Newswise — The data is daunting. A projected shortage of 25,000 nurses in California by 2005. Nearly 30 percent of the nursing workforce retiring by 2010. An educational system that can produce only 50 percent of the nurses needed. Attrition rates of 20 to 40 percent in most nursing programs. Significantly fewer high school students pursuing nursing—despite an encouraging 16.6 percent leap in 2003 nursing school enrollments—and still not enough to meet future demand. All of this in the face of California's new and stringent nurse-to-patient staffing ratios, implemented January 2004.

While many hospitals are wringing their hands, Cedars-Sinai Medical Center has rolled up its sleeves to develop an ambitious and innovative model that just might beat these dire odds. In truth, that "might" is actually a "will" for the nursing leadership that launched and now direct the Institute for Professional Nursing Development, opened in June 2002.

The brainchild of Vice President and Chief Nursing Officer Linda Burnes Bolton, Dr. P.H., R.N., F.A.A.N., the Institute is a one-of-a-kind for California, and among only a handful of similar institutions in the nation. The focus of the institute is four-fold: education, career development and retention; research and innovation; patient care and customer satisfaction; and community outreach.

"Though Cedars-Sinai is meeting staffing ratio requirements, we're still concerned about the future," says Dr. Burnes Bolton. "The Institute's goals are to ensure the availability of a qualified nursing workforce to meet the increasing demand for healthcare at Cedars-Sinai and the community at large."

The medical center, a magnet hospital, is investing both financial and human resources in the Institute, which is helping to increase nursing school enrollment in the area by providing direct monetary support to faculty and students. Dr. Burnes Bolton is quick to point out, however, that looming nurse shortages aren't just the healthcare industry's problem—or responsibility.

"The Institute serves as a model for creating public-private partnerships that address critical societal issues, in this case public health and the availability of qualified nurses to sustain it," she explains. "The success of such an undertaking is dependent on support and funding from multiple sources within our community."

The success of the Institute lies in programs that address the nursing crisis in an integrated, comprehensive manner, according to Director Jane Swanson, R.N., Ph.D., who joined the Institute in July 2003. Among her goals as director are: 1) increasing the number of students entering and graduating from nursing programs, 2) expanding the number of RNs in specialty and critical care nursing, and 3) improving the quality of nursing care through research and innovation.

"Education and leadership go hand in hand," states Dr. Burnes Bolton, explaining the philosophy behind the Institute for Professional Nursing Development. "Higher levels of learning translate into higher job satisfaction for nurses and, ultimately, into higher patient satisfaction rates."

The vision and ideals that guide the program will be realized, in part, when The Suzanne and David Saperstein Critical Care Tower opens at Cedars-Sinai in spring 2005. By then, the Institute will have ushered in 150 new nurses, all with specialty preparation, BSNs and leadership skills. The timing couldn't be better, since The Suzanne and David Saperstein Critical Care Tower will depend on a highly trained staff to care for the most fragile patients using the latest monitoring technology.

In less than two years, the Institute has established the following programs, rich in education, mentoring and preceptor experiences:

1. Collaborative relationships with area schools and health facilities, including California State University, Santa Monica College, Los Angeles Trade Technical College, LA Technology Center and Los Angeles Valley College, that will generate, in 2004, approximately 32 BSNs, 15 LVNs, and 20 associate degree nursing students. These numbers are expected to quadruple when the program is fully operational. Funding from Cedars-Sinai and California Employment Development helps pay for instructors, didactic training and nursing scholarships for CSMC nurses and other candidates.

2. A Student Assistant Program that allows nursing students to gain work experience and clinical skills as "entry level" members of the nursing team at Cedars-Sinai. By June 2004, an anticipated 50 students will complete the program and, hopefully, seek employment at Cedars-Sinai.

3. A Mentorship Incentive Program designed to attract experienced nurses to serve as mentors for nursing interns and new graduates. Nearly 200 nurses now function as official mentors, providing more than 20,000 mentorship hours a year. As incentives, mentors receive gift certificates or additional paid educational days.

4. Internship Training Programs that expose new graduates as well as experienced nurses to specialty areas. More than 250 nurses have trained in such areas as Emergency Nursing, Perioperative Services, Labor and Delivery, Telemetry, Critical Care, Neonatal Intensive Care and Pediatrics.

5. Career Ladder Programs designed to increase nursing capacity through educational planning and training of CNAs, LVNs and other entry-level health workers.

6. Preceptor Program that allows expert clinicians to share knowledge and experience with novice RNs. To date more than 150 basic and advance preceptors have participated in this program, enhancing their abilities as educators and role models.

7. An On-Site School of Nursing, conducted in partnership with California State University, for RNs with associate degrees who are seeking a BSN, or RNs with a BSN pursuing a master's degree. To date, 34 students have graduated, with 35 currently enrolled.

8. A Nursing Leadership Program to enhance leadership skills and competencies of nurse managers and provide education and management skills for emerging nurse leaders.

9. Funding to attract students to choose nursing as a career option and support culturally diverse career development programs, specialty educations and career development for novice and experienced nursing staff.

Responsibility for administering these programs rests with Dr. Swanson, Education Program Coordinator Jo Ann Whitaker, R.N., M.S., a staff of seven educators, and two support personnel. Classroom facilities with the latest technology and computer-assisted learning were created on-site to support the Institute's endeavors.

GUIDING A NEW GENERATION OF NURSES

A primary goal for both Dr. Swanson and the Institute is persuading more students to pursue nursing and successfully complete training. High attrition rates among students have been attributed to insufficient remedial education and support, inability to pay for education, and inability to reduce working hours to study and attend class. By supporting students' educational endeavors and providing mentoring opportunities, the Institute and nursing staff hope to create positive experiences that encourage students to become nurses at Cedars-Sinai.

"What excites me most within my role is helping students who are trying to get into nursing but can't—either because of limited resources or because the schools can't take them," explains Dr. Swanson, a retired Captain in the U.S. Navy Nurse Corps who served as director of Maternal Child Nursing and Ambulatory Care Nursing at the National Naval Medical Center in Bethesda, MD, and as director of Women's Health and Policy on the Navy Surgeon General's Staff. "It's also rewarding to work with employees in jobs with little or limited futures to get them into a nursing program and to help them realize the sky's the limit when it comes to their dreams."

One such student was Charlotte Guevarra, a fulltime respiratory therapist at Cedars-Sinai for two years who dreamed of being a nurse. Though she'd taken some prerequisites in her native Philippines, the credits didn't transfer to the U.S.

"I really wanted to be a nurse, and when I heard that the hospital would sponsor me I decided to join the program," she explains. "Cedars-Sinai paid for my tuition, books, even my uniforms. It's really been a great help."

Guevarra began classes at Santa Monica College last August and, at the program's accelerated pace, she completes one semester in eight weeks. This means almost 18 hours of classes on campus and clinical training at Cedars-Sinai plus working 12-hour work shifts three days a week

"Now that I'm in the program, I see how hard it would have been to go to nursing school on my own," says Guevarra, who has committed to work at Cedars-Sinai as a nurse for two years after graduation in 2005. She hopes to eventually work in the ICU—where she feels her RT background will be an asset—with the additional support of Cedars-Sinai's critical care nurse internship with didactic and clinical instruction.

Guevarra found the Institute's Nurse Mentor Program especially valuable, providing individualized training from a clinical instructor, Karen Estrella, R.N., ICU. "Our mentor is extra help," says Guevarra, "Everyone on the unit is so great—trying to help you, familiarizing you with paperwork and policies. The whole program is a great thing. I'm lucky I'm in it."

Dulce Timbre, R.N., C.N. III, on the Medical/Surgical Unit, serves as both a mentor for nursing students and preceptor for new graduates. "It's definitely a good concept. It's very important to have exposure and experience before actually starting to work on the unit."

Timbre, who has been precepting for three years, finds it important to identify new nurses' strengths and weaknesses during the training period, and tailor instruction to their individual needs.

One recent graduate, Ty Whitaker, R.N., C.N. I, was particularly impressed with the preceptor portion of his educational experience. "The nurses who precepted me were fantastic. I felt like I could ask anything without worrying that I'd hear, 'Why are you asking that?' The program did a good job of matching personalities and skills."

Whitaker, who plans to work in cardiothoracic surgery, trained with preceptors Myrna Lim, R.N., C.N. III, and Vivian Cruz, C.N. III on the surgical floor. "The focus was on skill building—dressing changes, TPNs, administrative tasks—while learning how Cedars-Sinai works."

A WORK IN PROGRESS

As the Institute and its leaders look ahead, six strategic aims guide its future:

1. To develop and implement new, innovative care delivery models that retain and attract nurses and provide safe, quality care;

2. To create innovate partnerships with educational institutions to expand nursing program capacities, resulting in an increased supply of nurses;

3. To expand nursing leadership programs and cultivate leaders at all levels;

4. To provide evidence-based clinical practice models through active engagement in translational and interdisciplinary research;

5. To expand the capacity and clinical effectiveness of nursing personnel through internships and mentorship programs;

6. To increase the diversity of the nursing workforce and the capacity of nurses and other clinicians to provide culturally appropriate and relevant care that meets the needs of the community and closes the gap in health disparities.

The Institute's greatest challenge? Creating funds to help increase resources for nursing schools and nursing students. Dr. Swanson points out that the number of nursing faculty are dwindling as the lure of better salaries—30 to 40 percent higher—draw nurses with advanced degrees to clinical practice. Faculties are also aging, with many instructors facing retirement in the near future. Fewer educators mean fewer classes and fewer graduates.

"Most community colleges have more than 200 students on waiting lists for nursing programs, and most schools are graduating only 50 to 60 students per class," says Dr. Swanson, explaining that many schools just don't have the budgets necessary to hire additional clinical instructors.

Complicating this problem is the fact that significantly fewer teenagers are choosing nursing as a profession, despite new data that this trend maybe shifting. The American Association of Colleges of Nursing has reported enrollments in entry-level baccalaureate programs in nursing increased dramatically in fall 2003, up 16.6 percent over the preceding year. The Institute hopes to further strengthen these numbers by establishing outreach programs, comprised in part of nurse volunteers, to interest middle and high school students in nursing careers. The Institute also hopes to establish programs that will support "under-represented" segments of the population in their efforts to secure nursing education.

"The population of Southern California—and our clients—is increasingly Hispanic and Latino, but these ethnic groups are under-represented within our workforce," explains Dr. Swanson, adding that while 44 percent of Los Angeles' population is Hispanic only 6 percent of nurses are Hispanic.

In response, the Institute is seeking Nursing Diversity Workforce grants through the Health Resources Services Administration to fund "Under-represented Advance to RN." Starting in fall 2004, this grant would enable 100 Fairfax County high school students in a youth development and enrichment program to explore nursing careers and fund 98 participants in licensed vocational nursing and registered nursing programs.

"As the Institute faces the future, our goals and objectives will become even broader and more ambitious in an effort to achieve a profound and permanent impact on nursing and patient care in Southern California," says Dr. Swanson. "Plans call for a 20 percent annual increase in clinical ladder progression and subspecialty certification, increased participation and collaboration in nursing research, including establishment of a Nursing Research Recognition award, expanded leadership development and, ultimately, funding of an endowed chair in nursing research."

Cedars-Sinai is one of the largest nonprofit academic medical centers in the Western United States. For the fifth straight two-year period, it has been named Southern California's gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities.