Western Carolina University - Western Carolina University | … · Web viewThis project also includes intentional curricular efforts to develop student interest in community based

Nurse Education, Practice, Quality and Retention

Bachelor of Science in Nursing Practicums in Community Settings Program BSN Practicums in Population Health (BSN PoP)

PROJECT NARRATIVE PURPOSE AND NEEDThe purpose of this BSN Practicums in Population Health (BSN PoP) project is to support theNEPQR-BPCS program as authorized by Section 831 of the Public Health Service Act, 42U.S.C.§ 296p, as amended by the Patient Protection and Affordable Care Act (Public Law 111-148). As such this project will support and develop community based practicum experiences to prepare baccalaureate prepared registered nurses for work in community and primary care settings following graduation.

The overarching goals of this project are to: 1) prepare a minimum of seventeen (17) baccalaureate nursing students with additional competencies to practice in a community based/primary care setting following graduation; 2) develop RN capacity to serve as preceptors in the region by educating ten (10) RNs through our Primary Care Certificate Program; and 3) educate a minimum of fifty (50) healthcare providers in the region about the benefits of having a BSN prepared RN in community/primary care settings.

We will accomplish these goals by supporting and developing RNs to serve as preceptors for these experiences; enhancing the current curriculum through expanded didactic content and experiential learning opportunities; and promotion of the expanded role of the RN in primary care to educate primary care providers about the benefits of the RN as care coordinator in primary care settings and to enhance sustainability of the project.

Consistent with this purpose, this application seeks funds to develop these intensive three to six month community based practicum experiences for undergraduate students in three of our undergraduate program offerings by partnering with regional primary care providers serving medically underserved and rural populations, as well as area hospital systems. These practicum experiences will be designed to support graduates’ achievement of generalist nursing competencies as defined by the Association of Community Health Nurse Educators (ACHNE) and development of competencies to execute the Care Coordination and Transition Management model (CCTM) in primary care settings. These competencies support the ability of the RN to meet the needs of patients and their families with chronic complex illnesses and support population health. The practicum experiences outlined in this project will help to expand an already strong community/mental health curriculum, and provide graduates with additional competencies for practice in community-based, primary care settings with underserved populations.

This collaborative program is designed to promote academic success through placement of dedicated full time baccalaureate prepared RN Consultants in primary care settings working with underserved populations to serve as full-time preceptors for student interns; having a dedicated Faculty Liaison to develop and oversee these experiences, and through creation of a regional advisory group of interested stakeholders to guide the project. The project includes use of a Rapid Cycle Quality Improvement plan involving frequent meetings with project stakeholders to assure program goals and objectives as well as student learning outcomes are

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being met. In addition, this project will capture specific data to examine the impact of these experiences on student learning, as well as documentation of the benefits of the role of the BSN-prepared RN (BSN-RN) as a care coordinator in primary care settings serving rural and underserved populations. The BSN-PoP will build capacity through development of RNs in the region to serve as preceptors for student interns to support sustainability of the project. This project also includes intentional curricular efforts to develop student interest in community based employment post- graduation as well as efforts to educate primary care providers about expanded roles for baccalaureate prepared RN’s in primary care. We anticipate that by providing sufficient infrastructure to support these learning experiences, intentional project objectives to guide work with regional partners to promote the expanded role of the BSN-RN, this project will become self-sustaining and meet regional and national needs to improve the health of the population of western North Carolina BSN PoP recognizes the value of inter-professional care and will implement inter-professional education experiences throughout the program. These will include student participation in interdisciplinary care team meetings and other interdisciplinary educational experiences embedded in the care delivery model used by our Partner Agencies.

Although the project will primarily focus on the role of the BSN- RN in executing the CCTM model, it will be with the understanding that to fully implement the CCTM, the RN interacts with all the healthcare disciplines to provide comprehensive coordinated care to clients.

Need for RNs in Primary CareThe Affordable Care Act (ACA) is projected to give millions of more US citizens access tohealth care by enhancing access to health insurance. “One study projects that by the year 2019, the demand for primary care in the U.S. will increase by between 15 million and 25 million visits per year, requiring between 4,000 and 7,000 more physicians to meet this new demand. Moreover, any increased demand for primary care will be added to an already existing shortageof primary care practitioners.” (NGA, 2012, 2). Given changes occurring in health care, expansion of coverage through the ACA an aging population and high rates of chronic disease among underserved populations, knowledge about primary care, care coordination and issues related to population health are crucial to the nurse of the future.

Prior research has demonstrated that nurses are an affordable option in primary care and can reduce the overall cost of health care delivery (Yang & Meniers, 2014). Inter-professional teamwork is an integral piece of primary care (Drummond 2012). Banner (2010) found that clear role responsibilities, expectations and scope of practice can be achieved by careful planning and development. Research has also recognized that the level of clinical training does matter for nurses working in primary care; higher education does mean more and better skills, greater interpersonal connections, greater autonomy and more patient-centered care (Erickson & Erickson 2012). Yang and Meniers (2014) also found that nurses with expanded roles in care coordination, including communication between the patient, family and other health care providers, improves health care outcomes.

In rural western North Carolina, as in other rural areas, trust is a big factor in the indigent population. In the free clinic, many patients have had limited access to health care and they place a lot of trust in an RN who cares for them. Therefore, we posit that the RN is the best choice of provider to serve as the care coordinator to work with clients and families to support


self- management of chronic disease and to promote health and wellness.

Despite increasing need for RNs to work in community based settings, most undergraduate nursing curriculums emphasize preparation for practice in acute care settings. At WCU, all undergraduate students have specific community/mental health practicum experiences. These include placements at local health departments, social service agencies, home health care agencies and community based service learning activities. This project will help to strengthen the existing community health curriculum in our undergraduate nursing programs by creating new clinical placement experiences and teaching/learning strategies to support additional competency development to prepare our students for employment in primary care settings following graduation. Due to cost restraints, many primary care settings do not currently utilize baccalaureate-prepared RNs in their current service delivery model, and instead, many primary care offices utilize LPNs and/or Medical Assistants as clinical staff. Thus, one of the project goals is to enhance capacity by developing a pool of RNs with specific expertise in primary care and care coordination. Prior studies have shown that the role of RNs in primary care is often task focused and does not fully utilize the skills and knowledge of RN’s to the extent of their full scope of practice.1 Since little is known about whether or how RN’s are functioning in primary settings around the region, this project seeks to capture regional data and educate healthcare providers in the region on the benefits of having BSN prepared RN working in primary care settings. This data will also help to identify potential barriers to sustainability of this project.

TARGET SERVICE AREA:PROJECT OVERVIEWUnder the BSN-PoP, The Western Carolina University School of Nursing (WCUSON) willpartner with two federally qualified community health centers (FQHCs): Blue Ridge Community Health Services (BRCHC) and Appalachian Mountain Community Health Centers (AMCHC). We will also partner with the Good Samaritan Clinic of Jackson County, which is a faith based free clinic for uninsured individuals living in rural western North Carolina. Additional hospital partners for this project include Harris Hospital in Sylva, North Carolina; Mission Health System (MHS) primarily in Buncombe County; and Park Ridge and Pardee Hospitals in Hendersonville, North Carolina.Through the use of a baccalaureate prepared Primary Care RN Consultant to be placed in each of the two partner FHQCs and the free clinic partner agency, a minimum of five (5) student participants each semester will have intensive internship experiences to support ACHNE and CCTM competency development when working with underserved and/or rural populations in primary care settings. As part of the BSN-PoP practicum experiences, hospital system partners will provide placements with RNs in their care coordination/discharge planning programs to support student learning related to transitions of care between acute and primary care settings. In order to ensure that all course learning outcomes are met for the courses in which the BSN-PoP practicums are embedded, students participating in the BSN-PoP will also participate in existing community health placements through local health departments, mental health agencies as well as a student home visit program for low income seniors which was founded by the SON in 2015. Essential to the sustainability of this project are efforts build capacity of BSN- RNs in primary care settings and promote the role of the BSN-RN in primary care to both students and regional primary care providers. Therefore, we intend to support


development of a total of 10 RNs in the region through our Primary Care Certificate Program, which was established in 2015 in response to requests from partner agencies in the region for specific post baccalaureate training for RNs to prepare them for work in primary care settings. This will include the three Primary Care RN Consultants and seven (7) additional BSN-RNs from the region. These RN’s along with BSN- PoP graduates, can serve as future preceptors for student interns once the grant period has ended and will support sustainability of the project.This project also includes intentional efforts to examine and develop student interest in community based/primary care employment post-graduation. Specific objectives to examine current roles of RN’s in primary care settings in the region are included as well as intentional program evaluation metrics to examine the impact of RN Consultant on client outcomes. These program evaluation efforts will inform content for a regional conference to be held in 2018 to educate primary care providers about expanded roles for baccalaureate prepared RN’s as they seek to redesign care delivery models to maximize value based reimbursement and achieve population health improvements for their community of clients.

Applicant PoolThe WCU SON currently has four program options to prepare undergraduate nurses at thebaccalaureate level. These options include the traditional BSN program, located on the main campus in Cullowhee, North Carolina in Jackson County. The three other BSN tracks are offered at the Biltmore Instructional Site in Buncombe County. These include 1) the Accelerated BSN program, which is a four consecutive semester program allowing students with prior degrees to complete their BSN in 15 months; 2) the RIBN program, which is an articulation program with area community colleges, by which students are dually enrolled in the community college and WCU while completing their associate’s degree in nursing. RIBN students complete their BSN in the final year at WCU after successfully passing their NCLEX examinations; and 3) the RN-BSN program, which is a fully online degree offering. The ABSN program accepts 35 students in each cohort, admitted in fall semester. The RIBN program projects to have 56 students in the pipeline during the project period. The traditional BSN track accepts 25 students per semester to the program. Because many of our RN-BSN students are located outside the region identified in this project, the project will only recruit from the residentially based programs, namely, the traditional BSN, ABSN and RIBN track offerings. We estimate that we will enroll roughly 10% of our student population in these three programs in the BSN-PoP over the grant funding period. Table 1 outlines the pool of students from which we will recruit participants for the BSN PoP project, along with the estimated percentage of the total student population we intend to recruit for this project.Currently, students in the traditional and ABSN program offerings complete a four (4) credit hour didactic and clinical community mental health course, which includes 168 hours of clinical practicum experiences in a variety of community based settings. Students rotate through regional health department settings, home health agencies, community based mental health agencies, inpatient mental health settings. In addition, students work in small groups to plan and execute a community based service project based on an identified population need. All students in the ABSN program and a subset of students in the traditional BSN program are placed in the Asheville area for their clinical practicum experiences and have been conducting home visits (with faculty oversight) in three low income senior housing communities in the area. Students in the traditional BSN and ABSN program offerings are also required to complete at least 120 hours with a baccalaureate-prepared preceptor to fulfill their Synthesis


Practicum course requirements in their final semester. The Synthesis Practicum course (NSG 421) is a 3 credit course and serves as the culminating clinical practicum experience for the BSN program. The RIBN students complete a practicum experience as part of their final three (3) credit practicum course (NSG 329). See Attachment 5 for the curriculum for each BSN program offering.Students in the RIBN track are embedded in the community health block as part of the RN-BSN online program offering. The community health block includes three courses: a three (3) credit hour theory course; a one (1) credit hour Intervention Project practicum (based on identified community need from needs assessment assignments); and a two (2) credit hour Practicum experience. In the RN-BSN program offering, students currently are required to identify their own preceptor as well as arrange their practicum hours. A minimum of 60 practicum hours are currently required as part of the practicum experience in the RN-BSN community health course. This project will focus and expand practicum requirements for these students as described below. We are proposing to educate a minimum of 17 unduplicated students from three undergraduate program offerings over the course of the two year grant period. This includes a total of 6 unduplicated students from the RIBN program; 6 unduplicated from the traditional program; and 5 from the ABSN program. See Table 5 for estimated BSN-PoP Enrollment by semester and program.Project BenefitsThis project seeks to enhance student learning beyond competencies outlined in the AmericanAssociation of Colleges of Nursing (AACN) Essentials of Baccalaureate Nursing Education to support 1) achievement of the ACNHE competencies, 2) develop additional competencies in care coordination (using the CCTM model) as well as 3) develop skills in measuring and articulating the impact and value of nursing involvement in care coordination activities on

Table 5.WCU BSN –PoP Enrollment EstimatesProgram Fall 2016Spring

2017Summer2017

Fall 2017 Spring2018

# of unduplicated students fromthe program/% of total

RIBN 3 (NSG329)

3 (NSG305/384)

3 (NSG329)

6/56= 10%

Trad 2(NSG421, 423)

2(NSG421, 423)

2(NSG421, 423)

6/75=8%

ABSN 1 (NSG421)**

5 (NSG423)

5 (NSG421)

5/35=14%

Total students inproject per semester

1* 5 5 10 5 Total unduplicated # students inproject (including 1 pilot ABSNsynthesis practicum intern)= 1710% of total enrolled

** fall 2016 ABSN student intern who will be part of synthesis practicum pilot are not included in student cohort totals

patient and population health outcomes in community based primary care settings. The project performance evaluation plan includes specific objectives and data collection strategies to examine the impact of these learning experiences beyond the undergraduate educational


experience. These include follow-up interviews with student participants who obtain a community based position at 3, 6 and 12 month intervals following graduation.

In addition to expansion of the curriculum to better prepare students for community based practice, the proposed project model will also provide enhanced resources to the Partner Agencies through placement of the Primary Care RN Consultant, who will serve as the full-time preceptor for student interns at each Partner Agency. Each agency will benefit from having an RN embedded in the practice setting to: 1) provide enhanced care coordination services, 2) assume all precepting responsibilities related for student learners, 3) help the agency to assess the impact of care coordination delivered by the RN, and 4) examine opportunities for an expanded RN role in primary care delivery while not presenting a drain on agency resources. The Faculty Liaison will also provide specific technical expertise to both the Primary Care RN Consultants and the Partner Agencies on how to quantitatively and qualitative assess the impact and benefits of RN care coordination services for quality improvement and demonstrate return on investment. Beyond benefits to student learners and Partner Agencies, we posit that this project will provide added benefits to the populations being served by the Partner Agencies. We also plan to use program evaluation data to help build the body of knowledge on the impact of care coordination services provided by RN’s in community based primary care settings.

The Rapid Cycle Quality Improvement Plan (RCQI) will provide valuable data to identify lessons learned, challenges and examine benefits of the project. Data from weekly RCQI meetings, monthly Project Team meetings and feedback from the BSN-PoP Advisory Board meetings will be used to improve coordination of services, teamwork, and the student experience.

The sections below describe the methods to be used to meet the project goals and purposes.

G oal 1 : Prepare a minimum of 17 unduplicated baccalaureate nursing students to assume a community based position upon graduation.The WCU SON already has a strong commitment to community based experiences for our students. One of the ways in which we are already working to increase interest among students to work in community based settings following graduation is to incorporate community based service learning experiences in early clinical coursework throughout the traditional and ABSN curriculum. For example, students in their first clinical course engage in community based learning experiences through the student home visit program in low income senior housing communities. RIBN students (along with ABSN students) can also participate in a year- long community interdisciplinary service learning program (Beyond Clinic Walls) which is a partnership with the University of North Carolina Chapel Hill school of Medicine, School of Pharmacy and AB Tech community college. As part of the Beyond Clinic Walls, interdisciplinary teams of students visit a client over the course of a year to learn about their lives and factors that contribute to health challenges. In addition to these current efforts to expose students to community based nursing practice, we propose as part of this project, to add specific presentations on various community based roles for RNs as part of the NSG 101 Introduction to Nursing Course to help introduce nursing students to community based roles of RNs early in their program. Didactic content on care coordination and the RN role in primary


care will also be embedded in existing community/mental health courses across all of our undergraduate curricular offerings.

We intend to survey students during the semester prior to enrollment in their community health course to identify interest in the program. Anecdotally, we know that several of our current students are interested in a primary care clinical experience. Over time, we anticipate that efforts to promote community based/primary care practice as an option will result in an increase level of interest among students and intend to measure differences across cohorts to examine whether promotion efforts have been successful. Students interested in participating in the BSN-PoP will complete an application and be vetted by program faculty and meet with the Faculty Liaison to assess specific areas of interest held by the student.

RIBN Students chosen to participate in the BSN PoP will be assigned to a special section of the NSG 305 and NSG 384 community courses (Fall offering only) to be taught by the Faculty Liaison. These students would be assigned into specially designed internship/practicum experiences in both community based primary care and transitional care settings (60 hours of practicum experiences). These students, who are licensed RN’s, will be able to function independently as a Registered Nurse, but will be precepted by the RN Consultant for additional role development as part of their baccalaureate preparation. As part of NSG 384, each student would develop a specific nursing intervention to address a population-based health concern within their agency placement (1 credit hour= additional 42 practicum hours). Furthermore, these students would engage in additional community based practicum hours to fulfill the NSG 329 Practicum component of the program curriculum in their final semester (3 credit hours= 126 practicum hours; Spring offering only). Total practicum hours= 228.

ABSN and Traditional Program students chosen to participate in the BSN-PoP will be assigned a special section of their NSG 423 clinical practicum course to be taught by the Faculty Liaison. As a four credit hour course, this course includes a total of 168 practicum hours. These practicum experiences would include assignments across a variety of community and mental health settings with a minimum of 100 hours in the primary care setting with the RN Consultant. As pre-licensure students, these students require specific levels of supervision by the faculty and preceptor in coordination with health care practice agency staff. All precepted experiences will be guided by the North Carolina Board of Nursing (NCBON) Suggestions for Utilization of Preceptors. As part of their Synthesis of Nursing Practicum (NSG 421), these students would have an additional two (2) week placement in the community setting (80 hours) in addition to 40 hours of preceptor guided experiences in acute care settings. Total practicum hours= 228Students in the ABSN program complete their community/mental health practicum (NSG 423) in the summer prior to their final semester and their Synthesis Course (NSG 421) in the last four weeks of their final semester in the fall semester, thus the ABSN practicum will extend over a six month period. Traditional students complete their community health and Synthesis Course (NSG 421) in their final semester.

Student Internships as part of this project will be embedded in the semester in which the student takes their community health practicum and synthesis practicum experiences. Student internship experiences as part of this project will be done over the course of a three (3) month semester for the traditional BSN students and extend over a six month period for RIBN and ABSN students. All student interns will have a total of 228 practicum hours as part of this


project. These will include practicum assignments and direct contact hours in both community, public health and primary care settings and placement with acute care discharge planning and care coordination teams (24 contact hours). We will capture specific data on the number of students enrolled in the project each clinical rotation, percent of total student population enrolled in the project and the total number of senior-level BSN students trained through the project (including demographic information). We will also capture the total number community-based practice exposure hours obtained by each student during the community based practicum experiences.

Through the use of a baccalaureate prepared Primary Care RN Consultants to be placed in each of the two partner FHQCs and the free clinic partner agency, student project participants will have intensive internship experiences to learn and practice the competencies needed to execute the CCTM model to provide care coordination services in primary care settings working with underserved and/ or rural populations and support learner attainment of ACNHE competencies for community/public health practice. The ACNHE competencies, revised in 2009, are based on essential competencies for baccalaureate nursing education as well as competencies needed for public and community health practice. The CCTM model was developed and endorsed by the American Academy of Ambulatory Care Nursing (AAACN) and has evolved to standardize work of ambulatory care nurses using evidence from interdisciplinary literature on care coordination and transition management (Haas & Swan, 2014). The model outlines the competencies needed to perform CCTM as well as specific knowledge, skills and attitudes needed for each competency.

In addition to existing community health and new primary care setting experiences with the Primary Care RN Consultant, each Student Intern will spend at least three days with the Care Coordination/Discharge Planning department at either Harris, Mission, Pardee or Park Ridge Hospitals. The Student Intern will be assigned to a RN working in these settings for specific applied learning experiences to support student learning around competencies needed to support seamless and effective transitions of care between acute care and community based healthcare services. We also intend to develop at least two specific high fidelity simulation experiences using standardized patients to enhance student learning.. New simulations and learning activities developed as part of the project can be incorporated into existing courses at the end of grant period. Simulation scenarios will also be shared with the nurse educator community through the National League for Nursing Simulation Innovation Resource Center shared simulation resource site.

To overcome the potential barrier of limited RNs in primary care practice settings to serve as full time preceptors for student interns, we propose to provide financial support to the Partner Agencies to hire Primary Care RN Consultants within the first two months of the project period. These Primary Care RN Consultants will serve as both a consultant to the practice on how to best utilize the RN to support value based reimbursement as well as serving as the preceptor for the Student Interns placed at the agency. The SON will subcontract with the Partner Agencies to hire the Primary Care RN Consultant. It will be critical for the Primary Care RN Consultant to be a good fit with the agency and have strong skills as a preceptor. However, selection of the RN Consultant will be jointly made by agency staff, the Faculty Liaison, and the Project Coordinator. In order to prepare them to successfully function as a preceptor for the Student Interns, the project work plan also includes development of a one day preceptor training, to be developed and executed by the Project Coordinator, Faculty Liaison


and other WCU faculty as appropriate.

The Primary Care RN Consultant will complete the WCU Primary Care Certificate as soon as feasible. Along with precepting responsibilities for Student Interns, the Primary Care RN Consultants will be engaged a number of aspects of care delivery including triage, health coaching, client assessment, chronic disease management and care coordination between transitions of care from acute to community settings and across community and or specialty providers. They will also be engaged in quality improvement activities and examination of meaningful use data to assess and improve population health indicators. See Attachment 1 for job description of the Primary Care RN Consultant. Care Coordination activities will be implemented using the Care Coordination and Transition Management (CCTM) model. See Figure 1 for the CCTM Logic Model that outlines the tasks and strategies that the RN is engaged in when implementing this model.

The Primary Care RN Consultants will also serve as key individuals to facilitate ongoing communication between Partner Agencies and the SON. The Faculty Liaison will mentor the Primary Care RN Consultants throughout the project period and conduct weekly site visits to the agencies. Primary Care RN Consultants will be evaluated on their performance through and student evaluations as well as annual performance reviews by the Partner Agency in which they are hired. The CCTM Consultant (Elaine Scherer) will also mentor Primary Care RN Consultants on the use of the CCTM model.

As part of the Student Intern practicum experiences in primary care settings, the Primary Care RN Consultants will work with Student Interns to provide care coordination services for a select group of patients of the Partner Agency. Student Interns will also participate in other aspects of care delivery consistent with the role of the Primary Care RN Consultant as appropriate. Partner Agency staff will determine which patients will be followed by the Primary RN Consultant and Student Interns.

Given our strong existing partnerships with these Partner Agencies as well as identified student interest from one of our current ABSN students, we are confident that we will be able to pilot a Synthesis (NSG 421) experience for one ABSN student during the fall of 2016 with full implementation of the practicum experiences for students from all three program offerings beginning in January 2017.The Faculty Liaison (Dr. Kae Livsey) will be responsible for the design of the practicum experiences, including development of specific student assignments to ensure that students’ learning outcomes are being met. Dr. Livsey has more than 10 years of experience in creating and developing applied community based learning experiences for undergraduate BSN students with particular emphasis on service learning experiences and use of simulation. Dr. Livsey also has experience working as a BSN prepared RN in a primary care setting, where she engaged in chronic disease management and practice redesign for a free clinic as the sole RN on staff. Dr. Livsey also works as a consultant with WNC Healthy Impact to assist public health and hospital systems to utilize the Results Based Accountability model to support program performance evaluation and impact population health goals. Dr. Livsey will work closely with the Primary Care RN Consultants and Partner Agencies to arrange student placements and ensure that the Primary Care RN Consultants and Partner Agency staff understand expectations of the practicum experience. She will be responsible for development of specific learning


activities for the student interns to support meeting of student learning outcomes, including development of assignments as well as simulation experiences, using expertise provided by the Simulation Consultant (Debbie Ezzell). Dr. Livsey will also provide primary faculty oversight for those students participating in this project. Dr. Livsey, along with the Project Evaluation Consultant (Viki Kowlowitz) will provide technical support through the RN Consultants to support, capture and analyze project evaluation metrics.

Figure 1. CCTM Tasks and Strategies (Logic Model) Nurs Econ. 2014


We will assess the impact of these specially designed community based/primary care experiences on the development of the ACNHE competencies, which are needed to work in population health/community/ settings. Program participants learning will be evaluated through a pre and post-test assessment using the Perceptions and Realities of C/PHN Academic Preparation for Population-focused Employment instrument as well as specific student performance measures during practicum and simulation experiences. Assessment will occur at the end of the community course experiences (pre) and at the end of the final practicum


experience, and 3 months after beginning work in a community based setting. We will capture the number of graduates hired directly into community based (primary care) employment settings following degree completion as well as follow up with these graduates at 3,6 and 12 months after graduation through structured interviews to assess learner perceptions of how well the BSN-PoP prepared them for community/primary care practice.

Goal 2) develop RN capacity in the region by educating ten (10) RNs through our PrimaryCare Certificate ProgramIn response to a request from local Partner Agencies, the WCU SON has established a PostBaccalaureate Primary Care Certificate program, which is a six course-18 credit hour program designed to develop BSN-RN’s with the knowledge and skills needed to serve in primary care service delivery. The certificate program was approved by the faculty in spring 2015 and will begin course offerings in the fall of 2016. We propose using this curriculum to develop the Primary Care RN Consultant expertise as they shape their role in the Partner Agencies. Content from the WCU Primary Care Certificate Program will also inform the development of student learning activities as part of the community based practicum experiences. It is also our hope that upon graduation, student participants in the BSN PoP program will consider furthering their education through completion of the Primary Care Certificate program.

In order to enhance regional capacity of RNs working in primary care settings as well as prepare future preceptors, we also seek to develop an additional seven (7) RN’s (beyond the 3 Primary Care RN Consultants) by supporting them to complete the WCU Primary Care Certificate Program and engage in a one day preceptor training workshop, to be developed and executed by the Faculty Liaison and other WCU faculty as appropriate. Specific development of RN’s for these roles will be paramount to ensure sustainability of the project and provide future preceptors for students after the grant funding period has ended. The PI and Project Coordinator will be responsible for recruitment and enrollment of RNs in the Primary Care Certificate Program with input from Partner Agencies and other primary care providers in the region. To determine whether or not we have enhanced regional capacity of RN’s working in primary care, we will assess the number of RN Consultants and/or RNs completing the Primary Care Certificate Program who are hired on with Partner Agencies after the grant period of support as well as RNs who have completed the Primary Care Certificate Program who are hired into community/primary care settings.

Given that we have little data on how RNs are being utilized in primary care settings in the region, one of the objectives of this project is to examine how RNs are being utilized in primary care settings in western North Carolina. With the support of a graduate assistant, we will conduct telephone interviews of a convenience sample of primary care providers in the region to ascertain how and if they are utilizing RN’s in their practice. This market data is needed to examine future sustainability of this project related to the number of available preceptors in the region for student interns after the grant period has ended. This data will also inform content to be delivered at the regional conference to be held in spring of 2018. We will also conduct annual structured interviews with Partner Agencies on perceived benefits of the RN Consultant during the grant support period. The PI/CO-PI and Project Coordinator will be responsible for executing these data collection activities.Goal 3) educate a minimum of fifty (50) healthcare providers in the region about benefits of having a BSN prepared RN in community/primary care settingsAs previously mentioned, many primary care practices in our region utilize LPN and or


Kae Livsey, 11/28/16,

This goal will need to be revised given that we were not able to support funding through the PC Certificate program.

Medical Assistants rather than RNs as clinical staff, as they are less expensive. Thus, this project includes intentional strategies to utilize the RN Consultant to assist Partner Agencies to support practice redesign to positively impact individual client and population health outcomes and to examine the impact of the expanded role for the RN in primary care. Student Interns can also benefit from participating in these quality improvement activities. Expertise developed by the Primary Care RN Consultants while embedded with the Partner Agencies will be shared with a broader audience through the educational conference to be held in spring of 2018. This conference will be designed to assist primary care practices in WNC to identify and measure benefits of the expanded role of the RN in primary care. We also intend to bring in experts in care coordination and population health in primary care as speakers for the conference.

Continuing education credits will be awarded to incentivize attendance for nursing and medical professionals. The target audience for the conference will also include primary care practice managers as well as organizations involved in regional Accountable Care Organizations. The Project Coordinator will lead development of the conference and development of marketing materials, including development of multi-media materials (i.e. video, social media, brochures, journal articles) on the benefits of having a BSN prepared RN in community/primary care settings. These materials will be directed at both nursing students, as well as the primary care provider community.


Successful implementation of a quality senior level BSN rotation in rural, underserved primarycare clinics as evidencedby students’- Positive course evaluations of clinic experience- Increased attitudes, knowledge, and skillsnecessary to practice in aprimary care practice,- Increased interest and confidence to practice in rural primary care clinics that serve underserved communities.(Goal 1)

Logic Model: BSN Population Health Practicum (BSN-PoP)


Provide professional development and

support for 10 RNs to serve as preceptors

Activities/Outputs

(c ) RESOLUTION OF CHALLENGESAnticipated challenges to implementing this project include:1. Lack of student interest in pursuing community based employment in underserved and/or rural settings following graduation. Strategies to overcome these challenges include inclusion of community based service learning experiences in early clinical coursework throughout the traditional and ABSN curriculum. We already have a number of students in the ABSN program who have indicted interest in pursuing community based practice. As part of this project, we seek to expand these efforts to include specific presentations on various community based roles for RNs as part of the NSG 101 Introduction to Nursing Course to introduce students to community based practice roles early in the nursing program. We also seek to obtain qualitative input from students on perceived barriers to enter into practice in community based settings following graduation as part of their community health course evaluation.2. Faculty concerns about students ability to be successful on NCLEX with limited inpatient synthesis practicum experiences. Strategies to overcome these challenges include a plan to develop faculty buy in by having community mental health course faculty shadow the Primary Care RN Consultant and Student Intern for at least one day to gain exposure to community based roles for RN’s in primary car practices. We will interview these faculty members who have shadowed the Student Interns during the primary care experience at the end of each semester to obtain feedback on how the experiences are supporting course learning outcomes. Additionally, all pre-licensure students who are in the BSN PoP will continue to have 40 hours of acute care preceptor experiences as part of their Synthesis practicum coursework.3. Lack of Baccalaureate prepared Registered Nurses working in community based primary care agencies in the region. Strategies to overcome these challenges include a plan to develop baccalaureate prepared RN’s through enrollment in the WCU Primary Care Certificate Program. See attachment 5 for the Primary Care Certificate Program curriculum. The project also seeks to capture market information, collect data on the impact of the Primary Care RN Consultant and to hold a regional conference in 2018 to educate primary care providers about expanded roles for baccalaureate prepared RN’s as they seek to redesign care delivery models to maximize value based reimbursement and achieve population health improvements for their community of clients.4. Limited market data on roles of RN’s in primary care settings in the region. Strategies to overcome these challenges include a plan to conduct telephone interviews of a convenience sample of primary care practices in the region to identify whether they employ RN’s the roles and functions of the RN working in primary care delivery settings within the first 6 months of the grant operating period.5. Limited outcome data on the impact of RN provided care coordination services in primary care settings. In order to develop and measure the impact of the RN Care Coordinator on patient outcomes in acute and primary care settings, the project includes specific objectives to examine current roles of RN’s in primary care settings and intentional project metrics to examine the impact of Primary Care RN Consultant on client outcomes through existing Partner Agency quality improvement efforts.


IMPACT(a) EVALUATION AND TECHNICAL SUPPORTCAPACITYProject Performance Evaluation Plan

This plan is guided by the Results Based Accountability TM Model developed by Mark Friedman1 which includes an outcomes focused way of thinking to work from ends to means. The framework includes concepts related to population outcomes and program performance outcomes. The RBA approach to program evaluation is guided by three basic questions:How much did we do? How well did we do it? Is anyone better off?

Overarching Goals:1) Prepare a minimum of seventeen (17) baccalaureate nursing students with additional competencies to practice in a community based/primary care setting following graduation;2) Develop RN capacity to serve as preceptors in the region by educating ten (10) RNs through our Primary Care Certificate Program; and3) Educate a minimum of fifty (50) healthcare providers in the region about benefits of having a BSN prepared RN in community/primary care settings.

The table below outlines select objectives of the BSN-PoP project and evaluation metrics to be be used to evaluate the project. Numbered items indicate specific elements that are included in the work plan.Program Objective How much did we do? How well did we do it? Is anyone better off?

1.4 Recruit and developthree (3) BSN preparedRN Consultants

# RN Primary Careconsultants hired

1.4.2 Student evaluations ofpreceptors.

1.4.2 Annual Partner Agency performance review of RN Consultants

1.4.1 RN Preceptors will workwith Partner Agencies to collect and analyze quality improvement data to examine impact of RN provided care coordination services.


1.5 Develop interestamong students in pursuing community based employment following graduation

Integration of communitybased RN role exposure (guest lectures/presentations) in pre nursing courses (NSG101) and community health courses (NSG422, NSG 302).# community based clinical experiences in other clinical course offerings.

Change in % of BSN studentsindicating potential interest in going directly into community based practice settings following degree completion

# RN graduates expressinginterest in/hired in community/primary care placements following graduation

1.6 Develop and executean intensive community based primary care practicum as part of community health and synthesis courses for students participating in the BSN-PoP.

# students enrolled inprogram each clinical rotation# hours students are in each practicum site (acute care coordination and primary care settings)% of total student population enrolled in programNumber and percent of senior-level BSN students trained through the program (including demographic information for diversity)# of community-based practice exposure hours obtained by each student during the community based practicum

Examine change in self-assessment of ACHNE competencies (pre and post practicum evaluations) Student evaluations of experiencesAgency evaluations of project (Primary Care RN Consultant role and impact of student intern placement on the agency)

Examine differences in self-assessment scores on the ACNHE assessment tool between students engaged in program offerings and students participating in the community based practicum program.Student evaluations of BSN-PoPexperiences.


1.8 Assess impact of the3-6 month specially designed community rotations as part of the grant project on development of learner competencies needed to work in population health/community/primary care settings

Conduct pre and post-testassessment* of program participants using the Perceptions and Realities of C/PHN Academic Preparation for Population- focused Employment# of BSN students indicating potential interest in going directly into community based practice settings following degree completion#clients followed by RN Consultant/Student Interns

# BSN graduates entering intocommunity based/PC settings following graduation.Agency partner feedback (qual) Preceptor evaluation of student. Evaluation of student performance using simulation with standardized patients.Analysis of employer perceptions of student graduate’s for community based practice Graduates perceptions of readiness for community based practice (3months, 6 months, and one year after graduation.

Examine client outcome data (forthose clients who had care coordination provided by student interns/RN Consultants) Retention rate of BSN PoP graduates who assumed community based practice following graduation.

2.1 Develop BSNprepared nurses working in community based practice to:a. serve as preceptors for student placementsb. engage in care coordination activities to promote positive client outcomes

# RNs completing the WCUPrimary Care Certificate program# RN’s participating inpreceptor training workshop

Participant evaluation ofpreceptor training program.

# new RNs agreeing to serve aspreceptors

3.2 Articulate the value ofthe RN Consultant.

#Structured interviews withPartner Agency staff/leadership

# of RN Consultants hired on topartner agencies after grant period of support

Findings from structuredinterviews with Partner Agency staff/leadership on perceived value of RN Consultant.


Program Objective How much did we do? How well did we do it? Is anyone better off?3.3 Provide an educationalconference to assist primary care practices in WNC to identify and measure benefits of RN expanded role.

# participants (withdemographic data by professional perspective) Conference participants’ evaluation of conference.# CEU/CME awarded

Analysis of participant surveyresponses

Analysis of participant surveyresponses (questions related to learning outcomes)

3.4 Develop anddisseminate educational materials demonstrating the impact of the RN as care coordinator in primary care settings and the role of the BSN RN in supporting population health

# and variety of materialsdeveloped# BSN PoP fact sheets distributed

# primary care practicesindicating interest in hiring RN (obtained via conference evaluation)

# new BSN RN positions created by Partner Agencies

# RN’s completing WCU PrimaryCare Certificate program who obtain employment in primary care settings (obtained via follow up survey following completion of Primary Care Certificate)



Documents

Western Carolina University - Western Carolina University | … · Web viewThis project also includes intentional curricular efforts to develop student interest in community based