Chair) 6.4. Practice-Research Model (PRM) 6.5. Collaborative Clinical Education Epworth Deakin (CCEED) model 6.6. The Collaborative Learning Unit (British Columbia) Model 6.7. The Collaborative Approach to Nursing Care (CAN- Care) Model 6.8. The Bridge to Practice Model 6.9. Collaboration of Nursing Education and Service in India 7 Conclusion 13 8 Bibliography 14 2 Page. <br />DIFFERENT MODELS OF COLLABORATION BETWEEN NURSING EDUCATION AND SERVICE1. Introduction The nursing profession is faced with increasingly complex health care issues driven bytechnological and medical advancements, an ageing population, increased numbers of people livingwith chronic disease, and spiraling costs. Collaborative partnerships between educational institutionsand service agencies have been viewed as one way to provide research which ensures an evolvinghealth-care system with comprehensive and coordinated services that are evidence-based, cost-effective and improve health-care outcomes<br />
Collaboration is a substantive idea repeatedly discussed in health care circles. Though thebenefits are well validated, collaboration is seldom practiced. The lack of a shared definition is onebarrier. Additionally, the complexity of collaboration and the skills required to facilitate the process are Different Models of Collaboration between Nursing Education & Serviceformidable. 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. Manyresearchers have validated the benefits of collaboration to include improved patient outcomes,reduced length of stay, cost savings, increased nursing job satisfaction and retention, and improvedteamwork (Abramson & Mizrahi 1996).
1The focus on benefits of collaboration could lead one to thinkthat collaboration is a favorite approach to providing patient care, leading organizations, educatingfuture health professionals, and conducting health care research. Contextual elements that influencethe formation of collaboration include time, status, organizational values, collaborating participants,and type of problem.
2. Meaning Collaboration is an intricate concept with multiple attributes. Attributes identified by severalnurse 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, areoften used as substitutes. The roots of the word collaboration, namely co-, and laborare, combine in Latin to mean “worktogether.” That means the interaction among two or more individuals, which can encompass a varietyof actions such as communication, information sharing, coordination, cooperation, problem solving,and negotiation. Teamwork and collaboration are often used synonymously. The description of collaboration asa dynamic process resulting from developmental group stages as an outcome, producing a synthesisof different perspectives. The reality is that collaboration evolves in partnerships and in teams. Baggsand Schmitt (1988) reframe the relationship between collaboration and teamwork by definingcollaboration 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 Folletts outcome-oriented perspective (1940) and Grays process-oriented perspective (1989). Both authors strengthenthe definition of collaboration by considering the type of problem, level of interdependence, and type 3of outcomes to seek. According to them: Collaboration is both a process and an outcome in which Page.shared interest or conflict that cannot be addressed by any single individual is addressed by keystakeholders. The collaborative process involves a synthesis of different perspectives to better
understand complex problems. A collaborative outcome is the development of integrative solutionsthat go beyond an individual vision to a productive resolution that could not be accomplished by anysingle person or organization. It is critical in collaboration that all existing and potential members of the collaborating groupshare the common vision and purpose. Several catalysts may initiate collaboration – a problem, ashared vision, a desired outcome, to name a few. Regardless of what the catalyst may be, it isessential to move from problem driven to vision driven, from muddled roles and responsibilities todefined relationships, and from activity driven to outcomes. Collaboration is an inclusionary processwith continuous engagement that reinforces commitment, recognizing the building of relationships asfundamental to the success of collaborations. An effective collaboration is characterized by buildingand sustaining “win-win-win” relationships8. <br />Different Models of Collaboration between Nursing Education & Service3. <br />Definition Henneman et al. have suggested that collaboration “is a process by which members of variousdisciplines (or agencies) share their expertise. Accomplishing this requires these individualsunderstand and appreciate what it is that they contribute to the whole”. "Collaboration is the most formal inter organizationl relationship involving shared authority andresponsibility for planning, implementation, and evaluation of a joint effort (Hord, 1986). Mattessich, Murray and Monsey (2001) define collaboration as ... a mutually beneficial andwell-defined relationship entered into by two or more organizations to achieve common goals8.4.<br /> Types of Collaboration Terms, such as interdisciplinary, multidisciplinary, transdisciplinary, and interprofessional,which further delineate and describe teams, teamwork, and collaboration, have evolved over time.4.1. <br />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.4.2. <br />Multidisciplinary refers to independent work and decision making, such as when disciplineswork side-by-side on a problem. The interdisciplinary process, according to Garner (1995) andHoeman (1996), expands the multidisciplinary team process through collaborative communicationrather than shared communication.4.3. <br />Transdisciplinary efforts involve multiple disciplines sharing together their knowledge and skillsacross traditional disciplinary boundaries in accomplishing tasks or goals (Hoeman, 1996).Transdisciplinary efforts reflect a process by which individuals work together to develop a sharedconceptual framework that integrates and extends discipline specific theories, concepts, and methodsto address a common problem.4.4. <br />Interprofessional collaboration has been described as involving “interactions of two or moredisciplines involving professionals who work together, with intention, mutual respect, and 4commitments for the sake of a more adequate response to a human problem” (Harbaugh, 1994). Page.Interprofessional collaboration goes beyond transdisciplinary to include not just traditional disciplineboundaries but also professional identities and traditional roles. Interdisciplinary collaboration team <br />members transcend seperate disciplinary perspectives and attempt to weave together resources,such as tools, methods, and procedures to address common problems or concerns2.5. Need for Collaboration between Education and Service Considerable progress has been made in nursing and midwifery over the past severaldecades, especially in the area of education. Countries have either developed new, or strengthenedand re-oriented the existing nursing educational programmes in order to ensure that the graduateshave the essential competence to make effective contributions in improving people’s health andquality of life. As a result nursing education has made rapid qualitative advances. However, theexpected 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 ofnursing schools from the control of hospitals to which they were attached. At the time when schools of Different Models of Collaboration between Nursing Education & Servicenursing were operated by hospitals, it was students who largely staffed the wards and learned thepractice of nursing under the guidance of the nursing staff. However, under the then prevailingcircumstances, service needs often took precedence over student’s learning needs. The creation ofseparate institutions for nursing education with independent administrative structures, budget andstaff was therefore considered necessary in order to provide an effective educational environmenttowards enhancing students learning experiences and laying the foundation for further educationaldevelopment. 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 aresult, they are no longer directly in the delivery of nursing services nor are they responsible forquality of care provided in the clinical settings used for student’s learning. The practicing nurses havelittle opportunity to share their practical knowledge with students and no longer share theresponsibility for ensuring relevance of the training that the students receive. As the gap betweeneducation and practice has widened, there are now significant differences between what is taught inthe 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 skillsdespite their significant knowledge of nursing process and theory. Nursing educators know thatdevelopment of technical expertise in the modern hospital is possible only through on-the-jobexposure to the latest equipment and medical interventions. Schools of nursing have tried to bridgethis 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 sitefrequently result in a less than optimal allocation of time to learn technical skills and frustration on thepart 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 additionaltraining. As a result, graduate nurses are required to attend an orientation to the hospital and haveadditional supervised practice before they can function independently in the hospital. The cost of 5orienting a new nursing graduate is significant, particularly with high levels of nursing turnover (Reiter, Page.Young, & Adamson, 2007). <br />The challenge to nursing education is how to combine theoretical knowledge with sufficienttechnical 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 meetthis challenge13.6. Models of Collaboration between Education and Service5 The nursing literature presents several collaborative models that have emerged betweeneducational institutions and clinical agencies as a means to integrate education, practice and researchinitiatives (Boswell & Cannon, 2005; McKenna & Roberts, 1998; Acorn, 1990), as well as, providing avehicle by which the theory -clinical practice gap is bridged and best practice outcomes are achieved(Gerrish & Clayton, 2004; Gaskill et al., 2003).6.1. <br />Clinical school of nursing model (1995) Different Models of Collaboration between Nursing Education & ServiceThe concept of a Clinical School of Nursing is one that encompasses the highest level of academicand clinical nursing research and education. This was the concept of visionary nurses from both LaTrobe and The Alfred Clinical School of Nursing University. This occurred within a context of a longhistory of collaboration and cooperation between these two institutions going back many years andculminating in the establishment of the Clinical School in February, 1995. The development of the Clinical School offers benefits to both hospital and university. Itbrings academic staff to the hospital, with opportunities for exchange of ideas with clinical nurses withincreased opportunities for clinical nursing research. Many educational openings for expert clinicalnurses to become involved with the universitys academic program were evolved. The move to theconcept of the clinical school is founded on recognition of the fundamental importance of the closeand continuing link between the theory and practice of nursing at all levels10.6.2. <br />Dedicated Education Unit Clinical Teaching Model (1999) In this model a partnership of nurse executives, staff nurses and faculty transformed patientcare units into environments of support for nursing students and staff nurses while continuing thecritical work of providing quality care to acutely ill adults. Various methods were used to obtainformative data during the implementation of this model in which staff nurses assumed the role ofnursing instructors. Results showed high student and nurse satisfaction and a marked increase inclinical 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 6 develop clinical reasoning skills, to identify clinical expectations of students, and evaluate Page. student achievement <br />• Commitment by all to collaborate to build an optimal learning environment.6.3. Research Joint Appointments (Clinical Chair) (2000) A Joint Appointment has been defined by Lantz et al. (1994), as “a formalised agreementbetween two institutions where an individual holds a position in each institution and carries outspecific and defined responsibilities”. The goal of this approach is to use the implementation of research findings as a basis forimproving critical thinking and clinical decision-making of nurses. In this arrangement the researcheris a faculty member at the educational institution with credibility in conducting research and with aninterest 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 practicesetting. She/he also lectures or supervises in the educational institution. A formal agreement exists Different Models of Collaboration between Nursing Education & Servicewithin the two organisations regarding specific responsibilities and the percentage of time allocatedbetween each. Salary and benefits are shared between the two organisations. Outcomes identified by Donnelly, Warfel and Wolfe (1994) for the educational institution arethat 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 caredelivery. There is also an increasing collaborative relationship with the service provider, which isimportant for long term workforce planning. The position has benefits to nursing/midwifery studentsdue to more explicit focus on directly linking the education setting to the clinical context. For practicethe outcomes are increased staff involvement in professional activities including writing for publication,presenting at seminars and conferences and preparing submissions on professional issues. Theclinical chair also facilitates improved access and support to external research project funding6.6.4. <br />Practice-Research Model (PRM) (2001)<br />Practice-Research Model (PRM) (2001) It is an innovative collaborative partnership agreement between Fremantle Hospital and HealthService and Curtin University of Technology in Perth, Western Australia. The partnership engagesacademics in the clinical setting in two formalized collaborative appointments. This partnership notonly enhances communication between educational and health services, but fosters the developmentof 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 betweenregistered nurses and academics, and has also facilitated strong links at the health service with theNursing Research and Evaluation Unit, medical staff and other allied health professionals. The keyconcepts exemplified in the application of the model include practice-driven research development,collegial partnership, collaborative ownership and best practice. Many specific outcomes have beenachieved through implementation of the model, but overall the partnership between registered nursesand 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 7 professionals, from the community health service and the university who recognized the need Page. 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 <br />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 Modelwas developed to operationalise the agreed aims of the partnership, which were: Different Models of Collaboration between Nursing Education & Service -> 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, methodologypublications and dissemination. Although the PRM was specifically designed to enhance nursingresearch activity and the implementation of evidence-based community health nursing practice, theModel also encouraged the involvement of the multi-disciplinary team to work to achieve the aims ofthe partnership agreement22.214.171.124. Operational framework of the PRM To fulfill the aims of the partnership several key elements formed the operational framework ofthe collaborative agreement. One important element of the framework was to enhance nursing staffsknowledge of the research process via research experience. To achieve this Journal Clubs wereestablished in the community health service on a monthly basis. The Nurse Research Consultant thenworked 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 currentnursing practice and identify clinical problems based on their knowledge and experience of nursing inorder to develop meaningful research proposals and best-practice guidelines. The main reason for thesuccess of the collaborative arrangement has been the provision of infrastructure to support thedissemination of research and quality improvement findings through clinical meetings, workshops andconference presentations by the nursing staff involved in the various projects.6.5. <br />Collaborative Clinical Education Epworth Deakin (CCEED) model (2003)7<br />Collaborative Clinical Education Epworth Deakin (CCEED) model (2003)7 In an effort to improve the quality of new graduate transition, Epworth Hospital and DeakinUniversity ran a collaborative project (2003) funded by the National Safety and Quality Council to 8improve the support base for new graduates while managing the quality of patient care Page.delivery. <br />Nursing education Students coached by Nurse supported by Clinical Clinician Facilitators Different Models of Collaboration between Nursing Education & Service Clinical facilitators are supported by Hospital administration and university The Collaborative Clinical Education Epworth Deakin (CCEED) model developed to facilitateclinical learning, promote clinical scholarship and build nurse workforce capability. This modelprovided a framework for the first initiative, a CCEED undergraduate program that nested the clinicalcomponent of Deakin Universitys undergraduate nursing curriculum within Epworth Hospitals healthservice environment. The CCEED undergraduate program sees undergraduate nursing students attendinglectures at Deakin University in the traditional manner but completing all tutorials, clinical learninglaboratories and clinical placements at Epworth Hospital throughout their three year course. Tutorials,laboratories and clinical placements are conducted by Epworth clinicians who are prepared andsupported by Deakin School of Nursing faculty. These clinicians also support the student-preceptor 9relationship in the clinical learning component of the curriculum. The expectation was that increased Page.integration between hospital and university would enhance clinical education resulting in improvedstudents’ application of knowledge and skill as well as increased socialization to the clinician role. <br />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.6.6. <br />The Collaborative Learning Unit (British Columbia) Model, 2005<br />The Collaborative Learning Unit (British Columbia) Model, 2005 Different Models of Collaboration between Nursing Education & Service The Collaborative Learning Unit model was based on the ‘Dedicated Education Units’concept developed, successfully implemented, and researched in Australia. The CollaborativeLearning Unit (CLU) model of practice education for nursing is a clinical education alternative toPreceptorship. In the CLU model, students practice and learn on a nursing unit, each following anindividual set rotation and choosing their learning assignment (and therefore the Registered Nursewith whom they partner), according to their learning plans. Unlike the traditional one-to-onepreceptorship-, an emphasis is placed on student responsibility for self-guiding, and forcommunicating their learning plan with faculty and clinical nurses (e.g., the approaches to learningand the responsibility they are seeking to assume). All nursing staff members on the CollaborativeLearning Unit are involved in this model and, therefore, not only do the students gain a widevariety of knowledge but the unit also has the ability to provide practice experiences for a largernumber 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 andprovide high quality nursing care. Clinical nurses preparing to adopt the CLU model havedescribed a positive learning environment as one where questions are expected. In the CLUapproach the students are not attached to the units as an ‘extra set of hands’ to augment thenursing workforce, but are present as learners with a primary interest in gaining entry-levelknowledge and competency associated with baccalaureate-prepared nursing practice. As learnersin the CLU model, students are supported by experienced clinical nurses, faculty and, ideally,nurse researchers. Students recognize a positive learning environment when they perceive theirquestions are welcomed, and when they receive thoughtful responses at mutually selected timesfor students and staff. For faculty (e.g., academic instructors), key questions focus on determiningwhat nursing knowledge is needed to provide high quality nursing care. Thus, in a CLU, wherecritical questioning is promoted, students can systematically learn to “think like a nurse” and candemonstrate what they know and can do, as undergraduate nurses who are members of a healthcare team. While staff and faculty work together to support and advance student learning and promote 10high quality nursing care, the CLU model enables a level of student independence that helps themmove into the work-world. As well, the CLU concept bridges a perceived gap between academic and Page.clinical expectations. In this model, nursing faculty, clinical nurses and students work collaboratively toenhance learning opportunities as well as develop the professional knowledge base of nursing.8 The Collaborative Learning Unit (British Columbia) Model, 2005 Clinical Site Clinical Nurses coordinators Different Models of Collaboration between Nursing Education & Service Student Nurses Nurse Nurse Educators Researchers6.7. <br />The Collaborative Approach to Nursing Care (CAN- Care) Model (2006)12<br />The Collaborative Approach to Nursing Care (CAN- Care) Model (2006)12 The CAN-Care model emerged as academic and practice leaders acknowledged the need towork together to promote the education, recruitment and retention of nurses at all stages of theircareer. 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 anAccelerated 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 secondarygoal was to enhance and support the professional and career development of unit-based nurses. Acommitment to a constructivist approach to learning, an immersion experience to recognize theunique needs of accelerated second-degree learners, and to emphasize the partnership among theacademic and practice setting, were guiding forces in the creation and enactment of the model. The 11model emerged from a dialogue among leaders from the academic and practice setting focusing onthe areas of expertise and potential contributions of each partner. Page. <br />The essence of the CAN-Care model is the relationship between the nurse learner (student) Careand nurse expert (unit-based nurse), within the context of each nursing situation. The semantics of the based nursingstudent as learner and unit-based nurse as expert, in place of the more common traditional labels of basedpreceptor and preceptee are critical to the intentionality of the collegial focus of the model. The labelnurse learner was designated to place the emphasis on the learning role and the reflective and ascontinuous nature of knowledge construction. The learner is responsible and accountable forengaging in the learning process and for taking an active role in establishing a dya dyadic learningpartnership with the nurse expert. Unit based nurses are experts in the work of nursing care. The title Unit-basednurse expert was chosen to recognize the gifts they bring to the profession and share with the nurselearner. The nurse learners and nurse experts engage in a dyadic partnership for the purpose of nursemeeting the needs of the assigned patient population as well as to reflect on and to come to know the Different Models of Collaboration between Nursing Education & Serviceart and science of nursing practice. The onsite faculty member is the expert in educational p processesand is essential in the support and nurturing of the expert/learner partnership. The faculty memberpromotes the growth of the nurse expert as a professional and the journey of the learner in coming toknow a career in nursing. This is a major change in focus from the more traditional role of faculty changebeing in control of the teaching of students By the application of CAN-Care model the focus of the students. Carestudent’s activities moves from the demonstration of discrete skills and prescribed outcomes to animmersion into the professional nurse role, learning to hear and respond to patient needs, and to mersionprovide nursing care to achieve quality outcomes. Through this model the student comes to know the organizational context of nursing practice,the multifaceted role of professionalnurses, and assumes responsibilityfor coming to know the meaning ofnursing in each unique situation. Theunit-based nurse acquires new skills basedin mentoring, exposure to evidenced evidenced-based practice, and to theoreticalknowledge through association withthe college. This approach toeducation in the practice setting isthought to be more consistent withthe educational needs of nurses whoare preparing for the challenges ofprofessional practice in today’s acutecare settings. The most dramatic changewith this model is the re re-conceptualization of the work of thefaculty member. The faculty is the 12education-focused expert pert whosupports and nurtures the nurse Page.expert/nurse learner partnership. Thefaculty member must relinquish control of the students. While the faculty still has accountability for <br />overall evaluation of the student’s achievement of the nursing practice course objectives, even theprocess of the on-going evaluation becomes a collaborative effort with the nurse expert. The primaryrole of the faculty member in the model is to nurture the nurse expert/nurse learner relationship and tosupport the growth and development of both expert and learner in their respective roles andresponsibilities. The on-site faculty member becomes an advisor, resource, role-model and educatorfor both the nurse expert and the nurse learner. The work of the faculty is re-conceptualized as thecreator of the environment to support learning and professional growth as opposed to the directteaching of preselected content. In this model, the healthcare organization becomes an active participant in creating learningenvironments and contributing to the learning activities, as opposed to just being a setting in whichcollege-affiliated faculty appear with students for a teaching encounter. In return, the college becomesan active partner in the professional development and retention of nurses at the practice facility. <br />Different Models of Collaboration between Nursing Education & Service6.8. <br />The Bridge to Practice Model (2008)11<br />The Bridge to Practice Model (2008)11 The Bridge to Practice model is distinctly different from other clinical models. First, studentscomplete all of their clinical experiences in one participating hospital. Second, one full-time teachingfaculty serves as a liaison for each bridge hospital. This faculty member is given a space, usually inthe nursing education department, and is then available to serve as a resource for not only the clinicalassociates but also for the hospital nursing staff. In this model, therefore, there can be numerousclinical associates in one hospital with one full-time University faculty overseeing the clinicalexperiences. 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 educationat the same facility. Students must apply for clinical placement in the hospital of their choice via aclinical application form. Clinical placement decisions are based on academic performance andmaturational level. Participating students undergo 415 hours of clinical experiences (nine academiccredits) focused on medical-surgical nursing. These clinical practice progresses from Adults in Healthand Illness: Basic, an introductory nursing course, to Medical-Surgical Nursing Leadership, a seniorlevel course taken in the last semester of baccalaureate study. Thus The Bridge to Practice Model provides undergraduate nursing students with continuity inmedical-surgical education through placement in the same hospital for all medical-surgical clinicalrotations. Hospitals that participate in the bridge model provide senior clinical nurse preceptors whosetime is paid for by the university. The Bridge to Practice model emphasizes professional incentives forhospital nurses to participate in nursing education. Planned incentives include the rewarding ofhospital nurses with continuing education credits for participation in the short-term training oneducational methodology and approaches. A tuition discount is offered for graduate course work atthe university for institutional students and faculty, more involvement with clinical support services andcare management, and more informed employment choices by senior students. Challenges includerecruitment of interested senior clinical nurses, retention of clinical liaison faculty, and management ofthe trade-off between institutional stability offered by clinical site continuity and the variety of 13experiences offered by rotation across several clinical settings. Page. <br />6.9. Collaboration of Nursing Education and Service in India The gap between nursing practice and education has its historical roots in the separation ofnursing schools from the control of hospitals to which they were attached. At the time when schools ofnursing were operated by hospital, it was the students who largely staffed the wards and learned thepractice of nursing under the guidance of the nursing staff. However, service needs often tookprecedence over students’ learning needs. The creation of separate institutions for nursing educationwith independent administrative structures, budget and staff was therefore considered necessary toprovide an effective educational environment towards enhancing students’ learning experiences andlaying the foundation for further educational development4. While this separation has been beneficial in advancing nursing education, it has also hadadverse effects. Under the divided system, the nurse educators are no longer the practicing nurses inthe wards or directly involved in the delivery of nursing services, nor responsible for the quality of care Different Models of Collaboration between Nursing Education & Serviceprovided in the clinical settings used for students’ learning. The practicing nurses have littleopportunity to share their practical knowledge with students and no longer share the responsibility forensuring the relevance of the training that the students receive. As the gap between education andpractice has widened, there are now significant differences between what is taught in the classroomand what is practiced in the service settings. The need for greater collaboration between nursingeducation and services calls for urgent attention. We have two institutions which are practicing dualrole, education & practice : NIMHANS, Bangalore and CMC, Vellore. More institutions need to adoptthis model. This will help improve the quality of Nursing Education with overall objective of improvingthe quality of nursing care to the patients and community at large126.96.36.199. Dual role model in NIMHANS Following the amalgamation of 1974 resulting in NIMHANS, the faculty of the nursingdepartment took up the dual responsibility of providing clinical services as well as conducting teachingprograms. In 1975, all the Grade II nursing superintendents working in the hospital were designatedtutors to maintain uniformity in the department. Combined workshops were conducted under theguidance of WHO consultant Mrs.Morril to prepare the tutors who came from Grade II NursingSuperintendent cadre for teaching purpose and to make the Lectures and tutors associated witheducational programmes (DPN course& 9-months course in psychiatric nursing) comfortable withclinical supervision. After both groups felt comfortable to assume the dual responsibility, the areas ofsupervision were designated. The Head of the Department of Nursing was given the responsibility forboth the service and the education component of the department. Integration of education with service raised the quality of patient care and also improved thequality of learning experiences for nursing students, under the close supervision of teachers who werealso practitioners.6.9.2. Integrative Service-Education approach in CMC Vellore College of Nursing under Christian Medical College, Vellore, where nurse educators arepracticing in the wards or directly involving in the delivery of nursing services. This enables thepracticing nurse to share her practical knowledge to the student nurse who is practicing in the 14concerned wards. Page. Government of India conducted a pilot study on bridging the gap between education andservice in select institutions like one ward of AIIMS. The project was successful, patients and medical <br />personnel appreciated the move but it required financial resources to replicate this process.7. Conclusion Estimating the future need for Registered Nurses with various educational backgrounds iscomplicated by differing perceptions of educators and employers about the appropriate base ofknowledge and skills new graduates need. These differences began to be apparent when nursingeducation moved away from its historical base in hospitals in response to abuses and inadequaciesthat were believed to characterize the apprentice type of training they provided. They continue toplague 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 idealenvironments that rarely exist in the real and extremely diverse worlds of work. In turn, many nurseeducators believe that nursing service administrators fail to provide work environments conducive tothe kinds of nursing practice their graduates--particularly baccalaureate RNs--are equipped to conduct Different Models of Collaboration between Nursing Education & Serviceand that, furthermore, new graduates of baccalaureate, and diploma programs should bedifferentiated in their functional work assignments. The report of a task force of the AmericanAssociation of Colleges of Nursing observes that "… conflicting philosophies, values, and prioritiesbetween nurse educators and nursing services administrators have generally served to deter a mutualunderstanding and acceptance of responsibility for quality patient care." To succeed, nursingeducators and care providers alike must strengthen their response to these challenges with innovativesolutions built into the program design and administration. Closer collaboration between nurseeducators and nurses who provide patient services is essential to give students an appropriatebalance of preparation12. All the models pursue collaboration as a means of developing trust, recognizing the equalvalue of stakeholders and bringing mutual benefit to both partners in order to promote high qualityresearch, continued professional education and quality health care. The literature supports the utilityof such collaborations. For example, the most frequently cited positive outcomes are job satisfaction,improved educational experiences for pre-registration nursing students, increased self-confidence andimproved knowledge base for nurses2. The majority of these models are based on a joint appointmentmodel where the nurse is initially employed by a health service or a university and divides his or hertime between teaching and clinical practice. 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