Chamberlain University Offers Specialty-Focused Training to Nursing Students

Practice-ready program is designed to fill significant shortages and stave off first-year nursing turnover by helping nursing students find their niche.

A new, innovative approach to fill a critical need for operating room nurses, along with reducing first-year nurse turnover, relies on a triad of academic, service, and a specialty association to attract and prepare nursing students to perioperative practice.

After nearly a year of planning, Practice Ready, Specialty Focused™ debuted in January at Chamberlain University to help prepare perioperative nurses upon graduation meet a significant demand, says Dr. Karen Cox, PhD, RN, FACHE, FAAN, Chamberlain's president.

Chamberlain, which has the largest nursing school in the country, has partnered with Emory Healthcare in Atlanta, Loyola Medicine of Chicago, Ochsner Health in New Orleans, and the Association of periOperative Registered Nurses (AORN) to launch Practice Ready, Specialty Focused.

Cox spoke with HealthLeaders about the unique program and how it may counteract the dreadfully high first-year 30% turnover rate by helping student nurses choose areas of practice that interest them most.

This transcript has been lightly edited for length and clarity.

HealthLeaders: Nurses are specializing like never before. Why is that?

Dr. Karen Cox: Healthcare itself has become more specialized. I worked at Children's Mercy Hospital here in Kansas City for many years, and we had general pediatricians who would send what we used to call minor or office-treatable [health conditions} to specialists. If somebody had a gut ache, they would send them to a pediatric GI specialist. That's happened in medicine.

There are so many different things that nurses can do and are qualified to do because of our background: You can work in informatics at an informatics company, you can work in quality in a hospital, you can work in the government. So as healthcare has gotten more specialized, the need for nursing to be more specialized has been the same.

HL: How often do Chamberlain's students enter nursing school with a specific specialty in mind?

Cox: Many of them aren't aware. They know they want to be a nurse, and a few of them come in because they saw how well a nurse took care of somebody close to them when they were younger. We have one nurse who just graduated from the Atlanta campus who had cancer as a child 10 years ago, and she's now going back as a nurse to that unit where she was cared for.

But a lot of time, students have perceptions that don't match reality and part of it is their clinicals are based on being a generalist, so they don't really focus in on an individual specialty interest. That goes into why this program is so important, because the first-year turnover rate is so high.

HL: Practice Ready, Specialty Focused is the first educational initiative of its kind being offered in partnership with AORN. How and when did this idea develop and why was perioperative nursing chosen as the first initiative?

Cox: With the first-year turnover rate being at 30%, that's not acceptable and it's a huge burden on the service side—on hospitals, health systems, and others who employ new nurses. A lot of time goes into orienting and onboarding and then they all of a sudden at six or eight or 12 months, they quit. It's a resource issue, and in my mind, at least one of the factors is this idea of how they're choosing where to go.

Back when there wasn't that big of a shortage, new grads would take whatever they could get at the hospital they wanted, knowing they could transfer after a year-and-a-half or so. But now there's so many options. Why not make sure that somebody knows what they're getting into? If I like structure, I'm probably not going to like the emergency department. On the other hand, structure in the OR and periop is what keeps patients safe; it's a big piece of it.

So, that was our theory. The reason we picked periop is because that's probably the largest shortage area and students don't get exposed to it. It's not a rotation.

So, we joined up with AORN and [AORN CEO/executive director] Linda Groah and I met and talked about it. Chamberlain has scale, and because of our size, number of campuses, and our BSN program, we can try some different, innovative things that don't disrupt their program of study that keep the generalist front and center, but that allow them to begin the thoughts. That's why we say, "specialty focused." We are not looking to pigeonhole them into anything; we're trying to help them.

Education has to take part of the responsibility for this, because by the time they get to their first job, it's too late. Residency programs in hospitals are trying to get at that, but there's only so much they can do.

HL: Describe what the program looks like from a student's perspective.

Cox: The Atlanta campus for us is one of our largest, with 1,200 students. And if you are a student in good standing, toward the end of your program of study you can choose to take what's called Intro to Periop Nursing that AORN developed and is free to the students so there's no additional dollars. There are no credits, but they get a badge if they complete it successfully.

It's 15 modules, so it's pretty comprehensive. If you get your badge, then you have the option to go to Emory and spend a significant amount of time in your last year doing clinicals in periop. Our research hypothesis is a couple of things: one is we think that probably a high percentage will stay and work at Emory in periop. But a smaller percentage will say, "Get me out of here fast. I never want to be here again. It's just not for me."  

It may be a little lofty, but my vision is that this is a way to maintain the generalist experience and preparation, but to have badge opportunities that are student choice. We're not there yet; the first thing we have to do is prove this works and the intended outcomes are occurring.

HL: What are you seeing so far?

Cox: We've had 90 students already in those three cities pass the Intro to Periop Nursing, and that's significant because last year, only four out of 100 new graduates selected periop.

HL: Do you see the program expanding into other specialties?

Cox: Yes, post-acute and homecare. It's another area where students don't get any exposure. For the longest time people said to work in home care you need a year of general med surg experience. Well, why? If you send them away when they want to start there, they're most likely not coming back. And home health is exploding [especially with] the concept hospital at home.