Guest Editorial: Reconnecting education and service: Partnering for success

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In this special issue of Nursing Outlook, we have collected a set of papers that addresses the long-standing and critically important topic of education-service partnerships in nursing. The tension in the education-service partnership dates back to nursing’s early history when nursing “training” was offered in the model of an apprenticeship. Student nurses who lived at the hospital “ran” the wards in addition to their devoted 15–20 hours each day to the management of ward-based activities and classroom training, generally within a few steps of the patient-care areas. Not until the recommendations issued in the 1923 Goldmark Report, the document that addressed nursing education reform as the 1910 Flexner Report had addressed medical education reform, did the profession begin to separate the education activities from those of service delivery. And we have struggled with how to reconnect ever since.

A closer connection between education-focused and service-focused organizations has been identified as the solution to many of the problems faced by nursing today:

Partnership-based solutions seem logical and easy to enact. Our experience suggests that good-willed intentions alone are not sufficient to support building and maintaining the needed partnerships. For although we are all “nurses,” the education and service sectors of our field have distinctly different missions, organizational structures, systems of accountability and metrics by which to measure success. Successful partnerships must be based on a more structured approach to navigating these differences.

Education-service partnerships require a comprehensive framework that clarifies goals, objectives, and responsibilities to assure success. This framework should also include a governance process to assure appropriate oversight and accountability of all parties involved in the partnership. Adequate resources are necessary to establish such partnerships and, when brought “to the table,” are viewed as an important indicator of broader organizational commitment. Those leading partnerships need to demonstrate strong commitment to the partnership by engaging all stakeholders to assist in development and implementation of the shared ventures. The partnership also requires ongoing evaluation including: adopting, measuring, and monitoring indicators of success and feedback mechanisms that meet changing needs and are considerate of the differing metrics to which each partner will be held accountable.

The collection of articles we have selected for inclusion in this issue provides positive examples of the many ways in which successful partnerships have been enacted. Each provides details of a different form of collaboration and the lessons learned from failure and success. Stanley and colleagues present an example of partnership based on the collaboration of organizations. The American Association of Colleges of Nursing (AACN), the national voice for America’s baccalaureate and higher-degree nursing education programs, convened its members and service leaders to address how improved patient outcomes might be achieved. From this was born the Clinical Nurse Leader. The process described provides insights into how a large audience of stakeholders can work together toward a common goal. Horns and her colleagues describe how an educational institution developed a successful partnership with a service setting in which no common mission or governance structure was in place. Despite this, the partnership is now 20 years old and thriving. Russell and colleagues write about their younger, but similarly successful, partnership between their college of nursing and a group of regional clinical colleagues who developed a broad network entitled the Chronic Illness Consortium. They point to the need to have a common framework for organizing the issues at hand and the importance of regular meetings and visible products of their work.

The next 3 articles address partnerships that are in the service of more specific goals. Kushto-Reese and colleagues developed a partnership in the community with the intention of improving children’s health. Based on principles from Service-Learning, the work explicates how adjustments must be made by both partners. Give and take, creativity, and adjustment of expectations helped to ensure the success of this partnership. McConnell and colleagues describe the development of an “academic practice collaboration” designed to improve practice in a long-term care facility by providing examples of how evidence can be used to improve oral care. An intended by-product of this was to improve the quality of the clinical site for use in training nurses. Guided by Diffusion of Innovation Theory, the faculty clinicians guided the staff through a process that could be replicated with other clinical topics. Hamner and her colleagues present an example of an academic unit delivering services in the community, thereby enriching the quality of the clinical care and improving the clinical experiences of the involved students. They identify 3 significant lessons related to continuity of person and place and the need to be persistent. Brief reports from Phillips and Giachetta-Ryan follow and appear as sidebars. Their reports provide factual descriptions of problems that were addressed with creative solutions implemented through partnerships.

Our own work in developing a strong partnership between the Duke University School of Nursing and the Duke University Health System Nursing Service has taken many forms. We have undertaken a plan to work from a common framework, with care taken to delineate governance and responsibility. This year we will launch the Duke Nursing Translational Institute, a joint venture aimed at improving patient care outcomes through the use of scientific inquiry. We will be highly dependent upon those who can design studies and evaluate the outcomes of care working with those who are experts in care. Success will be dependent upon collaboration among scientists, clinicians, and educators. As is true of every venture described in this issue, the challenges are great and the stakes are high. We have the advantage of a common governance structure but our missions and structures differ. The only way we can be successful in our planned work is to use the lessons we have learned from the writings of our colleagues in this special issue and to continue to be open to change and exploration.