What do Nurses Need? Ask the Next Generation

Forefront Magazine, Spring/Summer 2018
Photo and graphic collage showing snapshots of nursing in training, class, and having fun.

No one ever said being a nurse was easy. But these days, it can feel harder than ever for the next generation of care providers, health care leaders, and nurse scientists. Technology changes faster than academic curricula. The volume and complexity of patient care required in practice outpaces clinical education. And the field places increasing demands on a daily basis on its professionals, especially those new to the practice. What's a nursing school to do?

At the Frances Payne Bolton School of Nursing, the answer is obvious: Change

Story by Jessica Ullian

As the 2019 move to the new Health Education Campus nears, the directors of each of the School of Nursing's degree-granting program are taking an unsparing look at how nursing education needs to better serve its students. Overs the past two years, Teona Griggs, the School of Nursing's director of student services, and Catherine S. Koppelman, MSN, RN, the former system chief nursing and patient experience officer at University Hospitals and a FPB visiting instructor, have led a series of surveys and focus groups with students and faculty to identify the School of Nursing's strengths and challenges. Now, with the results in place, they have developed a series of student-focused initiatives to show these current and future nurses that their opinions matter, and their ideas will shape their education.

"we're relocating the entire school to an interprofessional building, and crafting courses for nursing, medical, and dental students," Koppelman says. "We are preparing to enter that process with an understanding of what students expect, and start off stronger with what they need."

Mary E. Kerr, PhD, RN, FAAN (GRS '91), the school's dean and May L. Wykle Endowed Professor, hired a consulting firm to work with School of Nursing leadership and coordinate with Griggs and Koppelman in the summer of 2016. "Together we examined every step of the student experience, from inquiry to acceptance, and from point of entry to graduation," Griggs says. Then, they convened student and faculty focus groups to learn more about how to increase efficiency and maximize the student experience.

The result? A sustained commitment to offering student-centered education initiatives at every level, from undergraduate to doctor, and a practical look at the teaching, technology, and communication practices that today's curriculum requires.

"I'm impressed at the dedication that faculty and staff have shown toward improving the program," says Andrew Kociubuk, a first-year master's student who represents the Graduate Entry Nursing (MN) program on the Dean's newly created Student Advisory Committee. "Everyone's very open to feedback, and willing to make changes."

A New Investment in Simulation and Equipment

University partnerships with local hospitals like the Cleveland Clinic, MetroHealth Medical Center, University Hospitals, and the Louis Stokes Cleveland VA Medical Center provide School of Nursing students an opportunity to spend increased time working in care settings in the skills and simulation lab. But students at every level reported that they wanted more time to practice these skills, and more interface among lab, class and clinical.

"We host 10,000 student visits every semester for simulation training, and play a significant role in education," says Celest M. Alfes, DNP, MSN, RN, CNE, CHSE, director of the Center of Nursing Education, Simulation and Innovation (CNESI). "So it was really important that we receive, listen and respond to feedback from the students."

As part of this effort, CNESI hired a full-time manager to oversee the equipment, train teaching assistants and serve as a liaison with course coordinators to ensure consistency of experience across different classes. Twelve hours of open lab time was added to CNESI's weekly schedule, so students can visit and run simulations independently. Alfes hopes to add another drop-in day in the coming academic year.

The school has also made a $150,000 investment in up-to-date equipment, through both new purchases and donations of refurbished items from Cleveland Clinic. The list includes everything from hospital beds to Hoyer lifts, so that students will have more opportunities to practice on the systems they might encounter at the four affiliated hospitals. "Students wanted to practice with IV pumps, but each of those institutions uses a different model or brand," Alfes says. "So we upgraded to make sure we would represent the range of equipment the students were operating in a clinical setting."

The school also further invested in its faculty by launching the Simulation Scholar Program last summer. Seven faculty participated in a paid 15-hour continuing education program to develop new simulations in providing multi-patient care, conducting advanced practitioner physical assessments, and administering anesthesia, among others. The new simulations were offered to students in fall 2017 and the Simulation Scholars Program will be offered again starting June 2018.

Meeting Students Where They Live: Online

Students also asked School of Nursing leadership to take a critical look at its interactions with current students. A wealth of information was available online for prospective students, they said, but once enrolled, resources were limited for navigating ongoing issues, ranging from individual class websites to financial aid processes.

A deeper assessment of the website revealed that some key information was being disseminated via word-of-mouth rather than being available for online reference: For example, scholarships for returning students working at FPB's hospital partners were not listed online. "It made me appreciate how much of the information is in my head," says Director of Financial Aid Dedra Hanna-Adams, a 14-year FPB staff member.

While a broader review at the website's organization gets underway, Hanna-Adams and the school's marketing team are developing a series of short videos to be posted online that describe how to navigate the financial aid system. Hanna-Adams hopes the videos will appeal to the current student population, highlight her availability as a useful resource on campus, and provide basic information to them to that she can provide more in-depth, personalized assistance to the students.

Academic success is also a key component of the communication upgrades, with an ongoing effort underway to provide key deadlines and course materials in a way that is consistent, timely, and easy to locate. CNESI has begun posting all materials, assignments, and video links to a central site, so that every student, no matter which session they attend, has access to the same materials. A smaller initiative is underway for course materials across all programs.

"We had an expectation that the course syllabus would be posted several weeks before classes started, but we surprised when students said it wasn't done with consistency," Koppelman says. "So we implemented a process last July, and are monitoring to ensure that the syllabi are available within the time frame we set as the guideline. We really measure our outcomes."

Prioritizing Professional Education

A focus on improving the student experience, however, does not automatically translate to readiness for professional practice. That is where the move to the new Health Education Campus comes in. The BSN program will be the only undergraduate program on the new campus, fully integrated with the School of Nursing's current master's and doctoral programs as well as Case Western Reserve University's medical and dental schools. Building on the existing connections with hospital partners, the integration with the other health sciences programs will help students prepare "to hit the ground running," says Amy Bieda, PhD, APRN, PNP-NC, NNP-BC, director of the BSN program.

"Nurses don't have a 10- or 12-week orientation in their new jobs. The field is rapid-paced and high-tech, and that's a big change over the last 30 to 40 years," Bieda says. "You're on your own, responsible and accountable, and we need to keep pace so that students are prepared."

From a practical standpoint, this has been operation at FPB for students early on in their education. They participate in clinical and community experiences from their first semester on campus. Mary F. Terhaar, DNSc, RN, FAAN, associate dean for academic affairs, says that in preparing to move to the new HEC, FPB leaders are critically reviewing the program's core competencies and making sure students have interdisciplinary opportunities throughout the program.

"For more than ten years, we've been engaged in interprofessional education," Terhaar says. "What we're doing now is enhancing our curriculum to prepare students to be effective in those engagements in health care. With a team of colleagues that represent the different health care disciplines, students share what they've learned conceptually and apply it to clinical practice."

Many students say that the school's commitment to providing extensive clinical experience was what drew them to FPB initially, and the move to the Health Education Campus is another exciting step forward.

"I don't think any school can compare to our clinical experiences within our hospital and community settings," says Emma Baker, president of the Undergraduate Student Nurses Association.

But with the results of the student focus groups in - and changes well underway - Baker says that she feels a renewed enthusiasm for FPB.

"Everyone has been so willing to listen and appreciate what we go through as student nurses," she says. "We're creating an open environment, and an experience that will be fundamental for incoming students."