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. 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. 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.

The focus on benefits of collaboration could lead one to think that collaboration is a
favourite 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 types 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. 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

A description of the concept of collaboration is derived by integrating Follett's outcome-

oriented perspective (1940) and Gray's process-oriented perspective (1989. According to them:

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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. An effective collaboration is characterized by building and
sustaining “win-win-win” relationships.

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'

TYPES OF COLLABORATION
Terms, such as interdisciplinary, multidisciplinary, transdisciplinary, and inter-professional,
which further delineate and describe teams, teamwork, and collaboration, have evolved over
time.
1. Interdisciplinary
It 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
It 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. Trans disciplinary
It efforts involve multiple disciplines sharing together their knowledge and skills
across traditional disciplinary boundaries in accomplishing tasks or goals. 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
It collaboration has been described as involving “interactions of two or more
disciplines involving professionals who work together, with intention, mutual respect, and

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commitments for the sake of a more adequate response to a human problem” (Harbaugh, 1994).
Interprofessional collaboration goes beyond trans disciplinary to include not just traditional
discipline boundaries but also professional identities and traditional roles. Interdisciplinary
collaboration team.

NEED FOR COLLABORATION BETWEEN EDUCATION AND SERVICE

 Increasing gap between nursing education and nursing service.

 Graduate nurses often lack practical skills despite their significant knowledge of nursing
process and theory.
 Clearly, a partnership between nursing educators and hospital nursing personnel is
educators and hospital nursing personnel is essential to meet this challenge.

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
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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).

MODEL 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 as well as, providing a vehicle by which the theory -clinical practice gap is
bridged and best practice outcomes are achieved

1. Clinical school of nursing model (1995)

2. Dedicated Education Unit Clinical Teaching Model
3. Research Joint Appointments (clinical Chair)
4. Practice-Research Model
5. Collaborative Clinical Education Epworth Deakin (CCEED) Model
6. The Collaborative Learning Unit (British Columia) Model
7. The Collaborative approach to Nursing Care(CAN-Care) Model
8. The Bridge to practice model
9. Collaboration of Nursing Education and Service in indea

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.

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2. DEDICATED EDUCATION UNIT CLINICAL 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 enrolment.

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. RESEACH JOINT APPOINTMENT (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.

4. 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.

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 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).

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 agreement.

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.

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  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.

5. COLLABORATIVE CLINICAL EDUCATION EPWORTH DEAKIA

(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. Nursing education supported by Clinical Facilitators
Clinical facilitators are supported by Hospital administration and university Students coached by
Nurse Clinician

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.

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6. 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

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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.

7. 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 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 nurse expert was chosen to recognize the gifts they bring to the profession and share
with the nurse learner.

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 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 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
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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

8. 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.

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9. 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 development4.

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 large.

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.

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

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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 profession3. 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.

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BIBLIOGRAPHY

1. Jaspreet Kaur Sodhi, Comprehensive Textbook of Nursing Education, 1 st Edition 2017,

published by Jaypee Brothers Medical (P)Ltd, page no:-450-457.

2. https://www.slideserve.com/.../different-models-of-collaboration-between-nursing-edu.

3. https://www.scribd.com/.../Collaboration-Issues-and-Models-Within-and-Outside-Nurs..

4. https://www.researchgate.net/.../259716649_Different_models_of_collaboration_betw...

5. https://dspace.nwu.ac.za/bitstream/handle/10394/17193/Direko_KK.pdf?sequence

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