MONTANA STATE BOARD OF NURSING
CLINICAL NURSING EDUCATION IN HELENA
ASSESSMENT, ANALYSIS, AND GUIDELINES
Connie Vance, RN, EdD, FAAN
March 29, 2004
This report consists of an assessment, analysis, and recommended guidelines related to the current and future availability of clinical sites to support the clinical education of licensed practical nurses and registered nurses in Helena, MT. The two schools with nursing programs in Helena are: (1) the University of Montana-Helena College of Technology (UM-H) which has submitted a feasibility study to change its current Associate of Applied Science two-year practical nursing program to a one-year certificate program and to offer an Associate of Science RN program (ASRN); and (2) Carroll College (CC), a private Catholic college which offers a four-year baccalaureate RN program (BSRN). A difference of opinion exists between the two nursing programs as to clinical site capacity to support the increased number and change in the type of students in the proposed ASRN program at Helena College of Technology.
This phase entailed in-person meetings with educational, clinical, and state nursing organization leaders in Helena on February 26 and 27, 2004, and telephone meetings with the nursing leader in Warm Springs on March 1, 2004, and the vice president of the Montana Hospital Association on March 19, 2004. These participants are as follows:
· Susan Beausoleil, RN, Director, Nursing Services, Montana State Hospital, Warm Springs
· Dick Brown, Senior Vice President, Montana Hospital Association
· Jill Caldwell, RN, Nursing Practice Manager, Montana Board of Nursing
· Cynthia Gustafson, RN, Chair, Department of Nursing, Carroll College; Lynn Etchart, VP, Finance and Administration; nine faculty members and department secretary
· Sherri Marcoux-Maharg, RN, Administrator, and Aimee Shein, RN, Director of Nursing, Big Sky Care Center
· Colleen McCabe, RN, Director and Education Coordinator, Shodair Children’s Hospital
· Chandra L. Snyder, RN, Chief, Patient Care Services, and Ruby Riesland, RN,
· Education Coordinator, Department of Veterans Affairs, VA Montana Health Care System
· Lisa Strom, RN, Vice President, Patient Care Services, St. Peter’s Hospital
· Ellen Wirtz, RN, Nursing Program Chair, The University of Montana-Helena, College of Technology
Various documents were also reviewed, including: Feasibility Study and Addendum Report (University of Montana-Helena College of Technology, 2003); Education Committee minutes of MT State Board of Nursing (2003); Competing for Quality Care; Findings and Proposals for Montana’s Health Care Workforce (Governor’s Blue Ribbon Task Force on Health Care Workforce Shortage, 2002); Projections for Montana’s Industries and Occupations 2000-2010; Legislative Network for Nurses (Vol. 21, No. 4, February 23, 2004); Faculty Shortages in Baccalaureate and Graduate Nursing Programs: Scope of the Problem and Strategies for Expanding the Supply ( American Association of Colleges of Nursing, 2003);The Nursing Faculty Shortage: National League for Nursing Perspective (Valiga, 2002).
The written documents, meeting notes, and summaries were analyzed to establish trends, concerns, and any consensus related to nursing workforce needs and availability of clinical education of nursing students (PN, ASRN, and BSN) in Helena.
A. Demand and Projected Shortages of Nursing Personnel
From the documents and meetings, it is clear that the demand for professional nursing services in Montana (and nationally) is increasing. There are pockets of current shortages in the State, and the projected supply of qualified nurses will not meet the future needs of its citizens. Montana is a rural, frontier state with a growing population of elder citizens who present multiple, complex health needs. In addition, a significant brain drain of health care workers exacerbates the crisis between need/demand and supply. The Montana Board of Nursing has reported that the number of nurses leaving the state has grown from N=91 in 1995 to N=738 in 2000. The Governor’s Blue Ribbon Task Force on Health Care Workforce Shortage (2002) notes that 73% of Montana hospitals are using overtime to cover shortages; 41% of hospitals use “travel nurses,” and 45 %, “on call” nurses. Recruitment is now costing up to 70% of a nursing position’s annual cost.
The Governor’s Blue Ribbon Task Force (2002) projects an increase in demand of all levels of nurses (PN, RN, and advanced practice RNs) of 22-23% from 1996-2006 in Montana. Since registered nurses are responsible for the largest portion of the nation’s health care and constitute the largest health care profession, the nursing shortage has serious implications for all citizens, including those who live in Helena and the state of Montana. Nurses comprise 37% of Montana’s health care workforce.
According to Projections for Montana’s Industries and Occupations 2000-2010, an annual growth rate of 2.4% is projected for private health services in Montana from 2000-2010. This includes annual job growth in this period of 6.5% in home health care services; 5.5% in specialty outpatient clinics; 3.3% and 5.3%, respectively, in MD and osteopathic offices and clinics; 2.5% in nursing and personal care facilities; and 1.2% in private hospitals.
The Montana Hospital Association has conducted a recent survey (February 2004) of their member hospitals, nursing homes, home health and hospice organizations, with a response rate of N=125. Anecdotal data related to health personnel shortages, recruitment and retention, and availability of clinical education resources have been obtained and are in process of analysis. Preliminary data, according to Mr. Dick Brown, suggest there is a nursing shortage, that a mix of nursing levels (from PN to MSN) is desirable in the clinical setting, and that qualified people are needed to support and oversee clinical education.
The “graying” of the nursing profession (Only 9% of RNs are under the age of 30; the average age of the registered nurse is 46 and over 50 for nursing faculty), as well as the downturn in people entering or remaining in the profession, have created a volatile situation. Recruitment and retention of all levels of nurses will continue to challenge every sector of the health care industry in the foreseeable future. The brain drain of RNs from Montana is a particular phenomenon of concern.
One clinical leader pointed to the aging of the nursing staff and impending retirements in her facility that will create replacement demands. The representative from Shodair Children’s Hospital spoke about increased regulatory demands for RN oversight of children’s services. There was a consensus of the need for critical thinking and clinical decision-making skills possessed by the RN due to the increased acuity of patients in hospitals, nursing homes, and long-term care facilities.
All of the clinical representatives claimed that they could hire additional RNs. There are instances, particularly in the summer, of importing Filipino nurses, use of travel nurses, and overtime usage of nursing staffs. These solutions are expensive, negatively affect the quality of care, and have serious safety and ethical implications. There have been attempts to address RN shortfalls by training of unlicensed personnel for nursing functions, including medication administration and patient assessment. This practice raises questionable safety, regulatory, and ethical issues.
B. Educational Opportunities in Nursing
In Helena, there is currently one baccalaureate program for professional nursing
(privately supported) and one practical nursing program (state supported). No articulation program exits for practical nurses seeking either the associate or baccalaureate degree. There is no master’s degree program or post-baccalaureate or post-master’s certificate program(s) for nurses seeking advanced education in the profession.
The clinical leaders stated that there should be greater opportunities in the Helena geographic area for entry into professional nursing and for educational advancement. They cited many instances of people obtaining their nursing education (PN to RN entry and master’s and doctoral study) through the Excelsior Program (NY), the University of Phoenix (distance education), out of city or state programs (Rush University, Gonzaga University in Spokane, MSU Bozeman, MSU Northern, and Montana Tech of UM. There is a significant “exiting” of potential students who desire to be educated for nursing in Helena.
Men and women who wish to enter nursing, as well as practical and professional nurses in Helena who want to further their education, encounter many barriers. Entry options into the profession are limited, as well as flexible baccalaureate and advanced educational options (master’s and doctorate). Additional barriers include cost; lack of appropriate tuition support and scholarships; curriculum and time rigidity; and the absence of articulation options, post-baccalaureate and post-master’s certificate programs, and a master’s program. These barriers present both recruitment and retention challenges for nursing in Helena and Montana. Several leaders spoke of “excellent” PNs in their facilities who have the ability and interest to enter either an associate or baccalaureate program and to explore graduate study. They further believe that a critical leadership pool of clinicians, faculty, and managers/administrators could be developed through this educational path.
C. Site Capacity for Clinical Education of the Practical and Professional Nurse
The Chair of Nursing at the University of Montana-Helena College of Technology, Ms. Ellen Wirtz, has identified new or under-utilized clinical sites in metropolitan Helena and at distances of 30-80 miles. These include Broadwater Health Care Center (Townsend), State Developmental Center, MT State Hospital (Warm Springs), Mountainview Medical Center (White Sulphur Springs), the Masonic Home (Helena), Rocky Mountain Care Center (Helena), Intrepid Home Care Agency/Hospice (with St. Peter’s Hospital), Sheridan Hospital, Evergreen of Clancy, several assisted living facilities in Helena (2 large and 5 small), Head Start, Planned Parenthood, Florence Crittendon Home, Leo Pocha Clinic, God’s Love (homeless shelter), Helena school system, and County and State health departments in Helena (Others are listed in UM-H Addendum Report, Appendix C). The Montana State Hospital has dormitory space for students. Mountainview Medical Center is willing to explore funding half a faculty salary to attract a nursing program. Ms. Wirtz has also identified new potential faculty, including master’s prepared obstetric/pediatric nurses and family nurse practitioners.
During the visit, several faculty members were introduced to the consultant. Students were seen practicing clinical skills in the laboratory. Two students are male displaced workers from two industries (lead smelter and vermiculite mine). Ms. Wirtz says that the typical ASRN population is older (31.6 average age), place-bound, carries heavy work and family responsibilities, and includes men and women from various working backgrounds.
The Shodair Children’s Hospital representative stated that they could accommodate students on Fridays, evenings, and weekends (with faculty). In addition, at least two more students with faculty could be placed MW, and an additional 5-7 students (no faculty; observation only) could be placed MWF (“perhaps more on deeper analysis”). Currently, Carroll College sends 5-7 students with faculty 9-10 hours/week TTh, and UM-H sends 2 students for observation without faculty 4-5 hours MW. Ms McCabe states that both students and staff learn collaboratively at their facility; that students make a unique contribution to patients and clinical care; and that having PN and RN students is a recruitment opportunity. She states that they are willing and prepared to collaborate with both schools to accommodate additional students with appropriate administrative approval, insurance and contractual agreements. Consistent and ongoing communication, careful theoretical and clinical skills preparation of students before clinical practicum, and examination of the roles of academic faculty and clinical preceptors are issues for exploration.
St. Peter’s Hospital employs approximately 150 RNs, 50 PNs for all clinical services. The RN vacancy rate is currently 8 %; the PN vacancy rate is 7.3%. The hospital likes the PN/RN partnership for clinical care and the BSRN for their critical thinking skills. The hospital has donated equipment and supplies to the nursing programs and offers $700/year for tuition support for educational advancement. Lisa Strong, the vice president for patient care services, and the hospital president support clinical education and are willing to deepen and expand communication and collaboration activities with both nursing programs and their current and future initiatives. They have a dedicated, caring staff for clinical care and education.
From review of the written materials of projected utilization of the hospital with both schools and the meeting with Ms. Strom, it appears that in the Fall, MTW are open for students, and that evenings are available for student placements M-F in both Fall and Spring. RNs work 12-hour shifts (6:30-6:30, and also sliding shifts). Ms. Strom states that the 6:30-10 pm time period is busy and complex (with admissions, doctor’s and family visits, post-operative patients), and offers students excellent learning opportunities. Weekends currently are used minimally or not at all for most of the year. Summers are not used by the schools.
The joint appointment model in which qualified specialty nurses share salaries and services with hospital and school should be explored, according to Ms. Strom. She also believes that an active advisory committee of the leaders of all clinical facilities and nursing programs is a key to successful collaborative arrangements. “Investing in each other is a win:win situation for everyone,” she states. Important questions that she thinks should be explored are: What is the strategic plan for clinical education? How can we come together as a community to expand and develop new collaborative arrangements? How do we resolve differences and conflicts?
Big Sky Care Center in Helena is a 106-bed long-term care facility that offers a broad range of patient services. Sherri Marcoux-Maharg, administrator, and Aimee Shein, director of nursing, describe the increasing acuity and complexity of their patients, which present excellent educational clinical opportunities for students. Students from both nursing programs are placed in the facility. In the fall, approximately 12 CC students are present from 7 am-12 noon ThF, and 2 management students are precepted by the administrator and director of nursing. Six to 8 UM-H students are in the Center MT from 6 am-6 pm.
There are no students in the spring and summer, and none on Wednesdays in the fall. The facility prefers not having students on weekends. These leaders are willing to expand student clinical opportunities, and state that careful clinical laboratory preparation of students and flexibility of skill sets and assignments are helpful in their work with students.
The Center does not offer tuition reimbursement. They have excellent, experienced PNs who would be interested in becoming nurses through the AD to BSN route. Ms. Maharg and Ms. Shein suggest the exploration of student affiliations with Rocky Mountain Care Center in Helena, a member of the Big Sky Corporation; Evergreen of Clancy, a private 70-bed nursing home, 12 miles from Helena (now used to some extent by UM-H); and Waterford, an assisted-living facility in Helena. They state that students’ management experiences can occur in non-traditional settings and these settings should be explored.
The Department of Veterans Affairs, Montana Health Care System at Fort Harrison has 40-50 inpatient beds with 90% occupancy. They like a staff mix of RNs and PNs. Every weekday there are students from both nursing programs on the two acute care units. In the fall, on MTW, UM-H students are present from 7-4; CC students are present one-half day ThF. In the spring, students from both programs are in the facility every weekday from 7-4 pm, and several CC students are present with a RN preceptor on varying shifts.
Ms. Snyder, chief of patient care services, and Ms. Riesland, education coordinator, expressed their willingness to explore expanded student usage, particularly on evenings and weekends and days when students are present half a day only. They are not sure about student placements in the summer but are willing to address this matter. They stated that they are part of the National Valor Program in which two nursing students work as summer interns (40 hours/week) with a nurse preceptor. Some of the nursing program faculty work as staff RNs in the summer. Ms. Riesland states that “maintenance of quality and enjoyment of the learning process are important.” Many of their staff nurses enjoy the preceptoring and teaching role with students. Clinical education is a recruitment opportunity for the facility. They state that because of the nursing brain drain from Montana, they are” donating” to the profession nationally through their educational contributions.
The meeting with Carroll College, a private Catholic college, included Dr. Cynthia Gustafson, chair of the Department of Nursing, 9 faculty members, the department secretary, and the vice president for finance and administration of the college. Their students are traditional-age and live in the resident halls. The main concern of the chair and faculty in relation to the proposal for an ASRN program at UM-H is capacity of clinical sites to support the program. Their program is also anticipating increased enrollments. The junior class is 22 students, and the sophomore and freshman classes each include 40 students. They believe they may need to limit enrollments due to scarce clinical and faculty resources. Increased numbers also create greater demands for laboratory and computer use and room space in the school and clinical areas.
The College had indicated an interest in exploring an articulation program with UM-H for PN to BSN, without the intermediary ASRN proposed by UM-H. Carroll College does not offer post-baccalaureate or master’s certificate programs or the master of science degree in nursing. They state that 50% of their nursing graduates stay in Montana in spite of low salaries. Some faculty work in clinical facilities in the summer. The department has no present plan to offer summer courses.
The nursing practice manager of the Montana Board of Nursing, Jill Caldwell, met with the consultant on request to clarify several issues about the consultative sessions and final report. Ms. Caldwell said that at a recent meeting of the Montana Hospital Association, it was noted that they will continue to employ the ASRN; that they want to “grow” additional professional nurses; and are exploring salary increases to boost RN retention.
A telephone meeting was held on March 1, 2004, with Ms. Susan Beausoleil, vice president of nursing, at Montana State Hospital in Warm Springs, the only publicly funded inpatient psychiatric facility in Montana. The average census is 189. In 2003, admissions were 500; they anticipate 580 admissions in 2004. There is a growing need for RNs in the area of geropsychiatry. The staff includes 40 RNs (half are ASRNs and half are BSNs), 40 PNs, 8 psychiatrists, a psychiatric nurse practitioner, social workers, rehab and psychiatric technicians. They currently have ASRN and BSN students from UM-H, Montana Tech, and MSU. Carroll College has sent nursing students to the site in the past, but is not currently using it. A dormitory is available for students (up to 40).
Mornings and evenings are available for additional students at various times of the year. Weekends and summers are also options. Ms. Beausoleil states that there are many rich opportunities available for clinical education. Students learn how to work with the entire treatment team on behalf of individual clients; develop listening, communication, and assessment skills; and become familiar with a specialty area of practice and the various roles of nursing. The staff is very interested in teaching; students bring energy, ideas, and stimulation to clients and staff. Clinical education presents recruitment opportunities to the psychiatric specialty and to the organization.
A telephone meeting with Mr. Dick Brown, senior vice president of the Montana Hospital Association, was held on March 19, 2004. Mr. Brown believes that a rural/frontier nurse should be educated for Montana, a distinctly rural state. People could be encouraged to enter nursing with the expectation that they will be educated for this type of practice and therefore be motivated to return to their rural communities to practice nursing instead of seeking opportunities out of state. Clinical training in rural areas where the student is introduced to a wide variety of clinical experiences in rural hospitals, clinics, and non-traditional settings would be an invaluable contribution to the state. Mr. Brown believes that a variety of clinical sites and appropriate personnel exist within a reasonable distance of Helena that could provide important training in rural health and nursing care. For example, Deer Lodge is a rural hospital and nursing home 60 miles from Helena that holds promise for a variety of clinical experiences. The state prison is located in the vicinity, and sends inmates for care to Deer Lodge, in addition to having their own infirmary. Mr. Brown believes that many untapped resources are available for clinical education.
The Montana Hospital Association is very interested in supporting clinical education in diverse settings that would provide various opportunities for nursing students. The nursing profession and other health careers should be introduced to young people from K-12, and then various entry points be provided for entry into the profession from PN-ASRN-BSN-MSN-PhD/EdD, along with seamless movement through articulation models. Mr. Brown states that the Hospital Association would like to strengthen collaborative partnerships among the schools and their member organizations; will explore funding for faculty education and collaborative projects; and work with the State legislature for increased funding support.
RECOMMENDATIONS AND GUIDELINES
Based on the assessment and analysis of the data gleaned from various documents and academic and clinical meetings, several recommendations and guidelines are offered.
A. Academic Access and Advancement Opportunities
There is a growing crisis in the healthcare industry due to the shortage of nurses at all levels. The Bureau of Labor Statistics (Feb.11) has announced that registered nurses rank first in the list of the ten occupations with the largest projected job growth in the years 2002-2012. Further, the Bureau states that the total job openings, including both job growth and the net replacement of nurses, will be more than 1.1 million by year 2012—just eight years from now. The State of Montana’s projections were highlighted earlier in this report. Another great need exists for the advanced practice nurse; only 7.3% of RNs in USA were advanced practice nurses in 2000. The shortage of management and education leaders is another serious crisis; just 10.4% of RNs in USA held the master’s or doctorate degree in 2000. A serious growing shortage of faculty in schools of nursing has been reported in studies by the National League for Nursing (2002) and the American Association of Colleges of Nursing (2003).
Clinical excellence and patient care safety are also deeply influenced by educational factors. Flexible educational opportunities that are attractive to people interested in entering the field of nursing as well as providing access for advancing their education and leadership skills should be a “call to arms” in the profession, whether in Montana or nationally.
1. Recommend: That UM-H be supported in their proposal to change the current Associate of Applied Science two-year practical nursing program to a one-year certificate program, and to offer an Associate of Science RN program. Recommended PN student population for the clinical component: up to 40 annually (proposed admission of 60 students into the program). Recommended ASRN population for the clinical component: three to four cohorts of 8 annually, or 24-32 students, depending on clinical capacity. The Addendum Report (July 2003) illustrates the proposed student shift in clinical site usage: PN students: Fall semester: none; Spring semester: long-term: Summer: acute and OB/peds RN students: Fall semester: acute; Spring semester: acute; Summer: none
- Develop a nursing articulation educational model in Helena by the University of Montana-Helena College of Technology (UM-H) and Carroll College (CC). This model would offer a diversity of access points into the nursing profession as well as various options for educational advancement. These various educational entry points and opportunities build on each other in an efficient and cost-effective manner for the student, and provide a rich diversity of nursing resources to clinical agencies. The PN-ASRN-BSN-MSN articulation route is essential in addressing the increasing demand for nurses both locally and nationally.
- Recommend: That CC be supported in their efforts to maintain classes of 30-40 baccalaureate students annually. In addition, recommend that CC develop and offer post-baccalaureate certificate programs (e.g., each program might consist of four 3-credit courses or total of 12 credits) in various areas of identified need, such as nursing education, long-term care, rural nursing, and palliative nursing. This initiative would address essential lifelong learning in the profession, provide an efficient means of developing nursing leadership, and provide an entry point for graduate study. A needs assessment of practicing nurses, nursing leaders, and clinical preceptors would provide important data re: compelling areas of study.
- Recommend: That CC conduct a needs assessment for a master’s degree program and develop a proposal for a program, if need is indicated. Post-master’s certificate programs could also be developed in conjunction with the degree program, to support the efficient preparation of academic and clinical leaders.
- Offer time-flexible theory and clinical courses to students in all programs, including evenings, weekends, all-day courses, and summer sessions.
- Schools could provide on-site credit-bearing courses, educational seminars, continuing education courses, and consultative support to the clinical nursing community. In particular, it is recommended that seminars/workshops on teaching and evaluation be offered to clinical preceptors to reward and acknowledge their value to the teaching-learning enterprise, to enhance excellence in clinical teaching, and to encourage interest in nursing education.
- Explore scholarships, loans, and grants writing to recruit and retain students, expand laboratory facilities and clinical simulation equipment, and to “grow” new faculty.
- Seek assistance from Montana legislature, in conjunction with Montana Hospital Association, to support various initiatives; e.g., scholarships for entry and advanced education in nursing, pilot projects of innovation in clinical education involving non-traditional training sites, and establishment of regional clinical training laboratories.
- Explore with MSU Bozeman the possibility of offering some distance nursing courses in their master’s degree program in selected clinical sites in Helena to encourage easy access for nurses seeking graduate study as advanced practice nurses, faculty, and administrators. Explore various forms of tuition support for these graduate students.
B. Clinical Education: Capacity and Enhancement
There is capacity in the clinical environment in metropolitan Helena and the surrounding communities to support the educational requirements of additional nursing students (PN, ASRN, and BSN), at present and in the future, according to the clinical leaders and analysis of the data presented. Openness, innovation, flexibility, and funding support will be necessary to develop and expand opportunities.
1. Develop new models for clinical instruction, including greater investment in and expansion of skills laboratories (including use of human patient simulators), interactive technology, peer teaching and learning (e.g., hiring exceptional undergraduates as lab assistants), rewarding and support of clinical preceptors (e.g., workshops, seminars, and post-baccalaureate and master’s certificate programs in education; tuition discounting for study; library privileges), etc.
2. Increase clinical preparation of students in laboratory and simulated clinical situations (including use of human patient simulators) before sending them to real-life clinical settings.
3. Recommend: That clinical instruction be offered on an increased basis during evenings, nights, weekends, and summer sessions.
4. Recommend: Greater use of nontraditional settings for community nursing, management, and specialty experiences in medical-surgical, maternal-child health, rural health, and others. These include long-term care and psychiatric facilities, nursing homes, schools (nursery through high school), health departments, rural hospitals and clinics, shelters, parish nursing and churches, employee and corporate health, doctors’ offices, home care, hospice, college health services, reservations, prison health, and others.
5. Expand/develop Helena Nurse Advisory Council for Education, Practice, and Research that includes representatives from both academic programs and all clinical institutions, including those not currently being used. Rotating chairs could lead the group in strategic planning, ongoing data collection and needs assessment, expanded collaborative arrangements, long-range operational plans, development and research of innovative preceptor and mentorship arrangements, regional resource sharing for skills laboratories expansion, conflict resolution, and mutual sharing and support.
6. Build different approaches to preceptoring and mentoring of nursing students in the clinical setting; e.g., joint appointment/clinical faculty appointment models, resource sharing of services and salaries, peer mentoring, etc.
7. Explore use of dormitory at Montana State for various rural clinical experiences.
8. Provide bus/van transportation for cohorts of students using more distant facilities and organize these clinical experiences in blocks for efficiency.
9. Develop ongoing evaluation mechanisms to examine clinical agency/preceptor, faculty, and student satisfaction, outcomes and anecdotal information (e.g., safety, patient satisfaction, preceptor effectiveness).
C. Clinical Faculty, Preceptors, and Mentors
A serious faculty shortage will continue to be a major problem in nursing education. Academic programs will need to “grow faculty” by identifying promising “stars” while they are in school (in ASRN and BSN programs) and to mentor them and encourage their entry into post-baccalaureate education certificate programs, master’s degree programs, and post-master’s certificate programs. Clinical preceptors will find increasing challenges as they encounter heavier and sicker patient care loads at the same time they are being asked to be active teachers, mentors, and role models for nursing students.
1. Examine role of clinical faculty and their collaboration and partnership with clinical preceptors and mentors. Clinical education is a shared professional responsibility and privilege. Respect, trust, and support between academic and clinical partners are essential elements in the relationships. This vital clinical training enterprise should be viewed not as “burden,” but as opportunity for promoting patient care excellence as well as recruitment and retention into the profession. This was a consistent theme from meetings with the clinical leaders.
2. Explore joint appointment models; e.g., faculty and clinical preceptors who share services, responsibilities, and salaries. Clinical nurse specialists and nurse practitioners are prime candidates for faculty practice arrangements. Clinical nurses also can be hired as lecturers and clinical faculty in special arrangements.
3. Recommend: Acknowledge, support, and reward clinical preceptors and mentors with tuition reduction, library privileges, seminars and continuing education opportunities by their academic partners, recognition events and awards, clinical ladders, etc.
4. Explore and build new models of clinical preceptoring and mentoring through “think tanks,” conferences, pilot projects, technology applications, etc.
5. Strengthen collaboration of Montana Hospital Association with nursing programs to explore assistance with faculty funding, sharing clinical faculty and preceptor salaries, funding assistance for state-of-the-art regional skills laboratories (in conjunction with State legislative funding), and other support activities.
The current and future status of nursing and nursing education in Montana demands visionary and vigorous leadership for action from many sectors--the government (State and local); regulatory bodies (Montana State Board of Nursing and Board of Regents); the hospital industry (Montana Hospital Association); and nursing leadership in all sectors of the profession. Strong academic, laboratory, and clinical collaborative partnerships are essential in solving the problems of the increasing demand and diminishing supply of nurses at every level. The projected trends are sobering; and the solutions, or lack thereof, will affect every citizen and every age group.
The choice lies between maintaining the status quo, or evolutionary change through strategic planning, decision-making, and fiscal/funding/grants support. Resistance to change; fear of the unknown; risk; “turf” issues; tradition; and political, philosophical, cultural, and economic factors are all factors involved in making difficult choices and thinking “out of the box.” The American Association of Colleges of (2003) states that the present shortages and challenges “offer nurse educators an unparalleled opportunity to challenge past norms and think collaboratively and nontraditionally to meet the future,” and that nursing education should be shaped in new and exciting ways by different solutions.
Montana nursing, particularly in Helena, is at a watershed moment for change. Decisions that are made will most certainly influence the long-term future of nursing and health care in the state and the country at large. It is a moment of opportunity and of challenge. This moment suggests the exploration of flexible partnerships, new consortial arrangements, and futuristic strategic planning. For example, clinical skills training could be supported through adaptation of technological advances and regional clinical skills laboratories.
The health care industry and policy bodies in the State appear to possess strong leadership and the desire and will to provide the highest quality health and nursing care services to its public. The clinical and academic leaders can serve as a rich resource to each other for sharing expertise, ideas, and problem solving. The relatively small-scale of the population and organizations provides the opportunity for efficient, personal, face-to-face communication and dialogue.
Investing in each other as students and professionals will offer solutions to the successful recruitment and retention of nurses; ensure the provision of rich academic and clinical education of students at all levels; and produce a cadre of strong clinical and academic leaders poised to meet the future challenges of providing high quality access to nursing care in Helena, Montana, and the United States.