Private Innovation with Public Funds
The public sector (i.e. government) discussed in the last post may be big and powerful in its control of funding and regulations of healthcare, the private sector is afforded flexibility and sometimes financial resources to create solutions to meet the needs of patients and providers alike. The Graduate Nurse Education (GNE) demonstration project was established by the Center for Medicare & Medicaid Services (CMS) to study a few options to increase the clinical training for nurse practitioner (NP) students. The project provided funding to five organizations across the United States, with more than 900 advanced practice registered nurses (APRNs) in Arizona benefiting from this four-year study. Unfortunately, it will take time for the data to be fully analyzed and reported; then additional time beyond that for regulatory changes to occur.
Popular Recognitions for Preceptors
Colleges and universities offering degree or certification programs for the NP have a two-fold reason for tackling the problem of preceptors. Schools want to offer students quality sites and schools need faculty. One means to address both the nursing faculty and preceptor shortages is to offer the preceptors adjunct faculty roles (Wiseman, 2013). This process is well established in medical training with the joint appointment many physicians hold with universities (Forsberg, Swartwout, Murphy, Danko, & Delaney, 2015). Creative financing methods used by the colleges to “pay” the preceptor include continuing education vouchers, tuition reduction, and access to campus services or events. The faculty can also aid the preceptor with professional certifications and recognition via manuscript editing, award nomination, and letters of reference. Many successful academic-preceptor partnerships also offer the preceptor free training and support to improve the skills used in mentoring an APRN student (Wiseman, 2013).
Melding Student and Employee Roles
Rosalie Mainous, PhD, APRN, NNP-BC, is now the Director of Academic Nursing Development with the American Association of Colleges of Nursing, but was involved with a very innovative transition to practice program during her tenure as Dean of the Wright State University-Miami Valley College of Nursing and Health (WSU) in Dayton, Ohio. Though this program was designed for the baccalaureate nursing student entering a registered nurse position, it has possibilities for APRNs as well. The final clinical semester is coordinated to also be the new nurses’ orientation time on the job. It provided the student with interview experience and a secured job upon graduation; the organization with 3-year commitment from the student, and reduced orientation and turn-over costs; and WSU with strong, consistent, appropriate clinical sites (Trepainer, Mainous, Africa, & Shinners, 2017). In a personal telephone interview, Dr. Manious stated that it is human nature to learn, as well as teach, slightly different if one is hired and orienting to a new role versus completing a clinical rotation or residency. This academic-organization partnership will not work for every RN or APRN student; however, it shows much promise in meeting the needs of the school, student, organization, and patients in a winning scenario for all.
A Negative Innovation
Some organizations are taking advantage of the limited clinical sites when contracting with universities by charging a fee; YIKES!! “We are the pipeline for their workforce” was Dr. Mainous’ observation regarding the needed relationship between schools and organizations. Schools are already struggling to keep tuition affordable, provide the latest technology teaching tools, and pay their faculty and staff adequate wages; adding a site fee per student could push some programs to the breaking point. From the viewpoint of the organization, their reasoning seems logical; they are paid to take medical students, shouldn’t they get paid for helping train the nursing students as well? Important differences are the funding source for the medical students (i.e, Graduate Medical Education funding through CMS), educational program design, and the coordination of medical school admissions with known site availability.
It will take all stakeholders in NP, as well as medical, education working together to find cost-effective, quality-promoting, patient-focused solutions to the challenges of securing and remunerating the preceptors and healthcare facilities for their investment. Efforts in the public sector combined with an examination of the many innovations in the private sector will help improve clinical education for the APRN and improve outcomes for the nation’s health.
Forsberg, I., Swartwout, K., Murphy, M., Danko, K., & Delaney, K.R. (2015). Nurse practitioner education: Greater demand, reduced training opportunities. Journal of the American Association of Nurse Practitioners, 27, 66-71. doi: 10.1002/2327-6924.12175
IOM (Institute of Medicine). 2014. Graduate medical education that meets the nation’s health needs. The National Academies Press. Retrieved from: https://www.nap.edu/catalog/18754/graduate-medical-education-that-meets-the-nations-health-needs
Trepanier, S., Mainous, R. Africa, L., & Shinners, J. (2017). Nursing academic-practice partnership: The effectiveness of implantation of an early residency program for nursing students. Nurse Leader, 15, 35-39. doi: 10.1016/j-mnl.2016.07.010
Wiseman, R.F. (2013). Survey of advanced practice student clinical preceptors. Journal of Nursing Education, 52, 253-258. doi:10.3928/01484834-20130319-03