Elsevier

Nursing Outlook

Volume 69, Issue 2, March–April 2021, Pages 234-242
Nursing Outlook

Academic/clinical nursing integration in academic health systems

https://doi.org/10.1016/j.outlook.2020.09.002Get rights and content

Highlights

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    Academic/clinical nursing integration in academic health systems.

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    Strategic alignment of academic and clinical nursing in academic health systems.

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    Perspectives of Deans and Chief Nurse Officers on leadership and governance in academic health systems.

    Unifying frameworks for academic/clinical integration in academic health systems.

Abstract

Background

Sustained partnerships that strengthen and expand nursing's contribution to the integration of academic nursing into clinical practice holds the promise of improving Academic Health Systems (AHS).

Purpose

The purpose of this paper is to propose a framework whereby academic/clinical integration can be achieved within the AHS to enhance relationships between academe and clinical nursing entities.

Methods

Nursing deans and chief nurse officers/vice presidents from top ranked AHS offer perspectives to advance the integration of nursing leadership into the governance of high functioning AHS.

Findings

Academic and clinical nursing entities within the AHS governance calls for a shared framework to promote an integrated approach to full engagement of academic and clinical nursing.

Discussion

The collaborative benefits of aligning nursing's academic/clinical missions within AHS are described. The challenges and opportunities inherent in the way forward must build on intentionality and commitment for academic and clinical nursing entities to transform the AHS and improve outcomes.

Introduction

Discourse on the state of partnerships between academic nursing and care delivery institutions has been a topic of recurring interest. The most recent literature has centered on the roles of academic nursing deans in assuming a leadership role to advance academic/service partnerships (AACN, 2016; Sebastian et al., 2018). The professional literature rarely includes reports of sustained academic/service nursing partnerships based on the commitment and engagement of chief academic officers (deans or chairs) and chief nurse officers. Rather, the literature includes recommendations for successful partnerships from academic and executive nurse leaders (Beal et al., 2012); Beal, 2011; Everett, Bowers, & Beal, 2012; Gilliss & Fuchs, 2007). In response, as promising as these recommendations could be, existing reports continue to focus on the nursing partnership and its value in developing workforce capacity (Beal, 2012; Clark & Allison-Jones, 2011). Although recognized as vital to the future of nursing education and nursing service (2011), relationships between the educational and service delivery leaders remain misaligned (Houston et al., 2018) with few exceptions (Bay & Tschannen, 2017). As noted in the New Era Report (AACN, 2016), nursing schools in academic health centers (AHCs) are ideally positioned to forge these relationships, although these premises can also be applied to nursing schools that are not AHC affiliated.

Partnerships seem to die out after bursts of episodic interest that feature new start-up initiatives, in contrast to building on previous successful experiences that advance the academic/service partnership agenda to build workforce capacity and improve quality care. Importantly, the inclusion of nursing leaders into the Academic Health System (AHS) governance structure that is not dependent on personal relationships has not been widely adopted.

Successful collaborations between schools of nursing and health care service-delivery organizations are often described as dependent upon the leadership and relationship of deans with chief nurse officers. Failure to optimize these partnerships has been identified as limiting opportunities for collaboration and innovation in nursing education and patient care delivery. The partnership approach frames the solution advanced by the New Era Report (AACN, 2016). Specifically, the Report recommends adding the dean to the clinical decision-making forum as the solution. We believe that the development of sustained and committed partnerships must move beyond personal relationships and novel strategies enacted by nurse leaders. In fact, rather than focus on nurses partnering with nurses, we believe that nursing leadership needs to be incorporated into the governance structure of the AHS. Only when both academic and clinical nurse leaders participate in the governance structure will the full promise of their value be realized. Although these nurse leaders may enact roles within each other's organizations (i.e., Associate Dean for Clinical Affairs or Vice-President for Academic Nursing), we believe that the required changes go beyond the nurse executive and the dean. Fundamental change through the integration of nursing education and nursing service leaders into the governance structure of the academic health system (AHS) is required to transform care delivery systems into high-value, patient-centric organizations.

Section snippets

Purpose

This paper builds on current literature reviews and The New Era Report (AACN, 2016) and proposes a framework in which academic/clinical integration can be further achieved within AHS through an enhanced relationship between academe and clinical nursing entities. We propose that the nursing education and nursing service can be organized within the governance structure of the AHS to promote an integrated and sustained approach to full engagement of nursing education, clinical preparation, and

Background

The original AACN-AONE Task Force on Academic-Practice Partnerships concluded its work several years ago (Beal et al., 2012) Charged to initiate a national dialogue on current/future best practices in academic-practice partnerships, the Task Force completed a detailed history, reviewed and defined characteristics of successful partnerships, and proceeded to identify the impact and propose strategies for success.

The Task Force concluded there was little replicable evidence to support nursing

Historical Context

The separation of academic nursing from the clinical system accelerated following the 1965 paper published by the American Nurses Association (ANA), which advanced the position that minimum preparation for entry into professional nursing practice should require a baccalaureate degree in nursing (BSN; ANA, 1965). The BSN, awarded by accredited institutions of higher education, is grounded in liberal arts and sciences coupled with evidence-based practice, nursing science, leadership, quality

Organizational Context

The New Era Report (2016) was commissioned by AACN to assess the alignment between major stakeholders in academic nursing and AHCs. The report was based on interviews and surveys with deans of nursing and chief nursing officers, as well as deans of medicine, chancellors and vice-chancellors, and health system chief executive officers. Findings highlighted differences in perspective (read: culture) among academic nursing leaders and service delivery leaders in AHC clinical environments. Key

Institutionalizing Priority Relationships

Long-standing relationships between colleges of medicine and health care systems have renewed their focus on collaboration in light of changing contexts. In 2013, the American Association of Medical Colleges (AAMC; 2014) commissioned Manatt Health Solutions to conduct a parallel study to The New Era Report. Under the guidance of the Advisory Panel for Health Care, AAMC and Manatt developed a framework for leadership that guided AMCs to move toward a sustainable model in the future. Perhaps the

Frameworks for Alignment

We propose the Academic/Clinical Integration framework, which depicts how the enhanced integration between academe and clinical in which the AHS can better achieve the Quadruple Aim Building from two familiar models, the Quadruple Aim and the Learning Health System (LHS), the Academic/Clinical Integration Framework is illustrated in Figure 1.

The Quadruple Aim drives patient and population care experiences and outcomes, workforce preparation, and well-being, and cost of care (Shirey et al., 2020

Collaborative Benefits

While carrying out the different components of the AHS mission, AHSs compete in highly competitive health care markets, resulting in dynamic nurse labor markets. Job markets constitute a significant factor in nurse turnover, and employers often consider this element of turnover, both costly and challenging to manage. Academic health systems can minimize turnover through the strategic alignment of education and training opportunities between nursing academe and practice offering cost-effective,

Assessing Challenges and Opportunities

Moving beyond rhetoric to the changes described is complex and requires strong leadership and collaboration. The essential messages of this paper are twofold: (a) the benefits of integration can and should serve the goals of the academic health system; and (b) the work of integration requires intentionality and commitment to collaboration across the AHS, beyond nursing. The movement from a focus on the partnership between the nursing entities to understanding the strategic importance of the

Intentionality and Commitment

The transformation to alignment across education and clinical service delivery in nursing and medicine begins with a commitment by the AHS leadership to working together. An integrated structure requires a detailed agreement that provides a foundation for direction and ongoing review and serves as a “true North” when the commitment is at risk through disagreement or competing priorities. The document, based on mutual respect and the acknowledgment of the differences and overlap in

Conclusion

The value of working together in an integrated AHS leadership model has never been so urgently needed. Care is more complex and new models are needed to care for people in remote areas and those with chronic illnesses. This is particularly true for those entities that have annexed other care partners to create the academic health systems that have replaced the academic health centers. Care will be improved through population approaches that employ evidence in care design, delivery and

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