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To purchase reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints{at}aacn.org.
The complete program materials from the GPC-AACN consortium may be purchased from the American Association of Critical-Care Nurses (product No. 128626), 101 Columbia, Aliso Viejo, CA 92656-1491, (800) 899-AACN.
Hospitals are aggressively recruiting new staff and use agency and traveling nurses to fill vacancies. These solutions are temporary and costly. Critical care internship programs seek to attract experienced nurses who want to transfer to a critical care area or new graduate nurses who have an interest in critical care. Although no standardized definition of an internship program has been published, this term is often used by clinical nurse specialists and educators to describe a program that provides specialty-area content combined with building of area-specific skills and time at the bedside with a clinical preceptor.3
In 1996, board members of the Greater Portland chapter of the American Association of Critical-Care Nurses (GPC-AACN) noted that 6 introductory internship programs in adult critical care were offered in the Portland area. These programs were sponsored by 6 different hospitals and involved approximately 120 participants. The GPC-AACN saw an opportunity and invited a group of area clinical nurse specialists, nurse educators, and managers to discuss the idea of forming an educational consortium to more effectively address entry-level education for novice critical care nurses. In this article, I describe the process this group went through to develop a 6-day course on the core theory of critical care nursing on a consortium basis, discuss how this core content can mesh with individual hospitals’ internship programs, and provide details that readers might use or adapt for use in their own facilities.
The idea of consortium-based education is not new. The literature describes a number of models.4–12 Although the specifics may vary, the factor that all these programs have in common is the consolidation of resources from a variety of institutions. These resources include content development, presenters’ time and expertise, sharing the organizational and structural details for putting on a program (ie, putting together a class schedule, developing and collating a syllabus, collating and analyzing evaluations), and use and maintenance of suitable educational spaces. This consolidation strives to reduce duplication and costs while providing a high-quality end product.
Educational consortiums have been defined as a partnership, where a group of institutions in a similar geographic area work together to sponsor a program. The Middle Tennessee Critical Care Program Consortium formed in 1971 was the first of its kind in the United States for critical care, and it is still in operation.12
THE PORTLAND PROCESS
Clinical nurse specialists, nurse educators, and managers met in January 1997 at the invitation of the GPC-AACN to discuss the possibility of creating an educational consortium. A letter was sent to all hospitals within the local AACN chapter’s area, as well as to surrounding communities within a 2-hour driving distance. Twenty-five nurses, representing 16 different hospitals, attended the first meeting, which was facilitated by the president of the GPC-AACN. A rich and productive discussion took place. General approval of the concept for an area-wide educational consortium was obtained, and the GPC-AACN’s Introduction to Critical Care Educational Consortium was born.
The initial group of 25 distilled down to a steering committee of approximately 12 nurses representing 7 different hospitals or hospital systems. Subcommittees were formed to explore the administrative details of developing a consortium and to outline its specific content. The subcommittees pooled information from their own experiences, but also reviewed information provided by the Seattle Area Critical Care Cooperative and the Greater Cincinnati Critical Care Program.
Because of the competitive nature of the healthcare market in this geographic area, the group committed itself to clearly outlining the processes and expectations of the consortium. Details were drafted into a letter of agreement that was formally approved by a senior nursing executive at each participating hospital. The letter of agreement served as a contract for the consortium members as well as a blueprint for how the consortium operates.
THE FRAMEWORK
The consortium developed objectives (Table 1
) that were agreed to by all 7 consortium members, all of whom believed that they would benefit from this collaboration. Participating institutions and the GPC-AACN selected a mix of clinical nurse specialists, educators, and managers to represent them on the consortium board. The end product of the consortium is a 6-day core course in critical care that provides a solid foundation for novice critical care nurses to build upon. This foundation is appropriate for the variety of critical care units found within the hospitals participating in the consortium. For each participating institution, this 6-day program provides the core content on critical care theory that is needed for their individual internship programs. Further educational content that may be necessary for a specialty area not found within the majority of participating hospitals (ie, burn patients, or level I trauma patients) is provided by the institution that deals with those populations of patients. Each participant receives hands-on skills laboratory practice with hospital-specific equipment (eg, pressure tubing and pulmonary artery catheter setups) and time at the bedside with a clinical preceptor at their home facility.
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A onetime initial fee of $495 is required to join the consortium. This money is designated to pay for the clerical assistant’s salary, printing costs, postage and mailing costs, and any other expenses that may occur. These funds are kept in an account specific to the consortium that is managed by the treasurer of the GPC-AACN (these funds are completely separate from the AACN chapter’s funds). After that, no money exchanges hands between participating institutions. All the tasks necessary to produce a course are outlined, and point values are attached to them (Table 2). These points are assigned by estimating the financial value they represent. An arbitrary dollar value of $12 per point was assigned. For example, lecturer time was valued at $30 per hour, and every 1 hour of lecture was credited 4 hours worth of points to account for preparatory time. So 1 hour of lecture is worth $120 (4 x $30) or 10 points ($120/$12 = 10). Consortium members earn points on the basis of the responsibilities they assume for an individual program. In addition, the convener and recorders for the monthly board meetings earn points for this service, as do participants in the content committee. The only out-of-pocket monies paid are for clerical services provided by the chapter assistant, postage/mailing costs, and printing of the syllabus (or a consortium member may choose to provide the syllabus for points). Revenue is generated from the onetime consortium membership fee and from tuition paid by participants not sponsored by a consortium member (approximately 5% to 10% of participants are not sponsored). Once every fiscal year, the consortium gives the chapter 10% of any profits generated in the past year as a way to acknowledge their ongoing contributions to the consortium’s efforts.
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shows the points earned by the 7 participating consortium hospitals for a program. They each send the nurses they have hired for positions in their critical care units or nurses they wish to cross-train in critical care. Dividing the total points earned by the number of participants sent derives a point/participant ratio.
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There is no charge to participants sponsored by a consortium institution; the workload is adjusted among members to keep the ratios as equal as possible. The course is open to nurses from nonmember hospitals. These non-sponsored participants pay $425 for the 6-day course. Nonsponsored GPC-AACN members pay a reduced fee of $350, and the nursing student fee is further reduced to $150. Nonsponsored participants would pay $75 per day if they did not need to attend all 6 days. All participants must provide evidence in the form of a faculty signature that they are attending the course as part of training with a clinical preceptor in a critical care unit.
Job descriptions were written for the various tasks needed to put on a course and are updated on a yearly basis. These include an overall course coordinator, individual day and site coordinators, a syllabus coordinator, an evaluation coordinator, a continuing education units coordinator, and chapter support activities. These descriptions were designed to serve as a checklist for the person performing the job, as well as a way to inform new members of the consortium board about the division of labor.
COURSE CONTENT
The majority of nurse participants are hired by individual hospitals for specific nursing positions. The consortium course provides the backbone of the didactic component of their internship program as novice critical care nurses. Other participants include nurses being cross-trained to work in a critical care area. The consortium content subcommittee started by examining content of courses already implemented by area hospitals. Very little variation existed as the courses had all been designed using the AACN Core Curriculum for Critical Care Nursing13 as a blueprint. There was wide agreement among committee members about what constituted core content in critical care.
The content of the program was deliberately organized to focus on the core curriculum that any entry-level critical care nurse would need to know. This core content was designed to be a firm base upon which novice nurses can build as they gain experience in their new practice setting, no matter what specific population of patients is their specialty. Once the core topics were selected, the group wrote specific lecture objectives. These objectives were designed to provide instructors with a framework for developing their lecture and to promote consistency of content among presenters. The program presents the core content in 6 days spread out over 6 weeks. The classes are offered 2 days in a row every other week. Each class day builds upon and reinforces content previously presented. During the intervening weeks, the participant spends time at the bedside with a preceptor applying concepts learned during class. Depending upon their institution’s particular internship program, participants may also be assigned to attend hospital-based skills training sessions and/or case study discussions on related core content.
The orientee spends 2 days every other week in these core lecture classes. The first 2 core days cover cardiovascular and pulmonary concepts and diseases, as well as transition issues. The second 2 core days expand on intermediate hemodynamics, pharmacology, and neurological topics. The last 2 core days address multisystem issues of shock, nutrition, and renal, liver, and endocrine issues (Table 4). Presenters are encouraged to use interactive classroom techniques and to incorporate the use of case studies within their presentation to illustrate and reinforce content. Participants are asked to prepare for the core lectures by reading about the lecture topics in a current critical care text. A working knowledge of basic nursing skills, the nursing process, and basic interpretation of electrocardiographic rhythm are prerequisites of the course.
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). Selection of specific evaluation methods to determine how well an orientee has assimilated the core content is left up to the individual hospital’s clinical nurse specialist or nurse educator. These methods generally include case study presentations and discussions in the smaller group of participants from the home hospital, as well as multiple-choice and short-answer tests.
The consortium takes a multi-disciplinary approach to selecting presenters, with 80% of the topics presented by nurses and 20% presented by physicians, respiratory therapists, or social workers. Approximately 20 presenters are used to deliver the 25 lecture topics of the program. The majority of presenters are experienced lecturers, but one of the long-term goals of the group is to mentor and develop new speakers. In order to meet the demands of multiple courses per year, the board has the goal of maintaining a potential list of speakers of 2 to 3 people per topic.
COLLABORATING WITH SCHOOLS IN THE AREA
In the spring of 1998, the GPC-AACN representative to the consortium board presented the idea that senior nursing students with a concurrent clinical rotation in critical care would benefit from this course. The board considered the facts that area nursing schools did not have an ongoing course on critical care theory as part of their curriculum and more and more students are expressing interest in being hired into a critical care area upon graduation.
The deans of the area’s schools of nursing were invited to a luncheon meeting with the consortium board, where the rationale and course content were presented. After discussion, it was decided to open up the course to seniors with a concurrent rotation in a critical care unit. These rotations are typically experiences with a preceptor supervised by a faculty member of record from their school of nursing. This extension of the course was successfully piloted with 1 school of nursing in 1999 and has been an option available to all area baccalaureate nursing programs in the area since 2000. Approximately 10 to 15 nursing students have attended a winter or spring program in each of the years since it has been available to them. Eighty percent of these students were hired into positions in a critical care unit after graduation, and all are still working in critical care or step-down units.
Student participation does not change the content or mission of the consortium, as all agreed that the consortium’s primary audience would remain registered nurses who are new to critical care. This collaboration not only benefits the schools of nursing and their students, but also helps to prepare the future new graduates who apply for positions in area hospitals.
EVALUATION
The consortium has sponsored 16 Introduction to Critical Care Nursing programs since the fall of 1997, with an average of 50 participants per course. The consortium offers 3 to 4 courses per year at the request of area nurse executives to help meet the ongoing demand for critical care nurses. The exact timing of the courses is set by the consortium board, but they are offered in the winter, spring, and summer and sometimes in the fall.
From 1997 to 1999, program participants were mostly experienced nurses with a medical/ surgical background who wished to transfer to critical care. In the year 2000, the consortium noted an increasing number of new graduate participants. This change, which is thought to be due to the increasing shortage of experienced nurses applying for jobs at each of the participating institutions, has not significantly affected the program’s didactic content, but it has changed the type of orientation issues noted at the bedside. More emphasis on acquiring competency in basic skills and development of organization and prioritization skills is necessary for new graduates.
New graduate hires who have completed the course as senior nursing students still have orientation needs typical of new graduate nurses, but they come to their orientation with a higher level of understanding of the nursing care requirements of critical care patients and a greater comfort level in the ICU environment than other new graduates. Individual institutions choose whether the new graduate will repeat the course as an orientee to reinforce and broaden this understanding.
Participants’ evaluations of the program have been largely positive. Overall scores for presenters are 3.5 or higher on a scale of 1 to 4. Typical evaluation comments include an appreciation for the presenters’ ability to make complex topics comprehensible and the use of case studies to illustrate points. The consortium board makes adjustments to the program, as needed, based on feedback from participants, presenters, and consortium members.
The job descriptions and content undergo yearly review by the consortium board to ensure relevance and clarity. Dividing the workload into specific job descriptions has generated cost savings to the participating institutions by reducing the individual workload for clinical nurse specialists and educators for putting on the 6-day course, while still providing quality education for nurses. These savings in time can be translated into other educational efforts and services that these individuals can provide to their home institution.
Consortium members and course participants receive tangible benefits from the shared resources. For example, site locations are rotated around the city for the class days. Benefits from this include (1) providing a tangible representation of the collaborative nature of the consortium, (2) spreading the workload among consortium members, (3) freeing up educational space for other endeavors, (4) fairly distributing the commute time for participants, and (5) making it more convenient for a variety of presenters to participate.
The consortium continues to have strong support from the participating hospitals’ managers and administrators. Five of the 7 participating institutions report a 3-year retention rate of 80% to 85% for successful participants in this program. Nurses hired for these internship positions typically are asked for a 1-to 2-year commitment at a minimum, but this is difficult to enforce because of legal issues.
This consortium’s approach to providing education for novice critical care nurses has met with praise from nurse leaders in the area. Other hospitals have met with the consortium to explore whether their needs can best be met by joining or by sending participants to the course. This openness has provided a venue for hospitals in the state who do not have an ongoing need for a critical care program, but appreciate being able to access one on a tuition basis. Two specialty-nursing associations in the area have approached the consortium board to learn about its process and experience. Each has taken elements from the GPC-AACN consortium and successfully adapted it to their own needs.
All participating consortium members describe a high level of satisfaction with this collaboration, and stated objectives are being met. In addition, the monthly board meetings provide a forum for the sharing of ideas and creative teaching methods, problem-solving of orientation issues, and mutual support.
CONCLUSION
The GPC-AACN’s Introduction to Critical Care Educational Consortium has been a success. It produces a tangible reward for all parties involved. The consortium members have forged a successful collaboration in a community where competition for healthcare professionals is very strong. Duplication of efforts has been reduced, and all area hospitals have access to a comprehensive and consistent introductory program at a reasonable outlay of money and effort.
Course participants benefit in a variety of ways as well. They are exposed to quality content that is directly applicable to the patients they care for at the bedside, they have an opportunity to network with other novice critical care nurses, and they get a glimpse of how other area hospitals function.
Local schools of nursing have benefited from being able to provide critical care content for their students without having to create a duplicative course on their own campuses. The local AACN chapter gains by participating in a joint venture that furthers the association’s core values14 to provide education and promote excellence in clinical practice. The whole community wins as more qualified critical care nurses enter the market to care for critically ill patients.
Acknowledgments
I thank the current and past consortium board representatives from the following institutions for their vital contributions to the ongoing success of the consortium: Adventist Medical Center, Kaiser Sunnyside Medical Center, Legacy Health Systems Hospitals, Oregon Health & Science University, Portland Veterans Affairs Medical Center, Providence Health Systems Hospitals, and Tuality Healthcare.
References
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