breaking the rules: redesigning the educational endeavor for...
TRANSCRIPT
Breaking the Rules: Redesigning the
Educational Endeavor for Nursing
School of Nursing &Health Professions
Judith F. Karshmer, PhD, APRNDean & Professor
Common Rules in Nursing Education
1. Don’t re-invent the wheel...
2. Start clinical experiences
with “simple” patients
(i.e., those in long-term care).
Common Rules in Nursing Education
3. Make patient assignments
(instead of “nurse”
assignments).
Common Rules in Nursing Education
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
5. Affirm that clinical instructors
are “faculty”- their relationship
with the setting is secondary.
Common Rules in Nursing Education
6. Value “breadth” across an
array of practice cultures
rather than “depth” within
one.
Common Rules in Nursing Education
7. Value “real patient”
experiences over simulated
ones.
Common Rules in Nursing Education
8. Treat hours of clinical time as
equal, regardless of the
experiences made available.
Common Rules in Nursing Education
9. Supervise students’
“interprofessional
communication.”
Common Rules in Nursing Education
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
11. Use clinical rotation times
that are different from the
“work day” of the facility.
Common Rules in Nursing Education
12. Focus on “getting the work
done,” rather than on seeking
learning opportunities.
Common Rules in Nursing Education
The Future is NOW
TIME TO
BREAK
THE
RULES…
“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?
“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??
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
So which rules do we break?
ALL OF THEM!
We need to re-invent the wheel...
• Preparing the nurse must be preparing for the future.
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
We need to assign students to nurses and other professionals:
• Preceptor/apprentice model• IPE joint appointments• Faculty as coach to
provider dyads
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
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.
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
We need to exploit the power of simulation.
Simulated experiences:• Standardized patients• IPE• High-fidelity simulators• Simulated systems
We must stop treating hours of
clinical time as equal.
• Competency Based Education
We must require
“interprofessional
communication” as a standard.
• IPE simulations• IP practice = required
We can’t continue to set an
expectation that nursing
practice is static.
• Mobile devises for prep• Point of Care learning• Treatment & teaching Apps
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
We must stop evaluating
students on “getting the work
done.”
• Focus on
demonstrating
competencies & learning
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
USF Lessons Learned
Partnerships• School districts• Home health agencies• Hospice• Community clinics; FQHCs• Specially clinics• Transitional care programs• Urgent care centers
USF Lessons Learned
Push Back…• What can they do?• How much time will they
take?• How safe are they?• State and agency
regulations.
USF Lessons Learned
Success:
• 40+ Partnerships
• 5 (& counting) cohorts
• 100+ jobs for new graduates
in these non-traditional
settings!
USF Lessons Learned
• BSN collaborative with VA to
prepare the nurse of the
future.
• 20%-80% not 80%-20%
USF Lessons Learned
• Master’s entry program for CNLs to prepare for ambulatory care & home health.
• Preceptors = faculty/staff
Change is easy – it’s keeping the status quo that’s so hard!
Questions?