The Birmingham VA Nursing Academy Partnership
Submitted by Dr. Laura Steadman, Kimberly D. Froelich, PhD, RN, NE-BC, ARNP, VHA-CM, Angie Harrison, RN, VANAP scholar, Taylor Wiggins, RN, VANAP scholar, Elijah Berry, RN, VANAP scholar
In 2009, the Birmingham VA Medical Center (BVAMC) partnered with the University of Alabama at Birmingham School of Nursing (UABSON) to become one of twelve schools and VA facilities to participate in the piloting of the Veterans Affairs Nursing Academic Partnerships, or VANAP. The VANAP is a unique clinical program that pairs accredited baccalaureate nursing programs with local VA medical facilities to provide nursing students with veteran-focused clinical experiences. Since adopting the VANAP program, the students, clinical faculty, UAB SON, and BVAMC have experienced consistently positive outcomes. This paper outlines the BVAMC and UAB SON partnership’s implementation of VANAP with the goal to inform and inspire other nursing programsto incorporate a VANAP into their curriculum.
Application and Selection Process
The VANAP is open to all baccalaureate nursing students enrolled in the UAB SON and is explained to incoming students at the pre-semester orientation. Interested students submit an application along with a 120-word essay describing the students’ interest in becoming a VANAP scholar prior to the start of their first nursing school semester.A representative panel from both the BVAMC and the UAB SON then conducts group interviews and reviewsapplicants’ responses to questions, essays, and overall applications (i.e. grade point average [GPA], academic affiliations [e.g. Honors Program], and veteran’s status). The panel averages and compares individual scores beforeconsideringthe top eight scores for the VANAP scholars program. In addition to each student’s score, the panel accounts for overall group dynamic, this is considered fundamental to the success of a VANAP cohort.Two slots are reserved for mobility students, who are non-traditional students seeking a baccalaureate degree in nursing.The eight traditional BSN and two mobility students form a cohort that completes all clinical practicums, with the exception of pediatrics and obstetrics,as a single, cohesivegroup. Specific UAB SON faculty in the program are designated for VANAP and monitor the students’ progress throughout the program.
Getting Started at the BVAMC
As a VANAP scholar, students are required to complete privacy, intake (i.e. identification cards, fingerprinting, background investigations), and computer trainingprior to accessing VA computers or caring forVA patients. Mandatory online training courses provide information promoting patient safety, professional development, and veteran-specific care needs (i.e., Agent Orange and Post Traumatic Stress Disorder [PTSD]). Additional classes are conducted to teach faculty and students how to operate VA equipment and navigate theVeterans Health Information Systems and Technology Architecture (VISTA)electronic health record system.The BVAMC screening and training process takes approximately 10-14 days to complete and has been implemented to protect Veterans’ privacy and to ensure everyone with access to the veteran is aware of VHA requirements.
Though this extended orientation may seem excessive, it highlights one of the major benefits of the VANAP program. Our scholars are, first and foremost, nursing students, but the close partnership between the UAB SON and the BVAMC allows the medical center staff to dependably rely on students to be trained and familiar withpolicies and procedures, allowing them to function more like trainedmedical center employees rather than temporary visitors. This benefits the BVAMC staff members who no longer feel burdened by “hosting” unfamiliar students while also benefiting the students whoare allowed to work as part of an interdisciplinary team that can comfortably expand to include BVAMC scholars.
Theunique setting provided by the Birmingham VA Medical Center is evident immediately upon arriving as students walk through the waiting room,past groups of veterans discussing shared experiences and retelling old war stories.Once on their assigned floor, students are exposed to a clinical setting that is, in many ways, at the forefront of medical technology and evidenced based practice. For example, Vista, the VA’s electronic health record (EHR) system, is fully integrated into all of the medical center’s clinics and allows the students to gain valuable experience with paperless charting. The VA was an early adopter of electronic health records and the widespread implementation has made Vistathe most widely used complete EHR system in the U.S.
The BVAMC also shows students the cutting edge of occupational health with its medical center wide no-lift policy. Each patient bed is equipped with an integrated ceiling lift with portable units available throughout the hospital. VANAP scholars are trained on the safe use of these devices as part of their initial orientation and are encouraged to rely on safe assisted lifting techniques rather than risk overuse or repetitive use injuries. In these, and many, ways,the BVAMC is instrumental in helping the UAB SON prepare a new generation of nurses who are able to develop a familiarity of the latest in electronic charting and assistive technology from the very beginning of their nursing careers.
The patient population of BVAMC represents a wide range of demographics and diagnoses, united by a common background of military service. This diversity allows VANAP scholars to practicetheirfundamental nursing skills while gaining experienceservingthe unique needs of the veteran population. Not only do the students in the program deal with thecommon health issues seen in all populations, such as diabetes and heart disease, they also gain experience caring for patients with diagnoses ranging from PTSD to amputation to Agent Orange exposure. Many of the VANAP students work as student nurse technicians to gain additional skill and knowledge of the BVAMC and veteran population.
The VANAP partnership was initiated in 2009 with the objective of increasing nursing staff engagement, placing greater emphasis on veterans in nursing school curricula, and allowing students to select a clinical experience based on personal interest or career goals. These intangible improvements have greatly improved the veteran-centric knowledge base throughout the UAB SON faculty and students. With administrative and evaluative support provided by continual engagement with the BVAMC, Office of Academic Affiliations and Office of Nursing Service ensuring fiscal diligence, cost effectiveness, and program success, this academic partnership implemented programs to enhance the professional development of VA nurses, facilitate nurse recruitment, reduce the turnover of VA nurses and foster innovation in education practices.
The workforce implications of the VANA program are especially promising. Only 15% of VA staff nurses report prior training at the VA compared to nearly two-thirds of VA staff physicians. This is despite the VA already having a number of general (non-VANAP) nursing student engagement programs. Not only does VANAP greatly increase the number of undergraduate nursing students who will be exposed to the VA system, there is impressive early data on the turnover rates of VANAP graduates who go on to become VA staff nurses. Compared to a historical 10—20% first year loss, VANA-trained nurses maintained a 100% first year retention rate. This partnership has created an avenue for the VANAP students to gain working knowledge of the VA Medical Center and a knowledge base for caring for our veterans.
VANAP scholars frequentlyidentify having a consistent clinical group and site location as one of the greatest benefits of the program. Whereas other nursing students spend several clinical days each semester reorienting to a new clinical group and environment, VANAP scholars have an established familiarity with their team members and the BVAMC facility, allowing them to immediately begin direct patient care. Familiarity with the BVAMC allows students to maneuver through the facility with ease and gain greater competency in their skills. Working with the same cohort throughout nursing school, VANAP scholars naturally establish an academic support group and a unique sense of camaraderie.The VANAP scholars develop a strong connection with their assigned faculty leadership and are offered increased access to academic and career counseling, research involvement, career advancement, as well as opportunities for academic presentations and publications.
The BVAMC and UAB SON VANAP program provides a unique clinicalsetting. Students leave the program equipped with the knowledge they need to embark on a career in nursing and having had the privilege to care for the unique veteran population, America’s Heroes. This experience provides an incentive for nursing students to pursue VA careers. Over time, this will increase efficiencies in VA nurse recruitment, lower orientation and “in-service” training costs, and reduce the turnover rates of nursing staff.All of this can be expected to produce significant savings. The benefits provided by the VANAP program to both the BVAMC and UAB SON have been greatly evident to everyone involved and have been steadily increasing as the program has aged.
Jha, A. K., DesRoches, C. M., Campbell, E. G., Donelan, K., Rao, S. R., Ferris, T. G., & Blumenthal, D. (2009). Use of electronic health records in US hospitals. New England Journal of Medicine, 360(16), 1628-1638.