Innovation in Nurse Education at Cleveland Clinic

Hospital leaders worldwide seek solutions from nurses when they look to improve the quality of patient services, says Joan Kavanagh, MSN, RN, NEA-BC, Associate Chief Nursing Officer of Nursing Education and Professional Development at Cleveland Clinic.

“Nurses comprise the majority of the healthcare workforce and we understand the nuances of delivering high-quality care, which has a profound impact on outcomes and patient experience,” she says.

Patients on both ends of the spectrum – from the youngest preemies to a growing elderly population with multiple chronic conditions – along with a host of new lifesaving therapies, are increasing complexity of care. These demands make it imperative that nurses are properly trained from the start to be accountable for patient care.

To achieve success, the Zielony Institute has developed a number of education programs to seek out and develop the best of the best. Here, we focus on three innovative education programs that are having a meaningful impact on nurse training and patient care.

The Acute Care Essentials (ACE) Program

Transitioning from nursing home to hospital

At Cleveland Clinic, one great source for bringing experienced RNs into an acute care setting has been local long-term care or home care settings. “In Northeast Ohio, many nurses are looking to transition to acute care,” says Clinical Instructor Nancy Steckel, MSN, MBA, RN.

In 2015 findings reflected that nurses who initially worked in nonacute care settings needed additional support to achieve competency in patient assessments. “In long-term care, a nurse might perform an assessment once a week. Acute care nurses do daily head-to-toe assessments and multiple focused assessments,” says Steckel.

“Nurses also told us they were concerned about their critical thinking skills in recognizing changes in a patient’s condition and knowing the immediate intervention,” says Christine Szweda, MSM, BSN, RN, CCRN, Senior Director of Operations in Nursing Education.

As a result, the Zielony Institute developed a two-week program called Acute Care Essentials (ACE) as a precursor to the usual 10-week nurse residency for new graduates, long-term care nurses, and nurses transitioning to a new specialty. Launched in November 2015, ACE focuses on:

• Critical thinking
• Head-to-toe assessments and documentation
• Peripheral vascular IVs and advanced vascular access
• Pneumonia prevention and respiratory stations
• Foley catheter insertion
• Neurological and sepsis overviews

Knowledge and clinical skills are reinforced with case-based instruction, experience on the unit with expert clinicians and instructors, and video simulations. “Each day we build on what they’ve learned the previous day,” says Szweda.

Endpoint data are not yet available, but in anecdotal reports, ACE was associated with improved knowledge and critical thinking. “An emergency department nurse told me she thought she could transition easily from skilled nursing care. Later, she realized she would have really struggled without the ACE program,” says Steckel.

Every nurse hired by Cleveland Clinic undergoes a clinical competency evaluation before and after residency, using the Performance Based Development System. “Since we hired many nurses from skilled facilities over several months, we were able to get actionable feedback and data showing progress made with the program,” Szweda relays. This is good news.

Nurse Associate Extern program

Reaching out to nursing students

In summer 2016, Cleveland Clinic nurse leaders are looking forward to meeting 70 BSN students as part of the new Nurse Associate Extern program. “Hospitals across the country are vying for new graduates. Our program allows student nurses to experience Cleveland Clinic between their junior and senior years. It also gives us the opportunity to identify students who display the attributes and possess the values and vision that align with putting patients first,” says Meg Duffy, MS, RN, Director of Nurse Recruitment and Staffing Resources.

Thirty students from 18 nursing schools participated in the pilot extern program in summer 2015. The expanded 2016 program will provide 10 weeks of classroom time and paid clinical experience to two cohorts.

The externs are hired as nurse associates and work 40-hour weeks with experienced RN mentors. “Students are not shadowing their mentors – they are experiencing many procedures and working collaboratively with an RN to enhance their critical thinking and organizational skills,” says Cynthia Willis, DNP, MBA, RN, CMSRN, Senior Director of Nursing Education.

Fifty of the 70 externships are in medical-surgical, critical care, neonatal intensive care, labor and delivery, and behavioral health specialties. Ten spots each are dedicated to the Sydell and Arnold Miller Family Heart & Vascular Institute and perioperative (OR) nursing — high-priority areas for Cleveland Clinic’s nurse recruitment. “Academic affiliations do not typically offer extensive OR experiences. We hope this externship will spark interest in the exciting specialty of perioperative nursing and attract individuals to our dynamic OR team,” says Dr. Willis.

Because Cleveland Clinic cares for the highest acuity patients, classroom topics include:

• Cardiac rhythms and defibrillation
• Neurologic and respiratory assessments
• Chest-tube care
• Wound and skin care
• Arterial blood gases
• Emergency response
• Hospital-acquired infections

Exercises in critical thinking, problem solving, influencing patient care, and ethical situations also are covered. “Case studies and simulations help with skills validation and specialty skills,” says Dr. Willis.

The 2015 externs gained confidence during the program, according to Dr. Willis. In self-assessments using a four-point scale, their confidence in patient interaction and clinical skills increased from a mean score of 2.17 to 3.64. Twenty-one participants expressed interest in continuing to work at Cleveland Clinic prior to graduation, and 22 said they “very likely” would pursue a career opportunity here. “Some externs have emailed me that they have become the leader-mentors of their senior class,” says Dr. Willis.

Since last summer, Dr. Willis and Duffy invited students who attended the 2015 extern program to meet them at nurse recruitment events at their schools. “It’s been very helpful having the nurse associates right there with us, describing their experience and sharing their enthusiasm with other nursing students,” says Duffy.

Visiting Nurse Scholars Program

Sharing our expertise

The Zielony Institute is also opening Cleveland Clinic’s doors to nurses worldwide. In 2015, 45 nurses from 15 healthcare organizations from around the world came to Cleveland Clinic as Visiting Nurse Scholars to observe our best practices.

“They reach out to us with learning objectives, and we try to match those with our nurse experts here,” explains Nancy Kanyok, MSN, RN-BC, CNS, Education Nurse Specialist.

Kanyok designs customized programs to meet the educational needs of nurses and their sponsoring organizations from the United States, Japan, Singapore, South Korea, China, Australia, South Africa and the Middle East. “Nurses may want to learn something specific or perhaps get a general overview,” she says.

For example, eight nurses from Australia came for a two-week visit, and each had different objectives. One was in case management, another was looking at orthopaedics, another worked in the intensive care unit, and others were interested in the patient experience. “We arranged group activities, then they broke off and shadowed clinical nurse specialists and bedside nurses,” says Kanyok.

This program is highly beneficial for Cleveland Clinic nurses too. “There is a very nice collegial exchange of ideas as our bedside nurses and clinical specialists learn how care is delivered in other places,” says Kanyok. “And after the visiting nurses leave, we continue conversations by email. This collaboration opens the door for new ideas and sharing of evidence-based best practices.”

“It is empowering for our nurses to know that other health organizations are actively seeking our expertise,” says Kavanagh. “The exchange of new knowledge about ongoing problems and sharing of medical research is a win for nurses and for healthcare overall.