Dedicated Education Unit: Increasing Educational Capacity and Improving Clinical Education

The looming U.S. nursing shortage can be viewed as a math problem with well established variables: an aging nurse workforce and a growing and aging patient population; insufficient numbers of nurse faculty and clinical education capacity; and thousands of qualified nursing school applicants turned away because there aren’t enough resources to educate them. Among the several innovations being implemented to tackle these problems is the dedicated education unit. While it cannot reverse the growing number of patients that are resulting from an aging Baby Boom and more Americans entering the health care system due to potential reforms, it is remarkable for its capacity to handle so many of the other critical variables.

A dedicated education unit (DEU) is a unit within a hospital or other health care facility that is dedicated to providing clinical education for upper level nursing students from nearby schools, while still delivering optimal care to patients on the unit. While each is unique, DEUs share some basic features that vastly improve on traditional clinical rotations for nursing students and maximize faculty and clinical resources, allowing more students to enter and graduate from nurse education programs, while increasing patient satisfaction.

In January 2008, Massachusetts General Hospital in Boston opened up Ellison 7, a 36-bed adult inpatient unit, to a dozen nursing students from the University of Massachusetts, Boston to begin their clinical education. Patients on this unit are generally surgical and multi-trauma patients who come there following an initial crisis period in the emergency department. By all accounts, the two year-old program is not only serving its intended purpose of providing vital hands-on training to more student nurses per semester, it is also benefiting staff morale and even improving patient satisfaction on the unit.

Clinical education is vital for student nurses because nursing is an applied practice discipline; this preparation allows them to greet their first job with experience in a health care setting. DEU’s create a team environment that benefits students, nurses and other staff employed on the unit, and patients during the training period – and well beyond.

At the end of four semesters of the DEU’s operation on Ellison 7, staff and administration at Mass General were asked to share their experiences. Their comments, excerpted below, speak directly to the advantages of a DEU over traditional methods of providing clinical education:

In traditional clinical rotations, a faculty member is removed from the classroom for weeks at a time and assigned six to eight students for the clinical training period. In a DEU, faculty members are largely replaced by staff nurses who are paired with up to two student nurses who shadow them, often for an entire semester. Faculty members provide guidance for several clinical instructors, expanding the numbers of students they can educate.
 

“Our academic partners don't have enough facility to teach all of their students. Our staff nurses become the clinical instructors who educate the students providing the most current clinical information. The school still has a faculty person that oversees the clinical instructors, but with this model they can double or even triple the number of students in clinical rotations.”

Gaurdia Bannister, Executive Director of the Institute for Patient Care, Massachusetts General Hospital.

“The problem with educational capacity is that we’ve got far too many nursing students to be able to educate them…. The benefits of the DEU have been tremendous. We’ve been able to admit more students, we’ve been able to reduce the number of faculty we need, our faculty and our students are energized… [and] the quality of care that the patients are receiving and the quality of education the nurses are receiving is the best it could be.”

Greer Glaser, Dean of Nursing and Health Sciences, University of Massachusetts, Boston
 

“Sometimes when you’re a traditional clinical instructor, you might have been away a little bit from the bedside [but] when you’re in a DEU setting and you’re a clinical instructor… you’re still a staff nurse and you still work with patients day in and day out.”

Vilma Pacheco, Staff Nurse on Ellison 7 with a Masters Degree in Nursing Education

In traditional clinical rotation, student nurses have limited opportunities to practice hands-on nursing or ask the many questions that arise once they are in a real world setting where patients are cared for. In a DEU, each student nurse is involved in caring for patients full-time and has almost constant access to their nurse instructor to pose questions and receive feedback on their work.

“You have students with you … the whole semester … so you really get to work with them and make it a very individualized teaching model … and see what their needs are, their weaknesses and strengths and play up to those and … help them develop throughout the semester … [T]hey really improve much faster than with a traditional program … .”
 

Vilma Pacheco, Staff Nurse on Ellison 7 with a Masters Degree in Nursing Education
 

“Students have said to me that they feel they have to be more prepared… because they know their nurse, THEIR nurse, is going to be asking them questions … . The students … have just raved about their clinical experience, a hundred percent.”

Greer Glaser, Dean of Nursing and Health Sciences, University of Massachusetts, Boston
 

“They’re learning more, they’re there for this 12-hour shift, they really get to see the ups and downs of a typical day that a nurse has and they have a better appreciation of what it’s going to be like for them when they graduate … .”

Gaurdia Bannister, Executive Director of the Institute for Patient Care, Massachusetts General Hospital.

In traditional clinical rotations, the presence of students and their instructor can be disruptive to the ongoing work on the unit. In a DEU, staff nurses assume the role of expert and benefit in numerous ways from the presence of the student nurses.

“In the traditional clinical practice, there may be a clinical instructor who comes to the unit and he or she may have eight students that they’re responsible for … . But [its] almost as if [the students] are a guest or a visitor to the unit.”

Gaurdia Bannister, Executive Director of the Institute for Patient Care, Massachusetts General Hospital.
 

“I have a personal benefit working with the nursing students as a clinical instructor… you can see such rapid growth … they become such a wonderful asset to the floor and to the patient care.”

Vilma Pacheco, Staff Nurse on Ellison 7 with a Masters Degree in Nursing Education

“The DEU … is going to improve retention and I know it has thus far … . We are hearing that [the staff nurses] love teaching. They are part of our clinical faculty … and it’s very satisfying because what they’ve told me is they’re giving back to the next generation … .”

Greer Glaser, Dean of Nursing and Health Sciences, University of Massachusetts, Boston

• Video: Dedicated Education Units