CNA to RN Without Leaving Home Miles Community College Miles City, Montana Shelly Weight, Vice President for Academic Affairs Karla Lund, Director of Nursing Kassie Taylor, Workforce Development Coordinator

Miles Community College Located in eastern Montana Montana has rural or “frontier” designation Population of Montana 957,861 (U.S. Census Bureau)

Region Served The region of the state served by Miles Community College’s healthcare programs is 66,000 square miles. The same approximate area of the New England states.

Eastern Montana

Rural Communities Miles City, Montana Regional Partnerships Population --8,120 Custer county population 11,188 Regional Partnerships Population of Glendive, MT -- 4,614 Dawson county population 8,558 Population of Sidney, MT – 4,746 Richland county population 9,182

Miles Community College 465 FTE 606 Students 62% Transfer students 38% Career and Technical MCC Registered Nursing Program Before Distance 28 graduates per year. After 2004 with Distance program 38 graduates per year.

Partnerships Glendive Medical Center & Sidney Health Center Letters of support FIPSE grant – Fund for the Improvement of Post-Secondary Education Foundations for Memorandum of Agreement Approval from the National League for Nursing Accrediting Commission and the Montana State Board of Nursing obtained.

Memorandum of Agreement Basic structure of services provided and benefits of the agreement. Responsibilities of both parties. Financial responsibilities of both parties including dollar amounts. Distance Education office contracts: Proctors ITV technicians Set up and maintenance of mobile lab for testing Responsibilities: Theory is offered over Interactive Television (ITV) Some classes, such as Professional Issues and Medical Ethics and Law are entirely online. All Testing is completed online. Preparation for NCLEX exam. CRRN’s and clinical hours provided at distance sites. Oversight by full-time theory instructors. Financial Responsibilities: Clinical Resource Nurse Test Proctors Travel Copies, postage and supplies Professional Development

Benefits to Hospitals What’s in it for me? Glendive Medical Center Before 2004 partnership Glendive Medical Center was short 10 Registered Nursing positions. They used traveling nurses. By 2009 they were no longer short of a qualified applicant pool. Last year 3 positions were filled by MCC graduates. The approximate yearly savings to the hospital has been $500,000. Scott Sanders Director of Human Resources

Benefits to Hospitals Sidney Healthcare Center “The partnership works very well—using two-year rotations to fill the vacancies we have. These graduates have filled critical vacancies we have in various areas.” Nancy Dennison, Clinical Services Administrator

Importance of a Career Ladder CNA Shortage Required to become an RN LPN to RN Completion Program ASN Program BSN Partnerships Masters Prepared Nurses

CNA Program through Workforce Training Miles Community College Miles City, Montana Kassie Taylor Workforce Training Coordinator

Certified Nurses Assistant Non-credit training program set up through Workforce Development Department Online Theory & Clinic Hours Approved by the Department of Health and Human Services Certificate of Completion Headmaster Exam

Partnerships Hospital or Nursing Home partnership for clinical hours Distance Sites Population of Columbus, MT – 1,959 Stillwater county population – 8,687 Population of Roundup, MT – 1,922 Musselshell county population – 4,498 Population of Circle, MT – 542 McCone county population – 1,676 Circle Roundup Columbus Miles City

Benefits of Partnerships Outreach Effective use of limited dollars & resources Collaboration between healthcare and higher education institutions Qualified workforce for region

Memorandum of Agreement Miles Community College responsibilities Enrollment services of approved candidates Theory training with State certified CNA instructor/director Instructional material Travel expenses Distance Sites Contact person Approval of candidates Required paperwork & medical records Clinical training with State certified CNA instructor All costs associated with clinical instruction Liability insurance

Statistics MCC Campus Students Distance Students Fall semester 2008 – Spring semester 2010 69 CNA Students 45% continued nursing education Distance Students Summer semester 2009 – Spring semester 2010 16 Distance Students Of the CNAs that completed program 45% hired at distance sites

Distant Education for Associate of Science in Nursing (ASN) Miles Community College Miles City, Montana Karla Lund, RN, MSN Director of Nursing

MCC Nursing Program- Partnerships have enable the Nursing Program to: Seek approval from Montana State Board of Nursing (MSBON) and National League of Nursing Accrediting Commission for expansion of distant sites in 2004 MSBON limits number of students in clinical 10:1 ratio 10 students in each clinical at Miles City Eight (8) students at each distant site. Partnerships assisted nursing faculty in obtaining scholarships BSN-MSN Masters in Nursing required for all didactic instructions BSN required by MSBON for all Clinical Resource Registered Nurses (CRRN’s). Masters in Nursing (MN) required by NLNAC for CRRN’s or in the process of obtaining MN. 2009 Of the six who did not pass two from a distant site, and four from the main campus. 2008 NCLEX pass rate 90%-Only two from distant sites 2007 NCLEX pass rate 70%-Five from distant site

Didactic: Local and Distant Sites Theory: Main Campus Lead Instructor On campus (30 students) ITV delivered to Glendive 75 miles north east of Miles City (8 students) ITV delivered to Sidney 125 miles north east of Miles City (8 students) Five to seven of these students may live 70 – 140 miles from any direction of Miles City. These students do not live in areas where partnerships are formed between MCC and local hospitals. Depending on the availability of ITV sites students can stay in their home towns for theory but will be required to come to Miles City for clinical one to three times a week

Clinical: Local Site Clinical: Main Campus Lead Instructor-MSN prepared Clinical experiences are supervised and directed by Lead Instructor. 10:1 Ratio at all clinical sites CRRN’s utilized when number of students for clinical exceed 10:1 ratio Students living in areas where there is not a partnership are required to travel (at their expense) to the closest available partner site. . Travel anywhere from one to three times a week for clinical experiences.

Clinical: Distant Sites Lead instructor responsible for all clinical experience distant sites Oversight Supervision of CRRN’s CRRN’s (Distant Sites) Under the direction of the Lead Instructor Student Supervision Student evaluations Preferable to find CRRN’s who live within the communities of the distant sites. Socialization: Students at distant sites come to main campus 4-5 times a semester. Each semester, Lead Instructors teach from a distant site.

How Far Do Our Students Travel for Clinical Rotations? Students who travel to attend clinical in Miles City 3 students from Billings – 135 miles 4 student from Colstrip – 90 miles 2 students from Jordan - 60 Students who travel to attend clinical at a Partner site: 1 student from Savage to Sidney: 21 miles 1 student from Plentywood to Sidney 85 miles 1 student from Wolf Point to Sidney: 92 miles

Unlicensed Assistive Personnel UAP 2005 Montana State Board of Nursing adopted rules that would allow nursing students to be employed as Nursing Student Unlicensed Personnel (UAP) Students have to be entering their last year of a nursing program Under direct supervision of an RN Advanced delegation duties: Medication calculations Administration of medications Insertion of peripheral IV catheter Hanging of IV fluids with out additives, adjust IV flow rates. Any nursing task which the student has received instruction with in a nursing program

UAP Eligibility Enrolled in a state nursing board approved education program In good academic standing Satisfactory completion of a nursing fundamentals course Satisfactory completion of a pharmacology course MCC Nursing assists any health care facility interested in UAPs. We do not administer the Program, however, we guide facilities to what they may need. Montana Health Network has partnered with many hospitals in eastern Montana providing UAP’s in small rural hospitals.

Support for Distant Sites Distant sites mirror the main campus ITV All student services offered on and off campus All clinical experiences are exact or comparable with main campus experiences Glendive and Sidney hospitals mirror Holy Rosary Health Care in Miles City. Rental of a human simulator Workshops-Learning Fairs MCC Nursing and their partners have a true symbiotic relationship that defy the distances between them.

Partnerships are Important With more animals than people living in Montana, we need to serve the needs of our constituents without over saturating the market. We have to make every effort to partner with other training programs, and healthcare providers, to deliver their workforce needs. -- Shelly Weight, Vice President of Academic Affairs Internal Partners – working with Distance Education Providers in your school.

Radiological Technicians Educational Partnership with Montana Tech College of Technology in Butte, MT. General Education and Advising Online Radiological Technician courses Clinical hours arranged in southeastern Montana Outline of expectations in Memorandum of Understanding. Students attend distance programs within 150 mile radius.

Future Programming Partnerships Pharmacy Technician with emphasis in telemedicine. Surgical Technician University of Montana College of Technology, Missoula. Med Lab Technician Bismarck State College, North Dakota.

Valuable Lessons for Rural Health Workforce Development Educate the people who have already chosen to live in your rural area. Use distance delivery methods to reach place-bound students with time restrictions. Healthcare and colleges must work together to provide valuable clinical training. Investing in education saves a hospital money over time. Invest in faculty training and growth to meet accreditation requirements. Montana Health Network

You Can Do It! Identify Stakeholders Identify Partners Who would program expansion benefit? Identify Partners What’s in it for them? Funding the Project How will we fund start-up costs? What are the projected costs of start-up? How will revenue be generated for program sustainability? Identify Technical Needs and Support Notify Accrediting Bodies What documentation is needed for accreditation? Split by Regions