Background: An innovative clinical partnership was developed between a major northeastern medical center and a university nursing program to enhance senior nursing students’ learning in community-based clinical settings. According to the Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, the employment of registered nurses is projected to grow 15 percent from 2016 to 2026. Accelerated growth of employment in ambulatory is expected due to financial pressure on hospitals to discharge patients sooner, increased number of same day procedures, and advanced technologies being performed in ambulatory care settings and provider offices. As healthcare moves out of inpatient settings, the need for a well-prepared workforce of community-based nurses is steadily increasing (Mastal, M., Matlock, A. M., & Start, R., 2016). At the same time nursing programs are struggling to provide high-quality community-based learning experiences for students due to numerous factors: limited capacity to accommodate students in smaller outpatient settings; logistical challenges for faculty covering multiple, separate outpatient settings; and the paucity of nurses to serve as preceptors in these settings. Prior to this collaborative project with this major medical center’s numerous outpatient clinics, students often had observational experiences due to the inability to have faculty centrally based in one community setting.
A summer pilot offered an opportunity to cohort students in co-located clinics on campus and in off-campus locations for 24 student clinical placements initially. The pilot also provided an opportunity for staff nurses to be clinical preceptors, some for the first time and exposure to the concept of hiring new graduate nurses in the ambulatory setting. Clinical placements for fall spring semesters is approximately 38 students combined.
Method: This clinical model maximized students’ exposure to individual mentoring from experienced community-based registered nurses coupled with direct coordination and instruction of onsite nursing faculty. Students participated in direct care, telephone triage, health screenings, transitional care, and working with multi-disciplinary teams. Pre- and post-surveys of preceptors, student evaluations, and faculty narrative feedback provided insight for program enhancement, engaged additional practice sites and preceptors, and prompted dialogue around hiring new graduates in ambulatory.
Implications: This quality improvement project has implications for developing better prepared nursing graduates with a more comprehensive understanding of transitions of care and the role of the community health nurse. For practice partners, this model can assist in development of community-based nurse residency programs to foster earlier entry into outpatient settings for new nurses.