Call of Duty
MINNESOTA NATIVE AND FORMER OLYMPIC CURLING competitor Courtney George MAOT’13 didn’t have to look far for a top graduate program in occupational therapy. “I heard a lot of good things about St. Kate’s,” says George. “It was the only school I wanted to apply to, and I was grateful to get in.”
One complex hurdle, however, in getting students like George from the classroom to graduation to a decent job is the required hands-on experience they need in clinical or fieldwork education. Between a growing demand for healthcare programs, and increased pressure on the professionals already working in the field, those clinical placements are both more essential and harder to come by.
As one of the region’s premier healthcare educators, St. Catherine, typically, isn’t sitting still.
The University’s Henrietta Schmoll School of Health currently offers 32 healthcare programs at a range of degree levels, from certificate to clinical doctorate. Almost all require some level of clinical or fieldwork hours, from about 200 up to the 2,400 hours that the Master of Physician Assistant Studies demands.
St. Kate’s has taken proactive steps to centralize and streamline clinical placement procedures. “We now have a formalized process to make the connection with various sites and secure the clinical affiliation agreements,” says Associate Dean Rebecca McGill, Ed.D., RN, M’79, MAOL’94, whose position as director of clinical education and practice was created in 2011. And a database — aptly named E-Value© — is being implemented to track and coordinate clinical placements.
Alumnae often are key in making clinical placements happen, whether through major health system partnerships — like Allina, Fairview, HealthEast, HealthPartners and North Memorial Medical Center — or small independent clinics, schools or community organizations such as People Serving People.
George, for example, secured half of the required 1,040 clinical hours for her MAOT through alumna Cynthia McCoy, OTR/L, SP’87, MAOL Cert’03, occupational therapy supervisor at Woodwinds Health Campus in Woodbury, Minnesota.
In addition, the Henrietta Schmoll School of Health advisory committee, launched in 2007 along with the school, fosters communication with healthcare leaders who work for a variety of the University’s clinical and community partners.
Although their titles vary — “preceptors” in nursing, “clinical instructors” in physical therapy, “fieldwork instructors” in social work and occupational therapy — real-world educators play an essential role in healthcare workforce development.
Working two years in the nursing float pool at United Hospital, Tricia Borg MANU’13 experienced a little bit of everything — primary care, neurology, orthopedics, medical-surgical. She likes working with geriatric patients the most — from the life stories they share to the complex medical challenges that keep her on her toes. That’s why she chose to pursue her master’s in nursing at St. Kate’s with a focus on gerontology as a nurse practitioner.
Borg had 600 clinical hours to clock in various specialties, including internal medicine, dermatology, gastroenterology, neurology, pain management and geriatrics. She also had the added pressure of completing the hours — at five different sites — during a pregnancy.
She ended up quitting work so she could focus on school full time and finish her clinical hours before the baby arrived.
Most of the 2,100 St. Kate’s students who complete clinical fieldwork at St. Kate’s each year get their placements through the Henrietta Schmoll School of Health — meaning they essentially compete with one another for some of the same placements at surrounding healthcare organizations.
An alumnus opened a door for Borg at the Park Nicollet clinic in Burnsville. “I’ll always take St. Kate’s students,” says Clint Swenson, RN, ANP/CNP, MANU ’01. “I went there. I know how difficult it is to place students in clinicals. I feel it’s my responsibility to give back.”
The presence of students can take patients by surprise — a delicate situation for healthcare professionals. “We’re not like a teaching hospital where you would expect to see students,” says Joanne Votel SP’78, MD, FACOG, a physician in Partners Obstetrics & Gynecology in Maplewood. “Sometimes our patients express some concerns about that, which slows down the flow,” she explains.
But the independent clinic will continue to provide clinical hours for St. Kate’s students. “I love to teach,” Votel says. “I’ve done it in many dimensions over the years.”
How do hospitals and clinics balance the resources required to take on students with the day-to-day reality of operating their institutions? Conversely, faced with the growing demand for capable, trained professionals, how can they afford not to?
“It is our professional responsibility to mentor the next generation of workers for our profession. That’s just a steadfast value of all healthcare,” says Heather Froehlich, RN, senior learning and development specialist for Allina.
Serving as a clinical site also builds a ready workforce pipeline. “It’s like having a 100-hour interview with a prospective employee,” Froehlich adds. “Are they a good fit? Do we like them? Do they like us? We both get to kick the tires.”
Concerns about productivity often are cited as a reason to turn down or step back from accepting students for clinical placements — even from the University’s longtime partners. “They’re facing a constant pressure of seeing patients and dealing with volume,” says St. Kate’s McGill. “Students at the beginning of their programs take more time to teach while those at the end require less supervision.”
For Swenson, a busy practitioner who averages 20 patients a day, it boils down to planning. He schedules students so they shadow him with alternating patients and limits their interac- tions with routine physicals or other common health issues.
“I try to ensure that they cover something they haven’t addressed before,” he says. “If it’s an overly complex patient, I want students to become familiar with someone who has 15 different issues going on.”
Meg Erlandson MPT’96, DPT’07, NCS, CBIS is a clinical educator at Courage Kenny Rehabilitation Institute, part of Allina Health. She has been heavily involved with St. Kate’s Integrated Clinical Education (ICE) program since its inception in 2003.
The nationally known program exposes first-year Doctor of Physical Therapy students to clinical settings with the ultimate goal of having them ready to work when it’s time to clock their clinical hours. Erlandson calls them “more attractive prospects” than students from other schools.
Students in clinical or fieldwork placements function sometimes as an extra pair of hands. Lisa Borneman MSW’92, LICSW is clinical services supervisor for YouthLink, a drop-in community center in Minneapolis for homeless teens. Demand for services is unpredictable, and the social work students help lighten the staff’s load when the center is busy. “The benefits totally outweigh the investment of time,” Borneman says.
Learning is a two-way street in healthcare settings, just as it is in St. Kate’s classrooms and labs. “It’s basically like a four-hour oral exam,” Erlandson says. “The students ask questions, they are observing, so it makes me very thoughtful about how and why I am going to provide a certain type of treatment. I think I am a better clinician because of that.”
Students can be resources for the latest trends and techniques. “They bring you the cutting-edge research, the newest theories that they’re learning, what’s new in the field,” says McCoy, the OT supervisor at Woodwinds. “We professionals learn as much as they do.”
That drives innovation in the healthcare industry, argues Penelope Moyers, Ed.D., OT, BCMH, FAOTA, dean of the Henrietta Schmoll School of Health. “There are things that we learn in academia sooner, and there are things that practice learns and knows sooner. You have to put the two together,” Moyers says.
In 2009, Fairview Health Services and St. Catherine University developed a “primary partner” relationship that is proving to benefit both institutions.
Laura Beeth, system director, talent acquisition at Fairview, calls it a “deep relationship” based on shared values. “It stems from having great preceptors, bridging education to practice, and working together to develop programs, research and grants,” she says. “We have adjunct faculty contracts, and we’ve typically been part of St. Kate’s accreditation process.”
Last summer and fall alone, 589 prelicensure nursing students from St. Kate’s clocked 17,462 hours at five different Fairview hospitals. In addition to offering prelicensure and graduate-level nursing clinicals, the Fairview partnership provided placements for 23 other healthcare programs offered by St. Kate’s.
The trust and shared knowledge benefit all concerned — not least of all the patients. But efficiency is part of such partnerships, too.
Each student in a clinical placement — whether it’s for 16 or 600 hours — must go through what the industry terms “on-boarding,” a process that can be as extensive as the mandates for a new hire. Students are required to have a background check. Training in patient confidentiality, patient safety and electronic medical records often is involved.
Onboarding makes sense from a patient safety point of view, but it is proving a disincentive for healthcare systems to accept students for shorter clinical stints.
“We both win if those clinical experiences are longer and deeper instead of these short little ones,” says Fairview’s Beeth. “They are expensive to manage and coordinate, and you can’t get much done in that time.”
A partner of St. Kate’s for over two decades, Allina is piloting an additional project this year specifically with the nurse practitioner program. Ten students from the incoming cohort will do all of their clinical experiences at Allina. “Obviously, we hope to be hiring them at the end of their degree," says Froehlich, the senior learning and development specialist for Allina.
The old school of thought said that "varied experiences" at a number of healthcare providers gave students more well-rounded experiences, she explains. But local healthcare systems have grown so large that the argument no longer holds true.
"Our clinic down in Northfield and our hospital up in Cambridge may have similar policies, but the cultures within the clinics and hospitals throughout our system are so varied that you are going to see different ways to do things," Froehlich says.
Although it's too early to gauge the full impact of the Affordable Care Act on the healthcare industry, one steadfast truth is that change is inevitable — and collaborative partnerships that benefit student, provider and patient alike are imperative.
“Our job at St. Kate’s is to continue to think of creative ways to work with our partners,” says McGill, “always with the intent of having practice-ready professionals in a variety of healthcare disciplines. We don’t do that alone.
You can help
Interested in offering your expertise as a preceptor, clinical instructor or fieldwork instructor?
Contact Associate Dean Rebecca McGill at 651.690.7763 or email@example.com.
By the numbers
Clinical placements are a massive project each year for the 32 programs in the Henrietta Schmoll School of Health. The annual effort involves:
5,000 clinical or fieldwork placements
500 sites (150 of which are outside Minnesota)
Over the course of their education, these 2,150 students in the Henrietta Schmoll School of Health will clock over 1.2 million clinical or fieldwork hours.
"We professionals learn as much as they do."
— Cynthia McCoy SP'87, MAOL CERT'03