Development and Evaluation of a Model for an Undergraduate, Precepted, Ambulatory/Community Care-Based Clinical Experience

Learning outcome: Describe features of an academic clinical coordinator (ACC) model and identify ACC model implementation evaluation strategies.
The value of registered nurses in the ambulatory care setting is now recognized as vital to the overall health of local communities. Unfortunately, organizing meaningful ambulatory care clinical experiences for BSN students remains a challenge. Academic practice-partnership models to guide ambulatory care experiences and help students build competency in this complex area are currently lacking. The academic clinical coordinator (ACC) model permanently assigns a school of nursing faculty member to an organization to coordinate ambulatory care clinical experiences for BSN students. Per the model, ACC responsibilities include preceptor training, site maintenance, quality improvement projects, and assurance of the relationship being beneficial to both university and healthcare organization. The purpose of this project was to test and refine the model in a large community health system.
The ACC model was implemented over a two-year period in a precepted BSN senior-level course and tested at ambulatory care clinics in a large community health institution. The goal was to enhance BSN students’ population health and systems-based practice competency development, strengthen the relationship between the school of nursing and the community health system, and enhance preceptor development/retention.
Program evaluation was conducted using both qualitative and quantitative methodologies focused on student, preceptor, clinical faculty, and leadership perspectives to iteratively improve the ACC model. Quantitative data were obtained using validated tool and focus groups were conducted with student clinical groups, preceptors, and clinical faculty and nurse managers. Feedback from the community hospital system’s nurse educator and administrator were also obtained.
Student outcomes support the continued implementation of the ACC model. Students in the ACC group demonstrated enhanced competency in population-based health and systems-based practice through competency assessment and quality improvement project assessment compared to their peers in the traditional course. Students appreciated the role that preceptors and managers played in integrating them into the facility, including providing mentorship and guidance in conducting meaningful quality projects. Preceptors and clinical faulty both reported overall satisfaction with the model but identified some challenges in initial implementation, such as coordinating site visits and relationship maintenance while teaching. Nurse managers appreciated the increased communication and involvement of the students in unit-based quality improvement projects. Organizational leaders believed the ACC model enhanced outcomes compared to prior semesters in which students were placed in ambulatory care settings. Importantly, the mutual relationship built between the university and healthcare organization was strengthened as a result of the ACC model, leading to improved outcomes for students including continued access to upcoming clinical placements.
Future work will focus on implementing a refined model that clarifies roles and relationship maintenance elements of the ACC model between the university and healthcare system, specifically, the role of the clinical instructors. Initially it was expected that all clinical instructors could take on the ACC role; however, after the initial implementation of the model, it was clear that a single ACC was more effective at building strong relationships between the academic and clinical settings.