In This Issue:

Accomplishments and Aspirations: NJNI Explores Innovations in Clinical Education
Leader’s Column: NJNI 2.0
RWJF Scholar Tackles Childhood Obesity
Catching Up With the CLC
Did You Know…?

Accomplishments and Aspirations: NJNI Explores Innovations in Clinical Education

After a year of supporting four pilot projects devoted to innovations in clinical education (ICE), the New Jersey Nursing Initiative (NJNI) brought together educators and practitioners at the Robert Wood Johnson Foundation (RWJF) for two day-long forums that explored NJNI’s initial ICE areas: the dedicated education unit (DEU), preceptor strategies, and clinical simulation.

“These small-scale projects are important as we move to larger-scale efforts,” NJNI Program Director Susan Bakewell-Sachs, PhD, RN, PNP-BC, told attendees at the first forum, which was held on Jan. 25, 2013, and highlighted the work of nursing schools and practice organizations that partnered for the pilot grants:

  • Georgian Court-Meridian Health School of Nursing and Meridian Health Affiliated Foundations (simulation);
  • Fairleigh Dickinson University and Holy Name Medical Center (preceptor strategies);
  • Rutgers-Newark College of Nursing and Saint Peter’s University Hospital (simulation); and
  • William Paterson University and St. Joseph’s Regional Medical Center (DEU).

Facing Challenges, Finding Success

In the Georgian Court/Meridian simulation project, students in the five-year-old nursing program worked alongside medical students to build interprofessional collaboration skills. The effort was successful, although the dynamic could be challenging. At times, “nursing students would defer to medical students, who had less experience than they did,” said Teri Wurmser, PhD, MPH, RN, NEA-BC, chair of the Georgian Court-Meridian Health School of Nursing. By the end of the project, outcomes and feedback encouraged its leaders to explore additional opportunities for interprofessional curriculum planning and for learning activities that engage students from different health care disciplines.

Representatives of the Rutgers/Saint Peter’s project reported that expanding high-fidelity simulation, already an established tool in the classroom, into the hospital setting served a dual purpose: It allowed Saint Peter’s to access emerging technologies for nurses’ continuing education, and it increased student interaction with experienced professionals.

A primary goal of the Fairleigh Dickinson/Holy Name project was to use preceptors in the community setting—home care, hospice, and palliative care. Although some preceptors were initially reluctant to allow students to perform more complex procedures, the project progressed successfully. Students gave positive evaluations of their experiences with the preceptors, and the nurses who served as preceptors expressed a desire for continued involvement in the education of nursing students. “They all said they were willing to be a preceptor again,” said Minerva Guttman, EdD, RN, NP, director of the nursing school at Fairleigh Dickinson. “We were very happy with that.”

Julie Bliss, EdD, RN, chair of the William Paterson University Department of Nursing, emphasized that one of the most significant challenges in launching a DEU at St. Joseph’s was ensuring adequate administrative support. “These are huge decisions we had to make,” she said of issues such as faculty roles, schedules, and expenses. “We needed to get buy-in at the university” as well as the nursing unit. Now the pilot project has laid the groundwork for a sustainable academic-practice partnership, including the addition of a pediatrics DEU.

Bakewell-Sachs praised all of the projects for the “enthusiasm and passion they have applied. Beyond the NJNI grants, this was an opportunity to bring people to the table. There really is an opportunity here to change education.”

“This is our future, folks,” she added. “This is part of our legacy, moving these issues forward.”

See presentation materials from the first ICE forum online.

Delving Into the DEU

NJNI’s second ICE forum, held on March 8, 2013, focused exclusively on the DEU model and why it should be a priority for educators and practitioners. In welcoming attendees, Bakewell-Sachs pointed out that “NJNI now has a convening role for the entire state, and that allows us to tackle big issues and bring in national perspectives.”

RWJF Senior Program Officer Maryjoan D. Ladden, PhD, RN, FAAN, also welcomed attendees. “Conversations like this one are critical to bring academic and practice communities together,” she said.

Susan Randles Moscato, EdD, RN, professor emerita at the University of Portland in Oregon, delivered the keynote address and moderated a panel that featured two other DEU experts from Portland, Cindy Lorion, RN, MSN, NE-BC, CMSRN, of Providence St. Vincent Medical Center and Chad O’Lynn, PhD, RN, RA, of the University of Portland, as well as DEU expert JoAnn Mulready-Shick, EdD, RN, CNE, ANEF, of the University of Massachusetts-Boston.

“Before the DEU was introduced 12 years ago at the University of Portland, we had good students, strong faculty,” Moscato said, “but students did not have good clinical experiences. The DEU brought us consistency and organization of the clinical environment, and a systematic plan to optimize clinical resources.”

As she introduced the panel, Moscato observed that “we can’t talk about nursing education only through faculty preparation. We have to talk about clinical education. I’m thrilled that we’re able to have these challenging conversations.”

O’Lynn discussed the importance of the clinical faculty coordinator’s role and efforts to adapt the Portland model to long-term care settings. “It’s not just about bringing students into these settings,” he said. “It’s about giving them meaningful experiences.”

Mulready-Shick said that a primary obstacle to the expansion of nursing education capacity nationwide is a lack of faculty and a lack of clinical sites. “The more evidence we have, the better to make the case for DEUs,” she said, adding that research at her institution has revealed a major finding: “DEU students spend twice as much time receiving instruction as traditional students do.”

As the day wound down, Bakewell-Sachs noted that efforts to expand DEUs in New Jersey come with challenges, notably that regulations require a ratio of one master’s-prepared faculty member for every 10 students, limiting full implementation of the DEU model that has staff nurses as preceptors. In addition, only about one out of every 10 registered nurses in the state has a master’s degree in nursing, the minimum standard to teach. “NJNI is committed to connecting clinical nurses to education,” she said. “We want to combat the statement ‘I will teach when I retire.’ However, the issue of DEUs is not ours alone. The state Board of Nursing has been involved and knows what NJNI is doing but needs to hear from all of us. These academic-practice partnerships are mutually beneficial and can support quality clinical education. If we’re not all on the same page yet, I want us all to at least be on the same bookshelf.”

Roxanne Sabatini, RN-BC, MSN, CCRN, a nurse educator at Morristown Medical Center, said the forum covered many of the issues that have to be considered in her community. “We’ve heard about DEUs for a long time,” she said, “and we’re very interested. It can be difficult, though, to have a unit for one school when there are multiple colleges and schools of nursing in our area. We have many stakeholders, and we want to be sure we make the right match.”
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Leader’s Column: NJNI 2.0

By Susan Bakewell-Sachs, PhD, RN, PNP-BC, program director of theNew Jersey Nursing Initiative

To many people, the New Jersey Nursing Initiative means scholarships, and I’m often asked when aspiring nurse faculty can apply for the next round of funds. I respond that NJNI is shifting its focus—and that’s good news.

It doesn’t mean that we’ve solved New Jersey’s nurse faculty shortage and looming nurse shortage, but it signals that there are multiple ways to address those crucial issues. That’s why NJNI is moving into its next phase.

In the first phase of the program, the major areas of focus and strategy were faculty preparation through master’s and doctoral education, building faculty capacity, making faculty a preferred career, securing funding to sustain support for nurse faculty in the state, and building collaboration. To date, the Faculty Preparation Program has resulted in 40 scholars graduated with master’s degrees, and the first cohort of 11 PhD scholars will graduate this year and join the faculty ranks, helping to fill vacancies and sustain educational capacity. Master’s graduates are teaching, practicing and/or returning to school for nursing practice (DNP) and research (PhD) doctoral study.

Examples of other recent accomplishments include completion of four pilot projects focused on innovative clinical education models and involving preceptors, simulation, or dedicated education unit development (faculty capacity support); annual meeting on geriatrics in nursing education and Collaborative Learning Community programs on a range of topics relating to the current national agenda (faculty preparation); continuing collaboration with the N.J. Action Coalition in support of the Future of Nursing: Campaign for Action (nursing education and leadership); and reaching the milestone of 2,000 graduate students gaining scholarly writing support through the online Academic Resource Center (advanced degrees).

Reauthorization of the program in 2011 by the Robert Wood Johnson Foundation allowed for a second cohort of PhD scholars to be admitted that fall at the Rutgers and Seton Hall colleges of nursing and provided funding through 2016 to continue to combat the faculty shortage and transform nursing education. In the next phase, which we refer to in the program office as “NJNI 2.0,” we are specifically focusing on leadership development and education progression beyond the baccalaureate degree. We need many more nurses to earn master’s and doctoral degrees to meet the demands for practice, education and research. Master’s and doctoral education is changing as advanced practice programs convert from master’s to DNP programs. However, hospitals and other health care organizations report needing master’s-level nurses who are not advanced practice nurses, and there will continue to be high demand for nurses with research doctoral degrees such as the PhD.

NJNI will be collaborating with academic and practice partners to discern how the advanced degree pipeline can meet health and health care needs going forward. Expected retirements of senior faculty and other nurse leaders in New Jersey will result in a loss of wisdom and a potential leadership void. NJNI has begun to engage stakeholders to determine specific goals NJNI should aim for with regard to leadership development, continuing an emphasis on supporting New Jersey Nursing Scholars and other faculty. We continue to collaborate with partner schools and others in the NJNI network, the N.J. Action Coalition, the Council of Magnet Hospitals, and other groups and individuals to inform and leverage our efforts.

As always, the NJNI program office keeps up with national conversations as well as those happening in the state. We will continue to convene meetings, facilitate dialogue, provide information, and support collaborative efforts. Thank you for your support to date and your continued commitment in the future.
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RWJF Scholar Tackles Childhood Obesity

New Jersey Nursing Scholar explores effects of neighborhood safety, family, and acculturation on Latina adolescent health.

Problem: The rate of childhood obesity is dangerously high and putting kids at risk for health problems normally associated with adults, such as diabetes, hypertension, and high cholesterol. Minority and low-income youth face particular barriers to achieving healthy weights for cultural and environmental reasons.

Background: When Shanda Johnson was a young girl, she watched in awe as nurses helped her family members survive a number of health problems including strokes, diabetes, and hypertension. She knew then that she wanted to grow up to be a nurse, and was given a strong blessing by her grandmother, who had wanted one of her six daughters to join a profession she believed was well-suited to women. None had done so, but Johnson wanted to fulfill her grandmother’s wish—and that she did.

“I told my grandma I’ll be her nurse,” Johnson says. “She didn’t live to see me finish, but she knew I was on my way and that was good enough for me.”

At age 21, Johnson, MS, RN, APN-C, FNP, became an orthopedic nurse in the medical-surgical department at a hospital in New Jersey and soon after decided to earn her master’s degree to become a family nurse practitioner. The position appealed to her because it enabled her to work with patients of all ages and backgrounds.

Johnson planned to earn her doctorate degree immediately after her master’s, but she became pregnant and had a son and decided to put plans to advance her education on hold while he was young.

When her son was in kindergarten, Johnson applied to the school of nursing at Rutgers, the State University of New Jersey, and to the Robert Wood Johnson Foundation (RWJF) New Jersey Nursing Initiative, which runs a Faculty Preparation Program that supports master’s and doctoral New Jersey Nursing Scholars who are interested in becoming nurse faculty. The goal is to ensure that the state has the well-prepared, diverse nursing faculty it needs to educate nurses to meet the demand for health care in the 21st century. Each scholar receives a scholarship covering tuition and fees, a $50,000-per-year living stipend, and a laptop.

Now in her fourth and final year of the program, Johnson plans to complete her research and earn her doctoral degree this spring and become a professor of nursing at a New Jersey college or university.

During her studies, Johnson has been working part-time as a nurse practitioner at a pediatrician’s office serving an urban, minority community in Plainfield, N.J., that has a high number of patients—including children—who are overweight or obese. Last December, for example, a 14-year-old girl came to the office and weighed in at 232 pounds—far above the healthy body weight for girls her age. The girl had high blood pressure and high cholesterol, two problems normally associated with adults but increasingly common in overweight children.

Johnson was saddened, but not surprised; ever since she started working there, she’s treated a number of overweight and obese teenage girls who are experiencing hypertension and high cholesterol as well as other health problems such as diabetes, depression, and social problems.

“A lot of the kids are being bullied because of their weight,” Johnson says. “And they don’t want to take physical education courses—the very kinds of courses they need to lose weight—because they don’t want to be bullied or made fun of. They’re dealing with that, too.”

Curbing obesity rates, however, is notoriously difficult to do, especially in low-income communities like the one in which Johnson works. Kids are inclined to stay indoors—and sedentary—because they don’t live in safe neighborhoods; because many live with migrant parents who are working multiple jobs and are not home to cook healthy meals; and because nearby grocery and convenience stores do not offer healthy items.

“These kids walk to school and eat Doritos and Pepsi, and that’s their breakfast,” Johnson says. “After school, a lot of them go out for fast food. Near one of the middle schools in our community, there’s a Wendy’s, a McDonald’s, a White Castle, a Burger King, and Italian and Chinese restaurants—all within walking distance of the school. These places wait for school to get out to serve them those high-calorie fast foods.”

Solution: There’s no silver bullet to a problem as complex as the nation’s high rate of childhood obesity, so Johnson is tackling the problem one step at a time. For her doctoral research, she’s exploring how neighborhood safety, the family, and acculturation—the process by which the patient or patient’s family has assimilated into American culture—affect the weights of adolescent Latinas.

For the study, Johnson will ask girls between the ages of 14 and 18 to fill out surveys about crime in their neighborhoods and whether it deters them from taking part in outdoor exercise. She will also ask about family relationships and about assimilation into the U.S. culture. And she will gauge the respondents’ allostatic loads—a person’s physiological response to stress—by measuring waist circumference, blood pressure, height, and weight.

The results aren’t in yet, but she hypothesizes that unsafe neighborhoods, family relationships, and acculturation into American society are linked to higher rates of stress and, consequently, obesity among teenage Hispanic girls. Johnson hopes her dissertation will form the basis of a research portfolio in adolescent health. She plans to develop the portfolio as a professor of nursing in New Jersey after she graduates this spring.

In addition to being a full-time student, Johnson is also maintaining her clinical practice as a nurse practitioner, and is the main caregiver for her 8-year-old son—so her life is more than full. Of her very busy life, she says: “I want to show my son that whatever he chooses to do, it can be done.”

Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.
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Catching Up With the CLC

New Jersey Nursing Scholars, alumni and supporters have enjoyed two Collaborative Learning Community (CLC) events already in 2013, with a third coming up later this month.

The CLC meeting on Feb. 8, 2013, at the Robert Wood Johnson Foundation focused on interprofessional education, practice and research, with a roster of guests that included three speakers from Johns Hopkins University—Elizabeth (Ibby) Tanner, PhD, RN, FNGNA; Laura Hanyok, MD; and Kathleen Becker DNP, ANP-BC—and Matthew McHugh, PhD, JD, MPH, RN, CRPN, from the University of Pennsylvania.

“We made a big effort to capture what’s going on in the moment,” said CLC Facilitator Diane Billings, EdD, RN, FAAN, “and because of the topic, we opened up the meeting to a broader segment of the academic and nursing communities. The scholars are in academic settings, but we thought the topic had merit for the practice side, too, and they contributed some great thoughts and ideas.”

On March 8, 2013, a CLC webinar focused on presenting yourself professionally, a topic that’s particularly relevant to doctoral scholars, Billings said. “The way you dress, giving an elevator speech, the way your business cards, biography and CV look—these are all elements that should create a strong image of success and confidence. The scholars are ready to hear this, and it’s something we have to keep front and center.”

The next CLC meeting will take place on April 12, 2013, at the Robert Wood Johnson Foundation, with a leadership development theme. The keynote speaker will be Joanne Disch, PhD, RN, FAAN, clinical professor at the University of Minnesota School of Nursing and president of the American Academy of Nursing.

“Joanne is a leader’s leader, so it will be fantastic to have her with us,” said Billings. “Leadership is such a big push in nursing now—cultivating more leaders, having better transition planning—and it’s a particularly big push in New Jersey. Leadership development is an underlying theme of the CLC.”

Immediately following the CLC meeting, there will be a special event to celebrate the New Jersey Nursing Scholars in Cohort 1 who are completing PhD programs this spring.
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Did You Know…?

The New Jersey Nursing Initiative (NJNI) last month announced that Susan Bakewell-Sachs, PhD, RN, PNP-BC, who has served as program director since NJNI launched four years ago, is stepping down in June. Bakewell-Sachs, who also until recently was interim provost of The College of New Jersey, has accepted an appointment as dean of the School of Nursing and vice president for nursing affairs at Oregon Health & Science University in Portland.
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