Starting a Bedside Revolution
OU's College of Nursing is tackling the national nursing shortage head-on through innovation and collaboration.
Most people have a story about a nurse. They remember the nurse who helped them learn to care for their child or the gentleness and kindness of the nurse who helped them through a frightening time. They remain grateful for the nurse who filled in for loved ones when hospitals were closed to visitors during the COVID-19 pandemic.
“Today, nurses are one of the most sought-after professionals. They provide care in every possible health-care setting,” says Julie Hoff, Ph.D., MPH, RN, dean of the University of Oklahoma’s Fran and Earl Ziegler College of Nursing and interim chief nursing executive for OU Health, the clinical partner of the OU Health Sciences Center.
“Nurses comprise the largest workforce in health care, and they provide the majority of health-care services,” Hoff says. “They’re also the ones ensuring that the most essential needs of patients and families are met. But the profession is facing major challenges.”
Even before the arrival of COVID-19, most health-care organizations across the nation faced a significant shortage of nurses, and the stresses of the pandemic exacerbated the need, Hoff says. In Oklahoma, the situation is especially urgent. According to the Oklahoma Nurses Association, the state has 712 nurses per 100,000 residents, making Oklahoma 46th in the nation. Without an adequate number of registered nurses, access to health care decreases and the quality and safety of patient care declines.
However, challenging times also create opportunities for innovation, which is right where Hoff wants to be. Since her arrival on campus in 2020, she has been leading the charge to revolutionize academic nursing and to transform the profession while building a solid pipeline of nurses and advanced-practice registered nurses for the future.
“I’m working to bring nursing to the forefront. At times I feel like I’m waking a sleeping giant,” Hoff says. “Registered nurses and advanced-practice registered nurses are essential to advancing health outcomes. It’s my desire to leverage the OU College of Nursing and OU Health Nursing to be the beacon for nursing education, nursing practice and nursing research for Oklahoma and beyond.”
Hoff is spearheading numerous initiatives that aim to bring more people into the profession and to further the education of existing nurses who want to advance their skills.
Beginning this fall, the OU College of Nursing has accepted all qualified applicants—555 students compared to 225 in fall 2021—to its traditional Bachelor of Science in Nursing (BSN) program and the accelerated BSN program. In addition, the college has developed a partnership with Norman Regional Health System and Duncan Regional Hospital to support this enrollment expansion.
“Because we have such a shortage of nurses at all levels of practice, our priority must be to create the best path to increase the number of nurses, which is to support people where they are,” Hoff says. “Our programs in Duncan and Norman are for people who may not be able to leave their communities and come to our campuses in Oklahoma City and Tulsa. These partnership programs also serve as a recruitment and retention initiative—because those hospital systems are investing in them, it is highly likely they will remain there and serve their communities.”
A similar effort is underway in Lawton, Okla., where the McMahon Foundation is investing in local nurses by paying for tuition and time off work so individuals can complete a BSN or pursue an advanced nursing degree. In another effort, OU College of Nursing faculty are collaborating closely with Cameron University in Lawton to identify, coach and mentor students who aspire to be nurses.
Hoff believes that an educated nursing workforce is an empowered workforce. Most other health professionals enter the workplace with a master’s degree or higher, but many nurses begin practicing with a technical degree or associate degree. While they have the skills and knowledge to practice nursing effectively, she says, inequity in education and maturity often poses barriers for nurses to be equal members of the interdisciplinary care team. Studies also show that, for patients, higher nursing education is associated with lower risks of death and a greater ability to prevent health deterioration caused by complications during hospitalization.
In addition to nurses entering the profession, Hoff says Oklahoma also needs nurse faculty who can prepare the next generation of registered nurses, advanced-practice registered nurses, nurse leaders and nurse scholars.
“Often, preparing to teach at the college level requires a terminal degree, and the average age this occurs in nursing is 47—14 years later than the age of other disciplines.
“Last year in Oklahoma, only 43% of registered nurses entered practice with a bachelor’s degree. So, we can only pull from that 43% to help someone work toward an advanced-practice degree or to become faculty or a nurse scientist,” Hoff explains. “It would be great if we could fund baccalaureate nursing education so that every nurse could get a bachelor’s degree in four years, but we need other pathways so we can meet people where they are.”
Ryan Setzkorn, a nursing student on the OU-Tulsa campus, is coming to the profession on his own unique path. He worked as a paramedic for 20 years, including a stint on a helicopter ambulance, during which he was paired with a nurse. When the helicopter picked up patients who needed to go to the ICU, he was impressed by the nurse’s in-depth knowledge and saw the profession as a way to expand his skills and further his career.
During nursing school, he has continued to work as a paramedic at the Emergency Center at Hillcrest, where nurse turnover has been high during the pandemic and traveling nurses make up more than half of the staff.
“I see myself working in an ER or ICU setting,” Setzkorn says. “I thrive on providing patient care in those stressful environments. But we need more registered nurses. Nurses are the boots on the ground who make sure everything gets done. I’m glad that OU is educating more nurses, and hopefully many of them will stay local.”
The College of Nursing also is addressing the need for mental health providers in Oklahoma by launching the Psychiatric Mental Health Nurse Practitioner Program with two pathways: a doctor of nursing practice degree or a post-graduate certificate.
“In addition, the college must add to its faculty ranks to support the increased number of students in various programs,” Hoff says. New faculty members have been hired, particularly those with advanced-practice licensure and/or terminal degrees. She also is increasing the number of faculty who are active clinicians. Educators with first-hand experience in the current health-care environment help academic programs stay abreast of changes.
Such educators will have an additional resource for teaching in a future experiential learning center, being built through a $2 million private gift to the College of Nursing.
“The center will offer a variety of patient settings, giving student nurses opportunities to learn, practice and refine their nursing knowledge and skills in a high-tech, simulation-rich environment,” Hoff says. The College of Nursing also is building out 25,000 square feet of space at University Research Park in Oklahoma City to accommodate classrooms and an additional experiential learning space supporting increased enrollment.
Hoff’s mission to transform nursing is enhanced by the fact that she holds a very unusual position as both college dean and interim chief nursing executive for OU Health. The dual positions allow her to drive the integration of academic nursing with the OU Health nursing enterprise to improve the work environment for nurses and the associated patient experience. OU Health is investing $25 million in its nursing workforce, including pay increases and retention bonuses, and initiatives like OU Health Travel at Home, which gives nurses the option of being paid like a traveling nurse—receiving a higher hourly rate in lieu of a benefits package.
Another initiative, the OU Health Degree Accelerator Program, will advance health care by funding seamless academic progression pathways for OU Health registered nurses seeking an advanced degree.
“Participants will have the opportunity to further their career through coursework at the OU College of Nursing, fully supported by OU Health,” Hoff says.
She also led the creation of the Senior Nurse Intern Program, in which undergraduate senior nursing students work closely with registered nurses at OU Health’s three hospitals—OU Medical Center, Oklahoma Children’s Hospital and OU Health-Edmond Medical Center. Like interns in other fields, students are paid while completing their clinical rotations.
“This strengthens ties to the health system and fosters the transition to practice after graduation in a way that isn’t necessarily achieved in traditional education models,” Hoff says. “We’re finding that we’re retaining more OU College of Nursing graduates at OU Health hospitals, versus them getting their clinical education at OU Health and then choosing to take their first job elsewhere.”
Daniela Dial, BSN, RN, benefited from the Senior Nurse Intern Program, working in the emergency department at Edmond Medical Center, where she was hired after graduating. During her internship, she worked closely with paramedics and nurses and felt comfortable asking questions.
“I was able to build relationships and got to be very hands-on with the work,” she says. “One of the important areas where I gained experience was educating patients about their medications. I also practiced handing off patients to other departments. It was an amazing experience. And the fact that I got paid was a huge benefit.”
Despite the many challenges facing her profession, Hoff says she considers today the golden age of nursing and believes the key to transforming health care lies with registered nurses.
“We have to change the paradigm of how we think about nurses—either they are an organization’s greatest cost, or they are an organization’s greatest asset,” she says. “My goal is to make OU Nursing the place where nurses can ‘become’ over and over again to reach their full potential. I’m grateful for our partners’ courageous collaboration and willingness to advance nursing in Oklahoma.”
April Wilkerson is the editor of OU Medicine.
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