AACN Issue Bulletin
October 2002

To overcome these obstacles, nursing institutions are collaborating with clinical partners and other stakeholders in an effort to build student capacity and satisfy mutual needs. These partnerships take many forms and serve various functions. Some schools use expert practitioners to augment the nursing faculty supply. Others involve collaborative arrangements among nursing education programs to increase student enrollments. Some service partners share physical resources and infrastructure with schools as a means of overcoming limitations in clinical, classroom, and research space. Still others form partnerships to provide tuition forgiveness to students in exchange for work commitments.

In 1999, the American Association of Colleges of Nursing (AACN) released the Essential Clinical Resources for Nursing’s Academic Mission, which included a section on partnerships and models that support nursing education. This publication explored innovative and effective collaborations that expand traditional clinical education boundaries and lead to new opportunities for nursing education and practice. AACN has produced this Issue Bulletin to provide an update on education-clinical partnerships and other joint ventures flourishing at nursing schools nationwide.

Initiating Strategic Partnerships

Educational partnerships serve many purposes with no limits on how they can be creatively structured. California State University-Fullerton actively pursues partnerships on a number of levels including University-University Programs between the Department of Nursing and the College of Medicine; University- Health Care Corporate Programs to support the nurse anesthetist program; and University-Community College Programs to share resources for establishing an on-site RN-to-BSN program at a local community college.“All of our partnerships came about by sharing ideas, initiating meetings, and building relationships,” explained Christine Latham, DNSc, RN, dean of the nursing department.

Florida International University (FIU) uses a network of clinical partners to satisfy multiple needs. Last year alone, FIU was awarded a $360,000 grant from Baptist Health Systems to recruit high school students into its baccalaureate program (BSN) and $600,000 in funding from four regional medical centers to launch a program that transitions foreign-educated physicians into baccalaureate-prepared nurses. “Our clinical partners have enabled us to reach out to new audiences and feed the pipeline of future nurses,” explained Divina Grossman, PhD, RN, FAAN, dean of the School of Nursing.

“At a time when BSN enrollments are unstable, we are expecting an unprecedented 44% increase in the size of our freshmen class this year,” said Joellen Edwards, PhD, RN, dean of the East Tennessee State University (ETSU) College of Nursing. “Much of this success is due to collaborations we have established with area hospitals, health care agencies, and partner educational institutions.” ETSU’s success is derived from agreements with regional health care agencies and federal funding to facilitate an LPN-to-BSN program; working with community college partners to share classroom space, provide seamless articulation, and expand program delivery options; joining with a regional health care system to encourage certified nursing assistants to pursue university programs; and partnering with a hospital system to offer high school students an ‘immersion experience’ in nursing.

Four schools in the area of Lubbock, Texas have joined forces as the South Plains Nursing Education Community Coalition to pursue federal funding and community support for increasing student enrollments. Coalition members, including Covenant School of Nursing, Lubbock Christian University, South Plains College, and Texas Tech University Health Science Center, represent the full spectrum of nursing education programs. Last year the coalition, working through the South Plains Workforce Development Board, was awarded a $2.9 million grant from the Department of Labor to increase the entry-level student nurse population, add faculty, and promote the nursing profession. Community partners, including the City of Lubbock, Market Lubbock, the 32-member Community Workforce Partnership, and three local Chambers of Commerce, provided an additional $2 million in matching funds to support this enterprise.

“The coalition is making great strides in advancing the nursing profession and addressing the nursing shortage,” said Lynda Billings, Texas Tech’s H1B project director. “Over $1 million in grant monies will go for student scholarships and another large portion will fund nine faculty positions to accommodate the new students.” Coalition members expect to boost the number of RN graduates by 240 during the two-year period of the grant and sustain enrollment increases as a result of the expanded faculty capacity.

In October 2002, Alaska’s five largest health care providers – Providence Health System of Alaska, Fairbanks Memorial Hospital, Yukon-Kuskokwim Health Corp., Alaska Regional Hospital, and the Alaska Native Tribal Health Consortium/ANMC –announced that they were committing $1.8 million over the next three years to share the cost of expanding the nursing programs at the University of Alaska-Anchorage. The university is matching that commitment through capital and other resources. These donations coupled with legislative appropriations will enable the school to implement its plan to double the number of graduates by 2006.

The University of Cincinnati has established a long-standing collaboration with the university hospital to develop and implement an institute for nursing research. Through this relationship, the college has access to an acute care setting ideal for implementing faculty-led research programs, and the hospital obtains research expertise needed to maintain an active program of evidence-based nursing practice. The hospital also provides an ideal site for graduate studentsto collaborate with agency personnel on research projects. “Since 1996, this collaboration has resulted in more than $700,000 in grants, contracts, and income to the hospital, while the college has benefited from an annual substantial gift from the hospital to support college personnel,” said Andrea Lindell, PhD, RN, FAAN, dean of the College of Nursing.

In July 2002, Georgia Governor Roy E. Barnes announced the establishment of a $4.55 million public/private partnership between Georgia health care providers and the University System of Georgia,which will increase the number of health professionals in the state by more than 500 over the next two years. Participating health care employers have committed to providing jobs for new fast-track graduates in 19 Georgia communities, bringing much needed health care services to citizens. With the vast majority of grants awarded to fund nursing education, the partnership will produce 294 registered nurses prepared at the baccalaureate level and 180 nurses prepared at the associate degree level. Those institutions that have developed and will implement partnerships that support BSN preparation include Armstrong Atlantic State University, Clayton College and State University, Columbus State University, Georgia State University, and Kennesaw State University.

Strengthening Clinical Connections

The University of Alabama Capstone College of Nursing has just launched a Cooperative Education Program that allows students to alternate full-time study with work in a local hospital. Through this arrangement, students are paid to work full-time at a hospital during their summers and for two spring semesters while upperclassmen. As students gain more training and experience, they advance in their work responsibilities and earn more money. “This program gives students more clinical experience, more money, and less reality shock upon graduation,”said Sara Barger, PhD, RN, dean of the nursing college.

In 2000, the University of North Carolina (UNC)-Chapel Hill began exploring the feasibility of an accelerated second-degree BSN option within its undergraduate program. UNC Hospital offered to help fund this concept and committed $75,000 to support faculty during the program planning and development year. When the program was launched in May 2001, UNC Hospital provided $270,000 in scholarship monies to enable students to complete the program. In return for financial assistance, students signed contracts to work at UNC Hospital after graduation. In May 2002, a second cohort of 39 second-degree students was admitted to the accelerated program with UNC Hospital increasing its scholarship funding to $550,000. “We have chosen to invest in our School of Nursing and its students,” explained Sandra Evans, MBA, RN, senior vice president of UNC Hospital. “The scholarship program assures us a supply of excellent new graduates that we helped to educate - new graduates who are pre-committing to an average service time of two years.”

The University of Colorado’s ability to double enrollments in the past three years has been facilitated by an education-practice partnership called the Clinical Scholar Model. A Clinical Scholar is a practicing expert nurse who is employed by a clinical agency or facility and holds a clinical appointment in the School of Nursing. Currently, Clinical Scholar agreements are in place in acute care and community-based settings, and provide continuity within the curriculum for obstetrics, pediatrics, medical-surgical nursing, community health nursing, nursing leadership, and management. “This model encourages meaningful participation of university faculty in the clinical agency and of clinicians in education,” explained Gayle Preheim, EdD, RN, CNAA, BC, director of the Baccalaureate Nursing Program.

Miami University pursues collaborations with a regional Health Alliance with the goal of graduating more nursing students and improving attrition rates. Through this partnership, the Alliance builds relationships with potential nursing recruits by pairing students with nurses in their system who serve as mentors, offering scholarships, and funding a faculty position to support students at risk.“Students have especially enjoyed the mentor-mentee relationship and the chance to learn from an experienced nursing professional,” said Eugenia M. Mills, PhD, RN, chair of the university’s nursing department.

The University of Alabama at Birmingham has worked with the local Children’s Hospital for years as a clinical agency to support student learning. In 1996, a new partnership model was formed by the two agencies whereby a nursing student is paired with a staff nurse for the student's pediatric clinical rotation. Each student works with a qualified staff nurse for an entire term and has the same hours as that nurse, i.e., weekends, nights, evenings, days, etc. The staff nurse participates in the students’ evaluation, though the faculty member remains responsible for the learning experience, makes unannounced visits, and is on call during the student's clinical practice time. “This model was developed to augment our faculty, allow us to admit more students, and provide a reality-based, high quality experience for the student,” explained Rachel Z. Booth, PhD, RN, dean and professor at the School of Nursing.

New York University (NYU) reaches out to its many partners to expand students’ clinical practica options, provide services to underserved populations, and create access to clinical research opportunities for faculty and students. The Division of Nursing has successfully secured federal funding to establish several school-based health centers in collaboration with two hospitals. These centers provide training opportunities for undergraduate/graduate nursing students and medical residents from the respective hospitals. “Through this arrangement, faculty collaborate with nurse practitioners who run the clinics and serve as preceptors for students,” stated Terry Fulmer, PhD, RN, FAAN, head of the NYU Division of Nursing.

Northern Illinois University enjoys a close relationship with Kishwaukee Community Hospital, the only hospital in the university’s semi-rural community. The hospital contributes financial support for the school’s health center,which provides the only nursing care for the working poor in a three-county area. “The hospital’s commitment to the school and the community extends to providing student internships, clinical practice sites, and free mammograms for underserved populations,” explained Marilyn Frank-Stromborg, EdD, JD, FAAN, chair and presidential research professor at the School of Nursing.

Self Regional Medical Center in South Carolina established a clinical externship program to provide financial assistance to graduates of Lander University in exchange for a post-graduation work commitment. In addition to the externships, the medical center also brings clinical instructors, medical preceptors, and a practice site to its university partnership. “The benefits to the medical center are real,” explained Carol J. Scales, PhD, RN, associate professor and dean of the university’s nursing program. “Last year, the center recruited more than 40% of Lander’s graduating class, a significant jump from the previous five years that saw the recruitment rate vary from 7-20%.”

In Massachusetts, Salem State College is collaborating with two local hospitals to provide a clinical externship program for students who have completed their junior year in the nursing major. The externship matches each student with a nurse mentor. Students are hired and paid as nursing assistants, but work the same shifts as their preceptor/mentor. “Students gain valuable practice experience while developing time management and organizational skills,” said Joanne M. Turco, PhD, RN, chair of the School of Nursing.

Mount Carmel College of Nursing (OH) initiated a partnership to recruit nurses into the profession with Mount Carmel Health, an integrated health system. Through the arrangement, the clinical partner agreed to pay 25% of a student’s tuition and fees during freshman and sophomore years, and 50% of expenses during junior and senior years, in exchange for students working a minimum of 32 hours per two-week pay period. After graduation, the health system will fully repay senior year tuition (up to $12,000) in exchange for a three-year service commitment. “Both the college and Mount Carmel Health recognized the need to increase enrollment in the baccalaureate program and address the nursing shortage,” said Robin Hutchinson-Bell, director of marketing and communications at the College of Nursing. “Removing a student’s financial barrier is a very attractive incentive to enter the profession, and it opens the door to students who might not otherwise be able to pursue a nursing education.”

Bridging the Faculty Shortage Gap

Last year, the University of Massachusetts - Amherst recognized that without private support for faculty, the nursing school would need to decrease capacity from 64 to 48 students. In order to keep level enrollments, the school began exploring creative ways to boost its faculty ranks. Two partnerships were developed in conjunction with two local hospitals to offset the cost of hiring new faculty. “Through funding provided by our partners, we were able to hire two full-time faculty members and one half-time faculty member,” explained Paula Sakey, director of the development office for the School of Nursing. “In addition to working with students, jointly appointed faculty members are available to the staff at the clinical agencies to assist on projects that support the development of a professional nursing culture.”

In response to the nursing faculty shortage in Texas, the Greater Houston Partnership and the Gulf Coast Workforce Board launched the Nurse Faculty Initiative last year to bolster the pool of available faculty at four community colleges and five schools with BSN programs, including Prairie View A&M University, Texas Woman’s University, University of Texas Health Science Center at Houston, and University of Texas Medical Branch at Galveston. Nineteen area hospitals “loaned” nurses qualified to teach in programs offered by the participating schools, resulting in 65 individuals donating 12,000 hours of teaching time during the 2001 fall and spring semesters. “Hospitals and schools who participated in the initiative were overwhelmingly positive about their experience and are enthusiastic about the program’s continuation,” explained Karen H. Love, health industry liaison for the Houston-Galveston Area Council. “Employers cited student recruiting benefits and stronger academic ties, while schools appreciated the staffing benefit and stronger clinical connection.”

The University of Washington is collaborating with the University of Washington Medical Center in a groundbreaking arrangement wherein the medical center offers an experienced staff nurse the opportunity to take a sabbatical as a clinical instructor of BSN students. The medical center, which continues to pay the nurse’s salary, benefits by rewarding and ultimately retaining a valued staff member. “The School of Nursing could not accomplish its goals without our clinical partners,” expressed Julie R. Katz, MEd, RN, assistant dean for the nursing school. “Their collaboration and willingness to participate in the development of the nursing profession is invaluable.”

Among its many alliances, the University of Delaware has cultivated clinical partners to allow the school to expand the education options for its nursing students. Centered on providing subject matter expertise and faculty support, these partnerships involve clinical education for perioperative, critical care, neuroscience, psychiatric, gerontology, medical-surgical, school, and community health nursing. “Our partnerships allow approximately 33% of our graduates to receive their clinical education,” said Betty J. Paulanka, PhD, RN, dean of the College of Health and Nursing Sciences. “Without these alliances, we would not have sufficient faculty manpower to graduate 100-120 baccalaureate students each year.”

At the University of Akron, master’s-prepared staff nurses at three Ohio hospitals serve as clinical faculty for the school’s 15-month accelerated baccalaureate program for second-degree students. The hospital benefits by developing relationships with future nurse recruits, and the school enjoys the chance to expand its program. “For a partnership to be successful, all stakeholders must win something,” explained Cynthia Capers, PhD, RN, dean of the College of Nursing. “In this partnership, everyone wins, including the college (increased enrollment, additional faculty); the agency (mature and bright nurses available for employment); the students (professional career launched in nursing); and the public (increased number of BSN-prepared nurses to provide needed care).”

Creating a Highly Educated Nursing Workforce

Many four-year schools across the country are working with fellow nurse educators and clinical partners to create a more highly educated nursing workforce. Last year, Holy Names College (CA) launched a partnership with Catholic Healthcare West (CHW) to provide its RN-to-BSN program via video conferencing to eight hospitals throughout the state. Patterned after a similar partnership with Kaiser Permanente, the college used this new connection to double enrollments. “Our hospital partners have enthusiastically embraced our efforts, which have enabled over 350 nurses to earn their BSN degree,” said Fay L. Bowers, PhD, RN, chair and professor of nursing at the college’sDepartment of Nursing. “Nurses completing this program were able to use their newly acquired knowledge and skills to change positions, advance in the profession, and, of course, improve patient care.”

The University of Phoenix is leading a national education and training partnership focused on nursing career mobility and recognition of prior learning. With initial funding from the Sloan Foundation, this partnership brings together Phoenix’s College of Health Sciences and Nursing, the Council for Adult and Experiential Learning, the Service Employees International Union (SEIU), and several major employers, including Kaiser of California. “The partners have developed a patient care provider training program that meets industry needs and takes advantage of distance learning technologies,” explained Catherine Garner, DrPH, RN, FAAN, dean of the College of Nursing and Health Sciences. “The first phase, a 30-month LPN-to-BSN program for working students, will include curriculum development and the creation of an innovative mentorship model for clinical training. Nursing executives will learn how the online learning model also can be used for re-entry, cross-training, and remediation of nursing staff.”

For the last 10 years, Saint Xavier University (IL) has formed partnerships with several health care organizations in the Chicago area to offer educational programs on-site for nursing staff. The School of Nursing offers both the RN-to-BSN completion program and the master’s program on the premises of its partnering organizations. “Student response to this model has been positive in that students know the schedule of classes, feel supported by their workplace to continue their education, and have the support of others in the cohort,” said Mary LeBold, EdD, RN, dean of the School of Nursing.

The University of Wisconsin-Madison (UWM) has established an innovative partnership to expand access to baccalaureate education in more rural parts of the state. UWM has partnered with an academic health center located in southwestern Wisconsin,which serves as a satellite site for its BSN program. “Our partners are committed to this project to help ensure that a pool of BSN-prepared nurses will be available to serve the rural, underserved population living in the tri-state area at the borders of Wisconsin, Minnesota, and Iowa,” stated Kathryn A. May, DNSc, RN, FAAN, dean of the School of Nursing.

The University of Rochester (NY) has established special relationships with two neighboring hospitals, including a Veterans Health Center, to offer lower tuition costs for nurses working in those institutions who pursue RN-to-BSN or RN-to-MSN programs. “The affiliation with the VA involved increasing our
number of online courses and offering several core courses in that community using the VA's infrastructure to facilitate the offerings,” explained Judith Baggs, PhD, RN, FAAN, associate dean for academic student affairs at the School of Nursing.

Expert Advice on Creating Strategic Partnerships

When asked what advice they would give to a nursing school interested in forming a partnership, the experts interviewed for this Issue Bulletin offered the following suggestions:

“Partnerships work best when they are part of a longstanding relationship that involves both parties in the governance structure of their respective institutions. That way, the collaboration is embedded in a strategic plan and is likely to be viewed as an ongoing commitment.” Angela Barron McBride, PhD, RN, FAAN, Indiana University

“It takes a lot of time, travel, communication, meetings, and energy to accomplish these types of partnerships. Donot promise anything until the budget is completely thought through. Start the planning process early as these things take time! Clear communications are critical and every detail of the arrangements must be agreed upon and communicated to students, faculty, administration and staff to avoid misunderstandings." A. Gretchen McNeely, DNSc, RNC, Montana State University

“Follow through, treat your partner respectfully, and attend to details. Be honest and direct in all your communications; if you cannot do something a partner requests, say so and find another route. Relationship is the foundation upon which successful partnerships are built." Joellen Edwards, PhD, RN, East Tennessee State University

“Have a structured, thoughtful plan which addresses the needs of all involved partners: the nursing programs, the health facilities, students and faculty. There should be room for negotiation, but definitive boundaries. Plans should be realistic with attention to the necessary academic details. It is essential to protect the academic integrity of the program while meeting the needs of the clinical partner.” Camille P. Stern, PhD, RN, Armstrong Atlantic State University (GA)

“Look at the needs of the school and the health care organization. Assess both the nursing practice environment and the learning needs of the institution. Expect that the first year will involve building mutually trusting relationships. Plan ahead for how to disseminate information about the partnership throughout the health care organization.” Paula Sakey, University of Massachusetts-Amherst

“A successful partnership is evidenced by the establishment of clear communication paths, coordination of schedules, shared vision of the benefits of cooperation, and flow of information between the partners. Developing partnerships isn’t always easy, but the shared resources, combined strengths, new opportunities, and chances for growth are worth the effort.” Yvonne Bennett, Blessing-Rieman College of Nursing (IL)

Partnerships Profiled on the Web

In an effort to provide a more in-depth examination of some of the partnerships at schools of nursing across the country, AACN has created a new Web resource that examines collaborative arrangements at the following institutions:

East Tennessee University · Lander University (SC)
Mount Carmel College of Nursing (OH)
New York University · Texas Tech University Health Sciences Center
University of Alabama at Birmingham · University of Colorado
University of Delaware · University of Massachusetts - Amherst
University of North Carolina-Chapel Hill
University of Pennsylvania · University of Washington

Click here to read more about these partnerships.

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