PROMOTING THE FIELDS OF NURSING AND NURSE EDUCATION THROUGH SIMULATION 2010 NAO Conference, Las Vegas Amy Nelson, AHEC of Southwest Oregon

Nursing Shortage Nationwide  Over 2.5 million RNs working as nurses in 2004 (of 3 million registered) ¹  Projected need of more than 3.2 million RNs in  Nearly 0.5 million replacement RNs needed 3  RN population is aging; % older than 50 years 1 :  25 percent in 1980  33 percent in 2000  45 percent in 2008

Nursing Shortage Nationwide Source: HRSA National Sample Survey of Registered Nurses 2008 Initial Findings

Nursing Shortage in Oregon  Current nursing workforce estimates 5 :  Number of licensed nurses: 37,170  Number working as nurses: 33,773  Aging population (patient & workforce)  Estimated number of nurses needed in 2018: 37,427 5  Number of job openings projected annually due to growth & replacement:

Nursing Shortage in Oregon Source: Oregon State Board of Nursing; Oregon Center for Nursing. (2010). A Brief Review of Nursing Workforce Research from The Oregon Center for Nursing. Portland, Oregon: Oregon Center for Nursing.

Nursing Shortage in Oregon  OCNE (Oregon Consortium for Nursing Education) efforts to increase enrollment in statewide programs since 2002 successful  Four to five qualified applicants for every available slot in a nursing program 4  Limited number of qualified faculty is key contributor 4  6.8 Student-to-faculty ratio in 2008 vs. 3.6 in 2001  Half of nursing faculty predicted to retire by 2025

Expanding & Promoting Simulation in Nursing Education

Expanding Nursing Education  Oregon Nursing Leadership Council strategic plan (2001) identified developing and using clinical simulation as a strategy to increase clinical opportunities and meet OCNE goals. 5  Governor Kulongoski’s Healthcare Workforce Initiative (2003) recognized simulation as key to increasing healthcare workforce training capacity by developing additional clinical training “slots” using simulation. 5  Oregon Simulation Alliance was formed to develop a plan to create statewide network of simulation centers 5

Promoting Nurse Education  Nursing students experience the difference between teaching in a clinical setting at the patient bedside and teaching in an academic setting in a controlled scenario  Studies indicate that encouragement from faculty and/or advisors is an important influence in choosing a career as a nurse educator 7

Promoting Nursing  High school students experience patient care from a nursing perspective in a realistic scenario  Simulation enables high school students to:  Realize what nurses actually do  Dispel myths they may have about the profession  Determine if this career is of interest to them

Promoting Nursing “The most effective strategy for ensuring youth are exposed to health careers and have the opportunity to prepare adequately is to provide intensive work- based learning and career exposure combined with academic preparation during middle and high school…". 8

The Pilot Program: 2009

Partners  OHSU (Oregon Health Sciences University) School of Nursing (Ashland Campus)  Nursing students & faculty, simulation lab & equipment, scenario development  Grants Pass High School, Health Services Instructor (Advanced Medical Skills Class)  I.V. arms & materials, students, classroom & class time  AHEC of Southwest Oregon  Impetus, communication facilitation, transportation to sim lab, release forms, thank you gifts

Goals  Create an opportunity for high school students to participate in activities in the simulation lab  Provide nursing students an opportunity to enhance their own skills by teaching younger students  Allow high school students to explore the field of nursing through a hands-on simulation  Allow nursing students to experience the difference between clinical and academic instruction

Day 1: Skill Instruction  8 OHSU nursing students visited the Advanced Medical Skills Class to teach I.V. insertion

Day 2: Skill Testing  4 of the nursing students returned to the classroom to test students in proficiency and speed of skill completion

Day 3: Skill Implementation  Top 9 high school students chosen to participate in scenario at OHSU simulation lab  7 nursing students mentored high school students in nursing roles during scenario  3 high school students per group according to nurse role  1-2 nursing student(s) assigned to each group

Prepping a patient for surgery Simulation Activity

Scenario Preparation  Each student group met with a nurse mentor to review responsibilities/ skills of scenario role

I.V. Nurse Start I.V. in patient, hang fluids and/or meds according to orders in chart

I.V. Nurse

Chart Nurse Review of patient chart: orders for meds, labs, etc.

Chart Nurse

Bedside Nurse Patient history and assessment (vitals, lung & bowel sounds)

Bedside Nurse

The Patients  Scenario 1: 36 year old female being prepped for hysterectomy  Scenario 2: 70 year old female being prepped for lung biopsy  Scenario 3: 80 year old female being prepped for hip fracture repair

Scenario Execution Students not involved in the scenario watched in the viewing room; nursing student facilitated

Scenario Debrief All students participated in debriefing session after each scenario

Lessons Learned  High school students learned skills quickly, provided positive response, “one of the most fun class activities”  Patient scenarios worked well, keep same scenarios and add depth of information with successive patients  Need to recruit nursing students earlier in term; provide open lab to allow nursing students to practice skill instruction  Create skill checklist for testing day so expectations are clear to both high school and nursing students

Oregon Content Standards (CTE )  Participating high school students will learn how to insert an IV into a simulation arm.  Aligns with Oregon Career and Technical Education Skill Sets for Health Sciences: HSD Demonstrate competency in basic patient care skills.  Participating high school students will learn nursing skills essential to the preparation of a patient for surgery by working one-on-one with OHSU Nursing Students in a given scenario in the Sim Lab.  Aligns with Oregon Career and Technical Education Skill Sets for Health Sciences: HSD10.01 Apply technical skills appropriate to a health care career.

Repeat Program 2010

Repeat Format  Day 1: I.V. Skill Instruction  Day 2: I.V. Skill Testing  Day 3: Skill Implementation (Simulation)  Additions/ changes:  Scenario Preparation “Teams” Pre-Surgical Checklist  Patient Notes  Medical Student Calling the Doctor  Career Intention Survey

Scenario Preparation  High school students divided into “nursing teams” that would work together to care for one patient  Each team met with a nurse mentor to review and assign scenario roles & responsibilities

Pre-Surgical Checklist

Patient Notes

Medical Student Involvement Mike Oakley, 3 rd year medical student on extended rotation in Grants Pass, as part of Oregon Rural Scholars Program played roles of Dr. Rasmussen, Dr. Johnson, & Dr. O’Malley in scenarios 1, 2, 3 respectively

Calling the Doctor

Career Intention Survey  Purpose to see if experience changed:  Nursing student thoughts regarding a career in nursing education (N=1; no post survey given)  High school student attitudes regarding career in nursing (pre N =21; post N = 18)  Results:  Top reasons for interest in nursing: desire to help people, interest in working with people  Top reasons for disinterest in nursing: unpleasant work, no desire to wait on people  No measurable change in attitudes towards nursing as career  Conclusion: Provide nursing career information to ALL students and/or survey students involved in simulation specifically

Lessons Learned  Allow high school students at least 1-2 days between I.V. instruction and testing for skill practice  Purchase or obtain donation of additional retractable I.V. catheters for classroom instruction  Prepare nursing students for instruction/ practice of skill in any conditions  “Old School” technique  May not always have all equipment; have to improvise

Student Feedback  "I had the time of my life! This experience definitely showed me I have what it takes to become a nurse. And without this program, I probably wouldn’t have known.” -D”Arcy  "This experience has set in stone my decision to be a part of the health care system. I know there is nothing else I would rather do with my life.” -Alex  “I had the most amazing experience ever! It was a blast and now I am positive of entering a health career related occupation.” -Allison  “Working in the simulation lab is an awesome experience, and it really influenced me to want to be in the medical field (more than I used to be).” -Melissa

Future Programs  Goal to establish dates for Grants Pass High School program  Improve experience for nursing and high school students - make more relevant to education/ career pursuits  Hope to duplicate for other area high schools:  Single day (Saturday)  One representative each from nine remaining Rogue Valley high schools

References 1. U.S. Department of Health and Human Services, Health Resources and Services Administration. (2010) The Registered Nurse Population: Initial Findings from the 2008 National Sample Survey of Registered Nurses. Retrieved April 6, 2010 from: U.S. Department of Labor, Bureau of Labor Statistics. (December 17, 2009) Occupational Outlook Handbook, Edition, Registered Nurse. Retrieved April 19, 2010 from: U.S. Department of Labor, Bureau of Labor Statistics. (December 17, 2009) Employment Projections, Replacement Needs. Retrieved April 19, 2010 from:

References 4. Oregon Center for Nursing. (2009) Oregon’s Nurse Faculty Workforce: A Report from the Oregon Center for Nursing. Retrieved October 23, 2009 from: e%20Faculty%20Workforce%20Report% pdf. e%20Faculty%20Workforce%20Report% pdf 5. Oregon Simulation Alliance. ( ) About OSA, Background to the Oregon Simulation Alliance Initiative. Retrieved April 6, 2010 from: Oregon Labor Market Information System (OLMIS). Occupational Information Center, Occupational Report for Registered Nurses, Statewide. Retrieved April 6, 2010 from: rpttype=full&action=report&occ=291111&go=Continue. rpttype=full&action=report&occ=291111&go=Continue

References 7. The North Carolina Center for Nursing. (2008) Influencing Factors in the Choice of a Nursing Education Career. Retrieved April 8, 2010 from: 01coll22&CISOPTR=21328&REC= coll22&CISOPTR=21328&REC=17 8. Washington State Workforce Training and Education Coordinating Board. (April 19, 2010) Progress 2004: A Report of the Health Care Personnel Shortage Task Force. Retrieved October 23, 2009 from: 9. Center for Rural Health, University of North Dakota School of Medicine and Health Sciences. ( ) North Dakota Nursing Needs: High School Student Survey. Retrieved February 11, 2010 from: _survey.pdf. _survey.pdf

Contact Amy Nelson Education Coordinator AHEC of Southwest Oregon x. 203