Take-along Tech and the Training of Specialty Nurses

Recruitment and retention of high producers are key factors in any organization’s business success. For a healthcare system, recruitment and retention are the tip of the iceberg; the nation’s nursing shortage automatically quadruples the challenge.

However, in Austin, Texas, a joint endeavor between The St. David’s HealthCare Partnership and Austin Community College (ACC)—along with a healthy grant from the U.S. Department of Labor (DOL), out of the President’s High Growth Job Training Initiative, has produced a possible solution that could be replicated in many communities nationwide.

Beginning in the fall of 2004, these two organizations placed PDAs loaded with nursing reference software into the hands of three of four nurse fellow cohorts, to total 70 registered nurses and 25 clinical coaches over a two-year period, as part of a twofold goal: 1) attract, train and retain the best nurses; 2) help shorten the nurses’ learning curves as they prepared for their futures in various nursing specialties. Along the way, the two organizations also hope to influence patient safety and to promote evidence-based outcomes.

From Think Tank to Point of Care
The St. David’s HealthCare Partnership is a partnership between St. David’s HealthCare System, a not-for-profit organization, and HCA-The Healthcare Company. Austin and central Texas residents receive care through The Partnership’s four acute care hospitals as well as through ambulatory surgery centers, a rehab center, a behavioral health facility and occupational health services.

Together, The St. David’s HealthCare Partnership and Austin Community College applied for and received a $2 million DOL grant to turn their brainstorm idea into a reality. ACC’s Susan Smith, R.N., who also holds a doctorate in health education, heads the innovative fellowship program. The concept, she says, came “from a St. David’s think tank of clinical nurse specialists, managers and educators who wanted to help recruit talented nurses to the organization,” and thought providing PDA-based information technology would be appealing. The PDAs and nursing software are just one part of a comprehensive, specially created learning environment that The Partnership believes will help attract top nursing talent to Austin.

The federal grant is for two years. Smith says the recruitment and selection process was deliberately arduous. For starters, all nursing candidates had to submit a comprehensive application with two letters of recommendation, a personal essay, evidence of community service, continuing education if applicable, and preferred affiliation with at least one professional association.

Each applicant had to be an R.N., but with no more than one year of experience in his or her medical specialty. Each had to possess basic IT literacy, i.e., have had access to e-mail and the Internet and be comfortable with mobile computing devices. Also, each had to be hirable and hired as an employee by The St. David’s HealthCare Partnership within the specialty track he or she was pursuing, and had to move to Austin. Failure to qualify on any of the criteria meant inability to participate in the fellowship. The two organizations began recruitment with local advertising and eventually expanded to national advertising to identify the best candidates.

Software That Nurses Use the Most
Fortunately for Smith, software selection wasn’t nearly so arduous. “I asked other nurses and colleagues what software applications they used the most,” says Smith, “and they all said ‘Skyscape—they have exactly what we want.’” Skyscape it was.

Taber’s Medical Dictionary, Davis’ Drug Guide for Nurses, ABCs of Interpretive Laboratory Data, and RNFastFacts (Nurse’s Fast Facts: The Only Book You Need for Clinicals, 2nd edition) became the foundation of references loaded onto Dell Axim hand-helds. “Many more applications exist for specialty nurses,” says Smith, “in the areas of geriatric, ambulatory care and pediatrics, for example, but those four are applicable across the board. I think every nurse should have access to those four resources.”

When it came to using the software, though, the fellowship nurses faced a brief learning curve. While all of the program fellows had some familiarity with IT, only about 10 percent had used a PDA device previously; in the beginning, when it was necessary to sync the devices, the nurses had to be taught how.

“You can’t compare this level of point-of-care reference to anything else,” says Smith. Traditionally, she says, a nurse with a new patient would invariably encounter questions: She might need to return to the nurses’ station to consult a textbook or medical dictionary or to access the hospital’s computer; she might return again for information on a lab test she is unfamiliar with, or for particular dosing information; she might want to consult a medical reference before contacting the patient’s physician. In the past, every question or concern could require a trip to the nurses’ station with a logon to the hospital’s system. Today, all the program fellows can use Skyscape nursing references on their PDAs to get answers without leaving a patient’s bedside.

The Integration Ingredient
While Skyscape keeps its medical references continually updated and nurses can download the most current information at any time, it is integration that Smith says makes the software most valuable. Skyscape provides smARTlink technology that integrates the subject matter in all its medical references. This means nurses can toggle or “smart link” back and forth among applications for specific drug, diagnostic, disease and dosing answers, all at one time. “Anytime one application ‘talks’ to another, it’s a plus,” says Smith.

To be sure, $2 million is a healthy chunk of change, and Smith is quick to say it funded a lot more than PDAs and software alone. The 70 fellows’ salaries are paid from the grant monies, as are memberships in professional associations and a degree of educational/conference expenses for each nurse—to say nothing of advanced educational tools.

The grant also helped pay for SimMAN, a human patient medical simulator, as well as cardiac simulators and learning models, in an effort to provide a safe educational environment where the fellows could “practice” as much as possible. (Editor’s Note: See “Medical Simulation Makes Medical Education Better and Safer,” in HMT, December 2005, Thought Leaders column.) “The more hands-on training a nurse has,” says Smith, “the more competent that nurse will become. The DOL grant allowed us to combine robotics, hands-on training and rotation into two affiliated HCA facilities with PDA-based medical and nursing references.”

For nurses, proficiency in a specialty track might require three to five years, says Smith. The St. David’s HealthCare Partnership and Austin Community College are hoping to shorten that time requirement, with two years being ideal and less than five years being expected. While everyone involved in the fellowship program is collecting data and stats like crazy, Smith says the final compilation of monster metrics for the DOL still will be geared to meeting grant requirements but won’t actually prove a reduced proficiency curve among nursing specialties. That, she says, will take more than a two-year grant program and 70 nursing fellows to demonstrate, although she fully expects success.

The Making of a Model
“The PDA is the highlight of each fellow’s experience in this program,” says Smith, adding that none of the nurses wants to be without a PDA. “We communicate with the fellows by e-mail and Blackboard, an Internet-based interactive communication vehicle. They can access Microsoft Word on their PDAs, and they have a scheduler built in along with a microphone. Also, the fellows feel valued. They are learning hands-on with medical simulation, but simultaneously, they are teaching hands-on with their PDAs.” Smith says the fellows are regularly sought out by other clinicians because of the speed and convenience of their portable medical references. “Can you look this up for me?” is a commonly asked question in The Partnership facilities.

The federal grant requires that The St. David’s HealthCare Partnership and Austin Community College provide a model to the DOL; most of the metrics collected and assembled by Smith and the program’s leadership team will be geared toward meeting federal requirements for the funding and toward the development of a workforce growth model. But another “model” being created in Austin is the expertly trained specialty nurse of tomorrow, a critical player on any patient’s treatment team and a clinician fully comfortable with and supported by information technology. No one is happier to be part of that endeavor than Smith. She calls the technology “awesome” and says every nurse should have a PDA.

For more information about point-of-care nursing references and decision support software from Skyscape,
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Editor’s Note: At the start of February 2006, Dr. Susan Smith resigned as program director for Austin Community College, to relocate to another state with her family. She remains a consultant to the ACC recruitment program.