Like many other schools, the faculty of the University of Oklahoma College of Nursing (OUCN) recently revised its baccalaureate and master's curricula to prepare students better for the evolving changes in the nursing profession and the health care job market. Our personal visions of needed changes, reviews of the literature, and feedback from nursing leaders and community employers supported the need for four significant changes. First, students needed more experiences in the community and clients' homes, with the aged, the chronically ill, and the disabled in all age brackets. Second, students needed greater familiarity with Medicare, Medicaid, and managed care, and more active involvement in the wise use of limited resources. Third, they needed more experience with interdisciplinary teams and with the management of care across sites and levels of acuity. Fourth, there was a need for more consistent integration of health promotion and research content into student learning related to emerging trends in health care and nursing practice.
Agreement on these needs was relatively simple to achieve. The more difficult task was determining how appropriate experiences might be provided. Two fundamental barriers were identified. Among students, there was a preference for acute care settings and resistance to working outside the hospital, with the elderly and the chronically ill. Among faculty, there was a lack of experience in the community with these same populations and with managed care systems. Most importantly, within the community, there was a lack of sufficient practice sites with nursing role models and nursing control to provide the desired learning.
A possible solution to our problem came with the state's entry into managed care. In 1995, the Oklahoma legislature created the ADvantage program, a Medicaid-funded program providing home and community-based services to frail elders and adults over 21 with physical disabilities, to be managed by the Long Term Care Authority of Tulsa (LTCA). A core of faculty found the ADvantage program philosophy to be highly consistent with our nursing values and curricular needs:
* Involvement of clients in service planning.
* Interdisciplinary and multiagency collaboration.
* Health promotion as well as maintenance.
* Use of family and community resources as well as state funds.
* Separation of case management from provision of actual health care.
In September 1995, the College became an accredited case management provider to the Oklahoma ADvantage Program. Our goals were to provide a quality, visible, nursing service to Oklahomans; a needed form of faculty practice and learning; a nurse-controlled experience for future undergraduate and graduate education; a source of revenue for the College, and, eventually, a site for research, thus integrating the missions of the university. This is an account of our experiences in launching the program as a faculty commitment and our early impressions of its impact on faculty and students.
Background: The ADvantage Program of Oklahoma The goal of the ADvantage program is to assist clients with nursing home-level needs to remain in their homes in a cost-effective manner. To meet this goal, case management, skilled nursing, personal care, and homemaking services are provided, along with specialized medical equipment and supplies, prescription medications, home-delivered meals, environmental modification to make the home safe and accessible, adult day care, various therapies, and respite for family caregivers. Currently, there are six case management (CM) providers to ADvantage, including Eldercare, for-profit home health agencies, a community mental health center, and OUCN. We are the only provider based in a university, with all-RN case managers and with all RNs holding at least a master's degree.
Prospective case managers must undergo a five-day training program by LTCA staff. …