New Clinical Education Model Piloted by Nursing School May Help Ease Shortages

BUFFALO, N.Y. -- The nursing shortage in the U.S. is straining the health-care system, exhausting the existing labor force and challenging professional nursing faculty.

The shortage is not due to a lack of interest in the profession. Nursing school enrollments reach a new high nearly every year.

The problem exists on the supply side of the educational equation. There is a chronic shortage of qualified clinical faculty to train the students.

The School of Nursing at the University at Buffalo is testing an innovative approach to clinical nurse education developed at Flinders University of Australia that should improve that situation in the region. Called the Dedicated Education Unit (DEU) approach, it is a partnership involving hospital administrators, nurse-clinicians and UB academic faculty who have combined their experience to develop a creative and innovative way to give students the best clinical experience.

The partnership is expected to benefit both the students and the nurses who supervise them, along with the hospitals and the nursing school.

UB is thought to be the first in the Northeast to try the new model. Nursing schools at the University of Portland and Pacific Lutheran University in Oregon are the only other locations in the U.S. known to have adopted the DEU concept to date.

The traditional approach of UB nursing school to hospital-based clinical nursing education assigns one UB clinical nursing faculty member to supervise and provide clinical education to eight nursing students. This ratio of 1:8 clearly has its limitations, requiring students often to wait their turn to receive the complete attention and direction of their faculty supervisor.

DEUs function differently. Specially trained hospital-based nurses act as staff clinical instructors, sharing their clinical experience, knowledge and expertise with the student nurses. These instructors are matched with two student nurses, who receive personalized attention and instruction in each hospital specialty unit. (A nursing "unit" refers to patients with similar needs who are grouped together.)

The model allows each student to develop a one-on-one relationship with the staff nurse instructor, and provides more opportunities to use critical thinking at the bedside and to develop the complex nursing care required by today's health-care consumer.

Mattie Rhodes, Ph.D., clinical associate professor of nursing, and Linda Steeg, MSN, clinical instructor in the UB nursing school, along with the respective nursing leadership teams, began pilot-testing the DEU model this fall on nursing units in Erie County Medical Center (ECMC) and Millard Fillmore-Gates Circle Hospital of the Kaleida Health System.

"The DEU, often referred to as an Academic/Service Partnership, changes the way nursing students receive their clinical education," said Rhodes. "Students, staff nurses and faculty who have participated in the DEU model agree that it provides educational and professional benefits for both the students and the staff nurses, who work closely together.

"Using proven teaching/learning strategies, the model maximizes the achievement of student learning outcomes, and capitalizes on the expertise of both expert nurse clinicians and experienced nursing faculty," she said.

Registered nurses with at least two years of clinical experience who have completed their hospital's preceptorship education program are eligible to become DEU staff clinical nurse instructors. They attend a one-day workshop in the UB nursing school, where they learn about the school's mission and vision and receive an overview of the nursing curriculum and teaching/learning strategies.

Nurses and members of the nursing leadership teams also receive DEU "Enrichment Days" midway through the teaching experience, which provide opportunities for professional development and for sharing their DEU experiences.

The nurses are critical to the success of the DEU, said Rhodes. "The DEU concept is based on the belief that the educational role of staff nurses is vital to the development of students' professional skills and knowledge. The nurses involved are some of the best," she added. "I think it is working well."

Rhodes and Claire Meyers, UB clinical nurse instructor, are overseeing implementation of the DEU program on two ECMC units this semester, while Steeg provides oversight of the pilot implementation at Millard Fillmore Gates.

"The role of the university faculty in this model, as the clinical faculty coordinator," explained Rhodes, "is to work directly with the DEU staff nurse and assist in their ongoing professional development as a clinical teacher. The clinical faculty coordinator also is responsible for making sure that theoretical nursing knowledge is applied to clinical nursing practice."

Steeg said she has been impressed and energized by the professional collaboration between academia and service. "It's incredible how supportive and nurturing the entire staff is to our students on the DEU. Staff, students and clinical faculty look forward to our clinical days on the DEU."

The UB nursing school's fall semester student clinical education focuses on learning to meet the needs of individuals with chronic health conditions. This year the initial fall DEU pilot project was carried out on traumatic brain and spinal cord injury and acute geriatric rehabilitation units at ECMC, and in the geriatric medical-surgical unit at Millard Fillmore Hospital Gates Circle. Students who did not participate in the pilot project were assigned to other settings in the hospitals using the traditional method of clinical supervision.

To no one's surprise, student nurses who were assigned to the DEU have become the model's best champions.

"I loved it," said senior nursing student Robin Basile, who spent six weeks in ECMC's Traumatic Brain and Spinal Cord Injury Rehabilitation unit. "It's a much better learning experience, more hands-on, more personalized.

"You didn't have to wait for the clinical faculty to come to you. You were able to ask the DEU nurse questions and she was by your side to answer them immediately. I hope more students in the future can experience this, and I hope more nurses will become DEU clinical instructors."

Basile expects to join the ECMC rehabilitation unit when she graduates from UB in the spring.

Lolita Small, a senior nursing student who holds a bachelor's degree in sociology, was assigned to the geriatric medical-surgical unit at Millard Fillmore Hospital Gates Circle this fall. "Every nursing program should incorporate this teaching method," she said. "You get to work one-on-one. You learn a lot more and become a more effective nurse. That's how it should be."

In May the newly graduated nurses will be looking for jobs. The DEU pilot project is expected to aid that process. "Students who have performed well and have formed positive professional relationships with their DEU nurses are likely to apply for employment in those hospitals and to be first-in-line for staff openings," said Rhodes.

The project should benefit the hospitals, as well, she noted, by helping to retain their best nurses and recruit new ones, both of which will help solve the nursing shortage locally. The DEU pilot project will expand in the spring semester into additional clinical units, and more staff nurses will be prepared to move into their DEU clinical nurse-teaching roles.

The UB nursing school also may benefit, said Steeg. "This project uses faculty members' expertise as educators to support the development of the staff nurses in their role as clinical educators. We hope this may encourage some nurses to seek further professional nursing education, possibly considering UB as their program choice.

Overall, Rhodes and Steeg agree that piloting the DEU has been a "win" situation for everyone involved.

The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities. The School of Nursing is one of five schools comprising UB's Academic Health Center.