Limitation in the number and scope of clinical practice sites is one of the most significant factors limiting enrollment in schools of nursing. Using a consensus model, OCNE launched a multiphase project to create and evaluate a new approach to clinical education. Goals of the project were to improve the use of clinical education sites, reduce the burden related to clinical education for staff nurses already stretched by increasing acuity of patients and short staff. The project aims focused on improving learning outcomes for students by reducing random access experiences and creating a clinical education curriculum aligned with the OCNE competencies.
The OCNE Clinical Education model project was launched in February 2006. The project found older models of clinical education were increasingly driven by availability of clinical placements, not by experience that correlates with course outcomes or competency development. The project included a comprehensive gap analysis and identified the need to assure clinical education experience includes purposeful connection to the curriculum and student progressive attainment of competencies. The first clinical education summit was held in October 2006. A thought-leader group was recruited and met regularly over the next six months. Results from the comprehensive gap analysis were interpreted and used to create the model.
The five elements of the OCNE Clinical Education model are sequenced across the curriculum to support student development of clinical judgment and clinical practice knowledge:
- Concept based experience
- Case based experience
- Intervention-skill based experience
- Direct focused client care experience
- Integrative experience
Concept-based experience is designed to support student learning of pattern recognition. Through multiple encounters with clients experiencing the same problem, students learn pattern recognition associated with a specific concept, illness, disease or health problem.
Case-based experience presents students with authentic clinical problems they will likely encounter in practice and provides opportunities for students to learn to think like a nurse through case exemplars. It encompasses seminar discussion of faculty-designed or computer-based cases, as well as a variety of simulations including use of high, mid and low fidelity environments using human patient simulators, standardized patients and role-playing.
Intervention skill-based experience builds proficiency in the “know-how” and “know-why” of nursing practice. These experiences include psychomotor skills, as well as communication, teaching, advocacy, coaching, and interpersonal skills.
Focused direct client care experience enables the student to gain progressive experience in the actual delivery of nursing care and to build and understand the role of developing relationships with patients. The assigned focus for a care experience allows the student to apply a growing knowledge and skill base to client care. Students learn to establish and nurture the nurse/client relationship and integrate the ethics of caring for individuals.
Integrative practicum provides opportunity for the student to apply all elements of prior learning into an authentic clinical practice situation. The purpose is also to begin the transition into practice. Rather than the student being assigned to a particular client, the student is assigned to work with a registered nurse and provides client care with, and under the direction of, the registered nurse. The student practices integration of knowledge, clinical judgment and competencies while providing client care and studies the role of the registered nurse as it is expressed in a particular organizational environment.
In May 2008 a second summit was held to engage stakeholders in consensus building around clinical education redesign and to develop implementation plans needed to launch the OCNE clinical education model.
The full model was implemented on 4 OCNE campuses through a study funded by the Fund for Improvement of Post-Secondary Education (FIPSE) administered by the U.S Department of Education. The study resulted in identification of best practices for each element of the model and provided evidence needed to further integrate the model on multiple OCNE campuses. Hawaii has also implemented the model on multiple campuses in their statewide consortium.
The following organizations generously provided funding to support the development of OCNE’s Clinical Education model: Kaiser Permanente Northwest, the Northwest Health Foundation, Meyer Memorial Trust, The Ford Family Foundation, and the U.S. Dept. of Education Fund for Improvement of Post-Secondary Education (FIPSE).
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Gubrud-Howe, P., & Schoessler, M. (2008). From random access opportunity to a clinical education curriculum. Journal of Nursing Education, 47(1), 3-4.
Nielsen, A. E, Noone, J., Voss, H. & Mathews, L. R. (2013). Preparing nursing students for the future: An innovative approach to clinical education. Nursing Education in Practice, 13, 301-309.
Niederhauser, V., Schoessler, M., Gubrud-Howe, P, Magnussen,L, & Codier. (2012). Creating innovative model of clinical nursing education. Journal of Nursing Education, 51(11) 603-608