11.7 Describe all innovative, creative academic practicum experiences that are in place in the organization.

11.7 Describe all innovative, creative academic practicum experiences that are in place in the organization. The Department of Nursing is affiliated with a number of nursing schools. It also provides a variety of academic practicum experiences for nurses and nursing students both at entry level and at advanced levels, as well as for individuals who are interested in nursing as a career. Carol A. Ghiloni Oncology Nursing Fellowship The Carol A. Ghiloni Oncology Nursing Fellowship, named for a Nursing Director who led the inpatient oncology unit for over 20 years, is a 10-week, full-time paid experience provides learning opportunities in oncology nursing for baccalaureate nursing students and faculty members. For nursing students, the fellowship introduces the student to the many and varied roles in oncology nursing, an experience that is generally very limited in traditional baccalaureate programs. Students who have completed their junior year may apply for the fellowship for the summer prior to their senior academic year. The fellowship is primarily a learning opportunity for the student who functions in a non-traditional Patient Care Associate (PCA) role. The student may assist the preceptor with the care of oncology patients and also takes advantage of observational experiences in the Cancer Center and other related areas of interest. For faculty members, the fellowship is open to baccalaureate faculty with an interest in oncology. It provides the selected faculty fellows with the opportunity to enhance their knowledge and understanding of cancer care, to observe and experience cutting-edge oncology nursing care, and to augment the substantive content of their oncology lectures. Both student and faculty fellows develop short presentations in oncology nursing which they present to the MGH community and to their academic communities. Since its inception, ten students and four faculty members have completed the fellowship program. Hausman Nursing Fellow The first Hausman Nursing Fellowship was awarded in the summer of 2007. The Hausman Nursing Fellowship is designed to enhance interest in and commitment to nursing students of color. The undergraduate fellowship has been developed to afford nursing students following their junior year an opportunity to experience clinical nursing at the MGH by participating in multiple roles within the department. These opportunities provide fellows with both inpatient and outpatient experiences in an arena rich with clinical experts. The Fellowship is specifically intended to engage 90

undergraduate nursing in a way that recognizes their level of current clinical skills and strengths and that builds on those strengths in a protected way. The Fellow is assigned a minority nurse preceptor who works collaboratively to manage encounters with patients and families that assist the Fellow to build a body of personal nursing experience. Fellows have opportunities to develop collegial relationships with staff nurses at all levels of practice from clinical nurse to advanced practitioner. Within the variety of experiences available at MGH, each Fellow is able to select an area of primary interest. This affords an opportunity to witness the unique contributions of each member of the interdisciplinary care team to an integrated approach within a patient care area. These clinical experiences are intended to energize and inform the Fellows future nursing practice. The first Hausman Fellow completed his fellowship in the summer of 2007 and described his experience in the local media (attachment 11.7.a). The Hausman fellowship is also discussed in Force 4.4. Accelerated BSN Program The Accelerated BSN Program is a collaborative effort between MGH and the Massachusetts College of Pharmacy and Health Sciences. The program involves total immersion in which students are at MGH for their clinical experiences two to four days a week for five week periods. MGH nurses with Masters Degrees and recent inpatient experience serve as faculty. Attachment 11.7.b is a summary description of the program. IV Therapy Experience Experience in the skills associated with intravenous therapy are not easily available to nursing students. The IV Therapy team has engaged in a relationships with Northeastern University and Curry College to provide practicum experience in intravenous therapy. Nursing students who have their clinical rotations at MGH may spend a day with an IV nurse (4 hours with an IV nurse, 4 hours with a nurse responsible for PICC insertions). In January, 2007, the IV Therapy team also started a Co-op placement for nursing students to function as PICC insertion assistants. The Nursing Director of the IV Therapy team also provided mentoring to a Northeastern RN-to-BSN student for a class in leadership. The student attended meetings with the nursing director, and assisted her in the development of staff meeting agendas and minutes. As an OR nurse, the student was also able to update the staff on maximum barrier technique for use during PICC insertions. 91

Northeastern University Cooperative Education Program MGH has long been associated with the Northeastern University (NEU) Cooperative Education program. Also known as Co-op, this is an educational model that allows students to alternate periods of faculty-directed academic-cum-clinical study with three-month periods of paid, full-time employment in the clinical setting. The Department of Nursing, in addition to providing facultysupervised clinical practicum experiences to NEU baccalaureate nursing students, regularly places these students in Patient Care Associate (PCA) positions. For the student, the combination of classroom learning, traditional practicum and co-op experience is the best possible way to develop the passion for learning, practical capability and maturity that leads to a lifetime of achievement. For the organization, the program provides knowledgeable, enthusiastic workers and is a pipeline for future Staff Nurse employees. The department may have anywhere from 40 to 80 Co-op nursing students employed at any one time. Preceptorship Student clinical experiences may focus on acquiring specific skills or becoming more knowledgeable about particular patient populations. Preceptorships provide the opportunity for students to integrate skills and knowledge and to become more familiar with the role of the Staff Nurse in the clinical setting. MGH cooperates with schools of nursing in programs in which Staff Nurses function as preceptors for senior nursing students. In addition to the benefit for the student, the program helps to develop Staff Nurses skills as teachers and mentors, as described in the following narrative: My Name is Kristen and I am a Staff Nurse on Bigelow 9 the Respiratory Acute Care Unit. I have had the privilege of precepting a Boston College student during her last semester of nursing school. She precepted with me for a total of 180 hours. We met once or twice a week for either an 8 or 12 hour shift depending on what her school and work schedule was. We worked together for a total of 3 ½ months. This was my first experience precepting; therefore, I was apprehensive and didn t know what to expect. When I first met her she also was nervous yet eager to learn and had a list of things she wanted to accomplish. The first few weeks were tough for me because I was so used to doing my own thing. It was very hard for me to sit back and let someone else do the work. After a few weeks I got used to it and learned to be patient. Through the next couple of months I saw her grow into a real nurse. It made such an impact on me to know that I had an influence on her and helped her develop into a nurse. I know that she will take our experience together with her and hopefully utilize some of my nursing style and practice throughout her career. By the 92

end of the preceptorship all her goals had been met and I developed my own teaching style that I will use during my next experience and throughout my nursing career. Protech Program The Norman Knight Nursing Center strives to encourage, engage and mentor the next generation of Health Care Workers through the Protech program. This cooperative venture between MGH, East Boston High School, the Health Careers Academy and the Private Industry Council provides a multiple year school-to-career program for junior and senior high school students. The program, designed to prepare students for challenging and rewarding career opportunities, helps individuals gain increased awareness of talents and career interests while getting paid to work in the health care setting. Protech students assume a variety of roles throughout the institution. On the Patient Care Units, they are employed as Operations Associates. Attachment 11.7.c describes the competencies for the Protech students. Norman Knight Nursing Center staff not only orient the students, but also participate throughout their tenure at MGH through continuing education and student forum opportunities. The Norman Knight Nursing Center has also successfully employed Protech students for several years and looks forward to continuing this rewarding practice in the future. Internship A Wheaton College Chemistry major who is interested in entering nursing as a career is doing a 24 hour/week internship on a patient care unit. She is working with a Staff Nurse, assisting in both small and large projects on the unit. One project she is working on is information management. The nurses are inundated with information from multiple sources on a daily basis. The student is reorganizing some of the bulletin boards so information can be made available to the staff without overwhelming them. She is conducting a survey to see what posted information nurses find useful and what is not useful. The student is also working with a Staff Nurse who is developing a mentor program for new nurses, assisting with the literature search as a basis for the program content. 93

Dedicated Education Unit In collaboration with the University of Massachusetts Boston, MGH is developing a proposal for a Dedicated Education Unit (DEU). The Dedicated Education Unit (DEU) is an innovative model of clinical nursing education. The overarching objective is that an entire patient care unit can be transformed into an optimal learning/teaching environment through the collaborative efforts of nurses, management, students and faculty. A key concept of the DEU is the belief that staff nurses educational role is vital to the development of student s professional skills and knowledge. In the DEU staff nurses are the Clinical Instructors, supported by university faculty, hospital leadership and nursing colleagues. A detailed description of the DEU is included in attachment 11.7.d. 94

Attachment 11.7.a 95

Attachment 11.7.b 2007 EXECUTIVE SUMMARY Massachusetts College of Pharmacy Nursing Program And MGH Goal: To develop a working relationship with Massachusetts College of Pharmacy Nursing Program (MCPHS) that enables baccalaureate nursing students to have their clinical immersion experiences at MGH. Mission: Immersion in daily practice of acute care nursing Practice to inform teaching Learning the real as well as the ideal in transitioning to a professional role Learning systems and their impact on care Method: First clinical experience will be Care of the Adult in Summer 2007 o Each clinical course will have didactic portion front-loaded during first 1/3 of each semester o Clinical portion will comprise ~28hrs/wk during final 2/3 of semester Clinical faculty will be drawn from interested Masters prepared clinicians within each MGH clinical practice area. o Each clinical Faculty will supervise 5 students o Clinical Faculty will provide onsite clinical instruction, support, and case review as needed o Clinical Faculty will participate in clinical evaluation of each student at the end of each clinical rotation Clinical Associates (Preceptors) for capstone experiences will be drawn from baccalaureate prepared clinicians within each MGH clinical practice area o Each student will be paired with a maximum of two Clinical Associates during each site rotation o Each Clinical Associate will bear primary responsibility for patient care. Clinical Faculty and Clinical Associates will be supported by MCPHS Faculty via: o Periodic site visits o Continuous availability for advice and problem-solving o Pedagogical self-directed education program Evaluation and Research MCPHS core faculty and The General clinical faculty will, to the extent there is mutual interest and opportunity, engage in collaborative research projects to advance nursing scholarship and enhance the education-service partnership to the benefit of both parties, including but not limited to opportunities for scholarly presentations, publications, and extramural grant funding. MCPHS and The General will collaborate to develop a plan for tracking outcomes of the collaborative partnership, to include but not be limited to numbers of students participating, student academic and NCLEX-RN success, # of students who become employed as new graduates, cost analysis (ROI in terms of reduced orientation costs, improved retention, etc.), satisfaction of students and partners (administrators and respective participating faculty and staff), scholarly productivity, etc. 96

Attachment 11.7.c Protech Student Competency Assessment Checklist And Training Record 97

Attachment 11.7.c continued INSTRUCTIONS: Assess performance of each criterion for identified skill or function. Indicate with a b and initial those criteria which were performed correctly. The learning coach should comment on performance with each assessment completed. All criteria must be performed satisfactorily during at least one assessment to achieve competence. MASSACHUSETTS GENERAL HOSPITAL DEPARTMENT OF NURSING Competency Assessment NAME: UNIT: PATIENT RIGHTS AND CONFIDENTIALITY Date Assessed * Performance Criteria 1.Describes hospital policy on patient rights. 2.Explains hospital policy regarding patient confidentiality. 3.Relates policy to Protech activities. 4. Describes the policy of patient rights and confidentiality surrounding a confidential patient (VIP), specific to medical record, census board, visitors and security. ASSESSMENT DATE: LEARNING COACH: ASSESSMENT DATE: LEARNING COACH: ASSESSMENT DATE: LEARNING COACH: 98

Attachment 11.7.c continued INSTRUCTIONS: Assess performance of each criterion for identified skill or function. Indicate with a b and initial those criteria which were performed correctly. The learning coach should comment on performance with each assessment completed. All criteria must be performed satisfactorily during at least one assessment to achieve competence. MASSACHUSETTS GENERAL HOSPITAL DEPARTMENT OF NURSING Competency Assessment NAME: UNIT: MAINTAINING THE PATIENT RECORD Date Assessed * Performance Criteria 1.Describes the importance and purpose of maintaining the medical record. 2.Describes the process of maintaining the medical record with the proper number of blank progress note pages stamped with the correct patient name and unit number. 3.Files forms and documents in the proper medical record order. 4.Demonstrates the process of setting up a new patient medical record. 5.Maintains confidentiality of the medical record at all times. 6.Describes the process of obtaining and returning a medical record to and from Health Information Management Systems (Medical Records) ASSESSMENT DATE: LEARNING COACH: ASSESSMENT DATE: LEARNING COACH: ASSESSMENT DATE: LEARNING COACH: 99

Attachment 11.7.c continued * INSTRUCTIONS: Assess performance of each criterion for identified skill or function. Indicate with a b and initial those criteria which were performed correctly. The learning coach should comment on performance with each assessment completed. All criteria must be performed satisfactorily during at least one assessment to achieve competence. MASSACHUSETTS GENERAL HOSPITAL DEPARTMENT OF NURSING Competency Assessment NAME: UNIT: MAINTAINING THE WORK AREA Date Assessed * Performance Criteria 1.Returns gray patient records that are not being used into the chart rack. 2.Returns green patient medication/data books to appropriate bedside when not in use. 3.Pick up and dispose of trash left in the nurses station. 4.Checks fax machine and all printers to assure adequate paper supply. 5.Replaces toner cartridges as necessary. 6.Distributes mail to patients, operations coordinator, nurse manager, and unit staff. 7.Functions as messenger/runner for supplies and errands, as per unit needs. ASSESSMENT DATE: LEARNING COACH: ASSESSMENT DATE: LEARNING COACH: 100

Attachment 11.7.c continued * INSTRUCTIONS: Assess performance of each criterion for identified skill or function. Indicate with a b and initial those criteria which were performed correctly. The learning coach should comment on performance with each assessment completed. All criteria must be performed satisfactorily during at least one assessment to achieve competence. MASSACHUSETTS GENERAL HOSPITAL DEPARTMENT OF NURSING Competency Assessment NAME: UNIT: ADMISSION and DISCHARGE COMPETENCIES Date Assessed * Performance Criteria Admission 1.Names the portals of entry, and general process through which a patient may enter the hospital. 2.Collates forms to create an inventory of unit specific admission packets. 3.Maintains a specific number of admission packets on the unit at all times. Discharge 1.Files copy of discharge documentation according to appropriate unit systems/procedures. 2.Describes the process for obtaining a wheelchair. 3.Demonstrates how to lock and unlock wheelchair brakes. 4.Demonstrates how to elevate footplates and lock brakes when a patient is about to stand up or sit down. 5.Demonstrates safe operation of a wheelchair overall. ASSESSMENT DATE: LEARNING COACH: ASSESSMENT DATE: LEARNING COACH: ASSESSMENT DATE: LEARNING COACH: 101

Attachment 11.7.c continued INSTRUCTIONS: Assess performance of each criterion for identified skill or function. Indicate with a b and initial those criteria which were performed correctly. The learning coach should comment on performance with each assessment completed. All criteria must be performed satisfactorily during at least one assessment to achieve competence. MASSACHUSETTS GENERAL HOSPITAL DEPARTMENT OF NURSING Competency Assessment NAME: UNIT: SAFETY AND SECURITY COMPETENCIES Date Assessed * Performance Criteria 1.Locates the key manuals on the Infection Control Manual, Disaster Manual, Manual of Safety Policies. (which pertain to safety and security). 2.States the emergency numbers for fire, code call, disaster, and disturbance. 3.Locates the panic button on the unit. 4.Describes responsibilities regarding safeguarding the medical record. 5.Names two resources from the MGH department of Police and Security available to employees. ASSESSMENT DATE: LEARNING COACH: ASSESSMENT DATE: LEARNING COACH: ASSESSMENT DATE: LEARNING COACH: 102

Attachment 11.7.c continued DEPARTMENT OF NURSING PROTECH STUDENT TRAINING RECORD NAME DATE UNIT NUMBER TRAINING PROGRAM DATES The purpose of the Training Record is to: 1. Provide evidence that the employee has met the requirements and the performance expectations of the PROTECH Training Program 2. Identify developmental needs and an action plan for meeting learning goals DIRECTIONS: SECTION I Using the rating scale, rate the employee in each of the performance standards. It is expected that all of the performance standards be met for successful completion of the program. SECTION II Define a specific plan for helping the employee gain the experience necessary for his/her development. This should be developed collaboratively with the faculty member, the employee and the manager. SECTION III Additional comments regarding the employee s performance (as needed). SECTION IV The record is reviewed and signed by the employee and manager. 103

Attachment 11.7.c continued I. KNOWLEDGE FOR PRACTICE Rating Scale M = MET: Performance fully meets the requirements of the role. U = UNMET: Performance does not meet the requirements of the role. A. INTERPERSONAL SKILLS/COMMUNICATION/ROLE DEVELOPMENT: 1. Describes the role and responsibilities associated with his/her position. Can describe role, skills, supervision requirements, etc. to others. Reviews the job description for the role. Describes performance expectations and evaluation process. Participates in maintaining own competency record. 2. Recognizes that the patient is the center of all care. Knows that a patient s needs are top priority. Respects patient confidentiality. RATING M U M U COMMENTS 3. Relates well with faculty, co-workers and health team members Is respectful of faculty and classmates. Offers help when needed. Works well with clinical staff Works well with team members M U 4. Communicates effectively, verbally and in writing. Completes requirements of performance criteria Participates in class discussion M U 5. Defines own learning needs and demonstrates initiative in meeting needs, seeking assistance appropriately. Seeks guidance in the work area. Asks for information re: assignment. Looks for opportunities to learn required skills. Asks questions. Seeks help from appropriate resources (RN, OA, OC) for guidance. 6. Meets attendance standards. Is on time for class/unit/floor assignment. Notifies faculty if unable to attend class or expects to be late. Wears ID badge. M M U U 104

Attachment 11.7.c continued I. KNOWLEDGE FOR PRACTICE (continued) Rating Scale M = MET: Performance fully meets the requirements of the role. U = UNMET: Performance does not meet the requirements of the role. B. TECHNICAL COMPETENCY - ABLE TO: RATING COMMENTS 1. Demonstrates correct use of hospital communication systems. M U Distributes mail, checks fax machine and all printers to assure adequate paper supply. 2. Completes the process of setting up admission packets, and assisting with discharge of patients to the lobby. M U 3. Describes the content of unit reference tools. M U 4. Assists with maintaining the patient medical record according to hospital policy and procedure. M U 5. Assists with maintaining the work area Returns patient records to chart rack, returns green M U medication books to bedside when not in use; picksup and disposes of trash left in the nurses station. 6. Describes measures to maintain the safety and security of the patient care unit. M U 7. Assists with providing unit hospitality functions. M U 8. Functions as a messenger/runner for supplies and errands, as per unit needs. M U 9. Describes the rights and confidentiality of patients. M U 105

Attachment 11.7.c continued II. ONGOING LEARNING PLAN & TIME FRAME FOR COMPLETION Recommend areas for additional practice or development (Be specific & include amount of practice needed): AREAS FOR DEVELOPMENT AND ACHIEVEMENT PLAN TIME FRAME III. IV. SIGNATURES: Employee Signature Date Manager/Faculty Signature Date This completed record should be sent to The Knight Nursing Center for Clinical and Professional Development (Founders House 6). After the Training Record is processed, a certificate will be issued to the employee and the original Record will be sent back to the Manager. The Manager is accountable for ensuring completion of learning plan and will document progress in the performance appraisal. 106

Attachment 11.7.d Partners/University of Massachusetts Boston DEU Pilot Proposal -- DRAFT -- Introduction: The Dedicated Education Unit (DEU) is an innovative model of clinical nursing education. The overarching objective is that an entire patient care unit can be transformed into an optimal learning/teaching environment through the collaborative efforts of nurses, management, students and faculty. A key concept of the DEU, is the belief that staff nurses educational role is vital to the development of student s professional skills and knowledge (Mascato et al, 2007). In the DEU staff nurses are the clinical instructors, supported by university faculty, hospital leadership and nursing colleagues. The UMass-MGH-BWH clinical partnership is designed to foster a collaborative association between the entities in which resources, knowledge, and experiences are both shared and reciprocal. This model allows nursing practice to inform nursing education and, in turn, nursing education to influence nursing practice and the delivery of healthcare. The goals of the clinical partnership include: 1. Collaborative engagement to inform nursing education through clinical practice and influence clinical practice through nursing education, 2. Providing a solid, functional and rigorous foundation for evidenced-based nursing practice, 3. Creating a teaching partnership that enables the student to integrate the core competencies of critical thinking, communication, assessment and technical skills in nursing practice, 4. Promoting individual and collective development of faculty and clinical partners through collaborative teaching, practice, service, and scholarship, and 5. Mentoring students in the transition from student to entry-level practitioner of nursing. 6. Provide a delivery model for clinical nursing education that addresses the nursing faculty shortage, the need for increased student enrollment, and the nursing workforce shortage. The clinical teaching-learning experiences are immersive and designed to allow students substantial continuity in concentrated blocks of time to apply their knowledge and skills in the practice setting. The UMass Lead Faculty and MGH/BWH Clinical Instructors are committed to providing students with clinical immersion experiences that assure adequate depth, breadth, peer support, and opportunity for understanding the nuances and context of providing and coordinating nursing care in today s health care environment. The collaborating entities are committed to be fully collaborative partners for all phases of curriculum development, implementation (teaching didactic and clinical experiences; supervising, mentoring and evaluating students), and program evaluation, as well as continuous program improvement. Specific practice settings will be selected to provide students with specialized and individualized learning experiences to ensure the achievement of expected program outcomes and individual student learning outcomes. Key Assumptions: DEU medical/surgical units at MGH/BWH host students only from UMass. UMass Lead Faculty and MGH/BWH Clinical Instructors will meet formally at the beginning and conclusion of each scheduled clinical immersion rotation to plan and orient to the 107

Attachment 11.7.d continued UMass will orient MGH Clinical Instructors to the BSN curriculum, expectations, evaluation tool, and effective clinical teaching strategies through online or instructor led programming in order to develop their expertise as clinical educators (e.g, teaching, guiding, mentoring, and evaluating student learning) including participation in professional development opportunities supported by either or both partners (workshops, online seminars, etc.). UMass Lead Faculty and MGH/BWH Clinical Instructors will work in partnership to evaluate overall student achievement. UMass and MGH/BWH will collaborate to develop an evaluation plan for tracking outcomes of the collaborative partnership, to include but not be limited to numbers of students participating, student academic and NCLEX-RN success, # of students who become employed as new graduates, cost analysis (ROI in terms of reduced orientation costs, improved retention, etc.), satisfaction of students and partners (administrators and respective participating faculty and staff), scholarly productivity, etc. UMass Lead Faculty and MGH/BWH Clinical Instructors will, to the extent there is mutual interest and opportunity, engage in collaborative research projects to advance nursing scholarship and enhance the education-service partnership to the benefit of both parties, including but not limited to opportunities for scholarly presentations, publications, and extramural grant funding. DEU Roles: Lead Faculty: Course professor at UMass who coordinates with Clinical Faculty Coordinator regarding student performance, what they have been taught, etc. Clinical Faculty Coordinator: Works with Clinical Instructors, provides support, help with teaching, and coaching. Coordinates with Lead Faculty and acts as a liaison between the hospital and university. Clinical Instructor: Bachelors prepared staff nurse who provides the instruction on the unit and oversees the student working within his/her patient assignment. Student Profile: Students from two different courses would come to the Massachusetts General Hospital (MGH) and Brigham & Women s Hospital (BWH) DEUs for their clinicals. 1. NU 310: Adult Health Nursing (taken during Junior year) Offered both fall & spring semesters Semester = 14 weeks Clinical requirement = 12-16 hours per week 2. NU 455: Nursing Synthesis & Capstone (taken during Senior year) Offered both fall & spring semesters Semester = 14 weeks Clinical requirement = 16-24 hours per week Proposed Models: Model #1 Characteristics: One Clinical Faculty Coordinator oversees six students per semester (spring and fall) per course (NU 310 & NU 455). Each student is paired with a staff nurse Clinical Instructor (1:1 ratio). Each Clinical Instructor maintains a normal patient assignment and student works together with his/her Clinical Instructor in the care of these patients. *The Clinical Faculty Coordinator role could be structured in one of the following ways: 108

Attachment 11.7.d continued Scenario A: UMass faculty will serve the role of Clinical Faculty Coordinator. Scenario B: MGH/BWH RNs serve the role of Clinical Faculty Coordinator. Scenario C: MGH/BWH RNs and UMass Faculty share the role of Clinical Faculty Coordinator. The cost associated with this model centers around the Clinical Faculty Coordinator because the staff nurse Clinical Instructor would maintain his/her patient assignment and backfill for their positions would not be necessary. Model #1 Diagram: Patient to RN ratio of 4:1 Lead Faculty (UMass) *Clinical Faculty Coordinator Clinical Clinical Clinical Clinical Clinical Clinical Instructor Instructor Instructor Instructor Instructor Instructor Student Student Student Student Student Student Model #2 Characteristics: One Clinical Faculty Coordinator oversees six students per semester (spring and fall) per course (NU 310 & NU 455). The Clinical Faculty Coordinator role could be structured according to one of the three scenarios outlined in Model #1. Two students are paired with 1 staff nurse Clinical Instructor (2:1 ratio). Each Clinical Instructor has a patient assignment of two (50% reduction) and the student works together with his/her Clinical Instructor in the care of these patients. The cost associated with this model includes the Clinical Faculty Coordinator and backfill for 1.5 FTEs. This assumes that a normal patient assignment is 1:4, therefore 6 patients would need nurses, equating to 1.5 FTEs. Model #2 Diagram: Patient to RN ratio of 2:1 Lead Faculty (UMass) *Clinical Faculty Coordinator Clinical Instructor Clinical Instructor Clinical Instructor Student Student Student Student Student Student 109

Attachment 11.7.d continued Discussion Points: Maintaining a full patient assignment as suggested in Model #1 is the least costly model yet could lead to higher RN Clinical Instructor workload and increased stress levels. Also, a larger patient assignment could potentially limit the amount of direct teaching provided to students given patient demands. Model #2 is a more costly model because RN Instructors would reduce their patient assignments to allow them more time to focus on teaching. This is a more desired model because it allows more time for student and instructor collaboration, evaluation and learning. MGH would like to further explore the roles that Advanced Clinicians and/or Clinical Scholars might play in the DEU, one of which might be the role of Clinical Faculty Coordinator. 110