Table 5 Critical elements: implementation activities and outputs for promoting collaboration

Initiate communication structure

● Pre-existing professional and/or personal relationships between leaders (i.e., Dean, Nurse Executive, Program Directors)

● Key leaders had never met

● No recent history of interaction between partnering institutions

● Prior and ongoing interaction between partnering institutions

● Significant disparity between benefits of the program to the partners

● Parallel institutional missions (e.g., caring/educating the underserved), shared participation of objectives, and overt expectation of benefits overlap and complement

● No cross-institutional relationship existed between nursing leaders (e.g., Dean and Nurse Executive) and no recognition that such a relationship was necessary or beneficial

● VA (or specifically VA Nursing Service) not respected by academic partner

Create partnership governance (e.g., power sharing, problem solving)

● Shared decision-making between partners

● Unilateral decision making by one side of the partnership or the other (e.g., determining selection criteria for faculty hires)

● HR departments of both institutions works closely with partnership in processing new faculty and in preparing student nurses for clinical placements in VA

● IT departments in both institutions willing and able to resolve issues efficiently

● Antagonistic relationship in VA between service departments (e.g., nursing and staff education) over emerging issues related to VANA implementation, such as who oversees VANA program

Elicit support for program from all levels of organizational leadership

● Formal and regular standing meetings planned (and held) between:

● Planned formal meetings poorly attended, especially by core leaders

→Program Directors

● Only interaction with OAA is through the scheduled program director calls despite presence of significant barriers to implementation

→Both program directors and faculty

→Dean and Nurse Executive

→Dean, Nurse Executive, and both program directors

● Frequent ad hoc contacts (e.g., in-person, email, phone) between:

● Tensions between program directors and nurse leader(s) that either inhibit collaborative problem solving or introduce barriers

→Program Directors

→Faculty members

→Dean, Nurse Executive, and program directors

● Dean and Nurse Executive regard themselves as colleagues

● Reluctance to contact OAA for advice and assistance in overcoming challenges that arise

● Contacts with OAA, as necessary, outside of regularly scheduled program director conference calls

Delineate level of each program director’s involvement

● Frequent, sometimes daily, informal contact between program directors to discuss and address program operations and issues

● At least one program director has minimal knowledge of program details and logistics

● Program directors have awareness of details beyond broad objectives of program

● One program director less involved in day-to-day operations than counterpart

● Both program directors have direct involvement in problem resolution

● A program director has limited respect and authority within own institution

● Each program director has strong sense of ownership for program and feels directly responsible for its success

● Scope of VANA role exceeds time allotment

● Program directors are actively involved in day-to-day activities

● A program director provides verbal support for program but has limited or no direct involvement

● Program directors are held in high esteem by partnership and organizational colleagues

Each program director holds a position with high level of responsibility within institution

● Each program director often has long employment history with one or both partnering institutions

● Each program director has sufficient protected time to fulfill VANA role

Delineate level of Dean’s and Nurse Executive’s involvement

● Both act as overseers and high level problem solvers for partnership

● Has minimal knowledge of program beyond its broadest objectives (e.g., being new to the position)

● Both facilitate provision of institutional resources by lending authority of role

In cases where position turns over, newly hired leader views value of VANA differently than predecessor

● Neither are involved in day-to-day operations

● Nurse Executive and Dean have limited or no relationship

● Both are frequently kept apprised of activities by other members of the partnership

● Both travel to attend at least at one VANA national meeting held annually in Washington, DC

● Leader introduces administrative barriers to program progress (e.g., in carrying out alleged organizational policy constraints)

● Has an adversarial relationship with program director(s)

Create visibility of VANA program

● VANA program has high visibility within institutions and community (e.g., logo on signs, lanyards, cups, pens, screen savers, informational spots developed for local television coverage)

● No attempts made to increase awareness of VANA, especially among nursing (i.e., VA staff, nursing school faculty and students

Identify and address logistical barriers

● Partnership leadership demonstrate flexibility in regard to interpretation of rules, regulations, and policies of institutions that would pose barriers

● Inadequate mechanisms to complete student paperwork prior to VA rotations

● Maintain regular meetings in order to provide a forum to bring up challenges and barriers

● Rigidity in interpretation of rules and regulations, creating barriers (e.g., defining work hours)

● Absence of open lines of communication between leadership of the two organizations

Market VANA to appropriate audiences

● Repeated efforts to develop awareness of VANA within the:

● No resources (e.g., available personnel, funds for flyers) for marketing program

→Medical Center

→Local community

→University (including outside of the nursing school)

Facilitate intra-organizational operation

● Presence of a program champion, a firm and ardent believer in the program, who is able to achieve the buy-in from within the leadership and faculty necessary for the program to develop

● Absence of program champion, in leadership positions in particular

● Holds annual off-site retreats to facilitate team building

Lack of attempts to build cohesion (e.g., retreats, team-building exercises)

Refill partnership positions as needed

● Key partnership leaders are consistent throughout the Launch Year

● Frequent turnover in key leadership positions

● If turnover of key leaders occurs, the positions are filled with persons very familiar with the project and its role responsibilities, and also who has the active support of other program participants

● Filling key leadership positions with persons unfamiliar with the program, or who are not supportive of some of its major objectives

● Proposal authors are no longer at the institution by end of first year of operation

Local recognition for VANA program

● Formal events and meetings held that highlight VANA participation (e.g., recognition ceremonies, information seminars)

● Lack of awareness of the VANA partnership both within institutions and in the local community

● Interest from other nursing schools to participate in a VANA-like program

● No effort to collaborate on VANA-related publications

VA-CON co-authored publications

● VA-based and nursing school faculty and leadership involved in development and submission of publications

● No effort to disseminate VANA-related products

Perceived benefits by all stakeholders

All key stakeholders perceive at least some benefit from VANA participation, such as:

Few stakeholders perceive any benefit from VANA participation, such as:

University:

University:

● Opportunity for expanded curriculum (new course/subject matter; addition of veteran and VA-specific content)

● Increased student enrollments and faculty positions not commensurate with level of perceived benefits

● Decreased concern about finding clinical placement slots

VA:

● Appreciation of clinical expertise of VA-based VANA faculty

● No value seen in increasing career opportunities for expert nurses

VA:

● Students: Negative VA experiences negatively impact student impressions of VA

● Increased unit staff and patient exposure to BSN-prepared students

Veteran patients:

● Improved retention of current nursing staff, especially those with valuable experience and clinical expertise

● Occasionally feel overwhelmed by presence of large clinical groups of student nurses

● Expansion of simulation lab use and capabilities

Students :

● Increased awareness of veteran-specific needs

● Increased awareness of employment opportunities at the VA

Veteran patients:

● Appreciation of interactions with VANA students, especially those with military background