DIFFERENT MODELS OF COLLABORATION BETWEEN NURSING EDUCATION AND SERVICE

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DEPARTMENT OF NURSINGDEPARTMENT OF NURSINGDEPARTMENT OF NURSINGDEPARTMENT OF NURSING

Chair Person

Prof. (Dr.) K. Reddemma

Dean, Behavioral sciences,

NIMHANS, Bengaluru

Presenter

Bivin, J.B

II MSc. Psychiatric Nursing,

NIMHANS, Bengaluru

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IndexIndexIndexIndex

S. No Content Page No

1 Introduction 1

2 Meaning 1

3 Definition 2

4 Types of collaborations 2

5 Need for collaboration between education and service 3

6 Models of collaboration between education and Service

6.1. Clinical school of nursing model

6.2. Dedicated Education Unit Clinical Teaching Model

6.3. Research Joint Appointments (Clinical Chair)

6.4. Practice-Research Model (PRM)

6.5. Collaborative Clinical Education Epworth Deakin (CCEED) model

6.6. The Collaborative Learning Unit (British Columbia) Model

6.7. The Collaborative Approach to Nursing Care (CAN- Care) Model

6.8. The Bridge to Practice Model

6.9. Collaboration of Nursing Education and Service in India

4-12

7 Conclusion 13

8 Bibliography 14

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DIFFERENT MODELS OF COLLABORATION BETWEEN NURSING EDUCATION AND SERVICE

1. Introduction

The nursing profession is faced with increasingly complex health care issues driven by

technological and medical advancements, an ageing population, increased numbers of people living

with chronic disease, and spiraling costs. Collaborative partnerships between educational institutions

and service agencies have been viewed as one way to provide research which ensures an evolving

health-care system with comprehensive and coordinated services that are evidence-based, cost-

effective and improve health-care outcomes1.

Collaboration is a substantive idea repeatedly discussed in health care circles. Though the

benefits are well validated, collaboration is seldom practiced. The lack of a shared definition is one

barrier. Additionally, the complexity of collaboration and the skills required to facilitate the process are

formidable. Much of the literature on collaboration describes what it should look like as an outcome,

but little is written describing how to approach the developmental process of collaboration. Many

researchers have validated the benefits of collaboration to include improved patient outcomes,

reduced length of stay, cost savings, increased nursing job satisfaction and retention, and improved

teamwork (Abramson & Mizrahi 1996).1The focus on benefits of collaboration could lead one to think

that collaboration is a favorite approach to providing patient care, leading organizations, educating

future health professionals, and conducting health care research. Contextual elements that influence

the formation of collaboration include time, status, organizational values, collaborating participants,

and type of problem.

2. Meaning

Collaboration is an intricate concept with multiple attributes. Attributes identified by several

nurse authors include sharing of planning, making decisions, solving problems, setting goals,

assuming responsibility, working together cooperatively, communicating, and coordinating openly

(Baggs & Schmitt, 1988). Related concepts, such as cooperation, joint practice, and collegiality, are

often used as substitutes.

The roots of the word collaboration, namely co-, and laborare, combine in Latin to mean “work

together.” That means the interaction among two or more individuals, which can encompass a variety

of actions such as communication, information sharing, coordination, cooperation, problem solving,

and negotiation.

Teamwork and collaboration are often used synonymously. The description of collaboration as

a dynamic process resulting from developmental group stages as an outcome, producing a synthesis

of different perspectives. The reality is that collaboration evolves in partnerships and in teams. Baggs

and Schmitt (1988) reframe the relationship between collaboration and teamwork by defining

collaboration as the most important aspect of team care but certainly not the only dimension.

A description of the concept of collaboration is derived by integrating Follett's outcome-

oriented perspective (1940) and Gray's process-oriented perspective (1989). Both authors strengthen

the definition of collaboration by considering the type of problem, level of interdependence, and type

of outcomes to seek. According to them: Collaboration is both a process and an outcome in which

shared interest or conflict that cannot be addressed by any single individual is addressed by key

stakeholders. The collaborative process involves a synthesis of different perspectives to better

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understand complex problems. A collaborative outcome is the development of integrative solutions

that go beyond an individual vision to a productive resolution that could not be accomplished by any

single person or organization.

It is critical in collaboration that all existing and potential members of the collaborating group

share the common vision and purpose. Several catalysts may initiate collaboration – a problem, a

shared vision, a desired outcome, to name a few. Regardless of what the catalyst may be, it is

essential to move from problem driven to vision driven, from muddled roles and responsibilities to

defined relationships, and from activity driven to outcomes. Collaboration is an inclusionary process

with continuous engagement that reinforces commitment, recognizing the building of relationships as

fundamental to the success of collaborations. An effective collaboration is characterized by building

and sustaining “win-win-win” relationships8.

3. Definition

Henneman et al. have suggested that collaboration “is a process by which members of various

disciplines (or agencies) share their expertise. Accomplishing this requires these individuals

understand and appreciate what it is that they contribute to the whole”.

"Collaboration is the most formal inter organizationl relationship involving shared authority and

responsibility for planning, implementation, and evaluation of a joint effort (Hord, 1986).

Mattessich, Murray and Monsey (2001) define collaboration as '... a mutually beneficial and

well-defined relationship entered into by two or more organizations to achieve common goals'8.

4. Types of Collaboration

Terms, such as interdisciplinary, multidisciplinary, transdisciplinary, and interprofessional,

which further delineate and describe teams, teamwork, and collaboration, have evolved over time.

4.1. Interdisciplinary is the term used to indicate the combining of two or more disciplines,

professions, departments, or the like, usually in regard to practice, research, education, and/or theory.

4.2. Multidisciplinary refers to independent work and decision making, such as when disciplines

work side-by-side on a problem. The interdisciplinary process, according to Garner (1995) and

Hoeman (1996), expands the multidisciplinary team process through collaborative communication

rather than shared communication.

4.3. Transdisciplinary efforts involve multiple disciplines sharing together their knowledge and skills

across traditional disciplinary boundaries in accomplishing tasks or goals (Hoeman, 1996).

Transdisciplinary efforts reflect a process by which individuals work together to develop a shared

conceptual framework that integrates and extends discipline specific theories, concepts, and methods

to address a common problem.

4.4. Interprofessional collaboration has been described as involving “interactions of two or more

disciplines involving professionals who work together, with intention, mutual respect, and

commitments for the sake of a more adequate response to a human problem” (Harbaugh, 1994).

Interprofessional collaboration goes beyond transdisciplinary to include not just traditional discipline

boundaries but also professional identities and traditional roles. Interdisciplinary collaboration team

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members transcend seperate disciplinary perspectives and attempt to weave together resources,

such as tools, methods, and procedures to address common problems or concerns2.

5. Need for Collaboration between Education and Service

Considerable progress has been made in nursing and midwifery over the past several

decades, especially in the area of education. Countries have either developed new, or strengthened

and re-oriented the existing nursing educational programmes in order to ensure that the graduates

have the essential competence to make effective contributions in improving people’s health and

quality of life. As a result nursing education has made rapid qualitative advances. However, the

expected comparable improvements in the quality of nursing service have not taken place as rapidly.

The gap between nursing practice and education has its historical roots in the separation of

nursing schools from the control of hospitals to which they were attached. At the time when schools of

nursing were operated by hospitals, it was students who largely staffed the wards and learned the

practice of nursing under the guidance of the nursing staff. However, under the then prevailing

circumstances, service needs often took precedence over student’s learning needs. The creation of

separate institutions for nursing education with independent administrative structures, budget and

staff was therefore considered necessary in order to provide an effective educational environment

towards enhancing students learning experiences and laying the foundation for further educational

development.

While separation was beneficial in advancing education, it has also had adverse effects.

Under the divided system, the nurse educators are no longer the practicing nurses in the wards. As a

result, they are no longer directly in the delivery of nursing services nor are they responsible for

quality of care provided in the clinical settings used for student’s learning. The practicing nurses have

little opportunity to share their practical knowledge with students and no longer share the

responsibility for ensuring relevance of the training that the students receive. As the gap between

education and practice has widened, there are now significant differences between what is taught in

the classroom and what is practiced in the service settings.

Most nursing leaders also assert that something has been lost with the move from hospital-

based schools of nursing to the collegiate setting. The familiar observation that graduate nurses can

"theorize but not catheterize" reflects the concern that graduate nurses often lack practical skills

despite their significant knowledge of nursing process and theory. Nursing educators know that

development of technical expertise in the modern hospital is possible only through on-the-job

exposure to the latest equipment and medical interventions. Schools of nursing have tried to bridge

this gap using state-of-the-art simulation laboratories, supervised clinical experiences in the hospital,

and summer internships. However, the competing demands of the classroom and the job site

frequently result in a less than optimal allocation of time to learn technical skills and frustration on the

part of the nursing student who tries to be both technically and academically expert.

The hospital industry has also recognized the need to support a graduate nurse with additional

training. As a result, graduate nurses are required to attend an orientation to the hospital and have

additional supervised practice before they can function independently in the hospital. The cost of

orienting a new nursing graduate is significant, particularly with high levels of nursing turnover (Reiter,

Young, & Adamson, 2007).

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The challenge to nursing education is how to combine theoretical knowledge with sufficient

technical training to assure a competent performance by a professional nurse in the hospital setting.

Clearly, a partnership between nursing educators and hospital nursing personnel is essential to meet

this challenge13.

6. Models of Collaboration between Education and Service5

The nursing literature presents several collaborative models that have emerged between

educational institutions and clinical agencies as a means to integrate education, practice and research

initiatives (Boswell & Cannon, 2005; McKenna & Roberts, 1998; Acorn, 1990), as well as, providing a

vehicle by which the theory -clinical practice gap is bridged and best practice outcomes are achieved

(Gerrish & Clayton, 2004; Gaskill et al., 2003).

6.1. Clinical school of nursing model (1995)

The concept of a Clinical School of Nursing is one that encompasses the highest level of academic

and clinical nursing research and education. This was the concept of visionary nurses from both La

Trobe and The Alfred Clinical School of Nursing University. This occurred within a context of a long

history of collaboration and cooperation between these two institutions going back many years and

culminating in the establishment of the Clinical School in February, 1995.

The development of the Clinical School offers benefits to both hospital and university. It

brings academic staff to the hospital, with opportunities for exchange of ideas with clinical nurses with

increased opportunities for clinical nursing research. Many educational openings for expert clinical

nurses to become involved with the university's academic program were evolved. The move to the

concept of the clinical school is founded on recognition of the fundamental importance of the close

and continuing link between the theory and practice of nursing at all levels10.

6.2. Dedicated Education Unit Clinical Teaching Model (1999)

In this model a partnership of nurse executives, staff nurses and faculty transformed patient

care units into environments of support for nursing students and staff nurses while continuing the

critical work of providing quality care to acutely ill adults. Various methods were used to obtain

formative data during the implementation of this model in which staff nurses assumed the role of

nursing instructors. Results showed high student and nurse satisfaction and a marked increase in

clinical capacity that allowed for increased enrollment.

Key Features of the DEU are

• Uses existing resources

• Supports the professional development of nurses

• Potential recruiting and retention tool

• Allows for the clinical education of increased numbers of students

• Exclusive use of the clinical unit by School of Nursing

• Use of staff nurses who want to teach as clinical instructors

• Preparation of clinical instructors for their teaching role through collaborative staff and faculty

development activities

• Faculty role to work directly with staff as coach, collaborator, teaching/learning resource to

develop clinical reasoning skills, to identify clinical expectations of students, and evaluate

student achievement

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• Commitment by all to collaborate to build an optimal learning environment.

6.3. Research Joint Appointments (Clinical Chair) (2000)

A Joint Appointment has been defined by Lantz et al. (1994), as “a formalised agreement

between two institutions where an individual holds a position in each institution and carries out

specific and defined responsibilities”.

The goal of this approach is to use the implementation of research findings as a basis for

improving critical thinking and clinical decision-making of nurses. In this arrangement the researcher

is a faculty member at the educational institution with credibility in conducting research and with an

interest in developing a research programme in the clinical setting. The Director of Nursing Research,

provides education regarding research and assists with the conduct of research in the practice

setting. She/he also lectures or supervises in the educational institution. A formal agreement exists

within the two organisations regarding specific responsibilities and the percentage of time allocated

between each. Salary and benefits are shared between the two organisations.

Outcomes identified by Donnelly, Warfel and Wolfe (1994) for the educational institution are

that it becomes more in touch with the real world and more readily able to identify research questions

(and the subsequent study), that have the potential to make a difference to quality of consumer care

delivery. There is also an increasing collaborative relationship with the service provider, which is

important for long term workforce planning. The position has benefits to nursing/midwifery students

due to more explicit focus on directly linking the education setting to the clinical context. For practice

the outcomes are increased staff involvement in professional activities including writing for publication,

presenting at seminars and conferences and preparing submissions on professional issues. The

clinical chair also facilitates improved access and support to external research project funding6.

6.4. Practice-Research Model (PRM) (2001)

It is an innovative collaborative partnership agreement between Fremantle Hospital and Health

Service and Curtin University of Technology in Perth, Western Australia. The partnership engages

academics in the clinical setting in two formalized collaborative appointments. This partnership not

only enhances communication between educational and health services, but fosters the development

of nursing research and knowledge.

The process of the collaborative partnership agreement involved the development of a Practice-

Research Model (PRM) of collaboration. This model encouraged a close working relationship between

registered nurses and academics, and has also facilitated strong links at the health service with the

Nursing Research and Evaluation Unit, medical staff and other allied health professionals. The key

concepts exemplified in the application of the model include practice-driven research development,

collegial partnership, collaborative ownership and best practice. Many specific outcomes have been

achieved through implementation of the model, but overall the partnership between registered nurses

and academics in the pursuit of research to support clinical practice has been the highlight.

The key elements underlying the process of collaboration and development of the PRM are: -

• Collaborative partnership: - The collaborative partnership was formed by nursing health

professionals, from the community health service and the university who recognized the need

to bridge the theory-clinical practice gap and acknowledged the futility of continuing to work in

isolation from each other. In practical terms, this involved a formal contractual arrangement

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between the organizations that led to the establishment of a Nurse Research Consultant

(NRC) position.

• Core values and aims of the collaborative partnership: - Before the actual framework of the

collaborative partnership was decided, a literature review of the most common models of

collaboration in nursing practice was used to promote discussion between the organizations to

clarify and formalize the assumptions underlying the core values, roles and responsibilities of

the partners, as indicated by Spross (1989). During this phase, four key concepts emerged:

firstly, that 'practice drives research'; secondly, the principle of 'collegial partnership'; thirdly,

'collaborative ownership', and finally, 'best practice' (Downie et al., 2001).

As a consequence of this process of clarification and negotiation, the Practice-Research Model

was developed to operationalise the agreed aims of the partnership, which were:

→ To encourage nursing staff to reflect on current nursing practice in order to develop

meaningful research proposals;

→ To teach staff the research process via research experience;

→ To enable nursing staff to have a key role in the professional development of other staff

via the dissemination of research and quality improvement findings; and

→ To plan and implement changes to practice based on research evidence.

Nurse Research Consultant (NRC): - In the PRM, the role of the Nurse Research Consultant

(NRC) was articulated as that of mentor and consultant on issues related to research, methodology

publications and dissemination. Although the PRM was specifically designed to enhance nursing

research activity and the implementation of evidence-based community health nursing practice, the

Model also encouraged the involvement of the multi-disciplinary team to work to achieve the aims of

the partnership agreement5.

6.4.1. Operational framework of the PRM

To fulfill the aims of the partnership several key elements formed the operational framework of

the collaborative agreement. One important element of the framework was to enhance nursing staffs'

knowledge of the research process via research experience. To achieve this 'Journal Clubs' were

established in the community health service on a monthly basis. The Nurse Research Consultant then

worked with staff to identify, plan and implement changes to practice based on research evidence.

A second important element of the PRM was to encourage nursing staff to reflect on current

nursing practice and identify clinical problems based on their knowledge and experience of nursing in

order to develop meaningful research proposals and best-practice guidelines. The main reason for the

success of the collaborative arrangement has been the provision of infrastructure to support the

dissemination of research and quality improvement findings through clinical meetings, workshops and

conference presentations by the nursing staff involved in the various projects.

6.5. Collaborative Clinical Education Epworth Deakin (CCEED) model (2003)7

In an effort to improve the quality of new graduate transition, Epworth Hospital and Deakin

University ran a collaborative project (2003) funded by the National Safety and Quality Council to

improve the support base for new graduates while managing the quality of patient care

delivery.

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The Collaborative Clinical Education Epworth Deakin (CCEED) model developed to facilitate

clinical learning, promote clinical scholarship and build nurse workforce capability. This model

provided a framework for the first initiative, a CCEED undergraduate program that nested the clinical

component of Deakin University's undergraduate nursing curriculum within Epworth Hospital's health

service environment.

The CCEED undergraduate program sees undergraduate nursing students attending

lectures at Deakin University in the traditional manner but completing all tutorials, clinical learning

laboratories and clinical placements at Epworth Hospital throughout their three year course. Tutorials,

laboratories and clinical placements are conducted by Epworth clinicians who are prepared and

supported by Deakin School of Nursing faculty. These clinicians also support the student-preceptor

relationship in the clinical learning component of the curriculum. The expectation was that increased

integration between hospital and university would enhance clinical education resulting in improved

students’ application of knowledge and skill as well as increased socialization to the clinician role.

Nursing education supported by Clinical

Facilitators

Clinical facilitators are supported by Hospital administration and

university

Students coached by Nurse Clinician

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Key findings of the 2005 pilot CCEED program were

1. Students’ learning objectives were met and satisfaction was high.

2. Undergraduate clinical education was valued by preceptors and managers as a workforce

investment strategy

3. Preceptors were enriched in their clinician role as a result of their participation in the program and

reflection on the process.

4. Preceptor continuity promoted a trusting relationship that enabled preceptors to confidently

encourage student initiative.

5. Preceptors managed multiple roles in order to meet demands of patient care and student

learning.

6.6. The Collaborative Learning Unit (British Columbia) Model, 2005

The Collaborative Learning Unit model was based on the ‘Dedicated Education Units’

concept developed, successfully implemented, and researched in Australia. The Collaborative

Learning Unit (CLU) model of practice education for nursing is a clinical education alternative to

Preceptorship. In the CLU model, students practice and learn on a nursing unit, each following an

individual set rotation and choosing their learning assignment (and therefore the Registered Nurse

with whom they partner), according to their learning plans. Unlike the traditional one-to-one

preceptorship-, an emphasis is placed on student responsibility for self-guiding, and for

communicating their learning plan with faculty and clinical nurses (e.g., the approaches to learning

and the responsibility they are seeking to assume). All nursing staff members on the Collaborative

Learning Unit are involved in this model and, therefore, not only do the students gain a wide

variety of knowledge but the unit also has the ability to provide practice experiences for a larger

number of students.

Specifically, a Collaborative Learning Unit is a nursing unit where all members of the staff,

together with students and faculty, work together to create a positive learning environment and

provide high quality nursing care. Clinical nurses preparing to adopt the CLU model have

described a positive learning environment as one where questions are expected. In the CLU

approach the students are not attached to the units as an ‘extra set of hands’ to augment the

nursing workforce, but are present as learners with a primary interest in gaining entry-level

knowledge and competency associated with baccalaureate-prepared nursing practice. As learners

in the CLU model, students are supported by experienced clinical nurses, faculty and, ideally,

nurse researchers. Students recognize a positive learning environment when they perceive their

questions are welcomed, and when they receive thoughtful responses at mutually selected times

for students and staff. For faculty (e.g., academic instructors), key questions focus on determining

what nursing knowledge is needed to provide high quality nursing care. Thus, in a CLU, where

critical questioning is promoted, students can systematically learn to “think like a nurse” and can

demonstrate what they know and can do, as undergraduate nurses who are members of a health

care team.

While staff and faculty work together to support and advance student learning and promote

high quality nursing care, the CLU model enables a level of student independence that helps them

move into the work-world. As well, the CLU concept bridges a perceived gap between academic and

clinical expectations. In this model, nursing faculty, clinical nurses and students work collaboratively to

enhance learning opportunities as well as develop the professional knowledge base of nursing.8

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The Collaborative Learning Unit (British Columbia) Model, 2005

6.7. The Collaborative Approach to Nursing Care (CAN- Care) Model (2006)12

The CAN-Care model emerged as academic and practice leaders acknowledged the need to

work together to promote the education, recruitment and retention of nurses at all stages of their

career. The idea of a partnership model emerged when the Christine E. Lynn College of Nursing,

Florida Atlantic University, was awarded a grant from Tenet HealthCare Foundation to initiate an

Accelerated Second-degree BSN Program. The goal was to design an educationally dense, practice-

based experience to socialize second-degree students to the role of professional nurse. A secondary

goal was to enhance and support the professional and career development of unit-based nurses. A

commitment to a constructivist approach to learning, an immersion experience to recognize the

unique needs of accelerated second-degree learners, and to emphasize the partnership among the

academic and practice setting, were guiding forces in the creation and enactment of the model. The

model emerged from a dialogue among leaders from the academic and practice setting focusing on

the areas of expertise and potential contributions of each partner.

Clinical Nurses

Nurse

Educators

Clinical Site

coordinators

Nurse

Researchers

Student

Nurses

The essence of the CAN-Care model is the relationship between the nurse learner (student)

and nurse expert (unit-based nurse), within the context of each nursin

student as learner and unit-based nurse as expert, in place of the more common traditional labels of

preceptor and preceptee are critical to the intentionality of the collegial focus of the model. The label

nurse learner was designated to place the emphasis on the learning role and the reflective and

continuous nature of knowledge construction. The learner is responsible and accountable for

engaging in the learning process and for taking an active role in establishing a dya

partnership with the nurse expert. Unit

nurse expert was chosen to recognize the gifts they bring to the profession and share with the nurse

learner.

The nurse learners and nurs

meeting the needs of the assigned patient population as well as to reflect

art and science of nursing practice. The onsite faculty member is the expert in educational p

and is essential in the support and nurturing of the expert/learner partnership. The faculty member

promotes the growth of the nurse expert as a professional and the journey of the learner in coming to

know a career in nursing. This is a major cha

being in control of the teaching of students

student’s activities moves from the demonstration of discrete skills and prescribed outcomes to an

immersion into the professional nurse role, learning to hear and respond to patient needs, and to

provide nursing care to achieve quality outcomes.

Through this model the student comes to know the organizational context of nursing practice,

the multifaceted role of professional

nurses, and assumes responsibility

for coming to know the meaning of

nursing in each unique situation. The

unit-based nurse acquires new skills

in mentoring, exposure to evidenced

based practice, and to theoretical

knowledge through association with

the college. This approach to

education in the practice setting is

thought to be more consistent with

the educational needs of nurses who

are preparing for the challenges of

professional practice in today’s acute

care settings.

The most dramatic change

with this model is the re

conceptualization of the work of the

faculty member. The faculty is the

education-focused expert who

supports and nurtures the nurse

expert/nurse learner partnership. The

faculty member must relinquish control of the students. While the faculty still has accountability for

Care model is the relationship between the nurse learner (student)

based nurse), within the context of each nursing situation. The semantics of the

based nurse as expert, in place of the more common traditional labels of


as designated to place the emphasis on the learning role and the reflective and


engaging in the learning process and for taking an active role in establishing a dya

partnership with the nurse expert. Unit-based nurses are experts in the work of nursing care. The title


The nurse learners and nurse experts engage in a dyadic partnership for the purpose of

meeting the needs of the assigned patient population as well as to reflect on and to come to know the

art and science of nursing practice. The onsite faculty member is the expert in educational p



know a career in nursing. This is a major change in focus from the more traditional role of faculty

being in control of the teaching of students. By the application of CAN-Care model the focus of the


mersion into the professional nurse role, learning to hear and respond to patient needs, and to

provide nursing care to achieve quality outcomes.


the multifaceted role of professional

nurses, and assumes responsibility

for coming to know the meaning of

nursing in each unique situation. The

based nurse acquires new skills

in mentoring, exposure to evidenced-

based practice, and to theoretical

knowledge through association with

the college. This approach to

education in the practice setting is

thought to be more consistent with

needs of nurses who

are preparing for the challenges of

professional practice in today’s acute

The most dramatic change

with this model is the re-

conceptualization of the work of the

faculty member. The faculty is the

pert who

supports and nurtures the nurse

expert/nurse learner partnership. The


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Care model is the relationship between the nurse learner (student)

g situation. The semantics of the

based nurse as expert, in place of the more common traditional labels of


as designated to place the emphasis on the learning role and the reflective and


engaging in the learning process and for taking an active role in establishing a dyadic learning

based nurses are experts in the work of nursing care. The title


e experts engage in a dyadic partnership for the purpose of

on and to come to know the

art and science of nursing practice. The onsite faculty member is the expert in educational processes



nge in focus from the more traditional role of faculty

Care model the focus of the


mersion into the professional nurse role, learning to hear and respond to patient needs, and to



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overall evaluation of the student’s achievement of the nursing practice course objectives, even the

process of the on-going evaluation becomes a collaborative effort with the nurse expert. The primary

role of the faculty member in the model is to nurture the nurse expert/nurse learner relationship and to

support the growth and development of both expert and learner in their respective roles and

responsibilities. The on-site faculty member becomes an advisor, resource, role-model and educator

for both the nurse expert and the nurse learner. The work of the faculty is re-conceptualized as the

creator of the environment to support learning and professional growth as opposed to the direct

teaching of preselected content.

In this model, the healthcare organization becomes an active participant in creating learning

environments and contributing to the learning activities, as opposed to just being a setting in which

college-affiliated faculty appear with students for a teaching encounter. In return, the college becomes

an active partner in the professional development and retention of nurses at the practice facility.

6.8. The Bridge to Practice Model (2008)11

The Bridge to Practice model is distinctly different from other clinical models. First, students

complete all of their clinical experiences in one participating hospital. Second, one full-time teaching

faculty serves as a liaison for each bridge hospital. This faculty member is given a space, usually in

the nursing education department, and is then available to serve as a resource for not only the clinical

associates but also for the hospital nursing staff. In this model, therefore, there can be numerous

clinical associates in one hospital with one full-time University faculty overseeing the clinical

experiences. Third, students are actively involved in selecting their clinical placements.

The Bridge to Practice model proposed by Catholic University of America, school of Nursing

(2008), uses a cohort approach in which students complete medical-surgical clinical nursing education

at the same facility. Students must apply for clinical placement in the hospital of their choice via a

clinical application form. Clinical placement decisions are based on academic performance and

maturational level. Participating students undergo 415 hours of clinical experiences (nine academic

credits) focused on medical-surgical nursing. These clinical practice progresses from Adults in Health

and Illness: Basic, an introductory nursing course, to Medical-Surgical Nursing Leadership, a senior

level course taken in the last semester of baccalaureate study.

Thus The Bridge to Practice Model provides undergraduate nursing students with continuity in

medical-surgical education through placement in the same hospital for all medical-surgical clinical

rotations. Hospitals that participate in the bridge model provide senior clinical nurse preceptors whose

time is paid for by the university. The Bridge to Practice model emphasizes professional incentives for

hospital nurses to participate in nursing education. Planned incentives include the rewarding of

hospital nurses with continuing education credits for participation in the short-term training on

educational methodology and approaches. A tuition discount is offered for graduate course work at

the university for institutional students and faculty, more involvement with clinical support services and

care management, and more informed employment choices by senior students. Challenges include

recruitment of interested senior clinical nurses, retention of clinical liaison faculty, and management of

the trade-off between institutional stability offered by clinical site continuity and the variety of

experiences offered by rotation across several clinical settings.

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6.9. Collaboration of Nursing Education and Service in India

The gap between nursing practice and education has its historical roots in the separation of

nursing schools from the control of hospitals to which they were attached. At the time when schools of

nursing were operated by hospital, it was the students who largely staffed the wards and learned the

practice of nursing under the guidance of the nursing staff. However, service needs often took

precedence over students’ learning needs. The creation of separate institutions for nursing education

with independent administrative structures, budget and staff was therefore considered necessary to

provide an effective educational environment towards enhancing students’ learning experiences and

laying the foundation for further educational development4.

While this separation has been beneficial in advancing nursing education, it has also had

adverse effects. Under the divided system, the nurse educators are no longer the practicing nurses in

the wards or directly involved in the delivery of nursing services, nor responsible for the quality of care

provided in the clinical settings used for students’ learning. The practicing nurses have little

opportunity to share their practical knowledge with students and no longer share the responsibility for

ensuring the relevance of the training that the students receive. As the gap between education and

practice has widened, there are now significant differences between what is taught in the classroom

and what is practiced in the service settings. The need for greater collaboration between nursing

education and services calls for urgent attention. We have two institutions which are practicing dual

role, education & practice : NIMHANS, Bangalore and CMC, Vellore. More institutions need to adopt

this model. This will help improve the quality of Nursing Education with overall objective of improving

the quality of nursing care to the patients and community at large4.

6.9.1. Dual role model in NIMHANS

Following the amalgamation of 1974 resulting in NIMHANS, the faculty of the nursing

department took up the dual responsibility of providing clinical services as well as conducting teaching

programs. In 1975, all the Grade II nursing superintendents working in the hospital were designated

tutors to maintain uniformity in the department. Combined workshops were conducted under the

guidance of WHO consultant Mrs.Morril to prepare the tutors who came from Grade II Nursing

Superintendent cadre for teaching purpose and to make the Lectures and tutors associated with

educational programmes (DPN course& 9-months course in psychiatric nursing) comfortable with

clinical supervision. After both groups felt comfortable to assume the dual responsibility, the areas of

supervision were designated. The Head of the Department of Nursing was given the responsibility for

both the service and the education component of the department.

Integration of education with service raised the quality of patient care and also improved the

quality of learning experiences for nursing students, under the close supervision of teachers who were

also practitioners.

6.9.2. Integrative Service-Education approach in CMC Vellore

College of Nursing under Christian Medical College, Vellore, where nurse educators are

practicing in the wards or directly involving in the delivery of nursing services. This enables the

practicing nurse to share her practical knowledge to the student nurse who is practicing in the

concerned wards.

Government of India conducted a pilot study on bridging the gap between education and

service in select institutions like one ward of AIIMS. The project was successful, patients and medical

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personnel appreciated the move but it required financial resources to replicate this process.

7. Conclusion

Estimating the future need for Registered Nurses with various educational backgrounds is

complicated by differing perceptions of educators and employers about the appropriate base of

knowledge and skills new graduates need. These differences began to be apparent when nursing

education moved away from its historical base in hospitals in response to abuses and inadequacies

that were believed to characterize the apprentice type of training they provided. They continue to

plague the profession3. Many nursing service administrators believe that academic nurse educators,

removed from the realities of the employment setting, are preparing students to function in ideal

environments that rarely exist in the real and extremely diverse worlds of work. In turn, many nurse

educators believe that nursing service administrators fail to provide work environments conducive to

the kinds of nursing practice their graduates--particularly baccalaureate RNs--are equipped to conduct

and that, furthermore, new graduates of baccalaureate, and diploma programs should be

differentiated in their functional work assignments. The report of a task force of the American

Association of Colleges of Nursing observes that "… conflicting philosophies, values, and priorities

between nurse educators and nursing services administrators have generally served to deter a mutual

understanding and acceptance of responsibility for quality patient care." To succeed, nursing

educators and care providers alike must strengthen their response to these challenges with innovative

solutions built into the program design and administration. Closer collaboration between nurse

educators and nurses who provide patient services is essential to give students an appropriate

balance of preparation12.

All the models pursue collaboration as a means of developing trust, recognizing the equal

value of stakeholders and bringing mutual benefit to both partners in order to promote high quality

research, continued professional education and quality health care. The literature supports the utility

of such collaborations. For example, the most frequently cited positive outcomes are job satisfaction,

improved educational experiences for pre-registration nursing students, increased self-confidence and

improved knowledge base for nurses2. The majority of these models are based on a joint appointment

model where the nurse is initially employed by a health service or a university and divides his or her

time between teaching and clinical practice. Application of these models can reduce the perceived

gap between education and service in nursing there by can help in the development of competent and

efficient nurses for the betterment of nursing profession.

Thank You!Thank You!Thank You!Thank You!

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Bibliography

1. Catherine Malloy & Francis T. Donahue. (2004). Collaboration projects between nursing

education and service. Nurse Education Today. 19(6), 368-77

2. Cathleen B. Gaberson & Marilynn G. Oermann (2010). Clinical Teaching Strategies in Nursing.

3rd Ed., New York, Springer Publishing Company. LLC. 307-343

3. Cowen.P.S & Moorhead.S(2006). Current Issues in Nursing. 7th Ed., Missouri, Mosby Inc.,

105-122

4. Dileep Kumar, T (2010). Quality of nursing education: Right of every student. The Nursing

Journal of India. Cl(1), 12

5. Downie.J et al.(2001). Research model for collaborative partnership. Journal of Royal College

of Nursing, Australia. 8(4). 27-32

6. Feltz, Joan, Tom Robin. (2000). Linking practice and education. Journal of Nursing

Administration. 30(9), 405-07

7. Fowler, J., Hardy.J., & Howrath.T. (2006). Trialing collaborative nursing models of care: The

impact of change. Australian Journal of Advanced Nursing. 24(1). 24-28

8. Gardner BD. (2005). Ten lessons in collaboration. The Online Journal of Issues in Nursing.

10(1), 24

9. Hannah Dean and Jan L. Lee (1995). Service and education: Forging Partnership. Nursing

Otulook, 43(3), 119-23

10. Hellen Forbes & Roslie Strother (2004). Collaboration: Integrating education and clinical

practice: The case of La Trobe University/The Alfred Clinical School of Nursing. Contemporary

Nurse, 17, 3-7

11. Patterson.M, & Gandjen. C (2008). The bridge to practice model: A collaborative program

designed for clinical experiences in baccalaureate Nursing. Nurse Economics. 26(5). 302-306

12. Raines.A.D (2006). An innovative model of practice- based learning. International Journal of

Nursing Education Scholarship. 3(1). 20-26

13. Sherry P. Palmer, et al. (2005). Nursing education and service collaboration: Making

difference in the clinical learning environment. The Journal of Continuing Nursing Education,

36(6). 123-28

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DIFFERENT MODELS OF COLLABORATION BETWEEN NURSING EDUCATION AND SERVICE

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