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Methods: The initial Partnership program was developed in July 2015 with the Genesee County Health Department (GCHD) Primary Care Clinic through HRSA Advanced Nursing Education grant funding. The Primary Care Clinic is in a medically underserved setting that provides primary care to HIV positive patients and their families within the HIV Treatment Cascade model. The model utilizes an interprofessional team approach including a nurse practitioner with a joint appointment at the GCHD and the UM-Flint DON and an HIV Infectious Disease Specialist, which ensures high-quality clinical training and preceptor preparedness. Partnerships will be expanded to additional clinic sites that are within Health Professional Shortage Areas (HPSA) and Medically Underserved Areas (MUA) in Michigan. Placing students in underserved settings increases their willingness to practice with vulnerable populations (Rasmor, Kooienga, Brown, & Probst, 2014). This aligns with the 2015 HRSA statutory purpose of Title VIII and Healthy People 2020.
The nurse Program Director chairs an interprofessional program planning committee to provide leadership to the partners to reach the program objectives. The project objectives include: 1. Increase the number of high-quality primary care clinical practice placements for the DNP and MSN nurse practitioner programs at UM-Flint. The goal of this program is to create more than fifty designated preceptorships over the next three years. Meetings were held between UM-Flint DON faculty leadership and healthcare organizational nurse executives to develop Academic Partnerships. Outreach to recruit partners was made using clinical contacts of the program Infectious Disease Specialist, to clinics within healthcare networks, and to nurse practitioners who were interested in precepting students. Communication with partners included meeting minutes, informational letters, and informal clinic visits, emails, and phone conversations. 2. Provide and evaluate preceptors in assessment, teaching, and evaluation of students by creating online preceptor training modules with learning assessment outcome measures and feedback surveys. Online training is an effective and satisfactory way to educate preceptors (Wilkinson, Turner, Ellis, Knestrick, & Bondmass, 2015); 3. Evaluate DNP and MSN student clinical experiences for increased effectiveness in primary care management of HIV positive patients via HIV/HCV online learning modules including pre- and post-clinical placement surveys of students and preceptors and knowledge testing of NP students; 4. Evaluate and make quarterly improvements in the learning modules and preceptor-student experiences using the Plan, Do, Study, Act model. Evaluation tools include: preceptor evaluation of student, preceptor satisfaction survey of program, and student evaluations of preceptors and clinic sites; 5. Increase the number of graduates who practice with underserved populations from 40% to 50% by requiring commitment letters from students in clinical placements to practice in these areas.
Results: Participation: Four graduate nurse practitioner students (3DNP, 1MSN) participated in the program during the Fall 2015 and Winter 2016 school semesters. Two nurse practitioners served as preceptors, with an additional three preceptors and six-seven graduate students expected to participate in the Spring/Summer 2016 semester. The preceptorships are in primary care clinics serving the HIV, HCV and geriatric populations. Recruitment of new partners via leadership meetings are in progress and the program expects to place eleven to twelve students with preceptors in the Fall, Winter and Spring semesters over the next two years, which will result in seventy-six students finding clinical placements through this program. Preceptors showed increased interest in the program with informal communication and clinic visits from program staff. Evaluation: Student feedback about the preceptors and clinic sites was consistently the highest-rank of Likert-scales. The Preceptor Learning Modules were consolidated and reorganized per preceptor feedback. Both the preceptor evaluation of students, and student self-evaluations reflected an increase in readiness to practice following student completion of the HIV/HCV Learning Modules. All participating students (100%) signed a Letter of Intent to practice as Primary Care Providers in underserved settings after graduation.
Conclusions: Program practices that facilitate Academic Partnerships: Involvement of nurse faculty leadership and nurse executives is necessary to establish contracts and form Academic Partnerships. The demand for quality preceptorships requires that Partnerships are not limited to one kind of clinic or healthcare network. Recruitment of nurse practitioners to be preceptors leads to forming Partnerships with healthcare systems. Informal communication (emails, phone calls, clinic visits) is more effective than formal communication to foster relationships between the program and clinic preceptors. Program evaluation identified: Student feedback reflects that the students are engaged in their clinics, and highly rate their preceptors, which have been identified as key factors influencing students to become primary care providers. Modifications to the Preceptor Learning Modules should be ongoing, to increase preceptor satisfaction and knowledge of precepting skills. The Preceptor Learning Modules provide quality improvement to the student-preceptor experience. Preceptors’ evaluation of students and student self-evaluation demonstrate that students have an increased readiness to practice when participating in this program. Program practices that increase students’ intent to work in underserved settings: Placing students in underserved settings, and use of the Letter of Intent are effective approaches to increase the number of students who intend to practice in primary care in underserved settings.