Future Vision of Clinical Education 2017

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Running head: FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA 1

Future Vision for Clinical Education & Professional Development 2017

Jacqueline Cardenas

Post University

The Future of Education

EDU505.91

Therese Atjum-Roberts

December 9, 2013



FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA 2

Future Vision for Clinical Education & Professional Development 2017

Introduction

As technology rapidly changes, it is used to advance medical practice, patient care, and

safety. Education and the way it is delivered to healthcare providers is changing too. In the next

five years there will be significant changes to the way clinical education is delivered and

consumed by nurses and other members of allied health teams. Hospitals in some regions of the

United States will be creative in leveraging new technology to provide quality education to

nurses who have little time for anything but patient care due to expected nursing shortages.

Changes to education will be part of the strategic plan to carry out the hospital mission and align

with its values. At Children‘s Hospital in Arizona, hospital values include being, ―…recognized

for providing advanced education and training for clinical providers‖ (Phoenix Children‘s

Hospital website, n.d., para. 2). The mission at Children‘s Hospital is to, ―… provide Hope,

Healing and the best Health Care for children and their families‖ (Phoenix Children‘s Hospital

website, n.d., para. 1). To prepare nurses to provide the best healthcare and to be recognized as

an education leader, the Clinical Education Department will use technology to transform the

current model of one way education transactions to an interactive, whole learning process that

can take place anywhere there is an internet connection.

Children’s Hospital Clinical Education Department Overview

Children‘s Hospital was founded in 1983 before technologies that are now widely used

for employee education were available. By 2002, the Clinical Education Department had three

employees delivering education. In 2005, the hospital joined a consortium of 40 other children‘s

hospitals which encouraged nationwide collaboration and provided online pediatric specific

education to nurses via the consortium‘s learning management system (LMS). In 2011, the




organization expanded to a new eleven story patient tower and gained 400 employees via

merger. By 2012, there were five new satellite locations throughout the city. From 2008 to

2013, use of the LMS increased tremendously, and the department grew to 15 educators.

Current State of the Clinical Education Department

Currently, the Clinical Education department provides orientation and education for

clinical staff that provide patient care, the majority of whom are nurses. Orientation includes

over twenty hours of online learning and nurses receive two hours of additional online education

quarterly. All employees receive two hours of annual regulatory online learning. Because

computer access at work can be a problem, a pilot program to use tablets for online learning on

each unit is in development.

Role of Technology in Advancing Training and Patient Care

As discussed in the NMC Horizon Report: 2013 Higher Education Edition, tablet

computing is an emerging technology that will have a major impact on education (Johnson,

Adams Becker, Cummins, Estrada, Freeman, and Ludgate, 2013). As evidence for tablet

computing in education builds, leadership may see it as a solution to meet nurses‘ learning needs.

Researchers looking at the effects of mobile learning technology on nurse practitioner students

with various learning styles found that mobile learning benefitted all students. Moreover, the

authors suggested that communicating in a social learning environment with other universities

benefitted students‘ learning outcomes (Wyatt et al., 2010).

Social learning was recently introduced at Children‘s Hospital when the LMS upgraded

in 2012 to include a social media component; a community site within the LMS on which

members communicate, collaborate, post files and blogs, conduct polls, and earn badges and

ratings for posting. It is likely that social learning will soon be used to increase communication




and collaboration in training for nurses and shared governance in the organization. As the use of

tablets and social media are in the pilot stages at Children‘s Hospital, there is great opportunity

for the organization to take information from the pilots to create innovative and customized

learning for employees. These technologies are important for increased access to training and

efficiency to support organizational growth.

Trends Affecting the Future of Clinical Education: a Review of the Literature

It is projected that by the year 2030, there will only be 700 registered nurses (RNs) per

100,000 residents in Western states including Arizona — fewer than any other region of the

United States (Buerhaus, Auerbach, Staiger, and Muench, 2013). Due to such projections,

nurses in Arizona must prepare to handle more patients and train for the types of healthcare they

will deliver. There are several trends that clearly have an important role in the future training

and education of nurses. The trends that will have the largest impact are educational technology

such as e-learning including social media and mobile devices, public policy such as the

Affordable Care Act (ACA), economic factors associated with the ACA, an aging population,

and population growth in Arizona.

Trends in Educational Technology

As more nursing programs embrace technology to educate student nurses, nurse

educators in hospital settings are also beginning to innovate using newer technologies.

According to Lois Neuman, (2006), they tend to be late adopters, but more nurse educators are

embracing the ideas of e-learning and mobile technology in training. New technologies include

high fidelity simulation, virtual environments, and least expensive and easy to implement —

interactive online training, social media, and mobile technology.




Many of the technologies mentioned by Neuman in her future vision for nursing

education can be implemented with the use of social media. A social media site where nurses

learn from teachers, mentors, and more importantly from each other, includes mass

communication, online simulations, online modules, and access via mobile technology. These

sites can also stockpile a mass of data on learners for customized learning (Neuman, 2006). In

addition to the major impact of technology, nursing education will see significant changes in

response to public policy and economic factors.

Policy, Economic, and Demographic Trends

The ACA is a public policy that has far reaching implications for insurance companies,

states, healthcare organizations, corporations, and possibly nursing education. The ACA will

affect advanced nursing education as nurses and nurse practitioners are expected to take a larger

role in providing healthcare (Auerbach, Staiger, Muench, and Buerhaus, 2013). In addition,

because the ACA has major implications for how insurers pay and on state healthcare budgets, it

will affect education budgets. Furthermore, economic factors affecting education as noted in

Betts, Hartman, and Oxholm, (2009), such as state funding, fundraising, and technology funding

will require hospitals to provide more training on smaller budgets. Nurse educators will be

tasked with educating new nurses to care for more patients and training them to replace larger

numbers of retiring nurses.

Because Arizona has a larger number of retirees and population growth over 100%, a

nursing shortage could affect Arizona disproportionately (Betts, Hartman, Oxholm, 2009;

Buerhaus, Auerbach, Staiger, and Muench, 2013). This could result in more online programs for

training on the job, and a greater availability for experienced nurses to work remotely as online

faculty to address the shortage of nurse educators and faculty.




Social media and online education via mobile technology are major elements that will

change nursing education in the future. Policies such as the ACA and its economic implications

as well as the retiring nurse workforce and population increases in the West, will also affect the

training and development programs for new and existing nurses in the future.

Futuring: Techniques to Prepare for the Future

Preparing for the future with specific plans of how decisions will be made given various

outcomes, a concept known as futuring, is an important exercise for educational organizations.

Planning is essential for any organization to deal with rapidly changing technological, economic,

political, and societal elements that affect both the way they deliver their product to learners and

the outcomes the learners experience. At the pace of technological change in today‘s world,

educational organizations must stay relevant and must be proactive with processes in place to

meet the educational needs of new students, those who are retraining, and those learning highly

skilled professions. Educators can use methods employed by futurists, such as scenario building

and scanning to think about and plan for the future in the midst of their dynamic environments.

Scenarios – Advantages and Challenges

Advantages. One way that educational leaders can plan is to build scenarios that help

them think about the various ways they might prepare to meet the future. The first item listed in

(Mietzner & Reger, 2005) as a strength of scenarios is that there is more than one future.

According to Wilson, (1998) the ―golden rule‖ of building scenarios for futuring is to create no

fewer than two, and no more than four in order to provide diversity and challenge what we

already know about the future (Wilson, 1998 as cited in Mietzner and Reger, 2005, p. 233).

Other strengths include promoting open thinking and communication to change culture,

assumptions, and strategies. The authors list other strengths such as flexibility in the many ways




to create/build scenarios and their ability to highlight weaknesses to encourage proactive

planning and coordination among experts and stakeholders.

Challenges. Conversely, scenarios may prove difficult as discussed in Mietzner and

Reger, because it takes a lot of time to gather the experts and participants needed to build quality

scenarios and to gain an exhaustive understanding of the subject matter. Additionally, they

indicate that it is sometimes hard to fully recognize the scenarios that contain any sort of

ambiguity. Furthermore, there is the danger of building in bias to the scenarios due to a societal

groupthink or extremism resulting from ideas presented in popular culture about the future as

suggested by (Clardy, 2011).

Scanning – Advantages and Challenges

Another technique used by futurists that has the potential for bias is scanning. Because

this technique involves examining various media for trends, it is possible that some data or trends

are missed due to bias on behalf of the experts conducting the scanning. In addition, according

to Amanatidou, Butter, Carabias, Könnölä, Leis, Saritas, and Van Rij, (2012), scanning may not

be viewed as reliable by stakeholders and policy makers when compared to modeling techniques.

Although these challenges exist with this technique, scanning can be a valuable tool in planning

for the future. Because it is conducted via multiple media outlets it can provide a context of the

overall society. This allows experts to identify less prominent events that may be creating a

trend which is an early warning signal that can be used to plan accordingly.

Both scenarios and scanning are techniques used by futurists that are easily adopted by

educational planners and policy makers. The Department of Clinical Education will benefit from

using these techniques together. By scanning data from the environment they can build




scenarios that are rich and contextual to provide creative and innovative decisions about shaping

the future of education for nurses at Children‘s Hospital.

A 2017 Vision for Clinical Education at Children’s Hospital

Looking into the future of nursing education at Children‘s Hospital one expects see a

technology rich environment that is blended with the live expertise of nurse educators as learning

guides. There is a simulation lab where physicians, nurses, other allied health professionals and

students run real life scenarios on hi-fidelity mannequins that are attached to computers and

monitors and have real vital signs, symptoms of distress, and body systems failure. In addition

to this lab, nurses are connected to technology and learning via hand-held devices such as their

own smart phones or tablets provided by the organization for mobile learning due to lack of

physical learning space for classes. In conjunction with e-learning in the form of online modules

including video demonstrations and scenarios, nurses will collaborate on best practices and

sharing evidence within and across specialties via social media. Hand-held mobile technology

and social media are two forms of educational technology that will be most prevalent in nursing

education and that will provide the most flexibility in learning for nurses at Children‘s Hospital.

Rationale for change

Embracing social media and mobile technology are vital to improving clinical education

at Children‘s and engaging students for optimum learning. Currently, nurses receive almost all

learning in live lecture format classes or via online modules that are essentially PowerPoint

presentations. There is little opportunity for interaction. In addition, the organization already has

extremely limited space in which to hold classes and computers for nurses to complete online

training at work. Adding mobile technology will address both of these needs, especially if

nurses can use their own smartphones, which will reduce budgetary needs for technology.




According to Lois Neuman in her (2006) article on the future of nursing education, in

order to address the predicted nursing shortage of the future, nurses will need access to

technology for teaching and learning purposes so that experts and learners have the opportunity

for interaction and sharing at all times. In addition, she discusses the importance of building

relationships through these interactions to increase human contact versus humans solely

interacting with technology. This is especially important in a hospital setting where

collaboration is vital to patient safety and service.

Opportunities and Challenges

Opportunities. By moving toward a technology rich future and including social media

and mobile technology as standard tools for nursing education, Children‘s can benefit from the

following opportunities: 1) social media is a technology that can be used for reflective learning,

2) according to Schmitt, Sims-Giddens, & Booth, (2012) in their article on social media in

nursing education, social media contributes to increased learning and communication and can be

used as a tool to educate nurses about writing, policy, and ethics. These pieces are vital to a

shared governance structure that is required for becoming recognized for patient safety and

quality in nursing; 3) as mentioned previously, mobile technology avoids the need for physical

classroom space and expensive desktop or laptop computers; 4) using technology that increases

communication and collaboration lends itself to more interesting and engaging delivery of

content, discussions, and creativity; and 5) there is the opportunity for cost savings on expensive

technology and time spent in classrooms.

Challenges. Implementing these changes in the future is not without potential barriers.

The following are challenges to the use of social media and mobile technology at Children‘s

Hospital. First and foremost, obtaining buy-in from stakeholders has been a barrier to advancing




technology. As mentioned by Neuman, (2006), and Buerhaus, Auerbach, Staiger, & Muench,

(2013), older nurses (who make up much of the leadership), and nurse educators tend to be slow

to adopt new technology. Other stakeholders are concerned about social media and privacy.

Healthcare providers are bound by law not to disclose protected health information (PHI) to

anyone who does not have direct need to know, and the use of social media concerns leaders in

that regard. This leads to the third challenge of monitoring. Who will be responsible for

monitoring the social media site or sites to ensure that patient information is not compromised

and the accurate information is being shared? There is potential for harm to the hospital and

individuals if social media is not monitored by someone accepting responsibility for the task.

The fourth challenge is the technology budget. This is both a challenge and an opportunity.

Technology expenses could be reduced if nurses use their own smart phones or if the hospital

purchases tablets versus desktop or laptop computers. However, if the hospital purchases

addition mobile technology, this increases costs over current expenses. Finally, support from the

Information Technology (IT) department is a challenge. IT has all of the above concerns

(budget, monitoring, privacy) as well as system integrity and the threat to hospital computer

systems from external access to internal social media. All of these opportunities and challenges

must be weighed when considering implementation of these new technologies.

If Children‘s Hospital maintains the status quo in education it will remain behind the

curve of what other children‘s hospitals in the nation are doing to improve nursing education. In

addition, it will find it increasingly difficult to deliver quality education to nurses who cannot

leave the bedside due to inadequate staffing resulting from a nursing shortage. The hospital must

grow with the gains in new technology and find innovative ways to educate nurses in less time

and space with fewer dollars.




Preparing for Change

The hospital and Clinical Education department can prepare for the future by following

through with five specific strategic moves toward this goal: 1) implement the social media piece

of the LMS offered at no additional cost by the vendor to all Children‘s Hospitals in the nation;

2) pilot the use of mobile technology with tablet computers procured by the Chief Information

Officer on loan from Microsoft; 3) pilot the social media piece of the LMS with unit-based

nursing councils on two hospital units with active councils; 4) create learning modules

publishable as podcasts viewable on smartphones and encourage reflective learning via

responses and interactions with educators post learning; 5) develop clear policies on the use of

social media and mobile technology and rollout to all nurses prior to implementation to avoid

misuse and privacy violations. Some of these preparations are already underway at Children‘s

Hospital, but a futurist view and commitment to progress is needed to bring the Clinical

Education department into the future with technology.

Conclusion

As Children‘s Hospital looks to the future there are vital decisions to consider regarding

new technology. As the hospital moves into a future of an imminent nursing shortage due to

aging patient and nursing populations, it must advance multiple methods of delivering the most

interactive and engaging education. It will need to provide education to nurses with limited time

for absorbing information, and it will need to provide maximum access to nurses for flexibility in

schedules. Other children‘s hospitals in nation are already using this technology, and if

Children‘s wants to be a world class hospital, a teaching hospital, it will need to utilize the best

and newest technologies for nurses to advance their knowledge in patient care.




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Future Vision of Clinical Education 2017

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