RN-BSN Rural Nurse Initiative for Missouri


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RN-BSN Rural Nurse Initiative for Missouri

  1. 1. Improving Rural Health Outcomes: the innovative rural nurse education initiative JoAnn Klaassen, RN, MN, JD Clinical Assistant Professor Director, UMKC Rural Nurse Initiative ©Not for use without permission
  2. 2. Focus on rural health <ul><li>Rural health outcomes are universally worse than urban health outcomes </li></ul><ul><ul><li>Higher MVA rate/MVA deaths </li></ul></ul><ul><ul><li>Higher smoking & substance abuse rates </li></ul></ul><ul><ul><li>Significantly higher male suicide rates </li></ul></ul><ul><ul><li>(Harkness & DeMarco, 2012; Rural Assistance Center, 2011) </li></ul></ul><ul><ul><li>Higher mortality rate for ages 1-24 (Bennett et al., 2008) </li></ul></ul><ul><ul><li>Less access to preventative/perinatal care </li></ul></ul><ul><ul><li>Higher rates of occupational injuries (Bushy, 2007) </li></ul></ul><ul><ul><li>Higher levels of non-insured, under-insured individuals </li></ul></ul>
  3. 3. Focus on rural health <ul><li>Fewer resources available i.e. HPSA </li></ul><ul><li>Disproportionately Medicare/Medicaid funded </li></ul><ul><li>Community-based focus </li></ul><ul><li>Targeted for major changes via PPACA </li></ul><ul><li>Technology – tele-health in particular – seen as an emerging solution </li></ul><ul><li>Future funding and resource allocation are a concern </li></ul><ul><li>Regulatory burdens are disproportionate </li></ul>
  4. 4. Rural Hospitals <ul><li>Tremendous variability </li></ul><ul><li>Significant underfunding from Medicare (as compared to urban) </li></ul><ul><li>470 hospital closures over past 25 yrs. </li></ul><ul><li>Some revitalization via CAH, block grants, etc. </li></ul><ul><li>Initially left out of health care law </li></ul><ul><li>Fewer physicians and specialists, shortage of nurses </li></ul><ul><li>Significant locus of control shift from community to federal/state govt </li></ul>
  5. 5. Rural hospitals <ul><li>Increasing pressure on rural hospitals struggling to comply with meaningful use, quality indicators and </li></ul><ul><li>Avalanche of new regulations </li></ul><ul><li>Potential negative impacts of ACOs </li></ul><ul><li>Under health care reform the potential for community-oriented care to be subsumed by large corporations </li></ul>
  6. 6. Implications <ul><li>Rural communities need visionary and innovative health care personnel </li></ul><ul><li>Every health care provider will need to operate at the “full extent of their scope of practice” (Wakefield, 2011) </li></ul><ul><li>Community collaboration is critical </li></ul><ul><li>Emphasis on aggregate and preventive care </li></ul><ul><li>Current information and appropriate educational levels/skill development are essential </li></ul>
  7. 7. Rural nurse role <ul><li>Perform as expert generalists </li></ul><ul><li>Function within the community culture </li></ul><ul><li>Rely on both formal and informal networks for health care services </li></ul><ul><li>Apply ethical principles in a cultural context (Bushy, 2009) </li></ul><ul><li>Independence, creativity, innovation required </li></ul><ul><li>Flat career ladder requires flexibility to incorporate non-traditional roles </li></ul>
  8. 8. Rural nurses <ul><li>More rural nurses with associate degrees which does not provide </li></ul><ul><ul><li>Leadership skills, community/preventive health, mental health, policy development, etc. </li></ul></ul><ul><li>Fewer opportunities to advance education i.e. </li></ul><ul><ul><li>Travel to attend continuing education courses/conferences is a significant challenge (Mason, Leavitt & Chaffee, 2012) </li></ul></ul><ul><li>Less exposure to emerging technologies but higher need </li></ul><ul><li>Rural nurses’ average age slightly higher than urban nurses -> older learners, higher learning curve </li></ul><ul><li>Often wear multiple hats in the health care setting – some for which they are not educationally prepared </li></ul><ul><li>Expectation for more complexity in role (Wakefield, 2011) </li></ul>
  9. 9. Nursing Education <ul><li>Majority of baccalaureate nursing programs are located in urban areas </li></ul><ul><li>Few incorporate rural health concepts </li></ul><ul><li>Rural nurses often feel disrespected by urban nurse educators </li></ul><ul><li>Studies confirm that rural nurses who leave for school often don’t return </li></ul><ul><li>Financial burden on rural nurses is higher </li></ul>
  10. 10. Nursing Education <ul><li>Access to and quality of on-line programs is an issue for rural nurses </li></ul><ul><ul><li>Isolating, lack of support, irrelevant, repetitive </li></ul></ul><ul><ul><li>Preceptorships, residency, clinical require expense and travel </li></ul></ul><ul><li>Nursing faculty are ill prepared to educate nurses about emerging technologies </li></ul><ul><li>Few programs offer authenticity for adult learners </li></ul>
  11. 11. UMKC RN-BSN Program <ul><li>On-line for the past six years </li></ul><ul><li>Traditionally urban focused </li></ul><ul><li>Uses an interactive approach (Wimba® Live Classroom) to connect cohort group members </li></ul><ul><li>A developmental framework based on Covey’s work – personal, interpersonal, human health outcomes, complex health systems </li></ul><ul><li>Multiple technology supports </li></ul><ul><li>Team-driven practicum </li></ul>
  12. 12. The Rural Nurse Initiative <ul><li>Designed to offer the same quality RN-BSN program to rural and remote practicing nurses </li></ul><ul><ul><li>Outcome goals include networking rural nurses to urban resources such as simulation, EHR and other technologies </li></ul></ul><ul><li>Rural health concepts are integrated into the curriculum </li></ul><ul><li>Broadband laptops provided to rural nurses and cost of service reimbursed </li></ul><ul><li>24/7 live technology support and tutoring </li></ul><ul><li>Re-design of the practicum </li></ul><ul><li>Tele-health concepts drive a live on-line health assessment course </li></ul><ul><li>HRSA grant funded the program re-design and delivery </li></ul>
  13. 13. Program success <ul><li>Increase in rural nurses from approx. 10% to almost 50% of enrolled students </li></ul><ul><li>Overall enrollment increase from 40 students to 250+ students in 3 years </li></ul><ul><li>Almost 30% of rural graduates go on to advanced practice education </li></ul><ul><li>Identified by NLN as a ‘top 10’ nursing program for use of technology </li></ul><ul><li>HLC* 100% on-line certified – “a model program” </li></ul><ul><li>Student feedback is overwhelmingly positive </li></ul><ul><li>Students have extensive experience with a variety of technology applications including tele-health concepts </li></ul><ul><li>Enhanced respect for rural nurses </li></ul>
  14. 14. Curriculum targeted to rural nurses <ul><li>Curriculum re-designed to integrate rural health concepts into every course </li></ul><ul><ul><li>Lecture/assignments </li></ul></ul><ul><ul><li>Faculty and guest experts </li></ul></ul><ul><ul><li>Discussion boards </li></ul></ul><ul><ul><li>Applied concepts </li></ul></ul><ul><li>Content designed to compare and contrast urban and rural health issues </li></ul><ul><li>Increased focus on technology applications in health care </li></ul>
  15. 15. Multi-modal technology supports <ul><li>Broadband laptops for rural nurses </li></ul><ul><li>Blackboard® platform with Wimba® Live Classroom </li></ul><ul><li>Wikis </li></ul><ul><li>Wimba-based workrooms </li></ul><ul><li>File exchange </li></ul><ul><li>Instant messaging </li></ul><ul><li>Tutorials and orientation to the technology </li></ul><ul><li>24/7 live technology support </li></ul>
  16. 16. Virtual Practicum <ul><li>Virtual practicum – encompasses 9 months across two courses utilizing virtual teams </li></ul><ul><li>Real projects in real communities – urban and rural </li></ul><ul><li>Every virtual team carefully combined with urban/rural and near/distance students </li></ul><ul><li>Utilization of the multi-modal technology to manage the virtual team project </li></ul><ul><li>Faculty work closely to set up projects and facilitate student groups in the ‘consultant’ role </li></ul><ul><li>Technology is used to connect community partners </li></ul>
  17. 17. <ul><li>Most projects have at least one student with ‘boots on the ground’ </li></ul><ul><li>Student teams collaborate with a health agency to identify a need, assess the target population, develop a plan of action and implement strategies and/or products designed to improve health outcomes </li></ul><ul><li>Examples: </li></ul>
  18. 18. Virtual Project <ul><li>http://www.youtube.com/watch?v=3H7wG-ZhVlM </li></ul><ul><li>Research based </li></ul><ul><li>Collaborative </li></ul><ul><li>Virtual team driven </li></ul><ul><li>Attitudinal changes documented </li></ul>
  19. 19. Student comments <ul><li>“ Now I don’t want to let go [of the project]…” </li></ul><ul><li>“ I had worked on projects before – nothing to this extent. I gained so much out of it…” </li></ul><ul><li>“ I learned how to take an idea from paper and actually make it happen.” </li></ul><ul><li>“ I was able to see how an effective team really can work together to achieve a common goal.” </li></ul><ul><li>“ I am excited to be looking at the publication of our handbook – I would never have dreamed of this…” </li></ul><ul><li>“ I learned that nurses truly can make a difference in the lives of people and entire communities.” </li></ul>
  20. 20. Live on-line health assessment
  21. 21. <ul><li>Traditional course – on-line instruction followed by 1 week of residency to practice and demonstrate skills </li></ul><ul><li>Learning Exchange Reverse Demonstration© - faculty developed model using best practices in skill demonstration coupled with tele-health techniques </li></ul><ul><ul><li>Student groups meet 8 times/semester on-line to practice and demonstrate enhanced skill acquisition </li></ul></ul><ul><ul><li>No residency requirement </li></ul></ul>
  22. 22. <ul><li>Model piloted for two semesters </li></ul><ul><ul><li>Equal skill attainment with traditional course </li></ul></ul><ul><ul><li>More positive student comments for on-line instruction </li></ul></ul><ul><ul><li>Immediate instructor feedback and correction </li></ul></ul><ul><ul><li>Less cost and time commitment for students </li></ul></ul><ul><ul><li>More time and cost intensive for instructors </li></ul></ul><ul><ul><li>Prepares students to utilize tele-health constructs </li></ul></ul><ul><ul><li>Provides a method of broadly teaching a variety of skill acquisition and enhancement to remote learners </li></ul></ul>
  23. 23. Student supports <ul><li>On-line site to access available supportive services </li></ul><ul><ul><li>Student developed based on peer feedback </li></ul></ul><ul><ul><li>Counseling/stress management </li></ul></ul><ul><ul><li>Financial aid/management </li></ul></ul><ul><ul><li>Social network/family supports </li></ul></ul><ul><ul><li>Study/Academic </li></ul></ul><ul><ul><li>Link to SON social worker </li></ul></ul><ul><li>Tutoring offered via desktop sharing (TeamViewer®) </li></ul>
  24. 24. <ul><li>Technology-supported peer mentoring </li></ul><ul><li>Faculty/Academic Advisor mentors for each student </li></ul><ul><li>24-hour response rule for faculty </li></ul><ul><li>Engagement via multiple technologies </li></ul><ul><li>Rich media connectedness for all students </li></ul><ul><li>Group engagement via long-term virtual team practicum </li></ul>
  25. 25. Faculty <ul><li>All faculty are full-time, experienced on-line educators who have demonstrated excellence </li></ul><ul><li>All faculty committed to student success </li></ul><ul><li>Faculty are a combination of urban and rural practicing nurses </li></ul><ul><li>Faculty have acute and community-based care experience </li></ul><ul><li>Faculty live across the nation and model virtual teamwork and collaborative practice with emerging technologies </li></ul>
  26. 26. <ul><li>Faculty cohesion is valued </li></ul><ul><li>Students are treated as colleagues and diversity of gender, ethnicity, experience and viewpoint is valued and encouraged </li></ul><ul><li>Respect, responsibility, communication and excellence are the driving principles of the program </li></ul><ul><li>Reasonable flexibility coupled with high expectations </li></ul>
  27. 27. How do we know it works? <ul><li>Student/employer feedback </li></ul><ul><ul><li>Relevance, role expansion, positive learning </li></ul></ul><ul><li>Student learning outcome portfolios demonstrate relevant learning </li></ul><ul><li>Our students are the primary recruiting tool </li></ul><ul><li>Recognition from our professional organizations </li></ul><ul><li>Thirty percent of our students keep going! </li></ul><ul><li>Approximately 100 rural nurse graduates by December, 2011. </li></ul>
  28. 28. Implications for rural health outcomes <ul><li>Nurses understand and function in an expanded role </li></ul><ul><li>Collaborative, team-building and conflict resolution skills </li></ul><ul><li>Leadership principles and problem-solving </li></ul><ul><li>Every graduate is equipped to take a large-scale project from beginning to end </li></ul><ul><li>Graduates prepared for emerging technology use </li></ul>
  29. 29. <ul><li>Nurses understand principles of evidence-based practice and research fundamentals </li></ul><ul><li>Aggregate health assessment and intervention skills </li></ul><ul><li>Data gathering and analysis skills </li></ul><ul><li>Policy and protocol development skills </li></ul><ul><li>Increased awareness of emerging health issues and health care changes </li></ul>
  30. 30. <ul><li>New awareness of community-based health initiatives </li></ul><ul><li>Better understanding of continuum of care issues </li></ul><ul><li>Exposure to innovation and creativity in health care </li></ul>
  31. 31. References <ul><li>Bennett, K., Olatosi, B. & Probst, J.C. (2008). Health disparities: A rural-urban chartbook. South Carolina Rural Health Research Center, 4. Retrieved from: http://rhr.sph.sc.edu/report/SCRHRC_RuralUrbanChartbook_Exec_Sum.pdf </li></ul><ul><li>Bushy, A. (2007). Rural Nursing: Practice and issues. ANA Continuing Education Program. Retrieved from http://www.nursingworld.org/MainMenuCategories/CertificationandAccreditation/CE.aspx </li></ul><ul><li>Bushy, A. (2009). A landscape view of life and healthcare, in rural settings in Handbook for rural health care ethics: A practical guide for professionals. Nelson, W. (Ed). Dartmouth College Press, N.H. </li></ul><ul><li>Harkness, G.A. & DeMarco, R.F. (2012). Community and public health nursing: Evidence for practice . Philadelphia, PA: Wolters Kluwer/Loppincott Williams & Wilkins. </li></ul><ul><li>Mason, D.J., Leavitt, J.K. & Chafee, M.W. (2012). Policy and politics in nursing and health care (6 th ed.). St. Louis, MO: Elsevier/Saunders. </li></ul>