By Debra Wood, RN, contributor
Oct. 6, 2009 - Designed to enrich students' clinical experience and expand nursing school capacity, the dedicated education unit model which has staff nurses serving as clinical instructors is catching on.
“I felt totally a part of the team and got to work with different aspects of care,” said Richard Botterill, a student at the University of Portland (Oregon) School of Nursing, which pioneered the dedicated education unit in the United States.
Botterill completed his first clinical rotation on a diabetes-renal unit at Providence Portland Medical Center and is in the midst of his second rotation on an orthopaedic floor at Providence St. Vincent Medical Center, also in Portland. A specially trained staff nurse on each unit served as his clinical instructor (CI).
Each staff nurse in the unit is responsible for two students, who each start out with one patient. After the students’ skills improve, they are assigned two patients. Rotations may take place on any shift.
“We went through everything we learned in our [class] education,” Botterill said. “The thing that stuck out was how the nurses guiding us through the experience had a sense of when to let go and let you do something and when to stop and give guidance. It was extraordinary.”
While students are assigned a specific clinical instructor, Botterill said all of the nurses on the floor welcomed questions and took the time to answer. Hospitalists, the pharmacist and the wound care nurse practitioner also spent time with him, offering opportunities to observe and learn.
Susan Randles Moscato, EdD, RN, credits dedicated education units with allowing the school to triple its enrollment and maintain high educational outcomes.
“We have a great deal of anecdotal evidence about its effectiveness,” said Susan Randles Moscato, EdD, RN, associate dean of the University of Portland School of Nursing. “A key outcome is that we have been able to triple our enrollment because of the dedicated education units, and we have high satisfaction of our students. Our pass rate is about 96 percent. Excellent outcomes. We attribute a huge percent of the success to the dedicated education units.”
Moscato called the collaborative partnership with the Providence Health & Services hospitals and the Portland VA Medical Center key to achieving the outcomes. The clinical instructors remain employees of the hospital.
“Their clinical experience is very efficient, and [students] establish a relationship with that nurse,” Moscato said. “The unit accepts the role of supporting the CI as the CI teaches the student.”
Several other universities have started dedicated education units; Moscato estimates the number at five or six. Nursing schools at the University of Massachusetts Boston and the University at Buffalo-State University of New York started assigning students to dedicated units last year.
“It really gets them into the clinical area and quickly caring for patients along with the experienced nurse,” said Patty Rossi, RN, a nurse manager on a dedicated education unit at Brigham and Women’s Hospital in Boston. “At first they are overwhelmed. But as they get into the rhythm, they are learning quickly.”
Massachusetts General Hospital in Boston also partners with UMass Boston. CIs receive an adjunct faculty appointment, stipend and support from the school.
Theresa Capodilupo, RN, MSN, director of surgical trauma, reports advantages on all levels, coupling the old immersion concept from diploma programs with a robust academic experience.
“It helps bridge the gap between practice and academics,” Capolilupo said. “People current at the bedside are doing the clinical instruction, so the students are getting current insights. It has stimulated my staff to continue their education.”
Rossi said the nurses and students establish an intense relationship. The CIs get to know the students’ strengths and adjust assignments accordingly. At the end of the shift, the clinical instructor and student debrief and discuss the day in depth. The learning goes both ways.
“The experienced clinical nurse is sharing his or her experience, the student is fresh from the books, so it’s reciprocal learning,” Rossi said. “There’s much more learning taking place.”
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