We identified five key characteristics and five key processes (refer to figure). A substantial body of literature was noted describing the characteristics and processes of the DEU model as they related to initial planning, adaptation and implementation Less research was available related to continuous improvement, evaluation and sustainability. We note that these critical characteristics and processes require commitment and sustained dialogue, shared visions for nursing practice, and generous cross-use of resources and infrastructure. Overall, the results of this scoping review reinforced the need for continued innovation in developing practice education models aligned with change in health delivery systems, to be followed by careful evaluation and continuous improvement for long-term sustainability.

Overall, we noted a pattern of substantial initial collaboration, investment and expansion followed by embedding of the CLU model as the primary practice education approach for senior BSN students who were consolidating their learning, despite changes and reductions in infrastructure during these years across healthcare and post-secondary education sectors (refer to timeline for these changes). We suggest that limited intentional focus on sustainability in and between academic and healthcare organizational contexts over time contributed to some erosion of nursing education infrastructure and potentially dilution of the positive impact of this practice education model. Despite these challenges, student placement data patterns in Victoria indicate that without the CLU model, it would be significantly more challenging to return to relying on the preceptorship model for senior practice education courses, particularly as many of the initial contextual factors endure. The CLU model, along with other practice education models, continues to evolve in response to shifting practice contexts. However, these models remain vulnerable to ongoing healthcare and post-secondary infrastructure challenges. We propose that one way forward is through intentional renewal and maintenance of academic-practice partnerships through the development, implementation, sustainability and surveillance/evaluation of the multi-institutional infrastructure required to support the CLU model and other practice education models. We also suggest expansion of the CLU model to emerging practice contexts that address population health including community care and population health, mental health and substance use (MHSU), senior’s health and Indigenous health.

Marcellus, L., Jantzen, D., Vermes, F., & Sawchuck, D. (2022). From innovation to embedded practice: Reflecting on the 20-year journey of implementation of a Collaborative Learning Unit practice education model in Victoria, British Columbia. Quality Advancement in Nursing Education, 8(1), Article 2.

Responses from all groups in the survey had similar patterns, regardless of whether the response was from a nurse, student, or faculty member. The majority of respondents felt that the staff and learning environments were supportive of student learning experiences and contributed to a culture of inquiry. Few nursing staff reported having training opportunities or demonstrated awareness of student learning objectives. Nurses reported lower scores than students and faculty for putting evidence into practice, with the highest scores from faculty. Five key themes emerged from the qualitative data: (1) concerns that supervision and accountability are not as rigorous as with the preceptorship model; (2) heavy practice setting workloads influence the ability of nurses to mentor students; (3) the opportunity to work with a range of nurses provides variety for learning but also less consistency for students who need more guidance; (4) limited collaboration and partnership was noted between practice and education; and (5) there was limited clarity and communication about roles and responsibilities in this model compared to preceptorship. Patients appreciated the care provided by students but were sometimes not clear about the type of student they were and their level of learning. There is a need for increased academic – practice infrastructure to ensure systematic and regular communication between education and practice at multiple levels to sustain effective and rigorous nursing CLU models.