Journal of Nursing Education

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Major Article 

Alliance for Clinical Education (ACE): Setting Community Standards Through Collaboration

Gayle Preheim, EdD, RN, NEA-BC, CNE; Kathlynn Bader-Kail, MSN, RN; Margaret (Peg) E. Miller, MA, RN; Jana Fae Berryman Kelly, ND, RN, CNS; Rebekah S. Lynch, PhD, RN, CNS

Abstract

Today’s clinical nursing education challenges center around managing complex issues related to clinical placements. The increased numbers and varying levels of nursing students, acuity and intensity of the clinical setting, and rise of regulatory and accrediting mandates provided impetus for the establishment of the Alliance for Clinical Education (ACE). This article describes community standards established by partnering educational programs and clinical agencies in the Denver, Colorado, and surrounding areas. ACE is successfully confronting the challenges of effectively using scarce clinical placements, validating student orientation mandates, and facilitating the availability and development of qualified clinical faculty. Examples of tools and resources created by ACE to provide uniformity in meeting mutual expectations and requirements are described. The power of collaboration and sharing expertise is described by current initiatives, which reflect the ability to influence policy and shape community standards to support excellence in clinical nursing education.

Abstract

Today’s clinical nursing education challenges center around managing complex issues related to clinical placements. The increased numbers and varying levels of nursing students, acuity and intensity of the clinical setting, and rise of regulatory and accrediting mandates provided impetus for the establishment of the Alliance for Clinical Education (ACE). This article describes community standards established by partnering educational programs and clinical agencies in the Denver, Colorado, and surrounding areas. ACE is successfully confronting the challenges of effectively using scarce clinical placements, validating student orientation mandates, and facilitating the availability and development of qualified clinical faculty. Examples of tools and resources created by ACE to provide uniformity in meeting mutual expectations and requirements are described. The power of collaboration and sharing expertise is described by current initiatives, which reflect the ability to influence policy and shape community standards to support excellence in clinical nursing education.

Dr. Preheim is Director, Baccalaureate Nursing Program, and Associate Professor, University of Colorado Denver, Anschutz Medical Campus, School of Nursing, Aurora, Ms. Bader-Kail is Facility Administrator, DaVita, Inc., Ms. Miller is RN Educator, Porter Adventist Hospital, Ms. Kelly is Project Coordinator, Colorado Center for Nursing Excellence, and Dr. Lynch is Dean, Denver School of Nursing, Denver, Colorado. At the time this article was written, Ms. Bader-Kail was Director of Clinical Education, Orbis Education, San Diego, California.

Presented in part at the 16th Annual International Nurse Educators Conference in the Rockies, Breckenridge, Colorado, July 2005. The authors thank the members of the Alliance for Clinical Education in Colorado for their support and innovative collaboration.

Address correspondence to Gayle Preheim, EdD, RN, NCEA-BC, CNE, Director, Baccalaureate Nursing Program, University of Colorado Denver, Anschutz Medical Campus, School of Nursing, C288-12, Education 2 North, Room 3240, 13120 E. 19th Avenue, P.O. Box 6511, Aurora, CO 80045; e-mail: Gayle.Preheim@ucdenver.edu.

Received: February 02, 2007
Accepted: August 09, 2007

The value of structured, well-supervised clinical experiences in the educational preparation of prelicensure nursing students is affirmed by the American Organization of Nurse Executives (2004) and the National Council of State Boards of Nursing (2005). Although new models of clinical education are evolving, typically a group of students is accompanied by a clinical instructor for a scheduled clinical experience in a health care facility. Educational programs and clinical agencies within large urban areas encounter numerous clinical placement issues when determining clinical schedules. Definitions of appropriate clinical experiences vary among multiple educational programs with differing levels of student learning within specific courses. Frequently, expectations and policies for student and clinical faculty orientation are inconsistent, with potentially a negative effect on student learning, staff productivity, and patient care delivery. Consistent compliance and verification of regulatory and accrediting agency requirements is becoming progressively more challenging due to increasing mandates to assure safe, quality care and security. Resulting legal implications, safety concerns, and strained working relationships between the educational program and the clinical agency are barriers that must be addressed if excellence in clinical education is to be mutually supported. The challenges of managing clinical placements are increasingly complex, time consuming, and problematic.

This article describes the early beginnings, development, challenges, and ongoing initiatives of an education-practice collaborative in metropolitan Denver, Colorado. The Alliance for Clinical Education (ACE), is a collaborative organization, cooperatively and creatively addressing the fundamental and increasingly complex challenges related to clinical education. Community standards established by partnering educational programs and clinical agencies and products of collaboration are described.

Quality clinical education requires purposeful and proactive management to promote patient safety and positive learning and working environments. When educational programs and clinical agencies mutually determine common protocols to manage the myriad clinical placements issues, community standards are established. Community standards clarify expectations and guide actions of a geographic or intellectual community for the purpose of achieving optimum outcomes. Universally implemented community standards provide an equitable and legally accountable foundation for clinical education partnerships.

Current Trends in Collaboration Nationally

Collaboration refers to mutually beneficial and well-defined relationships entered into by two or more organizations to achieve common goals. Innovative and successful partnerships between education and practice are evident in a variety of arenas. The literature describes collaborative models, including student-agency partnerships for community assessment and health promotion (Reifsnider et al., 2005), faculty-agency partnerships for improved client outcomes (Williams et al., 2002), faculty-student-staff involvement in preceptored clinical experiences (Haas et al., 2002) and initiatives promoting professional development and scholarship (Campbell, Prater, Schwartz, & Ridenour, 2001).

Initiatives focused on addressing the nursing and faculty shortages are described in the News Watch (American Association of Colleges of Nursing, 2006) and the Nursing Education Policy (National League for Nursing, n.d.). New partnerships among government sponsors and corporate entities effectively support increased nursing school enrollments through tuition reimbursement, scholarship programs, educational mobility, and career advancement for nursing faculty.

Several partnerships exist for the purpose of coordinating clinical placements to increase efficiency and effectiveness in managing increased enrollments of nursing students. Three unique Web-based clinical placement platforms emerged as early innovators in managing clinical placement data with multiple educational program and clinical partners. Maricopa Community Colleges (2004) offers a functional design for coordinating and scheduling clinical placement requests in Maricopa County, Arizona. The Oregon clinical placement system platform offers drop-down menus for additional choices and information and facilitated coordination (Oregon Center for Nursing, n.d.). The Centralized Clinical Placement System, hosted in the San Francisco Bay area, is the most sophisticated platform with the ability to match requests on a number of factors and generate reports for analysis (Bay Area Nursing Resource Center, 2006). The Clinical Placement Consortium in Michigan was developed to decrease competition among nursing schools in securing clinical placements (Meyers, 2005). A computerized database is used to organize and fairly manage the placement process. In each case, goals of collaboration were to establish a trusting environment to increase the quality and quantity of placements, and to collect supply and demand workforce data useful in addressing the nursing shortage.

The development of Web-based technology platforms to schedule and match clinical placements is vital to building capacity for nursing clinical education. To date, the implementation of matching platforms focuses primarily on managing schedules for assignment to clinical agencies. Future outcome evaluation will also assess the quality outcomes of clinical placements and impact on partner relationships. The current trends in collaboration nationally demonstrate that complex nursing workforce shortage and clinical education issues require mutual trust, open communication, and integrative problem solving.

Early Beginnings and Development

The definition and purpose (Table 1) underscore the fundamental reason for the existence of ACE. Uniquely focused on establishing professional and legally accountable community standards, ACE affects the quality of nursing clinical education, as well as the quantity of clinical placements.

Education and Practice Partnership for the Alliance for Clinical Education (ACE)

Table 1: Education and Practice Partnership for the Alliance for Clinical Education (ACE)

The developmental journey of ACE exemplifies the power of collaboration in managing the challenges of clinical education during competitive and chaotic times. The Denver area collaborative began informally in 1989, when two nurses, struggling with the complexity of scheduling clinical rotations within their facilities, arranged a problem solving meeting. Representatives from local schools of nursing were invited to examine the merit and disadvantages of the placement process in use and related issues affecting student learning and the nursing staff. Initially, the group identified themselves as the BrainTrust, recognizing that a think tank mentality was needed to build solutions and improve the efficacy of student clinical placements. In the early 1990s, the number of participants from educational programs and clinical agencies began to grow. The meetings were used as a safe forum to discuss expectations and to set goals for improving clinical nursing education. The format was a useful mechanism for disseminating current information about trends in health care affecting nursing, including governmental and legislative issues, grant-funding opportunities, national trends, policy changes, and regulatory and accrediting mandates. As the worth of BrainTrust was established, the membership began to include school of nursing directors and deans, nursing staff development directors, and hospital nurse educators.

Despite initial success, the BrainTrust entered a period of relative inactivity during the mid-1990s. Health care organizations focused on the negative fiscal effects of managed care and changing reimbursement systems. Nursing education departments were downsized and clinical educator positions eliminated. Schools of nursing experienced a trend of declining student enrollments, resulting in diminished need for clinical placements. Turnover in membership and inconsistent attendance became barriers to accomplishing work and achieving outcomes. The challenges faced by health care organizations and educational institutions fueled organizational competition and self-preservation.

However, as a critical nursing shortage became evident, nursing school enrollments soon began to increase significantly. Attention shifted to supporting nursing workforce development and securing adequate clinical placements in high-acuity, fast-paced, and often short-staffed nursing clinical environments. The urgent need to improve the clinical placement process was evident as enrollment in educational programs were increased significantly without adequate planning with affiliating clinical agencies. Resurgence in attendance at BrainTrust meetings was driven by a critical need for coordinated clinical placements. Simultaneously, BrainTrust members sought accurate and timely information regarding the changing regulatory and accrediting mandates that involved verification of additional training and criminal background checks. Regular meetings provided an environment to clarify and cooperatively untangle the issues associated with clinical placements and increased enrollments. Lacking resources, educational programs and clinical agencies determined that collaboratively untangling and addressing universal clinical education issues would be more effective and efficient than isolated and fragmented efforts. Members exchanged ideas, analyzed processes, and collaborated to recommend policy changes during biannual meetings. They confirmed the need for frequent communication and cooperation between meetings, and they developed a written contact list of participants. The membership roster, distributed and updated at meetings, symbolized an expectation of shared information and facilitated ongoing communication.

By 2002, a chairperson was elected to provide consistent leadership and visibility within the health care community. The BrainTrust formally changed its name to the Alliance for Clinical Education to reflect an education-practice partnership. With a unified focus on jointly managing the clinical placement process and increasingly complex issues encountered with clinical education, ACE gained momentum through the formation of issues-specific task forces comprised of members from across clinical agencies and educational programs. Task forces were charged to engage in fact-finding to generate proposals for action that were brought back to the full membership for consensus building. Thus, community standards were established to address compliance mandates of Occupational Safety and Health Administration (OSHA), Health Insurance Portability Accountability Act (HIPAA), and Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Tendencies for self-reliant and competitive behaviors were diminished by desperate needs for resolution, as well as past successful experiences in achieving shared goals through reciprocal actions. Collaboration improved efficiency by combining limited resources to create needed educational and orientation products. Effectiveness was also enhanced by establishing community standards implemented across educational programs and clinical agencies.

Today, ACE functions under ratified bylaws, which institutionalize definition and purpose, identify membership, leadership, meetings, governance, organizational archives, committees, amendments, and dissolution. Current membership is comprised of 125 individuals, representing 72 organizations, including Colorado State Board of Nursing, Colorado Nurses Association, Colorado Central Area Health Education Center, and the Colorado Center for Nursing Excellence, a nonprofit organization whose mission is to facilitate nursing workforce development through various education and practice initiatives. ACE exemplifies the principles and shared values of trust, respect, and fairness in dealing with common concerns. The group recognizes its power to tackle controversial contemporary issues and recommend cutting edge approaches. Agenda items revolve around the implications of the nursing workforce and nursing faculty shortages, recommendations for best practice in clinical education, mechanisms to assure regulatory compliance, and strategies to address legislative initiatives. A sample agenda (Table 2) displays professional organization representation and the scope of topics.

Alliance for Clinical Education Sample Agenda

Table 2: Alliance for Clinical Education Sample Agenda

Significance of ACE

Given the reality of current workloads and the urgency of day-to-day responsibilities, why do nurse leaders continue to take the time to attend ACE meetings and serve on task forces? The significance of ACE partnership and participation lies in a unique sense of belonging, ownership, and accountability in addressing the challenges and opportunities related to improving clinical nursing education. A grounding spirit of cooperation and sharing, versus competition, allows free idea exchange and interaction. Group members strategize to address issues collectively, without emphasis on individual gain. For example, the identification and release of available, limited clinical placements is frequently accomplished between schools and agencies to maximize appropriate use. Indicators for excellence in clinical nursing education are identified with processes for achieving those goals.

The individuals and organizations comprising the membership of ACE are significant. In any given assembly, the combined years of professional nursing education and practice experience is exceedingly impressive. Access to this level of expertise might otherwise require travel to national conferences or the expense of paid consultants. The visibility and voice of ACE is sufficiently strong to successfully ward off the involvement and authoritative decision making by those who may be less informed, invested, and passionate about the goals of positive patient outcomes and well-prepared nursing workforce.

Products of ACE Collaboration

Positive outcomes or products of collaboration sustain the membership and momentum of ACE. Members openly raise concerns, which lead to dialogue and solution building. Task forces are sparingly and purposefully charged to investigate and recommend solutions for achieving standardization and resolution, thus meeting the needs and requirements for educational programs and clinical agencies.

The fundamental issue of managing clinical placement schedules resulted in a standardized process for allocating appropriate level and adequate numbers of placements. Historically, the process for requesting and confirming clinical placements across schools and agencies was disjointed and ineffective. Each school and agency managed requests using different terminology, time frames, and communication modes. ACE developed a standardized form and outlined a process for submitting clinical placement requests (Figure). Educational programs specify annual projected clinical placement needs based on enrollments. Clinical agencies review the aggregate, consider available resources and the organizational climate, and communicate approval or denial to individual educational programs within 6 weeks. The time-intensive process requires planning and problem solving to achieve mutual goals of equity and appropriateness.

Alliance for Clinical Education Standardized Form for Submitting Clinical Placement Requests.

Figure. Alliance for Clinical Education Standardized Form for Submitting Clinical Placement Requests.

The following are additional examples of the collaborative efforts resulting in usable products (Table 3):

  • Accurate and comprehensive ACE membership rosters facilitate consultation between meetings allowing for proactive and timely interactions.
  • Standardized dress code and responsibilities for both student and clinical faculty were developed and institutionalized across agencies and schools as formal policies. Common terms (e.g., externship, internship) related to the student experience were also defined.
  • Preceptor recognition certificates were designed to be given at the conclusion of the rotation by the school of nursing faculty in recognition and appreciation to the preceptors who worked with the students.
  • The HIPAA education materials used in educational programs and clinical agencies were reviewed by facilities’ privacy officers for accuracy and incorporated into a CD-ROM. Students’ education regarding privacy regulations is validated prior to the clinical experience.
  • Occupational Safety and Health Administration training was standardized to assure uniformity in meeting OSHA requirements. Students must pass a paper-and-pencil or online OSHA examination annually to demonstrate competency.
  • Cultural diversity and sensitivity orientation is mandated by JCAHO. Content expert ACE members created a packet of resources, including a CD-ROM, for orientation. The CD-ROM included general transcultural nursing and cultural competence concepts; cultural assessment, including health promotion and lifestyle practices, spiritual beliefs, family organization and function, and communication patterns; and nurse-patient communication that facilitates culturally competent care.
  • Joint Commission on Accreditation of Healthcare Organizations (2005) required criminal background policies for all hospital personnel. In Colorado, student background checks must also be completed prior to nursing program admission. A task force identified an appropriate reporting agency to complete the background checks and negotiated a standard fee across educational programs. A list of disqualifying criminal offenses was created and any conviction or deferred adjudication of the listed criminal offenses (felony or misdemeanor) appearing on a criminal background check will disqualify an applicant for admission to the educational program.
  • A student nursing skills inventory was created and piloted by several educational programs. The inventory is available to cumulatively track students’ clinical experiences. Clinical instructors find it useful in assessing learning needs and planning appropriate learning activities.
  • Shadowing experiences for high school students are implemented in several facilities to encourage consideration of health care career choices, especially nursing. The comprehensive plan for implementing shadowing experiences was presented at ACE for adaptation in other facilities.
  • A 2-day clinical instructor development workshop was developed to prepare practicing nurses for roles in clinical education, thus addressing the shortage of qualified clinical instructors. Members of ACE served as workshop faculty, teaching in their areas of expertise related to clinical instruction and supervision. The Colorado Center for Nursing Excellence expanded this prototype with Federal and State Department of Labor funding to engage ACE members in development of a comprehensive curriculum and delivery of a 40-hour program. More than 250 clinical nurse experts, referred to as Clinical Scholars, have completed the highly successful faculty development program, significantly augmenting qualified, clinical faculty resources.
Summary of Alliance for Clinical Education (ACE) Accomplishments

Table 3: Summary of Alliance for Clinical Education (ACE) Accomplishments

The concept of collaboration can be as simple as exchanging information or as complex as changing social processes through creating relationships and sharing decisions and resources (Berkowitz, 2000). Through the process of clarifying priorities and identifying strategies to achieve mutual goals, ACE members in education and practice have gained an understanding and respect for the values and needs across education and practice settings. Evidence exists through the products of collaboration that barriers can be overcome and that strategies can be implemented to increase effectiveness and efficiency in nursing clinical education.

Effects on Student Learning, Recruitment, and Retention

ACE originated from the need to manage student clinical placements and resulted in the establishment of community standards to standardize the process and address regulatory and accrediting mandates. In addition, collaboration generated broader consequences of value to the schools of nursing and affiliating clinical agencies.

Preparation for entry into practice is based on sufficient clinical experiences at the right time, at the right level, and with the right instruction and supervision to develop safe, basic clinical competencies. The quality of the clinical education experience is enhanced for all involved when consistent planning, orientation, skillful clinical instruction and supervision, and ongoing communication and conflict management occur. The student, staff, educational program, clinical agency, and ultimately the patient benefit from well-organized and mutually facilitated clinical education experiences.

Another outcome of ACE is a heightened awareness of criteria for appropriate placements, which include volume and kind of service setting, quality and safe clinical care delivery, positive role models, opportunities for knowledge and skill development in a specific clinical area, cultural competency, and reciprocal support for the educational and practice missions and goals. In addition to ongoing planning and problem solving, educational programs and clinical agencies engage in summative evaluation for each clinical course. Anecdotal observations and course evaluations help in assessing the appropriateness of the clinical placement. Schools and agencies reflect on the experience and use the feedback to inform future placement decisions. For example, clinical placements in a renowned rehabilitation hospital have been determined to be excellent for senior-level medical-surgical or senior-integrated practicum (capstone) students focusing on holistic, patient-centered, interdisciplinary care for clients with traumatic brain or spinal cord injuries and their families. Other acute care settings may be better suited to provide junior-level students with less complex patient scenarios to practice fundamental skills. The ACE Clinical Request Form documents basic criteria helpful to the agency in assuring the most appropriate clinical placements are made.

Positive clinical experiences support student competency development and confidence and serve as an important approach to recruitment of new graduate nurses. The clinical experience begins with a standardized, well-organized, and communicated plan and orientation. Staff nurses are provided with specific information regarding the schedule, level of student learning, course expected outcomes, and clinical instructor role and contact information. Students are familiar with the patient care delivery approaches, available learning activities, and kind of instruction and supervision. A more welcoming and less disruptive experience for student and unit staff is facilitated when community standards are met. Positive clinical experiences encourage prospective new graduate nurse employment and increased receptivity of unit staff.

Many clinical expert nurses enjoy aspects of precepting and teaching when adequately prepared and rewarded. Clinical expert nurses may find interaction with students rejuvenating, particularly when students arrive on the unit prepared for engagement and with mutually understood learning goals. Nursing retention may be facilitated with preceptor development training or encouragement to continue formal education for roles in clinical nursing education. Opportunities for professional growth and advancement within the clinical agency may influence clinical nurse experts to remain in the practice setting or affiliate with an educational program as a clinical instructor.

Research is needed to quantify the cost-benefit of the alliance’s influence on student learning, recruitment, and retention. For example, considerable variability exists in required unit and hospital orientation and activities. Evidence is lacking as to which strategies correlate with positive learning outcomes or agency evaluation of the experience. No tracking mechanism is currently in use to determine whether multiple placements in a clinical agency correlate with new graduate applications, hiring, or retention. These data would be useful to inform future affiliation and placement decisions.

Overcoming Potential Barriers

The need and opportunity to address clinical nursing education issues exist in all communities. However, the threats to collaboration must be acknowledged. An initial assessment of readiness to change is essential to determine whether the timing is right to engage potential partners in new practices.

The barriers associated with developing a clinical education alliance include general contentment with the current status quo. Current placement issues may be managed within existing relationships involving individual education programs and clinical agencies. Partners may fear that standardization will create a bureaucratization of clinical education, decreasing spontaneity, uniqueness, and negotiation among individual entities. Establishing trust and working relationships takes considerable time and effort, and change will initially be disruptive. A collaborative alliance requires transparency of agenda and action, stimulating concerns if partners perceive favoritism or shifting relationships. Continuous effort must be directed at maintaining individual relationships within an organized alliance. Competition may increase among partners when concerns arise over ownership or rights to products developed, or insufficient credit given to those who developed a product then implemented or modified by others. Open dialogue, permission, and acknowledgement of originators must be consistent to assure continued willingness to share work with others for the benefit of achieving common goals.

Steps to Forming a Clinical Education Collaborative

The risks may be managed by identifying and building on concomitant strengths and opportunities. Trust-building activities focused on small-stake issues (e.g., membership roster encouraging contact between meetings) can demonstrate the advantages of collective versus individual interests and motivate collaboration for future goals. The following steps are recommended to initiate and formalize an education-practice alliance, and reflect lessons learned:

  • Invite membership to include key stakeholders in education across program levels and various clinical agencies. A small, working membership should include individuals with decision making authority and members knowledgeable of operations related to clinical placement process and issues. ACE was championed by a credible core, which aligned others through an articulated vision and perseverance.
  • Focus on motivating issues of mutual, urgent concern. ACE actions progressed from setting community standards regarding clinical placements to collectively addressing timely and significant regulatory and accrediting mandates, for example HIPAA and cultural competency, to reinforce collaboration and sustain momentum.
  • Formalize proceedings with elected officers, bylaws, agendas, minutes, and membership rosters. ACE sustainability is attributed to coordinated information sharing, referring issues to voluntary task forces for fact-finding and strategizing, and cycling back to ACE for deliberation and decision making. Officers and operating procedures lend visibility and voice to the alliance to external constituents. Agendas with fixed and new items, detailed minutes, and dissemination of membership rosters with updated contact information provide continuity between meetings and assurance that process-oriented discussions result in timely and tangible outcomes.
  • Redefine purpose and priorities to assure relevancy with current education and practice issues. Similar to a quality improvement process, a dynamic reevaluation of processes and goals is necessary to achieve positive outcomes. ACE continues to grapple with fundamental issues of clinical placements and regulatory or accrediting requirements and seeks to proactively address emerging issues. Future issues include student orientation to electronic medical records and standardization of simulation to augment onsite clinical experiences.

Opportunities and Future Challenges

Building on the success of collaborative partnerships, ACE continues to positively influence nursing education and practice in Colorado. As health care continues to change, broad collaboration is an effective way to meet the need for change. ACE has created a strong voice and can convey a consistent message to key policy and decision makers within the community. Deliberation to assure accurate assessment and critical analysis of issues and trends affecting nursing education, practice, and consumer health care are potentially far-reaching activities. Strategies to address current realities, such as the clinical faculty shortage and patient safety concerns, are constructed and forwarded to proactively influence the State Board of Nursing, Area Health Education, Colorado Nurse Association, and the Colorado Center for Nursing Excellence.

Projects that ACE is currently influencing include:

  • Clinical placement technology platform. In collaboration with the Colorado Center for Nursing Excellence and Colorado Central Area Health Education Center, ACE is instrumental in the development and piloting of a Web-based system to match clinical placements needs and resources. The platform will potentially maximize current placements, explore new and alternative placements, and support increasing enrollments. The platform is an interactive Web-based system based on the Oregon Center for Nursing (n.d.).
  • Preceptor development. An online, basic-level preceptor development course is planned in response to a needs assessment, verifying the lack of preceptor development opportunities and increased demand for preceptored clinical experiences statewide. The project is in collaboration with several educational programs, clinical agencies, and the Colorado Center for Nursing Excellence.
  • New graduate employment trends. A statewide new graduate employment survey is being conducted to explore hiring trends and new graduate orientation programs. A national environmental scan is in process to identify best practices. Findings will inform the design and development of a standardized model for new graduate orientation.
  • Recommendations to the Colorado State Board of Nursing. Dialogue is occurring to clarify the roles and qualifications for clinical nurse faculty, clinical scholars, and preceptors to support excellence in clinical nursing education during times of nursing and nursing faculty shortages.
  • Partnership with the Work, Education, and Lifelong Learning Simulation (WELLS) Center. The WELLS Center is a state-of-the-art patient simulation center, providing leadership in advancing the understanding and effective use of innovations in educational technology. Computer-driven mannequins, which virtually simulate clinical scenarios, and the VH Dissector, a cutting-edge computer program for learning anatomy through virtual dissection of the human body, are available educational tools. The WELLS Center project is funded through grants from the U.S. Department of Labor, Colorado Department of Labor, and the Colorado Workforce Council. The Colorado Center for Nursing Excellence oversees the operations and works collaboratively with ACE members to provide demonstration and consultation regarding scenario development and simulated learning activities.
  • Use of clinical simulation in prelicensure nursing education. ACE provides recommendations to the Colorado State Board of Nursing regarding the use of clinical simulation to augment clinical hours. The model for clinical education is developing on the basis of evidence from educational institutions and the WELLS Center for showing the efficacy of simulation in preparing and remediation students preparing for clinical practice.

An alliance consisting of representatives from educational programs, health care organizations, and regulatory agencies can be established as a solution-building mechanism. Opportunity exists for similar alliances to influence policy and shape the development of community standards. Collaboration builds a sense of partnership and power necessary for innovation, implementation, and evaluation of best practices in nursing education and practice.

References

Education and Practice Partnership for the Alliance for Clinical Education (ACE)

ACE DefinitionACE Purpose
The Alliance for Clinical Education (ACE) consists of representatives from Colorado health care organizations and educational institutions and regulatory agencies who come together to address clinical nursing education issues.The ACE group meets quarterly as a forum to share ideas and information and to make recommendations surrounding best practices, community standards, and regulatory compliance, in an effort to provide the optimum clinical student learning experiences.
Source: Alliance for Clinical Education (2006).

Alliance for Clinical Education Sample Agenda

Welcome and introductions
Fixed agenda items
  Approval of meeting minutes and member contact list updates
  Colorado State Board of Nursing Update: policies related to development and approval of nursing education programs
  Colorado Nurses Association: current issues and legislative update
  Colorado Center for Nursing Excellence Initiatives
    Clinical Student Placement Technology Platform
    Work, Education and Life-Long Learning Simulation Center project
  Colorado Area Health Education Center update
  Colorado Council on Nursing Education update
General agenda items
  Announcement and negotiation of ongoing clinical placement needs
  Presentation: evidence-based practice initiatives
  Presentation: a clinical scholar’s experience
  Task force reporting
    Occupational Safety and Health Administration Competency Examination
    Criminal background checks
    Survey of issues influencing clinical placements
Emerging issues
  New graduate orientation and employment trends
  Drug testing requirement for student placement
Round Robin announcements

Summary of Alliance for Clinical Education (ACE) Accomplishments

ProductCommunity Standards/Benefits
Comprehensive and updated ACE member contact listFacilitates dialogue and consultation among experts in nursing educational programs and clinical agencies
Standardized dress code guidelines, role expectations, and terminologyProvides guideline for developing internal policies for acceptable dress requirements and professional role behaviors across educational programs and clinical agencies
Preceptor Recognition CertificateEncourages educational programs to formally recognize contributions of the clinical staff nurse to student learning and clinical education
Educational CD-ROM for HIPAA privacy requirementsProvides efficient and uniform education for demonstrating compliance with HIPAA privacy regulations prior to clinical placement. Eliminated need for each school to develop independently
Standardized OSHA Competency ExaminationEstablishes uniform validation of student competency related to OSHA requirements prior to clinical placement, and eliminated need for each school to develop independently
Educational CD-ROM for cultural competencyAssists agencies in assuring requirement for cultural competency is met by students prior to clinical placement. Eliminated need for each school to develop independently
Standardized list of disqualifying events related to criminal background checksUniformly guides student applicant, nursing school admission, and clinical placement decisions
Student nursing skills inventoryAssists with planning individual student learning activities based on previous clinical experiences
Shadowing in health care careersFacilitates development of programs designed to encourage the younger generation to consider health care career opportunities
Clinical instructor development programsBuilds nursing student enrollment capacity and pool of qualified clinical instructors. Initial effort now expanded in collaboration with the Colorado Center for Nursing Excellence to a 5-day faculty development curriculum
Authors

Dr. Preheim is Director, Baccalaureate Nursing Program, and Associate Professor, University of Colorado Denver, Anschutz Medical Campus, School of Nursing, Aurora, Ms. Bader-Kail is Facility Administrator, DaVita, Inc., Ms. Miller is RN Educator, Porter Adventist Hospital, Ms. Kelly is Project Coordinator, Colorado Center for Nursing Excellence, and Dr. Lynch is Dean, Denver School of Nursing, Denver, Colorado. At the time this article was written, Ms. Bader-Kail was Director of Clinical Education, Orbis Education, San Diego, California.

Address correspondence to Gayle Preheim, EdD, RN, NCEA-BC, CNE, Director, Baccalaureate Nursing Program, University of Colorado Denver, Anschutz Medical Campus, School of Nursing, C288-12, Education 2 North, Room 3240, 13120 E. 19th Avenue, P.O. Box 6511, Aurora, CO 80045; e-mail: .Gayle.Preheim@ucdenver.edu

10.3928/01484834-20090301-08

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