Journal of Nursing Education

Major Article 

Dedicated Education Unit: Implementing an Innovation in Replication Sites

Susan R. Moscato, EdD, RN; Vicki M. Nishioka, PhD; Michael T. Coe, PhD

Abstract

An important measure of an innovation is the ease of replication and achievement of the same positive outcomes. The dedicated education unit (DEU) clinical education model uses a collaborative academic–service partnership to develop an optimal learning environment for students. The University of Portland adapted this model from Flinders University, Australia, to increase the teaching capacity and quality of nursing education. This article identifies DEU implementation essentials and reports on the outcomes of two replication sites that received consultation support from the University of Portland. Program operation information, including education requirements for clinician instructors, types of patient care units, and clinical faculty-to-student ratios is presented. Case studies of the three programs suggest the DEU model is adaptable to a range of different clinical settings and continues to show promise as one strategy for addressing the nurse faculty shortage and strengthening academic–clinical collaborations while maintaining quality clinical education for students. [J Nurs Educ. 2013;52(5):259–267.]

Dr. Moscato is Tyson Distinguished Professor Emerita, School of Nursing, University of Portland; Dr. Nishioka is Senior Researcher, Education Northwest; and Dr. Coe is President, Cedar Lake Research Group, Portland, Oregon.

This study was supported by the Robert Wood Johnson Foundation Evaluating Innovations in Nursing Education Program. The authors thank Sherry Webb and Veronica Engle, University of Tennessee Health Science Center, College of Nursing; and Linda Steeg, Mattie Rhodes, Claire Meyers, Beth Nicastro, Grace Dean, and Susan Grinslade, School of Nursing, University at Buffalo, for their contributions to the case studies presented in this article. The authors also thank Peggy Hewlett, Dean, University of South Carolina, College of Nursing, for her help in clarifying the essentials of the dedicated education unit concept.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Susan R. Moscato, EdD, RN, Tyson Distinguished Professor Emerita, School of Nursing, University of Portland, 5000 N. Williamette Boulevard, Portland, OR 97203-5798; e-mail: srmoscato@gmail.com.

Received: August 23, 2012
Accepted: November 28, 2012
Posted Online: March 28, 2013

Abstract

An important measure of an innovation is the ease of replication and achievement of the same positive outcomes. The dedicated education unit (DEU) clinical education model uses a collaborative academic–service partnership to develop an optimal learning environment for students. The University of Portland adapted this model from Flinders University, Australia, to increase the teaching capacity and quality of nursing education. This article identifies DEU implementation essentials and reports on the outcomes of two replication sites that received consultation support from the University of Portland. Program operation information, including education requirements for clinician instructors, types of patient care units, and clinical faculty-to-student ratios is presented. Case studies of the three programs suggest the DEU model is adaptable to a range of different clinical settings and continues to show promise as one strategy for addressing the nurse faculty shortage and strengthening academic–clinical collaborations while maintaining quality clinical education for students. [J Nurs Educ. 2013;52(5):259–267.]

Dr. Moscato is Tyson Distinguished Professor Emerita, School of Nursing, University of Portland; Dr. Nishioka is Senior Researcher, Education Northwest; and Dr. Coe is President, Cedar Lake Research Group, Portland, Oregon.

This study was supported by the Robert Wood Johnson Foundation Evaluating Innovations in Nursing Education Program. The authors thank Sherry Webb and Veronica Engle, University of Tennessee Health Science Center, College of Nursing; and Linda Steeg, Mattie Rhodes, Claire Meyers, Beth Nicastro, Grace Dean, and Susan Grinslade, School of Nursing, University at Buffalo, for their contributions to the case studies presented in this article. The authors also thank Peggy Hewlett, Dean, University of South Carolina, College of Nursing, for her help in clarifying the essentials of the dedicated education unit concept.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Susan R. Moscato, EdD, RN, Tyson Distinguished Professor Emerita, School of Nursing, University of Portland, 5000 N. Williamette Boulevard, Portland, OR 97203-5798; e-mail: srmoscato@gmail.com.

Received: August 23, 2012
Accepted: November 28, 2012
Posted Online: March 28, 2013

The University of Portland School of Nursing (UP), in collaboration with clinical partners, adapted the dedicated education unit (DEU) clinical education model in 2003 as an innovative way to provide quality education, increase effective use of existing nursing resources, and produce more nursing graduates. The original DEU concept was developed by the School of Nursing, Flinders University, South Australia (Edgecombe, Wotton, Gonda, & Mason, 1999). Our previous article describing the implementation and evaluation of the DEU model adapted for the U.S. system (Moscato, Miller, Logsdon, Weinberg, & Chorpenning, 2007) generated national interest among nursing education programs and health care facilities to explore implementation of DEUs at their sites. Leaders in the health care profession have identified this innovation as a possible solution to the faculty shortage and the expected nursing shortage (Institute of Medicine, 2011). Since that time, the UP and its clinical partners have provided consultation and technical assistance to universities and clinical sites across the United States on implementation and sustainability of the DEU model.

This article describes the DEU Portland model and how nursing education programs at the University of Tennessee Health Science Center College of Nursing (UTHSC) and the School of Nursing, University at Buffalo (UB), have replicated the model. These two programs participated in the Robert Wood Johnson Foundation-sponsored Evaluating Innovations in Nursing Education (EIN) project with the UP (Nishioka, Coe, Moscato, & Hanita, 2012). Both were chosen because nurse educators from these schools of nursing learned of the model during a 1-day symposium sponsored by the UP, and they received consultation support from the UP to develop DEUs with their clinical partners.

Overview of the DEU Portland Model

The DEU Portland model is an academic–service collaboration that reorganizes existing resources to improve the quality of clinical education and to expand the teaching capacity of nursing education programs. By definition, a DEU is a client unit or health care setting that is “developed into an optimal teaching/learning environment through the collaborative efforts of management, clinical faculty, and staff nurses” (Moscato et al., 2007, p. 32). It is a commitment by both academic and clinical partners to develop effective clinical learning environments. The commitment is carried out through using proven teaching and learning strategies and capitalizing on the competencies of staff clinicians and the teaching expertise of clinical faculty. Excellent patient care is always paramount. The DEU requires a shared commitment to clinical education, mutual respect for the importance of each partner’s contribution, and trust that the DEU benefits all—faculty, nurses, and students—while maintaining quality patient care.

The DEU model contrasts with the traditional education model in many ways. Key differences are summarized in Table 1.

Comparison of Dedicated Education Unit (DEU) and Traditional Clinical Nursing Education Modelsa

Table 1: Comparison of Dedicated Education Unit (DEU) and Traditional Clinical Nursing Education Models

The DEU differs from traditional clinical education models in the strength of the academic–clinical partnership and organization of clinical teaching roles. In the traditional model, the academic faculty provides clinical instruction for eight students, with varying levels of support from the staff nurse. Because students are assigned to patients, the students are paired with different nurses throughout their rotation. On the DEU, practicing expert clinicians, not faculty, provide bedside clinical instruction, each working with the same students throughout the entire rotation. The role of the clinical faculty coordinator is to coach the clinician instructors in their new teaching role, maintain collaborative relationships with unit staff members, ensure that students understand theoretical and conceptual concepts that guide their care, and ensure that the unit atmosphere promotes optimal student learning. DEU students become part of the unit, allowing them to experience the culture and workflow in a way that often is not feasible in the traditional model. Because of the open, inclusive learning environment, DEU students have a better opportunity to learn by doing, to practice clinical reasoning, and to build a realistic perspective on nursing (Lave & Wegner, 1991).

DEU Portland Model Outcomes

Use of the DEU model for clinical education at the UP has allowed for increased enrollment and graduation rates and has not adversely impacted the National Council Licensure Examination (NCLEX-RN®) pass rate. Figure 1 shows the number of students who enrolled and graduated from the UP annually from 2005 (the year prior to expansion to six DEUs) to 2011. Across the 5-year time span, the number of nursing enrollments and graduates at the UP increased from 557 to 720 students—a 29% increase in enrollment.

University of Portland, School of Nursing student enrollments and graduates, 2005 to 2011 statistics (Nishioka et al., 2012). Reprinted with permission from the University of Portland School of Nursing.

Figure 1. University of Portland, School of Nursing student enrollments and graduates, 2005 to 2011 statistics (Nishioka et al., 2012). Reprinted with permission from the University of Portland School of Nursing.

Because the Oregon State Board of Nursing allows a faculty-to-student ratio of 1:24 in DEU settings, the UP was able to increase the efficiency and number of students placed in the DEU unit. Prior to implementation of the DEU model, students were placed across a number of different settings, often at the same time that students from other nursing education programs were present. In 2002, 227 students were placed in 14 different traditional units—an average of 16.2 student placements per unit for the academic year. Following implementation of six DEUs in 2006, the average number of students placed in each DEU ranged between 50 and 61.5 student placements per year (Figure 2). The replication sites did not realize similar increases in student placement capacity; however, it is likely that the faculty-to-student ratio required by their state boards of nursing restricted their ability to increase the number of student placements.

University of Portland, School of Nursing’s average number of student placements per unit in 2002 and 2006 to 2011. Note. Calculation is based on 14 traditional units in 2002, six Dedicated Education Units (DEUs) in 2006, eight DEUs in 2007 to 2009, and nine DEUs in 2010 to 2011 (Nishioka et al., 2012). Reprinted with permission from the University of Portland School of Nursing.

Figure 2. University of Portland, School of Nursing’s average number of student placements per unit in 2002 and 2006 to 2011. Note. Calculation is based on 14 traditional units in 2002, six Dedicated Education Units (DEUs) in 2006, eight DEUs in 2007 to 2009, and nine DEUs in 2010 to 2011 (Nishioka et al., 2012). Reprinted with permission from the University of Portland School of Nursing.

Despite this rapid increase in student enrollment, the UP students’ first-time pass rates on the NCLEX-RN remained higher than the national average (Nishioka et al., 2012; Figure 3). Although these data do not provide evidence that the DEU has a positive impact on student achievement, they do suggest that shifting the responsibility for clinical instruction to expert nurses, with the support of the clinical faculty coordinator, does not negatively impact student learning.

Percent of University of Portland students who passed their first-time NCLEX-RN (Nishioka et al., 2012). Reprinted with permission from the University of Portland School of Nursing.

Figure 3. Percent of University of Portland students who passed their first-time NCLEX-RN (Nishioka et al., 2012). Reprinted with permission from the University of Portland School of Nursing.

DEU Implementation Essentials

Almost a year of conversations, negotiations, team building, and best thinking went into planning before the start of the first DEUs in Portland in 2003. The 12- to 18-month planning period has also been needed at DEU replication sites. Lessons learned while designing the Portland DEU model were documented and refined over the years as new DEUs were opened. Scholarly work led to the articulation of DEU essentials and the development of a DEU Implementation Checklist. Throughout the EIN project, this tool was revised by UP faculty and researchers at Education Northwest and Cedar Lake Research Group in accordance with the evaluation findings. The latest version is available on the UP School of Nursing’s Web site (University of Portland, 2012b).

The following components represent DEU implementation essentials, and they provide the foundation for the development of a successful DEU model.

Establish a Strong Academic–Clinical Partnership

Strong academic–clinical partnerships are essential to developing and operating a DEU. The senior leadership of the clinical partner and the nursing education program must endorse and commit resources to the DEU. Before beginning the process of developing a DEU, the academic and clinical partners should identify and address institutional factors that may influence the development or operation of their DEU. Table 2 shows the factors that the partnership should consider as they determine their readiness to develop a DEU.

Issues That Academic and Clinical Partners Should Discuss to Determine Their Readiness for the Dedicated Education Unit (DEU) Model

Table 2: Issues That Academic and Clinical Partners Should Discuss to Determine Their Readiness for the Dedicated Education Unit (DEU) Model

Ensure a Collaborative Commitment to Develop a DEU

Collaborative relationships are built on a commitment to a shared vision and a written set of assumptions that articulate a common set of beliefs, agreements, expectations, and tasks. The assumptions provide guidance for the operation of the DEU and support implementation fidelity of the model (University of Portland, 2012a). Assumptions should be reviewed and updated regularly to accommodate any policy or procedural changes in the DEU setting or academic–clinical partnership. The steps for collaborative development of a successful DEU unit are shown below.

Select a Unit. The collaboration selects a high-quality unit or health care setting to become a DEU. Potential DEUs should have the following characteristics: (a) unit delivers exemplary patient care, (b) staff work in effective teams, (c) unit staff believe teaching is a high priority, and (d) unit has efficient management systems that provide supportive conditions for developing an optimal learning community.

Designate a DEU Planning Team. Both academic and clinical partners assign a coordinator to plan and organize the implementation of the DEU model. Effective coordinators have the educational experience, organizational acumen, access to resources, and official administrative designation for their roles. Typically, the academic faculty member who will serve as the DEU’s clinical faculty coordinator and the unit’s nurse manager assume these important leadership roles, and they invite additional key members to join the team. Planning tasks include (a) reviewing and, if needed, revising organizational policies, union and contract obligations, and state board of nursing regulations; (b) establishing qualification standards and selection procedures for the clinician instructors; (c) determining additional compensation (monetary, professional development opportunities, faculty appointments, and clinical ladder advancement) and workload adjustments; and (d) outlining the orientation agenda, materials, and schedule for the clinician instructors.

Planners schedule discussions and events to engage buy in from all unit staff. At minimum, these events should include information-sharing meetings and formal opening ceremonies. Being intentional in explaining the DEU, identifying ways that unit staff members can help teach students, and planning gestures of appreciation for all staff members in the unit will encourage stronger unit-level support for the DEU. Finally, planners need to consider strategies to reduce the sources of stress caused by having six to eight students in the unit; these may include assuring adequate workspace, computer availability, and storage for backpacks, as well as creating agreements about use of the breakroom.

Transform the Clinical Faculty Role. In the DEU model, the primary role of the clinical faculty coordinators is to educate and coach expert clinicians in clinical teaching skills and to manage the clinical education of up to 18 students. This role change requires purposeful reframing of the faculty member’s clinical activities and work responsibilities. Orientation to the reframed clinical faculty role must include role transition dialogue and must provide theory and practice for the faculty member to teach and mentor the clinician instructors in the use of teaching–learning strategies. Clinical faculty must know how to help clinician instructors engage students in thinking and reasoning about a situation, develop a sense of saliency, and become active members of the unit team.

Select and Provide Orientation for Clinician Instructors. The DEU nurse manager selects expert nurses or clinicians who want to teach and who are committed to mentoring, guiding, and supporting the student learners in a collaborative learning environment. Clinician instructors are expert clinicians who receive specialized training to provide clinical instruction to nursing students. To prepare for their new role, clinician instructors attend a 6- to 8-hour orientation on the academic campus, which provides an overview of the DEU model, information about the students’ clinical learning expectations, available education program resources, and research-based teaching strategies.

Establish Communication Procedures. The clinical education team—clinical faculty member and clinician instructor—are responsible for monitoring each student’s clinical skill development and providing early intervention for struggling students. Effective clinical teams develop a teaching plan that outlines the students’ clinical performance requirements, monitors their progress daily, and schedules at least two formal student evaluation meetings during the rotation. Although the level of contact varies from site to site, clinical faculty coordinators recommend talking face-to-face with each clinician instructor each clinical day and answering e-mail and telephone messages within 24 hours. In addition, the clinical faculty coordinator should check in regularly with the nurse manager to share information and to address concerns or questions. Finally, the DEU faculty member maintains regular contact with the students during visits to the unit and at their weekly postconferences.

Establish Quality Assurance Systems

The DEU coordinator is responsible for ensuring program quality and for providing support for the DEU collaboration. This position oversees the DEUs, supports formal communication systems, and convenes regular advisory meetings to share information and address the concerns of collaboration members. The DEU coordinator may also coordinate the development of new DEUs and oversee continuous quality improvement and sustainability of the existing DEUs. In the UP program, the Associate Dean for Undergraduate Programs is designated as the DEU coordinator who oversees the clinical faculty coordinators.

The DEU model embeds internal evaluation systems that elicit information from students, clinician instructors, and clinical faculty about their DEU experience. The evaluations provide information about the relationships among clinician team members, the efficacy of DEU procedures, and the recommendations for improving students’ clinical instruction. The evaluation results are shared so each individual can reflect on the positive feedback about his or her role and the recommendations that might improve his or her work or the DEU model.

DEU Implementation in Replication Sites

One critical measure of an innovation is the ease of its replication and the achievement of the same positive outcomes in new sites. This section describes the application of the DEU Portland model in two replication sites.

Both replication sites were motivated to implement the DEU due to concerns about the faculty shortage, about maintaining quality education with increased numbers of students, about the limited number of clinical placements, and about the importance of reducing costs associated with the retention and recruitment of nurses. Curricular changes and new programs, such as the master’s-entry Clinical Nurse Leader program at the UTHSC, provided the opportunity to capitalize on interest and to try something new with clinical partners. Another driving factor was the desire for a reenvisioned clinical environment that would support knowledge acquisition, knowledge use, and role formation, as encouraged by the Carnegie Foundation’s Educating Nurses: A Call for Radical Transformation (Benner, Sutphen, Leonard, & Day, 2010).

The original DEU Implementation Checklist (version 1) that included the essentials discussed above was used to assess the extent to which each replication site implemented the components of the DEU Portland model (Table 3). Thirty-three checklist items were rated by respondents on the level of implementation at their DEUs: not in place, partially in place, and fully in place. During site visits, the EIN evaluator also completed the checklist based on archival documents and focus group and interview findings.

Items on the Dedicated Education Unit (DEU) Implementation Checklist (Version 1)Items on the Dedicated Education Unit (DEU) Implementation Checklist (Version 1)

Table 3: Items on the Dedicated Education Unit (DEU) Implementation Checklist (Version 1)

Both sites—the UTHSC College of Nursing and the School of Nursing, University at Buffalo—fully implemented five of the six components of the Portland model and 75% of the Evaluation and Quality Assurance component. At both sites, the clinical team members completed written evaluations of their model; however, the teams did not share these results consistently among team members. The clinician instructors expressed appreciation for the thank-you notes received from students, but they indicated it would be helpful to read the students’ written evaluations of their instruction.

DEU Program Characteristics

The two replication sites developed DEUs in a wide range of settings with relatively little external support from the developers of the DEU Portland model. Representatives from each of the sites attended the 2007 UP Innovation and Leadership Symposium and received some formative consultation support. Following this orientation, each site began to develop the model with its clinical partners. Table 4 summarizes program operations information for Portland and the replication sites, including education requirements for the clinician instructors, academic status of the students, use of the unit by other schools, types of patient care units, and the clinical faculty-to-student ratio.

Characteristics of the Dedicated Education Unit (DEU) by Participanta

Table 4: Characteristics of the Dedicated Education Unit (DEU) by Participant

Clinician Instructors’ Education Level

The clinician instructors at each school are registered nurses with a bachelor’s or associate’s degree.

Academic Status of DEU Students

The students who receive clinical instruction on the DEUs include juniors and seniors enrolled in undergraduate baccalaureate programs and, in Tennessee and Oregon, students in the prelicensure component of second-degree master’s programs.

Unit Use by Other Nursing Programs

Among the three DEU sites, the use of the DEU by more than one school of nursing varies. Two sites, the UP and the UTHSC College of Nursing, strongly advocate for exclusive use of the unit at all times. Exceptions to this policy do occur if the clinical faculty coordinator and nurse manager agree that it is warranted, if student placements by other schools are temporary or time limited, and if the students from other nursing education programs are not scheduled on the same shifts as DEU students.

DEU Patient Care Units

The three participant sites have developed DEUs in a wide range of patient care units, including oncology, emergency, intensive care, neurology, psychiatric, pediatrics, and maternity. In addition, the universities have collaborated with health care agencies that go beyond acute care facilities. For example, the UP operates DEUs in two long-term care facilities and is collaborating with a local education service district to develop a school-based DEU in which school nurses are the clinician instructors. The UB was the first to apply the DEU concept in a hospice setting that provides home-based services.

Faculty-to-Student Ratio

Although the Oregon State Board of Nursing allows a faculty-to-student ratio of 1:24 in DEU settings, the UP suggests that the clinical faculty coordinator supervise no more than 16 to 18 students per rotation. For the replication sites, the faculty-to-student ratio ranges between 1:8 and 1:24 students, depending on the state board of nursing supervision requirements for the DEU model.

Case Studies of the Replication Sites

Clinical faculty members involved in the development or operation of the DEUs at their replication sites were the key sources for the following case studies. Information from administrator interviews, stakeholder interest groups, and archival documents were used to corroborate the information presented. In addition, each school was asked to identify promising outcomes with the use of the model and lessons learned. The purpose was to understand the adaptability of the model to different settings while retaining fidelity to the key DEU tenets.

UTHSC College of Nursing

The UTHSC College of Nursing developed interest in the DEU model in 2008 when it was exploring a clinical innovation for its new master’s-entry Clinical Nurse Leader program, an innovation that was “interprofessional, client-centered, outcome-driven and cost-effective at the microsystem level” (Nishioka et al., 2012, p. 27). DEUs were opened with UTHSC’s clinical partner, Methodist Le Bonheur Healthcare, in 2009 in one adult and two pediatric units and in a second adult unit in 2011. A DEU task force, consisting of the dean, key faculty, and practice partner members, was formed to guide the 10-month planning process. Task force activities included (a) description of the DEU model and roles; (b) unit, nursing staff, and faculty selection criteria; (c) nursing staff training topics; (d) a communication plan for the hospitals and faculty, and (e) DEU opening celebrations. UTHSC closely followed the DEU Portland model by selecting clinician instructors from all educational levels who were expert clinicians. Once selected, the instructors were required to complete their agency’s preceptor course and to participate in a 1-day clinician instructor orientation workshop provided by the nursing education program.

Promising outcomes of the model included the students’ resounding satisfaction with their DEU experiences. One student said, “Being on a DEU was a very realistic view of how nursing really is. We were treated as colleagues rather than students, and this mutual respect made for a more inviting learning experience.” UTHSC reported continued upward trends in NCLEX-RN pass rates. Although this increase is not directly attributable to use of the DEU model, the trend suggests that shifting the responsibility for teaching from faculty to clinicians did not negatively impact pass rates. The relationship between the DEU and the nursing education program’s teaching capacity could not be examined due to the state board of nursing’s requirement to maintain the same faculty-to-student ratio (1:8) on the DEU as in a traditional unit. Based on discussions with stakeholders, lessons learned include the fact that DEU implementation requires strong commitment from the college of nursing, hospital management, faculty, and staff and that “ongoing communication and physical presence on the DEU is critical to success” (Nishioka et al., 2012, p. 29).

School of Nursing, UB

Interest in the DEU model at UB was promoted by a need to address clinical partner concerns “about the nursing shortage, retention and recruitment of nurses, and collectively managing clinical placement requests” and the school of nursing’s need to address “faculty shortage, increasing numbers of students and competition for clinical placements” (Nishioka et al., 2012, p. 32). Implementation meetings began in 2007 with a series of planning sessions among interested partners. Pilot DEU projects were launched in 2008 in three adult units with clinical partners at Kaleida Health and Erie County Medical Center. Like UTHSC, UB follows the Portland model in the role, expertise, selection, and orientation of the clinical faculty coordinator and clinician instructor. Unlike UP, but similar to UTHSC, the UB faculty members have a continual presence in the DEU, as required by the state board of nursing to “provide support and coaching for the DEU nurses while maintaining their role as clinical educators responsible for monitoring student progress” (Nishioka et al., 2012, p. 32).

Key promising outcomes included the welcoming environment that students felt in the DEU and their ability to “gain a more realistic view of the work of the nurse and the importance of cooperation in nursing” (Nishioka et al., 2012, p. 33). NCLEX-RN first-time pass rates continued an upward trend while the DEUs were instituted and the curriculum was reorganized. The challenge for faculty members as they learned a new role was emphasized. As one clinical faculty coordinator stated:

My comfort level really wasn’t there. It seemed like I didn’t really have as much of a handle on what the students were doing with the patients as I have in the past. It was certainly a learning curve regarding my new role.

Overall, the outcomes of participating in a DEU were reported as positive, with perceived high satisfaction from students, faculty, and nurses. An added bonus was early identification and early intervention for students struggling in the clinical setting. Like UTHSC, the teaching capacity did not increase because of the state board of nursing requirement for the traditional 1:8 faculty–student ratio.

A key lesson learned was that the relationship between university faculty and the DEU staff is crucial to the success of the program; there was also value added, as the DEU nurses were validated as “expert nurses” and teachers experienced a “reawakening of their passion for nursing” (Nishioka et al., 2012, p. 33).

Conclusion

This implementation study shows that the DEU Portland model was replicated with relatively little professional development support in two sites that vary in the curricular structure of their nursing education programs, in their state board of nursing requirements, and in their nurse union contract agreements. The procedures for placing students in clinical sites also varied, ranging from centralized, statewide clinical placement systems to site recruitment by individual clinical members. Despite these differences, each nursing education program developed the DEU concept into a clinical education program that was a contextual fit for their patient-care setting. The DEU Portland model has demonstrated appeal to a wide variety of schools of nursing and health care settings as a result of the ease with which it can be adapted for use. The DEU model continues to show promise in addressing the nurse faculty shortage, strengthening academic–clinical collaborations, and improving clinical education outcomes for students.

References

  • Benner, P., Sutphen, M., Leonard, V. & Day, L. (2010) Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.
  • Edgecombe, K., Wotton, K., Gonda, J. & Mason, P. (1999). Dedicated education units: A new concept for clinical teaching and learning. Contemporary Nurse, 8, 166–171 doi:10.5172/conu.1999.8.4.166 [CrossRef] .
  • Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
  • Lave, J. & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. New York, NY: Cambridge University Press doi:10.1017/CBO9780511815355 [CrossRef] .
  • Moscato, S.R., Miller, J., Logsdon, K., Weinberg, S. & Chorpenning, L. (2007). Dedicated education unit: An innovative clinical partner education model. Nursing Outlook, 55, 31–37 doi:10.1016/j.outlook.2006.11.001 [CrossRef] .
  • Nishioka, V., Coe, M., Moscato, S.R. & Hanita, M. (2012). Dedicated education units: Evaluating innovation in clinical education (Final technical report). Retrieved from the University of Portland website: http://nursing.up.edu/default.aspx?cid=12454&pid=2959
  • University of Portland. (2012a). Assumptions about dedicated education unit academic-service partnership. Retrieved from http://www.nursing.up.edu/default.aspx?cid=12216&pid=7292
  • University of Portland. (2012b). DEU implementation checklist. Retrieved from http://www.nursing.up.edu/default.aspx?cid=12207&pid=2959

Comparison of Dedicated Education Unit (DEU) and Traditional Clinical Nursing Education Modelsa

FeatureDEUTraditional Unit
Academic and clinical partners determine readiness for developing a DEU

Affirms a commitment to the DEU concept and mission of quality clinical education

Oversees the development and operation of quality DEUs in the clinical setting

Relationships are based on trust and collaboration

Coordinates scheduling for clinical placements

Coordinates and shares information about clinical learning opportunities

Relationships are cooperative

Unit selection

DEU partnership selects a high-quality unit

Unit is team oriented and well organized

Unit is committed to teaching

Unit is available to take students

Unit management style and quality varies

Commitment to teaching varies

Faculty role

Manages students’ clinical education

Provides coaching and professional development for the (nurse) clinician instructor

Manages eight to 16 students per rotation

Serves as primary clinical instructor for students

Manages students’ rotation (schedule, patient assignments, and evaluation)

Instructs six to eight students per rotation

Staff nurse role

Expert nurse with desire to teach

Mentor and clinician instructor for one to two students

Students are assigned to the same nurse for their entire rotation

Qualifications varyb

Assigned to one to two students each day, but relationship with student varies

Students are assigned to different nurses throughout their rotation

Communication

Formal and informal communication systems are in place

Formal communication systems are lacking; informal communication systems vary

Quality assurance

Uses evaluation and quality assurance systems to monitor implementation fidelity

Lacks evaluation and quality assurance systems to monitor implementation fidelity

Issues That Academic and Clinical Partners Should Discuss to Determine Their Readiness for the Dedicated Education Unit (DEU) Model

Are there union scheduling and floating policies that will prevent coordination of the clinician instructors’ work schedule with their students’ rotation days?
Will the DEU comply with state board of nursing regulations regarding clinical nursing instructor qualifications and required faculty-to-student ratios?
Will your organization’s policies allow for additional compensation for clinician instructors? If so, what types of compensation (e.g., monetary, career ladder advancement, adjunct faculty appointment) are available?
Does the clinical partner leadership agree that the unit will provide clinical placements exclusively for their nursing education partner or, at least, students from other nursing programs will not be on the unit at the same time?
Does each partner organization have the resources to designate a representative to plan and implement the DEU?
Can the academic partner conduct regular orientations for the clinician instructors, provide faculty privileges for the clinician instructors, coordinate quality assurance for the project, and ensure that the DEU complies with state board of nursing regulations?
Can the clinical partner release nurses to attend the DEU orientation, compensate the clinician instructors, collaborate with the nursing education program to maintain fidelity, and ensure that the DEU complies with union and other organization policies?

Items on the Dedicated Education Unit (DEU) Implementation Checklist (Version 1)

Essential/Item
Readiness for the DEU model

The academic and clinical administrators endorse implementation of the DEU model.

The academic and clinical partners commit resources to planning and development of the DEU model.

A liaison has been appointed from each academic and clinical partner to coordinate and help plan DEU implementation.

The academic–clinical partnership identifies client units that are enthusiastic about becoming a DEU.

The DEU planning and advisory committee identifies and agrees on a written set of core values or assumptions for a DEU model.

Academic–clinical partnership

The leadership of the academic and clinical partner facilitates and supports DEUs.

Stakeholder meetings are conducted at least twice yearly.

The DEU partners have an established process for communication between stakeholder meetings.

The academic and clinical partner uses a set of core DEU values, or assumptions, to guide decision making and planning.

The academic and clinical partner has the necessary resources to operate a DEU.

Decision making is by consensus among the DEU partners.

Clinical education environment

The student-to-clinical faculty coordinator ratio is no more than 24:1.

The academic leadership, clinical faculty, and faculty instructors of clinical courses have regular meetings to discuss DEU issues, share best practices, and prepare for clinical learning.

The clinical faculty coordinator communicates with the nurse manager on a routine basis.

Formal communication processes are in place between the clinical faculty coordinator and the clinician instructors.

The clinical faculty coordinator receives orientation and professional development to prepare and support him or her in his or her DEU clinical education role.

Clinician instructors

The nurse manager plays an active role in selecting nurses for the clinician instructor positions.

The clinician instructor attends one full-day orientation that includes five essential components.

Continuing education sessions related to clinical teaching are scheduled each year for clinician instructors.

The student-to-clinician instructor ratio is 2:1.

The clinician instructors are responsible for the same students during the entire rotation.

The clinician instructors are designated adjunct faculty.

The clinical partner releases nurses to attend orientation and professional development.

The clinician instructors participate in their students’ clinical evaluations.

Students’ evaluations or survey results indicate their clinician instructors were professional and supportive.

DEU clinical education environment

The DEU accepts students from one school of nursing.

The DEU schedules students for an entire rotation.

Students’ evaluation or survey results indicate the DEU nurses were supportive of the students’ clinical education.

Students are an integral part of daily operations.

Evaluation and quality assurance

Students complete an evaluation of their clinician instructor after each rotation.

The clinician instructor completes an evaluation of their clinical faculty coordinator regularly.

The clinical faculty coordinator completes an evaluation of the clinician instructors regularly.

The DEU planning and advisory committee meets regularly to review evaluation and quality indicator data.

Characteristics of the Dedicated Education Unit (DEU) by Participanta

DEU CharacteristicUniversity of PortlandUniversity at BuffaloUniversity of Tennessee Health Science Center
Clinician instructor’s education level
  Bachelor’s degreeXXX
  Associate’s degreeXXX
DEU student level
  JuniorX
  SeniorXX
  Prelicensure second-degree master’s degreeXX
Unit use by other nursing education programs
  DEU students onlyXX
  DEU students only on designated shiftsXX
  DEU and nonDEU students on same shifts
DEU patient care unit
  Medical–surgicalXXX
  Orthopedic–neurologicalXX
  PediatricsXX
  Obstetrics–gynecologyX
  OncologyX
  Emergency
  Intensive care
  Mental healthX
  HospiceX
  Long-term careX
DEU faculty-to-student ratio
  State board of nursing1:24b1:12b1:8
  DEU1:161:121:8

10.3928/01484834-20130328-01

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