The following are examples of settings, areas of practice, and final projects that could be considered to provide a broader array of opportunities particularly in geographic areas with limited access to traditional practice sites. A project developed in any of these settings or areas of practice delineated here should include planning, implementation, and evaluation.
Organizational Systems Leadership
Work with the Director of the Red Cross exploring ways to improve disaster preparedness; Work with a director of system IT exploring the preparedness strategies to prevent an IT shutdown and strategies for communication and charting to continue during a shutdown, or focus on the nursing leadership role in leading IT design and implementation issues; Work with the System Safety Office evaluating the disaster plan incorporating national best practices and making recommendations for quality improvement of the system plan.
Partner with community organizations that affect the health of high risk populations to address screening or health education processes, financial challenges (including how to raise money and manage money), volunteerism, and interactions/ collaborative opportunities with the healthcare system. Examples of community agencies include: Habitat for Humanity, food pantries, Catholic Charities, homeless shelters, Salvation Army, and Hope Center. Other opportunities might include collaboration with private sector companies to design healthcare facilities, or design and implement wellness/health programs in conjunction with business such as the airline or auto industry.
Evaluate evidence to develop a policy to reduce major events that trigger an ED visit, e.g. by notifying a provider that a fall has occurred, document evidence of need for the policy change; Evaluate geriatric trauma screening for triage; make a recommendation for policy change to revise criteria.
Long-Term Care Facilities
Evaluate and implement a quality improvement program within a long-term care facility, e.g. Evercare or a Medicare Advantage plan, to improve antibiotic selection for symptomatic UTIs in older adults without indwelling catheters and to decrease the inappropriate use of nitrofurantoin. Implement a policy and care practice for antibiotic selection guided by the Infections Disease Society of America guidelines for treatment of UTIs.
Focus on achieving the national benchmark of urgent care visit times lasting less than 60 minutes, identifying and mitigating impediments to efficient patient flow at a Family Medicine Center Walk-in Clinic. Implement a quality improvement project to identify measure and rectify bottlenecks impacting patient flow through the clinic while tracking total visit times.
Explore the effectiveness of chronic disease management models and mental health services among the aging population in prison systems. Focus on the institution of mental health screening and care models to be integrated into the prison system of care.
Evaluate Tobacco Free Teens program as a mobile device application, introduce the mobile application in a middle school classroom and evaluate the adolescents’ satisfaction with the tool; other areas of focus may include evaluating immunizations, weight loss, and healthy eating.
Community-based Care Network
Implement a quality improvement project developed to address the gaps in APRN practice and evaluate the impact of a competency-based training program on the translation of evidence in the APRNs’ practice. Specific projects may include:
- Increase documentation of didactic training and skills validation for transvaginal ultrasounds and endometrial biopsy from 0% to 90%.
- Increase the number of APRNs who perform transvaginal cervical length measurement in the assessment of symptomatic preterm labor patients from less than 40% to 75%.
- Decrease the number of fetal fibronectin studies run without a corresponding cervical length measurement by 20%.
- Decrease the number of inadequate endometrial samples from the current 25% to less than 10% by X date.
- ncrease the percent of endometrial biopsies being done by APRNs in the region to greater than 50%.
Rural Native American Reservation
Form a working group with health department personnel to discuss and address the issues of health literacy and cultural sensitivity; Develop a case management model for more complex patients that includes the development of a cost sharing plan that proposes utilizing social workers from the senior center to coordinate this service and proposes to the community council the need to add a professional nurse FTE position to the clinic to help coordinate the effort of the social workers in ensuring regular follow up of patients; implement the use of community health workers as a means of further engaging the community and as a means of increasing follow-up visits.
Public Health Department
Collaborate with state government units to improve access to health care, negotiating tribal governance, gender issues, language, and culture in a population by training lay health promoters e.g. to improve the diet and access to fresh foods or providing zinc supplementation to the under age 5 population in Guatemala.
Non-governmental Organizations and Community Health Organizations
Collaborate with in country NGOs to decrease stigmatization and increase screening for breast cancer in Zambia; or collaborate with the American Heart Association or other organization to improve outcomes in the community.
Focus on decreasing the percentage of employees in a manufacturing plant with a BMI in the obese or overweight category by changing cafeteria food options, educational initiatives and a voluntary employer-based 16 week wellness program.