Background: Public Health Seattle King County (PHSKC) and Seattle Pacific University (SPU) School of Nursing have partnered to create a training center of excellence for undergraduate baccalaureate nurses who have an interest in providing primary care to medically underserved populations (MUP). This academic-practice partnership is afforded by a 4-year health resources and services administration; nurse education, practice, quality and retention grant awarded to PHSKC in 2018. The project called ambulatory care system supported by education and training (ASSET) is currently in project year four.

Purpose: The purpose of this project is to create a training center of excellence utilizing the dedicated education unit (DEU) model to build student nurse competencies in ambulatory care and public health nursing. This transition to practice experience is designed to foster knowledge, skills, and attitudes to care for MUP in ambulatory care and public health settings. The intended outcome is a highly competitive pool of new graduates prepared for direct entry to ambulatory care and public health specialties.

Methods: PHSKC and SPU implemented a DEU model for nurse education in public health primary care settings. This innovative model allows for senior practicum immersion, called “ASSET fellowship,” in a longitudinal clinical experience where foundational concepts in social determinants of health, trauma-informed care, health equity, social justice, harm reduction, motivational interviewing, and patient-centered care are practiced. Fellows apply these concepts to the nursing process as they manage chronic disease, population health, behavioral health, and substance use disorders. The DEU model provides students with consistent, expert, reflective, and relationship-based mentorship throughout the fellowship.

Progress is monitored through survey data collection with the general self-efficacy (GSE) scale, clinical learning environment, supervision and nurse teacher (CLES-T) scale, seminar training surveys, preceptor evaluation of students, academic-practice partnership evaluation, and a daily student service logs.

Results: The ASSET grant is currently in project year four. Preliminary evaluation data show the following findings.
• DEU students experienced positive self-efficacy in 15 out of 16 GSE metrics compared to non-DEU students.
• CLES-T results suggest better outcome for DEU students in 24 of 34 metrics compared to non-DEU students.
•    The preceptors’ evaluation of students reveals staff value the precepting role and report the fellows greatly contribute to the agency in positive ways.
•    Seminar training surveys consistently show increases in students’ abilities and knowledge related to training topics.
•    The academic-practice partnership evaluation shows increasing collaboration and process development over the first three years of the grant.

Conclusions: To date, the data suggest that this innovative model of academic-practice partnership and DEU training is improving student self-efficacy, skill attainment, and enhancing staff satisfaction.

Implication to nursing practice: Academic-practice partnerships are essential for preparing student nurses for direct entry to ambulatory care and public health practice. The DEU model in a public heath primary care setting prepares nurses to work with MUP grounded in principles of health equity, social justice, and trauma-informed care. Further exploration of the DEU model in ambulatory care is needed to assess efficacy of building nursing competencies, nurse recruitment, retention, and staff satisfaction.

Tyra Dean-Ousley EdD, ARNP, FNP-BC

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