Michigan Teaming Tactically Educating Nurses (MITTEN) Project Abstract History of relationship between VA facility and school of nursing.

To achieve the Michigan Teaming Tactically Educating Nurses Project, the Michigan VA Medical Centers of VISN 11 are proposing to collaborate with key academic affiliates to create a sustainable regional partnership for the purposes of increasing the numbers of nursing faculty dedicated to professional nursing education and increasing the numbers of nurses receiving baccalaureate degrees in our region. Through this unique regional approach, teaching resources can be used more efficiently and the students have an opportunity to experience diverse ethnic, geographic and cultural settings that would not otherwise be available. Additionally, the various locations for clinical learning opens doors for many potential students and returning veterans from across the lower peninsula of Michigan to receive an excellent education closer to home.

Two of the Michigan VA Medical Centers will serve as the principle coordinating sites and will be responsible for establishing the model for the Nursing Academy within the VISN. The John D. Dingell VAMC and The Aleda E. Lutz VAMC will take the lead in establishing the working model, setting the foundation for a strong yet innovative program that can then be expanded to include the Battle Creek VAMC in year three and the Ann Arbor VAMC in year four of the four year pilot. The university partners, University of Detroit Mercy McAuley School of Nursing and Saginaw Valley State University College of Nursing and Health Sciences will serve as the academic affiliates and will assist the VA in developing a program that can be expanded statewide and can therefore be used as a model for replication across the VA nationally.

Currently, the MITTEN project is in year one of the four year program. We have sought and obtained VISN level funding to start of the program and are seeking this National funding to expand this much needed program. We have initiated discussions on establishing a process and identifying scholarship recipients. We have established a process of faculty selection. Detroit and Saginaw have already posted faculty positions. Ann Arbor is in the process of posting faculty positions. We have established a publicity plan which includes a promotional DVD. The group has also worked on developing an educational contract consistent across all the VA's.

Descriptions of new, enhanced, and innovative educational and practice opportunities for students at the VA and schools.

The VA settings will experience a cultural shift from a traditional operational model of practice according to hierarchically determined policies and procedures to a more participatory, critical thinking model that embraces ongoing learning by self and others. The education settings will experience curricular change that expands understandings of populations and nursing intervention activities, as well as promotes the interdisciplinary focus known to affect the best quality outcomes in health care. Creating the synergy desired through a new regional partnership will occur through the concept of learning communities. This concept was selected because learning is central to the unity desired in the activities of the MITTEN Project and community is about the connections desired, both between and among the partners and between and among the learner participants. The Dedicated Education Unit will provide further direction for the MITTEN project. Units within the VA system are known to be organized around population characteristics and needs, as well as focus of service; therefore, these can be readily adapted to become units dedicated to education for particular learning purposes and outcomes. While some staff members are designated as lead faculty, all staff members become part of the educational process for students placed on the unit for their clinical learning experiences; all are learners as a co-learning environment is created and students become immersed in the culture of the (VA) system. Finally, to provide a learning focus for curricular purposes in the MITTEN project, the competencies related to the new quality and safety education for nurses standards (QSEN) will be emphasized.

Roles and responsibilities of VA-based and school-based faculty.

The universities will establish a process to determine which areas of clinical expertise is most needed by the VA faculty. This process will include reviewing the academic credentials and curriculum vitae to determine the best fit to supplement the university's current faculty. Efforts will be made to include as many VA staff as possible to support a larger number of students or provide unique clinical rotation experiences given the number, diversity, and backgrounds of our interested nurses. One of the collaborating universities has a modular program focusing on preparing practicing nurses for a teaching role. All of the VA staff would complete this program regardless of their academic site which creates a consistent method of preparation regardless of geography and helps eliminate redundant activities. Both of which are significant benefits of our system approach.

VA-based Faculty will serve in a dual role of practitioner and educator, maintaining primary responsibility for the nursing care of the population served by the VA system and simultaneously being responsible for the clinical learning, at least initially, of undergraduate, pre-licensure BSN students from the partner education institutions. These faculty members will remain full-time employees of the VA system with a portion of time released to serve as educators; in that capacity, they will have the faculty designations and accompanying rights and privileges appropriate to/characteristic of the particular partner education systems. The VA-based faculty will assume responsibility for groups of (8-10) basic students to achieve the prescribed clinical learning activities for the course in which they are enrolled; specific role functions include, but are not limited to: attending planning and progress meetings with University faculty, selecting appropriate assignments, reviewing students' written materials, pre- and post-conferencing, observing and evaluating student performance, etc. They will also be involved in activities related to project management, implementation and evaluation. The VA based nursing faculty will potentially assume a variety of roles and responsibilities in Michigan's Nursing Academy pilot. These primarily include: leading a dedicated education unit; presenting didactic components of a class segment; overseeing all aspects of students' clinical experiences in the VA facilities; serving as clinical preceptors in specialty practice areas such as research; and evaluation of students' clinical performance. In short, they will contribute expertise in current nursing practice with complete and accurate knowledge of the routines, policies and procedures of the VA system. They also can provide input in the development of educational content and clinical experiences that mirror the practice environment so that students receive clinical supervision, guidance and mentoring from practicing nurses who are knowledgeable and committed to the institution.

The school/university-based faculty are expected to be those involved with the students who will be placed at the VA sites; therefore, their lead role will be essential to setting and communicating the expectations for the students' learning, as well as initiating and guiding any curricular work that may be necessary. Relative to the components of the MITTEN Project framework, this faculty will facilitate, support and participate in the formation and sustainability of the learning community (ies); for example, they may serve as mentors to the new VA-based faculty. In a similar capacity of facilitation, support and participation they will also serve the Dedicated Education Units; it is realistic to assume that these faculty will develop and exercise a collegial attitude/stance and utilize these units as opportunities for their own growth and development as professional practitioners. Likewise, relative to the focus on the quality and safety competencies, this faculty will contribute their research ability, as well as their unique professional assets of knowledge and skill pertinent to the topic; for example, they will join their colleagues at the VA sites in groups such as one that focuses on developing evidence-based practice.

Faculty development program for the VA-based faculty.

The VA staff selected to be Clinical Educators are well respected as expert practitioners, both in the sense of direct patient care and system function and management. Their preparation and experience with the education of the next generation of nurses, however, is generally limited to indirect contact with faculty and students when they have utilized the VA for clinical placements. The assumption, therefore, is that they will need assistance with the role expectations and functions of a clinical educator as outlined in the Faculty Development Program. It will consist of 7 modules for a total of 30 contact hours; 2 graduate credits will be earned. These credits will be accepted as meeting part of the requirements for the current nurse educator certificate program at the University of Detroit Mercy McAuley School of Nursing. A hybrid model (combination of online and face to face using net meeting) is proposed. Several ways of offering the program are available: 2 hours every other week for 14 weeks (September, October, November, December); 5 hours (Saturday) one per month September, October, November; 6 week intensive in July and August.