EDs struggling to save nurse educator programs
In an era of increased budget cuts, nurse educator positions are often the first to go, often to the detriment of nursing practice, performance
In response to increased staffing cuts, staff educator positions are increasingly being reduced or cut altogether. "When administrators are looking for budgetary cuts, they tend to look at education as a fluff position because those people don’t actually figure into day-to-day care hours," says Alice Conroy, RN, nurse manager at Columbia/Sunrise Hospital and Medical Center in Las Vegas.
Nurse educators offer benefits that are often overlooked by cost-cutting administrators. "You can look at these FTEs and ask, Are they really are hands-on, day-to-day caregivers?’ And, the answer is no. But, if you look at the amount of information getting out to the staff of almost 100 people, they are worth their weight in gold," says Conroy.
Nurse educator prevents stagnation
Having a dedicated educator can challenge the nursing staff on an ongoing basis. "When you don’t have someone in that role, you get stagnation of practice," says Conroy. "There is no one updating staff on the latest developments and articles, or with contacts in the community to find new and different ways of thinking."
At Sunrise, a nurse educator focuses on orientation and reinforcement of policies and procedures, and a clinical nurse specialist provides hands-on education on more advanced segments of clinical practice. "Education is a very big part of my focus, not only day to day, but doing competency assessments, keeping up with trends in the practice field, and working in program development and research," says Louise Colwill, RN, MS, CEN, the ED’s clinical nurse specialist.
It’s difficult to motivate the nursing staff to go out and find that on their own. "In most cases, people tend to get used to doing what they’ve always done," says Conroy. "The main challenge of the nurse educator role is to move people out of a sense of comfort and into what’s new."
At Riverside Methodist, a full-time nurse educator position was cut back to part-time. "It would be better if it were still a full-time position," says Gail Loadman, RN, CEN, director of emergency services for Grant/Riverside Methodist Hospital in Columbus, OH. "In the past, she was involved in more direct education of staff, but now there is not enough time. It’s a real loss to the staff when she’s not around as much."
The transition has been tougher than anticipated. "We rationalized cutting the position to half-time because we weren’t anticipating a lot of orientation. Therefore, half of the educator’s role would be eliminated, but this year we’ve had a lot of relocations and turnover, which have made things difficult," Loadman explains.
A decision was made that the ED’s assistant nurse managers would take on some of the responsibility for education. "We decided that each of them would take it on for a six-month period of time, trying to plan at least one educational program a month," says Loadman. "But it’s been tough, because most of their time is taken up with clinical practice."
The educator keeps staff up-to-date on equipment reviews, changes in policies and procedures, and assists with mandatory competencies. "She helps keep people up-to-date, as when we recently changed a restraint-policy procedure, and she also provides information for staff [on how] to access education programs," notes Loadman.
Nurses are reimbursed for mandatory programs such as ACLS. "Over and above that, we look at requests on a case-by-case basis, and try to support them in some way, either with a registration fee or an education day," says Loadman. Several nurses are sent to the Emergency Nurses Association’s (ENA) Scientific Assembly every year.
"As budgets for reimbursement of education are tightening, nurses are expected to pay for it themselves on their own time, which is very difficult," says Polly Zimmermann, RN, MS, MBA, CEN, senior course manager for the National Center for Advanced Medical Education in Chicago. Nurse educators can help ease that burden and make it easier for nurses to keep certifications current and seek ongoing education, she explains.
Educational cutbacks have made it difficult to promote advancement of the nursing staff’s clinical practice. "It’s getting tougher and tougher to support the staff’s educational efforts," stresses Loadman. "We do it any way we can, beg, borrow, and steal." A foundation account is set up with funds for continuing education, such as scholarships to the ENA state council annual meeting, TNCC courses, and the advanced trauma course.
The account is budgeted at $50 per FTE (full-time employee) for staff education. "I can also pull some education days out of my wage and salary budget because I have some non-productive time in there, but when it comes to a fee or travel expense, it has to come out of the fund," says Loadman.
Cite benefits to justify costs
ED managers should create a financial impact statement to defend nurse educator positions that provide nurses with the ongoing education they need, advises Colwill. "You can show the savings in the advancement in practice you provide to staff, staff satisfaction, improvement of quality of care and expertise, new patient populations you can treat, and new treatments you can perform," she emphasizes. "You need to present a justification package on your services to show that you have a direct financial impact on the facility."
Here are some of the benefits of a nurse educator:
Keep nurses current on compentencies. Sunrise’s nurse educator helps determine which skills should be assessed during the ED’s annual competency evaluation. "We have an ongoing educational piece for demonstration of competency for particular procedures or new equipment, such as a new pacemaker we did inservicing on," says Colwill.
Start new educational programs. Riverside’s nurse educator helped to put 11 nurses through the ED’s sexual assault nurse examiner (SANE) program. "It required a large chunk of time and money, which was extremely challenging, but the benefits were tremendous," says Loadman. "It just revived the nursing staff, and the excitement rippled over to the rest of the staff."
Nurses were recently required to attend a two-day class on issues affecting the elderly, including elder abuse and medication overdoses. "We looked at our strategic plan and saw that we’d be having more elderly people coming into the ED, so we needed to get prepared," recalls Loadman.
The educational rewards of the in-house courses go beyond basic knowledge. "When you educate people, the benefits go continue past a two- or three-day course," says Loadman. "The nurses keep growing and learning in that area, and a few people on a shift will get turned on and become experts, but you’ve got to plant the seed."
Offer on-the-spot access. Nurse educators are on hand to help nurses with new or rarely used equipment or procedures. "If the educator does a review on a new piece of equipment, the nurses may not touch that piece of equipment for three or four months," says Loadman. "When the time comes, it helps to be able to access that person, especially for low-volume, high-risk procedures."
Unorthodox ways of educating nurses are often most effective. At St. Mary Medical Center in Long Beach, CA, the educator posted puzzles, and questions on the doors in the bathroom stalls whenever she needed to get information out to the staff. "We would talk about the theme of the puzzle, such as rhabdomyolysis, go over important points," says Judy Selfridge-Thomas, RN, MSN, CEN, FNP, formerly the ED’s clinical nurse specialist and currently nurse practitioner and general partner in Selfridge, Sparger, Shea & Associates in Ventura, CA. "It was a fun way to get across information and didn’t take a lot of time."
Streamline orientation of new staff members. There are clear advantages to having a dedicated nurse educator provide orientation, says Selfridge-Thomas. "Every ED has its own quirks as to how they move patients, where supplies are kept, and what pieces of equipment are in the department," she says. "New employees have to learn that from someone who is based in the department, along with the policies and procedures that apply to the ED."
Avoid conflict of interest. Having a nurse educator on staff will provide balance if nursing staff participate in educational opportunities provided by pharmaceutical companies. "They will offer to come in and do in-servicing and provide free videos, supplies, and literature, but you must keep in the back of your mind that they’re going to be biased in what they present," stresses Zimmermann. "Purists feel this is tainted, that education should not have be influenced by commercialism, but a lot of EDs wind up doing it."
Ensure all certifications are current. "Certifications cost a lot of money and there are a lot of them to keep up with," Zimmermann notes. Nurse educators can facilitate the certification process and make sure nurses are up-to-date.
Having in-house staff certified as instructors is a cost-effective way to offset the financial burden of having a nurse educator on staff. "It’s a lot cheaper than going to outside companies," says Zimmermann. At Sunrise, the nurse educator is a certified ACLS and PALS instructor. The clinical nurse specialist teaches ACLS, PALS, TNCC, and ENPC, and the nurse manager teaches ENPC and ACLS.
Last year, a self-study modular program was developed at Sunrise to help nurses prepare for the national emergency nurses certification class. The nurse educator worked one-one-one with nurses to help them prepare. "For programs not offered at our facility, we have contacts in community to help nurses get into programs we know of," says Colwill.
Keeping nurses motivated. Having a dedicated nurse educator makes it easier for nurses to advance. "Otherwise, people are searching on their own, and achieving education externally is quite expensive," says Conroy. "What 80 nurses would need to provide for themselves, they can get here easier and cheaper."
Without ongoing education, the clinical practice of the nursing staff becomes stagnant, says Loadman. "It doesn’t have to be an educator, but somebody has to have that as part of their job," she emphasizes. "With staffing cuts, it’s very difficult for people to get time away from the workplace to pursue education. If staff is stagnating instead of learning and growing, that’s the first step toward really low morale. Nurses do need educational support to grow and continue to meet their mission." n
Standard 1
The registered professional nurse as an educator provides education regarding patient care based upon the nursing process and in compliance with hospital policies, protocols, and procedures.
Standard 2
The registered professional nurse as an educator monitors the patient’s behavioral and physiological status when functioning at the bedside.
Standard 3
The registered professional nurse as an educator performs delegated functions in compliance with hospital and nursing service policies, protocols, and procedures, when functioning at the bedside.
Standard 4
The registered professional nurse as an educator organizes for delivery of nursing care to groups of patients in compliance with hospital and nursing service policies, protocols, and procedures.
Standard 5
The registered professional nurse as an educator is accountable for maintaining and improving his or her own nursing knowledge and skills (nursing competence).
Standard 6
The registered professional nurse as an educator supports the hospital philosophy, goals, and objectives.
Source: Columbia/Sunrise Hospital and Medical Center, Las Vegas. Used with permission.
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