The Case for Nurse Education Programs
at Cooley Dickinson Hospital
An Urgent Need: A Timely Solution
“When we heard what the hospital is planning for nurses in this fundraising campaign, we got so excited,” says Cathy Neumann, administrative director for the Emergency Department. Cathy, a seasoned nurse, has served Cooley Dickinson Hospital for more than 40 years. She and many of our most experienced, highly-skilled nurses share a common concern: “Over the next several years, a lot of veteran nurses will be retiring. How will our patients continue to receive the high-level of quality care they need and deserve?”
Between 2010 and 2015, more than 30 percent of Cooley Dickinson’s most experienced nurses will be retiring. Many of these nurses work in specialty areas that require high-level nursing skills or in leadership positions. While hospitals across the nation are facing a similar loss of knowledge and experience, Cooley Dickinson is taking the lead in addressing this situation head on.
As we aspire to be a model community hospital, Cooley Dickinson must invest in its nurses. Nurses are the frontline caregivers at all hospitals, providing direct inpatient care. Their experience, knowledge, and job satisfaction directly impact patient outcomes and satisfaction. To ensure that our patients receive the highest-quality care possible, even as veteran nurses retire, we are establishing the following nurse education programs:
Clinical Track: Clinical Care Residency Programs
• Critical Care Track
• Childbirth Center Track
• Accountable Care and Care Transitions Training
Leadership Track: Nurse Leadership Programs
• Leadership Development Institute
• Leadership Residency
• Executive Leadership Training
The overall investment for these nurse education programs is $3.4 million, of which our current fundraising goal is $1 million.
A Closer Look at a Rapidly Developing Need
Cooley Dickinson needs to invest in nurse education now. To fully understand why, it’s helpful to look at the numbers:
• 96 percent of nurses at CDH generally retire at age 65.
• Between 2010-2015, 30 percent of our nurses are expected to retire.
• Between 2010-2020, 53 pecent of our nurses will retire.
Cooley Dickinson has a long history of commitment to nurses. The Cooley Dickinson School of Nursing operated on our campus for nearly 75 years (1901-1975). In more recent decades, CDH has established work development programs designed to create job opportunities for nursing graduates. CDH currently has recruitment agreements with the UMass School of Nursing, Elms College, Holyoke Community College, and Greenfield Community College.
But the need for nurses cannot simply be addressed by getting more new nurses into the pipeline. Currently, hospitals are dealing with a knowledge shortage; what they need are highly skilled, highly knowledgeable, experienced nurses.
Through our Clinical Care Residency Programs, we will train and retain mid-career nurses whose skill levels match those of our retiring veteran nurses. Through our Nurse Leadership Programs, we will cultivate future nurse leaders, who have the training, knowledge, and experience to manage the next generation of nurses.
The Case for the Clinical Care Residency Programs
At CDH, nurses typically start working on a medical/surgical unit. As their careers progress, they move to specialty areas which require a higher level skill set, such as Intensive Care, or the Childbirth Center. Each of these areas at CDH will be losing large numbers of experienced nurses in the next decade:
Intensive Care Unit – 45 percent expected turnover
Childbirth Center – 59 percent expected turnover
The Nurse Residency Programs build upon existing CDH strengths. Younger, mid-career nurses will have the opportunity to learn from experienced, veteran CDH nurses. Veteran nurses will have the opportunity to share their experience with younger, less skilled nurses thus ensuring that their wellspring of knowledge doesn’t retire when they do.
These programs also build upon CDH’s track record of strong retention among our registered nurses working in specialty areas. Once a nurse has developed the skills to work in these areas, she or he tends to stay. In the Intensive Care Unit (ICU), average length of service is 10 years. And in the Childbirth Center, it’s 14 years .
By investing in the continuing education of our mid-career RNs, we will be addressing CDH’s acute need to retain nurses with high-level skills. Because these nurses have already demonstrated loyalty and commitment to CDH, we can expect a high level of security in our investment. We will also be increasing employee satisfaction as our nurses have requested a more structured career ladder.
Patients, of course, will be the ultimate beneficiaries of these residencies, as they receive high-level care from an increasingly stable nursing force.
In specialty areas, nurses usually must undergo up to a full-year (12 months) of orientation and training before they are allowed to practice independently. The Clinical Care Residency Program will provide the requisite training. There will be two residency tracks – Critical Care and Childbirth.
Critical Care Track
This residency program, our first priority, will provide a 6 - 12 month period of clinical instruction and experience in various Critical Care settings that may include: 1) the Intensive Care Unit (ICU), 2) the Post Anesthesia Care Unit (PACU), 3) Endoscopy, 4) Telemetry, and 5) the Emergency Department (ED).
Critical Care nurses practice in settings where patients require complex assessment, high intensity therapies, interventions, and continuous nursing vigilance. They rely upon a specialized body of knowledge, skills, and experience to provide patients, as well as their families, with the highest level of care.
Nurse residents will cover an intensive curriculum led by a clinical nurse specialist and will also learn from veteran nurses, who will share their knowledge and expertise. They will be cross-trained in different Critical Care settings, which will lead to improved communication and coordination of care throughout the hospital.
During the program, residents will receive a staff nurse salary and full-time benefits. Upon successful completion of the program, residents will be prepared for a staff nurse position in one of the five Critical Care areas.
Childbirth Center Track
This clinical track will be structured much like the Critical Care track, but will train RNs in specialized childbirth nursing skills. During this 12-month program, residents will cover an intensive curriculum led by a clinical nurse specialist and they’ll also learn from veteran nurses.
During the 6 - 12 months that a nurse undertakes either of these residency programs, the areas in which she/he is working will have additional staff correlating to the number of residents in training. Funding need arises to cover the salary of each resident nurse.
For the Critical Care track, CDH is seeking funding for 17 Full Time Employees (FTEs) in the next 5 years. Over a ten-year period, we anticipate an additional 19 FTEs. For the Childbirth Center track, we hope to fund 4 FTEs over the next 5 years, roughly one per year.
The funding need for the Clinical Residency Program is $2,627,000.
The Case for the Nurse Leadership Programs
Research shows that strong nurse leaders have a tremendously positive impact on the recruitment and retention of nurses. Studies have shown that 30 percent of the variation in employee satisfaction can be attributed to his/her leader’s actions. Furthermore, strong nurse leaders have an overwhelmingly positive effect on quality of care, patient outcomes, and patient satisfaction.
Nationwide, there are simply not enough qualified individuals to fill important nurse leadership positions. Typically, hospitals require about 18 months to recruit a nurse leader. The duration of our leadership programs ranges from 6 - 12 months. We will be drawing on the many talents of our existing nursing staff to cultivate leadership within our organization, a strategic move which can strengthen employee morale and boost employee satisfaction.
Three different leadership programs address a range of different needs:
The Leadership Development Institute
A principal purpose of the Leadership Development Institute is to train current and future nurse leaders at CDH. Just as we train our staff in best clinical practices, we are training nurse leaders in best leadership practices, incorporating the latest knowledge in social intelligence, relationship building, and listening and communication skills.
Thanks to early campaign gifts, Phase I of the Leadership Development Institute, which focused on the training of existing nurse leaders throughout the hospital, has already been completed. During Phase I, Cooley Dickinson partnered with daVinci Consulting, which has a national reputation for helping hospitals maximize outcomes, including patient and staff satisfaction, clinical outcomes, nurse retention, and financial results.
With the active support of the Chief Nursing Officer and the daVinci coaches, talented nurse leaders at CDH – identified for their leadership ability and commitment to the hospital – learned the latest, critical leadership competencies. DaVinci worked closely with CDH to define the coaching areas that are most applicable at CDH, while creating an internal structure for sustainability. The nurse leaders enrolled in this program have enthusiastically embraced the chance to grow in knowledge, have greater decision-making ability, and pursue advancement opportunities.
One participant, Lynne Schmittlein, RN, MSN, the Administrative Director of Inpatient Care, says, “I absolutely loved the program. One of the most valuable strategies I learned is the ‘art of appreciative inquiry.’ A leader who uses this strategy asks a series of carefully worded questions in such a way that listeners are coached to explore their own thoughts and ideas, allowing them to reach solutions on their own. This and other strategies I learned during Leadership Training will help me realize what I most want to achieve as a leader – to ensure that everyone who reports to me feels cared for, supported, respected, and understood.”
Phase II of the Leadership Development Institute (beginning February 2012) will focus on the emerging nurse leaders poised to replace current nurse leaders who will be retiring. The selected candidates for Phase II include current CDH nurses as well as newly hired employees.
Sustainability of the Leadership Development Institute at CDH
The training of nurse leaders is part of a larger leadership development effort at CDH. Over a period of three years, the hospital is looking to train 100 managers, 30 of whom are registered nurses (RNs).
The Leadership Development Institute has been designed to be self-sustaining. We are already functioning without the assistance of daVinci, the outside consulting group. Cooley Dickinson’s Talent Management Coordinator shadowed daVinci during Phase I and received one-on-one mentoring on the fundamentals of the program. During the next two years, we will continue to phase in learning structures and peer coaching processes into standard management and human resources practices that become an integral part of every leader/manager’s daily work.
We are confident that the Institute’s success will lead to more satisfied patients, better patient outcomes, greater job satisfaction for nurses, improved nurse retention rates, and a stronger Cooley Dickinson Hospital. Furthermore, we expect the Leadership Development Institute will prove to be a model for other hospitals.
The funding need for the Leadership Development Institute is $250,000.
Nurse Leadership Residency Program
Nurse leaders and supervisors rely upon a specialized body of knowledge, skills, and experience to provide care to staff, patients and families and create environments that are healing, humane, supportive, and caring.
The Leadership Residency Program will support 2 - 4 full-time RNs (approximately two FTEs) in a 6 - 12 month immersion program designed to prepare a generalist practitioner with specialized skills in lateral integration of care and interdisciplinary collaboration. The nurse leader role focuses on developing enhanced clinical skills for management of patient care and the care environment.
This Residency program will provide clinical experience and instruction in various leadership settings, including full immersion in the Nurse Supervisor role. Upon completion of the competencies for Nurse Supervision and demonstration of independent practice, the Leadership Resident will support the supervisor team as needed and will continue leadership growth and development by participating in the Cooley Dickinson Leadership Development Institute educational series. The Leadership Resident will also be invited to spend time with the Director of Inpatient Care and with other clinical leaders, may be asked to work on special projects and initiatives, and will be provided with ongoing mentoring and support.
During the program, these leaders-in-training will receive a Nursing Supervisor’s salary with full-time benefits. Upon successful completion of the Leadership Residency program, the resident will be able to select a leadership position in one of the hospital areas, with the placement and shift based upon the staffing needs of the hospital.
The funding need for the Nurse Leadership Residency Program is $193,000.
Executive Leadership Training
Cooley Dickinson has identified five key nursing positions – all at the director level – whose high-level responsibilities call out for high-level executive training that will maximize their capacity to serve the hospital and our community. Nurse leaders in the following five positions report directly to the Chief Nursing Officer (CNO) and are the major nurse interface to the entire nursing staff and clinical operations of the hospital.
• Director, Inpatient Nursing
• Director, Inpatient Psychiatry
• Director, Perioperative Services
• Director, Childbirth Center
• Director, Emergency Department
Executive Leadership Training will take the form of a year-long professional development fellowship with a national organization designed to provide in-depth clinical leadership learning. Fellows will engage in a variety of learning modalities:
• Fellowship retreats – four face-to-face sessions during the course of the year at various locations
• Experiential learning – application of classroom learning in the workplace
• Virtual learning communities – year-round electronic communication with each other and expert faculty
The funding need for the Executive Leadership Training is $80,000.
Creating a Patient-Centered Health System: Training All of our Nurses for the Emerging World of Accountable Care and Care Transitions
The healthcare world is changing. As part of national health care reform, a new model of patient care and payment – the Accountable Care Organization (ACO) – is emerging that will be increasingly patient-focused and community-based. In this model, all health providers within a community – hospitals, physician practices, clinics, and home care agencies – will work together to coordinate the care of the population that comprises their community. Prevention and keeping people healthy will be the main focus for ACOs striving to improve healthcare quality and contain cost.
The expected outcomes for Accountable Care Organizations will be:
• a healthier community,
• improved quality of life and care experiences for patients and caregivers,
• greater access to health resources for everyone, and
• lower overall costs of providing care.
In our community, the care providers accountable for the health of our population are the following: Cooley Dickinson Hospital, the Cooley Dickinson Physician Hospital Organization (CDPHO), area physicians and specialists, the VNA & Hospice of Cooley Dickinson, and the Care/Cross Continuum members, which include area skilled nursing facilities and home care agencies.
Working together, all of our organizations must create an overall patient navigation system that best utilizes our collective resources. Case management is a key component of any new navigation system. Patient care plans will be organized around the needs of the patient, rather than be dictated by the way the different care practices are organized. The health and well being of the community are at the heart of this new approach to patient care.
No funding exists for making the transition from the old model to the new model of Accountable Care. Across the nation, providers must solve this issue on their own. Cooley Dickinson is developing a Care Transitions program that will position us to be a leader in Accountable Care.
Cooley Dickinson prides itself in already practicing many of the hallmark practices of an Accountable Care Organization. And our organization continues to evolve in this direction. One of our next steps is to train and immerse all our employees – especially nurses, our frontline caregivers – in this emerging model of disease management which incorporates new tools for patient self care.
The funding need for the Accountable Care and Care Transitions Training of all Nurses is $250,000.
Clinical Care Residency Program $ 2,627,000
Leadership Development Institute $ 250,000
Nurse Leadership Residency Program $ 193,000
Executive Leadership Training $ 80,000
Accountable Care Training $ 250,000
Total need $ 3,400,000
Initial fundraising goal $ 1,000,000
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Be Part of the Right Solution Right Now
When the need arises, every one of us wants to receive the very best care. At Cooley Dickinson and hospitals everywhere, a well-trained nursing staff is absolutely critical to the delivery of outstanding care.
Given the imminent retirement of so many of our most experienced, highly-skilled nurses and nurse leaders, Cooley Dickinson is stepping up to the plate to institute education programs that address the loss of knowledge with a solution that builds strength upon strength.
Cooley Dickinson is an organization passionately committed to being a learning organization. As community member and campaign supporter Al Griggs put it: “Yes, the nurse education programs will produce more highly-skilled nurses and nurse leaders. But it will do even more. It will make them better listeners, better team players, better people on the job.”
When you support these nurse education programs, you are supporting the hospital’s commitment to high-quality, compassionate medical care for you, the people you love, and our community. Ultimately, you are supporting Cooley Dickinson’s mission to be a national model of community hospital excellence. You are building our future, right here, right now.
Thank you for all you have done and plan to do for Cooley Dickinson Hospital.