University of Maryland Medical System, author of Daily Nurse
Following a successful pilot of its innovative Academy of Clinical Essentials (ACE) initiative, the University of Maryland Medical System (UMMS) is preparing to welcome its first full class of nursing students as the program expands to other locations in Maryland.
ACE places a cohort of bedside nursing students under the direction of an experienced hospital nurse. This academic-practice partnership model reinvents the preparation of nursing students and their transition to hospital practice and creates an integrated and innovative model of care delivery.
The ACE initiative helps students understand the patient care experience
“This is an important opportunity for nursing students to gain realistic clinical experience, to be immersed in clinical care for a full shift, and to have responsibility for patients from the start of their shift until they are transferred to the oncoming nurses at the end of their shift. says Lisa Rowen, DNSc, RN, CENP, FAAN, Chief Nursing Officer for UMMS. “Caring for a patient for a full 12 hours allows nursing students to experience the continuum of care, engage with a patient’s family members, and fully understand the patient care experience. .
ACE cohorts are assigned to hospital units for the duration of their clinical course, aligning with the skills nursing students acquire during their first or second year of nursing school.
For a 12-hour shift per week, small cohorts of four nursing students are paired with a UMMS-funded nurse clinician who serves as their instructor and who knows the patient population of the specific unit, assigned team members, policies, protocols, procedures and equipment.
“Historically, nurses received hands-on training under the guidance of an experienced hospital nurse, and the UMMS ACE teaching model takes the profession back to its roots,” adds Dr Rowen. “Modern healthcare demands rigorous classroom training for all nurses, and ACE combines the modern approach with real-world experience that will result in graduates much more prepared to begin caring for patients, who may be the greatest beneficiaries of this approach which adds more hands and resources to hospital units.
ACE Initiative Eligibility
Students enrolled in Medical-Surgical Nursing for Associate’s Degree in Nursing, Bachelor of Science in Nursing, and Entry-to-Practice Clinical Nurse Leader classes are eligible for the program.
During their clinical rotation, student nurses are integrated into the care delivery fabric of their unit and are considered an integral part of the care team. Since students and instructors are immersed in specific units for long periods of time, a critical aspect of the program is the inclusion of clinical instructors in hospital staffs.
Early pilots of the model have also shown that instructors benefit significantly from the UMMS ACE, which creates opportunities for experienced nurses with a passion for teaching to have a diverse role and be more engaged in the hospital.
UMMS piloted ACE, considered the first program of its kind in the country, in the spring of 2022, with seven cohorts of 28 medical/surgical students in the second semester. Eleven more students in their first semester foundation course joined the mid-semester cohorts and were able to practice basic nursing skills.
Over 30 nursing cohorts with over 120 nursing students are planned for the fall 2022 semester.
Feedback from ACE Initiative students
Rasheda Dukhin was an ACE Initiative student in the spring of 2022, gaining clinical experience in the UMMC Thoracic Intermediate Care Unit.
“It was an incredible experience that made me feel ready to practice nursing after graduation,” she says. “Many of the patients I cared for were in high acuity; I gained experience in all patient care, assisted doctors with medical procedures, administered medication, documented assessments, wrote reports, and more,” says Dukhin. “During the semester, I was able to directly align the course material with clinical practice, which allowed me to better understand and assimilate the material. The clinical instructors were a big part of my success because they challenged me, empowered me, and were patient and willing to teach me.
“Nursing students who participate in the ACE program will undoubtedly be better prepared for their nursing careers, as this training offers them the reality of being a health care nurse right now,” says Dr. Rowen. “Practicing skills in a simulation lab with manikins is an important part of nursing education, and adding this kind of immersive hands-on experience is invaluable. Nursing students will become more confident and competent in clinical skills and professional relationships with members of the multidisciplinary team. The goal is for these students to need less orientation time in their unit when hired so they can practice independently sooner.
CAOT’s goals include enhancing the education experience of student nurses through experiential learning by integrating them into hospital culture. Strengthen the nursing workforce, recruit students to join the UMMS workforce as new graduate nurses, and reduce orientation costs over time. ACE provides opportunities to diversify the roles of UMMS nurses to ensure they remain more engaged within the organization and enable their career advancement.
Robbie Francisco, BSN, RN confident on every shift. Francisco usually helps orient new nurses as a preceptor, so she’s comfortable working with recent graduates, but this was her first time as an instructor. “The idea was intimidating to me at first, but I thought of it as a new challenge and an incredible opportunity for me to grow as an educator as well as a bedside nurse, and I saw it as a place to share my experiences and knowledge to help train new generations of nurses.
Another first-time teacher, Genevieve Vidal, BSN, RN, PCCN, who also serves as Senior Clinical Nurse I, says her goal was to teach students about the realities of nursing at the bedside. “I was lucky to have motivated students who always helped and supported each other during difficult shifts,” says Vidal.
Celebrating his 20th year as a UMMC nurse this year, Vidal encouraged students to show initiative, challenged them to reach beyond their comfort zones, focused on patient communication and bedside nursing skills, taught students how to draw blood and place IVs and “saw their confidence grow as they continue to master their skills in their training clinical.
Deborah Trautman, Ph.D., RN, FAAN, AACN President and CEO of AACN and member of the UMMC Board of Directors, is a strong supporter of the ACE program. “In April 2021, the American Association of Colleges of Nursing released new guidelines for nursing education, urging nursing schools to adopt a more experiential and competency-based framework to prepare professional nurses,” says -she. “The UMMS ACE model illustrates how leaders in practice and academia can work together to meet these new expectations, which will propel the nursing profession into the future.
Maeve Howett, Ph.D., APRN, CPNP-PC, CNE, Professor and Associate Dean for Baccalaureate Education at UMSON, adds: “The ACE program has provided excellent learning opportunities for our students at a time when the need for nurse educators and additional sites was critical. Our ongoing partnership with UMMS has successfully contributed to increased enrollment to help meet the growing demand for nurses in Maryland. Additionally, ACE has created excitement among experienced UMMS nurses to help teach and mentor the next generation of nurses. We are delighted with the results of the spring pilot and look forward to expanding ACE this fall.