The Health Resources and Services Administration have estimated the requirement of nurses at 800,000 full-time equivalent nurses position by the year 2012 (Yordy, 2006). However, American Association of Colleges of Nursing [AACN] (2008) has reported that 40,285 qualified applicants to entry level baccalaureate and graduate nursing programs have been turned away in United States in the year 2007 mainly because of shortage of qualified faculty. On the contrary AACN (2008) data indicate that 814 faculty positions were vacant in 449 reporting schools which implies that approximately 3 positions per school have fallen vacant (Fang & Hut, 2008). The lack of qualified nursing faculty and the resultant nursing shortage has been well addressed by literature (AACN 2008; Zungolo, 2004). The current environment characterized by the increasing shortage of nurses, larger number of students desirous of enrolling into baccalaureate nursing courses and scarcity of trained faculty calls for creative solutions, if the current and future need for nurses are to be met successfully. Assuming that sufficient faculty resources have been created and larger number of students has been admitted to various nursing programs, there is still the concern of orienting the people leaving the institutions to meet the needs of older adults (Ganley, 2009). Guided clinical learning experiences form the basis for an effective nursing practitioner education (Burns, Beauschesne, Ryan-Krause, & Sawin, 2006). Present day nurses are expected to assimilate and manage a large amount of complex information which calls for integrated curriculum approaches using resource-based process methods. Well-prepared clinical faculty will facilitate the enhancement of student experience and this is more so when experienced clinicians adopt the role of educators. This endorses the view that there is the need to evolve qualified clinical educators and it is for the institutions and hospitals to readily prepare the novice adjunct clinical educators. In this context this thesis addresses the need for transition of prospective candidates from clinician to the role of educator. Such transition is expected to meet the twin needs of filling the shortage of qualified faculty and at the same time better orienting of the students to fulfill the expectations of improved and quality service delivery from them. However the transformation of clinicians to educators poses its own challenges. Although the clinicians possess knowledge and expertise in their given areas, they may not be expected to possess the skills required in an academic setting to become educators (Krisman-Scott, Kershbaumer, & Thompson, 1998). Insufficient preparation in the area of knowledge and skills required in the domain of education is the only one aspect of challenges faced by expert nurse clinicians who take up the role of educators. The role of educator has been perceived to be one which has to add more than the accumulation of a new knowledge or skill. The transition of clinician into educator involves assimilation of new set of values and norms and it also entails the development of an altogether new identity (Culleiton & Shellenbarger, 2007).
The purpose of this study is to elaborate a new plan which will be inclusive towards improving novice adjunct clinical educators, formerly a clinician, in adapting in their new role as an educator. Such work-role transition is defined as the human experience which is closely associated with the entry into a new community of practice different from nursing. Anderson, (2003) identifies this as a dynamic developmental process embedded with emotional work and critical tasks. It can also be viewed as diffusion through role boundaries which provide the incumbent with new identity, values, and knowledge base pertaining to the new role. Based on these contextual boundaries, the current thesis elaborates a project that embarks on the development of an orientation curriculum with modules that will enable the novice clinical faculty associate to become less apprehensive in transitioning from an expert clinician into the role of a clinical educator. The knowledge and skills acquired though the use of this orientation plan will become essential for their success in the clinical adjunct faculty role (O’Connor, 2006).
Education programs covering health professional courses normally include fieldwork or clinical education as an integral part of their curriculums. Clinical educators are expected to train the students in this part of their education to make them competent beginning practitioners, enabling them to acquire sufficient knowledge in evidence-based practice. This requires the preparation of clinicians to be ready for a complex and demanding role of an educator. Apart from the need created by the curriculums, there is the shortage of nursing faculty which also enlarges the need for more number of clinicians to turn into educators. The AACN 2006-2007 enrollment survey reports that 71 percent of the respondents cited the shortage in nursing faculty as the main reason for limiting the student admission to nursing courses (Ganley, 2009). In order to meet the shortage in nursing faculty one of the major sources is the transformation of clinicians to academicians forming part of the faculty. However, such work-role transformation creates different set of issues to be addressed. While advanced knowledge and skill in clinical areas is considered essential for the role of an educator, clinical expertise alone is not found to be sufficient in preparing the clinician for performing an academician’s role (Davis, Dearman, Schwab, & Kitchens, 1992). Efficacy in transmission to faculty role therefore turns to be an issue requiring serious consideration. Lack of available baccalaureate or masters prepared clinical nurses who could understand the faculty role with regard to effective teaching in the clinical practice environment has always been an issue needing attention (AACN, 2007).
The shortage in nurses has drawn the attention on the competencies of nursing faculty, since the faculty plays a vitally important role in the recruitment and retention of aspiring students to become nursing practitioners. Because of the immediate need for increasing the faculty positions, many of the nurses have accepted faculty positions with limited competencies as educators. Therefore preparation of the faculty role becomes critical not only for the success of the novice faculty members but also for the improvement of service delivery to the public (Kelley, 1990). The lack of adequate competence to meet the educational/clinical-training needs of prospective nursing students is perceived by this paper as a problem needs addressing forthwith.
Review of Evidence
The PICOT question which guided the literature search for this project is: Among novice clinical adjunct faculty (P), how would orientation modules (I) compared to no orientation (C) affect the efficacy of clinical education in undergraduate nursing students? (O). The Academic Search Premier, Cochrane Cumulative Index for Nursing and Allied Health Literature (CINAHL), Medline, and PubMed databases were searched. Limits used in the search of the databases included English. Keywords and combinations of these keywords included: orientation modules, nurse faculty shortage, part time clinical faculty, adjunct faculty, adult learning, and self-directed learning with modules, face-to-face orientation, and clinical education, nursing education, self efficacy and novice educators. A total of 884 articles from CINAHL resulted in potentially nine articles helpful to answer the question; 198 articles from Academic Search Premier resulted in potentially eleven related articles; 41 articles from Medline resulted in potentially eight articles; and 91 articles from PubMed resulted in potentially nineteen related articles. The Cochrane Library of Systematic Reviews revealed four systematic reviews with potentially one related to the search question; however, the Cochrane Central Register of Controlled Trials produced no randomized control trials potentially helpful to answer the PICOT question. A review of 61 abstracts resulted in nineteen articles, of which one was a systematic review about strategies to ameliorate the nurse faculty shortage by hiring more part-time faculty, including adjunct clinical educators, who were critically appraised to help answer the PICOT question. A review of the literature one month after the initial review revealed two potential articles resulting in addressing the PICOT question.
Literature about Nursing Education
The Health Resources and Services Administration have estimated the requirement of nurses at 800,000 full-time equivalent nurses position by the year 2012 (Yordy, 2006). However, the American Association of Colleges of Nursing [AACN] (2008) has reported that 40,285 qualified applicants to entry level baccalaureate and graduate nursing programs have been turned away in United States in the year 2007 mainly because of a shortage of qualified faculty. On the contrary, AACN (2008) data indicate that 814 faculty positions were vacant in 449 reporting schools which implies that approximately three positions per school have fallen vacant (Fang & Hut, 2008). The lack of qualified nursing faculty and the resultant nursing shortage has been well addressed by literature (AACN 2008; Zungolo, 2004). The current environment—characterized by the increasing shortage of nurses, larger number of students desirous of enrolling into baccalaureate nursing course and scarcity of trained faculty—calls for creative solutions, if the current and future needs for nurses are to be met successfully. Assuming that sufficient faculty resources have been created, and larger numbers of students have been admitted to various nursing programs, there is still the concern of orienting the people leaving the institutions to meet the needs of older adults (Ganley, 2009).
Guided clinical learning experiences form the basis for an effective nursing practitioner education (Burns, Beauschesne, Ryan-Krause, & Sawin, 2006). Present day nurses are expected to assimilate and manage a large amount of complex information, a situation which calls for integrated curriculum approaches using resource-based process methods. Well-prepared clinical faculty will facilitate the enhancement of student experience and this is even more the case when experienced clinicians adopt the role of educators. The fact that expert clinicians as academicians will enable students to expand their knowledge endorses the view that there is the need to develop qualified clinical educators and it is the responsibility of institutions and hospitals to readily prepare the novice adjunct clinical educators.
In this context this thesis addresses the need for the transitioning the expert clinicians to novice educators. Such transition is expected to meet the twin needs of filling the shortage of qualified faculty and at the same time better orienting of the students to fulfill the expectations of improved quality of service delivery from them. However the transformation of clinicians to educators poses its own challenges. Although the clinicians possess knowledge and expertise in their given area, they may not necessarily be expected to possess the skills that an academic setting requires to become educators (Krisman-Scott, Kershbaumer, & Thompson, 1998).
Insufficient preparation in the area of knowledge and skills required in the domain of education is only one aspect of the challenges faced by expert nurse clinicians who take up the role of educators. The role of educator has been perceived to be one which has to add more than the accumulation of a new knowledge or skill. The transition process of clinician into educator involves assimilation of new set of values and norms, and it also entails the development of an altogether new identity.
The purpose of this study is to elaborate a new plan which will be inclusive towards improving the teaching skills of novice adjunct clinical educators, formerly clinicians, in adapting to their new role of educator. Such work-role transition is defined as the human experience which is closely associated with the entry into a new community of practice different from nursing. Anderson, (2003) identifies this as a dynamic developmental process embedded with emotional work and critical tasks. It can also be viewed as a diffusion through role boundaries which provides the incumbent with new identity, values, and knowledge base pertaining to the new role. Based on these contextual boundaries, the current thesis elaborates a plan that encompasses development of an orientation curriculum with modules that will enable the novice clinical faculty associates to become less apprehensive about transitioning from an expert clinician into the role of a clinical educator. The knowledge and skills acquired though the use of this orientation plan will become essential for their success in the adjunct clinical faculty role.
The topic of preparation and needs of new faculty have been addressed by the literature for a long time. Fitzpatrick & Heller (1980) deal with the previous studies regarding the preparation of nurse educators. Choudhry (1992) elaborated on the minimum core competencies for the faculty role, suggesting several avenues for realistic preparation and the support of new teachers. DeYoung, Bliss, and Tracy (2002) identified education courses or certification programs for clinicians who would like to turn to academia. Krisman-Scott, Kershbaumer, & Thompson (1998) suggested a teacher education program devised to prepare nurse practitioners and midwives for the faculty role. Previous studies and research have added to the body of knowledge about the ways in which clinicians can be prepared for the new faculty role and can make the adjustment in order to be able to perform better (Choudhry, 1992; DeYoung & Bliss, 1995; Krisman-Scott, Kershbaumer, & Thompson, 1998).
Educating Clinicians in Academia
Every year there are significantly numerous job opportunities open in the field of nursing despite the fact that a large number of nursing graduates are added to the workforce seeking jobs. It can be seen that although there are enough nursing graduates per year, the jobs remain unfulfilled because of the fact that retention is a challenge in the employment of clinical nurses. Retention implies encouraging employees to remain in their respective areas of work as long as possible. One reason why the rate of retention is low in the field of clinical nursing is due to insufficient job satisfaction (Garbee & Killacky, 2008; Burns et al., 2006; Anderson, 2008).
Although there are many nurses who are devoted to their craft and regard their patients as family and would gladly stay in the job, there are also instances wherein bad leadership prompts them to leave their jobs. Mentorship and proper education also play a major factor in the matter of retention of the nurses. For a nurse to be well prepared in his/her profession, he/she must come from a good school where the essential aspects of nursing are taught. Even though a nursing practitioner might be efficient in the delivery of service within the clinical setting, he/she cannot be expected to possess the special skills and expertise required for performing as an educator.
Clinical educators can be described in a number of ways as having a strong presence and place in the healthcare community. Higgs and McAllister (2001) identified some key points regarding clinical educators which emphasized: the education of health professionals; the need for attention to the training and support of clinical educators; and the necessity to prepare the clinical educators for the complex and demanding role they will assume. The study also emphasized the need to provide a framework for clinical educator training by developing a model of the lived experience of being a clinical educator. Therefore the careful analysis of the role of these clinical educators and their ability to educate the students in a classroom setting (given the proper support and training on the importance of the role of a clinical educator in ensuring the overall success of the students) becomes even more important.
Nursing faculty has a multi-dimensional role—which demands the ability to bridge the two arenas of academic community and the service sector (Pennington, 1986). Selecting appropriate learning objectives, designing the learning objectives, employing plausible teaching strategies, and advising and counseling students are some of the important aspects of the teaching role of the nursing faculty. In addition to the fulfillment of the responsibility of a classroom teacher, the faculty has the additional duty of teaching the students in clinical settings (Davis & Williams, 1985). Surveys conducted among nursing students have identified vital skills that the clinical teacher should possess, such as “professional competence, positive interpersonal relationships, the ability to assist students in identifying principles, the ability to remain calm, and being considerate to students” (Theis, 1988).
Some different approaches can be taken as well, to make sure that clinical educators are given the proper support in order to be capable of developing the strongest clinical skills in their students. Higgs & McAllister (2001) conducted a study to elicit six discrete dimensions, each essential to shaping the role of the clinical educator. One of the main problems identified in the area of nursing education is the increasing shortage of nursing faculty. The faculty shortage is due to the fact that a high percentage of nursing educators are on the verge of retirement (DeYoung, Bliss, & Tracy, 2002). Utilizing “adjunct faculty” has been suggested as one of the possible solutions for meeting the nursing faculty shortage. Clinicians would take up the educator’s role, only for a shorter term, typically for one semester. They would also teach just one or two courses in which they are known as experts. This idea will enable the schools that run short of faculty to employ local nurses who are willing to take up the role of educators. The long-term goal would be to train a large number of clinicians so that there will be more clinical educators available to reduce the nursing faculty shortage (Peters & Boylston, 2006).
Barnard, Nash, & O’Brien, (2005) suggested that nursing staff even in their initial education should be taught methods for recognizing and assimilating required information on the professional standards and best available practices. The acquisition of such knowledge and information becomes critical when nursing staff members are trained to become educators.
A prominent role has been identified for the clinicians to play as educators. Penz & Bassendowski (2006) have pointed out a number of overall issues where the educators are expected to contribute in training the students. The best nursing educators, backed up by their own expertise and knowledge, can turn out to be academicians who may have the overall ability to prepare the students to acquire the requisite skills and expertise (Culleiton & Shellenbarger, 2007).
The available literature about the nursing educator shortage and the loss of nursing educators also suggest other underlying issues. One major issue which is usually not looked at in depth concerns the retention of faculty. Mentoring is one of the factors perceived to help improve nurse educator retention. Mentoring provides an overall satisfaction to the staff. For those educators who continued to teach, there was possible a higher level of job satisfaction, and they discovered that they could do things differently than before. These nurses also felt that nursing education allowed them to “give back” in some way which might mean that they felt more motivated to do well and to work through various types of issues (Garbee & Kilacky, 2008).
Transition from Clinician to Academician
There seems to be a decrease in the number of nursing educators, which has led to the hiring of clinical experts to fill the gap. Although the two job descriptions might have some similarities in certain respects, there are clear differences in their obligations and roles, making the shift a transition from a clinician to an academician. The focus of their attention differs—the nurse educators are focused on achieving self-efficacy and motivation, which is quite different from the actual role of the academician. Since the nurses who are expected to cooperate in the academic arena are not intended to be conversant with the cases that require long-term practical applications of their course, their shift from practical exercise to the academic setting is limited by restrictions imposed by the laws of the school in which the nurses has taken up the role of educators.
Other practitioners find the shift difficult, as their role has been changed. While they were nurses, they were tasked to save the lives of individuals, and now that they have become educators, they must teach would-be nurses the rules and guidelines of proper nursing, including their personal take on the subject. The role shift is challenging because it requires them to be adept at things that were not their strengths. In this context, the work of Patricia Benner, who elaborates on the findings regarding nurses’ acquisition of skills, is of relevance. Benner (1984) has identified, based on the Dreyfus model of skill acquisition, five levels which nurses must pass through as they progress from novice to expert levels. This progression is very applicable to the process of a clinician becoming an adjunct instructor. Although wish of any clinician may wish to have an impact on how future nurses will care for the sick, the mere desire cannot necessarily transform him/her to an expert academician who can educate students to become efficient nurses. It is not as easy as one might think. Certain sets of information need to be seriously studied before the role can be performed efficiently. In fact, there is the need for much preparation.
The new adjunct clinical educator may find the job overwhelming; before actually trying it out, he/she might have believed that it was not going to be different from what he/she was doing and that he/she can do it with ease just like all other academicians. When he/she experiences the job on first encounter, he/she may feel that he/she was better off as a clinician rather than pretending to be an efficient academician (Anderson, 2008).
Competency of Novice Nurse Educators
The literature examining the phenomenon of transition from clinician to academic educator, leading to theoretical assumptions on the areas of competency which the novice nurse educators have to possess to become successful, is not voluminous. Nonetheless, the literature identifies a marked disconnect between the expectations of the novice educators and the reality of the experience (Schriner, 2007). The other area where research has been extended is in identifying role stressors, such as heavy workloads (Dempsey, 2007), and to the topic of learning new teaching skills (Young & Diekelmann, 2002). The literature has also identified perceptions of inadequate preparation for the role (Dempsey, 2007).
Unlike other courses, clinical nursing needs to be based on the personal capacity to care for the patients and timeliness in the procedures and methods to be used (Beitz & Wieland, 2005). Based on theoretical considerations, it is observed that one of the important attributes of clinical teacher is that they should possess the ability to help students to apply the knowledge acquired in the classroom to practical situations involving clients. In order to prepare the nursing students to gain this knowledge, the faculty must have the discernment to interpret and apply information gleaned from research literature. Another important expectation for faculty is the possession of scholarly productivity (Davis, Dearman, Schwab, & Kitchens, 1992). Currently, nursing faculty is encouraged to involve themselves in research, publication and paper presentations in academic forums. The contribution of the nurse educators in all these areas by their involvement in professional activities is considered vital to the development of the skills and knowledge of the students they teach. However in the case of clinicians-turned-educators, it is difficult to expect such qualities in abundance. A complex process, successful teaching requires not only expertise in the clinical context but also other personal traits and qualities to improve the content and delivery of what is being taught (Burns, Beauschesne, Ryan-Krause, & Sawin, 2006).
Role of Clinical Educator in Undergraduate Nursing Education
Preparing a student to become a nurse is a process that needs to be understood with care and needs to be performed with efficiency. A nurse needs all the preparation for the work so that the responsibilities that are given to her will be faithfully fulfilled. The involvement of a clinical faculty towards activities that appraise their knowledge about the new ideas that are being raised within the bounds of clinical studies helps in the creation of clinical faculties that are open to the technological involvement which functions as a supplementary aid to the medical profession. Moreover, their independence and firm decision-making in regard to which opportunities to engage in, develops their capacity to make decisions for their own wellbeing and for the betterment of their patients (Kelly, 2006). In this context the role of a preceptor is of immense importance.
Clinical educators prepare the students for their career. , has been an attempt To prevent inexperienced nurses from diving into work without the proper knowledge of the ropes and knots that lie ahead, the use of clinical educators who are experienced nurses prepares the students to enter the nursing profession. The goal of the clinical educator is to help prepare the student nurses to perform in a clinical position, so that when they graduate they know more than what they need to know about the field and about how to cope up with it. Nursing can be very demanding work—as professional nurses have put it—and all the more so for novice nurses. Therefore, the nurses should receive the practice they need. Practical classes are required in courses like nursing so that they will have a firsthand experience of how to handle patients and the situations inside the hospital that may arise. Direct involvement makes them more knowledgeable and practical when the time comes for them to make real decisions. Some of the benefits of the use of experienced nurses in clinical education are the preparedness of nurses to satisfy their jobs, enhanced professional relations with their colleagues, open-mindedness, mutual assistance by both parties, and good application of the course material in the real environment (Letizia & Jennrich, 1998).
Burns et al. (2006) look at the perspective of the clinical educator and the status of their role as educator and mentor for nurses in training. As with any course of study, problems can arise at any time, sometimes leaving students inadequately prepared. This also happens in the field of nursing, and the risk is greater because of the involvement of life and death issues which need to be dealt with confidently. The educator sees to it that the students under their tutelage become knowledgeable in the field of study. It is the function of the educator to account for the time involvement of the student and to spend most of it on the educational activities that they have planned for their students. One problem is the lack of common time between the two parties (sometimes with the facilitators) to conduct their activities. It is also the obligation of the preceptor to work towards the enhancement of the learning style of the student; this practice is sometimes mistaken for the attempt to influence the student who follows in the preceptor’s way of thinking.
The consideration of the student’s personal attributes must be viewed as an important agenda item to work on before any further move is realized on the learning program which the student is undertaking. Due to the different learning styles among students, it is hard to use a general course plan for every student, as much so as setting a time frame that is uniform for everyone. Each student has a phase that enables him/her to soak up the data presented to her, and this varies from one person to another. Hence, the creation of a program that is individualized is best suited (Burns et al., 2006).
Nursing Faculty Shortage and Strategies for Solving the Problem
The primary factors that affect the shortage of licensed nurses in hospitals are the lack of sufficient faculty to train new nurses and the lack of schools that offer proper nursing education. Because of the operation of these factors, certain innovations within the system are being made to accommodate more nursing students in a shorter period of time. Studies have shown that students who are not socially involved with their faculty and classmates tend to drop out of school before they graduate, hence crippling the nursing workforce even more. Due to this situation, certain measures have been taken to ensure that nursing students and faculty get along with each other and fulfill their respective roles with ease (MacIntyre, Murray, Teel, & Karshmer, 2009).
Since there has been a scarcity of licensed nurses working for hospitals and clinics, it has become the most pressing issue so far. According to studies, due to the lack of proper nursing faculties and nursing schools, students consider nursing to be impractical, clearly not realizing that the need for nursing students multiplies, along with the emergence of new diseases and developments in hospitalization needs in various fields. It is therefore recommended that more nursing staff are hired and more nursing schools built to alleviate the problem. The performance of different schools must also be observed, to insure so that they are in line with each other so that all nurses graduate with proper and necessary information about their work.
There are a variety of factors that contribute to the shortage of nursing faculty. One of the major reasons that too few people opt for academia is that the compensation level in the clinical and private sector settings are higher compared to the compensation for nursing faculty (Lewallen, Crane, Letvak, Jones, & Hu, 2003). This fact drives potential nurse educators away from teaching. Another factor is the failure of master’s and doctoral programs to produce sufficient numbers of potential nurse educators to meet the demand (Oermann, 2004). Historically, it has taken a longer time for the nurses to become educators, as they must undergo the process of undergraduate work and then enter the graduate programs by attending graduate school part-time. The longer time needed to become an educator has discouraged many of them from entering the teaching profession (Thrall, 2005).
Several approaches have been suggested to mitigate the problem of the nursing faculty shortage. The approaches cover creative redesigning of education on nursing practices and strategies for retaining the current faculty. One of the strategies is to consider the dual role for critical care nurses taking up nursing faculty positions. Clinical nurses may perform dual roles. In this case either the clinical employer or the academic employer will be stipulated as the primary employer. Academic institutions offering joint appointment opportunities stand to gain from the current clinical skills and experience of the new faculty member. The clinical nurses taking up the joint appointment will get the chance to explore a new role in their professional development without spending extra time doing so (Siela, Twibell, & Keller, 2008).
Adjunct faculty have similar options, as joint appointments enable the services of clinical nurses whose primary employment is the clinical institutions to be offered to academic institutions for a limited time or for a specific purpose. For instance, an academic institution can take the services of a clinical nurse for teaching any particular course for a shorter period on a loan basis. While providing the academic institution with the benefits of the practical experience that the clinical nurses possess, the status of adjunct faculty also facilitates the nurses to gain practical experience in teaching without the obligation to a permanent commitment. The adjunct instructor is given time away from the clinical institution for undertaking teaching on a short-term assignment. (Velianoff, 2003)
Another solution identified to solve the issue of the faculty shortage is appointing part-time faculty who are either master’s degree qualified or doctoral degree-prepared. Part-time faculty bring with them significant experience of a niche area. However, Hinshaw (2001) cautions that over-reliance on part-time faculty would make the smaller core of fulltime faculty take the burden of curriculum and administrative responsibilities. Moreover, the institutions may find fewer professionals to carry out their missions in research, scholarship and community service.
A number of fulltime and part-time clinical faculty members have been studied; leading to the conclusion that involving clinical faculty who has a direct understanding of the role that they need to fulfill is related to their commitment to work and their open-mindedness when it comes to decision-making. Nurse educators are given the chance to expand their knowledge base as opportunities presented by their hospitals will give them a chance to prove their intelligence and also a chance to learn new things. Their learning scope varies with the type of activities to which they are assigned; in this kind of setup both the clinical faculty and the hospital institutions have the advantage of learning new things and appraising the intelligence of their nurses (Kelly, 2006). It is the personal choice of the member of the faculty to decide whether to work on a part-time or full-time basis. The opportunities existing in the area of teaching nursing students also provide the choice of work to the aspiring faculty member to choose from part-time and full-time employment.
The decline in the number of nurses has continued to cascade downwards due to a number of varying factors. The supply of available nurses has not matched the demand that has ballooned over the years. Whenever short-term solutions to the lack of nurses are being implemented, there seem to be issues that hinder the development of such goals. Thus, staff reductions have led to the lack of job opportunities for professional nurses. With the incongruence came the trend shift in the market, resolving to the need for more nurses which are now unavailable. There is a need to replace old nurses who are less competent with new innovations in the field of medical treatment. As the curriculum changes, older nurses have less knowledge of what are the latest practices in the field, thus making the hospital they are serving obsolete with regard to the new standards set by society (Allen & Aldeborn, 2008).
New nurses are bombarded with these innovations in nursing departments, making them more viable for the task of caring for the sick. However, their number is not able to cope with the demands that their insufficient numbers in the workforce requires to be constantly able to care for new patients. Because of the law of supply and demand, nurses’ salaries have increased. The empowerment of nursing schools and the information about nursing as a fast-growing source of employment have been causing more students to consider going to nursing schools and maneuvering their way towards higher-paying jobs and positions with job satisfaction (Allen & Aldeborn, 2008).
A considerable number of strategies have been found out to be used by varying institutions, some of which having positive results while others having uncertain purposes. This situation has led the researchers to limit the research to those who have had a positive impact on the encouragement of nurses to pursue their share of the work environment. Advertisement is one of the strategies that have rendered positive results. In fact, the media has made it possible to communicate the need for nurses all over the world through a presenting how well nurses are getting compensated. Nursing schools are also being supported by the respective governments for that same cause (Allen & Aldeborn, 2008).
Summary of the Literature Review
The review of the available literature provided extensive knowledge on the need for transforming expert clinicians into teaching faculty, in view of the existing shortage of nursing educators. Empirical data on the increasing nursing students and shortage of nursing faculty from the reports of American Association of Colleges of Nursing (AACN) reiterated the need for such transformation. The review dealt with the challenges faced by the expert nurses in taking the role of educators. There was an elaborated discussion on the shortage in teaching skills of novice adjunct clinical educators who were formerly clinicians and their problems in adapting to their new role as educators. The topic of preparation of the clinicians to the teaching role and their needs have been well addressed in this review. The reasons for low retention in the field of nursing and the need for mentorship and proper education were stressed by the review. Different approaches to ensure that the clinical educators are provided proper support to train students in clinical settings was outlined by the review. The phenomenon of transition from clinicians to academicians together with theoretical assumptions on the areas of competency of the novice educators was also focused in the review. The strategies for solving the social problem of nursing faculty shortage were the central focus of the review.
Focusing on the transformation of clinicians into nursing faculty, it is proposed to undertake an action research into developing a curriculum that will best fit for the model. This chapter describes the scope and nature of action research. A description of its use in the on-going development and evaluation of a new model for the transformation of clinicians into novice teachers is also presented in this chapter. The objective is to show that an action research approach to teaching can be used to provide the necessary teaching skills to the clinicians.
Action research has been the method employed in various social situations where it was necessary to understand the complexity in such situations and improve the quality of life. Industrial problems, health and community issues are some of the areas where action research has been found to be an effective developmental research method. Action research approaches have been found to be popular in ‘teacher-researcher’ movement in the secondary education field during the 1960s and 1970s. This sought to bring the clinical nursing practitioners into the research process of converting them into academicians. The process is intended to convert the clinician as an effective teacher who can identify problems and suggest suitable alternative solutions.
It is possible that an action research approach can contribute positively for the conversion of a clinician into a novice teacher who is concerned with developing teaching skills and quality issues in teaching. Through systematic controlled action research clinicians can be transformed into nursing faculty and they can be motivated to integrate their nursing skills into better academic programs aimed at improving student learning. Nurses as ‘reflective practitioners’ would be able to achieve greater ownership of an evaluative process by adopting a systematic self-assessment and along with this process develop their teaching skills.
Action research methodology offers a systematic approach to introduce innovative techniques in teaching by placing the clinicians in the dual role of producer and user of new techniques of teaching their own experiences in the field of nursing. This enables the clinical nurses to produce higher knowledge about education in nursing and teaching and a powerful way of imparting the knowledge on nursing practices. Actually there is no need to separate between nursing and teaching practices and thereby the clinicians can bring theory and practice close together.
There are different forms of action research that have been evolved over the period of time. All these approaches adopt a methodical and iterative approach. Such an approach involves problem identification. Elements of action planning, implementation, evaluation and reflection also form part of the approach. Kolb (1984) has extended the action research model into an action research cycle where people learn and create knowledge by critically reflecting upon their own actions and experiences. This enables them to form abstract concepts and test the implications of these concepts in new situations. This action research enables the participants to develop their own knowledge and understanding of specific situations. On such creation of the knowledge and understanding, the practitioners act upon that knowledge and thereby improve upon their practice. Later on the knowledge created can be imparted to the students to advance their knowledge.
Action research therefore can be considered as critical in the sense that it enables the clinicians to not only look for ways to improve their practice and knowledge in nursing but also to act as change agents for transforming such knowledge into teaching skills. Action research is reflective in that the participants analyze and develop concepts and theories about their experiences and convert such concepts into the tools for developing their teaching skills and abilities. Action researchers can be made accountable to make their learning process and the results of such learning public so that other interested clinicians can adopt the same methods to develop their own teaching skills. The practice of action researchers includes an element of self-evaluation. The self-evaluation incorporates the reflective and analytical insights of the practitioners themselves. These self-evaluations form the basis of the developmental process of teaching. Action research is participative in nature. The clinicians who are part of the actions research project contribute equally to the inquiry. They are also collaborative that they are not experts in the field of teaching but a partner in working towards solving the problem of faculty shortage in nursing.
The proposal is to take a group-based action research approach to the development of an introductory curriculum model for converting expert clinicians into novice clinical teacher. The model developed based on this research initiative can be utilized by other curriculum development initiatives. The objectives of the curriculum design is
- to enable expert clinicians to acquire greater skills of teaching and imparting knowledge to students and
- to enable nursing students to experience “deep” learning from the experiences of the expert clinicians.
Strategies to develop expert practicing skills in the area of clinical nursing, problem-based teaching methodologies, use of logical, precise, effective and efficient educational technology that are currently available, and to produce nursing graduates capable of delivering crating nursing care for a prolonged future period will form part of the curriculum.
The development of a curriculum will follow a defined action research cycle to achieve the following:
- Identification of a number of objectives and formation of initial working hypotheses about meeting them. For instance one of the key objectives is to provide an appropriate model for imparting problem-based learning to enhance the scope of deep learning by the students. This would involve preparing the clinicians as better academicians.
- Planning a curriculum model and devise materials and processes for supporting the development of the curriculum. For instance one of the features of the curriculum model may include engagement of clinicians in discussions on teaching methods of nursing care in actual clinical settings.
- Putting the support materials and processes into practice by running the module. The module will be designed to have adequate theory workshops, projects and seminars. The main form of assessment of clinicians is the course work represented by a group project on development of teaching skills supplemented by individual learning diaries detailing transformation of personal experiences in to teaching notes.
- Making observations on the practice of teaching and evaluating the individual abilities. The proposed curriculum development will encompass evaluation and self assessment strategies. These strategies include a number of feedback mechanisms from the clinicians highlighting their problem areas. The strategies also include debriefings by the respective trainers of the clinicians who help them in shaping the clinicians as teachers.
- Soliciting reflections upon the results of the evaluations which will provide insights for the individual clinicians to amend their teaching methods as well as for amending the practice modules for preparing the clinicians to be transformed into academicians.
The proposed action research will consist of a minimum number of clinicians who are desirous of taking up the profession of teaching and the inquiry process will be critical in spirit and purpose. This is considered essential for the own development of the clinicians as well as for the development of the curriculum into a purposeful one. This would not only improve the teaching skills of the clinicians but also would enable the students to learn within the constraints and practical considerations impose upon by them reflected through the experiences of the clinicians. The reflections and self-evaluation should be capable of providing more insights to the clinicians to feed them back into their practice as faculty and at the same time the reflections will also facilitate suitable modifications to the curriculum to take care of deficiencies in the materials or processes. There would be a continuous reassessment of the module and its structure to accommodate the changing needs of the clinicians to improve their skills. Suitable mechanisms built into the module would remind and encourage timely action for suitable amends to better the outcome of the training provided to the clinicians. One of the ways to ensure this is to maintain a ‘tutor diary’ which share the reflections of the trainers on teaching performance of the clinicians, content and structure of the course module and responses of the clinicians which will be useful in reviewing the module and shape them towards better utility and effectiveness. This way it is possible to make individual experience available among the trainers for comments ad analysis which enable them to challenge and support each other for redesigning the module and curriculum.
The approximate time for transforming expert clinicians to novice teachers is expected to be around six months. This period will be divided into different modules each of which deal with different stages in the transformation of clinicians into teachers. The course content and structure of the individual modules will be suitably prepared to accommodate the skill needs of the clinicians in the teaching area.
Modules for Curriculum Development
The following are some of the modules that may be considered in the development of the curriculum for the transformation of clinicians into novice teaching faculty.
- Module 1 Preparation of course syllabus
- Module 2 Designing learning activities
- Module 3 Preparing policies and procedures for the curriculum
- Module 4 Preparing schedule of clinical activities/student rotations and schedules
- Module 5 Completing orientation on clinical unit, including the training required and skills checks
- Module 6 Reviewing student clinical evaluation tools and methods
- Module 7 Devising evaluation methods for students like tests, case studies or others
- Module 8 Preparing record keeping methods like student check sheets, anecdotal note forms and remediation plans
- Module 9 Planning for pre-clinical and post-clinical conferences
Questionnaire for Focus Group
The following are some of the questions that may be used to draw further information for improvement in the curriculum and the relevant models.
- Is the teaching position full-time or part-time?
- How many clinical hours are required for effective teaching?
- What is the course content that is taught under the course?
- What level of students will be taught? (Freshmen, sophomore, junior or senior students in the nursing program)
- Are there pre-clinical and post-clinical contact programs as a part of the curriculum
- Which teaching strategies are preferred or welcomed by the institution and by the students?
- What course assignments are required of students? What are the improvements needed in the existing patterns?
- Is there a formal orientation which helps the novice teachers?
- Are there any new competencies that the faculty should gain? What is the intended mode to gain these competencies?
- Is there an assigned mentor? If not is there a need for such a mentor?
- What is the chain of command within the institution? Is the faculty member comfortable with that?
- What are the resources available to support teaching like secretarial, technological etc? Are they adequate? (Suggest any additions/improvements required)
- Is there a need for instituting continuing education hours? If so what is the length required per year?
- Is there a need to fix regular office hours? If so what are the preferred hours?
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