The Birmingham VA Nursing Academy: Academic Practice Partnership for Veteran Health Care

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Blake Wells
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1 The Birmingham VA Nursing Academy: Academic Practice Partnership for Veteran Health Care Greg Eagerton, DNP, RN, NEA BC Chief Nursing Officer Birmingham VA Medical Center Doreen C. Harper, PhD, RN, FAAN Dean and Professor UAB School of Nursing

NEA BC Chief Nursing Officer Birmingham VA Medical Center

2 Who Are Our Veterans? (U.S. Department of Veterans Affairs, 2012) US. Veteran population > 22 million Significant number of aging Veterans World War II Korean War Vietnam War Operation Iraqi Freedom (OIF) Operation Enduring Freedom (OEF)

3 Veteran Specific Health Issues Veterans have any/all of the same health issues as the general population Devastating wounds, amputations, disabilities Post traumatic stress disorder (PTSD) Traumatic Brain Injury (TBI) Behavioral health: substance abuse, depression Suicide

amputations, disabilities Post traumatic stress disorder (PTSD)

4 What is the VA Nursing Academy? Conceived in 2005, with initial funding in 2007 Program is funded by the Department of Veterans Affairs to address the nursing shortage Partnerships between nursing schools and select VAMCs 12 currently Prepare baccalaureate nursing workforce with knowledge and skills to improve Veterans health care

Department of Veterans Affairs to address the nursing shortage Partnerships

6 VA Nursing Academy Knowledge that changes the care and improves the lives of Veterans and their families At the point of care In the community In Universities and Institutions of Higher learning In VA Medical Centers Across systems of health care

point of care In the community In Universities and

7 Birmingham VA Nursing Academy Partnership UAB School of Nursing BSN, MSN, DNP, PhD programs Top producer of RNs in Southeast Birmingham VA Medical Center, including nine CBOCs Serves northern tier of Alabama where 405,600 Veterans reside, 75% of whom are war veterans Served 60,000 with > 700,000 outpatient visits annually Engages SON faculty, VA nursing faculty and VA professional staff Education for tomorrow s nurses about unique health needs of Veterans and their families across hospital, home and communitybased settings

war veterans Served 60,000 with > 700,000 outpatient visits annually Engages SON faculty, VA nursing faculty and VA professional

8 Relationship before VANA Longstanding between School and BVAMC Intermittent educational and research activities Clinical sites and preceptorships based on individual faculty and students Minimal joint strategic initiatives

activities Clinical sites and preceptorships based on

9 Relationship before VANA CNO and Dean recognized missed opportunities Strengthened relationship between 2006 and 2009 UAB SON Strategic Plan VA Nursing Leadership on UAB SON Advisory Committees Clinical Adjunct Faculty from VA Expansion of clinical sites Faculty Practice site developed

VA Nursing Leadership on UAB SON Advisory Committees Clinical Adjunct

10 Framework for Partnership Building Relationship Building Engagement Governance/Policy Implementation Evaluation Sustainability

11 The Beginning: VA Nursing Academy Relationship Strategic Planning UAB SON and Birmingham VAMC SWOT Analysis Preparation towards writing VA Nursing Academy proposal Organizational linkages between faculty and executive nursing leadership Leadership Organizational Resource Allocation and Incentives Coalition building across partnership Participatory governance and commitment to partnership through shared vision/mission Culture/Value Influence

nursing leadership Leadership Organizational Resource Allocation and Incentives Coalition building across

12 VANA: Relationship Building Who Executive Council Dean, CNO, Two Program Directors Program Directors Birmingham VAMC and UAB SON Birmingham VA Faculty/Executive Leadership and UAB SON faculty nine UABSON faculty, five VA nursing faculty and five nurse Coordinators What Provides leadership related to structure, processes and outcomes and strategic initiatives meet monthly Program management for students, faculty and VA nursing and professional staff meets regularly/prn Assigned to specific functions and initiatives associated with VANA program outcomes meets quarterly to track project outcomes

related to structure, processes and outcomes and strategic initiatives meet monthly Program management for students, faculty and VA nursing and

13 VANA Engagement: Getting to know you Commitment phase Cannot underestimate CQI Regularly revisit project goals and outcomes Anticipate setbacks and work through issues/problems

14 VANA Engagement: Synergies UAB s Graduate Nursing Programs VA Quality Scholars Program GREC Fellowship Endowed Scholarship from UAB s Board of Visitors Clinical Nurse Leader (CNL) HRSA BVAMC/affiliate committee representation

Endowed Scholarship from UAB s Board of Visitors

15 VANA: Evaluation Program Evaluation Clinical Program Evaluation Educational Program Evaluation

16 VANA Implementation and Evaluation Educational Outcome Faculty incorporates veterans health competencies into curricula in undergraduate and graduate programs at UAB SON. Measurement Strategies R Status Time Frame Number of UAB SON programs with veterans health competencies in curricula. Publication referencing proposed veterans health competencies. 1. Identify key concepts and issues (competencies) that all nurses should know related to veterans health and plan for integration into undergraduate and graduate nursing curricula. 2. Inform nursing program directors of these competencies and facilitate ways they can be incorporated into their program. 3. Begin integrating into key programs of study (undergraduate first, then graduate programs) 4. Include undergraduate honors students into BVAMC Quality and/or EBP activities. Specify responsible party Discussion has begun at undergraduate program level to develop veteran centric competencies. Notes/Comments: Look into cultural competencies for guidance/parallels. Make sure we think about militaryveteran civilian triad. Make sure we have appropriate consistency across programs (not spotty coverage of this topic). Development FY13 2QTR Information: FY13 2QTR Integration: FY13 3 4QTR

Identify key concepts and issues (competencies) that all nurses should know related to veterans health and plan for integration into undergraduate and graduate nursing curricula. 2.

17 Clinical Program Outcomes BVAMC nurses use of Veteran centered simulation for competency testing Professional development DVD distributed to 153 CNOs at VAMCs nationwide to teach behavioral responses in Med/Surg patients

Professional development DVD distributed to 153 CNOs

18 Clinical Program Outcomes

19 Clinical Program Outcomes Education modules to teach evidence based practice concepts (theory and application) BVAMC EBP/Research Council and membership structure established 20 faculty and VA professional staff engaged in partnership activities 9 VANA graduates have been hired by the BVAMC

and membership structure established 20 faculty and VA professional

20 Educational Program Outcomes 65 BSN prepared nurses completed two years of all clinical rotations at the BVAMC (except OB and Peds) New Elective course taken by more than 150 students entitled: Care of America s Hero s

BVAMC (except OB and Peds) New Elective course taken

21 Educational Program Outcomes 9 co authored publications 13 collaborative presentations VA Quality Scholars pre and postdocs 4 Development of a DVD for nurses caring for Veterans with PTSD, TBI and suicide Two Jonas VA Doctoral Scholars

22 Educational Program Outcomes Military/Veteran personnel enrollments increased by 666% at the UAB SON ( ) Curriculum revision integrates Veteran centric content for > 2,200 undergraduate and graduate students Clinical Simulation scenarios developed UAB SON Advisory Board raised $100,000 for an endowed scholarship for students with commitment to Veterans care

24 UAB SON VANA Website

25 Lessons Learned To Date Leadership by both chief officers Clarity and transparency of mission and goals Continuous partnership evaluation Be prepared for conflict and negotiation Need to embed faculty and VA staff at every level Monitor Partnership Value

26 Birmingham VANA Partnership Value ( ) Salary expense for VANA faculty Benefit expense for VANA faculty Total expense for VANA faculty $465 K TotalCost Avoidance $216 K $135 K Total Revenue Enhancement $100 K $600 K Total Fiscal Contribution $316 K Partnership Value* $284K * Partnership value is the variance between salary/benefit expense and fiscal contribution

27 Most Important Lesson! Educate every Nurse and Nursing Student to add to assessment two simple questions: Have you or any member of your family served in the Military? If so, did you or they experience combat?

28 Sustainability MOU Continue to seek funding/contract options Philanthropic Endowed Scholarship Develop collateral funded projects HRSA RWJF VA research Other initiatives

29 Thank you and Questions

New Jersey Action Coalition. RN Transitions into Practice Residency Model for Long Term Care

New Jersey Action Coalition. RN Transitions into Practice Residency Model for Long Term Care New Jersey Action Coalition RN Transitions into Practice Residency Model for Long Term Care IOM Recommendations Remove scope of practice barriers Expand opportunities for nurses to lead and diffuse collaborative