Healthcare organizations must use creative strategies in order to help nursing students transition to a novice nurse in the workforce. Academia is presented with the challenge of having to use resources prudently in their curriculum while ensuring that students have the essential nursing skills in place prior to the completion of their program. This effort by both hospitals and universities can impact the success of novice nurses and the level of care received by patients. The opportunity to partner with colleges of nursing through a Summer Study Hall program for rising senior nursing students will help to enhance the nursing student's academic program through the assistance and clinical expertise of clinical nurse specialists (CNSs) and clinical nurse educators (CNEs) in an academic medical center.
Hospital-based nursing education departments design orientation built that is based on the basic nursing competencies and theories taught. Over the past several years gaps have been identified in novice nurses' level of preparedness as they begin in an acute care setting.1,2 Novice nurses are expected to have acquired a solid understanding of basic nursing skills through didactic and clinical experience in their basic nursing curriculum. When this is not the case, the clinical units and preceptors must modify the orientation program in order to meet the new graduates' individual needs while making sure orientation is not prolonged and does not focused only on rudimentary nursing skills. Orientation on the clinical units at any given time is made up of experienced and inexperienced nurses, and having to modify the clinical orientation to address the knowledge gap of ill-prepared novice nurses can negatively impact the engagement of those experienced nurses in the unit and may lead to fragmentation in care. If too much time is spent in clinical orientation on reviewing basic nursing skills/competencies, this creates a delay in the orientation process. This delay may include missed opportunity in the development of critical thinking and critical reasoning skills that are crucial in the transition from novice to expert nurse. The development of sound critical reasoning and thinking skills at the onset of one's nursing career can prove to be very valuable for the novice. If the novice spends too much time focusing on rudimentary skills, this may contribute not only to missed opportunities for learning but also to an increase in healthcare costs.3 A Summer Study Hall for rising senior nursing students has the potential to develop many skills through a series of sessions that students spend time with clinical experts such as CNSs or CNEs. Clinical nurse specialists/CNEs have expert knowledge regarding how to successfully manage patients and the skills required to develop competence in an acute care setting. They can also ensure that resources are available for novices to successfully begin to navigate through the ever-changing healthcare environment. The purpose of this article was to describe the development and implementation of an innovative Summer Study Hall program developed by CNSs/CNEs in an urban academic medical center.
PREPROGRAM PLANNING
The CNSs/CNEs at Robert Wood Johnson University Hospital (RWJUH) identified a knowledge gap in novice nurses who began their careers. As the primary group responsible for the professional development of all nurses, they found that they and the staff preceptors were spending an inordinate amount of time working with novice nurses on basic skills and competencies that should have already been mastered in their undergraduate nursing curriculum. The group met with a representative from human resources to discuss their concerns regarding the novice nurses, and strategies were discussed, and the vision for a Summer Study Hall program was generated.
Many of the CNSs/CNEs have a faculty appointment at local universities and have recognized that many of the curricula do not afford students the additional opportunities or resources to develop basic skills. Together with human resources, the CNS/CNE group determined that in order to help address this gap the RWJUH Summer Study Hall program would be piloted. The purpose of this program is 2-fold: first, it is to provide a learning environment in which rising senior-level nursing students have the opportunity to refine their clinical nursing skills, enhance their knowledge, and develop professional relationships, so they may be better equipped to transition into the profession of nursing. Second, it gave RWJUH the opportunity to meet and screen potential new employees and help establish early mentoring relationships.
The CNSs/CNEs embraced this major undertaking and developed a curriculum with core objectives that they believed would be attainable, manageable, and meaningful to the rising senior nursing student. The curriculum was based on skills that have a major impact on patient and healthcare organizations. As a fourth-time recognized Magnet hospital, the RWJUH CNSs/CNEs identified skills derived from the American Nurses Association Nurse Sensitive Indicator model that have the greatest impact on patient outcomes (Table). This team agreed that there would be a 2-fold approach; not only would the skill be taught, but also the focus would be for expert clinicians to emphasize the empirical outcomes associated with each skill. For example, as tracheostomy care and suctioning techniques were practiced and reviewed, each CNS/CNE would focus on the risk factors for ventilator-associated pneumonia. The CNS/CNE would also provide case studies that illustrated the direct impact of nursing interventions. In addition, the concepts of never events and pay for performance were introduced and weaved into the program.
PROGRAM IMPLEMENTATION
A well-thought-out approach in which participants were invited to participate was critical to the success of the RWJUH Summer Study Hall program. The CNSs/CNEs and human resources team created a flyer that was sent to the deans of local universities inviting them to partner together on this program (Figure). In the flyer, the purpose of the program was clearly stated, which turned out to be very valuable as the purpose clearly differentiated this program from a more traditional paid intern/nurse extern program, which is desired by many nursing students. While the intern/extern programs do help bridge the gaps between academia and practice for many nursing students, there is a significant cost associated with it. There are many "lean initiatives" taken on by hospitals, so therefore nursing education departments must be creative in developing programs that are cost-effective, but at the same time beneficial.
The objectives are to provide a learning environment to rising senior-level nursing students that assists them in refining their clinical skills, enhances their knowledge, and develops professional relationships. The program was offered at no cost to participants; however, to be considered for the program, they needed to complete an application, provide a letter of recommendation from a faculty member, and submit a 250-word typed essay that describes a memorable patient experience. The students needed to be able to commit to attending a weekly 2-hour program for 4 weeks. In addition, participants were informed that the faculty of the program would be composed of RWJUH CNSs/CNEs, and a coordinator of the program was appointed by the director of Nursing Research, Advanced Practice and Education. The ratio of faculty to student was 5:1. All of the courses were held in the state-of-the-art simulation laboratory located on the hospital campus.
Twenty-five students applied for 20 spots. The program coordinator and the director of Nursing Research, Advanced Practice and Education reviewed the applications and selected the participants. The selection process was done based on the quality of the application and supporting documents. The students received an e-mail notification that they were selected and were given program details as it relates to dates, times, and the venue. The syllabus was shared ahead of time so the students could review the applicable theory or educational materials prior to attending the session.
Twenty students accepted the invitation to be part of the program, and 5 were placed on a waiting list. Members of the CNS/CNE team were asked to volunteer time to design the course curriculum and work side by side with the students. The CNSs/CNEs volunteered based on their experience, expertise, and passion. For example, chest tube management was taught by the trauma CNS, whereas tracheostomy care and suctioning were taught by the medical intensive care unit CNS.
To ensure that students would gain the most from this experience, individual supplies were given to each student to allow hands-on experience with our high-fidelity mannequins in the simulation laboratory. The coordinator of the program met with the CNS/CNE faculty to review expectations and objectives as this was a pilot program. The faculty was creative in their approach in designing their education program; several opted to use additional teaching methods such as videos and case studies in order to keep the students engaged and challenged. This program was a nominal cost. Expired equipment was used whenever possible, and parking was given at a discounted rate.
When the students arrived, they were highly engaged and interactive and participated in all topics offered. All students demonstrated a strong motivation to learn. At the outset of the program brief introductions were made by both the students and the faculty and a short skills demonstration was given. For the most part, the students immediately became immersed in the skills and aligned with each topic. Students asked thought-provoking questions, which were relevant to enhancing their understanding of the skills that were being practiced. The faculty utilized this opportunity to challenge the students to apply their learnings to questions that they may be presented in their clinical practice. The participants were composed of a diverse group of individuals; coming from various nursing programs with unique experiences and backgrounds. Each week, the students gained more confidence and insight into the skills, and they began asking more questions.
Throughout the 4-week period, relationships were created, and it became evident that an inclusive network of peers was established, which would continue beyond the end of the program. Both students and faculty exchanged contact information to establish the early stages of a mentoring relationship in which further support could be provided between students and faculty of the RWJUH Summer Study Hall program.
Upon the conclusion of the program, the students were asked to complete an online program evaluation. Each student was presented with a certificate of completion and was given the opportunity to speak with faculty individually to ask any remaining questions.
IMPLICATIONS
Numerous advantages were identified in the creation of this program for both the hospital and the student. The collegial relationship between the baccalaureate programs and the hospital grew even stronger by working collaboratively in advertising the program through the universities and colleges as well as answering queries from deans and program coordinators. Every RWJUH employee involved in the program has the opportunity to interact with the students who would be graduating soon and would be seeking jobs at our hospital. With the oversaturation of the market with novice nurses, the CNSs/CNEs and program coordinator have the ability to assess their verbal and writing ability through the application process, professionalism in the way they dress and how they conduct themselves during sessions, and their critical reasoning ability during the debriefing period. The financial impact of the RWJUH Summer Study Hall is significantly lower than that of an intern/externship program where the amount cost can run in to the thousands of dollars. Although the costs for the Summer Study Hall are nominal, the students are being provided a meaningful learning opportunity for skill enhancement, continual learning, increased confidence, networking, and professional development through role modeling with experienced CNSs/CNEs at a fourth-time Magnet-recognized academic medical center. The students had the privilege to attend the program free of charge and work side by side with experienced faculty in a small group simulated setting reflecting real patient experiences while thinking on their feet and not in their seat. Students were able to maintain their summer jobs or simultaneously sought other learning opportunities because of the time frame and convenient hours of the program. By successfully completing the program, students can use the experience to help build their professional portfolio in seeking employment after graduation.
LESSONS LEARNED
The design of the program will be improved by requesting that applicants provide an unofficial transcript to ascertain that they are actually "entering their senior year." It was noted that some of the applicants had already graduated and will eliminate any misunderstanding for those students "completing their senior year." A standardized evaluation tool would be beneficial for the CNS/CNE to evaluate the students' interaction during the class as opposed to subjective feedback of the students' professionalism and conduct during the sessions. Because this was the inauguration of the RWJUH Summer Study Hall program, a formative evaluation will be developed with human resources in order to get objective feedback after each week's class to make adjustments to future programs.
The overall response from the students' program evaluations is that the program was very valuable, and they would highly recommend it, but they wanted to have more time, and they expressed that 2 hours a week was not nearly enough. The results speak to the nursing leaders of the hospital and the importance and value in creating innovative programs to meet the needs of our future nurses so that they are able to transition from student to novice nurse with minimal difficulty when it comes to performing basic nursing skill in the patient care environment.
A mailing list of all participants will be developed and provided to human resources that would alert the nursing students in their senior year to upcoming open houses and events. Human resources will also help to coordinate a reunion in order to bring the students together again in an informal setting so we could assess their development and have them meet with various hospital leadership. The administrative director of human resources will provide a teaching session on interviewing skills.
CONCLUSION
Being a fourth-time Magnet-designated academic medical center, it is critical that we continue to develop innovations that are fiscally responsible and are sustainable year after year in order to help promote exemplary practice. The success of the Summer Study Hall program went beyond the original intent and objectives of the program. The faculty gained insights on how they can tailor their orientation program to better understand the needs of new nurses and to understand the challenges/concerns faced by many nursing students. The CNS/CNE team created an environment that not only fostered interactive learning but also created a guiding light for those nursing students who are about to embark on their nursing career in a healthcare environment that is daunting and ever changing. Through this program, these 20 students will have added resources and learning's in their "toolkit" to support them in their mission to make a difference in the life of a patient with passion and purpose.
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