partnership between the University of Michigan School of Nursing and The University of Michigan Health System.
� AACN Academic-Practice Partnership Collaborative Community discussions.
Collaboration Between Academic Programs and Clinical Sites
� Academic Practice co-design of the clinical experience
� Collaborate and synchronize rather than compete
The Nurse Practitioner Role
Shirlee M. Drayton-Brooks PhD, FNP-BC, FAANP Professor of Nursing, Widener University
NCSBN APRN Roundtable in Rosemont, Illinois April 15, 2015
} Widener University School of Nursing is a PENN Medicine CMS GNE Demonstration Project Partner ◦ Linda Aikens PhD, RN, FAAN, PI ◦ Barbara Todd DNP, RN, CRNP, FAANP, Overall PENN Medicine
Partnership GNE Project Director ◦ Shirlee Drayton-Brooks PhD, FNP-BC, FAANP, GNE Project
Director for Widener University } NONPF Past President, NONPF Representative to LACE
Communication Network and the National Task Force on Quality Nurse Practitioner Education
Limited evidence on best practices:
models, simulations, hours, competency-
based education
Students readiness for direct training in complex healthcare
environment
Limited financial resources and school
infrastructure Limited clinical
capacity building processes
Intraprofessional and interprofessional
competition for clinical experiences
Limited faculty resources to
meet the high quality standards
Limited preceptor
incentives and availability to meet clinical
education demand
Preceptor resistance, health care complexities and, productivity
when training
Stagnant clinical models in changing
environments
NONPF (2014). Communications with membership. IOM Report (2011). The future of nursing: Leading change, advancing health. Retrieved at http://www.thefutureofnursing.org/IOM-Report NTF (2012). Criteria for Evaluation of Nurse Practitioner Programs (4th Ed.) A Report on the National Task Force on Nursing Practitioner Education. Retrieved at http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/docs/ntfevalcriteria2012final.pdf
} Consortium Model ◦ Example PENN Medicine Partnership GNE
Demonstration Model } Health Care Institution Single School of
Nursing GNE Demonstration Model ◦ Example Other GNE Models
} Revisit Traditional Models ◦ Ratios 1:1; 1:2 ◦ Clinical hour requirements ◦ Simulation
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Penn Medicine GNE School of Nursing Partners w Greater Philadelphia GNE Consortium
• University of Pennsylvania • Drexel University • Thomas Jefferson University • Villanova University • Temple University • Widener University • LaSalle University • Neumann University • Gwynedd-Mercy College
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APRN Programs SON NP CNS CRNA CNM University of Pennsylvania
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Thomas Jefferson
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Drexel ♥
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Villanova ♥
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LaSalle ♥ ♥
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Widener ♥
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Temple ♥
Gwynedd-Mercy ♥
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Neumann ♥
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GNE Outcomes Demonstration Year 1 and 2 (NPs) w Increase in graduates from baseline (108%) w Increase in enrollment from baseline w Increase in clinical training from baseline
Partnering and
Stakeholder engagement
Assess capacity assets,
possibilities and determine
future need
Design strategies
Implement strategies
Evaluate outcomes,
monitor and enhance
processes
Clinical Capacity
Development
} Increased the enrollment in APRN clinical practice over baseline years (250%)
} Increased the graduates above the baseline years (96%)
} Increased sites and preceptors through a focus on clinical capacity development and untapped capacity
} Increased communications between partners and with stakeholders
} Increased resources and agency incentives ◦ Payment to agencies for lost effort related to
training ◦ Improved infrastructure and clinical processes � At Widener: Assistant Director of Advanced Clinical
Practice, secretarial support above existing resources, expanded clinical instructors and site visitors
� Sophisticated clinical tracking mechanisms � Comprehensive auditing and evaluation processes
Structures Processes Outcomes
Adherence to NTF Criteria; Clearly defined SON
criteria; Research on untapped capacity; and Evalua<on
PARTNERS Stakeholders Engagement: Agencies, Preceptors Advisory Panel, Faculty, and Students
FACULTY AND ADMINISTRATIVE SUPPORT Administra<ve, Program Directors, Faculty oversight; Course coordinators, Clinical Instructors based on NTF Criteria and workload computa<on guidelines; Assistant Director of Advanced Clinical Placement
EXPANDED STAFF SUPPORT Secretarial and Administra<ve Assistant
Defined direct clinical experiences; Clear agency criteria, contracts, and affilia<on agreements; Preceptor criteria and orienta<on to expecta<ons
Electronic Tracking Retrievable DocumentaJon System of clinical hours, experience type, evaluaJons, student , preceptor and faculty noJficaJons linked to Jmeline
SITE PROCUREMENT, Establishing contractual arrangements and veKng sites
STUDENT READINESS assessment, orienta<on, cer<fied background check
SITE EVALUATION VISITS AND FREQUENT PRECEPTOR COMMUNICATIONS
EVALUATION SITE/AGENCY, PRECEPTOR/ STUDENT of agency and Faculty/Preceptor competency based evalua<ons of student midterm and final, Preceptor Evalua<on of program
Short-‐Term
Indices of Program Quality and Successful
Achievement of Students on
assessment and measurement on:
• PorMolio • Preceptor
evalua<ons of students achievement of competencies
• Preceptor evalua<on of program
• Student Evalua<on of Preceptors and Clinical educa<on;
• Student interviews • Exit Interviews/
Focus Groups • Alumni Survey • Progression rates • Gradua<on Rates • Cer<fica<on Rates • Employment rates
Long-‐Term • Competent
PracJJoner • EducaJon,
research and pracJce goals are met
• Public healthcare workforce
needs are met
Widener University School of Nursing GNE Clinical Logic Model: A Donabedian Approach
Shirlee M. Drayton-‐Brooks, 2015
} First relationship building ◦ Must know where the capacity can be developed
through an assessment process ◦ Alumnae and student collaboration community
stakeholder linkages and collaboration ◦ Vetting clinical experiences and preceptors � FACE to FACE and through technology such as
FaceTime, Adobe Connect , etc. ◦ Maintaining relationships � Signs of appreciation � Preceptorship reports for certification each semester � Preceptor feedback meetings and evaluation of
program
} The Master Teacher / Master Clinician with student groups in clinical onsite with preceptors.
Master Teacher/ Clinician
Preceptor Students
Preceptor Students
Preceptor Students
• Clerkship Models • Alternative Models: High demand area
institutions and specialties over clinical experience • Intraprofessional • Interprofessional
Student rotate to primary care
Student Rotate to ENT
Student rotate to /
Orthopeadics Student rotate
Urology
Student Rotate to GI
} Perceptored by NPs who provide volunteer services
} Primary care for the uninsured } Chronic disease management for men with
substance abuse } Uninsured in the Chester community } Expanded to women’s health } Linkages for immunizations } Smoking cessation classes } Behavioral health services
} Medical Resident Night Call – fewer residents and more NP’s with the potential for clinical training
} Example : QCARE Nurse Managed FQHC Convenient care in a supermarket
} Expand use of this disruptive innovation for early primary care clinical
} Convenient but beyond the basics } Employment physicals ◦ Adolescent mother’s group home admissions physical ◦ Women’s health contraceptive management ◦ Pediatrics ◦ HIT and meaningful use ◦ Patient with New Chronic Disease Diagnosis linkage to
systems of care ◦ Acute problems
} Alumnae linkage: Preceptor and Clinical Instructor
} Opportunity Industrial Center Clinic in North Carolina
} Student will have 2 week immersion 1:1 } Travel and housing: Bed and breakfast
} Exemplar: Education Plus Charter Schools – School based primary care clinics/ School nurse model at every school with students
} Adult Health Primary Care } Women’s Health
} Building stronger linkages with local stakeholders
} Undergraduate and Graduate clinical capacity building
} Advocate for incentives or preference in funding for those applications that preceptor students
} State level advocacy for a culture of increase training of the future workforce
} Federal advocacy
} Build relationships with agency leaders and preceptors/clinical experts ◦ They must see the faculty and get to know SON well
} Develop the infrastructure to maximize clinical capacity improve clinical orientation for students
} Reduction of burden of long written evaluations
} Improve clinical preparation of students and competency based education ◦ Front load didactic material ◦ Incorporate competency-based assessments ◦ Teaching common primary care issues early ◦ History and Physical second check ◦ Orientations and pre-certifications with virtual
patients simulation and complex case studies as online modules prior to clinical ◦ Electronic documentation skills and meaningful use training upfront
} Regional consortia ◦ Shared curricula including shared clinical education
across schools } Clinical education match approach } Enhance IPE expectations
Preceptor Challenges in Midwifery Educa8on
2015 NCSBN APRN Roundtable April 15, 2015
Presented by Carrie Klima, CNM, PhD, FACNM Developed by Elaine Germano, CNM, DrPH, FACNM
Brief History of Midwifery Educa8on
• First program 1932, Maternity Center AssociaJon in NYC
• Second was FronJer Nursing Service, 1939, KY • Both educated public health nurses in midwifery, one urban, one rural, PNC + birth at home
Growth in number of programs • Slow growth through the 1960s • Midwifery moved to hospitals in late 1950s • Rapid growth in the 1970s, programs concurrent with large hospital-‐based services
• Growth always limited by requirement that students be taught by midwives
Change in type of preceptors • EducaJon programs located in medical centers with large midwifery services
• Midwifery pracJces move into the private sector, student placement in such pracJces
• Distance based educaJon began in 1980s, increased community based clinical educaJon
Factors that influence midwives to serve as preceptors*
• Survey of ACNM membership in 2012: – 83% could accept students – 78% took students from >1 program – 85% precepted other types of students – 65% could take only 1 student/semester
*Germano E, Schorn MN, Phillippi JC, Schuiling K. Factors that influence midwives to serve as preceptors: An ACNM Survey. J Midwifery Women’s Health.2014; 59 (2):167-‐175.
Mo8va8ng factors for preceptors • From a list of 14 opJons, most common was a commitment to the profession, 58.5%
• Least common: – Payment, 16% – Receive CEUs, 16% – SupporJve administraJon, 16%
Barriers to Precep8ng
• From a list of 23 opJons, most common was “Other”, 20%
• Not currently in pracJce, 14% • Need to meet paJent volume, 7% • Can only take students if paid, 0.7%
Contradictory findings • 38% of respondents were paid for precepJng • 16% idenJfied payment as a moJvaJng or enabling factor
• <1% idenJfied lack of payment as barrier • Most common write-‐in comment was importance of payment for precepJng
Midwifery Program Director Survey
• Undertaken by AccreditaJon Commission for Midwifery EducaJon (ACME)Fall 2014
• Greatest challenges to midwifery educaJon: – 88% cited clinical sites for students – 40% cited funding
Directors of Midwifery Educa8on
• Currently 39 midwifery educaJon programs • DOME meets twice per year, conJnual discussion of how to increase # clinical sites, to collaborate rather than compete
• All ideas welcome!
