In This Issue

Simulations and Celebrations: NJNI Scholars Gather for Learning, Graduation
Leader’s Column – Nursing, Business and Two Years of Transformative Change
Veteran Nurse Professor Has New Vision for Nurse Education
NJ’s Action Coalition Moving Ahead
Did You Know?

Simulations and Celebrations: NJNI Scholars Gather for Learning, Graduation

“My chest still hurts,” groaned the man lying on the hospital bed. “What are you doing? I need help!” Adding to the stressful atmosphere were the beeps of medical equipment, the raised voices of medical professionals, and the frustrated pleas of the man’s daughter who had accompanied him to the hospital.

The man, actually a human patient simulator mannequin, was part of a simulated—yet realistic—emergency room scenario involving the Robert Wood Johnson Foundation (RWJF) New Jersey Nursing Scholars. The agitated daughter was played by a nursing student.

Simulations, as the scenarios are called, were among the main topics at the April 15 in-person meeting of the New Jersey Nursing Initiative’s (NJNI’s)Collaborative Learning Community (CLC). The event, which took place at The College of New Jersey, convened all Scholars and included a ceremony for those who will be graduating from their master’s programs this summer.

“A Wonderful Day”

The 18 New Jersey Nursing Scholars who will receive their master’s degrees this year belong to the first cohort of Scholars. Their graduation marks the realization of one of NJNI’s top goals which is to strengthen the state’s ability to educate more nurses through the preparation of nurse faculty.

Calling it a “wonderful day” for the program, NJNI program director Susan Bakewell-Sachs, Ph.D., R.N., P.N.P.-B.C., who is the Carol Kuser Loser Dean and professor of nursing, School of Nursing, Health, and Exercise Science at The College of New Jersey, welcomed the graduates into the ranks of RWJF alumni and a new generation of nurse leaders.

“We expect a lot from you in terms of your nurse faculty careers. We want your help in transforming nursing education, in transforming health care and in becoming nurse leaders in education, research practice and policy,” she said to graduates at the ceremony.

Maryjoan Ladden, Ph.D., R.N., F.A.A.N., senior program officer for RWJF, echoed the sentiment. “We look forward to welcoming you as nurse faculty – you are the future leaders of the profession,” she said.

The graduating Scholars are:

Elizabeth Arnold, Kean University
Christine Bray, Richard Stockton College of New Jersey
Erin Cleary, Fairleigh Dickinson University
Caitlin Faupel, Richard Stockton College of New Jersey
Andrew Fruhschien, Fairleigh Dickinson University
Hye Jin Gehring, The College of New Jersey
Primrose Germain, The University of Medicine & Dentistry of New Jersey
Maryann Magliore-Wilson, The University of Medicine & Dentistry of New Jersey
Kristine Martinho, The College of New Jersey
Tara Lynne Parker, William Paterson University
Latoya Rawlins, Monmouth University
Mary “Rusti” Restaino, William Paterson University
Patricia Saveriano, The University of Medicine & Dentistry of New Jersey
Michelle Skiber, Monmouth University
Jenee Skinner-Hamler, The University of Medicine & Dentistry of New Jersey
Andrea Taylor, Kean University
Lia Valentin, The University of Medicine & Dentistry of New Jersey
Dorothy Withers, The University of Medicine & Dentistry of New Jersey

Learning in Real Life

The CLC is a signature program of NJNI’s Faculty Preparation Program. It provides special learning opportunities to help the Scholars offer their future students the best possible instruction. The meeting’s focus on simulations was a response to Scholar requests for more experience with this teaching tool.

Simulations are highly sophisticated exercises intended to provide a safe place to respond to a likely clinical scenario that is as realistic as possible. In simulations, nursing students learn the importance of effective communication, teamwork and handling stressful circumstances. Simulation can be used to create high or low stakes scenarios that students may one day face as nurses, without practicing on actual patients. After a simulation, students have the opportunity to re-group and discuss successes and challenges they faced during the exercise, so that they will be better prepared to respond to similar situations in real life.

Instructors use simulations to assess student skills and identify areas for improvement. They can be complicated affairs involving multiple actors or mannequins recreating a complex medical procedure or emergency, or they can be designed to test something as simple – but crucial – as remembering to wash one’s hands. Some schools and hospitals include simulations using mannequins programmed to speak foreign languages to recreate communication challenges that sometimes arise. In recent years, instructors often have a hard time finding available clinical sites for students to practice in, making simulations an attractive option for insuring competency development.

In addition to the simulation, Scholars at the CLC participated in a series of workshops, some led by their colleagues in the Ph.D. program who are specializing in simulations.

A Collective Experience

In the afternoon, Scholars participated in a session on team-based learning led by Michelle Clark, Ph.D., R.N., associate professor at the University of Nevada, Las Vegas, who is widely known for her work in this field. Team-based learning maximizes the effectiveness of learning in small groups, and can be used in place of lectures. The method requires active learning and makes students accountable to the instructor and their small groups. The Scholars, their mentors and invited guests formed small groups in the session and worked on solving problems and answering complex questions to experience and learn more about this engaging and effective teaching method.
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Leader’s Column – Nursing, Business and Two Years of Transformative Change

By Tom Bracken, president of the New Jersey Chamber of Commerce

Two years ago this month, the Robert Wood Johnson Foundation New Jersey Nursing Initiative (NJNI) launched with a hearing before the New Jersey Senate’s Health, Human Services and Senior Citizens Committee. Our launch came at a pivotal moment, when businesses were seeing health costs skyrocket, the state was facing looming nurse and nurse faculty shortages, and communication among stakeholders was infrequent and unproductive.

The New Jersey Chamber of Commerce Foundation viewed this partnership with the Robert Wood Johnson Foundation as an important opportunity to transform the health and health care of our residents and improve the economic health of the state. Each year, in this country, inadequate or poor quality health care costs businesses as many as 45 million avoidable sick days, which translates to more than $7 billion a year in lost productivity. Business in New Jersey cannot afford that kind of cost.

We know there is a clear link between the nurse faculty shortage and economic competitiveness. A strong nursing workforce—well-prepared by effective nurse faculty—can help improve employees’ health and wellness, and provide the health care and services that our workers and their families need. As the newly appointed president of the Chamber, I have seen how NJNI is helping to create partnerships, establish programs and lead efforts that will improve health and health care in the state, ultimately leading to a healthier and more productive workforce.

In just two years, we have accomplished much. We have held two Health Care Business Summits. We have partnered with the State Employment and Training Commission to develop a strategic plan for the health care workforce in New Jersey, which includes addressing faculty shortages at schools that educate health professionals. This plan is being further developed and implemented by the newly-established Health Care Workforce Council.

We have been selected as the host organization for New Jersey’s Action Coalition charged with implementing the recommendations of the Institute of Medicine’s landmark report Future of Nursing: Leading Change, Advancing Health. New Jersey’s coalition is one of 15 state coalitions nationwide that are part of the Robert Wood Johnson Foundation’s Future of Nursing: Campaign for Action, an unprecedented and ambitious initiative to use all the skills, talents, knowledge and experience of nurses to meet the increased demand for health care.

This summer, 18 New Jersey Nursing Scholars who were master’s candidates will graduate and begin looking for positions as nurse faculty. They are a keystone of NJNI’s efforts to address the nurse faculty shortage and are among our future nurse leaders. We wish them well as they begin their work and look forward to collaborating with them on future endeavors.

In the past two years we have sought out and cultivated partnerships with diverse stakeholders including leaders in business, health, academia, philanthropy and public policy. The opening of new channels of communication has strengthened our work and laid the framework for sustainability. We are proud to have played a central role in establishing these new and exciting collaborations.

Ensuring that New Jersey has the well prepared, diverse nurse faculty it needs to educate nurses to meet the demand for health and health care in the 21st century is a goal we all share. In the years to come, we hope to build upon our successes and make New Jersey a model for the nation. Thank you for your support.
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Veteran Nurse Professor Has New Vision for Nurse Education

May 31, 2011

Nancy Lenaghan teaches students to prevent and catch medical errors with heightened pedagogic focus on quality and safety in nursing.

Eight years ago, Nancy Lenaghan lost a family member to a medical error, and ever since she’s been working to keep others from experiencing the same kind of tragedy.

For Lenaghan, M.S.N., A.P.R.N., C.N.E., a nurse and nurse educator for more than four decades, that means transforming nurse education so that nursing school graduates are able to catch medical errors before they happen and save lives before they are lost.

A guiding light on Lenaghan’s journey is Quality and Safety Education for Nurses (QSEN), a project funded by the Robert Wood Johnson Foundation (RWJF) that aims to prepare aspiring nurses to improve the quality and safety of the health care systems in which they work.

QSEN is the Foundation’s response to recent reports documenting the high number of patient injuries and deaths that come from medical errors in hospitals. Nurses have a key role to play in reducing medical errors, the Foundation believes. They are largest group of health care professionals in the country and spend more time with patients than most other providers.

“Nurses are with patients 24 hours a day, seven days a week,” Lenaghan says. “They play a very pivotal role in terms of creating a culture of safety.”

Yet ensuring safe patient care today is a huge challenge. People are living longer and as a result are dealing with more chronic and more acute conditions. At the same time, because of the soaring cost of health care, patients are being discharged from hospitals sooner than in years past. Ultimately, nurses are responsible for more patients with more acute and chronic conditions.

Meanwhile, demands on nurses are growing. Nurses are responsible for everything from providing care to advocating on behalf of their patients and checking lab results to collaborating with physicians and other health care team members. “They’re managing so many issues at once,” Lenaghan says, “and there are lots of distractions.”

To improve care, Lenaghan is advocating for a transformation of nurse education. Toward that end, she developed a simulation project designed to teach nursing students to stay focused and manage competing responsibilities in the kind of chaotic, high pressure environments that are health care organizations today. “We can’t teach the same way we used to,” she says. “We need to develop new strategies so students can internalize what safety is all about.”

Lenaghan Embeds QSEN Competencies into Existing Curriculum

A nurse educator for more than three decades, Lenaghan knows as well as anyone how to do that. After earning her master’s degree in nursing in 1977, she became an instructor at Washington Hospital Center School of Nursing. A decade later she joined Brookdale Community College, where she now is a professor. “I became a nurse because I wanted to touch human lives,” she says. “I consider it a privilege to work with humans at their most vulnerable time in their life. I wanted to share that passion I have with students.”

In 2008, Lenaghan was serving as chair of the department of nursing at Brookdale and began to look seriously into developing a teaching activity that incorporates QSEN competencies such as evidence-based practice, patient centered care, safety, teamwork and collaboration, and quality improvement. Informatics is also a QSEN competency.

An expert in kidney disorders and sepsis, Lenaghan integrated the QSEN competencies into an existing case study about a simulated patient—an 85-year-old Italian woman—who arrives at the hospital with a urinary tract infection and goes into septic shock.

During the simulation, students encounter and respond to a range of safety problems such as incorrect IV solution, a missing ID band, and water on the floor; provide patient-centered care by communicating with a confused and reluctant foreign-born patient and advocating on behalf of the patient’s main caregiver, her daughter; and collaborate with other members of the health care team from radiology and respiratory therapy.

Before the simulation project, students research and discuss literature on evidence-based practice relating to cascading health crises such as occurs with multiple organ dysfunction syndrome. Afterward, students create a simulated quality improvement plan to reduce the incidence of hospital acquired urinary tract infections.

Before incorporating the activity into the school’s curriculum, Lenaghan instructed her colleagues on how to teach it and monitored its implementation. The simulation first ran in 2008 and is now a fixture in the curriculum.

The students responded extremely well, Lenaghan says. They enjoyed the detailed simulation and upon completion had a better grasp of the QSEN competencies. “The simulation was extremely helpful in learning how to communicate and report to other members of the health care team,” one student wrote in a follow-up report. “It also helped with learning about delegation.”

Lenaghan presented the activity at a national QSEN conference last year; in October, she presented it at the annual conference of the New Jersey Nursing Initiative (NJNI), a five-year, $22 million project of the Robert Wood Johnson Foundation and the New Jersey Chamber of Commerce Foundation that is working to transform nursing education in the state.

Since she attended the conferences, she has received emails from faculty in several states inquiring about the project. Meanwhile, Brookdale’s nursing program was recognized by the National League for Nursing as a Center of Excellence.

In the coming years, Lenaghan and her colleagues at Brookdale plan to embed the QSEN competencies more deeply into the school’s curriculum. “It’s a work in progress,” she says.
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NJ’s Action Coalition Moving Ahead

The New Jersey Action Coalition is one of 15 state coalitions working to implement the recommendations of the Institute of Medicine’s landmark report Future of Nursing: Leading Change, Advancing Health as part of the Robert Wood Johnson Foundation’s Future of Nursing:Campaign for Action. The action coalitions are responsible for developing and implementing plans that use all the skills, talents, knowledge and experience of nurses to meet the increased and growing demand for health care.

New Jersey’s coalition is seeking and investigating successful models in which nurses are exerting influence in health care design and delivery by: increasing the number of nurses in key decision-making roles in hospital and health care administration; exploring opportunities for nurses to play a greater role in ensuring the proper and efficient coordination of patients’ care across the continuum, working with the insurance industry and as Medicaid is restructured; increasing nurses’ influence in shaping patient care practice models and processes in all health settings; participating in the design of accountable care organizations; and exploring other models of care—for example, the Visiting Nurse Association of Central Jersey’s work with at-risk populations, such as the homeless and mentally ill who have been released from institutions.

Since its launch in December, the New Jersey Action Coalition and its members have been reaching out and talking with stakeholders, creating partnerships, and working toward solutions. The coalition held its first public forum in February, bringing together state leaders in health, business and education to learn more about how they could join this effort. In all, more than 200 participated in the Campaign for Action Forum, hosted by The College of New Jersey in honor of the 40^th anniversary of its nursing program.

“I have never seen anything quite like this,” said Robert Wood Johnson Foundation senior adviser for nursing Susan Hassmiller, Ph.D., R.N., F.A.A.N. about the response to the recommendations to improve health and health care through nursing in the recent Institute of Medicine report. Hassmiller, who was part of the illustrious committee that produced the recommendations, encouraged participants to take part in the “call to action.”

“The report is a rallying point,” she said. “There are a lot of decisions being made on Capitol Hill and at the statehouse without a nurse at the table. We need nurses’ perspectives and voices at every level.” Hassmiller encouraged participants to follow the Campaign for Action on Facebook and Twitter.

Campaign Already Underway in NJ

New Jersey’s Action Coalition has already identified several successful and replicable models in which nurses play leadership roles in improving health care. From nurse-led mobile outreach units that have been proven to prevent unnecessary visits to emergency rooms to education programs that are making it easier for nurses to attain advanced degrees, the coalition is using real-life stories to present successful strategies that can be brought to scale in New Jersey.

The New Jersey coalition is led by Edna Cadmus, Ph.D., R.N., N.E.A.-B.C., clinical professor and director, DNP Program-Leadership Track of Rutgers University College of Nursing; Mary Ann Christopher, M.S.N., R.N., F.A.A.N., president of the Visiting Nurse Association of Central Jersey and chair of the New Jersey Nursing Initiative’s National Advisory Committee; and David Knowlton, president of the New Jersey Health Care Quality Institute. Their excitement and enthusiasm were contagious at the February Forum. “It’s about time for something like this!,” said Patricia Murphy, Ph.D., A.P.N., chair of the New Jersey Board of Nursing. “We’re very ready to work in a collaborative way to make things happen and allow all of these initiatives to advance. We want to be a partner.”

Participants left the Forum armed with “sticky notes” with the message “Because you can’t do it without Nurses!” They were invited to get inspired, jot down their ideas and “stick” them on oversized columns representing each of the “pillars,” or main issue areas, included in the report. They include inter-professional collaboration, improving workforce data collection and analysis, improving nursing education and more. To learn more about the efforts underway in New Jersey, click here.
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Did You Know?

The New Jersey Nursing Initiative now has a blog! We’re celebrating our second anniversary by launching a brand new blog, “News & Notes on Nursing in NJ.” It will allow us to keep you informed about all of the latest developments related to nursing. In addition to keeping you up-to-date on our work, “News & Notes on Nursing in NJ” will provide updates on health, health care and education issues locally and nationally, and will serve as a forum for leaders across the state— including our very own New Jersey Nursing Scholars—to chime in with their own views.