By Melinda Young

EXECUTIVE SUMMARY

Health systems and their case management or population health departments could benefit from providing student nurses with clinical experience opportunities, such as calling complex care patients for follow-up.

  • Nursing students, following a script aimed at assessing social determinants of health, contacted the high-risk patients of UC San Diego Health.
  • The students learned about population health and developed listening skills.

When the COVID-19 pandemic hit California in early 2020, many regular opportunities for nursing students to gain clinical experience were put on hold. A health system devised a program that benefited both students and an elderly population followed under a population health program.1

“When COVID hit, we knew that students were being pulled from acute care sites,” says Eileen Haley, MSN, RN, CNS, CCM, director of population health at UC San Diego Health. “Since they could no longer be at the hospital, I reached out to nursing education, and someone asked if we could offer a curriculum that would allow nursing students to get clinical hours to graduate on time. We worry about the long-term supply of nurses. An assembly bill passed, saying that as long as the curriculum met certain standards, they would allow us to take students and offer them this work.”

In April 2020, the Board of Registered Nursing approved the health system’s plan for a computer-assisted, phone-based wellness outreach program. The clinical work brought students on site five days a week, taking COVID-19 precautions.

A study revealed 93% of nursing students believed the rotation was applicable to their clinical practice. Eight-two percent reported this was their first time performing phone outreach. Also, 91% of students said they believed the experience made them more comfortable and better prepared to speak with patients on a nursing level.1

“We were excited,” Haley says. “Students helped us reach out to patients — elder seniors who were high-risk based on their risk stratification score and the electronic health record.”

Patients are admitted to this wellness program with a general risk score of 11 or higher. The scoring is the UC San Diego Health metric built into the electronic health record. It accounts for risk factors including frequent emergency department visits, age, comorbidities, and hospital utilization.

Nursing students followed a script aimed at assessing patients’ social determinants of health, such as their medication supply. “Did they have food? Were they doing OK at home?” Haley says. “There were four to five questions.”

The nursing students received training on population health, social determinants of health, evidence-based patient outcomes, and the importance of medication management. They also received daily education and rounding with an onsite instructor, a dedicated population health registered nurse, and social work support.

Initially, nursing students found this work challenging. “What this did was allow them to look at things through the population health lens, using telehealth and connecting with patients and listening to them,” Haley says. “If they found any patients who had insecurities or barriers, those patients were escalated to our complex case management team.”

The health system’s complex case management program for ambulatory team-based care started in 2016 after a shift to value-based care. “When patients are discharged, they go into a black hole, and it’s up to family care doctors to understand this patient population,” Haley explains. “This program created the area of case management from a medical and social lens and getting primary care physicians to shift their thinking into a more holistic approach with the care plan.”

The nursing students started to contact patients in April 2020. They received clinical hours for their work, which entailed one day a week, for about 10 days over a semester. A dozen students were on site each day. “We set up space that had been vacated, and it had 70 cubicles in this space,” Haley says.

The students were separated due to COVID-19 distancing guidelines. Instructors also worked and trained in the space. “We make sure didactic training dovetails with the syllabus the instructors put out,” Haley says.

Students documented the information they collected in patients’ medical records, allowing case managers and providers to identify patterns. If a problem requires help from a social worker or someone else, the student can keep the patient on the phone and ask the social worker to join the call. For example, if a student calls a patient who expresses thoughts of potentially harming him- or herself, the student flags the instructor, who calls the social worker.

“It’s a very controlled environment,” she says. “The students’ questions are evidence-based, and they’re documented in the electronic record and statistical software so we have some data showing the value of the program.”

The health system pays for the program — mostly equipment costs and instruction — through its population health department.

REFERENCE

  1. Haley E, Harris V, Agnihotri P, et al. COVID-19: A unique opportunity for population health to align with nursing schools to help vulnerable populations at risk of adverse outcomes. Clin J Nurs Care Pract 2021;5:001-002.