Top-shelf nursing programs evolve to meet growing, changing health care industry

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JOHNSTOWN, Pennsylvania — On the third floor of a historic building at Mount Aloysius College in Cresson, Noelle was having a baby — and losing blood by the second.

Instructor Arlene Gorsuch, registered nurse and assistant professor of nursing, encouraged students to think quickly and find the appropriate medications.

As the students filled IVs, an information technology specialist worked a nearby laptop, manipulating Noelle's vital signs according to a faculty-approved script for the class, Nursing Care of the Family. The odds were against Noelle, but the students helped her pull through, despite postpartum hemorrhaging.

Fortunately, Noelle is a mannequin in the college's simulation lab, where technology mimics actual scenarios through realistic characters — some of which can speak or cry — faux bodily fluids and anything else that health care employees might encounter.

Rebecca Zukowski, the college's associate academic dean and nursing division chair, said the school aims to teach the most pressing need for today's nurses and future health care workers: critical thinking.

"We can make sure everybody gets that experience — as real as possible," Zukowski said. "This is a great place for them to make errors."

Faculty approve all scenarios so the students are tested in multiple disciplines. A specialist uses software to play out the script, react to students and create realistic situations with the mannequins.

"We like to say this is strategic use of simulator equipment," Zukowski said.

"Just having mannequins doesn't get the outcome we're looking for."

Zukowski said the next generation of nurses and others in health care fields will have to be quick-thinking, efficient and able to handle multiple disciplines.

Nurses, especially, will have to take on more administrative roles as demand increases for registered nurses along with increasing acuity levels in hospitals — and more patients.

"This technology teaches them to work in interdisciplinary teams," she said. "That is the reality of the new employment experience for them. They won't be isolated as much as they once were."

In another lab — past an electronic health care area, a room set up to train students for increasingly intricate electronic aspect of health care, and a traditional classroom — the college offers multi-patient scenarios with child and adult mannequins, some of which can actually mimic breathing and show blood pressure.

"Students have to make decisions quickly," Zukowski said. "Everything they might see in a hospital is here."

The ongoing investment in pricey technology — one of the mannequins, for example, cost a quarter of a million dollars — is part of administrators' commitment to supply a stream of prepared health care workers for the in-demand field, Zukowski said. The nursing division has grown over the past decade and now has more than 500 students enrolled.

Most graduates stay in the area and head to local hospitals, nursing homes and clinics.

Others work in home health, projected to be the fastest-growing sector of health care in the national economy.

Employment in that field is projected to increase by almost 60 percent between 2012 and 2022, according the most recent figures from the U.S. Bureau of Labor Statistics, Employment Projections program.

The health care industry overall has been growing steadily over the past decade, according to information from the bureau, and is expected to add nearly 3.5 million jobs between 2012 and 2022. The bureau attributes the anticipated need to an aging population — with more people who are 65 and older, more chronic conditions, medical advances and health insurance reform.

The Affordable Care Act likely added 30 million to 32 million additional individuals who could be seeking medical care because they are covered by insurance or now qualify for Medicaid, according to the American Nurses Association. On top of that, an additional two million to three million baby boomers are expected to age into Medicare every year for the next couple decades, creating an ongoing, increasing demand for registered nurses, the association predicts.

Those baby boomers can be nurses themselves, leaving a gap for new registered nurses, Zukowski added.

"Baby boomers are really the driving force for the upcoming need," she said.

"They probably stayed longer than expected in the workforce, but they can't stay forever."

Would-be nurses have plentiful options in the region —from Pitt-Johnstown's bachelor's degree, part of a nursing program rated seventh nationally in US News & World Report's rankings of America's Best Graduate Schools, 2011 — to shorter health care-related associate's degree programs at schools such as Pennsylvania Highlands Community College.

The nursing field offers more opportunities than ever before, according to Janet Grady, UPJ's vice president for academic affairs and chairwoman of nursing and health sciences division.

Informatics is a key area for growth, and Pitt-Johnstown's bachelor's degree programs can prepare students to earn graduate degrees in the field at the main campus in Pittsburgh. Faculty at Pitt-Johnstown guide undergraduates in the increasing — and changing — standards.

"Nurses work with a lot more information," Grady said. "That's an opportunity that didn't exist even 10 years ago."

The field of genetics also is opening new doors for nurses, she said.

"They could be researchers, or work with pharmaceutical companies," Grady said." Nurses were never involved in that before."

The way health care in general has evolved means the next generation of nurses will be faced with sicker patients, said Dr. Lisa Devineni, new director of the Conemaugh School of Nursing.

"The challenges today are increasing patient acuity and more complex-care patients with shorter stays," she said.

"As educators, we assure compliance with state and national standards, which are constantly changing."

The two-year curriculum at the Conemaugh School of Nursing combines evidence-based nursing education and state-of-the-art clinical practicum in a Level 1 trauma medical center and an advanced primary stroke center. Students also gain experience in a medical skills learning lab, one of 58 nationally accredited simulation labs.

The program is designed to prepare students for not only higher technical demands for the nursing field, but also for basic — but still critical — principles, said Heather Richards, an RN, BSN, CSN, and the school's academic admissions coordinator.

"It's not just the high-tech factor but also patient-centered care," she said.

"The philosophy is from Jean Watson's foundations of nursing: It's not just the body we care for but the soul inside. It's the human contact that is so important."

As new director, Devineni said her priority is to "continue and maintain" the level of respect the nursing school has earned over the decades. Having faculty who stay on top of a rigorous set of expanding skills is part of the school's foundation and success, she said.

"As an alumni, I take great pride and the challenge — and the need to maintain a school that creates highly qualified graduates," Devineni said.

At St. Francis University, administrators are seeing some of the same trends, according to Rita Trofino, nursing department chair at St. Francis.

The school just celebrated the 30th anniversary of its first graduating class, and enrollment in its nursing program has nearly doubled in the past decade.

All 13 of the 2014 graduates of the St. Francis University Nursing Program passed the National Council Licensure Examination on their first try.

"In 30 years, I've seen that our graduates are taking care of patients who are more acutely ill," Trofino said.

"Also, when you see more trauma centers, too, you're seeing more sick patients. A lot of our students do their clinicals at Conemaugh, which has a Level 1 trauma center."

Interdisciplinary simulation is one focus for preparing students to think quickly and critically, she said.

"They can make mistakes there," Trofino said. "They can give the mannequin an overdose and see what happens to its heart rate, and then see how students react to that. If the patient decelerated or crashed, how do they handle that? Who takes charge?"

A single simulation experience might include students studying nursing, physician assistant, physical therapy, occupational therapy or exercise physiology.

"We see how all those disciplines react," Trofino said. "Once they get to the hospital, students are more confident in dealing with those situations."

From the 2009-10 school year, enrollment has increased in each of Penn Highlands' health care-related programs, according to Gaynelle Schmieder, a registered nurse and assistant professor of health professions at the college. The college is also a vendor for those associate degree credits for Conemaugh School of Nursing, Conemaugh's histotechnology school and its radiologic technology school.

Many students who lean toward health care but haven't chosen a field begin with the college's medical assisting associate degree program.

"That prepares individuals for the versatility they need to have because they are educated on administrative functions, medical records, coding, billing, front office duties, and additionally educated clinically and can perform in a modified-lab setting and do many medical procedures," she said. "We have a very high placement rate. They could work in specialty offices, performing the administrative work in the front or go on to become medical coders.

Administrators are planning to add additional courses to the college's Blair County campus because they've seen an increase in demand. They also recently added certification exams on campus.

"With the (Affordable Care Act) being implemented — Meaningful Use in particular —most medical people must be either certified or licensed to do order entry," Schmieder said.

"Health care is a very solid field. Even though it's constantly changing — it's not a static field — it's always there and it's always needed.

"The challenge is to keep up with those changes."


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