xt70k649rx3m https://exploreuk.uky.edu/dips/xt70k649rx3m/data/mets.xml University of Kentucky College of Nursing Kentucky -- Lexington University of Kentucky College of Nursing 2010  newsletters  English University of Kentucky College of Nursing  Contact the Special Collections Research Center for information regarding rights and use of this collection. University of Kentucky College of Nursing publications Nursing In Step, March 2010 text In Step, March 2010 2010 2010 2019 true xt70k649rx3m section xt70k649rx3m March 2010

Advanced Practice
Nurses and Physicians—

Partners in Continuity of Care

The University of Kentucky College of Nursing, a leader in advanced
practice programs, opened the first Doctor of Nursing Practice (DNP)
Program in the nation in 2001. With the evolution of the profession and
new guidelines from the American Association of Colleges of Nursing
(AACN), the College has once again been a pioneer by being among the
first to transition from the master’s degree to the doctorate for advanced
practice, and offering a post-baccalaureate entry option to the DNP
Program to prepare nurse practitioners, clinical nurse specialists, public
health nurses and nurse managers. This professional, clinical-doctoral
program also prepares nurses for the highest executive level positions.

Making the decision
Vicky Turner, MSN, ACNP-BC, RN, CCRN, UK HealthCare, recalls
when she was a registered nurse she was triaging patients on the phone, in
the clinic, and in the hospital. With all of those responsibilities came
expectations for superior performance.
“I knew that I needed to have a greater depth of knowledge and be able to
intervene from a different skill set,” said Turner. By working at a higher
level, Turner would be able to provide more advanced care for patients
and keep the surgeons she worked with in the operating room. So, Turner
enrolled in the graduate program at the College of Nursing, graduating
in 2001 as an acute care nurse practitioner.
continued inside

Clockwise: Vicky Turner, MSN, ACNP-BC, RN, CCRN;
Lacey Troutman Buckler, MSN, ACNP-BC, RN; and Chand Ramaiah, MD

for the


* Introduction
An amazing opportunity is unfolding at
the University of Kentucky. The College of
Nursing (which will be celebrating its 50th
anniversary during the coming year) and UK
HealthCare nurses and nurse leaders are working
collaboratively to prepare the next generation
of nurses for the Commonwealth and to assure
quality health care for Kentucky’s citizens and
others in the region. In Step illustrates how
advanced practice nurses are partnering with
physicians to optimize the care provided within
UK HealthCare. The transition from nursing
school to one’s first professional nursing position
can be challenging.

Jane Marie Kirschling,

Colleen Swartz,

Professor and Dean,
UK College of Nursing

Chief Nurse Executive,
UK HealthCare



Our story also involves UK’s nursing faculty
and clinical leadership who are finding creative
solutions to support nursing student success and
to fully engage new nursing graduates at UK
HealthCare. Along with physician colleagues,
nurse leaders are engaged in the redesign of
the care delivery model to meet the dynamic
needs of the Commonwealth’s citizens. We
appreciate the opportunity to share some of our
success stories and invite you to share your ideas
for how nursing education at UK and nursing
practice at UK HealthCare can strengthen our
efforts to be in step with the needs of Kentucky.
Our commitment to the highest-quality health
care remains strong and we will provide you
with an annual update of our work.

continued from front

Nurse practitioners, like physicians and physician assistants, can write orders and make
treatment decisions.
“The advanced nursing program provided me with the groundwork to blend nursing and
medicine,” said Turner. “As nurses, we are trained to deliver patient care in a holistic
manner. Doctors are trained to deliver patient care based on a disease and diagnostic-driven
model. As a nurse practitioner, we deliver care blending the two models.”
Lacey Troutman Buckler, MSN, ACNP-BC, RN, a College of Nursing graduate and
nurse practitioner for UK’s Gill Heart Institute, said, “I was excited to provide my physician
group with a nursing-based approach to patient care to help fill any gaps to ensure that
patients are receiving the best possible care so when they return home they are prepared to
manage their disease.”

“While a PhD program
is designed to educate
an individual to generate
new knowledge, the DNP
helps translate the
information into practice.”
—Patricia B. Howard, PhD, RN, CNAA, Associate Dean for MSN
and DNP Studies, UK College of Nursing
(MSN, UK, 1980; PhD, UK, 1992).

* In a 2009 alumni satisfaction survey, 98 percent of UK College of
Nursing alumni who responded were very satisfied or satisfied with the
quality of their nursing education. Employers who responded indicated
they were unanimously very satisfied or satisfied with the quality of
the College’s graduates.

Continuity of care
“We have residents but they come and go,” said cardiac surgeon
Chand Ramaiah, MD. “There is a very low turnover in nurse practitioners
and most are specialized, which gives them an added edge when treating
patients as well as with continuity of care.”
The outcome of this stability is a deep level of trust that is built with the doctors.
“Vicky takes care of my patients on a day-to-day basis. I don’t spend as
much time with patients after surgery as Vicky does. So, I have to really
trust her more than I do myself,” said Ramaiah.
“My role as an advanced practice provider is to optimize the surgeons’
time doing actual surgery then employ the doctor’s patient care plan or
deviate from it if it doesn’t fit. I keep the attending physician informed
about the patient’s well-being and any changes in the level of care. In
addition, we keep the families informed,” Turner said.
Advanced practice nurses play an even greater role in clinical areas because
they enable physicians to see more patients while ensuring that follow up,
including lab tests, x-rays, and consultations, are handled in a timely manner.
Colleen Swartz, MSN, RN, MBA, Chief Nurse Executive for UK
HealthCare said, “Vicky’s role is critical in the daily management of critically
ill patients. Her partnerships with the surgeons allow them to focus on
surgical work and her expertise and critical thinking allow for more real-time
and fluid management of the patient’s postoperative condition.”
Statistically speaking, the College of Nursing ranks high (See Vital Stats),
but the real test is with the doctors and UK HealthCare staff.
“Advanced practice nurses can really be clinical partners. They allow
the doctor to manage more patients effectively and safely,” said James
McCormick, MD, FCCP, Division Chief and Medical Director of
Respiratory Care Services, UK HealthCare. “They are very well trained,
very professional, and eager to learn and to help.”
Lynn Kelso, MSN, ACNP-BC, RN, FCCM, FAANP, an assistant
professor who practices in pulmonary critical care with McCormick and is
also working on her PhD in nursing, said, “A university hospital setting
is where the most critically ill patients are receiving care. For the best outcomes
there needs to be a provider at the bedside. Advanced practice nurses working
with physicians can ensure that these patients’ needs are met.”

and James McCormick, MD

Still a growing demand
When the new hospital opens in 2011, UK HealthCare will have added
capacity to handle more patients and with that comes added demand for
physicians and nurse practitioners. In addition, working regulations for new
residents are becoming more restrictive in terms of time on call. Consequently,
hospitals will require more help from advanced practice nurses.
To those considering entering the nursing field, McCormick said,
“There is a great deal of job security in a job that can be both exciting and
rewarding. There will be new procedures to master as well as diseases that the
nurse practitioner will learn about in terms of evaluation and management.
Nurse practitioners contribute to improvement in patient care.”

More accessible learning
UK offers a tuition program for eligible employees to further their
education and the Department of Nursing works with schedules to ensure
that employees can get to their classes.
Buckler said, “Most people at UK HealthCare provide flexibility for
those who want to pursue their degrees. Since nursing jobs are typically on
12-hour shifts, you can work weekends and have the beginning of the
week for class. In my last year of graduate school, my job was more 8 to 5
but my boss worked with me to make a schedule that worked for both of us.”
Embarking on an advanced degree may sound intimidating and difficult
in terms of time management, but the College has taken that into
consideration and developed a distributed-learning model. DNP courses are
web-enhanced and require attendance at class meetings on UK’s campus
only about four times each semester on UK’s campus. With full-time study,
the program can be completed in two to three years, depending on whether
the student enters with a BSN or MSN. Part-time options are available.
“Some out-of-state students fly in, have class Friday and Saturday and go
home. It’s very manageable,” said Swartz. •

“Almost all of my
graduate school
was paid for by UK
HealthCare and it’s
an awesome benefit.”
—Lacey Troutman Buckler, MSN, ACNP-BC, RN,
nurse practitioner at UK’s Gill Heart Institute.

* From School
to the Real World

“During my clinical
in the Emergency
Department, the
doctors and nurses
worked so well
and efficiently with
each other that
sometimes I didn’t
know who was who
until after reading
their shirts.”
—Excerpt from a nursing student’s
Emergency Department clinical journal

Unique Partnership
The partnership between the UK College of Nursing and UK HealthCare
provides a rich environment for unique educational and clinical
experiences. Both sides work to develop curriculum, make the transition
to work smoother, provide career enhancement opportunities, develop
satisfied health care professionals, and, in the end, offer higher quality
patient care.
“We end up with a better learner who comes out ready for practice,”
said Colleen H. Swartz, MSN, RN, MBA, Chief Nurse Executive for
UK HealthCare. “The practice expectations are fairly dynamic. This
relationship allows us to stay ahead of that as much as possible. For
instance, understanding and knowing EKG interpretation 10 years ago
probably wasn’t considered a nursing fundamental and now it is. Our
patients are considerably more ill now. Expectations of critical thinking,
decision making and data analysis are much higher, especially in the
inpatient environment.”

“UK nursing students have an advantage as they start their professional
practice,” said Swartz. “Being exposed to the electronic documentation
system helps them understand that system of care better than someone
who has only experienced that system in the ‘paper’ world.” Expansion
into other interprofessional education is underway. “The physician
documentation is coming online this fall. Ideally we would like to have
the nurses sitting alongside their colleagues in other disciplines learning
together as they begin practice together. This is a unique aspect of the
integration with the Colleges of Medicine and Nursing, and the clinical
operations arm of the enterprise.”
While every clinical is unique, doing one in the Emergency Department
is especially distinct. “Patients are all ages, all types and we have every
different type of medical emergency,” said Patricia Kunz Howard, PhD,
RN, CEN, CPEN, FAEN, Operations Manager for Emergency and
Trauma Services at UK Chandler Hospital (PhD, UK, 2004). “Students
are paired with a nurse preceptor who is part of a trauma team. It is a skillsintensive clinical where students validate with true patients as they have
validated in simulation or a skills lab.”
For those students who have a good idea what area they want to do their
clinical practice in, UK HealthCare offers a full scope of disciplines. The
hospital also offers a broad clinical experience to explore career possibilities.
In addition to clinical placement, UK HealthCare is intricately involved
with helping to develop a practice-based nursing curriculum. Also, for
nursing students, being affiliated with a Research I university has added
benefits. Students see and participate in ongoing research that will
ultimately support practice protocols.
The success of the partnership is evident by the doubling of enrollment
in the traditional BSN Program since 2007. “The collaboration between
the College and UK HealthCare is critical to our success,” said Patricia
V. Burkhart, PhD, RN, associate dean for Undergraduate Studies. “UK
HealthCare ensures that we have the clinical sites our students need to
get the best learning experiences. They also supported the idea of having
students work 12-hour clinical shifts in order to simulate real world
nursing experiences. UK nurses also function as preceptors for our students
and many nurses serve as clinical group instructors. It is a partnership that
really works.”

UK HealthCare and the College of Nursing are working together to
make the transition from student to nursing professional more seamless.
For example, this past year electronic medical records were opened to
nursing students so they could document patient care just as staff nurses do.
Left to Right: Jeanne Bouvier, MSN, ACNS-BC, RN, BSN; Sara Comley, BSN,
RN; Claudia Diebold, MSN, RN, CNE; and Anne Hickman, BSN, RN

* The BSN Residency Program at the College of Nursing is a testament
to then-Dean Williams’ legacy of envisioning a stronger practice future and
working with Karen Stefaniak of UK Chandler Hospital to realize that the
two organizations could be stronger together than separate.

The BSN Residency Program
The first year of nursing practice is a critical time, requiring nurturing
and support for successful integration into nursing practice. In response
to this issue, the University Hospital Consortium (UHC) and American
Association of Colleges of Nursing (AACN) BSN Residency Program
was conceived and developed. In 2002 under then-College of Nursing
Dean Carolyn A. Williams, PhD, RN, FAAN, and Karen Stefaniak, PhD,
RN, then-Associate Hospital Director and Chief Nursing Officer, UK
Chandler Hospital, the College of Nursing and UK HealthCare became
one of six dyads participating in the pilot program. It is a mandatory oneyear orientation and support program that provides transition to practice
through education and support for new baccalaureate nursing graduates
employed as staff nurses on clinical units. To date, nearly 450 nurses at
UK HealthCare have gone through the program.
Claudia Diebold, MSN, RN, CNE, the BSN residency coordinator for
the College, said, “Our goal for that new nurse when they complete the BSN
residency is that they will be a bedside leader and that they will be
here. Turnover is extremely high for nurses—about 30 percent of nurses in
their first year will change jobs. With the residency, our turnover ranges
from 6 to 10 percent. We have three goals—a stable nursing staff, which
addresses turnover; better quality of care; and decreased recruitment costs.”
Facilitated by expert nurses, the program emphasizes critical thinking,
leadership skills, patient safety, and professional career development. As part
of the program, BSN residents are required to do an evidence-based project.
“One project led by nurse resident Kate Osman, BSN, RN, was focused
on safety issues as well as how time consuming it is to fill saline syringes
by hand rather than purchasing prefilled syringes,” said Jeanne Bouvier,
MSN, ACNS-BC, RN, BSN residency coordinator for UK HealthCare.
Two other nurses on Kate’s unit, Holly Russell, BSN, RN, and Jessica
Cayson, BSN, RN, assisted in the project, and staff from materials

management, pharmacy, nursing fiscal affairs, and outpatient services
provided nurse salary and materials data. The project was implemented
and a hospital-wide change to using commercially prefilled syringes
saved the hospital $36,900 in the first 11 months. Other implementation
benefits included significant time savings for nursing staff and enhanced
compliance with federally regulated pharmacy and infection-control
standards. The project tied for third place at the 2009 UHC/AACN
Nurse Residency Program’s annual meeting.

Safe environment
Support also comes from talking about shared experiences. BSN residents
meet as a group within their unit once a month with facilitators from both
the College and the hospital. The residents talk about the ups and downs
of their nursing experience.
“BSN residents are surveyed throughout the year to determine how effective
the program is,” said Bouvier. “We’ve gotten a lot of good feedback and
that has helped us shape our training going forward.”
In fact, many residents say that they would have quit if not for the BSN
Residency Program reports Diebold. The program benefits are evident not
only in the retention numbers but in the poise and confidence with which
new nurses carry out their duties and, in the end, in enhanced patient care.

In 2009, UK College
of Nursing students
had 38 clinical rotations
within UK HealthCare.

* VitalStats

UK College of Nursing transition programs such as SNAP and the Synthesis
course instill nursing students with more confidence through critical
thinking and proficiency in technical skills such as starting an IV, calculating
medications, changing dressings, and electronic medical charting.

UK College of Nursing
• * ere are more than 5,000 College of Nursing
alumni. Of those, more than 3,000 live in Kentucky,
including more than 1,000 in Fayette County.
• * e first-time pass rate for UK College of Nursing
BSN graduates taking the NCLEX (National
Council Licensure Examination) over the last
nine years has averaged 97 percent. This is higher
than both the national pass rate (88 percent) and
Kentucky’s pass rate (91 percent).
• * K College of Nursing’s graduate program is tied
at 26 among graduate schools of nursing according
to U.S. News & World Report in its 2008 edition of
America’s Best Graduate Schools.
• * e UK PhD program in nursing is ranked 10th out
of 99 private and public PhD programs in nursing
(2008 Academic Analytics, LLC Report).
• * e College ranked 33 among all schools of nursing,
with $1.3 million total in National Institutes of
Health (NIH) funding in 2008.
As part of the college’s upcoming 50th anniversary,
we will be honoring 50 accomplished alumni.
Nomination forms are due April 31, 2010 and are
available at www.mc.uky.edu/nursing

UK HealthCare
• * K Albert B. Chandler Hospital has been
redesignated a Magnet Hospital in recognition of
the outstanding nursing care at UK Chandler
Hospital and Kentucky Children’s Hospital. UK
Chandler Hospital is the first in Lexington and
the 38th among 6,000 hospitals in the nation to
have earned this achievement.
• * ationally, 30 percent of first-year nurses will
change positions. For nurses who complete UK
HealthCare’s Nurse Residency Program, turnover
is only 6 to 10 percent.

“We know that the first year of practice is a very difficult time of transition,” said
Jane Kirschling, DNS, RN, FAAN, Dean of the College of Nursing. “We have been
purposeful in looking at strategies to optimize that soon-to-be nurse’s ability to transition
more effectively into that first professional position and to have learning experiences
along the way that allow them to ask questions such as—Is this the type of nursing I want
to do? Is this the place that I want to do it?”
The Student Nurse Academic Practicum (SNAP) is one program that facilitates the
transition from student to professional. This three-credit-hour summer program was
revamped last year to focus on enabling student nurses to practice nursing under supervised
conditions. College faculty supervise students, assess their competencies, and pair them
with a UK nurse preceptor. SNAP occurs the summer before a BSN student’s senior year or
after they have completed one year in an associate degree nursing program. In 2009,
18 SNAP program graduates were hired by UK HealthCare.
A second opportunity for real-life experience is the Synthesis of Clinical Knowledge for
Nursing Practice, which takes place in the last eight weeks of the senior year. Students work
at the bedside with a registered nurse and are supervised by their clinical instructor from
the College of Nursing.
For both the SNAP program and Synthesis course, students are placed in clinical areas
that they ultimately want to work in when they graduate. “For instance, if someone is
interested in neonatal care, they would be placed in that specialty with the intention that we
would hire them into the neonatal care unit. Sometimes in the course of the year students
may decide that a certain specialty is not the area that they want to work in,” said Sharon W.
Lake, MSN, RN, Director of Nursing and Practice support, UK Chandler Hospital.
A secondary benefit for the hospital is that these students have had two intensive nursing
experiences and that their orientation needs are reduced. Students are more comfortable
with their skills and transition faster from the student role to a professional nurse role.
“Nurses hired who went through either the SNAP program or Synthesis course commented
that they were more comfortable, had already made contacts in their unit, and knew how
the unit operated,” said Lake. “The experience of starting their first job was less stressful and
they felt they had a leg up on other students who hadn’t had that experience.” •

• * uring the 2008-2009 academic year, 334 UK
HealthCare nurses took advantage of the tuition
benefit and were enrolled in classes.
• * K HealthCare has 188 nurses with specialty
Left photo: Penne Allison, BSN, RN, MSOM and
Patricia Kunz Howard, PhD, RN, CEN, CPEN, FAEN
Right photo: Left to right: Richard P. Lofgren, MD;
Paul D. DePriest, MD; and Colleen Swartz, MSN, RN, MBA

* Clinical and Academic Collaboration
Drive Cross-Discipline Learning

“There is an amazing synergy created when multiple disciplines learn
and work together in an academic health center, such as we have at UK,”
said Jane Kirschling, DNS, RN, FAAN, Dean of the College of Nursing.
One outcome of that synergy is a joint publishing workshop to facilitate
the publication and presentation of nursing research. The idea, which
originated at UK HealthCare, will use College of Nursing faculty to work
with participants throughout the process.
“The College of Nursing comes at it from an academic perspective,”
said Penne Allison, BSN, RN, MSOM, Director of Emergency and
Trauma Services, UK Chandler Hospital. “Being closely linked to
the school, we can influence what needs to be coming out of the college
and they can tell us what they are seeing as well.”
Colleen Swartz, MSN, RN, MBA, Chief Nurse Executive for UK
HealthCare, said, “We are trying to set ourselves apart as a unique learning
and career experience. Our students learn how complex the system can
be, and they are realizing this is an interdisciplinary team effort of
medicine, nursing, pharmacy, and other areas. No one can really stand
alone. Patient care is complicated and requires team thinking to drive
the necessary outcomes.”
Patricia Kunz Howard, PhD, RN, CEN, CPEN, FAEN, Operations
Manager for Emergency and Trauma Services at UK Chandler Hospital,
agrees that the environment is rife with opportunities. “Strong collegial
relationships foster an atmosphere that is committed to mutual respect
with a focus on developing future clinical leaders. Ready access to expert
clinical and academic nursing professionals is value added.”

“Our students learn
how complex the
system can be, and
they are realizing this is
an interdisciplinary
team effort...”
—Colleen Swartz, MSN, RN, MBA,
Chief Nurse Executive for UK HealthCare

Collaborating for the future
“The relationship between the College and UK HealthCare that started
under Williams’ tenure needs to continue to move forward, where we can
advocate for each other, impact practice, create the next generation of
the nursing workforce, and where we can prepare nurses through continual
learning,” said Kirschling.
When new American Association of Colleges of Nursing (AACN)
guidelines for the essentials of baccalaureate nursing education came
out in 2008, this relationship was put to work. The curriculum mapping
committee, which includes three UK HealthCare partners, was able to
interpret these guidelines from a practice setting.
“It is unique that we have this partnership—that we sit on their committees
and that they sit on ours,” said Associate Dean for Undergraduate Studies
Patricia V. Burkhart, PhD, RN. “It is really crucial because we want to
ensure that we put out high-quality practitioners. UK HealthCare gives us
that real world perspective and they have been involved at all levels.”

* “On our campus you can walk from a community hospital—Good
Samaritan—through all six associated health care colleges—to a brand
new 1.3 million square foot state-of-the-art hospital. There are only
about six campuses in the nation that have this type of complete package
where all colleges are in one contiguous space.”
—Paul D. DePriest, MD, Chief Medical Officer, UK HealthCare

“From a clinical
operational standpoint,
we’re excited because
we are able to recruit
the best. For the
complex patients that
we take care of—that
is really critical.”
—Richard P. Lofgren, MD, VP for Health Care
Operations and Chief Clinical Officer, UK HealthCare.

Putting that theory into practice is exactly what UK HealthCare and
its partners did a year and a half ago when it developed a relationship
with UK’s Gatton College of Business and Economics. UK HealthCare’s
Executive Leadership Development Program is a year-long certificate
program that accepts 30 applicants nominated by peers and managers
and representatives from the UK College of Nursing, the UK College of
Medicine, and Enterprise Finance. Participants work in interdisciplinary
teams with an enterprise sponsor to complete a project that can ultimately
be implemented.
The Executive Leadership program is novel in that, while some
academic centers may offer this type of program it is not offered as an
interdisciplinary team program. “The feedback that we got from program
participants was how valuable it was to get to interact with peers in this
way,” said DePriest.
That triad approach resonates with many members of the team, including
Richard P. Lofgren, MD, Vice President for Health Care Operations and Chief
Clinical Officer, UK HealthCare, who said, “Health care is a team sport.”

Bringing it all together
“Our relationship is very unique,” said Paul D. DePriest, MD, Chief
Medical Officer, UK HealthCare. “There are only a handful of centers
nationwide that would use this type of an enterprise model and care delivery
teams. The people who understand hospital operations best are nurses.
Close on the heels of that are medical directors, who have a good feel for
how floor or operating room care is rendered. Then you have a handful
of administrators who have their MHA or MBA and they have a unique
perspective and skill set but don’t have the clinical expertise that a nurse
has. The best teams are composed of those kinds of individuals—physician,
advanced practice nurse, administrator or finance partners. Those triads
are most effective in order to change or improve a clinical operation.”

Lofgren cautions that the new hospital is only the facade for providing
great-quality patient care and teaching. “The bricks and mortar are here
to house the outstanding people and programs,” he said. “The facility
will allow us to provide the physical structure to bring forward the latest
in technology and better advanced medical services. It will dramatically
enhance not only patient care but the ability to train individuals to prepare
for how best to utilize advanced technology to support our program.”
“Our mission is to make sure that every Kentuckian knows that regardless
of how sick they are that they can get the best care in the country right
here,” Lofgren said. “We expect that care to be not only technologically
advanced, but in the end to remember that health care is a human
endeavor—so patients and their families’ needs for information and
emotional support are also addressed and are critically important.” •

315 College of Nursing Building
Lexington, KY 40536-0232
Student Services: (859) 323-5108

800 Rose St.
Lexington, KY 40536-0293
Nurse Recruitment: (859) 323-5851
(800) 233-5851

UK HealthCare is UK Chandler Hospital; Kentucky Children’s Hospital; UK Good Samaritan Hospital; Markey Cancer Center; Gill Heart Institute; Kentucky Neuroscience Institute;
and the clinical activities of the UK Colleges of Dentistry, Health Sciences, Medicine, Nursing, Pharmacy and Public Health.