Clinical instructors’ (CIs’) perceptions of the academic nursing education environment can affect their empowerment to develop their role and facilitate student learning (Allan & Smith, 2010; Andrew, Halcomb, Jackson, Peters, & Salamonson, 2010). Clinical instructors are generally part-time faculty who have a key role as facilitators of small groups of nursing students’ knowledge, judgment, and skills in professional practice or clinical environments (Andrew et al., 2010; Calpin-Davies, 2001; Carson & Carnwell, 2007; Duffy, Stuart, & Smith, 2008). To be effective in their role, CIs also need to function within the academic environment to learn what the curriculum entails and how students are to be evaluated. The academic environment is where nursing faculty and administrators facilitate theory classes and program planning. If connections between CIs and the academic environment are limited, there can be repercussions for CIs’ identification with academic goals and their ability to function within that environment to effectively develop their teaching role (Andrew et al., 2010).
A study was undertaken to determine CIs’ perceptions of role empowerment within academic environments. Kanter’s (1977, 1993) theory of structural empowerment and Spreitzer’s (1995) theory of psychological empowerment were used as explanatory frameworks. An understanding of CIs’ empowerment could inform the development of a new and empowered role for CIs. Further, a collaborative role with academic faculty could support conceptually consistent learning for students.
Overview of Kanter’s Theory of Structural Power in Organizations
Power is defined by Kanter (1977, 1993) as the ability to accomplish work and meet organizational goals. According to Kanter, managers can empower employees through enabling access to structural components such as information, support, resources, and opportunity. Information represents knowledge that contributes to organizational decision making and technical skills. Support involves feedback and guidance about role effectiveness. Resources are the materials and finances required to accomplish goals. Opportunity constitutes professional growth and mobility within the organization. Formal power is derived from jobs that are central to organizational goals and allow independence in decision making. Informal power occurs from alliances within and without the organization. The more access employees have to structural empowerment, the more effective they could be at attaining professional goals in the work environment.
Overview of Spreitzer’s Theory of Psychological Empowerment
Empowerment, according to Spreitzer (1995), is a psychological experience perceived by employees that determines the success of their involvement in empowering initiatives. Psychological empowerment is a motivational construct and consists of the components of meaning, confidence, autonomy, and impact. These components combine to facilitate active participation in the work role. Meaning arises from the employee’s sense of congruency between role requirements and personal values. Confidence develops from the employee’s belief in his or her ability to perform the role and meet organizational expectations. Autonomy refers to the choice to initiate and maintain work processes. Impact is the individual’s perception of influence on significant work outcomes. An understanding of CIs’ empowerment can occur when both organizational and motivational perspectives are used in research.
A literature search for electronic articles published since 2005 about clinical faculty empowerment was conducted using CINAHL® and ProQuest®. Key terms used in the search included clinical faculty or instructors, Kanter’s theory of structural empowerment, and Spreitzer’s theory of psychological empowerment.
Role of Clinical Instructors
Typically, the CIs’ role involves creating learning opportunities for nursing students in practice environments and evaluating students’ professional development (Cash, Daines, Doyle, & von Tettenborn, 2009). Andrew and Wilkie (2007) and Andrew et al. (2010) emphasized that the role of CIs has been built on their current clinical knowledge and practice-oriented teaching of nursing care. Often, CIs are employed part-time in nursing education programs for their clinical expertise, not necessarily for their academic qualifications, and may not be familiar with the theoretical underpinnings of the nursing program (Cash et al., 2009; Jarrett, Horner, Center, & Kane, 2008; Regan, Thorne, & Mildon, 2009). Therefore, the clinical focus of CIs, along with the lack of academic connections or strategic input into curriculum development, may limit CIs’ role effectiveness. Their primary role is to guide students in clinical practice environments to integrate practice and theory at levels of critical thinking that are consistent with curriculum goals and professional competencies.
Empowerment Studies in the Nursing Literature
A review of recent nursing studies indicated an emphasis on CIs’ empowerment related to students in the clinical environment. In a survey utilizing Kanter’s (1977, 1993) structural components, Babenko-Mould, Iwasiw, Andrusyszyn, Laschinger, and Weston (2012) surveyed 64 CIs in Ontario and found that they perceived themselves as moderately structurally empowered. Structural empowerment in the acute care practice environment positively influenced CIs’ use of empowering teaching behaviors with students.
Babenko-Mould (2010) also found that some CIs associated their need for support with the level of role preparation from the academic employer. Support from those in the academic environment was related to CIs’ use of empowering teaching behaviors. This was the only known study that included CIs as a distinct group and involved both quantitative and qualitative findings framed according to Kanter’s (1977, 1993) empowerment theory.
The integration of structural conditions and psychological experiences has been researched with several nursing populations. Laschinger, Finegan, Shamian, and Wilk (2001) integrated Spreitzer’s (1995) psychological empowerment theory with Kanter’s (1977, 1993) structural empowerment theory in a study of 404 Canadian staff nurses. Nurses’ perceptions of structural components in the workplace influenced their personal experiences of empowerment, which directly affected job satisfaction. This study provides an understanding of the empowerment process in which both organizational components and personal perceptions affect outcomes.
The integrated structural empowerment and psychological empowerment approach was used by Baker, Fitzpatrick, and Griffin (2011) in an academic environment. They utilized established scales based on Kanter’s (1977, 1993) structural empowerment and Spreitzer’s (1995) psychological empowerment to survey perceptions of job satisfaction among 139 clinical and academic nursing faculty members in American community colleges. Most faculty (81%) were satisfied with their jobs and were moderately empowered, both structurally and psychologically. The researchers concluded that an understanding of faculty perceptions of structural empowerment and psychological empowerment can lead to improved structures in academic environments that promote role satisfaction and retention. That study did not distinguish between the empowerment experiences of clinical and academic faculty.
Summary of the Reviewed Literature
In the research literature, few studies have examined and explored nurse educators’ workplace environments (Cash et al., 2009) from an integrated theoretical perspective. Academic workplaces can be considered environments that foster CI development and shape teaching behaviors (Andrew et al., 2010). As recommended by Babenko-Mould et al. (2012), CIs need to be informed about empowerment components and how to alter learning situations to benefit students. No known studies could be located that used both structural and psychological empowerment theories as an explanatory framework to focus on clinical faculty’s perceptions of empowerment in the academic environment, rather than in the practice environment.
The research question was: How do clinical instructors describe their perceptions about the components of structural empowerment (formal and informal power, opportunity, information, support, resources) and psychological empowerment (meaning, confidence, autonomy, impact) within academic nursing environments?
Qualitative description is based on naturalistic inquiry and techniques used to view the phenomena without bias (Sandelowski, 2000, 2010). A framework can be used to guide qualitative descriptive research; however, analysis may indicate other considerations (Polit & Beck, 2008; Sandelowski, 2000, 2010). The chosen explanatory framework was Kanter’s (1977, 1993) structural empowerment theory and Spreitzer’s (1995) psychological empowerment theory. The structural empowerment and psychological empowerment theoretical components were the a priori concepts that framed the open-ended interview questions and guided the descriptive analysis of the data.
The method of qualitative description involved a combination of data collection to explore participants’ meanings, analysis of data into themes, interpretation of the most relevant themes within the theoretical explanatory framework, and determination of representative quotes. Themes were based on common empowerment ideas among participants, quantity of coded content, and depth of content.
Data Collection and Sample
Approval to conduct the study was obtained from the research ethics boards of three educational institutions in Ontario, Canada. Written consent was obtained from eight volunteers from two sites. A semistructured interview guide was used. Interviews proceeded until no new empowerment interpretations were offered by the eighth participant. Individual interviews (45 to 66 minutes in duration) were audiotaped and transcribed verbatim.
Participants’ clinical teaching experience ranged from less than 1 year to 14 years (mean = 4 years). Their length of time in nursing practice in acute care and community health varied from 4 to 45 years (mean = 22 years). All participants were female and, as is generally the employment situation of CIs, were part-time faculty teaching only practicum courses.
Data collection and analysis were conducted reciprocally to gain information in an ongoing process. During interviews, the researcher clarified perceptions for accuracy. All indications of empowerment were coded in NVivo 9, a computer software program for qualitative data management. Data were analyzed for patterns and themes.
After the analysis was complete, the credibility of the findings was discussed with two available participants. One participant stated she “identified with” all the psychological empowerment themes and the structural empowerment component of formal power. The other participant agreed with support and confidence as being the most important components. She also stated the need for these to occur together. Overall, the empowerment descriptions were congruent with their experiences as CIs.
Findings and Interpretation
Findings Related to Structural Empowerment
Formal Power. Pathways of formal power were often unclear to CIs, which limited the visibility and validation of their role. One CI who felt invisible due to a lack of formal connections with faculty, said:
[Academic faculty] don’t really know how we implement expectations in the teaching, in the clinical…. I don’t know if they do random reviews of all our work and then if they don’t like something that they see, do they come back? I don’t know.
The formal input of CIs into decisions affecting the program and their role was described by three participants as “voice” and was generally limited to team meetings with course coordinators. However, when CIs’ voices were validated and their roles were visibly valuable in a working relationship with academic faculty, they felt vitally involved and empowered to contribute to small changes within the academic environment.
Informal Power. The development of a scholarly and facilitative role by CIs required that they form collegial communication networks with faculty and administrators in the academic environment. One CI described her experience of open communication among CIs and coordinators in team meetings: “I think it is an opportunity to say ‘here is what worked well, here is what did not work well.’” With experience, CIs gained increased connections; however, they remained limited in their ability to use informal power to influence academic decisions.
Support. Comments related to support comprised the largest amount of structural empowerment interview data for five CIs and the second or third highest amount in the remainder of CIs’ data. Support for CIs included access to clinical and academic faculty for discussion and guidance about concerns, as well as feedback about role development. Four participants recalled feeling “lost” as novice CIs to accomplish their role. An experienced CI stated her greatest unmet need as, “support of the faculty—that is huge—the support and the guidance and the clarity of am I on the right track or what needs to change?” Almost all CIs expressed a sense of insufficient guidance and feedback from academic faculty to progress in their role. However, open access to course coordinators for collegial decision making and clarification of expectations was a key to perceptions of support. Positive feedback and structured ways to improve were essential to CIs’ decisions to continue in the role.
Information. Information about role expectations and program outlines was inconsistently available to CIs. Access to policies, goals, and curriculum in the nursing program was necessary to guide CIs’ understandings of academic expectations and as a foundation to facilitate clinical courses. One CI stated, “I think there’s a bit of a fallout [with access to academic information] and a lot…is left to the individual instructor, so the students don’t get consistency.” If challenges to develop their role were perceived as exceeding the available information, then the majority of CIs had difficulty facilitating student learning.
Resources. CIs perceived time and rewards as necessary resources for role effectiveness. The time to manage the workload of teaching and evaluating students, along with developing their own resources, such as manuals about their role requirements, was described by five CIs as “overwhelming.” Four CIs also perceived academic faculty as not having enough time to assist them in learning the role and managing student issues. When asked if she received enough rewards for the role, one CI replied “Personally? Yes!” Then she added that it would be nice if academic faculty thanked her directly for what she was accomplishing and stated that had never happened. Participants felt they lacked sufficient rewards to compensate them for their effort to manage the challenges of workload, student issues, and development of effective teaching strategies.
Opportunity. Comments from seven participants were primarily negative about opportunity. Opportunities to learn a scholarly teaching role from academic faculty were limited. One CI was searching for seminars specific to clinical teaching and stated, “I would be there so fast…. I would love to have those opportunities and I would make time for that for sure…having that opportunity to really advance my CI teaching skills.” Opportunities to expand the CI role to include academic responsibilities were perceived as not available by almost all participants.
Findings Related to Psychological Empowerment
Confidence. CIs identified confidence as growth in their ability to facilitate student learning and to meet challenges in understanding their role to competently meet program goals. Seven of the eight CIs shared more about confidence than any other psychological empowerment component. One novice described the need to move from feeling overwhelmed to gaining confidence as a choice. She said, “I felt like I either sink or swim. I decided always to swim so I did the best I could.” For all participants, confidence in their ability to accomplish their role took several years of considerable effort. Confidence was related to understanding the goals in the nursing program and interacting with academic faculty. Academic faculty did not offer much evaluation of CIs’ competence; however, CIs gained confidence if faculty acknowledged their expertise or when students progressed as a result of their efforts.
Autonomy. For CIs, autonomy reflected the ability to make decisions to support students in meeting course objectives. Decision making was left to CIs, with little information to guide choices. One CI said, “You just kind of went on your own and did what you could do…. I had a lot of leeway, as far as how to develop something, and determining whether I was doing it correctly or not.” Flexible decision making was easier to implement when CIs understood the academic goals and role expectations.
Meaning. Meaning for CIs was the personal evaluation of role expectations that were worthwhile and aligned with a sense of professionalism. For most participants, role meaning was stated in relation to student connections and outcomes, rather than from relationships with other faculty. One CI said:
My values are…to engender a real desire to be an excellent nurse in my students…to be creative and to strengthen the program to make it a program of excellence, that [is] why I’m there. But then the flip side is, I want a good [paycheck]…. I like being a university teacher. There’s a sense of pride with that.
However, detractors from a sense of worthwhileness to implement the CI role were noted by many CIs in their perceptions of isolation, helplessness in times of conflict, and a lack of appreciation from academic faculty.
Impact. CIs perceived their greatest impact through influence on students’ clinical outcomes, rather than on outcomes in the academic environment. Three CIs experienced positive outcomes in team meetings with coordinators. However, negative outcomes were experienced by three other CIs who “complained” or made decisions that were not acceptable to academic faculty. Altogether, CIs perceived that they were making a positive impact on the success of the nursing program by creating student learning opportunities to address theory–practice connections.
Summary of Findings
CIs’ perceptions about their structural empowerment and psychological empowerment experiences in academic environments were complex. The findings in the current study suggest that CIs experienced all empowerment components, however limited, in their role. The structural empowerment component of support and the psychological empowerment component of confidence were key priorities for participants. Clinical instructors were motivated to effectively facilitate the professional growth of nursing students; however, they struggled to learn how to navigate or participate in the academic environment in a way that would effectively empower their role performance. The confidence to provide quality clinical teaching and to continue in the role was critically affected by a lack of faculty support, specifically feedback. An absence of positive feedback and mentoring from academic faculty was a common experience of CIs. Coordinators were often the most important faculty member to connect CIs to the academic environment. Overall, seven of eight CIs felt disconnected from academic faculty and program goals.
Empowerment of CIs in academic environments can be comprehensively described with Kanter’s (1977, 1993) structural empowerment and Spreitzer’s (1995) psychological empowerment theories. Empowerment components were often integrated in CIs’ narratives about their role. As Spreitzer (2008) suggested, psychological empowerment is associated with structural empowerment in complex situations.
Clinical instructors perceived their most important structural empowerment component was support. Access to support was often mentioned in participants’ narratives, along with confidence, informal power, and meaning. Although some literature emphasizes that support in the form of mentoring is needed for novice CIs (Bell-Scriber & Morton, 2009; McDonald, 2010), the comments of expert CIs also indicated an ongoing need for support in the form of appreciation from coordinators and other academic faculty. The need for all CIs to receive supportive feedback is realistic because CIs often implement their role in isolation from other faculty and feel a lack of connection with academic faculty (Andrew et al., 2010; Andrew & Wilkie, 2007; Duffy et al., 2008).
Confidence to accomplish the CI role was the most important psychological empowerment component. Confidence was expressed by CI participants as being privy to information from faculty, support from faculty and students, opportunity to develop the role, and autonomy to effectively meet organizational goals. The importance of confidence was also found in a survey of nursing faculty by Baker et al. (2011), where confidence was rated, along with meaning, as the highest of psychological empowerment components. Confidence took CIs years of experience to develop; however, few remained in the role long enough to develop role confidence.
Five of eight CIs were not intending to continue in the role. This is similar to turnover rates found by Whalen (2009). The components of support, information, confidence, and autonomy were most often cited in decisions to discontinue the role. The need to be empowered in these components is concerning, given the shortage and turnover of CIs.
Implications and Recommendations
Struggles in the academic environment may cause CIs to align with the more familiar clinical environment where they may feel valued for their expertise. When CIs are not connected to the curriculum, students may experience two different curricula and views of nursing: one in the classroom, and one in the practice setting. Moreover, different emphases among CIs could lead to an inconsistent quality of clinical teaching, as well as inconsistent theory-based professional practice in students.
Clinical teaching is different from clinical nursing, and it requires specialized skills. A lack of opportunity to develop teaching skills through collaborative efforts between CIs and academic faculty may lead CIs to depend on the teaching styles they experienced in their own education or the teaching methods used in the practice setting. These teaching styles may not be congruent with the curriculum philosophy.
When CIs feel disconnected from the academic environment, they may feel undervalued. In addition, when CIs encounter challenging situations, they may leave the position. The lack of support, timely mentoring, and direction to access structural empowerment components when role concerns or student issues arise could lead CIs to perceive that academic faculty do not have enough time and interest to assist their growth. Such barriers to empowerment may diminish CIs’ professional responsibility to invest effort into finding the empowerment components that will benefit their role development. Thus, CIs are affected in their ability to effectively facilitate student learning.
Collaboration between academic and clinical faculty is recommended to strengthen CIs’ empowerment to meet goals in the nursing program. A strategy to increase collaboration could be to include academic faculty and administrators in team meetings with CIs. In this way, issues about the CI role, as well as opportunities to participate in academic initiatives, can be readily discussed. Ongoing communication could strengthen theory–practice ties through the sharing of information about what is being taught in the classroom and practice settings.
According to CIs in the current study, and as recommended by Pierangeli (2006) and Davidson and Rourke (2012), an orientation manual should be available. This should include best practice teaching strategies, topics to focus on in small group discussions, how to evaluate student progress, and contact information for appropriate faculty members who could assist with issues. To be effective facilitators of students’ achievements of curriculum goals, Benner, Sutphen, Leonard, and Day (2010) emphasized that CIs need the opportunity to study teaching strategies designed for nursing curriculum.
Empowerment could be greatly increased if CIs would actively develop their role in the academic environment (Gazza & Shellenbarger, 2005). Participation on committees could be a method for CIs to understand the formal power pathways, develop supportive networks, and gain information about their role in the context of the program.
Recommendations for Further Research
The integrated structural empowerment and psychological empowerment explanatory frameworks may be useful in further studies among the CI population to explore job satisfaction or mentoring by academic faculty. Also, psychological empowerment among CIs could be examined to obtain insight into how instructors are motivated to do their job well, despite the empowerment limitations they encounter.
The results of this study are limited to the specific context of CIs in two academic nursing environments. The small sample was adequate to reach data saturation; however, it may be that CIs who are male, full time, or from other programs would reveal other empowerment considerations.
In conclusion, the findings of the current study provided support for the use of Kanter’s (1977, 1993) structural empowerment and Spreitzer’s (1995) psychological empowerment theories to describe the experiences of CIs in academic environments. All empowerment components were important to CIs, although there was more emphasis on support and confidence. The development and retention of expert CIs would benefit by increased support. The slow growth of confidence in CIs’ abilities was a barrier to teaching that was consistent with goals in the curriculum. A logical extension of empowered CIs in the academic environment would be their increased ability to create empowered learning environments and to influence student perceptions of empowerment (Babenko-Mould et al., 2012). Clinical instructors who are provided with sufficient empowerment in the structure of the academic environment and take initiative to access those provisions would likely feel empowered psychologically and able to fulfil their role effectively.
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