THE AGING AND GRAYING OF

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1 CNE Objectives and Evaluation Form appear on page 149. Joyce A. Hahn Practicum Projects of Value: A Successful Strategic Partnership Between Nurse Executives and Master s Level Academia EXECUTIVE SUMMARY The opportunity exists for academia and the nursing executive community to collaboratively create cultures of excellence. One university formed relationships of collaborative synergy with nurse executives to provide practicum experiences of value for both the graduate nursing administration students and the health care facilities. The strategic preceptor partnerships offer graduate students the invaluable opportunity to experience the in-depth, real world perspective of nursing administration resulting in the enrichment of their academic scholarship. A final practicum work project is designed collaboratively with the preceptor and completed by the end of the second practicum semester. The resulting practicum project is an example of a mutually rewarding experience for the graduate nursing administration student and the preceptor. The collaborative synergistic model is a win-win situation for the university and the health care facility. THE AGING AND GRAYING OF the nursing workforce extends from the bedside staff nurse to executive management nursing leadership. Availability of educationally prepared nurses to fill the vacancies of the aging and retiring workforce is vital to filling the leadership void for the largest professional discipline in health care. Herrin and Spears (2007) state, Without knowledgeable, authoritative nurse leaders at each level of the organization, strategies to improve nursing workforce adequacy, provide safer environments for patients, and manage day-to-day operations of patient care departments cannot be successfully implemented (p. 231). The purpose of this article is to describe how one university has formed relationships of collaborative synergy with nurse executives in the metropolitan Washington, DC, region to provide practicum experiences of value for both the graduate nursing administration students and the health care facilities. An aging workforce study conducted by the Bernard Hodes Group (2006) in partnership with Nursing Management reported 75% of current nurse leaders planned to retire by Additionally, this survey of 980 nursing leaders from every state in the United States and Canada reported by 2010 approximately 20% of the nurse leaders will be approaching retirement or already retired. A chief nursing officer retention study (Jones, Havens, & Thompson, 2008) reported 62% of respondents anticipated making a job change in less than 5 years with slightly more than onequarter for retirement (p. 89). The data identify the necessity for senior nursing leadership in the health care organizations and master s-level academia to form strategic partnerships and work collaboratively to prepare the nurse leaders of tomorrow. The George Mason University School of Nursing is committed to working with our community health care partners to prepare the next generation of nurse leaders. Data from the last three graduating JOYCE A. HAHN, PhD, APRN, NEA-BC, is Assistant Dean of the Master s Division, School of Nursing, College of Health and Human Services, George Mason University, Fairfax, VA. NOTE: The authors and all Nursing Economic$ Editorial Board members reported no actual or potential conflict of interest in relation to this continuing nursing education article. 143

2 Practicum Projects of Value: A Successful Strategic Partnership between Nurse Executives and Master s Level Academia nursing administration classes demonstrates 91% of students hold nursing administration positions at the director level or higher in the regional area of Washington, DC. Academic Partnerships Academic partnerships with health care organizations are not a new paradigm. The rapidly changing health care environment, the nursing shortage, and specifically the looming leadership void have resulted in strong partnerships to transform knowledge, skills, and best practices into innovative models and deliverables (Harris & Walters, 2009). The current issues in health care have presented an incentive to forge new relationships of collaborative synergy. Fineout-Overholt, Melnyk, and Schultz (2005) identify collaborative partnerships between academic and health care settings as evident in a best practice culture. The opportunity exists for academia and the nursing executive community to collaboratively create cultures of excellence. This collaborative synergy of intellectually stimulating minds working together to achieve a positive outcome provides benefits above and beyond what the units could do separately (Kanter, 1989). The school of nursing at George Mason University welcomes the synergistic partnerships of our community health care facilities. The school s vision speaks to educating the next generation of nursing leaders empowered and focused on innovative responses to address the challenges of a rapidly changing and culturally diverse health care environment. A stakeholder meeting initiated by the director of the school of nursing brought together the nursing executives from our community of health care facilities to discuss the needs of the marketplace and how the graduate program could develop, improve, maintain and assure competent advanced practice nurses. The master s of science in nursing program is substantial in size with approximately 300 students. More than one-third of this graduate student population is in the nursing administration track. The current curricula in nursing administration meets the American Association of Colleges of Nursing s (AACN) Essentials of Master s Education for Advanced Practice Nursing (1996), the Joint AONE and AACN Position State - ment on Nursing Administration Education (1997), and the American Nurses Association (ANA) Scope and Standards of Practice for Nurse Administrators (2004). Each academic year students come together as a cohort for two semesters of nursing administration theory and strategies didactic on campus classroom work and concurrent semesters of practicum experiences (90 hours/semester) with designated nursing administrators. These are the final four courses of the nursing administration track. Prior to these experiences, the students have successfully completed courses in management and organizational theory, financial management, ethics, theoretical foundations in nursing, nursing research methodology, and health care delivery systems. Steps to Practicum Placement The coordinator for the nursing administration track conducts one-on-one student interviews to discuss the student s anticipated career path and professional goals. Areas of student interest as well as the agency of current employment are identified. Students are required to complete practicum hours outside of their agency of employment. The student is requested to submit a set of written goals and expectations for the practicum course sequence. It is at this point the preceptor match process is initiated. The coordinator relies upon past preceptors, nursing administration track graduates with 2 or more years experience in their role, and networking contacts to serve as the potential preceptor pool. Preceptors are required to have an MSN or PhD degree in nursing and be currently working in an administrative position. Preceptors with strong leadership experience and credentialing are preferred. Practicum sites can include hospital facilities, community-based agencies, professional organizations (e.g., ANA and AONE), health departments, long-term care facilities, correctional facilities, and entrepreneurial businesses. Students who are novices in the management role are paired with a mid-level administrator and students with previous relevant nursing management experience are paired with an executive-level administrator. The coordinator initiates the contact with the potential preceptor to discuss a possible student placement. The individual student goal statement is ed to the potential preceptor (see Figure 1). Upon communication to proceed from the potential preceptor the student is contacted and a dialogue via telephone or between the student and preceptor occurs. The preceptor and the coordinator then have a followup discussion and a student prac - ticum placement is determined or deferred. A practicum course packet inclusive of the course requirements, student contact information, and a student evaluation tool is mailed to the preceptor. A face-to-face meeting bet - ween the preceptor, instructor, and student at the preceptor facility occurs prior to the start of the fall semester. The coordinator will continue to be available as a resource to the preceptor, be available for additional on-site meetings as required, and will visit the preceptor at the mid-term point of the semester. A final on-site meeting with the coordinator, student, and preceptor occurs at the end of the practicum semester. 144

3 Practicum Projects of Value: A Successful Strategic Partnership between Nurse Executives and Master s Level Academia Fall Semester: The Big Picture The fall administrative theory and practicum semesters use the general system theory to examine health-related organizations and nursing administration practice within these organizations. Stu - dents are expected to integrate knowledge of environmental in - fluences on the health care delivery systems, health policy, and technology, and analyze internal organizational systems and processes which influence organizational success. Topics include the conceptualization of nursing theories and concepts, organization as systems and systems theory, the art of leadership, change management, strategic management, accountability, legal and regulatory compliance, nursing informatics, and organizational structure and analysis. Students meet weekly on campus as the entire cohort for the theory class Figure 1. Sample Student Goal Statement By the end of the practicum experience, the student will be able to: Identify one significant project of administrative leadership in alignment with the strategic goals of the organization and the resulting outcome. Identify at least one challenge of the health care organization/unit and the resulting success of implementing evidenced-based practice to meet the challenge. Understand the data, legal, and ethical implications used to drive performance improvement in meeting productivity goals for the organization. Figure 2. Practicum Objectives 1. Develop a project which relates to the purpose of the practicum assignment, student s interest, and agency s interest and approval. 2. Utilize appropriate administrative and/or nursing theories in project development and implementation. 3. Apply appropriate management principles in developing and implementing project. 4. Utilize research findings as found in the literature. 5. Analyze impact of nursing service and nursing education conceptual and theoretical formulations within agency on project. 6. Evaluate results of project in terms of purpose and objectives. and weekly in smaller groups (10-12 students) with an instructor for a seminar style practicum course. Students are expected to complete 90 hours within this semester with their preceptor. The work product deliverable of the precepted practicum is an organizational analysis paper utilizing the system s theory to identify the links between the theory and the practice within an agency with emphasis on role definition and collaboration between the leadership team at the practicum site. Students interview members of the leadership team to accomplish this assignment. It is within this first practicum semester when the final practicum project is identified with the preceptor to meet with the practicum project objectives. A practicum project proposal is written to meet the course objectives (see Figure 2) and to meet the identified project SERIES need of the nurse administrator and health care facility. The project proposal is reviewed and discussed by both the preceptor and the practicum instructor (see Figure 3) before the student can proceed with the project. The collaborative synergy of the preceptor, student, and practicum in - structor has identified practicum projects of value to the facility and the student s learning experience. Spring: The How to Semester The spring semester administrative strategies and practicum semester requires the student to integrate theory, research findings, and experience in the analysis of clinical systems, communication frameworks, and interactional processes. Topics include emotional intelligence, managerial and leadership theories in review, evidenced-based research and the nursing administrator, conflict resolution, decision making and problem solving, legal and ethical decision making, strategies to effectively manage a multigenerational and diverse staff, human resources, quality management, current topics in health policy, and the journey from management to leadership. The spring prac - ticum requires the 90 hours/ semester of on-site practicum and the weekly campus seminar. Deliverable practicum projects include a seminar presentation of administrative best practice case studies, a managerial work project to demonstrate managerial theory in practice in an actual health care setting, and the final practicum project. Practicum Projects Student practicum projects can be viewed within the broad categories of quality and safety, business skills, leadership, and strategic planning. All projects must be identified as having value to both the health care organization and the student. The student s participation in the project ends at the conclusion of the aca- 145

4 Practicum Projects of Value: A Successful Strategic Partnership between Nurse Executives and Master s Level Academia Table 1. Sample Practicum Projects Title of Practicum Project Surgical Care Improvement Project (SCIP) Performance Improvement and Quality Control for Compliance of the Centers for Medicare and Medicaid Services (CMS) Detailed Notice of Discharge Regulations Cultural Competency Assessment Cultural Competency Toolbox National Nursing Professional Organization Emergency Preparedness: Spring Disaster Drill Mass Casualty Triage Plan Wound Care Center Development An Evaluation of the Electronic Documentation System Transition to a New Acute Care Facility County Public Health Coalition Planning Grant Formalized Standard for Nurse Internships Lessons Learned from Litigation Appreciated Inquiry Project for Shared Governance Budget Development and Management Plan Action Plan to Address Issues Identified in Nursing Satis - faction Survey Description Project based on national standards (CMS) for reduction of surgical complications by 25%; Medicare reimbursement reduction of 2% if data are not reported. Development of a tracking tool for chart reviews created in response to the new regulation. Compliance monitoring to measure tool effectiveness. Hospital-wide cultural competency assessment with analysis, proposal for next steps. Reviewed submissions from state chapters, identified themes, Web page development. Student lead on disaster preparedness committee for drill implementation and outcome analysis. Emergency department response plan in anticipation of pandemic flu or terrorist biological attack. Student developed and presented business plan. Student measurement and analysis of data. Hospital expansion to a new facility in neighboring town. Student provided substantial input to the transition planning process. $20,000 planning grant for mental health services. Grant application to a nursing foundation for new systemwide internships. Report prepared utilizing retrospective data research and presentation to facility medical administrative board and board of directors. Preparation of a manual, guidelines, and staff presentations for developing unit and department shared governance. Resource allocation plan necessary for state hospital facing severe budget cuts. Development of an action plan with presentation to nursing management team and hospital CEO. demic spring semester with a copy of the written project report left with the preceptor. Student practicum project outcomes have been consistently reported by the nursing executives to be of positive value to their organization. A final written student evaluation inclusive of a practicum project rating is submitted by the preceptor. Our nursing administration track over the past 3 years has enjoyed a 100% satisfaction rate with the final practicum project. Open lines of communication between the student, preceptor, and the university faculty over the course of the two semesters beginning with the student goal statement, the mutually agreed upon practicum proposal, and face-to-face meetings result in positive collaborative and synergistic outcomes. A brief explanation of the outcomes of the practicum projects presented in Table 1 follows. The County Public Health Coalition planning grant and the grant application for system-wide nurse internships were both awarded. The Surgical Care Improvement project and the tracking tool for the Performance Improvement and Quality Control for Compliance (CMS) are both projects still in place and functioning after the student practicum conclusion. The Wound Care Center opened this spring. The new acute care facility opened utilizing the transition plan and staff orientation developed by the student. The Emergency Preparedness Spring Disaster Drill, written by the stu- 146

5 Practicum Projects of Value: A Successful Strategic Partnership between Nurse Executives and Master s Level Academia Figure 3. Sample Student Practicum Proposal Overview of the Project The completed project will address nurse staffing and scheduling, specifically the impact of using 12-hour shifts at Hospital X. The goal is to use data collected during the 3-month trial period to establish measurable evidenced-based outcomes to validate this change in staffing patterns. Description of Need There is an organizational need to examine the impact of 12-hour shifts on staff productivity, quality of care provided to clients, nursing staff morale, and nursing retention. Project Description The data collected will examine the effect of 12-hour shifts on: employee satisfaction, productivity, attendance, quality of patient care (medication errors, fall rates, accidents, injuries), impact on other team members, retention rates, impact on recruitment, overtime usage, documentation completion, and evaluation of project. Reports Generated A written report will be presented to the management team and members of the Twelve Hour Shift Work Team. A presentation of results will be given for all nursing staff. Project Timetable The project will be completed during the spring semester. The 3-month pilot period for 12-hour shifts started in November, and data collection will begin during the last week of January. An interim report will be presented the first week in March and a final report the last week in April. Comments Nurse staffing involves different components including planning, scheduling, and allocation. Scheduling entails assigning nurses for specific time periods by shift (8 hr vs. 12 hr), based on patient care needs. However, by increasing the length of RN shifts, administration must be sure that the hours worked in no way pose a threat to patient safety. The Joint Commission on Accreditation of Healthcare Organizations (2002) noted, The growing shortage of nurses in American Hospitals is putting patient lives in danger and requires immediate attention and warned of increased deaths, complications, length-of-stay and other undesirable patient outcomes. Hospital X strives to be responsive to staffing needs, retention, and moral issues during a time of national nursing shortages. By introducing a trial period of 3 months for 12-hour shifts, and following this up by producing measurable outcomes, any potential for negative patient outcomes can be avoided. Approved: GMU Practicum Instructor Preceptor Signature Student Signature Date: Date: Date: SERIES dent with scenarios impacting areas of the hospital from the ED to the OR and all departments in between, was declared a successful first attempt by the organization. The drill was critiqued, updated, and run again just prior to the Presidential Inauguration to prepare and raise staff awareness. Cultural competency projects in both the local health care organization and the professional organization continue. The leadership projects addressing shared governance and working on nursing satisfaction survey issues are moving forward on an organizational basis. The economy and state budget reductions placed the student in a position to use her knowledge and skill sets to assist the health care facility in a time of financial crisis. The evaluation of the electronic documentation system aided the organization with their strategic plan initiative to improve patient safety. These were all projects of importance and value. The nursing administration track coordinator and practicum faculty are available as resources throughout the practicum project process. A final student evaluation of the semester by the preceptor occurs with the coordinator or faculty member at the preceptor s organization. Comments, concerns, and suggestions are all solicited to assist in maintaining a nursing administrative track of high quality to continue meeting the needs of the nursing administrative community. Examples of three practicum project descriptions together with quotes from the student and preceptor is presented in Figure 4. Conclusion The collaborative synergistic model is a win-win situation for the university and the health care facility. The nurse administrator s time commitment is for the 90 hours of precepted time the student spends with the administrator. The student receives addition- 147

6 Practicum Projects of Value: A Successful Strategic Partnership between Nurse Executives and Master s Level Academia Figure 4. Practicum Project Descriptions with Comment Wound Care Center Business Plan Evidenced-based research conducted with wound care clinics demonstrated improved patient outcomes, the potential for a decreased hospital length of stay, and increased patient satisfaction. The Wound Care Healing Center project was undertaken to address the feasibility of bringing such a center to this health care organization. A strategic business plan was developed to include market analysis, business operations, and a SWOT analysis. This project afforded me the opportunity to experience all the components of a new project start up to include leading an interdepartmental project team and the development of a business plan. C.L., graduate student The Wound Healing Center business plan was a very well-researched plan that examined the competition, internal and external barriers and opportunities, identified the patient population and marketing plan as well as staffing and start up budget. The work team the student led brought together many diverse departments within the organization which enabled the development of a strong sense of mission vision for the project. W.A., associate director of nursing, preceptor Development of a Nurse Externship Program The nurse externship program was designed to be used as a recruitment and retention tool to facilitate a smooth transition from the student role to the professional role. Components of the plan involved writing a grant to financially support the program, developing an outline that delineated the program components, planning educational opportunities, and developing a competency checklist and participant evaluations. Each separate component of the project had unique requirements that collectively have given me valuable insight into program development and grant writing. This experience has instilled in me the confidence to seek out and pursue relevant opportunities for grant writing in my expanding professional career. J.F., graduate student The value to the organization included the deliverable of an externship project inclusive of evaluation tools for measurement of success. The full value of the project will be determined when we look at the retention rate of this cadre of externs S.S., director of staff development, preceptor Emergency Preparedness: Spring Disaster Drill The goal of this practicum project was to implement a disaster preparedness drill to test the emergency operational preparedness at the hospital. The project involved creating realistic threat scenarios with timelines and interjects. The drill was implemented successfully with an immediate critique for strengths and weaknesses by members of the emergency preparedness committee. Invaluable experience was gained in team leadership and implementation of the disaster drill utilizing the principles of adult learning in relation to theories of chaos and organizational stress. J.I., graduate student Terrorist attacks, natural disasters, biological and chemical threats have pushed emergency preparedness to the forefront of hospital agendas. Organized drills testing all levels of preparedness from the day of the incident to recovery phases are necessary. Meeting The Joint Commission Emergency Management Standards and adapting to the Hospital Incident Command Structure are required. Our student was tasked to be the project leader, and with members of our emergency preparedness committee, designed, implemented, and evaluated an exercise that would test our systems and the human response to an external or internal threat. R.F., associate director of nursing, preceptor al instruction and mentoring from the university faculty during classroom time. The program receives networking contacts from interested nursing administrators in the community and is open to new collaborative partnerships. Strategies for developing a nurse administrator and university collaboration include: meet with nurses in your own facility who are attending a college or university to discuss ideas for partnerships and solicit academic contacts; and engage in dialogue with nurse administrators in your organization to identify potential preceptors and organizational commitment then contact the dean of an area college or university to discuss possible collaborative partnerships based on organizational needs and the potential opportunities for preceptors and prac - ticum projects. The strategic preceptor partnerships offer graduate students the invaluable opportunity to experience the in-depth, real world perspective of nursing administration resulting in the enrichment of their academic scholarship. A final practicum work project is designed collaboratively with the preceptor and completed by the end of the second practicum semester. The resulting practicum project is an example of a mutually rewarding experience for the graduate nursing administration student and the preceptor. $ REFERENCES American Association of Colleges of Nursing (AACN). (1997). Joint position statement on nursing administration education. Washington, DC: American Association of Colleges of Nursing. American Association of Colleges of Nursing (AACN). (1996). The essentials of master s education for ad - vanced practice nursing. Washington, DC: American Association of Colleges of Nursing. American Nurses Association. (2004). Scope and standards for nurse administrators. Washington, DC: Author. continued on page

7 Practicum Projects of Value continued from page 148 Fineout-Overholt, E., Melnyk, B.M., & Schultz, A.Z. (2005). Transforming health care from the inside out: Advancing evidence-based practice in the 21st century. Journal of Professional Nursing, 21(6), Harris, J.L., & Walters, S.E. (2009). Building a portfolio for academic and clinical partnership. In L. Roussel & R.C. Swanburg (Eds.), Management and leadership in nursing administration (5th ed.) (pp ) Boston: Jones and Bartlett. Herrin, D., & Spears, P. (2007). Using nurse leader development to improve nurse retention and patient outcomes. Nursing Administration Quarterly, 31(3), Hodes Healthcare Division. (2006). The 2006 aging workforce study. Atlanta, GA: The Bernard Hodes Group. Jones, C.B., Havens, D.S., & Thompson, P.A. (2008). Chief nursing officer retention and turnover: A crisis brewing? Results of a national survey. Journal of Healthcare Manage - ment, 53(2), Kanter, R.M. (1989). When giants learn to dance. New York: Simon & Shuster. 158