More Nursing Schools Preparing Students to Provide Team-Based Care
A teenager and her mother make an appointment to establish primary care with a new provider. During the appointment, the provider learns that the girl, 15, is sexually active, abuses drugs, is underperforming in school, has a strained relationship with her mother, and has a history of depression and anxiety. Later, the provider learns that the mother restricts the girl’s access to birth control, has tied her to her bed and, on one occasion, submerged her in ice-cold water.
How should the provider go about reporting the case to state authorities? Should the provider inform the girl’s parents of her or his plans to do so? What other steps should be taken to ensure that the girl receives the appropriate level of care? And who else should be involved in her follow-up care?
These are the kinds of questions that arose during a two-hour interprofessional education session at the University of Washington last year. It was supported by a nurse education grant from the Health Resources and Services Administration (HRSA) and included advanced practice nursing, physician assistant and social work students, as well as family medicine residents.
But these questions are not just hypotheticals; they’re real-life questions that confronted Jennifer Sonney, a nurse practitioner and educator, early in her career. Lacking formal training in collaborative practice and team-based care, Sonney didn’t realize that other professionals could help her navigate this challenging case.
Now a senior lecturer at the University of Washington School of Nursing, Sonney, MN, ARNP, PPCNP-BC, has developed a case study around the experience to help train a new generation of health professions students to reach across disciplines and provide comprehensive team-based care when the situation demands it.
The University of Washington is one of at least four of the nation’s top nursing schools now requiring students to participate in at least one interprofessional education course or activity, according to a “dashboard” report released in June by the Future of Nursing: Campaign for Action. The Campaign is an initiative of the Robert Wood Johnson Foundation (RWJF) and AARP that is working to transform health care through nursing. It is grounded in a 2010 report by the Institute of Medicine (IOM) that promotes interprofessional education as a way to foster collaborative practice and improve the quality and safety of care.
Other schools named in the report are the University of California, San Francisco (UCSF), the University of North Carolina, and the University of Pittsburgh. But the trend toward more interprofessional education offerings goes well beyond these schools, says Barbara Brandt, PhD, the associate vice president for education at the University of Minnesota Academic Health Center and head of its National Center for Interprofessional Practice and Education, a public-private partnership that is supported by HRSA, RWJF and other organizations.
Because of the rapidly changing environment in interprofessional education and collaborative practice, there is no comprehensive data about the number of interprofessional activities and courses now offered nationwide, Brandt said. But there is “no question” the number of schools requiring these types of activities is growing rapidly, she added.
Change is apparent on the pages of some of the nation’s most prestigious health journals, too. The number of articles in 10 of the top health services research journals that were co-authored by a registered nurse (RN) is surging, according to a supplemental dashboard indicator released by the Campaign. In 2012, RNs co-authored 145 articles in 10 leading journals, up from 80 in 2010.
In Health Affairs, for example, RNs co-authored four articles in 2010 and 23 in 2012, a 475 percent increase. In the American Journal of Public Health, the number rose from 17 to 33, a 94 percent jump. And in the New England Journal of Medicine, the number grew from 9 to 20, a 122 percent increase. Two of the 10 journals—the Journal of the American Medical Association and Medical Care—saw small drops in the number of articles co-authored by RNs.
One program that has helped foster interdisciplinary research and collaborative practice is the Interdisciplinary Nursing Quality Research Initiative, an RWJF-funded program that pairs nurse researchers with scientists from other disciplines to study links between nursing care and patient outcomes.
Barriers Beginning to Fall
Experts have called for interprofessional education for decades, but more health professions schools are responding now because requirements are being written into health professions accreditation standards, Brandt said.
Nonetheless, barriers to interprofessional education are significant; they include conflicting schedules, already-crammed curricula, and a lack of joint clinical learning opportunities. But they are surmountable, as is evident at the University of Washington. Last year, it required health professions students to participate in a four-hour simulation activity and six two-hour, case-based learning activities covering complex problems such as how to care for a veteran dealing with issues ranging from family stress to drug abuse, post-traumatic stress disorder, and disability.
At UCSF, meanwhile, health professions students are now required to participate in a two-day interprofessional training where students and faculty from various disciplines engage in simulation activities and a team-based project.
“Interprofessional education is about improving patient safety and quality improvement,” said Brenda Zierler, PhD, RN, FAAN, professor of behavioral nursing and health systems at the University of Washington School of Nursing and an alumna of the RWJF Executive Nurse Fellows program (2008-2011). “Learning together in school may help health professionals work together in practice to improve coordination of care, communication across transitions of care, and relationships across the team. It’s less about each individual profession and more about how we can work together better.”
These kinds of educational activities help students understand the importance of collaborative practice in a health care system in which care is increasingly delivered by teams of providers. More collaborative practice is believed to result in safer, more effective care and greater clinician and patient satisfaction, according to the IOM report.
Interprofessional education and collaborative practice align with IOM report recommendations to expand opportunities for nurses to lead and build an infrastructure for the collection and analysis of interprofessional health care workforce data, Zierler said. It will also help boost recruitment and retention in the nursing workforce, she added.
“For much of history, physicians made the major care decisions,” said Joanne Spetz, PhD, professor at the Philip R. Lee Institute for Health Policy Studies, associate director for research strategy at the Center for the Health Professions at UCSF, and adviser to the National Center for Interprofessional Practice and Education. “We need to start teaching nursing students that they bring a set of skills to the table that are unique and distinct, and add value to the skills provided by other professionals. That will help them develop good, collaborative relationships over time.”