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Breaking the Rules: Redesigning the Educational Endeavor for Nursing School of Nursing & Health Professions Judith F. Karshmer, PhD, APRN Dean & Professor

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Common Rules in Nursing Education 1.Dont re-invent the wheel...

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2. Start clinical experiences with simple patients (i.e., those in long-term care). Common Rules in Nursing Education

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3. Make patient assignments (instead of nurse assignments). Common Rules in Nursing Education

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4. Hone the nursing skill-set in a structured in-patient setting before expanding to the more fluid ambulatory care setting. Common Rules in Nursing Education

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5. Affirm that clinical instructors are faculty- their relationship with the setting is secondary. Common Rules in Nursing Education

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6. Value breadth across an array of practice cultures rather than depth within one. Common Rules in Nursing Education

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7. Value real patient experiences over simulated ones. Common Rules in Nursing Education

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8. Treat hours of clinical time as equal, regardless of the experiences made available. Common Rules in Nursing Education

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9. Supervise students interprofessional communication. Common Rules in Nursing Education

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10. Always require a pre-lab the day before clinical so the student can prepare a well- researched plan of care. Common Rules in Nursing Education

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11. Use clinical rotation times that are different from the work day of the facility. Common Rules in Nursing Education

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12. Focus on getting the work done, rather than on seeking learning opportunities. Common Rules in Nursing Education

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The Future is NOW TIME TO BREAK THE RULES

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Now Questions Where is healthcare taking place? Who are the patients? What is the reimbursement model? What are the expectations of the patient; the provider? Who is providing it?

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Now Answers Ambulatory, transitional & home care settings An educated consumer Capitated = health promotion + keeping the patient at home Accessibility, connectivity, & data Who IS providing the care??

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If nursing education does not change and start preparing the nurse for ambulatory & transitional care & the home health and clinic settings it will be: CHWs Team-lets Tele-health Consortia

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So which rules do we break? ALL OF THEM!

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We need to re-invent the wheel... Preparing the nurse must be preparing for the future.

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We need to start students in the settings where they will practice: Out-patient and community clinics Home health/hospice Schools/health departments Transitional care programs

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We need to assign students to nurses and other professionals: Preceptor/apprentice model IPE joint appointments Faculty as coach to provider dyads

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We need to question the impact of focusing on the skill-set rather than the knowledge base & clinical decision making. Provide integrated skill development in simulated settings as prep for practice

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We need to move away from the arbitrary division among the nurse, preceptor, & faculty roles. Develop academic-practice partnerships in which faculty and staff are one in the same.

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We need to stop moving students from setting to setting. Expand the academic-practice partnerships so the student is a key part of the Health Care Home Nurses carrying patient panels

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We need to exploit the power of simulation. Simulated experiences: Standardized patients IPE High-fidelity simulators Simulated systems

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We must stop treating hours of clinical time as equal. Competency Based Education

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We must require interprofessional communication as a standard. IPE simulations IP practice = required

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We cant continue to set an expectation that nursing practice is static. Mobile devises for prep Point of Care learning Treatment & teaching Apps

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We must stop treating the clinical sites like real estate & demanding time to match academic schedules. Link student time with agency personnel time Use staff/faculty partners

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We must stop evaluating students on getting the work done. Focus on demonstrating competencies & learning

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USF Lessons Learned Transition to Practice (T2P) Programs in Ambulatory Care, Home Health, & School Nursing 16-week program: precepted clinical 20hr/week + class & simulation 1day/week

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USF Lessons Learned Partnerships School districts Home health agencies Hospice Community clinics; FQHCs Specially clinics Transitional care programs Urgent care centers New Graduates = Jobs 100+

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USF Lessons Learned Push Back What can they do? How much time will they take? How safe are they? State and agency regulations.

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USF Lessons Learned Success: 40+ Partnerships 5 (& counting) cohorts 100+ jobs for new graduates in these non-traditional settings!

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USF Lessons Learned BSN collaborative with VA to prepare the nurse of the future. 20%-80% not 80%-20%

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USF Lessons Learned Masters entry program for CNLs to prepare for ambulatory care & home health. Preceptors = faculty/staff

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Change is easy its keeping the status quo thats so hard!

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Questions?