Dedicated Education Unit

Innovations in Clinical Education: The Dedicated Education Unit

 

The UNMC College of Nursing has implemented an innovative Dedicated Education Unit (DEU) clinical model for both traditional and accelerated BSN students. In the DEU model, students provide patient care alongside an experienced staff nurse who has been oriented to the role of the Clinical Staff Instructor (CSI).

In the traditional clinical education model, one clinical faculty supervises 8-10 students. Students work with a variety of staff nurses and may work with a particular nurse only once leading to increased student anxiety that may interfere with learning. In addition, there is limited opportunity to build trust between the students and the staff nurse. This traditional model is depicted in the diagram below.

The diagram below depicts the DEU model. In the DEU clinical model, one faculty mentor oversees 10-12 nursing students, but each pair of students work at the bedside with one CSI, who is a nurse on the unit. The students work with the same CSI every clinical day. College of Nursing faculty function as a mentor for the staff nurse in this new role of clinical staff instructor. Final evaluation of student performance is completed jointly between the CSI and the faculty mentor.

The advantages to this model are:

  • CSIs volunteer or are recruited by managers to participate in this model. They participate in a formal orientation session. During this development session, they learn effective clinical teaching strategies, evaluation principles, and strategies for providing both positive feedback and feedback for improvement.
  • CSIs supervise two nursing students during the entire clinical rotation resulting in a trusting relationship between student and CSI. The CSI can effectively build on student strengths and remediate student learning needs. Students perceive themselves as part of a team [1] and have greater development of cognitive, psychomotor, and communication skills [2].
  • There is enhanced student accountability for health care delivery [3].
  • There is greater acceptance of students by staff, facilitating greater involvement in nursing work [4].

Although the HRSA grant that supported the development of this model at UNMC has come to a close, the DEU clinical education model remains in place so that nursing students and CSIs continue to reap the benefits of this innovative program. Reflection on this clinical model from students, faculty, CSIs and hospital administrators are on the right. Their comments operationalize the benefits of the DEU model.

[1] Edgecombe, 1999

[2] Edgecombe, 1999

[3] Boogaerts, 2005

[4] Ranse, 2007

Testimonials

Student Comments

 

  • “I wish all my clinicals had been like this.”
  • “I feel so much more capable than I ever have after a clinical rotation.”
  • “This clinical did more for my confidence than any other I’ve had. I feel ready to take on whatever nursing has to offer.”
  • “I felt much less anxiety than in other clinicals. My nurse really encouraged me and let me do things more independently because she knew I could.”
  • “I’ve never had nurses who were so encouraging. Like the night we had that code and they just grabbed us and made us do chest compressions. I will never forget how nervous I was, but they were right there helping me.”

Faculty Comments:

 

  • “The DEU experience enabled students to have a better understanding of the total nursing experience. By the end of the experience they were caring for 3 patients and had more practice with time management and delegation, something they were unable to do when the faculty member was covering all 8 students.”
  • “Mentoring of the CSIs was an opportunity to help them grow in their professional and peer relationships. Helping them to understand how to work with someone who is anxious gives them a broader perspective of ‘how to be’ with others.”
  • “I have worked with students in the ICU for over 20 years. While they always progress to a point that I believe makes them ready for independent practice, I believe the DEU experience took these students well beyond the level of preparation I have ever seen. These students are going to practice with a much greater confidence, skill level, and critical thinking ability than ever before.”

CSI Comments:

 

  • "Having the same students every week helps me support and develop the weaker students. I know what they know and I know their personality so that I can be a more effective teacher."
  • "Because I know the students better, I feel more comfortable involving them in clinical decisions. I don't just answer their questions and give them direction. I ask them 'What do you think we should do.'"
  • "I can challenge the students more...I know what patients they've had in prior weeks so I know what they're capable of doing."
  • "Normally in ICU, I wouldn't have students care for 2 patients. But, because I know these students better, I might tell one student to take report on both of my patients so that they can organize and prioritize care for 2 patients. Of course, I can do that only when I have one student [because the other student is in an alternate experience]."

Hospital Administrators:

 

  • “This is an opportunity for us that’s unlike anything else we’ve done before.”
  • “We’ve had a very positive response from the staff who served as CSIs. We’ve seen a different attitude among the rest of the nurses on the unit [those who did not serve as CSIs].”
  • “It would be great if we could expand this project more quickly and involve additional units.”
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