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Graduate Nursing Education (GNE): Duke University Hospital Demonstration Project
All Rights Reserved, Duke Medicine 2007
Concept: Professionalism
The Duke Nurse demonstrates integrity in nursing practice through self-knowing, nurturing students, and mentoring colleagues to provide exemplary professional practice every day, every patient, every setting. We support patient needs, changes in practice, and the nursing profession through active dialogue and partnership.
A commitment to continual learning and developing expertise is critical to advancing nursing practice.
All Rights Reserved, Duke Medicine 2007
Project Oversight
• Senior Leadership Oversight from Mary Ann Fuchs, DNP, RN, FAAN and Catherine Gilliss, PhD, RN, FAAN
• Day-to-day operations:
– Pamela Edwards, EdD, MSN, RN-BC, FABC, CNE; Associate Chief Nursing Officer; Education, DUHS
– Barbara Turner, PhD, RN, FAAN; Director, Doctor of Nursing Practice Program, DUSON
All Rights Reserved, Duke Medicine 2007
Innovating in clinical growth
• DMP & Cancer Center • Continued investment in Duke Primary Care
network expansion; affiliation models • Outpatient/inpatient access initiatives –
expanding patient volumes • Strategic network/partnerships; business
development • Local, statewide, & regional strategic marketing;
national promotion & marketing of Programs of Distinction
Duke: Transformation Requires Growth
All Rights Reserved, Duke Medicine 2007
Reinventing Care Design &
Payer Strategy
Innovating in Clinical Growth
Revolutionizing Care Delivery
• DMP & Cancer Center – growth drivers; meeting demand • Primary care network expansion • Outpatient/inpatient access initiatives – expanding volumes • Strategic clinical partnerships and network development • Targeted and strategic marketing locally, regionally, etc.
• Patient centered care; focus on patient experience • Maestro Care (electronic health record) • “Right patient, right place, right time” - full spectrum of care settings;
better integration/alignment across DUHS • Length of stay efficiencies; reduce unnecessary readmissions
• Population health management strategies • Creation of Clinically Integrated Network (CIN) • Care “bundles” • Pricing and contracting strategies with payers
Transforming Our Future
All Rights Reserved, Duke Medicine 2007
Revolutionizing Care
Delivery Patient-Centered Care
Maestro Care “Right patient, right place, right time”
Innovating in Clinical Growth
Primary/Specialty Network Development Access Improvement
DMP & Cancer Center
Reinventing care
design Population health
management Clinically Integrated
Network Care “bundles”
LEADING HEALTHCARE DELIVERY
SYSTEM IN THE NATION
Performance Excellence
Quality & Pa+ent Safety Pa+ent Experience Finance & Growth Work Culture
Physicians, Providers & Direct Care Staff
Deliver great, compassionate patient care efficiently and effectively;
constantly seek innovations in safety and quality
Support Care Staff Improve the patient
experience; support optimal care delivery; excellence in
operational execution
All Physicians, Staff, Volunteers
Demonstrate values-based behaviors and
decision-making
DUHS Values
Excellence Safety Integrity Teamwork Diversity
Caring for Our Pa+ents, Their Loved Ones, & Each Other
Cost Improvements Reduce costs for episodes of care
Expense management
Competitive pricing
All Rights Reserved, Duke Medicine 2007
Duke GNE Goals • Prepares APRN learners to play a greater leadership role in the
health system, both in delivering care and in decision making about care
• Provides APRNs more involvement in the development and evolution of a regional care infrastructure that is more accessible, cost-effective, and responsive to the needs of our region
• Provides direct support to develop, institute, and require new preceptors to participate in a comprehensive preceptor education program – further improving preceptor training already in place
All Rights Reserved, Duke Medicine 2007
Project Partners Half of clinical training occurs in non-hospital settings, which
strengthens nurses’ skills in handling preventive services, chronic disease management and other primary care needs
• School Partner:
– The Duke University School of Nursing
• Clinical Partners:
– Private Diagnostic Clinic (PDC)
– Duke Primary Care; 32 locations across the region
– Healing with CAARE, Inc., a non-profit community clinic that provides free health services in Durham
All Rights Reserved, Duke Medicine 2007
Project Partners • The Division of Community Health in Duke’s Department of
Community and Family Medicine, in partnership with: – Lincoln Community Health Center – Lyon Park Community Center – Walltown Neighborhood Clinic – Holton Wellness Center – Northern Piedmont Community Care
• Duke LifePoint: – N.C. community hospitals at Maria Parham Medical
Center in Henderson – Person Memorial Hospital in Roxboro
• Danville Regional Medical Center in Danville, Va.
All Rights Reserved, Duke Medicine 2007
Preceptor Planning & Development During the Fall, Spring, and Summer terms of Year 1 - a formal training program for preceptors was launched. • This program includes face-to-face seminars and online learning
modules for preceptors to develop skills in working with students in clinical settings.
• The online modules will be advised for all new clinical preceptors.
• Face-to-face preceptor training seminars will be delivered on a bi-annual basis through the end of the project and will include the use of standardized patients.
• These sessions will be digitally captured to enable preceptors to review them in the future.
All Rights Reserved, Duke Medicine 2007
0
5
10
15
20
25
30
Fall '12 Spring '13 Summer '13
APRN Student Placements In Duke Primary Care
APRN Students Duke Primary Care Year 1
# of APRN Students
All Rights Reserved, Duke Medicine 2007
0
25
50
75
100
Fall '12 Spring '13 Summer '13
% Increase in Duke Primary Care APRN Preceptors
DPC Provider Preceptors
% APRN Preceptors
All Rights Reserved, Duke Medicine 2007
0
10
20
30
40
Fall '12 Spring '13 Summer '13
Increase in Duke Primary Care APRN Preceptors
Duke Primary Care APRN Preceptors
# of APRN Preceptors
All Rights Reserved, Duke Medicine 2007
Accomplishments in Year 1 • Relationship Building • Began ENTICE (Enlisting New Teachers In Clinical
Environments) initiative to increase number of preceptors by learning “What Motivates Providers To Precept”
• Created Preceptor Development Workshop to help providers become better preceptors – upcoming on May 4, 2013
• Delivered on-site presentations to Primary Care Clinics throughout Duke Medicine and Research Triangle Park Communities to explain objectives of the Graduate Nursing Education Demonstration Project
All Rights Reserved, Duke Medicine 2007
Preceptor “Champions” Emerging: “It’s interesting how teaching can make you a better provider, especially with the really good questions they ask, such as why did you do that or why did you prescribe that?”
…Comment from a preceptor