VA Nursing Academy: Building Bridges to Care for Veterans Birmingham VA Medical Center and UAB School of Nursing

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VA Nursing Academy Building Bridges to Care
for Veterans Birmingham VA Medical Center and
UAB School of Nursing 
Doreen C. Harper, PhD, RN, FAAN Dean and
Professor UAB School of Nursing
Greg Eagerton, DNP, RN, NEA-BC Chief Nursing
Officer Birmingham VA Medical Center
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Goals of VA Nursing Academy2009-2012

• Expand faculty and professional development
• Increase nursing student enrollment
• Provide opportunities for educational and
  practice innovations
• Increase recruitment and retention of VA nurses
  as a result of enhanced roles in nursing education

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Building Bridges to Care for Veterans

• Describe a framework for the UABSON/BVAMC VA
  Nursing Academy academic/service partnership
• Analyze VANA goals, strategies, measures and
  outcomes
• Analyze the lessons learned to date

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Framework for Partnership-Building

• Relationship-Building
• Engagement
• Governance/Policy
• Implementation
• Evaluation
• Sustainability

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Relationship before VANA

• Longstanding pre-existing relationship between
  UAB SON and Birmingham VA Medical Center
• Intermittent educational research activities
• Random clinical sites and preceptorships based on
  individual faculty/student needs
• Minimal joint strategic initiatives

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Relationship before VANA (cont)

• Recognition of need to expand relationship by CNO
  and Dean SON
• Strengthened and further developed partnership
  between 2006 and 2009
• UAB SON Strategic Plan
• VA Nursing Leadership on UAB SON Advisory
  Committees
• Clinical Adjunct Faculty from VA
• Expansion of clinical sites
• Faculty Practice site developed

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VA Nursing Academy Relationship-Building2009 and
Beyond

• Strategic Planning
• UAB SON and Birmingham VAMC
• SWOT Analysis
• Preparation towards writing VA Nursing Academy
  proposal
• Organizational linkages between faculty and
  executive nursing leadership

• Leadership
• Organizational Resource Allocation and Incentives
• Coalition-building across partnership
• Participatory governance and commitment to
  partnership through shared vision
• Culture/Value Influence

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VA Nursing Academy Relationship-Building

• What
• Provides leadership related to structure,
  processes and outcomes
• Meets monthly
• Directs and manages all aspects of the program
  for students, faculty and VA nursing and
  professional staff
• Meet regularly and PRN
• Assigned to specific functions and initiatives
  associated with VANA program outcomes
• Meets quarterly to monitor and track clinical
  outcomes for the project
• Provides oversight and guidance on strategic
  initiatives associated with Quality and Safety ,
  UAB and VA initiatives relative to VANA
• Meets annually

• WHO
• Executive Council
• Dean, CNO, Two Program Directors
• Program Directors
• Birmingham VAMC and UAB SON
• Birmingham VA Faculty/Executive Leadership and
  UAB SON faculty
• nine UABSON faculty, five VA nursing faculty and
  five nurse executives
• Advisory Council
• Physicians (UAB SOM), VA Quality Scholars faculty
  (Medicine and Nursing), UAB SON Program
  Coordinators

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VANA Engagement

• Getting to know you
• Commitment phase
• Cannot underestimate
• Revisit project goals and outcomes at every level
  regularly for CQI
• Anticipate setbacks and work through
  issues/problems

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VANA Engagement

• Project planning
• Link project participants including faculty,
  staff, students around critical events
• Celebrate early/interim outcomes
• Orient both cultures to project mission/goals,
  structure, process and outcomes

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VANA Engagement

• Synergies
• VA Quality Scholars Program
• Interdisciplinary health professions education
  options
• Endowed Scholarship through UAB SON Board of
  Visitors
• Clinical Nurse Leader (CNL) HRSA Grant

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Governance/Policy

• Structure
• Executive Committee
• Program Directors
• University Governance/ Policies
• Birmingham VAMC Governance/ Policies
• Joint Faculty/Staff Committee
• Infrastructure Support
• Secretarial, VA and University HR, presentations
  and publications

• Process
• Participatory Governance
• Mission-based
• Blending Cultures of education/service
• Sensitivity and understanding
• Mutual Respect
• Team Development
• Project Performance Expectations
• Meeting Schedule

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Governance

• Leadership
• Attends to the needs of partnership members
• Provides structural mechanisms and resources for
  partners to accomplish mission
• Keeps goals visible while communicating progress
  and activities

• Tools
• VANA Project Management Plan and Worksheet
• Conference Call Participation
• Executive Committee meetings and Planning

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Project Implementation and Evaluation

• Project Outcomes
• Educational/Program Goals
• Clinical Outcome Goals

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Clinical Goal 1 Strategies Measurements
Enhanced skill level of BVAMC nurses through the use of veteran-centered simulation for competency testing Identify VA clinical competencies and link them to veteran-centered clinical scenarios Develop and refine VA centered scenarios that incorporate psychological and cultural aspects and link to simulation and competency testing Develop clinical competencies for RNs incorporating critical thinking skills Train VA based VANA faculty in the UAB SON Simulation Lab Clinical competency assessment Enhanced level of practice as measured by annual proficiency evaluation Decrease number of knowledge deficits related to incident reports
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Clinical Goal 2 Strategies Measurements
Greater nurse satisfaction with orientation and competency testing at BVAMC through the use of veteran-centered simulation Orient VA Nurse Managers and Staff Development Nurses to the use of the UAB SON simulation lab Identify appropriate competencies to be completed at simulation lab Review orientation process and content Utilize scenario based simulation (critical thinking skills) Pre and Post test evaluations to determine effectiveness Satisfaction survey related to orientation and competency testing
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Clinical Goal 3 Strategies Measurements
Develop, implement, and evaluate evidence based protocols Develop education modules to teach evidence based practice concepts (theory and application) Establish a BVAMC EBP/Research Council and membership structure Identify, develop, implement, and evaluate appropriate clinical protocols EBP educational modules developed Number of BVAMC nursing staff educated on EBP Establishment of BVAMC EBP/Research Council Number EBP protocols developed, implemented, and evaluated
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Clinical Goal 4 Strategies Measurements
Enhancement of nursing Quality Improvement initiatives Conduct quality improvement projects in partnership with staff nurses Identify potential DNP and CNL projects Establish a BVAMC Quality Improvement Council Collaborate with the VA Quality Scholars Program Number of quality improvement projects implemented and documented outcomes Establishment of a BVAMC Quality Improvement Council Collaborative initiatives with VA Quality Scholars
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Clinical Goal 5 Strategies Measurements
Publication of professional peer reviewed articles Include staff at all levels of both organizations in opportunities to write and publish articles Develop writing teams that are inclusive of UAB SON faculty and BVAMC Staff Submit poster presentations at professional organization meetings and conferences Number of published professional peer reviewed articles Number of posters presented at professional organization meetings and conferences Document names and positions of all authors of publications and posters
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Clinical Goal 6 Strategies Measurements
Recruitment of nurses with an understanding of the BVAMC Hire VA Nurse Scholars as Student Nurse Technicians (SNTs) Recruit from armed services and reserve units as VA Scholars Coordinate with faculty who have military commitment and/or retirees Number of VA Nurse Scholars hired as SNTs Number of VA Nurse Scholars hired as RNs Number of new students from military services/reserves
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Program Goal 1 Strategies Measurements
Increase student enrollment Recruit UAB SON BSN students to become VA Nurse Scholars through -New student orientation - Letters in student packets - Visibility of VANA at UAB SON Increase BSN enrollment from baseline enrollment of 110 each term
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Program Goal 2 Strategies Measurements
Positive ratings from students, faculty, and partnership members Students -Mentorship with VA based and SON based faculty and program directors -Meet and Greet Luncheon at first of semester -End of Term Luncheon VA and SON Based Faculty -Mentorship established from each organization and by each program director -At least one joint faculty meeting per semester Partnership Members -Meeting to establish program goals -Quarterly progress meetings IDEA student evaluations Feedback from VANA faculty Partnership meeting participation
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Educational Goal 1 Strategies Measurements
VA Based Faculty competent in teaching BSN Students to provide veteran-centered care including classroom, clinical practice, and distance technology learning needs Faculty Development Intensive developed to expedite learning Mentoring established through SON faculty and VA and SON program directors Curriculum developed to address classroom, clinical practice, and distance technology learning needs IDEA Student evaluations of faculty Teaching effectiveness evaluations Peer evaluations Course manager evaluations
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Educational Goal 2 Strategies Measurements
VA Nurse Scholar students competent in providing veteran-centered care Development of clinical experiences specific to veteran healthcare issues Development of elective credit course specific to veterans healthcare Specific classroom and clinical training utilizing CPRS, BCMA, VA specific documents Development of veteran specific simulations Evaluation of VA Nurse Scholars performance each semester
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Program Outcomes

• Educational Program Outcomes
• 33 students enrolled as VA Scholars including
  27 generic BSN and 6 RN to BSN
• 20 faculty and VA professional staff engaged in
  partnership activities
• New Elective course developed for all students
  entitled Care of Americas Heros (need web
  page)
• 3 Clinical Simulation scenarios for veterans
  developed
• VA CPRS added to clinical simulation lab for
  students

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Program Outcomes (cont)

• Educational Program Outcomes
• Publications and presentations
• VA Quality Scholar outcomes
• Educational products

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Program Outcomes

• Clinical Program Outcomes
• BVAMC nurses use of veteran-centered simulation
  for competency testing
• VA centered scenarios that incorporate
  psychological and cultural aspects and link to
  simulation and competency testing
• VA Nurse Scholars hired as SNTs
• Education modules to teach evidence based
  practice concepts (theory and application)
• BVAMC EBP/Research Council and membership
  structure established

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Sustainability

• Continue to seek funding/contract options
• Philanthropic Endowed Scholarship
• Develop Collateral funded projects
• HRSA
• RWJF
• VA research
• Other initiatives

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Lessons Learned To Date

• Collaborative leadership from chief officers is
  crucial
• Keep focused on mission and goals
• Continual partnership evaluation and reflection
  conduct perception checks with partners
• Be prepared for conflict and negotiation
• Need to embed faculty and VA staff at every level

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• Thank You and Questions?