Through the years, skilled nursing center providers have grappled with the impact that shifting demographics and significant changes in health care delivery systems have had on staffing needs. According to the American Health Care Association, more than 50 percent of all Medicare beneficiaries who need post-acute care are admitted to one of the nearly 16,000 skilled nursing centers nationwide.
On average, these individuals require a short rehabilitative stay of approximately 27 days before returning back into the community. Although today’s short-stay patients typically exhibit a higher level of acuity than that of “traditional” nursing home residents, recruiting the most qualified nursing staff into the skilled nursing environment can be challenging.

Education Units Offer New Model

There are multiple reasons why registered nurses (RNs) gravitate toward working in an acute-care setting. In baccalaureate nursing education, gerontological nursing content about—and clinical practicum placements in—long term care have been minimal or relegated too often to a fundamentals entry-level nursing course. For a beginning baccalaureate nursing student, who may harbor less than favorable attitudes toward aging and older adults, this exposure can be misinterpreted as the typical experience for all older adults.
Furthermore, students may be ill-equipped in an introductory course to appreciate the high-level nursing expertise necessary to fully address the needs for this population.
What if today’s dynamic skilled nursing and rehabilitation center could have a more direct role in the education of new nurses? Would nurses in their formative training be more apt to choose a career in long term care?
One answer to these questions may lie in the Dedicated Education Unit (DEU), an innovative clinical education model that provides meaningful academic experiences for students and promotes the development of select staff nurses in skilled nursing settings to serve as clinical teachers, while delivering high-quality care to patients.

Partnership Improves Care

A DEU in Lowell, Mass., is the result of a successful academic-practice partnership between the University of Massachusetts Lowell School of Nursing and D’Youville Life and Wellness Community.
Established with funding received from the Massachusetts Department of Higher Education, the DEU at D’Youville’s Center for Advanced Therapy operates within the skilled nursing setting and utilizes existing skilled nursing staff as clinical faculty.
The nursing students work closely with their clinical preceptor, gaining direct exposure to, and a deep understanding of, the multiple challenges facing patients and staff in this setting.
The designated university faculty member provides ongoing support and regular contact for the skilled nursing clinical preceptors to foster their teaching role with the assigned students.
This model differs significantly from the typical clinical rotation site contract between an educational institution and a skilled nursing center. The typical model often includes one faculty to a group of six to eight students.

Immersion Offers Rewards

In the DEU model, select center nursing staff members become an extension of the college or university. While they are working their usual shift and patient assignments, each center staff member also acts as preceptor to a nursing student in his or her third year of training.
By working side by side, the nursing student gains unique insights, while the staff preceptor enhances her own credibility and confidence as a clinician.
The presence of a DEU results in additional benefits to the skilled nursing center. The training of the center’s preceptors requires an ongoing direct relationship between center staff and the college/university faculty.
As many experienced nursing home nurses do not have a baccalaureate degree themselves, this may be their first personal exposure to higher education and the catalyst for their own professional advancement. Preceptors have the opportunity to “train the trainer,” imparting the essence of their hands-on knowledge to the university faculty who may not have recent geriatric experience themselves.
Also, the formal partnership between a skilled nursing center and an accredited college/university is a key element that can positively differentiate the center in the local marketplace.
The process for establishing a DEU partnership includes considerable planning and coordination. Using this toolkit as a guide can be helpful to academic and practice partners that wish to embark on such an endeavor.
The positive rewards are well worth the effort. Nursing students whose formal education includes immersion in a geriatric-oriented rehabilitative unit could ultimately represent the future of the profession by improving quality of care and enhancing patient outcomes.
Long Term Care Dedicated Education Unit:
  • Karen Devereaux Melillo, Ph.D., ANP-C, FAANP, FGSA, University of Massachusetts Lowell
  • Lisa Abdallah, Ph.D., RN, CNE, University of Massachusetts Lowell
  • Juliette M. Shellman, Ph.D, PHCNS-BC, University of Connecticut
  • Ruth Remington, Ph.D, APRN-BC, Framingham State University
  • Lea Dodge, MS, RN, University of Massachusetts Lowell
  • Jacqueline Dowling, Ph.D., RN, CNE, University of Massachusetts Lowell 
  • Stephanie R. Lane, MSW, Project Administrator, University of Massachusetts Lowell
  • Naomi Prendergast, CEO/President of D’Youville Life and Wellness Community 
  • Cynthia Thornton, Director, CAT, D’Youville Transitional Care Unit
  • Andrea Rathbone, Administrator, D’Youville Senior Care