Clinical Education, Clinical Instructor, Communities of Practice, Continuing Education, Learning Community, Nurse Adjunct, Professional Development



  1. Roman, Tammy


Abstract: Due to scarce opportunities for professional development in clinical teaching, an online learning community was developed to provide initial and ongoing education for novice and experienced clinical instructors. Asynchronous learning modules were developed that included discussion boards to share best practices. Results demonstrated a significant change in the participants' knowledge of clinical teaching as well as the identification of a lack of confidence among novice instructors (p < .05). This research establishes the benefit of a learning community for both new and experienced clinical instructors and the need to increase confidence in their teaching abilities.


Article Content

Improvements in critical thinking, skill development, and role transition support are just a few of the contributions that can be fostered in nursing students by well-prepared clinical educators (Davidson & Rourke, 2012; Hewitt & Lewallen, 2010). However, it has been determined that the professional development of the clinical teacher has not been standardized and is often lacking in graduate nursing programs (Santisteban & Egues, 2014; Suplee, Gardner, & Jerome-D'Emilia, 2014). Learning community groups that deliver professional development provide a platform to learn together through the sharing of ideas and the identification of solutions to problems (Lenning, Hill, Saunders, Solan, & Stokes, 2013).


Awareness of the shortfall of professional development opportunities for clinical instructors exists. Instructors have also identified a desire for increased support mechanisms beyond orientation in order to improve their own teaching strategies (Dahlke, Baumbusch, Affleck, & Kwon, 2012; Zakari, Hamadi, & Salem, 2014). Innovative professional development programs that include content such as mentoring, providing student feedback, hospital and college policies, adult learning principles, and managing student issues have been developed (Gies, 2013). Evidence also affirms that spending time in professional learning communities translate into improved teaching effectiveness and improved student learning (Roth, 2014).


Studies have examined the utilization of expert faculty to mentor and teach in both land-based courses and online formats, and each has found an enhancement of knowledge among participants (Barksdale et al., 2011; Fura & Symanski, 2014; Halabi, Abdalrahim, Persson, Hedemalm, & Lepp, 2012). However, findings from one study indicated that, when the course was not mandated for all clinical instructors, a lack of participation was seen.


The purpose of this study was to determine if a professional development learning community enhanced the teaching capabilities of novice and experienced clinical instructors by improving participants' knowledge, confidence, teaching effectiveness, and feedback abilities.



A professional learning community, developed in response to a needs assessment, was modeled after previous programs developed by the researcher. It was decided in the nursing undergraduate committee that all clinical instructors employed by the nursing college must complete the professional learning community over a four-month period (one semester). However, participation in the research study was optional. The timeframe was determined so that all participants had ample time to complete the training, because most worked full time.


Asynchronous modules were developed, which included identification of a teaching philosophy, utilizing appropriate instructional methods, utilizing appropriate evaluation techniques, administering appropriate verbal and written feedback, effectively instructing a group of students in a clinical setting, managing students who displayed inappropriate or unprofessional behaviors, teaching students with different learning styles, knowledge of school and hospital policies, knowledge of the clinical instructor role, and infusing components of TeamSTEPPS(R).


The modules were based on educational research both within and outside the field of nursing (Curran, 2014; Gies, 2013). They utilized an assortment of pedagogical techniques that included viewing and responding to video vignettes of student clinical behavior, reading and blogging about relevant journal articles, sharing current methods of clinical instructional techniques, and reviewing current school and hospital policies.


After completing each module, participants contributed to six discussion boards. They commented on insights gained, best practices utilized by experienced instructors, and plans for implementing learned techniques. Each module and associated discussion boards took approximately one hour to complete. Recruitment for the study was obtained via college email. The institutional review board reviewed and approved this study.



Upon completion of the online course, an anonymous, retrospective one-group pretest/posttest measure study design was deployed, and demographic information was obtained. The instrument, utilized and modified with permission, was based on Seal-Whitlock's (2000) "Needs Assessment Survey for Topic Inclusion in a Guide to Orientation for New Clinical Faculty." The reliability and validity of the entire data collection tool were completed beforehand by utilizing interrater reliability peer evaluation and pilot testing.


The electronic survey, which consisted of 18 questions, sought information regarding knowledge of school and hospital policies, teaching ability, verbal and written feedback ability, and confidence in effectively instructing a group in the clinical environment. Beyond demographics and confidence levels, questions were categorized into three subscales based on teaching skills (six questions), feedback abilities (three questions), and knowledge level as a clinical nursing instructor (three questions). Participants answered each question twice: first, for their knowledge, skills, feedback abilities, and confidence before the course and then after completing the course.


Data Analysis

The data were screened for a normal distribution on all outcome measures. Because of violations of normality, nonparametric statistics were used. Wilcoxon signed-rank tests were used to test for changes from pretest to posttest scores. Mann-Whitney U tests were used to test for differences based on experience as clinical instructors and educational attainment. Dose effect was not measured due to the electronic platform of the course and the ability of participants to start and stop the modules at will, which limited the ability to determine the amount of time spent on each module.



All 74 current clinical instructors completed the professional learning community; 37 chose to complete the study, resulting in a 50 percent response rate. Participants were 64 percent master's-prepared and 30 percent baccalaureate-prepared.


In response to the question regarding experience teaching clinical groups, 43 percent stated that they had worked with fewer than three clinical groups; 57 percent stated that they had worked with four groups or more. Sixty percent of participants had a background in adult medical-surgical/critical care. Other specialties were pediatrics (17 percent), obstetrics (16 percent), and mental health (5 percent). Ninety percent of participants were female, and 80 percent identified as non-Hispanic white.


The online retrospective pre/post 5-point Likert survey was used to measure participants' knowledge gained from completion of the modules and posting and reading discussion board content. Questions were categorized into three subscales: teaching skills, feedback abilities, and knowledge level of the participant's role as a clinical nursing instructor. Pre- and posttest mean scores were calculated for each subscale.


Because the mean scores on the subscales were not normally distributed, the Wilcoxon signed-rank test was used to test for changes in responses from pretest to posttest. This test revealed a significant change (p < .05) in the participants' self-reported knowledge of clinical teaching (instructional methods, effectively instructing a group of students, inclusion of various learning styles, reflection of teaching philosophy), providing feedback (evaluation techniques, verbal and written feedback, managing inappropriate or unprofessional behaviors), and knowledge of both nursing school and hospital policies governing student clinical experiences. The change was such that the medians increased from the pretest to posttest, indicating increases in knowledge.


The Mann-Whitney U tests found significant differences between novice and experienced clinical faculty members' self-reported confidence in their role as clinical instructor (p < .05). Novice instructors rated themselves less confident (median = 6.0) than more experienced faculty (median = 8.0) at the start of the course. Ratings at the end of the course revealed no significant difference between novice and more experienced faculty. Furthermore, no significant differences were found between baccalaureate-prepared instructors and those with master's degrees for any of the measures. Overall, participants had favorable comments about the learning community and professional development content.



This research study demonstrates the enhancement of clinical instructor teaching capabilities for both new and experienced or perceived "expert" clinical instructors after participating in a professional learning community. Furthermore, it demonstrates the suboptimal confidence level of novice clinical instructors and the resulting increased confidence level after participating in the training. Participants gained essential information regarding teaching strategies, administering feedback, and knowledge of both college and hospital clinical instructor policies. Based on narrative comments, the professional learning community gave participants a unique and rare opportunity to share "tips and tricks" with colleagues.


Even though clinical instructors have acquired the expertise necessary in their own practice areas, they often experience a major transition into the academic role. This role transition results in some degree of role ambiguity that can be alleviated not only by a professional development course but also by an online learning community that provides bidirectional mentoring between experienced and novice instructors. This classic role theory, described by Goffman (1959), highlights that role ambiguity can cause performance-affecting stress, which may result in students receiving less than optimal instruction in the clinical arena.


An essential element of this program was purposeful inclusion of discussion boards that resulted in an online mentoring component. The online mentoring advanced the science of nursing education by providing an ongoing, reusable platform from which clinical instructors could benefit according to their own schedules and role transition needs.


Because 30 percent of participants were baccalaureate-prepared and previous research indicated that the professional development of clinical instructors is often lacking in graduate nursing programs (Santisteban & Egues, 2014; Suplee et al., 2014), it was not surprising that most participants experienced an enhancement of their teaching capabilities. This was a significant factor in the decision to have all clinical instructors complete the course, contrary to the assumption that all master's-prepared clinical instructors would have had the education that is addressed in the modules. Because no significant differences were seen between baccalaureate-prepared instructors and those with master's degrees after the completion of the training, one may surmise that this course was equally beneficial for both levels of education.


One limitation of this study was the fairly small sample size (n = 37) and the possibility of a demand bias that could inflate the difference between pretest and posttest scores. However, looking at the frequency and pattern of individual responses may mitigate concerns about demand bias and lend assurance to the validity of the findings. Those reveal that some respondents rated their knowledge high on both the pretest and posttest. An additional limitation of this study was the lack of a longitudinal analysis to determine the effects of the intervention on study outcomes over time and the effects of testing.



The development and implementation of a professional learning community for clinical instructors in a school of nursing is clearly beneficial. Previous research has shown that it is not enough to depend on a clinical instructor's graduate-level coursework to be prepared for clinical teaching, especially when instructors are only baccalaureate-prepared. Although many colleges of nursing require clinical instructors to have a master's degree, the findings from this study indicate that this policy is subject to question as there are learning opportunities for both levels of education.


The recommendation of an online asynchronous format enabled the very busy clinical instructors not only to learn at their own pace but also to benefit from the sharing of best practices by more experienced colleagues. The identification of a faculty member with familiarity as a clinical instructor to facilitate the discussion boards is also recommended. Such practice allows for the utilization of probing questions to prevent the course from being stagnant - and simply becoming something for clinical instructors to check off their list.




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