University of Massachusetts, Boston, College of Nursing and Health Sciences

Project PDQ – Partnering for DEU Development and Quality

Principal Investigator: JoAnn Mulready-Shick, Ed.D., RN, CNE
Program Evaluator: Kathleen M. Flanagan, Ph.D., FBJ Consulting

Read Here for principal research project findings.

This project team evaluated the “Partnership for Dedicated Education Unit Development and Quality (PDQ)” program, an intervention implemented in 2007 by the University of Massachusetts, Boston and Partners Healthcare. The PDQ relies on a dedicated hospital unit in which staff nurses and nursing faculty take on new educational roles to deliver more efficient and effective clinical education to nursing students. Dr. Kathleen M. Flanagan from FBJ Consulting, led the evaluation and utilized a randomized design to assess the impact of the PDQ on faculty productivity, teaching capacity, work-life, institutional costs, and quality of education (including the breadth of education measure provided by the NPO); outcomes associated with the PDQ were compared to those achieved by the traditional clinical education units.

EIN Grantee Spotlight: University of Massachusetts, Evaluating the Dedicated Education Unit Model

U MassThe University of Massachusetts Boston (UMass Boston) research team recently completed work on their EIN-supported evaluation project, “Project PDQ: Partnering for Dedicated Education Unit (DEU) Development and Quality.” EIN staff interviewed principal investigator Dr. JoAnn Mulready-Shick (UMass Boston College of Nursing and Health Sciences) and Dr. Kathleen Flanagan, the EIN project evaluator, to learn more about their project outcomes. The researchers informed us that they are working on publications related to their findings; however, they offered to share some key highlights from their research.

Dr. JoAnnEIN: First, let’s talk briefly about the history and background of your intervention: what were the motivating factors that led to the decision by UMass Boston and its partners to adopt the Dedicated Education Unit (DEU) model? When did the process first begin?

PDQ: The overarching factor was a newly formed Academic-Practice Partnership between UMass Boston and Partners Healthcare in 2006 that was initiated at the Dean and Chief Nursing Officer (CNO) levels.  I had returned from an AACN conference in November 2006 and shared the idea with my Dean. This DEU taskforce and new clinical partnership began as one of three partnerships between UMass Boston and Partners Healthcare. The CNOs’ commitment began the DEU initiative.  One shared vision among DEU task force members and new partners was diversity, that is, increasing the numbers of underrepresented minorities, in the nursing workforce.  The DEUs became one potential mechanism for doing so because of the close working relationship between these students and the staff nurse instructor which fostered collegiality and bolstered the student’s confidence. Their integration on the patient care unit also helped students “imagine their future selves” as newly hired RNs in supportive working environments.

We began meeting regularly as a DEU clinical partnership in 2007, exploring each other’s common interests, formulating a shared set of agreements, and planning for DEU implementation.  Secondarily, we found we could benefit from each other’s presence in this partnership – to close the education-practice gap and mutually influence and positively affect outcomes in both academia and services – beginning with a shared goal in implementing quality and safety competency development and improvements at the unit level.  To learn more about the DEU model, representatives from the institutions attended the first University of Portland conference in 2007 and we returned with enthusiasm and initial ideas of how to get started.

  • For more on the history and background of the DEU at UMass Boston, visit HERE.
  • For a short video introducing the DEU unit at Massachusetts General Hospital, click HERE and scroll down to the headline: “The Center to Champion Nursing in America – Dedicated Education Unit.”

EIN: What types of buy-in and communications issues arose in developing the DEU unit and continue to be a part of the collaborative partnerships?

PDQ: Buy-in at all levels in both the education and practice setting is key – from CNO commitment, to the director and staff education levels, the nursing course and unit manager levels, and finally to the nursing staff and student levels – we are working together. Communication, transparency, and establishing trusting relationships are key components of all successful partnerships. We utilized a number of mechanisms, including: regularly scheduled meetings (rotating amongst our agencies), maintaining minutes, setting up telephone conferencing between meetings, and informal gatherings and dinners. A key element to move this initiative forward was regularly articulating, reviewing, and further refining the commitments we were making to one another and bringing concerns openly to the table.

DEU

EIN: How does your DEU model differ from the traditional model of clinical education? Can you also speak to how it differs from other current DEU models that have been implemented around the country?

PDQ: Staff nurses take on the role as the students’ clinical instructor (CI) in a ratio of 1 CI to 2 junior level students and the college faculty take on the new role of coaching staff nurses as clinical instructors. In Project PDQ, we limited our DEUs to the junior level and senior level acute, adult health courses. The model may differ from other DEUs regarding types of nursing units, number of CI participants per DEU, and numbers of CIs coached by each college faculty member. We have worked on one dosing question within Project PDQ: that is, for a faculty member who takes on the role of the Clinical Faculty Coordinator (CFC), what is the ideal number of staff nurse CIs to coach and what is the ideal number of students (greater than the traditional model of 8-10 students) to oversee, assess learning-wise and evaluate clinically. Although not a primary question in the study, we have learned more about this range of numbers on the types of units we used as DEUs.  Also, our nursing students most often return to the same nursing unit for the senior precepted experience and often to the same DEU instructor; this may be unlike other DEU implementations.  Our model maintains the foundational elements of other models yet varies in a number of additional ways.  For example, with the economic downturn other DEUs may have begun to attend less to addressing the nursing shortage and transitioning DEU graduates into newly licensed positions on the DEU unit or within the same institution. In our partnership, however, nurse managers have been keenly aware of the potential to hire DEU students as PCAs while in school and are making efforts to hire as many DEU graduates as possible, on the DEU units or within the institution.

As a tenet, our partnership also has a focus on quality and safety competency development and improvements. From the beginning we implemented quality improvement projects collaboratively – the students give QI presentations every semester to not only the DEU units and staff but to all nursing staff.  The success of these endeavors are demonstrated in our participation in Grand Rounds and creating substantive practice changes, although these outcomes were not a central focus of our evaluation study.  Furthermore, our college has been concerned with staff nurses returning to formal education. The DEU model of clinical education provides opportunities for staff nurses to become re-energized about learning while assisting students. We encourage them to take graduate level educator courses and also return for graduate education. Finally, our DEUs began small on a few units and large on a few others. We continue to work on finding the balance in numbers and determining growth in a way that makes sense for both the nursing education program and the nursing units.  Finally, our partnership is committed to education of both the students and nurses.  The college provides additional tuition waivers as incentives for graduate level nursing courses for the DEUs.

EIN: For your EIN evaluation project, can you summarize your project’s purpose and methodology used? As we understand it, a total of four DEUs and four traditional nursing units were included in your study over four semesters from 2010 to 2011.

PDQ: We studied the impacts of two clinical education models — the DEU and the traditional intervention — that take place in the first semester of students’ junior year.  The DEU model places students with a clinical instructor who is a staff nurse at the hospital and the traditional model places students with a clinical instructor who works for the university.  The student:instructor ratios differ: for the DEU it is 2:1 and for the traditional model it is 8:1.  The models differ in other ways besides the ratio of students to instructors.  The traditional model employs more of an a priori scope and sequence of clinical experiences while the clinical experiences in the DEU are more organic and arise from the daily patient care activities encountered by the staff nurse’s patient care assignment for that day.

EIN: And the methodology used?

PDQ: We conducted four separate randomized control studies (four semesters) by randomly assigning student participants to either the intervention (DEU) group or a traditional clinical education group within the same settings (66% of the students in the course elected to participate in the study). Those who did not participate in the study were assigned to a traditional clinical experience in other hospital settings.  We then compared survey responses and university measures by intervention group (DEU vs. Traditional) and by cohort.

We also conducted a mixed-methods evaluation to study the impact of the DEU model on the clinical instructors and the staff nurses on the DEU units, by eliciting responses from both DEU CIs and staff nurses, college faculty, CFCs, and our DEU partnership members.  We collected information on the nursing activities performed by DEU CIs and staff nurses when students were on the floor in these units for each cohort, and we collected interview and survey data from the nurses and clinical instructors each year.  We used the information collected from the nurses/clinical instructors in two ways: to provide context to the findings from the students, and also to describe how the DEU impacts the nursing units and the nurses.  This helped to provide an understanding of the viability and sustainability of the model.  Because the data collected from the nurses/CIs were descriptive, we triangulated the data sources and methods to take care to report findings that were repeated across the sources and the methods.

An additional benefit of the random assignment of students meant that DEU CIs’ experiences with  students were based on encounters with typical groups of students, and not based on hand-picked groups, for example, students with the highest GPAs. So in a sense subject selection effects were also ameliorated in the CI experience.

EIN: Your over-arching EIN research question was: “How does the DEU intervention support the development of new instructors (enhancing capacity), address faculty worklife (e.g., morale and retention) and enhance educational quality, within the local context and within an academic-service partnership?” We have some follow-up questions related to this:

What are the benefits of DEU model over traditional model on faculty worklife?

PDQ: In our study, we studied faculty with respect to the college nursing faculty, the CFCs and the clinical nurses serving as clinical instructors, the CIs.   We found that the DEU model itself had little bearing on the work lives of other college faculty not involved with DEU implementation, and much more bearing, obviously, on the work lives of the CFCs and the CIs directly involved with it.

With respect to the CIs, we found that the DEU model provides an avenue for greater professional attainments and greater professionalism for staff nurses who become clinical instructors.  The CIs report experiencing a heightened level of competency related to their work instructing students (a heightened meta-cognitive aspect to the work), greater on-the-job satisfaction related to working with students and increased opportunities for professional growth (“to a moderate extent” for the CIs vs. “to some extent” for the staff nurses on the DEUs).   There were no other role-based differences (nurses vs. CIs) on any of the other work life measures, indicating that both nurses and CIs reported comparable levels of job stress (on average, “somewhat stressful”), morale (“moderately positive”), and similar expectations of leaving their positions or even the field of nursing (“unlikely” to leave).

EIN: What key findings emerged in your study of the college faculty whose roles shifted to that of CFC on the DEU units, where they coached staff nurse CIs?

PDQ: We collected responses from the three CFCs over the course of our study.  These CFCs represented different stages of professional competency development, from “Competent” to “Expert.”  All three CFCs started their work as clinical instructors and advanced to the CFC position, and all reported missing the more direct and frequent interactions with students they enjoyed as CIs.  The lead CFC exemplified the expert status – this CFC oversaw the other two DEU CFCs, a portion of DEU CIs and all of the traditional clinical instructors on the team. She also served as the classroom faculty member and developed and taught a graduate-level course on clinical instruction.  This CFC worked with the other CFCs on processes for coaching and communicating with the CIs around a whole host of issues related to students’ clinical instruction, student interaction, organization of the clinical practicum time over the semester, supplemental clinical learning activities such as concept maps and quality improvement student presentations.  Much of the CFC’s work with CIs is focused on collaborative communications, and the CFCs reported increasing their skills in this area.  CFCs used this collaborative communication process to motivate CIs to enhance their instructional repertoire with students, particularly focusing on facilitating students’ critical thinking and reasoning skills development -

Project PDQ did collect quantitative attitudinal data from the CFCs that touched on work life satisfaction and work balance issues but because there were only three of them for most of the study we focused more on their interview responses which emphasized their weekly work more than their attitudes toward their work.   We can go back and analyze the attitudinal data more fully; however, we hesitate reporting on these data with such a small sample size.

EIN: Can you tell us about how faculty perceived the benefits of educational vouchers available to DEU nursing staff in order to continue their education?

PDQ: The college provided eight vouchers for online courses during the study period.  We had so many requests from both DEU CIs and other staff nurses on DEU units that we needed to create specific eligibility requirements. We could have used twice this number. We continue to get requests from staff nurses post the study period and partner members have begun to think about how to build upon that small success.  These online course vouchers were in addition to the usual tuition waivers the college provides to our agency partners. The college was able to provide additional waivers to the DEUs and a number of staff nurses and CIs take advantage of these each semester.

EIN: Did you experience any difficulty in attracting staff nurses to the clinical instructor (CI) role and to retain them in this role?

PDQ: Staff nurses reported becoming re-energized with taking on this new role. In Project PDQ, we elicited their concerns and suggestions about ongoing retention and recruitment. The challenge is to find the right “dose” or balance of DEU students and CIs for a particular nursing unit, given the unit’s particular readiness and capacity. We found that the natural break in having CIs take on seniors in alternating years reduces the amount of instructional time CIs put in and makes a positive difference in their attitudes toward the role.  Not all nurses on our DEUs participate; this may occur differently in other DEU models. We did also partner with a few Magnet hospitals; it is likely that professional expectations for innovation and education partnerships may be higher in these institutions. In all institutions with whom we have partnered there has been a very strong commitment to student learning and collaboration.

EIN: What resources are required to adequately prepare staff nurses for the clinical instructor role? How are the clinical instructors supported by clinical faculty coordinators?

PDQ: Orientation to the new role is central, beginning with an orientation program at the college and then moving to unit-based programming, and ongoing dialogue and coaching with CFCs. All receive a DEU Orientation Guide with important resources.  Clinical education resources are also provided to DEU units.  CFCs maintain weekly communication with all CIs, more so face-to-face at the beginning of the semester; this also includes 24-7 telephone communication and email.  The lead CFC also encourages ongoing communication with all instructors, including traditionally based instructors, thus providing quality oversight for all students.

EIN: What impact does the introduction of new types of clinical instructors have on the availability of clinical placements and the numbers of nurses per faculty member?

PDQ: Actually, having more students from one school on one nursing unit decreases the number of placements needed by the school and opens up units and placements for other schools of nursing.  Our nursing units have verbalized the positive effects of working more closely with students from one nursing program, working with a smaller cadre of faculty and more closely understanding clinical education goals. Similarly, the CFCs are working with a smaller number of staff nurses, thereby encouraging closer working relationships.

EIN: What are the workload benefits and challenges reported by CIs and staff nurses?

PDQ: CIs on a few of our DEUs did either have a slightly smaller workload or included a resource nurse, meaning, one additional staff RN, when DEU students were present. On a few occasions, sick calls by staff nurse CIs posed coverage concerns and each DEU handled these concerns somewhat differently.  Staffing is an issue more at the start of the semester when the students are new to the unit, and is only an issue with respect to juniors as students (seniors are generally viewed as very helpful on the unit as they tend to assist CIs with patient care activities).  At three out of the four units, CIs at the start of the semester were given one fewer patient than typical so that they had the time to instruct students.  Instructing students, particularly at the beginning of the semester, meant that the CIs’ patient care activities took a slower pace than usual, and during and outside of direct patient care encounters, CIs reported taking time to instruct students by articulating their immediate practice role or function or by questioning or coaching students.    When the unit was short-staffed, as was the case when a nurse called out sick and a replacement wasn’t readily available, it was the staff nurses on the floor who picked up the extra patient.  On average, midway through the semester, CIs had slightly fewer patients than nurses on three units.  They also, incidentally, had significantly fewer CNAs to assist them because students were available to help out.  CIs and nurses reported having patients with similar levels of acuity.  These findings generally held true across the units and across the cohorts. On one of our DEUs, CIs maintained their usual patient care load but they now had the support of two dedicated students per DEU nurse to assist in providing patient care.

EIN: Can you share specific findings regarding the effect of this model on clinical instructors’ work life satisfaction, professional development, leadership and job retention, compared to traditional staff nurses?

PDQ: As we reported earlier, the DEU model provides an avenue for greater professional attainment and greater professionalism for staff nurses who become clinical instructors.  The CIs report experiencing a heightened level of competency related to their work instructing students (a heightened meta-cognitive aspect to the work), and greater on-the-job satisfaction related to working with students and increased opportunities for professional growth (“to a moderate extent” vs. “to some extent”).   There were no other role-based differences (nurses vs. CIs) on any of the other work life measures.

Two benefits resonated with the CIs related to their work life satisfaction. First, CIs derived strong personal satisfaction from working with students, as both the survey findings and qualitative interviews indicated.  CIs were invested in the students’ progress and success and reported enjoying seeing the students’ growth throughout the 14 weeks and beyond, when they returned as senior students.  They were interested in how “their” students were progressing. Secondly, there was also a professional benefit from shaping the students’ professional growth. For example, some of the CIs reported recommending DEU students for hiring as PCAs or after having worked with DEU students who showed so much promise as students they recommended them for hiring as RNs, who when positions were available,  later came back to work as professional nurse colleagues on the DEU unit:

Staff Nurse Interview: “We’ve gotten a lot of good nursing staff from it [the DEU]…even nursing students. The PCAs that work on our floor from the program, even working with them.”

CI Interview:I like to watch the way they grow and how much better they are, you know.  They are so smart.  I am always amazed… “

Another benefit that resonated was the professional growth that came from: 1) instructing students, which, we hypothesize, helps nurses increase their meta-cognitive awareness of their own professional nursing competencies, and 2) the opportunities for professional growth via this instructional role that allowed the CIs to acquire additional knowledge, skills, and attitudes while performing their practice roles. -.  The acquisition of the university vouchers heightens this benefit as well, particularly if the CIs take advantage of the graduate-level courses geared toward clinical instruction:

CI Interview: “It definitely made me stronger as a nurse because it made me look things up a little bit more in depth than maybe I would’ve if it was just me.  So I definitely think it’s, it’s made me reflect on my own skills a little bit more.”

It is important to keep in mind that we discerned these benefits via a comparative analysis with the staff nurses on the unit.  We know from our interviews with staff nurses that the DEU affected everyone on the unit, and so nurses also reported experiencing growth related to their interactions with students and with the CIs; therefore, comparatively, the two roles weren’t entirely separate with respect to the DEU.  It is important to note that DEU task force members, who include nurse managers and staff educators, also reported heightened professionalism after DEU implementation on these particular units, so the DEU appears to positively impact unit culture.

DEU Teamwork

EIN: What are the advantages of DEU model over traditional model for students? Are there specific findings from your project that can be cited as evidence in support of this model?  Did DEU students report significantly more positive learning experiences and outcomes?

PDQ: While both groups of students in the study reported positive outcomes and learning experiences, the DEU students in their junior year reported significantly more positive learning experiences with respect to: instructor quality, opportunities to learning on the unit, growth in nursing knowledge, behaviors and skills, and more frequent opportunities to develop four out of six QSEN competencies (in teamwork and collaboration, informatics, quality improvement, and safety).  These significant findings were consistent across the four cohorts.

While both DEU and traditional students, on average, expressed positive clinical learning experience, we were surprised to see that DEU students’ ratings of both the instructors and the clinical environment were consistently higher than those by the traditional students.   Some of the largest differences between the DEU and traditional students’ responses were about their interactions with instructor and the student-to-instructor ratio.  The bar graph below indicates differences, especially in the following areas:

  • My instructor talked with me about new developments related to my patients’ care
  • The nursing staff encouraged me to pursue possible employment at this setting
  • I was encouraged by my instructor to ask questions

unit learning opportunities and instructor perceptions by group (deu and traditional)

chart

EIN: Can you speak to the overall effect on the quality of clinical education for students? I understand one of your findings was that the model influences student outcomes most when students are “relatively newer to the clinical learning environment.”

PDQ: Right, the effects of the model appeared stronger for students in their first semester of junior year than during the final senior semester. In this nursing program, these students have had one previous clinical education semester in nursing fundamentals in a sub-acute setting.  Junior level nursing students in the DEU setting reported two significant indicators associated with a high-quality clinical experience.  First, DEU students in all cohorts reported spending significantly more time with their instructor receiving coaching, and they reported spending significantly less time on “other tasks.”  We believe this was directly related to the higher student: instructor ratio on the DEU.  Second, DEU students reported a “wider range of learning opportunities” on the unit (see final bullet, above).  This second finding was borne out in qualitative interviews conducted on the DEU units where both the instructors and former DEU students noted the difference in learning opportunities in the two models:

“…by the end of the semester the DEUs are definitely way ahead.  They see more, do more. When you’re in a group of seven people with one instructor you’re just kind of lost.  You don’t, you do meds like once every three weeks if that…” – (from a staff nurse and former DEU student, comparing a student on a traditional unit to a student on a DEU unit)

“I think {they} benefit more because they’re, you know, one nurse to two students at the most.  So how do you not benefit?  I don’t know cons.  I mean, I think they’re getting, like I said, I think they’re getting a top-notch education this way because they’re really hands-on right from the get-go.” (from a staff nurse on a DEU unit)

In their final clinical semester of the senior year, all students receive a 1:1 precepted clinical experience with a staff nurse on a patient care unit.  There were fewer differences reported with respect to the quality of the clinical learning experience.  One difference noted again in the interviews was that the DEU students who were precepted by the same CI they had during their junior year, or who were on the same unit, valued the greater consistency than the traditional senior students experienced.  Both nurses and CIs noted the importance of this consistency in building strong working relationships on one patient care unit, and often with the same CI and similar staff.

The findings at the senior, final semester level are based on a single cohort of students – so these results are very preliminary).  There were fewer differences between the student groups for that single cohort of students who completed the study.  However, the significant findings included, on the four-point scale (from “strongly disagree” to “strongly agree”):

  • The instructor provided sufficient feedback about my clinical performance early enough in the rotation to allow for corrective actions, (Control=3.45, DEU=3.92 (F=5.903, p.=.034))
  • My instructor supported me as a team member in patient care delivery and decision making, (Control=3.36, DEU=3.92 (F=5.493, p.=.029))
  • My instructor facilitated the development of my clinical judgment skills, (Control=3.36, DEU=3.92 (F=5.493, p.=.029))

Another issue noted is that because the DEU students were already approaching the ceiling of a many of the attitudinal scales included in the survey as juniors, the ceiling effect may have hampered differences found between the clinical education models.

EIN: What has been its impact so far on student academic performance? Are there associated changes in the rates of first-time NCLEX pass rates?

PDQ: The learning outcomes found in Project PDQ come from growth in clinical learning.  Educational outcome measures for nursing education are not well developed and limited at best.  Our state boards do not allow for us to correlate licensure exam performance with individual students; therefore, Project PDQ studied comprehensive, standardized, predictive, assessment exam scores, course grades, standardized content exams, and clinical evaluations; no differences were found.  There was very little shared variance between the program variables such as course grades, content achievement exam scores, or the one comprehensive standardized NCLEX predictive exam measure used with the one senior student group, so we were unable to find any relationship between these variables and the student group.   Therefore, Project PDQ can state that the DEU innovation did not negatively impact student academic performance.

Other outcome variables to be considered in future studies that may be relevant include: orientation times for newly hired PCAs and RNs, transition to professional practice, and retention outcomes for DEU students, especially with regard to another significant difference noted for DEU students (Q6H_S):

  • The nursing staff encouraged me to seek possible employment at this setting, (Control=2.73, DEU=3.46 (F=5.27, p.=.03))

EIN: What specific study limitations would you share with potential replicators?

PDQ: Our limitations included issues with ecological generalizability resulting from the chosen study sites (3/4 of our DEU intervention units took place at Magnet hospitals with high patient acuity and low patient care loads), moderately low response rates among the nurses/CIs which also hampered statistical power, and a missing counterfactual response from the clinical instructors in the Traditional intervention (there were few of them and they had a response rate too low to be included in the study).

The predominant limitation that might affect replication is ecological generalizability. Six of the eight patient care units (DEU units and traditional) utilized for clinical education studied were in Magnet sites on highly complex medical or surgical units where patient acuity was high and the patient:nurse ratio was low (the other site was more similar to community-based hospital sites).  The DEU intervention may behave differently in settings where the nurses provide care for more patients and consequently may spend less time on direct patient care and instruction, or have less acute patients or perhaps a more narrow range of patient care activities to perform.  Further, the nature of the intervention of the DEU – the Dedicated Education Unit – requires strong unit buy-in and support, a prerequisite that may be harder to establish in other hospital settings.  It will be interesting to see what the tolerances are for the intervention in terms of staffing, unit buy-in, patient acuity, union bargaining presence, qualified numbers of staff willing and able to clinically instruct, and other considerations, with adjustments made to accommodate the model in other settings.

Those interested in DEU program resources can review them by clicking HERE, where they can find:

  • DEU Implementation Measures and Fidelity Guidelines
  • Various DEU Position Guidelines
  • DEU Clinical Experience

EIN: Can you tell us about your presentations and publications to date? We know that dissemination of findings is a key activity of your EIN project.

PDQ: We were fortunate to have presented at a prestigious conference with a panel presentation for 200 nurse leaders in both academia and nursing practice when our project began[i]. We have had numerous inquiries from other schools of nursing requesting advice or consultation about DEU implementation. The consultations provided has ranged from multiple email communications, to telephone conferencing, and  to thirteen members from a  school of nursing and its practice partners visiting our DEUs, school, and partnership members. We have also presented at national and statewide conferences.  A poster presentation will take place at an international nursing education conference in Israel this summer[ii] and a number of manuscripts and abstracts are in preparation.  Other past publications, presentations and related resources can be found HERE.

EIN: We’ve learned a great deal from our discussion. Are there any specific “lessons learned” that you can  share with those who have implemented or are considering implementing DEUs, especially related to challenges you may have encountered?

PDQ: The primary lesson learned is to spend time developing a strong partnership with a common vision and written tenets at all levels of the organization with built-in socialization activities.  When a school partners with multiple health care agencies or when a health care agency partners with multiple schools, local context needs to be thoroughly examined, for example recognizing similarities and differences in non-union and union institutional practices, in types of incentive provided, and in determining nursing units’ readiness, including having staff nurses who meet state board regulations for carrying out instructor or preceptor roles. Another important lesson learned is that we all have so much more in common to offer to one another working together, with regards to making quality improvements in education and practice and creating and sustaining important working relationships than we could have imagined before this opportunity.  

EIN: What other impacts do you think the project has had to date?

PDQ: We could not realize the impact this evaluation study has had on the students’ learning gains. Students reported great rewards from their DEU clinical learning experiences.  Their clinical growth was on exhibit in a series of presentations at the patient care unit and nursing organizational levels related to evidence-based, patient safety and quality improvements -.   They have presented evidence to support unit-based practice changes to improve patient care at nursing department practice meetings. DEUS demonstrate new ways to leverage expert knowledge of both education and practice in the students’ clinical learning, with staff nurses focusing on clinical judgment and practice performance , -with faculty collaborating and coaching staff nurses in nursing knowledge integration and thinking development  while maintaining the primary nursing unit focus on provision of quality patient care. Furthermore, all share a commitment to working towards more diverse and inclusive nursing education and nursing practice environments. Our nursing program was especially proud of a recent event demonstrating the value our nursing students place on their DEU clinical education.

The most recent graduating class provided a generous class gift for use toward the DEU program.  This generous gift will be used to provide resources to all clinical instructors (DEU and traditional) for continued development of their clinical coaching skills.

EIN: About sustainability: our last question goes to what specific elements (administrative, improvement, etc.)  need to be in place to ensure sustainability of the model?

PDQ: Leadership is key to creating and sustaining partnerships such as DEUs.  Leaders need to be committed to creating structures for sustaining DEUs into existing nursing programs. Resources with administrative assistance for DEU orientation programming and DEU position guidelines for CFCs CIs, and the DEU program head need to be created and put in place, particularly for time s of positive turnover of key DEU partnership members.  Structurally, an assigned faculty member or nurse program director needs to assume the role of DEU leader with workload accounted for.  Comparable workload for CFCs for clinical instruction needs to also be determined. Monies from the college or the practice partners or other sources to support staff nurses returning to school are invaluable resources to meet our Future of Nursing goals.  A dedicated space for student and instructor to teach and learn, educational resources and computer access, and DEU program visibility on the nursing units all help to set a positive professional tone for teamwork and collaboration in education and clinical practice.   EIN has provided us the opportunity to think ahead. We have begun to conceptualize  a model for  DEU sustainability that makes sense as more nursing students are educated on DEUs, and in turn, when they become competent professional RNs,  join the DEUs and grow  our faculty capacity by  becoming the new CIs of our future DEU nursing students.

DEU Sustainability


[i] . JoAnn Mulready-Shick, Laura Mylott, Kathleen Kafel, Theresa Capodilupo, Vilma Pacheco, and Merril Farrell. Academic Service Partnerships for Dedicated Education Unit Development”, at the Nurse Executive Leadership Conference, Institute for Nursing Healthcare Leadership, June 14, 2010, Boston, MA

[ii] Greer, Glazer, Jeanette Ives Erickson, Laura Mylott, JoAnn Mulready-Shick, and Gaurdia Banister.

International Nursing Conference Nursing:  Caring to Know, Knowing to Care. Jerusalem Israel June 4-7 2012

Poster June 7 2012. Sponsored by 3 organizations: Henrietta Szold Hadassah Hebrew University School of Nursing Faculty of Medicine; Sigma Theta Tau International Honor Society of Nursing; Registered Nurses’ Association of Ontario/L’Association des infirmieres et infirmiers autoristes de l’Ontario.