Southeastern Connecticut Report Southeastern Partners Co Leads o

Southeastern Connecticut Report

Southeastern Partners • Co- Leads o Ellen Freeman, MSN, RN, CNE, Director of Nursing and Allied Health at Three Rivers Community College o Paula Mc. Cauley DNP, RN, Associate Dean for Academic Affairs, Associate Clinical Professor, University of Connecticut School of Nursing • Faculty o Edith Ouellet, MSN, RN, Three Rivers Community College o Lillian Rafeldt, MA, RN, CNE. Three Rivers Community College o Joan K Graham, MSN, RN, CMSRN, CNE, Three Rivers Community College • Practice Partners o Mary Bylone, RN, VP and CNO Wm. W. Backus Hospital o Heidi Morse, MSN, RN, Medical/Surgical Clinical Educator, Wm. W. Backus Hospital o Lauren Williams, RN VP Patient Care Services and CNO, Lawrence and Memorial Hospital o Heather Bader, MSN, RN, CNE, Professional Development Specialist, Lawrence & Memorial Hospital

Structure • Massachusetts’ Nurses of the Future Nursing Core Competencies- 10 competencies • Practice Partners review the 10 competencies • Three Rivers Community College- TRCC o Associate degree program • 4 core 9 -credit nursing courses over 4 semesters with a clinical component second • Third and fourth semester with a pharmacology co-requisite • A Nursing Trends and Leadership course in the 4 th semester. o 8 courses were evaluated for the curricular content based on learning opportunities in the knowledge, attitude, and skill domains • University of Connecticut- UCONN o RN-MS

Process • University of Connecticut- UCONN o Evaluation of courses required in program for BS portion of the RN to MS program • 6 courses were evaluated o Research, Leadership, Ethics, Community, Asthetics and Capstone clinical praciticum UCONN’s philosophy uses the acronym PRAXIS with these behaviors emphasized and evaluated in all clinical and didactic courses: Professionalism in behavior, presentation, and conduct Respect for others, richness, and diversity, and self Accountability for actions e. Xcellence in research, practice, teaching and service Integrity and inquisitiveness Service to students, the profession and community

Process • TRCC divided the courses amongst the three faculty members. • To initiate the process: o Practice Partners review Safety, Quality Improvement after which their interpretation of theses competencies were forwarded to the Education Partners o Practice Partners and TRCC met to review the above competencies • Practice and Education partners continued their own review of each competencies • Practices Partners and TRCC met to perform a gap analysis in order for all of us to have an understanding of the process

Process continues • The Education Partner’s analysis o TRCC developed a “counting process that was unique” o After meeting and analyzing our assessment data, we came up with total learning event counts in KAS. o Our numbers appeared quite large, and after consultation with Maureen, we realized we counted a common activity (reflections for example) throughout each sub competency in each category and in each course if it was appropriate. • Therefore, we use the number or <10 events as a gap

Quality Improvement 1. Assessment of current values: o Score K-38/A-41/S-15 2. Validation of current status: o o o 3. Desired outcome in nursing programo 4. 5. Revise clinical foci and reflections for an increase of 8 opportunities Desired Outcomes- Practice Partners Gap between Nursing Program Desired Outcomes and Current Statuso o 6. K: Nursing Process, Role of nurse in lecture, reflections, virtual clinical, Sim. Chart, identify care using evidence based research, formative and summative evaluation tools, online discussions, simulations A: Reflections, formative and summative, evaluations, process recordings, geriatric case presentations, skills validation lab, post-conference S: Geriatric presentations, bed-sides reports, IDT rounds, huddles, clinical foci, formative evaluations, journal presentations Different language-i. e. micro and macro systems K 1, 3, A 1, 2, 4, S 1 a, 1 b, 2, 3, 4 GAP between Practice Partners Desired outcomes and nursing program desired outcomes

Quality Improvement 1. Assessment of current values: UCONN o Score K-19/A-6/S-11 2. Gap between Nursing Program Desired Outcomes and Current Statuso o Different language-i. e. micro and macro systems K 2, 4, A 2, A 3 a, 3 b 4, S 1 a, 1 b, 2, 3, 4 3. GAP between Practice Partners Desired outcomes and nursing program desired outcomes

1. 2. Safety Assessment of current values: o Validation of current status o o o 3. Familiarize student with HRO, we do not analysis data, can increase opportunities for handoffs/SBAR – increase in foci and reflections 8 opportunities Desired Outcomes- Practice Partners Gap between Nursing Program Desired Outcomes and Current Status o o o 6. K: Medication administration, alarms, SBAR, lectures, timeouts, SIDS prevention, newborn abduction prevention, formation evaluations, pre and post clinical discussions, online discussions A: Reflections and e. Portfolio program outcome assignment, lab referrals, clinical performance improvement plan (CPIP) S: Lab validations, formative and summative evaluations, Simulation, SBAR, Sim. Chart, EMR, post conference, hospital's intranet systems, foci, facility orientation Desired outcome in nursing programo 4. 5. Score K-30/A-18/S-25++ The students learn safety however not defined as particular design principle, K 4 c- not appropriate for a student- can be addressed in simulation Systems processes we don’t address K 1 -6 b, A 1 -6, S 3, 4 a, 4 c, 5 GAP between Practice Partners Desired outcomes and nursing program desired outcomes

Safety 1. Assessment of current values: UCONN o Score K-16/A-20/S-47++ 2. Gap between Nursing Program Desired Outcomes and Current Status o K 3, 4 a-b, A 3, S 3 3. GAP between Practice Partners Desired outcomes and nursing program desired outcomes

1. 2. Patient Centered Care Assessment of current values: o Validation of current status o o o 3. 4. 5. K: Virtual clinicals, Nursing process, geriatric presentation, cultural self assessments, theory objectives, tests, reflections, Health care culture fair, Sim chart, simulation, post conference discussions, foci, on-line discussions, clinical objectives, perioperative case studies, pediatric experiences, NCPs, Professional seminar (“the impaired nurse”) A: Reflections and review over time through e. Portfolio, formative evaluations, simulations, debriefings, clinical foci, pre/post clinical discussions, Sim Chart, on-line discussions, CLEWs, Process recordings S: Nursing process, CLEWS, journals, reflections, formative evaluations, Sim Chart, clinical foci, virtual clinical, pre/post clinical conference, pediatric response, pain assessment, Simulation, concept maps, process recording, Perioperative wordbook, Senior Center experience. Desired outcome in nursing program o o Increase experiences that focus on the IDT approach to PCC One experience across each course Desired Outcomes- Practice Partners Gap between Nursing Program Desired Outcomes and Current Status o o 6. Score K-53/A-178/S-191 The incorporation of the IDT concept K 2, 3, 5, 6, A 2 b, 3 c, 6, S 5 b, 6 a, 6 c, 6 d GAP between Practice Partners Desired outcomes and nursing program desired outcomes

Patient Centered Care 1. Assessment of current values: UCONN o Score K-25/A-38/S-57 2. Gap between Nursing Program Desired Outcomes and Current Status o Many of these concepts may be delivered in courses taught earlier in the curriculum, AD students would not be exposed to, gaps in the RN-MS courses included: o K 2, 3, 5, 6, A 2 a, 3 c, 4 b, 51, 6 a. 3. GAP between Practice Partners Desired outcomes and nursing program desired outcomes

1. 2. System-Based Practice Assessment of current values: o Validation of current status o o o 3. Familiarize student with Micro and macro-system concepts related to health care-increase opportunities for a better understanding– introduce in clinical foci at the senior level (3 rd and 4 th semesters) Gap between Nursing Program Desired Outcomes and Current Status o o o 5. K: Formative evaluations (objectives), hospital orientations, reflections, Sim Chart, CLEWs, Virtual clinical, program outcome assignment, on-line discussions, clinical foci A: Reflections, Formative evaluation objectives, CLEW, SBAR, teaching plans, medication teaching plans (pharm courses), Simulation (debriefing), Sim Chart, pediatric and perioperative assignments, perioperative case studies, and geriatric presentations, medical-surgical nursing case studies, Virtual clinical, program outcome assignment, online discussions, clinical foci S: Reflections, Formative evaluation objectives, CLEWs, Simulation, Sim Chart, Desired outcome in nursing program Desired Outcomes- Practice Partners o 4. Score K-58/A-100/S-112 Micro and macro systems are not terms or concepts we use currently in the ADN nursing curriculum Students are exposed to the concepts in the pre-requisite course: sociology K 1, 2 a, 3, 5 b, 6, A 1 a, 1 b, 2 a, 2 d, 2 e, 3 a, 3 b, 3 c, 4 b, 5 a, 5 b, 6 a, 6 d, S 1, 2, 2 d, 2 e, 3 a, 3 b, 3 d, 4 b, 5 a, 5 b, 6 GAP between Practice Partners Desired outcomes and nursing program desired outcomes

System-Based Practice 1. Assessment of current values: UCONN o Score K-10/A-13/S-6 2. Desired Outcomes- Practice Partners o Familiarize student with Micro and macro-system concepts related to health careincrease opportunities for a better understanding– introduce in clinical foci at the senior level (3 rd and 4 th semesters) 3. Gap between Nursing Program Desired Outcomes and Current Status o o Micro and macro systems are not terms or concepts we use currently in the nursing curriculum K 1, 2 a, 3, 5 b, 6, A 1 a, 1 b, 2 a, 2 d, 2 e, 3 a, 3 b, 3 c, 4 b, 5 a, 5 b, 6 a, 6 d, S 1, 2, 2 d, 2 e, 3 a, 3 b, 3 d, 4 b, 5 a, 5 b, 6 4. GAP between Practice Partners Desired outcomes and nursing program desired outcomes

1. 2. Evidence-Based Practice Assessment of current values: o Score K-85/A-68/S-37 Validation of current status o o o K: Sim Chart, Journal presentations, Discussions on-line (Trends), Reflections, pediatric responses, Case studies, Simulation, Use of peer-reviewed electronic professional web-links & use of data bases (TRCC nursing gateway), NCPs, Teaching plans, Information literacy (PICOT question skill tool), Formative and summative evaluations, development of annotated bibliography, reflections, use of a nursing diagnosis reference text A: Reflections and iterative review of development through e. Portfolio, formative/summative evaluations, teaching plans, post clinical conferences, clinical preparation, nursing process, N 103 (pharm IRB content), on-line discussions, journal presentations, Pediatric experiences/responses, Geriatric presentations, case studies, Sim Chart, Simulation S: Formative/evaluations objectives, CLEWS, teaching plans, information literacy assignments, Sim Chart, journal presentations, reflections, use of data bases, nursing gateway, and web links 3. Desired outcome in nursing program o Continue to use evidence-based practices in nursing care o Continue to have students identify evidence-based practice 4. Desired Outcomes- Practice Partners • Gap between Nursing Program Desired Outcomes and Current Status 1. o o Our curriculum does not cover formal research methodologies or learning activities K 3, 6 b, A 1 a, 5 b, 6, S 1 a, 1 b, 1 c, 4 a, 4 b, 5, 6 GAP between Practice Partners Desired outcomes and nursing program desired outcomes

Evidence-Based Practice 1. Assessment of current values: UCONN o Score K-13/A-15/S-33 2. Desired outcome in nursing program o Continue to use evidence-based practices in nursing care o Continue to have students identify evidence-based practice 3. Desired Outcomes- Practice Partners • Gap between Nursing Program Desired Outcomes and Current Status o o A formal research course with methodologies or learning activities is included in the curriculum. Professional standards are covered in a number of lower level courses. K 4, 5 A 6, S 6 1. GAP between Practice Partners Desired outcomes and nursing program desired outcomes

1. 2. Leadership Assessment of current values: o Validation of current status o o o 3. o Highlight the RN’s leadership role as a member of the IDT with regard to patient care as well as the role of “charge nurse” in the health care settings. Focus attitude and skill opportunities that develop leadership in nursing throughout the curriculum Desired Outcomes- Practice Partners Gap between Nursing Program Desired Outcomes and Current Status o o o 6. K: NCPs, Formative evaluations, teaching plans, on-line discussions (group work), Sim Charts, concept maps, clinical experiences, lectures (unit modules in Trends), leadership delegation seminar, graduate panel (rolemodeling for leadership), legislative day, SNA day A: NCP’s, reflections, formative/summative evaluations, on-line discussions S: NCP’s, concept maps, CLEW, teaching plans, psych IDT meetings, Sim Chart, collaborative on-line discussions, formative evaluations Desired outcome in nursing program o 4. 5. Score K-41/A-66/S-66 Although we don’t focus on professional nursing leadership in the ADN program, there are many opportunities; SNA (5 leadership positions), SGA -with leadership member opportunities, and various other club activities and organizations. Gaps existed on most sub categories in demonstration of leadership attitudes and skills. K 1, 3 a, 3 b, 4, 5, 6, A 1, 2, 3 b, 4 a, 4 b, 4 c, 4 d, 4 e, 5 a, 5 b, 6 a, 6 b, S 1, 3 a, 3 b, 3 c, 3 d, 4 a, 4 b, 4 c, 4 d, 4 e, 5 a, 5 b, 6 a, 6 b GAP between Practice Partners Desired outcomes and nursing program desired outcomes

Leadership 1. Assessment of current values: UCONN o Score K-20/A-32/S-41 o Highlight the RN’s leadership role as a member of the IDT with regard to patient care as well as the role of “charge nurse” in the health care settings. Focus attitude and skill opportunities that develop leadership in nursing throughout the curriculum 2. Desired outcome in nursing program o 3. Desired Outcomes- Practice Partners 4. Gap between Nursing Program Desired Outcomes and Current Status o Many of these concepts are introduced in lower level courses the AD student would not be required to take. Some would be reinforced in the advance level theory course required of the RN-MS. o K 3 a, 3 b A 4 b, 4 c, 4 d, 4 e, 5 a, 5 b, 6 b, S 4 b, 4 e, 5 a, 5 b, 6 a, 6 b 5. GAP between Practice Partners Desired outcomes and nursing program desired outcomes

1. Teamwork and Collaboration Assessment of current values: o 2. Validation of current status o o 3. Inclusion of specific strategies to prevent lateral violence. Include strategies throughout the curriculum (all 4 courses)-clinical learning objective Desired Outcomes- Practice Partners Gap between Nursing Program Desired Outcomes and Current Status o o 6. K: Formative evaluations (objectives), SBAR, reflections, Sim Chart, CLEWs, Virtual clinical, program outcome assignment, on-line discussions, clinical foci A: Reflections and iterative review of assignments over the four semesters through e. Portfolio, Formative evaluation objectives, CLEW, SBAR, teaching plans, medication teaching plans (pharm courses), Simulation (debriefing), Sim Chart, pediatric and perioperative assignments, perioperative case studies, and geriatric presentations, medicalsurgical nursing case studies, Virtual clinical, program outcome assignment, on-line discussions, clinical foci, collaborative testing (pharm), shift hand-off report (surgical lab exercise), Senior center experience, ethics module (trends) S: Reflections, Formative evaluation objectives, CLEWs, Simulation, Sim Chart, Desired outcome in nursing program, Senior center experience, teaching plans (pharm), SBAR, Virtual clinical excursions It is noted that there are teamwork and collaborative opportunities outside of the curriculum content and learning objectives: Pinning ceremony planning (student driven), SNA, and the college clubs. Desired outcome in nursing program o o 4. 5. Score K-83/A-71/S-124 The curriculum stresses professional and collegial behavior but lacks specific strategies to prevent lateral violence K 4, 6 b, 7 a, 7 b, 7 c, A 2, 4, 7 a, 7 b, 7 c, S 1 b, 3, 4 b, 5 b, 6 a, 6 b, 7 b GAP between Practice Partners Desired outcomes and nursing program desired outcomes

Teamwork and Collaboration 1. Assessment of current values: UCONN o Score K-14/A-18/S-39 2. Desired outcome in nursing program o o Inclusion of specific strategies to prevent lateral violence. Include strategies throughout the curriculum (all 4 courses)-clinical learning objective 3. Desired Outcomes- Practice Partners 4. Gap between Nursing Program Desired Outcomes and Current Status o Many of these concepts are addressed in lower level courses, the application is evident in the capstone clinical course as well as the leadership course K 2, 4, 6 b, 7 a, 7 c, A 4, 7 c, 5. GAP between Practice Partners Desired outcomes and nursing program desired outcomes

1. 2. Communication Assessment of current values: o Score K-273/A-218/S-436 Validation of current status o o o 3. Desired outcome in nursing program o o o 4. 5. K: Formative evaluations (objectives), SBAR, reflections, Sim Chart, CLEWs, Virtual clinical, program outcome assignment, on-line discussions, clinical foci, process recordings, Simulations, teaching plans, lecture discussion, lab, post clinical conferences, journal presentations, Exam review, BB use (messages & discussions with netiquette), Use of hospital EMR, Geriatric presentations, pediatric responses, jeopardy, collaborative testing, IDT rounds, Senior center experience A: Reflections, Formative evaluation objectives, CLEW, SBAR, teaching plans, medication teaching plans (pharm courses), Simulation (debriefing), Sim Chart, pediatric and perioperative assignments, perioperative case studies, and geriatric presentations, medical-surgical nursing case studies, Virtual clinical, program outcome assignment, on-line discussions, clinical foci, collaborative testing (pharm), shift handoff report (surgical lab exercise), Senior center experience, process recording, IDT rounds, Program outcome assignment and iterative review of process recordings S: Reflections, Formative evaluation objectives, Clews, Simulation, Sim Chart, Desired outcome in nursing program, Senior center experience, teaching plans (pharm), SBAR, Virtual clinical excursions, process recordings, general patient teaching plans, lecture discussion, lab, post clinical conferences, journal presentations, Exam review, BB use (messages & discussions with netiquette), Use of hospital EMR, Geriatric presentations, pediatric responses, jeopardy, collaborative testing, IDT rounds o Reinforce teaching and learning principles throughout the curriculum; covered in 101 (first semester) Enhance the understanding of group process principles (@ least 10 opportunities throughout the curriculum-based on our counting methods) Introduce strategies to for conflict management (@ least 10 opportunities throughout the curriculum-based on our counting methods)Desired Outcomes- Practice Partners Interdisciplinary communication as a norm Gap between Nursing Program Desired Outcomes and Current Status o o Teaching and learning principles are not reinforced throughout the curriculum; covered in 101 (first semester) We do not cover the understanding of group process principles as it relates to the health care team. We do not introduce strategies for conflict management K 4 a, 4 b, 4 c, 5 d, 5 e, A 2, 4 b, 5 c, S 2 a, 4 b GAP between Practice Partners Desired outcomes and nursing program desired outcomes

Communication 1. Assessment of current values: UCONN o Score K-49/A-44/S-110 2. Desired outcome in nursing program o o Reinforce teaching and learning principles throughout the curriculum; covered in 101 (first semester) Enhance the understanding of group process principles (@ least 10 opportunities throughout the curriculum-based on our counting methods) Introduce strategies to for conflict management (@ least 10 opportunities throughout the curriculum-based on our counting methods)Desired Outcomes- Practice Partners Interdisciplinary communication as a norm 3. Gap between Nursing Program Desired Outcomes and Current Status o K 5 c, 5 d, A 5 b, S 2 a, 4 b 4. GAP between Practice Partners Desired outcomes and nursing program desired outcomes

1. Technology and Informatics Assessment of current values: o 2. Validation of current status o o o 3. o Continue to offer valid and reliable opportunities for the graduate nurse to be competent and proficient in the use of clinical EMR and maintaining patient confidentiality. Possible use of additional simulation equipment to reinforce this competency. Desired Outcomes- Practice Partners Gap between Nursing Program Desired Outcomes and Current Status o o 6. K: Formative evaluation objectives, clinical orientations, Black board use, reflections, Sim Chart, Clinical EMR, Journal and Geriatric Presentations, e. Portfolio, Blackboard use, A: Clinical orientations, Formative evaluation objectives, Sim Chart, Clinical EMR, Reflections, Journal and geriatric presentations, Pediatric Responses, CLEWs, S: Formative evaluation objectives, clinical orientations, reflections, Sim Chart, Clinical EMR, Journal and Geriatric Presentations, e. Portfolio, Blackboard use, CSA 105 (pre-requisite), Simulation, Pediatric response, Clinical EMR, Pharm teaching plan, prep for clinical, use of Nursing Gateway, clinical safety equipment, web links, clinical intranet, CLEWs, Desired outcome in nursing program o 4. 5. Score K-79/A-61/S-267 K 1, 2, 3, 4, 5, 7, 8 a, 9, A 1, 2 a, 2 b, 3, 4, 5, 7, 8 a, 8 b, 8 c, S 2 a, 2 b, 2 c, 2 d, 3 c, 5 f, 5 g, 6 a, 6 b, 6 d, 6 e, 7 a, 7 b, 8 a-c, 8 h, 8 i, 9 b-e. We provide the student with opportunities to reach a basic competence level with EMR and IT systems. However we introduce TIGER as a concept in NUR 205 but could organize into a theoretical framework illustrated in the TIGER competencies. GAP between Practice Partners Desired outcomes and nursing program desired outcomes

Technology and Informatics 1. Assessment of current values: UCONN o Score K-3/A-15/S-75 2. Desired outcome in nursing program o o Continue to offer valid and reliable opportunities for the graduate nurse to be competent and proficient in the use of clinical EMR and maintaining patient confidentiality. Possible use of additional simulation equipment to reinforce this competency. 3. Desired Outcomes- Practice Partners 4. Gap between Nursing Program Desired Outcomes and Current Status many of these concepts are addressed in lower level courses, emphasis in the RNMS courses is on synthesis and application of these concepts. The knowledge and attitudes competencies are not emphasized. All the skills are addressed comprehensively. 5. GAP between Practice Partners Desired outcomes and nursing program desired outcomes

1. Professionalism Assessment of current values: o 2. Validation of current status o o 3. 10 or more opportunities (based on our counting process) to fill the gaps listed in 5 This can be achieved through clinical foci, reflections, and Simulation Realizing these experiences will focus at the novice level of nursing professionalism Desired Outcomes- Practice Partners Gap between Nursing Program Desired Outcomes and Current Status o o o 6. K: Formative evaluation objectives, remediation process, clinical orientation, Sim Chart, Clinical site EMR, Lecture content, Post conference, Clinical experiences, Teaching care plans, Simulation, Perioperative case studies, CLEWs, Lab exercises, A: Formative evaluation objectives, Wearing of uniforms in all clinical labs, Reflections, e. Portfolio iterative review of the semesters and program outcome assignment, Remediation process, Sim Chart, Teaching plans, Advisement process at TRCC S: Formative evaluation objectives, Reflections, Remediation process, Sim Chart, Teaching plans, lab exercises, Simulation, Pediatric response/discussion, Summative evaluation process, Opportunities for professional development include the membership eligibility of SNA, SGA, and Student government positions. However, this is not required. Desired outcome in nursing program o o o 4. 5. Score K-227/A-174/S-213 Noted gap is opportunities for peer review and the demonstration of life-long learning. Although we do have multiple articulation and dualadmission programs within the CT-CCNP. This is encouraged during advising. We do not have a particular ethical decision-making framework. We lack an evaluation method for students to identify conflict and to practice conflict resolution. We lack content to promote professional development in the RN that advocates for the role of the nurse K 4 b, K 5 b, K 8 b, A 3 b, A 4 c, A 7 c, A 8 a, A 8 b, S 4 a, S 5 b, S 5 c, S 7 b, S 7 c, S 7 d, S 7 e, S 7 f, S 8 a, S 8 b, S 8 c, S 8 e-i GAP between Practice Partners Desired outcomes and nursing program desired outcomes

Professionalism 1. Assessment of current values: UCONN o Score K-15/A-19/S-6 2. Validation of current status UCONN’s philosophy uses the acronym PRAXIS with these behaviors emphasized and evaluated in all clinical and didactic courses: Professionalism in behavior, presentation, and conduct Respect for others, richness, and diversity, and self Accountability for actions e. Xcellence in research, practice, teaching and service Integrity and inquisitiveness Service to students, the profession and community 3. Desired outcome in nursing program o 10 or more opportunities (based on our counting process) to fill the gaps listed in 5 4. Desired Outcomes- Practice Partners 5. Gap between Nursing Program Desired Outcomes and Current Status o K 4 b, K 5 b, K 8 b, A 3 b, A 4 c, A 7 c, A 8 a, A 8 b, S 4 a, S 5 b, S 5 c, S 7 b, S 7 c, S 7 d, S 7 e, S 7 f, S 8 a, S 8 b, S 8 c, S 8 e-i 6. GAP between Practice Partners Desired outcomes and nursing program desired outcomes

Learned • Practice Partners and Education use different language • Practice Partners uses a micro and macro systems approach • Education Partners use a patient/nurse approach • Education Partners realized that certain concepts such as SBAR and handoffs may be taught by individual faculty where there needs to be a more formal documentation in the curriculum

Suggestions • Add to course or class objectives important concepts in order that they won’t be missed, i. e. SBAR/handoffs • Review clinical foci for each level with attention on having students reflect on aspects of 10 competencies over their nursing education • Review the weekly clinical reflections with attention on having students reflect on aspects of 10 competencies over their nursing education • Consider use of the Digication Platform to promote synthesis of learning across the curriculum