Nursing Students' and Nurse Preceptors' Perspectives of an Ambulatory Dedicated Education Unit in Primary Care and General Internal Medicine.

BACKGROUND: The sustainability of prelicensure nursing clinical learning models within ambulatory care is dependent on strong partnership and the availability of ambulatory nurse preceptors. Evaluation of preceptor and student satisfaction with ambulatory clinical experiences is necessary to identify program strengths and opportunities. METHOD: Nursing students' and nurse preceptors' perceptions of an ambulatory dedicated education unit (DEU) in primary care and general internal medicine practices were measured from 2021 to 2023. RESULTS: Students' survey responses indicated a high level of agreement for 20 (90.9%) of 22 items in 2021, 35 (100%) of 35 items in 2022, and 32 (91.4%) of 35 items in 2023. Preceptor responses demonstrated favorable agreement with all of the work-life satisfaction across the 3 years of the survey, with the exception of one question on the 2021 survey. CONCLUSION: Nursing students and staff nurse preceptors found the ambulatory DEU teaching and learning experience to be positive and satisfying. [J Nurs Educ. 2024;63(3):171-177.].

The Ambulatory Dedicated Education Unit (DEU): An important example of academic practice partnership in ambulatory care.

BACKGROUND: Academic Practice Partnerships (APPs) work synergistically to support mutual goals and educate the nursing workforce of the future. Enhanced recognition of the need for undergraduate nursing educational experiences in ambulatory care has increased the importance of Ambulatory APPs specifically. One mechanism for building Ambulatory APPs and shifting clinical education into multiple spheres of care is the Ambulatory Dedicated Education Unit (DEU). METHODS: Partners at the University of Minnesota and Mayo Clinic in Rochester, Minnesota developed an Ambulatory DEU in early 2019. Barriers to educating nursing students in the ambulatory setting were effectively mitigated through the design of the DEU and mutual efforts to sustain the Ambulatory APP through flexibility and adaptation. RESULTS: The Ambulatory DEU clinical learning model is a strong example of an effective Ambulatory APP. The DEU was effective in overcoming eight common barriers to clinical learning in ambulatory settings and engaged 28 expert ambulatory registered nurses in the clinical teaching of between 25 and 32 senior Bachelor of Science in Nursing (BSN) students each year. Each student participating in the DEU experienced 90 h of ambulatory clinical learning. The Ambulatory DEU is in its fourth year and remains an effective mechanism for engaging nursing students in the competencies and complex care of ambulatory nursing. CONCLUSION: Increasingly complex nursing care is being provided in ambulatory care settings. The DEU is an effective mechanism to prepare students in the ambulatory sphere of care and is a unique opportunity for ambulatory practice partners to learn and grow from participating in a partnered teaching environment.

Pathway to Becoming a Progressive Care Certified Nurse.

ABSTRACT: Nurses working on progressive care units (PCUs) use specialized knowledge and skills to provide care to acutely ill patients. The literature suggests that specialty certification may have a positive impact on patient and nurse outcomes alike, although results are mixed. A project team set out to create a culture that encouraged nurses to pursue progressive care certified nurse (PCCN) certification on three cardiac medical PCUs at a large academic health center by implementing a Pathway to PCCN program, which is a structured, cohort-based approach to certification preparation.The primary aim of the intervention was to achieve a 10% PCCN certification rate within one year. Additionally, the project team evaluated whether participating in the Pathway to PCCN program affected staff nurses' self-reported confidence in their clinical judgment in 10 patient care domains: cardiac, pulmonary, behavioral, neurological, musculoskeletal, hematological, endocrine, gastrointestinal, renal, and multisystem.Project methods included structured strategies within a "4R" framework developed by the project team: recruitment, obtaining resources, providing reassurance, and celebrating certification through recognition. Project methods were evaluated using anonymous electronic surveys and staff interviews.The percentage of staff with PCCN certification increased from 0% to 15.2%. The average confidence levels reported by nurses who participated in the project (N = 64) increased in eight out of nine (89%) of the clinical judgment domains tested on the PCCN examination in Cohort 2, and in nine of the clinical judgment domains in Cohorts 1 and 3. Implementing a structured cohort pathway for specialty certification using the 4R framework is a strategy that can increase rates of specialty certification among eligible nurses.

Enhancing Nurse-Resident Physician Partnerships.

Literature has long suggested that collaboration and interprofessional communication are associated with improved provider satisfaction, patient satisfaction, and the provision of individualized care. More recent literature has documented the favorable influence of a collaborative culture on patient outcomes. In response to the growing need for enhanced nurse-physician partnership and recognition of its impact on the patient experience, nurses are designing unit-based programs to bring the two professions together for opportunities to enhance partnership. This article discusses two approaches to enhancing nurse-resident physician partnership introduced by Benike and Clark (2013) and identifies common elements that were critical to the programs' success.

Quality and safety in home and ambulatory settings.

Much of the work in quality and patient safety has been based in hospitals and other acute care settings, yet it has become increasingly apparent that there are errors in delivery of care in other settings, all of which require attention. This article reviews sources of errors in 3 nonacute settings: the home, children's day care, and ambulatory surgery centers. Also described are standards that have been developed to guide practice, as well as specific regulatory agencies that are involved and some of the safeguards that have been instituted in each of the settings to protect against errors.