Dedicated Education Unit Driven Learning on the Medical-Surgical Unit

Nursing deficit in the United States is a pressing issue, growing more acute each year. The aging population and retirement of experienced nurses contribute to a significant nursing care delivery shortage within our communities. The deficiency within the nursing community has also caused a significant shortage of practicing nurses, and nurse educators, which also limits the ability to grow new nurses. These gaps lead to an exponential problem to be addressed by hospitals, ambulatory and outpatient services, colleges, and universities. As the issue expands, it is essential to adapt an implementation process to support nursing students within the clinical community, especially on the medical-surgical units. A clinical model which uses dedicated education units (DEUs) can be beneficial on the medical-surgical unit through the academic-partnerships to help improve the learning of the students and improve clinical outcomes (Marcellus et al., 2021).

Many academic nursing programs rely on bedside nurses on the medical-surgical units to use a preceptive model to support clinical learning. In the model, nursing students work with a nurse partner in the unit to help with the education component. This adds pressure on the nurses, who have a high workload of medical-surgical patients in varying daily assignments. Creating additional pressure on nurses to educate and care for their patients contributes to a stressful environment and limits time available for the nurse to teach the student. This traditional model emphasizes the notion that nurses are educators and are expected to teach. However, not all nurses desire to be educators and some nurses do not like to teach or have students. This situation can be inconducive to student learning, creating an atmosphere where students feel uncomfortable and unvalued when trying to engage and learn from their nurse partners.

Nurses are often put into pressurized situations, which leaves them feeling overwhelmed on the medical-surgical floor. The added workload of teaching a student in addition to taking care of their patients can interrupt the nurses’ time, disrupt patient care, time spent by the nurse with patients, and cause nurses to experience burnout. 

In addition, placing students can be challenging for schools when the hospital has multiple schools on-site each day. This can lead to nurses expressing hostility toward students if there are no incentives to take on students, such as added monetary value or extra recognition for training nursing students. 

One way to combat these problems in the medical-surgical unit is establishing a DEU which allows the students to be in one unit and assigned to the patients only on that unit. The students in DEU can foster positive relationships, build rapport with staff, provide positive experiences, and gain realistic expectations in nursing. A DEU model is more formative and can allow increases in the number of students placed on one unit, thus facilitating student learning opportunities.

For example, placing 12 students in a unit can be significantly limiting when there is a shortage of staff. However, if students are on a 30-bed unit, they can be assigned two patients each. In this model, the student is assigned to the patient versus the nurse. It can be beneficial for students to be assigned to their own patients, as allows them to have more independent learning. The DEU model supports activities, including looking up reports, obtaining vital signs, performing assessments, and administering medications with their clinical instructors. DEUs also help facilitate learning using the clinical judgment model and allows students to be more autonomous when performing learned practices. This autonomy creates greater independence, effective communication, and results in increased reports of working with nurses in a team approach using student, nurse, and nurse educator (Lapinski & Ciurzynski, 2020). It creates an environment to foster focused education by the nursing instructor, including assigning patients with a focus on didactic topic, supervising student medication administration, and validating student skills. It helps reduce the workload of practicing nurses in the medical-surgical units.

Nurse educators working within the units can more readily facilitate learning when exciting opportunities arise. DEU support relationship and rapport building while giving nursing students the understanding that a team dynamic is essential to help with their education and training as new nurses. 

Nursing students in a DEU are found to have greater learning opportunities, including evidenced-based research projects, learn more independently, and improve patient safety outcomes through effective communication (Marcellus et al., 2021). These results are due to being focused on objectives and goals that need to be met through their education. Using the DEU approach reduces stress and pressure for the nurse partners on the unit and reduces burnout for nurses who frequently train students. Adopting this model can relieve workload pressures for practicing nurses, improve patient outcomes, and foster a nurturing environment for nursing students. Students can learn without impaction of the patient census and staffing. Nurses can educate students based on their previous learning and practices. Hospitals should consider adapting their approach to nursing education by utilizing the DEU model to create balance between helping to produce more nurses and reducing stress to nurses on medical-surgical floors.

References

Lapinski, J., & Ciurzynski, S. M. (2020). Enhancing the sustainability of a Dedicated Education Unit: Overcoming obstacles and strengthening partnerships. Journal of professional nursing: official journal of the American Association of Colleges of Nursing, 36(6), 659–665. https://doi.org/10.1016/j.profnurs.2020.09.00

Marcellus, Lenora; Jantzen, Darlaine; Humble, Robin; Sawchuck, Diane; Gordon, Carol. (2021). Characteristics and processes of the dedicated education unit practice education model for undergraduate nursing students: a scoping review. JBI Evidence Synthesis, 19(11), 2993-3039. DOI: 10.11124/JBIES-20-00462