History, change and opportunity are hallmarks of relationships with the Medical Center
Known for innovation and leadership, the University of Rochester School of Nursing moves forward, continuing to embrace collaborative relationships with University of Rochester Medical Center partners and affiliates.
“Nursing certainly has a social and ethical responsibility to evaluate itself as a profession. As a School we have to do that too, in a fully informed way,” said Kathy P. Parker, RN, PhD, FAAN, dean. “It is clear that while we have much to offer on our own and bring a richness to the Medical Center that would be lacking without a School of Nursing, we bring more when we are fully informed and engaged in partnerships that benefit the whole.”
To that end, Parker and her leadership team continue to earnestly pursue opportunities for collaboration within the University system and beyond. Nursing Practice at Strong has been a long-time educational partner without which students would not have the vast and varied clinical experiences they do. As health reform seems to signal an increase in home health care, the School is poised to embark on research with Visiting Nurse Service of Rochester and Monroe County, Inc. The arrival of a new chief nursing officer at Highland Hospital brings with it a plan to increase community outreach efforts. And with the School’s newly formed Center for Research Implementation and Translation equally integrated as one of four core components within the University’s Clinical and Translational Science Institute, nursing will have its place in the research continuum.
“Just as our three missions—practice, research, and education—inform each other, so too do our partnerships. They are critical to the future of the School,” Parker said.
The School of Nursing’s history with Strong Memorial Hospital goes back to 1925, when they were founded concurrently with the School of Medicine and Dentistry. Over the last 85 years, the relationship has evolved. Today, Strong can be counted among the School’s most critical community partners.
“We have a positive ongoing relationship based on a history featuring remarkable achievements on all fronts,” Parker said. “There is great potential for the future. I believe we can serve as a national model by bringing to bear the richness of the profession.”
In 1972, the independent nursing school was established at the University, along with a model that aligned the School and nursing practice at Strong. Faculty held appointments in practice, and clinical nurse specialists at Strong had appointments at the School; those in leadership roles at Strong taught classes in the School. Over time, that structure changed, resulting in some separation of the services. But in 2010, there is a resurgence in people playing critical roles on both sides of the street.
“We need educators who are clinically relevant. In turn, having clinicians informed about education is just as important,” said Parker.
Nearly 50 clinical faculty members work at Strong across a variety of practice sites. About 30 of those individuals hold joint appointments, meaning that while they retain a faculty position within the School, they are also appointed to a clinical service within Strong and vice versa. The purpose of joint appointments is to engage individuals in multidisciplinary work that will benefit both organizations. (To read more about joint appointments, click here.)
“Teaching challenges you and your skills as a nurse,” said Michael Ackerman, DNS, RN, associate director of nursing at Strong and director of the Sovie Center for Advanced Practice. “The experience forces you to be on top of your game, and it can be a refreshing change of pace.”
Clinicians at Strong, as well as at many other URMC and community sites, also work with the School as preceptors, spending one-on-one clinical time with students in the accelerated and master’s programs.
Evidence of Strong’s commitment to nursing education is the staggering number of clinical opportunities that it provides. Students from area nursing schools, including the University of Rochester’s, participate in more than 3,000 clinical experiences annually. Accommodating such a huge demand can be a challenge. The accelerated programs’ “capstone clinical” component in particular requires that each student spend nearly 100 clinical hours working one on one with nurse preceptors.
Patricia Witzel, RN, MS, Medical Center associate vice president and chief nursing officer at Strong, is integral in facilitating clinical sites and preceptors within the Hospital to make this possible. While it is a challenge given the growth of the accelerated programs, Witzel said, Strong makes it work. “It’s a priority for us,” she notes. “Certainly, a number of our staff enjoy the experience of working with students.” (Read about one preceptor’s experience here).
One of the benefits to having so many nursing students in the Hospital is being able to recruit early on by showing student nurses what their experience may be like as a Strong nurse. “It’s proven a very successful way for students and managers to learn about each other,” Witzel said.
The relationship between Nursing Practice and the School is fluid, changing right along with education, health care and community needs.
For instance, when Strong saw a reduction in resident hours in 2003, there was an increased need for people to fill the role of registered nurse first assistants (RNFA), perioperative RNs who work in collaboration with the surgeon and health care team. The School boasts a successful RNFA program.
“I think you have to be very open to the dynamic nature of health care,” said Witzel. “You have to be flexible and willing to try different things.”
And so they have. Just this spring, a collaborative fellowship was created by the School, its Center for Outcomes Measurement and Practice Innovation, and Strong Memorial Hospital Nursing Practice. This fellowship will give a nurse practitioner from Strong the opportunity to work in a high-need clinical area while earning a practice doctorate.
”The fellowship is an opportunity for us to test out the role of the DNP,” Witzel said. “It will be helpful to have experience and data in outcomes.”
When it comes to promoting and teaching patient safety, the School is committed to working across the Medical Center to ensure quality care. Simulation has served as a springboard for those efforts with the School of Nursing, Strong and the School of Medicine and Dentistry sharing simulation facilities. Cardiothoracic surgery has used the School’s simulation laboratory for their critical-incident simulation.
In May, faculty from the School of Nursing and the School of Medicine and Dentistry held an interdisciplinary simulation at Helen Wood Hall for nurse practitioner and medical students. The purpose was to promote teamwork, collaboration and appreciation for each other’s roles—all of which we know lead to better patient outcomes. (To read more about this simulation experience, click here.)
In other, quieter ways, the School and Strong have built relationships that maximize efficiency and collaboration. A School of Nursing representative sits on the Continuing Nursing Education Committee at Strong, which is a provider of continuing nursing education units from the American Nurses Credentialing Center. Diversity planning groups from the School and Strong Nursing Practice jointly present educational offerings. Strong utilizes facilities within Helen Wood Hall to offer orientation sessions and other programs.
Efforts to bridge clinical and research interests got a boost this spring when Gail Ingersoll, EdD, RN, FAAN, FNAP, director of the Clinical Nursing Research Center (CNRC) at Strong, was named interim associate dean for research at the School. Ingersoll’s appointment gives her oversight of both research centers at Strong Nursing Practice and the School.
“This appointment will enrich our efforts across the board,” said Parker. “It means that as researchers we will better understand the clinical perspective. I also expect it will make us more aware of funding opportunities. Gail’s appointment and her dual roles bring us clinical relevance and strengthen our research endeavors.”
The CNRC is Nursing Practice’s central resource for nursing research and is available to all nursing employees of Strong. Its members They serve as principal and co-investigators, data collectors, and facilitators of the research of others. They also actively promote the use of research and other sources of evidence in clinical and administrative decision-making.
Started 10 years ago by Ingersoll, the CNRC has grown tremendously, becoming a national model for hospital-based nursing research centers. “Particularly, as more and more hospitals apply for Magnet status, they are introducing nursing research centers,” Ingersoll said. “A large part of achieving Magnet designation is related to research and a facility’s ability to measure and disseminate outcomes.”
Strong’s center does this well through its highly successful one-year internship experience, designed to expose nurses to research and evidence-based practice (EBP) principles. Those chosen for the program complete a clinically relevant EBP or research project with the help of a mentor. To date, 46 evidence-based projects have been completed by research interns on a wide range of topics and 15 more are underway this year. (To read more about the impact that CNRC interns have, read about Trish Bieck.)
“We want to continue to grow the center, and I’m confident that opportunities for linkages with the School are great,” Ingersoll said. “The School has a wealth of wonderful resources, including people experienced in research design, methods and data analysis, as well as faculty who have conducted clinically relevant research and can share their expertise.”
Relationships with other research components of the Medical Center are productive and wide-ranging. The School’s research portfolio was recently reorganized to align more with that of the School of Medicine and Dentistry. “We want to do everything we can to increase opportunities for collaborative work with the Medical School and build effective health care teams, particularly in primary care,” Parker said.
Two current faculty members and one emeritus professor serve as chairs of biomedically focused Research Review Boards. (For one person’s experience, click here.) Several others serve on CTSI planning groups and review CTSI proposal drafts.
The nursing-run Center for Research Implementation and Translation (CRIT) within the CTSI takes the School to a new level. “We’re not talking about a partnership with the CTSI,” said Harriet Kitzman, RN, PhD, FAAN, senior associate dean for research. “We are the CTSI, and a key component of the continuum of research translation.”
The CRIT, a multidisciplinary center housed in the School of Nursing, has the developed infrastructure, experience and resource capacity to offer a wide array of services to investigators. The Center will provide assistance with proposal development, including treatment/intervention and study design, and implementation. It also houses support for comparative-effectiveness research.
“These are areas for which we have critical expertise,” Kitzman said. “Nursing focuses on the science of the person’s experiences in health and treatment. By increasing our understanding of the needs of patients and the characteristics of their environments, treatment can be shaped to increase its efficacy. Our involvement will optimize the movement of research from the bench to the bedside.”
The School’s new interprofessional Clinical Research Coordinator (CRC) track within the Leadership in Health Care Systems master’s program is designed for those interested in research coordination in health care, to be responsible for the “hands-on” implementation and oversight of study protocols. While serving as a central training resource for the CTSI, the School’s CRC track serves the entire upper New York State region.
“Between the CRIT and the new CRC program as well as the School being physically connected to the Clinical and Translational Science Building, we are fully integrated, and we have worked at all levels to make that happen,” Parker said.
In the coming months and years, Parker plans to continue reaching out to Medical Center and community partners with the hope of finding common ground and projects that open doors to collaboration. “We will not be an island unto ourselves,” she said. “We will be present every opportunity we get to bring value, to increase the visibility and role of nursing, and to contribute to the community.”
Multimedia in this Issue:
View a slideshow of the event.
Nursing and medical school students partner to learn teamwork
View the video.
URMC First in Nation to Implant Heart Failure Device
Learn more about the device.