As the workforce of more than 4 million registered nurses in the U.S. endures a shortage that is expected to persist through 2030, hospitals and universities are seeking ways to lessen the burden of an already stressed system. One proposal: Reconfigure the inner workings of nursing education.
After 41 years in the profession, Lisa Rowen, DNSc, RN, the senior vice president and chief nurse executive for Baltimore-based University of Maryland Medical System, has implemented a new way for clinical training to run that benefits students and addresses the staff shortage hospitals are facing. As of this spring, 355 students in 59 cohorts have been educated under a new model, one that 26 other hospitals and health systems — and counting — have also contacted Dr. Rowen to adopt as well.
"This could be the international model for how we educate nurses, how we support hospital nursing, our schools of nursing and our profession," Dr. Rowen told Becker's. "Because we have a big nursing shortage, we need to be creative and look at models of education and care that are mutually supportive, and that will ultimately help graduates be more job ready with greater insight about what it is to be a nurse."
A new way of doing things
As an 11-hospital academic medical system that provides 25 percent of the hospital care across Maryland, the University of Maryland Medical System has also endured its fair share of difficulties due to the nursing shortage nationwide, Dr. Rowen explained. Which is part of what prompted her to concoct the Academy of Clinical Essentials initiative, which educates a cohort of nurses at the bedside under the instruction of a hospital-based nurse.
With the ACE model, students are at the bedside for a full 12-hour shift overseeing the spectrum of continued care for patients throughout the course of a day and "get a realistic clinical experience, are immersed in clinical care for a full shift and have accountability for patients from the beginning of their shift until handing off to the oncoming nurses at the end of their shift," according to a news release.
"Typically, in the traditional model, you'll get between six and eight nursing students with one instructor who doesn't work in your hospital, and because of that there is a big learning curve," Dr. Rowen explained. "Instead, we are having our own nurses be ACE instructors. Our nurses know our patient population. They know each team member on their unit and because the instructors have the students on their own units, the students also learn this. They learn what the policies, procedures and guidelines are. They know where our equipment and medications are. There's no learning curve, so it creates this great situation where the students are paired with a really knowledgeable nurse who works on that unit and the students are immediately embedded in the culture of the unit."
With this model, Dr. Rowen says not only is it more efficient, but also "bolsters the staffing support that we have, because the students are so motivated to help and learn."
On top of that, it addresses one of the key difficulties nursing education faces: attracting educators. Typically, when an experienced nurse looks to move from hospital clinical work into education, they make less. However, under the ACE model, nurses can be clinical instructors, continue practicing in a clinical setting and not make any less.
"We've contributed 91 clinical instructors that we've paid for to Maryland, and we've found that many of them say they wouldn't normally be clinical instructors. Many have told us, 'I love teaching, and I thought about going to be a clinical faculty member at a school of nursing, but I didn't want to leave the hospital and give up my clinical skills or lose my normal rate of pay. So this has given me the best of both worlds,'" Dr. Rowen said. "We give them an hourly premium also when they do their ACE shifts, but they don't have to take a pay decrease to work at a school of nursing, and they're able to have one of their three 12-hour shifts be a diversified experience for themselves too."
Of course, the program, which took off in just three weeks initially, had some early challenges too — one of which was realizing that asking the ACE instructors to also grade student papers was not the way to go. Dr. Rowen said now they have a faculty liaison who does this for ACE instructors to coordinate with and discuss student progress. One of the biggest success metrics has been maintaining clear communication throughout all levels of the program, she said.
The program was piloted one year ago in April 2022 and since has grown significantly, even receiving international recognition for the model after its publication in the Journal of Nursing Administration.
Already, of the 355 students at the University of Maryland who have been educated under the ACE model, half of them have been recruited to work as paid patient technicians in the hospitals, which has significantly helped the workforce, Dr. Rowen said.
She hopes that one year from now, all graduate nurses will be recruited to work across the system in various capacities and that passing rates of the National Council Licensure Examination will increase, showcasing what she hopes will be another success metric of the ACE model.
"I truly hope that we see this model proliferated nationally or internationally," Dr. Rowen said.