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New Partnership Will Ease Nursing Shortage

   Portland, Ore.

The collaboration helps double nursing school enrollment, teaches students critical skills and rejuvenates clinical care.

A revamped curriculum at Oregon Health & Science University School of Nursing and a willingness to help students at Kaiser Permanente have dovetailed to offer a new way of educating nurses.

"The realities of the nursing shortage demand that we double enrollment with virtually the same faculty," said Bonnie Driggers, R.N., M.S., M.P.A., director of clinical teaching systems and programs in the OHSU School of Nursing. "It forces us to be creative and enhance every opportunity our students have."

The School of Nursing required additional clinical sites to absorb the increase in enrollees, and to provide experiences in health assessment, health promotion and chronic illness care. Both OHSU hospitals and clinics and Kaiser Permanente central and Westside clinics welcomed 95 nursing students into busy clinical settings as soon as classes began last July. The first-year students -- most of whom had never seen a patient -- observed nurses, medical assistants, physicians and nurse practitioners providing care across the life span. The students not only observed, but they were able to practice the skills they learned in the classroom and labs.

This fall students are learning in three different settings: a clinical site, a long-term care facility and an acute care hospital. Every week they put into practice new skills learned in the classroom and rehearsed in simulation labs.

In sharp contrast, students used to spend their first term mostly in the classroom and skills lab with only some patient contact.

"All that's changed. We looked at our teaching and asked, What clinical experiences should go with every piece? Now, students focusing on patient assessment in class are in labs and at Kaiser Permanente, putting what they learn into practice immediately: establishing patient rapport, identifying chief complaints, conducting actual physical assessments. This is simply revolutionary in nursing education," Driggers said. Traditionally these skills have been learned in the long-term care setting or in the hospital where students had limited access to a large number of patients.

"These students have been able to give injections, take patient histories, get vital signs and observe outpatient procedures," said Jan Weaver, R.N., ambulatory care manager for primary care at Kaiser Permanente's East Interstate Medical Office. Weaver is an OHSU alumna with a passion for creating excellent student experiences.

"Students are in primary care as well as specialty clinics, from surgery to the Emergicenter, dermatology to endoscopy. In the summer they were primarily able to observe. But now we have some of the same students back, and they're building on skills and doing more hands-on work," she said.

For those who mentor students, the experience has been rewarding as well.

"Their enthusiasm and innocence has been very refreshing," said Sammie Hathaway, R.N.C., staff nurse in the East Interstate obstetrics and gynecology clinic. "It made us all look at how we work and do an even better job."

Hathaway's students followed her during prenatal ultrasound testing and advice calls. With caller permission, students wore headsets and listened to conversations with patients and providers, learning how to communicate with patients and the health care team.

Weaver also is enthusiastic about what the students have given back to Kaiser. "We have had medical students do clinical rotations here for years," she said, "and occasional nursing students from Linfield College and the University of Portland. However, we've never before had a consistent nursing student presence here. For the nursing staff, it's been extremely positive. It's re-energized them and given them the opportunity to share the wonderful things they know. We're really excited about collaborating with the school to create this experience."

The new model provides students with a unique opportunity to see many patients, to understand ways people manage health and cope with chronic illness, and to learn strategies nurses use to support patients and their families.

Increasing faculty is one of the goals of the Oregon Nursing Leadership Council, a group of people from Northwest nursing organizations addressing the nursing shortage. Their goals include doubling the nursing school enrollment in Oregon by2004; redesigning nursing education to meet more directly the changing health care needs of Oregonians; recruiting and retaining nurses into the profession; and developing, implementing and evaluating staffing models that make the best use of the available nursing work force.

OHSU includes the schools of dentistry, medicine, nursing, and science and engineering; OHSU Hospital and Doernbecher Children's Hospital; numerous primary care and specialty clinics; multiple research institutes; and many outreach and community service units serving all the people of Oregon.

Kaiser Permanente is a prepaid, group practice health care organization founded in 1945. It serves the health care needs of about 435,000 people in Oregon and southwest Washington.

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