Tenured nursing faculty should Tenured nursing faculty should participate in relevant clinical participate in relevant clinical practicepractice

Opening PositionOpening PositionN. RitzN. Ritz

NURS 609NURS 609

“Universities are the wellspring of knowledge and understanding. And as long as scholars are free to pursue the truth, wherever it may lead, there will surely continue to be a flow of new scientific knowledge” (Vannevar Bush, as cited in Boyer, 1992).

•Nursing is a science rooted in praxis and committed to meeting the health needs of Canadians while schools of nursing are the gatekeepers of this scholarship (Bosold & Darnell, 2012; Gazza, 2009).

•However, several scholars are questioning why the role of tenured nursing faculty would be any different than the role of front-line nurses (Bosold & Darnell, 2012). If research is the key element of academic life, then how can tenured nursing scholars vigorously advance clinical nursing research if they are not engaged at the bedside (Boyer, 1992)?

Over the next few days, my esteemed opponent and I will present our differing positions on whether tenured nursing faculty should participate in relevant clinical practice.

IntroductionIntroduction

Raising the issueRaising the issueWhether tenured nursing faculty should participate in relevant clinical practice has been the focus of much debate over the years and continues to this day to be a contentious topic.

•With the advent of shifting nursing education from hospitals to the tertiary sectors such as colleges and universities (McFarland, 2003, p. 257; Elliott & Wall, 2008; Newland & Truglio-Londrigan, 2003), many postulate a theory-practice gap is ostensible (Andrew et al., 2010; Billings & Kowalski, 2006; Diem et al., 2004; Dracup, 2004; Elliott & Wall, 2008; Krafft, 1998; Kramer, Polifroni & Organek, 1986; Little & Milliken, 2007; Sherwen, 1998).

•As some suggest, it would appear that nursing faculty has lost touch with the “real” world of nursing (Andrew et al., 2010; Dracup, 2004; Krafft, 1998; Little & Milliken, 2007) as they seem to have been assimilated into academic life driven by aspirations of promotion, faculty tenure and dreams of recognition and respect from their peers (Blair, 2005; Bosold & Darnell, 2012; Sherwen, 1998).

Many would ask “Is the theory-practice gap a bad thing?”

•I concur with Haigh (2008) when she suggested a theory-practice gap is rather healthy as it implies that a discipline such as nursing is changing and evolving therefore new theories and techniques are constantly being developed revolutionizing how we provide nursing care. This is indicative of a vibrant, dynamic profession who is challenging the status quo and moving forward (Haigh, 2008).

•However, this also means that tenured nursing scholars must remain the gatekeepers of nursing scholarship and bridge the theory-practice gap to ultimately eliminate the fragmentation that currently exists between theory and praxis (Billings & Kowalski, 2006). To do so, tenured nursing faculty must be engaged in clinical practice (Blair, 2005; Elliott & Wall, 2008; Krafft, 1998).

Theory-Practice gap – a bad thing?Theory-Practice gap – a bad thing?

My esteemed opponent will undoubtedly posit that in light of demanding expectations associated with academic life of tenured nursing faculty, most universities do not recognize clinical practice as a mandatory requirement to secure and maintain one’s tenure (Blair, 2005; Bosold & Darnell, 2012; Dracup, 2004; Elliott & Wall, 2008; Newland & Truglio-Londrigan, 2003; Paskiewicz, 2003; Sherwen, 1998).

However, I counter, that if nursing is a profession fundamentally based on practice, and if nursing scholars are responsible to research nursing practice … then let me ask you, members of the audience, how can they do so without engaging in clinical practice? How can they propose evidence-based practice (EBP) if they are not engaged at the bedside?

Clinical practice … good or bad?Clinical practice … good or bad?

Clinical practice is beneficialClinical practice is beneficialGranted, clinical practice is demanding and consumes valuable time that might otherwise be dedicated to teaching and publishing one’s research (Krafft, 1998), but there are a number of benefits also associated with clinical practice that ultimately enhances nursing scholarship.

Perks might include:

a) enriched teaching with the advantage of contemporary clinical examples;

b) generation of clinical nursing research theories;

c) improved faculty credibility with students and staff;

d) heightened understanding of contemporary nursing conditions;

e) offers logical foundations for curriculum content;

f) recommends EBP nursing care for Canadians;

g) extends opportunities to shape nursing praxis and its application;

h) promotes currency in clinical proficiencies;

i) offers a living laboratory to analyse theory in practice; and,

j) provides for some personal job satisfaction (Blair, 2005; Kramer et al., 1986; Lang & Evans, 2004; Lent-Becker et al., 2007; Newland & Truglio-Londrigan, 2003).

There is a need to bring reality to the classroom to reflect contemporary nursing practice (Andrew et al., 2010).

•Proficiency to elucidate theoretical paradigms by illustrating them with real narratives of patients and circumstances that mirror modern clinical encounters can shift what students may construe as ideals into lasting influences (Bosold & Darnell, 2012; Elliott & Wall, 2008; Kramer et al., 1986; Little & Milliken, 2007; Newland & Truglio-Londrigan, 2003).

•To bridge the theory-practice gap, bringing reality to the classroom, grants faculty the ability to dissipate academic “ivory tower” perceptions held by students and nurses (Andrew et al., 2010).

•Linking with reality affords opportunity for faculty to convey their intelligence to nursing curriculum and conceivably modify teaching policies within nursing programs (Bosold & Darnell, 2012; Elliott & Wall, 2008).

•Nursing theory is studied, understood, and applied synergistically (Kramer et al., 1986).

Bringing reality to the classroomBringing reality to the classroom

• With emphasis on EBP, practice settings can become mediums for clinical research whereby tenured nurse faculty can substantiate nursing process effectiveness; assess new learning concepts and nursing theories (Blair, 2005); and, inspire nursing staff to engage in clinical nursing research (Elliott & Wall, 2008).

• Clinical settings offer fertile backdrops to monitor perceived theory-practice gaps and facilitate quality patient care through EBP implementation (Bosold & Darnell, 2012).

• Essentially, practice settings become a “living laboratory” for EBP advancement and refinement (Bosold & Darnell, 2012).

• Testing clinical nursing research breakthroughs can result in instant application of these breakthroughs in clinical praxis, and ultimately dispel perceptions of academic “ivory towers” (Paskiewicz, 2003).

So let me ask you this … if faculty is not involved in current nursing practice, how can they validate the effectiveness and validity of EBPs?

Relevant nursing clinical researchRelevant nursing clinical research

• Regardless of didactic motivations for nurse faculty to participate in clinical practice, students anticipate getting value for their money (Elliott & Wall, 2008; Krafft, 1998).

• Expectancy for expert edification in the classroom in return for time and money spent is consequently high (Elliott & Wall, 2012).

• Credibility from students’ standpoint incorporates wisdom and capacity to relate to or operationalize wisdom (Blair, 2005; Bosold & Darnell, 2012; Little & Milliken, 2007).

• Proficient nurse educators in “practic[ing] what they preach” are considered credible leaders, remarkable tutors, and compassionate peers (Bosold & Darnell, 2012).

• While students may not witness faculty practice they perceive values this practice has on: staff and staff-faculty interactions; patients and patient care; faculty-generated nursing care plans; and nurse-physician rapports (Kramer et al., 1986).

Students know if faculty practices and in their eyes those who practice are saying “nursing is ok” (Kramer et al., 1986).

Credibility – student’s point of viewCredibility – student’s point of view

• Visibility in clinical settings fosters credibility of faculty members and presents openings to keep in touch with political moods and administrative concerns (Fisher, 2005).

• Nursing staff, physicians and managers are most apt to relate to practicing faculty as greater credibility and competency is associated with practice (Kramer et al., 1986).

• Consequently, clinical staff are more amenable to facilitate clinical student placements (Kramer et al., 1986).

• Collaborative clinical nursing research projects nurture a valuable pragmatic culture of learning for both clinical staff and students (Billings & Kowalski, 2006; Sherwen, 1998) and, facilitates curriculum alignment with clinical needs (Diem et al., 2004; Krafft, 1998).

As most schools of nursing strive to be recognized as credible agents of scholarship, doesn’t faculty practice seem like a viable option?

Credibility – staff’s point of viewCredibility – staff’s point of view

• Nursing scholars must consider revising policies and procedures conceived during a period of nursing surplus for a period of nursing shortage (Villeneuve & MacDonald, 2006, p. 78).

• By 2020, two-thirds (2/3) of nurses will be employed in community settings (Villeneuve & MacDonald, 2006, p. 98).

• Nursing scholarship embodies an array of academic and innovative activities that incorporate creation, authentication, synthesis, and/or application of intelligence to advance the edification, research and praxis of nursing (Laryea et al., 2006).

Being in the knowBeing in the know

Let me ask you … if faculty is not engaged in community practice,

1.Are they prepared to flip the curriculum from acute to community care?

2.How will they modify curriculum contents to reflect nursing realities?

3.Will they be able to negotiate clinical placement opportunities for the next generation of nurses?

Being in the knowBeing in the know

• Nursing faculty agree clinical praxis is an integral part of their mentoring and educator roles, therefore as today’s healthcare systems are forever changing and students demand competent mentors, maintaining competency is critical (Bosold & Darnell, 2012; Dracup, 2004; Kramer et al., 1986; NONPF as cited in Blair, 2005).

• Although faculty is familiar with the curriculum, can situate learning experiences and promote student learning (Diem et al., 2004), not maintaining nursing skills competency can pose serious professional and ethical challenges when teaching nursing theory and safe clinical praxis (Milliken & Little, 2007).

• Ultimately, Canadians receive better care when nursing faculty model nursing skills proficiently and competently for the next generation of nurses (Bosold & Darnell, 2012).

Nursing care proficiencyNursing care proficiency

A few anecdotes:

“I had a long, critical look over the edge of theory-practice gap and saw where and why some places were better for bridge-building than others. Most satisfying was the chance to really nurse again and discover that I still had a passion for providing quality client care. My respect for nurses in clinical practice grew tremendously and they also expressed their appreciation of my efforts to truly understand their challenges” (Maureen, as cited in Little & Milliken, 2007).

“In the classroom, I can enliven discussion and illustrate theoretical concepts with my new stories, however, when teaching students in acute care practice, I am able to collaborate with experienced nurses to teach the nuances of their context-specific knowledge and skills” (Jane, as cited in Little and Milliken, 2007).

Personal job satisfactionPersonal job satisfaction

I suspect my esteemed opponent will present the following views:

1.Canadian Association of Schools of Nursing (CASN) sustains nurse scholars are not responsible to every facet of scholarship however each school of nursing is.

2.Tenured faculty’s role is to work in partnership with and mentor clinically credible partners to engender innovative theoretical and practical advances and not to be engaged clinical praxis.

3.There are multiple ways of remaining current without engaging in clinical praxis.

4.Universities does not place equal value on clinical practice therefore it is not mandatory to maintain tenure.

5.Part-time faculty and preceptors are current in nursing praxis and responsible for student clinical placements.

6.The theory-practice gap is at the front-line level where staff have not maintained theoretical currency, not at the academic level.

Counterpoints …Counterpoints …

7. There are too many competing priorities and no time to engage in clinical practice.

8. The primary focus is teaching therefore nursing faculty’s praxis is that of teaching the fundamentals of nursing and not expert levels of nursing.

9. Being engaged in clinical praxis does not necessarily mean knowledge transfer will occur in the classroom nor does it mean new knowledge and competency will incur.

10. It is unrealistic to expect tenured faculty to keep up with rapidly changing healthcare.

Counterpoints …Counterpoints …

Some of you are engaged in both clinical praxis and teaching nursing students whether it is as part-time sessional teachers or as preceptors. A few of you may aspire to pursue faculty tenure and in order to do so you will be unavoidably sucked into academia whereby nursing clinical practice is not considered an asset to promotion and tenure.

As you have so patiently sifted through this presentation, some will agree with my esteemed opponent that tenured faculty should not be required to engage in relevant clinical practice. At a minimum, all nursing faculty staff are graduates, while most have a doctorate degree. Being considered experts, their primary focus is teaching, curriculum development, research and publishing, not clinical practice.

However, I ask you, at which point in time, does one lose nursing clinical competency? And once lost, is there not a dissonance between theory and practice?

In my defense …In my defense …

Some of you may argue that there are multiple ways of remaining current. Many will argue that reading peer-reviewed research literature, attending conferences and perhaps even attending refresher courses are effective ways of remaining current.

However, if every nurse scholar decided to just “read about it”, who will generate the “new” stuff? Do we not owe future generations of nurses vigorous clinical nursing research to guide their practice?

After all, nursing care is shifting to the community. Is your curriculum able to accommodate the learning needs of the next generation? If you are not involved in relevant clinical praxis, how will you even know what the future nursing trends are and how will you address them?

In my defense …In my defense …

I leave you with the following message,

“Faculty who are not actively and concurrently involved in practice cannot and do not model the nurse role; they can

effectively model only the teacher and person roles, while faculty who practice do model all three (nurse role, teacher role and person role)” (Kramer et al., 1986).

As a faculty member, would you not aspire to model all that you can be?

Thank You!

In conclusion…In conclusion…

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