With the success of the dedicated educational nursing clinical units (DEU) within the VA Boston Healthcare system, academic-practice partners reached a decision to expand and revise the model to include senior nursing students completing their capstone experience (Glynn, 2016). Traditionally senior BSN students are placed with an experienced nurse for a one-to-one precepted clinical rotation during their final semester. The goal of clinical experience is to provide an intensive, individualized clinical learning opportunity to improve clinical competence and clinical judgment as the students nurse transitions to professional practice. The challenges of the traditional model is the availability and willingness of experienced staff nurses to work with nursing students and the significant time commitment. The decision to establish and implement a Senior Capstone DEU to provide students with a positive clinical learning environment and to enhance the experience of the practicing clinical nurses in the role of nurse educator was agreed upon.
Senior preceptorship is a valuable experience between an experienced nurse and a senior nursing student(Rogan, 2009). The preceptorship is a clinical experience in a baccalaureate nursing program to guide students in applying their knowledge and skills typically on a medical surgical unit. Clinical staff nurses serve in the preceptor role to assist nursing students in patient care, delegation and decision-making skills. Academic educators develop the course objectives, support the preceptors and oversee the students. The preceptorship is a teaching method that is used by 85.9% of professional schools in the United States offering a Bachelor of Science in Nursing (BSN) education(Altmann, 2006).
Professional nursing needs competent providers and nursing students must demonstrate proficiency in practice prior to graduation. Nurse preceptors play a vital role in transitioning students from the classroom to the bedside. However due to the forecasted nursing shortage, the precepted experience is in jeopardy due to a shortage of qualified nurses, increased need for staff orientations, role frustration and nursing burnout (Spann, 2005). According to American Association of Colleges of Nursing 2014-2015 report, U.S. nursing schools turned away nearly 70,000 qualified applicants from baccalaureate and graduate nursing programs due to lack of faculty, clinical site, clinical preceptors and budget constraints (Nursing, 2014-2015).
The traditional senior preceptor model is a one-to-one relationship between a nursing student and an experienced nurse who is employed by a health care agency. It is time limited with the goal to provide an intensive individualized clinical learning opportunity to improve clinical competence and clinical judgment. An alternative nursing clinical educational model is the Dedicated Educational Unit (DEU). A DEU is an example of an academic-practice partnership designed to provide students with a positive clinical learning environment. A DEU is described as an optimal teaching and learning environment through the collaborative efforts of nurses, management and faculty (Moscato, 2007). The goal is to maximize the learning outcomes not only of students, but also of practicing clinical nurses in the role of nurse educator (Moscato, 2007).
The VA Boston Healthcare System is a leader in the education of nursing students. The VA Boston has established DEUs for sophomore and junior nursing students on acute care and chronic care units. Consistent with the literature, the DEU experience at the VA Boston has documented successful outcomes(Mulready-Shick, 2014). To date, there is limited research evaluating the use of a DEU model for a Senior Capstone experience and an analysis of the staff nurses’ perceived outcomes of the clinical experience. The utilization of the DEU model for a senior nursing student experience is an effort to continue to develop experienced clinical nurses, expand the care provided to the Veteran population, to enhance the availability of nurses to serve as clinical preceptors, and enable senior nursing students to transition to practice.
Methods:
This descriptive study which took place in the spring 2016. The study was reviewed and deemed exempt by the VA Boston IRB. Simmons College, in partnership with the VA Boston, embarked on a collaborative effort to bring a Senior Capstone Dedicated Education Unit to an acute medical unit. A total of 40 senior nursing students from a variety of Boston area colleges completed their senior capstone at the Boston VA during the spring semester. Twelve of the nursing students were assigned to the Senior DEU unit. To gauge staff interest, an email was sent out to staff of the acute medical unit with the following inclusion criteria: at least three years of clinical experience, works at least twenty-four hours per week and will not be on any type of leave for more than two consecutive weeks during the semester. Names of interested candidates who met criteria were then forwarded to the program director and school representative to initiate the process of preceptor selection and student pairing.
Staff nurses participating in the research were oriented to the preceptor’s role and clinical educational objectives. A DEU instructor power point was developed that touched upon the history of the DEU, the unique advantages it affords the students and staff. Benefits to the unit and affiliated institution are clearly spelled out. The paradigm shift from the traditional model of clinical instruction to the new DEU model was compared side by side to show the forward thinking and evolution in nursing education. The DEU instructor power point education was rooted in Malcom Knowles adult learning theory of andragogy, with the goal of maximizing learning outcomes for the educators.
At the close of the 2016 spring semester, staff nurses serving as clinical educators to senior nursing students in the DEU setting and traditional preceptor experiences were surveyed. Staff nurses serving as clinical educators were asked to complete a Qualtrics® Survey tool to assess their satisfaction and confidence in the clinical instructor role. Staff nurses at VA Boston were invited via email to participate in the confidential, voluntary online survey. In order to ensure statistically significant response rate, reminder emails were sent out at the beginning of week two and three. The survey utilized the Likert scale for 14 questions to allow for additional comments if applicable, while 7 questions focused on demographics. Descriptive and Analysis of Variance were used to determine that staff nurses’ perception of the student outcomes, clinical teaching experience and effectiveness of the alternative senior experience.
Results:
A total of 23 clinical nurses participated in the survey. Eleven of the clinical nurses precepted senior nursing students in a traditional preceptor experience and twelve clinical nurses precepted students in the DEU Senior Capstone model. The majority of the nurses reported a minimum of 6 years of nursing experience and with an academic preparation of BSN.
The nurse were asked a series of questions related to the senior student experience. The questions included clinical role expectations, academic partner support, available learning opportunities for students, leaning atmosphere on the clinical unit, integration of students on the patient care unit, development of critical thinking and clinical reasoning skills, necessary available resources, and preparation of the students for professional practice. Although the sample size was limiting in this study, no statistical significance was found in the staff nurses perceptions of the senior capstone DEU experiences versus the traditional one-to-one precepted experience.
Conclusion:
Based on available data regarding the projected nursing shortages, the need for academic nursing faculty and qualified clinical preceptors will continue to grow. The utilization of the DEU model for a senior capstone experience is a possible solution to assist senior nursing students transition to professional practice. The results of the pilot study demonstrated no perceived difference in student outcomes when comparing the DEU experience to a traditional one-to-one senior preceptorship.
However, nursing leadership reports a change in the moral on the unit and a willingness to work with students in the Senior DEU model. As the students were assigned to all shifts with their staff nurses, leadership reports a sense of “teamwork and education” that was not present in the past. The nurse manager found that precepting in the DEU model was not viewed as a burden and researchers are now evaluating patient care outcomes on the acute medical unit.
This study will be repeated and plans to expand the model to other acute care units are being organized. Researchers are hopeful to capture the sense of “teamwork, improved moral, and education” in future studies.