Though nurses have traditionally been employed in inpatient acute-care settings, more and more nurses are now playing a larger role in providing and coordinating care across the continuum of care.
As services move from inpatient to outpatient services, Case Western Reserve University's Frances Payne Bolton School of Nursing and the Louis Stokes Cleveland VA Medical Center are teaming up to help address that shift.
A four-year, $2.2 million grant from U.S. Health Resources & Services will support the two institutions' efforts to prepare nursing students to work in nontraditional areas of healthcare delivery and train students and working nurses to lead more outpatient care.
"So, in nursing programs in the past, most of our curriculum is based on working in a hospital or inpatient, and I guess the community also," said Mary Dolansky, an associate professor at the school of nursing. "However, we have not focused on the competencies for new nurses to work in clinics and home-care services. ... So how can we get nurses ready to practice in these areas and also help nurses in these clinics to work to the top of their license?"
The institutions were awarded the grant last year and at the start of this year began a pilot program, dubbed the ENRICH Fellowship, with four students. Those participating in the pilot complete their clinical hours in a primary care setting, rather than the usual inpatient or community-based agency settings. The program highlights the importance of nurses' role in chronic-care education and management, Dolansky said.
In addition to the clinical hours, the fellowship requires that students participate in interprofessional learning sessions and quality-improvement initiatives. In Cleveland, putting students on interprofessional teams has been "sporadic," Dolansky said, but this model is more of a "continual, longitudinal program."
Students in the fellowship also participate in what are being called "field experiences": visiting organizations that address problems such as homelessness, food scarcity, mental health issues and addiction. The goal is to introduce them to community resources so they have a broader knowledge of the supports available when they're in a primary care setting, explained Rebecca Mitchell, project liaison for the grant.
"Preparing nursing students for the work that they will actually be doing, across the spectrum of care, is essential," nursing school dean Carol M. Musil wrote in an emailed response to questions. "Learning in an interprofessional environment is also important to maximize the potential to help patients achieve better health even in the face of chronic health problems. Nurses, and the entire healthcare team, can inspire and coach individuals to work to achieve better health, but there is much we still need to learn about how to do that."
Right now, the program places students in the fellowship at the VA for their primary care clinical hours, but Dolansky said the plan is to expand to other locations next year. They also intend to expand the pilot from four to 12 students, and then, over the course of the grant, grow it to up to 60 students.
Dolansky said the outpatient-focused experience will strengthen the students' understanding of the impact nurses have in patient care; enhance registered nursing students' communication and relationship skills with patients; and help students appreciate population health.
Chester Nguyen, a third-year student at CWRU studying nursing, is one of the four students participating in the pilot. He'll do his clinical hours at the VA in September after two-and-a-half weeks of intensive coursework.
"I was really interested to see how nursing was integrated in the primary care setting," he said, "and to not just be like hyperfocused on a certain aspect of their life but actually see how their healthcare fits in with their regular daily activities and their preferences and not just like a single acute problem."