Limitation in the number and scope of clinical practice sites is one of the most significant factors limiting enrollment in schools of nursing. OCNE is engaged in a multiphase project to create, build consensus on and evaluate a new approach to clinical education with goals of better use of clinical education sites, reduced burden for staff nurses – already stretched by increasing acuity of patients and short staff, and improved learning outcomes for students. Funding has been provided for preliminary work on the model by 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 )

The Clinical Education Model Project for the Oregon Consortium for Nursing Education was launched in February 2006. Based on early findings in the project it became clear that the current model of clinical education is increasingly driven by availability of clinical placements, not by experience that correlates with course outcomes or competency development (Gubrud et al, in press). The predominant current model of clinical education is taxing faculty, facilities, students, and staff. This makes it difficult to ensure that students get a planned experience with the appropriate mix of patients. Purposeful connection to the curriculum and student progressive attainment of competencies is limited.

Two Clinical Education Summits were held in September 2006 and May 2008 to engage stakeholders in consensus building around clinical education redesign and launch implementation plans and strategies for OCNE Clinical Education model. This model will serve as the foundation for implementation, and will continue to be refined as evaluation data is collected and analyzed through findings from demonstration projects.

View videostream Oregon Consortium for Nursing Education: Transforming Clinical Education

For the proposed new model, five types of learning experiences are identified, as follows:

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 client 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 among others.

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.