Hawai'i Health Services Corporation (HHSC) Nusing Preceptorship Program
|Grant AF-12104-02-60||Budget: $1,000,000||1,002 Participants Completed|
Hawai'i Health Systems Corporation (HHSC), a public benefit corporation, is the nation’s fourth largest public hospital system. With 3,400 employees staffing 1,260 beds on five islands, HHSC provided quality health care to the people of Hawai'i. HHSC is the largest health provider for Neighbor Island residients, providing acute, rural and long-term care, particularly in rural locations where private hospitals are unwilling or unable to provide service.
HHSC was established by Act 262, Session Laws of Hawai'i 1196, as an agency of the State of Hawai'i. HHSC has been given the responsibility of organizing Hawai'i’s state hospitals into an integrated, efficient system. At the same time, the corporation retains the historical character of these hospitals, especially those on rural areas. In addition to serving the needs of their communities, the facilities provide healthcare to thousands of neighbor island visitors and tourists.
HHSC is the fifth largest employer in Hawai'i, serving the state through twelve (12) HHSC facilities located in five different regions: East Hawai'i—Hilo Medical Center, Hale Ho’ola Hamakua and Kau Hospital; West Hawai'i—Kona Community Hospital and Kohala Hospital; Maui—Maui Memorial Medical Center, Kula Hospital and Lanai Community Hospital; O'ahu—Leahi Hospital and Maluhia; and Kaua'i—Kaua'i Veterans Memorial Hospital and Samuel Mahelona Memorial Hospital. Through this grant, each hospital developed a customized training program specific to the needs of their nurses, institutions and community.
There are three program components to this project:
- Upward Mobility
- Nurse Trainee
- Recruitment, Retention and Specialty Training
Participants included 824 Registered Nurses (RNs), 51 Licensed Practical Nurses (LPNs), 127 Certified Nursing Assistants (CNAs) and others including emergency room assistants, imaging assistants, psychiatric aides, occupational therapy aides, physical therapy aides, human resource managers and staff, health unit clerks, and other employees, many of whom participated in more than one event or program.
This program directly benefited the existing nurses and staff at the HHSC hospitals, who in turn benefited the patients. The trained nurses developed an increase in knowledge, skills and understanding, which directly benefited the resident care and assessment. The public benefit is a system with a better-trained workforce, with expectations of improved patient care and safety, sharper assessment skills and a commitment to improving the welfare of patients.
The combined program, BSN/AND, NCLEX, International RN and Patient Care Technician resulted in 24 employees upgrading to RNs, 2 to LPNs, 2 to CNAs and 23 to Patient Care Technicians. All of the vacancies created by the movement of employees who upgraded to a higher position were filled. The creation of the Graduate Nurse and RN II positions by HHSC have resulted in the hiring of 142 Graduate Nurses and 33 RN IIs during the project period which contributed greatly in meeting the hospitals’ staffing needs.
The practice of Preceptorships has been institutionalized. The regional facilities are providing specialty and didactic training for employees as a continuation of the grant. Training equipment is available now for on-going in-house training. Learning labs have been set up in hospitals across the state. New positions have been created and policies changed to address industry shortage issues.
Upward Mobility Approximately one year after implementation, HHSC realized that it would be difficult to meet the goal of 35 employees graduating from Bachelor of Science Nurse (BSN) and Licensed Practical Nurse (LPN) programs in the State of Hawai'i university and community college system for reasons which mirrored that of other nursing programs throughout the nation. Hawaii’s nursing programs also suffered from few openings in the degree programs and many potential students were denied acceptance because of the lack of nursing faculty, limited course offerings causing delay in completing pre-requisite courses, and intense competition for entrance into a nursing program.
Recognizing that a new method of upgrading employees to RNs and LPNs was needed, the program shifted to focus on internal resources within the hospitals. Due to a fairly large immigrant population in the State and within the Corporation, HHSC opted to provide resources to help foreign educated RNs employed in non-nursing positions become licensed RNs, hence the creation of the International RN program.
The Upward Mobility Program was expanded to include special training for CNAs in the O'ahu Region to upgrade their skills to a new position, “Patient Care Technician (PCT)” and as such, assume skills performed previously by RNs. This new approach extended the capacity of the currently employed RN’s at the two long-term care hospitals in the region, reducing the urgency of employing more RN’s.
National Council Licensure Exam for Registered Nurses (NCLEX-RN) Employees who previously had obtained an RN degree from a foreign university were assisted with pre-NCLEX remedial courses, CGFNS tracking, registration fee for certification of foreign educated RN’s, and airfare to the NCLEX exam site. Kaplan Test Prep and Admissions was contracted to provide the review course taken at their Honolulu office, at Maui and Hawai'i Community Colleges, or through their online school.
Bachelor of Nursing (BSN) and Associate Degree Nursing (ADN) Programs The grant covered tuition for credit courses taken through the Hawai'i, Honolulu, Kaua'i, Leeward and Maui Community Colleges and the University of Hawai'i-Hilo leading to licensure. Books and supplies were purchased for the students.
Nurse Aid Training Kona Community Hospital employees were trained as instructors, enabling them to teach the Nurse Aid course designed to fill an unmet urgent need at the hospital. On the island of Maui, employees who received training prior to the grant taught classes at Kula Hospital.
Patient Care Technicians Leahi and Maluhia Hospitals, both long term care facilities in the O'ahu Region, were hampered by longstanding vacancies, thus causing existing RN staff to assume considerably more responsibilities, including those which could have been managed by trained lower level staff. To better utilize the RNs, a program was developed to train Certified Nurse Aides as “Patient Care Technicians” to assume higher level responsibilities, with special focus on tube feeding of patients.
New Nurse Trainee Program The project goal was to hire and train 55 recent nurse graduates, establish a training program at Maui Community College for employees to become preceptors to the new graduates at Maui Memorial Medical Center, and create new positions to hire unlicensed graduates of various RN and AD nursing programs.
New Graduate Trainees The grant provided for curriculum development for the Nursing Administration at Hilo Medical Center, Maui Memorial Medical Center and Leahi Hospital working with Hawai'i Community College, Maui Community College, and Kapi'olani Community College respectively. Improvements to the core curriculum for Associate Degree Nurse (ADN) students prepared the soon-to-be graduates to cope with the complexities experienced in nursing, increasing their ability to recognize and address patient situations. New graduates received training in the emergency, obstetrics, surgery, psychiatric, pediatric, intensive care, and ambulatory surgery units.
This program also developed an 8-week orientation course at Maui Memorial Medical Center for new Nurse graduates to transition to the hospital environment and familiarize them with the responsibilities of the nursing units.
During the process of grant implementation, HHSC created two new positions, Graduate Nurse and RN II to enable hospitals to hire inexperienced applicants as a means of addressing critical staffing shortages and expediting the recruitment process for the units. The creation of the Registered Nurse II position in the corporation was unprecedented and represented a significant paradigm shift in corporate policy.
Preceptors Leahi Hospital and Maui Memorial Medical Center partnered with Kapi'olani Community College and Maui Community College respectively to train employees to become preceptors to new nurse graduates. The Leahi program focused on long term patient care. Instruction took place on the hospital’s campus taught by faculty from the college. At Maui Memorial Medical Center, employees attended a course designed by the college and the nursing administration.
Hilo Medical Center’s (HWC) nursing administration developed a mentor course for its supervisors who were charged with the new duty of preceptorship. The Chief Nurse Executive and Regional RDP Coordinator worked with Hawai'i Community College to create a pilot course to teach the concepts of mentoring to employees at Hale Ho’ola Hamakua, Hilo Medical Center, and Ka`u Hospital.
The East Hawai'i Region completed its pilot course for Hawai'i Community College’s Nurse Mentorship program in 2003. Twenty (20) nurse leaders from Hilo Medical Center, Hale Ho’ola Hamakua and Ka`u participated in a five-week, five-module course that included web-based learning with weekly face-to-face meetings.
HMC also created a Learning Center as a nursing skill and training lab, funded through the Rural Development Project Grant. The center, open 24 hours a day, provides education via the internet, video and traditional textbooks.
Recruitment/Retention/Specialty Training The goal of this multi-dimensional program was to provide employees with the skills needed to meet the changing demands of and complexities in healthcare. HHSC’s rural hospitals have experienced physicians leaving the island, nurses leaving the profession, an increase in foreign visitors, and a population with an extended life span. The demands placed on the nursing staff have increased significantly over the last decade and the Corporation recognized the need to address current and emerging healthcare trends with the grant.
To implement HHSC’s project, hiring consisted of four (4) coordinators, three (3) full-time and one (1) half-time, and the corporation designated a corporate staff member to serve as the statewide grant administrator. Salaries for the coordinators were paid by the grant; the corporation paid the administrator’s salary. The coordinators were responsible for working with nursing administration of the hospitals in their respective region to establish priorities for training, recruitment, and retention and for submitting funding requests to the statewide administrator for approval.
Coordinators Hired RNs, physicians, attorneys and educators to teach customized classes covering a wide range of subjects in conjunction with the priority training needs of each region.
Recruitment Program Through this grant funding, HHSC developed a recruitment brochure featuring RN, LPN and CNA positions to recruit nursing students, RNs who left the profession, military RNs exiting the service, and people seeking health care employment to inform them of employment with HHSC.
Coordinators designed banners and communication materials to educate students and the public about nursing as a profession. Coordinators and Human Resource staff hosted and attended career job fairs to familiarize the public about nursing positions in HHSC.
HHSC also established affiliation agreements with nursing programs at public and private colleges and universities, and provided airfare, registration and lodging for nurse managers and human resources staff to attend recruitment conferences.
High school students were introduced to the Health Services Career Pathway offered in two O'ahu public schools through high school based career day events. High school and college students attended career days on the University of Hawai'i campus. And prospective nurses attended job fairs, where they could learn about positions not only at the two (2) O'ahu hospitals, but also at HHSC hospitals statewide.
Retention and Specialty Training Nurse employees received training through in-service or out-service means to upgrade their skills in various fields as recommended by their supervisors to be better prepared to treat patients. This was an important step in preparing to meet the present health care needs and those anticipated in the coming years.
The coordinators sought programs, which would provide the specialty training needed to help staff address complex cases presented by patients. Kona Community Hospital sent employees to Tripler Medical Center, the largest U.S. Army hospital in the Pacific, to train in obstetrics and neonatal care. This was a two (2) month training which required employees to relocate for two months to another island to participate. The hospital had experienced complex cases which staff had not previously encountered and wanted to prepare itself for other cases which may present themselves in the future. Kona Community Hospital and Kaua'i Veterans Memorial Hospital also sent employees to be trained at Queen’s Medical Center, Kapi'olani Medical Center for Women and Children, and Kaiser Permanente, all private hospitals on the island of O'ahu, in emergency medicine due to the range of cases, services, and treatment options provided at the hospitals.
Hilo Medical Center, Maui Memorial Medical Center, and Kaua'i Veterans Memorial Hospital used grant funds to bring training offered by specialists at Queen’s Medical Center, Kapi'olani Medical Center for Women and Children, and Kaiser Permanente to their hospitals and were able to train a large number of nurses, Licensed Practical Nurses and Nurse Aids. Hilo Medical Center and Maui Memorial Medical Center also brought specialists from other states to teach techniques to its staff. This effort addressed cases which were occurring more frequently which the staff found to be complex and difficult to resolve.
Employees attended training events offered by HHSC hospitals; Kaua'i Veterans Memorial Hospital staff attended programs at Hilo Medical Center and Maui Memorial Medical Center; Hilo Medical Center staff went to Maui Memorial Medical Center and Kona Community Hospital; Kona Community Hospital employees received training at Maui Memorial Medical Center, Hilo Medical Center and Kaua'i Veterans Memorial Hospital; Leahi Hospital employees participated in Maui Memorial Medical Center courses; and Samuel Maheloha Memorial Hospital employees attended courses at Maui Memorial Medical Center. The grant provided an opportunity for HHSC’s hospitals to participate in and benefit from training services provided by sister hospitals.
The grant also provided financial support for equipment purchases: including mobile clinical simulators that can travel to the facility where needed. Mobile equipment purchased for training included adult and child mannequins, videos, DVDs, books and manuals.
Employees also took mandatory certification courses required for specialty units, which enabled the hospitals to provide necessary services to patients. Equipment was purchased to allow the units requiring certification to maintain licensed staff.
Upward Mobility Training Program Employees were provided an opportunity to upgrade their job status from Licensed Practical Nurse to Registered Nurse or from Para Medical Assistant/Nurse Aide to Licensed Practical Nurse. The goal was to have 35 employees participate in the program as a means for HHSC to gain additional nurses. Through this grant, HHSC pursued a second track to obtain more RNs through an international RN program, which proved to be successful and surpassed the original goal.
Nurse Aid Training Prior to this training, the sole provider of Nurse Aid training in West Hawai'i, the American Red Cross, was unable to offer regularly scheduled classes, which left the community without training for periods of more than a year. The Nurse Aid course taught through Kona Community Hospital now provides sustainability in training opportunities and more positions filled. Employees taught the Nurse Aide training classes at Kula Hospital and then hired the trainees.
Patient Care Technicians Upon completion of the class and demonstration of proficiency in tube feeding, 23 Certified Nurse Aides were promoted to Patient Care Technicians (PCT). This was a new position created as a result of the grant. The PTC position offers a higher salary, which reflects their higher level of skill and responsibilities. It addresses patient care issues by freeing up RN’s to attend to higher level tasks and provides more for a team approach and an upgraded entry level position.
New Nurse Trainee Program
Nurse Trainee The number of nurse graduates hired was 91 at facilities on the islands of Hawai'i, Maui, and O'ahu. Preceptor programs were developed at Maui Community College and individually at Leahi Hospital (O'ahu), Hilo Medical Center (Hawai'i), and Kona Community Hospital (Hawai'i). This established the capacity to continue new nurse training in-house through much of the state.
New Graduate Trainees 21 Graduate Nurse positions were created at Kona Community Hospital (5) and Maui Memorial Medical Center (16). An HHSC policy change enabled the hospitals to hire unlicensed graduates from the ADN and Bachelor of Science degree Nurse (BSN) programs at the State’s 4-year and community colleges. Partnerships with colleges created embedded short term career ladders such as Maui Community College’s requirement for students to be Licensed Practical Nurses (LPNs) prior to graduation, coupled with Maui Memorial Medical Center’s policy to utilize the new hires as LPNs in the units while they are awaiting RN licensure. Kona Community Hospital utilizes the unlicensed graduates as Nurse Aids until the new graduates achieve their licenses.
Additionally, 33 new positions were established at Hilo Medical Center (13), Ka`u Hospital (1), Kaua'i Veterans Memorial Hospital (1), Kona Community Hospital (4), Leahi Hospital (2), Maui Memorial Medical Center (10), and Samuel Mahelona Memorial Hospital (2). This was due to a HHSC policy change which enabled the hospitals to hire RN licensed individuals with no work experience as a nurse in an effort to meet staffing needs. These nurses worked closely with trained preceptors, a system created under this grant.
Preceptors 32 employees received training to serve as preceptors to new graduate nurses and were employed in medical-surgical units and specialty units ranging from surgery, emergency, pediatrics, intensive care, obstetrics, psychiatric, ambulatory surgery and observation care. Preceptors were trained to provide on-the-job orientation and clinical training for new hires after their orientation.
In response to the need for preceptors and the success of this pilot project, HHSC established a monetary program known as the Preceptor Differential to provide additional pay to preceptors. The preceptor differential has become a permanent HHSC program, both in terms of funding by the hospitals and memorialized in the collective bargaining contract negotiated between HHSC and the union for the nurses.
The mentoring course designed through Hawai'i Community College is now available online to other Hawai'i hospital managers as well as to Hawai'i Community College ADN program students.
Recruitment/Retention/Specialty Training The goals to train 55 preceptors and 40 employees in specialized fields were met and provided way beyond expectations. The grant provided an opportunity to provide training both on an individualized and group basis to staff at all 12 hospitals, many of whom had not received training opportunities during the course of their employment. The topics were carefully evaluated prior to the course offerings to meet each facility’s needs. Due to a significant need for leadership development and mentorship skills, a joint program between the University of Hawai'i-Hilo’s College of Business and Economics was developed to train nurse managers in four of the five regions in management, budgetary and leadership skills.
Recruitment Program A comprehensive five (5) and 10 year recruitment and retention strategic plan is being developed for the Corporation.
Retention and Specialty Training An unplanned accomplishment occurred in the hiring policies of HHSC. Prior to this program HHSC only hired full time RNs. Through this program they realized that they were excluding a segment of the population unable to work full time. HHSC therefore changed their policy and created half time RN positions.