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Stop a nursing shortage before it starts


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By Jennifer Thew, RN

We’ve all heard the saying, "An ounce of prevention is worth a pound of cure." In other words, a little foresight and planning can fend off a crisis.

At Seattle Cancer Care Alliance, nurse leaders have taken a preventive approach to the organization's future workforce needs.

"[Combined] with what was being anticipated nationally with the [nursing] shortage, we were also looking at a large group of our very experienced nurses retiring," says Sharol Kidd, BSN, MBA-HL, RN, advanced practice registered nurse, DEU and residency program coordinator at SCCA.

Additionally, more care is taking place in settings beyond acute care.

"When you look at the environment where care takes place, 60% of nursing care occurs in a hospital [setting] and 40% occurs in other places," says Rae Niculescu, MN, RN, professional practice coordinator at SCCA.

This is particularly relevant to an organization like SCCA.

"What we're seeing is that oncology care [is a shift] to the ambulatory clinic [setting]. So that's also driving the need to have to plan for the future," Kidd says.

As a result, SCCA has become proactive in developing the next generation of nurses in the community oncology setting. Here's how its program began and evolved to develop a pipeline of nurses with much needed specialty care knowledge.

The Dedicated Educational Unit
SCCA's journey to building this particular segment of its workforce began when leaders wanted to address recommendations from the National Academies of Science, Engineering, and Medicine's 2011 report The Future of Nursing: Leading Change, Advancing Health.

"They called for novel educational models," Kidd says. "At the Seattle Cancer Care Alliance, we were looking to introduce a dedicated educational unit that was a collaboration between the academic site with the clinical site."

With the DEU in the ambulatory clinic, students were given the opportunity to gain clinical experience in specialized oncology care.

"We partnered with an academic center in Seattle in 2012 to develop a clinical rotation for senior nursing students to learn about the ambulatory oncology center and what it is like to be an oncology nurse," Kidd says.

SCCA staff works closely with instructors from the university to ensure they met the school's requirements. The instructor and the student's preceptor, an SCCA staff nurse, meet throughout the student's rotation, but the staff nurse takes the lead in providing the student with learning experiences.

"It's the staff nurse who is teaching the students. The faculty is present and available if we need them, but the clinical expert is the staff nurse, who coordinates and provides the opportunities for the students to learn," Kidd says.

Additionally, participants attend a series of lectures by SCCA experts on a variety of topics, including how to successfully perform lab draws, bone marrow transplant issues, or cancer prevention and screening.

"That helps tie some of the knowledge together and to increase complexity a little bit as you go along," Niculescu says.
 
Expanding the Program
"When [the DEU] initially started, we were just going to bring in the students. We had not thought about the residency program," Kidd says.

But, once the first group of students completed their senior rotation, their interest in oncology was piqued.

"There were two students that really, really, really wanted to do their residency here. We were able to ask for that FTE for them, and they continued on the unit doing the residency," she says.

After that experience, both residents were hired by SCCA.

"After those two completed [the residency] and were hired, the [organization's] leaders really acknowledged and understood the benefit of it," Kidd says.

Today, the DEU hosts 16 students in their senior rotation and four senior practicum students annually. The senior rotation clinical experience is 128 hours, or about eight weeks long.

"We provide [nurses with the] opportunity to see what patients go through in the outpatient setting," Kidd says.

The experiences can include anything from learning about medication regimens, radiation, and chemotherapy; observing physician and social work appointments; and partaking in education from other nurses.

Students in the senior practicum spend 156 hours or about 10 weeks in their experience.

"The primary focus of the senior practicum is for [the students to have experience with] direct patient care. We usually assign [the students] to the infusion area where they're able to have hands-on bedside or chairside experience," Kidd says.

Some of the opportunities the students have include drawing blooding, starting hydration and antibiotics, and performing physical assessments.

All these experiences are guided by an SCCA staff nurse preceptor.

"The next step of the program is the residency program," Kidd explains.

Residencies are open to new graduates who have gone through the DEU or have done a clinical rotation within the organization.

The program is 16 weeks long (640 hours) and is a preceptor-based orientation program.

"It is designed to gradually introduce and develop critical thinking and experience," Kidd says.
 
Challenges, Opportunities, and Results
Since the residency program began, 42 nurses have gone through the program. Out of the 42, SCCA has hired 40 RNs. The group's retention rate is 95%.

Additionally, because of the program, leaders and staff nurses alike have changed their belief that new graduate nurses need one to two years of acute, inpatient care experience before moving to an ambulatory setting.

"We always thought new grads should go inpatient," Kidd says. "It took a little bit of convincing and work to embrace that new concept. I had to convince my staff that it was okay to bring students [to the outpatient setting]."

Though there is a time commitment, she points out, once the nursing staff supported and understood the idea that they're helping to develop the next generation of nurses, they can see the rewards.

"Once we hired the new grad after completing the program, the staff members were all impressed with 'their' accomplishment—that they were able to train a new grad to be so successful in the outpatient setting," Kidd says.

And contributing to others' success keeps staff engaged and benefits the nursing profession, Niculescu says.

"I think it's a part of being a witness to that journey … having [new nurses] come in the first week and they can't find their way around to when they have a first successful lab stick. Just seeing that growth is really rewarding," Niculescu says.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.