Jamie Sharp, a 21-year-old University of Portland (UP) nursing student who has performed clinical rotations in a variety of units, remembers a particularly unpleasant experience in a psychiatric unit where she felt she was “in the way” of her nurse preceptors. This was in stark contrast to her experience on a neurovascular unit at Providence St. Vincent Medical Center, where she had just one clinical instructor, a nurse who was eager to teach her.
That neurovascular unit was a dedicated education unit (DEU). Created in Australia in the late 1990s and launched in the United States at UP in 2003, the DEU model joins a school of nursing with units at local hospitals, where experienced staff nurses become clinical instructors of juniors and seniors in the bachelor’s degree program. Each instructor teaches no more than two students at a time, but the DEU can be used around the clock.
With a DEU, a nursing school can “cultivate a unit” as an excellent learning environment, said UP’s dean of nursing, Joanne Warner, PhD, RN, FAAN. Most important, she added, is “the expertise of the nurses there—they know the clinical procedures, the current medications, the policies of the hospital.” The DEU differs from a usual clinical rotation in the relationship that develops between instructor and student, something that cannot take place when a preceptor has eight students that change from week to week. The instructor gets to know the strengths and weaknesses of the student and supports the student in building confidence and relevant knowledge and skills.
Ms. Sharp was paired with Cathy Mead, ADN, RN, a nurse with 25 years of experience in the unit who received clinical instructor training from the nursing school. Her instruction is overseen by both a university faculty member and the unit’s nurse manager.
Dr. Warner said that the benefits to her school and to students are quite tangible: “We have tripled our enrollment. If we had a traditional model I would not have the budget to hire the clinical faculty needed.” The number of students on clinical rotations increased from 227 in 14 units in 2002, before the DEUs were implemented, to 333 in 6 units in 2006, after the DEUs were instituted (Moscato et al., 2007). Now, up to 60 percent of a UP nursing student’s clinical rotations take place in DEUs. But equally important, the students report learning more in DEUs and are seeking clinical placements on them.
It might appear that the university profits far more than the hospital—especially since nearly 40,000 qualified applicants were turned away from baccalaureate nursing programs in 2009 because of shortages of faculty and clinical teaching sites (AACN, 2009c)—but that is not the case, said Cindy Lorion, MSN, RN, nurse manager of the neurovascular and orthopedic units at Providence St. Vincent Medical Center. The clinical instructors are enthusiastic about their new role. They receive adjunct faculty appointments at UP, gaining such benefits as library access but no additional pay from the university (some but not all facilities increase a clinical instructor’s salary).
Ms. Lorion has seen an increase in evidence-based practice and in the retention of nurses, as well as better-prepared graduates, many of whom seek jobs at the hospital. She also said that “a village” grows around the students, with everyone from physicians to nurses’ aides taking part in “raising” them.
The partnership has led to changes in teaching and in clinical care. After a student made an error by injecting a medication into the wrong tube, the hospital changed its policy on syringe placement, and the school added a “tubes lab” to its courses.
A limited number of available clinical training sites in some areas may hamper widespread use of the model, and some units may take students on reluctantly, requiring a change in organizational culture. Nonetheless, more than 100 schools of nursing participated in an international symposium on DEUs in 2007, and more than 20 are developing their own DEUs.
After 25 years as a nurse, Ms. Mead is pursuing her bachelor’s degree. “I definitely have to keep it fresh,” she said of the challenge of working with students like Ms. Sharp. “And not everyone can say that after being on the same unit for years.”