Augusta University asked its College of Nursing to play a pivotal role as it took over the administration of East Central Regional Hospital, Dean Lucy Marion jumped at the chance to expand the institution's nursing education into the field of mental health.
Marion, a family nurse practitioner with extensive experience in psychiatric mental health nursing, proposed a three pronged approach: The college would help hire nurses for the hospital, partner with other institutions to graduate master's prepared nurses in mental health and create a Dedicated Education Unit to help guide students entering the field.
“The situation is dire,” Marion said. “These patients are the most vulnerable among us and we're not always kind to those who are vulnerable, so I'm really excited about doing something in this area.”East Central, part of the Georgia Department of Behavioral Health and Developmental Disabilities, serves mentally ill and developmentally disabled patients on two Augusta area campuses. Once considered for closure, the facility has seen improvement since the 2009 partnership agreement with Augusta University to provide clinical, educational and research opportunities.
To promote further growth and improvement, Augusta University submitted a Recruitment and Retention grant to the Health Resources and Services Administration, the federal agency charged with improving access to health care services for people who are uninsured, isolated or medically vulnerable.
The three-year, $780,000 grant proposal is designed to increase nurse retention and decrease nurse vacancy rates at East Central, where 46 of 74 full-time positions were unfilled as of summer 2011 and a high percentage of the nursing staff is close to retirement. The grant also would provide for educational opportunities for existing staff.
“We need about 60 new nurses,” said Dr. Deborah Natvig, Augusta University College of Nursing Associate Dean for Academic Nursing Practice and writer of the grant. “We're striving for consistency and quality of care with nurses who have psychiatric mental health backgrounds.” In the meantime, part-time nurses and temporary agencies fill in the gaps.
“We have an acute need for nursing staff,” said Margaret Tuck, Augusta University Interim Chief Nurse Executive at East Central. “Our other need is to improve quality of care for our patients, which directly relates to the education level, competencies and experience of the nursing staff.” One of the difficulties in attracting staff nurses is the “stigma” of mental health, Tuck said.
“You'd be surprised at how little students know about mental health in general and about mental health nursing practice,” she said. “Getting staff that are knowledgeable and experienced and dedicated is a big challenge.” To help meet the need, Marion envisions a future consortium between Augusta University, Valdosta State University and Georgia State University in Atlanta that will graduate much-needed master's-, post-master's- and doctoral-prepared nurses specializing in mental health.
“We've worked out the financial model and we have an agreement among the three universities, but we don't yet have the money or the product,” Marion said. She anticipates six online mental health courses, divided among the schools according to areas of expertise. Students' clinical experiences would be supervised by their home institution. Graduates would then be eligible to take a certifying exam through the American Nurses Credentialing Center. At East Central, newly hired Augusta University nurses go through an intensive three-week training period led by Nurse Educator Dianne Beauchamp, who, unlike many of her peers, has spent her entire nursing career in mental health.
“I went into nursing specifically to be a psych nurse,” she said, adding that she was the only person in her undergraduate class to go into the specialty. She now teaches nurses and other staff about psychiatric care.
Beauchamp wants to design a program that will educate all East Central employees, including long-time staff in forensics and mental health units, as well the Dedicated Education Unit. The challenge is getting everyone on board with a new approach to mental health care, she said. “The vision is just unbelievable. As more nurses are hired by Augusta University, we'll see a huge change in the overall mindset.”
One component in an evolving overall framework to develop more mental health nurses for East Central is an internship program in which baccalaureate or Clinical Nurse Leader students with an interest in the field can work part time while completing their studies. The hope, said Natvig, is that they will become permanent staff nurses upon graduation, then take on a preceptor role, grooming the next round of students for positions at the hospital. New hires will take part in a yearlong nurse residency program now under development, a recommendation emphasized in the 2010 Institute of Medicine Future of Nursing Report. The initiative will clearly define educational opportunities psychiatric mental health nurses have, Natvig said.
Yet another piece of the puzzle is a collaboration with the Center for Education at Georgia Regents Medical Center, in which East Central nurses participate in continuing education programs at no cost.
“Having this mechanism for our nurses to network, to share ideas and opportunities, is just wonderful,” Natvig said. “It also strengthens our bond with the campus. Now, in addition to the partnership between the state, Augusta University and East Central, we have one with the Medical Center.”
To facilitate competent staffing and improved patient care, Augusta University and East Central opened a 24-bed Dedicated Education Unit in November 2010. It is thought to be the first psychiatric DEU in the country.
“We very much want it to be a new and positive work environment for the staff, which should provide a more positive treatment environment for the patient,” Natvig said.
A key component of the unit is its all-inclusive approach. Patients in the DEU benefit from a team that includes nursing, psychology, psychiatry, medicine, pharmacy and social work practitioners. A treatment team facilitator coordinates direct care staff in addition to family and personal support systems.
One of the first nurses to be hired for the Dedicated Education Unit was Debbie Warren, a December 2010 graduate of Augusta University's Clinical Nurse Leader Program, which is designed to educate people with bachelor's degrees in other fields to become nurse leaders. As a student, Warren didn't realize that her previous career in customer service had prepared her for work in mental health, but her instructors and fellow students recognized her capacity for compassion and encouraged her in that direction. It has been a perfect fit.
“I wanted to be part of something that's innovative, challenging and new,” she said. “I like the idea of a Dedicated Education Unit because not only are we going to be working to improve the way mental health services are provided in Georgia, but we also are able to work with students � the nurses of the future. That's inspiring.”