When Alison Gilbert '09, RN, was in the eighth grade, she started experiencing terrible pain in her left leg. Her doctor assumed she had broken her fibula and put her in a cast for a few months, but the pain didn't go away, and she was hospitalized. While her doctors were flummoxed, Gilbert's nurse suspected she was suffering from osteomyelitis, a bone infection. “She fought tooth and nail for me to get all these tests,” recalls Gilbert. “And it turned out the nurse had been right all along.” Gilbert was transferred to Dartmouth-Hitchcock Medical Center (DHMC), where she underwent an emergency operation for an infection in her left fibula. That's when Gilbert decided to become a nurse. Years later, when she was accepted to Colby-Sawyer, she was pleasantly surprised to find that her college had a close connection with Dartmouth-Hitchcock Medical Center, the hospital where she was born and the hospital that successfully treated her bone infection.
A Healthy History
DHMC is New Hampshire's only academic medical center and, with over 7,000 employees, the state's largest employer. Colby- Sawyer's history with DHMC started in 1980, when the Mary Hitchcock Memorial Hospital School of Nursing closed its doors in response to changing nursing education across the country. The president and head of nursing at Mary Hitchcock, which is a member of DHMC, sought out an institution of higher learning that would be willing to take responsibility for nursing education, and the choice was Colby-Sawyer.
The new Colby-Sawyer nursing program opened in 1981 and was affiliated closely with DHMC. “Because it's an academic medical center, part of DHMC's stated mission is the education of future professionals,” explains Susan Reeves '88, Ed.D., RN, and chair of the Department of Nursing at Colby-Sawyer. “So you'll find that people who work at the medical center understand that inherent in their job is teaching others.”
In 2009 the college revitalized its affiliation with DHMC; now, DHMC considers the Colby-Sawyer curriculum its own undergraduate nursing program. “With that affiliation,” Reeves says, “came the responsibility to work very closely and collaboratively with DHMC around issues of workforce development, making sure that the Colby-Sawyer nursing curriculum was infused with the types of knowledge that DHMC was going to look for graduates to have when they came into practice.”
This relationship has made it possible for Colby-Sawyer to hire some of DHMC's nurses on a contract basis to teach at the college. These nurses work half the time at Colby-Sawyer and the other half with their units at DHMC. Normally, there's a step-down in pay from hospital to college, but DHMC agreed to hold the nurses' salaries steady while they teach at Colby-Sawyer—what they call the “faculty float pool.” That means there's no downside to educating Colby-Sawyer's nursing students—and in return, they get about 12 new graduates yearly who have significantly lower orientation time than graduates who didn't work with DHMC.
True Partners
Colby-Sawyer's Nursing Program is a combination of three kinds of teaching: classroom, laboratory and clinical. The majority of the classroom teaching occurs at Colby-Sawyer, the lab teaching is split between the college and DHMC, and the clinical education happens at DHMC, where nurses at the bedside work closely with student nurses from their sophomore year to their senior spring semester.
Colby-Sawyer nursing students have many opportunities to gain actual clinical work experience through internships, externships (between the junior and senior year), and preceptorships (during the spring semester of the senior year) at DHMC. These programs not only teach Colby-Sawyer students to become excellent nurses—they can also help them form a clear idea of what specific area of nursing they would like to pursue as a career. “When I had my first day at the labor and delivery unit [for a preceptorship], I said, wow, this must be what they're talking about when they say you'll find what you love in nursing,” says Sandra Guglielmi '10, RN, whose job in that unit started in July. “I knew when I began that rotation I did not want to leave. I've become addicted to it.”
Colby-Sawyer nursing students appreciate the fact that the DHMC staff they work with see them as true partners. “I've heard from the students that when they come here my nurses treat them like equals. They ask them questions. They engage them in the process,” says Donna Brown, RN, BSN, MHA, and the nursing director for Medical Specialties at DHMC. “Yes, the students are learners, but the nurses really support them in their independence, and in their ability to practice to the extent that they are able to under the license of the college.”
Medical Manikins
How can Colby-Sawyer or DHMC give student nurses the chance to practice on a patient who's in respiratory distress or having a cardiac arrest? It's not as though they can send a nursing student in to train on real patients who are in emergency medical situations. That's why DHMC has a simulation lab equipped with lifelike manikins that can be remotely controlled to present various symptoms; the lab is used by Colby- Sawyer students as well as other students and hospital staff.
These are no department store dummies: their pupils dilate, their chests rise and fall with their breathing, and their heartbeats can be projected onto a cardiac monitor. They gush real blood. New symptoms appear in the manikins depending on how the students react to the situation. The lab has pregnant woman manikins and infant manikins, as well as adult manikins. The room where the students learn looks like a typical hospital room and is fitted with the same equipment.
Simulation labs like the one at DHMC are becoming popular because there are so many nursing students, but so few opportunities for them to get practice, according to Renee Vebell, RN, MA, who serves as learning resource manager and assistant professor in the Department of Nursing at Colby- Sawyer. Some schools of nursing are using simulations for up to 25 percent of clinical time.
At DHMC, the students' interactions in the lab are videotaped, and then the instructors debrief the students to let them know what they did right and what they could do better. Students used to go through just one simulation, but DHMC suggested adding a second one. “They said to me, 'Do you want to schedule a second simulation immediately after so they can use what they learned?'” says Vebell. “So the students switch roles and do it again.” Students take turns playing the nurse and the patient's family. “You get to see a different side of it, not knowing what's going on and seeing how someone else works with the situation—as well as being the person who has to handle the situation and keep family members informed,” says Sandra Guglielmi.
The DHMC Simulation Lab gives Colby-Sawyer nursing students the chance to take their learning from the classroom to the hospital room, where they learn how to apply their training in real-life environments with buzzing monitors and frantic family members. “Doing the simulation definitely gives you an adrenaline rush—to actually see it happen and try to go through all the information you have in your mind and get it out as fast as possible,” says Rachael Smith '10, RN. “It's a challenge and it's absolutely exhilarating at the same time.”
On the Job
Thirty-six Colby-Sawyer students have been hired by DHMC in recent years, thanks in part to the close relationship they developed with the hospital's staff during their studies. “Our students are highly sought after, and that's just logical,” says Reeves. “They spent two-and-a-half years, and sometimes externships and preceptorships, embedded in the organization.” A graduate who comes to DHMC from another university has a much steeper learning curve than a student from Colby-Sawyer who has already worked with the staff on the floor.
Take Rachael Smith '10, RN: she did her preceptorship and externship at DHMC and landed a job in the in-patient surgery unit that began after her graduation. She says that because she had already worked with the people who interviewed her for the job, the interviewers had plenty of time to see her strengths and how well she functioned on the floor. According to Reeves, the employers were anxious to scoop up Smith — who not only excelled during her preceptorship and externship, but also won an award at the Alpha Chi National College Honor Society's Super-Regional Convention for her paper in the category of health.
The Healing Circle
Having Colby-Sawyer nursing students at DHMC is good for the students—but it also benefits the hospital and its patients. “Research, education and clinical practice are part of our mission, so we have not only nursing students but also medical students and respiratory therapy students and physical therapy students,” explains Ellen Ceppetelli RN, MS, CNL, director of Nursing Education at DHMC. “One of the things about coming to a hospital like ours is that you will have more students than you would have in a regular community hospital— but we think it's beneficial because the students are here with their faculty, who are educated in the latest things that are going on.”
“During their time at DHMC, nursing students learn not just nursing basics, but also important skills like time management and prioritization,” says Smith. “There were so many things that needed to be done and you had to figure out what needed to come first,” she recalls.
“Occasionally patients are taken aback when they're confronted with a student nurse,” says Guglielmi, “but the Colby- Sawyer faculty members teach students another important skill: how to build relationships with their patients. Even the most reticent patients wind up being appreciative because nursing students have more time for one-on-one patient interaction than working nurses do with their busy schedules.”
From College to Hospital
Nurses who study at Colby- Sawyer and DHMC have a healthy leg up on other graduates when it comes to not only finding a fulfilling nursing career, but also being the best nurse for their patients. Says Smith, “I think Colby- Sawyer nursing has provided great opportunities for me; it has helped in terms of the nurse that I'm going to be.”
Article by Linda Formichelli. Photos by Gil Talbot. This article first appeared in the Summer 2010 Colby-Sawyer Alumni Magazine.
