Presentation
An Innovative Educational Program to Expand the Roles of Pre-Licensure Students and Registered Nurse Preceptors in Community-Based Settings
Association of Community Health Nurse Educators
(2022)
Abstract
Purpose: What is Objective/Purpose of the study?
The current emphasis in health professions education on sickness care is not sustainable, and must be balanced with efforts to support healthy living, improved transitions of care, a focus on the individual, and improved integration of care (Lipstein et al., 2016). These are also the tenets of community-based care and are essential for all members of the healthcare team. Nurses have a long history of person-centered, health-oriented care dating back to Lillian Wald’s Henry Street Settlement in1893 in which she pioneered community-based, coordinated, integrated, and individualized care (Wald, 1915/199). Nursing and nursing education had foundations in community settings, although at present, nursing education is focused on acute care, and the vast majority of new nurses seek employment in hospitals (Kovner et al., 2014). There are many barriers for nurses to begin a career in community-based settings, but a major one is that they are not exposed or prepared in their educational programs.
Our HRSA funded project (2018-2022), Primary care Improved Outcomes with Nurses in Expanding and Evolving Roles (PIONEER), incorporates innovative strategies to enhance community/public health nursing education for undergraduate students working with medically underserved populations. Primary care capacity is decreasing, as fewer primary care providers are available, patients have increasingly complex needs, and payments to primary care settings are limited. This perfect storm has created unique opportunities for enhanced nursing roles in community-based settings, especially in the area of chronic disease management (Bauer & Bodenheimer, 2017).
The three main objectives of the project are to educate students in primary care settings through didactic and clinical immersion; support and educate currently practicing registered nurses at our clinical practice sites; and assist clinical partners in adopting primary care practices from the Learning from Effective Ambulatory Practices (LEAP) project. By building strong academic-clinical partnerships with six community-based primary care settings, the project provides robust clinical sites for nursing students while simultaneously educating and supporting currently practicing registered nurses towards full, patient-centered practice with vulnerable and underserved populations.
More specifically, the subgoals of our first objective, as stated above, are that 1.) At least 15 students per year will select PIONEER for their senior capstone experience, 2.) Students will attain an advanced beginner level of competence in primary care competencies and 3.) At least 75% of PIONEER students will seek employment in primary care settings in graduation and that at least 50% will be employed in primary care settings one year after graduation.
Materials and Methods: Please describe any methods used in your study.
Combining clinical education with a strong mentoring component is an effective method for graduating RNs who are capable, and committed to primary care as a career choice (Stark et al., 2001). The PIONEER project recruits students through a combination of an intensive summer “Primary Care Camp” (PCC) and financial support. PCC provides a two-week intensive between semesters and includes didactic content on primary care nursing, presentations from primary care professionals, site visits, and clinical experiences. PIONEER students complete their final clinical capstone course in community-based settings.
The clinical capstone requires 180 hours of clinical experience with an assigned RN preceptor. Topics related to primary care are introduced in earlier courses, but are not synthesized for practice, and this has been the focus of PIONEER. Historically, these clinical experiences were restricted to hospital settings, and by offering community-based settings, our project sought to shift this limited approach. A full-time Academic/Partnership Liaison (APL) was employed to facilitate the clinical experiences. The APL worked closely with students, preceptors, and faculty to ensure that students received robust clinical experiences that aligned with course objectives and required RN competencies. PIONEER students also benefited from other opportunities to enrich their knowledge and skills in primary care. Funds were provided to support student involvement in events such as disaster relief efforts, medical missions, or professional conferences. Throughout the PIONEER program, students received the didactic and clinical education needed for primary care practice, building on knowledge developed in previous coursework.
**It must be noted that the success of goal one, as described above, hinges on the education and support of primary care RNs and assisting clinical partners in adopting primary care practices from the LEAP project. Primary care nurses in our clinical partner sites are not only invited to precept our undergraduate PIONEER students, but are invited to engage with the PIONEER team and faculty through in-services, mentoring, and coaching. The APL is embedded in clinical partnership sites to work with, understand, and support the primary care RNs. CEUs have been made available by the university and affiliated Health System. The APL and faculty trained in areas of specific expertise (chronic disease management, care coordination, and behavioral health) have offered on-site in-services and developed self-paced, virtual modules available for CEUs. The PIONEER team most recently developed and launched two web-based, self-paced courses on Telehealth and Care Coordination, in the wake of the Covid-19 pandemic. While RN preceptors are essential for the education of the PIONEER students, RNs also benefit from the preceptor role. Engagement with students provides opportunities for professional growth, motivation to keep clinical knowledge and skills sharpened, and contributes to work satisfaction (Shpritz, 2006).
Clinical partners are given general operating funds to support enhanced RN practice. Additionally, PIONEER supported clinic partner for travel to Connecticut for a two-day clinic immersion at Community Health Center, Inc., an operating LEAP site, and individual consultation with Beth Ann Swan PhD, RN. Objectives and assessment strategies of these second and third objectives are not discussed in this abstract.
Results:
The number of students that selected PIONEER for their senior synthesis experience every year has approached or exceeded the goals for each year. There have been total of 43 students who completed the PIONEER experience, and an additional 18 students who are currently enrolled. Over the 4-year project, there are a total of 61 student participants.
Students’ attainment of advanced beginner level status in competencies in primary care competencies has been assessed using the , Entry-Level Public Health Nursing (PHN) Competencies Instrument (Henry Street Consortium, 2017), and Checklist of Primary Care RN Competencies (West County Health Centers, n.d), Pre- and post-semester data are analyzed for each instrument. At this point, results from pre- and post-surveys from the students who have completed the PIONEER program have not been fully-analyzed, pending completion of the final cohort.
Data on employment in primary care nursing are collected by direct contact with PIONEER graduates. Though not complete, the data to date provide insight about the current and changing attitudes towards community nursing and primary care. Of the first three cohorts (43 students total), 85% of the participants responded that they had taken jobs in acute care settings upon graduation, but at one year after graduation, that dropped to 70% (30% had roles in primary care settings). In addition, at the 1-year point, 75% responded that they were considering or actively seeking APRN or graduate studies.
Although some faculty were concerned that a clinical capstone in a non-acute care setting may decrease students’ readiness for NCLEX, 100% of PIONEER students have passed on the first attempt.
There are several challenges largely beyond the PIONEER scope that have been revealed during the program period. These include system culture barriers, lack of understanding of RN role and capacities and RN practice laws, physician- centered versus team-based practice models, and of course, the Covid-19 pandemic.
Conclusion:
By focusing on development of both the pre-licensure nursing student and RNs in primary care, the PIONEER project demonstrated effectiveness serves to advance primary care nursing and future of healthcare. It provides a model for successful academic-clinical partnerships in primary care and supports multiple goals that have been set forth in the newly released AACN Essentials (2021). For example, there is an identified need to increase nursing education’s focus on the essential spheres of chronic disease management and wellness and disease prevention, all of which have been integrated into clinical and didactic education as part of this project. Multiple domains are woven throughout the project's initiatives and serve to strengthen both the students and clinical RN partners, such as an emphasis on population health, quality and safety, interprofessional partnerships, and person-centered care. Additionally, by emphasizing the role of the registered nurse in primary care and community-based settings, the PIONEER project supports goals, such as valuing community and public health nursing and strengthening nursing education, that have been set forth in the National Academies of Sciences Future of Nursing report (2021).
References:
American Academy of Ambulatory Care Nursing (AAACN). (2017). Scope and
standards of practice for professional ambulatory care nursing (9th Ed.). Pitman, NJ: Author.
American Association of Colleges of Nursing (AACN). (2021). The essentials: Core
competencies for professional nursing education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf
Bauer, L. & Bodenheimer, T. (2017). Expanded roles of registered nurses in primary
care delivery of the future. Nursing Outlook, 65(5), 624-632. https://doi.org/10.1016/j.outlook.2017.03.011
Henry Street Consortium. (2017). Entry level population-based public health nursing competencies for the new graduate or novice public health nurse. Retrieved from http://www.henrystreetconsortium.org/uploads/1/1/1/9/11196081/henry_street_competencies_long_2017_[9.22.17].pdf.
Kovner, C.T., Brewer, C. S., Fatehi, F., & Katigbak, C. (2014). Changing trends in newly
licensed RNs. American Journal of Nursing, 114(2), 26-35. https://doi.org/10.1097/01.NAJ.0000443767.20011.7f
Lipstein, S. H., Kellerman, A. L., Berkowitz, B., Phillips, R., Sklar, D., Steele, G. D., &
Thibault, G. E. (2016). Workforce for the 21st century health and health care: A vital direction for health and health care. Retrieved from National Academy of Medicine website: http://www.nam.edu/VitalDirections
National Academies of sciences, Engineering, and Medicine. (2021). The future of
nursing 2020-2030: Charting a path to achieve health equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982.
Quad Council Coalition Competency Review Task Force. (2018). Community/Public
Health Nursing [C/PHN] Competencies. https://www.cphno.org/wp-content/uploads/2020/08/QCC-C-PHN-COMPETENCIES-Approved_2018.05.04_Final-002.pdf
Shpritz, D.W. (2006). A model preceptor program for student nurses. In J. Flynn & M.
Stack (Eds.), The role of the preceptor: A guide for nurse educators, clinicians,
and managers (pp. 15‐26). NY: Springer.
Stark, S., Warne, T., & Street, C. (2001). Practice nursing: An evaluation of a training
Wald, L. D. (1915/1991). The house on Henry Street. New Brunswick, NJ: Transaction
Press.
Keywords
- nursing,
- nursing education,
- primary care,
- preceptor training
Disciplines
Publication Date
Spring April 21, 2022
Location
Alexandria, VA
Citation Information
Hallel Basco, Kimberly Davis, Tamara Zurakowski, Dawn Goldstein, et al.. "An Innovative Educational Program to Expand the Roles of Pre-Licensure Students and Registered Nurse Preceptors in Community-Based Settings" Association of Community Health Nurse Educators (2022) Available at: http://works.bepress.com/tamara-zurakowski/3/