In 2007, the Northeast Region VA Nursing Alliance (NERVANA) was founded. NERVANA is an academic–practice partnership between the Boston VA Healthcare System and six schools of nursing, which include: Boston College, Northeastern University, Regis College, Simmons College, University of Massachusetts Boston and University of Massachusetts Lowell. NERVANA's mission is derived from the VA's mission, which is to provide the best health care to Veterans, advance medical knowledge through research, and train tomorrow's health care leaders. NERVANA's mission is as follows: “To employ an innovative educational model to expand and enrich nursing student and faculty, to educate nursing students in the care of Veterans, and to expose nursing students to the advanced model of medical informatics, patient safety, evidenced-based practice and integrated systems of care employed by the VA's National Healthcare System” (VA Nursing Academy, 2007, p. 1). Although the NERVANA schools are among some of the most prestigious in the nation and located in the heart of a health care mecca, none had an academic–practice partnership with an academic medical center. Thus, this consortium offers unique opportunities for both the schools of nursing and the VA Boston Healthcare Systems alike (VA Nursing Academy, 2007).
In accordance with the American Association Colleges in Nursing (AACN) and American Organization of Nurse Executives (AONE) Task Force on Academic–Practice Partnerships (AACN-AONE, 2012), the guiding principles of NERVANA are to strengthen nursing practice by enhancing educational preparation of nursing students and promoting career advancement for clinical nurses within the VA Boston Healthcare System. Collaborative relationships were established between the VA Boston and the six schools of nursing and mutual goals were agreed upon at the conception. The purpose of this retrospective review was to examine the outcomes of the NERVANA, in accordance with the mission and goals of the academic–practice partnership and evaluate the sustainability of the alliance.
The Institute of Medicine's (2010) report on the future of nursing called for a transformation of professional nursing practice. Academic–practice partnerships are a vital component to the transformation (Beal et al., 2012). Academic–practice partnerships have been identified as an instrument to enhance nursing practice and position professional nurses to lead change and advance health (Institute of Medicine, 2010). Successful partnerships will “create systems for nurses to achieve educational and career advancement, prepare nurses of the future to practice and lead, provide mechanisms for lifelong learning, and provide a structure for nurse residency programs” (AACN-AONE, 2012, p. 1). The AACN-AONE Task Force reported the need to develop relationships based on mutual goals, respect, and a shared knowledge (AACN-AONE, 2012). The guiding principles include collaborative relationships, mutual respect and trust, sharing of knowledge, commitment to maximize the potential of RNs, establishment of RN residency programs, commitment to academic progression, implementation of innovative patient-centered delivery systems, and research initiatives to analyze and support the future clinical challenges of the RN workforce (Dobalian et al., 2014).
In 2007, the Department of Veterans Affairs (VA) established the VA Nursing Academy (VANA)—a 5-year, $60-million pilot program funding 15 partnerships between schools of nursing and local VA health care facilities nationwide. The goals of the program were to expand nursing faculty, enhance clinical faculty development, increase nursing student enrollment, increase recruitment and retention of Bachelor of Science in Nursing (BSN) nurses, and promote educational innovations related to care of the Veteran population. The Office of Academic Affiliates called for applications for participation. NERVANA applied for the program but was denied on three separate application cycles. The feedback related to the application was that the model was too complex to include six schools of nursing and unlikely to be sustainable. Based on this feedback, NERVANA forged ahead with the academic–practice partnership to enhance nursing practice and care to the nation's Veteran population.
The partnership was established to benefit the academic members of NERVANA and the VA Boston Healthcare System by developing and maintaining a relationship across academic affiliates and sharing of innovations and research initiatives to improved patient care outcomes and nursing education. Goals for NERVANA include:
- Maintaining and refining the infrastructure for sustaining the mission and supportive activities of NERVANA.
- Increasing the number of VA staff nurses prepared and willing to serve in the role of faculty to teach in nursing programs and NERVANA.
- Creating novel clinical rotations including interprofessional dedicated educational units (DEU) for BSN programs, APN rotations for MSN and DNP students, and research opportunities for PhD students.
- Establishing a culture for evidence-based practice/research opportunities for students and staff interested in the care of Veterans within the academic–practice partnership.
- Educating students, faculty, and the community regarding the uniqueness of the health needs of the Veteran population.
- Expanding programs at partnering schools to address health care issues related to the Veteran (i.e., Care of the American Veteran Colloquia series).
- Translating knowledge to develop best practices for Veterans in all health care settings (VA Nursing Academy, 2007).
The NERVANA partnership has completed 10 years, and the purpose of this review was to reflect on lessons learned and the accomplishments of the unique academic–practice partnership model.
Maintain and Refine the Infrastructure for Sustaining the Mission, and Supportive Activities of NERVANA
Since the inception of the NERVANA academic–practice partnership, the Steering Committee has met twice per year and the advisory committee monthly. The Steering Committee is composed of VA leadership, deans of the schools of nursing, staff nurses, nurse scientists, nurse residents, and key stakeholders. The steering committee meets to review the goals of the alliance and review the strategic plan. The advisory committee meets to discuss specific areas related to the nurse residency program, recruitment and retention data, research initiatives, and publications and presentations. After 10 years, the six schools of nursing remain active participants in the partnership.
The alliance was acknowledged by the AACN-AONE in October 2014 for “Exemplary Academic–Practice Partnership.” In addition, the VA recognized NERVANA with a Network Directors I CARE award in January 2017 for their efforts in expanding the education of nursing students by building and sustaining academic affiliations with the most prestigious nursing schools in the Boston metropolitan area.
In 2017, the partnership received the inaugural New Era for Academic Nursing award from the AACN in recognition of implanted strategies related to the “Advancing Healthcare Transformation: A New Era for Academic Nursing” (News from AACN, 2016) report.
Increase the Number of VA Staff Nurses to Serve in the Role of Faculty to Teach in Nursing Programs and NERVANA
In 2008, 17 nursing schools had affiliation agreements with the VA Boston, with a total of 603 affiliating nursing students. Of these 603 students, three VA clinically practicing staff nurses were participating as paid adjunct faculty. Of the 603 students, 244 were BSN undergraduates and 23 were graduate students; there were no doctoral students. In 2016, the total number of undergraduate clinical rotations at the VA Boston was 66 clinical groups at the Boston campus and 17 clinical groups at the Bedford campus. This increase in clinical rotations resulted in close to 900 nursing students providing care to Veterans. Of these groups, 45% of the clinical instructors are VA Boston staff nurses serving as adjunct faculty.
To prepare the staff nurses for the clinical teaching role, the academic–practice partnership has participated in a series of staff nurse development activities. Staff nurses are encouraged to attend a “Preceptor Workshop,” which is offered a minimum of three times per year. In this workshop, nurses are educated on issues related to clinical education, conflict management, and the evaluation process. The workshops are intended for any staff nurses working as a paid adjunct clinical faculty or a nurse residency preceptor or working with a nursing student during their preceptor experience. To date, more than 100 staff nurses have participated in the 8-hour workshop. Monthly preceptor development and support meetings are held. Any nurses who are currently precepting new employees or nursing students are encouraged to attend the monthly meetings to discuss any issues related to the role.
Another initiative in the development of staff nurses as educators is the “Growing as a Mentor” series. Biannually, the academic affiliates provide a continuing educational program related to nursing education. Topics have included emotional intelligence, Nurse of the Future Competencies (Massachusetts Department of Higher Education, 2010), cultural competence, reflective practice, evaluation process, and time management skills.
Create Novel Clinical Rotations Including Intraprofessional and Interprofessional Dedicated Education Units of a BSN Program and APN Rotations for MSN and DNP Students
Given the initiation of NERVANA, a plethora of DEUs have been established at the VA Boston Healthcare System. A DEU is an example of an academic–practice partnership designed to provide students with a positive clinical learning environment (Mulready-Shick & Flanagan, 2014). The goal is to maximize the learning outcomes not only of the students, but also of the practicing clinical nurses in the role of nurse instructor (Glynn, McVey, Wendt, & Russell, 2017). An interdisciplinary DEU and two senior Capstone DEUs have been established (McVey, Vessey, Kenner, & Pressler, 2014). DEUs have been implemented in long-term care units, transitional care units, and palliative care units.
A Commission on Collegiate Nursing Education-accredited nurse residency program has been implemented at the VA Boston Healthcare System, and in October 2016 was the first in the nation to have both the postbaccalaureate (federally funded) and transition-to-practice (employee-based) cohorts successfully accredited. NERVANA played a vital role in the success of the programs by collaborating with clinical preceptors, academic faculty, nurse scientists, and leadership to provide novice nurses with the tools necessary for successful transition to professional practice. Given the inception of the nurse residency program, 90% of participants have been hired within the VA Boston health care system, and the retention rate after 3 years is 83.3%.
A mental health nurse practitioner residency program was initiated in conjunction with Boston College in 2014. The 12-month program offers training, supervision, education, and mentorship that enables board-certified graduates of MSN psychiatric–mental health nursing programs to move from clinically prepared novices to proficient health care providers who can address the mental health needs of Veterans.
Establish a Culture for Evidence-Based Practice and Research Opportunities for Students and Staff Interested in the Care of Veterans Within the Academic–Practice Partnerships
With the addition of the nurse scientist role at the VA Boston Healthcare Systems, an increase in evidence-based practice and research initiatives have occurred. The VA currently has three PhD-prepared nurse scientists who are faculty members with the NERVANA schools, working with nurse residents and nursing staff on a variety of projects and research initiatives. Annually, the postbaccalaureate nurse residents participate in evidence-based practice and present projects on a scheduled research day. Staff nurses are working on research initiatives related to patient care issues, interprofessional collaboration, and nursing educational improvements. The results have been disseminated through publications and podium presentations at national and international nursing conferences.
Educate Students, Faculty, and the Community Regarding the Uniqueness of the Health Needs of the Veteran Population
In 2009, NERVANA implemented the Care of the Veteran Colloquia Series. Biannually, programs are available to all students, faculty, the private health care sector, and the community on issues related to the health care needs of the Veteran population. These free programs take place on the college campuses to provide information related to current Veteran health services. Continuing education credits are offered to nurses who attend. A total of 13 programs have occurred to date. Topics have included traumatic brain injury, spinal cord injury, posttraumatic stress disorder, Veteran homelessness, military sexual trauma, palliative care, and women Veteran health care issues.
Expand Programs at Partnering Schools to Address Health Care Issues Related to Veterans
In addition to the Care of the Veteran Colloquium series, Boston College has established a course offering related to Veteran health care issues. This course will be offered in the near future on campuses at several of the academic partners.
Translate Knowledge to Develop Best Practices for Veterans in All Health Care Settings
NERVANA augments the commitment of the VA Boston health care system in training health professions on the unique needs of Veterans. The NERVANA partnership is aware that not all nursing students will have a clinical rotation within the VA facilities. As many Veterans seek care in private sector organizations, NERVANA demonstrates a commitment to include private sector professionals who likely encounter Veterans in their care in a variety of educational programs. NERVANA, through programs and presentations, reports that the partnership has improved the knowledge of all nurses in providing high-quality, patient-centered care in all health care organizations.
After a review of the mission, strategic plan, and advisory committee minutes since NERVANA's inception, the academic–practice partnership has increased the number of clinical faculty, increased Veteran-centered publications, and provided a plethora of educational programs to increased knowledge of Veteran health care issues. The partnership has demonstrated sustainability and continues to fulfill its mission. This structured review confirms that the partnership has developed an innovative educational model to expand and enrich nursing students and faculty, to educate nursing students in the care of Veterans, and to expose nursing students and newly licensed RNs to the advanced model of medical informatics, patient safety, evidence-based practice, and integrated systems of care employed by the VA's National Healthcare System. The academic–practice partnership has expanded the number VA clinical staff nurses who teach in clinical settings and have implemented and enhanced the DEU model to include spinal cord injury units and long-term care.
Moving forward, the academic–practice partnership plans to continue to grow and expand the development of clinical faculty and adjunct academic appointments, continue educational programs related to the care of American Veterans, and sustain the nurse residency, and transition-to-practice, and mental health nurse practitioner programs. The partnership plans to continue exploring novel clinical rotations and nurse residency programs to include the perioperative and critical care settings. As the partnership enters its second decade, the original goals and mission have been reviewed by the steering committee, and NERVANA continues to provide an exemplar of an exceptional academic–practice partnership.
- American Association of Colleges of Nursing. (2016). Advancing health-care transformation: A new era for academic nursing. Retrieved from http://www.aacnnursing.org/portals/42/publications/aacn-new-era-report.pdf
- American Organization of Nurse Executives and American Association of Colleges of Nursing. (2012). AACN-AONE task force on academic practice partnerships. Retrieved from http://www.aone.org/resources/academic-practice-partnerships.pdf
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- Glynn, D.M., McVey, C., Wendt, J. & Russell, B. (2017). Dedicated educational nursing unit: Clinical instructors role perceptions and learning needs. Journal of Professional Nursing, 33, 108–112. doi:10.1016/j.profnurs.2016.08.005 [CrossRef]
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- McVey, C., Vessey, J.A., Kenner, C.A. & Pressler, J.L. (2014). Interprofessional dedicated education unit (IDEU): An academic practice partnership. Nurse Educator, 39, 153–154. doi:10.1097/NNE.0000000000000051 [CrossRef]
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- VA Office of Academic Affiliations. (2007). VA Nursing Academy: Enhancing academic partnerships [Working document]. Washington, DC: Author.