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Advanced practice nursing (APN), in particular nurse practitioners (NPs), have well-established roles in many countries, especially the US and Canada. They have become integral members of the health care team (Pulchini, Jelic, Gul, & Loke, 2010). Nurse practitioner education programs moved into university settings in the early 1990’s and NPs earned academic graduate degrees and clinical NP licenses. The concept of nurse practitioners health care systems in the Middle East, and in particular, Israel has been explored but remains in an early stage (Kleinpell, Scanlon, Hibbert, Ganz, East, Fraser, Wong & Beauchesne, 2014). Although the Israeli Ministry of Health have endorsed the concept of approving NP practice, implementation has been lengthy. In addition, current NP training has been modeled after the older US NP certificate programs rather than university based graduate level programs. The only NPs who have been integrated into the Israeli healthcare system to date are part of a pilot program in geriatrics and palliative care, with approximately 20 NPs respectively (Kleinpell et al., 2014).
Similar to other countries, Israel has identified a significant primary care physician shortage and the need for advanced practice nurses. There currently are no nurse practitioner education programs in the country. The Evelyn Gruss Lipper Charitable Foundation has funded full scholarships and expenses for 20 Israeli Registered Nurses to complete the online Family Nurse Practitioner Master of Science in Nursing Program offered through the Simmons College School of Nursing and Health Sciences. Scholarship Program
The purpose of this presentation is to share the partnership creation processes, to identify cultural differences, needs, and barriers; develop common language and goals for the partnership; identify stakeholders, institutional supports and barriers to recruitment, international academic validation and acceptance, and enrollment.
Methods:
After a year of unsuccessful negotiations with the Israeli Ministry, the donor and Simmons identified an Israeli physician who served as a consultant within the Israeli medical system to assist with introductions and interpretations. Together we identified an Israeli HMO-the Meudedet-that was already considering APRN development with a goal to employ APRNs as nurse practitioners. Therefore the partnership ultimately was based on this shared goal and perspective. This consultant became the cultural mediator between the two groups until a formal partnership was formed. He also linked the medical and nursing leadership to nurses within the Meuhedet, a crucial part of the program success.
We developed a template based on the processes currently successfully used in the pre- existing pilot program in geriatrics. Using the concepts of building successful international collaborations (Vosit-Steller, Morse, & Mitrea, 2011), whereby the building blocks include setting a common goal, identifying cultural differences in learning styles, developing an effective communication strategy, establishing a collaborative plan for action, and allowing for iterative feedback, the Simmons-Meuhedet team built its partnership to support the Lipper Scholarship Program and to ultimately advance nursing and healthcare in Israel
As per the wishes of the donor, the Israeli students study side by side with US based online students in more than 43 states. This was a challenge, as distance learning in Israel was not well accepted. The Simmons Program incorporates both synchronous and asynchronous components in every class. The literature reports many benefits of on-line education, specifically using virtual classrooms where the education/teacher is in visual contact with the students, and the students are in visual contact with each other, there are many other benefits, especially for international programs (Gemmel, Harrison, Clegg, & Reed, 2015). In global collaborations such as ours, in a virtual classroom, students learn about each other, which in turn enhances cultural understanding of each other’s differences and ultimately improves cultural working skills between students (Martin, Parker & Deale, 2012). Internationalization of higher education has been found to be beneficial for the host culture and the guest culture, by enhancing discussions, enriching shared experiences, and developing shared perspectives of health. These are not found by just reading about different cultures. Voist-Steller et al. have demonstrated that direct immersion into each other’s world was a more effective way to develop collaborative partnerships (Vosit-Steller, Morse, & Mitrea, 2011).
The literature reports many benefits of on-line education, especially to working mothers, including: not driving to the university, being able to take classes after the children are sleeping, and being home more (de Souza Alves, Bohomol, & Kowal Olm Cunha, 2015); all of which dovetail with Israeli family life style.
For all of the benefits, there were many challenges. First of all there was a general mistrust of “systems” that had to be overcome. Additionally, recruitment presented several issues not previously experienced by Simmons. Several Israel students misunderstood application, admission, and grading processes. This necessitated increased personal support and assistance by all team members and an Israeli-based cultural mediator. Simmons hired an American educated FNP who lives in Israel as the director of clinical education who will not only serve as this cultural mediator but also will advise students, train preceptors, place students clinically in the Meuhedet, and “shepherd” the students throughout their program.
Results:
Simmons College introduced the idea to a group of corporate administrators at the HMO resulting in an educational partnership aimed as well at NP implementation. There were issues of cultural competence, such as finding a common language and setting common goals, determining a timeline to meet the needs of both organizations, and identifying the stakeholders. The students report a high level of satisfaction with the education platform, the learning experiences, and are working on collaborative partnerships in the health care system HMO.
Conclusion:
We are completing the first year’s implementation of an international education partnership project joining a US University Advanced Practice Nursing (APN/NP) program with an Israeli health providers’ organization (HMO) in Israel where the APN role is not yet well accepted. Upon graduation, the Meuhedet will hire all twenty FNP graduates who will in turn lead through example the transformation of primary care in Israel Building international collaborations though challenging is possible by setting mutual goals and following templates for success.
References
de Souza Alves, V. L., Bohomol, E., & Kowal Olm Cunha, I. C. (2015). Graduate distance education in nursing: assessment under students' perspective. Acta Paulista De Enfermagem, 28(2), 139-145 7p. doi:10.1590/1982-0194201500024
Gemmell, I., Harrison, R., Clegg, J., & Reed, K. (2015). Internationalisation in Online Distance Learning Postgraduate Education: A Case Study on Student Views on Learning Alongside Students from Other Countries. Innovations In Education And Teaching International, 52(2), 137-147.
Kleinpell R, Scanlon A, Hibbert D, Ganz F, East L, Fraser D, Wong FKY, Beauchesne M. (2014) : Addressing Issues Impacting Advanced Nursing Practice Worldwide. Online Journal of Issues in Nursing 19. doi: 10.3912/OJIN.Vol19No02Man05
Martin, F., Parker, M. A., & Deale, D. F. (2012). Examining interactivity in synchronous virtual classrooms. The International Review of Research in Open and Distributed Learning, 13(3), 228-261.
Pulcini J, Jelic M, Gul R, Loke AY (2010): An international survey on advanced practice nursing education, practice, and regulation. Journal of Nursing Scholarship, 42:31-39. doi: 10.1111/j.1547-5069.2009.01322.x
Vosit-Steller, J., Morse, A. B., & Mitrea, N. (2011). Evolution of an International Collaboration: A Unique Experience Across Borders. Clinical Journal Of Oncology Nursing, 15(5), 564-566 3p. doi:10.1188/11.CJON.564-566