Journal of Nursing Education

Major Article 

A Delphi Study to Understand Clinical Nursing Faculty Preparation and Support Needs

Sara McPherson, PhD, RN; Lori Candela, EdD, APRN, RN, FNP-BC, CNE

Abstract

Background:

Nursing programs are challenged with staffing qualified clinical faculty. Many hires, part time and full time, lack formal preparation or experience in leading student clinical groups. To have prepared clinical faculty, it is important to understand their learning preparation and support needs.

Method:

A two-round Delphi study was conducted to explore the preparation and support needs of undergraduate clinical faculty across nursing programs in a midwestern state.

Results:

Clinical faculty indicated several areas for development, including clear expectations of the role, better communication, training and orientation, and support. A better understanding of roles and expectations was demonstrated by clinical nursing faculty who were full time and those with nursing degrees that included nurse education coursework.

Conclusion:

Strategies for clinical faculty preparation and support include clarifying expectations, providing orientation, and communicating consistently and frequently. [J Nurs Educ. 2019;58(10):583–590.]

Abstract

Background:

Nursing programs are challenged with staffing qualified clinical faculty. Many hires, part time and full time, lack formal preparation or experience in leading student clinical groups. To have prepared clinical faculty, it is important to understand their learning preparation and support needs.

Method:

A two-round Delphi study was conducted to explore the preparation and support needs of undergraduate clinical faculty across nursing programs in a midwestern state.

Results:

Clinical faculty indicated several areas for development, including clear expectations of the role, better communication, training and orientation, and support. A better understanding of roles and expectations was demonstrated by clinical nursing faculty who were full time and those with nursing degrees that included nurse education coursework.

Conclusion:

Strategies for clinical faculty preparation and support include clarifying expectations, providing orientation, and communicating consistently and frequently. [J Nurs Educ. 2019;58(10):583–590.]

Nursing programs must graduate students who are prepared to care for diverse, complex patients in health care environments that are incorporating new knowledge, technologies, and processes at an increasing rate. Added to this is the need for nursing programs to graduate those students in sufficient numbers to meet the projected nationwide demand of 3,509,000 RNs by 2025 (U.S. Department of Health and Human Services, Health Resources and Services Administration, & National Center for Health Workforce Analysis, 2014). This requires adequate program fiscal and material resources, perhaps most importantly an adequate number of qualified faculty. As a practice discipline, this goes beyond the number of faculty to teach large, didactic courses to include the far greater number needed to teach smaller student clinical groups.

The Future of the Nursing Workforce (U.S. Department of Health and Human Services, 2014) indicated that by 2020, the need for more nurses would exceed the number of students graduating from nursing programs, recommending that nursing programs increase the number of graduating nurses to 130,000 annually. The American Association of Colleges of Nursing conducted national surveys in 2016 and identified 1,567 faculty vacancies in the United States, as well as a need to create nearly 133 new positions to meet demand (American Association of Colleges of Nursing, 2017). Due to this shortage, 64,067 qualified students were turned away from nursing programs during the 2016–2017 academic year (American Association of Colleges of Nursing, 2017). The National League for Nursing (2014) indicated that 28% of qualified students were turned away from nursing programs, with 45% turned away from associate degree nursing programs. The lack of nursing faculty, specifically the numbers required to teach small clinical sections, contributes to otherwise qualified applicants being rejected.

Nursing programs have full-time faculty who teach in clinical settings. However, it is often not enough, causing many nursing programs to turn to part-time and adjunct clinical faculty to fill these voids (Duffy, Stuart, & Smith, 2008; Gazza & Shellenbarger, 2010; Nardi & Gyurko, 2013; Roberts, Chrisman, & Flowers, 2013). Nursing students spend approximately half of their educational time in the clinical setting (Benner, Sutphen, Leonard, & Day, 2010; Ironside, McNelis, & Ebright, 2014). The knowledge that students gain in their clinical experiences is crucial to their development as nurses. Hiring enough qualified clinical faculty to teach smaller clinical sections has proven to be a challenge.

The need for adequate numbers of clinical faculty is growing. But what do these faculty need, in terms of preparation and support, to work with nursing student clinical groups? A targeted literature review was conducted to ascertain what is known about this issue.

Literature Review

Many nurses who take on the role of part-time and adjunct clinical faculty are expert clinicians but may lack formal knowledge about the academic setting (Koharchik, 2014, 2017; Meyer, 2017). Expert clinicians bring a significant amount of clinical knowledge and expertise to the academic setting; however, their expectations are often inconsistent with the expectations of the academic setting (Grassley & Lambe, 2015). In many cases, new faculty are expected to come to their new role with the knowledge and skills to teach (Schaar, Titzer, & Beckham, 2015). That in turn leaves many new clinical faculty feeling unsupported (Santisteban & Egues, 2014). For these reasons, the transition to becoming a clinical nursing faculty can be difficult and unsatisfying, creating a problem with retention. Santisteban and Egues (2014) noted that part-time clinical faculty “may be unintentionally unsupported in acquiring the mastery of essential competencies associated with the educator role” (p. 154). An integrated review by McPherson (2019) revealed five themes related to part-time clinical nursing faculty: mandatory/structured orientations; mentoring; issues of pay/compensation and the transient nature of contract work; support; and communication. The purpose of this study was to explore the preparation and support needs of undergraduate clinical faculty across nursing programs in a midwestern state.

Method

Three research questions guided the study:

  • What preparation and support have undergraduate clinical faculty received prior to assuming their clinical teaching responsibilities?
  • What do faculty believe they need to perform their jobs adequately?
  • Are there differences in perceptions of needs between part-time and full-time clinical faculty?

The review of the literature indicated a shortage of information on the best methods or preferences for orienting new clinical faculty; the Delphi research method was selected because it is a viable option when little is known about the topic. The approach allows for consensus by expert opinion on real-world problems (Kenney, Hasson, & McKenna, 2011). Experts can be surveyed throughout a large geographic area with the use of electronic communication, making the Delphi method a practical, inexpensive method to communicate with experts and gain consensus (Toronto, 2017).

Round 1

Round 1 of the Delphi study used an investigator-developed, nine-question, open-ended survey, informed by the literature review (Figure 1). For this study, the term expert was operationally defined as (a) clinical practitioners, clinical faculty, and/or theory faculty working at an institution of higher education; (b) having taught at least four clinical groups over the past 5 years, in any acute care setting; and (c) experience as an RN for at least 5 years. Following institutional review board approval, purposive sampling was used to recruit a potential panel of 21 experts. Nursing clinical faculty across the United States were identified by the researcher as potential experts. A recruitment e-mail describing the study was sent to each potential expert, which included a Qualtrics® link to the consent form and survey.

Round 1 survey questions.

Figure 1.

Round 1 survey questions.

During round 1, data collection and data analysis occurred simultaneously. As responses were returned from experts, data were analyzed. Experts were asked to provide an e-mail address if they were willing to review the results to confirm accuracy. Eleven experts (73%) provided e-mail addresses. To confirm accuracy, statements from the open-ended questionnaire were compiled and returned to the 11 experts. The experts had the opportunity to provide feedback to ensure that the statements accurately reflected what preparation and support they believed clinical faculty needed to perform their jobs. Content analysis and frequency counts of particular words, phrases, or groups of words were identified, and those items with a frequency count of four or more were used to develop the survey for Round 2.

Round 2

Round 2 participants were selected using convenience sampling of nursing faculty, part and full time, at accredited academic institutions in a midwestern state in the United States. The academic institutions were accredited by the Commission on Collegiate Nursing Education. Participants in round 1 were able to participate in round 2. This is considered acceptable for Delphi studies (Kenney et al., 2011).

After the academic institutions were identified, an e-mail was sent to the deans and directors of nursing, explaining the study and asking them to forward the e-mail to their part- and full-time clinical faculty. A link within the e-mail allowed faculty to access the consent and survey. A follow-up e-mail was sent weekly after the initial e-mail to the deans and directors of nursing programs to remind participants about the survey. The data collection period lasted 5 weeks. However, after 5 weeks, the response rate was low (n = 20), so the researcher contacted faculty directly (with institutional review board approval granted). Faculty were found on programs' websites, and 300 e-mails were sent directly to faculty.

Faculty read the recruitment e-mail and could click on the embedded link, which would take them to an informed consent webpage. Those who chose to participate clicked to advance to a brief demographic survey, followed by the investigator-developed, Likert scale survey (Table A; available in the online version of this article). The demographic survey asked if faculty had taught in a clinical course within the past 12 months. If faculty answered “No,” their survey was excluded. Ensuring that faculty had taught in a clinical course within the past 12 months allowed for the most current information to be collected in the study.

Table A:

Round 2 Survey

The Likert survey consisted of 76 items (Table A) based on the aggregated responses from round 1: support, training, resources, communication, the expectations of clinical nursing faculty, clinical evaluations, and knowledge about maintaining safety. Participants were asked to indicate their level of agreement or disagreement with each item (1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree). Participants were also asked to rank order the variables addressed in the study. This ranking provided information about what clinical faculty believed was needed most when taking on the new role as clinical faculty.

Results

Round 1 Results

A total of 21 surveys were sent to potential experts in round 1, with 15 responding (71% response rate). Most were full-time faculty with an average of 10 years of teaching experience (Table 1). A total of 315 unique responses were collected from the nine open-ended questions on the survey to which the expert panel responded. These were compiled into comprehensive lists according to the question. Data were analyzed using frequency counts. The aggregated responses were assigned a value based on the number of responses that correlated. The items were placed in order, and any item with a frequency count of four or more was used in the development of the round 2 survey. Table 2 represents the aggregated responses from the nine open-ended questions asked of the panel of experts.

Round 1: Panel of Experts Demographics

Table 1:

Round 1: Panel of Experts Demographics

Round 1: Aggregated Responses With Frequency Counts of Four or MoreRound 1: Aggregated Responses With Frequency Counts of Four or More

Table 2:

Round 1: Aggregated Responses With Frequency Counts of Four or More

Round 2 Results

A total of 86 surveys were returned (28% response rate). Data were reviewed for completeness, and it was determined that surveys with missing data would be included in analysis with the requirement that some portion of the Likert scale survey had been completed. After cleaning the data to meet this criterion, a total of 77 surveys were used for analysis. This included 32 (41.6%) from part-time/adjunct faculty and 45 (58.4%) from full-time faculty (Table 3). Of the participants, 36.4% believed they needed clear expectations on their role; 16.9%, more consistent and frequent communication with course coordinators; and 14.3%, more training on their new role (Table 4).

Round 2: Faculty Demographics

Table 3:

Round 2: Faculty Demographics

Clinical Faculty's Preferences for Developing New Clinical Faculty

Table 4:

Clinical Faculty's Preferences for Developing New Clinical Faculty

Research Question 1

Comparisons were made regarding the support given to clinical faculty between (a) the clinical nursing faculty who had a nursing education background and (b) the group with advanced practice or other educational backgrounds. There was a significant difference between the groups [t(74) = 2.35, p = .022]. More of those with a nursing education background reported that they were likely to use a colleague as a primary resource (nursing education: M = 4.57, SD = .82; other nursing: M = 4.07, SD = 1.0).

Research Question 2

Clinical faculty who participated in the study strongly advocated the use of clinical orientation (M = 4.53, SD = .50, n = 77). However, they were less enthusiastic about the usefulness of clinical evaluation tools to evaluate student performance, with the answers, on average, representing a neutral attitude (M = 3.18, SD = .74, n = 77).

Research Question 3

Overall, more full-time faculty felt prepared for their role as clinical faculty and indicated that new clinical faculty need daily communication from the nursing program. More were also concerned about certain issues identified by both types of faculty: keeping anecdotal notes, communication on how to have difficult conversations, and simulation as a strategy to assist new clinical faculty. The results to research question 3 appear in Table 5.

Variables and Descriptive Statistics by Employment Status

Table 5:

Variables and Descriptive Statistics by Employment Status

Discussion

Findings of this study indicated the kind of preparation and support that clinical faculty may need to be prepared to educate nurses properly in clinical settings. In round 1, themes identified were Support, Training, Resources, Communication, Expectations of the Role, Clinical Evaluations, and Knowledge About Maintaining Safety. In round 2, respondents rank ordered those variables; the top three in order were clear expectations of their role; more consistent and frequent communication with course coordinators; and more training on their new role. Full-time faculty indicated that new clinical faculty need daily communication from the nursing program and gave more importance to issues identified by both types of faculty: keeping anecdotal notes, communication on how to have difficult conversations, and simulation as a strategy to assist new clinical faculty.

The finding that clear expectations of their role was considered most important is in keeping with previous findings that new clinical faculty need a clear understanding of their roles and expectations (Santisteban & Egues, 2014). Keeping clinical faculty updated on course materials and what the student is expected to know may help improve student learning and meet the objectives of the class and clinical (Davidson & Rourke, 2012).

The finding that more consistent and frequent communication with course coordinators was considered important aligns with previous findings that part-time clinical faculty should not only be educated and supported but also regularly evaluated to ensure that high-quality education is occurring (Roberts et al., 2013). In our study, full-time faculty indicated that new clinical faculty need daily communication from the nursing program and gave more importance to issues identified by both types of faculty, such as keeping anecdotal notes, communication on how to have difficult conversations, and simulation as a strategy to assist new clinical faculty (maybe because they are more invested in the nurse education program or because they know from experience what investment of time and energy is required in these clinical faculty positions). Gazza and Shellenbarger (2010) reported on faculty just having to “jump in” without information about what is taught in the course (p. 356), and Roberts et al. (2013) discussed how they felt disconnected and “out there” (p. 299). Having a week-to-week content summary focus for the didactic portion of the class that is shared with clinical faculty may serve to keep them grounded in what the student is learning in each class.

Faculty were asked whether they had formal training, and many mentioned mentors or course coordinators, although this was not statistically significant. Previous literature reported that new faculty should be assigned a specific mentor who will be available throughout the semester to answer questions and assist with other needs (Gies, 2013; Hall & Chichester, 2014; Santisteban & Egues, 2014). Assigning a course coordinator or lead faculty member with responsibilities would ensure that a connection and support could provide better outcomes for the program and improve job satisfaction for clinical faculty (Duffy et al., 2008; Roberts et al., 2013). Reid, Hinderer, Jarosinski, Mister, and Seldomridge (2013) identified that mentoring is an important, yet often overlooked, resource for new faculty as they transition into education. Although many schools implement programs that include mentors, Santisteban and Egues (2014) described mentoring as a complete initiative that must have the appropriate resources, expectations, and a specific purpose. Experienced part-time clinical faculty may be appropriate mentors for new part-time clinical faculty (Santisteban & Egues, 2014).

The mentor needs to keep in close contact with new faculty members to ensure that they understand their role and are performing at the level of expectation for the nursing program. Nursing program administrators need to recognize the added workload mentors will have in developing new clinical faculty and allow for release time or added compensation (Meyer, 2017). Also, evaluating mentoring programs may be essential to ensuring that the purpose of the program and the needs of new faculty are actually being met.

Previous literature reported that, although many studies indicated that full-time faculty did not have the time to mentor new clinical faculty, some type of compensation may prove to be an incentive for mentoring new faculty (Kowalski et al., 2007; Meyer, 2017). Nursing programs may also consider providing release time or additional pay for full-time faculty who would be willing to mentor new clinical nursing faculty. Specific requirements could be made to meet with clinical faculty weekly in person or by telephone to address any issues or concerns they may be having. The mentoring faculty could assist new clinical faculty in documenting student performance and using the evaluation tools provided by the nursing program.

Study participants strongly advocated the use of clinical orientation. Previous literature reported that having a mandatory orientation would likely be beneficial for all new clinical nursing faculty and including simulation may have positive outcomes for new clinical faculty (Carlson 2015; Gies, 2013; Hall & Chichester, 2014; Koharchik, 2017; Koharchik & Jakub, 2014; Woodworth, 2017). One challenge, as identified in the literature, to having mandatory orientations is the distance clinical faculty may live from their academic institution and the lack of compensation (Forbes, Hickey, & White, 2010; Gies, 2013; Hewitt & Lewallen, 2010; Peters & Boylston, 2006). The literature indicated that paying part-time clinical faculty for the time spent attending clinical orientations might increase employee satisfaction (Carlson, 2015; Koharchik, 2014; Meyer, 2017; Woodworth, 2017). This would require pay beyond the negotiated contract for the clinical hours they are required to teach, but it would also add incentive for them to attend those programs that would enhance their knowledge and understanding of their role as clinical nursing faculty. If nursing programs use distant clinical sites, holding those mandatory orientations at the clinical sites may prove more beneficial and easier for part-time clinical faculty to attend. Another option may be to develop the orientation session as an online offering that can be done synchronously, with additional clinical faculty resources available anytime from a website.

During orientations, faculty can be introduced to the documentation system for student progress within the nursing program. They can be taught how to keep anecdotal notes and the importance of those notes in maintaining a safe environment and ensuring that future graduates are safe and competent as they enter practice. During orientations, a simulation could be conducted to help faculty with having difficult conversations and evaluating students. This would allow new faculty a better understanding of how to approach difficult or challenging situations and may instill more confidence in their ability to evaluate student learning. Orientation materials should also be provided in writing for easy access by faculty in the future. Evaluation of current orientation programs may also prove to be beneficial to determine if they are meeting the needs of new faculty.

Study participants were neutral about the usefulness of clinical evaluation tools to evaluate student performance. Many faculty do not know how to use them, and some tools are difficult to use (Luhanga, Yonge, & Myrick, 2008; Oermann, Yarbrough, Saewert, Ard, & Charasika, 2009). Simulation allows new clinical faculty the chance to assess student performance, communicate with students regarding their progression in the clinical course, and communicate with a difficult student (Reid, Hinderer, Jarosinski, Mister, & Seldomridge, 2013).

More of those with a nursing education background reported that they were likely to use a colleague as a primary resource. Those with a nursing education background sought out mentors or colleagues to assist them as they transitioned to their new role, probably because many came on full time, whereas part-time faculty did not have resource individuals.

Limitations

There were limitations to the study. Accessing faculty indirectly through electronic recruitment e-mails to deans and directors was ineffective and required additional time to secure additional institutional review board approval. Round 2 of the study was limited to nurse faculty in one state, which limits generalizability. The questionnaire in round 1 was based on information obtained in the literature review and developed by the principal investigator. The survey in round 2 was developed based on the consensus of items obtained from the panel of experts in round 1. Both instruments had a potential lack of reliability. Hasson, Keeney, and McKenna (2000) stated that it was difficult to establish the reliability of a study when using the Delphi method because sampling a different population may yield different results. Finally, the low response rate limits the findings due to possible nonresponse bias.

Implications

Clinical education is imperative for developing safe, competent nurses who are ready for the complexities of professional practice. The use of part-time and adjunct faculty in clinical education will continue to rise as the nursing faculty shortage increases (American Association of Colleges of Nursing, 2017). The common goal of nursing programs to educate and graduate the number of safe, competent nurses needed to care for an increasingly diverse populace cannot be achieved without a properly prepared clinical faculty workforce. It is incumbent on nursing programs to ensure the most qualified faculty are educating students. Academic administrators of nursing programs need to be diligent in preparing and supporting their clinical faculty, particularly part-time or adjunct faculty, to uphold the expectations of the nursing program and the profession of nursing. To hire and retain qualified clinical nursing faculty, nursing programs need to recognize the need for orientations, understanding of the clinical faculty role, mentors, and adequate compensation, especially for part-time clinical faculty, because many obtain full-time positions elsewhere to receive higher wages and benefits (Woodworth, 2017).

Conclusion

The study findings indicate that nursing programs should consider offering preparation and support for new clinical faculty. This could take the form of orientations, mentoring, and being clear about expectations for the role. Administrators of nursing programs may attract and retain higher quality faculty if they address the issues identified in this study. The next step in future research could be to extend the round 2 survey to a larger, more representative group. New clinical faculty orientation programs should be pilot tested and results used to make improvements. The literature base needs to be expanded through studies that evaluate roles and needs of clinical nursing faculty.

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Round 1: Panel of Experts Demographics

Descriptor Categoryn%M
Nurse educator employment status
  Full time1280
  Part time213.3
  Adjunct16.7
Primary clinical instruction area
  Medical/surgical1386.6
  Maternal/child16.7
  Critical care16.7
Experience as nurse educator
  Years as an RN10.87
  Years with student clinical groups12.73
  Clinical groups taught within past 5 years23.33

Round 1: Aggregated Responses With Frequency Counts of Four or More

Topic of InquiryMost Frequent Responsesn
Training and support receivedFrom a colleague7
Received no training4
Met with course coordinator or course lead4
Beneficial or needed resourcesExpectations11
Mentor5
Evaluation process5
Hospital orientation5
How to handle difficult students4
Clinical setting concernsSafety15
Clinical placements15
Communication4
Supporting communication systemsE-mail, telephone, text message12
Course lead in charge of communication and available to faculty6
Communication concernsMeetings on a regular basis4
Consistency13
Lack of knowledge and support7
Suggested communications improvementsCommunication4
Consistency/communication10
Input of each individual5
Method of constructive feedback to studentsClinical orientation5
Verbal19
Written10
Resources needed for constructive feedback to studentsEvaluations8
Communication13
Clinical evaluations12
Concerns regarding the clinical evaluation processTraining/orientation4
Handbook4
Clinical evaluations too abstract14
Time6
Dilemmas5
Faculty knowledge5

Round 2: Faculty Demographics

Demographic Descriptorsn%
Age group, years
  25–3467.8
  35–441519.5
  45–542329.9
  > 553342.9
Gender
  Male33.9
  Female7496.1
Race/ethnicity
  White7597.4
  Black/African American22.6
Professional Descriptorsn%
Educational level achieved
  Bachelor's11.3
  Master's5875.3
  Doctor of Nursing Practice45.2
  Doctor of Philosophy1114.3
  Other (Doctor of Education)33.9
Educational focus
  Nursing education4963.6
  Advanced practice1114.3
  Other1620.8
  Missing11.3

Clinical Faculty's Preferences for Developing New Clinical Faculty

Variables for Developing New Facultyn%
Support67.8
Training1114.3
Resources11.3
Communication1316.9
Expectations of the role2836.4
Clinical evaluations11.3
Knowledge about maintaining safety56.5
Missing data1215.5
Total77100

Variables and Descriptive Statistics by Employment Status

VariableEmployment StatusnM (SD)t (df)Sig.
No formal trainingPart time or adjunct323.34 (1.31)2.09 (75).040*
Full time452.71 (1.308)
Content presented in educational preparationPart time or adjunct323.41 (1.16)−2.32 (51).024*
Full time453.96 (0.8)
Quality and quantity of clinical placementsPart time or adjunct323.47 (1.135)−3.37 (54).001*
Full time454.27 (0.837)
The number of students I have in the clinical settingPart time or adjunct323.72 (0.991)−2.37 (75).020*
Full time453.40 (1.05)
Different faculty have different expectations for students.Part time or adjunct324.2 (0.66)−2.17 (50).040*
Full time452.53 (0.95)
New clinical faculty need continuous communication from the nursing program.Part time or adjunct323.96 (0.75)−2.48 (75).020*
Full time454.39 (0.74)
Have contact with the nursing program daily.Part time or adjunct322.72 (0.92)−2.1.040*
Full time453.20 (1.04)
Clinical faculty keep anecdotal notes of student clinical performance.Part time or adjunct322.72 (0.92)−2.86 (75).006*
Full time453.20 (1.04)
Communication training on how to have difficult conversations with students regarding their performance.Part time or adjunct324.07 (0.84)−2.83.006*
Full time454.53 (0.57)
Simulation experience on how to effectively communicate.Part time or adjunct323.49 (1.08)−1.96.050*
Full time453.94 (0.93)

Round 2 Survey

Please answer the following demographic questions. To participate in the survey you must have taught at least one student clinical group within the last twelve months.

Q3 Please indicate your age:

❍ 25–34 years old (1)

❍ 35–44 years old (2)

❍ 45–54 years old (3)

❍ >55 years old (4)

Q4 Please indicate your gender:

❍ Male (1)

❍ Female (2)

Q5 Please indicate your race/ethnicity:

❍ White (1)

❍ Hispanic or Latino (2)

❍ Black or African American (3)

❍ Native American or American Indian (4)

❍ Asian/Pacific Islander (5)

❍ Other (6)

Q6 Please indicate your education background:

❍ Bachelor's Degree (1)

❍ Master's Degree (2)

❍ Doctorate of Nursing Practice (3)

❍ Ph. D. (4)

❍ Other (5) ____________________

Q7 What was your graduate education focused on:

❍ Nursing Education (1)

❍ Advanced Practice Nursing (2)

❍ Other (3) ____________________

Q8 Are you employed as a clinical instructor:

❍ Part-time or Adjunct (1)

❍ Full-time (2)

Q9 Have you taught in a clinical course within the past 12 months?

❍ Yes (1)

❍ No (2)

Q10 How many years have you been instructing students in the clinical setting?

❍ (1)

❍ 1–5 years (2)

❍ 6–10 years (3)

❍ 11–15 years (4)

❍ >16 years (5)

Q11 Is your employer for the clinical instruction of nursing students the hospital or the college/university?

❍ Hospital (1)

❍ College/University (2)

Q12 Do you teach clinical nursing students in the hospital you work in?

❍ Yes (1)

❍ No (2)

Answer If Do you teach clinical nursing students in the hospital you work in? Yes Is Selected

Q13 On days when you are teaching a student clinical group, are you asked by hospital staff to complete duties not related to clinical instruction of students?

❍ Yes (1)

❍ No (2)

Q14 Were you previously employed at the hospital where you teach a clinical?

❍ Yes (1)

❍ No (2)

Q15 What clinical area do you primarily instruct students in?

❑ Medical/Surgical (1)

❑ Obstetrics (2)

❑ Pediatrics (3)

❑ Psych/Mental Health (4)

❑ Critical Care (5)

Q16 Is the clinical you are teaching in given a letter-grade or given a Pass/Fail at the end of the semester?

❍ Graded (1)

❍ Pass/Fail (2)

❍ Other (3) ____________________

Q17 Do you use a clinical evaluation tool?

❍ Yes (1)

❍ No (2)

Q18 If you use clinical evaluation tools, how often do you use them?

❍ Midterm and Final (1)

❍ Final (2)

❍ Other (3) ____________________

Q19 Do you use clinical contracts in the clinical setting?

❍ Yes (1)

❍ No (2)

Q20 Are you provided professional development in your clinical faculty position?

❍ Yes (1)

❍ No (2)

Q21 Are you reimbursed for professional development?

❍ Yes (1)

❍ No (2)

Q22 Which of the following best describes the reason you decided to take on the role of undergraduate clinical faculty?

❍ Additional compensation (1)

❍ Enjoyment of teaching (2)

❍ Seeking a full-time faculty position (3)

❍ Other (4) ____________________

Q24 The items listed below were identified by a panel of experts in Round 1 of this Delphi study. Directions: Using a 5-point Likert-scale below, please indicate your level of agreement with how important each of the following is in preparing and supporting you in your role teaching student clinical groups. Scale: 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree.

Q25 For support in my role as clinical faculty I have:

Strongly Disagree (1)Disagree (2)Neither Agree nor Disagree (3)Agree (4)Strongly Agree (5)
used a colleague as a primary resource. (1)
been assigned a mentor. (2)
used the course coordinator or faculty lead for support or questions. (3)

Q26 For training in my role as clinical faculty I have:

Strongly Disagree (1)Disagree (2)Neither Agree nor Disagree (3)Agree (4)Strongly Agree (5)
had no formal training. (1)
had a formal orientation to my role and responsibilities. (2)
had content presented in my educational preparation (master's or PhD degree in nursing education or education courses). (3)
received verbal instruction. (4)
received written instruction. (5)
received a brief overview of the clinical faculty role. (6)
relied on experience from m y previous work as a staff nurse. (7)

Q27 Please indicate how beneficial the resources below would be to you in the clinical setting.

Strongly Disagree (1)Disagree (2)Neither Agree nor Disagree (3)Agree (4)Strongly Agree (5)
Information on the expectations of my role as clinical faculty. (1)
Information on the expectations of student performance. (2)
Information on the course and student outcomes. (3)
A mentor for clinical nursing faculty. (4)
A clear understanding of the clinical evaluation process. (5)
An orientation to the clinical facility where my clinical course will be conducted. (6)
An orientation on how to handle difficult students. (7)

Q28 Please indicate with the Likert-scale how you agree or disagree with these concerns in the clinical setting.

Strongly Disagree (1)Disagree (2)Neither Agree nor Disagree (3)Agree (4)Strongly Agree (5)
Safety is a major concern for me in the clinical setting. (1)
Being responsible for students and patients. (2)
Medication administration. (3)
Unsafe students. (4)
Lack of confidential space for discussion. (5)
How I communicate my role to the staff and managers so they know what to expect from me and my students. (6)
Unclear expectations which influence safety. (7)
Orientation to the clinical placement site. (8)
Quality and quantity of clinical placements sites. (9)
Number of new Registered Nurses on clinical units with minimal experience. (10)
The number of student I have in the clinical setting. (11)

Q29 Please indicate using the Likert-scale how the communication systems in place between you and the nursing program you work for support you in completing your job.

Strongly Disagree (1)Disagree (2)Neither Agree nor Disagree (3)Agree (4)Strongly Agree (5)
The communication systems in place between me and the nursing program I work for support me in completing my job. (1)
The use of email, phone, and text allows for appropriate and effective communication with the nursing program. (2)
Meeting with my program of nursing (clinical faculty, course leader, etc.) on a regular basis is important. (3)
Good communication with the course leader is needed to effectively perform my job as clinical nursing faculty. (4)

Q30 Using the Likert-scale indicate how you feel about the communication between the nursing program you work for and clinical faculty.

Strongly Disagree (1)Disagree (2)Neither Agree nor Disagree (3)Agree (4)Strongly Agree (5)
Communication between the nursing program and clinical faculty is lacking in consistency. (1)
Clinical faculty have no input on changes made affecting clinical courses. (2)
Different faculty have different expectations for students. (3)
Clinical faculty do not have the adequate resources to follow policies and procedures. (4)
Clinical faculty are not familiar with the curriculum of the nursing program. (5)
New clinical faculty need continuous communication from the nursing program. (6)
Communication gaps exist between the faculty, dean, coordinators, and/or the hospital representatives. (7)

Q31 Please indicate using the Likert-scale how well you believe the items would improve communication between the nursing program you work for and clinical faculty. To improve communication between the nursing program and clinical faculty it would be beneficial to:

Strongly Disagree (1)Disagree (2)Neither Agree nor Disagree (3)Agree (4)Strongly Agree (5)
Meet with all clinical faculty so there is consistency. (1)
Have a course coordinator who communicates well with clinical faculty. (2)
Have contact with the nursing program daily. (3)
Have faculty from the nursing program meet with clinical faculty and student if there is a problem. (4)
Have faculty from the nursing program meet with clinical faculty and student if there is a problem. (5)
Have input from all faculty. (6)
Have open and honest communication. (7)
Face to face meetings with all faculty (including clinical faculty). (8)

Q32 A clinical orientation:

Strongly Disagree (1)Disagree (2)Neither Agree nor Disagree (3)Agree (4)Strongly Agree (5)
Should be mandatory for all clinical faculty. (1)
Should occur yearly to allow for clinical faculty to get the most up-to-date information. (2)
Provide information on expectations. (3)

Q33 Please indicate using the Likert-scale how you provide feedback to students regarding their progress towards program objective mastery in the clinical setting.

Strongly Disagree (1)Disagree (2)Neither Agree nor Disagree (3)Agree (4)Strongly Agree (5)
Constructive feedback is provided to students with the use of verbal communication. (1)
Concerns regarding student performance are verbally communicated to students. (2)
Clinical faculty document written feedback on each student weekly. (3)
Clinical faculty keep anecdotal notes of student clinical performance. (4)
Students receive written feedback immediately in the clinical setting if a problem has been identified. (5)
Written clinical evaluations are completed on each student. (6)
Written clinical evaluations are done at midterm and final. (7)

Q34 Please indicate on the Likert-scale how you think the items below would help you to communicate constructive feedback to students in the clinical setting.

Strongly Disagree (1)Disagree (2)Neither Agree nor Disagree (3)Agree (4)Strongly Agree (5)
Having an understanding of the clinical evaluation tool. (1)
Having a comprehensive clinical evaluation tools is needed to evaluate students. (2)
Having communication training on how to have difficult conversations with students regarding their performance. (3)
Having a simulated experience on how to effectively communicate. (4)
Having examples of constructive feedback that has been used in the past. (5)
Having an orientation that includes training on correctly filling out documents. (6)
A handbook for clinical faculty. (7)

Q35 Please indicate using the Likert-scale how much of a concern the items below are for you with the process of clinical evaluation of students.

Strongly Disagree (1)Disagree (2)Neither Agree nor Disagree (3)Agree (4)Strongly Agree (5)
Clinical evaluation tools are too abstract. (1)
Clinical evaluation tools do not provide a true reflection of student performance. (2)
Clinical evaluation tools are poorly written. (3)
Clinical evaluation tools are too subjective. (4)
Clinical faculty do not have proper training on how to complete the clinical evaluation tool. (5)
There is a lack of consistency in how clinical faculty fill out the clinical evaluation tool. (6)
There is a lack of consistency about what defines an unsafe student. (7)
Clinical evaluation tools are too long. (8)
It is difficult to complete the clinical evaluation tool because clinical faculty do not spend enough time with students. (9)
It is difficult to evaluate students when clinical faculty have large clinical groups. (10)
Failing a student is difficult. (11)
There is a lack of support in regards to clinical faculty's evaluation of student performance. (12)

Q36 Please prioritize (1= highest priority; 7= lowest priority) the variables in order you believe are the most important for developing clinical faculty. Drag the variables to place them in order.

______ Support (1)

______ Training (2)

______ Resources (3)

______ Communication (4)

______ Expectations on the role of clinical nursing faculty (5)

______ Clinical Evaluations (6)

______ Knowledge about maintaining safety (7)

Q37 At this time you may go back and review your answers or click the arrow to submit your survey. Thank you.

Authors

Dr. McPherson is Clinical Assistant Professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois Chicago, Springfield, Illinois; and Dr. Candela is Associate Professor, University of Nevada, Las Vegas, Nevada.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Kevin Grandfield, Publication Manager at University of Illinois at Chicago Biobehavioral Health Sciences, for his assistance with editing.

Address correspondence to Sara McPherson, PhD, RN, Clinical Assistant Professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, One University Plaza, Springfield, IL 62703-5407; e-mail: saramcph@uic.edu.

Received: May 17, 2019
Accepted: July 17, 2019

10.3928/01484834-20190923-05

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