By Melinda Young
One of the challenges facing health systems as patients are moved from the hospital to another healthcare facility is how to make these transitions as safe as possible — especially in rural and underserved areas.
A Veterans Affairs (VA) hospital has found a possible solution through its Transitions Nurse Training Program (TNTP). The hospital piloted the training program, offering a curriculum on how nurses could effectively handle care transitions, particularly in rural areas. The program proved successful and was expanded to other VAs across the country.1
Transitional care and patient care coordination is not a typical part of work for most hospital nurses, says Lynette Kelley, FNP, a research nurse practitioner/clinical analyst at the Denver-Seattle Center for Innovation for Veteran-Centered and Value-Driven Care.
“With our program, the focus was on providing care to rural veterans,” Kelley says. “The literature supports transitional care for all patients at high risk, but especially for those who live in rural areas and have limited access to healthcare.”
The evidence-based curriculum on transitional care training was limited when this project began in 2014 and 2015. “We [conducted] research on the nurses from 10 different VAs, all over the states,” explains Kelley, who is affiliated with the Geriatric Research Education and Clinical Center at the VA Eastern Colorado Health Care Rocky Mountain Regional VAMC. “We looked at evidence for guidance and pulled it into what became the VA Rural Nurse Transitions Program.”
They trained two groups of transitions nurses between 2017 and 2019. “It was really important to us that the training was evidence-informed,” Kelley says. “Even if we thought we had a good idea — unless we had evidence backing it up, we avoided those things.”
They also used a theoretical framework for researchers to see if it could strengthen the entire curriculum. “We chose adult learning theory and thought that was a good theory because it embraced situational learning,” Kelley says. “It’s an adult learning theory that embraces the social character of learning as an integral component.”
The theory uses social learning, combining it with occupational and apprenticeship learning. “What they define as occupational training is a didactic educational component, and what they consider apprenticeship is the reinforcement of behaviors through apprenticeship,” Kelley explains. “What it looks like is model training, and its coordination with a mentor is a clinical external facilitator.”
Kelley and another RN-level nurse served as the coordinating team and mentors for the nurses hired and trained in the program. “I did all of the on-the-job training because I was in that role for the pilot nurse training program,” Kelley says. “I was able to say, ‘This is how I dealt with these situations, and here’s advice on how to provide the best care in these situations.’”
Different sites around the country could use the training program to help them develop better care transitions for their rural veteran patients. The TNTP built in flexibility but required that only rural patients receive transitional care services from the trained nurses. “We give [sites] the freedom to make adaptations based on their health system and their own priorities,” Kelley says. For example, each site could create their own exclusion criteria for patients to be transitioned at their setting.
The training program was standardized. “We wanted to train everyone in a standardized fashion. That would give the program the best chance to have fidelity when it was used in different states,” Kelley explains.
A study of the training curriculum revealed the TNTP successfully created engagement. Nurses also reported satisfaction with the training and were confident in what they learned. They achieved a mean score of 92% on clinical and communication skills. Post-training observation revealed skill sustainment of 98%.
One of the drawbacks of a specialized transitional care program is that facilities may employ only one transitional care coordinator. This can be a lonely position, Kelley notes. “I felt from my personal experience when I was piloting the program that while I enjoyed the work, I didn’t have a team, and I was by myself in the office,” she explains. “It’s not the same as when you work on the floor and have a breakroom and can discuss things with patients and different aspects like that.”
Teamwork was missing, which can be a barrier for some nurses who are interested in training for transitional care positions. They may believe they have no support and are not part of the main hospital care.
The TNTP helps nurses with feelings of isolation by providing them with peers and mentors across the country. They can contact another transitions nurse to ask a question or resolve a patient problem.
Each care transitions nurse trainee also learned skills that could enrich their professional lives wherever they landed in their next position, Kelley says.
REFERENCE
- Kelley L, Broadfoot K, McCreight M, et al. Implementation and evaluation of a training curriculum for experienced nurses in care coordination: The VA Rural Transitions Nurse Training Program. J Nurs Care Qual 2023;Feb 27. doi: 10.1097/NCQ.0000000000000698. [Online ahead of print].
One of the challenges facing health systems as patients are moved from the hospital to another healthcare facility is how to make these transitions as safe as possible — especially in rural and underserved areas. A Veterans Affairs hospital has found a possible solution through its Transitions Nurse Training Program.
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