Website Pairs Nursing Students with Clinical Rotations
Debra Anscombe Wood, RN
Monday September 24, 2007
Laura Hernandez, ARNP, MSN, CPN, clinical educator at Miami Children's Hospital, foreground; nursing students, left to right, Christina McRay, Cristina Suarez, Tahir Gibson, and Carly Goldich.
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Schools need clinical space
A report by the Florida Hospital Association indicated hospitals throughout the state had an 8.5% vacancy rate for registered nursing positions in 2005. The Florida Agency for Workforce Innovation expects Florida will need 8,060 more registered nurses by 2011. But preparing those new nurses may prove problematic.
A Florida Center for Nursing study, released in May 2007, reported that interest in the profession has increased, with greater numbers of people applying to nursing schools. But colleges and universities turn many of them away. The survey found baccalaureate programs did not admit 62.7%, 3,318, of their qualified applicants and associate degree programs did not admit half, 3,844, of their applicants.
Too few faculty and inadequate clinical space were primary reasons for turning away qualified nursing students. The Florida Hospital Association survey found that 67% of schools indicated they could expand if they had more clinical locations, and 62% said they had inadequate space for their programs, says Jacqueline Gonzalez, ARNP, MSN, CNAA, FAAN, senior vice president and chief nursing officer at Miami Children's Hospital and project director for the Nursing Consortium of South Florida.
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Online matchmaking has worked for many dating singles; now Florida nursing educators and hospital leaders have harnessed computing power to bring students and clinical practice opportunities together through the Centralized Clinical Placement System (CCPS) on the new Florida Nursing Resource Center (NRC) website, www.floridanrc.org.More than 4,000 Florida nursing students were placed on clinical rotations this spring during a test run of the CCPS. Thirty-one clinical sites and 35 nursing schools participated. The real test comes this fall semester with the full rollout."It's a very fair, cost-effective and timely way of matching," says Jacqueline Gonzalez, ARNP, MSN, CNAA, FAAN, senior vice president and chief nursing officer at Miami Children's Hospital and project director for the Nursing Consortium of South Florida, one of the NRC's sponsors.The lifeblood of nurses' education, hospital and field rotations let students practice hands-on and critical-thinking skills. Educators always have struggled with negotiating with hospitals and finding enough of the right sites to provide students with optimal experience. Likewise, hospital leaders want to host promising students, because it is a great opportunity to introduce budding nurses to the joys of working at that facility. But juggling multiple requests for clinical space can be overwhelming."Hospitals didn't like to be in a bartering position between schools of nursing," Gonzalez says. "This is a more objective way to do it."The CCPS was created to streamline the process and find underused space that could increase nursing student capacity."This is a wonderful thing for nursing," says Claudia B. Distrito, RN, BSN, MSH, senior vice president of nursing and patient services for Mercy Hospital in Miami and president of the Nursing Consortium of South Florida. "It opens up more places for nursing students, which will help the overall nursing shortage."Helping curb shortages
The CCPS can help identify more sites to place students or discover if an area truly lacks sufficient clinical space."We believe we have space, but what kind of space do we have? Is it psych space we are lacking? Is it OB, peds, the specialty space?" asks Gonzalez. "Every school has looked at it in their own universe and every hospital within their own universe. I don't think anyone ever knew what was really there."The traditional barter method did not allow for a broad overview of assignments. Every facility and college kept records, but massive information sharing did not occur."Some hospitals had space available but no request for students, and some places were overloaded," says Judy Brustad, director of healthcare workforce retention strategies for the Palm Healthcare Foundation.For years, hospital and nursing school officials met one-on-one to negotiate clinical learning placements. Often, it took several sessions to arrange schedules. Schools take students to different providers and facilities invite more than one educational program to bring students."Everybody had a different process, and it was a total nightmare," says Marsha Tejeda, professional development consultant and student nursing coordinator for Baptist Health of South Florida, in Miami. Tejeda schedules clinical placements at the five Baptist hospitals. She estimates she would receive 500 or more requests for up to 200 slots. "The volume was crazy."Nursing schools did not have it any easier, with each hospital or provider having a specific process and time when it would accept requests, says Patricia Livingstone, RN, MN, clinical assistant professor of nursing at Florida International University in Miami and resource manager for the CCPS.With computer placements, "it will be so wonderful," says Anita Spies, clinical coordinator for Miami-Dade Community College, which places 800 students each semester. Under the old system, Spies explains, she would have to call around to find a place if an adjunct faculty member canceled at the last minute and the replacement would not go to the assigned clinical site. With the NRC, a few clicks with the mouse and she will know which facilities have space."The system will make things so much easier in a lot of ways," Spies says.Finding a better way
Palm Healthcare and the Nursing Consortium were independently exploring alternatives to the paper-and-pencil system, when they discovered they both were trying to tackle the same problem and decided to team up.Palm Healthcare had conducted a needs assessment and learned that scheduling clinical placements annually cost each hospital on average $9,608, and each school spent on average $8,868 to schedule students."It was pretty costly when you look at the time people spent," Brustad says.The two entities decided to investigate available electronic systems. Representatives checked out different software programs and talked with users. They decided to license the Nursing Resource Center system used in the San Francisco Bay area, which was developed by the Foundation of California Community Colleges and the California Institute for Nursing & Health Care."[This electronic system] has the most flexibility and is the most automated," Gonzalez says about the selection.The program features two components: the CCPS for scheduling clinical rotations and the Centralized Faculty Resource Center (CFRC) to help nurses interested in becoming educators find positions. Nurses can prepare candidate profiles for consideration by the schools, and educators can post openings."In addition to a lack of clinical space, the biggest thing is trying to find faculty to teach students in the clinical area," Livingstone says.The Health Foundation of South Florida awarded a $230,000 grant to fund the service in Broward, Miami-Dade, and Monroe counties, and the Palm Healthcare Foundation provided a matching grant to bring it to Palm Beach, Hendry, St. Lucie, Indian River, Okeechobee, and Martin counties. Palm Healthcare has purchased the rights to the system for the entire state and could add additional regions for nursing schools and clinical sites in other parts of Florida as interest builds.How the CCPS works
Clinical sites enter data about available learning opportunities. They might make several med-surg units available on different shifts and open up a labor and delivery floor on day shift or an oncology unit on evenings, for example. Some hospitals accept students on all shifts, seven days a week."[The computer match] provides a benefit to the staff nurse in the hospital, because there is an appropriate allocation of students on any given nursing unit," Distrito says. "And you don't have a mix of different levels of students. [If that happens,] it becomes difficult for staff nurses to oversee care. The staff nurses are still responsible for those patients."The providers can specify preferred schools. The Mercy Hospital School of Practical Nursing, in Miami, would be given preference over other educational facilities for placements at Mercy, however, the facility accepts students from multiple schools."We would like for all levels of nursing to have access at Mercy," Distrito says. "But like any hospital, we have limits. We can't have too many students on one unit. This helps make it more fair."The nursing schools submit their clinical site needs. They specify type of unit, such as orthopedics or telemetry and location by county. The more specific the request, the fewer choices will come up when the computer software compares the entries and presents a list of matches. The clinical sites and the educators can accept or turn down a match."You don't have to take whatever it is," Livingstone says. "You get choices. I can see eight to 10 slots to accommodate my students. I'm going to pick the one that makes the most sense for me, usually that means I have a faculty member who will go there."The software does not allow two groups of students on the same unit at the same time, which Livingstone says happened frequently with the manual system. If a school finds it has fewer students than expected, it can let the CCPS know and free up space for students from another program.During subsequent cycles, schools and clinical sites can modify the information that has changed but do not need to reenter all of the data.Program launch successful
Initially, the consortium planned to begin electronic matching with a pilot group, but so many entities wanted to participate, leaders decided to open it up to everyone. The group invited all hospitals in the Florida Hospital Association database, and the nurses hoped at least half would agree to use the computer. But only a few smaller specialty hospitals declined. And the consortium identified nursing programs it did not know existed as schools learned about the program and contacted the nursing leaders asking to participate.The process progressed smoothly, with minimal difficulties, Livingstone says. By summer, most of the schools had identified clinical sites for their students, with additional locations still available."I found it to be easier once the requests were added and accepted," says Beth Olafson, RN, BSN, MSEd, BC, director of education at Memorial Hospital West in Pembroke Pines. "It gave me a nice calendar to reference when all the students were scheduled."Olafson forwarded the calendar to nurse managers, directors, clinical nurse specialists, and the various schools. She has placed more than 400 students using the CCPS and found it saved time.The consortium and health foundation contracted with a research firm to survey clinical sites and educators to elicit feedback about the new system. Among the findings: One-third of the nursing schools responding reported an increase in the number of clinical spaces available, and three nursing school respondents reported an increase in their capacity to accommodate and educate nursing students as a result of using the computerized system. Several schools and clinical sites reported forming new partnerships. Thirty-eight percent of nursing school respondents and 44% of clinical facility respondents indicated there was an increase in their ability to better align clinical experience with students' skill levels when using the system.The real test will come this fall, when students arrive at the various facilities, says Tejeda, who expects any glitches will be minimal."I'm very hopeful this is going to work, and if it does, it will streamline all of our work and increase efficiencies," Tejeda says.Debra Anscombe Wood, RN, is a Nursing Spectrum contributing writer.
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