The Journal of Continuing Education in Nursing

Original Article 

The Clinical Nurse Educator Role: A Snapshot in Time

Jean Sheerin Coffey, PhD, APRN, CPNP; Briana Lee White, MSN, RN, CPN, CCRN-K, CNL

Abstract

Background:

The role of the clinical nurse educator (CNE), vital to safe patient care and professional development of clinical nurses, is poorly defined in the literature with respect to the how the CNE spends his or her time.

Method:

This study set out to quantify the role of the CNE in a large, rural, and tertiary academic medical center using the measure of time. A group of nine Master's-prepared CNEs voluntarily participated in a month-long time analysis hypothesizing, then reporting, the number of hours spent in each practice domain (clinical practice support, central orientation, system-wide initiatives, and professional development).

Results:

At the completion of the month, the data suggested that the majority of the time spent by the nurse educator was in clinical practice support.

Conclusion:

The findings begin to quantify the CNE role and reinforced the need for more role clarity related to how CNEs' time is spent. [J Contin Educ Nurs. 2019;50(5):228–232.]

Abstract

Background:

The role of the clinical nurse educator (CNE), vital to safe patient care and professional development of clinical nurses, is poorly defined in the literature with respect to the how the CNE spends his or her time.

Method:

This study set out to quantify the role of the CNE in a large, rural, and tertiary academic medical center using the measure of time. A group of nine Master's-prepared CNEs voluntarily participated in a month-long time analysis hypothesizing, then reporting, the number of hours spent in each practice domain (clinical practice support, central orientation, system-wide initiatives, and professional development).

Results:

At the completion of the month, the data suggested that the majority of the time spent by the nurse educator was in clinical practice support.

Conclusion:

The findings begin to quantify the CNE role and reinforced the need for more role clarity related to how CNEs' time is spent. [J Contin Educ Nurs. 2019;50(5):228–232.]

The role of the hospital-based clinical nurse educator (CNE) is fundamental to safe, excellent patient care. Along with nursing academics and administrators, CNEs “hold the excellence of nursing education in their hands” (Benner, 2012, p. 184). CNEs support both experienced and novice nurses to meet patient care quality and safety standards. Health care institutions across the United States embrace the role of the CNE; however, it can have a wide array of titles, as well as varied expectations for clinical expertise and educational preparation and responsibilities (Conway & Elwin, 2007). Although the CNE position is vital to health care institutions, it is often poorly understood and not well defined in most hospital settings (Sayers, DiGiacomo, & Davidson, 2011).

The Association for Nursing Professional Development (ANPD) published the Scope and Standards of Practice (2010) regarding the role of the CNE, named as the nursing professional development (NPD) practitioner. For the purposes of this article, the term CNE will be used. The document breaks down the job description into discreet topics to include mentor, change agent, learning facilitator, and partner for practice transitions. It also endorses clinical expertise as demonstrated by specialty certification and graduate education for all NPD professionals. However, it falls short of outlining the actual operationalization of the role (Harper, 2016).

Warren and Harper (2017), using a modified Delphi technique, explored further delineation of the role of the CNE. Engaging 11 nursing professional development experts from across the United States, they outlined the future of the role, which included consultation to the larger organization beyond the nursing department. Key concepts such as leader, mentor, and partner were described as part of the role of the CNE.

Johnson (2015) identified CNEs as role models who are saying and doing the right things at the bedside. She goes on to state that nursing staff at the bedside will “notice if there is dissonance between what the NPD specialist tells them to do and what they see the NPD specialist does” (p. 297). The power of the role modeling of nurses at the bedside goes back as far as Florence Nightingale (1914), who stated “Every year of her service a good nurse will say I learned something every day” and that “learning can be shared by giving the grace of our good example to all around us” (p. 8).

While the literature to date outlines the role of the CNE, a gap exists regarding how CNEs actually spend their time in the acute care setting. Our team set out to begin to close the gap by aligning the well-defined CNE job description as delineated by several authors and groups (American Nurses Association, 2010; Harper, 2016; Johnson, 2015; Warren & Harper, 2017) with the actual time spent in the role of the CNE in a large, rural, tertiary academic medical center in New England.

The interest in the clarification of the CNE role arose following a consultation to evaluate the education needs of the bedside nurses in the large, rural, academic medical center. The hospital had an outstanding nurse residency program that attracted graduates from across the country. Each summer, large cohorts of new graduates entered the 12-month new graduate resident program. Each spring, the cohorts dwindled due to nurse migration to bigger cities in the region. The significant turnover affected staffing and nurse seniority, with the majority of nurses possessing 2 years of experience or less. Based on the recommendation of the consultant, a nurse educator was assigned to each inpatient nursing unit, exponentially increasing the number of nurse educators on the team. The intent was to improve safety and support new nurses in their transition to practice, as well as decrease turnover.

The recommendation to increase the CNE numbers caused a significant change for the team as they went from a five-person group dedicated to central nursing orientation to a 20-nurse contingent with nursing unit and central orientation responsibilities. The educators all held graduate degrees in nursing and were recognized for their clinical expertise, with certification in their clinical area. As the team began to form, it was clear that there needed to be some guidance on how to structure and guide the work of the CNE. In addition, the nurse education team's organizational engagement survey results identified role clarity as an area of concern. Role ambiguity and lack of recognition of the CNE's graduate degree status can be drivers for dissatisfaction and frequent turnover in the role (Sayers, 2012). In response, the nurse education team met for a brainstorming session regarding role clarity and a discussion on how to manage their time.

The group hypothesized the current CNE role was divided into four areas of focus. The group then listed specific tasks under each area. The list of tasks and domains were then aligned with the current nurse educator job description held by the CNEs and the ANPD domains. The CNEs found that the four major headings and task lists aligned nicely with the job description. They also mirrored the role descriptions published in the recent Nursing Professional Development: Scope & Standards of Practice (Harper, 2016).

After the tasks and job description were aligned and supported by the ANPD document, the educators began to explore how to further describe their role. The percentage of time in each of the major areas of focus needed further clarification. The nurse educators proposed a hypothesized breakdown of the time percentages in each area of focus. The team then agreed to test the hypothesis by voluntarily participating in an analysis of how they spent their time each week. At the time of the analysis, nine experienced full-time nurse educators were working in the team. Recent hires and temporary educators were excluded from the analysis.

Each nurse educator was given a spreadsheet with the four major domains: clinical practice support, central orientation, system-wide initiatives as a liaison or consultant, and personal professional development. The definitions of these domains can be found in Table 1. The analysis was conducted over a 1-month period. Each week, the nine educators completed spreadsheets by reporting the number of hours in each domain, number of total hours worked, and any pertinent notes. The spreadsheets were electronically submitted to the program coordinator, who deidentified the data and entered them into a master spreadsheet. At the end of the month, the deidentified data were tabulated (Table 2).

Nurse Educator Role: Time Distribution GuidelinesNurse Educator Role: Time Distribution Guidelines

Table 1:

Nurse Educator Role: Time Distribution Guidelines

Educator Time Distribution: Hypothesized and Actual

Table 2:

Educator Time Distribution: Hypothesized and Actual

At the completion of the month, the data suggested that the majority of the time spent by the nurse educator was with the direct care nurses on the unit. The nurse educator working with nurses at the bedside employed skill and knowledge in using evidence to guide practice. The work in this realm positions the CNE to be seen as an expert member of the nursing team. Anecdotal examples of questions from learners provided by one CNE ranged from “Does this look right?” to “Where is that policy?” to “Can I walk through how to do a central line dressing change before I do it on the patient?” These questions reflected the broad scope of just-in-time educational need by the bedside nurses. This finding supported the proposed outcome to support bedside nurses as stated by the consultant when the organization made the decision to place CNEs on the nursing units.

The second area of focus, central orientation, was a labor-intensive process and took more time than hypothesized. Central orientation typically consists of organizational and accrediting bodies' requirements for nursing clinical orientation. CNEs taught multiple classes in the orientation and each required the educator to review the content via policy, procedure, video, and lesson plan. Additionally, the educators were expected to ensure there were enough materials and proper equipment to deliver the content. This preparation time was often left out of planning and it was found to increase the time originally theorized for central orientation by 6%.

The organizational initiative support time was more than expected as well. The nurse educators reported they were often asked by various departments to produce products and information or teach skills across the organization. This consultation regarding organizational initiatives often consisted of multiple planning meetings, time for evaluating evidence, and thoughtfully suggesting the best method for education. The educator was often also responsible for personally delivering the information to the front-line clinical staff and evaluating their learning. It was also common for the CNE to lend his or her expertise to projects with no direct impact on the bedside nurses. The CNE team anecdotally stated that this part of the role was the most invisible and often the most labor intensive.

The final category, professional development, was afforded the least amount of time in the analysis although it was hypothesized as 10% of the nurses' time each week. This finding may be skewed, as there is often seasonal variation in available educational offerings. In this academic medical center setting, however, the CNEs had access to free, high-quality seminars, grand rounds, and conferences year round. Despite the access, it was still a challenge to meet the hypothesized percent of time devoted to professional development.

The analysis process and the subsequent findings helped the team to continue to examine the role of the CNE in the large, rural academic medical center. It gave the CNEs data to use as they worked to further define the role and align it with the ANPD scope of practice while meeting the organization's needs. The findings confirmed the team hypothesis that they spend the majority of their time each day on the unit supporting nurses at the bedside. The results also brought to light some tasks and responsibilities that were taking more of the CNEs' time than expected. The findings highlighted the broad scope of the CNE role and reinforced the need for more role clarity moving forward.

The limitations of the analysis are the small sample size and short time frame of 1 month. The cycle of the nurse education activities has peaks and slow times during the 12-month calendar year, including influxes of new graduates in the summer months. Therefore, these data are not fully representative of the work in all times of the year. To our knowledge, there is no other similar analysis exists in the current nursing literature; so, although the sample size is small and time limited, this analysis can begin to add to the dearth of information on how the CNE spends his or her time in the acute care setting.

Recommendations for future study include a larger sample size of CNEs and time studies at different quarters in the year to encompass the busy summer season. Qualitative interviews with the educators regarding time allocation in their roles may also help with describing the position in more depth. The measurement of nursing turnover and the correlation to CNE time spent on the unit could help to assess the return on investment of the role.

This pilot study ultimately shed light on the current self-defined role of the nurse educator in relation to time spent in different areas, to the actual defined role through time measured. CNEs in this pilot thought they spent more time in clinical practice support and professional development than was measured. They also thought they spent less time in central orientation activities and system initiatives than actually measured. Generalized, CNEs underestimated their contributions to the larger organization's central orientation and initiatives, but focusing on their merit in their microsystem rather than the larger scope. Yet, in both hypothesized and actual measurement of the CNEs' time, the majority of the work is completed in clinical practice support. Two distinct truths speak to the importance of this support: the Bureau of Labor Statistics predicts more than one million RNs will be needed by 2024; and 18% of new nurses leave their first job within 1 year and that organizations that can offer support and training to this strained and highly competitive workforce will have better retention of nurses (Kennedy, 2018). Nurse educators not only are a marketing tool for retention, they also have the potential to grow the role for the future.

CNE or NPD specialists in the future will see more technology in developing staff, choices provided for how individuals learn best, increased partnerships through teaching teams and administration, and communities of learning (Johnson, 2016). On the basis of this snapshot in time, CNEs should welcome the involvement in hospital initiatives to be able to creatively plan and adapt to the changing workforce. Clinical practice support will grow into individualized learning support for nurses within four generations, rather than being the expert in patient care. Personal development in this role will also look technology focused, fostering innovation and creativity rather than complete subject expertise. This brief pilot study opens a window to the future and the ever-changing role of the CNE and the potential for adaptation on how time spent in the role can change over time according to the needs of the learners and organizations that it supports.

References

  • American Nurses Association. (2010). Nursing professional development: Scope and standards of practice. Silver Spring, MD: Author.
  • American Nurses Association. (2015). Nursing professional development: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.
  • Benner, P. (2012). Educating nurses: A call for radical transformation—How far have we come?Journal of Nursing Education, 51, 183–184. doi:10.3928/01484834-20120402-01 [CrossRef]
  • Conway, J. & Elwin, C. (2007). Mistaken, misshapen and mythical images of nurse education: Creating a shared identity for clinical nurse educator practice. Nurse Education in Practice, 7, 187–194. doi:10.1016/j.nepr.2006.08.005 [CrossRef]
  • Harper, M. (2016). Nursing professional development: Scope & standards of practice (3rd ed.). Chicago, IL: Association for Nursing Professional Development.
  • Nightingale, F. (1914). Florence Nightingale to her nurses: A selection from Miss Nightingale's addresses to probationers and nurses of the Nightingale school at St. Thomas's Hospital. London, United Kingdom: Macmillan.
  • Johnson, J.A. (2015). Nursing professional development specialists as role models. Journal for Nurses in Professional Development, 31, 297–299. doi:10.1097/NND.0000000000000202 [CrossRef]
  • Johnson, J.A. (2016). Nursing professional development specialists of the future. Journal for Nurses in Professional Development, 32, 158–160. doi:10.1097/NND.0000000000000251 [CrossRef]
  • Kennedy, M.S. (2018). Nurses wanted—Almost everywhere: It seems the nursing shortage has arrived. American Journal of Nursing, 118(6), 7.
  • Sayers, J. (2012). Nurse educators devalued drives change. Australian Nursing Journal, 19(7), 45.
  • Sayers, J., DiGiacomo, M. & Davidson, P. (2011). The nurse educator role in the acute care setting in Australia: Important but poorly described. Australian Journal of Advanced Nursing, 28(4), 44–52.
  • Warren, J.I. & Harper, M.G. (2017). Transforming roles of nursing professional development practitioners. Journal for Nurses in Professional Development, 33, 2–12. doi:10.1097/NND.0000000000000320 [CrossRef]

Nurse Educator Role: Time Distribution Guidelines

Area of FocusDescription of the WorkActivitiesAssociation for Nursing Professional Development Domain
Clinical practice supportResponsible for maintenance of clinical expertise related to the patient population. Responsible for staff development and competency in application of the nursing process and performance of critical thinking and clinical skills for that population. Engages regularly with interprofessional team in huddles, interdisciplinary rounds, and other forums to facilitate assessment and identification of educational needs. Performs needs assessment, develops, designs, implements, and evaluates evidence-based educational materials utilizing principles of instructional design for adult learners. Facilitates ongoing educational initiatives including nursing orientation, preceptor education, and other unit level and organizational learning initiatives. Promotes understanding of best practices in education among clinical nurses, clinical supervisors, and other leaders to empower these individuals to become education champions and engage nurses in supporting each other's learning and clinical practice. Member of the leadership team on the unit Support of nurse onboarding Preceptor oversight Support of current nursing staff Subject matter expert with a focus to support the nurse to give exceptional careParticipate in root cause analysis Rounding with preceptors and new graduate/experienced nurses Rounding with all staff Collaborate in the planning of unit competencies Assist with unit competencies Sign off training skills ambassadors Consult to practice area council Consult to cross-areas in population expertise Unit-based safety huddle Interdisciplinary rounds Just-in-time education Proactive planning with clinical nurse leader/clinical nurse specialist for specific patient needs with future admissions New policy/procedure education planning and roll out New equipment education planning and roll out Assess, plan, deliver, and evaluate continuing unit-based skills days and education where applicable. Collaborate with nursing research initiativesLearning facilitation
Central orientationResponsible for design and development of centralized orientation programs, and identification and development of adjunct faculty to delivery content. Teach CORE (Centralized Orientation Required Education) Preceptor Class Vizient Facilitator (Nurse residency program) CompetenciesZoll teaching/point of care testing/witnessed cardiac arrest Welcoming of new hires (licensed nursing assistant, nurse residency program, experienced nurse orientation, travelers, class preparation time, and cohort planning Collaboration with the Patient Safety Training Center Developing classes in new CORE modelPractice transition
System-wide initiatives consultantConsultant to the nursing education enterprise, including but not limited to the development, implementation, and evaluation of organizational competencies and regulatory practice requirements. In partnership with nursing leadership, fosters a culture of learning and continuous development for learners at all levels. Consults to regional and system initiatives as needed Consult with key stakeholder Hospital-wide committees Outreach to affiliates CommunityInterdepartmental Educational Liaison (e.g., with blood bank, simulation laboratory, materials management) Initiatives including inter professional education Affiliate Based Education Center for Nursing Excellence initiatives Community-Based EducationChange agent leader
Professional development scholarshipSeminars to improve teaching skills Evidence-based review of specialty nursing journals. Time for reading and curriculum development Specialty certification managementAttending Association for Nursing Professional Development webinars or local education workshops Keeping current on clinical specialtyPractice leader

Educator Time Distribution: Hypothesized and Actual

ActivityHypothesized %Actual %a
Clinical practice support75%64%
Central orientation10%16%
System-wide initiatives consultant5%9%
Professional development
Scholarship10%7%
Other4%
Authors

Dr. Coffey is Associate Professor and Director, Department of Nursing, Plymouth State University, Plymouth, and Ms. White is Clinical Nurse Supervisor, Children's Hospital at Dartmouth Hitchcock, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Sara A. Gilderdale Morcom for her help in managing the time analysis results, and the clinical nurse educators and coordinator for their contribution to the project.

Address correspondence to Briana Lee White, MSN, RN, CPN, CCRN-K, CNL, Clinical Nurse Supervisor, Children's Hospital at Dartmouth Hitchcock, Dartmouth Hitchcock Medical Center, P.O. Box 402, Wilmot, NH 03287; e-mail: Briana.L.White@hitchcock.org.

Received: May 21, 2018
Accepted: November 27, 2018

10.3928/00220124-20190416-09

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