Abstract
Review question/objective: The objective of this review is to describe the experience of expert nurse clinicians in their role transition to novice nurse educators in an academic setting.
The specific review question asks: How do graduate prepared nurse clinicians experience the transition from clinical practice to nursing faculty in an academic setting?
Background: The current nursing shortage is global in its scope. For example, in developed countries like the United States (US) and Australia, the nurse-to-population ratio is 1 to 100 and 1 to 103 respectively.1 The shortage is even more pronounced in developing countries like Bhutan (1 to 1158) and Thailand (1 to 397).1 The World Health Organization reported that Caribbean nations currently have 1.25 nurses for every 1000 people, while in Malawi, there are 17 nurses for every 100,000 people.2 There is clearly a critical global nursing shortage in both the developed and developing nations. This nursing shortage threatens the health of all global citizens.
Causes of the current nursing shortage are complex. Egenes reports that in the US, 40% of the nursing workforce is 50 years or older.3 Current graduation rates from schools of nursing are not sufficient to replace the nearly 500,000 registered nurses who are projected to retire by 2020.4 The core issue is not a lack of applicants. For example, in 2012, schools of nursing reported an inability to admit almost 80,000 qualified applicants. Insufficient numbers of nursing faculty within universities was a major factor. The present faculty vacancy rate in the US is 8.8%.5The faculty shortage is also affected by the aging of US nurse educators, among whom the average age of a professor is 61 years, an associate professor 57 years and an assistant professor 52 years.5 Difficulties in faculty recruitment stem from the salary differences between the private and academic sectors, which can exceed $20,000 and significantly add to poor faculty retention rates.5 The current lack of faculty was named as the primary obstacle in the expansion of educational programs in the US.6
Similar trends are reported in Australia, where the average age of a lecturer/educator in a non-clinical role s estimated to be 45 years. Nurse educators in Australia who choose to pursue an academic role face a major decrease in compensation. A qualified senior clinical nurse earns AUD 97,000 compared to a lecturer salary of 78,700.7Lower faculty salaries are also an issue in Canada, where a survey of schools of nursing revealed that 28% of respondents indicated that lower faculty salaries impaired recruitment of qualified faculty.7 Developing countries are particularly affected due to the migration of their qualified nurse faculty and researchers to the US and United Kingdom, major importers of these nurses.1
Creative strategies have been proposed to remedy this global faculty shortage, particularly in the US. Short-term solutions include the utilization of qualified non-nursing faculty, such as pharmacists, to teach nursing courses and recruiting retired nursing faculty who want to continue teaching. This would entail removal of barriers to continued employment imposed by current retirement systems.1,8 These strategies may provide an immediate relief to part of the faculty shortage, but long term solutions are needed. Evans argues that long-term strategies to increase the pool of nurse educators must focus on the active recruitment of qualified nurse clinicians into the academic setting.8 He emphasized the importance of providing competitive salaries and a positive message about the rewards of academic life.8 However, the transition from expert nurse clinician to novice faculty can be difficult. Clinicians may have unrealistic expectations of the faculty role.9 Nurse clinicians may find themselves unprepared for the cultural differences between nursing practice and academic nursing education. McDermid and colleagues noted that "the academic environment has its own distinct culture, language, expectations, values and behaviors".(7p.567) For example, in a clinical setting, promotions are based on clinical expertise, but in the academic setting, promotions are based on student evaluation of teaching and expectations surrounding scholarship such as publications and funded research.7 Clinicians who had enjoyed working with students in their own clinical settings were unprepared for setting teacher-student relationship boundaries and negative encounters with students in their transition to nurse educator.9 Cangelosi, Crocker and Sorrell analyzed 45 written narratives of nurse clinicians enrolled in a nurse educator course to become prepared to teach clinical skills to nursing students. They also found that clinicians felt unprepared for the faculty role.10The process of learning to teach was characterized by discomfort at being a novice again, uncertainty as to how to learn to teach, a lack of preparation and mentoring by experienced faculty and fear of failing in their new role.10 While it is apparent that the academic setting and the clinical setting are very different and nurse clinicians have difficulty navigating this transition to a nurse educator role, little is known about the process they experience as they transition to an academic faculty role.7
In order to improve recruitment and retention of this important source for qualified nursing faculty, it is imperative to have a clear understanding of the comprehensive experiences of expert clinical nurses in their transition to the role of novice nurse educator. A meaningful synthesis of existing qualitative evidence will assist stakeholders in establishing guidelines and programs to support clinicians in their role transition to novice educators. The result of incorporating such a framework into the world of nursing academia will help to maximize the retention of neophyte faculty in order to ease the current nurse faculty shortage. A preliminary search of the Joanna Briggs Library, CINAHL, PSYCInfo, PubMed, Medline and Dissertation databases revealed no existing systematic reviews on this topic.
For the purposes of this review, the following definitions will apply:
* Transition: a cultural shift needing differing skills and knowledge, such as a change from a primary role as a clinician to a new role as nursing faculty.
* Graduate-prepared: holding an earned masters or doctoral degree.
* Expert nurse clinician: nurses who have practiced for at least five years in a clinical setting.
* Novice academic nurse educator: nurses in their first three to five years as a teacher in an institution of higher education (e.g. college or university) that prepares students for licensure as professional nurses.
The latter two definitions are based upon Benner's (1984)11 "Novice to Expert" theoretical model of clinical nursing practice, stipulating that clinical competency is not achieved for at least two to three years of nursing practice and that clinical proficiency usually occurs after three to five years of nursing practice. This theory, though 30 years old, continues to have applicability in nursing. It has been applied to teaching nursing informatics12and to teaching nursing faculty to use high fidelity patient simulation in their classes.13In addition, the three to five year time frame and/or novice faculty designation ensure the participants' recent proximity to their individual novice experience and knowledge in order to provide a rich description of the experience under investigation.
Article Content
Inclusion criteria
Types of participants
This review will consider studies that focus on expert nurse clinicians who transition to an academic nurse educator role. To be included, study participants must be identified as nurses who have a minimum of three to five years in clinical practice, who have attained an advanced degree such as a masters or doctorate, and who are identified as novice nursing faculty and/or who are in their first three to five years as a nursing faculty in an institution of higher education (e.g. college or university). Studies that identify their sample as including both novice and experienced nursing faculty will be included if the findings clearly identify the novice participants' voices.
Exclusion criteria will include those studies whose population consists of experienced faculty or that do not identify their population as including novice nursing faculty. Experienced faculty is defined as having taught more than five years in an academic setting. Studies whose population consists of expert clinicians who transition to a role as a clinical educator in a clinical setting like a hospital will also be excluded.
Phenomena of interest
This qualitative review will consider as the phenomenon of interest, the actual experiences of nurses in their role transition from a clinical to an academic focus in order to describe and understand their experience.
Context
The context of this review is the academic setting of colleges and universities that educate students to practice as nurses and the cultural differences between the academic and clinical settings. Therefore, studies whose context focuses on clinical educators who practice in a clinical setting such as a hospital will be excluded.
Types of studies
This review will consider interpretive studies that draw on qualitative data and include, but are not limited to, designs such as phenomenology, grounded theory, ethnography, action research, thematic analysis, feminist research and the qualitative component of mixed methods studies. Studies that do not provide examples of participants' voices will be excluded.
Search strategy
The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of the Joanna Briggs Library, Cochrane Library, CINAHL and Dissertation databases will be undertaken, followed by analysis of the text words contained in the title and abstract and of the index terms used to describe the article. A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles will be searched for additional studies. Studies published in English or German will be considered for inclusion in this review. English is the language of the reviewers; their graduate assistant is fluent in both languages. International studies published between 2000 and 2014 will be considered for inclusion in this review. These years were chosen because publications related to the current faculty shortage and began to appear in the literature during this time period.5 The databases to be searched include:
CINAHL
PSYCInfo
PubMed(Medline)
ProQuest Dissertation Database
Hand searching will not be conducted.
Keywords include role, transition, nursing education, clinician, lecturer and academic nurse educator.
Assessment of methodological quality
Qualitative papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument JBI-QARI) (Appendix I. Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.
Data collection
Qualitative data will be independently extracted by each reviewer from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix II). The data extracted will include specific details about the phenomena of interest, populations, study methods and outcomes of significance to the review question and specific objectives.
Data synthesis
Qualitative research findings will, where possible, be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings rated according to their quality and categorizing these findings on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible, the findings will be presented in narrative form.
Conflicts of interest
The reviewers have no conflicts of interest to declare.
Acknowledgements
We acknowledge our affiliation with the Texas Christian University, Center for Evidence Based Practice and Research: A Collaborating Center of the Joanna Briggs Institute, the Northeast Institute for Evidence Synthesis and Translation and the Robert Wood Johnson Foundation and Boise State University School of Nursing for partial funding of the primary reviewers salary and to Andrea Lambe, graduate assistant, for her assistance in writing the protocol.
References
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