Courses are appropriate if the faculty and staff believe and agree that the site can provide learning activities for students that meet course competencies. Ideally, components of ECLEPs courses have benefits for the clinical site (e.g., students take on 'real world' assignments that fit with both their competency goals and the facility's needs). In the pilot project, ECLEPs Sites were rated high by students and faculty as clinical settings that helped students meet core competencies.

The pilot project used the Chronic Illness 2 course developed through the Oregon Consortium for Nursing Education (OCNE). Because of the high prevalence of multiple and complex chronic and mental health conditions found in residents in these settings, LTC provides a rich learning environment for students to learn assessment and chronic care management skills. ECLEPs is now being adapted for Chronic Illness 1, Health Promotion, and Leadership courses. Other courses being considered include Community Nursing and Integrative Practice.

Basic knowledge in the following content areas is needed for faculty in LTC settings:

• Person centered (or directed) care
• Culture change
• Supervisory skills including delegation to certified and unlicensed staffs
• Age-related changes
• Common geriatric syndromes (falls, incontinence, delirium-depression-dementia, polypharmacy, functional assessment)
• Oregon community-based residential care options including financial aspects and role of the nurse in these settings. These include SNFs/ICFs, assisted living, residential care, foster homes, and private home.
• Nursing practice in community-based residential care

Faculty development workshops are provided for faculty joining the ECLEPs project. Additional resources and expert geronotologic faculty within the OCNE curriculum are available to assist faculty. All ECLEPs faculty receive a copy of the "Threads of Tapestry" CD-rom and a copy of the reference book, Evidence-Based Geriatric Nursing Protocols for Best Practice. See Tool Box for more information.

The CELs are available as resources for faculty at the ECLEPs site. Part of the CEL role is to welcome and orient faculty and students to the agency, and to be an ongoing resource in developing learning experiences. Partnership and mutually beneficial learning are central to ECLEPs, and CELs can help faculty become familiar with their residential care setting.

The faculty gets to know the site prior to student placement, and establishes and maintains communication throughout the clinical experience. Communication is critical to building effective relationships and trust. Faculty should always err on the side of over-communicating. This includes written and oral forms, including email, face-to-face, and phone contacts as appropriate.

One to three weeks prior to the beginning of the course, the faculty orients to the facility with CEL guidance. At this time the faculty provides the CEL with specific written information about the course and student learning objectives, the student schedule, and specific learning activities on a week by week basis. If changes in the schedule or learning activities occur, the faculty notifies the CEL.

During the term when students are present, faculty checks in with the CEL at least weekly. Daily base touching may be appropriate. This process helps to identify and solve problems or challenges that arise as early as possible.

HINT: One faculty cc'd the CEL on weekly emails to students where the clinical goals for the upcoming week were identified. The CEL found this very helpful as a quick way to be current regarding the students' upcoming focus and schedule. Some faculty and CELs have together 'rounded' on residents with the students. This activity was well received by students, and enabled them to observe experienced nurses sharing their perspectives on the same resident including their approaches to care. Faculty may ask the CEL to attend some post conference discussions when a 'facility perspective' is helpful. Other agency staff (e.g., social worker, administrator) may also be invited to attend post conferences.

Just as in traditional clinical courses, learning activities are developed with the competencies in mind. Learning activities that have been used in other settings may transfer with little or no modification to the ECLEPs site. However, faculty may want to modify existing course learning activities for use in the nursing facilities and community-based care (CBC) settings or to take advantage of unique aspects of the settings. For example, students in nursing facilities may conduct assessments using the Minimum Data Set (MDS). Examples of learning activities are located in Tool Box.

As with all courses, activities based on adult learning principles and best instructional practices are the most engaging and effective with students. The approaches developed for clinical redesign by OCNE are appropriate and include concept-based learning, focused direct client care, integrative practice, intervention skill-based experience, and case-based learning. Examples of learning activities using these approaches are located in the Tool Box.

Existing protocols for determining student clinical assignments should apply to ECLEPs sites. In the pilot project, students had three options for settings: long-term care (nursing facilities, assisted living, memory care), a children's hospital focusing on chronic conditions, and a chronic mental health setting. Students identified their preferences and most received their first or second choice. In the rural replication project, most of the students enrolled in the course will spend some time in the ECLEPs sites.

Our experience indicates that students benefit from some pre-clinical discussion about their placement in an ECLEPs site. This discussion focuses on the unique partnership features of the setting including the role of both CELs and faculty in the setting. Students need to understand that faculty are responsible for the students' learning, faculty evaluate student performance and assign grades, yet the CELs are available to facilitate student learning by discussing facility resources and care scenarios with the students.

Many students need a preview of the setting and its richness for developing assessment and decision-making and other nursing skills. Many students are concerned that they will not practice or maintain their technical skills in LTC settings. These students need coaching to understand that although these settings, particularly assisted living and residential care, may not have the technological equipment and resources found in hospital settings, the level of nursing skills employed in these settings are of the highest order. Numerous opportunities exist for students to practice the following skills in the LTC setting: assessment, clinical decision-making, prioritizing care, person-centered care, interpersonal communication and team work. The following are a few experiences available in the LTC setting:

Students with an interest in working with older adults after graduation will have hands-on opportunities to gain clinical experience under the direction of knowledgeable and skilled nurses. Students who have not yet considered LTC careers will gain greater insight into care of older adults and LTC; this will benefit their practice regardless of the career path ultimately chosen. Furthermore, it may pique their interests in nursing practice outside of the hospital setting. Finally, older adults are the 'core business of health care' (Mezey, DATE), and the LTC setting is an excellent environment for honing practice skills with older adults.

Students participating in the pilot project found CELs to be positive, knowledgeable role models. They also reported more positive experiences working with older adults through the ECLEPs sites than they reported they had through their previous clinical experiences in LTC settings. Students assigned to ECLEPs sites were more likely than other students to imagine themselves working with older adults in their careers. Students also reported that the ECLEPs experience prepared them for effective transitional communications with nurses in the LTC setting during transitions (admissions and discharges).

Ideally the students are at the ECLEPs site for a full course rotation. Sustained presence at the site fosters 'deep' learning by students, and enables them to engage in meaningful activities on site. Alternatively, the ECLEPs site may be used for multiple courses so that students get to know the facility well over the course of their student careers. Faculty may have students re-visit the ECLEPs site for additional clinical experiences after the target course ends.

In both approaches the goal is to facilitate student/staff familiarity with each other, and student familiarity with the setting. This results in less time needed for the student to orient to the setting. Students and staff need to have clarity on the goals for re-visits to the site-how the learning experience/activities will be demonstrated. Setting familiarity may facilitate opportunities for in-depth learning in courses including leadership, population health, and integrative practicum.

Students may have additional, off-site learning experiences during the course. Faculty need to notify the CEL and other appropriate site staff in advance when students will not be on site during regularly scheduled clinical hours. Written and verbal notifications are desirable.

This is determined by the faculty and CEL/site based on factors used in all student site placements.

Students engage in course learning activities as at any other site. Students talk with the CEL and other staff, residents, and family members as appropriate, to tailor their learning experiences in ways that take advantage of being in the setting. Because this is a long-term partnership, the CEL and faculty may have identified specific projects that are either ongoing or need to be initiated by the students. These projects are selected based on both site needs and student learning needs.

Supervision is determined in ways similar to non-ECLEPs sites. CELs are not clinical teaching associates and are not responsible for formal evaluation of student performance. CELs are available to help students identify learning opportunities/resources in the facility, to demonstrate 'thinking outloud like a nurse', and to be involved in other student-related activities that the CEL and faculty have negotiated. CELs do not assign grades. For more information, see role descriptions in the tool box for CELs, faculty, and students.

Faculty determines post-conference schedules and activities in ways similar to other clinical post conferences. In previous ECLEPs courses, students have shared and discussed the commonalities and differences among various LTC clinical placement sites in post conference. The discussions depend in great part on the course objectives/competencies. CELs and other facility staff have sometimes attended post conferences either to present information (e.g., social worker discussing patient transitions; CEL attending a case study presentation or discussing the role of the RN in LTC ; differences and similarities to the RN role in acute care) or to add their setting/role-specific perspective to the topic being discussed. See Tool Box for suggestions for post conference activities