Better preparing NGNs to practice in today’s complex and dynamic health care environment requires dedicated and coordinated responses from both academic and practice organizations (Arkan, Ordin & Yılmaz, 2018; Huston et al., 2017; IOM, 2010; NEC, 2008; Shepard, 2018; Spector, 2015; Van Rooyen, Portia, Ham-Baloy & Caka, 2018).
The Dedicated Education Unit
The Dedicated Education Unit (DEU) was first introduced in the 1990s, at the School of Nursing and Midwifery at Flinders University, Australia, with the aim of enhancing academic practice partnerships and transforming the clinical experience of nursing students (Edgecombe, et al., 1999). In 2003, The University of Portland implemented the first DEU model in the United States (Moscato, Miller, Logsdon, Weinberg & Chorpenning, 2007).
Dedicated Education Units
- Collaborative evidence based teaching model pairs two nursing students with one staff nurse who supports and educates students with applying learned clinical skills to real world practice (Edgecombe, et al., 1999; Moscato et al., 2007).
- Staff nurse, recognized for expertise by Nurse Managers, are trained by nurse faculty to work with students in the clinical setting.
- Academic Faculty serve as Clinical Faculty Coordinators (CFC)
- Provide staff nurses ongoing coaching and support in their role as clinical instructor
- Challenge students to think critically and apply learned theory and clinical reasoning skills to problem solving in real world practice (Edgecombe, et al., 1999; Moscato et al., 2007; Rhodes, Meyer, & Underhill, 2012).
While the DEU is highly regarded as worthwhile and creating a positive clinical teaching/learning environment, most studies are limited to reporting qualitative outcomes. In fact, a paucity of literature exists in regards to measuring the impact of the DEU on NGNs’ transition to practice.
Study Site
In 2011, the faculty at one of New Jersey’s first and largest baccalaureate nursing programs sought to align a newly adopted innovative concept based curriculum with an equally innovative senior student clinical learning experience. At the same time one of New Jersey’s largest academic medical centers and second largest provider of charity care in the state, with a long-standing clinical affiliation with the university, was exploring ways to increase recruitment, retention, and ease the transition of the new graduate nurse.
With a recognized need for change at the academic and practice level, nurse leaders from both institutions visited the University of Massachusetts Amherst School of Nursing DEU, modeled after DEUs from the University of Portland and Flinders University, Australia, for instruction and guidance. With the additional support of a $10,000 Robert Wood Johnson Foundation grant, the already existing academic practice partnership strengthened its ties and initiated one of New Jersey’s first medical surgical/pediatric DEUs.
The purpose of the study was to explore outcomes of the Dedicated Education Unit (DEU) as they related to new graduate nurses’ experience transitioning from student to practicing professional nurse.
The quantitative portion of the study invited a convenience sample from the same BSN program who graduated between 2012-2018 and participated in either a DEU or a Traditional Clinical teaching model (N=137 (DEU=83 and Traditional Clinical [non-DEU] =54) during their senior year of nursing school, to participate in an electronic Revised Casey-Fink Graduate Nurse Experience Survey via email (Casey & Fink, 2006). NGNs with DEU experience reported feeling significantly more comfortable with making suggestions for changes to the plan of nursing care(X2 = 8.303, p < 0.04) and agreed in greater proportion that they felt more supported by nurses on the unit (X2 = 5.808, p <0.016)
The qualitative portion of the study invited a purposive sample of Nurse Managers (N=9) from an acute care hospital who have had experience hiring and working with both DEU trained and non-DEU-trained NGNs to answer three open-ended interview questions: 1. How do you define competency? 2. What qualities do you think contribute to a successful transition for a new nurse beginning practice? 3. Do you see any differences between new graduate nurses you have hired who have had DEU experience as an undergraduate nursing student from those who have not? If so, please explain. Thematic analysis of these semi-structured interviews defined competency as comfort communicating with patients, safe practice, being organized, prioritization, caring, compassionate, confident, knowledgeable, empathetic, prepared, strong clinical skills, critical thinker, and experience. Qualities contributing to a successful transition for a NGN identified as confidence, empathy, safe practice, willingness to learn, caring, knowledgeable, prepared, open minded and possessing the ability to think critically. Differences identified between NGNs with DEU experience from those without DEU experience included NGNs being more engaged and willing to learn, more confident and comfortable within the professional environment and possessing stronger leadership skills, including critical thinking skills, delegation and communicating and collaborating with patients, families, unit staff and physicians and decreased orientation time. One Nurse Manager described NGNs with DEU experience as being “2 months ahead of their non-DEU peers.”
This is the first known mixed method study to examine outcomes of a DEU on New Graduate Nurses’ (NGNs’) transition to practice. This study generates new knowledge as it highlights the positive impact collaborative clinical teaching models can have on preparing NGNs for practice. Limitations of this study include that is was conducted at only one BSN program with a history of implementing DEUs at one major medical center, self-reports are vulnerable to bias and lack of specific recall, survey sample size response was low, and challenges are inherent in quantifying NGNs’ experiences as they transition from student to practicing professional. Future Recommendations include identifying innovative strategies to support new graduate nurses’ transition into practice, further exploring the impact of the DEU clinical teaching model on preparing new graduate nurses for practice as well as costs and benefits for implementing DEUs and developing measurement tools to better assess collaborative clinical teaching models on NGNs’ transition.
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