50 Nurse Leader February 2005

February 2005 Nurse Leader 51

Michelle Denyer, MSN, APRNBC, GNP;
Nancy Girard, PhD, RN, FAAN;
Nancy Ray, MA, RN; and
Kathleen Reeves, MSN, RN, CNS
Facilitating the
Graduate Nurses
Transition into the
Profession
The Bridge Program:
The Bridge Program is an educational partnership between the
University Healthcare System (UHS) in San Antonio, Texas, and the
University of Texas Health Science Center at San Antonio (UTHSCSA)
School of Nursing. The program consists of three undergraduate elec-
tives that are offered every semester, including summer, and is coordi-
nated and implemented by the department of acute nursing care faculty.
Initially developed in 1995, the Bridge Program was
designed as a training program and partially funded by
UHS. Mutually agreed upon goals by the nursing
school and the hospital were to provide students an
opportunity to get additional clinical experience to
increase their confidence and competency, prepare
them to better assume the role of the professional
nurse after graduation, and decrease orientation time
of the newly hired graduate. Additionally, the hospital
hoped to increase its ability to hire the best-qualified
graduating nurses.
Since its inception in 1995, the program has under-
52 Nurse Leader February 2005
gone several revisions. These changes have always been
based on formal and informal suggestions, feedback, and
evaluations received from the students, their preceptors,
and hospital administrators. Although the early years were
effective, few students were willing to make the commit-
ment to complete clinical hours that were not required.
An effort to improve the experience for the students and
staff was initiated. The Bridge courses were reorganized
and approved as undergraduate electives in 1998; students
could choose to earn 1, 2, or 3 hours of credit and would
be graded on a pass/fail basis. This method proved suc-
cessful and continues today. Students choosing to earn 1
hour of credit must complete 45 clock hours. Students
choosing to earn 2 hours of credit must complete 90 clock
hours, and students earning 3 hours of credit must com-
plete a project along with the 90 clock hours.
Bridge electives are best described as a clinical precep-
torship program. The student is allowed to choose a spe-
cific unit or area that reflects his or her interests. It is an
intense, hands-on clinical experience and is unique in its
true partnership nature. The nursing administration, along
with specific units of the hospital, commits to consistently
provide the students with qualified preceptors. The avail-
ability of a dedicated, primary preceptor is mandatory for
the student to participate in this program. The philosophy
of the program strongly and clearly reflects the School of
Nursings community-based partnership curriculum of the
baccalaureate program.
1
A student must be enrolled in his or her final year of the
undergraduate bachelor of science in nursing generic or
registered nurse completion program and be in good aca-
demic standing. After an interview with the faculty coordi-
nator to determine clinical area of interest, the student
must meet with the director of that unit or his or her des-
ignated representative. Almost all units of the hospital are
available, including the emergency center, critical care
units, medical/surgical units, labor and delivery, pediatrics,
and newborn services. The student approaches the meet-
ing with the unit director as if it were an interview for a
position as a graduate nurse. The student is not guaran-
teed a position after graduation, so he or she is not
required to commit to work at the hospital after gradua-
tion.
Once accepted into the program and assigned a pre-
ceptor, the student is responsible for arranging clinical
hours. The student may schedule clinicals on any day or
time that coincides with the preceptors schedule and
complements his or her academic schedule, whether
weekends, days, evenings, or nights. The faculty member
coordinates the clinical practicum, evaluates students
when they are in clinics to ensure that goals and objec-
tives are being met, counsels students, and grades the
course.
As a clinical experience, the program is considerably
different from the core courses students must complete.
There are no mandatory written nursing processes, care
plans, or examinations. However, students are evaluated
on their abilities to document, according to hospital poli-
cy, all aspects of the care they deliver. They are held
accountable for the application of the nursing process, as
opposed to submitting a written process. This is the pri-
mary component of the program that students have over-
whelmingly enjoyed and to which they have positively
responded.
Students earning 3 hours of elective credit are given
several options regarding the method in which they com-
plete the project requirement. Most students opt to pre-
pare a poster presentation on a topic of interest to their
unit. Preceptors often play an integral part in the choice of
topics as they help the student identify the learning needs
of the unit and staff. Students also may become involved
in developing or revising specific unit policies and proce-
dures or patient education material. Whatever strategy the
student chooses, creativity, enthusiasm for the topic, and
fun are encouraged.
On completion of the program, students are asked to
evaluate their experiences by completing two question-
naires. As outlined in Table 1, the first form consists of
four brief, open-ended questions that assess the students
sense of their own capabilities, their impressions of their
preceptors support, and whether they would recommend
the program to other students. The last item requests any
I What has this program enabled you to accomplish?
I Describe your relationship with your preceptor.
I Would you recommend the program to other students?
I Do you have any suggestions or comments?
Table 1. Evaluation of Bridge Program
February 2005 Nurse Leader 53
provided to students. The programs design helps students
be the adult learners they were meant to be. The nursing
faculty and hospital staff know each other well and can
depend on well-established channels of communication
that are always open. This allows for changes and adjust-
ments that might not be possible in a more structured
course format. Last, but certainly not least, the faculty and
staff are very comfortable with the inherent flexibility of the
program.
Reference
1. Staats CR. The development of a community-based baccalaureate
model in a culturally diverse health care delivery area. Nursing
Education Perspectives 2003;24(2):94-7.
Michelle Denyer, MSN, RN, GNP, is an assistant clinical professor
in the department of acute nursing care at the University of
Texas Health Science Center in San Antonio. She can be reached
at denyer@uthscsa.edu. Nancy Girard, PhD, RN, FAAN, is an
associate professor and chairwoman of the department;
Kathleen Reeves, MSN, RN, CNS, is also an assistant clinical pro-
fessor. Nancy Ray, MA, RN, is the CNO and associate administra-
tor of University Hospital in San Antonio.
1541-4612/2005/$ - see front matter
Copyright 2005 by Elsevier Inc.
doi:10.1016/j.mnl.2004.10.001
comments or suggestions, and students are encouraged to
write what they truly believe.
The second evaluation tool, outlined in Table 2, is a
more structured self-assessment tool that asks the stu-
dents to evaluate how they addressed each program
objective. They may choose ratings of satisfactory, unsatis-
factory, or not applicable and are asked for examples or
comments. This form also provides the opportunity for
faculty and preceptors to comment.
Student and hospital staff evaluations of the Bridge
Program have consistently been strongly positive.
Students have unanimously said that they would recom-
mend the program to other students. The numerous
opportunities to improve critical thinking skills, along with
the ability to successfully demonstrate assessment and
psychomotor skills, have been cited by students as the fac-
tors that create a meaningful experience.
At the completion of the program, students also report
an increase in confidence and appreciation for their cho-
sen profession. Comments have included:
This program was definitely the closest experience
to real nursing that I participated in while in nursing
school.
For the first time, I know what it is to be mentored,
and I deeply appreciated it.
This was a rewarding experience, and I want to do it
again.
I have gained more confidence in my ability to be a
professional nurse.
To date, approximately 200 students have completed
the Bridge, and approximately 60% have been hired by the
hospital. Students who accept a position with the hospital
after graduation are highly regarded by staff and are hired
at a slightly higher monetary rate.
The success of the program has been attributed to sev-
eral factors. Although student and staff feedback has
shaped the program, strong support and guidance are
I Identify the roles of the professional staff nurse in the unit.
I Demonstrate effective time management and organizational skills.
I Recognize and appropriately use the various members of the health care team in accordance with the Texas Nursing Practice Act.
I Demonstrate basic medical/surgical competencies safely.
I Demonstrate specific competencies unique to the assigned unit as identified by the preceptor.
I Demonstrate proficiency with the computer or hard copy charting system.
I Demonstrate the ability to make decisions, problem solve, think critically, and prioritize in a fast-paced, potentially high-stress
environment.
I Demonstrate the ability to provide and direct nursing care for at least ___ (patients) in the ______ (unit).
(The number varies depending on the type of unit.)
Table 2. Self-Evaluation Tool