WHERE DO WE FIT AND WHAT SHOULD WE DO? (PART 1)
Where does your education department fit into the organizational structure? To whom do you report? How is the department organized and how does it function? These are all important questions. But there are even more crucial questions. Should it be that way? What can you do if you think things should be different?
There are several different organizational approaches to education, each with its own strengths and weaknesses. If you poll groups of educators as to the best approach, you will probably find as many opinions as there are people in the group. For years, the most common model was the centralized nursing education department. Typically, the department manager reported to either the director of nursing or an associate/assistant director, and the education director supervised a number of registered nurses who taught nursing orientation, nurse aide classes, and inservice classes on various nursing topics. The advantages of a completely centralized department include strong identification and loyalty of instructor staff, clear lines of communication, common goals, and defined expectations of what the department is supposed to accomplish. Disadvantages include no hospital-wide education (because nursing is the focus), limited bedside contact, a perception among staff nurses that the instructors lack clinical expertise, and vulnerability to budget cuts ("Do we really need education?").
In an attempt to address these and other concerns, some hospitals pioneered a decentralized approach to nursing education. The department director reported to a vice president-sometimes nursing, sometimes human resources. Instructors were assigned to cover nursing units, usually by specialty area. Instead of classroom instruction (except for orientation), instructors were expected to do more unit inservice classes and one-on-one bedside teaching. Although "traditional" nursing instructors worked in decentralized departments, the newer role of clinical specialist began to emerge, with the emphasis on clinical expertise. Advantages of the decentralized approach include more identification with nursing units and staff, higher profile with nursing administration, more patient contact, and a better feel for the nurses' education needs. Disadvantages include little emphasis on education for nonnursing departments, job dissatisfaction among instructors who enjoy classroom instruction, difficulty communicating within the department, and inefficiencies in using education staff cohesively and effectively.
Having worked in both centralized and decentralized departments, I believe that a hybrid model works more effectively than either of the "pure" approaches. Through trial and error, most of us have developed departments that centralize some functions (e.g., general orientation, grand rounds, record keeping, and hospital-wide classes such as safety, HIPAA, JCAHO preparation) and decentralize others (e.g., unit-specific information, new equipment inservice classes, and unit rounds). Many education directors now have a wide range of positions reporting to them, including instructors who specialize in classroom instruction, clinical specialists and other advanced practice nurses who practice and teach on the units, nonnursing instructors responsible for support and clerical department education, audiovisual specialists, biomedical artists, and informatics practitioners who develop computerized instruction and learning laboratories containing sophisticated patient simulations.
The challenges in dealing with any of these approaches include (a) keeping the department relevant to the organization and its strategic plan, (b) adapting to the rapid pace of change in healthcare, (c) juggling multiple priorities, and (d) keeping educational practitioners satisfied with their jobs and with the department and its direction.
One of the most crucial parts of keeping the department relevant is its position in the organizational structure. I have experienced departments reporting to the director/vice president of nursing, the director/ vice president of human resources, the chief operating officer, the vice president of the medical staff (!), and the chief executive officer. The structure that worked best was reporting to the chief operating or chief executive officer. The one that worked worst was reporting to the director/vice president of human resources (yes, it was even worse than reporting to a physician). Of course, part of this is affected by the personalities involved, but structurally, reporting to the chief operating officer or chief executive officer not only emphasizes the vital nature of education in today's healthcare environment but also keeps the department on the cutting edge of organizational developments and strategic direction.
Too often, education directors "keep their heads down" to avoid attracting attention to their departments. Unfortunately, this is an excellent way to be seen as unnecessary to the organization. Don't let them make you irrelevant-and even more importantly, don't make yourself irrelevant. If you feel shoved to one side or ignored in the organization, it's up to you to refocus your efforts and make everyone pay attention. Part of that can mean presenting a case for reporting to someone other than the person to whom you currently report, as well as clearly communicating what the education department can bring to the organization and its staff.
In the next column we'll talk about how to develop and present this information to the Powers That Be in a way that will show your department in the best possible light and catch the attention of administrators. (If you have already done this successfully, please e-mail to me what you have done at [email protected] and I will share your approach with everyone else.) Together, we can do this-education is critical to healthcare success, and we will demonstrate that fact to our respective organizations.