BILL DEANS Senior Lecturer Te Tari Matauranga Hauora Faculty of Nursing and Health Studies

1. BILL DEANS Senior Lecturer TeTariMatauranga Hauora Faculty of Nursing and Health Studies Manukau Institute of Technology Auckland, New Zealand Sabaah Al-khayrصباح الخير

2. U T S D E N D T - E L C L I N I C A L F A C N I O L I I T T A

3. The Problem • Community-based health and social services are changing at a remarkable rate and nurses will be key players in the delivery of many of these services. • Moving the focus from hospital to primary health care, has resulted in reduced numbers of placements.

4. The Concern • Increased co$tin supporting / supervising students across a wider range of service providers and larger geographical area. • Increased pressure on physical accommodation and/or staff availability making it difficult to take students for long periods or block placements. • Placements where the level of clinical opportunity fluctuates during the working day or week.

5. The Solution • Identify, or create, placement models that are flexible rather than the ‘one size fits all’approach that we have been using. • Design courses and clinical outcomes aimed at developing a different range of skills required for working in this new environment.

6. The Challenge • The emerging multi-disciplinary and inter-professional nature of health and social care delivery demands that: • education and service providers think more creatively about the type of placement experience our future workforce will require in order working in this new environment. • develop new supervision arrangements where there is limited access to an RN or noRN onsite.

7. Traditional Placement Models The most common of the traditional clinical supervision models are: • Preceptor-guided Practice Education Model • Team Preceptor Model Traditional placements are normally 8-12 and typically looks like this. 1 2 3 4 5 6 7 8 9 10 No. Weeks Student Placement Break Placement • The number of students placed with a service provider would be based on the physical capacity of the facility and/or the number of RNs able to act as Preceptors.

8. Alternative Clinical Placement Models In the Community Nursing with a Community Focus paper we have introduced variations on three (3) additional models: Project-focused Clinical Placement Model Facilitated Clinical Supervision Model Student-led Clinical Facilitation Model

9. 1. Project-focused Clinical Placement Model Project focused placements refer to placements where the student/s undertake one or more prescribed projects, in addition to working along side the Registered Nurse. Ideally, projects would be identified by the service provider and the student supervised by the on-site RN as part of the student/s completion of nursing competencies. In 2012 dedicated project supervision days were timetabled to provide students with additional support and to monitor progress. The ratio of project vs.clinical timeis negotiated on a case-by-case basis, with the learning needs of the student paramount.

10. 1. Project-focused Clinical Placement Model How this might look? EXAMPLES: Based on 2 students No. Weeks 1 2 3 4 5 6 7 8 9 10 Student 1 Clinical Break Project 1 Student 2 Project Break Clinical Student 1 Clinical Project Break 2 Student 2 Project Clinical Break Student 1 Student 1 P C P C P B C B P C P P B 3 Student 2 Student 2 P P C P C B B C P P C P B 4

11. 2. Facilitated Clinical Supervision Model Clinical facilitation by non-nurses has been about for some time, and mainly used as an adjunct to the main placement. However, changes in the configuration of interdisciplinary teams and an increasing range of health care being delivered by social care organisations, has impacted on the availability of Registered Nurses. This requires alternative clinical supervision arrangements, e.g. where the clinical lecturer has the role as mentor/preceptor. This model is used in situations where the supervisor is from another discipline, e.g. social work. Although the supervisor is able to facilitate the students learning experience he/she is not able to assess and sign off their skills against NZNC competencies.

12. 3. Student-led Clinical Facilitation Model SERVICE PROVIDER Student-led Clinical Facilitation Model (Bill Deans, 2011)

13. A combination of models 1 & 3

16. Archiving

17. References/Bibliography Clendon, J. (2004). Demonstrating outcomes in a nurse-led clinic: How primary health care nurses make a difference to children and their families. Journal for the Australian Nursing Profession, 18 (1-2), 164-176. Deans, B. (2011) Student-led Clinical Facilitation Model. A pilot project. MIT Report. Dickson, C., Walker, J., & Bourgeois, S. (2006). Facilitating undergraduate nurses clinical practicum: The lived experience of clinical facilitators. Nurse Education Today, 26 (5), 416-422. Fortune, T., Farnworth, L., & McKinstry, C. (2006). Project-focused fieldwork: Core business or fieldwork fillers? Australian Occupational Therapy Journal, 53 (3), 233-236. Pagels, A. A., Wång, M., & Wenström, Y. (2008). The impact of a nurse-led clinic on self-care ability, disease-specific knowledge, and home dialysis modality. Nephrology Nursing Journal, 35 (3), 242-248. Smith, M., & Flint, E. (2006). Project-focused placements: Enhancing students understanding of citizens' perspectives. Nurse Education in Practice, 6 (2), 117-121. Whitehorse Division of General Practice. (2007). Nurse Led Clinics - Chronic Disease Management in General Practice. Victoria: Whitehorse Division of General Practice.

18. شكرا Thank You

19. BILL DEANS Senior Lecturer Te Tari Matauranga Hauora Faculty of Nursing and Health Studies Manukau Institute of Technology Auckland, New Zealand http://www.billdeans.net billdeans.nz@gmail.com