Partnerships for Professional Advancement Mary Etta C. Mills, RN, ScD, NEA-BC, FAAN Linda J. Hickman, RN, PhD, FACHE Funding Support: NSP II Grant, Maryland Higher Education Commission Health Services Cost Review Commission

Projected shortages of nurses vary across the nation Workforce Demand* Projected shortages of nurses vary across the nation MidAtlantic: 42% of RNs are over 50 yrs of age 12% growth 2009-2014 9% growth 2015-2030 projected 1%- 2% growth in FTE RN per capita *Auerbach, D.I., Burerhaus, P.I. & Staiger, D.O. (2017). How fast will the registered nurse workforce grow through 2030? Nursing Outlook, 65 (1), 116-122.

Advancing Academic Preparation of Nurses in the Workforce Academic-service partnerships with 24 hospitals over 10 years (2006- present). Purpose: Initial- MS preparation of RNs to expand clinical access in support of increased nursing student enrollments Expanded – RN-BSN preparation to assist in meeting the IOM objectives of 80% For utilization as Clinical Instructors, Mentors and Preceptors; Programs online

Academic- Service Partnership Model University of Maryland, Baltimore School of Nursing NSP II Project Director, Academic Program Specialists Develop nursing cohort & mentorship model Recruit, admit & enroll nurses to earn BSN/MS degree Service excellence onsite for NSP II students Cohort: keeping student groups together throughout the program; individualized mentorship Onsite academic advisement, counseling, progression assistance (LOA, etc)

Partner Medical Center SERVICE Partner Medical Center Appoint NSP II Coordinator/Liaison Promote NSP II in hospital communications Provide tuition benefits and possible incentives Administrative support for NSP II students Administrative support through nurse educator coordinator working with the NSP II program directors

Partnership Process Relationship building: CNO  Project Directors MS Nurse Educator Academic Prgm Specialists Nurse Staff/Student Working as a team to coordinate the program, mentor, advise and guide students through the educational experience and career progression, while sharing resources

Hospital Partner Enhancements Tuition Reimbursement Support Consideration of additional post graduate role as clinical instructor, mentor, preceptor, staff educator Evaluation recognition Expanded clinical access for Schools of Nursing

Academic Enhancements One on one on-site advisement throughout academic program Special assistance with academic matters Guaranteed course availability Flexible course schedule Dual Role preparation in Leadership and Education

Evaluation Outcomes 150 MS Graduates with Leadership and Education focus over 10 years Additional 165 BSN/MS projected 45 MS currently enrolled Availability of hospital based clinical instructors has led to increased clinical rotations Schools seeking clinical rotations at partner hospitals have enrolled 13.2% more students Graduates are hospital based clinical instructors, faculty, preceptors, mentors Clinical rotations of undergraduate students and with an individual preceptor: One hospital clinical usage increased from125 requests from a combination of 10 schools of nursing to 146 requests for a total of 580 students.

Graduate Survey Conducted in 2015 42 randomly selected MS graduates invited to participate Response: 22/42 = 52.4%

Demographic Characteristics Initial Nursing Degree: BSN: 77.3% (n=17) ADN: 13.6% (n=3) Diploma: 9.1% (n=2) Yrs of Experience: 6-10 yrs 27.3% (n=6) 11-14 yrs 22.7% (n=5) > 15 yrs 50.0% (n=11) Yrs with Current Employer: Range <2 to > 15 yrs Full-time position: Educator 31.8% (n=7) Clinical Staff 22.7% (n=5) Manager 27.2% (n=6) Other 18.2% (n=4) The majority, 17 (77.3%) had a BSN degree. 50% (11) of respondents had more than 15 years of nursing experience and most of them have worked with the current employer at least 6 years. (Years with current employer: most 7 (31.8%) had 11-14 yrs; next 5 (22.7%) had less than 2 yrs.)

Program Impact on Organizational and Teaching Activities Organizational Participation: Research/EBP (from 10.7% to 17.9%) Leadership and Management (from 9.3% to 17.9%) Teaching Involvement: Increased frequency of participation: CE Instructors (from 9.8% to 21.7%); School of Nursing Clinical Instructor (from 4.9% to 13.0%) Simulation-Lab Instructor ( from 7.3% to 26.1%) “Program impact” refers to the frequency of formal involvement. Although difficult to measure, respondents self reported the change in frequency of their organizational and teaching activities upon program graduation. Research activity such as development of research and EBP projects increased from 8 (10.7%) engagement to 14 (17.9%); Leadership and Management such as increased involvement in leading key nursing and hospital committees changed from 7 (9.3%) to 14 (17.9%). Teaching involvement: Although there were small numbers of respondents, increased engagement was notable. 10 graduates taught more than 30 semesters at 6 Schools of Nursing. (20 semesters were at schools other than UMD

Professional Maturation Notable Shifts in roles following program graduation: From To - Informal staff education Formal CE instructor 25.3% - 16.7% 9.8%- 21.7% In-unit preceptor SON Clinical Instructor 39.0% - 17.4% 4.9% - 13.0% Simulation-lab instr. 7.3%- 26.1% Staff education or staff development took on a more formal staff continuing education role. In-unit preceptor included precepting nursing students on an informal basis and changed to the more formalized Clinical instructor or simulation- lab instructor role. Overall there was a shift gain of 11.9% from informal staff education to formal CE Instructor and 26.9% gain from in-unit preceptor to the formal roles of SON clinical instructor and simulation-lab instructor.

Challenges Realities of Organizations: - Meeting health environment demands - Changes in project personnel, hospital education coordinators, CNOs - Increasing competition from new and existing programs - Adequate tuition support combined with work obligations 1. Environment of pressures to contain costs, maintain revenue stream, meet IOM recommendations. Budgetary drawdowns can result in tight staffing on patient care units and produce constraints making it difficult to ensure staff nurses can be released to serve as clinical instructors. 2. Seven hospital program specialists among 6 hospitals left for other positions and almost one-third of CNOs changed. 3. Many new programs 4. Some staff, after program admission, delay progression due to work and family commitments. Project personnel: realities of hiring (timing and availability); health issues

Opportunities - Academic- service partnerships through relationship building to promote professional advancement Creation of innovative positions built on combined practice and faculty roles Increased enrollment in schools of nursing to meet future health care needs Positions include new performance standards and expanded clinical ladders (such as Hospital based clinical instructors, extended practice to care coordination across levels and settings) As more staff complete program requirements there may be more flexibility and availability to provide preceptors for student clinical groups.