COLLABORATIVE SOLUTIONS: IMPLEMENTING INNOVATIVE STRATEGIES.

COLLABORATIVE SOLUTIONS:

IMPLEMENTING INNOVATIVE STRATEGIES

Texas Board of Nursing Innovative Professional

Education Pilot Programs

Robbin Wilson, MSN, RNNursing Education ConsultantTexas Board of Nursing

Historical Background Texas Nurses Association Redesign

of Nursing Education Task Force

Texas Higher Education Coordinating Board Nursing Innovation Grant Program

Texas Nursing Practice Act Statutory Authority for Pilot Programs Patient Safety Pilot Program – University

of Texas M.D. Anderson Cancer Center

Texas Board of Nursing Rules Freedom in Existing Rules for Innovation Waivers for Existing Rules New Rules

Pilot Programs

Request for Proposals Midwestern State University

Partnerships Regional Interdisciplinary Simulation Center BSN-prepared Utilized as Lab Mentors

Request for Applications Victoria College

BSN-prepared Nurses Utilized as Certified Clinical Instructors (CCIs)

Must Complete 7 Specified Graduate Hours in Nursing Education

Legislative Actions

Sunset Review Issues/Recommendations

Passage of Texas House Bill 2426 Revised the Texas Nursing Practice Act Renamed the Board of Nurse Examiners as

the Texas Board of Nursing; and

Collaborate with Nursing Educators Texas Higher Education Coordinating Board Texas Health Care Policy Council

Implement, Monitor, & Evaluate a Statewide Plan for Creation of Innovative Nursing Education Models

Promote Increased Enrollments in Texas Nursing Programs

Address Nursing Shortage

Mandated that the Texas Board of Nursing:

What comes next? Encourage Nursing Programs to Increase

Enrollment/Retention/Graduation Consultant Expertise & Assistance Website Showcase Workshops

Suggest Models Clearinghouse Research Findings

Evaluate Enrollment, Retention & Graduation Rates NCLEX Examination Pass Rates

Collaborative Solutions:An Example

Susan Sportsman, RN, Ph.D.Dean, College of Health Sciences and Human Services

North Central Texas Health Care Consortium Midwestern State University (MSU) Vernon College (VC) United Regional Health Care System (350

bed regional hospital) (URHCS) $1.27 million grant to develop a regional

simulation center

Primary Purpose of the RSC:To Increase admissions to Nursing Programs Goal: Increase admission at MSU and VC by

56 over grant period.

Outcome: Increased admissions of the two schools by 57 MSU 41 (77 additional) VC 16

Structure of Regional Simulation Center (RSC) 3,410 square feet renovated nursing unit at

URHCS 7 high fidelity patient simulators (4 adults and

3 infants/child manikins) 4 clinically strong BSN lab mentors,

supervised by a MSN director Responsible for providing competency

education and validation to BSN, ADN, and hospital clinicians.

Relationship between Faculty and Lab Mentors Faculty developed/approved scenario template Faculty developed learning objectives for all

simulations consistent with course objectives Faculty & Lab mentors developed/revised

simulation scenarios Lab mentors implemented learning activities Lab mentors communicated to faculty student

progress

Opened January, 2005, providing scenario-based high fidelity patient simulation for competency education/validation

Opportunity for students to integrate clinical decision-making into the development of psychomotor skills

Clinical scenarios as the basis for learning. As students progress in the curriculum, scenarios become more complex

Student Schedules MSU and VC course coordinators work with RSC

Director each semester to schedule student time, according to course objectives.

Blocks of time assigned to each course prior to the beginning of the semester.

Students are allowed to sign up in class for their “Sims” experience at times convenient to them, as long as it falls in the appropriate class block.

Once schedule is made, students must call the RSC secretary to make changes to their schedule.

Student Learning Process Scheduled blocks of time typically during the

student’s “expected clinical day”. The first week of class and finals week avoided.

Students not allowed to sign up for “sims” time during regularly scheduled classes.

RSC staff blocks out additional times during the semester for “make-up” times

Substitution of RSC for Some Clinical Hours

Examples of MSU clinical experience

assignments in the RSC:

Health Assessment-100% of clinical experience

“Fundamentals”:50% Med-Surg courses: 25% Pedi; OB:10-14%

Outcomes of the 32-Month Grant 20,074 duplicated learner visits

13,444-MSU 4,042 VC 2,688 URHCS

44,963 duplicated learner hours 34,116 MSU 7742 VC 3,105 URHCS

900 members of URHCS Clinical Staff participated in annual competency validation through the RSC

What impact does the use of the RSC have on the quality of the education for the nurse?

RSC Allows More Students to be Admitted

Research QuestionWhat is the impact of participation in scenario-based simulation throughout their course of study on students’ sense of clinical competence, anxiety, and satisfaction with clinical learning environment, as well as GPA and HESI-E2 exit exam scores?

Development of a Model to Explain/Predict Factors which Influence Clinical Competency in New Graduates

Three Year Data Collection Process January 2005, 2006, & 2007: Juniors April 2005,2006 & 2007: Seniors

2005 Seniors-Little or no simulation experience

2005 Juniors/2006 seniors-3 semesters of simulation experience

2006 Juniors/2007 seniors-5 semesters of simulation experience

Data Collection Clinical Competence Appraisal Scale (PSP, Leadership,

Teaching/Collaboration, Interpersonal Relations/Communication, Planning/Evaluation)

LASSI (Motivation, Attitude, Concentration, Anxiety) PSVIII-R (Hardiness) Clinical Learning Environment Demographic Data Sheet GPA Scores on HESI

d

Demographics: Significant Difference A large majority of the respondents in both

schools were between the ages of 19 and 39 years of age

MSU students younger than VC

Comparison of Previous and Current Health Care Experience by Schools

VariableSchool N Mean St.D. f Df p

Previous Health Care Experience

VCMSU

117132

.72

.414549

5.13 247 .0001

Current Health Care Experience

VCMSU

117130

.63

.35.48.49

4.71 248 .0001

Comparison Among Years – Juniors 2005 juniors (no simulation experience before

completing the CCAS) rated their competence in psychomotor skills performance significantly higher (p=.0001) than juniors in 2006 and 2007 (participated in simulation before they responded to the CCAS).

Participating in simulation early in their clinical

experience may provide a “dose of realism” for students in their clinical courses.

Comparison Across Years -Seniors

No significant difference in mean score of the PSP, teaching/collaboration, planning/evaluation or interpersonal relations/communications subscales among the three groups of seniors in the study.

Substituting clinical experience in the RSC for a portion of the time required in clinical agencies does not make a difference in students’ perception of their clinical competence.

Argues for the substitution of simulation experience for some clinical experiences as a strategy for increasing student admissions when there are limited clinical experiences available to schools.

Only CCAS subscale for which there was significant difference in the mean scores of the seniors =Leadership subscale.

The 2005 Seniors (little or no experience in the RSC) perceived themselves to be less competent in leadership skills than the 2006 and 2007 Seniors (participated in simulation).

During the teaching scenarios, small groups of students worked together to provide care in the simulation. Students played various roles during these experiences, including charge nurse, recorder, family member, and/or primary nurse. Perhaps this opportunity to role play enhanced students’ sense of their competence in leadership activities.

Comparison by Year (LASSI) NO significant difference among mean scores on the

attitude, concentration and motivation subscales of the LASSI in the three groups of seniors.

The higher the mean score on the LASSI subscale, the lower the level of anxiety: 2005 seniors had significantly less anxiety than the seniors in 2006 and 2007.

2005 seniors had a significantly higher mean anxiety score (p=.015) than the seniors in 2006 and 2007 did, although the 2007 mean score rose above the 2006 score.

Increased participation in simulation experiences may have contributed to the increase in the 2006 and 2007 senior students’ anxiety.

Comparison by Year:Clinical Learning Environment The mean scores on the CLE Scale for the 2005

seniors were significantly lower than the mean scores for seniors in 2006 and 2007.

Simulation may positively influence students’ perceptions of the clinical environment where they are assigned during the last semester of their course of study.

Comparison among Years:Graduating GPA & HESI E2 Exit Exam

No significant difference in graduating GPA or HESI E2 Exit Exam for seniors in 2005, 2006 and

Participation in scenario-based simulation does not negatively impact the students’ performance on the HESI exam, the results of which is highly correlated with success on the NCLEX-RN licensing exam (Morrison, et. al, 2004).

Positive Factors

Negative Factors

Competence in Nursing Role

Lack of Competence in Nursing Role

Effect of RSC

Mimics the “real world”.

Too many scenarios assigned

Critical thinking Technical skills Makes you realizeyou know more than you think you do

Provides collaboration opportunities.

Lack of realism in some scenarios

Ability to plan patient care

Caring for multiple patients

Emphasis on the processes of care

Provides connection between class and clinical experience

Frustrating virtual IV

Organizational Skills

Delegation

Provides opportunity for “safe” mistakes

“Putting it all together”

Qualitative Evaluation: Focus Groups

Hardiness(HRD)

StudentEffort(SEFFT)

Clinical Learning Environment(CLE)

Grade Point Average(GPA)

Clinical Competence(CCAS)

Model of Factors Influencing New Graduate Competence