A State-University Collaboration to Improve State Hospital Nursing Care Oliver H. Osborne, R. Jalane Hagerott, Illa Hilliard, R.N., Mary
Durand
R.N., Ph.D. R.N., M.A. M.S.N.
Thomas,
R.N.,
Ph.D. Beginning in 1979, the department of psychosocial nursing at the Urnversity of Washington in Seattle entered a collaboration with the Washington State Division of Mental Health to improve nursing in the state’s two mental hospitals. This paper summarizes the development of the collaboration and describes its program components. Basis for collaboration The collaboration began in 1979 when a former faculty member of the department ofpsychiatry at the University of Washington was hired as director of the Washington State Division of Mental Health. She entered immediately into discussions with her former colleagues that resuited in a contract between the university and the state to improve the quality of nursing in the state hospitals (1,2). The meaning of “quality” was not defined, but it was agreed that the university would provide a variety of programs to increase the number of psychosocial nurses em-
Dr. Osborne is professor and Thomas is associate professor psychosocial nursing in School of Nursing, University Washington, Seattle, Washington 98195. Dr. Osborne is also junct professor of anthropology. Ms.
Hagerott
is director
ing at Western Fort Steilacoom, Hilliard
is director
Eastern
State Hospital Washington.
Lake,
1040
of
State Hospital Washington. of
Dr. of the of adnurs-
in Ms.
nursing
in Medical
at
ploycd in the hospitals and to raise their level ofeducation, clinical ability, and professionalism. The program budget was allocated from vacant hospital nursing positions and administered by the university’s departmcnt ofpsychosocial nursing. The hospitals involved are the 1,1 16-bed Western State Hospital, located in the Puget Sound region, a 60-minute drive from the university, and the 352-bed Eastern State Hospital, located across the Cascade Mountains, some 3 50 miles east of the university. The Division of Mental Health and the university’s department of psychiatry agreed that equivalent programs would be provided to each hospital. Program components The collaboration’s first venture was a series ofworkshops at the two state hospitals. Other program components developed over the past 12 years include graduate education for baccalaureate-degree nurses, opportunities for master’s-level nurses to become clinical faculty members, certification study groups, seminars, research projects, a fellowship program, conferences, and a communications program that produces brochures and a newsletter. The graduate program. One of the more challenging activities has been recruiting baccalaureate-degree nurses into graduate school. The collaboration first tried a state-sponsored tuition program in which participants agreed to work for a specifled time in a state hospital after graduation. The goal was to attract nurses with baccalaureate degrees to state hospitalemployment. This program did not thrive, and after three years it was discontinued. Even the neediest students resisted the requirement for state hospital employ-
October
1992
Vol.
43
No.
10
ment, which made them feel like indentured servants. Our experience suggests that a service payback strategy can work only ifprospectivc candidates see the service requirement as desirable. A more productive approach was developed to accommodate the needs of the growing number of baccalaureate nurses attracted to state hospital employment by the increased salaries made possible by improved state financing. These students are first enrolled in a graduate extension program, supported by the collaboration, in which they can earn credits toward their graduate degree. After successful participation in this program, they arc encouraged to enter the university’s master’s-dcgrcc program. Their tuition is funded by the collaboration. Clinical faculty. State hospital nurses with master’s degrees are invited to apply for clinical faculty status in the university’s department ofpsychiatry. Ordinarily, the nurses who apply for this status have previously worked with the faculty in several program components. Their application signals their readiness to commit significantly more time and effort to the collaboration. Seven state hospital nurses are currently members of the clinical faculty. They provide day-to-day program leadership. Their responsibilities include disseminating information about program activities and encouraging nurses’ participation, providing clinical consultations, engaging in joint staff-faculty research projects, offering seminars, and teaching undergraduate and graduate classes in their areas of cxpertise. Based on the needs of the hospitals, a clinical specialist from one hospital may act as consultant to the other. Seminars. Each fall the faculty and nursing staff leaders design a year-long seminar program. The seminars arc popular with both nursing staff and nonnurse professionals and paraprofessionals. Seminar prcsentations may be given by faculty members, clinical faculty members, or experts from the community who are paid consultants to the program.
Hospital
and Community
Psychiatry
Certification study groups. One means of developing nurses’ clinical expertise is to facilitate their certification as psychiatric-mental health nurse generalists or specialists. The collaboration encourages certification through resource materials and study groups that arc led by university faculty and state hospital clinical faculty. This program has been cxtremely successful. The numbers of certified nurses have increased, currently to nine at each hospital. The program is increasingly being managed by members of the clinical faculty. Research. Collaborative stafffaculty research projects arc designed and implemented to further nurses’ training in research design and methods and to increase knowledge about nursing practice in state hospitals. Two projects focusing on intrahospital relocation of state hospitab patients have been completed, and their results have been published (3,4). Other research projects arc in progress. Fellowships. In 1 990 a state hospital nursing fellowship program designed to develop advanced management and clinical leadership skills was initiated. This program encourages the exchange of nurses between hospitals and provides opportunitics for nurses from other state hospital systems to study aspects of the Washington system. Conferences. The successes of the collaboration
provided
the
stimulus
for a 1986 conference on the changing role of nurses in state hospitals (5). In 1990 the collaboration sponsored the first national conference on public-sector psychosocial nursing in institutions (6). It was designed to identify the unique features of psychosocial nursing in the public sector and specify its research, education, and clinical practice parameters. A second national conference on public-sector nursing, focusing on empowerment, was held in 1992. Communications. A major difficulty confronting the collaboration has been maintaining communication between the administrators the Division of Mental Health, pital superintendents, nursing
Hospital
and
Community
Psychiatry
of hosser-
vice directors, clinical faculty, the many nurses on each shift at each hospital, and faculty of the university’s department of psychosocial nursing faculty. The primary communication tools used during the early years of the program were memos, letters, telephone calls, and hospital newsletters. As the program became more complex, a brochure describing all program components
Study
of both the and successes of the collaboration has revealed that the most effective activities have been those that help individual nurses surmount barriers to their professional development. failures
invidious
their they has
place treat. Analysis indicated
public
of work
stereotypes
and
of program that
their
the
about
patients
components most
impor-
tant effect has been to facilitate nurses’ interaction with each other and with faculty members, clinical specialists, nurses in other hospitals, hospital directors and supenintendents, graduate students, and a wide variety of other professional groups. This social intercourse has been the most potent tool of change for the state hospital nurses participating in the collaboration. The new and challenging experiences offered by the program have stimulated the nurses’ intellect, sense ofadventure, and selfconfidence. Their heightened joic de vivre and increasing tendency to see their specialty as exciting have been highly important, albeit serendipitous, results of the collaboration.
References was developed and distributed to all nurses. An occasional newsletter was developed to keep staff updated on program events. Once a year the directors of nunsing services and clinical faculty from each hospital, department of psychosocial nursing faculty, and representatives of the State Division of Mental Health attend a two-day meeting at a site midway between the two hospitals. Participants share information about their hospital and community, discuss past and future collaboration activities, meet with state hospital and community mental health leaders, develop professional relationships, solve difficult clinical problems, dispel false rumors, and work to improve intraand interhospital communications. Conclusions Study of both the failures and the successes of the collaboration has revealed that the most effective activities have been those that help mdividual nurses surmount barriers to their professional development. The barriers include those created by different work shifts, entrenched status differences, real and imagined restrictions on nurses’ behavior, and
October
1992
Vol.
43
No.
10
1 . Thomas MD: Improving state psychiatric hospital nursing care: the Washington cxperience, in the Coanging Role of Nurses in State Hospitals: Problems and Solutions. Edited by Davis M, Sanchez M. Boulder, Cob, Western Interstate Commission on Higher Education, 1987 2. Osborne OH: State hospital university nursing collaboration, in The Changing Role of the State Hospital. Edited by Sanchez M, Davis M. Boulder, Cob, Western Interstate Commission on Higher Education, 1987
3. Thomas
MD, Ekland EE, Griffin M, et al: Intrahospital relocation ofpsychiatric patients and the effects on aggression. Archives ofPsychiatric Nursing 4:154-160, 1990 4. Osborne OH, Murphy H, Leichman 55, et al: Forced relocation of hospitalized psychiatric patients. Archives of Psychiatric Nursing 4:221-227, 1990
5. Davis M, Sanchez
M: The Changing Role of Nurses in State Hospitals: Problems and Solutions. Boulder, Cob, Western Interstate Commission on Higher Education, 1987
6. Public-Sector Nursing (special issue). Journal ofPsychosocial Nursing and Mental Health Services, vol 29, no 8, 1991
1041
Durand
R.N., Ph.D. R.N., M.A. M.S.N.
Thomas,
R.N.,
Ph.D. Beginning in 1979, the department of psychosocial nursing at the Urnversity of Washington in Seattle entered a collaboration with the Washington State Division of Mental Health to improve nursing in the state’s two mental hospitals. This paper summarizes the development of the collaboration and describes its program components. Basis for collaboration The collaboration began in 1979 when a former faculty member of the department ofpsychiatry at the University of Washington was hired as director of the Washington State Division of Mental Health. She entered immediately into discussions with her former colleagues that resuited in a contract between the university and the state to improve the quality of nursing in the state hospitals (1,2). The meaning of “quality” was not defined, but it was agreed that the university would provide a variety of programs to increase the number of psychosocial nurses em-
Dr. Osborne is professor and Thomas is associate professor psychosocial nursing in School of Nursing, University Washington, Seattle, Washington 98195. Dr. Osborne is also junct professor of anthropology. Ms.
Hagerott
is director
ing at Western Fort Steilacoom, Hilliard
is director
Eastern
State Hospital Washington.
Lake,
1040
of
State Hospital Washington. of
Dr. of the of adnurs-
in Ms.
nursing
in Medical
at
ploycd in the hospitals and to raise their level ofeducation, clinical ability, and professionalism. The program budget was allocated from vacant hospital nursing positions and administered by the university’s departmcnt ofpsychosocial nursing. The hospitals involved are the 1,1 16-bed Western State Hospital, located in the Puget Sound region, a 60-minute drive from the university, and the 352-bed Eastern State Hospital, located across the Cascade Mountains, some 3 50 miles east of the university. The Division of Mental Health and the university’s department of psychiatry agreed that equivalent programs would be provided to each hospital. Program components The collaboration’s first venture was a series ofworkshops at the two state hospitals. Other program components developed over the past 12 years include graduate education for baccalaureate-degree nurses, opportunities for master’s-level nurses to become clinical faculty members, certification study groups, seminars, research projects, a fellowship program, conferences, and a communications program that produces brochures and a newsletter. The graduate program. One of the more challenging activities has been recruiting baccalaureate-degree nurses into graduate school. The collaboration first tried a state-sponsored tuition program in which participants agreed to work for a specifled time in a state hospital after graduation. The goal was to attract nurses with baccalaureate degrees to state hospitalemployment. This program did not thrive, and after three years it was discontinued. Even the neediest students resisted the requirement for state hospital employ-
October
1992
Vol.
43
No.
10
ment, which made them feel like indentured servants. Our experience suggests that a service payback strategy can work only ifprospectivc candidates see the service requirement as desirable. A more productive approach was developed to accommodate the needs of the growing number of baccalaureate nurses attracted to state hospital employment by the increased salaries made possible by improved state financing. These students are first enrolled in a graduate extension program, supported by the collaboration, in which they can earn credits toward their graduate degree. After successful participation in this program, they arc encouraged to enter the university’s master’s-dcgrcc program. Their tuition is funded by the collaboration. Clinical faculty. State hospital nurses with master’s degrees are invited to apply for clinical faculty status in the university’s department ofpsychiatry. Ordinarily, the nurses who apply for this status have previously worked with the faculty in several program components. Their application signals their readiness to commit significantly more time and effort to the collaboration. Seven state hospital nurses are currently members of the clinical faculty. They provide day-to-day program leadership. Their responsibilities include disseminating information about program activities and encouraging nurses’ participation, providing clinical consultations, engaging in joint staff-faculty research projects, offering seminars, and teaching undergraduate and graduate classes in their areas of cxpertise. Based on the needs of the hospitals, a clinical specialist from one hospital may act as consultant to the other. Seminars. Each fall the faculty and nursing staff leaders design a year-long seminar program. The seminars arc popular with both nursing staff and nonnurse professionals and paraprofessionals. Seminar prcsentations may be given by faculty members, clinical faculty members, or experts from the community who are paid consultants to the program.
Hospital
and Community
Psychiatry
Certification study groups. One means of developing nurses’ clinical expertise is to facilitate their certification as psychiatric-mental health nurse generalists or specialists. The collaboration encourages certification through resource materials and study groups that arc led by university faculty and state hospital clinical faculty. This program has been cxtremely successful. The numbers of certified nurses have increased, currently to nine at each hospital. The program is increasingly being managed by members of the clinical faculty. Research. Collaborative stafffaculty research projects arc designed and implemented to further nurses’ training in research design and methods and to increase knowledge about nursing practice in state hospitals. Two projects focusing on intrahospital relocation of state hospitab patients have been completed, and their results have been published (3,4). Other research projects arc in progress. Fellowships. In 1 990 a state hospital nursing fellowship program designed to develop advanced management and clinical leadership skills was initiated. This program encourages the exchange of nurses between hospitals and provides opportunitics for nurses from other state hospital systems to study aspects of the Washington system. Conferences. The successes of the collaboration
provided
the
stimulus
for a 1986 conference on the changing role of nurses in state hospitals (5). In 1990 the collaboration sponsored the first national conference on public-sector psychosocial nursing in institutions (6). It was designed to identify the unique features of psychosocial nursing in the public sector and specify its research, education, and clinical practice parameters. A second national conference on public-sector nursing, focusing on empowerment, was held in 1992. Communications. A major difficulty confronting the collaboration has been maintaining communication between the administrators the Division of Mental Health, pital superintendents, nursing
Hospital
and
Community
Psychiatry
of hosser-
vice directors, clinical faculty, the many nurses on each shift at each hospital, and faculty of the university’s department of psychosocial nursing faculty. The primary communication tools used during the early years of the program were memos, letters, telephone calls, and hospital newsletters. As the program became more complex, a brochure describing all program components
Study
of both the and successes of the collaboration has revealed that the most effective activities have been those that help individual nurses surmount barriers to their professional development. failures
invidious
their they has
place treat. Analysis indicated
public
of work
stereotypes
and
of program that
their
the
about
patients
components most
impor-
tant effect has been to facilitate nurses’ interaction with each other and with faculty members, clinical specialists, nurses in other hospitals, hospital directors and supenintendents, graduate students, and a wide variety of other professional groups. This social intercourse has been the most potent tool of change for the state hospital nurses participating in the collaboration. The new and challenging experiences offered by the program have stimulated the nurses’ intellect, sense ofadventure, and selfconfidence. Their heightened joic de vivre and increasing tendency to see their specialty as exciting have been highly important, albeit serendipitous, results of the collaboration.
References was developed and distributed to all nurses. An occasional newsletter was developed to keep staff updated on program events. Once a year the directors of nunsing services and clinical faculty from each hospital, department of psychosocial nursing faculty, and representatives of the State Division of Mental Health attend a two-day meeting at a site midway between the two hospitals. Participants share information about their hospital and community, discuss past and future collaboration activities, meet with state hospital and community mental health leaders, develop professional relationships, solve difficult clinical problems, dispel false rumors, and work to improve intraand interhospital communications. Conclusions Study of both the failures and the successes of the collaboration has revealed that the most effective activities have been those that help mdividual nurses surmount barriers to their professional development. The barriers include those created by different work shifts, entrenched status differences, real and imagined restrictions on nurses’ behavior, and
October
1992
Vol.
43
No.
10
1 . Thomas MD: Improving state psychiatric hospital nursing care: the Washington cxperience, in the Coanging Role of Nurses in State Hospitals: Problems and Solutions. Edited by Davis M, Sanchez M. Boulder, Cob, Western Interstate Commission on Higher Education, 1987 2. Osborne OH: State hospital university nursing collaboration, in The Changing Role of the State Hospital. Edited by Sanchez M, Davis M. Boulder, Cob, Western Interstate Commission on Higher Education, 1987
3. Thomas
MD, Ekland EE, Griffin M, et al: Intrahospital relocation ofpsychiatric patients and the effects on aggression. Archives ofPsychiatric Nursing 4:154-160, 1990 4. Osborne OH, Murphy H, Leichman 55, et al: Forced relocation of hospitalized psychiatric patients. Archives of Psychiatric Nursing 4:221-227, 1990
5. Davis M, Sanchez
M: The Changing Role of Nurses in State Hospitals: Problems and Solutions. Boulder, Cob, Western Interstate Commission on Higher Education, 1987
6. Public-Sector Nursing (special issue). Journal ofPsychosocial Nursing and Mental Health Services, vol 29, no 8, 1991
1041
