Partners in Nursing Practice
At Kent State, unique partnerships and programs are helping prepare today’s nursing students to meet tomorrow’s nursing shortage.
By Lisa Abraham
Photos by Bob Christy, BS ’95
ven as their mother lay dying in her hospital bed, the brother and sister could not stop their squabbling. The son, who had just flown in from California, peppered nurses with endless questions about his mother’s care, while tossing jabs at his sister for having made all the decisions without him. His sister countered that he needed to answer his phone once in a while if he wanted to know what was happening.
Their quarrel continued as their mother struggled for what would become her last breath. Meanwhile, a team of nurses stood by, doing their best to mitigate the arguing and answer the siblings’ questions.
Dealing with dying patients and their grieving families at one of the most trying times of life is a common occurrence for nurses. Yet, knowing when to step in with compassionate words and gestures is a skill that requires some cultivation. That is why Kent State University’s College of Nursing partners with the School of Theatre and Dance to stage the type of death scene described above—as well as mental health crises—to help student nurses learn how to handle some of the most difficult patient situations they may encounter on the job.
“We video the scenes,” explains Tracey Motter, DNP, RN, associate dean for undergraduate programs in Kent State’s College of Nursing. “Then the students watch themselves after to see how they reacted.”
Many student nurses, Dr. Motter says, are surprised when they see “how they just stood there” without offering any assistance or kindness.
A bedside manner can be an easily overlooked skill when students are studying so many new things. But it is this type of training that sets Kent State nursing graduates apart in the workplace, say College of Nursing leaders.
“You want to produce a nurse who is holistic, which includes being thoughtful and caring, and also one who is knowledgeable about what it takes to provide good patient care—and good care doesn’t end at the bedside, but extends to all the family members there,” explains Barbara Broome, PhD, RN, FAAN, dean of Kent State’s College of Nursing.
An increasing need for nurses
When it comes to training such skilled and compassionate nurses, the race is on. An aging Baby Boomer generation has created a perfect storm for the nursing profession. Baby Boomers, born between 1946 and 1964, are retiring in droves and leaving widespread vacancies in nursing. By 2020, more than half of this large demographic will be 65 or older. At the same time, this tsunami of senior citizens is creating the need for even more nurses to attend to their health care.
The statistics are daunting: A national shortage of one million nurses by 2020. In Northeast Ohio, that shortage is estimated to be about 2,850, according to the Nursing Forecaster of the Center for Health Affairs in Cleveland.
Kent State’s College of Nursing leaders are keenly aware of the pressing shortage and are making a full-throttle effort to produce ever-increasing numbers of well-prepared nurses.
The College of Nursing has developed numerous pathways to a bachelor’s degree in nursing, including a traditional four-year college experience, an LPN to BSN and an accelerated course that can transform anyone with a prior bachelor’s degree into a registered nurse in 15 months. (See KSU Pathways to Becoming a Registered Nurse below.)
“Everybody doesn’t always know they want to be a nurse when they are graduating high school,” says Dean Broome. “We are helping people to recognize that just because you didn’t do it in your 20s, you can still be a nurse in your 40s, 50s or 60s.”
The university awards about 450 Bachelor of Science in Nursing (BSN) degrees each year, yet the numbers are hardly enough to fill the shortages in the profession.
Approximately 40 percent of Kent State graduates remain in Northeast Ohio for their careers, says Kathleen Norman, marketing, communications and public relations director for the College of Nursing.
With such widespread job openings, however, nursing graduates have their choice of where they want to work. The college boasts that 99.6 percent of its graduates are employed within six months of graduation.
Filling the gap
At University Hospitals, there are typically 400 openings for registered nurses at any given time, says Kim Shelnick, vice president of human resources for UH. And, on average, UH hires 1,200 nurses a year.
Dealing with the nursing shortage, she says, is one of the hospital system’s top priorities: “Without our nurses, we can’t achieve our mission to heal, teach and discover.”
UH works to create a robust pipeline of student nurses and fills many of their posts with new graduates, says Ms. Shelnick.
They help keep the pipeline full through various programs, including the creation of nursing assistant jobs just for student nurses. These jobs offer flexible schedules designed to accommodate students’ class and clinical schedules—and at the end of their schooling, the students have the opportunity to move to full-time nurse positions.
UH also offers a summer internship program in which student nurses can work full time, says Ms. Shelnick. (And they will earn Kent State credits toward the BSN degree while doing so.)
Kent State and University Hospitals, in February, announced a new collaboration that will expand the number of students admitted to the Kent State College of Nursing each year. To support the added students, UH will provide additional clinical slots for student nurses from Kent State and willl recruit more UH nurses to serve as clinical instructors for the student nurses.
The agreement also creates the UH Scholars program, in which UH offers incentives for KSU seniors who agree to work for the UH health system for two years after graduation.
Statistics show that nurses who remain on the job at least two years are likely to remain at their place of employment, Ms. Shelnick says. UH has cultivated similar arrangements with Cleveland State University and Cuyahoga Community College.
The UH Scholars program will select 20 KSU College of Nursing students annually who will be guaranteed full-time employment with UH following graduation and receive $12,000 each in financial support to help defray the costs of their education, provided they agree to work for UH for two years after graduation. UH Scholars is open to junior nursing majors for its inaugural year, which begins in the 2019 fall semester. Student nurses rotate through all medical units in the hospital to gain experience working in a large variety of environments, including surgery, emergency, intensive care, pediatrics, orthopedics and general medical.
Dr. Motter says the need for more clinical rotation time at hospitals is key to graduating more bachelor’s degree nurses. “We can add more university classes at our end, but there is only so much clinical time to go around,” she says.
When the collaboration with UH reaches its full capacity, Kent State will be able to graduate 80 more bachelor’s degree nurses each year, she says, bringing the total to 530.
Options for nursing students
Kent State nursing students, though, vary on whether they hope to remain in the region after graduating or move elsewhere.
Adam Roman, a junior nursing major from Garrettsville, Ohio, says working in his own backyard is just what he has been hoping for once he graduates. His plan always has been to seek employment with UH after graduation, so the possibility of having the additional $12,000 incentive only makes his desire stronger. The money, he says, would enable him to graduate from college virtually debt free.
Christina Hansen, a junior nursing major from Mentor, Ohio, hopes to remain in Northeast Ohio immediately after graduation, or at least until her student loans are paid off, but she also has considered the adventure of moving away, perhaps to somewhere warmer.
Nursing officials know the lure of warmer climates will always draw graduates south to Florida and the Carolinas. Still others, including junior nursing student Aaliyah Davis, will just want to return home.
A native of Westchester, Ohio, and a first-generation college student, Ms. Davis hopes to return to the Cincinnati area once she finishes her BSN at Kent State, because that is where she grew up and where her family still lives.
Ms. Davis says she has long ties to Cincinnati, where her mother’s family emigrated from Cambodia in the 1980s, and where her father’s family has lived for generations. Her parents encouraged her to come to Kent State because of the quality of the College of Nursing and because the amount of scholarship money she received outpaced the University of Cincinnati’s offer.
Her ongoing clinical rotations at UH have shown Ms. Davis that the nursing shortage is real. “It gets very hectic,” she says. When a nurse calls off, the workload can be “overwhelming.”
It is important for her to give back to the community where she was raised and where the nursing shortage rivals that of Northeast Ohio. “I will be part of the solution,” Ms. Davis says.
Quality over quantity
The drive to graduate more nurses, though, will never outweigh Kent State’s mission to graduate quality nurses, Dean Broome says. For that, she credits Kent State’s faculty and staff.
“Without the faculty, we could not produce the caliber of students that we do,” says Dean Broome. “We look for faculty who are compassionate, exciting, engaging and really love to teach others—and who are skilled clinicians themselves.”
Most conversations among College of Nursing staff, Dean Broome says, are not about how to generate more nurses, but about how to assure that Kent State’s graduates will possess the qualities they strive to develop in student nurses: “Exceptional health care providers, leaders and creative thinkers who actually make a mark on health care.”
Such efforts result in a much-sought-after brand of nurse. Last summer, for example, when UH offered paid summer internships to 100 student nurses from four universities, Kent State was proud to have claimed 55 of the spots, Dr. Motter says.
Kent State students also help fill the ranks of the ASCEND program, sponsored by Key Bank, which provides internships at Akron Children’s Hospital for diversity students, in hopes that the interns will eventually be hired as part of the nursing staff.
Ideas to improve care
To promote a high level of excellence, Dean Broome says she encourages healthy discussion among staff, whether that’s a quick conversation in a hallway or a meeting where everybody sits down, shares their ideas and discusses what they think might work.
Her faculty members, she says, joke that they often come up with their best ideas due to insomnia. In any event, those ideas get shared, vetted and often turned into classes or programs.
One such idea occurred to Dean Broome during a board meeting at UH Portage Medical Center, where she is a board member. The discussion was about how hospitals get reimbursed by Medicare and most major medical insurances— and how they don’t. Specifically, if a patient treated for pneumonia, congestive heart failure or diabetes is readmitted within 30 days of his or her discharge, insurance does not have to pay the hospital for the readmission.
As Dean Broome listened to the discussion, it occurred to her that a substantial group of patients could fall into that category—particularly the elderly and those who live alone. Following discharge orders regarding diet, medication and follow-up visits is not only important to their health, but to the hospital’s financial health as well. And yet, “these are people who fall through the cracks,” she says.
Dean Broome began to think about ways to help the situation, which resulted in the Kent State/University Hospital Discharge Transition to Home program, set to begin fall semester 2019. In this program, senior-year student nurses will visit the at-risk-group of patients to review their discharge orders and make sure they are carrying them out.
Not everyone qualifies to receive insurance reimbursement for treatment by visiting nurses. “If someone is old and sick, but not necessarily homebound, there is no funding for them and no follow-up visits,” Dr. Motter says.
With this program, those patients will gain a level of care that previously did not exist for them—someone to make sure they are properly taking their medications, checking to see if their home
is a safe environment and making sure they understand and are following any special dietary needs.
UH hopes the program will enhance the quality of life for the patients and help reduce the number of hospital readmissions.
And for the student nurses, the program will offer a new layer of community health nurse training, as they help the patients transition back home—and help the College of Nursing make a positive impact in the community.
It was Dr. Motter who came up with the idea of collaborating with theatre students to act out the end-of-life and mental health crisis scenes for nursing students in the simulation lab. The labs, which every nursing student must take, are designed to give students an idea of the kinds of behaviors they can expect when dealing with dying patients and their families or with mentally ill patients—two of the most challenging situations for nurses.
Dr. Motter coordinated the program with Eric van Baars, director of the School of Theatre and Dance, to use student actors to create real-life simulations. At the same time, the labs offer acting students the chance to create their own characters and act out scenes through improvisation rather than a script.
“The opportunity to immerse oneself into character research is great training for the actors involved in the nursing simulations,” says Eric van Baars. “One of the most valuable aspects of the partnership for actors is the ability to share feedback with the nursing students afterwards. Actors are always getting feedback from audiences, but the ability to give feedback to nursing students is something unique to this program and certainly helps student actors increase their capacity to empathize, remember and feel impacted by the actions of others.”
Plenty of universities educate both nursing and theatre students, but few put them together in the way that Kent State does for the patient simulation scenarios, Dean Broome notes.
Using the theatre students results in realistic experiences for the student nurses—along with some surprises.
“One acting student started taking his clothes off, which is what manic people will sometimes do,” Dr. Motter explains, noting that she sat quietly, hoping he would stop before he was completely naked. “He did stop.”
Kent State nursing majors Aaliyah Davis, Adam Roman and Christina Hansen have clinical rotations at University Hospitals in Cleveland.
The statistics are daunting: A national shortage of one million nurses by 2020.
In 2010, the Institute of Medicine issued “The Future of Nursing: Leading Change, Advancing Health,” a report that recommended the number of registered nurses with a bachelor’s degree in nursing should increase to 80 percent by the year 2020. For the past 10 years, universities and hospitals have been working toward that end. Kent State offers the following pathways to a Bachelor of Science in Nursing degree:
A traditional student who studies at Kent State, typically for four years, and graduates with a bachelor’s degree in nursing. This degree is available at the Kent, Geauga, Salem, Stark and Trumbull campuses. This path makes up approximately 325 of the 450 BSN degrees that Kent State awards each year.
The Accelerated Nursing program is for anyone who already holds any bachelor’s degree. This program, designed for those approaching nursing as a second career, will give the student a second bachelor’s degree in nursing in just 15 months. Participants in this program may attend school during week days, evenings or weekends, with clinical rotations offered at University Hospitals, the Cleveland Clinic or Summa Health. This program makes up approximately 125 of the 450 BSN degrees Kent State awards annually.
The LPN to BSN program, which began in 2018, offers licensed practical nurses a program in which they can earn a Bachelor of Science in Nursing degree. LPNs have less formal training than registered nurses and are able to perform fewer duties; they often have earned either an associate degree or certificate. Students in this program must first finish the general education core requirements, and then are moved into the accelerated nursing program and put on the 15-month schedule.
The RN to BSN program offers a registered nurse who graduated from a diploma school, such as a hospital program, the chance to earn a bachelor’s degree by taking 11 additional courses, all of which are online only. This program is available to residents in 20 states, including Ohio, and the US Virgin Islands.