The nursing shortage continues to grow and potential applicants to nursing programs are being turned away. Baccalaureate nursing students who are able to enter graduate education to become faculty are lacking because there is an insufficient number of qualified nurses to teach them (American Association of Colleges of Nursing [AACN], 2017). The AACN report from 2017 indicated that 64,067 qualified applicants to nursing programs were turned away in the 2016–2017 year due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and funding (AACN, 2017). As nurse faculty retire, nursing educational programs are challenged to find new ways of using their faculty resources for both classroom and clinical teaching (Benner, Sutphen, Leonard, & Day, 2009). Many studies have investigated retention and job satisfaction among nurse faculty; however, there is minimal research investigating retention and job satisfaction among nursing clinical teachers. The purpose of this study is to measure job satisfaction and intent to leave among dedicated education unit (DEU) and non-DEU clinical teachers through the University of Portland clinical partnerships. This study is based on a previous pilot study that utilized the Adapted Nurse Faculty Query (NuFaQs) (Robert Wood Johnson Foundation, 2011) instrument for clinical teachers. The long-term goal of this research is to contribute to the development of supportive clinical education environments for both clinical teachers and students.
A current projection of the national shortage of nurses indicates a need to increase the enrollment and graduation of nursing students by 90%. With more than half of current nurse faculty expected to retire in the next 10 to 15 years, an increasing shortage of nurse faculty is anticipated (Benner et al., 2009; Institute of Medicine Report, 2010). The impact of the shortage of nurse faculty resources has led to the utilization of new clinical teaching models. The DEU clinical teaching model for nursing was developed out of Findlers, Australia, with the original purpose of addressing the shortage of nursing faculty and clinical placement sites for nursing students (Moscato, Miller, Logsdon, Weinberg, & Chorpenning, 2007). Currently, the DEU clinical education model is growing in popularity and is recognized as both an efficient means of utilizing nurse faculty resources and a means to increase the quality of clinical nursing education (Moscato, Nishioka, & Coe, 2013). The DEU model utilizes expert clinicians at the bedside who perform the role of clinical instructor. These expert clinicians are then supervised by the clinical faculty coordinator, who is employed as either full-time or adjunct faculty (Auxier & Simpson, 2017).
This study was developed to measure retention and job satisfaction among clinical teachers at the University of Portland. Retention of clinical teachers is difficult to measure after they have left their teaching position. Therefore, for the purposes of this study, retention is measured as the end result of the concept intent to leave (Gui, Barriball, & While, 2009a). Some studies indicate that both recruitment and retention of nurse faculty is problematic primarily because the majority of nurses can earn a higher salary in clinical practice than in academia (AACN, 2017). Although nurse faculty retention rates and job satisfaction have been studied, little is known about these issues among clinical teachers in the traditional clinical model (non-DEU) or in the DEU model. Measuring retention rates among clinical teachers is somewhat problematic; non-DEU clinical teachers often hold positions as full- or part-time nurse faculty, whereas DEU clinical teachers are generally nursing staff employed by hospitals or medical centers (Moscato et al., 2007; Oregon Consortium for Nursing Education, personal communication, September, 2012; Woodworth, 2016). Because of the mixture of job titles and job responsibilities, retention of clinical teachers has not traditionally been a reported statistic (Oregon Consortium for Nursing Education, 2012).
Job satisfaction is measured as the level of contentment an individual has with his or her job, including intrinsic and extrinsic factors (Gui et al., 2009a; Herzberg, 1987). Information about job satisfaction and intent to leave for both DEU and non-DEU clinical teachers is minimal. With the increase in demand for nurses and a proportional decline in several nurses who teach students, a better understanding of the concepts of job satisfaction and intent to leave among clinical teachers is essential to develop incentives for clinical nurse teachers to remain.
A theoretical framework for job satisfaction was used to organize and inform this study. Herzberg's two-factor theory (also called the motivator-hygiene theory) was used to categorize elements of the physical and social work environment that affect clinical teacher job satisfaction (Herzberg, 1987). Herzberg's theory is based on the premise that both psychological growth and avoidance of unpleasantness are needed for job satisfaction. If the work environment is in some way unpleasant, dissatisfaction will occur. Herzberg's theory and a literature review of relevant articles about job satisfaction among clinical teachers resulted in the development of Figure 1. Elements affecting job satisfaction both positively and negatively were separated into intrinsic factors, which include recognition, responsibilities, communication, and relationships, and extrinsic factors that affect the work environment. Figure 1 displays the relationship between elements that positively and negatively affect job satisfaction.
Herzberg's applied to job satisfaction among clinical teachers. Note. DEU = dedicated education unit.
The pilot study preceding this work had several limitations. An overall low sample size and low response rate impacted data analysis procedures, as well as the ability to correlate findings and draw conclusions. All DEU clinical teachers in postacute care nursing facilities could not be contacted as they did not have work-related e-mails through the postacute care network. The limitations of the pilot study, including the need for a greater sample size, informed the development of this research study's methodology to access a greater sample size and improve overall response rates.
This study used a convenience sample of participants recruited from the University of Portland and affiliated clinical sites. This sample included both DEU and non-DEU clinical teachers in acute care, postacute care, obstetrics and pediatrics, behavioral health, and population health clinical settings. Currently, the University of Portland has DEU clinical settings in acute care, postacute care, and population health settings only. A panel of nurse faculty at the University of Portland reviewed the adapted NuFaQs instrument prior to administration to the sample. This panel of nurse faculty reviewed the instrument for both content and clarity as it pertained to the clinical teachers involved in the study.
University of Portland's Institutional Review Board approval was granted for this study. During the months of October, November, and December 2015, the principal investigator and student research assistant made contact with all of the 28 distinct clinical sites utilized through the University of Portland. Telephone calls and in-person visits, as appropriate, were made to introduce the research team and begin the process of participant recruitment. The survey administration period was January through May 2016. A second visit after the original recruitment was used to administer paper-and-pencil surveys to clinical teachers at their clinical sites. Token gift cards to a local food vendor were offered to all participants who elected to take the paper-and-pencil survey. Sample characteristics are reported in Table 1. A total of 207 surveys were returned, and approximately 66% were fully completed.
Participants' Sample Characteristics and Education
Data were transcribed by the student research assistant into the SPSS version 20 database under the supervision of the principal investigator. Answers to questions pertaining to job satisfaction and intent to leave were recorded using the Likert scale responses very satisfied, somewhat satisfied, neither satisfied or dissatisfied, somewhat dissatisfied, and dissatisfied. Participant response frequencies (n = 207) are reported for job satisfaction in Figure 2 and intent to leave in Figure 3. Chi-square tests (Pearson's correlation) to determine differences in overall satisfaction between DEU and non-DEU were not statistically significant (n = 207, p = .830). Power analysis post hoc was conducted based on sample size (DEU, n = 100; non-DEU, n = 107; total sample, n = 207), with Cronbach's alpha set at .05. Cohen's d for effective size was calculated as .056, leading to a power of .06 using a two-tailed test. Therefore, although the sample size was sufficient, there is insufficient effect size differences between groups and therefore adequate power was not achieved.
Job satisfaction (%). Note. CT = clinical teacher.
Intent to leave (%).
In response to the question “Overall how satisfied are you with your clinical teaching job at your clinical site?” job satisfaction for the total sample was reported to be 27.5% (n = 57, very satisfied) and 49.4% (n = 102, satisfied). Of the total sample, 3.4% (n = 7) reported they were somewhat dissatisfied. Participants also responded to matrices of questions titled: “How satisfied are you with each of these aspects of your clinical teaching job at your clinical site?” This included intrinsic and extrinsic factors. The two variables with the greatest negative response were workload and salary. For the variable workload, participants reported somewhat dissatisfied (8.2%, n = 17) and dissatisfied (1.4%, n = 3). For the variable salary, participants reported somewhat dissatisfied (7.7%, n = 16) and dissatisfied (9.7%, n = 20).
Between 25% and 30% of all participants in this study did not respond to the survey questions regarding retention (intent to leave), and approximately 26.1% (n = 54) of the sample responded to the question “Which best describes the next position you might have?” as retired.
Discussion and Conclusion
Overall job satisfaction was reported as high, with no statistically significant differences between DEU and non-DEU. This may suggest that clinical teachers in general are very satisfied with the intrinsic and extrinsic values in their work. This result may also suggest a hypothesis presented by Moscato et al. (2013) that after more than 10 years of DEU clinical experience, the University of Portland is bringing the principles of the DEU to all the clinical partner sites, including non-DEUs.
Differences in job satisfaction and retention (intent to leave) between DEU and non-DEU clinical teachers was not statistically significant; however, the overall data trends in job satisfaction and retention may suggest areas for improvement and research with additional education and practice changes for clinical teachers. Communication, distinction for work as clinical teachers, and relationships with academic colleagues were identified as potential areas for immediate intervention. Academic institutions should work with the clinical teachers—DEU or non-DEU—to provide continuing education to their professional development. Events such as lunch-and-learns or offering continuing education credits to clinical teachers can enrich their teaching practices with students, which may increase their intrinsic job satisfaction level. Clinical and academic partners should work closely to ensure that mutual needs are met in their partnership. This includes recognition to clinical teachers for their service to both the clinical site and the associated academic institution.
A follow-up qualitative study is planned to utilize focus groups to investigate possibilities for improving communication, recognition, and relationships between academic colleagues and both DEU and non-DEU clinical teachers.
Based on sample demographics, approximately one third of the sample will be reaching retirement age in the next 10 years, and approximately the same number reported their next role as retirement; this is consistent with the national average. The majority of clinical teachers in this sample were Bachelor of Science in Nursing and/or masters-prepared. This difference in education level may reflect an overall younger age demographic than the national average for nurse faculty. The age difference in this sample is due to the DEU model used by the University of Portland, which utilizes Bachelor of Science in Nursing–educated expert clinicians as the primary clinical teachers.
This survey took place during one academic semester, and some clinical sites had low enrollments of students. The completion rate of the surveys administered was not as high as expected; although the survey was timed at taking less than 10 minutes to complete, many participants did not fully complete the survey. Participants from population-based and postacute clinical settings anecdotally found the survey to be somewhat confusing and reported fewer areas of the survey applied to them and their specific role in working with students. Future studies may include a shorter and more simplified survey to prevent confusion and increase survey completion.
- American Association of Colleges of Nursing. (2017). Nursing faculty shortage. Retrieved from http://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Faculty-Shortage
- Auxier, N. & Simpson, H. (2018). Transforming the role of the clinical faculty coordinator in the dedicated education unit. Nursing Education Perspectives, 39, 383–384. doi:10.1097/01.NEP.0000000000000263 [CrossRef]
- Benner, P., Sutphen, M., Leonard, V. & Day, L. (2009). Book highlights from educating nurses: A call for radical transformation. Retrieved from http://www.carnegiefoundation.org/elibrary/educating-nurses-highlights
- Gui, L., Barriball, K.L. & While, A.E. (2009a). Job satisfaction of nurse teachers: A literature review. Part I: Measurement, levels and components. Nurse Education Today, 29, 469–476. doi:10.1016/j.nedt.2008.11.002 [CrossRef]
- Herzberg, F. (1987). One more time: How do you motivate employees?Harvard Business Review, 65, 109–120.
- Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
- Moscato, S.R., Miller, J., Logsdon, K., Weinberg, S. & Chorpenning, L. (2007). Dedicated education unit: An innovative clinical partner education model. Nursing Outlook, 55, 31–37. doi:10.1016/j.outlook.2006.11.001 [CrossRef]
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Participants' Sample Characteristics and Education
|Variable||Dedicated Education Unit (n)||Non-Dedicated Education Unit (n)||Total (n)|
| Associate degree RN||9.1% (9)||22.6% (22)||15% (31)|
| Baccalaureate RN||43.4% (43)||47.7% (51)||45.9% (94)|
| Some graduate||7.1% (7)||7.5% (8)||7.2% (15)|
| Master's||7.1% (7)||7.5% (8)||7.2% (15)|
| Doctor of Nursing Practice||1% (1)||0% (0)||0.5% (1)|
| Postdoctoral||1% (1)||0% (0)||0.5% (1)|
| Licensed practical nurse||3% (3)||0.9% (1)||1.9% (4)|
| Certified nursing assistants||9.1% (9)||3.7% (4)||6.3% (13)|
| Certified medical assistants||2% (2)||0% (0)||1% (2)|
| Master's in other field||0% (0)||0.9% (1)||0.5% (1)|
| Other||15.2% (15)||9.3% (10)||12.1% (25)|
| 20 to 30||15.5% (21)||9.8% (10)||15.5% (32)|
| 31 to 40||28.5% (25)||31.8% (34)||28.5% (59)|
| 41 to 50||24.6% (26)||23.4% (25)||24.6% (51)|
| 51 to 60||17.4% (15)||19.6% (21)||17.4% (36)|
| 61 to 70||0.5% (8)||7.5% (8)||7.7% (16)|
| Female||88.4% (87)||88.8% (95)||88.4% (183)|
| Male||11.1% (11)||11.2% (12)||11.1% (23)|
| Married||64.3% (59)||59.6% (73)||68.2% (133)|
| Single||15.9% (16)||16.2% (17)||15.9% (33)|
| Other||17.9% (20)||20% (17)||21% (24)|
| Excellent||25.6% (25)||26.2% (28)||25.6% (53)|
| Very good||48.8% (50)||46.7% (50)||48.8% (101)|
| Good||24.2% (23)||25.2% (27)||24.2% (50)|
| Fair||1.4% (0)||1.9% (2)||1.4% (3)|
| White/Caucasian||70% (70)||87.9% (94)||79.8% (165)|
| Hispanic/Latino||3.9% (4)||3.7% (4)||3.9% (8)|
| Asian/Pacific||14.1% (14)||6.5% (7)||6.5% (21)|
| Native||3% (3)||0% (0)||1.4% (3)|
| Black/African American||1% (1)||0% (0)||0.5% (1)|
| Two or more races||4.8% (7)||7.1% (3)||2.8% (5)|
|Country of birth|
| U.S. born||84.5% (79)||79.8% (95)||88.8% (175)|
|Total||47.8% (99)||51.7% (107)||100% (207)|