The current and projected shortages of nursing faculty have prompted calls for new, more efficient approaches to traditional baccalaureate nursing education (American Association of Colleges of Nursing [AACN], 2005; National League for Nursing [NLN], 2003, 2005). The number of qualified applicants turned away from baccalaureate nursing programs is steadily increasing and exceeded 30,000 in 2005. The primary barrier to accepting these potential nursing students is lack of qualified faculty (AACN, 2006). Our nursing program responded to these challenges with an innovative curriculum called the Nurse Residency model (Diefenbeck, Plowfield, & Herrman, 2006). Development of this nursing education model involved moving all clinical rotations to a senior-year clinical immersion (residency), emphasizing the role of a clinical simulation resource center as a safe place to learn psychomotor and decision making skills, and incorporating field experiences and a work requirement to provide patient contact in the early years of the program. Our school of nursing recently celebrated 50 years of providing quality nursing undergraduate and graduate education. We now have approximately 650 undergraduate nursing students, 200 graduate nursing students, and 38 full-time faculty. A large percentage of the faculty hold doctoral degrees. Class size is recommended by curriculum committee based on course content, class assignments, and budgetary constraints. Smaller seminar classes have 18 to 25 students, medium classes have approximately 80 students, and large lecture classes average 150 students.
One unique feature of this program is our integration of undergraduate students as teaching assistants in both the classroom and the clinical simulation laboratory. Use of these undergraduate teaching assistants (UTAs) has permitted us to increase the number of students enrolled in many courses without compromising the quality of the nursing education we offer.
Undergraduate teaching assistants have been used successfully in many disciplines, including sociology (Fingerson & Culley, 2001; Wallace, 1974), psychology (Fremouw, Millard, & Donahoe, 1979), mathematics (Goff & Lahme, 2003), research (McKeegan, 1998), and computer science (Reges, 2003). Although the majority of the UTAs were used to lead discussion sections, some were assigned to grade assignments, tutor other students, hold office hours, and enter grades. Reported advantages of using UTAs included support for students through tutoring and review sessions, approachability for student questions, serving as positive role models for their peers, and reduction in faculty time spent in course-related activities. Advantages for the UTAs consisted of gaining in knowledge of the material, improving communication skills, and increasing exposure to the faculty role. Disadvantages reported included cost, difficulty selecting appropriate students for the UTA role, ethical concerns about having undergraduate students grade other undergraduates’ work, and lack of visibility of some UTAs.
Reports in the literature on the use of UTAs in baccalaureate nursing programs primarily describe use of UTAs in clinical and laboratory settings. Goldsmith, Stewart, and Ferguson (2006) reported that the use of third-year nursing students to assist first-year students in learning clinical skills in the laboratory yielded mostly positive evaluations from both levels of students. All students thought the program enhanced their learning of clinical skills and provided opportunities for professional role modeling. Difficulty in coordinating student’s schedules was reported as a negative of this approach.
Several authors described programs in which senior-level peer coaches were used to help junior-level students in the clinical setting. Broscious and Saunders (2001) matched each senior student with one or two junior students providing nursing care in a long-term care facility. Similarly, Becker and Neuwirth (2002) used senior students as clinical teaching assistants with junior-level medical-surgical students. In both experiences, junior students reported decreased anxiety and increased confidence, whereas senior students positively described the leadership and role modeling aspects.
Chandler (2005) reported using sophomore nursing students to lead freshman-level discussion groups and mentor freshman students. This UTA experience was designed to foster leadership behaviors in the sophomores and provide an early collaborative experience. No descriptions were found in the literature of UTAs being used as traditional classroom aides for assistance with proctoring, scoring, and recordkeeping throughout a baccalaureate nursing program.
The Nurse Residency curriculum incorporates both traditional teaching methods, including lecture and discussion, and also more innovative teaching strategies, such as online discussions and e-mail assignments. The curriculum components of clinical decision making exercises, field experiences, and an emphasis on the resource simulation laboratory were embraced by faculty but were also noted to be time consuming and labor intensive (Diefenbeck et al., 2006). The simulation laboratory, for example, provides a safe environment in which students can practice psychomotor skills as needed. However, this laboratory requires a resource person to be available many hours each week to guide student self-learning and to answer questions as they arise.
As faculty brainstormed potential solutions to the impending workload increase, we discussed the fact that other departments in our university used UTAs to provide student mentoring and to assist with the rudimentary aspects of course work coordination. Although we were unable to find other nursing programs that used UTAs, we thought that undergraduate students might be an untapped resource to both assist with the conduct of undergraduate education and to provide leadership and mentoring experiences for more senior students. Thus began our development of the teaching assistant program within our nursing school.
Our school does have a graduate program and we have tried many times to use graduate teaching assistants to help with undergraduate classes. However, we have repeatedly been unable to recruit graduate students to work as teaching assistants because most are part-time students who work full time or part time at lucrative clinical jobs. In addition, most of our graduate students aspire to clinical specialty or nurse practitioner roles, rather than to the nurse educator role. Graduate students who are interested in nursing education as a field appear to gravitate to learning the clinical teaching role, rather than the tasks associated with assisting in didactic courses. However, faculty believed that there was strong potential for undergraduate students to mentor each other across the curriculum and thus the UTA program was born. We developed a course for UTAs to receive course credit for their work supporting their peers and assisting faculty.
The UTA program was intended to provide individualized peer support for students enrolled in large didactic courses and to provide course assistance to faculty so they could spend more time teaching and less on associated tasks. The first step was to develop a contract that included the objectives for the UTA experience, the expectations of the role, and guidelines about teaching assistant behavior. We designed the contract with the goal of meeting the needs of the UTAs, the students receiving the UTA services, and the faculty. We intended that the UTA role would allow junior and senior nursing students to develop beginning teaching, peer leadership, and communication skills while enhancing their knowledge base in course content. The course objectives specify that the teaching assistant will:
- Demonstrate mentoring and communication skills in working with other students.
- Demonstrate professional behaviors in the peer leadership role.
- Maintain strict confidentiality with regard to students’ identities, class performance, grades, and issues.
- Verbalize an increased knowledge level of course content.
We now have a university-approved course entitled Teaching Assistantship in Nursing. This is a pass-or-fail course, and students may take one or two credits per semester. The assignment of course credits ensures that the work of the UTAs meets academic standards, is an accepted part of the students’ course work, and reinforces the responsibilities associated with the teaching assistant role. Students may take up to eight teaching assistantship credits during their student tenure, although most take two to four credits in their junior and senior years. These credits often fulfill free elective spots in the curriculum and serve to provide additional course credits during lighter semesters when credits may be needed to qualify a student as full time.
After review of the work involved, the Curriculum Committee of the school decided that 28 hours of teaching assistant work correlated to one credit of course work. The rationale for this formula is related to the current clinical hour calculation we use in the undergraduate program. We maintain a 2:1 clinical hour ratio in which 2 hours of clinical per week equals 1 credit hour. Our semesters are based on 14 weeks, so 28 hours reflects one earned credit. Due to the intensity of the teaching assistant work and the important role the UTAs played in the curriculum, this was deemed to be a fair credit equation. We have found that students generally work more than the required 28 hours but occasionally faculty have needed to closely monitor the UTA to assure that they worked the number of hours necessary. We discuss with the UTAs that the number of hours of work will vary from week to week, but that the average will be 2 hours per week. Selected students are permitted to register for two credits for 56 hours of work per semester, although this requires a significant time commitment, and may negatively affect their own academic performance.
The program’s clinical coordinator reviews the contracts with each UTA prior to the student registering for the course. Following completion of appropriate signatures, they are maintained in the students’ files. The students then receive approval to register for the teaching assistant course. Prior to the start of each semester, students taking the UTA course must attend a 2-hour class that covers basic teaching principles, confidentiality, communication with faculty and students, proctoring, grade entry, and other UTA roles. Students who have previously taken the UTA course are encouraged to share their own successful strategies with new UTAs.
Selection of Undergraduate Teaching Assistants
Teaching assistants are selected based on a variety of criteria. The first criterion is a grade point average of 3.0. This minimum allows us to select strong students who have good study skills. The second criterion is that students have successfully completed the course for which they wish to assist. Of note, we do not require an “A” in the course to be selected as a teaching assistant. Previous experience has taught us that students who worked hard for a “B+” or an “A–” may be better able to mentor weaker students and use their own experiences to identify and deal with difficult material. On the other hand, the teaching assistants do need to have a solid understanding of class content to be able to tutor and evaluate other students. In addition, UTAs should have a strong desire to work with other students, a mastery of previously learned content, and a professional demeanor that makes them role models. Faculty often request students who have an interest in their class, perform reasonably well in the class, and with whom they have a good working relationship. We ask faculty to approve the final selection of teaching assistants for each course to avoid any personal relationship issues.
We generally employ approximately 30 UTAs each semester. They support two freshman-level nursing courses, six sophomore-level nursing courses, seven junior-level nursing courses, and some nursing electives. Course enrollment and types of assignments determine the number of teaching assistants assigned per course. Courses with enrollments of more than 100 students use two or three UTAs each semester, whereas those with enrollments of 40 or fewer students generally have only one UTA.
Role and Expectations
Under the guidance of the faculty member, UTAs tutor other students, lead study groups and review sessions, provide reviews before examinations, review online and e-mail assignments, score quizzes using a key, enter grades, monitor WebCT (our educational platform on the Internet), organize and keep records of field experiences, monitor and assist in the simulation resource center, document practice laboratory attendance, and provide other instructor support as needed. Each faculty member interprets the UTA role slightly differently, adapting expectations to meet their students’ needs. Our simulation laboratory uses a peer educator model, and the UTAs answer questions and facilitate students learning of less complex laboratory skills. Other duties assigned to UTAs by some faculty include assisting faculty with examination proctoring, checking American Psychological Association format on papers, maintaining course records for mandatory course requirements, spot checking and supporting students during their field experiences, and commenting on field experience journals. Several faculty have chosen to develop specific lists of duties for their courses to make the role of the UTA even more explicit. These include such details as rubrics for scoring of class assignments and the level of expected e-mail support for class students. Faculty are invited to the UTA orientation each semester to further clarify the role and experienced faculty frequently discuss UTA responsibilities with newer faculty. Faculty generally meet with UTAs at the beginning of the semester to clarify expectations, discuss concerns, and to ensure collaborative relationships.
Faculty differ in whether they use UTAs to enter course grades. Because most faculty use the online grade book, some faculty request teaching assistant status for the students, which allows them to enter grades. Others choose to keep this within their own purview, requesting a more restricted access code for UTAs. The UTAs and the faculty work together to ensure a fair workload and are encouraged to communicate often during the semester. For example, at some times during the semester, the UTAs are busy with their own school work. Negotiation with the faculty member may allow the student to devote more time to personal studies and resume teaching assistant responsibilities when their workload lightens.
One of the assets of our nursing program is that only faculty provide classroom and clinical teaching, and our UTA program allows faculty to spend more time on the essential teaching functions requiring advanced education and prior teaching experience. Faculty are able to focus on preparing and delivering classes, creating and implementing innovative teaching strategies, providing student support, and conducting ongoing classroom assessments. In the simulation laboratory, faculty and laboratory coordinators are able to design learning experiences, support student peer learning, and evaluate student competency with the support of the UTAs.
We have found that prospective students and their parents are fearful that at large universities, teaching assistants do much of the classroom teaching. Our policy is that faculty, most doctorally prepared, provide all the didactic instruction, and proctor all examinations, sometimes with UTA assistance. Our UTAs provide peer support, are role models, and help faculty in the clerical and administrative tasks of teaching. They do not replace qualified and experienced faculty, nor is the teaching assistant program designed to provide insulation between student and faculty. Faculty are ultimately accountable for student achievement of course objectives, but the teaching assistant program enhances the teaching the faculty are able to provide. The team and peer mentoring approaches add to the faculty’s teaching effectiveness, but UTAs do not subtract from the faculty’s dedication or student contact.
The clinical coordinator organizes the logistics of the UTA course for the following semester, soliciting interested students, verifying UTA needs with faculty, and matching UTAs with courses. These assignments are made before the end of the previous semester to ensure faculty-teacher assistant communication prior to the start of the next semester. Frequent communication between faculty and UTAs throughout the semester ensures that this relationship is meeting the needs of all parties. The UTA grade roster is completed at the end of the semester after the clinical coordinator confirms that the UTAs have met the course requirements.
Confidentiality was probably the biggest issue at the inception of the UTA program. Although our nursing students were well aware of client confidentiality and Health Insurance and Portability and Accountability Act (HIPAA) regulations, they appeared less cognizant of their responsibility to maintain confidentiality with student information. The addition of a confidentiality statement to the course contract, incorporation of a related course objective, and reinforcement of this information with each student during the orientation class has enabled students to frame their work as a UTA within the same context as client care, understanding that the rights of other students are just as important as those of their clients.
Another unanticipated problem occurred in spring semester, primarily with senior UTAs. Due to the clinical immersion in the senior year, many of the students completed their clinical work mid-May and left campus until graduation. In contrast, teaching assistants are needed until the very end of the semester, especially in courses with final examinations. Because of this problem, a statement was added to the contract, stating “Student work begins at the beginning of the semester and ends at the end of finals week, unless other arrangements have been made.”
Faculty also struggled with the need for UTAs to attend specific class sessions to best be able to tutor, conduct test reviews, and grade course-specific assignments. We recognized that if the time students attended class was calculated into the UTA hours, there would be little other time, so class attendance is considered optional. In fact, as use of UTAs increased, scheduling conflicts sometimes occurred such that UTAs could not attend class without missing a class of their own. Some UTAs choose to attend class on their own time when possible, whereas others do not. Faculty usually provide UTAs with lecture PowerPoint® notes and other resources to reflect updates in lecture content and changes in information since the UTAs’ own course experience.
It is important that faculty understand the potential roles of the UTA in their courses. Initially, some faculty did not benefit from the assigned UTAs as much as others due to their own lack of understanding of the UTA role. We learned that schedule conflicts, perceived overburdening of the UTA, the UTA’s comfort level with the material, and other difficulties need to addressed early in the semester to ensure the success of the program. The maturity level of the UTA also influences the success of the program and may effect whether the UTA takes the role seriously and thinks of their UTA work as course work. When selecting students, faculty approach students who seem mature and responsible in the classroom and in their coursework. Faculty and the clinical coordinator then discuss selected situations with potential UTAs, such as working with colleagues, confidentiality, and helping others help themselves to learn. These assessments allow us to determine whether the candidate has the maturity to serve as a peer teacher and UTA. A certain level of autonomy and responsibility is assigned with the UTA role and the students need these qualities to be of value to the program and the other students.
Evaluation of the Teaching Assistant Program
Preliminary evaluations of the UTA program by students and faculty have been highly positive. Evaluation forms were designed for administration with students as consumers of UTAs, the UTAs themselves, and faculty. Student evaluations ask about the contact and comfort with UTAs and the flexibility, knowledge, and role modeling behavior displayed by the UTAs. Faculty evaluations addressed expectations and use of UTAs, effects on workload, and future use of a UTA. Undergraduate teaching assistant evaluations include questions about the work done, the credit earned, and orientation to the role. The evaluation forms are distributed via e-mail and results are compiled by the University Office of Educational Assessment. Evaluations over two semesters and several courses indicate that approximately 75% of students interacted with the course UTA in some way and 91% were satisfied with the amount of contact they had with the UTAs. Seventy-nine percent of students found the UTAs helpful, whereas 82% thought the UTAs were knowledgeable about the course content. Student comments were almost all positive and included the following remarks:
- Both [teaching assistants] were very willing to help and offered weekly review sessions that were very helpful.
- The [teaching assistants] were responsive with e-mail assignments and review sessions.
- The [teaching assistants] were quite helpful and always accessible. They went out of their way to schedule reviews for all quizzes and [examinations] and were highly knowledgeable in the content areas.
Although students who feel intimidated speaking to faculty may be more comfortable approaching their peers with questions and concerns, only 18% of students responded positively to the item “I feel more comfortable contacting the [teaching assistants] than the instructor.” This suggests that most students felt at ease contacting the faculty member for help but used the UTAs as well.
Evaluations of the UTA experience by the UTAs themselves were 95.7% positive, with no negative scores. Comments such as the following were frequent:
Being a [teaching assistant] was a great experience. I really got to reinforce the material that I learned in this class, and it is helping me in the classes I am currently taking. Holding weekly reviews seemed to benefit the students that came. The work I put in matched the credit hour. It was a great experience, and I plan on doing it again for spring 08.
Similarly, faculty evaluations of the UTA program were 96.7% positive, with only one negative score (this professor indicated that the UTAs added to her own workload), and there were many positive comments.
The additional resources of tutoring and review sessions provide valuable services for the students less frequently available with traditional faculty instruction. The informal support in the way of “how I made it through” and “this is what you need to do” provided by UTAs has also been described by students as valuable, enhancing the communication and teaching within the nursing program. Students who have served as UTAs speak of increased knowledge, competence, and confidence after this experience. The repeat application of students for UTA positions and the continued interest of other students in filling these positions offer testimony to the program’s success. Faculty appreciate the assistance offered by the UTAs. Many of the innovative teaching strategies, such as e-mail exercises, critical incident journals, and field experiences write-ups, would not be possible without the support of the UTAs. The UTA program seems highly successful and we plan to continue to use it to support the undergraduate curriculum.
Although this article discusses the inclusion of UTAs into the residency model nursing curriculum, UTAs may be valuable in a variety of nursing education models. Undergraduate teaching assistants may assist in the simulation or traditional nursing laboratory by supporting students, stocking supplies, and setting up for laboratory experiences. In the classroom, UTAs may participate in proctoring examinations, conducting student review sessions, and tutoring students who are in need of extra support. These roles, and the others discussed above, are common to most nursing education programs.
Our faculty believe that the UTA program includes many of the characteristics recently identified by the NLN as hallmarks of excellence in nursing education (Ironside & Valiga, 2006). The partnering inherent in the UTA program helps to meet the collaborative needs of today’s learners. Working with UTAs helps students to experience team building and mentoring, and the active learning thought to be effective in educating the nurses of tomorrow. The UTAs are able to improve their leadership skills, and as several authors have indicated, nursing students are more likely to consider becoming nursing faculty in the future if they are exposed to this role as students (Hinshaw, 2001; Kelly, 2002). Finally, both faculty and students benefit greatly from the teaching support provided by the UTAs in this innovative, cost effective, and valuable program.
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