Journal of Nursing Education

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The Issue: Faculty Practice

Mary Wakefield-Fisher, RN, MSN

Abstract

This paper will address the issue of faculty practice as it relates to nurse educators. Faculty practice involves the expansion of a faculty role to include a clinical practice component. If faculty practice is mandated, it will have significant implications for the structure of nursing service and nursing education. The role of every faculty member will be altered. For example, in order to facilitate the additional responsibility of practice, the educational system might include faculty practice as one criterion for tenure. In addition, allowances would need to be made for the absence of faculty from campus. Similarly, nursing service would be required to devise a method whereby nursing faculty could practice in health care delivery systems on a part-time basis. The scheduling of nursing faculty in practice settings would require great flexibility, to accommodate other faculty responsibilities such as classroom teaching, committee meetings, and so forth.

Faculty practice is a multidimensional issue. However, the focus of this paper will be primarily directed toward two aspects of the faculty practice issue. First, is the shouldering of clinical practice a responsibility which can be realistically expected of nurse educators? Secondly, if faculty practice does not overextend faculty, are the benefits sufficient to justify necessary changes in nursing service and nursing education?

The subject of faculty practice will first be addressed through a brief historical perspective. The history will be followed by an analysis (utilizing role theory concepts) of the potential effects of faculty practice on nurse educators. The final section will identify current methods of implementing faculty practice, indicating related problems and benefits.

In tracing the issue of faculty practice historically, it is of interest to review thoughts espoused by Florence Nightingale. According to Deloughery (1977), Nightingale viewed the head nurse as a professional who was responsible for both nursing practice and nursing education. More specifically, the head nurse was responsible for both the management of her ward and the nursing students who functioned on that ward. In this setting, clinical instruction was the responsibility of the practitioner. Opposition to this model of combined service and education was voiced in 1923 by the Committee for the Study of Nursing Education (Deloughery, 1977). This committee published a report that recommended a schism of nursing education from nursing service. The committee advocated that the traditional service-education role combination be dissolved and replaced with two persons carrying out separate roles related to nursing service and nursing education. This committee deemed that such action was in the best interests of nursing. However, the fruition of this recommendation did not occur until the 1950s.

Through the 1940s, the typical hospital organization still depicted the head nurse as clinical instructor, and the director of nursing service as the director of the school of nursing (Mauksch, 1980). In the 1950s, with the advent of associate degree programs and an increased interest in baccalaureate nursing programs, an exodus of nursing educators from the hospital setting to the academic setting took place (Gray, 1979). Also, faculty who studied at the graduate level in the 1940s and 1950s received an indoctrination in educational administration, with scant emphasis placed on clinical practice (Mauksch, 1980). As a result of content in graduate programs and minimal faculty practice, nurse educators lost their orientation toward clinical practice. Nursing faculty taught nursing from textbooks rather than from their own clinical practice.

Mauksch (1980) states that during the 1950s, nursing lost its image of a clinical profession since the best qualified nurses were advanced to management positions in the hospital* or teaching positions in the educational system. The bulk of patient care was left to nonprofessionals. As a…

This paper will address the issue of faculty practice as it relates to nurse educators. Faculty practice involves the expansion of a faculty role to include a clinical practice component. If faculty practice is mandated, it will have significant implications for the structure of nursing service and nursing education. The role of every faculty member will be altered. For example, in order to facilitate the additional responsibility of practice, the educational system might include faculty practice as one criterion for tenure. In addition, allowances would need to be made for the absence of faculty from campus. Similarly, nursing service would be required to devise a method whereby nursing faculty could practice in health care delivery systems on a part-time basis. The scheduling of nursing faculty in practice settings would require great flexibility, to accommodate other faculty responsibilities such as classroom teaching, committee meetings, and so forth.

Faculty practice is a multidimensional issue. However, the focus of this paper will be primarily directed toward two aspects of the faculty practice issue. First, is the shouldering of clinical practice a responsibility which can be realistically expected of nurse educators? Secondly, if faculty practice does not overextend faculty, are the benefits sufficient to justify necessary changes in nursing service and nursing education?

The subject of faculty practice will first be addressed through a brief historical perspective. The history will be followed by an analysis (utilizing role theory concepts) of the potential effects of faculty practice on nurse educators. The final section will identify current methods of implementing faculty practice, indicating related problems and benefits.

In tracing the issue of faculty practice historically, it is of interest to review thoughts espoused by Florence Nightingale. According to Deloughery (1977), Nightingale viewed the head nurse as a professional who was responsible for both nursing practice and nursing education. More specifically, the head nurse was responsible for both the management of her ward and the nursing students who functioned on that ward. In this setting, clinical instruction was the responsibility of the practitioner. Opposition to this model of combined service and education was voiced in 1923 by the Committee for the Study of Nursing Education (Deloughery, 1977). This committee published a report that recommended a schism of nursing education from nursing service. The committee advocated that the traditional service-education role combination be dissolved and replaced with two persons carrying out separate roles related to nursing service and nursing education. This committee deemed that such action was in the best interests of nursing. However, the fruition of this recommendation did not occur until the 1950s.

Through the 1940s, the typical hospital organization still depicted the head nurse as clinical instructor, and the director of nursing service as the director of the school of nursing (Mauksch, 1980). In the 1950s, with the advent of associate degree programs and an increased interest in baccalaureate nursing programs, an exodus of nursing educators from the hospital setting to the academic setting took place (Gray, 1979). Also, faculty who studied at the graduate level in the 1940s and 1950s received an indoctrination in educational administration, with scant emphasis placed on clinical practice (Mauksch, 1980). As a result of content in graduate programs and minimal faculty practice, nurse educators lost their orientation toward clinical practice. Nursing faculty taught nursing from textbooks rather than from their own clinical practice.

Mauksch (1980) states that during the 1950s, nursing lost its image of a clinical profession since the best qualified nurses were advanced to management positions in the hospital* or teaching positions in the educational system. The bulk of patient care was left to nonprofessionals. As a result, the quality of patient care was not influenced by those nurses most capable of upgrading patient care.

The American Nurses' Association, in the 1960s, further separated education and practice through its position on the entry into practice issue. This issue branded graduates from hospital-based nursing programs with nonprofessional status. Through the mid to late sixties, nurses repositioned themselves within the health care system and the educational system. Graduate degree preparation acquired an expanded focus, including clinical specialization as a curriculum component. Toward the end of the sixties and the early seventies, a combined nursing service-nursing education model was reintroduced. Moreover, an avalanche of nursing leaders advocated the reinstatement of faculty practice in some form (Christman, 1979; Mauksch, 1980; Schlotfeldt, 1969; Smith, 1965). Whether the unification models being resurrected are dinosaurs, whose extinction should have occurred 30 years ago, is a determination which is yet to be made.

It is the contention of this author that central to the faculty practice issue, as it exists today, is whether nursing is overloading nurse educators by demanding faculty practice. It is generally accepted that educators currently expend well over 40 hours per week fulfilling their role obligations (S ay lor, 1979). The hours are spent meeting responsibilities related to research, service, and teaching. In carrying out these responsibilities, there is continuous interplay between a nurse educator and other members of the university community (Fry, 1975).

As a result, there are multiple causes of role strain, affecting educators, within the academic environment. Role strain, as defined by Goode (1960, p. 483), is "the felt difficulty in fulfilling role obligations." Role strain refers to any situation where an individual experiences difficulty, pressure, or tension while fulfilling role expectations (Sharan, 1977). A narrower focus of role dysfunction is termed role conflict. According to Sharan (p. 9), "role conflict ... is generally limited to situations where an actor is confronted with conflicting or competing expectations." More specifically, Sarbin (1954) views role conflict as a condition resulting from an individual occupying two or more roles, and role expectations of one role are incompatible with role expectations of the other. For purposes of this paper, role strain will include situations which produce conflicting or competing expectations.

While faculty practice ranges from being discouraged to mandated, depending on the particular school of nursing, the resulting ambiguity related to the actual value of faculty practice is, in itself, a source of role strain. That is, strain is produced when controversy exists about what is expected (Secord & Blackman, 1964). In addition, role expectations related to nurse educators have been in a constant state of flux for the better part of this century. For example, obligations to carry out nursing research were virtually unheard of until the 1950s. With the move into university settings, however, research has become a role obligation. The inclusion of faculty practice is yet another alteration in the role of the nurse educator. According to Rose (1951), frequent changes in a role produce a lack of clarity and thus further role strain. Certainly the role of the nurse educator could be a prime example of a profession whose role has often been ambiguous, questioned from both in and outside of the profession, and has undergone considerable change. Nevertheless, nursing leadership advocates further, immediate change. This is exemplified in a statement by Schlotfeldt (1969, p. 124) regarding faculty practice which argues that we must "... effect changes in role perceptions, expectations, [through] re-education and retraining programs ... in which the new role performance is expected and required."

It becomes obvious that the direction nurse educators are headed toward facilitates another type of role strain referred to as role overload. In defining role overload, Sharan (1977, p. 11) states that "on occasions, the burden of role demands become too heavy for an individual to fulfill all of them simultaneously." Kahn and Wolfe (1961) studied role overload occurring in certain occupations, and found that where strain had been especially strong, a corresponding increase in on-the-job tension, a decrease in job satisfaction, and decreased confidence in the organization became evident. With the rebirth of unification models, a means for validating Kahn and Wolfe's findings may be available.

Specifically, with regard to faculty practice as a cause of role strain, Goode's theory of role strain appears to be particularly applicable. Therefore, faculty practice will be addressed in terms of Goode's theory. Goode (1960) argues that with any role obligation, there are people who lack sufficient energy, resources and so forth to meet role obligations. Goode states that at times, contradictory performances are required which cause role strain. With regard to faculty practice, the educator who seeks to practice within the confines of a joint appointment or "moonlighting" on weekends and holidays, would be in a prime position to experience role strain. For while nurse educators believe and therefore practice nursing in an idealistic manner, the reality of service settings does not promote that idealistic practice. Therefore, expecting a nurse educator to practice in a mediocre setting requires that educator to compromise her care in order to meet demands of high patient census, insufficient staff or other typical problems. This type of role strain would probably be averted in many unification models where the quality of nursing care in the affiliated service setting is similar if not equal to, the quality of nursing care taught in the classroom (Christman et al., 1979).

A second source of role strain, according to Goode (1960, p. 485), involves the belief that "...each role relationship typically demands several activities or responses." Among those various responsibilities, inconsistent or contradictory norms might surface. To illustrate this concept with regard to faculty practice, Christman (1978, p. 39) offers the view that "the role components . . . [of] all professions are those of service, education, consultation and research. Role expression depends on the mixture of these components." Given the four major responsibilities of professionals, as Christman views them, contradictory activities might result. For example, to whom does the practitionerteacher give priority when both her patient and her student exhibit needs simultaneously? There is substantial doubt that quality time can be extended to both patient and student when the needs of each require separate actions. For as Goode (1960, p. 485) argues, when an individual "conforms fully or adequately in one direction, fulfillment will be difficult in another." Williamson (1978, p. 84) shares Goode's perspective as evidenced by his statement that

. . . educators have to stop feeling guilty about their lack of direct involvement in practice and should not be called upon to defend it. In no way can one person meet the demands of an academic position and fulfill adequately the obligations of a practitioner commitment. We cannot have the best of two worlds.

Similarly, Smoyak (1978) contends that when educators focus on their own performance as clinicians - the thrust of attention is ever ywhere but toward the student. On the other hand, numerous authors would disagree with Williamson and Smoyak. For example, Spilatro (1979, p. 21) asks "is it reasonable to expect nurses to teach current practice issues if they are not active in clinical practice?" Moreover, Wiedenback (1969, p. 63) argues that

... in a world in which scientific and medical knowledge is rapidly expanding and the realities are constantly changing, the nurse's ways of functioning and responding must also change. Competencies developed in nursing experiences of yesterday may not be adequate in those of today.

In light of the belief that faculty practice has the potential to produce role strain, it is interesting to note that Goode (1960) views role strain as normal and to be expected. Goode (p. 485) states "In general, the individual's total role obligations are overdemanding." Nevertheless, it is important to consider how we can best allocate our time and resources in order to reduce the strain from the added responsibility of faculty practice. The reality of the situation might best be described by Sholtis (1961, p. 10) who, while advocating faculty practice, states that "...too many times the nursing instructor...doe8 not have time on her own to give nursing care to patients." Proponents of unification models believe that they have identified a workable means of adequately carrying out all aspects of faculty role, including practice (Christman, et al., 1979; Pierick, 1973; Powers, 1976). At Case Western Reserve and Rush University, faculty practice is facilitated through organizational changes occurring in both the school of nursing and the practice setting. Acknowledging the importance of faculty practice, education accommodates this function by allowing the faculty flexibility in meeting other responsibilities. Such organizational changes are necessary in order to avoid overextending the nursing faculty.

If faculty practice, within the context of a unification model, joint appointment, or other alternatives, is to be developed, success is dependent on convincing the nursing profession that the "end" does justify the "means." If educators were shown that this role obligation is essential to achieving quality patient care, smoother staff-instructor relations, and other benefits frequently cited, and that role overload would be prevented, then it would seem that most faculty would want to engage in faculty practice. Methods for applying strain-reducing mechanisms to the faculty practice issue should then be considered.

Goode (1960) states that to minimize role strain, the individual should select a set of responsibilities which are minimally conflicting and will support each other to the extent possible. Christman's unification model at Rush University attempts this method. For example, a practitioner-teacher within the Rush model will provide primary patient care to a caseload of patients and also involve nursing students in the care of those patients. Christman et al. (1979, p. 8) states that faculty "...develop their practice and share it with their students, instead of merely visiting units __ " In addition, the fact that an educator would no longer be required to take time to identify and assign patients to nursing students would support clinical practice by eliminating a time consuming function. Also, faculty practice would negate the situation where, according to Mowry (1979, p. 18)

The traditional instructor enters the unit after little or no contact with the patients and nurses on that unit and attempts to construct a cohesive staff-student relationship that is frequently superficial at best.

Thus the often found contempt and avoidance for clinical instructors in the practice setting could be alleviated with the implementation of faculty practice, thereby eliminating a long standing conflict.

Another method of reducing role strain is through the delegation of responsibilities (Goode, 1960). Delegating certain teaching responsibilities to staff nurses would decrease unnecessary faculty-student interaction and allow the faculty member additional time to assume patient care responsibilities. This type of delegation exists in the Rush model since staff nurses are required to perform minimal student observation and participate in student evaluation (Mowry, 1979).

The last example of a strain-reducing mechanism advocated by Goode (1960) calls for building mechanisms for gratification into one's environment. Relating this method to faculty practice is simple. That is, if a faculty member does engage in faculty practice, she should receive remuneration, possibly in the form of advanced rank, merit points which would affect salary, first choice for committee work, or other options which faculty and administration find mutually agreeable. Since it has been shown that methods do exist for decreasing role strain in faculty required to practice in the clinical area, this author will now address perceived benefits resulting from faculty practice.

Faculty practice is often viewed as having numerous benefits for the nursing profession as well as for the recipients of nursing care. For example, educators, through faculty practice, are better able to role model clinical practice (Mauksch, 1980). According to Pierick (1973), nursing would produce an increased number of relevant research projects related to the clinical area. Also, the education provided to students would be reality based (Weidenback, 1969). In addition, class content would be up to date, emanating from experience rather than textbooks (Pierick, 1973). While all of these spin-offs of faculty practice are likely to occur, it is not enough to say "yes," the end justifies the means. Rather, if we propose faculty practice for all faculty, it should be facilitated through the following means:

1. Provide flexibility in meeting role responsibilities (i.e., decreased number of students to advise for a given semester);

2. Provide remuneration in the form of rank, salary, and so forth;

3. Establish administrative support from both the service and the educational setting;

4. Plan and support research directed toward identifying means of coping with role strain;

5. Acknowledge that the primary goals of education and service are different, thus avoiding the use of nursing students in providing patient care, with little regard for student learning.

For, as Goode (1960, p. 491) states, "...there are barriers against combining various roles, even when the individual might find such linkage congenial."

This paper has identified various aspects of the faculty practice issue. The author has indicated how implementing faculty practice with little forethought, can precipitate role strain and role overload. In addition, the pros and con of the faculty practice issue have been highlighted. Lastly, methods to facilitate the implementation of faculty practice have been suggested.

This author sees a need for validation of both the pros and cons of this issue, through research. It is not enough to accept the opinions of some nursing leaders when we are dealing with an issue possessing such broad ramifications. It is, nevertheless, the belief of this author that nurse educators should, as Notter and Spaulding (1976, p. 196) suggest, be able to demonstrate "expert clinical competence in those areas of clinical nursing being taught." However, if this is a goal that is virtually unattainable by the vast majority of nurse educators, due to limited energy and resources, then faculty practice should be encouraged but not mandated. Engaging in faculty practice might be likened to icing on a cake - it enhances, but is not always necessary. Finally, in discussing frequent changes involving the teaching role, Grace (1972, p. 107) states that "unless fairly specific efforts are made to assess and evaluate the results of . . . new approaches, it may be that once the initial enthusiasm has abated, teacher motivation may decline, resulting in a return to traditional patterns." Although faculty practice should be encouraged, all aspects continue to require study. It is probably wisest to proceed as if in the presence of a flashing orange light - with a degree of caution.

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10.3928/0148-4834-19830501-06

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