promoting the fields of nursing and nurse education through simulation 2010 nao conference, las...
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PROMOTING THE FIELDS OF NURSING AND NURSE EDUCATION THROUGH SIMULATION
2010 NAO Conference, Las VegasAmy Nelson, AHEC of Southwest Oregon
Nursing Shortage Nationwide Over 2.5 million RNs working as nurses in
2004 (of 3 million registered) ¹ Projected need of more than 3.2 million
RNs in 2018 2 Nearly 0.5 million replacement RNs needed
3
RN population is aging; % older than 50 years1: 25 percent in 1980 33 percent in 2000 45 percent in 2008
Nursing Shortage Nationwide
0
100
200
300
400
500
600
Less than 25
25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65 and over
Age Groups
Chart 7. Age distribution of the registered nurse population, 1980-2008*
1980
1988
1996
2004
2008
* The total numbers of nurses in each survey, across age groups may not equal the estimated total of all RNs due to incomplete information provided by respondents and the effect of rounding. Only those who provided age information are included in the calculations used for this chart.
Thousands
Source: HRSA National Sample Survey of Registered Nurses 2008
Initial Findings
Nursing Shortage in Oregon
Current nursing workforce estimates5: Number of licensed nurses: 37,170 Number working as nurses: 33,773
Aging population (patient & workforce) Estimated number of nurses needed in
2018: 37,427 5 Number of job openings projected
annually due to growth & replacement: 1200 5
Nursing Shortage in Oregon
Source: Oregon State Board of Nursing; Oregon Center for Nursing. (2010). A Brief Review of Nursing Workforce Research from The Oregon Center for Nursing. Portland, Oregon: Oregon Center for Nursing.
Nursing Shortage in Oregon
OCNE (Oregon Consortium for Nursing Education) efforts to increase enrollment in statewide programs since 2002 successful
Four to five qualified applicants for every available slot in a nursing program 4
Limited number of qualified faculty is key contributor 4
6.8 Student-to-faculty ratio in 2008 vs. 3.6 in 2001
Half of nursing faculty predicted to retire by 2025
Expanding & Promoting
Simulation in Nursing Education
Expanding Nursing Education Oregon Nursing Leadership Council strategic
plan (2001) identified developing and using clinical simulation as a strategy to increase clinical opportunities and meet OCNE goals. 5
Governor Kulongoski’s Healthcare Workforce Initiative (2003) recognized simulation as key to increasing healthcare workforce training capacity by developing additional clinical training “slots” using simulation. 5
Oregon Simulation Alliance was formed to develop a plan to create statewide network of simulation centers 5
Promoting Nurse Education
Nursing students experience the difference between teaching in a clinical setting at the patient bedside and teaching in an academic setting in a controlled scenario
Studies indicate that encouragement from faculty and/or advisors is an important influence in choosing a career as a nurse educator 7
Promoting Nursing
High school students experience patient care from a nursing perspective in a realistic scenario
Simulation enables high school students to: Realize what nurses actually do Dispel myths they may have
about the profession Determine if this career is of
interest to them
Promoting Nursing
“The most effective strategy for ensuring youth are exposed to health careers and have the opportunity to prepare adequately is to provide intensive work-based learning and career exposure combined with academic preparation during middle and high school…". 8
The Pilot Program: 2009
Partners
OHSU (Oregon Health Sciences University) School of Nursing (Ashland Campus) Nursing students & faculty, simulation lab &
equipment, scenario development Grants Pass High School, Health Services
Instructor (Advanced Medical Skills Class) I.V. arms & materials, students, classroom &
class time AHEC of Southwest Oregon
Impetus, communication facilitation, transportation to sim lab, release forms, thank you gifts
Goals
Create an opportunity for high school students to participate in activities in the simulation lab
Provide nursing students an opportunity to enhance their own skills by teaching younger students
Allow high school students to explore the field of nursing through a hands-on simulation
Allow nursing students to experience the difference between clinical and academic instruction
Day 1: Skill Instruction
8 OHSU nursing students visited the Advanced Medical Skills Class to teach I.V. insertion
Day 2: Skill Testing
4 of the nursing students returned to the classroom to test students in proficiency and speed of skill completion
Day 3: Skill Implementation
Top 9 high school students chosen to participate in scenario at OHSU simulation lab
7 nursing students mentored high school students in nursing roles during scenario 3 high school students
per group according to nurse role
1-2 nursing student(s) assigned to each group
Prepping a patient for surgery
Simulation Activity
Scenario Preparation
Each student group met with a nurse mentor to review responsibilities/ skills of scenario role
I.V. Nurse
Start I.V. in patient, hang fluids and/or meds according to orders in chart
I.V. Nurse
Chart Nurse
Chart Nurse
Bedside Nurse
Patient history and assessment (vitals, lung & bowel sounds)
Bedside Nurse
The Patients
Scenario 1: 36 year old female being prepped for hysterectomy
Scenario 2: 70 year old female being prepped for lung biopsy
Scenario 3: 80 year old female being prepped for hip fracture repair
Scenario Execution
Students not involved in the scenario watched in the viewing room; nursing student facilitated
Scenario Debrief
All students participated in debriefing session after each scenario
Lessons Learned
High school students learned skills quickly, provided positive response, “one of the most fun class activities”
Patient scenarios worked well, keep same scenarios and add depth of information with successive patients
Need to recruit nursing students earlier in term; provide open lab to allow nursing students to practice skill instruction
Create skill checklist for testing day so expectations are clear to both high school and nursing students
Oregon Content Standards (CTE) Participating high school students will learn
how to insert an IV into a simulation arm. Aligns with Oregon Career and Technical Education
Skill Sets for Health Sciences: HSD10.01.02 Demonstrate competency in basic patient care skills.
Participating high school students will learn nursing skills essential to the preparation of a patient for surgery by working one-on-one with OHSU Nursing Students in a given scenario in the Sim Lab. Aligns with Oregon Career and Technical Education
Skill Sets for Health Sciences: HSD10.01 Apply technical skills appropriate to a health care career.
Repeat Program 2010
Repeat Format
Day 1: I.V. Skill Instruction Day 2: I.V. Skill Testing Day 3: Skill Implementation
(Simulation) Additions/ changes:
Scenario Preparation “Teams” Pre-Surgical Checklist
Patient Notes Medical Student
Calling the Doctor Career Intention Survey
Scenario Preparation
High school students divided into “nursing teams” that would work together to care for one patient
Each team met with a nurse mentor to review and assign scenario roles & responsibilities
Pre-Surgical Checklist
Patient Notes
Patient Notes
Medical Student Involvement
Calling the Doctor
Career Intention Survey
Purpose to see if experience changed: Nursing student thoughts regarding a career in
nursing education (N=1; no post survey given) High school student attitudes regarding career
in nursing (pre N =21; post N = 18) Results:
Top reasons for interest in nursing: desire to help people, interest in working with people
Top reasons for disinterest in nursing: unpleasant work, no desire to wait on people
No measurable change in attitudes towards nursing as career
Conclusion: Provide nursing career information to ALL students and/or survey students involved in simulation specifically
Lessons Learned
Allow high school students at least 1-2 days between I.V. instruction and testing for skill practice
Purchase or obtain donation of additional retractable I.V. catheters for classroom instruction
Prepare nursing students for instruction/ practice of skill in any conditions “Old School” technique May not always have all equipment; have to
improvise
Student Feedback
"I had the time of my life! This experience definitely showed me I have what it takes to become a nurse. And without this program, I probably wouldn’t have known.” -D”Arcy
"This experience has set in stone my decision to be a part of the health care system. I know there is nothing else I would rather do with my life.” -Alex
“I had the most amazing experience ever! It was a blast and now I am positive of entering a health career related occupation.” -Allison
“Working in the simulation lab is an awesome experience, and it really influenced me to want to be in the medical field (more than I used to be).” -Melissa
Future Programs
Goal to establish dates for Grants Pass High School program
Improve experience for nursing and high school students - make more relevant to education/ career pursuits
Hope to duplicate for other area high schools: Single day (Saturday) One representative each from nine
remaining Rogue Valley high schools
References
1. U.S. Department of Health and Human Services, Health Resources and Services Administration. (2010) The Registered Nurse Population: Initial Findings from the 2008 National Sample Survey of Registered Nurses. Retrieved April 6, 2010 from: http://bhpr.hrsa.gov/healthworkforce/rnsurvey/initialfindings2008.pdf.
2. U.S. Department of Labor, Bureau of Labor Statistics. (December 17, 2009) Occupational Outlook Handbook, 2010-11 Edition, Registered Nurse. Retrieved April 19, 2010 from: http://www.bls.gov/oco/ocos083.htm#outlook.
3. U.S. Department of Labor, Bureau of Labor Statistics. (December 17, 2009) Employment Projections, Replacement Needs. Retrieved April 19, 2010 from: http://www.bls.gov/emp/ep_table_110.htm.
References
4. Oregon Center for Nursing. (2009) Oregon’s Nurse Faculty Workforce: A Report from the Oregon Center for Nursing. Retrieved October 23, 2009 from: http://www.oregoncenterfornursing.org/documents/OCN%20Nurse%20Faculty%20Workforce%20Report%202009.pdf.
5. Oregon Simulation Alliance. (2006-2008) About OSA, Background to the Oregon Simulation Alliance Initiative. Retrieved April 6, 2010 from: http://www.oregonsimulation.com/content/about-osa.
6. Oregon Labor Market Information System (OLMIS). Occupational Information Center, Occupational Report for Registered Nurses, Statewide. Retrieved April 6, 2010 from: http://www.qualityinfo.org/olmisj/OIC?areacode=4101000000&rpttype=full&action=report&occ=291111&go=Continue.
References
7. The North Carolina Center for Nursing. (2008) Influencing Factors in the Choice of a Nursing Education Career. Retrieved April 8, 2010 from: http://digital.ncdcr.gov/cdm4/document.php?CISOROOT=/p249901coll22&CISOPTR=21328&REC=17.
8. Washington State Workforce Training and Education Coordinating Board. (April 19, 2010) Progress 2004: A Report of the Health Care Personnel Shortage Task Force. Retrieved October 23, 2009 from: http://www.wtb.wa.gov/Pubs/2004_Pubs_hcrpt05.pdf.
9. Center for Rural Health, University of North Dakota School of Medicine and Health Sciences. (2008 - 2010) North Dakota Nursing Needs: High School Student Survey. Retrieved February 11, 2010 from: http://ruralhealth.und.edu/projects/nursing/pdf/highschoolstudent_survey.pdf.
