The eppiccnurse System in Pennsylvania - Review

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2 Executive Summary The Department of State s Board of Nursing establishes rules and regulations for the licensure and practice of professional and practical nursing in Pennsylvania and provides for the examination of all applicants. The Board also establishes standards for the approval and operation of nursing education programs. Pennsylvania has 138 nursing education providers, one of highest numbers in the nation. Yet, the commonwealth (and the rest of the nation) still faces a shortage of nurses. Many nursing schools have indicated that one of the main reasons they are unable to expand their program, is due to a lack of available clinical sites to place their students to complete the hands on training required to meet the current regulations to graduate from nursing school. The Electronic Program Portal and Information Communication Channel (eppiccnurse) began as a project to address this situation by assisting nursing schools to locate and identify additional clinical site resources in their areas. It has since grown into a secure website that facilitates the exchange of virtually all information between nursing schools and the Pennsylvania Department of State s Board of Nursing. eppiccnurse was deployed in October 2007 to all 138 of Pennsylvania s nursing education providers. In addition to a searchable database of over 3,000 clinical sites throughout the commonwealth, eppiccnurse also facilitates program registration, submission and processing of annual reports, entry of additional clinical sites, nursing education faculty qualifications approval, the approval of nursing education program use of clinical sites, clinical site capacity planning, and reporting. The eppiccnurse system has achieved numerous benefits for the Nursing Board, nursing schools, nursing students and, ultimately, the public at large. This includes access to a centralized database of clinical sites across the commonwealth, time and cost savings associated with the submission and processing of reports and applications, improved compliance auditing and reporting, availability of data to guide policy creation, and reduction of duplicative data entry. pg 2 of 7

3 C.Project Description eppiccnurse began as a means to assist prelicensure nursing programs produce more qualified nurses and facilitate efforts to overcome the nursing shortage in the Commonwealth of Pennsylvania. In addition to classroom instruction, prelicensure nursing education providers must also provide students with the required amount of hands-on training in the field in order to graduate and become licensed. To increase the number of nurses graduating, these education providers have sought to expand the list of clinical agencies where nursing students may acquire this experience. Such clinical agencies primarily include hospitals, nursing homes, clinics, and doctor s offices, but can also include correctional institutions, shelters, K-12 schools and other sites where health services or education can be provided. Despite the wide array of facilities at which clinical experience is available, this has been an uphill battle for nursing educators. Due to fewer patients and shorter hospital stays in recent years, education providers had been struggling to maintain an adequate number of clinical agencies that could allow prelicensure nurses to fulfill the clinical experience requirement of nursing regulations for their students. When faced with the necessity of managing an impending nursing shortage, the nursing education providers lacked the resources to expand their clinical experience capacity to produce more nurses. The Nursing Education Board sought a way to help prelicensure education providers find clinical agencies available in their area, and discovered a program used by another state to identify all clinical agencies available for nursing students throughout that state. However, the program was limited by the size and resources of the state where it originated. The Commonwealth of Pennsylvania, as one of the largest states for nursing schools, needed an alternative solution. The Nursing Education Board brought this need to the attention of the Department of State, which utilized the research and information provided and, considering the unique needs posed by a state as large as Pennsylvania, put together a team of developers and presented them with the issue and proposed solution. Solution The solution devised resulted in the creation of a custom application that would gather information on clinical agencies licensed by the Pennsylvania Department of Health (DOH). The Nursing Board s team worked closely with DOH to capture its licensed clinical agency data and present this information to the education providers via a secure web application. An analysis of business practices revealed that many nursing schools were utilizing clinical agencies other than those licensed by the Department of Health. As a result, an additional process was created to capture these other clinical agencies. While the business analysis was being performed and analyzed, it became apparent that the Board of Nursing routinely gathers and exchanges a great deal of other information with education providers using outmoded paper processes. The project team sought to address this situation in building its solution. During implementation, the following additional features were incorporated into eppiccnurse. pg 3 of 7

4 Annual Report The Board of Nursing is required to collect an annual report from each of the prelicensure education programs. This report, which was 19 pages long, had to be mailed with instructions annually to each of the 138 education providers. Once each of the 138 reports was returned to the Board, the results had to be reviewed and analyzed individually. After each report was reviewed and all the answers verified, the results were manually entered into an Excel spreadsheet. This process typically took Board staff about 2.5 hours per report to complete, resulting in a total of about 345 hours to compile all 138 reports. The cumulative spreadsheet printed as a result of this process was seven pages wide and four pages long. In contrast, eppiccnurse, which incorporates front-end checks to prevent about 95% of data anomalies, provides a cumulative spreadsheet that is system-generated. This year, each report, which previously took 2.5 hours to manually process, was completed in about 10 minutes, saving approximately 322 total staff hours. As a result of eppiccnurse, education providers also spend less time filling out the report. All data that is repeated from year to year does not need to be reentered and data collected in other parts of the system are pulled into the annual report to prevent duplicate entry. Enhancements continue to be made to improve the annual report process. The past three eppiccnurse releases have enhanced the annual report based on education providers needs, potential data anomalies, and the ability to tie all pieces of the application together to prevent duplicate work. Clinical Agency Collecting information has become a three-stage solution in eppiccnurse. In the first stage, all DOH-licensed facilities were loaded into the system. Each of the education providers was able to access eppiccnurse and build their clinical agency list by first selecting all of the DOH-licensed agencies they utilize. Next, they entered demographic information for all the other (not licensed by DOH) clinical agencies they utilize. These submissions were vetted to ensure that they were not duplicative and then approved or denied by Nursing Board staff. Once approved, these other agencies would appear in the lists to use for all schools. Once Stage One was completed by all education providers, the available clinical agencies database was built into eppiccnurse with this information. The education providers now have a centralized list of all clinical agencies where students either are practicing or have practiced in the past. Education providers are able to use eppiccnurse s searching capabilities to quickly locate potential new clinical agencies for their students to use. There are currently more than 3,000 clinical agencies listed in eppiccnurse. Stage Two With the clinical agency lists built for each of the education providers, they could then use eppiccnurse to submit all requests for approval for all new clinical site agreement approvals. This process previously required the nursing education provider to fill out a paper form and submit via mail to the Nurse board reporting the following: hours of use, days used, other schools using, units used, and total bed capacity. In eppiccnurse, all this information is still collected, but the system populates a lot of this information, pg 4 of 7

5 such as demographic information of the clinical site, bed capacity, and other schools using this facility. Capturing this data electronically has enabled the Board greater ability to place several more checks in the process to ensure patient safety and successful nursing student experience. For example, upon assessing requests for new clinical agencies, the Board assesses the clinical capacity of each of these agencies electronically in one location to readily determine approval. Previously, the Board of Nursing was forced to utilize an education provider s self-reported list of other providers using the agency, then go to the filing cabinet to verify each reported education provider individually to consider approval of the request. With the advent of eppiccnurse, the Board is now able to see a current list of all schools utilizing the clinical agency and in what capacity to ensure proper education experience and number one, patient safety. Stage Three As the clinical agency list continues to grow in eppiccnurse, the Board of Nursing has the ability to run aggregate reports to locate clinical underutilization and dangerous clinical capacity situations. This information assists education providers in finding clinical agencies in emergency situations. The reporting features in eppiccnurse also allow the Board to readily report clinical agency information to any and all stakeholders. Faculty Approval The Board of Nursing is required to approve all faculty members at prelicensure nursing education programs. One of the requirements for approval is to be an actively licensed nurse in the Commonwealth of Pennsylvania. Prior to the implementation of eppiccnurse, Board staff would have to access a separate system to verify the license number and status for each application arriving by mail. To improve this process, the project team connected eppiccnurse to the Department of State s License 2000 database to link to license information. When education providers enter the license numbers of their instructors into eppiccnurse, the system automatically returns the licensee name, license status, and license expiration date. As a result, the current turnaround time for getting an instructor approved is hours - down from a week. D. Significance eppiccnurse has fundamentally transformed the way the Nursing Board works with the prelicensure education programs from start to finish. All communication between the Board and education providers is now electronic. The Nursing Board was at maximum physical storage capacity at the onset of this project. Filing cabinets were bursting and filing took up a significant portion of staff time. Today, all information is housed in database servers, allowing for powerful reporting capabilities, including trending, capacity planning, and ease of program regulation auditing. eppiccnurse utilizes the License 2000 database to better regulate nursing educators. This system has cut back significantly on staffing hours needed to support the nursing education programs. E. Benefits of the Project Benefits to Prelicensure Education Programs: pg 5 of 7

6 All communication to and from the Nursing Board is routed through eppiccnurse. Searchable database of (and growing) clinical agencies in which to place students. Electronic annual report filing process that cuts down on repetitive data entry, with front-end error handling that significantly reduces interaction between education providers and the Nursing Board to correct erroneous data entry. Clinical agency requests and faculty qualification forms are now generally reviewed and approved in a day. Built-in security that is specific to the program and can be easily changed and updated as needed. Ease of use. The program directors are elated at how simple the system is to use. Even if they go a year without utilizing the system, it is intuitive enough for them to jump right in and work. Increased efficiency through the elimination of duplicative data entry. Benefits to Nursing Students Prelicensure education programs are able to identify more clinical agencies, thereby enabling them to expand their programs to accept more students. Electronic data collection means reports and audits can be easily performed to ensure regulations are being met or exceeded, assuring high quality educations for nursing students in Pennsylvania. Because clinical agency capacity is no longer self-reported, the Nursing Board can accurately determine if an agency is able support adding new programs. This has resulted in better experiences for the students. Benefits to the Pennsylvania Center for Health Careers Data can be analyzed easily to develop policies to increase the number of qualified nurses. Benefits to the Public Electronic data collection allows information to be reported more efficiently, enabling the creation of policies to prevent a mass nursing shortage. More clinical agencies allow education providers to graduate more nurses to assist in keeping the public safe. Financial Return on Investment Time savings: It now takes approximately 23 hours to review the annual reports submitted by Pennsylvania s 138 nursing education providers, down from a staggering 345 hours before. Over the past three years, this has resulted in a cumulative reduction of almost 1,000 staff hours. In 10 years, this piece alone will cover 50% of the cost to develop the application. Cost savings: The Nursing Board used to spend $500 each year to mail annual reports. Education providers spent another $1,000 in postage to return the report and supporting documentation to the Board. pg 6 of 7

7 Ease of Use: Ninety-five percent of all help desk issues can be handled by Nursing Board staff. Currently this is the only system in the country that communicates 100% electronically with nursing education providers. eppiccnurse has reduced the paper for the Nursing Board by at least 80%. The reporting features in the system support government transparency readily. eppiccnurse started with small one task: to gather all data relating to clinical facilities. However, it has grown to become so much more. This year, the system expanded again to collect information on clinical agencies licensed by the Departments of Public Welfare and Corrections, and efforts to incorporate postlicensure education programs is currently underway. Future development entails an ad hoc reporting system, enabling the Nursing Board to drill deep into the collected data to provide specific reports to the Governor s Office, the Pennsylvania Center for Health Careers, the Board of Nursing members and anyone else who may need it in order to better serve the commonwealth. Through eppiccnurse, the Nurse Board hopes to uncover all program difficulties and create paths to overcome those issues to create a streamlined nursing education system in the Commonwealth of Pennsylvania. pg 7 of 7