Graduate Nursing Education (GNE): Duke University Hospital ... · • School Partner: – The Duke...

Graduate Nursing Education (GNE): Duke University Hospital Demonstration Project

All Rights Reserved, Duke Medicine 2007

Concept: Professionalism

The Duke Nurse demonstrates integrity in nursing practice through self-knowing, nurturing students, and mentoring colleagues to provide exemplary professional practice every day, every patient, every setting. We support patient needs, changes in practice, and the nursing profession through active dialogue and partnership.

A commitment to continual learning and developing expertise is critical to advancing nursing practice.


Project Oversight

•  Senior Leadership Oversight from Mary Ann Fuchs, DNP, RN, FAAN and Catherine Gilliss, PhD, RN, FAAN

•  Day-to-day operations:

–  Pamela Edwards, EdD, MSN, RN-BC, FABC, CNE; Associate Chief Nursing Officer; Education, DUHS

–  Barbara Turner, PhD, RN, FAAN; Director, Doctor of Nursing Practice Program, DUSON


Innovating in clinical growth

•  DMP & Cancer Center •  Continued investment in Duke Primary Care

network expansion; affiliation models •  Outpatient/inpatient access initiatives –

expanding patient volumes •  Strategic network/partnerships; business

development •  Local, statewide, & regional strategic marketing;

national promotion & marketing of Programs of Distinction

Duke: Transformation Requires Growth


Reinventing Care Design &

Payer Strategy

Innovating in Clinical Growth

Revolutionizing Care Delivery

•  DMP & Cancer Center – growth drivers; meeting demand •  Primary care network expansion •  Outpatient/inpatient access initiatives – expanding volumes •  Strategic clinical partnerships and network development •  Targeted and strategic marketing locally, regionally, etc.

•  Patient centered care; focus on patient experience •  Maestro Care (electronic health record) •  “Right patient, right place, right time” - full spectrum of care settings;

better integration/alignment across DUHS •  Length of stay efficiencies; reduce unnecessary readmissions

•  Population health management strategies •  Creation of Clinically Integrated Network (CIN) •  Care “bundles” •  Pricing and contracting strategies with payers

Transforming Our Future


Revolutionizing Care

Delivery Patient-Centered Care

Maestro Care “Right patient, right place, right time”

Innovating in Clinical Growth

Primary/Specialty Network Development Access Improvement

DMP & Cancer Center

Reinventing care

design Population health

management Clinically Integrated

Network Care “bundles”

LEADING HEALTHCARE DELIVERY

SYSTEM IN THE NATION

Performance Excellence

Quality & Pa+ent Safety Pa+ent Experience Finance & Growth Work Culture

Physicians, Providers & Direct Care Staff

Deliver great, compassionate patient care efficiently and effectively;

constantly seek innovations in safety and quality

Support Care Staff Improve the patient

experience; support optimal care delivery; excellence in

operational execution

All Physicians, Staff, Volunteers

Demonstrate values-based behaviors and

decision-making

DUHS Values

Excellence Safety Integrity Teamwork Diversity

Caring for Our Pa+ents, Their Loved Ones, & Each Other

Cost Improvements Reduce costs for episodes of care

Expense management

Competitive pricing


Duke GNE Goals •  Prepares APRN learners to play a greater leadership role in the

health system, both in delivering care and in decision making about care

•  Provides APRNs more involvement in the development and evolution of a regional care infrastructure that is more accessible, cost-effective, and responsive to the needs of our region

•  Provides direct support to develop, institute, and require new preceptors to participate in a comprehensive preceptor education program – further improving preceptor training already in place


Project Partners Half of clinical training occurs in non-hospital settings, which

strengthens nurses’ skills in handling preventive services, chronic disease management and other primary care needs

•  School Partner:

–  The Duke University School of Nursing

•  Clinical Partners:

–  Private Diagnostic Clinic (PDC)

–  Duke Primary Care; 32 locations across the region

–  Healing with CAARE, Inc., a non-profit community clinic that provides free health services in Durham


Project Partners •  The Division of Community Health in Duke’s Department of

Community and Family Medicine, in partnership with: –  Lincoln Community Health Center –  Lyon Park Community Center –  Walltown Neighborhood Clinic –  Holton Wellness Center –  Northern Piedmont Community Care

•  Duke LifePoint: –  N.C. community hospitals at Maria Parham Medical

Center in Henderson –  Person Memorial Hospital in Roxboro

•  Danville Regional Medical Center in Danville, Va.


Preceptor Planning & Development During the Fall, Spring, and Summer terms of Year 1 - a formal training program for preceptors was launched. •  This program includes face-to-face seminars and online learning

modules for preceptors to develop skills in working with students in clinical settings.

•  The online modules will be advised for all new clinical preceptors.

•  Face-to-face preceptor training seminars will be delivered on a bi-annual basis through the end of the project and will include the use of standardized patients.

•  These sessions will be digitally captured to enable preceptors to review them in the future.


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5

10

15

20

25

30

Fall '12 Spring '13 Summer '13

APRN Student Placements In Duke Primary Care

APRN Students Duke Primary Care Year 1

# of APRN Students


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25

50

75

100


% Increase in Duke Primary Care APRN Preceptors

DPC Provider Preceptors

% APRN Preceptors


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10

20

30

40


Increase in Duke Primary Care APRN Preceptors

Duke Primary Care APRN Preceptors

# of APRN Preceptors


Accomplishments in Year 1 •  Relationship Building •  Began ENTICE (Enlisting New Teachers In Clinical

Environments) initiative to increase number of preceptors by learning “What Motivates Providers To Precept”

•  Created Preceptor Development Workshop to help providers become better preceptors – upcoming on May 4, 2013

•  Delivered on-site presentations to Primary Care Clinics throughout Duke Medicine and Research Triangle Park Communities to explain objectives of the Graduate Nursing Education Demonstration Project


Preceptor “Champions” Emerging: “It’s interesting how teaching can make you a better provider, especially with the really good questions they ask, such as why did you do that or why did you prescribe that?”

…Comment from a preceptor

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