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The Nightingale Experience: A community service collaboration between a Magnet® hospital and nursing program

Curl, Eileen Deges PhD, RN, CNE, ANEF; Hale, Regina PhD, RN, CNE; Wilsker, Donna MSN, RN; Guidroz, Paul MSN, RN; Price, Tammy BSN, RN, CCRN

doi: 10.1097/01.NUMA.0000512508.47324.25
Feature: Magnet(R) Excellence

This community service collaboration between a Magnet® hospital and nursing program fosters an interest in nursing as a career in high school students.

At the Lamar University JoAnne Gay Dishman School of Nursing in Beaumont, Tex., Eileen Deges Curl is a professor and director of research, Regina Hale is an assistant professor and director of recruitment and retention, and Donna Wilsker is an assistant professor and coordinator of community-based service learning. At CHRISTUS Southeast Texas in Beaumont, Tex., Paul Guidroz is the chief nurse executive and Tammy Price is a director and nurse recruiter.

The authors have disclosed no financial relationships related to this article.

Hospitals seeking or maintaining Magnet® recognition share a common interest in partnering with local nursing programs and providing community service.1 Nursing programs with national accreditation by the Commission on Collegiate Nursing Education or the Accreditation Commission for Education in Nursing also need to collaborate with communities of interest. We share a collaborative Nightingale Experience (NE) initiative that hospitals and nursing programs can implement to meet community service outcomes for national nursing program accreditation and Magnet recognition.

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Collaboration is key

Partnerships between academic institutions and healthcare agencies can satisfy mutual goals.2 Lamar University's JoAnne Gay Dishman School of Nursing (SON), CHRISTUS Southeast Texas St. Elizabeth and St. Mary Hospital, and local school districts established a partnership in 2003 to implement the NE. Planning committee members included SON faculty, a hospital nurse recruiter, and a high school counselor. This partnership has been an ongoing success for 14 years (2003 to 2016), with plans to continue collaborating in the future.

The purpose of the NE is to recruit academically qualified high school students to healthcare-related occupations, such as the nursing profession. The Institute of Medicine's Future of Nursing report recommends that 80% of RNs have a bachelor of science in nursing (BSN) degree by the year 2020.3 The NE provides an opportunity to inform high school students why a BSN degree is recommended for those who choose nursing careers.

Because of the vigorous academic demands of nursing curricula, students planning to become RNs need to be academically strong to develop into competent nurses. The NE recruitment program targeting high school sophomores allows students the opportunity to strengthen their prerequisite knowledge while finishing their secondary school education. Completing a rigorous high school curriculum provides students with a stronger foundation for college nursing courses.4

High school counselors may have a significant influence on students' career choices.5 Consequently, nursing programs wishing to increase high school students' interest in nursing careers need to ensure that guidance counselors accurately understand the current roles and responsibilities of nurses, opportunities for employment, and importance of critical thinking and leadership skills for nurses.5 To actively engage counselors in recruitment efforts, the SON and CHRISTUS Southeast Texas sponsor an annual counselor luncheon. Each year, approximately 45 area high school sophomore counselors and their principals, within a 50-mile radius (1-hour travel time) from Lamar University, are invited to attend the luncheon.

During the spring luncheon, counselors are provided with current information about nursing career opportunities, the SON curriculum, and recommendations for advising high school students who intend to pursue a career in nursing. The luncheon provides an excellent opportunity to address counselors' questions and ensure that their perceptions about nursing are accurate. Counselors also tour the nursing building and learn about resources and new technology available in the SON. A video and scrapbook of students' activities during previous NE events are displayed.

Representatives from 15 to 18 high schools typically attend the luncheon where they're asked to nominate two to four students, completing their sophomore year of high school, to attend the NE. Counselors nominate students who demonstrate academic achievement, leadership, community involvement, extracurricular activities, and potential interest in pursuing a healthcare-related degree. High school sophomores are selected for the NE for two main reasons: they have an opportunity to strengthen their course selection in high school to enter college with a stronger theoretical foundation and they're typically more mature and serious about college and career choices compared with younger students.6 Grade point averages of participating NE students reflect strong academic performance, with a mean GPA of 3.53 on a 4.0 scale.

A faculty project manager serves as a liaison between CHRISTUS Southeast Texas and the SON. Dates for the counselor luncheon and the NE are mutually identified 5 to 7 months before the events. The NE is scheduled on a Friday and Saturday to increase the number of hospital clinical areas accessible for activities. A nurse representative from CHRISTUS Southeast Texas coordinates the NE for the hospital and collaborates with the faculty project manager. The NE is fully funded by CHRISTUS Southeast Texas, which allows the high school students to attend the 2-day event free of charge. Costs associated with the NE include dorm rooms, a chartered bus, meals, T-shirts, snacks, door prizes, and gifts.

The faculty project manager plans, organizes, and directs NE implementation. After receiving the counselors' nominations, the faculty project manager mails information packets and consent forms to the parents of the selected students, ensuring that all NE students have signed parental permission to participate, as well as photo and medical releases required by the university.

SON nursing students serve as group leaders for the high school students. Group leaders are chosen through an application process and selected based on their ability to effectively communicate and represent the nursing profession in a positive manner. In addition, the nursing students earn service learning hours for guiding the high school students during the NE.

The SON includes community-based service learning (CBSL) in its program philosophy and curriculum. CBSL is a valuable alternative educational strategy to assist students in achieving nursing program competencies. Real world experiences provide students with opportunities to employ critical thinking and clinical reasoning abilities through reflecting on their service learning experiences.7 At Lamar University, BSN students are required to accumulate 120 CBSL hours to meet student learning outcomes for the program. Promoting the nursing profession is one CBSL outcome that teaches nursing students to advocate for the future of the profession.

Frequently, nursing students have already accumulated their required service hours but apply to be group leaders because they enjoy working with high school students and being part of the NE. Current nursing students who participated in the NE while in high school are encouraged to serve as group leaders. So far, 23 previous NE participants have served as group leaders, experiencing the event as both a high school student and a nursing student.

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The main event

The NE is held early in the summer following the end of the high school academic year. (See Table 1.) When NE participants arrive on campus, they're greeted by nursing students who assist them through the registration process (such as verifying emergency contact information and receiving an event T-shirt) and escort them to their assigned dorm rooms. After registration is completed, high school students are placed in small groups of five to eight, with two nursing students per group who serve as group leaders. Groups are named after body parts: Group A is “aorta,” Group B is “brain,” Group C is “cervical spine,” and so on. Group leaders construct creative signs that represent their respective group names and carry the signs during the NE to guide their group. In addition, each group has a color, with every individual in the group receiving a bandana in the corresponding group color. Group members decide the manner in which they wear the bandanas (as a belt, on their arm, on their head) as a sign of group spirit and unity.

After registration, students walk from the dorms to the nursing building and break into three groups. The groups rotate through three stations: the skills lab, the high-fidelity simulation center, and a classroom discussion on nursing as a career. In the skills lab, students participate in giving injections, taking vital signs, inserting nasogastric tubes, measuring pulse oximetry, and starting I.V. catheters. Nursing students supervise skill stations in the learning center and guide participants in performing the skills on manikins. In the high-fidelity simulation center, faculty and senior nursing students lead the high school students in a labor and delivery simulation using the birthing simulator. The third station is held in a classroom and begins with icebreaker activities led by nursing students. Round table discussions on topics such as academic requirements, nursing as a profession, and career opportunities are facilitated by faculty members, hospital representatives, and nursing students. During this session, Florence Nightingale's contributions to nursing are discussed, introducing the high school students to nursing history and the namesake of the event. Following these activities, lunch is provided in the university dining hall. Eating in the dining hall with other college students gives participants a glimpse of college life.

After lunch, NE participants are transported 10 miles to CHRISTUS Southeast Texas St. Mary via a chartered bus. Hospital staff members greet and escort the high school students through six stations at each hospital facility. Nurse escorts wear colored bandanas matching their respective high school group. CHRISTUS Southeast Texas associates spend a great deal of time creating unique learning experiences in a variety of clinical areas. (See Table 2.) In addition, NE participants learn about pet partners, explore a life flight helicopter on the helipad, and practice changing a diaper on a baby manikin in an incubator.

Students return to the SON after the hospital experience and participate in entertaining activities that include a scavenger hunt, an obstacle course, and a “blindfolded bed making” contest. These action-packed activities are fun, entertaining, and further enhance group spirit and unity. After the SON activities, group leaders provide the high school students with a walking tour of the university campus as they return to the dorms.

Friday evening is spent preparing for and participating in a style show. Before the style show, groups are given scrub sets in their respective group color and asked to design a nursing uniform. Minimal craft materials are provided and students supplement their designs with various objects acquired during the day from the hospital (such as gloves, masks, syringes, biohazard bags, and disposable gowns). Students then model their creative designs in an entertaining fashion show. Nursing students judge the style show using criteria such as creativity, resourcefulness, comfort, and “bling.” The faculty project manager and nursing student group leaders spend the night at the dorms, serving as chaperones and enjoying the evening activities with the students.

Saturday morning, the NE participants travel 6 miles to CHRISTUS Southeast Texas St. Elizabeth to engage in learning experiences and be recognized with a certificate at a luncheon. Students return to the dorms by mid-afternoon where they're met by their parents. Group leaders and faculty members greet parents as they pick up their children and assist with luggage to ensure a pleasant departure. All high school students receive personalized handwritten notes from their group leaders thanking them for participating in the NE. In addition, the high school students are given an NE group picture taken after registration on the first day.

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High school student outcomes

Since its inception, 459 high school students have participated in the NE; 423 female students and 36 male students. A total of 37 high schools (public, private, and charter schools) and 3 home school families have nominated students to participate in the NE. High school students' written evaluations affirm that the NE introduces them to the real world of nursing and assists them in solidifying their interest in choosing nursing as a profession. NE participants (N = 379) responded very positively (averaging 4.32 on a 5-point Likert-type scale) when asked if this experience assisted them in choosing nursing as a career. In addition, students overwhelmingly asserted that they enjoy the NE and rated the overall event as 4.87 out of a possible 5.0. Comments such as “It made me think of all the different places I could work as a nurse” and “I loved being able to experience things nurses do!” indicate that the high school students view the NE as a positive and informative experience.

Survey data have been collected from 2008 to 2015 to explore the NE participants' interest in pursuing nursing and/or a healthcare-related profession. Lamar University Institutional Review Board approval and parental consent were obtained. Students (N = 263) rated their career interest using a Likert scale rating from 1 (not interested) to 5 (definite interest) before attending the NE and at the conclusion of the NE. Data were entered into a statistics software system and analyzed using a paired t test. Mean scores for each item were treated as interval data, thus meeting the criteria for parametric tests.8 Data analysis revealed a significant difference between high school students' interest in pursuing nursing as a profession before (M = 3.99, SD = .977) and at the conclusion of the NE (M = 4.22, SD = .879, t(262) = -4.861, P = .000).

In addition, there was also a significant difference between high school students' interest in pursuing a healthcare-related profession before (M = 4.52, SD = .641) and at the conclusion of the NE (M = 4.71, SD = .511, t(262) = -5.405, P = .000). These findings suggest that the NE is influential in assisting high school students to choose nursing or another healthcare-related profession as a career. As one participant stated, “After this experience, I'm even more excited about having a career in nursing.”

A theme throughout participants' evaluations was the valuable insights gained about nursing as a profession. With a more accurate portrayal of nursing, students became aware of the qualities and characteristics necessary to be a nurse. Comments such as “It showed me...how they [nurses] impact people's lives” and “After seeing what nurses do, I can see myself doing it” indicate the positive impression of nursing gained by the NE participants. Additionally, their perception of nursing was strengthened compared with images in the media. One student said the NE “...helped me understand the real job of a nurse and not just what I see on TV.” Finally, students who were interested in a healthcare-related profession may be assisted in choosing nursing as a result of attending the NE. For example, one student shared, “I already knew I wanted to be in the medical field, however, this experience showed me how rewarding being a nurse can be.” Another student said, “At first I wanted to be in the medical [area]. Not quite sure what. Now I feel like when I become a nurse, I would have made the right choice.”

One year after participating in the NE, surveys are mailed to the high school students. From 2003 to 2014, surveys were sent to 426 previous participants; 133 surveys were returned (31% return rate). Evaluation results indicated that 77% of the NE participants plan on pursuing a career in nursing and 89% plan on majoring in a healthcare-related field (medicine, physical therapy, or radiology). Of those intending to major in nursing, 84% reported that they planned to pursue a BSN degree, 13% planned to pursue an associate degree, and 3% planned to pursue vocational nursing. One hundred percent of students who planned on majoring in nursing reported that the NE was influential in their decision to choose nursing as a career.

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Nursing program outcomes

The NE results in positive outcomes for the SON. Media coverage by local TV stations and newspapers increases visibility of the SON. Faculty members continue to strengthen partnerships with the hospital and area high schools while planning and implementing the NE. Also, high school counselors become more knowledgeable about career opportunities in nursing and advising students in academic course selection during high school. This potentially increases students' knowledge about pursuing a nursing degree.

Another important component of the event includes the involvement of nursing students as group leaders. The faculty project manager works closely with current nursing students in assisting them to understand their role as group leaders and directing them in planning and implementing the various activities during the high school students' time on campus. Nursing students demonstrate organizational skills while facilitating the group process; participating in the NE assists nursing students in building leadership, communication, and organizational skills.

Nursing student evaluations collected from 2005 to 2015 (N = 195) revealed positive outcomes, rating the NE as 4.97 on a scale of 1 (lowest) to 5 (highest). Nursing students reported that participating in the NE was beneficial to them as a nursing student, with a mean score of 4.79 (1 = strongly disagree, 5 = strongly agree). Comments included “I had the chance to help other students discover their own path in nursing” and “It was actually a great learning experience for me as well. I got to see many different areas of nursing that I haven't really learned about yet.” These quotes illustrate the benefits perceived by nursing student group leaders.

Evaluations from the nursing student leaders indicated that they enjoyed interacting with the high school students and recognized that promoting nursing as a profession is a valuable aspect of the event. The highlight for one leader was “seeing the high school students' faces light up in the hospitals.” Student leaders also reported that a similar experience before entering nursing school would've reinforced their career choice. Comments by student leaders included “I would've loved it when I was in high school. I enjoyed it now and I'm in nursing school.” Another said, “I would've probably chosen nursing prior to [the] 3 years I spent on another major.” Finally, group leaders gained an understanding of their professional responsibility to recruit nurses for the future. One nursing student said, “I felt I was part of the future of nursing!”

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Hospital outcomes

The NE is beneficial to the sponsoring hospital in a variety of ways. Recruiting young people into the nursing profession is the most rewarding benefit perceived by the staff. During the NE, the hospital is able to recruit high school students and current nursing students as future employees. Physicians also respond positively to the collaborative effort and provide on-site teaching during the NE. Moreover, The Joint Commission and Magnet evaluators recognize the hospital's cosponsorship of the NE as an exemplary, unique, best practice of community partnership. Another benefit is the good will that the hospital has created in the community due to sponsoring the NE. Families and schools of participating students hold the hospital in high regard for offering this opportunity free of charge to students. Due to these positive outcomes, CHRISTUS Southeast Texas is committed to funding the NE in the future.

An unanticipated outcome is the “friendly” competition between the two hospital campuses and among units at each campus. Each hospital unit wants to have the best experience for students attending the NE. Although it's a cordial competition, each unit strives to “out do” the others, resulting in a positive team spirit. Nurses take great pride in displaying what's special and unique about their units. Also, the nurses enjoy interacting with students and helping promote the profession through this community-focused project.

One staff member stated that the NE “...benefits the hospital because the students are made more aware of what happens in hospital settings. This experience presents nursing in a fun and entertaining manner, and will hopefully encourage them into nursing.... I loved seeing their faces and expressions when they saw new things.” Another staff member said, “All too often, as nurses we would like to encourage the youth in our community to consider a career in the field of nursing, but rarely get the time [to do so]. ... The young students have really embraced this event and are truly interested in what the ‘day in a life of a nurse’ is really like. Every year seems to bring more energy and excitement from our associates, and we truly hope we may in some small way have changed the future career paths of these young men and women.”

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Partnering for the future

The NE is a successful, collaborative partnership that other nursing programs and hospitals can replicate to recruit the best and brightest students into nursing schools. High school students enjoy learning about nursing through the NE and hospitals can showcase their positive nursing work environment. Current nursing students participate as role models, enhancing the experience for the high school students. An important component for recruiting qualified students is having knowledgeable high school counselors who can advise students to enroll in classes that better prepare them for nursing school. Evaluation data suggest that the NE assists in solidifying participants' decision to choose nursing as a career. Ultimately, the NE enhances community-based collaboration, which assists the SON in meeting accreditation standards and the hospital in meeting Magnet requirements.

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REFERENCES

1. American Nurses Credentialing Center. Magnet model. http://www.nursecredentialing.org/Magnet/ProgramOverview/New-Magnet-Model#TransformationalLeadership.
2. American Association of Colleges of Nursing, American Organization of Nurse Executives. AACN-AONE task force on academic-practice partnerships: guiding principles. http://www.aacn.nche.edu/leading-initiatives/academic-practice-partnerships/GuidingPrinciples.pdf.
3. Institute of Medicine. Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2010.
4. National Association for College Admission Counseling. Policy brief: rigorous curriculum. https://http://www.nacacnet.org/globalassets/documents/advocacy-and-ethics/gr/rigorous-curriculum.pdf.
5. Bolan CM, Grainger P. What do high school guidance counselors really think of nursing. J Nurs Educ. 2005;44(3):135–138.
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8. Norman G. Likert scales, levels of measurement and the “laws” of statistics. Adv Health Sci Educ Theory Pract. 2010;15(5):625–632.
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