Quality by design: The hybrid Dedicated Education Unit (DEU)

Stacy Fusner DNP, RN

Objectives

At the end of the presentation the participant will be able to:• Discuss the rationale for establishing a hybrid dedicated education unit• Describe the process for establishing a hybrid dedicated education unit• Identify the various roles within the hybrid dedicated education unit

Two Basic Clinical Learning Models

• Traditional Clinical Model

• Preceptor Model

Clinical Learning Models

Traditional Clinical ModelThe Framework:

• Academic-practice partnership formed between a College of Nursing, the academic partner and a Healthcare Organization, the practice partner.

• 8-10 nursing students: 1 clinical faculty• Student collaborates with nurse based on assignment • Clinical faculty present throughout clinical experience• Nurse not required to have minimal level of experience • Clinical faculty oversees student skills• Clinical faculty performs evaluations of competencies for nursing students

TRADITIONAL CLINICAL MODELPOSITIVE PERSPECTIVES

Nursing Perspective:

• Not always assigned a student/same student

• Decreased workload

• Not everyone enjoys teaching students

• Personality differences

• Not responsible for evaluating student

Student Perspective:

• Assigned patients with new RN each week

• Experience different nursing styles

• Peer socialization/support

• Faculty instructor available to turn to with questions

Faculty Perspective:

• Dedicated percentage of work week spent in clinical setting

• Partnership between academic partner and practice partner

• Promoting diverse learning experience for students with variety of patients and nurses

• Active role in evaluating student

TRADITIONAL CLINICAL MODELNEGATIVE PERSPECTIVES

Nursing Perspective:

• Nurses not familiar with faculty

• Nurses not familiar with course objectives

• Nurses lack training in nursing education

Student Perspective:

• Less time receiving 1:1 instruction & guidance

• Decreased understanding of time management with multiple patient load

Faculty Perspective:

• May not be familiar with unit/population/staff

• Difficulty fairly distributing time between 8-10 students

Preceptor Clinical ModelThe Framework:

• Academic-practice partnership formed between a College of Nursing, the academic partner and a Healthcare Organization, the practice partner.

• 1-2 nursing students: 1 staff nurse • Clinical faculty typically NOT present during the clinical experience• Staff nurse performs evaluations of competencies for nursing students with minimal input

from faculty• Students typically assigned with the same nurse each clinical day• Staff nurse required to have minimum of 2 years RN experience • Staff nurse oversees student clinical skills

PRECEPTOR CLINICAL MODELPOSITIVE PERSPECTIVES

Nursing Perspective:

• Increased leadership and role modeling experience

• Enjoy teaching

• Change of pace/flow of day to day

• Rewarding

• Refreshes basics- policies, guidelines, skills

Student Perspective:

• Increased 1:1 or 2:1 learning

• Experience realistic nursing day

• Increased patient care and skill opportunities

Faculty Perspective:

• Less required time on the unit

• Not directly responsible for students’ skills or care provided on the unit

• Increased time to encourage critical thinking skills in 1:1 informal meetings

PRECEPTOR MODELNEGATIVE PERSPECTIVES

Nursing Perspective:

• Staff nurses may not have educator training.

• Staff nurses may not know course objectives.

• May not know how to evaluate.

• Limited preceptors.

Student Perspective:

• Only one preceptor experience

• Poor fit between preceptor/student

• Limited connection between clinical and classroom

Faculty Perspective:

• Difficulty determining student success in precepted clinical due to lack of direct involvement.

• Increased student load with less face to face time with each student

• Lacking united partnership

WE NEED A MODEL THAT:

• Increases 1:1 instructional time with trained educator

• Increases exposure to various nursing styles

• Designated nursing staff for clinical education

• Peer support for students (not isolated on unit without fellow students)

• Exposure to nursing patient load

• Feedback from multiple individuals

DEU Clinical ModelThe Framework:

• Academic-practice partnership between a College of Nursing, the academic partner and a Healthcare Organization, the practice partner.

• Typically only one academic-partnership occur with the unit.• Unit that uses qualified nursing staff as primary clinical educators. • Similarities to a preceptor model, except:

• ENTIRE UNIT consumed with purpose of educating students. • Faculty clinical instructor typically NOT present during the clinical experience • Staff nurses responsible for evaluation of competencies for nursing students.

DEU CLINICAL MODELPOSITIVE PERSPECTIVES

Nursing Perspective:

• Engages staff into educator role/professional advancement

• Reduces new nurse orientation when precepted students are hired

• Improved new graduate retention rates

• Increased identification and application of EBP

• Improved patient outcomes

Student Perspective:

• Positive student outcomes with increased 1:1 learning

• Better prepares nurses with increased exposure to patient care/skills

• Reduced learning curve when hired on same unit

Faculty Perspective:

• Reduces need for faculty on clinical unit

• Not solely responsible for student evaluation with staff providing day to day assessment and evaluation feedback

DEU CLINICAL MODELNEGATIVE PERSPECTIVES

Nursing Perspective:

• Increased workload for staff nurses

• Entire unit consumed with purpose of educating students• Nurses who do not want to

educate or may not be a good fit.

• Must be qualified according to state guidelines

• Less experience with student assessment and evaluation

Student Perspective:

• Lack of faculty guidance

• Decreased alignment with specific course objectives

• Less focused feedback due to nurses lacking experience with assessment and evaluation

Faculty Perspective:

• Weakens partnership between academic partner and practice partner due to lack of faculty presence

• Faculty time not dedicated to clinical teaching each week

HYBRID DEU ModelThe Framework:

• Academic-practice partnership between a College of Nursing, the academic partner and a Healthcare Organization, the practice partner.

• Maximum of 10 nursing students on the unit at a time, with 1 faculty clinical instructor PRESENT at ALL TIMES.

• Qualified staff nurses assigned a maximum of 2 nursing students for clinical shift. • Unit that incorporates BOTH qualified nursing staff as clinical educators AND faculty

clinical instructors. • Faculty clinical instructors responsible for competency evaluation of nursing students

with feedback from staff nurse mentors.

HYBRID DEU CLINICAL MODELPOSITIVE PERSPECTIVES

Nursing Perspective:

• Engages staff into educator role if wanted/good fit

• Reduces new nurse orientation when precepted students are hired

• Improved new graduate retention rates

• Increased identification and application of EBP

• Improved patient outcomes

• Immediate support from faculty clinical instructor

Student Perspective:

• Positive student outcomes with increased 1:1 learning

• Better prepares nurses with increased exposure to patient care/skills

• Reduced learning curve when hired on same unit

• Peer socialization/support still present

• Students get a different educator each week at clinical.

• Well-rounded feedback from academic instructor with input from staff nurse mentor

Faculty Perspective:

• Dedicated weekly time spent on clinical unit

• Responsible for student evaluation with input from nurse mentors providing day to day feedback

• Partnership between academic setting and practice setting strengthened

HYBRID DEU CLINICAL MODELNEGATIVE PERSPECTIVES

Nursing Perspective:

• Increased workload for staff nurses.

• Need to complete training and practice EBP standards according to CON.

Student Perspective:

• Not all staff nurses are educators on the unit, may not see all EBP standards.

• Limited to qualified staff nurse educators availability weekly.

Faculty Perspective:

• Not reducing need for faculty in clinical setting

• Not all staff nurses are qualified educators.

WHY THIS MODEL?• Allow a stronger academic-practice partnership to form.

• Maximize the potential benefits for all individuals involved.

• Having a faculty clinical instructor present, permits staff nurse mentors to fully engage in educating students, without the constraints of formally evaluating student outcomes.

• Faculty clinical instructors serve as an immediate resource and coach for staff nurse mentors, allowing for additional evidence-based practice methods to be implemented.

QUALITY BY DESIGN:ESTABLISHING THE HYBRID

DEU

THE IOWA MODEL

STEP 1:IDENTIFY THE PROBLEM

We need new clinical learning models.

Proposal: The Hybrid DEU

STEP 2: FORMING THE

TEAM

Academic

Dean/Director

DEU coordinator

Faculty Clinical Instructors

Students

Practice

Director/CNO

DEU coordinator

Unit Managers

Staff Nurses

Patients???

STEP 3: EVIDENCE RETRIEVAL

Improves student satisfaction and learning with increased engagement in the nursing role

Provide educational experiences that refine clinical outcomes and increase EBP

Improved nurse leadership, mentorship, and professional development

Better preparing students to enter the workforce

Improves academic-practice partnerships-maximized benefits for all individuals involved

STEP 4: GRADING THE EVIDENCE• The fourth step dictated the assembly, synthesis, and critical appraisal of research.

STEP 5: DEVELOPING AN EBP STANDARD

The fifth step supported the fact that there was sufficient evidence to warrant practice change from a traditional clinical nursing education to a DEU model.

Rapid Critical Appraisal

1) Are the results of the study valid- rigorous research methods

2) What are the results and are they important? - impact of intervention on outcomes and likelihood of similar

results in different setting 3) Will the results help me?- applicability, feasibility, values

and preferences

Appraisal Results

1) Effectiveness-2) Appropriateness

3) Feasibility

STEP 6: IMPLEMENTATION

Where do we start?1. Gain buy-in from both sides.

2. Determine the units to transform based on interest and suitability for course objectives.

3. Identify roles/main players

4. Establish training for main players

5. Educate students on hDEU expectations

STEP 6: IMPLEMENTATION

1. Gain buy-in from both sides.

• Identify barriers and facilitators• Elicit feedback from team• Diffusion of evidence/support

for change

2. Determine the units to transform. • Based on unit interest in DEU• Based on unit acuity/suitability

related to course objectives

3. Identifying the main players

DEU Coordinators: • Communication between the

partnership• Provide training to faculty or staff

RN• Coordinating schedules

Staff Nurse Educators:• Supervise direct hands-on

education to nursing students

• Assist with evaluation each shift

Faculty Clinical Instructors:• Assist with direct hands-on

education • Support/coach staff nurse

educators• Formal student evaluation

STEP 6: IMPLEMENTATION

STEP 6: IMPLEMENTATION

4. Establish training for staff nurse educators:• Online (15 min sections), CE approved.

• Main Topics: • Framework of hDEU• Defining hDEU roles & specific role

descriptions• Policy & regulations• Principles of teaching• Critical thinking/critical reasoning• EBP• Evaluation process

5. Educate students on hDEUexpectations:• Competition-based learning (CBL)

• Handbook

• Discuss in course

STEP 7: EVALUATIONCreating and sustaining quality learning environments

• Re-evaluating from student, faculty, and nursing perspective. • satisfaction surveys

• unit retention as hDEU

• student retention and successful completion of clinical component of nursing program

• feedback on student preparedness for employment

• hiring rate of students onto hDEU

• Ongoing evaluation of barriers and facilitators to encourage ongoing sustainability and new implementation on other units

SUMMING IT UPRationale for hybrid dedicated education unit: • Limitations of Traditional Clinical Model, Preceptor Clinical Model, Designated

Education Unit Clinical Model• Incorporation of strengths of these models into hDEU

Process for establishing hybrid dedicated education unit: • Iowa Model: Identify Problem, Form Team, Retrieve Evidence, Grade Evidence,

EBP Standard, Implementation, Evaluation

Roles within the hybrid dedicated education unit:• DEU Coordinator• Staff Nurse Educators• Faculty Clinical Instructors

REFERENCES• Casey, M., Hale, J., Jamieson, I., Sims, D., Whittle, R., & Kilkenny, T. (2008). Dedicated education units -- a new

way of supporting clinical learning. Kai Tiaki Nursing New Zealand, 14(11), 24-25.

• Hunt, D., Milani, M., & Wilson, S. (2015). Dedicated education units: An innovative model for clinical education. American Nurse Today, (10)5.

• Moscato, S., Miller, J., Logsdon, K., Weinberg, S., & Chorpenning, L. (2007). Dedicated education unit: an innovative clinical partner education model. Nurse Outlook, (55), 31–37.

• Ranse, K. & Grealish, L. (2007). Nursing students’ perceptions of learning in the clinical setting of the Dedicated Education Unit. Journal of Advanced Nursing, 58(2), 171-9.

• Rhodes, M., Meyers, C., & Underhill, M. (2012). Evaluation outcomes of a dedicated education unit in a baccalaureate nursing program. Journal of Professional Nursing, 28(4): 223-230. doi:10.1016/j.profnurs.2011.11.019

• Saarikoski M., Isoaho H., Warne T. & Leino-Kilpi H. 2008. The Nurse Teacher in clinical practice: developing the new sub-dimension to Clinical Learning Environment and Supervision (CLES) scale. International Journal of Nursing Studies, 45, 1233-1237.

• Smyer, T., Gatlin, T., Tan, R., Tejada, M., & Feng, D. (2015). Academic outcome measures of a dedicated education unit over time. Nurse Educator, 40(6): 294-297. doi:10.1097/NNE.0000000000000176

• Springer, P., Johnson, P., Lind, B., Walker, E., Clavelle, J., & Jensen, N. (2012). The Idaho dedicated education unit model cost-effective, high-quality education. Nurse Educator, 37(6), 262-267. doi:10.1097/NNE.0b013e31826f2c4e

Stacy Fusner DNP, RNAssistant Professor of Clinical PracticeThe Ohio State University, College of NursingOffice Phone: 614-292-4917fusner.7@osu.edu