Over the past decade, health care leaders have called for a radical transformation in health care and nursing education. The 2010 Institute of Medicine Future of Nursing Report identified the need for change in nursing practice and nursing education (IOM, 2010). The report acknowledged specific goals related to an increased number of baccalaureate prepared nurses and implementation of nurse residency programs. In order to achieve these goals, academic and practice partnerships have been formed. The desired outcomes of the partnerships are to increase nursing student and practicing nurse’s satisfaction and performance, to increase research initiatives and to improve patient outcomes (Beal, 2011). With an increased acuity in patient care, the traditional “clinical placement model” is ineffective in preparing the nurse of the future for practice. Nurse educators are being challenged to develop new delivery systems of education to meet the goals of the IOM Report. Nursing education must immerse the student in the “real life” of the practice of nursing in order to prepare a proficient nursing workforce (Benner, Sutphen, Leonard & Day, 2010).
Patient care has become complex demanding succinct interprofessional communication and collaboration to optimize the care of the patient and the nurse at the bedside is the optimal leader at the point of care. Assistance with the clinical reasoning and critical thinking with nursing students is pivotal for successful patient outcomes. The expert clinical nurse at the bedside is the premier faculty to guide the young practitioner in the care of the patient.
The preceptor/clinical instructor role in undergraduate nursing education is complex and multifaceted. Undergraduate nursing students identify preceptors/clinical instructor as key to their learning in the clinical setting; however, staff nurse preceptors often feel unprepared to serve in this role (McClure & Black, 2013). Clinical educators are required to connect the classroom knowledge with the clinical practice requirement and support the students as they through both experiential and situated learning on the nursing units (Benner et al, 2010).
A Dedicated Educational Unit (DEU) is an example of an academic-practice partnership designed to provide students with a positive clinical learning environment. A DEU is defined as an “optimal teaching/learning environment through the collaborative efforts of nurses, management and faculty (Moscato, et al 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, et al 2007). In the DEU model, an expert nurse is responsible for the clinical education of 2 nursing students. The expert nurse, referred to as a Clinical Instructor (CI), provides instruction related to clinical skills and critical thinking to the nursing students in an integrated job-embedded manner (Nishiola, et al, 2014).
The nursing student’s successful outcomes in the DEU model have been well documented (Mulready-Shich & Flanagan, 2014; Edgecome & Bowden, 2013; Moore & Nahigian, 2013). However, little research has been completed evaluating the CIs perceptions of the role and perceived learning needs. The purpose of this research study was to identify the role perceptions of staff nurse’s participating as clinical instructors on a DEU and the perceived educational learning needs of the experienced staff nurses.
Methods:
The study took place at the VA Boston Healthcare System. The VA Boston has a unique academic-practice partnership which includes 6 colleges of nursing. After IRB approval, staff nurses serving in the role of clinical instructors were asked to participate in the interview process. Interview questions were developed to capture the perceived role perceptions of staff nurses participating as clinical instructors on a DEU and the perceived educational learning needs of the staff nurses. Participation in the study was voluntary and the clinical instructors remained anonymous. All clinical instructors were invited to participate regarding of the academic affiliation on the DEU. A total of 8 nurses participated in the study. The audiotapes were transcribed verbatim. Content analyses were used to code and synthesize common themes from the interviews.
Results:
The three themes which emerged regarding the perceptions of the role of clinical instructor by participating staff nurses on a DEU were mentoring, ensuring competency with basic skills and tasks and the critical thinking component of nursing education.
The themes which emerged related to the perceived learning needs of staff nurses participating in the role of clinical instructor on a DEU were clear objectives from the academic affiliate, more coordination and acknowledgement by the academic affiliate of the clinical instructor role and additional education in dealing with students with diverse learning needs and accommodations. An additional theme related to the commitment by all partners to work together was identified during the interviews. The CIs reported the need for a staffing commitment on the units to support the learning needs of the students and the staff nurses.
Conclusion:
The DEU model represents an important collaboration between academic and practice partnerships. The restructuring of traditional nursing clinical education will allow for the nursing students to participate in high quality care and be valued on the patient care unit. The expert staff nurses are allowed to expand their expertise and develop effective teaching skills. The traditional clinical faculty role is transformed to a position of coaching and support for the CIs. These efforts will have an important impact on nursing clinical education and the potential to reduce the clinical faculty shortage.
The Academic-Practice Partnerships must demonstrate a commitment to provide the infrastructure necessary to support the nursing students and the staff nurses serving in the role of CI. AACN recognizes that academic-practice partnerships are an excellent forum to bring both partners to the table and provide involvement in both selections of nursing students and clinical instructors on the nursing care units. As the role of CI continues to expand, further research evaluating the development of clinical judgment and reasoning in nursing students needs to be measured in the DEU model.