Eastern State Hospital Work Learning Program Strengthens Nursing Workforce
When Heather Robertson, MPA, saw how her daughter was flourishing at the University of Kentucky (UK), she recognized that a big part of the reason was the university’s Living Learning Program (LLP). The program, which enables students with similar interests or backgrounds to live in a residence hall together, offered her daughter support and a sense of belonging as she juggled a challenging schedule and adjusted to college life.
Robertson serves as assistant director of operations for Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATHE) at the UK College of Nursing (UKCON) and assistant director of operations for Evidence-Based Practice and Tobacco Dependence Treatment for UK HealthCare® (UKHC) Management of Eastern State Hospital (ESH). She began mulling what made the UK LLP program work so well and researched its evidence-based components. She noted students benefitted by sharing a common experience that drew them together and how as additional organized social activities helped them further feel part of a community. And, for students in LLPs based on academic interest, the setup also presented the opportunity for group study and mentoring.
“It created bonds between my daughter and the other students almost immediately,” she says. “Her transition was so smooth because UK provided these experiences and opportunities.” Robertson, whose work hours are split between the College and UKHC, began pondering how some of the LLP’s elements could be applied to entice associate degree (ADN)-prepared RNs at ESH to seek a baccalaureate degree through a similarly structured program.
“From my own experience with my daughter, I started researching and thought: What if I could tweak this and use some of the same components but apply them to working and learning together rather than living and learning together?” Robertson says.
She took her thoughts to Associate Professor Chizimuzo “Zim” Okoli, PhD, MPH, MSN, RN, CTTS. The pair talked through the idea of creating a structured program that establishes cohorts of RNs who can support each other while they work at Eastern State and further their education at UKCON, using its online RN-BSN Option.
The American Nurses Credentialing Center (AANC) has strongly encouraged these type of partnerships to “create systems for nurses to achieve educational and career advancement, prepare nurses of the future to practice and lead, provide mechanisms for lifelong learning, and provide a structure for nurse residency programs.”
The result? Since fall, the psychiatric hospital’s first cohort of RNs have been piloting the newly created Work Learning Program on their way to earning their BSNs through a partnership among ESH, UKCON and UKHC. The goals set forth include advancing education, enhancing staff development, supporting research and improving patient outcomes at ESH.
Upping the Ante at Eastern State Hospital
ESH has been managed by UKHC since the fall of 2013 when the psychiatric hospital moved from its original location on Newtown Pike, just north of downtown Lexington, to a new, state-of-the-art facility off of Citation Boulevard on Bull Lea Road.
The new facility is licensed for 239 beds but currently operates 140 acute beds. Stays vary from as short as three days to as long as many years. Patients with acquired brain injuries and geriatrics are usually placed in the 15-bed long-term care side, a new addition since moving. The campus also includes four personal care homes (only two of which are operating) that each house 16 patients.
Opened in 1824, ESH is the second-oldest psychiatric hospital in the nation. It was owned and run by the state for years, and though its census varied through the decades, patient numbers reached an all-time high of 2,000 in 1945. Those numbers declined drastically in the mid-1960s through the mid-1970s with legislation that appropriated money for more community-based outpatient care in place of institutionalized care.
Concerned that ESH might close and vital inpatient mental health services would be lost, the community-based Bluegrass Regional Mental Health-Mental Retardation Board, Inc. (now Bluegrass.org), took over its management in the mid-1990s.
When UKHC assumed management four years ago, says Eastern State Hospital Assistant Chief Nurse Executive Marc Woods, MSN, RN, who has worked at the hospital for 24 years, they changed the culture. One example he cites is that nursing staff at the former hospital site were using restraints and seclusion on patients at a rate four times that of other state psychiatric hospitals. “It represented a failure of treatment,” he says. “It doesn’t mean it wasn’t necessary, but, rather, that something should have occurred to prevent it from getting to that point.”
With more education and greater understanding of patient needs, Woods says UKHC reduced the use of restraints and seclusion by 85 percent within a year. “This was empowering to us as nurse leaders and showed us we could move big things and change how care is delivered,” he says. “It inspires us to do bigger things.”
Better Education, Better Outcomes
One of those “bigger things” is working toward ANCC Magnet Recognition®—the gold standard of nursing care. Woods says Magnet status had been on his agenda even before other nursing leaders advised that with ESH now managed by UKHC, there was no other option.
“I had thought, of course, we should make the journey and apply for Magnet status,” he says. “It shows a dedication to quality and represents a standard of care that no other state [psychiatric] hospital has been able to achieve.” One large aspect of gaining Magnet status includes a defined commitment to having a better educated nursing staff, with the aim of having a workforce comprising 80 percent BSN-degree, or higher, nurses to 20 percent RNs by 2020.
“There’s quite a body of research that shows higher-level education preparation among nurses leads to better outcomes among patients,” says Jessica Wilson, PhD, APRN, who coordinates the RN-BSN Option for UKCON and helps Dr. Okoli and Robertson to oversee the Work Learning Program. “[The nurses at Eastern State] are already accomplished nurses who are established and experienced. We want to support them in furthering their education while working.”
Dr. Okoli says the RN-BSN Option provides additional classes, including ones that focus on leadership and evidence-based practice, that help round out a nurse’s education. The result is better quality of care and better outcomes for patients. “It’s one of the main reasons that UKHC achieved Magnet status, and it’s a requirement as we go up for our next assessment that we continue to increase the number of nurses with bachelor’s degrees.”
Getting Started on the Work Learning Program
The first cohort in the Work Learning Program last fall contained four nurses, and Dr. Wilson says they are hoping for more this year.
“Like anything else that’s new, people want to watch others try it first to see what it’s like,” she says.
To be eligible, nurses must meet UKCON’s admission requirements for its RN-BSN Option.
As UKHC employees, tuition for their six credit hours per semester is covered as an employment benefit. Additional benefits include two paid hours per week, beyond regular work hours, that are spent on education. Once a month, those two hours include a required group meeting with faculty. In return, participants sign a two-year commitment to remain at Eastern State after completing their coursework, with the hospital intending to provide a secure job commensurate with their academic achievement.
“I am excited about what they’ll bring to our program,” says Dr. Wilson. “We haven’t had many psychiatric nurses. I am excited about increasing the other nurses’ awareness about mental health.”
Meanwhile, the cohort also provides its own room at ESH with a computer, a comfortable study nook and refreshments, which is used for the dedicated study times, meetings, mentoring, cohort social events and other program needs. The group is mentored by a faculty member once a month, and quarterly workshops are held on educational and professional topics.
“UKCON faculty will come and cover topics like writing CVs and resumes and doing research and evidence-based practice,” says Dr. Okoli.
The cohort will receive a list of Eastern State Hospital priorities from which they can choose evidence-based projects focused on the patient population for whom they provide care.
“From a nursing perspective, we’d like to understand and enhance the evidence for psychiatric nursing practice,” he says. One of the six evidence-based practice projects underway at ESH is seeing whether using nurses instead of only mental health associates to do rounds leads to better outcomes for the patients and lowers aggressive behaviors. Others are related to smoking, including surveying staff and managers on how they would feel about engaging patients in tobacco treatment.
“When we get the results, we can change the practice,” says Dr. Okoli, who also directs the Tobacco Treatment and Prevention Division of the Tobacco Policy Research Program for BREATHE. Currently, he is researching the use of tobacco in individuals with mental illness and using their stays at ESH as a window of opportunity to engage them in tobacco treatment.
The idea of the Work Learning Program, in addition to the cohort support, is to create academic-clinical partnerships and evidencebased practices that enhance patient outcomes while providing staff with more clinical expertise and education. “It makes sense to work together more closely to provide what the industry needs,” he says.
Woods gives a lot of credit to the administrators at ESH, UKCON, UKHC for supporting the endeavor. In particular, he commends ESH Chief Administrative Officer Carrie Rudzik; UKCON Dean and Warwick Professor of Nursing Janie Heath, PhD, APRN-BC, FAAN; and UKHC Chief Administrative Officer and Chief Nurse Executive Colleen Swartz, DNP, MSN, MBA, RN, NEA-BC.
“It’s amazing,” he says. “Once they heard the idea, they were pushing us to get the Work Learning Program out. The great news is, it’s just beginning. And the true fruits will be the high-quality care from those individuals who go through this program and the patients who benefit from this.”
Robertson, the catalyst behind the program and now its coordinator, says she is also appreciative of the support of everyone involved and the opportunity to implement the program.
“It really was figuring out all the details to determine how each partner could best contribute to this academic-clinical partnership,” says Robertson. “We came up with a win-win for everybody.”
