PARTNERSHIP TO IMPROVE QUALITY CARE FOR VETERANS: THE VA NURSING ACADEMY DOREEN C. HARPER, PHD, RN, FAAN⁎, CYNTHIA S. SELLECK, PHD, RN†, GREGORY EAGERTON, DNP, RN, NEA-BC‡,§, AND KIMBERLY FROELICH, PHD, RN, NE-BC|| More than 22 million living veterans reside in the United States. In fact, understanding military culture and the experiences of these veterans is important to their ongoing health care and the unique challenges faced by many. The Veterans Affairs (VA) Nursing Academy began in 2007 to fund pilot partnerships between schools of nursing and local VA health care facilities to better serve our veteran population. Fifteen academic/service partnerships were selected for funding between 2007 and 2009 with the goals of expanding faculty and professional development, increasing nursing student enrollment, providing opportunities for educational and practice innovations, and increasing the recruitment and retention of VA nurses. This article details critical components of the partnership developed between the Birmingham VA Medical Center and the University of Alabama at Birmingham School of Nursing, a VA Nursing Academy partnership funded in the 2009 cohort. Site-specific goals of the partnership are described along with a discussion of the framework used to develop the Birmingham VA Nursing Academy, which includes relationship building, engagement, governance, evaluation of outcomes, and sustainability. The logic model developed for the partnership is included, and the interim outputs and outcomes of this practice–academic partnership are detailed, a number of which can be replicated by VAs and schools of nursing across the country. (Index words: Veterans; Partnerships; Nursing education; VA Nursing Academy) J Prof Nurs 31:57–63, 2015. © 2015 Elsevier Inc. All rights reserved.
“M
Y EXPERIENCE OF soldiers is that they will go back into the fight to find a prostrate comrade or their wounded officer-& fight their way out again bringing him with them-or as often happened leaving their own lives behind. May I be worthy of them!” Florence Nightingale's Letter to Dr. Thomas Gillham Hewlett, November 4, 1888. ⁎Dean and Fay B. Ireland Chair in Nursing, The University of Alabama at Birmingham School of Nursing. †Associate Dean, Clinical Affairs and Partnerships, The University of Alabama at Birmingham School of Nursing, NB 443A, Birmingham, AL 35294-1210. ‡Chief Nursing Officer, Durham VA Medical Center. §Formerly Chief Nursing Officer, Birmingham VA Medical Center. ||Chief, Patient Care Service/Outpatient & Staff Development, Birmingham VA Medical Center. Address correspondence to Dr. Selleck: Associate Dean, Clinical Affairs and Partnerships, The University of Alabama at Birmingham School of Nursing, 1720 2nd Avenue South, NB 443A, Birmingham, AL 35294-1210. E-mail: [email protected] 8755-7223
Caring for the military has been an integral part of nursing since its earliest history as recounted in many of Nightingale's memoirs and letters (Nightengale, 1853– 1893). Today, the U.S. veteran population totals more than 22 million and includes a significant number of aging veterans from World War II, the Korean War, and the Vietnam War as well as those returning from Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn, some with devastating wounds, disabilities, traumatic brain injuries, and severe posttraumatic stress disorder (U.S. Department of Veterans Affairs, 2012). It is imperative that nurses be well educated to care for the unique needs of these veterans and their families.
Goals of the National VA Nursing Academy Partnerships In response to the ongoing and escalating needs of America's veterans, the Department of Veterans Affairs established the Veterans Affairs (VA) Nursing Academy in 2007 to fund pilot partnerships between schools of
Journal of Professional Nursing, Vol 31, No. 1 (January/February), 2015: pp 57–63 © 2015 Elsevier Inc. All rights reserved.
57 http://dx.doi.org/10.1016/j.profnurs.2014.06.004
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nursing and local VA health care facilities (U.S. Department of Veterans Affairs and Nursing Academy Partnerships, 2013). The goals of these partnerships include (a) expand faculty and professional development, (b) increase nursing student enrollment, (c) provide opportunities for educational and practice innovations, and (d) increase recruitment and retention of VA nurses (U.S. Department of Veterans Affairs, 2009). The VA Nursing Academy initially included 15 competitively selected academic/service partnerships nationally, 5 partnerships that began in academic year 2007, another 5 that began in 2008, and a final cohort of 5 partnerships that started in 2009–2010. Twelve of the original pilot partnerships remain in existence, and no two are alike because great latitude was allowed in their creation (Bowman et al., 2011; www.va. gov/oaa/vana/partners.asp, accessed September 21, 2013). Conceived in 2005, the VA Nursing Academy was created to address the predicted long-term nursing shortage, projected to be more acute within the VA because of the older average age of nurses and to recruit and retain baccalaureate nurses with the knowledge and skills to improve veteran's health care (Bowman et al., 2011). Although recruitment and retention were the perceived urgent need at that time, the VA Nursing Academy program has evolved well beyond this primary goal. Among the hallmarks of the program is the faculty and professional development that has resulted in educational and practice innovations that improve the quality of health care for veterans and their families. Since 2008, dramatic economic and health reform shifts have refocused the goals of these partnerships toward patient safety and quality and increased access to health care for veterans and their families. Sensitive to public concerns and dedicated to the VA mission, determination has grown to provide not only safe and competent care but also care provided by nurses educated and trained in the unique needs of veterans and their families across hospital and community settings throughout the nation. The purpose of this article is to describe the framework developed to build the academic/service partnership for the Birmingham VA Nursing Academy, including the evolving partnership outputs and outcomes, and the lessons learned to date that are transforming the care of veterans and their families. As one of the five funded programs in the 2009 cohort, the Birmingham Veterans Affairs Medical Center (BVAMC) and the University of Alabama at Birmingham School of Nursing (UABSON) were funded for a 3-year period through 2012. Funding was extended for the latter two cohorts to receive the full 5 years of support in order to meet the full intent of the pilot program.
Partners in the Birmingham VA Nursing Academy The BVAMC is an acute tertiary care facility, operating 139 beds, located within the University of Alabama at Birmingham's health sciences complex and medical center district. The largest of three VA Medical Centers in the state, this facility provides care in all medical and surgical specialties and subspecialties to the state's
veteran population of 405,600, 75% of whom are wartime veterans (U.S. Department of Veterans Affairs, 2012). The BVAMC served over 60,000 veterans with more than 70,000 outpatient visits during the past year. The facility also has several unique programs including safe harbor palliative care, Geriatric Research, Education and Clinical Center, mental health intensive care management, and home-based primary care, and it operates nine communitybased outpatient clinics in North Alabama. In addition, the BVAMC is one of the 13 blind rehabilitation centers. The UABSON is part of a research-intensive university and academic health center that prepares nurse leaders to excel as clinicians, researchers, and educators and advances knowledge and high-quality health care in Alabama and worldwide. The school of nursing offers baccalaureate (traditional, second degree, and AD to BSN), master's (traditional, accelerated, and second-degree options), and doctoral (DNP and the state's only doctor of philosophy in nursing) programs, all of which have experienced record growth in recent years. An explicit goal of the school's strategic plan is to expand partnership with the Birmingham VA Medical Center to include shared faculty, joint initiatives, increased funding for various partnership projects, and increased clinical exposure for students. This goal is synergistic with the intent of the VA Nursing Academy. These two institutions sit across the street from one another and already had a long-standing relationship in terms of regular clinical rotations and preceptor arrangements as well as intermittent joint educational and research efforts. The VA Nursing Academy program, however, has allowed these partner institutions to link institutional missions and governance, create a pipeline for the development of VA Nurse Scholars and faculty, and develop shared clinical, educational, and leadership opportunities for students, staff, and faculty in the BVAMC and UABSON.
Site-Specific Goals of the Birmingham VA Nursing Academy Partnership Building on prior relationships, the site-specific goals of the VA Nursing Academy between the BVAMC and UABSON are to (a) increase the recruitment and retention of baccalaureate nursing students and graduates into the VA nursing workforce, (b) increase the number of undergraduate nursing students educated about the population-specific needs of veterans through an innovative curriculum emphasizing high-quality, culturally competent care for veterans and their families, (c) develop and expand faculty expertise among VA master's-prepared nurses and UABSON faculty with a focus on the delivery of health care for veterans, and (d) expand partnership opportunities in education, clinical service, and evidence-based practice to improve quality outcomes specific to prevention and management of chronic conditions, cultural competence, nursing informatics, and simulation technology.
THE VA NURSING ACADEMY
Through the Birmingham VA Nursing Academy, 20 baccalaureate students are selected as VA “nurse scholars” each year of the award. These nurse scholars are provided with unique educational and leadership opportunities associated with this initiative, such as matriculating through the program as a cohort, having all clinical experiences at the BVAMC (except for pediatrics and obstetrics), having a full-time VA-based faculty as their advisor and mentor, the opportunity to be hired as student nurse technicians at the VA, the opportunity to become involved in VA Quality Scholars projects, and having individualized leadership development opportunities with BVAMC nursing administration personnel. Annually, the VA Nurse Scholars, along with all (greater than 500) undergraduate nursing students, have participated in the curricular revisions that occurred as a result of the project, including a newly designed elective course on “Caring for America’s Heroes: The VHA System,” incorporation of the simulated VA Computerized Patient Record System (CPRS) into the UABSON's clinical simulation laboratory, cultural competence specific to veterans with simulations developed to address the top 10 diagnoses seen at the BVAMC, and projects addressing quality improvement, service learning, and research. Three master's-prepared VA nurses who remain VA employees were initially selected as full-time UABSON faculty to learn all aspects of the faculty role and to work directly with the VA Nurse Scholars in didactic, simulation, and clinical experiences (VA-Based Faculty). Eight UABSON faculty members were originally selected for part-time experiences working with BVAMC staff on development and implementation of new processes in staff development, continuing education, performance improvement, leadership and management, and research. This number has varied slightly by year and is accomplished annually through the completion of the Intergovernmental Personnel Act Assignment Agreements between the VA and UABSON for each faculty member.
Framework for Development Although the four overarching VA Nursing Academy goals drove the vision for this program, the strengthened partnership between the BVAMC and UABSON was built using the following framework: (a) relationship building, (b) engagement, (c) governance, (d) evaluation of outcomes, and (e) sustainability. This framework guided our partnership expansion and provided the foundation for goals and outcomes. Prior to obtaining the VA Nursing Academy grant, the focus was on relationship building and included initial strategic planning sessions between the BVAMC Chief Nursing Officer (CNO) and the UABSON Dean. The leaders from both organizations engaged key members from the respective organizations to determine together the steps that would need to be taken to develop a robust partnership and a competitive proposal. Resources were allocated to support these efforts, and selected representatives from UABSON and the BVAMC met on a regular
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basis to learn about strengths and opportunities. A strengths, weaknesses, opportunities, threats analysis was developed to write the proposal and to provide direction to the team. It was clear from the beginning that in order for the partnership to thrive, the School of Nursing (SON) would need to synchronize its tripartite mission with the Birmingham VA, merging cultures and values between the two organizations. Senior administrators, led by the BVAMC CNO and UABSON Dean, and key stakeholders of both organizations were visible leaders in the initiative and regularly affirmed commitment to the project. As a result, trust was developed, and the expanded practice–academic partnership began. Relationship building quickly advanced to a formal engagement period. The commitment to the program and the process was solidified both prior to and after notification of funding. The dean and CNO began to identify mutually beneficial opportunities as they became available. For example, a clinical nurse leader Health Resources and Services Administration (HRSA) grant application that was submitted and funded included the Birmingham VA Medical Center as a major partner. Upon notification of award for the Birmingham VA Nursing Academy Program, both partners created the actual infrastructure to accomplish the goals and outcomes of the project. A participatory governance approach was established to include not only the dean and the CNO but also members of the funded partnership, which included faculty at the SON and staff nurses at the VA. Participatory governance and commitment to partnership through shared vision were the goals. This activity merged into organizational linkages, such as the VA Chief of Patient Care Service pairing with an SON faculty member as VA Nursing Academy codirectors and BVAMC clinical leaders linking with SON faculty. Meeting schedules and communication strategies were forged to assure full participation in direction and decisions, and an advisory council of stakeholders was formed to provide an external perspective. Most importantly, the partnership exchanged additional unfunded resources vital to each partner that would be mutually beneficial to the goals of the program, including senior faculty, professional and administrative staff, and financial and grant management staff. Another critical step in the framework involved establishing the process to evaluate goals and outcomes. Once the selection as a VA Nursing Academy site was confirmed, initial goals were revisited and refined, and new or subordinate goals emerged. To track and monitor goals, activities, and outcomes, we created a program management plan. The overarching goals of the VA Nursing Academy program were distilled into clinical, program, and educational goals. Likewise, the strategies, activities, and indicators of success were developed in conjunction with a quarterly reporting process from all funded and in-kind faculty and staff in the partnership. This structure was critical to the partnership's joint mission, direction, accountability, and outcomes.
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These activities confirmed our commitment to building a partnership that would be sustainable beyond the duration of funding. This meant that it was incumbent on both organizational entities to search and secure funding opportunities to grow and mature the clinical, program, and educational initiatives begun through the academy. Among the areas developed were faculty practice, educational and research grant opportunities, the VA Quality Scholars Program, private philanthropy to support VA nursing scholarships, in-kind/matching support of faculty and facility resources, such as Web-based learning and clinical simulation expertise and resources, and faculty scholarly activities synergistic with veteran-centric health care needs.
Clinical, Program, and Educational Goals Clinical goals include such things as the creation of VAspecific simulation scenarios, the development of a VA Nursing Academy video to better educate VA nurses on medical–surgical units how to care for veterans with mental health problems, the development of evidencebased practice protocols, and the enrichment of BVAMC nurses through the process of dissemination of scholarly work via professional presentations and publications in peer-reviewed journals. Program goals focus on mechanisms to build the VA Nursing Academy program itself. Through joint efforts, several avenues were conceived to increase the VA nurse workforce. For example, information on the VA Nursing Academy program is posted in Relationship Building
Inputs Partnership between BVAMC & UABSON, including MOU VA Nurses
Engagement
Governance
Dean’s appointment to VA/UAB Affiliation Partnership Council Collaboration within UAB Health System (between Medicine, Nursing, Dentistry, Health Professions, Optometry, Public Health) Shared goals and accountability VA Nursing Academy Advisory Council
Sustainability
Activities
Outputs
Outcomes
Clinical: Veteran-specific simulations/protocols “ Psychiatric Simulations” DVD and Guidelines Veteran-specific content inserted into courses across curricula “Caring for America’s Heroes” elective Scholarly presentations and publications
Improved quality of care for Veterans/ families demonstrated
Development of psychiatric simulations for medical surgical nurses Development of evidence based practice protocols Trading of staff between SON and VA Faculty Development Intensive for VA nurse Instructors Veteran-specific educational experiences through Dedicated Educational Unit (DEU) at VA Program Director, Leadership Team, Strategic Planning and Think Tank meetings Shared Governance Councils
VA Nursing Academy funding and in-kind support
Outcome Evaluation
Development of VA-specific simulation scenarios
UABSON Faculty UABSON Nursing students (students across all levels)
and around the school and on the Web site. Faculty and administrators talk about the program in multiple venues, both internally and externally, and the VA Nursing Academy became purposefully interwoven into the fabric of the SON. University of Alabama at Birmingham nursing students who may not have considered the VA as a place to work and grow are purposefully recruited to become VA Nurse Scholars, and after completion of the first semester, interested scholars are recruited into student nurse technician positions at the VA. Notably, many of the VA Scholars have previous military experience or family members who were veterans. Tied to this recruiting effort is a structured approach to program evaluation in order to keep a “finger on the pulse” of the program. VA Nursing Academy students, SON faculty, and BVAMC staff are carefully targeted for feedback. These formative evaluations allow for quick and nimble correction to the program as needed and cultivate a climate of communication, respect, and appreciation among BVAMC and UABSON partners. For example, “meet and greets” at the beginning of each semester and “end of term” luncheons promote enriching team-building experiences. Educational goals include the “trading of staff,” which has been critical to making the VA Nursing Academy program a success. Some UABSON faculty went to the BVAMC to work with nursing staff directly on improving quality care initiatives, and some BVAMC nurses became instructors in the SON. Both groups needed support and
Ongoing formative evaluation (Meet & Greets; End of Term luncheons)
Education: Select VA nurses prepared as faculty annually Select faculty annually integrated into VA for practice, research/scholarship VA Nurse Scholars involved in DEU at VA annually All undergraduate nursing students exposed to Veteran-centric curriculum annually Program: Evaluation plan and cost avoidance Nurse Scholars become VA Student Nurse Technicians Media outcomes Evaluation Plan
Figure 1. Logic model of Birmingham VA Nursing Academy.
Increased culturally competent nursing workforce for Veterans/families Increased number and competence of nursing faculty educated in Veteran’s health care Increased patient satisfaction by Veterans and their families Increased number of Veterans enrolled in SON programs by tenfold Increased number of BVAMC nurses enrolled in UABSON graduate programs (MSN, DNP, PhD) Establishment of Endowed VA scholarship Increased number of VA Nurse Scholars hired by VA Medical Centers
THE VA NURSING ACADEMY
assistance with the steep learning curve. The school developed and provided a 1-week faculty development intensive in which the various roles and responsibilities of faculty were thoroughly covered. The new VA-Based Faculty-Turned Instructors were coupled with SON faculty for mentoring and instruction in curriculum development, classroom teaching, and distance education technology. The final and perhaps most important educational goal of the program is to provide an educational experience for students that is veteran specific. Except when learning needs would be compromised (e.g., pediatrics, obstetrics), these students invest their clinical learning hours via a dedicated educational unit model at the BVAMC or in VA-specific simulation activities. This model assures that students are able to provide continuity of care to a veteran population, from young adult through geriatric, with increased efficiency and decreased time spent orienting to new facilities, while also benefitting from use of the VA's state-of-the-art CPRS. Likewise, the SON faculty participating in the VA Nursing Academy were partnered with VA-based faculty and the VA Chief of Patient Care Service to assist them in orientation and transition to the BVAMC Nursing Service.
Logic Model The five areas described in this partnership framework aided the development of the partnership logic model depicted in Figure 1. This logic model utilizes the practice– academic partnership framework previously developed by MacPhee (2009) and has allowed the partners to remain focused on our common mission, vision, and goals. The inputs, activities, outputs, and outcomes are those unique to the Birmingham VA Nursing Academy.
Outputs and Outcomes Four of the 5 years of this funded partnership are now complete; therefore, our clinical, educational, and programmatic outputs and outcomes remain ongoing. Outcomes have been evaluated annually and in the aggregate for the 4-year period, and we have begun to see impact based on the aggregate data. During the initial years of funding, leadership at the Office of Academic Affiliations at the national VA revised the annual evaluation process with the focus moving toward clinical outcome data related to patient safety and quality and the cost avoidance associated with a nursing workforce better educated to care for veterans. These datafocused efforts have enhanced collaboration between our VA Nursing Academy and the VA Quality Scholars Program on projects related to safe patient handling, prevention of hospital-acquired pressure ulcers, and reducing incontinence-associated dermatitis and catheter-associated urinary tract infections. Descriptive data related to the numbers of students, faculty, and staff engaged in the partnership are also collected annually. Finally, overall program outcome summative data for the 4 years of the partnership are presented in the box to the right.
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Box 1. Selected Birmingham VA Nursing Academy Outcomes Over 4-Year Partnership • Development of an educational DVD of psychiatric simulations entitled The Mental Health Patient on a Medical–Surgical Floor and distributed to all Veterans Affairs Medical Centers (VAMCs) across the country to educate nurses on the unique mental health needs of veterans. • Development of an elective course entitled Caring for America’s Heroes: The VHA System already completed by160 undergraduate nursing students. • Graduation to date of 57 BSN-prepared nurses who have been VA Nurse Scholars, 12 of whom have been hired at VAMCs in Birmingham and across the country. • Education of more than 2,000 baccalaureate nursing students on veterans and veteran's health competencies through clinical scenarios, simulations, case studies, and more. • Improving the quality of care for veterans through the VA Quality Scholars Program, including improving mobility while hospitalized and decreasing incontinence-associated dermatitis. • Partnering with the Alabama Statewide Area Health Education Center Program to present a statewide conference, Painting A Moving Train: Working with Veterans of Iraq and Afghanistan and Their Families, attended by 107 health professionals from Alabama. • Receipt of a $1.2 million HRSA Veterans BSN grant to educate veterans with military medical experience to attain a baccalaureate degree in nursing. • Development of a university system and personnel to support educational success and career mobility of veteran students. • Creation of a veteran-friendly culture that has allowed a more than 10-fold increase in veteran students (from 8 to 85) in 4 years and a similar increase in faculty who are veterans or family members.
Lessons Learned The Birmingham VA Nursing Academy, a practice– academic partnership, continues as a work in progress with many lessons learned that enhance educational and practice outcomes. The framework and evaluation model have served as a blueprint for our partnership. The models have been used to leverage a shared vision and experiences to discover the most relevant conversations, products, and services needed to improve the health status of veterans and their families. These structures have enabled us to identify several overarching lessons that continue to guide our work, some of which are shared below.
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The partnership relationship manifests its success based on the support demonstrated by each organization's leaders. This means that executive leaders from academe and service devoted the time, resources, and energy to relationship building that established trust and determined the business model and allocation of resources needed to support the partnership. Joint meetings and strategic planning were used to build a well-functioning partnership team that produced highly effective outcomes. Through relationship building, both partners are able to understand and value respective roles (i.e., SON faculty understanding the role of the VA faculty and the VA professional nursing staff understanding the role of nursing school faculty). As these relationships were built through the partnership, not only the education and training of prelicensure nursing students was accomplished but, also, the structures that support evidenced-based practice, shared governance, career advancement, and the dissemination of best practices through national presentations and peerreviewed publications were built to improve the quality of care for veterans. Engagement is dependent on collaborative leadership, role modeled not only by the CNO and dean but also by program codirectors at the BVAMC and UABSON, as well as faculty and professional staff. Ongoing participation relies on the engagement of all partnership parties and is crucial to remain focused on the mission and goals of the partnership. Engagement also requires that nursing faculty and professional staff involved with the partnership are held accountable for developing processes and measures to meet the identified partnership goals and deliverables. Clear communication and systems for communication must be instituted and maintained to continue engagement across both sides and to confront the opportunities and challenges associated with the partnership. Lastly, as the partnership evolves, engagement is evidenced through the celebration and acknowledgement of accomplishments at both the SON and VA and through public relations and media outlets. The governance of the partnership must be explicit for performance expectations to be met. The Birmingham VA Nursing Academy partnership is based on some simple, yet crucial, governance agreements and understandings that directed our work together. Memoranda of understanding allow for clarity of roles and responsibilities along with mutual understanding of the mission goals, strategy, and tactics. Implicit in these structures are the guiding principles that served to help each partner stay the course, in spite of significant mission and policy differences across our institutions. Respect and valuing each partner's mission are essential, as is commitment to ongoing communication, conflict resolution, working through institutional barriers and, most importantly, building on each partner's needs and strengths. These guiding principles allow us to work through partnership issues and challenges. These principles, coupled with a governance infrastructure are critical to partnership development. For example, an executive committee
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meets monthly composed of the two chief officers (dean and CNO), two program codirectors, and other associated administrative leaders, such as associate deans and chief nurses. These monthly executive meetings allow the executive leadership of each partner organization to address implementation issues and progress toward outcomes and areas for improvement. By delving into issues, we are able to resolve differences and work through our challenges together. During the executive meetings, we also plan quarterly meetings with all partner nursing faculty and professional staff to engage all partner participants in the planning, implementation, and evaluation of the partnership. During the quarterly meetings, reports of ongoing progress, outcomes, opportunities, and challenges are presented, and future opportunities are identified. This structure keeps all partner members focused on the purpose and intent of the VA Nursing Academy, allows for negotiation of differences with impending conflict, holds all participants accountable for meeting the expectations of the partnership initiative, and continues to be essential to our function and productivity. Evaluation of the outcomes of our partnership goals and activities has allowed us to achieve exceptional results, including product development (psychiatric simulations DVD) and media productions; distanceaccessible VA-centric courses, curriculum, and clinical simulation scenarios; the graduation to date of 57 VA Nurse Scholar graduates; and exposure for all undergraduates to a veteran-centric nursing curriculum, joint publications and national presentations. Ongoing evaluation and process improvement have been our mantra and have helped evolve our partnership outcomes. This reflection and analysis of ongoing improvements also allowed us to continually conduct perception checks with partners, meet our timelines, deliverables, and the VA Nursing Academy goals. The annual reporting process enables each partner to analyze overall progress in conjunction with the other VA Nursing Academy sites and to incorporate and implement future plans. The Birmingham VA Nursing Academy partnership was initiated with a commitment to a sustainability plan and a desire to create resources targeted at continuing the relationship. Clearly, funding drives the depth and breadth of the partnership and its related outcomes. While each partner's executive leaders invest resources to support the initiative, the extramural funding for the VA Nursing Academy provided the resources needed to produce the significant vertical and horizontal integration of the initiative across both organizations that led to the value-added outcomes associated with this initiative. The federal investment in the VA Nursing Academy extends well beyond funded resources, to unfunded personnel, space, supplies, operations, and joint ventures that mutually benefit the partnership. The educational component of the partnership included nursing student rotations and graduates with competencies in the clinical care of veterans and their families, together with the development of VA-centric curricula that addresses the
THE VA NURSING ACADEMY
unique health needs of veterans. However, the depth and breadth of the practice-based and partnership outcomes require time, energy, creativity, and commitment of both nursing faculty and VA nursing staff and would not have been achieved without underlying funding. The partnership has certainly helped to launch a firm and growing commitment to and focus on veterans and veteran's health within the UABSON. This commitment has resulted in tremendous growth in the numbers of veteran students in the past 4 years and the development of a system and personnel to support the educational success and career mobility of these students. Similarly, the commitment prompted UABSON to pledge our support to the Joining Forces Campaign and led to our recent success in receiving a federal veterans BSN grant to educate veterans with military medical experience to attain a baccalaureate degree in nursing.
Conclusion The Birmingham VA Nursing Academy continues to produce educational, clinical, and program outcomes associated with the overall and site-specific goals established for this partnership throughout and beyond the pilot funding period. As our partnership evolves, we continue to glean significant lessons and opportunities across academe and service that inform the care of veterans and their families within and outside of the VA
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Health System. Leveraging our resources and human capital, our partnership seeks to continue to grow and synergize our work as we address the ongoing health care needs and the unique challenges faced by veterans and their families across the nation.
References Bowman, C. C., Johnson, L., Cox, M., Rick, C., Dougherty, M, et al (2011). The Department of Veterans Affairs Nursing Academy (VANA): Forging strategic alliances with schools of nursing to address nursing’s workforce needs. Nursing Outlook, 59, 299–307. MacPhee, M. (2009). Developing a practice-academic partnership logic model. Nursing Outlook, 57, 143–147. Nightengale, F. (1853–1893). Correspondence. Florence Nightingale Letters, University of Alabama at Birmingham. Birmingham, AL: Reynolds Historical Collection of the Lister Hill Library of Health Sciences Archives. U.S. Department of Veterans Affairs & National Center for Veterans Analysis, Statistics, http://www.va.gov/vetdata/ index.asp (accessed May 30, 2012). U.S. Department of Veterans Affairs & VA Nursing Academy Partnerships, http://www.va.gov/oaa/vana/partners.asp (accessed September 21, 2013). U.S. Department of Veterans Affairs & Veterans Health Administration (2009). VA Nursing Academy: Enhancing academic partnerships program, request for proposals, 2009-2010.
“M
Y EXPERIENCE OF soldiers is that they will go back into the fight to find a prostrate comrade or their wounded officer-& fight their way out again bringing him with them-or as often happened leaving their own lives behind. May I be worthy of them!” Florence Nightingale's Letter to Dr. Thomas Gillham Hewlett, November 4, 1888. ⁎Dean and Fay B. Ireland Chair in Nursing, The University of Alabama at Birmingham School of Nursing. †Associate Dean, Clinical Affairs and Partnerships, The University of Alabama at Birmingham School of Nursing, NB 443A, Birmingham, AL 35294-1210. ‡Chief Nursing Officer, Durham VA Medical Center. §Formerly Chief Nursing Officer, Birmingham VA Medical Center. ||Chief, Patient Care Service/Outpatient & Staff Development, Birmingham VA Medical Center. Address correspondence to Dr. Selleck: Associate Dean, Clinical Affairs and Partnerships, The University of Alabama at Birmingham School of Nursing, 1720 2nd Avenue South, NB 443A, Birmingham, AL 35294-1210. E-mail: [email protected] 8755-7223
Caring for the military has been an integral part of nursing since its earliest history as recounted in many of Nightingale's memoirs and letters (Nightengale, 1853– 1893). Today, the U.S. veteran population totals more than 22 million and includes a significant number of aging veterans from World War II, the Korean War, and the Vietnam War as well as those returning from Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn, some with devastating wounds, disabilities, traumatic brain injuries, and severe posttraumatic stress disorder (U.S. Department of Veterans Affairs, 2012). It is imperative that nurses be well educated to care for the unique needs of these veterans and their families.
Goals of the National VA Nursing Academy Partnerships In response to the ongoing and escalating needs of America's veterans, the Department of Veterans Affairs established the Veterans Affairs (VA) Nursing Academy in 2007 to fund pilot partnerships between schools of
Journal of Professional Nursing, Vol 31, No. 1 (January/February), 2015: pp 57–63 © 2015 Elsevier Inc. All rights reserved.
57 http://dx.doi.org/10.1016/j.profnurs.2014.06.004
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nursing and local VA health care facilities (U.S. Department of Veterans Affairs and Nursing Academy Partnerships, 2013). The goals of these partnerships include (a) expand faculty and professional development, (b) increase nursing student enrollment, (c) provide opportunities for educational and practice innovations, and (d) increase recruitment and retention of VA nurses (U.S. Department of Veterans Affairs, 2009). The VA Nursing Academy initially included 15 competitively selected academic/service partnerships nationally, 5 partnerships that began in academic year 2007, another 5 that began in 2008, and a final cohort of 5 partnerships that started in 2009–2010. Twelve of the original pilot partnerships remain in existence, and no two are alike because great latitude was allowed in their creation (Bowman et al., 2011; www.va. gov/oaa/vana/partners.asp, accessed September 21, 2013). Conceived in 2005, the VA Nursing Academy was created to address the predicted long-term nursing shortage, projected to be more acute within the VA because of the older average age of nurses and to recruit and retain baccalaureate nurses with the knowledge and skills to improve veteran's health care (Bowman et al., 2011). Although recruitment and retention were the perceived urgent need at that time, the VA Nursing Academy program has evolved well beyond this primary goal. Among the hallmarks of the program is the faculty and professional development that has resulted in educational and practice innovations that improve the quality of health care for veterans and their families. Since 2008, dramatic economic and health reform shifts have refocused the goals of these partnerships toward patient safety and quality and increased access to health care for veterans and their families. Sensitive to public concerns and dedicated to the VA mission, determination has grown to provide not only safe and competent care but also care provided by nurses educated and trained in the unique needs of veterans and their families across hospital and community settings throughout the nation. The purpose of this article is to describe the framework developed to build the academic/service partnership for the Birmingham VA Nursing Academy, including the evolving partnership outputs and outcomes, and the lessons learned to date that are transforming the care of veterans and their families. As one of the five funded programs in the 2009 cohort, the Birmingham Veterans Affairs Medical Center (BVAMC) and the University of Alabama at Birmingham School of Nursing (UABSON) were funded for a 3-year period through 2012. Funding was extended for the latter two cohorts to receive the full 5 years of support in order to meet the full intent of the pilot program.
Partners in the Birmingham VA Nursing Academy The BVAMC is an acute tertiary care facility, operating 139 beds, located within the University of Alabama at Birmingham's health sciences complex and medical center district. The largest of three VA Medical Centers in the state, this facility provides care in all medical and surgical specialties and subspecialties to the state's
veteran population of 405,600, 75% of whom are wartime veterans (U.S. Department of Veterans Affairs, 2012). The BVAMC served over 60,000 veterans with more than 70,000 outpatient visits during the past year. The facility also has several unique programs including safe harbor palliative care, Geriatric Research, Education and Clinical Center, mental health intensive care management, and home-based primary care, and it operates nine communitybased outpatient clinics in North Alabama. In addition, the BVAMC is one of the 13 blind rehabilitation centers. The UABSON is part of a research-intensive university and academic health center that prepares nurse leaders to excel as clinicians, researchers, and educators and advances knowledge and high-quality health care in Alabama and worldwide. The school of nursing offers baccalaureate (traditional, second degree, and AD to BSN), master's (traditional, accelerated, and second-degree options), and doctoral (DNP and the state's only doctor of philosophy in nursing) programs, all of which have experienced record growth in recent years. An explicit goal of the school's strategic plan is to expand partnership with the Birmingham VA Medical Center to include shared faculty, joint initiatives, increased funding for various partnership projects, and increased clinical exposure for students. This goal is synergistic with the intent of the VA Nursing Academy. These two institutions sit across the street from one another and already had a long-standing relationship in terms of regular clinical rotations and preceptor arrangements as well as intermittent joint educational and research efforts. The VA Nursing Academy program, however, has allowed these partner institutions to link institutional missions and governance, create a pipeline for the development of VA Nurse Scholars and faculty, and develop shared clinical, educational, and leadership opportunities for students, staff, and faculty in the BVAMC and UABSON.
Site-Specific Goals of the Birmingham VA Nursing Academy Partnership Building on prior relationships, the site-specific goals of the VA Nursing Academy between the BVAMC and UABSON are to (a) increase the recruitment and retention of baccalaureate nursing students and graduates into the VA nursing workforce, (b) increase the number of undergraduate nursing students educated about the population-specific needs of veterans through an innovative curriculum emphasizing high-quality, culturally competent care for veterans and their families, (c) develop and expand faculty expertise among VA master's-prepared nurses and UABSON faculty with a focus on the delivery of health care for veterans, and (d) expand partnership opportunities in education, clinical service, and evidence-based practice to improve quality outcomes specific to prevention and management of chronic conditions, cultural competence, nursing informatics, and simulation technology.
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Through the Birmingham VA Nursing Academy, 20 baccalaureate students are selected as VA “nurse scholars” each year of the award. These nurse scholars are provided with unique educational and leadership opportunities associated with this initiative, such as matriculating through the program as a cohort, having all clinical experiences at the BVAMC (except for pediatrics and obstetrics), having a full-time VA-based faculty as their advisor and mentor, the opportunity to be hired as student nurse technicians at the VA, the opportunity to become involved in VA Quality Scholars projects, and having individualized leadership development opportunities with BVAMC nursing administration personnel. Annually, the VA Nurse Scholars, along with all (greater than 500) undergraduate nursing students, have participated in the curricular revisions that occurred as a result of the project, including a newly designed elective course on “Caring for America’s Heroes: The VHA System,” incorporation of the simulated VA Computerized Patient Record System (CPRS) into the UABSON's clinical simulation laboratory, cultural competence specific to veterans with simulations developed to address the top 10 diagnoses seen at the BVAMC, and projects addressing quality improvement, service learning, and research. Three master's-prepared VA nurses who remain VA employees were initially selected as full-time UABSON faculty to learn all aspects of the faculty role and to work directly with the VA Nurse Scholars in didactic, simulation, and clinical experiences (VA-Based Faculty). Eight UABSON faculty members were originally selected for part-time experiences working with BVAMC staff on development and implementation of new processes in staff development, continuing education, performance improvement, leadership and management, and research. This number has varied slightly by year and is accomplished annually through the completion of the Intergovernmental Personnel Act Assignment Agreements between the VA and UABSON for each faculty member.
Framework for Development Although the four overarching VA Nursing Academy goals drove the vision for this program, the strengthened partnership between the BVAMC and UABSON was built using the following framework: (a) relationship building, (b) engagement, (c) governance, (d) evaluation of outcomes, and (e) sustainability. This framework guided our partnership expansion and provided the foundation for goals and outcomes. Prior to obtaining the VA Nursing Academy grant, the focus was on relationship building and included initial strategic planning sessions between the BVAMC Chief Nursing Officer (CNO) and the UABSON Dean. The leaders from both organizations engaged key members from the respective organizations to determine together the steps that would need to be taken to develop a robust partnership and a competitive proposal. Resources were allocated to support these efforts, and selected representatives from UABSON and the BVAMC met on a regular
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basis to learn about strengths and opportunities. A strengths, weaknesses, opportunities, threats analysis was developed to write the proposal and to provide direction to the team. It was clear from the beginning that in order for the partnership to thrive, the School of Nursing (SON) would need to synchronize its tripartite mission with the Birmingham VA, merging cultures and values between the two organizations. Senior administrators, led by the BVAMC CNO and UABSON Dean, and key stakeholders of both organizations were visible leaders in the initiative and regularly affirmed commitment to the project. As a result, trust was developed, and the expanded practice–academic partnership began. Relationship building quickly advanced to a formal engagement period. The commitment to the program and the process was solidified both prior to and after notification of funding. The dean and CNO began to identify mutually beneficial opportunities as they became available. For example, a clinical nurse leader Health Resources and Services Administration (HRSA) grant application that was submitted and funded included the Birmingham VA Medical Center as a major partner. Upon notification of award for the Birmingham VA Nursing Academy Program, both partners created the actual infrastructure to accomplish the goals and outcomes of the project. A participatory governance approach was established to include not only the dean and the CNO but also members of the funded partnership, which included faculty at the SON and staff nurses at the VA. Participatory governance and commitment to partnership through shared vision were the goals. This activity merged into organizational linkages, such as the VA Chief of Patient Care Service pairing with an SON faculty member as VA Nursing Academy codirectors and BVAMC clinical leaders linking with SON faculty. Meeting schedules and communication strategies were forged to assure full participation in direction and decisions, and an advisory council of stakeholders was formed to provide an external perspective. Most importantly, the partnership exchanged additional unfunded resources vital to each partner that would be mutually beneficial to the goals of the program, including senior faculty, professional and administrative staff, and financial and grant management staff. Another critical step in the framework involved establishing the process to evaluate goals and outcomes. Once the selection as a VA Nursing Academy site was confirmed, initial goals were revisited and refined, and new or subordinate goals emerged. To track and monitor goals, activities, and outcomes, we created a program management plan. The overarching goals of the VA Nursing Academy program were distilled into clinical, program, and educational goals. Likewise, the strategies, activities, and indicators of success were developed in conjunction with a quarterly reporting process from all funded and in-kind faculty and staff in the partnership. This structure was critical to the partnership's joint mission, direction, accountability, and outcomes.
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These activities confirmed our commitment to building a partnership that would be sustainable beyond the duration of funding. This meant that it was incumbent on both organizational entities to search and secure funding opportunities to grow and mature the clinical, program, and educational initiatives begun through the academy. Among the areas developed were faculty practice, educational and research grant opportunities, the VA Quality Scholars Program, private philanthropy to support VA nursing scholarships, in-kind/matching support of faculty and facility resources, such as Web-based learning and clinical simulation expertise and resources, and faculty scholarly activities synergistic with veteran-centric health care needs.
Clinical, Program, and Educational Goals Clinical goals include such things as the creation of VAspecific simulation scenarios, the development of a VA Nursing Academy video to better educate VA nurses on medical–surgical units how to care for veterans with mental health problems, the development of evidencebased practice protocols, and the enrichment of BVAMC nurses through the process of dissemination of scholarly work via professional presentations and publications in peer-reviewed journals. Program goals focus on mechanisms to build the VA Nursing Academy program itself. Through joint efforts, several avenues were conceived to increase the VA nurse workforce. For example, information on the VA Nursing Academy program is posted in Relationship Building
Inputs Partnership between BVAMC & UABSON, including MOU VA Nurses
Engagement
Governance
Dean’s appointment to VA/UAB Affiliation Partnership Council Collaboration within UAB Health System (between Medicine, Nursing, Dentistry, Health Professions, Optometry, Public Health) Shared goals and accountability VA Nursing Academy Advisory Council
Sustainability
Activities
Outputs
Outcomes
Clinical: Veteran-specific simulations/protocols “ Psychiatric Simulations” DVD and Guidelines Veteran-specific content inserted into courses across curricula “Caring for America’s Heroes” elective Scholarly presentations and publications
Improved quality of care for Veterans/ families demonstrated
Development of psychiatric simulations for medical surgical nurses Development of evidence based practice protocols Trading of staff between SON and VA Faculty Development Intensive for VA nurse Instructors Veteran-specific educational experiences through Dedicated Educational Unit (DEU) at VA Program Director, Leadership Team, Strategic Planning and Think Tank meetings Shared Governance Councils
VA Nursing Academy funding and in-kind support
Outcome Evaluation
Development of VA-specific simulation scenarios
UABSON Faculty UABSON Nursing students (students across all levels)
and around the school and on the Web site. Faculty and administrators talk about the program in multiple venues, both internally and externally, and the VA Nursing Academy became purposefully interwoven into the fabric of the SON. University of Alabama at Birmingham nursing students who may not have considered the VA as a place to work and grow are purposefully recruited to become VA Nurse Scholars, and after completion of the first semester, interested scholars are recruited into student nurse technician positions at the VA. Notably, many of the VA Scholars have previous military experience or family members who were veterans. Tied to this recruiting effort is a structured approach to program evaluation in order to keep a “finger on the pulse” of the program. VA Nursing Academy students, SON faculty, and BVAMC staff are carefully targeted for feedback. These formative evaluations allow for quick and nimble correction to the program as needed and cultivate a climate of communication, respect, and appreciation among BVAMC and UABSON partners. For example, “meet and greets” at the beginning of each semester and “end of term” luncheons promote enriching team-building experiences. Educational goals include the “trading of staff,” which has been critical to making the VA Nursing Academy program a success. Some UABSON faculty went to the BVAMC to work with nursing staff directly on improving quality care initiatives, and some BVAMC nurses became instructors in the SON. Both groups needed support and
Ongoing formative evaluation (Meet & Greets; End of Term luncheons)
Education: Select VA nurses prepared as faculty annually Select faculty annually integrated into VA for practice, research/scholarship VA Nurse Scholars involved in DEU at VA annually All undergraduate nursing students exposed to Veteran-centric curriculum annually Program: Evaluation plan and cost avoidance Nurse Scholars become VA Student Nurse Technicians Media outcomes Evaluation Plan
Figure 1. Logic model of Birmingham VA Nursing Academy.
Increased culturally competent nursing workforce for Veterans/families Increased number and competence of nursing faculty educated in Veteran’s health care Increased patient satisfaction by Veterans and their families Increased number of Veterans enrolled in SON programs by tenfold Increased number of BVAMC nurses enrolled in UABSON graduate programs (MSN, DNP, PhD) Establishment of Endowed VA scholarship Increased number of VA Nurse Scholars hired by VA Medical Centers
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assistance with the steep learning curve. The school developed and provided a 1-week faculty development intensive in which the various roles and responsibilities of faculty were thoroughly covered. The new VA-Based Faculty-Turned Instructors were coupled with SON faculty for mentoring and instruction in curriculum development, classroom teaching, and distance education technology. The final and perhaps most important educational goal of the program is to provide an educational experience for students that is veteran specific. Except when learning needs would be compromised (e.g., pediatrics, obstetrics), these students invest their clinical learning hours via a dedicated educational unit model at the BVAMC or in VA-specific simulation activities. This model assures that students are able to provide continuity of care to a veteran population, from young adult through geriatric, with increased efficiency and decreased time spent orienting to new facilities, while also benefitting from use of the VA's state-of-the-art CPRS. Likewise, the SON faculty participating in the VA Nursing Academy were partnered with VA-based faculty and the VA Chief of Patient Care Service to assist them in orientation and transition to the BVAMC Nursing Service.
Logic Model The five areas described in this partnership framework aided the development of the partnership logic model depicted in Figure 1. This logic model utilizes the practice– academic partnership framework previously developed by MacPhee (2009) and has allowed the partners to remain focused on our common mission, vision, and goals. The inputs, activities, outputs, and outcomes are those unique to the Birmingham VA Nursing Academy.
Outputs and Outcomes Four of the 5 years of this funded partnership are now complete; therefore, our clinical, educational, and programmatic outputs and outcomes remain ongoing. Outcomes have been evaluated annually and in the aggregate for the 4-year period, and we have begun to see impact based on the aggregate data. During the initial years of funding, leadership at the Office of Academic Affiliations at the national VA revised the annual evaluation process with the focus moving toward clinical outcome data related to patient safety and quality and the cost avoidance associated with a nursing workforce better educated to care for veterans. These datafocused efforts have enhanced collaboration between our VA Nursing Academy and the VA Quality Scholars Program on projects related to safe patient handling, prevention of hospital-acquired pressure ulcers, and reducing incontinence-associated dermatitis and catheter-associated urinary tract infections. Descriptive data related to the numbers of students, faculty, and staff engaged in the partnership are also collected annually. Finally, overall program outcome summative data for the 4 years of the partnership are presented in the box to the right.
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Box 1. Selected Birmingham VA Nursing Academy Outcomes Over 4-Year Partnership • Development of an educational DVD of psychiatric simulations entitled The Mental Health Patient on a Medical–Surgical Floor and distributed to all Veterans Affairs Medical Centers (VAMCs) across the country to educate nurses on the unique mental health needs of veterans. • Development of an elective course entitled Caring for America’s Heroes: The VHA System already completed by160 undergraduate nursing students. • Graduation to date of 57 BSN-prepared nurses who have been VA Nurse Scholars, 12 of whom have been hired at VAMCs in Birmingham and across the country. • Education of more than 2,000 baccalaureate nursing students on veterans and veteran's health competencies through clinical scenarios, simulations, case studies, and more. • Improving the quality of care for veterans through the VA Quality Scholars Program, including improving mobility while hospitalized and decreasing incontinence-associated dermatitis. • Partnering with the Alabama Statewide Area Health Education Center Program to present a statewide conference, Painting A Moving Train: Working with Veterans of Iraq and Afghanistan and Their Families, attended by 107 health professionals from Alabama. • Receipt of a $1.2 million HRSA Veterans BSN grant to educate veterans with military medical experience to attain a baccalaureate degree in nursing. • Development of a university system and personnel to support educational success and career mobility of veteran students. • Creation of a veteran-friendly culture that has allowed a more than 10-fold increase in veteran students (from 8 to 85) in 4 years and a similar increase in faculty who are veterans or family members.
Lessons Learned The Birmingham VA Nursing Academy, a practice– academic partnership, continues as a work in progress with many lessons learned that enhance educational and practice outcomes. The framework and evaluation model have served as a blueprint for our partnership. The models have been used to leverage a shared vision and experiences to discover the most relevant conversations, products, and services needed to improve the health status of veterans and their families. These structures have enabled us to identify several overarching lessons that continue to guide our work, some of which are shared below.
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The partnership relationship manifests its success based on the support demonstrated by each organization's leaders. This means that executive leaders from academe and service devoted the time, resources, and energy to relationship building that established trust and determined the business model and allocation of resources needed to support the partnership. Joint meetings and strategic planning were used to build a well-functioning partnership team that produced highly effective outcomes. Through relationship building, both partners are able to understand and value respective roles (i.e., SON faculty understanding the role of the VA faculty and the VA professional nursing staff understanding the role of nursing school faculty). As these relationships were built through the partnership, not only the education and training of prelicensure nursing students was accomplished but, also, the structures that support evidenced-based practice, shared governance, career advancement, and the dissemination of best practices through national presentations and peerreviewed publications were built to improve the quality of care for veterans. Engagement is dependent on collaborative leadership, role modeled not only by the CNO and dean but also by program codirectors at the BVAMC and UABSON, as well as faculty and professional staff. Ongoing participation relies on the engagement of all partnership parties and is crucial to remain focused on the mission and goals of the partnership. Engagement also requires that nursing faculty and professional staff involved with the partnership are held accountable for developing processes and measures to meet the identified partnership goals and deliverables. Clear communication and systems for communication must be instituted and maintained to continue engagement across both sides and to confront the opportunities and challenges associated with the partnership. Lastly, as the partnership evolves, engagement is evidenced through the celebration and acknowledgement of accomplishments at both the SON and VA and through public relations and media outlets. The governance of the partnership must be explicit for performance expectations to be met. The Birmingham VA Nursing Academy partnership is based on some simple, yet crucial, governance agreements and understandings that directed our work together. Memoranda of understanding allow for clarity of roles and responsibilities along with mutual understanding of the mission goals, strategy, and tactics. Implicit in these structures are the guiding principles that served to help each partner stay the course, in spite of significant mission and policy differences across our institutions. Respect and valuing each partner's mission are essential, as is commitment to ongoing communication, conflict resolution, working through institutional barriers and, most importantly, building on each partner's needs and strengths. These guiding principles allow us to work through partnership issues and challenges. These principles, coupled with a governance infrastructure are critical to partnership development. For example, an executive committee
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meets monthly composed of the two chief officers (dean and CNO), two program codirectors, and other associated administrative leaders, such as associate deans and chief nurses. These monthly executive meetings allow the executive leadership of each partner organization to address implementation issues and progress toward outcomes and areas for improvement. By delving into issues, we are able to resolve differences and work through our challenges together. During the executive meetings, we also plan quarterly meetings with all partner nursing faculty and professional staff to engage all partner participants in the planning, implementation, and evaluation of the partnership. During the quarterly meetings, reports of ongoing progress, outcomes, opportunities, and challenges are presented, and future opportunities are identified. This structure keeps all partner members focused on the purpose and intent of the VA Nursing Academy, allows for negotiation of differences with impending conflict, holds all participants accountable for meeting the expectations of the partnership initiative, and continues to be essential to our function and productivity. Evaluation of the outcomes of our partnership goals and activities has allowed us to achieve exceptional results, including product development (psychiatric simulations DVD) and media productions; distanceaccessible VA-centric courses, curriculum, and clinical simulation scenarios; the graduation to date of 57 VA Nurse Scholar graduates; and exposure for all undergraduates to a veteran-centric nursing curriculum, joint publications and national presentations. Ongoing evaluation and process improvement have been our mantra and have helped evolve our partnership outcomes. This reflection and analysis of ongoing improvements also allowed us to continually conduct perception checks with partners, meet our timelines, deliverables, and the VA Nursing Academy goals. The annual reporting process enables each partner to analyze overall progress in conjunction with the other VA Nursing Academy sites and to incorporate and implement future plans. The Birmingham VA Nursing Academy partnership was initiated with a commitment to a sustainability plan and a desire to create resources targeted at continuing the relationship. Clearly, funding drives the depth and breadth of the partnership and its related outcomes. While each partner's executive leaders invest resources to support the initiative, the extramural funding for the VA Nursing Academy provided the resources needed to produce the significant vertical and horizontal integration of the initiative across both organizations that led to the value-added outcomes associated with this initiative. The federal investment in the VA Nursing Academy extends well beyond funded resources, to unfunded personnel, space, supplies, operations, and joint ventures that mutually benefit the partnership. The educational component of the partnership included nursing student rotations and graduates with competencies in the clinical care of veterans and their families, together with the development of VA-centric curricula that addresses the
THE VA NURSING ACADEMY
unique health needs of veterans. However, the depth and breadth of the practice-based and partnership outcomes require time, energy, creativity, and commitment of both nursing faculty and VA nursing staff and would not have been achieved without underlying funding. The partnership has certainly helped to launch a firm and growing commitment to and focus on veterans and veteran's health within the UABSON. This commitment has resulted in tremendous growth in the numbers of veteran students in the past 4 years and the development of a system and personnel to support the educational success and career mobility of these students. Similarly, the commitment prompted UABSON to pledge our support to the Joining Forces Campaign and led to our recent success in receiving a federal veterans BSN grant to educate veterans with military medical experience to attain a baccalaureate degree in nursing.
Conclusion The Birmingham VA Nursing Academy continues to produce educational, clinical, and program outcomes associated with the overall and site-specific goals established for this partnership throughout and beyond the pilot funding period. As our partnership evolves, we continue to glean significant lessons and opportunities across academe and service that inform the care of veterans and their families within and outside of the VA
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Health System. Leveraging our resources and human capital, our partnership seeks to continue to grow and synergize our work as we address the ongoing health care needs and the unique challenges faced by veterans and their families across the nation.
References Bowman, C. C., Johnson, L., Cox, M., Rick, C., Dougherty, M, et al (2011). The Department of Veterans Affairs Nursing Academy (VANA): Forging strategic alliances with schools of nursing to address nursing’s workforce needs. Nursing Outlook, 59, 299–307. MacPhee, M. (2009). Developing a practice-academic partnership logic model. Nursing Outlook, 57, 143–147. Nightengale, F. (1853–1893). Correspondence. Florence Nightingale Letters, University of Alabama at Birmingham. Birmingham, AL: Reynolds Historical Collection of the Lister Hill Library of Health Sciences Archives. U.S. Department of Veterans Affairs & National Center for Veterans Analysis, Statistics, http://www.va.gov/vetdata/ index.asp (accessed May 30, 2012). U.S. Department of Veterans Affairs & VA Nursing Academy Partnerships, http://www.va.gov/oaa/vana/partners.asp (accessed September 21, 2013). U.S. Department of Veterans Affairs & Veterans Health Administration (2009). VA Nursing Academy: Enhancing academic partnerships program, request for proposals, 2009-2010.
