Increasing Access to Nursing Careers: Validating Virtual Learning

Join Credly CEO, Jonathan Finkelstein, for a series of conversations with people advancing change that leads to a better and more equitable future of work. Meet change-makers, problem-solvers, and leaders who are bringing big ideas and doing the hard work.

In this episode, Jonathan chats with Dr. William Tammone, the Chief Academic Officer and Senior Vice President, Strategy & Innovation at American Sentinel University. 

American Sentinel University is changing the way nurses learn to care for patients through student-led and simulated courses. With the demand for medical professionals surging in recent months, American Sentinel is removing the need for in-person training to get more qualified nurses into the field. They're verifying their skills through digital credentials in courses like Advanced Pharmacology, Advanced Pathophysiology, and Online Teaching in Nursing Education. 

Listen to Jonathan and Dr. Tammone chat about nursing in a post-COVID world, the future of online learning and assessment, and how using digital credentials that offer proof of verified skills leads to a more equitable healthcare system. 

Conversation with Dr. William Tammone

Jonathan Finkelstein:

Hello everybody. And thanks for joining me. I'm being joined today by Dr. William Tammone, who is the Chief Academic Officer and Senior Vice President for Strategy and Innovation at American Sentinel University. William, I'm glad you're able to join me for this conversation.

William Tammone:

Morning Jonathan, happy to be here.

Jonathan Finkelstein:

I'm happy to have you. It occurs to me that we already had... American Sentinel University is known for its online healthcare programs, including its nursing programs. We had a nursing shortage long before this pandemic hit, now we find ourselves in the midst of a global health crisis. It seems like a really interesting time to have taken on a role as a head of Strategy and Innovation. What does that mean in your world right now?

William Tammone:

For Americans, Sentinel Innovation is a way of life. I first met our CEO, Rick Oliver, more than 20 years ago probably. I was attending a conference along with others from my college at the time, and Rick was giving a presentation. He was then on the faculty of the Owen School of Management at Vanderbilt University, and he is what you would call a futurist. He talked a lot about coming trends and things that we should expect. And I thought what he was talking about was very interesting, so I invited him to come up and talk with our faculty in Michigan and that was the beginning of our relationship. One of the interesting things about that first encounter with him, or rather in Michigan anyway, is that he was coming from Nashville, Tennessee. He was flying to Michigan in January and it was horrible weather, and as a result he was delayed quite a bit in the airports, and so had a lot of time to read magazines and things like that.

William Tammone:

And I remember him walking into the lecture hall to talk with our faculty, and under his arm he had several gaming magazines. And he was there to talk about things like nanotechnology and biotechnology, things that were really just then emerging, but he also asked the faculty a question, "How many of you are gamers?" And just a few of the younger faculty sheepishly raised their hand and said, "Yeah, I like to play computer games." And he said, "You are the future of education, because the future of education is going to involve a lot of gaming and simulation." And that has now come into fruition at American Sentinel where we are producing our own simulations and gamified activities, and so it's always been part of the DNA at American Sentinel. We're fairly young, established in 2006, we're completely online, as you mentioned. But innovation and scanning the environment, looking for new trends, thinking about how they might apply to higher education, how they might apply to us as an organization, that's always been part of what we do. And it really, I think, shows up in the programs and services that we provide for our students.

Jonathan Finkelstein:

I want to come back to some of those examples of innovation and use of technology and in a moment, you made reference to the faculty raising their hand and those who admitted or didn't admit to being gamers. When you think about the nursing profession as a whole and you think about attracting new learners and new people interested in becoming professionals in the field, what do you look to? Who makes a good nursing candidate? Are they typically people who may be making career changes or are these first jobs for individuals? It's a topic that matters to a lot of people right now considering the disruption that we have in the labor market, is nursing open to everybody?

William Tammone:

Yes. No question that it is open to everyone, it is a profession. It does take years of education and training, but it is open to anyone. One of my first experiences with nurses had to do with my first teaching job, where I was teaching anatomy and physiology to new nursing students. And I was struck immediately by how motivated the students were, but also how, in effect, they were nontraditional. They were people who had already gone out into the workforce, decided for whatever reason that they had a calling to become a nurse. And so, most of the people in nursing programs are really nontraditional. So, when we think about how do we reach out to these students, first of all, they are, at the earliest stages, they are going to be reaching out to the colleges and universities to get into a registered nurse program.

William Tammone:

But once they become registered nurses, they can go out into the workforce and start practicing as registered nurses. And if they want to advance their career beyond that, a university has to provide education and training in a way that will work with their busy work lives, busy personal lives, and so forth. And so being online and offering online programs that are completely asynchronous, primarily asynchronous, really is a starting point for serving those nontraditional working adults. We do other things though to help reach out to those students, and one of those things has to do with competency-based education. We've recently received approval from the higher learning commission to offer our RN to BSN program and MSN programs in a competency-based format. And that means that students can progress at their own pace. Competency-based education is wonderful from an employer's perspective because they can be assured that students graduating from the program have demonstrated all of the competencies that they're looking for and that they need to be effective nurses.

William Tammone:

But from a student perspective, it's very appealing because it is self-paced. There are not weekly deadlines for instance, and so if your workload one week is very heavy, you can adjust your work on your coursework accordingly. So, offering things online, offering them in a competency-based format, is helpful to get students through that pipeline. Another thing that we do is offer virtual simulations. American Sentinel University creates its own virtual simulations, which from a pedagogical point of view, helped to promote critical thinking and problem solving skills. But they also solve a practical problem, and that is it's very difficult for nurses these days to get the training they need in clinical settings. And in fact, with COVID, it's even become difficult for physicians in training, medical students, to get the clinical experiences they need. So, medical schools as well as nursing colleges are turning to simulations of various kinds. These can be things like high fidelity mannequins, but also in our case we're developing virtual simulations, which help students to learn some of the skills they need to learn to be effective in nursing without actually going into a clinical setting.

Jonathan Finkelstein:

William, I'm actually putting up on the screen-

William Tammone:

Okay, yes you are.

Jonathan Finkelstein:

... some examples here, I wonder if you can give us a sense as to what we're looking at.

William Tammone:

You're looking at a simulation called Sentinel City, which takes place in an urban setting. And many BSN students have to learn about community health, and so they need to either physically enter a community or neighborhood in a big city, walk through the neighborhood, talk with people, learn about the various factors that are impacting health on the streets, in the homes, in apartments and so forth. They either do that physically walking, or they might even be driving, and that's sometimes called the Windshield Survey. The challenge with the Windshield Survey is that it's difficult for a nurse to drive and take notes at the same time. Sentinel City helps students to learn about community health issues by interviewing the mayor and other people within the city, and making observations about factors that impact health without actually going into the city.

William Tammone:

And so, this is one example of a simulation that we use in our program. We also have a number of clinical scenarios where students learn about things like prioritization of care, encountering a whole bunch of different situations, health situations, and deciding which ones need priority care and which ones can wait a little bit. Another big thing that we're working on now is developing a new simulation regarding telehealth. Telehealth has already been on the rise in the United States, but with COVID-19 it's becoming even a bigger deal where physicians and nurses are providing healthcare via the internet or via telephone. And so, that's another way that we're developing these simulations to help students learn and be effective in the new world that we're going to be encountering.

Jonathan Finkelstein:

Oh yeah. It's amazing for many online learning programs, the online learning was just a means to an end. And now in many cases, the world in which you are preparing those learners to operate, requires the very tools that we use to train and educate. Your tele-health simulation sounds remarkably meta in that regard.

William Tammone:

Right.

Jonathan Finkelstein:

In that you're actually creating an online simulation for what is an online interaction.

William Tammone:

Right.

Jonathan Finkelstein:

How deep into the development are you? And what else can you share with us, any sense as to how that looks or works?

William Tammone:

The timeline is that it's going to be launched July 1st, and so it's a labor intensive process and we aren't capable of doing it all ourselves. We have faculty input into designing the scenarios that students will encounter, but when it comes to the technical aspect of developing the animations and so forth, we partner with other companies to help us do that.

Jonathan Finkelstein:

It's amazing, I can't wait to see it. Will that also be asynchronous or will there be a real time component for testing out your... or perhaps you'll simulate the act of doing telehealth conversations?

William Tammone:

Yeah, the simulations will be completely asynchronous. And so the asynchronous part, that's the way American Sentinel started and most online programs started 20 some years ago. When you hear about universities and high schools transitioning to an online` environment to deal with the COVID pandemic, they're really talking about synchronous learning. They're doing, like we're doing here, video conferencing and so forth, and it is synchronous. And that works well for certain types of students, like high school students, or maybe traditional college students, it doesn't work well at all for working adults. And so, it's really important for us to create these learning experiences that students can engage with in an asynchronous manner.

Jonathan Finkelstein:

Absolutely. Now you talked earlier about the use of competency-based education, tying, learning two specific skills, and you're talking now about working adults or adults with complex lives that don't necessarily have the same kind of a schedule as someone who might be earlier in their life. You recently announced the recognition of learning in a more competency-based approach with a series of digital credentials, can you talk a little bit more about what kinds of skills are being recognized in that way and what led you to innovate and create that kind of a learning oriented product, if you will, or outcome for learners?

William Tammone:

Right. Yeah, we've recently launched a digital badging program in which we're collaborating with Credly, and very happy with that partnership with Credly. What the appeal is to me about digital badges is twofold, first of all, these are, for us, competency-based credentials. And that is that students have to demonstrate mastery of certain skills, which are documented in the so-called metadata associated with digital credentials. And so, we don't grant them, for instance, just participation in a workshop or something like that. That they are verifications of specific skills that nursing professionals will need in the workplace these days. So, one of the ones that you're looking at is infection prevention and control. You can see some of the skills associated with that, you can see the criteria lower down about what you have to do to earn that particular credential. And so, when students earn this infection prevention and control badge, they can share it with others, which is really nice.

William Tammone:

They have control over who they share this with, and when they share that this credential, or when, say, an employer checks on this, they can go to the Acclaim platform and verify that this student really has demonstrated mastery of these skills that are so vital. So, you're looking at other ones, pathophysiology, which has required for all of MSN degrees, and we offer others associated with our nurse practitioner program. Lots of different ways of verifying skills that will be of value in the workplace. Again, we're working now on new simulations, such as one related to telehealth, and that will also be accompanied with a badge. So to earn the badge you have to demonstrate your mastery of the skills that are outlined in the metadata for the batch. And again, that helps to assure employers that you really have demonstrated mastery of the skills that they're looking for.

Jonathan Finkelstein:

I noticed that you are also taking advantage of the ability to link from these credentials to open jobs that are available. How does American Sentinel ensure that the skills that you are teaching to and indeed assessing in these credentials, align to what employers are most asking for?

William Tammone:

We have, first of all, what are called Program Advisory Committees, people involved in nursing and health care throughout the country, serving on this committee and giving us input on exactly what skills they're looking for in their nursing professionals. In addition to that, our programs have to meet program accreditation requirements, whether that's from a program accreditor called CCNE or ACEN, this is vitally important to students to know upfront, that our learning outcomes are aligned with those expected by the program accreditors. That's very well known in the nursing profession and a vitally important piece of information for our students. There are also other nursing organizations, that's issue standards and competencies that they're expecting nurses to acquire. And again, all of our programs are aligned with those external standards and that's vitally important for our students and the people that hire them.

Jonathan Finkelstein:

That sort of round trip and close connection between the learning that happens in your very authentic online virtual environments and what the workplace demands is so critical, perhaps more critical than ever. I know that I've read that American Sentinel really tries to keep the price of its programs low so that people graduate with as little or no debt as possible. And obviously the ability for them to connect to jobs is so vitally important, not just for them as individuals who've made an important investment, but our society needs more nurses now more than ever. I understand that we talked about the nursing shortage earlier, we have a great deal of people who are retiring from the trade, and we have an aging population that requires more nursing professionals. It's never been a more urgent calling for people to think of this as a vital career, and even as a national service.

William Tammone:

Right. We're in the uncertain times, of course. There's no doubt that the demand for nurses is already high, it's going to be higher in the post-COVID world. How society responds to that is still uncertain. There is some speculation that actually COVID-19 will scare away people from pursuing a career in nursing, that did happen apparently in the early eighties when HIV and AIDS burst on the scene, a couple of years went by, were enrollments in nursing programs actually decreased. Hopefully that won't be the case. Hopefully people will answer the call for more nurses. It really is a calling or vocation. But once they're in the program, once they've made that commitment, it really is incumbent on the university to make that learning as safe as possible and as convenient as possible for those students so that they can get through that pipeline, not just start into the nursing program, but actually finish the nursing program.

Jonathan Finkelstein:

Well, speaking of it being a calling and perhaps what may be different this time than during the HIV crisis, is our office is in one of the cities that every night at 7:00 PM opens their windows and bangs pots and pans to applaud first line responders and essential workers including nurses who are on the front lines, anything going on in your neck of the woods to celebrate?

William Tammone:

Yeah. We have our own local version of that. In Italy at a certain time every day, apparently people sing outside their windows and serenade each other and so forth. In England, they applaud. In New York city they bang pots and pans. Here in Colorado, the new tradition is that people are going out in to their lawns every evening at eight o'clock and they start howling. And in fact, the first time I heard it I thought they were actually coyotes because we do have coyotes around here. But then I realized that no, these are human beings, and it's really kind of fun. It started, I think, with young adults and maybe high school kids, but even little kids are enjoying this now and going out and howling every night to show their support for nurses and other health care professionals.

Jonathan Finkelstein:

Are you at the point where you were howling?

William Tammone:

Oh, absolutely. I'm howling.

Jonathan Finkelstein:

Is this the part where we end our conversation?

William Tammone:

That's true, yes.

Jonathan Finkelstein:

Right. Well, let's consider this a howl out to the nursing audience who are listening with us today and to prospective nurses who might consider this a calling that they might want to answer. And I want to thank you for sharing about your programs, for the work you're doing, and we look forward to hearing more, and maybe you can come back and join me again for a follow-up.

William Tammone:

I'd be happy to do that. Thank you, Jonathan, it's been a pleasure.

Jonathan Finkelstein:

Thanks, William.

By Jonathan Finkelstein