Breaking the Rules: Redesigning the Educational Endeavor for
Nursing School of Nursing & Health Professions Judith F.
Karshmer, PhD, APRN Dean & Professor
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Common Rules in Nursing Education 1.Dont re-invent the
wheel...
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2. Start clinical experiences with simple patients (i.e., those
in long-term care). Common Rules in Nursing Education
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3. Make patient assignments (instead of nurse assignments).
Common Rules in Nursing Education
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4. Hone the nursing skill-set in a structured in-patient
setting before expanding to the more fluid ambulatory care setting.
Common Rules in Nursing Education
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5. Affirm that clinical instructors are faculty- their
relationship with the setting is secondary. Common Rules in Nursing
Education
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6. Value breadth across an array of practice cultures rather
than depth within one. Common Rules in Nursing Education
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7. Value real patient experiences over simulated ones. Common
Rules in Nursing Education
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8. Treat hours of clinical time as equal, regardless of the
experiences made available. Common Rules in Nursing Education
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9. Supervise students interprofessional communication. Common
Rules in Nursing Education
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10. Always require a pre-lab the day before clinical so the
student can prepare a well- researched plan of care. Common Rules
in Nursing Education
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11. Use clinical rotation times that are different from the
work day of the facility. Common Rules in Nursing Education
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12. Focus on getting the work done, rather than on seeking
learning opportunities. Common Rules in Nursing Education
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The Future is NOW TIME TO BREAK THE RULES
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Now Questions Where is healthcare taking place? Who are the
patients? What is the reimbursement model? What are the
expectations of the patient; the provider? Who is providing
it?
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Now Answers Ambulatory, transitional & home care settings
An educated consumer Capitated = health promotion + keeping the
patient at home Accessibility, connectivity, & data Who IS
providing the care??
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If nursing education does not change and start preparing the
nurse for ambulatory & transitional care & the home health
and clinic settings it will be: CHWs Team-lets Tele-health
Consortia
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So which rules do we break? ALL OF THEM!
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We need to re-invent the wheel... Preparing the nurse must be
preparing for the future.
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We need to start students in the settings where they will
practice: Out-patient and community clinics Home health/hospice
Schools/health departments Transitional care programs
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We need to assign students to nurses and other professionals:
Preceptor/apprentice model IPE joint appointments Faculty as coach
to provider dyads
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We need to question the impact of focusing on the skill-set
rather than the knowledge base & clinical decision making.
Provide integrated skill development in simulated settings as prep
for practice
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We need to move away from the arbitrary division among the
nurse, preceptor, & faculty roles. Develop academic-practice
partnerships in which faculty and staff are one in the same.
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We need to stop moving students from setting to setting. Expand
the academic-practice partnerships so the student is a key part of
the Health Care Home Nurses carrying patient panels
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We need to exploit the power of simulation. Simulated
experiences: Standardized patients IPE High-fidelity simulators
Simulated systems
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We must stop treating hours of clinical time as equal.
Competency Based Education
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We must require interprofessional communication as a standard.
IPE simulations IP practice = required
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We cant continue to set an expectation that nursing practice is
static. Mobile devises for prep Point of Care learning Treatment
& teaching Apps
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We must stop treating the clinical sites like real estate &
demanding time to match academic schedules. Link student time with
agency personnel time Use staff/faculty partners
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We must stop evaluating students on getting the work done.
Focus on demonstrating competencies & learning
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USF Lessons Learned Transition to Practice (T2P) Programs in
Ambulatory Care, Home Health, & School Nursing 16-week program:
precepted clinical 20hr/week + class & simulation
1day/week
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USF Lessons Learned Partnerships School districts Home health
agencies Hospice Community clinics; FQHCs Specially clinics
Transitional care programs Urgent care centers New Graduates = Jobs
100+
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USF Lessons Learned Push Back What can they do? How much time
will they take? How safe are they? State and agency
regulations.
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USF Lessons Learned Success: 40+ Partnerships 5 (&
counting) cohorts 100+ jobs for new graduates in these
non-traditional settings!
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USF Lessons Learned BSN collaborative with VA to prepare the
nurse of the future. 20%-80% not 80%-20%
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USF Lessons Learned Masters entry program for CNLs to prepare
for ambulatory care & home health. Preceptors =
faculty/staff
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Change is easy its keeping the status quo thats so hard!