Greeting the changing face of health care
Janel Shoun-Smith |
Student nurses receive instruction at NHC Rutherford, a clinical site that exposes nurses to geriatric care.
Student nurses prepare to care for the aging, to use the newest technology and to be adaptable in a time of rapid change
When it comes to health care, it’s not hard to pick out two of the most important trends that will change the face of the profession over the next generation: the aging of the baby boomers and the continued rise of technology.
Health care providers today must graduate ready to practice in and adapt to a rapidly changing industry, and these two trends will bring many of those changes.
The Lipscomb University School of Nursing has taken important steps to make sure its student nurses graduate with the ability to care for more aging patients than the industry has ever seen before and to operate within an ever-changing high-tech environment that offers a great diversity of career roles.
The school has proactively recruited nursing faculty with geriatric care experience, who infuse their lectures with examples and lessons drawn from the realm of geriatric care. In addition, the school offers geriatric-specific clinical rotation sites on the geriatric floor at Vanderbilt University Hospital and at NHC Rutherford, a long-term care, rehabilitation and skilled nursing facility.
On the high-tech side, the school has expanded the hours of operation for the health simulation laboratory, allowing student nurses to enjoy more supervised practice with skills on high-tech patient simulators later in the evening and on weekends. In addition, all student nurses are required to use an electronic health records system called DocuCare to document their work and assessments in their clinical rotations beyond the basic documentation they are allowed to do at the clinical site.
To ensure adaptability of its graduates, the School of Nursing stresses fundamental skills, offers clinical experiences designed to expose student nurses to various areas of health care and requires a unique senior practicum—a 72-80-hour one-on-one preceptorship in one of the top three field choices of the student.
“Whatever specialty our student nurses go into upon graduation—acute care to nurse practitioner—they will be faced with caring for more and more elderly patients as the years progress,” said Roger Davis, dean of the College of Pharmacy & Health Sciences. “In addition, technology in health care will increase in presence and will change over the years. So these are two key areas that student nurses must be familiar with and be ready to adapt to throughout their careers.”
Confidence is key
As health care training technology becomes more advanced, nurses are now often working with health simulation technology throughout their career, said Mary Hesselrode, interim associate dean of the School of Nursing. Many organizations and hospital are now using health simulation laboratories to train and test nurses for additional certifications, she said.
Lipscomb has had its own cutting-edge health simulation laboratory since 2012, but now the school has expanded students’ ability to use the laboratory for practice on their own or through additional faculty trainings. Students were surveyed to see what time would work for them, and nursing faculty volunteered to staff the laboratory for more hours this school year, said Elaine Griffin, interim executive associate dean.
“The value of the health simulation laboratory is in the level of confidence for first-time nurses,” said Griffin. “Everyone must practice these procedures many times in order to do them well.”
The laboratory is now staffed by faculty from 8 a.m. to 7 p.m. on weekdays and for four hours during the weekend on either Saturday or Sunday.
“One thing I appreciate, as a faculty member, is that it gives students the opportunity to make a mistake in a controlled environment. It’s a comfort as an instructor, to send them out to real patients, when you have already seen them perform the skills well in the laboratory.”
“Being comfortable with the skills is really important. That is something that a lot of us really worry about,” said Tanner Brown, a senior student nurse from El Paso, Texas. “Within the first week or so, they throw you into a hospital setting, and the nurses are asking you to put in a catheter or drop a nasogastric tube. So practicing is really important to have confidence.”
Patience to treat patients
“According to Center for Disease Control statistics, by 2030, 20 percent of the population will be over the age of 65,” said Sarah Neller, instructor of nursing and an adult gerontology primary care nurse practitioner. “We have more people, period, and they are getting older. So we have to figure out how to help them live the best lives possible.”
Frequent problems with aging patients, Neller said, include the high risk of problems due to the side effects of polypharmacy (multiple medications taken at once), economic factors sometimes prohibit aging patients from taking their medications or going to the doctor, nutrition is often poor, and aging patients are also more likely to simply agree with their doctor and not speak up about relevant symptoms.
“Nurses can bridge that communication gap,” Neller said. “Nurses can ask questions in a way that often friends and family, or even their doctor, cannot.”
“Communication skills were really emphasized with geriatric patients because many had memory problems,” said Mariah Lester, a senior nursing student from Antioch, Tennessee, who had a clinical rotation at the Vanderbilt University Hospital geriatric floor in fall 2015. “Sometimes you interact with them, and then an hour later they wouldn’t remember you. So they often tell you the same story over and over, or sometimes they won’t let you touch them again. You have to have a lot of confidence and a lot of patience.”
Lester found the Vanderbilt rotation valuable because she experienced the effects of diseases like Alzheimer’s, Parkinson’s and dementia that nurses don’t see every day in other health care areas. “On the first day of the rotation, I felt like a brand new nursing student all over again,” she said.
Neller and two other faculty with geriatric expertise–Marty Kennedy and Jennifer Weber—weave their experience into lectures and activities for the Adult Health 1 and 2 classes, required for all student nurses, Neller said.
A few student nurses are interested in going into geriatric care, but with the aging of baby boomers, all nurses will experience an increase in geriatric patients no matter what specialty they go into, Neller said.
“As a student, it’s valuable to experience a wide variety of patients,” said Brown. “In my time at Lipscomb I have been able to experience a clinical in every age group from the neonatal intensive-care unit to geriatrics. It’s great to get a wide experience of patients throughout the lifespan.”
Technology is a reality
From their first semester as student nurses, Lipscomb students begin using DocuCare, an electronic records system that all student nurses use to document their procedures and assessments during their clinical rotations, said Neller.
Most facilities do not allow student nurses to chart care beyond the basics—vital signs, nutrition, activities of daily living--on their electronic records system, so nurses come home after rotations and chart physical assessments, the patient’s medical or social history and medications on DocuCare.
Nursing faculty can look over the charts and provides suggestions to improve the systematic evaluation of a patient. DocuCare also allows faculty to create mock patient scenarios and require students to chart the needed treatment, said Hesselrode.
DocuCare teaches the abbreviations commonly used at most facilities and familiarizes the student nurses with medications and the lingo in doctor’s notes, Lester said.
“Each facility’s electronic systems are different, but no matter what facility they end up working in, they can say, ‘Hey, I’ve worked with electronic health records before, so I just need to tweak my thinking a little to this one,’” said Neller.
Be ready for anything
Nursing remains a slam dunk when it comes to job security, and it also offers students variety within their careers, said Hesselrode.
“In a fast-changing health care system, one thing is constant: Nurses have always played, and will always play, a pivotal role,” said Susan B. Hassmiller, senior adviser for nursing at the Robert Wood Johnson Foundation.
“With such a variety of jobs options, the field keeps us on our toes to prepare our bachelor’s student nurses for whatever specialty they may choose,” she said. “On the job, nurses are constantly learning new things and earning new certifications for their specialties, so it’s important they become independent learners who are adaptable and innovative.”
Unlike clinical rotations at other nursing schools where one instructor is paired with six to eight students, Lipscomb senior preceptorship offers one-on-one mentorship and instruction, allowing the student to function as an “expert” student nurse. Almost 90 percent of the 2015 graduating class noted this preceptorship as a strength of the program.
“The preceptorship, by far, has been the most valuable clinical experience we have had,” said Ben Ashley, senior from Memphis, Tennessee, placed in the Vanderbilt University Medical Center Emergency Department. “In our previous clinical experiences we tended to work with one patient. In the preceptorship, we work with all the nurse’s patients. So we are much more like a full-time RN. It’s way more valuable. We get to learn more about time management and how the system works. And it’s just more fun.”
Other experiences unique to Lipscomb also introduce student nurses to care in a variety of settings. In the 2015-16 school year, 34 student nurses participated in global medical mission trips in areas such as Africa, and South and Central America. Other student nurses have participated in countless local community service opportunities and a handful are selected each year for a multi-disciplinary internship at Vanderbilt University Medical Center.
“Each year, there are probably as many as 15 to 20 easily accessible opportunities to experience on-the-ground health care,” said Ashley.
“More than in other career fields, nursing students at Lipscomb get to see what it is like in the real world,” said Danaly Chavarria (’15), medical-surgical nurse at Saint Thomas Rutherford Hospital. “It makes you more comfortable with how to use the equipment like the blood pressure machine and the heart monitor. After I graduated and began work, I learned so much more, but I think it would have been even harder if I hadn’t had that on-site experience through Lipscomb.”
Lipscomb University has doubled its nursing faculty as well as significantly increased adjunct faculty and clinical experience opportunities since 2013. Nursing enrollment has grown by more than 75 percent in that time.