The State of Rhode Island has a current and projected nursing shortage. Two commissioned studies, SHAPE, 2002 and SHAPE II, 2004, identify an aging workforce and project a shortage of 25% by 2020. This shortage impacts local nursing faculty and limits capacity building of nursing programs. At the same time, serving the veteran population is complicated by multi-generational needs and changing demographics that result in increased utilization of mental health, geriatric, and women's health services. Taken together it is undeniable that the future demand for nurses in Rhode Island far exceeds the potential supply.

Solutions for this shortage must target the identified problems in academia and clinical operations. An integrated, collaborative approach that establishes a pipeline of nurses for both settings and provides for professional development is ideal. The VA Nursing Academy Enhanced Academic Partnership funding will strengthen the mutually beneficial relationship between the Providence VA Medical Center and Rhode Island College (RIC), address the nursing shortage, and improve the care of veterans.

The PVAMC and the School of Nursing have a long-standing partnership that has been strengthened under the current leadership of both institutions. For many years, the School of Nursing has contracted with the PVAMC to offer clinical experiences to students. Location supports the partnership. The PVAMC is located less than five miles from the RIC campus in Providence, RI. In the spring of 2007, a collaborative team of academics and clinicians designed a pilot project to begin to address the shortage of nurses and nurse educators. The project, funded by the VISN, provides the salary for one full time VA employee, a clinical educator, who will have responsibilities at both the PVAMC and RIC. Through this project, a collaborative approach to simulation learning is being implemented to benefit both nursing students and VA nurses. Additionally, nursing student experiences at the PVAMC are being expanded. The pilot project is energizing the partnership.

This proposal focuses on expanding capacity of the faculty and students creating new opportunities for educational and practice innovations:

Faculty and student expansion

• Increase faculty by 3 VA-based and 2 RIC-based faculty in each of the first two years of the program.
• Increase student enrollment by 20 students for each cohort of five faculty positions funded per academic year.

Educational and Practice innovations

• Collaborative approach to clinical placements that reflects current trends in healthcare needs of veterans.
• Expansion of clinical settings to include areas of practice currently not utilized.
• Development of two new advanced clinical rotations in PTSD/mental health and in acute and critical medical-surgical care.
• Expanding use of the RIC Nursing Resource Laboratory (NRL) and simulation center to develop clinical expertise of VA nurses and students, including a simulated approach to testing the 36 new graduate competencies.
• Increasing collaborative relationships between VA nurses and RIC faculty to foster professional development activities such as scholarly projects related to the care of the veteran, evidence-based practice, and interdisciplinary learning.
• Promoting recruitment and retention of RIC students to the PVAMC.
• Developing a multifaceted approach to faculty development to foster the growth of participating faculty, including; individual needs assessment, teaching technologies and simulation learning, mentoring and peer coaching, and current topics of professional interest.

An excellent team is assembled for the PVAMC/RIC partnership. The team includes:

• VA-Based Director: Bonnie Dinwoodie, MBA, BS, RN
• RIC-based Director: Anne Carty, DNSc, RN
• VA Nurse Executive: Deborah Clickner, Med., RN, CNA, BC
• RIC Dean: Jane Williams, PhD, RN
• VA Associate Chief of Education: Nancy Lancaster, MBA, RN

The program directors will each devote 25% time to the program. Additional faculty and advanced practice VA nurses are participating in preliminary activities of the partnership. Faculty will educate students and VA nurses at the PVAMC and at RIC and participate on committees and professional activities at both institutions.

The institutions are well equipped to carry out the proposed program. RIC School of Nursing, accredited by Commission on Collegiate Nursing Education (CCNE), has the largest baccalaureate program in the state and a new graduate program in nursing. Highly regarded, RIC graduates consistently have a 95% plus pass rate on the NCLEX-RN licensure examination, a pass rate significantly above state and national averages. The School is fully staffed with 32 full time faculty and 11 part-time faculty. Fifty-seven percent of the faculty members are doctorally prepared.

In pursuit of excellence, the PVAMC began its Magnet journey with an organizational redesign in 2006 to create a partnership founded on the principles of shared governance that embraces professional accountability extending beyond service lines to support nurse collegiality, and ownership of professional nursing practice throughout the PVAMC. The quality of PVAMC nursing is evident in the academic achievements (a robust 37% of baccalaureate prepared and 23% masters prepared), in nurse satisfaction remaining above local and national averages for the past two years, and in above average performance on the nurse sensitive patient safety indicators.

A number of quality measures will be used to evaluate the proposed PVAMC/RIC partnership. While evaluation plans will be developed for all activities, standard, proven assessment measures will be used to evaluate overall effectiveness of the partnership program. Nursing-sensitive quality indicators collected by the VA Nursing Outcomes Database (VANOD) and patient satisfaction data from the Survey of Healthcare Experiences of Patients (SHEP) will be monitored from the beginning of the program. The RIC Performance Improvement Plan, which includes student, graduate and faculty outcomes, will be used to evaluate the nursing education component of the partnership program. The ultimate goal is to provide high quality healthcare to veterans.