Clinical Education, Clinical Faculty, Clinical Instructor, Dedicated Education Unit, Nursing Education



  1. Auxier, Nicole
  2. Simpson, Holly


Abstract: The dedicated education unit (DEU) clinical education model has been identified nationally as an innovative model for clinical nursing education. This article identifies the core values of the DEU clinical faculty coordinator role and describes the transformation of this role across three clinical models. The role has been adapted to fit the needs of acute care, post-acute care, and community nursing DEU models, meeting the needs of the clinical educational environment and clinical staff as well as student learning outcomes.


Article Content

The University of Portland School of Nursing dedicated education unit (DEU) concept has been identified nationally as an innovation and possible solution to the faculty shortage and expected nursing shortage (Moscato, Nishioka, & Coe, 2013). Developed in 2003, the DEU is an academic partnership between a clinical site and the educational institution, founded on a united commitment by both entities to create an optimal clinical learning environment for student learning (Moscato, Miller, Logsdon, Weinberg, & Chorpenning, 2007; Moscato et al., 2013; Nishioka, Coe, Hanita, & Moscato, 2014).


Since the initial development of the model in 2003, the role of the clinical faculty coordinator (CFC) has transformed from designated teacher to that of manager of the DEU clinical learning experience (Edgecombe, Wotton, Gonda, & Mason, 1999). This adaptable role is centralized around core themes (Moscato et al., 2013). This article discusses the transformed role of the CFC, identifies core values of the role, and demonstrates the adaptability of the DEU model through the CFC role.



This article builds on the foundational works of O'Lynn (2013) and Moscato et al. (2007). The transformation of the traditional clinical experience for undergraduate nursing students at the University of Portland School of Nursing DEU began through conversations with clinical site nursing administrators, nurse managers, and staff nurses (Moscato et al., 2007). This led to the first acute care DEU in the school of nursing (SON).


One of the foundational constructs of a DEU is that staff nurses become the instructors for nursing students while the university faculty member transitions to the role of facilitator (Moscato et al., 2007). This led to transforming the traditional role of faculty into two distinct roles: clinical instructor and clinical faculty coordinator. For the first, staff nurses and clinicians (including certified nursing assistants [CNAs], certified medication assistants [CMAs], and other nonnursing staff) at the clinical site, who were previously described as preceptor, are known as clinical instructor (CI), responsible for the education, engagement, and support of nursing students as they achieve their clinical outcomes.


The preceptor model is significantly different than the DEU model and is not discussed in this article. The CFC fulfills two roles. 1) The CFC becomes the university representative at the clinical site and facilitator of the student-CI team. 2) The CFC is the manager of the clinical learning experience for students, CIs, and other nurses and staff involved in the teaching and learning experience at the clinical site.


The application of the original University of Portland DEU model as described by Moscato et al. (2007) formed the foundation for the core values of the CFC role, which is built around four core responsibilities: 1) coaching CIs to develop skills as expert clinicians and primary educators; 2) supporting the clinical site(s), students, and clinical staff to maintain collaborative relationships with the classroom; 3) encouraging and guiding students to connect theory with nursing concepts; 4) and developing, in partnership with the clinical site, an educational environment that promotes optimal learning for students.


The Moscato et al. (2007) implementation study demonstrated how the DEU model could be replicated in a variety of nursing education programs. The success of the model, both in the original site and replication sites, inspired the SON to adapt the model and the CFC role to fit student learning needs in different clinical environments. Currently, the SON has three DEU models: acute care, post-acute care, and community nursing.



Acute Care Model

The first DEU model was developed for an acute care setting. In this model, CI staff nurses at the clinical site are responsible for the students' clinical education and provide ongoing feedback about performance. They collaborate with students and the CFC in the learning experience and set goals as appropriate for each student. One CI is assigned to one or two students per clinical rotation and remains with those students throughout that rotation. The CI assigns patients to the student(s) under the guidance of the clinical unit charge nurse or leadership team.


The CFC functions both as liaison and collaborator with the CIs and completes the final evaluation of student outcomes. CIs, who actively teach the students each day, provide their own midterm and final evaluations of student progress.


When the CFC arrives in the clinical unit, students often have already begun their shift with their assigned CI. The CFC checks on the progress of students and their CIs, answers questions, and provides in-the-moment coaching for both. The CFC also schedules regular "Lunch and Learn" sessions for clinical site staff, including CIs; the purpose is to provide a brief educational discussion based on topics of interest with regard to teaching methods. The CFC also holds weekly seminars for students that support clinical learning outcomes. The seminars allow students time to reflect on current themes taking place in the unit and to engage in critical thinking. The CFC enhances the unit atmosphere by posting weekly "This Is What Students Are Learning" signs to support connection between the classroom and the clinical education experience.


Post-Acute Care Model

O'Lynn (2013) identified a need to improve the quality and rigor of post-acute care clinical experiences; to address this need, the CFC in the post-acute care DEU model must have more involvement and coordination of student education than in an acute care DEU. Greater CFC facilitation improves communication and coordination among clinicians, nursing staff, and students while strengthening the connection between clinical experiences and learning outcomes.


The post-acute care DEU model was identified in O'Lynn's (2013) pilot study as having similar positive outcomes to simulation. Students experience a variety of care levels and transitions by working with CNAs, CMAs, and RNs while utilizing a BSN critical thinking lens.


In post-acute care, CNAs, CMAs, licensed practical nurses, and RNs are the CIs. With a variety of nursing staff coordinating patient care with students, the CFC maintains a greater physical presence on the clinical unit in order to coach the student-CI teams. The university's relationship with the clinical site is enhanced through permanent DEU signage, which recognizes the CI's designation on the clinical unit. Although such signs are also posted in most DEU acute care clinical sites, post-acute care CIs feel that the recognition positively influences staff as it signals accomplishments across all nursing care levels (i.e., a CNA and RN can each be recognized as clinical teaching experts). The CFC also functions as an expert educator and resource for best practices across all levels of nursing care.


Each CI in the care unit is assigned one student for the clinical week, and all students on the unit work through a rotation of different nursing staff, depending on the staffing setup. For example, students may be with a CNA for their first and third weeks, with a CMA for the second and fourth weeks, and with an RN or licensed practical nurse charge nurse during weeks 5 and 6. The CIs provide daily documented evaluations of their students, which are shared with the student at the end of the clinical day and submitted weekly to the CFC. The CFC completes midterm and final evaluations based on in-person observation of the student's performance, the student's progress on clinical-based paperwork, and the CI's daily evaluation forms.


Community Nursing Model

Faculty from the SON seeking an innovative approach to community nursing recognized that such clinical experiences could be developed using the principles of the DEU model (Braband & Vines, 2012). The DEU model could strengthen student educational experiences while supporting clinical sites in the community through the role of the CFC. The community clinical DEU experience takes place in the school nursing setting. Nursing students travel to different sites and adapt to different clinical environments during their training.


Before the clinical semester, the community DEU CFC orchestrates a formal "focused" assessment class for students in the academic skills laboratory environment (B. Braband, personal communication, April 27, 2016). This focused lab helps prepare students for the new clinical environment and explains expectations specific to the community students will experience. Lead course faculty and clinical site nurse managers recruit and select CIs interested in teaching these students.


The CFC is responsible for traveling to each clinical site and conducting, at a minimum, weekly visits to coach CI-student teams. A 1:1 student-to-CI ratio is used in this model instead of the 1:2 ratio used elsewhere. The community DEU CFC conducts postclinical seminars at a location convenient for the clinical site and works directly with school nurses to function as coach, collaborator, teacher, and resource to the student-CI team (Braband & Vines, 2012).



The DEU CFC model is adaptable to multiple patient care contexts. The acute care, post-acute care, and community DEU models can all support universities seeking to address the nursing faculty shortage while strengthening academic and clinical partnerships. Guidance from the CFC helps students connect didactic learning within the clinical context. These elements combine to yield a positive learning environment for students and clinical teachers.




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