DIFFERENT MODELS OF COLLABORATION BETWEEN NURSING EDUCATION AND SERVICE

Different Models of Collaboration between Nursing
Education and Service

Different Models of Collaboration between Nursing Education & Service
DEPARTMENT OF NURSING

Chair Person Presenter
Prof. (Dr.) K. Reddemma Bivin, J.B
Dean, Behavioral sciences, II MSc. Psychiatric Nursing,
NIMHANS, Bengaluru NIMHANS, Bengaluru

1 Page.

Index

S. No Content Page No

1 Introduction 1

2 Meaning 1

3 Definition 2

4 Types of collaborations 2

5 Need for collaboration between education and service 3

6 Models of collaboration between education and Service 4-12

6.1. Clinical school of nursing model

6.2. Dedicated Education Unit Clinical Teaching Model

6.3. Research Joint Appointments (Clinical Chair)

6.4. Practice-Research Model (PRM)

6.5. Collaborative Clinical Education Epworth Deakin (CCEED) model

6.6. The Collaborative Learning Unit (British Columbia) Model

6.7. The Collaborative Approach to Nursing Care (CAN- Care) Model

6.8. The Bridge to Practice Model

6.9. Collaboration of Nursing Education and Service in India

7 Conclusion 13

8 Bibliography 14
2 Page.

DIFFERENT MODELS OF COLLABORATION BETWEEN NURSING EDUCATION AND SERVICE

1. Introduction
The nursing profession is faced with increasingly complex health care issues driven by
technological and medical advancements, an ageing population, increased numbers of people living
with chronic disease, and spiraling costs. Collaborative partnerships between educational institutions
and service agencies have been viewed as one way to provide research which ensures an evolving
health-care system with comprehensive and coordinated services that are evidence-based, cost-
effective and improve health-care outcomes1.

Collaboration is a substantive idea repeatedly discussed in health care circles. Though the
benefits are well validated, collaboration is seldom practiced. The lack of a shared definition is one
barrier. Additionally, the complexity of collaboration and the skills required to facilitate the process are

formidable. Much of the literature on collaboration describes what it should look like as an outcome,
but little is written describing how to approach the developmental process of collaboration. Many
researchers have validated the benefits of collaboration to include improved patient outcomes,
reduced length of stay, cost savings, increased nursing job satisfaction and retention, and improved
teamwork (Abramson & Mizrahi 1996).1The focus on benefits of collaboration could lead one to think
that collaboration is a favorite approach to providing patient care, leading organizations, educating
future health professionals, and conducting health care research. Contextual elements that influence
the formation of collaboration include time, status, organizational values, collaborating participants,
and type of problem.

2. Meaning
Collaboration is an intricate concept with multiple attributes. Attributes identified by several
nurse authors include sharing of planning, making decisions, solving problems, setting goals,
assuming responsibility, working together cooperatively, communicating, and coordinating openly
(Baggs & Schmitt, 1988). Related concepts, such as cooperation, joint practice, and collegiality, are
often used as substitutes.

The roots of the word collaboration, namely co-, and laborare, combine in Latin to mean “work
together.” That means the interaction among two or more individuals, which can encompass a variety
of actions such as communication, information sharing, coordination, cooperation, problem solving,
and negotiation.

Teamwork and collaboration are often used synonymously. The description of collaboration as
a dynamic process resulting from developmental group stages as an outcome, producing a synthesis
of different perspectives. The reality is that collaboration evolves in partnerships and in teams. Baggs
and Schmitt (1988) reframe the relationship between collaboration and teamwork by defining
collaboration as the most important aspect of team care but certainly not the only dimension.

A description of the concept of collaboration is derived by integrating Follett's outcome-
oriented perspective (1940) and Gray's process-oriented perspective (1989). Both authors strengthen
the definition of collaboration by considering the type of problem, level of interdependence, and type
3

of outcomes to seek. According to them: Collaboration is both a process and an outcome in which
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shared interest or conflict that cannot be addressed by any single individual is addressed by key
stakeholders. The collaborative process involves a synthesis of different perspectives to better

understand complex problems. A collaborative outcome is the development of integrative solutions
that go beyond an individual vision to a productive resolution that could not be accomplished by any
single person or organization.

It is critical in collaboration that all existing and potential members of the collaborating group
share the common vision and purpose. Several catalysts may initiate collaboration – a problem, a
shared vision, a desired outcome, to name a few. Regardless of what the catalyst may be, it is
essential to move from problem driven to vision driven, from muddled roles and responsibilities to
defined relationships, and from activity driven to outcomes. Collaboration is an inclusionary process
with continuous engagement that reinforces commitment, recognizing the building of relationships as
fundamental to the success of collaborations. An effective collaboration is characterized by building
and sustaining “win-win-win” relationships8.

3. Definition
Henneman et al. have suggested that collaboration “is a process by which members of various
disciplines (or agencies) share their expertise. Accomplishing this requires these individuals
understand and appreciate what it is that they contribute to the whole”.

"Collaboration is the most formal inter organizationl relationship involving shared authority and
responsibility for planning, implementation, and evaluation of a joint effort (Hord, 1986).

Mattessich, Murray and Monsey (2001) define collaboration as '... a mutually beneficial and
well-defined relationship entered into by two or more organizations to achieve common goals'8.

4. Types of Collaboration
Terms, such as interdisciplinary, multidisciplinary, transdisciplinary, and interprofessional,
which further delineate and describe teams, teamwork, and collaboration, have evolved over time.

4.1. Interdisciplinary is the term used to indicate the combining of two or more disciplines,
professions, departments, or the like, usually in regard to practice, research, education, and/or theory.

4.2. Multidisciplinary refers to independent work and decision making, such as when disciplines
work side-by-side on a problem. The interdisciplinary process, according to Garner (1995) and
Hoeman (1996), expands the multidisciplinary team process through collaborative communication
rather than shared communication.

4.3. Transdisciplinary efforts involve multiple disciplines sharing together their knowledge and skills
across traditional disciplinary boundaries in accomplishing tasks or goals (Hoeman, 1996).
Transdisciplinary efforts reflect a process by which individuals work together to develop a shared
conceptual framework that integrates and extends discipline specific theories, concepts, and methods
to address a common problem.

4.4. Interprofessional collaboration has been described as involving “interactions of two or more
disciplines involving professionals who work together, with intention, mutual respect, and
4

commitments for the sake of a more adequate response to a human problem” (Harbaugh, 1994).
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Interprofessional collaboration goes beyond transdisciplinary to include not just traditional discipline
boundaries but also professional identities and traditional roles. Interdisciplinary collaboration team

members transcend seperate disciplinary perspectives and attempt to weave together resources,
such as tools, methods, and procedures to address common problems or concerns2.

5. Need for Collaboration between Education and Service
Considerable progress has been made in nursing and midwifery over the past several
decades, especially in the area of education. Countries have either developed new, or strengthened
and re-oriented the existing nursing educational programmes in order to ensure that the graduates
have the essential competence to make effective contributions in improving people’s health and
quality of life. As a result nursing education has made rapid qualitative advances. However, the
expected comparable improvements in the quality of nursing service have not taken place as rapidly.

The gap between nursing practice and education has its historical roots in the separation of
nursing schools from the control of hospitals to which they were attached. At the time when schools of

nursing were operated by hospitals, it was students who largely staffed the wards and learned the
practice of nursing under the guidance of the nursing staff. However, under the then prevailing
circumstances, service needs often took precedence over student’s learning needs. The creation of
separate institutions for nursing education with independent administrative structures, budget and
staff was therefore considered necessary in order to provide an effective educational environment
towards enhancing students learning experiences and laying the foundation for further educational
development.

While separation was beneficial in advancing education, it has also had adverse effects.
Under the divided system, the nurse educators are no longer the practicing nurses in the wards. As a
result, they are no longer directly in the delivery of nursing services nor are they responsible for
quality of care provided in the clinical settings used for student’s learning. The practicing nurses have
little opportunity to share their practical knowledge with students and no longer share the
responsibility for ensuring relevance of the training that the students receive. As the gap between
education and practice has widened, there are now significant differences between what is taught in
the classroom and what is practiced in the service settings.

Most nursing leaders also assert that something has been lost with the move from hospital-
based schools of nursing to the collegiate setting. The familiar observation that graduate nurses can
"theorize but not catheterize" reflects the concern that graduate nurses often lack practical skills
despite their significant knowledge of nursing process and theory. Nursing educators know that
development of technical expertise in the modern hospital is possible only through on-the-job
exposure to the latest equipment and medical interventions. Schools of nursing have tried to bridge
this gap using state-of-the-art simulation laboratories, supervised clinical experiences in the hospital,
and summer internships. However, the competing demands of the classroom and the job site
frequently result in a less than optimal allocation of time to learn technical skills and frustration on the
part of the nursing student who tries to be both technically and academically expert.

The hospital industry has also recognized the need to support a graduate nurse with additional
training. As a result, graduate nurses are required to attend an orientation to the hospital and have
additional supervised practice before they can function independently in the hospital. The cost of
5

orienting a new nursing graduate is significant, particularly with high levels of nursing turnover (Reiter,
Page.

Young, & Adamson, 2007).

The challenge to nursing education is how to combine theoretical knowledge with sufficient
technical training to assure a competent performance by a professional nurse in the hospital setting.
Clearly, a partnership between nursing educators and hospital nursing personnel is essential to meet
this challenge13.

6. Models of Collaboration between Education and Service5
The nursing literature presents several collaborative models that have emerged between
educational institutions and clinical agencies as a means to integrate education, practice and research
initiatives (Boswell & Cannon, 2005; McKenna & Roberts, 1998; Acorn, 1990), as well as, providing a
vehicle by which the theory -clinical practice gap is bridged and best practice outcomes are achieved
(Gerrish & Clayton, 2004; Gaskill et al., 2003).

6.1. Clinical school of nursing model (1995)

The concept of a Clinical School of Nursing is one that encompasses the highest level of academic
and clinical nursing research and education. This was the concept of visionary nurses from both La
Trobe and The Alfred Clinical School of Nursing University. This occurred within a context of a long
history of collaboration and cooperation between these two institutions going back many years and
culminating in the establishment of the Clinical School in February, 1995.

The development of the Clinical School offers benefits to both hospital and university. It
brings academic staff to the hospital, with opportunities for exchange of ideas with clinical nurses with
increased opportunities for clinical nursing research. Many educational openings for expert clinical
nurses to become involved with the university's academic program were evolved. The move to the
concept of the clinical school is founded on recognition of the fundamental importance of the close
and continuing link between the theory and practice of nursing at all levels10.

6.2. Dedicated Education Unit Clinical Teaching Model (1999)
In this model a partnership of nurse executives, staff nurses and faculty transformed patient
care units into environments of support for nursing students and staff nurses while continuing the
critical work of providing quality care to acutely ill adults. Various methods were used to obtain
formative data during the implementation of this model in which staff nurses assumed the role of
nursing instructors. Results showed high student and nurse satisfaction and a marked increase in
clinical capacity that allowed for increased enrollment.

Key Features of the DEU are
• Uses existing resources
• Supports the professional development of nurses
• Potential recruiting and retention tool
• Allows for the clinical education of increased numbers of students
• Exclusive use of the clinical unit by School of Nursing
• Use of staff nurses who want to teach as clinical instructors
• Preparation of clinical instructors for their teaching role through collaborative staff and faculty
development activities
• Faculty role to work directly with staff as coach, collaborator, teaching/learning resource to
6

develop clinical reasoning skills, to identify clinical expectations of students, and evaluate
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student achievement

• Commitment by all to collaborate to build an optimal learning environment.

6.3. Research Joint Appointments (Clinical Chair) (2000)
A Joint Appointment has been defined by Lantz et al. (1994), as “a formalised agreement
between two institutions where an individual holds a position in each institution and carries out
specific and defined responsibilities”.

The goal of this approach is to use the implementation of research findings as a basis for
improving critical thinking and clinical decision-making of nurses. In this arrangement the researcher
is a faculty member at the educational institution with credibility in conducting research and with an
interest in developing a research programme in the clinical setting. The Director of Nursing Research,
provides education regarding research and assists with the conduct of research in the practice
setting. She/he also lectures or supervises in the educational institution. A formal agreement exists

within the two organisations regarding specific responsibilities and the percentage of time allocated
between each. Salary and benefits are shared between the two organisations.

Outcomes identified by Donnelly, Warfel and Wolfe (1994) for the educational institution are
that it becomes more in touch with the real world and more readily able to identify research questions
(and the subsequent study), that have the potential to make a difference to quality of consumer care
delivery. There is also an increasing collaborative relationship with the service provider, which is
important for long term workforce planning. The position has benefits to nursing/midwifery students
due to more explicit focus on directly linking the education setting to the clinical context. For practice
the outcomes are increased staff involvement in professional activities including writing for publication,
presenting at seminars and conferences and preparing submissions on professional issues. The
clinical chair also facilitates improved access and support to external research project funding6.

6.4. Practice-Research Model (PRM) (2001)
It is an innovative collaborative partnership agreement between Fremantle Hospital and Health
Service and Curtin University of Technology in Perth, Western Australia. The partnership engages
academics in the clinical setting in two formalized collaborative appointments. This partnership not
only enhances communication between educational and health services, but fosters the development
of nursing research and knowledge.

The process of the collaborative partnership agreement involved the development of a Practice-
Research Model (PRM) of collaboration. This model encouraged a close working relationship between
registered nurses and academics, and has also facilitated strong links at the health service with the
Nursing Research and Evaluation Unit, medical staff and other allied health professionals. The key
concepts exemplified in the application of the model include practice-driven research development,
collegial partnership, collaborative ownership and best practice. Many specific outcomes have been
achieved through implementation of the model, but overall the partnership between registered nurses
and academics in the pursuit of research to support clinical practice has been the highlight.

The key elements underlying the process of collaboration and development of the PRM are: -
• Collaborative partnership: - The collaborative partnership was formed by nursing health
7

professionals, from the community health service and the university who recognized the need
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to bridge the theory-clinical practice gap and acknowledged the futility of continuing to work in
isolation from each other. In practical terms, this involved a formal contractual arrangement

between the organizations that led to the establishment of a Nurse Research Consultant
(NRC) position.

• Core values and aims of the collaborative partnership: - Before the actual framework of the
collaborative partnership was decided, a literature review of the most common models of
collaboration in nursing practice was used to promote discussion between the organizations to
clarify and formalize the assumptions underlying the core values, roles and responsibilities of
the partners, as indicated by Spross (1989). During this phase, four key concepts emerged:
firstly, that 'practice drives research'; secondly, the principle of 'collegial partnership'; thirdly,
'collaborative ownership', and finally, 'best practice' (Downie et al., 2001).

As a consequence of this process of clarification and negotiation, the Practice-Research Model
was developed to operationalise the agreed aims of the partnership, which were:

→ To encourage nursing staff to reflect on current nursing practice in order to develop
meaningful research proposals;
→ To teach staff the research process via research experience;
→ To enable nursing staff to have a key role in the professional development of other staff
via the dissemination of research and quality improvement findings; and
→ To plan and implement changes to practice based on research evidence.

Nurse Research Consultant (NRC): - In the PRM, the role of the Nurse Research Consultant
(NRC) was articulated as that of mentor and consultant on issues related to research, methodology
publications and dissemination. Although the PRM was specifically designed to enhance nursing
research activity and the implementation of evidence-based community health nursing practice, the
Model also encouraged the involvement of the multi-disciplinary team to work to achieve the aims of
the partnership agreement5.

6.4.1. Operational framework of the PRM
To fulfill the aims of the partnership several key elements formed the operational framework of
the collaborative agreement. One important element of the framework was to enhance nursing staffs'
knowledge of the research process via research experience. To achieve this 'Journal Clubs' were
established in the community health service on a monthly basis. The Nurse Research Consultant then
worked with staff to identify, plan and implement changes to practice based on research evidence.

A second important element of the PRM was to encourage nursing staff to reflect on current
nursing practice and identify clinical problems based on their knowledge and experience of nursing in
order to develop meaningful research proposals and best-practice guidelines. The main reason for the
success of the collaborative arrangement has been the provision of infrastructure to support the
dissemination of research and quality improvement findings through clinical meetings, workshops and
conference presentations by the nursing staff involved in the various projects.

6.5. Collaborative Clinical Education Epworth Deakin (CCEED) model (2003)7
In an effort to improve the quality of new graduate transition, Epworth Hospital and Deakin
University ran a collaborative project (2003) funded by the National Safety and Quality Council to
8

improve the support base for new graduates while managing the quality of patient care
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delivery.

Nursing education
Students coached by Nurse supported by Clinical
Clinician Facilitators

Clinical facilitators are
supported by Hospital
administration and
university

The Collaborative Clinical Education Epworth Deakin (CCEED) model developed to facilitate
clinical learning, promote clinical scholarship and build nurse workforce capability. This model
provided a framework for the first initiative, a CCEED undergraduate program that nested the clinical
component of Deakin University's undergraduate nursing curriculum within Epworth Hospital's health
service environment.

The CCEED undergraduate program sees undergraduate nursing students attending
lectures at Deakin University in the traditional manner but completing all tutorials, clinical learning
laboratories and clinical placements at Epworth Hospital throughout their three year course. Tutorials,
laboratories and clinical placements are conducted by Epworth clinicians who are prepared and
supported by Deakin School of Nursing faculty. These clinicians also support the student-preceptor
9

relationship in the clinical learning component of the curriculum. The expectation was that increased
Page.

integration between hospital and university would enhance clinical education resulting in improved
students’ application of knowledge and skill as well as increased socialization to the clinician role.

Key findings of the 2005 pilot CCEED program were
1. Students’ learning objectives were met and satisfaction was high.
2. Undergraduate clinical education was valued by preceptors and managers as a workforce
investment strategy
3. Preceptors were enriched in their clinician role as a result of their participation in the program and
reflection on the process.
4. Preceptor continuity promoted a trusting relationship that enabled preceptors to confidently
encourage student initiative.
5. Preceptors managed multiple roles in order to meet demands of patient care and student
learning.

6.6. The Collaborative Learning Unit (British Columbia) Model, 2005

The Collaborative Learning Unit model was based on the ‘Dedicated Education Units’
concept developed, successfully implemented, and researched in Australia. The Collaborative
Learning Unit (CLU) model of practice education for nursing is a clinical education alternative to
Preceptorship. In the CLU model, students practice and learn on a nursing unit, each following an
individual set rotation and choosing their learning assignment (and therefore the Registered Nurse
with whom they partner), according to their learning plans. Unlike the traditional one-to-one
preceptorship-, an emphasis is placed on student responsibility for self-guiding, and for
communicating their learning plan with faculty and clinical nurses (e.g., the approaches to learning
and the responsibility they are seeking to assume). All nursing staff members on the Collaborative
Learning Unit are involved in this model and, therefore, not only do the students gain a wide
variety of knowledge but the unit also has the ability to provide practice experiences for a larger
number of students.

Specifically, a Collaborative Learning Unit is a nursing unit where all members of the staff,
together with students and faculty, work together to create a positive learning environment and
provide high quality nursing care. Clinical nurses preparing to adopt the CLU model have
described a positive learning environment as one where questions are expected. In the CLU
approach the students are not attached to the units as an ‘extra set of hands’ to augment the
nursing workforce, but are present as learners with a primary interest in gaining entry-level
knowledge and competency associated with baccalaureate-prepared nursing practice. As learners
in the CLU model, students are supported by experienced clinical nurses, faculty and, ideally,
nurse researchers. Students recognize a positive learning environment when they perceive their
questions are welcomed, and when they receive thoughtful responses at mutually selected times
for students and staff. For faculty (e.g., academic instructors), key questions focus on determining
what nursing knowledge is needed to provide high quality nursing care. Thus, in a CLU, where
critical questioning is promoted, students can systematically learn to “think like a nurse” and can
demonstrate what they know and can do, as undergraduate nurses who are members of a health
care team.

While staff and faculty work together to support and advance student learning and promote
10

high quality nursing care, the CLU model enables a level of student independence that helps them
move into the work-world. As well, the CLU concept bridges a perceived gap between academic and
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clinical expectations. In this model, nursing faculty, clinical nurses and students work collaboratively to
enhance learning opportunities as well as develop the professional knowledge base of nursing.8

The Collaborative Learning Unit (British Columbia) Model, 2005

Clinical Site
Clinical Nurses coordinators

Student
Nurses

Nurse Nurse
Educators Researchers

6.7. The Collaborative Approach to Nursing Care (CAN- Care) Model (2006)12
The CAN-Care model emerged as academic and practice leaders acknowledged the need to
work together to promote the education, recruitment and retention of nurses at all stages of their
career. The idea of a partnership model emerged when the Christine E. Lynn College of Nursing,
Florida Atlantic University, was awarded a grant from Tenet HealthCare Foundation to initiate an
Accelerated Second-degree BSN Program. The goal was to design an educationally dense, practice-
based experience to socialize second-degree students to the role of professional nurse. A secondary
goal was to enhance and support the professional and career development of unit-based nurses. A
commitment to a constructivist approach to learning, an immersion experience to recognize the
unique needs of accelerated second-degree learners, and to emphasize the partnership among the
academic and practice setting, were guiding forces in the creation and enactment of the model. The
11

model emerged from a dialogue among leaders from the academic and practice setting focusing on
the areas of expertise and potential contributions of each partner.
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The essence of the CAN-Care model is the relationship between the nurse learner (student)
Care
and nurse expert (unit-based nurse), within the context of each nursing situation. The semantics of the
based nursing
student as learner and unit-based nurse as expert, in place of the more common traditional labels of
based
preceptor and preceptee are critical to the intentionality of the collegial focus of the model. The label
nurse learner was designated to place the emphasis on the learning role and the reflective and
as
continuous nature of knowledge construction. The learner is responsible and accountable for
engaging in the learning process and for taking an active role in establishing a dya dyadic learning
partnership with the nurse expert. Unit based nurses are experts in the work of nursing care. The title
Unit-based
nurse expert was chosen to recognize the gifts they bring to the profession and share with the nurse
learner.

The nurse learners and nurse experts engage in a dyadic partnership for the purpose of
nurse
meeting the needs of the assigned patient population as well as to reflect on and to come to know the

art and science of nursing practice. The onsite faculty member is the expert in educational p
processes
and is essential in the support and nurturing of the expert/learner partnership. The faculty member
promotes the growth of the nurse expert as a professional and the journey of the learner in coming to
know a career in nursing. This is a major change in focus from the more traditional role of faculty
change
being in control of the teaching of students By the application of CAN-Care model the focus of the
students. Care
student’s activities moves from the demonstration of discrete skills and prescribed outcomes to an
immersion into the professional nurse role, learning to hear and respond to patient needs, and to
mersion
provide nursing care to achieve quality outcomes.

Through this model the student comes to know the organizational context of nursing practice,
the multifaceted role of professional
nurses, and assumes responsibility
for coming to know the meaning of
nursing in each unique situation. The
unit-based nurse acquires new skills
based
in mentoring, exposure to evidenced
evidenced-
based practice, and to theoretical
knowledge through association with
the college. This approach to
education in the practice setting is
thought to be more consistent with
the educational needs of nurses who
are preparing for the challenges of
professional practice in today’s acute
care settings.

The most dramatic change
with this model is the re re-
conceptualization of the work of the
faculty member. The faculty is the
12

education-focused expert
pert who
supports and nurtures the nurse
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expert/nurse learner partnership. The
faculty member must relinquish control of the students. While the faculty still has accountability for

overall evaluation of the student’s achievement of the nursing practice course objectives, even the
process of the on-going evaluation becomes a collaborative effort with the nurse expert. The primary
role of the faculty member in the model is to nurture the nurse expert/nurse learner relationship and to
support the growth and development of both expert and learner in their respective roles and
responsibilities. The on-site faculty member becomes an advisor, resource, role-model and educator
for both the nurse expert and the nurse learner. The work of the faculty is re-conceptualized as the
creator of the environment to support learning and professional growth as opposed to the direct
teaching of preselected content.

In this model, the healthcare organization becomes an active participant in creating learning
environments and contributing to the learning activities, as opposed to just being a setting in which
college-affiliated faculty appear with students for a teaching encounter. In return, the college becomes
an active partner in the professional development and retention of nurses at the practice facility.

6.8. The Bridge to Practice Model (2008)11
The Bridge to Practice model is distinctly different from other clinical models. First, students
complete all of their clinical experiences in one participating hospital. Second, one full-time teaching
faculty serves as a liaison for each bridge hospital. This faculty member is given a space, usually in
the nursing education department, and is then available to serve as a resource for not only the clinical
associates but also for the hospital nursing staff. In this model, therefore, there can be numerous
clinical associates in one hospital with one full-time University faculty overseeing the clinical
experiences. Third, students are actively involved in selecting their clinical placements.

The Bridge to Practice model proposed by Catholic University of America, school of Nursing
(2008), uses a cohort approach in which students complete medical-surgical clinical nursing education
at the same facility. Students must apply for clinical placement in the hospital of their choice via a
clinical application form. Clinical placement decisions are based on academic performance and
maturational level. Participating students undergo 415 hours of clinical experiences (nine academic
credits) focused on medical-surgical nursing. These clinical practice progresses from Adults in Health
and Illness: Basic, an introductory nursing course, to Medical-Surgical Nursing Leadership, a senior
level course taken in the last semester of baccalaureate study.

Thus The Bridge to Practice Model provides undergraduate nursing students with continuity in
medical-surgical education through placement in the same hospital for all medical-surgical clinical
rotations. Hospitals that participate in the bridge model provide senior clinical nurse preceptors whose
time is paid for by the university. The Bridge to Practice model emphasizes professional incentives for
hospital nurses to participate in nursing education. Planned incentives include the rewarding of
hospital nurses with continuing education credits for participation in the short-term training on
educational methodology and approaches. A tuition discount is offered for graduate course work at
the university for institutional students and faculty, more involvement with clinical support services and
care management, and more informed employment choices by senior students. Challenges include
recruitment of interested senior clinical nurses, retention of clinical liaison faculty, and management of
the trade-off between institutional stability offered by clinical site continuity and the variety of
13

experiences offered by rotation across several clinical settings.
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6.9. Collaboration of Nursing Education and Service in India
The gap between nursing practice and education has its historical roots in the separation of
nursing schools from the control of hospitals to which they were attached. At the time when schools of
nursing were operated by hospital, it was the students who largely staffed the wards and learned the
practice of nursing under the guidance of the nursing staff. However, service needs often took
precedence over students’ learning needs. The creation of separate institutions for nursing education
with independent administrative structures, budget and staff was therefore considered necessary to
provide an effective educational environment towards enhancing students’ learning experiences and
laying the foundation for further educational development4.

While this separation has been beneficial in advancing nursing education, it has also had
adverse effects. Under the divided system, the nurse educators are no longer the practicing nurses in
the wards or directly involved in the delivery of nursing services, nor responsible for the quality of care

provided in the clinical settings used for students’ learning. The practicing nurses have little
opportunity to share their practical knowledge with students and no longer share the responsibility for
ensuring the relevance of the training that the students receive. As the gap between education and
practice has widened, there are now significant differences between what is taught in the classroom
and what is practiced in the service settings. The need for greater collaboration between nursing
education and services calls for urgent attention. We have two institutions which are practicing dual
role, education & practice : NIMHANS, Bangalore and CMC, Vellore. More institutions need to adopt
this model. This will help improve the quality of Nursing Education with overall objective of improving
the quality of nursing care to the patients and community at large4.

6.9.1. Dual role model in NIMHANS
Following the amalgamation of 1974 resulting in NIMHANS, the faculty of the nursing
department took up the dual responsibility of providing clinical services as well as conducting teaching
programs. In 1975, all the Grade II nursing superintendents working in the hospital were designated
tutors to maintain uniformity in the department. Combined workshops were conducted under the
guidance of WHO consultant Mrs.Morril to prepare the tutors who came from Grade II Nursing
Superintendent cadre for teaching purpose and to make the Lectures and tutors associated with
educational programmes (DPN course& 9-months course in psychiatric nursing) comfortable with
clinical supervision. After both groups felt comfortable to assume the dual responsibility, the areas of
supervision were designated. The Head of the Department of Nursing was given the responsibility for
both the service and the education component of the department.

Integration of education with service raised the quality of patient care and also improved the
quality of learning experiences for nursing students, under the close supervision of teachers who were
also practitioners.

6.9.2. Integrative Service-Education approach in CMC Vellore
College of Nursing under Christian Medical College, Vellore, where nurse educators are
practicing in the wards or directly involving in the delivery of nursing services. This enables the
practicing nurse to share her practical knowledge to the student nurse who is practicing in the
14

concerned wards.
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Government of India conducted a pilot study on bridging the gap between education and
service in select institutions like one ward of AIIMS. The project was successful, patients and medical

personnel appreciated the move but it required financial resources to replicate this process.

7. Conclusion
Estimating the future need for Registered Nurses with various educational backgrounds is
complicated by differing perceptions of educators and employers about the appropriate base of
knowledge and skills new graduates need. These differences began to be apparent when nursing
education moved away from its historical base in hospitals in response to abuses and inadequacies
that were believed to characterize the apprentice type of training they provided. They continue to
plague the profession3. Many nursing service administrators believe that academic nurse educators,
removed from the realities of the employment setting, are preparing students to function in ideal
environments that rarely exist in the real and extremely diverse worlds of work. In turn, many nurse
educators believe that nursing service administrators fail to provide work environments conducive to
the kinds of nursing practice their graduates--particularly baccalaureate RNs--are equipped to conduct

and that, furthermore, new graduates of baccalaureate, and diploma programs should be
differentiated in their functional work assignments. The report of a task force of the American
Association of Colleges of Nursing observes that "… conflicting philosophies, values, and priorities
between nurse educators and nursing services administrators have generally served to deter a mutual
understanding and acceptance of responsibility for quality patient care." To succeed, nursing
educators and care providers alike must strengthen their response to these challenges with innovative
solutions built into the program design and administration. Closer collaboration between nurse
educators and nurses who provide patient services is essential to give students an appropriate
balance of preparation12.

All the models pursue collaboration as a means of developing trust, recognizing the equal
value of stakeholders and bringing mutual benefit to both partners in order to promote high quality
research, continued professional education and quality health care. The literature supports the utility
of such collaborations. For example, the most frequently cited positive outcomes are job satisfaction,
improved educational experiences for pre-registration nursing students, increased self-confidence and
improved knowledge base for nurses2. The majority of these models are based on a joint appointment
model where the nurse is initially employed by a health service or a university and divides his or her
time between teaching and clinical practice. Application of these models can reduce the perceived
gap between education and service in nursing there by can help in the development of competent and
efficient nurses for the betterment of nursing profession.

Thank You!
15 Page.

Bibliography
1. Catherine Malloy & Francis T. Donahue. (2004). Collaboration projects between nursing
education and service. Nurse Education Today. 19(6), 368-77
2. Cathleen B. Gaberson & Marilynn G. Oermann (2010). Clinical Teaching Strategies in Nursing.
3rd Ed., New York, Springer Publishing Company. LLC. 307-343
3. Cowen.P.S & Moorhead.S(2006). Current Issues in Nursing. 7th Ed., Missouri, Mosby Inc.,
105-122
4. Dileep Kumar, T (2010). Quality of nursing education: Right of every student. The Nursing
Journal of India. Cl(1), 12
5. Downie.J et al.(2001). Research model for collaborative partnership. Journal of Royal College
of Nursing, Australia. 8(4). 27-32
6. Feltz, Joan, Tom Robin. (2000). Linking practice and education. Journal of Nursing
Administration. 30(9), 405-07

7. Fowler, J., Hardy.J., & Howrath.T. (2006). Trialing collaborative nursing models of care: The
impact of change. Australian Journal of Advanced Nursing. 24(1). 24-28
8. Gardner BD. (2005). Ten lessons in collaboration. The Online Journal of Issues in Nursing.
10(1), 24
9. Hannah Dean and Jan L. Lee (1995). Service and education: Forging Partnership. Nursing
Otulook, 43(3), 119-23
10. Hellen Forbes & Roslie Strother (2004). Collaboration: Integrating education and clinical
practice: The case of La Trobe University/The Alfred Clinical School of Nursing. Contemporary
Nurse, 17, 3-7
11. Patterson.M, & Gandjen. C (2008). The bridge to practice model: A collaborative program
designed for clinical experiences in baccalaureate Nursing. Nurse Economics. 26(5). 302-306
12. Raines.A.D (2006). An innovative model of practice- based learning. International Journal of
Nursing Education Scholarship. 3(1). 20-26
13. Sherry P. Palmer, et al. (2005). Nursing education and service collaboration: Making
difference in the clinical learning environment. The Journal of Continuing Nursing Education,
36(6). 123-28

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