AACN Issue Bulletin

October 2002

AACN Issue Bulletin:
Using Strategic Partnerships to Expand Nursing Education Programs

In an effort to provide a more in-depth examination of some of the partnerships outlined in this Issue Bulletin, AACN has created this new Web resource that examines collaborative arrangements at the following nursing colleges and universities:

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

East Tennessee University
Contact: Joellen Edwards, PhD, RN
Dean, College of Nursing
edwardsj@etsu.edu

The College of Nursing at ETSU, where an enrollment of approximately 750 students prepare for a career in nursing in BSN, MSN and DSN programs, has been highly successful in developing educational-clinical partnerships with regional health care agencies to increase the numbers and quality of professional nurses in our area. We continually address the full range of our potential student population, and have expanded and improved traditional BSN, LPN-BSN, RN-BSN, and MSN enrollment. Nationally BSN enrollments dropped 20-25%; during this same time frame, although we did drop slightly in enrollment numbers, we have been able to add many students to our pool. This year, we're experiencing an unprecedented increase of freshmen and transfer students declaring nursing; we are up 44% over last year! Much of this success is due to the partnerships we have established with area hospitals and other health care agencies, and partner educational institutions. Here is a sample:

Improving BSN Enrollment

1. LPN-BSN
In 2001, a team of faculty members, Dr. Priscilla Ramsey, Dr. Sally Bowers, and Ms. Carolyn Merriman, with several regional health care agencies as partners, received a Division of Nursing grant to create an avenue for qualified LPNs to move smoothly to the BSN. Agency partners include two major regional health systems, nursing homes, and community hospitals; as well as the local LPN program, where promising students are identified early and encouraged to consider further education. Agency partners agree to adjust scheduling to accommodate classes, pay tuition and fees, and provide an educational advocate from their staff who is familiar with the program and helps to eliminate barriers from within the institution. Our responsibilities in the partnership are to provide a part-time schedule of accessible classes for LPN-BSN students; and offer tutoring, mentoring, support groups, and intensive academic advisement through the university system to increase the chances of participants'successful completion of the program. The actual costs to the agency are only tuition and fees, many of which are a normal part of benefit packages for employees. The differentiating factor between someone who just decides to return to school alone and the LPN-BSN participants is that of support; a whole system is in place to offer these students the educational, workplace, and peer encouragement they need to be successful in a university setting.

In 1999, we had three LPNs enrolled in our BSN program. Today, we have 29, with another LPN cohort to be added in the fall. Agencies avoid recruiting costs, and as a full partner in the project, provide intangible but focused support and encouragement to their employees. This partnership came about as ETSU sought to increase BSN enrollment, agencies sought to support BSN education as a recruitment and retention strategy, and an external funding source was available to provide the impetus for innovation.

2. RN-BSN
Articulation agreements with AAS programs in community colleges, coupled with an agreements for space and facilities in the community colleges, makes a weekend RN-BSN program available throughout the eastern Tennessee region. Clinical agencies participate through tuition reimbursement and support of scheduling needs for those enrolled in the articulated programs. Dr.Kathleen Rayman heads our RN-BSN efforts.

Articulation agreements have long been a part of our effort to recruit associate degree nurses to higher education. In this partnership, however, both the community colleges and ETSU commits to making that education more accessible. The articulation agreements allow for smooth progression from AAS to BSN education. Two community colleges, Walters State Technical and Community College in Morristown, TN and Cleveland State Community College, in Cleveland, TN, provide classroom space and use of their nursing lab facilities. Other outreach sites are strategically located in the region to capture southwest Virginia and western North Carolina nurses who wish to enroll in the weekend program. Special agreements with hospitals and other health care agencies offer a mechanism through which nurses employed by those agencies pay in-state tuition.

Community college personnel share in recruiting students who wish to move directly to the RN-BSN program; and assist with marketing the program to their alumni and local agencies. Advisors from each institution work closely together to assure seamless progression and consistent information for students. ETSU's College of Nursing provides the RN-BSN classes in a weekend format, using face-to-face, web-based, web-enhanced, and interactive television teaching strategies. Fully qualified nursing faculty from the community colleges often teach in selected courses, along with nursing faculty from the university. ETSU gains the tuition and credit hours from the nursing courses, and the community colleges gain tuition and credit hours from associated general education courses required in the BSN program. Agencies retain nurses, avoiding new recruitment costs. Region-wide co-operation in educational settings is enhanced, and professional education is achievable for place-bound RNs.

In 1998, we had a handful of RN-BSN students in our program; in 1999, that number jumped to 51; today, we have 97. This partnership came about as a result of increased contact and interaction between regional agencies, AAS programs, and the BSN program, which encouraged trust and built the credibility of each institution. AAS faculty believed that their graduates should consider their two-year degree as the first step in their nursing education, BSN faculty believed that the RN students were capable and competent students, and agency leaders believed in the value of BSN education. Action followed philosophy, and win-win, almost cost-free strategy was developed. An additional positive outcome has been the transition of RN-BSN graduates to the MSN program; five have enrolled to date, with more planning to move directly to graduate education.

3. Certified Nursing Assistant Initiative
This partnership involves a large regional health care system and the ETSU BSN program. Increased use of ancillary personnel was a concern to agency leaders. They recognized the significance of the contributions to care made by CNAs, the increased supervisory responsibilities of RNs, and the difficulty of retaining experienced CNAs in the work setting. As a result of the success of the LPN-BSN project, ETSU recognized CNAs as another pool of talented potential students. Ms. Ellen Drummond and Ms. Melissia Honeycutt are the lead faculty for the course. Together, faculty and agency leaders devised a special university course for CNAs identified by the agency as showing promise of ability to become a registered nurse, or that they wished to reward for excellent service. CNAs were paid for their class time, helped to enroll in the university, and supported through scheduling that accommodated their class. The class included skills, and an orientation to the university. RNs at the agency were part of the support system; supervising RNs were familiar with the curriculum, and guided the "clinical" experiences assigned weekly by the faculty as well as encouraged the participants. Most of the CNAs had not attended college before, and through the course, began to recognize their own potential as students.

Since 2001, the course has been offered three times, with a total of 43 students participating. Of these, one has enrolled in the university and one in a community college nursing program. Though the number of participants who have so far entered a nursing program is small, we believe this investment will pay off in the long run.

4. Summer Residency for High School Students
Building interest in nursing among high school students is a critical piece of increasing the number of students in the BSN program. In addition to traditional recruiting activities, the College of Nursing formed a partnership with a large health care system to offer high school students an "immersion experience" in college life and nursing as a profession. The experience consisted of a week in the residence hall, under the supervision of senior nursing students; campus tours through scavenger hunts; shadowing a professional nurse in one of the system agencies; and classes on preparation for college and nursing curriculum, nursing skills, and nursing as a profession. A competitive opportunity to participate was offered through high school counselors, high school science teachers, and health occupations clubs.

The health system funded the residence hall counselor salaries, a welcoming picnic for parents and students, residence hall fees and several evening activities. They also invested the time of nurses on busy units in guiding the students' agency visits. The College funded the faculty member's salary, and the salary of our student services professionals; provided the facilities and equipment for nursing education; and directed the experience. The students were not charged any fees for the residency program. Ms. Jennie Walls, assisted by Ms. Rhonda Broderick, were the faculty members; Ms. Gloria Gammell and Mr. Scott Crowder-Vaughn were the student services leaders.

In 2001, 13 students participated; in 2002, 14 students joined the event. Students had completed at least their sophomore year of high school at the time of attendance. The total cost per program, including in-kind contributions, was approximately $1l,000. Evaluations revealed that all students except one were very sure that a career in nursing was their plan. While this is a long-term investment by both partners, seven students have already enrolled in ETSU, declaring nursing as their major.

Advice for Those Seeking Clinical Partnerships

Build trusting relationships. Follow through, treat your partner respectfully, and attend to details. Be honest and direct in all your communication; if you can't do something a partner requests, say so and find another route. Relationship is the foundation upon which successful partnerships are built.

Find common ground. Identify the shared vision for the partnership project. If both partners agree on the intended outcome, the implementation phase will be much smoother.

Find a win-win project. Each partner wants specific things. Universities want students and the tuition and funding they bring. Agencies want qualified, educated professionals who will stay with them for the long term. Community colleges want to maintain their enrollment, while promoting the career mobility of their graduates. Create a project that will meet the unique needs of each.

Think creatively. Go beyond traditional pools of students, and beyond traditional partners.

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Lander University (SC)
Contact: Carol J. Scales, PhD, RN
Associate Professor and Dean

1. The Lander University School of Nursing recognized:
a. the need to prepare students with current information about changes in clinical practice standards and regulations;
b. access to senior nursing students was in increasing demand by hospitals in the state;
c. there were educational support needs created as the school moved into a new location that were unfounded by the fiscally constrained state administered university.

The School created a senior seminar to discuss the newest issues in clinical practice and regulation, which would be co-taught by clinical agency staff. Initially, it was envisioned that there would be three (3) partners who would pay $15,000 per year for this access. When it was announced, our local hospital, Self Regional Medical Center, asked for an "exclusive" for five years. Two masters prepared hospital nurses, given adjunct faculty status, participate actively in the senior seminar where issues of current concern regarding practice issues, standards and regulations are discussed. Revenue generated by this agreement has allowed the school to purchase technology, software, equipment and furnishing otherwise unaffordable.

2. The hospital established a nursing position at the Masters level that was developed to work specifically with the two affiliating nursing programs. This individual has filled in as clinical instructor for students at the hospital when faculty has been ill, thus maintaining the continuity of clinical learning and avoiding cancelled clinical experiences. Students who have missed a clinical can make up their experience with this hospital staff instructor. Students who may require remediation, or simply and extended clinical learning experience can do so with this staff instructor, thus increasing successful completion of the program. (This initiative is starting its third year.)

3. The hospital has established a clinical externship program assisting students with financial help for a post graduation commitment to work at the hospital. Although many of our students from the immediate community would most likely work at the hospital, this program has attracted students coming from elsewhere, to remain in the area after graduation. (This program is starting its third year).

4. During the spring semester of the senior year, student in the Leadership and Management course have a two-week (9 days out of 14) evening clinical experience on a medical unit. The nurses on the evening shift of the unit agreed to serve as the medical preceptors for clinical procedures. Students work a full shift, weekends and holidays included, using floor nurses as the clinical preceptors, while supervising faculty work with time management, prioritizing, delegation, team leading and communication skills. This student experience is as close to being a "real nurse" experience as is legally possible. Students are assigned 4-5 patients each and work in teams with one student acting as team leader for the 6-8 students on the unit. This program has been so successful in recruiting graduates for this particular medical unit, that other units in the hospital have requested a similar student experience. (This program is beginning its fourth year)

5. Self Regional Medical Center submitted and received a substantial grant from the Duke Endowment. A portion of that grant was for a nursing faculty position for affiliating schools of nursing. Lander has opted to use the Duke funding to support joint appointment clinical faculty from Self Regional Medical Center. This will free up tenure track faculty to increase their teaching, while providing students with clinical instructors current and active in the clinical field. (This initiative will begin this fall)

Results: Recruitment to Self Regional Medical Center for the past two graduating classes impacted by these initiatives has exceeded 40% of the class, as compared to the five previous years when the percentage recruited to Self ranged from 7-20%. These programs have been win-win for students, faculty, programs, clinical units and the hospital.

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Mount Carmel College of Nursing (OH)
Contact: Robin Hutchinson Bell
Director Marketing and communications
614-234-1372
Rhutchinson-bell@mchs.com

What types of programs have your school initiated?

Columbus, Ohio based Mount Carmel College of Nursing has initiated a partnership to recruit nurses into the profession with its organizational partner, Mount Carmel Health, an integrated health network comprised of three hospitals, outpatient services and programs and more than 7,000 employees.
Program highlights:

• During College Years: If a Mount Carmel College of Nursing student works for Mount Carmel Health for at least six months at a minimum of 32 hours per two-week pay period, the health system will pay 25-percent of the student's tuition and fees for freshman and sophomore years; 50-percent of tuition and fees junior and senior years
• Post Graduation: Beginning with the 2002 College of Nursing graduates, Mount Carmel Health established a program where if a student grad commits to working for any Mount Carmel facility for a minimum of three years, he/ she will have their senior tuition fully paid by Mount Carmel Health, not to exceed $12,000.

How did these partnerships come about?

• Both the college and Mount Carmel Health recognized the need to increase enrollment in baccalaureate programs and address the nursing shortage
• Nursing/ healthcare shortage: Mount Carmel Health recognized clearly the importance of enrolling nurses into the college---nurses who would most likely be recruited to work at Mount Carmel (the college is located on the campus of one of the hospitals) while both at school and post graduation.

What are the hallmarks of a successful partnership?

• Approximately 70-percent of our student population (as current students) work as PCAs or other healthcare personnel within the organization
• Of the 70 students who graduated from Mount Carmel College in May 2002, 35 committed to the three-year, tuition waved program---making the decision to practice nursing within the Mount Carmel network.
• A total of 65-percent of our graduates make the decision to work at one of our Mount Carmel Health hospitals or services.
• Effective and streamlined communication between the two organizations
• As Catholic organizations, have same shared mission and faith based philosophies

What advice would you give to a school looking for clinical partners?

Clearly Mount Carmel College has an advantage by being apart of an overall tertiary health network, but the most important advice is to:

• Establish a comprehensive plan: Clearly define goals and objectives, timeline and responsibilities
• Timely communication in all appropriate internal and external collateral material
• Regularly update both parties (in our case, Mount Carmel Health human resources and key staff within college
  

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New York University
Anna Borelli Ferrer
Administrative Assistant to
Terry Fulmer, PhD,RN,FAAN
The Erline Perkins McGriff Professor and Head,
New York University Division of Nursing
Tel: (212) 998-5358
Fax: (212) 995-3143

The Division of Nursing, New York University has developed three models of collaboration with clinical agencies; collaborative efforts with the Departments of Nursing of the NYU Medical Center, community-based primary care clinics funded by DHHS BHPr's Division of Nursing, and partnerships with clinical agencies that have recognized the need for health services to assist clients to meet other goals.

NYU Medical Center's Departments of Nursing supports formal and informal collaboration with the Division through several mechanisms. First, the Division Head was a member of the Nursing Cabinet, while the merger was in effect with Mount Sinai Hospital, that met periodically to discuss issues common to the academic program and the nursing services of NYU and five affiliated hospitals. Second, the faculty leaders of the Division of Nursing were participants in the Senior Leadership Council of the affiliated hospitals. The Council meets biannually to share information, best practices in recruitment, staff development, and quality indicators. A new model of establishing a Principal Partnership is evolving throughout 2002.

Third, a number of nursing staff of the Hospital have appointments in the Division and serve either as paid clinical instructors for undergraduate clinical groups and or as preceptors to students in the advanced practice clinical specialty programs. Nursing administrators recognize the relationship between the Division of Nursing and the Hospital's Department of Nursing by accommodating NYU students before meeting the requests of other education programs. The Division and the Departments jointly support a position that links the research efforts of both units. The individual in that position also facilitates the jointly sponsored annual Research Conference.

Most recently, the Departments and the Division have participated in the University Healthsystem Consortium/American Association of Colleges of Nursing Collaboration that is proposing a pilot program to test a standardized nursing residency program for baccalaureate graduates that builds on senior competencies, is based on a professional model of practice, and supports the transition to practice. NYU is one of six participants in this demonstration project that began in June and will continue through September new hires. The AACN/UHC Chief Nursing Officers believe strongly that the baccalaureate prepared nurse possesses the knowledge base required for the complex patient populations typical of academic medical centers, but needs a transitional program. The residency curriculum is built upon programs in existence at NYU Medical Center and others in Pennsylvania, Massachusetts, and Colorado. Data is being collected on a variety of measures to assess the outcomes of an intensified educational, mentoring process throughout the first year of employment.

To further strengthen the partnership between the Division of Nursing and the Medical Center, the nursing staff at NYU enjoy the long-standing tuition remission program exclusively for the Division. This benefit encourages approximately 90 graduate students annually to work on their graduate degrees in a variety of advanced practice and functional degree programs. Consequently, the Medical Center builds its leadership in clinical, administrative, and educational positions principally from the partnership.

The Division reaches out to other partners as well in order to expand students' clinical practica options, provide services to clients from unserved or underserved groups, and create access to clinical research opportunities for faculty and students. The Division has successfully secured federal funding to establish several school-based health centers in collaboration with two hospitals, one public and the other private voluntary. The school-based clinics have provided clinical training opportunities for undergraduate and graduate nursing students and medical residents from the respective hospitals. Faculty members collaborate with nurse practitioners who run the clinics and serve as preceptors for nursing students. One of these schools has served as a site for a nursing faculty's NIH funded grant on childhood temperament.

A less traditional collaboration has been a partnership between the Division and the Court Innovation Project that establishes Community Drug Courts in New York City. Community Drug Courts impose community services on clients to repay the community in which the offense was committed and provide drug rehabilitation and other services to clients as well. The primary care clinics were established at Midtown Community Court and Brooklyn Drug Treatment Court with federal funding, again through the DHHS BHPr Division of Nursing. These partnerships met the criteria of having underserved clients, providing clinical training sites for undergraduate and graduate students and potentially providing access to clinical research opportunities. The nurse practitioners supported on the grants and the faculty precepted students and attempted to develop projects and programs beneficial to the clients and consistent with the students learning objectives.

The Division's third model of partnerships is one developed in the last five years; collaborating with health and social service agencies that recognize the potential of providing health services in conjunction with social services to improve the clients' ability to succeed. In this model, the Division and social service agency that meets the Division's criteria agree that the Division will hire a nurse practitioner for provide services, the nurse practitioner becomes part of the network of faculty and practitioners who participate in all three models, and students have clinical practica in non-traditional settings that may become practice sites post graduation.

In the Division's three partnership models, the students experience a wide variety of clinical experiences with a sense of ownership, the practice sites provide the opportunity to develop practitioners with skills needed in non-traditional, community-based settings, and faculty, students and the practitioners have a role in practice and health policy advancement.

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Texas Tech University Health Sciences Center
Article by Lynda Billings
H1B Project Director
(806) 743-3082 Ex. 304
Fax: (806) 743-1622
lynda.billings@ttuhsc.edu

The nursing shortage on the South Plains was addressed in a unique and aggressive way, with several community components and educational components coming together at precisely the right time.

To begin with, in the spring of 2001, Dr. Alexia Green, Dean of Texas Tech School of Nursing and Marla Cottenoir, Dean of South Plains College School of Allied Health, served together on a statewide advisory committee on nursing education in Austin, TX. They began to talk about the benefits of a South Plains Nursing Coalition between the four existing nursing schools that were in Lubbock and the surrounding area, and the fact that more could be done for the South Plains area with the strength of a unified partnership than individually as separate entities. When they returned to Lubbock, they contacted the two other nursing schools and agreed to form the "South Plains Nursing Education Community Coalition."

The four schools of nursing that exist on the South Plains are unique in the fact that every type of nursing education is represented. South Plains College (SPC) has a two-year RN Associate Degree, as well as CNA and LVN training. Covenant School of Nursing represents one of the few hospital-trained (diploma) RN programs left in the state of Texas. Lubbock Christian University (LCU) has a one-year RN to BSN program with a distance-learning component. Texas Tech University Health Sciences Center School of Nursing (TTUHSC SON) has a four-year BSN degree, with graduate programs in nursing through the PhD. Texas Tech also has a RN to BSN program and an expanding distance learning component that is extending into other areas of the state.

At the time the Coalition was being formed, a Department of Labor (DOL) H-1B Visa Grant was being offered to fund technical job training projects for American workers to take back jobs being held by foreign workers. The maximum amount to be funded was $3 million dollars. Dr. Green formed a partnership with the eligible applicant, the South Plains Workforce Development Board, to develop a project to include all four nursing schools to increase their entry-level student nurse population, increase the number of nursing faculty to accommodate the increased numbers of students, and promote the nursing profession in the community through partnerships with other community entities. Community partnerships were formed for support of the project, to publicize the grant and the results of the project, and to promote the nursing profession in each of the partners' unique business and educational areas. The community partners include the City of Lubbock, Market Lubbock, the thirty-two member Community Workforce Partnership, the 15 ISD's of the South Plains area, and the three local Chambers of Commerce. Support letters came from State and Federal Senators and Representatives.

The grant was funded for $2.9 million dollars with an additional $2 million being matched by community partners. The South Plains Workforce is the grantee and the fiscal agent, with TTUHSC the primary contractor. The schools of the Coalition are subcontractors. Over $1 million dollars will go for scholarships for entry-level students and graduate students for pursuing an education role in nursing. Another large portion will be used to fund nine new faculty to accommodate the new students being admitted to the four nursing schools. The Coalition expects to expand their RN graduates by 240 during the two-year period of the grant, and to sustain enrollment increases as a result of expanding faculty capacity.

The impact of this grant to the South Plains and the partnerships that were formed because of it are monumental. After the first five years, the economic impact in the area will amount to over $11 million dollars in additional salaries alone, but that is not the most impressive nor the most important result of this project. The cooperation within the group of competing area nursing schools has turned into a partnership that has benefits for all. The graduate program from TTUHSC will benefit the three other schools with a steady stream of new nurse educators. Entry-level students are recruited from the fifteen county area of the South Plains and urged to attend whichever RN program is the most logical for them. A pipeline has been formed from the new training of CNA and LVN candidates to the recruitment of existing CNAs and LVNs to continue their education through the RN, BSN, and graduate levels. The Texas Workforce Centers will provide funding and support systems such as childcare and transportation assistance to eligible students. Minorities and underserved populations are encouraged through scholarships, active promotion from local chambers of commerce that deal with specific populations, and through a marketing plan that will address the fact that the nursing profession can and should be pursued by candidates from all walks of life. Information about this project will extend far beyond the immediate community and South Plains area as the active members and collaborative partners report on the results of the grant and the benefits of cooperative efforts in the community.

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University of Alabama at Birmingham
Rachel Z. Booth, PhD, RN
Dean and Professor
Phone (205) 934-5360
Fax (205) 934-1894
Email: rzbooth@uab.edu

The University of Alabama School of Nursing, University of Alabama at Birmingham, has three models that we have used successfully in partnering with clinical agencies in our area. These models are described below:

1. Partnership With Childrens' Hospital, Birmingham

The School of Nursing (SON) has used the Childrens' Hospital (CH) as a clinical agency for our student learning for many years; however, in 1996 a new partnership model was formed between the two agencies whereby one nursing student was paired with one CH staff nurse for the student's pediatric clinical rotation. The model was developed for two purposes: to augment our faculty to allow us to admit more students and to provide a reality based, high quality experience for the student. Approximately 40-55
nursing students have this individualized experience each of three terms per year. Each nursing student is paired with a qualified staff nurse that is agreed upon by both partners (the SON and the CH). The student remains with that staff nurse the entire term and has the same hours as the staff nurse, i.e., weekends, nights, evenings, days, etc. The staff nurse frequently involves the student with additional learning experiences by identifying procedures, disease conditions, etc., on other units or for patients
assigned to another nurse. The staff nurse participates in the student's evaluation. The faculty member remains responsible for the learning experience, monitors the experience, makes unannounced visits/observations at any hour, any day, and is on call during the student's clinical practice time.

The benefits of this experience are:
a) Enables the SON to enroll larger numbers of students.
b) Many students choose CH for their clinical experience for a second course, Leadership and Management, therefore, the student has a longer experience in the same facility and has an opportunity to use the partnership model for the second course.
c) An increase in number of students indicating they have a position at least three weeks prior to graduation. The SON requires students to complete a form at least three weeks prior to graduation that gives this and other information. Although the number is highly likely an underestimation, the data that we do have is collected in a consistent manner each year. Using the underestimated method, the following numbers show the number of our graduates who indicated at least three weeks prior to graduation for the
last five years that they had accepted a position at CH upon graduation: four in 1997-98; one in 1998-99; three in 1999-00; thirteen in 2000-01; and the 2001-02 data will be available next week. Thus far, we have eight for this year but the rush occurs just before the deadline so we expect a greater number by the deadline. Likewise, we have noticed a significant increase in our graduates presenting anecdotal information about their interest in and plans to become employed at CH during the past two or three
years. We are curious about the cause and effect relationship(s).

2. Contract Teaching Assistants (CTAs)

For the past several years, we have used CTAs who are highly qualified nurses (RNs) employed in the Birmingham area health care facilities. Initially, there was a great deal of negotiating with the clinical agencies about these CTAs; however, it has become an easy process since all the agencies and the SON are accustomed to and support the practice. The SON agrees with the clinical agency or directly with the nurse that he/she will provide a specific number of hours, days, weeks, etc. clinical supervision
primarily (but may be selected class sessions in the nurse's specialty) for a specific number of students. The purposes of this model are to: be able to increase the number of students admitted or enrolled, cover for an unexpected faculty absence, or any other unusual circumstance. We compensate the person for an hourly rate and pay directly to the person or transfer the funds to the facility or the department of nursing.

For the 2001-2002 year, we hired 9 CTAs for the graduate program for various lengths of time and for their highly specialized expertise in acute care, neonatal nursing, occupational health, etc. There is a scarcity of faculty prepared in these specialized areas. In the undergraduate program for the same period of time, we hired three CTAs to assist us with the increase in enrollment.

3. Scholarships Provided by Health Care Agencies

Some hospitals in the Birmingham Metropolitan Area award scholarships to students who meet pre-established criteria consisting of a specified grade point average and recommendations from faculty, previous employer, clergy, Financial Aid Officer, etc. A contract is signed between the student and
the hospital which obligates the student as a graduate to work at the hospital for the length of time that is equivalent to the scholarship support. The purposes of these scholarships are to recruit students, and
later graduates, to the hospital and to relieve the financial burden of the student while in the SON's program.

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University of Colorado
Contact: Gayle Preheim, RN, Ed.D., CNAA, BC
Associate Professor
Director, Baccalaureate Nursing Program
303-315-4824
FAX: 303-315-0907
Gayle.Preheim@UCHSC.edu

Two model partnerships are described below. The Clinical Scholar Model and the Looping Clinical
Placement Model are currently in place at the University of Colorado Health Sciences Center, School of Nursing, in Denver. Descriptions of model development and impact follow.

The Clinical Scholar Model: Linking Practice and Education in Clinical Supervision
The nursing shortage experienced throughout the nation provides opportunities for increased collaboration among Schools of Nursing and the service sector. The University of Colorado School of Nursing's ability to
double enrollments in the past three years to address the nursing workforce demands has been facilitated by an education-practice partnership called the Clinical Scholar Model. A successful effort to establish and maintain relationships with acute care, community-based, and ambulatory care settings to accommodate the need for clinical placements will be described. The Clinical Scholar model for clinical supervision in pre-licensure courses is an excellent example of bridging the relationship between the classroom and the clinical setting.

The Clinical Scholar is a practicing expert nurse who is employed by a clinical agency or facility, and also holds a clinical appointment in the School of Nursing. The primary responsibility of the Clinical Scholar is to a client group or population within the clinical agency. In addition, he or she has teaching responsibilities that include working closely with the faculty course coordinator and agency preceptors, to plan and implement the student's clinical experience and learning activities to meet expected
competency outcomes. 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.

The goals of the Clinical Scholar model are to build strong links between the university faculty and practice setting clinicians, to encourage meaningful presence and participation of university faculty in the clinical agency and of clinicians in education. The clinical relevance of the educational program is enhanced though collaborative course planning. For example, Clinical Scholars and faculty are working jointly in designing tools for competency based clinical evaluation, known as competency
performance examination. In addition, research and scholarly activities are facilitated through the faculty-clinician partnership.

The benefits to the clinical agency include consistency of clinical faculty within the facility, which results in less disruption and better integration of nursing students into unit and staff activities. Preceptors within the clinical agency feel supported in their interactions with students when then know the Clinical Scholar as a colleague. Frequently, a positive clinical rotation enhances recruitment of potential employees.

Students and the School of Nursing benefit from the continuity provided by the expert clinical supervision and increased relevance of the educational program. Less fragmentation and greater flexibility in determining the clinical experience and long-term planning for placements have been facilitated. Students have reported increased self-confidence and sense of accountability when linked with expert clinicians who understand the expected outcomes of the course, student's level of ability, and curricular
concepts.

In the Clinical Scholar Model, collaboration between education and practice is promoted, closer relationships between faculty and agency clinicians are created, and educational programs are enhanced in preparing a workforce for the future.

The Looping Clinical Placement Model
Education and practice share common goals of preparing competent new graduates and facilitating transition into practice. Familiar challenges to any clinical placement model are securing quality clinical learning experiences, identifying skilled clinical preceptors, and pairing students with preferred clinical settings. Opportunities involve developing new models of clinical supervision to enhance every clinical experience and build student-employer relationships. The Looping Clinical Placement Model
(LCPM) is a philosophy of clinical education that outlines a process for supporting student learning through long-term relationships with a clinical facility.

Looping (Grant, 1995) in education is a theory and research-based, student-centered approach used primarily in K-12 education with positive outcomes in learning, socialization, and competency performance. By keeping students and teachers together for several years, students are more likely
to build supportive relationships and experience continuous or progressive learning. A recent study of new graduates also supports that consistency of learning environment and preceptors increases progressive learning and confidence. The LCPM is an adaptation, implemented in 2001 at the
University of Colorado Health Sciences Center School of Nursing in partnership with metro-area hospitals. Components of the model are paid tuition, employment as a nurse intern throughout their nursing education, and priority placement in the facility for four clinical nursing courses. In
return, students commit to employment for two years.

Within an existing Clinical Scholar Model for clinical supervision, the increased use of preceptors with expanded orientation to competency outcomes performance assessment is possible. The model clearly specifies roles of the student, clinical facility, and school of nursing in the process of recruiting, selecting, and placing students within the looping model. The goals of maximizing the clinical experience are specifically to reduce orientation time, provide consistency of expectations and supervision, and increase opportunity to build skills over courses. Benefits to the School of Nursing are increased abilities to fully utilize sites for placements, involve qualified preceptors ongoing, and partner in facilitating a significant number of students to obtain scholarships for their nursing education. The evaluation plan monitors outcome indicators relevant to the learning experience, preceptor supervision, program completion, recruitment opportunities, and transition into practice.

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University of Delaware
Contact: Betty J. Paulanka
Dean, College of Health and Nursing Sciences

Lisa A. Plowfield
Chair, Department of Nursing
University of Delaware

What types of partnerships has your school initiated?

Since the mid-1980s, the University of Delaware Department of Nursing has initiated and maintained clinical education partnerships for nursing education. The primary reasons for which our clinical education partnerships began were three-fold. First, the department had an insufficient number of nursing faculty to meet the clinical education needs. Second, our departmental faculty did not have all the specialty expertise required; therefore, clinical partners allowed us to expand the clinical education options for nursing students. And, third, many agencies had specialty needs that were not being met by new graduates, thus, they asked us to offer coursework in select specialty areas.

In more recent years, the partnerships have been used to provide service-learning educational experiences for undergraduate and graduate students, thus enhancing our clinical education. Our faculty also established a Nursing Center that provides outreach health services to underserved populations; clinical education partnerships for referral services and collaboration have been essential to serving our community.

The specific clinical education partnerships that we have include clinical education for perioperative nursing, critical care nursing, neuroscience nursing, psychiatric nursing, gerontology nursing, medical-surgical nursing, school nursing, and community health nursing. Within the neuroscience and perioperative specialties, both clinical and didactic education are provided by partnering agencies. For these nursing specialties, our Department of Nursing partners with local acute-care and long-term care agencies. In the area of community health nursing, our Department of Nursing continues to partner with the state's Public Health Department and local schools. Another partnership that evolved out of our need for clinical sites for APNs was a new relationship with the University's Student Health Center. This partnership has expanded to include opportunities for undergraduates to gain experience with injections during flu season. They also work in the University's Employee Wellness Center to support primary prevention programs.

One other partnership that the Department of Nursing holds with a regional psychiatric center is a continuing education certificate program in cognitive therapy. Many nurses and other health professionals have completed this certificate program. This program was funded by the Patricia Kind Foundation.

More recently, we are forming inter- and intra-professional partnerships with other colleges and universities to expand programs and share faculty. Asynchronous learning has also allowed us to meet more teaching needs with greater outreach to students. We hope to optimize this modality for our educational partnerships.

How did these partnerships come about?

Most partnerships evolved from need, either of the educational program or the clinical agency. Some resulted from faculty and student requests for more specialty experience. To be more specific, the perioperative, critical care, gerontological, school nursing, and community partnerships were initiated by outside agencies based on their increased need for nurses to practice in these specialty areas. The psychiatric and medical-surgical partnerships met the nursing program's need for enough clinical educators in the right specialty area to teach our growing numbers of students during the early 1990s. The partnerships have continued on an as needed basis. The community partnerships were fostered by faculty with strong interests in public service and health policy. Distance education also prompted some creative partnerships within the University that are now being explored to expand outside the University. If you want more detail, please call.

The outreach to vulnerable populations and the community health nursing partnerships were developed through multiple grants from federal and foundation sources as well as contracts with the state.

How long have they been active?

The majority of partnerships were established in the late 1980s and early 1990s and most still exist. The UD Nursing Center has had active partnerships for 7 years. (This includes a collaborative agreement for APN practice.) The Nursing Center began the partnership for graduate student education.

What are the hallmarks of a successful partnership?

• More students educated (our partnerships allow approximately 33% of our graduates to receive their clinical education; otherwise we would not have sufficient faculty manpower to graduate 100-120 traditional undergraduate nurses each year).
• Continuation of partnerships for the long-term (commitment to long-term).
• High-level student and faculty satisfaction and mutual satisfaction of partners (partners report satisfaction and recruitment benefits to them).
• Upon graduation, many students remain in the specialty area of their final practicum; students may even remain at the partnering agency for nursing employment (a great recruitment opportunity for agencies).
• Increased journal publications and presentations that highlight these unique experiences (a great way to promote faculty scholarship). See attached list.
• Additional requests for similar partnerships with other local and state health agencies.
• Increased opportunities to partner on research grants with outside agencies (Diabetes Alliance, American Lung Associations, etc.).
• More agencies are willing to preceptor students because of these partnerships.
• Some agencies are partnering with each other to benefit from specialty programs.
• Improves our bond with alumni who often teach this specialty coursework.
• Acts as a recruitment tool for us to encourage agency staff to return for graduate degrees.

What advice would you give to a school looking for clinical partners?

In our small state, resources are limited, especially resources for clinical education. Therefore, partnerships have been essential to meet the growing clinical education needs of our students. Nothing should prohibit the development of a partnership. Building successful partnerships takes time, tenacity, and determination. Finding the right person within an agency who recognizes the benefit facilitates moving the partnership forward. Partnerships promote agency collaboration and collegiality for high quality student-centered education and improved service-education relationships.

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University of Massachusetts - Amherst
Contact: Paula Sakey
psakey@admin.umass.edu

What types of partnerships has your school initiated?

The UMass Amherst School of Nursing (SON) has developed innovative partnerships that focus on recruitment and retention in the profession and the education of a greater number of nurses who will enter the workforce. Two partnerships were developed in conjunction with Baystate Medical Center (BMC) in Springfield, MA and Cooley Dickinson Hospital (CDH) in Northampton, MA, to work to ensure an adequate number of professional nurses to provide for the health care needs within these institutions.

How did these partnerships come about? How long have they been active?

They were created as a response both to the dwindling workforce within the profession and to sustaining current enrollment within SON. Without private support of faculty, SON was in a position of decreasing enrollment from 60-64 students to 48 students. In order to keep level admissions, it was necessary for us to find the resources to hire additional faculty.

These two partnerships allow us to hire additional faculty enabling the school to continue level enrollments (64) into our nursing program. In addition, it provides nurses with ties to western Massachusetts and our community's future workforce.

The BMC partnership began in the summer of 2001, while the CDH partnership began in the fall of 2001.

What are the hallmarks of a successful partnership? (Please provide any data, i.e. school was able to expand enrollments by XX number; hospital saved $XX in recruitment costs.)

Through funding provided by BMC, we were able to hire two full-time faculty members and one half-time faculty member. In addition to working with student clinical placements, as part of their joint appointment, these faculty members are available to the staff of BMC to assist on projects that support the ongoing development of a professional nursing culture at BMC and recruitment/retention activities as well as teaching and faculty commitments at SON.

Partnership Hallmarks:
To facilitate several hallmarks, our faculty members:

• Work with BMC Department of Nursing Staff Development to coordinate the placement of 32 UMass students that would allow for an 8-1 student/faculty ratio,
• Provide clinical teaching for these nursing students,
• Consult with the BMC nursing staff, who are acting as clinical educators, in supervising and working with the UMass students, thereby helping develop their precepting and coaching skills,
• Act as "culture brokers" between the two systems thereby enhancing the two organizations' relationships and increasing the likelihood of UMass nursing students remaining at BMC upon graduation, and
• Assist BMC staff by working on specific projects that support the ongoing development of a professional nursing culture at BMC and recruitment/retention activities.

Additionally, BMC, in collaboration with UMass, developed a summer intern program, which provides employment positions to UMass nursing students. The summer interns work full-time during the summer and one shift per week during the academic year.

The outcomes from the BMC/SON collaborative this year are:

• A 13% increase in the number of UMass nursing graduates who accepted employment at BMC upon graduation. 11 graduates from UMass class of 2002 accepted employment at BMC.
• Eight out of the ten BMC interns graduating in 2002 were hired as RN's at BMC.
• The development of an internship program for freshman and sophomore pre-nursing students is underway.
• Faculty and the director of nursing staff development presented at the 24th International Association for Human Caring Conference on May 24, 2002. Jointly faculty and staff are writing two articles for professional nursing journals.
• One of the faculty members will conduct dissertation research focussing on the relationship between organizational factors and level of expertise of staff nurses in the acute care setting.
• UMass instructors, in conjunction with BMC Nursing Staff Development, further developed the preceptor program that includes entry, mid, and advanced levels. This year preceptor classes expanded to basic, advanced and stress management for preceptors. Day long classes were developed for all topics. Twenty-five percent of current preceptors have attended class. The faculty ran support groups for new graduate nurses, provided ongoing site visits, and individual consultations with regard to specific issues/problems. The faculty developed a proposal with nursing leadership at BMC to provide a "night resource" for new nurses in the medical surgical areas. A highly qualified nurse is in place and will provide ongoing support and education to the new (this year's hires) and almost new (last year's hires) nurses.
• The preceptor program is becoming self sustainable and demonstrates the achievement of mutually agreed upon objectives/outcomes. Staff Development nurses are working with the partners to participate in support groups, consultations, site visits, evaluations and recognition. By year three, they will assume the duties of preceptor education and support.
• UMass faculty, in conjunction with BMC Nursing Staff Development, developed a Leadership series for RNs that will include entry, mid, and advanced levels. Specifically this year, a UMass instructor developed a mentoring module in Nursing Staff Development in the current leadership class, to continue for 2002-2003.
• BMC hired 70+ nurses in 2001. Retention rate (June - Nov) of new grads was 92.5% (@ 6 months). All RN hires had 90% retention. Nationally hospitals experience a 20% turnover in nurses each year. The satisfaction of orientation among new nurses at BMC was 40.9% Very Satisfied, 54.5% Satisfied, 4.5% Not Satisfied.
• $170,000 was provided in scholarships through an endowed fund at BMC to support first, BMC nurses and staff entering UMass for their nursing education and secondly for undergraduate scholarships for UMass students.

The joint venture at CDH formalized and strengthened the practice/educational partnership between the two institutions. Through this joint project, CDH provides funding for one full-time faculty member and one-half time faculty member. The full-time faculty member is available to the staff of CDH two days a week to assist on projects that support the ongoing development of a professional nursing culture at CDH and recruitment/retention activities. Other responsibilities of the position include teaching and faculty commitments at SON. In addition, funding allows for the clinical placement of 16 traditional pre-licensure students within CDH and provides advisement and support for RN's returning to school to obtain their baccalaureate degree.

Partnership Hallmarks:

To facilitate several hallmarks, our faculty members:

• Work with the CDH Department of Nursing Staff Development to coordinate the clinical placement of 16 UMass students. This would allow for an 8-1 student/faculty ratio.
• Provide clinical teaching for these nursing students. Eight senior students work with the full-time faculty member and eight junior students work with additional contract faculty members.
• Consult with the CDH nursing staff acting as clinical educators, in supervising and working with the UMass students, thereby helping to develop their precepting and coaching skills,
• Act as "culture brokers" between two systems thereby enhancing the two organizations' relationships and increasing the likelihood of UMass nursing students remaining at CDH upon graduation,
• Develop relationships with middle school and high school counselors in the area to develop "future nurse" mentoring programs,
• Conduct needs assessment for graduate nursing needs at CDH,
• Provide onsite recruitment, course evaluation, advisement, and mentoring for the returning RN to BS cohort,
• Work to get prerequisite courses for the RN program taught at CDH, and
• Assist CDH staff by working on specific projects that support the ongoing development of a professional nursing culture at CDH (i.e. Evidence based practice standards/protocols and recruitment/retention activities).

CDH, in collaboration with UMass, developed a summer intern program, which provides for greater opportunity for employment positions to UMass nursing students. The summer interns will work full-time during the summer and one shift per week during the academic year.

Outcomes at CDH this year include:

• A 100% increase in the number of UMass nursing students that accepted employment at CDH upon graduation.
• Nursing leaders at CDH and the UMass faculty partner worked to revamp and revise the nursing orientation program to the hospital. This included both general nursing orientation and unit specific orientation.
• A cohort of potential RN-BS students was identified. Three individuals accepted and started in the RN to BS program beginning this summer. Nine potential students are currently undergoing advisement to enter the RN to BS program.

What advice would you give to a school looking for clinical partners?

Look at the needs of both the school and the health care organization. Assess both the current nursing practice environment and the learning needs of the institution. Expect that the first year will involve activities that include building mutually trusting relationships. Plan ahead of time how to disseminate information about the partnership throughout the health care organization.

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University of North Carolina-Chapel Hill
Contact: Linda Cronenwett, PhD, RN, FAAN
Dean and Professor

This paper provides details about the multi-year clinical partnership between the University of North Carolina (UNC)-Chapel Hill School of Nursing and UNC Hospitals. For most of their mutual 50-year histories, the two agencies co-existed as neighbors, with mutual respect but limited interactions beyond planning and providing traditional clinical placements for nursing students.

In 1993, a new undergraduate-nursing curriculum in the School of Nursing prompted a joint venture called the UNC Clinical Partnership (UNC-CP). A capstone learning experience was designed, using clinician assistance to delineate course content, clinicians as guest lecturers, faculty consultation on clinical issues and assistance with research discussions and dissemination, joint collaboration on research projects, and implementation of a clinical teacher (preceptor) model for clinical education. The UNC-CP expanded over the years, and this capstone learning experience now extends to 100% of the senior class.

In 1998, the Partnership launched the "Cutting Edge" continuing education series for nurses throughout the State. Faculty and clinicians plan the full day programs and select topics and speakers. The series offers programs with broad appeal, such as, Pain Management, Women's Health Issues, and Autoimmune Disorders. This series recently celebrated its ninth bi-annual offering and has, over its life span, succeeded in providing continuing education to over 1000 nurses. Although Education and Service provided initial funding jointly, the "Cutting Edge" series became self-supporting in its second year.

The joint ventures have continued. Faculty served on the Hospitals' planning committee for a geriatric inpatient unit and collaborated with service on a joint proposal to develop and implement an elder care assistant program in the Hospitals. As elder care assistants, beginning nursing students learn core nursing concepts/skills while providing needed services to frail elderly. Other partnership outcomes include: a grant-supported study to develop models for integrating senior students into the workforce as new graduates and collaborative clinical research projects.

Building on these successes, the Clinical Partnership expanded notably in the past 18 months to include a more substantive sharing of resources and financial support for student recruitment. In early 2000, the School of Nursing began exploring the feasibility of developing an accelerated second degree BSN option within its undergraduate program. UNC Hospitals offered support for the concept noting that, when established, the option would produce a cohort of new graduates every 14 months in addition to the new graduates completing the 24-month program each May. UNC Hospitals committed $75,000 to support faculty during the program planning and development year.

Once the 14-month program option was launched in May, 2001, UNC Hospitals offered entering students a choice of multi-level stipends/scholarships to cover the cost of tuition, fees and books, plus a living wage each month of the program. This financial aid was particularly important because second-degree students do not qualify for the same types of financial aid as their generic undergraduate counterparts in the 24-month program. Furthermore, the program's pace and workload prohibit student employment. Eighteen of the 31 students who participated in the May 2001 pilot program were awarded stipends/scholarships totaling $270,000 in financial support. In return, the students signed contracts to work 14 - 24 months with UNC Hospitals. This summer, the School of Nursing graduated 129 BSN students in May and will graduate an additional 31 students in August (for a total of 160 compared to 125 new nurse BSN graduates in spring/summer, 2001).

In May 2002, the School of Nursing accepted another class of 39 second-degree students into the 14-month BSN option. This year, UNC Hospitals increased the level of funding, committing a total of $550,000 in scholarships to 25 students willing to commit to a service repayment ranging from 18 - 36 months.

Given the success of the scholarship program in attracting new graduates to medical surgical inpatient positions, the program has been expanded to the traditional 24-month undergraduate program. Rising seniors, who just completed the 10-week summer externship program at UNC Hospitals, are accepting scholarships and employment commitments on the unit where they worked as externs.

Sandra Evans, Senior VP and Interim Director of Nursing, describes the success of the Hospitals innovative approach to student support and new graduate recruitment this way: "The scholarship program is a win-win for the Hospitals and UNC-Chapel Hill School of Nursing. While many hospitals throughout the country have chosen to pursue foreign recruitment to fill long-standing vacancies, we have chosen instead to invest in our School of Nursing and its students. The scholarship program assures us a supply of excellent new graduates that we help to educate --- new graduates who are pre-committing to an average service time of two years. The scholarships enable many students to pursue a nursing career who otherwise could not afford it. Our partnership with the School of Nursing has become even more important as we work together to prepare tomorrow's nurses."

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University of Pennsylvania
Contact: Marcy Hinchcliffe
Director of Faculty Affairs
Phone: 215-898-9684

• The School of Nursing at the University of Pennsylvania developed a clinician educator track for its standing faculty in 1983. A clinician educator (CE) is a faculty member who is primarily a clinician, and who makes significant contributions to the education of students. The teaching provided by a CE is likely to be practice-oriented, occurring in both the classroom and a clinical setting, where the faculty member maintains their clinical appointment. Approximately 40% of the School of Nursing faculty hold CE appointments. The appointments of these highly skilled professionals have enabled the School of Nursing to develop strong collaborative relationships with hospitals and other health care facilities in and around the Philadelphia area. The ability to offer the expertise and reputation of these clinicians also enhances the School's recruitment efforts.
  
  
• In addition to the Clinician Educator appointments, the University of Pennsylvania School of Nursing and University of Pennsylvania Health System have also developed collaborative appointments for individuals who are called Master Clinicians. These Master Clinicians are nursing staff members who practice in the Health System and are clinical instructors at the School of Nursing. Once again, these collaborative appointments enhance the relationship between the hospital and the school and while providing students with the highest level of clinical instruction. Cl