Advancing Nursing Workforce Strategy Through a Tiered Academic Partnership Model

Abstract

The discrepancy between the supply and demand of RNs creates pressure on nursing leaders to find innovative solutions to strengthen the nursing workforce and reduce new graduate nurses' time in orientation. In response, Memorial Hermann Health System leaders developed the Tiered Academic Partnership Model (TAPM). The model provides a strategic framework to align academic partnerships with health system nursing workforce priorities. The TAPM supports strategic, outcomes-driven partnerships between health systems and academic partners. TAPM categorizes partnerships into 3 tiers to optimize clinical placements, improve new graduate nurse readiness, and enhance conversion-to-hire rates. This scalable model fosters intentional collaboration, operational efficiency, and stronger workforce development.

The nursing workforce is evolving as health systems respond to the changing healthcare landscape. The demand for nurses continues to grow faster than the average of all other occupations, with nearly 200 000 openings for RNs annually.¹ The number of new graduate nurses (NGNs) is falling short of meeting the need.² Meanwhile, academic nursing programs rely on clinical placements to develop nursing skills and application of knowledge.³ Clinical placements are arranged with hospital or other provider partners and are targeted to align with course objectives.³ This model accomplishes academic program requirements but leaves many NGNs feeling unprepared to transition into a professional role and independently provide nursing care.⁴ Many health systems use 12-month nurse residency programs (NRPs) to support NGNs' transition to practice.⁵ However, the literature suggests NRP models do not fully meet the needs of new nurses or reduce high first-year turnover rates.⁵ As nursing workforce challenges intensify, health systems and academic partners must collaborate to develop innovative strategies to enhance skill attainment, improve transition to practice, and strengthen the supply of competent, confident nurses.^6,7

Impetus for Development

Partnerships between nursing schools and health systems are important to support NGNs and strengthen nursing practice.⁸ Effective partnerships develop intentional strategies with a shared vision and mutual goals.⁸ At Memorial Hermann, a large not-for-profit health system in Southeast Texas, nursing leaders closely examined their partnerships with over 200 academic programs. This effort revealed variations in student placement processes, administrative inefficiencies involved in the assignment of clinical units, and the lack of a shared framework to guide partnerships. Hospital-based student placement coordinators worked diligently to place student groups with few data or tools to prioritize requests across the system. The siloed work and lack of a unified placement strategy created a disconnect between resource utilization and workforce needs. In addition, the team identified academic programs securing but not using clinical placements, multiple requests to reschedule academic placements, and increased demand placed on unit staff nurses. Nursing leaders recognized the opportunity to more strategically align workforce goals and develop practice-ready nurses, within a new academic partnership model.

Tiered Academic Partnership Model

To address these challenges, chief nursing officers and leaders from Memorial Hermann's Institute for Nursing Excellence partnered with hiring managers, frontline nurses, student placement coordinators, nursing educators, and talent acquisition leaders to draft a new partnership model. A subset of the team had initial conversations with several deans to gain their insight. Based on their feedback, nursing leaders developed the Tiered Academic Partnership Model (TAPM), shown in Supplemental Digital Content 1, http://links.lww.com/JONA/B353, to reimagine academic partnerships aligned with health system priorities. This 3-tiered model defines highly aligned strategic partnerships, enhanced partnerships, and standard academic affiliation agreements. TAPM streamlines the student-to-employee pathway, standardizes placement processes, improves student experience, reduces administrative burden, and creates a more personalized transition to practice for NGNs. This evidence-informed model was designed to flexibly support academic institutions of all sizes and aligns with the American Association of Colleges of Nursing–American Organization for Nursing Leadership guiding principles on academic-practice partnerships.⁸

The new TAPM model provides a framework to develop outcomes-driven partnerships, emphasizing clinical readiness, conversion to hire, and return on investment for nursing programs and health systems. The model, shown in Figure 1, focuses on levels of alignment. At higher levels of alignment, tier 1 academic partners have priority clinical placements, joint research and authorship goals, and closer alignment through advisory board positions. Highly aligned tier 1 partners also leverage shared faculty positions and align competency validations to streamline skills-based learning for students and employees. Tier 2 academic partners have the next available clinical placements and have specialty program alignment. Tier 3 academic partners have clinical placement opportunities and student support based on historical practices. The model provides a structure for academic partners and health systems to formalize relationships based on mutual goals. These goals may include, but are not limited to, improved student centeredness, personalized transition to practice, and enhanced business efficiency. The model was designed to be flexible and adaptable to various academic partners and hospital needs, allowing for potential growth to higher tiers over time.

Figure 1.

TAPM Components. Final components and implementation are determined between the academic partner and the hospital.

Early Outcomes and Benefits

Initial outcomes following implementation have been promising. Initial student-to-new-hire conversion rates, increased by up to 80%, ranging between 90% and 100% for tier 1 partners and between 70% and 80% for tier 2 partners. New graduate RN orientation hours are more personalized and efficient as evidenced by a 4-week reduction in orientation time. The model has also supported improved campus coordination, streamlined clinical placement processes, and increased NGN retention rates by 8%. Hiring leaders reported NGNs from tier 1 partners exhibit better alignment with the hospital culture, familiarity with the hospital policies, and understanding of role expectations. Additional anticipated benefits include enhanced NGN competence and increased engagement.

Implications for Nursing Administration

The TAPM framework serves as a guide to develop highly aligned partnerships between academic institutions and health systems. The TAPM offers a scalable framework to enhance strategic alignment, workforce development, and operational efficiency. Health system leaders can use the model to create predictable and sustainable pathways of more practice-ready NGNs by aligning student clinical placements with organizational priorities. This model allows hospitals and health systems to optimize clinical placement opportunities, align with employer-driven workforce goals, and attain a return on investment related to clinical placements. Nursing leaders should consider adapting a similar model to meet their needs in building strategic partnerships with academic nursing programs.