Journal of Nursing Education

Major Article 

Looking Through the Right End of the Telescope: Creating a Focused Vision for a School of Nursing

Paula Milone-Nuzzo, PhD, RN, FHHC, FAAN; Jeanette Lancaster, PhD, RN, FAAN

Abstract

The challenges facing nursing higher education necessitate that academic administrators have a focused vision for their schools of nursing. Nursing, like other areas of higher education, embraced the concept of strategic planning to set priorities, use resources wisely, and take advantage of available opportunities that were consistent with the strategic direction. While there has been a shift toward a less-structured approach to planning, nursing deans need tools to assess the environment, make rational decisions, set priorities, plan for change, and develop strategies to meet the short-term and long-term goals of the unit. Given the challenges facing nursing education and higher education, the need for a planning approach is critical. The case study in this article describes a flexible and creative approach to the planning process that helped the University of Virginia School of Nursing set priorities and achieve its goals.

Dr. Milone-Nuzzo is Professor and Director, The Pennsylvania State University School of Nursing, University Park, Pennsylvania; and Dr. Lancaster is Professor and Dean, University of Virginia School of Nursing, Charlottesville, Virginia.

Address correspondence to Paula Milone-Nuzzo, PhD, RN, FHHC, FAAN, The Pennsylvania State University School of Nursing, 201 Health and Human Development, East University Park, PA 16802; e-mail: pxm36@psu.edu.

Abstract

The challenges facing nursing higher education necessitate that academic administrators have a focused vision for their schools of nursing. Nursing, like other areas of higher education, embraced the concept of strategic planning to set priorities, use resources wisely, and take advantage of available opportunities that were consistent with the strategic direction. While there has been a shift toward a less-structured approach to planning, nursing deans need tools to assess the environment, make rational decisions, set priorities, plan for change, and develop strategies to meet the short-term and long-term goals of the unit. Given the challenges facing nursing education and higher education, the need for a planning approach is critical. The case study in this article describes a flexible and creative approach to the planning process that helped the University of Virginia School of Nursing set priorities and achieve its goals.

Dr. Milone-Nuzzo is Professor and Director, The Pennsylvania State University School of Nursing, University Park, Pennsylvania; and Dr. Lancaster is Professor and Dean, University of Virginia School of Nursing, Charlottesville, Virginia.

Address correspondence to Paula Milone-Nuzzo, PhD, RN, FHHC, FAAN, The Pennsylvania State University School of Nursing, 201 Health and Human Development, East University Park, PA 16802; e-mail: pxm36@psu.edu.

The challenges facing nursing higher education necessitate that academic administrators have a focused vision for their schools of nursing. Never before has nursing education faced such challenges from both the profession and the academic institutions in which it exists. Three major challenges, which began in the late 1900s, affect the way nursing schools function in the 21st century: the shortage of the faculty workforce, the need to be fiscally responsible in the face of declining resources (Minnick & Halstead, 2001), and consumer demand for new products and services. Each of these challenges influences the creation of a vision for schools of nursing.

Current Challenges

Nursing faculty drive the work that occurs in schools of nursing. Therefore, a ready supply of appropriately educated nursing faculty is critical to the health of a school. However, the United States is currently facing one of the most critical nursing faculty shortages due to the unprecedented shortage of RNs, the aging of the faculty workforce (American Association of Colleges of Nursing [AACN], 2003), and the career opportunities for doctorally prepared nurses outside academia, especially in clinical practice and industry.

In 2000, the AACN surveyed schools of nursing to determine the vacancy rate for faculty. A national sample of 220 schools had 5,132 full-time faculty positions, of which 7.4% were vacant. Other studies have estimated the vacancy rate as high as 9.2% (Farino, Gott, & Miller, 2000). While the nursing shortage has contributed to the current nursing faculty vacancy rate, the impending faculty vacancy rate will be complicated by the projection of the large number of faculty retirements in the next 10 years. Retirement projections for individuals who were faculty members in 2001 suggest that between 2004 and 2012, 200 to 300 doctorally prepared faculty will be eligible for retirement yearly (AACN, 2003).

Career opportunities for doctorally prepared nurses outside academia have also contributed to the shortage of nursing faculty. The number of doctoral graduates who choose careers outside teaching has steadily increased since 1984. Reasons for this choice include salary differentials, faculty workload, job satisfaction, and faculty role expectations (AACN, 2003), each of which can severely affect the ability of schools of nursing to enroll and educate students.

While the cost of higher education has continued to increase, the percentage of that cost that can be appropriately shifted to the students in tuition and fees is small. At The Pennsylvania State University, a large, public, land-grant institution, the percentage of the budget allocated by the legislature has decreased, and tuition increases have reached double digits for the first time in the University's history, a situation with which the University Board of Trustees is less than pleased. Decreases in public funding for higher education reflect social skepticism and a reordering of governmental priorities (Montez, Wolverton, & Gmelch, 2002), a view that is likely to continue. While tuition increases cover some of the deficit, academic administrators must be fiscally conservative if they are to further reduce the effect on the student population.

Schools of nursing are always vulnerable to losses in other sources of funding from foundation grants, industry sponsorships, and private donations. Organizations dependent on revenues from the stock market are now feeling the financial effects of its low performance in recent years. This may lead to fewer dollars to disperse and fewer revenue streams for schools of nursing.

Finally, as students, our “customers,” have changed over the years, the need to provide new services and products has also become more compelling. The average age of a student graduating from a basic nursing program is 30.9, compared to 23.9 in 1984 (Spratley, Johnson, Sochalski, Fritz, & Spencer, 2000). These adult learners are, at times, in need of remedial support, since they may have been out of the educational system for a period of time. They also want and value alternative teaching models, ones that combine Web-based learning with classroom instruction. These newer models allow students to incorporate the pursuit of education into their complex lives. New models of education that streamline the process to advanced degrees also provide educational opportunities that were previously unavailable.

Setting Priorities and Leveraging Resources

Nursing, like other areas of higher education, embraced the concept of strategic planning to set priorities, use resources wisely, and take advantage of available opportunities that were consistent with the strategic direction. For schools of nursing, this process seemed like a rational tool for orderly, systematic management, a disciplined effort to produce fundamental decisions and actions that shape and guide what an organization is, what it does, and why it does it (Bryson, 1988). The 1980s were also a complex time in nursing higher education, given the focus on nursing research and the need to shift from faculty as exclusively clinical experts to faculty as both clinical experts and researchers.

Yet little has been written in the current nursing literature about the need, process, or outcomes of planning in the academic program. In the 1990s, many business leaders and academic administrators, including nursing deans, questioned the value of strategic planning. They thought the process was cumbersome and that academic units spent more time developing the plan than implementing the initiatives. In industry, there were a number of positive stories in which companies found success with a much less-structured planning approach (Dooris, 2002). Others found it was impossible to project the future for the length of time the strategic plan encompassed, and responsibility and interest for initiatives waned (Minnick & Halstead, 2001). Still others believed the strategic planning process discouraged creativity, entrepreneurship, and positive change. The result is that some leaders abandoned strategic planning completely, while others invented new approaches to rational decision making.

While there has been a shift toward a less-structured approach to planning, nursing deans need tools to assess the environment, make rational decisions, set priorities, plan for change, and develop strategies to meet the short-term and long-term goals of the unit. New models of strategic planning include dimensions of flexibility, creativity, and strategic thinking within the educational, economic, and political contexts (Rhoades, 2000). Plans are no longer simple roadmaps for the future. Instead, they are vehicles for moving along a trajectory toward a series of goals.

It is widely accepted that planning is most important in times of significant and rapid change, as a method of coping with that change (Baker & Martin, 1993; Gilbert, 1991; Hall & Eliott, 1993). Given the challenges facing nursing education and higher education, the need for a planning approach is critical. The case study in this article (see pp. 508–509) describes a flexible and creative approach to the planning process that helped the University of Virginia School of Nursing set priorities and achieve its goals.

This approach came after years of trying to use a more conventional strategic planning approach. Like many companies had already learned, the more traditional approach was cumbersome and too much like a recipe. Times changed, and the more prescriptive plans became outdated. In contrast, using the envision process, which is discussed in the case study, faculty were able to agree on strategic directions and determine which areas in the school would be maintained, which would be strengthened, and what new areas would be developed.

Strategic Challenges for the Future

Fiscal Management and Resource Procurement

Fiscal management and resource procurement will continue to be the cornerstones of academic leadership, for, without them, academic units cannot achieve their missions. After an academic unit sets its priorities, the budgetary implications of those decisions must be examined and addressed. Resource allocation, through either existing or new funding streams, must follow a clear set of priorities. Planning failures can often be tied to an ambiguous link between the allocation of resources and the strategic initiatives of the academic unit (Minnick & Halstead, 2001).

Academic deans must have a clear and complete understanding of the unit's budget, including current revenue sources and expenditures. Existing revenue sources must be fully mined to ensure all opportunities are developed. New revenue sources must be found to fund new streams of activity. These new revenue sources can be found by answering the question, “Who benefits from the end product of the school's activity?,” whether it is education, research, clinical practice, or outreach. For example, if a community hospital is paying $2 million in bonuses to traveling nurses each year, perhaps they could be encouraged to fund the tuition for graduate students in exchange for part-time work during the academic year and full-time work during vacations and summers. These graduate students may remain at the institution after they graduate, resulting in a steady stream of permanent employees for the hospital. The benefit for the school of nursing is an increase in the number of full-time graduate students. Research centers may receive financial support from foundations that are interested in the scientific area. Alumni and donors must be cultivated based on strategic priorities. Through education and engagement, deans can make the school's priorities the donor's priorities.

Entrepreneurship

Entrepreneurship is essential to the evolution of any academic unit; yet, overcoming change and resistance is often difficult in academic institutions (Hanna, 2003). Bennis (1989) described the academic leader as a conceptualist, someone who understands the mission, has a strong vision, and is entrepreneurial within that mission. Longstanding traditions, coupled with strong and independent faculty who strive for autonomy, may resist strategic efforts. However, the organizations that have been most successful are those that have embraced change and encouraged faculty members' creativity within the context of the organizational mission. The opportunity to begin the change process with a “discussion,” as described in the case study, may reduce the resistance to innovation.

A clearly defined organizational and unit mission will aid decision making related to setting priorities. Schools of nursing must identify their core values—those activities and outcomes that define the fundamental elements of the school. Plans for innovation, growth, and change can be evaluated based on those core values. For example, The Pennsylvania State University and the School of Nursing have missions that include teaching, research, and outreach—three dimensions clearly defined and described by the University. The School of Nursing has been challenged to make decisions about strategic initiatives within this mission, given limited resources and faculty time. Through discussion with the academic leadership and faculty of the School, it was decided that clinical outreach would only be done if it furthered the School's academic or research missions. For example, clinical outreach in the form of health screenings or health education would be conducted by students as a service-learning activity or as part of a research project. Outreach activities could then continue to be important and visible, while strengthening the other two dimensions of the mission. As resources or priorities change, or if an exceptional opportunity presents itself, the School will be able to adapt to the current environmental context.

Through every step of the planning process, the faculty must have an integral role in setting direction, critiquing plans, and implementing activities. Without faculty consultation early and at every step of the process, the best plans will not be successful. As described in the case study, faculty members are integral in setting the direction for the academic unit.

Investment in the Future of the Faculty

Given the changes in the characteristics of the academic nursing population, it is essential that academic units invest in the future of the faculty. Nursing deans who help foster positive, supportive, and intellectually rewarding work environments encourage faculty longevity and inspire young professionals to choose careers in academia. Many strategies have been used to improve the work environment for faculty, including the development of mentorship programs for young faculty, the growth of interdisciplinary and intradisciplinary collaborations, and the examination of faculty workload within the context of individual strength and goals.

The impending retirement of faculty members in the coming years and the need to replace them with individuals new to teaching will require nursing deans to develop approaches to “teach the teachers how to teach.” The trend in master's education is toward nurse practitioner education and preparation as scientists at the doctoral level (AACN, 2003). While some of these individuals may have taken an elective course in teaching, it is likely they could begin an academic appointment with exceptional clinical or research skills but without an understanding of the teaching role. Providing summer institutes, teaching academies, and mentored teaching experiences will help these new faculty members become effective educators.

Telling the Story of the School of Nursing

Historically, the nursing profession, including academic nursing programs, has been less than effective in sharing the scope and significance of its work. While nursing has contributed much to the health of the nation through both practice and research, there has been little visibility of the contributions to that work. By developing priorities, identifying goals, and measuring outcomes, nursing schools can identify those scientific, academic, or clinical areas that make them distinctive. Those areas that define the academic unit can be highlighted in the effort to tell the story of the school of nursing. Deans and faculty should be encouraged to share the positive work of the school with others within the college or university, as well as with alumni, the board of trustees, legislators, and the public. By “telling the story,” it becomes clear to constituents how the school of nursing is advancing the mission of the university and the school.

Summary

While the strategic planning process of the past is outdated, nursing higher education continues to need a conscious process by which it assesses its current state and the likely future condition of its environment (Swenk, 1999). Contemporary planning processes include listening to the market, encouraging the emergence of good ideas, engaging employees in the process, recognizing opportunities, and helping the organization flourish in the face of change (Dooris, 2002). Through the planning process, academic nursing programs will proactively guide their future through inevitable change.

References

  • American Association of Colleges of Nursing. (2003). Faculty shortages in baccalaureate and graduate nursing programs: Scope of the problem and strategies for expanding the supply. Washington, DC: Author.
  • Baker, D. & Martin, R.J. (1993, May–June). A framework for strategic planning and change in higher education: The case of a business school. Paper presented at the 33rd annual forum of the Association for Institutional Research. , Chicago. . (ERIC Document Reproduction Service No. ED 360918)
  • Bennis, W. (1989). Why leaders can't lead: The unconscious conspiracy continues. San Francisco: Jossey-Bass.
  • Bryson, J.M. (1988). Strategic planning for public and nonprofit organizations. San Francisco: Jossey-Bass.
  • Dooris, M.J. (2002). Two decades of strategic planning: Is strategic planning a useful tool or a counterproductive management fad?Planning for Higher Education, 31(2), 26–32.
  • Farino, A., Gott, S. & Miller, D. (2000). Health and nurses in Texas: The future of nursing; data for action. A report of the Texas nurse workforce data system (3:1). Austin, TX: Texas Nurses Foundation.
  • Gilbert, A. (1991). Current issues and future developments in higher education. Journal of Tertiary Education Administration, 13, 117–130. doi:10.1080/1036970910130202 [CrossRef]
  • Hall, M. & Eliott, K. M. (1993). Strategic planning for academic departments: A model and methodology. Journal of Marketing for Higher Education, 4, 295–308. doi:10.1300/J050v04n01_20 [CrossRef]
  • Hanna, D.E. (2003). Building a leadership vision: Eleven strategic challenges for higher education. Educause Review, 38, 24.
  • Minnick, A.F. & Halstead, L. (2001). Use of a faculty investment model to attain the goals of a college of nursing. Journal of Professional Nursing, 17, 74–80. doi:10.1053/jpnu.2001.22269 [CrossRef]
  • Montez, J.M., Wolverton, M. & Gmelch, W.H. (2002). The roles and challenges of deans. The Review of Higher Education, 26, 241–266. doi:10.1353/rhe.2002.0034 [CrossRef]
  • Rhoades, G. (2000). Who's doing it right? Strategic activity in public research universities. The Review of Higher Education, 24, 41–66. doi:10.1353/rhe.2000.0025 [CrossRef]
  • Spratley, E., Johnson, A., Sochalski, J., Fritz, M. & Spencer, W. (2000). The registered nurse population: Findings from the National Sample Survey of Registered Nurses. Washington, DC: U.S. Dept. of Health and Human Services, Health Resources and Services Administration.
  • Swenk, J. (1999). Planning failures: Decision cultural clashes. The Review of Higher Education, 23, 1–21. doi:10.1353/rhe.1999.0025 [CrossRef]

Case Study

Setting Priorities and Leveraging Resources: The Story of the University of Virginia School of Nursing

In my 2 decades as a dean, there have been few activities more difficult and complex than setting academic priorities. The complicating factor relates to determining what programs and areas will be islands of excellence in a sea of respectability, as one of my colleagues used to say. It is human nature for each of us to want our area of research or teaching to be an island, not a part of the much larger sea. At the University of Virginia School of Nursing, we struggled for several years to determine exactly what we wanted to be best at. It was easy to identify areas to keep and grow but difficult to decide which areas to let go. In 2001, our work in setting strategic school priorities catapulted in response to a new university planning initiative.

“Envisioning” the Future

In the fall of 2001, when a new Provost was hired, he and the Vice President for Development launched a process called “Envision.” Each school was asked to craft a 3-hour conversation with the two of them, a few select people on their staff, and up to 15 people from within the school. As most of us are able to carry on conversations in daily life, initially this task seemed simple. However, having a conversation about the aspirations of a school proved to be complex.

Faculty and academic administrators are skilled at making presentations, but having a conversation was another thing. Fortunately, a facilitator was engaged to work with each school and, after a few discussions with him, the School of Nursing administrative team learned how to have the requisite conversation. The purpose of the conversation was to chart the future of the School, and this required thinking about where we were in our development; what our strengths and core values were; what our immediate and long-term needs were; and, importantly, what our aspirations were.

It is important to note that this planning process occurred simultaneously with 2 years of state budget cuts. The University of Virginia School of Nursing had approximately 500 students, ranging from traditional baccalaureate through postdoctoral students. There were 45 full-time faculty member and a number of clinical faculty who supervised groups of students in the clinical area. Since it is often difficult to plan for the future when funds are being reduced, the enthusiasm generated by this planning process was remarkable.

During the 3-hour conversation, there was a sense of electricity in the room. Faculty attendees included the dean; associate dean; directors of the baccalaureate, master's, and doctoral programs; division chairs; selected faculty representing research or program interests; and two members of the development staff. Most, but not all, of the attendees were tenured or on the tenure track. Faculty participants were energized, and soon the guests became infected with the contagious enthusiasm.

Five major aspirations were identified: to be innovative, collaborative, service oriented, research oriented, and student focused. When faculty were asked how they would apply a “transformational gift” from a donor, should one be available, they said they would use the money to create or enhance programs in areas such as rural health; chronic illness in an aging population; health promotion and disease prevention; practical ethics; international programs, especially efforts to train future leaders in nursing in the developing world; and emerging infectious diseases, including those spread by bioterrorism.

Planning Retreat

Deciding how to proceed may have been a difficult task, except for the occurrence of an intervening situation. Two months after this Envision session, the School of Nursing was offered 20 prepaid accommodations at a resort in Florida. The University had purchased the lodging for a University Envisioning session. However, the weekend selected was the one in which a new governor was to be inaugurated in Virginia. Although the School had no idea how it would use the accommodations, I immediately said yes.

We then decided to invite 11 faculty members and 9 volunteers to spend a weekend adding specificity to the Envisioning process. The volunteers were current or former members of the School's Advisory Board and the chief nurse of the University of Virginia Medical Center. The two goals of the School's Advisory Board are to help the school with public relations and visibility and with fundraising.

What an opportunity! Beginning on Friday evening and continuing until late Sunday afternoon, this group of 20 people, working with a facilitator from within the School of Nursing, delved into planning and setting priorities. Discussions were lively, animated, and at times, heated. Priorities were set, and there was strong buy-in from the participants. Of course, now the question was, “How do we get buy-in from the remainder of the faculty?”

Task Force Development

The participants insisted that we must act immediately. A town meeting was held the next day to provide feedback to the faculty on the areas the planning team had identified. This mechanism for communicating with faculty and obtaining buy-in was revolutionary for us. The report and action plan was met with a range of responses, including interest, fear, and apprehension. Right away a task force, called the Initiative 2010 Committee, was appointed. It consisted of stakeholders who had attended the planning retreat and others who had not. The task force included five respected faculty members who represented tenure, senior faculty, and tenure-track junior faculty. No administrators served on the task force. The members were charged with developing criteria by which foci (i.e., priority areas for the School) would be selected, and recommending foci that the School should strengthen and build.

The overall goal was to “keep the quality of our educational programs intact, while simultaneously promoting our research initiatives.” The task force worked diligently and reported back to the faculty in less than 3 months. Their recommendations focused on the near (3 to 4 years) and more distant (5 to 10 years) future, and they emphasized the importance of building on current strengths and then beginning to expand the priority foci areas in a deliberate way that took into account strengths and directions in which both the University and Medical Center were moving.

At this time, the School had three centers: Complementary and Alternative Therapies, Rural Mental Health, and Nursing History. With these centers in mind as guiding principles, the task force recommended that the School seek to build strength in oncology, a Medical Center growth area, and gerontology, a University growth area. It was recommended that once strength was built in these two areas, the School would develop strategies to grow in the following areas, which represented either current or emerging institutional strength: cardiovascular health and public health. The faculty also wanted to build on institutional strengths, including ethics and international health.

The goal was to expand and strengthen collaboration within the University and also to recruit senior faculty in priority areas. An overarching goal was to partner with others in the University. Being one of the smaller schools at the University of Virginia, it seemed logical for the School of Nursing to team up with initiatives in other schools and in the Medical Center. Often the groups comprising the larger initiative can develop and support some of the infrastructure needed to make the effort a success.

Goal Accomplishment

Now, 2½ years later, many of the overall goals of the Envision plan have been accomplished:

  • The original three centers are making good progress, with steady grant funding coming into the Center for the Study of Complementary and Alternative Therapies and the Southeastern Rural Mental Health Research Center, and private funds coming into the Center for the Study of Nursing Historical Inquiry.
  • Senior faculty have been recruited in oncology and gerontology to hold endowed professorships. In each specialty, new junior faculty have been recruited, and at least one faculty member from within the School is pursuing specialty education in each area.
  • An associate dean for research has been hired, and the previous research advisory committee has been made an elected, standing committee of the faculty organization and serves a key advisory function.
  • A close relationship has been forged with the Vice Provost for Research, and among other forms of support, he has offered funds to support major National Institutes of Health funding successes.
  • The National Institute for Nursing Research has funded a center for rural health care research. This has become the fourth Center within the School.
  • The role of division chair was strengthened; divisions were changed into departments, and budgets and other forms of authority and accountability were decentralized.
  • A formal mentoring program was set up by a senior faculty member to help new assistant professors develop in their roles of teacher and researcher.
  • A research incentive program was developed to provide discretionary funds to faculty members who bring in a certain level of support.
  • An international committee was also formed as part of the faculty organization. Members are elected and have considerable input into the international priorities selected and the ways in which funds are spent.
  • A diversity committee was established as part of the faculty organization. They have held their first annual diversity day and worked closely with the Professional Staff Nurse Organization in the Medical Center to collaborate on diversity work. In addition, the committee chair facilitated a program on diversity for the annual end-of-the-year faculty and staff retreat.

Summary

While it is never easy to balance all of the needs within a school for education, research, and service, we found that our involvement in the Envision process enabled us to maintain more focus than we had in the past. The Envision process and the subsequent work of the Initiative 2010 Committee provided a “roadmap” for us. So often our interests, aspirations, and good intentions outstrip our capacity, and we go in directions that distract from the more central focus.

Both named professors, for gerontology and oncology, developed strategic plans for growth in their areas. Because of a close and collaborative relationship with the University of Virginia Medical Center, both strategic plans had considerable involvement with colleagues in nursing and other disciplines in the Medical Center. In general, this process enabled faculty and administrators to hold one another accountable by referring back to what had been agreed on. For example, if as dean, I become intrigued by what seems like an exciting new venture, faculty and other administrators freely remind me of our agreed-on major goals and how this new venture could distract from, rather than enhance, goal attainment.

Jeanette Lancaster, PhD, RN, FAAN

10.3928/01484834-20041101-10

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