Based on my two-year experience as a joint appointee with a teaching hospital and a baccalaureate nursing program, I believe that the appointment of a staff nurse to a position which combines clinical practice with clinical instruction of nursing students can be a source of professional growth and personal satisfaction. I believe that it can also benefit the involved hospital and nursing program.
Rochester Methodist Hospital (RMH) is an 800-bed teaching hospital affiliated with the Mayo Clinic in Rochester, Minnesota. Luther College, a liberal arts college of the American Lutheran Church located in Decorah, Iowa, has worked closely with RMH to develop clinical learning experiences for nursing students within the acute care setting. Because of the established relationship between these two institutions, it was anticipated that a joint appointee could fit comfortably into the RMH-Luther fabric. Consequently, a position was designed to combine the hospital's staff nurse role with the college's teaching associate position.
Joint appointments are not new; the literature describes various practice-teaching combinations, often involving supervisory, specialist, or administrative roles shared between a teaching institution and a service setting (Christman, 1979; Nayer, 1980; Pierik, 1973; Powers, 1976; Rokosky, 1979). The joint appointment between RMH and Luther College was different in combining the staff nurse position with a clinical instructor role involving specific faculty responsibilities.
As a half-time RMH staff nurse, I provided direct patient care, and occasionally assumed charge duties. 1 worked holiday and weekend hours although, because of the time commitments of the joint appointment, my schedule was flexible. My shift assignment was generally, though not exclusively, days. It was my responsibility aa a staff nurse to maintain my level of competence in providing patient care as well as to participate in hospital-wide activities, such as emergency preparedness drills, staff meetings, and inservice education programs. As a staff nurse, I received a yearly evaluation of my performance.
As a half-time teaching associate with Luther College, my duties included teaching junior level nursing students in clinical areas at RMH. I worked with students on two nursing units, assigning and supervising patient care, assisting with preparation and intervention, conducting post-conferences after each clinical period, and grading written assignments. Though I was not responsible for presentation of theory content or for final student evaluations, my input into these areas was encouraged and accepted. I also assisted with teaching specific skills and with evaluation of students' ability to perform techniques in a lab setting as well as on the clinical units.
I was expected to attend general college and nursing department faculty meetings in Decorah about once a month. I also participated in college activities such as commencement ceremonies; however, my halftime position did not require college or departmental committee work. And, as at RMH, I received an annual evaluation.
Assimilating the components of this position was challenging. Probably the moat difficult aspect of the situation at first was the coordination of work hours between a hospital schedule of defined shifts and a clinical teaching schedule. Since the students' clinical hours were already established when I joined the Luther nursing faculty, I designed a relatively consistent schedule around them. Normally, I worked a full day shift prior to making patient assignments and meeting with a group of students for clinical preparation in the evening. The following morning was clinical, followed by office hours, meetings, or lab activities in the afternoon. This cycle occurred twice each week.
Accommodating the unusual hours of a staff nurse/joint appointee presented a problem for the hospital. Since my time schedule had to fit the students' appointed clinical hours, my hospital work hours were somewhat limited, and did not conveniently fit the staffing pattern of any one nursing unit. To resolve this, I joined the hospital float staff.
Another problem encountered at first was that my schedule did not facilitate communication with students outside of our clinical hours together. This was easily resolved by writing office hours into my weekly schedule, and by informing students of specific means to reach me if necessary outside of my "Luther time."
A joint appointment can easily become a greater than full-time job unless the time requirements of each half are carefully evaluated. It is important that the joint appointee has input into schedule planning so that proper time proportions can be maintained. I was permitted to write my own schedule, taking into consideration weekend hours, holiday work requirements, and the college events that I was expected to attend.
Both Luther College and RMH were open to variations in the percentage of time I spent working for each institution within a given pay period. That is, if I needed extra hours for a teaching activity, I wrote them into my schedule. During the next pay period, I worked an extra hospital shift and decreased my teaching time so that over the course of the academic year, my hours balanced evenly between staff nursing and teaching.
Because both the college and the hospital were helpful in defining and respecting the limits of a position which included multiple duties, I felt no "pull" for my loyalty, time or attention from either institution. Rather, I worked in one position with duties defined in two areas, each of which was respected by the other.
Luther Christman (1979) has written that in nursing, most practitioners are not allowed to carry out all of the components of the professional role: service, education, consultation, and research. As a result, nurses experience fragmentation of their role and frustration in achieving professional stature in society. My experience in a joint position served to unite some of the strands that are important in my professional life.
Service is the purpose of nursing, and service may be carried out in many ways. The direct care of clients is one; the education of future practitioners who will bring new ideas and energy to nursing is another. Both of these were parts of my joint role.
Although research was not the focus of my joint appointment position, I developed an increasing appreciation of the need for research in nursing. This was the result of an expanded view of the nursing profession which I gained both in the joint position as well as from my entry into graduate level coursework.
Similarly, I developed an appreciation of consultation as an aspect of the professional role. It was helpful for me to learn of others' experiences in similar, if not identical, positions. The sharing of positive experiences in service-education interaction can be a source of growth for the nursing profession as a whole.
One particular benefit of the joint appointment became clear to me soon after I accepted the new position: working as a clinical instructor improved my skill as a practitioner. The teaching-learning process at its best stimulates both student and instructor to explore, to experiment, and especially, to evaluate.
I am pleased to have held a position that allowed integration of professional roles early in my nursing career. It supported my inclination to learn, and allowed me to look at my commitment to nursing from a new direction. At the same time, my experience reflects institutional support of professional growth for staff nurses who remain in staff nurse positions. Rather than growing out of a direct patient care role that I liked, I grew within it.
In addition to the personal advantages of this experience, I believe that there were benefits to both institutions involved in the joint appointment. For example, RMH gained a better staff nurse. While this statement is offered without measurable evidence, I believe that the broadening of my skills and interests in nursing did contribute to the quality of patient care that is of central importance in the service setting. It would be useful to develop concrete ways of measuring the growth that I perceived.
A question of practical importance to the service setting is the effect of positions such as joint appointments on hiring and staff retention. The willingness of RMH to participate in joint appointments may add an attractive feature to its recruitment package.
Nursing education, on the other hand, gained a closer rapport with nursing service. The sharing of a joint appointment position promoted understanding between RMH and Luther College by providing a clinical instructor with whom unit staff could identify. Because we worked together on a daily basis, many RMH staff members and I had opportunities to talk about nursing education and about Luther's nursing program.
Furthermore, this particular joint appointment arrangement supports the role of staff nurses in nursing education. This not only lessens the distance between the nursing program and staff nurses, it may also increase nurses' acceptance of students when they are learning in the clinical area.
My familiarity with RMH was helpful in keeping nursing faculty in touch with the daily life of the hospital. The perspective of a staff nurse may help faculty understand concerns and problems that staff experience when working with nursing students.
Students had the advantage of observing an example of role integration early in their experience with the nursing profession. Luther College nursing students were supportive of the joint appointment, and some expressed interest in working in a similar situation in the future.
An additional benefit to students was the opportunity to talk about staff nursing. Students who planned to begin their careers as hospital nurses were interested in knowing how I felt about my job, and how I went through the transition from student to practitioner. The fact that students initiated such discussions suggested that it was important to them to talk about staff nursing with a staff nurse. I often wondered how exposure to an instructor who was also a staff nurse affected students' perception of the staff nurse role and their own entry into practice.
The joint appointment described between Rochester Methodist Hospital and Luther College is an example of how service and education positions can be united to the benefit of nursing. Personal and professional development of the individual staff nurse is one important outcome of the joint role.
In addition, nursing service and nursing education can both gain from the cooperative effort that a joint appointment demands. I believe that the large amounts of patience and flexibility inherent in making a joint appointment work despite potential problems can increase nurses' understanding of and respect for the different components of our profession. Perhaps as we develop more of these, we will all experience less frustration in achieving nursing's deserved professional stature in society.
- Christman, L. (1979). The practitioner-teacher Nurse Educator, 4, 8-11.
- Nayer, D. (1980). Unification: bringing nursing service and nursing education together. American Journal of Nursing, 80, 1110-1114.
- Pierik, M. (1973). Joint appointments: collaboration for better patient care. Nursing Outlook, 21, 576-579.
- Powere, M. 11976). The unification model in nursing. Nursing Outlook, 24, 482-487.
- Rokosky, J. (1979). Faculty observations in an interim joint appointment role. Nursing Administration Quarterly, 4, 32-38.