Time Specific Content Av Teacher Evaluati

objectives aids student on

activity
DIFFERENT MODELS OF COLLABORATION BETWEEN NURSING EDUCATION AND
SERVICE
Introduction

The nursing profession is faced with increasingly complex health care issues driven by technological and medical advancements,
an ageing population, increased numbers of people living with chronic disease, and spiraling costs. Collaborative partnerships
between educational institutions and service agencies have been viewed as one way to provide research which ensures an
evolving health-care system with comprehensive and coordinated services that are evidence-based, cost- effective and improve
health-care outcomes
Collaboration is a substantive idea repeatedly discussed in health care circles. Though the benefits are well validated,
collaboration is seldom practiced. The lack of a shared definition is one barrier. Additionally, the complexity of collaboration and
the skills required to facilitate the process are formidable. Much of the literature on collaboration describes what it should look
like as an outcome, but little is written describing how to approach the developmental process of collaboration. Many
researchers have validated the benefits of collaboration to include improved patient outcomes, reduced length of stay, cost
savings, increased nursing job satisfaction and retention, and improved teamwork (Abramson & Mizrahi 1996). 1The focus on
benefits of collaboration could lead one to think that collaboration is a favorite approach to providing patient care, leading
organizations, educating future health professionals, and conducting health care research. Contextual elements that influence
the formation of collaboration include time, status, organizational values, collaborating participants, and type of problem.

Meaning

Collaboration is an intricate concept with multiple attributes. Attributes identified by several nurse authors include sharing of
planning, making decisions, solving problems, setting goals, assuming responsibility, working together cooperatively,
communicating, and coordinating openly (Baggs & Schmitt, 1988). Related concepts, such as cooperation, joint practice, and
collegiality, are often used as substitutes.
The roots of the word collaboration, namely co-, and laborare, combine in Latin to mean “work together.” That means the
interaction among two or more individuals, which can encompass a variety of actions such as communication, information
sharing, coordination, cooperation, problem solving, and negotiation.
Teamwork and collaboration are often used synonymously. The description of collaboration as a dynamic process resulting from
developmental group stages as an outcome, producing a synthesis of different perspectives. The reality is that collaboration
evolves in partnerships and in teams. Baggs and Schmitt (1988) reframe the relationship between collaboration and teamwork
by defining collaboration as the most important aspect of team care but certainly not the only dimension.
A description of the concept of collaboration is derived by integrating Follett's outcome- oriented perspective (1940) and Gray's
process-oriented perspective (1989). Both authors strengthen the definition of collaboration by considering the type of
problem, level of interdependence, and type of outcomes to seek. According to them: Collaboration is both a process and an
outcome in which shared interest or conflict that cannot be addressed by any single individual is addressed by key stakeholders.
The collaborative process involves a synthesis of different perspectives to better
understand complex problems. A collaborative outcome is the development of integrative solutions that go beyond an
individual vision to a productive resolution that could not be accomplished by any single person or organization.
It is critical in collaboration that all existing and potential members of the collaborating group share the common vision and
purpose. Several catalysts may initiate collaboration – a problem, a shared vision, a desired outcome, to name a few. Regardless
of what the catalyst may be, it is essential to move from problem driven to vision driven, from muddled roles and
responsibilities to defined relationships, and from activity driven to outcomes. Collaboration is an inclusionary process with
continuous engagement that reinforces commitment, recognizing the building of relationships as fundamental to the success of
collaborations. An effective collaboration is characterized by building and sustaining “win-win-win” relationships 8.

Definition

Henneman et al. have suggested that collaboration “is a process by which members of various disciplines (or agencies) share
their expertise. Accomplishing this requires these individuals understand and appreciate what it is that they contribute to the
whole”.
"Collaboration is the most formal inter organizationl relationship involving shared authority and responsibility for planning,
implementation, and evaluation of a joint effort (Hord, 1986).
Mattessich, Murray and Monsey (2001) define collaboration as '... a mutually beneficial and well-defined relationship entered
into by two or more organizations to achieve common goals' 8.

Types of Collaboration

Terms, such as interdisciplinary, multidisciplinary, transdisciplinary, and interprofessional, which further delineate and describe
teams, teamwork, and collaboration, have evolved over time.
1. Interdisciplinary is the term used to indicate the combining of two or more disciplines, professions,
departments, or the like, usually in regard to practice, research, education, and/or theory.

2. Multidisciplinary refers to independent work and decision making, such as when disciplines work side-by-side
on a problem. The interdisciplinary process, according to Garner (1995) and Hoeman (1996), expands the
multidisciplinary team process through collaborative communication rather than shared communication.
 3. Transdisciplinary efforts involve multiple disciplines sharing together their knowledge and skills across
traditional disciplinary boundaries in accomplishing tasks or goals (Hoeman, 1996). Transdisciplinary efforts
reflect a process by which individuals work together to develop a shared conceptual framework that integrates
and extends discipline specific theories, concepts, and methods to address a common problem.

4. Interprofessional collaboration has been described as involving “interactions of two or more disciplines
involving professionals who work together, with intention, mutual respect, and commitments for the sake of a
more adequate response to a human problem” (Harbaugh, 1994). Interprofessional collaboration goes beyond
transdisciplinary to include not just traditional discipline boundaries but also professional identities and
traditional roles. Interdisciplinary collaboration team members transcend seperate disciplinary perspectives and
attempt to weave together resources, such as tools, methods, and procedures to address common problems or
concerns

Need for Collaboration between Education and Service

Considerable progress has been made in nursing and midwifery over the past several decades, especially in the area of
education. Countries have either developed new, or strengthened and re-oriented the existing nursing educational programmes
in order to ensure that the graduates have the essential competence to make effective contributions in improving people’s
health and quality of life. As a result nursing education has made rapid qualitative advances. However, the expected
comparable improvements in the quality of nursing service have not taken place as rapidly.
The gap between nursing practice and education has its historical roots in the separation of nursing schools from the control of
hospitals to which they were attached. At the time when schools of nursing were operated by hospitals, it was students who
largely staffed the wards and learned the practice of nursing under the guidance of the nursing staff. However, under the then
prevailing circumstances, service needs often took precedence over student’s learning needs. The creation of separate
institutions for nursing education with independent administrative structures, budget and staff was therefore considered
necessary in order to provide an effective educational environment towards enhancing students learning experiences and laying
the foundation for further educational development.
While separation was beneficial in advancing education, it has also had adverse effects. Under the divided system, the nurse
educators are no longer the practicing nurses in the wards. As a result, they are no longer directly in the delivery of nursing
services nor are they responsible for quality of care provided in the clinical settings used for student’s learning. The practicing
nurses have little opportunity to share their practical knowledge with students and no longer share the responsibility for
ensuring relevance of the training that the students receive. As the gap between education and practice has widened, there are
now significant differences between what is taught in the classroom and what is practiced in the service settings.
Most nursing leaders also assert that something has been lost with the move from hospital- based schools of nursing to the
collegiate setting. The familiar observation that graduate nurses can "theorize but not catheterize" reflects the concern that
graduate nurses often lack practical skills despite their significant knowledge of nursing process and theory. Nursing educators
know that development of technical expertise in the modern hospital is possible only through on-the-job exposure to the latest
equipment and medical interventions. Schools of nursing have tried to bridge this gap using state-of-the-art simulation
laboratories, supervised clinical experiences in the hospital, and summer internships. However, the competing demands of the
classroom and the job site frequently result in a less than optimal allocation of time to learn technical skills and frustration on
the part of the nursing student who tries to be both technically and academically expert.
The hospital industry has also recognized the need to support a graduate nurse with additional training. As a result, graduate
nurses are required to attend an orientation to the hospital and have additional supervised practice before they can function
independently in the hospital. The cost of orienting a new nursing graduate is significant, particularly with high levels of nursing
turnover (Reiter, Young, & Adamson, 2007

The challenge to nursing education is how to combine theoretical knowledge with sufficient technical training to assure a
competent performance by a professional nurse in the hospital setting. Clearly, a partnership between nursing educators and
hospital nursing personnel is essential to meet this challenge

Models of Collaboration between Education and Service

The nursing literature presents several collaborative models that have emerged between educational institutions and clinical
agencies as a means to integrate education, practice and research initiatives (Boswell & Cannon, 2005; McKenna & Roberts,
1998; Acorn, 1990), as well as, providing a vehicle by which the theory -clinical practice gap is bridged and best practice
outcomes are achieved (Gerrish & Clayton, 2004; Gaskill et al., 2003).

1. Clinical school of nursing model (1995)

The concept of a Clinical School of Nursing is one that encompasses the highest level of academic and clinical nursing research
and education. This was the concept of visionary nurses from both La Trobe and The Alfred Clinical School of Nursing University.
This occurred within a context of a long history of collaboration and cooperation between these two institutions going back
many years and culminating in the establishment of the Clinical School in February, 1995.
The development of the Clinical School offers benefits to both hospital and university. It brings academic staff to the hospital,
with opportunities for exchange of ideas with clinical nurses with increased opportunities for clinical nursing research. Many
educational openings for expert clinical nurses to become involved with the university's academic program were evolved. The
move to the concept of the clinical school is founded on recognition of the fundamental importance of the close and continuing
link between the theory and practice of nursing at all levels
 2. Dedicated Education Unit Clinical Teaching Model (1999)

In this model a partnership of nurse executives, staff nurses and faculty transformed patient care units into environments of
support for nursing students and staff nurses while continuing the critical work of providing quality care to acutely ill adults.
Various methods were used to obtain formative data during the implementation of this model in which staff nurses assumed the
role of nursing instructors. Results showed high student and nurse satisfaction and a marked increase in clinical capacity that
allowed for increased enrollment.
Key Features of the DEU are
 Uses existing resources
 Supports the professional development of nurses
 Potential recruiting and retention tool
 Allows for the clinical education of increased numbers of students
 Exclusive use of the clinical unit by School of Nursing
 Use of staff nurses who want to teach as clinical instructors
 Preparation of clinical instructors for their teaching role through collaborative staff and faculty
development activities
 Faculty role to work directly with staff as coach, collaborator, teaching/learning resource to develop
clinical reasoning skills, to identify clinical expectations of students, and evaluate student achievement
 Commitment by all to collaborate to build an optimal learning environment.

3. Research Joint Appointments (Clinical Chair) (2000)

A Joint Appointment has been defined by Lantz et al. (1994), as “a formalised agreement between two institutions where an
individual holds a position in each institution and carries out specific and defined responsibilities”.
The goal of this approach is to use the implementation of research findings as a basis for improving critical thinking and clinical
decision-making of nurses. In this arrangement the researcher is a faculty member at the educational institution with credibility
in conducting research and with an interest in developing a research programme in the clinical setting. The Director of Nursing
Research, provides education regarding research and assists with the conduct of research in the practice setting. She/he also
lectures or supervises in the educational institution. A formal agreement exists within the two organisations regarding specific
responsibilities and the percentage of time allocated between each. Salary and benefits are shared between the two
organisations.
Outcomes identified by Donnelly, Warfel and Wolfe (1994) for the educational institution are that it becomes more in touch
with the real world and more readily able to identify research questions (and the subsequent study), that have the potential to
make a difference to quality of consumer care delivery. There is also an increasing collaborative relationship with the service
provider, which is important for long term workforce planning. The position has benefits to nursing/midwifery students due to
more explicit focus on directly linking the education setting to the clinical context. For practice the outcomes are increased staff
involvement in professional activities including writing for publication, presenting at seminars and conferences and preparing
submissions on professional issues. The clinical chair also facilitates improved access and support to external research project
funding6.
1. Practice-Research Model (PRM) (2001)
It is an innovative collaborative partnership agreement between Fremantle Hospital and Health Service and Curtin University of
Technology in Perth, Western Australia. The partnership engages academics in the clinical setting in two formalized collaborative
appointments. This partnership not only enhances communication between educational and health services, but fosters the
development of nursing research and knowledge.
The process of the collaborative partnership agreement involved the development of a Practice- Research Model (PRM) of
collaboration. This model encouraged a close working relationship between registered nurses and academics, and has also
facilitated strong links at the health service with the Nursing Research and Evaluation Unit, medical staff and other allied health
professionals. The key concepts exemplified in the application of the model include practice-driven research development,
collegial partnership, collaborative ownership and best practice. Many specific outcomes have been achieved through
implementation of the model, but overall the partnership between registered nurses and academics in the pursuit of research to
support clinical practice has been the highlight.
The key elements underlying the process of collaboration and development of the PRM are: -
 Collaborative partnership: - The collaborative partnership was formed by nursing health professionals,
from the community health service and the university who recognized the need to bridge the theory-
clinical practice gap and acknowledged the futility of continuing to work in isolation from each other. In
practical terms, this involved a formal contractual arrangement between the organizations that led to
the establishment of a Nurse Research Consultant (NRC) position.
 Core values and aims of the collaborative partnership: - Before the actual framework of the collaborative partnership
was decided, a literature review of the most common models of collaboration in nursing practice was used to promote
discussion between the organizations to clarify and formalize the assumptions underlying the core values, roles and
responsibilities of the partners, as indicated by Spross (1989). During this phase, four key concepts emerged: firstly, that
'practice drives research'; secondly, the principle of 'collegial partnership'; thirdly, 'collaborative ownership', and finally,
'best practice' (Downie et al., 2001).
As a consequence of this process of clarification and negotiation, the Practice-Research Model was developed to operationalise
the agreed aims of the partnership, which were:
® To encourage nursing staff to reflect on current nursing practice in order to develop meaningful research proposals;
® To teach staff the research process via research experience;
® To enable nursing staff to have a key role in the professional development of other staff via the dissemination of research and
quality improvement findings; and
® To plan and implement changes to practice based on research evidence.
Nurse Research Consultant (NRC): - In the PRM, the role of the Nurse Research Consultant (NRC) was articulated as that of
mentor and consultant on issues related to research, methodology publications and dissemination. Although the PRM was
specifically designed to enhance nursing research activity and the implementation of evidence-based community health nursing
practice, the Model also encouraged the involvement of the multi-disciplinary team to work to achieve the aims of the
partnership agreement5.

Operational framework of the PRM

To fulfill the aims of the partnership several key elements formed the operational framework of the collaborative agreement.
One important element of the framework was to enhance nursing staffs' knowledge of the research process via research
experience. To achieve this 'Journal Clubs' were established in the community health service on a monthly basis. The Nurse
Research Consultant then worked with staff to identify, plan and implement changes to practice based on research evidence.
A second important element of the PRM was to encourage nursing staff to reflect on current nursing practice and identify
clinical problems based on their knowledge and experience of nursing in order to develop meaningful research proposals and
best-practice guidelines. The main reason for the success of the collaborative arrangement has been the provision of
infrastructure to support the dissemination of research and quality improvement findings through clinical meetings, workshops
and conference presentations by the nursing staff involved in the various projects.

Collaborative Clinical Education Epworth Deakin (CCEED) model (2003)

In an effort to improve the quality of new graduate transition, Epworth Hospital and Deakin University ran a collaborative
project (2003) funded by the National Safety and Quality Council to improve the support base for new graduates while
managing the quality of patient care delivery

The Collaborative Clinical Education Epworth Deakin (CCEED) model developed to facilitate clinical learning, promote clinical
scholarship and build nurse workforce capability. This model provided a framework for the first initiative, a CCEED
undergraduate program that nested the clinical component of Deakin University's undergraduate nursing curriculum within
Epworth Hospital's health service environment.
The CCEED undergraduate program sees undergraduate nursing students attending lectures at Deakin University in the
traditional manner but completing all tutorials, clinical learning laboratories and clinical placements at Epworth Hospital
throughout their three year course. Tutorials, laboratories and clinical placements are conducted by Epworth clinicians who are
prepared and supported by Deakin School of Nursing faculty. These clinicians also support the student-preceptor relationship in
the clinical learning component of the curriculum. The expectation was that increased integration between hospital and
university would enhance clinical education resulting in improved students’ application of knowledge and skill as well as
increased socialization to the clinician role.

Key findings of the 2005 pilot CCEED program were

1. Students’ learning objectives were met and satisfaction was high.
2. Undergraduate clinical education was valued by preceptors and managers as a workforce investment strategy
3. Preceptors were enriched in their clinician role as a result of their participation in the program and reflection on the
process.
4. Preceptor continuity promoted a trusting relationship that enabled preceptors to confidently encourage student
initiative.
5. Preceptors managed multiple roles in order to meet demands of patient care and student learning.

The Collaborative Learning Unit (British Columbia) Model, 2005

The Collaborative Learning Unit model was based on the ‘Dedicated Education Units’ concept developed, successfully
implemented, and researched in Australia. The Collaborative Learning Unit (CLU) model of practice education for nursing is a
clinical education alternative to Preceptorship. In the CLU model, students practice and learn on a nursing unit, each following
an individual set rotation and choosing their learning assignment (and therefore the Registered Nurse with whom they partner),
according to their learning plans. Unlike the traditional one-to-one preceptorship-, an emphasis is placed on student
responsibility for self-guiding, and for communicating their learning plan with faculty and clinical nurses (e.g., the approaches to
learning and the responsibility they are seeking to assume). All nursing staff members on the Collaborative Learning Unit are
involved in this model and, therefore, not only do the students gain a wide variety of knowledge but the unit also has the ability
to provide practice experiences for a larger number of students.
Specifically, a Collaborative Learning Unit is a nursing unit where all members of the staff, together with students and faculty,
work together to create a positive learning environment and provide high quality nursing care. Clinical nurses preparing to adopt
the CLU model have described a positive learning environment as one where questions are expected. In the CLU approach the
students are not attached to the units as an ‘extra set of hands’ to augment the nursing workforce, but are present as learners
with a primary interest in gaining entry-level knowledge and competency associated with baccalaureate-prepared nursing
practice. As learners in the CLU model, students are supported by experienced clinical nurses, faculty and, ideally, nurse
researchers. Students recognize a positive learning environment when they perceive their questions are welcomed, and when
they receive thoughtful responses at mutually selected times for students and staff. For faculty (e.g., academic instructors), key
questions focus on determining what nursing knowledge is needed to provide high quality nursing care. Thus, in a CLU, where
critical questioning is promoted, students can systematically learn to “think like a nurse” and can demonstrate what they know
and can do, as undergraduate nurses who are members of a health care team.
While staff and faculty work together to support and advance student learning and promote high quality nursing care, the CLU
model enables a level of student independence that helps them move into the work-world. As well, the CLU concept bridges a
perceived gap between academic and clinical expectations. In this model, nursing faculty, clinical nurses and students work
collaboratively to enhance learning opportunities as well as develop the professional knowledge base of nursing. 8

The Collaborative Learning Unit (British Columbia) Model, 2005

The Collaborative Approach to Nursing Care (CAN- Care) Model (2006)

The CAN-Care model emerged as academic and practice leaders acknowledged the need to work together to promote the
education, recruitment and retention of nurses at all stages of their career. The idea of a partnership model emerged when the
Christine E. Lynn College of Nursing, Florida Atlantic University, was awarded a grant from Tenet HealthCare Foundation to
initiate an Accelerated Second-degree BSN Program. The goal was to design an educationally dense, practice- based experience
to socialize second-degree students to the role of professional nurse. A secondary goal was to enhance and support the
professional and career development of unit-based nurses. A commitment to a constructivist approach to learning, an
immersion experience to recognize the unique needs of accelerated second-degree learners, and to emphasize the partnership
among the academic and practice setting, were guiding forces in the creation and enactment of the model. The model emerged
from a dialogue among leaders from the academic and practice setting focusing on the areas of expertise and potential
contributions of each partner
The essence of the CAN-Care model is the relationship between the nurse learner (student) and nurse expert (unit-based nurse),
within the context of each nursing situation. The semantics of the student as learner and unit-based nurse as expert, in place of
the more common traditional labels of preceptor and preceptee are critical to the intentionality of the collegial focus of the
model. The label nurse learner was designated to place the emphasis on the learning role and the reflective and continuous
nature of knowledge construction. The learner is responsible and accountable for engaging in the learning process and for taking
an active role in establishing a dyadic learning partnership with the nurse expert. Unit-based nurses are experts in the work of
nursing care. The title nurse expert was chosen to recognize the gifts they bring to the profession and share with the nurse
learner.
The nurse learners and nurse experts engage in a dyadic partnership for the purpose of meeting the needs of the assigned
patient population as well as to reflect on and to come to know the art and science of nursing practice. The onsite faculty
member is the expert in educational processes and is essential in the support and nurturing of the expert/learner partnership.
The faculty member promotes the growth of the nurse expert as a professional and the journey of the learner in coming to
know a career in nursing. This is a major change in focus from the more traditional role of faculty being in control of the teaching
of students. By the application of CAN-Care model the focus of the student’s activities moves from the demonstration of
discrete skills and prescribed outcomes to an immersion into the professional nurse role, learning to hear and respond to
patient needs, and to provide nursing care to achieve quality outcomes.
Through this model the student comes to know the organizational context of nursing practice, the multifaceted role of
professional
nurses, and assumes responsibility for coming to know the meaning of
nursing in each unique situation. The unit-based nurse acquires new skills in mentoring, exposure to evidenced- based practice,
and to theoretical knowledge through association with the college. This approach to education in the practice setting is
thought to be more consistent with the educational needs of nurses who are preparing for the challenges of professional
practice in today’s acute care settings.
The most dramatic change with this model is the re- conceptualization of the work of the faculty member. The faculty is the
education-focused expert who supports and nurtures the nurse expert/nurse learner partnership. The
faculty member must relinquish control of the students. While the faculty still has accountability for overall evaluation of the
student’s achievement of the nursing practice course objectives, even the process of the on-going evaluation becomes a
collaborative effort with the nurse expert. The primary role of the faculty member in the model is to nurture the nurse
expert/nurse learner relationship and to support the growth and development of both expert and learner in their respective
roles and responsibilities. The on-site faculty member becomes an advisor, resource, role-model and educator for both the
nurse expert and the nurse learner. The work of the faculty is re-conceptualized as the creator of the environment to support
learning and professional growth as opposed to the direct teaching of preselected content.
In this model, the healthcare organization becomes an active participant in creating learning environments and contributing to
the learning activities, as opposed to just being a setting in which college-affiliated faculty appear with students for a teaching
encounter. In return, the college becomes an active partner in the professional development and retention of nurses at the
practice facility.

The Bridge to Practice Model (2008)

The Bridge to Practice model is distinctly different from other clinical models. First, students complete all of their clinical
experiences in one participating hospital. Second, one full-time teaching faculty serves as a liaison for each bridge hospital. This
faculty member is given a space, usually in the nursing education department, and is then available to serve as a resource for
not only the clinical associates but also for the hospital nursing staff. In this model, therefore, there can be numerous clinical
associates in one hospital with one full-time University faculty overseeing the clinical experiences. Third, students are actively
involved in selecting their clinical placements.
The Bridge to Practice model proposed by Catholic University of America, school of Nursing (2008), uses a cohort approach in
which students complete medical-surgical clinical nursing education at the same facility. Students must apply for clinical
placement in the hospital of their choice via a clinical application form. Clinical placement decisions are based on academic
performance and maturational level. Participating students undergo 415 hours of clinical experiences (nine academic credits)
focused on medical-surgical nursing. These clinical practice progresses from Adults in Health and Illness: Basic, an introductory
nursing course, to Medical-Surgical Nursing Leadership, a senior level course taken in the last semester of baccalaureate study.
Thus The Bridge to Practice Model provides undergraduate nursing students with continuity in medical-surgical education
through placement in the same hospital for all medical-surgical clinical rotations. Hospitals that participate in the bridge model
provide senior clinical nurse preceptors whose time is paid for by the university. The Bridge to Practice model emphasizes
professional incentives for hospital nurses to participate in nursing education. Planned incentives include the rewarding of
hospital nurses with continuing education credits for participation in the short-term training on educational methodology and
approaches. A tuition discount is offered for graduate course work at the university for institutional students and faculty, more
involvement with clinical support services and care management, and more informed employment choices by senior students.
Challenges include recruitment of interested senior clinical nurses, retention of clinical liaison faculty, and management of the
trade-off between institutional stability offered by clinical site continuity and the variety of experiences offered by rotation
across several clinical settings.
 1. Collaboration of Nursing Education and Service in India
The gap between nursing practice and education has its historical roots in the separation of nursing schools from the control of
hospitals to which they were attached. At the time when schools of nursing were operated by hospital, it was the students who
largely staffed the wards and learned the practice of nursing under the guidance of the nursing staff. However, service needs
often took precedence over students’ learning needs. The creation of separate institutions for nursing education with
independent administrative structures, budget and staff was therefore considered necessary to provide an effective educational
environment towards enhancing students’ learning experiences and laying the foundation for further educational development 4.
While this separation has been beneficial in advancing nursing education, it has also had adverse effects. Under the divided
system, the nurse educators are no longer the practicing nurses in the wards or directly involved in the delivery of nursing
services, nor responsible for the quality of care provided in the clinical settings used for students’ learning. The practicing nurses
have little opportunity to share their practical knowledge with students and no longer share the responsibility for ensuring the
relevance of the training that the students receive. As the gap between education and practice has widened, there are now
significant differences between what is taught in the classroom and what is practiced in the service settings. The need for
greater collaboration between nursing education and services calls for urgent attention. We have two institutions which are
practicing dual role, education & practice : NIMHANS, Bangalore and CMC, Vellore. More institutions need to adopt this model.
This will help improve the quality of Nursing Education with overall objective of improving the quality of nursing care to the
patients and community at large4.
1. Dual role model in NIMHANS
Following the amalgamation of 1974 resulting in NIMHANS, the faculty of the nursing department took up the dual
responsibility of providing clinical services as well as conducting teaching programs. In 1975, all the Grade II nursing
superintendents working in the hospital were designated tutors to maintain uniformity in the department. Combined workshops
were conducted under the guidance of WHO consultant Mrs.Morril to prepare the tutors who came from Grade II Nursing
Superintendent cadre for teaching purpose and to make the Lectures and tutors associated with educational programmes (DPN
course& 9-months course in psychiatric nursing) comfortable with clinical supervision. After both groups felt comfortable to
assume the dual responsibility, the areas of supervision were designated. The Head of the Department of Nursing was given the
responsibility for both the service and the education component of the department.
Integration of education with service raised the quality of patient care and also improved the quality of learning experiences for
nursing students, under the close supervision of teachers who were also practitioners.
2. Integrative Service-Education approach in CMC Vellore
College of Nursing under Christian Medical College, Vellore, where nurse educators are practicing in the wards or directly
involving in the delivery of nursing services. This enables the practicing nurse to share her practical knowledge to the student
nurse who is practicing in the concerned wards.
Government of India conducted a pilot study on bridging the gap between education and service in select institutions like one
ward of AIIMS. The project was successful, patients and medical personnel appreciated the move but it required financial
resources to replicate this process.

Conclusion
Estimating the future need for Registered Nurses with various educational backgrounds is complicated by differing perceptions
of educators and employers about the appropriate base of knowledge and skills new graduates need. These differences began
to be apparent when nursing education moved away from its historical base in hospitals in response to abuses and inadequacies
that were believed to characterize the apprentice type of training they provided. They continue to plague the profession 3. Many
nursing service administrators believe that academic nurse educators, removed from the realities of the employment setting,
are preparing students to function in ideal environments that rarely exist in the real and extremely diverse worlds of work. In
turn, many nurse educators believe that nursing service administrators fail to provide work environments conducive to the
kinds of nursing practice their graduates--particularly baccalaureate RNs--are equipped to conduct and that, furthermore, new
graduates of baccalaureate, and diploma programs should be differentiated in their functional work assignments. The report of
a task force of the American Association of Colleges of Nursing observes that "… conflicting philosophies, values, and priorities
between nurse educators and nursing services administrators have generally served to deter a mutual understanding and
acceptance of responsibility for quality patient care." To succeed, nursing educators and care providers alike must strengthen
their response to these challenges with innovative solutions built into the program design and administration. Closer
collaboration between nurse educators and nurses who provide patient services is essential to give students an appropriate
balance of preparation12.
All the models pursue collaboration as a means of developing trust, recognizing the equal value of stakeholders and bringing
mutual benefit to both partners in order to promote high quality research, continued professional education and quality health
care. The literature supports the utility of such collaborations. For example, the most frequently cited positive outcomes are job
satisfaction, improved educational experiences for pre-registration nursing students, increased self-confidence and improved
knowledge base for nurses2. The majority of these models are based on a joint appointment model where the nurse is initially
employed by a health service or a university and divides his or her time between teaching and clinical practice. Application of
these models can reduce the perceived gap between education and service in nursing there by can help in the development of
competent and efficient nurses for the betterment of nursing profession

Bibliography
1. Catherine Malloy & Francis T. Donahue. (2004). Collaboration projects between nursing education and service. Nurse
Education Today. 19(6), 368-77
2. Cathleen B. Gaberson & Marilynn G. Oermann (2010). Clinical Teaching Strategies in Nursing. 3 rd Ed., New York,
Springer Publishing Company. LLC. 307-343
3. Cowen.P.S & Moorhead.S(2006). Current Issues in Nursing. 7th Ed., Missouri, Mosby Inc., 105-122
4. Dileep Kumar, T (2010). Quality of nursing education: Right of every student. The Nursing Journal of India. Cl(1), 12
5. Downie.J et al.(2001). Research model for collaborative partnership. Journal of Royal College of Nursing, Australia.
8(4). 27-32
6. Feltz, Joan, Tom Robin. (2000). Linking practice and education. Journal of Nursing Administration. 30(9), 405-07
7. Fowler, J., Hardy.J., & Howrath.T. (2006). Trialing collaborative nursing models of care: The impact of change.
Australian Journal of Advanced Nursing. 24(1). 24-28
8. Gardner BD. (2005). Ten lessons in collaboration. The Online Journal of Issues in Nursing.
10(1), 24
9. Hannah Dean and Jan L. Lee (1995). Service and education: Forging Partnership. Nursing Otulook, 43(3), 119-23
10. Hellen Forbes & Roslie Strother (2004). Collaboration: Integrating education and clinical practice: The case of La Trobe
University/The Alfred Clinical School of Nursing. Contemporary
Nurse, 17, 3-7
11. Patterson.M, & Gandjen. C (2008). The bridge to practice model: A collaborative program designed for clinical
experiences in baccalaureate Nursing. Nurse Economics. 26(5). 302-306
12. Raines.A.D (2006). An innovative model of practice- based learning. International Journal of Nursing Education
Scholarship. 3(1). 20-26
13. Sherry P. Palmer, et al. (2005). Nursing education and service collaboration: Making difference in the clinical learning
environment. The Journal of Continuing Nursing Education, 36(6). 123-28
14.