Council of University Teaching Hospitals STRATEGY PAPER. Collaborative Strategies for Bridging Practice-Ready and Job-Ready

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1 Council of University Teaching Hospitals STRATEGY PAPER for Bridging and Job-Ready September 2001

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3 Council of University Teaching Hospitals STRATEGY PAPER for Bridging and Job-Ready A. Summary of Topic This Strategy Paper focuses on high-level collaborative strategies for health and education to facilitate the transition of health professionals from practice-ready to job-ready. The Paper has been initiated through the Council of University Teaching Hospitals (COUTH) Health Sciences Committee, which has been considering a number of the issues and opportunities relating to the education of health and human services professionals. There are concerns of a growing gap between the practice-readiness and job-readiness of graduates in health sciences. The linkage between the health system, the education system and the many health professions in preparing health professionals to become job-ready is illustrated in Figure 1. The collaborative effort of these stakeholders is imperative given the evolving challenges in the transition of novice (here meaning new graduate, new staff or staff undergoing role transition or foreign trained) to beginning practice. Models such as co-operative education and paid work experiences could provide benefits such as staff relief for health care organizations and clinical practical experience to students or new practitioners to facilitate the transition to the practice environment. Professions a,b,c,d,e,f,g (68), Health Professions Act Figure 1. Preparing Health Professionals for Practice Focus on scope of activity, competencies, satisfaction of members and practice environments Health Professions Education System Health System Ministry of Education, Ministry of Advanced Education, University Act, College and Institute Act, Institute of Technology Act, Universities, University/Colleges, Colleges Prioritize production of critical thinkers with general skills for a specific discipline Desire to hire employees that can be fully functional as soon as possible after hiring Ministries of Health Services & Planning, Ministry of Children & Family Development, Canada Health Act, Hospital Act, Health Authorities Act, Health Authorities, Health Care Organizations and Agencies Public & Private Collaboration in preparing health professionals to become autonomous practitioners The intent of the Strategy Paper is to highlight key concepts from the literature and activities/ best practices across jurisdictions, and to propose actions by health and education partners to ensure that health sciences graduates are able to meet reasonable needs and expectations of the health care system and society at the beginning of their professional practice.

4 B. Overview of the /Job-Ready Gap 4 Practice-ready and job-ready are terms used to describe the transition of health sciences graduates/registrants, new staff or staff undergoing a role transition from when they complete their education program or become licensed to when they are integrated into the practice environment. When students complete an education program, they are practiceready: By the end of an educational program, students are educated to be safe, autonomous practitioners. Entry-level graduates must meet the competency standards set out by regulatory bodies. but not usually job-ready: In addition to being practice-ready, job-readiness implies integration of knowledge to the clinical experience. For example: agency-specific procedures; work culture rules, formal and informal powerbrokers, sacred cows, tradition; job descriptions, roles and responsibilities; union contract, stewards roles and responsibilities; how to set acceptable limits; how to negotiate the system and implement effective strategies to accomplish goals with timeliness and competence. (Healthcare Labour Adjustment Agency, 2001) The practice-ready/job-ready transition is described in Figure 2. Where job-ready sits on this continuum should be established by educator, employer and health professional bodies. The additional requirements, proficiency and ability to practice for health care professionals to be job-ready should be regularly assessed and provided for through orientation and life-long learning opportunities. Figure 2. Transition from to Job-Ready job-ready practice-ready x Baseline Competencies SKILLS ATTITUDE KNOWLEDGE JUDGEMENT Novice G A P Beginning Practice New Graduate Role Transition New Staff Foreign Trained Integration of knowledge, proficient in specific job and organizational requirements TIME EXPERIENCE Higher level practice A gap between practiceready and job-ready has always existed. Many believe that changes and pressures in the health and education systems have caused this gap to grow larger (see Table 1). Universities, university colleges and colleges historically have different ideas on theory and practice. In order to devise effective strategies to increase job-readiness, or to decrease the gap between practice-ready and job-ready, this gap must be analyzed and understood.

5 Table 1. Factors Driving Today s /Job-Ready Gap HEALTH EDUCATION «Fiscal constraints «Regionalization «Shift to community-based care «Beds «Acuity and complexity of care «Expectations that nurses are very skilled generalists upon graduation «Proliferation of specialties and sub-specialties «Shortage of health sciences professionals «Restructuring of health care delivery, e.g., increased expectation for decision making and problem solving at the direct care level «Staffing trends, e.g. casual, part-time, less experienced staff «Flexibility to support students «Closer supervision of students required «Time for beginning practitioners to become comfortable with their skill set «Fiscal constraints «Changes in health care system requires new skills of graduates «Curriculum changes «Shift in nursing education to an educational model in institutions of higher learning from a hospital-based apprenticeship model reflects shift from job to career preparation «Pressure to reduce the length of educational preparation in order to produce health sciences professionals faster «Longer, more numerous preceptorships, earlier in program, with different expectations of preceptor and student «Need for diverse preceptorship settings, e.g. hospital, community «Preceptors skills and knowledge not always compatible with current curriculum «Technology e.g. teleconferencing «Student diversity Source: Adapted from Clinical/Fieldwork Placement Issues and Opportunities, Appendix 8.2, COUTH, April Many health sciences professions express concern about job-readiness. Registered nurses, due to the complexity of role, context of the practice environment and human resources shortage are among the most affected. Nursing specialities of note include critical care, emergency, intensive care, orthopaedics, palliative care, perinatal care, and several subspecialities. The practice-ready/job-ready gap may have less of an impact in areas such as medical or radiology technicians, and licensed practical nurses. Both urban and rural health care agencies are experiencing challenges in regard to jobreadiness. One paradox for health sciences professionals is that they are increasingly required to supervise and monitor students at a time when the human resources shortage is affecting staffing levels. In the rural setting, inaccessibility of infrastructure limits the level of care/service that can be provided by health sciences professionals. Rural-based health professionals are typically isolated and not resourced with the breadth and depth of support when compared to the urban setting. Educational programs most vulnerable to a problematic practice-ready/job-ready gap may be those: with lower flexibility to match funding and program with changing health care system requirements (for example in universities where the senate system curtails flexibility in allocating and targeting funds); with funding shortages (reduced student intakes and number of faculty available for students); and programs with minimal or no clinical component to the academic course (for example, nutrition). more can and must be done to support new graduates in their transition to professional practice. (Gustavsen, 2001)

6 C. and Job-Ready 6 Given the reality of a complex healthcare environment and discordant aims among stakeholders, approaches and solutions for facilitating the transition of novice to beginning practice may differ widely. The model presented in Figure 3 is one structured approach to developing strategies that, through collaboration in four areas, has potential to achieve outcomes that ultimately satisfy all stakeholders. could be organized in multiple ways some examples are: a single profession, such as physiotherapy; multiprofession/same school, such as all health sciences at Kwantlen College; or single profession/multi school, such as nursing programs across BC. Figure 3. Four Strategy Areas to Increase Job-Readiness for Health Science Graduates *START HERE* GOALS The sounder the program in its conceptualization and delivery, the more effective in fulfilling its promise. DESIGN What to include in the curriculum? How to set out the parameters? Who does what? Sample Outcomes Job-Readiness Learning Outcomes Recruitment Retention Cost Satisfaction OUTCOMES TO EVALUATE DELIVERY OPTIONS How best to integrate theory and practice? How does the health system support staff and students? Source: Adapted from Dr. Selma Wassermann, Professor Emerita, Simon Fraser University, unpublished paper. The proposed model identifies four distinct areas with potential for collaboration; goals, design, delivery, and outcomes. Each area is discussed in terms of concepts and followed by strategies or opportunities for collaboration (see Appendix 1 for summary of strategies). An overall strategy might include incentives and structures to encourage and enable collaboration. Presumably, all stakeholders want to set new graduates up to succeed. Failure, which may be expressed by poor performance and turnover, carries with it great fiscal and human cost. STRATEGY AREA #1 Goals Concept In preparing health professionals for practice, evaluation is dependent on learners successful attainment of the goals or competencies. Yet different stakeholders ultimately evaluate new graduates based on their own criteria. This logic applies to entry level, continuing and post-entry level education. Health professions have the responsibility of setting their own practice standards and competencies. In addition to the professional bodies, health and education are key partners in establishing goals for health professional education that lead to positive outcomes for all stakeholders. Overarching inter-system issues such as the extent of the education system s obligation to meet health system needs and to address job-readiness, and the extent of the health system s obligation to increase stability and capacity and implement strategies that allow new graduates to become comfortable with their skill set provide the context in which subsequent decisions are made. Movement towards increasingly aligned goals by health and

7 education stakeholders concerning these challenging system issues may improve the communication, coordination and effectiveness of existing and future education and transition to practice strategies. Acknowledging a growing practice-ready/job-ready gap may be the first step in goal setting, from which the rest of the planning follows. Developed from standards, vision and values, best practices and other internal and external resources, goals must consider the reality of a dynamic, increasingly complex healthcare environment and be explicit, clearly articulated, flexible and continually refined. and Opportunities for Collaboration While acknowledging that stakeholders each have different mandates, health authorities, employers, ministries, unions, educational institutions and professional organizations must define what a student or new graduate should be capable of doing in the workplace: «Acknowledge a growing practice-ready/job-ready gap. «Consider need for provincial/ministerial leadership to develop framework/legislation/ policies that compel different sectors and professions to overcome historical, legislative and policy divides in order to more fully collaborate in strategies to address this gap and related issues. «Identify and implement mechanisms to jointly review health human resource trends in order to better match changes in health care system with school curricula and expected competencies (for example, Health Human Resources Advisory Committee, Canadian Institute for Health Research, conferences, inter-institutional working groups). «Establish cross-stakeholder representation on health authority, post-secondary institution and professional body planning committees with a requirement to use evidence from outcome evaluations in decision-making. «Mandate health authority education policy that includes dedicated resources for continuing education for staff and the coordination of preceptorships, including development of policies and procedures, liaison with educational organizations, research and evaluation. «Balance student needs, educator goals, employer desires and work toward agreement by major stakeholders. «Identify who funds what. «Discuss consistency of program goals among professions and within professions. 7 Through mechanisms as suggested above, explore what is specifically required in terms of job readiness and learning outcomes of the education program. Understand the education, administrative, economic and policy environments that are necessary to support novices as they make the transition to beginning practice. What are priority recruitment, retention, system pressures, and satisfaction issues?

8 8 STRATEGY AREA #2 Design Concept Design strategies focus on concepts and supporting infrastructure that are required to meet established goals. It is impossible to include everything everyone wants in a curriculum consensus on what to include can more easily reached if curriculum flows from collaboratively reached goals. In designing strategies to facilitate the practice-ready/job-ready gap, two components are considered: 1. Education/training curricula for undergraduates, post-graduate specialties, and beginning practitioners. 2. Supportive environment for experienced practitioners (role models, preceptors, mentors). The temptation is great to begin designing curricula and programs to address job-readiness gaps, but it important that goals be collaboratively identified first to ensure that initiatives complement rather than compete with each other. and Opportunities for Collaboration Increasing the collaboration between education and practice settings when designing health sciences curricula may not only encourage more reality-based education for students, but also create linkages and networks as new graduates transition from a student or novice to professional role. «Establish health sciences admission criteria based on candidates suitability and previous relevant experience. «Identify and implement mechanisms to jointly review health human resource trends in order to better match changes in health care system with school curricula and expected competencies. Conceptualize emergence of new and different health care workers, e.g. operating room technicians Perform impact analyses that identify health and education system capacity «Consider standardizing education/training program design among professions and across organizations as much as possible. Ease of coordination, expectations, preceptor training and support, measuring outcome Minimize duplication of orientation and training of staff that work part-time with multiple employers «Consider where clearly defined educational preparation for each discrete scope of practice (specialists versus generalists) is appropriate. For example, the model of the generalist registered nurse being equally competent to work in any of six practice careers (medicine, surgery, paediatrics, obstetrics/gynaecology, psychiatry, community) may not be realistic for today s health care environment.

9 Identify/create programs that could quickly and cheaply shape generalists to enter a variety of job-slots. These programs in particular must be flexible in terms of design, delivery, and number of seats funded. «Prioritize and implement strategies that stabilize the health system. For example, striving to employ a full-time or permanent part-time workforce and utilizing career laddering may impact on job-readiness by allowing new graduates to (a) own one position (b) transition in a more supportive environment and (c) clarify potential career advancement opportunities. «Enhance linkages between the education and health systems and professions: Jointly plan and fund adjunct appointments of staff and continuing education positions in the health system to provide ongoing recent knowledge to health sciences professionals in the field and assist in transitioning new graduates. Circumscribe the scope of practice and role of the preceptor. The Preceptor and Mentor Initiative for Health Sciences in BC, available March 2002 will provide a template. Enhance feedback loops between preceptors, mentors, students, faculty and health care system regarding the relevance of program curriculum and impact on health services. Create regular, supernumerary positions for transitioning purposes. STRATEGY AREA #3 Delivery Concept Delivery strategies focus on how the concepts and supportive infrastructure identified in the design strategy area are implemented. Recent trends in preparing health sciences professionals for practice The Nursing Practice and Education Consortium (N-PEC, a group of ten US nursing organizations) has developed Vision 2020, a comprehensive plan for nursing practice and education. N-PEC s general goals for this project are to 1) delineate scopes of practice with corresponding competencies for each type of nursing care provider, 2) identify strategies for developing licensure/credentialing for each type of nurse provider, and 3) develop practice settings where the new scopes of practice and roles can be enacted with organizational support. Demonstration projects requiring collaboration among educational institutions, practice settings of various types and respective state boards of nursing are in the planning stage. Registered Nurses Association of British Columbia has completed the whole cycle of competency identification with input from both practice and education (RNABC 2000). For nursing, BC is already in a position to move forward in a consortium-approach to planning. make use of more and earlier preceptorships. The Learning Loop theory demonstrates that continual integration of theory and experience/practice has a greater impact on learners thinking and in their subsequent practice than non-integrated programs (Barnes et al. 1994). Other opportunities to facilitate the transition from student or new staff to beginning practice arise during the transition period such as final preceptorships/internship and employer-focused initiatives are defined and discussed below. Undergraduate work experiences and the co-operative education format may better prepare the graduate for the transition period. 9

10 10 and Opportunities for Collaboration PRECEPTORSHIP is a traditional method of bridging classroom theory and professional practice. These work experiences have defined educational requirements and length of time. They may be paid or unpaid. Preceptorships may come prior to graduation (integrated throughout educational program and/or at the end), after graduation but prior to the granting of Advantages Integrated Theory and Practice Education FOR STUDENTS early exposure to profession to allow students to confirm and define their career goals; identification of strengths prior to completion of program; work-academic connection that allow students to dialogue with the educational institute about what is really required in the workplace thus more realistic job expectations; increased academic learning because of theory related to practical experiences; more confidence in decision making; more effective learning strategies; greater knowledge; ability to adjust to organizational life more effectively; and reduced financial burden if work experiences are paid and individual is successful. FOR HEALTH CARE ORGANIZATIONS AND AGENCIES staff relief for health care organizations; continuing education/lifelong learning opportunities for preceptors in organizations (increased knowledge, skill, satisfaction); a more qualified applicant pool from which to recruit and select new employees; fewer resources dedicated to new employee orientation if preceptorships have been completed at organization; more efficient use of resources if individuals are successful in license/registration, when a new graduate or new registrant enters the practice environment or when an otherwise experienced professional undergoes a role transition or switches area of practice. Preceptorships may be known as internship, clerkship, studentship, clinical or student placement, fieldwork, practicum, work experience, although the meaning of these terms varies. A final preceptorship is a defined period of pre or post-graduate integration into the practice setting. Remuneration, if provided, is often at a lower level than regular staff positions. Residencies and fellowships usually occur after a graduate is practice-ready. BC s Nursing their work and practice in their professions; Program (University of increased collaboration integrating theory and practice may allow inclusion of an even wider range of organizations, not just Victoria and nine university teaching hospitals. Currently, many non-traditional or underutilized settings such as home care, specialized care homes, rural Action Plan funding to colleges) received BC Health facilities and public/mental health settings are not able to support determine the feasibility and their own preceptorship program. outcomes of providing paid work experiences as part of increased retention in the profession and academic-practice nursing education in 2001/2. connection that connects faculty with the work setting. The study will evaluate the feasibility of two paid work experience models and the extent to which paid student work experiences are successful in retaining graduates of local nursing programs, preparing students to be job ready on graduation, and achieving specific program outcomes. The preceptorship study model is a paid final preceptorship position, FOR EDUCATIONAL INSTITUTIONS

11 which provides transition from education to practice and comes in the last semester of the educational program. This work experience has defined educational/ practice requirements and lasts weeks. A job description will be developed in collaboration with the employer. (Central Vancouver Island Health Region/Malaspina University College, Thompson Health Region) Other collaborative strategies related to the preceptorship method of integrating theory and practice: «Apply results from BC s Nursing Program s feasibility study as they relate to the transition to job-ready to nursing other health sciences professions. «Increase number of controlled real life or under fire situations during preceptorship. «Consider matching educational institutions with certain health care agencies. Limiting the number of preceptorship sites per student may enable students to maximize skill acquisition rather than continually re-orienting in new environments. «Explore opportunities for preceptorship in non-traditional, under-utilized settings to reflect the practice environments in which many health professionals work upon graduation. «Provide incentives for students to complete preceptorships in rural areas by funding their travel and living expenses. «Support the development of an Integrated Student Placement System for Health Sciences in BC which would provide a structure and resources for collaboration in providing student placements. «Consider standardizing the requirement for a final preceptorship prior to or post licensure (often cited is referred to as a one-year internship). Transition benefits such internships provide: additional time for learning and socialization (particularly for new graduates) prior to taking on full professional role; the opportunity for healthcare agencies to orient graduate nurses, improved retention and socialization of nurses, and the opportunity to attract new graduates to the institution (Gustavsen, 2001). In some circumstances, internship programs have been designed as collaborative efforts between health care organizations/practice settings and universities, in which interns complete assignments, make presentations and complete a skills checklist during the program. 11 Several health professions, for example pharmacy and physiotherapy, already incorporate a final preceptorship period prior to full licensure. Some nutrition programs have a final preceptorship requirement but lack earlier theory/practice exposure and are contemplating integrating the experiences earlier into the program. The dilemma of whether or not nursing internships are necessary includes considerating factors such as job-readiness and cost/benefit analysis. Unionized environments have wage scales and contract guidelines which may limit the opportunity for establishing nursing internships.

12 UNDERGRADUATE PAID STUDENT POSITIONS (sometimes known as externships) consist of work experiences as an employee within a health care agency. These experiences are over and above academic preceptorships and have no defined educational requirements. 12 In addition to paid student positions, students can also develop job-ready skills by taking positions in their professional area that are not specifically designated for students. For example, nursing students can work as licensed practical nurses or patient care assistants; pharmacy students can work as technicians; dietetics students can work as dietary aides. The undergraduate paid student position is the second work experience model BC s Nursing Program is currently evaluating in the Capital Health, Okanagan Similkameen and North Okanagan Health Regions. The structure of the work experience may vary by health agency and/or region. Vancouver Hospital & Health Sciences Centre and other areas are also piloting Undergraduate Nurse Employment Programs or similar. «Apply results from BC s Nursing Program s feasibility study as they relate to the transition to job-ready for nursing and other health sciences professions. «Explore opportunities for undergraduate paid student positions in non-traditional, under-utilized settings to reflect the practice environments in which many health professionals work upon graduation. «Provide incentives for students to pursue undergraduate paid student positions in rural areas by funding their travel and living expenses. [ } offering summer externships to nursing students has been a strategy to attract future nurses, and focus on recruitment and retention while they are still students. Another benefit to employers is that student externs who return to begin their careers as graduate nurses in their facility make an easier transition during orientation. (Gustavsen, 2001) 3. CO- OPERATIVE E DUCATION is a partnership between students, employers and post-secondary institutions. As an educational process, co-operative education formally integrates a student s academic studies with paid, approved, career-related work experience in employer organizations. While there are several possible types of co-op arrangements in BC, common to all is the length of time a student must spend in co-op placements (30%), and that placements do not receive academic credit. Co-op placements differ from typical preceptorship experiences because they are less structured and are based on independent learning objectives. Co-op programs for health sciences professions are not common and none currently exist in BC. Health-related programs in BC are kinesiology (Simon Fraser University, University of Victoria this undergraduate degree is sometimes an academic stepping stone to physiotherapy, occupational therapy and medicine), health information sciences (University of Victoria) and pharmacology (University of British Columbia). The Co-operative Education Fund of BC (under the Ministry of Advanced Education) cannot provide cost comparisons such as the cost per student for different co-op programs it supports. Although some funding subsidizes student wages, the majority of funding is directed toward program administration. Trends in non-health co-operative education programs indicate a decline in work placements in the public sector. Proposals for co-op

13 programs for the nursing profession in Canada have traditionally been rejected due to concerns about prohibitive costs. «Consider piloting co-op programs for nursing and health sciences most affected by a problematic practice-ready/job-ready gap. «Consider co-op programs for specialty areas in nursing and health sciences most affected by a problematic practice-ready/job-ready gap (see page 3), particularly if other strategies are not effective in preparing new graduates for the practice environment. 4. EMPLOYER-FOCUSED INITIATIVES refer to activities provided by health organizations/ agencies for the purpose of integrating theory and practice for health professionals employed in their organization. Although all new employees must be practice-ready to be hired, employers observe the need for growing resources (time, energy, funding) dedicated to orientation, in-house training, preceptoring and mentoring functions as graduates and practice environments become progressively less matched. «Consider increased use of e-based and other creative modes for orientation and mentoring. «Implement guidelines, supports and programs contained in the Preceptor and Mentor Initiative for Health Sciences in BC (available March 2002), or similar. «Structure a longer transition time for new graduates to refine knowledge and skills in order to establish a career foundation. For example, The New Graduate Transition Program as proposed by Gustavsen. «Develop transition pathways that describe the course of events and delineate specific activities that occur during the transition period. Vancouver Hospital & Health Sciences Centre Advanced Medical/Surgical Program There is a large practice contingent, led by and initiated by Vancouver Hospital & Health Sciences Centre (in conjunction with practice partners and other hospitals in BC) to develop a provincial advanced medical/surgical nursing specialty program with British Columbia Institute of Technology. This on-line-based program, piloting September 2001, will provide additional theoretical and clinical experiences to prepare nurses to work in acute care and continuing care facilities. The purpose of this program is to replace the extensive in-house orientation/training employees required for the practice environment. «Create means for undergraduates to gain jobready skills and support the transitional needs of new graduates by designing greater flexibility in collective agreements and new approaches to organizing work. 13 STRATEGY AREA #4 Outcomes to Evaluate Concept Evaluation at the end of an education/training program is dependent on learners successful attainment of the goals or competencies initially set. Stakeholders involved in the education of health professionals use different criteria in evaluating whether a program as a whole has been successful in meeting their needs. Figure 4 presents six evaluation criteria or outcomes that are important in today s health care environment job-readiness, learning outcomes, recruitment, retention, cost and stakeholder satisfaction. Acknowledgement that each of the

14 six outcomes is vital regardless of how different stakeholders rank them is imperative in taking a system perspective. 14 OUTCOMES TO EVALUATE What were goals? How well were goals achieved? What data was used in making these assessments? Figure 4. Evaluation of Program Success 1. Job-Readiness (to what extent has the program/strategy helped students move down the pathway to professional competence) 2. Learning Outcomes (to what extent have students wrestled with big ideas and applied these to their clinical practice, to what extent have students become more critically aware, to what extent has this program promoted more autonomous behaviour, to what extent have students become more reflective about who they are, what they believe in, and what they do) 3. Recruitment into discipline/specialty, into health system) 4. Retention (of graduates in profession, of employees in health system) 5. Cost (to student (debt load), post-secondary institutions, health organizations/regions) 6. Satisfaction employer, student, faculty and profession and Opportunities for Collaboration It is generally accepted that the more collaborative the model between health and education, the easier the transition of novice (new graduate, new staff, staff undergoing role transition, foreign trained staff) to the practice environment. Yet outcome studies and cost comparisons of different models of educating health professionals are not readily available. Preferably, research can be organized around selected outcome measures that are agreed upon, although prioritized differently, by major stakeholders. Further research is required in the following areas to generate evidence with which to make decisions regarding job-readiness, education and transition strategies: «In what programs/professions does the gap between practice-ready and job-ready appear to be growing? In what programs is there a closer match, and what are the characteristics of these programs/ professions? «What are the positive collaborative theory/practice features of a program? For example: number of placements; length of time at each placement; placement type or number of locations; matching placement type to student interest, payment for placement. «Is there value in matching educational institutions with health care agencies? Would decreasing orientation time per agency increase job-readiness? «In what type of health sciences professions is higher integration of theory/practice of more significance? Does low integration of theory/practice ever produce a benefit? «Does faster transition to the practice environment result in different career outcomes? Existing research indicates that in certain types of collaborative education such as coop, students are more likely to use their own initiative to learn tasks and understand organizational culture. For example, a co-op student may gain an advantage in job assignments and promotions. On the other hand, the socialization process and other aspects of job-readiness may take place so quickly that non-co-ops quickly catch up with their co-op counterparts. «Evaluate how critical thinking is developed in practice, in particular under fire situations.

15 «Evaluate impact of increasingly collaborative education models on the health system infrastructure. For example, what impact does the expanded role for preceptors have on staff satisfaction? D. Conclusion The strategies in this paper reflect the array of creative activities and innovations that are underway as individuals and organizations in health and education strive to facilitate the transition from practice-ready to job-ready. Collaboration in policy decisions, strategic planning and implementation of the goals, design, delivery and evaluation of programs offered by universities, university colleges, colleges and health care organizations/agencies to bridge practice-ready and job-ready will allow the highest yield in student and health professional productivity, long term professional development and multi-stakeholder satisfaction. Communication and/or coordination of these many efforts will create synergy and maximize existing resources. 15 The four-step model used in this paper may serve as a means to increase emphasis on collaborative goal setting. While difficult, collaborative goal setting is a worthwhile first step in turning the discussion away from stakeholders differences to focus on the public interest. Selecting the most effective and appropriate strategies to address job-readiness requires evidence-based decision making. Short term action and long term planning are necessary to contend with today s challenges while preparing for the future. E. Key References Barnes et al, Teaching and the Case Method, 1994 and Selma Wassermann, personal communication, Gustavsen, Kristyna. Transition and Support for New Nursing Graduates, Graduating Essay for Master of Science in Nursing, University of British Columbia, April Registered Nurses Association of British Columbia. Competencies required of a new graduate. Section One: Profile and generic competencies. Vancouver, BC Practice Ready versus Job Ready, taken from Mentoring in Healthcare Instructor Manual, Healthcare Labour Adjustment Agency, 1.3.2, 2001.

16 F. Appendix 1. Summary of and Job-Ready STRATEGY AREA PROPOSED COLLABORATIVE STRATEGIES Goals At the end of an education or training program, evaluation is dependent on students successful attainment of the goals or competencies. Design that focus on what concepts and supporting infrastructure are required to meet the established goals. Delivery «Acknowledge a growing practice-ready/job-ready gap. «Consider need for provincial/ministerial leadership to develop mechanisms that compel different sectors and professions to more fully collaborate in strategies to address this gap and related issues. «Establish cross-stakeholder representation on health authority, post-secondary institution and professional body planning committees with a requirement to use evidence from outcome evaluations in decision-making. «Mandate health authority education policy that includes dedicated resources for continuing education for staff and the coordination of preceptorships, including development of policies and procedures, liaison with educational organizations, research and evaluation. «Balance student needs, educator goals, employer desires and work toward agreement by major stakeholders. «Identify who funds what. «Discuss consistency of program goals among professions and within professions. «Establish health sciences admission criteria based on candidates suitability and previous relevant experience. «Identify and implement mechanisms to jointly review health human resource trends in order to better match changes in health care system with school curricula and expected competencies. Conceptualize emergence of new and different health care workers, e.g. operating room technicians Perform impact analyses that identify health and education system capacity «Consider standardizing education/training program design among professions and across organizations as much as possible. «Consider where clearly defined educational preparation for each discrete scope of practice (specialists versus generalists) is appropriate. Identify/create programs that could quickly and cheaply shape generalists to enter a variety of job-slots. «Prioritize and implement strategies that stabilize the health system. For example, striving to employ a full-time or permanent part-time workforce and utilizing career laddering may impact on job-readiness by allowing new graduates to (a) own one position (b) transition in a more supportive environment and (c) clarify potential career advancement opportunities. «Enhance linkages between the education and health systems and professions: Jointly plan and fund adjunct appointments of staff and continuing education positions in the health system to provide ongoing recent knowledge to health sciences professionals in the field and assist in transitioning new graduates. Circumscribe the scope of practice and role of the preceptor. The Preceptor and Mentor Initiative for Health Sciences in BC, available March 2002 will provide a template. Enhance feedback loops between preceptors, mentors, students, faculty and health care system regarding the relevance of program curriculum and impact on health services. «Create regular, supernumerary positions for transitioning purposes. «Apply results from BC s Nursing Program s feasibility study as they relate to the transition to job-ready to nursing other health sciences professions.

17 STRATEGY AREA that focus on how the concepts and supportive infrastructure identified in the design area are implemented. Evaluation Job-readiness, learning outcomes, recruitment, retention, cost and stakeholder satisfaction as compared to the goals initially set. PROPOSED COLLABORATIVE STRATEGIES «Increase number of controlled real life or under fire situations during preceptorship. «Consider matching educational institutions with certain health care agencies. Limiting the number of preceptorship sites per student may enable students to maximize skill acquisition rather than continually re-orienting in new environments. «Explore opportunities for preceptorship in non-traditional, under-utilized settings to reflect the practice environments in which many health professionals work upon graduation. «Provide incentives for students to complete preceptorships in rural areas by funding their travel and living expenses. «Support the development of an Integrated Student Placement System for Health Sciences in BC which would provide a structure and resources for collaboration in providing student placements. «Consider standardizing the requirement for a final preceptorship prior to or post licensure (often cited is referred to as a one-year internship). Undertake further research in areas such as: «In what programs/professions does the gap between practice-ready and job-ready appear to be growing? In what programs is there a closer match, and what are the characteristics of these programs/ professions? «What are the positive collaborative theory/practice features of a program? For example: number of placements; length of time at each placement; placement type or number of locations; matching placement type to student interest, payment for placement. «Is there value in matching educational institutions with health care agencies? Would decreasing orientation time per agency increase jobreadiness? «In what type of health sciences professions is higher integration of theory/practice of more significance? Does low integration of theory/practice ever produce a benefit? «Does faster transition to the practice environment result in different career outcomes? «How is critical thinking developed in practice, in particular under fire situations. «Evaluate impact of increasingly collaborative education models on the health system infrastructure. For example, what impact does the expanded role for preceptors have on staff satisfaction?