New Program Provides Pathways to Nursing Careers

With graduation just around the corner, one thing University of Maryland School of Nursing (UMSON) Bachelor of Science in Nursing (BSN) student John Vincent Adofina doesn’t have to worry about is the chaotic pressure of landing his first nursing job.

Thanks to the pilot Practicum to Practice Program, a partnership between UMSON and the University of Maryland Medical System (UMMS), Adofina knows this summer he will be reporting for duty on the Multitrauma Intermediate Care (MTIMC) unit on the fifth floor of the University of Maryland Medical Center (UMMC).

While his classmates are busily applying for jobs, Adofina said he has been focusing on his May 19 graduation and on preparing for his licensure exam. “It is a comfort knowing I already have a job waiting for me,” he adds.

The Practicum to Practice Program, also known as P3, provides a roadmap from UMSON’s senior practicum experience, required for all fourth-semester BSN students, to a registered nurse position at an UMMS hospital. P3 offers UMSON students an opportunity to select their senior practicum placement and first job as a nurse. 

To be eligible, students must be an UMSON entry-into-practice student in their final semester of study and maintain a cumulative GPA of 2.75 or greater. Qualified students interested in the program submit an online application that is reviewed by program leaders, complete an interview with the unit manager, and forrmally accept a nurse graduate position.

Upon accepting the position on a unit at an UMMS hospital, P3 participants complete their senior practicum on that unit. After graduation from UMSON, employment on that unit as a nurse graduate begins. Following successful completion of the NCLEX (National Council Licensure Examination) and licensure, the nurse transfers to a Clinical Nurse I position.

The P3 program launched with UMSON in January and has since expanded to Harford Community College. Program leaders are discussing expanding P3 into other schools of nursing.

Adofina took an interest in the P3 program as soon as he learned of it and excitedly applied last December, filling out a survey indicating the unit on which he wanted to complete his practicum.

“I wanted to join P3 because there’s a lot of randomization when it comes to the practicum placement process, and I felt like P3 enabled me to have a practicum spot that I knew I was going to work in in the future,” Adofina said. Having already worked as a student nurse in an acute care unit at the UMMC R Adams Cowley Shock Trauma Center, he requested placement on the MTIMC unit.

“I felt like the MTIMC would be a good starting point for a new grad nurse to see as many cool things as possible, and then eventually transition to the ICU,” said Adofina, who finished his practicum last month.

The program was the brainchild of Lisa Rowen, DNSc, MS ’86, RN, CENP, FAAN, chief nurse executive, UMMS, who was thinking of creative ways to address a national and statewide nursing shortage.

“We have a lot of open nursing positions, and it’s not just us,” she said. “There’s been a bit of an exodus of all health care workers out of hospitals, and nurses, in particular, have such a large number of opportunities outside of working in a hospital.”

During the COVID-19 pandemic, nurses across the country, including in Maryland, retired early, left hospitals to work for agencies and travel nurse companies, or decided to work in other types of community settings, Rowen said.

“A lot of opportunities have proliferated, not because of COVID, but in addition to what happened with COVID,” she said. “And so, there is a really big gap between what the state of Maryland needs, what the United States needs, and what is being produced at schools of nursing.”

As many as 1 million additional nurses will be needed by 2030, according to the federal Health Resources and Services Administration’s National Center for Health Workforce Analysis.

Given these challenges, Rowen said she began to consider how UMMS could encourage nursing students to begin exploring job placement opportunities prior to graduating and what UMMS could do to incentivize graduating students to consider employment at one of its hospitals.

Rowen said she knows that senior BSN students are eager to find a practicum placement and on-site experience that allows students to practice and refine nursing skills in preparation for joining the nursing workforce post-graduation. 

“They want a practicum placement that will meet their personal goals of what they want to learn about, and many of them already know what specialties they want to be in,” Rowen said. “For many of them, being in the right practicum sets them up to be in that specialty. I thought, ‘What could we do that would be a win-win for the student and the hospital, and a win for the School? What if we thought of a way to make the practicum experience the pathway to practice upon graduation? And if the nursing students had the option of selecting the practicum placement, rather than being placed by the faculty, would there be some nursing students who would be ready to commit to a job prior to practicum?’”

She discussed the idea with UMSON leadership, including Jane M. Kirschling, PhD, RN, FAAN, the Bill and Joanne Conway Dean of the University of Maryland School of Nursing; Maeve Howett, PhD, APRN, CPNP-PC, CNE, professor and associate dean of the baccalaureate program; and others who were immediately excited to get the P3 program up and running.

“It’s really a hiring strategy for the medical center, but at the same time, it’s a wonderful way for us to get students in clinical practicum slots that they would like,” Howett said. “It’s nice that P3 has expanded the units that students can do a practicum on and particularly units where they might want to work one day.”

Hospitals win by getting commitments from students early. By teaching students during the practicum, the amount of time required for onboarding them as new nurses can be decreased, Rowen added. Some UMSON faculty members have also told her that students can be distracted by their job searches by mid-semester. Getting a job offer up front, “it takes away all that stress and worry,” Rowen said.

Administrators at participating hospitals were eager to get the program kicked off, Rowen said. “They love the notion of getting early commitments and bringing students into the practicum experience where they can be immersed in the unit and the culture where they will be working as a clinical nurse upon graduation,” Rowen explained.

Chrissy McGee, MS, was Adofina’s preceptor, or mentor, on the unit. “He came in and was so eager to learn,” McGee said. “He was ready Day One, pedal to the metal. He did great.”

“I think the P3 program really does put these students in a good position, especially being on the unit and caring for the patient population that they are going to work with,” McGee said, noting Adofina offered to help his nursing colleagues at every turn and got along well with everyone. “I think it’s just a huge advantage, instead of walking into somewhere more blindly.”

For Adofina, his experience on the fifth floor fueled his confidence and made him even more eager to graduate than he already was.

“Everything went really well,” Adofina said. “I got exactly what I wanted out of it. I felt like I was well prepared to eventually work on that multitrauma unit after graduation. I felt like I got a good flow of the nurses there. They work well with each other. It made me feel at home. It also increased my confidence and made me look forward to graduation, knowing that once I take my NCLEX, there’s going to be a good team waiting for me that’s always willing to help me out.”