Online RN to MSN
Clinical Systems Leadership

IOM Future of Nursing Education Panel Discussion

As the industry continues to face the push for a more highly-educated workforce amid healthcare reform and an aging population, one challenge remains; accommodating this increased demand for nursing education.

In this panel discussion, Joan Shaver, industry thought-leader, Professor and Dean of the UA College of Nursing; Cindy Rishel, Clinical Associate Professor, Administrator, Nursing Research and Practice and Magnet Program Director, UA Medical Center; Cheryl Lacasse, Director of the online RN-MSN program; and Ki Moore, Anne Furrow Professor and Director discuss the IOM’s 2010 Future of Nursing report and how academic programs are evolving to address the changing landscape. In particular, our panelists will touch upon:

  • Key themes and recommendations from the IOM report
  • How nursing schools such as UA’s College of Nursing are revolutionizing curricula and instructional models to accommodate the diverse needs of today’s nurses
  • How online graduate programs like the RN-MSN in Clinical Systems Leadership program provide both the forward-thinking learning outcomes as well as the scalability to accommodate a larger student population
  • Degree path options for nurses who wish to pursue a future in education

Amanda Walter: Okay, let’s go ahead and get started. Again, we will have some people still joining us as we start. We have just over 15 people, or so, so far and are expecting a number of others but I did want to try to keep to today’s time. So, I just wanted to start by introducing myself. My name is Amanda. I’m the moderator of the Webinar today. We’re going to be focusing on the institute of medicines 2010 report about the future of nursing education and today’s session is a panel discussion. It will be a very interactive session where four key panelists are participating today. So, before I introduce them though, I did want to just really quickly go through some key logistics. The Webinar is being recorded. In case you do have to step out or miss anything or if you’d like to check back later and listen to the recording again or share it with any friends or colleagues, we will make that available to everyone in the coming days after the Webinar. And again, because as I said it’s going to be an interactive panel discussion, go ahead and submit your questions to me, the host, anytime in the Webinar today by using the chat window, which is on the right hand side of your screen. You can go ahead and submit those as we go along, as it pertains to the content of what’s being discussed, I might read some of them out for the panelists to respond to right way, others I might reserve until the end should we have the time to do an interactive Q&A session then as well.

So, really quickly, just introducing all our panelists before we get started with the discussion; number people we have Dean Joan Shaver with us. She’s the Dean of the College of Nursing and she’s also Professor in the program. Cheri Lacasse is also a Professor and she’s the Program Director for the online RN-MSN Program. Cindy Rishel is with us as well. She is a Professor in the program and she is also the Megna Program Director at UAMC, which is a medical center. And also, we have Ki Moore, who is our Faculty Administrator for the online program. And I guess I will turn things over now to Dean Shaver to kick things off.

Joan Shaver: Thank you very much Amanda and greetings to all of you in our audience. All of us are very happy to have you in the audience and be talking a little bit among ourselves and with you with regards to the topics for today. And the topics in the main have to do with the FMN dimensions 2010 IOM report, which, and will be harkening also to the Affordable Care Act because we all know that that’s changing a lot of how we’re thinking about delivering health care and those of us, as practicing nurses, have to pay attention to that. And the IOM report was really a call to action.

We’ll talk a little bit about changing health needs and health system dynamics that are causing the call for a shift in emphases’ and we have to pick, those of us in nursing education in particularly here at the University of Arizona College of Nursing, we’re looking at these kinds of reports to be guiding and helping us know how we should be transforming nursing education so there’s a good match to the kinds of things that are happening in nursing practice. And we’ll complete, today, our talk, dialogue, by talking about, a little bit, about the nursing work force adequacy because we do have some concerns about that over time, but as we see it, come challenges plus solutions equal opportunities. So, and we see a lot of opportunities coming in the direction of nursing.

You, in our audience, have embraced that, actually, more education will further your career, but let’s go to the next slide. I’m looking at another slide panel. The future of nursing report of the committee, considered a lot of things about the challenges that face nursing education and some solutions, but one bottom line recommendation was that nurses should achieve higher levels of education and training through an improved educational system that promotes seamless academic progression. And at the University of Arizona we’ve already braced these ideas and we’re, in fact, seeing that these were happening before the IOM report came out, but we definitely take this recommendation very seriously. And you, in our audience, have also embraced that more education will further your career and you are to be commended for having such foresight, but you would like to think that you’re coming into a modern or contemporary leading edge program that’s specifically designed for and recognizes your particular background.

Let’s talk a bit though about what is putting the pressure on changing how you need to think about attaching your practice in the future and how we need to think about transforming our education to match. On the next slide, you can see that the IOM report, which harkened, also, to the Affordable Care Act, which is one of our broadest tell system overhauls since 1965, and a lot of key factors could be mentioned but in particular we know that patient needs have changed to shift from acute care to chronic disease illness care, that we have an aging population. All of us know that, both offset as health care providers and the providers of patients, health care for patients as well as the patients are all aging and that within health care we’ve adopted a robust emphasis on patient outcomes, quality, and safety and everybody is still worried about the high rising cost of health care delivery.

I was looking at some figures and looking at how much we spent on health care in 1970, and it was about 75 billion dollars, that’s billion with a b. And by 2010 we were spending 2.6 trillion, that’s trillion with a t, but the numbers begin to get pretty mind boggling. And the estimation is, if we continue on this track, that we will be spending 4.8 trillion, 2.6 in 2010 to 4.8 trillion in 2021 and it will be accounting a fifth of our US economy, the productivity in our economy. The rate of increase has slowed in the past decade. It was nearly 10%, rate of rise was nearly 10% in 2002 and by 2010 it was roughly about 4% and it’s hovering in that area now, but it’s still well above the general rate of inflation, so everybody has that as a concern as well. And I know that, in this point in time, most of us have been watching multiple countries compete in the winter Olympics, so if you look on this next slide, you will see how we look competitively with respect to how much we spend on health care per person and as you can see on this slide, as the United States on the very left hand bar, that we spend quite a bit more money than lots of other countries in the world. And yet, the bad part of that, although we spend more money, our population health statistics are not as good as a lot of countries. Just to give you an example, we actually increased our life expectancy for our population from in 1990 it was 75.2 years and the life expectancy in 2010 was 78.2 years. So, we have improved life expectancy but when we were compared to 33 other countries that are well developed, wealthy countries like ours, we actually fell in rank against them. There’s a number of metrics that are measured but we went from, for example, from 20th to 27th out of 33 countries in life expectancy at birth, and we went from 14th to 26th for healthy life expectancy that is people being really healthy as they age.

So, clearly, costs are certainly a driver but not the only driver, but it was a good impatis for the affordable care act on the next slide, where there were a number of dynamics that we’re now looking to implement. Some of them aren’t as clear to us as others but there was certainly a call within the Affordable Care Act for substantially strengthening primary care, but in acute in speciality care, where a lot of us practice, there was also a call for an emphasis on care coordination and particularly transitional care. What is like? How are we helping people move from a hospitalized situation to back to their community and back to home? There’s an emphasis on disease prevention and wellness and I would say, particularly on obesity reduction because there’s a lot of contribution of our body weight and it’s increased to chronic conditions and chronic disease. And there was a lot of emphasis in that about trying to do things about preventing adverse events, for example, hospital acquired infections, but the bottom line being to redeem and ensure quality and then again there was the pesky bringing down cost.

Cindy Rishel, as faculty in our Magnet Designated University of Arizona Medical Center, could you comment on how you’re seeing the role of practicing nurses and ensuring the quality and safety of patient care?

Cindy Rishel: Sure, thank you Joan, I’d be happy to. We work very diligently in our organization through our shared leadership council structure on every unit to engage nurses at all levels to participate in the quality and improve patient outcomes. We, each unit has their own unique dashboard that their scores for the month are included for things like false prevention, catheter associated urinary tract infections, clap c’s etc. and there are a number of other data points on their dashboard. And the councils meet and they are, most of the participants are staff nurses on the unit and they lead the council and they make decisions about changes they want to make at the bedside, on their unit, to improve patient outcomes based on variances in their dashboard. Then we have higher level councils that are making decisions about more system wide changes throughout the organization. So, we really, the goal is to empower nurses at the point of care in all parts of the organization to take ownership and develop leadership skills so they can actually lead the change at the point that’s closest to the patient.

Joan Shaver: Thank you Cindy, and we really appreciate that you’re able to bring that kind of experience from the health systems into our programing in the College of Nursing to make our education very practical.

Cindy Rishel: Thank you.

Joan Shaver: You know, evidence shows that in today’s complex health system environments that patient’s safety is improved if the nursing workforce has a higher level of education, and again, kudos to you in the audience for recognizing this and I’m sure many of you are experiencing some of the dynamics Cindy outlined as happening, here, in Arizona.

One of the items on the slide that talks about significantly strengthening primary care. As a matter of fact, in the College of Nursing this morning, we had a guest come in who was talking, she’s a nurse practitioner for potentially considering joining us as faculty, and she made a presentation that that sort of very overtly highlighted that we’re not doing a particularly great job in primary care of particularly helping people prevent disease and engage in health behaviors. Her particular area, the presentation was made to us as faculty but several physicians and physician residents came over from rheumatology because her particular patient group that she provides services for have Systemic Lupus Erythematosus and as she looked at the literature and did some investigation herself, this particular group of people has a very much higher vulnerability to cardiovascular disease and to cardiac events, and yet it showed women with Systemic Lupus, most did not know that they had excess risk to cardiovascular disease. And most of them hadn’t been worked up within primary care for some risks that did exist, including Lipid control, etc. Showing that, indeed, we have to work harder and we, as nurses, can play a bigger role, I think, in strengthening primary care for the purposes of preventing disease and encouraging people to engage in healthy behaviors. Other comments?

Ki Moore: This is Ki and I would just like to comment that I think in following up to Dean Shaver’s comments, one of the exciting things about our RN to MS Program and hopefully some of students if they’re joining us would validate is that the program for patients graduate for leadership positions at the point of care and to be system leaders to coordinate and improve patient outcomes that includes health promotion within the context of illness in acute care settings for example. So I see there’s many opportunities for nurses to take the lead in integrating health promotion which is traditionally thought of as more of a disease model.

Joan Shaver: On the next slide, and I’ll read this until you can see it or we’ll skip over it if we’re beyond it by the time this comes back, but we all know that we provide a large amount of health care. We are the largest professional group and that we need redesigned and more education than ever before and lots of those reasons have to do with meeting patient’s needs, as mentioned, but leading health care transformation that is creating new models of health care are an imperative. Collaborating with multiple professions, there’s more and more of an emphasis on what this team based care looks like and within our educational programs, we have a focus on making sure we are increasing our skills with respect to team based care, as well as investigating what needs to this safer higher quality patient centered care.

Cindy Rishel: I totally agree and I think one of the courses that, actually I’m teaching right now in the program, is the health care business dynamics force which focuses on program development, cost effectiveness evaluation, how you develop and support different programs to improve outcomes in the patient community but there is a strong movement across the country towards inner professional practice and partnerships among all the professions that provide care to patients and their families and it’s very exciting. I think we’re going to see more and more nurses taking the lead in these programs across hospital systems; not that nurses are going to be directing everything, but we’re going to be spearheading the groups that are shaping the policies and procedures and the programs are going to be developed in large hospital systems and even in smaller hospitals to actually streamline and improve the quality of care that we’re delivering and improve our outcomes and also with the intent and part to drive readmission rates so that patients, once they leave the hospital, stay in the community and don’t come back in again for things, problems that could be easily managed in an outpatient basis.

Joan Shaver: Thank you Cindy. I know that at one point, I noticed, outside of the hospital, I think we have to realize that we have increasing opportunities that are community based opportunities as well. And a little more thought on the part of all of us have to go into the quality and safety issues when we get into community based care. I see lots of opportunities for nurse practitioners for sure, but also RNs and primary care in clinics where they are the patient coordinators of care, they’re the patient navigators through the system, there’s these roles where sometimes the quality and safety element has sort of colored, and most appropriately, in hospital care but we have to also consider the same kinds of principles I think when we get into community based care.

So the IOM report, the future of nursing report, as sort of a bottom line conclusion that especially spoke to us in nursing education is that, if nurses are to succeed in this increasingly complex and evolving health care system that that nursing education would need to be transformed, and they sort of made three points. One was; improve the educational system, and especially create multiple educational and career pathways and make sure that they’re enough nurses, have the capacity within the educational system to create enough nurses with the right skills, and I don’t think many of us have escaped one mantra that came out of the IOM report, which was that the proportion of nurses that have a bachelorette degree be above at least 80% or above by 2020 and that we double the number of nurses with doctoral degrees.

In thinking about our program when we were thinking about how could we help contribute to making sure the IOM report outcomes were achievable, was that although it says 80% should have a bachelorette, we put an extension on that and say “or more” because, for us, we have seen that the shift in doctoral advanced speciality practice is shifting, not shifted completely, but is shifting to a practice doctorate, frequently called the doctorate of nursing practice and that leaves the master’s degree to be a generalist, enriched generalist degree, in ways that wouldn’t happen if we weren’t shifting speciality practice to a doctorate. So when we thought about what kind of a foundation to build a program on for looking at more systems transformation, we elected to say RNs who have studied in the field already it’s a wonderful foundation on which to build then a generalist master’s program. Any comments? Does anybody want to make more comments?

Cheri Lacasse: I think one of the differences, I’m Cheri Lacasse, and I think one of the beauties of looking at the group of practicing nurses is their richness in experience and wisdom in the field of nursing and what they bring to the table for transformation of the health care system. So, most folks who have practiced for a while have seen at least one thing that they wish could change, and experiencing the skill building and some of the wisdom of colleagues and understanding what leadership is all about, really brings a whole new dimension to, how can I make this change in my facility or in my system or in the group of systems that I work for? So, I think that’s something that we always look forward to.

Joan Shaver: Thank you. You know, when we looked at the IOM report, there were some key points for strengthening nursing education that we really have tried to pay attention to in our college, and those are, they called for in the report, more patient’s centric health care. Again, we’ve already mention primary care and more of a prevention focus. They emphasized that care would be moving to be much more community based over time and that care needed to be much more coordinated. So, what the IOM report called for that spoke to us, as came out of also the Affordable Care Act ideas and that we needed to think about coordinating seamlessly across health conditions, coordinating across settings for health care, coordinating across providers. So, Cheri, can you give a couple of examples of any rate of health faculty who planned our RN to MSN program, we’re already trying to imply these emphases.

Cheri Lacasse: I think one of the things that we talked a lot about is how can we help people to develop a skill set that is very flexible in today’s health care system that can go across settings, that can go across different transitions that patients may be experiencing and we know that, with our aging population, we’re not just coordinating cardiac care. We’re coordinating quality and safety in a cardiac patient who may have just been diagnosed with cancer, who also has diabetes and working with a team to balance all of that and making sure patients get services exactly where they need them. That is the bedside approach, but also looking at the system around that patient. How does the patient fit within the system? Is the system working for the patient? Is it not working for the patient? How can we change that system to be more patient friendly, to be more family friendly, and being able to give nurses tools to be able to do that because that’s really beyond the basics.

Very often in our basic education, we just touch on some of those things, but as people are out in practice they learn a little bit more of what they’d like to change and sometimes people are feeling like they don’t have the skill set to be able to do that.

What I hear a lot from our students who are currently in the program is that they wanted to further their education so they felt worthy to have a seat at the table. So when changes are being discussed, they felt like they had something to contribute and the confidence to do so.

Joan Shaver: Great, thank you. Are there, is there a particular course where we would be focused on prevention in particular within the program? I was thinking the population health course, but of course Cheri has more expertise, but the population health course and the person who teaches the population health course was the previous director of the health department in our county, but it really focuses on health promotion and risk reduction across settings and patient population. Do you want to add anything to that Cheri?

Cheri Lacasse: So we have the population health course. We also have a health promotion course and it’s very interesting. Our health promotion course not only talks about health promotion of patient populations, but also really talks about something that we hardly ever do for ourselves in nursing and that is self-care, and it’s so important to weave that through what we give to our patients and what we need to do for ourselves.

We also have a course that’s somewhat unique, which as I’ve looked across programs across the country that we don’t see very often and that is a course on healing environments, and what does a healing environment look like from the prospective of the nurse who works there or the health care team that works there? Also, what does that look like from the perspective of the patient and the family and how can we, all together, create a healing environment that will work for all of those involved to help people to progress to their next level, whether it be the next level of care or their next step in the healing process. So, there’s quite a few courses that really combine to look at some of those aspects. Again, with the IOM report, there is a huge emphasis in, not only quality and safety but a patient centered care. And the other thing that I found fascinating is practicing nurses, when they’ve come into the program, have said “I thought I was doing patient centered care. I thought I knew what that really was,” and then after really delving into it, have found a whole different perspective and appreciation for how they might be able to do that better than they are, and the fascinating thing to me is people are so excited about what they learn, especially around patient centered care, they’re taking that back to their colleagues and infusing new knowledge right into the work place. So that’s one of the benefits of furthering education is to be able to have that excitement of learning something new and then taking it for a ride, if you will, right in your workplace and see what works, what doesn’t work, what do people think about these concepts, so really raising the level of care in a lot of different areas.

Amanda Walter: Okay, and actually, you know what, while I advance to the next slide, why don’t we use this as an opportunity to address a couple of the questions that has come in?

Some people have asked with the industry pushing for more advanced education, they’re curious why lower level or like deployment programs or associate programs would still be around and accredited.

Joan Shaver: That’s a really good question. You know, I see it as always being in kind of a shift mode. We’re shifting, on the basis of the dynamics we’ve talked about, we have to shift over but nursing is huge actually and actually nursing education is very large. I do not know how many accredited community college nursing programs there are but I do know that there are over 650 probably closer to 800 university level nursing programs in our country. So, shifts are always a little bit slow and you have infrastructure that you can’t afford to dismantle because it’s important to not throw the baby out with the bath water as it were.

What I see happening, though, is a number of, and I think this will happen even more so over time, connections between community college programs and university entry into the profession programs. And perhaps at some point, and I know they’ve done this a lot in Canada as a matter of fact; they actually created what they called university colleges. I thought that was kind of a blended name and they decided what is best done through the community college faculty who originally were at a community college faculty and what would be best done by the university ones. I believe, over time, that’s likely to happen here. Do you want to make more comments?

Cheri Lacasse: I agree with Joan. I think that we’re just very slowly trying to figure out the smoothest connection in the nursing education process and it is going to be an evolutionary process because community colleges do the very basic education very well, as do universities. So the question is, how can we all work efficiently and effectively to do what we need to do from the education perspective?

Joan Shaver: And I think, actually, the future of the nursing report actually called for making sure there are those connections but bureaucracy to bureaucracy, as you know, is challenging to create those connections but it will happen.

We hadn’t really talked too much about this. Again, at looking at the reports of a call to action and what we’ve been trying to pay attention to as we’ve thought about transforming our nursing education, they, of course, called for us to build diverse and transferable skills, which I think Cheri was mentioning in your comments, that being highly specialized and highly compartmentalized in what you do as a nurse is not serving the system as well as being a little bit more diverse and transferable. Of course, there’s a stage where you can become highly specialized as well and to offer evidence based learning and leader mentorship, which also speaks to us.

We’ve mentioned that the call was for multiple educational and career pathways and they especially, maybe that was partly the nucleus of the question that was just asked, but to bridge programs to streamline progression between undergraduate and graduate levels. We say between entry to the profession and advancing in the profession levels because, actually, we have an entry to the profession program that is at a graduate level. It is also a master’s degree. It’s called a master’s entry to professional nursing. That’s for people who we’re building the foundation on an already existing university degree in another field. So, graduate and undergraduate is beginning to mean different things than just BSN and master’s or doctorate, and so we talk about entry level programming and advancing in the profession programing. And then it called, also, for accelerated curriculum that recognized work experience and that was very much, Ki do you want to comment very much on our thinking when we designed the program?

Ki Moore: Yes, thank you Joan. This is Ki. One of the things we thought about in designing the program is how to minimize the number of prerequisites and how to stream line so the students could progress in a quicker more fluid way. So, we recognize the work experience and expertise that practicing nurses bring back to the educational arena and so there are no prereqs other than statistics of someone hasn’t had a course in the past five years. Because we recognize the depth of knowledge and clinical expertise that practicing nurse bring to the field, so that’s one way we have worked to facilitate and stream line.

The other is the program and Cheri Lacasse can speak to it in more detail, is designed on a carousel model where students can take courses as they appear and they don’t necessarily have to take courses in a prescribed order other than the first two courses in the program; so there’s much more flexibility in progressing in the program efficiently. Cheri, do you want to add to that?

Cheri Lacasse: And I think that particular model helps students to really work their life, their work life, and their student life into a balance that works for them. So, it does make it highly flexible and the fact that we have, this particular program has three entry times, which is not necessarily the usual for an entering program. So, we’ve tried to build something that’s very flexible for today’s working professional who has other responsibilities and I think when we look at the richness of not only the students that we have in the program now, but the depth of experience that they come with that really lets itself, for them, to be able to get more out of their educational process because they’ve had some experiences that they get really drawn and re-evaluate and learn from in ways they’ve never been able to do before and in a guided fashion with mentoring from faculty.

So, with respect to these elements as you pointed out, I think we really feel like, at least for the associate degree holders, we’ve bridged the bachelorette to the master’s degree with this program. We did design it from scratch. We didn’t retro fit an RN to a BSN at all because we really wanted to focus on a political systems leadership and understanding systems because RNs already have a lot of experience with one on one patient encounters, which is funding in programs.

At our college, actually we’ve also, and we’re still working on some elements, but we’ve tried to create expedite ways to get other degrees actually past the generalist MS degree. The next step for some people who want to stay highly involved in practice is, of course, a practiced doctorate, in our case it’s a doctorate of nursing practice. Presently for NP roles and, also, we have a PHD as preparation to be a political science host. And certainly, in the case of faculty physicians and colleges of nursing, we actually have faculty of both types. We have faculty with doctorates that are DNPs and faculty with doctorates that are PHDs and we have many people with the MS degree that assist across many of our programs.

So, we’ll go to the next slide, and as I said at the beginning this is another element of concern is whether or not we can maintain an adequate nursing work force over time. We’re talking about shifting, a little bit of a skill shift and emphases in what we do in practice and I see nursing positions just growing immensely. A lot of them are community based now, but also health system based and they may be in basic or general care, as well as advanced specialty care. Almost everybody is coming to me as a Dean and wanting to know about our graduates and particularly whether or not they can hire them, they can persuade them. I see it being very much a growing [verging] field to be in nursing. I always say you can create a string of careers and stay within nursing as a matter of fact. Some people are worried about nursing; you’ll see press about nursing schools rejecting students, candidates, and I was clarifying for someone that that’s basically at an entry level, not for people who are in a more advanced level because, and the entry level challenges have to do with a shortage of clinical placements and they need faculty. And we’re creating many solutions to get around that and we also know you’ll see press that a lot of nurses are nearing retirement and we’re pretty concerned about all kinds of nursing practice because of that but particularly our organizational and faculty leaders.

So there’s a number of solutions. All of these have different solutions, they’re kind of different challenges but I think one solution is to create innovative active learning formatted programs and enabling technology so the people have, nursing people have access, nurses have access to programs. Redesigning clinical experiences if we’re on the entry level programs and expanding stimulation. We’re creating new partnerships, I think, between practice and educational formades, and then there’s extended financial support for nurses and I’ll speak to that in a minute pursuant to that last question, but Cindy Rishel, can you comment on what you’re saying in new partnerships between practice and education, at least here in Tucson?

Cindy Rishel: Sure, absolutely. We, at the University of Arizona Medical Center, have a strong partnership with the College of Nursing, but we also provide clinical opportunities for the other educational programs in our community but we have worked very aggressively to design opportunities for students that will also help meet the ongoing staffing needs in our own organization. We’ve just recently started programming the entry level courses with our operating room. So, you know, I think everyone, both in the practice setting and in the educational setting, is certainly willing to try new ways of accomplishing the educational process, but also helping to meet the needs of the facilities of where nurses are going to be working.

We also support nurse practitioner students in our clinic and in our acute care setting. We have many of our students in this program work in this facility as well and we are offering opportunities for them, you know, for their practicum experience and they have a wealth of knowledge to pull from.

We also have a lot of students who go to our outpatient cancer center, which is an NCI designated clinic. We actually have two clinics, so I think, and we will continue to develop those opportunities, both in the acute care setting because there will always be patients coming to the acute care setting no matter how much community based care we provide, we still have people who become so ill they must be there. So, I see it as a real valuable opportunity for all of us to support the learning needs of the students while also helping to meet some of the challenges that we’ve faced on the academic medical center site. We also facilitate research opportunities and evidence based practice projects opportunities between students and faculty in the college of nursing who want to come into our facility and do their research here or engage in us, helping us develop innovations in our evidence based practice.

Ki Moore: And, Cindy, this is Ki. I think another example is that we are working to develop a UA nursing unit at the UA Medical Center, which is designed to be sort of a model for evidence based practice where we place our honor students to do honors projects and sort of have it be the premier model of how we bring together academic and clinical nursing.

Cindy Rishel: Exactly, and there’s just many different ways that we can partner together to meet the needs of our patients.

Joan Shaver: Thank you. I think if we think about care coordination, also, there’s just lots of opportunity to be creating both educational, we weave education to every experience that we can, I think.

Let me just say, I know that the comment was made that, of course, education is expensive or getting more expensive. I think there’s growing expense. Part of that is for a variety of reasons but we’re in a state assisted school, University College of Nursing and, in fact, state legislators have seen it fit to support universities in the same way that they used to. So, I think it does pass on costs to be a customer so to speak. We all feel that’s unfortunate but it’s the lay of the land at this point in time. The federal government, though, has created some, certainly opportunities for support of students who, the good example that we have are students who want to become teachers ultimately and I have heard that many people who come into our programs have in their mind, at some point in time, being able to do more within the teaching realm. And we, as aging professors, all herald that idea and cheer on that idea but for example, we have a nurse faculty loan program where we submit to the government a way for people to come to our college to study for one of our degrees and we have an extra, sort of enrichment component to that that prepares people to be faculty at the same time. There is some, if you get that kind of funding, there is some payback in the sense of a designated period of time in which you work with a college of nursing or a school of nursing.

It has been, in the past and as far as I know, it’s still relatively true that, for practicing nurses in many of their institutions, they get support to go to school and that’s another form of support. It’s where the employer is interested in supporting their workforce, I think. There are other loans that, of course, can be made and scholarships. And as a matter of fact, at our school, we do raise quite a bit of money for scholarships but we have a large group of people across many programs who apply for those scholarships. Other comments?

Cindy Rishel: This is Cindy. Just to tag in to what Joan just said, I do agree, certainly in our organization, we have a very generous tuition reimbursement program that is open to all staff, really, who want to pursue additional education but for the nurses, the amount of money that is available is very generous. It has increased by 100% over the last few years and as we move forward, I would expect that that would continue to grow because the organization clearly appreciates and recognizes the value of additional education for the nursing staff and that that will be a real driver in helping us improve our patient outcome. So, I think, you know, most organizations have some type of program like that that focuses on that then too, and it is a lifetime, for us it’s a lifetime benefit. So, it’s not that if you use it up in a year it’s gone. You can use it until you’ve accessed all the money through there.

Joan Shaver: So, let’s conclude our discussion on our dialogue with a summary on the next slide that has some of the features, a lot of them we’ve mentioned of our particular program and then, Amanda, if there are other questions from the audience, we’d be happy to respond to them.

But because, in thinking about the IOM report and the Affordable Care Act dynamics, which sort of spoke to us in saying that we needed to make education certainly convenient for working RNs, which I assume is a lot of you in the audience. We constructed this clinical systems leadership program, again designed without retrofitting it to any of our other programs to have two pathways to serve RNs with associates degrees or bachelorette degrees, either one, although the associate’s degree is a little bit longer because we’re bridging to the bachelorette.

It’s designed to recognize prior studies. We really had a strong feeling that graduating from a community college, for example, you had really strong backgrounds in our prerequisites already in, of course, nursing one on one patient encounter basics and that we could go beyond that in this kind of a program. We designed an entirely online format with a creative guided learning model. Online for us, we’re interested in reach to the nursing working community in whatever ways we can and my feeling has always been that as we’re still predominantly women, even men can’t always pick up and move and would like access to a really high quality program. Emphasis on unique health care transformation, as we’ve mentioned on patient’s safety evidence basis we’ve mentioned and we’re streamlining the options for pursuing even at more advanced degrees or certificates because we like to think of it if you become a Wildcat nurse that we we’ll always be able to help you in your career developments over time. And truthfully, we have a really standout experienced faculty and some of them are on the call today and I have to say, as the Dean, how much I appreciate the dedication of our faculty to our programs and they’re motivated to seek optimal student success.

So, panelists, would you like to add anything to that? I know we’ve mentioned a number of other advantages in the course of this conversation.

Cheri Lacasse: Thank you Joan. This is Cheri and I think one of the things I would like to emphasize is that although each course is unique, there’s a standardized approach and one hurtle that online students always scrapple with is, if you’re coming back to school, how do I be a graduate student? And then secondly, and no less importantly, how do I deal with this electronic world that I have to learn in when I’m a traditional learner? And I think students have a settling in period that they go through and I think once they go over that hurtle, really the world opens up to them.

The dynamics that we see in groups across the country, we generally do not work with students in this point and time with our particular program outside of the United States, but we have so many different experiences that are shared online that it really makes it so rich and you can’t get that in your own institution. It’s truly tremendous. I was just reading a project actually from someone who works in Hawaii and their coordination of care that has to happen between islands was outstanding. So there’s lots of opportunities to learn from colleagues.

Joan Shaver: So, let’s go to the last slide Amanda and were there any other comments or questions from the listening audience?

Amanda Walter: Some of which you’ve touched on in some regards but maybe you could elaborate. Obviously, in many discussions we’ve talked there’s many ways people can move on to become educators in some capacity or another. What options do students have if they want to move into a teaching realm? Obviously there’s certain prudentially required at a faculty level within the universities, but what are options or pathways that students could pursue or how could they go about becoming teachers down the road in outside of necessarily taking another full degree?

Ki Moore: Well, this is Ki. I’ll start. There are options because we have different levels of faculty depending on their level of preparation and the degree to which they’re contributing on their expertise. For exampling; in our entry programs, which is both our BSN and our MEP and our master’s entry to professional nursing, the majority of our faculty are master’s prepared clinical experts who bring their expertise from their specialty area and then develop, also I would say and improve, their lecture delivery style. So, they do both clinical supervision and clinical theory lecturing for our students. So we have what’s called clinical instructors and sort of a clinical instructor role that does not require the doctoral degree.

We do have some people with doctoral degrees teaching in our entry programs. Many of them teach in our PHD and our DMP programs. So, it’s mainly linking the faculty members’ expertise with that particular part of our program and there are opportunities.

Joan Shaver: Yeah, I think in most community colleges and universities, there would be a minimum of a master’s degree. So having a master’s degree is usually the issue and then there are different positions that can be held in either one of those kinds of agencies. I think there are opportunities within health care systems to have educational roles as well. Can you think of anything else?

Cheri Lacasse: I’m just thinking, the role of a nurse as an educator doesn’t mean only with students. It can mean with lots of different groups so you could educate the community, you could educate students, you could education physician colleagues on a team. You know, I think nurses have an inherent role in that educator but I know there’s some formal pieces to that, as well as what we do every day.

Joan Shaver: And I think there are certain universities or colleges that have certificates for teaching and actually we’re contemplating. We don’t have one at this point in time. We do have, in our faculty loan program, we have the opportunity for students to mentor with the faculty and we have a couple of courses but we don’t have a full-fledged certificate but certainly we’re contemplating that but there are some universities who have done that as well. Other comments Amanda?

Amanda Walter: Yeah, hi. So I think something Cindy has touched upon in some previous conversations ties into that about, like you’re saying, it doesn’t have to necessarily be teaching in a formal capacity in an academic setting. You know Cindy, maybe if you could share some experience of what you’ve seen and how some nurses are already kind of defining their own pathways within, you know, settings such as UAMC or…?

Cindy Rishel: Sure, yeah I’d be happy to. We have a formal staff development and education department, which is fairly common in most larger organizations and their focus, of course, is on working with all staff, not just nurses but with other clinical staff, but we have also developed in the last two years or so a unit based educator role for our non ICU units so we have nurses who are interested in providing additional or doing some teaching on the unit and working with, not only new graduate nurses, but with their colleagues on the unit providing their educational opportunities. So they have, each unit now, has one of those nurses who also provides direct care so they have sort of a dual role and that group has also formed and is moving forward with developing more of a professional model on each unit and helping nurses identify steps that they can take to further their own professional development in that area and their educational opportunities. We have nurses who precept new graduate nurses coming in and there’s educational opportunities there so they’re getting a chance to help teach, but also being mentored by people who have been preceptors before have more experience in that area; we offer them some classes in how to be a preceptor. And, again, there’s also just teaching at the bedside so it’s not just teaching other nurses but how are you working with patients and families and creating those opportunities so that we’re providing that level of support to them so they will be more successful when they leave the hospital.

Joan Shaver: Yes and thank you, Cindy, for expanding that and, actually, here at the University of Arizona, the staff development contingent from the University of Arizona Medical Center have their offices and use the classrooms in our college of nursing. Luckily we sit side by side. So, we have that partnership as well.

Amanda Walter: Something else I had come up is talking into the streamline pathway as a progression through different degree levels. This, the RN to MSN program not specifically being a clinical program itself, how would it potentially transition into a DNP type degree?

Joan Shaver: Do you want to speak to that Cheri?

Cheri Lacasse: Sure. It’s a slightly different focus. So, there is a very smooth transition from the clinical perspective but the difference will be that they’re, the RN to MS is foundational to advanced practice leadership and there is some translation of some of the concepts that are taught in the master’s level, but there will also be a lot of advanced clinical that will go along with that and advanced clinical leadership in that realm of clinical care.

Joan Shaver: In the DNP.

Cheri Lacasse: In the DNP. In the PHD, it’s a bit different because the focus is different. It’s on creating science so there’s different skill sets that will be developed should people choose that particular pathway. So, there’s lots of different pathways to choose beyond our antenna.

Joan Shaver: Yeah and the DNP has specialty tracks because it is meant to be advanced specialty practice and different universities have different tracks, but in the case of ours, right now, they’re NP tracks so it’s family nurse practitioner pediatric nurse practitioner acute care nurse practitioner which is probably a transition for people who work particularly in hospitals and we have mental health, psychiatric mental health nurse practitioner. We are in the process of hopefully pursuing, but we aren’t accredited yet; we have to be accredited first to have a certified registered nurse anesthetist program, for example. And coming from a generalist program to a speciality program at an advanced level, there’s still the advancing to do so to speak.

Amanda Walter: Thank you so much and I know we’re running out of time here. So, why don’t we go ahead and wrap up for today. What I will do is I’ll leave the web in our window open for a while with the chat window so if anyone has any further questions that I can direct back to the panelists afterwards or to someone from our recruitment team, certainly just submit them there. I’ll leave it open for another 10 minutes or so and, likewise, if you’d like to have an advisor follow up with you, just leave your number and email address and a preferred date and time or a few options and I’ll have someone get in touch with you.

Otherwise, I just wanted to thank everyone so much for their time joining us. Obviously, I want to really thank our panelists for their time and flexibility with the technical issues we had but thank everyone for staying on the line with us. We really appreciate your time and we look forward to hopefully welcoming you to the U of A very soon.

Joan Shaver: Let me say, on behalf of the panel to the audience, we thank you very much for joining us. We are the Wildcat College of Nursing and very much enjoy having contact with people from all across the nation.


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