|By the Innovations Exchange Team|
In the fall of 2011, Judith Kunisch, a lecturer at the Yale School of Nursing (YSN) in New Haven, CT used the Innovations Exchange Web site as a resource for her students in the graduate course, Contexts of Care. It is a required core course for all students in the final year of MSN/APRN study. From the YSN catalogue:
Advanced practice nursing occurs in contexts that inevitably influence practice. This course provides students an integrative experience in applying health policy and organizational, regulatory, safety, quality, and ethical concepts to care. The course utilizes cases for analysis of the contextual basis of practice in combination with assigned readings, lectures, discussion, and Web-based modules. The cases highlight various concepts that provide the infrastructure of the health care environment, including organizational leadership and culture; ethics; risk and liability; access and coverage; quality and safety; credentialing; and inter- and intra-professional issues. The course is organized into five content areas: Regulation and Scope of Practice; Leadership and Organizational Dynamics; Health Care Access, Coverage, and Finance; Clinical Ethics; and Safety and Quality.
Judith assigned students in her graduate class to make a 5-minute presentation about an Innovation or QualityTool of their choosing and write a memo evaluating its practicality. AHRQ interviewed her about the assignment's origins and execution.
Innovations Exchange: How did you get the idea to use the Innovations Exchange in your class?
Kunisch: One of my colleagues in the Yale School of Nursing, Nancy Yedlin, teaches a class on Project Planning. I was observing her class, and I saw that she asked her students to read an Innovation and submit a comment on it. I had seen the Innovations Exchange before, but this prompted me to a take a deeper look. After doing so, I thought this was something I could use in my class, too.
Tell us about the class and your students.
The class, which is required, is called "Contexts of Care." It addresses the health care environment in the context in which they'll be practicing. There are four modules: quality and safety, leadership, ethics and legal issues, and policy and politics. It is a large class, with 99 students, and it lasts 14 weeks.
The class is for second-year specialty students in the Graduate School of Nursing who will graduate in May with a master's degree in Science and Nursing, ready to take exams to be Advance Practice Registered Nurses (APRNs). It is a 2-year program with specialties such as psychology, family and primary care, nurse midwifery, pediatrics, acute care, and management.
The students are very diverse geographically—less than one-third are from New York, Connecticut, and Massachusetts, and the rest are from all over the country, plus a few international students. Most are in their late 20s, with a few in their 30s or over 40. Many had graduated college with a non-nursing degree. They come to Yale and spend 18 months getting an RN, and then move into one of the specialty programs. So they already have clinical experience, and many of them work part-time in nursing while in graduate school.
In the long term they're likely to move into leadership positions within their organizations, but their immediate goals are to get their license and certification and take care of patients. They're bright, highly educated people who enjoy being challenged intellectually.
Why did you think examining Innovations would benefit your students?
I was looking for an assignment that would appeal to them in terms of where they're going professionally. Because they will be APRNs, they will have future leadership roles in their organizations. They will be innovators; they will need to encourage innovation and bring new practices to the organization. I wanted to show them on a practical level where you can go for ideas—you don't solely have to go to the medical literature or a conference. Here's a site where you can find practical tools that are being used and have been tested in real situations.
Our students come from all over the country. One of the Innovations Exchange's strengths is that the Innovations cover a large geographic area, so the students could look for one in a state they've already worked in or are likely to end up working in.
Another is that there is tremendous variety among the Innovations and Tools in terms of the topics. The students have diverse interests, so whether they plan to practice at a rural clinic or a large city hospital, or treat children or geriatric patients, they can find something relevant to their area of interest.
And finally, it's well organized and easy to use. You can search with keywords, browse by subject—which includes by disease, setting of care, stage of care, and so on—or enter through the home page. Whichever way you choose, you can be reviewing something you're interested in within a few minutes.
What did the assignment entail?
I had them start by familiarizing themselves with the Innovations Exchange. This included reading a number of Innovations and reviewing the link about how to Submit an Innovation, which describes the inclusion criteria. Then they were to pick an Innovation they found interesting. After that, there were two main parts.
They had to prepare and deliver a 5-minute oral presentation on the Innovation, with at least one PowerPoint slide. The idea was to simulate a clinical conference—your clinic's medical director has invited you to identify an innovative practice from a real-world setting that might be implemented at the clinic. You have five minutes on the agenda to make your "elevator speech" about why this is something we should consider.
The second part was to write a "professional practice memorandum" to an AHRQ executive evaluating the Innovation. The memo had to summarize the Innovation, explain what about their professional interests led them to select it, and discuss its potential benefits and drawbacks. The assignment counted for 50 percent of their grade for the semester.
How did they handle the assignment?
Overall they really loved the assignment and put a lot of effort into it, and it showed. We had some excellent writers in the group. I was excited to see the wide assortment of topics they picked—even with 99 students there were no duplicates!
I was impressed with their ability to take a critical approach. Quite a few pointed out reasons why an Innovation might not work at their previous or current employer, or said they would have liked to hear more about some aspect of the innovation. I had suggested they contact the Innovator if they had questions or comments, and several of them did.
It was fascinating and in some cases quite moving to read the memos. One student plans to work at a solo practice in Maine. She found an Innovation about diabetic retinal screening she plans to introduce into her practice right away (http://www.innovations.ahrq.gov/content.aspx?id=1686). Another one who is working in an acute care setting in a hospital wrote about a QualityTool for diagnosing childhood leukemia (http://www.innovations.ahrq.gov/content.aspx?id=175). Again, she said it was something she could see herself using right away.
There was one student who is going into gerontology. She found a program in Wisconsin that uses group storytelling to enhance the lives of people with Alzheimer's disease (http://www.innovations.ahrq.gov/content.aspx?id=2113). Her memo was so beautifully written, I wrote on it: "Just by reading this, I can see you have made the right choice in a career."
For other faculty who might consider using this type of assignment in their classes, what would you tell them the students get out of it?
I think the key is that it's bridging theory with practicality and reality. That's what we're trying to do—help prepare people to leave school. People come to nursing school and learn an awful lot of theory. That's important, but I think we can do more on the practical side. When I was a student we had something we called a "learning lab." In many ways the Innovations Exchange is a learning lab—a lab opportunity that appeals to a lot of different people on a range of subjects.
The students see people like themselves doing these things. So much of what they read in school is written by scholars with a lifetime of scholarly work. With the Innovations Exchange, you're often reading ideas from people on the front lines of clinical work. So they're really able to relate to these practitioners. It reminds me of talking to your neighbor over the back fence: "Here's what I'm doing—I'll tell you all about it."
An important side benefit is improving communication skills. The students learn how to bring other people on board to an idea they support, in a concise fashion. In leadership positions you really have to know how to sell an idea to your peers.
Are you going to repeat the assignment next year?
Absolutely! Honestly I can't think of another assignment that works so well for a large group, appeals to specialty and regional interests, and has such practicality.
Description of Assignment from Course Syllabus
Select student essays
About Judith Kunisch
Judith Kunisch, BSN, MBA is a lecturer in Nursing Management, Policy, and Leadership at the Yale School of Nursing. She is a senior nurse executive with more than 20 years experience building and implementing innovative solutions to improve medical quality and manage medical costs. A former Fortune 100 insurance company vice-president, Judith was responsible for medical programs and managed care services in 50 states.
She received a BSN from Skidmore College and an MBA from Rensselaer Polytechnic Institute. In addition, she is a Six Sigma trained champion and attended the Leonard Davis Institute of Health Economics nurse executive training.
She currently serves as a member of the Innovations Exchange Expert Panel.
Disclosure Statement: Kunisch is aware of the Innovations Exchange requirement to disclose any financial interests, or business or professional affiliations, relevant to the work described in this Perspective. No disclosures were reported.