Fuld Fellows Leadership Program Advances Patient Safety Competence and Systems Thinking in Pre-Licensure Nursing Students

Sunday, 26 July 2015: 3:15 PM

Cheryl Dennison Himmelfarb, PhD, MSN, BSN, RN, FAAN, FAHA
School of Nursing, Johns Hopkins University, Baltimore, MD

Background: In response to complex healthcare challenges in the US, the 2010 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health called for nursing education to include development of leadership, teamwork and communication, quality care and system improvement competencies.  The purpose of this paper is to describe an innovative curriculum designed to advance nurse leadership in patient safety and healthcare quality and provide results of program evaluation.

Curriculum Innovation: The Johns Hopkins University School of Nursing developed The Fuld Fellows Leadership Program, a curriculum to provide selected nursing students with a solid foundation in the science of patient safety, quality improvement (QI) and leadership skills.  The Fuld Fellows Leadership Program consists of four courses threaded throughout the Baccalaureate curriculum, a 3-day interprofessional intercession course, and a 6-month, service-learning project.  The first semester course applies a systems approach introducing students (Fuld Fellows) to the science of patient safety and QI.  Using case studies, case-based quizzes and peer assessments, the course prepares fellows with basic knowledge and skills necessary for their work with a clinical project team.  Fellows work 50-hours per semester during semesters two and three with a mentor and interdisciplinary, patient safety or QI team in a Johns Hopkins clinical setting.  In addition, they participate in bi-weekly, online reflective learning journals focusing on specific attributes of safe, high reliability healthcare delivery teams.  In the fourth and final semester, fellows create a scholarly poster presentation and disseminate their project-based learning.  Fuld Fellows have an opportunity to participate in a 3-day interprofessional patient safety simulation course that includes nursing and medical students taught by interprofessional faculty.  This course focuses on improving students’ teamwork and communication skills and system-based thinking and addresses the causes of preventable harm and evidence-based strategies for harm prevention.  Cohorts I-III (n=56) have completed the program as of August 2014 and cohorts IV-VI (n=59) are ongoing. 

Evaluation Methods: Process evaluation includes specific questions about course content, delivery, and attainment of learning goals for each course and at end of program, as well as project mentor / mentee evaluation of one another.  Pre-post program evaluation includes fellows’ perceptions of patient safety competence at entry into practice, using the Health Professional Education in Patient Safety Survey (H-PEPSS), and systems thinking, using the Systems Thinking Scale.  Pre- and post- program scores for the H-PEPSS subscales and Systems Thinking Scale were compared using the Wilcoxon Signed-Rank Test.

Results (From Cohorts I-III):  The fellows reported that the mentor-mentee relationship was successful (96%), and they generally demonstrated problem-solving skills (99%), accountability (100%), and professional development (93%).  The students found the service-learning portion of the course to have provided a valuable experience (95%) and was intellectually stimulating (91%).  Overall, the mentors (n=54) reported that the experience was satisfying (90%), time commitment reasonable (86%), and that they generally were successful in actively involving students in their project (91%).  Moreover, mentors identified that student involvement enriched their project teams immensely. Fellows provided the following feedback in end of programs focus groups: “The best part of the Fuld Leadership Program was interprofessional collaboration.  The integration with medical students was very helpful and having the opportunity to work on a different aspect of nursing which other students may not have had.  I enjoyed the research component which provided an extra push to get a foot in the door with research.”  “The program was beneficial towards shaping me as a marketable future nurse.  I do believe I will be more aware of quality improvement and safety issues than my co-workers and this will make me a leader in the workforce.”  Mean+SD scores on the H-PEPSS scales improved from baseline to end of program as follows: teamwork (3.4+0.6 to 4.5+0.5), communication (3.1±0.6 to 4.7±0.4), managing risk (2.7±0.7) to 4.5±0.5), human environment (3.5±0.9 to 4.7±1.1), recognize and respond (3.2±0.8 to 4.6±0.5), and culture (3.5±0.6 to 4.9±0.3) (p<0.0001 for all).  Mean+SD scores on the systems thinking scale increased from 64.3±6.6 at baseline to 70.4±6.2 (p=0.0012).

Conclusion: This innovative program is effective in facilitating learning and application of the patient safety champion role among pre-licensure nursing students.  Fellows’ patient safety competence and systems thinking increased to high levels (or improved) after participation in the program, leaving them well-equipped as future leaders of patient safety and QI initiatives.  This program can serve as a model for integrating quality and safety concepts into nursing curriculum.