The second degree baccalaureate nursing program at the Texas Tech University Health Sciences School of Nursing is a little bit of legend in the world of nursing education. Guided in part by Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2001–2003) Alexia Green, RN, PhD, FAAN, the program has become a shining example and national model of how to address a state’s nursing shortage. Moreover, it’s emblematic of the valuable lessons learned by nurse educators in the RWJF scholar and fellow programs over the past four decades. More than 400 nurses have obtained baccalaureate degrees through the program.
“To help create our program, I took the knowledge I gained at the Foundation and applied it to our nursing curriculum,” Green says. “Many of the skills I acquired as an Executive Nurse Fellow were helpful, but perhaps the most memorable experience was spending several days immersed in courses at IDEO.”
Green is referring to the well-known design and engineering consulting firm that is responsible for everything from our streamlined, fast-moving version of the computer mouse, to a more consumer-friendly approach to getting a mammogram.
While we often think of great new ideas as the result of unexpected bursts of creative inspiration, Green explains, “IDEO taught me that spurring innovation within an institution requires creating a safe and solid structure in which that process can take place.”
Anatomy of an Innovation
The state of Texas was one of the first to address the national nursing shortage. Legislators there passed the Nursing Shortage Reduction Act of 2001 in response to dramatically dropping enrollment and graduation rates in the state’s nursing schools. The Act was created to encourage schools to find new ways to think about nursing education and reverse these declining trends.
But figuring out how to effectively use the funds the Act provided was the work of nurse educators like Green. “We had resources, but in education it’s very hard to innovate because of the culture and governing structure of institutions. It can take three to four years to develop a new idea because it has to go through so many institutional and bureaucratic hurdles.”
Using the IDEO model, Green and her team realized that the solution was to create a structure that would essentially protect their innovation team from the broader structure of the university.
“We created the Center for Innovation in Nursing Education at the university which gave a small group of leaders permission to experiment and introduce new ideas. As a result, our team developed a unique program in six months that could have otherwise taken years to gain approval,” Green says.
Working within the Center empowered faculty members and gave them permission to engage in trial and error while designing the second degree program. “They began with a ‘deep dive’—a methodology created by IDEO—throwing all ideas on the table, while looking for new concepts,” Green explains. Considering ideas from disciplines outside of nursing, including business models, psychological frameworks, engineering schematics and even Greek mythology, was also an important part of the process.
From Ideas to Action
Once a series of innovative ideas was selected, the next step was identifying strengths and useful partners. In the article, “Creating and Launching Innovative Nursing Programs: Perils and Pearls,” published in Nursing Education Perspectives in August 2012, Green and her team explained that, “hospital and community partners should be at the table during the second stage of innovative development.” Their path forward included these critical steps:
l. Plan, Do, Study, Act (PDSA). The PDSA cycle is a time-tested approach to exploring an innovation. By working through a list of questions, Green’s team established objectives, defined key players, analyzed initial data, and refined their ideas.
2. Fund and Staff. In addition to pursuing enough funding for all aspects of the second degree nursing program, Green’s group made sure every grant proposal explained how they hoped to sustain the project and eventually make it self-sufficient. “Because an innovation is an untested idea, potential funders will also want a statement of return on investment—an explanation of the project’s overall economic value. Many staff members will also want to know what will happen to their position once funding runs out,” Green advises.
3. Implement and Disseminate. Once the program was up and running, the Innovation Center published outcomes and evaluative data as it progressed. They understood that other nurses would be interested in how the project took shape.
The first, and perhaps most important lesson Green learned is that, “innovation is a planned process that will not happen without creativity and risk, but even small innovations can bring about great change,” she says. To accomplish their goals, the Texas Tech Center for Innovation team also shared resources freely at all levels of the nursing profession; pushed the idea of lifelong learning; and employed new technologies, equipment and curricula to enrich each student’s learning experience.
“Like all innovation teams, our great success also included a significant failure,” Green adds. “We attempted to expand our education program to train new nurses from the large number of military personnel who come back to Texas each year when they complete their tours of duty. But we found that the steps that worked magnificently for our non-military nursing student population did not work at all with the returning soldiers. We simply didn’t have the type of resources they needed to make such a transition.”
In the case of the military program, the Innovation Center’s most important strategic maneuver was knowing when to quit. “We stopped the military program before we wasted too many resources and too much energy. We also learned when to stop an experiment and admit it was beyond our abilities,” Green adds.
“In all honesty, if I had not learned key lessons about how to shape, nurture and encourage the innovation process during my time as an Executive Nurse Fellow, our second degree nursing program would have been the 150th to start in the country, not the second,” Green says. “I cannot stress enough the importance of creating a safe space to protect innovators from bureaucratic roadblocks so that they can be free to experiment and do their best work.”
40 Years of Innovation
The grantees of the Robert Wood Johnson Foundation’s Human Capital portfolio have become leaders in inventing methods of prevention, treatment and research that have greatly advanced health and health care in America. This series, 40 Years of Innovation in the Health Care Work Force, tells their stories.View all