Critical Job Training

Hiring new employees can be expensive. 2022 research from the Society for Human Resources Management shows the average cost to hire one new employee was about $4,700. In nursing, it can be more than ten times that amount.

Bloom Healthcare provider visits a patient.

What if a business could reduce those costs while giving potential employees a “try out” before starting a new job? A prospective employee could see if they are a great fit, and the company can see how the person works and gets along with other employees. The process would also save the company money because there would be less training and less time spent on job interviews.

The University of Colorado College of Nursing has created a partnership with Bloom Healthcare to provide a “try out” period while the advanced practice student earns their degree. COMPACT (Community Optimized Mentoring for Practice Accelerated Transitioning) started two years ago and is geared toward advanced practice nurses studying adult-gerontology.

Bloom Healthcare is based in Lakewood, Colorado, focusing on older adult patients. Bloom offers in-home care, telemedicine visits, and primary care at facilities across the Front Range, allowing seniors to maintain their independence. Bloom empowers patients and their families by offering individualized care at home and focuses on a patient-centered model of care.

CU Nursing Assistant Professor Kim Paxton, DNP, APRN, ANP-BC, LHIT-C, created COMPACT because finding practicum sites for students was difficult.

“COMPACT has two purposes: it helps the student and the business,” Paxton says. “Students are given placement within a high-quality healthcare system. Students can test out the environment to see if this is the right area for them, and Bloom can see if the student fits in with their system.”

Interviewing for a Job

CU Nursing alumna Megan Graeser, DNP, GNP-BC

Students complete clinical hours at Bloom Healthcare for two semesters (six to seven months).

The average number of clinical hours for advanced practice nurse programs at one specific site is 90-135 hours.

Students typically apply in their second semester of the AG program, but complete the COMPACT program in their third and fourth semesters. They are interviewed by Paxton and CU Nursing alumna Megan Graeser, DNP, GNP-BC, who is Bloom Healthcare’s director of clinical development.

At least four students have gone through the COMPACT program, and Bloom Healthcare has hired all but one.

“The student chooses to become a candidate because COMPACT is the type of healthcare system, career pathway, patient population that they are looking for to work in as a nurse practitioner,” Paxton says. “At the end of COMPACT, when the student graduates, Bloom Healthcare can see and determine if this student is a good fit and offer them a position.”

Students interview with their Team Lead to make sure they would be the right fit for an open position.

CU Nursing alumna Chelsea Goston

CU Nursing alumna Chelsea Goston was in the college’s Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) program when she applied for COMPACT.

“I was inspired to apply to the program because from what I heard, it offered more training and resources,” she says. “That was important to me because as a new nurse practitioner, I wanted to have more support, and a potential job opportunity after the program was very exciting to me.”

Graeser compares the program to a medical residency.

“Students get a taste of what our practice is like,” Graeser says. “They ideally get a couple of semesters of seeing the range of patients that we see, the complexity of the patients that we see, and realizing that our providers, specifically nurse practitioners are really working at the top of their scope of practice. So we’re able to see how great a nurse practitioner could be and how independent they can be.”

A Typical COMPACT Day

Students get a wide range of experiences in the COMPACT program that aren’t normally seen in a typical primary care practice. They are paired with and precepted by one of Bloom Healthcare’s nurse practitioners.

Goston shadowed her nurse practitioner at the beginning of COMPACT to get an understanding of procedures. Eventually, Goston took the lead and did things like asking the patients questions and working on charts.

A nurse discusses with a patient their healthcare at Bloom Healthcare.

“As I got more experience, my preceptor would sit outside a patient’s room to give me more independence with the patient, allowing me to do things on my own. Then, I’d report my findings to her, and she would confirm that information with the patient,” she says. “Privately, we would talk about the plan of care and she’d ask me what I’d do for a patient. I would tell her and then she’d provide feedback, so it was a great learning opportunity. It gave me a good strong foundation as a nurse practitioner and it gave me the ability to work on my own independently.”

Students have the opportunity to spend hours with wound care nurse practitioners and learn about integrating hospice and palliative care into primary care. Students are also able to better understand the role of clinical pharmacists and psychiatric nurse practitioners in the Bloom Healthcare organization.

“I think that’s the big thing with this COMPACT program is showing advanced practice nursing students an area they may not always see in some clinical rotations,” Graeser says. “It allows them to see what type of medical care can be done at home – whether it’s a patient’s home or an assisted living setting, we want them to see what we (at Bloom) can do for primary care.”

Students usually spend two days a week at Bloom Healthcare. They typically see 10 to 12 patients per day with their preceptor, which is different than an outpatient office setting where advanced practice nurses may see more than 18 patients a day. Bloom Healthcare understands the need for its primary care providers to collaborate with a patient’s family members and other patient care partners to ensure that patients receive quality medical care at home.

“A lot of what we do is not just taking care of the patient, but it's also being good communicators with the people that are helping take care of those patients,” Graeser says.

A Win-Win Situation

Another bonus of the COMPACT program: students learn the ins and outs of Bloom Healthcare’s system and procedures during the program. Bloom Healthcare says COMPACT reduces orientation time. There’s also a reduced cost for orientation, which is estimated to be around $60,000.

“COMPACT gives students increased levels of understanding what the expectations are,” Paxton says. “They’re able to begin independent care more quickly. Students have already been with Bloom for seven to nine months when they’re hired, so they go into this new job as a nurse practitioner knowing all the processes, how to document things, and understand the patient population.”

The in-depth mentoring and learning give students a higher level of confidence going into a new job after graduation.

“Students trust themselves and their ability to lock into intuition and understanding, knowing and being is at a higher level than a new graduate who hasn't had this experience. It's phenomenal,” Paxton says.

Goston says she liked her experience with Bloom so much that after COMPACT, she applied for a nurse practitioner opening. She went through the traditional interview process before accepting the position.

“It was easier to jump right into the job because I already had all that experience and knowledge. It felt like such a great fit,” she says. “One of the biggest challenges (starting the job) was figuring out Bloom’s electronic system, but I had already been using it for a semester. So already knowing how to use it made me feel more comfortable and confident, and it helped ease my way into starting a position as a new graduate nurse.”

An Evolving Program

The COMPACT program will likely evolve as the partnership with Bloom Healthcare and CU Nursing continues, including adding what kind of experiences students should have and nurse practitioners' different roles in primary care.

Another aspect is the number of students selected each semester. Bloom Healthcare is a large practice, and it wants to make sure students are still getting quality experience.

“The learning curve from a nurse to a nurse practitioner is huge, and no one told me how hard it was,” Goston says. “I appreciated COMPACT because I felt like I was given a good foundation so that way I could truly focus on a patient’s care and treatment. COMPACT definitely helped expand my learning and confidence compared to a more traditional clinical setting.”

“I did preceptorships during my NP program, but usually I’d spend one semester with just one preceptor, then move on to another healthcare organization,” Graeser says. “But with COMPACT, students get to spend more time with patients, do primary care, and see various aspects of primary care from a different perspective.”

Graeser says the COMPACT program is showcasing a shift in primary care for older adults, which includes giving them quality medical care at home.

“We’re trying to keep them at home for longer and provide that quality of care with a huge amount of support,” Graeser says. “We have 73 providers and 74 non-provider employees on Bloom’s primary care side, so it’s helping us realize how unique the experience is for students for CU Nursing students to be a part of our organization.”

“The University of Colorado is the birthplace of the nurse practitioner and is the birthplace of innovative thinking and community application. Our leadership at CU Nursing wants us (faculty) to be thinking outside the box and find ways to maximize opportunities for students,” Paxton says. “This program can be so impactful at a larger scale.”