Paula Gubrud Ed.D, RN FAAN
Maine Partners in Education and
Practice
May 22, 2012
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Transforming Nursing
Practice and Education
will require:
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Acknowledging new
realities
New Curriculum
New Pedagogy for
New Learners
New Models for
Clinical Education
New Organizations
New Leadership
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Increasing complexity
of population needs
Constant rapid change
in our organizations
Burgeoning use of
knowledge and
technology required
to practice
Paradoxical image at
the edge of health care
reform
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Essentially static
nursing education
system
 Practice/Education Gap
 Immobilized by disputes
about “levels of
education”
 Uninformed by
advances in science of
learning
 Clinical education
approaches unchanged
since the 1940’s
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Oregon Nurse Leadership
Council/Collaborative
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A conflict in practice created opportunity for
collaboration
Five Member Organization
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Oregon Council for Associate Degree Nursing
Oregon Council of Deans
Oregon Nurses Association
Northwest Organization of Nurse Executives
Oregon State Board of Nursing

2 Goals related to nursing education
 Double
Enrollment
 Transform
Nursing Education to align with
today’s practice environment

New Curriculum to Prepare a “New Nurse”
 with competencies beyond those in our
traditional nursing programs
 with deeper understanding of prevalent
health care conditions and situations
 prepared to function in times of chronic
nurse shortage
 prepared to lead and influence policy
A Partnership of Oregon nursing programs
designed to:
Prepare the “new” nurse with competencies
needed for changing health care
demographics
Increase capacity in nursing programs
Increasing number of baccalaureate graduates
by creating shared 4 year curriculum
Prepare leaders needed to influence new health
care systems
•
Competency-based, directed toward
knowledge & abilities needed to provide:
• Patient/relationship centered care
• For an aging & increasingly diverse
population
• In highly complex environments
• That increasingly require interdisciplinary
teamwork, leadership and use of quality
improvement, informatics and technology
•
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Competencies describe a “new” nurse
Preparation of this new nurse will probably
take 4 years
Requires a new system of nursing education
using all available resources from existing
educational programs
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Curriculum – outcomes,
selection, organization &
sequence of content &
learning experiences
Pedagogy – assumptions
about the learning and
approaches that
recognize the continued
advances in the science of
learning and integrates
the characteristics of
diverse learners
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Baccalaureate curriculum with opportunity for
community college students to complete AAS
and sit for NCLEX on the way to BSN
Built on redefined fundamentals
Competency-based
Integrated
Spiral
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Evidence-Based Practice
Relationship Centered Care
Clinical Judgment
Leadership
In the context of Health Promotion
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Ethical practice
Intentional (self-directed), reflective
learner
Engage in teamwork and provide
leadership
With strong communication skills and
capable of systems thinking
Skillful clinical judgment and evidencebased practice
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Courses organized around foci of care:
 Health Promotion
 Chronic Illness Management
 Acute Care
 End-of-Life Care
And “cross-cutting competencies”
 Leadership & Outcomes Management
 Population Based Care
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providing for
multiple encounters
with most important
concepts,
dimensions of
competencies, &
health & illness
context in varying
populations &
settings
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Draws on tremendous advances in the science
of learning from a variety of disciplines
(cognitive science, psychology, higher
education)
Emphasizes deep understanding of the
discipline’s most central concepts
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Guides design of
learning activities
which promote:
 Active
engagement of
the learner
 Clear
performance
expectations,
practice and
frequent, specific
and constructive
feedback
 Guides
design of learning
activities which promote:
 Strong, learning-focused
social interactions
 Development of habits in
metacognition/reflection,
self assessment, and selfdirected learning
.
CORE/Mega Cases that integrate across
competencies, relate to highly prevalent
health problems, across age span and diverse
populations
 Dilemma cases underscoring ethical issues
 Unfolding cases, demonstrated clinical
situations as they unfold
 Student narratives of their own experience
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Purposeful Design of Clinical Education
Considering development of
 Practical knowledge
 Skilled Know-how
 Habits of Thought
 Understanding of self as caring
clinician
Focused Direct
Client Care
Integrative
Experience
Intervention Skill
Based Experiences
CLINICAL
LEARNING
Concept Based
Case Based
Simulation
Focused Direct
Client Care
Intervention
Skill
Based
Experiences
Integrative
Experience
CLINICAL
LEARNING
Concept Based
Case Based
Simulation
Concept Based
Case Based
Intervention-Skill
Based
DirectFocused
Care
Case Based
Focused Direct
Patient Care
Concept Based
Intervention
Skill Based
Integrative Experience
Intervention
Skill Based
II
ConceptBased
Case-Based
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Coordinating Council
Faculty committees
Stakeholder involvement
Agreement for a new kind of leadership
Consortium-wide consensus building
approach
Faculty development & involvement
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Developing trusting
relationships
Keeping the vision alive
Setting the common
good above individual
interests
Celebration and humor
(Buttons)
Inclusiveness
Facilitation to smooth
rough edges & move
forward
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Front story – the statement of vision, tag line
“Working together for healthy communities”
Back story – commitment to collaborative
process and preparing a new kind of nurse for
future health care
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Embrace ambiguity
and tolerate false
starts – to enjoy the
“unfolding” process
A “good enough
vision”
 Paradox and Tension
 Multiple Actions
 Risk Taking
 Boundary Spanning
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Guiding principles for working
together
 Develop and Document
(sometimes a facilitator will be
needed)
 Front story – formal document
 Back story – living to the
agreement
Commitment to excellence
 Inclusiveness
 Beneficence, collegiality
 Courage/perseverance
 Healthy conflict,
and most importantly- support, embrace
and celebrate your commitment
to the health of Maine’s Citizens

If you want to go quickly, go alone.
If you want to go far, go together.
Visit us at
www.ocne.org
Gubrud, P., & Schoessler, M. (2010). OCNE clinical education model.
In N. Ard & TM Valiga (Eds) Clinical nursing education: Current
reflections (pp. 39-58). New York: National League for Nursing
Gubrud-Howe, P., & Schoessler, M. (2008). From random access
opportunity to a clinical education curriculum. Journal of Nursing
Education, 47(1), 3-4.
Gubrud-Howe P. Shaver KS. Tanner CA. Bennett-Stillmaker J.
Davidson SB. Flaherty-Robb M. Goudreau K. Hardham L. Hayden
C. Hendy S. Omel S. Potempa K. Shores L. Theis S. Wheeler P.
(2003) A challenge to meet the future: nursing education in
Oregon, 2010. Journal of Nursing Education. 42(4):163-7
Heifetz, R., Grashow, A., & Linsky, M. (2009). The Practice of
Adaptive Leadership. Boston MA: Harvard Business Press
Lindberg, C., Nash, S. & Lindberg, C. (2008). On the Edge: Nursing in
the Age of Complexity. Bordentown, New Jersey: Plexus Press
Tanner, C. A. (2010). From mother duck to
mother lode: Clinical education for deep
learning. Journal of Nursing Education, 49,(1),
3-4.
Tanner, C.A., Gubrud-Howe, P., & Shores, L.
(2008). The Oregon Consortium for Nursing
Education: A Response to the Nursing
Shortage. Policy, Politics and Nursing Practice,
9(3):203-09.
Zimmerman, B., Lindberg, C., & Plsek. (2008).
Edgeware: Lessons from complexity science for
health care leaders.