Published February 5, 2020
Recent School of Nursing graduate Noah Bourne remembers being “shocked” when he first visited a client as part of the Dedicated Education Unit (DEU), a program designed for nursing students to gain one-on-one, hands-on learning experiences in a clinical, real-life setting.
The woman, who had congestive heart failure, had been kicked out of her previous apartment. Her new place in a lower-income section of Buffalo had little furniture. She didn’t know how she was going to make her doctors’ appointments. She had issues preparing her own meals.
“I was overwhelmed by all the things that needed to be addressed, and all the things I didn’t know we could help with,” says Bourne, whose DEU was with the Visiting Nursing Association of Western New York.
Bourne didn’t face the home health care situation alone. He had a preceptor with him, a professional nurse acting as his hands-on educator and role model, teaching him firsthand. With her help, the two looked at the woman’s situation more “analytically,” Bourne says, “like any other health problem.”
Soon, with the help of his preceptor, those health and social needs started to be met. The VNA brought in a social worker. They contacted Meals on Wheels. Bourne helped find reliable transportation, all while continuing to treat the woman’s sickness. About a month ago, about nine months after Bourne’s initial visit, the VNA discharged her, signaling a stage of self-sufficiency that seemed remote during those first visits.
Since then, the VNA has hired Bourne as a registered home health nurse. He still works with the same preceptor who assisted and advised him when he first met the patient who had so many initial problems.
Bourne is among the “shining stars” of the School of Nursing’s DEU program, a student who excelled in the DEU model and then was hired by the organization providing hands-on experience. It’s a program School of Nursing (SON) administrators are especially proud of. The students receive hands-on experience, mentorship and individualized learning. The clinical settings benefit because the DEU model strengthens academic-clinical partnerships and provides DEU nurses with professional development as educators. And the DEU helps the university’s role as a research institution.
“The DEU experience gave me a head start going into this field,” Bourne says. “Home health care is so different from treating people in a hospital because of the amount of time we spend with patients. And the level of teaching is more involved. It was a very smooth transition from UB to this job. I picked up where my clinical experience left off.”
Based on a program developed at Flinders University of Australia, the UB DEU program debuted in 2008, and has grown since. Currently, the SON has more than 20 DEUs, most recently expanding partnerships with home care and primary care settings.
“It’s really a win-win situation,” says Catherine Mann, assistant dean of undergraduate studies and associate clinical professor of nursing. “Students love it. They get one-on-one attention. They really get to develop their critical thinking and clinical judgment. They feel more confident. And really, their patient contact time has increased because they are not waiting for an instructor to do something with them.”
Mann says the benefits go both ways. When a promising SON student spends time in real-life DEU settings, the student adds value for the clinical preceptor guiding the student.
“While we are there, we give back to the settings and develop evidence-based practice projects,” she says, citing a study on pressure injury prevention at Kenmore Mercy Hospital.
“The clinical instructors/DEU preceptors tell us it helps them stay current on best practices. It makes them think through all their actions. So it really keeps them fresh.
“And it really allows that professional nurse to be a strong role model. It promotes professionalism in practice across the board.”
Robin Brown, manager of clinical outreach and practice transitions for the VNA, says programs like the DEU address the nation’s nursing shortage.
“Driving this whole initiative in part is the Baby Boomer generation. They are leaving the nursing workforce at a great rate, resulting in a huge gap in the profession,” Brown says. “
“The largest pool of RNs to hire is quickly becoming the new graduate nurse. However, there are many challenges new graduates face in bridging the transition from new graduate to professional RN.”
Nurses need to gather all their essential skills and knowledge through classes, Brown says. “Then they need an avenue to apply that skill and learn to become competent and comfortable performing that.”
Available community sites are scarce, according to Brown.
“With the DEU, we can actually have the VNA staff member act as an instructor within the patient’s home. The VNA clinician has been educated to instruct, guide and train to provide that clinical experience for the students. It’s more of a peer-to-peer model where I feel the student learns better.”
The VNA placed 16 SON students in DEU settings. All in all, the School of Nursing places approximately 80 students each semester in 20 DEU clinical settings, including hospitals, primary care and home care settings, including hospice.
Other universities use DEU models, says Mann, but UB is unique because the DEUs expand beyond acute care settings, such as hospitals, into more community-based settings.
“The fact we are preparing graduates to work outside of acute care, that’s the future of nursing,” Mann says.
The hospice placement is particularly relevant, Mann explains. Samantha Mullen, another recent accelerated bachelor’s in nursing grad who served her DEU at Hospice Buffalo, is now a research associate at UB. “Being a research institution, I think it also helps show how we shape our students,” Mann says. “Not only to prepare them for their bedside role, but the importance of being involved in research to improve practice.”
Mullen is another example of a student hired by the organization that hosted her DEU experience.
After graduating last May, Mullen is now a registered nurse in Hospice Buffalo’s inpatient facility. The DEU helped her because she also has an informatics degree, so the opportunity to observe firsthand made a big difference.
“For someone unfamiliar with nursing who wants a second career, the DEU programs are valuable because they give you an idea of what you do and your responsibilities as a nurse,” says Mullen.
Her DEU experience at Hospice Buffalo was especially valuable because she followed a nurse in a home health care setting, but also spent time with other Hospice staff, including social workers, the chaplain and admissions.
“The whole point of doing that is to give us a well-rounded idea of what the organization can do, and also give you a better perspective as a nurse and what our responsibility is,” she says.
Mullen now uses informatics in her research to support nurses in identifying patients with serious illness who might benefit from a transition to palliative care.
Like Bourne, joining the staff after serving in a DEU seemed like a natural transition.
“Students walk away with increased confidence in their skill and clinical judgment abilities,” says Mann. “They are more prepared to do the real work because they see what a real day of the nurse is, in whatever setting that may be.”