Meeting the Future of Nursing Report™ Recommendations

A Successful Practice-Academic Partnership

Cindy Stout, DNP, RN, NEA, BC; Nancy Short, DrPH, MBA, RN; Kelly Aldrich, DNP, RN-BC, CCRN-A; R. Jacob Cintron, MBA, MAcc, BSIE, PE; Elias Provencio-Vasquez, PhD, RN, FAAN

Disclosures

Nurs Econ. 2015;33(3):161-166. 

In This Article

Introduction

Eight recommendations evolved from the key messages within the Institute of Medicine's (IOM, 2011) The Future of Nursing's Campaign for Action report. Two recommendations in the report specifically relate to this project. Recommendation 3 focuses on the implementation of nurse residency programs to support nurses' completion of transition-to-practice programs. Recommendation 4 focuses on increasing the proportion of nurses with a baccalaureate degree from 50% to 80% by 2020. The report calls for expanded clinical instruction through new clinical partnerships, and it recommends academic leaders partner with health care organizations to recruit and advance diverse nursing students.

Del Sol Medical Center is one of 163 hospitals in the United States owned by Hospital Corporation of America (HCA), a for-profit, publicly traded company. Del Sol is a 347-bed, acute care hospital in El Paso, TX, that services west Texas, southern New Mexico, and northern Mexico. El Paso is a diverse community with 81% of the population reported as Hispanic (City-data.com, 2012). In 2011, there were 34.1 average registered nurse (RN) full-time equivalents (FTEs) committed to orientation per month, translating to $1.57 million for orientee salaries, not including benefits.

Lee, Tzeng, Lin, and Yeh (2009) cite U.S. projections of 340,000 RN vacancies by 2020. Bowles and Candela (2005) cite new graduate nurse turnover at employment, while Kovner and co-authors (2007) report a 13%-75% turnover during the same time. According to estimates from the Robert Wood Johnson Foundation (RWJF, 2009), the average cost of replacing a RN ranges from $22,000 to over $64,000. Graduate nurses report they prefer additional clinical orientation time, more precepted exposure to technical skills, a wide range of real-life experiences, and more communication with physicians during their educational program (Chappy, Jambunathan, & Mamocha, 2010).

According to the IOM (2011), nurse residency programs provide a realistic experience for new graduates or those transitioning into a new area of practice. This dedicated time allows nurse graduates to transition into the workplace. Residency programs have reduced turnover rates, reduced costs, provided stability in staffing levels, and assisted new nurses to increase clinical decision-making skills and autonomy (IOM, 2011). Bachelor of science in nursing curricula prepare nurses to obtain better patient outcomes; however, national statistics show an additional 760,000 nurses must earn a BSN degree to meet the 2020 goal of 80% BSN-educated nurses (RWJF, 2011).

Pine and Tart (2007) used a cost-benefit analysis to determine a return on investment of $823,680 over 1 year for a nurse residency program. After 1 year of employment, turnover for residency program graduates decreased from 50% to 13%. Trepanier, Early, Ulrich, and Cherry (2012) concluded the 12-month turnover rate decreased from 36.08% to 6.41% and contract labor was reduced from $19,099 to $5,490 per average daily census as a result of a new graduate RN residency program. Additionally, Friedman, Cooper, Click, and Fitzpatrick (2011) noted a yearlong new graduate RN critical care orientation program decreased turnover from 12% in 2004 to 6.2% post fellowship in 2007. Gamroth, Budgen, and Lougheed (2006) cited the importance of paid positions for undergraduate nursing students with outcomes benefiting students, new graduates, and workplaces. Orientation time decreased and improved transition to the place of employment was reported.

A modified nurse residency program, called the Del Sol Internship Program, was created in collaboration with the University of Texas at El Paso (UTEP) as a strategy to manage these challenges. A BSN internship program similar to Del Sol's proposed nurse internship program was identified in Wisconsin. This Clinical Focus Program included enrolling and compensating senior nursing students in an intense orientation and resulted in decreased new graduate orientation costs for the hospital, improved retention to 100% in year 2, and improved staff feedback (Harrison, Stewart, Ball, & Bratt, 2007).

Outcome goals for the Del Sol Internship Program included (a) increasing the proportion of BSN-prepared nurses; (b) decreasing orientation FTEs, salaries, benefits, and recruitment costs; (c) producing competent nurses at Del Sol Medical Center; (d) measuring satisfaction of student participants and preceptors; and (e) tracking whether employment offers were extended to interns who successfully completed the internship and graduated from the UTEP nursing program.

A modified version of the Clinical Focus Program from the University of Wisconsin-Madison School of Nursing was used as a model for the Del Sol Internship Program (Harrison et al., 2007). Selectivity for the internship program was 79% (26 out of 33). Yield for the internship was 100%; yield for employment was 100%. Student nurse interns accepted into the program received a $3,500 stipend until they graduated and became hospital employees. In accordance with the promissory note, interns received this stipend based upon a pay rate comparable to a Del Sol nurse tech (senior level BSN nursing student) multiplied by the estimated number of hours the nurse interns were expected to complete above their committed UTEP clinical hours. The participants completed their eighth semester course rotations, including acute care and community practicums, at Del Sol in one of the following settings: the emergency department (ED), intensive care unit (ICU), cardiovascular ICU (CVICU), neonatal ICU (NICU), telemetry, or medical-surgical departments. Interns had the advantage of exposure to their assigned patient's continuum of care. For example, those selected into the medicalsurgical areas rotated through Del Sol's Wound Care Center, Diagnostic Center, and Diabetes Center to fulfill community practicum requirements. This allowed interns to care for their assigned patients pre and post-hospitalization. Del Sol's existing nurse orientation program was modified to fit within the timeline of the UTEP BSN eighth and final semester creditbearing clinical and didactic courses, the internship program, and post-graduation employment requirements. UTEP committed to changing their required didactic courses to 1 day of the week (versus the usual 2 days) to accommodate the intern's required hours in the internship program. There were 6 remaining days for the Del Sol team to provide additional clinical training time, above the required UTEP coursework. This schedule accommodation by UTEP allowed Del Sol to closely match the hospital's preceptor schedule.

The partnership between the academic (UTEP) and practice (Del Sol) settings was critical to the program's success. UTEP's guiding principles centered on excellence, innovation, and diversity; Del Sol's nursing department has similar pillars. The dean and the chief nursing officer presented the program to the students prior to the application process. Del Sol directors and UTEP faculty participated in the panel interviews for intern selection. This collaboration promoted insight from the faculty's classroom and clinical experience with the potential interns and integrated the director's perspective on preference for employment of future nurses. UTEP coordinated schedules with Del Sol and tracked the progress of the students during the internship program.

Upon graduation and successful completion of the intern program, the interns became hospital employees and completed the remaining portion of their in-hospital competencies. Importantly, FTEs were not allocated to the hospital budget during the interns' eighth semester because they were not yet employed with Del Sol. Instead, the stipend for interns was listed as a line item in the human resources budget. Once the interns were employed, they were then calculated in the hospital's total FTEs.

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