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Running head: FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA

Future Vision for Clinical Education & Professional Development 2017 Jacqueline Cardenas Post University The Future of Education EDU505.91 Therese Atjum-Roberts December 9, 2013

FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA Future Vision for Clinical Education & Professional Development 2017 Introduction As technology rapidly changes, it is used to advance medical practice, patient care, and safety. Education and the way it is delivered to healthcare providers is changing too. In the next five years there will be significant changes to the way clinical education is delivered and consumed by nurses and other members of allied health teams. Hospitals in some regions of the United States will be creative in leveraging new technology to provide quality education to nurses who have little time for anything but patient care due to expected nursing shortages.

Changes to education will be part of the strategic plan to carry out the hospital mission and align with its values. At Childrens Hospital in Arizona, hospital values include being, recognized for providing advanced education and training for clinical providers (Phoenix Childrens Hospital website, n.d., para. 2). The mission at Childrens Hospital is to, provide Hope, Healing and the best Health Care for children and their families (Phoenix Childrens Hospital website, n.d., para. 1). To prepare nurses to provide the best healthcare and to be recognized as an education leader, the Clinical Education Department will use technology to transform the current model of one way education transactions to an interactive, whole learning process that can take place anywhere there is an internet connection. Childrens Hospital Clinical Education Department Overview Childrens Hospital was founded in 1983 before technologies that are now widely used for employee education were available. By 2002, the Clinical Education Department had three employees delivering education. In 2005, the hospital joined a consortium of 40 other childrens hospitals which encouraged nationwide collaboration and provided online pediatric specific education to nurses via the consortiums learning management system (LMS). In 2011, the

FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA organization expanded to a new eleven story patient tower and gained 400 employees via merger. By 2012, there were five new satellite locations throughout the city. From 2008 to 2013, use of the LMS increased tremendously, and the department grew to 15 educators. Current State of the Clinical Education Department Currently, the Clinical Education department provides orientation and education for clinical staff that provide patient care, the majority of whom are nurses. Orientation includes

over twenty hours of online learning and nurses receive two hours of additional online education quarterly. All employees receive two hours of annual regulatory online learning. Because computer access at work can be a problem, a pilot program to use tablets for online learning on each unit is in development. Role of Technology in Advancing Training and Patient Care As discussed in the NMC Horizon Report: 2013 Higher Education Edition, tablet computing is an emerging technology that will have a major impact on education (Johnson, Adams Becker, Cummins, Estrada, Freeman, and Ludgate, 2013). As evidence for tablet computing in education builds, leadership may see it as a solution to meet nurses learning needs. Researchers looking at the effects of mobile learning technology on nurse practitioner students with various learning styles found that mobile learning benefitted all students. Moreover, the authors suggested that communicating in a social learning environment with other universities benefitted students learning outcomes (Wyatt et al., 2010). Social learning was recently introduced at Childrens Hospital when the LMS upgraded in 2012 to include a social media component; a community site within the LMS on which members communicate, collaborate, post files and blogs, conduct polls, and earn badges and ratings for posting. It is likely that social learning will soon be used to increase communication

FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA

and collaboration in training for nurses and shared governance in the organization. As the use of tablets and social media are in the pilot stages at Childrens Hospital, there is great opportunity for the organization to take information from the pilots to create innovative and customized learning for employees. These technologies are important for increased access to training and efficiency to support organizational growth. Trends Affecting the Future of Clinical Education: a Review of the Literature It is projected that by the year 2030, there will only be 700 registered nurses (RNs) per 100,000 residents in Western states including Arizonafewer than any other region of the United States (Buerhaus, Auerbach, Staiger, and Muench, 2013). Due to such projections, nurses in Arizona must prepare to handle more patients and train for the types of healthcare they will deliver. There are several trends that clearly have an important role in the future training and education of nurses. The trends that will have the largest impact are educational technology such as e-learning including social media and mobile devices, public policy such as the Affordable Care Act (ACA), economic factors associated with the ACA, an aging population, and population growth in Arizona. Trends in Educational Technology As more nursing programs embrace technology to educate student nurses, nurse educators in hospital settings are also beginning to innovate using newer technologies. According to Lois Neuman, (2006), they tend to be late adopters, but more nurse educators are embracing the ideas of e-learning and mobile technology in training. New technologies include high fidelity simulation, virtual environments, and least expensive and easy to implement interactive online training, social media, and mobile technology.

FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA Many of the technologies mentioned by Neuman in her future vision for nursing education can be implemented with the use of social media. A social media site where nurses learn from teachers, mentors, and more importantly from each other, includes mass communication, online simulations, online modules, and access via mobile technology. These sites can also stockpile a mass of data on learners for customized learning (Neuman, 2006). In addition to the major impact of technology, nursing education will see significant changes in response to public policy and economic factors. Policy, Economic, and Demographic Trends The ACA is a public policy that has far reaching implications for insurance companies, states, healthcare organizations, corporations, and possibly nursing education. The ACA will affect advanced nursing education as nurses and nurse practitioners are expected to take a larger role in providing healthcare (Auerbach, Staiger, Muench, and Buerhaus, 2013). In addition,

because the ACA has major implications for how insurers pay and on state healthcare budgets, it will affect education budgets. Furthermore, economic factors affecting education as noted in Betts, Hartman, and Oxholm, (2009), such as state funding, fundraising, and technology funding will require hospitals to provide more training on smaller budgets. Nurse educators will be tasked with educating new nurses to care for more patients and training them to replace larger numbers of retiring nurses. Because Arizona has a larger number of retirees and population growth over 100%, a nursing shortage could affect Arizona disproportionately (Betts, Hartman, Oxholm, 2009; Buerhaus, Auerbach, Staiger, and Muench, 2013). This could result in more online programs for training on the job, and a greater availability for experienced nurses to work remotely as online faculty to address the shortage of nurse educators and faculty.

FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA Social media and online education via mobile technology are major elements that will change nursing education in the future. Policies such as the ACA and its economic implications as well as the retiring nurse workforce and population increases in the West, will also affect the training and development programs for new and existing nurses in the future. Futuring: Techniques to Prepare for the Future Preparing for the future with specific plans of how decisions will be made given various outcomes, a concept known as futuring, is an important exercise for educational organizations.

Planning is essential for any organization to deal with rapidly changing technological, economic, political, and societal elements that affect both the way they deliver their product to learners and the outcomes the learners experience. At the pace of technological change in todays world, educational organizations must stay relevant and must be proactive with processes in place to meet the educational needs of new students, those who are retraining, and those learning highly skilled professions. Educators can use methods employed by futurists, such as scenario building and scanning to think about and plan for the future in the midst of their dynamic environments. Scenarios Advantages and Challenges Advantages. One way that educational leaders can plan is to build scenarios that help them think about the various ways they might prepare to meet the future. The first item listed in (Mietzner & Reger, 2005) as a strength of scenarios is that there is more than one future. According to Wilson, (1998) the golden rule of building scenarios for futuring is to create no fewer than two, and no more than four in order to provide diversity and challenge what we already know about the future (Wilson, 1998 as cited in Mietzner and Reger, 2005, p. 233). Other strengths include promoting open thinking and communication to change culture, assumptions, and strategies. The authors list other strengths such as flexibility in the many ways

FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA to create/build scenarios and their ability to highlight weaknesses to encourage proactive planning and coordination among experts and stakeholders. Challenges. Conversely, scenarios may prove difficult as discussed in Mietzner and

Reger, because it takes a lot of time to gather the experts and participants needed to build quality scenarios and to gain an exhaustive understanding of the subject matter. Additionally, they indicate that it is sometimes hard to fully recognize the scenarios that contain any sort of ambiguity. Furthermore, there is the danger of building in bias to the scenarios due to a societal groupthink or extremism resulting from ideas presented in popular culture about the future as suggested by (Clardy, 2011). Scanning Advantages and Challenges Another technique used by futurists that has the potential for bias is scanning. Because this technique involves examining various media for trends, it is possible that some data or trends are missed due to bias on behalf of the experts conducting the scanning. In addition, according to Amanatidou, Butter, Carabias, Knnl, Leis, Saritas, and Van Rij, (2012), scanning may not be viewed as reliable by stakeholders and policy makers when compared to modeling techniques. Although these challenges exist with this technique, scanning can be a valuable tool in planning for the future. Because it is conducted via multiple media outlets it can provide a context of the overall society. This allows experts to identify less prominent events that may be creating a trend which is an early warning signal that can be used to plan accordingly. Both scenarios and scanning are techniques used by futurists that are easily adopted by educational planners and policy makers. The Department of Clinical Education will benefit from using these techniques together. By scanning data from the environment they can build

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scenarios that are rich and contextual to provide creative and innovative decisions about shaping the future of education for nurses at Childrens Hospital. A 2017 Vision for Clinical Education at Childrens Hospital Looking into the future of nursing education at Childrens Hospital one expects see a technology rich environment that is blended with the live expertise of nurse educators as learning guides. There is a simulation lab where physicians, nurses, other allied health professionals and students run real life scenarios on hi-fidelity mannequins that are attached to computers and monitors and have real vital signs, symptoms of distress, and body systems failure. In addition to this lab, nurses are connected to technology and learning via hand-held devices such as their own smart phones or tablets provided by the organization for mobile learning due to lack of physical learning space for classes. In conjunction with e-learning in the form of online modules including video demonstrations and scenarios, nurses will collaborate on best practices and sharing evidence within and across specialties via social media. Hand-held mobile technology and social media are two forms of educational technology that will be most prevalent in nursing education and that will provide the most flexibility in learning for nurses at Childrens Hospital. Rationale for change Embracing social media and mobile technology are vital to improving clinical education at Childrens and engaging students for optimum learning. Currently, nurses receive almost all learning in live lecture format classes or via online modules that are essentially PowerPoint presentations. There is little opportunity for interaction. In addition, the organization already has extremely limited space in which to hold classes and computers for nurses to complete online training at work. Adding mobile technology will address both of these needs, especially if nurses can use their own smartphones, which will reduce budgetary needs for technology.

FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA According to Lois Neuman in her (2006) article on the future of nursing education, in order to address the predicted nursing shortage of the future, nurses will need access to technology for teaching and learning purposes so that experts and learners have the opportunity for interaction and sharing at all times. In addition, she discusses the importance of building relationships through these interactions to increase human contact versus humans solely interacting with technology. This is especially important in a hospital setting where collaboration is vital to patient safety and service. Opportunities and Challenges Opportunities. By moving toward a technology rich future and including social media and mobile technology as standard tools for nursing education, Childrens can benefit from the following opportunities: 1) social media is a technology that can be used for reflective learning, 2) according to Schmitt, Sims-Giddens, & Booth, (2012) in their article on social media in

nursing education, social media contributes to increased learning and communication and can be used as a tool to educate nurses about writing, policy, and ethics. These pieces are vital to a shared governance structure that is required for becoming recognized for patient safety and quality in nursing; 3) as mentioned previously, mobile technology avoids the need for physical classroom space and expensive desktop or laptop computers; 4) using technology that increases communication and collaboration lends itself to more interesting and engaging delivery of content, discussions, and creativity; and 5) there is the opportunity for cost savings on expensive technology and time spent in classrooms. Challenges. Implementing these changes in the future is not without potential barriers. The following are challenges to the use of social media and mobile technology at Childrens Hospital. First and foremost, obtaining buy-in from stakeholders has been a barrier to advancing

FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA technology. As mentioned by Neuman, (2006), and Buerhaus, Auerbach, Staiger, & Muench,

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(2013), older nurses (who make up much of the leadership), and nurse educators tend to be slow to adopt new technology. Other stakeholders are concerned about social media and privacy. Healthcare providers are bound by law not to disclose protected health information (PHI) to anyone who does not have direct need to know, and the use of social media concerns leaders in that regard. This leads to the third challenge of monitoring. Who will be responsible for monitoring the social media site or sites to ensure that patient information is not compromised and the accurate information is being shared? There is potential for harm to the hospital and individuals if social media is not monitored by someone accepting responsibility for the task. The fourth challenge is the technology budget. This is both a challenge and an opportunity. Technology expenses could be reduced if nurses use their own smart phones or if the hospital purchases tablets versus desktop or laptop computers. However, if the hospital purchases addition mobile technology, this increases costs over current expenses. Finally, support from the Information Technology (IT) department is a challenge. IT has all of the above concerns (budget, monitoring, privacy) as well as system integrity and the threat to hospital computer systems from external access to internal social media. All of these opportunities and challenges must be weighed when considering implementation of these new technologies. If Childrens Hospital maintains the status quo in education it will remain behind the curve of what other childrens hospitals in the nation are doing to improve nursing education. In addition, it will find it increasingly difficult to deliver quality education to nurses who cannot leave the bedside due to inadequate staffing resulting from a nursing shortage. The hospital must grow with the gains in new technology and find innovative ways to educate nurses in less time and space with fewer dollars.

FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA Preparing for Change The hospital and Clinical Education department can prepare for the future by following

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through with five specific strategic moves toward this goal: 1) implement the social media piece of the LMS offered at no additional cost by the vendor to all Childrens Hospitals in the nation; 2) pilot the use of mobile technology with tablet computers procured by the Chief Information Officer on loan from Microsoft; 3) pilot the social media piece of the LMS with unit-based nursing councils on two hospital units with active councils; 4) create learning modules publishable as podcasts viewable on smartphones and encourage reflective learning via responses and interactions with educators post learning; 5) develop clear policies on the use of social media and mobile technology and rollout to all nurses prior to implementation to avoid misuse and privacy violations. Some of these preparations are already underway at Childrens Hospital, but a futurist view and commitment to progress is needed to bring the Clinical Education department into the future with technology. Conclusion As Childrens Hospital looks to the future there are vital decisions to consider regarding new technology. As the hospital moves into a future of an imminent nursing shortage due to aging patient and nursing populations, it must advance multiple methods of delivering the most interactive and engaging education. It will need to provide education to nurses with limited time for absorbing information, and it will need to provide maximum access to nurses for flexibility in schedules. Other childrens hospitals in nation are already using this technology, and if Childrens wants to be a world class hospital, a teaching hospital, it will need to utilize the best and newest technologies for nurses to advance their knowledge in patient care.

FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA References

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Amanatidou, E., Butter, M., Carabias, V., Knnl, T., Leis, M., Saritas, O., Van Rij, V. (2012). On concepts and methods in horizon scanning: Lessons from initiating policy dialogues on merging issues. Science and Public Policy, 39, 208-221. http://dx.doi.org/10.l093/scipol/scs017 Auerbach, D.I., Staiger, D.O., Muench, U, & Buerhaus, P.I. (April, 2013). The nursing workforce in an era of health care reform. New England Journal of Medicine; 368, 1470147. DOI: 10.1056/NEJMp1301694 Betts, K., Hartman, K., & Oxholm, C. (2009). Re-examining & repositioning higher education: Twenty economic and demographic factors driving online and blended program enrollments. Journal of Asynchronous Learning Networks, 13(4), 3-23. Buerhaus, P. I., Auerbach, D. I., Staiger, D. O., & Muench, U. (2013). Projections of the LongTerm Growth of the Registered Nurse Workforce: A Regional Analysis. Nursing Economic$, 31(1), 13-17. Clardy, A. (2011, Summer). Six worlds of tomorrow: representing the future to popular culture. World Future Review, 37-48. Retrieved from http://www.wfs.org/wfr Johnson, L., Adams Becker, S., Cummins, M., Estrada, V., Freeman, A., and Ludgate, H. (2013). NMC Horizon Report: 2013 Higher Education Edition. Austin, Texas: The New Media Consortium. Mietzner, D., & Reger, G. (2005). Advantages and disadvantages of scenario approaches for strategic foresight. Int. J. Technology Intelligence and Planning, 1(2), 220-239. Retrieved from http://www.inderscience.com/jhome.php?jcode=ijtip

FUTURE VISION FOR CLINICAL EDUCATION & PROFESSIONA Neuman, L. (2006). Creating new futures in nursing education: envisioning the evolution of eNursing education. Nursing Education Perspectives, 27(1), 12-15. Phoenix Childrens Hospital website. (n.d.). http://www.phoenixchildrens.org/about/missionvalues Schmitt, T. L., Sims-Giddens, S. S., & Booth, R. G. (2012). Social media use in nursing education. Online Journal of Issues in Nursing, 17(3), 1. http://dx.doi.org/doi:10.3912/OJIN.Vol17No03Man02 Wilson, I. (1998) Mental maps of the future, in Ratcliff, J. (Ed.) (1999): Scenario Building: A Suitable Method For Strategic Property Planning, The Cutting Edge 1999, The Property Research Conference of the RICS, St. Johns College, Cambridge, 5th7th, September, 1999

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Wyatt, T. H., Krauskopf, P. B., Gaylord, N. M., Ward, A., Huffstutler-Hawkins, S., & Goodwin, L. (2010). Cooperative m-learning with nurse practitioner students. Nursing Education Perspectives, 31(2), 109-113. Abstract retrieved from http://nlnjournals.org/doi/abs/10.1043/1536-5026-31.2.109 (doi: http://dx.doi.org/10.1043/1536-5026-31.2.109)