The clinical education liaison is typically a registered nurse who bridges the clinical setting and the students who come to the long-term care setting with specific learning goals. The CEL normally works with 1-3 students during the clinical course. The CEL works with his/her organization to develop the site as a learning community for staff as well as for students. See Toolbox for CEL role description.

Student career goals are often shaped by their clinical experiences. Effective and satisfying clinical learning is largely dependent upon the staff nurses who mentor and guide students. Currently, LTC programs face nursing shortages and high turnover. More nurses with LTC expertise who can serve as positive role models are needed to recruit nursing graduates into LTC careers.

The major role of the CEL is to help students understand the role of a nurse in the long-term care setting. At least one CEL should be an RN. However, other staff can contribute to student learning and may include social workers, LPNs, administrators. CELs who are not nurses but working in partnerships with nurse CELs helps to emphasize and serve as a role model for the interdisciplinary nature of LTC. The key is to select CELs who are committed to student education and staff development and have the time and resources needed to perform the role.

See Tool Box for a description of CEL roles. These include:

• Participates in the CEL training program to learn about course goals and assignments
• Is knowledgeable about best practices in gerontologic nursing and current trends in residential care systems (e.g., culture change, resident-centered care, empowering staff, leadership at point of care).
• Explains course goals and learning assignments to other staff, patients, and families.
• Working with faculty, arranges initial student orientation activities.
• Facilitates faculty/student introductions to staff in other departments, and residents and their visitors as appropriate (e.g., assisted living facility, physical therapy, hospice RN; residents who may participate in student learning.
• Assists students in identifying facility opportunities, activities and resources that support student learning.
• Acts as a resource and 'friendly face' for students (practical info, resources, clinical judgment, project ideas)
• Advocates for student learning to other staff.
• Meets briefly with students at some point during the clinical day to review learning goals/activities.
• Shares her or his own expertise with students when opportunities ariserovides constructive feedback to students.
• Supports student creativity in approaching their assignments/activities (within boundaries of facility/unit).
• Meets regularly with faculty to discuss clinical activities including strengths/weaknesses of course implementation and student performance for problem identification and resolution.
• Participates in ECLEPs project evaluation.

CELs meet with faculty in advance to discuss the upcoming clinical experience including how they will communicate with each other. The CEL and the faculty need to share expectations about their own and each other's roles, how students will be oriented to the agency including meeting residents and staff, the course-related learning goals, and the students' schedule. Most importantly, they need to clarify how they will communicate with each other. Prior to a group of students coming to the agency, the CELs should have had some introduction to the course and clinical design, and faculty should have spent time orienting to the facility. CELs also benefit from knowing strategies that:

1. Help students 'think out loud like a nurse,'
2. Facilitate brief and focused discussions about resident situations with students, and
3. Provide constructive feedback to students.

Communication is key to establishing partnerships between faculty, CELs, and the clinical site as a whole. As described in Part 1, Faculty should meet with CELs prior to student placement to learn more about the clinical site and what it has to offer to students. At that time, CELs should receive copies of the syllabus, learning objectives for students, and assignments. Ideally, CELs will contribute to the development of learning activities to best take advantage of the learning environment and create deep understanding of students for the LTC environment.

Together, CELs and faculty can identify clients/residents for students to work with. Faculty should be available to support the CEL during student placement, share gerontological nursing resources and resources promote organizational development, and discuss student progress. Faculty are also in an excellent position to provide feedback to CELs about their role. More specific information about faculty roles is described in Part 1.

Faculty and CELs need to plan in advance how they will together manage difficult situations. Challenging situations are inevitable, and a key part of growing a learning community is developing respectful and trusting relationships. Examples of these include students presenting unprepared to the clinical site or behaving on site in ways that are considered inappropriate by the CEL/facility. Also, students and faculty may observe procedures within the agency that differ from their understanding of current best practices. How will the faculty and CELs discuss and resolve these types of issues? CELs and faculty need to acknowledge that these situations will arise and recognize these as opportunities for growth that can lead to better care of residents and professional development for students, faculty, staff, and the organization.

The time will vary from one facility to another based on the facility, the amount of time students are in the setting, and course requirements. CELs need some release time to schedule students with other LTC staff (e.g., nurses, social workers, administrators, CNAs, RCMs, therapists). CELs typically meet with students for a period of time each week to talk about residents, their needs, and the role of nurses in meeting those needs. CELs are also available during the day to respond to student questions and be alert to and direct students to learning opportunities as they emerge. Although CELs spend a portion of their day with students and supporting student learning, students work relatively independently and under the direction of faculty. CELs are not 'preceptors' or 'clinical teaching associates' partnered with a specific student over a term. CELs are not responsible for evaluating student performance or for planning learning experiences. Faculty usually have a presence in the setting for at least a portion of the time students are present.

In the pilot project, students spent two days a week during a 10-week term except for four days when they were in the simulation lab. This provided students the opportunity to get to know the facility and how it works, and participate in some in-depth activities with residents and staff (e.g., follow a resident over time; develop a teaching project).

In other applications of the ECLEPs program, students might spend as little as two days in a single clinical setting or may have experiences in more than one long-term care settings, such as spending two days in a nursing facility and two days in an assisted living facility.

Regardless of length of time students spend in LTC, it is important that they engage with LTC nurses to learn about the nursing role and develop a basic understanding of the long-term system.

CELs are in a unique position within their organizations. They are selected because of their excellent gerontological nursing skills and their abilities to mentor students and other staff. Administrators and managers can recognize this expertise by supporting preceptor development in the form of release time to attend CEL training activities and through workload accommodations for CELs when students are present. Administrators, managers, and other staff can work with CELs to assure that students feel welcomed in the organization (e.g., meeting with students, explaining their own roles in long-term care, participating in student learning activities coordinated by the CEL).

Organizations can also support the leadership and organizational development roles of CELs, by making commitments to be learning organizations. That is, ECLEPs sites benefit most when they take advantage of training opportunities for their entire staff that are part of CEL development. Details are presented in discussion below of preparing to be a CEL.

1. CELs report they enjoy working with students and feel students make important contributions to the organization. CELs feel that the benefits of having students outweigh challenges: students bring new energy to the organization and interact well with residents and staff. Furthermore, CELs describe students as motivated and willing to learn.
2. ECLEPs sites that are part of the grant funded project have access to training, consultants, and other educational resources that benefit the entire organization. Part of the CEL training, described in Part 3, includes evidence-based training programs (i.e., LEAP, Coaching Supervision) that facilities can use to support and enhance their own staff development and staff retention activities. Although these programs contribute to CELs skills to work with students, they were originally designed to support relationships between nurses and other staff, including direct care workers (e.g., CNAs, caregivers). Thus, the benefits of the ECLEPs training program will reach far beyond CEL-student-faculty relationships.
3. Being an ECLEPs CEL also means becoming part of a peer network of other nurses engaged in student and staff education. CELs can share information, resources, and strategies that have been helpful. Networking also provides opportunities to explore solutions to common problems and learn from one another.

A major objective of ECLEPs is to build a peer support network to support the CELs. Ongoing networking across organizations is beneficial in promoting sustainability and supporting those involved in practice and workforce change initiatives. The CEL development program is designed to foster relationships among the CELs, using a variety of learning activities that facilitated sharing information and/or working together in small groups.

Two professional organizations, the Community Nursing Network and the Oregon Center of Nursing LTC Leadership Task Force, provide forums for nurses involved with student education. Efforts are being made to expand this support to southern Oregon.

A website has been developed to support CELs (www.ecleps.org). Soon it will offer opportunities for peer support through discussion forums, connecting CELs from the pilot and replication ECLEPs projects.