placements has become increasingly problematic as more of the education of health care professionals—nurses, physicians, and other providers—moves out of the hospital. There are not enough community-based practice sites or clinical preceptors for all the students who need such clinical experience. Managed care organizations often have been unwilling to assume the costs of clinical education traditionally borne by hospitals and financed through various forms of graduate medical education funding.
Nursing has an additional challenge. There are too few examples of professional nursing practice to serve as models for the kinds of care suggested by research as essential for the future of health care delivery. The models that do exist (Barger, 1991; Buhler-Wilkerson, Naylor, Holt, & Rinke, 1998; Coenen, Marek, & Lundeen, 1996; Conway-Welch & Harshman-Green, 1995; Cotroneo, Outlaw, King, & Brince, 1997; Counts & Boyle, 1987; Dreher, Everett, & Hartwig, 2001; Evans, Yurkow, & Siegler, 1994; Grey & Walker, 1998; Lang, Sullivan-Marx, & Jenkins, 1996; Marek, Jenkins, Westra, & McGinley, 1998; Naylor & Buhler-Wilkerson, 1999; O’Sullivan & Jacobsen, 1992) are not widely available for use in education. Yet the preparation of nurses at the undergraduate and graduate levels requires greater access to laboratories for clinical learning that show and involve students in delivery of care in which best evidence-based nursing practice is integrated.
The University of Pennsylvania (Penn) School of Nursing has been a leader in the development of academic practices that integrate the tripartite mission. Since the 1970s, the school has embarked on practice partnerships and faculty practices. Since 1995, under the umbrella of the Penn Nursing Network (PNN), the school has launched and operated a range of community-based clinical practices (Evans et al., 1999; Lang et al., 1996; Naylor & Buhler-Wilkerson, 1999). Through PNN, advanced practice nurses provide best practice models of community-based, family-focused health care services to people of all ages in a variety of settings—from newborns to the frail elderly—with emphasis on vulnerable populations. Services have ranged from primary care and health promotion to tertiary care in the community. They have included nurse midwifery, well-child care, preteen and adolescent care, family planning, women’s health, primary care for children and adults, continence, gerontologic consultation, and, for frail older adults, comprehensive rehabilitation and integrated acute and long-term care. The practices also have spanned the full continuum of organizational and financial arrangements, from fee for service to fully capitated and blends of both.
Penn’s experience in developing PNN has shown that academic practices, though challenging to implement and maintain, are essential to achieving a fully integrated mission (Evans et al., 1999; Lang et al., 1996). These academic practices serve as living laboratories in which students are exposed to clinical information, research, and management experiences that go well beyond traditional clinical learning. In most practice arenas, it takes at least a decade before research outcomes find their way into common practice (Eisenberg, 2001; Lang, 2001). Academic nursing practices such as those of the PNN can provide a forum for rapid implementation of best practices that affect the quality and effectiveness of clinical care delivery. Such settings can, thus, change the nature of community-based nursing practice within one generation rather than
Author’s final copy prior to publication. See J Prof Nurs 18(2):63-69, March-April 2002, for the copy of record. Copyright 2002, Elsevier, Inc. All rights reserved.