This blog post is taken from Innovation for a New Generation of Nurses, an Interview with Belmont University’s Dr. Cathy Taylor, Dean of the Belmont University College of Health Sciences and Nursing since 2012.
Taylor shares that core characteristics of new nurses are changing compared to previous generations. Studies show new nurse turnover averages about 18% in year one and in some cases over 30% in year two. Burnout, levels of frustration, and even exhaustion are on the rise for physicians, for nurses, and for other clinicians.
Taylor explains the impact that changing demands have on healthcare workers, saying, “We have an older, more chronically ill, and culturally diverse patient population. With that comes increases in the number of ethical decisions surrounding end of life, genetics, and limited resources. On top of that, we frequently add tasks without taking anything away.”
Other stressors include mountains of data in different states of organization where the technology, old and new, doesn’t always work seamlessly. A recent University of Iowa study estimated that by 2020, medical knowledge will double in just 73 days. “There is no question knowledge is growing faster than any of us can assimilate and apply. That may be one of our greatest challenges ahead,” the dean predicts.
Changing to Meet Workforce Expectations
Since her arrival at Belmont in 2012, Taylor and the faculty have been exploring ways to better prepare nurses to enter the workforce. Taylor knew it would be important to bring the college’s healthcare partners into that process.
“We asked nurse leaders and hospital executives two simple questions. First, what gaps do you see in new graduate preparation? Second, what do you need to see?” recalls Taylor. Because of those conversations, several valuable themes emerged, but almost to a person these health leaders said, “We can teach them skills on the job, and they can learn our processes, but what we really need is…” followed by a list of capabilities of a very experienced nurse.
Taylor’s response was, “We are unlikely to be able to produce an experienced nurse.” She and her faculty could, however, educate students to address many of the things they were hearing and to fill the gaps the leaders saw between a new graduate and an experienced nurse.
Taylor went back to the leaders, saying “We hear you, and we hear you need our graduates to be more flexible and to have better teamwork skills, to be better communicators and better critical thinkers. We hear that you want them to be able to make ethical decisions and that you want them to be more resilient and to come to you with at least some basic leadership skills. While we can’t deliver an experienced nurse, we can help our graduates better understand what the workplace is like and how to make the connections better and faster.” With that, her group went to work.
Here are four innovations Belmont has implemented that Taylor recommends for preparing new nurses to be more successful in their profession:
For two years they worked on designing a new concept-based curriculum to address the gaps. Concept-based learning stimulates deep thinking, where students learn big ideas and how to organize information into categories. This contrasts with traditional models where students learn facts and then they work to apply them in a clinical setting. In concept-based teaching, students build on previous learning and actively work to integrate knowledge from other disciplines.
“Our aim is to hardwire their flexibility to think on their feet. While we are very aware concepts don’t take the place of content, we are teaching them to think and to link concepts to solve problems,” Taylor elaborates. The concepts include teamwork and collaboration, inquiry and the importance of curiosity, and being able to ask the big questions. Leadership, realism, and professional identity formation also top the list.
The college also took steps to add more deliberative practice opportunities with time in simulation labs. The labs offer high-tech interactive manikins that can be programmed with custom scenarios to simulate vital signs and health conditions. Four labs allow students to experience the demands of acute, adult, maternal-child, and pediatric care. There is also an embedded apartment where students observe home activities and evaluate if a home is safe, especially for seniors.
Recently the college concluded a pilot with Vanderbilt University using a dedicated education unit at the hospital. Students work entire shifts, one-on-one with staff nurse-preceptors. “For their part, the university and the hospital committed to training the preceptors, and we spent a full day clarifying their roles and competencies,” Taylor adds. “Our goal was to prepare the preceptors and other clinical staff to work with students.”
The preceptors in the pilot gave great feedback about how prepared they felt. “They told us this was a completely different experience compared to their previous experiences working with student nurses,” says Taylor. “The students identified almost immediately with the staff nurses they were paired with, and they spoke in loving, glowing terms about ‘my nurse.’ To a person, they described having more and richer experiences through the one-on-one coaching. They felt part of the team on the unit,” she explained. “Ultimately, they all walked out with realistic expectations.”
Given this challenge for even the most seasoned nurse, she believes expectations for new nurses must be a little more realistic. “Students now assign great value to life-balance and finding their own sense of purpose. We’re seeing more students who require a bit of additional attention and counseling, which tracks with national findings.”
In response, Belmont is teaching organizational skills that will help their students balance the demands of the workplace. The college is also working more closely with its clinical partners to make sure graduates’ expectations are as realistic possible.
The college recently completed a retreat based on a complete focus on well-being and care for the caregiver. “Compassionate self-care is going to become more important over time, not just for nurses but for the entire healthcare team. If you look at the feedback we get from our graduates, they have realistic expectations as they step into the workplace, but they still say it’s harder than they expected. The work is just harder,” reveals Taylor.
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