Lessons Learned

Overall SWIFT Nurse Educator Project

Project Length

  • Although the SWIFT project proposal submitted to the U.S. Department of Labor (DOL) was for a three-year project, the project was funded for only two years – from July 2005 through June 2007. Because the development of the partnerships and recruitment of nurse educator candidates proved to be complex and lengthy processes, in July 2006, a one-year no-cost extension of the project through June 2008 was requested and granted by the Department of Labor. The project activity timeline was also revised at this time to include the new projected timelines for activities. The funding was then spread over three years to complete the project.

Transition of SWIFT Graduates to Nursing Education Employment:

  • The health care system is undergoing constant change, making it extremely difficult to sustain implementation of long term programs and strategies. One example of this is the significant organizational changes implemented in one of the sponsoring large hospital employers during the SWIFT project. These caused in changes in clinical program strategies and structures and resulted in the loss of clinical nurse specialist positions within the hospital. Positions for nurse practitioners (NPs) were expanded, but nurse practitioners are not the best candidates for joint appointment teacher/practitioner positions because of the nature of NP jobs, which are more akin to physician roles rather than general nursing roles. NPs are better suited to positions in graduate education for advanced practice rather than those in pre-licensure education. The result of these organizational changes was that the employer was unable to fulfill earlier promises to the SWIFT candidates that there would be clinical nurse specialist positions for those candidates upon their achievement of their master’s degrees. Many of those candidates left the hospital for other employment, and we have been unable to contact them to find out whether any of them have sought part-time teaching roles in their new positions.

Master's Education for Nurse Educators

Streamlining Graduate Curricula

  • One of the objectives in the proposal was to revise the curricula in the UW nursing programs as appropriate to maximize the potential for accelerated progression through the graduate curricula. One of the first steps of the Educational Strategies Workgroup was to examine this objective and determine how to accomplish it. Since curricular revisions in graduate nursing programs are constrained by university and accrediting agency standards and requirements, it was determined that streamlining the process of acquiring a master’s degree involves actions on the part of the three stakeholders involved in the SWIFT project – the nursing schools, the students, and the sponsoring employers.
    • The schools were continually engaged in looking at their graduate programs to ensure that the courses were sequenced and formatted (online vs. classroom) in a manner that facilitates efficient progression. Core required courses were generally available in blocks and/or during evening hours to promote efficiency.
    • The schools focused on skilled advising for SWIFT candidates, especially for those who needed to acquire a BSN before they could be accepted into the graduate program. With proper advising, the time it takes to get a baccalaureate degree can be reduced considerably. Skilled advising was also essential for graduate students to help them select appropriate course loads each semester to balance the demands of school, work, and family.
    • Students needed to be willing to enroll in their programs on a full-time basis. This ensured the swiftest progress from initial enrollment to graduation. There was considerable data that students who progress on a part-time basis may lose momentum and never finish, and those who do complete their degrees are frustrated by the length of time they struggled to get the degree.
    • The SWIFT employers were not only committing to tuition support, but to paid time off during the school year. This time allowed the students to successfully balance the demand mentioned above. Also the employers intended to work with local Workforce Development Boards (WDBs) to find additional financial support for those candidates who need it.
    • Both employers and prospective candidates responded positively to this approach regarding “fast-tracking” the educational process. They understood that curriculum requirements are based on external standards and cannot be eliminated to make the programs shorter or easier. They also understood that taking a full load of courses every semester was difficult, but it leads to a greater likelihood of success that the degree will be completed. Finally, they appreciated the difference the paid time-off makes in the ability to maintain full-time status. As demonstrated by the group of employers participating in the SWIFT Initiative, employers were willing to provide this additional benefit of paid time-off in order to support employees who want to become nurse educators.

Nurse Practitioner Education for SWIFT Candidates

  • All of the four UW nursing programs offered master’s degrees preparing candidates for clinical nurse specialist and nurse practitioner roles (advanced practice), and three of the four programs had tracks for a focus in nursing education as well. However, SWIFT students who chose to prepare for nurse practitioner (NP) roles do not get any education courses in the normal course plan for NPs. Both the UW nursing programs and the participating SWIFT employers believed that SWIFT candidates need to take education courses during their study for their master’s degrees, so the Educational Strategies Work Group reviewed the graduate level education courses available on each campus and recommended that SWIFT candidates take six to nine credits in courses that would assist them to function effectively as teachers in schools of nursing.

Recruiting Employer Sponsors

Marketing Strategies

  • In marketing the SWIFT program to prospective employers and to the potential candidates themselves, face-to-face meetings and discussions worked better than mail or telephone communication. In many ways, the concepts of the SWIFT program needed to be “sold” to employers and potential nurse educators because the issue of the nurse educator shortage does not affect them in their daily lives, unless there is an acute general nursing workforce shortage going on. Most employers and potential candidates thought the central concepts of the SWIFT program (employers sponsoring employees to pursue their master’s degrees full-time; and cooperation between employers and nursing programs to allow the candidates to work in both practice and educator roles) were great ideas. However, these were great ideas that took quite a bit of effort to actually implement, so effective salesmanship was essential to ensure meaningful participation in this program.
    • Although most employers who learned about SWIFT expressed interest in becoming a sponsor of at least one employee, the majority of these did not follow through with a commitment to the program. This was largely due to the hectic pace of the health care delivery world, where multiple urgent priorities are being juggled every day. It appeared to be important that a representative of the SWIFT Initiative establish a relationship with a key leader in these uncommitted employers and continue to encourage them to take the next steps to becoming a sponsoring employer. This encouragement needed to take several forms, including phone calls, e-mails, and face-to-face meetings. Face-to- face meetings were probably the most effective, but it was also the most time-consuming. It was helpful to establish and implement a schedule of follow-up contacts.
    • The smallest employer participating as a SWIFT sponsor was licensed for 321 beds, and despite vigorous marketing, there were no long-term care employers who participated. Employers were expected to contribute both tuition support and paid time off for their SWIFT candidates, and those with fewer resources and/or unstable financial situations were simply unable to participate.

Recruiting SWIFT Candidates

General Recruitment Issues

  • The recruitment of candidates through sponsor employers was one of the primary challenges in this program. Health care employers are constantly engaged in complex day-to-day operations, managing crises, and implementing strategic changes. The processes involved in deciding to commit significant resources to support SWIFT candidates and to develop and implement recruitment strategies for their employees were not difficult, but they were time-consuming. Employers struggled to find staff who could devote time and energy to these processes. The SWIFT project staff developed and distributed the necessary tools to assist employers with the processes, but the employers still had to carry them out. So with most employers, making the initial decision to sponsor SWIFT candidates and the subsequent recruitment of those candidates was very slow, and the lack of momentum in these processes often led to failure to achieve them.

Processes for Recruiting and Selecting SWIFT Candidates

  • The SWIFT candidate selection process was developed by the Employer Strategies Work Group and ratified by the Educational Strategies Work Group and the UW nursing program advisors. It reflected the complex process between the employers and UW nursing programs that is essential to selecting the candidates who will be supported throughout their master’s education by the employers. Challenges and resolutions related to this process include the following:
    • Timetables for candidate recruitment and selection needed to be coordinated between employers and the local UW nursing programs where the candidates applied to graduate school. Some programs admitted twice a year to the graduate school; some admitted only once a year; and candidates with associate degrees could be admitted to the RN to BSN to Master’s program at various times throughout the year. Employers needed to time their recruitment activities so that candidates would be able to apply to the program they needed on a timely basis, and they needed to include significant information about the applications processes in their recruitment activities.

Recruiting Non-Nurses or Nurses without Baccalaureate Degrees as SWIFT Candidates

  • In the proposal funded by the U.S. Department of Labor the timeline of proposed activities contained strategies to recruit a number of SWIFT candidates who were non-nurses with baccalaureate degrees in other fields. These strategies were included because during the acute nursing shortage in Wisconsin in 2002-2004 there was increasing interest among health care employers and the state workforce initiatives to make a nursing career available to non-nurses. Direct-entry master’s nursing programs (DEM) had proven to be a viable way to attract candidates to nursing who already had degrees in other fields. Since there are many employees in health care who possess baccalaureate degrees, it seemed logical to target this population to become educated as master’s-prepared nurses and nurse educators under the sponsorship of their employers. In addition the initial direct-entry master’s programs had recently opened in Wisconsin, and it seemed to be a good way to recruit students into these programs. However, the Employer and Educational Strategies Work Groups disagreed with this strategy, primarily because both groups believed that newly prepared nurses were not experienced enough to be effective nurse educators, despite their additional graduate education. As a consequence it was decided not target non-nurses to become SWIFT candidates.
  • In a similar vein, the proposal targeted the recruitment of nurses with associate degrees to become nurse educators. Again, the Employer and Educational Strategies Work Groups believed there ought to be equal emphasis on recruiting nurses with baccalaureate degrees in nursing, and the strategy of targeting nurses with specific educational backgrounds was abandoned.
    Minority Candidate Recruitment:
  • Another project objective was to recruit candidates from ethnic minority backgrounds totaling 20% of the total candidates recruited as SWIFT Nurse Educators. The liaison from one of the larger employers reported it was that agency’s intent to solicit only minority candidates for SWIFT support, but this was not possible to implement. The agency’s legal department advised the human resources and nursing departments that they had to communicate the opportunity to become a SWIFT candidate to all qualified employees, not just those categorized as minorities. Other employers have received the same advice from their legal departments, so it was recommended to all employers that they plan for a broad advertisement of the SWIFT program. Their stated selection criteria should not focus on minority status, although there could be a statements encouraging minorities to apply.

Successful Candidate Recruitment Required Role Models:

  • There were some employers who agreed to support SWIFT candidates, but they were unable to find nurses among their staff who were motivated to return to school and advance their education. The nursing culture within those organizations appeared to be a primary reason why the nurses seemed to be uninterested in furthering their education. Social and peer support are major factors in determining human behavior, especially when people are making decisions about difficult endeavors. If there are no other nurses in a given environment with master’s degrees, and the nurses in that environment are not exposed to nurses with advanced degrees in other areas, such as professional meetings, it is likely those nurses will not be very interested in returning to school, even if inducements are offered.
    • Although culture in a given work environment is not easy to change, it can and will change fairly rapidly if there are external demands, such as accrediting and regulatory agencies, that exert influence to change. Hospitals staffed almost exclusively with Associate Degree graduates can transform their nursing staff to 60-70% Baccalaureate Degree graduates within 5 years when they are motivated to achieve Magnet accreditation. In addition, once nurses with advanced degrees are hired to improve practice outcomes, more nurses will seek advanced degrees because they witness the value of additional education.
    • What can be learned from this is to first focus on recruiting employer partners who have a number of master’s prepared nurses, ideally some of who teach part-time. Advancing nursing education should be a dominant value in the cultures within these employers. In such environments, it was relatively easy to recruit SWIFT candidates. Our examples of this included all of our partner employers.

Factors Related to Candidate Success in Completing the Master’s Degree or Teaching Certification

  • Out of the 66 candidates recruited to either complete the Health Professional Education Certificate or a master’s degree in nursing, 37 have actually completed their program and an additional 12 candidates are still on track to complete their degrees within the next year. Assuming that all 12 actually do complete their degrees, this is a success rate of 74%. Out of the multiple factors involved in why people did not complete the program, two major reasons stood out. Several candidates could not manage the intensity of working and going to school full-time, despite the paid time off from their employer. This occurred primarily with nurses in supervisory or managerial positions or nurses who had not been in school for at least 10 years. The second reason was that some candidates left their jobs with the sponsoring employer, and when that happened they were dropped from the program. It is interesting to note that most of the master’s degree candidates who left the SWIFT program actually did complete their degrees, often by dropping to a part-time status as a student.

Developing and Maintaining Partnerships

  • The success of this initiative was dependent upon complex partnerships among health care employers, nursing schools, and workforce initiatives at both the state and local levels. Establishing these partnerships was key to recruiting and motivating employers to support SWIFT candidates, locating and supporting individuals to become nurse educators, and developing workable arrangements for nurses to work as both educators and practitioners with their employers. Although we had considerable success in establishing partnerships between employers and nursing schools, we were less successful in developing partnerships with the Workforce Development Boards (WDBs). In hindsight, a plan for workforce development input and roles in supporting the SWIFT program should have been aggressively developed in the beginning. Observations about the barriers to the partnership development process with both prospective employer sponsors and WDBs are noted below:
    • Often the initial contact with prospective employers or WDBs resulted in a positive indication they were considering becoming involved in the SWIFT project, and the individual contacted from that organization offered to provide feedback to the SWIFT representative at a later date. This step was often where the process came to a halt. When a prospective partner was really not interested in becoming a SWIFT partner, nothing is heard from them again, even when SWIFT staff pursue a response by e-mail and/or telephone contact. This behavior is probably typical of organizational dynamics, and is not a significant barrier to partnership.
    • The real challenge occurred when there was a verbal agreement from the prospective employer or workforce partner that did want to participate in SWIFT, and next steps in the process were defined, including who will do what and by when. Lack of follow-through on these next steps frequently occurred at the beginning of the partnership process, when the relationship was new and tenuous. The commitment to partner was at its weakest point, and one or both parties involved did not carry out what they said they would do within the defined time period. Employer or workforce initiative representatives were more likely to falter at this step of the process, but the SWIFT representatives also engaged in this behavior at times .
    • If there is sufficient follow-through after the stage of initial decision-making to participate in the SWIFT program, the partnership strengthens and is likely to become successful. “Sufficient” follow-through does not require that every defined next step, including timing, has to occur as initially planned, but that key next steps do occur and communication between the responsible parties flows well without significant interruptions.
    • Overcoming the barrier of lack of follow-through was the real challenge. In today’s world most organizations and their well-meaning employees often are overwhelmed with competing demands and too many expectations. It is extremely difficult to define a set of priorities and stay focused on them. What we learned was how to set up a schedule of reminders that follow-though on specific action items had not occurred. The nature of these reminders needed to be progressive in candor and intensity. Initial reminders were gently phrased, but when these were ignored for a period of time (no longer than a month), there needed to be an attempt to have a frank discussion about the factors that were causing the delay. One of the biggest frustrations in this area was total silence from the other responsible party when communication about follow-through is attempted. Clearly, there is no communication if only one party is communicating. Lack of response could have been interpreted as a desire to end the attempt to establish a partnership, but that probably would have been giving up too early. A better technique wasa voice-mail and/or e-mail message to the effect of “I’ve left you several messages lately about X, and you haven’t responded. Have you been receiving my messages? Is there a better way to get in touch with you? Can I make telephone or face-to-face appointment with you?”
    • Thus, lack of follow-through seemed to be a primary barrier to the establishment of effective partnerships. It took creativity, persistence, and discipline to find ways to establish workable communication pathways with responsible parties from potential partners. Once good communication was developed, the parties involved appear to be more motivated to follow through on planned next steps to actualize the partnership. It was easy to get discouraged and distracted. It was best to approach this challenge with a positive attitude that most potential partners were interested in working with the SWIFT project and to remember their lack of responsiveness was not personal.
    • Another barrier appeared to be the significant mission and cultural differences among the prospective partners. During a discussion of the challenges related to employer sponsor recruitment at the Steering Committee meeting, the WDB representatives asked why they hadn’t been contacted to assist with the work of regular contact with employers who indicated they wanted to be sponsors, but were not actively working on recruiting candidates. That question led to an in-depth discussion about how the SWIFT staff and WDB representatives should be working together. It was recognized that the business frameworks and cultures of the education programs, employers, and WDBs were quite different, and we needed to develop explicit strategies about how best to work together to achieve common goals. It was relatively easy for the SWIFT staff to develop productive partnerships with health care employers and other educational institutions because we shared common business frameworks and cultures.

A Summary Statement about Effective Partnerships:

  • Although the SWIFT initiative team had decades of experience in developing successful collaborations, it became clear within the first year that the process of establishing academic community partnerships was extremely complex and time consuming. Additional insights about the partnership process were gained by studying the attached article from the Harvard Business Review entitled “Simple Rule for Making Alliances Work” (Hughes & Weiss, 2007). This article clarifies the framework and mutual expectations that result in successful alliances, or partnerships, between business entities. Rather than focusing on structural arrangements between partners, such as management systems and structures and defined outcomes, the business entities should focus on process elements, including working relationships and managing internal stakeholders involved the in partnership. Focusing on process elements such as relationships is time-consuming and difficult – more difficult than establishing contracts and metrics for measuring outcomes. In the SWIFT project partnerships between the project and health care employers often failed to come to fruition because neither side put enough resources into developing the relationships, and those partnerships that were established succeeded because the relationships among the principle participants were strong before the project even started. The principles developed in the article seem to bear out in the real world work of establishing effective partnerships and should be used in future programs that depend on alliances and partnerships.